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Professional development can provide opportunities to develop new skills and knowledge, and to apply them to practice in a sustainable way. However, delivery of professional development needs to consider the philosophies and pedagogies of training recipients, and activities should be tailored to meet their needs. This article reports on an exploratory study of an embedded, service-based model of professional development for early childhood educators (educators), targeting children's speech, language, and communication skill development. This innovative model, conducted by speech and language therapy (SLT) students and a SLT professional practice educator, utilized co-teaching strategies to facilitate the professional learning of educators and SLTs in this context. A qualitative research design was employed and data gathered through focus group interviews with educators and individual semi-structured interviews with centre directors. The data were triangulated with some observational data of educators' practices with young children several months post program completion to explore their application of skills and knowledge that had been covered in the professional development program. The data contained four main themes: Communication, relationships, environment, and translating knowledge into practice. Observational data lent further depth and validation to the results by confirming the presence or absence of expressed practice values and experiences in the educators' everyday interactions with children. The observational data supported the themes relationships and translating knowledge into practice. The results contribute to our understanding of educators' and childcare centre directors' perspectives on their knowledge, skills, and practice in response to this embedded professional development program. This model of professional development may be appropriate to facilitate knowledge and skill development about children's speech, language, and communication skills for educators working with young children in a childcare setting. Benefits for educators and SLTs were found where good working relationships and communication had been established.

Background: A clinical swallow examination (CSE) provides integral information that informs the diagnostic decision‐making process within dysphagia management. However, multiple studies have highlighted a high degree of reported variability within the CSE process. It has been hypothesized that such variability may be the result of the clinical reasoning process rather than poor practices. Aims: To elucidate the nature of expert, speech–language therapists' (SLTs) clinical reasoning during an initial bedside assessment of patients referred for suspected dysphagia in the acute care environment. Methods & Procedures: An exploratory 'observation of practice' qualitative methodology was used to achieve the aim. Four expert SLTs, from two clinical services, completed CSEs with 10 new referrals for suspected dysphagia. All assessments were video‐recorded, and within 30 min of completing the CSE, a video‐stimulated 'think aloud' semi‐structured interview was conducted in which the SLT was prompted to articulate their clinical reasoning at each stage of the CSE. Three types of concept maps were generated based on this video and interview content: a descriptive concept map, a reasoning map and a hypothesis map. Patterns that consistently characterized the assessment process were identified, including the overall structure; types of reasoning (inductive versus deductive), facts (i.e., clinical information) drawn upon; and outcomes of the process (diagnosis and recommendations). Interview content was examined to identify types of expert reasoning strategies using during the CSE. Outcomes & Results: SLTs' approach to clinical assessment followed a consistent structure, with data gathered pre‐bedside, during the patient interview and direct assessment before a management recommendation was made. Within this structure, SLTs engaged in an iterative approach with inductive hypothesis‐generating and deductive hypothesis‐testing, with each decision‐making pathway individually tailored and informed by patient‐specific facts collected during the assessment. Clinical assessment was primarily geared towards management of an initial acute presentation with less focus on formulating a diagnostic statement. Conclusions & Implications: Variability in reported dysphagia practice is likely the result of a patient‐centred assessment process characterized by iterative cycles of fact‐gathering in order to generate and test clinical hypotheses. This has implications for the development of novel assessment tools, as well as professional development and education of novice SLTs. What this paper addsWhat is already known on the subjectCSE practices are reportedly variable, which has led to calls for more stringent, standardized assessment tools. Emerging evidence suggests that this variation is non‐random, but may arise from clinical reasoning processes.What this paper adds to existing knowledgeWe directly observed expert SLTs conducting CSEs and identified patterns in practice that were consistent across all CSEs evaluated. These patterns were consistent in structure, whereas the content of the assessment items varied and was tailored to individual patient presentation. Overall, expert SLTs engaged in balanced cycles of inductive hypothesis generation and deductive hypothesis‐testing, a hallmark of good clinical assessment and practice.What are the potential or actual clinical implications of this work?Ensuring quality CSE requires a more nuanced approach that considers the role of clinical reasoning in SLTs' decision‐making and the potential unintended negative consequences of standardized assessment tools. [ABSTRACT FROM AUTHOR]

Objectives We explored the real cost of training the workforce in a range of primary health care professions in Australia with a focus on the impact of retention to contribute to the debate on how best to achieve the optimal health workforce mix. Methods The cost to train an entry-level health professional across 12 disciplines was derived from university fees, payment for clinical placements and, where relevant, cost of internship, adjusted for student drop-out. Census data were used to identify the number of qualified professionals working in their profession over a working life and to model expected years of practice by discipline. Data were combined to estimate the mean cost of training a health professional per year of service in their occupation. Results General medical graduates were the most expensive to train at $451,000 per completing student and a mean cost of $18,400 per year of practice (expected 24.5 years in general practice), while dentistry also had a high training cost of $352,180 but an estimated costs of $11,140 per year of practice (based on an expected 31.6 years in practice). Training costs are similar for dieticians and podiatrists, but because of differential workforce retention (mean 14.9 vs 31.5 years), the cost of training per year of clinical practice is twice as high for dieticians ($10,300 vs. $5200), only 8% lower than that for dentistry. Conclusions Return on investment in training across professions is highly variable, with expected time in the profession as important as the direct training cost. These results can indicate where increased retention and/or attracting trained professionals to return to practice should be the focus of any supply expansion versus increasing the student cohort. [ABSTRACT FROM AUTHOR]

Skills developed through play in early primary school years (5-8 years) underpin educational outcomes and language development. While Australian kindergartens consistently adopt a developmental play-based approach to learning, many children enter primary school without well-developed language skills and are expected to participate in a languageheavy didactic teaching environment. A search of recent literature was conducted to answer the clinical question “does a playbased curriculum improve educational outcomes including language for children in early primary school compared to usual didactic teaching strategies?” This article provides a critical appraisal of four articles representing the highest levels of available evidence. Results indicated that a play-based curriculum utilising a guided play framework—including scaffolding, elicited explanation, worked examples, and feedback—were associated with positive learning outcomes and dispositions for some children in early primary school. [ABSTRACT FROM AUTHOR]

Unlabelled: Breast cancer in males is much rare than in females so in practice, male breast cancer treatment is likely to follow the guidelines developed for female breast cancer patients. The objective of this study is to compare the characteristics and treatment pattern of male breast cancer patients with comparable subgroups of female breast cancer patients using data submitted to the National Breast Cancer Audit. This is a retrospective analysis of 151 male breast cancers diagnosed and treated between 2000 and 2008. Most of the male early breast cancer cases in this group were symptomatic ones in men aged >50 years with one invasive tumour. There was a similar proportion of lymph node positive cancer among males and females, although male breast cancer was more likely to be unifocal (P=0.007) and oestrogen receptor positive (P=0.001). Male breast cancer patients almost always underwent mastectomy and a significant proportion of them (11%) received no surgical treatment. There were no differences in axillary surgery although males were more likely to undergo a level 2 axillary surgery and less likely to have sentinel node biopsy. Male patients were significantly less likely to undergo radiotherapy, chemotherapy or hormonal therapy for oestrogen receptor positive tumours., Conclusion: While the female oriented treatment guidelines are available, male patients with early breast cancer received different surgical and adjuvant treatment from comparable females.

Objective: To explore the involvement of members of the Royal Australasian College of Surgeons (RACS) Section of Breast Surgery in Australia and New Zealand in multidisciplinary care (MDC) teams., Design and Setting: Questionnaire sent to all full members of the RACS Section of Breast Surgery in December 2006., Participants: 239 of 262 active full members of the RACS Section of Breast Surgery (response rate, 91.2%)., Main Outcome Measures: Surgeons' use of, and the composition and functioning of, MDC teams in public and private practice, and in metropolitan, regional and rural settings., Results: 85% of responding surgeons reported participating in at least one fully established MDC team. Public-sector teams were operationally more consistent and functional than private teams, and rural teams were less well developed than those in metropolitan and regional centres. The six core disciplines recommended by the National Breast Cancer Centre appear to be well represented in most teams. Patients and their general practitioners were not considered to be part of the treatment team by surgeons., Conclusions: MDC is supported by most breast surgeons, but there are deficits in rural areas, and in the private sector relative to the public sector.