Arie Rotem

The clinical learningenvironment: nurses' perceptions of professional development in clinical settings

Although the complexity of the working environment of Registered Nurses has been acknowledged, the relationship between the social context of work and perceptions of professional development have not been systematically studied. This research was designed to identify and explore the attributes of effective learning environments in clinical settings. Following an initial exploratory study of perceptions and experiences of registered and student nurses, a conceptual framework was developed and tested. The findings of the study ware based on responses to a questionnaire (n = 516) which was developed as a tool for assessing organisational and social factors associated with perceived professional development in clinical settings. There was a significant and positive correlation between professional development and six independent variables: Autonomy and Recognition, Role Clarity, Job Satisfaction, Quality of Supervision, Peer Support and Opportunities for Learning. These variables accounted for almost 40% of the variance in perceived professional development. There were differences between hospitals and wards on most of the independent variables suggesting that some wards and institutions are more conducive to learning than others. The implications of the findings in terms of further research and practice are discussed.

On the Effectiveness of Students’ Evaluative Feedback to University Instructors

This review deals with the use of student ratings as feedback to teachers. Evidence suggests that differences in the source and nature of the feedback and in the attributes of feedback recipients partly explain the differential effect which feedback has on teachers. Issues associated with the research design of feedback studies are also surveyed. The review suggests the existence of a minimal effect at best of feedback on instructional improvement at the university level. Suggestions are offered for improving the nature of the feedback.

Learning in hospital settings

The study that this article is based on was designed to portray and assess the appropriateness of the learning environment in hospital settings for Resident Medical Officers (RMOs) in New South Wales (NSW), Australia. It included visits to selected hospitals and a mailed statewide survey of RMOs. This article focuses on the latter component of the study, the survey of 209 RMOs practicing during the last quarter of 1992 in various clinical rotations in NSW hospitals. The study lends support to the perceived importance of organizational and sociopsychological variables as determinants of learning. These attributes include appropriate levels of autonomy, variety and workload, quality of supervision and social support, and, most important, the overall orientation toward teaching and learning, reflecting the culture prevailing in the clinical unit. The study provided an inventory of learning opportunities and their usefulness for the training of RMOs. It also explored the opportunity to practice particular pro...

A review of the cultural competence view of cardiac rehabilitation.

AIMS AND OBJECTIVES This paper describes cultural competence issues within the scientific and scholarly discourse surrounding cardiac rehabilitation (CR). BACKGROUND CR is an important secondary prevention strategy, improving health-related outcomes and reducing the risks of subsequent cardiovascular events. Internationally, it is widely accepted as a discrete health service model and is endorsed by government and professional bodies. Over past decades, low participation rates in CR remain a concern, particularly among minority groups and culturally and linguistically diverse populations. DESIGN Systematic review. METHODS Search of electronic databases. CONCLUSIONS Few studies to date have described cultural competence in CR service design and as a consequence, there are minimal data to assist CR professionals and policy makers in tailoring health service delivery models. The limited scholarly debate and discussion regarding cultural competence in the CR literature limits the development and evaluation of culturally appropriate interventions. RELEVANCE TO CLINICAL PRACTICE There needs to be greater attention to the concept of cultural competence, both in practice and research settings, to ensure access to CR for people from culturally and linguistically diverse backgrounds.

Addressing the human resources crisis: a case study of Cambodia’s efforts to reduce maternal mortality (1980–2012)

Objective To identify factors that have contributed to the systematic development of the Cambodian human resources for health (HRH) system with a focus on midwifery services in response to high maternal mortality in fragile resource-constrained countries. Design Qualitative case study. Review of the published and grey literature and in-depth interviews with key informants and stakeholders using an HRH system conceptual framework developed by the authors (‘House Model’; Fujita et al, 2011). Interviews focused on the perceptions of respondents regarding their contributions to strengthening midwifery services and the other external influences which may have influenced the HRH system and reduction in the maternal mortality ratio (MMR). Setting Three rounds of interviews were conducted with senior and mid-level managers of the Ministries of Health (MoH) and Education, educational institutes and development partners. Participants A total of 49 interviewees, who were identified through a snowball sampling technique. Main outcome measures Scaling up the availability of 24 h maternal health services at all health centres contributing to MMR reduction. Results The incremental development of the Cambodian HRH system since 2005 focused on the production, deployment and retention of midwives in rural areas as part of a systematic strategy to reduce maternal mortality. The improved availability and access to midwifery services contributed to significant MMR reduction. Other contributing factors included improved mechanisms for decision-making and implementation; political commitment backed up with necessary resources; leadership from the top along with a growing capacity of mid-level managers; increased MoH capacity to plan and coordinate; and supportive development partners in the context of a conducive external environment. Conclusions Lessons from this case study point to the importance of a systemic and comprehensive approach to health and HRH system strengthening and of ongoing capacity enhancement and leadership development to ensure effective planning, implementation and monitoring of HRH policies and strategies.

Measuring students' approaches to learning in different clinical rotations.

BackgroundMany studies have explored approaches to learning in medical school, mostly in the classroom setting. In the clinical setting, students face different conditions that may affect their learning. Understanding students’ approaches to learning is important to improve learning in the clinical setting. The aim of this study was to evaluate the Study Process Questionnaire (SPQ) as an instrument for measuring clinical learning in medical education and also to show whether learning approaches vary between rotations.MethodsAll students involved in this survey were undergraduates in their clinical phase. The SPQ was adapted to the clinical setting and was distributed in the last week of the clerkship rotation. A longitudinal study was also conducted to explore changes in learning approaches.ResultsTwo hundred and nine students participated in this study (response rate 82.0%). The SPQ findings supported a two-factor solution involving deep and surface approaches. These two factors accounted for 45.1% and 22.5%, respectively, of the variance. The relationships between the two scales and their subscales showed the internal consistency and factorial validity of the SPQ to be comparable with previous studies. The clinical students in this study had higher scores for deep learning. The small longitudinal study showed small changes of approaches to learning with different rotation placement but not statistically significant.ConclusionsThe SPQ was found to be a valid instrument for measuring approaches to learning among clinical students. More students used a deep approach than a surface approach. Changes of approach not clearly occurred with different clinical rotations.

How to…: use small groups in medical education.

This is the first of a number of articles on the use of small-group methods in medical education. The aim of this contribution is to introduce teachers to the underlying issues they must consider before embarking on a particular technique. The advantages of small-group learning are described and practical suggestions for facilitating effective small-group discussion are offered. Teachers are advised that the use of small groups for learning requires meticulous course planning. Specific examples of how small-group teaching methods can be used to advantage in preclinical and clinical courses will be published in future issues.

Evaluation of University Instructors in the United States: The Context.

This paper provides an overview of the context within which the teaching function in U.S. universities is carried out. It includes a conceptual scheme for the evaluation of instruction and suggests ways of analyzing evaluation in terms of (a) those components of the scheme which pertain to the instructor and his institutional context, and of (b) those which pertain to the institution and its societal context. The paper ends with advice for university administrators wishing to devise and implement evaluation for instructional improvement.

Plan and Conduct Programme Evaluation

This article describes the aim of programme evaluation and the steps involved in its implementation. Various methods of evaluation are summarized and their relevance in different situations addressed. Advice is offered on the analysis and presentation of data.

Linking Public Health Education And Practice: The Australian Experience

The public health workforce in Australia is highly skilled, multifunctional, and drawn from a variety of backgrounds, including clinical practice and non-health areas. A wide range of activities is needed to meet the educational and training requirements of this workforce, including on the job inservice training, context specific continuing education programs and short courses, distance and self-directed learning packages, and postgraduate University level courses. The core components of public health today include: a social and political commitment to health, a shared responsibility between government and the public, and a multidisciplinary field of action. The challenge for those providing education and training for the public health workforce is to ensure graduates have the broad range of knowledge and skills needed in this climate. A system-wide approach to learning, where knowledge and skill development is related to the practices and settings of service and program delivery, will ensure strong links between education and practice.