Recommendations from recent graduates in medicine, nursing and pharmacy on improving interprofessional education in university programs: A qualitative study

Background: Interprofessional education (IPE) has been recognized as an innovative approach for the development of a collaborative, practice-ready health workforce, but is not used consistently in undergraduate health professional programs. We sought to explore the reflections of graduates on the IPE experiences they had during their undergraduate education and training. It was anticipated that having completed their pre-vocational education and spent up to two years working in a clinical environment, recent graduates would be well-placed to provide insights into the value of the IPE opportunities they had, and to suggest approaches for improving these opportunities in undergraduate programs. Methods. This study was part of a larger research project (Interprofessional Education for the Quality use of Medicines; IPE for QuM) which used focus groups as part of an interpretive research design to inform other aspects of the research. Here, we report on focus groups with recent graduates recruited from area health services across Australia. Results: Sixty-eight recent graduates working in New South Wales, Western Australia, and Tasmania participated in 12 focus group sessions. In this paper, we report on new graduates' reflections on their experiences of IPE as part of their university degree, as well as their recommendations to improve interprofessional education before graduation. The new graduates were unanimous in valuing IPE from their current perspective of being in the health workforce. Most IPE experiences recalled were regarded as positive, but those valued most highly were experiences that involved genuine engagement and opportunities to interact with students in other professions working on a relevant problem. Clinical placement was a missed opportunity with few structured meaningful interprofessional learning experiences. Surprisingly there was little social contact between professions in universities even when programs were co-located, thus reinforcing professional silos. Conclusions: The graduates provided many insightful reflections about the value of university-based IPE and their preparedness for clinical practice. Although universally acclaimed as a good idea there is much room for improvement. We put forward a set of suggestions to improve IPE and guide the design of future IPE efforts. © 2014 Gilligan et al.; licensee BioMed Central Ltd

Impact of admission screening for methicillin-resistant Staphylococcus aureus on the length of stay in an emergency department.

Preventing and controlling methicillin-resistant Staphylococcus aureus (MRSA) includes early detection and isolation. In the emergency department (ED), such measures have to be balanced with the requirement to treat patients urgently and transfer quickly to an acute hospital bed. We assessed, in a busy and overcrowded ED, the contribution made to a patient\u27s stay by previous MRSA risk group identification and by selective rescreening of those patients who were previously documented in the research hospital as being MRSA positive. Patients with a previous diagnosis of MRSA colonisation were flagged automatically as \u27risk group\u27 (RG) on their arrival in the ED and were compared with \u27non-risk group\u27 (NRG), i.e. not previously demonstrated in the research hospital to be infected or colonised with MRSA. Over an 18 month period, there were 16 456 admissions via the ED, of which 985 (6%) were RG patients. The expected median times to be admitted following a request for a ward bed for NRG and RG patients were 10.4 and 12.9h, respectively. Female sex, age \u3e65 years, and RG status all independently predicted a statistically significantly longer stay in the ED following a request for a hospital bed. We consider that national and local policies for MRSA need to balance the welfare of patients in the ED with the need to comply with best practice, when there are inadequate ED and inpatient isolation facilities. Patients with MRSA requiring emergency admission must have a bed available for them

Epidemics in Networks of Spatially Correlated Three-dimensional Root Branching Structures

Using digitized images of the three-dimensional, branching structures for root systems of bean seedlings, together with analytical and numerical methods that map a common 'SIR' epidemiological model onto the bond percolation problem, we show how the spatially-correlated branching structures of plant roots affect transmission efficiencies, and hence the invasion criterion, for a soil-borne pathogen as it spreads through ensembles of morphologically complex hosts. We conclude that the inherent heterogeneities in transmissibilities arising from correlations in the degrees of overlap between neighbouring plants, render a population of root systems less susceptible to epidemic invasion than a corresponding homogeneous system. Several components of morphological complexity are analysed that contribute to disorder and heterogeneities in transmissibility of infection. Anisotropy in root shape is shown to increase resilience to epidemic invasion, while increasing the degree of branching enhances the spread of epidemics in the population of roots. Some extension of the methods for other epidemiological systems are discussed.Comment: 21 pages, 8 figure

The effect of heterogeneity on invasion in spatial epidemics: from theory to experimental evidence in a model system

Heterogeneity in host populations is an important factor affecting the ability of a pathogen to invade, yet the quantitative investigation of its effects on epidemic spread is still an open problem. In this paper, we test recent theoretical results, which extend the established “percolation paradigm” to the spread of a pathogen in discrete heterogeneous host populations. In particular, we test the hypothesis that the probability of epidemic invasion decreases when host heterogeneity is increased. We use replicated experimental microcosms, in which the ubiquitous pathogenic fungus Rhizoctonia solani grows through a population of discrete nutrient sites on a lattice, with nutrient sites representing hosts. The degree of host heterogeneity within different populations is adjusted by changing the proportion and the nutrient concentration of nutrient sites. The experimental data are analysed via Bayesian inference methods, estimating pathogen transmission parameters for each individual population. We find a significant, negative correlation between heterogeneity and the probability of pathogen invasion, thereby validating the theory. The value of the correlation is also in remarkably good agreement with the theoretical predictions. We briefly discuss how our results can be exploited in the design and implementation of disease control strategies

Negotiating professional and social voices in research principles and practice

This paper draws on work conducted for a qualitative interview based study which explores the gendered racialised and professional identifications of health and social care professionals. Participants for the project were drawn from the professional executive committees of recently formed Primary Care Trusts. The paper discusses how the feminist psychosocial methodological approach developed for the project is theoretically, practically and ethically useful in exploring the voices of those in positions of relative power in relation to both health and social care services and the social relations of gender and ethnicity. The approach draws on psychodynamic accounts of (defended) subjectivity and the feminist work of Carol Gilligan on a voice-centred relational methodology. Coupling the feminist with the psychosocial facilitates an emphasis on voice and dialogic communication between participant and researcher not always captured in psychosocial approaches which tend towards favouring the interviewer as ‘good listener’. This emphasis on dialogue is important in research contexts where prior and ongoing relationships with professional participants make it difficult and indeed undesirable for researchers to maintain silence

Who decides to grow orange sweet potatoes? Bargaining power and adoption of biofortified crops in Uganda.

The goal of the HarvestPlus reaching end users (REU) orange sweet potato (OSP) project is to increase vitamin A intake and improve vitamin status among Vulnerable populations (women and children) in rural Uganda by introducing beta-carotene-rich OSP, as well as related messages concerning agronomy, nutrition, and marketing. Most households obtain planting material for these crops through interaction with other households. This raises a number of important questions about the roles of social interaction, intrahousehold division of labor, and gender in determining the rates at which these biofortified crops are adopted and spread. As part of the Gender, Agriculture, and Assets Project (GAAP), this study examines the effect of women’s bargaining power, as revealed in gender¬‐based patterns of ownership and control of land and assets, on adoption ofOSP and vitamin A intake among children

Bargaining power and biofortification: The role of gender in adoption of orange sweet potato in Uganda

We examine the role of gender in adoption and diffusion of orange sweet potato, a biofortified staple food crop being promoted as a strategy to increase dietary intakes of vitamin A among young children and adult women in Uganda. As an agricultural intervention with nutrition objectives, intrahousehold gender dynamics regarding decisions about crop choice and child feeding practices may play a role in adoption decisions. Also, most households access sweet potato vines through informal exchange, suggesting again that gender dimensions of networks may be important to diffusion of the crop. We use data from an experimental impact evaluation of the introduction of OSP in Uganda to study how female bargaining power, measured by share of land and nonland assets controlled by women, affect adoption and diffusion decisions. We find that the share of assets controlled by women does not affect the probability of adopting OSP at the household level. In examining adoption decisions within households, plots of land exclusively controlled by women are not more likely to contain OSP, but plots under joint control of men and women, in which a woman has primary control over decisionmaking are significantly more likely to contain OSP. Plots exclusively controlled by men are the least likely to contain OSP. Also, we find that the share of nonland assets controlled by women increases dietary intakes of vitamin A, but this measure of female bargaining power does not increase the impact of the OSP project on vitamin A, suggesting that the project had similar impacts across households with different levels of female bargaining power

Widespread Infilling of Tidal Channels and Navigable Waterways in the Human-Modified Tidal Deltaplain of Southwest Bangladesh

Since the 1960s, ~5000 km2 of tidal deltaplain in southwest Bangladesh has been embanked and converted to densely inhabited, agricultural islands (i.e., polders). This landscape is juxtaposed to the adjacent Sundarbans, a pristine mangrove forest, both well connected by a dense network of tidal channels that effectively convey water and sediment throughout the region. The extensive embanking in poldered areas, however, has greatly reduced the tidal prism (i.e., volume of water) transported through local channels. We reveal that \u3e600 km of these major waterways have infilled in recent decades, converting to land through enhanced sedimentation and the direct blocking of waterways by embankments and sluice gates. Nearly all of the observed closures (~98%) have occurred along the embanked polder systems, with no comparable changes occurring in channels of the Sundarbans (2 of new land in the last 40–50 years, the rate of which, ~2 km2/yr, offsets the 4 km2/yr that is eroded at the coast, and is equivalent to ~20% of the new land produced naturally at the Ganges-Brahmaputra tidal rivermouth. Most of this new land, called ‘khas’ in Bengali, has been reclaimed for agriculture or aquaculture, contributing to the local economy. However, benefits are tempered by the loss of navigable waterways for commerce, transportation, and fishing, as well as the forced rerouting of tidal waters and sediments necessary to sustain this low-lying landscape against rising sea level. A more sustainable delta will require detailed knowledge of the consequences of these hydrodynamic changes to support more scientifically-grounded management of water, sediment, and tidal energy distribution

Educating Pharmacy Students to Improve Quality (EPIQ) in Colleges and Schools of Pharmacy

Objective. To assess course instructors’ and students’ perceptions of the Educating Pharmacy Students and Pharmacists to Improve Quality (EPIQ) curriculum. Methods. Seven colleges and schools of pharmacy that were using the EPIQ program in their curricula agreed to participate in the study. Five of the 7 collected student retrospective pre- and post-intervention questionnaires. Changes in students’ perceptions were evaluated to assess their relationships with demographics and course variables. Instructors who implemented the EPIQ program at each of the 7 colleges and schools were also asked to complete a questionnaire. Results. Scores on all questionnaire items indicated improvement in students’ perceived knowledge of quality improvement. The university the students attended, completion of a class project, and length of coverage of material were significantly related to improvement in the students’ scores. Instructors at all colleges and schools felt the EPIQ curriculum was a strong program that fulfilled the criteria for quality improvement and medication error reduction education. Conclusion. The EPIQ program is a viable, turnkey option for colleges and schools of pharmacy to use in teaching students about quality improvement