Browsing by Author "Hecker, Kent"
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- ItemOpen AccessA Multifaceted Educational Intervention to Increase Uptake of a Urinary Tract Infection Guideline(2016-01-22) Banks, Anke Marie; McLaughlin, Kevin; Samuel, Susan; Johnson, David; Hecker, KentPhysicians often fail to implement clinical practice guidelines. Our objective was to evaluate whether a multifaceted educational intervention would increase adherence to the American Academy of Pediatrics guideline regarding voiding cystourethrogram (VCUG) use in young children with a first febrile urinary tract infection. We conducted a prospective interventional study at one centre using a pretest-posttest design. We used a health promotion model to construct a multifaceted intervention that included an interactive lecture, clinical pathway and faxed reminder. Over the study period, pediatricians and non-pediatricians ordered a significantly greater monthly proportion of adherent VCUGs. There was a significant decrease in the pediatrician monthly ordering rate of VCUGs. Utilizing logistic regression, the odds of adherence to the guideline were significantly greater among pediatricians than non-pediatricians. In conclusion, following a multifaceted educational intervention, pediatricians were more likely to adhere to the VCUG guideline recommendation than prior to the intervention and than non-pediatricians.
- ItemOpen AccessCase study of virtual collaboration in health informatics research(2005) Palacios Mackay, Maria Felisa; Hebert, Marilynne A.; Donnon, Tyrone L.; Hecker, Kent
- ItemOpen AccessDistributed practice for cardiopulmonary resuscitation (CPR) training: improving educational efficiency and cost-effectiveness in clinical settings(2019-04-12) Lin, Yiqun; Hecker, Kent; Cheng, Adam; Grant, Vincent J.; Currie, Gillian R.Cardiac arrest is a major health problem; high-quality cardiopulmonary resuscitation (CPR) is one of the most important determinants of survival and survival with good neurological outcomes of the victims. Despite annual training, healthcare providers struggle to conduct guideline compliant CPR during the management of cardiac arrests. Increased likelihood of survival from cardiac arrest depends upon the integration of medical science, educational efficiency and local implementation (of science and education). There is some evidence to suggest that the use of distributed practice (i.e. separating the training into small portions dispersed over time) and real-time feedback (on compression depth, rate, and recoil) can improve CPR quality in healthcare providers and medical trainees. The aim of this research is to explore the efficacy and cost-effectiveness of distributed CPR training with real-time feedback relative to current CPR training practices. To accomplish this, the following work was completed: (1) designing a randomized trial to compare a new CPR training program incorporating workplace-based distributed CPR practice and real-time feedback with a group receiving conventional Heart and Stroke Foundation of Canada (HSFC) Basic Life Support (BLS) course; (2) describing the key components of, and approaches to economic evaluation in the context of simulation-based medical education; and (3) exploring the cost-effectiveness of distributed training program relative to conventional training to inform the decision whether or not to adopt the new CPR training program. This research shows that (1) workplace-based distributed CPR training significantly improves the acquisition and retention of CPR skills in practicing acute care providers and (2) this training method results in decreased training costs and increased learning outcomes in our local context. This research provides evidence to support the educational efficiency of distributed CPR training and informs the decision on implementation of this educational strategy by addressing the cost-effectiveness. Importantly, this research is the first study that comparing distributed CPR training with conventional training and longitudinally analyzing the CPR performance to address skill retention. Furthermore, this research represents the first economic evaluation studies in resuscitation training.
- ItemOpen AccessExperiences of Conformity in Postgraduate Medical Education(2015-12-22) Grendar, Jan; Beran, Tanya; Oddone Paolucci, Elizabeth; Hecker, Kent; Kassam, Aliya; Ellard, JohnA questionnaire was used to study the perception of conformity in Postgraduate Medical Education. The goals were to describe: (1) the extent of perception of pressure to conform in PGME, (2) factors that influence pressure to conform, and (3) trainees’ perception of how conformity influences their educational experience. 166 residents participated (21.3% of all residents). Individual characteristics (age, sex, PGY level, educational background) and residency program characteristics (surgical/nonsurgical, size) were not associated with a significant difference in perception of pressure to conform. Participants’ higher hierarchy rank, scenarios during off-service rotations and informal educational encounters were associated with significantly higher perception of pressure to conform. An equal number of residents perceived conformity as having a positive and negative influence on acquisition of knowledge and skills. In conclusion, although individual or program characteristics were not associated with differences in perception of pressure to conform in PGME, educational scenario characteristics were.
- ItemOpen AccessExploring the Responses of Prescribing Pharmacists and Family Physicians to Common Cases of Ambulatory Conditions(2022-09) Chiang, Vincent; Hecker, Kent; Warren, Amy; Topps, David; Anderson, Sarah; Guirguis, LisaChanges in the scope of practice of pharmacists have granted prescribing privileges to pharmacists in various jurisdictions. While seen as a natural progression of the expertise of pharmacy professionals by some, prescribing pharmacists have also been met with a range of cautionary warnings regarding proficiency and appropriateness because of the traditional training of pharmacists. Different models of prescribing pharmacist continue to be considered and implemented particularly regarding the treatment of ambulatory conditions, sometimes referred to as minor illness or ailments. Studies seeking to characterize the parameters of prescribing pharmacists with respect to ambulatory conditions such as clinical reasoning and clinical decision-making have been limited to using qualitative measures as well as focusing on a single prototypical clinical case. The following thesis describes a study which an online survey of multiple clinical cases of common ambulatory conditions was used to quantitatively assess the performance and behaviors of prescribing pharmacists in Alberta, Canada using family physicians as a comparison group. Participants were asked to respond to the clinical cases with diagnostic and therapeutic selections as well as report confidence in both selections. The prescribing pharmacists were hypothesized to demonstrate lower performance and confidence in selections compared to family physician counterparts due to aforementioned differences in training. The findings of the study concluded that were no significant differences in the diagnostic and therapeutic selection scores or in the reported confidence levels between a sample of prescribing pharmacists and family physicians. This research provides some of the first baseline evidence demonstrating the capabilities of prescribing pharmacists in the assessment and treatment of a range of ambulatory conditions. Future studies building on these findings should seek to understand how prescribing pharmacists can be better integrated into the healthcare system, particularly by using the methods of this study as a framework for the assessment of pharmacist in training and in practice.
- ItemOpen AccessExploring the Role of Communication in Companion Animal Obesity in the Veterinary Practice(2017) Phillips, Alexandra; Adams, Cindy; Hecker, Kent; Rock, MelanieVeterinarians are tasked with an important communication challenge when treating obese cats and dogs, as obesity among pets remains a prevalent health and welfare concern. Our objectives were to 1) foster further understanding of the owner and veterinary perspectives of the complex factors that influence obesity in dogs and cats; and 2) to contribute to the evidence surrounding the nature of obesity and diet discussions between veterinarians and cat owners. A review of diverse literatures suggested that a complex and multi-faceted set of influences complicate obesity management, and utility of communication between owners and veterinarians. A thematic analysis of an archive of video-recorded veterinarian-client-feline consultations revealed a lack of in-depth nutritional assessment by the veterinarian and communication misalignment between veterinarians and owners. Emergent themes included the use of humour and patient-directed speak to facilitate obesity conversations. Exploration and description of how veterinarians and owners of obese pets are communicating can inform veterinary education programming and continuing education opportunities.
- ItemOpen AccessFaculty Portfolio Development: Perception vs. Practices in a Major University, Riyadh, Saudi Arabia(2017) Alyousif, Sarah; Beran, Tanya; Baig, Lubna; Oddone Paolucci, Elizabeth; Hecker, Kent; Magzoub, Mohi EldinHigher educational institutions have been using faculty portfolios to help ensure that the mission of academia is being met. This study aimed to develop a faculty portfolio using a sequential mixed methods design. The portfolio development process took place in King Saud bin Abdulaziz University of Health Sciences (KSAU-HS) colleges based in Riyadh, Jeddah and Alhassa, Saudi Arabia. In-depth interviews and focus groups, two ubiquitous approaches for qualitative research, were used to collect data from purposefully selected interviewees (n = 18) and focus group participants (n = 24). The quantitative arm of this study included questionnaire administration to 66 participants. They completed a 59-item questionnaire developed to obtain evidence of the validity and reliability of items used to form a portfolio. The audio taped and videotaped data were transcribed and analysed using thematic content analysis. The quantitative data were analysed using between group differences. This hybrid approach identified five main portfolio domains and their 59 subdomains. The individual domains, which were prioritized using judgemental weightings assigned by 18 participants, included education, service, research, professional development and academic management and leadership. Subdomains were identified within focus groups, with a total of 59 items representing measurable faculty daily activities that constitute the five main domains. The portfolio scores were found to have good reliability and validity based on the quantitative analyses and their triangulation with the qualitative results, thereby providing evidence of the trustworthiness and credibility of the data. This study informs the scientific community by presenting a faculty portfolio developed through a multi-step validation process. It is expected that this faculty portfolio will be implemented successfully in KSAU-HS colleges because its development is based on the opinions of all stakeholders affiliated with this higher educational institution.
- ItemOpen AccessLeadership competencies for medical education and healthcare professions: population-based study(BMJ, 2012-03-27) Çitaku, Fadil; Violato, Claudio; Beran, Tanya; Donnon, Tyrone; Hecker, Kent; Cawthorpe, David
- ItemOpen AccessNeural Areas of Activation During Clinical Reasoning and Decision Making(2015-07-20) Hruska, Pamela; Hecker, Kent; Beran, TaraBackground: Neural areas of activation involved in clinical reasoning and decision making were assessed using functional magnetic resonance imaging (fMRI) in novice and expert clinicians as they reasoned through and assigned clinical diagnoses to sixteen different clinical cases (eight easy, and eight hard). Results: During the clinical reasoning phase, novices had increased activation in the left anterior temporal cortex during easy and hard clinical cases, and the prefrontal cortex during hard clinical cases. There were no significant differences in brain activity between groups during clinical decision making for the easy cases. During clinical diagnoses on hard cases, novices had increased left anterior temporal cortex and left ventrolateral prefrontal cortex activation, whereas experts had increased activations in the right parietal cortex and right dorsolateral and ventrolateral prefrontal cortex. Conclusion: Two modifiers of neural activation during clinical reasoning and clinical diagnoses include clinician level of expertise and task difficulty. Novice clinicians rely more heavily on semantic memory, when reasoning and as well demand more working memory (WM) when reasoning through cases. While both novices and experts demand use of the pre frontal cortex (PFC) during decision making, differences in hemispheric activations could suggest WM and supporting areas of the PFC evolve from use of semantic, factual knowledge that is rule-based guided by basic causal explanations in novices, to processes dedicating more attention to evaluative assessment in experts where comparisons between exemplars with more internal experiences are used.
- ItemOpen AccessNovice and Expert Differences and Educational Interventions to Improve Veterinary Pathology Visual Diagnostic Reasoning Measured by Eye-tracking Technology(2013-12-13) Warren, Amy Louise; Donnon, Tyrone; Hecker, Kent; Beran, TaraPurpose: There were two objectives, to 1) to use eye-tracking to establish baseline quantitative and qualitative differences between novice and expert veterinary pathologists and explore dual process theory of clinical reasoning, and 2) determine if the introduction of two educational interventions, the active use of key diagnostic features and image repetition, improved novice visual diagnostic reasoning skills. Method: A pre-experimental static group comparison between novice and expert veterinary pathologists was used. Participants were shown 10 veterinary cytology images and asked to formulate a diagnosis while wearing eye-tracking equipment (10 slides) and while concurrently thinking aloud (5 slides). A quasi-experimental, pre-test and post-test comparison group design was used to compare the two teaching interventions to a comparison group using eye-tracking as an assessment method. The time to diagnosis and percentage time spent viewing an area of diagnostic interest (AOI) were compared using independent t-tests (novice and expert) and paired t-tests (time) and analysis of covariance (ANCOVA) (between groups) was used for the educational interventions. Diagnostic accuracy as a dichotomous variable was compared using chi-square tables. Results: Compared to novice, experts demonstrated significantly higher diagnostic accuracy (p < 0.017), shorter time to diagnosis (p < 0.017) and a higher percentage of time spent viewing AOIs (p < 0.017). Experts elicited more key-diagnostic features in the think-aloud protocol and had more efficient patterns of eye-movement. Students in the extended visual reasoning teaching intervention: active learning, image repetition behaved most like experts with no significant difference to experts for diagnostic accuracy, percentage time spent in the AOIs and a significantly faster time to diagnosis than experts (p < 0.017). Discussion: I suggest that experts’ fast time to diagnosis, efficient eye-movement patterns, and preference for viewing AOIs supports system 1 (pattern-recognition) reasoning and script-inductive knowledge structures with system 2 (analytic) reasoning to verify their diagnosis. Our results from the educational interventions suggest a greater level of improvement in the eye-tracking of students that were taught key-diagnostic features in an active learning forum and were shown multiple case examples.
- ItemOpen AccessPerception of Interprofessional Learning during an Interprofessional Collaborative Care Pain Clinic Elective: An Embedded Mixed Methods Study(2021-02-01) Shinkaruk, Kelly Shallen; Hecker, Kent; Carr, Eloise C. J.; Lockyer, Jocelyn M.A changing landscape of complex medical conditions, in particular chronic pain, incorporates the use of interprofessional collaboration (IPC) to offer holistic patient care. Interprofessional education (IPE) and interprofessional learning (IPL) provide health professions students with the means of attaining IPC competencies and, furthermore, they catalyze dual professional identity development. This study was designed to explore the manner in which medical students perceive IPL during a clinical elective at an interprofessional pain clinic and whether this exposure led to any change in their favourability for IPL. Fourteen medical students from a variety of Canadian medical schools participated in this embedded mixed methods research study, which included pre- and post-elective surveys and in-person semi-structured interviews. Descriptive statistics and nonparametric sign testing were performed on the survey data and thematic analysis was utilized for the qualitative interview data. Quantitative analysis revealed that medical students competing this clinical elective were favourable to IPL at both time points and that no significant change occurred following the elective. Thematic analysis led to the description of a model demonstrating the elements contributing to the development of a dual professional identity. This model consisted of three major themes and three overarching moderating and mediating factors. Learning about allied health professionals, learning about how IPC teams function, and recognizing the benefit of IPC were key to gaining IPC competencies in the context of repeated exposure to IPL, active participation, and reflection. In addition, perceptions of IPC specifically related to a pain clinic setting were identified. Future directions include ensuring adequate faculty development for IPC as well as incorporating purposive IPL and facilitated reflection opportunities into clinical rotations.
- ItemOpen AccessPractice analysis of chiropractic radiologists: an exploratory study(2011) Smith, Sara Dawn Sheila; Beran, Tanya N.; Donnon, Tyrone L.; Hecker, Kent
- ItemOpen AccessQuality Improvement Training in Medical Education(2020-05-06) Brown, Allison J.; Kassam, Aliya; Hecker, Kent; Sharma, Nishan; McCaughey, DeirdreProblem: Training healthcare professionals in Quality Improvement (QI) has been highlighted as a potential strategy to reduce the prevalence of error and harm in healthcare. As a result, various health professions education programs have integrated QI into the competency frameworks that inform the core curriculum, including those used in the training of medical doctors. However, QI has been integrated, emphasized, and taught to medical trainees (i.e., medical students and residents) in a variety of ways across countries, programs, and stages of training. As contemporary medical education increasingly adapts outcomes-oriented, competency-based models of training, medical trainees may be required to demonstrate competency in QI during their training. Method of Study: This research considered how best to train future physicians in QI during their core medical training. First, methods for examining complex social phenomena were analyzed through a thought experiment exploring the methodological intersections of realist inquiry (RI) with structural equation modelling (SEM). Next, a realist synthesis examined the literature for teaching QI at the undergraduate and postgraduate levels of medical training. This generated an explanatory program theory that highlighted common associations between contexts, mechanisms, and outcomes of QI training in undergraduate and postgraduate medical training. Finally, a collective case study of four postgraduate programs at the University of Calgary examined how residents learned about QI during their training using four data sources. The combinations of RI and SEM were re-visited and operationalized as the program theory informed the specification of structural models using the quantitative data in the case study. This resulted in a novel, realist-informed SEM that statistically modelled elements associated with resident self-assessments of QI knowledge, skills, and attitudes. Conclusions: Explicit training in QI might ensure that all physicians enter practice equipped with the fundamental knowledge and skills to not only recognize areas for improvement, but implement sustainable solutions that improve the quality and safety of care. The conscientious design of QI curricula in the core medical curriculum that considers integrating features commonly associated with successful QI curricula may be beneficial to optimize training in this domain, and ultimately, catalyze the development of QI competencies amongst future physicians.
- ItemOpen AccessReducing the impact of intensive care unit mattress compressibility during CPR: a simulation-based study(2017-11-16) Lin, Yiqun; Wan, Brandi; Belanger, Claudia; Hecker, Kent; Gilfoyle, Elaine; Davidson, Jennifer; Cheng, AdamAbstract Background The depth of chest compression (CC) during cardiac arrest is associated with patient survival and good neurological outcomes. Previous studies showed that mattress compression can alter the amount of CCs given with adequate depth. We aim to quantify the amount of mattress compressibility on two types of ICU mattresses and explore the effect of memory foam mattress use and a backboard on mattress compression depth and effect of feedback source on effective compression depth. Methods The study utilizes a cross-sectional self-control study design. Participants working in the pediatric intensive care unit (PICU) performed 1 min of CC on a manikin in each of the following four conditions: (i) typical ICU mattress; (ii) typical ICU mattress with a CPR backboard; (iii) memory foam ICU mattress; and (iv) memory foam ICU mattress with a CPR backboard, using two different sources of real-time feedback: (a) external accelerometer sensor device measuring total compression depth and (b) internal light sensor measuring effective compression depth only. CPR quality was concurrently measured by these two devices. The differences of the two measures (mattress compression depth) were summarized and compared using multilevel linear regression models. Effective compression depths with different sources of feedback were compared with a multilevel linear regression model. Results The mean mattress compression depth varied from 24.6 to 47.7 mm, with percentage of depletion from 31.2 to 47.5%. Both use of memory foam mattress (mean difference, MD 11.7 mm, 95%CI 4.8–18.5 mm) and use of backboard (MD 11.6 mm, 95% CI 9.0–14.3 mm) significantly minimized the mattress compressibility. Use of internal light sensor as source of feedback improved effective CC depth by 7–14 mm, compared with external accelerometer sensor. Conclusion Use of a memory foam mattress and CPR backboard minimizes mattress compressibility, but depletion of compression depth is still substantial. A feedback device measuring sternum-to-spine displacement can significantly improve effective compression depth on a mattress. Trial registration Not applicable. This is a mannequin-based simulation research.
- ItemOpen AccessSimulation in laparoscopic surgery training: a meta-analysis(2011) Al-Kadi, Azzam S.; Donnon, Tyrone L.; Hecker, Kent
- ItemOpen AccessWhat should we be selecting for? a systematic approach for determining which personal characteristics to assess for during admissions(BioMed Central, 2012-11-05) Conlon, Peter; Hecker, Kent; Sabatini, Susan