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The growing number of students who are culturally and linguistically diverse (CALD) relative to the host university undertaking fieldwork placements raises questions about how to best support their needs and the needs of their fieldwork supervisors so as to maximize the experience for both parties. This research aims to quantify and compare fieldwork supervisors' perceptions of CALD versus non-CALD students' performance during placements, the areas and levels of concern they experience in providing this supervision. Placement supervisors from health and non-health courses affiliated with an Australian University were randomly assigned to a survey containing question sets relating to their experiences in supervising CALD (n = 153) or non-CALD students (n = 168). The survey comprised Likert scale questions assessing "pressure points" to supervision and open-ended questions including strategies fieldwork supervisors typically used to assist students. Using univariate ordinal logistic regression analyses, "speaking" (coefficient, 95% CI 2.1 (1.56, 2.65)), "writing" in English (1.69 (1.17, 2.20)), and "adapting to culture of workplaces" (1.20 (0.71, 1.69)) were perceived by placement supervisors as the top "pressure points" in supervising CALD students. Interaction effects demonstrated that "difficulties in assessing CALD students' competency" (coefficient, 95% CI-1.14 (-2.27, -0.01), "feeling competent in supervising students for placements" (1.35 (0.26, 2.45)), and the "perception of lack of support" from either the university or employing organization (-1.70 (-2.83, - 0.56)) were evident within fieldwork placement of health courses only. These results can assist universities and placement organizations to prioritize resources to address the key areas affecting CALD students' performance on placements, and to improve supervisors' experience in supervising CALD students on placements in health courses.

Long-term or residential services are designed to support older people who experience challenges to their physical and mental health. These services play an important role in the health and well-being of older adults who are more susceptible to problems such as malnutrition. Estimates of the significance of malnutrition require up-to-date prevalence data to inform government strategies and regulation, but these data are not currently available in Australia. The aim of this study was to collect malnutrition prevalence data on a large sample of people living in residential aged care facilities in Australia. A secondary aim was to examine the relationship between malnutrition and anthropometry (body mass index (BMI) and weight loss). This prevalence study utilised baseline data collected as part of a longitudinal study of malnutrition in 10 Residential Aged Care facilities across three states in Australia (New South Wales, South Australia, and Queensland). The malnutrition status of eligible residents was assessed by dietitians and trained student dietitians using the Subjective Global Assessment (SGA) with residents categorised into SGA-A = well nourished, SGA-B = mildly/moderately malnourished, and SGA-C = severely malnourished. Other data were extracted from the electronic record. Of the 833 listed residents, 711 residents were eligible and had sufficient data to be included in the analysis. Residents were predominantly female (63%) with a mean (SD) age of 84 (8.36) years and a mean (SD) BMI of 26.74 (6.59) kg/m2. A total of 40% of residents were categorised as malnourished with 34% (n = 241) categorised as SGA-B, and 6% (n = 42) SGA-C. Compared to the SGA, BMI and weight loss categorisation of malnutrition demonstrated low sensitivity and high specificity. These findings provide recent, valid data on malnutrition prevalence and highlight the limitations of current Australian practices that rely on anthropometric measures that under-detect malnutrition. There is an urgent need to implement a feasible aged care resident screening program to address the highly prevalent condition of malnutrition in Australia. [ABSTRACT FROM AUTHOR]

Demand for clinical placements in physiotherapy education continues to outstrip supply. Peer assisted learning, in various formats, has been trialled to increase training capacity and facilitate student learning during clinical education. There are no documented examples of measurable or repeatable peer assisted learning models to aid clinicians in implementing these strategies. The aim of this research was to develop a repeatable and quantifiable peer assisted learning model of clinical education for paired undergraduate physiotherapy students. Additionally, the project aimed to evaluate the impact of clinician engagement in the model development process on their self-rated ability to facilitate peer assisted learning. A series of four workshops was conducted to facilitate development and refinement of a peer assisted learning model by physiotherapy clinical educators. The workshops introduced relevant peer learning principles and a range of clinically relevant educational tools to educators. Consensus was targeted on the tools and approaches that would underpin the peer assisted learning model. A survey investigating participants' self-rated ability to facilitate components of peer assisted learning was administered prior to, and on completion of, the workshop series. Educators agreed on a model to facilitate student peer interaction in clinical reasoning, observation of performance, risk identification and mitigation, and feedback and coaching. Tools to evaluate student and clinical educator outcomes were developed. On completion of the workshops, participants reported significantly more confidence in their ability to facilitate peer assisted learning. Development of a peer assisted learning model of clinical education that is acceptable to clinical educators was achieved through stakeholder involvement from concept stage. Assessment of educator knowledge and confidence, combined with critical review of stakeholder feedback at multiple stages in model development, appeared effective in conveying ownership of the model to clinical educators and identifying the support required for confidence in facilitating peer assisted learning.

Patients are central to healthcare clinicians and organizations but often subsidiary to clinical expertise, knowledge, workplace processes, and culture. Shifting societal values, technology, and regulations have remoulded the patient-clinician relationship, augmenting the patient's voice within the healthcare construct. Scaffolding this restructure is the global imperative to deliver person-centered care (PCC). The aim of the scoping review was to explore and map the intersection between patient feedback and strategies to improve the provision of PCC within acute hospitals in Australia. Database searches yielded 493 articles, with 16 studies meeting inclusion criteria. Integration of patient feedback varied from strategy design, through to multi-staged input throughout the initiative and beyond. Initiatives actioning patient feedback fell broadly into four categories: clinical practice, educational strategies, governance, and measurement. How clinicians can invite feedback and support patients to engage equally remains unclear, requiring further exploration of strategies to propel clinician-patient partnerships, scaffolded by hospital governance structures. [ABSTRACT FROM AUTHOR]

Introduction: Cost studies are increasingly popular given resource constraints. While scholars stress the context‐dependent nature of cost, and the importance of theory, cost studies remain context‐blind and atheoretical. However, realist economic evaluation (REE) privileges context and the testing/refinement of economic programme theory. This preliminary REE serves to test and refine economic programme theory for supervision training programmes of different durations to better inform future programme design/implementation. Methods: Our preliminary REE unpacked how short (half‐day) and extended (12 week) supervision training programmes in Victoria, Australia, produced costs and outcomes. We employed mixed methods: qualitative realist and quantitative cost methods. Economically optimised programme models were developed guided by identified cost‐sensitive mechanisms and contexts. Results: As part of identified context‐mechanism‐outcome configurations (CMOCs) for both training programmes, we found a wider diversity of positive outcomes but greater costs for the extended programme (11 outcomes; AU$3069/learner) compared with the short programme (7 outcomes; $385/learner). We identified four shared cost‐sensitive mechanisms for both programmes (training duration, learner protected time, learner engagement, and facilitator competence) and one shared cost‐sensitive context (learners' supervisory experience). We developed two economically optimised programme models: (1) short programme for experienced supervisors facilitated by senior educators ($406/learner); and (2) extended programme for inexperienced supervisors facilitated by junior educators ($2104/learner). Discussion Our initial economic programme theory was somewhat supported, refuted and refined. Results were partly consistent with previous research, but also extended it through unpacking cost‐sensitive mechanisms and contexts. Although our preliminary REE fills a pressing gap in the methodology literature, conducting REE was challenging given our desire to integrate economic and realist analyses fully, and remain faithful to realist principles. Attention to training duration and experience levels of the facilitator–learner dyad may help to balance the cost and outcomes of training programmes. The authors test and refine economic program theory for supervision training programs of different durations to better inform program design and implementation. [ABSTRACT FROM AUTHOR]

The growing number of students who are culturally and linguistically diverse (CALD) relative to the host university undertaking fieldwork placements raises questions about how to best support their needs and the needs of their fieldwork supervisors so as to maximize the experience for both parties. This research aims to quantify and compare fieldwork supervisors' perceptions of CALD versus non-CALD students' performance during placements, the areas and levels of concern they experience in providing this supervision. Placement supervisors from health and non-health courses affiliated with an Australian University were randomly assigned to a survey containing question sets relating to their experiences in supervising CALD (n = 153) or non-CALD students (n = 168). The survey comprised Likert scale questions assessing "pressure points" to supervision and open-ended questions including strategies fieldwork supervisors typically used to assist students. Using univariate ordinal logistic regression analyses, "speaking" (coefficient, 95% CI 2.1 (1.56, 2.65)), "writing" in English (1.69 (1.17, 2.20)), and "adapting to culture of workplaces" (1.20 (0.71, 1.69)) were perceived by placement supervisors as the top "pressure points" in supervising CALD students. Interaction effects demonstrated that "difficulties in assessing CALD students' competency" (coefficient, 95% CI−1.14 (−2.27, −0.01), "feeling competent in supervising students for placements" (1.35 (0.26, 2.45)), and the "perception of lack of support" from either the university or employing organization (−1.70 (−2.83, − 0.56)) were evident within fieldwork placement of health courses only. These results can assist universities and placement organizations to prioritize resources to address the key areas affecting CALD students' performance on placements, and to improve supervisors' experience in supervising CALD students on placements in health courses. [ABSTRACT FROM AUTHOR]

Context: The design of selection methods must balance, amongst a range of factors, the desire to select the best possible future doctors with the reality of our resource‐constrained environment. Examining the cost of selection processes enables us to identify areas in which efficiencies may be gained. Methods: A cost description study was conducted based on selection for 2018 entry into medical school directly from secondary school. The perspectives of applicants, volunteer interviewers and the admitting institution were considered. Costs were modelled based on the Monash University (Australia) selection process, which uses a combination of secondary school matriculation score, aptitude test score (Undergraduate Medicine and Health Sciences Admission Test) and multiple mini‐interview score. A variety of data sources were utilised, including bespoke surveys, audit data and existing literature. All costs are expressed in 2018 Australian dollars (AU$). Applicant behaviours in preparing for selection tests were also evaluated. Results: A total of 381 of 383 applicants returned the survey. Over 70% of applicants had utilised commercial preparation materials. The median total cost to applicants was AU$2586 (interquartile range [IQR] AU$1574‐3999), including costs to both prepare for and attend selection tests. Of 217 volunteer interviewers, 108 returned the survey. These were primarily health professional clinicians at a mid‐career stage. The median total cost to interviewers was AU$452 (IQR AU$252‐715) for participation in a half‐day interview session, largely due to the loss of income. The cost to the admitting institution was AU$269 per applicant, accounted for by the costs of equipment and consumables (52%), personnel (34%) and facilities (14%). Conclusions: The costs of student selection for medical school are substantial. Understanding costs facilitates achievement of the objective of selecting the desired future medical workforce within the constraints of the resources available. Opportunities for change may arise from changes in applicant preparation behaviours, opportunities for economies of scale, and efficiencies driven by technological solutions. What does it take to get into medical school? Money for one thing. The authors demonstrate that, in Australia, students spend AU$2, 586 on preparation, attendance. The universities to which they apply spend AU$269 per applicant, money that is likely to be recouped if selection can avoid student attrition. [ABSTRACT FROM AUTHOR]

Background: Student failure creates additional economic costs. Knowing the cost of failure helps to frame its economic burden relative to other educational issues, providing an evidence-base to guide priority setting and allocation of resources. The Ingredients Method is a cost-analysis approach which has been previously applied to health professions education research. In this study, the Ingredients Method is introduced, and applied to a case study, investigating the cost of pre-clinical student failure. Methods: The four step Ingredients Method was introduced and applied: (1) identify and specify resource items, (2) measure volume of resources in natural units, (3) assign monetary prices to resource items, and (4) analyze and report costs. Calculations were based on a physiotherapy program at an Australian university. Results: The cost of failure was £5991 per failing student, distributed across students (70%), the government (21%), and the university (8%). If the cost of failure and attrition is distributed among the remaining continuing cohort, the cost per continuing student educated increases from £9923 to £11,391 per semester. Conclusions: The economics of health professions education is complex. Researchers should consider both accuracy and feasibility in their costing approach, toward the goal of better informing cost-conscious decision-making. [ABSTRACT FROM AUTHOR]

Context: Health practitioner registration boards require health professionals to evaluate and maintain “fitness to practice” (FTP). This encompasses the professional behavior, clinical competence, and freedom from impairment required for safe and effective service provision. We developed and implemented policies to promote student self-assessment and support of FTP that were pre-emptive and designed to be helpful and sought clinician feedback on this initiative.Method: An innovative student-centered FTP approach was devised with consideration of defensible ethico-legal practice. A survey explored clinical educators’ perceptions of the FTP policy and the associated education and support. Closed and open survey questions were analyzed using descriptive statistics, qualitative evaluation, and thematic analysis.Results: Seventy-nine physiotherapy clinical educators from 34 sites across eight Australian health services returned surveys. Educators had positive perceptions of policy components, particularly incorporating professionalism as a hurdle requirement and the attendance and incident reporting policies.Conclusions: The benefits of a student-centered FTP approach included clarity and consistency in managing FTP issues and facilitation of student awareness through active engagement in maintaining their FTP. To our knowledge, this paper is the first to report a comprehensive approach to the range of FTP issues incorporating student self-declaration of issues that may affect desirable progression through clinical placements. The policy and program of education and support are likely to be generalizable to health professional training programs that utilize workplace training. [ABSTRACT FROM PUBLISHER]

CONTEXT Failure by students in health professional clinical education intertwines the health and education sectors, with actions in one having potential downstream effects on the other. It is unknown what economic costs are associated with failure, how these costs are distributed, and the impacts these have on students, clinicians and workplace productivity. An understanding of cost drivers and cost boundaries will enable evidence-based targeting of strategic investments into clinical education, including where they should be made and by whom. OBJECTIVES This study was designed to determine the additional economic costs associated with failure by students in health professional clinical education. METHODS A cost analysis study involving cost identification, measurement, valuation and the calculation of total cost was conducted. Costs were considered from the perspective of the student, the education institution, the clinical educator, the health service placement provider organisation and the government. Data were based on a 5-week clinical education programme at Monash University,Australia. Data were collected using quantitative surveys and interviews conducted with health professional students, clinical educators and education institute staff. Reference group representation was also sought at various education institution and health service organisation levels. A transferable model with sensitivity analysis was developed. RESULTS There is a total additional cost of US $9371 per student failing in clinical education from the perspective of all stakeholders considered. Students bear the majority of this burden, incurring 49% of costs, followed by the government (22%), the education institution (18%), the health service organisation (10%) and the clinical educator (1%). CONCLUSIONS Strong economic links for multiple stakeholders as a result of failure by students in clinical education have been identified. The cost burden is skewed in the direction of students. Any generalisation of these results should be made with consideration for the unique clinical education context in which each health professional education programme operates. [ABSTRACT FROM AUTHOR]

Questions: What is the economic value for an individual to invest in physiotherapy undergraduate education in Australia? How is this affected by increased education costs or decreased wages? Design: A cost-benefit analysis using a net present value (NPV) approach was conducted and reported in Australian dollars. In relation to physiotherapy education, the NPV represents future earnings as a physiotherapist minus the direct and indirect costs in obtaining the degree. Sensitivity analyses were conducted to consider varying levels of experience, public versus private sector, and domestic versus international student fees. Comparable calculations were made for educational investments in medicine and nursing/midwifery. Results: Assuming an expected discount rate of 9.675%, investment in education by domestic students with approximately 34 years of average work experience yields a NPV estimated at $784,000 for public sector physiotherapists and $815,000 for private sector therapists. In relation to international students, the NPV results for an investment and career as a physiotherapist is estimated at $705,000 in the public sector and $736,000 in the private sector. Conclusion: With an approximate payback period of 4 years, coupled with strong and positive NPV values, physiotherapy education in Australia is a financially attractive prospect and a viable value proposition for those considering a career in this field. [Rivers G, Foo J, Ilic D, Nicklen P, Reeves S, Walsh K, Maloney S (2015) The economic value of an investment in physiotherapy education: a net present value analysis. Journal of Physiotherapy 61: 148–154] [ABSTRACT FROM AUTHOR]

Question : What is the efficacy and acceptability of a peer-assisted learning model compared with a traditional model for paired students in physiotherapy clinical education? Design : Prospective, assessor-blinded, randomised crossover trial. Participants : Twenty-four physiotherapy students in the third year of a 4-year undergraduate degree. Intervention : Participants each completed 5 weeks of clinical placement, utilising a peer-assisted learning model (a standardised series of learning activities undertaken by student pairs and educators to facilitate peer interaction using guided strategies) and a traditional model (usual clinical supervision and learning activities led by clinical educators supervising pairs of students). Outcome measures : The primary outcome measure was student performance, rated on the Assessment of Physiotherapy Practice by a blinded assessor, the supervising clinical educator and by the student in self-assessment. Secondary outcome measures were satisfaction with the teaching and learning experience measured via survey, and statistics on services delivered. Results : There were no significant between-group differences in Assessment of Physiotherapy Practice scores as rated by the blinded assessor ( p = 0.43), the supervising clinical educator ( p = 0.94) or the students ( p = 0.99). In peer-assisted learning, clinical educators had an extra 6 minutes/day available for non-student-related quality activities (95% CI 1 to 10) and students received an additional 0.33 entries/day of written feedback from their educator (95% CI 0.06 to 0.61). Clinical educator satisfaction and student satisfaction were higher with the traditional model. Conclusion : The peer-assisted learning model trialled in the present study produced similar student performance outcomes when compared with a traditional approach. Peer-assisted learning provided some benefits to educator workload and student feedback, but both educators and students were more satisfied with the traditional model. Trial registration : ACTRN12610000859088. [Sevenhuysen S, Skinner EH, Farlie MK, Raitman L, Nickson W, Keating JL, Maloney S, Molloy E, Haines TP (2014) Educators and students prefer traditional clinical education to a peer-assisted learning model, despite similar student performance outcomes: a randomised trial. Journal of Physiotherapy 60: 209–216] [ABSTRACT FROM AUTHOR]

Objectives Improving efficiencies in the education sector via the sharing of resources is currently the source of much interest and investment within Australia and throughout the world. Despite the development of multiple educational resource repositories worldwide, educators seldom use repositories to share materials. Interprofessional sharing is similarly scarce. This research was designed to identify staff perceptions about inter-departmental sharing of teaching and learning resources within a university faculty. Methods Representatives were recruited over a 2-week period from four campuses of a university, spanning six departments. Participants took part in two focus groups and six semi-structured interviews. A thematic analysis was undertaken by two independent researchers. Results Five key themes emerged: the benefits of electronic resources for improving student education; perceptions of sharing; perceptions of ownership; the ethical use of resources and digital repositories; the requirements for adoption. Conclusions Our research confirms that educators believe interprofessional resource sharing to be beneficial and appropriate. However, concerns that resources are of insufficient quality or will be incorrectly attributed surfaced as barriers to sharing. Poor understanding and ambiguity surrounding intellectual property rights highlighted the need for repository communities to be sufficiently educated. Developing a commonly agreed metadata and labelling system, and linking with existing infrastructure, will enhance the impact of a learning object repository. Providing avenues for sharing, such as resource repositories, may assist in aligning education with the well-established process of peer review utilised by the research community, improving resource quality through exposure to others' perspectives and feedback. Furthermore, the increased accountability, restriction and familiarity of repositories may prove beneficial in encouraging sharing. [ABSTRACT FROM AUTHOR]

Background: Due to the complex nature of healthcare professionals' roles and responsibilities, the education of this workforce is multifaceted and challenging. It relies on various sources of learning from teachers, peers, patients and may focus on Work Integrated Learning (WIL). The COVID-19 pandemic has impacted many of these learning opportunities especially those in large groups or involving in person interaction with peers and patients. Much of the curriculum has been adapted to an online format, the long-term consequence of which is yet to be recognized. The changed format is likely to impact learning pedagogy effecting both students and teachers. This requires a systematic approach to evaluation of online teaching and learning adaptation, in comparison to the previous format, where, in person education may have been the focus., Methods: The proposed study is a broad based evaluation of health professional education in a major Australian University. The protocol describes a mixed methods convergent design to evaluate the impact of online education on students and teachers in health professional courses including Medicine, Nursing, Allied Health and Biomedical Science. A framework, developed at the university, using Contribution Analysis (CA), will guide the evaluation. Quantitative data relating to student performance, student evaluation of units, quantity of teaching activities and resource utilization will be collected and subjected to relevant statistical analysis. Data will be collected through surveys (500 students and 100 teachers), focus groups (10 groups of students) and interviews of students and teachers (50 students beyond graduation and 25 teachers, for long term follow up to 12 months). Application of CA will be used to answer the key research questions on the short term and long-term impact of online education on teaching and learning approaches., Discussion: The protocol describes the study, which will be widely implemented over the various courses in Health Professional Education and Biomedical Science. It will evaluate how students and teachers engage with the online delivery of the curriculum, student performance, and resources used to implement these changes. It also aims to evaluate longitudinal outcome of student learning attributes and impact on graduate outcomes, which is poorly reported in educational literature., (© 2021. The Author(s).)