J. Denekens

Patient adherence to treatment: three decades of research. A comprehensive review

Low compliance to prescribed medical interventions is an ever present and complex problem, especially for patients with a chronic illness. With increasing numbers of medications shown to do more good than harm when taken as prescibed, low compliance is a major problem in health care. Relevant studies were retrieved through comprehensive searches of different database systems to enable a thorough assessment of the major issues in compliance to prescribed medical interventions. The term compliance is the main term used in this review because the majority of papers reviewed used this term.

Can medical schools rely on clerkships to train students in basic clinical skills

 Many medical schools have drawn up lists of basic clinical skills that students are required to have mastered at the end of medical training. To determine whether undergraduate students actually perform these basic clinical skills during clerkships and whether different approaches to skills training led to different results, we surveyed 365 final‐year medical students in 1996 and 1997.

An evaluation study of the didactic quality of clerkships

Previous qualitative research at the University of Antwerp revealed dissatisfaction amongst medical students about clinical clerkships.

Effectiveness of basic clinical skills training programmes: a cross-sectional comparison of four medical schools

Training in physical diagnostic skills is an important part of undergraduate medical education. The objective of this study was to study the outcome of skills training at four medical schools.

Correlation of a written test of skills and a performance based test: a study in two traditional medical schools

Studies in innovative curricula have shown that a written test of skills is potentially able to predict OSCE scores. In this study we verified the potential of a written test of skills as an alternative to an OSCE in two traditional medical schools. A 12 station OSCE was scored using detailed checklists and global rating scales. The written test of skills consisted of 132 true-false questions. Students were assessed immediately before graduation in 1997. The size of the reported correlations confirms that the written test of skills can be used to predict performance-based test scores in traditional medical schools to some extent. For research purposes, particularly for outcome research to compare curricula of medical schools, a written test of skills is a viable alternative to performance-based testing. A written test of skills is unable to replace the OSCE for assessment of individual students.

Unsatisfactory basic skills performance by students in traditional medical curricula

Effectivity of basic clinical skills among students in their final year at two typically European medical schools was evaluated. The two schools rely heavily on clerkships to train basic clinical skills. Three groups of final-year students from two medical schools were studied in a 12-station, 13-minute OSCE. This OSCE was based on existing skill lists and was constructed in close consultation with faculty of both schools. Observers were senior faculty and experienced general practitioners. Students were rated unsatisfactory in any station when a mean score of 50% was given. Results show poor overall performance, indicating defective skills training, for skills of both the compulsory and the non-compulsory clerkships. Therefore curricula need revision and in the meantime basic clinical skills should receive ample attention in postgraduate education.

Contraceptive knowledge and expectations by adolescents: an explanation by focus groups.

To determine the needs and expectations of adolescent girls concerning contraceptive use as well as their attitude to health care providers, a qualitative research was performed with four focus groups of 17-year-old girls of different education levels. All 26 girls except one were of Belgian origin. There was a fixed scenario for each group. The discussions were tape-recorded, transcribed and analysed via content analysis. Knowledge concerning the daily use and side-effects of contraceptives was insufficient. A school physician is not the person they want to talk to. The influence of the peer in the group is very important. The general practitioner is the most frequently consulted health care provider for the first pill prescription, but for a gynaecological examination they thought they had to visit a gynaecologist. The girls expected confidentiality from their general practitioner and wanted sufficient consultation time. Factors inhibiting the visits for obtaining contraceptives were the cost, waiting time and fear of the gynaecological examination. Adolescents intended to visit their general practitioner for contraceptives, but the family practice had to be easily accessible. It is a challenge for general practitioners to provide good contraceptives to adolescents and to promote compliance.

Factors determining the place of palliative care and death of cancer patients

Abstract Factors determining the place of palliative care and death were studied by interviewing 40 patients using a semi-structured questionnaire. The 86 interviews assessed showed that both emotional and somatic factors played a part in the determination of whether patients were transferred and of their place of death. Emotional factors were mentioned in 41% as being of importance, and physical factors in 32%. Material and financial factors are probably underestimated owing to the methodology.

A contingency perspective on team learning and innovation in nursing

AIMS To report a correlational study of the relation between team learning activities and implementation-effectiveness of innovations in nursing teams. BACKGROUND Non-compliance to implementation of innovations is a problem in nursing teams. In the literature, team learning is proposed as a facilitator for change. Still, studies reporting the effects of team learning activities on the implementation of innovations in nursing teams are scarce. To address this gap in the literature, this study explored the influence of team learning on the implementation of two innovations. DESIGN A cross-sectional survey. METHODS The survey was conducted in 2008-2009 with a sample of 469 nurses, representing 30 nursing teams from The Netherlands and Belgium. The relationship between variables representing team learning and the use and the knowledge of an incremental (n = 14) or a radical innovation (n = 16) was examined by correlation and multiple regression analyses. RESULTS Correlation analyses revealed positive relationships between the team learning activities handling production-oriented information and implementation-effectiveness of an incremental innovation. In addition, team learning activities about development-oriented information positively affected the implementation of a radical innovation. Multiple regression yielded models that explain 83% of the variance on the use of an incremental variable, 73% on knowledge of a radical innovation, and 80% on use of a radical innovation. CONCLUSION In nursing teams, team learning activities that relate to the production of nursing care affect the implementation of an incremental innovation. The implementation of a radical innovation is effected by team learning activities that relate to the development of the provided nursing care.

Team learning and innovation in nursing, a review of the literature

The capability to learn and innovate has been recognized as a key-factor for nursing teams to deliver high quality performance. Researchers suggest there is a relation between team-learning activities and changes in nursing teams throughout the implementation of novelties. A review of the literature was conducted in regard to the relation between team learning and implementation of innovations in nursing teams and to explore factors that contribute or hinder team learning. The search was limited to studies that were published in English or Dutch between 1998 and 2010. Eight studies were included in the review. The results of this review revealed that research on team learning and innovation in nursing is limited. The included studies showed moderate methodological quality and low levels of evidence. Team learning included processes to gather, process, and store information from different innovations within the nursing team and the prevalence of team-learning activities was contributed or hindered by individual and contextual factors. Further research is needed on the relation between team learning and implementation of innovations in nursing.