The Readiness of Australian Health Care Students to Encounter Patients Experiencing Partner Abuse.

Partner abuse is a significant contributor to mortality and morbidity worldwide, and has been identified as a priority health care issue. Most health care students rarely receive education on partner abuse and report not feeling ready to encounter patients experiencing partner abuse. Analysis of the current readiness of health care students and can inform educational needs to address this gap. The READIness to encounter partner abuse patients Scale was delivered to a convenience sample of Australian prequalification health care students. Participant demographics and estimated hours of education were also reported. Mean readiness scores were calculated by discipline. The relationship between hours of education and readiness scores was calculated using linear regression. A total of 926 participants were included in the analysis. Approximately half of the participants (47.5%) reported less than two hours of education. Mean readiness of students was 4.99 out of 7 (SD 0.73, range 4.39-5.95). Linear regression revealed a significant association between hours of education and readiness, r(925) = .497, p < .000. Australian health care students receive little education about partner abuse, and do not report feeling ready to encounter patients experiencing partner abuse. An individual's confidence and belief in their abilities appear to be the key factor influencing overall readiness. Participants indicated a strong belief that responding to partner abuse was part of their professional role, which is a positive change from previous research. Higher hours of education is associated with higher readiness, though which educational methodologies are most impactful remains unclear.

Physiotherapy Students' Exposure to Confronting Clinical Situations: A Qualitative Review.

OBJECTIVES: To ascertain an understanding of the confronting situations that physiotherapy students encounter in clinical practice. METHODS: Eighty-two final-year physiotherapy students attended an interactive workshop on confronting situations, and 46 of these students completed a follow-up survey. There were no selection criteria. Students wrote about these confronting situations, and the responses were used to formulate an online survey which was emailed to participants. RESULTS: Students wrote about the types of confronting situations that they had experienced. Survey results revealed that the most commonly seen confronting situations were clients in pain, clients with a condition that impacted significantly on their life and the life of their family and clients with degenerative diseases. Students primarily sought support from colleagues, clinical educators, and family/friends. Peers and clinical educators may be ill-equipped to manage these confronting situations. CONCLUSION: Students are exposed to confronting situations in the clinical environment and feel they need more preparation in dealing with these distressing cases. While education regarding appropriate resources can be put in place, there is further work to do in preparing students for the confronting nature of working as a health professional.

Understanding students' and clinicians' experiences of informal interprofessional workplace learning: an Australian qualitative study.

OBJECTIVES: While postgraduate studies have begun to shed light on informal interprofessional workplace learning, studies with preregistration learners have typically focused on formal and structured work-based learning. The current study investigated preregistration students' informal interprofessional workplace learning by exploring students' and clinicians' experiences of interprofessional student-clinician (IPSC) interactions. DESIGN: A qualitative interview study using narrative techniques was conducted. SETTING: Student placements across multiple clinical sites in Victoria, Australia. PARTICIPANTS: Through maximum variation sampling, 61 participants (38 students and 23 clinicians) were recruited from six professions (medicine, midwifery, nursing, occupational therapy, paramedicine and physiotherapy). METHODS: We conducted 12 group and 10 individual semistructured interviews. Themes were identified through framework analysis, and the similarities and differences in subthemes by participant group were interrogated. RESULTS: Six themes relating to four research questions were identified: (1) conceptualisations of IPSC interactions; (2) context for interaction experiences; (3) the nature of interaction experiences; (4) factors contributing to positive or negative interactions; (5) positive or negative consequences of interactions and (6) suggested improvements for IPSC interactions. Seven noteworthy differences in subthemes between students and clinicians and across the professions were identified. CONCLUSIONS: Despite the results largely supporting previous postgraduate research, the findings illustrate greater breadth and depth of understandings, experiences and suggestions for preregistration education. Educators and students are encouraged to seek opportunities for informal interprofessional learning afforded by the workplace.

How do professional Australian Football League (AFL) players utilise social media during periods of injury? A mixed methods analysis.

OBJECTIVES: The objective of this study was to explore how social media is used by a population of injured professional athletes, by comparing the content and frequency of posts on social media, pre and post-injury. DESIGN: A retrospective mixed methods design was utilised. METHODS: Professional Australian Football League (AFL) players, injured during the 2015 season, were included in the study. Publicly accessible social media profiles for these players were identified on Twitter and Instagram. All posts published on verified profiles, from four weeks prior to injury until return to play, were extracted. Thematic analysis was used to investigate the content of these posts, while univariate and multivariate linear regression was used to investigate the frequency of posts during this time period. RESULTS: Two reoccurring themes were identified exclusively post-injury; 'supporting team from the sideline' and 'sharing information about injury and rehabilitation'. The frequency of total posts did not differ significantly pre and post-injury, but the frequency of injury related posts increased in the immediate post-injury phase, then decreased between 4-8 weeks and 8-12 weeks post-injury. The frequency of injury related posts was higher with more severe injuries. CONCLUSIONS: The findings of this study suggest that injured players use social media to seek social support from their followers, especially in the immediate post-injury period and after sustaining a severe injury. The role of social media in injury rehabilitation may warrant further investigation, to determine if it could be used to facilitate return to play.

Effects of head flexion posture on the multidirectional static force capacity of the neck.

BACKGROUND: Neck muscle force protects vertebral alignment and resists potentially injurious loading of osteoligamentous structures during head impacts. As the majority of neck muscles generate moments about all three planes of motion, it is not clear how the force capacity of the neck might be modulated by direction of force application and head posture. The aim of our study was to measure the multidirectional moment-generating capacity of the neck and to evaluate effects of 20° of head flexion, a common head position in contact sports, on the measured capacity. METHODS: We conducted a cross-sectional study, with 25 males, 20-30years old, performing maximum voluntary contractions, with ballistic intent, along eight directions, set at 45° intervals in the horizontal plane of the head. Three-dimensional moments at C3 and T1 were calculated using equations of static equilibrium. The variable of interest was the impulse of force generated from 0-50ms. Effects of direction of force application and head posture, neutral and 20° flexion, were evaluated by two-way analysis of variance and linear regression. FINDINGS: Impulse of force was lower along diagonal planes, at 45° from the mid-sagittal plane, compared to orthogonal planes (P<0.001). Compared to neutral posture, head flexion produced a 55.2% decrease in impulse capacity at C3 and 45.9% at T1. INTERPRETATION: The risk of injury with head impact would intrinsically be higher along diagonal planes and with a 20° head down position due to a lower moment generating capacity of the neck in the first 50ms of force application.

Registration factors that limit international mobility of people holding physiotherapy qualifications: A systematic review.

INTRODUCTION: There is no enforced international standardisation of the physiotherapy profession. Thus, registration is used in many countries to maintain standards of care and to protect the public. However, registration may also limit international workforce mobility. QUESTION: What is known about the professional registration factors that may limit the international mobility of people holding physiotherapy qualifications? DESIGN: Systematic review using an electronic database search and hand searching of the World Confederation for Physical Therapy and International Network of Physiotherapy Regulatory Authorities websites. Analysis was conducted using thematic analysis. RESULTS: 10 articles and eight websites were included from the search strategy. Data is representative of high-income English speaking countries. Four themes emerged regarding limitations to professional mobility: practice context, qualification recognition, verification of fitness to practice, and incidental limitations arising from the registration process. CONCLUSION: Professional mobility is limited by differences in physiotherapy education programmes, resulting in varying standards of competency. Thus, it is often necessary to verify clinical competencies through assessments, as well as determining professional attributes and ability to apply competencies in a different practice context, as part of the registration process. There has been little evaluation of registration practices, and at present, there is a need to re-evaluate current registration processes to ensure they are efficient and effective, thereby enhancing workforce mobility.

Remote-online case-based learning: A comparison of remote-online and face-to-face, case-based learning - a randomized controlled trial.

BACKGROUND: Case-based learning (CBL) is an educational approach where students work in small, collaborative groups to solve problems. Computer assisted learning (CAL) is the implementation of computer technology in education. The purpose of this study was to compare the effects of a remote-online CBL (RO-CBL) with traditional face-to-face CBL on learning the outcomes of undergraduate physiotherapy students. METHODS: Participants were randomized to either the control (face-to-face CBL) or to the CAL intervention (RO-CBL). The entire 3rd year physiotherapy cohort (n = 41) at Monash University, Victoria, Australia, were invited to participate in the randomized controlled trial. Outcomes included a postintervention multiple-choice test evaluating the knowledge gained from the CBL, a self-assessment of learning based on examinable learning objectives and student satisfaction with the CBL. In addition, a focus group was conducted investigating perceptions and responses to the online format. RESULTS: Thirty-eight students (control n = 19, intervention n = 19) participated in two CBL sessions and completed the outcome assessments. CBL median scores for the postintervention multiple-choice test were comparable (Wilcoxon rank sum P = 0.61) (median/10 [range] intervention group: 9 [8-10] control group: 10 [7-10]). Of the 15 examinable learning objectives, eight were significantly in favor of the control group, suggesting a greater perceived depth of learning. Eighty-four percent of students (16/19) disagreed with the statement "I enjoyed the method of CBL delivery." Key themes identified from the focus group included risks associated with the implementation of, challenges of communicating in, and flexibility offered, by web-based programs. DISCUSSION: RO-CBL appears to provide students with a comparable learning experience to traditional CBL. Procedural and infrastructure factors need to be addressed in future studies to counter student dissatisfaction and decreased perceived depth of learning.

The sympathetic nervous system and tendinopathy: a systematic review.

BACKGROUND: Tendinopathy is a clinical diagnosis of localised tendon pain often confirmed by imaging findings. The pathophysiological cause of the pain is unknown and the sympathetic nervous system (SNS) may be implicated. OBJECTIVE: To review what is known regarding the role of the SNS in human tendinopathy. STUDY SELECTION: Published data describing sympathetic innervation or an index of sympathetic activity in human tendons were eligible for inclusion. DATA SOURCES: Bibliographical databases (AMED, Biological Abstracts, CINAHL Plus, EMBASE, MEDLINE, Scopus, SPORTDiscus and Web of Science) were searched for relevant articles. Reference lists from included articles were screened for additional articles. STUDY APPRAISAL: Studies were scored with a quality assessment tool to identify potential sources of bias. Each question had an explicit decision rule to guide assessment. RESULTS: Nine case-control and four cross-sectional studies examined sympathetic innervation of tendons. There was evidence suggesting a lack of difference in sympathetic innervation of tendon proper between tendinopathy biopsies and healthy controls. In contrast, the paratendinous tissue showed evidence of increased sympathetic innervation in painful tendons. The most notable increase in SNS markers was seen in abnormal tenocytes from painful tendons. Data from two studies were suitable for meta-analysis. These heterogeneous studies revealed no difference in sympathetic innervation between painful and pain-free tendons. No studies recorded SNS activity in vivo. CONCLUSION: Sympathetic innervation in painful tendons depends on tissue type. Abnormal tenocytes may have increased capacity for self-production of sympathetic neurotransmitters. Future insight may be gained by measuring global in vivo sympathetic drive in tendinopathy.

Implementing student self-video of performance.

BACKGROUND: Resource and curriculum constraints within contemporary university programmes limit opportunities for supervision and feedback of student practice. This study investigated the technological challenges, solutions and educational rewards in implementing Web-based student self-video of performance as a method to foster the development of student self-evaluation. METHODS: Physiotherapy students (n = 60) in their final preclinical semester participated in the study. All students received guidelines for constructing and uploading self-videos of performance to a Web-based learning system. Students completed a reflective task on each video submission after receiving online tutor feedback and viewing an exemplar peer performance. Students completed a survey of their learning experiences and challenges in completing the learning tasks. Technical information on submissions was obtained in usage reports from the Web-based learning system. RESULTS: Students were successful in recording and uploading digital videos of performance for remote tutor review. Students and tutors encountered technical problems that could be rectified and potentially avoided through activity design. Students reported that the utility of Web-based self-video for enhancing clinical performance outweighed the additional time and effort required in participation. CONCLUSIONS: Web-based student self-video of performance, with remote tutor feedback and guided reflection, is a feasible method for increasing students' capacity for reflection and self-evaluation. Although technical difficulties are inherent in any technology-reliant activity, the students' increasing competence with emerging technologies encourage self-video teaching and learning activities as a resource for facilitating clinical skill development.

Corticospinal Facilitation of Erector Spinae and Rectus Abdominis Muscles During Graded Voluntary Contractions is Task Specific: A Pilot Study on Healthy Individuals.

INTRODUCTION: IN THIS STUDY WE COMPARED TRANSCRANIAL MAGNETIC STIMULATION (TMS) ELICITED MOTOR EVOKED POTENTIALS (MEPS) IN A POSTURAL (BILATERAL LOW BACK EXTENSION: BLBE) and a respiratory (forced expiration during breath holding: FEBH) task. METHODS: Using TMS of the left motor cortex, simultaneous patterns of corticospinal facilitation of the contralateral erector spinae (ES) and rectus abdominis (RA) muscles during graded voluntary activation were compared in seven healthy subjects. RESULT: The facilitation pattern demonstrated task dependency by showing that MEP amplitudes in the ES muscle tended to be smaller at any given contraction level in the FEBH task than in the BLBE task. DISCUSSION: The results suggested a linear-type relationship between the size of MEPs with increasing background contraction of ES and RA in the BLBE task. However, both muscles showed a plateau effect with higher background contractions (>50% of maximum) during the FEBH task. The varied response of ES and RA across these two tasks reinforces the importance of task specific training in clinical settings.

Investigating the efficacy of practical skill teaching: a pilot-study comparing three educational methods.

Effective education of practical skills can alter clinician behaviour, positively influence patient outcomes, and reduce the risk of patient harm. This study compares the efficacy of two innovative practical skill teaching methods, against a traditional teaching method. Year three pre-clinical physiotherapy students consented to participate in a randomised controlled trial, with concealed allocation and blinded participants and outcome assessment. Each of the three randomly allocated groups were exposed to a different practical skills teaching method (traditional, pre-recorded video tutorial or student self-video) for two specific practical skills during the semester. Clinical performance was assessed using an objective structured clinical examination (OSCE). The students were also administered a questionnaire to gain the participants level of satisfaction with the teaching method, and their perceptions of the teaching methods educational value. There were no significant differences in clinical performance between the three practical skill teaching methods as measured in the OSCE, or for student ratings of satisfaction. A significant difference existed between the methods for the student ratings of perceived educational value, with the teaching approaches of pre-recorded video tutorial and student self-video being rated higher than 'traditional' live tutoring. Alternative teaching methods to traditional live tutoring can produce equivalent learning outcomes when applied to the practical skill development of undergraduate health professional students. The use of alternative practical skill teaching methods may allow for greater flexibility for both staff and infrastructure resource allocation.

The effect of student self-video of performance on clinical skill competency: a randomised controlled trial.

Emerging technologies and student information technology literacy are enabling new methods of teaching and learning for clinical skill performance. Facilitating experiential practice and reflection on performance through student self-video, and exposure to peer benchmarks, may promote greater levels of skill competency. This study examines the impact of student self-video on the attainment of clinical skills. A total of 60 Physiotherapy students (100%) consented to participate in the randomised controlled trial. One group (50%) was taught a complex clinical skill with regular practical tutoring, whilst the other group (50%) supplemented the tutoring with a self-video task aimed at promoting reflection on performance. Student skill performance was measured in an objective structured clinical examination (OSCE). Students also completed an anonymous questionnaire, which explored their perception of their learning experiences. Students received significantly higher scores in the OSCE when the examined clinical skill had been supplemented with a self-video of performance task (P = 0.048). Descriptive analysis of the questionnaires relating to student perceptions on the teaching methods identified that the self-video of performance task utilised contributed to improvement in their clinical performance and their confidence for future clinical practice. Students identified a number of aspects of the submission process that contributed to this perception of educational value. The novel results of this study demonstrate that greater clinical skill competency is achieved when traditional tutoring methods are supplemented with student self-video of performance tasks. Additional benefits included the ability of staff and students to monitor longitudinal performance, and an increase in feedback opportunities.