A Growing Body of Law: Obesity, Disability, and the Airline Industry

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Design and evaluation of a novel professional identity development program for pharmacy students

Professionalism, which is integral to the practice of pharmacy, is evolving to include a recognition of the importance of the development of professional identity. What is lacking, however is the presence of a framework for understanding the formation of student professional identity and the selection of suitable pedagogical approaches to facilitate such development. Educators are under increasing pressure to produce work-ready graduates, which involves the development of student professionalism. Current competency-based approaches focus on promoting student professional attitudes, values and behaviours. While these competencies are important to professional practice, they fail to adequately capture the complexity and richness of the professional role. A greater understanding of the mechanism of identity development, paired with pedagogies, which support identity formation, would better enable educators to adequately prepare students for professional practice. Professional identity is formed on two levels; the individual or psychological level and the collective level, also known as socialisation. The aim of this study was to develop a Professional Identity Program (PIP), designed to facilitate student professional identity formation, targeting the psychological development of the individual student. This study utilised the theoretical tenets of Self-Determination Theory (SDT), a psychological theory of human motivation and identity development, as a basis for the design of the program. SDT states that satisfaction of the three human basic psychological needs; competence, relatedness and autonomy, results in increased motivation (autonomy) and identity development. The PIP featured autonomy-supportive teaching in a longitudinal, early intervention, theory-based approach to professional development for pharmacy students. Methods Design: In line with the central tenets of SDT, the PIP was designed to support student competence, relatedness and autonomy, with a view to enhancing student motivation and eliciting identity development. Recognised pedagogical strategies for providing such support were employed throughout the 2 year program. Early intervention was a feature of this program, providing students with the opportunity to consider professionalism and professional identity development by participating in active discussions with practicing pharmacists and other students, in their first year of study. Emotional intelligence training was included in the program for its link to professional identity development. In addition approaches previously proven to enhance professional development such as reflective activity, role models and authentic practice-related activity were also incorporated into the program. Delivery: The PIP was integrated into the existing curricular structure, in each semester for the first two years of the BPharm. Sessions were delivered together with a practicing pharmacist, offering the students an opportunity to interact with the profession, in the absence of workplace exposure. Autonomy-supportive teaching techniques underpinned the delivery of the program, and a variety of teaching styles were employed to promote student participation and engagement. Evaluation: A previously validated professional identity measure, the McLeod Clarke Professional Identity Scale (MCPIS-9), was utilised as part of a mixed methods approach to the evaluation of the PIP. The Pharm-S, an instrument for measuring student motivation was adapted from an existing scale, modifying the context for pharmacy education. The Pharm-S was validated using recognised techniques and incorporated, alongside the MCPIS-9 and demographic questions to form the student survey. Students in two separate first year cohorts (2014 and 2015 intake) were surveyed at 0, 12 and 24 months. The 2014 cohort did not receive the PIP, whereas the 2015 cohort had the PIP integrated into their curriculum. The student survey scores were summarised as averages in the case of the MCPIS items, and a weighted scoring protocol, the Relative Autonomy Index (RAI) was used for the Pharm-S. To effectively explore inter and intra group differences, inferential statistical techniques, using non-parametric analysis, was undertaken. An additional survey, using likert-response, was also administered to the 2015 students for the purposes of evaluating the content and delivery of the PIP. Data from this survey were analysed using basic descriptive statistical techniques. Focus groups of first and fourth year students were also conducted to gain a more in-depth understanding of the student experience of professional development. Responses from the focus groups were audio recorded and transcribed. The written transcriptions were then analysed using an analytical framework identifying key concepts, which were subsequently organised into themes. Results The Pharm-S instrument proved to be suitable for use after successfully conducting face, content, test-retest, construct and convergent validation techniques. A positive correlation (r=0.64) between motivation scores and professional identity scores was also revealed. Analysis of the systematic monitoring of student motivation during the PIP, using the Pharm- S, showed a statistically significant increase in their motivation (autonomy) after 2 years participation in the program (U=421, Z=-2.5, p=0.012). Comparing student scores from those who received the PIP with student scores who did not receive the PIP, also revealed a statistically significant increase in motivation (autonomy) scores after two years in the program (Z=-2.3, p=0.020). Autonomy-supportive teaching has previously been reported to increase student autonomy through its student-centred focus1 and by increasing motivation to learn.²,³ Observed increases in motivation (autonomy) and a demonstrated link between Pharm-S and MCPIS-9 scores, provided evidence of professional identity formation when support is provided for student competence, relatedness and autonomy. This reflects the theoretical basis of SDT which states that the satisfaction of the three human basic psychological needs, lays a necessary foundation for identity development.⁴ The PIP was positively received by students with 100% stating that they gained a greater understanding of the importance of professionalism and 84% reporting that it improved their sense of professional identity (n=44, 88% response rate, M=18, F=26), mean age=20 yrs, SD=4.2). Student (first and fourth year) perceptions of their professional development revealed three major influencing factors; pharmacist-educators, curriculum and placement. Differences however were noted between groups, however, with the first years prioritising pharmacist educators and the fourth years, placement. Conclusion This study builds on and contributes to work in professional education by demonstrating the impact of an early intervention, theory-based, professional identity program. It is the first of its kind to apply the tenets of a psychological theory on motivation and to feature pedagogies that facilitate motivation and identity development in pharmacy students. Adopting autonomy-supportive teaching, a student-centred approach, increases their motivation and autonomy, this being linked with more effective patient-centred care and better patient health outcomes. References 1. Ten Cate TJ, Kusurkar RA, Williams GC. How self-determination theory can assist our understanding of the teaching and learning processes in medical education. AMEE guide No. 59. Med Teach. 2011;33(12):961-973. 2. Orsini C, Evans P, Jerez O. How to encourage intrinsic motivation in the clinical teaching environment?: a systematic review from the self-determination theory. J Educ Eval Health Prof. 2015;12(8). 3. Niemiec CP, Ryan RM. Autonomy, competence, and relatedness in the classroom: Applying self-determination theory to educational practice. Theory and Research in Education. 2009;7(2):133-144. 4. Luyckx K, Vansteenkiste M, Goossens L, Duriez B. Basic need satisfaction and identity formation: Bridging self-determination theory and process-oriented identity research. J Couns Psychol. 2009;56(2):276-288

An Apple Out of Reach: The Unattainable Ideal Beloved and Sappho’s Poetics in the Poetry of Marguerite Yourcenar and Anne Carson

The way the Archaic Greek poet Sappho and her poetry is represented and engaged with in the writing of Anne Carson and Marguerite Yourcenar appears on the surface to be decidedly disparate. However, when the thematic elements of Yourcenar and Carson's respective Sapphic texts are excavated, the two authors in fact demonstrate resemblance, specifically in how they both engage with Sappho and her poetry as a way to push eroticism beyond the profane and into the realm of the sacred. By drawing on criticism of Sappho, moral philosophy, and other writings from Yourcenar and Carson, I argue that both Youcenar and Carson invoke Sappho as an incarnation of the ideal beloved inside the text and in their biographies

Pharmacist and student evaluation of a preceptor training program in a regional Australian University: a multi-method study

Background: Increased emphasis on workplace-based learning within pharmacy curricula has led to a focus on the quality of preceptors and the provision of preceptor training, with a diverse range of training programs for preceptors being developed across the globe. To ensure that preceptors are trained appropriately and deemed to be competent in their role, it is essential that all training programs are suitably evaluated. This research aimed to evaluate an online preceptor training program at a regional Australian University. Methods: Kirkpatrick’s four level model for assessment of training was used to evaluate this program. A multi method approach included a preceptor post training survey and interviews and a student survey evaluating the preceptor. Preceptor survey data were analysed using descriptive statistics and content analysis, while inductive thematic analysis was used to analyse the interviews. Student evaluations of trained and untrained preceptors were compared to determine whether training had impacted on student-rated preceptor effectiveness. Results: Twenty-eight preceptor post-training surveys were received, ten preceptor post-training interviews were conducted, and 35 student surveys were completed. The program was rated positively overall, with notable mention by preceptors of the interactive networking session. Following their first post-training student placement, preceptors found that their overall confidence levels had improved, particularly in relation to student management, evaluating students and providing feedback. Student evaluations of preceptors revealed improved ratings of trained versus untrained preceptors, especially as effective communicators. Conclusions: This study demonstrated that training had a positive impact on preceptor attitudes, behaviour and confidence levels. From the perspective of the student, training was also found to improve preceptor performance. These results highlight the beneficial effects of training for preceptors, to optimize the student placement experience and their preparation for future practice

Mindfulness training: success in reducing first year health professional students' study and exam related stress

Purpose: Students enrolling in high stakes, undergraduate entry, professional programs like medicine, dentistry and pharmacy may struggle to effectively achieve the transition from high school. This often results in high levels of mental distress. Method: The College of Medicine and Dentistry at James Cook University have implemented a health professional self-care program (HPSC) with an aim of helping students recognize stressors and develop coping strategies. The HPSC program has been running for three years in the first year of each of the three courses. The HPSC program was delivered as a series of eight sessions focusing on evidenced based theory with some time for practicing coping strategies. Five-point Likert scale surveys were administered prior to commencing the program and after completion. Results: Across the College, students reported significantly improved abilities to reduce study and exam related stress and develop effective coping skills. These results were more pronounced in students that practiced techniques of mindfulness. Discussion: The HPSC program changed student perceptions in being able to improve their own self-care and reduced study and exam related stress

Do differences in diagnostic criteria for late fetal growth restriction matter?

BACKGROUND: Criteria for diagnosis of fetal growth restriction differ widely according to national and international guidelines, and further heterogeneity arises from the use of different biometric and Doppler reference charts, making the diagnosis of fetal growth restriction highly variable. OBJECTIVE: This study aimed to compare fetal growth restriction definitions between Delphi consensus and Society for Maternal-Fetal Medicine definitions, using different standards/charts for fetal biometry and different reference ranges for Doppler velocimetry parameters. STUDY DESIGN: From the TRUFFLE 2 feasibility study (856 women with singleton pregnancy at 32+0 to 36+6 weeks of gestation and at risk of fetal growth restriction), we selected 564 women with available mid-pregnancy biometry. For the comparison, we used standards/charts for estimated fetal weight and abdominal circumference from Hadlock, INTERGROWTH-21st, and GROW and Chitty. Percentiles for umbilical artery pulsatility index and its ratios with middle cerebral artery pulsatility index were calculated using Arduini and Ebbing reference charts. Sensitivity and specificity for low birthweight and adverse perinatal outcome were evaluated. RESULTS: Different combinations of definitions and reference charts identified substantially different proportions of fetuses within our population as having fetal growth restriction, varying from 38% (with Delphi consensus definition, INTERGROWTH-21st biometric standards, and Arduini Doppler reference ranges) to 93% (with Society for Maternal-Fetal Medicine definition and Hadlock biometric standards). None of the different combinations tested appeared effective, with relative risk for birthweight &lt;10th percentile between 1.4 and 2.1. Birthweight &lt;10th percentile was observed most frequently when selection was made with the GROW/Chitty charts, slightly less with the Hadlock standard, and least frequently with the INTERGROWTH-21st standard. Using the Ebbing Doppler reference ranges resulted in a far higher proportion identified as having fetal growth restriction compared with the Arduini Doppler reference ranges, whereas Delphi consensus definition with Ebbing Doppler reference ranges produced similar results to those of the Society for Maternal-Fetal Medicine definition. Application of Delphi consensus definition with Arduini Doppler reference ranges was significantly associated with adverse perinatal outcome, with any biometric standards/charts. The Society for Maternal-Fetal Medicine definition could not accurately detect adverse perinatal outcome irrespective of estimated fetal weight standard/chart used. CONCLUSION: Different combinations of fetal growth restriction definitions, biometry standards/charts, and Doppler reference ranges identify different proportions of fetuses with fetal growth restriction. The difference in adverse perinatal outcome may be modest, but can have a significant impact in terms of rate of intervention.</p

Current practice in the diagnosis and management of fetal growth restriction: An international survey

Introduction The aim of this survey was to evaluate the current practice in respect of diagnosis and management of fetal growth restriction among obstetricians in different countries. Material and methods An e-questionnaire was sent via REDCap with "click thru" links in emails and newsletters to obstetric practitioners in different countries and settings with different levels of expertise. Clinical scenarios in early and late fetal growth restriction were given, followed by structured questions/response pairings. Results A total of 275 participants replied to the survey with 87% of responses complete. Participants were obstetrician/gynecologists (54%; 148/275) and fetal medicine specialists (43%; 117/275), and the majority practiced in a tertiary teaching hospital (56%; 153/275). Delphi consensus criteria for fetal growth restriction diagnosis were used by 81% of participants (223/275) and 82% (225/274) included a drop in fetal growth velocity in their diagnostic criteria for late fetal growth restriction. For early fetal growth restriction, TRUFFLE criteria were used for fetal monitoring and delivery timing by 81% (223/275). For late fetal growth restriction, indices of cerebral blood flow redistribution were used by 99% (250/252), most commonly cerebroplacental ratio (54%, 134/250). Delivery timing was informed by cerebral blood flow redistribution in 72% (176/244), used from >= 32 weeks of gestation. Maternal biomarkers and hemodynamics, as additional tools in the context of early-onset fetal growth restriction (<= 32 weeks of gestation), were used by 22% (51/232) and 46% (106/230), respectively. Conclusions The diagnosis and management of fetal growth restriction are fairly homogeneous among different countries and levels of practice, particularly for early fetal growth restriction. Indices of cerebral flow distribution are widely used in the diagnosis and management of late fetal growth restriction, whereas maternal biomarkers and hemodynamics are less frequently assessed but more so in early rather than late fetal growth restriction. Further standardization is needed for the definition of cerebral blood flow redistribution

Current practice in the diagnosis and management of fetal growth restriction: An international survey

Introduction The aim of this survey was to evaluate the current practice in respect of diagnosis and management of fetal growth restriction among obstetricians in different countries. Material and methods An e-questionnaire was sent via REDCap with "click thru" links in emails and newsletters to obstetric practitioners in different countries and settings with different levels of expertise. Clinical scenarios in early and late fetal growth restriction were given, followed by structured questions/response pairings. Results A total of 275 participants replied to the survey with 87% of responses complete. Participants were obstetrician/gynecologists (54%; 148/275) and fetal medicine specialists (43%; 117/275), and the majority practiced in a tertiary teaching hospital (56%; 153/275). Delphi consensus criteria for fetal growth restriction diagnosis were used by 81% of participants (223/275) and 82% (225/274) included a drop in fetal growth velocity in their diagnostic criteria for late fetal growth restriction. For early fetal growth restriction, TRUFFLE criteria were used for fetal monitoring and delivery timing by 81% (223/275). For late fetal growth restriction, indices of cerebral blood flow redistribution were used by 99% (250/252), most commonly cerebroplacental ratio (54%, 134/250). Delivery timing was informed by cerebral blood flow redistribution in 72% (176/244), used from >= 32 weeks of gestation. Maternal biomarkers and hemodynamics, as additional tools in the context of early-onset fetal growth restriction (<= 32 weeks of gestation), were used by 22% (51/232) and 46% (106/230), respectively. Conclusions The diagnosis and management of fetal growth restriction are fairly homogeneous among different countries and levels of practice, particularly for early fetal growth restriction. Indices of cerebral flow distribution are widely used in the diagnosis and management of late fetal growth restriction, whereas maternal biomarkers and hemodynamics are less frequently assessed but more so in early rather than late fetal growth restriction. Further standardization is needed for the definition of cerebral blood flow redistribution