Continuing Professional Development Program in Health Facilities in Rwanda: A Qualitative Study on the Perceptions of Health Professionals.

Background: Continuous professional development (CPD) is an important pillar in healthcare service delivery. Health professionals at all levels and disciplines must continuously update their knowledge and skills to cope with increasing professional demands in the context of a continuously changing spectrum of diseases. This study aimed to assess the CPD programs available in healthcare facilities (HFs) in Rwanda. Methodology: Semi-structured interviews were conducted using purposive sampling. Accordingly, the respondents belonged to different categories of health professionals, namely nurses, midwives, laboratory technicians, pharmacists, general practitioners, and specialist doctors. Thirty-five participants from district, provincial, and national referral hospitals were interviewed between September and October 2020. A thematic analysis was conducted using Atlas ti.7.5.18, and the main findings for each theme were reported as a narrative summary. Results: The CPD program was reported to be available, but not for all HPs and HFs, because of either limited access to online CPD programs or limited HF leaders. Where available, CPD programs have sometimes been reported to be irrelevant to health professionals and patients' needs. Furthermore, the planning and implementation of current CPD programs seldom involves beneficiaries. Some HFs do not integrate CPD programs into their daily activities, and current CPD programs do not accommodate mentorship programs. The ideal CPD program should be designed around HPs and service needs and delivered through a user-friendly platform. The motivators for HPs to engage in CPD activities include learning new things that help them improve their healthcare services and license renewal. Conclusion: This study provides an overview of the status and perceptions of the CPD program in HFs in Rwanda and provides HPs' insights on the improvements in designing a standardized and harmonized CPD program in Rwanda.

Modern educational needs of specialists in the public health system.

OBJECTIVE: Aim: Studying the opinion of public health system workers (emlpoyees) regarding existing educational problems and needs in the context of continuous professional development. PATIENTS AND METHODS: Materials and Methods: Bibliosemantic, medical-statistical, sociological methods are used in the study. The research program provided for conducting sociological surveys of public health specialists in different regions of the country regarding the establishment of priority training topics for public health specialists; preferred methods of learning; barriers to access to education, etc. The scientific base of the research the regional centers for disease control and prevention have become. Statistical processing and mathematical analysis of materials was carried out using methods of statistical analysis. RESULTS: Results: The research has found that the priority topics of training for public health specialists are issues of epidemiology (which were indicated as very important by 67.7±3.7 and as important by 22.0±3.2 per 100 respondents); emergency and disaster management (67.7±3.7 and 31.1±3.6 per 100 respondents), quality and safety (53.0±3.9 and 38.4±3.8), practices based on on evidence (42.1±3.9 and 45.7±3.9) eHealth and digitalization (40.2±3.8 and 38.4±3.8), statistics (38.4±3.8 and 51 ,2±3.9), research methodology (32.9±3.7 and 51.2±3.9) and research ethics (12.8±2.6 and 67.7±3.7, respectively). Webinars (62.2±3.8 per 100 respondents) and online training (60.4±3.8), classroom (42.1±3.9) and hybrid (40.2±3.8) were identified as preferred forms. teaching. The obstacles to the continuous professional development of public health specialists are a lack of time and a lack of finances, a lack of information about desired training programs, their regulations, insufficient support from management, military aggression and the problems caused by it, etc. CONCLUSION: Conclusions: The priority topics of training for public health specialists, preferred methods of training and barriers to access to training determined in the course of the study are the basis for improving the organization of continuous professional development of employees of public health centers.

Knowledge, perceived needs of continuous professional's development, and associated factors among healthcare workers in East Ethiopia: a multi-health facility-based cross-sectional study.

BACKGROUND: The Ethiopian Ministry of Health (EMOH) has recently introduced a Continuous Professional Development (CPD) program for healthcare workers to ensure they maintain the necessary competencies to meet the community's health needs. However, there is limited information on healthcare workers' knowledge and perceived need for CPD. This study aims to assess healthcare workers' CPD knowledge, perceived needs, and factors associated with these in eastern Ethiopia. METHODS: A health facility-based cross-sectional quantitative study was conducted from September 1, 2022, to October 30, 2022. Health facilities and study participants were selected using a simple random sampling technique. A total of 731 healthcare professionals were randomly selected. Data was collected using a self-administered questionnaire developed from national CPD guidelines. Data analysis was performed using the STATA statistical package version 14. A logistic regression model was used to assess the association between predictors and the outcome variable. Adjusted odds ratios with 95% confidence intervals were calculated to determine the strength of the association. A p-value < 0.05 was considered statistically significant. RESULTS: In this study, 731 healthcare workers participated. Among them, 65.80% (95% CI: 62.35%, 69.24%) had knowledge of CPD, and 79.48% (CI95% 76.54, 82.41) expressed a strong perceived need for CPD. Female healthcare workers [AOR: 0.54 (95% CI: 0.37, 0.78)] and lack of internet access [AOR: 0.68 (95% CI: 0.47-0.97)] were predictors of knowledge of CPD. Age above 35 [AOR: 0.39 (95% CI: 0.17, 0.91)] and being female [AOR: 0.59 (95% CI: 0.40-0.87)] were predictors of a strong perceived need for CPD. CONCLUSION: The study found that there was a low level of knowledge about Continuing Professional Development among healthcare workers. The perceived needs of healthcare workers varied. It is important for health sectors and stakeholders to prioritize developing strategies that address knowledge gaps, particularly among female healthcare workers, improve access to the Internet for CPD resources, and address the diverse needs of professionals for effective CPD implementation.

Evaluation of the feasibility of a midwifery educator continuous professional development (CPD) programme in Kenya and Nigeria: a mixed methods study.

BACKGROUND: Midwifery education is under-invested in developing countries with limited opportunities for midwifery educators to improve/maintain their core professional competencies. To improve the quality of midwifery education and capacity for educators to update their competencies, a blended midwifery educator-specific continuous professional development (CPD) programme was designed with key stakeholders. This study evaluated the feasibility of this programme in Kenya and Nigeria. METHODS: This was a mixed methods intervention study using a concurrent nested design. 120 randomly selected midwifery educators from 81 pre-service training institutions were recruited. Educators completed four self-directed online learning (SDL) modules and three-day practical training of the blended CPD programme on teaching methods (theory and clinical skills), assessments, effective feedback and digital innovations in teaching and learning. Pre- and post-training knowledge using multiple choice questions in SDL; confidence (on a 0-4 Likert scale) and practical skills in preparing a teaching a plan and microteaching (against a checklist) were measured. Differences in knowledge, confidence and skills were analysed. Participants' reaction to the programme (relevance and satisfaction assessed on a 0-4 Likert scale, what they liked and challenges) were collected. Key informant interviews with nursing and midwifery councils and institutions' managers were conducted. Thematic framework analysis was conducted for qualitative data. RESULTS: 116 (96.7%) and 108 (90%) educators completed the SDL and practical components respectively. Mean knowledge scores in SDL modules improved from 52.4% (± 10.4) to 80.4% (± 8.1), preparing teaching plan median scores improved from 63.6% (IQR 45.5) to 81.8% (IQR 27.3), and confidence in applying selected pedagogy skills improved from 2.7 to 3.7, p < 0.001. Participants rated the SDL and practical components of the programme high for relevance and satisfaction (median, 4 out of 4 for both). After training, 51.4% and 57.9% of the participants scored 75% or higher in preparing teaching plans and microteaching assessments. Country, training institution type or educator characteristics had no significant associations with overall competence in preparing teaching plans and microteaching (p > 0.05). Qualitatively, educators found the programme educative, flexible, convenient, motivating, and interactive for learning. Internet connectivity, computer technology, costs and time constraints were potential challenges to completing the programme. CONCLUSION: The programme was feasible and effective in improving the knowledge and skills of educators for effective teaching/learning. For successful roll-out, policy framework for mandatory midwifery educator specific CPD programme is needed.

Acceptance of virtual patients as a continuous professional development approach among practicing nurses in primary health care settings in a low-income country: a quasi-experimental posttest setup design.

BACKGROUND: Virtual patients are an educational technological approach used in healthcare education. Its distinctive features have rendered virtual patient technology appealing for the training of medical and healthcare students, particularly in the enhancement of clinical reasoning. Virtual patients are less often applied for continuous professional development for practicing healthcare providers, and there is a scarcity of studies exploring this possibility. This study aimed to assess the acceptability of nurses for using virtual patients as a continuous professional development approach. METHOD: The study used a quasi-experimental posttest setup design. The study was conducted in ten primary healthcare settings in Rwanda. Among 76 nurses who consented to participate in the study, 56 completed the intervention and responded to the study questionnaire. Following a one-week program of continuous professional development on four non-communicable diseases, the study used a self-administered questionnaire based on the Technology Acceptance Model 3 to collect data. Descriptive analysis served as the primary method for analyzing participants' responses. The study also used a correlation test to assess the relationship of variables. RESULTS: Across all items in the questionnaire, the median response tended towards either agree or strongly agree, with only a minority number of participants expressing strong disagreement, disagreement, or neutrality. The results indicated a significant positive correlation between perceived usefulness and behavior intention (p < 0.001). CONCLUSION: The findings indicate an acceptability and behavioral intention of adopting virtual patients as an alternative continuous professional development approach among nurses working at health centers in Rwanda or other locations with similar contexts.

Enhancing clinical reasoning for management of non-communicable diseases: virtual patient cases as a learning strategy for nurses in primary healthcare centers: a pre-post study design.

BACKGROUND: In Rwanda, nurses manage all primary care at health centres, and therefore are their clinical reasoning skills important. In this study, a web-based software that allows the creation of virtual patient cases (VP cases) has been used for studying the possibility of using VP cases for the continuous professional development of nurses in primary health care in Rwanda. Previous studies in pre-service education have linked VP cases with the enhancement of clinical reasoning, a critical competence for nurses. This study investigated the feasibility of continuous professional development through VP cases to further train in-service nurses in clinical reasoning. METHOD: The study used a pre-post test design. Initially, seventy-six participants completed a questionnaire as part of the pre-test phase, subsequently invited to engage with all four VP cases, and finally responded to the post-test questionnaire evaluating clinical reasoning skills. Fifty-six participants successfully completed the entire study process and were considered in the analysis. The primary outcomes of this study were evaluated using a paired t-test for the statistical analysis. RESULTS: The results show that the mean score of clinical reasoning increased significantly from the pre-test to the post-test for all four illness areas (p < 0.001). The study findings showed no statistically significant difference in participants' scores based on demographic factors, including whether they worked in urban or rural areas.  CONCLUSION AND RECOMMENDATION: Utilizing VP cases appears to significantly enhance the continuous professional development of nurses, fostering a deliberate learning process that enables them to reflect on how they manage cases and, in turn, refine their clinical reasoning skills. This study strongly recommends incorporating VP cases in the continuous professional development of nurses at the primary health level (health centers). This is especially pertinent in a context where nurses are required to perform diagnostic processes similar to those employed by physicians.

Evaluation of the quality and impact of online learning through the SAFE EUROPE webinars.

INTRODUCTION: The SAFE EUROPE project, a European-funded project, addressed educational gaps of Therapeutic Radiographers/Radiation Therapists (TR/RTTs) by offering a series of free webinars. This study aimed to assess the quality of these webinars and their impact on professional practice. METHODS: Data collection involved two methods: an automated feedback form administered after each webinar, supplemented by a survey disseminated through social media. The collected data encompassed attendance statistics, participants' professions and geographic locations, webinar quality assessment, the acquisition of new knowledge and skills, the application of this newfound knowledge in practice, and the likelihood of recommending these webinars. Descriptive statistics and thematic analysis were used to analyse the quantitative and qualitative data, respectively. Ethical approval for the study was obtained. RESULTS: 11,286 individuals from 107 countries participated in 18 webinars. Despite 72.7% being radiographers, a diverse array of professionals attended the webinars, including medical physicists, oncologists, radiologists, and academics. Remarkably, 98.7% of respondents rated the webinar quality as either good or excellent. The average rating for the likelihood of recommending these webinars to colleagues was 8.96/10. A substantial proportion of respondents expressed agreement or strong agreement that the webinars enhanced their knowledge (85%) and skills (73%). Furthermore, 79% of participants indicated that the webinars motivated them to change practice, with 65% having already implemented these changes. The insights from open-ended questions corroborated these findings. CONCLUSION: The webinars effectively achieved the aim of the SAFE EUROPE project to enhance practice by increasing knowledge and skills. Participants overwhelmingly endorsed the quality of these webinars. IMPLICATIONS FOR PRACTICE: Webinars represent a cost-efficient training tool that reaches a global audience and various radiography/radiotherapy professions. The development of additional webinars is strongly recommended.

The identification of requirements for competency development during work-integrated learning in healthcare education.

BACKGROUND: Work-integrated learning (WIL) is widely accepted and necessary to attain the essential competencies healthcare students need at their future workplaces. Yet, competency-based education (CBE) remains complex. There often is a focus on daily practice during WIL. Hereby, continuous competency development is at stake. Moreover, the fact that competencies need to continuously develop is often neglected. OBJECTIVES: To ultimately contribute to the optimization of CBE in healthcare education, this study aimed at examining how competency development during WIL in healthcare education could be optimized, before and after graduation. METHODS: Fourteen semi-structured interviews with 16 experts in competency development and WIL were carried out. Eight healthcare disciplines were included namely associate degree nursing, audiology, family medicine, nursing (bachelor), occupational therapy, podiatry, pediatrics, and speech therapy. Moreover, two independent experts outside the healthcare domain were included to broaden the perspectives on competency development. A qualitative research approach was used based on an inductive thematic analysis using Nvivo12© where 'in vivo' codes were clustered as sub-themes and themes. RESULTS: The analysis revealed eight types of requirements for effective and continuous competency development, namely requirements in the context of (1) competency frameworks, (2) reflection and feedback, (3) assessment, (4) the continuity of competency development, (5) mentor involvement, (6) ePortfolios, (7) competency development visualizations, and (8) competency development after graduation. It was noteworthy that certain requirements were fulfilled in one educational program whereas they were absent in another. This emphasizes the large differences in how competence-based education is taking shape in different educational programs and internship contexts. Nevertheless, all educational programs seemed to recognize the importance of ongoing competency development. CONCLUSION: The results of this study indicate that identifying and meeting the requirements for effective and continuous competency development is essential to optimize competency development during practice in healthcare education.

The UEMS experience in continuous medical education accreditation process: a 'quo vadis' analysis of our global database.

Background: The authors systematically appraise a large database of continuous professional development (CPD) and continuous medical education (CME) events against the European Accreditation Council for Continuous Medical Education (EACCME) framework. Methods: The authors performed a retrospective observational study of all CPD or CME events within the European Union of Medical Specialists (UEMS) database between 2017 and 2019, including 91 countries and 6034 events. Assessment of event design, quality and outcomes was evaluated against a validated, expert-derived accreditation framework, using thematic analysis to extract distinct themes, and subsequent quantitative analysis. Results: The authors included 5649 live educational events (LEEs) and 385 e-learning materials (ELMs). Three thousand seven hundred sixty-two [3762 (62.3%)] of the events did not report clear justification in their needs assessment process. Most accreditation applications claimed covering a single educational need [1603/2277 (70.3%)]. Needs assessments were reported to be similar across conferences, courses and other types of events (P<0.01); 5642/6034 events (93.5%) had clearly documented expected learning outcomes; only 978/6034 (16.2%) reported a single expected learning outcome while the rest report 2-10 outcomes. Providers who declared more than one educational need also declared multiple learning outcomes (ρ=0.051, P<0.01). Conclusions: Despite EACCME providing a robust framework for the CPD/CME accreditation process, reporting quality can still be improved, as more than 1 in 2 events fail to provide a clear description of their needs assessment. To the authors' knowledge, this is the largest educational LEE/ELM database, which can be a starting to revisit the CME/CPD accreditation process.

The Commitment to Excellence: Understanding Nurses' Perspectives on Continuous Professional Development.

Continuous Professional Development (CPD) is essential for nurses to maintain up-to-date knowledge and skills in the evolving healthcare sector. This study explores nurses' attitudes toward CPD, its necessity, and the challenges encountered. The aim is to examine nurses' perspectives on CPD, focusing on their participation and motivation, in relation to their workplace, workplace function, and form of work. A cross-sectional study design was employed with 151 nurses from University Hospital Centre Split, Croatia. Data were collected using the "Professional Development of Nurses questionnaire (Q-PDN)" and analyzed using descriptive statistical methods, the Kolmogorov-Smirnov test, Pearson's correlation, ANOVA test, and t-test. The average level of participation in CPD activities was 4.27 (±0.63), indicating a positive inclination towards CPD. The study identified a statistically significant difference in activities related to CPD (t = 2.12; p = 0.036) among employees of surgical and intensive care units compared to other departments, where a higher level of engagement was present among employees of other departments. Notably, nurses without managerial roles showed 0.16 points higher participation in CPD activities compared to their managerial counterparts, though this was not statistically significant (t = 0.92; p = 0.357). Nurses in managerial roles valued CPD for professional development more highly, with a significant difference (t = 2.77; p = 0.006). Full-time nurses demonstrated a higher perception of the importance of personal professional development compared to part-time nurses, with a significant difference (F = 2.88; p = 0.038). The study reveals a strong commitment to CPD among nurses, with variations based on workplace roles and schedules. It underscores the need for role-specific and adaptable CPD programs to meet diverse needs and enhance professional competence in the nursing workforce.

Utilization of continuous professional development among health professionals in East Ethiopia: a multi-health facility-based cross-sectional study.

BACKGROUND: Healthcare workers must maintain their knowledge, attitude, and skills regarding the most recent technology and competencies to deliver quality health care. The Ministry of Health, Ethiopia developed guidelines and directives for the utilization of continuous professional development programs. However, there is limited evidence on utilization and barriers to utilization in the study area. Therefore, this study aimed to assess the utilization and barriers to the utilization of continuous professional development among health professionals working in health facilities in eastern Ethiopia. METHODS: A health facility-based cross-sectional quantitative study was conducted among 731 healthcare professionals from September 01, 2022, and October 30, 2022. A multistage sampling technique was utilized. A simple random sampling technique selected health facilities and study participants. A self-administered questionnaire developed from national continuous professional development guidelines was disseminated to healthcare professionals working in the selected forty health centers and four hospitals. STATA statistical package version 14 was used for data analysis. A descriptive summary was used to summarize the variables. A logistic regression model was used to assess the association between independent variables and the outcome variable. Adjusted odds ratios along with 95% CIs were estimated to assess the strength of the association, and a p-value < 0.05 was used to declare the level of statistical significance in the analysis. RESULTS: Continuous professional development utilization was determined for 731 healthcare professionals, of whom 241 (32.97%) [(95% CI: (29.55, 36.38)] had utilized continuous professional development. Lack of continuous professional development knowledge AOR 0.23 [(95% CI: 0.14, 0.37)], being female AOR 0.58 [(95% CI: 0.39, 0.86)], lack of internet access AOR 0.62 [(95% CI: 0.43, 0.89)], greater than 20 km distance from main road AOR 0.58 [(95% CI: 0.37, 0.91)], not heard importance of continuous educational units AOR 0.45 [(95% CI: 0.31, 0.65)], and poor perceived need of continuous professional development AOR 0.61 [(95% CI: 0.38, 0.97)], had a negative statistically significant association with the utilization of continuous professional development. CONCLUSION: The utilization of continuous professional development in the study area was low. Health sectors and stakeholders working on continuous professional development programs are required to focus on developing strategies for knowledge creation, female health workers, and access to the internet, remote areas, information on the importance of continuous educational units, and the variety of needs of professionals for continuous professional development implementation.

The impact of patients as trainers on registered nurses' patient engagement in primary care clinics: a qualitative study.

BACKGROUND: In Canada, primary care is usually the front door to health care for people with health issues. Among these primary care services are primary care clinics (PCC), where the competencies of registered nurses (RNs) are needed. However, nursing practice in PCCs is variable and sometimes suboptimal from one PCC to another. In 2019, the Quebec Ministry of Health and Social Services deployed a practical guide for RNs practicing in PCCs. This guide was intended to support best professional and interprofessional practices and enhance the quality of services offered according to a physical-social vision of care, interprofessional collaboration and partnership with the patient. The Formation de formateurs en première ligne (F2PL) project team developed a train-the-trainer educational intervention to support RNs in assimilating the content of this guide. This educational intervention is uncommon because it includes patients as trainers (PTs). PTs developed and provided andragogic content about patient's experience to enhance patient engagement. OBJECTIVE: To describe the impacts of the educational intervention provided by the PTs in nurses' patient engagement practices in PCCs. METHODS: A descriptive qualitative approach was used to describe in-depth changes in RNs' practices. Individual interviews were conducted with 10 RNs and 3 PTs to explore the changes in RNs' practice and the barriers and facilitators to adopting this new practice. An inductive and deductive thematic analysis was carried out according to a conceptual model of patient engagement (the Montreal Model), and emerging themes were condensed into propositions. To ensure credibility, a peer review was conducted with the F2PL team, which includes a patient co-leader. RESULTS: The educational intervention provided by PTs has impacted RNs' practice in 3 ways: awareness or reminding of general principles, updating commitment to already known principles and enhancing the development of new professional skills. CONCLUSIONS: PTs could effectively support the RNs' motivation to use patient engagement practices in primary care.

The impact of COVID-19 on professional development for physiotherapists in Lagos, Nigeria.

Background: Continuous professional development is important to maintain standards of care in the healthcare sector. However, in Lagos, Nigeria, the additional burden of COVID-19 and limited resources may provide separate challenges for physiotherapists' continuous professional development (CPD). Objectives: To examine the availability and perceived quality of continuous professional development opportunities for physiotherapists working before and during the pandemic in Lagos, Nigeria. Method: A qualitative study was conducted with 10 conveniently sampled physiotherapists, recruited via email. Interviews took place via Zoom, and the video function was utilised. Data were collected via semi-structured interviews using a pilot tested interview, and was transcribed and analysed thematically. Results: The main method of workplace teaching pre-COVID-19 and during COVID-19 was bedside teaching (BT), which most participants received. Pre-COVID-19, the main barrier to receiving teaching was a lack of national guidelines providing specific details on CPD. During COVID-19, the main barrier was the difficulty of increased online teaching instead of teaching on real life patients. The main barriers for non-workplace CPD pre-COVID-19 were a lack of availability of learning opportunities and monetary cost of conferences. This was partially combatted by the increasing trend of online learning events during the pandemic, which increased access to non-workplace learning opportunities. Conclusion: Because of COVID-19, most CPD learning opportunities for physiotherapists in Lagos, Nigeria, were online, increasing overall accessibility. Adequate training to improve utilising online learning resources as well as specific guidelines for workplace physiotherapists CPD in Nigeria should be implemented and promoted to improve confidence and quality of care. Clinical implications: Key insight into the CPD experiences of physiotherapists currently working in Lagos, Nigeria, which can guide policies and improve clinical outcomes.

Master's degree in sexual and reproductive health: enhancing career development opportunities for midwives in Mali.

BACKGROUND: Midwives' contribution to improving outcomes for women and newborns depends on factors such as quality of pre-service training, access to continuing professional development, and the presence of an enabling work environment. The absence of opportunities for career development increases the likelihood that health professionals, including midwives, will consider leaving the profession due to a lack of incentives to sustain and increase motivation to remain in the field. It also limits the opportunities to better contribute to policy, training, and research. This study aimed to assess the influence of a Master in Sexual and Reproductive Health (SRH) at the INFSS on midwives' career progression in Mali. METHODS: This mixed methods study was conducted using an online questionnaire, semi-structured interviews, and a document review. The study participants included graduates from two cohorts (N = 22) as well as employers, managers, and teachers of the graduates (N = 20). Data were analysed according to research questions, comparing, and contrasting answers between different groups of respondents. RESULTS: The study revealed that graduates enrolled in the programme primarily to improve their knowledge and skills in management and public health. The graduates' expected roles are those of programme and health project manager and participation in planning and monitoring activities at national or sub-national level. The managers expected the programme to reflect the needs of the health system and equip midwives with skills in management and planning. The Master enhanced opportunities for graduates to advance their career in fields they are not usually working in such as management, research, and supervision. However, the recognition of the master's degree and of the graduates' profile is not yet fully effective. CONCLUSION: The master's degree in SRH is a capacity building programme. Graduates developed skills and acquired advanced knowledge in research and management, as well as a postgraduate degree. However, the master programme needs to be better aligned with health system needs to increase the recognition of graduates' skills and have a more positive impact on graduates' careers.

Current status of the educational environment to acquire and maintain the professional skills of radiotherapy technology and medical physics specialists in Japan: a nationwide survey.

This study aimed to investigate the educational environment of radiotherapy technology and medical physics specialists (RTMP) in Japan. We conducted a nationwide questionnaire survey in radiotherapy institutions between June and August 2022. Participants were asked questions regarding the educational system, perspectives on updating RTMP's skills and qualifications, and perspectives on higher education for RTMP at radiotherapy institutions. The results were then analyzed in detail according to three factors: whether the hospital was designed for cancer care, whether it was a Japanese Society for Radiation Oncology (JASTRO)-accredited hospital, and whether it was an intensity-modulated radiation therapy charged hospital. Responses were obtained from 579 (69%) nationwide radiation therapy institutions. For non-qualified RTMP, 10% of the institutions had their own educational systems, only 17% of institutions provided on-the-job training, and 84% of institutions encouraged participation in educational lectures and workshops in academic societies. However, for qualified RTMP, 3.0% of institutions had their own educational systems, only 8.9% of the institutions provided on-the-job training, and 83% encouraged participation in academic conferences and workshops. Less than 1% of the facilities offered salary increases for certification, whereas 8.2% offered consideration for occupational promotion. Regarding the educational environment, JASTRO-accredited hospitals were better than general hospitals. Few institutions have their own educational systems for qualified and non-qualified RTMP, but they encourage them to attend educational seminars and conferences. It is desirable to provide systematic education and training by academic and professional organizations to maintain the skills of individuals.

Field Epidemiology: Fit for the future.

In recent years, field epidemiologists have embraced rapidly evolving digital tools, data sources and technologies, and collaborated with an ever-growing field of scientific specialisms. The COVID-19 pandemic put field epidemiology under unprecedented demand and scrutiny. As the COVID-19 emergency recedes, it is timely to reflect on the core values of our profession and the unique challenges and opportunities that lie ahead. In November 2022, alumni of the European Programme for Intervention Epidemiology Training (EPIET) and the European Public Health Microbiology (EUPHEM) training programme celebrated 25 years of EPIET, and the present and future of field epidemiology was discussed. The output was recorded and qualitatively analysed. This Perspective reflects the authors' interpretation of the discussion. We should reaffirm our commitment to field epidemiology's core strengths: competence and rigour in epidemiology, surveillance, outbreak investigation and applied research, leading to timely and actionable evidence for public health. Our future success will be defined by an ability to adapt, collaborate, harness innovation, communicate and, ultimately, by our tangible impact on protecting and improving health.

Introduction and roll-out of self-learning App for midwifery during the COVID-19 pandemic and its sustainability in Cambodia.

Similar to other countries, coronavirus disease (COVID-19) pandemic significantly impacted not only the ability of midwives to deliver high quality maternal care, but also their ability to access professional development opportunities, including in-service training in Cambodia. In response, we developed a Cambodian version of Safe Delivery App (SDA), aligned to Cambodia's clinical guidelines. The SDA is a free digital job aid and learning platform for skilled birth attendants developed by Maternity Foundation that works offline and is used in more than 40 countries after adapting to the country context. In the year and a half since its launch in June 2021, SDA has become established in Cambodia, with more than 3,000 people, accounting for nearly half the number of midwives in Cambodia, downloading and using it on their devices, and 285 people having completed its self-learning modules. The review of the introduction process revealed that publicity on the professional association's social networking sites, in-person in-depth hands-on training, and troubleshooting in a managed social networking group were useful in promoting the use of the application, and that the Continuing Professional Development Program accreditation has been a strong motivator for completing the self-study program. On the other hand, the COVID-19 pandemic has led to increased use of digital tools, but it is important to prevent the expansion of the digital divide when implementing new digital tools, including SDA.

Emergency care nurses' self-reported clinical competence before and after postgraduate education - a cross-sectional study.

Changing prerequisites in healthcare leads to the increased complexity of nursing. Since there are no regulations on re-validation of competencies for emergency nurses in Sweden there is sparse knowledge on how nurses develop competencies after registration as nurses (RN). AIM: To describe self-reported professional competence after postgraduate education among RNs in emergency care settings. METHOD: A cross-sectional design and STROBE guidelines were used. The short version of the Nurse Professional Competence Scale was used for data collection and the data were collected before and after postgraduate education, descriptive and comparative statistic was used for analysis. RESULTS: 62 (71%) students participated in the first data collection and an independent group of 31 (48%) students participated in the second data collection. The results showed generally good competencies before entering education and significantly improved competencies after education were found in areas of working independently and reviewing literature for evidence-based nursing Conclusion: The competencies were assessed as very good after education. Evaluating nurses' competencies supports educators in developing education to ensure the need for knowledge in emergency care. To ensure required competencies among emergency care nurses there is a need to regulate additional training and re-validation of emergency nurses' competencies.