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Aim: The aim of the study was to identify the nature and extent of scientific research addressing continuing education for advanced practice nurses. Design: A scoping review. Review Methods: The Joanna Briggs Institute's methodology for scoping reviews. Data Sources: Electronic search was conducted on 17 September 2023 via CINAHL, PsycINFO, PubMed, Scopus, Web of Science, Cochrane Library and the Joanna Briggs Institute's Evidence‐Based Practice Database for research articles published between 2012 and 2023. Results: Nineteen papers were included in this review. Scientific research on continuing education for advanced practice nursing roles (i.e. nurse practitioner, clinical nurse specialist) has primarily been conducted in the United States and mostly addresses online‐delivered continuing education interventions for clinical care competency. Most of the interventions targeted nurse practitioners. Conclusion: Continuing education has a pivotal role in supporting advanced practice nursing competency development. In addition to clinical care, future continuing education research should focus on other advanced practice nursing competencies, such as education, leadership, supporting organizational strategies, research and evidence implementation. Implications for the Profession and/or Patient Care: Continuing education programmes for advanced practice nurses should be rigorously developed, implemented and evaluated to support the quality and effectiveness of patient care. Impact: Continuing education for advanced practice nursing roles is an understudied phenomenon. This review highlights future research priorities and may inform the development of continuing education programmes. Reporting Method: PRISMA‐ScR. [ABSTRACT FROM AUTHOR]

Introduction: The real‐world mechanisms underlying prospective entrustment decision making (PEDM) by entrustment or clinical competency committees (E/CCCs) are poorly understood. To advance understanding in this area, the authors conducted a realist synthesis of the published literature to address the following research question: In E/CCC efforts to make defensible prospective entrustment decisions (PEDs), what works, for whom, under what circumstances and why? Methods: Realist work seeks to understand the contexts (C), mechanisms (M) and outcomes (O) that explain how and why things work (or do not). In the authors' study, contexts included individual E/CCC members, E/CCC structures and processes, and training programmes. The outcome (i.e. desired outcome) was a PED. Mechanisms were a substantial focus of the analysis and informed the core findings. To define a final corpus of 52 included papers, the authors searched four databases, screened all results from those searches and performed a full‐text review of a subset of screened papers. Data extraction focused on developing context–mechanism–outcome configurations from the papers, which were used to create a theory for how PEDM leads to PEDs. Results: PEDM is often driven by default (non‐deliberate) decision making rather than a deliberate process of deciding whether a trainee should be entrusted or not. When defaulting, some E/CCCs find red flags that sometimes lead to being more deliberate with decision making. E/CCCs that seek to be deliberate describe PEDM that can be effortful (when data are insufficient or incongruent) or effortless (when data are robust and tell a congruent story about a trainee). Both information about trainee trustworthiness and the sufficiency of data about trainee performance influence PEDM. Several moderators influence what is considered to be sufficient data, how trustworthiness data are viewed and how PEDM is carried out. These include perceived consequences and associated risks, E/CCC member trust propensity, E/CCC member personal knowledge of and experience with trainees and E/CCC structures and processes. Discussion: PEDM is rarely deliberate but should be. Data about trainee trustworthiness are foundational to making PEDs. Bias, equity and fairness are nearly absent from the papers in this synthesis, and future efforts must seek to advance understanding and practice regarding the roles of bias, equity and fairness in PEDM. Entrustment decisions made by committees are rarely deliberate, but should be. These authors provide practical advice, based in the literature, for improvement. [ABSTRACT FROM AUTHOR]

Background: There has been rapid growth of chiropractors pursuing career opportunities in both public and private hospitals and other integrated care settings. Chiropractors that prosper in integrated care settings deliver patient-centered care, focus on the institutional mission, understand and adhere to organizational rules, and are proficient in navigating complex systems. The Council on Chiropractic Education Accreditation Standards do not outline specific meta-competencies for integrated care clinical training. Objective: The purpose of this study was to develop preliminary integrated health care competencies for DC programs to guide the advancement of clinical chiropractic education. Methods: A systematic literature search was performed. Articles were screened for eligibility and extracted in duplicate. Domains and seed statements were generated from this literature, piloted at a conference workshop, and evaluated via a modified Delphi consensus process. Of 42 invited, 36 chiropractors participated as panelists. Public comment period yielded 20 comments, none resulting in substantive changes to the competencies. Results: Of 1718 citations, 23 articles met eligibility criteria. After 2 modified Delphi rounds, consensus was reached on all competency statements. A total of 78 competency statements were agreed upon, which encompassed 4 domains and 11 subdomains. The 4 domains were: 1) Collaboration, (2) Clinical Excellence, (3) Communication, and (4) Systems Administration. Conclusion: We identified 78 preliminary competencies appropriate for preparing DC students and early career chiropractors for clinical practice in integrated healthcare settings. Educational programs may consider these competencies for curricular design and reform to strengthen DC program graduates for integrated practice, advanced training, and employment. [ABSTRACT FROM AUTHOR]

Purpose: Rural communities are disproportionately impacted by acute shortages of mental health providers. This problem, combined with complex behavioral health conditions, elicited the need for a university-based, remote telepsychiatric traineeship for newly board certified psychiatric–mental health nurse practitioners (PMHNPs). Method: The Psychiatric Advanced Practice Registered Nurse TechNology Enhanced Residency (PARTNER) Program was developed to advance behavioral health equity by increasing state-wide access to care, removing geographical barriers, and enhancing PMHNP workforce readiness by strengthening trainees' ability to manage complex behavioral health conditions. Results: In a southeastern state over a period of 3 years, six PMHNPs cumulatively provided behavioral health services to 1,195 patients, managed >118 diagnoses, and completed 3,535 visits, with 95.6% of visits comprising provision of care to patients residing in rural areas. Conclusion: Care was provided through the implementation of a collaborative-interdisciplinary-care model provided by route of telehealth and comprising a partnership between PMHNPs and patients' primary care providers. The training program enhanced providers' clinical proficiency, improved patient outcomes, and increased the number of skilled providers trained to manage patients with complex behavioral health conditions. [Journal of Psychosocial Nursing and Mental Health Services, 62(8), 19–24.] [ABSTRACT FROM AUTHOR]

Many transgender individuals face inequities, discrimination, and sometimes even a lack of transgender-specific knowledge in health care settings. Educational curricula can address such disparities and help future health professionals to become more knowledgeable, confident, and well-prepared for addressing the needs of transgender individuals. This systematic review aims to summarize current training interventions about care of transgender individuals for health and allied health students, and to analyse the effects of the respective intervention. A total of six databases (Pubmed, MEDLINE, Scopus, Web of Science, Embase and SciSearch) were screened for original articles published between 2017 and June 2021. Search terms and eligibility criteria were pre-specified, and after a structured selection process 21 studies were included into further analysis. Extracted data contained information on general study properties, population, design, program format and outcomes of interest. A narrative synthesis was used to summarize detected results. Study quality was assessed for each individual study. A self-developed 18-item checklist combining criteria of two prior published tools was used to assess overall quality of quantitative studies. For qualitative studies a 10-item checklist by Kmet et al. [HTA Initiat, 2004] was applied. Eligible studies were designed for multiple health or allied health profession students, and varied widely regarding program format, duration, content, and assessed outcomes. Almost all (N = 19) interventions indicated improvements in knowledge, attitude, confidence and comfort levels or practical skills concerning care for transgender clients. Major limitations included the lack of long-term data, validated assessment tools, control groups and comparative studies. Training interventions contribute to prepare future health professionals to deliver competent and sensitive care and which may improve the prospective experienced health care reality of transgender individuals. However, currently there is no common consensus about best practice of education. Additionally, little is known about whether detected effects of training interventions translate into noticeable improvements for transgender clients. Further studies are warranted to assess the direct impact of specific interventions in the light of the respective target populations. [ABSTRACT FROM AUTHOR]

Aims: Diagnostic Reasoning (DR) is an essential competency requiring mastery for safe, independent Nurse Practitioner (NP) practice, but little is known about DR content included in NP education programs. The aims of this study were to identify whether and how the concept of DR is addressed in NP education. Design: We conducted a scoping review on DR‐related content and teaching innovations in U.S. primary care NP education programs, with implications for NP education programs worldwide. Concepts and principles with global applicability include: conducting focused and hypothesis‐directed histories and exams, generating the problem statement, formulating the differential diagnosis, appropriate and relevant diagnostic testing, determining the working diagnosis and developing evidence‐based, patient‐centred management plans. Data sources N = 1115 articles retrieved from Medline, Embase, PsycINFO, and CINAHL for the period 2005–2021. Forty‐one scholarly articles met inclusion/exclusion criteria. Review methods: Data were extracted, synthesized and grouped by theoretical frameworks, content included, educational interventions and assessment measures. Results: Most articles provided descriptions of approaches for teaching NP clinical or diagnostic reasoning. Ten papers directly referenced the current science and theory of DR. Conclusion: The US NP education literature addressing DR is limited and demonstrates a lack of shared conceptualizations of DR. Whilst numerous components of DR are identifiable in the literature, a robust teaching/learning scholarship for DR has not yet been established in the US NP education literature. Impact Whilst primary care NP education programs are beginning to incorporate DR education into their curricula, little research has been conducted to demonstrate the effectiveness of educational outcomes. Increased integration of DR content into NP education is needed, including increased educational research on teaching DR competencies. Patient or public contribution: No patient or public contribution was included in this review, as the public is generally not familiar with DR or its teaching approaches. [ABSTRACT FROM AUTHOR]

Purpose: Family--professional partnerships are important for youth learning to use aided augmentative and alternative communication (AAC). This study examined the family-oriented beliefs and practices of speech-language pathologists (SLPs) working with preschool and school-aged children learning to use aided AAC (aged 3--21 years), specifically during the COVID-19 pandemic. Method: Participants were 25 SLPs who participated in an individual semistructured interview. Qualitative analysis was used to identify and describe groups of SLPs based on commonalities and differences in their beliefs and practices working with families. The characteristics of SLPs in each group was also explored descriptively (e.g., race/ethnicity, work setting, caseload). Results: SLPs clustered into three groups based on their beliefs and practices: (a) professionally centered, (b) family-allied, and (c) family-focused. SLPs varied across these groups in how they planned services, offered training/coaching, communicated, shared resources, offered emotional support, and adapted to and with different families. Conclusions: Findings indicate the need to support greater family-centeredness in AAC services by building on the strengths of SLPs in the field. Promoting strong family--professional partnerships could in turn improve outcomes for students who use AAC. [ABSTRACT FROM AUTHOR]

Background: Pediatric healthcare today shows a rising demand for research focusing on children's perspectives on and consumer satisfaction with the nursing care they receive. Therefore, the purpose of this study was to translate and adapt the Consumer Emergency Care Satisfaction Scale (CECSS), a paper-based, self-administered 19-item questionnaire originally developed in the United States and targeted towards adults, and then test the new version in Swedish pediatric emergency departments.Methods: The study was designed with a two-phase approach. Firstly, a forward-backward translation of the CECSS, involving expert consensus, was performed, and then the questionnaire was adapted for children aged 10-18 and assessed for face and content validity. Secondly, the translated and adapted questionnaire was tested with a clinical sample for construct validity, internal consistency, and reliability. This last aspect was assessed using a structured telephone interview 7-10 days after the participant visited a pediatric emergency department. All children participating in this study gave their assent (< 15 years) or consent (≥ 15 years), and their guardian's written informed consent was also obtained.Results: The paper-based, self-administered 19-item Swedish version of the CECSS was tested on a clinical sample consisting of 203 nonurgent children (boys: n = 109, 53.7 % and girls: n = 94, 46.3 %) between 10 and 18 years (mean age 13.8, SD 2.29). The factor analysis revealed three factors that explain 63.1 % of the total variation in the 15 items. The Cronbach's alphas for the three dimensions (caring, teaching, and clinical competence) varied between 0.79 and 0.88. The intraclass correlation coefficient (ICC) for the entire Swedish version of the CECSS was 0.58, and the ICCs for the three dimensions varied between 0.56 and 0.71.Conclusions: The results show that the developed Swedish Pediatric Consumer Emergency Care Satisfaction Scale (p-CECSS-S) is a valid, stable and easy-to-use-questionnaire that can be used to assess children's satisfaction with nursing care. [ABSTRACT FROM AUTHOR]

Aim: To examine the diagnostic reasoning skills of two nurse practitioner student cohorts. Introduction: Nurse practitioners continue to play a pivotal role in health care provision. Diagnostic reasoning is a core skill of advanced practice. A comparative diagnostic reasoning study between two student cohorts was undertaken between 2018 and 2019. Methods: A validated diagnostic reasoning scale was completed by nurse practitioner students in the United Kingdom and the United States of America at the beginning and end of their clinical placements. The study utilized descriptive quantitative statistics from the data submitted by 22 survey respondents from an online survey. Results: Analysis of the diagnostic reasoning skills suggested there was a difference in the structural memory scores when compared with the beginning of their clinical placements and the final semester of their clinical placements. Conclusion: Diagnostic reasoning skills are a core skill of advanced practice. As students progress through their training, these skills improve. Despite the statistical difference in diagnostic reasoning scores, caution should be made in determining any larger implications due to the small number of participants in this study. Further study is needed in this area. Summary statement: What is already known about this topic? Diagnostic reasoning is a core skill for nurse practitioners.There is minimal research in this area.Diagnostic accuracy is vital for ensuring patient safety. What this paper adds? Structural memory scores improved at the end of nurse practitioner clinical placements. What are the implications of this paper for policy/practice/research/education? Further global research in the field of diagnostic reasoning for nurse practitioners and nurse practitioner students is needed to validate these findings.It is important to ensure nurse practitioners have competency in diagnostic reasoning to reduce diagnostic error.Curricula could be designed to incorporate the use of the DTI to evaluate a student's progress throughout the clinical portion of the nurse practitioner programme. [ABSTRACT FROM AUTHOR]

Background: Thematic arts have been integrated throughout various undergraduate medical education programs to improve students' clinical skills, knowledge, and behaviours to train clinically competent physicians. Applied theatre and drama use theatrical performances and exercises respectively to guide education. Several medical schools across Canada and the United States have incorporated applied theatre and drama within their curriculums, but there is currently no compilation of these initiatives. Methods: Using Arksey and O'Malley's methodological framework for scoping reviews, the two authors searched journal databases for articles pertaining to theatre or drama activities being used in undergraduate medical education in Canada and the United States. Search terms revolved around applied theatre and undergraduate medical education. Twenty articles were read in full, 14 were included in this review. The articles were subjected to content analysis to understand how the studies connected with the CanMEDS framework, allowing to understand the impacts and merits of applied theatre and drama in undergraduate medical education. Results: Content analyses generated three categories for how theatre and drama can help medical faculties improve their students' communication skills, integrate creative medical learning, and aid professional development. These three categories touched upon all seven aspects of the CanMEDS framework, indicating the value of drama being included in the current framework for medical education. Conclusion: This scoping review illustrates the intersections between thematic arts and undergraduate medical education by highlighting how applied theatre or drama activities connect to the entire Can-MEDS framework. This review informs current theatre and drama initiatives led by medical faculty aiming to develop their undergraduate medical curricula. [ABSTRACT FROM AUTHOR]

Background. Many diseases are linked to lifestyle in the United States, yet physicians receive little training in nutrition. Medical students' prior knowledge of nutrition and cooking is unknown. Objective. To determine incoming medical students' prior nutrition knowledge, culinary skills, and nutrition habits. Methods. A dual-methods study of first-year medical students. Cross-sectional survey assessing prior knowledge, self-efficacy, and previous education of cooking and nutrition. Interviews of second-year medical students explored cooking and nutrition in greater depth. Results. A total of 142 first-year medical students participated; 16% had taken a nutrition course, with majority (66%) learning outside classroom settings. Students had a mean score of 87% on the Nutritional Knowledge Questionnaire versus comparison group (64.9%). Mean cooking and food skills score were lower than comparison scores. Overall, students did not meet guidelines for fiber, fruit, vegetables, and whole grains. Interviews with second-year students revealed most learned to cook from their families; all believed it important for physicians to have this knowledge. Conclusions. Medical students were knowledgeable about nutrition, but typically self-taught. They were not as confident or skilled in cooking, and mostly learned from their family. They expressed interest in learning more about nutrition and cooking. [ABSTRACT FROM AUTHOR]

Introduction: An estimated 38 million people are living with human immunodeficiency virus (HIV) worldwide. Pharmacists are well positioned to provide care to patients with HIV, but gaps in HIV education among pharmacists exist. Recognizing the need to educate and prepare future pharmacists, a 2-credit advanced HIV elective course was created for Doctor of Pharmacy students at Washington State University College of Pharmacy and Pharmaceutical Sciences in the United States, and Masters of Clinical Pharmacy students from University of Western Cape School of Pharmacy in South Africa. Methods: Course topics included diagnosis and treatment of HIV in children and adults, management of common comorbidities, pre-exposure prophylaxis, pharmacogenetic applications, and antiretroviral drug-drug interactions. Course effectiveness was evaluated using student examination results. Student perceptions were evaluated using pre- and post-course self-assessments involving abilities, confidence, and attitudes toward caring for people living with HIV. Results: Student pharmacists demonstrated competency in HIV knowledge, demonstrated skills in application to clinical-based scenarios, and reported significantly improved confidence and abilities as well as positive changes in attitudes toward people with HIV. Conclusion: This course contributed to student learning across different student cohorts in an institutional program in the United States including successful execution of distance learning and clinical application for students at a program in South Africa. [ABSTRACT FROM AUTHOR]

Objectives: For decades, there have been calls to action to change the status quo of public health education in the United States to respond to workforce needs and help reinforce capacity. During the last 10 years, schools and programs of public health have planned and implemented programmatic and curricular changes. This study explored the focus of master of public health (MPH) education in the United States today. Methods: We used a 3-phase mixed-methods study to compile data to describe the current state and focus of MPH education in the United States via survey data collection (November–December 2019), semistructured interviews (January–February 2020), and document reviews. Results: Survey responses represented at least 43% (93/215) of eligible MPH programs in the United States. Most respondents (86%, 99/115) reported that the primary focus of MPH education in the United States is to prepare graduates for public health practice and employment linked to public health, and 54% (59/109) reported that their MPH programs adopted this focus in the last 5 years. MPH programs invested in student learning, competence development, and supporting workforce readiness, including a focus on leadership abilities. Programs noted that they seek to develop strategic thinkers and engaged leaders with abilities to understand and address emergent public health needs. Conclusions: Public health education in the United States is in a period of change. MPH programs reported responding to workforce needs by closing gaps in workforce capacity and developing compassionate and professional leaders who can understand needs, collaborating with communities, and facilitating action that will ameliorate health disparities and promote social injustice by practicing public health in new ways. [ABSTRACT FROM AUTHOR]

The United States (US) National Center for Interprofessional Practice and Education was funded at the University of Minnesota to serve as the National Coordinating Center for Interprofessional Education and Collaborative Practice (IPECP) in the US In 2012, the funders had specific expectations for operationalizing their vision that included scholarship, programs and leadership as an unbiased, neutral convener to align education with health system redesign. While US specific, the National Center benefited from and contributed to the international maturity of the field over the past decade. Through its various services and technology platforms, the National Center has a wide reach nationally and internationally. This perspective provides a unique view of the field in the US with observations and implications for the future. [ABSTRACT FROM AUTHOR]

Background: The involvement of speech and language therapists (SLTs) within paediatric palliative care (PPC) settings has been recognized within the extant literature. However, there is little understanding of SLT's specific roles and practices when working with this vulnerable cohort of children and their families. As part of a larger body of work to develop consensus‐based recommendations for SLTs working in PPC, it is important to investigate demographic and caseload characteristics. Aims: This exploratory study aimed to gather previously undocumented international demographic data pertaining to SLT service provision, caseload and training in PPC. Additionally, it sought to ascertain the current treatment and assessment approaches of SLTs, and if variations exist in beliefs and practices. Methods & Procedures: An anonymous cross‐sectional survey was designed and reported according to the Checklist for Reporting Results of Internet E‐Surveys (CHERRIES). The online survey consisted of 40 items spanning four domains: (1) demographic information, (2) caseload information, (3) service provision and (4) training and education. SLTs from Australia, Canada, New Zealand, the UK, Ireland and the United States were recruited using a purposive snowball sampling approach. Descriptive analysis of closed‐ended survey responses and content analysis of open‐ended responses are presented. Outcomes & Results: A total of 52 respondents completed the survey. SLTs worked in a variety of PPC settings, with patients of varying age and disease groups. Over 50% of participants reported working in PPC for ≤ 4 years. Genetic disorders (34%), oncology (27%) and neurological conditions (21%) made up a significant portion of respondents' caseloads. Reported treatments and assessment approaches used by SLTs are not unique to a PPC population. Barriers and enablers for practice were identified. A portion of participants did not feel trained and prepared to assess (19.2%) or treat (15.4%) PPC clients. Conclusions & Implications: This study confirms that SLTs internationally have a role in the management of communication and swallowing impairments in a PPC context. However, whether current training and resources adequately support SLTs in this role remains questionable. This paper helps to provide SLTs, administrators, professional associations and tertiary institutions with foundational data to help inform workforce planning, advocacy efforts and training priorities. What this paper addsWhat is already known on the subjectThe published multidisciplinary literature has identified that SLTs have a role in PPC. However, there has been no targeted research investigating the professional characteristics of clinicians in this context, nor any detailed information regarding associated clinician beliefs or management approaches.What this paper adds to existing knowledgeThis study is a snapshot of attributes, practice patterns and beliefs of SLTs who work with a PPC population. It highlights SLT perspectives of education and training, as well as meta‐perceptions of themselves within the multidisciplinary team.What are the potential or actual clinical implications of this work?Data presented in this paper will help to enable SLTs, organizations and associations to augment service provision and determine future professional development priorities within the field of PPC. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to describe the results of an online program evaluation survey conducted in the USA in 2018 which was designed to understand how members of an enhanced multidisciplinary team (E-MDT) use the expertise of a forensic accountant (FA) in suspected cases of elder financial exploitation. Design/methodology/approach: This paper analyzes responses to an online survey from 54 E-MDT members. Narrative responses to open-ended questions were analyzed by using cross-case thematic analysis. Data from demographic questions and those with nominal response options were analyzed using descriptive statistics. Findings: Overwhelmingly, the E-MDT members described how useful the FA's expertise and subsequent detailed reports are in helping determine whether financial exploitation is taking place and providing information needed to continue an investigation and pursue criminal charges. Practical implications: The increasing longevity and sheer number of older adults present ongoing challenges in the fight to address financial exploitation. Findings suggest that FAs working with E-MDTs can help identify signs, collect evidence and help investigate cases of suspected financial abuse of older adults. The development of training programs focused on educating accountants to fill a need in a growing area of forensic accounting may be needed. Originality/value: This paper adds to the growing evidence of multidisciplinary teams as an effective model for investigating cases of financial elder exploitation by focusing specifically on the expertise of an FA. [ABSTRACT FROM AUTHOR]

Phenomenon: Many U.S. medical schools have responded to the adoption of competency-based medical education (CBME) frameworks by renewing their final-year curricula and including internship preparatory courses. The purpose of this scoping review was to map the published literature regarding the final year to discern how medical schools have responded to this paradigm change. Approach: A structured 5-step approach was used to conduct this scoping review. Electronic searches of PubMed, ERIC, Scopus, MedEdPortal, and 8 medical education journals were conducted to identify relevant articles published from 2006 to 2016. Four authors screened articles for inclusion using standardized eligibility criteria; interrater agreement was discussed and calculated. Authors extracted data elements, and a consensus-based approach was used to categorize, sort, and structure information gathered. Findings: Among 6,485 articles retrieved, 817 articles were included in the study. From 2007–2011 to 2012–2016, articles addressing the final year of medical school increased 93%, whereas articles describing internship preparatory courses increased 218%. The majority of articles did not reference a CBME framework (572/817; 70%), the frequency of mentions increased 268% from 2007–2011 to 2012–2016. Nearly three fourths of preparatory course-related papers reference a CBME framework (37/50; 74%). Insights: Our findings may reflect a movement in U.S. medical schools toward using shared assessment metrics to support 4th-year medical students' preparation for their postgraduate medical education. Despite an increased reference to CBME, there is relatively little use of competency-based assessment frameworks to evaluate learning outcomes. This review also found a substantial increase in the frequency of articles referencing senior-year preparatory courses in U.S. medical schools. Articles tended to describe institution-specific research or experiences. Opportunities likely exist for multi-institutional and organizational collaboration in determining the structure of the final year of medical school. [ABSTRACT FROM AUTHOR]

Continued competency is poorly defined in emergency medical services (EMS), with no established method for verifying continued competency at a national level. The objective of this project was to refine understanding of continued competency for EMS clinicians in the U.S. and establish priorities for developing competency assessments. A panel of EMS managers, educators, medical directors, and experts in competency assessment, simulation, and certification used a modified Delphi technique to address two questions: "What is the content for continued competency in EMS that should be assessed or verified?" (content) and "How should continued competency of EMS clinicians be demonstrated?" (process). The Delphi process was conducted through electronic conferencing and survey software over a 6-month period. In round one, panelists responded to open-ended prompts and their contributions were analyzed and categorized into themes by independent reviewers. In round two, the panel rated theme importance using five-point Likert-type scales. In round three, the panel ranked their top 10 themes, and in round four, the panel selected the most important themes for each of the two questions through consensus-building discussions. Descriptive statistics and thematic analyses were performed with Excel and STATA 16. Fourteen invited experts participated in all Delphi activities. The panel contributed 70 content and 35 process items from the original prompts. Following thematic analysis, these contributions were reduced to 21 and 14 unique themes, respectively. The final top five prioritized themes for content important for continued competency included (1) airway, respiration, and ventilation, (2) patient assessment, (3) pharmacology, (4) pediatrics, and (5) management of time critical disease progressions. The final top five prioritized themes for the processes for continued competency assessment included (1) assessments of evidence-based practice, (2) performance-based assessments, (3) combined knowledge and skill assessments, (4) performance improvement over time, and (5) frequent, short knowledge assessments. This modified Delphi process identified priorities for content and assessment, laying the groundwork for EMS continued competency at a national level. These findings can be leveraged by national task forces to develop transparent and consistent guidelines for systems that verify continued competency related to certification, licensure, and local credentialing. [ABSTRACT FROM AUTHOR]

Introduction: Racial and language disparities in the United States healthcare system have long undermined the quality of care provided to minority patients. With the projected growth of the Hispanic population, there is an urgent need for medical schools to integrate high-quality medical Spanish and cultural competency content. We propose a comprehensive medical Spanish curriculum aligned with the preclinical curriculum as a solution to these issues. The primary goal of this study is to demonstrate the effectiveness of a clinically focused, culturally competent medical Spanish program and advocate for its widespread adoption in medical institutions nationwide. Methods: The study utilized the Kirkpatrick Model to evaluate the success of the medical Spanish curriculum. A total of 111 medical students voluntarily enrolled in the medical Spanish course. Out of these students, 47 completed the final evaluation, which included a Spanish Objective Structured Clinical Examination and a 40-question Multiple-Choice Exam assessing the integration of Spanish language skills and cultural competency. Both assessment methods took place in clinical skills facilities. Descriptive statistics summarized exam results, and two-tailed t-tests compared mean exam scores between students of different proficiency levels. Results and discussion: Students achieved a mean score of over 80% on all components of the Spanish Objective Structured Clinical Examination and the Multiple-Choice Exam. Survey data suggest that students felt able to communicate in Spanish with patients after completing the course series. The study also provides a model for a medical Spanish curriculum that applies expert-recommended best practices to meet the needs of Hispanic patient populations. Limitations and conclusions: Students who sat for the OSCE and MCE were self-selected. Baseline data on student perceptions and Spanish competency are not sufficient for making comparisons. [ABSTRACT FROM AUTHOR]

Healthcare-associated infections are a significant reason for readmission to hospital post-discharge to the community. In this paper, the authors describe some of the key findings from a programme of work conducted in a home care agency (community care organisation) in the US. A survey was conducted to explore home care nurses' knowledge, attitudes and beliefs around infection control (n=415); 400 nurse-patient visits were observed, and 50 nurses were interviewed about their infection control practices. Nurses reported high compliance with infection control practices. However, the overall average adherence rate to observed hand hygiene practices was 45.6%. Interview data provided valuable insights into specific challenges faced by nurses in a home care setting. This study provides insights that can be used to enhance infection control practice in community care in the UK. [ABSTRACT FROM AUTHOR]

Recent changes to clinical psychology training and supervision in Australia have been driven by a deliberate endeavour by regulatory authorities and professional bodies to align education and training with competency-based models of training, a development that is apparent internationally across health disciplines. A critical question is: how do reforms in Clinical Psychology training standards match international benchmarks for competency-based pedagogies? Objective: To outline key principles of competency-based pedagogies and to critically examine whether Australia's new standards and guidelines for accreditation of coursework, practicum requirements, and supervision are consistent with competency principles, and match similar guidelines proposed in the U.K. and the U.S.A. Method: Following a critical analysis of the extant literature, the authors highlight progress achieved, discuss major gaps and challenges, and examine the extent to which current accreditation changes constitute a reliable blueprint for the development of a competent psychology workforce for the country. Results and Conclusions: The current review indicates that in an overall sense, practitioner training in Australia is tracking well in comparison to international developments. Specifically, the decreased emphasis on the regulation of inputs (e.g., nature and type of coursework and practicum) is pedagogically sound and has the potential to promote training innovation and efficiencies. However, a revision of the current competency framework is required to underpin future progress. Also, the lack of reliable and valid competence instruments in combination with less than rigorous adherence to systematic, timely, and ecologically valid assessments constitute a major challenge and a serious threat to ensuring safe and competent psychology practice. What is already known about this topic: (1) Competency-based education and clinical training play important coordinated roles in ensuring the competence of clinical psychologists, consistent with the accreditation standards and registration requirements of the Psychology Board of Australia. (2) The Australian Psychology Accreditation Council (APAC, 2019) have recently published new accreditation standards for psychology programs that are based on competency principles. (3) The shift to the new paradigm is both exciting and challenging. It is exciting because it provides opportunities for innovation; it is challenging because it demands systemic change. What this topic adds: (1) The current paper compares and contrasts current standards and guidelines for accreditation in Australia with their counterparts in the U.K. and the U.S.A. (2) Although significant progress has been made in Australia, additional implementation efforts should be taken to establish a comprehensive and authoritative competency framework, incorporating empirically-supported means of assessment. Such a framework should be fit-for-purpose providing a grid that maps shared and unique aspects of competencies across registration levels and specialised endorsements. (3) The progressive relaxing of input criteria has the potential to seriously compromise the commitment to safe and competent psychological practice if training institutions do not adopt a re-designed system of ecologically valid assessments both during training and at the point of entry to the profession. (4) The need to ensure competence is maintained throughout a psychologist's career will remain a major challenge, given the ongoing and rapid advance of science. A commitment to the competency-based approach provides the necessary scaffolding for ongoing professional development. [ABSTRACT FROM AUTHOR]

This research analyzes factors that patients consider when offered the option to have surgeries (knee-replacement or heart bypass) at one of three locations (local hospital, Center of Excellence hospital, or Medical Tourism) with financial incentives varying based on location/surgery. Quantitative and qualitative results, based on a national online survey of respondents over 45 years old, found a significant relationship between perceived risk and satisfaction based on location of the surgery. However, specific individual factors, such as personal responsibilities, concerns with travel, perception of healthcare quality, are found to impact patient location preference for surgery. [ABSTRACT FROM AUTHOR]

This qualitative study evaluates physician training and experience with treatment and prevention services for people who inject drugs (PWID) including medications for opioid use disorder (MOUD) and HIV pre-exposure prophylaxis (PrEP). The Behavioral Model of Healthcare Utilization for Vulnerable Populations was applied as a framework for data analysis and interpretation. Two focus groups were conducted, one with early career physicians (n = 6) and one with mid- to late career physicians (n = 3). Focus group transcripts were coded and analyzed using thematic analysis to identify factors affecting implementation of treatment and prevention services for PWID. Respondents identified that increasing the availability of providers prescribing MOUD was a critical enabling factor for PWID seeking and receiving care. Integrated, interdisciplinary services were identified as an additional resource although these remain fragmented in the current healthcare system. Barriers to care included provider awareness, stigma associated with substance use, and access limitations. Providers identified the interwoven risk factors associated with injection drug use that must be addressed, including the risk of HIV acquisition, notably more at the forefront in the minds of early career physicians. Additional research is needed addressing the medical education curriculum, health system, and healthcare policy to address the addiction and HIV crises in the U.S. South. [ABSTRACT FROM AUTHOR]

Background: Most medical educational programs emphasize clinical observation or clinical skill acquisition, fewer focus upon research. The Danish-American Research Exchange (DARE) program, sponsored by the Lundbeck Foundation, is unique in that the medical student initiates biomedical research collaboration between Danish and US medical institutions. To achieve this, Danish medical students (DARE students) conduct binational mentored research projects while based in the United States for 10 months. In addition, DARE students are introduced to interdisciplinary thinking about how to develop ultra-low-cost healthcare interventions through the '$10 Challenge'. Methods: We conducted a cross-sectional study of DARE alumni over five consecutive years (2015–2020, n = 24). Research metrics included completion of a research project, primary authorship, and co-authorship of publications. The number of publications, prior to and after the DARE program were enumerated. For the first four cohorts, graduation from medical school and acceptance or intention to enter a joint MD-PhD program also were assessed. Two focus groups were conducted using constructivist grounded theory. Discussions were transcribed, redacted, and coded using Dedoose software. Results: DARE Medical students were 31.2 years (range 24–35), the majority were women (67%;16/24). The majority (17/24;71%) completed a first author publication in a peer-reviewed journal with a median of 3.9 per DARE alumnus. DARE alumnus reported increased proficiency in biostatistics, epidemiology, coding and public speaking as well as stronger research qualities in creativity, critical thinking, comfort in approaching scientist in both the US and Denmark (p < 0.001 for all). Qualitative key themes included: increased confidence, a deepening of research inquiry and linkage to a research network. Conclusions: Preliminarily, this study suggests that medical students can initiate binational collaboration in medicine. Benefits include research productivity, intention to pursue academic medical careers, as well as positive impacts on motivation. This medical student-initiated research model lays the groundwork for using this model across other country pairs to promote binational collaboration. [ABSTRACT FROM AUTHOR]

Competence in healthcare is a recognized expectation by consumers. In 2018 following an extensive review and consensus-building process, burn nursing practice competencies were published. Clinical nurse leaders were called upon to use these published competencies in practice as a basis for the requisite knowledge and skills needed in the care of the burn-injured individual. In 2019 at the 51st Annual Meeting of the American Burn Association, nurses from four U.S. burn centers reported on their center's incorporation of the competencies within their educational nursing curriculums. This paper provides a forum for each of the lead authors from Rhode Island Hospital Burn Center, the University of Utah Health Burn Trauma Intensive Care Unit, Parkland Regional Burn Center, and the University of Chicago Medicine Burn Center to outline their current utilization of the new burn nurse competencies and plans for future use. [ABSTRACT FROM AUTHOR]

Introduction: To prevent cardiopulmonary resuscitation (CPR) skills decay, the International Consensus on Resuscitation suggested retraining every three to six months. Current retraining practices nationwide exceed one to two years, suggesting that clinical staff's CPR skills are rarely at optimum proficiency. The Resuscitation Quality Improvement (RQI) program offers skills decay prevention through quarterly sessions. This manuscript addresses the challenges and opportunities of implementing the RQI program in a hospital system to increase CPR skills quality and cost-savings. Purpose & Methods: This manuscript describes the challenges and opportunities of implementing the RQI program as a quality improvement initiative in a system of hospitals and serves as a guide for implementation at similar institutions considering the adoption of RQI-basic life support (BLS). Results: Multiple successes and challenges were identified during the program implementation. Challenges included learning management system integration and RQI station damage. Successes included a 47% improvement in clinical staff's psychomotor CPR skills (i.e., compressions, ventilation, and chest compression fraction) and a $1.6 million cost avoidance for the system of hospitals. The RQI program implementation significantly increased the psychomotor skills of the RQI users, satisfaction, staff productivity, and cost avoidance. Discussion: Although implementing the RQI in a system of hospitals brought many challenges, the overall improvement in staff CPR skills and cost-avoidance superseded the cost-benefit analysis and justified its implementation. Implementing this program promotes superior CPR skills that could improve patient outcomes. [ABSTRACT FROM AUTHOR]

The article presents position papers approved by the American Association of Dental Schools (AADS) related to dental education in the U.S. It mentions incorporation of peer review in dental school curricula provides an opportunity to learn skills of working with other practitioners and learn actual clinical skills. AADS believes that federal funds must be included to finance basic healthcare benefits.

Introduction: The high rate of maternal mortality among Black women in the United States continues to gain attention; yet research has not yet fully illuminated the precursors to these events, most impactful among them being "maternal near misses." A maternal near miss occurs when a woman nearly dies but survives a complication that occurred during pregnancy, childbirth, or within 42 days of termination of pregnancy. Researchers have focused on reviewing patient medical records after sentinel maternal events to help determine major contributors to them; however, qualitative studies with near-miss survivors, especially among Black women, may be a more useful approach. Methods: Using a qualitative methodology, we conducted semi-structured interviews with 12 Black women to explore how they perceived the care provided to them during their near-miss experiences. Our study also employed a phenomenology framework to understand the lived experience of Black women who had a maternal near miss in the context of a hospital setting. Results: We interviewed 12 women between October 2020 and March 2021. All participants had a maternal near miss between the years 2010 and 2020 and were aged between 19 and 41 years when they had their near-miss experience. These women identified communication, patient–provider relationship, skills/competency of staff, provider discrimination, systems issues, and emotional distress as major contributors to their experiences. Conclusion: Maternal near misses serve as a precursor to maternal mortality events. By listening to patients and their families recount their perspectives on what leads up to these near misses, we can unearth valuable lessons that can aid in the development of strategies and interventions to decrease the numbers of pregnancy-related deaths; especially among Black women who suffer disproportionately from maternal morbidity and mortality. Based on these findings, we recommend that hospitals and OB-GYN practices consider the unique predispositions of their Black patients; account for their own personal biases, revisit the near-miss experiences of past patients to keep patients central to care and build rapport between patients and hospital birthing support staff; and center discussions about improvements in care around racist structures and systems. [ABSTRACT FROM AUTHOR]

Background: Despite a fast-paced environment, the emergency clinician has a duty to meet the palliative patient's needs. Despite suggested models and interventions, this remains challenging in practice. Aim: To raise awareness of these challenges by exploring the experience of palliative care patients and their families and informal carers attending the emergency department, and of the clinicians caring for them. Design: Qualitative systematic literature review and thematic synthesis. Search terms related to the population (palliative care patients, family carers, clinicians), exposure (the emergency department) and outcome (experience). The search was international but restricted to English and used a qualitative filter. Title, abstracts and, where retrieved, full texts were reviewed independently by two reviewers against predefined inclusion criteria arbitrated by a third reviewer. Studies were appraised for quality but not excluded on that basis. Data sources: MEDLINE [1946-], Embase[1947-], CINAHL [1981-] and PsycINFO [1987-] with a bibliography search. Results: 19 papers of 16 studies were included from Australia (n = 5), the United Kingdom (n = 5), and United States (n = 9) representing 482 clinical staff involved in the emergency department (doctors, nurses, paramedics, social workers, technicians), 61 patients and 36 carers. Nine descriptive themes formed three analytic themes: 'Environment and Purpose', 'Systems of Care and Interdisciplinary Working' and 'Education and Training'. Conclusion: In the included studies, provision of emergency palliative care is a necessary purpose of the emergency department. Failure to recognise this, gain the necessary skills or change to systems better suited to its delivery perpetuates poor implementation of palliative care in this environment. [ABSTRACT FROM AUTHOR]

To examine the effect of a change in the delivery mode of clinical neurology, a postgraduate subject at Macquarie University, following COVID-19 restrictions on face-to-face teaching. Participants were master of chiropractic students (n = 212) who completed 2019 or 2020 clinical neurology. The main outcome measure was a comparison of objective structured clinical examination (OSCE) marks between the 2019 and 2020 cohorts. The 2019 group underwent traditional, face-to-face learning, whereas the 2020 group were taught and examined remotely in session 1 but returned to campus in session 2. Descriptive analyses, between-group differences, and generalized linear models were performed. Means for OSCE marks between the 2 groups were higher in the 2020 group in session 1 (p <.001). However, when students returned to campus in session 2, the means were significantly lower in the 2020 group compared with the 2019 group (p <.001). Generalized linear regression indicated that the web-based mode of delivery in 2020 might have had a significant impact on OSCE marks compared with their 2019 counterparts (p <.001). The sudden change in the mode of delivery from face-to-face to remote learning and the change in testing methods in response to the global COVID-19 pandemic had a significant effect on clinical neurology student performance scores. The OSCE marks in the 2020 cohort for session 1 were higher than those in 2019. However, when the 2020 cohort returned to on-campus tutorials in session 2, their marks were lower than those of their 2019 counterparts. [ABSTRACT FROM AUTHOR]

This study investigated factors influencing success of physician scientists in Academic Medical Centers. These organizations and individuals drive healthcare in the United States. Translation of scientific discovery to medical practice moves at an astoundingly slow and ineffective rate. We must understand what contributes to physician scientist success to speed up translation. Through a lens of dialectic process theory, a grounded theory approach identified emergent factors from lived experiences of 31 individuals, at various experience levels, with MD and PhD degrees. Role balance, autonomy, organizational support, teamwork, life-cycle mentorship, and relational capacity were relevant factors impacting success. Role balance was important for success. Teamwork, organizational support, and life-cycle mentorship helped individuals grow, achieve balance, and respect, but relational capacity emerged as a critical driver for realizing both individual and organizational success. One person cannot execute these complex roles on their own, but development of deep and meaningful relationships through teamwork, collaboration, and life-cycle mentorship are essential for life satisfaction and success. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is twofold: first, to identify the types of adaptations made by service providers (i.e. practitioners) during a large-scale US statewide implementation of SafeCare®, an evidence-based intervention to reduce child neglect; and second, to place adaptations within a taxonomy of types of adaptations. Design/methodology/approach: Semi-structured interviews and focus groups were conducted with 138 SafeCare providers and supervisors. Grounded theory methods were used to identify themes, specific types of adaptations and factors associated with adaptation. Findings: Adaptations were made to both peripheral and core elements of the evidence-based practice (EBP). The taxonomy of adaptations included two broad categories of process and content. Process adaptations included presentation of materials, dosage/intensity of sessions, order of presentation, addressing urgent concerns before focusing on the EBP and supplementing information to model materials. Content adaptations included excluding parts of the EBP and overemphasizing certain aspects of the EBP. Adaptations were motivated by client factors such as the age of the target child, provider factors such as a providers' level of self-efficacy with the EBP and concerns over client/provider rapport. Client factors were paramount in motivating adaptations of all kinds. Research limitations/implications: The present findings highlight the need to examine ways in which adaptations affect EBP implementation and sustainment, client engagement in treatment, and client outcomes. Practical implications: Implementers and EBP developers and trainers should build flexibility into their models while safeguarding core intervention elements that drive positive client outcomes. Originality/value: This study is unique in examining and enumerating both process and content types of adaptations in a large-scale child neglect implementation study. In addition, such adaptations may be generalizable to other types of EBPs. [ABSTRACT FROM AUTHOR]

Aim: Curriculum reform in medical schools continues to be an ever-present and challenging activity in medical education. This paper describes one school's experiences with specific curricular innovations that were developed or adapted and targeted to meet a clear set of curricular goals during the curriculum reform process. Those goals included: (a) promoting active learning and learner engagement; (b) establishing early professional identity; and (c) developing physician competencies in an integrated and contextual manner while allowing for individualized learning experiences for the millennial student. Methods: Six specific innovations championed by the school are described in detail. These included Themes in Medical Education, Translational Pillars, Stony Brook Teaching Families, Transition Courses, Educational Continuous Quality Improvement Processes, and our Career Advising Program. Development of the ideas and design of the innovations were done by faculty and student teams. Results: We discuss successes and ongoing challenges with these innovations which are currently in the fourth year of implementation. Conclusions: Our curriculum reform has emphasized the iterative process of curriculum building. Based on our experience, we discuss general and practical guidelines for curriculum innovation in its three phases: setting the stage, implementation, and monitoring for the achievement of intended goals. [ABSTRACT FROM AUTHOR]

Background: Residency program directors will likely emphasize the United States Medical Licensing Exam (USMLE) Step 2 clinical knowledge (CK) exam more during residency application given the recent USMLE Step 1 transition to pass/fail scoring. We examined how internal medicine clerkship characteristics and NBME subject exam scores affect USMLE Step 2 CK performance.Design: The authors used univariable and multivariable generalized estimating equations to determine associations between Step 2 CK performance and internal medicine clerkship characteristics and NBME subject exams. The sample had 21,280 examinees' first Step 2 CK scores for analysis.Results: On multivariable analysis, Step 1 performance (standardized β = 0.45, p < .001) and NBME medicine subject exam performance (standardized β = 0.40, p < .001) accounted for approximately 60% of the variance in Step 2 CK performance. Students who completed the internal medicine clerkship last in the academic year scored lower on Step 2 CK (Mdiff = -3.17 p < .001). Students who had a criterion score for passing the NBME medicine subject exam scored higher on Step 2 CK (Mdiff = 1.10, p = .03). There was no association between Step 2 CK performance and other internal medicine clerkship characteristics (all p > 0.05) nor with the total NBME subject exams completed (β=0.05, p = .78).Conclusion: Despite similarities between NBME subject exams and Step 2 CK, the authors did not identify improved Step 2 CK performance for students who had more NBME subject exams. The lack of association of Step 2 CK performance with many internal medicine clerkship characteristics and more NBME subject exams has implications for future clerkship structure and summative assessment. The improved Step 2 CK performance in students that completed their internal medicine clerkship earlier warrants further study given the anticipated increase in emphasis on Step 2 CK. [ABSTRACT FROM AUTHOR]

The traditional competency frameworks for coaches, the International Coaching Federation (ICF) and the European Mentoring and Coaching Council (EMCC) disregard the differences in expertise required among the diverse professions that may provide coaching. A recent systematic review has identified competencies specific to health professionals who health coach. There are increasing workload pressures in primary care; pharmacists can potentially shift to the greater provision of health promotion services, such as health coaching. The provision of such services needs to be underpinned by competency frameworks, which support the role of pharmacists as health coaches. This analysis identifies the competency gaps for pharmacists if they are to take on the role of health coaching. The enabling competencies of health coaches were compared to the competency frameworks of pharmacists from Australia (AUS), Canada (CAN), New Zealand (NZ), the United Kingdom (UK) and the United States of America (USA). Correlations between the international pharmacist competency frameworks and the competencies enabling health coaching showed that entry to practice pharmacists from AUS, CAN and NZ all require training enabling the health coaching competency 'demonstrates confidence', whereas competency frameworks for pharmacists from both the UK and the USA included all competencies required to health coach. Although pharmacists from the countries examined had most of the competencies required to health coach, gaps within the international pharmacist competency frameworks were apparent, university curricula addressing these gaps would equip entry to practice pharmacists with the knowledge and understanding to confidently provide emerging professional pharmacy services such as health coaching. [ABSTRACT FROM AUTHOR]

Introduction: In 2013, the National Institutes of Health and the Food and Drug Administration funded a network of 14 Tobacco Centers of Regulatory Science (TCORS) with a mission that included research and training. A cross-TCORS Panel was established to define tobacco regulatory science (TRS) competencies to help harmonize and guide their emerging educational programs. The purpose of this paper is to describe the Panel's work to develop core TRS domains and competencies.Methods: The Panel developed the list of domains and competencies using a semistructured Delphi method divided into four phases occurring between November 2013 and August 2015.Results: The final proposed list included a total of 51 competencies across six core domains and 28 competencies across five specialized domains.Conclusions: There is a need for continued discussion to establish the utility of the proposed set of competencies for emerging TRS curricula and to identify the best strategies for incorporating these competencies into TRS training programs. Given the field's broad multidisciplinary nature, further experience is needed to refine the core domains that should be covered in TRS training programs versus knowledge obtained in more specialized programs.Implications: Regulatory science to inform the regulation of tobacco products is an emerging field. The paper provides an initial list of core and specialized domains and competencies to be used in developing curricula for new and emerging training programs aimed at preparing a new cohort of scientists to conduct critical TRS research. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 lockdown in March 2020 had a significant consequence for nursing students worldwide including limited access to learning situations in clinical rotation. Therefore, this study aims to explore how an innovative redesign of a clinical course in a time of pandemic supported nursing students in learning the fundamentals of care in their first year. The redesign involved the transformation of a traditional hands-on clinical course into a technology-enhanced learning environment. Design: This was an explorative convergent mixed-methods study using both quantitative and qualitative methods. Methods: Twenty-four first-year nursing students responded to an online questionnaire with open-ended questions. Two nursing students and one faculty member participated in individual online interviews, and three faculty members participated in an online focus group interview. All the data were collected in June 2020. The quantitative data were analyzed using descriptive statistics and the qualitative data using content analysis. The GRAMMS guideline was applied. Results: The students achieved the learning outcomes regarding fundamental care, basic physical assessment skills, and clinical reasoning with the help of academic assignments, multimedia learning resources, and virtual patients. Further, six central aspects of the facilitator role in the virtual simulation were identified. The aspect that was considered most valuable involved uncovering the "red thread" between different areas of knowledge in the first year of nursing education; this supported the students to better understand how to think and talk like a nurse. Conclusion: This study offers insight into how a technology-enhanced clinical course can foster the learning of fundamental nursing care, basic physical assessment skills, and clinical reasoning skills; enhancing students' preparedness for clinical hours. Virtual patients' scenarios contributed to integrating different types of knowledge and skills that are important when providing nursing care for patients in clinical practice. This study also highlighted a gap in pedagogical competence among faculty members with regards to facilitating learning in a technology-enhanced learning environment. Study findings suggest promising pedagogical strategies that should be further developed post-pandemic, in response to the call for a renewal of nursing education using more technologically supported learning designs. [ABSTRACT FROM AUTHOR]

Learning is a complex phenomenon in which learners can vary in their learning orientation, learning approaches, and perception of the learning environment. Learners may be characterized as mastery oriented or performance oriented, and this learning orientation can influence their learning approaches, such as whether to seek feedback or ask for help. The learning environment includes institutional assessment policies and informal interactions that emphasize outcomes and differentiation among students. When learners perceive the learning environment as performance oriented, they feel competition from other learners and fear negative feedback. This complex interplay of learning orientation, its influence on feedback-seeking behavior, and the environmental influence and reinforcement of both can be captured through learner profiles. In this multi-institutional cross-sectional survey study of students from six U.S. medical schools, we investigated learner profiles that characterize how these domains manifest together across individual learners. We then determined how these profiles are associated with students' clerkship grades. Measures included the Patterns of Adaptive Learning for learning orientation, self-reports for learning approaches, and perceptions of the learning environment. We used latent profile analysis to cluster students who share common characteristics around orientation, behavior, and environment. The relationship between these profiles and the percentage of honors earned was examined using multiple regression analysis. We found four distinct learner profiles within 666 of 974 (68%) analyzable responses: (1) performance oriented with negative perceptions of environment, (2) mastery oriented with desirable learning approaches, (3) "average" group, and (4) mastery orientation only. Profile 1 (M = 39%) and Profile 4 (M = 38%) students received fewer clerkship honors compared with other profiles. Profile 2 students earned a significantly higher percentage of honors grades (M = 54%) compared with other students. Profile 3 students (average group) earned the second highest percentage of honors (M = 46%). Effect sizes comparing the percentage of honors varied from 0.32 to 0.65, indicating medium to large differences. The highest performers, as measured by clerkship honors grades, were mastery oriented, perceived a more positive learning environment, and were comfortable asking questions and seeking feedback for their learning. The lowest performing students were performance oriented and had negative perceptions of their learning environments. Contrary to previous findings, we found that the relationship between mastery orientation and learning approaches is not unidirectional but rather seems to be mediated by perceptions of the learning environment. [ABSTRACT FROM AUTHOR]

Introduction: The high rate of maternal mortality among Black women in the United States continues to gain attention; yet research has not yet fully illuminated the precursors to these events, most impactful among them being “maternal near misses.” A maternal near miss occurs when a woman nearly dies but survives a complication that occurred during pregnancy, childbirth, or within 42 days of termination of pregnancy. Researchers have focused on reviewing patient medical records after sentinel maternal events to help determine major contributors to them; however, qualitative studies with near-miss survivors, especially among Black women, may be a more useful approach. Methods: Using a qualitative methodology, we conducted semi-structured interviews with 12 Black women to explore how they perceived the care provided to them during their near-miss experiences. Our study also employed a phenomenology framework to understand the lived experience of Black women who had a maternal near miss in the context of a hospital setting. Results: We interviewed 12 women between October 2020 and March 2021. All participants had a maternal near miss between the years 2010 and 2020 and were aged between 19 and 41 years when they had their near-miss experience. These women identified communication, patient–provider relationship, skills/competency of staff, provider discrimination, systems issues, and emotional distress as major contributors to their experiences. Conclusion: Maternal near misses serve as a precursor to maternal mortality events. By listening to patients and their families recount their perspectives on what leads up to these near misses, we can unearth valuable lessons that can aid in the development of strategies and interventions to decrease the numbers of pregnancy-related deaths; especially among Black women who suffer disproportionately from maternal morbidity and mortality. Based on these findings, we recommend that hospitals and OB-GYN practices consider the unique predispositions of their Black patients; account for their own personal biases, revisit the near-miss experiences of past patients to keep patients central to care and build rapport between patients and hospital birthing support staff; and center discussions about improvements in care around racist structures and systems. [ABSTRACT FROM AUTHOR]

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Accessible summary In the Western world, many people who have mental health problems experience poor physical health. Research suggests that those with mental illness often have difficulties in accessing health care services, reporting that when they do, their physical health needs are often overlooked., Nurses are expected to deliver safe and effective care that meets the needs of service users. In order to help mental health nurses address physical health care needs, changes to nurse education, supported by government policy, have been made in the United Kingdom. Despite these changes, mental health nurses still feel less confident and prepared to address physical health needs of service users. However, this same problem is also reported by nurses throughout Europe and in other Western countries, who have undergone different training and education programmes., This paper discusses important factors affecting the mental health nurses' ability to deliver physical care and how they impact on confidence and competence., The paper concludes by highlighting the role of the mental health nurse being key in addressing the physical health needs of those in their care, and how this will only be realized when education and practice provide sufficient opportunity for them to develop and maintain their knowledge and skills., Abstract In the Western world, there is increasing concern regarding the ability of health care professionals to meet the physical health care needs of those diagnosed with mental illness. This discussion paper seeks to explore some of the issues facing mental health nurses in delivering care to those who have both mental and physical illness. Criticism of the National Health Service for failing to meet the physical health needs of people with serious mental illness has generated a number of political strategies aimed at addressing inequalities between mental and physical health care, a consequence being a change in pre-registration nurse education. It is envisaged that such changes will enable all nurses to deliver safe, effective care to service users, with adult and mental health nurses being more adept at meeting both the mental and physical health needs of those in their care. The impact of three key areas identified within the literature will be considered: the impact of co-existing physical and mental illness; the role of mental health nurses and perceptions of service users re physical health care; and education, training and learning from others in the Western world. In conclusion, the complexities of delivering such care will be addressed. [ABSTRACT FROM AUTHOR]

This paper presents perspectives and controversies surrounding the use of milestones to assess competency in outcomes-based medical education. Global perspectives (Canada, Europe, and the United States) and developments supporting their rationales are discussed. In Canada, there is a significant movement away from conceptualizing competency based on time, and a move toward demonstration of specific competencies. The success of this movement may require complex (rather than reductionist) milestones that reflect students' progression through complexity and context and a method to narrate their journey. European countries (United Kingdom, France, and Germany) have stressed the complexity associated with time and milestones for medical students to truly achieve competence. To meet the changing demands of medicine, they view time as actually providing students with knowledge and exposure to achieve various milestones. In the United States, milestones are based on sampling throughout professional development to initiate lifelong learning. However, the use of milestones may not imply overall competence (reductionism). Milestones must be developed alongside outcomes-based curriculum with use of faculty and competency committees. The perspectives outlined in this paper underscore emerging challenges for implementing outcomes-based medical education and call for new conceptualizations of competence. [ABSTRACT FROM AUTHOR]

Phenomenon: Point-of-care ultrasound is fast becoming standard clinical bedside practice for diverse specialties. Medical schools are responding by adding ultrasound education, though the majority use it to supplement the learning of basic sciences. Point-of-care ultrasound practice-based clinical skills education is rare. There also is a lack of standardization across curricula, leading to much variability in the ultrasound skills that medical students from different schools bring to residency. To best inform a point-of-care ultrasound curriculum for our Transition-to Residency program, we investigated literature on 1) how medical students are being prepared for use of point-of-care ultrasound in clinical practice, 2) what skills are being taught, 3) what point-of-care ultrasound skills residency programs expect from incoming residents. Approach: We reviewed literature to identify curricula in U.S. medical schools that teach the concepts, knowledge, and skills related to point-of-care ultrasound. We also mapped point-of-care ultrasound expectations set forth by the Entrustable Professional Activities for undergraduate medical education to the specialty-specific milestones identified by the Accreditation Council for Graduate Medical Education. Additionally, we reviewed specialty-specific professional organizations for position statements and guidelines describing the point-of-care ultrasound skills expected for practicing physicians in their respective specialties. The goal was to identify any needs and gaps in education regarding point-of-care ultrasound across the undergraduate to graduate medical education continuum to practice. Findings: We found seven published point-of-care ultrasound curricula for medical students. There was wide variability in these curricula regarding what point-of-care ultrasound content is being taught, as well as when and how this skill is taught. No Entrustable Professional Activity listed point-of-care ultrasound as a skill requirement for graduating medical students. For graduate medical education, there was wide variability across specialties in residency milestones related to point-of-care ultrasound; some (e.g., emergency medicine) listed extensive milestones while others (e.g., internal medicine) listed none. However, we found that many specialty-specific professional organizations do list detailed point-of-care ultrasound expectations for their practicing physicians. Insights: As point-of-care ultrasound is fast becoming common practice across many specialties, standardization of education and related competencies—similar to other clinical skills training—is necessary across medical schools. Mapping point-of-care ultrasound expectations to current teaching across the continuum from undergraduate to graduate medical education may allow schools to tailor point-of-care ultrasound training for Transition-to-Residency programs. We provide a sample pilot point-of-care ultrasound curriculum that we designed for our Transition-to-Residency course. [ABSTRACT FROM AUTHOR]

A clinician's perceived competence determines his or her ability to attain clinical outcomes and persevere through challenging situations. This study examined the perceived competence of 337 speech-language pathologists (SLPs), including monolingual and bilingual, working with culturally and linguistically diverse (CLD) clients within the United States. Results indicated comparable competence levels of both monolingual and bilingual SLPs in their service delivery to monolingual English-speaking clients. However, bilingual SLPs reported significantly higher competency than monolingual SLPs while working with non-English-speaking clients in different areas of service delivery, including speech and language assessment, dealing with challenging clinical situations, and responding to questions regarding intervention outcomes. It is likely that language concordance, awareness, and understanding of linguistic and cultural expectations of non-English-speakers help surpass communication barriers leading to increased perceived competence among bilingual SLPs. This study summarizes persisting challenges in service delivery of CLD populations and possible recommendations for preservice training of SLPs. [ABSTRACT FROM AUTHOR]

An evidence-based approach to Public/Community Health Nursing (P/CHN) requires that P/CHN educators prepare practitioners with the relevant skills, attitudes, and knowledge. Such education should be competency-based and have measurable outcomes to demonstrate student preparation. In 2003, the Quad Council competencies were developed to be applied at two levels of public health nursing practice: the staff nurse/generalist role and the manager/specialist/consultant role. This paper describes a process for evaluation and revision of a graduate curriculum to prepare Advanced Practice Clinical Nurse Specialists (CNS) in P/CHN, to ensure that the educational program addresses and develops knowledge and proficiency in all relevant competencies. This paper documents the process of integrating the competencies throughout the P/CHN graduate curriculum at varying levels, guiding students to achieve proficiency in each competency by the end of the program. Measurement of achievement in these competencies will be discussed, and examples provided. Advanced Practice Public Health Nurses educated via this competency-based approach will be prepared to sit for national certification as a CNS in Public/Community Health, and to assume leadership roles in public health nursing. [ABSTRACT FROM AUTHOR]

Over the past 4 decades Chinese medicine (CM) has come increasingly into the spotlight in the United States as the clinical effectiveness of CM has been not only empirically well-tested over a long period of time but also proven by recent scientific research. It has proven cost effectiveness, safety, and is authorized for natural and holistic approaches. In consideration, CM is one of the underutilized health care professions in the United States with a promising future. However, CM faces many challenges in its education and system, its niche in the health care system as an independent profession, legal and ethical issues. This paper discusses the confronting issues in the United States: present education, standards of CM education with shifting first professional degree level, new delivery systems of CM education. Development of new research models, training of evidence-based practice, and implementation of integrative medicine into CM education also are the key issues in the current CM profession. This paper also discusses opportunities for the CM profession going beyond the current status, especially with a focus on fusion medicine. [ABSTRACT FROM AUTHOR]

Background In 2015, the American Council for Academic Physical Therapy (ACAPT) developed 3 strategic initiative panels to address integrated clinical education, student readiness, and common terminology for physical therapist clinical education. Objective The purpose of this paper is to describe the results of the work from the Common Terminology Panel. Design This was a descriptive, consensus-based study. Methods Using a consensus process and data that were collected from a review of literature, a document analysis of core and historical professional documents, focus group discussions, and an online open comment period, panel members developed a glossary for physical therapist clinical education. Results The final glossary included 34 terms in 4 categories. The categories included clinical education infrastructure, sites, stakeholders, and assessment. The ACAPT Board of Directors approved the glossary in June 2017, and the ACAPT membership approved the glossary in October 2017. Limitations The focus of the glossary was on physical therapist clinical education. A future, similar project should be undertaken for physical therapist assistant clinical education. Conclusion This process resulted in a comprehensive glossary for physical therapist clinical education; changes to several current terms, including “internship” and “full-time clinical education experience”; and the addition of new terms, including “preceptor” and “site coordinator for clinical education.” New terminology will provide standard language for consistent communication and a common framework for all stakeholders. [ABSTRACT FROM AUTHOR]

Background/aim The successful development and maintenance of professional identity is associated with professional development and retention in the health workforce. This paper explores students' perspectives on the ways pre-entry experiences and curricula content shape professional identity. Methods An online cross-sectional survey was sent to students enrolled in the final year of entry-level programmes in five countries. Descriptive statistical analyses of data were completed. Results The results reflect the perceptions of 319 respondents from five countries. Respondents identified professional education (98%) and professional socialisation during placement (92%) as curricula components with the greatest influence on professional identity formation. Discipline-specific knowledge such as, occupation-focussed models and occupational science were ranked lower than these aspects of practice. The students' length of programme and level of entry-level programme did not impact on these results. Conclusion When designing curricula educators need to be mindful that students perceive practice education and professional socialisation have the greatest affect on professional identity formation. The findings reinforce the need for curricula to provide students with a range of practice experiences, which allow the observation and application of occupation-based practices. It highlights a need for educators to provide university-based curricula activities, which better prepare students for a potential dissonance between explicit occupation-based curricula and observed practice education experiences. The study indicates the need for further research into the role curricula content, and in particular practice education, plays in the multidimensional formation of professional development within entry-level programmes. [ABSTRACT FROM AUTHOR]

Librarians in many types of libraries frequently find themselves positioned as instructors in formal and informal educational settings. Librarians can help ensure that learner needs are better defined and addressed by gaining basic competency in instructional design (ID), an intentional process used to create effective, efficient educational and training programs. Additionally, instructional design skills have the potential to benefit librarians in nonteaching roles. This paper examines existing library literature to determine how librarians can benefit from ID skills and to identify core ID competencies for the profession, and suggests opportunities to investigate how librarians might best acquire these skills. [ABSTRACT FROM AUTHOR]

Background: Health care organizations need to be responsive to the needs of increasingly diverse patient populations. We compared the contents of six publicly available approaches to organizational responsiveness to diversity. The central questions addressed in this paper are: what are the most consistently recommended issues for health care organizations to address in order to be responsive to the needs of diverse groups that differ from the majority population? How much consensus is there between various approaches?Methods: We purposively sampled six approaches from the US, Australia and Europe and used qualitative textual analysis to categorize the content of each approach into domains (conceptually distinct topic areas) and, within each domain, into dimensions (operationalizations). The resulting classification framework was used for comparative analysis of the content of the six approaches.Results: We identified seven domains that were represented in most or all approaches: organizational commitment, empirical evidence on inequalities and needs, a competent and diverse workforce, ensuring access for all users, ensuring responsiveness in care provision, fostering patient and community participation, and actively promoting responsiveness. Variations in the operationalization of these domains related to different scopes, contexts and types of diversity. For example, approaches that focus on ethnic diversity mostly provide recommendations to handle cultural and language differences; approaches that take an intersectional approach and broaden their target population to vulnerable groups in a more general sense also pay attention to factors such as socio-economic status and gender.Conclusions: Despite differences in labeling, there is a broad consensus about what health care organizations need to do in order to be responsive to patient diversity. This opens the way to full scale implementation of organizational responsiveness in healthcare and structured evaluation of its effectiveness in improving patient outcomes. [ABSTRACT FROM AUTHOR]