Teacher, Gatekeeper, or Team Member: supervisor positioning in programmatic assessment.

Competency-based assessment is undergoing an evolution with the popularisation of programmatic assessment. Fundamental to programmatic assessment are the attributes and buy-in of the people participating in the system. Our previous research revealed unspoken, yet influential, cultural and relationship dynamics that interact with programmatic assessment to influence success. Pulling at this thread, we conducted secondary analysis of focus groups and interviews (n = 44 supervisors) using the critical lens of Positioning Theory to explore how workplace supervisors experienced and perceived their positioning within programmatic assessment. We found that supervisors positioned themselves in two of three ways. First, supervisors universally positioned themselves as a Teacher, describing an inherent duty to educate students. Enactment of this position was dichotomous, with some supervisors ascribing a passive and disempowered position onto students while others empowered students by cultivating an egalitarian teaching relationship. Second, two mutually exclusive positions were described-either Gatekeeper or Team Member. Supervisors positioning themselves as Gatekeepers had a duty to protect the community and were vigilant to the detection of inadequate student performance. Programmatic assessment challenged this positioning by reorientating supervisor rights and duties which diminished their perceived authority and led to frustration and resistance. In contrast, Team Members enacted a right to make a valuable contribution to programmatic assessment and felt liberated from the burden of assessment, enabling them to assent power shifts towards students and the university. Identifying supervisor positions revealed how programmatic assessment challenged traditional structures and ideologies, impeding success, and provides insights into supporting supervisors in programmatic assessment.

Professional Identity Formation in Allied Health: A Systematic Review with Narrative Synthesis.

Phenomenon: Professional identity formation is a key component of health professional education. Changing expectations of healthcare requires more than competencies, but also an ingrained responsibility to patients, with our values and behaviors aligned with community expectations of patient-centered health professionals. Research into professional identity formation has focused on nursing and medical training, and, although allied health professionals make up one third of the workforce, research is uneven across these disciplines. Health professions educators from these under-researched disciplines have less guidance for how to support students' professional identity, meaning students may graduate with less mature professional identities. This systematic literature review synthesizes the research on professional identity formation across nine similar allied health disciplines. The purpose is to guide health professions educators in the formation of professional identity in allied health students. Approach: We carried out a systematic literature review, registered on Prospero, following the PRIMSA framework, to find, appraise, and synthesize research on professional identity for nine allied health professions. We synthesized extracted data using a narrative synthesis with convergent qualitative meta-integration of qualitative and quantitative data. Results: Our database searches combined with ancestry and forward searching resulted in 70 studies that met inclusion criteria. Studies came from 17 countries, from seven of the included disciplines (art therapy, dietetics, occupational therapy, physiotherapy, podiatry, psychology, and speech pathology) and from undergraduate, postgraduate, and new graduate perspectives. We found professional identity was influenced by the places of learning (curriculum and clinical experiences or placements), interactions with people (relationships with academics, peers, supervisors, patients,and role models), and educational practices engaged (dialogue, reflection, processing challenges), each acting on the individual person (student or new graduate) who also brought unique characteristics and experiences. Insights: This model of influences can inform health professions education to enable students to develop and graduate with a stronger professional identity formation.

Implementing programmatic assessment transforms supervisor attitudes: An explanatory sequential mixed methods study.

INTRODUCTION: Programmatic assessment (PA) is an increasingly popular approach to competency-based assessment (CBA), yet evaluation evidence is limited. This study aimed to identify and explore supervisor attitudes before and after implementing a novel PA using a sequential explanatory mixed methods design. In phase one, a survey was used to identify supervisor perspectives on work-based placements, PA and CBA. Survey results were then applied to develop focus group questions to further explore supervisor attitudes. RESULTS: PA was found to improve supervisor-student relationships by removing high-stakes assessment decisions and creating greater capacity for feedback and teaching, leading to a productive learning environment. Assessment was perceived as an important role and supervisors wanted to feel valued and heard within PA. Trust was conceptualised as a triad between supervisor, student and university, and enabled supervisors to engage with PA which was important for success. Supervisor learning of PA was experiential and often supported by students, highlighting the need for hands-on training. CONCLUSION: Participants reported a high level of agreement with PA and CBA principles which may have made them amenable to educational change. Further research is needed to explore the experience of all stakeholders and to understand how worldviews and culture influence assessment initiatives.

Designing programmes of assessment: A participatory approach.

Programmatic approaches to assessment provide purposeful and meaningful assessment yet few examples of their development exist. The aim of this study was to describe the development of a programme of assessment using a participatory action research (PAR) approach. Nine work-based assessors together with three academics met on six occasions to explore the current approach to competency-based assessment in the placement component of a dietetics university course, the findings of which were used to design a programme of assessment. Findings revealed disconnect between current assessment approaches and best practice. The PAR methodology fostered a shared vision for the design of a programmatic approach to assessment and strong leadership was essential. Participants experienced a philosophical shift in their views towards assessment, supporting the implementation of a new assessment programme. This paper is the first to describe a PAR approach as a feasible and effective way forward in the design of programmatic assessment. The approach engaged stakeholders to strengthen their abilities as work-based assessors and produced champions for best practice assessment.

Measuring energy requirements during pulmonary exacerbations of cystic fibrosis using indirect calorimetry.

OBJECTIVE: The energy demands of individuals with cystic fibrosis (CF) vary depending on pancreatic function, body composition, lung function, and clinical status. In clinical practice, predictive equations are used to determine energy requirements yet do not reliably account for these factors. Research regarding energy requirements during CF pulmonary exacerbation (CFPEx) and clinical stability is conflicting. The aim of this study was to investigate potential within-individual changes in measured resting energy expenditure (mREE) using indirect calorimetry (IC) at the commencement and completion of intravenous antibiotic treatment (IVABx) for CFPEx and during clinical stability. Secondary aims were to investigate potential differences between predicted resting energy expenditure (pREE) using Schofield equation and correlations between clinical factors with mREE. METHODS: Body composition using bioimpedance analysis and mREE were conducted at three time points: commencement of IVABx; completion of IVABx; and clinically stable period thereafter. RESULTS: Twenty-eight adults with CF completed at least one valid IC measurement. No significant within-person changes in mREE and body composition parameters were observed across time points. The mREE was positively correlated with fat-free mass (kg; r = 0.6; P = 0.008). The mREE was significantly higher than pREE at all time points with the mREE/pREE ratio elevated at time point 1:118% ± 19.5%; time point 2: 112% ± 13.2%; and time point 3: 122 ± 14.3%. CONCLUSION: The mREE remained stable during CFPEx and clinical stability. The pREE underestimated mREE and application of injury factor adjustment of 110% to 130% could potentially account for this discrepancy. The potential role of IC and body composition in individualizing CF nutritional assessment and prescription requires further exploration.

Assessment Practices for Dietetics Trainees: A Systematic Review.

High-quality education is essential to produce competent graduates in the field of dietetics. Assessment is a fundamental component of education and driver of learning, yet little is known about methods used to assess dietetics trainees. The objective of this review is to evaluate the practices and outcomes of methods used to assess dietetics trainees. A systematic review of the literature was undertaken. MEDLINE, the Cumulative Index to Nursing and Allied Health Literature Plus, Embase, and the Education Resources Information Center databases were searched from inception until May 31, 2017, using key terms that identified studies reporting practices for the assessment of dietetics trainees. Abstract and title screening was completed by three independent reviewers followed by full-text screening using the eligibility criteria. Quantitative and qualitative data were extracted. Study outcomes were evaluated using Miller's Pyramid, Kirkpatrick's Hierarchy, and the principles of programmatic assessment. Thirty-seven studies were identified. Assessments targeted all levels of Miller's Pyramid with the does level being the most prevalent (n=23). Most studies focussed on evaluating Level 1 (participation) (n=16) and Level 2b (n=16) (knowledge and skills) of Kirkpatrick's Hierarchy. Studies described single assessment instruments that focussed on instrument validity and reliability. Few studies considered a program of assessment or the role of expert judgment. Six themes were identified from qualitative data: (1) assessment for learning and professional development, (2) assessment requires motivated and skilled assessors, (3) trainees value authentic and global assessment, (4) assessment is evolving and context-sensitive, (5) poor assessment has negative implications, and (6) assessment evokes an emotional response. Studies focused on the development and evaluation of single quantitative-based instruments applied in isolation, with low-level outcomes sought. There is room to improve practices and design programs of assessment that combine quantitative and qualitative data for meaningful trainee feedback and credible assessment decisions. Comprehensive evaluation of assessment practices is required and must consider the contribution to improved health outcomes in all practice settings.

A dietetic clinical educator enhances the experience and assessment of clinical placement.

AIM: The aim of this study was to evaluate the impact of a Clinical Educator model on the learning experience and environment for students, preceptors and managers. METHODS: A Clinical Educator position was established for the 10-week dietetic clinical placement at Edith Cowan University. The Clinical Educator was responsible for overseeing the placement and assisting in the supervision of students. A qualitative descriptive approach using focus groups with purposive sampling explored the research question. Students (n = 10), preceptors (n = 21) and managers (n = 3) participated in separate focus groups. Data were thematically analysed with consideration given to participant and focus group commonalities and differences. RESULTS: The findings revealed that the Clinical Educator (i) reduced the logistical burden of student placements and improved time efficiency; (ii) facilitated student assessment within a programme of assessment; (iii) was uniquely positioned to provide support and enhance student confidence; and (iv) enhanced capacity to manage underperforming and challenging students. CONCLUSIONS: The Clinical Educator model increased student confidence, facilitated quality assessment and supported the management of underperforming students. This was achieved by reducing the burden of clinical placements, facilitating effective and timely communication between stakeholders and supporting the establishment of meaningful relationships which enriched learning. The results highlight the importance of the people involved in placement to facilitate a positive student learning environment and high quality assessment.