An evaluation of palliative care education in the specialist training programme in family medicine

Aim: The study aimed to evaluate the teaching in palliative care (PC) provided during the Specialist Training Programme in Family Medicine (STPFM) in Malta. Methodology: A questionnaire was used, based on two other validated questionnaires used in a similar population. Fifteen topics commonly encountered in PC were analysed. Results: Twenty-two (74.4%) trainees returned the questionnaire. All trainees received exposure to palliative care patients, but only 5 (22.7%) felt involved in their care and only 6 (27.3%) ever used a syringe driver. Most PC teaching in the STPFM was formal in nature. Trainees felt that palliative care subjects were covered well in the STPFM, but non-medical areas received lower scores. Trainees’ confidence closely mirrored the scores for subject coverage. The Half-Day Release Programmes were the most useful palliative care teaching resource. A correct answer for the question on pain management was obtained by 63.3% of trainees and 23.7% got a correct answer for the question on the use of a syringe driver. Concerns on managing dying patients in the community were raised by 40.9% of trainees. Trainees judged overall positively their STPFM. Conclusion: GP trainees need to be trained in PC in a manner that adequately addresses their future caseload. Changes need to be made in the PC teaching within the STPFM to address areas such as ethical issues in end-of-life; using a syringe driver; selfcare and managing patients in the community.peer-reviewe

The development of a rich multimedia training environment for crisis management: using emotional affect to enhance learning

PANDORA is an EU FP7-funded project developing a novel training and learning environment for Gold Commanders, individuals who carry executive responsibility for the services and facilities identified as strategically critical e.g. Police, Fire, in crisis management strategic planning situations. A key part of the work for this project is considering the emotional and behavioural state of the trainees, and the creation of more realistic, and thereby stressful, representations of multimedia information to impact on the decision-making of those trainees. Existing training models are predominantly paper-based, table-top exercises, which require an exercise of imagination on the part of the trainees to consider not only the various aspects of a crisis situation but also the impacts of interventions, and remediating actions in the event of the failure of an intervention. However, existing computing models and tools are focused on supporting tactical and operational activities in crisis management, not strategic. Therefore, the PANDORA system will provide a rich multimedia information environment, to provide trainees with the detailed information they require to develop strategic plans to deal with a crisis scenario, and will then provide information on the impacts of the implementation of those plans and provide the opportunity for the trainees to revise and remediate those plans. Since this activity is invariably multi-agency, the training environment must support group-based strategic planning activities and trainees will occupy specific roles within the crisis scenario. The system will also provide a range of non-playing characters (NPC) representing domain experts, high-level controllers (e.g. politicians, ministers), low-level controllers (tactical and operational commanders), and missing trainee roles, to ensure a fully populated scenario can be realised in each instantiation. Within the environment, the emotional and behavioural state of the trainees will be monitored, and interventions, in the form of environmental information controls and mechanisms impacting on the stress levels and decisionmaking capabilities of the trainees, will be used to personalise the training environment. This approach enables a richer and more realistic representation of the crisis scenario to be enacted, leading to better strategic plans and providing trainees with structured feedback on their performance under stress

Attitudes of advanced Australian medical oncology trainees to rural practice

Aim: To identify the views of medical oncology trainees regarding rural training posts and rural practice overall, and to identify factors that may improve recruitment. Methods: A questionnaire was posted to all advanced oncology trainees in Australia in June 2006. The trainees were questioned on the perceived advantages and disadvantages of rural practice, their experience during previous rural rotations and potential incentives and barriers in recruiting trainees and specialist oncologists to regional and rural centers. Results: There was a 60% response rate. Of all participants 58% had considered rural practice. Those with a rural family background were more likely to have considered rural practice. Attitudes based on responses to listed disadvantages and advantages of rural practice were heterogenous. Lifestyle factors seemed to be of particular importance. Although there were perceived deficiencies in opportunities for professional education in rural oncology rotations, 94% felt their rotation had been a positive experience overall and 62% were more likely to consider a rural career following their rural rotation. Improving locum cover for leave was seen as a potential incentive by 97% trainees. Conclusion: Despite positive attitudes towards rural practice, many barriers exist preventing recruitment of medical oncology trainees to rural areas, in particular lifestyle factors that are difficult to modify. Factors that can be improved include improving access to clinical trials, enabling access to locum cover. Educational opportunities for current rural trainees need to be improved. Further study into potential incentives to enhance rural recruitment is required

Using Cooperative Learning Model to Enhance Academic Performance of Teacher Trainees in Some Selected Topics in Integrated Science at Saint Monica’s College Of Education

The study sought to investigate the effects of using cooperative learning on female teacher trainees of the Colleges of Education in learning some selected topics in Integrated Science. The investigation also sought to determine whether the Cooperative Learning Approach enhances the attitude and motivation of the trainees towards learning of Integrated Science. The study was carried out at the St. Monica’s College of Education in the Mampong Municipality of the Ashanti Region. In all, 80 teacher trainees consisting of 40 each from control and experimental groups were purposively sampled to participate in the study. The teacher trainees in the experimental group were exposed to the Cooperative Learning Approach and the trainees in the control group were lectured during the period of the study. The results of the study showed that the cooperative learning strategy was very relevant and beneficial in helping the teacher trainees of the St. Monica’s College of Education to improve on their performance in, and attitudes towards, the teaching and learning of Integrated Science. It was therefore recommended among other things that the science teachers should endeavour to integrate cooperative learning into their routine methods of instruction in the teaching and learning of Integrated Science

Fit Into College II: Physical Activity and Nutrition Behavior Effectiveness and Programming Recommendations

Purpose: To determine whether residency (living on campus versus off campus) was related to the effects of Fit into College on students’ health behaviors, and to understand interns’ perceptions of their roles in mentoring their trainees. Design: Pre-experimental, one-group, pretest-posttest design and a posttest focus group interview. Setting: University-offered health and internship courses. Subjects: Twenty-four students (trainees) participated in the intervention, nine of whom lived on campus. Five student-interns served as their mentors. Intervention: Fit into College was a 14-week intervention in which trainees teamed up with an intern to improve and/or maintain healthy nutrition and physical activity behaviors. Measures: Trainees’ nutrition and physical activity behaviors and perceptions were quantitatively assessed through surveys at preintervention and postintervention. Interns’ mentoring perceptions were qualitatively assessed through a focus group interview after the intervention. Analysis: Two-factor repeated measure ANOVAs and qualitative theme identification. Results: Regardless of their residency location, the trainees’ perceptions of the health benefits of eating fruits and vegetables improved during the intervention. However, for trainees living on campus, the intervention was not effective in increasing the number of fruits and vegetables consumed or the planning for food preparation. The interns perceived that they did not have adequate access to healthy foods, the knowledge or skills to prepare healthy foods, or the competency to teach food preparation strategies to their trainees. For trainees living on campus, the intervention was more effective in decreasing perceived exercise barriers than trainees living off campus. Conclusion: Future iterations of Fit into College may focus on 1) improving college students’ planning and preparation of healthy foods, 2) segmenting trainees into more homogeneous groups for the interns to tailor their areas of expertise (campus vs. off-campus and/or freshman vs. upperclass students), and 3) collaborating with university-partners to improve environmental conditions to promote physical activity and healthy nutrition

Improving Retention of Science Student Teachers

Our on-going research aims to try and find out why some Science graduates on one year (PGCE) teacher training courses are not successful in completing the course. The course itself has been judged ‘Outstanding’ (Ofsted, 2010), so we have focused on the student teachers (trainees). Some key characteristics of trainees ‘at risk’ of being unsuccessful were identified in a variety of ways, including data analysis of records for trainees who left the course early and those who successfully completed the course, focus groups, questionnaires and case studies. Loss of trainees during PGCE courses appears to be a characteristic across many providers of initial teacher education for Science in the UK. Key factors emerging include gender, age, previous experiences/careers, support (or otherwise) of family/partner, caring issues (children/parents), subject knowledge, attendance at a subject knowledge enhancement course and more. If characteristics of ‘at risk’ trainees can be identified, strategies can be put into place to identify applicants, who might be at risk, at the selection stage and to support them during the course to reduce the drop-out rate. Recent work, described in the paper, appears to be improving our retention. Further research is needed to confirm and extend our current approach, which could, perhaps, be applied in other institutions and across other disciplines

GP trainees’ perceptions on learning EBM using conversations in the workplace : a video-stimulated interview study

Background To be able to practice evidence-based medicine (EBM) when making decisions for individual patients, it is important to learn how to combine the best available evidence with the patient's preferences and the physician's clinical expertise. In general practice training, these skills can be learned at the workplace using learning conversations: meetings between the supervising general practitioner (GP) and GP trainee to discuss medical practice, selected topics or professional performance. This study aimed to give insight into the perceptions of GP trainees on their EBM learning processes during learning conversations. Methods We held semi-structured video-stimulated elicitation interviews (n = 22) with GP trainees affiliated to GP training institutes in the Netherlands and Belgium. GP trainees were shown fragments of their learning conversations, enabling reflection during the interview. Taking an inductive approach, interview recordings were transcribed verbatim and analysed with NVivo software. Results GP trainees perceived learning conversations as useful for learning and discussing EBM. Multiple EBM learning activities were identified, such as discussing evidence together, relating evidence to cases in daily practice and discussing the supervisor's experience and the specific local context in the light of what the evidence recommends. However, for learning to occur, trainees need and expect specific behaviour, both from their supervisors and themselves. Supervisors should supply well-substantiated answers that are applicable in practice and give the trainee confirmation. In turn, the trainee needs to prepare well in order to ask focused, in-depth questions. A safe space allowing equal and open discussion between trainee and supervisor is perceived as an essential context for optimal EBM learning. Conclusions Our findings show that trainees find learning conversations useful for EBM learning in general practice. To bring EBM learning to its full potential, attention should be paid to optimising the behavioural and contextual factors found relevant to enhancing EBM learning

Differences in level of confidence in diabetes care between different groups of trainees: the TOPDOC diabetes study

Background There is an increasing prevalence of diabetes. Doctors in training, irrespective of specialty, will have patients with diabetes under their care. The aim of this further evaluation of the TOPDOC Diabetes Study data was to identify if there was any variation in confidence in managing diabetes depending on the geographical location of trainees and career aspirations. Methods An online national survey using a pre-validated questionnaire was administered to trainee doctors. A 4-point confidence rating scale was used to rate confidence in managing aspects of diabetes care and a 6-point scale used to quantify how often trainees would contribute to the management of patients with diabetes. Responses were grouped depending on which UK country trainees were based and their intended career choice. Results Trainees in Northern Ireland reported being less confident in IGT diagnosis, use of IV insulin and peri-operative management and were less likely to adjust oral treatment, contact specialist, educate lifestyle, and optimise treatment. Trainees in Scotland were less likely to contact a specialist, but more likely to educate on lifestyle, change insulin, and offer follow-up advice. In Northern Ireland, Undergraduate (UG) and Postgraduate (PG) training in diagnosis was felt less adequate, PG training in emergencies less adequate, and reporting of need for further training higher. Trainees in Wales felt UG training to be inadequate. In Scotland more trainees felt UG training in diagnosis and optimising treatment was inadequate. Physicians were more likely to report confidence in managing patients with diabetes and to engage in different aspects of diabetes care. Aspiring physicians were less likely to feel the need for more training in diabetes care; however a clear majority still felt they needed more training in all aspects of care. Conclusions Doctors in training have poor confidence levels dealing with diabetes related care issues. Although there is variability between different groups of trainees according to geographical location and career aspirations, this is a UK wide issue. There should be a UK wide standardised approach to improving training for junior doctors in diabetes care with local training guided by specific needs.</p

The impact of Mexico's retraining program on employment and wages

The authors evaluated how Mexico's Labor Retraining Program (PROBECAT) affected unemployment and displaced workers. As part of the World Bank supported Manpower Training project, PROBECAT has provided short-term vocational training to more than 250,000 unemployed people. Their evaluation was based on new longitudinal data on PROBECAT trainees developed for this purpose, and includes data on a control group of unemployed people who did not join PROBECAT. Their main findings were as follows: On average, the trainees found jobs more quickly than the control group. But training does not shorten the term of unemployment for those without work experience. Male trainees are more likely to be employed three and six months after training than are the controls. Female trainees with work experience are more likely to be employed three, six, and twelve months after training than are the controls. Male trainees are more likely to find employment in large firms than are comparable controls. Training increases the monthly earnings of male trainees, but this effect varies systematically depending on the person's level of schooling attainment. The monetary benefits of training outweigh the costs of the PROBECAT program for certain groups of trainees. For male trainees over 25 with prior work experience, the benefits outweigh the costs of training within three months of starting work. For all other males except those with no prior work experience, the benefits outweigh the costs within one year. Men with no prior work experience spend the longest time job hunting after training (8 months, compared with the trainee mean of 4.4 months) and benefit less from training in terms of monthly earnings (128 thousand pesos compared with the average benefit of 152 thousand pesos). For this group, the costs of training are offset only after 17 months of higher earnings.Teaching and Learning,Environmental Economics&Policies,Health Monitoring&Evaluation,Vocational Education&Technical Training,Labor Standards

Adaptive Guidance: Enhancing Self-Regulation, Knowledge, and Performance in Technology-Based Training

Considerable research has examined the effects of giving trainees control over their learning (Steinberg, 1977, 1989; Williams, 1993). The most consistent finding of this research has been that trainees do not make good instructional use of the control they are given. Yet, today’s technologically based training systems often provide individuals with significant control over their learning (Brown, 2001). This creates a dilemma that must be addressed if technology is going to be used to create more effective training systems. The current study extended past research that has examined the effects of providing trainees with some form of advisement or guidance in addition to learner control and examined the impact of an instructional strategy, adaptive guidance, on learning and performance in a complex training environment. Overall, it was found that adaptive guidance had a substantial effect on the nature of trainees’ study and practice, self-regulation, knowledge acquired, and performance