From The Editor

Welcome to the 4th Volume, 1st Issue of Health Education in Practice: Journal of Research for Professional Learning. We have a very interesting series of articles in this volume.

General practice registrars’ clinical uncertainty, and in-consultation information- and assistance-seeking

Purpose: To explore the association of Australian general practitioner (GP) registrars’ responses to uncertainty with their in-consultation information-, advice- and assistance-seeking.Design/methodology/approach: A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) cohort study in four Australian states. In ReCEnT, GP registrars record details of 60 consecutive consultations, six-monthly, three times during training.Outcome factors in logistic regression models included whether the registrar sought in-consultation information or assistance from (i) their supervisor or (ii) an electronic or paper-based source. Independent variables were the four independent subscales of the Physicians’ Reaction to Uncertainty (PRU) instrument, as well as registrar, practice and consultation variables.Findings: 589 registrars contributed details of 70,412 consultations.On multivariable analysis, scores on the two ‘affective’ PRU subscales ‘anxiety regarding diagnosis/management’ (OR 1.03; 95% confidence intervals [CIs] [1.01, 1.05], p = 0.003) and ‘concern about a bad outcome’ (OR 1.03; 95% CIs [1.01, 1.06], p = 0.008) were significantly associated with seeking supervisor assistance. There was no association with ‘behavioural’ subscales ‘reluctance to disclose uncertainty to patients’ and ‘reluctance to disclose mistakes to physicians’.None of the PRU subscales were significantly associated with information-seeking from electronic or hard copy sources.Research implications: Further research is required to explore the role of uncertainty within registrar–supervisor interactions and to define the role of supervisors in registrars’ functional adaptation to clinical uncertainty (including how best to support and train supervisors in this role).Practical implications: GP registrars’ ‘affective’ responses to clinical uncertainty are associated with assistance-seeking from clinical supervisors. While in-consultation assistance-seeking may promote registrars’ tolerance of uncertainty, it may also contribute to supervisor workload.Originality/value: This is the first study to examine trainees’ levels of uncertainty and their seeking of information and assistance.Limitations: We have not investigated whether registrars’ seeking assistance resolved or attenuated, for the index problem, their anxiety or concern.

SEED Program: The development of a program that has enabled the learning and growth of staff in the response to a community crisis.

This paper aims to share a program that took a whole-hospital approach in considering the wellbeing of staff at a time of recovery following the 2019–2020 bushfires. The SEED Program enlisted a person-centred participatory methodology that was embedded within a transformational learning approach. This methodology included collaboration, authentic participation, critical reflection, critical dialogue and listening where the staff voice was the driving factor in the development of strategies for recovery. The SEED Program resulted in the development of five initiatives that included four strategies and a celebration event where staff celebrated their New Year’s Eve in February 2020. The four strategies included the establishment of a quiet room, coffee buddies, Wellness Warriors and 24/7 Wellness. The outcomes from the SEED Program resulted in the development of a more person-centred culture and transformation of staff perspectives in how they understood their role in their learning and learning of others in recovery and support at a time of crisis. The key learnings were the effect of authentic collaboration, the benefit from enabling authentic leadership at all levels within a hospital, and the power of a staff connection to the ‘CORE’ values of the hospital and Local Health District. In conclusion, the staff involved hold the hope that others may benefit from their experience of transformational learning in creating more person-centred workplace cultures while supporting each other to move forward during a crisis. The limitation of the SEED Program was that it was a bespoke practice innovation designed in the moment, responding to an identified need for the staff following a crisis in the local community rather than a formal research approach to meeting the needs of this group of staff.

Student Perceptions of MASK-EDTM Simulation in Physiotherapy Education: A Mixed Methods Cohort Study

Introduction: MASK-EDTM simulation is a novel educational approach in which a clinically experienced educator dons a high-fidelity silicone mask and plays the role of a patient. MASK-EDTM simulation has not yet been evaluated in physiotherapy education. The purpose of this study was to describe physiotherapy students’ perceptions of the value of MASK-EDTM simulation and its effect on perceived preparedness for clinical placements.Methods: Design: Mixed-methods cohort study, using questionnaires and focus groups over 12 months.Setting: Entry-level Physiotherapy course at an Australian university.Participants: Eighty-one physiotherapy students enrolled in their first unit of cardiorespiratory Physiotherapy.Intervention: MASK-EDTM simulation in five tutorials across two semesters, practising skills including history-taking and secretion clearance techniques.Main outcome measures: Questionnaires pre- and post clinical placement; thematic analysis of focus group data following clinical placement exposure.Results: One hundred per cent of students described MASK-EDTM as helpful in developing manual handling skills (mean 3.8/4.0, SD 0.4), establishing rapport and empathy with patients (mean 3.7/4.0, SD 0.5), and communicating with an older patient (mean 3.4/4.0, SD 0.6). Following exposure to clinical placement, students perceived MASK-EDTM as slightly less helpful in enhancing readiness for clinical placement (MD –0.20 out of 5, 95% CI –‍0.54 to –0.04) compared with before clinical exposure. However, they still considered MASK-EDTM somewhat helpful (mean 3.2/4.0). Three themes were identified: the safety of the learning environment with MASK-EDTM, the importance of communication in MASK-EDTM simulation and the performative aspects of MASK-EDTM simulation. All three themes were underpinned by the importance of authenticity in learning and practice.Conclusions: Physiotherapy students perceive MASK-EDTM simulation as valuable in enhancing learning relating to clinical practice, particularly prior to clinical placement.

The effect of rural placements on future rural general practice

Background: Providing health care to rural populations is a major issue in Australia. Disease burdenand health risk factorsincrease with remoteness, but the access to appropriate service decrease. The introduction of Rural Clinical Schools, rural locations for internship and residency, and decentralisation of the Australian General Practitioner Training Programaim to address this disparity. This systematic review aimed at determining if rural placements throughout medical training are associated with future rural general practice in Australia.Methods: Medline (Ovid), Pubmed, CINAHL and Science Direct were searched for the period January 2000 to July 2019. Included studies related specifically to rural general practitioners in Australia and studies were excluded if they reported only on intention to practice rurally. Evidence was assessed using the Standards for Quality Improvement Reporting Excellence Guidelines.Results: Eleven articles met the inclusion criteria. Three studies examined the effect of rural placements in medical school on future rural general practice. Three studies looked at placements as a junior doctor on future rural general practice. Four studies looked at the effect of rural general practitioner training on future rural general practice. One study reported on the effect of rural placements during both medical school and junior doctor years on future rural general practice. The studies supported an association between rural placements and future rural general practice, particularly for Australian born doctors, Australian graduates and individuals from rural backgrounds.Discussion: This review suggests that rural placements during medical training increase the likelihood of future rural general practice. The interplay of personal and professional life influence whether rural intention is sufficient to result in rural practice. Addressing human factors that influence rural practice will contribute to achieving equitable rural health care.

Giving and receiving written feedback on research reports: a narrative review and guidance for supervisors and students

PurposeWritten feedback on research-related writing is an important educational component of novice researcher development. Limited evidence exists to inform effective written feedback, particularly in relation to research reports by novice researchers. The aim of this narrative literature review was to explore supervisor and novice researcher perspectives on the provision of written feedback, particularly in the context of their evolving supervisory relationship. MethodsA systematic search of peer-reviewed journals in educational and health databases was undertaken for the terms ‘written feedback’ and ‘research report’, from January 2001 to August 2020. Identified literature was critiqued for methodological quality. Findings were coded, grouped and described as themes. Next, the themes and their parts were applied to the development of a two-part written feedback checklist that includes separate but related recommendations for supervisors and novice researchers.FindingsFrom 35 included papers, the four main themes that related to written feedback on research reports by novice researchers were: the emotional impact of receiving or giving written feedback; written feedback in the supervisory power dynamic; communicating written feedback; and the content and structure of written feedback. The changing nature and complexity of factors associated with written feedback from research supervisors reflected the transition from a supervisory relationship to a peer relationship. The checklist developed from the synthesised data is intended to provide guidance for supervisors and students about their respective and shared responsibilities within a supervisory relationship. ImplicationsIncreased awareness of the characteristics, roles and impact of written feedback will assist supervisors of novice researchers to provide effective written feedback, and for students to effectively utilise written feedback. Progression of written feedback throughout the supervisory period is proposed as a means of transitioning from a teacher-student to a peer researcher relationship.

Using reflection. Mentoring midwifery students in India

Purpose: This study aims to offer guidance to lecturers and undergraduate midwifery students in using reflective practice and to offer a roadmap for academic staff accompanying undergraduate midwifery students on international clinical placements. Design: Drawing on reflection within the Constructivist Theory, the Gibbs Reflective Cycle (GRC) provides opportunities to review experiences and share new knowledge by working through five stages—feelings, evaluation, analysis, conclusion and action plan. Findings: The reflections of the midwifery students in this study provide insight into expectations prior to leaving for international placement, practical aspects of what local knowledge is beneficial, necessary teaching and learning strategies and the students’ cultural awareness growth. Implications: The analysis and a reflective approach have wider implications for universities seeking to improve preparations when embarking on an international clinical placement. It can also inform practices that utilise reflection as an impetus to shape midwifery students to be more receptive to global health care issues.

The use of the objective structured clinical examination (OSCE) in a practice-based health discipline: Academic and student experience in paramedicine

Purpose:Over the past two decades, the discipline of Paramedicine has seen expediential growth as it moved from a work-based training model to that of an autonomous profession grounded in academia. With limited evidence-based literature examining assessment in paramedicine, this paper aims to describe student and academic views on the preference for OSCE as an assessment modality, the sufficiency of pre-OSCE instruction, and whether or not OSCE performance is a perceived indicator of clinical performance.Design/Methods:A voluntary, anonymous survey was conducted to examine the perception of the reliability and validity of the Objective Structured Clinical Examination (OSCE) as an assessment tool by students sitting the examination and the academics that facilitate the assessment. Findings:The results of this study revealed that the more confident the students are in the reliability and validity of the assessment, the more likely they are to perceive the assessment as an effective measure of their clinical performance. The perception of reliability and validity differs when acted upon by additional variables, with the level of anxiety associated with the assessment and the adequacy of feedback of performance cited as major influencers. Research Implications:The findings from this study indicate the need for further paramedicine discipline specific research into assessment methodologies to determine best practice models for high quality assessment.Practical Implications:The development of evidence based best practice guidelines for the assessment of student paramedics should be of the upmost importance to a young, developing profession such as paramedicine.Originality/Value: There is very little research in the discipline specific area of assessment for paramedicine and discipline specific education research is essential for professional growth.Limitations:The principal researcher was a faculty member of one of the institutions surveyed. However, all data was non identifiable at time of data collection. Key WordsParamedic; paramedicine; objective structured clinical examinations; OSCE; education; assessment.

Preparing student paramedics for the mental health challenges of the profession by using the wisdom of the experienced

Given the significant mental health issues affecting our paramedics, there exists an urgent need to promote positive mental health and well-being among future cohorts of student paramedics. This study investigated the preparedness of student paramedics for the mental health challenges of the profession and explored the coping strategies used by experienced paramedics.The study was conducted in two parts. Part A comprised of two surveys which were developed and administered to 16 course coordinators and 302 students of the 16 accredited undergraduate paramedicine courses across Australia and New Zealand. The survey aimed to identify the perceived need for preparation within the curriculum. In addition, the anticipations, confidence and fears of student paramedics, Course Coordinators and paramedics were also collected as a means to explore the preparedness through self-evaluation, reflection and discussion.Part B included twenty semi-structured interviews with experienced paramedics, from Australia and New Zealand. The interviews were conducted to gain an understanding of their experiences and the mental health coping strategies they employed, as well as capture the advice they would give to student paramedics. Results from the interviews were validated by three focus groups comprised of six paramedics each, representative of the geographic spread.Results suggest there is widespread recognition for the need to include preparation for the mental health challenges of the profession, within accredited undergraduate paramedic courses, with 100% of course coordinators and 97% of students recognising this need.The interviews with paramedics provided valuable insights into the experiences and strategies used to aid the survival of the paramedics throughout their careers. Within the interviews, 70% of participants expressed a sincere love for the paramedic role, and 70% identified black humour as the coping strategy most used by themselves and colleagues. In addition, extensive advice was given to students based upon the paramedics’ lived experiences. This advice comprised of three themes; support, health and the profession. These findings were mapped against the aims of Australia’s current Mental Health Policy to provide evidence-based and policy-informed guidelines for the integration of positive mental health strategies into undergraduate paramedicine curricula.Preparing student paramedics for the mental health challenges of the profession could be advantageous. One way to achieve this is through the inclusion of key content within the undergraduate curriculum by utilising the relatable data collected on anticipation, confidence, fears and the advice offered by the veteran paramedics can be integrated. These lived experiences are highly credible and an opportunity for veterans to contribute positively to the future of paramedicine.

From The Editor

Welcome to the 3rd Volume, 2nd Issue of Health Education in Practice: Journal of Research for Professional Learning