Squaring the circle: a priority-setting method for evidence-based service development, reconciling research with multiple stakeholder views.

BACKGROUND: This study demonstrates a technique to aid the implementation of research findings through an example of improving services and self-management in longer-term depression. In common with other long-term conditions, policy in this field requires innovation to be undertaken in the context of a whole system of care, be cost-effective, evidence-based and to comply with national clinical guidelines. At the same time, successful service development must be acceptable to clinicians and service users and choices must be made within limited resources. This paper describes a novel way of resolving these competing requirements by reconciling different sources and types of evidence and systematically engaging multiple stakeholder views. METHODS: The study combined results from mathematical modelling of the care pathway, research evidence on effective interventions and findings from qualitative research with service users in a series of workshops to define, refine and select candidate service improvements. A final consensus-generating workshop used structured discussion and anonymised electronic voting. This was followed by an email survey to all stakeholders, to achieve a pre-defined criterion of consensus for six suggestions for implementation. RESULTS: An initial list of over 20 ideas was grouped into four main areas. At the final workshop, each idea was presented in person, visually and in writing to 40 people, who assigned themselves to one or more of five stakeholder groups: i) service users and carers, ii) clinicians, iii) managers, iv) commissioners and v) researchers. Many belonged to more than one group. After two rounds of voting, consensus was reached on seven ideas and one runner up. The survey then confirmed the top six ideas to be tested in practice. CONCLUSIONS: The method recruited and retained people with diverse experience and views within a health community and took account of a full range of evidence. It enabled a diverse group of stakeholders to travel together in a direction that converged with the messages coming out of the research and successfully yielded priorities for service improvement that met competing requirements

Procedural Medical Training in VR in a Smart Virtual University Hospital

A smart virtual university hospital representing a real-life one, can prepare students for direct patient contact and provide possibilities for clinical practice. Such a virtual hospital will support student learning by providing adaptive and flexible solutions for practicing a variety of clinical situations at the students’ own pace. This paper builds on a previous research on the Smart Virtual University concept and explores the possibilities for medical procedural training with Virtual Reality. A scenario focusing on pre-operative neurosurgical procedural training was developed and tested. The procedural training has been enhanced with real world medical data (MRI and ultrasound). The feedbacks from the tests have been generally positive, both in terms of general user experience and expected learning outcomes. The paper presents the implementation procedure, evaluation results and outlines the directions for future work.acceptedVersio

Procedural Medical Training in VR in a Smart Virtual University Hospital

A smart virtual university hospital representing a real-life one, can prepare students for direct patient contact and provide possibilities for clinical practice. Such a virtual hospital will support student learning by providing adaptive and flexible solutions for practicing a variety of clinical situations at the students’ own pace. This paper builds on a previous research on the Smart Virtual University concept and explores the possibilities for medical procedural training with Virtual Reality. A scenario focusing on pre-operative neurosurgical procedural training was developed and tested. The procedural training has been enhanced with real world medical data (MRI and ultrasound). The feedbacks from the tests have been generally positive, both in terms of general user experience and expected learning outcomes. The paper presents the implementation procedure, evaluation results and outlines the directions for future work