Associations between type 1 diabetes and educational outcomes: an Aotearoa/New Zealand nationwide birth cohort study using the Integrated Data Infrastructure.

AIMS/HYPOTHESIS: Type 1 diabetes is one of the most common chronic diseases of childhood. It is hypothesised that the metabolic and psychosocial consequences of type 1 diabetes may affect educational outcomes; however, existing literature presents conflicting results. This study aimed to assess whether educational outcomes differ for young people with and without type 1 diabetes in Aotearoa/New Zealand (NZ). METHODS: This was a nationwide 9 year birth cohort study of all people born in NZ from 1993 to 2001 using linked administrative data held within the Integrated Data Infrastructure, a national research database containing linked health and non-health data. Educational outcomes of high school attainment, high school attendance and university enrolment were measured from age 13 years until 20 years. Generalised linear regression models with log link and Gaussian distributions were used to compare educational outcomes between those with and those without type 1 diabetes, adjusting for sociodemographic and maternal characteristics. RESULTS: Of the 442,320 children in the birth cohort, type 1 diabetes was identified in 2058 (0.47%) (mean [SD] age of type 1 diabetes diagnosis 7.7 [3.4] years). Educational outcomes were significantly lower for children with type 1 diabetes than for those without type 1 diabetes, including for any high school qualification (RR 0.97 [95% CI 0.95, 0.99]), university entrance-level high school attainment (RR 0.88 [95% CI 0.84, 0.92]), regular high school attendance (RR 0.91 [95% CI 0.85, 0.97]) and university enrolment (RR 0.93 [95% CI 0.88, 0.98]), even after adjusting for sociodemographic and maternal factors. In addition, educational outcomes were substantially lower for those with post type 1 diabetes diagnosis hospitalisations for diabetic ketoacidosis and hypoglycaemia. CONCLUSIONS/INTERPRETATION: In this whole NZ birth cohort study, type 1 diabetes was associated with lower educational outcomes spanning secondary school and into university enrolment. Ongoing efforts to support students with type 1 diabetes are needed, particularly for those with a greater risk profile.

Mobile agency and relational webs in women's narratives of international study.

Internationalisation and forced migration are rarely thought about as related phenomena in higher education (HE) literature. Internationalisation is associated with movement, choice and brand recognition, and used in international rankings methodologies as a proxy for quality. Forced migration is associated not only with movement, but also with lack of choice, containment, or 'stuckness'. Some scholars have called for a rethinking of 'the international' through attention to students as mobile agents, and international study as situated within broader mobile lives. Our study responded to these calls through exploring the educational biographies of 37 international and refugee-background women students based in two universities: 21 in New Zealand and 16 in Bangladesh. Ten of the women were from refugee or refugee-like backgrounds, while the remainder were international students. The women's accounts revealed the complex ways in which circumstances shaped their educational journeys similarly and differently. One woman represented mobility in relation to autonomy and choice; but most emphasised relational webs as shaping their access to and experiences of international study, and post-study aspirations. In this paper, we draw on selected narratives to illustrate the range of ways in which family and/or community members appeared in women's accounts of their education journeys: as a source of (1) sustenance and support; (2) inspiration and motivation; and (3) obligation, and sometimes regulation. We conclude by suggesting that attention to the affective and embodied entanglements that shape students' international study journeys might inform new ways of thinking about both 'the international' and higher education more broadly.

When personal experience overlaps with study.

BACKGROUND: Health professional education programmes increasingly seek to train a generation of clinicians who reflect the population they serve. However, teaching approaches in health professional education have not always kept pace with this drive, and some educators tend to assume a lack of overlap between students' life experience and aspects of the curriculum. METHOD: In-depth interviews were conducted with 22 health professional students and graduates, who self-identified as having experienced a significant overlap between their personal life and their course of study. These interviews were analysed thematically to explore the role of teaching practices that created either alienating or inclusive learning environments. RESULTS: Participants identified areas where clinical teachers could modify their teaching approach and assumptions about the student cohort to be more inclusive of students whose life experience overlapped with the curriculum. They wanted educators to treat any teaching topic as if it could be personal for some students, which may include teaching inequities carefully, acknowledging family members' perspectives, moderating discussions, and avoiding stereotyping patients. Participants also wanted educators to practice shared decision-making about alternative arrangements or time off. DISCUSSION: Clinical educators have a key role in shaping an inclusive health sciences programme. Their assumptions, attitudes and teaching strategies can either strengthen or undermine the development of a diverse health workforce.

Coping strategies and the Salutogenic Model in future oral health professionals.

BACKGROUND: Attention to the role of context in shaping individuals' coping strategies is necessary. This study used the Salutogenic Model (SM) as a framework to identify the coping strategies of oral health profession students from three countries. METHODS: Students from Australia, New Zealand and Chile were invited to participate in this cross-sectional study, and were given a questionnaire including socio-demographics, the Perceived Stress Scale, The SOC-13 and the Brief COPE. Descriptive analysis, correlation analysis and profile analysis were computed using SPSS v 20.0. RESULTS: Eight-hundred and ninety-seven valid questionnaires were returned, achieving a 44 % response rate. The coping dimension that the participants most commonly reported using was "Active Coping" with a mean value of 5.9 ± 1.5. Chilean respondents reported higher stress levels (19.8 vs. 17.7) and a lower Sense of Coherence (55.6 vs. 58.0) compared to Australian/New Zealand participants (p < 0.001). The SOC was positively correlated with active coping (p < 0.01) and positive reframing (p < 0.01). Profile analysis showed that when the differences in responses by sex were accounted for, there was no significant effect by country on the coping strategies used (p < 0.32). CONCLUSION: This initial investigation provides insights into the students' coping strategies and the validity of the SM. Students reporting high SOC scores where those who demonstrated the use of active coping and positive reframing as strategies to deal with stressful situations, which indicates the accuracy of the theoretical framework of the SM in health education environments. The results also suggest that a distinctive coping strategy pattern may apply to all participants, regardless of their country and sex.

Stress and health-promoting attributes in Australian, New Zealand, and Chilean dental students.

This study investigated stress levels and health-promoting attributes (sense of coherence, social support, and coping strategies) in dental students using a Salutogenic approach. All dental students (n=2,049) from two Australian universities, two Chilean universities, and one New Zealand university were invited to participate in this cross-sectional study. The questionnaire covered sociodemographic and career choice questions, Perceived Stress Scale, Orientation to Life Questionnaire, Multidimensional Scale of Perceived Social Support, and Brief COPE scale. A total of 897 students participated, for a 44 percent response rate. Students' mean age was 22.1 (SD=2.7). The majority were females (59.3 percent). Students reported moderate stress, moderate sense of coherence (SOC), and high levels of social support. Significant differences in the SOC scores by country were reported. The linear regression model for stress explained 44 percent of the variance, in which SOC and social support are negatively associated with stress and the use of maladaptive coping strategies positively predicts high stress. These findings confirm that health-promoting attributes were negatively related to stress in these dental students. This is an initial approach to guide academics in the creation of Salutogenic programs that optimize students' chances to successfully cope with stress.

Initial University of Otago oral health graduates' employment pathways and preparedness for work.

OBJECTIVES: To examine University of Otago BOH graduates' post-graduation pathways and employment experiences; and graduate, employer and host therapist perspectives of the new BOH programme and student/ graduate preparedness for work. DESIGN: A survey-based qualitative research project. SETTING: Private and public oral healthcare settings. PARTICIPANTS AND METHODS: Open-ended questionnaires were used to conduct a 2010 survey of 2009 BOH graduates and consenting graduates' employers, and a 2011 survey of dental therapists who had hosted BOH students on clinical placement since 2009. Data were analysed inductively using a thematic content and analysis approach. MAIN OUTCOME MEASURES: 18 (60%) of the 30,2009 BOH graduates completed the online graduate questionnaire with 10 providing employer information. Six employers completed the 'graduate attribute' questionnaire, and 30 (45%) of the 66 eligible host therapists, the 'student attribute' questionnaire. Clear themes emerged from the three participant groups. RESULTS: Of the 18 graduate participants, 10 were working in dental therapy and dental hygiene, with the remaining eight working in only one area. Graduates' primary concern was with maintaining both scopes of practice. Graduates and host therapists stressed a need for students' exposure to complex cases, while employers indicated that graduates' clinical confidence had developed over time. CONCLUSION: Recommendations for improving BOH graduates' transition outcomes included (1) increasing students' exposure to complex clinical and placement experience; (2) improving continuing education opportunities for new graduates; and (3) promoting interaction between BOH and dental students with a view to improving (future) dentists' knowledge of BOH graduate skills and attributes.

New Zealand dental technicians and continuing education: findings from a qualitative survey.

Under the 2003 Health Practitioners Competence Assurance (HPCA) Act, New Zealand registered dental technicians are subject to mandatory Continuing Professional Development (CPD) requirements. Internationally, little published literature has examined dental technicians' perspectives of CPD and CPD needs, and there is no published literature relating to the New Zealand context. Available research highlights the importance of CPD for maintaining high professional standards, ensuring patient safety, allowing dental technicians to keep abreast of current research and technological advances, fostering peer networks, and promoting job satisfaction. In 2009, an online open-ended questionnaire was developed to examine New Zealand dental and clinical dental technicians' perspectives of CPD and their perceived CPD needs. In total, 45 New Zealand registered dental technicians responded. Questionnaire responses provided rich qualitative insights into dental technicians' wide-ranging perceptions of CPD, factors that make CPD involvement more or less difficult and more or less desirable, and ways in which CPD access and relevance might be improved. This paper discusses the survey findings in the light of the existing literature on CPD and in relation to the unique New Zealand regulatory environment. It highlights the factors which respondents identified as shaping their CPD decisions, barriers to CPD engagement, perceived CPD needs, suggestions as to how the current CPD system could be improved, and areas for future research.

Undergraduate dental education in New Zealand: 2007-2009 final-year student feedback on clinical learning environments.

Dental education is a unique form of health professional education. This is because the clinical training component largely occurs within the dental school and involves students carrying out irreversible patient interventions early in their education. Perhaps not surprisingly, previous research indicates that dental education (and particularly the clinical component) is stressful for many students. In their responses to an annual clinical learning environment survey, final-year Bachelor of Dental Surgery (BDS) students at the University of Otago have suggested that teaching staff play a key role in mitigating or compounding stressors associated with students' clinical work. In 2007-2009 questionnaire responses, students identified the kinds of staff feedback which they found constructive or unhelpful while working in patient clinic settings, described their responses to feedback received, and identified ways in which students' clinical learning experiences might be improved. This paper outlines 2007-2009 University of Otago Faculty of Dentistry clinical learning environment survey findings, and relates these to the literature on effective teaching and clinical teaching. It then describes programmatic changes and research initiatives developed in response to student feedback.

A new predoctoral endodontic module: evaluating learning and effectiveness.

The teaching of advanced endodontic courses at the predoctoral level is common, but it can be difficult to assess teaching effectiveness. Advanced modules placed later in the dental curriculum provide the opportunity to introduce a new topic, revisit and reinforce concepts learned previously, and instill the notion of lifelong learning. At any level, the introduction of new techniques to novices must be based on recognition of their prior knowledge and experience and their need for explicit direction, stepwise instruction, and comprehensive feedback. Assessment of students' performance should not only provide insights into what they know and can do, but also steer them towards desired outcomes. In addition, assessment can provide valuable feedback on teaching effectiveness. In this article, we describe a module piloted for inclusion in the University of Otago (New Zealand) fourth-year dental curriculum. This involved the use of tapered hand and rotary nickel-titanium files for root canal preparation and was taught through a didactic program (lectures and problem-based learning seminars) and a series of preclinical hands-on sessions. Findings from formative and summative assessments as well as student, peer, and self-evaluation indicated that the objectives of the module were met and that it was effective in both providing students with the basic skills for using this type of instrumentation and increasing their understanding and enthusiasm for endodontics. We conclude by discussing curriculum changes resulting from our module evaluation, directions for future research, and suggestions for teaching advanced endodontic techniques.