Medical students as agents of change: a qualitative exploratory study

BackgroundThere is evidence that medical students have the potential to actively initiate, lead and bring about change through quality improvement within healthcare organisations. For effective change to occur, it is important that students are introduced to, and exposed to the value and necessity of quality improvement early in their careers. The aim of this study was to explore the perspectives and experiences of medical students and their mentors after undertaking quality improvement projects within the healthcare setting, and if such practice-based experiences were an effective way of building improvement capacity and changing practice.MethodsA qualitative interpretive description methodology, using focus groups with medical students and semi-structured interviews with academic and clinical mentors following completion of students’ 4-week quality improvement projects was adopted.ResultsThe findings indicate that there are a range of facilitators and barriers to undertaking and completing quality improvement projects in the clinical setting, such as time-scales, differing perspectives, roles and responsibilities between students and multidisciplinary healthcare professionals.ConclusionsThis study has demonstrated that quality improvement experiential learning can develop knowledge and skills among medical students and transform attitudes towards quality improvement. Furthermore, it can also have a positive impact on clinical staff and healthcare organisations. Despite inherent challenges, undertaking quality improvement projects in clinical practice enhances knowledge, understanding and skills, and allows medical students to see themselves as important influencers of change as future doctors.

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Midwives' evaluation of their role in crowdsourcing activities to improve the maternity experience: part 2

British Journal of Midwifery ◽

10.12968/bjom.2019.27.7.420 ◽

2019 ◽

Vol 27 (7) ◽

pp. 420-426

Author(s):

Sam Frewin ◽

Sarah Church

Keyword(s):

Quality Improvement ◽

Maternity Care ◽

Service Evaluation ◽

Qualitative Approach ◽

Structured Interviews ◽

Shared Learning ◽

Face To Face ◽

Agents Of Change ◽

Generic Qualitative

BackgroundAlthough all members of staff can be involved in improving the quality of maternity services, midwives can identify areas in need of improvement through their relationships with women and their families, and can influence care through activities such as crowdsourcing.AimsA service evaluation was undertaken to explore how midwives who attended the workshop viewed their involvement in crowdsourcing, and to examine whether midwives who attended the workshop considered themselves as agents of change for quality improvement in maternity care.MethodsA generic qualitative approach was selected. Data were collected using face-to-face, semi-structured interviews with six midwives who attended the workshop.FindingsFour key themes emerged from analysing the data: improving communication, experiencing different perspectives, shared learning, and positivity.ConclusionsInvolving stakeholders as a ‘crowd’ to find solutions to problems in care is successful and highly rewarding. Midwife participants took pride in sharing their ideas for improvement.

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Medical students’ readiness and perceptions about Interprofessional Education: A cross sectional study

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.36.4.2214 ◽

2020 ◽

Vol 36 (4) ◽

Author(s):

Hana Zamil ◽

Sultan Ayoub Meo

Keyword(s):

Medical Students ◽

Professional Identity ◽

Interprofessional Education ◽

Positive Impact ◽

Medical Schools ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Roles And Responsibilities ◽

Clinical Scenarios

Objectives: Interprofessional Education (IPE) provides an environment where learners demonstrate the knowledge, skills and attitude required to manage the complex clinical scenarios in a collaborative and interprofessional manner. The actual sphere of influence of Interprofessional Education in many medical schools has been limited. Therefore, the present study aim was to evaluate the medical students’ readiness and perception of Interprofessional Education in a medical college in Saudi Arabia. Methods: This questionnaire based cross sectional study was executed in the Department of Physiology, College of Medicine, King Saud University during the period September 2016 to December 2017, using the 19-item Readiness for Interprofessional Learning Scale (RIPLS) with four subscales teamwork and collaboration, negative professional identity, positive professional identity and roles and responsibilities. The questionnaire was e-mailed to 1411 medical students and responses were analyzed using 5-point Likert scale. Results: A total of 158 medical students and trainees responded to the survey, 69 (43.6%) were males and 89 (56.4%) were females. The majority of participants 122-148 (77-94%) acknowledged the positive impact of IPE on teamwork and collaboration, more than two thirds 105 (64.45%) disagreed with negative attitude and 110-126 (70-80%) showed positive professional identity. Conclusions: Medical students showed a positive perception and ready to adopt the Interprofessional Educational allied activities in medical schools. The shared academic events would improve in clarifying the roles and responsibilities of medical students in health care professions. doi: https://doi.org/10.12669/pjms.36.4.2214 How to cite this:Alzamil H, Meo SA. Medical students’ readiness and perceptions about Interprofessional Education: A cross sectional study. Pak J Med Sci. 2020;36(4):---------. doi: https://doi.org/10.12669/pjms.36.4.2214 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Quality Improvement Efforts in VA Community Living Centers Increased Following Public Reporting of Performance

Innovation in Aging ◽

10.1093/geroni/igab046.077 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 22-22

Author(s):

Heather Davila ◽

Whitney Mills ◽

Valerie Clark ◽

Christine Hartmann ◽

David Mohr ◽

...

Keyword(s):

Quality Improvement ◽

Nursing Homes ◽

Positive Impact ◽

Public Reporting ◽

Performance Ratings ◽

Comparative Case Study ◽

Community Living ◽

Structured Interviews ◽

Improve Performance ◽

Community Living Centers

Abstract In 2018, the US Department of Veterans Affairs (VA) began publicly reporting performance ratings for its 134 Community Living Centers (CLCs; nursing homes) based on health inspections, staffing, and clinical quality measures. CLCs operate within a large, integrated healthcare system with unique financial and market incentives. Although public reporting has led to quality improvements in non-VA nursing homes, we do not know whether CLCs respond to public reporting differently than private sector nursing homes. To address this knowledge gap, we used a comparative case study approach involving 3 purposively selected CLCs with varied (low, medium, high) performance ratings. We conducted semi-structured interviews with personnel (n=12) responsible for quality measurement and improvement. Interviews focused on opinions of public reporting, actions taken to improve performance ratings, and motivations for change. Participants indicated public reporting improved transparency and provided an “outside perspective” on their performance. Strategies to improve performance ratings involved 1) data/information, 2) individual roles, and 3) teamwork/communication. All 3 CLCs made changes in these areas, yet respondents in the higher performing CLCs described implementing more strategies immediately after learning their ratings. Respondents in all 3 CLCs described being motivated to deliver good care and achieve public ratings that reflected the care they provided. This meant addressing internal weaknesses that contributed to lower scores for 2 CLCs. Our findings suggest public reporting may improve internal data collection, reporting, and quality improvement efforts in CLCs. They highlight the potential positive impact of public reporting in prompting quality improvement in nursing homes.

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‘A Way of Being in the World’: An Exploration of the Experience of Developing Self-Compassion through Online Training

OBM Integrative and Complementary Medicine ◽

10.21926/obm.icm.2104050 ◽

2021 ◽

Vol 6 (4) ◽

pp. 1-1

Author(s):

Jack Deacon ◽

◽

Clare Northover ◽

John King ◽

Chris Irons ◽

...

Keyword(s):

Positive Impact ◽

Social Contexts ◽

Subjective Experiences ◽

Structured Interviews ◽

Self Compassion ◽

Self Help ◽

Barriers To Change ◽

Compassion Focused Therapy ◽

The World ◽

Facilitators And Barriers

Compassion Focused Therapy (CFT) has increasingly been shown to have a positive impact for people experiencing a range of difficulties, and online self-help formats could provide a way of increasing its accessibility and scalability. This study explored adult participants’ subjective experiences of engaging with online self-compassion training drawn from Compassionate Mind Training (CMT) and CFT. Semi-structured interviews were conducted with 15 participants who had completed online self-compassion training, and the interview data was analysed using reflexive thematic analysis. The analysis generated four main themes and 17 sub-themes. The four main themes generated were ‘A way of being in the world’, ‘Old habits die hard’, The learning process, and Context and resources. These themes showed that while the process of developing self-compassion was often challenging, most participants described experiencing positive changes in their ways of relating to themselves and others. Participants identified many facilitators and barriers to change, including factors related to the training format and their wider social contexts. These findings support previous research into CMT and CFT, particularly in relation to some common positive changes people experience and some of the difficulties with this process (e.g. fears of compassion). Participants’ descriptions offer promise that approaches based on CMT and the CFT model can be experienced as acceptable and helpful by people engaging through an online self-help format as well as through individual and group-based interventions. The facilitators and barriers to change described by participants indicate the strong influence of people’s contexts and the need for these to be carefully considered when designing and implementing approaches.

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A Critical Reflection on Relationship between ICT and Change Management in Enhancing Teaching and Learning Performances

Balkan Region Conference on Engineering and Business Education ◽

10.2478/cplbu-2020-0049 ◽

2019 ◽

Vol 1 (1) ◽

pp. 406-415

Author(s):

Ratana Som ◽

Danut Dumitrascu

Keyword(s):

Quality Improvement ◽

Change Management ◽

Teaching And Learning ◽

Positive Impact ◽

Education Quality ◽

Management Approach ◽

Ict In Education ◽

Information Communication ◽

Effective Change ◽

Critical Content

AbstractNumerous studies have pointed out direct positive impacts of Information Communication Technology (ICT) on education quality. From just tool, ICT is being viewed in itself as quality or as catalyst for quality improvement. These findings have led universities worldwide to adopt ICT regardless of uncertainties. Consequently, not all of them succeeded. Proofs from cases around the world show that ICT produces positive impact only in the environment that fits. Such environment is fostered by an effective change management approach. The main aim of this paper is therefore to present the symbiotic relationship between ICT and change management, zeroing on how changes are managed to attain a proper ICT ecosystem for education quality improvement. It also aims to understand, through the conducts of extensive bibliographical research, along with critical content analyses, the roles of ICT in education, its design and impacts, and what constitutes effective change management approach for ICT inclusion. Key findings include: that the integration of ICT alone does not necessarily produce direct positive impact on teaching and learning, but its design; that a good design requires a proper change management process, driven by ICT, and that the involvement of all stakeholders, particularly functional managers, is critical to attain better performances.

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Engaging community pharmacists in quality improvement (QI): a qualitative case study of a partnership between a Higher Education Institute and Local Pharmaceutical Committees

BMJ Open Quality ◽

10.1136/bmjoq-2020-001047 ◽

2021 ◽

Vol 10 (1) ◽

pp. e001047

Author(s):

Asam Latif ◽

Nargis Gulzar ◽

Fiona Lowe ◽

Theo Ansong ◽

Sejal Gohil

Keyword(s):

Quality Improvement ◽

Focus Groups ◽

Qualitative Methodology ◽

Positive Impact ◽

Community Pharmacists ◽

Educational Institute ◽

Collaboration And Communication ◽

Improve Service Quality ◽

The Impact

BackgroundQuality improvement (QI) involves the use of systematic tools and methods to improve the quality of care and outcomes for patients. However, awareness and application of QI among healthcare professionals is poor and new strategies are needed to engage them in this area.ObjectivesThis study describes an innovative collaboration between one Higher Educational Institute (HEI) and Local Pharmaceutical Committees (LPCs) to develop a postgraduate QI module aimed to upskill community pharmacists in QI methods. The study explores pharmacist engagement with the learning and investigates the impact on their practice.MethodsDetails of the HEI–LPCs collaboration and communication with pharmacist were recorded. Focus groups were held with community pharmacists who enrolled onto the module to explore their motivation for undertaking the learning, how their knowledge of QI had changed and how they applied this learning in practice. A constructivist qualitative methodology was used to analyse the data.ResultsThe study found that a HEI–LPC partnership was feasible in developing and delivering the QI module. Fifteen pharmacists enrolled and following its completion, eight took part in one of two focus groups. Pharmacists reported a desire to extend and acquire new skills. The HEI–LPC partnership signalled a vote of confidence that gave pharmacists reassurance to sign up for the training. Some found returning to academia challenging and reported a lack of time and organisational support. Despite this, pharmacists demonstrated an enhanced understanding of QI, were more analytical in their day-to-day problem-solving and viewed the learning as having a positive impact on their team’s organisational culture with potential to improve service quality for patients.ConclusionsWith the increased adoption of new pharmacist’s roles and recent changes to governance associated with the COVID-19 pandemic, a HEI–LPC collaborative approach could upskill pharmacists and help them acquire skills to accommodate new working practices.

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Improving the experience of facility-based delivery for vulnerable women through obstetric care navigation: a qualitative evaluation

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03842-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kirsten Austad ◽

Michel Juarez ◽

Hannah Shryer ◽

Patricia L. Hibberd ◽

Mari-Lynn Drainoni ◽

...

Keyword(s):

Health Workers ◽

Positive Impact ◽

Qualitative Evaluation ◽

Obstetric Care ◽

Hospital Staff ◽

Public Hospitals ◽

Future Research ◽

Care Seeking ◽

Structured Interviews ◽

The Impact

Abstract Background Global disparities in maternal mortality could be reduced by universal facility delivery. Yet, deficiencies in the quality of care prevent some mothers from seeking facility-based obstetric care. Obstetric care navigators (OCNs) are a new form of lay health workers that combine elements of continuous labor support and care navigation to promote obstetric referrals. Here we report qualitative results from the pilot OCN project implemented in Indigenous villages in the Guatemalan central highlands. Methods We conducted semi-structured interviews with 17 mothers who received OCN accompaniment and 13 staff—namely physicians, nurses, and social workers—of the main public hospital in the pilot’s catchment area (Chimaltenango). Interviews queried OCN’s impact on patient and hospital staff experience and understanding of intended OCN roles. Audiorecorded interviews were transcribed, coded, and underwent content analysis. Results Maternal fear of surgical intervention, disrespectful and abusive treatment, and linguistic barriers were principal deterrents of care seeking. Physicians and nurses reported cultural barriers, opposition from family, and inadequate hospital resources as challenges to providing care to Indigenous mothers. Patient and hospital staff identified four valuable services offered by OCNs: emotional support, patient advocacy, facilitation of patient-provider communication, and care coordination. While patients and most physicians felt that OCNs had an overwhelmingly positive impact, nurses felt their effort would be better directed toward traditional nursing tasks. Conclusions Many barriers to maternity care exist for Indigenous mothers in Guatemala. OCNs can improve mothers’ experiences in public hospitals and reduce limitations faced by providers. However, broader buy-in from hospital staff—especially nurses—appears critical to program success. Future research should focus on measuring the impact of obstetric care navigation on key clinical outcomes (cesarean delivery) and mothers’ future care seeking behavior.

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Changing relationships: how does patient involvement transform professional identity? An ethnographic study

BMJ Open ◽

10.1136/bmjopen-2020-045520 ◽

2021 ◽

Vol 11 (7) ◽

pp. e045520

Author(s):

Marie-Pierre Codsi ◽

Philippe Karazivan ◽

Ghislaine Rouly ◽

Marie Leclaire ◽

Antoine Boivin

Keyword(s):

Quality Improvement ◽

Data Collection ◽

Health Professionals ◽

Clinical Care ◽

Ethnographic Study ◽

Structured Interviews ◽

Administrative Team ◽

Nurse Clinician ◽

New Perspective ◽

Relational Framework

ObjectivesTo understand identity tensions experienced by health professionals when patient partners join a quality improvement committee.DesignQualitative ethnographic study based on participatory observation.SettingAn interdisciplinary quality improvement committee of a Canadian urban academic family medicine clinic with little previous experience in patient partnership.ParticipantsTwo patient partners, seven health professionals (two family physicians, two residents, one pharmacist, one nurse clinician and one nurse practitioner) and three members of the administrative team.Data collectionData collection included compiled participatory observations, logbook notes and semi-structured interviews, collected between the summer of 2017 to the summer of 2019.Data analysisGhadiri’s identity threats theoretical framework was used to analyse qualitative material and to develop conceptualising categories, using QDA Miner software (V.5.0).ResultsAll professionals with a clinical care role and patient partners (n=9) accepted to participate in the ethnographic study and semi-structured interviews (RR=100%). Transforming the ‘caregiver–patient’ relationship into a ‘colleague–colleague’ relationship generated identity upheavals among professionals. Identity tensions included competing ideals of the ‘good professional’, challenges to the impermeability of the patient and professional categories, the interweaving of symbols associated with one or the other of these identities, and the inner balance between the roles of caregiver and colleague.ConclusionThis research provides a new perspective on understanding how working in partnership with patients transform health professionals’ identity. When they are called to work with patients outside of a simple therapeutic relationship, health professionals may feel tensions between their identity as caregivers and their identity as colleague. This allows us to better understand some underlying tensions elicited by the arrival of different patient engagement initiatives (eg, professionals’ resistance to working with patients, patients’ status and remuneration, professionals’ concerns toward patient ‘representativeness’). Partnership with patients imply the construction of a new relational framework, flexible and dynamic, that takes into account this coexistence of identities.

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Video-Based Intervention for Improving Maternal Retention and Adherence to HIV Treatment: Patient Perspectives and Experiences

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18041737 ◽

2021 ◽

Vol 18 (4) ◽

pp. 1737

Author(s):

Steven Masiano ◽

Edwin Machine ◽

Mtisunge Mphande ◽

Christine Markham ◽

Tapiwa Tembo ◽

...

Keyword(s):

Positive Impact ◽

Low Cost ◽

Hiv Treatment ◽

Sub Saharan Africa ◽

Hiv Care ◽

Structured Interviews ◽

Convenience Sample ◽

Long Term Conditions ◽

Art Initiation ◽

Retention In Hiv Care

VITAL Start is a video-based intervention aimed to improve maternal retention in HIV care and adherence to antiretroviral therapy (ART) in Malawi. We explored the experiences of pregnant women living with HIV (PWLHIV) not yet on ART who received VITAL Start before ART initiation to assess the intervention’s acceptability, feasibility, fidelity of delivery, and perceived impact. Between February and September 2019, we conducted semi-structured interviews with a convenience sample of 34 PWLHIV within one month of receiving VITAL Start. The participants reported that VITAL Start was acceptable and feasible and had good fidelity of delivery. They also reported that the video had a positive impact on their lives, encouraging them to disclose their HIV status to their sexual partners who, in turn, supported them to adhere to ART. The participants suggested using a similar intervention to provide health-related education/counseling to people with long term conditions. Our findings suggest that video-based interventions may be an acceptable, feasible approach to optimizing ART retention and adherence amongst PWLHIV, and they can be delivered with high fidelity. Further exploration of the utility of low cost, scalable, video-based interventions to address health counseling gaps in sub-Saharan Africa is warranted.

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Music Is Life—Follow-Up Qualitative Study on Parental Experiences of Creative Music Therapy in the Neonatal Period

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18126678 ◽

2021 ◽

Vol 18 (12) ◽

pp. 6678

Author(s):

Friederike Barbara Haslbeck ◽

Lars Schmidli ◽

Hans Ulrich Bucher ◽

Dirk Bassler

Keyword(s):

Music Therapy ◽

Positive Reinforcement ◽

Positive Impact ◽

Complementary Therapy ◽

Structured Interviews ◽

Developmental Problems ◽

Creative Music ◽

Modifiable Factors ◽

Hospitalization Period ◽

Extremely Preterm

Developmental problems in extremely preterm (EP) infants and the associated longitudinal burden for their families are major health issues worldwide. Approaches to social-emotional support such as family-integrating Creative Music Therapy (CMT) are warranted. We aimed: (1) to explore parental perspectives on the use of CMT with EP infants in the neonatal hospitalization period and (2) to examine the possible longitudinal influence of CMT. A qualitative design was used to examine the perspective of six families from various backgrounds. Semi-structured interviews were carried out when the infants reached school age. We used an inductive–deductive thematic analysis to identify three main themes, each with three sub-themes: (1) the positive impact of CMT on the infants, the parents, and bonding; (2) the attitude toward CMT, from being open-minded to recommending it as complementary therapy; and (3) the experience of overall healthy infant development despite unique developmental delay issues. The findings elucidate the positive and formative impact of CMT on both infants and parents in the stressful NICU setting and beyond. CMT may empower positive transformation in the parents through individualized early nurturing musical interactions, capacity building, and positive reinforcement. Further research may help to identify and implement potentially modifiable factors for improving health care in this vulnerable group through early family-integrating, resource-based approaches such as CMT.

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