Self-management support and training for patients with chronic and complex conditions improves health-related behaviour and health outcomes

The Sharing Health Care SA chronic disease self-management (CDSM) project in rural South Australia was designed to assist patients with chronic and complex conditions (diabetes, cardiovascular disease and arthritis) to learn how to participate more effectively in the management of their condition and to improve their self-management skills. Participants with chronic and complex conditions were recruited into the Sharing Health Care SA program and offered a range of education and support options (including a 6-week peer-led chronic disease self-management program) as part of the Enhanced Primary Care care planning process. Patient self-reported data were collected at baseline and subsequent 6-month intervals using the Partners in Health (PIH) scale to assess self-management skill and ability for 175 patients across four data collection points. Health providers also scored patient knowledge and self-management skills using the same scale over the same intervals. Patients also completed a modified Stanford 2000 Health Survey for the same time intervals to assess service utilisation and health-related lifestyle factors. Results show that both mean patient self-reported PIH scores and mean health provider PIH scores for patients improved significantly over time, indicating that patients demonstrated improved understanding of their condition and improved their ability to manage and deal with their symptoms. These results suggest that involvement in peer-led self-management education programs has a positive effect on patient self-management skill, confidence and health-related behaviour.

Global cancer surgery : delivering safe, affordable, and timely cancer surgery

Surgery is essential for global cancer care in all resource settings. Of the 15.2 million new cases of cancer in 2015, over 80% of cases will need surgery, some several times. By 2030, we estimate that annually 45 million surgical procedures will be needed worldwide. Yet, less than 25% of patients with cancer worldwide actually get safe, affordable, or timely surgery. This Commission on global cancer surgery, building on Global Surgery 2030, has examined the state of global cancer surgery through an analysis of the burden of surgical disease and breadth of cancer surgery, economics and financing, factors for strengthening surgical systems for cancer with multiple-country studies, the research agenda, and the political factors that frame policy making in this area. We found wide equity and economic gaps in global cancer surgery. Many patients throughout the world do not have access to cancer surgery, and the failure to train more cancer surgeons and strengthen systems could result in as much as US $6.2 trillion in lost cumulative gross domestic product by 2030. Many of the key adjunct treatment modalities for cancer surgery--e.g., pathology and imaging--are also inadequate. Our analysis identified substantial issues, but also highlights solutions and innovations. Issues of access, a paucity of investment in public surgical systems, low investment in research, and training and education gaps are remarkably widespread. Solutions include better regulated public systems, international partnerships, super-centralisation of surgical services, novel surgical clinical trials, and new approaches to improve quality and scale up cancer surgical systems through education and training. Our key messages are directed at many global stakeholders, but the central message is that to deliver safe, affordable, and timely cancer surgery to all, surgery must be at the heart of global and national cancer control planning.

International students in the private VET sector in Melbourne, Australia: rethinking their characteristics and aspirations outside the deficit model

The reconstruction of the Australian Vocational Education and Training (VET) sector into a competitive training market, which led to the participation of international students and commercial for-profit private VET providers, has until
recently focused on the importance of international students to the national economy whilst ignoring the students ’important educational characteristics and the other benefits that accrue to Australia. Drawing on views and perspectives of students, teachers, training managers and quality assurance auditors, this article presents an analysis of the VET provider-level processes, which have contributed tolimited discursive constructions of the identities of international students in private VET providers in Melbourne. It argues that there is an urgent need for a rethinking of the way international students are conceptualised and represented in the competitive training market environment.

Inequalities and agencies in workplace learning experiences: international student perspectives

National systems of vocational education and training around the globe are facing reform driven by quality, international mobility, and equity. Evidence suggests that there are qualitatively distinctive challenges in providing and sustaining workplace learning experiences to international students. However, despite growing conceptual and empirical work, there is little evidence of the experiences of these students undertaking workplace learning opportunities as part of vocational education courses. This paper draws on a four-year study funded by the Australian Research Council that involved 105 in depth interviews with international students undertaking work integrated learning placements as part of vocational education courses in Australia. The results indicate that international students can experience different forms of discrimination and deskilling, and that these were legitimised by students in relation to their understanding of themselves as being an ‘international student’ (with fewer rights). However, the results also demonstrated the ways in which international students exercised their agency towards navigating or even disrupting these circumstances, which often included developing their social and cultural capital. This study, therefore, calls for more proactively inclusive induction and support practices that promote reciprocal understandings and navigational capacities for all involved in the provision of work integrated learning. This, it is argued, would not only expand and enrich the learning opportunities for international students, their tutors, employers, and employees involved in the provision of workplace learning opportunities, but it could also be a catalyst to promote greater mutual appreciation of diversity in the workplace.

What contributes to vocational excellence? Characteristics and experiences of competitors and experts in WorldSkills London

Modelling Vocational Excellence (MoVE) International is a WorldSkills Member research initiativesupporting:• skills improvement and Competition best practice• international skills benchmarking, and• promotion of vocational excellence to young people, employers and policy makers.MoVE International is the inaugural research project for the WorldSkills Foundation and is alsosupported by Skills Finland, WorldSkills UK, WorldSkills Australia and the Dusseldorp Skills Forum.The research team is a partnership between: University of Tampere, Finland; University of Oxford,UK; and RMIT University, Australia, with support from Deakin University, Australia.The research initiative sets out to produce outcomes relevant to the interests of its majorstakeholder groups. The data produced by the study offers WorldSkills International and individualWorldSkills Members a framework for international benchmarking on skills quality, and a windowinto the WorldSkills experience for Competitors and Experts. Through the research reports,WorldSkills Member organizations will also gain access to global data on WorldSkills Competitorsand Experts which may be applied to improve training and professional development. Importantly,young people are afforded a global voice. In telling their own stories they can share theirexperiences with peers, and provide future Competitors with insights into the experience of beinginvolved in international skill competitions. For WorldSkills International, the data is a source ofpromotional material, and may contribute to event and organizational evaluation.The MoVE research project launches the WorldSkills Foundation’s program of research,engagement and advocacy. MoVE offers the Foundation an opportunity to influence the globaldebate on vocational education and training, and to shift the orientation of VET research away froma ‘deficit’ framework to one which highlights benefits and opportunities (see section 2.2 for a fullerexplanation of these research orientations).The outputs of the 2011 MoVE international research project include this global report and casestudies of the Australian, Finnish and British teams that competed at WorldSkills London 2011.

Initial teacher education and assessment of graduates in Australia

In this chapter we discuss the impact of recent standards-based legislation and implementation in Australia designed to improve the quality of teacher education and examine the ways in which teacher educators are assessing graduates in relation to beginning teacher standards, the evidence they are using within the context of accreditation of their programs, and the impact this is having on the teacher education curriculum. We report on research into the implementation and evaluation of an authentic teacher assessment approach being used in one Australian university and argue that such an approach not only empowers pre-service teachers but also teacher educators.

Barriers, enablers and challenges to initiating end-of-life care in an Australian intensive care unit context.

BACKGROUND: Patients admitted to Australian intensive care units are often critically unwell, and present the challenge of increasing mortality due to an ageing population. Several of these patients have terminal conditions, requiring withdrawal of active treatment and commencement of end-of-life (EOL) care. OBJECTIVES: The aim of the study was to explore the perspectives and experiences of physicians and nurses providing EOL care in the ICU. In particular, perceived barriers, enablers and challenges to providing EOL care were examined. METHODS: An interpretative, qualitative inquiry was selected as the methodological approach, with focus groups as the method for data collection. The study was conducted in Melbourne, Australia in a 24-bed ICU. Following ethics approval intensive care physicians and nurses were recruited to participate. Focus group discussions were discipline specific. All focus groups were audio-recorded then transcribed for thematic data analysis. RESULTS: Five focus groups were conducted with 11 physicians and 17 nurses participating. The themes identified are presented as barriers, enablers and challenges. Barriers include conflict between the ICU physicians and external medical teams, the availability of education and training, and environmental limitations. Enablers include collaboration and leadership during transitions of care. Challenges include communication and decision making, and expectations of the family. CONCLUSIONS: This study emphasised that positive communication, collaboration and culture are vital to achieving safe, high quality care at EOL. Greater use of collaborative discussions between ICU clinicians is important to facilitate improved decisions about EOL care. Such collaborative discussions can assist in preparing patients and their families when transitioning from active treatment to initiation of EOL care. Another major recommendation is to implement EOL care leaders of nursing and medical backgrounds, and patient support coordinators, to encourage clinicians to communicate with other clinicians, and with family members about plans for EOL care.

International student mobility and its impact on the Australian private VET sector

In recent years governments have legitimated neoliberal educational policy reforms such as the internationalization and commercialization of education through mobilising the discourses of globalization and the knowledge economy. In Australia for instance, a raft of policy initiatives over the last two and a half decades (beginning in the early 1990s) targeted full-fee paying international students prompting a surge in international student enrolments and a burgeoning private vocational education and training (VET) sector for international students. Drawing on a study of situated realities influencing international students in private VET providers in Melbourne Australia, this chapter analyses, from training managers’ and quality assurance auditors’ perspectives, the impact of international student mobility on the private VET sector. The chapter also utilises the notion of social structure as systems of human relations amongst social positions to examine how international student mobility has led to shifts in VET manager and quality assurance auditors’ perceptions and practices outside the boundaries of the education sector, particularly how private VET providers and international students are represented. In this instance by reforming the VET sector, governments change conventional characteristics through which people relate and the relationships that bind them with intended and unintended consequences. The findings suggest that whilst VET policy posits an easy and ready association between the needs of capital and the development of the workforce, this association is highly contestable and problematic as it can lead to negative student learning outcomes.