Educational Experiences Within the Learning Community: ECHO Effects on Participants and Clients

Although Project ECHO is a well-established, effective model to promote quality care in the general healthcare field, this project is the first attempt to implement the model with community care providers of individuals with IDD who are affected by dementia. In order to capture spokes’ (community providers and NTG-Affiliated Regional Trainers) experiences and explore potential benefits, we conducted a content analysis of qualitative data gathered from a spoke feedback session and follow-up surveys from the same group (n = 20). Our findings indicated that spokes appreciated (1) didactic sessions by gaining new knowledge; (2) in-depth, mutual discussion about their cases; (3) experts taking time and ensuring their good practices; and (4) the ability to apply this gained knowledge to their day-to-day practices to improve quality of life for individuals with IDD and their families. We will discuss specific examples that inform future practices.

Using Padlets as E-Portfolios to Enhance Undergraduate Students’ Writing Skills and Motivation

Despite the increasing support for the use of e-portfolios, research on its utility is just beginning to emerge. In terms of the current study, 200 students were asked to create digital portfolios with Padlet, share their e-portfolios via their Virtual Learning Platform (VLE), and ask for peer and lecturer feedback every time they completed a written task. Using a diagnostic test and their final assignment, students had to write a reflective report at the beginning and the end of an academic term. They also interacted every week using a forum created by their lecturer to enhance collaboration and peer support. At the end of each interactive feedback session, they had to reflect on their work and the feedback they received and post their self-reflections on the forum. Findings indicated that students managed to improve their writing performance significantly and enhance their motivation towards writing and learning in general due to this innovative alternative assessment method. This was evident from their final reflective reports, their focus group discussions, and the anonymous feedback they provided through Mentimeter. Students reported that they enjoyed this interactive experience which was both engaging and rewarding. However, students expressed their wish for more support when using IT tools and e-portfolios and asked to be guided to develop their writing and reflective skills and engage even more with their e-portfolios.

How Do Simulated Interviews Increase the Self-efficacy of Medical Students? - Quasi-experimental Research-

Background Self-efficacy is crucial in improving medical student communication skills. This study aims to clarify whether the self-efficacy of medical students conducting medical interviews increased after simulated interviews or after feedback discussions. Methods A total of 162 medical students (109 men, 53 women) in their fourth or fifth year at a university in Japan participated in this study. The degree of self-efficacy in medical interviewing was measured before and after a medical interview with a simulated patient, and after the subsequent feedback session. Results ANOVA analysis revealed that self-efficacy for medical interviews was higher after both the interview and the feedback session than before the interview. Self-efficacy was highest after the feedback session among all three time points. Conclusions Feedback following a simulated interview with a simulated patient is important to improve the self-efficacy of medical students learning medical interviewing skills.

The Thurston Cradock Test of Shame as a Crucial “Empathy Magnifier”

This article presents a Therapeutic Assessment (TA; Finn, 2007 ) case study of a teenage girl assessed because of a complex set of symptoms: history of suicidal statements, sensory sensitivity, questions about gender identity, depression, anxiety/OCD, and possible subclinical psychotic symptoms. Logan’s parents, Joe and Susan, participated in the assessment, with Susan attending every appointment and Joe attending only the first and last. Ten instruments were administered, with each providing information about different aspects of Logan. The Thurston Cradock Test of Shame (TCTS; Thurston & Cradock O’Leary, 2009 ) scores and analysis encompassed all of the other test findings, clarified details not fully explained by tests such as the Rorschach and MMPI-A, and brought the core adolescent and family issue of shame to the foreground. When the assessors explained shame to Logan’s mother, she was better able to understand her daughter’s shame and connect with her own feelings of shame. When Logan’s father arrived for the final feedback session, he was quite tense, argumentative, and threatened to cancel the appointment. The TCTS allowed the assessors to understand Joe’s aggressive behavior as signs of TCTS defenses of deflation, aggression, and inflation/contempt, appreciate his underlying feelings of shame, and to delicately restore the “interpersonal bridge” ( Kaufman, 1996 ), which is key to reducing shame. As a result, Joe’s defensiveness decreased, and he was open to continuing the feedback session. In the end, Joe was able to identify with his daughter in a new way and even admit his own sense of shame in the session. This provided an opportunity for healing in the whole family.

SP6 Building on the druggle: personalised feedback to improve and maintain good prescribing practice

BackgroundInspired by work from a number of other centres,1 2 a weekly ‘Druggle’ was set up on our 28 cot tertiary, level 3 neonatal intensive care unit in June 2018. The Druggle is a short pharmacist-led briefing in the clinical area involving doctors and nurses, focussing on prescribing and administration issues and errors. Over the first year a concurrent zero tolerance audit shows an improvement in prescribing practice, with an increased number of charts with zero errors (63% in June 2018, 95% in June 2019). Despite the improvements in prescribing practice, average attendance at the Druggle has fallen from 17 people per week to 7 over the year. It was decided to consider personalised feedback on prescribing as a potential new mechanism to improve and maintain prescribing standards.AimTo investigate if structured, personalised feedback to prescribers on a neonatal unit could be an innovative way of improving prescribing standards and patient safety. The project was set up to gain an insight into prescribers attitudes towards prescribing feedback and to see what impact that feedback might have on their attitudes after it had been carried out.MethodAll prescribers on the unit were invited to complete an online questionnaire which included questions on previous experience of feedback and attitudes towards structured, personalised prescribing feedback. Participants were also able to express their interest in participating in a feedback session.A selection of prescribers who had chosen to participate were then monitored and contacted to arrange a feedback session. This comprised of a short interview style session based on Pendleton’s rules for feedback3 in which pictures of their prescriptions were appraised and a structured feedback form completed by the pharmacist was reviewed. The feedback form was split into sections covering legibility, accuracy and completeness, with each section having a non-numerical scoring system, together with practical examples and suggestions for improvement.After the feedback session, prescribers were asked to complete a feedback response form which allowed them to express how useful they found the feedback, whether they felt it would change their practice and to give comments.ResultsThe initial questionnaire was completed by a wide variety of prescribers including different grades of doctor and advanced neonatal nurse practitioners (ANNPs) with a range of 0–15 years of neonatal prescribing experience. 45% of respondents had never received personalised prescribing feedback, and 90% of respondents said they would welcome it. Comments included a desire for positive feedback as well as suggestions for how to improve. Feedback sessions are still ongoing, and initial results of the post-feedback questionnaire are positive – mean score of 4.3/5 for usefulness of feedback to practice. Comments include ‘This has been the single most useful feedback for my prescribing practice to date’ – ST5 Doctor.ConclusionProviding personalised feedback to prescribers is welcomed and should be explored more widely. Initial results show that prescribers find personalised feedback useful and they can use it as a basis for reflecting on prescribing practice.ReferencesReece A, Hill A, Platt B, et al. G171 Improving situation awareness in prescribing: A medication safety huddle – the DRUG-gle (Druggle). Arch Dis Child 2016;101:A89.Bell C, Jackson J, Shore H. P3 S.a.f.e. – the positive impact of ‘druggles’ on prescribing standards and patient safety within the neonatal intensive care environment. Arch Dis Child, 2018;103:e2.Pendleton D, Schofield T, Tate P, et al. The consultation: an approach to learning and teaching. Oxford: Oxford University Press, 1983.

Group-facilitated audit and feedback to improve bronchiolitis care in the emergency department

ABSTRACTObjectiveDespite strong evidence recommending supportive care as the mainstay of management for most infants with bronchiolitis, prior studies show that patients still receive low-value care (e.g., respiratory viral testing, salbutamol, chest radiography). Our objective was to decrease low-value care by delivering individual physician reports, in addition to group-facilitated feedback sessions to pediatric emergency physicians.MethodsOur cohort included 3,883 patients ≤ 12 months old who presented to pediatric emergency departments in Calgary, Alberta, with a diagnosis of bronchiolitis from April 1, 2013, to April 30, 2018. Using administrative data, we captured baseline characteristics and therapeutic interventions. Consenting pediatric emergency physicians received two audit and feedback reports, which included their individual data and peer comparators. A multidisciplinary group-facilitated feedback session presented data and identified barriers and enablers of reducing low-value care. The primary outcome was the proportion of patients who received any low-value intervention and was analysed using statistical process control charts.ResultsSeventy-eight percent of emergency physicians consented to receive their audit and feedback reports. Patient characteristics were similar in the baseline and intervention period. Following the baseline physician reports and the group feedback session, low-value care decreased from 42.6% to 27.1% (absolute difference: −15.5%; 95% CI: −19.8% to −11.2%) and 78.9% to 64.4% (absolute difference: −14.5%; 95% CI: −21.9% to −7.2%) in patients who were not admitted and admitted, respectively. Balancing measures, such as intensive care unit admission and emergency department revisit, were unchanged.ConclusionThe combination of audit and feedback and a group-facilitated feedback session reduced low-value care for patients with bronchiolitis.

Quantification of Passive Ventilation Produced by Manual Chest Compressions Using a New Cardiopulmonary Resuscitation Feedback Device

Several studies have shown that chest compressions (CC) alone may produce in addition to blood circulation, a short-term passive ventilation. However, it is not clear whether high CC quality may produce in even greater amount of ventilation volumes. The aim of this study was to evaluate whether CC, using a new feedback device, can produce a substantial and sustainable passive volumes compared to standard CC. Thirty inexperienced volunteers performed CC for 2 min on a developed thoracic lung model and using a new feedback device. Participants were randomized into two groups that performed either CC with feedback first, followed by a trial without feedback, or vice versa. Efficient compression rate (correct CC rate and depth simultaneously) was significantly higher in feedback session (43.6% versus 25.5%; P = 0.006). As well, CC rate and depth efficiency were improved with feedback. Moreover, average tidal volumes and minute volumes that occurred during CC alone were significantly improved in feedback session (79.8 ± 5 ml versus 72.9 ± 7 ml) and (8.8 l/min versus 7.9 l/min), respectively (P < 0.001). Yet, no significant difference was found between the first and the 90th second interval (9.04 l/min versus 8.68 l/min, P = 0.163) in the feedback session. Conversely, a significant difference was evident after the first 15th seconds interval without feedback (8.77 l/min initially versus 8.38 l/min; P = 0.041). This study revealed that the new CPR feedback device improved CC quality in inexperienced volunteers. As well, the passive ventilation volumes were significantly increased and sustained when the device was used.