Paediatrics

Problem based learning in paediatrics

Developed by: 
The Paediatrics teaching team at the School of Physiotherapy (Genevieve Dwyer, Jane Butler, Adrienne Hunt, Vicki Williams and Nia Luxton)
Institution: 
The University of Sydney
Teaching and Learning Strategy: 

The Paediatrics unit of study has sought to provide students with a comprehensive understanding of physiotherapy in relation to paediatrics. The unit was developed within a framework of a problem-based learning (PBL) curriculum model and done so with direct input from paediatric clinical educators. More specifically, the underlying theme of the unit is growth and development from infancy to maturity. In addition, students address issues related to assessment, therapy and training strategies in children with dysfunction in neuromotor, musculoskeletal and cardiopulmonary systems. A PBL education model supports students in contextual learning: so that the students are able to identify and apply relevant theoretical knowledge to clinical practice and also to be able to appreciate outcome measures of clinical interventions.
The theme of the impact of growth and development is embedded within 5 case scenarios that represent either areas of common practice in paediatric physiotherapy, and/or areas in which there are important clinical lessons to be learned. In each of the problem case modules there was integrated use of online web-based support through a dedicated Paediatrics unit website that included unit of study information regarding structure of the unit, learning outcomes for the unit as well as learning for each case scenario. The latter helped to direct and structure the student learning, as did the emphasis on a clinical reasoning approach. In addition resource material was provided on the website such as online learning topics using multimedia (e.g. the impact of prematurity on the respiratory system, motor control in children etc), and links to web-based resources within and outside the university. To help consolidate the learning experience, summaries were posted after completion of the cases.

Tutors were supported by the use of comprehensive case scenario notes and weekly team meetings. This enabled a consistent approach to the students' PBL experience.

Assessments were congruent with a PBL approach and incorporated experiential learning. For example students learned about normal development in infants and children by actively assessing and videoing a subject from a selected age group and then analyzing and comparing the subject's development to theoretical norms. Students presented their work to their peers in a seminar format. At the conclusion of the unit students had an individual viva examination that reflected clinical reasoning approach to learning utilized in the PBL case scenarios.
 

Course Name: 
Bachelor of Applied Science (Physiotherapy): Paediatrics I and II
Year Level: 
Third Year
Expected Outcomes: 

Year Level : (Undergraduate Year 3 students and Graduate Entry Masters Year 2 students.)
 
The aim of this unit of study is to prepare the student as a competent entry-level practitioner in the area of paediatric physiotherapy. In this unit of study it is anticipated that the student will become aware of the changes which occur from infancy through to adulthood in neuromotor, musculoskeletal and cardiopulmonary development and will address issues related to the assessment and training strategies in infants, young children and adolescence with potential dysfunction in these systems.
Paediatrics I and II are closely aligned units of study with common learning outcomes. It is anticipated that students will be able to achieve the following learning outcomes with increasing refinement throughout the year:

  • Solve complex clinical problems accessing appropriate resources and using a process of clinical reasoning.
  • Evaluate their own clinical reasoning ability through self assessment.
  • Demonstrate an understanding of normal growth and development from conception to maturity.
  • Discuss the occurrence of variations in normal development and possible reasons for these.
  • Differentiate between normal and abnormal growth, development and function.
  • Describe the potential impact of abnormal development on the skeletal, respiratory and neurological systems.
  • Identify the potential psychological impact of illness, disease and/or disability on a child, their family and the community.
  • Describe a plan of management for a paediatric problem that recognizes the potential role of other health practitioners.
  • Select physiotherapy intervention based on the best evidence available.
  • Identify how a selected physiotherapy intervention would be managed.
  • Identify how the effectiveness of the intervention would be evaluated.

Example of specific learning outcomes for a problem case module: Cystic Fibrosis:

  • Describe the pathophysiology of cystic fibrosis (CF) and how it impacts upon the growth, development and function of the cardiopulmonary system.
  • Outline the psychosocial issues associated with a chronic, fatal condition.
  • Name other healthcare practitioners involved in the care of a child with CF.
  • Describe the overall health management of a child with CF.
  • Discuss the role of physiotherapy in the management of people with CF.
  • Outline physiotherapy treatment regimens available and the rationale/evidence and limitations for each technique.
  • Design an individualized treatment program for someone with CF justifying the choice of management.
  • Relate knowledge of psychosocial issues of adolescence to optimize the physiotherapy management of someone with CF.
  • Discuss some of the cultural issues that might impact upon the healthcare management of this adolescent with chronic illness.

 

Effective Aspects: 
  • Students are responsible for broad, deep learning with support in terms of being given direction, resources and feedback)
  • Students are responsible for their own learning, thereby allowing integration of prior knowledge and heightening motivation for learning and developing lifelong learning skills.
  • Students bring with them a wide background of prior learning and experience.
  • Learning in small groups enhances understanding, exploration, discussion and debate.
  • Academic staff facilitate the learning process and translate concepts rather than 'teach' or serve solely as information givers.
  • Information used to comprehend and deal with real-life scenarios is integrated from a variety of traditional disciplines.
     
Evaluation: 

The evaluation of this unit of study was undertaken in depth in the first 2 years that the unit was run. The evaluation occurred in two phases and involved two student cohorts, with revisions to the second cohort's learning program and the questionnaire based on findings from the first cohort investigation. In Phase 1 (cohort 1), 154 (82 percent) of the students completed questionnaires evaluating the learning program. Focus groups were conducted ten months later with 18 students by an independent assessor from the University of Sydney Institute for Teaching and Learning. In Phase 2 (cohort 2), 118 (62 percent) of the students completed a revised questionnaire.

Evaluation Outcomes: 

For Phase 1, mean rating agreement for meeting all learning outcomes (listed above) was between 84 percent and 97 percent. Most suggestions from the questionnaires and focus groups concerned unit structure and process. For Phase 2, mean rating agreement for meeting all learning objectives was between 88 percent and 96 percent.

Plans for Changes/Developments in Future: 

The specific changes made from Phase 1 included: conducting a practice case scenario in the introductory tutorial; the entire problem case module learning tasks being made available in the first week of each module; learning tasks being congruent with the criteria of the final oral examination (i.e. emphasising the clinical reasoning process more overtly), a concluding session for each case module with a guided review of learning processes and issues arising from the same, and providing a composite case summary on the Paediatrics website. Other changes included the removal of the peer assessment because of concerns about its lack of validity. Furthermore, there was a change in the respective weighting of the assessment components of the unit. The mark allocation for the group written reports covering the learning tasks and outcomes of each case module was increased to acknowledge student value and effort.
Following Phase 2 (the second cohort evaluation), there were suggestions for further change, the most common of which related to workload and marks, i.e. a reduction in work, allocation of marks according to workload and removal of the self-assessment of clinical reasoning skills. Changes to assessment were: a higher (relative) weighting for each case report, and the removal of mark allocation for the clinical reasoning skills self-assessment.
 
For both cohorts, students' perceptions of their abilities were congruent with the fact that all students passed the unit of study and with the generally high mean level of achievement in the final oral examinations. Although there was no assessment of student ability in the clinical setting, the focus group report indicated that students attributed their enhanced sense of clinical competence in large part to their PBL experience.

For Further Details
Contact Name: 
Genevieve Dwyer
Contact Faculty/School: 
School of Physiotherapy
Contact Institution: 
The University of Sydney
Contact Link: 
http://www.fhs.usyd.edu.au/phy/

Teaching and learning in Paediatrics

Developed by: 
Developed by the Staff curriculum group led by Assoc. Prof. Y. Burns, since continued/ promoted by Dr P Watter
Institution: 
The University of Queensland
Teaching and Learning Strategy: 

In year 1 of the Undergraduate course and the first summer semester of the Graduate Entry Course, students are introduced to information about normal development in children. In addition to lecture format supported by slide presentations to demonstrate reactions and stages described, students participate (in groups) in practical classes to which (1)babies (0-18months) and (2) children aged 2-5 years are invited. As the children play with each other and the equipment provided, the tutor is able to demonstrate in real time the range of reactions appropriate for each child's age. Students can interact with the children if they are approached and also gain an appreciation of the social and behavioral aspects of development.
Students can then choose to seek a placement in a Paediatric context when completing their Preclinical Professional Practice commitment throughout their program. This supports the "lifespan" context in which Paediatrics is taught in stages across the programs. The whole approach is further developed during later courses in the undergraduate and GEMS programs when video footage of specific cases is used as stimulus material for group discussion and presentation, which prepares the students for their clinical practice.
 
To complete the cycle of experience, in the Physiotherapy Motor Clinics placement during final year, as well as assessing and treating children with a range of Paediatric conditions, students also attend a local kindergarten where they complete specific observational tasks on normal children to provide them with an enhanced knowledge base of "normal skill and development" against which they can compare their clients. We feel that this sequence of experiences allows students to gradually and with increasing complexity build their understanding of how children develop and the range of skills they may demonstrate at different ages, providing a baseline for comparison of clinical clients.

Course Name: 
The initial children's visits occur in PHTY1110 and PHTY7800. Follow up case based information is provided in PHTY2230/7823 and PHTY3130/7823 for Undergraduate and GEMS students respectively. (Undergraduate Courses: PHTY1110; PHTY2230; PHTY3130. GEMS Courses: PHTY7800; PHTY7823)
Year Level: 
First Year
Expected Outcomes: 

Year Level : (Initially year 1, then again for the later courses in years 2 and 3 of the undergraduate program .Initially Summer Semester and then Semester 2 in the GEMS program)
 
We expect that students will gain insight into, and knowledge of children's development, and that the manner of its presentation will engender enthusiasm for the core material and introduce many of them to a group in the community to which they may have little exposure.
 

Effective Aspects: 
  • Presented in a smaller group than the whole class so participation is more easily promoted
  • Re-presents information in another format from the lecture content so may be more effective for some learners depending on their own preferred style
  • Experienced staff are able to model behavior management appropriate to each child and management strategies useful in paediatric clinical practice.
Evaluation: 

It is routinely evaluated as part of the Course Evaluations for the courses involved, but not necessarily as a specific strategy.

Evaluation Outcomes: 

Informally, students comment favorably on the impact this class has on their interest in the area and their learning in this area.

Plans for Changes/Developments in Future: 

We have considered using videotape instead of these classes, but the "real life" aspect is so rewarding that we have retained it despite it being difficult to provide.

For Further Details
Contact Name: 
Dr Pauline Watter
Contact Faculty/School: 
Division of Physiotherapy, School Health and Rehabilitation Sciences
Contact Institution: 
The University of Queensland
Contact Link: 
http://www.shrs.uq.edu.au/physio/