How to effectively promote interprofessional collaboration? - a qualitative study on physicians' and pharmacists' perspectives driven by the theory of planned behavior

BackgroundAjzen’s theory of planned behavior (TPB) postulates that individuals’ behavioral intention is influenced by their attitudes, subjective norms, and perceived behavioral control. Therefore, it can be used to broaden the understanding of particular behaviors, including healthcare workers’ professional activities.MethodsIn this study, we used TPB as a theoretical framework to evaluate semi-structured interviews with pharmacists and physicians to build an understanding of the interprofessional collaboration between them. Sixteen semi-structured interviews were conducted with pharmacists and eleven with physicians. The sample of participants comprised a diverse group with varying work experience and workplaces. Data were analyzed independently by two researchers following the thematic analysis method using ATLAS.ti software. Data saturation was set in the absence of new issues arising during the interviews.ResultsThe content analysis allowed for the determination of six main themes: the relationship between previous experiences and attitudes towards collaboration, pharmacist’s role in collaboration, mutual reluctance toward collaboration, the role of decision- and policy-makers, knowledge and qualifications gaps regarding collaboration, and lack of organizational paths.ConclusionsDespite both physicians and pharmacists displaying positive attitudes towards collaboration may foster their intention to establish a professional partnership, subjective norms (e.g., the lack of appropriate legal regulations) and perceived behavioral control (physicians’ lack of awareness about pharmacists’ qualifications and the low level of interpersonal skills) might impede the process

Guidelines on Writing Multiple Choice Questions: A Well-Received and Effective Faculty Development Intervention

Multiple choice questions (MCQs) are commonly used for assessing students, but medical teachers may lack training in writing them. MCQs often have imperfections called item-writing flaws (IWFs) that can affect students’ results and impede objective evaluation of their knowledge. This study aimed to evaluate a guideline-based faculty development intervention on writing MCQs at Levels 1 and 2 of the Kirkpatrick Model. MCQs written by teachers prior and after the intervention were analyzed with the Shapiro–Wilk test, Student’s t-test, and Wilcoxon signed-rank test as appropriate. In addition, the phenomenological approach was chosen to describe experiences of 10 teachers in semi-structured in-depth interviews. Results showed satisfaction of teachers with the document. They found it helpful in writing MCQs and noticed the requirement for another guidelines. They appreciated it for its briefness and clarity. The statistical analysis of the quality of MCQs before and after the intervention showed that the document contributed to a statistically significant reduction of IWFs. To conclude, our results showed that a guideline document on writing MCQs may serve as a well-received and effective faculty development intervention. The document may be used as a flexible, time-saving, and just-in-time learning method, fitting needs of medical teachers

Factors influencing behavioral intentions of graduating pharmacy students regarding interprofessional collaboration - a theory-driven qualitative study

BackgroundInterprofessional collaboration enhances the use of competencies of different medical team members. Additionally, pharmacists’ involvement in patient care has been shown to improve their outcomes and seems particularly valuable in chronic diseases. Therefore, due to the aging of society and the increasing prevalence of chronic diseases, efforts are needed to involve pharmacists more broadly in patient care. However, there is a limited understanding of what factors could influence their willingness to participate in an interprofessional care team, especially among pharmacy students only entering the profession. This study aimed to fill these knowledge gaps by exploring graduating pharmacy students’ intentions in this regard guided by the theory of planned behavior.MethodsWe conducted seventeen semi-structured interviews with graduating pharmacy students of Poznan University of Medical Sciences, which were then thematically analyzed by two researchers.ResultsPositive attitudes of respondents, who mentioned the possibility of acquiring new knowledge, skills, and competencies, increased prestige and appreciation of the pharmacist’s profession, a better quality of patient care, and the support and relief offered to other team members as a result of collaboration, seem to strengthen their intentions. However, they also expressed their worries about potential errors and knowledge gaps, which constituted an example of some existing negative feelings. The identified sources of generally mixed social pressure toward the behavior included other pharmacists and pharmacy students, physicians, patients, their relatives and friends, and the decision and policymakers. Finally, their intentions may also be weakened by the mentioned perceived behavioral control aspects, like their level of pharmaceutical and clinical knowledge, skills, and experience, their knowledge of representatives of other professions and collaboration, the atmosphere at their future place of work, co-workers’ potential reluctance to collaborate with them, finding time for collaboration, the existence of incentives and gratification system, and existing legal regulations.ConclusionsThe attitudes of graduating pharmacy students toward interprofessional collaboration seem mostly positive, but their intentions might be weakened by the mixed sense of social pressure and factors decreasing their perceived behavioral control

‘Difficult Conversations with Patients’—A Modified Group Objective Structured Clinical Experience for Medical Students

This study presents a modified Group Objective Structured Clinical Experience (GOSCE) focused on difficult conversations, in which, due to limited time and financial resources, only some students could actively participate in scenarios. We aimed to evaluate the intervention, including differences between them and observers. The intervention was organized for sixth-year medical students at a Polish medical university. The study protocol assumed a pre-post analysis of students’ attitudes and self-efficacy of communication skills and their opinions about the intervention. Complete questionnaire pairs were returned by 126 students. The pre-post analysis revealed a significant improvement in their self-efficacy levels of almost all skills as well as their affective attitudes and belief in outcomes of communication learning. The improvement was significant among both the active participants and observers. It also showed a decrease in the motivation score, significant only in females. Regardless of their roles, students had positive opinions about the course and its particular aspects. The modified GOSCE may be an enjoyable and effective learning experience for students, especially in the light of limited resources. However, changes in their motivation score suggest the necessity to increase the importance of communication learning in the curriculum

Future physicians' behavioral intentions towards collaborative practice-a qualitative study on polish final-year medical students guided by the theory of planned behavior

BackgroundInterprofessional collaboration constitutes a vital part of modern patient care, and many of its benefits for patients, medical staff, and the healthcare system have been described. However, little is known about factors influencing medical students’ intentions to work in a collaborative practice after graduation. Therefore, with the theory of planned behavior by Ajzen as a framework, this study aimed to evaluate their intentions and identify factors that influence their attitudes, subjective norms, and perceived behavioral control.MethodsFor this purpose, eighteen semi-structured interviews were conducted with medical students following a thematic guide developed according to the theory. They were thematically analyzed by two independent researchers.ResultsThe results showed that their attitudes contained positive (better patient care, comfort and safety of work, learning and development opportunities) and negative examples like the fear of conflicts, losing authority and mistreatment. Sources of social pressure regarding the behavior (subjective norms) involved their peers, other physicians, representatives of other medical professions, patients, and managing bodies. Finally, perceived behavioral control included limited occasions for contacts and interprofessional learning during the studies, existing stereotypes and prejudices, legal regulations and systemic solutions, organizational aspects, and existing relations at the ward.ConclusionsAnalysis showed that Polish medical students generally seem to hold positive views on interprofessional collaboration and feel positive social pressure to get involved in interprofessional teams. However, factors listed in perceived behavioral control may act as barriers in the process

The effectiveness of ‘practice while watching’ technique for the first aid training of the chemical industry employees

INTRODUCTION: Industrial accidents constitute about 20% of all causes of accidents. They are often sudden, unexpected and may lead to tragic consequences, which however can be partially reduced if first aid and emergency treatment are given as soon as possible. The most important part of a chain of survival is the bystanders’ response. In practice, it is highly dependent on the ability of co-workers to perform basic first-aid tasks. The aim of this paper was to present the effectiveness of ‘practice while watching’ training method for the first aid training of the chemical industry employees. The authors focused on the most important elements of the training, which have an impact on the acquisition of knowledge and skills of first aid.  MATERIAL AND METHODS: The training involved 69 employees of the chemical industry. The test sheets were used for the assessment, where each of the action steps was assigned points 0 for incorrect and 1 for a properly performed activity.  RESULTS: Each step was completed by at least 76% of workers. When providing both adult and infant CPR, the main difficulty was calling for help. Younger employees obtained better results than older colleagues.  CONCLUSIONS: The study demonstrated the high effectiveness of the ‘practice while watching’ method. In addition, workers’ age turned out to be a significant variable which affected their performance.

Good practices in asynchronous e-learning — a short guideline document for Polish medical teachers — a pilot study

INTRODUCTION: E-learning is gaining popularity also in medical education. It offers students unlimited access to educational materials, helps meet their individual preferences by adapting various learning styles, and is considered to be at least as effective as traditional lectures. However, this can only be true provided that e-learning is of good quality. Short guidelines may be used to familiarise medical teachers with good practices in e-learning, but they should meet the needs of their users, and some areas may require more attention. They should be identified, and medical teachers should be provided with additional resources covering them. This study aimed to develop a short guideline for Polish medical teachers and determine potentially troublesome areas. METHODS: A detailed review of the literature was performed to create a guideline on preparing and conducting e-learning classes. The most important items from it were listed as an evaluation template and pre-tested on a sample of 10 e-learning courses in a search for areas requiring more attention. RESULTS: Half of the courses did not provide students with a syllabus, and none of them clearly defined intended learning outcomes. Also, adult learning concepts were not introduced satisfactorily. Only seven out of 10 courses used activities at all, and they often tested simple knowledge reproduction, were limited to poorly-written test questions, and placed at the end of lessons. CONCLUSIONS: In this pilot study three potentially troublesome areas were identified: defining learning outcomes, application of adult learning theory, and choice of activities. KEY WORDS: e-learning quality, e-learning guidelines, medical teacher

Distance Learning and Assessment During the COVID-19 Pandemic-Perspectives of Polish Medical and Healthcare Students

The abrupt transition from the traditional model of medical education to online learning caused by the COVID-19 pandemic led to unprecedented changes in the education of future healthcare professionals. This study aimed to evaluate the opinions of Polish healthcare students on the changes introduced due to the COVID-19 pandemic and propose recommendations for improvement. Data were collected from June to July 2020 using an online questionnaire. The results demonstrate that students were generally satisfied with the online learning solutions implemented during the pandemic and appreciated their teachers’ efforts. In their opinion, some of the solutions should also be continued after the pandemic. Students noticed positive aspects of online learning: time efficiency, bigger student-friendliness and unlimited attention from teachers, the flexibility of the learning process, better learning conditions for students, and absences due to illness and other random situations. However, they also noticed its disadvantages: problems with the Internet connection and technical aspects, attitudes of teachers, limited interpersonal relations, limited learning of practical skills, health concerns, students’ engagement and distractions at home, and assessment. To conclude, our results indicate some necessary recommendations to improve the quality of further online learning in medical schools during the COVID-19 pandemic

Pre-hospital management of penetrating pelvic injuries — a case study

INTRODUCTION: Penetrating pelvic injuries and the complications caused by them are a global problem in the provision of services by emergency medical teams. They often pose a significant challenge for medical personnel, particularly in patient evacuation and stabilization during transport. CASE REPORT: The emergency medical service (EMS) was dispatched to a traffic accident — the report contained information about one conscious victim with a foreign body within the patient's body. At the accident scene, a delivery truck crashed into the tow bar of a trailer standing on the road, and one person was seriously injured due to the impact. The preliminary assessment confirmed a foreign body penetrating the right thigh, deformation and enlargement of the thigh contour, pain in the thigh, pelvis, and tenderness in the thoracic-lumbar spine with the end part of the tow bar hook palpable under the skin. The victim was suspected of having a femur fracture, pelvic injuries, and damage to internal organs. On neurological examination, sensation and motor functions were preserved in all limbs. The evacuation procedure was established after the Fire Department (FD) rescuers arrived. The injured person was removed from the vehicle on an orthopedic board with the help of eight rescuers. The victim was placed on his left side with the right side elevated, with continuous manual stabilization supported by a blanket, pillows, and orthopedic boar straps. CONCLUSIONS: Each traumatic injury event requires selecting and using the appropriate equipment. A good compromise between speed and precision of actions should not significantly contribute to the worsening of the injury. An increase in a rescuer's substantive knowledge on how to proceed in the case of this type of trauma and injuries, as well as close cooperation with the fire department, will undoubtedly result in more appropriate actions

Transferase S-glutathione class p gene (GSTP1) polymorphism in thyroid cancer patients

Wstęp: Jednym z potencjalnych genów zwiększających ryzyko zachorowania na niektóre nowotwory jest gen GSTP1 kodujący enzym szlaku detoksykacyjnego transferazę S-glutationu klasy &#960;. Polimorfizmy w obrębie tego genu mogą prowadzić do substytucji aminokwasów, co wpływa na strukturę centrum aktywnego enzymu i zmienia aktywność katalityczną wobec części substancji kancerogennych. Niewłaściwe działanie szlaku utylizacji substancji szkodliwych przekłada się bezpośrednio na zwiększenie liczby czynników oddziałujących z DNA i prowadzących do mutacji, co może zapoczątkowywać onkogenezę. Cel: Celem pracy była analiza dwóch polimorfizmów genu transferazy S-glutationu (GSTP1) pod względem ich asocjacji z występowaniem raka zróżnicowanego tarczycy (DTC, differentiated thyroid cancer). Dodatkowo przeprowadzono analizę wpływu badanych polimorfizmów na wiek rozpoznania choroby. Materiał i metody: Badania przeprowadzono u 156 osób. Grupę kontrolną stanowiły 53 zdrowe osoby, a grupę badaną - 103 osoby ze zdiagnozowanym DTC. Genotypowanie przeprowadzono za pomocą metody PCR&#8211;RFLP (polymerase chain reaction&#8211;restriction fragment length polymorphism). Wyniki: W przypadku obu polimorfizmów nie wykazano znamiennej statystycznie asocjacji z występowaniem raka tarczycy. Porównano częstości alleli oraz wyznaczono potencjalne allele ryzyka. Dla polimorfizmu c.313A>G był to allel Ile, OR = 1,257; 95% CI [0,792&#8211;1,997] (p = 0,332); dla polimorfizmu c.341C>T allel Val, OR = 1,283; 95% CI [0,6260&#8211;2,631] (p = 0,495). Przy korelacji wieku rozpoznania choroby z określonymi genotypami w grupie chorych wykazano znamienną statystycznie asocjację genotypu Val/Val (polimorfizm c.313A>G) z wcześniejszym wiekiem rozpoznania choroby (41,1 &plusmn; 15,2 w porównaniu z genotypami Ile/Val + Val/Val 48,9 &plusmn; 13,2 [p < 0,05]). Nie stwierdzono takiej asocjacji dla polimorfizmu c.341C>T. Wnioski: Nie można stwierdzić znamiennej statystycznie asocjacji polimorfizmów GSTP1 z występowaniem raka tarczycy w badanej grupie, natomiast obecność genotypu Val/Val (polimorfizm c.313A>G) wiąże się z wcześniejszym wystąpieniem choroby.Introduction: One of the potential genes which can increase the risk of cancer is GSTP1 gene. It encodes enzyme called glutathione S-transferase &#960; class, which is involved in the detoxification of a variety of potential carcinogenic compounds. Polymorphism in this gene can cause the amino acid substitution. This substitution, close to the substrate binding site, changes the enzymatic activity for particular substrates and subsequently increases the risk of carcinogenesis. The aim of this study was to evaluate the function of GSTP1 polymorphism in thyroid cancer and possible association between GSTP1 polymorphism and age at diagnosis. Material and methods: 103 patients with differentiated thyroid cancer (DTC) and 53 individuals from control group were examined using PCR&#8211;RFLP. Results: Statistically insignificant association of studied polymorphisms with thyroid cancer was observed. Comparison of allele frequency between cases and control groups revealed the presence of risk alleles. For the first polymorphism Ile OR = 1.257; 95% CI [0.792&#8211;1.997] (p = 0.332), and for the second one Val OR = 1.283; 95% CI [0.6260&#8211;2.631] (p = 0.495). The presence of Val/Val (c.313A>G) led to a significant earlier age of onset as compared with other genotypes (p < 0.05). Mean age at diagnosis for Val/Val genotype was 41.1 &plusmn; 15.2, and for Ile/Val + Ile/Ile reached 48.9 &plusmn; 13.2. There was no association between age and genotype for c.341C>T polymorphism. Conclusions: Statistically insignificant association of GSTP1 gene polymorphism with thyroid cancer was observed in studied group of patients. The Val/Val genotype for c.313A>G polymorphism led to earlier age of tumour diagnosis as compared with other genotypes