Echocardiography curriculum development for physician assistants using entrustable professional activities

BACKGROUND: With the projected increase of cardiovascular disease in the aging population, a higher demand for echocardiography use is predicted. However, there is a shortage in the supply of cardiologists, to the point that a 2009 American College of Cardiology survey report called it a "cardiology workforce crisis". The report also recommends a more aggressive use of PAs and NPs as one of the solutions to fill the shortage. Currently, echocardiography is not routinely included in the scope of practice for PAs in cardiology. While PAs attain strong basic science knowledge and clinical training experience in PA school, they typically do not receive additional formal postgraduate training. PAs have limited training opportunities to train in echocardiography and receive certification of recognition, but a formally standardized training program and certifying examination geared specifically for PAs are yet to be developed. This study seeks to develop a pilot curriculum in training echocardiography which can be standardized for utilization across various regions and medical subspecialties. The curriculum draws on the concept of Entrustable Professional Activities (EPA), which is being actively used in graduate medical education. HYPOTHESIS: After participating in the proposed pilot curriculum which involves online didactic learning and supervised hands-on clinical training, trained PAs will be able to reach proficiency in echocardiography operation and interpretation at level 4 supervision according to the EPA guidelines. METHODS: This study proposes a pilot curriculum with framework based on the EPA titled “performing and interpreting echocardiography” by PAs. The curriculum involves didactic and clinical training in echocardiography, with the goal to achieve mastery of level 4 supervision (minimal supervision). 2 subjects will be recruited from a teaching medical institution in the Greater Boston area with an IAC accredited echocardiography laboratory. After the 12-month training, participants will take ASCeXAM/ReASCE Online Practice Exam Simulation offered by the ASE. Upon 1) achievement of individualized EPAs as assessed by supervisor, and 2) simulation exam score of >80%, participants will earn a STAR in echocardiography. CONCLUSION: The study is the first step to establishing an effective training curriculum that will eventually be a basis for creating a certifying exam in echocardiography, designed specifically for PAs. As this study merely suggests a new curriculum, future studies should focus on identifying strengths and weaknesses of the curriculum after implementation and expansion to multiple sites, and gather data to use for continual improvement of the training curriculum

Curriculum renewal for interprofessional education in health

In this preface we comment on four matters that we think bode well for the future of interprofessional education in Australia. First, there is a growing articulation, nationally and globally, as to the importance of interprofessional education and its contribution to the development of interprofessional and collaborative health practices. These practices are increasingly recognised as central to delivering effective, efficient, safe and sustainable health services. Second, there is a rapidly growing interest and institutional engagement with interprofessional education as part of pre-registration health professional education. This has changed substantially in recent years. Whilst beyond the scope of our current studies, the need for similar developments in continuing professional development (CPD) for health professionals was a consistent topic in our stakeholder consultations. Third, we observe what might be termed a threshold effect occurring in the area of interprofessional education. Projects that address matters relating to IPE are now far more numerous, visible and discussed in terms of their aggregate outcomes. The impact of this momentum is visible across the higher education sector. Finally, we believe that effective collaboration is a critical mediating process through which the rich resources of disciplinary knowledge and capability are joined to add value to existing health service provision. We trust the conceptual and practical contributions and resources presented and discussed in this report contribute to these developments.Office of Learning and Teaching Australi

New Graduate RN Transition Program Evaluation and Replication

Evaluates the impact of pilot programs to improve new nurses' self-confidence, competencies in acute and non-acute specialties and advanced generalist skills, and employment outcomes. Includes best practices and recommendations for future programs

WS19. From pedagogy to practice: implementing transformative learning in clinical reasoning

BackgroundHealthcare professionals must provide high quality care that is both efficient and safe. Underpinning this requirement is a presumption that individuals are able to make accurate clinical decisions. Knowledge is not sufficient: judgment and reasoning are required to translate clinical information into accurate decisions to produce effective care. Clinical reasoning skills need to be developed in healthcare professionals in a way that produces change in behaviour. This is aplies to the spectrum of healthcare education: from undergraduate to postgraduate to lifelong practice. Though much is understood about clinical decision-making theory, direction for systematic implementation of teaching in both undergraduate and postgraduate medical education programmes is lacking. In particular, evidence describing transformative teaching methods is limited. This workshop will explore how to design effective spiral curricula in clinical reasoning, compare and contrast experiences from three medical schools in the UK, discuss challenges in implementation, share a variety of teaching methods, provide hands on demonstration of technological resources that have produced changes in learner behaviour and support attendees to adapt methodology to their programmes.Structure of workshopWe will briefly review current knowledge on clinical decision-making learning before sharing experiences from three UK medical schools.Attendees will participate in discussions supported by interactive exercises to explore each subtopic. These exercises will include role play, video and trial of electronic teaching tools used in our current practice. The session will conclude with a reflection on principles and ideas shared during the event

Refraction in Mozambique: Evaluations of Practice and Development of Competency Frameworks for Eye Care Personnel

Purpose The development of competency- based education for optometrists and mid-level eye-care personnel has been identified as an important component in the elimination of avoidable blindness and vision impairment. The Mozambique Eye care Project (MEP) is a multi-institutional collaboration, which seeks to facilitate greater access to training in eye health professions, which will ultimately contribute to providing affordable and accessible eye care within the public health system in Mozambique. An important tenet of the MEP is to develop and enhance the refraction training of all existing (ophthalmic technicians) and new eye care personnel (four-year training of optometrists and eighteen-month training of ophthalmic technicians) and evaluate the outcome of the training. The overall aim of my research was to develop competency frameworks for ophthalmic technicians (OTs) and optometrists and provide recommendations for developing a comprehensive training plan for eye care service provision in the country. Methods A comprehensive evaluation of refraction competencies of OTs was conducted by the use of demographic and confidence levels questionnaire and theoretical and practical competency assessments. A competency assessment process was developed for the assessment of optometry students at UniLúrio, which consisted of direct observation of refractions on two clinic patients, a two-part theory exam consisting of short answer questions and an oral structured viva. Qualitative observations of the competency assessment process were also made. Factors affecting student performance were identified using semi-structured individual interviews with the course lecturers and a course evaluation questionnaire with the students. A modified Delphi approach was used to develop competency frameworks for the two cadres, OTs and optometrists in Mozambique. Results, Initial evaluations of the OTs demonstrated that their refraction confidence and competence levels varied depending on their training (location and duration), and their location of work (clinical load, availability of equipment and other eye care personnel). The only skill the OTs and trainees demonstrated competence in was correcting presbyopia. Only four optometry students out of fifteen were graded as competent in all the elements of the clinical competency exam. Analysis of data from lecturer interviews and student questionnaire yielded four dominant themes that were viewed as important determinants of student performance: student learning context; teaching context; clinic conditions and assessment; and the existing operating healthcare context. Two socially responsive competency frameworks for both cadres were developed using the modified Delphi approach. Conclusion These evaluations identified factors affecting the refraction competencies of the OTs and optometrists at UniLúrio while taking country-specific factors into context. The socially responsive frameworks developed will inform the evolution of standardised curricula for both OTs and optometrists

Roundtable Discussion (RTD03) - Is there a downside to using Simulated Patients to teach and assess communication skills?

Background Simulated Patients (SPs) are widely used to facilitate the learning of communication skills enabling students to receive detailed feedback on experiential practice in a safe environment. They are also used in the assessment of students’ communication skills in Objective Structured Clinical Examinations (OSCEs). We have observed that our most experienced SPs are highly conversant with medical jargon and consultation skills and have almost become ‘medical faculty’. Consultations can therefore lack the true patient perspective, with SPs focussing their feedback on process rather than giving a true patient perspective. Roundtable objectives To consider the challenges in ensuring that highly experienced SPs continue to respond from a true patient perspective To critique whether the use of SPs in OSCE stations is a valid way to assess students’ communication skills with real patients To consider whether using consultations with Simulated Patients is useful for students in the later years of an Undergraduate medical course who are learning to integrate the different components of a consultation and reasoning clinically in a real-life clinical context To share best practice with colleagues Roundtable A brief interactive presentation including the authors’ experiences of working with experienced Simulated Patients which will draw on current literature regarding the evidence for using Simulated Patients in the teaching and assessing of communication skills Delegates will have the opportunity to take part in three roundtable discussions • OSCE Stations using SPs assess how good students are at communicating with SPs but not with real patients • Experienced SPs are in danger of responding with a faculty not a patient perspective • By using SPs in teaching we over focus on process and forget the global picture

Competencies and skills to enable effective care of severely obese patients undergoing bariatric surgery across a multi-disciplinary healthcare perspective: a systematic review.

Increasing numbers of illicit and unlicensed medicines are in general circulation and regularly seized by the police and other regulatory authorities. Forensic identification of seized tablets tends to focus on visual appearance and chromatographic identification of the contained drug. This process is relatively time consuming and places a strain on forensic laboratories. It was therefore of interest to investigate the possible application of differential scanning calorimetry (DSC) as a fast and efficient tool to facilitate the identification of contained drug/s and associated tablet excipients. Sixteen different cases (Cases A to P) of diazepam tablets obtained from Police Scotland were characterised based on visual appearance (colour and manufacturers' logos), physical attributes (size, weight and hardness), drug type, drug quantity (HPLC) and thermal properties (DSC). Raw DSC data was further processed using principal component analysis (PCA) as an objective assessment of the thermograms obtained with a view to statistical grouping of different cases. Cases J/K, M/O and L/P could be paired on visual appearance and Cases B/C/E/G and J/K/L/P on tablet hardness (17-23 and 80-89 N respectively). HPLC indicated that 75% of the cases examined contained diazepam but less than half of these contained the recognised amount (10 mg); Cases B/E/L/P contained phenazepam and J/K contained etizolam. The thermal signatures of individual tablets provided by DSC produced qualitative information about both drugs and excipients, indicating lactose in Cases D/F/H/I/J/K/M/N/O and Emcompress' in B/E/L/P. In particular, DSC coupled with PCA provided confident groupings of A/C/G, B/E/L/P and H/I/J/K, and specific pairings of B/E, L/P and F/N

The Evidence Base for Developing a Veterinary Business Management Curriculum

<p><strong>Objective: </strong>This paper sets out to highlight the ongoing need for integrated teaching of business skills in the veterinary curriculum.</p><p><strong>Background:</strong> In response to the changing environment of the veterinary profession, it is important to understand the future needs of veterinary practitioners. While changes to the veterinary curriculum have been made in recent years, they have been highly varied across schools and little evidence is available on how these have improved students’ non-technical skills, knowledge, aptitudes, and attitudes. </p><p><strong>Evidentiary value:</strong> This literature review of 23 papers provides a solid basis for the further development of knowledge on business management issues in veterinary curricula. The impact on practice from our findings is substantial. The role of clinicians in academia is recognised as a primary source of engaging students with business management through their day-to-day teaching. Furthermore, the role of first-opinion vets who take on placement students (known as extra mural studies or ‘EMS’ in the UK) cannot be underestimated as they play an essential role in ensuring that students perceive business skills with the same importance as clinical skills.</p><p><strong>Methods:</strong> This research draws on the findings of 23 papers that emerged as relevant from the structured literature search.  The search yielded 124 papers but many were excluded because they focused on issues beyond the search strategy, did not report empirical findings so were based largely on discussion and conjecture, were not about the undergraduate veterinary curriculum, were not written in English or were not related to business teaching.</p><p><strong>Results: </strong> Employers of recent graduates highly value business skills, and often base their hiring decision on non-technical skills, rather than clinical skills. While changes to the veterinary curriculum have been made to include more non-technical training by individual veterinary schools, it is unclear how effective these programmes have been.</p><p><strong>Conclusion: </strong> Veterinarians have identified a need for greater inclusion of business skills in the veterinary curriculum, however successfully integrating business skills into the curriculum will mean that students learn business principles in non-traditional, non-lecture-style environments with materials inter-twining with clinical teaching. This will mean a significant shift from traditional classroom based delivery of business lectures to an integrated approach. This can only be achieved if business and clinical teaching staff work together in delivering business education to the next generation of veterinarians. That said, the evidence regarding the importance of business within the veterinary medical curriculum, coupled with increasing competition in the market for first-opinion veterinary services, means that changes in the approach to teaching business may be easier to achieve than ever before.</p><p><strong>Application:</strong> The results of this research are applicable to practicing veterinarians in both academic and private practice. It is clear that business management needs to be integrated throughout the veterinary curriculum and thus ‘owned’ by academics with both clinical and non-clinical roles. Veterinarians in private practice also have a critical role to play as these people are the gatekeepers to the real-world experience that placement students encounter. </p><br /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed" /