Self-rated Competence Research Articles

Training pre-service general educators in assistive technology competencies for students with visual impairments

Teacher knowledge of, and comfort with, assistive technology (AT) is key for student use of AT. Previous research identified the AT competencies needed for instructing students with visual impairments (VI) and level of competency required in each. The authors selected 20 of the competencies most appropriate for general education teachers instructing students with VI and investigated the impact of pre-service teacher training in AT on their self-rated competency levels. Pre-service teachers were given a pre-test (using qualitative and quantitative measures), trained in AT using a scavenger hunt in the AT Lab at the university where the study took place, and then completed a post-test of the same measures. Participants could name more AT software and devices on the post-test and viewed themselves as more competent with regards to the 20 SAT competencies.

Self-perceived competence and willingness to ask about intimate partner violence among Swedish social workers

ABSTRACT In this article we explore the extent to which Swedish social workers encounter IPV, as well as their readiness to handle these cases. The study draws from data gathered in an online survey answered by 787 caseworkers within the personal social services, exploring the rate of asking clients about intimate partner violence, access to IPV training, level of self-rated competence, and amount and frequency of IPV-cases in the caseload. Our findings do on the one hand confirm that IPV is a widespread problem that a large proportion of social workers come across on a regular basis, and on the other show that substantial parts of Swedish social workers consider themselves to be rather ill-equipped at handling cases of IPV. Results from multiple regression analyses show that training, high self-perceived competence and administrative procedures each tend to increase the likeliness of social workers regularly asking clients about IPV. Social service organisations striving to increase their ability to detect and support victims of IPV are thus likely to benefit by raising the level of staff competence as well as implementing administrative procedures throughout the organisation.

Tell Me Straight: Teaching Residents to Disclose Adverse Events in Surgery

The purpose of this effort was to create an educational experience that provided learners a realistic disclosure experience and improved resident confidence discussing an adverse outcome with a patient and family. Residents practiced disclosing a surgical complication to a patient/family with simulated patients (SPs). We paired professional SPs with former patient SPs to present a realistic case. Junior residents were given extra training time before their disclosure of a laparoscopic cholecystectomy conversion to an open procedure; senior residents disclosed a bile duct injury. Residents rated pre and post-module confidence levels, and skills performance using the Disclosure of a Complication Checklist. 900-bed tertiary care hospital with surgical residency program and simulation center. General surgery residents (PGY 1-5). Eighteen residents participated in the disclosure module. Analysis of the medians and interquartile ranges of pre and post-module confidence scores showed significant improvement for each individual item and mean score of learners. Residents assessed their completion rates of individual Checklist tasks positively. For example, 94% self-endorsed completion of "explanation of facts," 89% self-endorsed "took responsibility," and 78% self-endorsed "apologized sincerely." Self-rated competence scores from the Checklist were low: 7% indicated they would be "extremely comfortable" entrusting their loved one's care to themselves, 11% rated their ability to explain the facts as "outstanding," and 12% felt they were "outstanding" in their "ability to disclose a complication in a professional manner." Residents received important skills practice in our disclosure training; disclosure confidence increased after participation. Residents scored high on completion of disclosure tasks and low on comfort and proficiency of those tasks. The Checklist provided a useful set of tasks to review and complete in the exercise. Separating residents by PGY level enabled senior residents to experience a more complex scenario and junior residents extra time to practice.

Cultural adaptations and therapist multicultural competence: Two meta-analytic reviews.

Mental health treatments can be more effective when they align with the culture of the client and when therapists demonstrate multicultural competence. We summarize relevant research findings in two meta-analyses. In the meta-analysis examining culturally adapted interventions, the average effect size across 99 studies was d = 0.50 (0.35 after accounting for publication bias). In the second meta-analysis on 15 studies of therapist cultural competence, the results differed by rating source: Client-rated measures of therapist cultural competence correlated strongly (r = 0.38) with treatment outcomes but therapists' self-rated competency did not (r = 0.06). We describe patient considerations and research limitations. We conclude with research supported therapeutic practices that help clients benefit from modifications to treatment related to culture.

Abortion education in Canadian family medicine residency programs

BackgroundAbortion has been decriminalized in Canada since 1988 and is considered an essential medical service. There is concern that decreasing numbers of abortion providers may impair access to abortion. This study examined the quantity of exposure and education that Canadian family medicine residents receive on abortion during training and their preparation to provide abortions. In addition, the study assessed residents’ attitudes, intention and expressed competency to provide abortion in future practice and the association between medical training and changes in these factors.MethodsThe authors developed a 21-item survey in consultation with experts in medical education. The survey was distributed online in 2016. A total of 1517 family medicine residents in their first, second and third year of training attending 8 English language schools across Canada were invited to participate. Associations between attitudes, education, exposure and intention were assessed using relative risks based on bivariate analysis of self-reported measures and odds ratios from ordered logistic regression.ResultsThe response rate was 28.7% (436/1517). The majority of residents, 79%, reported never observing or assisting with an abortion during training. Similarly, 80% of residents reported receiving less than 1 hour of formal education on abortion. Residents strongly supported receiving abortion education. Self reported exposure to a single abortion during training was associated with an increase in residents’ intention (RR = 1.95, 95% CI 1.54–2.47) and self-rated competency to provide a medical abortion (RR = 2.16, 95% CI 1.60–2.93). Twenty five percent of residents were unaware of ethical and legal requirements towards abortion provision and referral.ConclusionsCanadian family medicine residents receive little education or exposure to abortion during training most do not feel competent to provide abortion services. Residents expressed strong support for receiving abortion training. The Canadian College of Family Physicians curriculum does not currently include abortion as a training objective. The authors argue there is a need for family medicine training programs to increase education and exposure to abortion during residency, while respecting residents’ rights to opt out of such training. Failure to do so may impair future access to abortion provision.

Training in youth-friendly service provision improves nurses' competency level in the Great Lakes Region.

This survey investigates whether relevant training and availability of guidelines improve self-reported competencies of nurses in the provision of youth-friendly sexual and reproductive health services in South-Kivu Province in the Democratic Republic of the Congo, Burundi, and Rwanda. A quantitative baseline survey was conducted among nurses in randomly selected health facilities. Nurses providing youth-friendly sexual and reproductive health services were asked to self-rate their competencies with regards to technical knowledge, clinical, and communication skills. In South-Kivu, Burundi, and Rwanda, 135, 131, and 99 nurses were interviewed, respectively. Overall differences of service and guideline availability and self-rated competencies can be observed between the three countries. In two countries, more than one in five nurses considered themselves to be only somewhat or not confident to counsel young people. Nurses from Rwanda showed the highest level of competencies followed by Burundi and South-Kivu. Lack of training in youth-friendly health services or family planning showed significant associations with reporting feeling somehow or not competent. The lack of training, supervision, and guidelines expressed by the nurses is of great concern. Competency-based training in youth-friendly health services is an important approach in improving nurses' competency level.

Well-being of nursing staff on specialized units for older patients with combined care needs.

Working in long-term care is seen as a stressful, physically and mentally demanding occupation, and thus, nursing staff are at risk for work and stress-related diseases. In older patients, psychiatric illnesses often occur in combination with physical illnesses, requiring nursing care that is specific to these combined care needs. The impact of caring for these patients on the mental well-being of nurses is unknown. Nursing staff working on specialized units for patients with combined care needs experience high levels of self-efficacy in combination with strong feelings of self-rated competence. Although levels of burnout are relatively low, mental healthcare nursing staff is more at risk for burnout when working in specialized settings for patients with combined care needs than nursing home staff working in specialized settings for these patients. Nursing staff characteristics, such as years of working experience and age, seem more important in relation to staff well-being than patient characteristics in specialized settings for combined care needs. Staff well-being might benefit from specializing care, so that patients with similar care needs are placed together and care is focused. The presence of specialized care units for older patients with combined care needs can allow for both targeted and focused allocation of nursing staff to these units and provision of specific training. Introduction In older patients, psychiatric illnesses frequently exist in tandem with physical illnesses, requiring nursing care that is specific to these combined care needs. The impact of caring for these patients on the mental well-being of nursing staff is unknown. To investigate whether care characteristics of patients with combined care needs are related to the mental well-being of nursing staff. Well-being of nursing staff was studied within a larger exploratory observational cross-sectional study that examined the differences and similarities of specialized combined care units in Dutch mental healthcare and nursing home settings. Nursing staff across settings, with more than 5years of work experience, felt competent in caring for patients with combined care needs. No significant effects of care characteristics of patients with combined care needs on the work-related well-being of nursing staff were shown. Both mental health nursing staff and older employees, however, were found to be more at risk for burnout. Staff well-being might benefit from placing patients with combined care needs together, so care is focused. The presence of specialized care units can allow for both targeted and focused allocation of nursing staff to these units and provision of specific training.

An evaluation of classroom-based cognitive behaviour therapy teaching for first-year clinical psychology trainees

This study evaluated CBT teaching on a clinical psychology programme by exploring changes in trainees’ knowledge and self-rated competency. Improvements in CBT knowledge and perceived skills occurred across the first year of training, which trainees attributed to classroom-based teaching.

Trauma Providers' Knowledge, Views, and Practice of Trauma-Informed Care.

Trauma-informed interventions have been implemented in various settings, but trauma-informed care (TIC) has not been widely incorporated into the treatment of adult patients with traumatic injuries. The purpose of this study was to examine health care provider knowledge, attitudes, practices, competence, and perceived barriers to implementation of TIC. This cross-sectional study used an anonymous web-based survey to assess attitudes, knowledge, perceived competence, and practice of TIC among trauma providers from an urban academic medical center with a regional resource trauma center. Providers (nurses, physicians, therapists [physical, occupational, respiratory]) working in trauma resuscitation, trauma critical care, and trauma care units were recruited. Descriptive statistics summarized knowledge, attitudes, practice, competence, and perceived barriers to TIC and logistic regression analyses examined factors predicting the use of TIC in practice. Of 147 participants, the majority were nurses (65%), followed by therapists (18%) and physicians (17%), with a median 3 years of experience; 75% answered the knowledge items correctly and 89% held favorable opinions about TIC. Nineteen percent rated themselves as less than "somewhat competent." All participants rated the following as significant barriers to providing basic TIC: time constraints, need of training, confusing information about TIC, and worry about retraumatizing patients. Self-rated competence was the most consistent predictor of providers' reported use of specific TIC practices. Despite some variability, providers were generally knowledgeable and held favorable views toward incorporating TIC into their practice. TIC training for trauma providers is needed and should aim to build providers' perceived competence in providing TIC.

The Times They Are A-Changin': Knowledge and Perceptions Regarding Medical Cannabis in an Academic Family Medicine Department.

The United States has seen an evolving perspective on the medical use of cannabis in recent years. Although a majority of states have enacted medical cannabis programs, physicians practicing in these states report a lack of knowledge, lingering concerns, and a need for more training regarding medical cannabis. This study provides a current snapshot of medical cannabis education in an academic family medicine department in a state with a medical cannabis program. An electronic survey was sent to all 134 faculty physicians and residents within a family medicine department to assess current knowledge and attitudes regarding medical cannabis. Study authors performed descriptive statistical analysis of the survey data. Of the 61 individuals to complete the survey, 34 were residents and 27 were faculty. Overall, respondents displayed poor understanding of the state's medical cannabis program as well as cannabis regulations. A majority of both faculty and residents reported low self-rated competency levels for medical cannabis efficacy, adverse effects, and safety using Likert scales (1 to 5; 1=low competency, 5=high competency). A majority of faculty (56%) expressed that they did not intend to certify patients for medical cannabis compared to only 33% of residents. Residents were statistically more likely to think of a patient who might benefit from medical cannabis compared to faculty (39% vs 11%, P=.004, chi-square). Increasingly, family physicians will be called on to provide informed patient counseling regarding medical cannabis. These results highlight a knowledge gap for family medicine learners in a changing practice landscape.

Perceptions of the impact of an advanced training programme on the management skills of health professionals in Gauteng, South Africa

Background. South Africa’s health sector spans the private and the public sectors. Within the sectors, health managers take on strategic leadership roles without formal training in management or leadership – a trend more common in the public sector than the private sector. Health managers are selected based on their clinical skills rather than their leadership or management skills. Objective. To compare self-rated competencies in management and leadership before and after training of the participants; to assess participants’ experience of the training programme; and to evaluate the management and leadership skills of the participants after training. Methods. A cross-sectional, descriptive analytical method and 360° interviewing were used in this study. Participants were evaluated ~18 months after completion of the training programme. A 360° evaluation (360° E) of six of the 12 leadership/management competencies was done with the supervisors, colleagues, and subordinates of the participants. Results. All participants rated themselves as improved in 12 managerial and leadership competencies. The 360° E affirmed five of these competencies as improved, with the ability to create and implement a marketing plan rating poorly. Conclusion. Training in management leads to improvement in both leadership and managerial skills of health professionals.

Self-Assessment of Skills and Competencies among Residents Participating in a Pediatric Hospice and Palliative Medicine Elective Rotation.

To describe our institutional experience with a four-week pediatric HPM elective rotation and its impact on residents' self-rated competencies. In the spirit of bolstering primary hospice and palliative medicine (HPM) skills of all pediatricians, it is unclear how best to teach pediatric HPM. An elective rotation during residency may serve this need. An anonymous online survey was distributed to pediatric and internal medicine/pediatrics residents at a single, tertiary academic children's hospital. Respondents were asked to rate education, experience, and comfort with five aspects of communication with families of children with terminal illnesses and six domains of managing the symptoms of terminal illnesses. Self-ratings were recorded on a 1-5 scale: none, minimal, moderate, good, or excellent. Demographic data, including details of training and prior HPM training, were collected. Respondents completed a set of six questions gauging their attitude toward palliative care in general and at the study institution specifically. All respondents desire more HPM training. Those residents who self-selected to complete a pediatric HPM elective rotation had significantly higher self-ratings in 10 of 11 competency/skill domains. Free-text comments expressed concern about reliance on the specialty HPM team. A pediatric HPM elective can significantly increase residents' self-rated competency. Such rotations are an under-realized opportunity in developing the primary HPM skills of pediatricians, but wider adoption is restricted by the limited availability of pediatric HPM rotations and limited elective time during training.

The relationship between intolerance of uncertainty in chiropractic students and their treatment intervention choices

BackgroundPsychological factors, such as intolerance of uncertainty (IU), have been shown to impact on the quality of medical care. However, this psychological measure has not been studied in the chiropractic profession. Our objective was to investigate if higher levels of IU in chiropractic students were related to poor choices of management in specific clinical scenarios. Also, we sought to investigate if levels of IU were related to students’ intentions to adopt a prescriptive chiropractic technique system and evaluate their levels of self-belief.MethodBetween October and November of 2016, students from two Australian chiropractic programs (N = 444) answered a questionnaire on measures of IU levels, patient case scenarios for neck and low back pain, and questions about self-ratings of their future chiropractic abilities and perceived need for the adoption of a chiropractic technique system. Associations were tested by the IU score and the therapeutic choices relating to a) a neck pain case scenario, b) a low back pain scenario, c) various technique systems, and d) the self-rated competence level treating the IU score both as a continuous and a categorical variable.ResultsThere was an overall response rate of 53%. Those students who were high in levels of IU were significantly more likely to make incorrect clinical decisions than those with normal or low levels of IU for the neck pain case scenario. No differences were found on the low back pain scenario, on preferences to use a technique system in the future, or on predicted self-rating of competence after graduation.ConclusionsPsychological factors, such as IU, may have an impact on chiropractic students’ clinical decisions. However, it does not impact on all aspects of practice. This finding has implications for chiropractic educators, especially when dealing with neck pain. However, it may be relevant to continue the search for specific personality profiles in relation to various favourable and unfavourable practice patterns, as it is unknown whether these dynamics are important for other aspects of chiropractic education.

Understanding the current state of infection preventionists through competency, role, and activity self-assessment

The Association for Professionals in Infection Control and Epidemiology (APIC) MegaSurvey, administered in 2015, was completed by approximately 4,079 APIC members. The survey sought to gain a better understanding the current state of 4 components of infection prevention practice: demographic characteristics, compensation, organizational structure, and practice and competency. The data for this analysis come from the APIC MegaSurvey Practice and Competency domain. Descriptive statistics and χ2 analyses were conducted to examine differences in infection preventionist (IP) competency, roles, and activity self-assessments. The majority of IPs self-assessed their competency as Proficient compared with Novice or Expert for each of the 8 IP core competency activities. Forty percent of IPs self-rated their competency as Expert in the Preventing/Controlling the Transmission of Infectious Agents/HAIs component. IPs reported Novice competency in Employee/Occupational Health (29%); Cleaning, Sterilization, Disinfection, and Asepsis (23%); and Education and Research categories (22%). Differences in self-rated competency among IPs by discipline type (public health, nurse, and laboratory) were identified. Differences in self-rated competency were identified for each of the 8 IP core competency activities. IPs report using various resource types to gain competency. Future research is needed to identify opportunities to increase competency levels in the weakest-rated competency activities.

Self-Reported Driving Difficulty in Veterans With Traumatic Brain Injury: Its Central Role in Psychological Well-Being

The ability to drive is a core function supporting independent living. Traumatic brain injury (TBI) may impair driving capacity in numerous ways. Previous research has documented that individuals with TBI have more driving-related problems than other people and has identified predictors of driving status or capacity, mostly among civilians; however, no research has examined the implications of driving limitations for the well-being of individuals with TBI. To examine the association between self-reported difficulty in driving with important domains of psychological well-being in veterans with TBI, with adjustment for posttraumatic stress disorder (PTSD) and years since most recent TBI. Cross-sectional. Veterans' homes. A total of 61 veterans of the Global Wars on Terrorism diagnosed with TBI, all outpatients at a Veterans Affairs medical center rehabilitation service. Home interviews as a baseline assessment for a larger randomized controlled trial. Community reintegration (extent of social participation), depressive symptomatology, and role limitations due to physical health problems and those due to emotional problems. Self-rated competence in driving was the predictor, and sociodemographic characteristics, diagnosis of PTSD, severity of TBI, and time since most recent TBI were covariates. Self-rated driving difficulty was associated with decreased community reintegration (β = .280, P =.028), greater depressive symptomatology (β = -.402, P < .001), and greater role limitations due to physical problems (β = -.312, P =.011) and to emotional problems (β = -.324, P = .006), after we adjusted for PTSD and other variables. The self-reported ability to drive seems to be central to psychological well-being in veterans with TBI, showing clear associations with depression, community reintegration, and health-related role limitations. These associations cannot be attributed to comorbid PTSD. Rehabilitation specialists should view driving difficulty as a risk factor for poor psychosocial outcomes in veterans with TBI and seek ways to compensate for the veteran's loss of driving if it is no longer advisable. II.

Reduction of Neonatal Mortality Requires Strengthening of the Health System: A Situational Analysis of Neonatal Care Services in Ballabgarh.

Planning a comprehensive program addressing neonatal mortality will require a detailed situational analysis of available neonatal-specific health infrastructure. We identified facilities providing essential and sick neonatal care (ENC, SNC) by a snowballing technique in Ballabgarh Block. These were assessed for infrastructure, human resource and equipment along with self-rated competency of the staff and compared with facility-based or population-based norms. A total of 35 facilities providing ENC and 10 facilities for SNC were identified. ENC services were largely in the public-sector domain (68.5% of births) and were well distributed in the block. SNC burden was largely being borne by the private sector (66% of admissions), which was urban-based. The private sector and nurses reported lower competency especially for SNC. Only 53.9% of government facilities and 17.5% of private facilities had a fully equipped newborn care corner. Serious efforts to reduce neonatal mortality would require major capacity strengthening of the health system, including that of the private sector.

Social Work Involvement in Advance Care Planning: Findings from a Large Survey of Social Workers in Hospice and Palliative Care Settings.

Few data are available describing the involvement and activities of social workers in advance care planning (ACP). We sought to provide data about (1) social worker involvement and leadership in ACP conversations with patients and families; and (2) the extent of functions and activities when these discussions occur. We conducted a large web-based survey of social workers employed in hospice, palliative care, and related settings to explore their role, participation, and self-rated competency in facilitating ACP discussions. Respondents were recruited through the Social Work Hospice and Palliative Care Network and the National Hospice and Palliative Care Organization. Descriptive analyses were conducted on the full sample of respondents (N = 641) and a subsample of clinical social workers (N = 456). Responses were analyzed to explore differences in ACP involvement by practice setting. Most clinical social workers (96%) reported that social workers in their department are conducting ACP discussions with patients/families. Majorities also participate in, and lead, ACP discussions (69% and 60%, respectively). Most respondents report that social workers are responsible for educating patients/families about ACP options (80%) and are the team members responsible for documenting ACP (68%). Compared with other settings, oncology and inpatient palliative care social workers were less likely to be responsible for ensuring that patients/families are informed of ACP options and documenting ACP preferences. Social workers are prominently involved in facilitating, leading, and documenting ACP discussions. Policy-makers, administrators, and providers should incorporate the vital contributions of social work professionals in policies and programs supporting ACP.

Do Doctors Gain More Confidence from a Longer Palliative Medicine Posting?

Doctors report inadequate training and lack confidence in providing palliative care. Although palliative care training improves self-assessed competence, it is not known whether the duration of a palliative medicine (PM) posting affects the extent of improvement in confidence. The aim of this study was to determine whether the duration of a PM posting affects the extent of improvement in doctors' confidence in various aspects of palliative care. This was a retrospective study analyzing doctors' self-rated competence level in different aspects of palliative care at the start and end of a PM posting. The change in scores was analyzed to determine the extent of improvement corresponding to the length of the posting. Seventy-one residents and medical officers participated in the study, which was conducted in a hospital-based palliative care consultative service. Participants reported low baseline self-rated competence in palliative care. A longer posting duration resulted in a greater improvement in the doctors' confidence across different domains of palliative care, particularly in end-of-life communication. A one-month posting may suffice in training a doctor in basic end-of-life medical issues, but a longer posting duration results in a greater improvement in the doctors' confidence across different domains of palliative care, particularly in end-of-life communication. Trainee doctors in specialties that frequently deal with terminally ill patients should undertake a longer posting in PM to be further equipped with greater confidence to better care for these patients.

Self-reported competencies related to end of life care among residents and attending physicians

This article was migrated. The article was not marked as recommended. AimsResearch with residents demonstrates perceptions of insufficient skills and comfort with end of life (EOL) care, and there is a paucity of evidence regarding attending physicians' competencies in such care. The purpose of this study was to gain an understanding of self-reported competencies among medical school graduates and to assess the impact of a 3rd year hospice rotation.MethodsAn online survey was sent to 510 medical school alumni assessing experiences, self-rated competencies and preparedness regarding EOL care, and perceptions of the hospice rotation. Analyses explored a range of possible variable associations.Results116 surveys were completed. EOL care experience was substantial during undergraduate and residency training. More experience was predictive of greater skills and comfort. Pain management skills were rated lower than other skills. Completion of the hospice rotation was associated with confidence-building and perceptions of preparedness. Attending physicians did not report stronger skills than residents. There was strong support for training in EOL care.ConclusionsOur findings support previous research about the benefits of EOL care experiences for residents and exposure to such care during undergraduate training, underscoring the importance of well-tailored EOL care education at all levels of training for optimal development of competencies.

Changes in Caregiver Knowledge and Perceived Competency Following Group Education about Sensory Processing Disturbances: An Exploratory Study.

Parents or teachers (n = 10) of children diagnosed on the autism spectrum and exhibiting sensory processing disorders (SPD) attended a series of six weekly educational sessions designed to increase the participants' knowledge of SPD, skills in interacting with children exhibiting SPD and confidence in intervening with children exhibiting undesirable behaviours stemming from SPD. The sessions consisted of group classroom instruction with instructional methods including PowerPoint-assisted lecture/discussion and short video clips. Pre-test and post-test assessment was made of the participants' (a) self-perceived knowledge of sensory processing concepts; (b) actual knowledge of sensory processing concepts; and (c) self-rated competency for dealing with children exhibiting behaviours related to SPD. Statistical analysis revealed significant gains were achieved on all measures. The results were interpreted as indicating that group classroom instruction is an effective means of increasing such caregivers' self-perceived knowledge of sensory processing concepts, actual knowledge of sensory processing concepts and self-rated competency for dealing with children exhibiting behaviours related to SPD. Future research to assess the short-term and long-term impacts of these gains and to gauge the relative effectiveness of various contents for such sessions is recommended. Copyright © 2016 John Wiley & Sons, Ltd.