Capacity building for integrated health care at the local level

Aims & Rationale/Objectives
Taking a capacity building approach to research and evaluation within the context of a federally funded national program challenges the traditional paradigms of both research and evaluation. The objective of this approach was to foster attitudes and behaviours of reflection, critical inquiry and collaborative action amongst participants responsible for health care integration activities.

Methods
A series of workshops focusing on different elements of health care integration was conducted. Each workshop offered skill development in research and evaluation methods relevant to the participants' clinical practise. The workshops were multidisciplinary and cross-sectoral in order to promote discussion about shared patient care issues.

Principal Findings
Participatory action research facilitated by external agents can build the capacity of participants to identify and make changes that improve health care integration at local levels. A capacity building approach to research and evaluation can mediate tensions between top-down initiatives and on-the-ground practitioners.

Discussion
A capacity building approach was crucial to the success of this project particularly as the project proposal was developed at the corporate level. The workshops played an important role in engaging the participants and fostering the development of solutions for locally identified clinical issues. The opportunities for discussion with other health care service providers were both readily embraced and appreciated by the participants. The networks formed during the workshops are likely to be vital in sustaining integration efforts.

Implications
Education sessions such as the workshops held within this project ensure that health care integration remains on the agenda of the relevant organisations. These workshops fostered a continuous quality improvement approach whilst focusing on the skills required and the systemic barriers to achieving health care integration. The success of these workshops is evidence that the need and desire for shared education opportunities exists and the interdisciplinary focus is a powerful tool for developing an appreciation of the cultures within disciplines as well as linkages.

Marginalisation of dental students in a shared medical and dental education programme

OBJECTIVES: Internationally, there are a number of universities at which medical and dental education programmes share common elements. There are no studies about the experiences of medical and dental students enrolled in different programmes who share significant amounts of learning and teaching. METHODS: Semi-structured interviews and focus groups were conducted with 36 students and staff in a learning programme shared between separate medical and dental faculties. They were transcribed and an iterative process of interpretation and analysis within the theoretical framework of the contact hypothesis and social identity theory was used to group data into themes and sub-themes. RESULTS: Dental students felt 'marginalised' and felt they were treated as 'second-class citizens' by medical students and medical staff in the shared aspects of their programmes. Contextual factors such as the geographical location of the two schools, a medical : dental student ratio of almost 3 : 1, along with organisational factors such as curriculum overload, propagated negative attitudes towards and professional stereotyping of the dental students. Lack of understanding by medical students and faculty of dental professional roles contributed further. CONCLUSIONS: Recommendations for reducing the marginalisation of dental students in this setting include improving communication between faculties and facilitating experiential contact. This might be achieved through initiating a common orientation session, stronger social networks and integrated learning activities, such as interprofessional problem-based learning and shared clinical experiences.

Multidisciplinary research perspectives in education shared experiences from Australia and China

The editors of this extraordinary book, Indika Liyanage and Badeng Nima, have brought together a wonderfully wide-ranging collection of chapters. The breadth and depth of the studies of education issues in China and Australia are impressive. The topics encompass important questions concerning education policies, curricula, pedagogy, equality, parental engagement, cultural heritage, and anti-drug education. The scope of the book includes Chinese and Australian settings that range from kindergartens to higher education, and from rural to urban environments. The diversity of the book strengthens rather than weakens its coherence, because the golden thread running through all the chapters is a portrayal of the complexity of education provision when global, national and local forces interact. Written by academics with hands-on experience, the chapters provide evidence-based discussions of practical conundrums, enriched by the sophisticated use of interdisciplinary approaches. As a result, this book is powerful, challenging and ground-breaking.

Bringing shared values out of the shadows

As part of its wider promotion of a world that is peaceful and tolerant, the United Nations declared 2005 the International Year of Sport and Physical Education. At the fore of the UN's proclamation was recognition of the important role sport and PE play in nurturing the health and harmony of society. Sport and PE, the UN declared, provide important nodes for social connection around which shared values and understandings can be formed. In the wake of the UN's endorsement of the role that sport and PE can play in fostering social and emotional development, it is more important that ever that we reflect on and refine our practices towards this end. This paper draws on two research narratives to illustrate how easily this potential can be undermined. Indeed, behind some of the wonderful opportunities for connection that exist through a participation in PE and sport exists a dark shadow of alienation and oppression. The challenge raised through this paper centres on the need for PE teachers and coaches to work deliberately and strategically towards the cultivation of inclusive, tolerant and responsible forms of participation, and not leave their development to chance.

Seeking industry perspectives to enhance experiential education in university-industry partnerships: going beyond mere assumptions

Setting up and running a program with an industry experiential learning component is based on certain core assumptions. A shared vision of what constitutes a satisfying placement is essential. In this paper we present findings from research into the operation of an Australian Bachelor of Business Information Technology program. In-depth interviews were held with 10 experienced industry sponsors/mentors and one member of a relevant professional body. Industry mentors identify pragmatic reasons for industry involvement in experiential learning programs. They identify some seven skills required of a good industry mentor, and report eight features of a meaningful/satisfying placement

Shared learning: reflecting on practice using a collaborative approach

Independent learning and critical thought are developed when students are encouraged to express and review their own understandings and the ideas of others as part of their learning journey. This paper focuses on an innovation to engage and support pre-service teachers (students) in a collaborative approach to learning following a teaching practicum. Through the creation of a learning community, information and practice is shared and further challenged in a supportive environment. The opportunity for students to review their own work in relation to responses of peers enables them to become involved in the process of critiquing their own beliefs and practices as well as their peers, within a set framework. Favourable outcomes for both students and university staff augur well for the future development of the process.

Continuous improvement through shared understanding : reconceptualising instructional design for online learning

Many Australian tertiary institutions provide support for academic staff in the design and development of online teaching and learning resources, often employing a centralised unit staffed with educational and instructional designers, multimedia and online developers, audio/video producers and graphic artists. It is not unusual for these units to have evolved from print-based distance education providers and consequently the design and development processes inherent within those units are often steeped in ‘traditional’ sequential instructional development models. We argue that these models are no longer valid for effectively working with academic staff given the dynamic nature of online learning environments and the diversity of skills to implement effective online learning. This paper therefore presents an extended instructional design model in which the development cycle for online teaching and learning materials uses a scaffolding strategy in order to cater for learner-centred activities and to maximise scarce developer and academic resources. The model also integrates accepted phases of the instructional development process to provide guidelines for the disposition of staff and to more accurately reflect the creation of resources as learning design rather than instructional design. It is a model that builds on instructional design processes and integrates concepts of team-based development, shared understanding and the development of relevant communities of practice.

Shared learning : a collaborative approach for supporting pre-service teacher's reflective practice

Independent learning and critical thought are developed when students are encouraged to express and review their own understandings and the ideas of others as part of their learning journey. This paper focuses on an innovation to engage and support pre-service teachers (students) in a collaborative approach to learning following a teaching practicum. Through the creation of a learning community, information and practice is shared and further challenged in a supportive environment. The opportunity for students to review their own work in relation to responses of peers enables them to become involved in the process of critiquing their own beliefs and practices as well as their peers, within a set framework. Favourable outcomes for both students and university staff augur well for the future development of the process.  

Education and training institutions : building social capital for regional development

Education and training institutions from schools through to universities have a vital role in supporting development in regional Australia. The interaction between these institutions and their rural communities influences the social capital of the community and the extent to which the community is a learning community, willing and able to manage change to the community’s advantage.

There are benefits to be had from a collaborative approach to planning and delivering training. This approach is consistent with theories of social capital that emphasise the crucial part played by networks, values and trust in generating superior outcomes for individuals, communities and regions. Research has found that education and training is most effective in building social capital and learning communities were there is attention to customising or targeting education and training provision to local needs. The key to matching provision with local needs, particularly in the more rural and remote areas, is collaboration and partnerships. Partners can be regional organisations, other educational institutions, businesses and government. The factors that enhance the effectiveness of the collaborations and partnerships are the elements of social capital: networks, shared values and trust, and enabling leadership.

Networks are most effective where there were opportunities and structures for interaction, which can be termed interactional infrastructure, that foster networks within the region, and networks that extended outside the region. Interactional infrastructure includes regional forums, committee structures, consultative processes and opportunities for informal discussion addressing the issues of education, training and employment in a community or region. Better outcomes are evident when there is an interactional infrastructure that is resourced with financial, physical and human resources of sufficient quantity and quality. Collaborations provide access to a greater range of external resources through extended external networks. Effective networks and shared visions, values and trust among the partners in a collaboration, are fostered by enabling leaders. Educational institutions are well placed to supply the ‘human infrastructure’ that makes collaborations and partnerships work, including enabling leadership.

Attention to factors associated with the quality of social capital, especially interactional infrastructure including leadership, shared vision and values and networks within and external to the community, can be expected to improve the effectiveness of education and training outcomes. More importantly, a collaborative approach to planning for education and training in rural regions will build the capacity of regions and their constituent communities to develop and change by building social capital resources. Leadership is an important driver of processes that build community and regional capacity and ultimately produce social and economic benefits through regional development. Educational providers in rural regions are well placed to act as enabling leaders.

Skill shortages in health : innovative solutions using vocational education and training

Introduction: This article reports findings of a project funded by the Australian National Council for Vocational Education Research. The project explores solutions to current and projected skills shortages within the health and community services sector, from a vocational education and training perspective. Its purpose is to locate, analyse and disseminate information about innovative models of health training and service delivery that have been developed in response to skill shortages.

Methods: The article begins with a brief overview of Australian statistics and literature on the structure of the national health workforce and perceived skill shortages. The impact of location (state and rurality), demographics of the workforce, and other relevant factors, on health skill shortages is examined. Drawing on a synthesis of the Australian and international literature on innovative and effective models for addressing health skill shortages and nominations by key stakeholders within the health sector, over 70 models were identified. The models represent a mixture of innovative service delivery models and training solutions from Australia, as well as international examples that could be transposed to the Australian context. They include the skill ecosystem approach facilitated by the Australian National Training Authority Skill Ecosystem Project. Models were selected to represent diversity in terms of the nature of skill shortage addressed, barriers overcome in development of the model, healthcare specialisations, and different customer groups.

Results: Key barriers to the development of innovative solutions to skills shortages identified were: policy that is not sufficiently flexible to accommodate changing workplace needs; unwillingness to risk take in order to develop new models; delays in gaining endorsement/accreditation; current vocational education and training (VET) monitoring and reporting systems; issues related to working in partnership, including different cultures, ways of operating, priorities and timelines; workplace culture that is resistant to change; and organisational boundaries. For training-only models, additional barriers were: technology; low educational levels of trainees; lack of health professionals to provide training and/or supervision; and cost of training. Key enhancers for the development of models were identified as: commitment by all partners and co-location of partners; or effective communication channels. Key enhancers for model effectiveness were: first considering work tasks, competencies and job (re)design; high profile of the model within the community; community-based models; cultural fit; and evidence of direct link between skills development and employment, for example VET trained aged care workers upskilling for other health jobs. For training only models, additional enhancers were flexibility of partners in accommodating needs of trainees; low training costs; experienced clinical supervisors; and the provision of professional development to trainers.

Conclusions: There needs to be a balance between short-term solutions to current skill shortages (training only), and medium to longer term solutions (job redesign, holistic approaches) that also address projected skills shortages. Models that focus on addressing skills shortages in aged care can provide a broad pathway to careers in health. Characteristics of models likely to be effective in addressing skill shortages are: responsibility for addressing skills shortage is shared between the health sector, education and training organisations and government, with employers taking a proactive role; the training component is complemented by a focus on retention of workers; models are either targeted at existing employees or identify a target group(s) who may not otherwise have considered a career in health.

Collaboration : integrating education and clinical practice : The Case of La Trobe University/The Alfred Clinical School of Nursing

A Clinical School of Nursing combines resources, opportunities and benefits for hospital and university staff as well as students. Collaboration is essential in the partnership between the two institutions and aspects will be explored in this paper, including antecedent conditions of organisational commitment, cooperation and trust, identification of costs, and a formal agreement. Collaboration itself is built on cooperative endeavour, willing participation, shared planning and decision making, a team approach, and shared responsibility and power. These attributes are readily identifiable in this exciting initiative.

Networked interactive whiteboards : rationale, affordances and new pedagogies for regional Australian higher education

This article presents an argument for the use of networked interactive whiteboards (NIWBs) in regional Australian higher education and identifies new pedagogies for this context. Most Australian universities operate multiple campuses, and many use video conference facilities to deliver courses across these sites. For students at remote video conference sites, their classroom experience is often one of isolation and limited student to student contact. In this article, NIWBs are proposed as a tool to enhance this mode of delivery and exploratory research into the additional affordances they provide is presented. By using networking with IWBs, annotation and gesture can be shared across distances. Emerging possibilities from the integration of NIWBs with video conference, web conference and lecture capture systems are also explored. Three new pedagogies for regional Australian higher education are proposed based on these new capabilities.

Many layers of meaning : multicultural music education in Victoria, Australia

This paper explores music education viewed through lenses of cultural identity and the formation of personal identity in contemporary, multicultural Victoria, Australia. The people of this state come from more than 280 countries, speak more than 240 languages and follow more than 120 faiths. Our population diversity is constantly changing which challenges music educators to respond to classroom demographics and as tertiary educators we prepare our pre-service students to become culturally responsive teachers. As music educators, we occupy and are situated in multiple identities that shape the ways in which we experience and understand music and its transmission. As Australian tertiary music educators, we explore pre-service teacher cultural identity, attitudes and values about the inclusion of multicultural music in the classroom where cultural dialogue provides a platform for the construction of meaning. While marginalization and diversity occurs within multifaceted forms, we question: What music do we present in contemporary Victorian schools? Why do we make these choices? How do we present this music? This consideration, contextualized within the curricular framework, addresses issues of access, equity and community engagement. The making of meaning in shared cultural experiences contributes to the formation of identity which is a fluid and multilayered construct.

More towards the centre : searching for field position for student equity in Australian higher education

The field of Australian higher education has changed, is changing and is about to change, as it is repositioned in relation to other ‘fields of power’. It is a sector now well defined by its institutional groupings – the Go8, the IRUs, the ATN and the rest – and by their relative claims to selectivity and exclusivity, with every suggestion of their differentiation growing. Even within these groupings there are distinctions and variations. Moreover, Australian universities now compete within an international higher education marketplace, ranked by THES and Shanghai Jiao Tiong league tables. ‘Catchment areas’ and knowledge production have become global. And the potential of a ‘joined‐up’ tertiary education system, of VET and universities, will rework relations within Australian higher education, as will lifting the volume caps on university student numbers. In sum, Australian universities (and agents within them) are positioned differently in the field, although not in the stable relations imagined by Pierre Bourdieu in the France of the 1960s. And being so variously and variably placed, institutions and agents have different stances available to them, including the positions they can take on student equity. In this paper I begin from the premise that our current shared stance on this has been out‐positioned. Nation‐bound proportional representation loses its equity meaning when the Australian elite send their children to Harvard, Yale, Oxford and Cambridge. The same could also be said, and has been, about equity representations by region, institution, discipline and degree. What then, also, for a new national research centre with a focus on student equity and higher education, for its research agenda and positioning in the field? What stance can it take on student equity that will resonate on a national and even international scale? And, given a global field of higher education, what definitions of equity and propositions for policy and practice can it offer? What will work in the pursuit of equity?