Pain assessment in intensive care units of a low-middle income country: impact of the basic educational course.

BACKGROUND: Patients admitted to ICU usually have moderate-to-severe pain at rest and during care-related activities. The "Critical Care Pain Observation Tool (CPOT)" is a reliable and validated objective assessment tool for those patients who cannot self-report pain in ICU. The objectives of the educational course were to assess the baseline knowledge, and practice of pain assessment in critically ill patients and reassess the same in all participants of the course by comparing the results of pre and post-test. METHODS: The educational course of six hours of contact time on the use of CPOT for pain assessment in ICU patients was designed and conducted by the authors after approval from the Ethics Review Committee, Aga Khan University. This educational course was delivered at five different tertiary care hospitals in the Sindh province of Pakistan. A pre-test consisting of 25 true/false multiple-choice questions was conducted at the beginning of the course to assess the baseline knowledge, and practice of participants regarding pain assessment in critically ill patients and the same test was taken at the end of the course. RESULTS: A total of 205 critical care physicians and nursing staff attended the courses. Both pre-test and post-test were completed by 149 (72.6%) participants, of which 53 (35.6%) were female and 96 (64.4%) were male. The mean pre-test score of participants was 57.83 ± 11.86 and the mean post-test score of participants was 67.43 ± 12.96 and this was statistically significant (p = < 0.01). In univariate analysis, the effect of training was significantly higher in the female gender (p = 0.0005) and in those participants, who belong to the metropolitan city (p = 0.010). In multivariate analysis, participants from non-metropolitan cities showed less improvement in post-test scores compared to those who come from the metropolitan city (p = 0.038). CONCLUSIONS: The participating physicians and nurses showed a positive impact on the knowledge and clinical skills regarding pain assessment in CIPs. The participants from hospitals in metropolitan cities showed a significant improvement over those who were from non-metropolitan cities.

Educational Challenges in Healthcare Design: Training Multidisciplinary Professionals for Future Hospitals and Healthcare.

BACKGROUND: Healthcare environments are one of the most complex and demanding fields of work. Scientific, technological and research developments along with new discoveries within health promotion and prevention strategies are increasingly requiring a multidisciplinary and interdisciplinary approach. Therefore, it is likely that the current professions will need to be significantly adapted to accommodate new and more specialized roles. OBJECTIVES: To present an overview of the current educational and training courses of the emerging professions, such as hospital planner, physician-engineer, doctor-architect, nurse-architect or engineer, we review the present global training courses (BSc, MSc, specialization and PhD courses) related to healthcare design focusing on the fields of Medicine and Nursing, Architecture and Engineering sciences. RESULTS: The paper analyses the literature review and website analysis about active teaching programs and courses. Several academic institutions offer BSc, MSc and PhD degree programs in Healthcare Design, Environmental and Building Hygiene, and Public Health. In addition, there are several professional postgraduate courses, either in classroom, hybrid-based or online. CONCLUSIONS: A considerable number of international training experiences addresses the topic of training multidisciplinary professionals. Further in-depth investigations are needed to examine the content, teaching format and impact of the courses, student outcomes and professional careers, fields of interest and the degree of collaborations with other institutions.

Training the trainers and disseminating information: a strategy to educate health professionals on epilepsy

PURPOSE: To evaluate the knowledge, attitudes and perceptions of epilepsy in primary care system health professionals prior to and after an educational intervention. METHODS: Educational interventions were delivered to three groups of people with an interest in epilepsy: 1. Information courses for physicians (241 subjects); 2. Social re-integration course for health professionals and community leaders (631 subjects); 3. "Training the Trainers" Course for physicians (11 subjects). The whole program is flexible and can be tailored for local or regional needs. For the evaluation of this process, health professionals completed a quantitative and qualitative questionnaire to assess their knowledge, attitudes and perception (KAP) of epilepsy prior to the training (pre-test) and 6 months after it (post-test). RESULTS: Comparison of knowledge scores prior to (mean=55.8, standard deviation=14.0) and after (mean=71.5, standard deviation=12.0) the intervention showed that physicians had improved knowledge after the training (t-test=7.8, p<0.001). The same pattern occurred with the health professionals: the knowledge score prior to (mean=22.3, standard deviation=12.5) and after (mean=36.6, standard deviation=12.5) the intervention showed that health professionals had improved knowledge after the training (t-test=12.4, p<0.001). Improvements in attitudes and perception also occurred after the courses. DISCUSSION: Training courses can promote increased knowledge, attitude and perception in a cost effective way in the primary care setting. However, a continuous education program is required to correct oversights and to improve the management of people with epilepsy.

OBJETIVO: Avaliar conhecimentos, atitudes e percepção sobre epilepsia de profissionais da saúde do sistema de atenção básica antes e depois de curso de capacitação. MÉTODO: Cursos de capacitação foram realizados em três grupos de profissionais de saúde: 1. cursos de capacitação para médicos (241 sujeitos); 2. cursos de inserção social para agentes comunitários de saúde (631 sujeitos); 3. cursos de replicadores para médicos (11 sujeitos). O programa de capacitação foi adaptado para as condições de cada local. Para avaliar o processo, foram aplicados questionários a respeito do seu conhecimento, sua atitude e percepção perante à epilepsia (KAP) antes dos cursos (pré-teste) e após a intervenção (pós-teste). RESULTADOS: A comparação feita a respeito do conhecimento com médicos mostrou que os mesmos melhoram seu conhecimento com os cursos (pré-teste: nota média=55.8; DP=14,0) vs. pós-teste: nota média=71,5; DP=12,0; t-test=7,8; p<0,001). O mesmo padrão ocorreu com os agentes comunitários de saúde: pré-teste: nota média=22.3; DP=12,5) vs. pós-teste: nota média=36,6; DP=12,5; t-test=12,4; p<0,001. Com relação a atitudes e percepção, foram observadas melhoras significativas depois da realização dos cursos. DISCUSSÃO: Os cursos de capacitação promovem melhoras no conhecimento, atitude e percepção, com baixo custo e de maneira efetiva, no sistema básico de saúde. Entretanto, um programa de educação continuada deve existir para que consiga corrigir os erros e melhorar o tratamento das pessoas com epilepsia.

Training medical students to improve the management of people with epilepsy

PURPOSE: To evaluate the knowledge, attitude and perception of medical students prior to and after a training course about epilepsy. METHODS: We used a KAP questionnaire with sixty-one questions which assesses knowledge, attitude and practice of epilepsy. Questionnaires were completed by 185 medical students, before and after epilepsy training. We compared the answers to see whether the lecture had changed the knowledge, attitude and practice in epilepsy. RESULTS: One hundred and six students completed the questionnaire before an eight hour course on epilepsy and 79 students completed the questionnaire one year after the course. Comparison of the knowledge scores prior to (mean=53.9, standard deviation=11.4) and after the course (mean=63.8, standard deviation=11.9) showed that students had improved knowledge after the course (t-test=5.6, p<0.001). DISCUSSION: Training course on epilepsy for medical students can promote improvement in the knowledge, attitudes and perception regarding epilepsy, which is maintained one year later. These results highlight the importance of continuous educational programs within the Medical Curriculum.

OBJETIVO: Avaliar conhecimentos, atitudes e percepção sobre epilepsia em estudantes de medicina antes e depois de curso de capacitação. MÉTODO: Foi utilizado o questionário KAP da Campanha Global "Epilepsia fora das sombras", liderada pela OMS, ILAE e IBE. Este questionário avalia conhecimento, atitude e percepção sobre epilepsia em 61 questões. Foi aplicado este questionário em 185 estudantes de medicina, antes e depois de cursos de capacitação sobre epilepsia. As questões foram comparadas para analisar as mudanças obtidas com o treinamento. RESULTADOS: Cento e seis estudantes de medicina responderam ao questionário antes do curso de capacitação e 79 estudantes responderam após um ano do curso. A comparação feita a respeito do conhecimento com estes estudantes mostrou que os mesmos melhoram seu conhecimento com os cursos (pré-teste: nota média=53,9; DP=11,4 vs. pós-teste: nota média=63,8; DP=11,9; t-test=5,6; p<0,001). DISCUSSÃO: O curso de capacitação promove melhoras no conhecimento, atitude e percepção sobre epilepsia, mesmo após um ano. Estes resultados salientam a importância de programas de educação continuada dentro do currículo médico.