Optimizing falls risk prediction for inpatient stroke rehabilitation: A secondary data analysis.

BACKGROUND: Identifying individuals at risk for falls during inpatient stroke rehabilitation can ensure timely implementation of falls prevention strategies to minimize the negative personal and health system consequences of falls. OBJECTIVES: To compare sociodemographic and clinical characteristics of fallers and non-fallers; and evaluate the ability of the Berg Balance Scale (BBS) and Morse Falls Scale (MFS) to predict falls in an inpatient stroke rehabilitation setting. METHODS: A longitudinal study involving a secondary analysis of health record data from 818 patients with stroke admitted to an urban, rehabilitation hospital was conducted. A fall was defined as having ≥1 fall during the hospital stay. Cut-points on the BBS and MFS, alone and in combination, that optimized sensitivity and specificity for predicting falls, were identified. RESULTS: Low admission BBS score and admission to a low-intensity rehabilitation program were associated with falling (p < .05). Optimal cut-points were 29 for the BBS (sensitivity: 82.4%; specificity: 57.4%) and 30 for the MFS (sensitivity: 73.2%; specificity: 31.4%) when used alone. Cut-points of 45 (BBS) and 30 (MFS) in combination optimized sensitivity (74.1%) and specificity (42.7%). CONCLUSIONS: A BBS cut-point of 29 alone appears superior to using the MFS alone or combined with the BBS to predict falls.

A framework for interprofessional team collaboration in a hospital setting: Advancing team competencies and behaviours.

Healthcare teams that practice collaboratively enhance the delivery of person-centred care and improve patient and systems outcomes. Many organizations have adopted existing interprofessional frameworks that define the competencies of individual health professionals that are required to meet practice standards and advance interprofessional goals. However, to support the collective efforts of team members to deliver optimal care within complex hospital settings, healthcare organizations may benefit from adopting team-based competencies for interprofessional collaboration. The Sunnybrook framework for interprofessional team collaboration was intentionally created as a set of collective team competencies. The framework was developed using a comprehensive literature search and consensus building by a multi-stakeholder working group and supported by a broad consultation process that included patient representation, organizational development and leadership, and human resources. The six core competencies are actionable and include associated team behaviours that can be easily referenced by teams and widely implemented across the hospital.

Mapping of pain curricula across health professions programs at the University of Toronto.

BACKGROUND: There is a growing societal need for health professional competency in pain care. The University of Toronto Centre for the Study of Pain-Interfaculty Pain Curriculum (UTCSP-IPC) has been offered since 2002. Content and process have been updated annually. In addition, participating health professions programs have advanced their pain teaching. A curricular scan was needed to creatively and constructively advance the UTCSP-IPC. AIM: The aim of this study was to map curricular pain content in participating health professions programs onto the UTCSP-IPC content as a first step to further curriculum design. METHODS: UTCSP-IPC committee members and faculty representatives from six health profession programs completed a 27-item online survey in this collaborative action study. Descriptive statistics were completed in Microsoft Excel. RESULTS: The UTCSP-IPC provided an average of 43.3% (range 32%-62%) of total pain content teaching hours to participating health professions students and a range of 8% to 100% of total opioid-related teaching hours. Curricular overlaps and gaps in pain content were identified and will be used to update and inform the iterative design of the UTCSP-IPC. Ninety-three percent of participating health professions faculty indicated that the interprofessional focus on pain care in the UTCSP-IPC was important. CONCLUSION: This study highlighted the value of the UTCSP and areas of curricular refinement to ensure continued relevance in relationship to pain content within the six participating health professions programs. Mapping a coordinated approach between uniprofessional and interprofessional teaching will both meet the demands of professional competence and create greater applicability to future practice settings.

Contexte : Il est de plus en plus nécessaire que les professionnels de la santé aient les compétences nécessaires pour la prise en charge de la douleur au sein de la société. Le Programme interfacultaire sur la douleur du Centre pour l'étude de la douleur de l'Université de Toronto (UTCSP-IPC) est offert depuis 2002. Son contenu et son processus ont été mis à jour chaque année. Les programmes des professions du domaine de la santé participantes ont eux aussi perfectionné leur enseignement sur la douleur. Une radiographie du programme était donc nécessaire afin d'améliorer l'UTCSP-IPC de manière créative et constructive.Objectif : Recenser le contenu sur la douleur dans les programmes des professions du domaine de la santé participantes afin de l'inclure dans l'UTCSP-IPC en tant que première étape pour améliorer la conception du programme.Méthodes : Des membres du comité de l'UTCSP-IPC et des représentants des facultés de six programmes de professions du domaine de la santé ont répondu à un sondage en ligne comprenant 27 énoncés dans le cadre de cette étude collaborative. Des statistiques descriptives ont ensuite été compilées dans Microsoft Excel™.Résultats : Au total, l'UTCSP-IPC a donné en moyenne 43,4 % (entre 32 et 62 %) d'heures d'enseignement sur la douleur aux étudiants des professions du domaine de la santé participantes, et de huit à 100 % d'heures d'enseignement liées aux opioïdes. Les lacunes et les chevauchements dans le contenu portant sur la douleur ont été répertoriés. Cette information sera utilisée pour la mise à jour et la conception itérative de l'UTCSP-IPC. Quatre-vingt-treize pour cent des facultés des professions du domaine de la santé participantes ont souligné l'importance de continuer à mettre l'accent sur l'aspect interprofessionnel de la prise en charge de la douleur dans l'UTCSP-IPC.Conclusion : Cette étude a mis en évidence l'importance de l'UTCSP ainsi que les aspects du programme qui doivent être peaufinés pour maintenir sa pertinence en ce qui concerne le contenu sur la douleur au sein des six programmes des professions du domaine de la santé participantes. L'élaboration d'une approche coordonnée entre l'enseignement uniprofessionnel et l'enseignement interprofessionnel permettra à la fois de répondre aux exigences en matière de compétences professionelles et d'améliorer l'applicabilité dans les futurs milieux de pratique.

The Pain Interprofessional Curriculum Design Model.

Objective: Although the University of Toronto Centre for the Study of Pain has successfully implemented an Interfaculty Pain Curriculum since 2002, we have never formalized the process in a design model. Therefore, our primary aim was to develop a model that provided an overview of dynamic, interrelated elements that have been important in our experience. A secondary purpose was to use the model to frame an interactive workshop for attendees interested in developing their own pain curricula. Methods: The faculties from Dentistry, Medicine, Nursing, Occupational Therapy, Pharmacy, and Physical Therapy met to develop the model components. Discussion focused on patient-centered pain assessment and management in an interprofessional context, with pain content being based on the International Association for the Study of Pain-Interprofessional Pain Curriculum domains and related core pain competencies. Profession-specific requirements were also considered, including regulatory/course requirements, level of students involved, type of course delivery, and pedagogic strategies. Results: The resulting Pain Interprofessional Curriculum Design Model includes components that are dynamic, competency-based, collaborative, and interrelated. Key questions important to developing curricular components guide the process. The Model framed two design workshops with very positive responses from international and national attendees. Conclusions: The Pain Interprofessional Curriculum Design Model is based on established pain curricula and related competencies that are relevant to all health science students at the prelicensure (entry-to-practice) level. The model has been developed from our experience, and the components resonated with workshop attendees from other regions. This Model provides a basis for future interventions in curriculum design and evaluation.

Reaching Consensus on Measuring Professional Behaviour in Physical Therapy Objective Structured Clinical Examinations.

Purpose: We determined which professional behaviours (PBs) are important and feasible to measure in an objective structured clinical examination (OSCE) intended to assess the hands-on skills and knowledge of students in a Canadian physical therapy (PT) program. Methods: We used a modified Delphi technique to identify the criteria required to assess PBs in PT students during an OSCE. We conducted a focus group to better understand the results of the modified Delphi process. Results: Experienced local OSCE examiners participated in the modified Delphi panel, which consisted of two rounds of surveys: round 1 (n=12) and round 2 (n=10). A total of 31 PBs were reduced to 18 through the two rounds. Five of the panellists participated in the focus group, reduced the 18 PBs to 15, and then identified 4 as clinical skills. Participants categorized the remaining 11 as mixed PBs and clinical skills (1 item), PBs (4 items), or communication skills (6 items). Conclusion: This study provides preliminary evidence to support the feasibility and importance of evaluating 5 PB items in practical skills OSCEs for entry-to-practice PT students.

Objectif : déterminer les comportements professionnels (CP) qui sont importants et évaluables durant un examen clinique objectif structuré (ECOS) afin d'évaluer les compétences et les connaissances pratiques des étudiants d'un programme de physiothérapie au Canada. Méthodes : nous avons utilisé une méthode Delphi modifiée pour cibler les critères requis pour évaluer les CP des étudiants en physiothérapie durant un ECOS. Nous avons mené un groupe de discussion pour mieux comprendre les résultats du processus Delphi modifié. Résultats : des examinateurs ECOS expérimentés locaux ont participé au groupe d'experts sur la méthode Delphi modifiée, qui consistait en deux rondes de sondages : ronde 1 (n=12) et ronde 2 (n=10). Un total de 31 CP ont été réduits à 18 au cours des deux rondes. Cinq des experts ont participé au groupe de discussion et ont réduit les 18 CP à 15, puis en ont ciblé quatre comme étant des compétences cliniques. Les participants ont catégorisé les 11 CP restants comme étant des compétences cliniques et des CP mixtes (un élément), des CP (quatre éléments) ou des compétences en communication (six éléments). Conclusion : cette étude fournit des données probantes préliminaires pour appuyer la faisabilité et l'importance d'évaluer cinq CP faisant partie des compétences pratiques de l'ECOS nécessaires à l'admissibilité à la pratique des étudiants en physiothérapie.

Measuring professional behaviour in canadian physical therapy students' objective structured clinical examinations: an environmental scan.

PURPOSE: To identify professional behaviours measured in objective structured clinical examinations (OSCEs) by Canadian university physical therapy (PT) programs. METHOD: A cross-sectional telephone survey was conducted to review current practice and determine which OSCE items Canadian PT programs are using to measure PT students' professional behaviours. Telephone interviews using semi-structured questions were conducted with individual instructors responsible for courses that included an OSCE as part of the assessment component. RESULTS: Nine PT programmes agreed to take part in the study, and all reported conducting at least one OSCE. The number and characteristics of OSCEs varied both within and across programs. Participants identified 31 professional behaviour items for use in an OSCE; these items clustered into four categories: communication (n=14), respect (n=10), patient safety (n=4), and physical therapists' characteristics (n=3). CONCLUSIONS: All Canadian entry-level PT programmes surveyed assess professional behaviours in OSCE-type examinations; however, the content and style of assessment is variable. The local environment should be considered when determining what professional behaviours are appropriate to assess in the OSCE context in individual programmes.

Objet : Cerner les comportements professionnels mesurés dans les examens cliniques objectifs structurés dans le cadre des programmes de physiothérapie des universités canadiennes. Méthode : Un sondage téléphonique transversal a été effectué pour examiner la pratique actuelle et déterminer les éléments des examens cliniques objectifs structurés (ECOS) utilisés dans le cadre des programmes canadiens de physiothérapie pour mesurer les comportements professionnels des étudiants en physiothérapie. On a mené des entrevues téléphoniques dans lesquelles on posait des questions semi-structurées aux instructeurs chargés des cours comportant un ECOS dans la composante d'évaluation. Résultats : Neuf programmes de physiothérapie ont accepté de participer à l'étude, et les répondants ont tous déclaré qu'ils effectuaient au moins un examen clinique objectif structuré. Le nombre et les caractéristiques des ECOS variaient à la fois au sein d'un même programme et entre les programmes. Les participants ont cerné 31 éléments de comportement professionnel à mesurer dans un ECOS; ils se regroupent en quatre catégories: communication (n=14), respect (n=10), sécurité des patients (n=4) et caractéristiques des physiothérapeutes (n=3). Conclusions : Tous les programmes de physiothérapie sondés au niveau débutant évaluent les comportements professionnels à l'aide d'examens de type ECOS; toutefois, le contenu et le style de l'examen sont variables. Il faut tenir compte de l'environnement local lorsqu'on détermine les comportements professionnels qu'il faut évaluer dans le contexte de l'ECOS dans les programmes individuels.

Vision screening in preschoolers: the New South Wales Statewide Eyesight Preschooler Screening program.

OBJECTIVE: To evaluate screening and diagnostic outcomes of the New South Wales Statewide Eyesight Preschooler Screening (StEPS) program, a state-funded, universal vision screening program for 4-year-old children. DESIGN, SETTING AND PARTICIPANTS: A cross-sectional evaluation of the StEPS program, in which eligible 4-year-old children were offered a vision screen in local health districts in NSW, between 1 July 2010 and 30 June 2011. MAIN OUTCOME MEASURES: Number and proportion of eligible children who were offered screening; accepted screening; were screened and scored a pass or were referred (routinely or urgently) for further vision assessment; and were referred for further assessment and required intervention. RESULTS: Of 91 324 eligible 4-year-olds in NSW, 80 328 (88.0%) were offered screening, and 65 834 (72.1% of the eligible population) were screened. Of the children who were screened, 3867 (5.9%) scored less than 6/9-2 but better than 6/18 in one or both eyes and were referred to their general practitioner or eye health professional for further vision assessment. A further 1425 children (2.2%) scored 6/18 or less in one or both eyes and were referred for high-priority assessment. In the two local health districts with the most complete follow-up data, 704 of 779 children (90.4%) with routine referrals and 278 of 285 (97.5%) with high-priority referrals required treatment or review at a later date. CONCLUSIONS: The StEPS program has achieved a high screening participation rate in NSW. Many children have been diagnosed and received treatment for previously undetected serious vision disorders that may otherwise have been diagnosed too late for effective intervention.

Developing and implementing the community nursing research strategy for Wales.

In order to obtain the best patient outcomes in community nursing, practice needs to be underpinned by robust research-based evidence. This article describes a Community Nursing Research Strategy developed and implemented in Wales to provide the nursing profession with the evidence to support future organisational and professional change in achieving excellence in the community. This was developed in partnership with education, research, health services, workforce planning and Government using consensus methodology (specifically, a nominal group technique). Consequently, the process was inclusive and included three steps: escalating presentation of ideas, topic debate and topic rating. The result was a strategy with four implementation strands, including a virtual network, research portfolio, application to practice and leadership.

Virtually present: the perceived impact of remote facilitation on small group learning.

BACKGROUND: The engagement of facilitators located remotely for small group learning has received little research attention. However, this approach could increase the pool of experts for small group learning, thus addressing challenges to sustainability faced by in-person models of small group facilitation. AIM: The objective of this study was to describe the experiences and perceptions of students regarding the use of remote facilitation for small group learning in a health education setting. METHODS: This qualitative study involved three focus groups (n = 16) composed of students in the advanced neuromusculoskeletal teaching unit in the University of Toronto, Department of Physical Therapy. Focus groups were audio-taped and transcribed verbatim, and data were analyzed thematically. RESULTS: Three main influences emerged related to the experiences of students regarding the use of remote facilitation for small group learning in a health education setting: technology (including audio and visual), facilitator (including quality of facilitation and facilitator expertise), and group dynamics (including ground rules, roles and responsibilities, and learning style). Each of these influences acted independently and interdependently to shape participants' perceptions. CONCLUSION: This study prompts a widening of the concept of distance learning to also include distance teaching, which may have wide applicability to health profession programs.

The Impact of Structured Inter-professional Education on Health Care Professional Students' Perceptions of Collaboration in a Clinical Setting.

PURPOSE: To examine how a structured inter-professional education (IPE) clinical placement influences health care professional (HCP) students' perceptions of inter-professional collaboration (IPC) relative to that of students in a traditional clinical placement. METHODS: This study used a mixed-methods design. The Interdisciplinary Education Perception Scale (IEPS) was administered to HCP students (n=36) in two Toronto hospitals before and after a structured 5-week IPE clinical placement to examine changes in their perceptions of IPC. Students in a traditional clinical placement (n=28) were used as a control group. Focus groups were then conducted with seven students who took part in the structured IPE clinical placement. A coding framework was devised a priori, and the qualitative results were used to explain the quantitative findings. RESULTS: There were no statistically significant differences between groups after the structured IPE clinical placement, but the intervention group showed a greater positive trend in total IEPS scores from baseline to follow-up. Qualitative data suggest that students valued the knowledge and skills gained through the structured IPE clinical placement. CONCLUSIONS: Findings suggest that structured IPE clinical placements may provide students with valuable collaborative learning opportunities, enhanced respect for other professionals, and insight into the value of IPC in healthcare delivery. More research is needed to explore other factors that influence specific perceptions among physical therapy students.Purpose: To examine how a structured inter-professional education (IPE) clinical placement influences health care professional (HCP) students' perceptions of inter-professional collaboration (IPC) relative to that of students in a traditional clinical placement. Methods: This study used a mixed-methods design. The Interdisciplinary Education Perception Scale (IEPS) was administered to HCP students (n=36) in two Toronto hospitals before and after a structured 5-week IPE clinical placement to examine changes in their perceptions of IPC. Students in a traditional clinical placement (n=28) were used as a control group. Focus groups were then conducted with seven students who took part in the structured IPE clinical placement. A coding framework was devised a priori, and the qualitative results were used to explain the quantitative findings. Results: There were no statistically significant differences between groups after the structured IPE clinical placement, but the intervention group showed a greater positive trend in total IEPS scores from baseline to follow-up. Qualitative data suggest that students valued the knowledge and skills gained through the structured IPE clinical placement. Conclusions: Findings suggest that structured IPE clinical placements may provide students with valuable collaborative learning opportunities, enhanced respect for other professionals, and insight into the value of IPC in healthcare delivery. More research is needed to explore other factors that influence specific perceptions among physical therapy students.

RÉSUMÉ Objectif : Analyser comment un stage clinique en formation interprofessionnelle structuré peut influencer les perceptions des étudiants professionnels de la santé face à la collaboration interprofessionnelle, en comparaison avec celles des étudiants qui réalisent un stage clinique traditionnel. Méthodes : Des méthodes mixtes ont été utilisées. L'échelle de perception en éducation interdisciplinaire (IEPS) a été administrée aux étudiants professionnels de la santé de deux hôpitaux de Toronto (n=36) avant et après un stage clinique en formation interprofessionnelle de 5 semaines afin d'analyser les changements dans leur perception de la collaboration interprofessionnelle. Les étudiants en stage clinique traditionnel (n=28) ont été utilisés comme groupe de contrôle. Des groupes de discussion ont ensuite été organisés avec sept étudiants qui ont participé au stage clinique interprofessionnel. Une structure de codage a d'abord été conçue, et les résultats qualitatifs ont été utilisés pour expliquer les conclusions quantitatives. Résultats : Il n'y a pas eu de différences statistiques entre les groupes après le stage clinique interdisciplinaire, mais le groupe d'intervention a démontré une tendance plus positive dans l'échelle IEPS (Interdisciplinary Education Perception Scale, ou échelle de perception en éducation interdisciplinaire) entre le début du stage et le suivi. Les données qualitatives suggèrent que les étudiants étaient sensibles à la valeur des connaissances et des habiletés acquises dans le cadre du stage interprofessionnel structuré. Conclusions : Les conclusions suggèrent que les stages cliniques en formation interprofessionnelle structurés peuvent faire en sorte que les étudiants bénéficient de possibilités d'apprentissage interprofessionnel valables, acquièrent plus de respect pour les autres professionnels et soient plus conscients de la valeur de la collaboration interprofessionnelle dans la prestation de soins. Plus de recherches seront nécessaires pour explorer d'autres facteurs susceptibles d'influencer les perceptions précises des étudiants en physiothérapie.

"They put you on your toes": Physical Therapists' Perceived Benefits from and Barriers to Supervising Students in the Clinical Setting.

PURPOSE: To identify the perceived benefits of and barriers to clinical supervision of physical therapy (PT) students. METHOD: In this qualitative descriptive study, three focus groups and six key-informant interviews were conducted with clinical physical therapists or administrators working in acute care, orthopaedic rehabilitation, or complex continuing care. Data were coded and analyzed for common ideas using a constant comparison approach. RESULTS: Perceived barriers to supervising students tended to be extrinsic: time and space constraints, challenging or difficult students, and decreased autonomy or flexibility for the clinical physical therapists. Benefits tended to be intrinsic: teaching provided personal gratification by promoting reflective practice and exposing clinical educators to current knowledge. The culture of different health care institutions was an important factor in therapists' perceptions of student supervision. CONCLUSIONS: Despite different disciplines and models of supervision, there is considerable synchronicity in the issues reported by physical therapists and other disciplines. Embedding the value of clinical teaching in the institution, along with strong communication links among academic partners, institutions, and potential clinical faculty, may mitigate barriers and increase the commitment and satisfaction of teaching staff.