Utilisation de l’apprentissage hybride pour développer le raisonnement clinique dans un cours d’enseignement clinique en techniques de physiothérapie

Les programmes de formation en techniques de physiothérapie comptent sur l'apprentissage traditionnel basé sur la pratique pour aider les apprenants à développer leurs compétences de raisonnement clinique. Cependant, ce modèle d'enseignement clinique présente des défis et des limites. Ce projet de recherche a donc exploré un modèle alternatif d'enseignement clinique dans le but d’améliorer le développement des compétences de raisonnement clinique. Une conception de recherche quasi-expérimentale a été utilisée pour étudier l'efficacité de l'approche d'apprentissage hybride sur le développement des compétences de raisonnement clinique chez un échantillon de commodité composé de 23 étudiants en techniques de physiothérapie inscrits dans un cours d'enseignement clinique de troisième année offert dans un Collège d'Enseignement Général et Professionnel (CÉGEP). Aucun changement dans les compétences de raisonnement clinique telles que mesurées par des tests de concordance de scripts n'a été observé après sept semaines d'enseignement mixte dans le bloc orthopédique du cours d'enseignement clinique, dans lequel 1,5 heure d'apprentissage asynchrone basé sur des études de cas a été combiné avec neuf heures d'apprentissage basé sur la pratique sur une base hebdomadaire. Une exploration des perceptions des participants a suggéré que malgré le fait qu'ils ont eu plus d'opportunités de pratiquer et de réfléchir sur leurs connaissances avec une approche d'apprentissage hybride, l'engagement dans l'environnement en ligne était limité en raison de la faible cohésion entre l'apprentissage en ligne basé sur des études de cas et l'apprentissage basé sur la pratique en personne, un manque d'évaluations sommatives liées aux activités d'apprentissage en ligne basées sur des études de cas, et une faible maîtrise de l'environnement d'apprentissage asynchrone. Ce manque d'engagement des participants lié aux faiblesses de la conception du cours est considéré comme un facteur contribuant au manque d'amélioration des compétences de raisonnement clinique après l'apprentissage hybride. De plus, des examens préliminaires des réponses des participants aux études de cas suggèrent que la faiblesse des connaissances fondamentales acquises dans le programme avant le cours d'enseignement clinique était également un facteur qui a contribué au manque d'amélioration des compétences de raisonnement clinique. Cette absence de connaissances peut également expliquer pourquoi les compétences de raisonnement clinique des participants ne se sont pas améliorées malgré la grande composante pratique du cours.Abstract: Clinical education in physiotherapy technology programs rely on traditional practice-based learning to assist learners in developing clinical reasoning skills; however, this model of clinical education presents with challenges and limitations. This research project explored an alternative model of clinical education to improve the development of clinical reasoning skills. A quasi-experimental research design was used to investigate the effectiveness of the blended learning approach on the development of clinical reasoning skills in a sample of convenience consisting of 23 physiotherapy technology students enrolled in a third-year clinical education course offered at a Collège d’Enseignement Général et Professionnel (CEGEP). No change in clinical reasoning skills as measured by script concordance testing was observed following seven weeks of blended instruction in the orthopaedic block of the clinical education course in which 1.5 hours of asynchronous case-based learning was blended with nine hours of practice-based learning on a weekly basis. An exploration of participants’ perceptions of their experience suggested that despite being afforded more opportunity to practice and reflect upon their knowledge with a blended learning approach, engagement in the online environment was low due to poor cohesion between the online case-based learning and in-person practice-based learning environments, a lack of summative assessments related to the online cased-based learning activities, and poor proficiency with the asynchronous learning environment. This lack of participant engagement related to weaknesses in course design is thought to be a contributing factor to the lack of improvement in clinical reasoning skills following blended learning. In addition, preliminary reviews of participants’ case study responses suggest that weakness in foundational knowledge acquired in the curriculum prior to the clinical education course was also a factor that contributed to the lack of improvement in clinical reasoning skills. This lack of knowledge may also explain why participants’ clinical reasoning skills did not improve despite the large practice-based component of the course

Payment by results and demand management: learning from the South Yorkshire laboratory

The need for effective demand management has become more transparent following the introduction of Payment by Results, Patient Choice and other reforms. This report details the findings of an empirical study exploring the South Yorkshire experience of demand management. By being ahead of the game in introducing PbR for all activity in all its acute trusts in the South Yorkshire area, the experience in South Yorkshire has the potential to inform the national roll-out of Payment by Results and Choose and Book. Specific objectives included: • assessing local perceptions of the nature and scale of changes in demand and whether this will be affected as other reforms, specifically Patient Choice, are implemented; • identifying what strategies are being developed locally to manage demand effectively; • documenting any benefits and drawbacks of different strategies for patients, PCTs, providers and the wider health economy; • identifying any facilitators and barriers to developing effective approaches for managing demand; • eliciting opinions on how current demand management strategies could be improved or adapted

Association between physician characteristics and payments from industry in 2015-2017: observational study.

OBJECTIVE:To investigate the association between physician characteristics and the value of industry payments. DESIGN:Observational study. SETTING AND PARTICIPANTS:Using the 2015-2017 Open Payments reports of industry payments linked to the Physician Compare database, we examined the association between physician characteristics (physician sex, years in practice, medical school attended and specialty) and the industry payment value, adjusting for other physician characteristic and institution fixed effects (effectively comparing physicians practicing at the same institution). MAIN OUTCOME MEASURES:Our primary outcome was the value of total industry payments to physicians including (1) general payments (all forms of payments other than those classified for research purpose, eg, consulting fees, food, beverage), (2) research payments (payments for research endeavours under a written contract or protocol) and (3) ownership interests (eg, stock or stock options, bonds). We also investigated each category of payment separately. RESULTS:Of 544 264 physicians treating Medicare beneficiaries, a total of $5.8 billion in industry payments were made to 365 801 physicians during 2015-2017. The top 5% of physicians, by cumulative payments, accounted for 91% of industry payments. Within the same institution, male physicians, physicians with 21-30 years in practice and physicians who attended top 50 US medical schools (based on the research ranking) received higher industry payments. Across specialties, orthopaedic surgeons, neurosurgeons and endocrinologists received the highest payments. When we investigated individual types of payment, we found that orthopaedic surgeons received the highest general payments; haematologists/oncologists were the most likely to receive research payments and surgeons were the most likely to receive ownership interests compared with other types of physicians. CONCLUSIONS:Industry payments to physicians were highly concentrated among a small number of physicians. Male sex, longer length of time in clinical practice, graduated from a top-ranked US medical school and practicing certain specialties, were independently associated with higher industry payments

Developing and implementing an integrated delirium prevention system of care:a theory driven, participatory research study

Background: Delirium is a common complication for older people in hospital. Evidence suggests that delirium incidence in hospital may be reduced by about a third through a multi-component intervention targeted at known modifiable risk factors. We describe the research design and conceptual framework underpinning it that informed the development of a novel delirium prevention system of care for acute hospital wards. Particular focus of the study was on developing an implementation process aimed at embedding practice change within routine care delivery. Methods: We adopted a participatory action research approach involving staff, volunteers, and patient and carer representatives in three northern NHS Trusts in England. We employed Normalization Process Theory to explore knowledge and ward practices on delirium and delirium prevention. We established a Development Team in each Trust comprising senior and frontline staff from selected wards, and others with a potential role or interest in delirium prevention. Data collection included facilitated workshops, relevant documents/records, qualitative one-to-one interviews and focus groups with multiple stakeholders and observation of ward practices. We used grounded theory strategies in analysing and synthesising data. Results: Awareness of delirium was variable among staff with no attention on delirium prevention at any level; delirium prevention was typically neither understood nor perceived as meaningful. The busy, chaotic and challenging ward life rhythm focused primarily on diagnostics, clinical observations and treatment. Ward practices pertinent to delirium prevention were undertaken inconsistently. Staff welcomed the possibility of volunteers being engaged in delirium prevention work, but existing systems for volunteer support were viewed as a barrier. Our evolving conception of an integrated model of delirium prevention presented major implementation challenges flowing from minimal understanding of delirium prevention and securing engagement of volunteers alongside practice change. The resulting Prevention of Delirium (POD) Programme combines a multi-component delirium prevention and implementation process, incorporating systems and mechanisms to introduce and embed delirium prevention into routine ward practices. Conclusions: Although our substantive interest was in delirium prevention, the conceptual and methodological strategies pursued have implications for implementing and sustaining practice and service improvements more broadly

The Development of Sports Medicine in Twentieth-century Britain

Annotated and edited transcript of a Witness Seminar held on 29 June 2007. Introduction by Dr John Lloyd Parry, Institute of Sports and Exercise Medicine. First published by the Wellcome Trust Centre for the History of Medicine at UCL, 2009. ©The Trustee of the Wellcome Trust, London, 2009. All volumes are freely available online at: www.history.qmul.ac.uk/research/modbiomed/wellcome_witnesses/Annotated and edited transcript of a Witness Seminar held on 29 June 2007. Introduction by Dr John Lloyd Parry, Institute of Sports and Exercise Medicine.Annotated and edited transcript of a Witness Seminar held on 29 June 2007. Introduction by Dr John Lloyd Parry, Institute of Sports and Exercise Medicine.Annotated and edited transcript of a Witness Seminar held on 29 June 2007. Introduction by Dr John Lloyd Parry, Institute of Sports and Exercise Medicine.Annotated and edited transcript of a Witness Seminar held on 29 June 2007. Introduction by Dr John Lloyd Parry, Institute of Sports and Exercise Medicine.Sports medicine has grown in importance and visibility in recent years, yet as a discipline it struggled to gain broad recognition within the medical profession from c.1952 until specialty status was granted in 2005. It has also been neglected by historians: we have little beyond the image of a coach with his ‘magic sponge’ as a cure for all injuries, although the late twentieth-century picture is of new specialists developing high-tech interventions for elite athletes. This Witness Seminar arose from the Wellcome Trust-funded project on ‘Sport and Medicine in Britain, 1920–2000’ at the University of Manchester and examined the establishment of a recognizably modern specialty. Chaired by Professor Domhnall MacAuley, topics addressed included the importance of the 1948 London Olympics; the first 4-minute mile; training and altitude physiology; the postwar institutionalization of sports medicine; the relationship between the different main bodies involved in sport and their aims; the changing practice of professionals including physiotherapists, etc.; the relationship of NHS and private sports medicine practitioners and insurance companies; and the key debates within the sports medicine community over the period. Contributors include: Sir Roger Bannister, Dr Malcolm Bottomley, Dr Ian Burney, Professor John Elfed Davies, Professor Charles Galasko, Dr Robin Harland, Dr Vanessa Heggie, Mr Barry Hill, Professor Michael Hobsley, Dr Michael Hutson, Professor Monty Losowsky, Professor Domhnall Macauley (chair), Mrs Rose Macdonald, Professor Donald Macleod, Professor Moira O’Brien, Dr Malcolm Read, Professor Peter Sperryn, Professor Harry Thomason, Dr Dan Tunstall Pedoe and Mrs Sally Williams. Reynolds L A, Tansey E M. (eds) (2009) The development of sports medicine in twentieth century Britain. Wellcome Witnesses to Twentieth Century Medicine, vol. 36. London: The Wellcome Trust Centre for the History of Medicine at UCL. ISBN 978 085484 1219The Wellcome Trust Centre for the History of Medicine at UCL is funded by the Wellcome Trust, which is a registered charity, no. 210183