Recruiting for values in healthcare: a preliminary review of the evidence

Displaying compassion, benevolence and respect, and preserving the dignity of patients are important for any healthcare professional to ensure the provision of high quality care and patient outcomes. This paper presents a structured search and thematic review of the research evidence relating to values-based recruitment within healthcare. Several different databases, journals and government reports were searched to retrieve studies relating to values-based recruitment published between 1998 and 2013, both in healthcare settings and other occupational contexts. There is limited published research related to values-based recruitment directly, so the available theoretical context of values is explored alongside an analysis of the impact of value congruence. The implications for the design of selection methods to measure values is explored beyond the scope of the initial literature search. Research suggests some selection methods may be appropriate for values-based recruitment, such as situational judgment tests (SJTs), structured interviews and multiple-mini interviews (MMIs). Personality tests were also identified as having the potential to compliment other methods (e.g. structured interviews), as part of a values-based recruitment agenda. Methods including personal statements, references and unstructured/'traditional' interviews were identified as inappropriate for values-based recruitment. Practical implications are discussed in the context of values-based recruitment in the healthcare context. Theoretical implications of our findings imply that prosocial implicit trait policies, which could be measured by selection tools such as SJTs and MMIs, may be linked to individuals' values via the behaviours individuals consider to be effective in given situations. Further research is required to state this conclusively however, and methods for values-based recruitment represent an exciting and relatively unchartered territory for further research

Remediating doctors' performance to restore patient safety: a realist review protocol.

INTRODUCTION: Underperformance by doctors poses a risk to patient safety. Remediation is an intervention designed to remedy underperformance and return a doctor to safe practice. Remediation is widely used across healthcare systems globally, and has clear implications for both patient safety and doctor retention. Yet, there is a poor evidence base to inform remediation programmes. In particular, there is a lack of understanding as to why and how a remedial intervention may work to change a doctor's practice. The aim of this research is to identify why, how, in what contexts, for whom and to what extent remediation programmes for practising doctors work to support patient safety. METHODS AND ANALYSIS: Realist review is an approach to evidence synthesis that seeks to develop programme theories about how an intervention works to produce its effects. The initial search strategy will involve: database and grey literature searching, citation searching and contacting authors. The evidence search will be extended as the review progresses and becomes more focused on the development of specific aspects of the programme theory. The development of the programme theory will involve input from a stakeholder group consisting of professional experts in the remediation process and patient representatives. Evidence synthesis will use a realist logic of analysis to interrogate data in order to develop and refine the initial programme theory into a more definitive realist programme theory of how remediation works. The study will follow and be reported according to Realist And Meta-narrative Evidence Syntheses-Evolving Standards (RAMESES). ETHICS AND DISSEMINATION: Ethical approval is not required. Our dissemination strategy will include input from our stakeholder group. Customised outputs will be developed using the knowledge-to-action cycle framework, and will be targeted to: policy-makers; education providers and regulators, the National Health Service, doctors and academics. PROSPERO REGISTRATION NUMBER: CRD42018088779

Optimising the delivery of remediation programmes for doctors: A realist review

Context: Medical underperformance puts patient safety at risk. Remediation, the process which seeks to “remedy” underperformance and return a doctor to safe practice, is therefore a crucially important area of medical education. However, while remediation is used in healthcare systems globally, there is limited evidence for the particular models or strategies employed. The purpose of this study was to conduct a realist review to ascertain why, how, in what contexts, for whom and to what extent, remediation programmes for practising doctors work to restore patient safety. Method: We conducted a realist literature review consistent with RAMESES standards. We developed a programme theory of remediation by carrying out a systematic search of the literature and through regular engagement with a stakeholder group. We searched bibliographic databases (MEDLINE, Embase, PsycINFO, HMIC, CINAHL, ERIC, ASSIA and DARE), and conducted purposive supplementary searches. Relevant sections of text relating to the programme theory were extracted and synthesised using a realist logic of analysis to identify Context‐Mechanism‐Outcome configurations (CMOcs). Results: 141 records were included. The majority of studies were from North America (64%). 29 CMOcs were identified. Remediation programmes are effective when a doctor’s insight and motivation is developed and behaviour change reinforced. Insight can be developed by providing safe spaces, using advocacy to promote trust, and framing feedback sensitively. Motivation can be enhanced by involving the doctor in remediation planning, correcting causal attribution, goal‐setting, and destigmatising remediation. Sustained change can be achieved by practising new behaviours and skills, and through guided reflection. Conclusion: Remediation can work when it creates environments that trigger behaviour change mechanisms. Our evidence synthesis provides detailed recommendations on tailoring implementation and design strategies to improve remediation interventions for doctors.</p

The educational impact of assessment: a comparison of DOPS and MCQs

Aim: To evaluate the impact of two different assessment formats on the approaches to learning of final year veterinary students. The relationship between approach to learning and examination performance was also investigated. Method: An 18-item version of the Study Process Questionnaire (SPQ) was sent to 87 final year students. Each student responded to the questionnaire with regards to DOPS (Direct Observation of Procedural Skills) and a Multiple Choice Examination (MCQ). Semi-structured interviews were conducted with 16 of the respondents to gain a deeper insight into the students’ perception of assessment. Results: Students’ adopted a deeper approach to learning for DOPS and a more surface approach with MCQs. There was a positive correlation between an achieving approach to learning and examination performance. Analysis of the qualitative data revealed that deep, surface and achieving approaches were reported by the students and seven major influences on their approaches to learning were identified: motivation, purpose, consequence, acceptability, feedback, time pressure and the individual difference of the students. Conclusions: The format of DOPS has a positive influence on approaches to learning. There is a conflict for students between preparing for final examinations and preparing for clinical practice

The importance of the exposome and allostatic load in the planetary health paradigm

In 1980, Jonas Salk (1914-1995) encouraged professionals in anthropology and related disciplines to consider the interconnections between "planetary health," sociocultural changes associated with technological advances, and the biology of human health. The concept of planetary health emphasizes that human health is intricately connected to the health of natural systems within the Earth's biosphere; experts in physiological anthropology have illuminated some of the mechanisms by which experiences in natural environments (or the built environment) can promote or detract from health. For example, shinrin-yoku and related research (which first emerged from Japan in the 1990s) helped set in motion international studies that have since examined physiological responses to time spent in natural and/or urban environments. However, in order to advance such findings into planetary health discourse, it will be necessary to further understand how these biological responses (inflammation and the collective of allostatic load) are connected to psychological constructs such as nature relatedness, and pro-social/environmental attitudes and behaviors. The exposome refers to total environmental exposures-detrimental and beneficial-that can help predict biological responses of the organism to environment over time. Advances in "omics" techniques-metagenomics, proteomics, metabolomics-and systems biology are allowing researchers to gain unprecedented insight into the physiological ramifications of human behavior. Objective markers of stress physiology and microbiome research may help illuminate the personal, public, and planetary health consequences of "extinction of experience." At the same time, planetary health as an emerging multidisciplinary concept will be strengthened by input from the perspectives of physiological anthropology.Peer reviewe

In-training assessment using direct observation of single-patient encounters: a literature review

We reviewed the literature on instruments for work-based assessment in single clinical encounters, such as the mini-clinical evaluation exercise (mini-CEX), and examined differences between these instruments in characteristics and feasibility, reliability, validity and educational effect. A PubMed search of the literature published before 8 January 2009 yielded 39 articles dealing with 18 different assessment instruments. One researcher extracted data on the characteristics of the instruments and two researchers extracted data on feasibility, reliability, validity and educational effect. Instruments are predominantly formative. Feasibility is generally deemed good and assessor training occurs sparsely but is considered crucial for successful implementation. Acceptable reliability can be achieved with 10 encounters. The validity of many instruments is not investigated, but the validity of the mini-CEX and the ‘clinical evaluation exercise’ is supported by strong and significant correlations with other valid assessment instruments. The evidence from the few studies on educational effects is not very convincing. The reports on clinical assessment instruments for single work-based encounters are generally positive, but supporting evidence is sparse. Feasibility of instruments seems to be good and reliability requires a minimum of 10 encounters, but no clear conclusions emerge on other aspects. Studies on assessor and learner training and studies examining effects beyond ‘happiness data’ are badly needed

The reliability of in-training assessment when performance improvement is taken into account

During in-training assessment students are frequently assessed over a longer period of time and therefore it can be expected that their performance will improve. We studied whether there really is a measurable performance improvement when students are assessed over an extended period of time and how this improvement affects the reliability of the overall judgement. In-training assessment results were obtained from 104 students on rotation at our university hospital or at one of the six affiliated hospitals. Generalisability theory was used in combination with multilevel analysis to obtain reliability coefficients and to estimate the number of assessments needed for reliable overall judgement, both including and excluding performance improvement. Students’ clinical performance ratings improved significantly from a mean of 7.6 at the start to a mean of 7.8 at the end of their clerkship. When taking performance improvement into account, reliability coefficients were higher. The number of assessments needed to achieve a reliability of 0.80 or higher decreased from 17 to 11. Therefore, when studying reliability of in-training assessment, performance improvement should be considered

The Dust & Gas Properties of M83

We examine the dust and gas properties of the nearby, barred galaxy M83, which is part of the Very Nearby Galaxy Survey. Using images from the PACS and SPIRE instruments of Herschel, we examine the dust temperature and dust mass surface density distribution. We find that the nuclear, bar and spiral arm regions exhibit higher dust temperatures and masses compared to interarm regions. However, the distribution of dust temperature and mass are not spatially coincident. Assuming a trailing spiral structure, the dust temperature peaks in the spiral arms lie ahead of the dust surface density peaks. The dust mass surface density correlates well with the distribution of molecular gas as traced by CO (J=3-2) images (JCMT) and the star formation rate as traced by H?2 with a correction for obscured star formation using 24 micron emission. Using HI images from THINGS to trace the atomic gas component, we make total gas mass surface density maps and calculate the gas-to-dust ratio. We find a mean gas-to-dust ratio of 84 \pm 4 with higher values in the inner region assuming a constant CO-to-H2 conversion factor. We also examine the gas-to-dust ratio using CO-to-H2 conversion factor that varies with metallicity.Comment: 13 pages, 13 figures, accepted to MNRA

Investigations of dust heating in M81, M83, and NGC 2403 with the Herschel Space Observatory

We use Spitzer Space Telescope and Herschel Space Observatory far-infrared data along with ground-based optical and near-infrared data to understand how dust heating in the nearby face-on spiral galaxies M81, M83, and NGC 2403 is affected by the starlight from all stars and by the radiation from star forming regions. We find that 70/160 micron surface brightness ratios tend to be more strongly influenced by star forming regions. However, the 250/350 micron and 350/500 micron surface brightness ratios are more strongly affected by the light from the total stellar populations, suggesting that the dust emission at >250 microns originates predominantly from a component that is colder than the dust seen at <160 microns and that is relatively unaffected by star formation activity. We conclude by discussing the implications of this for modelling the spectral energy distributions of both nearby and more distant galaxies and for using far-infrared dust emission to trace star formation.Comment: 28 pages, 17 figures, accepted for publication in MNRA