Small Group Training Research Articles

Librarian-Led Information Literacy Training Delivered in Small Groups Improved Medical Students’ Confidence in Their Ability to Use Evidence Based Resources Effectively

A Review of:
 McClurg, C., Powelson, S., Lang, E., Aghajafari, F., & Edworthy, S. (2015). Evaluating effectiveness of small group information literacy instruction for Undergraduate Medical Education students using a pre- and post-survey study design. Health Information & Libraries Journal. 32(2), 120-130. http://doi.org/10.1111/hir.12098 
 
 Abstract
 
 Objective – To assess the effectiveness of librarian-led small group information literacy sessions, which were integrated into the second year of a three-year undergraduate medical course.
 
 Design – A pre- and post-intervention survey questionnaire.
 
 Setting – A large university in Canada.
 
 Subjects – A cohort of 160 second year undergraduate medical students enrolled in the three-year programme of a large university in Canada.
 
 Methods – As part of the redevelopment of the undergraduate three-year medical course, information literacy skills in evidence based medicine were integrated into the seminar and small group teaching programme. Every week for five weeks, 3 librarians each visited 4 small groups of 15 students to deliver a 15-minute session as part of a 2-hour long seminar led by practising physicians. The sessions did not include a formal hands-on component, however, students were encouraged to try out searches on their own devices. Each 15-minute session covered 3 learning objectives, including how to use PubMed clinical queries, how to use MeSH, and how to search for systematic reviews and guidelines.
 A pre- and post-intervention survey design was used to assess students’ perceptions of the impact of these sessions. The students were asked to complete an online Survey Monkey survey before and after the five week lecture block. The questions covered resource selection, perception of barriers to finding evidence based information, and the students’ confidence in using evidence based resources. The data were analysed descriptively.
 
 Main results – The pre-survey achieved a 90% (144/160) response rate while the post-survey achieved a 75% (112/160) response rate. The post-survey indicated an increase in the likelihood that students would use Ovid MEDLINE, carry out a literature search, and consult a librarian, with a decrease in those who would consult a print or online textbook. There was limited change in the students’ confidence that they could find answers quickly, but more of an increase in the proportion of students who were confident they could find systematic reviews and guidelines, and use search limits, PICO, and MeSH. Before the intervention, “knowing where to search,” devising a search strategy, and retrieving too many results were all thought to be obstacles by the students. After the small group training, students considered these issues less of a problem. 
 
 The post-survey also included an opportunity for the students to comment on their experience with the programme overall. Of the 54 responses received, 34 identified the library component as being the most important thing they had learned in the small group part of the course. 
 
 Conclusion – The authors conclude that integrating information literacy into the undergraduate curriculum as part of the small group seminar series is effective. They suggest future directions for research, such as a study to assess the impact of the training on specific skills rather than student confidence and evaluations of other teaching methods.

Pharmacist Behavior Changes Following a Medication Counseling Training Program Targeting Teach-Back and Plain Language

Purpose: To evaluate whether active learning-based training in teach-back and plain language (TBPL) techniques can lead to observable changes to patient-centered practices in pharmacist-patient counseling.
 Methods: All pharmacists in direct patient care roles, inpatient and outpatient, were required to complete a didactic module and a workshop / webinar or small group training. The workshop / webinar and small group modalities incorporated elements of adult education theory. Following completion, pharmacists were surveyed to assess their ability, confidence and commitment to incorporating TBPL techniques into practice. Evaluation of pharmacist-patient counseling was completed pre- and post- training through direct observation. Student pharmacists were trained to evaluate pharmacists’ consultations on patients with ≥2 new medications. Students recorded completeness rates for 39 communication techniques.
 Results: One-hundred and eighteen pharmacists completed the TBPL training program and 59 pharmacists completed an evaluation. A total of 84 direct observations were completed (40 pre-training and 44 post-training). Skills improved included: using plain language (p
 Conclusion: Implementing a TBPL training program improved observable pharmacist-patient consultation skills. This approach is replicable and could be utilized as a model for other competencies.
 
 Type: Original Research

Use of office spirometers in Flemish general practice: results of a telephone survey

While office spirometry is seen as potentially useful and feasible in general practice, little is known about its use in Flemish general practice. Our aim was to describe the use of spirometers by Flemish GPs, characteristics of their spirometry practice, training needs and preferences, and attitudes towards office spirometry. A telephone survey was set up in a random sample of Flemish GPs. Interviews were carried out by a GP researcher using a structured piloted questionnaire. 197 out of 243 eligible GPs (81%) were interviewed. Most GPs (66%) had never used an office spirometer, 17.3% were using one and 16.7% stopped using one. Time constraints (54%) and insufficient knowledge and skills (27%) were the main reasons for not using an office spirometer (any longer). GPs particularly used their spirometer to diagnose COPD and asthma, and less frequently in follow-up. GPs (67.9%), especially current users (91.2%), considered spirometry as a GP task. Spirometry training should be provided (86%) and spirometry by GPs should be reimbursed (79.5%). More information on spirometry would be very useful (62.3%), with a marked preference for training in small groups (86.8%). Although office spirometry is not widespread in Flemish general practice, GPs show an undoubted interest in it. They need educational and financial support to overcome prevailing barriers in establishing office spirometry on a routine basis.

VitalTalk: Intensive Small Group Training—Addressing Goals of Care (P02)

VitalTalk: Intensive Small Group Training—Addressing Goals of Care (P02)

Implementing guidelines to routinely prevent chronic vascular disease in primary care: the Preventive Evidence into Practice cluster randomised controlled trial

ObjectiveTo evaluate an intervention to improve implementation of guidelines for the prevention of chronic vascular disease.Setting32 urban general practices in 4 Australian states.RandomisationStratified randomisation of practices.Participants122 general practitioners (GPs) and...

Teaching telehealth consultation skills.

Although teleconsultations have been used for many years in Australia, there has been a recent increase following new government incentives. There is a paucity of literature on enabling medical students to acquire the relevant skills. With a focus on equipping students for practice in rural and remote areas, our medical school has developed an innovative clinical skills lesson to prepare our students for their rural practice placements. This lesson was delivered to all students in their third year of training in small groups to enable interactive learning. The objectives of the lesson were to familiarise students with: the various methods of conducting teleconsultations currently in use; the legal and ethical considerations; the technical and procedural issues; and the barriers and benefits for patients and doctors. Students rotated through four different stations over 2 hours and the lesson was evaluated using a student survey. Medical students self-reported statistically significant improvements in understanding the issues and procedures, and in confidence in conducting a telehealth consultation. Analysis of the results and student comments demonstrated that students recognise the value of telemedicine learning, and benefit from formal teaching on all aspects of telemedicine, including technology, ethics and protocols. Interestingly, the students found the opportunity to discuss areas such as the ethics of, and barriers to, the use of teleconsultations to be the most challenging and helpful of all of the stations. There is a paucity of literature on enabling medical students to acquire the relevant [teleconsultation] skills.

Prescriber and patient-oriented behavioural interventions to improve use of malaria rapid diagnostic tests in Tanzania: facility-based cluster randomised trial.

BackgroundThe increasing investment in malaria rapid diagnostic tests (RDTs) to differentiate malarial and non-malarial fevers, and an awareness of the need to improve case management of non-malarial fever, indicates an urgent need for high quality evidence on how best to improve prescribers’ practices.MethodsA three-arm stratified cluster-randomised trial was conducted in 36 primary healthcare facilities from September 2010 to March 2012 within two rural districts in northeast Tanzania where malaria transmission has been declining. Interventions were guided by formative mixed-methods research and were introduced in phases. Prescribing staff from all facilities received standard Ministry of Health RDT training. Prescribers from facilities in the health worker (HW) and health worker-patient (HWP) arms further participated in small interactive peer-group training sessions with the HWP additionally receiving clinic posters and patient leaflets. Performance feedback and motivational mobile-phone text messaging (SMS) were added to the HW and HWP arms in later phases. The primary outcome was the proportion of patients with a non-severe, non-malarial illness incorrectly prescribed a (recommended) antimalarial. Secondary outcomes investigated RDT uptake, adherence to results, and antibiotic prescribing.ResultsStandard RDT training reduced pre-trial levels of antimalarial prescribing, which was sustained throughout the trial. Both interventions significantly lowered incorrect prescribing of recommended antimalarials from 8% (749/8,942) in the standard training arm to 2% (250/10,118) in the HW arm (adjusted RD (aRD) 4%; 95% confidence interval (CI) 1% to 6%; P = 0.008) and 2% (184/10,163) in the HWP arm (aRD 4%; 95% CI 1% to 6%; P = 0.005). Small group training and SMS were incrementally effective. There was also a significant reduction in the prescribing of antimalarials to RDT-negatives but no effect on RDT-positives receiving an ACT. Antibiotic prescribing was significantly lower in the HWP arm but had increased in all arms compared with pre-trial levels.ConclusionsSmall group training with SMS was associated with an incremental and sustained improvement in prescriber adherence to RDT results and reducing over-prescribing of antimalarials to close to zero. These interventions may become increasingly important to cope with the wider range of diagnostic and treatment options for patients with acute febrile illness in Africa.Trial registrationClinicalTrials.gov (#NCT01292707) 29 January 2011.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-015-0346-z) contains supplementary material, which is available to authorized users.

Addressing Goals of Care: Intensive Small Group Training (P02)

Addressing Goals of Care: Intensive Small Group Training (P02)

A qualitative study of the anticipated barriers and facilitators to the implementation of a lifestyle intervention in the Dutch construction industry.

BackgroundLifestyle interventions have proven effective for lowering a cardiovascular risk profile by improving lifestyle behaviors, blood glucose and blood cholesterol levels. However, implementation of lifestyle interventions is often met with barriers. This qualitative study sought to determine anticipated barriers and facilitators to the nationwide implementation of an effective lifestyle intervention in the construction industry in the Netherlands.MethodsPrior to implementation, focus groups were held with 8 lifestyle counselors and semi-structured interviews with 20 employees of the construction industry, 4 occupational physicians, 4 medical assistants, and 1 manager of an occupational health service. The transcripts were coded by two coders and analyzed by constant comparison.ResultsHypothetical employee willingness to sign up for the intervention was facilitated by a high level of perceived risk, perceived added value of the intervention, and perceived social support. It was hampered by a preference for independence and perceived interference with their work. All professionals named a lack of time as an anticipated barrier to implementation. Lifestyle counselors suggested several strategies to improve the proficiency of their counseling technique, such as training in small groups and a continuous stream of employee referrals. Occupational physicians thought they would be hampered in screening employees and referring them to a lifestyle counselor by the perception that addressing employee lifestyles was not their task, and by a counter-productive relationship with other stakeholders. The manager addressed financial incentives and a good intervention fit with the current approach of the OHS.ConclusionThe findings suggest that employees can be motivated to sign up for a lifestyle intervention by tailoring the implementation strategy to various subgroups within the target group. Occupational physicians can be motivated to refer employees for the intervention by making a referral personally and professionally rewarding.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-1317) contains supplementary material, which is available to authorized users.

Clinical Reasoning and Improvement in the Quality of Medical Education

Background: “Clinical is the key skill in medical practice, and well beyond mere medical knowledge. However, regarding the current medical school curriculums, little attention has been paid to develop such skills. It might be the reason why diagnostic errors are still the major causes of the patients' harm. Objectives: The purpose of this study was to investigate the effect of teaching clinical reasoning skills (problem-based training in small groups) on improvement of the clinical performance of medical interns. Materials and Methods: This quasi-experimental study was conducted from September 2012 to September 2013. All of the interns entering the Pediatrics Department of Hamadan Medical Faculty (4 three-month courses) were enrolled. Courses were assigned alternately as intervention and control. Interns in the control group had conventional training but for intervention group, a clinical reasoning workshop was held in addition to the conventional education. To assess both groups, the Clinical Reasoning Problem (CRP) test was used as the pretest and posttest. Data were analyzed with t test and paired t test. Results: Out of 62 participants, 30 (48) were in the control group and 32 (52) in the case group. Two groups were similar in baseline characteristics such as age and sex (P > 0.05). There was no significant difference between the scores of the two groups’ pretests (P > 0.05). The mean pretest and posttest scores of the control group had no significant difference (P > 0.05), but comparison of the mean pretest and posttest scores of case group represented significant difference (P < 0.05). Conclusions: Clinical reasoning workshop will probably have a positive impact on upgrading clinical problem-solving skills. © 2014, Shiraz University of Medical Sciences.

Therapeutic Patient Education

Patient education in atopic dermatitis (AD) represents an essential therapeutic tool, which should be offered in addition to routine care, since previous studies have revealed that AD outpatients are often insufficiently treated and show severe limitations of quality of life. Considering the multifactorial pathogenesis of this chronic skin disease, the success of therapeutic patient education seems to depend on the involvement of a multidisciplinary team of professionals. The training program should include aspects on dermatology and allergy, but also on diet and nursing, as well as on disease-specific psychological issues. Synergistic beneficial effects upon interaction between affected patients or parents should be considered by performing the training in small groups. The overall aim of therapeutic patient education in AD should be an improvement of self-management strategies to finally achieve a decrease in disease severity and an increase in quality of life. For children (and their parents) and adolescents with AD, successful programs have already been developed. However, in many countries, there is still a need for official recommendations in order to regulate reimbursement for the costs of such programs. Since the preliminary results from pilot studies in adults have been promising, further large controlled trials on patient education in this age group are needed to finally improve outpatient care also in adulthood AD.

The Effects of Parent Training on Knowledge of Transition Services for Students With Disabilities

This study examined effects of two parent-training approaches to increase knowledge of transition resources by (a) giving parents a brochure describing local transition services or (b) providing the same brochure plus 60 min of small-group training. We randomly assigned parents to groups who completed pre- and posttests on knowledge of transition services. Results indicated posttest scores in the Brochure Plus Training group were higher than the Brochure Only group. The standardized mean difference effect size between groups was 1.6. Following the posttest, parents were asked to contact a transition community service provider described in the brochure, and to await a follow-up phone call from one of the researchers. Thirty-day follow-up data indicated that more Brochure Plus Training parents (64%) than Brochure Only parents (0%) contacted community service providers.

The development of a feeding, swallowing and oral care program using the PRECEDE-PROCEED model in an orphanage-hospital in Guatemala

Purpose: The purpose of this study was to evaluate a long-term on-going international academic service-learning (I-ASL) intervention. Its goal was to improve swallowing, feeding and oral care technique of medical staff in an orphanage in Guatemala to children who are medically complex and have special needs.Method: The PRECEDE-PROCEED model was used as the conceptual framework of the program. Five major target areas were identified during the diagnosis, assessment, implementation and evaluation phases of the model: knowledge and skills, feeding equipment, feeding and oral care technique, positioning and communication. Verbal instruction, modelling and small group training was provided by the research team across all visits. A five-day intervention designed to increase feeders’ knowledge of feeding and oral care technique, signs and symptoms and complications of dysphagia and to improve their feeding, positioning and oral care technique was implemented and evaluated.Result: Statistical analyses showed significant increases in knowledge and appropriate feeding, positioning and oral care technique.Conclusion: As a consequence of the intervention, a trusting and mutually supportive relationship was built between the I-ASL team and the host organization.

G274(P) Simulation Training – Transition from Straight to Pigtail Catheter Chest Drain (PCCD) Insertion

AimsNeonatal trainees are infrequently exposed to chest drain insertion due to reduced working hours and low prevalence of pneumothoraces. Procedure performance assessment during simulation using cadaveric models is more effective...

Addressing Goals of Care: Intensive Small Group Training (P2)

1.Respond empathically to patient's expression of emotion.2.Elicit details about the patient’s values.3.Make a recommendation about the treatment plan that best meets the patient's values. As a palliative care consultant from any professional background, discussing goals of therapy when things are not going well is the most common reason for an inpatient consult. Discussing goals of care is difficult because it requires the consultant to accomplish a number of inter-related, emotional tasks in a short period of time: give bad news, assess what is important to the patient, and make a recommendation about how to best proceed. The core skills helpful to accomplishing these tasks include: Ask-Tell-Ask, responding to emotion, and “wish” statements. This workshop will, using a mix of short didactic talks and experiential practice, help participants develop a model for handling these difficult conversations. This workshop will be unique in that learning will occur predominantly in small groups (one faculty: 8 participants) to allow participants to practice the skills, observe others, and give feedback. The groups will be multidisciplinary, led by faculty with experience in facilitation, and teach skills appropriate for all palliative care clinicians.

Enduring Effect of Cognitive Training in Older Adults

The ACTIVE study was initiated in 1998 to determine whether cognitive training could improve outcomes in 2800 older adults without significant cognitive deficits at baseline. Participants (age, >65; mean age, 74) were randomized to undergo memory training, reasoning training, speed-of-processing training, or no intervention. Training consisted of 10 hour-long small-group training sessions during a 5- to …

Implementing an Audience-Specific Small-Group Gatekeeper Training Program to Respond to Suicide Risk Among College Students: A Case Study

Objective: This case study evaluated the effectiveness of an audience-specific, single-session, small-group interactive gatekeeper training program conducted at a large northeastern public university. Participants: Participants were 335 faculty, staff, and students completing gatekeeper training programs tailored to their group needs. Methods: Baseline assessments of knowledge about suicide, risk factors, resources for assistance, and comfort in intervening with a student in distress were administered to participants prior to the small-group training sessions; posttest assessments of knowledge and comfort in intervening with students in distress were administered upon completion of training and at 3-month follow-up. Results: There was a statistically significant increase in knowledge and comfort upon completion of training for both faculty/staff and student groups, although degradation of training effects at 3-month follow-up was evident. Conclusions: There are benefits associated with the implementation of audience-specific gatekeeper training programs. Booster training sessions to address skill degradation over time are recommended.

Didactic Lecture Versus Interactive Workshop for Continuing Pharmacy Education on Reproductive Health

Pharmacists are routinely providing reproductive health counseling in community pharmacies, but studies have revealed significant deficits in their competencies. Therefore, continuing pharmacy education (CPE) could be utilized as a valuable modality to upgrade pharmacists' capabilities. A randomized controlled trial was designed to compare the efficacy of CPE meetings (lecture based vs. workshop based) on contraception and male sexual dysfunctions. Sixty pharmacists were recruited for each CPE meeting. Small group training using simulated patients was employed in the workshop-based CPE. Study outcomes were declarative/procedural knowledge, attitudes, and satisfaction of the participants. Data were collected pre-CPE, post-CPE, and 2 months afterward and were analyzed using repeated measure analysis of variance and Mann-Whitney U test. Results showed that lecture-based CPE was more successful in improving pharmacists' knowledge post-CPE (p < .001). In contrast, a significant decrease was observed in the lecture-based group at follow-up (p = .002), whereas the workshop-based group maintained their knowledge over time (p = 1.00). Knowledge scores of both groups were significantly higher at follow-up in comparison with pre-CPE (p < .01). No significant differences were observed regarding satisfaction and attitudes scores between groups. In conclusion, an interactive workshop might not be superior to lecture-based training for improving pharmacists' knowledge and attitudes in a 1-day CPE meeting.

Assessing Extension Methods for Improving Livestock Health Care in the Indian Himalayas

Abstract A field study in the western Himalayan foothill region of Uttarakhand found widespread resistance to livestock vaccinations and medications based on a number of misconceptions, including that they would cause miscarriages, reduction in milk yield, reduction in feed consumption, weakness, fibroid formation, or fever. Over a 3-year period, 150 farmers received, free of cost, livestock vaccinations and antiparasite medications along with advice on sanitation and feeding, delivered by using 3 different communication methods. Group 1 received individualized training by a veterinary professional and a youth volunteer, group 2 received small-group training at a central location, and group 3 was exposed to wall posters that advertised a distribution of free medications at a veterinary outreach event where they could also interact with animal health personnel. The intervention that had the greatest impact was the one with the group that received personalized training, which resulted in a 96% vaccination r...

The effect of training in primary health care centers on medical students' clinical skills.

Medical students' effective clinical skills training are an important goal of any medical school. When adequate, graduate doctors will have sufficient skills to consult a patient by taking proper history and conducting appropriate physical examination. The question under scrutiny is the optimal place for providing such training. Since the aim is to graduate general physicians, many literatures highlighted the importance of implementing such training in the primary health care centers. A special clinical skills training program was developed for the Year 4 pre-clerkship medical students of the Arabian Gulf University during the academic year 2011-2012. It was important for these students to acquire certain skills before transferring to the clerkship phase where they deal directly with patients. For the 130 students involved in this study, a self-assessment and clinical exam were conducted at the beginning and end of the program. The study showed that students benefited greatly from this training program with significant differences between their preexisting known skills and clinical skills acquired by the end of the program. Primary care centers are ideal places for optimal training because of small group training setting that is one tutor to two students and of the advantage that students face real patient environment.