<p>This thesis explores the Cognitive Load Theory (CLT) framework with health professions education research, and applies the principles of CLT to one specific area of health professions education: the acquisition of cardiac and respiratory auscultation and physical assessment skill in undergraduate nursing students. The first study evaluates context-based learning environments on the acquisition of auscultation skill and physical assessment performance. Results suggest that for novice level students, high-context-based learning environments may contribute to extraneous cognitive load and may not be beneficial for learning. The next cluster of studies evaluates auscultation test performance following manipulation of cognitive load variables. The interleaving approach instruction was found to be most helpful for auscultation test performance. The series of studies conducted in this thesis demonstrate a useful direction for health professions research and promotes the use of cognitive load theory as a framework for instructional design and evaluation.</p> / Doctor of Philosophy (PhD)

In recent years the complexity and integrated nature of health care has increased. It has become accepted that the needs of patients are often greater than one single health profession can address and requires collaboration on the part of health care providers (Freeth, 2001). Interprofessional health education (IPHE) is the interactive educational process and cooperation among various health care professions. It is a valuable pedagogical approach for teaching health care students that they cannot work effectively without the use of a team, and is thought to be the first step in the direction of changing health care practice in the clinical setting. Using a two phase mixed methods approach, this dissertation investigated changes in student attitudes and measured interprofessional readiness as a result of a longitudinal interprofessional educational experience at Thomas Jefferson University called Health Mentors. The health care professions included in this program are: medicine, nursing, physical therapy, occupational therapy, and pharmacy. Together, these students visit an individual living in the greater Philadelphia, PA region with one or more chronic health conditions four times during the year. Of the five hundred and seventy-six students participating in the Health Mentors program, four hundred and ninety-six completed two surveys in September 2008 and again in April 2009. These were the Interprofessional Education Perception Scale (IEPS) and the Readiness for Interprofessional Learning Scale (RIPLS) which measured their attitudes and readiness toward interprofessional education. Analysis revealed slight significant differences in the means of the health programs and showed small significant decreases in attitudes and readiness over time. Two focus groups were conducted to better understand the quantitative results. Using grounded theory, the following themes emerged: preparation for future professional experience, personal enjoyment from working with their Mentor, logistical conflicts, unknown roles, and program assignments seen as an `add on' or `busy work'. The results from both the qualitative and quantitative methods indicate that students have a high opinion of the theory of IPHE but find the application difficult in practice. / Educational Psychology

Occupational therapy (OT) is a rehabilitation profession in which licensed therapists facilitate functional independence, to the greatest extent possible, of an individual with disabilities. Education for OT is at the Master’s level consisting of a two-year academic program followed by clinical Fieldwork II, a required 12-week internship under the mentorship of a licensed therapist with at least one year’s experience. In light of the fact that clinical fieldwork sites differ in size and resources, and clinical instructors may have only one year’s experience and no formal training in instruction, there is great variability in students’ clinical fieldwork experiences. The purpose of this study was to determine novice rehab OT’s perceptions of four key factors in clinical education: First, skill areas in which they felt most prepared; second, areas perceived as obstacles in adjustment to entry-level practice; third, essential elements of an ideal clinical learning environment; and fourth, the need for credentialing clinical instructors. Participants were 1-3 years post rehab fieldwork with first job in rehab. An online survey (N=45) and audiotaped interviews (N=9) were utilized to collect data on the perceptions of new OT’s on Fieldwork II experiences. Interviewees represented a convenience sample independent of survey participants. Most participants reported feeling prepared to perform basic clinical skills, communicate on interdisciplinary teams and seek mentorship in the workplace. Less proficiency was perceived in the areas of patient/family communication, and coping with reality shock (adjustment to real life practice). Over half of the participants felt that there should be some kind of mandatory credentialing for clinical instructors. There was consensus among OT’s regarding the ideal Fieldwork II setting which included well-trained instructors, availability for onsite learning and a well-equipped clinical site. / Educational Psychology

Background: The prevalence rate of Obstructive Sleep Apnea (OSA) has been increasing steadily over the past two decades. OSA is often misdiagnosed with other medical conditions, and there are several complications associated with OSA, such ashypertension, coronary artery disease, and cognitive problems, including higher rates of strokes and epilepsy. Further, dental complications may arise from being diagnosed with OSA, impacting overall systemic health. Patients suffering from OSA are more susceptible to developing dry mouth, thus increasing bacterial/fungal growth, leading to tooth decay and periodontal disease. There is currently a lack of data exploring OSA in College Students and the Oral Manifestations (symptoms or conditions linked in the oral cavity) related to having OSA. The present study investigated the relationship between OSA and Oral Manifestations among College Students. Methods: Approximately 230 college students from a large university were recruited to participate in our cross-sectional study. The Epworth Sleepiness Scale was used to screen for students at higher risk for OSA. Oral manifestations were also assessed by providing a survey/questionnaire for the students to list their dental history. Results: Overall, the prevalence of excessive daytime sleepiness was 24.9% in our sample, and males reported a higher percentage of excessive daytime sleepiness (31.0%) compared to females (23.7%). A statistically significant relationship was observed between ESS score and the previous use of orthodontic treatment(s) (chi-square with two degrees of freedom = 7.3277, p = 0.026), ESS and academic standing (chi-square with two degrees of freedom = 6.6348, p = 0.036), bruxism and academic standing (chi-square with two degrees of freedom = 7.4323, p = 0.006), recent cavity in the last two years and gender (chi-square with two degrees of freedom = 8.0029, p = 0.005), previous use of orthodontic treatment(s) gender (chi-square with two degrees of freedom = 4.9005, p = 0.027), and current or previous abnormal bite and gender (chi-square with two degrees of freedom = 4.4447, p = 0.035). No other statistically significant relationships were observed between ESS and dental health outcomes in our sample, or by subgroup. Conclusions: Findings from our study show that higher scores on the ESS are related to certain oral health indicators, with some notable differences by academic standing and gender. Future studies are needed that include a diverse sample of college students and incorporate a clinical measure of OSA in this population. Universities can take an active role in addressing OSA and related issues by launching health campaigns, raising awareness through workshops and seminars, and fostering a culture of proactive well-being among students and staff.

Graduating competent healthcare providers to meet increasing demands of the United States leads to interest in graduate health science student success. In this study, I explored the relationship between self-regulated learning strategies and licensing exam readiness among Doctor of Chiropractic students. Two research questions asked (1) how self-regulated learning strategies vary by gender and year of study, and (2) how self-regulated learning strategies relate to licensing exam readiness. One hundred thirty-three students from five chiropractic institutions were surveyed with questions from the Motivated Strategies for Learning Questionnaire (MSLQ) and exam readiness items. A series of t-tests, one-way analyses of variance, Kruskal-Wallis H tests, and ordinary least squares (OLS) regression addressed the research questions. Results indicated (1) self-regulated learning strategies do vary by gender and year of study, and (2) self-regulation is related to licensing exam readiness, particularly in Parts I and II of the exam. Chiropractic institutions and policymakers should focus efforts on introducing and reinforcing self-regulated learning strategies throughout the curriculum and explore licensing exam implications. Future research should continue expanding the literature on chiropractic education by considering actual licensing exam performance and determining appropriateness of the MSLQ for chiropractic students.

An important question in teaching language is, what accounts for the emergence of either receptive or expressive labels when teaching only one of them? The teaching procedures in the present study were intended to reproduce the natural development of bidirectional naming in which caregivers comment on the items a child is interacting with and children echo those vocalizations they hear. Thus, the only vocalizations presented by the researcher during teaching occurred after the learner pointed to a specific stimulus, and were specific to the stimulus being targeted. These vocalizations are referred to in this study as stimulus-specific consequences. The purpose of this research was to investigate if the stimulus-specific consequences could become discriminative stimuli for receptive labels, and lead to the emergence of expressive labels. Three studies were conducted, each with four adults. Results demonstrated that using a stimulus-specific consequence during teaching led to receptive labels for all participants, but led to the emergence of expressive labels for only four participants. In other words, bidirectional naming did not occur for the majority of participants. Factors that may improve interrelations between receptive and expressive labels were analyzed, but further evaluations are needed to account for the inconsistent demonstrations of naming.

Thesis (MPhil)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Students undertake their clinical placement in various clinical settings for the exposure to and acquisition of skills related to that particular context. The operating room, for example, is a context that offers the opportunity to develop critical skills related to the perioperative care of the patient. Despite the numerous studies that have been undertaken in this field, few studies that have investigated the operating room as a clinical learning environment in the South African healthcare system have been published. The aim of this study was to determine students’ perceptions of the operating room as a clinical learning environment in a private hospital context. An exploratory, interpretive and descriptive design generating qualitative data was utilized. Data was collected from nursing students undertaking their training at a private nursing education institution. Ten nursing students participated in an open-ended questionnaire (N=10), and twelve students participated in the focus group discussion (N=12). From the results, four themes emerged, namely, ‘interpersonal factors’, ‘educational factors’, ‘private operating room context’, and ‘recommendations’. This study has highlighted some of the challenges experienced by students in the private sector operating room context. Despite the potential learning opportunities, the key findings reveal negative perceptions of students regarding learning experiences. However, the opinion that the operating room offers an opportunity to gain skills unique to this context, as well as facilitates the integration of theory and practice, was also expressed. Some students reported that the emphasis on profitability and cost to patient, and the lack of a mentoring process in this context posed a constraint to learning. Exploration into the specific preparatory needs of students specific to learning outcomes before operating room placement should be considered. It would also be necessary to improve collaboration between lecturers, mentors and theatre managers so that a structured teaching programme may be developed for students entering the perioperative environment. / AFRIKAANSE OPSOMMING: Studente onderneem hul kliniese plasing in verskeie kliniese omgewings vir die blootstelling aan en aanleer van vaardighede wat verband hou met daardie spesifieke konteks. Die operasiesaal, byvoorbeeld, is ’n kliniese omgewing wat die geleentheid bied om kritiese vaardighede te ontwikkel wat verband hou met die perioperatiewe versorging van die pasiënt. Ten spyte van die talle studies wat in die operasiesaal onderneem was, het slegs ’n paar studies uit ’n Suid-Afrikaanse gesondheidsorg oogpunt, die operasiesaal as ’n kliniese opleidings omgewing ondersoek. Die doel van hierdie studie was om studente se persepsies van die operasiesaal as ’n kliniese omgewing in ’n privaat hospitaal konteks te bepaal. ’n Ondersoekende, verklarende en beskrywende ontwerp wat kwalitatiewe data genereer, is gebruik. Data is ingesamel van verpleegstudente wat hul opleiding by ’n privaat verpleegonderrig instelling ontvang. Tien verpleegstudente (N=10) was genooi om ’n onbepaalde vraelys te voltooi en twaalf student (N=12) het aan die fokusgroep bespreking deelgeneem. Vier temas het na vore gekom, naamlik ‘interpersoonlike faktore’, ‘opvoedkundige faktore’, ‘privaat-operasiesaal konteks’, en ‘aanbevelings’. Hierdie studie het ’n paar van die uitdagings uitgelig wat die studente in ’n privaat sektor operasiesaal ondervind. Ten spyte van die potensiële leergeleenthede teenwoordig in die privaat sektor operasiesaal, toon die belangrikste bevindings egter die negatiewe persepsies van studente jeens hierdie kliniese omgewing. Die opinie is egter ook uitgespreek dat hierdie omgewing ook ’n geleentheid aanbied om unieke vaardighede aan te leer. Dit bied ook ’n geleentheid om teorie en praktiese kundigheid te integreer. Sommige studente rapporteer dat die klem op winsgewendheid en koste vir die pasiënt, asoók die gebrek aan mentorskap in hierdie kliniese omgewing ’n beperking plaas op die leerproses. Die spesifieke voorbereidings behoeftes van studente insake leeruitkomste voordat plasing in die operasiesaal omgewing geskied, moet eers deeglik ondersoek word. Dit is ook nodig om die nodige samewerking tussen dosente, mentors en operasiesaal bestuurders te verbeter sodat ’n gestruktureerde onderrig program ontwikkel kan word vir studente wat die perioperatiewe omgewing betree.

Thesis (MPhil)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Educators across the health professions are now concerned with the teaching and assessment of professional skills. Caring behaviour is one of the attributes of professionalism in the health sciences professions and in the nursing profession it is regarded as the essence of the profession. The aim of this study is to explore the understandings and experiences of caring behaviours of first- and fourth year nursing students and how they would like to be assessed about their caring behaviours in a curriculum where it is not overtly taught. This will be investigated according to Watson’s carative factors and theoretical framework of caring, while Bloom’s Taxonomy of the affective learning domain will also be consulted. The design of the study is qualitative and explorative. A purposive sample was drawn from first-year nursing students (n=64), and fourth-year nursing students (n=41) at one nursing education institution. The sample of students (n=105) from seven (7) private training hospitals in the Western Cape participated in nine (9) focus group interviews (n=10-15). Data analysis was done by means of a framework analysis approach with a deductive strategy. Research findings from this study are extensively discussed and will be used to inform the undergraduate nursing curricula in South Africa about the profiles of caring nursing students and to make recommendations about the internalisation of caring behaviours, according to the affective learning domain. / AFRIKAANSE OPSOMMING: Opvoeders vanuit die verskeie gesondheidsberoepe, is tans met die leer en assessering van professionele vaardighede gemoeid. Sorgsame gedrag is een kenmerk van professionalisme in die gesondheidsberoepe. In verpleegkunde word sorgsame gedrag as die kern van die beroep beskou. Die doel van hierdie studie is om die begrip en ervarings van eerste- en vierde-jaar verpleegkunde studente rondom sorgsame gedrag te ondersoek. ʼn Verdere doel is om te bepaal hoe hierdie studente graag geassesseer wil word oor hul sorgsame gedrag in ʼn kurrikulum waar hierdie kenmerk nie pertinent geleer word nie. Watson se sorgsaamheidsfaktore en teoretiese raamwerk oor sorgsaamheid, sal gebruik word om die onderwerp na te vors. Bloom se Taksonomie van die affektiewe leergebied sal gesamentlik met Watson gebruik word as teoretiese grondslag vir die navorsing. Die studie-ontwerp is kwalitatief en verkennend. ʼn Doelbewuste seleksie is gedoen om spesifieke eerstejaar verpleegkunde studente (n=64) en vierdejaar verpleegkunde studente (n=41) by die navorsing te betrek. Die geselekteerde studente (n=105) van sewe (7) private opleidingshospitale in die Wes-Kaap, het aan nege (9) fokusgroep onderhoude deelgeneem (n=10-15). Die data-analise is deur middel van ʼn raamwerk-analise benader en ʼn deduktiewe strategie is gebruik. Die resultate van hierdie navorsing word omvattend bespreek en sal gebruik word ten doel voorgraadse verpleegkunde kurrikula in Suid-Afrika te informeer rakende die sorgsaamheidsprofiel van verpleegkunde studente. Aanbevelings, volgens die affektiewe leergebied, word ook gemaak oor hoe sorgsame gedrag geïnternaliseer kan word.

Master of Science / Department of Hospitality Management and Dietetics / Kevin R. Roberts / International college students are becoming a sizable part of the overall college student population in American universities. Studies show that these students come to the United States (U.S) with food habits that could be in variance with the U.S. food safety norms. While food safety in the U.S. is among the safest in the world, foodborne illness has remained a growing concern. Food experts are showing increasing concern about how food habits associated with cultural and ethnic norms are impacting basic food safety practices in the U.S. While minimal research regarding food safety has been conducted with college students in general, no studies have sought to understand food safety practices among international college students. This study investigated self-reported food safety practices of international college students. Specific objectives included: determine international college students’ knowledge regarding basic food safety principles, evaluate international college students’ belief towards food safety, and examine international students’ current food safety practices. The target population was international college students at Kansas State University. An online survey system was used to administer the questionnaires. The respondents were allowed two weeks to complete the questionnaires. To facilitate a higher response rate, two email reminders were sent, the first after one week and another two days prior to the expiration date. SPSS (version 17.0) was used for data analysis. Descriptive statistics were computed to understand the nature of data and provide characteristics of international college students in the study. Independent Samples t-tests were used to examine differences between demographic characteristics. A One-way ANOVA was used to identify differences in food safety knowledge and food handling practices among different ethnic groups regarding food safety. The Pearson correlation coefficient was used to measure association between variables. The majority of the respondents did not answer correctly questions related to cooking foods adequately and keeping foods at safe temperatures. The study suggests that most participants had beliefs that enhanced good safety practices. Respondents rarely practiced using a thermometer to determine correct temperatures of cooked foods or using separate cutting boards when preparing raw and ready-to-eat foods. They also reported using towels that were available to others to dry their hands. No significant differences were found between training and self-reported food safety handling practices.

Thesis (MPhil)--Stellenbosch University, 2014. / INTRODUCTION: For this MPhil research assignment, I have chosen to write an article based on a small scale research project conducted in the Clinical Skills Centre (CSC) at Stellenbosch University. Medical students’ perceptions were gathered in order to evaluate the usefulness and relevance of the Clinical Skills module and the different components thereof as experienced by the students themselves. This in the end led to valuable feedback that were given to the course coordinators which in turn may lead to curricula changes being made to improve the overall teaching and learning experience for future medical students rotating through the CSC.