Publications by authors named "Koshila Kumar"

22 Publications

  • Page 1 of 1

Clinical supervisors' perspectives of factors influencing clinical learning experience of nursing students from culturally and linguistically diverse backgrounds during placement: A qualitative study.

Nurse Educ Today 2021 Apr 26;102:104934. Epub 2021 Apr 26.

University of New England, New South Wales, Australia. Electronic address:

Background: Undergraduate nursing students from culturally and linguistically diverse backgrounds experience unique challenges with their learning needs during clinical placements. There is limited research on clinical supervisors' perspectives of the factors impacting clinical learning experience of nursing students from culturally and linguistically diverse backgrounds during placement.

Objectives: This study sought to identify clinical supervisors' perspectives of the factors impacting on the clinical learning experience of nursing students from culturally and linguistically diverse backgrounds and strategies to overcome challenges.

Design: A qualitative research design using semi-structured interviews.

Methods: Nine nurses who had experience supervising culturally and linguistically diverse nursing students were interviewed as part of data collection. Thematic analysis was used for data interpretation.

Results: Identified factors include: Poor proficiency in English language, unfamiliarity with Australian slang and medical terminologies, cultural expectations interfering with professional responsibilities, incongruity with teaching delivery and learning style, short duration of placement, inconsistency with preceptor allocation and inadequate preceptor training.

Conclusion: Recommendations to facilitate the learning of nursing students from culturally and linguistically diverse (CALD) backgrounds on clinical placement include flexibility with assessments, modifying teaching styles according to learning needs, providing appropriate orientation, creating a welcoming environment, providing consistency with allocation of preceptors, and providing appropriate training for preceptors. Inconsistency in preceptor allocation was reported to have a negative influence on CALD student learning. A collaborative approach between Universities and the health care settings is essential in assisting clinical supervisors to address the unique learning needs of nursing students from culturally and linguistically diverse backgrounds while on clinical placement.
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http://dx.doi.org/10.1016/j.nedt.2021.104934DOI Listing
April 2021

Importance of research higher degree training availability in rural and remote regions.

Aust J Rural Health 2021 Apr 8. Epub 2021 Apr 8.

Prideaux Centre for Research in Health Professions Education, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.

Aims: This commentary contends that research by higher degree research training is a sustainable strategy for capacity building the rural and remote health research workforce, provided they have equitable opportunity for access, participation and attainment.

Context: The path for health professionals into academic roles, particularly in rural and remote areas, can be fraught. A strong research skill set might not form a significant component of a clinician's prior experience. Concurrently, university academic positions usually include the PhD as an essential qualification which is misaligned with the experience and skills of rural and remote applicants who are otherwise well-qualified.

Approach: Higher degree researches are one mechanism for extending the research expertise and capabilities. However, non-traditional and remotely located cohorts such as the rural and remote health research workforce can face barriers to accessing, participating in and successfully completing formal research training. Barriers include the prevalence of the apprenticeship model of research training grounded in assumptions of colocation and face-to-face learning and supervision and a focus on the binary relationship between supervisors and students. In this commentary, the authors call for greater flexibility and equity in the higher degree research training system to cater for health professionals located in rural and remote practice contexts.

Conclusion: Institutional investment in, and commitment to, a truly distributed higher degree research model would ensure a stronger rural and remote workforce who can aspire to a range of career options and thereby positively impacting on the health and research outcomes for rural and remote Australia.
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http://dx.doi.org/10.1111/ajr.12710DOI Listing
April 2021

Navigating the qualitative manuscript writing process: some tips for authors and reviewers.

BMC Med Educ 2020 11 16;20(1):439. Epub 2020 Nov 16.

Division of Medical Education, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, M13 9NT, Manchester, UK.

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http://dx.doi.org/10.1186/s12909-020-02370-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7668005PMC
November 2020

Health Professions Educators' System-Oriented Roles as Educational Advocate, Quality Improver, and Broker.

J Contin Educ Health Prof 2020 ;40(3):176-181

Dr. Kumar: Senior Lecturer and Course Coordinator of the Postgraduate Programs in Clinical Education, Prideaux Centre for Research in Health Professions Education, College of Medicine and Public Health, Flinders University, Adelaide, Australia, and a Fellow of the Australian & New Zealand Association for Health Professional Educators (ANZAHPE). Dr. Schoo: Academic Status Holder, Prideaux Centre for Research in Health Professions Education, College of Medicine and Public Health, Flinders University, Adelaide, Australia, and a Fellow of the Australian & New Zealand Association for Health Professional Educators (ANZAHPE).

Introduction: Health professionals have many facets to their educational role. Although the teaching and student support dimensions of health professionals' educational role are highly visible in the literature, other nontraditional elements are not. This study presents a broader conceptualization of health professionals' educational role, with a focus on the strategic dimensions of their role.

Methods: Participants were health professionals from different clinical backgrounds and teaching settings, with a formal role in education. Data were collected using a survey (n = 41) and interviews (n = 9), and this article focuses on reporting the qualitative findings of this study. Thematic analysis was used for data interpretation.

Results: Health professionals have three strategic dimensions to their educational role. The first strategic dimension is educational advocacy, which is aimed at championing education at different levels and parts of the educational system and building educational capacity. The second strategic dimension is educational quality improvement which is focused on shifting narratives around education and educational change in health service settings and leveraging educational evidence. The final strategic dimension is educational brokerage which is oriented at connecting clinical and educational communities and building trust and consensus.

Discussion: Beyond the microlevel of learning and teaching, health professionals engage in strategic work that is focused on the broader educational mission within health. Continuing professional development initiatives can empower health professionals to optimize these strategic and system-focused educational roles and responsibilities.
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http://dx.doi.org/10.1097/CEH.0000000000000309DOI Listing
January 2020

Education Needs of Australian Flight Nurses: A Qualitative Study.

Air Med J 2020 May - Jun;39(3):178-182. Epub 2020 Feb 29.

Prideaux Centre for Research in Health Professions Education, Flinders University, Adelaide, South Australia, Australia.

Objective: Flight nurses work in physically challenging environments, often alone, in the confines of moving aircraft at altitudes with limited resources. Although this challenging environment has been previously described, there are no Australian studies that outline flight nurses' learning needs and the education activities they find useful in learning about their role.

Methods: This was a qualitative exploratory study using one-on-one interviews with 8 currently practicing flight nurses from 1 air medical retrieval organization. Data were analyzed thematically.

Results: Four key themes emerged: flight nurses need to learn how to work autonomously in a resource-constrained air medical environment, flight nurses need to learn how to develop physical and mental resilience to work in the air medical environment, flight nurses need to learn nontechnical skills such as flexibility and adaptability, and flight nurses learn how to perform in their role through formal and informal learning strategies.

Conclusion: Existing clinical knowledge aids decision making as a sole practitioner in the resource-limited air medical environment. Previously unreported nontechnical skills of mental resilience, adaptability, and flexibility were highlighted. Flight nurses learn how to prepare for their role through simulation, case reviews, in situ observation through buddy flights, and a range of socially situated learning activities.
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http://dx.doi.org/10.1016/j.amj.2020.02.001DOI Listing
February 2020

The clinical educator and complexity: a review.

Clin Teach 2018 08 8;15(4):287-293. Epub 2018 Feb 8.

Prideaux Centre for Research in Health Professions Education, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.

Background: Complexity science perspectives have helped in examining fundamental assumptions about learning and teaching in the health professions. The implications of complexity thinking for how we understand the role and development of the clinical educator is less well articulated. This review article outlines: the key principles of complexity science; a conceptual model that situates the clinical educator in a complex system; and the implications for the individual, organisation and the system.

Key Findings: Our conceptual model situates the clinical educator at the centre of a complex and dynamic system spanning four domains and multiple levels. The four domains are: personal (encompassing personal/professional needs and expectations); health services (health agencies and their consumers); educational (educational institutions and their health students); and societal (local community/region and government). The system also comprises: micro or individual, meso or organisational, and macro or socio-political levels.

Conclusion: Our model highlights that clinical educators are situated within a complex system comprising different agents and connections. It emphasises that individuals, teams and organisations need to recognise and be responsive to the unpredictability, interconnectedness and evolving nature of this system. Importantly, our article also calls for an epistemological shift from faculty development to capacity building in health professions education, aimed at developing individual, team, organisational and system capabilities to work with(in) complexity. Clinical educators are situated within a complex system comprising different agents and connections.
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http://dx.doi.org/10.1111/tct.12757DOI Listing
August 2018

Learning on the fly: How rural junior doctors learn during consultations with retrieval physicians.

Emerg Med Australas 2017 Jun 8;29(3):342-347. Epub 2017 Mar 8.

Adult Retrieval Victoria, Melbourne, Victoria, Australia.

Objective: This study explores how rural junior doctors learn while consulting retrieval physicians about critically ill and injured patients, as well as the tensions characterising teaching and learning in this setting.

Methods: Data were collected via three focus groups, involving rural junior doctors (n = 8), rural senior doctors (n = 3) and retrievalists (n = 3). The discussions were transcribed and subject to multistage coding.

Results: Rural junior doctors believe they learn from interactions with retrieval physicians. Their learning was greatest when the retrieval physician explained his or her clinical reasoning and provided feedback. The level of stress was sometimes overwhelming and learning ceased. Both groups described limited time for teaching due to the medical needs of the patient and the needs of concurrent patients. Retrieval physicians were not certain that rural junior doctors wanted to learn. Rural junior doctors hold retrievalists in very high regard.

Conclusion: Support provided by retrievalists extends the abilities of the junior doctors and often results in learning. When junior doctors are extended too far, they become overwhelmed and learning ceases. Junior doctors would like the retrievalists to spend more time explaining their actions and providing feedback. Even when both retrievalists and junior doctors are interested in teaching, it may not occur due to misunderstandings and differences in status.
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http://dx.doi.org/10.1111/1742-6723.12754DOI Listing
June 2017

A qualitative exploration of anesthesia trainees' experiences during transition to a children's hospital.

Paediatr Anaesth 2017 Mar 22;27(3):263-270. Epub 2016 Nov 22.

Flinders University Rural Clinical School, Flinders University, Adelaide, SA, Australia.

Background: The stresses of starting a new job can make anyone feel tired and inefficient. In health care, this may impair the ability to learn at a time when there is most to learn, and increase the risk of error in a context where errors may lead to patient harm.

Aim: The aim of this study was to understand issues which influence anesthesia trainees' transition to a pediatric setting.

Methods: This qualitative study utilized in-depth semi-structured interviews to gather data from 31 anesthesia trainees who had commenced work at a tertiary children's hospital between 4 and 6 weeks previously. Data were examined using thematic analysis.

Results: Two key themes were identified: feeling ineffective, which appeared to have both a cognitive component (feeling disoriented) and an emotional component (feeling useless), and feeling anxious or afraid. Trainees found the pediatric environment highly unfamiliar, which made them feel disoriented, inefficient, and at times incompetent. Many experienced difficulty identifying a useful role in a highly specialized area of practice, leading to loss of identity as an expert clinician. Many described an ever-present fear of making an anesthetic error or being unable to manage a rapidly evolving clinical situation. Some trainees developed a negative mindset, which was reinforced by subsequent perceived failures. Overall, these experiences impeded trainees' ability to concentrate and learn.

Conclusions: The impact of disorientation and anxiety on anesthesia trainees as they adapt to a highly specialized clinical environment such as a children's hospital should not be underestimated. Study findings illustrate the importance of helping new trainees to feel less afraid, more useful, and more realistic in assessing their own performance during the transition period.
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http://dx.doi.org/10.1111/pan.13064DOI Listing
March 2017

Factors shaping how clinical educators use their educational knowledge and skills in the clinical workplace: a qualitative study.

BMC Med Educ 2016 Feb 18;16:68. Epub 2016 Feb 18.

Flinders University Rural Clinical School, Flinders University, GPO Box 2001, Adelaide, 5001, South Australia, Australia.

Background: In order to consolidate their educational knowledge and skills and develop their educational role, many clinicians undertake professional development in clinical education and supervision. It is well established that these educationally-focussed professional development activities have a positive impact. However, it is less clear what factors within the clinical workplace can shape how health professionals may use and apply their educational knowledge and skills and undertake their educational role. Looking through the lens of workplace affordances, this paper draws attention to the contextual, personal and interactional factors that impact on how clinical educators integrate their educational knowledge and skills into the practice setting, and undertake their educational role.

Methods: Data were gathered via a survey of 387 clinical educators and semi-structured interviews with 12 clinical educators and 6 workplace managers. In this paper, we focus on analysing and reporting the qualitative data gathered in this study. This qualitative data were subject to a thematic analysis and guided by theoretical constructs related to workplace affordances.

Results: Three key themes were identified including contextual, personal and interactional factors. Contextual elements referred to organisational structures and systems that impact on participants' educational role, how participants' clinical education role was articulated and configured within the organisation, and how the organisation shaped the educational opportunities available to clinicians. Personal factors encompassed clinicians' personal motivations and goals to teach and be involved in education, develop their own educational skills and function as a role model for students. Interactional factors referred to the professional interactions and networks through which clinicians shared their educational knowledge and skills and further consolidated their profile as educational advocates in their workplace.

Conclusions: There are a number of contextual, personal and interactional factors which interrelate in complex ways and impact on how clinical educators use their educational knowledge and skills and undertake their educational role in the clinical setting. To fully realise the potential of and fulfil the requirements of their educational role, clinical educators need to be provided appropriate experiential and meaningful workplace opportunities and the guidance to use, share and reflect on their educational knowledge and skills in the clinical workplace.
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http://dx.doi.org/10.1186/s12909-016-0590-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4758173PMC
February 2016

Student learning in interprofessional practice-based environments: what does theory say?

BMC Med Educ 2015 Nov 26;15:211. Epub 2015 Nov 26.

Flinders University Rural Clinical School, Adelaide, Australia.

Student learning in interprofessional practice-based environments has garnered significant attention in the last decade, and is reflected in a corresponding increase in published literature on the topic. We review the current empirical literature with specific attention to the theoretical frameworks that have been used to illustrate how and why student learning occurs in interprofessional practice-based environments. Our findings show there are relatively few theoretical-based studies available to guide educators and researchers alike. We recommend a more considered and consistent use of theory and suggest that professional identity and socio-cultural frameworks offer promising avenues for advancing understandings of student learning and professional identity development within interprofessional practice-based environments.
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http://dx.doi.org/10.1186/s12909-015-0492-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4662027PMC
November 2015

Rural and remote young people's health career decision making within a health workforce development program: a qualitative exploration.

Rural Remote Health 2015 Oct-Dec;15(4):3303. Epub 2015 Nov 11.

Sydney Medical School-Northern, The University of Sydney, Sydney, New South Wales, Australia .

Introduction: One strategy aimed at resolving ongoing health workforce shortages in rural and remote settings has been to implement workforce development initiatives involving the early activation and development of health career aspirations and intentions among young people in these settings. This strategy aligns with the considerable evidence showing that rural background is a strong predictor of rural practice intentions and preferences. The Broken Hill Regional Health Career Academy Program (BHRHCAP) is an initiative aimed at addressing local health workforce challenges by helping young people in the region develop and further their health career aspirations and goals. This article reports the factors impacting on rural and remote youths' health career decision-making within the context of a health workforce development program.

Methods: Data were collected using interviews and focus groups with a range of stakeholders involved in the BHRHCAP including local secondary school students, secondary school teachers, career advisors, school principals, parents, and pre-graduate health students undertaking a clinical placement in Broken Hill, and local clinicians. Data interpretation was informed by the theoretical constructs articulated within socio cognitive career theory.

Results: Young people's career decision-making in the context of a local health workforce development program was influenced by a range of personal, contextual and experiential factors. These included personal factors related to young people's career goals and motivations and their confidence to engage in career decision-making, contextual factors related to BHRHCAP program design and structure as well as the visibility and accessibility of health career pathways in a rural setting, and experiential factors related to the interaction and engagement between young people and role models or influential others in the health and education sectors.

Conclusions: This study provided theoretical insight into the broader range of interrelating and complex personal, contextual and experiential factors impacting on rural and remote youths' career decision-making within a health workforce development initiative.
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July 2016

"It Was Definitely Very Different": An evaluation of palliative care teaching to medical students using a mixed methods approach.

J Palliat Care 2015 ;31(1):21-8

Given our ageing population and the increase in chronic disease, palliative care will become an increasingly important part of doctors' workloads, with implications for palliative care education. This study used a mixed methods strategy to evaluate second-year medical students' learning outcomes and experiences within a palliative care education program. Analysis of pre- and post-test scores showed a significant improvement in students' attitudinal scores, but no change in knowledge as measured by multiple-choice questions. Analysis of qualitative data revealed that students' learning experience was marked by a lack of clear learning objectives and experiential learning opportunities. Students also reported divergent reactions to death and dying and noted that palliative care was different from other areas of clinical medicine. This study revealed that palliative care teaching results in improved attitudes toward palliative care, reflecting the holistic and patient-focused nature of the palliative care curriculum.
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http://dx.doi.org/10.1177/082585971503100104DOI Listing
October 2015

The multiple spaces for health professional students' learning.

Med Educ 2015 Sep;49(9):946

Academic GP Unit, Sydney Medical School-Northern, University of Sydney, Sydney, NSW, Australia.

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http://dx.doi.org/10.1111/medu.12790DOI Listing
September 2015

Perceptions of Indonesian general practitioners in maintaining standards of medical practice at a time of health reform.

Fam Pract 2015 Oct 9;32(5):584-90. Epub 2015 Jul 9.

Flinders University Rural Clinical School, Flinders University, Adelaide, Australia.

Background: There is little research on how GPs experience the demands of maintaining standards of medical practice in developing countries and what strategies might improve their capability to provide high-quality primary health care (PHC).

Objective: This study aims to explore the underlying factors, which shape GPs' experience within the Indonesian PHC system and impact on their experience of professional practice.

Methods: A grounded theory approach was applied using semi-structured interviews of 25 purposively selected GPs in West Sumatra, Indonesia. The interviews were analysed inductively through an iterative process of the interplay between empirical data, emerging analysis and theory development.

Results: Three major health care systems attribute shaped GPs' experiences of professional practice, including (i) a restricted concept of the PHC system, (ii) lack of regulation of private primary care practice conducted by GPs, midwives, nurses and specialists and (iii) low coverage and inappropriate policy of the health insurance system.

Conclusion: The findings indicate that a major revision of current health care system is required with a focus on promoting the concept of PHC services to the population, redefining the role of the GP to deliver recognised best practice within available resources, changing the way GPs are remunerated by the public health system and the health insurance industry, policing of the regulations related to the scope of practice of other health care professionals, particularly midwives and nurses, and regulation of prescribing. GPs can be the champions of the PHC service that Indonesia needs, but it requires sustained systematic change.
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http://dx.doi.org/10.1093/fampra/cmv057DOI Listing
October 2015

An exploratory review of pre-qualification interprofessional education evaluations.

J Interprof Care 2015 28;29(4):292-7. Epub 2014 Nov 28.

UTS , Sydney , Australia .

There are diverse perceptions about the primary purpose of evaluation. In interprofessional education (IPE), there has been a perceived focus on evaluating against the outcome of improved collaborative practice and quality of care. This paper presents an exploration of the nature and purpose of evaluation methods commonly utilized in the IPE literature with its focus on outcomes-based evaluation and particularly the Kirkpatrick framework. It categorises recent evaluations of pre-qualification (pre-certification) IPE interventions. Of the 90 studies included, most evaluated soon after the educational intervention, only five specifically referred to an evaluation framework and the most frequently used tool was the RIPLS. There was a noteworthy reliance on students' self-rated perceptions of their attitudes towards collaborative practice collected through surveys, focus groups and interviews. There appears to be a need to reconsider the type of evaluation required. In conclusion, this paper offers recommendations for evaluation practice that is moving towards realist approaches; describes the longer term effects of interventions on attitudes and behaviour; develops and validates data collection tools including direct observation of practice and more comprehensively engages with all stakeholders to ensure that evaluation activities are not only focused on improving IPE but also on enhancing our understanding of interprofessional practice.
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http://dx.doi.org/10.3109/13561820.2014.985292DOI Listing
December 2016

What factors in rural and remote extended clinical placements may contribute to preparedness for practice from the perspective of students and clinicians?

Med Teach 2013 Nov 12;35(11):900-7. Epub 2013 Aug 12.

Broken Hill University Department of Rural Health, University of Sydney , Australia.

Background: Community-based rural education opportunities have expanded in Australia, attracting more medical students to placements in rural and remote settings.

Aim: To identify the factors in an integrated, community-engaged rural placement that may contribute to preparedness for practice (P4P) from the perspective of students and clinicians.

Method: Forty-two semi-structured interviews with medical students, supervisors and clinicians analysed thematically.

Results: Opportunities for clinical learning, personal and professional development and cultural awareness were reported by students and clinicians as key factors that contribute to P4P. Potential barriers in rural and remote settings included geographical and academic isolation, perceived educational risk and differing degrees of program engagement.

Conclusions: A longitudinal clinical placement in a rural setting may enable development of enhanced competencies leading to P4P. A rural setting can provide a unique experience through hands-on learning, enhanced personal and professional development opportunities and observation of the cultural and contextual impact on health.
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http://dx.doi.org/10.3109/0142159X.2013.820274DOI Listing
November 2013

Longitudinal integrated rural placements: a social learning systems perspective.

Med Educ 2013 Apr;47(4):352-61

Broken Hill University Department of Rural Health and Centre of Research Excellence in Rural and Remote Primary Health Care, University of Sydney, Broken Hill, New South Wales, Australia.

Objectives: There is currently little theoretically informed exploration of how non-traditional clinical placement programmes that are longitudinal, immersive, based on community-engaged education principles and located in rural and remote settings may contribute to medical student learning. This paper aims to theoretically illustrate the pedagogical and socio-cultural underpinnings of student learning within a longitudinal, integrated, community-engaged rural placement.

Methods: Data collected using semi-structured interviews with medical students, their supervisors and other health clinicians participating in a longitudinal rural placement programme were analysed using framework analysis. Data interpretation was informed by the theory of social learning systems (SLSs).

Results: In a longitudinal, rural clinical placement students participate in an SLS with distinct yet interrelated learning spaces that contain embedded communities of practice (CoPs). These spaces are characterised by varying degrees of formality, membership and interaction, and different learning opportunities and experiences. They are situated within and shaped by a unique geography of place comprising the physical and social features of the placement setting. Within these learning spaces, students acquire clinical knowledge, skills and competencies, professional attitudes, behaviours and professional values. The process of connectivity helps explain how students access and cross the boundaries between these learning spaces and develop a more complex sense of professional identity.

Conclusions: Longitudinal, integrated clinical placement models can be understood as SLSs comprising synergistic and complementary learning spaces, in which students engage and participate in multiple CoPs. This occurs in a context shaped by unique influences of the geography of place. This engagement provides for a range of student learning experiences, which contribute to clinical learning and the development of a more sophisticated professional identity. A range of pedagogical and practical strategies can be embedded within this SLS to enhance student learning.
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http://dx.doi.org/10.1111/medu.12097DOI Listing
April 2013

A longitudinal integrated placement and medical students' intentions to practise rurally.

Med Educ 2012 Feb;46(2):179-91

Academic GP Unit, Sydney Medical School - Northern, University of Sydney, New South Wales, Australia.

Context: Integrated longitudinal rural placements are designed to promote favourable student attitudes towards and facilitate return to rural practice upon graduation. We explored the impact of an integrated placement on medical students' attitudes towards rural practice.

Methods: Data were available from interviews with 10 medical students, 15 clinical supervisors and teachers, three community health staff, and focus groups made up of medical students. Socio-cognitive career theory gave insight into the personal, contextual and experiential factors, as well as the career barriers, that influence students' rural practice intentions. Framework analysis was used to develop a thematic framework illustrating the key findings.

Results: The longitudinal placement enabled students to achieve personal goals, and enhanced self-efficacy beliefs and orientation towards the complex personal and professional demands of rural practice. The informal curriculum, including multifaceted interactions with patients and their families, clinical teachers and other health care staff, was a vital experiential component. Students assimilated these rich experiences into their practice and evolving notions of professional identity as rural practitioners. Some students had little intention of practising rurally, partly as a result of contextual barriers such as geographic isolation, family and relationship needs, restricted postgraduate training opportunities and limited opportunities for specialist practice.

Conclusions: The richness of the informal curriculum in a longitudinal rural placement powerfully influenced students' intentions to practise rurally. It provided an important context for learning and evolving notions of professionalism and rural professional identity. This richness could be reinforced by developing formal curricula using educational activities based around service-led and interprofessional learning. To overcome the contextual barriers, the rural workforce development model needs to focus on socialising medical students into rural and remote medicine. More generic issues include student selection, further expansion of structured vocational training pathways that vertically integrate with longitudinal rural placements and the maintenance of rurally focused support throughout postgraduate training.
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http://dx.doi.org/10.1111/j.1365-2923.2011.04102.xDOI Listing
February 2012

Entering and navigating academic medicine: academic clinician-educators' experiences.

Med Educ 2011 May;45(5):497-503

Office of Medical Education, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.

Objectives: Despite a recognised need for richer narratives about academic medicine, much of the literature is limited to an analysis of the enablers and barriers associated with recruitment and retention, and focuses on analysing the development of research career pathways. We explored academic clinician-educators' experiences of entering into and navigating academic medicine, with a particular focus on those who privilege teaching above research.

Methods: Data were collected through interviews and focus groups conducted across a medical school at one Australian university. We used socio-cognitive career theory to provide theoretical insight into the factors that influence academic clinician-educators' interests, choice and motivations regarding entering and pursuing a teaching pathway within academic medicine. Framework analysis was used to illustrate key themes in the data.

Results: We identified a number of themes related to academic clinician-educators' engagement and performance within an academic medicine career focused on teaching. These include contextual factors associated with how academic medicine is structured as a discipline, cultural perceptions regarding what constitutes legitimate practice in academia, experiential factors associated with the opportunity to develop a professional identity commensurate with being an educator, and socialisation practices.

Conclusions: The emphasis on research in academia can engender feelings of marginalisation and lack of credibility for those clinicians who favour teaching over research. The prevailing focus on supporting and socialising clinicians in research will need to change substantially to facilitate the rise of the academic clinician-educator.
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http://dx.doi.org/10.1111/j.1365-2923.2010.03887.xDOI Listing
May 2011

Experiences of the multiple mini-interview: a qualitative analysis.

Med Educ 2009 Apr;43(4):360-7

Office of Postgraduate Medical Education, University of Sydney, New South Wales 2006, Australia.

Context: Multiple mini-interviews (MMIs) are increasingly used in high-stakes medical school selection. Yet there is little published research about participants' experiences and understandings of the process. We report the findings from an international qualitative study on candidate and interviewer experiences of the MMI for entry into a graduate-entry medical school.

Methods: Qualitative data from six interviewer focus groups and 442 candidate and 75 interviewer surveys were analysed using framework analysis. Multiple researchers (n = 3) analysed a proportion of the data and developed a thematic framework capturing content-related (i.e. what was said) themes that emerged from the data. This thematic framework was then used to code the complete dataset.

Results: Several key themes were identified, including participants' perspectives on having: (i) a one-to-one interview; (ii) multiple assessment opportunities; (iii) a standardised, scenario-based interview; (iv) a mini-interview, and on (v) the attributes currently measured by the MMI, and (vi) other attributes that should be assessed.

Conclusions: We gained a deeper understanding of participants' experiences of a high-stakes, decision-making process for selection into a graduate-entry medical school. We discuss our findings in the light of the existing literature and make recommendations to address the issue of differing participant expectations and understandings of the MMI, and to improve the credibility and acceptability of the process.
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http://dx.doi.org/10.1111/j.1365-2923.2009.03291.xDOI Listing
April 2009

Factors affecting the utility of the multiple mini-interview in selecting candidates for graduate-entry medical school.

Med Educ 2008 Apr;42(4):396-404

Centre for Innovation in Professional Health Education and Research, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.

Context: We wished to determine which factors are important in ensuring interviewers are able to make reliable and valid decisions about the non-cognitive characteristics of candidates when selecting candidates for entry into a graduate-entry medical programme using the multiple mini-interview (MMI).

Methods: Data came from a high-stakes admissions procedure. Content validity was assured by using a framework based on international criteria for sampling the behaviours expected of entry-level students. A variance components analysis was used to estimate the reliability and sources of measurement error. Further modelling was used to estimate the optimal configurations for future MMI iterations.

Results: This study refers to 485 candidates, 155 interviewers and 21 questions taken from a pre- prepared bank. For a single MMI question and 1 assessor, 22% of the variance between scores reflected candidate-to-candidate variation. The reliability for an 8-question MMI was 0.7; to achieve 0.8 would require 14 questions. Typical inter-question correlations ranged from 0.08 to 0.38. A disattenuated correlation with the Graduate Australian Medical School Admissions Test (GAMSAT) subsection 'Reasoning in Humanities and Social Sciences' was 0.26.

Conclusions: The MMI is a moderately reliable method of assessment. The largest source of error relates to aspects of interviewer subjectivity, suggesting interviewer training would be beneficial. Candidate performance on 1 question does not correlate strongly with performance on another question, demonstrating the importance of context specificity. The MMI needs to be sufficiently long for precise comparison for ranking purposes. We supported the validity of the MMI by showing a small positive correlation with GAMSAT section scores.
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http://dx.doi.org/10.1111/j.1365-2923.2008.03018.xDOI Listing
April 2008

Online CME: an effective alternative to face-to-face delivery.

Med Teach 2007 Oct;29(8):e251-7

Faculty of Pharmacy, University of Sydney, NSW, Australia.

Background: The Pharmacotherapies Accreditation Course (PAC) is a continuing medical education (CME) course designed to prepare practitioners for accreditation as pharmacotherapies prescribers for opioid dependence. The course incorporates a preparation stage, a workshop stage and a clinical placement component. The PAC continues to be successfully delivered in face-to-face mode since 2001. From 2003 onwards, an online alternative of the PAC was also implemented.

Aims: The aim of this study was to evaluate the effectiveness of an online alternative to an existing face-to-face CME workshop in preparing practitioners for accreditation as a pharmacotherapies prescriber for opioid dependence.

Methods: Participants were 62 practitioners who undertook the PAC between 2003 and 2006. A pretest/posttest-control group design was used, with outcome measures across the domains of knowledge, skill, and attitudes, together with a course feedback survey for both the online and face-to-face modes of the course.

Results: Results demonstrate that the online CME mode was equally as effective as the face-to face mode in preparing participants for their role in the treatment and management of opioid dependence, and was also rated highly by participants.

Conclusions: The findings have implications for the effective design and delivery of e-learning environments for professional practice, in terms of equipping participants with requisite clinical knowledge and skills and facilitating the development of attitudes congruent with professional practice.
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http://dx.doi.org/10.1080/01421590701551698DOI Listing
October 2007