Assessment of students is a cornerstone of health profession education programs. It is essential assessment methods are valid, reliable, fair, defensible and evidence-based. Assessment is a popular topic in health professions literature, although discussions specifically relating to assessment in osteopathic education are limited. This commentary provides an overview of the current assessment methods utilised to assess clinical competency and fitness-to-practice in the final year clinical practicum subjects in an Australian osteopathy program. This summary may be useful to other osteopathy programs in the development and implementation of assessments. Further, this commentary also introduces the concept of programmatic assessment and discusses its application in an osteopathy program.

Objective: The objective of this study was to explore osteopathy students' perceptions of occupational stress and clinical practice competence, and how these perceptions changed after six months of osteopathic practice.Participants: Students who graduated in 2010 from Victoria University's osteopathy program.Method: Participants completed one survey as final year osteopathy students in November 2010 and one survey as registered osteopaths in July 2011. The surveys were developed by drawing on previous work investigating health professional capabilities and also graduates transition to practice. Key areas of exploration were work related stressors and self-perceived clinical competence.Results: Job related stressors experienced were different from those expected by students, however, the overall level of stress as a new practitioner was accurately anticipated by students. New graduates were found to experience high levels of stress caused by: managing tricky patients; feeling like they should know everything; medico-legal issues; time management; and, overwork. Students in their final months of the osteopathy program felt more competent than after six months in practice. However, they perceived a lack of competence in: establishing a prognosis and using appropriate outcome measures; managing risks; maintaining currency of knowledge and skills; and, maintaining current knowledge of other health practices.Conclusion: Osteopathy graduates have similar experiences of stress and perception of competence to other health graduates in their transition to practice. New graduates in osteopathic practice perceived a lack of competence in several clinical areas. Mentorship and graduate programs are required to ensure osteopathic graduates are supported in their early professional careers. Crown Copyright (C) 2014 Published by Elsevier Ltd. All rights reserved.

INTRODUCTION:There is increasing pressure for Australian rural general practices to engage in educational delivery as a means of addressing workforce issues and accommodating substantial increases in learners. For practices that have now developed a strong focus on education, there is the challenge to complement this by engaging in research activity. This study develops a rural academic general practice framework to assist rural practices in developing both comprehensive educational activity and a strong research focus thus moving towards functioning as mature academic units.METHODS:A case study research design was used with the unit of analysis at the level of the rural general practice. Purposively sampled practices were recruited and individual interviews conducted with staff (supervisors, practice managers, nurses), learners (medical students, interns and registrars) and patients. Three practices hosted 'multi-level learners', two practices hosted one learner group and one had no learners. Forty-four individual interviews were conducted with staff, learners and patients. Audio recordings were transcribed for thematic analysis. After initial inductive coding, deductive analysis was undertaken with reference to recent literature and the expertise of the research team resulting in the rural academic general practice framework.RESULTS:Three key themes emerged with embedded subthemes. For the first theme, organisational considerations, subthemes were values/vision/culture, patient population and clinical services, staffing, physical infrastructure/equipment, funding streams and governance. For the second theme, educational considerations, subthemes were processes, clinical supervision, educational networks and learner presence. Third, for research considerations, there were the subthemes of attitude to research and research activity. The framework maps the development of a rural academic practice across these themes in four progressive stages: beginning, emerging, consolidating and established.CONCLUSIONS:The data enabled a framework to be constructed to map rural general practice activity with respect to activity characteristic of an academic general practice. The framework offers guidance to practices seeking to transition towards becoming a mature academic practice. The framework also offers guidance to educational institutions and funding bodies to support the development of academic activity in rural general practices. The strengths and limitations of the study design are outlined.

Background: General practices vary in the provision of training and education. Some practices have training as a major focus with the presence of multi-level learners and others host single learner groups or none at all. This study investigates the educational benefits and challenges associated with 'multi-level learner' practices.Methods: This paper comprised three case studies of rural general practices with multiple levels of learners. Qualitative data were collected from 29 interviews with learners (n = 12), staff (n = 12) and patients (n = 5). Interviews were initially analyzed using open and axial coding and thematic analysis.Results: Thematic analysis showed 'multi-level learning' in general practices has benefits and challenges to learners and the practice. Learner benefits included knowledge exchange, the opportunity for vertical peer learning, a positive learning environment and the development of a supportive network. The presence of multi-level learners promoted sharing of knowledge with all staff, a sense of community, an increase in patient services and enthused supervisors. Challenges for learners included perception of decreased access to supervisors, anxiety with peer observation, reduced access to patient presentations and patient reluctance to be seen by a learner. Practice challenges were administration requirements, high learner turnover, infrastructure requirements and the requirement for supervisors to cater to a range of learner level needs.Conclusions: The presence of medical students, interns and registrars in general practice has educational benefits to the learners extending to the other stakeholders (staff and patients). Multi-level learners present challenges to the learners and the practice by increasing pressures on resources, staff (administrative and supervisors) and infrastructure.

BACKGROUND:Measurement of the educational environment has become more common in health professional education programs. Information gained from these investigations can be used to implement and measure changes to the curricula, educational delivery and the physical environment. A number of questionnaires exist to measure the educational environment, and the most commonly utilised of these is the Dundee Ready Educational Environment Measure (DREEM).METHODS:The DREEM was administered to students in all year levels of the osteopathy program at Victoria University (VU), Melbourne, Australia. Students also completed a demographic survey. Inferential and correlational statistics were employed to investigate the educational environment based on the scores obtained from the DREEM.RESULTS:A response rate of 90% was achieved. The mean total DREEM score was 135.37 (+/- 19.33) with the scores ranging from 72 to 179. Some subscales and items demonstrated differences for gender, clinical phase, age and whether the student was in receipt of a government allowance.CONCLUSIONS:There are a number of areas in the program that are performing well, and some aspects that could be improved. Overall students rated the VU osteopathy program as more positive than negative. The information obtained in the present study has identified areas for improvement and will enable the program leaders to facilitate changes. It will also provide other educational institutions with data on which they can make comparisons with their own programs.

Case A man aged 42 years, who works as a police officer, presented with severe lower back pain, which he had experienced for 24 hours after spending the previous day helping his brother to move house. He had difficulty ambulating and most movements aggravated the pain. There were no lower limb symptoms and no red flags present on history or examination. He was otherwise well and was not taking any regular medications.

This chapter aims to document contemporary sp practice in role portrayal and the contexts in which SPs work. Drivers for the uptake of simulation influence the ways in which SPs currently work. The main areas for SP practice focus on communication, professionalism and patient safety. The last decade has witnessed the inclusion of SPs in teaching and learning procedural, operative and physical examination skills. Masks, suits and moulage can extend SPs' ability to play different roles. Acknowledging the widening scope of practice, other human-based simulations such as simulated relatives, trainees and healthcare professionals are briefly considered. After a general description of practices, profession-specific applications are outlined, followed by some concluding notes.

This paper addresses some of the challenges met when developing widely distributed, broad spectrum, simulation-based education (SBE) for health professionals, such as resource duplication, inconsistent facilities utilization, discipline-specific silos, and the intersection of academic institutions and health services sectors. We examine three primary contributors to successful simulation-based practices - strategic planning, program development, and professional networks. Further, we provide examples of how each of these contributors function at different levels to assure comprehensive, yet sustainable approaches to implementing SBE for greatest impact at national, state, regional, and institutional levels. We draw on the example of Australia and its state and regional government structures, including the challenges in providing health services across a widely variable geography and population distribution. The types of health services and issues relating to health provision and management reflect those found in many western countries. Our hope is that the experiences gained at each level of governance within Australia may inform similar, successful development in other countries. We emphasize the importance of leadership and investment at the national level that serves to inform state, regional, and institutional efforts through a trickle down effect. Although evaluation of the strategic planning, program development, and professional networks described in this case study is still ongoing, their preliminary coordination has resulted in significant investment and support at all levels.

BACKGROUND:The literature on simulated or standardized patient (SP) methodology is expanding. However, at the level of the program, there are several gaps in the literature. We seek to fill this gap through documenting experiences from four programs in Australia, Canada, Switzerland and the United Kingdom. We focused on challenges in SP methodology, faculty, organisational structure and quality assurance.METHODS:We used a multiple case study method with cross-case synthesis. Over eighteen months during a series of informal and formal interactions (focused meetings and conference presentations) we documented key characteristics of programs and drew on secondary document sources.RESULTS:Although programs shared challenges in SP methodology they also experienced differences. Key challenges common to programs included systematic quality assurance and the opportunity for research. There were differences in the terminology used to describe SPs, in their recruitment and training. Other differences reflected local conditions and demands in organisational structure, funding relationships with the host institution and national trends, especially in assessments.CONCLUSION:This international case study reveals similarities and differences in SP methodology. Programs were highly contextualised and have emerged in response to local, institutional, profession/discipline and national conditions. Broader trends in healthcare education have also influenced development. Each of the programs experienced challenges in the same themes but the nature of the challenges often varied widely.