What indicates competency in systems based practice? An analysis of perspective consistency among healthcare team members.

In many parts of the world the practice of medicine and medical education increasingly focus on providing patient care within context of the larger healthcare system. Our purpose is to solicit perceptions of all professional stakeholders (e.g. nurses) of the system regarding the U.S. ACGME competency Systems Based Practice to uncover the extent to which there is agreement or discrepancy among key system stakeholders. Eighty-eight multidisciplinary personnel (n = 88) from two academic medical centers were invited to participate in one of 14 nominal group process sessions. Participants generated and prioritized resident characteristics that they believed were important for effective System Based Practices. Through content analysis the prioritized attribute statements were coded to identify embedded themes of resident roles and behavior. From the themes, three major resident roles emerged: resident as Self-Manager, Team Collaborator, and Patient Advocate. No one professional group (e.g., nurses, attending physicians, social workers) emphasized all of these roles. Some concepts that are emphasized in the ACGME definition like using cost-benefit analysis were conspicuously absent from the healthcare team generated list. We showed that there are gaps between the key stakeholders prioritizations about the ACGME definition of SBP and, more generally, the behaviors and roles identified by healthcare team stakeholders beyond the U.S. This suggests that within the process of developing a comprehensive working understanding of the Systems Based Practice competency (or other similar competencies, such as in CanMEDS), it is necessary to use multiple stakeholders in the system (perhaps including patients) to more accurately identify key resident roles and observable behaviors.

Teaching cultural competency through narrative medicine: intersections of classroom and community.

BACKGROUND: Cultural competency and narrative medicine are perspectives that assist medical educators in teaching effective, empathetic communication and service delivery to a variety of patients. PURPOSE/METHODS: In this article, we describe a unique educational activity at the crossroads of these perspectives in which pediatric residents participated in a monthly reading and discussion group with staff members of an inner-city Dominican American community organization. RESULTS: By discussing a literary text rather than cases and facilitating discussions with particular attention to power, not only were historic conflicts between the groups circumvented, but an environment was created in which discussants drew heavily from personal and professional experiences. Qualitative evaluation of both groups revealed improved self-reported understanding of (a) issues of cultural diversity, (b) issues of medical culture, and (c) physicians' attitudes and behaviors in practice. CONCLUSION: Methodologies drawing from cultural competency and narrative medicine can be used to help physicians work in multidisciplinary, multicultural teams in and out of the medical institution.

Effectiveness of an emergency preparedness training program for public health nurses in New York City.

A public health workforce that is competent to respond to emergencies is extremely important. We report on the impact of a training program designed to prepare public health nurses to respond appropriately to emergencies. The program focused on the basic public health emergency preparedness competencies and the emergency response role of public health workers employed by the New York City School Department of Health and Mental Hygiene School Health Program. The evaluation methods included pre/post-testing followed by a repeat post-test one month after the program. The program resulted in positive shifts in both knowledge and emergency response attitudes.

Emergency preparedness training for public health nurses: a pilot study.

The Columbia Center for Public Health Preparedness, in partnership with the New York City Department of Health, recently developed an emergency preparedness training program for public health workers. A pilot training program was conducted for a group of school health nurses and evaluated using a pre/posttest design. A surprising finding was that 90% of the nurses reported at least one barrier to their ability to report to duty in the event of a public health emergency. The most frequently cited barriers included child/elder care responsibilities, lack of transportation, and personal health issues. These findings suggest that it may be prudent to identify and address potential barriers to public health workforce responsiveness to ensure the availability of the workforce during emergencies.