A survey of the clinical acceptability of screening for postnatal depression in depressed and non-depressed women

BACKGROUND: Information on clinical acceptability is needed when making cost-utility decisions about health screening implementation. Despite being in use for two decades, most data on the clinical acceptability of the Edinburgh Postnatal Depression Scale (EPDS) come from qualitative reports, or include relatively small samples of depressed women. This study aimed to measure acceptability in a survey of a relatively large, community sample with a high representation of clinically depressed women. METHODS: Using mail, telephone and face-to-face interview, 920 postnatal women were approached to take part in a survey on the acceptability of the EPDS, including 601 women who had screened positive for depression and 245 who had received DSM-IV diagnoses of depression. Acceptability was measured on a 5-point Likert scale of comfort ranging from "Not Comfortable", through "Comfortable" to "Very Comfortable". RESULTS: The response rate was just over half for postal surveys (52%) and was 100% for telephone and face-to-face surveys (432, 21 and 26 respondents for postal, telephone and face-to-face surveys respectively) making 479 respondents in total. Of these, 81.2% indicated that screening with the EPDS had been in the range of "Comfortable" to "Very Comfortable". The other 18.8 % rated screening below the "Comfortable" point, including a small fraction (4.3%) who rated answering questions on the EPDS as "Not Comfortable" at the extreme end of the scale. Comfort was inversely related to EPDS score, but the absolute size of this effect was small. Almost all respondents (97%) felt that screening was desirable. CONCLUSION: The EPDS had good acceptability in this study for depressed and non-depressed women. Women's views on the desirability of postnatal depression screening appear to be largely independent of personal level of comfort with screening. These results should be useful to policy-makers and are broadly supportive of the Edinburgh Postnatal Depression Scale as a suitable tool for universal perinatal depression screening

Monitoring progression of clinical reasoning skills during health sciences education using the case method - A qualitative observational study

Background: Outcome- or competency-based education is well established in medical and health sciences education. Curricula are based on courses where students develop their competences and assessment is also usually course-based. Clinical reasoning is an important competence, and the aim of this study was to monitor and describe students' progression in professional clinical reasoning skills during health sciences education using observations of group discussions following the case method. Methods: In this qualitative study students from three different health education programmes were observed while discussing clinical cases in a modified Harvard case method session. A rubric with four dimensions - problem-solving process, disciplinary knowledge, character of discussion and communication - was used as an observational tool to identify clinical reasoning. A deductive content analysis was performed. Results: The results revealed the students' transition over time from reasoning based strictly on theoretical knowledge to reasoning ability characterized by clinical considerations and experiences. Students who were approaching the end of their education immediately identified the most important problem and then focused on this in their discussion. Practice knowledge increased over time, which was seen as progression in the use of professional language, concepts, terms and the use of prior clinical experience. The character of the discussion evolved from theoretical considerations early in the education to clinical reasoning in later years. Communication within the groups was supportive and conducted with a professional tone. Conclusions: Our observations revealed progression in several aspects of students' clinical reasoning skills on a group level in their discussions of clinical cases. We suggest that the case method can be a useful tool in assessing quality in health sciences education

Occupational therapy students' experiences in learning occupation-centred approaches to working with children

Background. The increasing emphasis on performance outcomes and the use of occupation-centred approaches has implications for practice education. Purpose. This study aimed to describe students' experiences of learning to use occupation-centred approaches when working with children within a university clinic. Methods. Nine occupational therapy students and two clinical educators completed three indepth interviews at intervals across the students' fieldwork experiences. Therapy observations, review of therapy documentation, and tutorial group e-mails informed data triangulation. Thematic analysis was used to identify key themes. Findings. Students described needing to make a theoretical shift in thinking to focus on occupational performance and identified a number of challenges relating to learning complex techniques and strategies. Implications. Teaching methods that assist in making occupation-centred assessment and intervention techniques more explicit and learner-friendly for new users are required. These findings provide valuable new insights in guiding this process