Report 4: The Dissemination Potential of a European Network

The report that follows represents an extraordinary and unique exchange of information. Unfolding here are the capabilities for dissemination and exploitation in the EU-funded Thematic Network ‘Dietitians Implementing Education and Training Standards’ in Europe (DIETS). At the beginning of the Network there were 112 Partners and about 500 registered users of the DIETS website, but over a three-year period this has increased to 123 Partners and well over 1000 users. The activity of these Partners and their determination to publicise the Network and, more importantly, the role of the dietitian, has been immense and sometimes difficult to capture. However, captured in this report are the learning and change to practice that has resulted, as well as closer engagement between HEIs and their dietetic departments across Europe. Some of the good practice described here will be of value to others starting this type of journey. This network of HEIs, their dietetic colleagues and others will endure long after the DIETS Network has finished its work, largely due to the enthusiasm of the Partners and the social network that has been built and embedded. The ultimate benefit to dietitians, through education, lifelong learning and their contribution to nutritional health in Europe will continue to unfold

Rating Communication in GP Consultations: The Association Between Ratings Made by Patients and Trained Clinical Raters.

Patient evaluations of physician communication are widely used, but we know little about how these relate to professionally agreed norms of communication quality. We report an investigation into the association between patient assessments of communication quality and an observer-rated measure of communication competence. Consent was obtained to video record consultations with Family Practitioners in England, following which patients rated the physician's communication skills. A sample of consultation videos was subsequently evaluated by trained clinical raters using an instrument derived from the Calgary-Cambridge guide to the medical interview. Consultations scored highly for communication by clinical raters were also scored highly by patients. However, when clinical raters judged communication to be of lower quality, patient scores ranged from "poor" to "very good." Some patients may be inhibited from rating poor communication negatively. Patient evaluations can be useful for measuring relative performance of physicians' communication skills, but absolute scores should be interpreted with caution.The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was funded by a National Institute for Health Research Programme Grant for Applied Research (NIHR PGfAR) program (RP-PG-0608-10050).This is the final version of the article. It first appeared from SAGE via http://dx.doi.org/10.1177/107755871667121

Understanding high and low patient experience scores in primary care: analysis of patients' survey data for general practices and individual doctors.

OBJECTIVES: To determine the extent to which practice level scores mask variation in individual performance between doctors within a practice. DESIGN: Analysis of postal survey of patients' experience of face-to-face consultations with individual general practitioners in a stratified quota sample of primary care practices. SETTING: Twenty five English general practices, selected to include a range of practice scores on doctor-patient communication items in the English national GP Patient Survey. PARTICIPANTS: 7721 of 15,172 patients (response rate 50.9%) who consulted with 105 general practitioners in 25 practices between October 2011 and June 2013. MAIN OUTCOME MEASURE: Score on doctor-patient communication items from post-consultation surveys of patients for each participating general practitioner. The amount of variance in each of six outcomes that was attributable to the practices, to the doctors, and to the patients and other residual sources of variation was calculated using hierarchical linear models. RESULTS: After control for differences in patients' age, sex, ethnicity, and health status, the proportion of variance in communication scores that was due to differences between doctors (6.4%) was considerably more than that due to practices (1.8%). The findings also suggest that higher performing practices usually contain only higher performing doctors. However, lower performing practices may contain doctors with a wide range of communication scores. CONCLUSIONS: Aggregating patients' ratings of doctors' communication skills at practice level can mask considerable variation in the performance of individual doctors, particularly in lower performing practices. Practice level surveys may be better used to "screen" for concerns about performance that require an individual level survey. Higher scoring practices are unlikely to include lower scoring doctors. However, lower scoring practices require further investigation at the level of the individual doctor to distinguish higher and lower scoring general practitioners.This work was funded by a National Institute for Health Research Programme Grant for Applied Research (NIHR PGfAR) programme (RP-PG-0608-10050). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health.This is the final published article. It first appeared at http://www.bmj.com/content/349/bmj.g6034

Report 1: building a technologically informed information and communication network in europe

This report represents an extraordinary and unique exchange of information across Europe through the creation of a website and learning how to use technology more effectively. Over the three-year period the capabilities conducted as part the EU funded Thematic Network „Dietitians Implementing Education and Training Standards‟ in Europe (DIETS) are presented here. The number of users registered to access the intranet (password-protected) section of the website grew rapidly from 0 at launch to 965 by the end of the third year. A great deal of learning and change to practice has resulted as well as closer engagement between HEIs and their dietetic departments across Europe. This Network of HEIs and their dietetic colleagues will endure long after the DIETS Network has finished its work, largely due to the enhanced ITC capabilities. The ultimate benefit to the dietetic profession, their education and lifelong learning and their contribution to nutritional health in Europe will continue to unfol

Wikis, blogs and podcasts: a new generation of Web-based tools for virtual collaborative clinical practice and education

BACKGROUND: We have witnessed a rapid increase in the use of Web-based 'collaborationware' in recent years. These Web 2.0 applications, particularly wikis, blogs and podcasts, have been increasingly adopted by many online health-related professional and educational services. Because of their ease of use and rapidity of deployment, they offer the opportunity for powerful information sharing and ease of collaboration. Wikis are Web sites that can be edited by anyone who has access to them. The word 'blog' is a contraction of 'Web Log' – an online Web journal that can offer a resource rich multimedia environment. Podcasts are repositories of audio and video materials that can be "pushed" to subscribers, even without user intervention. These audio and video files can be downloaded to portable media players that can be taken anywhere, providing the potential for "anytime, anywhere" learning experiences (mobile learning). DISCUSSION: Wikis, blogs and podcasts are all relatively easy to use, which partly accounts for their proliferation. The fact that there are many free and Open Source versions of these tools may also be responsible for their explosive growth. Thus it would be relatively easy to implement any or all within a Health Professions' Educational Environment. Paradoxically, some of their disadvantages also relate to their openness and ease of use. With virtually anybody able to alter, edit or otherwise contribute to the collaborative Web pages, it can be problematic to gauge the reliability and accuracy of such resources. While arguably, the very process of collaboration leads to a Darwinian type 'survival of the fittest' content within a Web page, the veracity of these resources can be assured through careful monitoring, moderation, and operation of the collaborationware in a closed and secure digital environment. Empirical research is still needed to build our pedagogic evidence base about the different aspects of these tools in the context of medical/health education. SUMMARY AND CONCLUSION: If effectively deployed, wikis, blogs and podcasts could offer a way to enhance students', clinicians' and patients' learning experiences, and deepen levels of learners' engagement and collaboration within digital learning environments. Therefore, research should be conducted to determine the best ways to integrate these tools into existing e-Learning programmes for students, health professionals and patients, taking into account the different, but also overlapping, needs of these three audience classes and the opportunities of virtual collaboration between them. Of particular importance is research into novel integrative applications, to serve as the "glue" to bind the different forms of Web-based collaborationware synergistically in order to provide a coherent wholesome learning experience

The feasibility of collecting information from people with Multiple Sclerosis for the UK MS Register via a web portal: characterising a cohort of people with MS.

BACKGROUND: A UK Register of people with Multiple Sclerosis has been developed to address the need for an increased knowledge-base about MS. The Register is being populated via: a web-based portal; NHS neurology clinical systems; and administrative data sources. The data are de-identified and linked at the individual level. At the outset, it was not known whether people with MS would wish to participate in the UK MS Register by personally contributing their data to the Register via a web-based system. Therefore, the research aim of this work was to build an internet-mounted recruitment and consenting technology for people with Multiple Sclerosis, and to assess its feasibility as a questionnaire delivery platform to contribute data to the UK MS Register, by determining whether the information provided could be used to describe a cohort of people with MS. METHODS: The web portal was developed using VB.net and JQuery with a Microsoft SQL 2008 database. UK adults with MS can self-register and enter data about themselves by completing validated questionnaires. Descriptive statistics were used to characterise the respondents. RESULTS: The web portal was launched in May 2011, and in first three months 7,279 individuals registered on the portal. The ratio of men to women was 1:2.4 (n = 5,899), the mean self-reported age at first symptoms was 33.8 (SD 10.5) years, and at diagnosis 39.6 (SD 10.3) years (n = 4,401). The reported types of MS were: 15% primary progressive, 63% relapsing-remitting, 8% secondary progressive, and 14% unknown (n = 5,400). These characteristics are similar to those of the prevalent MS population. Employment rates, sickness/disability rates, ethnicity and educational qualifications were compared with the general UK population. Information about the respondents' experience of early symptoms and the process of diagnosis, plus living arrangements are also reported. CONCLUSIONS: These initial findings from the MS Register portal demonstrate the feasibility of collecting data about people with MS via a web platform, and show that sufficient information can be gathered to characterise a cohort of people with MS. The innovative design of the UK MS register, bringing together three disparate sources of data, is creating a rich resource for research into this condition

Using information technology to share experiences and enhance communication skills 2006-2009

This report follows the unique exchange of information across Europe that took place through visits conducted as part the EU-funded Thematic Network ‘Dietitians Implementing Education and Training Standards’ in Europe (DIETS). A great deal of learning and change to practice was anecdotally reported from the face-to-face visits. These will take time to implement following focussed reflection. This report attempts to capture some of these reflections. Reflection across great distances was an environmental and resource challenge. The meetings were therefore conducted ‘virtually’ using information technology available to the Partners. This had the added advantage of improving further the ITC skills of the Partners. Finally, students were encouraged to undertake joint meetings or seminars and these are also reported. Using ITC successfully, and building the confidence of Partners, has increased the capabilities of the Network of HEIs and their dietetic practice placement colleagues. These improvements will endure long after the DIETS Network has finished its work. The ultimate benefit to the dietitians, through education, lifelong learning and their contribution to nutritional health in Europe will continue to unfold.Tunings Educational Structures in Europe Erasmus Thematic Networks (Socrates