Health Education in Practice: Journal of Research for Professional Learning

From the Editor

kichu Nair — 2024-02-13

Welcome to the 7^th Volume of the Health Education in Practice: Journal of Research for Professional Learning (HEPJ).

We are pleased to open the first volume of HEPJ published under a continuous publication model.

The continuous publication model will allow us to maintain our commitment to increase the visibility of the knowledge published on HEPJ by expediting its dissemination, with articles being published as soon as they undergo our rigorous process of peer review and production. By eliminating the need to wait for a predetermined number of articles to form a volume, we aim to provide authors with the immediacy they desire and, consequently, increase the likelihood of their work receiving timely citations.

I hope you enjoy reading our journal and I look forward to sharing more papers in this volume in the coming months.

ISBAR+ a communication tool to advocate for patients

Matthew Links — 2024-02-13

Introduction

Recognising the importance of social determinants of health is a key part of the curriculum for health practitioners. The ability to advocate on behalf of patients is a competency that demonstrates enacting this understanding in practice. Communication frameworks are used to structure difficult conversations in multiple settings, notably handover. There is no commonly accepted communication framework to structure a patient advocacy conversation.

Approach

We assembled a team with skills in patient advocacy, healthcare communication, community advocacy, education and business negotiation to identify the knowledge, skills and attitudes required and to develop a framework suitable for this purpose. We chose to adapt the ISBAR framework as an existing communication framework commonly used for handover.

Outcomes

ISBAR+ is a framework that is based on a person-centred approach and ‘integrated negotiation’. ‘Intention and Inquiry’ involves a compassionate understanding of the patient’s position. ‘Situation’ is a succinct framing of the problem. ‘Background’ is the information required for the decision-maker to make a person-centred decision. The next step is ‘alignment’ of the priorities of the patient, practitioner and decision-maker. ‘Response’ is the proposed solution, and ‘+’ (‘plus’) is the actions taken for implementation.

Conclusions

ISBAR+ provides a framework for conversations advocating on behalf of patients that draws from the literature around advocacy inside and outside health. A communication framework allows the development and evaluation of interventions to teach and promote this critical function to promote person-centred care.

GP registrars' deprescribing in older patients: a non-randomised controlled study.

Amanda Tapley — 2024-03-13

Purpose: To evaluate the effect of a multi-component educational program aimed at improving general practitioner (GP) trainees’ (registrars') deprescribing in patients 65 years and over. The hypothesis was that an educational program would increase registrars' deprescribing of potentially inappropriate medicines (PIMs) in older patients, relative to a control group, six months post-education.

Design: This was a pragmatic, non-randomised, non-equivalent control group design nested within an ongoing cohort study of registrars' practice (the ReCEnT study). The program consisted of an online module, face-to-face sessions for registrars, webinars for their supervisors, and facilitation of the registrar–supervisor dyad, including case-based discussions of deprescribing in teaching meetings. The program was underpinned by the Behaviour Change Wheel framework and delivered to registrars of a single registrar educational/training organisation (other educational/training organisations served as controls). Primary outcome measures were deprescribing any medicines and deprescribing medicines categorised as PIMs. Secondary outcomes were deprescribing of medications taken for three months or more and dose reduction with a view to deprescribing (cessation).

Findings: Data from 779 education-receiving registrars and 438 control registrars were analysed. Intervention group registrars showed no significant increase in deprescribing of any medication compared to controls (interaction aOR 1.00 (95%CI 0.69, 1.46) or of PIMs (aOR 1.29 (95%CI 0.74, 2.24), or significant changes in secondary outcomes.

Research implications: Despite no differences in prescribing, in this analysis, six months post-intervention, aspects of the findings suggest extended observation and further evaluation may be indicated.

Practical implications: The continuation of education for registrars around deprescribing of PIMs is essential. Further investigation is required to assess the effectiveness and efficiency of the behaviour change approach adopted in this study.

Originality/value: The multi-component behaviour change theory-based approach is novel for this educational setting, and this is an initial step in evaluating the approach.

Limitations: The major limitation is that randomisation in the study design was not practicable.

Online learning for allied health knowledge translation: A systematic review

Anna Joy — 2024-04-05

Purpose: To synthesise evidence on the effectiveness of online learning platforms for facilitating knowledge translation in allied health professionals.

Methodology: A systematic review of the literature searched three databases (Medline-OVID, CINAHL, Embase) in November 2023 for studies measuring outcomes of knowledge translation initiatives targeting allied health professionals delivered using online learning platforms. Papers were eligible if allied health professionals made up at least 50% of the sample, most of the learning component was online, and comparative data was reported. Data were extracted using a customised form. Quality of studies was appraised using the Downs and Black checklist. Meta-analyses were conducted where sufficient homogenous data were available.

Findings: Twenty-three studies published over a 13-year period were included in this review primarily using pre-post study designs. All reported improvements in either knowledge, skill and/or confidence, with an meta-analysis (n=9 studies) showing a significant increase in knowledge gain after exposure to online learning (SMD 1.39; 95% CI = 0.96-1.83). However, there is little evidence that participation in online learning is associated with a change in clinical practice.

Research Implications: This study supports previous research that online learning can improve knowledge but highlights a need for more rigorous studies addressing the impacts on behaviour change.

Practical Implications: Online learning is an effective way of improving knowledge, skill and/or confidence but additional knowledge translation strategies may be needed to lead to a behaviour change.

Originality/Value: Synthesis of current knowledge of the value and limitations of online learning as a tool to facilitate the implementation of evidence into practice in the allied health professions.

Limitations: This review was limited to studies published in the English language only. The quality of studies in this field is low. Few studies measure behaviour change.

Changing how ‘rural’ is understood in health professional education

Margaret Adams — 2024-04-18

Purpose: For students enrolled in tertiary education courses, learning to work rurally is mainly reliant on placement experiences. An international scoping review (Adams 2023) found that rural placement and other learning experiences are seldom supported by published evidence or evaluative research related to rural theory, specific curricula content, pedagogy or assessment. The implications of the scoping review findings are discussed using relevant theoretical perspectives. This argument aims to raise awareness amongst health professional educators of opportunities and outcomes that may support confident, capable, autonomous work in broader scopes of practice through specific, structured rural content in health professional curricula.

Findings: Once theoretical foundations of rural education are established, structured evaluation of educational design and advancement of the scholarship of learning and teaching can occur.

Research implications: Extension of research into educational practice in rural contexts can contribute to rural health professional retention and improved health outcomes for rural populations.

Originality/value: This paper highlights a novel approach to rural health professional education for rural practice beyond standardised curricula delivered in rural contexts.

Limitations: The lack of published research does not mean that rural curricula and pedagogy do not exist in health professional curricula. Instead, it highlights that rural health education rarely includes analysis/evaluation of health programme content.

[1] The terms ‘rural’, ‘remote’ and ‘regional’ are often poorly differentiated and used interchangeably in the literature. ‘Rural’ is used throughout this document, although the authors wish to acknowledge the considerable differences between the practice contexts.