Background: The quality of medical education is affected by many factors, one of which is the educational environment of medical education. However, there is paucity of studies addressing the educational environment from African medical schools. The aim of this study was to determine the clinical year students’ perceptions of their educational environment at a medical school in Ghana. This was done with the goal of identifying factors that may impact positive changes in the school.Methods: A cross-sectional study was undertaken using the DREEM questionnaire. The questionnaire was administered to students in clinical years 1, 2, & 3 at the time of the study. 298 students participated in the study by convenience sampling. Data was analyzed using SPSS version 24. The total score and the five subscales of DREEM scores were used in the final analysis.Results: A total of 298 out of 300 students completed the questionnaire out of which Fifty six percent of respondents were male. There was no significant gender differences in the total DREEM scores [F(1, 274) = 1.019, p=0.314]. The overall educational environment was positive M=117.32 ± 15.45. Areas for improvement were students’ perception of the teachers (26.09 ± 3.59) and students’ perception of the atmosphere (25.71 ± 5.62). The students’ perception of learning (30.70 ± 5.20), and students’ academic self-perceptions (21.11 ± 3.74) were positive. Students’ social self-perceptions (13.71 ± 2.99) was neutral. There was no significant difference in perception by clinical year [F(2, 274) = 0.298, p = 0.742].Conclusion: The perception of students at this Ghanaian medical school can be described as positive and negative. The school should consider the two domains with negative perceptions as areas for improvement. Students reported problem-based learning as a preferred method of teaching versus the traditional method. Attention to the learning atmosphere and student-focused learning is likely to increase perception.

Background:It has been observed that some Nigerian Families that immigrated to North America (NINA) seem to have very stressful marital relationships that lead to separation or divorce. The goal of this study was to determine the level of marital satisfaction among NINA Method: A simple, standardized survey tool was utilized to measure the index of marital satisfaction (IMS). The score varied from 0-100 with a lower score (<30 points) indicating marital satisfaction. A demographic questionnaire was also administered to the subjects. Descriptive data analysis and level of marital satisfaction were computed in SPSS (version 25).Results: Forty-five of the fifty questionnaires were returned completed. Fifty-one percent of respondents were female. The majority (44%) were between the ages of 41-50 years. 81% were married and living with spouses. Average year of marriage was 13.5 years. The majority (85%) of respondents were married in Nigeria with only one spouse immigrating first (35%). The primary reason for immigration was employment for most subjects (48%). Seventy-two percent of the respondents scored < 30 on the IMS scale, indicating marital satisfaction. The scores were not significant when compared within the demographic variable groups. Most participants (71.4%) reported significant marital satisfaction (Z=-3.209, p=0.001. r = 0.47). Conclusion:Initial pilot study did not support the observation in the Nigeria community regarding stressful marital relationships among NINA. The IMS tool may not be sensitive to the Nigerian marriage culture and possible factors affecting marital satisfaction with cultural influence. The authors plan to conduct a more extensive study with a qualitative approach to elicit the Nigerian culturally sensitive factors.

This article describes a quality improvement process for "do not return" (DNR) notices for healthcare supplemental staffing agencies and healthcare facilities that use them. It is imperative that supplemental staffing agencies partner with healthcare facilities in assuring the quality of supplemental staff. Although supplemental staffing agencies attempt to ensure quality staffing, supplemental staff are sometimes subjectively evaluated by healthcare facilities as "DNR." The objective of this article is to describe a quality improvement process to prevent and manage "DNR" within healthcare organizations. We developed a curriculum and accompanying evaluation tool by adapting Rampersad's problem-solving discipline approach: (a) definition of area(s) for improvement; (b) identification of all possible causes; (c) development of an action plan; (d) implementation of the action plan; (e) evaluation for program improvement; and (f) standardization of the process. Face and content validity of the evaluation tool was ascertained by input from a panel of experienced supplemental staff and nursing faculty. This curriculum and its evaluation tool will have practical implications for supplemental staffing agencies and healthcare facilities in reducing "DNR" rates and in meeting certification/accreditation requirements. Further work is needed to translate this process into future research.

Background: ‘Waiting’ can be frustrating for anyone especially when it comes to healthcare. The Institute of Medicine advocates changes to improve the quality of the health care delivery system in the United States.Purpose: The purpose of this retrospective study was to determine the factors contributing to increased patient wait times in selected wound care patients. The question guiding this project is-in selected wound care patients who received treatment between September1-December 31, 2013; are factors contributing to prolonged wait times related to treatment-related diagnosis, providers, and clinicians?Method: After institutional review board approval, retrospective charts review was conducted. 300 charts were randomly selected from the electronic health record (EHR) database at a local hospital wound care clinic. 120 charts met the inclusive criteria and were analyzed using ANOVA and SPSS version 22. The Deming cycle for quality improvement was adopted as the framework for practice review and changes.Result: Among all the factors examined, Treatment diagnosis accounted for 4% of the variance (p = 0.416); Providers 1% (p = 0.208); and Clinicians 8% (p = 0.195). Though clinicians had the highest variance, it was not a significant factor for patient wait times. The Deming cycle helps to prioritize and improve communication by creating a chart for effective patient flow through the clinic to reduce wait time.Conclusion: Correcting and improving wait times has the potential for increasing timely access and patient satisfaction. Clinicians and providers are not significant factors contributing to wait times. Wait time should be given priority and be regularly reviewed as part of the quality improvement plan within any organization.