Clinical Instructors' Experiences Working with and Assessing Students Who Perform below Expectations in Physical Therapy Clinical Internships.

Purpose: Clinical education is an integral component of the curriculum of all physical therapy (PT) entry-to-practice programmes in Canada. The literature indicates that working with and assessing students performing below expectations (SPBE) can be procedurally and emotionally difficult. Our study aimed to explore the experiences of clinical instructors (CIs) and the decision-making process involved when supervising SPBE in PT. Method: A total of 19 in-depth, semi-structured interviews were conducted with CIs, transcribed, and coded using qualitative thematic analysis. Results: Four factors appeared to be important for CIs when they were deciding how to assess SPBE: (1) features of student performance, (2) factors related to the CIs, (3) academic and clinical facility influencers, and (4) strategies and available resources. Concerns about safety and professional behaviour, a student's clinical reasoning skills, and a lack of progression were key factors that CIs considered in recommending a final grade. CIs were more likely to recommend a failing grade if there was a series of repeated incidents rather than an isolated incident. Conclusions: We make several recommendations for the student, CI, and facilities to consider to better support and facilitate the process of working with SPBE in PT clinical education.

Objectif : la formation clinique fait partie intégrante des tous les programmes d'accès à la pratique en physiothérapie au Canada. Selon les publications, il peut être difficile sur le plan technique et affectif de travailler avec des étudiants dont le rendement est inférieur aux attentes (ÉRIA) et de les évaluer. La présente étude visait à explorer les expériences des moniteurs cliniques (MC) et les processus décisionnels en cause lors de la supervision d'ÉRIA en physiothérapie. Méthodologie : Au total, les chercheurs ont procédé à 19 entrevues semi-structurées approfondies avec des MC, qu'ils ont transcrites et codées au moyen d'une analyse thématique qualitative. Résultats : quatre facteurs semblent importants pour les MC lorsqu'ils décident comment évaluer les ÉRIA : 1) caractéristiques du rendement des étudiants, 2) facteurs liés aux MC, 3) influenceurs de l'établissement universitaire et clinique et 4) stratégies et ressources disponibles. Les inquiétudes quant à la sécurité et au comportement professionnel, les capacités de raisonnement clinique de l'étudiant et le manque de progression étaient des facteurs clés pour les MC au moment de recommander une note finale. Ceux-ci étaient plus susceptibles de recommander une note d'échec devant une série d'incidents répétés que devant un incident isolé. Conclusions : les chercheurs font plusieurs recommandations pour les étudiants, les MC et les établissements afin de mieux soutenir et de faciliter le processus de travail avec les ÉRIA dans le cadre de la formation clinique en physiothérapie.

Role of immune factors in angiotensin II-induced hypertension and renal damage in Dahl salt-sensitive rats.

The present study assessed the importance of immunity in angiotensin (ANG) II (5 ng·kg-1·min-1 iv)-mediated hypertension in Dahl salt-sensitive (SS) rats and SS rats deficient in T and B lymphocytes (SSRag1-/-) fed a 0.4% NaCl diet. Baseline mean arterial blood pressure (MAP) was not different between groups. ANG II infusion significantly increased MAP in both groups, although MAP increased more rapidly in SS rats, and the maximal MAP achieved was significantly greater in SS than SSRag1-/- rats (190 ± 3 vs. 177 ± 3 mmHg) after 12 days. Renal damage, as assessed by albumin excretion rate, was significantly increased after 12 days of ANG lI infusion in SS (from 32 ± 4 to 81 ± 9 mg/day) and SSRag1-/- (from 12 ± 2 to 51 ± 8 mg/day) rats; albumin excretion rate was significantly different between SS and SSRag1-/- rats at all points measured. After 9 days of recovery from ANG II, MAP was decreased to a greater extent in SSRag1-/- than SS rats (143 ± 5 vs. 157 ± 8 mmHg) compared with the peak MAP during ANG II infusion. At this same time point, albumin excretion rate was significantly lower in SSRag1-/- than SS rats (42 ± 8 vs. 66 ± 7 mg/day). Further studies demonstrated an increase in CD45+ total leukocytes, CD11b/c+ macrophages/monocytes, and CD3+ T cells in kidneys of ANG II- compared with vehicle-treated SS rats. The present data suggest that infiltrating T cells in the kidney exacerbate renal damage in ANG II-induced hypertension in SS rats maintained on a 0.4% NaCl diet, similar to results observed with a salt stimulus in SS rats.

Role of immune cells in salt-sensitive hypertension and renal injury.

PURPOSE OF REVIEW: Immune mechanisms exacerbate the severity of hypertension in humans and animal models of disease. This review summarizes recent mechanistic studies exploring the pathways whereby immunity influences salt-sensitive hypertension and renal disease. RECENT FINDINGS: Emphasis is placed on the role of T cell subtypes, the mechanisms of T-cell activation, and the identification of potential antigens or neoantigens. SUMMARY: Significant advancements have occurred in the search for pathways which activate the adaptive immune response. An enhanced understanding of the factors contributing to hypertension can lead to better therapies.