Using a boundary crossing lens to understand basic science educator and clinical educator collaboration in instructional design.

PURPOSE: Collaborations between basic science educators (BE) and clinical educators (CE) in medical education are common and necessary to create integrated learning materials. However, few studies describe experiences of or processes used by educators engaged in interdisciplinary teamwork. We use the lens of boundary crossing to explore processes described by BE and CE that support the co-creation of integrated learning materials, and the impact that this work has on them. MATERIALS AND METHODS: We conducted qualitative content analysis on program evaluation data from 27 BE and CE who worked on 12 teams as part of a multi-institutional instructional design project. RESULTS: BE and CE productively engaged in collaboration using boundary crossing mechanisms. These included respecting diverse perspectives and expertise and finding efficient processes for completing shared work that allow BE and CE to build on each other's contributions. BE and CE developed confidence in connecting clinical concepts with causal explanations, and willingness to engage in and support such collaborations at their own institutions. CONCLUSIONS: BE and CE report the use of boundary crossing mechanisms that support collaboration in instructional design. Such practices could be harnessed in future collaborations between BE and CE.

National evaluation of DNP students' use of the PICOT method for formulating clinical questions.

BACKGROUND: The intent of the PICOT (i.e., Population, Intervention, Comparison, Outcome, Time) method is to formulate focused clinical questions to facilitate the discovery of relevant evidence through systematic searching, with the components of the question serving as the foundation for the search. Doctor of Nursing Practice (DNP) graduates use evidence-based practices to institute changes in their organizations' systems and policies, thereby yielding positive effects on both patient and system outcomes. Given that the clinical question is the foundation of the evidence-based practice process, DNP graduates' competence in the PICOT method needs to be better understood. AIMS: This analysis aimed to describe how DNP students used the PICOT method to ask clinical questions in their DNP projects. METHODS: Project questions were retrieved from a subset (n = 129, 60.56%) of an existing national random sample of publicly available DNP projects spanning the years 2010 to 2021 from Commission on Collegiate Nursing Education-accredited schools (n = 213). Project questions using the PICOT method were further evaluated with a scoring system of 0 = no and 1 = yes for missing elements, formatting, directional outcome, and project purpose. Possible scores ranged from 0 to 8, with higher scores indicating more errors. Discussion among five researchers, until agreement was achieved, yielded consensus. RESULTS: Although the PICOT method was project author-identified in 66 (31.0%) projects, only four (6%) followed the PICOT method. All 66 (100%) were intervention questions. There were 2.74 (SD 1.55) mean errors, ranging from 0 to 6. No questions were missing P or O. Specific errors included missing I 3 (4.5%) or missing C 37 (56%), poor formatting 34 (51.5%), directional outcome 44 (66.7%), and project purpose 38 (57.6%). Thirty-three (50%) of the questions were missing T; however, T is not used for searching, so researchers recalculated the mean error without T (M = 2.24, SD = 1.28, range 0-5). LINKING EVIDENCE TO ACTION: Gaps in the accurate use of the PICOT method to construct clinical questions can lead to biased searches, inaccurate clinical problem identification, and, when used as the project purpose, jumping to non-evidence-based solutions. Academic faculty and clinical educators can mitigate these skewed outcomes and enhance their impact on quality outcomes by helping DNP-prepared nurses shore up this foundational skill.

Physiotherapy students' rating on lecturers' and supervisors' clinical education attributes.

Background: Clinical education is considered a vital aspect of education of health science students. Attributes of clinical educators play a crucial role in determining the outcome of clinical teaching and learning. A good clinical educator ensures that students get maximum benefits of the clinical learning experience. Objective: To determine the ratings of physiotherapy students on clinical education attributes of lecturers and clinical supervisors. Methods: The study was conducted with 81 clinical physiotherapy students from two universities in Ghana. Two copies of McGill clinical teachers' evaluation (CTE) tool were used to obtain students' ratings on their clinical supervisors' and lecturers' clinical education attributes. Independent t-test was used to compare the means of students' level of study and ratings regarding the clinical education attributes of clinical supervisors and lecturers. Results: Students had a high rating on their clinical education attributes of supervisors and lecturers with a mean score of (121.22±18.12) and (122.11±16.71), respectively. Rating on clinical education attributes of supervisors (p=0.111) and lecturers (p=0.124) did not differ significantly between the different levels of study. Conclusion: Clinical physiotherapy students rated the clinical education attributes of their lecturers and supervisors high.

ASPIRE: A Program for Developing Clinician Educators' Scholarship, Advancement, and Sense of Community.

INTRODUCTION: Faculty development programs encouraging clinician educators' scholarship have been established at many medical schools. The same is true for programs that address the isolation and loneliness many faculty members feel in their day-to-day clinical work and administration. Few programs have explicitly combined development of scholarship and sense of community. AIM: The goals of the Advanced Scholars Program for Internists in Research and Education (ASPIRE) are as follows: (1) provide training in scholarship development including research methods, implementation, and dissemination; (2) provide expert mentoring and support for professional development; and (3) create a greater sense of campus community. SETTING: ASPIRE scholars are clinician educators in the Department of Medicine at Indiana University School of Medicine. PROGRAM DESCRIPTION: The program runs 18 months, includes intensive mentoring, covered time for scholars and mentors, resources, and two half-day educational sessions per month focused on scholarship and community development. PROGRAM EVALUATION: Institutional leaders' public statements and actions regarding ASPIRE were documented by program leadership. Data collected from ASPIRE mentors and scholars through interviews and free text survey responses were analyzed using an immersion/crystallization approach. Two central themes were identified for both scholars and mentors: benefits and challenges of the program. Benefits included mentors, program design, community development, increased confidence, skills development, improved patient care, and institutional impact. Challenges included time to accomplish the program, balance of community-building and skills development, and lack of a clear path post-ASPIRE. DISCUSSION: Combining skills-based learning with safe psychological space were judged important elements of success for the ASPIRE program. Conversations are ongoing to identify opportunities for scholars who have completed the program to continue to pursue scholarship, expand their skills, and build community. We conclude that the program both is feasible and was well-received. Sustainability and generalizability are important next steps in ensuring the viability of the program.

The clinical educator's guide to fostering learner motivation: AMEE Guide No. 137.

Motivation theory and research remain underused by health professions educators. Some educators say it can seem too abstract. To address this, we applied health care language to learner motivation theories. Using a familiar metaphor, we examined the indications, mechanism of action, administration, and monitoring of learner motivation interventions. Similar to the treatment monographs in medicine compendia, we summarized each motivation intervention in the form of a monograph. The purpose of this guide is for health professions educators to develop an understanding of when (i.e. indication) and how (i.e. mechanism of action) learner motivation interventions work. With this information, they can then access ready-to-implement strategies (i.e. administration) to increase their learner interest and assess the effects of these interventions (i.e. monitoring).

Multisource feedback to graduate nurses: a multimethod study.

AIMS AND OBJECTIVES: (1) To explore graduate nurses' perceptions of the influence of multisource feedback on their performance and (2) to explore perceptions of Clinical Nurse Educators involved in providing feedback regarding feasibility and benefit of the approach. BACKGROUND: Graduate registered nurses are expected to provide high-quality care for patients in demanding and unpredictable clinical environments. Receiving feedback is essential to their development. Performance appraisals are a common method used to provide feedback and typically involve a single source of feedback. Alternatively, multisource feedback allows the learner to gain insight into performance from a variety of perspectives. This study explores multisource feedback in an Australian setting within the graduate nurse context. DESIGN: Multimethod study. METHODS: Eleven graduates were given structured performance feedback from four raters: Nurse Unit Manager, Clinical Nurse Educator, preceptor and a self-appraisal. Thirteen graduates received standard single-rater appraisals. Data regarding perceptions of feedback for both groups were obtained using a questionnaire. Semistructured interviews were conducted with nurses who received multisource feedback and the educators. RESULTS: In total, 94% (n = 15) of survey respondents perceived feedback was important during the graduate year. Four themes emerged from interviews: informal feedback, appropriateness of raters, elements of delivery and creating an appraisal process that is 'more real'. Multisource feedback was perceived as more beneficial compared to single-rater feedback. Educators saw value in multisource feedback; however, perceived barriers were engaging raters and collating feedback. CONCLUSIONS: Some evidence exists to indicate that feedback from multiple sources is valued by graduates. Further research in a larger sample and with more experienced nurses is required. RELEVANCE TO CLINICAL PRACTICE: Evidence resulting from this study indicates that multisource feedback is valued by both graduates and educators and informs graduates' development and transition into the role. Thus, a multisource approach to feedback for graduate nurses should be considered.

Preparing Our Future Physicians: "We Will Reap What We Sow".

As Designated Institutional Officer (LMB) and Program Director (EM) in a community teaching hospital, we are intimately involved with all aspects of Graduate Medical Education (GME) and find the rewarding part to consist of contributing towards the teaching of our future physicians, as well as the challenges imposed by the continuously evolving training requirements as set forth by the Accreditation Council for Graduate Medical Education (ACGME). While we are very aware of the standard training requisites that are put in place without exception for all accredited GME residency programs, whether they are part of a major (University) or minor (Community) teaching medical center, in this manuscript we are hoping to perhaps initiate a dialogue among clinical educators as to the future of graduate medical training, and how we as a medical community can commit to providing the best education experience for our residents, while preparing them to be the physicians our patients expect and deserve.

Telehealth usability in a university student physiotherapy clinic during COVID-19.

BACKGROUND: 'Telehealth' online delivery of physiotherapy was the only option during the Covid 19 pandemic in many areas. This was a challenge for physiotherapy training in student clinics where students, clinical educators (CEs) and clients were in three separate locations. The aim of this study was to determine the usability and acceptability of online delivery in a physiotherapy student clinic. METHODS: An observational cross-sectional design was used. Clients (adult clients or carers of paediatric clients), students and CEs participated in telehealth physiotherapy appointments over a Telehealth platform called NeoRehab. The three groups were then invited to complete the Telehealth Usability Questionnaire (TUQ). The 21 item TUQ uses a 7-point Likert scale and covers six constructs (Usefulness, Ease of Use, Interface quality, Interaction quality, Reliability, Satisfaction). RESULTS: Data were analysed from 39 clients, 15 students, and seven CEs. The respective domain scores (SD) for Usefulness [(5.3 (1.5), 5.4 (0.7), 5.1 (0.7)] and Satisfaction [5.1 (1.6), 5.0 (1.0), 5.4 (0.7)] were similarly high across groups, while scores for Reliability [3.7 (1.5), 3.6 (1.0), 3.0 (0.5)] were similarly low across groups. Interface Quality [5.0 (1.5), 4.5 (1.2), 4.1 (0.8)] scores were similarly moderate. Ease of Use [5.6 (1.5), 5.3 (1.0), 4.1 (1.1)] scores were significantly higher in clients than CEs (p = 0.043). Interaction Quality [5.0 (1.4), 3.9 (1.3), 4.2 (0.9)] scores were significantly higher in clients compared with students (p = 0.03). CONCLUSIONS: All groups agreed that the delivery format was useful, easy to use and provided a satisfactory service but was not reliable.

Practical Tips and a Template for Developing Your Curriculum Vitae.

The Alliance of Leaders in Academic Affairs in Radiology (ALAAR) advocates for a Universal Curriculum Vitae for all medical institutions and to that end, we have developed a template that can be downloaded on the AUR website (ALAAR CV template) that includes all of the elements required by many academic institutions. Members of ALAAR represent multiple academic institutions and have spent many hours reviewing and providing input on radiologists' curricula vitae. The purpose of this review is to help academic radiologists accurately maintain and optimize their CVs with minimal effort and to clarify common questions that arise at many different institutions in the process of constructing a CV.

Beyond mere respect: new perspectives on dignity for healthcare workplace learning.

Introduction: Although dignity in workplace learning in healthcare is gathering interest, we know little about stakeholders' conceptualizations in this area across professional groups. Dignity breaches in workplace learning are common, often with serious and long-lasting consequences for the affected. Conceptualizations shape behaviours and experiences. To prevent dignity violations in students' learning, it is thus important to understand stakeholders' understandings of the topic. This study therefore explores the dignity conceptualizations around workplace learning that students, placement educators and university staff hold across seven allied health professional groups. Methods: Using a social constructionist perspective, we conducted individual and group narrative interviews (n = 51) with students, placement educators and university workplace learning staff from seven allied health professional groups. We used the 5-step Framework Analysis to explore and develop themes, identifying differences and similarities across stakeholder groups. Results: We identified eight distinct, yet interrelated, dimensions of dignity from participants' narratives: dignity as respect, dignity as self-x (the various relationships we have with ourselves), dignity as feeling safe, dignity as understanding otherness, dignity as supporting others, dignity as equality, dignity as professionalism, and dignity as belonging. Dignity as respect was identified across all participants, although mutual respect and a culture of respect were only present in academic participants' talk. The remaining seven dimensions all present important factors extending our understanding of the construct of dignity. Discussion: In line with existing research, our study identifies the absence of an unambiguous, positive conceptualization of dignity in workplace learning among stakeholders. It adds novelty in two ways: by identifying dignity dimensions that require informed action beyond respecting others, and by revealing a tension between dignity as professionalism and dignity as equality. We suggest revising existing dignity concepts in workplace learning to address this tension and to reinforce that active care, team integration and skilled support are all non-negotiable elements of dignified behaviour within workplace learning.

Teaching Mental Health and Well-Being Online in a Crisis: Fostering Love and Self-compassion in Clinical Social Work Education.

The coronavirus (COVID-19) pandemic has shifted clinical social work (CSW) and mental health education in Australia, and indeed throughout much of the globe, onto online delivery. The disruption caused by COVID-19 presents unexpected challenges in fostering the development of skill sets among social work educators in partnership with students. This article is a reflexive collaborative autoethnography written by four educators of different international and cultural backgrounds at a regional university in Queensland. Our university has experienced a shift from primarily a face-to-face delivery to online delivery due to social distancing. This article is grounded in an ethic of love, a values-based relationship-oriented practice promoting care, collaborative dialogue and solidarity between people, using self-compassion and reflexivity. We explore how COVID-19 has forced the authors to alter their teaching practice, cope with uncertainties, and respond with loving kindness to the shifting needs of students. We draw upon our experiences as educators of diverse cultural, linguistic, gender, and sexualities from Australia, the United States, the United Kingdom, and Nigeria and reflect upon how we have simultaneously turned inward and outward through technology. We draw upon person-centered, narrative, trauma informed and anti-oppressive clinical and educational approaches when exploring self-compassion and loving approaches with the students. We discuss the need for self-compassion and love of others as we respond to the current crisis by modeling self-compassion and love for CSW students who are experiencing crises, including loss of employment, separation from family overseas and interstate, isolation from colleagues and loved ones, and healthcare issues.

The flipped classroom in medical education: A new standard in teaching.

Many medical educators, out of necessity imposed by the COVID-19 pandemic, had to flip their classrooms. However, instead of adapting to this new teaching style, many have proceeded in the manner that they have always used to create content, opening a slide deck and inserting content until they are satisfied with the result. When in fact, we know based on evidence and our own experience, that educators should first plan, organize, and storyboard before collecting information into a presentation [1,2]. If educators need to replace real-world teaching and interaction, we believe the next best option is video education, although there are other forms of prework that can be utilized to flip medical classrooms, including short readings and exercises. We discuss the case for flipping medical classrooms, the limitations, and how educators can get started flipping their classrooms today.

Clinical educator's experiences of the decentralised training platform for Occupational Therapy students in KwaZulu-Natal, South Africa.

Background: In piloting a shift from traditional practice-based placements to decentralised clinical training (DCT), there was a need to explore the factors that influenced the placement as part of monitoring and evaluation. DCT involves placement to clinical sites away from the higher education institution necessitating changes to supervision strategies utilised. Objective: This study explored the experiences of clinical educators supervising occupational therapy students within this new model during a pilot phase of the DCT programme at one institution in South Africa. Method: The study was located in KwaZulu-Natal province and followed an explorative qualitative design with semi-structured interviews and focus groups with purposively sampled clinical educators (n=11). Data were audio-recorded and d thematically analysed. Findings: Two central themes emerged and included the clinical educators' expectations (organisation factors, role and scope of partners in decentralised training and communication) and experiences (perspectives and value of decentralised training). Conclusion: Decentralised training has considerable potential to contribute to authentic student learning. Improved communication between all stakeholders would assist in enhancing the quality of the learning experiences on such platforms. Students need to be more prepared prior to commencing DCT, and there is a need for more rural placements with a primary health care focus.

Development of undergraduate nursing entrustable professional activities through using a participatory design approach.

BACKGROUND: Competencies represent sets of general abilities and attributes that graduating nurses must acquire. Most nursing programs adopt competency based assessment and training approaches to prepare their students to enter the clinical environment. However, some concern has been raised regarding their interpretation and implementation in everyday clinical training. To operationalize competencies for better use in clinical practice, the Entrustable Professional Activities framework (EPAs) was introduced in 2005 by ten Cate. AIM: The aim of this study is to develop a framework of EPAs for an Undergraduate Nursing Program. METHOD: Through using a participatory action design approach, the participants developed a set of EPAs linked with competencies for an Undergraduate Nursing Program. Thematic analysis was performed, and EPAs framework validity was constructed. RESULT: A total of eight core EPAs were developed and each one was operationalized by a brief description and nested within the related core competency domains. Supervision levels and entrustment decisions were determined. CONCLUSION: The development of EPAs specific to undergraduate nursing programs may offer the opportunity to have standardized language to evaluate students' progress toward competency in nursing. It is recommended to conduct further research to improve the developed EPAs.

Nursing Salons Take to Hospital Education Days.

Salon gatherings featuring conversations about current themes in a profession are evolving with time and practice to meet the needs of modern nurses and their clinical partners. Nursing clinical educators at a Midwestern pediatric hospital system offered a nursing salon experience as a new component of education days to provide an opportunity for clinical staff to engage in content and conversations about practice in a setting away from direct patient care. The objective of the nursing salons was to engage in professional reflection. Staff members of a professional development center and a department of quality and safety collaborated to provide this experience for over 500 nurses, clinical support associates, and leaders, to enhance clinical education days.

Optimizing Projectional Radiographic Imaging of the Abdomen of Obese Patients: An e-Delphi Study.

PURPOSE: Obesity is increasing in prevalence globally, with increased demands placed on radiology departments to image obese patients to assist with diagnosis and management. The aim of this study was to determine perceived best practice techniques currently used in clinical practice for projectional radiography of the abdomen for obese patients with the aim to help elucidate areas for future research and education needs in this field. EXPERIMENTAL DESIGN: A two round e-Delphi study was undertaken to establish a consensus within a reference group of expert Australian clinical educator diagnostic radiographers (CEDRs). Initially, a conceptual map of issues regarding imaging obese patients was undertaken by analysing interview transcripts of 12 CEDRs. This informed an online questionnaire design used in Delphi rounds 1 and 2. A consensus threshold was set <75% "agreement/disagreement", with 15 and 14 CEDRs participating in rounds 1 and 2, respectively. RESULTS: Seven of the 11 statements reach consensus after round 2. Consensus on using a combination of higher peak kilovoltage (kVp) and milliampere-seconds (mAs) to increase radiation exposure increased source-to-image distance and tighter collimation was achieved. There was no consensus regarding patient positioning practices or patient communication strategies. The expert group reported the importance of personal confidence and treating patients as individuals when applying techniques. CONCLUSION: Diversity of experts' opinions and current practice may be due to the variations in obese patients' size and presentation. Therefore, there is a need for extensive empirical evidence to underpin practice and education resources for radiographers when imaging obese patients.

Factors associated with patient-satisfaction in student-led physiotherapy clinics: A qualitative study.

BACKGROUND AND PURPOSE: Student-led physiotherapy clinics are a valuable means for providing clinical education opportunities for student learning and providing cost-effective services to the public. Understanding patient satisfaction within the student-led physiotherapy clinic setting is important to inform organizational, educational, and clinical processes that aim to balance both student learning experiences and quality patient care. DESIGN: A cross-sectional qualitative design using semi-structured interviews. RESULTS: A total of 20 patients from three different university student-led physiotherapy clinics were interviewed. Five major themes were associated with patient satisfaction, style of supervision, student-supervisor relationship, quality of physiotherapy care, student qualities and cost, and location of the service. CONCLUSION: The results emphasize the importance placed by patients on effective communication, as well as the relationship between the supervisor and student overseeing their care. The findings highlight the influence of both the student and supervisor on patient satisfaction and provide insight into the style of student supervision from the perspective of the patient.

Importance of clinical educators to research use and suggestions for better efficiency and effectiveness: results of a cross-sectional survey of care aides in Canadian long-term care facilities.

OBJECTIVE: This study explored the effect of clinical educators as facilitators of research use and how it may be modified by organisational context in the settings. DESIGN: Cross-sectional observational study. SETTING: A representative sample of 91 residential long-term care (LTC) facilities across Western Canada. PARTICIPANTS: We used surveys to collect data from the frontline care aides and information about the organisational context of the care units. OUTCOME MEASURE AND EXPLANATORY VARIABLES: We assessed research use (the outcome) with the Conceptual Research Utilization (CRU) scale. Explanatory variables in the multiple regression analysis were facilitation, organisational context and the interaction terms. Facilitation was measured by the frequency of contacts between care aides and clinical educator or person who brings new ideas about resident care. Three core organisational context variables were measured using the Alberta Context Tool. RESULTS: We included data of 3873 care aides from 294 care units in the LTC facilities. We found significant associations between CRU and facilitation, leadership, culture and evaluation. Interactions of facilitation x leadership and facilitation x culture were negative. The coefficient of the facilitation x evaluation term in the regression model was positive (0.019, 95% CI 0.012 to 0.026), suggesting synergistic effects between facilitation and a well-developed process to evaluate care quality using relevant data. CONCLUSIONS: Findings indicate clinical educators are effective facilitators of research use among the care aides, but the effect is modified by organisational context. For greatest impact, managers can direct efforts of the clinical educators to care units where leadership and culture ratings are lowest, but a proficient feedback and evaluation process is in place. This understanding enables managers to deploy clinical educators (a scarce resource in LTC settings) most efficiently.

Clinical reasoning of nursing students on clinical placement: Clinical educators' perceptions.

Graduate nurses may have knowledge and adequate clinical psychomotor skills however they have been identified as lacking the clinical reasoning skills to deliver safe, effective care suggesting contemporary educational approaches do not always facilitate the development of nursing students' clinical reasoning. While nursing literature explicates the concept of clinical reasoning and develops models that demonstrate clinical reasoning, there is very little published about nursing students and clinical reasoning during clinical placements. Semi-structured interviews were conducted with ten clinical educators to gain an understanding of how they recognised, developed and appraised nursing students' clinical reasoning while on clinical placement. This study found variability in the clinical educators' conceptualisation, recognition, and facilitation of students' clinical reasoning. Although most of the clinical educators conceptualised clinical reasoning as a process those who did not demonstrated the greatest variability in the recognition and facilitation of students' clinical reasoning. The clinical educators in this study also described being unable to adequately appraise a student's clinical reasoning during clinical placement with the use of the current performance assessment tool.