Osteopathy Program Research Articles

Using A Community of Inquiry in the Design of Histology Curriculum for First Year Medical Students

Histology faculty in the Doctor of Osteopathy (DO) program at the Philadelphia College of Osteopathic Medicine revised the delivery methodology of first‐year histology content in order to improve student performance, increase social interaction among students and faculty, shift to an all‐distance learning environment, and align curricula across our three campuses. This abstract describes an Action Research approach to implementing a Community of Inquiry (CoI) model of learning during a time of unprecedented change at both the program and the global level. An Action Research approach is a pragmatic methodology for improving medical education practice by incorporating change in a collaborative, reflective, cyclical, planned, and practical manner. We chose the CoI model of learning as it is a collaborative‐constructivist approach to instruction and well suited for online and team‐based learning. This model encompasses three prongs to delivering content: a teaching, social, and cognitive presence. In our curriculum, the teaching presence is composed of curated content in the form of self‐guided learning activities (videos, text, assessments) delivered through the Tophat learning platform and organized to support retrieval, interleaving, and spaced learning; the social presence involves student interactions online and in the classroom through discussion boards and team‐based learning activities (independent and faculty‐led); and the cognitive presence takes place with students interacting with learning modules, posting and responding to discussion threads, taking assessments, receiving feedback from assessments and engaging in problem solving exercises during the small‐group learning sessions. Within this model, students are encouraged to take responsibility for self‐directed learning, allowing for personalized investment in life‐long learning. CoI provides a platform to implement the best evidence‐based practices for histology instruction across three campuses with varying student population sizes and educational needs. Early data suggests an increase in student engagement and an improvement in student performance. We believe our model provides insight into effective curricular design for the ever‐changing face of undergraduate medical education.

Preparing osteopathy graduates for future careers: A review of osteopathic education in Australia

Introduction: Osteopathy in Australia faces an uncertain future as an unprecedented number of graduates enter the profession. While most are destined to work in private practice, workforce data suggests that limited career diversity and practitioner maldistribution are associated with growing rates of job dissatisfaction and professional attrition. Cultivating employability skills that promote diverse careers is the responsibility of education providers, yet it is unclear whether existing osteopathy programs are achieving this. Our aim was to determine if osteopathic curricula provide the employability skills required to prepare graduates for diverse careers.Methods: This study was conducted as part of a larger project by RMIT University and Osteopathy Australia entitled “Strategic plan for the osteopathy profession 2030”. A two-part approach was utilised. Part A involved a comparison of core learning outcomes (contained within current Australian osteopathy curricula) against key employability skills required for success in a diverse range of careers. A consensus development panel was consulted in Part B to capture the perspectives of experts in the field. Results: Content analysis and expert panel discussions identified the curricula has a strong focus on critical thinking, communication and problem solving and less focus on teamwork, leadership, initiative and enterprise and technological skills. Furthermore, osteopathy programs offer limited elective and micro-credentialing opportunities. Conclusions: Career diversity and increased job satisfaction for osteopathy graduates may be achieved by empowering them with the skills to succeed in careers beyond private practice. This calls for curriculum reforms and expanded elective and micro-credentialing options to enable students to broaden their skills and widen their options.

Clinical assessment during a global pandemic – Transitioning to a COVID safe hybrid OSCE

Objective structured clinical examinations (OSCEs) are often used to assess the clinical competence of students in preprofessional osteopathy training. During the COVID-19 global pandemic, the final year OSCE in the RMIT University osteopathy program was redeveloped leveraging online technologies within COVID-19 guidelines such as hygiene and occupancy limitations. Final year osteopathy students were assessed using a hybrid ten station OSCE, comprising both online and face-to-face components. The examination was led by a pre-recorded narrated PowerPoint video. The video contained instructions, case information for five cases and prompts for the practical stations. A student model stepped into the room as needed for practical stations. The examiner assessed students from another room via video streaming, with limited interaction with students. The hybrid OSCE was conducted safely during Stage 4 restrictions adhering to COVID Safe guidelines, allowing robust competency assessment of final year students, enabling timely graduation and transition to practice. Institutional support, technology infrastructure, clear communication and stakeholder collaboration are key to successful implementation. The hybrid OSCE format offers a potential solution for institutions delivering high-stakes assessment in the continuing challenges of clinical assessment in the post COVID landscape. Adopting hybrid assessment formats may facilitate remote assessment of students in clinical placements.

Clinical educator self-efficacy, self-evaluation and its relationship with student evaluations of clinical teaching

BackgroundIn a whole-of-system approach to evaluation of teaching across any degree, multiple sources of information can help develop an educators’ understanding of their teaching quality. In the health professions, student evaluations of clinical teaching are commonplace. However, self-evaluation of teaching is less common, and exploration of clinical educators’ self-efficacy even less so. The aim of the study was to evaluate how a clinical educator’s self-evaluation of teaching intersects with their self-efficacy, to ascertain if that matches student evaluation of their teaching. This information may assist in facilitating targeted professional development to improve teaching quality.MethodsClinical educators in the osteopathy program at Victoria University (VU) were invited to complete: a) self-evaluation version of the Osteopathy Clinical Teaching Questionnaire (OCTQ); and b) the Self-Efficacy in Clinical Teaching (SECT) questionnaire. Students in the VU program completed the OCTQ for each of the clinical educators they worked with during semester 2, 2017.ResultsCompleted OCTQ and SECT were received from 37 clinical educators. These were matched with 308 student evaluations (mean of 6 student ratings per educator). Three possible educator cohorts were identified: a) high clinical eductor self-OCTQ with low student evaluation; b) low clinical educator self-evaluation and high student evaluations; and, c) no difference between self- and student evaulations. Clinical educators in the first cohort demonstrated significantly higher SECT subscale scores (effect size > 0.42) than their colleagues. Age, gender, teaching qualification, and years practicing or years as a clinical educator were not associated with clinical educator OCTQ scores or the SECT subscales.ConclusionsTargeted professional development directed towards fostering self-efficacy may provide an avenue for engaging those clinical educators whose self-efficacy is low and/or those who did not receive high student evaluations. Given there is no gold standard measure of clinical teaching quality, educators should engage with multiple sources of feedback to benchmark their current performance level, and identify opportunities to improve. Student and self-evaluations using the OCTQ and evaluation of self-efficacy using the SECT, are useful tools for inclusion in a whole-of-system approach to evaluation of the clinical learning environment.

A study of the factors impacting on workforce distribution of Australian osteopaths: The perspectives of osteopathic students, academics and clinicians

ObjectiveThe study aimed to investigate the major factors influencing osteopaths’ choice of clinical workplace and their experience practising in their geographical location. MethodsSemi-structured interviews and focus groups with Australian osteopathic clinicians, academics and students. ResultsFactors influencing practice location include personal factors and other external factors (such as financial and business skills, the practice environment, and the features of the destination). Osteopaths practising outside the greater Melbourne area describe their major challenges as the (1) lack of consistency of associates, (2) location of osteopathy programs, (3) characteristics of new graduates, and (4) expectations and availability of mentoring. ConclusionsThe unique workforce distribution issues of the Australian osteopathic profession identifies new perspectives beyond the urban/rural divide commonly explored within health workforce literature to now include drivers, facilitators and barriers to relocation between urban centres.

Expanding options: Supporting skills transfer from a post-graduate osteopathy program to clinical practice

BackgroundContinuing education is a requirement for most health professions including osteopaths in Australia and other jurisdictions around the world. Osteopaths need to be sure that the time and effort spent on their ongoing education translates to practice and meets their needs. ObjectiveTutors on a postgraduate osteopathic course asked: as educators, how do we support students transfer skills developed from this program to their clinical setting? Design, Setting, Methods and ParticipantsStudents in postgraduate fee-paying osteopathic programs were asked to provide unidentified written responses to what advice or strategies they would use to transfer learning from a course to practice. Responses were collated, coded and analysed for themes to support a presentation outlining strategies to support learning transfer. Additional data collections underpinned review of the initial theme and category leading to saturation. ResultsThe outcome was an over-arching theme: Expanding Options, supported by six categories that emerged from the data: Choice of Tools; Managing Time; Patient Selection, Developing Support Networks; Learning ‘AT Stillness’ and Building Trust & Confidence. The results were presented at a focus group type workshop on the post-graduate course. ConclusionThe themes generated may be applied to other training programs. However, the limitation of the small data set, the specific nature of the course and that it teaches in an area that generates controversy within the osteopathic profession need to be recognised when reflecting on the utility of outcome.

Evaluation of teaching in a student-led clinic environment: Assessing the reliability of a questionnaire

IntroductionThe Osteopathy Clinical Teaching Questionnaire (OCTQ) has been designed to evaluate the quality of clinical teaching in osteopathy student-led clinics. Previous research has provided evidence for the scoring, generalisation and implications components of the validity argument for the OCTQ. The aim of the present study was to assess the reliability of the OCTQ providing further evidence for the validity argument. MethodSenior students in the final years of two Australian osteopathy programs completed the OCTQ for each clinical educator with whom they had worked with during a semester. Generalisability analysis, test-retest reliability and internal structure estimation were used to investigate the reliability. ResultsEach of the forty-one clinical educators received an average of 5.97 evaluations resulting in a G-coefficient of 0.63. D-studies demonstrated eight evaluations are required for a coefficient of 0.7 and fourteen for a coefficient of 0.8. Test-retest reliability demonstrated substantial to almost perfect agreement for all but one OCTQ item. Internal structure estimations using Cronbach's alpha and McDonald's omega were both 0.93. ConclusionThe results suggest that the OCTQ is a reliable tool to provide feedback to clinical educators, and potentially, used to inform decisions to reward clinical educators for their performance.

Measurement Properties of the Interdisciplinary Education Perception Scale in an Australian Allied Health Student Cohort

PurposeMeasurement of interprofessional practice perceptions of students is commonplace in the health professions education literature. There are a range of questionnaires available for researchers to use however the psychometric properties of these vary substantially. The Interdisciplinary Education Perception Scale (IEPS) has been widely used and multiple researchers have published alternative factor structures. The present study sought to build on this work by evaluating the psychometric properties of the IEPS using Rasch analysis. MethodThree-hundred and nineteen students in two Australian osteopathy programs completed the IEPS as part of a larger project into interprofessional education. The measurement properties of the questionnaire were evaluated using Rasch analysis and reliability estimations were also generated for the IEPS. ResultsFit to the Rasch model was achieved by modifying the original 18 item scale, however this was not unidimensional. Subsequent analysis using an alternative factor structure from the literature achieved Rasch model fit and was unidimensional. The final model produced an eight item version of the IEPS (IEPS8) with appropriate psychometric properties, including the ability to create a valid total score. DiscussionThe questionnaire developed as a result of the Rasch analysis provides researchers with a short, psychometrically sound measure of perceptions of their own profession and how their profession works with others. The results also provide an opportunity to explore perceptions pre-post intervention IPE interventions using an interval-scale measure compared to an ordinal one. Researchers are encouraged to utilise this version of the IEPS in future research as it has the potential to be able to discriminate between levels of perception of their own profession and how their profession works with others.

A Mokken scale analysis of the peer physical examination questionnaire

BackgroundPeer physical examination (PPE) is a teaching and learning strategy utilised in most health profession education programs. Perceptions of participating in PPE have been described in the literature, focusing on areas of the body students are willing, or unwilling, to examine. A small number of questionnaires exist to evaluate these perceptions, however none have described the measurement properties that may allow them to be used longitudinally. The present study undertook a Mokken scale analysis of the Peer Physical Examination Questionnaire (PPEQ) to evaluate its dimensionality and structure when used with Australian osteopathy students.MethodsStudents enrolled in Year 1 of the osteopathy programs at Victoria University (Melbourne, Australia) and Southern Cross University (Lismore, Australia) were invited to complete the PPEQ prior to their first practical skills examination class. R, an open-source statistics program, was used to generate the descriptive statistics and perform a Mokken scale analysis. Mokken scale analysis is a non-parametric item response theory approach that is used to cluster items measuring a latent construct.ResultsInitial analysis suggested the PPEQ did not form a single scale. Further analysis identified three subscales: ‘comfort’, ‘concern’, and ‘professionalism and education’. The properties of each subscale suggested they were unidimensional with variable internal structures. The ‘comfort’ subscale was the strongest of the three identified. All subscales demonstrated acceptable reliability estimation statistics (McDonald’s omega > 0.75) supporting the calculation of a sum score for each subscale.ConclusionThe subscales identified are consistent with the literature. The ‘comfort’ subscale may be useful to longitudinally evaluate student perceptions of PPE. Further research is required to evaluate changes with PPE and the utility of the questionnaire with other health profession education programs.

A Rasch analysis of the Revised Study Process Questionnaire in an Australian osteopathy student cohort

There are a number of questionnaires designed to capture a students’ self-reported learning approach. One example is the Study Process Questionnaire and its modified version, the 2-factor revised Study Process Questionnaire (R-SPQ-2F). Students in the first year of the 2014 and 2015 cohorts in the osteopathy program at (institution) completed the R-SPQ-2F at the commencement of their course. Rasch analysis was employed to evaluate the R-SPQ-2F internal structure. Reliability estimations were calculated for both subscales using Cronbach’s alpha and McDonald’s omega. Both the Deep and Surface subscales failed to fit the Rasch model at initial analysis. Modifications included item rescoring, removal of misfitting responses, and removal of one item from both subscales. After modification, both subscales fit the Rasch model and demonstrated unidimensionality. Reliability estimations were acceptable and consistent with previous literature. The study has provided evidence for the internal structure of the R-SPQ-2F in this cohort.

Reliability of a viva assessment of clinical reasoning in an Australian pre-professional osteopathy program assessed using generalizability theory.

Clinical reasoning is situation-dependent and case-specific; therefore, assessments incorporating different patient presentations are warranted. The present study aimed to determine the reliability of a multi-station case-based viva assessment of clinical reasoning in an Australian pre-registration osteopathy program using generalizability theory. Students (from years 4 and 5) and examiners were recruited from the osteopathy program at Southern Cross University, Lismore, Australia. The study took place on a single day in the student teaching clinic. Examiners were trained before the examination. Students were allocated to 1 of 3 rounds consisting of 5 10-minute stations in an objective structured clinical examination-style. Generalizability analysis was used to explore the reliability of the examination. Fifteen students and 5 faculty members participated in the study. The examination produced a generalizability coefficient of 0.53, with 18 stations required to achieve a generalizability coefficient of 0.80. The reliability estimations were acceptable and the psychometric findings related to the marking rubric and overall scores were acceptable; however, further work is required in examiner training and ensuring consistent case difficulty to improve the reliability of the examination.

Perception of peer physical examination in two Australian osteopathy programs.

BackgroundPeer physical examination (PPE) is an efficient and practical educational approach whereby students can practise their examination skills on each other before commencing clinical practice with actual patients. Little is known about the use of PPE in osteopathy education.MethodsStudents in Year 1 of the osteopathy programs at Victoria University (Melbourne, Australia) and Southern Cross University (Lismore, Australia) completed the Examining Fellow Students and the Peer Physical Examination questionnaires prior to, and at the completion of, their first 12-week teaching session. Descriptive statistics were generated for each questionnaire. The McNemar and sign tests were used to evaluate differences between each questionnaire administration. Logistic regression was used to evaluate the influence of demographics on responses to both questionnaires.ResultsResults showed that students in both programs were generally willing to examine non-sensitive areas both before and after the 12-week teaching session. Students’ were less apprehensive about PPE at the end of the teaching session, and this was reinforced by results for previous exposure to PPE in other courses. Consistent with previous studies, unwillingness to participate in PPE was associated with being female, being born outside Australia, holding religious beliefs, and being older.ConclusionsThis is the first study to explore students’ perceptions of PPE in this cohort and provides a basis for further work, including evaluating longer term changes in student perception of PPE, and whether these perceptions extend to practising manual therapy techniques. This study demonstrates that perceptions about PPE reported in medicine and other disciplines, namely that unwillingness to participate in PPE is associated with being female, being born outside Australia, holding religious beliefs, and being older, also apply to osteopathy. These findings are significant for all manual therapy students who spend a substantial portion of their course developing skills in PPE and practising manual therapy techniques. They highlight the need for curriculum development that acknowledges the importance of good practice in PPE, including discussions about body image, feedback skills training for educators, and providing detailed information to students about what to expect in practical skills classes before they commence their course.Electronic supplementary materialThe online version of this article (doi:10.1186/s12998-016-0102-2) contains supplementary material, which is available to authorized users.

Australian osteopathic students' perceptions of interprofessional relationships

BackgroundInterprofessional education is increasingly included in health profession education programs as governments strive to improve patient care and outcomes through interprofessional teams. ObjectiveTo investigate Australian osteopathy students perceptions of interprofessional relationships. DesignSingle administration of a questionnaire to students explore perceptions of interprofessional relationships. SettingTwo Australian university-based osteopathy programs. MethodsStudents completed the Interdisciplinary Education Perception Scale (IEPS) and a demographic questionnaire. Descriptive data were generated for each of the IEPS items, total and factor scores. Ordinal logistic regression was used to evaluate the association between the IEPS items and the demographic variables: age; gender; university; and year level. Cronbach's alpha was calculated as the reliability estimate. ParticipantsStudents enrolled in the osteopathy programs at Victoria University (Melbourne, Australia) and Southern Cross University (Lismore, Australia). ResultsResponses from 319 students were analysed (63% response rate). The mean total IEPS score was 246.46 (±23.79). No association was observed for the demographic variables and eleven of the IEPS items in the regression models. Moderate odds ratios were observed for year 3 students in relation to their perception of autonomy and respect, where these perceptions were less positive compared to students in other year levels. Age, gender and university were significant in the regression models for other IEPS items however these odds ratios were either trivial or small. Cronbach's alpha was 0.818 indicating an acceptable internal structure for the 18-item IEPS. ConclusionsThe perception of Australian osteopathy students towards interprofessional relationships was largely positive, and not associated with demographics such as age, gender, program year level and the university they were attending. Students identified positive aspects such as the need to cooperate with other professions and that osteopaths are well trained. Where demographics were associated with an IEPS item, the odds ratio was typically trivial to small. Aspects that may also need to be improved were identified, including the students' perception of the status of osteopathy in the eyes of other health professions. The data from the present study could be used to inform the development of interprofessional programs involving osteopaths and osteopathy students. Further work to replicate the results of the present study is required.

Confirmatory factor analysis of the Study Process Questionnaire in an Australian osteopathy student population

Evaluation of student learning strategies can be a useful way of measuring the impact of educational interventions, and provide information to educators about how best to engage students during their teaching. The Study Process Questionnaire has been widely used to evaluate student learning strategies. Students in the 2014 and 2015 year 1 cohorts of the osteopathy program at Victoria University completed the revised Study Process Questionnaire (R-SPQ-2F) as part of a larger study investigating the assessment and evaluation practices in the program. Confirmatory factor analysis was used to determine the fit of the data to the 2 factor structure of the R-SPQ-2F. Satisfactory fit was achieved through the removal of one item and the internal consistency was acceptable. This study proposes a version of the R-SPQ-2F that could be used in an Australian osteopathy student population.

The mini Clinical Evaluation Exercise (mini-CEX) in a pre-registration osteopathy program: Exploring aspects of its validity

Workplace-based assessment is commonplace, particularly in medicine. These assessments typically involve the assessment of a student conducting a consultation, or part thereof, on a real patient in an authentic clinical practice setting. In disciplines such as medicine substantial work has been directed towards the evaluation of the processes and tools used to perform these assessments and understand their educational impact. At present, there is little literature on the tools used for workplace-based assessment in osteopathy yet they form a picture of the student's capability. The current study presents data from a new workplace-based assessment tool for osteopathy, the mini Clinical Examination (mini-CEX) and is used to inform the implementation of the mini-CEX more broadly. Data presented here suggest the mini-CEX in this cohort is feasible, efficient, acceptable to stakeholders, internally consistent, and can differentiate between students at different stages of an osteopathic teaching program. Further research into the use of the mini-CEX in osteopathy is required, particularly focusing on educational impact, the reliability of the tool and its generalisability to clinical learning environments in other osteopathy teaching institutions.

Perceived teaching quality between near-peer and academic tutors in an osteopathic practical skills class

BackgroundNear-peer teaching (NPT) has been reported in a number of teaching programs across different health professions. The utilisation of near-peer teaching in a teaching program has been demonstrated as beneficial for the student, the near-peer tutor and the teaching institution. The literature reports that students evaluate near-peer teaching as comparable to faculty teaching. The use of near-peers with academic tutors in the same classroom and utilising near-peer teaching for an extended period is unreported in osteopathy and limited in the broader literature. ObjectiveThis study aimed to investigate the quality ratings of the academic tutors and near-peer tutors teaching in the same classroom, over a semester. DesignQuestionnaire-based study using the Practical Class Teaching Questionnaire (PCTQ). SettingOsteopathic practical skills laboratory. MethodsThe PCTQ is a 9-item teaching quality tool developed for this study. Students were asked to rate the academic tutors (ATs) and near-peer tutors with the PCTQ at week 5 and week 12 of a 12-week semester. Descriptive and inferential statistics were used to investigate differences between the tutor types and differences between administration times. ParticipantsStudents in the first year of the osteopathy program at Victoria University. ResultsStatistically significant differences in mean ratings (p < 0.05) between tutor types were noted at week 5. These differences had largely been ameliorated by week 12. There is a strong relationship between the total PCTQ and a global rating of teaching quality. ConclusionsTeaching quality of near-peer tutors and ATs is comparable at the end of a 12-week teaching period in a first year osteopathic practical skills subject. Although the mean near-peer tutors ratings were lower than the ATs at week 5, with increasing experience and confidence of the near-peer tutors these differences largely resolved by week 12. NPT should be considered for osteopathic practical skills subjects in the early years of the training program.

Assessment in the final year clinical practicum of an Australian osteopathy program

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.

Developing a clinical teaching quality questionnaire for use in a university osteopathic pre-registration teaching program.

BackgroundClinical education is an important component of many health professional training programs. There is a range of questionnaires to assess the quality of the clinical educator however none are in student-led clinic environments. The present study developed a questionnaire to assess the quality of the clinical educators in the osteopathy program at Victoria University.MethodsA systematic search of the literature was used to identify questionnaires that evaluated the quality of clinical teaching. Eighty-three items were extracted and reviewed for their appropriateness to include in a questionnaire by students, clinical educators and academics. A fifty-six item questionnaire was then trialled with osteopathy students. A variety of statistics were used to determine the number of factors to extract. Exploratory factor analysis (EFA) was used to investigate the factor structure.ResultsThe number of factors to extract was calculated to be between 3 and 6. Review of the factor structures suggested the most appropriate fit was four and five factors. The EFA of the four-factor solution collapsed into three factors. The five-factor solution demonstrated the most stable structure. Internal consistency of the five-factor solution was greater than 0.70.ConclusionsThe five factors were labelled Learning Environment (Factor 1), Reflective Practice (Factor 2), Feedback (Factor 3) and Patient Management (Factor 4) and Modelling (Factor 5). Further research is now required to continue investigating the construct validity and reliability of the questionnaire.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-015-0358-6) contains supplementary material, which is available to authorized users.

Osteopathic graduates perceptions of stress and competence – A longitudinal study

ObjectiveThe 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. ParticipantsStudents who graduated in 2010 from Victoria University's osteopathy program. MethodParticipants 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. ResultsJob 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. ConclusionOsteopathy 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.

The DREEM, part 2: psychometric properties in an osteopathic student population

BackgroundThe Dundee Ready Educational Environment Measure (DREEM) is widely used to assess the educational environment in health professional education programs. A number of authors have identified issues with the psychometric properties of the DREEM. Part 1 of this series of papers presented the quantitative data obtained from the DREEM in the context of an Australian osteopathy program. The present study used both classical test theory and item response theory to investigate the DREEM psychometric properties in an osteopathy student population.MethodsStudents in the osteopathy program at Victoria University (Melbourne, Australia) were invited to complete the DREEM and a demographic questionnaire at the end of the 2013 teaching year (October 2013). Data were analysed using both classical test theory (confirmatory factor analysis) and item response theory (Rasch analysis).ResultsConfirmatory factor analysis did not demonstrate model fit for the original 5-factor DREEM subscale structure. Rasch analysis failed to identify a unidimensional model fit for the 50-item scale, however model fit was achieved for each of the 5 subscales independently. A 12-item version of the DREEM was developed that demonstrated good fit to the Rasch model, however, there may be an issue with the targeting of this scale given the mean item-person location being greater than 1.ConclusionsGiven that the full 50-item scale is not unidimensional; those using the DREEM should avoid calculating a total score for the scale. The 12-item ‘short-form’ of the DREEM warrants further investigation as does the subscale structure. To confirm the reliability of the DREEM, as a measure to evaluate the appropriateness of the educational environment of health professionals, further work is required to establish the psychometric properties of the DREEM, with a range of student populations.