Letter to the editor

Comment on the article Melikyan G, Kamran S, Akhtar N, Deleu D, Miyares FR. Cortex-sparing infarction in triple cervical artery dissection following chiropractic neck manipulation. Qatar Med J. 2015; (2):1

Developing a clinical teaching quality questionnaire for use in a university osteopathic pre-registration teaching program

Clinical education is an important component of many health professional training programs. There is a range of questionnaires to assess the quality of the clinical educator however none are in student-led clinic environments. The present study developed a questionnaire to assess the quality of the clinical educators in the osteopathy program at Victoria University. A systematic search of the literature was used to identify questionnaires that evaluated the quality of clinical teaching. Eighty-three items were extracted and reviewed for their appropriateness to include in a questionnaire by students, clinical educators and academics. A fifty-six item questionnaire was then trialled with osteopathy students. A variety of statistics were used to determine the number of factors to extract. Exploratory factor analysis (EFA) was used to investigate the factor structure. The number of factors to extract was calculated to be between 3 and 6. Review of the factor structures suggested the most appropriate fit was four and five factors. The EFA of the four-factor solution collapsed into three factors. The five-factor solution demonstrated the most stable structure. Internal consistency of the five-factor solution was greater than 0.70. The five factors were labelled Learning Environment (Factor 1), Reflective Practice (Factor 2), Feedback (Factor 3) and Patient Management (Factor 4) and Modelling (Factor 5). Further research is now required to continue investigating the construct validity and reliability of the questionnaire

Exploring the construct validity of the Patient Perception Measure-Osteopathy (PPM-O) using classical test theory and Rasch analysis

Evaluation of patients’ experience of their osteopathic treatment has recently been investigated leading to the development of the Patient Perception Measure – Osteopathy (PPM-O). The aim of the study was to investigate the construct validity of the PPM-O. Patients presenting to osteopathy student-led teaching clinics at two Australian universities were asked to complete two questionnaires after their treatment: a demographic questionnaire and the PPM-O. Confirmatory factor analysis (CFA) and Rasch analysis were used to investigate the construct validity of the PPM-O. Data from the present study did not fit the a-priori 6-domain structure in the CFA. Modifications to the 6-domain model were then made based on the CFA results, and this analysis identified two factors: 1) Education & Information (9 items); and 2) Cognition & Fatigue (6 items). These two factors were Rasch analysed individually. Two items were removed from the Cognition & Fatigue factor during the analysis. The two factors independently were unidimensional. The study produced a 2-factor, 13-item questionnaire that assesses the patients’ perception of their osteopathic treatment using the items from a previous questionnaire. The results of the current study provide evidence for the construct validity of the PPM-O and the small number of items makes it feasible to implement into both clinical and research settings. Further research is now required to establish the measures’ validity in a variety of patient populations

The Osteopathic Clinical Practice Assessment - a pilot study to develop a new workplace-based assessment tool

Background It is widely recognised that multiple forms of assessment are required in order to make decisions about learner competency and fitness-to-practice. One assessment tool that is gaining popularity in the Australian allied health professions is the global clinical competency assessment. These tools are designed to assess learner performance across a range of areas required for professional practice, with the assessment typically performed at the end of a ‘block’ clinical placement. There is no literature on their use in osteopathy longitudinal placements. Objective To explore the applicability of an adaptation of the Assessment of Physiotherapy Practice in an osteopathic context. The study presents pilot data and discussion about the adaptation of a workplace-based assessment tool – the Osteopathic Clinical Practice Assessment (OCPA). Design Evaluation of the OCPA using data from multiple administrations. Setting Osteopathic on-campus, student-led teaching clinic at one Australian university. Methods Clinical Educators completed the OCPA for learners during weeks 5 and 12 of a 12 week semester. Descriptive statistics were generated for the data. The Wilcoxon signed rank test was used to investigate differences between the week 5 and 12 ratings. Cronbach\u27s alpha was used to assess the internal consistency and Spearman\u27s coefficient used to assess the relationship between the total OCPA score and global rating. Participants The OCPA was completed by 12 Clinical Educators assessing 31 learners in year 4 of the program. Results Learners were rated, on average, at the ‘expected level’ at each of the two time points. This was consistent for both the OCPA items and the global rating contained on the OCPA. Cronbach\u27s alpha was 0.822 and Spearman\u27s coefficient was 0.59 suggesting a ‘large’ relationship between the total OCPA score and the global rating. Conclusions There is a clear need for the OCPA to be used in conjunction with other assessment tools in order to make learner progress and fitness-to-practice decisions. Data suggest if learners are assessed at two or more different time points (across a longitudinal placement) changes need to be considered in the rating scale used on the OCPA in order to more clearly demonstrate learner progression. The OCPA could be used as a formative assessment tool in osteopathy with an adjustment to the current rating scale. In its current format caution should be applied if it is to be used as a summative tool as we do not have data supporting its use for this purpose. At present we cannot make any further arguments about the ability of the OCPA results to be extrapolated and make reliable and defensible decisions as there are no data correlating it with other performance assessments nor data supporting its reliability. This will be the subject of future research

Sensations Experienced and Patients’ Perceptions of Osteopathy in the Cranial Field Treatment

Osteopathy in the cranial field is an approach used by manual and physical therapists. However, there is minimal information in the literature about patient experiences of this treatment. The present study was undertaken to explore patients’ experiences of osteopathy in the cranial field. Patients completed the Patient Perception Measure–Osteopathy in the Cranial Field and identified sensations they experienced during treatment. Additional measures of anxiety, depression, Satisfaction With Life, and Meaningfulness of Daily Activity were completed. The Patient Perception Measure–Osteopathy in the Cranial Field was internally consistent (Cronbach’s α = .85). The most frequently experienced sensations of osteopathy in the cranial field patients were “relaxed,” “releasing,” and “unwinding.” Satisfaction With Life and Meaningfulness of Daily Activity were positively associated with Patient Perception Measure–Osteopathy in the Cranial Field scores. Negative associations were observed between the Patient Perception Measure–Osteopathy in the Cranial Field and depression. Psychometric properties of the Patient Perception Measure–Osteopathy in the Cranial Field require further testing. The observed associations of Satisfaction With Life and depression with patients’ perceptions of osteopathy in the cranial field treatment needs to be tested in larger clinical manual therapy cohorts. </jats:p

Perception of peer physical examination in two Australian osteopathy programs

Background Peer physical examination (PPE) is an efficient and practical educational approach whereby students can practise their examination skills on each other before commencing clinical practice with actual patients. Little is known about the use of PPE in osteopathy education. Methods Students in Year 1 of the osteopathy programs at Victoria University (Melbourne, Australia) and Southern Cross University (Lismore, Australia) completed the Examining Fellow Students and the Peer Physical Examination questionnaires prior to, and at the completion of, their first 12-week teaching session. Descriptive statistics were generated for each questionnaire. The McNemar and sign tests were used to evaluate differences between each questionnaire administration. Logistic regression was used to evaluate the influence of demographics on responses to both questionnaires. Results Results showed that students in both programs were generally willing to examine non-sensitive areas both before and after the 12-week teaching session. Students’ were less apprehensive about PPE at the end of the teaching session, and this was reinforced by results for previous exposure to PPE in other courses. Consistent with previous studies, unwillingness to participate in PPE was associated with being female, being born outside Australia, holding religious beliefs, and being older. Conclusions This is the first study to explore students’ perceptions of PPE in this cohort and provides a basis for further work, including evaluating longer term changes in student perception of PPE, and whether these perceptions extend to practising manual therapy techniques. This study demonstrates that perceptions about PPE reported in medicine and other disciplines, namely that unwillingness to participate in PPE is associated with being female, being born outside Australia, holding religious beliefs, and being older, also apply to osteopathy. These findings are significant for all manual therapy students who spend a substantial portion of their course developing skills in PPE and practising manual therapy techniques. They highlight the need for curriculum development that acknowledges the importance of good practice in PPE, including discussions about body image, feedback skills training for educators, and providing detailed information to students about what to expect in practical skills classes before they commence their course

Students today…educators tomorrow

The article describes the use of the mini clinical examination (mini-CEX) in a pilot study to introduce peer assessment in one allied health programme to explore students’ capacity as clinical educators. Preparing today\u27s pre-professional health students to be clinical educators by engaging them in peer teaching, learning and assessment may encourage them to become tomorrow\u27s clinical educators