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ItemContinuing Professional Development programmes through the lens of Habermas’ Knowledge-Constitutive Interests: a novel approach to evaluating and (re)designing CPD.(AMEE, 2024)Background: Clinician-educators are usually experienced clinicians seeking information and strategies to improve their teaching. Continuing Professional Development (CPD) programmes can address a range of learning requirements for clinician-educators if they can respond to the particular educational and contextual needs of participants. A critical review of a one-day postgraduate course was conducted. It focused on how the course was tailored to the learning needs and interests of participants and drew on the early work of Jürgen Habermas and his Knowledge-Constitutive Interests schema in its analysis. Habermas describes technical, practical and emancipatory interests. For clinician-educator CPD, ‘teaching tips that work’ align with the technical interest, while learning why certain teaching techniques suit specific situations or learners is a practical interest. Understanding the material so attendees can flexibly apply it in their context aligns with the emancipatory interest in autonomy. Summary of Work: Examination of the course through the lens of Habermas' interests was conducted by asking: What type of interest does each session target? How does it do this? How could the teaching method shift from fostering technical or practical knowledge towards meeting the participants' emancipatory interests? Summary of Results: Using Habermas’ schema, most of the instruction was focused on technical or practical skills and knowledge, with little teaching designed to promote emancipatory (or transformational) learning. Discussion and Conclusion: This review highlighted opportunities to shift the focus of CPD toward empowering participants to understand the educational concepts underpinning their teaching practices so they can use that knowledge to develop the pedagogical basis of their teaching in their context. As many CPD programmes are short, it is essential to ensure that the methods and goals enable participants to take away not only tips for teaching but also a deeper understanding of how to influence learning in others and why. A key conclusion from this review is that CPD course developers need to ask: how can I deliver material that will empower and motivate participants to reflect on and further develop their teaching? Take Home Message: Habermas’ Knowledge-Constitutive Interests provide a novel lens through which to consider the intent – and guide the (re)design – of CPD programmes.
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ItemNo Preview AvailableMore than another pair of hands? The impact of medical student placements on the healthcare service(AMEE, 2018)Background: Clinical placements are key to developing work-ready graduates. To date, the literature on workplace learning has focussed on learner-as-consumer, rather than learner-as-contributor. This study aimed to identify the impact of medical student clinical placements for multiple stakeholders in healthcare services. Method: This study was conducted at a large outer metropolitan healthcare service. Qualitative data collection included: observation of students on placement; activity profiling of supervisors and students; student and supervisor focus groups; and interviews with clinicians, academic and hospital leaders, and patient advocates. The data were analysed using Braun and Clarke’s (2006) thematic analysis. Results: The effects of medical students on the healthcare service were categorised into two higher order themes: ‘impact on workflow’; and ‘student presence amplifying quality of care’. In terms of affecting workflow, students in their earlier years reportedly absorbed clinicians’ time on account of direct teaching, task selection, and supervision of activities. As they approached graduation, students began to take on tasks independently (e.g. history taking, data entry, and coordinating patient discharge). Amplifying quality of care was observed through students’ prompting clinicians to reflect on their own practice. Students attended to different aspects of care, often responding to patient or family questions in the specialist’s absence. As one supervisor reported, “students often form an important, informed, but lay, connection between the patient and the medical staff so they can identify a mismatch of expectations.” Discussion: The results suggest that although students require an upfront investment of supervisor energy on clinical placement, they add value along a number of dimensions, particularly in the final year of their program. These contributions are beyond being “another set of hands”. The presence of students encouraged clinicians to reflect on their practice. Conclusion: The presence of students prompted clinicians to adopt a more critical gaze on their own work, and students focussed on humanistic elements of care – elements that can be missed or deprioritised when there is an attending expert only. The role of students as a bridge between patients and experienced staff, and how this can be optimised, warrants further exploration
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ItemNo Preview AvailableGathering evidence for medical students’ contribution to health services: A communities of practice informed methodology(Australian & New Zealand Association for Health Professional Educators, 2018)Introduction: Immersion in clinical environments is key to developing work-ready graduates. Workplace learning literature has focused on the benefits of clinical placements for students and the burden for health services, such as the cost of supervisor time away from patient care. There has been little focus on mapping the benefits (obvious and hidden) of clinical placements to multiple stakeholders. Aim: To develop a methodology for capturing the benefits of clinical placements for multiple stakeholders. Methods: Using ethnographic methods of observation and interviews, as well as surveys, and drawing from the concept of legitimate peripheral participation within a Community of Practice, we charted student activities on clinical placements at an outer metropolitan health service. Results: The multiple data collection methods helped to identify how students learn through work as their expertise develops. The activity logs, survey and interviews prior to the observation phase, helped sensitise researchers to the less visible student contributions. Students in their final year contributed like a junior team member: taking patient histories, completing discharge planning and taking on ‘busy jobs’ that freed up senior team members. Discussion: The multiple data collection methods and variety of stakeholder participants allowed for triangulation of the findings, and the phased approach sharpened the focus for the student observations. Capturing the patient perspective presents challenges, as does taking into account differences in student year levels, and different levels of student engagement. Conclusions: A multi-phased, mixed methods approach can identify bi-directional benefits, mapping student contributions along a number of dimensions.
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ItemNo Preview AvailableBurden or bonus? The impact of medical student placements on health services(Australian & New Zealand Association for Health Professional Educators, 2018)Introduction Workplace learning plays a key role in developing work-ready medical graduates. The literature has focussed on how students learn in these complex settings with little research exploring the costs and benefits of student placements for different stakeholders. Aim This study identified the perceived costs and benefits of medical student clinical placements for multiple stakeholders in the healthcare system. Methods The study, funded by the Medical Deans of Australia and New Zealand, was conducted at a large outer metropolitan healthcare service. Data collection included observation of students, activity profiling, focus groups, and interviews with a range of stakeholders. Quantitative data were analysed using descriptive statistics and qualitative data were thematically analysed. Results Multiple data sets identified the time cost in hosting medical students including briefing and debriefing with students, questioning/explanation, and more formalised teaching such as tutorials. Benefits identified included students contributing to clinical work, increasing reflective practice of clinicians, workforce recruitment, and improving patient experience through education. The extent of student contribution depended on clinical domain, student proactivity and level of experience. Discussion The degree to which medical students contribute to healthcare depends on the characteristics of the clinical context, as well as the experience and engagement of learner and supervisor. Further research across programs and contexts is warranted, including extended ethnographic approaches to capture the less visible contributions. Conclusions This multi-phased study identified that students do more than complete ‘busy tasks’ on clinical placements. Their presence as observers was reported to heighten clinicians’ reflective practice.
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ItemNo Preview AvailableMeeting Halfway: Engaging Clinician-Educators(tba, 2024-07-04)
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ItemNo Preview AvailableSleep & Physiology SIG(Wiley, 2009-04)Obstructive Sleep Apnoea (OSA) is a common condition, the diagnosis of which is often delayed by prolonged waiting lists at the point of referral or in the sleep laboratory. Clinical prediction tools may become useful in triaging assessment and management of this condition. Recent publications have proposed and validated two new pre-operative screening tools for Obstructive Sleep Apnoea (OSA) in surgical patients (STOP and STOP-BANG). These screening tools have not been examined in a general sleep population. Methods All patients attending for in-laboratory polysomnography at Box Hill Hospital during the study period were asked to complete the STOP question-naire, and sleep scientists recorded the biometric data required for the BANG component. Polysomnography proceeded with sleep staging and event scoring performed according to the Chicago Criteria. Risk stratification by the STOP and STOP-BANG tools was combined with total Respiratory Disturbance Index from polysomnogram reports. Results 25 patients have been reviewed, although data continues to be collected. There is a high prevalence of moderate or severe OSA within this population (22/25, 88%). The STOP-BANG tool maintains higher sensitivity, negative predictive value and odds ratios than the STOP tool at each degree of OSA severity examined. Conclusions With ongoing data collection we hope to confirm trends seen in predictive values with these tools. Removal of less discriminatory criteria may improve their statistical usefulness, perhaps allowing development into risk stratification tools that will assist in triaging investigation and management of patients with suspected OSA.
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ItemNo Preview AvailableTSANZSRS 2024 The Australia & New Zealand Society of Respiratory Science and The Thoracic Society of Australia and New Zealand (ANZSRS/TSANZ) Annual Scientific Meeting for Leaders in Lung Health & Respiratory Science, 22-26 March 2024.(Wiley, 2024-03)Introduction/Aim: Malignant pleural effusion (MPE) is a complication of advanced cancer that can result in limited life expectancy and significant morbidity. Recurrence of MPE is common and definitive management with either pleurodesis or indwelling pleural catheter (IPC) insertion is often required. This study aimed to review the management of MPE at two tertiary hospitals to identify potential areas for improvement with an emphasis on the hospital length of stay, frequency of non-definitive pleural procedures and frequency of unplanned pleural related admissions. Methods: Retrospective audit of all patients diagnosed with MPE at Western Health over a 3-year period. Results: Of 79 patients with MPE were identified during the time period (mean age 66.1 years, 59% female). 25 patients (13.1%) had a non-definitive pleural procedure following diagnosis, including 16 (38.1%) of the 42 patients who subsequently went on to have a definitive procedure. The median hospital length of stay for pleural effusion related hospitalisations was 9 days. 22 of the 42 pleural effusion-related admissions occurred after a presentation via the emergency department (ED). When compared with planned admissions, those who presented via ED had a higher rate of non-definitive procedures (77% vs 25%) and a longer length of stay (12 vs 7 days). Conclusion: The pleural effusion-related hospital length of stay was in line with previously published Australasian data. Despite this, our data suggests that there might still be scope for improvement. In particular, our data has suggested that interventions to reduce the number of unplanned admissions via ED might result in a reduced rate of non-definitive procedures and a reduced hospital length of stay. Future research could assess the impact of interventions such as the introduction of dedicated pleural clinic or a streamlined admissions pathway on these measures.