Impact of clinical clerkship integrated with clinical ladder on attending physicians' teaching self-efficacy.

BACKGROUND: Self-efficacy plays an important role in enhancing the teaching capabilities of attending physicians (APs). The clinical ladder (CL) is an educational approach developed in the field of nursing education that increases difficulty in an incremental manner. However, no previous study has confirmed the effectiveness of CL in medical education. Therefore, this study aimed to examine the effect of clinical clerkship integrated with clinical ladder (CC-CL) on the self-efficacy of APs. METHODS: Sixth-year medical students participated in CC-CL for 6 months starting from April 2023, and the changes in the self-efficacy of APs were retrospectively evaluated. The students were trained by the APs concurrently, and the achievement levels of each student were shared. The primary outcome measure was the physician teaching self-efficacy questionnaire (PTSQ) score. The PTSQ scores before and after CC-CL were analyzed using the Wilcoxon matched-pair signed-rank test. RESULTS: Fifteen APs from the Department of Pediatric and Child Neurology were included in this study. No significant difference was observed in the total PTSQ scores of the APs before and after CC-CL. However, a significant increase was observed in the PTSQ score of APs who participated for at least 2 h per week over a period of more than 3 months (n = 8) after CC-CL (p = 0.022). Furthermore, APs who had received their pediatrician certification < 10 years ago (n = 8) showed a significant increase in the total PTSQ score after CC-CL (p = 0.022). CONCLUSIONS: CC-CL may play an important role in cultivating the self-efficacy of less experienced APs. Further comparative studies must be conducted in the future to validate the findings of this study.

A global examination of clinical ladder programs - A synthesis of commonalities and opportunities for standardization.

BACKGROUND: Clinical ladder programs (CLPs) have been part of the nursing profession for nearly 4 decades. However, the structure and implementation of CLPs vary widely throughout healthcare systems. CLPs are a valuable factor in nurse retention and employee satisfaction initiatives, but globally replicating and measuring their impact is difficult due to lack of standardization. AIM: To identify opportunities for global standardization of CLPs through a systematic review of published evidence and facility-sourced CLPs applications and program documents. METHOD: This study used a systematic literature search and scan of existing programs from facilities within the United States (US), Lebanon, and Ghana obtained through professional ties and organizational membership. RESULTS: Seventy-nine articles were screened with 30 studies identified for inclusion, plus 20 CLPs from the US and international facilities. Identified commonalities were the lack of consistency in the number of clinical levels across the CLPs, eligibility requirements and application process, reward and recognition, lack of emphasis on technology and informatics, and missed opportunities to use CLPs to drive a culture of safety. The administrative burden of the programs and the time required by the nurse to complete the CLP application were rarely referenced. LINKING EVIDENCE TO ACTION: The lack of consistency between facilities and across the healthcare sectors limits the measurable impact CLPs have on the nursing profession. Recommendations for practice include developing a standardized professional development framework. A standardized framework will encourage adoption of a retention tool that will provide the profession with a measurable method to demonstrate the value it brings to patient care. Providing guidance to health care facilities in low- and middle-income countries on the implementation of a professional development framework will assist in closing the global gap of professional development opportunities for nurses.

Attributes of a Successful Clinical Ladder Program for Nurses: An Integrative Review.

BACKGROUND: Clinical ladder programs (CLPs) are often utilized by healthcare organizations to monitor and incentivize staff nurse development. Few studies exist related to this topic, yet implementation of CLPs can be an important factor in staff nurse retention and satisfaction, and therefore requires better understanding. AIM: To identify and examine the factors that contribute to a successful CLP. METHODS: A systematic search of the literature was conducted in PubMed and CINAHL. Studies were not limited by year and were included if the focus was CLP attributes. PRISMA and PICOT were used to guide the process. A matrix of the existing studies was used, and interrater reliability was established at 90% with consensus building for inclusion of studies by the research team. RESULTS: Twenty-nine studies were identified for inclusion. Most were program evaluation. Institution's organizational culture was identified as the overarching attribute contributing to a successful CLP. Common themes identified as important to a supportive organizational culture were (a) education and experience; (b) competence and critical thinking; (c) job satisfaction and retention; and (d) compensation and institutional cost. Each of these components can play a significant role in the overall success of a CLP. LINKING EVIDENCE TO ACTION: While further research of a higher caliber is needed, some recommendations for practice can be made: (a) CLP description and terminology needs to be consistent with intent, (b) mandatory CLP engagement has positive implications, and (c) implementation needs to be driven by bedside nurses and includes both continuous education and refinement of program requirements and incentives.

Application of nursing clinical ladder program in training of nurses in ICU / 现代临床护理

Objective To investigate the effect of nursing clinical ladder program on the training of nurses in ICU.Methods Seventy seven nurses in ICU were trained with nursing clinical ladder program including defining the ladder system of nurse’s ability, regulating the standard of each level,conditions for promotion,range for practice,establishing courses.Regular assessment,classification and retraining were performed.Result After training,the qualification rate in special theory and skills was increased.The incidences of major complications were significantly lower than that before training(P<0.05).Conclusions Nursing clinical ladder program is good for the development of personal career and specialization.It may promote the improvement of positivity and the quality of nursing.