The VaRP Project: qualitative evaluation of the training effectiveness of Post Graduate Specializations for health professionals.

INTRODUCTION: The healthcare professionals' specialized training has a positive impact on professional values, patient's outcome, and promotion of evidence-based practices. To raise the educational standard, the University of Parma has created Post Graduate Specializations which, in addition to learning sector-specific techniques and skills, include the acquisition of soft skills. Aim of the study is investigating the perception of the tutors dedicated to the organization, management, and teaching of the Post Graduate Specializations on the skills gained and the changes achieved in clinical practice, training, and research.
MATERIALS AND METHODS: Qualitative research was carried out through a semi-structured interview to 11 tutors who have been coordinating the Post Graduate Specializations.
RESULTS: The Qualitative analysis developed "thick" descriptions characterized by analytical density and interpretative richness. The emerging thematic nuclei were: General/unpredicted aspects, Professional empowerment, Satisfaction, Professional outcomes, Limits of the Post Graduate Specializations, and Development areas.
CONCLUSIONS: We identified the most effective areas of the Post Graduate Specializations that emerged consistently from the interviews. We hypothesized that the values and mission the Scientific Board, are effectively lived and championed in the everyday activities of the Post Graduate Specializations. Some domains still need to be furtherly developed, as the professional record, the absence of a "follow up" relationship with former students, and the effective management of workload both for students and tutors. The rise of these limits, can be particularly fruitful, as it gives the chance to identify the development trajectory the post-graduate trainings should pursue to raise the standard of excellence.

Introduction

The international literature has indicated that the specialized training of healthcare professionals is an important resource for the health system, with a positive impact on professional values, patient’s outcome, and on the promotion of evidence-based practices (1–3). At the European Union level, the document “Competences of the Clinical Nurse specialist (CNS): Common plinth of competences for a Common Training Framework of each specialty (4) was created to identify the essential competencies of a nurse specialist, meant as “an advanced practice Nurse prepared in a clinical specialty at the master’s, post master’s or doctoral level as specialist”. These competencies are supposed to involve: the Clinical role, Patient relationship, Patient Teaching/coaching, Mentoring, Research, Organization and management, Communication and teamwork, Ethic and decision making, Leadership /policy making, Prevention.

Moreover, another crucial aspect is represented by soft skills, defined as “socio-emotional intra and interpersonal skills important for personal development, social participation and job success [...]” (5), that can be taught and developed with specialization courses. Soft skills are characterized by being general skills that can be spent in different working contexts which, if possessed and properly used, can contribute both to the achievement of excellent work results and personal development (6).

As from the previous definition, soft skills are considered by literature as a heterogeneous set of transversal skills concerning the capability to adjust to the work environment that healthcare professionals need to develop (7).

Among the main soft skills associated with positive outcomes for both the patient and healthcare professionals, emerges the capability to manage the workload and resilience to burnout mediated by empathy and self-compassion (8), the communication skills, the ability to work in a team, general adaptability, time-management (9,10).

So to raise the educational standard of healthcare professionals, therefore, the University of Parma has created first and second level Post Graduate Specializations that approach specialization with a “collaborative model” (11) which, in addition to learning sector-specific techniques and skills, also includes the acquisition of the soft skills transversal to practice in the socio-health sector. Following what is present in the literature, the Post Graduate Specializations for the health professions, promoted by the University of Parma, active in the years span 2013-2020, share a vision that develops around to the following transversal macro areas:

The cultural development of learners through the collaborative creation of research literacy (12–15);

The orientation of the learners to the assisted person and his/her family and not only to the clinical case (16,17);

The orientation towards the development of competencies through the internship activity (18–20);

The focus on communication, relational and teamwork skills (21–27);

Inter-professionalism (28–33);

Co-creation of the curriculum (34–36);

Personalization of the training course (37–39).

Given the salience of short-term and long-term outcomes of post-base training in the health sector, the need for an approach to the training offer that provides for a continuous evaluation of the same becomes evident, to guarantee a high level of “effectiveness” of the training.

The evaluation of post-base specialist training, in the literature, seems to involve different variables such as:

- Learner satisfaction with the content and methods used (40–42).

- Professional record (41,43).

- Perceived levels of effectiveness and preparation in the specialization (43,44)(43).

One approach to evaluate both competences and soft skills, could be through the perception of post graduate trainings Tutors.

As emerged from the study conducted by the Emilia-Romagna Regional Health and Social Agency (45), there are some common identifying functions of the role of the tutor: establishing a relationship climate, organizational and educational conditions that favour learning; encourage the development of meta-skills; adopt the most suitable training methods to guide and support the student’s path; encourage the integration of theoretical and practical knowledge; provide constant feedback.

Aim

This study aims to investigate the perception of the team of expert tutors dedicated to the organization, management, and teaching of the Post Graduate Specializations concerning the skills gained by the learners and the possible changes achieved from the learners in clinical practice, training, and research.

Methods

Research design and context

Qualitative research was carried out through a semi-structured interview.

The Post Graduate Specializations subject to evaluation are:

First level (Post - Bachelor degree):

Post Graduate Specialization in Palliative Care and Pain Therapy for Healthcare Professions;

Post Graduate Specialization in Case care management in hospital and on the territory for health professions

Post Graduate Specialization in Intensive Care nursing

Post Graduate Specialization in Interprofessional Management of Chronicity in the Hospital and the Territory

t Graduate Specialization in Infectious Risk Related to Health Care

Post Graduate Specializations in Integrated Family and Community Assistance

Post Graduate Specializations in Innovative Training Methodologies

Second level (Post- Master degree)

Post Graduate Specialization in Innovative Training Methodologies and European Standards.

These Post Graduate Specializations encompasses three kind of active roles: Didactic tutor, who deals with didactic planning, direct relationship with learners and logistics, organizational and classroom management. Research tutor: who follows the individual groups of students in the research project, with the role of trainer and facilitator. E-learning innovative methodologies tutor: who deals with the research and implementation of multimedia learning and organization systems for learners.

More details on the organizational structure of the Post Graduate Specializations are reported in Table 1.

Table 1.

Organizational structure of University of Parma Post Graduate Specializations in Health Professions

Scientific Board
President Scientific Coordinator
2 Research Supervisors 1 E-learning innovative methodologies tutor
2 Research Supervisors 1 E-learning innovative methodologies tutor	Case care management in hospital and on the territory for health professions	Intensive Care Nursing	Interprofessional Management of Chronicity in the Hospital and the Territory	Infectious Risk Related to Health Care	Integrated Family and Community Assistance	Innovative Training Methodologies	Innovative Training Methodologies and European Standards
1 didactic tutor	1 didactic tutor	1 didactic tutor	1 didactic tutor	1 didactic tutor	1 didactic tutor	1 didactic tutor	1 didactic tutor
4 research tutor	4 research tutor	6 research tutor	4 research tutor	4 research tutor	4 research tutor	2 research tutor	2 research tutor

Sample

The sample consists of 11 tutors (didactic tutors, research tutors, e-learning innovative methodologies tutor), who agreed to participate in the research and gave informed consent. Out of 11 participants, 9 are current or past Didactic Tutors of the specializations, 1 Research Tutor and the e-learning innovative methodologies tutor, the latter being transversal to the different specialization courses.

The average years of experience as a tutor is 2.8 years (Min 1, Max 6)

In the team of 11 Tutors, 6 have the professional qualification of Psychologist or Psychologist / Psychotherapist, 3 of Nurses or Nursing Coordinator, 1 Sociologist.

7 have the title of Ph.D. and 4 Master’s Degree.

The totality plays multiple professional roles currently, including freelancers (6), trainers (5), university teachers (2), nurses (2), managers of the Degree Course in Nursing (3).

In total, 7 women and 4 men were interviewed. The description of each participant is in table 1

Instruments

The interviews were conducted and recorded using Skype, the average duration being 30 minutes (Min 13, Max 47, SD: 9,7)

They were subsequently fully transcribed and analysed through the segmentation and identification of meaning units and grouping into descriptive categories.

The semi-structured interview includes 3 sections aimed at exploring 3 themes:

1. Professional empowerment: meant as the skills and competencies that students have gained, with attention to educational innovation, project work, research, e-learning platform, program co-construction, soft skills.

2. Satisfaction: meant as the actual level of student satisfaction with the classic areas of training such as theory, laboratories, internships, seminars, collaborations with institutions, and for areas of innovation

3. Professional outcomes: meant as an opportunity to understand if and in what way the tutors had the opportunity to follow the professional development of the participants and the idea the tutor made of professional development, intended not only as a change/improvement of the working position, but also as development of the thinking ability, ability to socialize the results of one’s work also in scientific conferences, or research results through publications, or again, learning of transversal skills such as soft skills.

At the end of the interview, the participant is also invited to add any ideas related to the improvement of the evaluation and the specialization courses themselves.

Results

The interpretative effort has been oriented to the development of “thick” descriptions (46), characterized by analytical density and interpretative richness of the tutors’ descriptions. This approach allows this research to get closer to understand and make sense of the teaching-learning practices taken by the Post Graduate specializations currently active in the Department of Medicine and Surgery at the Parma’s Major Hospital.

The first reading of the transcripts allowed to access a global idea of their content and the identification of the categories. During the second reading, we built different thematic nuclei made by categories emerged in the first reading through an inductive, open, and generative process and selected the ones relevant for the objectives of the study. The thematic nuclei that have emerged encompass the categories revealed by the interviewed sample. To some extent, all the tutors participating in this study converged to the categories and thematic nuclei that have been defined.

Below are the categories that form each thematic nuclei (Tab. 3).

Table 3.

Categories and thematic units that form up each core of meaning

Thematic nuclei	Category
general/unpredicted aspects	Tutor experience
	Student expectations
Professional empowerment	Skills developed by students through the post-graduated training*
	More effective training instruments*
Professional outcomes
	Impact in the professional career*
Satisfaction	Methodologies / activities most appreciated by students
	Peculiarities of the post-graduated training
Limits of the specialization courses and Development areas	Criticality / future developments of the post-graduated training
The categories marked with an * belong to the two thematic nuclei on the left

The thematic nuclei were defined as follows:

General/unpredicted aspects

The heterogeneity of the groups is an aspect that has an important place for the tutor. The groups are made up of different age students, with different degrees of experience and different work areas. This heterogeneity tends to cause, mainly in the initial period, conflicts and some discomfort in students, who may not find their expectations reflected with the way in which the Post Graduate Specializations are organized.

“…the student is placed in front of a huge challenge... maybe they don’t expect to collaborate, to have to participate from the beginning to the end…”

It is difficult for the tutor, but also enriching, to manage or mediate between the characteristics of the students - at a personal level and at the level of specific professional characteristics - and the methodology offered in the specializations. This professional path is enriching not only professionally but also personally. The professionals are relocated because of their relationships with their classmates, their teachers and Post Graduate Specializations’ staff, returning to a position of students and peers with their colleagues, a factor that seems to enrich the psychosocial attitude of the group.

“…asking students to enter into relationships with each other, to collaborate… the fact that there is such a high involvement in the group among students in the class group, with the teachers, with the tutor and with all the rotating staff figures of the course … That is, this means that the student enters a professionalizing path but, at the same time, personal…”

Professional empowerment

Regarding the skills and competences that the students have gained in the Post Graduate Specializations’ path, as a first point, the tutors find that the diversification of professions within the specializations is a wealth and a particularity for the students. This heterogeneity, which we discussed earlier, that bring together professionals from various occupational fields at the public health level, different ages and different degrees of experience that are immersed in a collaborative environment, invites them to make decisions within the formative path and, consequently, to develop mainly relational skills and abilities.

“…in the sense that the specializations mainly ask for a relational and communicative competence that already starts from the teamwork. Because immediately they are asked to conform groups, to work in a group, and this already develops or, in some way, requires the student to access these skills, shall we say relational and communicative: therefore team building, leadership development, the ability to collaborate on an inter-professional level for a project...”

“...where in every specialization we talk about the management of inter-professional conflicts, we talk about the management of teamwork, we talk about leadership, of all, therefore, that part of communication… this is a skill that, specifically, our specializations help to develop...”

From the tutors’ point of view, one of the most important skills that students acquire are the research methodology, which they perceive as a very useful resource in the field of work.

“…Well, definitely the project work… the whole part of the research, because, however, when someone wants to present a new project, the specialization teach them to do it right on each phase.” “Even just the request: “How can I request or how can I inform the manager that I want to carry out this project? From the start to the finish…”

“... there are also repercussions in practice ... some of them already had research experiences, but related only to the basic degree course ... in flashes, without a structured research methodology ... and therefore also there, make them learn research principles by doing research ...”

On the other hand, technological skills, such as the use of the online platform, the use of new technologies and the English language, are developed in an important way in this process.

“...people of a certain age make a great effort ... they have fewer tools than necessary to carry out a research… Just, for example, in the knowledge of English language... or the use of the PC; even very trivial, basic things, basic skills. However, they all arrive to the end (of the specialization) happy with what they have done...they realize that they have done something that many of them, especially - I repeat - those with more years of experience, thought they were unable to do, so, I must say that, in the end, everyone is happy and everyone feels enriched by the path...”

“…coordinate and collaborate remotely using communication methods that, perhaps, many were not used to or were unable to do. And, therefore, this already leads to the development of a competence or knowledge…”

Satisfaction

From the tutors’ perspective, there are different characteristics and modalities of the specializations that grant a greater or lesser degree of satisfaction for the students who participate in them. Students especially like the internship, who turns out to be the modality reported as mostly valued by them. It is a very rewarding experience since the way in which internships are organized puts the participants in contact with real situations addressed in the classrooms and in their areas of professional interest.

“...because the internships have allowed them to learn about foreign realities, external to their daily professional life...”

“...even the internship is something that ... they go there to touch reality, some realities where there is this professional figure...”

Students particularly appreciate the simulations that exemplify situations that they experience daily in their workplaces. These simulations involve technical and practical situations related to their professions, but also imply an interactional level with other professionals, a factor that contributes to enrich their problems’ vision but also the relational modalities in which they participate. The professionals who are part of these specializations have a theoretical and methodological background which is certainly very important, however, in the specializations’ context, this background would lose relevance to them if it was not put into simulated practice, that is, theoretical knowledge is complemented and enriched with the interactive experience and the know-how.

“...in the sense that, through simulation the student truly obtains access to the experience and understand then what is the message, the theoretical content… So, that practicing, experiencing helps the student to take, to really learn ... an experiential learning that seems to be much more effective...”

A common aspect to all the specializations is the initial students’ perplexity when they are faced with the research activities. It seems less difficult to manage and negotiate with them the technical activities, which are initially more linked to their professional areas and, therefore, creates in them a greater perception of security and capacity, even when these activities are not favorites in the course.

In their work environments, students are not accustomed doing research activities, so the question is how research would be useful for their daily practices. This is a time of crisis in which tutors try to work with them to integrate the ideas about the usefulness of the research methodology in their fields of work. Although initially it seems not to be one of their favorite areas, the research modules capture their attention and interest as they get more fully into the subjects. As the research takes more form, they seem to realize the importance of disseminating knowledge and linking it to other capacities and areas of interest. For example, in several moments, the tutors report that students find a meeting point between the activities and practices developed in the internship and the application in these places of the knowledge acquired through the project work.

“...and it has often be able to notice an initial resistance, due to the various reactions that can occur; even due to rejection, often due to strong reactions… then, gradually, the satisfactions come, there begins to be an enthusiasm, because then, they enter a little more into what their research theme is......when they understood the connection, the strong connection was one of the satisfactions.. and I would say it was one of the strongest results. That is, make it clear that you can be very good, but if what you learn you do not study, you don’t publish it, you don’t divulge it...... Because they have a profile, it is true, more clinical, but they also access research. So, for example, with Dr. A. they do their research internship, and most of them ... enjoyed it...”

Professional outcomes

In terms of the ways in which the specializations have impacted the students’ professional development/change, in some cases the project work has opened job development opportunities through innovation. In fact, on several occasions this research projects are carried out in collaboration with the students’ workplace, opening firstly the possibility of following on the project deepening the subject and, on the other hand, favoring the students’ growth and roles change.

“...in fact, some often glimpse in the possibility that the research project opens in their work... they glimpse a way of being considered by the corporation, perhaps to recognize them in another way, in the professional sense…”

“... glimpse the opportunity to also change their job role ... For example, someone who says: “Yes, I really hope that this research project can be carried out ... maybe this activity in my corporation ...... let’s say that the student has an impact at a professional and concrete level ... and some students ... have turned their research project into a project within their workplaces and from there have developed their own area within the company ...”

For many students, the Post Graduate Specialization represents a way to deepen their own knowledge of their work but above all, to enrich the practice. This is reflected in the relationships they establish not only with their colleagues, but with users.

“... they know how important it is to develop skills at the level of relationships, to relate with the patient but also with the caregivers, with the patients’ relatives; so, some lessons about this aspect are particularly appreciated ...”

When the monitoring and continuity of these projects is not possible in the workplace, students try to maintain contact with the tutors once the academic path is done. In those cases it opens the possibility of making scientific publications, which represent, besides job growth opportunities, a curricular contribution for the participants. Through the project work and other particularities of the specializations, some students have acquired a catalyst of change/transformation role in their work area. At the level of individual work development, some students acquire the possibility of being transferred to other areas where they can take advantage of the acquired skills; they have agreed to promotions and work improvements. Others decide to insert themselves in academic environments and, those who are responsible for internship students, report having a different approach towards the apprentices, not only at the level of specific knowledge, but also at the pedagogical level.

“...well, I think it was also an important opportunity. And some of those students, in fact, 2 or 3 people who went ahead, wanted to continue with the research project that had started during the course or presented posters ... and, therefore, in my opinion, also that kind of relapse…... then some students who requested, who applied to be transferred to critical area units; for example, I know a participant who was transferred to neonatal intensive care, she decided to work in this area in order to take advantage of these skills that she had acquired...”

“… I understood that they had a different approach even with the students in the internship ... some educational strategies, which they had learned during the course and then reflected ... they also used them with their students...”

The tutors report that sometimes the impact of this specialization process is not reflected in work environments; there seems to be no formal recognition of the implications of the training. This can be negatively reflected in a lack of economic and professional growth, which implies a low motivation of those affected.

“... what is lacking is a formal acknowledgment ... of participation in the courses ... by the workplace. But ... we hope that there may be implications, because otherwise, all the personal motivation that a professional can have... in summary, formal/economic recognition has a great motivational weight...”

Limits of the Post Graduate Specializations

There is a particularity of these specializations that is seen as a limit but also as an advantage: the considerable burden and the level of demand they entail. It is seen as a limitation when is taken into account that the participants are professionals who already have an important workload, so their availability of time is more limited compared to those who are only students. But it also represents an advantage as regards the level of soft skills development, due to the challenge of being immersed in a condition of high demand and constant stress.

“... often, precisely, the student behaves a little, a little reluctantly, this sometimes challenging attitude is precisely because he is asked a lot ...... they had to challenge themselves and go through an evolutionary challenge. And this cannot fail to have caused a change ... the characteristic is this: that they are constantly requested from this point of view. In other words, they are always very demanded. And this is a characteristic that I think is quite distinctive, from the point of view only as a methodology...”

Some tutors argued that there is little clarity as to which of the skills students are expected to develop are transversal to all specialization courses and which are particular to each of them. There is also no formal evaluation of the training and organizational results, which makes it difficult to be clear on what aspects it is important to implement changes or improvements to the processes.

“…it would be interesting to evaluate the more specific spillover effects from an organizational point of view ... I don’t know, asking the coordinators who manage the whole area, if they actually have the same perception of ours. Because of course we speak from an educational perspective…”

“…understand also their participation simply in the organization’s strategic lines, comes to my mind, that is: “has their contribution been decisive?” This in my opinion would be an important area to investigate…”

Development areas

The tutors seem to have adequate but limited ability to follow the professional development of the students. It is evident that there are professional changes and improvements in the students who participate in the specializations, but the tutors feel somewhat limited in their own vision of the specific competencies offered by each training course. Transversal competencies seem clearer to them than the specific competencies of each training course.

The tutors also report that the professional impact is not very clear to them either and they consider that a feedback from the students or, more formally, an evaluation, is necessary to have more clarity on how much this formative process has had a determining effect at the professional level. The tutors make a difference between the evaluation that they can do about this aspect and the evaluation that has been done in the students’ work environments because, while the vision of the tutors is from the academic point of view, the vision of the people that collaborate or direct those who participate in the specialization courses is an organizational view.

“…when, in reality, maybe training is what they need most and also understand the relapses; not only in formative terms but, in my opinion, also in organizational terms. However, this is not always the case in this evaluation phase in the training courses…”

Discussions

The results of this qualitative study offer important food for thought for the assessment of the effective areas and also of the areas for improvement of the Post Graduate Specializations in health professions proposed by the University of Parma.

Adopting a general point of view on the contents of the interviews of the tutors, beyond the categories that emerged with the analysis, some salient points that deserve to be discussed are outlined very clearly.

Several of the main categories that emerged appear totally aligned with the Vision pursued in the Post Graduate Specializations.

The first is the centrality of inter professionalism (28–33). The tutors report how the specializations are progressively more “plural” both in the composition of the class and in the teaching. This dimension represents an initial difficulty and is a form of displacement for students but, through the management of the tutor, this becomes a source of enrichment of the experience that allows them to acquire the skills related to inter-professional collaboration (47) which as a construct assumes a central role in the healthcare profession (48) and a wider way of structuring content, in line with the inter-professional education approach (49).

Another aspect, which is linked to inter-professionalism but extends across all the areas of the profession taken into consideration, is the acquisition of a set of transversal soft skills including the advanced relational and communicational skills (9,10,21–27). Moreover, still in the domain of the developed soft skills, it seems that the need to manage a doubled workload (considering the professional activity accompanied by the academic one) in the collaborative environment of the classroom implicitly allows students to learn the skills of load and stress management that are fundamental in the prevention of negative outcomes in the healthcare profession such as burnout (8,50). It is important to underline how this transversal competence is not built only by exposure to the load but, above all, through the mediation of the tutor and the support of the working group to which the students belong.

Although it may seem banal, students acquire skills and tools in the handling of technology and in the use of the English language, that belong to the domain of research literacy (12–15). This knowledge is very useful at the work level and is related not only to practicality but also to the implementation of new instruments in their work centers or, for example, in the development of research. Especially for professionals who already have an important career, this aspect is a great contribution to their professional development. These technical competencies, belong to the greater crucial area related to the approach to research. This specific domain is initially experienced negatively by students and encounters a lot of resistance as it is a new and “unexpected” field of experience. However, during the specializations and the practical exposure to the research methodology through the project work, it is reinterpreted by students as a means of keeping up to date in professional practice and empowers them in considering themselves capable of being cutting-edge professionals who have the means to acquire high-level knowledge independently and to apply it in one’s work, thanks to research training. In essence, the students find themselves truly immersed in a context of evidence-based practice (51). Contrary to what can be imagined, research is also a means by which students can access professional development which, in many cases, allows them to access to work areas more in line with their specialization.

The students, in their academic process, are led to express themselves “on the field” (52) also and above all through experiences such as that of the internship and the simulations in the classroom (18–20). This allows them to learn beyond the classroom experience and beyond the purely professional aspect, entering into a multiplicity of systems that require them to acquire horizontal skills (technical, technological, linguistic, relational, psychosocial, and organizational).

In general, according to Tutors’ point of view, the students’ satisfaction emerges from the possibility of integrating their previous knowledge and skills with new knowledge and skills experienced in the field, which comes from the personalization of the training course (37–39) and the co-creation of the curriculum (34–36). It is also necessary to note how this occurs, in many areas, starting from initial resistances which, through the professional and relational investment of the tutors, are transformed into points of satisfaction and individual and professional growth.

We should underline that, from the interviews, a few lines emerged for the Vision domain concerning the orientation of the learners to the assisted person and his/her family (16,17). We can hypothesize that this can be linked to the sample of the study. As didactic Tutors, they mostly manage the structure and management of the courses, as well as the relationship with students, not getting deeply in touch with the contents of classes. This could have placed their focus far from the approach of the contents that are shared during the classes.

However, monitoring professional growth is one of the strongest limits of the specializations, weakening the domain of professional record (41,43) identified for the training evaluation. In fact, for some students, the acquisition of skills does not correspond with a growth in their specific context of professional activities, and this generates a loss of motivation in the acquisition of the proposed skills, for those who already see an impossibility of application in the real context.

Furthermore, at an organizational level, it emerges how difficult it is for tutors to follow up on the relationship with students and, therefore, to trace the real effects of the specialization in a transversal way. Added to this is the lack of formal evaluations in organizations that could provide data on the impact of training in terms of student professional performance.

Precisely this is proposed by the tutors, as the main area of development and improvement of the specializations: the structuring of a “follow up” path and contact over time with former students to realistically define the actual professional impact.

Conclusions

This study aimed to collect useful information to assess the effectiveness of Post Graduate Specializations in health professions offered by the University of Parma, following European guidelines which suggest the constant monitoring of the effectiveness of training, especially postgraduate.

Interesting results emerge related to the considerations of the tutors, therefore the experts at the forefront of course management, regarding the areas of empowerment, satisfaction, and professional development.

In particular, we were able to identify the most effective areas of the Post graduate specializations that emerged consistently from the interviews. This allows to hypothesize that the values and mission the Scientific Board elaborated starting from the scientific literature and the present and future challenges of the nursing professions also proposed from the European Guidelines, are effectively lived and championed in the everyday activities of the Post Graduate Specializations, having an effect on the students.

Nonetheless, there are some domains that still need to be furtherly developed, as the professional record, the absence of a “follow up” relationship with former students, and the effective management of workload both for students and tutors. The rise of these limits in this study, can be particularly fruitful, as it gives the chance to identify the development trajectory the post-graduate trainings should pursue to raise the standard of excellence.

A possible limitation of this research is based on the fact that the interpretative analysis carried out in this work corresponds only to the vision of the tutors. This could justify the weak presence, in our data, of categories related to the approach person-centered, which still is a main pillar in the Post Graduate Specializations’ vision. We hypothesize that this domain could emerge when directly investigating the Post Graduate specializations’ effectiveness with students and former students.

So, we propose, as a development of this study, an investigation always linked to these themes, carried out directly on the students population, to promote an independent and reliable evaluation of the areas of strength and limits detected in the specializations, so that to continuously improve the level of training.

Table 2.

Participants

Code	Qualification	Specialization	N. of editions	Professional qualification	Study title	Work
01	DT	Palliative care	3	Psyc/PsyT	PhD	PsyT; trainer
02	DT	Intensive care	2	Psyc	PhD	Psyc; Professor; research fellow
03	DT	Infectious risk/Innovative methodologies	2/1	Nursing coordinator	PhD	Nursing Science Bachelor tutor
04	DT	Palliative care	2	Psyc/PsyT	LM	PsyT;research fellow
05	RMI	All	6	Sociologist	PhD	Research fellow; trainer
06	DT	Infectious risk/intensive care	1/2	Psyc/PsyT	PhD	PsyT; trainer
07	TR	Different	/	Psyc/PsyT	PhD	Psyc; trainer; professor; research fellow
08	DT	Pediatric care	2	Nurse	LM	Nursing Science Bachelor tutor
09	DT	Family community assist/Innovative Meth/Infective risk	1/1/1	Psyc/PsyT	LM	PsyT; trainer; research fellow
10	DT	Invensive Care	1	Course Manager	PhD	Course Manager
11	DT	Chronic care	4	Nurse	LM	Nurse; Nursing Science Bachelor tutor

DT=Didactic Tutor;RT=Research tutor; EIM=E-learning Innovative Methodologies Tutor; Psyc/PsyT =Psychologist/Psychotherapist