Contemporary Challenges for Veterinary Medical Education: Examining the State of Inter-Professional Education in Veterinary Medicine

Educational training in professional programs forms the foundation for how a person problem-solves throughout their career. However, training focused on only one profession ignores the value realized through collaborations among multiple professions for solving health-related problems. This is at the core of inter-professional education (IPE). Effective IPE programs can result in inter-professional collaboration and translation science endeavors across the health sciences and beyond. Recent events such as the COVID-19 pandemic and the opioid crisis highlight the importance of veterinary medicine in advancing One Health through IPE. The prevalence of IPE programs in veterinary curricula, and the process by which these have been established, has not been widely described in the literature. Through an 18-question survey sent to associate deans (ADs) of 50 veterinary schools, we sought to determine the status of IPE in the veterinary curriculum. Thirty-nine schools agreed to participate, representing primarily United States Doctor of Veterinary Medicine public and private programs with some representation from Canadian, United Kingdom, and Australasian programs. Schools that provide IPE courses developed their programs in collaboration with other health sciences programs across the 4-year curriculum. The perceived barriers for IPE offerings were no different between schools with or without opportunities; however, a lack of faculty and student-perceived value and lack of adequate space in the academic schedule were common threads. Our findings provide a snapshot of the current state of IPE in veterinary medical curricula, with a particular emphasis on the United States, and point to areas of programmatic need for the field.

Impact of the COVID-19 Pandemic on Cardiovascular Science: Anticipating Problems and Potential Solutions: A Presidential Advisory From the American Heart Association

The coronavirus disease 2019 (COVID-19) pandemic has had worldwide repercussions for health care and research. In spring 2020, most non-COVID-19 research was halted, hindering research across the spectrum from laboratory-based experimental science to clinical research. Through the second half of 2020 and the first half of 2021, biomedical research, including cardiovascular science, only gradually restarted, with many restrictions on onsite activities, limited clinical research participation, and the challenges associated with working from home and caregiver responsibilities. Compounding these impediments, much of the global biomedical research infrastructure was redirected toward vaccine testing and deployment. This redirection of supply chains, personnel, and equipment has additionally hampered restoration of normal research activity. Transition to virtual interactions offset some of these limitations but did not adequately replace the need for scientific exchange and collaboration. Here, we outline key steps to reinvigorate biomedical research, including a call for increased support from the National Institutes of Health. We also call on academic institutions, publishers, reviewers, and supervisors to consider the impact of COVID-19 when assessing productivity, recognizing that the pandemic did not affect all equally. We identify trainees and junior investigators, especially those with caregiving roles, as most at risk of being lost from the biomedical workforce and identify steps to reduce the loss of these key investigators. Although the global pandemic highlighted the power of biomedical science to define, treat, and protect against threats to human health, significant investment in the biomedical workforce is required to maintain and promote well-being.

[Notes of method to imagine an education tailored to the future]

. Notes of method to imagine an education tailored to the future. Health and social inequalities represent a problem not only from an ethical point of view but also from the point of view of public and social health. Unfortunately, this issue remains confined to conferences and debates and is not yet the subject of a serious reflection on how to constructively and permanently incorporate it in the education of health professionals, to provide the skill to read and interpret data, and to make research. This contribution, in addition to providing some reflections, launches an initiative that aims at incorporating these contents in the basic education, to make the message of Florence Nightingale real: wounds, suffering, dying and the absurdity of disability can be taken care of, be part of the care, only if you learn to recognize the causes, which are not only in the medical domain.

Philosophy of Science Series: Harnessing the Multidisciplinary Edge Effect by Exploring Paradigms, Ontologies, Epistemologies, Axiologies, and Methodologies

Health professions education (HPE) researchers come from many different academic traditions, from psychology to engineering to rhetoric. Trained in these traditions, HPE researchers engage in science and the building of new knowledge from different paradigmatic orientations. Collaborating across these traditions is particularly generative, a phenomenon the authors call the multidisciplinary edge effect. However, to harness this productivity, scholars need to understand their own paradigms and those of others so that collaboration can flourish. This Invited Commentary introduces the Philosophy of Science series-a collection of articles that introduce readers to 7 different paradigms that are frequently used in HPE research or that the authors suggest will be increasingly common in future studies. Each article in the collection presents a concise and accessible description of the main principles of a paradigm so that researchers can quickly grasp how these traditions differ from each other. In this introductory article, the authors define and illustrate key terms that are essential to understanding these traditions (i.e., paradigm, ontology, epistemology, methodology, and axiology) and explain the structure that each article in this series follows.

Philosophy of Science Series: Harnessing the Multidisciplinary Edge Effect by Exploring Paradigms, Ontologies, Epistemologies, Axiologies, and Methodologies

Health professions education (HPE) researchers come from many different academic traditions, from psychology to engineering to rhetoric. Trained in these traditions, HPE researchers engage in science and the building of new knowledge from different paradigmatic orientations. Collaborating across these traditions is particularly generative, a phenomenon the authors call the multidisciplinary edge effect. However, to harness this productivity, scholars need to understand their own paradigms and those of others so that collaboration can flourish. This Invited Commentary introduces the Philosophy of Science series-a collection of articles that introduce readers to 7 different paradigms that are frequently used in HPE research or that the authors suggest will be increasingly common in future studies. Each article in the collection presents a concise and accessible description of the main principles of a paradigm so that researchers can quickly grasp how these traditions differ from each other. In this introductory article, the authors define and illustrate key terms that are essential to understanding these traditions (i.e., paradigm, ontology, epistemology, methodology, and axiology) and explain the structure that each article in this series follows.

Does the DSW Practice Doctorate Provide Opportunities for Closing Gaps in Gerontology?

The 2019 annual conference of the Group for the Advancement of Doctoral Education in Social Work (GADE) highlighted the increasing role that the Doctor of Social Work (DSW) degree is playing in social work education. Over the past 15 years, social work has followed suit with a number of other health and helping professions (PsyD, DNP, DPT, etc.) by expanding access to practice doctorate programs for professionals who are interested in doctoral-level training, but primarily have interest to remain working in the field as practitioners, rather than become researchers. As more DSW programs have emerged, questions and concerns persist about the DSW, with most questions pertaining to the meaning of the degree for the overall field and the value of having an additional advanced practice degree in social work beyond the MSW degree. However, I urge readers of the Journal of Gerontological Social Work to consider the opportunities that the DSW may present for advancing gerontological education, research, and practice.

Is the speech-language pathology profession prepared for an ageing population? An Australian survey

PURPOSE

This study profiled the demographic characteristics and practice patterns of speech-language pathologists working with older Australians to inform future workforce planning and service development in response to an ageing population and aged care sector reform.

METHOD

Data were collected through snowball distribution of an online survey comprising six sections: demographic details; caseload and service delivery practices, degree of inter-professional practice; engagement with professional development and support; and assessment and management of swallowing, mealtime and communication difficulties. All data were analysed using descriptive statistics and chi-square to determine the independence of key variables.

RESULT

Data from 145 speech-language pathologists highlight the need for increased numbers of clinicians working outside of metropolitan areas and greater workforce diversity, along with increased incentive, supervision and inter-professional support for new graduate and early career clinicians considering working outside of hospital settings. To ensure evidence-based practice, further research into the validity of current assessment and intervention methods used across aged care settings is needed.

CONCLUSION

The findings highlight the need for an extended scope of practice and improved models of support for speech-language pathologists working with older people to better respond to the needs of an ageing population and on-going aged care sector reform.

Holding a mirror to society? Progression towards achieving better sociodemographic representation among the University of Otago's health professional students

AIM

1) To describe the sociodemographic characteristics of students accepted into eight health professional programmes at the University of Otago in 2016. 2) To provide an update on an earlier (2012) paper to illustrate progress towards increasing diversity within the health professional student cohort.

METHODS

Student data were obtained from the University of Otago's central student records system. Data were obtained in anonymous, summary form. New Zealand population data were obtained from Statistics New Zealand. Descriptive statistics were calculated.

RESULTS

Between 2010 and 2016 there was: a marked increase in the proportion of Māori (124% increase) and Pacific students (121% increase) in health professional programmes, more pronounced in medicine and dentistry (increases of 179% and 133% respectively); an increase in the proportion of students from rural areas from 19.2% to 22.5%; an increase in the proportion of female students from 59.6% to 61.3%; and little overall change in the overall socioeconomic profile.

CONCLUSION

Between 2010 and 2016 there was an overall increase in diversity in the health professional student body, with strong growth in Māori, Pacific and rural students. The recent introduction of new affirmative categories will hopefully result in an increase in socioeconomic diversity and in the number of refugee students.

Dilemmas of Representation: Patient Engagement in Health Professions Education

The role of the patient in bedside teaching has long been a matter of consideration in health professions education. Recent iterations of patient engagement include patients as storytellers, members of curriculum planning committees, guest lecturers, and health mentors. While these forms of patient engagement are reported to have many benefits for learners, educators, and the patients themselves, there is concern that such programs may not be representative of the diversity of patients that health care professionals will encounter throughout their careers. This problem of representation has vexed not only educators but also sociologists and political scientists studying patients' and the public's involvement in arenas such as health services research, policy, and organizational design.In this Perspective, the authors build on these sociological and political science approaches to expand our understanding of the problem of representation in patient engage-ment. In doing so, the authors' reconfiguration of the problem sheds new light on the dilemma of representation. They argue for an understanding of representation that not only is inclusive of who is being represented but that also takes seriously what is being represented, how, and why. This argument has implications for educators, learners, administrators, and patient participants.

What Should Guide Health Policy? A Perspective Beyond Politics

As the U.S. electorate has become increasingly polarized, these divisions are poised to shape legislative and regulatory work in the years ahead. For those whose focus is on the public goods of health care for all, the advancement of science through rigorous research, and the contribution of higher education to the continual improvement of the nation's workforce, there is profound uncertainty about the future. There are several pressing questions facing the nation and academic medicine, including the future of affordable, accessible insurance; acceptance of scientific evidence; sustainable learning and teaching methodologies; and the well-being and preparation of the nation's health workforce to care for an increasingly diverse nation. For those in academic medicine and policy making alike, the authors propose a framework, grounded in scientific evidence and guided by clinical ethics, for designing and evaluating health policy solutions for these and other pressing questions.

A Report on Ten Asia Pacific Countries on Current Status and Future Directions of the Genetic Counseling Profession: The Establishment of the Professional Society of Genetic Counselors in Asia

The Professional Society of Genetic Counselors in Asia (PSGCA) was recently established as a special interest group of the Asia Pacific Society of Human Genetics. Fostering partnerships across the globe, the PSGCA's vision is to be the lead organization that advances and mainstreams the genetic counseling profession in Asia and ensures individuals have access to genetic counseling services. Its mission is to promote quality genetic counseling services in the region by enhancing practice and curricular standards, research and continuing education. The PSGCA was formally launched during the Genetic Counseling Pre-Conference Workshop held at the 11th Asia-Pacific Conference on Human Genetics in Hanoi, Viet Nam, September 16, 2015. The pre-conference workshop provided an opportunity for medical geneticists and genetic counselors from across 10 Asia Pacific countries to learn about the varied genetic counseling practices and strategies for genetic counseling training. This paper provides an overview of the current status and challenges in these countries, and proposed course of unified actions for the future of the genetic counseling profession.

Googling in anatomy education: Can google trends inform educators of national online search patterns of anatomical syllabi?

The role of e-learning platforms in anatomy education continues to expand as self-directed learning is promoted in higher education. Although a wide range of e-learning resources are available, determining student use of non-academic internet resources requires novel approaches. One such approach that may be useful is the Google Trends^© web application. To determine the feasibility of Google Trends to gain insights into anatomy-related online searches, Google Trends data from the United States from January 2010 to December 2015 were analyzed. Data collected were based on the recurrence of keywords related to head and neck anatomy generated from the American Association of Clinical Anatomists and the Anatomical Society suggested anatomy syllabi. Relative search volume (RSV) data were analyzed for seasonal periodicity and their overall temporal trends. Following exclusions due to insufficient search volume data, 29 out of 36 search terms were analyzed. Significant seasonal patterns occurred in 23 search terms. Thirty-nine seasonal peaks were identified, mainly in October and April, coinciding with teaching periods in anatomy curricula. A positive correlation of RSV with time over the 6-year study period occurred in 25 out of 29 search terms. These data demonstrate how Google Trends may offer insights into the nature and timing of online search patterns of anatomical syllabi and may potentially inform the development and timing of targeted online supports to ensure that students of anatomy have the opportunity to engage with online content that is both accurate and fit for purpose. Anat Sci Educ 10: 152-159. © 2016 American Association of Anatomists.

Education vs. Training: Does it Matter?

The National Council on Radiation Protection and Measurements' (NCRP) "Where are the Radiation Professionals?" initiative brought renewed attention to the declining numbers of individuals in radiation protection fields. This paper is an expanded version of the oral presentation by the author at the 2016 NCRP Annual Meeting. Health physics (HP) as a discipline and vocation is at a critical juncture. Perhaps less well recognized is the extreme peril facing academic HP programs. Higher education today is vastly different from what it was even 20 y ago. Every academic program must now make a budget case to justify its existence. Consequently, HP programs, which are by anyone's measure minuscule, are in very real danger of closing. Given that the country will continue to need radiation protection expertise, we must take immediate steps to reinvigorate the profession and preserve academic programs. We simply cannot train or short-course our way out of this problem. Under routine conditions, individuals trained in basic HP can be expected to safely manage daily operations. But life is full of the unexpected. When the unexpected event involves radiation, we need someone well-versed in radiological fundamentals to understand, assess and safely deal with the problem. A three-pronged approach to bolster academic programs was offered: (1) increase academic cooperation and provide an infusion of cash, (2) more formally recognize the discipline of HP and increase respect for its role in safety, and (3) regulate who can be designated as a health physicist while increasing retention of individuals within the discipline.

From chalkboard, slides, and paper to e-learning: How computing technologies have transformed anatomical sciences education

Until the late-twentieth century, primary anatomical sciences education was relatively unenhanced by advanced technology and dependent on the mainstays of printed textbooks, chalkboard- and photographic projection-based classroom lectures, and cadaver dissection laboratories. But over the past three decades, diffusion of innovations in computer technology transformed the practices of anatomical education and research, along with other aspects of work and daily life. Increasing adoption of first-generation personal computers (PCs) in the 1980s paved the way for the first practical educational applications, and visionary anatomists foresaw the usefulness of computers for teaching. While early computers lacked high-resolution graphics capabilities and interactive user interfaces, applications with video discs demonstrated the practicality of programming digital multimedia linking descriptive text with anatomical imaging. Desktop publishing established that computers could be used for producing enhanced lecture notes, and commercial presentation software made it possible to give lectures using anatomical and medical imaging, as well as animations. Concurrently, computer processing supported the deployment of medical imaging modalities, including computed tomography, magnetic resonance imaging, and ultrasound, that were subsequently integrated into anatomy instruction. Following its public birth in the mid-1990s, the World Wide Web became the ubiquitous multimedia networking technology underlying the conduct of contemporary education and research. Digital video, structural simulations, and mobile devices have been more recently applied to education. Progressive implementation of computer-based learning methods interacted with waves of ongoing curricular change, and such technologies have been deemed crucial for continuing medical education reforms, providing new challenges and opportunities for anatomical sciences educators. Anat Sci Educ 9: 583-602. © 2016 American Association of Anatomists.

Connectivism: A knowledge learning theory for the digital age?

BACKGROUND

The emergence of the internet, particularly Web 2.0 has provided access to the views and opinions of a wide range of individuals opening up opportunities for new forms of communication and knowledge formation. Previous ways of navigating and filtering available information are likely to prove ineffective in these new contexts. Connectivism is one of the most prominent of the network learning theories which have been developed for e-learning environments. It is beginning to be recognized by medical educators. This article aims to examine connectivism and its potential application.

CONTENT

The conceptual framework and application of connectivism are presented along with an outline of the main criticisms. Its potential application in medical education is then considered.

CONCLUSIONS

While connectivism provides a useful lens through which teaching and learning using digital technologies can be better understood and managed, further development and testing is required. There is unlikely to be a single theory that will explain learning in technological enabled networks. Educators have an important role to play in online network learning.

The evolution of perfusion education in America

Clinical cardiopulmonary perfusion has evolved significantly during its 50 years. The science, technology and educational processes related to cardiopulmonary bypass have undergone continual change and metamorphosis. Perfusionists were initially trained on the job or in the laboratory, but with the advent of myocardial revascularization and the explosion in cardiac surgery, the need for formal educational training programs became apparent. The American Society of Extracorporeal Technology began the arduous processes of credentialing and developing certification guidelines that have continued under the American Board of Cardiovascular Perfusion. Licen-sure has also been adopted in many states during the past 10 years where nearly 50% of all perfusionists are covered by some legislative act. One additonal challenge has been developing minimal standards in which perfusionists practice. The initial standards included the use of a checklist and have evolved to monitoring and recording the significant events and parameters of each clinical procedure. The education of perfusionists will continue to be a challenge related primarily to reduced fiscal resources, the applicant pool and the ever-changing demands for extracorporeal circulation services. According to demographic and census information, it is expected the overall number of cardiovascular interventions will increase dramatically towards the latter end of the current decade in the US. The question arises as to what role perfusionists will play, as treatment strategies continue to change. If the number of education programs and new graduates continue to decline, the total number of perfusionists will decline, especially as many senior perfusionists leave the field or retire. It may be difficult to predict the total number of cardiovascular interventions that will be required in the next several years. However, if the total number of cardiovascular interventions that require perfusion services increase as a function of the aging population and if the overall incidence of cardiovascular treatment does not change, it will be imperative that perfusion education ramp up and train more perfusionists to meet the supply and demand or a shortage of skilled personnel may develop.

[Facilitations for medical education should be taken into consideration when designing new hospitals]

Based on trends in medical education and in patient management we discuss how new hospitals can be designed to focus on healthcare education. Hospitals have a major commitment and responsibility in the education of all kinds of undergraduate and postgraduate healthcare professionals, and this calls for dedicated environments. New hospitals must be designed not only for patient management, but also for healthcare education. This article is written by a multidisciplinary group and includes experiences within hospital management, medical education, implementation and architecture.

Central Application Service for Physician Assistants Ten-Year Data Report, 2002 to 2011

PURPOSE

This study highlights the trends and data points of interest in physician assistant (PA) applicant data over the first 10 years of the Central Application Service for Physician Assistants (CASPA) (2002-2011) and PA matriculant data over the last 5 years of that 10-year period (2007-2011).

METHODS

A retrospective study of data provided by applicants to all CASPA-participating PA programs between 2002 and 2011 was conducted. Applicant data analyzed over the 10-year period were provided by applicants and collected through an online CASPA applicant portal. Academic information was verified by CASPA staff through official transcript review. Matriculant data were obtained from CASPA-participating programs through the online CASPA admissions portal, which linked to applicant data in the CASPA applicant portal.

RESULTS

During the first 10 years of the CASPA service, the Physician Assistant Education Association experienced a 93% increase in the number of CASPA-participating programs and a 255% increase in the number of unique applicants identified through CASPA. Relatively constant trends were identified in the major demographic features (age, gender, ethnic composition, and disadvantaged status) and the academic data of applicants. Major demographic features of matriculants (2007-2011) also remained relatively constant, whereas trends in academic data of matriculants revealed an increasing total grade point average.

CONCLUSION

This 10-year comprehensive analysis of the CASPA data will benefit the profession by establishing a baseline of applicant characteristics. Ultimately, these data will help redefine recruitment strategies at program, state, and national levels by providing programs and national organizations with data needed to target applicants not previously included in recruitment activities.

Deafness and Diversity: Reflections and Directions

Concluding a two-part American Annals of the Deaf special issue on deafness and diversity (DAD), the editors provide reflections and guidance to the field regarding d/Deaf and hard of hearing (d/Dhh) children with a disability (DWD; e.g., learning or intellectual disability, autism) and d/Dhh children from homes where parents use a language other than English or American Sign Language (d/Dhh Multilingual Learners; DMLs). Contributing authors addressed the application of theory, research, and practice to five topics: (a) early intervention, (b) communication/language, (c) assessment, (d) transition, (e) teacher preparation. An overview of the main recommendations of the contributors and editors is presented in an effort to advance research and pedagogy with these learners. In conclusion, the editors discuss the "Radical Middle" approach (Easterbrooks & Maiorana-Basas, 2015) to working with students who are DAD: providing learners with all options for academic, social, and emotional success.

Increasing Cultural And Linguistic Diversity In Deaf Education Teacher Preparation Programs

As the field of education of the d/Deaf and hard of hearing (d/Dhh) continues to diversify, postsecondary institutions must pay close attention not only to the changing needs of d/Dhh students but to the practitioners they are preparing to serve this population. Students who are d/Dhh and come from homes where a language other than English or American Sign Language is used--d/Dhh Multilingual Learners (DMLs)--constitute 19.4%-35.0% of the d/Dhh student population (Gallaudet Research Institute, 2013). In the present article, part of a special American Annals of the Deaf issue on DMLs, the authors review demographic trends, examine the theory behind teacher effectiveness and culturally responsive teaching, provide examples from research on effective components of teacher preparation programs and discuss how they align with the field's certification standards, and recommend practices for programs and teachers to meet these standards within the field's ever-changing landscape.

Looking to the future: Framing the implementation of interprofessional education and practice with scenario planning

BACKGROUND

Adapting to interprofessional education and practice requires a change of perspective for many health professionals. We aimed to explore the potential of scenario planning to bridge the understanding gap and framing strategic planning for interprofessional education (IPE) and practice (IPP), as well as to implement innovative techniques and technology for large-group scenario planning.

METHODS

A full-day scenario planning workshop incorporating innovative methodology was designed and offered to participants. The 71 participants included academics from nine universities, as well as service providers, government, students and consumer organisations. The outcomes were evaluated by statistical and thematic analysis of a mixed method survey questionnaire.

RESULTS

The scenario planning method resulted in a positive response as a means of collaboratively exploring current knowledge and broadening entrenched attitudes. It was perceived to be an effective instrument for framing strategy for the implementation of IPE/IPP, with 81 percent of respondents to a post-workshop survey indicating they would consider using scenario planning in their own organisations.

DISCUSSION

The scenario planning method can be used by tertiary academic institutions as a strategy in developing, implementing and embedding IPE, and for the enculturation of IPP in practice settings.

Content of non-pharmacological care for systemic sclerosis and educational needs of European health professionals: a EUSHNet survey

OBJECTIVES

To describe the non-pharmacological care in systemic sclerosis (SSc) provided by European health professionals (HPs) including referrals, treatment targets, interventions, and educational needs.

METHODS

In this observational study, European HPs working in SSc care were invited to complete an online survey through announcements by EUSTAR (European League Against Rheumatism (EULAR) Scleroderma Trials and Research) and FESCA (Federation of European Scleroderma Associations), the EULAR HPs' newsletter, websites of national patient and HP associations, and by personal invitation.

RESULTS

In total, 56 HPs, from 14 different European countries and 7 different disciplines, responded to the survey. A total of 133 specific indications for referral were reported, 72% of which could be linked to the International Classification of Functioning, Disability and Health domain "body functions and structures". Of the 681 reported treatment targets 45% was related to "body functions and structures". In total, 105 different interventions were reported as being used to address these treatment targets. Almost all (98%) respondents reported having educational needs, with the topics of management of stiffness (67%), pain (60%), and impaired hand function (56%) being mentioned most frequently.

CONCLUSIONS

Non-pharmacological care in SSc varies in Europe with respect to the content of interventions, reasons for referral, and treatment targets. Reasons for referral to HPs are not well-aligned to HPs subsequent treatment targets in SSc care suggesting suboptimal communication between physicians and HPs. The wide variations reported indicate a need to consolidate geographically disparate expertise within countries and to develop and improve standards of non-pharmacological care in SSc.

Transforming students into digital academics: a challenge at both the individual and the institutional level

BACKGROUND

Little is known of students' Information and Communication Technology (ICT) readiness in a learning context. Information about students' capabilities and resources is an important prerequisite for designing meaningful teaching and learning activities that engage and motivate students. To learn about health science students' usage of digital equipment, familiarity with software, online behavior and communication with the university, we have conducted a survey focusing on these areas.

METHODS

A digital questionnaire was sent to 9134 health science students, of whom 1165 responded (12.8%).

RESULTS

Almost all students owned a laptop (98.3%) and a smartphone (86.5%) and used these for internet access. The students were most familiar with typical office programs like word processing and spread sheets. Students used social media in their private lives but to a lesser extent in relation to their studies; they also experienced that their teachers made limited use of these media. The most commonly used tool for working with fellow students was email (80%) and for communication, SMS (47.6%). An age difference was found in relation to the way students communicated with each other. The mean age of chat users was 23.8 (Standard deviation 3.7) years, SMS users, 25 (Standard deviation 4.2) years and email users, 27.9 (Standard deviation 6.5) years. Over half of the students (53.4%) found that the degree of ICT incorporated in the teaching and learning activities was insufficient to provide them with the skills necessary in their future profession.

CONCLUSIONS

Although a large percentage of the students had access to the internet, reported familiarity with basic software and used online services in their private lives, they were unfamiliar with the software and services they were expected to use in their studies. The students experienced that teachers did not use internet resources, which apparently influenced their perception of the importance of, and thereby their usage of, these services. The way the younger students communicate differs from the way communication takes place at the university, and it is recommended that the institutions should look into how they can meet the students in ways they are familiar with.

Leading the way: changing the focus from teaching to learning in large subjects with limited budgets

To lead positive change in the teaching practice of teams that service large numbers of diverse students from multiple degree programs provides many challenges. The primary aim of this study was to provide a clear framework on which to plan the process of change that can be utilized by academic departments sector wide. Barriers to change were reduced by adapting and utilizing Kotter's principals of change specifically by creating a sense of urgency and defining a clear goal designed to address the problem. Changing attitudes involved training staff in new teaching and learning approaches and strategies, and creating a collaborative, supportive team-based teaching environment within which the planned changes could be implemented and evaluated. As a result senior academics are now directly involved in delivering sections of the face-to-face teaching in the new environment. Through promoting positive change we enabled deeper student engagement with the theoretical concepts delivered in lectures as evidenced by favorable student evaluations, feedback, and improved final exam results. A collaborative team-based approach that recognizes the importance of distributed leadership combined with a clearly articulated change management process were central to enabling academics to design, try, and evaluate the new teaching and learning practices. Our study demonstrates that a concerted focus on "change management" enabled teaching team members to adopt a major shift in the teaching and learning approach that resulted in measurable improvements in student learning.

Canadian demand for highly qualified personnel for therapeutic evaluation: an opportunity for academic institutions

Achievement of optimal therapeutics requires individuals with analytic skills appropriate to the balancing of enterprise, innovation and the need for rigorous scientific validation. A synergistic convergence of discovery research, clinical investigation, evaluative, regulatory and implementation sciences will be essential. None of the needed research capacities are likely to prove obtainable on demand. On the contrary, they require accurate projection of future needs and careful planning of post-secondary training programs. A survey conducted for Health Canada in 2010 revealed significant shortfalls in research skills available outside government and industry. This commentary argues that such an environment represents an outstanding opportunity for the academic community to demonstrate that it is eager to meet the needs of the Canadian public. University leaders should be assertive about their commitment to the ideals of patient oriented research and all governments should be clear about deliverables anticipated in return for consistent post-secondary funding.

Physician assistant education in Germany

The first physician assistant (PA) program in Germany began in 2005. As of 2013 there are three PA programs operational, with a fourth to be inaugurated in the fall of 2013. The programs have produced approximately 100 graduates, all with a nursing background. The PA model of shifting tasks from medical doctors to PAs appears to be growing among senior physicians and hospital administrators. While the development of a German PA movement is in its nascent stage, the training, deployment, and evolution of PA training programs appears underway.

Bioethics in Mediterranean culture: the Spanish experience

This article presents a view of bioethics in the Spanish context. We may identify several features common to Mediterranean countries because of their relatively similar social organisation. Each country has its own distinguishing features but we would point two aspects which are of particular interest: the Mediterranean view of autonomy and the importance of Catholicism in Mediterranean culture. The Spanish experience on bioethics field has been marked by these elements, trying to build a civic ethics alternative, with the law as an important support. So, Spanish bioethics has been developed in two parallel levels: in the academic and policy maker field (University and Parliament) and in clinical practice (hospitals and healthcare ethics committees), with different paces and methods. One of the most important changes in the paternalistic mentality has been promoted through the recognition by law of the patient's rights and also through the new generation of citizens, clearly aware on the exercise of autonomy. Now, the healthcare professionals have a new challenge: adapt their practice to this new paradigm.