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OBJECTIVE: The objective of this scoping review is to identify, collate, and map the evidence on simulation interprofessional education activities in any setting for the education of health professional students. INTRODUCTION: Simulation interprofessional education activities comprise in-person and collaborative online learning embedded in formal curricula. Though the number of simulation interprofessional education activities has increased with the knowledge of the importance of effective interprofessional collaboration, the literature still lacks a description of the characteristics of existing activities. INCLUSION CRITERIA: This scoping review will consider interprofessional education activities taking place within a simulation environment. Included papers will report on activities with two or more types of learners in health professional programs. METHODS: The proposed scoping review will be conducted in accordance with the JBI methodology for scoping reviews. Databases searched will include PubMed, CINAHL, and ERIC. Results will be limited to English-language publications from 2016 to the present year. Data extraction will be performed using a purposefully developed data extraction tool. Teams of reviewers will screen abstracts and full texts of articles for potential inclusion, and decisions will be determined via consensus of two out of three reviewers. Extracted data will be presented in diagrammatic or tabular form in a manner that aligns with the objective of this scoping review. A narrative summary will accompany the tabulated and/or charted results and will describe how the results relate to the review's objective and questions, and how the results might inform future simulation interprofessional education activities in health professions education.

Background: Patient-centredness (PCN) is an increasingly demanded objective in health care and has gained importance for the care situation, for research, and the education of healthcare professions. The literature shows that the term PCN is not uniformly defined. Key aspects for the concept of PCN can be found in the integrative model and its dimensions by Scholl and colleagues (2014), which are incorporated into the acquisition of competencies in Objective Structured Clinical Examination (OSCE) examination formats. The inclusion of subjective experiences of persons directly affected in health-related situations is recognized as an important factor for continuous improvement in health care. In the interprofessional education of healthcare professions, subjective experiences serve as a starting point in relation to OSCE exams. In this context, the project "DIPEx" "Database of Individual Patients' Experiences" stands for the systematic collection and evaluation of subjective experiences of illness using scientific methods. Aim: The aim of this interprofessional training workshop was to show how PCN can support the writing of case vignettes based on real experiences from systematically collected narratives within the DIPEx project, as well as the preparation of simulation subjects for OSCE examinations in the healthcare professions. Methods: Interactive, moderated workshop with two theory-based input presentations on the systematic development of interprofessional case vignettes based on four steps, group work with synthesis in the form of statements, and a concluding outlook. Results: With regard to the aims of the workshop, the synthesis included results at two levels: exemplary results on aims not explicitly addressed: Interprofessional teaching is full of presuppositions and requires clarification of four different perspectives in advance to be included in case development;exemplary results on explicitly addressed aims: Listening to and incorporating the real-life experiences and narratives of persons directly affected in health-related situations and their families was seen as an important learning aspect for PCN in relation to the practitioner-patient relationship. Five key statements on explicit aims for case development involving PCN emerged from the group work. Conclusion: Competency-based interprofessional education of health professionals and PCN can benefit from real patient narratives of health and illness as simulated patients can portray roles in OSCE formats in a realistic and convincing manner.

Abstract Background

The global spread of the SARS-CoV-2 virus highlights both the importance of frontline healthcare workers (HCW) in pandemic response and their heightened vulnerability during infectious disease outbreaks. Adequate preparation, including the development of human resources for health (HRH) is essential to an effective response. ICAP at Columbia University (ICAP) partnered with Resolve to Save Lives and MOHs to design an emergency training initiative for frontline HCW in 11 African countries, using a competency-based backward-design approach and tailoring training delivery and health facility selection based on country context, location and known COVID-19 community transmission.

Methods

Pre- and post-test assessments were conducted on participants completing the COVID-19 training. Parametric and non-parametric methods were used to examine average individual-level changes from pre- to post-test, and compare performance between countries, cadres, sex and facility types. A post-evaluation online training survey using Qualtrics was distributed to assess participants’ satisfaction and explore training relevance and impact on their ability to address COVID-19 in their facilities and communities.

Results

A total of 8797 HCW at 945 health facilities were trained between June 2020 and October 2020. Training duration ranged from 1 to 8 days (median: 3 days) and consisted of in person, virtual or self guided training. Of the 8105 (92%) HCW working at health facilities, the majority (62%) worked at secondary level facilities as these were the HF targeted for COVID-19 patients. Paired pre- and post-test results were available for 2370 (25%) trainees, and 1768 (18%) participants completed the post-evaluation training survey. On average, participants increased their pre- to post-test scores by 15 percentage points (95% CI 0.14, 0.15). While confidence in their ability to manage COVID-19 was high following the training, respondents reported that lack of access to testing kits (55%) and PPE (50%), limited space in the facility to isolate patients (45%), and understaffing (39%) were major barriers.

Conclusion

Ongoing investment in health systems and focused attention to health workforce capacity building is critical to outbreak response. Successful implementation of an emergency response training such as this short-term IPC training initiative in response to the COVID-19 pandemic, requires speed, rigor and flexibility of its design and delivery while building on pre-existing systems, resources, and partnerships.

Abstract Background

General practitioners (GPs) were at risk of violence in their everyday working lives. Workplace violence (WPV) among GPs is a global public health concern. This study aimed to investigate the prevalence and factors associated with WPV among GPs in China.

Methods

A cross-sectional study was conducted among 4376 GPs in eastern, central, and western China between March and May 2021 using a structured self-administered questionnaire. The multivariable stepwise logistic regression model was used to examine the factors associated with WPV among GPs in China.

Results

Among these respondents, 14.26% of them reported exposure to WPV in the past 12 months. GPs who were female, practised in a rural area, made home visits occasionally, worked in a fair or good practice environment or work environment, and had a fair or good relationship with patients were less likely to encounter any type of WPV. In addition, GPs who served patients over 20 per day and worked overtime occasionally or frequently were more likely to be exposed to WPV. The determinants of WPV varied in different types of WPV and sexes.

Conclusions

The prevalence of WPV among GPs is low in China. Our findings could inform the measures to reduce the WPV among GPs.

OBJECTIVES: Indonesia aims to achieve universal health coverage (UHC) and Sustainable Development Goals (SDGs), including SDG 3 target 4, which focuses on cancer control, by 2030. This study aimed to forecast the human resources for health (HRH) and facilities required for cancer control in Indonesia over an 11-year period to support these goals. DESIGN: A two-stage Markov model was developed to forecast the demand side of facilities and HRH requirements for cancer control in Indonesia over an 11-year period. SETTING: Data sources used include the Indonesia Health Profile Report (2019), the Indonesian Radiation Oncology Society Database and National Cancer Control Committee documents (2019). METHODS: The study involved modelling the current availability of HRH and healthcare facilities in Indonesia and predicting future requirements. The gap between the current and the required HRH and facilities related to oncology, and the costs associated with meeting these requirements, were analysed. RESULTS: Results indicate the need to increase the number of healthcare facilities and HRH to achieve SDG targets. However, UHC for cancer care still may not be achieved, as eastern Indonesia is predicted to have no tertiary hospital until 2030. The forecast shows that Indonesia had a median of only 39% of the HRH requirements in 2019. Closing the HRH gap requires around a 47.6% increase in salary expenditure. CONCLUSION: This study demonstrates the application of decision-analytical modelling approach to planning HRH and facilities in the context of a low-to-middle-income country. Scaling up oncology services in Indonesia to attain the SDG targets will require expansion of the number and capability of healthcare facilities and HRH. This work allows an in-depth understanding of the resources needed to achieve UHC and SDGs and could be utilised in other disease areas and contexts.

Abstract Background

The 2014–2016 Ebola virus disease outbreak in West Africa revealed weaknesses in the health systems of the three most heavily affected countries, including a shortage of public health professionals at the local level trained in surveillance and outbreak investigation. In response, the Frontline Field Epidemiology Training Program (FETP) was created by CDC in 2015 as a 3-month, accelerated training program in field epidemiology that specifically targets the district level. In Guinea, the first two FETP-Frontline cohorts were held from January to May, and from June to September 2017. Here, we report the results of a cross-sectional evaluation of these first two cohorts of FETP-Frontline in Guinea.

Methods

The evaluation was conducted in April 2018 and consisted of interviews with graduates, their supervisors, and directors of nearby health facilities, as well as direct observation of data reports and surveillance tools at health facilities. Interviews and site visits were conducted using standardized questionnaires and checklists. Qualitative data were coded under common themes and analyzed using descriptive statistics.

Results

The evaluation revealed a significant perception of improvement in all assessed skills by the graduates, as well as high levels of self-reported involvement in key activities related to data collection, analysis, and reporting. Supervisors highlighted improvements to systematic and quality case and summary reporting as key benefits of the FETP-Frontline program. At the health facility level, staff reported the training had resulted in improvements to information sharing and case notifications. Reported barriers included lack of transportation, available support personnel, and other resources. Graduates and supervisors both emphasized the importance of continued and additional training to solidify and retain skills.

Conclusions

The evaluation demonstrated a strongly positive perceived benefit of the FETP-Frontline training on the professional activities of graduates as well as the overall surveillance system. However, efforts are needed to ensure greater gender equity and to recruit more junior trainee candidates for future cohorts. Moreover, although improvements to the surveillance system were observed concurrent with the completion of the two cohorts, the evaluation was not designed to directly measure impact on surveillance or response functions. Combined with the rapid implementation of FETP-Frontline around the world, this suggests an opportunity to develop standardized evaluation toolkits, which could incorporate metrics that would directly assess the impact of equitable field epidemiology workforce development on countries’ abilities to prevent, detect, and respond to public health threats.

Abstract Background

The global commitment to primary health care (PHC) has been reconfirmed in the declaration of Astana, 2018. India has also seen an upswing in national commitment to implement PHC. Health and wellness centres (HWCs) have been introduced, one at every 5000 population, with the fundamental purpose of bringing a comprehensive range of primary care services closer to where people live. The key addition in each HWC is of a mid-level healthcare provider (MLHP). Nurses were provided a 6-month training to play this role as community health officers (CHOs). But no assessments are available of the clinical competence of this newly inducted cadre for delivering primary care. The current study was aimed at providing an assessment of competence of CHOs in the Indian state of Chhattisgarh.

Methods

The assessment involved a comparison of CHOs with rural medical assistants (RMAs) and medical officers (MO), the two main existing clinical cadres providing primary care in Chhattisgarh. Standardized clinical vignettes were used to measure knowledge and clinical reasoning of providers. Ten ailments were included, based on primary care needs in Chhattisgarh. Each part of clinical vignettes was standardized using expert consultations and standard treatment guidelines. Sample size was adequate to detect 15% difference between scores of different cadres and the assessment covered 132 CHOs, 129 RMAs and 50 MOs.

Results

The overall mean scores of CHOs, RMAs and MOs were 50.1%, 63.1% and 68.1%, respectively. They were statistically different (p < 0.05). The adjusted model also confirmed the above pattern. CHOs performed well in clinical management of non-communicable diseases and malaria. CHOs also scored well in clinical knowledge for diagnosis. Around 80% of prescriptions written by CHOs for hypertension and diabetes were found correct.

Conclusion

The non-physician MLHP cadre of CHOs deployed in rural facilities under the current PHC initiative in India exhibited the potential to manage ambulatory care for illnesses. Continuous training inputs, treatment protocols and medicines are needed to improve performance of MLHPs. Making comprehensive primary care services available close to people is essential to PHC and well-trained mid-level providers will be crucial for making it a reality in developing countries.

Abstract Context

There is an uneven distribution of general practitioners (GPs) across territories of developed countries leading to inequalities in access to health care. Countries are implementing incentive or coercive policies depending on the characteristics of their health system. Several studies suggest that the location of practical training may influence the location of GPs’ practices. The objective of this study is to investigate the existence of a relationship between training supervision and evolution of the density of GPs in French municipalities between 2018 and 2021.

Methods

The evolution of the density of GPs in almost all French municipalities between 2018 and 2021 was followed up. A bivariate statistical analysis was carried out to look for a relationship between the evolution of the density of GPs and the number of training supervisors. Other bivariate analyses were carried out with other factors likely to influence the density of GPs, such as the existence of financial aid in the territory or the age of GPs. A multivariate analysis with all the significant variables in bivariate analysis was then carried out using the stepwise descending method.

Results

A total of 34 990 (99.9%) French municipalities were included in the follow-up. Among these, 9427 (26.9%) had a GP and 3866 (11%) had a GP involved in the training supervision. The density of GPs in French cities decreased on average by 2.17% between 2018 and 2021. Territories without training supervisors decreased by 4.63% while those with at least one increased by 1.36% (p < 0.01). This significant relationship was also found in multivariate analysis.

Conclusion

The training supervision is associated with a better evolution of density of GPs in French municipalities. This association persisted when other factors were considered. The results of this 3-year follow-up may lead us to consider the training supervision as a factor to regulate the distribution of GPs.

This study presents a reflective analysis of the implementation of interprofessional education in undergraduate nursing courses, considering as an example the curricula of undergraduate nursing careers in Brazil. Despite investments to advance interprofessional education, its practice is not institutionalized in the curricula of undergraduate courses. These findings represent a limitation for the implementation of interprofessional education in nursing courses, and the case of Brazil allows to learn lessons for the education of nursing professionals in other countries of the Region of the Americas. Recommendations are provided for training, management and intersectoral articulation of health and education services, with emphasis on primary health care and the Sustainable Development Goals, aimed at educational institutions wishing to implement interprofessional education. Neste estudo, foi realizada uma análise reflexiva sobre a implementação da educação interprofissional em cursos de graduação em enfermagem, considerando como exemplo os currículos dos cursos de graduação em enfermagem no Brasil. Apesar dos investimentos para avançar a educação interprofissional, sua prática não está institucionalizada nos currículos de graduação. Esses achados representam uma limitação para a implementação da educação interprofissional em cursos de enfermagem, e o caso do Brasil fornece lições para a formação de profissionais de enfermagem em outros países da Região das Américas. Medidas de treinamento, gestão e articulação intersetorial de serviços de saúde e educação, com ênfase nos cuidados primários de saúde e nos Objetivos de Desenvolvimento Sustentável, são recomendadas para instituições educacionais que desejam implementar a educação interprofissional.

Educação Interprofissional e Prática Interprofissional Colaborativa são temas emergentes, constituindo-se em componentes fundamentais de formação profissional e de atenção à saúde. Este trabalho teve tem como objetivo analisar as características de prontidão para o trabalho interprofissional bem como o uso da prática colaborativa dos preceptores do internato médico de Porto Velho, Rondônia.Trata-se de um estudo transversal, realizado a partir do questionário The Readiness for Interprofessional Learning Scale, traduzido e validado para o Brasil em 2015, aplicado a 30 profissionais de saúde, entre médicos e enfermeiros, preceptores do internato médico em Atenção Primária à Saúde. Entre os resultados, observou-se que, no domínio "identidade profissional" ­que se refere à autonomia profissional e aos objetivos clínicos de cada profissão ­, os profissionais avaliados estão nas zonas de alerta e de perigo,sendo as médias apuradas de 3,7483±0,96896para médicos e de 3,5873±1,09561para enfermeiros. Faz-se necessário, então, investir na qualificação de profissionais voltada aos temas "trabalho em equipe" e "trabalho colaborativo", com ênfase no domínio "identidade profissional". Interprofessional Education and Collaborative Interprofessional Practice are emerging themes, constituting fundamental components of professional training and health care, particularly in addressing the various morbidities for good user assistance. The objective was to analyze the characteristics of readiness for interprofessional work as well as the use of collaborative practice by preceptors of the medical internship in Porto Velho, Rondônia. This wasa cross-sectional study based on The Readiness for Interprofessional Learning Scale questionnaire, which was translated and validated for Brazilin 2015and was applied to 30 health professionals, including physicians and nurses, who arepreceptors ofmedical internships in primary care andpublic health. Among the results, it was observed that, in the domain of professional identity, which refers to the professional autonomy and clinical objectives of each profession, both professions were evaluated as belonging to the alert and danger zone, with an average of 3.7483±0.96896 for doctors and 3.5873±1.09561 for nurses. It is, therefore, necessary to invest in the qualification of professionals focused on the theme of teamwork and collaboration, with an emphasis on the professional identity domain.

Introducción: la educación interprofesional se produce cuando dos o más profesionales se conocen y se relacionan entre sí para permitir una colaboración eficaz con la intención de mejorar los resultados de salud. Diferentes marcos de referencia de identidad profesional y competencias han establecido la importancia de este tipo de formación. Sin embargo, cada programa puede contar con diferentes niveles de implementación para integrarlo en el mismo. Método: el objetivo del presente trabajo fue desarrollar un instrumento de autodiagnóstico sobre Integración de la Educación Interprofesional en los programas de salud, considerando su formalización y des-pliegue. Se utilizó una validación de expertos para el diseño del instrumento y una prueba piloto con directivos de cinco programas de salud. Resultados: el instrumento consta de 12 ítems para valorar si los alumnos cuentan con condiciones formativas interprofesio-nales: 1) Identifican, 2) Colaboran, 3) Toman decisiones y 4) Construyen soluciones. Para ello la institución educativa puede A. Definir, B. Comunicar, C. Formar, D. Evaluar o E. Mejorar las intervenciones formativas para garantizar una implementación adecuada de dichos propósitos. El modelo resultante es una guía taxonómica que permite identificar la formalización de la implementación cada una de las competencias en un programa de salud. Conclusiones: el instrumento propuesto cuenta con contenidos comprensibles y adecuados para cumplir con sus propósitos de autodiagnóstico en la formalización en la implementación de competencias interprofesionales. Sin embargo, más que un carácter estrictamente incremental, confiere una visión dinámica en la cual pueden implementarse escalas superiores sin haber cerrado un ciclo de mejora completo en las competencias previas. Introduction: Interprofessional education occurs when two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes. Different frameworks of professional identity and competencies have established the importance of interprofessional education. However, each program may have different levels of formalisation or implementation. Methods: The objective of this work was to develop a self-assessment instrument regarding the interprofessional education integration for health care programs. An expert validation was applied for the instrument design, and the heads of five health programs conducted a pilot test. Results: The instrument consists of 12 items to assess interprofessional education: 1) Identify, 2) Collaborate, 3) Make deci-sions, and 4) Build solutions. The educational institution can A. Define, B. Communicate, C. Train, D. Evaluate, or E. Improve educational interventions to ensure adequate implementation. The resulting model is a taxonomic guide that allows identifying the formalisation of the implementation of each of the competencies in a health care undergraduate program. Conclusions: The proposed self-assessment has understandable and adequate content to address its purposes. However, more than a strictly incremental approach, it confers a dynamic vision in which higher scales can be implemented without closinga complete improvement cycle in the previous competencies.

Healthcare services in Australia are the primary responsibility of state and territory governments, which recruit and deploy health providers in hospital and primary-care services. Among the various health professional roles, that of Aboriginal and Torres Strait Islander Health Worker (A&TSIHW) is one of only two positions that must be occupied by an Aboriginal and/or Torres Strait Islander person, carrying unique responsibility for enacting cultural brokerage and promoting cultural safety at the facility-level. Implicit to these responsibilities is the assumption that A&TSIHW will use cultural capital to build clients' trust in themselves and ultimately the broader health system. Drawing on 82 in-depth interviews including 52 with A&TSIHWs, we applied Kroegar's Facework theory to explore the structures, processes and relationships that contribute to, or inhibit, A&TISHWs' capacity and willingness to build trust (beyond themselves) in government health services in Queensland, Australia. Analysis demonstrates that despite A&TSIHWs viewing and enacting interpersonal trust-building as central to their role, structural features of the health system inhibit the development of service-users' system-level trust. Findings re-establish that health systems are not 'cultureless,' but rather, shaped by a dominant culture that privileges certain actors, types of knowledge, and modes of communication and action, which in turn influence efforts to build trust. The study demonstrates a novel theory-driven approach to exploring the interactions between behavioural and structural factors that influence the production of systems-level trust. In the context of the Queensland public health service findings highlight a disconnect between the expectations of, and support provided to A&TISHWs to engage Aboriginal and Torres Strait Islander service-users.

Abstract Background

In April 2020, the World Health Organization (WHO) Information Network for Epidemics produced an agenda for managing the COVID-19 infodemic. “Infodemic” refers to the overabundance of information—including mis- and disinformation. In this agenda it was pointed out the need to create a competency framework for infodemic management (IM). This framework was released by WHO on 20th September 2021. This paper presents the WHO framework for IM by highlighting the different investigative steps behind its development.

Methods

The framework was built through three steps. Step 1 included the preparatory work following the guidelines in the Guide to writing Competency Framework for WHO Academy courses. Step 2 was based on a qualitative study with participants (N = 25), identified worldwide on the basis of their academic background in relevant fields of IM or of their professional experience in IM activities at the institutional level. The interviews were conducted online between December 2020 and January 2021, they were video-recorded and analyzed using thematic analysis. In Step 3, two stakeholder panels were conducted to revise the framework.

Results

The competency framework contains four primary domains, each of which comprised main activities, related tasks, and knowledge and skills. It identifies competencies to manage and monitor infodemics, to design, conduct and evaluate appropriate interventions, as well as to strengthen health systems. Its main purpose is to assist institutions in reinforcing their IM capacities and implementing effective IM processes and actions according to their individual contexts and resources.

Conclusion

The competency framework is not intended to be a regulatory document nor a training curriculum. As a WHO initiative, it serves as a reference tool to be applied according to local priorities and needs within the different countries. This framework can assist institutions in strengthening IM capacity by hiring, staff development, and human resources planning.

Abstract Background

For countries to achieve universal health coverage, they need to have well-functioning and resilient health systems. Achieving this requires a sufficient number of qualified health workers and this necessitates the importance of investments in producing and regulating health workers. It is projected that by 2030, Africa would need additional 6.1 million doctors, nurses, and midwives. However, based on the current trajectory, only 3.1 million would be trained and ready for service delivery. To reduce current shortages of the health workforce, Africa needs to educate and train 3.0 million additional health workers by 2030. This study was conducted to describe the distribution and ownership of the health training institutions, production of health workers, and the availability of accreditation mechanisms for training programmes in the WHO African Region.

Methods

A cross-sectional study was conducted using a standardized questionnaire from January 2018 to April 2019. All the 47 countries in the Region were invited to complete a structured questionnaire based on available secondary information from health sector reports, annual HRH reports, country health workforce profiles, and HRH observatories and registries.

Results

Data from 43 countries in the World Health Organization African Region in 2018 show that there were 4001 health training institutions with 410, 1469 and 2122 being medical, health sciences, and nursing and midwifery schools, respectively, and 2221, 1359 and 421 institutions owned by the public, private for-profit and private not-for-profit sectors, respectively. A total of 148 357 health workers were produced in Region with 40% (59, 829) being nurses and midwives, 19% (28, 604) other health workers, and 14% (20 470) physicians. Overall, 31 countries (79%) in the Region have an accreditation framework for the health training institutions and seven countries do not have any accreditation mechanism.

Conclusion

To achieve universal health coverage, matching of competencies with population needs, as well as increasing capacities for health worker production to align with demand (numbers and skill-mix) for improved service delivery should be prioritized, as this would improve the availability of skilled health workforce in the Region.

Abstract

The organisation of the 24-h day for hospital nurses in two 12-h shifts has been introduced with value propositions of reduced staffing costs, better quality of care, more efficient work organisation, and increased nurse recruitment and retention. While existing reviews consider the impact of 12-h shifts on nurses’ wellbeing and performance, this discussion paper aims to specifically shed light on whether the current evidence supports the value propositions around 12-h shifts. We found little evidence of the value propositions being realised. Staffing costs are not reduced with 12-h shifts, and outcomes related to productivity and efficiency, including sickness absence and missed nursing care are negatively affected. Nurses working 12-h shifts do not perform more safely than their counterparts working shorter shifts, with evidence pointing to a likely negative effect on safe care due to increased fatigue and sleepiness. In addition, nurses working 12-h shifts may have access to fewer educational opportunities than nurses working shorter shifts. Despite some nurses preferring 12-h shifts, the literature does not indicate that this shift pattern leads to increased recruitment, with studies reporting that nurses working long shifts are more likely to express intention to leave their job. In conclusion, there is little if any support for the value propositions that were advanced when 12-h shifts were introduced. While 12-h shifts might be here to stay, it is important that the limitations, including reduced productivity and efficiency, are recognised and accepted by those in charge of implementing schedules for hospital nurses.