Health Education in Practice: Journal of Research for Professional Learning
Health Education in Practice: Journal of Research for Professional Learning (HEPJ) (ISSN: 2209-3974) is an electronic journal dedicated to research and evaluation related to health education in practice.
Health Education & Training Institute, NSW Health
Multidisciplinary team-based primary care: questions for general practice training
Multidisciplinary teams delivering person-centred care are a central feature of primary care reforms in Australia and North America. General Practice is a primary care service that prioritises clinical person-centred care. The recent Strengthening Medicare Taskforce Report recognised that a person-centred team care approach needs strengthened education and training programs to support multidisciplinary teams in general practice. While the premise of multidisciplinary care is well established, strengthening education and training programs in general practice offers opportunities at the vocational training level and for intra-practice education. This Education in Practice paper discusses the relevance to contemporary general practice of findings from Tasmanian research projects conducted over the past decade, addressing three questions for general practice training: How can approaches to team-based education be tailored to different general practice settings? What strategies are best for delivering interprofessional training in general practice? How can patients be involved in the process of training and education of collaborative healthcare teams? The challenges presented by these questions are addressed by drawing from a consensus project on best practice in interprofessional training for collaborative primary healthcare, and from projects using in-person and online education and training. We propose a model that uses the clinical training space as a way of promoting multidisciplinary general practice. The model incorporates online and face-to-face spaces, where primary health professionals, patients, practices/teaching organisations, educators and technology are aligned through facilitation and feedback channels in ways that promote collaborative practice. Tasmania, as an island state with close connections between its university, state public health service and GP training, is well placed to have the strategic conversations about coordinating general practice education and training to meet the need for an integrated primary care workforce.
Copyright (c) 2024 Health Education in Practice: Journal of Research for Professional Learning
Evaluating FREDeX (Falls Reduction and Empathy Development eXperience) – a novel simulation training program for healthcare workers
Abstract Purpose: Care after falls constitutes a substantial cost to the Australian health system. The Falls Reduction and Empathy Development Experience (FREDeX), a hybrid simulation training program, was designed in rural NSW. This paper initiates a multi-pronged evaluation of FREDeX. Methodology: Pre- and post-training survey data was collected from voluntary FREDeX trainees. Surveys included validated empathy, compassion, and person-centred-care assessment tools, as well as questions about workshop quality and open-ended response questions. Findings: There was significant improvement in trainees' empathy, compassion, and person-centred care scores. Trainees expressed positivity about FREDeX, noting facilitators and challenges of the program, and implications for professional practice. FREDeX enhanced empathy, aiding better patient understanding, communication, and personalised care. Implications: Significant evidence has emerged demonstrating the efficacy of virtual reality and other simulation training for empathy and compassion in clinical contexts. FREDeX enhances soft skills through a hybrid simulation training approach, proving to be engaging and educational. It is valuable for the delivery of person-centred care, and a compelling program based on effectiveness and ease of implementation. Originality and value: FREDeX has demonstrated implications for improving empathy and compassion in rural and urban healthcare professionals and enables more person-centred care. The positive outcomes from FREDeX suggest broader adoption of hybrid simulation training may enhance soft skills and healthcare quality, emphasising the potential of technology-driven learning for health workforce capacity. Limitations: While this evaluation demonstrates the value of FREDeX, further evaluation will seek to bridge the gap between demonstrated improvements in assessed metrics of care ability and direct improvements to patient care, by assessing fall rates, harm assessments, and clinical notes for participating facilities. This will endeavour to determine changes in fall prevalence and improvement in management and care for falls.
An evaluation of the use of a “short moment of intensive training” (SMIT) in delivering trauma-nursing education
Abstract Background In 2021, Westmead Hospital opened a 13-bed trauma ward, drawing the nursing workforce from various surgical specialties and generating an urgent need for trauma-nursing education. The SMIT (short moment of intensive training) method was developed to deliver targeted, flexible, priority focused and customised education. Aim The primary aim of the study was to demonstrate that specific education on chest trauma using the SMIT method improved nurses’ knowledge and confidence in caring for patients who have experienced trauma. Methods Nurses who met the recruitment criteria completed a pre-SMIT chest-trauma knowledge assessment and trauma-nursing confidence assessment. The SMITs, comprising five sessions, were conducted by the trained instructors. On completion of each session, the instructor recorded the duration of the session, and the nurses completed the “Participant Feedback of SMIT” tool. Once a nurse had completed all five SMITs, they completed the post-SMIT knowledge and confidence assessments. Results A sample size of 13 nurses participated in the study; 14 nurses were recruited, and one excluded. A statistically significant difference was found between the post-SMIT and pre-SMIT knowledge tests (p = 0.003), and post-SMIT and pre-SMIT confidence tests (p = 0.000). No difference was found in the amount of time needed to complete the knowledge test post-SMIT (p = 0.434). Instructor feedback included the time-consuming nature of one-to-one teaching, and the need to conduct sessions close together to minimise the need to revise previous content. Conclusions The SMIT teaching method was beneficial for our novice cohort of trauma nurses to increase their knowledge and confidence in treating patients with chest trauma. Recommendations for future research include additional trauma topics, and application of SMITs to other clinical settings. Keywords: Trauma Nurse Education, nursing confidence, critical thinking, chest trauma, trauma ward education, opportunistic learning, teachable moment.
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Sleep Patterns and Awareness in Medical Imaging Students Using Wearable Technology
Purpose This study explores the relationship between sleep quality and fatigue in medical imaging students using biometric devices. It examines the impact that objectively measuring and discussing sleep data has on students’ understanding and appreciation of the role of sleep in their academic and professional practices. Design The study adopts a case-based approach, with participants engaging in open collaborative discussions and personal investigation of their sleep data. Biometric devices were used to record sleep data over the course of one semester. Findings Results show that while all students recognised the importance of sleep, they had very little knowledge about sleep patterns, the effects of sleep on performance and memory, or sleep consistency. However, students engaged with their data and showed interest in learning more about sleep. As the study progressed, participants moved away from discussing sleep duration and focused more on the impact of sleep types on patterns of sleep quality. Some students used this newfound knowledge to try and change their sleep behaviours and optimize their performance, while others struggled to change their habits. Implications Overall, this study highlights the need for a more comprehensive approach to sleep education and the potential for personal analytics to facilitate understanding and behaviour change.
Evaluation of a multicomponent educational intervention to decrease general practice registrars’ prescribing of benzodiazepines and related drugs: the BENEFIT prospective controlled study
Background: Benzodiazepines and medicines (including Z-drugs) are associated with frequent and serious related adverse effects. Despite this, they are frequently prescribed by general practitioners (GPs). We aimed to evaluate the effectiveness of a multi-component educational intervention designed to decrease the prescribing and initiation of these drugs by GPs in training ('registrars'). Methods/design: A pragmatic non-randomised, non-equivalent control-group design nested within the Registrar Clinical Encounters in Training (ReCEnT) cohort study was used to assess an educational intervention delivered to registrars in Australia. The intervention was underpinned by the Behaviour Change Wheel framework and included face-to-face workshops with pre- and post-session readings, a webinar for supervisors, and facilitation of registrar-supervisor dyad interactions. Analyses employed univariable and multivariable logistic regression. The p-value of an interaction term in the multivariable regression was used to determine the statistical significance of intervention-related change. Results: Analyses included data of 1,088 intervention registrars and 1,003 control registrars. While some decrease in prescribing was seen, compared to the change from pre-post in controls, there were no statistically significant decreases in the ‘Intention to Treat’ (interaction aOR = 0.92, 95%CI: 0.70, 1.20, p = 0.52) or ‘On Treatment’ (interaction aOR = 0.87, 95%CI: 0.65, 1.16, p = 0.33) populations, and no statistically significant decrease in new prescriptions in the ‘Intention to Treat’ population (interaction aOR = 0.88, 95%CI: 0.58, 1.35, p = 0.57). Implications: Our study may have implications for further research aiming to identify effective strategies to promote appropriate benzodiazepine prescribing among GP registrars. Continued education for registrars around rational benzodiazepine prescribing is essential. This study is an initial step in evaluating the behaviour change intervention and further investigation and extended observation is warranted. This study highlights the educational challenges in improving rational benzodiazepine prescribing. Limitations: Randomization in the study design was not practicable. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12618000824268
Feasibility of personalised online learning programs aligned with authentic workplace practice
Introduction: Online learning is an accessible method that enables medical practitioners to undertake training to develop new, and reinforce existing, knowledge and skills. Early career medical practitioners may find engaging in online learning particularly beneficial as they have a stronger motivation to refine knowledge and skills than their more senior peers. One under-explored mechanism to strengthen the delivery of online learning for medical practitioners is the use of clinical data to tailor learning so it is closely aligned with the individual health professional’s clinical practice. Methodology: This study aimed to evaluate the feasibility of personalising an online learning program for early career doctors working in oncology using electronic medical record (EMR) data. An online program was developed by clinical domain experts that could be triggered using pathology orders and/or results closely aligned to when the test was ordered in clinical practice. The program content was designed to cover three categories: (1) test ordering, (2) interpreting test results, and (3) patient management. Early career medical practitioners undergoing oncology training were recruited to participate in the study. The program was evaluated using metrics captured by the online learning platform, and a post-program survey. Results: All early career medical practitioners eligible to participate in the study consented to participate (n=5). It was feasible to personalise the online program using pathology ordering data. Further, analysis of survey responses indicated that personalising an online learning program using EMR data was acceptable to early career doctors and facilitated engagement with the course. Conclusion: Personalising an online learning program for early career medical practitioners in cancer care using electronic health-record data is both feasible and acceptable.
Attitudes towards research in graduate-entry Australian physiotherapy students: a survey
Purpose: To assess the attitudes towards research in a two-year, graduate-entry Master of Physiotherapy course. Methodology: All students starting (T0) and ending (T1) their degrees in 2020 and 2021 were invited to complete the revised Attitudes Towards Research Questionnaire. This is a three-factor instrument with 13 statements assessing Research Usefulness (four statements, scores ranging from 4 to 28), Research Anxiety (five statements, scores ranging from 5 to 35), and Positive Research Predispositions (four statements, scores ranging from 4 to 28). Each statement was scored using a seven-item Likert scale ranging from ‘Strongly Agree’ (1) to ‘Strongly Disagree’ (7). Student responses between T1 and T0 for factor scores were compared using independent samples t-tests and summarised using mean differences (95% CIs). We defined the minimally important difference as 15% of the scale range. Findings: Ninety-seven percent (n=124/129) of students completed the survey at T0 and 57% (n=79/125) at T1. We found no difference between T0 and T1 in research anxiety (0.2 points, 95% CI: –1.5 to 2.0) and research usefulness (–0.9 points, 95% CI: –1.8 to 0.1), but a significant (although not meaningful) decrease in positive research predispositions between T0 and T1 (–1.7 points, 95% CI –3.2 to –0.2). Research implications: Qualitative research could complement these quantitative findings and provide in-depth reasons for student scores. Practical implications: Educators need more active strategies to improve attitudes and engagement in research-focused subjects to further engage students. Originality/value: This is the first study to document attitudes towards research in an Australian graduate-entry Master of Physiotherapy program. Limitations: There is likely bias (unclear in which direction) at T1 given that 57% of students completed the survey. Surveys were not linked, so group differences were assessed independently. Keywords: Evidence-based practice; research methods; Master of Physiotherapy, UTS Physiotherapy Student surveys (PHYSS) study
An Education Model for Paediatric Palliative Care
Introduction: Meeting the palliative care needs of children and their families is complex and challenging. For countries such as Australia, whose relatively small paediatric palliative care population is dispersed across a very large geographical area, one challenge is maintaining a skilled workforce in regional, rural, and remote areas, where, when compared to major cities, there are fewer resources, and the workforce is often transient. Methods: The Quality of Care Collaborative Australia (QuoCCA) Pop-up Model of Education was used to provide palliative care education to health professionals across three geographical locations and facilities, to facilitate a 2,500-km transfer of a child with complex palliative care needs from a tertiary hospital to the remote family home on Country. Results: Each Pop-Up provided effective education to facilitate the successful transfer of the child to the next hospital location. Over 18 months, three Pop-Ups occurred. Relational learning and real-time problem solving enabled health professionals to build confidence and capacity to successfully transfer the child from the regional hospital to the remote family home. Implications: The QuoCCA Education Pop-up Model is a feasible method to deliver timely access to speciality education. The model can be successfully applied in multiple settings. Keywords: paediatric, palliative care, integrated health care delivery, learning, rural, education models.
Building capacity and promoting health through online volunteering
Purpose Significant changes to in-person volunteering were necessary during the COVID-19 pandemic. Health Volunteers Overseas (HVO) responded to the pandemic by developing an online education platform and pivoting to online volunteering. This qualitative study explores the dynamics of online volunteering and provides visibility to this novel trend in the training of health professionals in resource-scarce countries. Methodology/approach Barriers and facilitators, actual and potential outcomes, and recommendations for online volunteering were addressed through a comparative case study approach focusing on three HVO global projects: physical therapy in Rwanda and Ghana, oral health in Nepal, and anesthesiology—a multi-country collaboration between Bhutan, Cambodia, and Laos. Findings A total of 15 participants, including project directors, host country representatives, and teaching volunteers, were interviewed online. Three themes emerged through the online interviews with HVO volunteers, project directors, and host country directors: Creating Space, the Future is Hybrid, and Geographical Expansion. Research implications Online volunteering provides a new opportunity for volunteers to expand their networks, learn new skills, and meet the needs of the host country participants. There is also an opportunity to expand projects beyond national boundaries, but logistical, cultural, and linguistic challenges must be considered. Practical implications Online volunteering is a feasible approach for building teaching and research capacity globally, and volunteer agencies should consider a hybrid model combining online volunteering with in-person volunteering. Originality Online volunteering provides support to meet the needs of both volunteers and in-country program participants. Limitations This study focused on the volunteer, project director, and host coordinator experience and not on the learner. More research is needed to investigate how online and in-person dynamics coalesce.
Welcome to the 7th Volume of the Health Education in Practice: Journal of Research for Professional Learning (HEPJ). We are pleased to open the first volume of HEPJ published under a continuous publication model. The continuous publication model will allow us to maintain our commitment to increase the visibility of the knowledge published on HEPJ by expediting its dissemination, with articles being published as soon as they undergo our rigorous process of peer review and production. By eliminating the need to wait for a predetermined number of articles to form a volume, we aim to provide authors with the immediacy they desire and, consequently, increase the likelihood of their work receiving timely citations. I hope you enjoy reading our journal and I look forward to sharing more papers in this volume in the coming months.
Changing how ‘rural’ is understood in health professional education
Purpose: For students enrolled in tertiary education courses, learning to work rurally is mainly reliant on placement experiences. An international scoping review (Adams 2023) found that rural placement and other learning experiences are seldom supported by published evidence or evaluative research related to rural theory, specific curricula content, pedagogy or assessment. The implications of the scoping review findings are discussed using relevant theoretical perspectives. This argument aims to raise awareness amongst health professional educators of opportunities and outcomes that may support confident, capable, autonomous work in broader scopes of practice through specific, structured rural content in health professional curricula. Findings: Once theoretical foundations of rural education are established, structured evaluation of educational design and advancement of the scholarship of learning and teaching can occur. Research implications: Extension of research into educational practice in rural contexts can contribute to rural health professional retention and improved health outcomes for rural populations. Originality/value: This paper highlights a novel approach to rural health professional education for rural practice beyond standardised curricula delivered in rural contexts. Limitations: The lack of published research does not mean that rural curricula and pedagogy do not exist in health professional curricula. Instead, it highlights that rural health education rarely includes analysis/evaluation of health programme content. [1] The terms ‘rural’, ‘remote’ and ‘regional’ are often poorly differentiated and used interchangeably in the literature. ‘Rural’ is used throughout this document, although the authors wish to acknowledge the considerable differences between the practice contexts.
Online learning for allied health knowledge translation: A systematic review
Purpose: To synthesise evidence on the effectiveness of online learning platforms for facilitating knowledge translation in allied health professionals. Methodology: A systematic review of the literature searched three databases (Medline-OVID, CINAHL, Embase) in November 2023 for studies measuring outcomes of knowledge translation initiatives targeting allied health professionals delivered using online learning platforms. Papers were eligible if allied health professionals made up at least 50% of the sample, most of the learning component was online, and comparative data was reported. Data were extracted using a customised form. Quality of studies was appraised using the Downs and Black checklist. Meta-analyses were conducted where sufficient homogenous data were available. Findings: Twenty-three studies published over a 13-year period were included in this review primarily using pre-post study designs. All reported improvements in either knowledge, skill and/or confidence, with an meta-analysis (n=9 studies) showing a significant increase in knowledge gain after exposure to online learning (SMD 1.39; 95% CI = 0.96-1.83). However, there is little evidence that participation in online learning is associated with a change in clinical practice. Research Implications: This study supports previous research that online learning can improve knowledge but highlights a need for more rigorous studies addressing the impacts on behaviour change. Practical Implications: Online learning is an effective way of improving knowledge, skill and/or confidence but additional knowledge translation strategies may be needed to lead to a behaviour change. Originality/Value: Synthesis of current knowledge of the value and limitations of online learning as a tool to facilitate the implementation of evidence into practice in the allied health professions. Limitations: This review was limited to studies published in the English language only. The quality of studies in this field is low. Few studies measure behaviour change.
ISBAR+ a communication tool to advocate for patients
Introduction Recognising the importance of social determinants of health is a key part of the curriculum for health practitioners. The ability to advocate on behalf of patients is a competency that demonstrates enacting this understanding in practice. Communication frameworks are used to structure difficult conversations in multiple settings, notably handover. There is no commonly accepted communication framework to structure a patient advocacy conversation. Approach We assembled a team with skills in patient advocacy, healthcare communication, community advocacy, education and business negotiation to identify the knowledge, skills and attitudes required and to develop a framework suitable for this purpose. We chose to adapt the ISBAR framework as an existing communication framework commonly used for handover. Outcomes ISBAR+ is a framework that is based on a person-centred approach and ‘integrated negotiation’. ‘Intention and Inquiry’ involves a compassionate understanding of the patient’s position. ‘Situation’ is a succinct framing of the problem. ‘Background’ is the information required for the decision-maker to make a person-centred decision. The next step is ‘alignment’ of the priorities of the patient, practitioner and decision-maker. ‘Response’ is the proposed solution, and ‘+’ (‘plus’) is the actions taken for implementation. Conclusions ISBAR+ provides a framework for conversations advocating on behalf of patients that draws from the literature around advocacy inside and outside health. A communication framework allows the development and evaluation of interventions to teach and promote this critical function to promote person-centred care.
GP registrars' deprescribing in older patients: a non-randomised controlled study.
Purpose: To evaluate the effect of a multi-component educational program aimed at improving general practitioner (GP) trainees’ (registrars') deprescribing in patients 65 years and over. The hypothesis was that an educational program would increase registrars' deprescribing of potentially inappropriate medicines (PIMs) in older patients, relative to a control group, six months post-education. Design: This was a pragmatic, non-randomised, non-equivalent control group design nested within an ongoing cohort study of registrars' practice (the ReCEnT study). The program consisted of an online module, face-to-face sessions for registrars, webinars for their supervisors, and facilitation of the registrar–supervisor dyad, including case-based discussions of deprescribing in teaching meetings. The program was underpinned by the Behaviour Change Wheel framework and delivered to registrars of a single registrar educational/training organisation (other educational/training organisations served as controls). Primary outcome measures were deprescribing any medicines and deprescribing medicines categorised as PIMs. Secondary outcomes were deprescribing of medications taken for three months or more and dose reduction with a view to deprescribing (cessation). Findings: Data from 779 education-receiving registrars and 438 control registrars were analysed. Intervention group registrars showed no significant increase in deprescribing of any medication compared to controls (interaction aOR 1.00 (95%CI 0.69, 1.46) or of PIMs (aOR 1.29 (95%CI 0.74, 2.24), or significant changes in secondary outcomes. Research implications: Despite no differences in prescribing, in this analysis, six months post-intervention, aspects of the findings suggest extended observation and further evaluation may be indicated. Practical implications: The continuation of education for registrars around deprescribing of PIMs is essential. Further investigation is required to assess the effectiveness and efficiency of the behaviour change approach adopted in this study. Originality/value: The multi-component behaviour change theory-based approach is novel for this educational setting, and this is an initial step in evaluating the approach. Limitations: The major limitation is that randomisation in the study design was not practicable.
Welcome to the 6th Volume, 1st Issue of Health Education in Practice: Journal of Research for Professional Learning. We have a very interesting series of articles in this volume.
Copyright (c) 2023 Health Education in Practice: Journal of Research for Professional Learning
The review of Aboriginal and Torres Strait Islander content within an undergraduate paramedicine degree curriculum
A review of Aboriginal and Torres Strait Islander content within an accredited paramedicine degree curriculum was undertaken as part of major course review and ongoing evaluation of the program. The aim of which was to ensure the course content was appropriate and relevant to Aboriginal and Torres Strait Islander communities. All content and teaching activities were audited where specific content was explored and noted. Findings were presented to a review team where good practice was highlighted and areas for development were addressed. This has encouraged staff to seek opportunities to embed content in both clinical and non-clinical skills, knowledge teaching and experiences. In addition to encouraging further review of other diverse communities.
Website redesign in a maternity setting: Co-designing a resource for consumer support and education
Women want to be informed about their healthcare. Google searches provide an accessible option for women during pregnancy, but the content is largely unmonitored. Women have expressed dissatisfaction and confusion about receiving conflicting information from clinicians across the maternity service. It is essential for providers to offer person-centred care and listen to the voices of consumers. If the aim is to provide a service women want to use, women must have the opportunity to voice what they want. The local health district (LHD) maternity website development project aimed to redesign maternity website pages over 12 months to meet community needs and increase hits to the site by 70% within six months. Consumers were approached to participate through maternity services in a regional Australian health district where approximately 3,500 babies are born yearly. In a three-phase participatory action research study, researchers identified the areas of concern for consumers, worked with them to co-design and implement a new website, and evaluated the changes. Almost 20% of women who birthed from January to March 2022 responded to the evaluation survey. Half of these had explored the website. After the upgrades, the number of hits to the district website service page increased by 875 (from 124 to 999). Post-development surveys showed that women who felt they received inconsistent information at the hospital during their pregnancy were more likely to visit the website for clarification (p = 0.009). Of women who visited the website, 78% found the information useful, and 73% said they would use it again. This study highlighted that women engaging in maternity services desire access to relevant, quality information through digital technology. Maternity website development improvements increased patient satisfaction and reduced confusion, providing a reliable source of accessible health information for consumers.
Developing and evaluating a professional development plan pilot for doctors in unaccredited posts: A pilot study
Purpose In Australia, doctors from their third-year post graduation who are not on specialist training pathways frequently work in unaccredited posts with varying amounts of education and support. In 2019, the New South Wales Ministry of Health (NSW Health) and the Health Education and Training Institute (HETI) agreed on a pilot process for these doctors to develop a professional development plan (PDP). The pilot aimed to implement the process and evaluate its feasibility and acceptability. Methodology/approach The process was piloted at four sites in 2021. The evaluation methodology was informed by the non-adoption, abandonment and challenges to scale-up, spread and sustainability (NASSS) framework with data derived from site meetings, interviews with doctors in unaccredited positions and PDP supervisors, and analysis of PDPs and time required. Findings A total of 42 doctors undertook the PDP process, of whom 25 were interviewed. Of the 28 supervisors recruited, 13 were interviewed. Three sites reported successful implementation, with most doctors having a PDP in progress. Despite challenges associated with the diversity of the workforce and workplaces, all sites were supportive of the process being rolled out with appropriate resourcing. Research implications The research findings indicated that embedding a PDP process more widely across the state will be complex due to the diversity of the workforce and clinical workplaces. Practical implications The PDP process, while acceptable and feasible, needs to adapt to local circumstances, including the workforce, supervisory capacity and experience, individual doctor needs and available resources. Originality The evaluation supports the need for a supported PDP process for doctors in unaccredited positions. Limitations The findings may not be transferable to all NSW Health facilities or to other states or territories. Doctors who consented to be interviewed were more likely to be positive about the process than those who did not. The study did not include a cost evaluation or explore cost-effectiveness due to the short time frame.
The SEED Team journey: A phenomenological study of a multidisciplinary healthcare team's experience using the new creative tool ‘photovoice’ for critical reflection.
Purpose This paper describes how a newly formed multidisciplinary healthcare team used photovoice as a creative way to improve team bonding and explore individual and team wellbeing Methodology A phenomenological methodology was used to explore connections and team bonds in the Stability Encompassing Endurance Direction (SEED) Team, a newly formed team of healthcare professionals, using photovoice. Findings The SEED Team’s reflections provide insights into using creative photography as a way to express feelings and the importance of wellbeing. The process encouraged individuals to take time away from their cognitive task state. Research implications The use of photovoice in a newly formed team highlighted the effectiveness of reflective practice that can strengthen team connections and provide opportunities to take a break. Originality This study explored a simple yet powerful tool from an experiential perspective. The tool has potential for use in future wellbeing activities and initiatives. The process added value to the participants’ existing facilitation skills and fostered awareness of their surroundings while taking creative photographs. Keywords: Photovoice, SEED, reflection, connections, wellbeing
Welcome to the 5th Volume, 1st Issue of Health Education in Practice: Journal of Research for Professional Learning. We have a very interesting series of articles in this volume.
Copyright (c) 2022 Health Education in Practice: Journal of Research for Professional Learning
Hospital discharge planning: a qualitative study of new-graduate physiotherapists' experiences
Purpose: Discharge planning constitutes a large part of a physiotherapist's role when working in hospital settings. The challenges of decision-making relating to discharge planning have been identified by experienced physiotherapists. Despite known challenges associated with the transition from student to clinician, the experiences of new-graduates undertaking discharge planning are largely unknown. Therefore, this study aimed to explore: 1) new-graduate physiotherapists' experiences of discharge planning in hospital settings, and 2) the influence of pre-professional training on their perceived preparedness for discharge planning. Design: A qualitative general inductive approach using semi-structured interviews. New-graduate physiotherapists (n = 14) working in hospital settings were recruited. Finding: Four themes were generated: 1) responding to the pressures associated with discharging patients, 2) complex decision-making, 3) the role of the interprofessional team, and 4) desiring additional context and complexity from pre-professional training. Practice Implications: The study has identified that new-graduates underestimate the extent to which discharge planning features in their roles within hospital settings, and are unaware of the interprofessional practice required. Whilst they felt that their pre-professional training provides the technical skills required for their roles, they felt that they were not prepared for their role within the broader healthcare system, nor the complexity of clinical practice. This study encourages education providers to emphasise the role of physiotherapists within the broader health care system, through highlighting contexts where physiotherapy knowledge can be applied (i.e., discharge planning) and understanding the role of the physiotherapist within the interprofessional team. Limitations: Important perspectives of mentors and other members of the interprofessional team involved in discharge planning have not been included in this study which may have impacted the interpretation of the results.
Development and Evaluation of Strategies to Support Rural Secondments for Junior Physiotherapists
Abstract Purpose Rural workforce shortages are a national issue. One strategy is the use of secondments from larger healthcare sites to staff rural sites on a rotational basis. The purpose of this evaluation is to explore the impact of the development, implementation of an educational, training and supervision package for junior Physiotherapists undertaking rural secondments in Northern NSW. Design/methodology/approach Pre post evaluation of a training, education and supervision package to support junior Physiotherapists undertaking rural secondments across Northern NSW. A baseline survey of Physiotherapists who had undertaken a secondment in the previous 12 months defined current practice and limitations. From this a targeted education, training and supervision package was developed. Post implementation surveying for a period of 12 months was undertaken to evaluate the packages implementation. Findings Statistically significant improvements in staff reporting they felt supported and were aware of escalation processes for patients under their care were reported. Additionally improvements were seen in staff reported access to and completing competencies relevant to their secondment. Research implications These findings provide guidance in regards to junior Physiotherapists working on rural secondments and the importance of structured education, training and support mechanisms. Practical implications The findings from this work support the development and implementation of structured education, training and supervision plans prior to undertaking rural secondments. Originality/value These findings provide evidence and support the need for structured and target training, education and supervision for staff undertaking rural secondments to ensure staff are confident to work in a rural setting. Limitations Larger response rates for post implementation survey results may result in different outcomes being reported in comparison to pre implementation results.
Primary care pharmacists’ knowledge and perception of Inflammatory Bowel Disease: a cross-sectional study in Australia.
Purpose: Inflammatory bowel disease (IBD) management is complex and challenging, and therefore, requires a multidisciplinary approach. Whilst pharmacists may play a key role as the first point of contact for patients with initial symptoms or disease relapse, there is scant literature on pharmacists’ knowledge in IBD management. We conducted a survey to explore pharmacists’ knowledge and their perception of pharmacists and other healthcare professionals’ roles in managing patients with IBD. Design and Methodology: An online survey was distributed to pharmacists through professional organisations. The survey included questions about demographic information, concepts related to IBD management and the roles of pharmacists and healthcare professionals in managing patients with IBD. Findings: Fifty two respondents completed the survey. The overall knowledge score for the majority of respondents was categorised as ‘low’ (25-50%) to ‘average’ (51-75%). IBD concept that demonstrated the highest level of accuracy in knowledge scores among pharmacists was the importance of vaccination in IBD (94.2%). Pharmacists who had exposure to patients with IBD demonstrated better knowledge scores compared to those who did not have any exposure to IBD patients in their practice (p = 0.005). Furthermore, General Practitioners (GPs) were perceived as the key care providers to IBD patients, whilst pharmacists considered themselves as important in providing medication related information to patients. Conclusion: This study indicated that pharmacists’ knowledge of IBD and its’ management was suboptimal, but with education and training there are opportunities for pharmacists to play a more active role in managing patients with IBD.
Student Perceptions of MASK-EDTM Simulation in Physiotherapy Education: A Mixed Methods Cohort Study
Introduction: MASK-EDTM simulation is a novel educational approach in which a clinically experienced educator dons a high-fidelity silicone mask and plays the role of a patient. MASK-EDTM simulation has not yet been evaluated in physiotherapy education. The purpose of this study was to describe physiotherapy students’ perceptions of the value of MASK-EDTM simulation and its effect on perceived preparedness for clinical placements. Methods: Design: Mixed-methods cohort study, using questionnaires and focus groups over 12 months. Setting: Entry-level Physiotherapy course at an Australian university. Participants: Eighty-one physiotherapy students enrolled in their first unit of cardiorespiratory Physiotherapy. Intervention: MASK-EDTM simulation in five tutorials across two semesters, practising skills including history-taking and secretion clearance techniques. Main outcome measures: Questionnaires pre- and post clinical placement; thematic analysis of focus group data following clinical placement exposure. Results: One hundred per cent of students described MASK-EDTM as helpful in developing manual handling skills (mean 3.8/4.0, SD 0.4), establishing rapport and empathy with patients (mean 3.7/4.0, SD 0.5), and communicating with an older patient (mean 3.4/4.0, SD 0.6). Following exposure to clinical placement, students perceived MASK-EDTM as slightly less helpful in enhancing readiness for clinical placement (MD –0.20 out of 5, 95% CI –‍0.54 to –0.04) compared with before clinical exposure. However, they still considered MASK-EDTM somewhat helpful (mean 3.2/4.0). Three themes were identified: the safety of the learning environment with MASK-EDTM, the importance of communication in MASK-EDTM simulation and the performative aspects of MASK-EDTM simulation. All three themes were underpinned by the importance of authenticity in learning and practice. Conclusions: Physiotherapy students perceive MASK-EDTM simulation as valuable in enhancing learning relating to clinical practice, particularly prior to clinical placement.
Copyright (c) 2021 Health Education in Practice: Journal of Research for Professional Learning
SEED Program: The development of a program that has enabled the learning and growth of staff in the response to a community crisis.
This paper aims to share a program that took a whole-hospital approach in considering the wellbeing of staff at a time of recovery following the 2019–2020 bushfires. The SEED Program enlisted a person-centred participatory methodology that was embedded within a transformational learning approach. This methodology included collaboration, authentic participation, critical reflection, critical dialogue and listening where the staff voice was the driving factor in the development of strategies for recovery. The SEED Program resulted in the development of five initiatives that included four strategies and a celebration event where staff celebrated their New Year’s Eve in February 2020. The four strategies included the establishment of a quiet room, coffee buddies, Wellness Warriors and 24/7 Wellness. The outcomes from the SEED Program resulted in the development of a more person-centred culture and transformation of staff perspectives in how they understood their role in their learning and learning of others in recovery and support at a time of crisis. The key learnings were the effect of authentic collaboration, the benefit from enabling authentic leadership at all levels within a hospital, and the power of a staff connection to the ‘CORE’ values of the hospital and Local Health District. In conclusion, the staff involved hold the hope that others may benefit from their experience of transformational learning in creating more person-centred workplace cultures while supporting each other to move forward during a crisis. The limitation of the SEED Program was that it was a bespoke practice innovation designed in the moment, responding to an identified need for the staff following a crisis in the local community rather than a formal research approach to meeting the needs of this group of staff.
The effect of rural placements on future rural general practice
Background: Providing health care to rural populations is a major issue in Australia. Disease burdenand health risk factorsincrease with remoteness, but the access to appropriate service decrease. The introduction of Rural Clinical Schools, rural locations for internship and residency, and decentralisation of the Australian General Practitioner Training Programaim to address this disparity. This systematic review aimed at determining if rural placements throughout medical training are associated with future rural general practice in Australia. Methods: Medline (Ovid), Pubmed, CINAHL and Science Direct were searched for the period January 2000 to July 2019. Included studies related specifically to rural general practitioners in Australia and studies were excluded if they reported only on intention to practice rurally. Evidence was assessed using the Standards for Quality Improvement Reporting Excellence Guidelines. Results: Eleven articles met the inclusion criteria. Three studies examined the effect of rural placements in medical school on future rural general practice. Three studies looked at placements as a junior doctor on future rural general practice. Four studies looked at the effect of rural general practitioner training on future rural general practice. One study reported on the effect of rural placements during both medical school and junior doctor years on future rural general practice. The studies supported an association between rural placements and future rural general practice, particularly for Australian born doctors, Australian graduates and individuals from rural backgrounds. Discussion: This review suggests that rural placements during medical training increase the likelihood of future rural general practice. The interplay of personal and professional life influence whether rural intention is sufficient to result in rural practice. Addressing human factors that influence rural practice will contribute to achieving equitable rural health care.
Welcome to the 4th Volume, 1st Issue of Health Education in Practice: Journal of Research for Professional Learning. We have a very interesting series of articles in this volume.
General practice registrars’ clinical uncertainty, and in-consultation information- and assistance-seeking
Purpose: To explore the association of Australian general practitioner (GP) registrars’ responses to uncertainty with their in-consultation information-, advice- and assistance-seeking. Design/methodology/approach: A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) cohort study in four Australian states. In ReCEnT, GP registrars record details of 60 consecutive consultations, six-monthly, three times during training. Outcome factors in logistic regression models included whether the registrar sought in-consultation information or assistance from (i) their supervisor or (ii) an electronic or paper-based source. Independent variables were the four independent subscales of the Physicians’ Reaction to Uncertainty (PRU) instrument, as well as registrar, practice and consultation variables. Findings: 589 registrars contributed details of 70,412 consultations. On multivariable analysis, scores on the two ‘affective’ PRU subscales ‘anxiety regarding diagnosis/management’ (OR 1.03; 95% confidence intervals [CIs] [1.01, 1.05], p = 0.003) and ‘concern about a bad outcome’ (OR 1.03; 95% CIs [1.01, 1.06], p = 0.008) were significantly associated with seeking supervisor assistance. There was no association with ‘behavioural’ subscales ‘reluctance to disclose uncertainty to patients’ and ‘reluctance to disclose mistakes to physicians’. None of the PRU subscales were significantly associated with information-seeking from electronic or hard copy sources. Research implications: Further research is required to explore the role of uncertainty within registrar–supervisor interactions and to define the role of supervisors in registrars’ functional adaptation to clinical uncertainty (including how best to support and train supervisors in this role). Practical implications: GP registrars’ ‘affective’ responses to clinical uncertainty are associated with assistance-seeking from clinical supervisors. While in-consultation assistance-seeking may promote registrars’ tolerance of uncertainty, it may also contribute to supervisor workload. Originality/value: This is the first study to examine trainees’ levels of uncertainty and their seeking of information and assistance. Limitations: We have not investigated whether registrars’ seeking assistance resolved or attenuated, for the index problem, their anxiety or concern.
Using reflection. Mentoring midwifery students in India
Purpose: This study aims to offer guidance to lecturers and undergraduate midwifery students in using reflective practice and to offer a roadmap for academic staff accompanying undergraduate midwifery students on international clinical placements. Design: Drawing on reflection within the Constructivist Theory, the Gibbs Reflective Cycle (GRC) provides opportunities to review experiences and share new knowledge by working through five stages—feelings, evaluation, analysis, conclusion and action plan. Findings: The reflections of the midwifery students in this study provide insight into expectations prior to leaving for international placement, practical aspects of what local knowledge is beneficial, necessary teaching and learning strategies and the students’ cultural awareness growth. Implications: The analysis and a reflective approach have wider implications for universities seeking to improve preparations when embarking on an international clinical placement. It can also inform practices that utilise reflection as an impetus to shape midwifery students to be more receptive to global health care issues.
Copyright (c) 2020 Health Education in Practice: Journal of Research for Professional Learning
Consistency in dental clinical feedback to students: clinical teachers’ perspectives
Purpose: In dental education, feedback from clinical teachers is critical for developing students’ clinical competence. However, students have identified inconsistency of clinical feedback from clinical teachers as a major area of concern. Compared to research on the student perspective of consistency in clinical feedback, dental clinical teachers’ own views of the consistency of their feedback is not as thoroughly researched. The purpose of this study is to redress that balance. Methodology: This qualitative study explored dental clinical teachers’ views of the clinical feedback process during the 2017 academic year, with a focus on their perceptions of consistency of their own feedback. Findings: Our results show that clinical teachers use a number of parameters in judging students’ performance and giving feedback, and were aware that their feedback may not be consistent with other clinical teachers’ feedback. Teachers also recognised that this inconsistency could lead to an adverse effect on students’ learning and clinical competence. Research implications: To improve the consistency of their feedback and calibrate their judgement of students’ performance, clinical teachers recommended that their Dental School should provide opportunities for them to engage in collegial discussion and interactive, case-based teaching development programs. They also believed clinical teaching and its significance to dental student learning and competence should be recognised and valued more highly by the School. Practical implications: Implementation of professional development initiatives endorsed by clinical teachers has the potential to improve the consistency of teachers’ feedback and the quality of clinical dental education, and ultimately the quality of oral health care. Originality: This is the first study to explore clinical teachers’ views of how they judge students’ performance and the consistency of their feedback. Limitations: A limitation of this study is that clinical teachers who volunteered to participate may have different opinions compared to teachers who did not participate.