The Interprofessional Collaborative Competency Attainment Survey (ICCAS): A replication validation study.

This study replicates a validation of the Interprofessional Collaboration Competency Attainment Survey (ICCAS), a 20-item self-report instrument designed to assess behaviours associated with patient-centred, team-based, collaborative care. We appraised the content validity of the ICCAS for a foundation course in interprofessional collaboration, investigated its internal (factor) structure and concurrent validity, and compared results with those obtained previously by ICCAS authors. Self-assessed competency ratings were obtained from a broad spectrum of pre-licensure, health professions students (n = 785) using a retrospective, pre-/post-design. Moderate to large effect sizes emerged for 16 of 20 items. Largest effects (1.01, 0.94) were for competencies emphasized in the course; the smallest effect (0.35) was for an area not directly taught. Positive correlations were seen between all individual item change scores and a separate item assessing overall change, and item-total correlations were moderate to strong. Exploratory factor analysis was used to understand the interrelationship of ICCAS items. Principal component analysis identified a single factor (Cronbach's alpha = 0.96) accounting for 85% of the total variance-slightly higher than the 73% reported previously. Findings suggest strong overlaps in the proposed constructs being assessed; use of a total average score is justifiable for assessment and evaluation.

Designing faculty development to support the evaluation of resident competency in the intrinsic CanMEDS roles: practical outcomes of an assessment of program director needs.

BACKGROUND: The Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada mandate that faculty members demonstrate they are evaluating residents on all CanMEDS (Canadian Medical Education Directions for Specialists) roles as part of the accreditation process. Postgraduate Medical Education at the University of Ottawa initiated a 5-year project to develop and implement a comprehensive system to assess the full spectrum of CanMEDS roles. This paper presents the findings from a needs assessment with Program Directors, in order to determine how postgraduate medical faculty can be motivated and supported to evaluate residents on the intrinsic CanMEDS roles. METHODS: Semi-structured individual interviews were conducted with 60 Postgraduate Program Directors in the Faculty of Medicine. Transcribed interviews were analyzed using qualitative analysis. Once the researchers were satisfied the identified themes reflected the views of the participants, the data was assigned to categories to provide rich, detailed, and comprehensive information that would indicate what faculty need in order to effectively evaluate their residents on the intrinsic roles. RESULTS: Findings indicated faculty members need faculty development and shared point of care resources to support them with how to not only evaluate, but also teach, the intrinsic roles. Program Directors expressed the need to collaborate and share resources across departments and national specialty programs. Based on our findings, we designed and delivered workshops with companion eBooks to teach and evaluate residents at the point of care (Developing the Professional, Health Advocate and Scholar). CONCLUSIONS: Identifying stakeholder needs is essential for designing effective faculty development. By sharing resources, faculties can prevent 'reinventing the wheel' and collaborate to meet the Colleges' accreditation requirements more efficiently.

Residents' and preceptors' perceptions of the use of the iPad for clinical teaching in a family medicine residency program.

BACKGROUND: As Family Medicine programs across Canada are transitioning into a competency-based curriculum, medical students and clinical teachers are increasingly incorporating tablet computers in their work and educational activities. The purpose of this pilot study was to identify how preceptors and residents use tablet computers to implement and adopt a new family medicine curriculum and to evaluate how they access applications (apps) through their tablet in an effort to support and enhance effective teaching and learning. METHODS: Residents and preceptors (n = 25) from the Family Medicine program working at the Pembroke Regional Hospital in Ontario, Canada, were given iPads and training on how to use the device in clinical teaching and learning activities and how to access the online curriculum. Data regarding the use and perceived contribution of the iPads were collected through surveys and focus groups. This mixed methods research used analysis of survey responses to support the selection of questions for focus groups. RESULTS: Reported results were categorized into: curriculum and assessment; ease of use; portability; apps and resources; and perceptions about the use of the iPad in teaching/learning setting. Most participants agreed on the importance of accessing curriculum resources through the iPad but recognized that these required enhancements to facilitate use. The iPad was considered to be more useful for activities involving output of information than for input. Participants' responses regarding the ease of use of mobile technology were heterogeneous due to the diversity of computer proficiency across users. Residents had a slightly more favorable opinion regarding the iPad's contribution to teaching/learning compared to preceptors. CONCLUSIONS: iPad's interface should be fully enhanced to allow easy access to online curriculum and its built-in resources. The differences in computer proficiency level among users should be reduced by sharing knowledge through workshops led by more skillful iPad users. To facilitate collection of information through the iPad, the design of electronic data-input forms should consider the participants' reported negative perceptions towards typing data through mobile devices. Technology deployment projects should gather sufficient evidence from pilot studies in order to guide efforts to adapt resources and infrastructure to relevant needs of Family Medicine teachers and learners.

Validation of the interprofessional collaborative competency attainment survey (ICCAS).

The purpose of this study was to obtain evidence regarding the validity and reliability of an instrument to measure the self-reported competencies of interprofessional care in interprofessional education programs. Five hundred and eighty-four students and clinicians in Canada and New Zealand who were registered in 15 interprofessional education undergraduate, postgraduate, and continuing professional development programs completed the Interprofessional Collaborative Competency Attainment Survey (ICCAS) using a retrospective pre-test/post-test design. Factor analyses showed the presence of two factors in the pre-program items and one factor in the post-program items. Tests conducted provided evidence in support of the validity and reliability of the ICCAS as a self-assessment instrument for interprofessional collaborative practice. Internal consistency was high for items loading on factor 1 (α = 0.96) and factor 2 (α = 0.94) in the pre-program assessment and for the items in the post-program assessment (α = 0.98). The transition from a two factor solution to a single factor structure suggests interventions influence learners' understanding of interprofessional care by promoting the recognition of the high degree of interrelation among interprofessional care competencies. Scores on the ICCAS are reliable and predict meaningful outcomes with regard to attitudes toward interprofessional competency attainment.

Spherical, cylindrical and tetrahedral symmetries; hydrogenic states at high magnetic field in Si:P.

Phosphorous donors in silicon have an electronic structure that mimics the hydrogen atom, albeit on a larger length, smaller energy and smaller magnetic field scale. While the hydrogen atom is spherically symmetric, an applied magnetic field imposes cylindrical symmetry, and the solid-state analogue involves, in addition, the symmetry of the Si crystal. For one magnetic field direction, all six conduction-band valleys of Si:P become equivalent. New experimental data to high laboratory fields (30 T), supported by new calculations, demonstrate that this high symmetry field orientation allows the most direct comparison with free hydrogen.

The REDIH experience: an emerging design to develop an effective training program for graduate students in reproductive science.

BACKGROUND: A training program in Reproduction, Early Development, and the Impact on Health (REDIH) was initiated in 2009 by researchers specializing in biomedical, clinical, population health, and ethics research from seven collaborating universities in Quebec and Ontario, and Health Canada. This paper reports the findings from the first three years of the 6-year program. OBJECTIVES: The objective of the REDIH program is to provide increased opportunities for excellent training in reproduction and early development for graduate students and fellows, in order to build research, clinical, regulatory, decision-making, and industry capacity in Canada. METHODS: A mixed methods approach was used to evaluate the REDIH training program, so as to combine the strengths of both qualitative and quantitative studies. A total of four focus groups (two with mentors and two with trainees) were run during the June 2012 REDIH meeting. Surveys were administered directly after each training module. The W(e)Learn framework was used as a guide to design and evaluate the program and answer the research questions. RESULTS: The data from the analysis of the focus group interviews, in corroboration with the survey data, suggested trainees enjoyed and benefited from the REDIH experience. Trainees provided several examples of new knowledge and skills they had acquired from REDIH sessions, regarding reproductive and early developmental biology, and health. A few trainees who had been in the program for over a year provided examples of knowledge and skills acquired during the REDIH session that they were using in their place of work. Next steps will include following up on REDIH graduates to see if the program has had any impact on trainees' employment opportunities and career development. CONCLUSION: Trainees and mentors concluded that the curricular design, which focuses on modules in 2-day learning sessions over a 6-year period, with opportunities for application in the workplace, enabled the sessions to be tailored to the outcomes of the formative evaluation. By sharing our experiences with REDIH, we hope that others can benefit from this unique emerging design, which focuses on the flexibility and receptivity of the mentors, and results in a program that lends itself to curriculum modification and tailoring as learners' needs are solicited and addressed.

Building positive relationships in healthcare: evaluation of the Teams of Interprofessional Staff interprofessional education program.

The Teams of Interprofessional Staff (TIPS) project consisted of five healthcare teams from across Ontario, participating in three, two-day face-to-face interprofessional educational (IPE) sessions over an 8-month period. The purpose of TIPS was to explore whether interprofessional team development for practicing healthcare professionals, makes a difference in team functioning, team member satisfaction, ability to work effectively both individually and as a team, and improved patient well-being. A comprehensive formative and summative evaluation revealed that all teams perceived they benefitted from and engaged in successful team development. Success meant different things to each team reflecting the continuum of team development from building a safe, trusted group to becoming leaders of team development for other interprofessional teams. Effective teamwork is crucial to nurses who often take on the role of coordinator of care on a day-to-day basis, or are in managerial roles in interprofessional clinics or clinical program teams.

Striving for excellence: developing a framework for the Triple C curriculum in family medicine education.

PROBLEM ADDRESSED: Postgraduate medical education programs will need to be restructured in order to respond to curriculum initiatives promoted by the College of Family Physicians of Canada. OBJECTIVE OF PROGRAM: To develop a framework for the Triple C Competency-based Curriculum that will help provide residents with quality family medicine (FM) education programs. PROGRAM DESCRIPTION: The Family Medicine Curriculum Framework (FMCF) incorporates the 4 principles of FM, the CanMEDs-FM roles, the Triple C curriculum principles, the curriculum content domains, and the pedagogic strategies, all of which support the development of attitudes, knowledge, and skills in postgraduate FM training programs. CONCLUSION: The FMCF was an effective approach to the development of an FM curriculum because it incorporated not only core competencies of FM health education but also contextual educational values, principles, and dynamic learning approaches. In addition, the FMCF provided a foundation and quality standard to designing, delivering, and evaluating the FM curriculum to ensure it met the needs of FM education stakeholders, including preceptors, residents, and patients and their families.

Developing a curriculum framework for global health in family medicine: emerging principles, competencies, and educational approaches.

BACKGROUND: Recognizing the growing demand from medical students and residents for more comprehensive global health training, and the paucity of explicit curricula on such issues, global health and curriculum experts from the six Ontario Family Medicine Residency Programs worked together to design a framework for global health curricula in family medicine training programs. METHODS: A working group comprised of global health educators from Ontario's six medical schools conducted a scoping review of global health curricula, competencies, and pedagogical approaches. The working group then hosted a full day meeting, inviting experts in education, clinical care, family medicine and public health, and developed a consensus process and draft framework to design global health curricula. Through a series of weekly teleconferences over the next six months, the framework was revised and used to guide the identification of enabling global health competencies (behaviours, skills and attitudes) for Canadian Family Medicine training. RESULTS: The main outcome was an evidence-informed interactive framework http://globalhealth.ennovativesolution.com/ to provide a shared foundation to guide the design, delivery and evaluation of global health education programs for Ontario's family medicine residency programs. The curriculum framework blended a definition and mission for global health training, core values and principles, global health competencies aligning with the Canadian Medical Education Directives for Specialists (CanMEDS) competencies, and key learning approaches. The framework guided the development of subsequent enabling competencies. CONCLUSIONS: The shared curriculum framework can support the design, delivery and evaluation of global health curriculum in Canada and around the world, lay the foundation for research and development, provide consistency across programmes, and support the creation of learning and evaluation tools to align with the framework. The process used to develop this framework can be applied to other aspects of residency curriculum development.

eLearning, knowledge brokering, and nursing: strengthening collaborative practice in long-term care.

Interprofessional collaboration is vital to the delivery of quality care in long-term care settings; however, caregivers in long-term care face barriers to participating in training programs to improve collaborative practices. Consequently, eLearning can be used to create an environment that combines convenient, individual learning with collaborative experiential learning. Findings of this study revealed that learners enjoyed the flexibility of the Working Together learning resource. They acquired new knowledge and skills that they were able to use in their practice setting to achieve higher levels of collaborative practice. Nurses were identified as team leaders because of their pivotal role in the long-term care home and collaboration with all patient care providers. Nurses are ideal as knowledge brokers for the collaborative practice team. Quantitative findings showed no change in learner's attitudes regarding collaborative practice; however, interviews provided examples of positive changes experienced. Face-to-face collaboration was found to be a challenge, and changes to organizations, systems, and technology need to be made to facilitate this process. The Working Together learning resource is an important first step toward strengthening collaboration in long-term care, and the pilot implementation provides insights that further our understanding of both interprofessional collaboration and effective eLearning.

W(e)Learn: a framework for online interprofessional education.

A framework is required to guide online Interprofessional Education (IPE) (Casimiro et al., 2009). The purpose of this paper is to present such a framework: W(e)Learn. W(e)Learn can be used as a quality standard and a guide to design, develop, deliver and evaluate online IPE in both pre- and post-qualification educational settings. The framework is presented in the spirit that educational programs have defining features that, when carefully designed with the appropriate blend of factors, can help achieve desired outcomes. W(e)Learn must now be applied in various contexts to assess its constructs and its applicability.

Grounding theories of W(e)Learn: a framework for online interprofessional education.

Interprofessional care (IPC) is a prerequisite for enhanced communication between healthcare team members, improved quality of care, and better outcomes for patients. A move to an IPC model requires changing the learning experiences of healthcare providers during and after their qualification program. With the rapid growth of online and blended approaches to learning, an educational framework that explains how to construct quality learning events to provide IPC is pressing. Such a framework would offer a quality standard to help educators design, develop, deliver, and evaluate online interprofessional education (IPE) programs. IPE is an extremely delicate process due to issues related to knowledge, status, power, accountability, personality traits, and culture that surround IPC. In this paper, a review of the pertinent literature that would inform the development of such a framework is presented. The review covers IPC, IPE, learning theories, and eLearning in healthcare.

An online interprofessional learning resource for physicians, pharmacists, nurse practitioners, and nurses in long-term care: benefits, barriers, and lessons learned.

The importance of collaborative practice in health care has been emphasized.1,21, 2 There is a critical need for convenient and flexible education opportunities that support the development of collaborative practice skills among the health care workforce. Consequently, the purpose of this project was to create and evaluate an online learning resource for physicians, nurses, nurse practitioners, and pharmacists working in long-term care that provided practitioners with the skills, knowledge, and motivation necessary to enhance their ability to act as an interprofessional team while providing clinical care. The Demand-Driven Learning Model 3 was used to guide the project. Findings revealed learners enjoyed the programme and acquired new skills and knowledge relating to collaborative practice that they transferred to their workplace resulting in higher levels of collaborative practice. The data did not reveal significant changes in the learners' attitudes towards collaborative practice; perhaps because the participants were early adopters and already had positive attitudes. Requests to change organizational structure to enhance collaborative practice were minimal, as was the impact of the resource on resident care. Given the short time frame from completion of the learning resource to the evaluation, this is perhaps not surprising as it is reasonable to expect that these types of changes will take time to take effect within the organization. Follow-ups at a later date are suggested.

Measuring patient safety climate: a review of surveys.

OBJECTIVE: Five years ago the Institute of Medicine recommended improving patient safety by addressing organizational cultural issues. Since then, surveys measuring a patient safety climate considered predictive of health outcomes have begun to emerge. This paper compares the general characteristics, dimensions covered, psychometrics performed, and uses in studies of patient safety climate surveys. METHODS: Systematic literature review. RESULTS: Nine surveys were found that measured the patient safety climate of an organization. All used Likert scales, mostly to measure attitudes of individuals. Nearly all covered five common dimensions of patient safety climate: leadership, policies and procedures, staffing, communication, and reporting. The strength of psychometric testing varied. While all had been used to compare units within or between hospitals, only one had explored the association between organizational climate and patient outcomes. CONCLUSIONS: Patient safety climate surveys vary considerably. Achievement of a culture conducive to patient safety may be an admirable goal in its own right, but more effort should be expended on understanding the relationship between measures of patient safety climate and patient outcomes.

Defining strategies to extend duration of gene expression from targeted compacted DNA vectors.

Gene transfer complexes containing poly-L-lysine (poly-K) and DNA with ligands directed at the serpin enzyme complex receptor (sec-R) deliver reporter genes to receptor-bearing cells in vivo. Expression lasts for about 30 days, when complexes containing long-chain poly-K are used. Extending the duration of expression would be desirable if correction of genetic defects is the goal. To test whether the mechanism by which expression is extinguished was due to an immune response to the transgene, or the loss of the transgene, we conducted two experiments. In the first, we injected sec-R-targeted lacZ complexes intravenously (i.v.) into mice genetically engineered to express this gene briefly during development. These mice, who should recognize the protein as 'self', also extinguished lacZ expression after 30 days. In a second experiment, we injected immunodeficient animals with sec-R-targeted human factor IX complexes. A similar temporal pattern of expression was observed in Rag-1 -/- mice, in whom expression also extinguished by 40 days. Moreover, factor IX plasmid DNA was detected in the lung and spleen 50 days after injection of complexes, suggesting that not all cells which had taken up the transgene had been destroyed. Thus, the host's immune response to the transgene may not account for the loss of reporter gene expression from these molecular conjugates. We further tested whether repeat administration of sec-R-targeted complexes will be limited by host immune responses. Mice were pre-dosed twice with sec-R-targeted complexes containing lacZ over a 40-day period. We then injected the animals i.v. with sec-R-targeted human factor IX complexes and measured gene expression and antibody production. Although 14 of 36 animals displayed low-titer antibodies to the ligand in targeted complex, expression levels were unaffected compared with virgin dosing. When the complexes were administered three times intranasally (n=10), no antibodies against the complex were detected in blood. Plasma from mice dosed with saline, nontargeted complex or naked DNA did not react with the ligand, ligand-poly K conjugate or targeted complex. All animals exhibiting human factor IX expression developed antibodies to that transgene by 21 days. Thus, at least three repeat administrations of sec-R-directed molecular conjugates are possible, provided that immune responses to the transgene itself are not limiting.

Contrasting evolution of the human leukocyte N-formylpeptide receptor subtypes FPR and FPRL1R.

N-formylpeptides are phagocyte chemoattractants that act by binding to two structurally related receptors, FPR (formylpeptide receptor) and FPRL1R (FPR-like-1 receptor), which are encoded by the human genes FPR1 and FPRL1. Single nucleotide polymorphisms (SNPs) in the FPR coding region have been reported and two have been associated with the disease juvenile periodontitis; however, their frequency and linkage relationships are unknown. Here we systematically analyzed polymorphism in the open reading frames of FPR1 and FPRL1 by direct sequencing of cloned alleles from random blood donors from North America. For FPR1 we detected five non-synonymous SNPs and two synonymous SNPs in a sample of 26 chromosomes one each from 17 Caucasian and nine black random blood donors. Although all five non-synonymous SNPs were common in Caucasians, Blacks, and Asians, notable differences in allele frequency were found for each SNP in the different racial groups, suggesting differential selective pressures. We found that the FPR1 polymorphisms are linked in 15 common haplotypes. No polymorphisms were detected in FPRL1 after sampling 44 chromosomes from 36 random blood donors from the same three racial groups. Thus FPR1 and FPRL1, though they originated from a common gene, appear to have undergone markedly different evolutionary events.