Surgery (Austin & Northern Health) - Research Publications

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    Three principles for the progress of immersive technologies in healthcare training and education.
    Mathew, RK ; Immersive Healthcare Collaboration, ; Mushtaq, F (BMJ, 2021)
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    From clinician to educator: A scoping review of professional identity and the influence of impostor phenomenon
    Freeman, KJ ; Carr, SE ; Phillips, B ; Noya, F ; Nestel, D (Yong Loo Lin School of Medicine, 2022-01-01)
    Introduction: As healthcare educators undergo a career transition from providing care to providing education, their professional identity can also transition accompanied by significant threat. Given their qualifications are usually clinical in nature, healthcare educators’ knowledge and skills in education and other relevant theories are often minimal, making them vulnerable to feeling fraudulent in the healthcare educator role. This threat and vulnerability is described as the impostor phenomenon. The aim of this study was to examine and map the concepts of professional identity and the influence of impostor phenomenon in healthcare educators. Methods: The authors conducted a scoping review of health professions literature. Six databases were searched, identifying 121 relevant articles, eight meeting our inclusion criteria. Two researchers independently extracted data, collating and summarising the results. Results: Clinicians who become healthcare educators experience identity ambiguity. Gaps exist in the incidence and influence of impostor phenomenon in healthcare educators. Creating communities of practice, where opportunities exist for formal and informal interactions with both peers and experts, has a positive impact on professional identity construction. Faculty development activities that incorporate the beliefs, values and attributes of the professional role of a healthcare educator can be effective in establishing a new professional identity. Conclusion: This review describes the professional identity ambiguity experienced by clinicians as they take on the role of healthcare educator and solutions to ensure a sustainable healthcare education workforce.
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    Measuring impostor phenomenon in healthcare simulation educators: a validation of the clance impostor phenomenon scale and leary impostorism scale
    Freeman, KJ ; Houghton, S ; Carr, SE ; Nestel, D (BMC, 2022-03-03)
    BACKGROUND: Impostor phenomenon is a term used to describe feelings of intellectual and professional fraudulence. The Clance Impostor Phenomenon Scale and the Leary Impostorism Scale are two self-report measures used to determine whether an individual experiences impostor phenomenon. This study examined the psychometric properties of both measures in healthcare simulation educators. METHODS: The study sample comprised 148 educators, 114 (77%) females, 34 (23%) males, who completed an online version of each instrument. Exploratory factor analysis was used to examine the factor structure of the Clance Impostor Phenomenon Scale and the Leary Impostorism Scale. RESULTS: Exploratory factor analysis revealed that for both instruments a one-factor solution best fit the data, suggesting all items in both measures fit onto a single theoretical construct. Both instruments demonstrated high internal reliability, with the Cronbach's alpha for the Clance Impostor Phenomenon Scale being α = .96 and the Leary Impostorism Scale α = .95. CONCLUSIONS: This study suggests that impostor phenomenon as measured by the Clance Impostor Phenomenon Scale and the Leary Impostorism Scale is a unidimensional construct among healthcare simulation educators. With a growing interest in impostor phenomenon, the present findings will assist researchers to evaluate the phenomenon in healthcare settings.
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    Evaluation of IMproving Palliative care Education and Training Using Simulation in Dementia (IMPETUS-D) a staff simulation training intervention to improve palliative care of people with advanced dementia living in nursing homes: a cluster randomised controlled trial
    Tropea, J ; Nestel, D ; Johnson, C ; Hayes, BJ ; Hutchinson, AF ; Brand, C ; Le, BH ; Blackberry, I ; Caplan, GA ; Bicknell, R ; Hepworth, G ; Lim, WK (BMC, 2022-02-14)
    BACKGROUND: People with dementia have unique palliative and end-of-life needs. However, access to quality palliative and end-of-life care for people with dementia living in nursing homes is often suboptimal. There is a recognised need for nursing home staff training in dementia-specific palliative care to equip them with knowledge and skills to deliver high quality care. OBJECTIVE: The primary aim was to evaluate the effectiveness of a simulation training intervention (IMPETUS-D) aimed at nursing home staff on reducing unplanned transfers to hospital and/or deaths in hospital among residents living with dementia. DESIGN: Cluster randomised controlled trial of nursing homes with process evaluation conducted alongside. SUBJECTS & SETTING: One thousand three hundred four people with dementia living in 24 nursing homes (12 intervention/12 control) in three Australian cities, their families and direct care staff. METHODS: Randomisation was conducted at the level of the nursing home (cluster). The allocation sequence was generated by an independent statistician using a computer-generated allocation sequence. Staff from intervention nursing homes had access to the IMPETUS-D training intervention, and staff from control nursing homes had access to usual training opportunities. The predicted primary outcome measure was a 20% reduction in the proportion of people with dementia who had an unplanned transfer to hospital and/or death in hospital at 6-months follow-up in the intervention nursing homes compared to the control nursing homes. RESULTS: At 6-months follow-up, 128 (21.1%) people with dementia from the intervention group had an unplanned transfer or death in hospital compared to 132 (19.0%) residents from the control group; odds ratio 1.14 (95% CI, 0.82-1.59). There were suboptimal levels of staff participation in the training intervention and several barriers to participation identified. CONCLUSION: This study of a dementia-specific palliative care staff training intervention found no difference in the proportion of residents with dementia who had an unplanned hospital transfer. Implementation of the intervention was challenging and likely did not achieve adequate staff coverage to improve staff practice or resident outcomes. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618002012257 . Registered 14 December 2018.
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    Remediation for surgical trainees: recommendations from a narrative review
    To, H ; Cargill, A ; Tobin, S ; Nestel, D (WILEY, 2021-02-03)
    BACKGROUND: Remediation involves formalized support for surgical trainees with significant underperformance to return to expected standards. There is a need to understand current evidence of remediation for surgical trainees to inform practice and justify investment of resources. METHODS: Following the principles of a systematic review, we conducted a narrative analysis to make recommendations for remediation of underperforming surgical trainees. RESULTS: From a review of 55 articles on remediation of trainees in medical and surgical sub-specialities, we have identified system and process level recommendations. Remediation is reported as long-term, complex and resource-intensive. Establishing a defined and standardized remediation framework enables co-ordination of multi-modal interventions. System level recommendations aim to consolidate protocols via developing better assessment, intervention and re-evaluation modalities whilst also strengthening support to supervisors conducting the remediation. Process level recommendations should be tailored for the specific needs of each trainee, aiming to be proactive with interventions within a programmatic framework. Regular reassessment is required, and long-term follow-up shows that remediation efforts are often successful. CONCLUSION: While remediation within a programmatic framework is complex, it is often a successful approach to return surgical trainees to their expected standard. Future directions involve applying learning theories, encouraging research methods and to develop integrated collaborate protocols and support to synergize efforts.
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    Ad hoc supervision of general practice registrars as a 'community of practice': analysis, interpretation and re-presentation
    Clement, T ; Brown, J ; Morrison, J ; Nestel, D (SPRINGER, 2016-05-01)
    General practice registrars in Australia undertake most of their vocational training in accredited general practices. They typically see patients alone from the start of their community-based training and are expected to seek timely ad hoc support from their supervisor. Such ad hoc encounters are a mechanism for ensuring patient safety, but also provide an opportunity for learning and teaching. Wenger's (Communities of practice: learning, meaning, and identity. Cambridge University Press, New York, 1998) social theory of learning ('communities of practice') guided a secondary analysis of audio-recordings of ad hoc encounters. Data from one encounter is re-presented as an extended sequence to maintain congruence with the theoretical perspective and enhance vicariousness. An interpretive commentary communicates key features of Wenger's theory and highlights the researchers' interpretations. We argue that one encounter can reveal universal understandings of clinical supervision and that the process of naturalistic generalisation allows readers to transfer others' experiences to their own contexts. The paper raises significant analytic, interpretive, and representational issues. We highlight that report writing is an important, but infrequently discussed, part of research design. We discuss the challenges of supporting the learning and teaching that arises from adopting a socio-cultural lens and argue that such a perspective importantly captures the complex range of issues that work-based practitioners have to grapple with. This offers a challenge to how we research and seek to influence work-based learning and teaching in health care settings.
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    "Underdiscussed, underused and underreported": pilot work in team-based qualitative research
    Morrison, J ; Clement, T ; Nestel, D ; Brown, J (EMERALD GROUP PUBLISHING LTD, 2016-01-01)
    Purpose: The authors, with disparate organisational affiliations and in different geographic locations, worked together on a qualitative multiple-case study of ad hoc supervisory encounters between general practice (GP) supervisors and GP-registrars. The purpose of this paper is to share our experiences and learning to highlight how valuable pilot work can be when conducting team-based qualitative research. Design/methodology/approach: This paper outlines the value of pilot work in consolidating whole team understanding of the research plan, using our experiences as an example. We first offer a synthesis of published literature relating to pilot work, especially in qualitative research approaches. Next, we outline and justify the pilot work undertaken for the ad hoc supervision study. Lastly, we use each researcher’s voice to describe our experiences and then share the lessons we learned undertaking pilot work in qualitative research. Findings: We found that while pilot work can be useful in refining strategies, data collection processes and analytic instruments. There are further benefits in galvanising whole team understanding of the research plan, in encouraging reflexivity, in ensuring transparency of the research process, and for ethical considerations. Originality/value: There are few published papers or books which offer researchers guidance regarding pilot work, especially within a qualitative paradigm. Our experience shows there is value in planning and conducting pilot work. We believe others may benefit from our experience as they embark on team-based research.
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    'It's going to change the way we train': Qualitative evaluation of a transformative faculty development workshop
    Ong, CCP ; Foo, YY ; Chiu, FY ; Nestel, D (SPRINGERNATURE, 2021-10-25)
    INTRODUCTION: Relatively little is known about faculty development (FD) activities that help participants achieve sustainable behavioral change. This qualitative study evaluated the medium- to long-term impact of a FD workshop informed by transformative learning (TL) theory. It aimed to discover which aspects of FD prompted healthcare professionals (HPs) to adopt effective teaching and learning practices. METHODS: Seventeen participants were interviewed between January and July 2020, 7 to 30 months after the workshop. Purposeful sampling strategies were used to collect data and analysis was performed using reflexive thematic analysis. RESULTS: Four themes were identified: perspectival shift in educational practice, re-affirmation of current practices, becoming an educator, and valuing FD that accommodates HPs' multiple communities of practice (CoPs). Workshop activities foregrounding critical discourse and reflection helped participants gain new knowledge and deeper understanding of education. TL was likely when participants already identified as an educator in addition to their HP identity. Additionally, a workplace CoP determined the type and level of support affecting HPs' development as educators. DISCUSSION: Aspects of FD that prompted HPs to adopt effective teaching and learning practices included initiatives that catalyzed critical discourse and reflection. Readiness for TL is promoted when HPs have a strong educator identity because of workplace educator CoPs. Future research could explore effecting sustainable post-workshop behavioral change in HPs through the strengthening of workplace educator CoPs. To do this, institutions could send co-located HPs from different disciplines to the same FD program.
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    Simulation training in non-cancer palliative care for healthcare workers: a systematic review of controlled studies
    Tropea, J ; Bicknell, R ; Nestel, D ; Brand, CA ; Johnson, CE ; Paul, SK ; Le, BH ; Lim, WK (BMJ PUBLISHING GROUP, 2021-06-01)
    BACKGROUND: The need for healthcare workers (HCWs) to have skills and knowledge in non-cancer palliative care has been recognised. Simulation is increasingly being used for palliative care training, offering participants the opportunity to learn in a realistic environment and fully interactive way. OBJECTIVE: The aim of this systematic review was to summarise and critically appraise controlled studies on simulation training in non-cancer palliative care for HCWs. SELECTION: Medline, CINAHL, PubMed and Cochrane Library databases were searched using palliative care and simulation terms. Randomised controlled trials (RCTs), non-randomised RCTs and controlled before-and-after (CBA) studies were included. Two reviewers independently screened titles and abstracts and undertook full article review using predefined selection criteria. Studies that met the inclusion criteria had data extracted and risk of bias assessed using the Cochrane Effective Practice and Organisation of Care risk of bias criteria. FINDINGS: Five articles were included: three RCTs and two CBA studies. All studies assessed learners' palliative care communication skills, most studies evaluated learners' perception of change in skills and one study assessed impact on patient outcomes and learners' change in behaviour when applied in practice. There was variation in intervention content, intensity and duration, outcome measures and study design, making it difficult to compare and synthesise results. CONCLUSION: There is a paucity of evidence to support simulation training to improve non-cancer palliative care. This review highlights the need for more robust research, including multicentre studies that use standardised outcome measures to assess clinician skills, changes in clinical practice and patient-related outcomes.
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    The supervisory encounter and the senior GP trainee: managing for, through and with
    Brown, J ; Nestel, D ; Clement, T ; Goldszmidt, M (WILEY, 2018-02-01)
    OBJECTIVE: Help-seeking supervisory encounters provide important learning experiences for trainees preparing for independent practice. Although there is a body of expert opinion and theories on how supervisor encounters should happen, supporting empirical data are limited. This is particularly true for the senior general practice (GP) trainee. Without knowing what happens during these encounters, we cannot know how to maximise their educational potential. This study aimed to understand what happens when senior GP trainees call on their supervisor when caring for patients and how learning can be enhanced when this occurs. METHODS: This is an analysis of data from a multi-case study of five GP supervisory pairs, each with a GP registrar and their supervisor. The data are recordings of 45 supervisory encounters, 78 post-encounter reflections and six interviews. We used Wenger's communities of practice theory and rhetorical genre theory as analytical lenses. RESULTS: The supervisory encounters followed a consistent format, which fitted the form of a genre. Within this genre, three dominant interactional patterns were identified, which we labelled 'managing for', 'managing through' and 'managing with'. Each pattern presented different opportunities and drew on different skills. The primary agenda was always developing a plan for the patient. Education agendas included acquiring knowledge, developing skills and achieving independence. Other agendas were issues of control, credibility and relationship building. Both supervisor and trainee could be purposeful in their supervisory engagement. CONCLUSIONS: For supervisors and trainees to achieve the educational potential of their supervisory encounters they require flexibility. This depends on understanding the genre of the supervisory encounter, the agendas at play, the options they have in engaging and having the skills to utilise these options. Educators can facilitate supervisors and trainees in acquiring this understanding and these skills. We recommend further research into the genre of the supervisory encounter.