Medical Education - Research Publications
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ItemSystematic reviews of osteopathic care: protocol for an umbrella review(Taylor and Francis Group, 2024)Background: The practice of osteopathy differs around the world. However, the dominant practice is that of manual therapy interventions guided by assessment of the neuromusculoskeletal system. Patient populations treated by osteopaths vary across the lifespan and include groups with more-nuanced care requirements such as those who are pregnant. The volume of evidence for osteopathy care is increasing. Objectives: This umbrella review seeks to identify systematic reviews of osteopathic care with the purpose of highlighting current knowledge about the high-level evidence underpinning the profession. Methods: The umbrella review will be conducted consistent with the Joanna Briggs Institute umbrella review methodology. Articles will be limited to those describing osteopathic care. An initial search did not identify a similar study and nor is one registered. A search of MEDLINE and CINAHL informed the search syntax. A full search will be performed across MEDLINE (PubMed), CINAHL (EBSCO), Scopus, Web of Science, PEDro, Osteopathic Research Web, AMED, Index to Chiropractic Literature, Cochrane Database of Systematic Reviews, and the Osteopathic Medicine Digital Repository (OSTMED.DR). The reference lists of included articles will be reviewed to identify potentially relevant systematic reviews. Data will be extracted from each systematic review and presented in tabular format. Conclusion: The umbrella review will synthesise what is known about osteopathic care as described in systematic reviews. The review will inform stakeholders about the role of osteopathic care in the health system and provide recommendations for future research. The findings will be submitted for peer-review publication.
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ItemOsteopathy Referrals to and from General Practitioners: Secondary Analysis of Practitioner Characteristics from an Australian Practice-Based Research Network(MDPI, 2024-01)Australian osteopaths engage in multidisciplinary care and referrals with other health professionals, including general practitioners (GPs), for musculoskeletal care. This secondary analysis compared characteristics of Australian osteopaths who refer to, and receive referrals from, GPs with osteopaths who do not refer. The analysis was undertaken to identify pertinent characteristics that could contribute to greater engagement between Australian osteopaths and GPs. Data were from the Australian osteopathy practice-based research network comprising responses from 992 osteopaths (48.1% response rate). Osteopaths completed a practice-based survey exploring their demographic, practice, and clinical management characteristics. Backward logistic regression identified significant characteristics associated with referrals. Osteopaths who reported sending referrals (n = 878, 88.5%) to GPs were more likely than their non-referring colleagues to receive referrals from GPs (aOR = 4.80, 95% CI [2.62-8.82]), send referrals to a podiatrist (aOR = 3.09, 95% CI [1.80-5.28]) and/or treat patients experiencing degenerative spinal complaints (aOR = 1.71, 95% CI [1.01-2.91]). Osteopaths reporting receiving referrals (n = 886, 89.3%) from GPs were more likely than their non-referring colleagues to send referrals to GPs (aOR = 4.62, 95% CI [2.48-8.63]) and use the Medicare EasyClaim system (aOR = 4.66, 95% CI [2.34-9.27]). Most Australian osteopaths who report engaging in referrals with GPs for patient care also refer to other health professionals. Referrals from GPs are likely through the Chronic Disease Management scheme. The clinical conditions resulting in referrals are unknown. Further research could explore the GP-osteopath referral network to strengthen collaborative musculoskeletal care. The outcomes of this study have the potential to inform Australian osteopaths participating in advocacy, public policy and engagement with Australian GPs.
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ItemEducational Interventions for Medical Students to Improve Pharmacological Knowledge and Prescribing Skills: A Scoping Review(UBIQUITY PRESS LTD, 2023)INTRODUCTION: Medication-related errors place a heavy financial burden on healthcare systems worldwide, and mistakes are most likely to occur at the stage of prescribing. Junior doctors are more likely to make prescribing errors, and medical graduates also lack confidence and preparedness towards prescribing. Thus, this review aimed to evaluate the existing educational approaches to improve pharmacological knowledge and prescribing skills among medical students. METHODS: CENTRAL, CINAHL, ERIC, Ovid Embase, Ovid MEDLINE, Ovid PsycINFO, and Scopus were searched with keywords related to "pharmacological knowledge", "prescribing skills", "educational interventions" for articles published since 2016. RESULTS: 3595 records were identified, and 115 full-text articles were assessed for eligibility. Eighty full-text articles were eligible and included in this review. Thirty-seven studies focused on improving prescribing skills, whilst 43 targeted pharmacological knowledge. A broad range of interventions was implemented, including e-learning, case-based, interprofessional, and experiential learning. Pharmacological knowledge and prescribing skills were measured in various ways, and all studies reported one or more positive findings at Kirkpatrick level 1 or 2. No study reported outcomes at Kirkpatrick levels 3 and 4. DISCUSSION: The World Health Organisation's Good Guide to Prescribing was the foundation of the development of prescribing educational interventions. Emerging interventions such as experiential and interprofessional learning should be incorporated into the prescribing curriculum. Innovative approaches such as game-based learning can be considered for clinical pharmacology teaching. However, there was a lack of outcomes at Kirkpatrick levels 3 and 4. Robust methodology and reliable outcome measures are also needed in future studies.
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ItemAssessments Used for Summative Purposes during Internal Medicine Specialist Training: A Rapid Review(MDPI, 2023-10)Assessments used for summative purposes of patient-facing clinical competency in specialist internal medicine training are high-stakes, both to doctors in training, as it is a prerequisite for qualification, as well as their community of prospective patients. A rapid review of the literature evaluated methods of assessments used for summative purposes of patient-facing clinical competency during specialist internal medicine training in Australia. Four online databases identified literature published since the year 2000 that reported on summative assessment in specialist medical training. Two reviewers screened and selected eligible studies and extracted data, with a focus on evidence of support for the criteria for good assessment as set out in the 2010 Ottawa Consensus framework for good assessment. Ten eligible studies were included. Four studied the mini-clinical evaluation exercise (mini-CEX), two the Royal Australasian College of Physicians short case exam, three a variety of Entrustable Professional Activities (EPAs) or summative entrustment and progression review processes, and one a novel clinical observation tool. The mini-CEX assessment demonstrated the most evidence in support of the Ottawa criteria. There was a paucity of published evidence regarding the best form of summative assessment of patient-facing clinical competency in specialist internal medicine training.
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ItemNo gain without pain education: Improving knowledge and biopsychosocial attitudes and beliefs in a predominantly non-health-related undergraduate target audience(WILEY, 2022-09)OBJECTIVES: Chronic pain (CP) impacts individuals and society and is the leading cause of disability globally. Pain education interventions are often evaluated in patients and health professional students, but not in non-health student groups. Increasing knowledge of pain may facilitate shifts in attitudes and beliefs towards sufferers. We report on changes in pain knowledge, attitudes and beliefs of predominantly non-health-related tertiary degree students participating in online education. METHODS: Quantitative cohort study design. Students reported demographics and completed the Chronic Pain Myth Scale and 12-item Neurophysiology of Pain Questionnaire (NPQ) before (T1) and after (T2) the 7-week online module at The University of Sydney in 2020. RESULTS: Twenty-two students undertaking predominantly non-health-related bachelor's degrees (16.5% response rate, 90.9% female, mean = 19.5 years) participated. NPQ scores increased from 47.3% to 62.9%. Attitudes and beliefs towards biopsychosocial impact improved (p < 0.027) but not towards individuals suffering from CP or treatment of CP. A negative correlation was found between age and people suffering from CP (ρ = -0.437, p < 0.042) and age and towards treatment of CP; ρ = -0.556, p < 0.007) at T2. CONCLUSION: Completing the elective online module resulted in improved knowledge and biopsychosocial attitudes towards CP in this predominantly non-health cohort, as reported in health and patient cohorts.
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ItemPeer teaching and Pecha Kucha for pharmacology(WILEY, 2022-04)BACKGROUND: Peer teaching involves learners at the same level in their academic career aiding each other's education. In medical education, it has had success in clinical and procedural skills; we set out to design a pharmacology peer teaching initiative and evaluate its acceptability and value as a learning tool. APPROACH: Second-year medical students (n = 62) were invited to participate in a peer-led pharmacology educational initiative over 2 months. Students created PowerPoint presentations on medications using Pecha Kucha principles (automatic slide advancement that emphasises concision through time and content limitations to sustain the audience's attention). Presentations occurred over eight, 1-hour sessions, facilitated by senior academics. EVALUATION: The evaluation consisted of an anonymous questionnaire with 10 Likert-scale questions and two open-ended questions on the learners' perceptions of feasibility, acceptability and effectiveness in improving knowledge, teaching and independent learning skills. Fifty-three students presented at well-attended sessions. Twenty-nine students completed the Kirkpatrick Level 1 evaluation with largely positive perceptions, including improved pharmacology knowledge (n = 21, 72%), teaching skills (n = 23, 79%) and independent learning skills (n = 22, 76%). Satisfaction with both the quality of peer teaching (n = 21, 72%) and presence of expert facilitators (97%, n = 28) was high. Three found the initiative burdensome, and 23 reported information overload. Nevertheless, 23 deemed the experience valuable. Facilitator reflections were also positive. IMPLICATIONS: Our peer teaching initiative appeared useful to our learners, but in this process, we gained valuable information to improve the next iteration. We plan to use this format either for revision material or reduce session length and increase interval time between sessions to address the perceived information overload.
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ItemDoes the student-led osteopathy clinical learning environment prepare students for practice?(BMC, 2022-08-05)BACKGROUND: For many allied health disciplines, pre-professional clinical education takes place in student-led, on-campus clinic environments. In these environments, pre-professional students undertake patient care under the supervision of qualified health professionals. Literature exploring the benefits of the student-led clinical learning environment is limited and little is known about the role student-led clinics play in preparing pre-professional osteopathy students for professional practice. AIM: To explore the perceptions of osteopathy clinical educators about the role of the student-led clinic at Victoria University (VU) in preparing pre-professional students for professional practice. METHODS: A qualitative collective case study methodology was utilised to explore clinical educator perceptions. Individual interviews were conducted with clinical educators employed in the university osteopathy clinic. Interview questions were framed around the Capabilities for Osteopathic Practice which set the Australian osteopathy practice standards. Data were assessed by two of the authors using thematic analysis. RESULTS: Nine clinical educators out of 31 employed at the university clinic (29%) agreed to participate. Qualitative analysis generated three themes: perceptions of the student-led clinic (SLC) as a learning environment; clinical educator perception of their role in the SLC; and, challenges to and of the SLC environment. CONCLUSIONS: Clinical educators perceived that the student-led osteopathy clinical learning environment develops pre-professional learners to meet some, but not all, of the capabilities for professional practice as an osteopath in Australia. The environment may be improved through faculty development, fostering a proactive learning approach, addressing system-based issues, and providing opportunities to interact with other health professions.
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ItemNo Preview AvailableUtilisation of pain counselling in osteopathic practice: secondary analysis of a nationally representative sample of Australian osteopaths(WALTER DE GRUYTER GMBH, 2021)OBJECTIVES: Advice, reassurance and education are recommended as first line treatments for musculoskeletal pain conditions such as low back pain. Osteopaths are registered primary contact allied health professionals in the Australian healthcare system who primarily manage acute and chronic musculoskeletal pain conditions. This study aimed to investigate the proportion of Australian osteopaths who do and do not utilise advice, reassurance and education (pain counselling) in their clinical practice, and determine the characteristics associated with the frequency of using pain counselling in clinical practice. METHODS: A secondary analysis of practice characteristics from a nationally representative sample of Australian osteopaths was undertaken. Participants completed a 27-item practice characteristics questionnaire between July-December 2016. Bivariate analyses were used to identify significant variables for inclusion in a backward multiple logistic regression model. Adjusted odds ratios (OR) were calculated for significant variables. RESULTS: Responses were received from 991 Australian osteopaths, representing 49% of the profession. Of these 264 (26.64%) indicated often utilising pain counselling, and 727 (73.36%) reported not often utilising pain counselling. Those who utilised pain counselling were more than twice as likely to report research evidence had a high impact on their clinical practice (OR 2.11), and nearly twice as likely to discuss physical activity with their patients (OR 1.84). CONCLUSIONS: Pain counselling is under-utilised by nearly three quarters of the Australian osteopathic profession as a management strategy. Future studies are required to explore the reasons why most in the profession comprised in this sample are infrequently utilising this guideline recommendation. Given the frequency of chronic musculoskeletal pain conditions presenting to Australian osteopaths, strategies appear to be needed to advance the profession via professional development in accessing and using evidence-based care for pain conditions.
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ItemDemographic, practice and clinical management characteristics of osteopaths referring to podiatrists: secondary analysis of a nationally representative sample of Australian osteopaths(BMC, 2022-02-18)BACKGROUND: Interprofessional care is paramount in contemporary healthcare practice. How different professions interact, and the characteristics of those practitioners who practice in an interprofessional way are rarely described in the literature. The aim of the current work was to identify the demographic, practice and clinical management characteristics of Australian osteopaths who report referring to podiatrists. METHODS: The study was a secondary analysis of data from the Osteopathy Research and Innovation Network (ORION). Inferential statistics were generated to identify statistically significant demographic, practice and clinical management characteristics associated with referrals to podiatrists by Australian osteopaths. RESULTS: Nine-hundred and ninety-two Australian osteopaths responded to the questionnaire. Sending referrals to a podiatrist was reported by 651 participants (65.6%). Female Australian osteopaths were less likely to report referring to podiatrists compared to male osteopaths (OR 0.76, 95%CI 0.59-0.99). Australian osteopaths who reported referring to podiatrists were more likely to report receiving referrals from podiatrists (OR 9.75, 95%CI 6.98-13.61), use orthopaedic testing in patient assessment (OR 7.62, 95%CI 2.82-20.60), and often treat patients with postural disorders (OR 1.71, 95%CI 1.03-2.26), compared to osteopaths who do not refer to podiatrists. CONCLUSION: This study provides initial evidence for the referral relationship between Australian osteopaths and podiatrists. Further work could explore the nature of these referrals, including the complaints resulting in referral and outcomes of care. This information will be useful to those involved in health policy development and the professions advocating for their role in the wider healthcare system.
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ItemNo Preview AvailableClinical characteristics of Australian osteopaths who teach: A national sample(AUSTRALIAN NZ ASSOC HEALTH PROFESSIONAL EDUCATORS-ANZAHPE, 2021)Background: Health professionals involved in teaching future practitioners have been studied to some extent, but our knowledge of their clinical characteristics is variable. Our study sought to profile the clinical characteristics of osteopaths who teach in the three Australian universities delivering pre-professional osteopathy education.Materials: This study is a secondary analysis of data collected via the Australian Osteopathy Research and Innovation Network (ORION) project. Descriptive statistics were generated for each of the 27-item questionnaire variables. For binary responses, unadjusted odds ratios were calculated, and for continuous variables, independent t-tests were used. Backward step-wise regression modelling was used to identify significant characteristics associated with university teaching in osteopathy. Results: The survey demonstrated 9.9% of Australian osteopaths reported being involved in university teaching. Compared to non-teaching survey respondents, the osteopaths involved in university teaching were more likely to be female (OR 1.56), older (p 0.01) and in clinical practice for longer (p 0.01) but report fewer patient care hours (p 0.01) and patient visits per week (p 0.01). Osteopaths involved in university teaching were also more likely to be involved in research (OR 18.54) and clinical supervision (OR 12.39). They also reported a broader range of patient presentations and therapeutic modalities than their counterparts.Conclusions: This nationally representative survey demonstrates a small percentage of the Australian osteopathy profession are engaged in university teaching. Our secondary analysis has highlighted several characteristics associated with involvement in university teaching that begin to shed light on the composition of the Australian osteopathy teaching workforce. This data may inform development of a skilled and experienced teaching workforce.
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