Using psychological theory to understand the clinical management of type 2 diabetes in Primary Care : a comparison across two European countries

Peer reviewedPublisher PD

Pharmacy students' perceptions toward peer assessment and its use in teaching patient presentation skills.

Background and purposeConducting peer assessment has been associated with positive learning outcomes in higher education. The primary objective was to evaluate pharmacy students' perceptions of using peer assessment as a pedagogical strategy in learning patient presentation skills. Secondary objectives were to determine helpful factors for providing and/or receiving peer assessment and to compare students' perceptions of peer assessment relative to receiving feedback from teaching assistants (TAs).Educational activity and settingPatient presentation skills were taught to third-year pharmacy students in three sessions (session 1: didactic lecture, session 2: faculty-led patient presentation workshops followed by peer assessment, session 3: one-on-one patient presentations to TAs). An anonymous survey instrument consisting of five-point Likert scale, yes/no, and open-ended questions was administered.FindingsA total of 187 students (98%) completed the survey. Peer assessment was perceived as a useful way to obtain feedback on patient presentations (87%). It facilitated higher level thinking and a self-reflection of students' own patient presentations. Most students felt that they received constructive feedback from peers (82%) that helped them improve their patient presentation skills (72%). However, students were more trusting of TAs' skills in assessing patient presentations (76% versus 93%, p < 0.001). Some students were concerned about the specificity and criticalness of feedback they received from peers.SummaryPeer assessment is a useful pedagogical strategy for providing formative feedback to students in learning patient presentations skills in the classroom setting. Students may benefit from additional training to improve the quality of feedback in peer assessment

Medical students’ knowledge and attitudes towards shared decision-making: results from a multinational cross-sectional survey

Introduction: We aimed to conduct a multinational cross-sectional online survey of medical students' attitudes towards, knowledge of, and experience with shared decision-making (SDM). Methods: We conducted the survey from September 2016 until May 2017 using: 1) a convenience sample of students from four medical schools each in Canada, the US, and the Netherlands (n=12), and 2) all medical schools in the UK through the British Medical School Council (n=32). We also distributed the survey through social media. Results: 765 students read the information sheet and 619 completed the survey. Average age was 24, 69% were female. Mean SDM knowledge score was 83.6% (range:18.8%-100%; 95% CI 82.8%-84.5%). US students had the highest knowledge scores (86.2%, 95% CI 84.8%-87.6%). The mean risk communication score was 57.4% (range: 0%-100%; 95% CI 57.4%-60.1%). Knowledge did not vary with age, race, gender, school, or school year. Attitudes were positive, except 46% believed SDM could only be done with higher educated patients and 80.9% disagreed that physician payment should be linked to SDM performance (increased with years in training, p<.05). Attitudes did not vary due to any tested variable. Students indicated they were more likely than experienced clinicians to practice SDM (72.1% vs. 48.8%). 74.7% reported prior SDM training and 82.8% were interested in learning more about SDM. Discussion: SDM knowledge is high among medical students in all four countries. Risk communication is less well-understood. Attitudes indicate that further research is needed to understand how medical schools deliver and integrate SDM training into existing curricula

An Internet-Based Telemedicine System in Nigeria

Telecommunication technologies are being used to change the healthcare industry in unprecedented and irreversible ways. These technologies are enabling delivery of healthcare to remotely placed patients and facilitating information exchange between generalists and specialists. For many decades now, the use of advanced telecommunications and information technologies has been investigated in an effort to improve healthcare. In particular, the focus has been centered on telemedicine. Telemedicine has been defined as the delivery of healthcare and the exchange of health information across distances, including all medical activities: making diagnosis, treatment, prevention, education and research (Craig, 1999). Telemedicine is also defined as the use of telecommunication technologies to provide medical information and services (Perednia & Allen, 1995). It may be as simple as two health professionals discussing a patient\u27s case over the telephone, or as sophisticated as using satellite technology to broadcast a consultation between healthcare centres in two countries using videoconferencing equipment. The American Telemedicine Association defines telemedicine as the use of medical information exchanged from one site to another via electronic communication for health and education of the patient or healthcare providers and for the purpose of improving patient care (ATA, 2001). Wootton (1996) considered telemedicine as a process, rather than a technology: telemedicine connects patients and healthcare professional in a chain of care

M-health review: joining up healthcare in a wireless world

In recent years, there has been a huge increase in the use of information and communication technologies (ICT) to deliver health and social care. This trend is bound to continue as providers (whether public or private) strive to deliver better care to more people under conditions of severe budgetary constraint

Dual disorders and implications for assessment and treatment

Part 1: Literature review. This review of the published literature examines the consequences for individuals with co-occurring substance use disorder and chronic mental illness in traditional treatment systems that provide separate mental health and substance use treatment and identifies barriers to effective service delivery. Barriers to effective assessment and treatment are related to a lack of integration of treatments, a Jack of networking among services, and a failure to identify and assess adequately for the presence of a dual disorder. The attitude of professionals towards DD individuals is indicated as a potential barrier. Professional education in dual disorders is emphasized and recommendations from the literature are discussed. Part 2: Research report. This study was undertaken to examine the attitudes and practice of psychologists towards patients with dual disorders, and to establish whether the acquisition of additional education in dual diagnosis made a difference regarding assessment and treatment. An 18-item questionnaire was developed and mailed to 200 registered psychologists throughout Australia. A total of 98 responded after receiving two reminder letters. Results of univariate tests and discriminant function analysis indicated that education in dual diagnosis was significantly related to better knowledge of, and practice by psychologists towards, dually disordered patients. These findings were significantly related to the successful identification of individuals with a dual disorder as well as effective assessment and treatment

The Gezira Family Medicine Project (GFMP). A scientific evaluation of a Master program for family physicians in Gezira, Sudan

Background: Family medicine based health systems are accepted worldwide as the best suitable model to provide integrated, high quality health services. In Sub-Saharan Africa, there is a recent movement towards implementing family medicine in health system; consequently, high up scaling of family medicine training is targeted and is going on like a fast track. Sudan faces the same challenges found in other Sub-Saharan African countries including the predominance of the tropical diseases that over-shadow the emerging problem of Non-Communicable Diseases (NCDs). The Gezira Family Medicine Project (GFMP) was established in 2010 as a collaboration project between several local partners including the State Ministry of Health and the University of Gezira. The project aimed to train qualified family physicians who can participate in providing high quality, accessible, and affordable primary health care services in Gezira. A twoyear Master curriculum was designed as an “in-service” model of training to meet both service provision and training's goals. A total of 207 candidates were enrolled in the first batch of the program in 2010. The project used information and communication technology (ICT) in a comprehensive way; it is used to provide health care in a distance (telemedicine), to facilitate and increase the accessibility in medical education (e-learning) and to manage patients' information (Electronic Medical Records- EMR). Study objectives: This study aimed to: Describe the GFMP during its first batch (2010-2012), its implementation, curriculum structure, baseline data of the trainees and their health centres. Assess the candidates' utilization of information and communication technology at the GFMP, and their perception of its use. Assess the impact of the Master programme on candidates' confidence to perform certain manual and cognitive clinical skills. Assess the impact of the GFMP on candidates' adherence to the core values of family medicine including patient-centeredness. Methods: Three comprehensive questionnaires were used to collect data both at the start of the Master program for the first batch and again at its end. The first questionnaire included background data regarding the candidates and their self-assessment of confidence to perform certain skills. The second questionnaire was a checklist for the health centres including the buildings, available equipment and provided services. The third questionnaire aimed to assess candidates' practice including adhesion to the core values of family medicine during patient consultations. A cross sectional, questionnaire and administrative data based observational design was used in paper 1 and paper 2. Self-evaluation questionnaire was used to collect data about the trainees' skills, while a checklist was used to collect data from the health centres. Administrative data was used to describe the project implementation, its curriculum design and candidates' utilization of ICT during the master period. A prospective cross sectional study with a before-and-after design was used in paper 3 and paper 4 to assess the progress change of the trainees during the Master period 2010-2012 (cohort observational design). Self-evaluation questionnaire and practicebased data were used to assess trainees' confidence in performing certain clinical skills and to assess their adhesion to some family medicine core values. The Patient- Practitioner Orientation Scale (PPOS) was used to assess patient-centeredness. Results: The 2-year in-service Master program at the GFMP could recruit 207 physicians to be trained in family medicine and to provide health services in 158 health centres, of which, 84 centres had never been served by a doctor before. The mean age of the enrolled trainees was 32.5 years, 57% were males and one third of them were graduated from the University of Gezira. Self-evaluation in confidence to perform certain clinical skills showed significant variations between individual skills, between medical disciplines, and between genders. Health centres were generally equipped to deal with tropical diseases, but poorly equipped to deal with Non Communicable Diseases (NCDs) Information and communication (ICT) reports showed a performance of 3808 online telemedicine consultations in the period April 2011 to December 2012. Over 165000 new patients' electronic medical records (EMRs) were established by the candidates at their graduation (N: 125 candidate). Candidates were generally highly satisfied with the use of ICT during their master period. They highlighted some patients' concerns regarding the use of EMR and telemedicine during consultations. To assess candidate’s improvement after the Master program, self-assessment of 46 clinical skills was done before and after the master program using a five-grade Likert scale (1-5). It showed an overall improvement of 21.7% from 3.23 (before) to 3.92 (after). Improvement variation is observed between the different medical disciplines. Males have constantly scored higher confidence than females, while females showed higher progress percentage in improvement compared with males. Statistically significant improvement is also detected regarding candidates' development in certain role skills like leadership, health promotion, and communication with colleagues and the community. In contrast, there was an overall significant decrease in orientation towards patient-centred care by 4% using the Patient-Practitioner Orientation Scale (PPOS). Conclusion: GFMP represented a good model for local collaboration, which resulted in performing training goals and providing high quality primary health care services. The in-service model of training was attractive for trainees (207 joined the program) and promising for health service provision (158 health centres were served by GFMP, of which 84 had never been served by physicians before). Information and communication technology (ICT) supported both training goals and service provision goals at the GFMP. The GFMP curriculum had a positive impact on candidates' confidence to perform the targeted clinical skills. Practice data showed a positive impact of the Master program on candidates' adherence to family medicine core values. Patient centred care was a weak point in candidates' training that needs more attention in future curriculum planning and implementation. Recent assessment of the status of the GFMP and family medicine training in Sudan as a whole done in Apr 2018, showed still high up-scaling of family medicine training in the whole country, presented by several institutes including the University of Gezira and the National Public Health Institute (PHI). The development of the GFMP as a project is affected by economical challenges and a decline in the political commitment, which affected the partnership between the University of Gezira and the State Ministry of Health