Maximising the world wide web for high quality educational and clinical support to health and medical professionals in rural areas

Is Reflective Learning Visible in Online Discussion Forums for Medical Students on General Practice Placements? A Qualitative Study

Problem: Reflection is important for lifelong learning and professional development, and discussion forums have been highlighted as a potential platform for enhancing reflection further through peer interaction and teacher feedback. Forums provide students on general practice (GP) placement the opportunity to engage in collaborative reflective learning despite their geographical isolation and disparate schedules. This case report seeks to explore whether online discussion forums demonstrate community presence and reflective learning among medical students on GP placement. Intervention: Online discussion forums were introduced into the curriculum for University of Auckland Year 5 and 6 medical students on their respective 4- and 6-week GP placement. Via asynchronous posts and comments, groups of eight students on average presented cases and experiences for discussion with peers and an overseeing GP faculty member. Context: Students were dispersed across a large geographical area and were unlikely to have peer contact in their assigned practices. Online discussion forums were implemented for a number of reasons, including facilitating reflective learning. An adapted community of inquiry framework was used to investigate the cognitive, social, and teacher presence elements visible in the discussion forum transcripts of unanimously consenting groups. Content analysis of the transcripts was performed to evaluate the presence and quality of reflective learning. Impact: The forums were predominately student-led with relatively scarce comments by GP faculty facilitators. The majority of cases and experiences presented related to clinical management of patients and dissonance triggered by the on-site supervisor's actions. Ideas, knowledge, and understanding of presented encounters were shared and built on by positive and supportive interaction, broadening students' perspectives and, at times, leading to the formation of solutions. However, students' reflection was mostly superficial. Deep reflection was rarely present, and affective dimensions of reflection were disclosed relatively less than clinical cognitive aspects of reflection. Direct instruction, based on prior experience and pedagogical expertise, was the main form of comment made by faculty facilitators, who prompted with questions to a far lesser extent. Lessons Learned: Online discussion forums appeared to enable medical students on GP placement to interact positively with peers and faculty facilitators. However, deep reflection was not reached. Modifying the discussion forums to facilitate more peer interaction and addressing the barriers that limit faculty facilitation may encourage deeper and more affective reflections.

Mandatory continuing professional development in South Africa: Rehabilitation therapists' perspective

Aims:

In 2007, Health Professions Council of South Africa (HPCSA) introduced mandatory continuing professional development (CPD), which enables therapists to acquire new knowledge and skills to improve patient care. To remain registered, therapists must meet CPD standards by formal HPCSA audits; however, latest figures revealed a compliance rate of 35% due to non-attendance of CPD activities. This study reviewed the experiences of therapists to identify barriers and obtain suggestions to improve attendance.

Methodology:

This cross-sectional descriptive study used a questionnaire with closed and open questions to explore the aims from a sample of 138 rehabilitation therapists, comprising speech and language therapists (9%), occupational therapists (21%) and physiotherapists (70%), attending an ethics workshop.

Results:

Eighty five (62%) supported CPD and 97 (71%) supported compulsory ethics. Short 1 to 3 day courses, mini-congresses and journal club activities were the most frequently-attended events. Barriers to CPD were: time, cost of courses, cost of travel due to geographical distance, staff shortages, lack of employee support, and multi-disciplinary or inappropriate courses. Suggestions for improving attendance were: introducing state subsidised and corporate sponsorships, increased in-service journal club activities, tele- and video-conferences, on-line presentations, and profession-specific courses.

Conclusion:

Therapists support mandatory CPD, but stakeholders must take cognisance of the barriers and suggestions to improve CPD attendance and compliance.

Computer-supported collaborative learning in the medical workplace: Students' experiences on formative peer feedback of a critical appraisal of a topic paper

BACKGROUND

Medical workplace learning consists largely of individual activities, since workplace settings do not lend themselves readily to group learning. An electronic Learning Management with System Computer-Supported Collaborative Learning (CSCL) could enable learners at different workplace locations to discuss personal clinical experiences at a distance to enhance learning.

AIM

To explore whether CSCL-enabled structured asynchronous discussions on an authentic task has additional value for learning in the medical workplace.

METHODS

Between January 2008 and June 2010, we conducted an exploratory evaluation study among senior medical students that were engaged in clinical electives. Students wrote a Critical Appraisal of a Topic paper about a clinical problem they had encountered and discussed it in discipline homogeneous subgroups on an asynchronous forum in a CSCL environment. A mixed method design was used to explore students' perceptions of the CSCL arrangement with respect to their preparation and participation, the design and knowledge gains. We analysed the messages recorded during the discussions to investigate which types of interactions occurred.

RESULTS

Students perceived knowledge improvement of their papers. The discussions were mostly task-focused. The students considered an instruction session and a manual necessary to prepare for CSCL. A high amount of sent messages and a high activity in discussion seem to influence scores on perceptions: 'participation' and 'knowledge gain' positively.

CONCLUSION

CSCL appears to offer a suitable environment for peers to provide formative feedback on a Critical Appraisal of a Topic paper during workplace learning. The CSCL environment enabled students to collaborate in asynchronous discussions, which positively influenced their learning.

Factors associated with physiotherapists' interest in cardiorespiratory continuing education using computer-assisted learning: a survey

PURPOSE

To determine factors associated with Canadian physiotherapists' interest in undertaking continuing education in various cardiorespiratory content areas and their willingness to complete a portion of study within each of these content areas via computer-assisted learning (CAL).

METHODS

In a six-page mailed questionnaire, 1,426 potential participants were asked to indicate their interest in 11 cardiorespiratory content areas, their continuing-education preferences, and their access and willingness to do continuing education by CAL. Demographic data were also collected from respondents.

RESULTS

Respondents included 285 physiotherapists from cardiorespiratory interest groups (CRGs) and 447 from the licensing bodies' sample (overall response rate = 56%). Physiotherapists in public employment and practice areas other than orthopaedics had increased interest in all cardiorespiratory content areas except Exercise Physiology. Membership in a CRG increased their likelihood to be willing to learn the cardiorespiratory content area via CAL.

CONCLUSIONS

In developing content and determining the accessibility of cardiorespiratory continuing education, educators should consider the type of employer and area of practice of interested attendees as well as the lack of willingness to use CAL by those not involved in CRGs.

Factors influencing rural health care professionals' access to continuing professional education

OBJECTIVES

The purposes of this study were to explore the perceived barriers and challenges to continuing professional education (CPE) access for Canadian health care professionals and to identify best practices for improving access to CPE.

DESIGN

Key informant interviews and Web-based online surveys were conducted.

PARTICIPANTS

Key informant interviews were conducted with national CPE accreditation bodies and health professional associations. An online survey was distributed to health professional education programs, as well as provincial professional associations, licensing and professional regulatory bodies.

MAIN OUTCOME MEASURES

The perceived barriers and challenges to CPE access for Canadian health care professionals and best practices for improving access to CPE.

RESULTS AND CONCLUSIONS

Geographic isolation and poor technological and telecommunications infrastructure were identified as key barriers to CPE delivery and access. Financial factors, such as funding to support travel or cost of attendance, were also identified as major challenges. Tele-education programming was identified as a best practice approach to improve CPE access, as were regional CPE activities and self-directed learning programs. Employer-sponsored initiatives, including staff coverage or locum support, remuneration for time off and paid travel expenses for CPE participation were also identified as best practice approaches.