Philosophiae Doctor - PhD / High attrition, low retention and low throughput are major problems facing South African higher education institutions. These problems have been attributed to student under-preparedness as a result of the legacy of apartheid education provision and associated limited academic opportunities available to working-class learners. South African studies indicate that black and working-class students are less likely to perform well than their middle-class peers. In the health sciences poor academic achievement is frequently associated with poor clinical competence. Diminished clinical competence has the potential to compromise patient treatment success. This study, therefore, set out to examine the influence of diversity, with particular reference to race and social class, and the educational climate in shaping the clinical competence of students in an oral health program at a Faculty of Dentistry in South Africa. The purpose of the study was to understand the relationship between diversity, educational climate, and clinical competence so as to better support the learning of all students in the oral health program. Two concepts informed the theoretical parameters of the study – diversity and educational climate. In addressing diversity, Bourdieu’s construct of economic and cultural capital provided the conceptual tools for examining the extent to which students’ race and social class locations shaped their readiness for higher education and hence influenced their experiences and performance in the program. In terms of the educational climate, Tinto’s constructs of social and academic integration, provided the lens for explicating students’ persistence in the program, taking into account their social and academic experiences. Set in a qualitative paradigm, a case study design was used, based on its characteristic principles of bounded place, context, time and activity. The cohort was the first-year class of 2007 in the oral health program. The students of the cohort were tracked longitudinally from 2007 to 2010. Data was gathered from a range of quantitative and qualitative sources, such as, analysis of faculty documents, observations, mark schedules, student reflective writing, focus group and individual interviews. Thematic analysis was used to analyse the data. This process involved drawing on the literature related to diversity and educational climate to identify emergent patterns and themes from the data, and then interpreting their meaning through the lenses of capital and social and academic integration. This study illuminated many ways in which student performance was affected by diversity, with particular reference to race and social class locations and associated access to economic and cultural capital. Differences between middle-class and working-class students were noted in their performance, their preparation for university and its academic demands as well as in how these two groups of students interacted in the classroom. Significant differences were also noted in their transition and integration experiences at a social, professional and academic level. In addition, the study explicated ways in which the faculty, through its culture, structure, and pedagogy, appeared to contribute to an educational climate which either supported or deterred student integration, both in social and academic ways. Cumulatively the challenges experienced by working-class students in particular appeared to have had real effects. The most significant effects were on their morale, their intent to engage and integrate and their consequent learning, academic performance and clinical competence. This study did not intend to solve but rather to understand the issue of differential performance. The findings of the study are envisioned to inform faculty and institutional strategies toward increasing effectiveness and responsiveness to differing student needs.

Indiana University-Purdue University Indianapolis (IUPUI) / Parents have increasingly participated in their children’s bedside care. Parental participation has led to more provider-parent interactions and communication during such stressful events. Helping parents through such stressful events requires nurses to be skilled communicators. Brief methods of training emotion-focused communication with newly licensed nurses are needed, but as yet are rare. The purpose of this study was to evaluate the impact of a validated brief communication (Four Habits Model) training program for newly licensed pediatric nurses. The intervention focused on ways to improve nurses’ emotion-focused conversations with parents. Information processing and Benner’s novice to expert informed this study. The intervention is based on the four habits model, with “habits” providing a structure for nurses to organize their thinking and behavior during emotion-focused conversations with parents. Thirty-five pediatric nurses with 0–24 months of nursing experience at a large mid-western children’s hospital participated in the study. Mixed methods provided data for this experimental study, using a group-by-trials repeated measures ANOVA design. Participants randomized to the intervention group participated in a one-hour three-part training: adapted four habits model content, simulated nurse-parent communication activity, and debrief. Participants randomized to the control group observed a one-hour travel video. Key outcome variables were Preparation, Communication Skills, Relationships, Confidence, Anxiety, and Total Preparation. Compared with the controls, the intervention group improved significantly in the following areas: Preparation, F(1,33) = 28.833, p < .001; Communication Skills, F(1,33) = 9.726, p = .004; Relationships, F(1,33) = 8.337, p = .007; Confidence, F(1,33) = 36.097, p < .001; and Total Preparation, F(1,33) = 47.610, p < .001. Nurses’ experience level had no effect, with the exception of Anxiety. Nurses with more experience (≥ 12 m) showed a greater reduction in Anxiety, when compared to nurses with less experience (< 12 m), F(1,31) = 5.733, p = .023. Fifty-two percent of the nurses involved in the intervention later reported specific examples of implementing the four habits when working with parents in clinical settings. A one-hour four habits communication-training program is effective in improving newly licensed nurses’ preparation for emotion-focused conversations with parents.

No / This paper reports the findings of a study which was carried out to evaluate the educational preparation of cancer and palliative care nurses in England. The study was carried out in three stages and covered the following areas; documentary analysis of curriculae, assessment of practice, patients and professionals views of threshold and expert practice. The findings suggested that although there was widespread compliance with a national standard for cancer nursing, this was not the case for palliative care nursing. There was uncertainty about what should be assessed in practice and ambiguity about what was actually assessed. Partnership with children and their parents, clinical skills, multi-disciplinary working, and personal attributes were the main foci for expectations of threshold practice but an expert panel had difficulty in describing the attributes of higher level practice. The paper also describes how some of recommendations from the study are being taken forward in current policy and practice.

Towards a Franciscan model of Clinical pastoral supervision is a study of interaction between two movements: Clinical Pastoral Education (CPE) and Franciscan Spirituality. Francis and Clare were the primary founders of the Franciscan movement and Franciscan spirituality arose from their reflections on their unique response of following Christ. From the early Franciscan sources, essential elements are retrieved. Compassion is illustrated as a key quality of this model through textual analysis of four stories of Francis and his early followers. Clinical Pastoral Education is a result of the contributions of three founders: Keller, Cabot and Boisen. Clinical pastoral supervision (CPS) is a distinguishing concept of CPE. Various models of CPS are categorised according to three paradigms of western society: classical, modern and postmodern. The study concludes by framing a Franciscan model of clinical pastoral supervision. Contemplation and compassion are the two Franciscan characteristics which give this model a unique Franciscan dimension. / New Testament / M.Th.

The purpose of midwifery nursing education is to prepare midwives who are fully qualified to provide high-quality, evidence-based mother and child health care services. A quantitative descriptive explorative design was used to identify and explore midwifery students’ experiences of clinical teaching at Sovenga Campus, (Limpopo College of Nursing), Limpopo province. Structured questionnaires were used to collect data. The research sample consisted of fifty (50) midwifery students from Sovenga Campus. Ethical principles were adhered to. Validity and reliability were maintained. The findings showed that learning opportunities are being utilised and clinical accompaniment by tutors has improved. The findings indicated that clinical teaching in midwifery units does not include implementation of the maternity guidelines and protocols’ being used .A recommendation was that tutors be included in student orientation and the planning of monthly unit in-service programmes. / Health Studies / M.A. (Nursing Science)

Text in English / The current changes in health care systems challenges knowledgeable, mature and independent practitioners to be able to integrate theoretical content with practice. The study aims to investigate the problems of integrating theory with practice in selected clinical nursing situations. The study focused on the rendering of family planning services to clients which is a component of Community Nursing Science. The findings of the study reveal that there is a need for an integrated holistic curriculum which will address the needs of the community. It was concluded that a problem-based and community-based curriculum, safe and patient-friendly clinical environments, intersectoral collaboration between college and hospital management and student involvement in all processes of teaching and learning will improve the integration of theory and practice. There also appears to be a need for tutors to be more involved in clinical teaching, accompaniment and the continuous evaluation of students. / Health Studies / M.A. (Nursing Science)

La collaboration est une compétence essentielle que les futurs médecins doivent développer. La détermination des niveaux de compétence est cruciale dans la planification de cet apprentissage. Les échelles descriptives suscitent un intérêt croissant, car elles décrivent en termes qualitatifs les performances attendues. Nous inspirant de la méthodologie mixte de Blais, Laurier, & Rousseau (2009), nous avons construit en cinq étapes une échelle de niveau de compétence de collaboration: 1) formulation d’une liste d’indicateurs situés à quatre niveaux de la formation médicale (préclinique, externat, résidence junior et sénior) par les chercheurs (n= 3) et un groupe d’éducateurs (n=7), leaders pédagogiques possédant une expertise pour la compétence de collaboration; 2) sondage en ligne comprenant quatre questionnaires portant sur les niveaux de 118 indicateurs, auprès d’enseignants cliniciens représentant les différentes spécialités (n=277); 3) analyse, avec le modèle partial credit de Rasch, des réponses aux questionnaires appariés par calibration concurrente; 4) détermination des niveaux des indicateurs par les éducateurs et les chercheurs; et 5) rédaction de l’échelle à partir des indicateurs de chaque niveau. L’analyse itérative des réponses montre une adéquation au modèle de Rasch et répartit les indicateurs sur l’échelle linéaire aux quatre niveaux. Les éducateurs déterminent le niveau des 111 indicateurs retenus en tenant compte des résultats du sondage et de la cohérence avec le curriculum. L’échelle comporte un paragraphe descriptif par niveau, selon trois capacités : 1) participer au fonctionnement d’une équipe; 2) prévenir et gérer les conflits; et 3) planifier, coordonner et dispenser les soins en équipe. Cette échelle rend explicites les comportements collaboratifs attendus à la fin de chaque niveau et est utile à la planification de l’apprentissage et de l’évaluation de cette compétence. La discordance entre les niveaux choisis par les éducateurs et ceux issus de l’analyse des réponses des enseignants cliniciens est principalement due au faible choix de réponse du niveau préclinique par les enseignants et aux problèmes d’adéquation pour les indicateurs décrivant la gestion des conflits. Cette recherche marque une avan- cée dans la compréhension de la compétence de collaboration et démontre l’efficacité de la méthodologie de Blais (2009) dans un contexte de compétence transversale, en sciences de la santé. Cette méthodologie pourrait aider à approfondir les trajectoires de développement d’autres compétences. / Being able to collaborate is a key competence that physicians need to learn. Determining competence levels is crucial to planning the learning process. By defining performance levels in qualitative terms, descriptive scales are a promising avenue. We developed a five-stage competence-level scale based on Blais, Laurier & Rousseau (2009) mixed methodology: 1) having researchers (n= 3) and a group of educators (n= 7), pedagogical leaders with expertise in the field of collaboration, list indicators that apply to the four training levels (preclinical, clerkship, junior and senior residencies); 2) conducting with clinician teachers, representative of various specialties (n= 277), an online survey that includes four questionnaires on the 118 indicator levels; 3) performing an analysis using the Rasch partial credit model on responses to questionnaires linked through concurrent calibration; 4) having educators and researchers determine the indicator levels; 5) creating a scale based on indicators at each level. The iterative analysis of the responses shows that it fits the Rasch model and distributes indicators on the linear scale on the four levels. The educators were responsible for determining the level of 111 selected indicators by taking into account the results of the survey and coherence with the curriculum. The scale includes a descriptive paragraph for each level as it applies to the 3 abilities : 1) taking part in running the team; 2) preventing and managing conflicts; 3) planning, coordinating and providing care as a team. The scale explains the collaborative behaviors expected at the end of each level and can be used to plan learning and evaluate competence. The source of disagreement between the levels set by the educators and those resulting from the analysis of clinician teacher responses are mostly explained by the low response by teachers at the preclinical level and misfit issues for the indicators describing conflict management. The research provided a broader understanding of collaboration competency and demonstrated the effectiveness of the Blais et al.1 methodology within the context of cross-curricular competency in health sciences. The methodology could be useful to go deaper into other competencies development path.

Introdução: Feedback é uma ferramenta de ensino poderosa. Para otimizar o feedback em avaliações tipo OSCE (Objective Structured Clinical Examination), uma modificação no papel do avaliador, apelidada de \"avaliador sombra\", foi testada. Os \"avaliadores sombras\" acompanham os estudantes por todas as estações realizando todas as avaliações. Ao término da atividade, realizam feedback do desempenho clínico aos estudantes. Objetivos: Descrever e discutir a experiência na aplicação deste modelo OSCE modificado, avaliar as opiniões dos alunos em relação a este novo método, e apresentar um estudo onde foram realizadas comparações entre o \"avaliador sombra\" e o formato original do examinador OSCE, nomeado de \"avaliador fixo\", com o objetivo de responder se este novo formato de avaliação apresenta vieses em relação ao formato original. Metodologia: Em 2011 foram realizados experimentos com as modificações no papel do avaliador para definir o formato final do \"avaliador sombra\". No período compreendido de fevereiro de 2012 a maio de 2014 foi realizado um protocolo de pesquisa com 415 estudantes do 6º ano de medicina. Destes, 316 estudantes foram randomizados para serem avaliados por avaliadores \"sombras\" e \"fixos\". Para analisar as comparações entre os avaliadores \"sombras\" e \"fixos\", foram utilizados o coeficiente de correlação de Pearson com regressão linear, teste t de Student e gráficos de Bland-Altman. Para aprofundar estas análises, os itens dos checklists foram classificados por domínios para realização de comparações mais específicas. Considerando que esta foi a primeira vez em que esta nova estratégia de avaliador (\"sombra\") foi aplicada, foram realizados questionários de opinião aos 415 estudantes que participaram do OSCE com o \"avaliador sombra\". Resultados: Foram encontradas altas e significativas correlações entre as notas globais por estação dadas aos estudantes pelos avaliadores \"sombras\" e \"fixos\",r = 0,87 (0,85 - 0,89; p < 0,05). Nas análises por domínios (afetivo, psicomotor e cognitivo), os resultados demonstraram maiores correlações entre as notas no domínio cognitivo e menores no afetivo. Não houve diferenças significativas comparando as médias das notas dadas pelos examinadores em relação às notas globais e nos domínios psicomotor e cognitivo. Análises de Teste t e de Bland-Altman demonstraram que as notas dadas aos estudantes no domínio afetivo foram maiores pelos \"avaliadores sombras\", mas a magnitude desta diferença foi muito pequena. De acordo com os questionários aplicados aos 415 estudantes, o feedback realizado pelos \"avaliadores sombras\" contribui para o aprimoramento de habilidades. Mais do que 90% dos estudantes concordaram que o feedback realizado pelo \"avaliador sombra\" é mais efetivo do que outras estratégias de feedback realizadas em outras aplicações de OSCE durante o curso de graduação de medicina até aquele momento. Conclusão: As modificações no papel do avaliador, \"avaliador sombra\", não levaram a vieses significativos nas notas dos estudantes quando comparado ao modelo de avaliador original do OSCE. Esta nova estratégia pode fornecer importantes melhorias na avaliação formativa de competências clínicas / Background: Feedback is a powerful learning tool. To improve the opportunity for feedback provided during an Objective Structured Clinical Examination (OSCE), a modification of the examiner\'s role nicknamed the \"shadow examiner\" was tested. In this new strategy, examiners follow the students across all OSCE stations, and may provide important insights for formative assessments of clinical performance Objective: Describe and discuss the experience in applying this modified OSCE, evaluate students\' opinions regarding this new method, and present an experience to analyze comparisons between the \"shadow examiner\" and original examiner OSCE format, nicknamed \"fixed examiner\". The objective of this study was to answer if this new assessment format presents biases in relation to the original format. Methods: In 2011, some experiments were carried out with modifications in the examiner\'s role to define the format of \"shadow examiner\". From February 2012 to May 2014, the research protocol was performed with 415 6th year medical students. Of these, 316 were randomly assigned to assessments made up of \"shadow\" and \"fixed\" examiners. Pearson correlation coefficients with linear regression, Student\'s t-test analysis, Bland-Altman plots were the statistical methods used to compare the assessment modes. To strengthen the analysis, checklist items were classified by domains in order to make specific comparisons. Considering that this was the first application of this new examiner (\"shadow\") strategy was applied, were conducted opinion surveys of the 415 students who participated in the OSCE with the \"shadow examiner\". Results: High correlations for global scores between \"shadow\" and \"fixed\" examiners were observed, r = 0,87 (0,85 - 0,89; p < 0,05). Analysing specific domains (affective, psychomotor and cognitive), the results demonstrated higher correlations for cognitive scores and lower correlations for affective scores. No statistically significant differences between mean examiners\' global scores, psychomotor and cognitive domains were found. T-test and Bland-Altman reviews showed that affective scores from \"shadow examiners\" were significantly higher than those from \"fixed examiners\", but the magnitude of this difference was small. According to the questionnaires applied to the 415 students, feedback from \"shadow examiners\" contributes to skills training, and more than 90% of these students agree that feedback from \"shadow examiners\" is more effective than other feedback formats achieved in other OSCE applications during the medical graduation course up to that time. Conclusion: The modifications in the role of examiner, \"shadow examiner\", did not lead to any important bias in the students\' scores comparing with the original examiner strategy of OSCE. This new strategy may provide important insights for formative assessments of clinical performance

La collaboration est une compétence essentielle que les futurs médecins doivent développer. La détermination des niveaux de compétence est cruciale dans la planification de cet apprentissage. Les échelles descriptives suscitent un intérêt croissant, car elles décrivent en termes qualitatifs les performances attendues. Nous inspirant de la méthodologie mixte de Blais, Laurier, & Rousseau (2009), nous avons construit en cinq étapes une échelle de niveau de compétence de collaboration: 1) formulation d’une liste d’indicateurs situés à quatre niveaux de la formation médicale (préclinique, externat, résidence junior et sénior) par les chercheurs (n= 3) et un groupe d’éducateurs (n=7), leaders pédagogiques possédant une expertise pour la compétence de collaboration; 2) sondage en ligne comprenant quatre questionnaires portant sur les niveaux de 118 indicateurs, auprès d’enseignants cliniciens représentant les différentes spécialités (n=277); 3) analyse, avec le modèle partial credit de Rasch, des réponses aux questionnaires appariés par calibration concurrente; 4) détermination des niveaux des indicateurs par les éducateurs et les chercheurs; et 5) rédaction de l’échelle à partir des indicateurs de chaque niveau. L’analyse itérative des réponses montre une adéquation au modèle de Rasch et répartit les indicateurs sur l’échelle linéaire aux quatre niveaux. Les éducateurs déterminent le niveau des 111 indicateurs retenus en tenant compte des résultats du sondage et de la cohérence avec le curriculum. L’échelle comporte un paragraphe descriptif par niveau, selon trois capacités : 1) participer au fonctionnement d’une équipe; 2) prévenir et gérer les conflits; et 3) planifier, coordonner et dispenser les soins en équipe. Cette échelle rend explicites les comportements collaboratifs attendus à la fin de chaque niveau et est utile à la planification de l’apprentissage et de l’évaluation de cette compétence. La discordance entre les niveaux choisis par les éducateurs et ceux issus de l’analyse des réponses des enseignants cliniciens est principalement due au faible choix de réponse du niveau préclinique par les enseignants et aux problèmes d’adéquation pour les indicateurs décrivant la gestion des conflits. Cette recherche marque une avan- cée dans la compréhension de la compétence de collaboration et démontre l’efficacité de la méthodologie de Blais (2009) dans un contexte de compétence transversale, en sciences de la santé. Cette méthodologie pourrait aider à approfondir les trajectoires de développement d’autres compétences. / Being able to collaborate is a key competence that physicians need to learn. Determining competence levels is crucial to planning the learning process. By defining performance levels in qualitative terms, descriptive scales are a promising avenue. We developed a five-stage competence-level scale based on Blais, Laurier & Rousseau (2009) mixed methodology: 1) having researchers (n= 3) and a group of educators (n= 7), pedagogical leaders with expertise in the field of collaboration, list indicators that apply to the four training levels (preclinical, clerkship, junior and senior residencies); 2) conducting with clinician teachers, representative of various specialties (n= 277), an online survey that includes four questionnaires on the 118 indicator levels; 3) performing an analysis using the Rasch partial credit model on responses to questionnaires linked through concurrent calibration; 4) having educators and researchers determine the indicator levels; 5) creating a scale based on indicators at each level. The iterative analysis of the responses shows that it fits the Rasch model and distributes indicators on the linear scale on the four levels. The educators were responsible for determining the level of 111 selected indicators by taking into account the results of the survey and coherence with the curriculum. The scale includes a descriptive paragraph for each level as it applies to the 3 abilities : 1) taking part in running the team; 2) preventing and managing conflicts; 3) planning, coordinating and providing care as a team. The scale explains the collaborative behaviors expected at the end of each level and can be used to plan learning and evaluate competence. The source of disagreement between the levels set by the educators and those resulting from the analysis of clinician teacher responses are mostly explained by the low response by teachers at the preclinical level and misfit issues for the indicators describing conflict management. The research provided a broader understanding of collaboration competency and demonstrated the effectiveness of the Blais et al.1 methodology within the context of cross-curricular competency in health sciences. The methodology could be useful to go deaper into other competencies development path.

Towards a Franciscan model of Clinical pastoral supervision is a study of interaction between two movements: Clinical Pastoral Education (CPE) and Franciscan Spirituality. Francis and Clare were the primary founders of the Franciscan movement and Franciscan spirituality arose from their reflections on their unique response of following Christ. From the early Franciscan sources, essential elements are retrieved. Compassion is illustrated as a key quality of this model through textual analysis of four stories of Francis and his early followers. Clinical Pastoral Education is a result of the contributions of three founders: Keller, Cabot and Boisen. Clinical pastoral supervision (CPS) is a distinguishing concept of CPE. Various models of CPS are categorised according to three paradigms of western society: classical, modern and postmodern. The study concludes by framing a Franciscan model of clinical pastoral supervision. Contemplation and compassion are the two Franciscan characteristics which give this model a unique Franciscan dimension. / New Testament / M.Th.