International graduate entry nursing students: A qualitative study on engagement

AIM

This study aims to elicit graduate entry nursing students' views on factors that enable and constrain their learning engagement.

BACKGROUND

Learning engagement has been associated with student retention/attrition and the achievement of learning confidence and success. While all students are subject to challenges that affect their learning engagement, those experienced by international students who are learning in a foreign and unfamiliar context are of particular concern to academics. An understanding of international graduate entry nursing students' perspectives on factors that enable and constrain their engagement can inform development of learning and teaching strategies that are more responsive to the needs of this group of students and can support their learning achievement.

DESIGN

A qualitative descriptive design conducted in one Australian multi campus university School of Nursing. Participants included first and second-year international students enrolled in a graduate entry Master of Nursing course.

METHODS

Data, including demographic information, was collected via a theoretically informed online survey consisting of a Likert scale and open- ended questions. This study reports participant responses to open ended questions included in the survey. A thematic analysis was used to interpret findings.

FINDINGS

Analysis identified participants' perspectives on factors that influenced their learning engagement in four theme areas: 1) Availability of study support resources, 2) Opportunities for social interaction, 3) Opportunities to build a sense of belonging, and 4) Constraints on development of a sense of engagement. Opportunities for social engagement emerged as a dominant finding across all themes.

CONCLUSION

This research, which focused on international students' perspectives on learning engagement, contributed to existing knowledge on student engagement in higher education graduate entry nursing courses. Opportunities for social interaction within and beyond formal course learning experiences were valued by students and identified as key to their learning engagement. These findings have implications for academics and student support services who together, can influence the context of students learning to better meet their engagement needs.

Radiography students' viewpoints of the clinical learning environment: A cross-sectional study

INTRODUCTION

The quality of clinical learning environments (CLEs) impact learners' experience and competence development. Objective instruments have been developed to evaluate CLEs from the perspective of medical and nursing students. No such instruments have been used in Radiography.

METHODS

Radiography students' perspectives of CLEs were investigated using the validated Undergraduate Clinical Education Environment Measure (UCEEM). Undergraduate (UG) (n = 365) and graduate entry (GE) radiography students (n = 45) from an Irish university were invited to participate. CLEs consisted of 25 public and 10 private hospitals. The UCEEM contains 26 items under two overarching dimensions, experiential learning and social participation, with four subscales: opportunities to learn in and through work and quality of supervision; preparedness for student entry; workplace interaction patterns and student inclusion; and equal treatment.

RESULTS

Two hundred and ten students participated (response rate 52.4%; n = 185 UG, n = 30 GE), most of whom were based in public hospitals (87.4%). The mean UCEEM score was 107.5 ± 17.7 (optimal range: 90-125). Experiential learning and social participation were scored 74.2 ± 12.5 (optimal range: 60-85) and 33.37 ± 6.29 (optimal range: 30-40), respectively. Private hospitals ranked slightly higher than public hospitals for 'opportunities to learn in and through work and quality of supervision' (p = 0.018). Items ranked highest related to 'equal treatment' and 'opportunity to put theory into practice'. Clinical supervision-related items were scored highest by first-year students.

CONCLUSION

High UCEEM scores indicate radiography students' positive perceptions of their CLEs, particularly regarding equality and experiential learning. Findings support the expansion of radiography placement to include public and private hospitals.

IMPLICATIONS FOR PRACTICE

The UCEEM is a theoretically robust, validated tool which appears suitable for evaluating radiography CLEs. This study provides valuable baseline data for comparison of Radiography CLEs.

An accelerated dispensing course for grad entry students - Can we teach dispensing skills over a day?

BACKGROUND AND PURPOSE

This study aimed to evaluate an accelerated dispensing course for graduate entry (GE) pharmacy students with prior science-related degrees to join undergraduate (UG) students in year three of the Monash Pharmacy degree.

EDUCATIONAL ACTIVITY AND SETTING

A one day accelerated dispensing course using MyDispense software was delivered to 59 GE students. The accelerated dispensing course was identical to the standard three-week dispensing course delivered to UG students. The same assessment of dispensing skills was conducted after course completion for both UG and GE students and included dispensing four prescriptions of varying difficulty. The assessment scores of the UG and GE students were compared. Perception data from the accelerated course were also collected.

FINDINGS

The accelerated dispensing curriculum was well received by students. They found the simulation relevant to practice, easy to navigate, and helpful for preparing them for assessment. Overall, 5.1% of GE students failed the assessment, which was lower than the 32.6% failure rate in the UG cohort. Comparison of assessment grades between UG and GE students showed no notable disadvantage to attainment of learning outcomes with the accelerated curriculum. However, UG students were more likely to provide unsafe instructions compared to GE students in their labeling for three out of four prescriptions.

SUMMARY

An accelerated dispensing curriculum can be effectively delivered to mature learners with a prior science-related degree as no notable deficiencies were identified when comparing the assessment results of GE students against UG students when both student cohorts undertook the same dispensing assessment.

A comparison of the academic performance of graduate entry and undergraduate entry pharmacy students at the course exit level

INTRODUCTION

Graduate entry (GE) pharmacy students are trained in a shorter timeframe than undergraduate entry (UE) students. This study compares the academic performance of GE and UE pharmacy students at the course exit point.

METHODS

A retrospective analysis of final exam grades in written and objective structured clinical examination (OSCE) was performed between GE and UE students from three graduating cohorts. Final written examination contained clinical case study questions, whereas OSCE involved role play with simulated patients or doctors. Statistical analyses were performed by t-test and one-way analysis of variance at .05 significance level and Pearson's correlation coefficient.

RESULTS

No significant difference in academic performance was seen between GE and UE groups at course exit (P > .05). There was a trend for GE students performing marginally better in OSCE than UE students. Females showed better performances in verbal communication than males. GE males showed significantly lower empathy scores than all other groups. No significant difference was seen in problem-solving scores amongst all groups. Both UE and GE groups scored significantly better in written examinations compared with OSCE.

CONCLUSIONS

Graduate entry pharmacy students from accelerated learning pathway and UE students performed similarly at the course exit point, providing empirical support for non-traditional graduate entry pathway as a viable option.

It's how we practice that matters: professional identity formation and legitimate peripheral participation in medical students: a qualitative study

BACKGROUND

The process of Legitimate Peripheral Participation (LPP) within a community of practice framework (CoP) was used to explore graduate entry medical students' professional identity formation (PIF) during their first year of study. A conceptual model has been developed that can be used by medical educators to better understand PIF and to aid the explicit incorporation of PIF activity within the undergraduate curriculum.

METHODS

Ten students from one UK medical school participated in the longitudinal study and were interviewed at three points during the first year. Semi-structured group interviews were used to explore students' experience of the clinical environment and the nature of their interactions with both clinicians and patients in a community-based medicine practice. The interviews were audio recorded and transcribed. Thematic analysis was used to identify overarching themes which are represented as facets in the model of PIF.

RESULTS

Results demonstrate that students are legitimately peripherally participating within both medical student CoPs and wider medical CoPs. Themes identified within the narratives have allowed the development of a new model to understand PIF within the context of LPP in a CoP. This has five facets: Awareness, Collaboration, Negotiation, Evaluation and Realisation. Sophisticated reflection-in-action is shown to be an important aspect of PIF and enables a more conscious understanding of the change that is occurring in our students.

CONCLUSION

PIF is a complex, non-linear process that is supported by reflection-in-action and early student introduction to clinical practice. It can be recognised in students' narratives in their changing use of language, their understanding of the medical COP, and their evolving relational participation with those around them. This study adds to those that have previously explored PIF. The model of PIF developed in this study illustrates how experiences in the clinical environment support PIF. Medical educators may find this model helpful when considering how PIF can be explicitly encouraged in the medical curriculum and how reflection may be used for the purpose of identity change.

Listening to student voice-understanding student and faculty experience at two UK graduate entry programmes

CONTEXT

Shortage of physicians in the UK has been a long-standing issue. Graduate entry medicine (GEM) may offer a second point of entry for potential doctors. However, the challenges of developing and implementing these programmes are still unrecognised. This small-scale study aimed to briefly explore the opportunities and challenges facing students at two UK GEM programmes.

METHODS

Two case studies were conducted at Imperial College and Scotland's GEM (ScotGEM) and used a triangulated qualitative approach via semi-structured and elite interviews. Data analysis, informed by grounded theory, applied thematic and force-field analysis in an empirical approach to generate evidence and instrumental interpretations for Higher Education Institutions.

RESULTS

Although GEM forms an opportunity for graduates to enter medicine, the different drivers of each programme were key in determining entry requirements and challenges experienced by postgraduates. Three key dilemmas seem to influence the experiences of learners in GEM programmes: (a) postgraduate identity and the everchanging sense-of-self; (b)self-directed and self-regulated learning skills, and (c) servicescape, management and marketing concepts.

CONCLUSIONS

Graduate entry programmes may support policy makers and faculty to fill the workforce gap of healthcare professionals. However, their successful implementation requires careful considerations to the needs of graduates to harness their creativity, resilience and professional development as future healthcare workers.

Relative progress and academic performance of graduate vs undergraduate entrants to an Australian medical school

BACKGROUND

Whether graduate entrants to medical school perform better academically than undergraduate entrants remains controversial. Differences in the discipline backgrounds of graduates may, at least in part, have accounted for differences in the results of comparative studies reported to date. This study aimed to address the dual issues of whether academic performance and progression rates were different between GE and UG students and the extent to which the discipline background of GE students may underpin any differences observed.

METHODS

Relative academic performance as well as indicators of student progression (supplementary examinations, repeat years, leave of absence, withdrawal from the programme) were compared between graduate entrants (GE) (N = 410) and both school leaver entrants (SLE) (N = 865) and non-standard entrants (some prior tertiary education) (NSE) (N = 148) who combined for the final 4 yr. of a 6 yr. MBBS undergraduate programme in 8 consecutive cohorts from 2006 to 2013 in Western Australia.

RESULTS

Examination scores were generally at or very close to a distinction grade or higher across all groups. Higher mean examination scores were seen for GE versus both SLE and NSE in the first 2 years with no significant differences in the final 2 years. GE from biological science / science backgrounds (N = 241) or physical science backgrounds (N = 26) performed the same as SLE and NSE throughout the programme. GE with a health / allied health background (N = 91), however, performed better throughout. They also performed better when compared to their GE counterparts from a humanities (N = 32) or a biological science / science background. GE had increased odds of withdrawing when compared to SLE (OR 2.50, 95% CI 1.30, 4.79, P = 0.006), but not compared to NSE. NSE had increased odds of repeating at least one level when compared to either GE (OR 2.74, 95% CI 1.21, 6.21, P = 0.016) or SLE (OR 4.10, 95% CI 1.93, 8.70, P < 0.001). There were no differences by entry category in the odds of sitting at least one supplementary examination during the programme. There was an increase in the odds of taking at least one leave of absence in both SLE (OR 2.55, 95% CI 1.79, 3.63, P < 0.001) and NSE (OR 2.47, 95% CI 1.50, 4.07, P < 0.001) compared to GE.

CONCLUSIONS

Better academic performance by GE compared to SLE and NSE was predominantly due to higher scores for GE with a health / allied health background. GE were also less likely to have impeded progress during the course.

Graduate entry students' early perceptions of their future nursing careers

Graduate entry nursing programs designed for individuals with prior degrees in other disciplines are becoming increasingly popular internationally. They provide entry into nursing for people with unique skill-sets. Yet, little is known about why these individuals choose career change into nursing and what they expect from their new careers. This component of a larger study sought to explore graduate entry nursing students' short and longer term career intentions on commencement of their courses. A cross-sectional survey was used. Descriptive frequencies were used to analyse demographic data, while summative content analysis was used with the open-ended questions. Participants were drawn from eight cohorts of commencing students from enrolled in one graduate entry masters program in Australia between 2009 and 2015. Content analysis identified three main categories: professional role, work location, and work context. Longer term responses were categorised under four categories: professional role, work location, work context and personal and professional goals. Many students had clear directions about their future nursing careers. On graduation, many envisioned working in advanced roles or in clinical specialty areas, primarily in hospital settings. However, in the longer term, there was diversity among with many envisaging work outside traditional hospital settings, and some in other health disciplines.

Graduate entry nurses' initial perspectives on nursing: Content analysis of open-ended survey questions

BACKGROUND

Graduate entry nursing courses offer individuals with prior degrees the opportunity to gain nursing qualifications and facilitate career change. While it is known that accelerated graduate entry courses are increasingly popular, the perceptions of nursing held by such individuals and the influence this has on those seeking to enter the profession are less clearly understood.

OBJECTIVE

To explore graduate entry nursing students' perceptions of nursing on entering their pre-registration course.

DESIGN

A descriptive design utilising cross-section survey with two open-ended questions: What do you believe the role of the nurse is? What things have influenced that view? were asked. Demographic data were analysed using descriptive frequencies, while the two open-ended questions were analysed using summative content analysis.

SETTING

One university-based postgraduate graduate entry nursing course in Australia PARTICIPANTS: Eight cohorts (n=286) commencing students with prior degrees other than nursing.

RESULTS

The course attracts students from diverse backgrounds. Exposure to nursing and nurses, either as a consumer of health care or other health care role, plays a primary role in influencing career change. However, similar to those found with school leavers, there remains much misinformation about nurses' roles for students in these courses. Most identify the role of caring in nursing. For some, media representations are the only information sources.

DISCUSSION

Graduate entry courses offer opportunities to attract new nurses and contribute to addressing workforce shortages. However, there is still a lack of knowledge of nursing roles among students on entry. More work is required by the profession to ensure nursing is accurately and positively represented to the community.