Thesis (MPhil)-- Stellenbosch University, 2013. / ENGLISH ABSTRACT: At the core of clinical education, within the allied health professions, is the teaching-learning relationship between the clinical educator and the student which is reinforced by and grounded in the explanatory theories of socio-constructivism, experiential learning and positioning. A good teaching-learning relationship is fundamental to the success of the students’ learning in the clinical environment. Clinical educators fulfil a dual role as mentors and assessors to students. The purpose of this study is to explore the students’ and clinical educators’ perceptions of the dual role of a clinical educator of students in the physiotherapy clinical environment, and how the perceptions of both parties influence the teaching-learning relationship. By following a phenomenological qualitative research approach with an interpretivist paradigm the researcher obtained data from focus groups and individual interviews. Data analysis involved a contextualised interpretive content analysis paradigm. The perceptions of the participants in the teaching-learning relationship, their particular expectations, challenges and preferences, reflect their experiences and are presented in the findings of the study. The findings of this study are comprehensively discussed and recommendations are made to transform the teaching-learning relationship by repositioning the participants (both students and clinical educators) in order to enhance the quality of the clinical learning experience within the physiotherapy clinical environment. / AFRIKAANSE OPSOMMING: Die onderrig-leerproses-verhouding tussen die kliniese dosent en die student vorm die kern van kliniese onderrig, ondersteun deur en op grond van die verduidelikende teorieë van sosiale konstruktivisme, leerervaring en posisionering, vir verwante gesondheidsberoepe. Die onderrigleerproses- verhouding word daarom beskou as die grondslag vir die sukses van leergeleenthede, aangesien die kwalitiet van die verhouding deurslagggewend is om studente se leerproses in die kliniese omgewing te ondersteun. Kliniese dosente speel ‘n dubbele rol as mentors en assessore vir studente. Die doel van die studie is om studente en kliniese dosente se sienings van die dubbele rol van ‘n kliniese dosent van studente binne die kliniese onderrigveld van fisioterapie in die kliniese omgewing te ondersoek, asook hoe die persepsies van albei partye die onderigleerproses- verhouding beinvloed. Die data word verkry van fokusgroepe en individuele onderhoude deur ‘n fenomenologiese kwalitatiewe navorsingsbenadering met ‘n interpreterende paradigma te volg. Die data is ontleed volgens ‘n kontekstuele interpreterende inhoudsontledingsproses. Die persepsies van die deelnemers aan die onderrig-leerprosesverhouding, hul spesifieke verwagtinge, uitdagings en voorkeure as drie breë temas van hierdie tesis, weerspieël hul ervarings en word weergegee in die bevindings van die studie. Die navorsing bespreek hierdie bevindings en doen regstellende aanbevelings oor die bevindings. Hierdeur kan die onderrig-leerproses-verhouding, deur herposisionering van albei partye (studente sowel as kliniese dosente), getransformeer word en die gehalte van die kliniese leerervaring in die fisioterapeutiese kliniese omgewing verbeter word.

MSc. Thesis / Introduction: In 2018, the College of Midwives of Ontario expanded the scope of practice for registered midwives to include performing point of care ultrasound (POCUS) to aid their obstetrical clinical assessments. This project evaluated learner sonography knowledge, skill acquisitions, and integration of this technology following an innovative POCUS curriculum developed for midwives to understand the impacts of this training. Methods: Concurrent triangulation with mixed methods was used in this study through surveys and interviews. First, the surveys were used to collect data across four time points including before and after the intervention. Five- and seven-point Likert scale questions were analyzed through descriptive statistics. Open-ended questions were qualitatively analyzed using thematic analyses. Second, the semi-structured interviews were conducted to better understand participants’ attitudes and clinical behaviours. Interviews were coded and analyzed using a combination of Corbin and Strauss as well as Charmaz approaches to grounded theory. Results: The findings demonstrated how there was a positive growth in learner comfort with POCUS and a desire to continue using it during clinical practice. The frequency of POCUS use within antenatal care increased with common applications including fetal presentation and assessment of pregnancy viability. The interviews highlighted five themes: facilitating learning, improving care, refining the role of the midwife, serving community, and maintaining competency. Access to clinical placements and the cost of a device were identified as barriers to promoting POCUS skill sets. Participants who had access to a device and completed the clinical practicum are continuing to use sonography within their clinics to provide more comprehensive client care. Conclusions: This project demonstrates how POCUS training can positively impact midwives particularly with aiding clinical decision making such as those regarding fetal viability and presentation. However, the challenges with obtaining a clinical practicum to ensure competency and the cost and access to a device, are significant barriers that unless they are addressed, may result in minimal integration within community practices. / Thesis / Master of Health Sciences (MSc) / The ability to conduct ultrasounds has recently been included in Ontario midwives’ scope of practice. This project evaluated a newly developed Point of Care Ultrasound (POCUS) curriculum for practicing midwives to understand how midwives can learn and apply POCUS into their clinical work. Learners completed surveys at four time points from pre-course to one-year post-course to share their experiences of knowledge and skill acquisition and applying this training to their clinical work. Five midwives also participated in an interview to share their perspectives about the course more in-depth. It was found that Ontario midwives were very interested to learn POCUS to improve client care. Unfortunately, they struggled finding time and opportunities to refine their sonography skills such as securing a clinical practicum or the funds to purchase a device. However overall, POCUS in midwifery was well received, this technology and its respective education should continue to be supported in Ontario.

Thesis (MPhil)--Stellenbosch University, 2012. / Background: Formative feedback is an important process in facilitating student learning as it helps students identify learning gaps early enough and devise means of covering those gaps. Most health professional educators spend most of the time designing summative assessment tools and pay little emphasis to giving qualitative feedback to students throughout the learning process. This problem has been identified at Makerere University College of Health Sciences (MaKCHS) and forms the basis of this study. Objectives: To investigate prior understanding of students and lecturers about formative feedback. The study also aimed at exploring experiences of students and lecturers regarding implementation of feedback in a resource-constrained context. Methods: This was an action research study using a participatory approach. Results: Initially, lecturers had some prior knowledge of feedback, however, students had misconceptions of what feedback could mean. After introducing a written feedback form, all participants expressed satisfaction with the feedback process. Key themes that emerged included: enhancing motivation, enhancing learning, promoting reflection and clarifying understanding. Conclusion: Students` motivation to learn can be greatly enhanced through formative qualitative feedback. A simple structured form is one way of providing qualitative formative feedback to students in resource-limited settings. Key words: formative feedback, structured form, action research.

Thesis (MPhil)-- Stellenbosch University, 2013. / ENGLISH ABSTRACT: Anatomy remains a foundational subject in the preclinical years of medical and other allied health sciences courses, with exceptionally large volumes of content, and a unique practical aspect: conducting cadaveric dissection and the use of pre-dissected cadaver specimens. The educational climate can be set by incorporating a suitable introduction to the subject, addressing academically and emotionally underprepared students before the formal commencement of the Anatomy curriculum. The literature does not mention what such an Introduction Module should entail. Quantitative means such as questionnaires have been used to evaluate the perceptions and the emotional and psychological influence of Anatomy. It is often assumed that through words meaning is conveyed, providing researchers with data that can be objectively interpreted. But questionnaires are rather pre-emptive of what students might say about what they experience, and the number of possible answers is restricted. The use of drawings might be an opportunity for the students to express their unmediated feelings; strong emotions could appear in the form of images instead of words, allowing students to experience rather than verbalize feelings especially with a limited vocabulary. Qualitative data analysis enables the researcher to get at complex layers of meaning, interprets human behaviour and experiences beyond the surface appearance, provides rich evidence of this behaviour and/or experiences and consequently builds theory inductively from the data source. The primary purpose of this study is to establish the feasibility of using drawings to explore how a diverse group of students from the University of Limpopo, Medunsa Campus, view Anatomy and what insights can be gained from these drawings to inform the Introduction Module. Students were asked to draw their perceptions of Anatomy after approximately 10 weeks of allocated contact time, which includes lectures as well as practical sessions. A total of 74% (134 out of 181) drawings were handed in. A matrix-type method of analysis based on existing literature was formulated to analyse the drawings. Three dimensions were identified for each of the drawings: “what” is illustrated, then “how” is the message conveyed or illustrated, and lastly, the “emotion” communicated through the drawing. The reliability was increased with two interpreters who analysed the drawings. Learning approaches, orientation on human life and death, the general emotional state of individuals influenced by Anatomy, their course of study, the influence of family and friends are some of the aspects that were depicted in the drawings. The rich data encountered through the drawings provided curriculum organisers with insights enabling them to implement necessary changes to the Introduction Module in order to improve student preparedness for what is to follow during the Anatomy curriculum. Further studies are recommended on how student drawings can be utilised to inform curricula and in other educational contexts. / AFRIKAANSE OPSOMMING: Anatomie bly 'n fundamentele vakgebied in die prekliniese jare van mediese en ander verwante gesondheidswetenskappe kursusse, met besonder groot volumes van die studieinhoud en 'n unieke praktiese aspek: die uitvoer van kadawer disseksie en die gebruik van voorafgedissekteerde kadawer monsters. Die opvoedkundige klimaat kan ingestel word deur 'n geskikte Inleiding Module tot die kurrikulum te voeg wat akademies en emosioneel swak voorbereide studente kan voorberei vir die formele Anatomie kurrikulum. Literatuur noem nie wat so 'n Inleiding Module moet behels nie. Kwantitatiewe praktyke soos vraelyste is voorheen gebruik om die persepsies en die emosionele en sielkundige invloed van Anatomie te evalueer. Dit word dikwels aanvaar dat deur woorde betekenis oorgedra word wat navorsers van data voorsien wat objektief vertolk kan word. Maar vraelyste is vooropgestel ten opsigte van dit wat studente mag ervaar, en die aantal moontlike antwoorde is beperk. Sterk emosies kan na vore kom in die vorm van beelde in plaas van woorde, wat studente in staat stel om te ervaar, eerder as om gevoelens te verwoord, veral met 'n beperkte woordeskat. Die gebruik van tekeninge is 'n geleentheid vir die student om hul onverdeelde gevoelens uit te druk. Kwalitatiewe data-ontleding stel die navorser in staat om komplekse lae van betekenis te interpreteer, menslike gedrag en ervarings buite die oppervlak te analiseer, bied voldoende bewyse van hierdie gedrag en ervarings en kan gevolglik teorie induktief uit die data bron bou. Die primêre doel van hierdie studie is om die lewensvatbaarheid van die gebruik van tekeninge te verken in hoe 'n diverse groep studente aan die Universiteit van Limpopo, Medunsa-kampus, Anatomie sien en watter insigte kan verkry word uit hierdie tekeninge om die temas wat in die Inleiding Module aangespreek moet word, vas te stel. Studente is gevra om hul persepsies van Anatomie uit te beeld na ongeveer tien weke se formele kontaktyd, wat lesings, sowel as praktiese sessies insluit. 'n Totaal van 74% (134 uit 181) tekeninge is ingehandig. 'n Matriks-tipe metode van analise gebaseer op bestaande literatuur is geformuleer om die tekeninge te ontleed. Drie dimensies is geïdentifiseer vir elk van die tekeninge: "wat" is geteken, dan "hoe" is die boodskap wat oorgedra word geïllustreer, en laastens die “emosie” gekommunikeer deur die tekening. Die betroubaarheid is verhoog met twee individue wat die tekeninge ontleed. Leerbenaderings, oriëntering op die menslike lewe en die dood, die algemene emosionele toestand van individue en hoe dit hul persepsies van Anatomie beinvloed, die studiekursus waarvoor hul ingeskryf is, die invloed van familie en vriende, is 'n paar aspekte wat in die tekeninge uitgebeeld is. Die ryk data teëgekom in die tekeninge kan kurrikulum organiseerders in staat te stel om die nodige veranderinge aan die Inleiding Module te implementeer ten einde die voorbereiding van studente te verbeter vir wat gaan volg tydens die Anatomy kurrikulum. Verdere studies word aanbeveel oor hoe student tekeninge gebruik kan word om leerplanne en in ander opvoedkundige kontekste in te lig.

ABSTRACT Background: Electronic cigarettes are used to deliver nicotine to consumers. E-cigarettes are claimed to be an alternative method for smoking cessation. The use of electronic cigarettes is increasing among young people, especially current and former smokers. It is unknown what the harm or benefit that result from e-cigarettes’ use of the individuals on the well-being. Purpose: This study was conducted to explore the prevalence of e-cigarettes use and exposure among college-based health care students. Also to assess the awareness level and beliefs in regard to electronic cigarettes use among the college-based health care students. Methods: 217 college-based health care undergraduate students from nursing, nutrition and respiratory therapy programs were surveyed in this study. The survey was composed of 17 questions in regards to the awareness, prevalence of e-cigarettes use and beliefs about e-cigarettes use. The data analysis included descriptive statistics, independent sample t-test and one-way ANOVA. A significance level was set at 0.05. Results: The response rate was 98.1%, 87% of the respondents were female and 70% were between the ages of 19-25 years. Most of the respondents were nursing students (47.5%); followed by nutrition students (29.5%); and respiratory therapy students (23%). Most of the respondents were non-smokers (83.4%); former smokers were 13.8%; and smokers were 2.8%. Almost all the respondents had heard of e-cigarettes (99.5%), and 21.2% had tried e-cigarettes at least once in their lifetime. The mean awareness score was 5.1 (SD 0.11); smokers showed the highest mean awareness score of 6.0±2.28. The majority of the participants disagreed that e-cigarettes are less dangerous than traditional cigarettes or can help smokers to quit; and more than half of the participants disagreed that e-cigarettes are used only by smokers. There was a significant difference among male (5.71±1.51) and female (5.03±1.71) in regards to the e-cigarettes awareness level (p=0.047). The awareness level was significantly different among respondents who had previously used e-cigarettes (5.63±1.49) than participants who have not tried e-cigarettes at least once during their lifetime (4.98±1.72) (p=0.021) Conclusion: This study found that most of the students in the college of nursing and health professions were not e-cigarettes’ users. People who have tried e-cigarettes, have friends who have tried e-cigarettes as well. Furthermore, curiosity is the major reason that led them to try e-cigarettes. E-cigarettes’ awareness is high among smokers and e-cigarettes’ users; older students seem to have higher awareness than younger students. There were general disagreements on the use of e-cigarettes as a less dangerous alternative to tobacco cigarettes to help smokers to quit. Finally, male and female participants showed significant differences in their awareness of e-cigarettes.

Purpose: This study aimed to assess the feasibility of implementation of the Health Professions Council of South Africa's (HPCSA) clinic-based hearing screening subsection of its 2007 Position Statement on Early Hearing Detection and Intervention (EHDI) programmes in South Africa. Specific sub-aims included (a) establishing the prevalence of hearing screening conducted at Maternal Child Woman’s Health (MCWH) immunisation clinics; (b) determining the hearing screening procedures and protocols in use at MCWH immunisation clinics; (c) determining and exploring the possible concomitant personnel-associated factors which may influence the implementation of newborn and infant hearing screening programmes; (d) determining and exploring other factors that may have influenced implementation of newborn and infant hearing screening; and lastly, (e) comparing any hearing screening procedures and protocols in use to the HPCSA (2007) EHDI position statement clinic guidelines and associated clinic benchmarks Participants: Thirty primary healthcare immunisation clinic managers/acting managers were interviewed in two South African sample groups, in the North West province (NW) and Gauteng (GP). Design: An exploratory, non-experimental, qualitative research design was employed incorporating both quantitative and qualitative information within the two sample groups. Methods and Materials: An interview using a questionnaire was administered with primary health care (PHC) clinic nursing manager/acting manager, placed within the identified sites. The questionnaire encompassed areas such as work contexts, hearing screening contexts and information management systems, as well as quality control measures in place at these clinics. Data Analysis: Content analysis was used to code emergent themes into specific categories. Frequency calculations of the emergent themes were calculated and results described qualitatively. Results: No PHC clinics placed within the identified sites offered or provided formalised newborn/infant hearing screening and none of these facilities had equipment to do so. Most sites attributed the lack of formalised hearing screening to budgetary and human resource issues, staff training in particular. Non-formalised hearing screening protocols in place demonstrated inconsistencies in application across districts and none complied with HPCSA (2007) clinic guidelines. Most respondents were willing to implement formalised hearing screening to coincide with their immunisation schedules. The immunisation context was considered favourable for implementation of formalised hearing screening. Other factors such as reduced parental awareness of the importance of hearing screening, and caregiver cultural issues were considered surmountable by respondents. Conclusions: HPCSA (2007) implementation of clinic hearing screening protocols at PHC immunization clinics (level one) does not appear to be feasible based on current evidence. Results from the current study have assisted in identifying procedural and logistical assets and barriers to implementation of HPCSA (2007) clinic guidelines for EHDI at immunisation clinics in South Africa. Future research implications include formal investigations of central directorate versus district differences in PHC Package Integrated Management of Childhood Illnesses (IMCI); Otitis Media, and Road to Health Chart (RtHC) protocols; provincial and district inequities in funding as they impinge on hearing health care service delivery; costing of rudimentary protocols in place versus formalised HPCSA (2007) EHDI service delivery; research into parental awareness, education and willingness in specific reference to certain procedures such as otoacoustic emissions; and replication of the current study throughout the country for quantitave data with increased ability to draw causal inferences and generalize findings.

Hip fracture is the most common reason for admission to an orthopaedic trauma word. It is usually a 'Fragility' fracture caused by a fall affecting an older person with osteoporosis or osteopenia (a condition in which bones lose calcium and become thinner, but not as much as in osteoporosis). The National Hip Fracture Database worldwide reports the average age of a person with hip fracture is 84 years for men and 83 years for women, 76% of fracture occurs in women. By 2050, the worldwide incidence of hip fracture in men is projected to increase by 24% in women and 31% in men. Hip fractures due to sideways falls are a worldwide health problem, especially amongst elderly people. The experienced force to the proximal femur during a fall leading to hip fracture is significantly dependent on density, thickness and stiffness of the body during impact. The process of fracture and healing can only be understood in terms of structure and composition of the bone and also its mechanical properties. Bone fracture analysis investigates to predict various failure mechanisms under different loading conditions. In an effort to improve and assist scientists and researchers to predict the impact damage response of bone structures and estimate femoral fracture load in vitro, an accurate explicit finite element (14E) method has been investigated in this study. In the first part, the main goal is to create a 3D reconstruction and registration of semi-transparent Computed Tomography (CT) scan image data using SIMPLEWARE software. In the second part, effect of cortical thickness and impact velocity on the energy absorption of hip during a fall has been investigated on a 3D model. Additionally composite femora were mechanically tested to failure and regression analyses between measured fracture load and FE-predicted fracture load were performed. The results indicate that this sophisticated technique, which is still early in its development, can achieve precision comparable to that of densitometry and can predict femoral fracture load to within 18% with 95% confidence.

The Healthcare Quality Strategy for NHS Scotland, relates its overall vision of healthcare quality to six dimensions of care as: Safe, Efficient, Effective, Equitable, Timely and Patient Centred. Patient Centred Care also underpins many subsequent policies such as the management of Long Term Conditions (Scottish Government, 2008) and the Chief Medical Officers Realistic Medicine report (Barlow, et al., 2015) Leadership styles and associated policies and procedures are often assumed to inhibit or encourage the delivery of quality Patient Centred Care and the NHS invests millions of pounds per year in Leadership training. At a clinical team and management level there are behaviours and initiatives that can arguably have positive and negative impacts on the ability of individual practitioners to provide quality Patient Centred Care. However there have been no attempts to empirically test the association between (good) Leadership and quality Patient Centred Care. Without any evidence of such a relationship, NHS investment of substantial resources may be misguided. Additionally, much of the focus of research in both Leadership and Patient Centred Care has focused on medical practitioners and nurses. There is little research that focuses on the impact of allied health professionals' (a term describing 12 differing health care professional groups representing over 130,000 clinicians throughout the United Kingdom) practice on the quality of person centred care and how this is affected by Leadership structures and styles. This study aimed to explore whether there is a direct or indirect link between (transformational) Leadership and achieving the delivery of high quality Patient Centred Care (PCC) in allied health professional (AHP) practice. Aim The aim of this thesis was to explore whether it was possible to empirically demonstrate a relationship between Leadership (good or bad) and Patient Centred Care, and to do this in relation to Allied Health Professional practice. Research questions I. Is there a relationship between Transformational Leadership and Patient Centred Care in AHP practice? II. How do AHP’s conceptualise Leadership and its impact on their ability to deliver PCC? III. Do local contexts influence the ability of leaders to support Patient Centred Care? Study one Study one was designed to answer research question one: exploring the relationship between transformational Leadership and Patient Centred Care using survey design. Two groups of Allied Health Professionals were selected to take part in the study: Podiatrists and Dieticians. Clinical team leaders from across 12 Podiatry teams and 12 Dietetic teams completed a survey composed of measures of transformational Leadership and self-monitoring. Clinicians from these teams were also be asked to complete questionnaires on their perception of their clinical leaders’ transformational Leadership skills. This allowed comparison of self-assessed Leadership and team assessed Leadership. Clinicians were also asked to collect patient experience measures from 30 of their patients. Study Two Study Two was designed to answer research questions 2 and 3: how do AHPs conceptualise Leadership and how do they view the link between Leadership and their ability to deliver Patient Centred Care; and how might local context impact on professional Leadership and therefore its potential to enable or inhibit Patient Centred Care. In depth interviews were conducted with clinicians and clinical team leaders to explore the barriers and facilitators to effective Leadership, teamwork and the provision of quality care. Interviews were conducted with 21 Podiatrists and 12 Dieticians and analysed using a framework analysis approach. Results I. Is there a relationship between Patient Centred Care and transformational Leadership in AHP practice? The theory that there is a link between transformational Leadership and Patient Centred Care was confirmed. A significant relationship was discovered for the dietetics group linking Transformational Leadership with patient centred quality of care measures. There was also a relationship in the podiatry group that was suggestive of a relationship. II. How do AHP’s conceptualise Leadership and its impact on their ability to deliver PCC? AHP’s in both groups had broadly similar conceptualisations of Leadership and both groups played down the role of Leadership in the delivery of Patient Centred Care. A far more salient factor in achieving the delivery of high quality Patient Centred Care for the AHP’s interviewed was professional autonomy. III. Do local contexts influence the ability of leaders to support Patient Centred Care? A number of contextual issues related to both Patient Centred Care and Leadership were identified from the qualitative analysis. These were centred on systemic factors, relating to management and bureaucracy, and individual factors, such as relationships within teams. In Podiatry a major shift in the context of care was ongoing during the study, namely a greater emphasis on encouraging patients to self-care. This affected the relationships between patients and Podiatrists, and Podiatrists and managers, in a way that Podiatrists felt it negatively impacted on their ability to provide quality Patient Centred Care. Conclusion A weak relationship was observed between Transformational Leadership styles and the delivery of Patient Centred Care in two Allied Health Professional groups. Professional autonomy was identified as being more likely to facilitate delivery of person centred care. Organisational issues and intervening policy directives can impact on the delivery of Patient Centred Care, regardless of Leadership. Recommendations Further work exploring the link between Leadership and Patient Centred Care is required. The concept of professional autonomy should be fostered within Leadership programs to enhance delivery of Patient Centred Care. The impact of individual policies, such as moves towards more self-care, on quality criteria need to be more fully considered. Whilst such policies may make care more efficient, there may be negative consequences for other quality care criteria, such as Patient Centred Care.

Context: Self-learning (i.e., students learning independently) and clinical simulation are essential components in contemporary health professions education (HPE). Self-learning is discussed often, yet the concept is seldom the target of rigorous study. Likewise, simulation modalities are abundant, though educational theory that guides their use in HPE remains elusive. Objectives: This dissertation investigates the effects of directed self-guided learning (DSGL) on novice health professions students’ skill acquisition, retention, and transfer in the context of simulation-based education. The objective is to explore how the combination of external direction and student self-guidance influences: students’ cognitive and metacognitive processes, students’ interactions with the learning environment and available resources, and how students learn in different DSGL contexts. Methods: Three research studies used randomized, controlled experimental designs to address five hypotheses. All studies included a performance assessment one-week after the initial practice session that evaluated skill retention and/or skill transfer. Data analysis employed univariate and multivariate analyses of variance and correlational techniques. Results: Regarding students’ cognitive and metacognitive processes, the data show a relation between DSGL and goal-setting. The results suggest that self-guided students benefit when they are directed to set goals related to performance processes, rather than performance outcomes. Regarding the learning environment, when students are directed to practice on simulators that increase progressively in fidelity (i.e., realism) they self-guide their advancement between those simulators effectively and display successful skill transfer. Finally, self-guided students that controlled their learning progression and learning sequence selected the theoretically most appropriate practice schedule (i.e., progressive learning). Students in this latter group seemed able, surprisingly, to direct their own self-guidance. Conclusions: This dissertation adds support to the hypothesis that self-guided students benefit due to their autonomy in controlling practice conditions to meet their own learning needs. Thus, the question of whether or not DSGL is effective, becomes how best to augment the DSGL experience. The instructional design of elements such as goals lists and task structuring (e.g., progressive increases in simulator fidelity) represent techniques that an educator can use to fulfill the role of director in a student’s SGL.

Context: Self-learning (i.e., students learning independently) and clinical simulation are essential components in contemporary health professions education (HPE). Self-learning is discussed often, yet the concept is seldom the target of rigorous study. Likewise, simulation modalities are abundant, though educational theory that guides their use in HPE remains elusive. Objectives: This dissertation investigates the effects of directed self-guided learning (DSGL) on novice health professions students’ skill acquisition, retention, and transfer in the context of simulation-based education. The objective is to explore how the combination of external direction and student self-guidance influences: students’ cognitive and metacognitive processes, students’ interactions with the learning environment and available resources, and how students learn in different DSGL contexts. Methods: Three research studies used randomized, controlled experimental designs to address five hypotheses. All studies included a performance assessment one-week after the initial practice session that evaluated skill retention and/or skill transfer. Data analysis employed univariate and multivariate analyses of variance and correlational techniques. Results: Regarding students’ cognitive and metacognitive processes, the data show a relation between DSGL and goal-setting. The results suggest that self-guided students benefit when they are directed to set goals related to performance processes, rather than performance outcomes. Regarding the learning environment, when students are directed to practice on simulators that increase progressively in fidelity (i.e., realism) they self-guide their advancement between those simulators effectively and display successful skill transfer. Finally, self-guided students that controlled their learning progression and learning sequence selected the theoretically most appropriate practice schedule (i.e., progressive learning). Students in this latter group seemed able, surprisingly, to direct their own self-guidance. Conclusions: This dissertation adds support to the hypothesis that self-guided students benefit due to their autonomy in controlling practice conditions to meet their own learning needs. Thus, the question of whether or not DSGL is effective, becomes how best to augment the DSGL experience. The instructional design of elements such as goals lists and task structuring (e.g., progressive increases in simulator fidelity) represent techniques that an educator can use to fulfill the role of director in a student’s SGL.