Most in-hospital adverse events are attributable to surgical care and of these, clinical decision-making (CDM) errors account for approximately half. The assessment of CDM is integral to establishing competence among surgical trainees. One proposed assessment tool is the script concordance test (SCT), which is based on the dual process theory of CDM, but evidence demonstrating valid results is needed. This thesis collects content and response process validity evidence for the assessment of CDM using the SCT. To gather content evidence, a Delphi technique was conducted with a panel of local general surgeons (n=15) consisting of the top decision-makers voted by staff and resident surgeons. Items achieving consensus were mapped on a table of specifications to determine the breadth of topics covered as defined by the Royal College medical expert competencies in general surgery. The final SCT was administered to 29 residents and 14 staff surgeons and results were analyzed. To gather response process evidence, cognitive interviews were then conducted with ten residents and five staff surgeons based on results of the final SCT. Data from the cognitive interviews were analyzed using a priori deductive codes based on Tourangeau’s cognitive model of response process. The first round of the Delphi yielded agreement ranging from 40-100% and consensus for 21 cases. The 21 cases made up the final SCT and encompassed 13 of the 19 competencies in general surgery. The final SCT reflected a test of the intraoperative management of open, adult general surgery. Notable absent competencies were described by experts to be outside the scope of general surgery, too difficult for the resident level of training, or presenting an unrealistic intraoperative finding. Cognitive interviews demonstrated variability in CDM among test-takers. Consistent with the dual process theory, test-takers relied on scripts formed through past experiences, when available, to make decisions. However, test-takers’ response process was also influenced by issues with respect to their comprehension, recall, and response matching cognitive steps. Due to issues with response matching in particular, when answering an SCT question test-takers indicating different numerical ratings may have the same rationale. The Delphi technique, table of specifications, and cognitive interviews provide validity evidence supporting the SCT for assessing CDM of general surgery trainees. Substantial issues with respect to the numerical rating scale suggests further revisions to the test format are required before consideration of its use in summative assessment.

Educating Nurses About a Nurse Residency Program by Tammy Lea Franklin MSN, Walden University, 2012 BSN, Oklahoma City University, 2010 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University May 2019 The problem addressed in this project was the challenges related to retention of new graduate nurses. This includes Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and Bachelor of Science Nurses (BSNs) on two medical/surgical units in an acute care facility. The purpose was to work with a project team to develop an education module and accompanying resources to present to new medical/surgical BSNs, RNs, and LPNs through a 3-month nurse residency program. The framework guiding the project was Duchscher's transition shock which guides the stages of doing, being, and knowing for new graduate nurses as they move from classroom to the bedside. The project question was: Will an educative process specifically designed to implement a 3-month nurse residency program for new graduate RNs, and LPNs in the two medical/surgical units increase retention rates when compared to data 1 year pre-intervention? The educational modules included 6 2-hour concept based sessions delivered biweekly over a 3-month period by the medical/surgical specialty coordinators. Results showed positive and statistically significant results of a 17% turnover rate of new graduate medical/surgical nurses compared to a 33% turnover rate specific to the medical-surgical new graduate nurses 1 year pre-intervention. The project contributed to positive social change by providing education that increased retention, job satisfaction, and provided professional socialization.

UA Open Access Publishing Fund / Background: The transition from medical student to first-year intern can be challenging. The stress of increased responsibilities, the gap between performance expectations and varying levels of clinical skills, and the need to adapt to a new institutional space and culture can make this transition overwhelming. Orientation programs intend to help new residents prepare for their new training environment. Objective: To ease our interns’ transition, we piloted a novel clinical primer course. We believe this course will provide an introduction to basic clinical knowledge and procedures, without affecting time allotted for mandatory orientation activities, and will help the interns feel better prepared for their clinical duties. Methods: First-year Emergency Medicine residents were invited to participate in this primer course, called the Introductory Clinician Development Series (or “intern boot camp”), providing optional lecture and procedural skills instruction prior to their participation in the mandatory orientation curriculum and assumption of clinical responsibilities. Participating residents completed postcourse surveys asking for feedback on the experience. Results: Survey responses indicated that the intern boot camp helped first-year residents feel more prepared for their clinical shifts in the Emergency Department. Conclusion: An optional clinical introductory series can allow for maintenance of mandatory orientation activities and clinical shifts while easing the transition from medical student to clinician.

UA Open Access Publishing Fund / Background: Medical residency can be a time of increased psychological stress and sleep disturbance. We examine the prospective associations between self-reported sleep quality and resident wellness across a single training year. Methods: Sixty-nine (N69) resident physicians completed the Brief Resident Wellness Profile (M17.66, standard deviation [SD] 3.45, range: 017) and the Pittsburgh Sleep Quality Index (M6.22, SD 2.86, range: 1225) at multiple occasions in a single training year. We examined the 1-month lagged effect of sleep disturbances on residents’ self-reported wellness. Results: Accounting for residents’ overall level of sleep disturbance across the entire study period, both the concurrent (within-person) within-occasion effect of sleep disturbance (B 0.20, standard error [SE]0.06, p0.003, 95% confidence interval [CI]: 0.33, 0.07) and the lagged within-person effect of resident sleep disturbance (B 0.15, SE0.07, p0.037, 95% CI: 0.29, 0.009) were significant predictors of decreased resident wellness. Increases in sleep disturbances are a leading indicatorof resident wellness, predicting decreased well-being 1 month later. Conclusions: Sleep quality exerts a significant effect on self-reported resident wellness. Periodic evaluation of sleep quality may alert program leadership and the residents themselves to impending decreases in psychological well-being.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.

The Implications of the Estonian E-Residency Project on Statehood and Territoriality Liis Peets Charles University Prague 2017 Faculty of Social Sciences; Political Studies Programme; Geopolitical Studies Curriculum Academic Supervisor Mgr. Martin Riegl, Ph.D. Abstract In 2014 Estonia became the first country in the world to launch an e-residency project. It is advertised as opening the country's digital borders to the world. This allows for anyone anywhere to apply for an e-resident status and thus gain access to certain parts of the Estonian e-governance platform allowing almost complete location independence when it comes to creating and running a limited company. The e-residency card also gives the holder a secure state guaranteed digital identity. The program has sparked a lot of international interest on both governmental levels in various states as well as in the media. One can find an abundance of claims and expectations regarding what the e-residency project is and what it could be. Many authors in the media claim that the program could quite likely change the meaning of concepts such as citizenship, residency, borders, territoriality and sovereignty. There are also claims that the whole meaning of statehood is under threat and the behavioral logic of countries in fundamentally changing. The paper...

Title: Assessing Resident Physician Knowledge about Breastfeeding Medicine in a Rural Family Medicine Clinic Authors: Samantha Jensen, MD and Amanda Stoltz, MD, Bristol Family Medicine Residency Program, Department of Family Medicine, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN Introduction: Many residents and faculty encourage the long-term goal of breastfeeding, and our residency program provides extensive training in obstetrics and newborn nursery. However, there is little structure and direct guidance for breastfeeding medicine already built in to the family medicine residency training. We aimed to develop a dedicated breastfeeding medicine longitudinal curriculum to improve the effectiveness of family medicine physician residents as teachers and advocates by improving residents’ fund of knowledge, provide structure for encouraging breastfeeding at prenatal visits, and incorporate breastfeeding into our family medicine practice by improving the on-site locations for breastfeeding and pumping. Method: The method of research was pre-lecture and post-lecture surveys comprised of 15 questions, including knowledge-based questions, assessment of confidence level, and a question on perceived barriers to breastfeeding. Participants attending two educational sessions during the study, and additional educational sessions have continued after study conclusion. The post-lecture survey was completed 12 weeks after first lecture. Lecture topics included an overview of breastfeeding medicine, how to encourage breastfeeding at prenatal appointments, contraindications, maternal nutritional supplements, formula supplementation, galatogogues, and the storage of breastmilk. Results: Results were compiled from the responses of 20 pretests and 9 posttest surveys. Results showed an increase in correct responses to the knowledge portion 61.15% pretest versus 77.69% posttest (t(28) 3.41, p<0.01). Resident physician confidence also increased by the conclusion of the study (t=28, p<.01). Conclusions: It can be concluded that educational lectures increase knowledge and confidence in resident physicians with regards to breastfeeding medicine. Areas for future study include specific research focusing on methods to increase access to resources for breastfeeding mothers.

Caregiver burnout is an issue for health care organizations, negatively influencing cost, engagement, and workforce stability. Nurse residency programs are intended to address the gap in practice between academia and clinical practice and provide social support during this transitional time. Self-care education can positively affect novice acute care nurses' transition into their new professional role while building connections with the health care organization during the first year of employment. The purpose of this project was to develop a staff educational module to address the nursing practice problem of evidence-based self-care education within a nurse residency curriculum at the doctoral site. The practice focus question for this project was can evidence-based staff development project be developed identifying self-care strategies for novice acute care nurses within a nurse residency program. Orem's theory of self-care, which highlights the importance of taking time to care for self as integral to human functioning, and Watson's caring theory, which emphasizes the loving care of self as a vital prerequisite for caring for others, were the theoretical frameworks. This module was developed based on existing peer-reviewed journals, national organizations' position statements, white papers, and expert opinion and was synthesized using Melynk's hierarchy of evidence for intervention studies tool. This module was developed and shared with doctoral site stakeholders. The recommendation was to integrate this educational product into the existing nurse residency program. The positive implications this project has for the nursing profession include improved well-being and job satisfaction for the novice acute care nurses and potential long-term effects on organizational cost related to turnover

Almost 30% of new nurse graduates leave the position within the first year of practice, and almost 60% leave within 2 years. When new nurse graduates do not effectively transition into practice, nursing satisfaction is affected, and additional costs are incurred by their organizations through continual hiring of nurses. The purpose of this project was to develop a comprehensive, evidence-based nurse residency program (NRP) for new nurse graduates working in a 16-bed intensive care unit (ICU) of a 160-bed community hospital in the mid-Atlantic region of the United States. Using a team approach, Rosswurm and Larrabee's model of evidence-based practice was used to guide the project design, which included a pretest followed by 10 educational sessions. The plan concluded with a posttest to assess knowledge gained. The curriculum focused on 3 key areas identified by the Commission on Collegiate Nursing Education: leadership, patient outcomes, and the professional role of the nurse. Evaluation of the curriculum was completed by 3 Master of Science in Nursing-prepared content experts using a dichotomous scale. An average score revealed that the content met the objectives of each session. The experts also conducted a content validation index (CVI) of each pretest/posttest item using a Likert scale that ranged from 1 (not relevant) to 4 (highly relevant). The scale-CVI average, or the average CVI of all items, was .99; the universal agreement scale-CVI, or universal agreement of all items was .98, meaning there was high agreement across raters. Nurses who participate in the nurse residency program will be better able to transition into practice in the ICU as they provide care for today's complex patients, thereby positively impacting social change in their role as nurses as well as impacting patient, family, and organizational outcomes.

While academic nursing programs teach the concepts and theory of providing care, these programs cannot provide sufficient experiential learning to prepare the nurse for all that might be faced in diverse clinical practice settings. As a result, each nurse faces transition to practice hardships with the first nursing role and again each time the clinical setting changes. The Specialty Nurse Residency intervention offers support and instruction during the crucial transition period. Efficacy of the intervention is evaluated based on data analysis from pre and post-intervention survey responses. This quantitative, descriptive study solicits feedback from experienced staff to answer the question: Are the positive outcomes of the Specialty Nurse Residency program reproducible in specialty units other than the Burn ICU as evidenced by preceptor, manager and educator feedback before and after program implementation? The intervention engages new-to-specialty nurses within an evidence-based support system that validates competence and development of clinical reasoning skills. Preceptor development and support are key elements of intervention and program delivery, as these crucial staff members safeguard program and learner success. / Doctorate of Nursing Practice