Clinical Educator and Student Perceptions of iPad™ Technology to Enhance Clinical Supervision: The Electronically-Facilitated Feedback Initiative (EFFI)

Purpose: Growing demands placed upon healthcare systems require more health professionals to be trained. Clinical placement education is an integral component of health professional training, however accommodating increasing numbers of student placements is a challenge for health services. Personal digital assistants such as iPads™ may assist in delivery of clinical education, by facilitating transfer of knowledge and skills from clinical educators to health professional students, however such an initiative has not been formally investigated. The present study sought to explore perceptions of clinical educators and allied health students regarding the impact of an iPad™-based feedback delivery system on student reflection and learning. Methods: A pilot study was performed using iPads™ with specialised software to deliver electronic formative feedback to physiotherapy, occupational therapy and speech pathology students during clinical placements. Students and clinical educators completed a questionnaire exploring advantages and disadvantages of the technology. Results: Nine clinical educators and 14 students participated and completed the survey. Clinical educators largely (n=7, 78%) reported the electronic feedback system was easy to use and 67% (n=6) reported it improved the quality of feedback provided to students. Five (56%) clinical educators thought electronic feedback improved student performance. Most students (n=10, 71%) reported electronic feedback facilitated reflection upon performance, and 64% (n=9) reported improved performance as a result. Disadvantages included poor wireless internet access and software inefficiencies (n=7 [78%] clinical educators, n=7 [50%] students), and difficulties using iPads™ in settings requiring infection control (n=2 [22%] clinical educators). Conclusions: Clinical educators and students perceived electronic feedback as a positive adjunct to student learning on clinical placement, however technological and software interface factors need to be considered for implementation in some settings

Do Children and Adolescents with Anorexia Nervosa Display an Inefficient Cognitive Processing Style?

Objective: This study aimed to examine neuropsychological processing in children and adolescents with Anorexia Nervosa (AN). The relationship of clinical and demographic variables to neuropsychological functioning within the AN group was also explored.  Method: The performance of 41 children and adolescents with a diagnosis of AN were compared to 43 healthy control (HC) participants on a number of neuropsychological measures.  Results: There were no differences in IQ between AN and HC groups. However, children and adolescents with AN displayed significantly more perseverative errors on the Wisconsin Card Sorting Test, and lower Style and Central Coherence scores on the Rey Osterrieth Complex Figure Test relative to HCs.  Conclusion: Inefficient cognitive processing in the AN group was independent of clinical and demographic variables, suggesting it might represent an underlying trait for AN. The implications of these findings are discussed

Implementation of an electronic Objective Structured Clinical Exam for assessing practical skills in pre-professional physiotherapy and occupational therapy programs: examiner and course coordinator perspectives

Assessment of practical clinical skills is essential in the health fields. Objective Structured Clinical Exams (OSCEs), where examiners assess students performing clinical procedures on simulated patients (actors), are central to the evaluation of practical skills. However, traditional OSCEs require considerable time-investment to administer, and providing timely, individualised student feedback is difficult. To address these issues, an electronic OSCE (eOSCE) was developed utilising the iPad and specialised software. The eOSCE was trialled in four courses within two entry-level rehabilitative pre-professional programs at two universities, physiotherapy and occupational therapy. Evaluation consisted of student surveys (n = 206), eight student focus groups (n = 25), examiner surveys (n = 25) and interviews with course coordinators (n = 3). This paper describes the administration of the eOSCE and reports on its evaluation from the academic’s perspective. A majority of examiners (68%) preferred the eOSCE over traditional paper-based OSCEs, primarily because of the consistency and promptness of student feedback. The advantages academics cited were equitable student feedback and post-examination administrative time-savings. Disadvantages of the eOSCE were the pre-examination preparation required and challenges for examiners not comfortable using technology. Overall, the key benefits of the eOSCE were the automated, immediate individualised student feedback and a time saving in OSCE administration

Electronic Practical Skills Assessments in the Health Professions: A Review

Objective Structured Clinical Examinations (OSCEs) evaluate the practical skills of students training in the health professions. OSCEs have several limitations, including a large administrative burden, potential inaccuracies when transferring student scores from paper to electronic mediums, and difficulties providing individualised student feedback. The “eOSCE,” an electronic version of the traditional paper-based OSCE, potentially addresses these issues. In the eOSCE, examiners use electronic means (e.g. computer, personal digital assistant) to record student scores and comments about their performance, and the system provides students with individualised feedback. The literature from 12 databases was searched to identify articles discussing the use of electronic methods for practical skills assessment, focussing on health professions. Thirteen articles described the evaluation of health students’ practical skills using electronic means. This review discusses the types of electronic methods used for practical skills assessments and the advantages and disadvantages of the types of eOSCEs compared to traditional paper-based formats

Weight Management Advice for Clients with Overweight or Obesity: Allied Health Professional Survey

The prevalence of obesity is increasing. The potential for allied health professionals to intervene through the provision of lifestyle advice is unknown. This study aimed to determine the knowledge, attitudes and practices of health professionals in the provision of dietary and physical activity advice for clients with overweight or obesity. Dietitians, exercise physiologists, nurses, occupational therapists, physiotherapists and psychologists (n = 296) working in New South Wales were surveyed using paper-based and online methods. The majority of health professionals (71%) believed that providing weight management advice was within their scope of practice; 81% provided physical activity advice but only 57% provided dietary advice. Other than dietitians, few had received training in client weight management during their professional qualification (14%) or continuing education (16%). Providing dietary advice was associated with: believing it was within their scope of practice (OR 3.9, 95% CI 1.9–7.9, p < 0.01), training during their entry-level qualification (OR 7.2, 3.2–16.4, p < 0.01) and having departmental guidelines (OR 4.7, 2.1–10.9, p < 0.01). Most health professionals are willing to provide lifestyle advice to clients with overweight or obesity but few have received required training. Developing guidelines and training for in client weight management may potentially impact on rising obesity levels

Weight management including dietary and physical activity advice provided by Australian physiotherapists: a pilot cross-sectional survey

Physiotherapists may have an impact on obesity prevention and treatment by providing nutrition and physical activity advice to overweight or obese clients; yet little is known about physiotherapists’ beliefs and practices related to client weight management. The aim of this pilot study was to determine the practices, beliefs, attitudes and knowledge of physiotherapists regarding the provision of weight management advice to overweight or obese clients. Physiotherapists (n = 65) working in multiple practice settings completed a self-administered questionnaire. Logistic regression determined factors associated with the provision of dietary and physical activity advice for weight management. The majority of physiotherapists (n = 53 [81.5%]) believed providing weight management advice was within their scope of practice, yet only a minority had received training during their professional entry level education (n = 13 [20%]) or through professional development (n = 7 [11%]). Most physiotherapists (n = 55 [84.6%]) provided physical activity advice for weight management, but a minority (n = 27 [41.5%]) provided dietary advice. Having received training in weight management during their professional entry level education was associated with providing dietary advice (Odds ratio 8.8, 95% confidence interval 2.0–38.9, p = 0.004). Training in weight management may increase the likelihood of physiotherapists providing dietary advice, improving physiotherapists’ management of obesity

Difference in perceived knowledge, confidence and attitudes between dietitians and other health professionals in the provision of weight management advice

Aim: The aim of this analysis is to establish if dietitians have the knowledge, skills and attitude to provide support to other health professional (HP) groups in the provision of weight management advice to overweight/obese patients. Methods: A secondary data analysis of a cross-sectional survey of HPs was undertaken to perform a gap analysis with regard to practices, knowledge, confidence and attitudes in the provision of weight management advice. Survey responses and additional measures (practice, knowledge, confidence and attitude scores) were compared between dietitians and other HPs. Descriptive statistics were undertaken, and differences between group x² tests were performed for nominal data and the Wilcoxon rank sum test for ordinal and non-parametric data. Results: About 100% of dietitians had received initial weight management training and 85% had participated in professional development training, compared with 18 and 19% of HPs, respectively, although 70% believed it was within their scope of practice to provide evidence-based advice. Dietitian respondents achieved a higher median score (maximum 10) in the following areas (practice = 6.5, knowledge = 8.0, confidence = 8.3) when compared with HP respondents (practice = 4.2, knowledge = 7.0, confidence = 5.4). The median attitude score for both groups was 6.0. Conclusions: HPs are receptive to providing evidence-based weight loss messages to overweight/obese clients in their current practice. However, weight management training is required to enhance HPs' knowledge and skills in order to increase confidence and improve practice skills. Dietitians can assist HPs to ensure that clear, consistent, evidence-based messages are delivered to overweight clients throughout the health-care system

Utility of phosphatidylethanol testing as an objective measure of alcohol use during the preoperative evaluation for bariatric surgery

BACKGROUND: The risk of alcohol use disorder increases after bariatric surgery. Preoperative alcohol use is a risk factor, and this is evaluated during the routine preoperative psychosocial evaluation. However, it is not clear whether patients accurately report their alcohol use. OBJECTIVE: To determine whether an objective measure of alcohol use, phosphatidylethanol (PEth) testing, offers utility beyond self-reported alcohol use during the preoperative evaluation for bariatric surgery. SETTING: Single healthcare system. METHODS: PEth testing was included as part of the routine laboratory work for 139 patients undergoing evaluation for bariatric surgery. PEth testing results were compared with self-reported alcohol use and scores on the Alcohol Use Disorders Identification Test-Concise (AUDIT-C) questionnaire obtained during the preoperative psychosocial evaluation. PEth testing results were categorized into abstinent, light use, moderate use, or heavy use. There were 85 patients who completed both PEth testing and a preoperative psychosocial evaluation. RESULTS: There were 25 participants (29.4%) who had a positive PEth test; about half had moderate or heavy use values (15.3% of the total sample). The majority of participants with a positive PEth test (82.6%) denied recent alcohol use. Of those with PEth values indicating moderate or heavy use, 61.5% did not have an elevated AUDIT-C score. CONCLUSIONS: Patients appeared to underreport their alcohol use during the preoperative psychosocial evaluation. There appears to be utility for routine PEth testing as part of the evaluation process to identify those with risky drinking patterns. Patients with preoperative risky drinking could be educated about their risk and/or referred to programs to mitigate the development of preoperative alcohol misuse

Hybrid allele-specific ChIP-seq analysis identifies variation in brassinosteroid-responsive transcription factor binding linked to traits in maize

Genetic variation in regulatory sequences that alter transcription factor (TF) binding is a major cause of phenotypic diversity. Brassinosteroid is a growth hormone that has major effects on plant phenotypes. Genetic variation in brassinosteroid-responsive cis-elements likely contributes to trait variation. Pinpointing such regulatory variations and quantitative genomic analysis of the variation in TF-target binding, however, remains challenging. How variation in transcriptional targets of signaling pathways such as the brassinosteroid pathway contributes to phenotypic variation is an important question to be investigated with innovative approaches