Good practice report : clinical teaching

Clinical experience, or experience in the ‘real world’ of practice, is a fundamental component of many health professional courses. It often involves students undertaking practical experience in clinical workplace settings, typically referred to as clinical placements, under the supervision of health professionals. Broadly speaking, the role of clinical supervisors, or teachers, is aimed at assisting students to integrate the theoretical and skills based components of the curriculum within the context of patient/client care (Erstzen et al 2009). Clinical experience also provides students with the opportunity to assimilate the attitudes, values and skills which they require to become appropriately skilled professionals in the environments in which they will eventually practise. However, clinical settings are particularly challenging learning environments for students. Unlike classroom learning, students in the clinical setting frequently find themselves involved in unplanned and often complex activities with patients and other health care providers, being supervised by a variety of clinical staff who have very different methods and styles of teaching, and negotiating bureaucratic or hierarchical structures in busy clinical workplaces where they may only be spending a limited amount of time. Kilminster et al (2007) also draw attention to tensions that may exist between the learning needs of students and the provision of quality care or need to prevent harm to the patient (e.g. Elkind et al 2007). All of these factors complicate the realisation of clinical education goals and underscore the need for effective clinical teaching practices that maximise student learning in clinical environments. This report provides a summary of work that has been achieved in relation to ALTC projects and fellowships associated with clinical teaching, and a review of scholarly publications relevant to this field. The report also makes recommendations based on issues identified and/or where further work is indicated. The projects and fellowships reviewed cover a range of discipline areas including Biology, Paramedic Practice, Clinical Exercise Physiology, Occupational Therapy, Speech Pathology, Physiotherapy, Pharmacy, Nursing and Veterinary Science. The main areas of focus cover issues related to curriculum, particularly in relation to industry expectations of ‘work-ready’ graduates and the implications for theoretical and practical, or clinical preparation; development of competency assessment tools that are nationally applicable across discipline-specific courses; and improvement of clinical learning through strategies targeting the clinical learning environment, building the teaching capacity of clinical supervisors and/or enhancing the clinical learning/teaching process.

Transformation in educational practices through STEM

The need for strong science, technology and innovation linkages between Higher Education Institutions (HEIs) and industries is a pivotal point for middle-income countries in their endeavor to enhance human capital in socioeconomic development. Currently, the University-Industry partnerships are at an infant stage in Sri Lankan higher education context. Technological maturity and effective communication skills are contributing factors for an efficient graduate profile. Also, expanding internship programs in particular for STEM disciplines provide work experience to students that would strengthen the relevance of higher education programs. This study reports historical overviews and current trends in STEM education in Sri Lanka. Emphasis will be drawn to recent technological and higher education curricular reforms. Data from the last 10 years were extracted from the higher education sector and Ministry of Higher Education Policy portfolios. Associations and trend analysis of the sector growth were compared with STEM existence, merger and predicted augmentations. Results were depicted and summarised based on STEM streams and disciplines. It was observed that the trend of STEM augmentation in the Sri Lankan Higher Education context is growing at a slow but steady pace. Further analysis with other sectors in particular, Industry information, would be useful and a worthwhile exercise.

Is it RIP for the IEP? The future of individual education plans in an era of accountability

This article presents a brief overview of the development of the Individual Education Plan (IEP) and prompts teachers to question its use and relevance in an era of accountability in Australian schools. Many Australian teachers do not realise that the IEP was adopted from the United States where is was legislated practice based on that country's Human Rights Legislation. It is not included in the Australian policy context. Though not embedded in the legislation of many other countries, it became a process and a product synonymous with the education of students with disability worldwide. In the era of standards-based education and curriculum for all, the relevance of the IEP process and product has been questioned or re-imaged in some Australian schools. The story of one school leader, Violet, is presented here as an example.

Too much knowledge for a nurse? Use of physical assessment by final-semester nursing students

There is debate around the scope of physical assessment skills that should be taught in undergraduate nursing programs. Yet this debate is largely uninformed by evidence on what is learned and practiced by nursing students. This study examined the pattern and correlates of physical assessment skill utilization by 208 graduating nursing students at an Australian university, including measures of knowledge, frequency of use and perceived barriers to physical assessment skills during clinical practice. Of the 126 skills surveyed, on average only five were used every time students practiced. Core skills reflected inspection or general observation of the patient; none involved complex palpation, percussion or auscultation. Skill utilization was also shaped by specialty area. Most skills (70%) were, on average, never performed or learned and students perceived nursing physical assessment was marginalized in both university and workplace contexts. Lack of confidence was thus a significant barrier to use of skills. Based on these findings we argue that the current debate must shift to how we might best support students to integrate comprehensive physical assessment into nursing practice.

The literacy curriculum: A critical review

This is a critical review of the scope of the literacy curriculum in the twenty-first century, uncovering the strengths, controversies, and silences that have divided literacy researchers and educators. It conceptualizes the literacy curriculum as a particular set of socially organized symbolic practices that are always selective, and which are inextricably connected to the function and organization of schooling. We trace the political, historical, and ideological antecedents of literacy curriculum and schooling as a form of cultural apparatus of the nation-state, before tracing some of the major interpretive paradigms that have influenced the shape of the literacy curriculum in many parts of the world. These include debates about skills-based approaches, whole language, systemic functional grammar, and critical literacy. It then draws attention to noteworthy advances and shifts in the field over recent decades: debates about the role of orality in the literacy curriculum, home-school community literacy practices, teacher and student knowledge of language and grammar, and the role of curriculum area literacies. It anticipates the future of the literacy curriculum in online textual environments and the changing sensorial and material nature of literacy practices, while acknowledging that curriculum innovation is always limited in complex ways by historically established pedagogic discourses of schooling.

Empowering innovative and active citizens: Design education in an Australian independent school

Consumerism is arguably one of the strongest forces affecting society today. Its affect on young people and their ability and desire to create, design, and innovate is cause for concern. It has been suggested that design, when viewed as “a fundamental category of meaning making” (Cope and Kalantzis, 2010, p.597), can be conceived as a “foundational paradigm for representation and action” (Cope and Kalantzis, 2011, p.49). As a component of a general education, it has the capacity to give future generations a framework for collaborative creative and critical thinking required for business innovation, while developing resourceful optimism, motivation, morality and the citizenship needed to develop awareness and resilience to this ideology (Design Commission, 2011; Design Council, 2011). However, to date clearly defined frameworks and empirical data surrounding design education integration in secondary school contexts and its impact on innovation and active citizenship in Australia, is extremely limited. This paper will explore the value of a hands-on and collaborative design-based education model in an independent secondary school environment in Australia and its effect on students’ self- perception, core beliefs, empowered participation and ability to innovate towards sustainability. Following is an overview of relevant literature, the research question, and potential significance and contribution of this research.

Koulukasvatusta teknologisoituvaan yhteiskuntaan : Kansakoulun opetussuunnitelman rakentuminen, 1945-1952

Education for a Technological Society. Public School Curriculum Construction, 1945-1952. The subject of my research is the significance of technology in the construction process of the public school curriculum during the years 1945-1952. During the period the war reparation and rebuilding placed demands and actions to rationalise and dramatise industry and agriculture. Thereby the ambitions of building a technological country and the reformation of curriculum took place simultaneously. Fordistian terms of reference, of which the principles were mass production, rationalisation and standardisation, a hierarchical division of labour and partition of assignments, provided a model for the developing curriculum. In the research the curriculum is examined as an artefact, which shapes socio-technically under the influence of social and technical factors. In the perspective of socio-technical construction the artefact is represented by the viewpoints of members of relevant social groups. The groups give meaning to the curriculum artefact, which determines the components of the curriculum. The weakness of the curriculum was its ineffectiveness, which was due to three critical problems. Firstly, the curriculum was to be based on scientific work, which meant the development of schools through experiments and scientific research. Secondly, the civilised conseption in the curriculum was to be composed of theoretical knowledge, as well as practical skills. Practical education was useful for both the individual and society. Thirdly, the curriculum was to be reformed in a way that the individuality of the pupil would be taken into account. It was useful for the society that talents and natural abilities of every pupil were observed and used to direct the pupil to the proper place in the social division of labour, according to the "right man in a right place" principle. The solutions to critical problems formed the instructions of the public school curriculum, which described the nature and content of education. Technology and its development were on essential part of the whole school curriculum process. The quality words connected to the development of technology - progress, rationality and effectiveness - were also suitable qualifiers and reasons for the reform of the curriculum. On the other hand, technology set a point of comparison and demand for the development of all phases of education. The view of technology was not clearly deterministic - it was also possible to shape technological society with the help of education. The public school curriculum process indicates how originally the principles of technological systems were shaped to the language of education and accepted in educational content.

Preadolescents and Their Mothers as Oral Health-Promoting Actors : Non-biologic Determinants of Oral Health among Turkish and Finnish Preadolescents

Is oral health becoming a part of the global health culture? Oral health seems to turn out to be part of the global health culture, according to the findings of a thesis-research, Institute of Dentistry, University of Helsinki. The thesis is entitled as “Preadolescents and Their Mothers as Oral Health-Promoting Actors: Non-biologic Determinants of Oral Health among Turkish and Finnish Preadolescents.” The research was supervised by Prof.Murtomaa and led by Dr.A.Basak Cinar. It was conducted as a cross-sectional study of 611 Turkish and 223 Finnish school preadolescents in Istanbul and Helsinki, from the fourth, fifth, and sixth grades, aged 10 to 12, based on self-administered and pre-tested health behavior questionnaires for them and their mothers as well as the youth’s oral health records. Clinically assessed dental status (DMFT) and self-reported oral health of Turkish preadolescents was significantly poorer than the Finns`. A similar association occurred for well-being measures (height and weight, self-esteem), but not for school performance. Turkish preadolescents were more dentally anxious and reported lower mean values of toothbrushing self-efficacy and dietary self-efficacy than did Finns. The Turks less frequently reported recommended oral health behaviors (twice daily or more toothbrushing, sweet consumption on 2 days or less/week, decreased between-meal sweet consumption) than did the Finns. Turkish mothers reported less frequently dental health as being above average and recommended oral health behaviors as well as regular dental visits. Their mean values for dental anxiety was higher and self-efficacy on implementation of twice-daily toothbrushing were lower than those of the Finnish. Despite these differences between the Turks and Finns, the associations found in common for all preadolescents, regardless of cultural differences and different oral health care systems, assessed for the first time in a holistic framework, were as follows: There seems to be interrelation between oral health and general-well being (body height-weight measures, school performance, and self-esteem) among preadolescents: • The body height was an explanatory factor for dental health, underlining the possible common life-course factors for dental health and general well-being. • Better school performance, high levels of self-esteem and self-efficacy were interrelated and they contributed to good oral health. • Good school performance was a common predictor for twice-daily toothbrushing. Self-efficacy and maternal modelling have significant role for maintenance and improvement of both oral- and general health- related behaviors. In addition, there is need for integration of self-efficacy based approaches to promote better oral health. • All preadolescents with high levels of self-efficacy were more likely to report more frequent twice-daily toothbrushing and less frequent sweet consumption. • All preadolescents were likely to imitate toothbrushing and sweet consumption behaviors of their mothers. • High levels of self-efficacy contributed to low dental anxiety in various patterns in both groups. As a conclusion: • Many health-detrimental behaviors arise from the school age years and are unlikely to change later. Schools have powerful influences on children’s development and well-being. Therefore, oral health promotion in schools should be integrated into general health promotion, school curricula, and other activities. • Health promotion messages should be reinforced in schools, enabling children and their families to develop lifelong sustainable positive health-related skills (self-esteem, self-efficacy) and behaviors. • Placing more emphasis on behavioral sciences, preventive approaches, and community-based education during undergraduate studies should encourage social responsibility and health-promoting roles among dentists. Attempts to increase general well-being and to reduce oral health inequalities among preadolescents will remain unsuccessful if the individual factors, as well as maternal and societal influences, are not considered by psycho-social holistic approaches.

Young Actors in Transnational Agoras : Multi-sited Ethnography of Cosmopolitan Micropolitical Orientations

This study examines young people s political participation in transnational meetings. Methodologically the study aims to shed light on multi-sited global ethnography. Young people are viewed here as a social age group sensitive to critical, alternative and even radical political participation. The diversity of the young actors and their actions is captured by using several different methods. What is more, the study spurs us coming from the Global North to develop social science research towards methodological cosmopolitanism and to consider our research practices from a moral cosmopolitan perspective. The research sites are the EU Presidency Youth Event (2006 Hyvinkää, Finland), the Global Young Greens Founding Conference (2007 Nairobi, Kenya), the European Social Forum (2008 Malmö, Sweden) and three World Social Forums (2006 Bamako, Mali; 2007 Nairobi Kenya and 2009 Belém, Brazil). The data consists of participant observation, documents and media articles of the meetings, interviews, photos, video, and internet data. This multidisciplinary study combines youth research, development studies, performative social science and political sociology. In this research the diverse field of youth political participation in transnational agoras is studied by using a cross-table of cosmopolitan resources (or the lack of them) and everydaymakers expert citizen dichotomy. First, the young participants of the EU Presidency youth event are studied as an example of expert citizens with cosmopolitan resources (these resources include, for example, language skills, higher education and international social network). Second, the study analyses those everyday-makers who use performative politics to demonstrate their political missions here and now. But in order to make the social movement global they need cosmopolitan resources to be able to use the social media tools and work globally. Third, the study reflects upon the difficulties of reaching those actors who lack cosmopolitan resources, either everyday-makers or expert citizens. The go-along method and the use of the interpreters are shown as ways to reach these young people s political missions. Fourth, the research underlines the importance of contact zones (i.e. spaces or situations where the aforementioned orientations and their differences temporarily disappear or weaken) for deeper democracy and for boosted dialogue between different kinds of participants. Keywords: political participation, young people, multi-sited ethnography, youth research, political sociology, development studies, performative social science

A framework for revising preservice curriculum for nonphysician clinicians: The mozambique experience.

Mozambique, with approximately 0.4 physicians and 4.1 nurses per 10,000 people, has one of the lowest ratios of health care providers to population in the world. To rapidly scale up health care coverage, the Mozambique Ministry of Health has pushed for greater investment in training nonphysician clinicians, Tιcnicos de Medicina (TM). Based on identified gaps in TM clinical performance, the Ministry of Health requested technical assistance from the International Training and Education Center for Health (I-TECH) to revise the two-and-a-half-year preservice curriculum. A six-step process was used to revise the curriculum: (i) Conducting a task analysis, (ii) defining a new curriculum approach and selecting an integrated model of subject and competency-based education, (iii) revising and restructuring the 30-month course schedule to emphasize clinical skills, (iv) developing a detailed syllabus for each course, (v) developing content for each lesson, and (vi) evaluating implementation and integrating feedback for ongoing improvement. In May 2010, the Mozambique Minister of Health approved the revised curriculum, which is currently being implemented in 10 training institutions around the country. Key lessons learned: (i) Detailed assessment of training institutions' strengths and weaknesses should inform curriculum revision. (ii) Establishing a Technical Working Group with respected and motivated clinicians is key to promoting local buy-in and ownership. (iii) Providing ready-to-use didactic material helps to address some challenges commonly found in resource-limited settings. (iv) Comprehensive curriculum revision is an important first step toward improving the quality of training provided to health care providers in developing countries. Other aspects of implementation at training institutions and health care facilities must also be addressed to ensure that providers are adequately trained and equipped to provide quality health care services. This approach to curriculum revision and implementation teaches several key lessons, which may be applicable to preservice training programs in other less developed countries.

Student nurses need more than maths to improve their drug calculating skills

Nurses need to be able to calculate accurate drug calculations in order to safely administer drugs to their patients (NMC, 2002). Studies have shown however that nurses do not always have the necessary skills to calculate accurate drug dosages and are potentially administering incorrect dosages of drugs to their patients (Hutton, M. 1998. Nursing Mathematics: the importance of application. Nursing Standard 13(11), 35–38; Kapborg, I. 1994. Calculation and administration of drug dosage by Swedish nurses, Student Nurses and Physicians. International Journal for Quality in Health Care 6(4), 389–395; O’Shea, E. 1999. Factors contributing to medication errors: a literature review. Journal of Advanced Nursing 8, 496–504; Wilson, A. 2003. Nurses maths: researching a practical approach. Nursing Standard 17(47), 33–36). The literature indicates that in order to improve drug calculations strategies need to focus on both the mathematical skills and conceptual skills of student nurses so they can interpret clinical data into drug calculations to be solved. A study was undertaken to investigate the effectiveness of implementing several strategies which focussed on developing the mathematical and conceptual skills of student nurses to improve their drug calculation skills. The study found that implementing a range of strategies which addressed these two developmental areas significantly improved the drug calculation skills of nurses. The study also indicates that a range of strategies has the potential ensuring that the skills taught are retained by the student nurses. Although the strategies significantly improved the drug calculation skills of student nurses, the fact that only 2 students were able to achieve 100% in their drug calculation test indicates a need for further research into this area.

Impact of the intrinsic motivation on the academic performance through voluntary assignments: An empirical analysis

The students academic performance is a key aspect for all agents involved in a higher education quality program. However, there is no unanimity on how to measure it. Some professionals choose assessing only cognitive aspects while others lean towards assessing the acquisition of certain skills. The need to train increasingly adapted professionals in order to respond to the companies’ demands and being able to compete internationally in a global labour market requires a kind of training that goes beyond memorizing. Critical and logical thinking are amongst written language skills demanded in the field of Social Sciences. The objective of this study is to empirically demonstrate the impact of voluntary assignments on the academic performance of students. Our hypothesis is that students who complete high quality voluntary assignments are those more motivated and, therefore, those with higher grades. An experiment with students from the "Financial Accounting II" during the academic year of 2012/13 at the Business and Economics School of the UCM was carried out. A series of voluntary assessments involving the preparation of accounting essays were proposed in order to develop skills and competencies as a complement to the lessons included in the curriculum of the subject. At the end of the course, the carrying-out or not of the essay together with its critical, reflective quality and style, were compared. Our findings show a relationship between the voluntarily presented papers of quality and the final grade obtained throughout the course. These results show that the students intrinsic motivation is a key element in their academic performance. On the other hand, the teachers role focuses on being a motivating element through the learning process.

ABA-Based Programs for Children Diagnosed With Autism Spectrum Disorder: Parental and Professional Experiences at School and at Home

Having a child diagnosed with Autism Spectrum Disorder (ASD) poses a range of challenges to families, many of which can be addressed through appropriate intervention. A study of parental (n = 95) and professional (n = 67) experiences was carried out in relation to two settings: (a) schools that provided intensive interventions based on the science of Applied Behavior Analysis (ABA), and (b) non-intensive ABA-based home programs. Results show that parents whose children attend ABA-based schools were generally more satisfied with their child's educational provision, monitoring procedures, and level of staff training, than parents who were not offered ABA-based education in schools. © 2012 Copyright Taylor and Francis Group, LLC.

Behavioural and cognitive-behavioural group-based parenting programmes for early-onset conduct problems in children aged 3 to 12 years.

Early-onset child conduct problems are common and costly. A large number of studies and some previous reviews have focused on behavioural and cognitive-behavioural group-based parenting interventions, but methodological limitations are commonplace and evidence for the effectiveness and cost-effectiveness of these programmes has been unclear. To assess the effectiveness and cost-effectiveness of behavioural and cognitive-behavioural group-based parenting programmes for improving child conduct problems, parental mental health and parenting skills. We searched the following databases between 23 and 31 January 2011: CENTRAL (2011, Issue 1), MEDLINE (1950 to current), EMBASE (1980 to current), CINAHL (1982 to current), PsycINFO (1872 to current), Social Science Citation Index (1956 to current), ASSIA (1987 to current), ERIC (1966 to current), Sociological Abstracts (1963 to current), Academic Search Premier (1970 to current), Econlit (1969 to current), PEDE (1980 to current), Dissertations and Theses Abstracts (1980 to present), NHS EED (searched 31 January 2011), HEED (searched 31 January 2011), DARE (searched 31 January 2011), HTA (searched 31 January 2011), mRCT (searched 29 January 2011). We searched the following parent training websites on 31 January 2011: Triple P Library, Incredible Years Library and Parent Management Training. We also searched the reference lists of studies and reviews. We included studies if: (1) they involved randomised controlled trials (RCTs) or quasi-randomised controlled trials of behavioural and cognitive-behavioural group-based parenting interventions for parents of children aged 3 to 12 years with conduct problems, and (2) incorporated an intervention group versus a waiting list, no treatment or standard treatment control group. We only included studies that used at least one standardised instrument to measure child conduct problems. Two authors independently assessed the risk of bias in the trials and the methodological quality of health economic studies. Two authors also independently extracted data. We contacted study authors for additional information. This review includes 13 trials (10 RCTs and three quasi-randomised trials), as well as two economic evaluations based on two of the trials. Overall, there were 1078 participants (646 in the intervention group; 432 in the control group). The results indicate that parent training produced a statistically significant reduction in child conduct problems, whether assessed by parents (standardised mean difference (SMD) -0.53; 95% confidence interval (CI) -0.72 to -0.34) or independently assessed (SMD -0.44; 95% CI -0.77 to -0.11). The intervention led to statistically significant improvements in parental mental health (SMD -0.36; 95% CI -0.52 to -0.20) and positive parenting skills, based on both parent reports (SMD -0.53; 95% CI -0.90 to -0.16) and independent reports (SMD -0.47; 95% CI -0.65 to -0.29). Parent training also produced a statistically significant reduction in negative or harsh parenting practices according to both parent reports (SMD -0.77; 95% CI -0.96 to -0.59) and independent assessments (SMD -0.42; 95% CI -0.67 to -0.16). Moreover, the intervention demonstrated evidence of cost-effectiveness. When compared to a waiting list control group, there was a cost of approximately $2500 (GBP 1712; EUR 2217) per family to bring the average child with clinical levels of conduct problems into the non-clinical range. These costs of programme delivery are modest when compared with the long-term health, social, educational and legal costs associated with childhood conduct problems. Behavioural and cognitive-behavioural group-based parenting interventions are effective and cost-effective for improving child conduct problems, parental mental health and parenting skills in the short term. The cost of programme delivery was modest when compared with the long-term health, social, educational and legal costs associated with childhood conduct problems. Further research is needed on the long-term assessment of outcomes.

Peer assisted learning in health education.

There are many forms of Peer Assisted Learning (PAL). There are well-established theoretical models as to why PAL is proven to be effective across educational sectors. To maximise gains from PAL careful consideration needs to be given to the roles of peers. Evidence suggests that PAL projects with clearly defined roles for interaction result in strongest outcomes. Effect Sizes (ES) from meta-analyses of peer assisted learning indicate ES of between 0.25-0.50. Outcomes can be social and emotional as well as academic. PAL generally requires adaptation of existing resources and can be cost-effective to implement compared to other educational developments.