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PubMed2003

Corneal flap complications in refractive surgery: Part 1: development of an experimental animal model.

PURPOSE: To report the outcome, learning curve, and complication rates of an experimental animal model for corneal flaps in refractive surgery. SETTING: Magill Research Center for Vision Correction, Storm Eye Institute, Charleston, South Carolina, USA. METHODS: Corneal flaps with a nasal or a temporal hinge were created in 190 eyes of 95 Dutch Belted rabbits using the Automated Corneal Shaper microkeratome (Bausch & Lomb Surgical). Diffuse lamellar keratitis (DLK) was induced by inoculating the corneal interfaces with 1 of 7 substances. Postoperatively, the eyes were examined with a slitlamp. Special emphasis was placed on corneal flap complications and the relationship between slipped flaps and hinge position and/or inoculation agent. RESULTS: A good corneal flap was achieved in 174 eyes (92%). The eyes with a nasal hinge had a lower incidence of slipped flaps (14%) than eyes with a temporal hinge (37%) (P =.02). CONCLUSION: With the animal model described, corneal flaps were created in a precise and reproducible way in more than 90% of eyes. Nasal hinged flaps showed less postoperative displacements than temporal hinged flaps and are adequate for further study.

Animals↗

PubMed2006

Mentor evaluation of a year-long mentorship program: a quality improvement initiative.

This paper presents 23 mentors' perceptions of their role in a year-long mentorship program during the period 1999- 2002. The majority of mentors were clinical specialists, had bachelor degrees and over five years clinical experience. The mentorship program was informed by the Deming Cycle of Plan, Do, Check and Act. This quality improvement framework was used to evaluate the mentorship program from the mentors' perspective. Information was gathered through surveys and focus group discussions. Responses were analysed to identify three themes of 'Enhancing student learning outcomes', 'Time and resources' and 'Personal and professional growth'. Mentors perceived their role as valuable in students' education and development. Despite concerns regarding adequate time and resources for an effective mentoring program, mentors acknowledged benefits to themselves in terms of personal and professional growth. Their vision and commitment to nursing was also evident in the perceived benefits of the program for the profession.

Australia↗

PubMedDate not supplied

A school-based strategy to assess children's environmental exposures and related health effects in economically disadvantaged urban neighborhoods.

The School Health Initiative: Environment, Learning, Disease (SHIELD) study is a novel school-based investigation of children's environmental health in economically disadvantaged urban neighborhoods of Minneapolis. This article describes the study design and summarizes lessons learned about recruiting and monitoring this historically understudied population. The SHIELD study focused on measuring children's exposures to multiple environmental stressors [volatile organic chemicals (VOCs), environmental tobacco smoke, allergens, bioaerosols, metals, pesticides, polychlorinated biphenyls (PCB), phthalates] and exploring related effects on respiratory health (e.g., lung function) and learning outcomes (e.g., standardized test scores, academic achievement). It involved intensive exposure monitoring, including environmental measurements inside and outside the children's schools and inside their homes, personal measurements with passive dosimeters worn by the children, and biological marker measurements in blood and urine. The SHIELD participants comprised a stratified random sample of 153 "index" children and 51 of their siblings enrolled in grades 2-5 at two adjacent elementary schools. The Minneapolis Public Schools (MPS) assisted with identifying, contacting, recruiting, and monitoring this population, which traditionally is difficult to study because families/children are highly mobile, speak a diversity of languages, frequently do not have a telephone, endure economic hardships, often do not trust researchers, and have a spectrum of unconventional lifestyles and living arrangements. Using a school-based approach, the overall SHIELD enrollment (response) rate was 56.7%, with a wide disparity between English-speaking (41.7%) and non-English-speaking (71.0%) families/children. Most children remained involved in the study through both monitoring sessions and exhibited an acceptable degree of compliance with study protocols, including providing blood and urine samples. Results indicate that it is both practical and affordable to conduct probability-based exposure studies in this population, but that it is also important to improve our understanding of factors (e.g., cultural, economic, psychological, social) affecting the willingness of families/children to participate in such studies, with special emphasis on developing cost-effective recruitment methods.

Air Pollution, Indoor↗

PubMed1993

The use of curriculum objectives in nursing education.

This empirical study has its roots in the Finnish nursing education reform of the 1980s. The reform emphasized the formulation of national curriculum objectives and a criterion-oriented, responsive evaluation of learning outcomes. The data were collected by using a questionnaire, answered by Finnish graduating nursing students in 1990 (n = 379). The results indicate certain problems in the criterion-oriented evaluation.

Adult↗

PubMed2003

Personal improvement project in nursing education: learning methods and tools for continuous quality improvement in nursing practice.

BACKGROUND: All health care providers, including nurses, need to learn how to improve the care they give. Continuous quality improvement (CQI) is a theory and method used in health care to guide improvement. The question is how best to teach it, particularly to nursing students. It was conjectured that a systematic approach to improve study habits and lifestyle would increase nursing students' awareness of how they handled their studies and, at the same time, became acquainted with improvement knowledge methodology. Using the starting point that 'quality is personal', students worked on personal change and improvement. The purpose was to learn methods and tools for improvement in their personal life and enable them to transfer and use this knowledge in their professional work. AIMS: To describe the use of a personal improvement project (PIP) by nursing students and the resulting increased knowledge, skills, and enthusiasm to continue working with CQI. METHODS: Forty-four nursing students worked on a PIP, which they felt was important, and presented their projects to fellow students. The students answered a questionnaire, and their presentations documented the results of their work. RESULTS: All 44 students followed the instructions in a workbook describing PIPs over an 8-week period and answered a questionnaire. Forty-five per cent felt they had made an improvement in their study habits or lifestyle. Eighty-nine per cent reported that this project helped them to start learning CQI, and 75% reported that they could see the benefit of this kind of knowledge in their future clinical practice. CONCLUSIONS: Personal improvement projects seem to be an effective way of introducing CQI knowledge to nursing students. Even those who did not succeed in achieving personal improvement felt they had a positive learning outcome from the project.

Adult↗

PubMed2003

Evaluation of students' satisfaction with nursing education in Norway.

BACKGROUND: The use of standardized questionnaires for measuring student satisfaction in higher education is motivated by theories predicting a close relationship between students' satisfaction and learning outcomes. The reliability and validity of the Course Experience Questionnaire as an indicator of teaching performance have been established by factor analysis in earlier studies from several countries. The Nursing Clinical Facilitators Questionnaire has been used for measuring satisfaction with clinical practice. AIMS: The aims of this study were (1) to find out how satisfied nursing students in their last semester were with their clinical practice and the nursing programme as a whole, and (2) to measure the reliability and validity of the two standardized questionnaires. METHODS: The data were collected using the two standard questionnaires, combined with some background items, in a survey design. Exploratory factor analysis was performed. FINDINGS: A total of 276 nursing students from three university colleges in Western Norway answered the questionnaire in 1999/2000. The scores indicated slight overall dissatisfaction with the nursing programme, but general satisfaction with clinical practice. Furthermore, 70% of the students who expressed dissatisfaction with the quality of the nursing programme were nevertheless satisfied with clinical practice. The broad constituent structure of the Course Experience Questionnaire was replicated, with some deviation for the appropriate assessment scale. The Nursing Clinical Facilitators Questionnaire turned out to have two subscales, representing supportive and challenging behaviour, with satisfactory internal reliability. CONCLUSION: Annual evaluations using the two standardized questionnaires may result in greater focus being given to students' satisfaction with the nursing programmes and clinical practice in Norwegian nursing education departments. Comparative studies with the same instruments in other countries would also be of interest.

Adult↗

PubMed2004

Monitoring the development of clinical skills during training in a clinical placement.

BACKGROUND: The education and training of health care practitioners has undergone recent reform, and indicate that curricula should place emphasis on the development of clinical skills and attitude. The purpose of this study was two-fold: to define the key skills necessary for a competent dietetic student practitioner and to devise a reliable assessment tool to measure and track performance in these key skill areas throughout the period of clinical placement. METHODS: Key clinical skills were identified by a concensus group of experienced dietitians and academic practitioners. An assessment tool was then developed to measure these attributes in 43 students undertaking clinical placement at a number of training centres in Scotland. Development of skills was tracked for the entire duration of placements using the novel assessment tool. The assessment tool used a visual analogue scale (VAS) as the measuring score. RESULTS: A high level of skill attainment was equated with high VAS scores. Performance in three of the four key skills (written skills: r = 0.762, P </= 0.001; interviewing skills: r = 0.697, P < 0.001; and dietary assessment technique: r = 0.697, P </= 0.001) showed impressive correlation co-efficients, indicating a striking and significant positive correlation with the length of training. A high skill performance level attainment was achieved by week 16/17 of training. CONCLUSION: The authors are confident that the assessment tool is valid and reliable and measures skill performance objectively. A high level of skill attainment was observed in most students by about the mid-point in training: this allows the student to consolidate these skills in the latter stages of training which is in keeping with educational and practice philosophy of placement learning outcomes.

Clinical Competence↗

PubMed2004

Social and behavioural science education in UK medical schools: current practice and future directions.

INTRODUCTION: The increasing importance accorded the social and behavioural sciences in medical education presents opportunities for developing new and innovative forms of teaching and learning in this field. Yet social and behavioural scientists often feel isolated and marginalized. This research was designed to build a network of such practitioners to share and compare current practice, and to develop better models and resources. METHODS: Questionnaire survey and workshop discussions describe current practice among social and behavioural scientists in UK medical education, and identify current and future issues. RESULTS: Most UK medical curricula feature a significant social and behavioural science component, often in multidisciplinary contexts. Questions of core content, and how this relates to desired learning outcomes, particularly in the attitudinal sphere, remain unresolved. Identity problems result from differing perspectives of medics and social and behavioural scientists, staffing constraints, assessment regimes, and relationships with external examiners. DISCUSSION: This project identified barriers and opportunities for providing adequate training in the social and behavioural sciences in medical schools. Some of the barriers are common to higher education generally. Through our network, a database of core cases and assessments can be developed that would be available to all for teaching purposes. CONCLUSION: Social and behavioural scientists involved in medical education show commonality and difference in the extent and scope of their input. While they have made great progress, there remains much to achieve.

Behavioral Sciences↗

PubMed2003

International comparison of quality indicators in United States, Icelandic and Canadian nursing facilities.

AIM: To discuss the results of a comparison using minimum data set (MDS)-based quality indicators (QIs) for residents in nursing facilities in three countries (Iceland; Ontario, Canada; and Missouri, United States) together with implications regarding nursing practices and resident outcomes in these countries. METHOD: Data were extracted from databases in each country for four consecutive quarterly periods during 1997 and 1998. All facilities investigated had the required consecutive quarterly data. Analytical techniques were matched to measure resident outcomes using the same MDS-based QIs in the three countries. RESULTS: Similarities among the three countries included the use of nine or more multiple medications, weight loss, urinary tract infection, dehydration, and behavioural symptoms that affect others. Differences among the three countries included bowel and bladder incontinence, indwelling catheter use, fecal impaction, tube feeding use, development of pressure ulcers, bedridden residents, physical restraint use, depression without receiving antidepressant therapy, residents with depression, use of anti-anxiety or hypnotic drugs, use of anti-psychotic drugs in the absence of psychotic and related conditions, residents spending little or no time in activities, and falls. CONCLUSIONS: Comparisons highlighted differences in clinical practices among countries, which may account for differences in resident outcomes. Learning from each other's best practices can improve the quality of care for older people in nursing homes in many countries.

Aged↗

PubMedDate not supplied

Lake Superior Rural Cancer Care Project, part II: provider knowledge.

PURPOSE: The purpose of this article is to report the main learning outcomes of the Lake Superior Rural Cancer Care Project. DESCRIPTION OF STUDY: The authors designed and tested a multimodal intervention directed at rural providers and their healthcare systems in a large rural area in the north central United States. An experimental design was used to randomize rural providers at the group level. The intervention consisted of providing increased education for rural providers with a number of approaches, including the use of clinical opinion leaders. The main outcome of the intervention was knowledge scoring on discipline-specific cancer management tests. RESULTS: Knowledge scores for providers in the experimental group significantly increased from pretest to post-test: 66 to 79 for physicians (and physician assistants) (P=.02); 58 to 71 for nurses (P=.01); and 54 to 64 for pharmacists (P=.01). At post-test, participating providers in the experimental group performed significantly better on the knowledge tests (P <.01) than those in the control groups. CLINICAL IMPLICATIONS: This study may be the first to test educational interventions to improve rural providers' knowledge about cancer practice using an experimental design. The intervention may possibly change provider practice behaviors and, thus, patient outcomes, data that will be reported in a future issue. Finally, this educational intervention may prove useful for providers in other rural areas.

Humans↗

PubMed1999

Psychological care in nursing education and practice: a search for definition and dimensions.

Despite a wealth of literature from the medical and nursing arenas pointing to the significance of psychological care in illness, there appears to be little consensus on definition, description and dimensions of the concept. A literature review and analysis of textbook content was conducted to explore the nature of the concepts of psychological need and care which might inform nurse educationalists in the preparation of appropriate teaching and learning programmes. Preliminary findings indicate that there is little consensus upon definition or description and, with the exception of information-giving, upon the dimensions or components of psychological care, despite the fact that student nurses are prepared to meet the same nationally prescribed learning outcomes by pursuing broadly the same guidelines for educational content. It is suggested that this has particular implications for nursing lecturers with a responsibility for teaching the philosophy and practice of holistic care.

Counseling↗

PubMed2001

Nurses' educational preparation for a medication education role: findings from a national survey.

Nurses have a potentially important contribution to make to educating patients about medications. This nursing role is likely to acquire increasing significance as the number of nurses independently prescribing medicines grows, in addition to those nurses occupying autonomous and extended roles that involve ongoing assessment and monitoring of patients' medicine-taking behaviour. As part of a study(1)commissioned to evaluate nurses' educational preparation for, and practice of, medication education, a national survey of nurse education institutions was undertaken. A postal questionnaire was distributed to identified individuals within 51 education institutions in England. Respondents were asked about a number of curriculum design and delivery factors related to subjects central to medication education: pharmacology, patient education and communication skills. Analysis highlighted a number of themes: the teaching of pharmacology is generally integrated within other curricular modules; respondents were dissatisfied with insufficient curricular time devoted to taught pharmacology; the importance of lecturers' ability to apply theory to practice; a lack of clarity concerning pharmacology learning outcomes applied to medication education; and respondents' perceptions that opportunities for integrating pharmacology knowledge, patient education and communication skills were available within practice settings. The significance and implications of the findings are discussed in the context of current educational policy.

Communication↗

PubMed2001

Education for a new role: a review of neonatal nurse practitioner programmes.

A comparison was made of the different educational programmes developed to train Neonatal Nurse Practitioners (ENB A19) in the UK. The structure and character of the programmes were examined in relation to course aims and philosophies, learning outcomes, content, teaching strategies and methods of assessment. Documentation provided by course leaders included hand-books, timetables, teaching staff details and documents concerning supervision and assessment. When viewed closely there are differences between the programmes that are evident in design and curriculum content and which present a quality assurance issue to the institutions validating and running these programmes. The issue of parity and standards is also a critical one for those supporting the development regionally and nationally. Viewed within the broader perspective of post-registration nurse education, these relatively new programmes could be regarded as experiments in which professionals, as teachers and learners, are trying to address the changing boundaries of expertise and professional identities. It is suggested that the nurse practitioner programmes developed for neonatal care could provide a model for similar programmes in other specialties and argued that the experience gained in planning and running these courses could contribute positively to the development of other comparable educational programmes for established and experienced nurses.

Curriculum↗

PubMed2002

Nurse education in higher education: understanding cultural barriers to progress.

Nurse education is established in higher education but nurse academics remain concerned about nursing's lack of equal status within the academy. This paper reports findings of a small study of nurse lecturers' views which support other published studies. It argues that cultural factors which contribute to nursing's problems gaining equal status include anti-intellectualism within nursing and academic denigration of practice. These cultural factors are linked to the history of women in higher education, the separation between intellectual education and practical, skill-based training, the low status of caring courses and the resulting mutual denigration of culturally opposed groups. Anti-intellectualism in nursing can be seen as a defensive reaction against an academic culture that defines practical activity as inferior to abstract thinking skills. This can lead to limited educational opportunities to examine the structural and cultural context of nursing. In Freire's view, this is a necessary part of education for freedom. Current cultural change, in nursing and higher education, including an emphasis on learning outcomes and transferable skills, provides new opportunities for nursing to contribute to educational change. Removing cultural barriers to the educated nurse is a responsibility shared by universities and by the nursing profession.

Attitude of Health Personnel↗

PubMed2004

The Times of Ira Hirsh: Multiple Ranges of Auditory Temporal Perception.

Ira Hirsh was among the first to recognize that the auditory system does not deal with temporal information in a unitary way across the continuum of time intervals involved in speech processing. He identified the short range (extending from 1 to 20 milliseconds) as that of phase perception, the range between 20 and 100 milliseconds as that in which auditory patterns emerge, and the long range from 100 milliseconds and longer as that of separate auditory events. Furthermore, he also was among the first to recognize that auditory time perception heavily depended on spectral context. A study of the perception of sequences representing different temporal orders of three tones, by Hirsh and the author (e.g., Divenyi and Hirsh, 1978) demonstrated the dependence of auditory sequence perception on both time range and spectral context, and provided a bridge between Hirsh's view of auditory time and Bregman's view of stream segregation. A subsequent search by the author for psychophysical underpinnings of the cocktail-party phenomenon (e.g., Divenyi and Haupt, 1997) suggests that segregation of simultaneous streams of speech might rely on the ability to follow spectral changes in the demisyllabic-to-syllabic (100 to 200 milliseconds) range (i.e., Hirsh's long range).Learning Outcomes: As a result of this activity, the participant will be able to (1) describe the importance of temporal processing in hearing; and (2) identify time ranges where the auditory system will spontaneously adopt different analysis techniques.

Journal Article↗

PubMed2001

Teaching medical students about the impact of radical treatments on patients' sexuality.

This three-hour teaching aims to raise students' awareness of patients' sexuality problems after radical treatments, particularly the importance of respect for an individual patient's perception of self, the depression that can result from disturbed body image, and the incidence of problems of sexuality following surgery, chemotherapy and radiotherapy. In 1997, this half-day experiential learning session was introduced to the under-graduate curriculum. Evaluation by questionnaire 5 months after the 1998 teaching session showed a significant attitudinal impact of the teaching on attendees - 98% of respondents stated positive learning outcomes: 72% volunteered that they had an increased awareness of the holistic needs of patients and 27% had reflected on the session afterwards.

Journal Article↗

PubMed2003

A case study of methods used to tackle a common pedagogic problem in medical and dental education: time pressure.

This case study describes how the common problems of time shortage, factual overload and curriculum overcrowding were tackled in one context, using good practice guidelines. It examines the impact of two hours of intensive, interactive teaching on the knowledge and attitudes of senior medical undergraduates at one United Kingdom school, and the effectiveness of two different ways of presenting information. The session raised student awareness of the importance to medical practice of the topic. There were statistically significant increases in the ability and knowledge of students over the period, as self-rated by students and assessed by the teacher; results of the impact on learning outcomes of different versions of a handout were not statistically significant. Further research on modes of presentation of information and their impact on forming and accessing illness scripts is suggested. Minority subjects in potentially overcrowded, time-pressured curricula can be effectively introduced in short time slots.

Clinical Competence↗

PubMed2003

Standards in medical education in the European Union.

Standards in medical education are necessary to enable evaluation of programmes and comparison between institutions. EC Directive 93/16 lays down the standards for both the duration and content of basic medical education in the European Union but the directive is open to wide variations in interpretation. A new approach is needed and the development of common learning outcomes is suggested as a possible solution.

Curriculum↗