How do trainee doctors learn about research? Content analysis of Australian specialist colleges' intended research curricula

Objectives: Patients do better in research-intense environments. The importance of research is reflected in the accreditation requirements of Australian clinical specialist colleges. The nature of college-mandated research training has not been systematically explored. We examined the intended research curricula of Australian trainee doctors described by specialist colleges, their constructive alignment and the nature of scholarly project requirements. Design: We undertook content analysis of publicly available documents to characterise college research training curricula. Setting: We reviewed all publicly accessible information from the websites of Australian specialist colleges and their subspecialty divisions. We retrieved curricula, handbooks and assessment-related documents. Participants: Fifty-eight Australian specialist colleges and their subspecialty divisions. Primary and secondary outcome measures: Two reviewers extracted and coded research-related activities as learning outcomes, activities or assessments, by research stage (using, participating in or leading research) and competency based on Bloom’s taxonomy (remembering, understanding, applying, analysing, evaluating, creating). We coded learning and assessment activities by type (eg, formal research training, publication) and whether it was linked to a scholarly project. Requirements related to project supervisors’ research experience were noted. Results: Fifty-five of 58 Australian college subspecialty divisions had a scholarly project requirement. Only 11 required formal research training; two required an experienced research supervisor. Colleges emphasised a role for trainees in leading research in their learning outcomes and assessments, but not learning activities. Less emphasis was placed on using research, and almost no emphasis on participation. Most learning activities and assessments mapped to the ‘creating’ domain of Bloom’s taxonomy, whereas most learning outcomes mapped to the ‘evaluating’ domain. Overall, most research learning and assessment activities were related to leading a scholarly project. Conclusions: Australian specialist college research curricula appear to emphasise a role for trainees in leading research and producing research deliverables, but do not mandate formal research training and supervision by experienced researchers

Long term tailored implementation of structured "TREAT" journal clubs in allied health: a hybrid effectiveness-implementation study

BACKGROUND: Allied Health Professionals (AHPs) commonly use journal clubs (JCs) to support Evidence-Based Practice (EBP). There is however little research regarding implementing and sustaining JCs in the long term, and their impact on EBP use and skills in AHPs. This study investigated the impact of implementing a structured JC format, called “TREAT” (previously only investigated across 6 sessions), over a longer period of 16 sessions for AHPs in a public health service. The study also investigated AHP’s attendance, adherence, satisfaction and barriers and enablers to implementing the format. METHODS: A mixed methods hybrid-effectiveness implementation design was employed, guided by the Knowledge-to-Action cycle. EBP skills, confidence, use, and attitudes were assessed (Adapted Fresno Test, EBPQ, tailored journal club culture questionnaire) at baseline, and after 10 and 16-monthly sessions. Satisfaction and impact on clinical practice were explored using questionnaires at 10 and 16-months, with free-form responses identifying enablers and barriers to EBP culture and implementation. Data on attendance and adherence to the TREAT format were also collected. RESULTS: Six JCs comprising a total of 132 unique participants from seven Allied Health professions were assessed across three time points. EBP skills improved on the Adapted Fresno Test after 10-monthly (6.6 points: 95% CI, 0.43 to 12.7) and 16-monthly sessions (7.8 points, 95% CI, 0.85 to 14.7), and on self-reported total EBPQ ratings of confidence at 10-months (4.9 points: 95% CI, 2.2 to 7.5) and 16-months (5.7 points: 95% CI 2.7 to 8.7). Of 132 AHPs, 88 reported adopting new treatments/resources and 64 reported updating clinical procedures. Mean attendance was 5.7 sessions (SD = 3.8). Adherence to TREAT components in each session was 86% (95% CI, 83% to 89%). Most participants recommended the format and reported a desire to continue. Enablers to the JC included using clinically relevant topics and active participation while reported barriers included limited time to prepare. CONCLUSIONS: Despite variable attendance, TREAT JCs can continue to be implemented within a service for 16 monthly-sessions, and may contribute to improved EBP skills and confidence and changes in clinical practice over time. Tailoring of implementation strategies was shown to be important to address local enablers and barriers. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12909-022-03333-7

Evaluating the use of clinical decision aids in an Australian emergency department: A cross-sectional survey

Objective: To identify healthcare professionals' knowledge, self-reported use, and documentation of clinical decision aids (CDAs) in a large ED in Australia, to identify behavioural determinants influencing the use of CDAs, and healthcare professionals preferences for integrating CDAs into the electronic medical record (EMR) system. Methods: Healthcare professionals (doctors, nurses and physiotherapists) working in the ED at the Gold Coast Hospital, Queensland were invited to complete an online survey. Quantitative data were analysed using descriptive statistics, and where appropriate, mapped to the theoretical domains framework to identify potential barriers to the use of CDAs. Qualitative data were analysed using content analysis. Results: Seventy-four healthcare professionals (34 medical officers, 31 nurses and nine physiotherapists) completed the survey. Healthcare professionals' knowledge and self-reported use of 21 validated CDAs was low but differed considerably across CDAs. Only 4 out of 21 CDAs were reported to be used ‘sometimes’ or ‘always’ by the majority of respondents (Ottawa Ankle Rule for ankle injury, Wells' criteria for pulmonary embolism, Wells' criteria for deep vein thrombosis and PERC rule for pulmonary embolism). Most respondents wanted to increase their use of valid and reliable CDAs and supported the integration of CDAs into the EMR to facilitate their use and support documentation. Potential barriers impacting the use of CDAs represented three theoretical domains of knowledge, social/professional role and identity, and social influences. Conclusions: CDAs are used variably by healthcare professionals and are inconsistently applied in the clinical encounter. Preferences of healthcare professionals need to be considered to allow the successful integration of CDAs into the EMR

ENHANCE Project - Enhancing Research Development of Medical Specialty Trainees

This program of work describes the exploration and improvement of Medical Specialty Trainee research training requirements

A needs-based approach to patient-relevant information delivery

The plethora of medical studies that are published annually leaves many health professionals (HPs) overwhelmed with new health information. To assist HPs, information from research is often summarised and presented in a practice ready fashion through disease specific guidelines, drug monographs, and up-date newsletters. Although these have been effective in improving the quality of medical care, criticisms of these resources are focused on their inability to deal with complex patients such as those with comorbidities and the aged. Resources tailored specifically to the aged are either simplistic and do not take into account all issues surrounding complex patient management, drug therapy individualisation and end of life care or are impractical to use at the point of care. The hypothesis of this research was that HPs’ information needs were not currently being met and would require the identification, development and testing of an information delivery framework that would address their needs. The overall aim of this research was to identify HP information needs when delivering healthcare to complex patients, such as the aged, and was conducted in three phases. The first phase of this research used fifteen personal interviews with key HPs (geriatricians, GPs and accredited pharmacist) from the Melbourne metropolitan area to explore whether they felt currently available information resources meet their needs during complex patient healthcare delivery. Specifically it explored what HPs consider when making a clinical decision during healthcare delivery, what resources they use to assist in decision making and what features they desire in an information resource. Findings suggested that currently available resources did not meet HPs information needs. Issues identified included exclusion of complex patients from the literature, lack of relevance to the Australian environment and inability to access the literature due to lack of time to search for appropriate information and costs associated with subscriptions. Other identified hurdles included HPs inability to interpret and contextualise the literature and incomplete patient information that would otherwise influence their management choices. Features that were thought to make an information resource useful included clear formatting, simplicity, use of peer-reviewed evidence-based recommendations, local relevance and ready access via an easy to use electronic interface. A new framework for delivering disease state management information to HPs that took into account all the complexities of care but did not jeopardise clinical autonomy was designed and developed in the second phase of this research. Past successes and failures of other electronic systems were identified to inform the basis of system design. These fundamental elements included adherence to usability guidelines when developing user interface, provision of recommendations based on up-to-date reputable information sources accompanied by rationale and additional information links or references, identification of all important interactions clearly identifiable by level of importance, good integration into workflow and HP involvement throughout the design and development process. In order to take into account all of the complexities of appropriate care, the clinical decision making process was modelled by reviewing Australian and international literature regarding quality prescribing, medication review, disease state management and drug monographs. Features common across all sources included making a correct diagnosis, making a decision whether to treat a patient with non-pharmacological or pharmacological treatment, documenting care, and reviewing progress. Common considerations that influence treatment choice can be divided into patient characteristics and drug attributes. The clinical decision making model developed was used to design the system framework. Issues with updating the system knowledge and subsequent retesting were overcome by developing a business rule engine rather than coding decision making algorithms. Clinical autonomy was maintained by allowing HPs to choose the guideline for the system to use as the basis of decision support, as well as display of recommendations and associated potential issues based on patient data rather than providing absolute recommendations. The usefulness of the way in which information is provided by the system was evaluated in phase three using ‘think out aloud’, questionnaire and focus group techniques. Five pharmacy academics were asked to think-out aloud while using the system to make decisions regarding the management of newly diagnosed osteoarthritis in a complex patient in order to give insight into the usability, aesthetics and usefulness of information presentation. Although there were some minor issues identified, overall participants found the way in which information was displayed useful. A validated modified computer system usability questionnaire (mCSUQ) was used to gain feedback from pharmacists and medical practitioners regarding system usefulness after a demonstration of the programme. The 17 question mCSUQ used a 7-point scale (1 = strongly disagree, 7 = strongly agree) and allows for open-ended feedback to measure user satisfaction with the system overall, its usefulness, the information and interface quality. When validated it demonstrated good internal consistency and congruent validity. Fifty-two HPs completed the mCSUQ and were invited to participate in focus group feedback. The system scored well on all domains: overall usability (mean 5.05, SD 1.07), system usefulness (mean 5.06, SD 1.11), interface quality (mean 4.84, SD 1.25) and highest on information quality (mean 5.09, SD 1.24). Two HPs were successfully recruited for focus group feedback. Results were used to confirm findings from open-ended question answers. Participants felt that the system interface was simple, clear and could be easy to learn but required colour to help identify important issues. Positive aspects to the system included linking information to patient data and the comprehensive nature of the information given. Additional information desired included statistical information on treatment efficacy and provision of medication review and deprescribing guidance. Major determinants to using the system included ability to integrate with electronic health records (EHR) and use of high quality information within the knowledge base. Barriers identified to CDSS implementation in general included lack of access to accurate and complete patient information and inconsistent medical terminology use among HPs. This research defines the types of information required during clinical decision-making as well information delivery preferences of HPs. It has resulted in the development of a new framework for delivering the information HPs need when requiring guidance during complex patient healthcare delivery. The framework developed is universal as the clinical decision making model is based on local and international literature. Only alterations to knowledge are required, rather than changes to code, to reflect local practice and drug availability. Future work could expand system knowledge, develop EHR integration capability, implement identified desired features and further evaluate the usability of the system and whether it is able to improve quality of prescribing