An Introduction to Interprofessional Education for First Semester Doctoral Occupational Therapy and Physical Therapy Students

Purpose: Interprofessional education (IPE) engages health care professional students in order to develop the knowledge, skills, and attitudes required of a health care practitioner. IPE can be challenging to execute; however, exposing students early in their professional education in IPE has positive results. Occupational therapy (OT) and physical therapy (PT) are health care professions who commonly work with each other. The purpose of this study is to describe the process and outcomes of implementing an IPE experience with first year doctoral OT (OTD) and PT (DPT) students completed within the first six weeks of the first semester of their respective programs. Methods: Ninety-one (31 OTD, 60 DPT) students were placed in small groups and discussed professional identities and interprofessional collaboration among OT/PT during pre-professional observations. Students completed the Readiness for Interprofessional Learning Scale (RIPLS) pre-post-meeting and a written reflection post-meeting. Results: Ninety-one students completed the Pre-RIPLS survey, while only 58 Post-RIPLS were completed (13 OTD, 45 DPT). The response rate was 63.7% overall (41.9% OT and 75% PT). A statistically significant difference was found between pre- to post-test RIPLS score among the entire group (p = 0.013), and the DPT students (p = 0.020), but not the OTD students (p = 0.414). Written reflections included the following themes: influence of personal experiences leading to choice of profession, observations shaping knowledge of the professions, similarities and differences between the two professions, and future collaboration. Conclusion: An IPE activity can be implemented early in the professional education of OTD/DPT students with positive results

Problems with Current Dental Documentation in Germany

Background: dental documentation is essential for the representation and communication of dental information amongst researchers and practitioners. Dental documentation has to provide the respective means for (a) the representation of the patient status’ and (b) the possible actions. Methods: the consistency of German definitions currently used for dental findings is evaluated by projecting well known examples onto problem axes like “existence of a structure” and “condition of a structure”. Results: it can be shown that current German dental terminology does not support an unambiguous documentation for any situation in dental practice. In some cases, Multiple aspects are merged in several finding statements and make a stringent derivation of the treatment planning difficult. Conclusions: dental documentation in Germany can in some aspects be improved with respect to (a) precision, (b) expressiveness, (c) simplicity and (d) reproducibility. The main axes of dental documentation are enumerated in preparation of a future top-down approach. Clinical Implications: an optimised finding scheme can enhance the communication amongst researchers and practitioners and thus is supposed to improve the treatment quality in the long run

Analysis of a foundational biomedical curriculum: exploring cumulative knowledge-building in the rehabilitative health professions

This study was motivated by the researcher's experience that students in the rehabilitative health professional programmes were finding it difficult to access fundamental knowledge upon which their professional practices and clinical contexts are based. An important focus of the research was the extent to which cumulative knowledge-building was impacted after the foundational biomedical curriculum became an interdisciplinary programme. The study explored whether the organisation of the interdisciplinary foundational curriculum served the fundamental needs of the professions, and whether, as a matter of social justice, students' access to powerful knowledge was enabled by the form that the fundamental curriculum assumed. This curriculum study at a particular Faculty of Health Sciences foregrounds the structuring, organisation and differentiation of disciplinary knowledge, and reflects a twenty year period that included not only transitions in professional education but also extensive transformation in, and a different approach to, health delivery. At the institution, physiology and anatomy, the biomedical sciences basic to the health professions, underwent disciplinary merging and subsequent altered positioning in curricula. Medicine opted for a problem-based learning approach whereas the rehabilitation health sciences did not. Legitimation Code Theory (LCT) provided the means for analysis of the extent to which interdisciplinary organisation in the foundational curriculum for Physiotherapy and Occupational Therapy enabled integrative, cumulative building of knowledge for professional and clinical contexts. Specialisation and Semantics dimensions of Legitimation Code Theory were used to reveal the principles underpinning practices, contexts and dispositions of Anatomy and Physiology at the Faculty of Health Sciences over a twenty year period post democratisation in South Africa (1994 - 2013). Disciplinary positioning in curriculum prior- and post-merger, were compared and contrasted. LCT were used to characterise the distinctiveness of Physiotherapy and Occupational Therapy at the university including the kind of knowledge and the kind of knower that specialises the different professions, and what is valorised and legitimated for each kind of professional. Semantic gravity was used to explore the expected knowledge recontextualisations in diverse and complex clinical settings for each of the professions. Registered professionals who are clinical educators as well as curriculum designers for clinical studies were interviewed. Profession-specific course outlines were further data sources. The biomedical disciplines Anatomy and Physiology were characterised for their measures of distinction and their respective knowledge-knower structures. Analysis traced each discipline from its strongly classified form in autonomous curricula when there were separate learner-cohorts for physiotherapists and occupational therapists, to post-merger when the disciplines were framed as human biology in an integrated foundational curriculum for a joint cohort of students. Curricular documents for the twenty year period were analysed quantitatively and qualitatively to establish the positioning of Physiology and Anatomy before and after the disciplines merged to a single course of Human Biology. Teaching staff were interviewed for their understanding of what specialises the physiological and anatomical components of the Human Biology curriculum, what they considered as powerful knowledge for the professions, and who they envisaged as the ideal student-knower exiting the basic sciences platform to enter more advanced clinical studies. The degree of context-dependence for meaning-making in the different disciplinary domains and the condensation of meanings inherent in the respective practices and contexts, were analysed. The thesis argues that following the merger Anatomy is preferentially legitimated as powerful knowledge at the expense of Physiology; that the ideal of disciplinary integration is not reached, and that the segmental organisation and structuring of the curriculum negatively impacted on cumulative knowledge-building and application of professional knowledge in the clinical arena. After the merger the disciplines lost their shape, and in particular the hierarchical knowledge structure of Physiology collapsed. By not having access to the necessary disciplinary knowledge structures and their associated practices, students' ability for scaffolding and integrating knowledge into the clinical arena was constrained. The organisation of the current Human Biology curriculum does not facilitate cumulative learning, and in so doing may not contribute to the envisaged graduate professional who is required to practice within a complex and demanding healthcare work environment. The significance of this study conveys that interdisciplinary programmes should be carefully considered, and there is an added imperative in the health professions which ultimately realise treatment of patients. If, aside from interdisciplinary teaching, there are also merged cohorts of participant students, then a sound understanding of the epistemic requirements of each profession is required. Those involved in curriculum development in various fields need to take these recommendations into account to enable cumulative learning and enable epistemological access to powerful knowledge for an increasingly diverse student body

Clinical foundations and information architecture for the implementation of a federated health record service

Clinical care increasingly requires healthcare professionals to access patient record information that may be distributed across multiple sites, held in a variety of paper and electronic formats, and represented as mixtures of narrative, structured, coded and multi-media entries. A longitudinal person-centred electronic health record (EHR) is a much-anticipated solution to this problem, but its realisation is proving to be a long and complex journey. This Thesis explores the history and evolution of clinical information systems, and establishes a set of clinical and ethico-legal requirements for a generic EHR server. A federation approach (FHR) to harmonising distributed heterogeneous electronic clinical databases is advocated as the basis for meeting these requirements. A set of information models and middleware services, needed to implement a Federated Health Record server, are then described, thereby supporting access by clinical applications to a distributed set of feeder systems holding patient record information. The overall information architecture thus defined provides a generic means of combining such feeder system data to create a virtual electronic health record. Active collaboration in a wide range of clinical contexts, across the whole of Europe, has been central to the evolution of the approach taken. A federated health record server based on this architecture has been implemented by the author and colleagues and deployed in a live clinical environment in the Department of Cardiovascular Medicine at the Whittington Hospital in North London. This implementation experience has fed back into the conceptual development of the approach and has provided "proof-of-concept" verification of its completeness and practical utility. This research has benefited from collaboration with a wide range of healthcare sites, informatics organisations and industry across Europe though several EU Health Telematics projects: GEHR, Synapses, EHCR-SupA, SynEx, Medicate and 6WINIT. The information models published here have been placed in the public domain and have substantially contributed to two generations of CEN health informatics standards, including CEN TC/251 ENV 13606

A Socio-History and Genealogy of Dementia Thought and Conceptualisation in Western Society

Background: Debates concerning the conceptualisation of dementia in Western society, including its framing as a specific type of disorder (such as neuro-psychiatric, part of the natural aging process, cognitive, and so on) are important in understanding how it has come to be problematized. The manner by which this has been framed has implications not only for the perceived disciplinary ownership of dementia, but also for the lived experience of people diagnosed with dementia, their families, and the care professionals and nurse educators supporting them or their carers. The work of Michel Foucault is useful in setting this debate within a critical socio-historical context. Aims: The problematization and conceptualisation of dementia in Western society, including its socio-history, is re-examined, drawing on an approach influenced by Foucault’s history of problematization. Here, through exploring alternative conceptualisations, using a Foucauldian critical history, this study reviews society’s understanding of what it is to be a person with dementia. The aim of this study then is to challenge dominant neuro-psychiatric conceptualisations of dementia in Western society and to examine and explore how alternative conceptualisations have existed through our history. This requires taking a critical review of the historical evidence of the different ways of seeing, speaking about, or understanding dementia and its subsequent problematization. Methods: An in-depth analysis of 500 documents, spanning 4,000 years, covering early Egyptian, Greek and Roman periods, through to the twenty-first century, are examined. These were sourced through academic databases and archival sources as well as snowball sampling from reference lists and bibliographies. Based on carefully considered inclusion and exclusion criteria, including personal reflexivity and consideration for researcher bias, relevant documents were compiled into an Archive representing a socio-history of dementia thought. Framework analysis was then used to examine the manner in which dementia is conceptualised and problematized in different texts or fields of discourse taken from the Archive, and emerging analytical themes were then interpreted using Foucauldian analysis. Results: Six differing conceptualisations or problematizations of dementia were found (as a natural consequence of ageing, a mental or neuro-psychiatric disorder, a bio-medical disorder, a neuro-cognitive disorder, a disability; and, a terminal illness). Conclusion: What it is to be a person with dementia is located within a particular conceptual framework, with ideas or considered truths about the condition reliant upon historically-contingent assumptions. It is here, through understanding the inter-connectedness, dominance, and the subjugation of dementia discourse, we are able to understand a range of possibilities in how we ‘make up people’ (classifications based on social determinants) with dementia. Through this critically reflective position, taken-for-granted assumptions about dementia are called into question

Adviser\u27s guide to health care: Volume 1, An Era of Reform

https://egrove.olemiss.edu/aicpa_guides/1800/thumbnail.jp

"If we can't measure it, we can't do it". The role of health outcomes in community and allied health service accountability

Health outcomes fulfill a number of roles in the health sector. Economists, clinicians, researchers and managers use health outcomes in a range of different contexts for distinct purposes. New management approaches that use contracts as the basis for health service accountability have attempted to take health outcomes from their clinical role into a management setting. In particular, the purchasers and managers of some health services expect that service providers should demonstrate that they improve the health outcomes of their patients to justify their on-going funding. However, a number of organisations have experienced barriers to the application of the outcomes approach to health service management and there has been no systematic evaluation of the approach. Nor has there been an investigation into why purchasing organisations have difficulty introducing health outcomes into purchasing contracts. The result is that managers and purchasers continue to assign resources to the pursuit of health outcomes as an accountability tool. This thesis addresses two research questions around the use of health outcomes in community and allied health service accountability. The first is the barriers to the application of health outcomes to health services accountability. The second question examines the conditions that must be met before health outcomes can be used as an accountability tool in purchasing contracts for allied health. The research questions are addressed through the analysis of case studies that explore systematically the approach taken by two organisations, the Department of Veterans’ Affairs and ACT Community Care, in their attempts to identify health outcomes that could be used in purchasing contracts for community and allied health services.

2006 - 2007 University Catalog

Volume 96, Number 1, June 30, 2006 Published once a year June 30, 2006https://scholarsrepository.llu.edu/univcatalog/1009/thumbnail.jp