Implementing a clinical education evaluation model for physiotherapy students and supervisors

Mr Thao Nguyen1

1Melbourne Health, Parkville, Australia

AIM: To implement an evaluation tool for clinical education within a tertiary hospital physiotherapy department; embed a culture of reflection; foster high quality education experiences for students and staff.

METHOD: Process evaluation approach. Paper surveys were provided to students at the completion of each placement and educators completed an electronic survey. Students reported on the learning environment and the supervision received. Staff disclosed satisfaction with supervision and factors that influenced performance. Responses were collected and analysis conducted to identify themes.

RESULTS: 64 student surveys were collected and 60 responses received from staff over a period of four months. The completion rate for students at the acute campus was 91%; at the rehabilitation campus 37%. 60 staff completed their evaluation, 45 were from the acute campus, 8 rehabilitation and 7 unidentified. Students enjoyed structured learning activities but wanted consistency in supervisor and environment, and orientation to key processes. Staff reported satisfaction when supervising motivated students and facilitating their development however staffing shortages and time pressures had major impact. Discrepancies between the campuses in survey response rates were related to staff turnover and the project lead based at the acute campus. More staff were involved in clinical education at the acute campus suggesting greater engagement and established culture for evaluation. Time pressures on staff differed between campuses and require specific solutions.

SIGNIFICANCE OF THE FINDINGS TO ALLIED HEALTH:

Evaluation of programs is essential to understand effectiveness, outcomes and impact. This study outlines a process in implementing an evaluation tool and highlights differences between two campuses at one organisation. These cultural differences require local staff to drive implementation and embed practice. Ongoing evaluation will inform how programs are performing and provide solutions to benefit the delivery of clinical education.

World Social Work Day Forum: Fostering a culture of sharing practice and research

Mrs Bobbi Henao Urrego1, Ms Elisabeth Long1

1Western Sydney Local health District, Sydney, Australia

Aim:

In New South Wales, the South East Sydney Local Health District (SESLHD) holds an annual World Social Work Day Forum. Established in 2011 it aims to foster a culture of sharing practice and research while developing social worker’s presentation skills.

Method:

Having never been formally reviewed from a presenter’s perspective, an online survey of past presenters of the SESLHD World Social Work Day Forum was conducted in 2016 to ascertain whether the aims of the Forum had been achieved. The hypothesis being that the Forum attracted less experienced social workers that then went on to pursue further experiences.

Results:

The hypothesis was disproved, with findings showing the majority of respondents had 5-10 years’ experience, and post-graduate qualifications. A review of presentation topics also showed the evolving depth of practice and research among those  participating in the Forum. It was also noted that a significant proportion of respondents had remained working within the local health district since presenting.

Significance of the findings to allied health:

Both the Forum and the outcomes of this review are translatable across allied health.  Creating a supported space for people to share their practice and research within their disciplines allows growth for the individual and organisation, which in turn can enhance evidence based practice and patient care. Alongside this, from a managerial capacity it has the potential to contribute to workforce retention strategies.

A credentialing tool for AHA/PSO workforce

Mrs Lucy Whelan1

1Monash Health, Cheltenham, Australia

 

Aim: Monash Health Allied Health’s Competency and Credentialing Framework is well established and implemented however it has not previously included AHAs or Psychiatric Service Officers (PSOs) who are the Mental Health equivalent of the AHA workforce and have recently come under Allied Health governance at Monash Health. The aim was to write the document which would encompass this workforce under the same credentialing framework as their allied health professional peers.

Method: Extensive consultation with Monash Health Allied Health Managers and Credentialing and Scope of Practice Committee.

Results: A credentialing document covering the skills we expect of a Grade Two or Grade Three AHA, on recruitment and to be learned on the job. Each additional skill has a learning and assessment package attached to it.

Significance of the findings to Allied Health: We have developed a tool such that any AHA or PSO can prove their skills anywhere they go through the means of this document, such that expectations of performance can be clear and set and learning goals worked towards in a transparent manner.

Cross-network AHA workforce professional development – how does this look?

Mrs Lucy Whelan1

1Monash Health, Cheltenham, Australia

 

Aim: To improve access for AHAs at Monash Health to relevant Professional Development opportunities.

Method: A small working party was formed by interested members of the workforce. External benchmarking revealed very few opportunities offered to AHAs for meaningful professional development. Internal survey revealed that the AHA workforce was not aligned with the Growing through Learning Education Framework for Allied Health at Monash Health.

External benchmarking.

Internal workforce survey.

Monthly Professional Development Program developed for AHA workforce for 2017.

Results: External benchmarking revealed very few opportunities offered to AHAs for meaningful professional development. Internal survey revealed that the AHA workforce was not aligned with the Growing through Learning Education Framework for Allied Health at Monash Health. Further to this the survey revealed that X% of AHAs at Monash Health never have access to Professional Development while X% have access on a weekly basis. The inequity was evident.

Significance of the findings to Allied Health: The AHA workforce is one which required ongoing professional development in order to fulfil its potential. Guiding this professional development in a meaningful and evidence based manner means that the workforce feels values and retention is likely to be maintained but that we can ensure that our AHA workforce has  the skills we expect of them.

One referral tool for AHAs – maintaining accountability

Mrs Lucy Whelan1

1Monash Health, Cheltenham, Australia

 

Aim: To establish an appropriate written referral tool that allows for written support of delegation to all AHAs in the network. Limiting this to one tool allows the Allied Health professionals across the network to be aware of the expectation and the information required for appropriate delegation.

Method: Referral tools were collated from internal programs and departments and some external benchmarking took place. In line with the Monash Health internal referral forms, a referral form was formulated using the ISBAR format. This referral form was developed and will be trialled across the network in early 2017 on the premise that all referrals must be written and stored in the medical record.

Results: On network survey of AHAs in mid-2016, 72% of respondents receive their referrals verbally from an AHP; 36% of respondents reported that referrals are stored in medical record.

Further results will be available in March 2017 after trial of the newly established form.

Significance of the findings to Allied Health: It is a medicolegal requirement that referrals are documented in the medical record and are written in order that the patient and their care team are clear as to what is expected. The fact that only 36% of respondents could say that referrals are stored in the medical record exposed a large risk and indicates a large gap in communication for referrals to the AHA workforce. It is important that while a reciprocal conversation is encouraged for delegation to AHAs that it must be backed up in written form.

eLearning programs are an effective platform to improve malnutrition knowledge

Ms Lauren Atkins1

1Peter MacCallum , Melbourne, Australia

 

Aim: Malnutrition is prevalent in cancer patients and is associated with inferior outcomes. The Malnutrition in Victorian Cancer Service project commenced in 2012 to examine the magnitude and impact of cancer malnutrition and highlight gaps in service delivery. A key finding from phase I of this project was clinicians were seeking further education on malnutrition. This was addressed through development of eLearning programs for multidisciplinary clinicians during phase II. Phase III is currently underway and aims to evaluate the effectiveness of the eLearning programs.

 

Methods: Ethics approval was granted to embed surveys in the eLearning programs at three time-points – prior to completion, immediately following completion and 6 months following completion – to explore knowledge, opinions and practices of clinicians before and after program completion.

 

Results: Of 232 national and international registered users, 55% were dietitians, 38% nurses, 2.5% radiation therapists, and the remainder medical staff, pharmacists, allied health assistants and students.

Following completion of the program, there was an increase in proportion of participants reporting very good or excellent knowledge of cancer malnutrition (26% pre-program versus 89% post). This knowledge was retained at 6 months post with 89% of those surveyed still reporting very good or excellent knowledge.

Familiarity with valid and reliable malnutrition screening tools  improved from 65% pre-program to 92% post-program and 100% 6 months post. Knowledge of malnutrition diagnostic criteria improved from 76% pre-program to 95% post-program and 100% 6 months post. Post-program, 100% of participants agreed that nutritional screening should occur at regular intervals during their cancer journey. This perspective was maintained at 6 month post completion.

 

Significance: The Malnutrition in Cancer eLearning program has demonstrated strong potential to improve and sustain knowledge and practice related to malnutrition in oncology care. Strategies to promote clinician and organisation uptake are recommended.

Testing assumptions of peer assisted learning in clinical education

Mrs Samantha Sevenhuysen 1,2, Associate Professor Elizabeth Molloy 2, Professor Terry Haines 1,2

Monash Health, Dandenong, Australia

Monash University, Clayton, Australia

 

Title: Testing assumptions of peer assisted learning in clinical education

Aim: Identify key assumptions of educators that may serve as barriers to PAL in clinical education practice, and test whether these conceptions are justified or misplaced.

Method: Two consecutive stages of research were conducted to address the research aims. In stage one, four PAL workshops were conducted for clinical educators. Data specific to any assumptions, conceptions or concerns about PAL were extracted from workshop transcripts, participant written feedback and facilitator reflective debrief forms and analysed thematically. In stage two, these assumptions were tested through two separate experimental studies. Both quantitative data pertaining to student and clinical educator outcomes and qualitative data on the clinical education experience were collected.

Results: Stage one revealed that clinical educators perceived student involvement in PAL could result in: peer relationships which are difficult to manage, a reduction in the students’ ability to perform independently, a limitation to students’ exposure to ‘hands on’ patient experiences, inferior quality of information being shared between students compared with what would be taught by the clinical educator and increased clinical educator workload. Through testing in stage two, all these assumptions were refuted with the exception the administration and planning requirements of the clinical educator and the impact of the cohesion of the peer-peer relationship.

Significance of the findings to allied health: Misconceptions about the effect of utilising PAL in clinical education may serve as barriers to its use. This study has demonstrated that some assumptions held by clinical educators are not supported by evidence. We recommend that these assumptions and any others that may emerge from stakeholder engagement are openly discussed as part of any PAL education initiative.

 

Integration of simulation to education of optometry students

Dr Kwang Cham1, Ms Anthea Cochrane1

1Department of Optometry and Vision Sciences, University Of Melbourne, Parkville, Australia

Aim:

Binocular Indirect Ophthalmoscopy (BIO) is a core competency optometric skill. It is challenging for clinicians to provide meaningful feedback as the retina examined cannot be viewed simultaneously by both student and clinician. Hence, it is difficult for students to improve their BIO skills efficiently and effectively. We sought to assess the educational experience in Year 2 and 3 students using a BIO simulator as a teaching tool.

Method:

The BIO simulator integrates a realistic and interactive 3D experience, providing students with high-quality instant feedback as the examined retina is displayed live on the screen. Aspects of the technique such as efficiency and accuracy are also evaluated. Year 2 students are rostered in groups of three to use the simulator for six two-hour self-directed sessions for the year. In Year 3, they will again have access to the simulator for the same number of sessions, but this time on an individual basis.

Results:

104 students were surveyed (response rate = 46%) over two years. 90-100% of students strongly agreed or agreed that the technology: (i) is useful and highly valued; (ii) contributes to them being more confident, competent and proficient in performing BIO; and (iii) improves their stability, orientation and alignment when examining the retina on a real patient.

Significance of the findings to allied health:

Implementing a simulation-based environment has provided students with an interactive and immersive learning experience. It has improved students’ clinical examination and reasoning skills, allowing clinicians to concentrate on the translation of the technique to a real patient in the clinical setting in later years.

Multimedia knowledge translation interventions

Dr Christian Barton1, Mrs Rachael Lowe2, Mrs Allison  Ezzat3,4

1La Trobe Sport And Exercise Medicine Research Centre, Bundoora, Australia, 2Physiopedia, , United Kingdom, 3School of Population and Public Health, University of British Columbia, Vancouver, Canada, 4British Columbia Children’s Hospital Research Institute, Vancouver, Canada

Aim: Our previous research highlights knowledge gaps amongst physiotherapists managing musculoskeletal conditions, with a paucity of engaging learning resources identified as a key barrier.  Recent online multimedia innovations have potential to be more engaging than traditional written information formats (e.g. journal articles). This study explores online learning preferences of physiotherapists to inform the design of multimedia knowledge translation interventions.

Method: 323 physiotherapists from 67 countries were recruited from a ‘Physiopedia’ led massive open online learning course (MOOC) related to physical activity and exercise. Each completed an online survey exploring preferred multimedia formats (podcasts, infographics, video, research articles, written summaries, and images), and other knowledge translation interventions. The value of active learning interventions including face-to-face workshops, online discussion forums, reflective activities and literature searches were also explored.

Results: Physiotherapist learning preferences were diverse. Information visualisation resources were most desired, with infographics and videos preferred by 38% and 35% of respondents respectively. Podcasts were least desired, preferred by only 13% of respondents. Physiotherapists found quizzes the most useful additional active intervention (64% finding them ‘very useful’). Discussion forums were reported to be least useful (21% finding them ‘not useful’). Online resources were preferred compared to face-to-face workshops. However 61% of respondents believed workshops in addition to an online course would enhance learning.

Significance of the findings to allied health: Diverse learning preferences of physiotherapists highlight the need for multifaceted multimedia interventions when designing online knowledge translation interventions. Visualisation resources including infographics and video should be prioritised, and active learning strategies

Negotiation skills and influencing behaviours for Allied Health professionals

Ms Anna Nethercote1, Ms  Gabriela Veliz1, Ms  Prue  Deckert1, Ms Linda Betts2

1Western Health, Allied Health and Community Services Planning, Innovation, Research and Education (ASPIRE) Unit, St Albans, Australia, 2Linda Betts & Associates, ,

Aim: To investigate whether a novel Negotiation Skills and Influencing Behaviours Training Program, developed by and for Western Health Allied Health and Community Services (AH&CS), improved clinician self-rated skill and confidence to participate in effective team communication.

Method: Pre and post study of AH&CS clinicians undertaking a training program of e-learning modules and two interactive workshops during 2015-2016. Participants completed an online survey before training and following each workshop to evaluate perceived skill and confidence related to individual and team communication capabilities (E.g. confidence to express opinions, resolve conflict, participate in difficult conversations).

Results: 427 clinicians participated in Workshop 1 and 323 in Workshop 2.  Survey response rate was 100% pre training, 43% post Workshop 1 and 31% post Workshop 2.  Ten individual communication capabilities and five team communication capabilities showed statistically significant improvements (p<0.05).  Respondents who ‘never’ or ‘rarely’ avoid difficult conversations increased from 23% to 46%.  Respondents  who are ‘always’ or ‘often’ confident to speak up when a mistake is made increased from 58% to 77%.  Teams reported as ‘always’ or ‘often’ able to address issues of difference and resolve conflict increased from 76% to 90%.  Participants were highly satisfied with the program.

Significance of the findings: This innovative program enhanced clinician communication and teamwork skills, filling a significant workforce gap in improving these essential non-technical skills.  The program provides a template to be replicated in other health services.  We hypothesise acquiring improved communication skills may have a flow on effect to patient care although this requires testing.