Consensus-Based Palliative Care Competencies for Undergraduate Nurses and Physicians: A Demonstrative Process with Colombian Universities.
ABSTRACT: A World Health Assembly (WHA) resolution adopted in 2014 strongly encourages member states to integrate palliative care (PC) in undergraduate training for health professionals.The study objective was to describe a consensus-based process workshop to develop PC competences for medical and nursing schools in Colombia and to present a summary of the findings.The workshop included 36 participants representing 16 medical and 6 nursing schools from 18 universities in Colombia. Participants were distributed in four thematic groups. Using the International Association for Hospice and Palliative Care (IAHPC) List of Essential Practices (LEP) as guidance, they were asked to discuss and define PC competencies at the undergraduate level. Participants provided feedback and approved each recommendation, and then were asked to complete an evaluation.The resulting competences were separated into six categories: (1) Definition and Principles of PC, (2) Identification and Control of Symptoms, (3) End-of-Life Care, (4) Ethical and Legal Issues, (5) Psychosocial and Spiritual Issues, and (6) Teamwork. A comparative analysis revealed that treatment of several symptoms in the IAHPC LEP (pain, dyspnea, constipation, nausea, vomit, diarrhea, delirium, and insomnia) were included in the competencies. All of the IAHPC LEP related to psychological/emotional/spiritual care was included. The evaluation rate of return was 80%. The assessment was very positive: total score of 4.7/5.0; SD?=?0.426), with 89% considering the workshop to be helpful.The workshop provided an opportunity for individuals from different disciplines to discuss competencies and achieve consensus. The resulting competencies will be helpful in the development of PC curricula for physicians and nurses throughout schools in Colombia and other countries.
Project description:INTRODUCTION:Including palliative care (PC) in overloaded medical curricula is a challenge, especially where there is a lack of PC specialists. We hypothesised that non-specialised rotations could provide meaningful PC learning when there are enough clinical experiences, with adequate feedback. OBJECTIVE:Observe the effects of including PC topics in non-specialised placements for undergraduate medical students in two different medical schools. DESIGN:Observational prospective study. SETTING:Medical schools in Brazil. PARTICIPANTS:134 sixth-year medical students of two medical schools. METHODS:This was a longitudinal study that observed the development of Self-efficacy in Palliative Care (SEPC) and Thanatophobia (TS) in sixth-year medical students in different non-specialised clinical rotations in two Brazilian medical schools (MS1 and MS2). We enrolled 78 students in MS1 during the Emergency and Critical Care rotation and 56 students in MS2 during the rotation in Anaesthesiology. Both schools provide PC discussions with different learning environment and approaches. PRIMARY OUTCOMES:SEPC and TS Scales were used to assess students at the beginning and the end of the rotations. RESULTS:In both schools' students had an increase in SEPC and a decrease in TS scores. CONCLUSION:Non-specialised rotations that consider PC competencies as core aspects of being a doctor can be effective to develop SEPC and decrease TS levels.
Project description:There has been a growing emphasis on the use of core competencies to design and inform curricula. Based on our Faculty for Undergraduate Neuroscience workshop at Pomona we developed a set of neuroscience core competencies. Following the workshop, faculty members were asked to complete an online survey to determine which core competencies are considered most essential and the results are presented. Backward Design principles are then described and we discuss how core competencies, through a backward design process, can be used to design and assess an undergraduate neuroscience curriculum. Oberlin College is used as a case study to describe the use of core competencies to help develop learning objectives, activities, and assessment measures for an undergraduate neuroscience major.
Project description:BACKGROUND:Telemedicine has grown exponentially in the United States over the past few decades, and contemporary trends in the health care environment are serving to fuel this growth into the future. Therefore, medical schools are learning to incorporate telemedicine competencies into the undergraduate medical education of future physicians so that they can more effectively leverage telemedicine technologies for improving the quality of care, increasing patient access, and reducing health care expense. This review articulates the efforts of allopathic-degree-granting medical schools in the United States to characterize and systematize the learnings that have been generated thus far in the domain of telemedicine training in undergraduate medical education. OBJECTIVE:The aim of this review was to collect and outline the current experiences and learnings that have been generated as medical schools have sought to implement telemedicine capacity-building into undergraduate medical education. METHODS:We performed a mixed-methods review, starting with a literature review via Scopus, tracking with Excel, and an email outreach effort utilizing telemedicine curriculum data gathered by the Liaison Committee on Medical Education. This outreach included 70 institutions and yielded 7 interviews, 4 peer-reviewed research papers, 6 online documents, and 3 completed survey responses. RESULTS:There is an emerging, rich international body of learning being generated in the field of telemedicine training in undergraduate medical education. The integration of telemedicine-based lessons, ethics case-studies, clinical rotations, and even teleassessments are being found to offer great value for medical schools and their students. Most medical students find such training to be a valuable component of their preclinical and clinical education for a variety of reasons, which include fostering greater familiarity with telemedicine and increased comfort with applying telemedical approaches in their future careers. CONCLUSIONS:These competencies are increasingly important in tackling the challenges facing health care in the 21st century, and further implementation of telemedicine curricula into undergraduate medical education is highly merited.
Project description:European medical students should have acquired adequate prescribing competencies before graduation, but it is not known whether this is the case. In this international multicenter study, we evaluated the essential knowledge, skills, and attitudes in clinical pharmacology and therapeutics (CPT) of final-year medical students across Europe. In a cross-sectional design, 26 medical schools from 17 European countries were asked to administer a standardized assessment and questionnaire to 50 final-year students. Although there were differences between schools, our results show an overall lack of essential prescribing competencies among final-year students in Europe. Students had a poor knowledge of drug interactions and contraindications, and chose inappropriate therapies for common diseases or made prescribing errors. Our results suggest that undergraduate teaching in CPT is inadequate in many European schools, leading to incompetent prescribers and potentially unsafe patient care. A European core curriculum with clear learning outcomes and assessments should be urgently developed.
Project description:BACKGROUND:Spiritual care competencies are among the primary professional skills that enable best practices in nursing. Assessing these competencies and identifying those that are insufficient are important tasks. The traditional Chinese version of the Palliative Care Spiritual Care Competency Scale (PCSCCS) used in Taiwan is a well-validated tool to measure palliative caregivers' competencies in providing spiritual care. However, whether this scale is valid and reliable for use with nurses in other health-care contexts is unknown. The purpose of this study is to determine this version's validity and reliability for use with nurses in mainland China. METHODS:The PCSCCS was first converted into a simplified Chinese version (PCSCCS-M) from the traditional Chinese version used in Taiwan such that mainland nurses could read and understand it easily. Then, the validity and reliability of the PCSCCS-M was evaluated with 400 Chinese nurses recruited using convenience sampling from three university-affiliated comprehensive hospitals, two cancer hospitals, one psychiatric hospital, two traditional Chinese medicine hospitals, one marital and child service care center, and one community health service center. Concurrent validity was assessed using Pearson's correlation coefficients of the PCSCCS-M and the Chinese version of the Spiritual Care-Giving Scale (C-SCGS). Exploratory factor analysis (EFA) was performed to determine the construct validity. Confirmatory factor analysis (CFA) was conducted using another sample of 351 nurses to verify the quality of the factor structures of the PCSCCS-M. An internal consistency test based on Cronbach's alpha coefficient and a stability test based on the Guttman split-half coefficient were also conducted. RESULTS:Useful data were obtained from 356 participants (response rate: 89%). EFA confirmed a three-dimensional structure of the scale after one item was deleted, and the three factors explained 63.839% of the total variance. Cronbach's alpha coefficients of the three subscales were 0.811, 0.889 and 0.896, and the Guttman split-half coefficient for the PCSCCS-M was 0.862. Modified CFA indicated a well-fitting model. The correlation between the PCSCCS-M and C-SCGS was 0.340 (p < 0.01). CONCLUSIONS:The PCSCCS-M is a brief, easy-to-understand, and psychometrically sound measurement tool to evaluate spiritual care competencies in nurses from mainland China.
Project description:BACKGROUND: Since 2008 the Verbundweiterbildung(plus) programme of the Competence Centre General Practice Baden-Wuerttemberg offers continual improvement with regards to content and structure of general practice training. The programme uses the didactical concept of the CanMEDs competencies, which were developed in Canada, as a postgraduate medical training framework. Train the trainer (TTT)-programmes are an additional important element of these contentual optimisations of postgraduate training. Within this article we describe the conception and evaluation of the first TTT-workshop within the programme Verbundweiterbildung(plus). METHODS: The conception of the first TTT-workshop was influenced by results of a survey of general practitioner (GP) trainers and by experiences with teaching GP trainers involved in medical undergraduate teaching. A questionnaire was designed to get a self-assessment about organisational and didactic aspects oriented on the CanMEDs competencies of postgraduate medical training. In addition, the workshop was evaluated by the participants. RESULTS: The workshop lasted 12 teaching units and included the following elements: introduction into the CanMEDs competencies, feedback training, fault management, legal and organisational aspects of post graduate training. From the 29 participating trainers 76% were male and on average 57 years old. The evaluation showed a good to very good acceptance of the workshop. Initial self-rating showed the need of improving in the fields of determining learning objectives, providing formative feedback and incorporation of a trainee. Most trainers rated themselves as very good in procure CanMEDs competencies with the exclusion of the competencies "Manager" and "Scholar". CONCLUSION: A TTT-programme is an important method to improve GP training which has not been used in Germany so far. Such a GP TTT-programme should highlight especially training in providing feedback and teaching in management aspects. Results of this article add information that can be used for developing TTT-programmes also in other specialties.
Project description:BACKGROUND:Patient-led education contributes to the implementation of practical experience of working with patients in health care professional curricula. There are few descriptions of patients' involvement in pharmacists' training and most often, the patients have been used as passive props to facilitate training. More recently, greater emphasis has been given to a more active form of patient involvement but the application in the curriculum of pharmacy has not been conceptualized. Thus, the aim of our study was to implement a workshop involving patients as partners in undergraduate pharmacy educational programme, and to evaluate its impact of on students' perspectives. METHOD:On a prospective observational study basis, the impact was assessed in terms of relevance, learning outcomes and achievement transfer using the Kirkpatrick training assessment method. In addition, we evaluated social representations of the students before and after the workshop. RESULTS:Ninety-four students attended the sessions. All participants were satisfied and emphasized the relevance of the involvement of patients. Postworkshop scores were significantly improved in both competencies to be acquired. At the end of the workshop, students reported two to three actions to implement in order to meet patients' expectations, illustrating an intent to transfer learning outcomes in professional context. Interestingly, about patients' expectations on pharmacist's role, students' social representations had evolved significantly after the session. CONCLUSION:These results highlight the positive impact of the innovative workshops and the additive value of patients' involvement in the pharmacy undergraduate programme.
Project description:BACKGROUND:Although spiritual care is a basic element of holistic nursing, nurses' spiritual care knowledge and abilities are often unable to satisfy patients' spiritual care needs. Therefore, nurses are in urgent need of relevant training to enhance their abilities to provide patients with spiritual care. DESIGN:A nonrandomized controlled trial. OBJECTIVE:To establish a spiritual care training protocol and verify its effectiveness. METHODS:This study recruited 92 nurses at a cancer treatment hospital in a single province via voluntary sign-up. The nurses were divided into two groups-the study group (45 people) and the control (wait-listed) group (47 people)-using a coin-toss method. The study group received one spiritual care group training session every six months based on their routine nursing education; this training chiefly consisted of lectures by experts, group interventions, clinical practice, and case sharing. The control group participated in monthly nursing education sessions organized by the hospital for 12 continuous months. RESULTS:After 12?months of intervention, the nurses in the study group had significantly higher overall spiritual health and spiritual care competency scores as well as significantly higher scores on all individual dimensions compared with those in the control group (P?<?0.01). CONCLUSIONS:A spiritual care training protocol for nurses based on the concept of mutual growth with patients enhances nurses' spiritual well-being and spiritual care competencies.
Project description:<h4>Background</h4>Identifying essential competencies in end-of-life care, as well as general practitioners' (GPs) confidence in these competencies, is essential to guide training and quality improvement efforts in this domain.<h4>Aim</h4>To determine which competencies in end-of-life care are considered important by GPs, to assess GPs' confidence in these competencies in a European context and their reasons to refer terminally ill patients to a specialist.<h4>Design and setting</h4>Cross-sectional postal survey involving a stratified random sample of 2000 GPs in Switzerland in 2014.<h4>Method</h4>Survey development was informed by a previous qualitative exploration of relevant end-of-life GP competencies. Main outcome measures were GPs' assessment of the importance of and confidence in 18 attributes of end-of-life care competencies, and reasons for transferring care of terminally-ill patients to a specialist. GP characteristics associated with main outcome measures were tested using multivariate regression models.<h4>Results</h4>The response rate was 31%. Ninety-nine percent of GPs considered the recognition and treatment of pain as important, 86% felt confident about it. Few GPs felt confident in cultural (16%), spiritual (38%) and legal end-of-life competencies such as responding to patients seeking assisted suicide (35%) although more than half of the respondents regarded these competencies as important. Most frequent reasons to refer terminally ill patients to a specialist were lack of time (30%), better training of specialists (23%) and end-of-life care being incompatible with other duties (19%). In multiple regression analyses, confidence in end-of-life care was positively associated with GPs' age, practice size, home visits and palliative training.<h4>Conclusions</h4>GPs considered non-somatic competencies (such as spiritual, cultural, ethical and legal aspects) nearly as important as pain and symptom control. Yet, few GPs felt confident in these non-somatic competencies. These findings should inform training and quality improvement efforts in this domain, in particular for younger, less experienced GPs.
Project description:In the context of the 2016 Peace Agreement signed between the Colombian government and the FARC-EP (Fuerzas Armadas Revolucionarias de Colombia-Ejército del Pueblo), several challenges for society and academia have emerged: (1) overcoming the gap between the rural and urban settings, which has been one of the roots of the Colombian armed conflict, and (2) training psychologists and transforming traditional educational practices, which have not been designed to fulfill community needs in a post-conflict setting. One of the strategies from academia to overcome these difficulties is to create alliances with rural communities where students learn key competences to foster a horizontal approach while actively working with the community. In the region of Caquetá, Colombia, two Territorial Spaces for Training and Reincorporation (ETCR) were created in order to provide a space for former guerrilla members' reintegration to civil society. In the ETCR Héctor Ramírez, 27 students and two faculty participated in a service-learning project (2 weeks in December 2018 and two in June 2019) where they engaged in local daily practices and social projects based on the community's prioritized needs. The aim of this study was to analyze the learning process of undergraduate psychology students in this community psychology service-learning project in the context of peacebuilding in Colombia. This study is grounded in a Participatory Action Research (PAR) approach and data collected include reflective narratives and video diaries by students before and during the course, and two focus groups after the experience. Findings suggest that students who participated in the experience are in the process of developing cultural humility, through affective understandings and the consolidation of communities of practice that include the former guerrilla members and their knowledges. Preparing psychologists to lead peacebuilding and reconciliation processes is of importance to the field because the professional competencies gained in this context surpass the professional practice as they become part of the students' abilities as citizens. The social impact is twofold: the students learn to create partnerships where purposes are co-constructed and trust-based, while the community takes the lead of their processes creating alliances with an academia that recognizes their knowledge and practices.