The Facilitator Instrument for Team-Based Learning (FIT).

Construct: We sought to evaluate the quality of Team-Based Learning facilitation in both large and small group settings. Background: Team Based Learning (TBL) is an increasingly popular small group instructional strategy in health science education. TBL facilitation skills are unique and differ from those needed to lecture or facilitate other types of small groups. Measuring facilitation skills and providing feedback to TBL instructors is important, yet to date no valid instrument has been developed and published for this purpose. Approach: We created an 11-item instrument (ratings of each item on a 7-point scale) designed to assess TBL facilitation skills, considering major sources of validity. Twelve experts in TBL facilitation and training developed the content of the FIT. To ensure response processes were valid, we used an immediate retrospective probing technique with 4th year medical students who were not part of the study. The Facilitator Instrument for Team-Based Learning (FIT) was piloted with 2,840 medical students in 7 schools in large (year 1 and 2) and small (year 3) courses. The internal structure of the FIT was analyzed. Results: In total, 1,559 and 1,281 medical students in large and small TBL classes, respectively (response rate 88%) rated 33 TBL facilitators. The composite mean score for the FIT was 6.19 (SD = 1.10). Exploratory factor analysis and Cronbach's alpha indicated that all items loaded on 1 factor, accounting for 77% of the item variance. Cronbach's alpha for the 11 items was 0.97. Analysis of facilitator variables and course context indicated that FIT scores were statistically significantly correlated with type of class (pre-clinical or clinical) and size of class as well as the facilitator enjoyment in using TBL as a method. Gender and the amount that facilitators used TBL each year was weakly correlated, with other factors not correlated (years facilitating TBL, confidence in facilitating TBL, and age). Conclusions: Analysis of FIT scores from 2,840 medical students across multiple institutions and teaching settings suggests the utility of the FIT in determining the quality of TBL facilitation across a range of medical education settings. Future research is needed to further analyze course contexts and facilitator variables that may influence FIT scores with additional facilitators. Additionally, FIT scores should be correlated with additional measures of TBL facilitator quality, such as direct observations, especially if these data are used for summative decision-making purposes.

Intellectual Disabilities and Health Care Communication: A Continuing Education Program for Providers.

Communication with others is a core human imperative; this is especially true in health care. Individuals with intellectual disabilities often face daunting challenges in both health literacy and communicating their health needs and questions. Education for professionals in specialized communication is critical in improving care for their clients with intellectual disabilities. To address this issue, an educational framework, ID-COMMUNICATE, was created to guide improved interactions between health care providers and clients with intellectual disabilities and was further developed into a continuing education program. The modules of the ID-COMMUNICATE program focus on specialized communication techniques and strategies and related professional practice issues. This program can be disseminated in a variety of ways and is easily adapted for professionals in many disciplines. [J Contin Educ Nurs. 2019;50(1):20-25.].

Application of the SEIPS Model to Analyze Medication Safety in a Crisis Residential Center.

PURPOSE: Medication safety and error reduction has been studied in acute and long-term care settings, but little research is found in the literature regarding mental health settings. Because mental health settings are complex, medication administration is vulnerable to a variety of errors from transcription to administration. The purpose of this study was to analyze critical factors related to a mental health work system structure and processes that threaten safe medication administration practices. BACKGROUND: The Systems Engineering Initiative for Patient Safety (SEIPS) model provides a framework to analyze factors affecting medication safety. The model approach analyzes the work system concepts of technology, tasks, persons, environment, and organization to guide the collection of data. METHODS: In the study, the Lean methodology tools were used to identify vulnerabilities in the system that could be targeted later for improvement activities. The project director completed face-to-face interviews, asked nurses to record disruptions in a log, and administered a questionnaire to nursing staff. The project director also conducted medication chart reviews and recorded medication errors using a standardized taxonomy for errors that allowed categorization of the prevalent types of medication errors. RESULTS: Results of the study revealed disruptions during the medication process, pharmacology training needs, and documentation processes as the primary opportunities for improvement. The project engaged nurses to identify sustainable quality improvement strategies to improve patient safety. CONCLUSION: The mental health setting carries challenges for safe medication administration practices. Through analysis of the structure, process, and outcomes of medication administration, opportunities for quality improvement and sustainable interventions were identified, including minimizing the number of distractions during medication administration, training nurses on psychotropic medications, and improving the documentation system. A task force was created to analyze the descriptive data and to establish objectives aimed at improving efficiency of the work system and care process involved in medication administration at the end of the project.

The ADMSEP Milestones Project.

OBJECTIVE: Credentialing bodies mandate that a medical school's curriculum be based upon recognized guidelines. Within the field of psychiatry, the Association of Directors of Medical Student Education in Psychiatry (ADMSEP) has previously published recommended guidelines for the pre-clinical and clerkship curriculum. Ongoing changes within the Liaison Committee on Medical Education's requirements for medical school curricula, and the publication of the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition, necessitated review of these guidelines. METHODS: ADMSEP convened a task force of psychiatric educators to develop a consensus report outlining new guidelines. The ADMSEP membership reviewed and approved this final document. RESULTS: The guidelines outline six core learning objectives with corresponding competencies. Each of these competencies specifies accompanying milestones to be achieved through the course of medical school. CONCLUSIONS: ADMSEP believes these guidelines will aid educators in crafting a school's psychiatric curriculum. Clearly articulated milestones may foster the further development of validated educational and assessment tools by ADMSEP and other organizations.

Smokeless tobacco use among rural women in NE Alabama.

Smokeless tobacco use among women living in rural areas is poorly understood and largely ignored. This qualitative study explored the use of smokeless tobacco with 10 participants living in rural areas in Alabama, with the women telling their own stories of use. Themes emerging from interviews included the initiation of use, secrecy, health-risk beliefs, daily-use patterns, and thoughts about quitting. The study results could assist community health nurses in awareness of risks, case finding, and development of community-based prevention strategies. Additional research would help better understanding of the epidemiology of the problem, cultural implications, and practice interventions.

Assessment of smokeless tobacco use in the history and physical examination by primary healthcare providers.

PURPOSE: Following a simple descriptive research design, we examined how and to what extent primary healthcare providers in rural southern regions of the United States ask patients about the use of smokeless tobacco as indicated in the document used for the patient history. DATA SOURCES: Copies of blank history and physical forms used in offices of primary care providers in Alabama, Georgia, South Carolina, and Tennessee were examined to identify items related specifically to tobacco use. CONCLUSIONS: Twenty-nine providers returned history and physical forms, which revealed 24% showed no item related to tobacco use. Others included questions related to smoking, but only 7% mentioned any sort of smokeless tobacco use. IMPLICATIONS FOR PRACTICE: Although a few studies have suggested the use of smokeless tobacco to be less harmful than smoking, all forms of smokeless tobacco are recognized carcinogens and dangerous for health. It is not sufficient to simply ask patients about smoking behaviors. Primary care providers, especially nurse practitioners, have the unique opportunity to assess use of smokeless tobacco and to offer treatment and counsel to help patients to stop the behavior.

Evaluation of a tobacco prevention program for children: ToPIC.

This intervention study focused on evaluating the effectiveness of teaching tobacco prevention in children using ToPIC, an interactive program. The program was presented in 2 or 3 class sessions to increase awareness of health risks related to tobacco use. Participants consisted of 201 students from the Boys and Girls Clubs in 5 rural counties of a southeastern state. A significant increase in knowledge from pretest to posttest was found; t(200) = -13.65, p < .0001. Children's responses to the effects of smoking correlated to the content material incorporated in ToPIC. Recommendations for program improvement are discussed.

Developing population health competencies among public health nurses in Georgia.

As part of a new vision for public health in Georgia, the role of the public health nurse (PHN) is shifting from a predominantly individual and clinic-based care model to a population health practice model. Based on focus groups conducted with management and frontline PHNs in 2001, nurses in Georgia were unprepared for this transition and lacked a strong understanding of population health concepts and competencies. To prepare nurses for their new and expanded responsibilities, an online population health course was developed specifically for currently employed PHNs. The Quad Council PHN Competencies (2003) provided the roadmap in identifying the population health online course and continuing education training program priority competencies for PHNs in Georgia. Along with incorporating the competencies into case studies and didactic learning, the required projects served as evidence of competency application. The population health online course was offered from fall 2000 to spring 2005 in collaboration with Georgia schools of nursing and has enabled a cohort of nurses to lead the way as Georgia transitions into a new public health model. Nurses who completed the course reported greater experience with and an understanding of population health competencies.