Characteristics of doctors transitioning to a non-clinical role in the MABEL study

Objective: To investigate the characteristics and satisfaction of medical doctors transitioning from a clinical into an entirely non-clinical role.

Design and setting: Wave 1 to Wave 5 data from 2008- 2012 in the Medicine in Australia: Balancing Employment and Life (MABEL) longitudinal, populationbased survey were analysed.

Participants: Medical doctors including general practitioners (GPs), specialists, specialists in training (SIT) and hospital non-specialists (HNS). Hospital nonspecialists represent doctors working in a hospital who were not enrolled in a specialty training program. The total number of participants surveyed across the 5 waves was 15,195 doctors.

Main outcome measures: The number of medical doctors making the transition from a clinical role to a nonclinical role from one wave of data to the subsequent wave of data. Individuals who responded 'Yes' to the question 'Are you currently doing any clinical medical work in Australia?' were defined as working in a clinical role. Individuals who stated that they were 'Doing medical work in Australia that is non-clinical' were defined as working in a completely non-clinical role. Each doctor's characteristics while partaking in clinical work prior to making the change to a non-clinical role were noted.

Results: Over 5 years, there were a total of 498 individuals who made the transition from a clinical role to a completely non-clinical role out of a possible 15,195 doctors. Increasing age was the strongest predictor for transition to a non-clinical role. With regards to doctor type, specialists, hospital non-specialists and specialists-in- training were more likely to make the transition to a totally non-clinical role compared to GPs. There was minimal evidence of a relationship between lower job satisfaction and making a transition, and also between higher life satisfaction and making a transition.

Conclusions: Understanding the characteristics of, and reasons for non-clinical career transition are important for workforce training, planning and development.

Staff compliance with protocols to improve the management of behavioral and psychological symptoms of dementia

Using data from a larger study investigating the effectiveness of a structured clinical protocol to manage individuals in residential facilities who experience behavioral and psychological symptoms of dementia (BPSD), the current study investigated whether external clinical support in using the protocol with specific residents increased compliance in its use, over and above only providing a generic workshop about the protocol and management of BPSD. Results indicated that provision of the workshop, in addition to clinical support, was associated with significantly higher compliance. However, compliance was only found to be related to positive outcomes when staff received the generic workshop and not clinical support. When clinical support was provided, compliance was not related to outcomes or worse outcomes. These findings, when considered in the context of the results of the larger trial, suggest that the relationship among clinical support, compliance with BPSD protocols, and clinical outcomes for residents and staff is complex and needs further investigation.

Apps for IMproving FITness and increasing physical activity among young people: the AIMFIT pragmatic randomized controlled trial

BACKGROUND: Given the global prevalence of insufficient physical activity (PA), effective interventions that attenuate age-related decline in PA levels are needed. Mobile phone interventions that positively affect health (mHealth) show promise; however, their impact on PA levels and fitness in young people is unclear and little is known about what makes a good mHealth app. OBJECTIVE: The aim was to determine the effects of two commercially available smartphone apps (Zombies, Run and Get Running) on cardiorespiratory fitness and PA levels in insufficiently active healthy young people. A second aim was to identify the features of the app design that may contribute to improved fitness and PA levels. METHODS: Apps for IMproving FITness (AIMFIT) was a 3-arm, parallel, randomized controlled trial conducted in Auckland, New Zealand. Participants were recruited through advertisements in electronic mailing lists, local newspapers, flyers posted in community locations, and presentations at schools. Eligible young people aged 14-17 years were allocated at random to 1 of 3 conditions: (1) use of an immersive app (Zombies, Run), (2) use of a nonimmersive app (Get Running), or (3) usual behavior (control). Both smartphone apps consisted of a fully automated 8-week training program designed to improve fitness and ability to run 5 km; however, the immersive app featured a game-themed design and narrative. Intention-to-treat analysis was performed using data collected face-to-face at baseline and 8 weeks, and all regression models were adjusted for baseline outcome value and gender. The primary outcome was cardiorespiratory fitness, objectively assessed as time to complete the 1-mile run/walk test at 8 weeks. Secondary outcomes were PA levels (accelerometry and self-reported), enjoyment, psychological need satisfaction, self-efficacy, and acceptability and usability of the apps. RESULTS: A total of 51 participants were randomized to the immersive app intervention (n=17), nonimmersive app intervention (n=16), or the control group (n=18). The mean age of participants was 15.7 (SD 1.2) years; participants were mostly NZ Europeans (61%, 31/51) and 57% (29/51) were female. Overall retention rate was 96% (49/51). There was no significant intervention effect on the primary outcome using either of the apps. Compared to the control, time to complete the fitness test was -28.4 seconds shorter (95% CI -66.5 to 9.82, P=.20) for the immersive app group and -24.7 seconds (95% CI -63.5 to 14.2, P=.32) for the nonimmersive app group. No significant intervention effects were found for secondary outcomes. CONCLUSIONS: Although apps have the ability to increase reach at a low cost, our pragmatic approach using readily available commercial apps as a stand-alone instrument did not have a significant effect on fitness. However, interest in future use of PA apps is promising and highlights a potentially important role of these tools in a multifaceted approach to increase fitness, promote PA, and consequently reduce the adverse health outcomes associated with insufficient activity.

Effect of an acute bout of plyometric exercise on neuromuscular fatigue and recovery in recreational athletes

Although plyometric training is widely used by sports coaches as a method of improving explosive power in athletes, many prescribe volumes in excess of the National Strength and Conditioning Association recommendations. The purpose of this study was to assess voluntary and evoked muscle characteristics to assess the neuromuscular impact of a high-volume bout of plyometric exercise that was non-exhaustive. Ten athletes who did not have plyometric training experience and were in their competitive season for club-level sport volunteered for the study. After at least 2 days without high-intensity activity, subjects were assessed on maximal twitch torque, time to peak torque, rate of twitch torque development, twitch half-relaxation time, rate of twitch relaxation, and voluntary activation by the interpolated twitch technique before, immediately after, and 2 hours after a high-volume plyometric training program (212 ground contacts). Data were analyzed by repeated-measures analysis of variance and described as mean +/- SD and Cohen d. Statistically significant decrements appeared immediately after the training protocol in the total torque generated by maximal voluntary contractions (p < 0.05, d = -0.51) and twitch (p < 0.01, d = -0.92), rate of twitch torque development (p < 0.01, d = -0.77), and rate of relaxation (p < 0.01, d = -0.73). However, we did not observe any differences that remained statistically different after 2 hours. There were no significant differences observed at any time point in time to peak twitch, half-relaxation time, or voluntary activation. We conclude that high-volume plyometric training results primarily in peripheral fatigue that substantially impairs force and rate of force development. We recommend that coaches carefully monitor the volume of plyometric training sessions to avoid neuromuscular impairments that can result in suboptimal training.

An internet-supported physical activity intervention delivered in secondary schools located in low socio-economic status communities : study protocol for the activity and motivation in physical education (AMPED) cluster randomized controlled trial

BACKGROUND: School-based physical education is an important public health initiative as it has the potential to provide students with regular opportunities to participate in moderate-to-vigorous physical activity (MVPA). Unfortunately, in many physical education lessons students do not engage in sufficient MVPA to achieve health benefits. In this trial we will test the efficacy of a teacher professional development intervention, delivered partially via the Internet, on secondary school students' MVPA during physical education lessons. Teaching strategies covered in this training are designed to (i) maximize opportunities for students to be physically active during lessons and (ii) enhance students' autonomous motivation towards physical activity. METHOD: A two-arm cluster randomized controlled trial with allocation at the school level (intervention vs. usual care control). Teachers and Year 8 students in government-funded secondary schools in low socio-economic areas of the Western Sydney region of Australia will be eligible to participate. During the main portion of the intervention (6 months), teachers will participate in two workshops and complete two implementation tasks at their school. Implementation tasks will involve video-based self-reflection via the project's Web 2.0 platform and an individualized feedback meeting with a project mentor. Each intervention school will also complete two group peer-mentoring sessions at their school (one per term) in which they will discuss implementation with members of their school physical education staff. In the booster period (3 months), teachers will complete a half-day workshop at their school, plus one online implementation task, and a group mentoring session at their school. Throughout the entire intervention period (main intervention plus booster period), teachers will have access to online resources. Data collection will include baseline, post-intervention (7-8 months after baseline) and maintenance phase (14-15 months after baseline) assessments. Research assistants blinded to group allocation will collect all data. The primary outcome will be the proportion of physical education lesson time that students spend in MVPA. Secondary outcomes will include leisure-time physical activity, subjective well-being, and motivation towards physical activity.
DISCUSSION: The provision of an online training platform for teachers could help facilitate more widespread dissemination of evidence-based interventions compared with programs that rely exclusively on face-to-face training.

Can an online tutorial pass the test for library instruction? An evaluation and comparison of library skills instruction methods for first year students at Deakin University

An online, interactive tutorial, Smart Searcher, was introduced at Deakin University as part of the Iibrary's information skills program in late 2000. As liaison librarians responsible for library skills training we wanted to compare and evaluate this mode of instruction with our normal face-to-face delivery of library instruction. This study found that students with face-to-face instruction did, in fact, gain higher posttest mean scores than students completing the online tutorial. Also, students attending these library sessions felt more confident about their library skills than those in the online tutorial only session.

The impact of information and communications technology on teaching and design of flexible, online and distance education courses at Deakin University

This paper describes the use of an online learning environment which has been established for postgraduate students studying at Master’s level in Professional Education and Training Deakin University. A detailed evaluation of the use of computer conferences in an Open and Distance Education specialism was undertaken during 2000 as part of a CUTSD funded project, Learner Centred Evaluation of Computer Facilitated Learning Projects in Higher Education. As the Open and Distance Education specialism is being revised and new units are written, the information gathered in this evaluation is being integrated into the pedagogical planning and the technological decisions being made about the design of the new master’s program.

How E-business can provide a sustainable framework for online learning in the vocational education and training arena

The author undertook a major national study of e-business for the Australian National Training Authority (ANTA) from November 1999 - February 2000, resulting in the report E-competent Australia: The Impact of E-commerce on the National Training Framework (ANTA, 2000; available at http;://www.anta.gov.au). This ANTA study and other research by the author show that e-business will eventually have a significant impact on the Australian economy, on industries, organisations, occupations and education and training organisations. From April-May 2000, the author is undertaking a major study for the Commonwealth Government (DETYA): a scoping study of e-commerce in the education and training sector (higher education, VET, schools) of Australia.

This paper starts where the ANTA study (Mitchell 2000a) and the DETYA study stop, by exploring the implications of e-business for online learning systems. E-business will eventually impact not only on the organisations providing online education but on their online learning systems.

The paper is based also on research by the author for a Doctorate in Education within the Faculty of Education at Deakin University that commenced in 1997 and is continuing. The research for this paper involved a review of national and international developments in ebusiness, relating them to online learning systems.

This paper traces the origins, definitions and drivers of both e-business and online learning systems in the 1990s, showing how e-business principles and strategies in the future will have a beneficial impact on online learning systems, even if online learning systems eventually lose their identities as separate from the rest of the organisation.

An e-business focus for online learning systems would start with an understanding of the customers' needs; would find a customer-centric solution, not a technology-centric solution; would empower the customer; would provide sufficient and multiple types of support for the customer; would provide quality and skilled input; and would provide cost effective, reliable and accessible technology.

This vision of an e-business approach to training varies greatly from the traditional business model for the delivery of training, particularly by VET Registered Training Organisations (RTOs). The traditional business model includes real estate prices dictating location of campuses; architecture dictating class sizes; industrial relations dictating the number and length of sessions and prescribing tight role descriptions; queues of students enrolling in February and July each year; and students seated in teacher-dominated classrooms. In contrast, an e-business basis for RTOs would involve the use of electronic communication to improve business performance, improve the use of existing resources, enhance existing services and increase market reach.

An e-business model for RTOs would include the following features: the development of new relationships with customers, using electronic communication to strengthen the relationship; the pursuit of new student markets; and the development of new relationships and alliances between providers. In this new arena of potential and threat, of disintermediation and reintermediation, there will be new roles for new intermediaries; and there will emerge new ways of supporting teaching and learning. Progressive education and training organisations will realize the potential offered by e-business and enjoy the fruits of reintermediation.

Is the lecturer in the room? a study of student satisfaction with online discussions in practical legal training

Reports an exploratory practitioner-initiated study that developed and implemented an online questionnaire to collect data from PLT students in three states, regarding their satisfaction with online discussions. Students’ perceptions of ‘community of inquiry framework’ elements, Marzano and Kendall’s ‘self-system’ factors, and other contextual aspects, were investigated and tested for correlations.The study found student satisfaction with the online discussions was most closely associated with ‘teaching presence’. Students’ satisfaction with student-student interactions was closely associated with ‘self-system’ factors.