Practice Team Research Articles

93 Comparison of physically conditioned and non-conditioned university horses after semester break

It is not uncommon for horses to receive breaks from riding that may last as long as several months. During this time of disuse, horses are likely to receive pasture turn-out while not being ridden. This pattern of cyclical work is especially common for horses used in university riding programs. This study aimed to evaluate fitness of physically conditioned and non-conditioned university horses after a semester break, hypothesizing that non-conditioned horses would have a lower level of fitness, resulting in higher resting heart rates and lower levels of muscling, compared with horses remaining in work during the 3-mo period between Spring and Fall semester. Twelve mature stock-type horses aged 16.4 ± 5 yrs at Middle Tennessee State University were divided into 2 groups, a conditioned group that maintained light-to-moderate riding and a non-conditioned group that received no ridden exercise during summer break. Research began at the beginning of the Fall semester and monitored horses for 28 d through their return to work in riding lessons and team practices. On d 0, 14, and 28 peak heart rate during submaximal exercise, resting heart rate, body weight, body condition score, topline muscling score, gaskin circumference, and forearm circumference were recorded. Heart rates were recorded using Polar Equine H10 monitors during rest in stalls and placed under tack while ridden innormal class use of light-to-moderate work. Topline muscling was scored on a previously published scale of 1–5 (1 poor for the breed, 5 exceptional for the breed). Data were analyzed using a mixed model, with effects of day and treatment, with repeated measures (SAS Ver. 9.4). Peak heart rate during submaximal exercise was not different between treatments (P = 0.17) but increased for both treatments through the 28-d study (P = 0.04). The resting heart rate of conditioned horses tended to be lower (P = 0.08). Heart rate results may be influenced by weather, as daily high temperatures decreased from 33°C to 19°C from d 0 to d 28. Forearm circumference was not different (P = 0.30), but gaskin circumference of non-conditioned horses was larger (P = 0.04), although the non-conditioned horses tended to have larger average body weight (P = 0.07). No difference was detected in BCS between groups (P = 0.22). Conditioned horses had higher topline muscling scores (P = 0.02). Compared with their non-conditioned counterparts, horses that were continuously conditioned over a summer semester break had mixed improvement in fitness, based on resting heart rate and topline muscling, suggesting that horses retain a degree of fitness during a 3-mo period of rest on pasture turn-out.

Enveloppes psychiques précoces : la difficulté d’être contenant auprès d’un bébé en retrait relationnel

ContextAutism spectrum disorder (ASD) results from a complex interaction between innate factors of the infant and their environment. Many risk factors have been identified. The difficulties in physical organization of at-risk children can allow us to identify the most fragile infants at birth. The baby in relational withdrawal can teach us about the part played by the infant in the weaving of early psychic envelopes. Research on babies who have become autistic children demonstrates disturbances in their motor skills, from their general movements to difficulties with body organization. The infant's sensorimotor difficulties hinder the expression of subjectivity. They also have an impact on the parents’ ability to interpret the signs coming from the baby. It is difficult for a parent to be the receptacle of the intentions of a baby who does not seem to be addressing its parent. An accompaniment of the parents supports them in their capacity to provide a secure “container” for their baby. A transdisciplinary team ensuring the continuity of the group psychic envelope may be necessary to establish harmony between the baby and their environment. ObjectivesThe goal of early post-natal care is to support parents so that they feel they are the receptacle to the baby's intentions. We want the baby to be able to actively engage in the relationship with its parent from the first months of its life, despite any sensorimotor difficulties that may be present. MethodIn this theoretical reflection on the difficulties of containment with a baby in relational withdrawal, we develop the theoretical-clinical bases which underlie our work as care providers. We focus here mainly on supporting parents in the containing function they occupy as the organizing center of their baby's instinctual life. ResultsThe result targeted by this treatment is the entry of the baby into goal-directed movement towards the other from 4 months, as evaluated by the Préaut grid, within the framework of a pleasant relationship of shared pleasure. We promote the establishment of a relationship in which the parent can both perceive the signs emitted by their baby while being attentive to their own internal experience. Particular attention is paid to joint listening. From this theoretical-clinical base stems the current practice of a transdisciplinary team and two ongoing research projects.

Introducing Advanced Paramedics into the Rural General Practice Team in Ireland – General Practitioners Attitudes

Introduction:As Ireland's population increases and chronic disease becomes more prevalent, demand for limited general practice services will increase. Nursing roles within a general practice are now considered to be standard, yet alternative non-medical professional roles are under-explored within an Irish context. Non-medical personnel such as Advanced Paramedics (APs) may have the capability to provide support to general practice.Method:A sequential explanatory mixed methodology was adopted. A questionnaire was designed and distributed to a purposeful sample of GPs attending a rural conference followed by semi-structured interviews. Data was recorded and transcribed verbatim and thematically analyzed.Results:In total n=27 GPs responded to the survey and n=13 GPs were interviewed. The majority of GPs were familiar with APs and were receptive to the concept of closely collaborating with APs within a variety of settings including out-of-hours services, home visits, nursing homes, and even roles within the general practice surgery.Conclusion:GP and AP clinical practice dovetail within many facets of primary care and emergency care. GPs believe that current models for providing rural general practice care are unsustainable, and they realize the potential of integrating APs into the general practice team to help support services into the future. These interviews provide a detailed insight into the opinions of rural general practitioners in Ireland on healthcare provision and the clear necessity for support and change.

Factors contributing to pharmacists leaving employment in general practice in Australia: an exploratory study.

To identify perceived factors contributing to pharmacists leaving employment in general practice. Qualitative semi-structured interviews were conducted with pharmacists who had left employment in general practice within 12 months of commencing (5 pharmacists out of 14 recruited into these roles) in Canberra, Australia. Thematic analysis was undertaken. The main specific reasons cited for leaving were lack of utilisation and part-time hours, while the over-arching themes identified were: challenges of the new role, poor role definition, professional relationships and job satisfaction. In this cohort of newly appointed general practice pharmacists, employment turnover was relatively high. The interview findings indicated a need for strategies, including having clear role descriptions that are understood by all members of the practice team, so that pharmacists with appropriate skillsets can be supported and retained in the general practice setting.

Perspectives on the Person-Centered Practice of Healthcare Professionals at an Inpatient Hospital Department: A Descriptive Study.

The characteristics of health professionals and their understanding of person-centeredness may have important implications for the development of person-centered practice in specific care settings. In this study, we characterized the perceptions of the person-centered practice of a multidisciplinary team of health professionals working in the internal medicine inpatient unit of a Portuguese hospital. Data were collected using a brief sociodemographic and professional questionnaire and the person-centered practice inventory-staff (PCPI-S), and the effect of different sociodemographic and professional variables on each PCPI-S domain was determined using an analysis of variance (ANOVA). The results showed that a person-centered practice was positively perceived in the major constructs of prerequisites (M = 4.12; SD = 0.36), the practice environment (M = 3.50; SD = 0.48), and person-centered process (M = 4.08; SD = 0.62) domains. The highest scored construct was developed interpersonal skills (M = 4.35; SD = 0.47), and the lowest was supportive organization systems (M = 3.08; SD = 0.80). Gender was found to influence the perceptions of knowing self (F(2,75) = 3.67, p = 0.03, partial η2 = 0.089) and the physical environment (F(2,75) = 3.63, p = 0.03, partial η2 = 0.088), as was profession on shared decision-making systems (F(2,75) = 5.38, p < 0.01, partial η2 = 0.125) and commitment to the job (F(2,75) = 5.27, p < 0.01, partial η2 = 0.123), and the educational level on being professionally competent (F(1,75) = 4.99, p = 0.03, partial η2 = 0.062) and having commitment to the job (F(2,75) = 4.49, p = 0.04, partial η2 = 0.056). In addition, the PCPI-S proved to be a reliable instrument for characterizing healthcare professionals' perceptions of the person-centeredness of care in this context. Identifying personal and professional variables that influence these perceptions could provide a starting point for defining strategies to move practice toward person-centeredness and for monitoring changes in healthcare practice.

A Team-Based Training for Continuous Glucose Monitoring in Diabetes Care: Mixed Methods Pilot Implementation Study in Primary Care Practices.

The American Academy of Family Physicians (AAFP) develops and maintains continuing medical education that is relevant to modern primary care practices. One continuing medical education modality is AAFP TIPS, which are comprised of resources designed for family medicine physicians and their care teams that aid in quick and accessible practice improvement strategies, with actionable steps. Evaluating physicians' use of and satisfaction with this modality's content and implementation strategies has not been prioritized previously. Continuous glucose monitoring (CGM) plays an increasing role in the treatment of diabetes; uptake occurs more rapidly in endocrinology settings than in primary care settings. To help address such differences in CGM uptake and diabetes care, AAFP TIPS on Continuous Glucose Monitoring (AAFP TIPS CGM) was developed, using published evidence and input from content experts (family medicine faculty; AAFP staff; and an advisory group comprised of other primary care physicians, patients, a pharmacist, and a primary care practice facilitator). A pilot implementation project was conducted in 3 primary care practices. To evaluate AAFP TIPS CGM in primary care practices, the research team assessed use of and satisfaction with the content and assessed barriers to and facilitators for strategy and workflow implementation. In total, 3 primary care practices participated in a mixed methods pilot implementation of AAFP TIPS CGM between June and October 2021. Practice champions at each site completed AAFP TIPS CGM and baseline practice surveys to evaluate practice characteristics and CGM prescribing. They conducted team trainings (via webinars or in person), with the goals of implementing CGM into practice and establishing or improving CGM workflows. Practice champions and team training participants completed posttraining surveys to evaluate the training, AAFP TIPS materials, and likelihood of implementing CGM. Interviews were conducted with 6 physicians, including practice champions, 2 months after team training. Satisfaction surveys were also distributed to those who completed the AAFP TIPS CGM course via the internet during the study period. Of the 3 practices, 2 conducted team trainings. The team training evaluation survey showed that practice staff understood their role in implementing CGM in practice (19/20, 95%), and most (11/20, 55%) did not have questions after the training. Insurance coverage for CGM was a remaining knowledge gap and potential barrier to implementing CGM in practice. Physicians and interdisciplinary care team members who took the AAFP TIPS CGM course via the internet, as well as those who attended in-person team training, expressed a high degree of satisfaction with the education, content, and applicability of the course. This pilot implementation of AAFP TIPS CGM offers pertinent and timely information for primary care practices that desire to initiate or expand CGM use to best meet the needs of their patients with diabetes.

The role of the pregnancy heart team in clinical practice.

Significant maternal and fetal morbidity and mortality risk has been shown to be associated with cardiovascular disease in pregnancy. Several determinants, such as the increasing number of females with corrected congenital heart disease in reproductive age, a more advanced maternal age associated with cardiovascular risk factors, and a greater prevalence of preexisting comorbidities related to cardiac disorders such as cancer and COVID-19), lead to a higher incidence of cardiac complications in pregnancy in the last few decades. However, adopting a multidisciplinary strategy may influence maternal and neonatal outcomes. This review aims at assessing the role of the Pregnancy Heart Team, which should ensure careful pre-pregnancy counseling, pregnancy monitoring, and delivery planning for both congenital and other cardiac or metabolic disorders, addressing several emerging aspects in the multidisciplinary team-based approach.

Supporting post-stroke access to services and resources for individuals with low income: understanding usual care practices in acute care and rehabilitation settings

Purpose Following stroke, individuals who live in a low-income or are at risk of living in a low-income situation face challenges with timely access to social services and community resources. Understanding the usual care practices of stroke teams, specifically, how they support this access to services and resources, is an important first step in promoting the implementation of practice change. Method A qualitative multiple-case study of acute care, inpatient, and outpatient rehabilitation stroke teams in an urban area of Canada. Semi-structured interviews and questionnaires about the workplace context were conducted with 19 professionals (social workers, occupational therapists, physiotherapists, speech-language pathologists) at four sites. Results In their usual practice, stroke teams prioritized immediate care needs. The stroke team professionals did not address income or resources unless it directly affected discharge. Usual care was influenced by factors such as time constraints, lack of knowledge about services and resources, and social service system limitations. Conclusion To better support post-stroke access to social services and resource for low-income individuals, a multidisciplinary approach, with actions beginning earlier on and extending throughout the continuum of care, is recommended, in addition to system-level advocacy.

Achieving software development agility: different roles of team, methodological and process factors

PurposeAgile principles have been widely used in software development team practice since the creation of the Agile Manifesto. Studies have examined variables related to agile principles without systematically considering the relationships among key team, agile methodology, and process variables underlying the agile principles and how these variables jointly influence the achievement of software development agility. In this study, the authors tested a team/methodology–process–agility model that links team variables (team autonomy and team competence) and methodological variable (iterative development) to process variables (communication and collaborative decision-making), which are in turn linked to software development agility (ability to sense, respond and learn).Design/methodology/approachSurvey data from one hundred and sixty software development professionals were analyzed using structural equation modeling methods.FindingsThe results support the team/methodology–process–agility model. Process variables (communication and collaborative decision-making) mediated the effects of team (autonomy and competence) and methodological (iterative development) variables on software development agility. In addition, team, methodology and process variables had different effects on the three dimensions of software development agility.Originality/valueThe results contribute to the literature on organizational IT management by establishing a team/methodology–process–agility model that can serve as a basis for developing a core theoretical foundation underlying agile principles and practices. The results also have practical implications for organizations in understanding and managing holistically the different roles that agile methodological, team and process factors play in achieving software development agility.

The Intervention Selection Toolbox to improve patient-relevant outcomes: an implementation and qualitative evaluation study in colorectal cancer surgery

BackgroundThe concept of value-based healthcare is being used worldwide to improve healthcare. The Intervention Selection Toolbox was developed to bridge the gap of value-based healthcare, between insights in outcomes and actual quality improvement initiatives. In this study we aimed to evaluate the use of the Intervention Selection Toolbox in daily practice of a quality improvement team in a hospital setting.MethodsA methodological triangulation design was used. The Intervention Selection Toolbox was used by a multidisciplinary quality improvement team for colorectal cancer care in a large teaching hospital. In-depth semi-structured interviews, focusing on the key elements of process evaluation, were conducted after implementation with representatives of the quality improvement team to evaluate the use of the Intervention Selection Toolbox. Quantitative data regarding improvement initiatives and degree of implementation was also collected.ResultsThe use of the Intervention Selection Toolbox initially resulted in 80 potential quality improvement initiatives. Eventually, two high potential improvement initiatives were selected. Some components of the toolbox were successfully implemented in daily practice, although ‘standard monitoring’ and ‘causal chain analysis’ proved more difficult to implement. Qualitative analysis was performed with ten members of the multidisciplinary team before thematic saturation occurred. Interviewed members had a wide range in characteristics: age 28–61 years, clinical experience 6–38 years and educational attainment from vocational program to academic doctorate. The Interviews showed added value in the use of the toolbox, but identified time and organizational management as restricting factors.ConclusionsThe Intervention Selection Toolbox is useful to systematically identify improvement initiatives with impact on health outcomes that matter to patients. However, before implementation organizational structure should be optimized to maximize success and efficiency on integration of the Intervention Selection Toolbox.

The impact of personal reputation on leader emergence in autonomous work teams: theoretical considerations for future research

PurposeResearch has demonstrated that varying degrees and combinations of individual traits, behaviors and characteristics influence the emergence of leaders in teams. While existing models have shown that such variables affect leader choice independently and interactively, the overall findings suggest that there is still a lack of research on a potentially significant factor, the impact of personal reputation on leader selection in autonomous work teams (AWTs), an increasingly ubiquitous team practice in organizations. This preliminary review thus aims to offer a general overview of personal reputation and its effects on leader emergence in the context of AWTs.Design/methodology/approachBy surveying extant literature on team leader emergence, this review has identified that the potential impact of personal reputation on leader selection in teams is significant yet largely ignored.FindingsModels of leader emergence in teams should incorporate the realistic assumption that teams formed in organizations are often comprised of individuals who have information on others either directly or indirectly. Personal reputation based on an individual’s history thus moderates how one’s behaviors or traits exhibited become contextualized in the overall assessment of leader desirability and selection in teams.Research limitations/implicationsBased on a review of existing research on leadership emergence and personal reputation, this work contends that the external validity and predictive value of leader emergence models would greatly benefit from the inclusion of employee reputations as a moderating variable in the future assessment of the leader emergence process in AWTs.Practical implicationsBy designing models that explain the potential effects of personal reputations on leader emergence in self-managed teams, team members and managers can be better elucidated and ultimately improve their understanding of the process of the evaluation and selection of team leaders.Originality/valueDespite the prolific research on leader emergence, there is still a paucity of studies examining personal reputational effects on leader selection, especially in the context of AWTs. This work is the first review piece calling for the inclusion of personal reputation, a substantive factor overlooked and excluded in previous models, to enhance the current understanding of leader emergence in AWTs.

Give your autoclave the care it deserves

Lee Morris talks through six important tips to help practice teams take care of autoclaves and avoid problems.

Design, Development and Evaluation of an Application based on Clinical Decision Support Systems (CDSS) for Over-The-Counter (OTC) Therapy: An Educational Interventions in Community Pharmacists.

Mobile health (mHealth) technology-based applications provide strong medical health-care support. Applications have an important impact as tools to improve the knowledge and support the health-care team practice. In this study, an over-the-counter (OTC) therapy application was developed based on Clinical Decision Support Systems (CDSS). CDSS is a key to improve health-related decisions and healthcare delivery. Furthermore, the quality and effectiveness of this application were evaluated among community pharmacists. The application was designed and developed for 10 topics of OTC therapy. After the approval of the expert panel, 40 pharmacists affiliated with Tehran University of Medical Science (TUMS) participated in this before and after quasi-experimental study. The related scenarios and checklists were designed for the ten topics. The participants had to manage the scenarios first by their knowledge and then with the application. The knowledge and pharmaceutical skills in OTC therapy were evaluated based on the obtained scores and the time recorded. The quality of the application was evaluated by pharmacists using user version of mobile application rating scale (uMARS) questionnaire. To compare before/after measurements of parametric and non-parametric data, we used the paired t-test and Wilcoxon matched-pairs test, respectively. Besides, the variables was compared using Mann-Whitney test. The statistical significance was considered at P<0.05. The analyses were performed using the statistical software Stata (ver. 13). All scores after using the application increased, and the P-value was not significant. Also, the recorded time was increased after the use of the application, and the P-value was not significant. The minimum mean scores of the six uMARS questionnaire sections were 3. It means that acceptable scores were obtained in all sections of the questionnaire. The "App quality score" section of the application was reported 3.45±0.94. No relationship was found between gender and the median score of each section of the uMARS questionnaire. The OTC therapy application developed in this study will help Persian-speaking pharmacists to increase their knowledge and pharmaceutical skills.

Research on the new path of deepening grassroots medical care from the perspective of metaverse

Metaverse and related technologies can break the traditional model in the field of medical care, and provide a feasible infrastructure platform for modern medical care and even future medical care through the Metaverse full-scene interaction mode, and improve medical services with computing power The ability to combine clinical research with clinical practice provides the possibility to break down the time and space barriers of medical care. The current level of grassroots medical care lags behind that of the city. It is of great practical significance to study the feasibility of implementing virtual surgical micro-manipulation technology in grassroots medical care under the perspective of metaverse and the current awareness of grassroots people on virtual medical technology to solve this problem. [Research method] Based on the provincial college students' innovation and entrepreneurship project "Virtual Surgical Micromanipulation Technology under the Perspective of Yuan Universe", this research group relies on the social practice team of Anhui Medical University's 2022 summer trips to the countryside to go to a town in Shou County, Huainan City, Anhui Province. Investigate science popularization activities to understand the current level of understanding of the grassroots people on the new medical model and investigate the feasibility and generalization of virtual surgery micro-manipulation technology under the perspective of the metaverse in grassroots hospitals. [Research conclusion] In view of this, the analysis of the questionnaire survey results of grassroots general practitioners and grassroots people shows that the current level of grassroots medical care has a lot of room for development, the level of general practitioners needs to be improved, the concept of the metaverse needs to be popularized and promoted, and the masses are not interested in new medical technologies. The ability to accept is high, and Metaverse virtual medical care can be promoted and feasible at the grassroots level.

Research on the Influence of Inconsistency Between Anchor Image and Product Image on Consumers' Purchase Intention

In recent years, the live broadcast industry has been booming, but some anchors have realized that their images are not consistent with the images of recommended products, which will affect consumers' purchasing intentions. This paper takes consumer perception as the theoretical basis to construct a hypothesis model and takes situational experiment as the research method. Finally, the conclusion is drawn that the inconsistency between anchor image and product image will have a negative effect on consumers' purchase intention, and consumers' perception of anchor professionalism and perceived product reliability play a mediating role between the two. The text puts forward a new explanation mechanism in theory, and has some enlightening effect on the selection of anchor team in practice.

Interprofessional collaboration within general practice teams following the inclusion of non-dispensing pharmacists

BackgroundPharmacists have been included in general practice teams to provide non-dispensing services in the Australian Capital Territory (ACT) since 2016. Interprofessional collaboration and team effectiveness are key considerations in providing high-quality patient care. These concepts have not been well studied following the inclusion of a pharmacist in general practice teams.MethodsA mixed methods study was conducted to explore collaboration between pharmacists and health professionals in eight general practices in the ACT, where pharmacists were included in their teams. A validated survey instrument was adapted and utilised to assess the changes in interprofessional collaboration over time following the addition of a pharmacist. Another validated survey was utilised to explore team effectiveness at the end of the study. Semi-structured interviews, with a thematic analysis, were conducted with a purposeful sample of general practice staff members to understand the factors influencing the development of interprofessional collaboration.ResultsIn total, 56 and 41 participants completed the baseline and follow-up survey, including 26 who completed both surveys to assess the change in collaboration over time. Interprofessional collaboration scores were high initially and did not change over time. Team effectiveness was also high at the end of the study. Twenty-one individuals participated in interviews, which generated four main interrelated themes related to interprofessional collaboration: professional working relationships, trust, commitment to collaboration, and barriers to collaboration. Trust was integral to professional working relationships and commitment to collaboration. The barriers to collaboration included not having a role description for pharmacists, inadequate interest to initiate working relationships, lack of dedicated time for interaction, lack of utilisation, and poor awareness of pharmacist-led activities in general practice.ConclusionInterprofessional collaboration was initially high and not influenced by the addition of a pharmacist, perhaps reflecting the inherent nature of the general practices willing to include a pharmacist within their team. Introducing a clear job description for pharmacists, and dedicating time to interact with pharmacists, could be beneficial in improving trust and professional working relationships and enhancing collaboration between the pharmacists and other general practice team members.

An established abdominal wall multidisciplinary team improves patient care and aids surgical decision making with complex ventral hernia patients.

Abdominal wall reconstruction (AWR) is an emerging subspecialty within general surgery. The practice of multidisciplinary team (MDT) meetings to aid decision making and improve patient care has been demonstrated, with widespread acceptance. This study presents our initial experience of over 150 cases of complex hernia patients discussed in a newly established MDT setting. From February 2020 to July 2022 (30-month period), abdominal wall MDTs were held bimonthly. Key stakeholders included upper and lower gastrointestinal surgeons, a gastrointestinal specialist radiologist, a plastic surgeon, a high-risk anaesthetist and two junior doctors integrated into the AWR clinical team. Meetings were held online, where patient history, past medical and surgical history, hernia characteristics and up-to-date computed tomography scans were discussed. Some 156 patients were discussed over 18 meetings within the above period. Ninety-five (61%) patients were recommended for surgery, and 61 (39%) patients were recommended for conservative management or referred elsewhere. Seventy-eight (82%) patients were directly waitlisted, whereas seventeen (18%) required preoperative optimisation: three (18%) for smoking cessation, eleven (65%) for weight-loss management and three (18%) for specialist diabetic assessment and management. In total, 92 (59%) patients (including operative and nonoperative management) have been discharged to primary care. A multidisciplinary forum for complex abdominal wall patients is a safe process that facilitates decision making, promotes education and improves patient care. As the AWR subspecialty evolves, our view is that the "complex hernia MDT" will become commonplace. We present our experience and share advice for others planning to establish an AWR centre.

How Do Oncology Nurses Feel During a Hypersensitivity Reaction?

I was working in an outpatient infusion center at the time of this event. We had a strong team, including nurses and advanced practice providers who would respond when called upon, but did not have a code team. If a patient w.

A nominal group technique to review undergraduate medical students’ training in emergency care

Background. The management of clinical emergencies is an essential skill for medical practitioners; therefore, proper training in these skills is crucial. This is a review of emergency care training by recent graduates of a medical programme to provide feedback on the usefulness of their training experience for entry into clinical practice. Academic clinicians working in the clinical environment, who provide the training, and academic managers who manage the training programme, could provide valuable inputs into reviewing the emergency care training programme contextualised for the uniquely South African challenges.Objectives. To obtain and prioritise experience-based and relevant suggestions for improving the current teaching and to invite comment on the suggestions from the relevant managers.Methods. Research was conducted in three phases using a nominal group technique to review an undergraduate medical programme. In the first phase, recent graduates from the existing programme identified its strengths and weaknesses. In the second phase, academic clinicians and technical experts provided suggestions for addressing these challenges. In the third phase, data obtained were discussed with academic managers responsible for the undergraduate medical programme.Results. Findings were grouped into thematic categories: skills and short courses, module structure and content, experiential learning opportunities, health professions educational practice and interprofessional education. Opportunities to gain experience in emergencies in different clinical fields and as a multi-professional team, both in simulation and real-life practice, were among the highlights of the findings.Conclusion. Many of the suggested improvements, such as a dedicated emergency care module, and more simulated and small-group case-based teaching, are achievable with the given resources. Additionally, with recent changes due to the COVID‑19 pandemic and lockdown, an environment for change that benefits online content delivery was created. The creation of longitudinal themes will be an enhancement of the current programme.

A multicriteria decision framework for governance of PPP projects towards sustainable development

The lack of a suitable decision framework for the governance of public-private partnership (PPP) projects in Africa, especially Ghana, is a major setback to project success, retarding sustainable development. This study develops a hierarchical decision framework for prioritizing project governance factors and their relationships using the Decision Making Trial and Evaluation Laboratory (DEMATEL) method. We employ 30 experts to evaluate two main PPP governance factors and eleven subfactors. We found that contractual governance factors of PPP are more prominent than noncontractual ones for sustainable PPP projects. However, noncontractual governance factors have the highest net effect on contractual factors. Again, policy diffusion is the contractual factor with the highest net effect, while best practice team norm is the noncontractual factor with the highest net effect. Additionally, effective risk allocation is the most prominent contractual subfactor of PPP, while effective communication of project information is the most prominent noncontractual governance factor. The results imply that PPP project managers should improve governance factors for the sustainable development of PPP projects in Africa. However, they should emphasize the prominent and high net effect governance factors but not wholly disregard the less prominent ones.