Needs Assessment in Postgraduate Medical Education:A Review

Although the concept of needs assessment in continuing medical education is well accepted, there is limited information on needs assessment in postgraduate medical education. We discuss the learning needs of postgraduate trainees and review the various methods of needs assessment such as: questionnaire surveys, interviews, focus groups, chart audits, chart-stimulated recall, standardized patients, and environmental scans in the context of post graduate medical education

Robert Louis Stevenson’s South Seas Writing: Its Production and Context within the Victorian Study of Culture

The thesis is split into two parts. The first part investigates the production, reception, and reconstruction of Robert Louis Stevenson's South Seas writing during his travels there in the years 1888-91, and its subsequent publication as In the South Seas in 1896. The second part concentrates on the findings that Stevenson makes during his Pacific travels in respect of the discourses of culture that shape the academic sciences of his day. The writing that Stevenson produces for his 'Big Book' on the cultures of the Pacific Islands is among the least-examined of all his works. His book of travel, In the South Seas, is published posthumously and contains material that is presented in a way that is not intended by the author. In the present study the reasons for this situation are investigated, and the work that the author intends to produce is recovered on the basis of the plans, notes, and photographs which remain from the period of his travels. The reconstructed work is then compared with the published volume of In the South Seas to show the extent to which textual mutilation and re-editing has significantly altered the meaning of Stevenson's original writing. In the South Seas is a text that is re-shaped by his editor in order to satisfy what is seen as a Victorian readership's desire for sentimental voyaging. Stevenson's writing is then read within the context of the Victorian study of culture as represented by Edward Burnett Tylor, to show his engagement with and criticism of some of Tylor's theories. Finally, the South Seas writing is framed within the perspective of Stevenson's reading of GWF Hegel, showing the extent to which his observations on Pacific landscapes and cultures are informed by Hegel's discussion of the antinomies of Immanuel Kant

Pain in Children: Assessment and Nonpharmacological Management

Pain perception in children is complex, and is often difficult to assess. In addition, pain management in children is not always optimized in various healthcare settings, including emergency departments. A review of pain assessment scales that can be used in children across all ages, and a discussion of the importance of pain in control and distraction techniques during painful procedures are presented. Age specific nonpharmacological interventions used to manage pain in children are most effective when adapted to the developmental level of the child. Distraction techniques are often provided by nurses, parents or child life specialists and help in pain alleviation during procedures

Continuing medical education as a national strategy to improve access to primary care in Saudi Arabia

The purpose of this study was to describe the development, implementation, and evaluation of an educational program in family medicine for general practitioners in Saudi Arabia from 2009 to 2011. A continuing medical education program called Family Medicine Education (FAME) was developed with 7 modules each consisting of 12-14 hours of teaching to be delivered in 3 day blocks, over 45 days. Twenty percent (2,761) of all general practitioners participated in the FAME program. Initial assessment of the program showed significant improvement of knowledge from scores of 49% on a pre-test to 89% on post-tests. FAME program in Saudi Arabia facilitated primary care physicians’ knowledge

Frederic Rogers, Oxford Movement Ecclesiology, and British Imperial Thought

The article aims to show the value of taking ecclesiology – the theology of the church – into account in the study of British imperial ideology by describing how Anglican intra-ecclesiological debates shaped mid-nineteenth-century discourse about the British Empire. It highlights the impact of the Oxford Movement on the mind of the British colonial administrator Sir Frederic Rogers, Lord Blachford (1811-1889), by revealing the connections between his imperial thought and concepts arising from Tractarian ecclesiology. In particular, it argues that Rogers’ understanding of British colonial development builds on Tractarian ideas of balance and consistency. By retaining a sense of the importance of the historic connection with the colonies of settlement while respecting their right to be free, Rogers constituted the imperial relationship as a via media.Cet article vise à montrer l'intérêt de prendre en compte l'ecclésiologie - la théologie de l'Église - dans l'étude de l'idéologie impériale britannique en décrivant comment les débats intra-ecclésiologiques anglicans ont façonné le discours du milieu du dix-neuvième siècle sur l'Empire britannique. Il met en lumière l'impact du Mouvement d'Oxford sur l'esprit de l'administrateur colonial britannique Sir Frederic Rogers, Lord Blachford (1811-1889), en révélant les liens entre sa pensée impériale et les concepts issus de l'ecclésiologie tractarienne. En particulier, l'article démontre que la compréhension du développement colonial britannique par Rogers s'appuie sur les idées tractariennes d'équilibre et de cohérence. En conservant le sens de l'importance du lien historique avec les colonies de peuplement tout en respectant leur droit à la liberté, Rogers a constitué la relation impériale comme une via media

Teaching Residents to Teach: Do Program Directors and Trainees Agree on Format and Content?

Background: Despite the important number of teaching-skills programs described in the literature, previous needs assessment of such curricula have examined primarily residents’ perceived learning needs in this field. The purpose of this study was to identify the optimal content and format of a resident teaching-skills training curriculum and compare the perspective of medical students (MS), residents and residency program directors (PD).Methods: This needs assessment was an observational study with a cross-sectional design. Online or printed questionnaires were used to assess the preferred format and content for this curriculum among MS, residents from most postgraduate medical training programs, and PD from Faculté de médecine de l’Université Laval. Results: The questionnaires were completed by 26 PD (response rate 72.2%), 146 residents (response rate 21.9%) and 154 MS (response rate 15.7%). Among the list of potential subjects that could be included in the curriculum, Learning styles, Working with students in difficulty and Self-directed learning were scored high by both residents and PD. MS favored Learning styles, Teaching in the ambulatory care setting, Teaching health promotion and prevention, Teaching with time constraints and Direct supervision strategies. PD also favored Teaching conflict management and Teaching professionalism, however these were both among the residents’ lower scores. The preferred formats were One half-day, One day and Online learning for PD and One day, Two consecutive days and A few one-day sessions over several months for residents. Conclusion: The PD and MS perception of the optimal format and content for residents’ teaching-skills training showed some discrepancies when compared with residents’ preferences. Since PD are largely involved in curriculum development for their respective specialties and since MS are also well positioned to assess residents’ teaching performance, we suggest that PD, residents and MS should all be consulted locally before organizing any intervention for teaching curricula

Structured sedation programs in the emergency department, hospital and other acute settings: protocol for systematic review of effects and events.

BACKGROUND: The use of procedural sedation outside the operating theatre has increased in hospital settings and has gained popularity among non-anesthesiologists. Sedative agents used for procedural pain, although effective, also pose significant risks to the patient if used incorrectly. There is currently no universally accepted program of education for practitioners using or introducing procedural sedation into their practice. There is emerging literature identifying structured procedural sedation programs (PSPs) as a method of ensuring a standardized level of competency among staff and reducing risks to the patient. We hypothesize that programs of education for healthcare professionals using procedural sedation outside the operating theatre are beneficial in improving patient care, safety, practitioner competence and reducing adverse event rates. METHODS: Electronic databases will be systematically searched for studies (randomized and non-randomized) examining the effectiveness of structured PSPs from 1966 to present. Database searches will be supplemented by contact with experts, reference and citation checking, and a grey literature search. No language restriction will be imposed. Screening of titles and abstracts, and data extraction will be performed by two independent reviewers. All disagreements will be resolved by discussion with an independent third party. Data analysis will be completed adhering to procedures outlined in the Cochrane Handbook of Systematic Reviews of Interventions. If the data allows, a meta-analysis will be performed. DISCUSSION: This review will cohere evidence on the effectiveness of structured PSPs on sedation events and patient outcomes within the hospital and other acute care settings. In addition, it will examine key components identified within a PSP associated with patient safety and improved patient outcomes.Trial registration: PROSPERO registration number: CRD42013003851

Improving Empathy in Healthcare Consultations-a Secondary Analysis of Interventions.

A recent systematic review of randomised trials suggested that empathic communication improves patient health outcomes. However, the methods for training healthcare practitioners (medical professionals; HCPs) in empathy and the empathic behaviours demonstrated within the trials were heterogeneous, making the evidence difficult to implement in routine clinical practice. In this secondary analysis of seven trials in the review, we aimed to identify (1) the methods used to train HCPs, (2) the empathy behaviours they were trained to perform and (3) behaviour change techniques (BCTs) used to encourage the adoption of those behaviours. This detailed understanding of interventions is necessary to inform implementation in clinical practice. We conducted a content analysis of intervention descriptions, using an inductive approach to identify training methods and empathy behaviours and a deductive approach to describe the BCTs used. The most commonly used methods to train HCPs to enhance empathy were face-to-face training (n = 5), role-playing (n = 3) and videos (self or model; n = 3). Duration of training was varied, with both long and short training having high effect sizes. The most frequently targeted empathy behaviours were providing explanations of treatment (n = 5), providing non-specific empathic responses (e.g. expressing understanding) and displaying a friendly manner and using non-verbal behaviours (e.g. nodding, leaning forward, n = 4). The BCT most used to encourage HCPs to adopt empathy behaviours was "Instruction on how to perform behaviour" (e.g. a video demonstration, n = 5), followed by "Credible source" (e.g. delivered by a psychologist, n = 4) and "Behavioural practice" (n = 3 e.g. role-playing). We compared the effect sizes of studies but could not extrapolate meaningful conclusions due to high levels of variation in training methods, empathy skills and BCTs. Moreover, the methods used to train HCPs were often poorly described which limits study replication and clinical implementation. This analysis of empathy training can inform future research, intervention reporting standards and clinical practice

Development of a Training Needs Assessment for an Education Scholarship Fellowship in Emergency Medicine

At the 2012 Academic Emergency Medicine consensus conference, “Education Research in Emergency Medicine: Opportunities, Challenges, and Strategies for Success,” a breakout session convened to discuss postgraduate fellowship training in emergency medicine ( EM ), which would focus on education research. Graduates will form a growing cadre of education scholars who conduct and publish quality education research. This proceedings article reports the consensus findings of a breakout session subgroup whose goal was to construct a needs assessment for the proposed 2‐year education scholarship fellowship. The authors describe, based on expert and participant consensus, a framework for a large‐scale, mixed‐methods needs assessment for such a fellowship.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/95526/1/acem12035.pd

Documentation of best interest by intensivists: a retrospective study in an Ontario critical care unit

<p>Abstract</p> <p>Background</p> <p>Intensive care physicians often must rely on substitute decision makers to address all dimensions of the construct of "best interest" for incapable, critically ill patients. This task involves identifying prior wishes and to facilitate the substitute decision maker's understanding of the incapable patient's condition and their likely response to treatment. We sought to determine how well such discussions are documented in a typical intensive care unit.</p> <p>Methods</p> <p>Using a quality of communication instrument developed from a literature search and expert opinion, 2 investigators transcribed and analyzed 260 handwritten communications for 105 critically ill patients who died in the intensive care unit between January and June 2006. Cohen's kappa was calculated before analysis and then disagreements were resolved by consensus. We report results on a per-patient basis to represent documented communication as a process leading up to the time of death in the ICU. We report frequencies and percentages for discrete data, median (m) and interquartile range (IQR) for continuous data.</p> <p>Results</p> <p>Our cohort was elderly (m 72, IQR 58-81 years) and had high APACHE II scores predictive of a high probability of death (m 28, IQR 23-36). Length of stay in the intensive care unit prior to death was short (m 2, IQR 1-5 days), and withdrawal of life support preceded death for more than half (n 57, 54%). Brain death criteria were present for 18 patients (17%). Although intensivists' communications were timely (median 17 h from admission to critical care), the person consenting on behalf of the incapable patient was explicitly documented for only 10% of patients. Life support strategies at the time of communication were noted in 45% of charts, and options for their future use were presented in 88%. Considerations relevant to determining the patient's best interest in relation to the treatment plan were not well documented. While explicit survival estimates were noted in 50% of charts, physicians infrequently documented their own predictions of the patient's functional status (20%), anticipated need for chronic care (0%), or post ICU quality of life (3%). Similarly, documentation of the patient's own perspectives on these ranged from 2-18%.</p> <p>Conclusions</p> <p>Intensivists' documentation of their communication with substitute decision makers frequently outlined the proposed plan of treatment, but often lacked evidence of discussion relevant to whether the treatment plan was expected to improve the patient's condition. Legislative standards for determination of best interest, such as the Health Care Consent Act in Ontario, Canada, may provide guidance for intensivists to optimally document the rationales for proposed treatment plans.</p