An Evaluation of Natural Environment Interventions for Informal Cancer Caregivers in the Community

Home-based informal caregiving by friends and family members of patients with cancer is becoming increasingly common globally with rates continuing to rise. Such caregiving is often emotionally and cognitively demanding, resulting in mental exhaustion and high perceived burden. Support for caregivers may be fostered by engagement with the natural environment. Interaction with nature is associated with mental health benefits such as stress reduction and improved wellbeing. The purpose of this paper was to evaluate the state of the science regarding the use of natural environment interventions to support caregivers of cancer patients in the community. A comprehensive scoping review using the Arksey and O’Malley framework and the Preferred Reporting Items for Systematic Reviews and Meta-analyses assessed natural environment therapies and mental health outcomes among cancer caregivers. Databases searched included CINAHL, PubMed, Scopus, Cochrane, and Alt HealthWatch. Findings recovered a total of five studies over a 10-year period that met criteria, demonstrating a lack of empirical evidence addressing this potential resource to support caregivers. Often, study appraisal was not on nature exposure, but rather other aspects of the projects such as program evaluation, exercise, or complementary therapies. Both qualitative and quantitative designs were used but sample sizes were small. Caregivers experienced beneficial results across the various studies and future work could enhance these findings.

A Conceptual Framework for the Evaluation of Social Agriculture: An Application to a Project Aimed at the Employability of Young People NEET

Agriculture can be a possible provider of social services of relevant importance for the whole society. In order to generate a valuable social service, a multi-actor approach is often applied, based on an active collaboration among public institutions, non-profit organizations, and private firms, and capable of generating multiple positive impacts. This new approach may both favorite agricultural diversification and enhance the quality of life of rural communities. However, in order to enable policymakers in motivating the public support to these types of initiatives, an evaluation method capable of disentangling the multiple benefits generated by social agricultural projects is required. In this paper, we adapted the evaluation method previously developed by the SIMRA consortium for Social Innovation initiatives, to a project aimed at the employability of NEETs in the south of Italy. A selection grid, framed by cross-referencing the national policy objectives of social agriculture and the criteria of eligibility adopted in public calls is proposed, to choose the suitable indicators for the evaluation. The evaluation experience allowed the measurement of 34 indicators of performance. The results prove that 12 indicators are positive, while 12 are moderate, and 10 are low and are mainly related to the enhancement of social inclusion. The evaluation exercise may be useful to disentangling the multiple outcomes generated by initiatives based on social innovation, which are highly based on intangible assets, and exert a positive effect on the internal cohesion and the engagement of the civil society.

Evaluación de competencias clínicas y quirúrgicas de una Residencia de Ortopedia y Traumatología Infantil

Objetivo: Evaluar competencias profesionales de una residencia de Ortopedia y Traumatología Infantil. Instrumentos pedagógicos utilizados: Mini-Clinical Evaluation Exercise (Mini-CEX) y Direct Observation of Procedural Skills (DOPS) para competencias clínicas y quirúrgicas, respectivamente. Ambas evalúan la cúspide de la pirámide de Miller; se precisaron su confiabilidad y validez. Materiales y Métodos: Estudio observacional prospectivo de una cohorte de seis residentes de primero, segundo y tercer año quienes fueron evaluados por seis docentes en diversos contextos y situaciones reales: consultorio externo y de guardia, sala de internación, interconsultas, quirófano y sala de yesos. Resultados: Se realizaron 65 observaciones. Cada residente fue evaluado como media en 10 oportunidades por entre 3 y 6 docentes. Para las variables clínicas, en general, los residentes más antiguos obtuvieron valores sobresalientes y los residentes de primer año, valores satisfactorios. No hubo diferencias significativas para las competencias quirúrgicas globalmente, pero los residentes de tercer año fueron más competentes para resolver situaciones inesperadas. El coeficiente de Cronbach fue superior a 0,90. Conclusiones: Ambos instrumentos de evaluación tuvieron una elevada confiabilidad. El método estadístico permitió individualizar exactamente las fragilidades y fortalezas de la residencia. El coeficiente de Cronbach obtuvo un valor de alto impacto psicométrico.

Evolving from Didactic to Dialogic: An Action Research for Improving Teaching Practices in the mini-CEX Workshops

BackgroundFaculty development is imperative to ensure successful outcomes in the training of competent physicians. However, how faculty developers can improve the delivery of an assessment workshop through researching their individual teaching practices remains unexplored.MethodsIn 2016, the authors conducted four cycles of action research in the context of mini-Clinical Evaluation Exercise (mini-CEX) workshops. Multiple sources of qualitative data, including a faculty developer’s reflective journal, field notes taken by a researcher-observer, and post-workshop written reflection and feedback from fourteen workshop attendees, were collected and analyzed thematically.ResultsBy doing action research, the faculty developer scrutinized each step as an opportunity for change, enacted adaptive practice and reflection on teaching practices and formulated action plans to transform a workshop design. In so doing, a workshop evolved from didactic to dialogic with continuous improvement on enhanced engagement, focused discussion and participant empowerment through a collaborative inquiry into feedback practice. These action research cycles also supported development of adaptive practice and identity formation in the faculty developer.ConclusionsThe systematic approach of action research serves as a vehicle to enable faculty developers to investigate individual teaching practices as a self-reflective inquiry, to examine, rectify, and transform processes of program delivery, and ultimately introduce themselves as agents for change and improvement.

Assessment of medical professionalism using the Professionalism Mini-Evaluation Exercise (P-MEX): A survey of faculty perception of relevance, feasibility and comprehensiveness

Introduction: This study aimed to examine the perception of faculty on the relevance, feasibility and comprehensiveness of the Professionalism Mini Evaluation Exercise (P-MEX) in the assessment of medical professionalism in residency programmes in an Asian postgraduate training centre. Methods: Cross-sectional survey data was collected from faculty in 33 residency programmes. Items were deemed to be relevant to assessment of medical professionalism when at least 80% of the faculty gave a rating of ≥8 on a 0-10 numerical rating scale (0 representing not relevant, 10 representing very relevant). Feedback regarding the feasibility and comprehensiveness of the P-MEX assessment was also collected from the faculty through open-ended questions. Results: In total, 555 faculty from 33 residency programmes participated in the survey. Of the 21 items in the P-MEX, 17 items were deemed to be relevant. For the remaining four items ‘maintained appropriate appearance’, ‘extended his/herself to meet patient needs’, ‘solicited feedback’, and ‘advocated on behalf of a patient’, the percentage of faculty who gave a rating of ≥8 was 78%, 75%, 74%, and 69% respectively. Of the 333 respondents to the open-ended question on feasibility, 34% (n=113) felt that there were too many questions in the P-MEX. Faculty also reported that assessments about ‘collegiality’ and ‘communication with empathy’ were missing in the current P-MEX. Conclusion: The P-MEX is relevant and feasible for assessment of medical professionalism. There may be a need for greater emphasis on the assessment of collegiality and empathetic communication in the P-MEX.