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Cavaleri R, Withington A, Chalmers KJ, Blackstock F. The Influence of Stress on Student Performance during Simulation-based Learning: A Pilot Randomized Trial. ATS Sch 2023; 4:474-489. [PMID: 38196683 PMCID: PMC10773496 DOI: 10.34197/ats-scholar.2022-0042oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/06/2023] [Indexed: 01/11/2024] Open
Abstract
Background Simulation-based learning is an important educational medium that is being implemented increasingly for the purpose of improved patient care and safety. However, there is evidence to suggest that simulation-based education (SBE) may increase anxiety, as illustrated through self-reporting and physiological responses. Despite such data, no studies have investigated whether anxiety and stress can be manipulated through SBE scenario design and delivery to facilitate optimal learning conditions. Objective This pilot study examined perceived anxiety and physiological stress experienced by entry-level physiotherapy students while learning a skill using SBE and the relationship between this anxiety and their subsequent skill performance. Methods Final-year physiotherapy students were randomly allocated to one of three SBE experiences: low, medium, or high stress. The experiences were designed to induce increasing levels of stress and anxiety. Performance of the learned skill (endotracheal airway suctioning) was measured after the SBE using a bespoke assessment form. Cortisol levels, heart rate, and perceived anxiety measurements (State-Trait Anxiety Inventory and visual analog scale) were also collected. Results Twenty-seven participants completed the trial. There were significant differences in perceived stress and physiological response between the groups. The low-stress group demonstrated significantly better performance of airway suctioning than the higher-stress groups (P = 0.02). Higher anxiety was correlated with poorer skill performance (r = -0.410). Conclusions Students report SBE to be stressful, and scenarios themselves can influence the stress and anxiety experienced. Greater stress is associated with poor learning outcomes during SBE. Healthcare educators involved in SBE scenario design need to consider the stress levels experienced. Future research to determine optimal stress and embed measurement of stress in SBE experiences is warranted.
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Affiliation(s)
- Rocco Cavaleri
- School of Health Sciences and
- Brain Stimulation and Rehabilitation
(BrainStAR) Lab, Western Sydney University, Penrith, New South Wales,
Australia
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Flew B, Judd B, Lange B, Lee D, Blackstock F, Tai J, Tognon K, Chipchase L. Understanding underperformance in a high-stakes clinical-based simulation assessment in physiotherapy: a descriptive analysis. BMC Med Educ 2023; 23:676. [PMID: 37723496 PMCID: PMC10506262 DOI: 10.1186/s12909-023-04649-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/04/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND High-stakes assessments are often used as a 'gate-keeper' activity for entry into the health professions by ensuring that the minimum core competency thresholds of the profession are met. The aim of the study was to explore if common areas of underperformance existed in international candidates assessed with a high-stakes clinical-based simulation assessment for entry into the physiotherapy profession in Australia. METHODS A retrospective mixed methods analysis of the clinical assessments completed by international candidates over a one-month period in 2021 that were deemed as not meeting competency. The clinical assessments were completed in one of the three practice areas: cardiorespiratory, musculoskeletal, or neurological rehabilitation. Each assessment was scored by two independent assessors, who discussed the performance and then completed a moderated assessment form. The assessment form used to score competency included seven domains such as initial assessment, effective treatment, communication skills, and risk management. RESULTS Fifty-one clinical assessments graded as not competent were analysed. Across the practice areas, a high failure rate was found in domains related to interpreting assessment findings and developing a treatment plan. This trend was also observed in the qualitative data, suggesting candidates struggled to meet competency in areas of planning and prioritisation, interpretation and implementation of the information gathered, and selection and evaluation of effective treatment. CONCLUSION These findings align with published data on the underperformance of Australian physiotherapy students in clinical placement settings, suggesting these issues are not specific to high stakes assessment of overseas physiotherapists, and that education needs to focus on improving these skills within the profession at all levels. With the identified areas of underperformance aligning with the ability to use higher order thinking and skills integral to clinical reasoning, improvements in the education and implementation of clinical reasoning may be a place to start.
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Affiliation(s)
- Brooke Flew
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.
| | - Belinda Judd
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Belinda Lange
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Darren Lee
- Australian Physiotherapy Council, Melbourne, Australia
| | | | - Joanna Tai
- Centre for Research in Assessment and Digital Learning, Deakin University, Geelong, Australia
| | | | - Lucy Chipchase
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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Agusti A, Ambrosino N, Blackstock F, Bourbeau J, Casaburi R, Celli B, Crouch R, Negro RD, Dreher M, Garvey C, Gerardi D, Goldstein R, Hanania N, Holland AE, Kaur A, Lareau S, Lindenauer PK, Mannino D, Make B, Maltais F, Marciniuk JD, Meek P, Morgan M, Pepin JL, Reardon JZ, Rochester C, Singh S, Spruit MA, Steiner MC, Troosters T, Vitacca M, Clini E, Jardim J, Nici L, Raskin J, ZuWallack R. COPD: Providing the right treatment for the right patient at the right time. Respir Med 2023; 207:107041. [PMID: 36610384 DOI: 10.1016/j.rmed.2022.107041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/07/2022] [Indexed: 12/14/2022]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a common disease associated with significant morbidity and mortality that is both preventable and treatable. However, a major challenge in recognizing, preventing, and treating COPD is understanding its complexity. While COPD has historically been characterized as a disease defined by airflow limitation, we now understand it as a multi-component disease with many clinical phenotypes, systemic manifestations, and associated co-morbidities. Evidence is rapidly emerging in our understanding of the many factors that contribute to the pathogenesis of COPD and the identification of "early" or "pre-COPD" which should provide exciting opportunities for early treatment and disease modification. In addition to breakthroughs in our understanding of the origins of COPD, we are optimizing treatment strategies and delivery of care that are showing impressive benefits in patient-centered outcomes and healthcare utilization. This special issue of Respiratory Medicine, "COPD: Providing the Right Treatment for the Right Patient at the Right Time" is a summary of the proceedings of a conference held in Stresa, Italy in April 2022 that brought together international experts to discuss emerging evidence in COPD and Pulmonary Rehabilitation in honor of a distinguished friend and colleague, Claudio Ferdinando Donor (1948-2021). Claudio was a true pioneer in the field of pulmonary rehabilitation and the comprehensive care of individuals with COPD. He held numerous leadership roles in in the field, provide editorial stewardship of several respiratory journals, authored numerous papers, statement and guidelines in COPD and Pulmonary Rehabilitation, and provided mentorship to many in our field. Claudio's most impressive talent was his ability to organize spectacular conferences and symposia that highlighted cutting edge science and clinical medicine. It is in this spirit that this conference was conceived and planned. These proceedings are divided into 4 sections which highlight crucial areas in the field of COPD: (1) New concepts in COPD pathogenesis; (2) Enhancing outcomes in COPD; (3) Non-pharmacologic management of COPD; and (4) Optimizing delivery of care for COPD. These presentations summarize the newest evidence in the field and capture lively discussion on the exciting future of treating this prevalent and impactful disease. We thank each of the authors for their participation and applaud their efforts toward pushing the envelope in our understanding of COPD and optimizing care for these patients. We believe that this edition is a most fitting tribute to a dear colleague and friend and will prove useful to students, clinicians, and researchers as they continually strive to provide the right treatment for the right patient at the right time. It has been our pleasure and a distinct honor to serve as editors and oversee such wonderful scholarly work.
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Affiliation(s)
- Alvar Agusti
- Clinic Barcelona Hospital University, Barcelona, Spain.
| | | | | | - Jean Bourbeau
- Department of Medicine, Division of Experimental Medicine, McGill University Health Centre, Montreal, QC, CA, USA.
| | | | | | | | - Roberto Dal Negro
- National Centre for Pharmacoeconomics and Pharmacoepidemiology (CESFAR), Verona, Italy.
| | - Michael Dreher
- Clinic of Cardiology, Angiology, Pneumology and Intensive Medicine, University Hospital Aachen, Aachen, 52074, DE, USA.
| | | | | | - Roger Goldstein
- Respiratory Rehabilitation Service, West Park Health Care Centre, Toronto, Ontario, CA, USA.
| | | | - Anne E Holland
- Departments of Physiotherapy and Respiratory Medicine, Alfred Health, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia; Institute for Breathing and Sleep, Melbourne, Australia.
| | - Antarpreet Kaur
- Section of Pulmonary, Critical Care, and Sleep Medicine, Trinity Health of New England, Hartford, CT, USA; University of Colorado School of Nursing, Aurora, CO, USA.
| | - Suzanne Lareau
- University of Colorado School of Nursing, Aurora, CO, USA.
| | - Peter K Lindenauer
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School - Baystate, Springfield, MA, USA.
| | | | - Barry Make
- National Jewish Health, Denver, CO, USA.
| | - François Maltais
- Institut Universitaire de cardiologie et de pneumologie de Québec, Université Laval, Quebec, CA, USA.
| | - Jeffrey D Marciniuk
- Division of Respirology, Critical Care and Sleep Medicine, Department of Medicine, University of Saskatchewan, Saskatoon, CA, USA.
| | - Paula Meek
- University of Utah College of Nursing, Salt Lake City, UT, USA.
| | - Mike Morgan
- Dept of Respiratory Medicine, University Hospitals of Leicester, UK.
| | - Jean-Louis Pepin
- CHU de Grenoble - Clin Univ. de physiologie, sommeil et exercice, Grenoble, France.
| | - Jane Z Reardon
- Section of Pulmonary, Critical Care, and Sleep Medicine, Trinity Health of New England, Hartford, CT, USA.
| | | | - Sally Singh
- Department of Respiratory Diseases, University of Leicester, UK.
| | | | - Michael C Steiner
- Department of Respiratory Sciences, Leicester NIHR Biomedical Research Centre, Professor, University of Leicester, UK.
| | - Thierry Troosters
- Laboratory of Respiratory Diseases and Thoracic Surgery, KU Leuven: Leuven, Vlaanderen, Belgium.
| | - Michele Vitacca
- Department of Respiratory Rehabilitation, ICS S. Maugeri Care and Research Institutes, IRCCS Pavia, Italy.
| | - Enico Clini
- University of Modena and Reggio Emilia, Italy.
| | - Jose Jardim
- Federal University of Sao Paulo Paulista, Brazil.
| | - Linda Nici
- nBrown University School of Medicine, USA.
| | | | - Richard ZuWallack
- Section of Pulmonary, Critical Care, and Sleep Medicine, Saint Francis Hospital and Medical Center, 114 Woodland Street, Hartford, CT, 06105, USA.
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Judd B, Brentnall J, Scanlan JN, Thomson K, Blackstock F, Mandrusiak A, Chipchase L, Phillips A, McAllister S. Evaluating allied health students' readiness for placement learning. BMC Med Educ 2023; 23:70. [PMID: 36709272 PMCID: PMC9883866 DOI: 10.1186/s12909-023-04005-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/05/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Experiential learning opportunities, such as work integrated learning placements, are often challenging for health professional students. It is therefore imperative that students are adequately prepared before engaging in placement learning. Operationalising 'readiness for learning on placement' as a construct, is necessary for providing quality student feedback and assessment. METHODS An integrative mixed methods approach was adopted for this study, utilising a survey to canvass the perspectives of academics, students, and placement educators around the construct of readiness to inform potential assessment items. An assessment tool measuring student readiness for placement was then developed. Data from occupational therapy, physiotherapy and speech pathology programs were evaluated using Rasch analysis to explore the unidimensionality of this construct. RESULTS The online survey was completed by 64 participants, confirming the importance and measurability of foundational skills integral to readiness for placement learning. These foundational skills were then reflected in a pilot 20-item tool covering domains of professional and learner behaviour, communication, information gathering skills and reasoning. The Rasch analysis of 359 pre-registration student assessments confirmed unidimensionality, suggesting that the skills and attributes (operationalised as assessment items) that are considered part of 'readiness for placement' are components of this construct. Together, these findings provide support that the items on this tool are relevant and representative of the skills and behaviours that indicate readiness for placement learning. Two items regarding documentation and appropriate professional dress demonstrated some lower importance scores and interpretation variance warranting further investigation. CONCLUSION Through the exploration of the construct of readiness for placement learning, we have created and subsequently revised, an innovative assessment tool that measures novice students' pre-placement capabilities. Further research is now needed to explore the psychometric properties of the tool.
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Affiliation(s)
- Belinda Judd
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Jennie Brentnall
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | | | - Kate Thomson
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Felicity Blackstock
- School of Health Sciences, Western Sydney University, Campelltown, Australia
| | - Allison Mandrusiak
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Lucy Chipchase
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Anna Phillips
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Sue McAllister
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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Calo M, Judd B, Chipchase L, Blackstock F, Peiris CL. Grit, Resilience, Mindset, and Academic Success in Physical Therapist Students: A Cross-Sectional, Multicenter Study. Phys Ther 2022; 102:6566435. [PMID: 35421232 PMCID: PMC9350533 DOI: 10.1093/ptj/pzac038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/21/2021] [Accepted: 02/22/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the relationships between noncognitive traits (grit, resilience, and mindset-type), academic success, and clinical performance in physical therapist students. METHODS This cross-sectional study using self-administered surveys was undertaken with final-year physical therapist students enrolled in 4 Australian universities. Participants completed validated questionnaires measuring grit, resilience, and mindset type. Academic transcripts were obtained to quantify academic success and clinical performance. A multiple regression analysis explored predictors of academic success and clinical performance in relation to sociodemographic factors, grit, resilience, and mindset type. RESULTS A total of 266 students participated in the study (80% recruitment rate). Overall, 25% of students had low resilience, 20% had low grit, and 14% had a fixed mindset type. Grittiness was positively associated with academic success (r = 0.24) and clinical performance (r = 0.22) and negatively associated with failing a clinical placement (r = -0.20). Grit was an independent predictor of overall academic success (β = 0.24, P ≤ .01) and clinical performance (β = 0.15). Students with low grit were twice as likely to fail a clinical placement compared with students with moderate or high grit (risk ratio = 2.03, 95% CI = 1.06 to 3.89). CONCLUSION Grit was an independent predictor for overall academic success and clinical performance in final-year physical therapist students. Low grit may impact negatively on learning and students' ability to cope with challenges associated with university studies and clinical education. Further studies should investigate interventions that best develop grit in health professional students and the overlapping nature of grit, resilience, and a growth mindset. IMPACT This study helps universities and educators understand noncognitive factors predicting academic success and clinical performance in physical therapist students. Universities and clinical educators may consider screening and providing proactive strategies for students with low grit to improve success and general wellbeing.
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Affiliation(s)
- Marlena Calo
- Address all correspondence to Ms Calo at: ; Follow the author(s): @PhysioPowell; @samstuart87; @godfreybiomed
| | - Belinda Judd
- Department of Physiotherapy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Lucy Chipchase
- Department of Physiotherapy, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Felicity Blackstock
- Department of Physiotherapy, School of Health Sciences, Western Sydney University, Sydney, Australia
| | - Casey L Peiris
- Department of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
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Dalwood N, Pritchard SA, Blackstock F. Patient-present teaching: Recasting roles for patients, learners and educators. Med Educ 2022; 56:245-247. [PMID: 34841559 DOI: 10.1111/medu.14703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/19/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Narelle Dalwood
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
| | - Shane A Pritchard
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
| | - Felicity Blackstock
- Department of Physiotherapy, School of Science and Health, Western Sydney University, Campbelltown, New South Wales, Australia
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Saliba KA, Blackstock F, McCarren B, Tang CY. Effect of Positive Expiratory Pressure Therapy on Lung Volumes and Health Outcomes in Adults With Chest Trauma: A Systematic Review and Meta-Analysis. Phys Ther 2022; 102:6414523. [PMID: 34723337 DOI: 10.1093/ptj/pzab254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/27/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purposes of this study were to evaluate the effect of positive expiratory pressure (PEP) therapy on lung volumes and health outcomes in adults with chest trauma and to investigate any adverse effects and optimal dosages leading to the greatest positive impact on lung volumes and recovery. METHODS Data sources were MEDLINE/PubMed, Embase, Cochrane Library, Physiotherapy Evidence Database, CINAHL, Open Access Thesis/Dissertations, EBSCO Open Dissertations, and OpenSIGLE/Open Grey. Randomized controlled trials investigating PEP therapy compared with usual care or other physical therapist interventions were included. Participants were >18 years old and who were admitted to the hospital with any form of chest trauma, including lung or cardiac surgery, blunt chest trauma, and rib fractures. Methodological quality was assessed using the Physiotherapy Evidence Database Scale, and the level of evidence was downgraded using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS Eleven studies involving 661 participants met inclusion eligibility. There was very low-level evidence that PEP improved forced vital capacity (standardized mean difference = -0.50; 95% CI = -0.79 to -0.21), forced expiratory volume in 1 second (standardized mean difference = -0.38; 95% CI = -0.62 to -0.13), and reduced the incidence of pneumonia (relative risk = 0.16; 95% CI = 0.03 to 0.85). Respiratory muscle strength also significantly improved in all 3 studies reporting this outcome. There was very low-level evidence that PEP did not improve other lung function measures, arterial blood gases, atelectasis, or hospital length of stay. Both PEP devices and dosages varied among the studies, and no adverse events were reported. CONCLUSION PEP therapy is a safe intervention with very low-level evidence showing improvements in forced vital capacity, forced expiratory volume in 1 second, respiratory muscle strength, and incidence of pneumonia. It does not improve arterial blood gases, atelectasis, or hospital length of stay. Because the evidence is very low level, more rigorous physiological and dose-response studies are required to understand the true impact of PEP on the lungs after chest trauma. IMPACT There is currently no strong evidence for physical therapists to routinely use PEP devices following chest trauma. However, there is no evidence of adverse events; therefore, in specific clinical situations, PEP therapy may be considered.
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Affiliation(s)
- Kerrie A Saliba
- Physiotherapy Department, School of Health Sciences, Western Sydney University, NSW, Australia
| | - Felicity Blackstock
- Physiotherapy Department, School of Health Sciences, Western Sydney University, NSW, Australia
| | | | - Clarice Y Tang
- Physiotherapy Department, School of Health Sciences, Western Sydney University, NSW, Australia
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Pritchard SA, Dalwood N, Keating JL, Nestel D, Te M, Blackstock F. ‘It’s the ultimate observer role…you’re feeling and seeing what’s happening to you’: students’ experiences of peer simulation. BMJ Simul Technol Enhanc Learn 2020; 7:329-337. [DOI: 10.1136/bmjstel-2020-000633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 09/08/2020] [Accepted: 10/15/2020] [Indexed: 11/04/2022]
Abstract
IntroductionSimulation-based education (SBE) benefits learners, but multiple barriers limit curriculum integration. Peer simulation, where students are formally educated to portray patient roles in simulated interactions with their peers, might maintain the educational benefits of SBE, be cost-effective, and enable additional learning. Our research question was: ‘What are the perspectives and experiences of physiotherapy students who participated in peer simulation?’.MethodsSecond-year physiotherapy students (n=16) participated in a blended peer simulation programme that included preparation for patient role portrayal and simulated clinical interactions with peers. Using an interpretivist approach, students’ experiences and perspectives were explored in two focus groups. Inductive thematic analysis was completed by two researchers.ResultsThree primary themes were identified that characterised the experiences and perspectives of physiotherapy students: peer simulation is a valuable learning experience, specific design features enable effective peer simulation, and portraying a patient provides unique insight. Peer simulation was unexpectedly realistic, revealed knowledge and skill deficits, and improved their clinical skills. Specific design features included consistent engagement, repetitive, individualised practice, multiple forms of feedback, and detailed role preparation. Being the patient in peer simulation gave students unique and valuable insight into patients’ experiences of and feelings about health issues and healthcare interactions.ConclusionPhysiotherapy students acquire new insights during peer simulation that may enrich their capabilities for practice through understanding healthcare interactions from patients’ perspectives. Physiotherapy students’ learning in peer simulation appears to align with the powerful learning experiences of health professional students in other immersive simulation modalities.
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Borovskis J, Cavaleri R, Blackstock F, Summers SJ. Transcranial Direct Current Stimulation Accelerates The Onset of Exercise-Induced Hypoalgesia: A Randomized Controlled Study. J Pain 2020; 22:263-274. [PMID: 32927091 DOI: 10.1016/j.jpain.2020.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/09/2020] [Accepted: 08/24/2020] [Indexed: 02/06/2023]
Abstract
Exercise-induced hypoalgesia (EIH) describes acute reductions in pain that occur following exercise. Current evidence suggests that the magnitude of EIH is small-to-moderate at best, warranting exploration of novel avenues to bolster these effects. Transcranial direct current stimulation (tDCS) has been shown to relieve pain and represents a promising intervention that may enhance EIH. This study aimed to determine whether anodal tDCS of the primary motor cortex (M1) can augment EIH in healthy individuals experiencing experimentally-induced musculoskeletal pain. Twenty-four healthy subjects attended 2 experimental sessions ("Day 0" and "Day 2"). On Day 0, subjects were injected with nerve growth factor into their right extensor carpi radialis brevis to induce persistent elbow pain. On Day 2, each subject received active or sham tDCS over M1 followed by an isometric grip exercise. Pain intensity, muscle soreness, sensitivity (pressure pain thresholds), and conditioned pain modulation were assessed prior to the nerve growth factor injection, on Day 2 before tDCS, immediately post-exercise, and 15 minutes post-exercise. Active tDCS expedited the onset of EIH, inducing immediate reductions in pain intensity that were not present until 15 minutes post-exercise in the sham group. However, active tDCS did not reduce muscle soreness or sensitivity when compared to sham tDCS. PERSPECTIVE: These findings suggest that active tDCS accelerates the onset of EIH in healthy individuals experiencing experimentally-induced pain. This may represent a promising means of enhancing adherence to exercise protocols. However, larger randomised controlled trials in persistent pain populations are required to confirm the clinical impact of these findings.
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Affiliation(s)
- Jana Borovskis
- School of Health Sciences, Western Sydney University, NSW 2560, Australia; Brain Stimulation and Rehabilitation (BrainStAR) Lab, Western Sydney University, NSW 2560, Australia
| | - Rocco Cavaleri
- School of Health Sciences, Western Sydney University, NSW 2560, Australia; Brain Stimulation and Rehabilitation (BrainStAR) Lab, Western Sydney University, NSW 2560, Australia
| | | | - Simon J Summers
- School of Health Sciences, Western Sydney University, NSW 2560, Australia; Brain Stimulation and Rehabilitation (BrainStAR) Lab, Western Sydney University, NSW 2560, Australia; Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, ACT 2617, Australia; Research School of Biology, Australian National University, ACT 2600, Australia.
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Te M, Blackstock F, Liamputtong P, Chipchase L. New graduate physiotherapists' perceptions and experiences working with people from culturally and linguistically diverse communities in Australia: a qualitative study. Physiother Theory Pract 2020; 38:782-793. [PMID: 32729348 DOI: 10.1080/09593985.2020.1799459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Upon entering the workforce, physiotherapists are required to provide safe and effective care toward people from culturally and linguistically diverse (CALD) communities. Objective: To explore new graduate physiotherapists' perceptions and experiences when working with people from CALD communities in Australia. METHODS A phenomenological framework guided this qualitative study. Seventeen new graduate physiotherapists who had experience working with people from CALD communities were interviewed. Interviews were audio-recorded, transcribed verbatim, and then thematically analyzed. RESULTS New graduate physiotherapists felt challenged when they encountered people from CALD communities. Although they had good intentions, their healthcare approach was limited. Their perceived approach to care was unidirectional and anchored in a western healthcare framework, and they used superficial strategies for cultural adaptation. Perceptions that people from CALD communities were passive recipients to healthcare also underpinned their practices. While participants described pockets of patient-centered care, their perceived healthcare approach lacked appropriate consideration and integration of their patients' cultural perspective. CONCLUSION New graduate physiotherapists may need support with effectively integrating different cultural perspectives into their care and adapting their practices and interventions for people from CALD communities. Education and training at entry-level and after graduation should address these learning needs. However, there is limited research on how to culturally adapt physiotherapy practices and interventions that impact patient engagement outcomes. Thus, research is needed to understand how current evidence-based interventions can be culturally adapted to integrate patients' cultural perspectives into care.
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Affiliation(s)
- Maxine Te
- School of Health Sciences, Western Sydney University, Penrith, Australia
| | | | - Pranee Liamputtong
- School of Health Sciences, Western Sydney University, Penrith, Australia
| | - Lucy Chipchase
- School of Health Sciences, Western Sydney University, Penrith, Australia
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11
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Dalwood N, Bowles KA, Williams C, Morgan P, Pritchard S, Blackstock F. Students as patients: A systematic review of peer simulation in health care professional education. Med Educ 2020; 54:387-399. [PMID: 31912550 DOI: 10.1111/medu.14058] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 12/05/2019] [Accepted: 12/19/2019] [Indexed: 06/10/2023]
Abstract
CONTEXT Evidence supports the substitution of both clinical placement time and traditional educational activities with simulation-based education (SBE). However, lack of resources can be a barrier to SBE implementation. Peer simulation provides an alternative to simulated patient (SP)-based SBE by educating students to portray patient roles. This diversifies learning experiences for students using SBE and may decrease costs. OBJECTIVES This study aimed to determine the impact of students portraying the roles of patients in a simulation-based learning environment (peer simulation) on learning outcomes in entry-level health care professional students. METHODS Seven databases were searched (from inception to 8 May 2019) using terms including 'peer simulation,' 'role-play' and 'simulated/standardised patient.' The studies included described a health care professional student SBE interaction involving peer simulation. Data were extracted by two independent investigators. Study quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI) and Critical Appraisal Skills Programme (CASP). A descriptive analysis was completed and meta-analysis conducted in instances in which outcomes could be pooled. RESULTS A total of 12 studies met the inclusion criteria. Constructs measured by the studies included communication, empathy, self-efficacy and confidence. Five randomised controlled trials compared peer simulation with the use of SPs and demonstrated greater or equivalent patient empathy gains in peer simulation. Meta-analysis determined no difference in communication capabilities between the two groups. Students perceived peer simulation as comparably valuable and frequently superior to other forms of learning. This review was unable to determine effective design features of peer simulation initiatives. CONCLUSIONS Students were positive about peer simulation, but there has been limited evaluation of learning outcome attainment. Significant heterogeneity was observed; studies were diverse in design, outcome measures and the training provided for peer patients. Peer simulation positively influences student communication and development of patient empathy and offers an alternative to learning with SPs. Further rigorous research is required to understand the impact of peer simulation for a broader range of learning outcomes and to confirm the impact of this developing educational approach.
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Affiliation(s)
- Narelle Dalwood
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
| | - Kelly-Ann Bowles
- Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia
| | - Cylie Williams
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
| | - Prue Morgan
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
| | - Shane Pritchard
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
| | - Felicity Blackstock
- Department of Physiotherapy, School of Science and Health, Western Sydney University, Campbelltown, NSW, Australia
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Liang Z, Blackstock F, Howard P, Leggat G, Hughes A, Maddern J, Briggs D, Isouard G, North N, Leggat SG. A health management competency framework for Australia. AUST HEALTH REV 2020; 44:958-964. [DOI: 10.1071/ah19006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 01/16/2020] [Indexed: 11/23/2022]
Abstract
ObjectiveThis study examined whether the management competency framework for health service managers developed in the Victorian healthcare context is applicable to managers in other Australian states.
MethodsAn online questionnaire survey of senior and middle-level health service managers in both community health services and hospitals was conducted in New South Wales and Queensland.
ResultsThe study confirmed that the essential tasks for senior and middle-level managers are consistent across health and social care sectors, as well as states. Core competencies for health services managers identified in the Victorian healthcare context are relevant to other Australian states. In addition, two additional competencies were incorporated into the framework.
ConclusionThe Management Competency Assessment Program competency framework summarises six competencies and associated behaviours that may be useful for guiding performance management and the education and training development of health service managers in Australia.
What is known about the topic?The evidence suggests that competency-based approaches can enhance performance and talent management, and inform education and training needs, yet there has been no validated competency framework for Australian health service managers.
What does the paper add?This paper explains the process of the finalisation of the first management competency framework for guiding the identification of the training and development needs of Australian health service managers and the management of their performance.
What are the implications for practice?The Management Competency Assessment Program competency framework can guide the development of the health service management workforce in three Australian states, and may be applicable to other jurisdictions. Further studies are required in the remaining jurisdictions to improve the external validity of the framework.
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Summers S, Blackstock F, Borovskis J, Cavaleri R. Can non-invasive brain stimulation augment the hypoalgesic effects of exercise? J Sci Med Sport 2019. [DOI: 10.1016/j.jsams.2019.08.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Te M, Blackstock F, Chipchase L. Fostering cultural responsiveness in physiotherapy: curricula survey of Australian and Aotearoa New Zealand physiotherapy programs. BMC Med Educ 2019; 19:326. [PMID: 31470833 PMCID: PMC6717323 DOI: 10.1186/s12909-019-1766-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 08/26/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Developing cultural responsiveness among physiotherapists is considered essential to promote quality and equity in healthcare provision for our culturally diverse populations. The aim of this study was to evaluate how entry-level physiotherapy programs in Australia and Aotearoa New Zealand (NZ) design curricula to foster the development of cultural responsiveness in physiotherapy students. Further, the challenges of integrating educational content and approaches, and the perceptions of the effectiveness of these curricula were also explored. METHODS A cross-sectional telephone survey with closed and open-ended questions, was conducted with 18 participants representing 24 entry-level physiotherapy programs (82% of all programs) in Australia and NZ between May and September 2017. Data were analysed descriptively in the form of frequencies, percentages or ratios as appropriate. Open-ended responses were thematically analysed. RESULTS Results suggest variability in the structure, and teaching and assessment methods used across all programs. The majority of programs appeared to rely on didactic teaching methods, along with knowledge based and implicit assessment methods. The main challenges reported were that cultural responsiveness was thought to be perceived by academic staff as unimportant and that the curriculum was perceived to be 'overcrowded'. Participants also felt there was room for improvement despite perceiving the curriculum to be effective at fostering cultural responsiveness. CONCLUSION Results provide insight into the educational content and approaches integrated in entry-level physiotherapy curricula in Australia and NZ, and suggest opportunities for further research and development to foster cultural responsiveness among physiotherapy students.
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Affiliation(s)
- Maxine Te
- School of Science and Health, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Felicity Blackstock
- School of Science and Health, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Lucy Chipchase
- School of Science and Health, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2751 Australia
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Te M, Blackstock F, Fryer C, Gardner P, Geary L, Kuys S, McPherson K, Nahon I, Tang C, Taylor L, Van Kessel G, van der Zwan K, Chipchase L. Predictors of self-perceived cultural responsiveness in entry-level physiotherapy students in Australia and Aotearoa New Zealand. BMC Med Educ 2019; 19:56. [PMID: 30760254 PMCID: PMC6375174 DOI: 10.1186/s12909-019-1487-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 02/06/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Ensuring physiotherapy students are well prepared to work safely and effectively in culturally diverse societies upon graduation is vital. Therefore, determining whether physiotherapy programs are effectively developing the cultural responsiveness of students is essential. This study aimed to evaluate the level of self-perceived cultural responsiveness of entry level physiotherapy students during their training, and explore the factors that might be associated with these levels. METHODS A cross sectional study of physiotherapy students from nine universities across Australia and Aotearoa New Zealand was conducted using an online self-administered questionnaire containing three parts: The Cultural Competence Assessment tool, Altemeyer's Dogmatism scale, and the Marlowe-Crowne social desirability scale- short form. Demographic data relating to university, program, and level of study were also collected. Data was analysed using one-way ANOVA, t-tests and multiple regression analysis. RESULTS A total of 817 (19% response rate) students participated in this study. Overall, students had a moderate level of self-perceived cultural responsiveness (Mean (SD) = 5.15 (0.67)). Fewer number of weeks of clinical placement attended, lower levels of dogmatism, and greater social desirability were related to greater self-perceived cultural responsiveness. Additionally, fourth year undergraduate students perceived themselves to be less culturally responsive than first and second year students (p < 0.05). CONCLUSIONS These results provide educators with knowledge about the level of self-perceived cultural responsiveness in physiotherapy students, and the factors that may need to be assessed and addressed to support the development of culturally responsive practice.
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Affiliation(s)
- Maxine Te
- School of Science and Health, Western Sydney University, Penrith, NSW 2751 Australia
| | - Felicity Blackstock
- School of Science and Health, Western Sydney University, Penrith, NSW 2751 Australia
| | - Caroline Fryer
- School of Health Sciences, University of South Australia, Adelaide, SA Australia
| | - Peter Gardner
- School of Physiotherapy and Exercise Science, Curtin University, Bently, WA Australia
| | - Louise Geary
- School of Allied Health, La Trobe University, Melbourne, VIC Australia
| | - Suzanne Kuys
- School of Physiotherapy, Australian Catholic University, Brisbane, QLD Australia
| | - Kerstin McPherson
- School of Community Health, Charles Sturt University, Bathurst, NSW Australia
| | - Irmina Nahon
- Faculty of Health, University of Canberra, ACT Bruce, Australia
| | - Clarice Tang
- School of Allied Health, La Trobe University, Melbourne, VIC Australia
| | - Lynne Taylor
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Gisela Van Kessel
- School of Health Sciences, University of South Australia, Adelaide, SA Australia
| | - Kelly van der Zwan
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD Australia
| | - Lucy Chipchase
- School of Science and Health, Western Sydney University, Penrith, NSW 2751 Australia
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Donner CF, Raskin J, ZuWallack R, Nici L, Ambrosino N, Balbi B, Blackstock F, Casaburi R, Dreher M, Effing T, Goldstein R, Krishnan J, Lareau SC, Make BJ, Maltais F, Meek P, Morgan M, Pépin JL, Rabbito C, Rochester CL, Silverman AR, Singh S, Spruit MA, Vitacca M, Williams L. Incorporating telemedicine into the integrated care of the COPD patient a summary of an interdisciplinary workshop held in Stresa, Italy, 7-8 September 2017. Respir Med 2018; 143:91-102. [PMID: 30261999 DOI: 10.1016/j.rmed.2018.09.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
Abstract
This report is a summary of a workshop focusing on using telemedicine to facilitate the integrated care of chronic obstructive pulmonary disease (COPD). Twenty-five invited participants from 8 countries met for one and one-half days in Stresa, Italy on 7-8 September 2017, to discuss this topic. Participants included physiotherapists, nurses, a nurse practitioner, and physicians. While evidence-based data are always at the center of sound inference and recommendations, at this point in time the science behind telemedicine in COPD remains under-developed; therefore, this document reflects expert opinion and consensus. While telemedicine has great potential to expand and improve the care of our COPD patients, its application is still in its infancy. While studies have demonstrated its effectiveness in some patient-centered outcomes, the results are by no means consistently positive. Whereas this tool may potentially reduce health care costs by moving some medical interventions from centralized locations in to patient's home, its cost-effectiveness has had mixed results and telemonitoring has yet to prove its worth in the COPD population. These discordant results should not be unexpected in view of patient complexity and the heterogeneity of telemedicine. This is reflected in the very limited support offered by the National Health Services to a wider application of telemedicine in the integrated care of COPD patients. However, this situation should challenge us to develop the necessary science to clarify the role of telemedicine in the medical management of our patients, providing a better and definitive scientific basis to this approach.
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Affiliation(s)
- Claudio F Donner
- Fondazione Mondo Respiro ONLUS, Via Monsignor Cavigioli, 10, 28021, Borgomanero, NO, Italy.
| | - Jonathan Raskin
- Pulmonary and Internal Medicine, 1000 Park Ave, New York, NY, 10028, USA.
| | - Richard ZuWallack
- University of CT, Pulmonary and Critical Care, St Francis Hospital and Medical Center, Hartford, CT, 06015, USA.
| | | | | | - Bruno Balbi
- ICS Maugeri, I.R.C.C.S. Institute of Veruno (Novara), Italy.
| | - Felicity Blackstock
- School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia.
| | - Richard Casaburi
- UCLA School of Medicine, Rehabilitation Clinical Trial Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center Torrance, California, 90502, USA.
| | - Michael Dreher
- Division of Pneumology, University Hospital RWTH Aachen, Germany.
| | - Tanja Effing
- College of Medicine & Public Health, Flinders University, Adelaide, Australia, Department of Respiratory Medicine, Southern Adelaide Local Health Network, Adelaide, Australia.
| | - Roger Goldstein
- University of Toronto, NSA Chair in Respiratory Rehabilitation Research, USA.
| | | | - Suzanne C Lareau
- College of Nursing, Univ. of Colorado Denver, Anschutz Medical Campus, C288-04, ED 2 North, Rm 4327, 13120 East 19th Ave, Aurora, CO, 80045, USA.
| | - Barry J Make
- Department of Medicine, University of Colorado, USA.
| | - Francois Maltais
- Institut Universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada.
| | - Paula Meek
- College of Nursing, Anschutz Medical Campus, University of Colorado, USA.
| | - Michael Morgan
- University of Leicester, Chair NHS England Respiratory Clinical Reference Group, National Clinical Director Respiratory NHS, UK.
| | - Jean-Louis Pépin
- Sleep and Exercise Department, Scientific Director of Clinical Research Administration, Research Division at Grenoble University Hospital, Grenoble, FR, France.
| | - Chiara Rabbito
- Rabbito Law Firm, Via Piave 44, San Lazzaro, 40068, BO, Italy.
| | - Carolyn L Rochester
- Yale University School of Medicine, Pulmonary Rehabilitation Program, VA Connecticut Healthcare System, USA.
| | - Adam R Silverman
- Quinnipiac University School of Medicine, 95 Woodland St, 4th Floor, Hartford, CT, 06105, USA.
| | - Sally Singh
- University Hospitals of Leicester Leicester, UK.
| | - Martijn A Spruit
- Department of Research and Education, Ciro, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands; REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium.
| | - Michele Vitacca
- Respiratory Department ICS S. Maugeri IRCCS Lumezzane (Bs) Italy, Respiratory Department, Via Mazzini 129, Lumezzane, 25066, Bs, Italy.
| | - Loreen Williams
- Management Program, Pulmonary and Critical Care, St Francis Hospital & Med Ctr, Hartford, CT, 06105, USA.
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Leahy E, Chipchase L, Blackstock F. Which learning activities enhance physiotherapy practice? A systematic review protocol of quantitative and qualitative studies. Syst Rev 2017; 6:83. [PMID: 28416011 PMCID: PMC5393023 DOI: 10.1186/s13643-017-0475-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 04/05/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Learning activities are fundamental for the development of expertise in physiotherapy practice. Continuing professional development (CPD) encompasses formal and informal learning activities undertaken by physiotherapists. Identifying the most efficient and effective learning activities is essential to enable the profession to assimilate research findings and improve clinical skills to ensure the most efficacious care for clients. To date, systematic reviews on the effectiveness of CPD provide limited guidance on the most efficacious models of professional development for physiotherapists. The aim of this systematic review is to evaluate which learning activities enhance physiotherapy practice. METHODS A search of Ovid MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO (Psychological Abstracts), PEDro, Cochrane Library, AMED and Educational Resources and Information Center (ERIC) will be completed. Citation searching and reference list searching will be undertaken to locate additional studies. Quantitative and qualitative studies will be included if they examine the impact of learning activities on clinician's behaviour, attitude, knowledge, beliefs, skills, self-efficacy, work satisfaction and patient outcomes. Risk of bias will be assessed by two independent researchers. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) and Confidence in the Evidence from Reviews of Qualitative research (CERQual) will be used to synthesise results where a meta-analysis is possible. Where a meta-analysis is not possible, a narrative synthesis will be conducted. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016050157.
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Affiliation(s)
- Edmund Leahy
- Physiotherapy, School of Science and Health, Western Sydney University, Campbelltown, New South Wales, Australia.,School of Allied Health, La Trobe University, Bundoora, Victoria, 3086, Australia.,Physiotherapy Department, Northern Health, Epping, Victoria, 3076, Australia
| | - Lucy Chipchase
- Physiotherapy, School of Science and Health, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Felicity Blackstock
- Physiotherapy, School of Science and Health, Western Sydney University, Campbelltown, New South Wales, Australia.
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Chipchase L, Davidson M, Blackstock F, Bye R, Colthier P, Krupp N, Dickson W, Turner D, Williams M. Conceptualising and Measuring Student Disengagement in Higher Education: A Synthesis of the Literature. ACTA ACUST UNITED AC 2017. [DOI: 10.5430/ijhe.v6n2p31] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Much has been written about why students engage in academic studies at university, with less attention given to the concept of disengagement. Understanding the risks and factors associated with student disengagement from learning provides opportunities for targeted remediation. The aims of this review were to 1) explore how student disengagement has been conceptualised, 2) identify factors associated with disengagement and 3) identify measureable indicators of disengagement in previous literature. A systematic search was conducted across relevant databases and key websites. Reference lists of included papers were screened for additional publications. Studies and national published survey data were included if they addressed issues pertaining to student disengagement with learning or the academic environment, were in full text and in English. In the 32 papers that met the inclusion criteria, student disengagement was conceptualised as a multi-faceted, complex yet fluid state that has a combination of behavioural, emotional and cognitive domains influenced by intrinsic (psychological factors, low motivation, inadequate preparation for higher education and unmet or unrealistic expectations) or extrinsic (competing demands, institutional structure and processes, teaching quality and online teaching and learning). A number of measurable indicators of disengagement were synthesised from the literature including those that were self-reported by students and those collected by an institution. An examination of the conceptualisation, influences and indicators of disengagement could inform intervention programs to ameliorate the consequences of disengagement for students and academic institutions.
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O'Halloran PD, Shields N, Blackstock F, Wintle E, Taylor NF. Motivational interviewing increases physical activity and self-efficacy in people living in the community after hip fracture: a randomized controlled trial. Clin Rehabil 2016; 30:1108-1119. [PMID: 26603892 DOI: 10.1177/0269215515617814] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate if motivational interviewing improved physical activity, self-efficacy, quality of life, mobility and mental health in people living in the community after hip fracture. DESIGN Single-blind randomized controlled trial. SETTING Community. PARTICIPANTS A total of 30 adults after hip fracture who had been discharged from rehabilitation to independent living in the community and allocated to a control group ( n = 14) or an intervention group ( n = 16). INTERVENTION All participants received usual care. The intervention group also received eight weekly sessions of motivational interviewing as additional input, with the control group having no additional matching input. MAIN OUTCOMES The primary outcome was physical activity levels as measured by an accelerometer (steps taken per day, time spent walking per day, and time spent sitting or lying each day). Secondary outcomes included self-efficacy (confidence about walking and not falling), health-related quality of life, mobility and mental health. RESULTS Relative to usual care, the motivational interviewing group took significantly more steps per day (mean = 1237 steps, 95% confidence interval (CI) 12 to 2463), walked for longer per day (mean = 14.4 minutes, 95% CI 0.6 to 28.8), had improved self-efficacy evidenced by being more confident about walking (mean = 1.6 units out of 10, 95% CI 0.3 to 2.9) and not falling (mean = 1.1 units out of 10, 95% CI 0.3 to 1.9) and improved health-related quality of life and mental health. CONCLUSION This study provides preliminary evidence that motivational interviewing can result in clinically meaningful improvements in physical activity and psychosocial outcomes for people recovering from hip fracture.
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Affiliation(s)
- Paul D O'Halloran
- 1 La Trobe University, College of Science, Health and Engineering, Melbourne, Victoria, Australia
| | - Nora Shields
- 1 La Trobe University, College of Science, Health and Engineering, Melbourne, Victoria, Australia.,2 Northern Health, Victoria, Australia
| | - Felicity Blackstock
- 1 La Trobe University, College of Science, Health and Engineering, Melbourne, Victoria, Australia
| | | | - Nicholas F Taylor
- 1 La Trobe University, College of Science, Health and Engineering, Melbourne, Victoria, Australia.,3 Eastern Health, Victoria, Australia
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Wright A, Moss P, Watson K, Rue S, Jull G, Mandrusiak A, Reubenson A, Connaughton J, Redmond C, MacIntosh S, Alison J, Chipchase L, Clements T, Blackstock F, Morgan P, Laakso L, van der Zwan K, Corrigan R, Jones A, Teys P, Palmer T. A profession-wide collaboration to embed role-play simulation into Australian entry-level physiotherapy clinical training. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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O’Halloran PD, Blackstock F, Shields N, Holland A, Iles R, Kingsley M, Bernhardt J, Lannin N, Morris ME, Taylor NF. Motivational interviewing to increase physical activity in people with chronic health conditions: a systematic review and meta-analysis. Clin Rehabil 2014; 28:1159-71. [DOI: 10.1177/0269215514536210] [Citation(s) in RCA: 227] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective: A systematic review and meta-analysis of randomized controlled trials to determine if motivational interviewing leads to increased physical activity, cardiorespiratory fitness or functional exercise capacity in people with chronic health conditions. Data sources: Seven electronic databases (MEDLINE, PsychINFO, EMBASE, AMED, CINHAL, SPORTDiscus and the Cochrane Central Register of Controlled trials) were searched from inception until January 2014. Trial selection: Two reviewers independently examined publications for inclusion. Trials were included if participants were adults (>18 years), had a chronic health condition, used motivational interviewing as the intervention and examined physical activity, cardiorespiratory fitness or functional exercise capacity. Data extraction: Two reviewers independently extracted data. Risk of bias within trials was assessed using the Physiotherapy Evidence Database Scale. Data synthesis: Meta-analyses were conducted with standardized mean differences and 95% confidence intervals (CIs) were calculated. The Grades of Recommendation, Assessment, Development and Evaluation approach was used to evaluate the quality of the evidence. Results: Eleven publications (of ten trials) were included. There was moderate level evidence that motivational interviewing had a small effect in increasing physical activity levels in people with chronic health conditions relative to comparison groups (standardized mean differences = 0.19, 95% CI 0.06 to 0.32, p = 0.004). Sensitivity analysis based on trials that confirmed treatment fidelity produced a larger effect. No conclusive evidence was observed for cardiorespiratory fitness or functional exercise capacity. Conclusion: The addition of motivational interviewing to usual care may lead to modest improvements in physical activity for people with chronic health conditions.
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Affiliation(s)
| | | | - Nora Shields
- Faculty of Health Sciences, La Trobe University, Australia
- Northern Health, Australia
| | - Anne Holland
- Faculty of Health Sciences, La Trobe University, Australia
- Department of Physiotherapy, Alfred Health, Australia
| | - Ross Iles
- Department of Physiotherapy, Monash University, Australia
| | - Mike Kingsley
- Faculty of Health Sciences, La Trobe University, Australia
| | - Julie Bernhardt
- Faculty of Health Sciences, La Trobe University, Australia
- Florey Institute of Neuroscience and Mental Health, Australia
| | - Natasha Lannin
- Faculty of Health Sciences, La Trobe University, Australia
- Department of Occupational Therapy, Alfred Health, Australia
| | - Meg E Morris
- Faculty of Health Sciences, La Trobe University, Australia
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Watson K, Wright A, Morris N, McMeeken J, Rivett D, Blackstock F, Jones A, Haines T, O'Connor V, Watson G, Peterson R, Jull G. Can simulation replace part of clinical time? Two parallel randomised controlled trials. Med Educ 2012; 46:657-667. [PMID: 22646319 DOI: 10.1111/j.1365-2923.2012.04295.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
CONTEXT Education in simulated learning environments (SLEs) has grown rapidly across health care professions, yet no substantive randomised controlled trial (RCT) has investigated whether SLEs can, in part, substitute for traditional clinical education. METHODS Participants were physiotherapy students (RCT 1, n = 192; RCT 2, n = 178) from six Australian universities undertaking clinical education in an ambulatory care setting with patients with musculoskeletal disorders. A simulated learning programme was developed as a replica for clinical education in musculoskeletal practice to replace 1 week of a 4-week clinical education placement. Two SLE models were designed. Model 1 provided 1 week in the SLE, followed by 3 weeks in clinical immersion; Model 2 offered training in the SLE in parallel with clinical immersion during the first 2 weeks of the 4-week placement. Two single-blind, multicentre RCTs (RCT 1, Model 1; RCT 2, Model 2) were conducted using a non-inferiority design to determine if the clinical competencies of students part-educated in SLEs would be any worse than those of students educated fully in traditional clinical immersion. The RCTs were conducted simultaneously, but independently. Within each RCT, students were stratified on academic score and randomised to either the SLE group or the control ('Traditional') group, which undertook 4 weeks of traditional clinical immersion. The primary outcome measure was a blinded assessment of student competency conducted over two clinical examinations at week 4 using the Assessment of Physiotherapy Practice (APP) tool. RESULTS Students' achievement of clinical competencies was no worse in the SLE groups than in the Traditional groups in either RCT (Margin [Δ] ≥ 0.4 difference on APP score; RCT 1: 95% CI - 0.07 to 0.17; RCT 2: 95% CI - 0.11 to 0.16). CONCLUSIONS These RCTs provide evidence that clinical education in an SLE can in part (25%) replace clinical time with real patients without compromising students' attainment of the professional competencies required to practise.
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Affiliation(s)
- Kathryn Watson
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
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Abstract
A systematic review was conducted to determine the benefits of disease-specific health education for people with chronic obstructive pulmonary disease (COPD). A search was conducted through Medline, CINAHL, PsycINFO, Embase, Cochrane Library, Physiotherapy Evidence Database and reference lists to obtain publications reporting on educational interventions compared with usual medical care. Two reviewers independently assessed each paper for methodological quality and data extraction. Thirteen publications describing 10 randomized controlled trials were identified for inclusion. The studies reported on a very broad variety of outcomes and follow-up periods, making a meta-analysis not possible for most measures. Didactical educational intervention for the COPD population appeared to have minimal effect on health outcomes including quality of life, health care utilization, exercise capacity or lung function and is therefore not the education delivery method recommended. Education focusing on self-management showed encouraging results with a tendency for improvements in quality of life and health care utilization, but the results did not reach statistical significance as sample sizes were insufficient to detect an effect. Further research is required into self-management education as it is not possible to make generalizations from the current published literature as to the benefits in changing health status in the COPD population.
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