Background and Objectives: The Philippine Department of Health (DOH) is mandated by law to, among others, develop capacities and accredit physicians and rehabilitation practitioners across the country on the assessment and management of drug dependence. This paper describes the design and presents the outputs of an advanced course on screening and assessment of drug dependence developed by DOH in partnership with the College of Public Health of the University of the Philippines Manila, Philippine College of Addiction Medicine, and the Group for Addiction Psychiatry of the Philippines.

Methodology: Review, abstraction and synthesis of data from training-related documents and records for the training activities implemented in 2014.

Results: The Level 2a course is a five-day program that focuses on enhancing the skills of physicians and rehabilitation practitioners on the screening and assessment of drug dependence using team-based and practical learning approaches, and builds on learnings from the basic accreditation course. A total of 36 participants from ten Drug Abuse Treatment and Rehabilitation Centers (DATRCs) in nine regions completed the pilot implementation of the course in 2014. In general, the overall participant feedback on the training was mainly favorable based on data from 47% of participants who agreed or strongly agreed to statements on the relevance and attainment of the course aims (mean rating of 1.10±0.31, 1 = Strongly agree, 5 = Strongly disagree), and the appropriateness of its content (1.24±0.43) and design (1.18±0.39). A paired-samples t-test comparing scores for 44% of participants showed that there was a highly statistically significant difference in the pre-test (54%±13%) and post-test scores (69%±10%); t(16)=6.4240, p <0.0001.

Conclusion: Development and design of capability-building initiatives in the field of drug rehabilitation will necessitate alignment with practice standards, grounding in the real-world setting in which professionals work, and orientation towards practical learning.

INTRODUCTION: Telestroke allows for remote determination of suitability for treatment with thrombolysis in patients with acute ischaemic stroke. However, this approach is time-dependent and most centres have yet to achieve the recommended treatment times. We describe a quality improvement initiative aimed at improving the telestroke workflow and treatment times at our centre. METHODS: A multidisciplinary workgroup comprising clinicians, stroke case managers and radiology staff was formed to oversee the initiative. A phase-by-phase review of the existing workflow was done to identify the reasons for delay. Phase-specific measures were then introduced to address these delays, and a data-monitoring system was established to track the impact of these measures. The initiatives were implemented through four Plan-Do-Study-Act cycles. The door-to-needle (DTN) times for thrombolysis and clinical outcomes before and after the interventions were compared. RESULTS: A total of 104 patients were evaluated. The median DTN time improved from 96 minutes to 78 minutes post implementation of initiatives (p = 0.003). Fewer patients had symptomatic intracranial haemorrhages (8.5% vs. 24.2%; p = 0.03), and more patients had improvements in their National Institutes of Health Stroke Scale score (47.9% vs. 25.0%; p = 0.031) after the initiatives were introduced. CONCLUSION The quality improvement initiative resulted in a reduction in median DTN time. Our approach allowed for a systematic method to resolve delays within the telestroke workflow. This initiative is part of an ongoing effort aimed at providing thrombolysis safely to eligible patients in the shortest possible time.
Adult ; Aged ; Aged, 80 and over ; Emergency Service, Hospital ; organization & administration ; Female ; Humans ; Interprofessional Relations ; Intracranial Hemorrhages ; prevention & control ; Male ; Middle Aged ; Quality Improvement ; Severity of Illness Index ; Singapore ; Stroke ; therapy ; Telemedicine ; methods ; organization & administration ; standards ; Thrombolytic Therapy ; methods ; Time ; Tissue Plasminogen Activator ; therapeutic use ; Treatment Outcome

PURPOSE: The aim of this study was to examine degrees of nurse-nurse collaboration and nurse-physician collaboration, and investigate their relationships to the occurrence of medical errors. METHODS: A cross-sectional questionnaire survey was conducted with 264 nurses in a university hospital. The questionnaire included fivecomponent nurse-nurse collaboration and three-component nurse-physician collaboration scales. Data were analyzed using independent t-tests, ANOVA, χ2 tests, and multiple logistic regression. RESULTS: Mean score for nurse-nurse collaboration was 2.8 out of 4.0, and for nurse-physician collaboration, 3.4 out of 5.0. There were significant differences in the nurse-nurse and nurse-physician collaboration scores by nurses' preference to workplace and work unit. A significant difference was found in the nurse-nurse collaboration scores by job position. Fifty-seven (21.60%) nurses responded that they had experienced a medical error in the last six months. Logistic regression analysis revealed that nurse-physician collaboration was a significant factor associated with nurses' error experience. Nurses with higher scores for the nurse-physician relationship component were less likely to experience medical errors. CONCLUSION: Findings from this study show that nurse-nurse and nurse-physician collaboration were moderate. Negative relationship between nurse-physician collaboration and the occurrence of medical error indicates that enhancing nurse-physician collaboration would contribute to improving patient safety.
Cooperative Behavior ; Interprofessional Relations ; Logistic Models ; Medical Errors ; Patient Safety ; Physician-Nurse Relations ; Weights and Measures

PURPOSE: Interprofessional communication skills are an essential competency for medical students training to be physicians. Nevertheless, interprofessional education (IPE) is relatively rare in Korean medical schools compared with those overseas. We attempted to evaluate the effectiveness of the first IPE program in our school. METHODS: In the first semester of the school year 2018, third-grade medical students (N=149) at the Seoul National University College of Medicine participated in ‘communication between healthcare professionals in the clinical field’ training, which consisted of small group discussions and role-play. To evaluate the effectiveness of this training, we conducted pre- and post-training questionnaire surveys. Comparing paired t-tests, we evaluated the students' competency in interpersonal communication and their attitude towards the importance of IPE before and after the training. The Global Interpersonal Communication Competence Scale (GICC-15) was used to evaluate competency in interpersonal communication. RESULTS: Out of 149 students, 144 completed the pre- and post-training questionnaires. The total GICC-15 scores before and after training were 55.60±6.94 (mean±standard deviation) and 58.89±7.34, respectively (p=0.000). All subcategory scores of GICC-15 after training were higher after training and were statistically significant (p<0.05), except for two subcategories. The importance of IPE score also improved after training but was not significant (p=0.159). The appropriateness of content and training method scores were 3.99±0.92 and 3.94±1.00, respectively. CONCLUSION: From the results, our school's IPE program demonstrated a positive overall educational effect. Deployment of systematic and varied IPE courses is expected in the future, with more longitudinal evaluation of educational effect.
Delivery of Health Care ; Education ; Humans ; Interprofessional Relations ; Mental Competency ; Methods ; Role Playing ; Schools, Medical ; Seoul ; Students, Medical

PURPOSE: The purpose of this study was to investigate the level of perceived readiness for interprofessional learning and its differences between nursing and other health-related students. Methods METHODS: A web-based survey was conducted from April 25 to June 30, 2017 in one university in Korea. A total of 325 undergraduate nursing students and other health-related disciplines completed the structured questionnaire consisting of Readiness for Interprofessional Learning Scale and general characteristics. Data were analyzed by descriptive statistics, t-test, ANOVA, and multiple linear regression. RESULTS: The scores of readiness for interprofessional learning in nursing students were significantly higher than those in other health-related students (t=3.50, p=.001). Nursing students had higher collaboration, professional identity, and roles and responsibilities than other health-related students. The class experiences with other major students was a significant factor related to the readiness for interprofessional learning both in nursing (p=.001) and other health-related students (p=.001). CONCLUSION: The findings suggest that nursing educators consider the different level of readiness for interprofessional learning between nursing and other health-related students while integrating interprofessional education into nursing education curricula.
Cooperative Behavior ; Curriculum ; Education ; Education, Nursing ; Humans ; Interprofessional Relations ; Korea ; Learning ; Linear Models ; Nursing ; Students, Nursing

Incivility creates an environment of hostility among healthcare providers in the workplace, and undermines a culture of patient safety. Although this phenomenon is pervasive in the profession, nurses tolerate or ignore its occurrence due to inadequate knowledge, fear and lack of institutional policies. There are no empirical studies in the local context which explore incivility among nurses in the hospital setting. This study examined the sources and forms of incivility among nurses working in a hospital according to nurse-related variables. A descriptive, cross-sectional design was utilized. Respondents were asked to answer Nurse's Profile and Nursing Incivility Scale. A stratified random sampling was used. A sample of 280 nurses from different clinical nursing units in a national tertiary hospital completed the questionnaire. Incivility outcome was analyzed using One-way Analysis of Variance (ANOVA) according to nurse-related variables such as nursing designation, practice setting, type of clinical nursing unit and length of hospital work experience. Post-hoc analysis was performed using Tukey's Honestly Significant Difference. Data were collected from September to October 2017.

Majority of the participants are female (78 %) and single (50 %) with an average age of 36 years old (SD= 9.96, range 21-62). They are employed in the hospital for an average of 9 years (SD = 8.82). Most of the sample works in general clinical nursing units (68 %) in a service/ charity setting (57 %). More than half of the respondents are staff nurses (67%) who provide direct care (Nurse I/II) followed by charge nurses (Nurse III) (19%) and head and chief nurses (IV/VI) (13%). Significant in civil interactions were reported between nurses and their colleagues at work, physicians and patients and their families according to the nursing designation, practice setting, type of clinical nursing unit and length of work experience. The moderately in civil interactions were exhibited in the forms of inconsistent behaviors, hostile climate and displaced frustrations. Nurse-related variables have significant impact on in civil interactions in the hospital setting. Understanding the sources and forms of incivility is of paramount importance in mitigating its impact on healthcare delivery and patient outcomes, and developing relevant policies and interventions that protect the welfare of nursing workforce.

PURPOSE: The purpose of this study was to investigate how interprofessional education has been designed, implemented, and evaluated in undergraduate programs in nursing through a systematic review. METHODS: The literature was searched using the PubMed, CINAHL, EMBASE, and Cochrane central databases to identify interventional studies including teaching-learning activities among nursing students and other disciplines in English between January 2000 and May 2017. Thirty studies were selected for the analysis. RESULTS: Twenty-four studies out of 30 were designed as a pre-post, no control group, quasi-experimental study design. Interprofessional education learners were primarily engaged in medicine, physical therapy, dentistry, occupational therapy, pharmacy, and respiratory therapy. Patient care related activity was the most frequently selected topic and simulation was the most common teaching-learning method. Evaluation of learning outcomes was mainly based on the aspects of teams and collaboration, professional identity, roles and responsibilities, patient care, and communication skills. Nursing students in 26 out of the 30 reviewed studies were found to benefit from interprofessional education, with outcome effects primarily related to changes in learning outcomes. CONCLUSION: The development and integration of interprofessional education with collaborative practices may offer opportunities in nursing education for training professional nurses of the future.
Cooperative Behavior ; Education* ; Education, Nursing ; Humans ; Interprofessional Relations ; Learning ; Methods ; Non-Randomized Controlled Trials as Topic ; Nursing* ; Occupational Dentistry ; Patient Care ; Pharmacy ; Physical and Rehabilitation Medicine ; Respiratory Therapy ; Students, Nursing*

For advanced stage tumor patients who can not receive radical treatment, quite a part of them require surgical intervention. Surgeons play a important role and are still the main force in palliative treatment for tumors. But in present medical education system, training contents for surgeon involving palliative treatment are few. In fact, surgeons have responsibilities for improving the quality of life, ameliorating pain, preserving the dignity and relieving symptoms of patients in the palliative treatment of tumors. Surgeons should pay attentions to the communication with patients, play a part of clinical multidisciplinary team and apply reasonable surgical intervention approach. Education of palliative treatment for surgeons should also include medical humanistic concern, and the recognition of effects of medical humanity, ethics, dignity and religion on the recovery of tumor patients.
Communication ; Education, Medical ; standards ; Humans ; Interprofessional Relations ; Neoplasms ; surgery ; Pain Management ; methods ; Palliative Care ; methods ; Patient Care Team ; Physician-Patient Relations ; Quality of Life ; Surgeons ; education ; psychology

Since the World Health Organization identified interprofessional education (IPE) as an important component in primary health care in the 1980s, medical and health sciences educators have continued to debate factors for implementing effective IPE in the classroom. Although IPE research is widespread internationally, few studies have been done in South Korea. This study explored the current status of IPE and examined factors that influence IPE in South Korea. A total of 30 (70%) out of 41 medical education experts in medical schools participated. Forty-seven percent of the participants reported that they allocated less than 5% of their time implementing IPE in the curriculum of their schools throughout the 4 years of medical school. Although all experts (100%) agreed that IPE is essential for medical students, they expressed practical difficulties in implementing IPE in the current education system. Factors that influence IPE are scheduling and curriculum (e.g., rigid curriculum vs. providing learning environment) and attitudes (e.g., lack of reciprocal respect vs. willingness to change). In addition, participants reported that communication skills and collaborative practice employing clinical practice or role-playing would be appropriate education methods and content for IPE in the future. The findings of this study provide a foundation for the implementation of IPE in South Korea. Future research directions for IPE in medical, nursing, and pharmacy schools are discussed.
Cooperative Behavior ; Curriculum ; Education ; Education, Medical ; Humans ; Interprofessional Relations ; Korea ; Learning ; Nursing ; Primary Health Care ; Professionalism ; Schools, Medical ; Schools, Pharmacy ; Students, Medical ; World Health Organization

For the last half-century, interprofessional education (IPE) has been identified and discussed as a critical educational process to facilitate collaboration in order to improve healthcare outcomes for healthcare participants. While the concept is not new, outcome-based research has provided few valid and reliable explanations of whether and how IPE can be effective in healthcare quality improvement. This challenge stems from the struggle to understand the epistemological meaning of IPE. The purpose of this literature review paper is to provide a synthesized understanding of IPE, its meaning, and to provide practical guidance for medical educators. The paper reviewed several key aspects of IPE. Professionalility was discussed to understand the historical background of IPE, followed by an explanation of the international trend of embracing the complexity of health care practice and the need for interprofessional collaboration. Additionally, several theoretical perspectives, such as general systems theory, social identity theory, and community of practice were reviewed to pinpoint what constitutes IPE. Several existing definitions were discussed with similar concepts (i.e., disciplinary vs. professional, and multi-, inter-, vs. trans-) to clarify the nature of knowledge and collaboration in IPE. Three concepts, including practice, authenticity of context, and socialization were proposed as key constructs of IPE, followed by appropriate timing of IPE, outcome research, directions for future research, and guidance for implementation. Community-based medical education practice, professional socialization within a community, and longitudinal system-based outcome research are recommended as future directions for research and practice.
Cooperative Behavior ; Delivery of Health Care ; Education ; Education, Medical ; Education, Professional ; Interprofessional Relations ; Professional Practice ; Quality of Health Care ; Social Identification ; Socialization ; Systems Theory