"Could You Work in My Team?": Exploring How Professional Clinical Role Expectations Influence Decision-Making of Assessors During Exit-Level Medical School OSCEs.

Decision-making in clinical assessment, such as exit-level medical school Objective Structured Clinical Examinations (OSCEs), is complex. This study utilized an empirical phenomenological qualitative approach with thematic analysis to explore OSCE assessors' perceptions of the concept of a "prototypical intern" expressed during focus group discussions. Topics discussed included the concept of a prototypical intern, qualities to be assessed, and approaches to clinical assessment decision-making. The thematic analysis was then applied to a theoretical framework (Cultural Historical Activity Theory-CHAT) that explored the complexity of making assessment decisions amidst potentially contradicting pressures from academic and clinical perspectives. Ten Australasian medical schools were involved with 15 experienced and five less experienced assessors participating. Thematic analysis of the data revealed four major themes in relation to how the prototypical intern concept influences clinical assessors' judgements: (a) Suitability of marking rubric based on assessor characteristics and expectations; (b) Competence as final year student vs. performance as a prototypical intern; (c) Safety, trustworthiness and reliability as constructs requiring assessment and (d) Contradictions in decision making process due to assessor differences. These themes mapped well within the interaction between two proposed activity systems in the CHAT model: academic and clinical. More clinically engaged and more experienced assessors tend to fall back on a heuristic, mental construct of a "prototypical intern," to calibrate judgements, particularly, in difficult situations. Further research is needed to explore whether consensus on desirable intern qualities and their inclusion into OSCE marksheets decreases the cognitive load and increases the validity of assessor decision making.

The Balanced Scorecard: a tool to monitor IPL curriculum implementation: January 2020.

This article was migrated. The article was marked as recommended. Introduction: Implementing interprofessional learning (IPL) in health profession curriculum is difficult despite widespread acknowledgement of the importance of interprofessional collaborative health care practice. The aim of this study was to develop a balanced scorecard using a Delphi technique to document and monitor implementation of IPL in a faculty of health and medical sciences. Methods/Results: Twenty-four academic teachers and health service clinical supervisors completed two electronic questionnaires as part of a two stage Delphi survey. Consensus (70% agreement/disagreement) was achieved for 27/36 items in round one and for all 10 items in round two. Ten performance metrics were subsequently identified. Discussion: The Delphi was an efficient and effective method for identifying performance metrics for monitoring faculty IPL implementation. With a strong focus on learning outcomes and assessment, the scorecard will enable the faculty to formally monitor implementation of our IPL strategy over time. A follow up process of identifying data sources for reporting against each of the scorecard items has already highlighted gaps in our current practices, predominantly in staff professional development and assessment.

Implementing interprofessional learning curriculum: how problems might also be answers.

BACKGROUND: Despite interprofessional learning (IPL) being widely recognised as important for health care professions, embedding IPL within core curriculum remains a significant challenge. The aim of this study was to identify tensions associated with implementing IPL curriculum for educators and clinical supervisors, and to examine these findings from the perspective of activity theory and the expansive learning cycle (ELC). METHODS: We interviewed 12 faculty staff and ten health practitioners regarding IPL. Interviews were semi-structured. Following initial thematic analysis, further analysis was undertaken to characterise existing activity systems and the contradictions associated with implementing IPL. These findings were then mapped to the ELC. RESULTS: Five clusters of contradictions were identified: the lack of a workable definition; when and what is best for students; the leadership hot potato; big expectations of IPL; and, resisting cultural change. When mapped to the ELC, it was apparent that although experienced as challenges, these contradictions had not yet generated sufficient tension to trigger 'break through' novel thinking, or contemplation and modelling of new solutions. CONCLUSIONS: The application of activity theory and the ELC offered an approach in which the most troublesome challenges might be reframed as opportunities for change. Seemingly intractable problems could be worked on to identify and address underlying fears and assumptions. If sufficient tension can be generated, an ELC could then be triggered. In reframing challenges as opportunities, the power of tensions and contradictions as potential levers for effective change might be more successfully accessed.

Standard setting in Australian medical schools.

BACKGROUND: Standard setting of assessment is critical in quality assurance of medical programs. The aims of this study were to identify and compare the impact of methods used to establish the passing standard by the 13 medical schools who participated in the 2014 Australian Medical Schools Assessment Collaboration (AMSAC). METHODS: A survey was conducted to identify the standard setting procedures used by participating schools. Schools standard setting data was collated for the 49 multiple choice items used for benchmarking by AMSAC in 2014. Analyses were conducted for nine schools by their method of standard setting and key characteristics of 28 panel members from four schools. RESULTS: Substantial differences were identified between AMSAC schools that participated in the study, in both the standard setting methods and how particular techniques were implemented. The correlation between the item standard settings data by school ranged from - 0.116 to 0.632. A trend was identified for panel members to underestimate the difficulty level of hard items and overestimate the difficulty level of easy items for all methods. The median derived cut-score standard across schools was 55% for the 49 benchmarking questions. Although, no significant differences were found according to panel member standard setting experience or clinicians versus scientists, panel members with a high curriculum engagement generally had significantly lower expectations of borderline candidates (p = 0.044). CONCLUSION: This study used a robust assessment framework to demonstrate that several standard setting techniques are used by Australian medical schools, which in some cases use different techniques for different stages of their program. The implementation of the most common method, the Modified Angoff standard setting approach was found to vary markedly. The method of standard setting used had an impact on the distribution of expected minimally competent student performance by item and overall, with the passing standard varying by up to 10%. This difference can be attributed to the method of standard setting because the ASMSAC items have been shown over time to have consistent performance levels reflecting similar cohort ability. There is a need for more consistency in the method of standard setting used by medical schools in Australia.

Exploring undergraduate students' attitudes towards interprofessional learning, motivation-to-learn, and perceived impact of learning conflict resolution skills.

Conflict resolution skills are important for all healthcare professionals as conflict and mis-communication can have detrimental effects on decision-making, potentially impacting significantly on patient care, morbidity, and mortality. Interprofessional learning (IPL) has been found to increase collaboration and improve collegial relationships and hence may be an appropriate way to increase conflict resolution skills among healthcare graduates. This study examined transference of conflict resolution skills, motivation-to-learn, and attitudes to IPL of medical (n = 52) and nursing (n = 74) undergraduate students who undertook an IPL conflict resolution program. Results indicated that motivation-to-learn, attitudes to IPL, and transfer of conflict resolution skills were significantly related to each other, even when controlling for other variables, such as age and gender. When comparing the two groups, undergraduate nursing students were found to have statistically higher motivation-to-learn and transference of conflict resolution skills, and reported a more positive attitude to IPL than medical students. Some of these differences may be attributed to lack of clinical placements for medical students in the first half of their degree at their university, giving them less opportunity to apply the conflict resolution skills taught, as well as less contextual relevance. This may potentially affect their motivation-to-learn and attitude to IPL thus impacting on how they perceive the relevance of learning conflict resolution skills. Without the contextual relevancy of placements at the time of learning for medical students, the newly acquired conflict resolution skills are less likely to transfer to practice in an optimal fashion.

Educating for interprofessional practice: moving from knowing to being, is it the final piece of the puzzle?

BACKGROUND: Professional socialisation and identity arise from interactions occurring within university-based interprofessional education, and workplace-based interprofessional practice experience. However, it is unclear how closely language and concepts of academic learning situations align with workplace contexts for interprofessional learning. This paper reports on a study that brought together university-based educators responsible for teaching health professional students and health service-based practitioners who supervise students in the field. METHODS: Interviews and focus groups with university-based educators and health service-base practitioners were used to explore perceptions of capabilities required for interprofessional practice. The qualitative data were then examined to explore similarities and differences in the language used by these groups. RESULTS: This analysis identified that there were language differences between the university-based educators and health service based practitioners involved in the project. The former demonstrated a curriculum lens, focusing on educational activities, student support and supervision. Conversely, health service-based practitioners presented a client-centred lens, with a focus on communication, professional disposition, attitude towards clients and co-workers, and authenticity of practice. CONCLUSIONS: Building on these insights, we theorise about the need for students to develop the self in order to be an interprofessional practitioner. The implications for health professional education in both university and workplace settings are explored.

Palliative Care in Undergraduate Medical Education-How Far Have We Come?

PURPOSE: There is an increasing demand for quality palliative care teaching within undergraduate medical education. Studies suggest that many junior doctors feel underprepared to perform end-of-life care. Previous systematic reviews on palliative care teaching within medical schools have identified significant variability and lack of consistency in teaching. This review aims to update the literature on the current status of palliative care teaching to undergraduates within medical schools. METHOD: A systematic review was undertaken on articles published from December 2001 to November 2015 on palliative care teaching for undergraduate medical students. In all, 650 abstract citations were obtained, of which 126 were relevant to the research questions. Thematic analysis was performed on remaining articles according to whether they discussed content and/or methodology of palliative care education, and data collated. RESULTS: There is greater consistency in the content being delivered as part of end-of-life care education within medical schools. The most frequently taught topics include attitudes to death and dying, communication skills, and pain management. Pediatric care and religious/cultural issues are less frequently addressed. Teaching institutions are also utilising a broader range of teaching modalities. CONCLUSION: There is significant progress in palliative care education within medical schools. Ongoing challenges relate to correlating our current practice in medical education to professional recommendations and the expressed needs of junior doctors to practice competent end-of-life care.

A systematic review of faculty development initiatives designed to enhance teaching effectiveness: A 10-year update: BEME Guide No. 40.

BACKGROUND: This review, which focused on faculty development initiatives designed to improve teaching effectiveness, synthesized findings related to intervention types, study characteristics, individual and organizational outcomes, key features, and community building. METHODS: This review included 111 studies (between 2002 and 2012) that met the review criteria. FINDINGS: Overall satisfaction with faculty development programs was high. Participants reported increased confidence, enthusiasm, and awareness of effective educational practices. Gains in knowledge and skills, and self-reported changes in teaching behaviors, were frequently noted. Observed behavior changes included enhanced teaching practices, new educational initiatives, new leadership positions, and increased academic output. Organizational changes were infrequently explored. Key features included evidence-informed educational design, relevant content, experiential learning, feedback and reflection, educational projects, intentional community building, longitudinal program design, and institutional support. CONCLUSION: This review holds implications for practice and research. Moving forward, we should build on current success, broaden the focus beyond individual teaching effectiveness, develop programs that extend over time, promote workplace learning, foster community development, and secure institutional support. We should also embed studies in a theoretical framework, conduct more qualitative and mixed methods studies, assess behavioral and organizational change, evaluate transfer to practice, analyse key features, and explore the role of faculty development within the larger organizational context.

Clinical participation of medical students in three contemporary training models.

OBJECTIVES: As community settings are being used increasingly in undergraduate medical programmes, this study aimed to explore and compare the clinical experiences of students in hospital-based and community-based training programmes. It measured students' clinical participation and compared the perspectives of Year 3 medical students in three different models of clinical education: a tertiary hospital block programme; a community hybrid programme, and a rural longitudinal integrated clerkship (LIC) programme. METHODS: The study used a mixed methodology approach to examine the clinical experiences of students through the analysis of logbooks and semi-structured student interviews. This involved the quantitative analysis of 88 logbook weeks, data from which were triangulated through the analysis of 101 individual interviews using grounded theory. RESULTS: A total of 35 students across the three different clinical training models participated in the study. The results demonstrate significant differences among the three models in students' clinical participation and suggest that community settings provide more opportunities to students for meaningful engagement in patient care activities. CONCLUSIONS: Consistent wider and more direct access to patients for students, as found in the community-based model, provides a pathway for engaging students in the learning processes, and a step towards making them aware of their learning needs and knowledge. Interviews provide evidence that authentic clinical activities can be enhanced through structured systems of supervision and through the provision of authentic roles for students in clinical teams.

Developing an interprofessional capability framework for teaching healthcare students in a primary healthcare setting.

This article is based on a partnership between a primary health service and a university whose shared goal was to prepare students and graduates for interprofessional practice (IPP). This collaborative process led to the development of consensus on an interprofessional capability framework. An action research methodology was adopted to study the development and progress of the partnership between university and health service providers. The initial aim was to understand their perceptions of IPP. Following this, the findings and draft capabilities were presented back to the groups. Finalisation of the capabilities took place with shared discussion and debate on how to implement them in the primary care setting. Several ideas and strategies were generated as to how to prepare effective interprofessional learning experiences for students in both environments (university and primary health care setting). Extensive stakeholder consultation from healthcare providers and educators has produced a framework, which incorporates the shared views and understandings, and can therefore be widely used in both settings. Development of a framework of capabilities for IPP, through a collaborative process, is a useful strategy for achieving agreement. Such a framework can guide curriculum for use in university and health service settings to assist incorporation of interprofessional capabilities into students' learning and practice.

Outcomes of longitudinal integrated clinical placements for students, clinicians and society.

CONTEXT: Longitudinal integrated clerkships (LICs) have been widely implemented in both rural and urban contexts, as is now evident in the wealth of studies published internationally. This narrative literature review aims to summarise current evidence regarding the outcomes of LICs for student, clinician and community stakeholders. METHODS: Recent literature was examined for original research articles pertaining to outcomes of LICs. RESULTS: Students in LICs achieve academic results equivalent to and in some cases better than those of their counterparts who receive clinical education in block rotations. Students in LICs are reported to have well-developed patient-centred communication skills, demonstrate understanding of the psychosocial contributions to medicine, and report more preparedness in higher-order clinical and cognitive skills in comparison with students in traditional block rotations (TBRs). Students in LICs take on increased responsibility with patients and describe having more confidence in dealing with ethical dilemmas. Continuity of supervision reportedly facilitates incremental knowledge acquisition, and supervisors provide incrementally progressive feedback. Despite early disorientation regarding the organising of their learning, students feel well supported by the continuity of student-preceptor relationships and value the contributions made by these. Students in LICs living and working in rural areas are positively influenced towards primary care and rural career choices. DISCUSSION: A sound body of knowledge in the field of LIC research suggests it is time to move beyond descriptive or exploratory research that is designed to justify this new educational approach by comparing academic results. As the attributes of LIC alumni are better understood, it is important to conduct explanatory research to develop a more complete understanding of these findings and a foundation for new theoretical frameworks that underpin educational change. CONCLUSIONS: Longitudinal integrated clerkships are now recognised as representing credible and effective pedagogical alternatives to TBRs in medical education.

Faculty perceptions of interprofessional education.

Nurses and other health professionals are required to demonstrate broad levels of expertise and service to ensure quality patient-centred health care. Interprofessional practice aligned with interprofessional education (IPE) has been promoted as a vehicle to promote broad levels of expertise. However, challenges remain for universities and other higher education institutions to successfully provide IPE opportunities for students. This paper presents perceptions of academic staff towards IPE from one Australian multi-campus health faculty. Perceptions were collected using interviews and two workshops. Findings are themed under the categories of faculty barriers, industry challenges and future opportunities. The perceptions of one health faculty regarding the fundamental factors required for IPE success were executive leadership of IPE, a supportive funding framework and an IPE based curricula. Nursing education can play a key role in embracing and leading future IPE approaches given that nurses are the numerically dominant health professional group and work collaboratively with other professionals to deliver patient-centred care.

Consumers' views of pharmacogenetics--A qualitative study.

BACKGROUND: Adverse drug reactions are recognized as a significant public health issue. Pharmacogenetics (PGx) provides a potential means of preventing some adverse drug reactions by predicting the optimal medication dose for an individual; however, PGx is rarely used in clinical practice. Thus far, there have been few studies investigating consumers' perceptions of the barriers to the implementation of PGx in clinical practice. OBJECTIVES: This study explored the views of the general public regarding their current use of medications, and their experiences of side effects and opinions on PGx. METHODS: Members of the general public who suffered a chronic medical condition and/or had an immediate family member with a chronic medical condition were recruited to form 5 separate focus groups (n=35). Three separate age ranges were used in the focus groups. A questioning route was developed and used in focus groups to determine participants' experiences with medication use and opinions on PGx (referred to as "Personalized Medicine"). Focus group discussions were transcribed by 2 separate investigators, and qualitative analysis, based on the framework approach, was applied to the data. Data were independently coded to identify key themes then compared both within and between focus groups. RESULTS: A common theme was a desire to have a holistic approach to disease diagnosis and medication selection. A wide range of views were expressed by the focus group participants. Concerns were raised regarding the current level of side effects experienced with medications. Storage and privacy of genetic information, and the costs involved, were also seen as potential barriers to implementation of PGx. CONCLUSIONS: PGx testing was seen as a potential positive contribution, but only if other factors were considered during the prescribing process. As participants desired a high level of information and effective communication from their health-care professionals, PGx education of clinicians and pharmacists will be essential to satisfy consumers' requirements.

Pharmacists' role in targeted cancer therapy in Australia and implications for pharmacy education.

OBJECTIVES: To investigate the pharmacists' role in providing targeted therapies to patients and its implications for pharmacy education. METHODS: Nine pharmacy faculty members, 12 clinical pharmacists, and 4 oncologists from across Australia and New Zealand participated in semistructured interviews, which were analysed using the framework method. RESULTS: Education about targeted therapies was seen as being important, although content about pharmacodiagnostic tests was taught inconsistently among 7 universities. Issues including funding, clinical and diagnostic validity of tests, and time taken for turnaround of tests were perceived as impediments to the acceptance by clinicians of the utility of pharmacodiagnostic tests. CONCLUSIONS: Pharmacists may be the ideal professionals to interpret test results and provide counselling for patients to assist them in compliance with targeted cancer therapies. Pharmacy education in cancer therapies is critical to training pharmacists who can assist patients in the correct use of these therapies.

Engaging the learner: Embedding information literacy skills into a biotechnology degree.

One of the challenges of the Biotechnology industry is keeping up to date with the rapid pace of change and that much of the information, which students learn in their undergraduate studies, will be out of date in a few years. It is therefore crucial that Biotechnology students have the skills to access the relevant information for their studies and critically evaluate the vast volume of information and its sources. By developing information literacy skills, which are part of lifelong learning, Biotechnology graduates are better prepared for their careers. Students also need to understand the issues related to the use of information such as social, political, ethical, and legal implications. This paper will outline the embedding of information literacy skills within the Biotechnology degree at the University of South Australia. Examples of specific activities and their link to assessment will be discussed.

Low adoption of pharmacogenetic testing: an exploration and explanation of the reasons in Australia.

The research reported here sought to identify and illuminate the reasons for the low adoption of pharmacogenetic tests in Australia. The research initially established possible reasons and propositions drawn from previous studies and surveys on the problem in Europe and the literature on the adoption of innovations. A small-scale exploratory, qualitative study was undertaken in one state in Australia; clinicians and other stake-holders were interviewed about their use of or support for pharmacogenetic tests. The expected, quite extensive individual factors known to influence adoption and rejection of innovations were found to be present in the situations covered. The reasons for nonadoption that were found in previous surveys were also supported. Some other, possibly critical, reasons were also identified. The implications from this initial exploration are discussed and the prospects for the increased use of the tests proposed.