What does an enquiry-based approach offer undergraduate physiotherapy students in their final year of study?

Background. Physiotherapy students in their final year at Stellenbosch University (SU) complete a module that follows an enquiry-based learning (EBL) approach. This module exposes them to higher-order problem solving and was developed to facilitate independent self-directed learning and improved higher-order thinking skills.Objective. To describe the perceptions of undergraduate physiotherapy students on the impact of this EBL approach on their learning.Methods. A cross-sectional descriptive study was conducted with three consecutive cohorts of final-year undergraduate physiotherapy students. A questionnaire was used to obtain information related to the students’ perception of this module. Coding and identification of themes were done independently using an inductive approach. Initial themes were compared and discussed to achieve consensus regarding the final themes reported.Results. Students reported the development of skills such as the ability to source relevant information and problem-solving abilities. Students attributed improvements in their clinical reasoning and performance during clinical work to the skills they developed during this module. The main themes identified as barriers to learning during this module were availability of learning materials, quality assurance and time constraints. Group work was identified as both a facilitator and a barrier to their learning.Conclusion. Physiotherapy students at SU perceived the introduction of a module following an EBL approach positively. They developed skills such as sourcing information and problem-solving, which they perceived improved their clinical work. The main barriers to learning were time constraints and concerns regarding quality assurance of learning material. Group work was regarded as both facilitatory and a barrier to learning. Programmes considering the implementation of EBL should ensure sufficient resource material and that quality assurance mechanisms are in place to address students’ anxiety regarding learning material. Guidance and support to students during the initial implementation phase of an EBL approach are necessary to allay fears and frustrations

Evaluation of clinical sites used for training undergraduate physiotherapy students: Factors that may impact on learning

Background. Clinical education forms an integral part of the training of undergraduate healthcare students. Clinical learning and education can be influenced by a number of factors.Objectives. To evaluate clinical service sites used to train undergraduate physiotherapy students at Stellenbosch University, in terms of: (i) the suitability of the site as a training facility; and (ii) the range of clinical problems students encounter at these clinical service sites.Methods. A descriptive study was conducted. Data were gathered through structured clinical site visits, staff interviews and student record sheets documenting the number and type of patients students encountered at the clinical service sites.Results. Seven of the nine clinical sites used for training were evaluated. Close proximity to the Faculty was an identified strength of three of the sites. There were opportunities for the expansion of multidisciplinary services and group treatment classes. There were safety concerns at most of the sites visited. The number of qualified physiotherapists was low and there was also a lack of basic equipment needed for patient management at more than half of the clinical sites. Students’ exposure to the various fields of physiotherapy varied greatly at the tertiary service settings versus primary healthcare settings. On average students saw only two patients per day during a 5-hour clinical day.Conclusion. The suitability of healthcare service sites for training undergraduate students should be carefully evaluated prior to commencing training at these sites. The development of good clinical training sites for undergraduate healthcare students requires the availability of adequate resources such as equipment, an adequate complement of clinical staff and effective measures to ensure student and patient safety

Impairment of IFN-Gamma Response to Synthetic Peptides of Mycobacterium tuberculosis in a 7-Day Whole Blood Assay

Studies on Mycobacterium tuberculosis (MTB) antigens are of interest in order to improve vaccine efficacy and to define biomarkers for diagnosis and treatment monitoring. The methodologies used for these investigations differ greatly between laboratories and discordant results are common. The IFN-gamma response to two well characterized MTB antigens ESAT-6 and CFP-10, in the form of recombinant proteins and synthetic peptides, was evaluated in HIV-1 uninfected persons in both long-term (7 day) and 24 hour, commercially available QuantiFERON TB Gold in Tube (QFT-GIT), whole blood assays. Our findings showed differences in the IFN-gamma response between 24 hour and 7 day cultures, with recombinant proteins inducing a significantly higher response than the peptide pools in 7 day whole blood assays. The activity of peptides and recombinant proteins did not differ in 24 hour whole blood or peripheral blood mononuclear cell (PBMC) based assays, nor in the ELISpot assay. Further analysis by SELDI-TOF mass spectrometry showed that the peptides are degraded over the course of 7 days of incubation in whole blood whilst the recombinant proteins remain intact. This study therefore demonstrates that screening antigenic candidates as synthetic peptides in long-term whole blood assays may underestimate immunogenicity

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Benefits of curriculum renewal: The Stellenbosch University physiotherapy experience

Background. Driven by a changing healthcare environment, the Division of Physiotherapy (Stellenbosch University) reduced core content and adopted a multimodal approach to teaching and learning. The benefits of curriculum renewal, however, are seldom investigated despite ongoing internal appraisal. Evaluation of the BSc Physiotherapy programme was considered incomplete without determining the worth of the programme.Objectives. To determine whether there was a change in students’ perception of the impact of the programme on personal development; and whether the programme prepared them for community service.Methods. A descriptive comparative desktop analysis was conducted in which the data from the Faculty’s Programme Evaluation process were compared between students enrolled in the old curriculum (2006) and students enrolled in the new curriculum (2011) using pooled data and t-tests to compare responses between the two groups. A level of significance was set at p<0.05.Results. A significant increase in scores was noted for various graduate attributes developed as a result of the programme, such as critical thinking, clinical reasoning, communication and sourcing information (p<0.01). Similarly, students scored their perceptions related to programme structure significantly higher (p<0.01). No change was reported regarding students’ ability to maintain a balance between studies and other activities. Scores pertaining to their perception of readiness for community service or professional practice remained the same with both cohorts believing they were well prepared.Conclusion. The renewed format seemed to benefit students greatly in assisting the development of graduate attributes. Students were significantly more satisfied with the structure of the renewed curriculum and – despite extensive changes – the principles-based multimodal approach to teaching and learning was perceived as effective for preparing students for community service. Programmes undertaking curriculum renewal should not only focus on the curriculum content but also develop a variety of learning opportunities to facilitate the development of graduate attributes. The next cycle of evaluation should however reflect on clinical practice

Bone mineral density and menstrual function in adolescent female long-distance runners - A prospective comparative study of bone structure and menstrual function in adolescent female endurance athletes from five secondary schools in Pretoria

Background. In recent years, endurance running as a sport has become very popular. This trend has led to the identification of specific problems during the female athlete's life, especially with regard to reproduction, delayed sexual maturation, menstrual abnormalities and early osteoporosis. Methods. Bone mineral density (BMD) and menstrual function were compared between a group of long-distance female adolescent runners (N=17) from five schools in Pretoria and an age-matched inactive control group of adolescents (N=18). Groups were matched for body height, mass index (BMI 18 to 25) and eating habits. The SAHARA Clinical Sonometer was used to measure BMD on the calcaneus. Menstrual function was denoted by onset of menarche, duration of menstrual periods (days) and number of menstrual periods per year. Results. Baseline BMD was significantly higher in the athletic group: mean = 0,6126 g/cm3 and SD = 0,1217, versus non-athletes: mean = 0,5329 g/cm3 and SD=0,0733 (p = 0,0228). There was a significant delay in the onset of menarche in the athletes: mean = 14,873 and SD = 1,37798, in comparison to the non-athletes: mean = 13,468 and SD = 1,2194 (p = 0,0030). The athletes had a significantly higher incidence of menstrual abnormalities (p = 0,005). Conclusions. BMD at the focus of strain for running (the legs) is higher in endurance adolescent female runners. Endurance runners have a significantly higher incidence of menstrual abnormalities. Key words: . SA Fam Pract 2003;45(10):14-1

Deriving criteria by which to determine core curriculum content: A high engagement process

Background. During curriculum revision, an important task is identifying a core curriculum. Deciding what criteria to use to determine core content is crucial and impacts on graduate outcomes and patient care.Objective. To identify criteria to apply in order to determine core content.Methods. A high engagement process involving eleven staff and two undergraduate student representatives was used. The process consisted of a stimulus question; brainstorming; sharing, clarification and clustering of ideas; second-phase brainstorming, clarification and clustering; prioritisation; and finally vote tally and categorisation.Results. The group initially identified 28 criteria to use when deciding on core content. The criteria were reduced stepwise to 15, and finally 3 criteria that enjoyed widespread support were identified. Content would be included in the curriculum if: (i) it was relevant to the South African context; (ii) it would ensure safe and effective practice by first-line practitioners; and (iii) it was evidence-based.Conclusion. The process lends itself to the participation of multiple stakeholders in an engaging yet anonymous manner. It helps ensure that all voices are heard and ideas included in prioritisation. The process easily manages a multiplicity of ideas; similar ideas are efficiently identified and clustered. Finally, the process is time-efficient

Learning experiences of physiotherapy students during primary healthcare clinical placements

Background. Primary healthcare (PHC) is necessary to address the health needs of communities. It creates the opportunity for the attainment of curricular outcomes through community-based education. Appropriate learning opportunities are needed to enable students to develop the necessary skills to attain these outcomes.Objectives. To describe the learning opportunities occurring during physiotherapy PHC placements and to explore the role the learning environment and learning opportunities played in attaining the outcomes for the placements.Methods. A descriptive case study was conducted using different strategies for data collection and analysis. Participants completed a record sheet to indicate time spent on different activities. Observational site evaluations, individual interviews with site representatives and focus-group discussions with students were conducted to explore their perceptions about PHC clinical placements.Results. The results indicated that the participants valued PHC placements as powerful learning environments. However, students did not have the opportunity to engage satisfactorily in activities that foster the principles of PHC. Participants acknowledged that several resource constraints existed in this context; however, they identified several potential valuable learning opportunities. Students suggested curriculum-specific strategies needed to prepare them for PHC, and recognised the need for healthcare services in the communities they served.Conclusion. While the PHC learning environment was rich and authentic, learning opportunities need to be optimised to enable students to fully reach the outcomes for the placements. Learning opportunities need to be crafted to foster collaborative learning, interdisciplinary learning, community engagement and empowerment

Physiotherapy students’ perceptions about the learning opportunities included in an introductory clinical module

Background. Clinical education forms a core component of physiotherapy training. However, the transition from the classroom to clinical learning environments can be challenging. An introductory clinical placement with appropriate learning opportunities is therefore important to ensure that learning outcomes are reached.Objectives. To determine second-year physiotherapy students’ perceptions about the learning opportunities provided in an introductory clinical module and to determine their perception about the attainment of the learning outcomes.Methods. A descriptive case study was undertaken, using mixed methodology. All 39 second-year physiotherapy students were invited to participate. Data were collected using a self-developed questionnaire which focused on the outcomes of the module and the perceived value of the learning opportunities. A focus group discussion was conducted with a random subset (n=15) of the population.Results. The response rate to the questionnaire was 79% (n=31). Peer learning by observing senior students, demonstrations by clinical lecturers and the assessment of specific skills were perceived by students to be particularly useful. However, several learning opportunities did not contribute effectively to learning. Participants highlighted a transitional process between classroom and clinical environments during which they became aware and could respond mentally to the demands of a clinical placement.Conclusions. The clinical education introductory module provided valuable opportunities, where students learnt productively in a non-threatening learning environment. Junior students linked theoretical and practical concepts to clinical implementation. Peer mentoring and progressive mastering were valuable learning strategies. Reflection and students’ emotional adjustment to clinical practice are topics for further investigation