scholarly journals Morning report for all: a qualitative study of disseminating case conferences via podcasting

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gregory M. Ow ◽  
Lindsey C. Shipley ◽  
Saman Nematollahi ◽  
Geoffrey V. Stetson
Keyword(s):  
Teaching Style ◽  
Psychological Safety ◽  
Clinical Problem ◽  
Diagnostic Reasoning ◽  
List Type ◽  
Clinical Knowledge ◽  
Morning Report ◽  
Structured Interviews ◽  
Actual Usage ◽  
Case Conferences

Abstract Background Despite its long-established importance, diagnostic reasoning (DR) education has suffered uneven implementation in medical education. The Clinical Problem Solvers (CPSolvers) podcast has emerged as a novel strategy to help teach DR through case conferences with expert diagnosticians and trainees. CPSolvers has 25,000 listeners in 147 countries. The aim of this study was to evaluate the podcast by eliciting the developers’ goals of the podcast, then determining to what extent they aligned with the listeners’ actual usage habits, features they valued, and perceptions of the podcast. Methods We conducted semi-structured interviews with 3 developers and 8 listeners from April–May 2020, followed by qualitative thematic analysis. Results Three major developer goals with sub-goals resulted: To teach diagnostic reasoning in a case-based format by (1a) teaching schemas, (1b) modeling expert diagnostic reasoning, (1c) teaching clinical knowledge, and (1d) teaching diagnostic reasoning terminology. To change the culture of medicine by (2a) promoting diversity, (2b) modeling humility and promoting psychological safety, and (2c) creating a fun, casual way to learn. To democratize the teaching of diagnostic reasoning by leveraging technology. Listeners’ usage habits, valued features, and perceptions overall strongly aligned with all these aspects, except for (1c) clinical knowledge, and (1d) diagnostic reasoning terminology. Listeners identified (1a) schemas, and (2c) promotion of psychological safety as the most valuable features of the podcast. Conclusion CPSolvers has been perceived as a highly effective and novel way to disseminate DR education in the form of case conferences, serving as an alternative to traditional in-person case conferences suspended during COVID-19. CPSolvers combines many known benefits of in-person case conferences with a compassionate and entertaining teaching style, plus advantages of the podcasting medium — democratizing morning report for listeners around the world.

International pharmacy students’ transition to Nottingham: Semi-structured interviews (Preprint)

2019 ◽  
Author(s):  
Yicong Liu
Keyword(s):  
International Students ◽  
Teaching Style ◽  
Cultural Adjustment ◽  
Independent Study ◽  
Cross Cultural ◽  
Pharmacy Students ◽  
Learning Ability ◽  
Structured Interviews ◽  
International Pharmacy ◽  
The Uk

BACKGROUND The transition from China to the UK can be challenging, and there is increasing concern among academics since cross-cultural learning and living may be a challenge for these students. OBJECTIVE To find out international pharmacy students’ worries and challenges as well as benefits on the transition experience from China to the UK. METHODS Semi-structured interviews were used to explore this group of students’ transition experiences. Selective transcription was done because of time limitations in the project. RESULTS The natural and cultural environment was the most pleasant experience for Tianjin students during this transition process. Cross-cultural adjustment and self-adaptability, as well as their autonomous learning ability were the main barriers for international students. CONCLUSIONS The difference between Asian and Western culture caused barriers for international students to fit into a new environment. In terms of integrating into local students, insufficient English language skills, culture shock and personality could be the influence factors. Moreover, the different teaching style and learning style could be the possible reasons for students having difficulty in an independent study. CLINICALTRIAL N/A

Therapy discontinuation in a primary care psychological service: why patients drop out

2020 ◽  
Vol 13 ◽  
Author(s):  
Aisan Ghaemian ◽  
Mahdi Ghomi ◽  
Miles Wrightman ◽  
Colm Ellis-Nee
Keyword(s):  
Drop Out ◽  
Treatment Withdrawal ◽  
List Type ◽  
Structured Interviews ◽  
Group Settings ◽  
Psychological Therapies ◽  
Psychological Service ◽  
Wide Range ◽  
Key Factor ◽  
Therapy Services

Abstract The present study aimed to explore patients’ experience with an Improving Access to Psychological Therapies (IAPT) service, and to investigate the reasons for discontinuing their treatment. A qualitative approach was adopted using thematic analysis of semi-structured interviews carried out with 818 patients attending for treatment in Talking Change from November 2015 to January 2019, retrospectively. The five main themes that emerged from the study were: ‘Felt better’, ‘Issues with group settings’, ‘Therapeutic alliance breakdown’, ‘Miscommunication’ and ‘Impracticalities’. The qualitative study uncovered a wide range of reasons for people who had dropped out from their treatment. The findings mainly emphasised general dissatisfaction and inconvenient appointments. However, improvement in symptoms of depression and anxiety was also identified as a key factor among patients who discontinued their treatment. This recovery is known as ‘progress withdrawal’ in which patients withdraw from treatment early due to good therapeutic progress. We present clinical and procedural implications arising from these themes. Key learning aims (1) To explore what can cause discontinuation of therapy. (2) To obtain the experience of people who have received treatment and dropped out from Talking Change Psychological Therapy services. (3) To explore whether people recovered as part of the treatment withdrawal and what may have helped towards that recovery.

15 Triggers for the pharmacological management of delirium in palliative care: a mixed methods study

2018 ◽  
Vol 8 (3) ◽  
pp. 365.2-365
Author(s):  
Catherine L Fairfield ◽  
Anne M Finucane ◽  
Juliet A Spiller
Keyword(s):  
Palliative Care ◽  
Severe Form ◽  
Screening Tools ◽  
Pharmacological Intervention ◽  
Inpatient Setting ◽  
List Type ◽  
Structured Interviews ◽  
Retrospective Case ◽  
Pharmacological Management ◽  
High Prevalence

IntroductionDelirium is a serious neurocognitive disorder with a high prevalence in palliative care and debate regarding its management is ongoing.AimsTo describe how delirium and its symptoms is documented in patient recordsTo determine the use of delirium screening tools and how these are viewed by staffTo identify triggers for pharmacological intervention in delirium management in a terminally ill population.MethodsA retrospective case-note review concerning all patients admitted to a hospice inpatient setting between 1–17th August 2017 and semi-structured interviews with 7 hospice doctors and nurses.Results21 patients were reviewed. 62% were screened for delirium using the 4AT on admission. 76% had documented symptoms of delirium and of these 81% died without delirium resolution. There were inconsistencies in the documentation of delirium and the term itself was used infrequently. Non-pharmacological measures were poorly documented. Midazolam was the most commonly used medication. Triggers for pharmacological intervention included failure of non-pharmacological measures distress agitation and risk of patient harm. Nursing staff recognised delirium in its severe form but were less likely to do so in milder cases.ConclusionsTriggers for pharmacological intervention are in-keeping with guidelines however the level of understanding of delirium’s presentation varied between participants. This along with the high prevalence of delirium frequent use of midazolam and limited awareness and documentation of non-pharmacological measures (e.g. structured family support) highlights the need for further training and research.

scholarly journals An exploration of the attitudes and views of general practitioners on the use of video consultations in a primary healthcare setting: a qualitative pilot study

2018 ◽  
Vol 20 ◽  
Author(s):  
Ratan S. Randhawa ◽  
Joht S. Chandan ◽  
Tom Thomas ◽  
Surinder Singh
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Healthcare Setting ◽  
List Type ◽  
Structured Interviews ◽  
Convenience Sample ◽  
Telephone Consultation ◽  
Video Consultation ◽  
Mixed Feelings ◽  
The Government

AbstractBackgroundIn 2014, in the United Kingdom, the government made a commitment to spend £3.6 million on the introduction of Skype video calling consultations in general practice, however the efficacy of such technology has not yet been explored fully.AimThe study aimed to explore the views and attitudes of General Practitioners (GPs) towards video consultation in primary care; specifically, in three broad areas∙The benefits of video consultations to patients and healthcare professionals.∙Potential problems with video consultation and its implementation.∙The cost-effectiveness of video consultation in this setting.MethodA convenience sample of the views of 12 general practitioners across two primary care centres in North London were identified using topic guide based semi-structured interviews. A thematic framework approach was used to analyse the data collected to isolate main and sub-themes.FindingsThree main themes were identified1.Technology – GPs expressed concerns about the ability of patients to use technology, the availability of technology and the quality of technology available.2.Utility – encompassing GP’s ideas about the usefulness of video consultations to patients, practitioners and the doctor–patient relationship. GPs presented mixed views on the extent to which video consultation would be useful.3.Practicality – covering the views of GPs on implementation and effects on workload. GPs unanimously felt that it was not a practical substitute for face-to-face consultation. There were mixed feelings about it being used as an alternative to telephone consultation.ConclusionGPs did see potential benefits to using video consultations but also expressed concerns that need to be addressed if they are to have full confidence in the system. The views of those who are going to use video consultation as a means of increasing patient access are paramount if such tools are to be a core part of primary care.

Nurses’ roles in informed consent in a hierarchical and communal context

2013 ◽  
Vol 20 (4) ◽  
pp. 413-425 ◽  
Author(s):  
Astrid P Susilo ◽  
Jan Van Dalen ◽  
Albert Scherpbier ◽  
Sugiharto Tanto ◽  
Patricia Yuhanti ◽  
...  
Keyword(s):  
Informed Consent ◽  
Family Involvement ◽  
Comparative Approach ◽  
Medical Procedures ◽  
Clinical Knowledge ◽  
Structured Interviews ◽  
Group Discussions ◽  
Hospital Managers ◽  
Hospital Culture ◽  
Patient Advocates

Although the main responsibility for informed consent of medical procedures rests with doctors, nurses’ roles are also important, especially as patient advocates. Nurses’ preparation for this role in settings with a hierarchical and communal culture has received little attention. We explored the views of hospital managers and nurses regarding the roles of nurses in informed consent and factors influencing these roles. We conducted a qualitative study in a private, multispecialty hospital in Indonesia. Semi-structured interviews were conducted with seven managers. Two rounds of focus group discussions with nurses (n = 27) were conducted. Constant comparative approach was used in the analysis. Nurses can act as manager, witness, information giver, and advocate in the informed consent process. These roles are influenced by nurses’ preparedness, hospital culture and policy, patients’ understanding, family involvement, and cost-related issues. In preparation for these tasks, nurses should acquire communication skills, clinical knowledge, and legal and ethical knowledge.

scholarly journals Development and Validation of a Theory-Informed Group Learning Environment Assessment Tool for Graduate Medical Education Programs

2020 ◽  
Vol 12 (4) ◽  
pp. 447-454
Author(s):  
Cristina E. Welch ◽  
Melissa M. Carbajal ◽  
Shelley Kumar ◽  
Satid Thammasitboon
Keyword(s):  
Medical Education ◽  
Factor Analysis ◽  
Learning Outcomes ◽  
Assessment Tool ◽  
Group Learning ◽  
Psychological Safety ◽  
Validity Evidence ◽  
Mean Square ◽  
Morning Report ◽  
Environment Assessment

ABSTRACT Background Recent studies showed that psychological safety is important to resident perception of the work environment, and improved psychological safety improves resident satisfaction survey scores. However, there is no evidence in medical education literature specifically addressing relationships between psychological safety and learning behaviors or its impact on learning outcomes. Objective We developed and gathered validity evidence for a group learning environment assessment tool using Edmondson's Teaming Theory and Webb's Depth of Knowledge model as a theoretical framework. Methods In 2018, investigators developed the preliminary tool. The authors administered the resulting survey to neonatology faculty and trainees at Baylor College of Medicine morning report sessions and collected validity evidence (content, response process, and internal structure) to describe the instrument's psychometric properties. Results Between December 2018 and July 2019, 450 surveys were administered, and 393 completed surveys were collected (87% response rate). Exploratory factor analysis and confirmatory factor analysis testing the 3-factor measurement model of the 15-item tool showed acceptable fit of the hypothesized model with standardized root mean square residual = 0.034, root mean square error approximation = 0.088, and comparative fit index = 0.987. Standardized path coefficients ranged from 0.66 to 0.97. Almost all absolute standardized residual correlations were less than 0.10. Cronbach's alpha scores showed internal consistency of the constructs. There was a high correlation among the constructs. Conclusions Validity evidence suggests the developed group learning assessment tool is a reliable instrument to assess psychological safety, learning behaviors, and learning outcomes during group learning sessions such as morning report.

scholarly journals Returning to nursing during the COVID-19 pandemic: experiences and needs of re-entering nurses

2021 ◽  
Author(s):  
Sofie A. Noorland ◽  
Trynke Hoekstra ◽  
Maarten O. Kok
Keyword(s):  
The Netherlands ◽  
Training Programme ◽  
Vital Role ◽  
Practical Training ◽  
List Type ◽  
Healthcare Staff ◽  
Structured Interviews ◽  
Roles And Responsibilities ◽  
Clinical Community ◽  
Clear Description

AbstractAimAssessing the needs and experiences of re-entering nurses during the COVID-19 pandemic.BackgroundDuring the COVID-19 outbreak in the Netherlands, thousands of former nurses have returned to nursing to support healthcare staff. After a period of absence and with little time to prepare, these former nurses re-entered during a challenging, uncertain and rapidly evolving pandemic. Little is known about the experiences and needs of these re-entering nurses.DesignQualitative studyMethodsWe conducted semi-structured interviews with 20 purposively selected nurses who had re-entered nursing during the first wave of the COVID-19 pandemic in the Netherlands. Interviews were transcribed verbatim and analysed via thematic content analysis. This study followed the COREQ guidelines.ResultsParticipants mentioned that a lack of a clear job description led to unclarity about the kind of tasks that re-entering nurses were expected and allowed to perform. This unclarity was especially notable in the newly established COVID-19 departments. Re-entering nurses mentioned to wish for an easily accessible mentorship structure and an individualised and practical training program. Re-entering nurses felt supported by a positive team dynamic, which was shaped by the sense of urgency and relevance of their work and helped them deal with stressful experiences.ConclusionThe results indicate that a rapid and safe return to nursing during a pandemic could be facilitated by: a clear description of roles and responsibilities; an individualised assessment determining the competences and knowledge disparities of re-entering nurses; practical training focussing on competencies needed during a pandemic; and a collaborative mentorship structure to guide re-entering nurses.Relevance to clinical practiceThe rapid recruitment of former nurses to mitigate an acute shortage of qualified nurses could play a vital role during a pandemic. To deploy these nurses effectively, safely and sustainably, it is important to address the needs of these re-entering nurses.What does this paper contribute towards the wider global clinical community?This research showed the need to prepare a flexible individualised training programme which could support re-entering nurses during crisis situations, such as a pandemic.A responsive mentorship structure helps to provide support to re-entering nurses in a dynamic, uncertain and rapidly evolving situation.In a rapidly evolving situation, it is essential to continue to create clarity about the roles and responsibilities of re-entering nurses.

Diagnostic reasoning

2018 ◽  
Author(s):  
David Sprigings
Keyword(s):  
Cognitive Psychology ◽  
Clinical Problem ◽  
Computer Programs ◽  
Diagnostic Reasoning ◽  
Mental Process

Diagnostic reasoning is the mental process by which physicians turn information about the patient into the name of a disease. To do this, physicians must gather and evaluate evidence relevant to the clinical problem, and then choose a diagnosis or make a decision about management. As in detective work, with which diagnostic reasoning has many similarities, physicians have to reason from observed effects to their possible causes. This chapter explores the thinking behind diagnostic reasoning, drawing on insights from cognitive psychology, philosophy, and the design of computer programs. If physicians have a deeper understanding of the reasoning that underpins making a diagnosis, they may be more astute diagnosticians, and better able to teach the skill to novices. And, however physicians arrive at a diagnosis, they need to be able to articulate their reasoning to the patient and their colleagues.

scholarly journals Towards an Open Medical School without Checkerboards during the COVID-19 Pandemic: How to Flexibly Self-Manage General Surgery Practices in Hospitals?

Healthcare ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 743
Author(s):  
Héctor Guadalajara ◽  
Álvaro Palazón ◽  
Olatz Lopez-Fernandez ◽  
Pilar Esteban-Flores ◽  
José Miguel Garcia ◽  
...  
Keyword(s):  
General Surgery ◽  
Teaching Style ◽  
Teaching Styles ◽  
Mobile App ◽  
Teacher Involvement ◽  
Teaching Hospitals ◽  
Structured Interviews ◽  
Self Directed Learning ◽  
Clinical Culture ◽  
Directed Learning

Background: Can we create a technological solution to flexibly self-manage undergraduate General Surgery practices within hospitals? Before the pandemic, the management of clerkships was starting to depend less on checkerboards. This study aims to explore undergraduates’ perceptions of doing rotations in teaching hospitals using different teaching styles and elicit their views regarding the options of managing practices to design a mobile app that substitutes for checkerboards. Methods: In this sequential exploratory mixed methods study, 38 semi-structured interviews at a teaching hospital were conducted. The data was used to survey 124 students doing their rotations in four teaching hospitals during the first wave of COVID-19. Results: 21 themes highlighted concerns related to the practices, the teacher involvement in the students’ education, and the students’ adaptation to clinical culture. The students reported positive perceptions concerning self-managing and organizing practices via a mobile application. However, problems emerged regarding transparency, the lack of feedback, and the need for new tools. Regarding the teaching styles, the facilitator and personal models were perceived as optimal, but the personal style had no effect on using or not using a tool. Conclusions: A mobile-learning application designed like an educational opportunities’ manager tool can probably promote self-directed learning, flexible teaching, and bidirectional assessments. However, teachers who employ a personal teaching style may not need either checkerboards or a tool. This solution supports teaching at hospitals in pandemic times without checkerboards.

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