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[Training before departure of volunteers during nutritional emergencies. From inception to evaluation].

Predeparture training is rarely undertaken within emergency nongovernmental organizations. Although field-training is considered as the only real school, the technical requirements are increasingly more constraining. To cope with this problem, the technical officers of Action contre la faim planned a predeparture training project based on self-instruction of any volunteer leaving for a nutritional emergency mission. The project began in 1994. Six self-instruction sessions were produced to enable volunteers to learn. To improve the quality of work, this framework encouraged creativity, constant research and motivation. The training supervisor accompanied the volunteers and put them in simulated situations where various tools were made available to them. A series of measures have been used to improve this basic training: 1) a training contract meant to make the volunteer responsible for his training; 2) better programming to ensure adequate relay from one volunteer to the next; 3) an apprentice report covering the first 15 days of the volunteer's integration into the field, thereby providing important feed-back to the supervisor; 4) an evaluation of the monthly report and an interview-grid used to follow the volunteer in the short and medium-term; 5) and an evaluation form completed by the volunteer which enables the updating of sessions and simulated situations. This initiative has made us aware of the importance of following the volunteers at all stages: this can increase the volunteer's efficiency and their fidelity to the non-governmental organization. Currently, the main objective is to gain the support of qualified technical coordinators who will be the most important factor in continuous training.

Creativity↗

Self-directed patient education in soft-tissue rehabilitation: rationale and analysis of a pilot project.

OBJECTIVES: To determine the compliance level and topic choice selection frequency of rehabilitation patients in a self-directed education program offered in conjunction with a rehabilitation exercise program. DESIGN: Descriptive study. SETTING: Soft-tissue injury rehabilitation clinic located within a chiropractic college. SUBJECTS: Twenty-four rehabilitation patients with injured spines who were enrolled in a daily in-clinic program. OUTCOME MEASURES: Data was collected from patient log-book pages, which recorded frequency of use, topic, medium and personal satisfaction for each selected resource. Clinic attendance data was collected by the clinical staff. RESULTS: Eighty-one percent (81%) of the patient group voluntarily used the learning center. Average frequency of use was approximately one visit per patient per week. Of the 13 subject areas included in the resource center collection, back injury care (30), nutrition (22) and fitness/exercise (14) received the most use. Patient satisfaction with the resources' value/interest averaged 78.4%. CONCLUSIONS: Most (81%) patients in this group were willing to spend some of their own time learning information that they thought was important. The results may allow for patient education program designs that put more responsibility for learning with the patient and allow for more efficient clinician time allocation.

Adult↗

[Evaluation model of the extra-mural program in nursing: cycle II, Colombia].

In Cali, Colombia, a study was done to test and apply a model for the evaluation of out-of-school training programs in nursing in comparison with classroom programs. The article describes the evaluation model, which starts with the admission factors, considers how they are changed in the process, and compares the results by measuring the effects obtained against the established objectives. The information on admission factors was obtained by means of a questionnaire on health, a survey of teachers, pairing tests for students, and records of input/cost ratios; the source of information on the process was the tests of academic performance in the three courses provided in the design, the evaluation forms, and the student records. The academic records, a survey of graduates and a form for monitoring nursing activities were the three instruments used to measure the effects of the program. The conclusion of the study was that the objectives of the program were attained. Tested experimentally, the model of out-of-school nursing training was found to offer instruction of quality that is helpful to the learning process. The evaluation of the process made it possible both to identify and to solve the curricular, learning and administrative problems. The learning modules have been adapted for the wider diversity of students brought in by expansion of the program. Meanwhile, the instruments for the collection of data for the evaluation have been simplified on the basis of the experimental study.

Colombia↗

A self-instruction nutrition program for pregnant women.

The Prenatal Nutrition Program (PNP), a self-instruction program, consists of a videocassette and three pamphlets concerning nutrition during pregnancy. An evaluation study made PNP available to 52 white, middle-class, well-educated pregnant women in their physician's waiting room. PNP improved their knowledge but had no significant effect on their attitudes (initially very positive) or dietary behavior. On the basis of combined pre- and post-PNP program testing, significant correlations were found between the pregnant women's knowledge and attitudes and between their knowledge and dietary behavior. All subjects rated PNP very favorably. It is concluded that self-instruction programs offer a viable and less costly alternative to individual nutrition counseling.

Adult↗

Anxiety sensitivity and treatment outcome in panic disorder.

The purpose of this study was to examine the relationship between change in anxiety sensitivity, as measured by the Anxiety Sensitivity Index (ASI), and treatment outcome in a sample of 106 subjects with a DSM-III-R diagnosis of panic disorder (with or without agoraphobia) who were participants in an evaluation study of cognitive-behavioral treatment. Results revealed that subjects who received active treatment had significantly lower anxiety sensitivity scores at post-treatment than the wait-list control group. We also examined change in anxiety sensitivity from pre- to post-treatment in reference to Clinical Global Improvement (CGI) ratings and with the effect size statistic. Subjects who showed improvement based on CGI ratings also demonstrated a reduction in anxiety sensitivity. Furthermore, the effect sizes obtained with the ASI were greater in magnitude than those obtained with other widely used anxiety self-report measures. Taken together, the finds supported the use of the Anxiety Sensitivity Index as a treatment outcome measure in panic disorder research.

Adult↗

Improved cognitive knowledge of midwives practising in the eastern Cape Province of the Republic of South Africa through the study of a self-education manual.

OBJECTIVES: To determine whether the Maternal Care manual of the Perinatal Education Programme (PEP) is effective in improving the cognitive knowledge of midwives. DESIGN: A prospective controlled trial in a region where PEP was not previously used. The midwifery knowledge of all midwives caring for pregnant women in the three towns was tested before the commencement of the study. The Maternal Care manual was then introduced to the midwives in he study town and they worked through the programme. Following the completion of the manual, all midwives were tested again with the same test. The time interval between the pre and post testing was 12 months. SETTING: Three towns on the Eastern Cape Province of South Africa. PARTICIPANTS: All Midwives caring for pregnant women in three towns. INTERVENTIONS: The Maternal Care manual of PEP was studied by the midwives in the study town. MEASUREMENTS AND FINDINGS: Changes in cognitive knowledge were tested with multiple choice questions. A significant improvement (p < 0.0001) was achieved in the study town. The mean score (maximum 70) improved by 22.4 (32%) marks, from 35.9 (51%) to 58.3 (83%). KEY CONCLUSIONS: The cognitive knowledge of midwives who completed the Maternal Care manual improved significantly. IMPLICATIONS FOR PRACTICE: These findings are to particular importance as the method by which the Maternal Care manual of PEP was applied conforms to the method suggested for the its national use.

Adult↗

A pilot study comparing the effectiveness of conventional training and virtual reality simulation in the skills acquisition of junior dental students.

The use of virtual reality (VR) in the training of operative dentistry is a recent innovation and little research has been published on its efficacy compared to conventional training methods. To evaluate possible benefits, junior undergraduate dental students were randomly assigned to one of three groups: group 1 as taught by conventional means only; group 2 as trained by conventional means combined with VR repetition and reinforcement (with access to a human instructor for operative advice); and group 3 as trained by conventional means combined with VR repetition and reinforcement, but without instructor evaluation/advice, which was only supplied via the VR-associated software. At the end of the research period, all groups executed two class 1 preparations that were evaluated blindly by 'expert' trainers, under traditional criteria (outline, retention, smoothness, depth, wall angulation and cavity margin index). Analyses of resulting scores indicated a lack of significant differences between the three groups except for scores for the category of 'outline form', for group 2, which produced significantly lower (i.e. better) scores than the conventionally trained group. A statistical comparison between scores from two 'expert' examiners indicated lack of agreement, despite identical written and visual criteria being used for evaluation by both. Both examiners, however, generally showed similar trends in evaluation. An anonymous questionnaire suggested that students recognized the benefits of VR training (e.g. ready access to assessment, error identification and how they can be corrected), but the majority felt that it would not replace conventional training methods (95%), although participants recognized the potential for development of VR systems in dentistry. The most common reasons cited for the preference of conventional training were excessive critical feedback (55%), lack of personal contact (50%) and technical hardware difficulties (20%) associated with VR-based training.

Competency-Based Education↗

Limitations of audiovisual aids and educational objectives in a clinical clerkship.

The several components of a clinical clerkship were analyzed and correlated with Part II National Board scores and career choice. No positive correlations could be made between fulfilling educational objectives, utilization of audiovisual aids, general satisfaction and the clerkship, and eventual career choice or performance on National Board Examinations.

Attitude of Health Personnel↗

Effect of problem-based, self-directed undergraduate education on life-long learning.

OBJECTIVE: To compare how well graduates of a self-directed, problem-based undergraduate curriculum (at McMaster University [MU], Hamilton, Ont.) and those of a traditional curriculum (at the University of Toronto [UT]) who go on to primary care careers keep up to date with current clinical practice guidelines. DESIGN: Analytic survey. Management of hypertension was chosen as an appropriate topic to assess guideline adherence. An updated version of a previously validated questionnaire was mailed to the participants for self-completion. SETTING: Private primary care practices in southern Ontario. PARTICIPANTS: A random sample of 48 MU graduates and 48 UT graduates, stratified for year of graduation (1974 to 1985) and sex, who were in family or general practice in Ontario; 87% of the eligible subjects in each group responded. MAIN OUTCOME MEASURES: Overall and component-specific scores; analysis was blind to study group. RESULTS: The overall mean scores were 56 (68%) of a possible 82 for the MU graduates and 51 (62%) for the UT graduates (difference between the means 5, 95% confidence interval 1.9 to 8.2; p < 0.01). Multivariate linear regression analysis of seven factors that might affect questionnaire scores revealed that only the medical school was statistically significant (p < 0.01). The MU graduates had significantly higher mean scores than the UT graduates for two components of the questionnaire: knowledge of recommended blood pressures for treatment (p < 0.05) and successful approaches to enhance compliance (p < 0.005). The trends were similar for the other components but but were not significant. CONCLUSIONS: The graduates of a problem-based, self-directed undergraduate curriculum are more up to date in knowledge of the management of hypertension than graduates of a traditional curriculum.

Curriculum↗

Teaching acute care nurses cognitive assessment using LOCFAS: what's the best method?

The Levels of Cognitive Functioning Assessment Scale (LOCFAS) is a behavioral checklist used by nurses in the acute care setting to assess the level of cognitive functioning in severely brain-injured patients in the early post-trauma period. Previous research studies have supported the reliability and validity of LOCFAS. For LOCFAS to become a more firmly established method of cognitive assessment, nurses must become familiar with and proficient in the use of this instrument. The purpose of this study was to find the most effective method of instruction by comparing three methods: a self-directed manual, a teaching video, and a classroom presentation. Videotaped vignettes of actual brain-injured patients were presented at the end of each training session, and participants were required to categorize these videotaped patients by using LOCFAS. High levels of reliability were observed for both the self-directed manual group and the teaching video group, but an overall lower level of reliability was observed for the classroom presentation group. Examination of the accuracy of overall LOCFAS ratings revealed a significant difference for instructional groups; the accuracy of the classroom presentation group was significantly lower than that of either the self-directed manual group or the teaching video group. The three instructional groups also differed on the average accuracy of ratings of the individual behaviors; the accuracy of the classroom presentation group was significantly lower than that of the teaching video group, whereas the self-directed manual group fell in between. Nurses also rated the instructional methods across a number of evaluative dimensions on a 5-point Likert-type scale. Evaluative statements ranged from average to good, with no significant differences among instructional methods.

Acute Disease↗