Effectiveness and cost-effectiveness of embedded simulation in occupational therapy clinical practice education: study protocol for a randomised controlled trial

The PIER framework for healthcare simulation integration in undergraduate physiotherapy education

BACKGROUND

The need for healthcare curricula renewal to facilitate a continuum in education from classrooms to diverse healthcare settings is undeniable. Simulation has been recognized as an educational strategy to address healthcare education challenges, with limited reporting on the integration of simulation-based learning experiences in physiotherapy education. The study aimed to describe the finalisation of a framework for integration of healthcare simulation in an undergraduate physiotherapy program.

METHODS

A qualitative descriptive research design was utilized. Five South African experts in the fields of healthcare simulation and/or physiotherapy education contributed to the finalization of the framework during a consensus meeting. Content analysis was employed and credibility was ensured through double coding.

RESULTS

Structural coding yielded five themes- Planning, Implementation, Program Evaluation, Program Revision and Framework. The five themes consisted of fifteen categories, two sub-categories and 44 codes. The planning theme was most robust with seven categories. The Planning, Implementation, Evaluation, Revision (PIER) framework was developed and finalized by expert participants. following the consensus meeting.

CONCLUSION

Needs analyses when planning and incorporating simulation is essential. Collaboration through resource and knowledge sharing is vital in developing a responsive curriculum integrating simulation. Furthermore, facilitator and student preparation are paramount in ensuring active engagement in simulated-based learning experiences. The interconnectedness of all framework elements and integration phases, as well as the implied importance of competent facilitators and prepared students is crucial and highlights careful consideration to be given to these aspects. The PIER framework is generic in nature and represents the continuous process of simulation integration for any healthcare program.

How Does Organizational Unlearning Influence Product Innovation Performance? Moderating Effect of Environmental Dynamism

Product innovation integrates technology, knowledge, management practices, and market innovation, making it essential to gain a competitive advantage. Effective management of dynamic knowledge, which is the foundation of and driving force for product innovation, is a powerful tool that allows a firm to successfully innovate, adapt to environmental changes, and improve its competitiveness. In the "nanosecond age," unlearning and learning in an organization is crucial to a firm's ability to promptly update its organizational knowledge and maintain innovation vitality. Based on the dynamic knowledge management perspective, this study integrates and constructs a theoretical model with environmental dynamism as the moderating variable, discusses the impact of organizational unlearning on product innovation performance, and empirically analyzes 208 valid questionnaires in the Yangtze River Delta using the multiple regression method. The results show that organizational unlearning shares a positive relationship with dynamic capabilities and product innovation performance. Dynamic capability is positively related to product innovation performance and has a partial mediating effect on the relationship between organizational unlearning and product innovation performance. Environmental dynamism shares a positive moderating effect on the relationship between organizational unlearning and product innovation performance. This study deepens the existing research on the factors that influence product innovation performance, which may help firms improve their dynamic knowledge management and product innovation performance.

Simulation-based clinical assessment identifies threshold competence to practise physiotherapy in Australia: a crossover trial

BACKGROUND

Although evidence exists for the efficacy of high-fidelity simulation as an educational tool, there is limited evidence for its application in high-stakes professional threshold competency assessment. An alternative model of simulation-based assessment was developed by the Australian Physiotherapy Council (APC), using purpose-written standardised patients, mapped to the appropriate threshold level. The aim of this two-phase study was to investigate whether simulation-based clinical assessments resulted in equivalent outcomes to standard, real-life assessments for overseas-trained physiotherapists seeking registration to practice in Australia.

METHODS

A randomised crossover trial comparing simulation-based assessment to real-life assessment was completed. Participants were internationally trained physiotherapists applying for registration to practice in Australia, voluntarily recruited from the Australian Physiotherapy Council (APC) assessment waiting list: study 1 n = 25, study 2 n = 144. Study 1 participants completed usual APC real-life assessments in 3 practice areas, completed on different days at APC partner healthcare facilities. Participants also underwent 3 practice area-matched simulation-based assessments, completed on the same day at purpose-designed simulation facilities. Study 2 participants completed 3 simulation-based assessments and 1 real-life assessment that was randomly allocated for order and practice area. Assessment of competency followed the standard APC procedure of 90-minute examinations using The Moderated Assessment Form (MAF).

RESULTS

The overall pass rate was higher for real-life assessments in both studies: study 1, 50% versus 42.7%; study 2, 55.6% versus 44.4%. Chi-square analysis showed a high to moderate level of exact matching of pass/fail grades across all assessments: study 1, 73.4% (p < 0.001); study 2, 58.3% (p = 0.027). Binary logistic regression showed that the best predictors of real-life pass/fail grade were simulation-based MAF pass/fail grade (study 1, OR 7.86 p < 0.001; study 2, OR 2.037, p = 0.038) and simulation-based total MAF score (study 1, OR 1.464 p < 0.001; study 2, OR 1.234, p = 0.001).

CONCLUSION

Simulation-based assessment is a significant predictor of clinical performance and can be used to successfully identify high stakes threshold competence to practice physiotherapy in Australia.

What do we know about written assessment of health professionals' communication skills? A scoping review

OBJECTIVE

The aim of this scoping review was to investigate the published literature on written assessment of communication skills in health professionals' education.

METHODS

Pubmed, Embase, Cinahl and Psychnfo were screened for the period 1/1995-7/2020. Selection was conducted by four pairs of reviewers. Four reviewers extracted and analyzed the data regarding study, instrument, item, and psychometric characteristics.

RESULTS

From 20,456 assessed abstracts, 74 articles were included which described 70 different instruments. Two thirds of the studies used written assessment to measure training effects, the others focused on the development/validation of the instrument. Instruments were usually developed by the authors, often with little mention of the test development criteria. The type of knowledge assessed was rarely specified. Most instruments included clinical vignettes. Instrument properties and psychometric characteristics were seldom reported.

CONCLUSION

There are a number of written assessments available in the literature. However, the reporting of the development and psychometric properties of these instruments is often incomplete. Practice implications written assessment of communication skills is widely used in health professions education. Improvement in the reporting of instrument development, items and psychometrics may help communication skills teachers better identify when, how and for whom written assessment of communication should be used.

The use of simulation in occupational therapy education: A scoping review

INTRODUCTION

Simulated learning experiences are a common feature of many health professions' pre-registration curricula. However, the use of simulation within occupational therapy is still largely undefined. This scoping review seeks to identify and summarise the available evidence exploring the use of simulation within occupational therapy pre-registration education.

METHODS

A search was conducted in four databases for articles published between 2009 and 2020 to identify international literature relevant to the use of simulation within occupational therapy education. Articles were evaluated using the appropriate Critical Appraisal Skills Programme (CASP) tool and key features and benefits of current simulation education were identified using thematic analysis.

RESULTS

A total of 32 papers were included within the review. Four themes were identified and explored: simulation methods, authenticity, global approaches to simulation, and relationship to practice education.

CONCLUSION

Simulation is taking place in many different forms within occupational therapy internationally. It is positively received by students and may provide an effective replacement for practice education if focussed on professional standards and competencies. Further research into the potential effectiveness of simulation in relation to practice learning is indicated.

Economic evaluation of simulated and traditional clinical placements in occupational therapy education

INTRODUCTION

This economic evaluation complements results of the randomised controlled trial that established non-inferiority of the learning outcomes of a one-week simulated clinical placement (SCP) in occupational therapy qualifying degrees in comparison to an equivalent traditional clinical placement (TCP). This companion study presents detailed cost analyses of two placement alternatives and a cost-benefit study to assess the value for money of SCP. An economic evaluation of simulated versus traditional placements has not previously been conducted in Australia.

METHODS

Nine SCP/TCP rounds were conducted by six Australian universities. Costs were collected using study-specific instruments. Public health sector costs were sourced from available literature. Willingness-to-pay for SCP/TCP was estimated using both a Discrete Choice Experiment and a Contingent Valuation method. These methods were employed to assess a comparative 'value' of SCP/TCP from the perspective of heads of occupational therapy departments (N = 28), who were asked to put a monetary value on the broader range of benefits associated with SCP/TCP.

RESULTS

From the universities' perspective the average cost per student ranged from AUD$460 to AUD$1511 for simulated and AUD$144 to AUD$1112 for traditional placement. From the health care sector perspective, the difference in costs favoured simulated placements for four implementations and traditional placements for five. In the Discrete Choice Experiment respondents preferred traditional rather than simulated placement and would pay additional AUD$533. The estimated monetary value of simulated placements from a contingent valuation ranged from AUD$200 to AUD$1600.

CONCLUSIONS

For universities that procure TCPs predominately at public health care facilities and sustain high administrative overheads, the SCP program could be a cost-saving alternative. From a broader value-for-money perspective, respondents favoured TCP over SCP, yet placed importance on placement availability and opportunity to demonstrate competence for students during the placement. Results should be interpreted with caution and further research with larger sample sizes is required.