Faculty Development (FD) has become essential in shaping design, delivery and quality assurance of health professions education. The growth of FD worldwide has led to a heightened expectation for quality and organizational integrity in the delivery of FD programmes. To address this, AMEE, An International Association for Health Professions Education, developed quality standards for FD through the development of the AMEE ASPIRE to Excellence criteria. This guide uses the ASPIRE criteria as a framework for health professions educators who wish to establish or expand approaches to FD delivery and scholarship within their institutions.

BACKGROUND: The diagnosis and treatment of rare diseases in childhood can affect the quality of life and mental health of the entire family. The psychosocial challenges are significant for those affected and are often compounded by a lack of appropriate support services.
OBJECTIVE: This article aims to summarize the barriers of current pathways to psychosocial care and identify potential solutions for a care strategy adapted to the needs of families.
METHODS: In three focus group sessions with 14 professionals from the field of rare pediatric diseases, the results of a previous qualitative study on barriers in current pathways to psychosocial care were presented. In the focus groups, the experts discussed possible solutions.
CONCLUSIONS: Despite an increased need for psychosocial support services, it is difficult for children with rare diseases and their families to access these. To facilitate access, interventions should address multiple levels. On the one hand, care should be increasingly adapted to the needs of families. At the same time, long-term and reliable care structures need to be established to ensure sustainable care. Structural interdisciplinary collaboration should be promoted, while the training of health professionals should also be more strongly geared to rare diseases.
UNASSIGNED: HINTERGRUND: Diagnose und Behandlung einer seltenen Erkrankung im Kindesalter können die Lebensqualität und die psychische Gesundheit der ganzen Familie beeinträchtigen. Die psychosozialen Herausforderungen sind für Betroffene und ihre Angehörigen erheblich und werden gegebenenfalls durch das Fehlen geeigneter psychosozialer Unterstützungsangebote zusätzlich verstärkt.
UNASSIGNED: In diesem Beitrag sollen die Hindernisse und Barrieren der derzeitigen Zugangswege zur psychosozialen Versorgung zusammengefasst und mögliche Lösungsansätze für eine an die Bedarfe der Familien angepasste Versorgungsstrategie aufgezeigt werden.
METHODS: In drei Fokusgruppensitzungen mit insgesamt 14 Expert:innen aus der Versorgung von Kindern mit seltenen Erkrankungen und ihrer Familien wurden die Ergebnisse einer vorangegangenen qualitativen Studie über Hindernisse und Barrieren bei den derzeitigen Zugangswegen zur psychosozialen Versorgung vorgestellt. Mögliche Lösungsansätze wurden in den Fokusgruppen diskutiert.
UNASSIGNED: Trotz eines erhöhten Bedarfs an psychosozialen Unterstützungsangeboten ist es für Kinder mit seltenen Erkrankungen und deren Angehörige schwierig, diese in Anspruch zu nehmen. Um den Zugang zu erleichtern, sollten Maßnahmen auf mehreren Ebenen ansetzen. Einerseits sollte die Versorgung verstärkt an die Bedarfe der Familien angepasst werden. Gleichzeitig müssen langfristige und verlässliche Versorgungsstrukturen geschaffen werden, um eine nachhaltige Versorgung zu gewährleisten. Die strukturelle interdisziplinäre Zusammenarbeit sollte gefördert und die Ausbildung von Gesundheitsfachkräften stärker auf seltene Erkrankungen ausgerichtet werden.

BACKGROUND: Clinical practice guidelines (CPGs) have teaching potential for health professionals in training clinical reasoning and decision-making, although their use is limited. The objective was to evaluate the effectiveness of a game-based educational strategy e-EDUCAGUIA using simulated clinical scenarios to implement an antimicrobial therapy GPC compared to the usual dissemination strategies to improve the knowledge and skills on decision-making of family medicine residents. Additionally, adherence to e-EDUCAGUIA strategy was assessed.
METHODS: A multicentre pragmatic cluster-randomized clinical trial was conducted involving seven Teaching Units (TUs) of family medicine in Spain. TUs were randomly allocated to implement an antimicrobial therapy guideline with e-EDUCAGUIA strategy ( intervention) or passive dissemination of the guideline (control). The primary outcome was the differences in means between groups in the score test evaluated knowledge and skills on decision-making at 1 month post intervention. Analysis was made by intention-to-treat and per-protocol analysis. Secondary outcomes were the differences in mean change intrasubject (from the baseline to the 1-month) in the test score, and educational game adherence and usability. Factors associated were analysed using general linear models. Standard errors were constructed using robust methods.
RESULTS: Two hundred two family medicine residents participated (104 intervention group vs 98 control group). 100 medicine residents performed the post-test at 1 month (45 intervention group vs 55 control group), The between-group difference for the mean test score at 1 month was 11 ( 8.67 to 13.32) and between change intrasubject was 11,9 ( 95% CI 5,9 to 17,9). The effect sizes were 0.88 and 0.75 respectively. In multivariate analysis, for each additional evidence-based medicine training hour there was an increase of 0.28 points (95% CI 0.15-0.42) in primary outcome and in the change intrasubject each year of increase in age was associated with an improvement of 0.37 points and being a woman was associated with a 6.10-point reduction. 48 of the 104 subjects in the intervention group (46.2%, 95% CI: 36.5-55.8%) used the games during the month of the study. Only a greater number of evidence-based medicine training hours was associated with greater adherence to the educational game ( OR 1.11; CI 95% 1.02-1.21).
CONCLUSIONS: The game-based educational strategy e-EDUCAGUIA shows positive effects on the knowledge and skills on decision making about antimicrobial therapy for clinical decision-making in family medicin residents in the short term, but the dropout was high and results should be interpreted with caution. Adherence to educational games in the absence of specific incentives is moderate.
BACKGROUND: ClinicalTrials.gov Identifier: NCT02210442 . Registered 6 August 2014.

BACKGROUND: In the context of fragility that characterizes the Republic of Guinea-Bissau, there is an absence of effective management of human resources for Health, which begs reflection regarding training that is provided. The purpose of this study was to analyse the training of human resources for Health in the Republic of Guinea-Bissau since 1974, placing it in the national context and relating the analysis to the situation described for Fragile States.
METHODS: Using the content analysis of the results of semi-structured interviews, focus group and documentary analysis, we analysed the training offer on human resources for Health in two pillars - at the level of the structures / training institutions; and at the level of processes. The consideration of the context in which it takes place allowed for an integrated analysis in the reality experienced by Fragile States.
RESULTS: We synthesize the historical steps of the establishment of human resources for Health, describing the structures and their procedures, concretely of the public entities like the National School of Health and the Faculty of Medicine, as well as of the private entities that proliferate in the country.
CONCLUSIONS: The country reflects the problems that have been identified for the African Region, and for Fragile States in particular, namely: weak health leadership / governance; limitation in the implementation of the planned training strategies; inadequate human resources training capacity; total / partial dependence on training funding, proliferation of private, unofficially recognized training providers.
CONCLUSIONS: The models that emerge as a response to the fragility in this area partially allow to respond to the training needs of the country but neglect the quality and perpetuate dependencies, aggravating the weaknesses of the State and of the public sector.
Introdução: No contexto de fragilidade que caracteriza a República da Guiné-Bissau constata-se uma ausência de gestão eficaz de recursos humanos da Saúde, impondo-se a reflexão sobre a sua formação. Tivemos por objetivo analisar a oferta formativa de recursos humanos da Saúde na República da Guiné-Bissau de 1974 a esta parte, enquadrando-a no contexto nacional e relacionando a análise com o descrito para Estados-Frágeis. Material e Métodos: Recorrendo a análise de conteúdo dos resultados de entrevistas semi-estruturadas, grupo focal e análise documental, analisámos a oferta de formação de recursos humanos da Saúde em dois pilares – ao nível das estruturas/instituições formadoras; ao nível dos processos de formação. A consideração do contexto em que esta decorre permitiu uma análise integrada na realidade vivida por Estados-Frágeis. Resultados: Sintetizámos os passos históricos da formação de recursos humanos da Saúde, descrevendo as estruturas e seus procedimentos, concretamente das entidades públicas como a Escola Nacional de Saúde e a Faculdade de Medicina, e também das entidades privadas que proliferam no país. Discussão: O país enquadra os problemas definidos para a Região Africana, aproximando-se do descrito para Estados-Frágeis, apresentando: fraca liderança/governação em saúde; limitação na implementação das estratégias de formação planeadas; inadequada capacidade de formação de recursos humanos; dependência total/parcial no financiamento da formação, proliferação de entidades formadoras privadas, não oficialmente reconhecidas. Conclusão: Os modelos que emergem como resposta à fragilidade nesta matéria permitem parcialmente responder às necessidades de formação do país mas negligenciam a qualidade e perpetuam dependências, agravando as fragilidades do Estado e do setor público.

OBJECTIVE: Within the framework of the PaSQ (Patient Safety and Quality care) Project, this hospital decided to implement a multifaceted hospital-wide Hand Hygiene (HH) intervention based on a multimodal WHO approach over one year, focusing on achieving a sustained change in HH cultural change in this hospital.
METHODS: Setting: University Hospital Marqués de Valdecilla, Santander (Spain), a tertiary hospital with 900 beds. Intervention period: 2014. An action plan was developed that included the implementation of activities in each component of the 5-step multimodal intervention. An observation/feedback methodology was used that included the provision of performance and results feedback to the staff. A 3/3 strategy (non-blinded direct observation audits performed during 3 randomised days every 3 weeks with pro-active corrective actions at the end of each observation period). HH compliance, alcohol-based hand-rub (ABHR) consumption, and rate of MRSA infection, were monitored during the intervention.
RESULTS: Hospital ABHR consumption increased during the study period: from 17.5 to 19.7mL/patient-days. In the intervention units, this consumption was 24.8mL pre-intervention, 42.5mL during the intervention, and 30.4mL two months post-intervention. There were 137 evaluation periods in 30 different days, in which a total of 737 health-care workers were observed and 1,870 HH opportunities. HH compliance was 54.5%, ranging between 44.8% and 69.9%. The incidence of MRSA infection decreased during the intervention in the selected units, from 13.2 infections per 10,000 patient-days pre-intervention to 5.7 three months post-intervention.
CONCLUSIONS: Our HH strategy, supported by a 3/3 strategy increased alcohol-based hand-rub consumption and compliance. A reduction in MRSA infections was observed.

BACKGROUND: Clinical practice guidelines (CPGs) have been developed with the aim of helping health professionals, patients, and caregivers make decisions about their health care, using the best available evidence. In many cases, incorporation of these recommendations into clinical practice also implies a need for changes in routine clinical practice. Using educational games as a strategy for implementing recommendations among health professionals has been demonstrated to be effective in some studies; however, evidence is still scarce. The primary objective of this study is to assess the effectiveness of a teaching strategy for the implementation of CPGs using educational games (e-learning EDUCAGUIA) to improve knowledge and skills related to clinical decision-making by residents in family medicine. The primary objective will be evaluated at 1 and 6 months after the intervention. The secondary objectives are to identify barriers and facilitators for the use of guidelines by residents of family medicine and to describe the educational strategies used by Spanish teaching units of family and community medicine to encourage implementation of CPGs.
METHODS: We propose a multicenter clinical trial with randomized allocation by clusters of family and community medicine teaching units in Spain. The sample size will be 394 residents (197 in each group), with the teaching units as the randomization unit and the residents comprising the analysis unit. For the intervention, both groups will receive an initial 1-h session on clinical practice guideline use and the usual dissemination strategy by e-mail. The intervention group (e-learning EDUCAGUIA) strategy will consist of educational games with hypothetical clinical scenarios in a virtual environment. The primary outcome will be the score obtained by the residents on evaluation questionnaires for each clinical practice guideline. Other included variables will be the sociodemographic and training variables of the residents and the teaching unit characteristics. The statistical analysis will consist of a descriptive analysis of variables and a baseline comparison of both groups. For the primary outcome analysis, an average score comparison of hypothetical scenario questionnaires between the EDUCAGUIA intervention group and the control group will be performed at 1 and 6 months post-intervention, using 95 % confidence intervals. A linear multilevel regression will be used to adjust the model.
CONCLUSIONS: The identification of effective teaching strategies will facilitate the incorporation of available knowledge into clinical practice that could eventually improve patient outcomes. The inclusion of information technologies as teaching tools permits greater learning autonomy and allows deeper instructor participation in the monitoring and supervision of residents. The long-term impact of this strategy is unknown; however, because it is aimed at professionals undergoing training and it addresses prevalent health problems, a small effect can be of great relevance.
BACKGROUND: ClinicalTrials.gov: NCT02210442 .

OBJECTIVE: Health care providers influence parental vaccination decisions. Over 90% of parents report receiving vaccine information from their child\'s health care provider. The majority of parents of vaccinated children and children exempt from school immunization requirements report their child\'s primary provider is a good source for vaccine information. The role of health care providers in influencing parents who refuse vaccines has not been fully explored. The objective of the study was to determine the association between vaccine-related attitudes and beliefs of health care providers and parents.
METHODS: We surveyed parents and primary care providers of vaccinated and unvaccinated school age children in four states in 2002-2003 and 2005. We measured key immunization beliefs including perceived risks and benefits of vaccination. Odds ratios for associations between parental and provider responses were calculated using logistic regression.
RESULTS: Surveys were completed by 1367 parents (56.1% response rate) and 551 providers (84.3% response rate). Parents with high confidence in vaccine safety were more likely to have providers with similar beliefs, however viewpoints regarding disease susceptibility and severity and vaccine efficacy were not associated. Parents whose providers believed that children get more immunizations than are good for them had 4.6 higher odds of holding that same belief compared to parents whose providers did not have that belief.
CONCLUSIONS: The beliefs of children\'s health care providers and parents, including those regarding vaccine safety, are similar. Provider beliefs may contribute to parental decisions to accept, delay or forgo vaccinations. Parents may selectively choose providers who have similar beliefs to their own.