Megan Dalton

The objective structured clinical examination (OSCE): optimising its value in the undergraduate nursing curriculum.

This article explores the use of the objective structured clinical examination (OSCE) in undergraduate nursing education. The advantages and limitations of this assessment approach are discussed and various applications of the OSCE are described. Attention is given to the complexities of evaluating some psychosocial competency components. The issues are considered in an endeavour to delineate the competency components, or skill sets, that best lend themselves to assessment by the OSCE. We conclude that OSCEs can be used most effectively in nurse undergraduate curricula to assess safe practice in terms of performance of psychomotor skills, as well as the declarative and schematic knowledge associated with their application. OSCEs should be integrated within a curriculum in conjunction with other relevant student evaluation methods.

The Assessment of Physiotherapy Practice (APP) is a valid measure of professional competence of physiotherapy students: a cross-sectional study with Rasch analysis

QUESTION Is the Assessment of Physiotherapy Practice (APP) a valid instrument for the assessment of entry-level competence in physiotherapy students? DESIGN Cross-sectional study with Rasch analysis of initial (n=326) and validation samples (n=318). Students were assessed on completion of 4, 5, or 6-week clinical placements across one university semester. PARTICIPANTS 298 clinical educators and 456 physiotherapy students at nine universities in Australia and New Zealand provided 644 completed APP instruments. RESULTS APP data in both samples showed overall fit to a Rasch model of expected item functioning for interval scale measurement. Item 6 (Written communication) exhibited misfit in both samples, but was retained as an important element of competence. The hierarchy of item difficulty was the same in both samples with items related to professional behaviour and communication the easiest to achieve and items related to clinical reasoning the most difficult. Item difficulty was well targeted to person ability. No Differential Item Functioning was identified, indicating that the scale performed in a comparable way regardless of the students age, gender or amount of prior clinical experience, and the educators age, gender, or experience as an educator, or the type of facility, university, or clinical area. The instrument demonstrated unidimensionality confirming the appropriateness of summing the scale scores on each item to provide an overall score of clinical competence and was able to discriminate four levels of professional competence (Person Separation Index=0.96). Person ability and raw APP scores had a linear relationship (r(2)=0.99). CONCLUSION Rasch analysis supports the interpretation that a students APP score is an indication of their underlying level of professional competence in workplace practice.

Is education immune from evidence-based scrutiny?

Evidence-based practice appears to be well established in our profession. However, the main focus of evidence-based practice has been in the clinical and research realms; with clinicians and researchers often bearing the brunt of criticism concerning the lack of evidence supporting physiotherapy management practices. In the move towards global evidence-based practice, very little attention has been given to the practices of physiotherapy education programs in Australia. If universities and physiotherapy educators are put under the same evidence-based practice spotlight, how well do their educational programs and curricula rate? How defensible are their teaching and learning practices?

Identifying educator behaviours for high quality verbal feedback in health professions education: literature review and expert refinement

BackgroundHealth professions education is characterised by work-based learning and relies on effective verbal feedback. However the literature reports problems in feedback practice, including lack of both learner engagement and explicit strategies for improving performance. It is not clear what constitutes high quality, learner-centred feedback or how educators can promote it. We hoped to enhance feedback in clinical practice by distinguishing the elements of an educator’s role in feedback considered to influence learner outcomes, then develop descriptions of observable educator behaviours that exemplify them.MethodsAn extensive literature review was conducted to identify i) information substantiating specific components of an educator’s role in feedback asserted to have an important influence on learner outcomes and ii) verbal feedback instruments in health professions education, that may describe important educator activities in effective feedback. This information was used to construct a list of elements thought to be important in effective feedback. Based on these elements, descriptions of observable educator behaviours that represent effective feedback were developed and refined during three rounds of a Delphi process and a face-to-face meeting with experts across the health professions and education.ResultsThe review identified more than 170 relevant articles (involving health professions, education, psychology and business literature) and ten verbal feedback instruments in health professions education (plus modified versions). Eighteen distinct elements of an educator’s role in effective feedback were delineated. Twenty five descriptions of educator behaviours that align with the elements were ratified by the expert panel.ConclusionsThis research clarifies the distinct elements of an educator’s role in feedback considered to enhance learner outcomes. The corresponding set of observable educator behaviours aim to describe how an educator could engage, motivate and enable a learner to improve. This creates the foundation for developing a method to systematically evaluate the impact of verbal feedback on learner performance.

We must seek to understand what constitutes effective entry level clinical education

Thank you for the opportunity to respond to the concerns raised by Emeritus Professor Ruth Grant, Chair of ACOPRA, regarding our Editorial Is education immune from evidencebased scrutiny ? As Professor Grant has confirmed, ACOPRA does not require that entry level physiotherapy programs provide 1000 hours of supervised clinical practice to their students. We acknowledge that an explicit statement about the amount of clinical education required within entry-level physiotherapy programs is not within ACOPRA documentation. However, the responses and feedback to this Editorial suggest that there is a level of misunderstanding amongst clinicians and academics that 1000 clinical hours is still a requirement for entry level training. The clarification provided by the WCPT and the response by ACOPRA to our Editorial provide timely and accessible statements concerning this issue.