Need For More Formal Training Research Articles

She said, “Really, you’re just going to have to suffer through it”: The lack of discussion of perimenopause between women and healthcare professionals

Perimenopausal symptoms adversely impacting women’s sexual health are often unacknowledged or even dismissed by healthcare professionals (HCP). Using semi-structured interviews with 23 women experiencing perimenopause, we aimed to understand how HCPs address women’s sexual health needs and concerns during this transition. Thematic data analysis was employed with the reduction of data into themes. Several major themes were identified concerning participants’ experiences with a HCP and sexual health, including insufficient sexual health information and preventative education; the lack of open discussion about sexual health; the need for enhanced support and treatment options; feeling dismissed by a healthcare professional; and sexual pleasure not addressed by healthcare professionals. Additionally, women expressed concerns regarding medical education and training in healthcare professionals on approaching sexual health conversations. There appears to be a need for more formal training, both within medical school and continuing medical education (CME), to address these important aspects of women’s sexual and reproductive health.

An exploration of community pharmacists’ experience, knowledge and perspectives of frailty and medicines optimisation in frail older people: A qualitative study

IntroductionFrailty is a heightened state of vulnerability due to an accumulation of age-related defects in separate physiological systems (1). Frailty is becoming increasingly common, with up to 50% of older adults being diagnosed with mild, moderate or severe frailty (35%, 12% and 3% respectively) (2). Community pharmacists may often be the primary healthcare professional with whom frail older people have most frequent contact due to their convenience and accessibility. Therefore, it is hypothesised that community pharmacists could play a wider role in frailty identification and medicines optimisation for frail older people.AimTo explore community pharmacists’ knowledge of frailty and its assessment, their experiences and contact with frail older patients in the community pharmacy setting, and their perceptions of their role in optimising medicines for frail older people.MethodsTwo strategies were used to recruit community pharmacists registered in Northern Ireland (NI). Community pharmacists were recruited through the Pharmacy Forum NI bi-monthly newsletter and the School of Pharmacy Undergraduate Placement Network, followed by snowballing. The interview topic guide was developed based on the published literature, current frailty guidelines and through discussion within the research team; it was piloted with four pharmacists. Semi-structured interviews commenced in March 2020. Due to the Covid-19 pandemic, face-to-face interviews were logistically not possible, therefore telephone interviews were conducted at a time convenient to participants. All interviews were recorded, transcribed verbatim and analysed using inductive thematic analysis.ResultsTo date, 14 interviews have been conducted, lasting between 24 and 72 minutes. Apart from one interview, all were conducted over the telephone. Participant characteristics are summarised in Table 1. Analysis of interview transcripts is ongoing. Findings to date have highlighted the key role community pharmacists feel they play in assisting frail older patients with their medicines (especially during the current pandemic). Many saw themselves as a ‘point of contact’ for frail older people and highlighted the holistic approaches they used to care of such patients: “It’s easier to get in contact with us than other healthcare professionals and we tend to be the first port of call really” [CP2]. Interviews highlighted a lack of pharmacist knowledge surrounding frailty as a condition and its assessment, with participants primarily focusing on the physical aspects of frailty (e.g. weight loss, weakness) when observing or ‘informally assessing’ patients. None of the participants reported formally assessing their patients using validated frailty tools or checklists: “It’s not something that I’ve ever thought about. We don’t have any tools readily available to us that I know of and certainly nothing that would be standardised” [CP1].Table 1.Characteristics of interview participants and the community pharmacies in which they worked (n=14) Participant characteristics n (%) Female9 (64.3)Male5 (35.7) Time qualified in years n (%) <5 5 to 9 10 to 15 >154 (28.6) 1 (7.1) 5 (35.7) 4 (28.6) Location of pharmacy n (%) Urban Suburban Rural7 (50) 4 (28.6) 3 (21.4) Size of pharmacy n (%) Independent Small/medium chain Large chain5 (35.7) 2 (14.3) 7 (50)ConclusionThis study has highlighted that community pharmacists felt they could contribute to optimising medicines for frail older people. However, the findings emphasise the need for more formal training for community pharmacists about the clinical aspects of frailty, frailty assessment and future interventions to address the medicines-related issues they have encountered with this patient population.

030 Management and attitudes towards persons with epilepsy in general practice: how far have we come?

IntroductionPrevious surveys of general practitioners (GP) attitudes regarding epilepsy and people with epilepsy (PWE), conducted 20–30 years ago1 2, identified the need for further education in epilepsy care for GPs. This follow up study of GPs in Sydney, Australia, was conducted to determine the degree of changes in knowledge, attitudes and management of PWE, to evaluate if there had been significant improvement during this period.MethodsA piloted questionnaire addressing epilepsy investigations, preferred care provider and attitudes towards epilepsy was developed and completed by a representative sample of Sydney GPs.ResultsA total of 52 completed responses were received. 36 out of 47 GPs (77%) chose neurologists as the most important care giver, followed by the GP (9/47; 18.7%), 25/51 respondents (49%) mentioned they never personally initiated anti-epileptic medication (AEM) and another 27% (14/51 GPs) rarely commenced AEM therapy. 6/50 GPs did not mention EEG as a routine investigation and 21/50 did not mention MRI as routine for PWE. The five most commonly prescribed AEMs, according to frequency were sodium valproate (42), carbamazepine (37), levetiracetam (31), lamotrigine (16) and phenytoin (15). Newer AEMs, available for over a decade in Australia were not mentioned. Emotional, behavioral psychosocial issues were perceived to be more common amongst PWE.ConclusionThe study indicates little perceptual shift regarding GP’s attitudes to epilepsy, and significant deficiencies in knowledge, particularly with regards to investigations and management. The findings reinforce a need for more formal training of GPs caring for PWE.ReferencesBeran RG, Read T. A survey of doctors in Sydney, Australia: perspectives and practices regarding epilepsy and those affected by it. Epilepsia. 1983;24(1):79–104.Frith JF, Harris MF, Beran RG. Management and attitudes of epilepsy by a group of Sydney general practitioners. Epilepsia. 1994;35(6):1244–7.

Management and attitudes toward patients with epilepsy in general practice: How far have we come in three decades?

BackgroundPrevious surveys of Australian primary care physicians' attitudes regarding epilepsy and persons with epilepsy (PWE), conducted 20–30 years ago, identified the need for further education in epilepsy care for frontline clinicians. This follow-up study of general practitioners (GPs) in Sydney was conducted to determine the degree of changes in knowledge, attitudes, and management of PWE, with the purpose of evaluating if there had been significant improvement during this period. MethodsA questionnaire, evaluating various aspects of epilepsy care, including investigations, preferred healthcare provider (HCP), and attitudes toward epilepsy was developed, largely based on the previous work, piloted, and completed by a representative sample of Sydney GPs. ResultsA total of 52 completed responses were received. Thirty-six out of 47 GPs (77%) chose neurologists as the most important HCP followed by the GP (9/47; 18.7%). Almost half of the GPs (25/51; 49%) mentioned that they never initiated antiepileptic medication (AEM) therapy by themselves yet half of these GPs would alter the neurologist's regimen, without necessitating referral back to that neurologist. Another 27% (14/51 GPs) rarely commenced AEM therapy. Six out of 50 GPs did not mention an electroencephalogram (EEG) as a routine investigation, and 21/50 did not mention magnetic resonance imaging (MRI) as routine for PWE. The five most commonly used AEMs, identified by at least 10% of respondents, were sodium valproate (42), carbamazepine (37), levetiracetam (31), lamotrigine (16), and phenytoin (15). Emotional, behavioral, and psychosocial issues were perceived to be more common among PWE; however, they could contribute equally well to society as people without epilepsy. ConclusionThe results of the study indicate a perceptual shift regarding GP's attitudes to epilepsy; however, there remain deficiencies in knowledge, particularly with regard to investigations and management. The study highlights the need for more formal training of GPs in caring for PWE.

A Comparison of Autism-Specific Training Outcomes for Teachers and Paraeducators

Most students with autism engage in the general education (GE) setting for a majority of the school day. Though there are standards to identify the expectations for educating students with autism in the inclusive classroom, GE teachers and paraeducators report limited knowledge and self-efficacy in supporting students with autism, and both indicate a need for more formal training in autism. In the present study, the authors analyzed GE teachers’ and paraeducators’ levels of knowledge and self-efficacy prior to and following autism-focused in-service training. Participants attended an informational and a practical training in which knowledge, self-efficacy, and satisfaction were measured. Results for GE teachers and paraeducators followed similar patterns in that knowledge of autism increased significantly, but did not sustain over time. Levels of self-efficacy increased significantly following the practical training. GE teachers demonstrated higher levels of knowledge compared to paraeducators across time, while levels of self-efficacy converged between the two groups. Implications regarding training and professional development are discussed.

Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents.

As a traditionally underserved population that faces numerous health disparities, youth who identify as transgender and gender diverse (TGD) and their families are increasingly presenting to pediatric providers for education, care, and referrals. The need for more formal training, standardized treatment, and research on safety and medical outcomes often leaves providers feeling ill equipped to support and care for patients that identify as TGD and families. In this policy statement, we review relevant concepts and challenges and provide suggestions for pediatric providers that are focused on promoting the health and positive development of youth that identify as TGD while eliminating discrimination and stigma.

Trends and Scope of Dermatology Procedures Billed by Advanced Practice Professionals From 2012 Through 2015

ImportanceAdvanced practice professionals (APPs) such as nurse practitioners and physician assistants independently perform a large number and variety of dermatologic procedures, but little is known about how the number and scope of these procedures have changed over time.ObjectiveTo examine the trends in scope and volume of dermatology procedures billed by APPs over time.Design, Setting, and ParticipantsA longitudinal study was conducted using the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File from 2012 through 2015. The data encompass nearly all outpatient procedures paid by Medicare Part B in the United States and include the type of clinician under which procedures were billed.Main Outcomes and MeasuresFor each type of dermatology procedure, the total number performed by APPs and the total number performed by dermatologists each year.ResultsThe total number (and percentage) of all dermatologic procedures performed by APPs increased from 2.69 million of 30.7 million (8.8%) in 2012 to 4.54 million of 33.9 million (13.4%) in 2015. The most common procedures performed by APPs in 2015 were destructions of benign neoplasms (3.6 million), biopsies (788 834), and destructions of malignant neoplasms (48 982). The numbers of patch tests, removals of benign and malignant neoplasms, intermediate and complex repairs, flaps, and surgical pathologic specimen examinations by APPs also increased each year from 2012 through 2015.Conclusions and RelevanceThe number and scope of dermatologic procedures performed by APPs appear to be increasing over time. These procedures can be difficult and invasive. This study suggests that further studies are needed to determine what association these procedures have with patient outcomes and the potential need for more formal training.

Community-based mealtime management for adolescents with anorexia nervosa: A qualitative study of clinicians' perspectives and experiences.

Community-based mealtime management is an intensive, focused, and time-limited intervention for young people with an eating disorder which aims to support refeeding at home and thus prevent hospital admission. Little is known about clinicians' experiences of delivering this intervention. We aimed to explore mental health clinicians' perspectives on community mealtime management with children and adolescents diagnosed with an eating disorder. A qualitative design was used. Semistructured interviews were conducted with six mental health clinicians with experience of delivering or referral for the intervention. Interview recordings were transcribed and subjected to a thematic analysis. Analysis resulted in identification of three themes: (a) technical aspects of mealtime management, (b) emotional aspects of mealtime management, and (c) a mixed zone of uncertainty around the use of dietary supplements. Overall, participants believed mealtime management to be a valuable intervention. Findings highlight the perceived need for more formal training for clinicians undertaking mealtime management, and the positive impact this could potentially have on their practice. Clinicians' emotion regulation during intervention delivery was perceived to be important. There was a perceived need for greater adherence to protocols but an acceptance that flexibility was also required.

Training Social Workers and Human Service Professionals to Address the Complex Financial Needs of Clients

ABSRACTIn social work and other community-based human services settings, clients often present with complex financial problems. As a need for more formal training is beginning to be addressed, evaluation of existing training is important, and this study evaluates outcomes from the Financial Stability Pathway (FSP) project. Designed to prepare professionals with the knowledge, attitudes, and skills to effectively assess and respond to clients’ financial problems, we evaluated the FSP using a one-group pre-, post-, and follow-up design. Results suggest that with training and ongoing booster sessions including peer support, professionals’ preparedness and confidence increased, which strongly predicted the use of practice behaviors learned during training. Implications for professional education and training are discussed.

Pediatric Dysphagia: A Rise in Preterm Infants and a Need for More Formal Training for Speech-Language Pathologists

Pediatric Dysphagia: A Rise in Preterm Infants and a Need for More Formal Training for Speech-Language Pathologists

Supervision Training, Practices, and Interests of California Site Supervisors

In this descriptive study, the authors surveyed 220 California school counselor site supervisors of interns about supervision training, practices, and interests. Respondents overwhelmingly (71%) felt unprepared for this role and identified the need for more formal training and support. Results indicate a crucial leadership and advocacy role for counselor education programs.

Interrater variation in scoring radiological discrepancies

Discrepancy meetings are an important aspect of clinical governance. The Royal College of Radiologists has published advice on how to conduct meetings, suggesting that discrepancies are scored using the scale: 0=no error, 1=minor error, 2=moderate error and 3=major error. We have noticed variation in scores attributed to individual cases by radiologists and have sought to quantify the variation in scoring at our meetings. The scores from six discrepancy meetings totalling 161 scored events were collected. The reliability of scoring was measured using Fleiss' kappa, which calculates the degree of agreement in classification. The number of cases rated at the six meetings ranged from 18 to 31 (mean 27). The number of raters ranged from 11 to 16 (mean 14). Only cases where all the raters scored were included in the analysis. The Fleiss' kappa statistic ranged from 0.12 to 0.20, and mean kappa was 0.17 for the six meetings. A kappa of 1.0 indicates perfect agreement above chance and 0.0 indicates agreement equal to chance. A rule of thumb is that a kappa ≥0.70 indicates adequate interrater agreement. Our mean result of 0.172 shows poor agreement between scorers. This could indicate a problem with the scoring system or may indicate a need for more formal training and agreement in how scores are applied. Scoring of radiology discrepancies is highly subjective and shows poor interrater agreement.

Psychosocial Issues and Care in Pediatric Oncology

Children with cancer and their families have psychosocial support needs. Medical and nursing professionals in pediatrics and pediatric oncology are in a position to identify and help manage these. However, little is known about their perceptions of psychosocial issues and interventions. The purpose of this study was to investigate physicians' and nurses' perceptions of psychosocial issues in pediatric oncology including their awareness of the psychosocial impact of childhood cancer on families and their knowledge and views of psychosocial interventions. A phenomenological approach was taken whereby semistructured interviews were conducted with a purposive sample of 10 physicians and nurses. Findings showed that despite a lack of formal training in psychosocial issues, professionals identified a number of psychosocial issues associated with childhood cancer, including effects for family members. In addition, findings illustrated the psychosocial roles that they frequently adopt in relation to the identification, treatment, and referral of psychosocial issues. Finally, physicians and nurses recognized the value of formal intervention, reporting benefits for children, families, and themselves. These findings give a preliminary insight into physicians' and nurses' perceptions and awareness of the psychosocial issues experienced by children with cancer and their families and their knowledge of psychosocial interventions. They highlight ways to enhance the delivery of care in pediatric oncology. Specifically, they suggest the need for more formal training on psychosocial issues for medical and nursing professionals, for additional experienced psychosocial professionals to be recruited, and for more access to services for both families and medical and nursing professionals.

Mentoring in Sport Psychology: Students’ Perceptions of Training in Publication and Presentation Guidelines

A seven-item survey on training and ethics in publication and conference presentation was sent to 406 student members of the Association for the Advancement of Applied Sport Psychology (AAASP). Students used a 5-point scale (1 = very poor to 5 = excellent) to rate the training and experience received from advisors and professors. Items included exposure to some formal ethical guidelines of publishing and authorship, explanation of the importance of publications and conference presentations, demonstration of enthusiasm toward student publishing or presenting at conferences, and receiving appropriate authorship (e.g., first, second, third) on publications or conference presentations. Return rate was 43%. Results show that although a majority of students feel they are receiving fair to excellent training in this area, a substantial number believe their training is inadequate. This suggests a need for more formal training and guidance in publication and conference presentation for graduate students in psychology and physical education/exercise science programs.