Inside the black box – an inter-professional education session on how to teach clinical reasoning in others

Mrs Tameeka Robertson1

1Northern Health, Epping, Australia

Background: Northern Health Clinical Educators are often asked to teach clinical reasoning (CR) to their students or learners but receive very little formal training on how.  Clinical reasoning is often thought as complex and difficult to teach with little available allied health specific evidence to guide this process. A needs analysis indicated staff wanted to learn more about this topic.

An inter-professional education program titled ‘Teaching Clinical Reasoning in others’ was developed by the Allied Health Education team and due to its success expanded to nursing and medical staff.

A program was developed to facilitate participants to unpack the process of problem solving from their experience and reflect on this in relation to the journey from novice to expert.  The program requires active involvement and sharing of learning and experiences to benefit the group learning

Method: The education program was developed from a synthesis of literature on clinical reasoning across disciplines, via expert consultation and via participant engagement in the learning process.

Results: 31 participants have attended from allied health, medicine and nursing.   Evaluation data highlighted increased knowledge and confidence from participants in understanding and teaching clinical reasoning.  Qualitative comments highlight the benefit of the inter-professional nature, the importance of thinking about how to teach and self-reflection.

Discussion: This program has highlighted the need for health professionals to undertake explicit training in clinical reasoning and explicit self –reflection regarding their own thinking and problem solving.  We need to invest in the training and support of our clinical educators to ensure we have quality graduates of the future.  This presentation will provide ideas on how to teach clinical reasoning relevant to your context.


Biography:

I am an Occupational Therapist by background who has been working in public health for the last 12 years.  I have always enjoyed teaching and educating others which led me to complete a Masters in Health Science with electives focusing on teaching and learning.  My current role at Northern Health as the Allied Health Clinical Schools Co-ordinator and Education leader means that I have the opportunity to teach Allied Health staff and students fundamental skills that will shape the future work force.  Clinical Reasoning is a topic i find fascinating and have really enjoyed exploring this area.

Innovative Culturally Integrative Models in Psychological Treatments of CALD Population

Mr Dragos Ileana1, Mrs  Annette  Ruzicka1

1World Wellness Group, Stones Corner, Brisbane, Australia

Historically, psychological approaches on treatment and their validity on wider population have been widely disputed since its first years of inception. Whilst most of the psychotherapy approaches have been researched and validated on Western population responding to specific symptoms from the spectrum, the applicability of these theories on CALD population remains a significant challenge for both consumers of services and the Allied Health Practitioners.  When the challenge around language barriers are enhanced by the cultural diversity and their explanatory models plus specific challenges in delivering, adapting and tailoring Western approach treatments to CALD consumers, the effect can be seen on multiple levels – from client’s attendance and response to treatment to further impact on wider systems costs and sustainability.

This paper will present the experience of World Wellness Group in the development of their Multicultural Psychological Therapies Program  based on a 4-Tiered  Model to meet cultural and language needs of CALD consumers via therapeutic approaches in an integrative manner in order to provide culturally responsive psychological services. The 4 tiers consist of ethnic matching, co-therapy with a bicultural worker, therapy via an interpreter and therapy in English.

With half of the Australian population being born overseas or having one or both parents born overseas, the provision of culturally responsive psychological therapies presents unique challenges in the primary mental health setting.

This presentation will be present the Multicultural Psychological Therapies Program model,  a case study and preliminary research results with the aim to outline to inform innovative and evidence based approaches in primary mental health care for an increasingly diverse Australian population.


Biography:

Dragos is a clinical psychologist with expertise in working cross-culturally in the mental health, counselling and psychotherapy areas. He is the Acting Coordinator of the Transcultural Clinical Services at the Qld Transcultural Mental Health Centre, where, since 2010 he has been providing transcultural consultation to public MHS and non government organisations across the state and clinical care to clients from a diverse cultural background and with a wide range of mental health diagnoses.

He is a part of the Brisbane Metro South Trauma Leadership Group which aims to implement, educate and train mainstream mental health practitioners and services in culturally sensitive trauma informed and trauma trained care. He is an AHPRA clinically endorsed psychologist supervisor and has been involved in delivering training in culturally sensitive practice, to clinical psychology Master and PhD students from different Brisbane based universities.

In parallel, since 2012, he has been a part of the World Wellness Group Clinic, providing psychological treatments under Medicare, ATAPS and more recently Multicultural Psychological Therapies Group Program, assisting migrants, refugees, asylum seekers, as well as, other vulnerable CALD consumers who experience mental health issues in their visa processes, settlement and acculturation journey. He is one of the co-creators of MPTG Program and Assoc. Board Director at the World Wellness Group – overseeing the clinical program of the Allied Health Practitioners portfolio within a multidisciplinary integrative health care clinic designated for vulnerable population.

Annette is a member of the Australian Association of Social Work, and is an accredited mental health Social Worker. Annette has over 20 years of professional work in both generalised and clinical social work in mental health. Annette has a number of qualifications including Bachelor of Adult Education and Training, Bachelor of Social Work, Master in Social Work, Certificate in Nursing, and Graduate Diploma in Buddhist Psychotherapy & Counselling and is an accredited Family Dispute Resolution Practitioner.

Annette has management experiences working in Queensland government in particular in the child protection area as a Director for Transitional Placements Unit and Manager for a number of Child Safety Service Centres in South East Queensland. Annette also has significant social work experiences working in hospital Emergency Department &, Community Mental Health. She is the current Manager of the Multicultural Psychological Therapies Group Program and a health practitioner at the World Wellness Group.

Annette speaks three languages (Sinhala, Tamil, and English) and values of social justice approach to respecting culturally appropriate health outcomes for clients and their families with mindful and clinical practices that enhance a sense of purpose, connectedness, with a quest for wholeness filled with hope and harmony. Annette’s aspirations to work in the human services resonates these values and reflects in her approaches to social work practice and theoretical frameworks.

The Allied Health work readiness study: Identifying personal characteristics signalling work readiness in Allied Health students

Dr Maxine O’brien1, Ms Kelli Troy1, Ms Jayne Kirkpatrick1

1Darling Downs Health, Toowoomba, Australia

Background: Clinical placements associated with university degrees for the allied health professions aim to support the preparation of students for post graduate employment through the practical application of theoretical constructs. However, employers recognise that a range of individual skills and attributes outside of technical and academic achievement impact on work readiness. This project sought to identify these individual characteristics, and their relative importance.

Method: The study utilised the knowledge and experience of allied health Clinical Educators, experienced Clinical Supervisors, and Allied Health Directors, across six AH disciplines. Participants completed a brief demographic questionnaire before participating in one of three groups which employed the structured, Nominal Group Technique to seek answers to the research question “What do you believe are the most important personal characteristics signalling work readiness in allied health students?”

Results: Data were analysed by group and then overall, resulting in a complete list of 103 characteristics raised, 37 of which were judged as among the “most important” by study participants. Analysis revealed six characteristics which were identified and voted as among the most important by each independent group. Personal insight and self-awareness rose to the top of the list of most important characteristics, with resilience being second on this list, followed by communication skills, organisational skills, lifelong learning, and professionalism.  A further nine characteristics were selected by two of the three groups, while an additional 22 characteristics were raised and voted as among the most important by members of a single group.

Discussion: We believe that these results will be of interest to allied health students and staff, universities, recruiters and management. It is our hope that identification of these characteristics may also lead to the development of targeted education and support programs within DDH to assist students’ growth in these areas.


Biography:

Dr Maxine O’Brien has enjoyed a rich and varied career as a psychologist including clinical, teaching, supervision and research roles. Despite an abiding love for the clinical practice of psychology, Maxine also has a passion for useful, practical research and has completed a PhD and numerous publications. Accordingly, Maxine’s current roles within Queensland Health include that of Senior Psychologist, Alcohol and Other Drug Service, and DDH Acting Research Fellow. Maxine’s lengthy experience as a Clinical Supervisor has prompted curiosity about work readiness in health service staff, making her a natural fit for this research team.

Who wins when multidisciplinary health students have immersive service learning placements in regional communities with high needs and limited services?

Ms Robyn Fitzroy1

1University Centre For Rural Health, Lismore, Australia

The University Centre for Rural Health (UCRH) in Northern NSW was required to double its multidisciplinary health placements to 4,300 using innovative models. The goal was to develop placements beyond the acute care setting, into communities whilst still meeting curriculum outcomes and skill-development needs of over 23 universities. Placements involved high levels of disadvantage including isolation, limited health literacy and limited health services for community. Finding ways to give multidisciplinary health students a broad, inter-professional and community-immersive placement experience required innovative methods and challenged the existing paradigms used by traditional health settings, community agencies and universities.

A model of placement that met curriculum standards, enabled students to provide a community service and met UCRH and community needs was developed based on four key principles; continuous service, site engagement/enhancement, non-traditional supervision and inter-professionalism. Students placed into schools, pre-schools, aged-care facilities and community clinics are exposed to challenging yet positive rural training.

This models provides continuous service at the placement site with student placement blocks, one after the other. Community engagement is a priority so students learn clinically relevant challenges while simultaneously teaching communities about the benefits of these disciplines. Supervision is not one-to-one or necessarily discipline specific and requires students to expand their inter-professional skills and resilience.

Student services in 2018 included:

  • occupational therapy (254 weeks), speech pathology (223 weeks) -7 schools, 2 aged care
  • dietetics (30 weeks) – Aboriginal Medical Services, Red Cross
  • exercise physiology (40 weeks) community clinic
  • social work (36 weeks) – school, headspace, employment agency.

The community benefits are far-reaching as new services are delivered, health literacy enhanced and an understanding of the roles and value of health care therapies alongside general practice is improved.  The multi-pronged impacts of this model, presents opportunities for expansion and replication and benefits both students and communities.

The initiator of this work, Dr Lindy Swain is acknowledged.


Biography: 

Robyn Fitzroy is the Program Director at the University Centre for Rural Health

Faster, fairer, stronger: Subacute physiotherapy workforce redesign – methodology, implementation and outcomes

Alana Jacob1, Uyen Phan1, Katherine  Hodgson1, Dr. Catherine Granger1,2

1Allied Health, Physiotherapy, Melbourne Health, Melbourne, Australia, 2Physiotherapy Department, The University of Melbourne, Melbourne, Australia

Background: Physiotherapy services face multiple competing demands including increasing patient numbers and complexity, with finite staffing resources. This project aimed to implement a comprehensive subacute workforce redesign at Melbourne Health using existing resources. The target was to improve patient and staff outcomes primarily through responsive allocation of resources (right patient, right care, right time).

Method: Implementation involved establishment of governance and steering committees including organisational key stakeholders; pre/post patient and staff satisfaction surveys with focus on frustration lists and areas for improvement; mapping of current and future processes; service benchmarking; and review of staff workload. Data were utilised to inform the new model for implementation.

Results: Prior to implementation, 77 patients were surveyed and the main area for improvement identified was ‘time waiting for therapy’, 39 staff (physiotherapists, EP’s and AHA) were surveyed and main areas for improvement identified were ‘job satisfaction’, ‘stress and fatigue’, and ‘communication’. Top staff frustrations were ‘limited leave cover’, ‘leave planning’, and ‘duplication of paperwork’. Based on findings, a new model was implemented across 2018. Changes included: a standardised prioritisation tool across inpatients and community therapy service; an ‘early starter staff role’ and team huddles to improve communication regarding staffing and workload across the department; creation of workflow processes for staff to assist across teams; streamlined processes and paperwork to reduce duplication; enhanced electronic communication systems for management of leave and improved mechanisms for requesting and offering assistance.

Discussion: Innovative workforce models are required to meet the changing demands. A comprehensive redesign of subacute services, utilising a ‘ground-up’ approach was implemented. Preliminary results indicate staff and patient areas for improvement were met. Evaluation is currently in progress and full post-evaluation results will be presented at the conference. The learnings from the development and implementation of this redesign could be applied to other disciplines and organisations.


Biography:

Alana Jacob is the Manager of Physiotherapy and Exercise Physiology at The Royal Melbourne Hospital. She has extensive experience managing acute and subacute inpatient and outpatient services across the public and private sector. Alana has a clinical background as a Physiotherapist and has completed a MBA majoring in Health and Human Services Management. Alana has a passion for improving patient outcomes by working with teams to improve systems and processes within the healthcare network.

The Metro South Health Allied Health Assistant Learning and Development Project

Mr Jeremy Lindsay1

1Metro South Hosptial And Health Service, Brisbane, Australia

Background: Perceived inconsistent and/or insufficient allied health assistant (AHA) learning and development is commonly reported by allied health professionals (AHP/s) as a barrier to enhanced task delegation to AHAs, and may prevent optimal utilisation of AHAs, with potential service efficiency, and quality of care implications.

Aims:The MSH AHA Learning and Development Project began in 2016 and was aimed to address the lack of a clear and coordinated MSH AHA learning and development plan, which had resulted in fragmentation of the AHA training procedures and resources across the different MSH locations and services. The project aims to produce a new framework to improve the structure and consistency of AHA learning and development, optimising AHA clinical practice, and driving excellence in allied health service delivery across MSH.

Methods: Project activities to date have included: email based surveys of AH professional directors to map the MSH AHA workforce; literature review and benchmarking of existing learning and capability frameworks; AHA focus groups to evaluate and select most appropriate framework; and surveys of AHA learning and developing needs.

Results: Project outcomes include: formation of the MSH AHA Network; creation of the MSH AHA Intranet (QHEPS) page, development and publication of MSH AHA Capability Development Framework (CDF) with Learning and Development planning resource; and implementation of the inaugural MSH AHA Learning and Development Forum in May 2018.

Next steps include: Implementation and evaluation of the AHA CDF; gap analysis of existing AHA learning and development resources; sourcing and/or development of new resources to fill gaps identified.

Future directions: Implementation of the Allied Health Professional Office Queensland AHA framework audit tool, and a specific evaluation of current AHP delegation practices.


Biography:

Jeremy Lindsay is a registered Physiotherapist with 14 years clinical work experience within Queensland and the UK. He has worked in allied health workforce develop roles at both Metro South Hospital and Health Service, and in the Department of Health at the Allied Health Professions’ Office of Queensland. Through this work he has developed an interest in the use of allied health assistant roles, allied health professional expanded scope roles, and interdisciplinary clinical education to support the delivery of efficient, high quality, patient-focused care.

Young people with complex trauma – keeping them Connected when they “just want to be at the beach”

Ms Kate Headley1, Ms Sophie Phillips1, Ms Kelsey Stalker1

1LINKS Trauma Healing Service, Family And Community Services NSW, Charlestown, Australia

In October 2017 the LINKS Trauma Healing Service commenced a 3 year pilot study offering multidisciplinary trauma treatment for children living in Out Of Home Care (OOHC) in NSW. The service delivers a range of evidence-based trauma interventions combined with allied health services, for children aged 16 and under living in OOHC.

Occupational Therapy and Speech Pathology services have focused on improving quality of life outcomes for young people through consumer-centred goal prioritisation, discipline-specific screening, connecting young people with service providers and strengthening caregiver capacity. Difficulties engaging in education, community activities and social networks have been identified as themes through clinical work.

In late 2018 the team identified the risk of young people disengaging with therapeutic services during the holiday period. This concern coincided with the allied health priorities of increasing engagement in meaningful activities, to promote health, wellbeing and connection with community. An allied health, carer and client-driven initiative enabled young people to participate in a range of leisure activities across the summer including Trauma Sensitive Yoga, Graffiti Art, Soccer, Creative Space, Rugby League and Surf Therapy.

Consumers self-reported therapeutic benefits of engaging in meaningful occupation within a social environment. Activities supported generalisation of skills targeted in psychological therapy, connection with peers and promoted interest in engaging with the external service providers, supporting sustainable relationships.

This presentation will outline the critical and practical considerations for development of a consumer-driven meaningful activities program. The qualitative therapeutic outcomes will be discussed and showcased through feedback provided by young people engaged in the program. The Occupational Therapists and Speech Pathologist will share their reflections of therapeutic benefits, the impact of consumer engagement and future considerations.


Biography:

Kate Headley

Since graduating as a speech pathologist in 2001, Kate has been passionate about working with vulnerable populations. Kate has worked extensively in the disability sector delivering direct therapeutic interventions, clinical supervision, community capacity building projects and student education. Kate’s work across Western NSW has helped her develop her knowledge of the unique challenges faced by allied health providers living in rural and remote communities. Kate is a certified Key Word Sign presenter and a trainer in Inclusive Communication and Behaviour Support. Kate currently works as part of a multidisciplinary team providing trauma treatment to children living in Out of Home Care.

Kelsey Stalker

Kelsey grew up and studied Occupational Therapy in New Zealand. She graduated in 2011 and worked in CAMHS in Auckland for 8 years. During this time Kelsey discovered two areas she is highly passionate about, Dialectical Behaviour Therapy and Outreach work. She is highly motivated to increase access to healthcare for vulnerable populations within a sustainable, community based and culturally appropriate framework. In 2018 she moved to Newcastle NSW, and began working with the LINKS Trauma Healing Service. Here she is relishing the opportunity to combine evidence based practice with Occupational Therapy in the role of Mental Health Clinician.

Sophie Phillips

Sophie’s interest working with disadvantaged communities commenced with university placements in primary health care, mental health rehabilitation and paediatrics. Her career commenced as an occupational therapist in forensic mental health in Melbourne.  She then worked as a family therapist in the areas of child protection and disability. After having three children, she returned to occupational therapy in acute mental health. Her current position as an occupational therapist with the LINKS Trauma Healing Service aligns with her values of family centred practice, community based service delivery and working within a multi-disciplinary framework to improve the wellbeing of young people in out of home care.

Allied Health Rural Generalist Training Program – Experiences from the top end

Ms Justine Williams1, Ms Renae Moore1

1Top End Health Services, Casuarina, Australia

Introduction: The Allied Health Rural Generalist Pathway is a strategy to build the capacity, value and sustainability of allied health services and multi-disciplinary teams in rural and remote areas.  The components of an allied health rural generalist pathway are:

  1. Service models that address the challenges of providing the broad range of healthcare needs of rural and remote communities,
  2. Workforce and employment structures that support the development of rural generalist practice capabilities, and
  3. an education program tailored to the needs of rural generalist practitioners.

This paper provides an overview of the application of the Allied Health Rural Generalist Training Program in the Top End from 2017 to date, shares the key learnings of our journey so far and our plans for the program moving forward.

Implementation: In 2017, the Top End Health Services committed to funding four rural generalist training positions for up to two years on a rolling funding basis. The initial cohort, with trainees from the professions of podiatry, pharmacy and speech pathology, commenced in July 2017 and concluded their traineeship in December 2018. A further trainee, a physiotherapy graduate joined the program in April 2018.

Discussion of Challenges & Opportunities: The vast geography of the Top End combined with small and disparate populations covered by the Top End Health Services of the Northern Territory provide great challenges in delivering comprehensive integration of care close to homes.   Unique challenges experienced with this program have included engagement with the many stakeholders about the strategy, the scope of the service development projects and “isolation” of the graduates from their professional colleagues.  Learnings from the initial cohort will be applied to the next cohort of graduates due to commence in early 2019.


Biography:

Renae’s professional background is a speech pathologist with experience in remote, rural and urban settings across health, education and community sectors. Renae has been actively involved in rural and remote allied health issues at a local, State/Territory and national level throughout her career More recently, Renae has worked in a variety of senior policy and project roles across aboriginal health, early childhood intervention, aged and disability; and workforce strategy; including the position of Principal Allied Health Advisor for NT Health. Currently, Renae is the Executive Director Allied Health with Top End Health Services.

Justine Williams is the TEHS Allied Health Workforce Development Officer. She has worked for many years as an Occupational Therapist, Team Leader and Manager in a variety of health settings in the Northern Territory.  She is based in Darwin and has had oversight of the Allied Health Rural Generalist Training Program since 2017.

Allied Health succession planning practices in Large Health District: A descriptive study

Ms Kate Vickers1,2, Dr. Nazlee Siddiqui2, Ms Sue  Colley1, Ms Leann Lancaster1

1South Western Sydney Local Health District, Liverpool, Australia, 2The Unviersity of Tasmania, Rozelle, Australia

Introduction: Succession planning (SP) is an effective strategy to manage workforce shortages and high staff turn-over. The SP process includes: strategic planning; desired skills and needs identification; development processes; mentoring and resources. In a large Local Health District, Allied Health (AH) has informal SP processes in place for workforce planning and development. This study aims to (1) evaluate if AH informal SP practices meet this process; (2) identify if AH staff perceive a district-wide SP program meets their needs.

Method: A descriptive qualitative design using focus group discussion was utilised for the study. Two groups of participants were sampled, which included drivers of SP (n = 9), that is AH managers and receivers of SP (n = 10), that is staff progressing their careers. Data was analysed using thematic analysis.

Results: Strategic planning, desired skills identification and development processes were inconsistently informally implemented within the district. However, implementation was dependent on manager’s attitude and the availability of development opportunities which focused predominantly on managerial and leadership positions. Two areas that were viewed as inadequate were mentoring and resource allocation to support SP, particularly for highly specialised clinical positions. All participants demonstrated limited awareness and knowledge of the district-wide formal SP program. Receivers of SP, identified the program has potential to meet their development needs if the barriers above are well managed. Drivers of SP identified that there is lack of opportunity to translate the management skills learned in the district-wide program.

Conclusion: Current and desired AH SP practices reflect the recommended processes of SP. The perception is that the current district-wide formal SP program does not meet the needs of AH but has potential to do so. Development and maturing of informal SP processes needs to occur to reach district-wide consistency with a shift in focus towards highly-specialised clinical position.


Biography:

Kate Vickers has been a speech pathologist for 15 years and is currently the Allied Health Workforce and Development Officer for South Western Sydney Local Health District. She has been in the Workforce and Development Officer role for over 5 years and in that time has focused on projects for workforce redesign, staff development and education. She is also undertaking a Masters of Health Management, specialising in organisational development.

Strengthening interprofessional culture across health professional education and the workplace – the Interprofessional Twilight Challenge

Mrs Kathryn Vick1, Ms Nicole Shaw1,2, Ms Sherryn Evans2

1Barwon Health, Clinical Education & Training, Geelong, Australia, 2Deakin University, Faculty of Health, Geelong, Australia

The Interprofessional Twilight Challenge (ITC), an initiative between Barwon Health (BH) and Deakin University (DU) which began in 2017, was conceived to improve interprofessional collaboration (IPC). BH and DU share a commitment to developing effective IPC in the healthcare workforce to improve workplace culture, practice and achieve best outcomes for healthcare consumers(1). Staff from both organisations had past experiences of national team events which, whilst very valuable, represented limited opportunities for participation at scale and required a level of pre-event preparation that acted as a disincentive for busy health professionals to participate. An opportunity arose for staff from BH and DU to develop an event that would overcome these issues.

Although conceptually the ITC was sparked by other team events, it is innovative in its adaptation to the health service setting and its partnership approach including the institution-level reach, varied composition of teams, and elimination of pre-event work for participants.

In the ITC, twelve teams comprising students, academics, health professionals or clinical educators, compete in six problem-solving activities based on a case study to demonstrate mastery in IPC skills. The activities are judged against a rubric based on the Canadian Interprofessional Health Collaborative (CIHC) Framework. The team with the highest score is declared the winner.

138 individuals have competed in the event. Collation of feedback (n = 92) revealed 95% of respondents agreed the ITC increased awareness of the key competency domains of IPC and created an authentic learning experience promoting IPC. All respondents (100%) agreed the ITC enabled interprofessional learning in a fun and engaging manner, whilst 90% agreed it showcased a collaborative partnership between BH and DU.

Evaluation has demonstrated the ITC provides a learning experience which is helping to strengthen interprofessional culture. With organisational support from BH and DU, it is programmed as an ongoing annual event.

(1) World Health Organisation. (2010). Framework for action on interprofessional education & collaborative practice.  Retrieved from http://www.who.int/hrh/nursing_midwifery/en/


Biography: To be confirmed

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