A Problem-Based Learning Approach to Facilitate Evidence-Based Practice in Entry-Level Health Professional Education:

Education in prosthetic and orthotic training: Looking back 50 years and moving forward

There is a long history of prosthetic and orthotic services helping to mitigate the impact of physical impairment by restoring function, and enabling and equipping the user. The training of health professionals who design, fit, and maintain prosthetic and orthotic devices has evolved over the centuries, reflecting an increase in knowledge, technology, understanding, and social attitudes in each era. Improvements in pedagogical thinking and biomechanical understanding, as well as the advent of new integrated technologies, have driven the profession over the past 50 years to modernize, evolve training and service delivery models in line with new attitudes toward clients, and search for new ways to improve users' quality of life. In this narrative review, the authors examined the evolution of prosthetic and orthotic education, the impact of changing educational techniques and technologies, and the impact of the International Society for Prosthetics and Orthotics in that process. Through conversations with experts and review of peer-reviewed literature, accreditation documents, and the International Society for Prosthetics and Orthotics records and databases, the authors identified three areas of change in prosthetics and orthotics education over the past 50 years: (1) prosthetic/orthotic curriculum content, (2) pedagogy and course delivery, and (3) internships/residencies. This narrative review is a snapshot of a growing profession and we can only speculate where the next 50 years will lead us as we strive to serve patients, ever placing their needs and aspirations at the center of this professional service.

Problems of problem-based learning: Towards transformative critical pedagogy in medical education

Problem-based medical education is based in a biomedical worldview that works to entrench deterministic ways of thinking about socioculturally-influenced health disparities in the minds of medical trainees. This perspective paper considers the utility of Paolo Freire's critical pedagogy as a means of redressing this issue, as it may enable medical learners to perceive and address the social sources of illness that shape their patients' lives. With an eye to advancing health equity, and educating health professionals who are responsive to marginalized and vulnerable communities, this paper considers how a problem-posing medical education could redefine physicians' relationships to knowledge, identity, and to their patients.

The influence of staff training and education on prosthetic and orthotic service quality: A scoping review

BACKGROUND

Education and training in prosthetics and orthotics typically comply with International Society for Prosthetics and Orthotics standards based on three categories of prosthetic and orthotic professionals.

OBJECTIVE

This scoping study sought to describe the evidence base available to answer the question, How are prosthetic and orthotic services influenced by the training of staff providing them?

STUDY DESIGN

Scoping review.

METHODS

A structured search of the peer-reviewed literature catalogued in major electronic databases yielded 3039 papers. Following review of title and abstract, 93 articles were considered relevant. Full-text review reduced this number to 25.

RESULTS

Only two articles were identified as providing direct evidence of the effects of training and education on service provision. While both suggested that there was an impact, it is difficult to see how the more specific conclusions of either could be generalised. The other 23 articles provide a useful background to a range of issues including the specification of competencies that training programmes should deliver (3 articles), descriptions of a range of training programmes and the effects of training and education on student knowledge and skills.

CONCLUSION

Although it is considered axiomatic, the service quality is dependent on practitioner education and training. There is insufficient evidence to establish whether levels of training and education in prosthetics and orthotics have an effect on the quality of prosthetic and orthotic services. Clinical relevance There is very little evidence about the effects of training and education of prosthetists and orthotists on service quality. While this is a somewhat negative finding, we feel that it is important to bring this to the attention of the prosthetics and orthotics community.

Students' perspectives of core value development in a modified problem-based learning program

Physical therapy educational programs are tasked to develop core values in their students as the foundation of professionalism. Problem-based learning (PBL) is an approach that intends to enrich exploration of issues in clinical decision making, understand how patient care is supported by other aspects of professional practice, and develop examination, intervention and communication skills. This qualitative study aimed to understand, interpret, and describe doctoral physical therapy students' perspectives of core value development in a modified PBL program. Twenty-seven of 49 students from a single class participated in the study at the time of graduation. Phenomenological methods via semi-structured focus group interviews were used to foster an in-depth understanding of students' experiences. Interviews were thematically organized by the constant comparison method and several strategies were used to establish trustworthiness. Eleven emerging themes represented the adjustment to PBL and essence of core value development from the students' perspective. An additional overarching theme "transformation" was also identified as students described a process of "transformation" from student to professional, supported by the curricular elements of the modified PBL process. These findings inform faculty on educational methods and curricular strategies, which may enhance the development of professional core values, regardless of curricular format.

Threshold concepts in prosthetics

BACKGROUND

Curriculum documents identify key concepts within learning prosthetics. Threshold concepts provide an alternative way of viewing the curriculum, focussing on the ways of thinking and practicing within prosthetics. Threshold concepts can be described as an opening to a different way of viewing a concept. This article forms part of a larger study exploring what students and staff experience as difficult in learning about prosthetics.

OBJECTIVES

To explore possible threshold concepts within prosthetics.

STUDY DESIGN

Qualitative, interpretative phenomenological analysis.

METHODS

Data from 18 students and 8 staff at two universities with undergraduate prosthetics and orthotics programmes were generated through interviews and questionnaires. The data were analysed using an interpretative phenomenological analysis approach.

RESULTS

Three possible threshold concepts arose from the data: 'how we walk', 'learning to talk' and 'considering the person'.

CONCLUSION

Three potential threshold concepts in prosthetics are suggested with possible implications for prosthetics education. These possible threshold concepts involve changes in both conceptual and ontological knowledge, integrating into the persona of the individual. This integration occurs through the development of memories associated with procedural concepts that combine with disciplinary concepts. Considering the prosthetics curriculum through the lens of threshold concepts enables a focus on how students learn to become prosthetists. Clinical relevance This study provides new insights into how prosthetists learn. This has implications for curriculum design in prosthetics education.

Undergraduate prosthetics and orthotics teaching methods: A baseline for international comparison

BACKGROUND

Education of Prosthetics and Orthotics is a relatively recent professional program. While there has been some work on various teaching methods and strategies in international medical education, limited publication exists within prosthetics and orthotics.

OBJECTIVES

To identify the teaching and learning methods that are used in Bachelor-level prosthetics and orthotics programs that are given highest priority by expert prosthetics and orthotics instructors from regions enjoying a range of economic development.

STUDY DESIGN

Mixed method.

METHODS

The study partly documented by this article utilized a mixed method approach (qualitative and quantitative methods) within which each phase provided data for other phases. It began with analysis of prosthetics and orthotics curricula documents, which was followed by a broad survey of instructors in this field and then a modified Delphi process.

RESULTS

The expert instructors who participated in this study gave high priority to student-centered, small group methods that encourage critical thinking and may lead to lifelong learning. Instructors from more developed nations placed higher priority on student's independent acquisition of prosthetics and orthotics knowledge, particularly in clinical training.

CONCLUSIONS

Application of student-centered approaches to prosthetics and orthotics programs may be preferred by many experts, but there appeared to be regional differences in the priority given to different teaching methods.

CLINICAL RELEVANCE

The results of this study identify the methods of teaching that are preferred by expert prosthetics and orthotics instructors from a variety of regions. This treatment of current instructional techniques may inform instructor choice of teaching methods that impact the quality of education and improve the professional skills of students.

Teaching strategies to support evidence-based practice

Evidence-based practice is an expected core competency of all health care clinicians regardless of discipline. Use of evidence-based practice means integrating the best research with clinical expertise and patient values to achieve optimal health outcomes. Evidence-based practice requires nurses to access and appraise evidence rapidly before integrating it into clinical practice. Role modeling and integrating the skills necessary to develop evidence-based practice into clinical and nonclinical courses is an important part in developing positive attitudes toward evidence-based practice, an essential first step to using evidence to guide practice decisions. The step-by-step approach to evidence-based practice proposed by Melnyk and colleagues provides an excellent organizing framework for teaching strategies specifically designed to facilitate nurses' knowledge and skill development in evidence-based practice.

Awareness, knowledge and practice of evidence-based dentistry amongst dentists in Kuwait

This study assessed the awareness, knowledge and practice of evidence-based dentistry (EBD) amongst dentists working in the public sector in Kuwait. Of the 150 randomly selected dentists from all five health districts in Kuwait who had originally been approached, 120 participated by completing a pre-tested, self-administered questionnaire (80% response rate). Whereas 60.9% of the group stated that they practice EBD most of the time, fewer (40.8%) had a reasonable understanding of EBD based upon tested knowledge scores of EBD-related topics. Clinical decisions appeared to be mostly based on the clinician's own judgment (73.3%) rather than on evidence-based sources such as PubMed (28.3%) or the Cochrane Library (6.7%). A number of within-group differences were noted, with women (P<0.05), those working in a particular district (P<0.05), those with <10years' experience (P=0.05), those whose first dental qualification had been obtained in Kuwait (P<0.05), and those who had had any EBD training (P<0.05) showing greater knowledge of EBD. Training in EBD was felt necessary by a majority of the group, and this may be facilitated if dental centres have access to evidence-based sources to remove some of the possible barriers to implementation of EBD.

Library use by medical students: A comparison of two curricula

This study explored 1) whether there were any differences in the way medical students used library resources under problem-based learning (PBL) and scenario-based learning (SBL) curricula; and 2) what improvements the library could make to facilitate its use by medical students using the different curricula. Twenty medical students selected from two different medical universities in different countries were interviewed in depth. The study found that a) PBL and SBL students used the library significantly differently; b) SBL students presented a wider range of demands and behaviors in seeking information; c) more PBL students preferred using solely electronic resources to solve PBL problems; and d) more SBL students preferred using textbooks in their study and to solve the problems. It is concluded that the characteristics of the two learning approaches affect the medical students in their uses of library resources. The library staff must interact differently with students depending on the curriculum they are following. The study suggests several directions (‘SHELTER’) to the library and recommends it to provide service targeting students’ needs after exploring the following three dimensions of the curriculum: students’ perceptions of the library’s collection related to the curriculum, course requirements for gathering information, and the librarian’s role in the curriculum. When new reforms are initiated it is necessary for the library to undertake a comprehensive review and to gain understanding of the curriculum at the outset.

Challenging Knowledge Reproduction: Problem-Based Learning for Evidence-Based Practice

This opinion piece supports the use of problem-based learning (PBL) as a teaching and learning method that can be used to support evidence-based practice. The PBL process reflects that of evidence-based practice: by engaging in this process, the occupational therapy student can gain the skills, ability and confidence to use his or her personal and professional knowledge, existing or new, in challenging and changing practice environments.

The propensity to adopt evidence-based practice among physical therapists

Background

Many authors, as well as the American Physical Therapy Association, advocate that physical therapists adopt practice patterns based on research evidence, known as evidence-based practice (EBP). At the same time, physical therapists should be capable of integrating EBP within the day-to-day practice of physical therapy. The purpose of this study was to determine the extent to which personal characteristics and the characteristics of the social system in the workplace influence the propensity of physical therapists to adopt EBP.

Methods

The study used a 69 item mailed self-completion questionnaire. The questionnaire had four major sections. The first three sections were each drawn from a different theoretical framework and from different authors' work. The instrument was developed to capture the propensity of physical therapists to adopt EBP, characteristics of the social system in the workplace of physical therapists, personal characteristics of physical therapists, and selected demographic variables of physical therapists. The eligible population consisted of 3,897 physical therapists licensed by the state of Georgia in the United States of America. A random sample of 1320 potential participants was drawn.

Results

939 questionnaires were returned for a response rate of 73%. 831 of the participants' questionnaires were useable and became the basis for the study. There was a moderate association between desire for learning (r = .36, r² = .13), highest degree held (r = .29, r² = .08), practicality (r = .27, r² = .07) and nonconformity (r = .24, r² = .06) and the propensity to adopt EBP. A negative correlation was found between age, years licensed and percentage of time in direct patient care. The findings demonstrated that the best three variables for predicting the propensity to adopt EBP in physical therapy were: desire for learning, highest degree held, and practicality.

Conclusion

The study confirms there is no single factor to facilitate research evidence into day-to-day practice. Multiple practice change strategies will be needed to facilitate change in practice.

The application of critical psychology to facilitate reflective clinical practice in orthotics/prosthetics

The co-construction of a psychology module for a postgraduate training course in orthotics/prosthetics is socially constructed for the first time in Southern African history. This paper elucidates the integration of theory and practice in a model for the development of a professional identity as orthotist/prosthetist. In creating a context where trainees can learn to develop their practice while also enabling them to deconstruct notions of 'expert knowledge', orthotist/prosthetists move from a position of scientist-practitioner to negotiating an alternative position of reflective practitioner. In the process of co-constructing knowledge, an alternative story of teaching and learning evolves. The result is a celebration of life as it is really lived by health professionals.

Critical Thinking and Evidence-Based Practice

Critical thinking (CT) is vital to evidence-based nursing practice. Evidence-based practice (EBP) supports nursing care and can contribute positively to patient outcomes across a variety of settings and geographic locations. The nature of EBP, its relevance to nursing, and the skills needed to support it should be required components of baccalaureate education and must be introduced early in students' development as independent, self-directed learners and as professional nurses. Among the knowledge, skills, and processes needed to support EBP, CT is paramount. The development of CT can prepare nurses with the necessary skills and dispositions (habits of mind, attitudes, and traits) to support EBP. The intents of this study were to explore the importance of CT as an essential skill to support EBP and to describe some of the strategies and processes considered key to the ongoing development of CT.