TPS-grupper i praksis (Tverrprofesjonell samarbeidslæring i praksisstudier) Delprosjekt 1b i OPERASJON BACHELORPRAKSIS, FHS

I denne rapporten presenteres modeller for tverrprofesjonell praksis-læring som benyttes både i primærhelsetjenester (TVEPS) og i spesialisthelsetjenesten (TPS i sykehuspraksis). I tillegg presenteres en mal for informasjonsskriv til ledere og veiledere i helseforetak og kommuner, der det oppfordres til å legge til rette for tverrprofesjonelt studentsamarbeid når studenter fra flere profesjonsutdanninger har samtidig praksis i samme institusjon. Utvikling av modellene som beskrives har pågått gjennom flere år. Som del av prosjekt Operasjon Bachelorpraksis er modellene presentert samlet og er prøvd ut på nye praksis-arenaer og på flere HVL-campus. Modeller og mal for informasjonsskriv er også presentert i «Ressursemne for TPS i teori og praksis, opprettet i læringsplattformen Canvas (se rapport fra TPSgruppens oppdrag fra punktene 1 og 3)

Radiografstudenters læring i praksis

Tema for hovedfagsoppgaven er læring i praksis. Hvordan uttrykker radiografstudentene sine opplevelser av læring i praksis på røntgenavdelingene? Det foreligger lite forskning som spesielt omhandler læring i radiografyrket. Radiografstudentenes fortellinger er det empiriske materiale i denne undersøkelsen og danner grunnlaget for å belyse deres opplevelser av læring. Jeg har benyttet Adrian van Kaam sin fenomenologiske begrepsanalyse som metode. Hensikten er å få frem hvilke nødvendige og tilstrekkelige komponenter fenomenet læring i praksis består av. Ved å la radiografstudentene uttrykke sine opplevelser og følelser i tilknytning til læresituasjoner og hva som gjorde at de lærte, kan denne erfaringen begrepsfestes, på samme måte som andre uttrykte følelser og opplevelser. Data ble innsamlet ved hjelp av spørreskjema fra tre høgskoler som utdanner radiografer. I bearbeidelsen av datamaterialet er de seks trinnene i van Kaams analysemetode benyttet. I analysen medvirket to sakkyndige i tillegg til meg selv for å ivareta intersubjektiviteten i undersøkelsen. I spørreskjemaet ble radiografstudentene bedt om å beskrive situasjoner med opplevd læring i praksisfeltet og uttrykke hva det var som gjorde at de lærte, samt uttrykke følelsene i situasjonen. Refererte situasjoner dannet grunnlaget for opplevd læring og uttrykte følelser. De fremkomne hovedkategorier fra Uttrykk av opplevd læring var; læring gjennom egen aktiv deltakelse, i møte med pedagogisk takt, synliggjøring av omsorgsaspektet i yrket og refleksjoner rundt praksislæring. De Uttrykte følelser knyttet til læring skilte seg i tre hovedkategorier hvor følelsene uttryktes; i møte med seg selv, i møte med veileder og andre og i møte med pasienten. Resultatet fra de 98 fortellingene med i alt 639 uttrykk, viser at læring i praksis er et sammensatt fenomen med dertil flytende grenser. Likevel viste undersøkelsen konkrete og nyanserte detaljer i beskrivelsene av praksislæring. Funnene diskuteres hovedsakelig opp mot Illeris (2000) sitt læringsteoretiske ståsted og Molanders (1998) teori om kunnskap i handling

Digital zoom of the full-field digital mammogram versus magnification mammography: a systematic review

Objectives To summarise and compare the performance of magnification mammography and digital zoom utilising a full-field digital mammography (FFDM) system in the detection and diagnosis of microcalcifications. Methods We ran an extended search in MEDLINE, EMBASE, CINAHL, Engineering Village and Web of Science. Diagnostic test studies, experimental breast phantom studies and a Monte Carlo phantom study were included. A narrative approach was selected to summarise and compare findings regarding the detection of microcalcifications, while a hierarchical model with bivariate analysis was used for the meta-analysis of sensitivity and specificity for diagnosing microcalcifications. Results Nine studies were included. Phantom studies suggested that the size of microcalcifications, magnification or zoom factor, exposure factors and detector technology determine whether digital zoom is equivalent to magnification mammography in the detection of microcalcifications. Pooled sensitivity for magnification and zoom calculated from the diagnostic test studies was 0.93 (95% CI 0.84–0.97) and 0.85 (95% CI 0.70–0.94), respectively. Pooled specificity was 0.55 (95% CI 0.51–0.58) and 0.56 (95% CI 0.50–0.62), respectively. The differences between the sensitivities and specificities were not statistically significant. Conclusions Digital zoom may be equivalent to magnification mammography. Diagnostic test studies and phantom studies using newer detector technology would contribute additional knowledge on this topic

Equity into early detection of breast cancer education via interprofessional e-learning

Background: Interprofessional education (IPE) is central when competences needed in managing complex patient service chains, like the diagnostic process of breast cancer is being taught. The purpose of this study was to evaluate the e-learning modules related to early detection of breast cancer produced in earlier phases of the project for biomedical laboratory scientists, midwifes, nurses, public health nurses and radiographers. Methods: An evidence-based developmental method was applied for the preparation of modules on early detection of breast cancer for health care professionals (the EBreast project). The learning modules were evaluated by the relevance of the content, technical quality and achievement of learning outcomes by health care students and professionals in the five European countries (totalling 176 evaluations). Also, usefulness of the modules was evaluated by 13/21 health care staff members and lecturers participating in the intensive course related to the implementation of project outcomes. Results: The students and health care professionals in the countries participating in the EBreast project evaluated the materials related to the interprofessional way of working and radiation safety as most relevant, and the technical quality as good. As for achieving the learning outcomes, basic issues related to the breast cancer diagnostic process were learned the best. The participants of the project related to the intensive course perceived this course as useful or very useful. They thought that they can use the materials either module by module, or as a whole course in CPD or as a part of basic degree education for all the professional groups it is intended for. Conclusions: Although e-learning is not the best way for acquiring interprofessional skills or practical competences, nevertheless, this is a suitable way to offer education about the diagnostic process of breast cancer to a wider audience across the world, harmonizing health care education and clinical processes. From the clinical practice point of view e-learning is a suitable way of orientating new beginners in mammography into breast cancer diagnostics and the process in all. In larger educational development projects multiphase evaluation methods like the ones used in this project are recommendable to use

Interprofessional work in early detection of breast cancer: An integrative review

Highlights • Health care professional's role in breast cancer diagnostic process was described mostly from each professionals' viewpoint. • Health care professional's responsible for promoting breast cancer awareness must be knowledgeable, updated and skilled. • Support from leadership and management is needed in order to promote interprofessional work, which will benefit all involved. Objectives To identify the roles of health care staff in interprofessional work related to breast cancer detection and diagnosis. Key findings A comprehensive search was performed using PICO to support inclusion and exclusion criteria. A shortened version of the STROBE checklist ensured evaluation of the studies. 21 included studies resulted in three main categories describing the role of health care professionals; (1) Communicating breast cancer awareness; (2) The Professional's tasks; (3) Efficacy of Interprofessional Teamwork relative to the profession and the individuals. Conclusions Health care professionals' roles in the breast cancer diagnostic process were described mostly from each professional's viewpoint. Support from leadership and management is needed in order to promote interprofessional work, which will benefit health care professions, professionals, and the patient

Characterization of radiographers’ mammography practice in five European countries ::a pilot study

Objectives : This pilot study aimed to characterize and compare radiographers’ mammography practice, including quality control and continuous professional development in five European countries. Methods: Online survey was performed to collect data regarding participants’ profile, institution’s profile, mammography practice, quality control and continuous professional development. The questionnaire was sent to clinical radiographers working in Estonia, Finland, Norway, Portugal and Switzerland. Descriptive statistical and subgroup analyzes were performed. Results: The amount of returned questionnaires was 140. Most respondents were female (92%), having radiography bachelor. The majority (89%) of radiographers was working with full-field digital mammography. The majority (97%) of mammography images were acquired using AEC, and half of the radiographers were using dose saving programmes suggested by the manufacturers. The most typical (50%) compression force ranged from 8 to 11 kg. Part of the radiographers (44%) did not know if their practice followed specific guidelines. The most challenging tasks in mammography identified by radiographers were patient positioning (86%), coping with pain (88%), managing anxiety (83%) and imaging breast implants (71%). The majority (88%) of the respondents undertook continuous professional development activities. Conclusions: The mammography practice varies across the five countries. We found country-specific traits related to mammography image acquisition, patient-centered care and quality management procedures. The lack of evidence-based knowledge suggests the importance of well-designed studies on these topics. The variability found in this pilot study encourages radiographers to question their own practice and teachers to review and revise the training programmes. Validation in larger studies including more countries is needed

Interprofessional work in early detection of breast cancer: An integrative review

Highlights • Health care professional's role in breast cancer diagnostic process was described mostly from each professionals' viewpoint. • Health care professional's responsible for promoting breast cancer awareness must be knowledgeable, updated and skilled. • Support from leadership and management is needed in order to promote interprofessional work, which will benefit all involved. Objectives To identify the roles of health care staff in interprofessional work related to breast cancer detection and diagnosis. Key findings A comprehensive search was performed using PICO to support inclusion and exclusion criteria. A shortened version of the STROBE checklist ensured evaluation of the studies. 21 included studies resulted in three main categories describing the role of health care professionals; (1) Communicating breast cancer awareness; (2) The Professional's tasks; (3) Efficacy of Interprofessional Teamwork relative to the profession and the individuals. Conclusions Health care professionals' roles in the breast cancer diagnostic process were described mostly from each professional's viewpoint. Support from leadership and management is needed in order to promote interprofessional work, which will benefit health care professions, professionals, and the patient.publishedVersio

Characterization of radiographers’ mammography practice in five European countries: a pilot study

Objectives This pilot study aimed to characterize and compare radiographers’ mammography practice, including quality control and continuous professional development in five European countries. Methods Online survey was performed to collect data regarding participants’ profile, institution’s profile, mammography practice, quality control and continuous professional development. The questionnaire was sent to clinical radiographers working in Estonia, Finland, Norway, Portugal and Switzerland. Descriptive statistical and subgroup analyzes were performed. Results The amount of returned questionnaires was 140. Most respondents were female (92%), having radiography bachelor. The majority (89%) of radiographers was working with full-field digital mammography. The majority (97%) of mammography images were acquired using AEC, and half of the radiographers were using dose saving programmes suggested by the manufacturers. The most typical (50%) compression force ranged from 8 to 11 kg. Part of the radiographers (44%) did not know if their practice followed specific guidelines. The most challenging tasks in mammography identified by radiographers were patient positioning (86%), coping with pain (88%), managing anxiety (83%) and imaging breast implants (71%). The majority (88%) of the respondents undertook continuous professional development activities. Conclusions The mammography practice varies across the five countries. We found country-specific traits related to mammography image acquisition, patient-centered care and quality management procedures. The lack of evidence-based knowledge suggests the importance of well-designed studies on these topics. The variability found in this pilot study encourages radiographers to question their own practice and teachers to review and revise the training programmes. Validation in larger studies including more countries is needed