An Assessment of Quality of Service Extended by Select Agriclinics and Agribusiness Centres in Union Territory of Puducherry

The establishment of Agri clinics and Agribusiness Centers is a Government of India Scheme implemented through NABARD and MANAGE, Hyderabad for promotion of rural entrepreneurship through effective training and handholding of the graduate youth. Agri-Clinics are intended to provide expert advice and services to farmers on various aspects to improve crop/animal yield and increase farmers’ revenue. This study was conducted to assess the quality of services provided by the Agri clinics and agribusiness centers in the union territory of Puducherry. 90 farmers were personally interviewed using the service quality instrument - SERVQUAL to explore their expectation and perception of service quality provided by the Agri -clinics and agribusiness centers. The results indicated that the level of quality of the services provided by the Agri clinics is not to the expected level of the sample farmers i.e., all perception ratings were lower than their expectation scores. In all five dimensions of service quality, a gap was observed between farmers’ perceptions and expectations: Tangible: -0.93, Reliability: -0.89, Responsiveness: -0.78, Assurance: - 0.58, Empathy: -0.61. The results indicated that much more service improvement activities are needed for improving the service quality. The Agri-clinics need to modernize facilities and equipment to reduce the gap between farmers' perceptions and expectations.

Evidence-based Medical Leadership Development: A Systematic Review

1Alexander Mafi, 2Oscar Lyons, 3Robynne George, 4Joao Galante, 5Thomas Fordwoh, 6Jan Frich,7Jaason Geerts 1University of Oxford, UK, 2University of Oxford, UK, 3Royal United Hospital Bath NHS Trust,4Oxford University Hospitals NHS Trust, UK, 5University of Oxford, UK, 6University of Oslo,Norway, 7Canadian College of Health Leaders, Ottawa, Canada Health systems invest significant resources in leadership development for physicians and other health professionals. Competent leadership is considered vital for maintaining and improving quality and patient safety. We carried out this systematic review to synthesise new empirical evidence regarding medical leadership development programme factors which are associated with outcomes at the clinical and organisational levels. 117 studies were included in this systematic review. 28 studies met criteria for higher reliability studies. The median critical appraisal score according to the Medical Education Research Study Quality Instrument for quantitative studies was 8.5/18 and the median critical appraisal score according to the Jonna Briggs Institute checklist for qualitative studies was 3/10. There were recurring causes of low study quality scores related to study design, data analysis and reporting. There was considerable heterogeneity in intervention design and evaluation design. Programmes with internal or mixed faculty were significantly more likely to report organisational outcomes than programmes with external faculty only (p=0.049). Project work and mentoring increased the likelihood of organisational outcomes. No leadership development content area was particularly associated with organisational outcomes. In leadership development programmes in healthcare, external faculty should be used to supplement in-house faculty and not be a replacement for in-house expertise. To facilitate organisational outcomes, interventions should include project work and mentoring. Educational methods appear to be more important for organisational outcomes than specific curriculum content. Improving evaluation design will allow educators and evaluators to more effectively understand factors which are reliably associated with organisational outcomes of leadership development.

Psychometric evaluation of a decision quality instrument for medication decisions for treatment of depression symptoms

Background A high quality treatment decision means patients are informed and receive treatment that matches their goals. This research examined the reliability and validity of the Depression Decision Quality Instrument (DQI), a survey to measure the extent to which patients are informed and received preferred treatment for depression. Methods Participants were aged 18 and older from 17 US cities who discussed medication or counseling with a physician in the past year, and physicians who treated patients with depression who practiced in the same cities. Participants were mailed a survey that included the Depression-DQI, a tool with 10 knowledge and 7 goal and concern items. Patients were randomly assigned to either receive a patient decision aid (DA) on treatment of depression or no DA. A matching score was created by comparing the patient’s preferred treatment to their self-reported treatment received. Concordant scores were considered matched, discordant were not. We examined the reliability and known group validity of the Depression-DQI. Results Most patients 405/504 (80%) responded, 79% (320/405) returned the retest survey, and 60% (114/187) of physicians returned the survey. Patients’ knowledge scores on the 10-item scale ranged from 14.6 to 100% with no evidence of floor or ceiling effects. Retest reliability for knowledge was moderate and for goals and concerns ranged from moderate to good. Mean knowledge scores differentiated between patients and physicians (M = 63 [SD = 15] vs. M = 81 [SD = 11], p < 0.001), and between patients who did and didn’t receive a DA (M = 64 [SD = 16] vs. M = 61 [SD = 14], p = 0.041). 60.5% of participants received treatment that matched their preference. Based on the multivariate logistic regression, ‘avoiding taking anti-depressants’ was the only goal that was predictive of taking mediation (OR = 0.73 [0.66, 0.80], p < 0.01). Shared Decision Making Process scores were similar for those who matched their preference and those who didn’t (M = 2.18 [SD = 0.97] vs. M = 2.06 [SD = 1.07]; t(320) = − 1.06, p = 0.29). Those who matched had lower regret scores (matched M = 1.72 [SD = 0.74] vs. unmatched M = 2.32 [SD = 0.8]; t(301) = − 6.6, p < .001). Conclusions The Depression DQI demonstrated modest reliability and validity. More work is needed to establish validity of the method to determine concordance. Trial registration: NCT01152307.

Skills-Based Programs Used to Reduce Physician Burnout in Graduate Medical Education: A Systematic Review

ABSTRACT Background Physician burnout is pervasive within graduate medical education (GME), yet programs designed to reduce it have not been systematically evaluated. Effective approaches to burnout, aimed at addressing the impact of prolonged stress, may differ from those needed to improve wellness. Objective We systematically reviewed the literature of existing educational programs aimed to reduce burnout in GME. Methods Following the PRISMA guidelines, we identified peer-reviewed publications on GME burnout reduction programs through October 2019. Titles and abstracts were reviewed for relevance, and full-text studies were acquired for analysis. Article quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI). Results A total of 3534 articles met the search criteria, and 24 studies were included in the final analysis. Article quality varied, with MERSQI assessment scores varying between 8.5 and 14. Evaluation was based on participant scores on burnout reduction scales. Eleven produced significant results pertaining to burnout, 10 of which yielded a decrease in burnout. Curricula to reduce burnout among GME trainees varies. Content taught most frequently included stress management (n = 8), burnout reduction (n = 7), resilience (n = 7), and general wellness (n = 7). The most frequent pedagogical methods were discussion groups (n = 14), didactic sessions (n = 13), and small groups (n = 11). Most programs occurred during residents' protected education time. Conclusions There is not a consistent pattern of successful or unsuccessful programs. Further randomized controlled trials within GME are necessary to draw conclusions on which components most effectively reduce burnout.

Development of the Feedback Quality Instrument: a guide for health professional educators in fostering learner-centred discussions

Background Face-to-face feedback plays an important role in health professionals’ workplace learning. The literature describes guiding principles regarding effective feedback but it is not clear how to enact these. We aimed to create a Feedback Quality Instrument (FQI), underpinned by a social constructivist perspective, to assist educators in collaborating with learners to support learner-centred feedback interactions. In earlier research, we developed a set of observable educator behaviours designed to promote beneficial learner outcomes, supported by published research and expert consensus. This research focused on analysing and refining this provisional instrument, to create the FQI ready-to-use. Methods We collected videos of authentic face-to-face feedback discussions, involving educators (senior clinicians) and learners (clinicians or students), during routine clinical practice across a major metropolitan hospital network. Quantitative and qualitative analyses of the video data were used to refine the provisional instrument. Raters administered the provisional instrument to systematically analyse educators’ feedback practice seen in the videos. This enabled usability testing and resulted in ratings data for psychometric analysis involving multifaceted Rasch model analysis and exploratory factor analysis. Parallel qualitative research of the video transcripts focused on two under-researched areas, psychological safety and evaluative judgement, to provide practical insights for item refinement. The provisional instrument was revised, using an iterative process, incorporating findings from usability testing, psychometric testing and parallel qualitative research and foundational research. Results Thirty-six videos involved diverse health professionals across medicine, nursing and physiotherapy. Administering the provisional instrument generated 174 data sets. Following refinements, the FQI contained 25 items, clustered into five domains characterising core concepts underpinning quality feedback: set the scene, analyse performance, plan improvements, foster learner agency, and foster psychological safety. Conclusions The FQI describes practical, empirically-informed ways for educators to foster quality, learner-centred feedback discussions. The explicit descriptions offer guidance for educators and provide a foundation for the systematic analysis of the influence of specific educator behaviours on learner outcomes.

Physical Activity Participation and the Environment in Children and Adolescents: A Systematic Review and Meta-Analysis Protocol

Physical activity (PA) and sports are efficient ways to promote the younger generation’s health and wellbeing. However, evidence is limited due to heterogeneous samples and measurements. This study aims to identify promoting and inhibiting correlates associated with children’s and adolescents’ non-organized PA participation and further demonstrate the complexity of PA and ecological factors. A systematic review and meta-analysis will be applied by following the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P). Seven bibliographic databases (PubMed, SPORTDiscus, PsycInfo, MEDLINE Complete, ERIC, Dimensions, and Academic Search Complete) will be systematically searched to identify eligible articles based on a series of inclusion and exclusion criteria. Inclusion criteria are that the study: (a) is not classified as a systematic review with or without meta-analysis; (b) is published in last 20 years; (c) includes children and adolescents; (d) quantitively measures PA; (e) includes review of ecological factors. The internal validity will be evaluated using a validated quality instrument. Calculations will be produced in SPSS 27.0 and Comprehensive Meta-Analysis 3.3. This study will provide evidence and address the questions regarding the factors that significantly impact children’s PA participation and limitations regarding the design, sampling, and measurement in currently selected studies. PROSPERO registration number: CRD42021244918.

Immediate consequences and solutions used to maintain medical education during the COVID-19 pandemic for residents and medical students: a restricted review

BackgroundThe COVID-19 outbreak has dramatically impacted medical education, both bedside and academic teaching had to be adapted to comply with the reorganisation of care and social distancing measures.ObjectivesTo overview the impact of the pandemic on medical education, including the pedagogical responses adopted and their assessment by medical students and residents.Material and methodsThis restricted systematic review was performed using Rayyan QCRI, to select observational or interventional articles and field experience reports assessing the impact of the COVID-19 pandemic on medical education for medical students and residents. Study design, study population, geographical origin, use of an educational tools (including softwares and social media), their type and assessment, were recorded. For studies evaluating a specific tool the Medical Education Research Study Quality Instrument (MERSQI) was used to assess study quality.ResultsThe literature search identified 1480 references and 60 articles were selected. Most articles focused on residents (41/60; 69%), and half (30/60; 50%) involved surgical specialties. Online courses were the most frequently used pedagogical tool (52/60; 88%). Simulation tools were used more frequently in articles involving surgical specialties (15/29; 52%) compared with medical specialties (2/14; 12%) (p=0.01). Only four studies reported the assessment of pedagogical tools by medical students, their MERSQI scores ranged from 5.5/18 to 9.0/18.ConclusionMedical education was highly impacted by the COVID-19 pandemic particularly in surgical specialties. Online courses were the most frequently attempted solution to cope with social distancing constraints. Medical students’ assessment of pedagogical tools was mostly positive, but the methodological quality of those studies was limited.

The Story as a Quality Instrument: Developing an Instrument for Quality Improvement Based on Narratives of Older Adults Receiving Long-Term Care

The individual experiences of older adults in long-term care are broadly recognized as an important source of information for measuring wellbeing and quality of care. Narrative research is a special type of qualitative research to elicit people’s individual, diverse experiences in the context of their lifeworld. Narratives are potentially useful for long-term care improvement as they can provide a rich description of an older adult’s life from their own point of view, including the provided care. Little is known about how narratives can best be collected and used to stimulate learning and quality improvement in long-term care for older adults. The current study takes a theoretical approach to developing a narrative quality instrument for care practice in order to discover the experiences of older adults receiving long-term care. The new narrative quality instrument is based on the available literature describing narrative research methodology. The instrument is deemed promising for practice, as it allows care professionals to collect narratives among older adults in a thorough manner for team reflection in order to improve the quality of care. In the future, the feasibility and usability of the instrument will have to be empirically tested.

Impact of suspending minimum volume requirements for knee arthroplasty on hospitals in Germany: an uncontrolled before–after study

Background In 2004, the Federal Joint Committee, supreme decision-making body in German healthcare, introduced minimum volume requirements (MVRQs) as a quality instrument. Since then, MVRQs were implemented for seven hospital procedures. This study evaluates the effect of a system-wide intermission of MVRQ for total knee arthroplasty (TKA), demanding 50 annual cases per hospital. Methods An uncontrolled before–after study based on federal-level data including the number of hospitals performing TKA, and TKA cases from the external hospital quality assurance programme in Germany (2004–2017). Bi- and multivariate analyses based on hospital-level secondary data of TKA cases and TKA quality indicators extracted from hospital quality reports in Germany (2006–2014). Results The number of TKAs performed in Germany decreased by 11% after suspending the TKA-MVRQ in 2011, and rose by 13% after its reintroduction in 2015. The number of hospitals with less than 50 cases rose from 10 to 25% and their case share from 2 to 5.5% during suspension. Change in hospital volume after the suspension of TKA-MVRQ was not associated with hospital size, ownership, or region. All four evaluable quality indicators increased significantly in the year after their first public reporting. Compared to hospitals meeting the TKA-MVRQ, three indicators show slight but statistically significant better quality in hospitals below the TKA-MVRQ. Conclusions In Germany, TKA-MVRQs seem to induce in-hospital caseload adjustments rather than foster regional inter-hospital case transfers as intended.