Integrating the sustainable development goals into health professions' curricula: using the nominal group technique to guide their contextualisation.

BACKGROUND: To embed the Sustainable Development Goals in health profession education, educators must contextualise them to their profession and geographical region. This study used the nominal group technique to contextualise the SDGs for Australian nutrition and dietetics tertiary education programs by determining the specific knowledge, skills, and values required for graduating dietitians to practise sustainably. METHODS: In 2022, 23 experts in food and sustainability attended a group session that employed the nominal group technique to discuss the Sustainable Development Goals knowledge, skills, and values Australian dietetic students should develop. After the group session, participants ranked the Sustainable Development Goals according to their perceived level of importance for student dietitians. These data were analysed using multi-methods, including a summation of the rankings, directed qualitative content analysis and reflexive thematic analysis. RESULTS: The three highest-priority Sustainable Development Goals identified were (1) Zero Hunger, (2) Good Health and Well-Being, and (3) Responsible Consumption and Production, which were then considered with the qualitative findings. The main categories that were generated from the content analysis reflected the broad knowledge, skills, and values student dietitians should develop. The preliminary codes provided specific details for each of the main categories. The thematic analysis generated two additional themes: the importance of Indigenous ways of knowing, being and doing, and authentic experiential learning activities. CONCLUSIONS: The method employed for this study provides a useful framework for health professions to contextualise the Sustainable Development Goals to their profession and geographical region. For this study, the ranking process and the qualitative data analysis enabled the Sustainable Development Goals to be reframed in a way that would be meaningful for dietetic educators and students and demonstrate the interrelatedness of the goals. The direct qualitative content analysis and reflexive thematic analysis identified the knowledge, skills, and values student dietitians should develop.

Evolving beyond antiracism: Reflections on the experience of developing a cultural safety curriculum in a tertiary education setting.

There is an inextricable link between cultural and clinical safety. In Australia high-profile Aboriginal deaths in custody, publicised institutional racism in health services and the international Black Lives Matter movement have cemented momentum to ensure culturally safe care. However, racism within health professionals and health professional students remains a barrier to increasing the number of Aboriginal and Torres Strait Islander Health professionals. The Australian Health Practitioner Regulation Agency's Aboriginal and Torres Strait Islander Health Strategy's objective to 'eliminate racism from the health system', and the recent adoption of the Aboriginal and Torres Strait Islander peoples led cultural safety definition, has instigated systems level reflections on decolonising practice. This article explores cultural safety as the conceptual antithesis to racism, examining its origins, and contemporary evolution led by Aboriginal and Torres Strait Islander peoples in Australia, including its development in curriculum innovation. The application of cultural safety is explored using in-depth reflection, and the crucial development of integrating critical consciousness theory, as a precursor to culturally safe practice, is discussed. Novel approaches to university curriculum development are needed to facilitate culturally safe and decolonised learning and working environments, including the key considerations of non-Indigenous allyship and collaborative curriculum innovations and initiatives.

Facilitating interprofessional affective learning in health professional students through digital client documentation: a comparison of simulation modes.

Digital Interprofessional Learning Client Documentation (D-IPL Client Docs) is an initiative designed to develop student interprofessional communication skills through electronic record writing and a virtual simulation (VS) or live virtual simulation (LVS) case conference. The aims of the study were to (a) identify whether D-IPL Client Docs supports student learning in the affective domain and (b) compare the learning outcomes for students participating in the VS versus the LVS case conference. Data were drawn from 83 Bachelor of Social Work students who had participated with other health professional students in the D-IPL Client Docs activities. The reflective journals submitted by this cohort of social work students were analyzed qualitatively and quantitatively using the Griffith University Affective Learning Scale. Qualitative analyses revealed that the activities enabled students in both groups to learn about themselves, their roles, and the roles of others, and the benefits of interprofessional collaboration in optimizing client outcomes. Quantitatively, the VS mode appeared to be more effective in supporting students to develop higher order affective learning; however, the effect size was small. Future studies should involve a larger sample size and include students from various professions to ascertain the transferability of findings.

International Delphi Recommendations for Pediatric Lower Limb Neurological Test Protocols for Muscle Strength, Reflexes, and Tactile Sensitivity.

PURPOSE: To gain consensus from physical therapists on pediatric lower limb neurological tests of muscle strength, tactile sensitivity, and reflexes. METHODS: A Delphi technique was used for 2 sequential questionnaire rounds to gain consensus from a panel of pediatric physical therapists (n = 28). Physical therapists rated their agreement to items from statements on pediatric lower limb neurological tests, their protocols, and interpretation using a 6-point Likert scale. RESULTS: Ninety percent of items gained consensus: 80% on pediatric lower limb neurological tests, 88% on test protocols, and 92% on test interpretation. Fifty-one percent of items had high agreement and high importance. CONCLUSION: There is variability in pediatric neurological tests used, their protocols, and interpretation. Identification of items with high agreement and importance is the first step to develop a standardized lower limb neurological assessment for pediatric clients of varying ages and diagnoses.

A Survey of Pediatric Competencies in Entry-Level Physical Therapy Programs in Australia.

PURPOSE: To describe perspectives of pediatric physical therapy clinical facilitators on contemporary curricula for Australian entry-level physical therapy programs. METHODS: Physical therapy clinical facilitators completed an online survey based on the Academy of Pediatric Physical Therapy of the APTA essential competencies. RESULTS: Conditions including cerebral palsy, cystic fibrosis, and prematurity were highly rated by most participants to include in an entry-level program. Exercise prescription, goal-directed training, and group-based physical therapy were the highest rated interventions. Outcome measures considered important to include were the Alberta Infant Motor Scale and Goal Attainment Scale. Students should demonstrate knowledge and skills using relevant frameworks and have practical opportunities to interact with children. CONCLUSION: Pediatric clinical facilitators perceived that theoretical knowledge on frameworks, human development, movement skills, pediatric conditions, exercise prescription, and outcome measurement as well as face-to-face experiences with children are important to include in Australian entry-level physical therapy programs.

Professional identity measures for student health professionals - a systematic review of psychometric properties.

BACKGROUND: Professional identity is critical to the safe and effective clinical practice of all health professions. University programs play an important role in the formation of professional identity of students, and so it essential to understand professional identity at this stage of students' development. However, the majority of research into professional identity has been conducted using the qualitative paradigm so further quantitative analysis through the use of psychometrically-sound professional identity measures is required. This study aimed to identify professional identity measures used with university students enrolled in health programs and synthesise the evidence of their psychometric properties. METHODS: The systematic review was conducted in two phases. Phase 1 involved searching five online databases for studies that used professional identity measures with student health professionals. These studies were assessed against a priori criteria for inclusion and a list of measures was identified. Phase 2 involved searching the same databases for psychometric evidence of the measures identified in Phase 1. The psychometric properties of each measure were compared against the Consensus-based standards for the Selection of Health Measurement Instruments (COSMIN) checklist. Data were narratively synthesised, and comparisons were made between measures. RESULTS: Phase 1 identified eight professional identity measures. Phase 2 identified a total of 15 studies that evaluated the psychometric properties of at least one of the professional identity measures. There was a paucity of psychometric evidence for the measures. The revised Nurses' Professional Values Scale and Macleod Clark Professional Identity Scale had the greatest volume of psychometric evidence. None of the measures fulfilled all criteria in the COSMIN checklist. CONCLUSION: There is a paucity of evidence underpinning the psychometric of professional identity measures. Evidence which uses these measures should be interpreted with caution. Further research is warranted to ensure that the results of quantitative professional identity studies are valid and reliable.

Preliminary Psychometric Evaluation of the Brachial Assessment Tool Part 2: Construct Validity and Responsiveness.

OBJECTIVES: To evaluate construct validity and responsiveness of the Brachial Assessment Tool (BrAT), a new patient-reported outcome measure for people with traumatic brachial plexus injury (BPI), and to compare it to the Disabilities of the Arm, Shoulder and Hand (DASH) and the Upper Extremity Functional Index (UEFI). DESIGN: Cross-sectional study. SETTING: Outpatient clinics. PARTICIPANTS: Adults (N=29; age range, 20-69y) with confirmed traumatic BPI. INTERVENTIONS: Participants completed the BrAT 3 times over an 18-month period together with 16 DASH activity items and the UEFI. Evaluations were undertaken of construct validity, known-groups validity, 1-way repeated analysis of variance, and effect size. MAIN OUTCOME MEASURES: BrAT, DASH, and UEFI. RESULTS: The BrAT demonstrated a moderate to low correlation with the DASH activity items (<0.7) and a large correlation with the UEFI (>0.7). According to known-groups validity, only the BrAT was able to discriminate between people who stated they could use their hand versus those who were unable to use their hand to perform activities. All measures indicated a significant effect for time with the exception of BrAT subscale 1. The effect size was highest for the BrAT but lower than expected (BrAT, .52-.40; DASH, .15; UEFI, .36). CONCLUSIONS: These preliminary findings support the BrAT as a valid and responsive patient-reported outcome measure for adults with traumatic BPI. The BrAT activity items appear to be more targeted than the DASH or UEFI particularly for people with more severe BPI. The BrAT also appears to be measuring a different activity construct than the DASH and the UEFI. Further work is required to confirm these results with larger sample sizes.

Psychometric Evaluation of the Brachial Assessment Tool Part 1: Reproducibility.

OBJECTIVE: To evaluate reproducibility (reliability and agreement) of the Brachial Assessment Tool (BrAT), a new patient-reported outcome measure for adults with traumatic brachial plexus injury (BPI). DESIGN: Prospective repeated-measure design. SETTING: Outpatient clinics. PARTICIPANTS: Adults with confirmed traumatic BPI (N=43; age range, 19-82y). INTERVENTIONS: People with BPI completed the 31-item 4-response BrAT twice, 2 weeks apart. Results for the 3 subscales and summed score were compared at time 1 and time 2 to determine reliability, including systematic differences using paired t tests, test retest using intraclass correlation coefficient model 1,1 (ICC1,1), and internal consistency using Cronbach α. Agreement parameters included standard error of measurement, minimal detectable change, and limits of agreement. MAIN OUTCOME MEASURE: BrAT. RESULTS: Test-retest reliability was excellent (ICC1,1=.90-.97). Internal consistency was high (Cronbach α=.90-.98). Measurement error was relatively low (standard error of measurement range, 3.1-8.8). A change of >4 for subscale 1, >6 for subscale 2, >4 for subscale 3, and >10 for the summed score is indicative of change over and above measurement error. Limits of agreement ranged from ±4.4 (subscale 3) to 11.61 (summed score). CONCLUSIONS: These findings support the use of the BrAT as a reproducible patient-reported outcome measure for adults with traumatic BPI with evidence of appropriate reliability and agreement for both individual and group comparisons. Further psychometric testing is required to establish the construct validity and responsiveness of the BrAT.

Evaluation of Internal Construct Validity and Unidimensionality of the Brachial Assessment Tool, A Patient-Reported Outcome Measure for Brachial Plexus Injury.

OBJECTIVE: To evaluate the internal construct validity and dimensionality of a new patient-reported outcome measure for people with traumatic brachial plexus injury (BPI) based on the International Classification of Functioning, Disability and Health definition of activity. DESIGN: Cross-sectional study. SETTING: Outpatient clinics. PARTICIPANTS: Adults (age range, 18-82y) with a traumatic BPI (N=106). INTERVENTIONS: There were 106 people with BPI who completed a 51-item 5-response questionnaire. Responses were analyzed in 4 phases (missing responses, item correlations, exploratory factor analysis, and Rasch analysis) to evaluate the properties of fit to the Rasch model, threshold response, local dependency, dimensionality, differential item functioning, and targeting. MAIN OUTCOME MEASURES: Not applicable, as this study addresses the development of an outcome measure. RESULTS: Six items were deleted for missing responses, and 10 were deleted for high interitem correlations >.81. The remaining 35 items, while demonstrating fit to the Rasch model, showed evidence of local dependency and multidimensionality. Items were divided into 3 subscales: dressing and grooming (8 items), arm and hand (17 items), and no hand (6 items). All 3 subscales demonstrated fit to the model with no local dependency, minimal disordered thresholds, no unidimensionality or differential item functioning for age, time postinjury, or self-selected dominance. Subscales were combined into 3 subtests and demonstrated fit to the model, no misfit, and unidimensionality, allowing calculation of a summary score. CONCLUSIONS: This preliminary analysis supports the internal construct validity of the Brachial Assessment Tool, a unidimensional targeted 4-response patient-reported outcome measure designed to solely assess activity after traumatic BPI regardless of level of injury, age at recruitment, premorbid limb dominance, and time postinjury. Further examination is required to determine test-retest reliability and responsiveness.

Perceptions of preparedness for the first medical clerkship: a systematic review and synthesis.

BACKGROUND: The transition from university-based to clerkship-based education can be challenging. Medical schools have introduced strategies to ease the transition, but there has been no systematic review synthesizing the evidence on the perceptions of preparedness of medical students for their first clerkship to support these interventions. This study therefore aimed to (1) identify and synthesize the published evidence on medical students' perceptions of preparedness for their first clerkship, and (2) identify factors that may impact on preparedness for clerkship, to better inform interventions aimed at easing this transition. METHODS: Electronic databases (Medline, Journals@Ovid, CINAHL, ERIC, Web of Science, Embase) were searched without restriction and secondary searching of reference lists of included studies was also conducted. Included studies used quantitative or qualitative methodologies, involved medical students and addressed student/supervisor perceptions of preparedness for first clerkship. The first clerkship was defined as the first truly immersive educational experience during which the majority of learning was vocational and self-directed, as per the MeSH term 'clinical clerkship' and associated definition. Using an inductive thematic synthesis approach, 2 researchers independently extracted data, coded text (from results and discussion sections), and identified themes related to preparedness. Any disagreements were resolved by discussion and findings were then narratively synthesized. RESULTS: The initial search identified 1214 papers. After removing duplicates and assessing abstracts and full articles against the inclusion criteria, 8 articles were included in the review. In general, the body of evidence was of sound methodological quality. Ten themes relating to perceptions of preparedness of medical students for their first clerkship were identified; competence, disconnection, links to the future, uncertainty, part of the team, time/workload, adjustment, curriculum, prior life experiences and learning. CONCLUSIONS: Eight of the ten themes related to perceptions of preparedness are potentially amenable to curricula strategies to improve the transition experience. The evidence supports clinical skills refreshers, clarification of roles and expectations, demystification of healthcare hierarchy and assessment processes and student-student handovers. Evidence also supports preclinical educational strategies such as enhancing content contextualization, further opportunities for the application of knowledge and skills, and constructive alignment of assessment tasks and pedagogical aims.