Parents Need More Support: A Qualitative Study of the Experiences of Australian Parents Who Are Waiting for Surgical Intervention for Their Children With Otitis Media.

OBJECTIVE: To explore the experiences, expectations, and motivations of parents/caregivers of children with otitis media who were booked to undergo tympanostomy tube insertion. METHOD: A cross-sectional cohort study was conducted using semistructured interviews with 39 parents. Interviews were conducted via telephone and analyzed for key themes. RESULTS: Three themes emerged that incorporated a range of subthemes: (1) the impact of the child's underlying condition on the family, (2) the cues and prompts that influenced parents to seek intervention, and (3) the parents' expectations of the health-care system. The child's otitis media disrupted the day-to-day functioning of the family and the child's well-being, but despite this, the families found ways to adapt and cope. Parents were influenced by their friends, family, and medical practitioners when making treatment decisions and had differing expectations of the health-care system. CONCLUSION: Parents need support during their child's illness to help with pressures placed on the family and also in making health-care decisions for their child. Clinicians should consider these issues when discussing treatment options with parents.

Moving IPE from being 'worthy' to 'required' in health professional curriculum: Is good governance the missing part?

Introduction: There is an accelerating trend towards interdisciplinary learning and teaching activities in higher education. However, traditional discipline-based approaches to making and implementing decisions (academic governance) can be out of step. Within health professional education, there is a particular need to embrace interdisciplinary approaches to learning in the form of interprofessional education (IPE). The aim of this study was to identify academic governance models that successfully, or otherwise, supported the maintenance of quality standards of IPE programs and learning activities.Method: A 10-year literature search yielded 11 articles that addressed the IPE governance of academic standards.Results: Three models were identified: centralized, decentralized, and stand-alone. Key features of each are described with discussion on strengths and weaknesses for curriculum development, academic leadership and student learning, and the challenges of enabling interprofessional governance within traditional university academic governance structures.Conclusion: As with interdisciplinary education more broadly, there is emerging literature regarding effective governance systems to enable quality IPE within individual institutions. Educators should give careful consideration to the optimal governance model for their particular institution and context.

Acceptability of the culturally adapted ASQ-TRAK developmental screening tool to caregivers of Aboriginal children.

AIM: The Ages and Stages Questionnaire-Talking about Raising Aboriginal Kids (ASQ-TRAK) culturally adapted developmental screening tool is widely used in Australian Aboriginal communities. However, there has been limited exploration of the tool's acceptability to caregivers. The aim of the study is to determine the acceptability of the ASQ-TRAK developmental screening tool to caregivers of Aboriginal children in urban, regional and remote South Australia. METHODS: Caregivers of Aboriginal children completed a survey regarding acceptability of the ASQ-TRAK. Convenience samples of caregivers were invited to a telephone interview. RESULTS: Ninety-two caregivers completed the survey (96% response). Acceptability (92%) and caregiver satisfaction (73%) were high. Families perceived the screen as easy to use and understand, strengths-based and providing valuable information about their child's development. CONCLUSIONS: The ASQ-TRAK tool was highly acceptable to caregivers in Aboriginal communities in South Australia. The study highlights the importance of culturally safe practice and supports ASQ-TRAK implementation. Broader use and further evaluation of the ASQ-TRAK in Aboriginal communities needs consideration.

Governance options for effective interprofessional education: Exposing the gap between education and healthcare services.

CONTEXT: The increase in interprofessional models of collaborative practice and identification of health services as interprofessional organisations, sits somewhat awkwardly with traditional governance systems for both health services and educational institutions. Whereas health services have a primary focus on assuring competence and safety for health care practice, educational institutions have a primary focus on assuring academic standards within specific qualifications. Bridging the gap between these two systems with a workable option has proven challenging, especially in relation to interprofessional education (IPE). OBJECTIVES: Given the need to ensure 'work ready' graduates within a more interprofessional and collaborative workforce, it is important to review the quality assurance governance models that are in place and to consider which of these existing governance systems, if either, is the more appropriate model for enabling and supporting IPE. METHODS: This paper describes current issues in relation to governance for quality assurance, summarises the current state of research in the field and discusses potential governance options moving forward. CONCLUSION: Given that existing governance models are not meeting the challenges of IPE, there is a need to achieve greater alignment between the academic and health service governing systems.

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.

Defining a set of common interprofessional learning competencies for health profession students.

INTRODUCTION: Increasingly recognized as a core component of contemporary health profession education, interprofessional learning outcomes remain difficult to define and assess across disciplines. The aim of this study was to identify a single set of interprofessional learning competency statements with relevance to all health professions. METHODS AND RESULTS: Six national and international interprofessional competency frameworks were reviewed and combined to give a total of 165 competency statements. Following a process of mapping and grouping these statements into common content areas, duplicate content was removed. In addition, content deemed as a core competency for one or more individual health professions was removed. A round table of experts reviewed the remaining statements and agreed a final set of eight. Each statement was expressed as a specific learning outcome that could be assessed and which described behaviors and practices that students could routinely expect to engage with, and participate in, during the course of their study. CONCLUSION: Identifying specific interprofessional competencies that students of all health professions require will enable more effective implementation of interprofessional learning activities and assessment within the core curriculum.

Intersectoral collaboration to implement school-based health programmes: Australian perspectives.

Understanding the processes and the factors influencing intersectoral collaboration is vital for the ongoing success of programmes that rely on effective partnerships between sectors, such as the school-based immunization programme, the school dental health programme and health promotion interventions delivered in school settings. We studied school-based health programmes delivered by partnerships between health, education and the local government sectors. We used purposive sampling to identify 19 people working in school-based health programmes and interviewed them about the barriers and enablers of successful collaboration. Data were analysed thematically. We found that collaboration between complex systems was a skilled endeavour which relied on a strong foundation of communication and interpersonal professional relationships. Understanding the core business, operational context and intersectoral point-of-view of collaborative partners was important both for establishing good intersectoral programmes and sustaining them as contexts and personnel changed. Aligning divergent sectoral agendas early in the collaborative process was essential for ensuring that all partners could meet their core business needs while also delivering the programme outcomes.

Improving management of student clinical placements: insights from activity theory.

BACKGROUND: An approach to improve management of student clinical placements, the Building Teams for Quality Learning project, was trialed in three different health services. In a previous paper the authors explored in some detail the factors associated with considerable success of this approach at one of these services. In this paper, the authors extend this work with further analysis to determine if the more limited outcomes observed with participants at the other two services could be explained by application of activity theory and in particular the expansive learning cycle. METHODS: Staff at three health services participated in the Building Teams for Quality Learning project: a dental clinic, a community aged care facility and a rural hospital. At each site a team of seven multi-disciplinary staff completed the project over 9 to 12 months (total 21 participants). Evaluation data were collected through interviews, focus groups and direct observation of staff and students. Following initial thematic analysis, further analysis was conducted to compare the processes and outcomes at each participating health service drawing on activity theory and the expansive learning cycle. RESULTS: Fifty-one interview transcripts, 33 h of workplace observation and 31 sets of workshop field notes (from 36 h of workshops) were generated. All participants were individually supportive of, and committed to, high quality student learning experiences. As was observed with staff at the dental clinic, a number of potentially effective strategies were discussed at the aged care facility and the rural hospital workshops. However, participants in these two health services could not develop a successful implementation plan. The expansive learning cycle element of modeling and testing new solutions was not achieved and participants were unable, collectively to reassess and reinterpret the object of their activities. CONCLUSION: The application of activity theory and the expansive learning cycle assisted a deeper understanding of the differences in outcomes observed across the three groups of participants. This included identifying specific points in the expansive learning cycle at which the three groups diverged. These findings support some practical recommendations for health services that host student clinical placements.

Ethical Challenges in School-Based Immunization Programs for Adolescents: A Qualitative Study.

OBJECTIVES: We investigated ethical issues in school-based immunization programs for adolescents and how they are addressed. METHODS: We used qualitative methods and an ethnographic approach to observe 9 secondary schools on immunization days in South Australia in 2011; concurrently, we conducted 9 focus groups with female secondary school students, 6 semistructured interviews with parents, and 10 interviews with nurses and teachers. We explored ethical challenges from the perspective of these groups. RESULTS: We identified ethical challenges for the delivery of adolescent immunization in a school-based setting in 3 main areas: informed consent, restrictions on privacy, and harm to students in the form of fear and anxiety. CONCLUSIONS: We found areas in which the design and delivery of school-based immunization programs can be improved. Information about immunization should be provided in ways that are appropriate to young people and their parents, and privacy protections should be enhanced when possible. Involving young people in the design and delivery of programs would assist with making these improvements.

Rethinking attitudes to student clinical supervision and patient care: a change management success story.

BACKGROUND: The aim of this project was to explore the process of change in a busy community dental clinic following a team development intervention designed to improve the management of student supervision during clinical placements. METHODS: An action research model was used. Seven members of a community dental clinic team (three dentists, two dental therapists, one dental assistant and the clinic manager), together with the university clinical placement supervisor participated in the team development intervention. The intervention consisted of two profiling activities and associated workshops spread six months apart. These activities focused on individual work preferences and overall team performance with the aim of improving the functioning of the clinic as a learning environment for dental students. Evaluation data consisted of 20 participant interviews, fourteen hours of workplace observation and six sets of field notes. Following initial thematic analysis, project outcomes were re-analysed using activity theory and expansive learning as a theoretical framework. RESULTS: At project commencement students were not well integrated into the day-to-day clinic functioning. Staff expressed a general view that greater attention to student supervision would compromise patient care. Following the intervention greater clinical team cohesion and workflow changes delivered efficiencies in practice, enhanced relationships among team members, and more positive attitudes towards students. The physical layout of the clinic and clinical workloads were changed to achieve greater involvement of all team members in supporting student learning. Unexpectedly, these changes also improved clinic functioning and increased the number of student placements available. CONCLUSIONS: In navigating the sequential stages of the expansive learning cycle, the clinical team ultimately redefined the 'object' of their activity and crossed previously impervious boundaries between healthcare delivery and student supervision with benefits to all parties.

Eliciting youth and adult recommendations through citizens' juries to improve school based adolescent immunisation programs.

OBJECTIVES: Completion of adolescent immunisation schedules in Australia is sub-optimal despite a well-established school based delivery program. The aim of this study was to seek adolescent and adult views on how existing adolescent school based immunisation policy and program delivery could be improved to increase adolescent immunisation uptake. METHOD: Two citizens' juries held separately, one with adolescent participants and one with adult participants deliberated on recommendations for public policy. Jury members were selected using a stratified sampling technique and recruited from a standing panel of community research participants through a market research company in South Australia. Juries were conducted in Metropolitan South Australia over two days and used university facilities with all meals and refreshments provided. RESULTS: Fifteen adults and 16 adolescents participated in the adult and youth juries respectively. Similar recommendations were made by both juries including increased ensuring the accuracy of information provided to adolescents and parents; employing a variety of formats for information delivery; and greater consideration of students' physical and emotional comfort in order to improve the experience for adolescents. While the youth jury recommended that it should be compulsory for adolescents to receive vaccines through the school based immunisation program, the adult jury recommended an 'opt-out' system of consent. Both juries also recommended the use of incentives to improve immunisation uptake and immunisation course completion. CONCLUSIONS: Eliciting adolescent views and including the perspectives of adolescents in discussions and development of strategies to improve engagement in the school based immunisation program provided valuable insight from the group most impacted by these policies and practices. Specifically, incorporation of adolescent and community views using citizens' juries may lead to greater overall support from the community as their values and needs are more accurately reflected.

Parental and societal support for adolescent immunization through school based immunization programs.

OBJECTIVES: Adolescent immunizations such as human papillomavirus vaccine have been implemented through school based immunization programs (SBIPs) in Australia. We assessed community attitudes toward immunization of adolescents though SBIPs. METHODS: A cross-sectional population survey of rural and metropolitan households in South Australia in 2011. Univariate and multiple regression analyses identified predictors of support for a SBIP. RESULTS: Participation rate was 57.3% with 1926 adults interviewed. Overall, 75.9% regarded school as the best place to offer adolescent immunizations, with 16.4% preferring the family physician. Parents of high school students were most supportive (88.4%) of a SBIP with 87.9% of their adolescents reported as having participated in the program. Adults 18-34 years (79.4%) were more likely to support a SBIP compared to older adults (68.7% of >55 years) [adjusted OR=2.39, p=0.002] and men were more supportive (80.3%) than women (71.7%) [adjusted OR=1.54, p=0.003]. Reasons for participation in the SBIP included convenience (39.9%), public funding for the service (32.4%), and confidence in immunization recommendations (21.0%). CONCLUSIONS: Public support for the SBIP was very high particularly amongst parents whose adolescent/s had participated in the program.

A student-centred feedback model for educators.

BACKGROUND: Effective feedback is instrumental to effective learning. Current feedback models tend to be educator driven rather than learner-centred, with the focus on how the supervisor should give feedback rather than on the role of the learner in requesting and responding to feedback. CONTEXT: An alternative approach emphasising the theoretical principles of student-centred and self-regulated learning is offered, drawing upon the literature and also upon the experience of the authors. INNOVATION: The proposed feedback model places the student in the centre of the feedback process, and stresses that the attainment of student learning outcomes is influenced by the students themselves. This model emphasises the attributes of the student, particularly responsiveness, receptiveness and reflection, whilst acknowledging the important role that the context and attributes of the supervisor have in influencing the quality of feedback. IMPLICATIONS: Educational institutions should consider strategies to encourage and enable students to maximise the many feedback opportunities available to them. As a minimum, educators should remind students about their central role in the feedback process, and support them to develop confidence in meeting this role. In addition, supervisors may need support to develop the skills to shift the balance of responsibility and support students in precipitating feedback moments. Research is also required to validate the proposed model and to determine how to support students to adopt self-regulatory learning, with feedback as a central platform.

Twelve tips for supporting student learning in multidisciplinary clinical placements.

Healthcare profession students participate in a range of clinical placements within multidisciplinary health care settings. Often these placements offer students opportunities to participate in activities with staff and/or students from other healthcare disciplines. Although health service staff generally recognise the importance of clinical placements for student learning, they sometimes feel overwhelmed by workload and resource constraints. As a consequence, the potential of the clinical team to contribute to student learning may not be fully realised. A key element of successful clinical placement programs across all healthcare disciplines is a coordinated approach to the development and management of complex university/health service partnerships. Explicit mechanisms to support clinical team members in their teaching roles can also contribute to develop and sustain staff capacity for student supervision, as appropriate recognition of clinical staff contributes to student learning. Twelve tips are offered for consideration by universities, health services and clinical staff when planning and implementing student clinical placements in multidisciplinary healthcare settings.

Interprofessional education in clinical practice: not a single vaccine.

In increasingly complex health service environments, the quality of teamwork and co-operation between doctors, nurses and allied health professionals, is 'under the microscope'. Interprofessional education (IPE), a process whereby health professionals learn 'from, with and about each other', is advocated as a response to widespread calls for improved communication and collaboration between healthcare professionals.

Increasing health-care options: the perspectives of parents who use complementary and alternative medicines.

AIM: To explore the relationship between conventional medicine and complementary and alternative medicine (CAM) with parents who use CAM, and to consider factors that may contribute to parent non-disclosure of CAM usage to their doctor. METHODS: Thirty-three parents participated in one of seven focus groups. Transcripts were analysed using an iterative process of theme identification and testing against transcript data. RESULTS: The participants believed they should trust their instincts as parents in caring for their child. It was important also to the participants that they understood why their child was ill, and a range of theories of health and illness were discussed. The use of CAM was attractive as it offered more options in health care than just relying on conventional medicine alone. The use of additional therapies was seen as a means to increase the likelihood that something would work. Many of the participants described bad experiences with doctors when they discussed CAM use previously so they had become more circumspect in mentioning it. The participants were most satisfied with medical care for their child when they felt the doctor respected their point of view and listened to them. CONCLUSIONS: Doctors caring for children and their families should expect that many parents are using CAM to increase health-care options. Inquiries about CAM usage should be made in a non-judgmental and encouraging manner so parents feel comfortable in providing an honest answer. Advice to parents about CAM may need to be backed up with evidence to address differing parent understanding of illness.