Effects of a single interprofessional simulation session on medical and nursing students’ attitudes toward interprofessional learning and professional identity: a questionnaire study

Background Participation in simulation-based interprofessional education (sim-IPE) may affect students’ attitudes towards interprofessional learning (through gaining experience with others) and their professional identity (by increasing the ‘fit’ of group membership). We examined this in two questionnaire studies involving students from four universities in two areas of the UK. Method Questionnaire data were collected before and after students took part in a sim-IPE session consisting of three acute scenarios. Questionnaires included the Readiness for Interprofessional Learning Scale (RIPLS) and measures of professional identity derived from the social identity theory literature. In Study 1, only identification with Professional Group (doctor or nurse) was measured, while in Study 2 identification with Student Group (medical or nursing student) and the immediate interprofessional Team worked with in the simulation were also measured. Linear mixed effects regression analysis examined the effect of the simulation session, and differences between medical and nursing students, sites and identity measures. Results A total of 194 medical and 266 nursing students completed questionnaires. A five-item subset of RIPLS (RIPLSCore) was used in analysis. In both studies RIPLSCore increased for all groups following participation in sim-IPE, although this was larger for nursing students in Study 1. Nursing students had consistently higher RIPLSCore scores than medical students at one site. Effects of the session on identity varied between sites, and dimensions of identity. Notably, while positive emotions associated with group membership (Ingroup Affect) increased for Student Group, Professional Group and Team, the sense of belonging (Ingroup Ties) and importance (Centrality) of the group increased only for Team. Nursing students had consistently higher identification scores than medical students. Conclusions Participation in a sim-IPE session can improve attitudes towards interprofessional learning. It can also enhance professional identity, particularly as related to emotional aspects of group membership, with possible benefits for wellbeing. Changes in identification with the immediate Team suggest positive psychological consequences of ad hoc Team formation in the workplace. Differences between medical and nursing students suggest their differing opportunities to work with other professions during training may change baseline attitudes and identity. However, a single sim-IPE session can still have an additive effect

Cost-Effective Extracorporeal Membrane Oxygenation Simulation

©2018 Official Publication of The Simulation Society (TSS), accredited by International Society of Cardiovascular Ultrasound (ISCU). This is an open access article published under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International licence (CC BY-NC-ND 4.0). For further information see: https://creativecommons.org/licenses/by-nc-nd/4.0/This invited review article was presented orally on the occasion of the South West Asian Chapter conference of the Extracorporeal Life Support Organization (ELSO) held in New Delhi, India in January 2018. It has an educational focus on the topic of extracorporeal membrane oxygenation (ECMO), which is increasingly being used as a lifesaving bridge therapy. A case is being made regarding the adage “practice makes perfect” to be considered in the context of simulation-based education to ensure patient safety. Technology-enhanced simulation-based deliberate practice should be used more commonly to support clinicians in the development of all their professional skills. This is an ethical imperative that may be addressed using low-cost simulation modalities that are sometimes proven to be as effective as more expensive approaches. Educators can now design their programs according to published best practice standards for the benefit of their learners, and ultimately the patients they care for. Simulation-based education clearly has a place and important role to play in preparing ECMO teams dealing with routine procedures as well as emergency situations. Several solution and approaches are being presented alongside innovative work currently being done in collaboration between a regional ELSO center of excellence and an academic institution. This innovative simulator is composed of several modules serving different functions required for the simulation of ECMO emergencies at a much lower cost than using the real machine and its various expensive disposable components.Peer reviewedFinal Published versio

The Objective Structured Clinical Exam (OSCE): A qualitative study exploring the healthcare student’s experience

The paper relates to delivering vocational higher education to prospective building surveyors. Preparing students for the workplace requires inclusion of academic knowledge, workplace skills and practical vocational experience. This is reinforced by feedback from the four stakeholders to surveying education, learner, employer, education provider and professional institution. Successful delivery of learning to distinct vocational groups requires specific pedagogy. The paper analyses a realistic industrial simulation delivered to teach knowledge and skills to undergraduate building surveying students. Initial pedagogy was proposed by CEEBL, Centre for Excellence in Enquiry Based Learning. Work based skills requirements were taken from published work including leading building surveying academics and practitioners like Professor Mike Hoxley and Professor Malcolm Hollis. Data analysis is used to evolve future simulations. These become better suited to delivering appropriate learning, valid assessment and usable vocational skills, against academic, student focused and industrial criteria. An action research approach is utilised by the author to develop specialist pedagogy through analysis of outcome data and stakeholder feedback. Action research is undertaken through an approach using trial, evaluation and development. The paper concludes, simulation can be a valid tool for delivering teaching, learning, assessment and vocational skills training to surveying students and justifies further research

Different patterns of illness-related interaction in couples coping with rheumatoid arthritis

Objective. To learn more about the effect of rheumatoid arthritis (RA) on couples’ relationships and how couples manage the illness within their dyad. Methods. Eight women with RA (ages 31–60 years) and their partners, and 4 men with RA (ages 43–75 years) and their partners were recruited from the rheumatology case load of a hospital in the UK. Interpretative phenomenologic analysis was used for data collection and analysis. During semi-structured interviews, couples were asked about the effect of RA on their lives and relationship. Results. This study found clear differences in the way couples managed the illness of one partner and in the nature of their illness-related interactions. Based on these differences, the couples were allocated to 1 of 3 groups: the shared illness management group (SIM), the ill partner in charge group (IPIC), or the conflict over management group (COM). In the SIM group, both partners attended appointments and shared decisions about illness management. In the IPIC group, the ill person claimed and was conceded the right to make autonomous decisions about illness management. In the COM group, the well partner was dissatisfied with the way the ill person was managing the illness, and conflict resulted. Conclusion. Heterogeneity exists in the intradyad management of RA. Identifying each couple’s style of illness management could make medical consultations and education programs more responsive to the needs and preferences of patients and their partners. Dissatisfaction of either partner with illness management and resulting conflict could be addressed, with benefits for both partners and possible improvement in disease management.ObjectiveTo learn more about the effect of rheumatoid arthritis (RA) on couples' relationships and how couples manage the illness within their dyad.MethodsEight women with RA (ages 31–60 years) and their partners, and 4 men with RA (ages 43–75 years) and their partners were recruited from the rheumatology case load of a hospital in the UK. Interpretative phenomenologic analysis was used for data collection and analysis. During semistructured interviews, couples were asked about the effect of RA on their lives and relationship.ResultsThis study found clear differences in the way couples managed the illness of one partner and in the nature of their illness-related interactions. Based on these differences, the couples were allocated to 1 of 3 groups: the shared illness management group (SIM), the ill partner in charge group (IPIC), or the conflict over management group (COM). In the SIM group, both partners attended appointments and shared decisions about illness management. In the IPIC group, the ill person claimed and was conceded the right to make autonomous decisions about illness management. In the COM group, the well partner was dissatisfied with the way the ill person was managing the illness, and conflict resulted.ConclusionHeterogeneity exists in the intradyad management of RA. Identifying each couple's style of illness management could make medical consultations and education programs more responsive to the needs and preferences of patients and their partners. Dissatisfaction of either partner with illness management and resulting conflict could be addressed, with benefits for both partners and possible improvement in disease management

A pilot study of operating department practitioners undertaking high-risk learning: a comparison of experiential, part-task and hi-fidelity simulation teaching methods

Health care learners commonly rely on opportunistic experiential learning in clinical placements in order to develop cognitive and psychomotor clinical skills. In recent years there has been an increasing effort to develop effective alternative, non-opportunistic methods of learning, in an attempt to bypass the questionable tradition of relying on patients to practice on. As part of such efforts, there is an increased utilisation of simulation-based education. However, the effectiveness of simulation in health care education arguably varies between professions (Liaw, Chan, Scherpbier, Rethans, & Pua, 2012; Oberleitner, Broussard, & Bourque, 2011; Ross, 2012). This pilot study compares the effectiveness of three educational (or ‘teaching’) methods in the development of clinical knowledge and skills during Rapid Sequence Induction (RSI) of anaesthesia, a potentially life-threatening clinical situation. Students of Operating Department Practice (ODP) undertook either a) traditional classroom based and experiential learning, b) part-task training, or c) fully submersive scenario-based simulated learning

Adolescent Health Services: Missing Opportunities

Examines the status of adolescents' health and health services, including critical needs, promising models, and components for improving disease prevention and health promotion. Recommends better primary care, coordinated policy, and expanded coverage

Genetic Correlates of Brain Aging on MRI and Cognitive Test Measures: A Genome-Wide Association and Linkage Analysis in the Framingham Study

BACKGROUND: Brain magnetic resonance imaging (MRI) and cognitive tests can identify heritable endophenotypes associated with an increased risk of developing stroke, dementia and Alzheimer's disease (AD). We conducted a genome-wide association (GWA) and linkage analysis exploring the genetic basis of these endophenotypes in a community-based sample. METHODS: A total of 705 stroke- and dementia-free Framingham participants (age 62 +9 yrs, 50% male) who underwent volumetric brain MRI and cognitive testing (1999–2002) were genotyped. We used linear models adjusting for first degree relationships via generalized estimating equations (GEE) and family based association tests (FBAT) in additive models to relate qualifying single nucleotide polymorphisms (SNPs, 70,987 autosomal on Affymetrix 100K Human Gene Chip with minor allele frequency ≥ 0.10, genotypic call rate ≥ 0.80, and Hardy-Weinberg equilibrium p-value ≥ 0.001) to multivariable-adjusted residuals of 9 MRI measures including total cerebral brain (TCBV), lobar, ventricular and white matter hyperintensity (WMH) volumes, and 6 cognitive factors/tests assessing verbal and visuospatial memory, visual scanning and motor speed, reading, abstract reasoning and naming. We determined multipoint identity-by-descent utilizing 10,592 informative SNPs and 613 short tandem repeats and used variance component analyses to compute LOD scores. RESULTS: The strongest gene-phenotype association in FBAT analyses was between SORL1 (rs1131497; p = 3.2 × 10-6) and abstract reasoning, and in GEE analyses between CDH4 (rs1970546; p = 3.7 × 10-8) and TCBV. SORL1 plays a role in amyloid precursor protein processing and has been associated with the risk of AD. Among the 50 strongest associations (25 each by GEE and FBAT) were other biologically interesting genes. Polymorphisms within 28 of 163 candidate genes for stroke, AD and memory impairment were associated with the endophenotypes studied at p < 0.001. We confirmed our previously reported linkage of WMH on chromosome 4 and describe linkage of reading performance to a marker on chromosome 18 (GATA11A06), previously linked to dyslexia (LOD scores = 2.2 and 5.1). CONCLUSION: Our results suggest that genes associated with clinical neurological disease also have detectable effects on subclinical phenotypes. These hypothesis generating data illustrate the use of an unbiased approach to discover novel pathways that may be involved in brain aging, and could be used to replicate observations made in other studies.National Institutes of Health National Center for Research Resources Shared Instrumentation grant (ISI0RR163736-01A1); National Heart, Lung, and Blood Institute's Framingham Heart Study (N01-HC-25195); National Institute of Aging (5R01-AG08122, 5R01-AG16495); National Institute of Neurological Disorders and Stroke (5R01-NS17950

The Check-Up, April-June 2013

An update on issues and ideas related to health reform in Iowa Second Story Headline The Check-Up is a monthly health care reform newsletter designed to keep interested Iowans up to date on the progress of health reform initiatives assigned to IDPH

Decision aids for people facing health treatment or screening decisions (Review)

Background Decision aids prepare people to participate in ’close call’ decisions that involve weighing benefits, harms, and scientific uncertainty. Objectives To conduct a systematic review of randomised controlled trials (RCTs) evaluating the efficacy of decision aids for people facing difficult treatment or screening decisions. Search strategy We searched MEDLINE (Ovid) (1966 to July 2006); Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library; 2006, Issue 2); CINAHL (Ovid) (1982 to July 2006); EMBASE (Ovid) (1980 to July 2006); and PsycINFO (Ovid) (1806 to July 2006). We contacted researchers active in the field up to December 2006. There were no language restrictions. Selection criteria We included published RCTs of interventions designed to aid patients’ decision making by providing information about treatment or screening options and their associated outcomes, compared to no intervention, usual care, and alternate interventions. We excluded studies in which participants were not making an active treatment or screening decision, or if the study’s intervention was not available to determine that it met the minimum criteria to qualify as a patient decision aid. Data collection and analysis Two review authors independently screened abstracts for inclusion, and extracted data from included studies using standardized forms. The primary outcomes focused on the effectiveness criteria of the International Patient Decision Aid Standards (IPDAS) Collaboration: attributes of the decision and attributes of the decision process. We considered other behavioural, health, and health system effects as secondary outcomes. We pooled results of RCTs using mean differences (MD) and relative risks (RR) using a random effects model. Main results This update added 25 new RCTs, bringing the total to 55. Thirty-eight (69%) used at least one measure that mapped onto an IPDAS effectiveness criterion: decision attributes: knowledge scores (27 trials); accurate risk perceptions (11 trials); and value congruence with chosen option (4 trials); and decision process attributes: feeling informed (15 trials) and feeling clear about values (13 trials). This review confirmed the following findings from the previous (2003) review. Decision aids performed better than usual care interventions in terms of: a) greater knowledge (MD 15.2 out of 100; 95% CI 11.7 to 18.7); b) lower decisional conflict related to feeling uninformed (MD -8.3 of 100; 95% CI -11.9 to -4.8); c) lower decisional conflict related to feeling unclear about personal values (MD -6.4; 95% CI -10.0 to -2.7); d) reduced the proportion of people who were passive in decision making (RR 0.6; 95% CI 0.5 to 0.8); and e) reduced proportion of people who remained undecided post-intervention (RR 0.5; 95% CI 0.3 to 0.8). When simpler decision aids were compared to more detailed decision aids, the relative improvement was significant in knowledge (MD 4.6 out of 100; 95% CI 3.0 to 6.2) and there was some evidence of greater agreement between values and choice. In this review, we were able to explore the use of probabilities in decision aids. Exposure to a decision aid with probabilities resulted in a higher proportion of people with accurate risk perceptions (RR 1.6; 95% CI 1.4 to 1.9). The effect was stronger when probabilities were measured quantitatively (RR 1.8; 95% CI 1.4 to 2.3) versus qualitatively (RR 1.3; 95% CI 1.1 to 1.5). As in the previous review, exposure to decision aids continued to demonstrate reduced rates of: elective invasive surgery in favour of conservative options, decision aid versus usual care (RR 0.8; 95% CI 0.6 to 0.9); and use of menopausal hormones, detailed versus simple aid (RR 0.7; 95% CI 0.6 to 1.0). There is now evidence that exposure to decision aids results in reduced PSA screening, decision aid versus usual care (RR 0.8; 95% CI 0.7 to 1.0) . For other decisions, the effect on decisions remains variable. As in the previous review, decision aids are no better than comparisons in affecting satisfaction with decision making, anxiety, and health outcomes. The effects of decision aids on other outcomes (patient-practitioner communication, consultation length, continuance, resource use) were inconclusive. There were no trials evaluating the IPDAS decision process criteria relating to helping patients to recognize a decision needs to be made, understand that values affect the decision, or discuss values with the practitioner. Authors’ conclusions Patient decision aids increase people’s involvement and are more likely to lead to informed values-based decisions; however, the size of the effect varies across studies. Decision aids have a variable effect on decisions. They reduce the use of discretionary surgery without apparent adverse effects on health outcomes or satisfaction. The degree of detail patient decision aids require for positive effects on decision quality should be explored. The effects on continuance with chosen option, patient-practitioner communication, consultation length, and cost-effectiveness need further evaluation. This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2009, Issue 3. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.</p

Health Care Coverage and Access for Children in Low-Income Families: Stakeholder Perspectives from Colorado

An important question to ask about any health care system is how well it serves children in low-income families. In Colorado, as in many states, there are reasons to ask that question with optimism and concern. On one hand, the proportion of eligible Colorado children enrolled in Medicaid or the Children's Health Insurance Program (CHIP) increased from 70 percent in 2008 to 84 percent in 2013. The passage of the Affordable Care Act (ACA) in 2010, the reauthorization of CHIP in 2015, and earlier Colorado policies to expand Medicaid and CHIP help protect these gains. But uncertainty exists: although Colorado expanded Medicaid and established a state-run health insurance Marketplace, Medicaid's rapid growth in the state may become politically contentious,and the Marketplace faces a challenging transition from a start-up to a sustainable entity. Moreover, CHIP is funded only through 2017 and reauthorized until 2019; there are concerns about how Colorado would cover children if CHIP were eliminated. This issue brief was prepared as part of a small-scale qualitative study funded by the Colorado Health Foundation to convey recent policy developments, remaining unmet needs, and emerging issues in children's health care coverage and delivery, from the perspective of knowledgeable stakeholders. Issue briefs on children's health in California and Texas and a cross-state analysis are also available