Training Of Health Professionals Research Articles

Multi-Level Approaches to Fetal Alcohol Spectrum Disorders Prevention Education and Training for Health Professionals.

Alcohol-exposed pregnancies, which can lead to fetal alcohol spectrum disorders (FASDs), is one of the most common preventable causes of lifelong intellectual and developmental disabilities in the U.S. Healthcare teams can play a critical role in preventing FASDs; however, they are currently unprepared to do so. Training can remediate this problem. This article explores the different approaches to the education and training of healthcare providers around FASD prevention used by six Centers for Disease Control (CDC)-funded programs, and how they have been adapted to (1) the specific needs of the healthcare professionals and/or the clinical setting and (2) the challenges posed by the COVID-19 pandemic. This article offers an in-depth description and comparison of the models utilized by the programs described, detailing the challenges of each model as well as the adaptations made. Interdisciplinary collaboration and review highlights these models and offers a variety of solutions and lessons learned that can be implemented in similar practice settings and/or educational initiatives. Based on organizational structure (i.e., national organization, educational institution, and clinical settings) and program purpose, different methods were employed for FASD education. Some programs were focused on FASD prevention through staff training and alcohol screening and brief intervention/clinical intervention and others were focused on broadscale professional education and awareness. Improvements were made on an ongoing basis as challenges related to COVID-19, staff shortages, and patient and clinician discomfort were identified, resulting in modifications to content and delivery modality (e.g., online forums and use of social media). FASD prevention education is wrought with a variety of challenges related to stigma, discomfort, and misinformation, which these programs encountered in a variety of ways.

Improving health behaviours and attitudes around podoconiosis in Northern Western Ethiopia: Implementation and intervention effectiveness.

Assessing how interventions are implemented is essential to understanding why interventions may or may not achieve their intended outcomes. There is little evidence about how interventions against Neglected Tropical Diseases (NTDs) are being implemented. Guided by the Context and Implementation of Complex Intervention (CICI) framework, we evaluated an ongoing intervention against the NTD podoconiosis to examine the implementation process and its effectiveness in terms of improving shoe wearing practices, increasing knowledge and reducing stigmatizing attitudes towards podoconiosis in rural Ethiopia. We employed an exploratory mixed methods approach, qualitative followed by quantitative, between April and July 2022 to assess implementation agents, theory, strategy, process and outcomes of the intervention. We conducted document analysis, observations, focus group discussions, in-depth interviews and key informant interviews for the qualitative phase. We administered a survey to 369 rural residents, of whom 42 were affected by podoconiosis. The implementers utilized government healthcare centers in a bid to mainstream podoconiosis services within local healthcare structures. The implementers provided training for health professionals and the public and distributed supplies to patients over a three-month period. The intervention reached 62% of patients, but female patients were less likely to participate than male patients. Only 18% of community members had participated in health education campaigns linked to the intervention. Involvement in the intervention resulted in improved shoe wearing practice and holding fewer stigmatizing attitudes. However, internalized stigma among patients was still rife; and the plan to utilize community assets to extend the intervention activities was not effective. Implementers must monitor the fidelity and progression of programs on a constant basis to make corrections. They also need to expand health education, provide psychosocial support and design economic empowerment programs for patients to reduce stigma. They must also collaborate with policy makers and international partners to sustain program activities at intervention delivery points.

Assessing Visceral Fat Percentage with Advancing Age in Women using Bioelectric Impedance Analysis

Obesity and related morbidities are rising globally. This study aims to evaluate the relationship between visceral fat percentage (VF%) and advancing age in 126 female participants aged 20-70 years. These participants underwent anthropometric measurements and Bioelectric Impedance Analysis (BIA). The correlation between VF% and advancing age was 0.42 (P<0.001). BIA is a simple and effective measurement technique for estimating VF%, which can be performed by trained health professionals. This study demonstrated a strong correlation between VF% and advancing age in females.

Video-based compilation of acute pain behaviours in cats.

The aim of this work was to create a video-based compilation of acute pain behaviours in cats as an open-access online resource for training of veterinary health professionals. A database comprising 60 h of video recordings of cats was used. Videos were previously recorded after ethical approval and written client consent forms, and involved cats with different types (eg, medical, surgical, trauma, orofacial) and degrees (eg, from no pain to severe pain) of acute pain, before and after surgery or the administration of analgesia. The database included videos of cats of different coat colours, ages, sex and breeds. Video selection was based on a published ethogram of acute pain behaviours in cats. Videos were selected by one observer (SM) according to their definition and quality, followed by a second round of screening by two observers (SM and PVS). Video editing included a standardised template (ie, watermark and titles). A total of 24 videos (mean length 33 ± 17 s) with each acute pain-related behaviour described in the ethogram were uploaded to an open-access online video-sharing platform (http://www.youtube.com/@Steagalllaboratory) with an individual hyperlink. Videos were provided with a short description of the behaviour for the public. This video-based compilation may promote better training of veterinary health professionals on acute pain assessment while improving feline health and welfare and the understanding of cat behaviours.

Real Patient Participation in Workplace-Based Assessment of Health Professional Trainees: A Scoping Review.

The aim of this scoping review is to outline the existing landscape of how real patients participate in the workplace-based assessment of trainees across diverse healthcare professions. In 2019-2020, the authors searched MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, and Web of Science databases for studies that included descriptions of experiences whereby patients received care from a health professional trainee and participated in workplace-based assessments of that trainee. Full-text articles published in English from 2009 to 2020 were included in the search. Of the 8770 studies screened; 77 full-text articles were included. Analysis showed that strategies for patient participation in workplace-based assessment varied widely. Aspects studied ranged from validation of an assessment tool to evaluation of the impact of an educational intervention on trainees' performance. Assessment of patient satisfaction was the most common approach to patient involvement. The majority of studies were conducted in North America and in the context of physician training. Formal patient participation in the assessment of health professional trainees appears heterogeneous across health professions. Gaps in the literature are evident; therefore, this review points to an inclusive approach to workplace-based assessment to ensure patient feedback of the trainees who care for them is represented.

When “Immersive” Learning Goes Remote: Interdisciplinary Lessons Learned in a Pandemic

Abstract: Background: Due to the COVID-19 pandemic, health professional training programs made substantial changes to shift previously in-person student training opportunities to remote settings. Objectives: We present lessons learned from changes made to one community-engaged internship program, Bridging the Gaps (BTG)-Pittsburgh, that should prove helpful in future times of crisis. Methods: BTG-Pittsburgh places inter-disciplinary graduate pairs of students in community-based organizations that serve marginalized populations, to work directly with program participants and develop tangible products aimed to build organizational capacity. Students get additional training on poverty awareness, health literacy, community violence, food justice, trauma-informed self-care, cultural and academic humility, oral health and advocacy. Upon pandemic onset, given increased community need and community partner feedback, BTG-Pittsburgh pivoted quickly, shifting to remote engagement and making critical adjustments to ensure responsiveness to student and community partner needs. Adjustments included: 1) adopting a trauma-informed approach, 2) developing remote mentoring guidance, and 3) doubling site visits to ensure that students and site mentors felt sufficiently supported. Conclusions: Several program and partnership attributes contributed to our overall program success, including a model of reciprocal benefits, providing supports, flexibility, and long-standing relationships. The university’s quick adoption of remote technology and each participating school’s commitment to supporting the program model, further enabled effective student-organization-program collaboration. These lessons can inform community-partnered experiential learning programs that may need to incorporate remote components moving forward.

The Digital Determinants of Health: A Guide for Competency Development in Digital Care Delivery for Health Professions Trainees.

Health care delivery is undergoing an accelerated period of digital transformation, spurred in part by the COVID-19 pandemic and the use of "virtual-first" care delivery models such as telemedicine. Medical education has responded to this shift with calls for improved digital health training, but there is as yet no universal understanding of the needed competencies, domains, and best practices for teaching these skills. In this paper, we argue that a "digital determinants of health" (DDoH) framework for understanding the intersections of health outcomes, technology, and training is critical to the development of comprehensive digital health competencies in medical education. Much like current social determinants of health models, the DDoH framework can be integrated into undergraduate, graduate, and professional education to guide training interventions as well as competency development and evaluation. We provide possible approaches to integrating this framework into training programs and explore priorities for future research in digitally-competent medical education.

More, better feedback please: are learning analytics dashboards (LAD) the solution to a wicked problem?

There is a long-standing lack of learner satisfaction with quality and quantity of feedback in health professions education (HPE) and training. To address this, university and training programmes are increasingly using technological advancements and data analytic tools to provide feedback. One such educational technology is the Learning Analytic Dashboard (LAD), which holds the promise of a comprehensive view of student performance via partial or fully automated feedback delivered to learners in real time. The possibility of displaying performance data visually, on a single platform, so users can access and process feedback efficiently and constantly, and use this to improve their performance, is very attractive to users, educators and institutions. However, the mainstream literature tends to take an atheoretical and instrumentalist view of LADs, a view that uncritically celebrates the promise of LAD's capacity to provide a 'technical fix' to the 'wicked problem' of feedback in health professions education. This paper seeks to recast the discussion of LADs as something other than a benign material technology using the lenses of Miller and Rose's technologies of government and Barry's theory of Technological Societies, where such technical devices are also inherently agentic and political. An examination of the purpose, design and deployment of LADs from these theoretical perspectives can reveal how these educational devices shape and govern the HPE learner body in different ways, which in turn, may produce a myriad of unintended- and ironic- effects on the feedback process. In this Reflections article we wish to encourage health professions education scholars to examine the practices and consequences thereof of the ever-expanding use of LADs more deeply and with a sense of urgency.

Use of Intersectionality as a tool in the development of interventions, protocols and advanced health analyzes associated with people living with HIV. A Scoping Review

Introduction: Intersectionality has been used as a tool to understand and address health inequalities, especially in the context of health care for people with HIV. However, its application in the development of intervention strategies and care protocols is scarce.Methods: a systematic scoping bibliographic review was carried out to identify studies that use intersectionality in the field of health, as a tool for the development of advanced information analysis, development of instruments and protocols associated with people with HIV. Databases such as Scopus, PubMed and Clarivate Analytics Wos of Science were used.Results: Intersectionality has been used as a tool for the development of basic frameworks for the development of protocols and measurement instruments, its use in the development of intervention programs is scarce.Conclusions: Intersectionality is a valuable tool to understand health inequalities, but its application in the development of intervention strategies and care protocols is limited. It is necessary to develop research that uses intersectionality to create health intervention and professional training programs that address health inequalities and reduce the stigma associated with HIV.

Pilot qualitative exploration of the impact of community asset mapping within the undergraduate psychiatry curriculum at an Irish medical school

IntroductionProviding an effective response to global health disparities requires that future doctors are better prepared to embrace a public health ethos. Asset-based approaches see people and communities as coproducers of...

The objectively structured clinical examination for safe nursing care: a scoping review

Introduction: The Objective Structured Clinical Examination (OSCE) has been utilized as an educational strategy in the training of health professionals. Its application in this context can enhance the development of both technical and non-technical skills, as well as safety in care.Objective: To map the patient safety skills developed by nursing professionals through the Objective Structured Clinical Examination as found in the literature.Method: This is a scoping review structured according to the JBI framework and guided by the Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. The review is registered in the Open Science Framework with the DOI number 10.17605/OSF.IO/MESC3. A search was conducted in the following databases: PubMed, Scopus, Web of Science, Cumulative Index of Nursing and Allied Health Literature (CINAHL), the CAPES Catalog of Theses and Dissertations, and Google Scholar, between February and April 2023.Results: Twenty-five studies were selected, demonstrating that the OSCE is used to train nursing teams with a focus on safety skills such as communication, teamwork, decision-making, clinical care, and situational safety awareness.Conclusion: The OSCE has been used as an educational strategy to improve the quality and safety of care. It is applied from primary care to high-complexity settings to evaluate professional skills that are technical, attitudinal, or behavioral in nature. The use of OSCE aids in the development of professional skills related to patient safety.

Teaching and Evaluating the Virtual Physical Exam in Telemedicine.

With the rapid adoption of telemedicine since the COVID-19 pandemic, it has become imperative to teach and evaluate health professional trainees on skills important to conducting effective virtual visits. We developed a simulation-based workshop with (1) readings, (2) a lecture covering online communication and the virtual head and neck exam, (3) a telemedicine simulation with a standardized patient observed by faculty, (4) personalized feedback from faculty, and (5) a group debrief session. We created an evaluation rubric based on three of 20 Association of American Medical Colleges (AAMC) telemedicine competencies to assess learner performance during the simulations. Students (medical and physician assistant students; n = 50), and internal medicine residents (n = 20) completed this workshop in 2023. At least 90% of trainees across the two groups were rated as approaching entrustment or entrustable in each competency. This workshop is an example of a scalable telemedicine curriculum that can be used to teach and evaluate learners in the virtual physical exam across the training continuum.

Task-shifting of prolonged exposure for primary care (PE-PC) for PTSD in a semirural setting in South Africa: A pilot implementation study.

Implementation science (IS) has received increased attention as it provides a means to bridge the know-do gap to implement evidence-based interventions in real-world settings. Against this backdrop, posttraumatic stress disorder (PTSD) is a global mental health concern (Koenen et al., 2017), especially in low- and middle-income countries characterized by limited trained health professionals, infrastructure, and limited access to evidence-based mental health care (Chen et al., 2017). Over the last 3 decades, effective trauma-focused psychotherapies (TFPs) for PTSD have been developed (Hamblen et al., 2019). Prolonged exposure therapy (PE) is a first-line TFP for PTSD (Hamblen et al., 2019), yet the dissemination and implementation of PE have been limited to specialty care settings in developed or industrialized countries (Booysen & Kagee, 2020). Implementation science provides an opportunity for disseminating and implementing TFPs like PE in low- and middle-income countries. This article describes mixed-method data from a pilot implementation study of an abbreviated version of PE, known as prolonged exposure for primary care (S. A. M. Rauch, Kim, et al., 2023), in a semirural city in the Eastern Cape of South Africa. Importantly, prolonged exposure for primary care shows a significant reduction in PTSD when provided by lay counselors and good feasibility and acceptability. In addition, we reflect on the barriers and facilitators related to implementation research within a low-resourced community, namely, (a) training lay counselors, (b) cultural diversity, and (c) mental health literacy. Mental health literacy is proposed as an essential component to consider in implementation science, especially in low-resourced communities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Contribuições da Ciência da Informação para Melhorar o Acesso ao Sistema Único de Saúde

This research aimed to study the difficulties encountered by the population in accessing the Brazilian Unified Health System. This was also intended to provide support for thinking about the transversality of Information Science in the Health sector. To this end, exploratory research was carried out, following a mixed methods approach, in Pernambuco State. It was observed that the majority of the 103 research participants use the system in their daily lives, for specialized care and surgeries, have access to the Internet, access to information and communication technologies, and are open to using technologies in their relationship with the system. The difficulties they have in accessing the Health System relate to: lack of health professionals, lack of computerization of health units, need for training of health professionals, limited number of health units and disorganized waiting lists. In this context, the potential contributions of Information Science to improving access to the Unified Health System include development of information services focused on access to the system, development of tools that can assist health professionals and the population on several fronts and collaboration in computerization and interoperability of health unit systems.

HIV and hepatitis B virus co-infection in Mozambique: Policy review and health professionals' knowledge and practices.

Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) co-infection is a public health problem affecting 2.7 million worldwide. In Mozambique, the prevalence of this co-infection is 9.1%, calling for specific policies on prevention, diagnosis and adequate management in health facilities caring for HIV patients. This study aimed to review the existing policies and to assess the knowledge and practices of health professionals about HIV/HBV co-infection. A document and literature review to describe the existing policies and guidelines on HIV/HBV co-infection in Mozambique was performed. Key informants were contacted to clarify or add information. Health Professionals who care for HIV-positive patients in four health centers in Maputo City, the capital of Mozambique, responded to a questionnaire on knowledge and practices about this co-infection. Qualitative analysis was done to identify main themes using content analysis. Descriptive statistics of socio-demographic, knowledge and practice variables was presented using the SPSS Program version 20 and bivariate analysis was applied to describe the association between variables. Twenty-one policy documents were found, and five key informants were interviewed. Fifty-two participants answered the questionnaire. Only one policy document explicitly referred to HIV/HBV co-infection treatment. Most Health Professionals (96%) were aware of HIV/HBV co-infection. Although the only existing policy is on the treatment, few (33%) referenced antiretroviral formulations containing Tenofovir and Lamivudine. Only 29% of Health Professionals reported screening HIV patients for HBV and 21% practiced HIV/HBV co-infection counselling. No statistically significant differences were found when relating the socio-demographic variables with knowledge and practices. Policy documents relating to prevention, diagnosis and clinical management of HIV/HBV co-infection were rare or absent. Health Professionals had little knowledge about HIV/HBV co-infection. Defining adequate policies and training of Health Professionals may help increase awareness, increase counselling of patients for disease prevention, diagnosis and proper management of HIV/HBV co-infected patients.

Wellness and Stress Management Practices Among Healthcare Professionals and Health Professional Students.

Healthcare professionals experience stressors that begin during training and persist into their careers that adversely impact their well-being. This study aims to identify students' and professionals' stress levels, satisfaction with wellness domains, barriers to wellness, and stress management practices. This study was a cross-sectional self-reported survey study. The study included students (N = 242) and professionals (N = 237) from medicine, nursing, pharmacy, physical therapy, social work, and counseling/psychology. The Managing Health & Wellness in Health Professions Training and Practice survey was used to capture wellness practices and barriers among participants. Results: Students reported significantly higher perceived stress compared to professionals (P < 0.001). Total wellness is significantly higher among professionals compared to students (P < 0.001). A higher stress rate is significantly related to being female, having a lower wellness score, and facing more barriers (P < 0.001). Intellectual health is the most valuable wellness domain for providers (M = 3.71, SD = 0.9) and students (M = 3.43, SD = 0.85), followed by spiritual health for providers (M = 3.4, SD = 1.1), and work/learning environment for students (M = 3.33, SD = 0.93). Professionals and students are least satisfied with their physical and financial health. Barriers include fatigue, workload/productivity in clinical practice, work hours, and burnout. Healthcare professionals exhibit a variety of stress management practices, encounter barriers, and prioritize different wellness domains. Healthcare systems should incorporate self-care education into their curricula and implement systemic changes to foster a thriving healthcare workforce.

A novel oral medicine-centered interprofessional curricular initiative to promote collaboration and build oral health capacity.

Oral physicians should possess knowledge, skills, and attitudes required for functioning in the evolving integrated care systems. Paramount for addressing the existing oral health disparities is also adequate training of non-dental health professionals in the foundations of oral health. We conducted interprofessional oral medicine-centered case conferences to prepare dental students for collaborative care and to increase awareness of non-dental students about the mouth-body connection. Herein, we share our perspective and the students' feedback about this educational program. Students from seven health profession and social work programs attended an interactive, online oral medicine-centered case conference facilitated by an oral medicine faculty and at least one faculty from another profession. Faculty facilitators guided students to identify key points and encouraged team-based care. Anonymous, voluntary online surveys were distributed to participants immediately after each session. Descriptive data tabulated and analyzed. A total of 151 students participated in conferences between 11/11/2022 and 3/24/2023 and 132 (87%) submitted postexperience surveys. Students agreed that the case conference was applicable to their profession (95%) and meaningful (94%), they learned new information about other professions (94%), they could contribute to discussions (90%), interactions were respectful (99%), and discussions emphasized interprofessional collaboration (96%). Non-dental respondents learned more about oral-systemic link (95%), recognized a broader role for dentists (90%), and agreed with inclusion of more oral health content in their curricula (79%). Oral medicine-centered case conferences provided an effective curricular path for demonstrating oral-systemic connection, promoting meaningful interprofessional collaboration, and building oral health capacity among students of non-dental health professions.

Theorizing epidemiology, the stories bodies tell, and embodied truths: a status update on contending 21st c CE epidemiological theories of disease distribution.

This critical review considers the status of 21st-century epidemiological theories of disease distribution, updating to 2024 prior analyses published up through 2014, and discusses the implications of these theories for research, practice, and pedagogy. Three key trends stand out: (a) the continued dominance of individualistic biomedical and lifestyle theories; (b) growth and elaboration of social epidemiological alternatives; and (c) the ongoing inattention to epidemiologic theories of disease distribution in the training of epidemiologists and public health professionals and in current efforts to improve the rigor of epidemiological research and causal inference. In a context of growing global political polarization, climate crisis, broader environmental and ecological crises, and stubbornly persistent health inequities within and between nations, producing actionable knowledge relevant to improving the people's health and advancing health justice will require much greater engagement with social epidemiologic theories of disease distribution in research, pedagogy, and practice. At issue is critically engaging with the embodied truths manifested in the stories bodies tell in population patterns of health, disease, and well-being.

Bridges between two medical realities: Perspectives of Indigenous medical and nursing students on snakebite care in the Brazilian Amazon.

In the Brazilian Amazon, snakebite envenomations (SBEs) disproportionately affect Indigenous populations, and have a significantly higher incidence and lethality than in non-Indigenous populations. This qualitative study describes the Indigenous and biomedical healthcare domains for SBE care from the perspective of the Indigenous medical and nursing students in Manaus, Western Brazilian Amazon. In-depth interviews were conducted with five Indigenous students from the Amazonas State University, between January and December 2021. The interviews were analyzed using inductive content analysis. We organized an explanatory model with five themes: (1) participants' identities; (2) causality levels in Indigenous and biomedical systems; (3) therapeutic itineraries in Indigenous and biomedical systems; (4) ideological implications of adding biomedical devices to Indigenous healing systems; and (5) therapeutic failure in and efficacy of Indigenous and biomedical systems. From a noncolonial perspective and seeking to increase the quality and acceptability of health care for the Indigenous populations of the Brazilian Amazon, the training of Indigenous health professionals presents itself as a promising strategy. For this goal, universities should serve as empowering settings for Indigenous health students that support them in their growth and development, raise their awareness of injustice, and catalyze change toward a culturally adapted and effective service for the users.

Children and adolescents at risk for seclusion and restraint in inpatient psychiatric treatment: a case control study

To reduce coercion in acute inpatient child and adolescent psychiatric units, a better understanding of individuals at risk for seclusion and/or restraint (S/R) is needed. We report data on the proportion of patients secluded/restrained and factors associated with higher risk of S/R. Identifying preventative mechanisms through risk stratification upon inpatient admission can aid the training of mental health professionals, and support shaping specific workflows for at-risk populations for example by joint crisis plans or post-coercion review sessions. Methods: A case-control study included all admissions (n = 782) to a department of child and adolescent psychiatry within 36 months between 2019 and 2022. Data on age, sex, out of home care, primary and comorbid ICD-10 diagnoses, length of stay, prior/multiple admissions were compared between admissions with and without S/R using chi square tests for categorical and t-tests for continuous variables. Uni- and multivariate binary logistic regression models were computed. Results: The overall proportion of S/R was 12.8% (n = 100). Females (p = 0.001), patients in out of home care (p < 0.001), with prior admission (p < 0.001), Post-traumatic stress disorder (PTSD; p < 0.001) and Borderline personality disorder (BPD; p < 0.001) were at a significantly higher risk of S/R. Length of stay in days (OR 1.01), out of home care (OR 3.85), PTSD (OR 6.20), BPD (OR 15.17), Attention deficit hyperactivity disorder (ADHD)/conduct disorder (OR 4.29), and manic episode/bipolar disorder (OR 36.41) were significantly associated with S/R in multivariate regression. Conclusions: Child and adolescent psychiatric staff should consider risk factors when using coercive measures. Patients with PTSD and/or BPD are the most vulnerable subgroups. Training of professionals and clinical practice need to be adapted in order to prevent the use of S/R and its potential hazards.