Breast and prostate cancer survivor responses to group exercise and supportive group psychotherapy

This study qualitatively examined an 8 week group exercise and counseling intervention for breast and prostate cancer survivors. Groups exercised 3 days per week, 50 minutes per session, performing moderate intensity aerobic and resistance training. Groups also underwent 90 minute supportive group psychotherapy sessions once per week. Survivors discussed their experiences in focus groups post intervention. Transcripts were analyzed using interpretative phenomenological analysis. Survivors described how exercise facilitated counseling by creating mutual aid and trust, and counseling helped participants with self-identity, sexuality, and returning to normalcy. When possible, counselors and fitness professionals should create partnerships to optimally support cancer survivors

Improving muscular endurance with the MVe Fitness ChairTM in breast cancer

Objectives To assess the feasibility and efficacy of delivering Pilates exercises for resistance training to breast cancer survivors using the MVe Fitness Chair™. Design Pilot randomized controlled trial. Methods Twenty-six female breast cancer survivors were randomized to use the MVe Fitness Chair™ (n = 8), traditional resistance training (n = 8), or a control group (no exercise) (CO) (n = 10). The MVe Fitness Chair™ and traditional resistance training groups completed 8 weeks of exercise. Muscular endurance was assessed pre and post-test for comparisons within and between groups using push ups, curl ups, and the Dynamic Muscular Endurance Test Battery for Cancer Patients of Various Ages. Results Feasibility of the MVe Fitness Chair™ was good, evidenced by over 80% adherence for both exercise groups and positive narrative feedback. Significant improvements in muscular endurance were observed in the MVe Fitness Chair™ (p \u3c 0.002) and traditional resistance training groups (p \u3c 0.001), but there were no differences in improvement between the MVe Fitness Chair™ and traditional resistance training groups (p \u3c 0.711) indicating that Pilates and traditional resistance training may be equally effective at improving muscular endurance in this population. Conclusions The MVe Fitness Chair™ is feasible for use in breast cancer survivors. It appears to promote similar improvements in muscular endurance when compared to traditional resistance training, but has several advantages over traditional resistance training, including cost, logistics, enjoyment, and ease of learning

The assessment partnership –assessing student readiness to practice

Assessment is a critical component of the educational paradigm. Teaching, learning and assessment need to be aligned to optimise learning outcomes (Boud, 1995), and ensure graduates are safe and competent to practice in their professions (Eva, 2007; Holmboe et al. 2010; Van der Vleuten, 1996). In this session we will present and critically evaluate the roles of the student, the University, clinical supervisor/s, and the professional body in ensuring graduates' readiness to practice. In order to maximise their learning, students need to take active roles in the learning process. We will report on research on the use of ePortfolios in which students collected and presented evidence that demonstrated their competency. Embedded in this research were students' reflections around their learning. Assessment of clinical competency in the university environment has been criticised for lacking fidelity (ie: not being real, believable, or reflecting the work environment). Clinical employers want to be assured that graduates are "work ready". We will explore several creative, innovative, evidence-based strategies to increase the fidelity of university assessments so that assessors can be more assured of students' preparedness to enter the workplace. Clinical placements offer excellent opportunities to assess students' performance in the environments in which they will eventually work. Although having greater fidelity than the university setting, significant threats to the validity of assessment remain in these environments. Particularly concerning are: variability between supervisors' judgments, and the unpredictability of clinical workplaces such that we cannot ensure that all students experience placements of the same difficulty of challenge. In this section we will present and critically evaluate a range of workplace assessments, allowing participants to consider what might work in different environments. We will further discuss ways in which assessments might be changed to manage threats to validity

Theoretically and empirically-informed narrative descriptions of competency development

Background: Determining whether a student has demonstrated readiness to enter their profession, particularly in professions where semi-autonomous practice is required on graduation, is challenging. Discourse regarding performance assessment has moved from measurement and psychometric validity towards the value of qualitative approaches and narratives to support sound judgement of readiness for practice. The objective of this study was to develop narrative descriptions of competency development. The research questions were: (i) how do experienced clinicians describe students who are developing their clinical competency, and (ii) how do they describe a student who is ready for semi-autonomous professional practice? We investigated these questions within the profession of clinical exercise physiology (CEP). CEP is a role emerging health profession in Australia and therefore is in the early stages of articulating its understanding of readiness for practice and related assessment of performance. Summary of Work: A social constructivist theoretical perspective informed the methodology. Across three focus groups, 17 CEP clinicians with clinical educator experience were asked to describe (i) what students who are developing their clinical competency 'look like' and (ii) what students who were ready for professional practice 'look like'. Data saturation was reached at the third focus group. A thematic analysis identified the behavioural constructs describing competency development which were then used to write three narrative descriptions of points along a competency continuum. These narrative descriptions were further evaluated and refined through semi-structured interviews. Summary of Results: The behavioural constructs which informed the narrative descriptions included: consistency, managing complexity, flexibility, safe practice, independence and insight into own performance. Participants considered the narrative descriptions to accurately describe the continuum of competency development and a student who is ready for professional practice. Discussion and Conclusions: The narrative descriptions fit with contemporary discourse on assessment in clinical workplace settings. The narrative descriptions may be useful in providing support for quality judgements of students' performances in the workplace setting. That is, the narrative descriptions could be used as reference points by those constructing their judgements of student performances. Take-home Messages: The broad behavioural constructs in the narratives may be relevant to other health professionals' practice

Acceptance and Continuance Usage Intention of Mixed Reality for Australian Healthcare Interprofessional Education

Virtual-Reality and augmented-reality are becoming innovative teaching and learning approaches across many industries, including healthcare, especially during the COVID-19 pandemic. However, the adoption rate of this technology is very low, especially in Australian healthcare Interprofessional Education. This study investigates factors influencing adoption and use of mixed-reality technology for Australian healthcare IPE. In this study, a theoretical model based on the Expectation and Confirmation Model and Task Technology Fit is developed and will be tested to determine Australian healthcare professionals’ intentions to continue using mixed-reality for Interprofessional Education through three validated surveys using a voluntary non-probability sampling strategy, over a 10-week period, targeting 124 healthcare professionals at the Tweed hospital, NSW Australia. The research outcome will assist in determining the validity of the proposed hybrid model in the context of MR healthcare training. It may assist in developing a more suitable theoretical framework and future characteristics of MR for healthcare training

Determination of clinical competencies for exercise physiology students

Introduction: Clinical placements and assessment are a key part of health professional education. However, quality assessment in a clinical environment is difficult to achieve without a clear picture of what constitutes competence. The aim of this study was to establish a set of competencies that describe the attributes considered critical to ensuring an entry-level exercise physiologist (EP) can practice safely and effectively with a client-centred philosophy. Methods: This study used a mixed methods, multiphase approach. The competencies, which are organised into units of competency with underlying elements, were developed following online surveys and focus groups involving those with expertise in the area, with additional refinement provided by the project team. A first-stage validation was conducted via electronic survey where (i) participants rated the importance of each unit of competency to practice as an entry-level EP; and (ii) those participants who were recently graduated EPs rated the extent to which they perceived they were competent in each unit. Results: The final set of competencies is described as 19 elements organised into 6 units. The units are: (i) Communication, (ii) Professionalism, (iii) Assessment and Interpretation, (iv) Planning and delivery of an exercise and/or physical activity intervention, (v) Lifestyle Modification and (vi) Risk Management. The majority of survey participants (93-97%) considered each unit of competency as being important to practice successfully as an entry-level EP. The majority (78-95%) of the sub-group who identified as new EPs considered themselves competent in each unit, suggesting the competencies are articulated at the level of a new EP. Conclusion: The competencies resulted from an extensive, iterative process involving those with expertise in the area followed by initial validation. The competencies will have a range of applications, including informing the development of a student placement assessment tool

Determination of clinical competencies for exercise physiology students

Introduction: Clinical placements and assessment are a key part of health professional education. However, quality assessment in a clinical environment is difficult to achieve without a clear picture of what constitutes competence. The aim of this study was to establish a set of competencies that describe the attributes considered critical to ensuring an entry-level exercise physiologist (EP) can practice safely and effectively with a client-centred philosophy. Methods: This study used a mixed methods, multiphase approach. The competencies, which are organised into units of competency with underlying elements, were developed following online surveys and focus groups involving those with expertise in the area, with additional refinement provided by the project team. A first-stage validation was conducted via electronic survey where (i) participants rated the importance of each unit of competency to practice as an entry-level EP; and (ii) those participants who were recently graduated EPs rated the extent to which they perceived they were competent in each unit. Results: The final set of competencies is described as 19 elements organised into 6 units. The units are: (i) Communication, (ii) Professionalism, (iii) Assessment and Interpretation, (iv) Planning and delivery of an exercise and/or physical activity intervention, (v) Lifestyle Modification and (vi) Risk Management. The majority of survey participants (93-97%) considered each unit of competency as being important to practice successfully as an entry-level EP. The majority (78-95%) of the sub-group who identified as new EPs considered themselves competent in each unit, suggesting the competencies are articulated at the level of a new EP. Conclusion: The competencies resulted from an extensive, iterative process involving those with expertise in the area followed by initial validation. The competencies will have a range of applications, including informing the development of a student placement assessment tool

An assessment tool to judge exercise physiology student performance in a clinical placement setting

Introduction/background: Assessment in clinical settings has historically been problematic due to lack of standardisation and objectivity. This had led to calls to look at assessment in the clinical setting differently. Aim/objectives: The overall aim of this research is to develop a competency assessment tool for use by clinical educators to make valid judgments of exercise physiology students' performances in clinical placement settings. This presentation reports on the design of the assessment tool and considers the features that will support quality judgments. The research question is: What are the elements required in the assessment tool that will support quality judgments? Methods: An educational design based research model was used to design and develop the assessment tool. Focus groups exploring the continuum of competency development and the required design features, and educational theory were used to develop an initial prototype. Results: The prototype uses a visual analogue scale to record judgments of student performance against 19 elements related to exercise physiology professional and clinical competencies. A rich description of the developmental continuum towards entry-level competence, which draws on the language used by exercise physiologists, is designed to support clinical educators to make meaning of the multiple observations they make of student performance. Conclusions: An educational design based research model has been used to design an assessment tool prototype aimed at supporting quality judgements of student performance. The design principles generated by the focus groups and literature have led to a prototype that is less measurement focussed than traditional workplace based assessment tools

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research