This document discusses international and culturally diverse (CALD) students in health professional placements in Australia. It finds that international students and those with English as an additional language are more likely to have poor placement outcomes. The document presents research exploring international students' placement experiences and finding they face additional cognitive load from acculturation adjustments. It suggests clinical educators also experience increased cognitive load facilitating learning for these students. The document calls for research facilitating intercultural learning between students and clinical educators to improve outcomes for CALD communities.
This is an abbreviated version of Dr. Collier's slideshow for her Keynote presentation at the Oregon Teachers of English to Speakers of Other Languages conference in Portland, Oregon, November 15, 2014.
A mini research investigating the challenges experienced by special needs students in a mainstream classroom, in Antigua and Barbuda, following the implementation of an initiative to prepare them for the Common Entrance Examinations (now called national Assessment)
This is an abbreviated version of Dr. Collier's slideshow for her Keynote presentation at the Oregon Teachers of English to Speakers of Other Languages conference in Portland, Oregon, November 15, 2014.
A mini research investigating the challenges experienced by special needs students in a mainstream classroom, in Antigua and Barbuda, following the implementation of an initiative to prepare them for the Common Entrance Examinations (now called national Assessment)
این پاورپوینت در کارگاه تخصصی توانبخشی شناختی در اختلالات یادگیری توسط دکتر هاشم فرهنگ دوست ارائه شده است.
برای مطالعه مطالب بیشتر در این زمینه به وب سایت فروردین مراجعه فرمایید.
www.farvardin-group.com
What is a Learning Disability?
A learning disability is a neurological disorder. In simple terms, a learning disability results from a difference in the way a person's brain is "wired." Children with learning disabilities are as smart or smarter than their peers. But they may have difficulty reading, writing, spelling, reasoning, recalling and/or organizing information if left to figure things out by themselves or if taught in conventional ways.
Assisting Nursing Students Through Linguistic Modification of Multiple Choice...Kaplan Nursing
Multiple choice questions are an important means of assessing students’ mastery of course
content in many nursing courses. These types of questions often constitute a large percentage of
the final grades in many nursing courses and comprise the largest type of test items on the
NCLEX®. Kaplan Nursing is interested in determining if exposure to linguistically modified
language on practice tests for the NCLEX® benefits English as a second language (ESL) or
English as an additional language (EAL) students. The purpose of this whitepaper is to discuss
the effect of linguistic modification on multiple choice questions.
Supporting the academic success of underprepared college students at an Engli...Serpil Tekir
Pre-conference presentation for the study entitled "Supporting the academic success of underprepared college students at an English Medium Instruction (EMI) university."
این پاورپوینت در کارگاه تخصصی توانبخشی شناختی در اختلالات یادگیری توسط دکتر هاشم فرهنگ دوست ارائه شده است.
برای مطالعه مطالب بیشتر در این زمینه به وب سایت فروردین مراجعه فرمایید.
www.farvardin-group.com
What is a Learning Disability?
A learning disability is a neurological disorder. In simple terms, a learning disability results from a difference in the way a person's brain is "wired." Children with learning disabilities are as smart or smarter than their peers. But they may have difficulty reading, writing, spelling, reasoning, recalling and/or organizing information if left to figure things out by themselves or if taught in conventional ways.
Assisting Nursing Students Through Linguistic Modification of Multiple Choice...Kaplan Nursing
Multiple choice questions are an important means of assessing students’ mastery of course
content in many nursing courses. These types of questions often constitute a large percentage of
the final grades in many nursing courses and comprise the largest type of test items on the
NCLEX®. Kaplan Nursing is interested in determining if exposure to linguistically modified
language on practice tests for the NCLEX® benefits English as a second language (ESL) or
English as an additional language (EAL) students. The purpose of this whitepaper is to discuss
the effect of linguistic modification on multiple choice questions.
Supporting the academic success of underprepared college students at an Engli...Serpil Tekir
Pre-conference presentation for the study entitled "Supporting the academic success of underprepared college students at an English Medium Instruction (EMI) university."
An overview of knowledge required by a teacher prior to teaching children of Non English Speaking Background (NESB). A comprehensive overview is provided here.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Complexity or mutual learning: reframing the narrative of health professional placements for international students
1. Complexity or mutual learning: reframing
the narrative of health professional
placements for international students
Dr. Stacie Attrill
Senior Lecturer, College of Nursing and Health Sciences
Teaching Program Director (Health Professions)
@SAttspeech
2. Who are culturally &
linguistically diverse
(CALD) students?
•International and domestic students who:
•Speak another language at home +
English
•Include: Migrants, +1st, 2nd gen (?3rd)
•Broad acculturative experiences
•Influence of culture and language on
learning experiences
•Differing experiences of education and
health professional practice in Australia
3. Health services for CALD
communities in Australia
•Our CALD communities are growing and diversifying.
•Globalisation, international mobility, and prominence of 2nd and
3rd generation Australians from migrant backgrounds (Schwartz, et al
2010).
•Health access and outcomes for CALD communities in Australia (and
globally) are comparatively poorer than for dominant communities
(Anderson, et al. 2003; Berger, 2008).
•Varied acculturation leading to differing understanding of and
engagement with health services
•CALD communities perceive that health services do not meet their
health needs.
•May prefer to access healthcare from culturally concordant
clinicians, even when their language differs
•People from CALD backgrounds are grossly under-represented among
health care professions (Betancourt et al., 2003; Lattanzi & Pechak, 2012).
•Structural, procedural, systemic and cultural reforms required to
improve health access and outcomes for CALD communities (Betancourt, et
al. 2003; Napier et al., 2014)
4. Health Services for
CALD communities
• CALD students, including international students,
bring cultural capital to education environments
and health workplaces (Nápoles-Springer et al.,
2005; Nash, 2011)
• CALD health professionals and students:
• Facilitate culturally responsive services and
practice (Betancourt, et al. 2003).
• Model intercultural knowledge and skills for
majority culture clinicians and students
(Nápoles-Springer et al., 2005).
5. Academic barriers for CALD
students...
•Being CALD, including being an international
student is a known predictor of poor academic
performance in medicine and other health
professions (Haq etal, 2005; Lumb etal. 2004; Woolf etal. 2011).
•Being a non-native English speaker also predicts
poor academic outcomes (Green, 2015; Woolf etal, 2013).
•Students who speak English as a first language,
but a Language Other than English at Home
(LOTEH) may also have poor academic outcomes
(Schwartz etal, 2010).
6. Health Professional
placements
•Completed by all health professional students, as part of
their competency development.
•Clinical Educators/Facilitators supervise and support
students’ learning on placement.
•Situated in workplace settings.
•the complex and changing needs of patients often have
primacy over student learning (Rodger, et al. 2008)
Placements are likely to be challenging learning
environments for international students (Nash et al, 2011)
7. Placement research: International students
•Communication load
• intelligibility, vocabularly; understanding instructions;
• confidence; burden of translation; speed of processing
• Adjustment load
• Influence of Cultural background on expectations of learning & interactions w
patients and health practitioners.
• Limited knowledge about Aust health culture & need more individual
supervision and time compared with other students.
•Strategies suggested increase time and expense of student supervision :
•providing earlier introduction to placements,
•more 1:1 support with the clinical educator,
•conducting role plays to support verbal communication.
8. International students
as a (wicked) problem
• Presented as lacking knowledge and skills for
Western educational experiences and as being
problematic to teach (Madge et al. 2014).
• Deficit approach focusses on the short comings
of international students
• Insufficient English
• Difficulties participating in class/placement
• What if international students are
conceptualised as assets to practice?
• Intercultural skills
• Different 'ways' to enact practice that
may be more appropriate for CALD
communities?
• Opportunities for shared learning w
practitioners & other students?
9. Program of
research
1.Who are international students and CALD
students in Australia?
2. Does cultural background, being an international
student, or language background predict placement
outcome?
3. Explore the nature of international students’
competency development and professional
placement experiences, and placement outcomes.
4.Identify strategies to assist international students
in placements.
5.Do opportunities exist for clinical
educators/facilitators to learn from international
students?
10. Does being an international student predict
placement outcome?
1. Scoping Survey of university based, clinical education coordinators in
Australia.
• Descriptive information about background, number of international
students in 10/12 Australian Speech Pathology programs.
• Retrospective cohort: included 3,455 student placements.
• Ratings and qualitative competency perceptions of placement
performance of international students.
2. Prospective regression analysis to model whether being an international
student, being a CALD student, or factors related to English language
predict poor placement outcome
• 852 students from 3 universities, who contributed 2747
placements between 2011-2013.
• At risk = student had required additional university supports
during the placement but had subsequently passed;
• Required supplementary placement or extension of time on
placement and subsequently passed;
• OR failed the placement.
11. Risk of poor placement
outcome
• 12.4% international students.
• From South-eastern and Eastern Asia.
• 41.5% speak English as an Additional Language.
• Compared with International students, domestic students:
• lower rate of placement failure (x2=4.62, p = .032)
• and supplementary placements (x2=26.98, p = 0.000)
• and additional placement support (x2=21.021, p = 0.0000).
• International students were 1.83 times more likely to have an ‘at risk’ placement
outcome than domestic students (p = .01).
• English as an Additional Language students were 2.38 times more likely than
students with English as a first language (p < 0.001).
• “Perceived CALD” did not predict ‘at risk’ placement outcome.
• LOTEH did not predict ‘at risk’ placement outcome.
Study 1
Study 2
12. So, we could blame it on language....
• International students compared with “Perceived CALD” students:
• No significant differences in the proportion of EAL students in the
two groups→ suggests that factors other than language important
for placement outcome.
• Acculturative factors like prior education experiences, cultural
similarity and fluency in the language of the host country may
impact International Students differently to domestic CALD
students.
• International students may need to undertake greater
acculturative adjustment cf domestic CALD students for
placements
13. Perceptions of international students' placement
experience and competency development
• Separate focus group interviews
of international and domestic
students; and clinical educators
in Adelaide and Sydney.
• 14 FGs in total.
• Explored placement experiences,
competency and strategies for
success
15. Learning theories used
to interpret the data
• Cognitive Load Theory (Sweller, 1998)
• Legitimate Peripheral Participation (Lave &
Wenger, 1991)
• Workplace Learning (Billett, 2002, 2006,
2014)
16. Synthesised findings
• International students experience and competency development in
placements is complex.
• Linked with acculturative adjustments for culture, learning and
communication.
• Impact students’ ability to manage usual learning expected of all students
in placements.
• ??? linked to the greater likelihood for international students to have an ‘at
risk’ placement outcome.
• Supervisors perceived international students’ adjustments and
behaviours to increase the complexity of facilitating learning.
• Strategies and training opportunities identified to assist
international students to adjust for culture and learning in their
placements, and to help supervisors to manage this.
17. • International students undertake acculturative adjustments to
approximate the learning behaviours that they perceive will
help them to succeed.
• Clinical Educators shape learning and behaviours according to
their expectations – grounded in Western learning principles.
• •Clinical Educators perceive students who demonstrate
Western learning and professional behaviours to be more
successful.
• When students enact expected behaviours, they are given
access to more learning activities in the placement, and
provided with greater autonomy.
• Students’ acculturative adjustments add to their cognitive load.
• Clinical Educators also experience more cognitive load, as they
manage and support the acculturative adjustments.
• Students’ prior learning, and intercultural knowledge present
opportunities for mutual learning for the clinical educator.
• Facilitator: CE perception of a positive placement
experience
• Barrier: CE perceives the placement as challenging –
increased cognitive load.
18. Hypothesis
Students who are undertaking more acculturative adjustments for
communication, culture and learning experience more cognitive load for
competency development in placements.
Adjustments are directed according to the nature of the placement, supervisor style,
expectations, learning opportunities afforded.
Supervisors experience more cognitive load in facilitating learning for
international students who are undertaking more acculturative
adjustments.
This may impact perceptions of a positive placement, reducing the receptiveness of
Supervisors for mutual learning of intercultural skills and knowledge.
19. Current research Clinical educators' learning during
culturally and linguistically diverse
students' health professional
placements
• Preliminary findings: CEs
conceptualise learning from
CALD students as transferrable
to future students.
• No evidence of transfer to CALD
populations.
• Research that seeks to facilitate health
outcomes for CALD communities
through facilitating successful CALD
student training experiences and
opportunities for shared intercultural
learning with health practitioners.
20. References
• Anderson, L. M., Scrimshaw, S. C., Fullilove, M. T., Fielding, J. E., & Normand, J. (2003). Culturally competent healthcare systems: A systematic review. American Journal of Preventive
Medicine, 24(3, Supplement), 68-79. doi:http://dx.doi.org/10.1016/S0749-3797(02)00657-8
• Attrill, S., et al. (2012). "Student diversity and implications for clinical competency development amongst domestic and international speech-language pathology students." International Journal
of Speech-Language Pathology 14(3): 260-270.
• Attrill, S.L., Lincoln, M. and McAllister, S. (2015). International students in speech-language pathology clinical education placements: Perceptions of experience and competency
development. International Journal of Speech-Language Pathology, 17(3) pp. 314-324.
• Attrill, S., et al. (2016). "Supervising international students in clinical placements: perceptions of experiences and factors influencing competency development." BMC Medical Education 16: 180.
• Attrill, S., et al. (2017). "Culturally and linguistically diverse students in speech–language pathology courses: A platform for culturally responsive services." International Journal of Speech-
Language Pathology: 1-13.
• Bandura, A. (1986). Social foundations of thought and action: a social cognitive theory. USA, Prentice-Hall.
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21. Questions
For further information contact:
Dr. Stacie Attrill
Flinders University
E: Stacie.Attrill@flinders.edu.au
P: (08) 72218811
@SAttspeech
Editor's Notes
I’m going to talk with you today about my research program that is really seeking to make connections between a culturally diverse health workforce and better health outcomes for culturally diverse communities. Specifically, my research is about teaching and learning outcomes for international students and particularly those who are culturally and linguistically diverse, or CALD in clinical placements. My team includes Professor Michelle Lincoln from University of Canberra and Professor Sue McAllister from University of Sydney.
Firstly who are we talking about when we are talking about CALD students? In our student bodies, we are talking about international and domestic students, who either speak English as an Additional Language or a language other than English at home; For this research we are looking at international students, a group with broad acculturative experiences, who are making many active adjustments for culture and language , and importantly, have different experiences and expectations of health and education practices here in Australia. They’re also a group who can contribute to how we understand health practice and how this might be applied with CALD communities who live here.
We know that the proportion and diversity of CALD communities here in Australia are growing – at about 50% of the overall population right now, and will probably grow steeply in the next century. Our CALD communities, including second and third generation CALD Australians are experiencing worse health outcomes than those from the majority white, Anglo culture, and we know that this results from differences in their access to healthcare, but also differences in the ways they’re treated by majority culture health professionals. We also know that CALD people often prefer services from CALD health professionals, even when they don’t share a first language.
But, people from CALD backgrounds are grossly under-represented in the healthcare professions, and are virtually absent from management or policy making discussions, meaning that their perspectives and needs are poorly represented. So there needs to be change at multiple levels if outcomes are going to change.
That brings me to my research: We are responding to two assumptions in the literature about how to address these disparities: 1) That increasing the proportion of CALD health professionals will facilitate more access, choice and availability of culturally responsive services. And 2) That CALD professionals and students bring cultural capital to health and education environments; and that opportunities must exist for these CALD clinicians to model intercultural knowledge and skills for all clinicians. Both of these strategies are assumed to increase the availability of culturally responsive services.
However, there are barriers for CALD students in health professional qualifying programs. They’re noted to experience academic challenges, and it’s likely that these issues are magnified for international students who are often making adjustments for both culture and language. Much of this research focusses on how English proficiency contributes to their academic difficulties, but that there is probably more to it than this.
But international students are key to increasing the prominence of CALD clinicians in our communities – about 40% stay following qualification, as well as through opportunities during their training to share their intercultural skills and knowledge.
However, the less overt finding of research about international students’ academic performance is that their difficulties are often associated with clinical placements. All our health professions have clinical placements as critical for students' competency development. In these placements, students are supervised by clinical supervisors, also known as clinical educators who are also managing complex patient and workplace needs. We know that placements present specific challenges for international students, but the factors underpinning this aren’t known, and workable supports are few and far between.
What previous research about international students in placements collectively suggests is that they carry a communication load if they are non-native English speakers, and an adjustment load from transitioning from their understanding of culture and learning in their previous health and education experiences at home.
Their supervisors, meanwhile, may experience more burden if they need more time to understand the Australian health culture, help with communication skills for practice, or more individualised supervision than other students. Given the number of IS enrolled in health professional programs, and the prominence of clinical placements as part of curricula, research that looks at the learning needs of this group is surprisingly limited, and the strategies are largely impractical.
And all of this is lensed by the general narrative about international students- they’re a 'problem‘; they need 'remediation' in order to be successful in practice. That they must adjust so that their skills match ours. That the skills they come with – whether these be communication, cultural, approaches to learning and teaching or 'ways to enact practice' are not sufficient and must be fixed. All of this rests the blame with the student, and ignores what they could be positively contributing to our knowledge and practice. Yet, when we look at the ongoing, and recursive health disparities of our CALD communities, perhaps we need to reflect about the insufficiencies of our own ways of enacting practice. In this light, what if international and other CALD students could be reconstructed as the assets that we need to identify different and better ways to enact culturally responsive practice?
And so it was with this in mind that I embarked on a program of research about international students in health placements, and I’ve largely used speech pathology students as a case study. To date, six studies have comprised this research, including my PhD and two post-doctoral studies. Overall, we’ve aimed to determine whether acculturative factors predict placement performance, and to explore features of international students' learning and experiences in their placements, what responsive supports and scaffolds might work, and what are enablers for placement supervisors to learn from their students’ intercultural skills. I’m not going to go into much detail about each study – rather, will provide you with an overview of the findings and how they relate to each other.
So we needed to preface our understanding of what happens for international students in placement by first understanding if indeed they had more risk of failing or needing more support. To do this, we did a retrospective scoping study of University clinical placement coordinators in Australia using data from 3,455 placements, and a prospective regression analysis of data from 2747 placements from three universities to model the acculturative factors that predict poor placement outcome.
And the short answer is yes, being an international student did predict poor placement outcome. Our international students were largely from East and South-Eastern Asia, and almost half spoke English as an Additional language, and they were more likely to fail a placement and more likely to need additional support to complete their placement successfully. In line with research about academic performance, those who spoke English as an Additional Language were most at risk of poor placement outcome. But, students who perceived themselves to be CALD or who spoke English as a first language with another language at home did not have more risk.
So we could blame everything on English proficiency, except that when we compared the international student group who did predict poor placement outcome with the 'perceived CALD' group who did not, we found that the proportion of English as Additional Language speakers in the two groups were the same. This suggests that other acculturative factors like adjusting for culture and learning differences are likely to affect international students more than local CALD students. But why are these factors impacting?
To answer this, our third and fourth research questions were about the nature of placement experiences and competency development for international students, and strategies to support this. We conducted 9 focus groups with students and 5 with supervisors so that we could explore both perspectives.
When we synthesised categories from the student and supervisor focus groups, we identified four overarching themes: communication skills, adjustment, complexity and positive placement experiences.
In interpreting the focus group data, we used three learning theories to provide different lenses on the international students’ placement experiences and learning.
The first was Cognitive load theory which explains how WM processes information, and what happens when too much load is placed on our processing system. It helps to identify what features of the learner or a learning environment might increase cognitive load, and suggests ways to reduce this.
Secondly, Lave and Wenger’s theory of Legitimate Peripheral Participation, which talks about how novices develop sociocultural skills and knowledge about a practice community, and how prior skills and knowledge of a learner might impact or shape or change the community that they enter. To participate and progress in a placement, a student starts at the periphery of the community, and must be seen as being a legitimate member of that community to progress.
And finally, Billett’s workplace learning theory – which explains how a student’s prior knowledge and learning experiences, and their goals and aspirations, all influence their engagement with learning in a placement.
So, to summarise the findings, IS’ experience and competency development in placements is complex, and this complexity is linked with the acculturative adjustments they are making for culture, learning and communication, which they are actively enacting to help them succeed in the placement. These extra adjustments may impact their ability to manage the usual learning expected of all students, which may increase their likelihood for an ‘at risk’ placement outcome.
Supervisors, meanwhile, also felt the cultural, communication and learning behaviours that many international students demonstrate make it more complex to facilitate their learning. We identified strategies that supervisors can responsively and flexibly implement to help IS to adjust for their placements, and to help supervisors to manage this.
But, developing IS’ communication skills for practice was actually perceived as too challenging to manage within the practical and temporal constraints of the placement, and we’ve got some recommendations for universities about this. We also found that IS and supervisors were positive about their experiences, and did identify mutual intercultural skills that developed from interacting and learning together that particularly related to how they might work with CALD students and patients in the future.
So to add a theoretical take on our findings: International students undertake acculturative adjustments according to what they perceive they need to change to succeed in the placement.
When supervisors see students enacting professional or learning behaviours that they expect, they give students more access to learning activities and more autonomy which helps them to demonstrate the complex skills needed to pass the placement. Conversely, when students enact behaviours they don’t anticipate, or that seem unusual, they supervise students more closely, and give them less access to learning activities, which reduces their capacity to demonstrate the skills and autonomy to pass.
For international students, the adjustments that they undertake add cognitive load to the already loaded task of competency development that all students must undertake in their placements.
Similarly, supervisors experience more cognitive load, as they support international students to enact these adjustments whilst also managing their usual competency development, and all this in the context of managing complex patients and workplace activities.
Prior learning experiences and cultural skills and knowledge that international students bring to their placements can present opportunities for mutual learning with supervisors, but only if the placement is perceived as positive. The greater the supervisors’ cognitive load, especially where learning challenges exist, the more barriers for them to undertake new learning, and the less receptive they may be to intercultural learning where this is the case.
So, we’ve hypothesised that students undertaking more acculturative adjustments to participate in their placements experience greater cognitive load for competency development than students undertaking less, and this places them at risk of poor placement outcomes. Conversely, if their supervisors are also experiencing more cognitive load, they may be less receptive to shared opportunities for learning intercultural skills and knowledge.
So now, to close the loop, my current research is looking at opportunities for mutual learning of intercultural skills between students and supervisors, and how these skills might transfer to practice with CALD communities. We are interested in the moments of learning for supervisors, and how they perceive they might apply this in the future. Our preliminary findings suggest that supervisors conceptualise this learning can be transferred to other CALD students, but not to work with CALD populations – so there is still much to be done in this space, and much more to be done to reverse the health disparities of our CALD communities.