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BACKGROUND: Studies have consistently found high rates of unintended pregnancy among women with opioid use disorder (OUD). Few interventions have been developed to specifically engage and address the family planning (FP) needs of women in substance use disorder treatment. OBJECTIVES: Our goal was to collect formative qualitative data to identify the FP experiences, needs and service preferences of women receiving medications for OUD and to use these data to develop a FP education and navigation intervention that could be tested in diverse, resource-limited treatment settings. METHODS: From August 2016-April 2017, we conducted 21 guided qualitative interviews with women from two outpatient treatment clinics in Denver, Colorado. We recorded, transcribed, and coded all interviews. We then facilitated three focus groups (n=16) from May-July 2017 to verify or challenge interview themes and to further inform the development of the FP intervention. RESULTS: Most participants expressed ambivalence or low perceived risk regarding unintended pregnancy and desired more information about contraceptive methods. Many participants described mistrust or lack of engagement in the medical system and histories of trauma were a common barrier to seeking services. Focus group participants endorsed a peer-led FP navigation intervention and provided feedback to tailor existing FP educational materials to fit the specific needs of women in recovery. CONCLUSIONS/IMPORTANCE: Results from this qualitative study suggest that women in recovery from OUD have unique, unmet FP education and service needs. These findings provide important information for the development of feasible and acceptable FP service delivery within diverse, resource-limited treatment settings and informed the development of a trauma-informed, peer-led FP education and navigation intervention that would be implemented in a subsequent phase of the study.

Reinfection and partner transmission are common with Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT). We assessed treatment and follow-up laboratory testing for GC and CT and evaluated associations with patient- and system-level factors.The analysis included positive GC and/or CT nucleic acid amplification test results from patients aged 14 to 24 years at a federally qualified health center system site in Denver, CO, from January 2018 to December 2019. Outcomes assessed include treatment within 14 days, HIV/syphilis testing within 6 months, and repeat GC and CT testing within 2 to 6 months. Bivariate and multivariable regression modeling assessed associated factors.Among 27,168 GC/CT nucleic acid amplification tests performed, 1.8% (484) were positive for GC and 7.8% (2125) were positive for CT. Within the assessed time frames, 87% (2275) of patients were treated, 54.1% (1411) had HIV testing, 50.1% (1306) had syphilis testing, and 39.9% (1040) had GC and CT retesting. Older patients were more likely to receive treatment (adjusted odds ratio 1.13; 95% confidence interval, 1.00-1.27; P = 0.05) than younger patients, whereas males were less likely to receive GC and CT retesting (adjusted odds ratio, 0.19; 95% confidence interval, 0.11-0.33; P0.001) than females. Patients treated on the day of testing were less likely to receive follow-up laboratory tests than those treated 2 to 14 days after.Although most patients received antibiotic treatment, only about half received HIV/syphilis testing and less than half received GC and CT retesting. It is critical to find innovative strategies to improve treatment and follow-up management of these infections to decrease complications, reduce transmission, and combat the rising rates of sexually transmitted infections.

Purpose of the Article: Between 2018-2021, eight European medical schools took part in a study to develop a medical knowledge Online Adaptive International Progress Test. Here we discuss participants’ self-perception to evaluate the acceptability of adaptive vs non-adaptive testing.Materials and Methods: Study participants, students from across Europe at all stages of undergraduate medical education with varying levels of prior experience with progress testing, sat remotely invigilated tests using the QuizOne® platform. Participants completed online feedback questionnaires on their experiences and perceptions of adaptive and non-adaptive tests.Results: Overall satisfaction with the organisation and delivery of online tests was high regardless of previous experience with progress testing. In questions probing the appropriateness of the level and the length of testing, differences were observed between adaptive and non-adaptive tests. There was a high level of agreement that the adaptive test was a good measure of personal knowledge and increased participants’ motivation for study.Conclusions: Students’ self-perception of the assessment is an important factor in evaluation of acceptability of the exam and its further development. The assessment linked to students’ true knowledge increases their motivation for learning and in turn, improves their performance.

An increasing number of data across many higher education programmes indicate that the traditional construction of knowledge assessments allows students to pass all exams even if they lack knowledge in certain areas of the curriculum. This may be particularly problematic for healthcare programmes such as medicine, where students can graduate without achieving sufficient competency in certain subjects. Summative and formative knowledge assessments may indicate areas of weakness, but there is no guarantee that students will address them. Therefore, compensation of content both within and across assessments can potentially lead to graduating students with insufficient knowledge. To address this issue and remove any compensation it is now possible to use personalised knowledge assessments in the form of adaptive progress testing to improve graduate students’ knowledge and increase their safety to practice. Computerized adaptive assessments utilise algorithms to select items depending on the candidate’s previous answers. Such assessments can select questions according to their difficulty or content of the blueprint. Adaptive testing by difficulty aims to give a more reliable measure of each individual student’s performance, while adaptive testing by content aims to ensure successful performance in all required content by all students. Here we present an overview of computerised adaptive progress testing and discuss the rationale and practicality of this approach to assessment.

Studies have consistently found high rates of unintended pregnancy among women with substance use disorder. While research efforts have begun to focus on understanding needs and providing family planning services for women in treatment, few studies have included men. This has resulted in a gap in the literature regarding men's reproductive health experiences and family planning desires.Between December 2019 and February 2020, we conducted semistructured qualitative interviews with adult men receiving medications for opioid use disorder at a safety-net healthcare system in Denver, Colorado. Interviews were recorded and analyzed using the Rapid Assessment Process.Fifteen men participated in an interview. Overall, men described feeling excluded from family planning education and services as well as from decision making with their partners. Participants desired knowledge and resources related to contraceptive methods, partner communication, and parenting. Additional themes included loss of autonomy around pregnancy decisions, the importance of fatherhood, and the importance of addressing family planning during recovery. Participants expressed interest in a family planning intervention but indicated that engaging men on this topic may be challenging.Our findings suggest that men in treatment desire education and involvement in family planning. Participants endorsed access to a subject expert within the treatment environment, but engagement strategies that underscore topic relevance to men will be critical. Initiating a conversation involving education and service navigation in the treatment setting may be a promising strategy for engaging men in recovery in family planning and improving men's access to needed services and resources.

Undergraduate education often leaves future healthcare professionals insufficiently prepared for the complex and unpredictable workplace. Competency-based medical education (CBME) is widely utilised in health professions’ education, but a growing literature highlights its limitations. Capability is a complex concept which builds on competence, while embedding the integration and adaptation of knowledge, skills and personal qualities. While capability can prepare learners for uncertainty and complexity, the concept has been slow to progress within health professions’ education. We introduced the concept of capability to over 110 international health profession educators through six conference workshops, using a visual model to facilitate understanding. Participants’ post-workshop qualitative feedback was collated and thematically analysed. One hundred and thirty-three free text comments were received and four main themes identified: conceptualising capability, capability as curriculum goal, educating for capability, challenges to implementation. The need for capability resonated with participants, although most were unfamiliar with the concept prior to the workshop. The workshop enabled participants to recognise the limitations of CBME’s ‘tick box’ culture when preparing learners to address complexity. The model helped educators grasp the concept of capability and its potential value in health professions’ education. Participants were then able to identify challenges and suggest approaches for implementing capability in practice. Educating for capability is fundamental for preparing students successfully for the ‘real world’ of professional practice. Most participants agreed it should be the end goal of healthcare education curricula. Healthcare educators are likely, however, to need support to embrace this paradigm shift.

Improvements to skill (and other characteristics) of quantitative probabilistic rainfall forecasting for weather and hydrological purposes are a high priority at the Australian Bureau of Meteorology (the Bureau), highlighted by a series of major floods in eastern Australia in early 2022. Post-processed ensemble numerical weather prediction (NWP) rainfall guidance is key to increasing forecast automation in routine conditions and providing better guidance for high impact rainfall events. The Bureau's existing NWP post-processing system has markedly increased weather rainfall forecast skill in recent years. However, to enable further forecast improvements and greater integration of rainfall processing for weather and hydrological purposes, a more general approach with fewer calibration steps was required. To these ends, we have developed 'RainForests': a multi-ensemble rainfall processing system, utilising gradient boosted decision tree (GBDT) ensembles for forecast calibration.RainForests is inspired by the ECPoint method of Hewson and Pillosu (2021). RainForests, like ECPoint, is a non-parametric and generally non-local method which uses decision trees to create situation-dependent error distributions for each input (analogous to an extension of Bayesian Joint Probabilities) that can be used to calibrate grid-scale rainfall guidance to point-scale.Key features of RainForests:Uses a series of GBDT ensembles to construct the error distribution in place of a single manually trained decision tree. This produces robust outputs which are near-continuous relative to inputs, allows for rapid retraining on new data or addition of feature variables, and utilises open source GBDT software. Uses additive error (delta = obs - forecast) in place of the forecast error ratio. This allows for calibration when forecast rainfall is zero. Error distributions vary with forecast rainfall amount (and other predictors). Models are trained and verified using both rain gauge and gauge-calibrated radar data, each of which have their uncertainties, strengths and weaknesses. Basic Bureau and RainForests QC is applied to the data to reduce gross errors. Error distributions are pooled for each NWP model (e.g. ECMWF ensemble), from around 100 individual input ensemble and deterministic ('ensemble of one') members in total. Resulting calibrated probability distributions for each model are then blended in probability space. Additionally, RainForests uses and contributes to capabilities in the Integrated Model post-PROcessing and VERification (IMPROVER) system being developed in collaboration with the UK Met Office.Initial RainForests outputs have comparable skill to the Bureau's existing post-processing system. Improvements are planned and will be reported on. It is also planned to provide calibrated rainfall ensemble members, derived from RainForests outputs, to downstream applications. This aims to support production of ensemble multiple-variable indices, hydrological applications and aggregation of rainfall forecasts in space and time.

Harmonising education to support workforce mobility has been a policy objective for the European Union. However, alignment across varied national contexts presents challenges in dental education.A systematic literature review with narrative synthesis. Searches of the electronic databases Embase [Ovid]; MEDLINE [Ovid]; Scopus; CINAHL; AMED and PsycINFO were conducted for relevant material published between 2000 and 2019 on undergraduate curricula, quality standards and learning outcomes in dentistry.Seventy-six papers met the inclusion criteria. Fifty-three papers were commentaries or editorials, twenty-one were research studies, and two were literature reviews on specific dental subfields. Eighteen of the research studies reported surveys. The literature contains extensive proposals for undergraduate curricula or learning outcomes, either broadly or for subfields of dentistry. Included papers demonstrated the importance of EU policy and educator-led initiatives as drivers for harmonisation. There is limited evidence on the extent to which proposed pan-European curricula or learning outcomes have been implemented. The nature and extent of dental students' clinical experience with patients is an area of variance across European Union member states. Arrangements for the quality assurance of dental education differ between countries.Harmonisation of European dental education has engaged educators, as seen in the publication of proposed curricula and learning outcomes. However, differences remain in key areas such as clinical experience with patients, which has serious implications if graduate dentists migrate to countries where different expectations exist. Mutual recognition of professional qualifications between countries relies on education which meets certain standards, but institutional autonomy makes drawing national comparisons problematic.

Background There is an international drive to increase human factors training in undergraduate medical curricula through various educational platforms. E-learning can be effective at teaching technical skills but there is limited research exploring the benefits of e-learning in human factors training. This study aimed to utilise hybrid simulation to investigate the impact of a human factors focused e-learning package for intravenous cannulation on safety behaviours. Methods Video-reflexive ethnography (VRE) techniques and interviews were used to explore human factor-related behaviour change in hybrid simulation scenarios, before and after e-learning modular training. Ten final-year medical students were recruited for the study. Content analysis of VRE data from hybrid simulation scenarios identified which behaviours had changed; thematic analysis of semi-structured interviews uncovered why. Results Results demonstrate improvement in safety behaviours in the domains of physical-, cognitive- and macro-ergonomics, suggesting safer cannulation practice following training. Online videos with interactive activities were reported as the major pedagogical driver for change. The impact of the e-learning was identified across four themes: environment, person, policy-related tasks, and preparedness for practise. Reported intention to change practise and altered behaviour in the workplace supports the conclusion that this training prepares students for practise by facilitating them to incorporate human factors principles in their clinical work. Conclusion E-learning is a valuable and effective method for supporting medical student learning about human factors. Hybrid simulation and VRE combine well together to evaluate behaviour change following educational interventions.

Objective To evaluate the feasibility, acceptability, and initial efficacy of a pilot texting intervention (“t4she”) in primary care designed to increase sexual health knowledge and promote dual protection strategies to reduce unintended pregnancies and sexually transmitted infections among adolescent females. Methods Participants were recruited from 2 federally qualified health centers. Eligibility included: being 13 to 18 years of age; assigned female at birth; English-speaking; not currently pregnant and/or intending to become pregnant; and having texting capabilities. A randomized controlled trial assessed between-group differences at 3 and 6 months on knowledge, Health Belief Model constructs, and sexual behaviors. Input on intervention acceptability was obtained at 3 months. Results Among 244 participants enrolled and randomized, the average age was 16 (±1.6), 80% were Hispanic/Latina, 53% had ever had vaginal sex, and 50% had used prescription birth control with 24% currently using a long-acting reversible method. Among those sexually active, 29% reported consistent condom use and 24% reported engaging in dual protection behaviors at last sex. Among participants with all follow-up data (N = 136), intervention participants had significant increases in sexual health knowledge and reported more prescription birth control use at follow-up than control participants. No significant outcome differences were found for condom use or dual protection behaviors. Intervention participants reported receiving messages, being introduced to new information, and reading and sharing the messages. Conclusions The pilot t4she sexual health intervention significantly improved knowledge and use of short-acting prescription birth control among young females in primary care and was acceptable by youth and feasible to implement.

Supplemental material, sj-doc-1-jpc-10.1177_21501319221131382 for Closing the Equity Gap: An Intervention to Improve Chlamydia and Gonorrhea Testing for Adolescents and Young Adults in Primary Care by Margaret M. Tomcho, Yingbo Lou, Sonja C. O’Leary, Deborah J. Rinehart, Tara Thomas-Gale, Lara Penny and Holly M. Frost in Journal of Primary Care & Community Health

Augmented reality is considered one of the enabling technologies of the fourth industrial revolution, within the Industry 4.0 program and beyond. Indeed, augmented reality solutions can increase the working quality and the productivity and allow a better use of the human resources. This technology can help the operator in the industrial applications during the crucial phases of the processes. Since the quality assessment of the surfaces is recognized to be a key phase in the polishing process, in this paper we propose a novel method that exploits augmented reality to support the operators during this phase. The metrology data measured by a surface measurement system are directly projected on the polished component through an augmented reality headset worn by the operators and used to assess the quality of the worked surfaces. Rather than imagine how a certain parameter change can affect the result achieved, the information is directly there on the component’s surface. Users can see from the data where refinements are required and make better and faster decisions, which is compelling for its potential beyond industrial polishing. The proposed method is implemented and validated on an industrial cell, where the robot automatically perform the polishing task and move the head of the surface measurement system along the surface to measure the metrology parameters. Thanks to the proposed approach, the end-user and the operator can directly see on the component if the quality reached satisfies the specifications or if some parts of the surface require further refinements through additional polishing steps.

There is growing evidence supporting the use of simulation-based education to improve teamwork in the clinical environment, which results in improved patient outcomes. Interprofessional simulation improves awareness of professional roles and responsibilities, promotes teamwork and provides training in non-technical skills. Tools have been developed to assess the quality of teamwork during simulation, but the use of these tools should be supported by validity evidence in appropriate contexts. This study aims to assess the validity of teamwork tools used in simulation-based interprofessional training for healthcare workers and students, and to compare the design and reporting of these studies. Medline, EMBASE, ERIC, and CINAHL were searched using terms synonymous with simulation, crew resource management, training, assessment, interprofessional, and teamwork, from 2007-2017. Interprofessional healthcare simulation studies involving objectively rated teamwork training were included. The initial search provided 356 records for review, of which 24 were ultimately included. Three tools demonstrated good validity evidence underpinning their use. However, three studies did not explore tool psychometrics at all, and the quality of reporting amongst these studies on design and participant demographics was variable. Further research to generate reporting guidelines and validate existing tools for new populations would be beneficial.

Purpose of the study To explore which factors increase the likelihood of being deemed appointable to core anaesthesia training in the UK and whether those factors subsequently predict performance in postgraduate training. Study design Observational study linking UK medical specialty recruitment data with postgraduate educational performance, as measured by Annual Review of Competence Progression (ARCP) outcomes. Data were available for 2782 trainee doctors recruited to anaesthesia core training from 2012 to 2016 with at least one subsequent ARCP outcome. Results Both higher interview and shortlisting scores were independent and statistically significant (p≤0.001) predictors of more satisfactory ARCP outcomes, even after controlling for the influence of postgraduate exam failure. It was noted that a number of background variables (eg, age at application) were independently associated with the odds of being deemed appointable at recruitment. Of these, increasing age and experience were also negative predictors of subsequent ARCP rating. These influences became statistically non-significant once ARCP outcomes associated with exam failure were excluded. Conclusions The predictors of ‘appointability’ largely also predict subsequent performance in postgraduate training, as indicated by ARCP ratings. This provides evidence for the validity of the selection process. Our results also suggest that greater weight could be applied to shortlisting scores within the overall process of ranking applicants for posts.

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BackgroundAn underperforming doctor puts patient safety at risk. Remediation is an intervention intended to address underperformance and return a doctor to safe practice. Used in health-care systems all over the world, it has clear implications for both patient safety and doctor retention in the workforce. However, there is limited evidence underpinning remediation programmes, particularly a lack of knowledge as to why and how a remedial intervention may work to change a doctor’s practice.ObjectivesTo (1) conduct a realist review of the literature to ascertain why, how, in what contexts, for whom and to what extent remediation programmes for practising doctors work to restore patient safety; and (2) provide recommendations on tailoring, implementation and design strategies to improve remediation interventions for doctors.DesignA realist review of the literature underpinned by the Realist And MEta-narrative Evidence Syntheses: Evolving Standards quality and reporting standards.Data sourcesSearches of bibliographic databases were conducted in June 2018 using the following databases: EMBASE, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Education Resources Information Center, Database of Abstracts of Reviews of Effects, Applied Social Sciences Index and Abstracts, and Health Management Information Consortium. Grey literature searches were conducted in June 2019 using the following: Google Scholar (Google Inc., Mountain View, CA, USA), OpenGrey, NHS England, North Grey Literature Collection, National Institute for Health and Care Excellence Evidence, Electronic Theses Online Service, Health Systems Evidence and Turning Research into Practice. Further relevant studies were identified via backward citation searching, searching the libraries of the core research team and through a stakeholder group.Review methodsRealist review is a theory-orientated and explanatory approach to the synthesis of evidence that seeks to develop programme theories about how an intervention produces its effects. We developed a programme theory of remediation by convening a stakeholder group and undertaking a systematic search of the literature. We included all studies in the English language on the remediation of practising doctors, all study designs, all health-care settings and all outcome measures. We extracted relevant sections of text relating to the programme theory. Extracted data were then synthesised using a realist logic of analysis to identify context–mechanism–outcome configurations.ResultsA total of 141 records were included. Of the 141 studies included in the review, 64% related to North America and 14% were from the UK. The majority of studies (72%) were published between 2008 and 2018. A total of 33% of articles were commentaries, 30% were research papers, 25% were case studies and 12% were other types of articles. Among the research papers, 64% were quantitative, 19% were literature reviews, 14% were qualitative and 3% were mixed methods. A total of 40% of the articles were about junior doctors/residents, 31% were about practicing physicians, 17% were about a mixture of both (with some including medical students) and 12% were not applicable. A total of 40% of studies focused on remediating all areas of clinical practice, including medical knowledge, clinical skills and professionalism. A total of 27% of studies focused on professionalism only, 19% focused on knowledge and/or clinical skills and 14% did not specify. A total of 32% of studies described a remediation intervention, 16% outlined strategies for designing remediation programmes, 11% outlined remediation models and 41% were not applicable. Twenty-nine context–mechanism–outcome configurations were identified. Remediation programmes work when they develop doctors’ insight and motivation, and reinforce behaviour change. Strategies such as providing safe spaces, using advocacy to develop trust in the remediation process and carefully framing feedback create contexts in which psychological safety and professional dissonance lead to the development of insight. Involving the remediating doctor in remediation planning can provide a perceived sense of control in the process and this, alongside correcting causal attribution, goal-setting, destigmatising remediation and clarity of consequences, helps motivate doctors to change. Sustained change may be facilitated by practising new behaviours and skills and through guided reflection.LimitationsLimitations were the low quality of included literature and limited number of UK-based studies.Future workFuture work should use the recommendations to optimise the delivery of existing remediation programmes for doctors in the NHS.Study registrationThis study is registered as PROSPERO CRD42018088779.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 9, No. 11. See the NIHR Journals Library website for further project information.