Developing professional education for primary healthcare providers about nutrition.

Nutrition care is an important component of primary health care as a way to promote positive lifestyle behaviours and reduce risks of chronic disease. Despite this, it appears that primary healthcare settings, including antenatal care, miss opportunities to deliver nutrition care. Time constraints, lack of nutrition knowledge and lack of confidence have been identified as barriers for primary healthcare providers in delivering nutrition care. Nutrition training to upskill primary healthcare providers to deliver nutrition care in a timely manner therefore appears warranted. This forum article discusses models and methods of continuing professional development (CPD) and the effectiveness of nutrition CPD for primary healthcare professionals. It includes a case study as an example of developing nutrition CPD for midwives using adult learning theory and concludes with implications for developing nutrition education resources for primary healthcare providers.

Evaluation of an educational board game to improve use of the partograph in sub-Saharan Africa: A quasi-experimental study.

BACKGROUND: The partograph is a tool used to record labour observations and support decision-making. Although used globally, it has not reached its full potential. We aimed to determine whether an educational board game can improve labour-monitoring skills and influence practice. STUDY DESIGN: A quasi-experimental study, underpinned by Kirkpatrick's evaluation model, was used. Midwives and student midwives from Malawi, Kenya and Tanzania were given an identical hypothetical case-scenario of a woman in labour pre-and post-implementation of a game, to assess recording and interpretation abilities. This was supplemented by qualitative inquiry 3 months post-game-playing using semi-structured interviews (n = 24) and expert case-record reviews (n = 24). Quantitative data were analysed using the paired t-test and qualitative data were subjected to framework analysis. RESULTS: 95 midwives and 97 students participated. In each country the mean test scores improved; Kenya from 86.5 (6.7) to 95.5 (3.7) (paired t = 11.82, p < 0.001), Malawi from 83.6 (6.7) to 94.6 (4.1) (paired t = 13.35, p < 0.001), and Tanzania from 83.8 (6.2) to 94.9 (4.1) (paired t = 15.27, p < 0.001). Qualitative findings revealed six themes: 'an enjoyable way of practicing,' 'learning and re-learning,' 'improved clinical decision-making', 'promoting team-work', 'a catalyst for additional learning' and 'barriers to transference of learning'. Expert case-record review demonstrated good adherence to recommendations. CONCLUSION: Board games have the ability to improve labour-monitoring knowledge. Retention of information was apparent and application of learning into practice was encouraging. Health-system barriers need to be resolved for midwives to apply theory to practice. Whether such application results in improved clinical outcomes is uncertain and requires further evaluation.

Increasing provider awareness of and recommendations for yoga and meditation classes for cancer patients.

OBJECTIVE: The purpose of the current study was to (1) assess healthcare providers' beliefs about and referral patterns to yoga and meditation services, and (2) evaluate the effectiveness of a brief yoga/meditation educational presentation to increase providers' intent to recommend these programs. METHOD: A brief 5-min presentation regarding the benefits of yoga and meditation for cancer patients and instruction about referring and enrolling patients was delivered in four different oncology settings: breast, gynecologic, radiation, and surgical. Healthcare provider participants filled out pre- and post-surveys assessing knowledge and attitudes surrounding yoga and meditation classes. RESULTS: A total of 40 healthcare providers were surveyed, consisting of 18 physicians, 12 nurses, six nurse practitioners, two physician assistants, one pharmacist, and one clinical researcher. Of these 40 healthcare providers, 43% were unaware at baseline that yoga and meditation classes were offered through the cancer center and 55% responded that they rarely or never recommend yoga or meditation for patients. Following a brief presentation about the benefits of yoga and meditation for cancer patients, 90% of providers stated they would be more likely to recommend these services to patients in the future. There was a significant (p < 0.01) increase in providers from pre- to post-presentation (65 to 85%) stating they strongly believe yoga and meditation can provide physical or emotional benefits for their patients. SIGNIFICANCE OF RESULTS: These data demonstrate that a brief educational intervention about yoga and meditation for cancer patients is effective at significantly increasing provider knowledge about the benefits of these therapeutic modalities, with a majority indicating they are more likely to recommend these services in the future. Increasing provider awareness regarding the health-promoting benefits of such supportive services for cancer patients could result in greater service utilization as well as physical and emotional benefits for patients.

Clinical learning spaces: Crucibles for practice development in physiotherapy clinical education.

This paper, through a deep examination of clinical workplaces as learning spaces, uses a holistic interpretation of clinical education and offers a practice development crucible metaphor as a useful way to deepen how clinical education can be conceptualized. An in-depth conceptualization of clinical education is needed if educators are able to develop wise educational practice and optimize the time students spend in clinical learning settings. The research reported here was undertaken in the qualitative paradigm guided by philosophical hermeneutics. Data collection strategies included observation, semi-structured interviews, focus groups and photo-elicitation. Twenty-four undergraduate physiotherapy students and twelve physiotherapy clinical supervisors participated in this research. Consistent with hermeneutic principles of dialogue of question and answer and hermeneutic circle, data analysis was achieved through an iterative process of reading, interpreting and re-reading the transcripts resulting in the emergence of a deeper understanding of clinical education that is represented for the reader. Clinical education has been revealed as a multidimensional learning space where workplace influences, engagement in professional practices, clinical supervisors' intentions and actions in combination with students' dispositions interact to shape and challenge students' clinical learning. A practice development crucible metaphor has been introduced as a way to represent this complexity and conceptualize clinical education, not as a set of techniques or supervision ratios but as a relational, fluid, complex space where learning is catalyzed. Importantly, the crucible metaphor assists academics, clinical supervisors and students to harness the power of clinical education to facilitate learning during clinical placements.

Avaliação de percepções sobre gestão da clínica em cursos orientados por competência / Assessment of perceptions of clinical management in courses oriented by competency

Resumo O estudo objetiva avaliar percepções de domínio de capacidades em gestão da clínica de participantes de cursos orientados por competência e baseados em metodologias ativas de ensino-aprendizagem, antes e após o processo de formação oferecido. Três marcos conceituais foram utilizados: gestão da clínica, expectativa de autoeficácia e concepção holística de competência. Metodologicamente, disponibilizou-se instrumento eletrônico para alunos de cursos de especialização adaptado da escala de Likert, em dois momentos, antes da realização dos cursos e ao término dos mesmos. O conjunto dos sujeitos que participaram simultaneamente nos dois momentos foi composto de 825 especializandos. Na análise, foram utilizados média, mediana, desvio-padrão e o teste de Wilcoxon. Em termos de resultados, em geral, a percepção de domínio de capacidades em gestão da clínica aumentou após os cursos, evidenciando a contribuição positiva do processo na formação dos especializandos. Conclui-se, dentre outros aspectos, que as inciativas educacionais estudadas, orientadas por competência e baseadas em metodologias ativas de ensino e aprendizagem, podem obter, dentre os seus resultados, o aumento da percepção de seus participantes acerca do domínio de capacidades presentes no perfil de competência, confirmando a hipótese do estudo.

Abstract The study aims to assess perceptions of mastery of abilities in clinical management in participants of courses oriented by competency and based on active methodologies of teaching and learning, before and after the offered training process. Three conceptual frameworks were utilized: clinical management, expectation of auto-efficacy, and the holistic concept of competency. Methodologically, an electronic instrument was made available to students of the training courses, adapted to the Likert scale, in two stages: before the courses were undertaken and after their completion. The group of subjects that participated simultaneously in both stages was comprised of 825 trainees. Average, mean, standard deviation, and the Wilcoxon test were utilized in the analysis. Generally, in terms of findings, the perception of mastery of abilities in clinical management increased after the courses, proving a positive contribution of the training process of the students. Among other aspects of their results, it is concluded that the educational initiatives studied, oriented by competency and based in active methodologies of teaching and learning, can obtain the increase in perception of their participants regarding the mastery of abilities present in the competency profile, confirming the study's hypothesis.

Assessment of perceptions of clinical management in courses oriented by competency. / Avaliação de percepções sobre gestão da clínica em cursos orientados por competência.

The study aims to assess perceptions of mastery of abilities in clinical management in participants of courses oriented by competency and based on active methodologies of teaching and learning, before and after the offered training process. Three conceptual frameworks were utilized: clinical management, expectation of auto-efficacy, and the holistic concept of competency. Methodologically, an electronic instrument was made available to students of the training courses, adapted to the Likert scale, in two stages: before the courses were undertaken and after their completion. The group of subjects that participated simultaneously in both stages was comprised of 825 trainees. Average, mean, standard deviation, and the Wilcoxon test were utilized in the analysis. Generally, in terms of findings, the perception of mastery of abilities in clinical management increased after the courses, proving a positive contribution of the training process of the students. Among other aspects of their results, it is concluded that the educational initiatives studied, oriented by competency and based in active methodologies of teaching and learning, can obtain the increase in perception of their participants regarding the mastery of abilities present in the competency profile, confirming the study's hypothesis.

O estudo objetiva avaliar percepções de domínio de capacidades em gestão da clínica de participantes de cursos orientados por competência e baseados em metodologias ativas de ensino-aprendizagem, antes e após o processo de formação oferecido. Três marcos conceituais foram utilizados: gestão da clínica, expectativa de autoeficácia e concepção holística de competência. Metodologicamente, disponibilizou-se instrumento eletrônico para alunos de cursos de especialização adaptado da escala de Likert, em dois momentos, antes da realização dos cursos e ao término dos mesmos. O conjunto dos sujeitos que participaram simultaneamente nos dois momentos foi composto de 825 especializandos. Na análise, foram utilizados média, mediana, desvio-padrão e o teste de Wilcoxon. Em termos de resultados, em geral, a percepção de domínio de capacidades em gestão da clínica aumentou após os cursos, evidenciando a contribuição positiva do processo na formação dos especializandos. Conclui-se, dentre outros aspectos, que as inciativas educacionais estudadas, orientadas por competência e baseadas em metodologias ativas de ensino e aprendizagem, podem obter, dentre os seus resultados, o aumento da percepção de seus participantes acerca do domínio de capacidades presentes no perfil de competência, confirmando a hipótese do estudo.

Evaluation of the general university requirements: what did students say?

The General University Requirements (GUR) is the core general education component of the new 4-year undergraduate curriculum at The Hong Kong Polytechnic University (PolyU) commencing from the 2012/2013 academic year. The major objective of the GUR is to widen students' horizons and promote their holistic development in their undergraduate years. To evaluate the perceived effectiveness of the GUR in its second year implementation, 18 focus group interviews (n=74 students) were conducted in the 2013/2014 academic year. Findings showed that subjects under the GUR framework were overall welcomed by students for the well-designed subject contents, dedicated teaching staff, and collaborative and experiential learning methods. Students perceived that the GUR was beneficial to their development in effective communication, critical thinking, problem solving, lifelong learning, and ethical leadership. Some challenges encountered by students were noted to further revamp the GUR curriculum in the future.

[Assessment of curricular contents and perception of competencies of health students related to the integrated health care model in Colombia]. / Evaluación de contenidos curriculares y percepción de competencias de estudiantes del área de la salud respecto del Modelo Integral de Atención en Salud en Colombia.

OBJECTIVE: To identify the perception of the last level students of the professional and technical health training programs regarding their competences to perform in the MIAS, and to evaluate the presence of said competences within the curricular contents of the health programs in Santander. METHODS: A transversal descriptive study was carried out in 451 students and a documentary review of curricula was performed for 26 programs. The content of an online questionnaire on the perception of competences in the areas of knowledge, attitudes and abilities was constructed and validated. RESULTS: In the documentary review, deficiencies were found in the inclusion of competencies such as leadership (80 %) and differential approach in care (84 %). In the perception survey, 36 % of the students stated that they had regular or deficient knowledge about Integral Routes of Health Care, benefit plans and actors of the health system. Additionally, 7.5 % stated they were not competent to carry out intersectoral coordination activities, epidemiological surveillance or public health research. CONCLUSION: The results show the need to include in the curricula of health programs some fundamental aspects for the proper implementation of MIAS.

OBJETIVO: Identificar la percepción de los estudiantes de último nivel de los programas de formación profesional y técnica en salud respecto a sus competencias para desempeñarse en el MIAS, y evaluar la presencia de dichas competencias dentro de los contenidos curriculares de los programas de salud en Santander. MÉTODOS: Se realizó un estudio descriptivo transversal en 451 estudiantes y una revisión documental de currículos de 26 programas. Se construyó y validó el contenido de un cuestionario en línea de percepción de competencias en los ámbitos del saber ser, saber conocer y saber hacer. RESULTADOS: En la revisión documental se encontró deficiencias en la inclusión de competencias tales como las de ejercer liderazgo (80 %) y realizar un enfoque diferencial en la atención (84 %). En la encuesta de percepción, el 36 % de los estudiantes manifestaron tener un conocimiento regular o deficiente sobre Rutas Integrales de Atención en Salud, planes de beneficios y actores del sistema de salud. Adicionalmente, el 7,5 % afirmaron ser poco competentes para realizar actividades de coordinación intersectorial, vigilancia epidemiológica o investigación en salud pública. CONCLUSIONES: Los resultados evidencian la necesidad de incluir en los currículos de programas de salud algunos aspectos fundamentales para la adecuada implementación del MIAS.

Self-testing produces superior recall of both familiar and unfamiliar muscle information.

Dozens of studies have found learning strategies based on the "testing effect" promote greater recall than those that rely solely on reading; however, the advantages of testing are often only observed after a delay (e.g., 2-7 days later). In contrast, our research, which has focused on kinesiology students learning kinesiology information that is generally familiar to them, has consistently demonstrated that testing-based strategies produce greater recall both immediately and after a delay. In an attempt to understand the discrepancies in the literature, the purpose of the present study was to determine if the time-related advantages of a testing-based learning strategy vary with one's familiarity with the to-be-learned information. Participants used both read-only and testing-based strategies to repeatedly study three different sets of information: 1) previously studied human muscle information (familiar information), 2) a mix of previously studied and previously unstudied human muscle information (mixed information), and 3) previously unstudied muscle information that is unique to sharks (unfamiliar information). Learning was evaluated via free recall assessments administered immediately after studying and again after a 1-wk delay and a 3-wk delay. Across those three assessments, the read-only strategy resulted in mean scores of 29.26 ± 1.43, 15.17 ± 1.29, and 5.33 ± 0.77 for the familiar, mixed, and unfamiliar information, respectively, whereas the testing-based strategy produced scores of 34.57 ± 1.58, 16.90 ± 1.31, and 8.33 ± 0.95, respectively. The results indicate that the testing-based strategy produced greater recall immediately and up through the 3-wk delay regardless of the participants' level of familiarity with the muscle information.

The Effects of CPE on Primary Relationships--Is It Worth Exploring?

Clinical Pastoral Education (CPE) can be a life transforming experience for students, but does it also transform students' primary relationships? An online survey of past CPE students at Royal Perth Hospital, Western Australia, found that--overall--CPE had a positive effect on primary relations in key areas, in particular communication, intimacy and spirituality. Recent relationships were more negatively affected. Some relationships did not survive CPE. Structural and pedagogical implications require further research.

Estrategia pedagógica para la formación profesional en ciencias biomédicas / Pedagogical strategy for the vocational training in biomedical sciences

Las insuficiencias en la orientación formativa de los contenidos científico-médicos en correspondencia con la comprensión, explicación e interpretación del ser humano, que limitan la lógica de actuación de los profesionales de la medicina y su desempeño futuro, fueron tratadas a través de la dinámica del proceso de formación profesional en las ciencias biomédicas, que tiene lugar en la Universidad de Ciencias Médicas de Santiago de Cuba. Por tal motivo, se ideó la elaboración de una estrategia pedagógica para la formación del profesional de las ciencias biomédicas, que contribuya al perfeccionamiento del ciclo básico de la carrera de medicina en cuanto al estudio del organismo humano con una visión holística. Se valoró la pertinencia científica de los resultados investigativos, se realizó la aplicación parcial de la estrategia pedagógica propuesta y se logró un impacto social en el perfeccionamiento del proceso de formación del médico general, lo cual lleva a la transformación de su desempeño, al ofrecer una solución a los problemas de salud que debe enfrentar en la atención al individuo, la familia y la comunidad(AU)

The inadequacies in the training orientation of the scientific-medical contents in correspondence to the understanding, explanation and interpretation of the human being that limit the logic of the medicine professionals performance and their future acting, were treated through the dynamics of the vocational training process in biomedical sciences taking place in the University of Medical Sciences from Santiago de Cuba. For such a reason, the elaboration of a pedagogical strategy was drawn for the training of the biomedical sciences professional, contributing to the improvement of the basic cycle of the medicine career as for the study of the human organism with a holistic vision. The scientific relevance of the investigative results was evaluated, the partial application of the pedagogical strategy proposed was carried out, and a social impact was achieved in the improvement of the general doctor training process, which brings the transformation of his acting, as it offers a solution to the health problems that he should face in the care to the individual, the family and the community(AU)

Relationship between chiropractic teaching institutions and practice characteristics among Canadian doctors of chiropractic: a random sample survey.

OBJECTIVE: The objectives of this study were to determine if faction membership among Canadian doctors of chiropractic (DCs) is associated with differences in educational program characteristics among English-speaking Canadian and United States chiropractic colleges and to determine if those differences are expressed in terms of surveyed attitudes and behaviors regarding treatment efficacy, radiographic imaging, vaccinations, and interprofessional referrals. This study also aims to identify if educational programs may be a potential source of multiple professional identities. METHODS: A randomly selected sample of Canadian DCs, stratified across the English-speaking provinces, was surveyed by mail. Survey items included school of graduation, self-categorization by chiropractic subgroup, perceptions of condition-specific treatment efficacy, use of plain film radiographic imaging, vaccination attitudes/behaviors, and patient referral patterns. Self-categorization by chiropractic subgroup included: the unorthodox faction (associates the chiropractic subluxation as an encumbrance to the expression of health) and the orthodox perspective (associates with musculoskeletal joint dysfunction, public health, and lifestyle concerns). For data analysis, chiropractic schools were divided into 2 groups according to location: English-speaking Canada and the US. The US was further clustered into liberal ("interested in mixing elements of modern and alternative therapies into the practice of chiropractic") and conservative categories ("chiropractors who believe in continuing the traditions of chiropractic"). RESULTS: Of 740 deliverable questionnaires, 503 were returned for a response rate of 68%. χ(2) Testing revealed significant differences in self-categorized faction membership associated with the clustering of colleges based on ideological viewpoints (χ(2) = 27.06; P = .000). Descriptive results revealed a relationship between school of origin and perceived treatment efficacy, use of radiographic imaging, and vaccination attitudes. No significant differences were found relative to interprofessional referral patterns. CONCLUSION: Chiropractic program attended is a significant predictor of orthodox vs unorthodox faction membership and professional practice characteristics for Canadian DCs. This suggests that the current chiropractic education system may contribute to multiple professional identities.

Developing midwifery and complementary medicine collaboration: the potential of interprofessional education?

A higher percentage of referrals to complementary and alternative medicine (CAM) by midwives can be linked to their affinity with CAM. However, midwifery education does not commonly include CAM as part of the curriculum leaving potential for misinformation and unsafe practice. An approach to CAM education which encourages collaboration between all care providers is needed to ensure safe, woman-centred maternity care. Whilst a number of models have been considered in health education they are not without their limitations when aiming to promote interprofessional collaboration. It is proposed through this paper that improved communication between midwives and qualified CAM practitioners may be developed through employing the interprofessional education model. This model develops attributes for collaborative practice and improves the delivery of interprofessional care. Achieving this collaboration is vital for safe, woman-centred care for the many pregnant women accessing CAM and conventional care for their pregnancy and birth.

Developing behavioural training services to meet defined standards within an Australian statewide disability service system and the associated client outcomes.

BACKGROUND: LaVigna, Christian, and Willis (2005) reported on a project where Institute for Applied Behaviour Analysis (IABA) staff trained a professional team in New Zealand (NZ) to provide behavioural services that met defined criteria. The NZ team was then trained to train other practitioners to meet the same professional standards. However, no client outcomes were reported in that study. METHOD: This study replicates the NZ study within disability services in Tasmania, Australia. Further, this study examined the associated client outcomes and the impact of the training on severity ratings of subsequent referrals. RESULTS: Tasmanian trainers trained participants to provide behavioural services that met the same professional standards. Client behavioural outcome data showed significant improvement. Referral data showed decreases in severity ratings. CONCLUSIONS: The trainer of trainers process is effective in training staff to meet defined professional standards, including desired client outcomes, and to effectively make positive behaviour support accessible to a large number of people.

Differences between African-American and Caucasian students on enrollment influences and barriers in kinesiology-based allied health education programs.

Kinesiology departments have recently started to offer allied health education programs to attract additional students to teacher education units (9). Although allied health professions offer increased work opportunities, insufficient enrollment and training of minority students in these academic fields contribute to underrepresentation in the workforce (3). To improve workforce diversity, kinesiology departments must understand how enrollment influences and barriers differ by race among prospective students. Therefore, the purpose of this study was to identify differences in allied health education enrollment influences and enrollment barriers between minority and Caucasian students. Participants (n = 601) consisted of students enrolled in kinesiology-based allied health education programs. Multivariate ANOVA was used to compare group differences in enrollment decision making. "Personal influence," "career opportunity," and "physical self-efficacy" were all significantly stronger enrollment influences among African-American students than among Caucasian students, and "social influence," "experiential opportunity," "academic preparation," and "physical self-efficacy" were all perceived as significantly greater barriers compared with Caucasian students. Findings support the need to recruit African-American students through sport and physical education settings and to market program-based experiential opportunities.

Effects of aerobic endurance, muscle strength, and motor control exercise on physical fitness and musculoskeletal injury rate in preprofessional dancers: an uncontrolled trial.

OBJECTIVE: The purpose of this study was to evaluate musculoskeletal injury rate and physical fitness before and 6 months after an endurance, strength, and motor control exercise program in preprofessional dancers. METHODS: This uncontrolled trial was completed at a college offering a professional bachelor degree in dance. Forty preprofessional dancers underwent a test battery before and after a 6-month lasting exercise program in addition to their regular dance lessons. Physical fitness was evaluated by means of a submaximal exercise test with continuous physiological monitoring and by a field test for explosive strength. Anthropometric measurements were taken to analyze the influence of fitness training on body composition. Musculoskeletal injury incidence and quality of life were recorded during the 6-month lasting intervention. An intention-to-treat analysis ("last observation carried forward" method) was used with a Student t test for normally distributed variables. The Wilcoxon signed rank and Mann-Whitney U tests were used as nonparametric tests. RESULTS: Physical fitness improved after the 6 months of additional training program (P<.05). The waist:hip ratio (P=.036) and the sum of the measured subcutaneous skin thickness (P=.001) significantly decreased. Twelve dancers developed musculoskeletal complaints, requiring temporary interruption of dancing. CONCLUSIONS: The combination of regular dance lessons with an additional exercise program resulted in improved physical fitness in preprofessional dancers, without affecting the aesthetical appearance. A relatively high injury rate was observed during the intervention period. These results suggest that a randomized, controlled trial should be performed to examine the effectiveness of additional exercise in dancers on physical fitness and musculoskeletal injury rate.

A transformative perspective on learning and professional development of Afghan physiotherapists.

The aim of this article is to explore factors that impacted learning of Afghan physiotherapists in a development project to improve the physiotherapy services in a disability programme implemented by a Swedish nongovernmental organisation in Afghanistan. Participant observation, recorded as field notes, was used to document the process, to gain a better understanding of professional development of physiotherapists in Afghanistan. Field notes were analysed and factors affecting learning were interpreted from a perspective inspired by transformative learning. Various factors were identified: a pattern approach to treatment, linear thinking, and socially oriented decision making affected how new things learned were put into practice; concrete representations and an instrumental view of knowledge characterised learning approaches; language barriers, different interpretations of meaning, and cultural codes challenged communication; and a prescriptive, encouraging approach of the expatriate physiotherapy development worker affected teaching and learning. Working with professional development across cultural borders is challenging, and the identified factors impacting learning can help expatriate physiotherapists in adapting training to the Afghan context. Exploring meaning perspectives and communicative learning could enhance understanding of these factors for both expatriate and Afghan physiotherapists and should be a focus in future development activities.

Teaching nutrition integration: MUST screening in cancer.

RATIONALE: Nutritional risk screening should be routine in order to select patients in need of nutrition care; this conduct change has to rely on education. In this project, radiotherapy department health professionals were trained on how to use the Malnutrition Universal Screening Tool (MUST), to foster its integration into cancer outpatient management; we also aimed to identify those more adherent to screening. METHODS: Research dieticians (the standard) conducted interactive sessions with all physicians, nurses, and radiotherapy (RT) technicians, who were closely supervised to facilitate routine MUST integration. There were two phases: after the first session, phase 1 assessed 200 patients over 4 months; after the second session, phase 2 screened 450 patients, always before RT. Validity was evaluated comparing results from the standard against all other health professionals, adjusted for number. RESULTS: RT technicians were most adherent to the MUST: 80% of patients in phase 1, increasing to 85% in phase 2. Nurses doubled their input, from 19% to 36%. Physicians had poor MUST integration, yet they progressively incorporated percentage weight loss into patient records, increasing from 57% in phase 1 to 84% in phase 2, independently of diagnosis and stage. The highest concordance (κ coefficient) with dieticians was found with RT technicians' use of the MUST (p < .002) and percentage weight loss determination by physicians (p < .001). CONCLUSIONS: We show that systematic screening in cancer is feasible by all professionals involved, once a proximity teaching project is put into practice. RT technicians, who daily treat patients, were highly adherent to integrate the MUST and might be in charge of selecting at-risk patients. Physicians are unlikely to use the MUST, but acknowledged nutrition value and changed their routine by integrating recent percentage weight loss into their approach to patients. Our structured methodology may be used as a model for the development of teaching adapted to different departments with other realities.

The impact of Masters education in manual and manipulative therapy and the 'knowledge acquisition model'.

This study aimed to explore the professional and personal impact that a clinical Masters program of manipulative therapy education had on the lives of individuals who had undertaken the course and was a follow-on study of participants' career pathways following Masters education (Green et al., 2008). Seven graduates from the program took part in a focus group. The narrative data obtained was independently verified prior to two researchers conducting a systematic, thematic content analysis. Three key themes were identified and the 'knowledge acquisition model' developed. Findings revealed that studying at Master's level is a 'life changing' and rewarding experience that develops individuals in three key domains; professionally, personally and intellectually. During Masters education students described a journey of multi-compartmental development whereby their knowledge-base was challenged and their existing cognitive framework deconstructed. Progression through the program resulted in the development of a new, clearer framework for thinking and understanding that extended, universally, into all aspects of their lives; clinically, managerially, emotionally, politically and intellectually. Participants also described two cultures for career progression in the UK National Health Service (NHS). Findings could help students considering undertaking Masters level education, employers and clinical mentors of these practitioners and academic educators.

From the ideal to the real world: a phenomenological inquiry into student sojourners' reentry adaptation.

This phenomenological study examines the thematic structure of reentry transition for international music therapy graduates who have returned home after studying in the United States. Emphasis is placed upon career development. Standardized open-ended interviews were used to obtain rich and in-depth descriptions of the participants' experiences. Ten music therapists from six countries participated in the study. The themes that emerged from the data include moving from the ideal to the real world, shifting from the role of student to professional, confronting reality and working through challenges, and achieving personal growth and self-transformation. The dynamics of cross-cultural comparison, confronting the home culture, and redefining music therapy and professional identities within the local cultural context are illustrated via quotations from the participants. Implications and recommendations for music therapy education and career preparation for international graduates are discussed.