Use of the International IFOMPT Cervical Framework to inform clinical reasoning in postgraduate level physiotherapy students: a qualitative study using think aloud methodology

BACKGROUND

Vascular pathologies of the head and neck are rare but can present as musculoskeletal problems. The International Federation of Orthopedic Manipulative Physical Therapists (IFOMPT) Cervical Framework (Framework) aims to assist evidence-based clinical reasoning for safe assessment and management of the cervical spine considering potential for vascular pathology. Clinical reasoning is critical to physiotherapy, and developing high-level clinical reasoning is a priority for postgraduate (post-licensure) educational programs.

OBJECTIVE

To explore the influence of the Framework on clinical reasoning processes in postgraduate physiotherapy students.

METHODS

Qualitative case study design using think aloud methodology and interpretive description, informed by COnsolidated criteria for REporting Qualitative research. Participants were postgraduate musculoskeletal physiotherapy students who learned about the Framework through standardized delivery. Two cervical spine cases explored clinical reasoning processes. Coding and analysis of transcripts were guided by Elstein's diagnostic reasoning components and the Postgraduate Musculoskeletal Physiotherapy Practice model. Data were analyzed using thematic analysis (inductive and deductive) for individuals and then across participants, enabling analysis of key steps in clinical reasoning processes and use of the Framework. Trustworthiness was enhanced with multiple strategies (e.g., second researcher challenged codes).

RESULTS

For all participants (n = 8), the Framework supported clinical reasoning using primarily hypothetico-deductive processes. It informed vascular hypothesis generation in the patient history and testing the vascular hypothesis through patient history questions and selection of physical examination tests, to inform clarity and support for diagnosis and management. Most participant's clinical reasoning processes were characterized by high-level features (e.g., prioritization), however there was a continuum of proficiency. Clinical reasoning processes were informed by deep knowledge of the Framework integrated with a breadth of wider knowledge and supported by a range of personal characteristics (e.g., reflection).

CONCLUSIONS

Findings support use of the Framework as an educational resource in postgraduate physiotherapy programs to inform clinical reasoning processes for safe and effective assessment and management of cervical spine presentations considering potential for vascular pathology. Individualized approaches may be required to support students, owing to a continuum of clinical reasoning proficiency. Future research is required to explore use of the Framework to inform clinical reasoning processes in learners at different levels.

Teacher or Researcher: Who Comes First in Medical Academia?

The field of medical academia presents a unique challenge in the professional development of individuals, as it requires balancing two distinct roles: that of a teacher and that of a researcher. This dilemma arises from the inherent tension between the educational responsibilities of imparting knowledge and the scholarly pursuits of generating new knowledge. In this commentary, we seek to explore the question of whether teachers or researchers should take precedence in the medical academic setting.

Improving the quality of reporting findings using computer data analysis applications in educational research in context

Data analysis is an important step in the research process as it influences the quality and standard of reporting research findings. Based on a review of the content of 255 doctorate theses, the use of computer applications for data analysis in educational research was assessed. It was feasible to assess how extensively used and accepted computer packages had become in educational research using an aspect of the diffusion of innovations theory as part of the conceptual framework. The results showed that the use of computer applications to analyse data was more prevalent among researchers using quantitative and mixed-methods research methodologies than among qualitative educational researchers. Educational researchers have not yet fully adopted innovative computer data analysis techniques in their research. It is evident that they use traditional technologies more than computer applications in their research. Name dropping of the computer applications used without employing the language or visualisations features provided by the applications was rife. This article bridges the gap between methodological scholarship and the use of computer applications in data analysis. It illuminates the potential of computer software to enhance the quality of the reporting of findings. The article aims to contribute to improvements in the standard of research reporting and the attributes of the graduates. The practical methodological advice in this article is aimed at guiding researchers who consider using computer packages in data analysis, irrespective of their methodological orientation. It stimulates debate on the use of computer applications in data analysis.

Vygotsky's Legacy Questioned: A Review of his "Analysts" and a Challenge to his "Emulators"

This article first proposes a literature review on the questioning of Lev Vygotsky (1896-1934)'s legacy. Four main points of disagreement are distinguished: (1) the authenticity issues of Vygotsky's published work; (2) the unreflective use of concepts and ideas attributed to the Russian psychologist; (3) the story telling of a mythical Vygotsky-Leontiev-Luria school; and (4) the assimilation of his works with major currents of North American developmental psychology. The underlying divergence on what constitutes Vygotsky's core theory is then highlighted, namely the role of meaning in mental development. Finally, a study of the dissemination of his conceptions within the scientific community is proposed, based on the reconstitution of two networks of authors: Vygotsky's "analysts" and "emulators". This study demonstrates that the revision of Vygotsky's legacy may be understood by the very play of scientific production processes. Major Vygotskian scholars have emulated his ideas within mainstream but possibly incompatible intellectual frameworks.

Robotic-assisted surgery training (RAST) program: module 1 of a three-module program. Assessment of patient cart docking skills and educational environment

There is currently no standardized robotic surgery training program in General Surgery Residency. RAST involves three modules: ergonomics, psychomotor, and procedural. This study aimed to report the results of module 1, which assessed the responsiveness of 27 PGY (postgraduate year) 1-5 general surgery residents (GSRs) to simulated patient cart docking, and to evaluate the residents' perception of the educational environment from 2021 to 2022. GSRs prepared with pre-training educational video and multiple-choice questions test (MCQs). Faculty provided one-on-one resident hands-on training and testing. Nine proficiency criteria (deploy cart; boom control; driving cart; docking camera port; targeting anatomy; flex joints; clearance joints; port nozzles; emergency undocking) were assessed with five-point Likert scale. A validated 50-item Dundee Ready Educational Environment Measure (DREEM) inventory was used by GSRs to assess the educational environment. Mean MCQ scores: (90.6 ± 16.1 PGY1), (80.2 ± 18.1PGY2), (91.7 ± 16.5 PGY3) and (PGY4, 86.8 ± 18.1 PGY5) (ANOVA test; p = 0.885). Hands-on docking time decreased at testing when compared to base line: median 17.5 (range 15-20) min vs. 9.5 (range 8-11). Mean hands-on testing score was 4.75 ± 0.29 PGY1; 5.0 ± 0 PGY2 and PGY3, 4.78 ± 0.13 PGY4, and 4.93 ± 0.1 PGY5 (ANOVA test; p = 0.095). No correlation was found between pre-course MCQ score and hands-on training score (Pearson correlation coefficient = - 0.359; p = 0.066). There was no difference in the hands-on scores stratified by PGY. The overall DREEM score was 167.1 ± 16.9 with CAC = 0.908 (excellent internal consistency). Patient cart training impacted the responsiveness of GSRs with 54% docking time reduction and no differences in hands-on testing scores among PGYs with a highly positive perception.

Approach to cardiology residents clinical aptitude evaluation. Multicenter design

INTRODUCTION

To the best of our knowledge, the research herein presented is the first multicenter study in Mexico to analyze the development of clinical aptitude in medical units that train cardiologists.

OBJECTIVE

To determine the degree of development of clinical aptitude in cardiology residents at three High Specialty Medical Units.

METHODS

Multicenter, cross-sectional design. All students of the 2019-2020 academic year were included in the study. An instrument was constructed that evaluated clinical aptitude based on eight indicators and 170 items; conceptual/content validity and reliability were assessed by five cardiologists with teaching and educational research experience.

RESULTS

By indicator and year of residence, significant statistical differences were observed in the CMN20Nov academic site. At HCSXXI and INCICh, statistically significant differences were observed in one of eight indicators. Differences between R1 residents (n = 41) of all three academic sites were estimated by indicator, with statistical significance being recorded in three of eight indicators. Between R2 (n = 35) and between R3 residents (n = 43), the result was similar.

CONCLUSIONS

The degree of clinical aptitude development can be considered intermediate in all three academic sites, probably because the instrument explored problematized clinical situations that required for the residents to critically reflect on their clinical experience.

Awareness, knowledge, and utilisation of online digital tools for literature review in educational research

There is an inequality in developed and developing countries' research output in highly reputable databases. One way to reduce this inequality is to encourage researchers in developing countries to use online digital tools. This article examines the contribution of lecturers' awareness and knowledge to utilising the free online digital tools (FODT) available for literature review in the field of education. A correlation research approach involving 180 academic staff in tertiary institutions in southern Nigeria was adopted, using descriptive statistics and regression analysis. A structured questionnaire elicited the participants' awareness, knowledge, and utilisation of the free online digital tools available for literature review. The findings indicate a low level of awareness, knowledge, and utilisation of the FODT. The two regression models revealed that the lecturers' level of awareness and knowledge accounted for significant contributions to the level of the lecturers' utilisation of the FODT. These results demonstrate a link between lecturers' level of awareness and knowledge to their utilisation of the FODT. It was recommended that stakeholders in research and education create awareness of the availability of these FODTs, carry out workshops on how to use them and replicate this study in other developing countries.

An impact of content delivery, equity, support and self-efficacy on student's learning during the COVID-19

Due to the outbreak of Covid-19, the colleges and universities across the world have shifted to online classes in place of face-to-face classes. In the wake of this outbreak, the present study focuses on analyzing the impact of sudden shift to online classes, on the undergraduate and postgraduate student's overall learning. The PLS-SEM results concluded that the content delivery has been the most significant construct to impact both self-efficacy and overall learning. The self-efficacy partially mediates the support and equity relationship with the overall learning. The student with greater self-efficacy will have better overall learning from this e-synchronous teaching methodology. However, content delivery has a stronger role in impacting the overall learning even if there is absence of self-efficacy, thus concluding no mediation.

Bachelor nursing students´ and their educators´ experiences of teaching strategies targeting critical thinking: A scoping review

AIM

The objective of this scoping review was to review the published literature on existing teaching strategies targeting bachelor nursing students' critical thinking and explore how these strategies are described by students and educators. The research questions were: (i) Which teaching strategies are described in the literature targeting critical thinking among nursing students? and (ii) How are these teaching strategies described and experienced by students and/or nurse educators?

BACKGROUND

Critical thinking is integrated in the many clinical assignments and responsibilities with which registered nurses are faced. Therefore, it is important that nurse educators implement teaching strategies supporting bachelor nursing students' development of critical thinking to prepare them for their professional responsibilities.

DESIGN

Scoping review, Open Science Framework (OSF) registries DOI: 10.17605/OSF.IO/D89SB.

METHODS

The scoping review followed the six steps of Arksey and O'Malley (2005). Systematic searches were conducted using the databases PubMed, CINAHL, ERIC, ERC and PsycINFO. Eligible studies were quality assessed and text excerpts answering the research questions were analysed by a thematic analysis.

RESULTS

Our findings represent 19 published studies and can be understood according to two themes: the importance of the educational conditions and the impact of implemented teaching strategies. The first theme reflected not only the descriptions of important traits in the educational milieu facilitating the development of critical thinking but also the importance of how the content targeting such skills were delivered and organised. The second theme mirrored descriptions of how the students, through the teaching strategies, realized the need for collaboration to facilitate critical thinking. Further, it showed how the teaching strategies fostered professional growth and learning adaptation, by encouraging the students to question their knowledge and facilitating their development of clinical knowledge.

CONCLUSIONS

The strategies used in the facilitation of critical thinking need to incorporate collaboration and student-centredness, creating a relaxed climate where the educators can assist through guidance and support. This calls for the implementation of teaching strategies whereby both educators and students are active in facilitating the learning environment.

Mentoring Medical Education Research: Guidelines from a Narrative Review

Mentorship is critical to develop research scholars. Current literature provides mentorship guidance for biomedical research; however, mentorship for educational research is scarce. We explored literature to offer evidence-based guidance for medical education research mentors. A librarian searched peer-reviewed literature from 2001 to 2021 to identify guidelines for research mentors. Thirty-five articles were included in this narrative review. Our results identified attributes of mentors, overlapping roles, and barriers and benefits of mentoring. The structures and processes related to mentoring are reviewed and applicability to medical education research mentorship is summarized.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-022-01565-2.

Exploring how national educational organizations can promote educational research amongst members: a survey-based study

BACKGROUND

Engagement of academic faculty in research remains low. While barriers to research have been explored, there are no data on how national organizations can help overcome these barriers. Our study explored faculty satisfaction and motivational drivers for engagement with research opportunities offered by the Council on Medical Student Education in Pediatrics (COMSEP), an organization of pediatric medical educators, and characterize strategies perceived by faculty to promote the use of these opportunities.

METHODS

In 2021, 5 survey questions were administered to faculty members of COMSEP to explore satisfaction with COMSEP's research offerings, the perceived value of educational research, and the facilitators, barriers and potential opportunities for COMSEP to promote research. Clark's Commitment and Necessary Effort model on motivation served as the theoretical framework for our study, which explores motivation, self-efficacy and contextual factors influencing an individual's pursuit of goals. Chi-square analysis and Wilcoxon Signed Ranks Test were used to compare categorical and scaled variables among groups who did and did not avail of COMSEP's research offerings.

RESULTS

90 (25%) of 360 recipients responded. 61% expressed satisfaction with COMSEP's research offerings. 68% indicated research was an expectation of their academic appointment, that education was their primary research focus (74%) and that they did not have other research opportunities that met their needs (58%). Of respondents, 75.7% of females had submitted a proposal compared to 60% of non-responders who were females. The comparison by gender was not statistically significant. Exploration by academic rank revealed that 35% of instructor/assistant professors had submitted a proposal compared to 65% of associate professors/professors (p =.05). Barriers leading to non-submission to any of the offerings included having too much other work, lack of enjoyment in writing and inability to find mentors. Respondents endorsed the importance of several strategies to promote engagement in research-skill building opportunities, personalized consultations and increased funding.

CONCLUSIONS

Faculty educators value the importance of educational research and recognize that research opportunities offered by COMSEP address an unmet need, but express ambivalence in the enjoyment of writing (reflecting their mood), and endorse structural barriers, that are amenable to change, affecting their personal agency.

Training Undergraduate Students in HIPAA Compliance

The Health Insurance Portability and Accountability Act (HIPAA) has radically changed the way healthcare is conducted, and its relevance continues to expand as healthcare technology evolves. This article describes a method for training inexperienced undergraduate students to become HIPAA-compliant clinical research volunteers in a pediatric traumatic brain injury (TBI) study. Volunteers are trained to use the hospital's electronic health records system (EHR) to identify potential study candidates for approach, and they develop this skill set through google classroom modules/quizzes along with routine zoom calls to solidify their consenting approach. Since the inception of this study in 2018, there have been over one hundred different undergraduate research volunteers involved, and there has not been a single HIPAA violation to date. This compliance success rate is indicative of the efficacy of this training protocol. This paper serves as a guide to implementing HIPAA compliance training and ensuring accountability in new and existing clinical research studies.

[How does a patient-centered, future-oriented medical curriculum look like? The patients' view]

AIM OF THE STUDY

Medical training in Germany is in a state of flux. Medical education must be adapted to fit the changing health care needs of future societies. This study aims to gain the patients' perspective on the education of medical students to improve future curricula.

METHODOLOGY

Using a semi-structured interview guide, 17 interviews were conducted with patients undergoing inpatient (N=9) or outpatient (N=8) medical treatment. The interviews were subjected to computer-assisted analysis guided by Grounded Theory.

RESULTS

480 codings were condensed into seven main categories: Science Fiction Medicine, Society and the Patient, Professional Environment and Health Care System, Medical Curriculum and Continuing Education, Value System and Motivation, Psychosocial Competence and Medical Professional Competence. The largest main categories are Psychosocial Competence (114 codings) and Professional Environment and Health Care System (105 codings).

CONCLUSION

There is a need for psychosocial education in addition to medical knowledge. A future-focused curriculum should entail practice-oriented education to ensure the training of motivated physicians who possess strengthened digital skills and act on ethical principles and values. Assessment of the patients' perspective should play a crucial role in medical education research.

[Development and validation of a checklist for evaluating videos for learning resuscitation measures]

BACKGROUND

Well-performed resuscitation measures can improve the outcome in the event of cardiovascular arrest. Medical students often use teaching videos to learn practical skills. Studies confirmed the often inadequate quality of the videos on resuscitation available on the Internet. An evaluation using a validated checklist based on the current guidelines has so far been lacking.

OBJECTIVE

The development and validation of a checklist for evaluating instructional videos on resuscitation.

MATERIAL AND METHODS

In an expert workshop, checklist items were formulated based on the current guidelines. The checklist was tested by emergency physicians in a 4-step review process. The evaluations were analyzed and the items adjusted and specified if necessary. After the review process was completed, the checklist was applied to 74 videos on the topic of resuscitation.

RESULTS

The checklist consists of 25 items in 4 categories (initial measures, chest compression, AED use, breathing), which are rated on a 3-level Likert scale. A total of 16 emergency doctors participated in the study and rated an average of 9.3 ± 5.7 videos each. The reviewers agreed in 65.1 ± 12.6% of the cases. The highest agreement was achieved in the subtopic AED, with the item "do not touch patients in shock" having the highest agreement. The items in the thoracic compression category were most often rated differently.

CONCLUSION

For the first time, a checklist for evaluating instructional videos for resuscitation was created and validated for German-speaking countries.

Learning objectives of cultural immersion programs: A scoping review

BACKGROUND

Cultural immersion as a learning activity provides students with the opportunity to experience diversity and develop cultural safety. Both, 'Study Abroad Programs' and 'Internationalisation at Home' (IaH) aim to provide a cultural immersion experience for students. However, explicit learning objectives are essential for quality pedagogy and for students to develop cultural safety from their learning experience.

OBJECTIVE

To identify the learning objectives of study abroad and Internationalisation at Home (IaH) programs in higher education health profession programs.

DESIGN

A scoping review was undertaken according to recommendations by the Joanna Briggs Institute (Peters et al., 2020) and PRISMA guidelines.

DATA SOURCES

The electronic databases CINAHL, MEDLINE, PsychINFO and PubMed and were searched in November 2019 and updated September 2020. The search was limited to qualitative studies, text and opinion pieces, English language, published between 2015 and 2019.

REVIEW METHODS

Inclusion criteria using the participants, concept, and context (PCC framework) was utilised and search terms such as study abroad and Internationalisation at Home were combined with learning objectives to identify articles. The articles were screened for eligibility by title, abstract, and full text review by two independent reviewers. A data extraction tool was utilised to extract and synthesise data into categories that represent the core learning objectives of cultural immersion programs reviewed.

RESULTS

Fourteen of the 66 initially identified studies were included in this scoping review. Qualitative synthesis yielded five broad categories of learning objectives used in cultural immersion programs: cultural competence, internationalisation, pedagogy, collegiality, and personal growth.

CONCLUSION

A minimum set of essential learning outcomes was derived from this review that will be of interest to developers and implementers of cultural immersion programs.

Are we there yet? Research with and for teachers and children and the possibilities of schooling in a complex world

Shifting the relationship between schooling, social justice and equity, and the present and future experiences of children, young people, and their families and communities, has been a focus of educational research, and indeed policy and practice, for many decades. In this paper, I discuss education and its preparedness to work towards social justice, by drawing on examples across a number of studies. While I consider the possibilities for teachers and young people and children in schools today and present several counter narratives to those in popular circulation, I also detail initiatives that I engaged in with members during the time I was President of AARE. The point is to highlight social justice issues in education in Australia and highlight some ways forward.

Research in nursing education and the institutional review board/ethics committee

BACKGROUND

Institutional review board (IRB) or research ethics committee approval is intended to protect the rights of human subjects. Assurance that ethical standards are met is essential for educational research and quality improvement (QI) projects involving human subjects.

PURPOSE

The purposes were to describe the requirements of nursing journals for educational studies and QI projects related to education to be reviewed by an IRB or a research ethics committee and to identify the types of statements of approval or exemption to be included in manuscripts.

METHOD

The investigators employed an electronic survey sent to members of the International Academy of Nursing Editors list serve. Responses representing 64 nursing journals were received.

RESULTS

The majority of journals that publish academic educational studies (n = 32, 86.5%) always required IRB or other ethics committee review, and 17 (45.9%) required the same for QI projects related to education. An IRB or research ethics committee review was always required by journals for educational studies (n = 24, 88.9%) and for QI projects (n = 14, 51.9%) involving the professional development of nurses.

CONCLUSIONS

Educational studies that involve human subjects should be reviewed by an IRB or other type of research ethics committee before implementing the study. Any determination of exemption should be made by the IRB or research ethics committee, not by the investigator.

The data on exploratory factor structure of [pre-service] teacher beliefs about educational research scale

This article presents data on factors that depict [pre-service] teacher beliefs about educational research. A cross-sectional survey was used to collect the data that involved 352 final-year students working on their undergraduate theses. The students were registered in the faculty of teacher training and education in one of the private universities with an A (excellent) accreditation in Jakarta, Indonesia. The participants were selected conveniently. Exploratory factor analysis was performed to reveal the factors comprised in the data. 49 out of 72 items formed five factors: negative views about educational research, positive views about educational research, knowledge about educational research, open-mindedness, and accessibility.

[Medical training in palliative care at the Hannover Medical School: development of the interdisciplinary and cross-sectoral education in the cross-sectional subject Q13 (WEISE-Q13)]

BACKGROUND

The implementation of the cross-sectional subject of palliative care (Q13) at medical faculties in Germany is heterogeneous. In faculties without a chair for palliative medicine, other solutions are needed.

OBJECTIVES

This study describes the development and implementation process of the new educational concept in Q13 at the Hannover Medical School and its evaluation by medical students and lecturers.

MATERIALS AND METHODS

The new educational concept was developed in 2017/18 following the six-step approach of curriculum development by Kern, and was implemented and tested in the academic year 2018/19. Evaluation was assessed in two steps, both in qualitative and quantitative terms (mixed methods): an anonymous written evaluation by students with the option of free text answers and feedback discussions with lecturers.

RESULTS

Students and lecturers welcomed the new educational concept in equal measures. Students thought that education in Q13 stimulates reflection on the individual attitude towards the issues of death and dying and prepares them for encounters with terminally ill and dying people. The case-based learning units in particular led to a consolidation of theoretical knowledge (i.e. pain management) with adequate patient orientation. Teachers positively highlighted the organization and the educational material. Content structuring was considered to be particularly helpful.

CONCLUSIONS

With the new teaching concept, medical students feel well prepared for the treatment of terminally ill and dying patients. The combination of different learning formats with an interdisciplinary and cross-sectoral focus promotes education with a practical orientation.

The road taken - changing one's professional focus at a large research university

The scientific endeavor has many facets, extending well beyond the experimental research bench. However, in most fields, especially in the biomedical sciences, the traditional career pathway for scientists is first joining and later leading an experimental research laboratory or program. As a result, scientific education is often focused on training new bench researchers. My own journey from a traditional bench scientist to that of an educator and educational researcher will be discussed in the context of a large research university environment. Being a scientist with an educational focus at such an institution poses significant challenges, but also opens new opportunities. In my opinion, these two professional pathways are not exclusive or alternative choices, but rather are complementary, both representing important and essential elements of scientific progress.

A failed review of CCE site inspection standards and processes

Background

Accreditation of educational programs involves an independent agency assessing quality against a set of defined standards. Site inspection teams are appointed by an accrediting agency and compile a report with the intention of identifying deficiencies and making recommendations for their rectification and continued improvement. For chiropractic programs accreditation is carried out by Councils on Chiropractic Education (CCEs). However, the reliability of their site inspection teams remains unknown. Recent research has suggested that variability in chiropractic practice may be partially traced back to the education provider. This raises the possibility of deficient accreditation procedures that may include unsatisfactory site inspection standards or processes or the accreditation standards by which they work to.

We sought to compare the various CCEs documented standards and processes for site inspection teams for similarities and differences with the intent of making recommendations to create uniform and high quality standards. Further, we sought to compare a sample of CCEs site inspection team surveys / reports for commonly identified recommendations and quality improvements and determine if they are adequately described in their accreditation standards.

Method

In December of 2018 invitation emails were sent to 4 CCEs through their website portals outlining a proposed study investigating site inspection teams’ standards and processes. Access was requested to all appropriately redacted documentation relating to site inspection teams and their chiropractic program reports. Follow up emails were sent several weeks later.

Results

Only one of four of the CCEs responded by providing the requested information.

Conclusion and recommendations

Three CCEs did not cooperate with this educational research. The possible reasons for the non-engagement is discussed.

Electronic supplementary material

The online version of this article (10.1186/s12998-019-0270-y) contains supplementary material, which is available to authorized users.

Student nurses' attitudes to social justice and poverty: An international comparison

BACKGROUND

In both the United Kingdom (UK) and the United States (US), health inequities are proving resistant to improvement. Nurses are ideally placed to advocate for social justice. It is therefore important that nurse education encourages awareness of the social determinants of health and equips students to act to address health inequity. However, little is known about student nurses' attitudes to social justice and poverty and the impact of pedagogical strategies used to teach the determinants and patterns of health inequities.

OBJECTIVES

To assess and compare UK and US student nurses' attitudes towards social justice and poverty before and after learning about social determinants of health and health inequities.

DESIGN

Cross-sectional study with embedded before and after design using validated measures.

SETTING

Two universities: one urban UK university and one US university with urban and rural campuses.

PARTICIPANTS

230 student nurses in the UK (n = 143) and US (n = 87) enrolled in courses teaching content including health inequities and social determinants of health.

RESULTS

Student nurses generally disagreed with stigmatizing statements about people living in poverty and mostly agreed with statements promoting social justice. However, US students were significantly more likely to have positive attitudes towards both social justice (p = 0.001) and poverty (p < 0.001). In multiple regression analyses, engagement in social justice-promoting activities, activism and higher levels of education were associated with positive attitudes to social justice and poverty. Statistically significant positive changes in attitudes to poverty and social justice after their courses were observed only among US student nurses.

CONCLUSION

UK and US student nurses' attitudes to poverty and social justice were generally positive. Education around social determinants of health and health inequity had a different effect in the UK and the US. There is a need to explore further what specific components of educational programmes lead to positive changes in attitudes.

Conducting and presenting qualitative research in pharmacy education

SITUATION

The evolution of practices in healthcare and the content and delivery of pharmacy education have generated new challenges for practitioners and academicians. Fittingly, pharmacy education research in the academic setting has grown rapidly to provide innovative solutions to these challenges. One approach for addressing these challenges includes the collection and analysis of qualitative research (QR). Though a useful methodological tool, many pharmacy educators are not trained to appropriately conduct QR and present the findings of their work.

METHODOLOGICAL LITERATURE REVIEW

QR offers many advantages for pharmacy education researchers. However, prior to delving into QR projects it is important to understand the key distinctions of the approach, role of the researcher, and the significance of situating the study so that the research question, data collection techniques, and analysis procedures are aligned.

RECOMMENDATIONS

We provide recommendations for several key components for conducting QR, articulating the process, and presenting and contextualizing the findings.

IMPLICATIONS

This article serves as a primer on QR methods, offering relevant background information, ways to apply this approach in pharmacy education research, and recommendations for presenting qualitative findings. Employing rigorous qualitative approaches in pharmacy education and appropriately presenting the procedures and findings will increase the visibility of QR and provide an opportunity for scholars to become familiar with the approach.

Evaluating an Advance Care Planning Curriculum: a Lecture, a Game, a Patient, and an Essay

PURPOSE

Curricula on advance care planning are commonly absent or inadequate in the majority of medical schools. This study assessed an advance care planning mini-curriculum involving a lecture, an end-of-life conversation game, a patient encounter during which students facilitated completion of an advance directive, and a subsequent reflective essay.

METHODS

This convergent, mixed methods study used a pre-post, longitudinal design. Confidence having end-of-life conversations was assessed at three timepoints. A linear mixed effects model compared mean confidence at the three timepoints. Focus groups and open-ended questionnaires (analyzed using content analysis) explored student perceptions of the curricula.

RESULTS

Sixty-nine of 149 students completed the questionnaires; 18 students participated in the focus groups. Confidence scores increased by 10.3 points (+ 4.2 post-lecture/game; + 6.1 post-patient assignment/essay; p < 0.001 for all timepoints). Students felt the game (1) was a good "starting point" for learning to initiate end-of-life conversations; (2) fostered internal and external reflections about advance care planning; and (3) allowed exploration of the complexities of end-of-life discussions. Qualitative exploration suggested that high-level learning-interpreted through the lens of Bloom's taxonomy-occurred.

CONCLUSION

Mixed methods data suggest that the advance care planning mini-curriculum effectively increased student confidence having end-of-life conversations. Qualitative analyses revealed student learning covering all of tiers of Bloom's taxonomy.

Simulation Training in Medical Education-an Exploration Through Different Theoretical Lenses

Different theoretical frameworks offer specific, but separate, understandings of the same phenomenon. With the increasing use of simulation for training and assessment in medical education, it is vital to consider how different frameworks grant various insights into the pedagogical value of simulation. In this article, the author evaluated three exemplar theoretical frameworks, cultural-historical activity theory, cognitive load theory, and grounded theory, considering their ontological and epistemological stances, their limitations, and their application to simulation training. The greater understanding offered by this article will inform research design and interpretation of results, enabling a more theoretically poised construction of pedagogical techniques.

The Benefits of Required Forensic Clinical Experiences in Residency

OBJECTIVE

The growth of forensic psychiatry has spurred efforts to improve forensic psychiatry training in general psychiatry residency. The Accreditation Council for Graduate Medical Education requires that residencies provide an experience that "exposes" residents to forensic issues, but leaves the specifics to individual programs. However, there is growing need for psychiatrists to understand the unique circumstances of individuals with mental illness involved in the criminal justice system.

METHODS

The authors developed a new mandatory forensic rotation for general psychiatry residents and conducted a pilot study to assess its impact on residents' interest and comfort working with criminal justice-involved patients, interest in forensic fellowship, and knowledge of available resources for consultation and supervision.

RESULTS

Rotation completion was associated with a significantly increased interest in working with forensic populations and pursuing forensic fellowship, but no changes in residents' level of comfort or knowledge of supervisory and consultative resources.

CONCLUSIONS

This study adds to the growing body of literature describing the benefits of expanding forensic education for residents.

Perceptions of pharmacy faculty need for development in educational research

INTRODUCTION

Pharmacy educators have identified that pharmacy faculty need a better understanding of educational research to facilitate improvement of teaching, curricula, and related outcomes. However, the specific faculty development needs have not been assessed. The purpose of this study was to investigate self-reported confidence among clinical doctor of pharmacy faculty in skills essential for conducting educational research.

METHODS

Faculty members with primary responsibilities in teaching at the University of Florida College of Pharmacy were invited to the take the Adapted Self-Efficacy in Research Measure (ASERM). Descriptive analysis and independent samples t-tests were used to compare the self-efficacy items by faculty rank, gender, and years of experience.

RESULTS

Twenty-two of the 37 faculty members answered the 30-item survey that identified their self-efficacy in items and categories of skills, including writing skills, statistical skills, research design, research management and dissemination in education research. Senior faculty had significantly higher confidence than junior faculty on seven items. Participants who worked more than ten years had statistically higher confidence in preparing and submitting grant proposals to obtain funding for educational research. Skills where both junior and senior faculty had low confidence were related to using non-traditional methods such as qualitative methods and identifying funding resources for educational research.

DISCUSSION AND CONCLUSIONS

Findings from the ASERM provided insights among pharmacy educators regarding self-efficacy related to skills needed for educational research, options for faculty development opportunities and actions for improving educational research knowledge and skills among them.

Instructional strategies and course design for teaching statistics online: perspectives from online students

BACKGROUND

Teaching online is a different experience from that of teaching in a face-to-face setting. Knowledge and skills developed for teaching face-to-face classes are not adequate preparation for teaching online. It is even more challenging to teach science, technology, engineering and math (STEM) courses completely online because these courses usually require more hands-on activities and live demonstrations. Although the demand for online STEM courses has never been higher, little has been done to develop effective instructional and online course design strategies for teaching STEM courses online. This paper reports the effectiveness of the instructional strategies adopted and the online course design features in a fully online statistics course from the students' perspectives. The online statistics course was an introductory, quantitative research course that covered common statistical concepts and focused on the application of educational research concepts for graduate students in educational technology. In terms of the statistics concepts covered, the course was similar to an introductory statistics class for students majoring in science, technology, math and engineering (STEM). The participants were mostly K-20 (meaning from kindergarten to college) instructors who had knowledge of instructional strategies.

RESULTS

Data collected from participants' reflections and course evaluations revealed that a range of instructional strategies and course design features were effective and helped students learn statistics in an online environment. Specifically, case studies, video demonstrations, instructor's notes, mini projects, and an online discussion forum were most effective. For online course design features, consistent structure, various resources and learning activities, and the application focused course content were found to be effective.

CONCLUSIONS

The implications of this study include effective instructional strategies and online course design for application-oriented STEM courses such as physics and engineering. The study results can be used to guide online teaching and learning as well as online course design for instructors, course designers, and students in STEM fields.

Development and evaluation of a continuing pharmacy education (CPE) program in thrombosis management

BACKGROUND AND PURPOSE

A continuing education (CE) course in thrombosis management for pharmacists was developed through the Office of Continuing Professional Development (CPD) at the University of Toronto to address pharmacists' needs for the knowledge and skills to provide care to patients receiving anticoagulants. This article describes the development of the course as well as the evaluation designed to assess its impact on pharmacists' knowledge, attitudes, and changes in practice.

EDUCATIONAL ACTIVITY AND SETTING

A three-day course was developed. Outcomes were evaluated using a feedback questionnaire, pre- and post-session quizzes and semi-structured interviews conducted six months after course completion. Participant satisfaction, knowledge acquisition and perceived change in knowledge, skills and practice were evaluated.

FINDINGS

Thirty-seven pharmacists enrolled in the program, 21 of whom participated in a semi-structured interview. More than 90% reported that the program exceeded their expectations. Pharmacists' knowledge in thrombosis care improved significantly after each day of the course. Participants felt the greatest benefits of the program were increases in knowledge and confidence and the opportunity to network. The case-based discussions and practical tips gained from experts and peers were highly ranked. Participants strongly agreed that they were applying what they learned in the course to clinical practice, and they provided numerous examples of how their practice changed because of the program.

DISCUSSION AND SUMMARY

The development of this CE course demonstrates application of best practices in continuing education. The evaluation of the program suggests that a CE course in thrombosis improves pharmacist knowledge, confidence and ability to incorporate what was learned into practice. This course design and evaluation can serve as a model for other CE courses for pharmacists as this field continues to grow and encourages thoughtful use of theoretical principles and well-designed evaluation for continual improvement of CE.

Teaching implementation science in a new Master of Science Program in Germany: a survey of stakeholder expectations

Background

Implementation science in healthcare is an evolving discipline in German-speaking countries. In 2015, the Medical Faculty of the University of Heidelberg, Germany, implemented a two-year full-time Master of Science program Health Services Research and Implementation Science. The curriculum introduces implementation science in the context of a broader program that also covers health services research, healthcare systems, research methods, and generic academic skills. Our aim was to assess the expectations of different stakeholder groups regarding the master’s program.

Methods

An online survey listing desired competencies of prospective graduates was developed and administered to four groups: national experts in the field (including potential employers of graduates), teaching staff, enrolled students, and prospective students (N = 169). Competencies were extracted from the curriculum’s module handbook. A five-point Likert scale was used for the assessment of 42 specific items. Data were analyzed descriptively.

Results

A total of 83 people participated in the survey (response rate 49%). The online survey showed a strong agreement across the groups concerning the desired competencies of graduates. About two-thirds of the listed competencies (27 items) were felt to be crucial or very important by 80% or more of participants, with little difference between stakeholder groups. Of the eight items specifically related to implementation in practice, six were in this category. Knowledge of implementation strategies (90% very important), knowledge of barriers and enablers of implementation (89%), and knowledge of evidence-based practice (89%) were the top priorities.

Conclusions

The master’s program is largely orientated towards the desired competencies of graduates according to students, teaching staff, and national experts.

A five-year retrospective evaluation of a faculty research fellowship programme at the medical college of Georgia

INTRODUCTION

In institutional assessments of faculty, scholarly activity is often cited as a deficiency. Faculty lack the training and resources needed to produce peer-reviewed, quality scholarship. Although a variety of formats have been suggested and used to fill this void, fellowships are a commonly used format to foster educational leaders within institutions. In 2010, the Educational Innovation Institute at the Medical College of Georgia created an educational research fellowship to address this need.

METHODS

To assess the success of our programme, we compared all graduating fellows' current curriculum vitae (CVs) with the version submitted at the time of their application, looking for educational scholarship produced during and after their participation in the fellowship. Qualitative data sources, such as article reflections, mid-fellowship surveys, and exit surveys were analyzed to identify the mechanisms that contributed to their success. The constant comparative method was used to identify themes and patterns.

RESULTS

A comparison of CVs collected at the time of application with a current CV indicate the 11 participants produced: 60 presentations at regional or national meetings, 16 peer reviewed publications, received funding for 7 grants supporting educational research, and won 7 national research awards. Our qualitative analysis identified three major mechanisms: 1) dedicated time to conducting educational research, 2) opportunities to engage with others, and 3 ) understanding the differences between educational and clinical research.

DISCUSSION

Previous criticisms of fellowships include faculty not producing educational scholarship after completing their programme. Our retrospective analysis indicates our research fellowship was successful in developing physicians and clinical educators to become educational researchers. What was most useful was having dedicated time to work with others interested in producing educational scholarship, and expert guidance in understanding the differences between clinical and educational research. The most challenging aspect of conducting education research was their need to use conceptual frameworks and learning theory in their work. Implications for this study include the need for a strong curricular focus on the differences between clinical and educational research for any fellowship programme.

Shifting concepts, changing contexts: the new schools' drive for change

Seventeen new medical schools were founded in the US and Canada in the decade prior to 2014. These new medical schools continue the tradition of utilizing mission statements (MSs) to convey goals and ideals. The authors aimed to compare these 17 new medical schools' MSs with MSs of previously established medical schools in the US and Canada. The MSs of the 17 newest medical schools were processed and analyzed utilizing network text analysis software that assessed centrality of concepts within new medical schools' MSs. This semantic network data was then compared to existing similar analysis by Grbic et al. (Acad Med 88(6):852-860, 2013. doi: 10.1097/ACM.0b013e31828f603d ). Four concepts were found to be more central in new medical schools' MSs as compared to established medical schools' MSs: "physicians," "improve," "diversity," and "innovation." Grbic et al. found four concepts to be central to all 132 medical schools "health" or "health_care," "research," "education," and "premier" which are shared top themes of the new medical schools' MSs. The author's analysis has demonstrated that new medical schools, as compared to previously established subsets of medical schools, developed both shared and unique language within their MSs. This unique vocabulary reflected a response to a dynamic healthcare environment during the decade of new medical school development. New medical schools may have responded to environmental challenges including a physician shortage while also recognizing the need for a diverse physician workforce prepared to apply innovative strategies to healthcare.

Research priorities for multi-institutional collaborative research in surgical education

BACKGROUND

Research in surgical education has seen unprecedented growth but originates from single institutions and remains uncoordinated; this study aimed to generate a list of research priorities in surgical educational topics.

METHODS

The membership of the Association for Surgical Education was asked to submit up to 5 research questions concerned with multi-institutional collaborative surgical education research and to identify challenges faced by surgical education researchers. A modified Delphi methodology was used to create the research agenda based on these responses.

RESULTS

Surgical educators responded to 3 survey rounds. Categories of submitted questions included teaching methods and curriculum development; assessment and competency; simulation; medical student preparation and selection; impact of work hour restrictions; and faculty development. Participants cited institutional culture and practice variability and lack of institutional review board coordination as common barriers to collaborative research, while identifying extensive planning, frequent communication, and availability of dedicated research coordinators as the most important facilitators.

CONCLUSIONS

Using a Delphi methodology, a prioritized agenda for multi-institutional surgical education research was developed that may help advance surgeon education.