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March MK, Dennis SM, Caruana S, Mahony C, Elliott JM, Polley S, Thomas B, Lin C, Harmer AR. Boosting inpatient exercise after hip fracture using an alternative workforce: a mixed methods implementation evaluation. BMC Geriatr 2024; 24:149. [PMID: 38350882 PMCID: PMC10865645 DOI: 10.1186/s12877-024-04730-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 01/19/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Hip fracture has a devastating impact on individuals and is an increasing burden for health systems and society. Compared to usual care, increased physiotherapy provision has demonstrated efficacy in improving patient and health service outcomes in this population. However, physiotherapy workforce challenges prevent sustained implementation. METHODS Our aim was to evaluate the safety, feasibility, acceptability, effectiveness and implementation cost of thrice daily physiotherapy for patients in the acute care setting after hip fracture at two public hospitals. We added twice-daily exercise implemented by an alternative workforce, to usual care consisting of daily mobility practice by a physiotherapist. Sites identified their preferred alternative workforce, with pre-registration physiotherapy students and allied health assistants chosen. We used a mixed methods approach, using the Consolidated Framework for Implementation Research (CFIR) as a determinant framework to guide implementation planning and data collection. We compared hospital length of stay data to a reference cohort. RESULTS We recruited 25 patients during the study period. Acute care hospital length of stay decreased from 11 days in the reference cohort to 8 days in the BOOST cohort (mean difference - 3.3 days, 95%CI -5.4 to -1.2 days, p = 0.003). Intervention fidelity was 72% indicating feasibility, no safety concerns were attributed to the intervention, and uptake was 96% of all eligible patients. The intervention was acceptable to patients, carers and healthcare providers. This intervention was cost-effective from the acute orthopaedic service perspective. CONCLUSION Higher daily frequency of physiotherapy can be safely, feasibly and effectively implemented by an alternative workforce for patients in the acute care setting following hip fracture surgery.
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Affiliation(s)
- Marie K March
- Physiotherapy Department, Blacktown Mt Druitt Hospitals, Western Sydney Local Health District, Blacktown, NSW, Australia.
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia.
| | - Sarah M Dennis
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- South Western Sydney Local Health District, Liverpool, NSW, Australia
- Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Sarah Caruana
- Physiotherapy Department, Blacktown Mt Druitt Hospitals, Western Sydney Local Health District, Blacktown, NSW, Australia
| | - Christopher Mahony
- Physiotherapy Department, Hornsby Ku-ring-gai Hospital, Northern Sydney Local Health District, Hornsby, NSW, Australia
| | - James M Elliott
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- The Kolling Institute, St Leonards, NSW, Australia
| | - Stephanie Polley
- Department of Rehabilitation and Aged Care, Blacktown Mt Druitt Hospitals, Western Sydney Local Health District, Blacktown, NSW, Australia
- Department of Aged Care, Hornsby Ku-ring-gai Hospital, Northern Sydney Local Health District, Hornsby, NSW, Australia
| | - Bijoy Thomas
- Department of Orthopaedic Surgery, Blacktown Mt Druitt Hospital, Western Sydney Local Health District, Blacktown, NSW, Australia
| | - Charlie Lin
- Department of Orthopaedic Surgery, Hornsby Ku-ring-gai Hospital, Northern Sydney Local Health District, Hornsby, NSW, Australia
| | - Alison R Harmer
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
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Verhees MJM, Landstra AM, Engbers R, Koksma JJ, Laan RFJM. Exploring workplace-based learning in distributed healthcare settings: a qualitative study. BMC MEDICAL EDUCATION 2024; 24:78. [PMID: 38254144 PMCID: PMC10804752 DOI: 10.1186/s12909-024-05053-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Distributed healthcare settings such as district hospitals, primary care, and public health facilities are becoming the real-life settings for workplace-based learning required to educate the future healthcare workforce. Therefore, a major focus should be on designing and developing workplace-based learning in these learning environments. Healthcare professionals and educational policymakers play a significant role in these settings as role models in workplace-based learning, and as leaders in integrating learning into their work environments. It is relevant to explore their beliefs, attitudes, and behaviors towards workplace-based learning in their own settings, in order to provide context-relevant recommendations that can assist in shaping workplace-based learning environments. METHODS We used individual interviews to understand professionals' experiences with workplace-based learning in distributed healthcare settings. We - three clinicians, an educationalist, and a philosopher - thematically analyzed transcripts of 13 interviews with healthcare professionals and educational policymakers from different healthcare settings who were involved in the clinical phase of undergraduate medical education. RESULTS Clustering and categorizing of the data led to the construction of five overarching themes: Identification with and attitude towards medical education, Sense of ownership, Perceived time and space, Mutual preconceptions and relations, and Curriculum for a changing profession. CONCLUSIONS These themes accentuate aspects relevant to the development of workplace-based learning in distributed healthcare settings on the individual, team, or organizational level. We highlight the significance of individual professionals in the development of workplace-based learning and emphasize the need for recognition and support for those occupying the 'broker' role at the intersection of education and practice. For future research and educational practice, we recommend prioritizing initiatives that build on good-practices in workplace-based learning and involve dedicated individuals in distributed healthcare settings.
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Affiliation(s)
- Myrthe J M Verhees
- Radboudumc Health Academy, Radboudumc, Gerard van Swietenlaan 2, Nijmegen, 6525 GB, the Netherlands.
| | - Anneke M Landstra
- Radboudumc Health Academy, Radboudumc, Gerard van Swietenlaan 2, Nijmegen, 6525 GB, the Netherlands
- Rijnstate, Arnhem, the Netherlands
| | - Rik Engbers
- Radboudumc Health Academy, Radboudumc, Gerard van Swietenlaan 2, Nijmegen, 6525 GB, the Netherlands
| | - Jur J Koksma
- Radboudumc Health Academy, Radboudumc, Gerard van Swietenlaan 2, Nijmegen, 6525 GB, the Netherlands
| | - Roland F J M Laan
- Radboudumc Health Academy, Radboudumc, Gerard van Swietenlaan 2, Nijmegen, 6525 GB, the Netherlands
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Klinner C, Dario AB, Bell A, Nisbet G, Penman M, Monrouxe LV. Beyond mere respect: new perspectives on dignity for healthcare workplace learning. Front Med (Lausanne) 2024; 10:1274364. [PMID: 38293301 PMCID: PMC10824899 DOI: 10.3389/fmed.2023.1274364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/27/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Although dignity in workplace learning in healthcare is gathering interest, we know little about stakeholders' conceptualizations in this area across professional groups. Dignity breaches in workplace learning are common, often with serious and long-lasting consequences for the affected. Conceptualizations shape behaviours and experiences. To prevent dignity violations in students' learning, it is thus important to understand stakeholders' understandings of the topic. This study therefore explores the dignity conceptualizations around workplace learning that students, placement educators and university staff hold across seven allied health professional groups. Methods Using a social constructionist perspective, we conducted individual and group narrative interviews (n = 51) with students, placement educators and university workplace learning staff from seven allied health professional groups. We used the 5-step Framework Analysis to explore and develop themes, identifying differences and similarities across stakeholder groups. Results We identified eight distinct, yet interrelated, dimensions of dignity from participants' narratives: dignity as respect, dignity as self-x (the various relationships we have with ourselves), dignity as feeling safe, dignity as understanding otherness, dignity as supporting others, dignity as equality, dignity as professionalism, and dignity as belonging. Dignity as respect was identified across all participants, although mutual respect and a culture of respect were only present in academic participants' talk. The remaining seven dimensions all present important factors extending our understanding of the construct of dignity. Discussion In line with existing research, our study identifies the absence of an unambiguous, positive conceptualization of dignity in workplace learning among stakeholders. It adds novelty in two ways: by identifying dignity dimensions that require informed action beyond respecting others, and by revealing a tension between dignity as professionalism and dignity as equality. We suggest revising existing dignity concepts in workplace learning to address this tension and to reinforce that active care, team integration and skilled support are all non-negotiable elements of dignified behaviour within workplace learning.
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Tomlin D, Bowers P, Graydon K. E-Learning Simulations for Teaching Clinical Decision-Making in an Audiology Training Program. Am J Audiol 2023; 32:878-888. [PMID: 37678161 DOI: 10.1044/2023_aja-22-00210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
Abstract
PURPOSE Clinical decision-making is an essential component of most clinical processes across the health sector and an ongoing challenge for clinical education programs to teach to students. The traditional methods of teaching these skills outside of lectures are mainly through clinical placements and problem-based learning (PBL) sessions, but availability and consistency can be variable and resource heavy. To address these challenges, an e-simulation module specific to pediatric infant diagnostic testing has been developed and implemented into the teaching program. We aimed to establish whether e-simulation resulted in student skill acquisition. METHOD Academic performance measures for 67 audiology students who used a traditional PBL and 108 students who used the e-simulation module were collected and analyzed. Student survey results generated both quantitative and qualitative data, which were analyzed using a thematic analysis with an inductive approach. RESULTS Findings indicated that the e-simulation platform introduced in this study yielded learning outcomes similar to the traditional PBL format previously used. Participants experienced a significant in situ increase in understanding of infant diagnostic testing concepts following the use of the e-simulation and evaluated the e-simulation platform positively. CONCLUSION The data support that an e-simulation-based approach in clinical education presents pedagogical benefits and can provide a meaningful sustainable inclusion in today's clinical teaching programs.
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Affiliation(s)
- Dani Tomlin
- Department of Audiology and Speech Pathology, The University of Melbourne, Australia
| | - Patrick Bowers
- Department of Audiology and Speech Pathology, The University of Melbourne, Australia
| | - Kelley Graydon
- Department of Audiology and Speech Pathology, The University of Melbourne, Australia
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Sharda L, Wright K. A critical review of undergraduate education and teaching in forensic psychiatry. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2023; 33:401-414. [PMID: 37817329 DOI: 10.1002/cbm.2314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 09/18/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Although forensic psychiatry is recognised as a full medical speciality in the UK, training in it is not routinely offered to medical students. With growth both in forensic psychiatry and availability of medical school places, it is a good time to explore the nature and quality of experience already available. AIMS 1. To map the literature against the guideline for reporting evidence-based practice educational interventions and teaching checklist. 2. To critically review research and scholarship. 3. To identify gaps in evidence-based education for medical students in forensic psychiatry. METHOD A systematic search of three bibliographic databases from inception to December 2021 was undertaken using keywords related to medical students and forensic psychiatry between December 2021 and March 2022. The search was supplemented by citation and hand searching. RESULTS Eight articles were identified. Collectively, they suggest that education and teaching were implemented at a local level and not linked to theories of learning. Exposure to forensic psychiatry stimulated positive attitudes, which amplified interest in psychiatry. There was insufficient evidence to determine optimal undergraduate education and teaching practice in forensic psychiatry. CONCLUSIONS Forensic psychiatry appears to have much to offer the medical undergraduate as part of core learning in psychiatry, including universal skills and knowledge such as ethical decision-making and handling emotions. There appears to be considerable opportunity for education, teaching and research innovation in undergraduate education and teaching in forensic psychiatry. Interesting areas for development include simulated and coproduced education.
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Affiliation(s)
- Leila Sharda
- Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
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Nisbet G, Thompson T, McAllister S, Brady B, Christie L, Jennings M, Kenny B, Penman M. From burden to benefit: a multi-site study of the impact of allied health work-based learning placements on patient care quality. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022:10.1007/s10459-022-10185-9. [PMID: 36401661 DOI: 10.1007/s10459-022-10185-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/05/2022] [Indexed: 06/16/2023]
Abstract
Allied health clinical placements take place within an increasingly overstretched health care system where demand for services often exceeds availability of resources. Within this environment, student placements are often perceived as an additional burden to an already overwhelmed workforce. This study explored whether the quality of patient care was enhanced when services were re-designed using a collaborative partnership approach to more purposefully integrate students into delivery of care. Using an embedded multiple case study design, data were collected through focus groups and interviews, patient experience surveys, and secondary administrative data sources. Cases were across physiotherapy and occupational therapy in six different hospital settings. Perception of care provided by students was viewed positively by all stakeholders, including patients. Perceived health outcomes of faster improvement of health condition, improved mobility and function identified through our qualitative findings were supported by quantitative service delivery markers such as increased therapy sessions, more patients being discharged home instead of to other care facilities and reduced length of stay. Health care providers and students alike perceived improvements in service efficiencies whilst maintaining high quality care. This study has provided preliminary evidence towards improved patient care when a partnering approach is adopted whereby students are intentionally integrated into services that otherwise might not have been delivered. Furthermore, it has shifted the associated narrative from students as additional burden to students as benefit.
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Affiliation(s)
- Gillian Nisbet
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Tanya Thompson
- South Western Sydney Local Health District, Sydney, Australia
| | - Sue McAllister
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Bernadette Brady
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- South Western Sydney Local Health District, Sydney, Australia
| | - Lauren Christie
- South Western Sydney Local Health District, Sydney, Australia
- St Vincent's Health Network Sydney, Sydney, Australia
| | | | - Belinda Kenny
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- School of Health Sciences, Western Sydney University, Sydney, Australia
| | - Merrolee Penman
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
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Gladman T, Grainger R. Cultural historical activity and the complexity of health professions education. MEDICAL EDUCATION 2022; 56:1058-1060. [PMID: 35953689 PMCID: PMC9804292 DOI: 10.1111/medu.14913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
Commenting on Hu et al., Grainger and Gladman comment on how the purpose of student‐led community learning can change focus from the development of technical and professional skills to the aspirations and goals of the community in which students work.
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Affiliation(s)
- Tehmina Gladman
- Education UnitUniversity of Otago WellingtonWellingtonNew Zealand
| | - Rebecca Grainger
- Education UnitUniversity of Otago WellingtonWellingtonNew Zealand
- Te Whatu Ora Health New Zealand—Capital, Coast and Hutt ValleyWellingtonNew Zealand
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Dario A, Simic M. Innovative physiotherapy clinical education in response to the COVID-19 pandemic with a clinical research placement model. J Physiother 2021; 67:235-237. [PMID: 34511381 PMCID: PMC8429026 DOI: 10.1016/j.jphys.2021.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Amabile Dario
- Work Integrated Learning, The University of Sydney, Sydney, Australia.
| | - Milena Simic
- Discipline of Physiotherapy, The University of Sydney, Sydney, Australia
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Mette M, Baur C, Hinrichs J, Narciß E. Gaining interprofessional knowledge and interprofessional competence on a training ward. MEDICAL TEACHER 2021; 43:583-589. [PMID: 33651970 DOI: 10.1080/0142159x.2021.1885638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Since 2017, interprofessional training wards have been established in Germany. On these wards, different health professions collaboratively provide patient care supervised by facilitators from the background. We investigated the gains in interprofessional knowledge and interprofessional competence reported after the mandatory placements on Mannheim's Interprofessional Training Ward MIA. We also compared these levels of knowledge and competence at the end of the placement with control groups. METHODS In a quasi-randomized controlled study, we used a questionnaire to collect self-reported data on the interprofessional learning outcome. We used t-tests to compare (a) pretest and posttest data in the experimental group and (b) the levels of interprofessional knowledge and competence between the experimental and control groups. RESULTS The results confirmed that the MIA participants perceived a significant increase in interprofessional knowledge and competence during the placement on the training ward. MIA participants also reported significantly higher levels of interprofessional knowledge and competence than the control groups. CONCLUSIONS Placements on an interprofessional training ward make it possible to experience and practise interprofessional collaboration in real patient care. They help to prepare all future health professionals to assume their professional role in an interprofessional team to provide the best possible patient care.
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Affiliation(s)
- Mira Mette
- Division for Study and Teaching Development, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christina Baur
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jutta Hinrichs
- School of Physiotherapy, Academy of University Medical Centre Mannheim, Mannheim, Germany
| | - Elisabeth Narciß
- Division for Study and Teaching Development, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Brouwer E, Frambach J. Solutionism across borders: Sorting out problems, solutions and stakeholders in medical education internationalisation. MEDICAL EDUCATION 2021; 55:10-12. [PMID: 33001479 PMCID: PMC7756551 DOI: 10.1111/medu.14384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 09/22/2020] [Indexed: 05/12/2023]
Abstract
Just whose problems are being solved when we internationalize medical education? Here Brouwer et al. reflect on the misalignment between the challenges of globalization and solutions of internationalization.
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Affiliation(s)
- Emmaline Brouwer
- Department of Educational Development and ResearchFaculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Janneke Frambach
- Department of Educational Development and ResearchFaculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
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