Students in interprofessional clinical placements: How supervision facilitates patient-centeredness in collaborative learning

The patient’s role in interprofessional education is fundamental; however, it has received insufficient attention. This study explores how supervision facilitates and supports undergraduate students’ learning of patient-centeredness in interprofessional clinical placements. Data were generated in three clinical contexts based on a focused ethnography approach. We found that supervisors are engaged in student teams’ interprofessional learning, but often in their preparations or debriefings and seldom during patient encounters. The patient perspective is also less frequently scrutinized in planned interprofessional supervision sessions. Nevertheless, clinical settings provide numerous opportunities that may be exploited further

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

Virtual Reality Games for Motor Rehabilitation

This paper presents a fuzzy logic based method to track user satisfaction without the need for devices to monitor users physiological conditions. User satisfaction is the key to any product’s acceptance; computer applications and video games provide a unique opportunity to provide a tailored environment for each user to better suit their needs. We have implemented a non-adaptive fuzzy logic model of emotion, based on the emotional component of the Fuzzy Logic Adaptive Model of Emotion (FLAME) proposed by El-Nasr, to estimate player emotion in UnrealTournament 2004. In this paper we describe the implementation of this system and present the results of one of several play tests. Our research contradicts the current literature that suggests physiological measurements are needed. We show that it is possible to use a software only method to estimate user emotion

Persuasive technology in cross-platform systems

Persuasive technology is a branch of human-centered science, which aims to modify user’s attitude or behaviour with help of technology. Persuasive technology is related to vast amount of other topics from human-centered science, such as user experience which plays a major part in successful persuasion. Considerations of suited methods to achieve wanted persuasion is essential in persuasive technology and the consequences of the used methods on the user. Persuasive technology is especially present in health-related systems, which aims to improve the users’ physical health. This can be done with various methods, such as by including social efficacy features to the system. Cross-platform design is the answer for designing application for various platforms. Theoretical background of cross-platform design can be used to solve user experience and technical issues. Positive cross-platform user experience has positive coherent user experience regardless of the used system component. Positive coherent user experience can be reached by considering the specific characteristics of cross-platform systems and by aiming for coherent system design. Technical issues include how the implementation could be done efficiently, how the components of the system are connected to each other and how the system could be maintained. This thesis represents theoretical background for both of these presented subjects. This thesis aims to explore and test the introduced theoretical frameworks for designing cross-platform persuasive system. By using this theoretical background, a prototype for physiotherapy was redesigned and implemented. The prototype’s implementation was evaluated: how well it fulfilled its defined goals and how the prototype could be developed further. Additionally the relevancy in the development process of used theoretical frameworks and models will be discussed. User studies for the prototype were not conducted in order to study how well the prototype suited for its purpose and context of use, or how effective and suited the selected persuasive system characteristics were for the system. However, the selected approaches for the design process including Model-Driven Development and Persuasive System Design model were found suited for this particular development of a prototype

Portuguese physiotherapists’ self-efficacy and preparedness for patient education practice: a mixed methods study

Introdução: A educação centrada no utente é reconhecida como parte integrante da prática efetiva em fisioterapia. A literatura atual sugere que os fisioterapeutas recém-licenciados, que intervêm com utentes com condições músculo esqueléticas, podem não estar adequadamente preparados para implementar esta modalidade de intervenção de forma efetiva. Estes profissionais tendem a identificar mais barreiras e desafios, comparativamente aos fisioterapeutas mais experientes. Objetivos: O objetivo deste estudo foi analisar a autoeficácia e explorar a preparação de fisioterapeutas recém-licenciados para utilizar a educação, enquanto modalidade terapêutica integrada no tratamento de utentes com condições músculo-esqueléticas. Metodologia: Foi implementado um estudo misto sequencial explanatório, que combinou métodos quantitativos (1ª fase) e métodos qualitativos (2ª fase). Na 1ª fase, os participantes responderam a um questionário relativo à autoeficácia para uma prática de educação ao utente. Na 2ª fase, foram realizadas entrevistas individuais, semiestruturadas, gravadas em formato áudio. Os dados foram transcritos na íntegra, para posterior análise temática. Resultados: 151 fisioterapeutas recém-licenciados participaram na 1ª fase. Os itens que obtiveram a pontuação de autoeficácia mais alta foram: "Compreendo o papel da educação ao utente" e "Compreendo o impacto de fatores sociais, culturais e comportamentais na aprendizagem do utente". O item com a pontuação mais baixa foi: "Sinto-me confiante em reconhecer e gerir de forma eficaz barreiras à efetividade da educação". Na 2ª fase do estudo, foram realizadas 12 entrevistas. Na análise qualitativa foram identificados quatro temas: (1) perspetivas acerca da prática de educação ao utente, (2) desafios em torno da prática de educação ao utente, (3) preparação para uma prática de educação ao utente, e (4) reflexões sobre a formação base. Conclusões: Os participantes demonstraram níveis elevados de autoeficácia na maioria dos itens para a educação ao utente. A análise das entrevistas evidenciou dificuldades em gerir barreiras no uso da educação ao utente e na abordagem de condições clínicas complexas. Os participantes percecionaram que a sua formação base poderá não ter sido suficiente para a preparação para a prática de educação ao utente. Uma abordagem mais aprofundada da educação ao utente e o contacto com utentes reais foram vistas como experiências de aprendizagem com potencial para aumentar a perceção de preparação para uma prática de educação ao utente.Background: Patient-centred education is recognized as an integral part of effective physiotherapy practice. Current literature suggests that novice physiotherapists, working with patients with musculoskeletal conditions, may not be adequately prepared for patient education practice. They seem to identify more barriers to effective patient education practice, than their experienced colleagues. Objectives: This study aims to examine the self-efficacy of Portuguese novice physiotherapists for patient education practice and to explore their perceived preparedness to use patient education practice in their work context and the impact of their pre-professional training. Methods: An explanatory sequential mixed methods research design was used, combining quantitative (1 st phase) and qualitative (2 nd phase) methods. In the 1st phase, participants completed a self-efficacy survey regarding their patient education practice. In the 2nd phase, qualitative data collection was carried out through one-to-one, semi-structured interviews. The interviews were recorded in audio format and the data transcribed verbatim for subsequent thematic analysis. Results: 151 novice physiotherapists participated in the 1st phase. The items with the highest score were: “I understand the role of patient education” and “I understand the impact of social, cultural, and behavioral variables on patient learning”. The item with the lowest self-efficacy score was “I feel confident to recognise and effectively manage barriers to effective education”. In the 2nd phase, 12 interviews were completed. Four themes were generated: (1) perspectives of patient education practice, (2) challenges around patient education practice, (3) preparedness for patient education practice, and (4) reflections on pre-professional training. Conclusion: Novice physiotherapists demonstrated high self-efficacy in most aspects of patient education. Interview analysis showed difficulties in managing barriers to use patient education practice and in addressing complex conditions. Participants perceived that their undergraduate training may not have been sufficient to prepare them for patient education practice. A more in-depth approach to patient education and contact with real patients were seen as learning experiences with the potential to improve the perception of preparation for patient education practice

Application of Digital Ecosystem Design Methodology Within the Health Domain

We define a digital ecosystem (DES) as the dynamic and synergetic complex of digital communities consisting of interconnected, interrelated, and interdependent digital species situated in a digital environment that interact as a functional unit and are linked together through actions, information, and transaction flows. The design of DESs requires the integration of a number of different and complementary technologies, including agent-based and self-organizing systems, ontologies, swarm intelligence, ambient intelligence, data mining, genetic algorithms, etc. The integration of multiple technologies and the resulting synergetic effects contribute to the creation of highly complex, dynamic, and powerful systems. The application of DESs within different domains has the power to transform these domains by giving them a more intelligent and a more dynamic nature. In this paper, we illustrate how a DES design methodology can be used to systematically create a Digital Health Ecosystem (DHES). We address the key steps associated with the DES design and focus specifically on the use of the electronic health records within the DHES. The design methodology framework illustrated in this paper serves as a navigating tool during the design of DHESs

Physical rehabilitation based on kinect serious games: ThG therapy game

This thesis presents a serious game platform developed using Unity 3D game Engine and Kinect V2 sensor as a natural user interface. The aim of this work was to provide a tool for objective evaluation of patients’ movements during physiotherapy sessions as well as a pleasant way that may increase patient engagement on training motor rehabilitation exercises. The developed platform based on Kinect V2 sensor detects 3D motion of different body joints and provides data storage capability in a remote database. The platform for patient’s data management during physiotherapy process includes biometric data, some data relevant for physiotherapist related to patient’s clinical history, obtained scores during serious game based training and values of metrics such as the distance between feet during a game, left and right feet usage frequency and execution time for imposed movement associated with game mechanics. A description of technologies and techniques used for development of the platform and some results related to usability of the platform are presented in this thesis.Esta tese apresenta uma plataforma de jogo séria desenvolvida usando o motor de jogo Unity 3D juntamente com o sensor Kinect V2 como uma interface natural de utilizador. O objetivo deste trabalho foi fornecer uma ferramenta para avaliação objetiva dos movimentos dos pacientes durante as sessões de fisioterapia, bem como uma maneira agradá- vel que possa aumentar o envolvimento do paciente nos treinos de reabilitação motora. A plataforma desenvolvida baseada no sensor Kinect V2 deteta o movimento 3D de diferentes articulações do corpo e fornece capacidade de armazenamento de dados em uma base de dados remota. A plataforma que gere só dados do paciente durante o processo de fisioterapia inclui dados biométricos, alguns dados relevantes para fisioterapeuta relacionados com o historial clínico do paciente, pontuações durante o treino e valores de métricas, como a distância entre os pés durante o jogo, o uso do pé esquerdo e direito, frequência e tempo de execução do movimento associado à mecânica do jogo. A tese apresenta a descrição das tecnologias e técnicas utilizadas para o desenvolvimento da plataforma, e alguns resultados relacionados com o uso da plataforma

An exploration of the construct of Masters level clinical practice

This study aimed to explore the construct of Masters level clinical practice. A mixed methods approach converging quantitative and qualitative data was undertaken. Consensus of behaviours indicative of the construct was explored through a quantitative Delphi study. Participants represented a total population sample of Masters course tutors in healthcare (n = 48). Round 1 requested behaviours indicative of the construct. Quantitative content analysis informed the behaviours explored in round 2, where participants rated their relative importance. Round 3 asked participants to rank the behaviours in order of importance. Descriptive and inferential analysis enabled interpretation of consensus. The construct was also explored through an in-depth qualitative case study, using semi-structured interviews and participant observation. Purposive sampling selected the `case' of a manipulative physiotherapy course and the participants for the study. Analytic categories were derived from the data using a constant comparative process until saturation of the data were achieved. Theoretical propositions to identify the components of the construct were developed. The response rate for the Delphi study was very good (79.1%, 77.1% and 70.8% for rounds 1-3 respectively). Rounds 1 and 2 achieved good consensus enabling 21 agreed 'important' behaviours to be taken into round 3. The ranking process in round 3 afforded consensus overall, but also highlighted some differences between professions regarding the prioritisation of components of the construct. There was good convergence of the data with the case study, with clinical reasoning and knowledge identified as the most important components of the construct. The study has identified generic components of the construct of Masters level clinical practice. In addition specific components and their prioritisation for the speciality of manipulative physiotherapy are identified. Development of this work by exploring several case studies to enable further consideration of professions and specialities through analytic generalisation would be beneficial