Jose M. Frantz

The role of blended learning in the clinical education of healthcare students: a systematic review

Background: Developing practice knowledge in healthcare is a complex process that is difficult to teach. Clinical education exposes students to authentic learning situations, but students also need epistemological access to tacit knowledge and clinical reasoning skills in order to interpret clinical problems. Blended learning offers opportunities for the complexity of learning by integrating face-to-face and online interaction. However, little is known about its use in clinical education. Aim: To determine the impact of blended learning in the clinical education of healthcare students. Methods: Articles published between 2000 and 2010 were retrieved from online and print sources, and included multiple search methodologies. Search terms were derived following a preliminary review of relevant literature. Results: A total of 71 articles were retrieved and 57 were removed after two rounds of analysis. Further methodological appraisals excluded another seven, leaving seven for the review. All studies reviewed evaluated the use of a blended learning intervention in a clinical context, although each intervention was different. Three studies included a control group, and two were qualitative in nature. Blended learning was shown to help bridge the gap between theory and practice and to improve a range of selected clinical competencies among students. Conclusion: Few high-quality studies were found to evaluate the role of blended learning in clinical education, and those that were found provide only rudimentary evidence that integrating technology-enhanced teaching with traditional approaches have potential to improve clinical competencies among health students. Further well-designed research into the use of blended learning in clinical education is therefore needed before we rush to adopt it.

The prevalence of intimate partner violence in the family: a systematic review of the implications for adolescents in Africa

BACKGROUND Intimate partner violence (IPV) and its multiple effects are well documented in Western research, but these are not adequately described in Africa. The effects of IPV on adolescent health and well-being are not conclusive. OBJECTIVE The aim of this review was to systematically appraise prevalence studies conducted on the African continent to establish the prevalence of IPV and the implications of exposure on adolescents in Africa. METHODS A comprehensive search was conducted in May 2012 for the previous 10 years, using databases such as Ebscohost (Medline, CINAHL, PsyArticles), Directory of Open Access Journals (DOAJ), Project Muse and BioMed Central and also specific journals Lancet, and JSTOR. Two reviewers independently evaluated the methodological quality of the studies reviewed. RESULTS Seven eligible epidemiological studies were included in this review. Five of the studies were conducted in South Africa, one in Liberia, and another was a multi-country study that included Egypt, Kenya, Malawi, Rwanda and Zambia. The prevalence of IPV in African countries ranged from approximately 26.5% to 48%. All studies reported exposure to family violence during childhood. CONCLUSION The findings support the global burden of IPV. There is also a need for standardized tools to determine IPV in Africa and a clear definition that can be used in research to allow comparison with future IPV studies. In addition, the studies point to a need for interventions focusing on adolescents exposed to family violence.

Using Google Drive to facilitate a blended approach to authentic learning

While technology has the potential to create opportunities for transformative learning in higher education, it is often used to merely reinforce didactic teaching that aims to control access to expert knowledge. Instead, educators should consider using technology to enhance communication and provide richer, more meaningful platforms for the social construction of knowledge. By using technology to engage in shared learning experiences that extend beyond the walls of the classroom, we can create opportunities to develop the patterns of thinking that students need to participate in complex, real world situations. We used authentic learning as a framework to guide the implementation of a JOUR-based, blended module in a South African physiotherapy department. Google Drive was used as a collaborative online authoring environment in which small groups of students used clinical JOURs to create their own content, guided by a team of facilitators. This paper describes an innovative approach to clinical education using authentic learning as a guiding framework, and Google Drive as an implementation platform. We believe that this approach led to the transformation of student learning practices, altered power relationships in the classroom and facilitated the development of critical attitudes towards knowledge and authority. [ABSTRACT FROM AUTHOR]

Beyond knowledge and skills: the use of a Delphi study to develop a technology-mediated teaching strategy

BackgroundWhile there is evidence to suggest that teaching practices in clinical education should include activities that more accurately reflect the real world, many educators base their teaching on transmission models that encourage the rote learning of knowledge and technical skills. Technology-mediated instruction may facilitate the development of professional attributes that go beyond “having” knowledge and skills, but there is limited evidence for how to integrate technology into these innovative teaching approaches.MethodsThis study used a modified Delphi method to help identify the professional attributes of capable practitioners, the approaches to teaching that may facilitate the development of these attributes, and finally, how technology could be integrated with those teaching strategies in order to develop capable practitioners. Open-ended questions were used to gather data from three different expert panels, and results were thematically analysed.ResultsClinical educators should not view knowledge, skills and attitudes as a set of products of learning, but rather as a set of attributes that are developed during a learning process. Participants highlighted the importance of continuing personal and professional development that emphasised the role of values and emotional response to the clinical context. To develop these attributes, clinical educators should use teaching activities that are learner-centred, interactive, integrated, reflective and that promote engagement. When technology-mediated teaching activities are considered, they should promote the discussion of clinical encounters, facilitate the sharing of resources and experiences, encourage reflection on the learning process and be used to access content outside the classroom. In addition, educational outcomes must drive the integration of technology into teaching practice, rather than the features of the technology.ConclusionsThere is a need for a cultural change in clinical education, in which those involved with the professional training of healthcare professionals perceive teaching as more than the transmission of knowledge and technical skills. Process-oriented teaching practices that integrate technology as part of a carefully designed curriculum may have the potential to facilitate the development of capable healthcare graduates who are able to navigate the complexity of health systems and patient management in ways that go beyond the application of knowledge and skills.

Health-promotion needs of youth with a spinal cord injury in South Africa

Purpose. To determine the health promotion needs through an exploration of health-related behaviours and the factors that influence the behaviour of physically disabled youth with spinal cord injury. Methods. A descriptive and exploratory study that utilized a qualitative approach was carried out among ten participants aged between 15 and 29 years who were purposely selected. Information was obtained from individual face-to-face interviews and a focus-group discussion. Results. The participants were involved in risky health behaviours including sedentary lifestyles, use of alcohol, tobacco, and drugs. Various factors that influenced their participation in these behaviours were identified including personal struggles with identity and adjustment issues. Conclusions. The results emphasize that participants were involved in health-risk behaviours, which are associated with development of secondary conditions such as respiratory problems, heart diseases, and stroke. Health-promotion strategies employed for these individuals should address the psychological impact of spinal cord injury (SCI) on the individual as an influence to participation in health risk behaviours.

HIV/AIDS knowledge, behaviour and beliefs among South African university students

Globally, South Africa has the highest prevalence of HIV/AIDS. In the absence of cure, prevention is the only available method to reduce HIV prevalence rates. This can only be obtained through behavioural change, which is associated with a good knowledge about HIV. The study aims to determine the knowledge, beliefs, behaviours and sources of HIV and AIDS information among university students at two tertiary institutions in South Africa. The study was a quantitative, cross-sectional, descriptive and comparative survey. Students from the Western Cape Province and the KwaZulu-Natal Province participated in the study. The main findings of the study were that although students had an adequate general knowledge on HIV/AIDS, both groups scored the lowest in the transmission modes of HIV. The media was the main source of HIV/AIDS information for students and university health care facilities need to be more proactive in informing students about the transmission of HIV/AIDS.

The physical activity levels among people living with human immunodeficiency virus/acquired immunodeficiency syndrome receiving high active antiretroviral therapy in Rwanda

Abstract The accessibility of high active antiretroviral therapy (HAART) for local human immunodeficiency virus (HIV) patients is improving in Rwanda. It is well known that this therapy is associated with serious adverse effects, such as metabolic and morphologic changes. One of the recommended preventive modalities for these complications is participation in physical activity. The current study aims to determine the anthropometric profile and physical activity levels among people living with HIV and receiving HAART in Kigali, Rwanda. The study was a cross-sectional, descriptive quantitative survey. The participants levels of physical activity participation and their association with anthropometric profiles were measured, using a structured self-administered questionnaire for 407 clients passing through the clinics. Of the participants, approximately 70% were inactive and in addition, 40% were obese and 43% overweight. Obesity was found to be strongly associated with inactivity. Lack of motivation, and time as well as fear of worsening the disease were found to be barriers to participation in physical activity.

Health promotion needs of physically disabled individuals with lower limb amputation in Rwanda

Purpose. The objectives of the study were to identify the health-related behaviors among physically disabled individuals with lower limb amputation resident in Rwanda, the factors that influenced these behaviors, and the major issues that should be targeted in health promotion programs for physically disabled individuals with lower limb amputation. Method. A cross-sectional survey, utilizing a self-administered questionnaire, was carried out among 334 lower limb amputees who volunteered to take part in the study. In addition, a sub-sample of 15 participants was purposively selected for in-depth face-to-face interviews. Results. Many participants did not engage in physical exercises (64.7%). Others abused alcohol on daily basis (14.4%), smoked 11 – 20 cigarettes daily (13.2%), and used recreational drugs such as marijuana, opium and cocaine (9.6%). There were significant associations between the age group of the participants and participation in exercises (P = 0.001), and consuming alcohol, tobacco and recreational drugs (P = 0.001). In-depth interviews revealed factors influencing the behavior of participants. Conclusions. Participants were found to be at risk of secondary complications because of poor lifestyle choices. There is a need to develop and promote wellness-enhancing behaviors in order to enhance the health status of physically disabled individuals in Rwanda who have lower limb amputations.

A model for community physiotherapy from the perspective of newly graduated physiotherapists as a guide to curriculum revision

Background. Limitations in physiotherapy curricula have been reported. Work-based experiences, especially during compulsory community service, could inform curricula. Objective. To develop a model of community service physiotherapy to guide curriculum reform. Methods. In this appreciative inquiry, trained physiotherapy students conducted tele-interviews with newly graduated physiotherapists. Twelve recently graduated community-service physiotherapists – heterogeneous in gender, mother tongue, university attended and work setting – were purposively recruited. Two coders applied Tesch’s coding technique to the transcripts; one did paper-based work and the other used AtlasTi software. Consensus was reached and a member check done. Results. Four themes identified were: (i) the essence of community physiotherapy; (ii) the collaborative nature of community physiotherapy; (iii) prerequisites for a positive practice environment; and (iv) community physiotherapy as a gateway to personal growth and professional development. Physiotherapists consult clients from varied cultural backgrounds, ages and health and disease profiles. Health education is a key intervention, but clients emphasised therapeutic touch. Team work enhances services, especially within a context of poverty, and prevents isolation. New graduates have to deal with inefficient management, lack of transport, inadequate equipment and needs resilience. They want discipline-specific supervision. Conclusion. Community physiotherapy makes specific demands, especially for novice therapists. Service-learning in authentic diverse contexts would foster professional development and cultural competence. Clinical competency should remain the backbone of the curriculum, complemented by competency in health education. Different ways of reflection would facilitate lifelong learning and growth in attributes such as resilience, which is necessary for dealing with sub-optimal practice environments.

Physical activity and health promotion strategies among Physiotherapists in Rwanda

BACKGROUND Physical inactivity has become a global health concern and is among the 10 leading causes of death and disability. Physiotherapists are in a position to combat inactivity and effectively promote physical activity to their clients. OBJECTIVES To establish the relationship between physical activity levels of physiotherapists and their physical activity promotion strategies. METHODS A sequential mixed method design was used by means of a self-administered questionnaire (n=92) and a focus group discussion comprising of 10 purposively selected physiotherapists. Descriptive statistics were employed to summarize demographic information. Inferential statistics was used to test the associations between different categorical variables (p<0.05). Tape recorded interviews were transcribed. Thematic analysis was then done. RESULTS The findings revealed that 64% of the participants were physically active both within the work and recreation domains and 65% of the participants had good physical activity promoting practices. Discussing physical activity and giving out information regarding physical activity were most common methods used in promotion of physical activity. Policies on physical activity, cultural influence, and nature of work, time management as well as the environment were the barriers highlighted. CONCLUSION Although physiotherapists experience barriers to promoting physical activity, they have good physical activity promoting practices.