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Self-Assessment (SA) is often assumed to be essential for learning, however, this assumption has been extensively rebutted. Research shows SA has significant limitations, including its lack of correlation with competence.We undertook a scoping review of SA in medical education (2011-2021) and surprisingly discovered substantial research where SA was erroneously assumed to be a valid measure of successful learning, or a skill needing to be taught. Although the initial intent of our scoping review was to explore where SA is being effectively used to advance lifelong learning, we paused to explore the extent of the problem of its misuse and resulting in wasted research, by examining excluded studies.From 1151 articles, we identified 207 which ignored the documented limitations of SA. Thirty-nine studies explored SA of learning. This research has limited utility: increasing the accuracy of SA does not improve performance or lifelong learning. One hundred and sixty-eight used SA as an outcome measure to assess a program or intervention, including 63 where self-assessed improvement in knowledge/skills was the sole measure. SA of self-confidence was measured in 62 studies. When confidence was compared with an objective measure of performance, both invariably increased, but confidence did not always align with competence when measured.Many researchers mistakenly assume the ability to accurately self-assess is essential for learning, so focus on teaching self-calibration rather than evidence-based methods of advancing learning. Other researchers incorrectly suppose that self-reported improvements in knowledge/skills provide evidence of the efficacy of a program/intervention. This is particularly troubling with regards to novices, who may believe that because they self-assess to have improved/gained confidence, they are now competent.Our findings highlight the significant volume of research being done where SA is misunderstood and/or misused as a measurement. We posit reasons that such research continues to take place and suggest solutions moving forward.

The purpose of this review was to explore how professional identity is formed and shaped within pre-registration physiotherapy curricular.A scoping review using the PRISMA guidelines from the Joanna Briggs Institute to capture a range of evidence describing how professional identity has been formed and shaped in pre-registration physiotherapy curricular.Databases searched included: PubMed 1996-Present, Embase 1974-Present, CINAHL 1961-Present, ProQuest Health and Medical Collection 1938-Present and Google Scholar (2004-Present). Additional studies were identified by scanning reference lists and hand searching for relevant articles.The research team collaboratively designed the data charting table and two project leads independently extracted and screened the data as per guidance from the Joanna Briggs Institute Reviewers Manual. A meta-synthesis was conducted in this scoping review to identify common themes from qualitative research to provide a deeper understanding of literature. To ensure feasibility of collating results, components of pre-registration curricular in physiotherapy students describing associations of forming and shaping professional identity were charted.A total of 21 articles were reviewed. Articles were categorised into three categories of shaping (5, 24%), forming (9, 43%) or forming and shaping (7, 33%). Five themes emerged from the meta-synthesis pertaining to forming and shaping professional identity: self, skills, curriculum, program, location.This scoping review illustrates the evidence for multidimensional components of physiotherapy curricular involved to assist in shaping and forming professional identity in pre-registration physiotherapy students. The results of this review can provide a foundation level into the understanding of what professional identity is, although further research is required to understand how it could be best implemented in pre-registration physiotherapy curricular.

Background and purpose The impact of stress and burnout in students is an emerging topic. When students perceive that they are unable to cope with stressors, there is increased potential for burnout. To maximise students’ higher educational institution outcomes, students must be able to effectively cope with stressful demands. Research suggests physiotherapy students, in particular, suffer from a high risk of stress and burnout, however limited research exists on postgraduate, pre-registration, physiotherapy students. The purpose of this study was to determine perceived stress, burnout and associated coping strategies across three timepoints in the first year of a postgraduate, pre-registration physiotherapy program. Methods A qualitative and quantitative survey design was utilised at one Australian Higher Education Institution. The 51-item self-administered questionnaire consisted of demographics, the Coping Self Efficacy (CSE) Scale and Maslach Burnout Inventory – General Survey for Students (MBI-GS (S)), and open-ended questions. The questionnaire was administered at three timepoints (T) in the program: T1 at the start of semester 1, T2 before the first placement in semester 2 and T3 after 10-weeks of placement. Data were analysed using descriptive, statistical and thematical analysis. Subjects All first year Doctor of Physiotherapy students. Results A response rate of 62% (n = 38) was achieved. There were no differences in stress and burnout scores between sexes, nor differences in stress and burnout over time. Highest median CSE scores were seen at T1, with highest median MBI-GS (S) cynicism scores at T2, exhaustion (EX) at T1 and T2, and professional efficacy at T1 and T2. The greatest mean CSE changes were seen from T1-T2 and T1–3, and PE greatest changes from T2-T3 and T1-T3. No strong correlation was found between stress and burnout. Curriculum coursework was a frequently reported stressor, along with clinical placement and transition periods. Coping strategies utilized by students were both positive and maladaptive. Positive strategies included sporting activities, baking, listening to music, and social connections, whereas maladaptive strategies included alcohol consumption, excessive eating, and gaming. Conclusion Student consistently identified periods of stress and burnout, with curriculum coursework in particular being a trigger. Findings acknowledge the need for further investigation on sources of perceived stress, burnout, and coping mechanisms to optimise student welfare and enhance Higher Education Institution outcomes.

Background Respiratory diseases impose an immense health burden worldwide and affect millions of people on a global scale. Reduction of exercise tolerance poses a huge health issue affecting patients with a respiratory condition, which is caused by skeletal muscle dysfunction and weakness and by lung function impairment. Virtual reality systems are emerging technologies that have drawn scientists’ attention to its potential benefit for rehabilitation. Methods A systematic review and meta-analysis following the PRISMA guidelines was performed to explore the effectiveness of virtual reality gaming and exergaming-based interventions on individuals with respiratory conditions. Results Differences between the virtual reality intervention and traditional exercise rehabilitation revealed weak to insignificant effect size for mean heart rate (standardized mean difference, SMD = 0.17; p = 0.002), peak heart rate (SMD = 0.36; p = 0.27), dyspnea (SMD = 0.32; p = 0.13), and oxygen saturation SpO2 (SMD = 0.26; p = 0.096). In addition, other measures were collected, however, to the heterogeneity of reporting, could not be included in the meta-analysis. These included adherence, enjoyment, and drop-out rates. Conclusions The use of VRS as an intervention can provide options for rehabilitation, given their moderate effect for dyspnea and equivalent to weak effect for mean and maximum peak HR and SpO2. However, the use of virtual reality systems, as an intervention, needs further study since the literature lacks standardized methods to accurately analyze the effects of virtual reality for individuals with respiratory conditions, especially for duration, virtual reality system type, adherence, adverse effects, feasibility, enjoyment, and quality of life.

Background Personal activity intelligence (PAI) is a single physical activity metric based upon heart rate responses to physical activity. Maintaining 100 PAI/week is associated with a 25% risk reduction in cardiovascular disease mortality and 50 PAI/week provides 60% of the benefits. The effect of utilising this metric within a cardiac population has not been previously investigated. The aim of this study was to determine the effect of PAI monitoring on the amount and/or intensity of physical activity for people in the maintenance phase of cardiac rehabilitation and to explore participants’ perceptions of this approach. Methods A concurrent mixed methods approach was undertaken. Participants in the maintenance phase of cardiac rehabilitation monitored PAI for six weeks via a wearable physical activity monitoring device (WPAM). In the first three weeks participants were blinded to their PAI score. A quality-of-life questionnaire (EQ-5D-5L) was completed, and semi-structured interviews conducted to investigate attitudes to PAI monitoring. Daily PAI data was collected throughout the 6-week period. Results Twenty participants completed the trial. PAI earned/day was increased after participants could view their data (mean difference: 2.1 PAI/day (95% CI 0.3, 4.0), p = 0.027). The median change in percentage of days participants achieved a Total PAI score of 25 (p = 0.023) and 50 (p = 0.015) were also increased. The mean change in total scores for the EQ-5D-5L and EQVAS were improved after 6 weeks (0.6 ± 1.05; 95% CI (0.11–1.09); p = 0.019); (5.8/100; 95% CI (2.4–9.2); p = 0.002 respectively). Thematic framework analysis identified three global themes (perceptions on the WPAM, PAI and factors affecting exercise). Most participants stated motivation to exercise increased after they could view their PAI data. Many of the participants believed they would continue to use PAI long-term. Others were undecided; the latter primarily due to technical issues and/or preferring devices with greater functionality and attractiveness. All participants would recommend PAI. Conclusion This exploratory study showed monitoring PAI via a WPAM increased the amount and/or intensity of physical activity within the cardiac population. Participants found PAI interesting, beneficial, and motivating. If technical issues, aesthetics, and functionality of the WPAM were improved, participants may continue to use the approach long-term. PAI may be a viable strategy to assist people with cardiac disease maintain physical activity adherence.

Background and Purpose: The impact of stress and burnout in students is an emerging topic. When students perceive that they are unable to cope with stressors, there is increased potential for burnout. To maximise students’ higher educational institution (HEI) outcomes, students must be able to effectively cope with stressful demands. Research suggests physiotherapy students, in particular, suffer from a high risk of stress and burnout, however limited research exists on postgraduate, pre-registration, physiotherapy students. The purpose of this study was to determine perceived stress, burnout and associated coping strategies across three time points in the first year of a post-graduate, pre-registration physiotherapy program. Subjects: All first year Doctor of Physiotherapy (DPHTY) students at Bond University 2019 were invited to participate. Methods: A mixed methods observational cohort design was implemented in one Australian HEI to determine stress, burnout and coping strategies across 3 time points. The 51-item self-administered questionnaire consisted of demographics, the Coping Self Efficacy (CSE) Scale and Maslach Burnout Inventory – General Survey for Students (MBI-GS (S)), and open-ended questions.Results: A response rate of 62% (n=38) was achieved. There were no differences in stress and burnout scores between sexes, nor differences in stress and burnout over time. Highest median CSE scores were seen at T1, with highest median MBI-GS (S) cynicism (CYN) scores at T2, exhaustion (EX) at T1 and T2, and professional efficacy (PE) at T1 and T2. The greatest mean CSE changes were seen from T1-T2 and T1-T3, and PE greatest changes from T2-T3 and T1-T3. No strong correlation was found between stress and burnout. Curriculum coursework was a frequently reported stressor, along with clinical placement and transition periods. Coping strategies utilized by students were both positive and maladaptive. Positive strategies included sporting activities, baking, listening to music, and social connections, whereas maladaptive strategies included alcohol consumption, excessive eating and gaming. Conclusion: Student consistently identified periods of stress and burnout, with curriculum coursework in particular being a trigger. Findings acknowledge the need for further investigation on sources of perceived stress, burnout and coping mechanisms to optimise student welfare and enhance HEI outcomes.

Purpose: To explore the influence of education and other factors on an athlete’s decision to return to sport post-concussion injury, and whether general risk-taking tendencies are related to return to sport post-concussion decisions in these athletes. Participants and Methods: A self-administered electronic survey was designed to examine their decision-making process when faced with scenario-based questions regarding returning to sport post-concussion injury. Students from the Health Sciences and Medicine Faculty at Bond University were invited to participate. Participants were allocated to a concussion education or non-education group prior to commencement of questionnaire via the random generator on Qualtrics software function. The risk propensity scale was used to assess the risk aversion of each participant. Results: Sixteen respondents were randomized evenly to education and non-education groups. Seven (43.8%) had previously received concussion education training prior to completing the questionnaire, with one (14%) choosing to return to sport in the scenario-based questions. The education group reported two (25%) respondents return to sport, while three (75%) respondents out of four returned to sport with no education or previous concussion training. Influential factors that impacted the decision whether to return to sport or not included: game importance, concussion severity and symptoms, and various internal and external factors. Finally, there was a divergence in results from the risk propensity scale when deciding to return to sport and general risk-taking propensities. Conclusion: This study identified several influential factors including game importance, concussion severity and symptoms which play a significant role in the return to sport decisions post-concussion injury.

Physical activity is important to prevent chronic disease and improve mental health. Physical activity education needs to be delivered in an efficient, effective and persuasive way by health professionals to increase participation. Message framing can be used to influence health decision-making and motivate behavior change. This systematic review investigates the influence of different message framing characteristics on potential physical activity participation. A search of relevant databases, reference lists and grey literature was performed. Systematic review was performed. Thirteen studies met the inclusion criteria. The majority of participants were healthy adults with the exception of one study who included overweight people. All studies investigated gain and loss as well as at least one other message framing characteristic and how this influenced physical activity participation. The other characteristics included: source credibility (n = 4), presentation of affect (n = 1), number of arguments (n = 1), type of activity (n = 1), narrative versus statistical (n = 3), intrinsic versus extrinsic motivation (n = 1), social endorsement (n = 1), kernel type (n = 1) and ease of imagination (n = 2). There is no consistent consensus for the best message frame to increase physical activity participation. Further research is needed.

Introduction The achievement of effective overall communication skills can be complex and challenging for children with Special Educational Needs (SEN) who use augmentative and alternative communication (AAC) systems (Light and McNaughton, 2014). LEGO®-based therapy is primarily being used with people on the autistic spectrum, as a social intervention to target communication and interaction skills (LeGoff, 2004). This presentation outlines the novel use of LEGO®-based therapy that has been adapted to enhance the development of communicative competence of children aged 7–13 who use AAC systems. Methods This adapted LEGO®-based therapy approach is based on the principles of Baron Cohen’s Empathising-Systemising model (Baron-Cohen et al., 2005) and social constructivism. Children take turns to play different roles (a supplier, an engineer, and a builder). They are provided with a LEGO® set or allowed to freestyle, in order to build a model as a team. The role of the adult facilitator is to prompt the resolution of any social or communication difficulties that may arise. The gamification approach provides a balance between the development of social interaction and gaming (Mosley and Whitton, 2014) as the children collaboratively create a LEGO® model as a team. Outcomes The initial findings from a series of case studies highlighted the potential benefits of using a gamification approach featuring adapted LEGO®-based therapy, to develop single or multiple communication competences in young children using AAC devices. The case studies provide insights into the development of multiple (linguistic, operational, social, strategic) communication competencies coupled with the influence of psychosocial factors and environmental support. These case studies highlighted the additional development of social skills, (including joint attention, problem solving, negotiation and both verbal and non-verbal communication), which enhance overall communicative competence. The project highlighted the importance of recognising and responding to linguistic, operational, social and strategic challenges faced by children using AAC devices during therapeutic intervention. Discussion, conclusions and recommendations The initial findings illustrated in the case studies indicates the successful adaption of LeGoff’s (2004) original LEGO®-based therapy, as a therapeutic intervention to enhance single and multiple communicative competences of young AAC users. The use of adapted LEGO®-based therapy with AAC users is not without challenges, but these are not insurmountable. Practical and theoretical recommendations for the integration of adapted LEGO®-based therapy in educational and healthcare settings will be shared. References Baron-Cohen S, Wheelwright S, Lawson J, et al. Empathizing and systemizing in autism spectrum conditions. In: Volkmar, F, Klin, A, Paul R (eds.), Handbook of autism and pervasive development disorders (3rd edition) 2005. Chichester: John Wiley & Sons. LeGoff DB. Use of Lego© as a therapeutic medium for improving social competence. Journal of Autism and Developmental Disorders2004;34(5):557–71. Light JC, McNaughton D. Communicative competence for individuals who require augmentative and alternative communication: A new definition for a new era of communication?Augmentative and Alternative Communication2014;30(1):1–18. Mosley A, Whitton N, eds. New traditional games for learning: A case book 2014. London: Routledge.

Background On the subject of human factors is an innovative approach developed using gamification and serious games methodology to enhance the educational value of existing human factors training. This workshop will provide insights into the challenges and barriers of adopting of a commercially available game ‘Keep Talking and Nobody Explodes’ (KTaNE) followed by a facilitator-led debrief, to enhance existing human factors training. Workshop aim The aim of this workshop is to allow delegates to develop an understanding of the application of gamification and serious games to enhance the educational value of existing human factor training in healthcare. Session description Participants to explore the challenges and barriers of implementing gamification and serious games to enhance the educational value of existing human factor training in healthcare. Delegates will be invited to participate in discussions and activities. Pre-recorded video excerpts will also be used to illustrate key consideration when embedding games within healthcare education and training. The session will conclude with delegates reflecting on the application to their own area of practice. Learning objectives By the end of this workshop, participants will have: Gained an insight into educational theory and practices that support the use of gamification/serious games in healthcare Developed insights into the challenges and barriers of implementing gamification and serious games human factor training Critically discussed the application of a commercially available game (KTaNE) within human factors training in healthcare Reflected on the application of commercially available games/serious games to their own area of practice Educational methods Participants will be encouraged to actively participate in discussions to explore each of the workshop objectives Video examples of the use of a commercially available game (suitable for PC/Virtual Reality headsets) will be shared Small group activities will focus on exploring the practicalities of gamification/serious games in healthcare education and training within the delegates’ own area of practice. Target audience Intermediate/Advanced healthcare professionals who are interested or involved in simulation design and debriefing.

Background With increasing complexities placed on healthcare services, team collaboration is imperative. Well-designed interprofessional in-situ simulation-based education allows teams to develop and strengthen essential technical and non-technical skills, within their own working environment. On reviewing literature regarding interprofessional in-situ simulation-based education, previously published models did not account for the pressures and considerations required for constructing simulations in the clinical setting, especially relating to organisational involvement in scenario / programme design (Jeffries, 2005; Gough et al., 2016). As partial fulfilment of a Masters level module, a new model for designing and evaluating interprofessional in-situ simulation was devised, allowing the new ASPiH standards to be met, which has subsequently been implemented in a neonatal staff mandatory training programme. Workshop Aim The aim of this workshop is to share a new model for designing and evaluating interprofessional in-situ simulation-based education. Session Description This workshop will allow participants to explore the challenges and barriers of designing and evaluating interprofessional in-situ simulation-based education and reflect on the potential application of a new model within their area of practice. Learning Objectives By the end of this workshop, participants will have: Developed insight into the challenges and barriers of implementing sustainable interprofessional in-situ simulation activities in the healthcare setting Critically discussed methods to overcome local challenges to the provision of interprofessional in-situ simulation Developed insight into a new model to facilitate the design and evaluation of interprofessional in-situ simulation Reflected on the application of the new model to their own area of practice. Educational Methods Participants will be encouraged to actively participate in discussions to explore each of the workshop objectives A new model will be shared to facilitate the design and evaluation of interprofessional in-situ simulation activities A case study will be presented to illustrate the application of the new model in neonatology Small group activities will focus on exploring the practicalities of using a model to guide the design and evaluation of interprofessional in-situ simulation in the participants9 own area of practice. Target Audience, Maximum Number of Participants All healthcare professionals who are interested or involved in simulation design and evaluation in the healthcare setting. No prior knowledge of educational theory / simulation. Maximum number = 30.

Background Simulated patients (SPs) are people trained to consistently portray a patient or other individual in a scripted scenario for the purposes of instruction, practice, or evaluation. SPs may also participate in teaching and assessment and provide feedback to learners. They have particular value in providing feedback on issues related to patient-centeredness. SPs can be trained to standardise their performance, to provide a consistent and accurate presentation over time and between learners. SPs offer the human element in examination questions for performance-based assessments (Nestel & Bearman, 2015). They act as a proxy for real patients; representing the patient, rather than clinician perspectives. By involving SPs in assessments, examiners have the opportunity to offer realistic, patient-centred experiences to learners. Embedding SPs in assessments contributes positively to the development of safe, patient-centred healthcare practice (Nestel & Bearman, 2015). Aim To provide information for Educators and Trainers to optimise the involvement of SPs within formative and summative performance-related assessments. Session Description This session will allow delegates to explore the rationale, scope, responsibilities and ethical considerations when involving Simulated Patients in performance-based assessments. Learning Objectives At the end of the session, participants will have: Developed an insight into the rationale and scope of involving SPs in formative and summative assessments. Considered the responsibilities, requirements and expectations of both SPs and Educators/Trainers involved in assessments. Gained an awareness of the ethical considerations of involving SPs in assessments. Reflected on the application of the session content to their own area of practice. Educational Methods Participants will be encouraged to explore each of the session learning objectives. Case studies and videos will be used to illustrate key considerations pertaining to the rationale, scope, responsibilities and ethical considerations related to adult and children SPs involved in assessments. The session will conclude with an introduction the structured SP Common Framework and Checklist (Gough et al., 2015), which can be used for guidance when involving SPs in participants’ own practice. References . Nestel D, Bearman M. Chapter 1: Introduction to simulated patient methodology. In D Nestel, M Bearman (Eds.), Simulated patient methodology theory, evidence and practice 2015:pp. 1–4. West Sussex: Wiley Blackwell. . Gough S, Greene L, Nestel D, Hellaby M, MacKinnon R, Natali A, Roberts S, Tuttle N, Webster B. Simulated patients : A standardised, quality assured approach to training and implementation (Final Project Report) 2015. Manchester: Health Education North West.

Containing examples of innovations from around the world, the book offers opportunities to make clear connections between the underlying rationale for the use of simulation, and what this looks like in practice.

Background Limited health economic costs analysis has been published in relation to the use of simulation-based education (SBE) in healthcare. Whilst two research studies have previously reported the cost of delivering simulation scenarios within a physiotherapy research study, both omitted full economic costs (FEC) associated with SBE design and delivery.1,2 To date, the cost analysis of combining SBE and video-reflexive ethnography (VRE) in pre-registration physiotherapy is unreported. Methodology Cost consequence analysis has been undertaken in relation to phase 2 of a pragmatic mixed methods study of the use of SBE in cardio-respiratory physiotherapy in the UK. Phase 2 featured the use of SBE and VRE to explore performance, behaviours and personal experiences of final year pre-registration physiotherapy students.3 The transparent approach to costing (TRAC) was used to calculate FEC of 12 scenarios and respective video-reflexive interviews (debriefs). Results The value attributed by participants included an opportunity to promote skills development, increase self-awareness, placement preparation and the potential to influence patient safety.3 Whereas, the cost analysis of providing this intervention was £3706 per 24 learners, equating to £154.42 per learner. Alternatively, streaming the scenario to an entire cohort reduces costs per learner to £31.10 (saving £123.32 per learner). The cost consequence analysis related to SBE design and delivery, equity of provision, capital investment costs and associated faculty training costs. Conclusion and recommendations Further experimental studies will be required to demonstrate the value of combining different mediums, modalities and methods of SBE with VRE before comprehensive health economic evaluations relating to impact on learning outcomes and academic performance, transfer to practice and healthcare can be established. Future research will help to ascertain the value and the associated costs to inform decisions of the efficacy, viability and sustainability of SBE in physiotherapy. References Black B, Marcoux B. Feasibility of using standardized patients in a physical therapist education program: a pilot study. J Phys Ther. 2002;16:49–56. Shoemaker M, Beasley J, Cooper M, Perkins R, Smith J, Swank C. A method for providing high-volume interprofessional simulation encounters in physical and occupational therapy education programs. J Allied Health. 2011;40:15–21. Gough S, Yohannes A, Murray J. Using video-reflexive ethnography and simulation-based education to explore patient management and error recognition by pre-registration physiotherapists. Adv Simulation. 2016;1:1–16.

Background Simulated Patients (SP) are trained to portray different roles in healthcare education (Nestel and Bearman, 2015). This project developed and evaluated the ‘Train-The-Simulated Patient’ (2TSP) package (Greene and Gough, 2015). The 2TSP package provides a standardised approach to training SPs, featuring an e-learning course and face-to-face workshop. The innovative 2TSP package includes The PrOPS Process© (Gibson, 2015), which blends performing arts pedagogies to enhance characterisation and role portrayal for non-arts professionals. Utilising Process Drama techniques, The PrOPS Process© involves four-stages of SP development: Profile building, Objective-setting, Physicality and Speech modification. Methodology/methods A pragmatic, mixed-methods design facilitated a comprehensive exploration of the 2TSP package; University ethical approval was obtained. None of the participants (NHS Service Users/volunteers, NHS staff, university staff and students, n = 34) had completed SP training previously. Data collection methods included an electronic evaluation questionnaire featuring open and closed questions. Results All participants commented that they would recommend the 2TSP workshop to others. The PrOPS Process© evaluated positively, with participants: Valuing performing arts techniques to enable a greater understanding of the character they were developing Able to connect with the perspectives and feelings that patients may experience during scenarios Reporting improved levels of confidence in assuming future SP roles Conclusions The 2TSP package is implemented throughout the region with performing arts methodology embedded throughout. The PrOPS Process© aims to support users through character development, particularly in non-arts settings. It is anticipated that this will enhance role portrayal skills and improve the learning environment and thus, the quality of learning. References Gibson J. Train The Simulated Patient. Manchester: Manchester Metropolitan University; 2015. http://www.cheshire.mmu.ac.uk/dca/projects/train-the-simulated-patient/ Greene L, Gough S. Simulated Patients: blending performing arts pedagogy and healthcare education. Final Project Report. Manchester: Health Education North West; 2015. Nestel D , Bearman M. Chapter 1: Introduction to simulated patient methodology. In: Nestel D, Bearman M, eds. Simulated Patient Methodology: Theory, Evidence and Practice . West Sussex: Wiley Blackwell; 2015:1–4.

The term ‘Simulated Patient’ (SP) commonly refers to people trained to portray the role of a patient, relative, carer or co-worker in healthcare education. 1 This project aimed to develop, pilot and evaluate a bespoke, evidence-based training programme for Trainers and SPs in the North West of England. The regional SP Programme incorporates the ‘SP Train-The-Trainer’ (SP3T) and ‘Train-The-SP’ (2TSP) e-learning and workshops. A pragmatic, mixed-methods design facilitated a comprehensive exploration of the SP Programme. University ethical approval was obtained. Data collection methods included: A regional survey (n = 89 from 24 different organisations) Electronic evaluation questionnaire featuring open and closed questions; SP3T (n = 18) and 2TSP (n = 34) SP3T participant focus groups (n = 18) to explore course delivery methods and resources Usability testing of the SP Database and SP Passport in healthcare organisations (n = 5). The survey identified variances in SP terminology, recruitment, payment, contracts, risk assessment, training and quality assurance procedures. Survey findings were used to develop the SP Common Framework and SP3T package. 2 The SP3T package 2 was positively reviewed by all pilot participants (SP trainers). The depth of information and content was considered appropriate for novice and experienced simulation facilitators. The 2TSP package 3 was found to be stimulating, useful, flexible, and provided a good level of activity. SP Database testing confirmed usability in organisations with diverse IT infrastructures. The SP Passport was valued to track, record and monitor SP training and involvement. The SP Programme is now implemented throughout the region. The SP Common Framework and SP Programme are designed to empower simulation trainers to effectively work with SPs in education and training, thus promoting educational excellence. It is envisaged that engagement with well-trained SPs will improve education for the health and social care workforce and ultimately lead to improvements in patient safety and public engagement. References Nestel D, Bearman M. Chapter 1: Introduction to simulated patient methodology. In: Nestel D, Bearman M, eds. Simulated patient methodology: theory, evidence and practice. West Sussex: Wiley Blackwell, 2015: 1 –4. Gough S, Greene L, Nestel D, Hellaby M, MacKinnon R, Natali A, Roberts S, Tuttle N, Webster B. Simulated patients: a standardised, quality assured approach to training and implementation. Final Project Report. Manchester: Health Education North West, 2015. Greene L, Gough S. Simulated Patients: blending performing arts pedagogy and healthcare education. Final Project Report. Manchester: Health Education North West, 2015.

Background: Despite recognition of the need to embed patient safety within undergraduate healthcare education, there are limited examples of how this has been achieved within physiotherapy. The purpose of this regional initiative was to develop a course and teaching resources to support Higher Education Institutions in the United Kingdom (UK) when embedding the World Health Organization (WHO) multiprofessional patient safety curriculum into undergraduate healthcare education.Objectives: In this pilot study, researchers assessed the impact of the interprofessional simulation-based education (IPSE) course on students’ perceptions of interprofessional learning and patient safety post-course, and explored the participants’ perceived application of knowledge and skills 3 months later.Methods: A sequential mixed-methods evaluation was conducted, including pre- and post-course Readiness for Interprofessional Learning Scale (RIPLS) questionnaires and two course evaluation questionnaires featuring open and...

Summary Background The application and extent of simulation-based education use within cardiorespiratory physiotherapy postgraduate education (in-house/regional provisions) and emergency oncall services were previously unexplored. Objectives This survey aimed to investigate the extent to which simulation-based education is currently utilised by physiotherapy services in the UK. Design A national postal questionnaire-based survey. Setting All 280 National Health Service Critical/Intensive Care Units in England, Northern Ireland, Scotland and Wales, providing emergency on-call physiotherapy services were included in the survey. Participants Emergency on-call physiotherapy service leads. Method A self-administered 20-item postal questionnaire survey was designed to establish the extent to which simulation-based education was currently being used within cardio-respiratory physiotherapy post-registration training. Results A useable response rate of 55% (155/280) was achieved, representing a range of respiratory and emergency on-call service leads. Sixty-one Trusts (39%) currently use simulation within acute respiratory or emergency on-call postgraduate training. The provision of simulation equipment varied with respect to type, fidelity and accessible to the physiotherapy service. Simulation-based education featured in emergency on-call induction, updates, competency assessment, assessment skills, treatment skills and scenarios (75, 92, 39, 28, 82, 48% respectively). Conclusions Simulation is currently used to teach a wide variety of cardio-respiratory physiotherapy skills relevant to the acute respiratory and on-call environments. Adoption was dependent upon local facilities, needs and training requirements. National inconsistencies in availability, fidelity and accessibility were identified. The evidence base surrounding the current use of simulation-based education within physiotherapy is limited and evidence of transferability to the practice arena remains relatively unknown. Future research is warranted to determine the education outcomes, impact on skill performance, competency, retention and patient safety when integrating SBE within EOC training activities.

This thesis is situated in the context of simulation-based education (SBE) within cardio-respiratory physiotherapy in the UK. A pragmatic mixed methods study has provided a comprehensive examination of the use of SBE from two perspectives: 1) physiotherapy education and 2) pre-registration physiotherapy students’ experiences of managing a deteriorating patient in a simulation context. Two national surveys in Phase 1 provided the first insight into the spectrum of SBE utilised in pre-registration and postgraduate physiotherapy education in the UK between 2009 and 2010. National inconsistencies in simulation provision and accessibility were identified. Financial costs, time and access to simulation centres/laboratories reportedly influenced the use of SBE within cardio-respiratory physiotherapy education. Phase 2 combined SBE and video-reflexive ethnography (VRE) methods to elicit a unique and comprehensive exploration of performance, behaviours, errors and personal experiences of 21 final year (pre-registration) physiotherapy students from one higher education institution in the UK. This study has identified the multi-layered impact of personal experiences and behaviours on practices, clinical decisions, dynamics and the complexities and interconnectivity of participants to the simulation environment. The range of errors identified by this study also highlights the complexity of managing an acutely deteriorating patient in a simulation context. The combination of SBE and VRE allowed the participants to explore errors and defences erected within the scenario and their impact on patient safety. The findings of this thesis emphasise the importance of scenario design, considering the learner’s level of experience, prior knowledge and sequencing of abstract skills before requiring contextualisation within a complex scenario. Carefully planned and executed SBE and VRE methods can provide a safe learning environment to allow participants to explore routine, evolving and complex situations whilst allowing them to learn to be become comfortable with making and exploring errors. Thus, the findings provide valuable insights to inform future research regarding physiotherapy practice and integration of educational methods to augment patient safety awareness and enhance safe healthcare practice. The key message of this thesis is that SBE is a valuable learning modality to explore the complexities of healthcare education and practice.

Background Upon graduation, physiotherapists are required to manage clinical caseloads involving deteriorating patients with complex conditions. In particular, emergency on-call physiotherapists are required to provide respiratory/cardio-respiratory/cardiothoracic physiotherapy, out of normal working hours, without senior physiotherapist support. To optimise patient safety, physiotherapists are required to function within complex clinical environments, drawing on their knowledge and skills (technical and non-technical), maintaining situational awareness and filtering unwanted stimuli from the environment. Prior to this study, the extent to which final-year physiotherapy students were able to manage an acutely deteriorating patient in a simulation context and recognise errors in their own practice was unknown. Methods A focused video-reflexive ethnography study was undertaken to explore behaviours, error recognition abilities and personal experiences of 21 final-year (pre-registration) physiotherapy students from one higher education institution. Social constructivism and complexity theoretical perspectives informed the methodological design of the study. Video and thematic analysis of 12 simulation scenarios and video-reflexive interviews were undertaken. Results Participants worked within the professional standards of physiotherapy practice expected of entry-level physiotherapists. Students reflected appropriate responses to their own and others’ actions in the midst of uncertainty of the situation and physiological disturbances that unfolded during the scenario. However, they demonstrated a limited independent ability to recognise errors. Latent errors, active failures, error-producing factors and a series of effective defences to mitigate errors were identified through video analysis. Perceived influential factors affecting student performance within the scenario were attributed to aspects of academic and placement learning and the completion of a voluntary acute illness management course. The perceived value of the simulation scenario was enhanced by the opportunity to review their own simulation video with realism afforded by the scenario design. Conclusions This study presents a unique insight into the experiences, skills, attitudes, behaviours and error recognition abilities of pre-registration physiotherapy students managing an acutely deteriorating patient in a simulation context. Findings of this research provide valuable insights to inform future research regarding physiotherapy practice, integration of educational methods to augment patient safety awareness and participant-led innovations in safe healthcare practice. Electronic supplementary material The online version of this article (doi:10.1186/s41077-016-0010-5) contains supplementary material, which is available to authorized users.

Background Simulated Patients (SP) are volunteers, actors or people trained to portray the role of a patient or relative in healthcare education. 1 This project has developed, piloted and evaluated a bespoke Simulated Patient Train-The-Trainer programme (SP3T) for Simulation Trainers in the North West of England. Methodology A sequential exploratory mixed methods design was selected to provide comprehensive analysis of the SP3T programme. Results Firstly, the evidence base was explored to develop a regional questionnaire-based survey. A regional survey was undertaken with 89 responses received from participants working within 24 different organisations (including 4 HEIs, 20 NHS Trusts and 31 separate departments). The findings from a review of the evidence and survey were used to develop the bespoke standardised, evidence-based SP3T programme. The programme consists of a pre-requisite e-learning course and interactive workshop. Eighteen SP Trainers have completed the e-learning and workshop programme as well as the post-workshop and impact evaluations. Feedback from the 18 participants (from 16 different organisations across the North West of England) and 5 SPs has been incorporated to further develop the SP3T course resources and ‘Simulated Patient Common Framework’. 2 Conclusions The overall aim of improving knowledge, awareness and best practice in relation to incorporating SPs within simulation-based education (SBE) or workforce development training programmes in the region has been achieved through a regional survey and four different evaluations of the pilot SP3T programme. The Simulated Patient Common Framework provides a reference point to guide the involvement of SPs within healthcare education. The Simulated Patient Common Framework and associated SP3T programme was designed to empower simulation trainers to effectively work with SPs in education and training, and ultimately lead to improvements in patient safety. It is anticipated that this programme will encourage simulation trainers to maximise the potential of embedding SPs in their practice. References Nestel D, Bearman M. Chapter 1: Introduction to simulated patient methodology. In: Nestel D, Bearman M, eds. Simulated patient methodology : theory, evidence and practice. West Sussex: Wiley Blackwell, 2015: 1–4 Gough S, Greene L, Nestel D, Hellaby M, MacKinnon R, Natali A, Roberts S, Tuttle N, Webster B. Simulated patients: a standardised, quality assured approach to training and implementation. Final Project Report . Manchester: Health Education North West, 2015

Background On-call physiotherapy is a duty expected of all qualified physiotherapists. It is important to ensure that on-call physiotherapists are appropriately trained. It is hypothesised that simulation may be a suitable method for training post-graduate staff for on-call duties, even if respiratory is not their chosen speciality. This project is designed to evaluate the effectiveness of simulation for developing clinical reasoning, and to address the real world challenge of how to train staff and maintain competency for working in respiratory care. Methodology: mixed methods approach A pre-post design will be used to evaluate the impact of simulation training on clinical reasoning, self-efficacy, self-confidence, and competency. Video-ethnography featuring triangulation of skills, behaviours and clinical reasoning. Participants will attend a day of simulation training and be video-recorded assessing and treating simulated patients. The participants’ self-perception of their clinical reasoning and competency for on-call will be measured using the ‘Critical Thinking in Respiratory Care’ instrument (CTRC); 1 secondly with the ‘ ACPRC on-call clinical competency questionnaire ’ 2 before and immediately after the training. The participants’ perception of the effect of the simulation training will be measured immediately post-simulation via the ‘ Simulation User’s Evaluation Questionnaire ’. 3 The CTRC and the ACPRC questionnaires will be repeated at 6 months after the training. Analysis Means and standard deviations will be analysed for all outcome measures. 1–3 The primary analysis will be a paired t-test of pre and immediate post-training CTRC scores to evaluate the effect of training on clinical reasoning. Participants’ skills, behaviours and clinical reasoning will be compared to the scenario learning outcomes developed by expert physiotherapists and respiratory academics and triangulated with the video data to determine the effect of training. Potential impact It is anticipated that training using simulation will improve the self-confidence and self-efficacy of on-call physiotherapists alongside performance improvements. References Goodfellow LT, Valentine T, Holt ME. Construction and validation of an instrument to assess critical thinking in respiratory care: an empirical process. Respir Care Educ J 1999;8:13–26 Thomas S, Gough S, Broad MA, Cross J, Harden B, Ritson P, et al . On call competence: developing a tool for self-assessment. Physiotherapy 2008;94:204–211 Levett Jones T, McCoy M, Lapkin S, Noble D, Hoffman K, Dempsey J, Arthur C, Roche J. The development and psychometric testing of the satisfaction with simulation experience scale. Nurse Educ Today 2011;31(7):705–710

Background A literature review failed to identify a framework to facilitate the instructional design of SBE in physiotherapy. Instructional design models, 1 technology enhanced learning 2 and nursing simulation 3 frameworks have previously been used to guide the development of some healthcare SBE initiatives. 1–4 Methodology A sequential, two phased explanatory mixed methods was study selected to provide a comprehensive examination of the use of simulated learning in cardio-respiratory physiotherapy in the UK. Phase 1 consisted of two national surveys during 2009–10. Phase 2 featured the use of video-reflexive ethnography (VRE)to explore performance, behaviours and personal experiences of final year (pre-registration) physiotherapy students. A new conceptual ‘integrated simulated learning framework ’, was developed from phase 2 methodological design, VRE analysis and educational and SBE pedagogy. Results The new framework consists of 3 distinct but interlinking, essential components to be considered when designing, developing and evaluating SBE including: ‘ preparation ’, ‘ intervention ’ and ‘ evaluation/research ’. The ‘ preparation’ component includes three constituent elements: learner, facilitator and educational practices. Intervention: The ‘intervention’ component features three separate elements: the ‘simulation design characteristics’, ‘pre-brief and debrief’ and ‘linked learning activities’. ‘ Evaluation/research’: It is essential that an evaluation of the simulated learning intervention is undertaken to evaluate effectiveness/assess learning outcomes. 1,2,3 Evaluation should be undertaken to explore the impact of learning from SBE through to practice. Following evaluation, information may then be analysed, and actioned accordingly within curriculum/programme/course review. Conclusion This framework presents 3 major interlinking components for consideration when designing SBE, whether this be for a short course or embedded within healthcare curricular. One of the key additions of the proposed framework was to illustrate that evaluation and research cyclically drive changes in SBE. The new framework is proposed to support the instructional design of SBE in healthcare. Further testing of this framework is required in physiotherapy and other healthcare disciplines. References Chiniara G, Cole G, Brisbin K, Huffman D, Cragg B, Lamacchi M, Norman D. and Canadian Network for Simulation in Healthcare Guidelines Working Group. Simulation in healthcare: a taxonomy and a conceptual framework for institutional design and media selection. Med Teach. 2013:35:1380–1395 Department of Health. A framework for technology enhanced learning . London: Department of Health, Crown Copyright, 2011 Jeffries PR. A framework for designing, implementing, and evaluating simulations. Nurs Educ Perspect. 2005:26:97–104 Ravert P, McAfooes J. NLN/Jeffries simulation framework: State of the science summary. Clin Simulation Nurs. 2014;8:410–411

Background Although simulation is an effective learning tool that improves patient safety, 1 the space, time and resources to achieve additional training for theatre staff are at a premium. Algorithms are routinely used to support patient safety in healthcare but the opportunity to learn them is rare. 2 This presentation will provide insights into how the combination of in-situ team training (on a budget) was developed to improve patient safety in theatres. Methodology To facilitate improvements in the use of common algorithms in both paediatric and adult theatres, a simulation innovation was developed to allow the multi-disciplinary team (MDT) to train and rehearse ‘ high risk, low frequency ’ (HRLF) events together. 3 This innovation generated the possibility to allow MDT teams to practice rare (HRLF) events in-situ. This innovation was developed with minimal funding and utilised theatre space when not in use. Intervention ‘Train’: Related to the standard MDT training (e.g. basic and advanced life support). ‘Rehearse’: The MDT were given the opportunity to rehearse rare HRLF events using in-situ simulation. ‘Think’: Following simulation, all MDT members participated in a detailed debrief. ‘Repeat’: Post-debrief, participants had the opportunity to repeat elements of the simulation to galvanise new learning. A further opportunity for participants to repeat the scenario is provided six months later, to demonstrate retention of skills and knowledge. Results/outcomes Initial evaluations will be presented including, cost analysis, simulation facilitator observations, participant feedback and impact. Key findings include changes in participant’s technical and non-technical skills, improved understanding and use of algorithms. Potential impact Initial findings indicate that this low cost in-situ simulation innovation improves the use of algorithms in theatre. By augmenting emergency algorithms and mandatory life support training, MDT members are able to ‘train, rehearse, think and repeat’: learning together in-situ to build resilience and confidence amidst the unpredictability of theatre practice. References Department of Health. A framework for technology enhanced learning . London: Department of Health, 2011 Von Der Heyden M, Meissner K. Simulation in preclinical emergency medicine. Best Pract Res Clin Anaesthesiol 2015;29(1):61–68 Chiniara G, Cole G, Brisbin K, Huffman D, Cragg B, Lamacchia M, Norman D. Simulation in healthcare: a taxonomy and conceptual framework for instructional design and media selection. Med Teach 2013;35(8):1380–1395

Background Within clinical practice it was identified there was no framework available to guide the design and implementation of simulation-based education (SBE) in midwifery. Simulation frameworks within healthcare exist,1,2 however these frameworks lacked direct application to midwifery skills and drills. This has led to the design of a new framework which is currently being utilised and evaluated. Results The new framework is subdivided into key components with a specific focus on the role of the facilitator, candidate prior knowledge, and the design and evaluation of the pre-brief, SBE and debrief. Facilitator preparation prior to simulation design is essential to identify potential boundaries that may affect candidate learning.1,3 Recognition of candidate pre-existing knowledge and ensuring psychological safety is essential and will help create the optimal learning environment. Ensuring pedagogical principles are understood and applied methodically for the design and implementation of SBE will help facilitate effective learning.4 Effective pre-brief must be incorporated within SBE to allow candidates to understand learning objectives and expectations. Feedback/debriefing has been identified as one of the most essential components within SBE3,5,6 and is a distinctive component within the framework. It was observed within practice prior to the new framework being applied that existing debrief practices at the Trust were unstructured and ineffective. Through application of the proposed framework, improvements in debriefing have been achieved. Potential impact The proposed framework was designed to support maternity services with the design, implementation and evaluation of SBE for skills and drills. It is anticipated that it will help to improve knowledge and awareness and help bridge the gap between theory and practice.7 The proposed framework identifies the importance of ensuring the learning objectives match the curriculum and have educational benefit.3,5 Further development of the framework is required and will occur following evaluation from SBE within midwifery skills and drills. References Jefferies PR. A framework for designing, implementing, and evaluating simulations. Nurs Educ Perspect. 2005;26(2):97–104 Chiniara G, Cole G, Brisbin K, Huffman D, Cragg B, Lamacchi M, Norman D. Canadian network for simulation in healthcare guidelines working group. Simulation in healthcare: a taxonomy and a conceptual framework for institutional design and media selection. Med Teach. 2013;35:1380–1395 MotolaI, Devine LA, Chung HS, Sullivan JE, Issenberg B. Simulation in healthcare education: a best evidence practical guide. AMEE Guide No. 82. Med Teach. 2005;35:1511–1530

Objective To develop and validate a self-evaluation tool (questionnaire) to identify perceived competence and confidence felt by physiotherapists undertaking respiratory on-call duty. Design A questionnaire to rate specific acute care respiratory competencies was developed from criteria in the Emergency Duty Guidelines. A triangulation approach was used to evaluate content validity. The questionnaire was completed by a group of respiratory physiotherapists and a group of non-respiratory physiotherapists. Feedback from respiratory physiotherapists was through open (written) questions, and 15 participated in semi-structured telephone interviews. Participants A total of 263 participants: a purposive sample of 180 respiratory physiotherapists attending ‘On course for on-call’ courses in Autumn 2005, and a convenience sample of 83 non-respiratory physiotherapists attending on-call training courses or the 2005 Congress of the Chartered Society of Physiotherapy. Results Thirty-eight questionnaire items were compiled and tested (12 assessment and 10 treatment competencies, 10 range and six confidence items). There were 222 responses (86% overall response rate). Cronbach's alpha found internal consistency for all items ( α > 0.9). There was a significant difference in competence scores between the respiratory group (median 118, interquartile range 111 to 121) and the non-respiratory group (median 76, interquartile range 64 to 87) ( P Conclusions Respiratory physiotherapists involved in on-call training supported the development of a tool to assess self-perceived competence, and endorsed the content validity of the questionnaire items. The study findings support the validity of the tool as a competency measure since it is able to discriminate between those at different levels of seniority and experience. Participants varied in their approach to rating their own competence in unfamiliar situations; this seemed to depend on self-concept and self-efficacy. Since this tool is based on core respiratory competencies, it may also be used as supportive continuous professional development evidence for the Knowledge and Skills Framework and professional development portfolios. It also has the potential adaptation for use with physiotherapy students and those working in acute respiratory care.

PURPOSE:Rock climbing is becoming increasingly popular despite the risk of serious injury. Previous research has established that elite indoor climbers are susceptible to overuse injuries of the hand and fingers. However, the present study examines the prevalence of climbing injuries in a more diverse group. In addition, self-efficacy is investigated as a potential risk factor.RELEVANCE:Information about the aetiology of climbing injuries should form the basis of communication strategies and educational interventions designed to prevent injury, and inform rehabilitation. PARTICIPANTS:Of 205 active British rock climbers, 201 (98%) agreed to participate voluntarily and yielded useable results. The 163 male climbers (Mage = 35.2 years,SD= 11.8) and 38 female climbers (Mage =35.1 years,SD= 10.7) did not differ significantly in age (p>0.05).METHODS:Climbers approached in their naturalistic environment were asked to complete items relating to their climbing behaviours,injuries, and self-efficacy. Climbing items included number of years experience, and the frequency and technical difficulty of routes or problems accomplished in different styles (soloing, traditional leading,sport leading and bouldering) in the last 12 months. Injury items included days unable to climb due to climbing injuries, anatomic allocation of injuries incurred (related to falling, overuse, and strenuous moves), and sources of treatment or advice sought. Self-efficacy was measured using the 10-item Climbing Self-efficacy Questionnaire(CSQ; developed following an initial pilot study), in which climbers rate their confidence to accomplish domain specific tasks on a scale of 0-100.ANALYSIS:Statistical analysis included uni-variate statistics, logistic regression and t-tests.RESULTS:Twenty-one climbers (10%) had been injured as the result of a fall, with 4 reporting upper or lower limb fractures. Sixty-seven (33%) had incurred overuse injuries, including 35 finger injuries. Fifty-seven(28%) had suffered injuries from strenuous climbing moves, including 31 finger injuries. The most common sources of advice or treatment were physiotherapists, other climbers, and physicians. Fall-related injuries could not be predicted by any of the independent variables.The probability of sustaining an overuse injury was higher for climbers who completed difficult climbs whilst soloing or traditional leading(odds ratio (OR) 1.23; 95% confidence interval (CI) 1.06 to 1.42), sport leading (OR 1.40; CI 1.18 to 1.66), and bouldering (OR 1.40; CI 1.17 to 1.68). Overuse injuries were more likely for climbers soloing and traditional leading (OR 1.12; CI 1.01 to 1.24), sport leading (OR 1.12; CI 1.023 to 1.22), and bouldering (OR 1.24; CI 1.08 to 1.43)more frequently. Bouldering difficulty also predicted injuries incurred from strenuous moves (OR 1.24; CI 1.04 to 1.49).CONCLUSIONS:Climbing injuries are relatively common, and medical professionals provide key sources of advice and treatment. Climbers with the most ability and dedication are most at risk of injury, particularly finger overuse. Fall-related injuries are comparatively infrequent, though all climbers may incur them. Self-efficacy does not appear to predictclimbing injuries.IMPLICATIONS:Climbers should be aware of the risk factors for injury, warm up progressively, incorporate rest periods,and recognise injury symptoms when they occur.KEYWORDS:Exercise, Climbing, Injury.FUNDING ACKNOWLEDGEMENTS: The second author was supported by The British Academy grant SG-39588. ETHICS COMMITTEE:Leeds Metropolitan University, School of Allied Health Professions, Ethics Committee

Objective: To evaluate current emergency on-call service preparation and education provision for newly qualified physiotherapists within the UK, including an audit of adherence to Standard 9 of the Association of Chartered Physiotherapists in Respiratory Care (ACPRC).Design: National postal questionnaire survey.Main instrument: Questionnaire including audit of adherence to ACPRC Standard 9.Participants: Random selection of 75 UK hospital trusts that had intensive care units detailed in the Directory of Critical Care. Telephone contact was made to identify the senior/superintendent respiratory physiotherapist responsible for the on-call physiotherapy service, to whom the questionnaire was addressed.Results: Seventy-two trusts responded, representing a range of respiratory service leads and managers responsible for on-call services. All respondents indicated provision of on-call preparation and education, although content, delivery methods and duration varied considerably. A wide variety of methods are currently used to assess newly qualified physiotherapists prior to undertaking on-call duties. Despite variations in on-call service provision, there is national adherence to ACPRC Standard 9 at the present time (92–100% adherence to Criteria 1–5). Adherence to Criteria 6, 7 and 8 occurs in fewer trusts (79%, 49% and 73%, respectively).Conclusions: This study indicated that there is a broad level of national adherence to ACPRC Standard 9, despite the fact that this is not a mandatory requirement. National inconsistencies in preparation duration, format and ongoing education were identified. Further guidance by the ACPRC and the Chartered Society of Physiotherapy is required to provide national consistency of on-call preparation and education.

Objectives: To explore the debriefing methodologies utilised in high-risk/high-stakes industries with the intention of informing healthcare practice. Methods: A sequential mixed methods approach was adopted to explore the use of feedback/debriefing methodologies in ten different industries. A first phase standardised survey focused on timing of debriefing post-event, debriefing techniques used, duration of debrief provision, technology used, and follow-up provision. A second phase observational study at one site (aerobatic team) explored debriefing in detail with a standardised tool and semi-structured interview technique. Results: This study highlighted variability in debriefing practices, style, and duration amongst ten high-risk/high-stakes industries. The second phase observation study identified a highly effective method of self-directed video-based auto-debriefing.

Interprofessional simulation-based education (IPSE) is becoming an increasingly popular educational strategy worldwide within undergraduate healthcare curricular. The purpose of the literature review was to examine qualitative, quantitative and mixed/multi-method research studies featuring undergraduate IPSE. A literature review was conducted using CINAHL, MEDLINE, and PsycINFO databases from January 1999 to September 2011 and pre-set criteria. The criteria used to screen all 120 abstracts included: (a) the article pertained to both simulation and undergraduate IPE and (b) the article reported a research study. Eighteen articles which met the pre-set criteria were included in the literature review. All studies featured outcome measures; many were purposely designed and lacked psychometric development and evaluation. Key IPSE drivers included capacity planning, preparedness for disaster management and improving patient care through the evaluation of teambuilding, teamwork skills or communicating within inter-disciplinary teams. Studies evaluated/explored either student or teacher perspectives of learning within the context of IPSE or both. The IPSE learning processes varied considerably in relation to duration, fidelity and professions involved. The scenarios ranged from managing adults admitted to hospital settings, mass casualty/mock disaster patient management to the use of training wards. The majority of the articles identified common IPSE outcomes relating to increased confidence, knowledge, leadership, teamwork, and communication skills. Based on the findings of this review, the authors suggest that further multi-site, longitudinal research studies are required to provide evidence of the transferability of skills developed during IPSE and their overall impact on both undergraduate education and healthcare.

Background: It is imperative that healthcare professionals and students understand how and why systems breakdown and why mistakes happen, to enable them to act to prevent and learn from them. The literature review revealed an absence of research exploring the ability of pre-registration physiotherapy students to identify errors in their practice.

Transesophageal echocardiographic-guided cardioversion is a safe, accepted technique to minimize risk of stroke and embolic events when electrically converting atrial fibrillation to normal sinus rhythm. The presence of thrombus in the left atrial appendage (LAA) is a contraindication to performing cardioversion in these patients. For patients with a surgically ligated LAA, thrombus may be more prevalent and may still represent an embolic risk because of incomplete closure of the LAA. We report use of an echocardiographic contrast agent in a patient with a thrombus in a ligated LAA to determine safety of cardioversion.