Participant Confidence Research Articles

Screening and Brief Intervention and Referral to Treatment for Drug Use in Primary Care

The use of drugs other than alcohol is a leading cause of fatal injury in the United States, accounting for more than 40 000 deathsperyear.1 Increases intherateofdrug-attributabledeaths over the past 2 decades have beenfueledbyoverdosesof illicitlyusedprescriptiondrugs (such as opioids and sedatives, sometimes in combination with alcohol). In 2011, an estimated 1 280 134 hospitalizations were related to drug overdosesnationwide,ofwhich1 021 563 (80%) involveddrugsonly and258 571 (20%) involveddrugs incombinationwithalcohol.2 National roadside research surveys have detected more drivers on roads after using drugs than alcohol,3 and severalmetaanalyses indicate that fatal trafficcrashrisksofdriverswhohave simultaneously used drugs and alcohol exceed the fatal crash risk of driving after either alone.4,5 In addition, marijuana use has increased in the past decade,6,7 perhaps accelerated by legalizationofmedicalmarijuanain22statesandWashington,DC, and legalization of recreational use by Colorado andWashington State. These public health trends underscore the need for continuing research to develop effective interventions for unhealthy drug use, and the emphasis on primary care in health care system reforms suggests that approaches to identify and effectively intervenewith patients exhibiting risky patterns of drug use should be evaluated in a variety of clinical settings. A substantial number of experimental studies have indicated that screeningandbriefnegotiated intervention (BNI) are effective inadultprimarycare inreducingriskyalcoholmisuse.8 Other research, such as a study of illicit drug screening and intervention for adults in anurgent care setting9 andanobservational study of screening and interventions in a broad array of generalmedical settings,10havesuggested thatBNImayalsobe effective in helping patients reduce their use of illicit drugs. A large multicenter international study showed overall significanteffects inprimarycare,althoughnosignificanteffectswere identifiedwhentheUSsiteswereexaminedseparately.11 Buildingonthesestudies, this issueofJAMA includesreports12,13 from 2well-designedandimplementedrandomizedclinical trials that foundscreeningandbrief interventions ingeneralmedical settings were not effective for reducing drug use. In a 3-group randomized trial, Saitz et al12 tested the efficacyof2briefcounseling interventions for illicitdruguseorprescription drug misuse. Adult primary care patients with Alcohol,Smoking,andSubstanceInvolvementScreeningTestscores of 4 or greaterwere studied (N = 528). The authors compared a 15-minute BNI and a 30to 45-minute adaption of motivational interviewing (MOTIV) and a booster with no brief intervention. The BNI included motivational interviewing feedback, review of “pros” and “cons” of use, and development of plans forchange.TheMOTIVinterventionelicitedpossible links betweendruguseandhealth concerns, highlighteddiscrepanciesbetweennegativedruguseoutcomesandvaluedgoals, enhanced self-efficacy about behavior change, and provided options for change. At intake, the reported main drug use was marijuana (63%), cocaine (19%), andopioids (17%), andboth interventionsaddressedalcohol in the15%forwhomitwasaconcern. In addition, all patients received a written list of substance use disorder treatment andmutual help resources. At the6-month follow-up, therewereno significantdifferences between groups inmeanmain drug use days in the past month, inanydruguse,or in riskofdrugdependence.Norwere there significant differences in drug use consequences, injectiondruguse, unsafe sex, hospitalizations, emergencydepartmentvisits, ormutualhelp attendance. Lackof effectwas consistent regardless of drug used, severity, alcohol use, and substance-relatedhealthcondition.Theauthorsconcludedthat if other trials yield consistent results, widespread implementation of drug screening and brief interventionwith referral to treatment should be reconsidered. Of note, contrary to many studies on alcohol screening and brief intervention, there was notareduction inheavydrinking.This raises thepossibility that drugandalcohol-using, single, low-incomepatientswithhigh unemployment and comorbidities may benefit less from BNI. In another study in this issue, Roy-Byrne et al13 randomized 868 adult (age ≥18 years) primary care patients in 7 safetynet clinics to receive enhanced care as usual or a brief 30minute intervention and booster within 2 weeks providing feedback on drug use, discussing pros and cons of use, raising participant confidence in being able to change, and presenting options for change. Patients in both groups received a handout depicting their drug problem, severity score, and a list of substance abuse treatment resources. The authors identified and trackedpast30-dayuseof themost frequentlyuseddrug,aswell as chemicaldependence treatment records, statealcohol arrest records,andin-patienthospitalizationanddeathrecords. Inboth groups, follow-up at 3, 6, 9, and 12monthswasmore than87%. During follow-up, therewerenosignificantdifferencesbetween the2 studygroupsondaysofdruguse,AddictionSeverity Indexdruguse,oranysecondaryoutcomesoradmissions to chemicaldependency.Bothgroupsreduceddrugusefrequency Related articles pages 492 and 502 Opinion

Bank Panics, Government Guarantees, and the Long-Run Size of the Financial Sector: Evidence from Free-Banking America

Governments often attempt to increase the confidence of financial market participants by making implicit or explicit guarantees of uncertain credibility. Confidence in these guarantees presumably alters the size of the financial sector, but observing the long-run consequences of failed guarantees is difficult in the modern era. We look to America's free-banking era and compare the consequences of a broken guarantee during the Indiana-centered Panic of 1854 to the Panic of 1857 in which guarantees were honored. Our estimates of a model of endogenous market structure indicate substantial negative long-run consequences to financial depth when panics cast doubt upon a government's ability to honor its guarantees.

Bank Panics, Government Guarantees, and the Long‐Run Size of the Financial Sector: Evidence from Free‐Banking America

Governments attempt to increase the confidence of financial market participants by making implicit or explicit guarantees of uncertain credibility. Confidence in these guarantees presumably alters the size of the financial sector, but observing the long‐run consequences of failed guarantees is difficult. We look to America's free‐banking era and compare the consequences of a broken guarantee during the Indiana‐centered Panic of 1854 to the Panic of 1857 in which guarantees were honored. Our estimates of a model of endogenous market structure indicate substantial negative long‐run consequences to financial depth when panics cast doubt upon a government's ability to honor its guarantees.

Development and Preliminary Assessment of a Critical Care Ultrasound Course in an Adult Pulmonary and Critical Care Fellowship Program

The focused ultrasound examination has become increasingly recognized as a safe and valuable diagnostic tool for the bedside assessment of the critically ill patient. We implemented a dedicated on-site critical care ultrasonography curriculum with the goal of developing a model for teaching ultrasound skills to pulmonary and critical care medicine fellows. The program was comprised of blended didactic and bedside sessions in the following topic domains: fundamentals; vascular access and diagnosis; and abdominal, thoracic, and cardiac ultrasonography. Formal knowledge and image acquisition assessments were performed before and after the program to assess success in meeting predefined learning objectives. Participants completed surveys (on Likert scale 1-5) before and after the program to assess their confidence in ultrasonography knowledge and skills as well as their perception as to training effectiveness. The preintervention knowledge and bedside image acquisition scores were 71 and 32%, respectively. The global preintervention score was 51%. All postintervention measures demonstrated significant improvement: 89% (P < 0.01), 86% (P < 0.0001), and 87% (P < 0.0001). Preintervention participant confidence in their ultrasound knowledge and skill was 2.9/5, which improved to 4.3/5 (P = 0.007) after intervention. Participants rated the curriculum as meeting course objectives at a mean of 4.8/5. At one academic medical center, the knowledge of eight adult pulmonary and critical care fellowship trainees regarding critical care ultrasound was high at baseline; however, bedside image acquisition skills were poor. A dedicated 6-week educational intervention resulted in highly significant improvements in subject knowledge and image acquisition skills. These preliminary results warrant validation studies at other medical centers.

4 Improving Undergraduate and Postgraduate Medical Trainees Confidence and Competence in Electrocardiogram Interpretation: Abstract 4 Table 1

Introduction The Electrocardiogram (ECG) is the most commonly used diagnostic test in modern medicine. 1 Competency in ECG interpretation is central to undergraduate and postgraduate clinical training and minimising potential adverse consequences on patient care. Several studies have demonstrated postgraduates interpret ECG’s sub-optimally. 2,3 Our study compares the effectiveness of two cost neutral learning strategies to improve competence and confidence in this core clinical skill. Method A prospective randomised study was carried out over a one-month period comparing the learning strategies in two cohorts: undergraduate 3 rd year medical students and postgraduate foundation year one (FY1) doctors.Both had blinded randomisation to one of these strategies; focused teaching program (FTP) and self-directed learning (SDL). All volunteers completed a confidence questionnaire on ECG interpretation before and after completing the intervention. Additionally, all undertook an ECG recognition multiple choice question (MCQ) paper at the end of the learning period to assess competence. Results A total of 21 FY1’s and 25 3rd year medical students participated. The undergraduates in the FTP group demonstrated a significant difference in successfully interpreting ‘Ventricular Tachycardia’ (p = 0.046) and ‘Narrow Complex Tachycardia’ (p = 0.009) than the SDL group. Overall, participant confidence increased in both groups in each cohort. The FTP group demonstrated a greater improvement in confidence compared to SDL in both cohorts. Conclusion A dedicated teaching program can improve trainee confidence and competence in ECG interpretation. A larger benefit is observed in those undertaking a focused teaching program. ECG interpretation can be improved at any training level, especially undergraduates with a dedicated teaching program. References Rubinstein J, Dhole A, Ferenchick G. Puzzle based teaching versus traditional instruction in electrocardiogram interpretation for medical students – a pilot study. BMC Medical Education 2009; 9(4):1–7 Sur D, Kaye L, Mikus M, Goad J, Morena A. Accuracy of electrocardiogram reading by family practice residents. Fam Med 2000; 32(5): 315–9 Jensen MSA, Thomasen JL, Jensen SE, Lauritzen T, Engberg M. Electrocardiogram interpretation in general practice. Family Practice 2005; 22:109–113

Simulated job interview improves skills for adults with serious mental illnesses.

Adults with serious mental illnesses (e.g., Autism Spectrum Disorder [ASD], schizophrenia, post-traumatic stress disorder [PTSD]) often have difficulties obtaining employment. The Job Interview Training System with Molly Porter, developed in collaboration with Yale and Northwestern Universities and vocational rehabilitation specialists with funding from The National Institutes of Health (R43/44MH080496), allows learners to practice job interviews on computers in a stress free environment. The system includes user-driven educational materials, an interactive job application, a practice simulation with a fictional interviewer (Molly Porter), and extensive feedback. SIMmersion's PeopleSIM™ technology allows each conversation with Molly to provide a unique interview experience, enabling users to gain confidence while building skills. The on-screen coach provides insight during the conversation, and a comprehensive after-action review provides learners with feedback on the entire interview. In a randomized control trial, the system was proven effective at improving participants' interview skills and confidence. Ninety-six (96) unemployed adults with ASD (n=26), schizophrenia/other (n=37) or PTSD (n=33) were recruited. Participants were randomized into control (n=32) and experimental (n=64) conditions. The control group was "wait-listed" to receive training, and the experimental group used the training system with Molly Porter. Both groups completed pre- and post-intervention role-play interviews and self-assessment questionnaires. Analyses of covariance showed that the simulation provided a highly significant training effect, with experimental group participants scoring better in the role-play interviews and self-assessing higher than control group participants. By increasing skills and confidence, this system may ultimately reduce the length of unemployment for adults with mental illnesses.

Creating our future: conformity or change?

Creating our future: conformity or change?

Teaching general practitioners and doctors-in-training to discuss advance care planning: evaluation of a brief multimodality education programme

ObjectiveTo develop and evaluate an interactive advance care planning (ACP) educational programme for general practitioners and doctors-in-training.DesignDevelopment of training materials was overseen by a committee; informed by literature and previous...

Technology usage intent among apparel retail employees

Purpose– The purpose of this paper is to identify variables important to acceptance and use of advanced technologies by apparel retail employees and to recommend management strategies for effective technology integration in retail stores.Design/methodology/approach– Current or past retail employees (N=71) were introduced to and given time to use three technologies – a 3D body scanner, product configurator, and social networking – in a laboratory setting using a within subjects design. A questionnaire measured participants’ perceptions of each technology in terms of usefulness, enjoyment, ease of use, task importance, technology self-efficacy – overall participant confidence in using new technology – and usage intent.Findings– Results showed that employee's perceived usefulness of technology was a mediating influence on usage intent for all three technology types. Enjoyment also emerged as a significant mediator for 3D body scanning technology usage intent. Employees’ high self-efficacy scores corresponded to higher ratings for usefulness of each technology, suggesting that more technologically confident employees would be more likely to use the three types of technology presented in this study as part of their work.Research limitations/implications– The controlled environment of the laboratory setting may limit the generalizability of results to actual retail store settings. Future evaluations of technology usage in actual retail store environment involving both employees and customers are recommended.Originality/value– This research explores the use of advanced in-store technologies from the perspective of apparel retail employees, applying the Technology Acceptance Model. It provides insight as to why employees accept and use innovative technologies that are relevant to their jobs and increase and enhance the points of contact between employees and customers. This knowledge of employee technology usage in the store environment could be used to improve job performance and job satisfaction – issues that often confront apparel retailers.

The assets of ASSET: improving surgical performance confidence through an anatomy and skills review course for surgeons (536.11)

Rapid control of major hemorrhage is a primary goal in trauma surgery. However, many surgeons have little practical experience with the required vascular exposures. To address this, the American College of Surgeons developed the Advanced Surgical Skills for Exposure in Trauma (ASSET) course to review anatomy, skills and techniques for major vascular exposures. Since 2008, a broad range of participants have attended, including surgeons of many specialties, deploying military surgeons and surgery residents.We compared self‐reported confidence of participants (n=562) in surgical tasks (n=47) at baseline and directly after ASSET training to examine the effect of the course stratified by surgical experience level (resident/fellow; &lt;8 years post‐residency; 8+ years post‐residency), specialty (trauma/vascular; general surgery; other specialties), and body region.Results of Freeman‐Halton 3x2 tests indicated significant gains in confidence scores for all specialties (p&lt;0.02), particularly for general surgeons (p&lt;0.01) and exposures in the chest (p&lt;0.001), after ASSET. There was no difference in confidence gained by surgical experience. This study demonstrates the value of continuing education in applied anatomy for clinical practice. Given the frequency of vascular trauma in current military conflicts, the impact of ASSET is particularly relevant for preparing deploying surgeons for the theatre.Grant Funding Source: Supported by: US Army W81XWH‐13‐2‐0028

HIGH FIDELITY SIMULATION: A MODALITY FOR TEACHING END OF LIFE CARE?

BackgroundThe hospice model of care is held as the model of excellence for delivering high quality care to dying patients. However, only a small number of patients in the UK...

Exploring the Feasibility of Text Messaging Intervention in Intimate Partner Violence

Introduction: Intimate Partner Violence (IPV) is defined as controlling, abusive, and aggressive behavior in a romantic relationship. Women between the ages 16 and 24 experience the highest rate of IPV. IPV costs US society at least $13.6 billion annually and is expected to rise to $15.6 billion by 2021. The purpose of this study is to explore the feasibility of Text Messaging Intervention (TMI) in recognizing, responding and preventing IPV among college students. The research questions are: Will TMI 1) improve participant knowledge of warning signs of IPV? (Knowledge) and 2) improve participant confidence to intervene in IPV? (Confidence). Methods: A mixed methods design in data collection and data analysis was used. One-way ANOVA and Chi-square test were used to analyze quantitative data from the pre and post TMI survey. Results of the qualitative data analysis are included verbatim. Results: Results showed that knowledge level pre to post test increased from 2.00 ± 1.00 to 2.7 ± 0.48 (p

Improving ECG Competence in Medical Trainees in a UK District General Hospital.

BackgroundCompetency in electrocardiogram (ECG) interpretation is central to undergraduate and postgraduate clinical training. Studies have demonstrated ECGs are interpreted sub-optimally. Our study compares the effectiveness of two learning strategies to improve competence and confidence.MethodA 1-month prospective randomized study compared the strategies in two cohorts: undergraduate third year medical students and postgraduate foundation year one (FY1) doctors. Both had blinded randomization to one of these learning strategies: focused teaching program (FTP) and self-directed learning (SDL). All volunteers completed a confidence questionnaire before and after allocation learning strategy and an ECG recognition multiple choice question (MCQ) paper at the end of the learning period.ResultsThe FTP group of undergraduates demonstrated a significant difference in successfully interpreting “ventricular tachycardia” (P = 0.046) and “narrow complex tachycardia” (P = 0.009) than the SDL group. Participant confidence increased in both learning strategies. FTP confidence demonstrated a greater improvement than SDL for both cohorts.ConclusionA dedicated teaching program can improve trainee confidence and competence in ECG interpretation. A larger benefit is observed in undergraduates and those undertaking a FTP.

Board 526 - Technology Innovations Abstract Thoracotomy Task Trainer (Submission #501)

Introduction/Background Background: Simulation within the healthcare industry has become increasingly popular and has proven to be an effective tool1; however, it usually is associated with a high price tag.1,2 Thoracotomies are one of the most difficult surgeries to perform but are rare in occurrence and thus not performed frequently; therefore, skill level and self-efficacy tends to be low. A thoracotomy is an incision into the chest wall (i.e. thorax) and is performed in various situations including treatment or diagnosis of diseases, resuscitative, or emergency trauma to the chest.3 Practicing a thoracotomy in simulation often requires the use of either a cadaver or a fresh thorax, which is expensive, time consuming, and requires multiple stipulations (i.e. a room with proper ventilation, privacy regulations, transport laws, etc.). The creation of a Thoracotomy task trainer would eliminate these issues, be cost effective, and offer frequent training of a skill rarely practiced. Methods Objectives: Increase skill level and self-efficacy with residents;
Decrease the cost of training for thoracotomies; Create a low cost, reusable, mobile task trainer to increase competency; Develop effective communication between hospital staff during the procedure.

Methods: After developing and coordinating a previous thoracotomy training with over 40 general surgery residents and measuring outcomes, it was determined that although more costly than using a cadaver (approx. $2000), a fresh human thorax (approx. $5000) would be more beneficial, secondary to it being more realistic. Both the cadaver and thorax offer excellent training; consequently, they can only be used once. Additionally, feedback from residents who participated in past training indicated there was an obvious need for a cost effective, mobile, and reusable Thoracotomy task trainer. The cost to develop and construct the thoracotomy task trainer is approximately $200, while the cost to run one resident through the Thoracotomy task trainer is $5.

To do this, staff purchased (or find someone willing to donate) a used ALS SimMan by Laerdal)5 and carefully removed the mechanical parts from within the chest, making an open space. The idea is to then recreate a functioning chest wall with skin and ribs, as well as, a realistic substitute for a human heart; consisting of proper anatomy, fluid, and vasculature. Parts list included: ALS SimMan, cow ribs, pig pluck, IV and suction tubing, screws, zip ties, super glue, medium sized Tupperware to house pig pluck, zip lock bag, simulated blood, simulated human skin, and moulaged epigastric puncture wound. For training to be complete; a Thoracotomy Tray, pertinent medical instruments, and a subject matter expert are necessary. Results: Conclusion The thoracotomy task trainer is a cost effective, mobile, and reusable training tool. This innovative approach will allow each training center, hospital, healthcare facility the opportunity to build their own trainer, as well as, offering every resident the opportunity to perform this high stakes, low frequency procedure. Using this task trainer will amplify participants confidence, frequency of training, and skill level, while also helping to create an effective interdepartmental communication process throughout this procedure.5 All in all, the Thoracotomy task trainer is a low cost, highly efficient tool that can help save lives.

Optimizing study design for interobserver reliability: IUGA–ICS classification of complications of prostheses and graft insertion

Results of interobserver reliability studies for the International Urogynecological Association-International Continence Society (IUGA-ICS) Complication Classification coding can be greatly influenced by study design factors such as participant instruction, motivation, and test-question clarity. We attempted to optimize these factors. After a 15-min instructional lecture with eight clinical case examples (including images) and with classification/coding charts available, those clinicians attending an IUGA Surgical Complications workshop were presented with eight similar-style test cases over 10 min and asked to code them using the Category, Time and Site classification. Answers were compared to predetermined correct codes obtained by five instigators of the IUGA-ICS prostheses and grafts complications classification. Prelecture and postquiz participant confidence levels using a five-step Likert scale were assessed. Complete sets of answers to the questions (24 codings) were provided by 34 respondents, only three of whom reported prior use of the charts. Average score [n (%)] out of eight, as well as median score (range) for each coding category were: (i) Category: 7.3 (91 %); 7 (4-8); (ii) Time: 7.8 (98 %); 7 (6-8); (iii) Site: 7.2 (90 %); 7 (5-8). Overall, the equivalent calculations (out of 24) were 22.3 (93 %) and 22 (18-24). Mean prelecture confidence was 1.37 (out of 5), rising to 3.85 postquiz. Urogynecologists had the highest correlation with correct coding, followed closely by fellows and general gynecologists. Optimizing training and study design can lead to excellent results for interobserver reliability of the IUGA-ICS Complication Classification coding, with increased participant confidence in complication-coding ability.

Impact of model-based risk analysis for liver surgery planning

A model-based risk analysis for oncologic liver surgery was described in previous work (Preim et al. in Proceedings of international symposium on computer assisted radiology and surgery (CARS), Elsevier, Amsterdam, pp. 353–358, 2002; Hansen et al. Int I Comput Assist Radiol Surg 4(5):469–474, 2009). In this paper, we present an evaluation of this method. To prove whether and how the risk analysis facilitates the process of liver surgery planning, an explorative user study with 10 liver experts was conducted. The purpose was to compare and analyze their decision-making. The results of the study show that model-based risk analysis enhances the awareness of surgical risk in the planning stage. Participants preferred smaller resection volumes and agreed more on the safety margins’ width in case the risk analysis was available. In addition, time to complete the planning task and confidence of participants were not increased when using the risk analysis. This work shows that the applied model-based risk analysis may influence important planning decisions in liver surgery. It lays a basis for further clinical evaluations and points out important fields for future research.

Participant perspectives from the Indian Health Service Anticoagulation Training Program

The Indian Health Service Anticoagulation Training Program serves to improve patient safety through advanced anticoagulation management training. Although post-program evaluations of program content were conducted at the time of program delivery, little is known about translation of these learned skills into clinical practice. This research sought to describe levels of self-reported participant confidence in anticoagulation management; development, implementation, and performance management of both core and supplemental activities of anticoagulation clinics or services; and current anticoagulation clinical practices subsequent to participating in the Anticoagulation Training Program. A federal Indian Health Service healthcare facility in Oklahoma, USA. A cross-sectional, electronic mail survey was designed, pretested, and administered to 267 eligible Anticoagulation Training Program participants from 1999 to 2009. Data were analyzed using descriptive statistics and interpreted to identify areas of strength and opportunities for improvement. Information about confidence in anticoagulation management skills; development, implementation and improvement of both core and supplemental activities of anticoagulation clinics or services; and current anticoagulation clinical practices was collected. After training, over 90 % of participants reported agreement/strong agreement with statements about confidence in performing patient-care related anticoagulation activities. A smaller proportion (83.3-85.4 %) reported agreement/strong agreement with confidence in measuring, analyzing and reporting anticoagulation outcomes. Improvement activities were more common than development or implementation activities (65.4, 31.9 and 35.1 %, respectively). Not having well established reimbursement procedures, lack of dedicated clinic space, and lack of dedicated personnel salaries (47.3, 38.3 and 32.6 %, respectively) were reported as the most common barriers to developing, implementing or improving an anticoagulation clinic. Participants indicated that anticoagulation outcomes tracking was the most common supplemental development, implementation and improvement activity (37.9, 37.0 and 43.8 % respectively). Benchmarking was the least commonly reported outcomes-related activity by participants (33.6 %). Although there was only a modest gain in the number of established anticoagulation clinics after attending the Anticoagulation Training Program, approximately 21 % of participants reported using skills learned to establish other disease state management clinics. In general, a majority of participants reported high levels of confidence related to direct patient care activities after attending the Anticoagulation Training Program. However there is a need to raise confidence in performance improvement and outcomes management activities to align with current accreditation standards in anticoagulation management as the Anticoagulation Training Program evolves.

An appraisal of spoken English Language in Nigeria

A general observation in the Nigerian classrooms today is that spoken language has not been accorded the recognition it rightly deserves. This is not surprising for approaches to language teaching in these areas have not been reviewed to reflect the revolutionary trend of communicative language teaching pedagogy. To underscore this, a study was carried out among two Nigerian speakers of English who were admitted to study at the University of Leeds using three monologic tasks.The study showed that features often found in spoken language like paratactic phrases, pausing, incomplete sentences, false starts, formulaic chunks were not fully exploited. The study therefore canvassed that teachers should teach thesespecific linguistic features which distinctly characterize spoken language using tasks that can enhance production and boost confidence in the focal participants and increased their ability to use language in real situation Key words: Nigeria, appraisal, spoken, English language

Improved modelling for urban sustainability assessment and strategic planning: local government planner and modeller perspectives on the key challenges

Many technical and modelling tools are available to support the strategic assessment of land-use and infrastructure policy proposals in local government. However, there remains a lack of guidance and general confusion as to how modelling may be integrated into the policy- and decision-making process or how to practically set up participatory model-building with practitioners. Although major advances have been made in modelling over recent decades, several unresolved implementation issues remain in practice. This paper provides the results of a panel survey, which explored what planners and modellers believe to be key modelling implementation issues, their perceived importance and a set of modelling requirements. The results suggest that planners generally feel that they do not understand models and the modelling process, and modellers, in turn, feel that they do not always understand policy development and decision-making. Problems regarding data preparation were viewed as the most important challenge. Ensuring leadership and management support and initiatives aimed at improving the communication and confidence of participants were perceived as key requirements. Limited resources, leadership support and a lack of education are some of the challenges that are perceived as important before planners and other government officers can take advantage of modelling.

DEVELOPING ADVANCE CARE PLANNING AND COMMUNICATION SKILLS IN THE NEW ZEALAND HEALTHCARE WORKFORCE

BackgroundResponding to a gap in the healthcare workforce training in advance care planning (ACP) and advanced communications skills, an ACP training programme was initiated. As part of this, an intense...