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BACKGROUND: Shared decision making (SDM), whereby patients and clinicians work collaboratively to make health care decisions, brings multiple benefits. It has, however, been slow to integrate into clinical practice. There are some examples of SDM being embedded and evaluated within medical undergraduate curricula but, despite role models being important in promoting students' patient-centred attitudes, these examples do not involve students reflecting on clinicians' use of SDM in practice. METHODS: We undertook a qualitative evaluation of a small group educational intervention. A key element was the students' use of a structured reflective template, drawing on the SHARE (seek, help, assess, reach, evaluate) SDM tool, to analyse examples of clinicians using SDM in practice critically. We undertook a thematic analysis of students' completed templates and evaluated their engagement with the SHARE tool. FINDINGS: A total of 44 templates were analysed. Four main themes were identified, including new learning about SDM, noticing and deconstructing SDM, participants' responses to SDM and struggles in learning. Students were positive about SHARE and used it to critique experiences and suggest specific ways that clinicians could have improved SDM. DISCUSSION: A structured training intervention that promotes critical reflection on clinical role models can help to shift undergraduate medical students' understanding of, and attitudes towards, SDM. The ethical arguments for SDM, evidence for its benefits and the alignment of SDM with participants' own core values appeared to help achieve student 'buy in'. Students struggled with notions of power, risk and time constraints, and empathised with both patients and clinicians. They highlighted the scarcity of SDM in practice.
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Toma de Decisiones Conjunta , Estudiantes de Medicina , Curriculum , Toma de Decisiones , Humanos , Aprendizaje , Participación del PacienteRESUMEN
OBJECTIVES: To investigate the effect of Antarctic residence on energy dynamics and aerobic fitness over the course of a year in over-wintering personnel. STUDY DESIGN: A prospective longitudinal observational study. METHODS: A convenience sample of personnel over-wintering at Rothera Research Station in Antarctica was studied. Body weight, body fat, food intake, activity and aerobic fitness were recorded every 30 days for 1 year. Body weight, body fat and food intake were measured using weighing scales, skinfold callipers and diet records, respectively; activity was measured using accelerometer-based activity trackers and aerobic fitness using a treadmill protocol. Climate markers of temperature and sunlight hours were also recorded. RESULTS: Twenty-one subjects took part in the study over the 12-month period. A statistically significant increase in body weight and body fat in winter was observed (p=0.012 and p=0.049, respectively). There were no statistically significant trends in activity, food intake or aerobic fitness. CONCLUSIONS: There were significant seasonal changes in body weight and body fat, with both measures increasing in winter but no significant changes in the other main outcome measures.
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Tejido Adiposo/fisiología , Peso Corporal/fisiología , Metabolismo Energético/fisiología , Aptitud Física/fisiología , Adulto , Regiones Antárticas , Frío , Ingestión de Alimentos/fisiología , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estaciones del Año , Adulto JovenRESUMEN
AIM: To test the feasibility and acceptability of the use of a mobile device to access evidence-based practice (EBP) resources in the clinical setting. METHODS: A pretest/posttest design was used with a convenience sample of 2nd- and 3rd-year preregistration undergraduate health care students in the United Kingdom. Questionnaires were used to measure (1) feasibility and acceptability of the mobile device and (2) perceptions of the development of EBP knowledge and skills. The study took place during the students' clinical practice and involved two meetings at the beginning and end of the placement period. A Web page was developed to support the process and provide links to key EBP resources. RESULTS: Nineteen undergraduate physiotherapy and nursing students took part in the study. The main findings indicated a generally low level of utilisation of the mobile device in the clinical setting, primarily due to practical difficulties associated with accessing the Internet and the small size of the screen. Consequently, the majority of the students used personal computers (PCs) to access EBP resources. Through the process, students reported improvements in their knowledge and skills in relation to EBP and the appraisal of clinical guidelines. CONCLUSIONS: Students were able to complete the EBP activity using either the mobile device or PC and reported improvements in their knowledge and skills in relation to EBP and the appraisal of clinical guidelines. Findings suggest that for undergraduate health care students, rapid access to online evidence in the clinical environment is not necessarily essential for the integration of the EBP process into practice, or for the development of EBP knowledge and skills, provided there is easy access to such evidence at some point during the placement period.
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Actitud hacia los Computadores , Teléfono Celular , Computadoras de Mano , Educación en Enfermería/métodos , Práctica Clínica Basada en la Evidencia/educación , Especialidad de Fisioterapia/educación , Inglaterra , Estudios de Factibilidad , Humanos , Internet , Proyectos PilotoRESUMEN
The aim was to examine the feasibility of introducing an evidence based practice (EBP) cycle into a practice area within an undergraduate pre-registration programme. The cycle involved four meetings over five weeks on a cardiac intensive care unit. Three 3rd year adult branch nursing students participated with their mentors. A web page for the project was developed to support the process. Evaluation focused on changes in EBP knowledge and skills and issues around implementation and perceived value of the EBP cycle. The findings showed that the EBP cycle was straight forward to set up and was recognised as being of value by both students and mentors. The students demonstrated modest improvements in EBP knowledge and skills. The main problems were lack of time and difficulties in accessing on-line resources.
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Bachillerato en Enfermería/organización & administración , Práctica Clínica Basada en la Evidencia/educación , Evaluación de Resultado en la Atención de Salud , Evaluación de Programas y Proyectos de Salud , Inglaterra , Estudios de Factibilidad , Humanos , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Encuestas y CuestionariosRESUMEN
BACKGROUND: A degree level EBP module is undertaken by students on post-qualifying programmes to develop critical appraisal skills gained at diploma level. Despite training in EBP skills, there is some suggestion that health care professionals lack confidence in this area and fail to make the links between evidence and practice. The purpose of this study was to investigate this issue further. AIMS: To identify how the EBP skills developed on the module were utilised in practice, and to identify what local barriers there were in using these skills. METHODS: A survey of all students who had completed the module within the past three years (n=393) followed by interviews to explore further issues that emerged from the survey. RESULTS: One hundred and ninety one completed questionnaires (48.6% response rate). The results showed that the students perceived themselves as 'quite skilled' or 'competent' with regard to the key EBP skills, and that completion of the module had contributed 'greatly' to this skill acquisition. Results from the interviews showed that time and cultural issues were the greatest barriers to using and developing further the EBP skills gained. CONCLUSIONS: The value of the module was apparent. For skills to be developed further in the work place, cultural changes need to occur.