Evaluation of the Allied Health Rural Generalist Program 2017-2019.

OBJECTIVE: To evaluate the development and implementation of the Allied Health Rural Generalist Program, a two-level online post-graduate education program, which includes Level 1, an entry-level non-award pathway program, and Level 2, a Graduate Diploma in Rural Generalist Practice. DESIGN: A convergent mixed methodology evaluation in two overlapping stages: a process evaluation on quality and reach, together with a mixed method case study evaluation on benefits, of the program. SETTING: Rural and remote Australia across ten sites and seven allied health professions: dietetics; occupational therapy; pharmacy; physiotherapy; podiatry; radiography; speech pathology. PARTICIPANTS: Process evaluation included 91 participants enrolled in all or part of the Rural Generalist Program. Case study evaluation included 50 managers, supervisors and Rural Generalist Program participants from the ten study sites. INTERVENTIONS: The Allied Health Rural Generalist Program. MAIN OUTCOME MEASURES: Process evaluation data were derived from enrolment data and education evaluation online surveys. Case study data were gathered via online surveys and semi-structured interviews. Quantitative and qualitative data were collected concurrently, analysed separately and then integrated to identify consistency, expansion or discordance across the data. RESULTS: The Rural Generalist Program was viewed as an effective education program that provided benefits for Rural Generalist Program participants, employing organisations and consumers. Key improvements recommended included increasing profession-specific and context-specific content, ensuring Rural Generalist Program alignment with clinical and project requirements, strengthening support mechanisms within employing organisations and ensuring benefits can be sustained in the long term. CONCLUSION: The Rural Generalist Program offers a promising strategy for building a fit-for-purpose rural and remote allied health workforce.

Profile and rural exposure for nursing and allied health students at two Australian Universities: A retrospective cohort study.

OBJECTIVE: Linking enrolment and professional placement data for students' from 2 universities, this study compares characteristics across universities and health disciplines. The study explores associations between students' location of origin and frequency, duration and type of placements. DESIGN: Retrospective cohort data linkage. SETTING: Two Australian universities, Monash University and the University of Newcastle. PARTICIPANTS: Students who completed medical radiation science, nursing, occupational therapy, pharmacy or physiotherapy at either university between 2 February 2017 and 28 February 2018. INTERVENTIONS: Location of origin, university and discipline of enrolment. MAIN OUTCOME MEASURE(S): Main measures were whether graduates had multiple rural placements, number of rural placements and cumulative rural placement days. Location of origin, discipline and university of enrolment were the main explanatory variables. Secondary dependent variables were age, sex, socio-economic indices for location of origin, and available placements. RESULTS: A total of 1,315 students were included, of which 22.1% were of rural origin. The odds of rural origin students undertaking a rural placement was more than 4.5 times greater than for urban origin students. A higher proportion of rural origin students had multiple rural placement (56.0% vs 14.9%), with a higher mean number of rural placement days. Public hospitals were the most common placement type, with fewer in primary care, mental health or aged care. CONCLUSIONS: There is a positive association between rural origin and rural placements in nursing and allied health. To help strengthen recruitment and retention of graduates this association could be further exploited, while being inclusive of non-rural students.

International allied health student placements: A meta-synthesis.

BACKGROUND: Increasingly universities are offering international student placements as part of the global internationalisation movement. This review sought to synthesize the findings of studies to further understand the learning outcomes described by allied health students. AIMS/OBJECTIVES: To contribute to the understanding of the learning outcomes described by allied health students who have undertaken an international placement. METHODS: A qualitative meta-synthesis was conducted. From six databases, twenty-one studies were identified and critically appraised. Data were meta-aggregated, integrated and interpreted to develop new themes, with the experiences of over 259 allied health students synthesized. RESULTS: Themes include: the intertwined personal and professional development experienced by the students; confidence and independence, relationship building, insight into culture, service provision and differences in socio-economic and political contexts. CONCLUSION: Universities offering students international placements provide their students with opportunities to achieve unique learning outcomes with significant personal and professional transformational development that cannot be replicated by local placements.

Strategies to develop student support mechanisms in medical radiation sciences clinical education.

Clinical placement experience is an important component of medical radiation science (MRS) education, equipping students to safely transition into complex healthcare environments. This commentary draws on evidence from the literature that reports challenges allied health students face in clinical environments. As several factors are implicated that could result in a higher prevalence of psychological distress and mental ill-health in MRS students, there is a need to re-emphasize the importance of developing strategies to support students in clinical education. A key recommendation is to identify associated risk factors early as they can impact on the quality of education and in severe cases be detrimental to students' psychological well-being. This requires an understanding of the full extent and nature of the challenges through partnered approaches between professional organisations, clinical departments, academics and students. Developing evidence-based strategies for improving students' well-being in clinical environments is also essential.

Psychological interventions to foster resilience in healthcare students.

BACKGROUND: Resilience can be defined as maintaining or regaining mental health during or after significant adversities such as a potentially traumatising event, challenging life circumstances, a critical life transition or physical illness. Healthcare students, such as medical, nursing, psychology and social work students, are exposed to various study- and work-related stressors, the latter particularly during later phases of health professional education. They are at increased risk of developing symptoms of burnout or mental disorders. This population may benefit from resilience-promoting training programmes. OBJECTIVES: To assess the effects of interventions to foster resilience in healthcare students, that is, students in training for health professions delivering direct medical care (e.g. medical, nursing, midwifery or paramedic students), and those in training for allied health professions, as distinct from medical care (e.g. psychology, physical therapy or social work students). SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, 11 other databases and three trial registries from 1990 to June 2019. We checked reference lists and contacted researchers in the field. We updated this search in four key databases in June 2020, but we have not yet incorporated these results. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing any form of psychological intervention to foster resilience, hardiness or post-traumatic growth versus no intervention, waiting list, usual care, and active or attention control, in adults (18 years and older), who are healthcare students. Primary outcomes were resilience, anxiety, depression, stress or stress perception, and well-being or quality of life. Secondary outcomes were resilience factors. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, extracted data, assessed risks of bias, and rated the certainty of the evidence using the GRADE approach (at post-test only). MAIN RESULTS: We included 30 RCTs, of which 24 were set in high-income countries and six in (upper- to lower-) middle-income countries. Twenty-two studies focused solely on healthcare students (1315 participants; number randomised not specified for two studies), including both students in health professions delivering direct medical care and those in allied health professions, such as psychology and physical therapy. Half of the studies were conducted in a university or school setting, including nursing/midwifery students or medical students. Eight studies investigated mixed samples (1365 participants), with healthcare students and participants outside of a health professional study field. Participants mainly included women (63.3% to 67.3% in mixed samples) from young adulthood (mean age range, if reported: 19.5 to 26.83 years; 19.35 to 38.14 years in mixed samples). Seventeen of the studies investigated group interventions of high training intensity (11 studies; > 12 hours/sessions), that were delivered face-to-face (17 studies). Of the included studies, eight compared a resilience training based on mindfulness versus unspecific comparators (e.g. wait-list). The studies were funded by different sources (e.g. universities, foundations), or a combination of various sources (four studies). Seven studies did not specify a potential funder, and three studies received no funding support. Risk of bias was high or unclear, with main flaws in performance, detection, attrition and reporting bias domains. At post-intervention, very-low certainty evidence indicated that, compared to controls, healthcare students receiving resilience training may report higher levels of resilience (standardised mean difference (SMD) 0.43, 95% confidence interval (CI) 0.07 to 0.78; 9 studies, 561 participants), lower levels of anxiety (SMD -0.45, 95% CI -0.84 to -0.06; 7 studies, 362 participants), and lower levels of stress or stress perception (SMD -0.28, 95% CI -0.48 to -0.09; 7 studies, 420 participants). Effect sizes varied between small and moderate. There was little or no evidence of any effect of resilience training on depression (SMD -0.20, 95% CI -0.52 to 0.11; 6 studies, 332 participants; very-low certainty evidence) or well-being or quality of life (SMD 0.15, 95% CI -0.14 to 0.43; 4 studies, 251 participants; very-low certainty evidence). Adverse effects were measured in four studies, but data were only reported for three of them. None of the three studies reported any adverse events occurring during the study (very-low certainty of evidence). AUTHORS' CONCLUSIONS: For healthcare students, there is very-low certainty evidence for the effect of resilience training on resilience, anxiety, and stress or stress perception at post-intervention. The heterogeneous interventions, the paucity of short-, medium- or long-term data, and the geographical distribution restricted to high-income countries limit the generalisability of results. Conclusions should therefore be drawn cautiously. Since the findings suggest positive effects of resilience training for healthcare students with very-low certainty evidence, high-quality replications and improved study designs (e.g. a consensus on the definition of resilience, the assessment of individual stressor exposure, more attention controls, and longer follow-up periods) are clearly needed.

What students and new graduates perceive supports them to think, feel and act as a health professional in a rural setting.

OBJECTIVE: Clinical placements in rural locations are perceived by students to provide positive learning experiences to support their transition to practice. This study explores how clinical placements in a rural health setting might influence students and new graduates to think, feel and act as a health professional. DESIGN: A qualitative study comprising focus group discussions was conducted. SETTING: The study was conducted in a rural health service in Queensland, Australia. PARTICIPANTS: Allied health students (n = 12) on placement and new graduates (n = 11) working in a regional health service. MAIN OUTCOME MEASURES: This study identified allied health student and new graduate perspectives on clinical placement factors which support them to think, feel and act as a health professional. RESULTS: Thematic analysis was used to understand student and new graduate perceptions of how rural placements support thinking, feeling and acting as a health professional. Suggestions for supporting learning included the following: Development of learning partnerships between students and clinical educators with inbuilt expectations and opportunities for reflection and supervision. Creating a culture where students are welcomed, valued and encouraged to take meal breaks with the team supported connectedness. The importance of balancing student autonomy with educating and grading support to increase independence. CONCLUSIONS: Findings show clinical placement experiences identified by allied health students and new graduates which support them to begin to think, feel and act as a health professional. Suggestions provided by students and new graduates can be used to inform implementation of clinical placement experiences.

Fluctuations in Stress Over Time During the First Year of Health Science Programs.

PURPOSE: Psychological adjustment can impact individuals at various points during the formative years of their educational process. Health science programs can be highly stressful and potentially negatively impact physical and psychological health. This study intended to explore the fluctuations in stress levels in health science students during their first year of graduate school. METHODS: Study participants included students enrolled in four graduate health sciences programs: Doctor of Physical Therapy (DPT), Occupational Therapy (OT), Speech-Language Pathology (SLP), and Physician Assistant (PA). Students completed the Brief Symptom Inventory (BSI) during the first week of graduate school (time 1), during the last 2 weeks of semester 1 (time 2), and at mid-semester for semester 2 (time 3). Subscales on the BSI included anxiety, depression, obsessive compulsive, phobia and somatization. RESULTS: A total of 79 students completed the scale at all three time points. Mean anxiety scores changed over time from time 53 at time 1, 57 at time 2, to 54 at time 3. At the three time points, mean depression scores were 53, 56, and 53; mean obsessive-compulsive scores were 57, 63, 59; mean phobia scores 51, 50, and 50; and mean somatization scores 49, 54, and 51. DISCUSSION: There are notable fluctuations in anxiety levels in health science students, and therefore, it is necessary to assist students in developing effective stress management techniques to help moderate the negative consequences of stress.

A Framework for Teaching Development at a Specialized Graduate Institution.

The path for faculty advancement and self-improvement is often uncertain in higher education. Even in the health professions, where we diligently prepare graduate students for clinical roles, our pathways for new faculty transitioning from clinical to teaching roles are often nebulous. This article describes the process that the MGH Institute of Health Professions undertook in developing a set of Faculty Development Domains to guide graduate health professions faculty as they progress through their teaching careers. The aim was to provide faculty with a framework for guidance and self-assessment to identify areas for improvement that align with institutional priorities and that will elevate their teaching and professional roles. This process of developing the framework, which included a review of the literature, iterative revisions, and faculty focus groups, ultimately yielded four comprehensive domains that encompass "good teaching": planning and preparation, classroom environment, instruction, and professional responsibilities.

A Historical Cross-Professional Perspective on the Fellowship in Occupational Therapy.

Health professions education is increasingly creating learning experiences after one's entry-level practice degree. Such experiences include residency and fellowship experiences for health professions practitioners. This review of residency and fellowship programs across several health professions includes the development of residency programs and the implications these developments have on occupational therapy. The analysis across health professions includes medicine, pharmacy, physical therapy, speech-language pathology, and occupational therapy. This thorough analysis can help guide the development of occupational therapy fellowships. This background provides a foundation to focus on the implications for emerging fellowships within occupational therapy. The findings can be utilized to assist in the development of new successful fellowship programs.

Perceived Barriers and Challenges of Leadership Positions in Schools and Colleges of Health Professions in Higher Education: A Survey of Faculty at ASAHP Institutions.

AIMS: Faculty recruitment into leadership positions is increasingly more difficult. The purpose of this research study was to explore the perceived barriers and challenges to leadership positions in schools of allied health professions from a faculty perspective. METHODS: This study utilized an exploratory, survey design with convenience sampling. The survey was electronically disseminated to academic representatives within the 115 ASAHP member institutions. Survey questions included basic demographic and faculty information and addressed perceptions of barriers and challenges related to leadership positions. RESULTS: Responses were collected from 310 individuals, of whom 268 who completed the entire survey. Of these, 125 identified themselves as "full-time faculty within the institution and no prior administrative/leadership experience." Respondents were primarily female, white, non-Hispanic, with 10 or fewer years of faculty experience. The top five perceived barriers included: time demands, concerns about increased workload, lack of experience, family obligations, and lack of mentoring. The top five perceived challenges included: time management/workload demands, budgeting, faculty personnel issues, resource constraints, and fundraising. CONCLUSION: Institutions should consider position announcements that reflect behaviors and characteristics versus rank and faculty line, provide education on daily responsibilities, and implement intentional mentoring and professional development in the area of leadership positions.

Interdisciplinary Healthcare Students' Experiences of Intimidation, Harassment, and Discrimination During Training.

Healthcare professionals are trained on cultural competence and the treatment of patients with respect. Little research exists to examine intimidation, harassment, and discrimination (IHD) of interdisciplinary health professions trainees in the clinical training experience or policies around such actions. We surveyed a group of interdisciplinary students in the advanced years of their programs about IHD while in clinical training. Descriptive data and open-ended questions were analyzed. Of 87 respondents, the most frequently observed and experienced IHD were inappropriate verbal comments, 26.4% and 41.4%, respectively; the most frequent basis of observed IHD was race/ethnicity (17.2%) and the most frequently experienced was gender (26.4%). Physicians were noted most often to be the primary source of IHD (16.1%), followed by nurses (12.6%) and fellow trainees (12.6%). Of respondents experiencing IHD, 12 reported harassment, 11 reported intimidation, 6 reported discrimination, and 4 reported bias. When asked if anyone intervened at the time of the incident, 21 replied yes, most often supervisors or colleagues who were told (n=12). The incidence of IHD in clinical training warrants development of interdisciplinary training initiatives to address these issues.

A Case-Based, Brief, Intensive Interprofessional Education Experience for School Practitioners.

Professionals from healthcare and education frequently work together to serve clients in public schools. We devised an interprofessional activity including students in occupational therapy, physical therapy, speech-language pathology, social work, and education in which students designed an interprofessional intervention program for a school child with complex needs. Allied health students who expressed interest in pediatric practice were recruited to participate. Students filled out the Interdisciplinary Education Perception Scale (IEPS), a Likert-scale measure of perceptions about related disciplines, before and after the experience. Quantitative analysis of responses on the IEPS showed a significant improvement in interdisciplinary perceptions after the experience as evidenced by higher IEPS scores. Qualitative analysis using a narrative thematic description of reflections on the experience confirmed this finding. These findings suggest a brief, intensive preservice interprofessional experience can have a positive effect on students' interprofessional attitudes, and points toward aspects of these experiences, including student-led discussions and small group conversations, that students find especially appealing.

Clinical Education in Transition: Recommendations and Strategies: A Report of the ASAHP Clinical Education Task Force.

The practice models, interdisciplinary team functions, intersecting competencies, economies, and settings of contemporary healthcare are all in flux, demanding that educators reconsider traditional health professions clinical education models and partnerships. The Association of Schools Advancing Health Professions (ASAHP) and Allied Health (AH) deans, collectively and individually, must determine the priorities and strategies to advance AH education. This paper offers five recommendations that stem from a review of literature pertaining to current changes in the healthcare sector and higher education that challenge the availability of AH clinical education. Vetted by AH educators and health system representatives, the recommendations subsume proactive strategies that target factors affecting learning in the clinical environment and aim to meet the needs of patients/clients, employers, students, and educators. The recommendations are: 1) Develop meaningful strategic partnerships with healthcare organizations; 2) Assess and integrate interprofessional competencies for efficient and effective interprofessional practice (IPP); 3) Incorporate effective use of healthcare technology into AH education and practice; 4) Advocate within and among healthcare systems, higher education leadership, accreditation and professional organizations, and governmental agencies to foster and support IPP competencies and effective cross-discipline referrals; 5) Drive excellence in clinical education through promotion of research and scholarly activity.

High School Students' College Outcomes in a Dual Enrollment Program, 1998-2015.

AIMS: This paper examines the college outcomes of dual-enrolled high school health science careers' students from 1998 to 2015. METHODS: For this retrospective descriptive evaluation of the program, the university requested from the National Student Clearinghouse (NSC) data on 6,831 students who had earned college credit through the Rutgers high school program. Descriptive statistics were used for analysis using Excel. RESULTS: Final dataset had 5,315 students, with 3,339 students who had been in college long enough to graduate. Of the 2,358 (71%) who had graduated from college, 62% (1,470) completed their associates or bachelor's degrees within 2 or 4 years, while an additional 25% (581) finished their respective degrees within 3 to 6 years. Students attending 2-year colleges had a 42% overall, on-time graduation rate, and students attending 4-year colleges had a 95% graduation rate. One or more health professions degrees were earned by 36% (862) of graduated students. DISCUSSION: College degree completion rates of these students are better than national performance and many students entered health careers. This paper adds to the literature on design and outcomes of dual high school/college enrollment at a time when states are expanding these partnerships.

Simulation of integrative physiology for medical education.

Medical education is founded on the understanding of physiology. While lecture materials and reading contribute to the learning of physiology, the richness and complexity of the subject suggest that more active learning methods may provide a richer introduction to the science as it applies to the practice of medicine. Simulation has been previously used in basic science to better understand the interaction of physiological systems. In the current context, simulation generally refers to interactive case studies performed with a manikin or anatomic device. More recently, simulation has grown to encompass computational simulation: virtual models of physiology and pathophysiology where students can see in a mechanistic setting how tissues and organs interact with one another to respond to changes in their environment. In this manuscript, we discuss how simulation fits into the overall history of medical education, and detail two computational simulation products designed for medical education. The first of these is an acute simulator, JustPhysiology, which reduces the scope of a large model, HumMod, down to a more focused interface. The second is Sycamore, an electronic health record-delivered, real time simulator of patients designed to teach chronic patient care to students. These products represent a new type of tool for medical and allied health students to encourage active learning and integration of basic science knowledge into clinical situations.

Learning from those who have gone before: strengthening the rural allied health workforce in Aotearoa New Zealand.

Context and issues: The pipeline for the allied health, scientific and technical workforce of Aotearoa New Zealand is under growing pressure, with many health providers finding recruitment and retention increasingly difficult. For health providers in rural settings, the challenges are even greater, with fewer applicants and shorter tenures. As the health needs of rural communities increase, along with expectations of uptake of technologies and the Ministry of Health's strategy to ensure care is provided closer to home, being able to retain and upskill the diminishing workforce requires new ways of thinking. Lessons learned: Understanding the activity that has been undertaken by medical and nursing workforces in New Zealand and abroad, as well as the work of the Australian allied health workforce provides context and opportunities for New Zealand. The challenge is for educators, professional bodies, the Ministry of Health and health providers to develop new ways of thinking about developing a rural workforce for the allied health scientific and technical professions.

Research Success in Schools of Allied Health Professions.

Although the value of research within schools of allied health professions is widely accepted, its practice is limited, and the means of achieving success is poorly understood. This project aimed to characterize schools that have achieved research success, to explore the activities that allow schools to become successful, and to evaluate the metrics by which research success may be monitored. Using data from the 2016 ASAHP Institutional Survey (n=83 schools) and interviews with leadership at top-funded schools, we examined the relationships between external research funding, publications, and program rank for ASAHP member schools and explored the characteristics of well-funded schools. The hallmarks of success include high and clear expectations of faculty, significant levels of institutional investment in research infrastructure, and protected time for faculty research. Institutional support for publishing, including support for pilot studies, statistical analysis, and writing, may be important first steps in achieving research success. While average program rank is higher among schools with research funding than schools without it, program standing alone is not highly correlated with overall research success among ASAHP member institutions.

On-Campus Clinics in Allied Health Education: Necessity or Legacy?

On-campus clinics have been a pillar of graduate education in allied health programs for decades. However, traditional clinical education is under scrutiny due to budget cuts, reimbursement rates, and supervision requirements. Some universities opening new programs have opted out of building on-campus clinics. The purpose of this multisite qualitative case study was to examine an alternative model of clinical education. Four graduate programs were selected that did not have an on-campus clinic and were not affiliated with a medical school. Four main themes emerged: authentic experiences, professional networking, collaborative partnerships, and responsiveness. The findings suggested on-campus clinics are not necessary for providing clinical education. The participants suggested more programs should consider this alternative model of clinical education to expose students to authentic and diverse clinical experiences throughout their graduate education.