Indonesian physicians working in rural and remote areas must be equipped not only with generic co... more Indonesian physicians working in rural and remote areas must be equipped not only with generic competencies but also with the attributes and skills necessary to provide health care services without compromising quality. This study sought to reach a consensus on the attributes and competencies that are viewed as essential and important for working effectively as an early career doctor in rural and remote practice in Indonesia. A two-round Delphi study was conducted by reference to 27 consenting physicians working in rural and remote Indonesia. Forty-three items covering 9 attributes and 34 competencies were sent to these physicians to be rated on a Likert scale ranging from 1 to 5 in terms of their importance for effective rural and remote practice. Nine attributes and 29 competencies progressed to Round 2. All nine attributes and 29 competencies were identified as essential or important for junior physicians’ ability to be effective in their practice. The essential attributes includ...
BACKGROUND In response to growing curriculum pressures and reduced time dedicated to teaching ana... more BACKGROUND In response to growing curriculum pressures and reduced time dedicated to teaching anatomy, research has been conducted into developing innovative teaching techniques. This raises important questions for neuroanatomy education regarding which teaching techniques are most beneficial for knowledge acquisition and long-term retention, and how they are best implemented. This focused systematic review aims to provide a review of technology-enhanced teaching methods available to neuroanatomy educators, particularly in knowledge acquisition and long-term retention, compared to traditional didactic techniques, and proposes reasons for why they work in some contexts. METHODS Electronic databases were searched from January 2015 to June 2020 with keywords that included combinations of 'neuroanatomy,' 'technology,' 'teaching,' and 'effectiveness' combined with Boolean phrases 'AND' and 'OR.' The contexts and outcomes for all studies were summarised while coding, and theories for why particular interventions worked were discussed. RESULTS There were 4287 articles identified for screening, with 13 studies included for final analysis. There were four technologies of interest: stereoscopic views of videos, stereoscopic views of images, augmented reality (AR), and virtual reality (VR). No recommendation for a particular teaching method was made in six studies (46%) while recommendations (from weak to moderate) were made in seven studies (54%). There was weak to moderate evidence for the efficacy of stereoscopic images and AR, and no difference in the use of stereoscopic videos or VR compared to controls. CONCLUSIONS To date, technology-enhanced teaching is not inferior to teaching by conventional didactic methods. There are promising results for these methods in complex spatial anatomy and reducing cognitive load. Possible reasons for why interventions worked were described including students' engagement with the object, cognitive load theory, complex spatial relationships, and the technology learning curve. Future research may build on the theorised explanations proposed here and develop and test innovative technologies that build on prior research.
International Journal of Environmental Research and Public Health
Complex factors influence physicians’ decisions to remain in rural and remote (RR) practice. Indo... more Complex factors influence physicians’ decisions to remain in rural and remote (RR) practice. Indonesia, particularly, has various degrees of poor governance contributing to physicians’ decisions to stay or leave RR practice. However, there is a paucity of literature exploring the phenomenon from the perspective of Indonesian RR physicians. This study explores physicians’ lived experiences working and living in Indonesian RR areas and the motivations that underpin their decisions to remain in the RR settings. An interpretative phenomenological analysis was utilised to explore the experiences of 26 consenting voluntary participants currently working in the RR areas of Maluku Province. A focus group discussion was undertaken with post-interns (n = 7), and semi-structured interviews were undertaken with junior (n = 9) and senior physicians (n = 10) working in district hospitals and RR health centres. Corruption was identified as an overarching theme that was referred to in all of the de...
Table S1. Estimated unit marks (%) over level 3 from GLM ANOVA by entry category (non-standard en... more Table S1. Estimated unit marks (%) over level 3 from GLM ANOVA by entry category (non-standard entry, school leaver entry and graduate entry), for students who completed all 4 levels. Table S2. Estimated unit marks (%) over level 3 from GLM ANOVA by entry category (non-standard entry, school leaver entry and graduate entry broken down by background discipline), for students who completed all 4 levels. Table S3. Estimated unit marks (%) over level 4 from GLM ANOVA by entry category (non-standard entry, school leaver entry and graduate entry), for students who completed all 4 levels. Table S4. Estimated unit marks (%) over level 4 from GLM ANOVA by entry category (non-standard entry, school leaver entry and graduate entry broken down by background discipline), for students who completed all 4 levels. Table S5. Estimated unit marks (%) over level 5 from GLM ANOVA by entry category (non-standard entry, school leaver entry and graduate entry), for students who completed all 4 levels. Tab...
Focus on health professional education : a multi-disciplinary journal, 2010
The practice of Evidence Based Medicine (EBM) enables clinicians to integrate the individual pati... more The practice of Evidence Based Medicine (EBM) enables clinicians to integrate the individual patient situation, clinical expertise, and the best available evidence for quality patient care. A pilot series of tutorials in which students were guided through the EBM process to answer clinical questions focused on a patient seen in a clinical attachment are highlighted.
Predicting workplace performance of junior doctors from before entry or during medical school is ... more Predicting workplace performance of junior doctors from before entry or during medical school is difficult and has limited available evidence. This study explored the association between selected predictor variables and workplace based performance in junior doctors during their first postgraduate year. Two cohorts of medical students (n = 200) from one university in Western Australia participated in the longitudinal study. Pearson correlation coefficients and multivariate analyses utilizing linear regression were used to assess the relationships between performance on the Junior Doctor Assessment Tool (JDAT) and its sub-components with demographic characteristics, selection scores for medical school entry, emotional intelligence, and undergraduate academic performance. Grade Point Average (GPA) at the completion of undergraduate studies had the most significant association with better performance on the overall JDAT and each subscale. Increased age was a negative predictor for junio...
Introduction: As healthcare educators undergo a career transition from providing care to providin... more Introduction: As healthcare educators undergo a career transition from providing care to providing education, their professional identity can also transition accompanied by significant threat. Given their qualifications are usually clinical in nature, healthcare educators’ knowledge and skills in education and other relevant theories are often minimal, making them vulnerable to feeling fraudulent in the healthcare educator role. This threat and vulnerability is described as the impostor phenomenon. The aim of this study was to examine and map the concepts of professional identity and the influence of impostor phenomenon in healthcare educators. Methods: The authors conducted a scoping review of health professions literature. Six databases were searched, identifying 121 relevant articles, eight meeting our inclusion criteria. Two researchers independently extracted data, collating and summarising the results. Results: Clinicians who become healthcare educators experience identity amb...
International Journal of Health Policy and Management, 2020
Background: Medical workforce scarcity in rural and remote communities is a global problem, sever... more Background: Medical workforce scarcity in rural and remote communities is a global problem, severely challenging healthcare delivery and health equity. Both developed and developing countries report geographically uneven distributions of the medical workforce. This scoping review synthesizes evidence from peer-reviewed and grey literature concerning approaches implemented to improve the recruitment, development, and retention of the rural medical workforce in both developed and developing countries. Methods: We will utilize the Arksey and O’Malley (2005) framework as the basis for this scoping review. The databases to be searched include Medline, Embase, Global Health, CINAHL Plus, and PubMed for articles from the last decade (2010-2019). Searches for unpublished studies and grey literature will be undertaken using the Google Scholar - Advanced Search tool. Quantitative and qualitative study designs will be included. Two authors will independently screen and extract relevant article...
BackgroundIt is important for health professions educators to consider not just the potential ben... more BackgroundIt is important for health professions educators to consider not just the potential benefits humanities education can contribute but the central learning outcomes health humanities education can achieve, how achievement of this learning can be meaningfully measured or assessed and the effectiveness of learning strategies evaluated. This research asked, what could an internationally informed curriculum and evaluation framework for the implementation of health humanities for health professions education look like?MethodsThe participatory action research (PAR) approach applied was based on three iterative phases 1. Perspective sharing and collaboration building. 2. Evidence gathering 3. Development of an internationally relevant curriculum and evaluation framework for health humanities. A series of online meetings, virtual workshops and follow up communications produced the curriculum framework documents.ResultsFollowing the perspective sharing and evidence gathering, the Ins...
BackgroundIt is important for health professions educators to consider not just the potential ben... more BackgroundIt is important for health professions educators to consider not just the potential benefits humanities education can contribute but the central learning outcomes health humanities education can achieve, how achievement of this learning can be meaningfully measured or assessed and the effectiveness of learning strategies evaluated. This research asked, what could an internationally informed curriculum and evaluation framework for the implementation of health humanities for health professions education look like?MethodsThe participatory action research (PAR) approach applied was based on three iterative phases 1. Perspective sharing and collaboration building. 2. Evidence gathering 3. Development of an internationally relevant curriculum and evaluation framework for health humanities. A series of online meetings, virtual workshops and follow up communications produced the curriculum framework documents.ResultsFollowing the perspective sharing and evidence gathering, the Ins...
Background Many factors contribute to engagement in rural and remote medical practice but little ... more Background Many factors contribute to engagement in rural and remote medical practice but little is known about the determinant factors of rural and remote medical practice in the such remote locations as the Maluku Province of Indonesia. This study describes determinants, preferences and intentions of doctors in the rural and remote practice. Methods An online survey of work-related experience and intentions for future rural work was administered to 410 doctors working in the Maluku province of Indonesia. Participant characteristics were described using descriptive statistics, associations between the independent variables with the location of workforce, preference for rural practice and intention to remain in rural and remote Maluku were analysed using Chi-square tests and logistic regression. Results A total of 324 responses (79% response rate) were recorded comprising 70% females and 30% Pattimura University graduates of doctors employed in Maluku. Graduating from Pattimura Univ...
Background:The articulation of learning goals, processes and outcomes related to health humanitie... more Background:The articulation of learning goals, processes and outcomes related to health humanities teaching currently lacks comparability of curricula and outcomes, and requires synthesis to provide a basis for developing a curriculum and evaluation framework for health humanities teaching and learning. This scoping review sought to answer, how, and why the health humanities are used in health professions education. It also sought to explore how health humanities curricula are evaluated and whether the programme evaluation aligns with the desired learning outcomes. Methods:A focused scoping review of qualitative and mixed-methods studies that included the influence of integrated health humanities curricula in pre-registration health professions education with programme evaluate of outcomes was completed. Studies of students not enrolled in a pre-registration course, with only ad-hoc health humanities learning experiences that were not assessed or evaluated were excluded. Four databa...
Indonesian physicians working in rural and remote areas must be equipped not only with generic co... more Indonesian physicians working in rural and remote areas must be equipped not only with generic competencies but also with the attributes and skills necessary to provide health care services without compromising quality. This study sought to reach a consensus on the attributes and competencies that are viewed as essential and important for working effectively as an early career doctor in rural and remote practice in Indonesia. A two-round Delphi study was conducted by reference to 27 consenting physicians working in rural and remote Indonesia. Forty-three items covering 9 attributes and 34 competencies were sent to these physicians to be rated on a Likert scale ranging from 1 to 5 in terms of their importance for effective rural and remote practice. Nine attributes and 29 competencies progressed to Round 2. All nine attributes and 29 competencies were identified as essential or important for junior physicians’ ability to be effective in their practice. The essential attributes includ...
BACKGROUND In response to growing curriculum pressures and reduced time dedicated to teaching ana... more BACKGROUND In response to growing curriculum pressures and reduced time dedicated to teaching anatomy, research has been conducted into developing innovative teaching techniques. This raises important questions for neuroanatomy education regarding which teaching techniques are most beneficial for knowledge acquisition and long-term retention, and how they are best implemented. This focused systematic review aims to provide a review of technology-enhanced teaching methods available to neuroanatomy educators, particularly in knowledge acquisition and long-term retention, compared to traditional didactic techniques, and proposes reasons for why they work in some contexts. METHODS Electronic databases were searched from January 2015 to June 2020 with keywords that included combinations of 'neuroanatomy,' 'technology,' 'teaching,' and 'effectiveness' combined with Boolean phrases 'AND' and 'OR.' The contexts and outcomes for all studies were summarised while coding, and theories for why particular interventions worked were discussed. RESULTS There were 4287 articles identified for screening, with 13 studies included for final analysis. There were four technologies of interest: stereoscopic views of videos, stereoscopic views of images, augmented reality (AR), and virtual reality (VR). No recommendation for a particular teaching method was made in six studies (46%) while recommendations (from weak to moderate) were made in seven studies (54%). There was weak to moderate evidence for the efficacy of stereoscopic images and AR, and no difference in the use of stereoscopic videos or VR compared to controls. CONCLUSIONS To date, technology-enhanced teaching is not inferior to teaching by conventional didactic methods. There are promising results for these methods in complex spatial anatomy and reducing cognitive load. Possible reasons for why interventions worked were described including students' engagement with the object, cognitive load theory, complex spatial relationships, and the technology learning curve. Future research may build on the theorised explanations proposed here and develop and test innovative technologies that build on prior research.
International Journal of Environmental Research and Public Health
Complex factors influence physicians’ decisions to remain in rural and remote (RR) practice. Indo... more Complex factors influence physicians’ decisions to remain in rural and remote (RR) practice. Indonesia, particularly, has various degrees of poor governance contributing to physicians’ decisions to stay or leave RR practice. However, there is a paucity of literature exploring the phenomenon from the perspective of Indonesian RR physicians. This study explores physicians’ lived experiences working and living in Indonesian RR areas and the motivations that underpin their decisions to remain in the RR settings. An interpretative phenomenological analysis was utilised to explore the experiences of 26 consenting voluntary participants currently working in the RR areas of Maluku Province. A focus group discussion was undertaken with post-interns (n = 7), and semi-structured interviews were undertaken with junior (n = 9) and senior physicians (n = 10) working in district hospitals and RR health centres. Corruption was identified as an overarching theme that was referred to in all of the de...
Table S1. Estimated unit marks (%) over level 3 from GLM ANOVA by entry category (non-standard en... more Table S1. Estimated unit marks (%) over level 3 from GLM ANOVA by entry category (non-standard entry, school leaver entry and graduate entry), for students who completed all 4 levels. Table S2. Estimated unit marks (%) over level 3 from GLM ANOVA by entry category (non-standard entry, school leaver entry and graduate entry broken down by background discipline), for students who completed all 4 levels. Table S3. Estimated unit marks (%) over level 4 from GLM ANOVA by entry category (non-standard entry, school leaver entry and graduate entry), for students who completed all 4 levels. Table S4. Estimated unit marks (%) over level 4 from GLM ANOVA by entry category (non-standard entry, school leaver entry and graduate entry broken down by background discipline), for students who completed all 4 levels. Table S5. Estimated unit marks (%) over level 5 from GLM ANOVA by entry category (non-standard entry, school leaver entry and graduate entry), for students who completed all 4 levels. Tab...
Focus on health professional education : a multi-disciplinary journal, 2010
The practice of Evidence Based Medicine (EBM) enables clinicians to integrate the individual pati... more The practice of Evidence Based Medicine (EBM) enables clinicians to integrate the individual patient situation, clinical expertise, and the best available evidence for quality patient care. A pilot series of tutorials in which students were guided through the EBM process to answer clinical questions focused on a patient seen in a clinical attachment are highlighted.
Predicting workplace performance of junior doctors from before entry or during medical school is ... more Predicting workplace performance of junior doctors from before entry or during medical school is difficult and has limited available evidence. This study explored the association between selected predictor variables and workplace based performance in junior doctors during their first postgraduate year. Two cohorts of medical students (n = 200) from one university in Western Australia participated in the longitudinal study. Pearson correlation coefficients and multivariate analyses utilizing linear regression were used to assess the relationships between performance on the Junior Doctor Assessment Tool (JDAT) and its sub-components with demographic characteristics, selection scores for medical school entry, emotional intelligence, and undergraduate academic performance. Grade Point Average (GPA) at the completion of undergraduate studies had the most significant association with better performance on the overall JDAT and each subscale. Increased age was a negative predictor for junio...
Introduction: As healthcare educators undergo a career transition from providing care to providin... more Introduction: As healthcare educators undergo a career transition from providing care to providing education, their professional identity can also transition accompanied by significant threat. Given their qualifications are usually clinical in nature, healthcare educators’ knowledge and skills in education and other relevant theories are often minimal, making them vulnerable to feeling fraudulent in the healthcare educator role. This threat and vulnerability is described as the impostor phenomenon. The aim of this study was to examine and map the concepts of professional identity and the influence of impostor phenomenon in healthcare educators. Methods: The authors conducted a scoping review of health professions literature. Six databases were searched, identifying 121 relevant articles, eight meeting our inclusion criteria. Two researchers independently extracted data, collating and summarising the results. Results: Clinicians who become healthcare educators experience identity amb...
International Journal of Health Policy and Management, 2020
Background: Medical workforce scarcity in rural and remote communities is a global problem, sever... more Background: Medical workforce scarcity in rural and remote communities is a global problem, severely challenging healthcare delivery and health equity. Both developed and developing countries report geographically uneven distributions of the medical workforce. This scoping review synthesizes evidence from peer-reviewed and grey literature concerning approaches implemented to improve the recruitment, development, and retention of the rural medical workforce in both developed and developing countries. Methods: We will utilize the Arksey and O’Malley (2005) framework as the basis for this scoping review. The databases to be searched include Medline, Embase, Global Health, CINAHL Plus, and PubMed for articles from the last decade (2010-2019). Searches for unpublished studies and grey literature will be undertaken using the Google Scholar - Advanced Search tool. Quantitative and qualitative study designs will be included. Two authors will independently screen and extract relevant article...
BackgroundIt is important for health professions educators to consider not just the potential ben... more BackgroundIt is important for health professions educators to consider not just the potential benefits humanities education can contribute but the central learning outcomes health humanities education can achieve, how achievement of this learning can be meaningfully measured or assessed and the effectiveness of learning strategies evaluated. This research asked, what could an internationally informed curriculum and evaluation framework for the implementation of health humanities for health professions education look like?MethodsThe participatory action research (PAR) approach applied was based on three iterative phases 1. Perspective sharing and collaboration building. 2. Evidence gathering 3. Development of an internationally relevant curriculum and evaluation framework for health humanities. A series of online meetings, virtual workshops and follow up communications produced the curriculum framework documents.ResultsFollowing the perspective sharing and evidence gathering, the Ins...
BackgroundIt is important for health professions educators to consider not just the potential ben... more BackgroundIt is important for health professions educators to consider not just the potential benefits humanities education can contribute but the central learning outcomes health humanities education can achieve, how achievement of this learning can be meaningfully measured or assessed and the effectiveness of learning strategies evaluated. This research asked, what could an internationally informed curriculum and evaluation framework for the implementation of health humanities for health professions education look like?MethodsThe participatory action research (PAR) approach applied was based on three iterative phases 1. Perspective sharing and collaboration building. 2. Evidence gathering 3. Development of an internationally relevant curriculum and evaluation framework for health humanities. A series of online meetings, virtual workshops and follow up communications produced the curriculum framework documents.ResultsFollowing the perspective sharing and evidence gathering, the Ins...
Background Many factors contribute to engagement in rural and remote medical practice but little ... more Background Many factors contribute to engagement in rural and remote medical practice but little is known about the determinant factors of rural and remote medical practice in the such remote locations as the Maluku Province of Indonesia. This study describes determinants, preferences and intentions of doctors in the rural and remote practice. Methods An online survey of work-related experience and intentions for future rural work was administered to 410 doctors working in the Maluku province of Indonesia. Participant characteristics were described using descriptive statistics, associations between the independent variables with the location of workforce, preference for rural practice and intention to remain in rural and remote Maluku were analysed using Chi-square tests and logistic regression. Results A total of 324 responses (79% response rate) were recorded comprising 70% females and 30% Pattimura University graduates of doctors employed in Maluku. Graduating from Pattimura Univ...
Background:The articulation of learning goals, processes and outcomes related to health humanitie... more Background:The articulation of learning goals, processes and outcomes related to health humanities teaching currently lacks comparability of curricula and outcomes, and requires synthesis to provide a basis for developing a curriculum and evaluation framework for health humanities teaching and learning. This scoping review sought to answer, how, and why the health humanities are used in health professions education. It also sought to explore how health humanities curricula are evaluated and whether the programme evaluation aligns with the desired learning outcomes. Methods:A focused scoping review of qualitative and mixed-methods studies that included the influence of integrated health humanities curricula in pre-registration health professions education with programme evaluate of outcomes was completed. Studies of students not enrolled in a pre-registration course, with only ad-hoc health humanities learning experiences that were not assessed or evaluated were excluded. Four databa...
Background: Reporting on the effect of health humanities teaching in health professions education... more Background: Reporting on the effect of health humanities teaching in health professions education courses to facilitate sharing and mutual exchange internationally, and the generation of a more interconnected body of evidence surrounding health humanities curricula is needed. This study asked, what could an internationally informed curriculum and evaluation framework for the implementation of health humanities for health professions education look like? Methods: The participatory action research approach applied was based on three iterative phases 1. Perspective sharing and collaboration building. 2. Evidence gathering 3. Development of an internationally relevant curriculum and evaluation framework for health humanities. Over 2 years, a series of online meetings, virtual workshops and follow up communications resulted in the production of the curriculum framework. Results: Following the perspective sharing and evidence gathering, the InspirE5 model of curriculum design and evaluation framework for health humanities in health professions education was developed. Five principal foci shaped the design of the framework. Environment: Learning and political environment surrounding the program. Expectations: Graduate capabilities that are clearly articulated for all, integrated into core curricula and relevant to graduate destinations and associated professional standards. Experience: Learning and teaching experience that supports learners' achievement of the stated graduate capabilities. Evidence: Assessment of learning (formative and/or summative) with feedback for learners around the development of capabilities. Enhancement: Program evaluation of the students and teachers learning experiences and achievement. In all, 11 Graduate Capabilities for Health Humanities were suggested along with a summary of common core content and guiding principles for assessment of health humanities learning. Discussion: Concern about objectifying, reductive biomedical approaches to health professions education has led to a growing expansion of health humanities teaching and learning around the world. The InspirE5 curriculum and evaluation framework provides a foundation for a standardised approach to describe or compare health humanities education in different contexts and across a range of health professions courses and may be adapted around the world to progress health humanities education.
Background:
The articulation of learning goals, processes and outcomes related to health humanit... more Background: The articulation of learning goals, processes and outcomes related to health humanities teaching currently lacks comparability of curricula and outcomes, and requires synthesis to provide a basis for developing a curriculum and evaluation framework for health humanities teaching and learning. This scoping review sought to answer how and why the health humanities are used in health professions education. It also sought to explore how health humanities curricula are evaluated and whether the programme evaluation aligns with the desired learning outcomes.
Methods: A focused scoping review of qualitative and mixed‐methods studies that included the influence of integrated health humanities curricula in pre‐registration health professions education with programme evaluate of outcomes was completed. Studies of students not enrolled in a pre‐registration course, with only ad‐hoc health humanities learning experiences that were not assessed or evaluated were excluded. Four databases were searched (CINAHL), (ERIC), PubMed, and Medline.
Results: The search over a 5 year period, identified 8621 publications. Title and abstract screening, followed by full‐ text screening, resulted in 24 articles selected for inclusion. Learning outcomes, learning activities and evaluation data were extracted from each included publication.
Discussion: Reported health humanities curricula focused on developing students’ capacity for perspective, reflexivity, self‐reflection and person‐centred approaches to communication. However, the learning outcomes were not consistently described, identifying a limited capacity to compare health humanities curricula across programmes. A set of clearly stated generic capabilities or outcomes from learning in health humanities would be a helpful next step for benchmarking, clarification and comparison of evaluation strategy.
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Papers by Sandra Carr
The articulation of learning goals, processes and outcomes related to health humanities teaching currently lacks comparability of curricula and outcomes, and requires synthesis to provide a basis for developing a curriculum and evaluation framework for health humanities teaching and learning. This scoping review sought to answer how and why the health humanities are used in health professions education. It also sought to explore how health humanities curricula are evaluated and whether the programme evaluation aligns with the desired learning outcomes.
Methods:
A focused scoping review of qualitative and mixed‐methods studies that included the influence of integrated health humanities curricula in pre‐registration health professions education with programme evaluate of outcomes was completed. Studies of students not enrolled in a pre‐registration course, with only ad‐hoc health humanities learning experiences that were not assessed or evaluated were excluded. Four databases were searched (CINAHL), (ERIC), PubMed, and Medline.
Results:
The search over a 5 year period, identified 8621 publications. Title and abstract screening, followed by full‐ text screening, resulted in 24 articles selected for inclusion. Learning outcomes, learning activities and evaluation data were extracted from each included publication.
Discussion:
Reported health humanities curricula focused on developing students’ capacity for perspective, reflexivity, self‐reflection and person‐centred approaches to communication. However, the learning outcomes were not consistently described, identifying a limited capacity to compare health humanities curricula across programmes. A set of clearly stated generic capabilities or outcomes from learning in health humanities would be a helpful next step for benchmarking, clarification and comparison of evaluation strategy.