Neurophobia among general practice trainees: The evidence, perceived causes and solutions

Introduction

As general practice (GP) is the main source of referrals to neurologists, neurology education for GP trainees is important. We investigated the existence of neurophobia, contributing factors and potential prevention strategies among GP trainees.

In a questionnaire survey interest, knowledge, confidence and perceived difficulty in neurology were compared with different medical specialties. Reasons for difficulty with neurology, postgraduate neurology education experience, learning methods and suggested teaching improvements were examined.

Of 205 GP trainees, 118 (58%) completed the questionnaire. Threshold analyses justified categorical intervals for the Likert responses. Trainees recorded poorer knowledge (p < 0.001), less confidence (p < 0.001) and more perceived difficulty (p < 0.001) with neurology than with any other medical specialty. GP trainees had less interest in neurology than any other medical specialty (Duncan test, p < 0.001). There was a similar gradation in difficulty and confidence perception across medical specialties. Hospital and community-based neurology teaching was graded as “poor” or “very poor” by over 60% of GP trainees. There were multiple perceived causes of neurophobia, including neuroanatomy and poor quality teaching. More organised clinical teaching and referral guidance were suggested to address GP neurophobia.

Neurophobia is common among GP trainees in Northern Ireland. GP trainees have clear and largely uniform ideas on improving their neurology education. GP training posts should reflect the importance of neurology within the GP curriculum.

A systematic review protocol on the use of online learning and blended learning for teaching clinical skills to undergraduate health professional students

Aim: This paper is a review protocol that will be used to identify, critically appraise and synthesize the best current evidence relating to the use of online learning and blended learning approaches in teaching clinical skills in undergraduate nursing.

Background: Although previous systematic reviews on online learning versus face to face learning have been undertaken (Cavanaugh et al. 2010, Cook et al. 2010), a systematic review on the impact of online learning and blended learning for teaching clinical skills has yet to be considered in undergraduate nursing. By reviewing nursing students’ online learning experiences, systems can potentially be designed to ensure all students’ are supported appropriately to meet their learning needs.

Methods/Design: The key objectives of the review are to evaluate how online-learning teaching strategies assist nursing students learn; to evaluate the students satisfaction with this form of teaching; to explore the variety of online-learning strategies used; to determine what online-learning strategies are more effective and to determine if supplementary face to face instruction enhances learning. A search of the following databases will be made MEDLINE, CINAHL, BREI, ERIC and AUEI. This review will follow the Joanna Briggs Institute guidance for systematic reviews of quantitative and qualitative research.

Conclusion: This review intends to report on a combination of student experience and learning outcomes therefore increasing its utility for educators and curriculum developers involved in healthcare education.

Teaching family carers about home based palliative care: Final results from a group education program

Without the considerable support provided by family carers, many patients receiving palliative care would be unable to remain at home. However, family carers typically lack the required information and skills to prepare them for such a role. Pilot work has demonstrated that group education programs for family carers can be readily developed; they are feasible, accessible, and useful. This project sought to build on our pilot research to further examine the effectiveness of a group education program by evaluating the outcomes with a larger number of participants. The program aimed to prepare primary family carers for the role of supporting a relative with advanced, noncurative cancer at home. The psycho-educational program consisted of three consecutive weekly sessions presented in a group format, conducted at six home-based palliative care services across metropolitan and regional Victoria, Australia. The following dependent variables were measured at three time points: carer competence, preparedness, rewards, and information needs. The three time points were: commencement of the program (Time 1), upon completion (Time 2), and two weeks later (Time 3). A total of 156 participants (including the pilot phase) completed Time 1 questionnaires and 96 completed all three time periods (62%). Between Time 1 and Time 2, the intervention had a statistically significant positive effect on preparedness, competence, rewards, and having informational needs met. Outcomes were maintained at Time 3. There was no difference in the effectiveness of the intervention for participants in regional areas compared to participants in metropolitan areas.

This study demonstrated that a group education program to prepare family carers for the role of supporting a dying relative at home was effective. Implications for further research and practice are outlined.

Development of a multi-media book for clinical supervision training in undergraduate nursing

There is an increased interest in higher education in the use of e-learning resources for students. This can be attributed to many factors including, the availability of advanced technology systems, a growing student population that is technology focused, financial implications and the recruitment of international students. However, the introduction of technology and e-learning into teaching has given rise to issues regarding quality and quantity of educational practice . The challenge now is for educationalists is to deliver an optimal learning experience that is effective and appropriate for students’ learning needs.

Prevalence and Causes of Prescribing ErrorsL The PRescribing Outcomes for Trainee Doctors Engaged in Clinical Training (PROTECT) Study

Objectives: Study objectives were to investigate the prevalence and causes of prescribing errors amongst foundation doctors (i.e. junior doctors in their first (F1) or second (F2) year of post-graduate training), describe their knowledge and experience of prescribing errors, and explore their self-efficacy (i.e. confidence) in prescribing.

Method: A three-part mixed-methods design was used, comprising: prospective observational study; semi-structured interviews and cross-sectional survey. All doctors prescribing in eight purposively selected hospitals in Scotland participated. All foundation doctors throughout Scotland participated in the survey. The number of prescribing errors per patient, doctor, ward and hospital, perceived causes of errors and a measure of doctors’ self-efficacy were established.

Results: 4710 patient charts and 44,726 prescribed medicines were reviewed. There were 3364 errors, affecting 1700 (36.1%) charts (overall error rate: 7.5%; F1:7.4%; F2:8.6%; consultants:6.3%). Higher error rates were associated with : teaching hospitals (p,0.001), surgical (p = ,0.001) or mixed wards (0.008) rather thanmedical ward, higher patient turnover wards (p,0.001), a greater number of prescribed medicines (p,0.001) and the months December and June (p,0.001). One hundred errors were discussed in 40 interviews. Error causation was multi-factorial; work environment and team factors were particularly noted. Of 548 completed questionnaires (national response rate of 35.4%), 508 (92.7% of respondents) reported errors, most of which (328 (64.6%) did not reach the patient. Pressure from other staff, workload and interruptions were cited as the main causes of errors. Foundation year 2 doctors reported greater confidence than year 1 doctors in deciding the most appropriate medication regimen.

Conclusions: Prescribing errors are frequent and of complex causation. Foundation doctors made more errors than other doctors, but undertook the majority of prescribing, making them a key target for intervention. Contributing causes included work environment, team, task, individual and patient factors. Further work is needed to develop and assess interventions that address these.

An Innovative teaching tool for students is it Appropriate?

Background: Clinical supervision takes place once the newly qualified nurse is employed in clinical practice. However, often the variety and diversity of nursing jobs can result in a hit and miss delivery of supervision training. By introducing training uniformly at undergraduate stage a more seamless transition may occur (McColgan K, Rice C. 2012).

There is an increased interest in higher education in the use of online learning resources for students. As part completion of a DNP an App. for training students in clinical supervision was developed.

Aim: The creation of a clinical supervision training App. for use in undergraduate nursing.

Objectives:
•To develop a teaching tool that is up to date, current and easily accessible to students.
•To introduce supervision training for undergraduate nursing students
•To motivate the undergraduate nursing student to identify examples from their clinical experience to encourage change and promote professional development.

Approach:
Stage 1
In 2010/11 informal inquiries with senior nurses regarding the introduction of supervision training in undergraduate nursing
Stage 2
A review of UK supervision training.
Stage 3
Template production of teaching tool.
Stage 4
Collaboration with a computer technician to transfer multimedia outputs onto an App.
Stage 5
App. piloted with lecturers (n=4) and post registration students (n=20).
Stage 6
Minor alterations made to App. design template
Stage 7
App. included in an experimental study looking at online learning versus blended learning June 2013 (n=61, n=63)

Conclusion: A collaborative approach to the development of any educational programme is essential to ensure the success of the final teaching product (McCutcheon 2013). The end result is that this App. could be:
•Made available to nurses in the UK.
•Adapted to suit other healthcare professionals and students.
•Used as a prototype for other healthcare related subjects.

McColgan K., Rice C. (2012) An online training resource for clinical supervision. Nursing Standard, 26(24) 35-39.
McCutcheon K. (2013) Development of a multi-media book for clinical supervision training in an undergraduate nursing programme. Journal of Nursing Education and Practice, 3(5) 31-38.

A systematic review evaluating the impact of online or blended learning vs. face-to-face learning of clinical skills in undergraduate nurse education.

Aim: To determine whether the use of an online or blended learning paradigm has the potential to enhance the teaching of clinical skills in undergraduate nursing.

Background: The need to adequately support and develop students in clinical skills is now arguably more important than previously considered due to reductions in practice opportunities. Online and blended teaching methods are being developed to try and meet this requirement, but knowledge about their effectiveness in teaching clinical skills is limited.

Design: Mixed methods systematic review, which follows the Joanna Briggs Institute User guide version 5.

Data Sources: Computerized searches of five databases were undertaken for the period 1995-August 2013.

Review Methods: Critical appraisal and data extraction were undertaken using Joanna Briggs Institute tools for experimental/observational studies and interpretative and critical research. A narrative synthesis was used to report results.

Results: Nineteen published papers were identified. Seventeen papers reported on online approaches and only two papers reported on a blended approach. The synthesis of findings focused on the following four areas: performance/clinical skill, knowledge, self-efficacy/clinical confidence and user experience/satisfaction. The e-learning interventions used varied throughout all the studies.

Conclusion: The available evidence suggests that online learning for teaching clinical skills is no less effective than traditional means. Highlighted by this review is the lack of available evidence on the implementation of a blended learning approach to teaching clinical skills in undergraduate nurse education. Further research is required to assess the effectiveness of this teaching methodology.

Evaluation of the contribution of theatre attendance to medical undergraduate neuroscience teaching - a pilot study.

Introduction: Medical students often attend the neurosurgical theatre during their clinical neurosciences attachment. However, few studies have been performed to objectively assess the value of this theatre-based learning experience. The main aim of this study was to explore student perceptions on the contribution of neurosurgical theatre attendance to clinical neuroscience teaching.

Materials and Methods: Third-year medical students undergoing their 2-week clinical neurosciences rotation at the Royal Hospitals Belfast were invited to participate in this study. A multi-method strategy was employed using a survey questionnaire comprising of closed and open-ended questions followed by semi-structured interviews to gain a greater 'in-depth' analysis of the potential contribution of neurosurgical theatre attendance to neuroscience teaching.

Results: Based on the completed survey responses of 22 students, the overall experience of neurosurgical theatre-based learning was a positive one. 'In-depth' analysis from semi-structured interviews indicated that students felt that some aspects of their neurosurgical theatre attendance could be improved. Better preparation such as reading up on the case in hand and an introduction to simple theatre etiquette to put the student at ease (in particular, for students who had never attended theatre previously), would improve the learning experience. In addition, having an expectation of what students are expected to learn in theatre making it more learning outcomes-based would probably make it feel a more positive experience by the student.

Conclusions: The vast majority of students acknowledged the positive learning outcomes of neurosurgical theatre attendance and felt that it should be made a mandatory component of the curriculum.

What Are the Effects of Teaching Evidence-Based Health Care (EBHC)? Overview of Systematic Reviews

Background

An evidence-based approach to health care is recognized internationally as a key competency for healthcare practitioners. This overview systematically evaluated and organized evidence from systematic reviews on teaching evidence-based health care (EBHC).

Methods/Findings

We searched for systematic reviews evaluating interventions for teaching EBHC to health professionals compared to no intervention or different strategies. Outcomes covered EBHC knowledge, skills, attitudes, practices and health outcomes. Comprehensive searches were conducted in April 2013. Two reviewers independently selected eligible reviews, extracted data and evaluated methodological quality. We included 16 systematic reviews, published between 1993 and 2013. There was considerable overlap across reviews. We found that 171 source studies included in the reviews related to 81 separate studies, of which 37 are in more than one review. Studies used various methodologies to evaluate educational interventions of varying content, format and duration in undergraduates, interns, residents and practicing health professionals. The evidence in the reviews showed that multifaceted, clinically integrated interventions, with assessment, led to improvements in knowledge, skills and attitudes. Interventions improved critical appraisal skills and integration of results into decisions, and improved knowledge, skills, attitudes and behaviour amongst practicing health professionals. Considering single interventions, EBHC knowledge and attitude were similar for lecture-based versus online teaching. Journal clubs appeared to increase clinical epidemiology and biostatistics knowledge and reading behavior, but not appraisal skills. EBHC courses improved appraisal skills and knowledge. Amongst practicing health professionals, interactive online courses with guided critical appraisal showed significant increase in knowledge and appraisal skills. A short workshop using problem-based approaches, compared to no intervention, increased knowledge but not appraisal skills.

Conclusions

EBHC teaching and learning strategies should focus on implementing multifaceted, clinically integrated approaches with assessment. Future rigorous research should evaluate minimum components for multifaceted interventions, assessment of medium to long-term outcomes, and implementation of these interventions.

The effect of choice on motivation for young children on the autism spectrum during discrete trial teaching

Self-determination and decision-making are acknowledged internationally as key rights of persons with disabilities and should play an important role in the development of educational plans and procedures. Not only is the chance for individuals with developmental disabilities to select their own tasks, leisure activities or reinforcers a valuable way of enhancing rights-based education and personal dignity, but choice-making opportunities may also function as a useful clinical or educational tool if they actually improve the efficacy of programmes aimed at the acquisition of socially relevant behaviours and life skills or the reduction of challenging behaviours.

The study reported here assessed whether or not choice affected effectiveness of an educational procedure for three children on the autism spectrum. Following a preference assessment, a number of discrete teaching trials were conducted with each child and, contingent upon targeted responses, either the child or the therapist selected one of three preferred reinforcer items. Reinforcer choice did not affect intervention effectiveness for two of the children; however, performance and motivation improved for the third child. Results re-affirmed the importance of thorough preference assessments prior to intervention and showed that additional stimulus choice contingent on the target response may improve motivation and outcomes for some children.