The evolution of a state-wide continuing education programme for allied health professionals

Allied health professionals require continuing education (CE) to maintain and improve competencies and standards of care. Research suggests that professional access to CE in rural areas can be difficult.

This article uses an action research framework to describe the development and implementation of a CE programme for allied health professionals in a rural area in Australia, and its subsequent evolution into a state-wide programme. To evaluate programme relevance, attendance and perceived clinical relevance, physiotherapists (n = 75) in southwest Victoria were surveyed 1year after commencement of a CE programme. A secondary outcome was the perceived effect on clinical practice.

More than two-thirds (68.6%) of physiotherapists attended at least one workshop, 57.2% attended four or more sessions and 22.9% attended at least one of the two conducted courses over the period. In addition, 20% of the physiotherapists perceived that attending the programme had a large positive effect on their therapeutic skills, whereas 68.6% reported some effect. From a regional CE programme for physiotherapists the programme evolved into a state-wide programme for 22 allied health professions.

What do general practitioners think depression is? A taxonomy of distress and depression for general practice

Objective:
To create a taxonomy of distress and depression for use in primary care, that mirrors the thinking and practice of experienced general practitioners.

Design:
Qualitative study, using an ethnomethodological approach, with observation of videotaped routine GP–patient consultations and in-depth interviews with GPs.

Setting and participants:
The study was conducted in metropolitan Melbourne in 2005. Fourteen GPs conducted 36 patient consultations where depression was a focus; nine GPs participated in in-depth interviews to elicit details of how they recognised and diagnosed depression in their patients.

Results:
GPs consider distress and depression in three steps. In the first step, a change in a group of symptoms and signs is observed (eg, facial expression, loss of drive). The second step categorises the syndrome according to whether or not there is an identifiable environmental cause (reactive or “endogenous”), with the final step categorising the reactive syndromes according to their most prominent symptoms: either anxiety and worry, or helplessness and hopelessness. The resulting taxonomy includes: endogenous depression (a chronic and perhaps characterological depression characterised by a lack of interest and motivation); anxious depressive reaction (stress or worry); and hopeless depressive reaction (demoralisation).

Conclusion:
This simple and parsimonious taxonomy has validity based on its derivation from within the primary care setting.

Barriers to care for depressed older people : perceptions of aged care among medical professionals

The current study evaluated barriers to detection of depression among older people. Focus groups were conducted with 21 professional carers, 4 nurses, 10 general practitioners, and 7 aged care managers. The results demonstrated that care for older people is primarily focused on physical care. Further, staff resources, a lack of continuity of care, multiple co-morbidities, reluctance by older people to discuss depression, negative attitudes among carers, as well as a lack of skills all contributed to a failure to detect and treat depression. The implications of these findings for training programs for professional carers are discussed.

Supervision among mental health workers in the ACT

There is a common perception among mental health professionals of the purpose of clinical supervision. However, only two-thirds of professionals in the ACT currently receive regular supervision with comparisons between nurses and allied health workers showing few differences in experience, training, access and barriers to supervision, both supervisees and supervisors.

Training improves interobserver reliability for the diagnosis of scaphoid fracture displacement

Background The diagnosis of displacement in scaphoid fractures is notorious for poor interobserver reliability.

Questions/purposes We tested whether training can improve interobserver reliability and sensitivity, specificity, and accuracy for the diagnosis of scaphoid fracture displacement on radiographs and CT scans.

Methods Sixty-four orthopaedic surgeons rated a set of radiographs and CT scans of 10 displaced and 10 nondisplaced scaphoid fractures for the presence of displacement, using a web-based rating application. Before rating, observers were randomized to a training group (34 observers) and a nontraining group (30 observers). The training group received an online training module before the rating session, and the nontraining group did not. Interobserver reliability for training and nontraining was assessed by Siegel’s multirater kappa and the Z-test was used to test for significance.

Results There was a small, but significant difference in the interobserver reliability for displacement ratings in favor of the training group compared with the nontraining group. Ratings of radiographs and CT scans combined resulted in moderate agreement for both groups. The average sensitivity, specificity, and accuracy of diagnosing displacement of scaphoid fractures were, respectively, 83%, 85%, and 84% for the nontraining group and 87%, 86%, and 87% for the training group. Assuming a 5% prevalence of fracture displacement, the positive predictive value was 0.23 in the nontraining group and 0.25 in the training group. The negative predictive value was 0.99 in both groups.

Conclusions Our results suggest training can improve interobserver reliability and sensitivity, specificity and accuracy for the diagnosis of scaphoid fracture displacement, but the improvements are slight. These findings are encouraging for future research regarding interobserver variation and how to reduce it further.

Interobserver reliability of radial head fracture classification : two-dimensional compared with three-dimensional CT

Background: The Broberg and Morrey modification of the Mason classification of radial head fractures has substantial interobserver variation. This study used a large web-based collaborative of experienced orthopaedic surgeons to test the hypothesis that three-dimensional reconstructions of computed tomography (CT) scans improve the interobserver reliability of the classification of radial head fractures according to the Broberg and Morrey modification of the Mason classification.

Methods: Eighty-five orthopaedic surgeons evaluated twelve radial head fractures. They were randomly assigned to review either radiographs and two-dimensional CT scans or radiographs and three-dimensional CT images to determine the fracture classification, fracture characteristics, and treatment recommendations. The kappa multirater measure (κ) was calculated to estimate agreement between observers.

Results: Three-dimensional CT had moderate agreement and two-dimensional CT had fair agreement among observers for the Broberg and Morrey modification of the Mason classification, a difference that was significant. Observers assessed seven fracture characteristics, including fracture line, comminution, articular surface involvement, articular step or gap of ≥2 mm, central impaction, recognition of more than three fracture fragments, and fracture fragments too small to repair. There was a significant difference in kappa values between three-dimensional CT and two-dimensional CT for fracture fragments too small to repair, recognition of three fracture fragments, and central impaction. The difference between the other four fracture characteristics was not significant. Among treatment recommendations, there was fair agreement for both three-dimensional CT and two-dimensional CT.

Conclusions: Although three-dimensional CT led to some small but significant decreases in interobserver variation, there is still considerable disagreement regarding classification and characterization of radial head fractures. Three-dimensional CT may be insufficient to optimize interobserver agreement.

What counts as effective communication in nursing? Evidence from nurse educators' and clinicians' feedback on nurse interactions with simulated patients.

To examine the feedback given by nurse educators and clinicians on the quality of communication skills of nurses in interactions with simulated patients.

Challenges and opportunities of undertaking a video ethnographic study to understand medication communication

AIMS AND OBJECTIVES: To examine the challenges and opportunities of undertaking a video ethnographic study on medication communication among nurses, doctors, pharmacists and patients. BACKGROUND: Video ethnography has proved to be a dynamic and useful method to explore clinical communication activities. This approach involves filming actual behaviours and activities of clinicians to develop new knowledge and to stimulate reflections of clinicians on their behaviours and activities. However, there is limited information about the complex negotiations required to use video ethnography in actual clinical practice. DESIGN: Discursive paper. METHOD: A video ethnographic approach was used to gain better understanding of medication communication processes in two general medical wards of a metropolitan hospital in Melbourne, Australia. This paper presents the arduous and delicate process of gaining access into hospital wards to video-record actual clinical practice and the methodological and ethical issues associated with video-recording. CONCLUSIONS: Obtaining access to clinical settings and clinician consent are the first hurdles of conducting a video ethnographic study. Clinicians may still feel intimidated or self-conscious in being video recorded about their medication communication practices, which they could perceive as judgements being passed about their clinical competence. By thoughtful and strategic planning, video ethnography can provide in-depth understandings of medication communication in acute care hospital settings. Ethical issues of informed consent, patient safety and respect for the confidentiality of patients and clinicians need to be carefully addressed to build up and maintain trusting relationships between researchers and participants in the clinical environment. RELEVANCE TO CLINICAL PRACTICE: By prudently considering the complex ethical and methodological concerns of using video ethnography, this approach can help to reveal the unpredictability and messiness of clinical practice. The visual data generated can stimulate clinicians' reflexivity about their norms of practice and bring about improved communication about managing medications.

Knowledge on dental trauma and orthodontic tooth movement held by a group of orthodontists

The objective of this work was to assess the knowledge about orthodontic tooth movement and dental trauma held by a group of orthodontists in specific areas of Brazil. For this purpose, 166 questionnaires with 15 objective questions about this subject were distributed. One hundred and five questionnaires were properly filled and collected after 30 days. It was concluded that, except for avulsion, the knowledge on dental injuries held by the professionals interviewed was considered unsatisfactory, and about 40% of them were not acquainted with the recommendations for the orthodontic movement of traumatized teeth.

Acquisition of suture skills during medical graduation by instructor-directed training: A randomized controlled study comparing senior medical students and faculty surgeons

Due to shortage of time and limited availability of faculty surgeons to teach basic surgical skills during medical graduation, the search for alternative ways of simulated training with feedback is needed. The purpose of this study was to compare the simulated teaching of suture skills to novice medical students by senior medical students and by experienced faculty surgeons. Forty-eight novice medical students were randomly assigned to three practice conditions on bench model (n = 16): self-directed suture training (control), senior medical student-directed suture skills' training, or experienced faculty surgeon-directed suture skills' training. Pre- and post-tests were applied. Global Rating Scale with blinded evaluation and self-perceived confidence based on Likert scale were used to assess all suture performances in pre- and post-training. Effect size was also calculated. The analysis made after training showed that the students who received feedback from the instructors had better performance based on the Global Rating Scale (all p < 0.0000) and felt more confident to carry out sutures (all p < 0.0000) when compared to the control. There was no significant difference (all p > 0.05) between the student-directed teaching and faculty-directed teaching groups. The magnitude of the effect (instructor-directed training suture) was considered large (>0.80) in all measurements. The acquisition of suture skills after student-directed training was similar to the training supervised by faculty surgeon, and the increase in suture performances of trainees that received instructor administered training was superior to self-directed learning. © 2013 Springer-Verlag Italia.

Aufbau eines strukturierten Auswahlverfahrens für Schauspielpatienten

Einleitung In unserer Institution sind die Anforderungen an Schauspielpatienten (SPs) seit 2010 stetig angestiegen(Guttormsen et al., 2013). Zudem stieg auch die Zahl der benötigten SPs insgesamt, so dass wir uns entschieden ein effektives Aufnahmeverfahren gemäss professioneller Qualitätskriterien (Wallace, 2007) zu gestalten. Methoden Seit 2012 organisieren wir 2 x jährlich eine Informations-Veranstaltung für interessierte Bewerber. In einem ersten Teil wird über die Einsätze von SPs informiert und die Rahmenbedingungen dargelegt. In einem zweiten Teil werden Improvisationsübungen in Gruppen, zu zweit oder einzeln durchgeführt. Die SP-Trainer beobachten das Spiel. Zusätzlich wird die Performance gefilmt. Alle Interessierten müssen sich nach dieser 2-stündigen Veranstaltung für 2 weitere Einzeltermine einschreiben: 1. Spielen eines OSCE-Falles (mit SP-Trainer) 2. Körperliche Untersuchung (mit Arzt). Anschliessend wird im Team entschieden, ob alle Voraussetzungen in Bezug auf Teamfähigkeit/Zuverlässigkeit, schauspielerische Fertigkeiten, körperliche Merkmale für eine Anstellung erfüllt sind. Ergebnisse Mit der Einführung dieses strukturierten Auswahlverfahrens haben wir folgendes erreicht: die ausgewählten SPs passen sehr gut in das Team und erfordern weniger organisatorischen Aufwand. Die Rollen können exakter auf das Profil der jeweiligen SPs abgestimmt werden (insbes. durch die körperliche Untersuchung).  Mit der Informationsveranstaltung für die Gruppe wird der zeitliche Aufwand für die Information der SPs gegenüber reinen Einzelinterviews gesenkt (50%), trotzdem können durch die Einzeltermine detaillierte Informationen erhoben werden. Diskussion Seit der Neustrukturierung des Auswahlverfahrens entsprechen die gewählten SPs deutlich besser unserem Anforderungsprofil. In Zukunft planen wir das Anforderungsprofil schriftlich zu dokumentieren und zu veröffentlichen, um das Verfahren transparent zu machen. Literatur: [1] Guttormsen, S., C. Beyeler, R. Bonvin, S. Feller, C. Schirlo, K. Schnabel, T. Schurter, and C. Berendonk. 2013. The new licencing examination for human medicine: from concept to implementation. Swiss Med Wkly 143:w13897. [2] Wallace, P. 2007. Coaching Standardized Patients for Use in the Assessment of Clinical Competence. Springer Publishing Company, New York

Nursing cluster /

Project staff: Joseph A. Bonefeste, Kathryn Torricelli, Mary Mulcahy. Cf. p. [2] of cover.