The purpose of this study was to validate the proposed Metaparadigm of Clinical Dietetics. The proposed Metaparadigm of Clinical Dietetics is the most abstract level of the profession's body of knowledge and is a statement of seven domains of concern. The seven domains are Reference Person, Human Condition, Practitioner Actions/Attitudes, Practitioner Environment, Client Actions/Attitudes, Client Environment and Nutraceuticals and are characterized by ninety-four knowledge topics. A further purpose was to determine comparative relevance of these ninety-four knowledge topics to other health professionals and nutritional scientists. A descriptive-correlational-factor-analytical design was used for this study. An expert panel of clinical dietetic practitioners and an extensive literature review were used to develop the mailed survey instrument. A random sample of five hundred clinical dietitians was selected from members of thirteen clinical Dietetic Practice Groups of The American Dietetic Association. One hundred thirty-six surveys were returned for a response rate of twenty-seven percent.

The present study surveyed occupational therapy clinical supervisors working in a number of university affiliated hospitals in the Montreal area, via a mail questionnaire. Therapists were first asked to rate the importance of behaviours in facilitating student learning during clinical instruction. Then they were asked to report their attendance at continuing education courses on clinical instruction. The relationship between attendance at these courses, number of years of clinical experience and rating of behaviours was investigated. Therapists with few years of clinical experience had a low rate of attendance and rated behaviours as important more frequently. Therapists who attended a course rated behaviours as important less frequently. Behaviours rated as most important belonged to the area of communication, followed by the areas of teaching and interpersonal relationships. The results of this study demonstrated that a workshop on clinical instruction would benefit therapists by improving their clinical supervisory skills.

Thesis (Ed.D.)--Argosy University/Honolulu, 2007. / (UMI)AAI3256145. Source: Dissertation Abstracts International, Volume: 68-03, Section: B, page: 1555. Adviser: Carole E. Freehan.

Thesis (Ph.D.)--University of California, San Francisco, 2008. / Source: Dissertation Abstracts International, Volume: 69-09, Section: B, page: 5321. Adviser: Patricia Benner.

No description available.

Purpose: The authors examined Health Sciences students’ willingness to reflect on an academic failure at the students’ point-of-entrance into university in order to gauge how students’ willingness to engage in reflective tasks might be predictive of their subsequent academic success and, ultimately, of their potential to become health professionals. Methods: Following Health Sciences students’ failure on an English diagnostic test, the authors determined the proportion of 568 Health Sciences students who voluntarily reviewed or did not review (SR and SNR respectively) their failed tests before sitting a second-chance test 60 days later. The authors then compared the improvements between SR and SNR on the second-chance test and determined three relationships: 1) whether SR or SNR showed greater improvement on the second-chance test; 2) whether SR or SNR had higher mean marks in their four requisite Health Sciences courses; 3) if SR were more likely to be subsequently placed in a health professional programme. Results: 42% (N=237) of students chose not to review their test after failing it and being advised that they could review the test. Those same students were already performing at a lower level on this first test for their Reading Comprehension (F(1,566)= 5.608, p=0.18) and Listening Comprehension (F(1,566)=4.117, p = 0.043). While SR improved more than did SNR when they sat the second test, reviewing the failed test did not significantly correlate with improved success on the second test. However, SR achieved higher mean marks across their four requisite Health Sciences courses than did SNR (Wald’s Z = 8.015, p Wald’s Z = 3.108, p = 0.002) and were more likely to be offered a place in a professional programme (Wald’s Z = 3.108, p = 0.002). Conclusions: Choosing to engage in a relatively simple reflective task following an initial failure predicts subsequent academic success for our Health Sciences students and their potential of becoming health professionals.

Thesis (MPhil (Centre for Health Sciences Education)--University of Stellenbosch, 2010. / AFRIKAANSE OPSOMMING: Doel: Te min spraak-taalterapeute (STT’e) wêreldwyd spreek vlotheidsversteurings aan. Dit mag aan hul gevoelens van onbevoegdheid in die hantering van persone wat hakkel toegeskryf word. Nuut-gegradueerde STT’e, in die Suid-Afrikaanse konteks, het dikwels nie toegang tot ondersteuning en leiding van ervare klinici om hul vaardighede en bevoegdheid in die hantering van persone wat hakkel, te ontwikkel nie. Die doel van hierdie studie was om voorgraadse STTstudente se persepsies van hul eie bevoegdheid om persone wat hakkel te hanteer, te ondersoek en beskryf 1) direk na die voltooiing van hul teoretiese module en voor kliniese plasing, en 2) na blootstelling aan ‘n bykomende opleidingskomponent waar hulle waargeneem het hoe intervensieprosedures op ‘n gesimuleerde pasiënt toegepas word. Metodes: ‘n Beskrywende opnameontwerp, met pre- en post-intervensie-vraelyste is gebruik om die andragogiese benadering se impak op studente, voor en nadat hulle die bykomende opleidingsgeleentheid ontvang het, te evalueer. Resultate: Voor die intervensie het die meeste studente hulself nie as bevoegd geag om persone wat hakkel te evalueer of behandel nie. Na die intervensie is statisties beduidende veranderinge in die studente se self-ervare bevoegdheid vir die meeste aspekte verwant aan die evaluering en behandeling van mense wat hakkel, gerapporteer. Opsomming: Daar is tot die gevolgtrekking gekom dat die studente hierdie tipe innoverende opleidingsmetodologie hoog op prys stel en dat dit ‘n nodige aanvulling tot studente se bestaande kliniese plasings is.

Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Aim: This study aimed to explore the perceptions of third year nursing students regarding the ethics module at Shifa College of Nursing, Islamabad, Pakistan. Methods: Third year nursing students (n=26) completed a retrospective pre/post survey rating their knowledge before and after the ethics module. Focus group discussions (FGDs) addressed the importance of ethics teaching in nursing, the content, teaching and learning strategies of the module as well as whether the application of the concepts learned in the classroom were practiced in the clinical setting. Results: Participants rated their knowledge higher in the post-test (4.00) than the pretest questionnaire (2.26) (p=0.003). The main themes identified during the focus group discussions were: understanding their responsibilities towards the patient; an appreciation of the patient as a human being; applicability of the module to the clinical setting; the role of student nurses in ethical decision making in the clinical setting; and the teaching and learning strategies. The context of the nurse’s practice was also identified as being important. Conclusion: The participants valued the ethics module and its applicability to the clinical setting, but changes in the content of the module and the teaching and learning strategies were suggested.

Thesis (MPhil)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Home-based rehabilitation (HBR) in under-resourced areas in a primary health care context exposes students to the real life situations of clients. The educational experience of HBR, underpinned by the theory of situated learning, promotes experiential and transformative learning. HBR leads not only to academic learning and personal development, but also to an understanding of social accountability and responsibility. Physiotherapy students and their clients frequently have diverse lingual, socio-economic and cultural backgrounds which may hinder the provision of appropriate treatment to clients in their residences. Increased knowledge of HBR in the physiotherapy context could result in an enhanced experience for both student and client. This study sought to explore the perceptions of physiotherapy students and their clients regarding HBR as part of clinical training in resource-constrained settings. Whether the students felt adequately prepared to perform HBR was also explored. A qualitative research design in the interpretivist paradigm was used. An exploratory case study was performed. Semi-structured interviews were conducted with clients (N=7) living in an under-resourced setting who had received HBR from physiotherapy students. Paired interviews were conducted with final year physiotherapy students (N=6) after their HBR placement. The data were subjected to inductive thematic analysis and themes developed. The findings showed that while clients appreciated the students’ services, there were communication barriers and unmet expectations. Students reported difficulty in adapting to the unfamiliar context, resulting in interventions not being sufficiently client-centred. They voiced a need for language competency to assist in communication. Earlier facilitated exposure to under-resourced contexts in the early clinical phase was suggested to reduce culture shock. An awareness of home environments in under-resourced areas influenced the students’ interventions in other contexts. To gain maximum benefit from the learning opportunities available through HBR, students require support for client management and client-centred problem solving in an under-resourced setting. Guided reflection should form part of the HBR placement to facilitate the construction of new knowledge, to promote deep transformative learning and to increase the students’ awareness of their role as change agents. Exposure to real life situations in under-resourced settings in the form of HBR provides valuable situated and authentic learning opportunities for physiotherapy students. The experience can be useful in preparing graduates to address the needs of the populations they will serve during community service. / AFRIKAANSE OPSOMMING: Tuisgebaseerde rehabilitasie (TBR) in ondervoorsiende gebiede in die primêre gesondheidsorg-konteks stel studente bloot aan die werklike lewensomstandighede van kliënte. Die opvoedkundige ondervinding van TBR, gerugsteun deur die teorie van gesitueerde leer, bevorder ervarings- en transformasionele leer. TBR lei nie net tot akademiese leer en persoonlike ontwikkeling nie, maar bevorder ook insig in maatskaplike verantwoordbaarheid en verantwoordelikheid. Fisioterapie-studente en hul kliënte het dikwels verskillende taal-, sosio-ekonomiese en kulturele agtergronde wat kan verhinder dat die toepaslike behandeling vir kliënte tuis verskaf word. ’n Toename in kennis van TBR in die fisioterapie-konteks kan lei tot ’n beter ondervinding vir beide die student en die kliënt. Die doel van die studie is om die persepsies van die fisioterapie-studente en hul kliënte met betrekking tot TBR, as deel van die kliniese opleiding in omgewings waar daar beperkte hulpbronne is, na te vors. Daar is ook nagegaan of die studente gevoel het dat hulle genoegsaam voorberei is om die TBR toe te pas. ’n Kwalitatiewe navorsingsontwerp in die interpreterende paradigma is gebruik. ’n Verkennende gevalle-studie is gedoen. Semi-gestruktureerde onderhoude is met die kliënte (N=7) wat in ondervoorsiende omstandighede leef en wat TBR van fisioterapie-studente ontvang het, gevoer. Onderhoude is in pare met fisioterapiestudente in hul finale jaar (N=6) gevoer nadat hulle hul TBR-plasing voltooi het. ’n Induktiewe tematiese analise van die data is gedoen en temas is ontwikkel. Die resultate het getoon dat, alhoewel die kliënte waardering gehad het vir die dienste wat deur die studente gelewer is, daar kommunikasiegapings en onvervulde verwagtinge was. Die studente het gerapporteer dat hulle gesukkel het om aan te pas by die onbekende omgewing met die gevolg dat die intervensies nie genoegsaam kliëntgerig was nie. Hulle het ook aangedui dat daar ’n behoefte is om die nodige taalvaardigheid te ontwikkel om kommunikasie te verbeter. Die kultuurskok wat beleef is, kan moontlik in die vroeë kliniese fase reeds gefasiliteer word deur die studente aan ondervoorsiende kontekste bloot te stel. Die kennis van die tuisomgewings in ondervoorsiende areas het ’n invloed gehad op die studente se intervensies in ander kontekste. Studente benodig ondersteuning in kliëntebestuur en kliëntgesentreerde probleemoplossing in ondervoorsiende omgewings ten einde maksimum voordeel te verkry uit leergeleenthede wat beskikbaar is deur TBR. Begeleide refleksie behoort deel te vorm van die TBR-plasing om die opbou van nuwe kennis te fasilliteer, diepgaande transformatiewe leer te bevorder en die student se bewustheid van hul rol om verandering teweeg te bring, op te skerp. TBR voorsien nie net waardevolle, outentieke leergeleenthede ter plaatse nie, maar gee ook die fisioterapie-studente blootstelling aan die werklike situasies waarin mense hulle in ondervoorsiende omgewings bevind. Hierdie ondervinding kan waardevol wees om graduandi voor te berei om die behoeftes aan te spreek van die bevolkingsgroepe wat hulle tydens hul gemeenskapsdiensjaar sal bedien.

Thesis (MPhil)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Background - The College of Phycians and Surgeons Pakistan (CPSP) was established in 1962 and its role is to oversee the postgraduate medical education within Pakistan. At present, various specialties belonging to the CPSP carry out quality assurance visits including evaluation of the learning environment of the teaching hospitals by asking the supervisors and doctors in training about the qualification and experience of supervisors, equipment, library, infrastructure and type of work load. The CPSP do not make use of a valid and reliable method when performing these assessments and therefore there is a need for the CPSP to develop a standardized method of assessing the learning environments of the teaching hospitals in Pakistan. This method needs not only to be valid and reliable but also reproducible and transferable so that it can be used to measure the learning environments in various departments and teaching hospitals .It can further be used to compare the learning environments across different teaching hospitals and specialties with in Pakistan. The learning environment of teaching hospitals of Pakistan have not been studied before therefore the purpose of this study was to measure the postgraduate learning environment of private and public sector teaching hospitals of twin cities in Pakistan Islamabad and Rawalpindi .Public sector hospitals are fully funded by the government of Pakistan and patients receive free treatment, while private hospitals are commercial hospitals where everything is paid by patients. Following the postgraduate educational environment measurement results between house officers and residents working in the above mentioned environments was then compared. These results can inform supervisors and institutions about short comings as well as strong points with regards to the learning environment. Materials and Methods After approval from the Shifa International Hospital`s Ethical committee and Health Research Ethical committee of the University of Stellenbosch, and informed consent were obtained from research participants. The Postgraduate Hospital Educational Environment Measurement questionnaire (PHEEM) was administered to the house officers and residents of six public and one private sector teaching hospital of twin cities (Islamabad and Rawalpindi) in Pakistan with the help of the supervisors of CPSP based at these hospitals. The PHEEM was completed during their respective teaching sessions at the various hospitals .The supervisors was asked to encourage students to complete the PHEEM questionnaire .Supervisors were instructed to collect the completed questionnaires the from doctors in training at their individual hospitals and then send it back using the enclosed envelope The PHEEM contains of 40 items covering a range of issues directly related to the clinical learning environment of house officers and residents1. These statements make up 3 subscales of the clinical learning environment namely autonomy, social support and teaching. Autonomy (such as the quality of supervision) is represented by 14 statements teaching (the qualities of teachers by 15 statements and social support (such as facilities and atmosphere) by 11statements. Each of the 40 statements can be rated from 0-4 .The respondents are asked to indicate their agreement using a 5 point Likert scale .These range from strongly agree(4) ,agree(3), unsure(2), disagree(1) to strongly disagree (0). Agreement with the items indicates a positive learning environment and will result in high scores. The maximum possible scores are 56 for autonomy, 60 for teaching, 44 for social support and an overall score of 160.It is essential that each junior doctor applies the items to their own current learning place1. - Statistical analysis - The statistical analysis was conducted by using SPSS 16.0 and the four negative items were scored in reverse (question 7, 8, 11, 13). The scores for the total as well as the sub-scales were described by using means and standard deviations (SD). Comparisons of the perception of the educational environments between house officers and residents were expressed as a mean and ± SD and its statistical significance was determined by student t- tests. A p value ≤ 0.05 was considered statistically significant. The results from the three construct of the PHEEM survey were compared among the house officers and residents from surgery, medicine, pediatrics and Obstetrics’ and Gynecology by ANNOVA and post hoc sidak test. A p value ≤ 0.05 was considered statistically significant. - Results - The internal reliability of the questionnaire was good with a total Cronbach`s Alpha value of 0.92 (a Cronbach`s alpha of more than 0.7 or 0.8 is accepted as being good). The questionnaire further revealed Crobach`s alpha value of 0.78, 0.89 and 0.70 for the various subscales of autonomy, teaching and social supports .When this was analyzed to exclude each question in turn, using the alpha if deleted there was no significant improvement in the score, thus confirming all questions were relevant and should be included. A total of 286 out of 300 (95.33% response rates) house officers and residents belonging to the seven different teaching hospitals of twin cities of Islamabad and Rawalpindi, Pakistan participated in the study. The PHEEM questionnaire was completed by all the participating doctors composing of 51% house officers and 49 % residents .Both genders were almost equally represented in the two groups comprising of 52% male and 48% female doctors. The distribution of male and female gender is different among respondents from various specialties. There was 23.60% male and 15.03% females in surgery, 22.20% males and 18.30% females in medicines, 6.20% males and 4.32% females in Pediatrics and 10.33% females in obstetrics. House officers and residents belonging to all major specialties took part in the study with the distribution looking as follows, Medicine 44.8%, Surgery 33.6% Obstetrics and Gynecology11.2% and Pedriatics10.50%. The mean score (M) and the standard deviation (SD) for each of the subscale namely the perceptions of autonomy, teaching and social support of house officers and residents are shown Table number 1 (Autonomy), Table number 2 (Teaching) and Table number 3 (Social support) respectively. These tables also show the mean of the total scores of each subscale. The lowest recorded score was 1.37 for question number 4.Question number 1, 4,5,9,11,17 and 32 with in the autonomy section were found to have a relatively low rating as shown in table number 1. Teaching quality questions 3, 21 and 33 showed a low rating as demonstrated in table number 2. Social support showed a low rating for question number 19, 20, 25, 26, 36 and 38 again shown in table number 3. The results from the three subscales of the PHEEM survey were compared between residents and house officers from the teaching hospitals of the twin cities are shown in Table number 1, 2, and 3 respectively. The perception of autonomy was higher amongst residents with a mean of 28.74 compared to house officers 28.27. The difference, however, was not statistically significant between the two groups but there was a statistically significant difference between the two groups in question number 32, where the residents perceived that work load for them was better than house officers. It seems as the residents have better opportunities to access and participate in educational events and programs compared to the house officers seeing that there was a statistically significant difference in question numbers 12 and 21 respectively as shown in table number 1. The perceived level of quality of teaching was higher for residents with mean of 32.02 as compared to the house officers with a mean of 31.12. However this difference was not statistically significant as shown in table 2. The perception of social support was high amongst house officers with a mean of 19.66 compared to residents with a mean of 19.06. There was statistically no difference between the two groups regarding the social support provided at these teaching hospitals; however the house officers felt physically more save compared to residents as shown in table 3 Regarding the difference between private and public sector hospitals, the mean score of the three subscales of the PHEEM, namely the mean score for the perception of autonomy (28.71 vs. 27.14, p=0.24) teaching (33.08 vs. 32.37, p=0.25) and social support (21.94 vs. 21.22, p=0.24) were not statistically significant. The results from the three subscales of the PHEEM survey were compared amongst the junior doctors from Surgery, Medicine, Pediatrics and Obstetrics’ and Gynecology by ANNOVA and post hoc sidak test. There was no statistically significant difference among these junior doctors in the majority of the PHEEM questions. For question number 4, I had an informative induction programme, there was statistically significant difference between the junior doctors of medicine and obstetrics & gynecology .Regarding the question number 5, I had appropriate level of responsibility in this post, and there was statistically significant difference between junior doctors of surgery & pediatrics and surgery and obstetrics & gynecology. There was significant difference between the junior doctors of medicine and Obstetrics and gynecology for question number 29, I feel part of the team working here. Regarding perception of question number 30, I have opportunity to acquire the appropriate practical procedures for my grade; there was significant difference between the junior doctors of obstetrics & gynecology and surgery. For perception of teaching, there was a significant difference between the junior doctors of medicine and obstetrics & gynecology in the following questions. Question number 10: my clinical teachers have good communication skills; Question number 23: my clinical teachers are well organized; and question number 27: I have enough clinical learning opportunity of my needs. In the subscale of social support there was a significant difference for item number 13 which states that there is sex discrimination in this post between the junior doctors of surgery and pediatrics .The junior doctors from medicine perceive that there was more calibration among the doctors of medicine as compared to pediatrics. - Discussion and conclusion - This study shows that the PHEEM questionnaire consists of a practical, reliable and simple set of questions to measure the learning environment of doctors in training at teaching hospitals of Pakistan; a country which is socially, culturally and economically different from the country where this questionnaire was originally constructed. This could imply that the perceptions of doctors in training are similar regardless of geographical boundaries and economic conditions of the country where they live. . Other studies that employed PHEEM in different parts of the world show similar scores. This study does not show a statistically significant difference between house officers and residents in terms of teaching, role of autonomy and social support. The reasons for this may be that house officers and residents share the same infrastructure for accommodation, catering and social support. Furthermore, there is no practically organized structured training programme with a specified job description for doctors at different levels of training. This study therefore does not confirm results of the studies performed in United Kingdom and Australia, where house officers experienced a better learning environment than residents in many respects. This study was completed by house officers and residents from private as well as public sector teaching hospitals. We did not find a statistical difference in the level of perceptions between doctors in training working in these two different set up of hospitals. This goes against the common notion present amongst junior doctors that training at public sector hospitals have a higher level of satisfaction due to better and more learning opportunities than at private sector hospitals because in these hospitals independent work is not allowed. The result off this study indicates that the perception level of house officers and residents in training in various specialties was different regarding the learning environment. This difference was even more marked for the specialty of Gynecology and obstetrics where the PHEEM items were scored lessened compared to the other specialties. The reason for this could be due to better training opportunities, more structured and availability of mentors in Surgery, Medicine and Pediatrics compared to the female dominated specialty of Gynecology and obstetrics. The female work and learn in different way because they score three items directly related to perception of teaching lower compare to male dominated specialities. The PHEEM questionnaire results have been taken from seven teaching hospitals of the twin cities, and therefore provide a good overall picture of the learning environments of teaching hospitals in Pakistan seeing that the teaching hospitals of Pakistan almost have similar infrastructure and faculties with few individual variations. This sample represents all major specialties thus provide a good picture of the learning environment for all doctors in training. It is clear that in order to ensure high standards in education and training of junior doctors, the importance of the learning environment cannot be ignored. The following are recommendations for the CPSP so that they take steps in collaboration with administrative and medical staff to improve the learning environments where needed. 1. A meeting between the CPSP and administrative staff should held every year to overcome the weakness pointed out in this study 2. Teaching hospitals should publish an informative junior doctors hand book , with a job description, responsibilities, expectation and information about working hours 3. The junior doctors should have protected time for educational activities 4. The attendance at educational sessions must be supported by the Supervisors of CPSP 5. Career advice and counseling opportunities should be avaible at each regional center of CPSP 6. Accommodation should meet the appropriate standards 7. Good quality hygienic catering facilities should be present around the clock for junior doctors. 8. Each teaching hospital should administer the PHEEM ever year to measure their quality and potentially improve their standards. In conclusion this study shows a great need for the creation of a supportive environment as well as designing and implementing interventions to remedy unsatisfactory elements of the educational environment if effective and successful learning is to be realized by the CPSP.