Shifting the narrative and practice of assessing professionalism in dietetics education: An Australasian qualitative study.

AIM: We aimed to explore current approaches to assessing professionalism in dietetics education in Australia and New Zealand, and asked the questions what is working well and what needs to improve? METHOD: We employed a qualitative interpretive approach and conducted interviews with academic and practitioner (workplace-based) educators (total sample n = 78) with a key stake in dietetics education across Australia and New Zealand. Data were analysed using team-based, framework analysis. RESULTS: Our findings suggest significant shifts in dietetics education in the area of professionalism assessment. Professionalism assessment is embedded in formal curricula of dietetics programs and is occurring in university and placement settings. In particular, advances have been demonstrated in those programs assessing professionalism as part of the programmatic assessment. Progress has been enabled by philosophical and curricula shifts; clearer articulation and shared understandings of professionalism standards; enhanced learner agency and reduced power distance; early identification and intervention of professionalism lapses; and increased confidence and capabilities of educators. CONCLUSIONS: These findings suggest there have been considerable advances in professionalism assessment in recent years with shifts in practice in approaching professionalism through a more interpretivist lens, holistically and more student-centred. Professionalism assessment in dietetics education is a shared responsibility and requires further development and transformation to more fully embed and strengthen curricula approaches across programs. Further work should investigate strategies to build safer learning cultures and capacity for professionalism conversations and in strengthening approaches to remediation.

"We Are Our Own Worst Enemies": A Qualitative Exploration of Sociocultural Factors in Dietetic Education Influencing Student-Dietitian Transitions.

BACKGROUND: The transition from student to dietitian is an implicit expectation of dietetic education. Although there has been an expanding literature around elements of competency-based education, little attention has focused on sociocultural aspects of learning and professional identity formation in dietetic education. OBJECTIVE: The aim of this study was to explore sociocultural factors in dietetics education influencing the transition into the profession from the perspective of dietetics students and educators. DESIGN: An exploratory qualitative study underpinned by social constructionism. PARTICIPANTS/SETTING: From March 2018 until June 2019, interviews (individual and group) with final-year students (n = 22), dietetic preceptors (n = 27), and university faculty members (n = 51) from 17 of the 18 universities in Australia and New Zealand with accredited dietetic programs were undertaken and explored sociocultural factors in dietetic education. ANALYSIS PERFORMED: Data were analyzed into key themes using framework analysis and applying the sociocultural theory of landscapes of practice. RESULTS: Sociocultural factors are powerful influences on the student-professional transition. Dietetic cultures and minicultures of cohesion, conformity, competition, and conflict aversion exist. Boundaries exist within learning environments, which can limit or pose challenges to professional identity formation and transition into the profession. CONCLUSION: Stakeholders involved in dietetics education play pivotal roles in shaping the microcultures students learn and work within, which influence and impact socialization and transition into the profession. Opportunities exist to re-vision curriculum and foster positive learning cultures with a focus on sociocultural learning, including supporting boundary crossing and professional identity development.

Conceptualizing Professionalism in Dietetics: An Australasian Qualitative Study.

BACKGROUND: Professionalism is a vital aspect of health care and multidisciplinary teamwork. Although there is substantive professionalism literature in medicine and an expanding health care professions literature, there is a significant gap in understanding professionalism in dietetics. There are very few research papers in the dietetics literature on this issue compared with other health professions. Given the multidisciplinary nature of health care, it is important to understand what professionalism means within each profession to develop shared understandings across health care teams. OBJECTIVE: The study aim was to explore how dietetics professionalism is conceptualized by dietetic practitioners/preceptors, faculty, and new graduates. DESIGN: A constructionist exploratory qualitative interview study was conducted. PARTICIPANTS/SETTING: One hundred participants (dietetics graduates, faculty, and practitioners/preceptors), associated with 17 universities across Australia and New Zealand and from diverse geographical and work settings, participated in 27 group and 24 individual interviews from March 2018 to June 2019. STATISTICAL ANALYSES PERFORMED: Thematic framework analysis was used to examine participants' understandings of professionalism. RESULTS: Twenty-three dimensions of dietetics professionalism were identified, with the most common being communication and including four novel dimensions of professionalism (generational, emotion management, cultural capability, and advocacy) not previously described in other professions. Professionalism as emotion management and generational adds new insights to the professionalism literature, expanding understandings of this vital aspect of health care. Although high levels of consistency in professionalism understandings existed across the three stakeholder groups, some interesting differences were found. The profession of dietetics shares similarities with other professions in the ways professionalism is conceptualized. CONCLUSIONS: Using these dimensions of professionalism as a framework for teaching and learning about professionalism will help in clarifying expectations and expand shared understandings about professionalism for dietitians, other health professions, and across multidisciplinary teams.

Toward a Global Definition of Professionalism for Nutrition and Dietetics Education: A Systematic Review of the Literature.

BACKGROUND: Professionalism of health care practitioners is central to safe and ethical health care, and forms part of the trust that the public places in health care practitioners. Lapses in professionalism in health care present considerable challenges and can have serious consequences and outcomes. Teaching, learning, and assessing professionalism is an important component of nutrition and dietetics education. There is scant peer-reviewed published research related to professionalism in nutrition and dietetics. Providing a definition of professionalism will support progress in curriculum planning and design, teaching, learning and assessment of students, and ongoing professional development of educators and practitioners. OBJECTIVE: The aim of this study was to conceptualize and define professionalism for the purpose of teaching nutrition and dietetics. DESIGN: This study included a critical systematic literature review of original research and a targeted and systematic search of national and international dietetics competency standards, exploring the concept and definitions of professionalism in nutrition and dietetics. Competency standards were chosen as an additional focus in the systematic literature search, as they are the key framework documents that guide curriculum development and education standards internationally. Thematic analysis was used to synthesize extracted data and an inductive, interpretivist approach was then applied in conceptualizing a definition of professionalism. RESULTS: Seven studies and six national and international sets of competency standards were included in the literature review. Four major themes conceptualizing a definition of professionalism for nutrition and dietetics were identified from the integration of the original research and targeted gray literature reviews: 1) personal attributes; 2) interpersonal communication; 3) approach to practice; and 4) commitment to lifelong learning. CONCLUSIONS: Defining professionalism for nutrition and dietetics supports progress toward shared understandings, building trust, and assisting in dietetics education and practice. It can be used to support and extend teaching, learning, and assessment of professionalism.

The future of the Primary Examination.

The objective of the Primary Examination is to ensure that trainees have the required level of knowledge and understanding of the four basic sciences of anatomy, pathology, physiology and pharmacology to underpin their further learning and development towards careers as emergency medicine physicians. The candidate is expected to show an understanding of the subject matter and demonstrate their ability to apply their knowledge to the practice of emergency medicine. As part of the curriculum review, ACEM undertook to implement changes to the Primary Examination in order to make it more clinically relevant.

Empathy levels among health professional students: a cross-sectional study at two universities in Australia.

BACKGROUND: Empathy is paramount in the health care setting, optimizing communication and rapport with patients. Recent empirical evidence suggests that empathy is associated with improved clinical outcomes. Therefore, given the importance of empathy in the health care setting, gaining a better understanding of students' attitudes and self-reported empathy is important. The objective of this study was to examine self-reported empathy levels of students enrolled in different health disciplines from two large Australian universities. MATERIALS AND METHODS: A total of 1,111 students from two different universities enrolled in eight different health professions were administered the Jefferson Scale of Physician Empathy - Health Profession Students version, a 20-item 7-point Likert scale questionnaire to evaluate self-reported empathy levels. RESULTS: A total of 1,111 students participated in this study. The majority of participants were from Monash University (n=771), with 340 students from Edith Cowan University. No statistically significant differences were found between universities: Monash University (mean 110.1, standard deviation [SD] 11.8); Edith Cowan University (mean 109.2, SD 13.3, P=0.306). The mean female empathy score (mean 110.8, SD 11.7) was significantly higher than the mean male score (mean 105.3, SD 13.5; P<0.0001; d=0.44). Paramedic students had significantly lower empathy scores (mean 106.3, SD 12.73) than all other participants except nursing students (P<0.0001). CONCLUSION: Results relating to sex are reflective of previous studies. There is some discrepancy in results relating to empathy and its incline/decline as students progress through a program. Further study is warranted to explore why there are variations in empathy levels in students of different health disciplines.

A qualitative evaluation of an Australian public health nutrition workforce development intervention involving mentoring circles.

OBJECTIVE: To evaluate a mentoring circle workforce development intervention among a group of public health nutrition novices. DESIGN: The mentoring circle intervention focused on facilitating practice-based public health nutrition competence development and supporting reorientation of practice from clinical services to preventive services. A retrospective post-intervention qualitative semi-structured interview was used to explore the experiences of those participating in the mentoring circle and to make evaluative judgements about intervention attributes and effectiveness. SETTING: Victoria, Australia. SUBJECTS: Thirty-two novice public health nutrition practitioners employed in the state public health system. RESULTS: Key evaluative theme categories relating to the mentoring circle intervention were identified, including the structure and function of the group, the utility of using advanced-level competency items to guide planning, having a safe and supportive environment for learning and the utility of learning via mentoring and on-the-job experiences. These qualitative evaluation data identify the attributes of the mentoring circle intervention contributing to intervention effectiveness. CONCLUSIONS: This qualitative evaluation indicates that mentoring circles can be an effective workforce capacity-building intervention, particularly in novice workforces characterised by professional isolation and split function roles.

Practice education learning environments: the mismatch between perceived and preferred expectations of undergraduate health science students.

BACKGROUND: Practical hands-on learning opportunities are viewed as a vital component of the education of health science students, but there is a critical shortage of fieldwork placement experiences. It is therefore important that these clinical learning environments are well suited to students' perceptions and expectations. PURPOSE: To investigate how undergraduate students enrolled in health-related education programs view their clinical learning environments and specifically to compare students' perception of their 'actual' clinical learning environment to that of their 'preferred/ideal' clinical learning environment. METHOD: The Clinical Learning Environment Inventory (CLEI) was used to collect data from 548 undergraduate students (55% response rate) enrolled in all year levels of paramedics, midwifery, radiography and medical imaging, occupational therapy, pharmacy, nutrition and dietetics, physiotherapy and social work at Monash University via convenience sampling. Students were asked to rate their perception of the clinical learning environment at the completion of their placements using the CLEI. RESULTS: Satisfaction of the students enrolled in the health-related disciplines was closely linked with the five constructs measured by the CLEI: Personalization, Student Involvement, Task Orientation, Innovation, and Individualization. Significant differences were found between the student's perception of their 'actual' clinical learning environment and their 'ideal' clinical learning environment. CONCLUSION: The study highlights the importance of a supportive clinical learning environment that places emphasis on effective two-way communication. A thorough understanding of students' perceptions of their clinical learning environments is essential.

Clinical placements and nursing students' career planning: a qualitative exploration.

Many nursing students enter undergraduate programmes with preconceived ideas about their future nursing careers, and intend to practice in particular areas such as midwifery or paediatrics. Through clinical placements, students are exposed to different clinical areas and professional socialization is facilitated. However, little is known about the influence of clinical placements on students' career intentions. This paper reports nursing findings drawn from a large qualitative study conducted in Victoria, Australia that sought to explore the influence of health professional students' clinical placements on their future career intentions. Participants were invited to be involved in either face-to-face or focus group interviews depending upon their own preference. Thematic data analysis revealed three main themes: 're-affirming career choice', 'working in a particular area' and 'work location'. Findings from the study add to our understanding of factors influencing nursing students' planning for their future careers including the impact of clinical placements.

Influence of clinical placement on undergraduate midwifery students' career intentions.

OBJECTIVE: to explore the influence that clinical placements have on career intentions for undergraduate midwifery students. DESIGN: a qualitative approach involving a combination of focus group and individual interviews. SETTING: the study was part of a larger study undertaken across a range of health disciplines within one university. PARTICIPANTS: 11 Bachelor of Midwifery students who had either undertaken their first or last clinical placement. FINDINGS: data were managed with QSR NVivo and analysis was influenced by the work of Strauss and Corbin. Two main themes emerged: midwifery as a career choice and future midwifery career. Findings indicated that students entered the course with preconceived ideas of midwifery and where they would practice after graduation. Clinical placements allowed students to experience the reality of midwifery practice, promote identification with the profession, and influenced decision-making about future careers. Finally, it raised limitations placed on diversity of available clinical experience. KEY CONCLUSIONS: clinical placements are essential for midwifery preparation. They challenge students' preconceived ideas about midwifery practice and assist them to develop perspectives on, and directions for, their future careers. The diversity and quality of placement experience plays a significant role in career decision-making and employment choices. IMPLICATIONS FOR PRACTICE: positive placement experiences influence where students will choose to work after graduation. These experiences can directly influence the organisations and clinical areas chosen by students for graduate practice.

'They don't know much about us': educational reform impacts on students' learning in the clinical environment.

Placements are an integral component of the medical, nursing, and allied health curriculum. Literature on problem-based learning indicates that curriculum change can impact student experience. However, outside of the nursing literature, there is little research on the impact of education reform on students' experiences of placements. This paper reports on medical, midwifery and paramedic students' perception of the impact of education reform they experienced in the clinical setting. A qualitative study using a semi-structured schedule was conducted. Data was collected using focus groups (17), individual interviews (48) and written responses (2) from undergraduate students (103) and graduates (27) from a tertiary institution in Victoria, Australia. Recorded interviews were analysed, coded and categorised into themes. Whilst students indicated they were prepared for the impact of educational reform on their placement experience, they perceived that clinical educators responsible for teaching them were less prepared. Three themes were identified from the data: clinical educator's lack of familiarity with new curriculum, clinical educator's negative attitudes to curricular change and looking to the future. Our study advances the understanding of the implications of education reform during the clinical placement of medical, midwifery, and paramedic students. Whilst important lessons can be learned from the medical and nursing literature this study highlights that staff responsible for curriculum change need to action change management process to ensure that the clinical educators are able to deliver the revised program.

Exploring continuous clinical placement for undergraduate students.

Clinical placements are integral to health professional preparatory courses. These placements allow for the application of classroom-based learning into real patient care situations. In doing so, they provide opportunities for applying theoretical knowledge into practice contexts, skills development and socialisation into the chosen profession. However, despite its recognised importance across health professions, little has been written about optimal structures for supporting clinical learning. This paper presents one group of findings from a larger qualitative study aimed at exploring health professional student's clinical experiences and their impact on career intentions. Findings reported here present a group of undergraduate midwifery student's perspectives on a "home" hospital clinical placement model where continuous clinical placements were taken in the same agency (or hospital group) for 2 days per week over the final 2 years of their course. Two main themes emerged from the data analysis, these being, 'familiarity' and 'continuity'. It is concluded that continuous placements in the same clinical setting have the potential to offer greater opportunities for learning and early professional socialisation than traditional block (Monday to Friday) placements. They can offer a more integrated approach to classroom theory and its application into practice.

The role of mentoring in public health nutrition workforce development. Perspectives of advanced-level practitioners.

OBJECTIVE: To explore the nature, role and utility of mentoring in the development of competence in advanced-level Australian public health nutritionists. DESIGN: Qualitative study using in-depth interviews. SUBJECTS AND SETTING: Eighteen advanced-level public health nutritionists working in academic and practice settings in Australia. RESULTS: The attributes and career pathways of the subjects were consistent with previous findings. Dissatisfaction with clinical practice was a key reason for choosing a career in public health. Experiential learning, postgraduate education and mentoring from both peers and senior colleagues were the most significant contributors to competency development. The subjects supported mentoring as an important strategy for public health nutrition workforce development and articulated the characteristics and models important for mentoring relationships in public health nutrition. CONCLUSIONS: The present study suggests mentoring was an important part of competency development for advanced-level public health and community nutritionists in Australia. Mentoring programmes based on experiential learning may assist in developing public health nutrition workforce competence.

Money matters: students' perceptions of the costs associated with placements.

CONTEXT: Placements are an integral component of the medical, nursing and allied health curricula. However, apart from the relocation costs associated with placements, little research on students' understandings and experiences of the financial implications of placements has been carried out. OBJECTIVES: We report on students' financial concerns associated with placements, which emerged as a main theme in a broader study we conducted on the impact of undergraduate student placement experiences on graduate practice. METHODS: We conducted a qualitative study which included focus group discussions (n = 17), individual interviews (n = 48) and written responses (n = 2) with undergraduate students (n = 103) and graduates (n = 27) from a tertiary institution in Victoria, Australia. RESULTS: Students identified that income generation and the costs associated with transport and placement location contributed to the financial burden of placements. Students also spoke of the implications of high financial strain impacting on their accumulation of debt as well as on their health and wellbeing. DISCUSSION: Our study advances our understanding of the implications of financial hardship experienced by medical, nursing and allied health students. In our study, students, regardless of their placement location, experienced increased demands and associated stress as a result of managing placements, paid employment and limited financial resources. We recommend that further quantitative research be conducted to measure the variables identified as emerging themes in this study.

Evaluation of a short course in psychiatry for general practitioners.

OBJECTIVE: To assess the acceptability and benefits to general practitioners (GPs) of a short course on the management of depression and anxiety. METHOD: One hundred and twenty-two GPs from southeast metropolitan Melbourne participated in a five-session short course. Pre- and post-measures of knowledge, attitude and self-evaluated clinical practice and a post-measure of participant satisfaction were completed. RESULTS: The course was overwhelmingly appreciated by participating GPs. In the group as a whole, knowledge, attitude and certain elements of clinical practice changed in a positive and predicted direction. General practitioners affirmed the use of an interpersonal and problem-solving framework for patients more commonly than a cognitive-behavioural one. CONCLUSIONS: Brief educational interventions are useful and, through improving GP knowledge, attitude and clinical practice, have an important role to play in enhancing the capacity of GPs to assist people with depression and anxiety.

A Graduate Certificate and Master in General Practice Psychiatry by distance education--1998-2001.

BACKGROUND: The General Practice Psychiatry Program is a collaborative initiative between two universities and two professional colleges. Since 1998 it has offered general practitioners a one year part time Graduate Certificate, and a two year Master of General Practice Psychiatry. The learning is by distance education and multimode, including text packages sent out, tapes, teleconferences and two annual residential weekends with role plays and didactic teaching. OBJECTIVE: To describe the development of a Graduate Certificate and Master in General Practice Psychiatry. DISCUSSION: The program has been well supported with 141 general practitioners enrolling in the Graduate Certificate and 48 in the Masters during 1998-2001. General practitioners have been enrolling from around Australia, with rural, female and more experienced GPs predominating.

A questionnaire to measure general practitioners' attitudes to their role in the management of patients with depression and anxiety.

OBJECTIVE: Attitude, together with knowledge, is important in determining behaviour. Doctors' attitudes affect the recognition and management of mental health. We detail the development of an instrument to measure general practitioner attitudes to the recognition and management of depression and anxiety disorders. METHOD: A literature review and semistructured interviews with GPs identified constructs for inclusion into the questionnaire. Items were written and examined by a panel of psychiatrists, GPs and statisticians to establish face and content validity. The resulting 30 item questionnaire was given to a convenience sample of 63 GPs in Australia with an interest in mental health, and their responses analysed using exploratory factor analysis. RESULTS: Exploration of the data identified two factors. Factor 1 contained 12 items measuring professional comfort and competence with the care of mental health disorders (alpha = 0.82). Factor 2 contained five items that assessed GP concerns about difficulties with the health care system in this area (alpha = 0.73). DISCUSSION: The factor analysis shows that GPs' attitudes can be parsimoniously described by two factors, instead of the five that the literature suggests. The high values of Cronbach's alpha demonstrate that these two factors can be measured reliably. These were not the anticipated results, and can be taken to indicate that GPs' attitudes to their roles in the recognition and management of patients with depression and anxiety disorders are less complex than might otherwise be imagined.