Stakeholder Review Research Articles

Incorporation of Trauma-Informed Care Into Entrustable Professional Activities for Medical Student Assessment.

Trauma-informed care (TIC) provides a medical framework for addressing and mitigating the negative consequences of trauma. In response to student and faculty advocacy, medical schools are developing trauma-informed curricular content. However, medical education literature does not present a comprehensive assessment rubric to evaluate medical students' acquisition of trauma-informed clinical skills. A committee of medical students, trainees, and faculty developed a longitudinal TIC curricular theme at Harvard Medical School (HMS). Guided by the National Collaborative on Trauma-Informed Health Care Education and Research competencies, the committee created a set of medical student TIC competencies from July to December 2019. From November 2021 to November 2022, 3 committee subgroups generated new TIC descriptors for each HMS entrustable professional activity (EPA), then circulated these to other subgroups, external experts, and stakeholders for review and feedback. From April to June 2023, the committee iteratively reviewed the materials until reaching consensus for content and pedagogy. The committee integrated TIC content into HMS's existing EPAs expected of students, provided anchoring descriptions of each level, and achieved consensus using a process of iterative review with TIC content experts. The committee identified 10 TIC competencies and revised all 13 general HMS EPAs to include specific items based on these competencies. The committee incorporated at least 1 trauma-informed competency into each HMS EPA. This novel set of HMS EPAs provides a framework for assessment of TIC clinical skills. Faculty will be trained to correctly and reliably incorporate TIC competencies into patient care and to use the TIC-inclusive EPAs for student assessment, ensuring that TIC is standard medical practice at HMS. This work may facilitate the adoption of trauma-inclusive EPAs by other institutions to educate the next generation of physicians to practice TIC and thus promote a more accessible, safe, and equitable health care system.

Implications of the Nigerian Broadcasting Code on Broadcast Copyright and Competition

Abstract The National Broadcasting Commission (NBC) in Nigeria recently released an amendment to the 6th edition of the Broadcasting Code. Its aim is to increase local content, generate advertisement revenue and prevent anti-competitive practices in the Nigerian broadcast industry. To this end, it prevents exclusivity or monopolisation of content by broadcasting organisations, including Pay TV and Video on Demand (VOD) platforms. Drawing from European and South African experiences, this article begins by examining the provisions of the Broadcasting Code, particularly the amendment vis-à-vis the Nigerian Copyright Act and Nigeria’s international obligations under treaties such as the Rome Convention and the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS Agreement). It then looks at the impact of the amended Code on the broadcast industry. The article seeks to determine whether the provisions of the amended Code can qualify as limitations and exceptions to exclusive rights allowed under the treaties and the Nigerian Copyright Act. It also examines whether, in attempting to foster competition in the Nigerian broadcast industry, the amended Code has taken away the exclusive rights granted by the Copyright Act to owners of Pay TV and VOD platforms and thereby runs contrary to Nigeria’s international obligations. Where appropriate, recommendations are made for consultation among relevant stakeholders for review of the amended Code to align it with the Copyright Act and Nigeria’s international obligations.

Abstract 237: Curriculum Development of Pitt Bystander Response Education: Developing "Caring Leaders" Through Early Exposure to Cpr Fundamentals

Introduction: Fewer than 25% of US adults feel trained in bystander CPR (bCPR). Barriers include the lack of social acceptance of bCPR, poor understanding of Good Samaritan laws, and inadequate knowledge of the steps needed to help a patient suffering out-of-hospital cardiac arrest. Hypothesis: We developed a novel, streamlined curriculum for children ages 11-13 to introduce the principles of bCPR and frame it as a shared social responsibility, hoping to increase bystander response and motivate young citizens to seek future CPR certification. Methods: The curriculum development process employed the Assess Design Develop Implement Evaluate (ADDIE) method of the Instructional System Design (ISD) model. We used an iterative approach where the novel curriculum was developed and then presented to stakeholders for review, editing and revision. Stakeholders included experts in CPR training, educational theory and elementary/middle school education. Pre- and post- survey tools were designed to evaluate curriculum outcomes, using the same process. Upon completing the iterative review, the curriculum and surveys were prepared for a pilot implementation in a middle school setting. Results: Using the ISD approach, we consulted with 9 experts to design the CPR curriculum. Three curriculum goals were identified: awareness, social responsibility and training. The novel curriculum will meet these goals through a single 50 minute in-class session of didactic, technique demonstration of compression-only CPR, and hands-on practice with manikins. Due to the present global pandemic, the curriculum has not yet been implemented as planned. Current efforts are being made to determine the feasibility of potential future implementation of the program and/or virtual options due to need for social distancing. Conclusions: An iterative process can be used to bring together multiple stakeholders to design a novel, age appropriate CPR training curriculum. Another round of stakeholder review of the curriculum is planned post piloting prior to wider dissemination.

Characteristics of stakeholder involvement in systematic and rapid reviews: a methodological review in the area of health services research

ObjectiveEngaging stakeholders in reviews is considered to generate more relevant evidence and to facilitate dissemination and use. As little is known about stakeholder involvement, we assessed the characteristics of their...

Development of the ACTIVE framework to describe stakeholder involvement in systematic reviews.

Objectives Involvement of patients, health professionals, and the wider public (‘stakeholders’) is seen to be beneficial to the quality, relevance and impact of research and may enhance the usefulness and uptake of systematic reviews. However, there is a lack of evidence and resources to guide researchers in how to actively involve stakeholders in systematic reviews. In this paper, we report the development of the ACTIVE framework to describe how stakeholders are involved in systematic reviews. Methods We developed a framework using methods previously described in the development of conceptual frameworks relating to other areas of public involvement, including: literature searching, data extraction, analysis, and categorization. A draft ACTIVE framework was developed and then refined after presentation at a conference workshop, before being applied to a subset of 32 systematic reviews. Data extracted from these systematic reviews, identified in a systematic scoping review, were categorized against pre-defined constructs, including: who was involved, how stakeholders were recruited, the mode of involvement, at what stage there was involvement and the level of control or influence. Results The final ACTIVE framework described whether patients, carers and/or families, and/or other stakeholders (including health professionals, health decision makers and funders) were involved. We defined: recruitment as either open or closed; the approach to involvement as either one-time, continuous or combined; and the method of involvement as either direct or indirect. The stage of involvement in reviews was defined using the Cochrane Ecosystem stages of a review. The level of control or influence was defined according to the roles and activities of stakeholders in the review process, and described as the ACTIVE continuum of involvement. Conclusions The ACTIVE framework provides a structure with which to describe key components of stakeholder involvement within a systematic review, and we have used this to summarize how stakeholders have been involved in a subset of varied systematic reviews. The ACTIVE continuum of involvement provides a new model that uses tasks and roles to detail the level of stakeholder involvement. This work has contributed to the development of learning resources aimed at supporting systematic review authors and editors to involve stakeholders in their systematic reviews. The ACTIVE framework may support the decision-making of systematic review authors in planning how to involve stakeholders in future reviews.

Revisiting the need for a literature search narrative: A brief methodological note.

In this method note, we question if the primary search strategy in a systematic review should be accompanied by a search narrative. A search narrative could offer a conceptual and contextual report on the search strategy, which we suggest might benefit the peer review of literature searches and increase engagement with, and discussion of, the literature search strategy from review stakeholders, topic experts, and lay users of research. Search narratives would also increase the transparency of decision-making in literature searching.

Geodesign application for bio-swale design: rule-based approach stormwater management for Ottawa Street North in Hamilton, Ontario

ABSTRACTWith increases in storm frequency and intensity, municipalities are finding new ways of managing stormwater. Solutions require collaboration across planning disciplines and input from an informed public. This study compares a system of bioswales to existing curb and gutter infrastructure in a post-industrial streetscape of Hamilton, Ontario. Using the geodesign process, a section of Ottawa St. North was modelled to show how green infrastructure can ease the burden on aging, combined sewer systems. Qualitative data was gathered from residents of the neighbourhood through field notes, and quantitative geospatial data through GIS. Parametric modelling was used to generate a design, and scenarios created to show resulting impacts on stormwater run-off. The model was posted online as an interactive presentation, accessible to all stakeholders for review and comment. The results of the study demonstrate powerful new tools that can assist landscape architects in designing, collaborating and communicating stormwater strategies.

Monitoring the Situation: Implementation of a Patient Information Monitor in a Radiation Therapy Department Waiting Room

The waiting room experience can drive patient satisfaction and affect outlook on encounters with healthcare professionals and quality of care. Patient education initiatives in waiting areas can improve overall patient experience in the primary care setting. A recent survey conducted in the radiation therapy department of a large metropolitan cancer centre revealed patients and their families were dissatisfied with the waiting room experience. Patients reported a lack of distraction and a desire for more information on available resources. The aim of this initiative was to evaluate the impact of a patient information monitor on the experience of patients and families visiting the radiation therapy department at our centre. This initiative was executed by a pre-existing patient experience working group with representation from different areas within the department including administration, treatment delivery, specialty areas, research and education. A brainstorming session was held and five categories of content were identified: 1) Organizational Information (e.g. parking services), 2) Resources Available (e.g. family and supportive services), 3) Trivia and Random Facts, 4) Brain Teasers, and 5) Scenic Photos. Categories were assigned to group members for content development. Template pages were created using Microsoft PowerPoint™ to ensure consistency and uniformity of content presentation. Where possible, information from existing patient education and information materials was used verbatim. To avoid repetition during a patient visit, a minimum of one hour of content was required, with each page of content displayed for 30 seconds for a total of 120 pages. Sample pages were sent to various stakeholders for review, including patient education experts, patient representatives and interprofessional groups. Once the monitor was on display, 50 patients and caregivers were approached for their reaction and feedback on the content. Development and upload of content is labour intensive. This is compounded by the volume of content required to reduce repetition. Additionally, content needs to be reviewed periodically to ensure information is accurate and up-to-date. Currently, there is a single monitor positioned in the middle of the radiation therapy waiting area. Only 21 of the 50 individuals approached for feedback had noticed the monitor. However, 29% (6/21) of patients that noticed the monitor found the Organizational and Resource content informative and helpful while 48% (10/21) enjoyed the distraction provided by the Scenic Photos, Trivia and Brain Teasers. The experience of patients and families in the radiation therapy waiting room is an important component of overall patient experience in our department. In the radiation therapy department, the patient information monitor serves as an easily accessible source of information and distraction for our patients and families. In the future, additional monitors in different locations could increase the number of individuals that benefit from this initiative.

Engaging Stakeholders in Review and Recommendations for Models of Outcome Monitoring for Substance Abuse Treatment

We present an example of a collaborative process designed to review models of outcome monitoring for substance abuse services, with a view to assessing the feasibility of different approaches in Ontario, Canada. A conceptual framework that describes the parameters of an outcome monitoring system and four models of outcome monitoring were identified. Consultations were held with stakeholders (managers, directors, researchers, clinicians, and governmental representatives) about the types of information they would like to obtain from an outcome monitoring system. Our process is useful as a model for collaborative research with respect to performance measurement. The study's implications and limitations are noted.

Involving program stakeholders in reviews of evaluators’ recommendations for program revisions

Why is the use of stakeholder expertise a sound rationale for involving program staff and beneficiaries in reviewing evaluators’ recommendations for program revisions? What procedures might evaluators use for involving these stakeholders in this task? What can we conclude about the likely success of these procedures? This article seeks to address these questions. In the context of educational program evaluation, some of the theoretical and practical issues about the participation of stakeholders in reviewing recommendations are discussed. The participation of program stakeholders for the purpose of tapping their expertise is explained; a recent evaluation, in which program stakeholders reviewed evaluators’ recommendations for program revisions, is described; and the implications of the article for stakeholder-based evaluation and practical participatory evaluation are presented.