The impact of using an authentic patient video on health professional students' attitudes toward interprofessional and person-centered care.

Authentic patient activities in an interprofessional education (IPE) setting can develop collaborative, practice ready health professionals who have the skills to work within and across teams with patients at the center of their care. In this qualitative study, the student experience of a novel interprofessional case study activity, with lived experience content delivered via an authentic patient video was explored. Transcripts were analyzed using reflexive thematic analysis and identified three major themes: (a) from disease-centered to person-centered care, (b) reflecting on roles in interprofessional collaborative practice, and (c) teamwork and lived experience facilitates learning. When considered within the Interprofessional Education Collaborative (IPEC) framework, the student experience suggested positive change in all four core competencies: interprofessional communication, values and ethics, roles and responsibilities and teamwork. In addition, students highly valued the interprofessional learning experience, and the patient video created a more realistic case study by reducing clinical assumptions. In conclusion, a short, single exposure to a written case followed by an authentic patient video in an IPE setting had an immediate positive impact on entry-level student health professionals. This simple methodology is a viable way of bringing the authentic patient voice into the classroom with additional benefit from the interprofessional format.

"IT's too much to do alone": A mixed-methods exploration of patient experiences implementing emergency department management plans for chronic pain.

OBJECTIVES: To explore the experiences of socio-culturally diverse community members attempting to manage their chronic pain and enact evidence-based management plans following an index Emergency Department (ED) visit. METHODS: A convergent parallel mixed-methods design with qualitative interviews and descriptive analysis was undertaken in two public hospitals in a multicultural region in Sydney, Australia. Consecutive adults were recruited from culturally and linguistically diverse (CALD: n = 45) or Australian-born (n = 45) backgrounds, who presented to the ED for a chronic neuromusculoskeletal pain condition. Consenting participants were prescribed an individualised chronic pain management plan following examination by a physiotherapist, who collected standardised measures of pain and health literacy. Six months later, participants underwent a structured phone survey regarding their pain status and whether they had actioned management plans. Participants were invited to participate in a semi-structured interview. RESULTS: Six-month data were available for 82 of 90 participants who attended the ED and consented to the baseline assessment (40 CALD and 42 Australian-born). Participants were 52% females, predominately middle-aged (mean age 54.7 years), with an overall mean symptom duration of 10 years (SD 9.0). At 6 months, there were nine representations by six CALD participants and 23 by nine Australian-born participants. Overall, 52% reported unchanged pain, 24% were worse and 23% improved, with similar action plan progress for CALD (58%) and Australian-born (53%) participants. Pain features and health literacy were similar, irrespective of progress with pain management plans. From 41 participants who consented to phone interviews, three themes emerged to explain their progress with recommendations: 'illness model', 'urgency' and 'control orientation'. CONCLUSIONS: Patients presenting to the ED with chronic pain might be more likely to action discharge recommendations if primary care providers identify patient-specific and contextual barriers to implementation.

Physical activity and associated factors in Australian women during pregnancy: A cross-sectional study.

ISSUE ADDRESSED: Whilst the benefits of regular physical activity during pregnancy are well known, the few studies conducted in Australian pregnant women suggest that most do not meet recommended exercise guidelines. The aim of this study was to determine the levels of physical activity, sedentary behaviours, and associated factors in Australian pregnant women. METHODS: A random sample of pregnant women (N = 780) of (mean [SD]) 31 (5) years of age completed a questionnaire describing weekly physical activity and sedentary behaviours. A number of potential risk factors, including socio-demographic characteristics and ethnicity, were investigated using logistic regression. RESULTS: Approximately one-third (34%) of women were classified as "active"; however, only 7% of women performed the recommended amount of physical activity according to Australian guidelines. Women reported (mean [95% CI]) sitting for 8 (7.8-8.2) hours and lying down during the day for 0.5 (0.5-0.6) hour while pregnant. Being university educated (OR [95% CI]) (2.87 [1.6-4.9]), in paid employment (2.12 [1.14-3.94]) and having a lower body mass index (0.91 [0.87-0.95]) were factors associated with being active. CONCLUSION: Australian women performed low levels of physical activity during pregnancy and spend long periods of time in sedentary behaviours. SO WHAT?: There is a strong need for a concerted health promotion strategy to endorse increased physical activity, along with a reduction in sedentary behaviours, during pregnancy to support better maternal outcomes in Australia.

The benefits of virtual learning abroad programs for higher education students: A phenomenological research study.

BACKGROUND: Higher education institutions offer in-country learning abroad programs to provide healthcare students with the opportunity to gain the intercultural and global competencies they need to work in a globally interconnected world. During the Covid-19 pandemic, institutions offered virtual learning abroad programs as an alternative to the in-country programs, however, little is known about whether they provide comparable benefits to students. OBJECTIVES: The purpose of this study was to investigate, and identify, the benefits gained by higher education healthcare students through their participation in a virtual learning abroad program. DESIGN/METHODS: This research implemented a qualitative approach, conducting semi-structured interviews with four higher education students enrolled in the final year of their healthcare studies. Data were analyzed using interpretative phenomenological analysis. RESULTS: The results revealed that virtual programs provide a range of benefits students can use in their future careers. They also provide students with a positive learning experience and an opportunity for personal growth. However, although the benefits students gain from virtual learning abroad programs are similar to those they gain from in-country programs, they are not identical. While virtual learning abroad programs are a viable alternative for in-country programs and offer many benefits, they fail to replicate the intercultural and global competencies that in-country programs offer to students. CONCLUSION: This study focusses on virtual learning abroad programs and whether the benefits healthcare students gain from them are comparable to the traditional in-country programs. Students gain personal and professional benefits from these programs without the risks and costs associated with international travel. However, the identified lack of increased global awareness has implications for how the benefits of virtual learning abroad programs should be promoted to students.

Developing student nurses' evaluative judgement in clinical practice tertiary education: A systematic scoping review of teaching and assessment methods.

OBJECTIVES: This review aimed to systematically scope undergraduate or postgraduate tertiary higher education nursing students' clinical practice teaching and assessment methods to identify features that align with promoting students' evaluative judgement. INTRODUCTION: Evaluative judgement is a new concept to nursing tertiary education. Currently, there are no published reviews of evaluative judgement in nursing clinical practice education. This review aims to assist nursing educators to operationalise the concept of evaluative judgement in clinical practice education. As such the starting point was to determine features of evaluative judgement in current clinical teaching and assessment designs. INCLUSION CRITERIA: Peer reviewed qualitative or quantitative studies that have evaluated teaching and/or assessment of tertiary (university/higher education) pre-registration (undergraduate) or post-registration (postgraduate) nursing students' clinical practice. METHODS: The systematic scoping review was prospectively registered systematic review (OSF DOI 10.17605/OSF.IO/PYWZ6) reported using PRISMA guidelines. A systematic search of five databases (Medline, Scopus, Web of Science, ProQuest, CINAHL) was conducted, limited from 1989 onwards and in English. Two reviewers independently screened titles and abstracts, then full text, with disagreements resolved with a third independent author. Data were extracted, including the frequency and methods of developing students' evaluative judgement across the categories of discerning quality, judgement process, calibration and feedback. A narrative synthesis was performed. RESULTS: Seventy-one studies were included (n=53 teaching, n=18 assessment). Most of the included studies, included some, but not all, of the features to develop nursing students' evaluative judgment. For teaching methods, the most identified evaluative judgement features in the included studies were discerning quality (n=47), feedback (n=41) and judgement process (n=21). Only three studies included a method of calibration. For the assessment methods, feedback (n=16), discerning quality (n=15), judgement process (n=9) and calibration (n=4) were included. Many clinical practice teaching and assessment methods in nursing included features that develop students' evaluative judgement, with methods relating to discerning quality and feedback well embedded. Further adjustments are required to include methods to assist students to judge and calibrate their own performance. CONCLUSION: This systematic scoping review identified that evaluative judgement in current nursing clinical teaching and assessment is not an overt aim. With minor adjustment to teaching and assessment design, nursing students could be better supported to develop their ability to judge the value of their own work.

"We are not there yet": perceptions, beliefs and experiences of healthcare professionals caring for women with pregnancy-related pelvic girdle pain in Australia.

BACKGROUND: Pregnancy-related pelvic girdle pain (PPGP) is a common condition worldwide. Women report being unprepared about PPGP, and state they receive little recognition and support from healthcare professionals. Situated within the Common-Sense Model and Convergent Care Theory, this study sought to gain a conceptual understanding of the perceptions, beliefs and experiences of healthcare professionals who provide routine care for women with PPGP in Australia. METHODS: A qualitative research design, using individual, semi-structured interviews with purposive sampling of healthcare professionals (N=27) consisting of doctors (N=9), midwives (N=9) and physiotherapists (N=9). Most participants were female (22/27) with a range of professional experience. An interview guide consisting of open-ended questions was used with a flexible and responsive approach. Thematic analysis was performed where interview data were transcribed, coded, grouped into meaningful categories and then constructed into broad themes. RESULTS: Four themes were identified: 1. Identity and impact of PPGP; 2. What works well?; 3. What gets in the way?; and 4. Quality care: What is needed? Healthcare professionals recognised PPGP as a common and disabling condition, which created a large impact on a woman's life during pregnancy. Stepped-level care, including education and physiotherapy intervention, was seen to be helpful and led to a positive prognosis. Barriers at patient, clinician and organisation levels were identified and led to consequences for women with PPGP not receiving the care they need. CONCLUSION: This study elucidates important implications for health care delivery. Acknowledging that PPGP is a common condition causing difficulty for many women, healthcare professionals identified strong teamwork and greater clinical experience as important factors in being able to deliver appropriate healthcare. Whilst healthcare professionals reported being committed to caring for women during pregnancy, busy workloads, attitudes towards curability, and a lack of formal education were identified as barriers to care. The findings suggest timely access, clear referral pathways and an integrated approach are required for best care practice for women with PPGP. A greater emphasis on the need for multidisciplinary models of care during pregnancy is evident.

Understanding underperformance in a high-stakes clinical-based simulation assessment in physiotherapy: a descriptive analysis.

BACKGROUND: High-stakes assessments are often used as a 'gate-keeper' activity for entry into the health professions by ensuring that the minimum core competency thresholds of the profession are met. The aim of the study was to explore if common areas of underperformance existed in international candidates assessed with a high-stakes clinical-based simulation assessment for entry into the physiotherapy profession in Australia. METHODS: A retrospective mixed methods analysis of the clinical assessments completed by international candidates over a one-month period in 2021 that were deemed as not meeting competency. The clinical assessments were completed in one of the three practice areas: cardiorespiratory, musculoskeletal, or neurological rehabilitation. Each assessment was scored by two independent assessors, who discussed the performance and then completed a moderated assessment form. The assessment form used to score competency included seven domains such as initial assessment, effective treatment, communication skills, and risk management. RESULTS: Fifty-one clinical assessments graded as not competent were analysed. Across the practice areas, a high failure rate was found in domains related to interpreting assessment findings and developing a treatment plan. This trend was also observed in the qualitative data, suggesting candidates struggled to meet competency in areas of planning and prioritisation, interpretation and implementation of the information gathered, and selection and evaluation of effective treatment. CONCLUSION: These findings align with published data on the underperformance of Australian physiotherapy students in clinical placement settings, suggesting these issues are not specific to high stakes assessment of overseas physiotherapists, and that education needs to focus on improving these skills within the profession at all levels. With the identified areas of underperformance aligning with the ability to use higher order thinking and skills integral to clinical reasoning, improvements in the education and implementation of clinical reasoning may be a place to start.

The feasibility of implementing a cultural mentoring program alongside pain management and physical rehabilitation for chronic musculoskeletal conditions: results of a controlled before-and-after pilot study.

BACKGROUND: Culturally diverse communities face barriers managing chronic musculoskeletal pain conditions including navigation challenges, sub-optimal healthcare provider engagement and difficulty adopting self-management behaviours. OBJECTIVES: To explore the feasibility and trends of effectiveness of implementing a cultural mentoring program alongside clinical service delivery. METHODS: This quasi-experimental controlled before-and-after multiple case study was conducted in three hospital-based services that provide treatment for patients with musculoskeletal pain. Two prospective cohorts, a pre-implementation and a post-implementation cohort, of adults with chronic musculoskeletal pain who attended during the 6-month recruitment phase, were eligible if they self-identified with one of the cultures prioritised for mentoring by the clinic. The pre-implementation cohort received routine care for up to 3-months, while the post-implementation cohort received up to 3-months of cultural mentoring integrated into routine care (3 to 10 sessions), provided by a consumer (n = 6) with lived experience. Feasibility measures (recruitment and completion rates, attendance, satisfaction), and trends of effectiveness (Patient Activation Measure and Health Literacy Questionnaire items one and six) were collated over 3-months for both cohorts. Outcomes were presented descriptively and analysed using Mann-Whitney U-tests for between-group comparisons. Translation and transcription of post-treatment semi-structured interviews allowed both cohorts' perspectives of treatment to be analysed using a Rapid Assessment Process. RESULTS: The cultural mentor program was feasible to implement in clinical services with comparable recruitment rates (66% pre-implementation; 61% post-implementation), adequate treatment attendance (75% pre-implementation; 89% post-implementation), high treatment satisfaction (97% pre-implementation; 96% post-implementation), and minimal participant drop-out (< 5%). Compared to routine care (n = 71), patients receiving mentoring (n = 55) achieved significantly higher Patient Activation Measure scores (median change 0 vs 10.3 points, p < 0.01) at 3-months, while Health Literacy Questionnaire items did not change for either cohort over time. Three themes underpinned participant experiences and acceptability of the mentoring intervention: 'expectational priming', 'lived expertise' and 'collectivist orientation' to understand shared participant experiences and explore the potential differential effect of the mentoring intervention. CONCLUSION: Participant experiences and observations of improved patient activation provide support for the acceptability of the mentoring intervention integrated into routine care. These results support the feasibility of conducting a definitive trial, while also exploring issues of scalability and sustainability.

Evaluating allied health students' readiness for placement learning.

BACKGROUND: Experiential learning opportunities, such as work integrated learning placements, are often challenging for health professional students. It is therefore imperative that students are adequately prepared before engaging in placement learning. Operationalising 'readiness for learning on placement' as a construct, is necessary for providing quality student feedback and assessment. METHODS: An integrative mixed methods approach was adopted for this study, utilising a survey to canvass the perspectives of academics, students, and placement educators around the construct of readiness to inform potential assessment items. An assessment tool measuring student readiness for placement was then developed. Data from occupational therapy, physiotherapy and speech pathology programs were evaluated using Rasch analysis to explore the unidimensionality of this construct. RESULTS: The online survey was completed by 64 participants, confirming the importance and measurability of foundational skills integral to readiness for placement learning. These foundational skills were then reflected in a pilot 20-item tool covering domains of professional and learner behaviour, communication, information gathering skills and reasoning. The Rasch analysis of 359 pre-registration student assessments confirmed unidimensionality, suggesting that the skills and attributes (operationalised as assessment items) that are considered part of 'readiness for placement' are components of this construct. Together, these findings provide support that the items on this tool are relevant and representative of the skills and behaviours that indicate readiness for placement learning. Two items regarding documentation and appropriate professional dress demonstrated some lower importance scores and interpretation variance warranting further investigation. CONCLUSION: Through the exploration of the construct of readiness for placement learning, we have created and subsequently revised, an innovative assessment tool that measures novice students' pre-placement capabilities. Further research is now needed to explore the psychometric properties of the tool.

Inclusion of Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and Other Related Identities Content in Australian Physical Therapy Curricula: Perceived Barriers and Priorities for Inclusive Education.

INTRODUCTION: Providing culturally responsive, patient-centered care is crucial for ensuring safe and positive health care experiences for individuals with diverse gender identities and sexual orientations. Doing so requires adequate training and knowledge of the health professionals involved in those health care experiences. REVIEW OF LITERATURE: Individuals identifying as lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other related identities (LGBTQIA+) experience significant barriers to health and positive health care experiences. In physical therapy, research has identified that individuals who identify as LGBTQIA+ experience discrimination, discomfort, and lack of practitioner knowledge about health needs. The aim of this study was to determine how, and to what extent, content related to LGBTQIA+ individuals is included in Australian physical therapy curricula as well as perceived barriers to inclusion. SUBJECTS: Physical therapy program directors (PDs) as of January 2022 for all Australian universities that deliver physical therapy programs (n = 24). METHODS: A Qualtrics survey was emailed to PDs to collect quantitative and qualitative data regarding the inclusion and mode of delivery of LGBTQIA+ content, as well as the perceived importance, and barriers to inclusion, of LGBTQIA+ curricula. RESULTS: Twenty-four (100%) universities (PD or proxy) responded to the survey. More than 62% (15/24) of PDs reported that their programs included LGBTQIA+ content with 88% (21/24), indicating that LGBTQIA+ content is relevant to the physical therapy curriculum. Time devoted to LGBTQIA+ content ranged from 0 to 6 (median 2-4) hours across any year, delivered primarily in general or foundational courses (37%). Perceived lack of trained faculty (14/22; 64%) and time (13/22; 59%) were barriers to the integration of LGBTQIA+ specific content into the curriculum. DISCUSSION: Our results indicate that the physical therapy curriculum may be contributing to ongoing negative experiences of individuals identifying as LGBTQIA+ with physical therapy encounters. Although most (87%) physical therapy program leaders in Australia believe that LGBTQIA+ specific content is relevant to the training of new graduates, content is included in only 62% of curricula. Perceived barriers to inclusion of LGBTQIA+ specific curriculum were a lack of time and appropriately trained faculty. Externally developed content is available to address limited expertise within programs, but faculty may require guidance on how to overcome perceived lack of time (ie, space in the curriculum). CONCLUSION: Most Australian physical therapy programs include LGBTQIA+ content to a limited extent in their curricula, indicating a lack of perceived importance relative to other topics. In this way, Australian universities are maintaining the pervasive heteronormativity of the physical therapy profession and are complicit in the ongoing health disparities between the LGBTQIA+ and heteronormative communities.

Does Online Professional Development for Physical Therapists Enhance Clinical Practice and Patient Outcomes? Protocol for a Mixed Methods, Randomized Controlled Trial.

OBJECTIVE: Online clinical mentoring has shown potential as a flexible professional development activity that enhances physical therapist practice. Online delivery can overcome time and distance barriers to participation in professional development. The impact of this learning activity on physical therapist practice and patient outcomes has not been rigorously tested. Thus, the aim of this study is to determine whether online clinical mentoring is more effective than asynchronous online lectures at improving physical therapist practice and patient outcomes. An additional aim is to explore the lived experience of physical therapist learners who participate in online clinical mentoring. METHODS: In this mixed methods evaluation, 24 physical therapist learners will be randomized to 1 of 2 online professional development activities. Experimental group physical therapists will complete 6 online clinical mentoring sessions. Control group physical therapists will complete 6 online lectures. The primary outcome evaluated will be the effect on the physical therapist's patients, using the Patient-Specific Functional Scale. Physical therapist learner secondary outcomes are confidence, self-reflection, and satisfaction. Accounting for possible dropouts, a sample size of 216 patients was determined using a pragmatic sample of 24 physical therapists, power of 0.80, alpha of 0.05, and between-group differences of 1.0 (SD = 2.0) on the Patient-Specific Functional Scale. Consecutive, eligible patients under the care of the physical therapist learners will complete outcome measures at initial appointment and at 4 weeks follow-up. Linear mixed model regression analysis will be used to estimate treatment effects from the posttreatment group means at 4 weeks. Participants undertaking online clinical mentoring will complete semi-structured interviews that will be thematically analyzed using a phenomenological approach. IMPACT: This research study will establish the effectiveness of online clinical mentoring to inform future professional development. The qualitative component will identify the potential mechanisms by which online clinical mentoring might be effective, thus informing future implementation of this professional development activity.

The first year of private practice - new graduate physiotherapists are highly engaged and satisfied but edging toward burnout.

BACKGROUND: A greater understanding of physiotherapists' work-life during their first year of work in private practice, and whether their experiences are mediated by personal traits, may provide valuable information to support their transition and retention. OBJECTIVES: Describe the first year of practice for graduate physiotherapists in terms of employee engagement, job satisfaction, performance, and burnout, and evaluate the relationship between these measures and personal traits (resilience, grit, mind-set). DESIGN: One-year longitudinal mixed-methods study. METHODS: Twenty new graduate physiotherapists completed questionnaires evaluating resilience, grit, and mind-set within 1-week of commencing employment. Engagement and job satisfaction were evaluated at 3, 6 and 12-months, and burnout evaluated at 12-months. Performance data (number of patients seen, revenue) were collected throughout the year. Individual semi-structured interviews were conducted at baseline, 3, 9 and 12-months. RESULTS: Engagement and satisfaction were high at all time points. At 12-months, burnout was at a medium level. Resilience was positively associated with job satisfaction at 6 (ρ = 0.56, p = .019) and 12-months (ρ = 0.54, p = .027). Engagement (ρ = -0.57, p = .04) and job satisfaction (ρ = -0.56, p = .03) were negatively associated with burnout at 12-months. All participants remained passionate about their work although increasing administrative burden and patient complexity contributed to feelings of burnout. CONCLUSIONS: Resilience was positively associated with job satisfaction suggesting those with capacity to 'bounce back' were more satisfied and engaged with their job. Although moderate levels of burnout were reported at 12-months, those with higher job satisfaction and employee engagement had lower levels of burnout. Participants proposed practical strategies to help mitigate burnout.

Consensus marking as a grading method for the development of evaluative judgement: Comparing assessor and students.

AIM: This study explored postgraduate nursing students' perceptions, anxiety and satisfaction of an innovative and novel grading method for online vivas, consensus marking, compared with traditional assessor judgement. BACKGROUND: Reflection, self-evaluation and feedback conversations have the potential to develop nursing students' evaluative judgement. Consensus marking is a novel method of grading students' performance that supports students to reflect, self-evaluate and grade their own work. Active engagement in a feedback dialogue supports students to calibrate their self-evaluation to the required standard in a grade negotiation. Through this approach, students are supported to develop evaluative judgement and lifelong learning skills. DESIGN: A convergent mixed-methods parallel research design was used. METHODS: Students enrolled in a postgraduate emergency nursing unit of study completed two online viva assessments. One viva was graded using traditional assessor judgement and the other used consensus marking, involving a two-way feedback dialogue, where students had an opportunity to actively engage in grading their own work with the assessor. Student perceptions of each grading method were explored through semi-structured interviews. Interview data were analysed thematically using a six-stage approach. Student anxiety and satisfaction were measured pre- and post each viva using valid and reliable questionnaires. Non-parametric analyses explored differences in anxiety and satisfaction between the two grading methods. Alpha was set at 0.05. RESULTS: Forty-six participants had complete data for anxiety and satisfaction across both test occasions (82%) and were included in the analysis. Of these, 13 students participated in follow up interviews. Students perceived that the ability to self-evaluate performance and discuss their grade with the assessor using consensus marking was less hierarchical and similar to a collegial debrief. Student anxiety was significantly lower prior to consensus marking compared with the assessor judged viva (p < 0.001). Students were significantly more satisfied with consensus marking compared with assessor judgement (p < 0.01). CONCLUSIONS: Consensus marking created an opportunity for students to identify knowledge deficits through reflection and self-evaluation of their own performance prior to external judgement. Students were more satisfied and less anxious with the consensus marking grading method compared with traditional assessor judgement. These findings have implications for the development and application of new grading methods in nursing education to facilitate the development of evaluative judgement.

Agreement between hand therapists and hand surgeons in the management of adults with closed metacarpal fractures.

BACKGROUND: Hand therapists often work in roles which require an advanced level of experience as Advanced Scope Practitioners (ASP). However, it is not known whether clinical decisions are similar between hand therapists and surgeons when managing simple hand fractures. OBJECTIVES: To determine the level of agreement between (i) a hand therapist and five hand surgeons and (ii) three hand therapists, for the management of adults with closed metacarpal fracture(s). DESIGN: A prospective, blinded, crossover inter-rater reliability study. METHOD: Patient volunteers with closed metacarpal fracture(s) were assessed independently in the first study (n = 90) by a hand therapist and one of five hand surgeons and in the second study (n = 57) by three hand therapists in a randomised order, with each practitioner recording whether the patient participant should be managed conservatively, trialled with conservative or offered surgical treatment. The level of agreement between the hand therapist and hand surgeons was calculated using Cohen's kappa coefficient and between the three hand therapists by calculating Fleiss' Kappa. The observed agreement was also calculated as the proportion of cases for which the assessors had agreement for management. RESULTS: There was good agreement between the hand therapist and surgeons (k = 0.68; 95% CI: 0.537-0.831) and amongst the three hand therapists (k = 0.663; 95% CI: 0.554-0.773) in determining the management of adults with closed metacarpal fracture(s). CONCLUSIONS: Hand therapists and surgeons make similar management decision for patients with metacarpal fractures supporting the role of hand therapists as ASP.

Grit, Resilience, Mindset, and Academic Success in Physical Therapist Students: A Cross-Sectional, Multicenter Study.

OBJECTIVE: The purpose of this study was to determine the relationships between noncognitive traits (grit, resilience, and mindset-type), academic success, and clinical performance in physical therapist students. METHODS: This cross-sectional study using self-administered surveys was undertaken with final-year physical therapist students enrolled in 4 Australian universities. Participants completed validated questionnaires measuring grit, resilience, and mindset type. Academic transcripts were obtained to quantify academic success and clinical performance. A multiple regression analysis explored predictors of academic success and clinical performance in relation to sociodemographic factors, grit, resilience, and mindset type. RESULTS: A total of 266 students participated in the study (80% recruitment rate). Overall, 25% of students had low resilience, 20% had low grit, and 14% had a fixed mindset type. Grittiness was positively associated with academic success (r = 0.24) and clinical performance (r = 0.22) and negatively associated with failing a clinical placement (r = -0.20). Grit was an independent predictor of overall academic success (ß = 0.24, P ≤ .01) and clinical performance (ß = 0.15). Students with low grit were twice as likely to fail a clinical placement compared with students with moderate or high grit (risk ratio = 2.03, 95% CI = 1.06 to 3.89). CONCLUSION: Grit was an independent predictor for overall academic success and clinical performance in final-year physical therapist students. Low grit may impact negatively on learning and students' ability to cope with challenges associated with university studies and clinical education. Further studies should investigate interventions that best develop grit in health professional students and the overlapping nature of grit, resilience, and a growth mindset. IMPACT: This study helps universities and educators understand noncognitive factors predicting academic success and clinical performance in physical therapist students. Universities and clinical educators may consider screening and providing proactive strategies for students with low grit to improve success and general wellbeing.

Application of Caring Life-Course Theory to explore care needs in women with pregnancy-related pelvic girdle pain.

AIMS: To describe the care needs of women with pregnancy-related pelvic girdle pain based on the Caring Life-Course Theory. DESIGN: A descriptive qualitative research design. METHODS: Data were collected between November 2019 and February 2021 from 20 purposively selected pregnant women with pelvic girdle pain aged between 22 and 39 years in antenatal care at a tertiary hospital in Australia. Individual semi-structured interviews were recorded via a digital audio recorder and transcribed verbatim. Qualitative content analysis method was used to analyse the data. FINDINGS: Five broad themes were identified: pain is an added burden to pregnancy; knowledge is power to own what happens to me; engaging in self-help; care from others is useful; and pain deserves more attention from healthcare professionals. CONCLUSION: Caring Life-Course Theory presented a useful and applicable scaffold for describing care needs of pregnant women with pelvic girdle pain. The study revealed experiencing pelvic girdle pain led to additional care needs during pregnancy, highlighting the importance of self-management strategies and an appreciation of care from others to assist women in limiting the effects of the pain. Participants identified the need for more information and attention from healthcare professionals to be able to better manage their condition. IMPACT: This study presents a comprehensive picture of the change in care needs triggered by experiencing pelvic girdle pain during pregnancy. The findings have the potential to facilitate better care provision by considering novel methods of delivery, such as information and communication technology, whilst acknowledging the value placed on credible and trusted sources. Knowledge acquired through this study may be used by nurses and midwives, along with other healthcare professionals, to enhance the provision of comprehensive care that is acceptable to women with pelvic girdle pain during pregnancy.

New graduate physiotherapists' perceptions and experiences working with people from culturally and linguistically diverse communities in Australia: a qualitative study.

INTRODUCTION: Upon entering the workforce, physiotherapists are required to provide safe and effective care toward people from culturally and linguistically diverse (CALD) communities. Objective: To explore new graduate physiotherapists' perceptions and experiences when working with people from CALD communities in Australia. METHODS: A phenomenological framework guided this qualitative study. Seventeen new graduate physiotherapists who had experience working with people from CALD communities were interviewed. Interviews were audio-recorded, transcribed verbatim, and then thematically analyzed. RESULTS: New graduate physiotherapists felt challenged when they encountered people from CALD communities. Although they had good intentions, their healthcare approach was limited. Their perceived approach to care was unidirectional and anchored in a western healthcare framework, and they used superficial strategies for cultural adaptation. Perceptions that people from CALD communities were passive recipients to healthcare also underpinned their practices. While participants described pockets of patient-centered care, their perceived healthcare approach lacked appropriate consideration and integration of their patients' cultural perspective. CONCLUSION: New graduate physiotherapists may need support with effectively integrating different cultural perspectives into their care and adapting their practices and interventions for people from CALD communities. Education and training at entry-level and after graduation should address these learning needs. However, there is limited research on how to culturally adapt physiotherapy practices and interventions that impact patient engagement outcomes. Thus, research is needed to understand how current evidence-based interventions can be culturally adapted to integrate patients' cultural perspectives into care.

An Exploration of the Experiences of Physical Therapists Who Identify as LGBTQIA+: Navigating Sexual Orientation and Gender Identity in Clinical, Academic, and Professional Roles.

OBJECTIVE: The purpose of this study was to explore physical therapy through the stories of physical therapists who identify as lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other related identities (LGBTQIA+) to consider how the profession enacts and constructs gender and sexual orientation. METHODS: Physical therapists with clinical, academic, and professional roles who identify as LGBTQIA+ were recruited from Australia, the United Kingdom, Canada, and the United States. In-depth data were collected via narrative interviews. An iterative group discourse analysis was used to examine key discourses underpinning interview narratives and how these relate to the physical therapy profession. RESULTS: Twenty-two physical therapists were interviewed. Participants had between 1.5 and 40 years of experience across various clinical areas and settings. Participants identified with varying sexual orientations and gender identities. Analysis identified discourses discussed under the following headings: (1) normativity, which related to hetero-normative assumptions about sexual orientation and cisnormative assumptions about gender identity and the intersectionality among sexual orientation, gender identity, and other forms of marginalization; (2) stress and labor, which explored the stress experienced by physical therapists who are LGBTQIA+ (due to fear of discrimination or actual discrimination) and additional emotional and other types of labor or work done in the workplace to hide aspects of their lives to feel safe, educate colleagues, and be a role model; and (3) professionalism, which related to the heterosexual/cisnormative (and other) "norms" that comprised participants' ideas of presenting as "professional" and positioning physical therapists who are LGBTQIA+ as "unprofessional." CONCLUSION: Findings suggest that cultural norms may need to be reconceptualized in physical therapy to promote inclusion and belonging of individuals who identify as LGBTQIA+. Approaches to upskill new and existing physical therapists may include elements such as individual and institutional reflexivity, learning and implementing appropriate terminology, displaying indicators of inclusivity, and cultural safety training. These elements may provide the first steps to promote inclusive and culturally safe environments for individuals who identify as LGBTQIA+ within the profession. IMPACT: This is the first known study to explore the lived experiences of those who identify as LGBTQIA+ in the physical therapy profession. The findings highlight how prevailing normative discourses in Western society are also present in physical therapy and impact those who identify as LGBTQIA+.

Postgraduate nursing students' perceptions of consensus marking with online oral vivas: A qualitative study.

BACKGROUND: Authentic assessment design that fosters self-reflection and evaluation seeks to develop evaluative judgement; a capability required of registered nurses. A new method of grading, known as consensus marking, was introduced to an online oral viva that required post-graduate nursing students to evaluate and reflect on their performance and grade their level of competence in collaboration with the assessor. This study aimed to explore postgraduate nursing students' perceptions about their experience of online oral viva examination and the use of consensus marking. DESIGN: A qualitative study using retrospective student interviews. METHODS: A retrospective, thematic analysis of open-ended questions from students who had participated in an online viva using consensus marking that was recorded for assessment and quality improvement. RESULTS: Postgraduate emergency nursing students perceived that the online viva while creating some anxiety was relatable to their workplace and overall, they preferred this assessment method to others. Students perceived that consensus marking enabled self-evaluation and reflection provided an opportunity for beneficial critical reflective discussions, and facilitated a positive shift in the power dynamics between the student and assessor. CONCLUSIONS: The online oral vivas provided an authentic assessment method that, despite causing anxiety, was preferred to written assessment. The students perceived that consensus marking provided an opportunity to reflect and engage in bidirectional feedback dialogue with the assessor in a collegial discussion. Further research is required to evaluate the use of consensus marking in other assessment designs.

Work Readiness of New Graduate Physical Therapists for Private Practice in Australia: Academic Faculty, Employer, and Graduate Perspectives.

OBJECTIVE: The purpose of this study is to explore academic faculty, employer, and recent graduate perspectives of the work readiness of Australian new graduate physical therapists for private practice and factors that influence new graduate preparation and transition to private practice. METHODS: This study used a mixed-methods design with 3 surveys and 12 focus groups. A total of 112 participants completed a survey, and 52 participated in focus groups. Descriptive statistics were used to summarize the quantitative data, and thematic analysis was used to analyze the qualitative data. Triangulation across participant groups and data sources was undertaken. RESULTS: Australian new graduate physical therapists were perceived to be "somewhat ready" for private practice and "ready" by their third year of employment. Participants proposed that new graduates bring enthusiasm, readiness to learn, and contemporary, research-informed knowledge. New graduates were also perceived to find autonomous clinical reasoning and timely caseload management difficult; to have limited business, marketing, and administration knowledge and skills; and to present with underdeveloped confidence, communication, and interpersonal skills. Factors perceived to influence graduate transition included private practice experience, such as clinical placements and employment; employer and client expectations of graduate capabilities; workplace support; university academic preparation and continuing education; and individual graduate attributes and skills. CONCLUSION: Australian new graduate physical therapists have strengths and limitations in relation to clinical, business, and employability knowledge and skills. New graduate work readiness and transition may be enhanced by additional private practice experience, employer and client expectation management, provision of workplace support, and tailored university and continuing education. IMPACT: The number of new graduate physical therapists employed in private practice in Australia is increasing; however, until this study, their work readiness for this setting was unknown. This exploration of new graduate performance in private practice and transition can help to increase understanding and enhancement of work-readiness.