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"Humans"

Background: In studies exploring the patient mixes of general practitioner (GP) trainees, gaps were repeatedly found, as there were disparities between the patient mixes of GP trainers and trainees. This reduces the opportunities of trainees to acquire enough competence. Aims: To investigate whether steering the patient mix can be effectuated by instructing medical receptionist, trainer and trainee, and to study the effects of this intervention on trainee's self-efficacy (SE) and knowledge. Method: Randomized Controlled Trial (RCT). After a six-month basic registration period, 73 trainees were randomized. Patients with skin conditions and psychosocial conditions were actively assigned to trainees in the intervention group (n=35) during two successive periods of three months. The patient mix was measured by extracting data from electronic patient records. Learning outcomes were measured by SE questionnaires and by a knowledge test. Results: No increase was found in patient volume and diversity of the steered conditions in the intervention group as compared to the control group. However, the percentual increase of exposure to skin conditions was greater in the intervention group. No difference in skin SE and psychiatric knowledge was found. The increase of psychosocial SE was greater in the intervention group. In a regression analysis, patient volume was a significant predictor of both skin and psychosocial SE. Conclusions: Despite the difficulty in implementing steering in daily practice, tailoring the patient mix to the individual learning needs of trainees could be considered. © 2013 Informa UK Ltd.

As many other European countries, Switzerland is facing a shortage of young general practitioners (GPs). This review summarizes and compares the different characteristics of vocational training programs in Switzerland and other Eu ropean countries concerning their duration, learning objectives and setting. Countries with a GP-centered healthcare system offer highly structured training programs tailored to the everyday work in general practice, whereas vocational training programs in countries where patients have unlimited access to specialized care are less differentiated. Today, the vocational training of Swiss GPs lacks topically focused learning objectives and seems to be rather underdeveloped when compared to foreign programs. Particularly with regard to the duration and funding of practice-based training periods spent in GP surgeries, Switzerland still has a great development potential. © 2013 Verlag Hans Huber, Hogrefe AG, Bern.

The objective of this study was to examine undergraduate health science students' attitudes toward interprofessional learning using a web-based interprofessional education package. METHODS: A before and after study of student attitudes toward a web-based interprofessional education package was conducted using the 17-item Readiness for Interprofessional Learning Scale (RIPLS). Students completed the RIPLS before and after the educational package. RESULTS: Forty-six students commenced the study with 2 students failing to complete. The group contained mostly females with a mean age of 22.6 yrs. A statistically significant change was found for RIPLS subscale one, "shared learning," p=0.035. CONCLUSIONS: This study demonstrated that a web-based interprofessional education package did appear to have an impact on undergraduate students' attitudes toward interprofessional learning. © 2013 Association of Schools of Allied Health Professions, Wash., DC.

[No abstract available]

QUESTION UNDER STUDY: Switzerland is facing a shortage of general practitioners (GPs). Knowledge of the factors influencing career choice is crucial for increasing the attractiveness of general practice. The aim of our study was to report the working conditions of recently certified GPs and the effect of vocational training in general practice on GP skills and knowledge, and economic skills. Furthermore, we recorded when GPs chose general practice as a career, as well as potential barriers to and facilitators of their decision. METHODS: Study design: Cross-sectional survey with an online-based questionnaire. Study group: 1,133 physicians certified in general practice between the years 2000 and 2010. RESULTS: The response rate was 40.6% (456); 426 (44.1% females) were included in further analysis. A total of 341 (80.0%) were currently working in general practice. Female GPs were significantly more often employed (rather than working independently), working part-time and in group practices. Fifty-two (12.2%) of the participants did not work in general practice although they had intended to earlier. The majority (54.3%) of the participants working as GPs decided to become a GP during their residency. Overall, 60.6% of all participants completed vocational training in a general practice, which significantly improved self-perceived general practice skills compared with their colleagues without such training. CONCLUSIONS: Residency is a more important time-period than medical school for career decisions to become a GP. Attractive residency programmes must be developed to engage physicians in this vulnerable phase. The workplace settings of female GPs were significantly different from those ofmale GPs. Vocational training in general practice had a positive effect on self-perceived GP skills.

Objective: To evaluate the effectiveness of reflective exercises in obstetrics and gynaecology (OB/GY) residents for theimprovement in certain identified skills.Study Design: Experimental study.Place and Duration of Study: Gynaecology Unit III, Services Institute of Medical Sciences / Services Hospital, Lahore,from September 2009 to August 2010.Methodology: Twenty-four residents from all 4 years of residency program were included in the study after their informedconsent. The competencies identified were surgical skills, professionalism, communication skills and critical appraisalskills. The reflective exercises evaluation was done on questionnaire designed for this purpose.Results: The results showed that the residents initially had underdeveloped ability to engage into purposeful reflectiveexercises, which improved with practice and showed encouraging results. Reflective exercises particularly helped inimprovement of surgical skills as opposed to other identified competencies.Conclusion: Regular engagement of postgraduate trainees in reflective exercises in a purposeful manner hasencouraging results in terms of improvement in surgical, communication, critical appraisal skills and has a role in boostingprofessionalism among residents. However, a longitudinal multicentre study can give better insight regarding theeffectiveness of this practice.

Background: Concern about the process of identifying underlying competencies that contribute to effective nursing performance has been debated with a lack of consensus surrounding an approved measurement instrument for assessing clinical performance. Although a number of methodologies are noted in the development of competency-based assessment measures, these studies are not without criticism. Research aim: The primary aim of the study was to develop and validate a Performance Based Scoring Rubric, which included both analytical and holistic scales. The aim included examining the validity and reliability of the rubric, which was designed to measure clinical competencies in the operating theatre. Research method: The fieldwork observations of 32 nurse educators and preceptors assessing the performance of 95 instrument nurses in the operating theatre were used in the calibration of the rubric. The Rasch model, a particular model among Item Response Models, was used in the calibration of each item in the rubric in an attempt at improving the measurement properties of the scale. This is done by establishing the 'fit' of the data to the conditions demanded by the Rasch model. Results: Acceptable reliability estimates, specifically a high Cronbach's alpha reliability coefficient (0.940), as well as empirical support for construct and criterion validity for the rubric were achieved. Calibration of the Performance Based Scoring Rubric using Rasch model revealed that the fit statistics for most items were acceptable. Conclusion: The use of the Rasch model offers a number of features in developing and refining healthcare competency-based assessments, improving confidence in measuring clinical performance. The Rasch model was shown to be useful in developing and validating a competency-based assessment for measuring the competence of the instrument nurse in the operating theatre with implications for use in other areas of nursing practice. © 2012.

Medical professionals and public consumers expect that new physical therapy graduates possess cognitive, technical, and behavioral skills required to provide safe and high-quality care to patients. The purpose of this study was to determine if a repertoire of ten professional behaviors assessed at the beginning of doctorate of physical therapy education and before the first significant clinical internship could be enhanced in a semester course in gross human anatomy using individual formative feedback. During the human anatomy course, 28 first-year physical therapy students completed six biweekly, anonymous self- and peer assessment surveys that targeted ten professional behaviors important to physical therapists. All professional behaviors were assessed using a five-point Likert scale. Feedback reports occurred at week eight (mid-semester) and week 16 (end-of-semester) and comprised the direct intervention components of this study. At the midpoint of the semester, professional behavior scores and narrative comments from weeks two, four, and six were compiled and shared with each student by one of three faculty members in a feedback session. Students then submitted biweekly self-and peer professional behavior assessments (weeks 10, 12, and 14) for the remainder of the human anatomy course. Differences between preintervention and postintervention scores for each of the ten professional behaviors were compared using the Wilcoxon signed-ranks test. Upon receiving mid-semester individual feedback, students demonstrated significant improvement in each of the ten professional behaviors. Results from this study indicated a gross anatomy laboratory dissection experience during the first academic semester provided an effective opportunity for teaching and assessing professional behaviors of doctoral students in physical therapy. © 2013 American Association of Anatomists.

Clinical education has long been accepted as integral to the education of physiotherapy students and their preparation for professional practice. The clinical environment, through practice immersion, situates students in a powerful learning context and plays a critical role in students' construction of professional knowledge. Despite this acknowledged centrality of practice and clinical environments to the students' experiential construction of professional knowledge, there has been limited exploration of learning theories underpinning clinical education in the literature. In this paper, we explore a selection of learning theories underpinning physiotherapy clinical education with a view to providing clinical educators with a firm foundation on which to base wise educational practices and potentially enhance physiotherapy students' clinical learning experiences. This exploration has drawn from leading thinkers in the field of education over the past century. © 2013 Informa Healthcare USA, Inc.

Background. Many factors affect student learning throughout the clinical education (CE) component of professional (entry-level) physical therapist education curricula. Physical therapist education programs (PTEPs) manage CE, yet the material and human resources required to provide CE are generally overseen by community-based physical therapist practices. Purpose. The purposes of this systematic review were: (1) to examine how the construct of quality is defined in CE literature and (2) to determine the methodological rigor of the available evidence on quality in physical therapist CE. Methods. This study was a systematic review of English-language journals using the American Physical Therapy Association's Open Door Portal to Evidence-Based Practice as the computer search engine. The search was categorized using terms for physical therapy and quality and for CE pedagogy and models or roles. Summary findings were characterized by 5 primary themes and 14 subthemes using a qualitative-directed content analysis. Results. Fifty-four articles were included in the study. The primary quality themes were: CE framework, CE sites, structure of CE, assessment in CE, and CE faculty. The methodological rigor of the studies was critically appraised using a binary system based on the McMaster appraisal tools. Scores ranged from 3 to 14. Limitations. Publication bias and outcome reporting bias may be inherent limitations to the results. Conclusion. The review found inconclusive evidence about what constitutes quality or best practice for physical therapist CE. Five key constructs of CE were identified that, when aggregated, could construe quality. © 2013 American Physical Therapy Association.