Physical education resources, class management, and student physical activity levels: a structure-process-outcome approach to evaluating physical education effectiveness.

BACKGROUND: This study was conducted to empirically evaluate specific human, curricular, and material resources that maximize student opportunities for physical activity during physical education (PE) class time. A structure-process-outcome model was proposed to identify the resources that influence the frequency of PE and intensity of physical activity during PE. The proportion of class time devoted to management was evaluated as a potential mediator of the relations between resource availability and student activity levels. METHODS: Data for this cross-sectional study were collected from interviews conducted with 46 physical educators and the systematic observation of 184 PE sessions in 34 schools. Regression analyses were conducted to test for the main effects of resource availability and the mediating role of class management. RESULTS: Students who attended schools with a low student-to-physical educator ratio had more PE time and engaged in higher levels of physical activity during class time. Access to adequate PE equipment and facilities was positively associated with student activity levels. The availability of a greater number of physical educators per student was found to impact student activity levels by reducing the amount of session time devoted to class management. CONCLUSION: The identification of structure and process predictors of student activity levels in PE will support the allocation of resources and encourage instructional practices that best support increased student activity levels in the most cost-effective way possible. Implications for PE policies and programs are discussed.

Individual and Instructional Determinants of Student Engagement in Physical Education.

This study was conducted to identify student characteristics and instructional factors that impact student engagement in physical education (PE). Data were derived from the systematic observation of 124 sessions taught by 31 physical educators and the administration of health and PE engagement questionnaires to 2,018 students in grades 5-8. Physical activity was directly affected by student engagement and perceived competence in PE and indirectly affected by students' body image through its association with PE engagement. Multilevel analyses revealed that the proportion of class time devoted to game play was negatively associated with student engagement in PE. Although less frequently used during PE sessions, skill practice was positively associated with student engagement and inactive instruction was negatively associated with student engagement. These effects were particularly pronounced among students with poor competence beliefs. Implications for PE instructional practice and future research are presented.

Synchronous communication facilitates interruptive workflow for attending physicians and nurses in clinical settings.

STUDY OBJECTIVE: Inter-clinician communication accounts for more than half of all information exchanges within the health care system. A non-participatory, qualitative time-and-motion observational study was conducted in order to gain a better understanding of inter-clinician communication behaviors, routine workflow patterns, and the use of information communication technologies (ICTs) within the clinical workspace. METHOD: Over a 5-day period, seven attending physicians and two nurses were shadowed for 2-4h at a time. Inter-clinician communication events were tracked in real-time using synchronized digital stopwatches. Observations were recorded on a paper-based, semi-structured observation tool and later coded for analysis. RESULTS: Nine hundred and eighty-seven communication events were observed over 2024.67 min. Clinicians were observed to spend the majority of their time on patient care (85.4% in this study) with about three-fourths of that time spent on indirect patient care (e.g. charting). Clinicians were observed to prefer using synchronous communication modes, which led to multitasking and created a highly interrupted workflow. Forty-two percent (n=415) of communication events were coded as interruptions and study participants were seen multitasking 14.8% of the time. Though each interruption was short-lived (on average 0.98+/-2.24 min for attending physicians), they occurred frequently. Both attending physicians and nurses were the recipients of more interruptions than they initiated. CONCLUSION: This study demonstrated that the clinical workspace is a highly interruptive environment. Multiple interruptions in the communication processes between clinicians consume time and have the potential to increase the risk of error. This workflow analysis may inform the development of communication devices to enhance inter-clinician communication by reducing interruptions or deferring interruptions to more appropriate times.

Understanding communication capacity. Communication patterns and ICT usage in clinical settings.

Organizational complexity and interruptive workflows present challenges to communication in clinical workspaces, compromising healthcare quality and cost, and potentially leading to negative patient outcomes. To understand how information communication technology (ICT) could be improved, we reviewed the literature on inter-clinician communication problems, impacts on clinical workflows, ICT usage and barriers to communication. Our search yielded more than 300 articles; 98 met our inclusion criteria. In general, we found that clinical communication tends to flow along synchronous channels and is highly interruptive. Both electronic and non-electronic solutions to communication problems have met with mixed results. Implementation failures have been linked to barriers to technology adoption, including such factors as age, gender and computer experience. More research is needed to understand how improved communication reduces adverse clinical events and healthcare costs. Cost-effective ICTs to improve communication efficiency and workflow patterns in healthcare settings have great potential to enhance quality of care and reduce medical costs.