David Hollar

Teamwork training with nursing and medical students: does the method matter? Results of an interinstitutional, interdisciplinary collaboration

Objectives The authors conducted a randomised controlled trial of four pedagogical methods commonly used to deliver teamwork training and measured the effects of each method on the acquisition of student teamwork knowledge, skills, and attitudes. Methods The authors recruited 203 senior nursing students and 235 fourth-year medical students (total N=438) from two major universities for a 1-day interdisciplinary teamwork training course. All participants received a didactic lecture and then were randomly assigned to one of four educational methods: didactic (control), audience response didactic, role play and human patient simulation. Student performance was assessed for teamwork attitudes, knowledge and skills using: (a) a 36-item teamwork attitudes instrument (CHIRP), (b) a 12-item teamwork knowledge test, (c) a 10-item standardised patient (SP) evaluation of student teamwork skills performance and (d) a 20-item modification of items from the Mayo High Performance Teamwork Scale (MHPTS). Results All four cohorts demonstrated an improvement in attitudes (F1,370=48.7, p=0.001) and knowledge (F1,353=87.3, p=0.001) pre- to post-test. No educational modality appeared superior for attitude (F3,370=0.325, p=0.808) or knowledge (F3,353=0.382, p=0.766) acquisition. No modality demonstrated a significant change in teamwork skills (F3,18=2.12, p=0.134). Conclusions Each of the four modalities demonstrated significantly improved teamwork knowledge and attitudes, but no modality was demonstrated to be superior. Institutions should feel free to utilise educational modalities, which are best supported by their resources to deliver interdisciplinary teamwork training.

Progress along developmental tracks for electronic health records implementation in the United States

The development and implementation of electronic health records (EHR) have occurred slowly in the United States. To date, these approaches have, for the most part, followed four developmental tracks: (a) Enhancement of immunization registries and linkage with other health records to produce Child Health Profiles (CHP), (b) Regional Health Information Organization (RHIO) demonstration projects to link together patient medical records, (c) Insurance company projects linked to ICD-9 codes and patient records for cost-benefit assessments, and (d) Consortia of EHR developers collaborating to model systems requirements and standards for data linkage. Until recently, these separate efforts have been conducted in the very silos that they had intended to eliminate, and there is still considerable debate concerning health professionals access to as well as commitment to using EHR if these systems are provided. This paper will describe these four developmental tracks, patient rights and the legal environment for EHR, international comparisons, and future projections for EHR expansion across health networks in the United States.

Increasing Interest in Child and Adolescent Psychiatry in the Third-Year Clerkship: Results from a Post-Clerkship Survey

ObjectiveThe authors aimed to determine whether a structured clinical experience in child and adolescent psychiatry (CAP) during the third-year psychiatry clerkship would impact interest in pursuing careers in psychiatry and CAP.MethodsThe authors constructed and administered a postrotation survey, the Child and Adolescent Psychiatry Experiences Questionnaire (CAPE-Q), to evaluate clinical experiences and career interest in psychiatry and CAP both before and after a clerkship in psychiatry. The value of specific aspects of the clerkship to students’ career decisions was also assessed. The students completed the surveys at the end of their psychiatry clerkship in the 2005–2006 academic year and in their first rotation of 2006–2007.ResultsOf the 98 respondents, the majority reported no change in interest in general psychiatry or in CAP after the clerkship. However, exposure to inpatient CAP correlated with increased interest in the field and in its influence on pursuing a CAP career Interest in CAP positively correlated with agreement that the CAP clinical experience influenced their career decision. The influence of the CAP clinical experience on career decision was associated with interest in both psychiatry and CAP, as well as with change in CAP interest after the clerkship.ConclusionThese preliminary results suggest that the CAPE-Q may be useful for assessing students’ clerkship experiences and the impact of these experiences on their decision to pursue a career in child psychiatry. Here, inpatient CAP experience led to increased interest in the field. The CAPE-Q could be used to identify students for whom electives and mentoring opportunities could be arranged. It could also be used in assessment of clerkship experiences.

COCOA: A New Validated Instrument to Assess Medical Students' Attitudes Towards Older Adults

This study tested the reliability and validity of the Carolina Opinions on Care of Older Adults (COCOA) survey compared with the Geriatric Assessment Survey (GAS). Participants were first year medical students (n = 160). A Linear Structural Relations (LISREL) measurement model for COCOA had a moderately strong fit that was significantly better than the null model (GFI = 0.81, TLI = 0.90) and the GAS (GFI = 0.76). A reduced, 24-item COCOA performed well (GFI = 0.90, TLI = 1.00) with R 2 = .595 on five factors. The COCOA and GAS represent complementary instruments for assessing attitudes towards older adults.

Genetic and Metabolic Conditions for Children with Special Health Care Needs

Public health disease prevention programs have expanded newborn screening to most nations, although lack of access to prenatal and birth care continues to be a major challenge to improving child health and reducing morbidity/mortality in poor, rural, and other disadvantaged regions. Newborn screening involves collection of a few blood spots from a newborn infant’s heel, followed by rapid laboratory analysis, often at a centralized testing facility, and relaying of the test results to the pediatrician for appropriate action. Such testing and rapid reporting are important for some genetic conditions such as phenylketonuria and classical galactosemia, where failure to provide treatment and restricted diets within days can result in severe brain damage, permanent disability, and/or death. Newborn screening started in the 1970s with a core set of tested conditions, including phenylketonuria, sickle-cell anemia and other hemoglobinopathies, galactosemia, and congenital hypothyroidism. Beginning around 2000, the invention of Tandem Mass Spectrometry enabled testing of a wide array of additional amino acid, organic acid, and fatty acid metabolic conditions so that currently in the United States, more than 50 genetic or metabolic conditions are tested. An overview of many of these screened conditions is provided along with resources for more information, although the number of documented, different conditions numbers in the thousands, most of which cannot be diagnosed with current newborn screening technology. The provided resources provide excellent details and emphasize the importance of proper prenatal and postnatal pediatric care and monitoring to identify these conditions if they arise. Most conditions are treatable with proper nutritional restrictions.

Development from Conception through Adolescence: Physiological and Psychosocial Factors Impacting Children with Special Health Care Needs

Human development for children with special health care needs (CSHCN) can be approached from purely psychological/psychosocial or physiological perspectives. Nevertheless, both of these developmental perspectives are rooted in the combined genetic, epigenetic, and environmental factors that uniquely shape each individual. With advances in genomics, we are finding that every person experiences disability and special needs, whether major or minor in extent, and that childhood and adolescent physiology and behaviors derive from events in utero and even earlier in the individual’s ancestry. Therefore, we start with theories of psychosocial development, mostly nonbiological in scope, then trace back to physical development from conception to birth, and conclude with a summary of “birth defects,” that is, conditions monitored by public health systems and that arise from genetic, cell division, or environmental exposures in utero that impact later physical and psychosocial development. The ultimate goals are to illustrate Wilson’s consilience concept as applied to human development as well as contextual, biopsychosocial approaches (e.g., theInternational Classification of Functioning, Disability and Health) towards improving CSHCN life outcomes from social and community perspectives.

Epilogue: Advancing Health Outcomes and Social Participation for CSHCN

Children with special health care needs (CSHCN), including children with disabilities, represent a large percentage of children in every human society. CSHCN represent just another aspect of human variation or diversity, with focal conditions arising from a multitude of genetic and/or environmental causes, many of which are incompletely understood at present. As outlined in the chapters of this book, considerable medical, public health, and educational research is being conducted worldwide to better understand the etiology of numerous conditions, to identify effective treatments that improve health outcomes and quality of life for CSHCN, and to provide safe, healthy environments where children with and without disabilities can positively interact socially so that CSHCN can grow and develop into independent and productive adult lives wherever possible.

Research Methods and Epidemiology for Children with Special Health Care Needs

Children with special health care needs (CSHCN) are the subject of many research activities that aim to directly or indirectly benefit CSHCN. Consequently, researchers must abide by high ethical standards in the planning, design, conduct, reporting, and protection of CSHCN data in their research work. Most importantly, researchers must view and respect CSHCN research participants as unique individuals with equal human and civil rights. The purpose of this chapter is to describe appropriate research design approaches, research ethics, respect for CSHCN, their families, and privacy rights, and epidemiological statistical methodologies. We discuss these issues within the context of biopsychosocial models such as the International Classification of Functioning, Disability and Health (ICF), Healthy People 2010 and 2020, Focus Group 6 (Disability and Secondary Conditions), as well as with respect to US legislation such as the Family Educational Rights and Privacy Act (FERPA) and the Health Insurance Portability and Accountability Act (HIPAA). Throughout research activities with CSHCN, the focus should be on rigorous methods that have the potential to benefit CSHCN while minimizing risks and protecting individual rights of CSHCN.