Entwicklung von (inter-)professionellen Kompetenzen und Identität auf einer interprofessionellen Ausbildungsstation

Hintergrund: Für eine optimale Patient*innenversorgung ist eine funktionierende interprofessionelle Zusammenarbeit beteiligter Berufsgruppen, Patient*innen und Angehöriger von zentraler Bedeutung. Vorbereitend für diese Zusammenarbeit kann die Entwicklung von (inter-)professionellen Kompetenzen und (inter-)professioneller Identität durch interprofessionelle Ausbildung sein. Die Integration interprofessioneller Ausbildung und der Fokus auf Kompetenzerwerb hat in Deutschland sowohl in der Gesundheits- und Krankenpflegeausbildung, sowie auch im Studium der Humanmedizin an Bedeutung gewonnen. Mehr Möglichkeiten zur Verantwortungsübernahme und dem Erwerb praxisbezogener Kompetenzen sollen die Lernenden auf die Komplexität in der Versorgung optimal vorbereiten. Aktuell findet die Ausbildung oder das Studium jedoch noch vorwiegend monoprofessionell statt und interprofessionelle Ausbildung in klinischen Einsätzen wird noch nicht flächendeckend eingesetzt. Evaluationen interprofessioneller Ausbildungsstationen aus dem englischsprachigen und skandinavischen Raum zeigen vielversprechende Ergebnisse im Hinblick auf den Kompetenzerwerb der Lernenden, es liegen allerdings kaum Erkenntnisse zur Identitätsentwicklung auf entsprechenden Ausbildungsstationen vor. In Deutschland gibt es zu diesen Aspekten so gut wie keine Evidenz. Fragestellung: Wie entwickeln sich (inter-)professionellen Kompetenzen und Identität von Lernenden aus Pflege und Humanmedizin durch den Einsatz auf einer interprofessionellen Ausbildungsstation? Methodik: Das Forschungsdesign entspricht einer prospektiven Mixed Methods Beobachtungsstudie ohne Kontrollgruppe mit Pflegeauszubildenden und Medizinstudierenden aus 16 Kohorten, die auf der Heidelberger interprofessionellen Ausbildungsstation HIPSTA eingesetzt waren. Mit Hilfe von validierten Fragebögen aus dem englischsprachigen Raum, die die selbsteingeschätzten Kompetenzen in Kommunikation und Teamarbeit sowie die Einstellungen gegenüber interprofessionellem Lernen (UWE-IP) und interprofessioneller Zusammenarbeit und Sozialisation (ISVS) erfassen, werden die Lernenden zu drei Zeitpunkten befragt (direkt vor dem Einsatz auf der HIPSTA (T0), am Ende des HIPSTA-Einsatzes (T1) und drei Monate nach dem Einsatz (T2)). In einer Analyse anhand des gemischten linearen Modells werden die festen Effekte Zeitpunkt, Geschlecht und Berufsgruppe untersucht. Gruppeninterviews am Ende des HIPSTA Einsatzes (T1), die mit Hilfe der qualitativen Inhaltsanalyse ausgewertet werden, geben einen tieferen Einblick in die Einstellungen und Erfahrungen der Lernenden, und eine weiterführende rekonstruktive Analyse der Gruppeninterviews anhand der dokumentarischen Methode ermöglicht eine Rekonstruktion der interprofessionellen Sozialisation in den einzelnen Gruppen und eine komparative Analyse der kollektiven Orientierungsrahmen. Die qualitative Inhaltsanalyse von Einzelinterviews, die 1 – 1,5 Jahre nach dem Einsatz auf der HIPSTA durchgeführt wurden, gibt Aufschluss über die Nachhaltigkeit des Kompetenzerwerbs und der Identitätsentwicklung, sowie der Faktoren, die diese beeinflussen. Ergebnisse: Die Untersuchung hat gezeigt, dass die Lernenden der Pflege und Medizin sowohl interprofessionelle Kompetenzen, als auch professionsspezifische und teilweise auch -übergreifende Kompetenzen durch das interprofessionelle Lernen, die interprofessionelle Zusammenarbeit, das eigenverantwortliche Handeln, die Begleitung von Lernbegleiter*innen und den intensiven Patient*innenkontakt entwickelten, die auch nach bis zu 1,5 Jahren noch abrufbar sind. Auch die professionelle Identität konnte in diesem Zusammenhang weiterentwickelt werden und erste Grundlagen für die Entwicklung einer dualen Identität im Sinne einer interprofessionellen und professionellen Identität wurden gelegt. Diskussion: Die Lernenden aus Medizin und Pflege konnten durch den Einsatz auf der interprofessionellen Ausbildungsstation sowohl interprofessionelle wie auch professionsspezifische Kompetenzen erwerben. HIPSTA wurde als eine gute Vorbereitung auf den Berufseinstieg und näherten sich an ihre berufliche Rolle an. Für die nachhaltige Entwicklung einer interprofessionellen Identität und die Festigung der interprofessionellen Kompetenzen könnten das gemeinsame Reflektieren von Stereotypen und das explizite Adressieren von Hierarchien und deren Bedeutung für die Zusammenarbeit bereichernd sein. Darüber hinaus bedarf es auch in der Praxis in anderen Einsätzen im Rahmen der Berufsausbildung, sowie auch in der regulären Versorgung Strukturen, die die Zeit und den Raum geben, um interprofessionell zusammenzuarbeiten und diese Zusammenarbeit auch selbst zu gestalten, zu reflektieren und zu optimieren

Students´ perception of interprofessional education in the bachelor programme “Interprofessional Health Care” in Heidelberg, Germany: an exploratory case study

Background: Interprofessional education is receiving increased attention worldwide. This has led to the development of a bachelor programme “Interprofessional Health Care” at the University of Heidelberg, Germany beginning in the winter semester 2011. Aim of this study was to evaluate the students’ perception of this innovative programme regarding interprofessional learning. Methods: An exploratory case study was conducted. A semi-structured guideline was developed and seven focus groups were performed with the students of the first three cohorts in 2012–2014. Data was transcribed and analyzed using content analysis leading to main categories, one of which was titled “interprofessional learning”. This article presents the results focussing on the students’ experiences regarding interprofessional education and learning during their first two semesters of the programme. Results: Four main categories related to interprofessional learning were developed inductively. Students assessed “interprofessional learning” in general as positive and wished to encounter a more intense experience and collaboration with different health professions during their studies. Students reported to benefit from the programme due to a better understanding of other professions and their different perspectives. They described decreased hesitance to approach other health professions in every day practice. Results are in line with the four domains of the Interprofessional Core Competencies. Conclusion: All in all students at an early stage recognized the benefit of interprofessional learning for their studies and their everyday work in practice showing the way forward for the bachelor programme and encouraging more interprofessional encounters with students from other health care programmes

Development of individual competencies and team performance in interprofessional ward rounds: results of a study with multimodal observations at the Heidelberg Interprofessional Training Ward.

INTRODUCTION Interprofessional training wards (IPTW) aim to improve undergraduates' interprofessional collaborative practice of care. Little is known about the effects of the different team tasks on IPTW as measured by external assessment. In Heidelberg, Germany, four nursing and four medical undergraduates (= one cohort) care for up to six patients undergoing general surgery during a four-week placement. They learn both professionally and interprofessionally, working largely on their own responsibility under the supervision of the medical and nursing learning facilitators. Interprofessional ward rounds are a central component of developing individual competencies and team performance. The aim of this study was to evaluate individual competencies and team performance shown in ward rounds. METHODS Observations took place in four cohorts of four nursing and four medical undergraduates each. Undergraduates in one cohort were divided into two teams, which rotated in morning and afternoon shifts. Team 1 was on morning shift during the first (t0) and third (t1) weeks of the IPTW placement, and Team 2 was on morning shift during the second (t0) and fourth (t1) weeks. Within each team, a tandem of one nursing and one medical undergraduate cared for a patient room with three patients. Ward round observations took place with each team and tandem at t0 and t1 using the IP-VITA instrument for individual competencies (16 items) and team performance (11 items). Four hypotheses were formulated for statistical testing with linear mixed models and correlations. RESULTS A total of 16 nursing and medical undergraduates each were included. There were significant changes in mean values between t0 and t1 in individual competencies (Hypothesis 1). They were statistically significant for all three sum scores: "Roles and Responsibilities", Patient-Centeredness", and "Leadership". In terms of team performance (Hypothesis 2), there was a statistically significant change in mean values in the sum score "Roles and Responsibilities" and positive trends in the sum scores "Patient-Centeredness" and "Decision-Making/Collaborative Clinical Reasoning". Analysis of differences in the development of individual competencies in the groups of nursing and medical undergraduates (Hypothesis 3) showed more significant differences in the mean values of the two groups in t0 than in t1. There were significant correlations between individual competencies and team performance at both t0 and t1 (Hypothesis 4). DISCUSSION The study has limitations due to the small sample and some sources of bias related to the external assessment by means of observation. Nevertheless, this study offers insights into interprofessional tasks on the IPTW from an external assessment. Results from quantitative and qualitative analysis of learners self-assessment are confirmed in terms of roles and responsibilities and patient-centeredness. It has been observed that medical undergraduates acquired and applied skills in collaborative clinic reasoning and decision-making, whereas nursing undergraduates acquired leadership skills. Within the study sample, only a small group of tandems remained constant over time. In team performance, the group of constant tandems tended to perform better than the group of random tandems. The aim of IPTW should be to prepare healthcare team members for the challenge of changing teams. Therefore, implications for IPTW implementation could be to develop learning support approaches that allow medical and nursing undergraduates to bring interprofessional competencies to team performance, independent of the tandem partner or team

The impact of an interprofessional training ward on the development of interprofessional competencies: study protocol of a longitudinal mixed-methods study

Background: To meet the patients’ needs and to provide adequate health care, students need to be prepared for interprofessional collaborative practice during their undergraduate education. On interprofessional training wards (IPTW) undergraduates of various health care professions potentially develop a mutual understanding and improve their interprofessional competencies in clinical practice. To enhance collaboration of 6th-year medical students and nursing trainees in the third year of their vocational training an IPTW (Heidelberger Interprofessionelle Ausbildungsstation – HIPSTA) was implemented at the University Hospital Heidelberg, Germany. On HIPSTA future physicians and nurses take care of the patients self responsibly and in close interprofessional collaboration, supervised by facilitators of both professions. Although there are positive experiences with IPTWs internationally, little is known about the impact of IPTW on the acquisition of interprofessional competencies. For future interprofessional training and implementation of IPTWs evaluation of interprofessional learning and collaborative practice on Germany’s first IPTW is of high relevance. Methods: To evaluate the acquisition of interprofessional competencies the study follows a mixed-methods approach. Quantitative data is collected from undergraduate participants, staff participants and facilitators on HIPSTA (intervention group) and undergraduate participants and staff participants on a comparable ‘conventional’ ward without special interprofessional training (comparison group) immediately pre and post HIPSTA and, as follow-up, after three to six months (T0, T1, T2), using three questionnaires, namely the University of the West of England Interprofessional Questionnaire (UWE-IP), the Interprofessional Socialization and Valuing Scale (ISVS) and the Assessment of Interprofessional Team Collaboration Scale (AITCS). Qualitative data is gathered in form of interviews and focus groups based on semi structured guidelines, video recordings of handovers and overt non-participant observations of daily rounds. Quantitative data will be analysed in a longitudinal comparison, presented descriptively and tested with an analysis of variance. Qualitative data will be analysed deductively and inductively. Discussion: The results of the evaluation will give insight in undergraduates’, staff’s and facilitators’ experiences and their self-perception of competency development. In addition the results will help identify benefits, challenges and areas for modification when implementing and establishing similar interprofessional training wards

Diagnostic Gene Panel Testing in (Non)-Syndromic Patients with Cleft Lip, Alveolus and/or Palate in the Netherlands

Objectives: Clefts of the lip, alveolus and/or palate (CLA/P) are the most common craniofacial congenital malformations in humans. These oral clefts can be divided into non-syndromic (isolated) and syndromic forms. Many cleft-related syndromes are clinically variable and genetically heterogeneous, making it challenging to distinguish syndromic from non-syndromic cases. Recognition of syndromic/genetic causes is important for personalized tailored care, identification of (unrecognized) comorbidities, and accurate genetic counseling. Therefore, next generation sequencing (NGS)-based targeted gene panel testing is increasingly implemented in diagnostics of CLA/P patients. In this retrospective study, we assess the yield of NGS gene panel testing in a cohort of CLA/P cases.Methods: Whole exome sequencing (WES) followed by variant detection and interpretation in an a priori selected set of genes associated with CLA/P phenotypes was performed in 212 unrelated CLA/P patients after genetic counseling between 2015 and 2020. Medical records including family history and results of additional genetic tests were evaluated.Results: In 24 CLA/P cases (11.3%), a pathogenic genetic variant was identified. Twenty out of these 24 had a genetic syndrome requiring specific monitoring and follow-up. Six of these 24 cases (25%) were presumed to be isolated CLA/P cases prior to testing, corresponding to 2.8% of the total cohort. In eight CLA/P cases (3.8%) without a diagnosis after NGS-based gene panel testing, a molecular diagnosis was established by additional genetic analyses (e.g., SNP array, single gene testing, trio WES).Conclusion: This study illustrates NGS-based gene panel testing is a powerful diagnostic tool in the diagnostic workup of CLA/P patients. Also, in apparently isolated cases and non-familial cases, a genetic diagnosis can be identified. Early diagnosis facilitates personalized care for patients and accurate genetic counseling of their families.</p

Three red suns in the sky: A transiting, terrestrial planet in a triple M-dwarf system at 6.9 pc

We present the discovery from Transiting Exoplanet Survey Satellite (TESS) data of LTT 1445Ab. At a distance of 6.9 pc, it is the second nearest transiting exoplanet system found to date, and the closest one known for which the primary is an M dwarf. The host stellar system consists of three mid-to-late M dwarfs in a hierarchical configuration, which are blended in one TESS pixel. We use MEarth data and results from the Science Processing Operations Center data validation report to determine that the planet transits the primary star in the system. The planet has a radius of ${1.38}_{-0.12}^{+0.13}$ ${R}_{\oplus }$, an orbital period of ${5.35882}_{-0.00031}^{+0.00030}$ days, and an equilibrium temperature of ${433}_{-27}^{+28}$ K. With radial velocities from the High Accuracy Radial Velocity Planet Searcher, we place a 3σ upper mass limit of 8.4 ${M}_{\oplus }$ on the planet. LTT 1445Ab provides one of the best opportunities to date for the spectroscopic study of the atmosphere of a terrestrial world. We also present a detailed characterization of the host stellar system. We use high-resolution spectroscopy and imaging to rule out the presence of any other close stellar or brown dwarf companions. Nineteen years of photometric monitoring of A and BC indicate a moderate amount of variability, in agreement with that observed in the TESS light-curve data. We derive a preliminary astrometric orbit for the BC pair that reveals an edge-on and eccentric configuration. The presence of a transiting planet in this system hints that the entire system may be co-planar, implying that the system may have formed from the early fragmentation of an individual protostellar core.Accepted manuscrip

The Role of TiO2 Doping on RuO2-Coated Electrodes for the Water Oxidation Reaction

Electrochemical water splitting into H2 and O2 presents a significant and challenging energy loss due to the high overpotential required at the anode. Today, in industrially relevant applications, dimensionally stable anodes (DSA) based on the electrocatalytic active RuO2 are conventionally utilized. To enhance the resistance against corrosion, incorporation of TiO2 in the RuO2-coated electrodes is widely employed. In the present work we have used scanning electrochemical microscopy (SECM) to demonstrate that TiO2-doped RuO2-coated electrodes, in addition to being more durable, also show an electrocatalytic activity that is, on average, 13% higher as compared to the pure RuO2-coated electrodes. We also demonstrate that cracks in the pure RuO2 coating are the most active zones, probably because Ti from the Ti support has diffused into the first applied layer of the RuO2 coating. To reveal the nature of this enhanced activity for water oxidation displayed on TiO2-doped RuO2 electrodes, we have employed X-ray photoelectron spectroscopy (XPS) for material characterization. The results show that the electrocatalytic activity enhancement displayed on the mixed (Ru1–x:Tix)O2 coating is promoted through a charge transfer from the RuO2 to the TiO2, which provides new and more reactive sites designated as activated RuO2δ+.This study has partly been carried out in the framework of the European Commission FP7 Initial Training Network “ELCAT”, Grant Agreement No. 214936-2. Portions of this research were performed at SPring-8 with the approval of Japan Synchrotron Radiation Research Institute as Nanotechnology Support Project of the Ministry of Education, Culture, Sports, Science and Technology (Proposal No. 2007A2005 and 2008A1671/BL-47XU)

Two Massive Jupiters in Eccentric Orbits from the TESS Full-frame Images

We report the discovery of two short-period massive giant planets from NASA's Transiting Exoplanet Survey Satellite (TESS). Both systems, TOI-558 (TIC 207110080) and TOI-559 (TIC 209459275), were identified from the 30 minute cadence full-frame images and confirmed using ground-based photometric and spectroscopic followup observations from TESS's follow-up observing program working group. We find that TOI-558 b, which transits an F-dwarf (M-* =1.349(-0.065)(+0.064) M-circle dot, R-* =1.496(-0.040)(+0.042) R-circle dot, T-eff = 6466(-93)(+95) K, age 1.79(-0.73)(+0.91) Gyr) with an orbital period of 14.574 days, has a mass of 3.61 +/- 0.15 M-J, a radius of 1.086(-0.038)(+0.041) R-J, and an eccentric (e = 0.300(-0.020)(+0.022)) orbit. TOI-559 b transits a G dwarf (M-* = 1.026 +/- 0.057 M-circle dot, R-* =1.233(-0.026)(+0.028) R-circle dot, T-eff = 5925(-76)(+85) K, age 6.8(-2.0)(+2.5) Gyr) in an eccentric (e = 0.151 +/- 0.011) 6.984 days orbit with a mass of 6.01(-0.23)(+0.24) M-J and a radius of 1.091(-0.025+)(0.028) R-J. Our spectroscopic follow up also reveals a long-term radial velocity trend for TOI-559, indicating a long-period companion. The statistically significant orbital eccentricity measured for each system suggests that these planets migrated to their current location through dynamical interactions. Interestingly, both planets are also massive (>3 M-J), adding to the population of massive giant planets identified by TESS. Prompted by these new detections of high-mass planets, we analyzed the known mass distribution of hot and warm Jupiters but find no significant evidence for multiple populations. TESS should provide a near magnitude-limited sample of transiting hot Jupiters, allowing for future detailed population studies