Susan Hanekom

The development of a clinical management algorithm for early physical activity and mobilization of critically ill patients: synthesis of evidence and expert opinion and its translation into practice

Objective: To facilitate knowledge synthesis and implementation of evidence supporting early physical activity and mobilization of adult patients in the intensive care unit and its translation into practice, we developed an evidence-based clinical management algorithm. Methods: Twenty-eight draft algorithm statements extracted from the extant literature by the primary research team were verified and rated by scientist clinicians (nu2009=u20097) in an electronic three round Delphi process. Algorithm statements which reached a priori defined consensus – semi-interquartile range <0.5 – were collated into the algorithm. Results: The draft algorithm statements were edited and six additional statements were formulated. The 34 statements related to assessment and treatment were grouped into three categories. Category A included statements for unconscious critically ill patients; Category B included statements for stable and cooperative critically ill patients, and Category C included statements related to stable patients with prolonged critical illness. While panellists reached consensus on the ratings of 94% (32/34) of the algorithm statements, only 50% (17/34) of the statements were rated essential. Conclusion: The evidence-based clinical management algorithm developed through an established Delphi process of consensus by an international inter-professional panel provides the clinician with a synthesis of current evidence and clinical expert opinion. This framework can be used to facilitate clinical decision making within the context of a given patient. The next step is to determine the clinical utility of this working algorithm.

Deriving criteria by which to determine core curriculum content : a high engagement process

Hanekom, S.D., Unger, M., Cilliers, F. 2014. Deriving criteria by which to determine core curriculum content: a high engagement process. AJHPE, 6(2):180-184. DOI:10.7196/AJHPE.496

Teaching my peers: Perceptions of tutors in physiotherapy practical skills training

Background. A near-peer tutorial system was introduced and implemented as part of a second-year module to assist physiotherapy students with the practising of manual techniques. Although not the primary drive for initiating this system, there are potential added benefits for the tutor reported in the literature.xa0 Objective. To determine the effect of near-peer teaching on the perceptions undergraduate physiotherapy students have of their own learning.xa0 Methods. A descriptive study utilising mixed methods was used. A pre-tutorial focus group discussion (FGD) format explored the expectations and perceptions of tutors’ own abilities and the proposed tutorial system. The researchers conducted a post-tutorial FGD to explore the experiences and perceptions of the tutors’ learning experiences. The responses were transcribed and analysed using deductive thematic analysis. A questionnaire was used to quantify which competencies or skills student tutors thought they had obtained through the facilitation of the tutorial sessions. The results were explored using a competency framework. Results. All ten tutors in the 2012 programme participated in the study. Students moved from unconscious incompetence to conscious incompetence , and seemed to have reached the phase of conscious competence by the end of the programme. Unconscious competence was not observed. More than half of the tutors agreed that the programme had a positive impact on their communication, ability to transfer skills and their own understanding of techniques and underlying theory, while two tutors felt that the programme did not improve their own theoretical basis of techniques. Conclusion. Participating and functioning as near-peer tutors had a positive influence on physiotherapy students’ perceptions of their own learning both in terms of own clinical technique competency, but also as teachers and facilitators of learning. It is hypothesised that these students will transition effectively between clinician and health advocator/teacher.

The use of periodized exercise prescription in rehabilitation: a systematic scoping review of literature:

Objective: To describe the use of periodized exercise prescription with patients in the context of rehabilitation. Data source: The following databases were searched: The Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, CINAHL, ScienceDirect, PEDro, Web of Science, SPORTDiscus, SAGE and Google Scholar. Databases were searched from inception to March 2018. Results: The literature search yielded 1772 articles with 1755 being excluded leaving 17 articles in total for the full review. Methodological quality and internal validity of the included papers were lacking. The included studies failed to indicate in which phase rehabilitation had occurred. Programme structure relating to the use of a familiarization phase, sequencing of exercises and structuring of specific phases (i.e. macrocycle, mesocycle and microcycle) was not present and lacked consistency across the board. Conclusion: Periodization models of exercise prescription are being used within a variety of population groups in the rehabilitation setting. Integration of periodization principles into a rehabilitation programme still however remains a challenge. Although there is a lack of consistency with regard to the structure and implementation of a periodized model of exercise prescription in the rehabilitation context, it seems to be an alternative way in which to prescribe exercise within the rehabilitation setting.

Does a problem-based learning approach benefit students as they enter their clinical training years? Lecturers’ and students’ perceptions

Background. This paper presents the findings of a study completed to establish the differences between the lecturers’ and students’ perceptions of a hybrid problem-based learning (PBL) approach in successfully completing a PBL module in the third year of physiotherapy training at Stellenbosch University. Objectives. To assess the perception of the achievement of the PBL benefits, the module outcomes, the barriers to learning and positive aspects of the module. Methods. A theory-based evaluation approach using both qualitative and quantitative methods was used. All students and lecturers involved with the new module were invited to participate in the study. The participants consisted of 37 students and 11 lecturers. The data were collected using questionnaires and focus group discussions for both groups. The different components of the theory (PBL methods) were used as the guiding themes for the analysis of the qualitative data. The quantitative (ordinal) data are presented using descriptive statistics. Results. The results indicated that the module was enjoyed by both groups. The achievement of the generic outcomes for the module produced mixed results. Areas of agreement and areas of differences in perceptions relating to the achievement of the expected PBL benefits are discussed. Conclusion. PBL as a new methodology presents challenges for both groups; however, many of the benefits of PBL, in particular self-directed learning, were achieved. Some areas of shortfall are discussed.

Evaluation of clinical sites used for training undergraduate physiotherapy students: Factors that may impact on learning

Background. Clinical education forms an integral part of the training of undergraduate healthcare students. Clinical learning and education can be influenced by a number of factors.xa0 Objectives. To evaluate clinical service sites used to train undergraduate physiotherapy students at Stellenbosch University, in terms of: ( i ) the suitxadability of the site as a training facility; and ( ii ) the range of clinical problems students encounter at these clinical service sites. Methods. A descriptive study was conducted. Data were gathered through structured clinical site visits, staff interviews and student record sheets documenting the number and type of patients students encountered at the clinical service sites.xa0 Results. Seven of the nine clinical sites used for training were evaluated. Close proximity to the Faculty was an identified strength of three of the sites. There were opportunities for the expansion of multidisciplinary services and group treatment classes. There were safety concerns at most of the sites visited. The number of qualified physiotherapists was low and there was also a lack of basic equipment needed for patient management at more than half of the clinical sites. Students’ exposure to the various fields of physiotherapy varied greatly at the tertiary service settings versus primary healthcare settings. On average students saw only two patients per day during a 5-hour clinical day.xa0 Conclusion. The suitability of healthcare service sites for training undergraduate students should be carefully evaluated prior to commencing training at these sites. The development of good clinical training sites for undergraduate healthcare students requires the availability of adequate resources such as equipment, an adequate complement of clinical staff and effective measures to ensure student and patient safety.

Mapping of a curriculum renewal journey : lessons learned : supplement 1 - editorial

A curriculum is described as an expression of educational ideas in practice. [1] It is a living document which should be adaptable to a changing environment. When faced with specific contextual challenges that required curriculum renewal, we took a phronetic approach. The process was predominantly based on craft knowledge and relied in most part on the insightfulness of staff. The curriculum renewal provided a unique opportunity to evaluate both the content and the mode of delivery. In this edition of AJHPE we share the valuable lessons learned along the journey of curriculum renewal. We started with the end in mind by defining the profile of the Stellenbosch University physiotherapy graduate (Table 1).