Melinda Lewis

Implementing curriculum evaluation: case study of a generic undergraduate degree in health sciences

This case study presents a longitudinal, evidence‐based approach to health science curriculum reform and evaluation. Curriculum in higher education must meet the needs of diverse stakeholders and must respond to dynamic local, national and international contexts, and this creates challenges for evaluation. The long lead time prior to the introduction of new or revised university curriculum (at least two years), the length of degree programmes (three to five years) and the lag time in the availability of objective indicators of degree outcomes (at least one year post‐graduation) mean that findings may be obsolete before an evaluation can be completed. Few would argue that evaluation is important and methods and approaches for conducting curriculum evaluation are proposed in the literature, although few published reports of the outcomes of comprehensive evaluations are evident. This paper discusses potential for evaluation to establish responsive communication between students, teaching staff and programme administrators, ensuring a match between the intended, implemented and attained curriculum.

Mitii™ ABI: Study protocol of a randomised controlled trial of a web-based multi-modal training program for children and adolescents with an Acquired Brain Injury (ABI)

BackgroundAcquired brain injury (ABI) refers to multiple disabilities arising from damage to the brain acquired after birth. Children with an ABI may experience physical, cognitive, social and emotional-behavioural impairments which can impact their ability to participate in activities of daily living (ADL). Recent developments in technology have led to the emergence of internet-delivered therapy programs. “Move it to improve it” (Mitii™) is a web-based multi-modal therapy that comprises upper limb (UL) and cognitive training within the context of meaningful physical activity. The proposed study aims to compare the efficacy of Mitii™ to usual care to improve ADL motor and processing skills, gross motor capacity, UL and executive functioning in a randomised waitlist controlled trial.Methods/DesignSixty independently ambulant children (30 in each group) at least 12 months post ABI will be recruited to participate in this trial. Children will be matched in pairs at baseline and randomly allocated to receive either 20 weeks of Mitii™ training (30 min per day, six days a week, with a potential total dose of 60 h) immediately, or be waitlisted for 20 weeks. Outcomes will be assessed at baseline, immediately post-intervention and at 20 weeks post-intervention. The primary outcomes will be the Assessment of Motor and Process Skills and 30 s repetition maximum of functional strength exercises (sit-to-stand, step-ups and half kneel to stand). Measures of body structure and functions, activity, participation and quality of life will assess the efficacy of Mitii™ across all domains of the International Classification of Functioning, Disability and Health framework. A subset of children will undertake three tesla (3T) magnetic resonance imaging scans to evaluate functional neurovascular changes, structural imaging, diffusion imaging and resting state functional connectivity before and after intervention.DiscussionMitii™ provides an alternative approach to deliver intensive therapy for children with an ABI in the convenience of the home environment. If Mitii™ is found to be effective, it may offer an accessible and inexpensive intervention option to increase therapy dose.Trial RegistrationANZCTR12613000403730

Impact of multi-modal web-based rehabilitation on occupational performance and upper limb outcomes: pilot randomized trial in children with acquired brain injuries.

To determine whether the multi‐modal web‐based rehabilitation ‘Move it to improve it’ (Mitii) is more effective than wait list control (usual care) to improve occupational performance, upper limb function, and visual perception in children with acquired brain injury (ABI).

Test–retest reproducibility of the Assessment of Motor and Process Skills for school-aged children with acquired brain injuries

Abstract Background Persistent impairments resulting from childhood acquired brain injury (ABI) can impact performance of activities of daily living (ADL). Objective and reliable measures of ADL skills are required for treatment planning and research. Aim To evaluate test–retest reproducibility of the Assessment of Motor and Process Skills (AMPS) for children with ABI. Methods Twenty-eight children with ABI (mean age 11 years 7 months, SD 2 years 4 months; males = 11) were recruited. Two AMPS tasks were performed over two consecutive days, as per standardized AMPS procedures. Intraclass correlation coefficients (ICC; 2,1), standard error of measurement (SEM), smallest detectable difference (SDD), and 95% limits of agreement (Bland–Altman) were calculated. Results Test–retest reliability was fair to good for AMPS ADL motor (ICC 0.55) and ADL process (ICC 0.58) measures. The SEM was 0.36 and 0.34 logits for AMPS ADL motor and ADL process measures respectively. The SDD was 1.0 (motor) and 0.93 logits (process) measures. A learning effect was evident. Conclusion Test–retest reproducibility of the AMPS was fair to good for children with ABI, which is poorer than previously published data. Administration of the AMPS in an unfamiliar environment, fatigue, and the small time interval between testing sessions may have contributed to poorer results. The AMPS remains a useful measure of ADL, contributing to our understanding of task execution processes.

Keep Calm and Credential on: Linking Learning, Life and Work Practices in a Complex World

This chapter will discuss the ideas and aims of higher education and the needs of the sector to continually innovate to meet workforce changes and labour market demands. The place of micro-credentials and open badges as approaches to locate, measure and validate learning within the academy are discussed. The affordances of technologies to map learning intentions and graduate outcomes of bodies of knowledge, skills-based tasks, and values acquisition at various levels of granularity are raised. The imperative to link learning, life and work practices for continued professional development and growth are highlighted. However, we raise cautionary tales about the use of competency-based approaches within the complexity of developing higher-order professional capabilities that require knowledge synthesis, abstract and novel ways of being, and the crafting of professional dispositions and identities through ongoing reflexive processes. Our key principle suggests that curriculum designs aimed to link ways of knowing, being, doing and valuing with ways of being practical in the world are important for life and professional practices. Finally, we suggest hopeful ways to keep calm and reflect on current approaches to digital badges and micro-credentialing acknowledging the many complexities of preparing professionals for practice.

Writing well in medicine and other disciplines

LETTERS TO THE EDITOR style conventions, rather than poor content. Physicians can feel frustrated if they need to use a different writing style, such as an education style for medical education journals. Most readers of Journal of Paediatrics and Child Health would be familiar with the scientific writing style, which aims to be ‘clear and significant, [rather] than curiously adorn’d’. However, even here, you highlight the ‘incomprehensible scientific jargon’ and ‘resounding banality’ in a template-driven style of writing. In contrast, writing in education and the humanities involves stylistic writing and can be criticised for ‘dense and extended prose’. It seems that these writing styles can deter those within, as well as those outside, their disciplines. Individual disciplines also approach research in different ways. For example, medicine and science typically conduct research based on observable and measureable data and ‘objective rationality’. In contrast, social science-based disciplines, such as education and nursing, typically argue that data can be interpreted frommultiple perspectives, permitting ‘a diversity of ideas and truths’. Although there have been successful collaborations between researchers with different approaches and writing styles, such as in medical education, there have been many disappointments. We argue for a greater understanding of research approaches and writing styles, especially given the increasing interest in, and funding for, interdisciplinary research. The University of Sydney’s recently opened Charles Perkins Centre, for example, aims to address increasingly complex health issues (obesity, diabetes and cardiovascular disease) by bringing together researchers from a Dear Editor,

Blended Learning in Health Professional Education

The impact of technology in society and particularly in educational settings is extensive, challenging traditional notions of teacher-centred approaches to learning, learners and learning locations. Now embedded within the higher education sector are (a) new learning technologies including software such as learning management systems and e-portfolios, (b) collaborative learning approaches such as case- and problem-based learning, and (c) professional demands for curricula that facilitate both critical and inquiry-based learning.

Sakzewski et al. reply

SIR–We would like to thank Dr Basu and Professor Eyre for their comments regarding our randomized clinical trial comparing equal doses of modified constraint-induced movement therapy (mCIMT) and bimanual training in school-aged children with unilateral cerebral palsy. The primary concern proposed is the potential that constraint of the unimpaired hand used in mCIMT may have a deleterious impact on functioning of that hand, and that for many children with unilateral cerebral palsy, the unimpaired hand may also have subtle difficulties. We agree with Basu and Eyre that the unimpaired upper limb needs to be considered and may not be truly ‘unimpaired’. Our findings in a previous cross-sectional study which included all baseline data of children in the randomized trial confirmed a modest reduction in stereognosis ability for the unimpaired upper limb, although this may reflect developmental progression as all of the children who had difficulties were under the age of 8 years. We also found that movement efficiency of the unimpaired upper limb, (measured on the Jebsen Taylor Test of Hand Function [JTTHF]), was more than two standard deviations below published norms for 68% of the group. It is important to note in a small group of typically developing children, 47% also scored greater than one standard deviation below published norms. This certainly highlights the need to re-evaluate normative data for the JTTHF which is now nearly 40 years old. The question of whether constraining the unimpaired hand would have a deleterious effect on that limb was a consideration in our study. We sought to measure movement efficiency (JTTHF), grip strength, and sensation (stereognosis and moving two-point discrimination) on the unimpaired upper limb at baseline and each follow-up. In the process of preparing this reply, we found an error in Table I in the original paper regarding the 3-week follow-up score on the JTTHF for the mCIMT group. We would like to clarify these results. Data for the JTTHF, stereognosis and moving two-point discrimination were highly skewed so that non-parametric Mann–Whitney U tests were used to determine whether follow-up scores were significantly different from baseline. Generalized estimating equations were used to determine within group changes for grip strength between baseline and each follow-up. Our results for the unimpaired limb before and after each intervention are summarized in Table I in this letter. Our results demonstrate that movement efficiency on the unimpaired upper limb was not compromised following