METHODS: Twelve orthopedic surgeons participated in a modified Delphi panel consisting of 2 parts (each part comprising two rounds) from September-October 2018. Questionnaires were developed based on published evidence and guidelines on surgical techniques/materials. Questionnaires were administered via email (Round 1) or at a face-to-face meeting (subsequent rounds). Panelists ranked their agreement with each statement on a five-point Likert scale. Consensus was achieved if ≥70% of panelists selected 4/5, or 1/2. Statements not reaching consensus in Round 1 were discussed and repeated or modified in Round 2. Statements not reaching consensus in Round 2 were excluded from the final consensus framework.
RESULTS: Consensus was reached on 13 goals of wound management. Panelists agreed on 38 challenges and 71 strategies addressing surgical techniques or wound closure materials for each tissue layer, and management strategies for blood loss reduction or deep vein thrombosis prophylaxis in TKA. Statements on closure of capsular and skin layers, wound irrigation, dressings and drains required repeat voting or modification to reach consensus.
CONCLUSION: Consensus from Asia-Pacific TKA experts highlights the importance of wound management in optimizing TKA outcomes. The consensus framework provides a basis for future research, guidance to reduce variability in patient outcomes, and can help inform recommendations for wound management in TKA.
DISCUSSION: Creating an inclusive assessment culture is important for equitable education, even if priorities for inclusion might differ between contexts. We recognise challenges in the enactment of inclusive assessment, namely, the notion of lowering standards, harming reliability and robustness of assessment design and inclusion as a poorly defined and catchall term. Importantly, the lack of awareness that inclusion means recognising intersectionality is a barrier for well-designed inclusive assessments. This is why we offer considerations for HPE practitioners that can guide towards a unified direction of travel for inclusive assessments. This article highlights the importance of contextual prioritisation and initiatives to be considered at the global level to national, institutional, programme and the individual level. Utilising experience and literature from undergraduate, higher education contexts, we offer considerations with applicability across the assessment continuum.
CONTEXT: In this state of science paper, we were set the challenge of providing cross-cultural viewpoints on inclusive assessment. In this discursive article, we focus on inclusive assessment within undergraduate health professions education whilst looking to the wider higher education literature, since institutional policies and procedures frequently drive assessment decisions and influence the environment in which they occur. We explore our experiences of working in inclusive assessment, with the aim of bridging and enhancing practices of inclusive assessments for HPE. Unlike other articles that juxtapose views, we all come from the perspective of supporting inclusive assessment. We begin with a discussion on what inclusive assessment is and then describe our contexts as a basis for understanding differences and broadening conversations. We work in the United Kingdom, Australia and Malaysia, having undertaken research, facilitated workshops and seminars on inclusive assessment nationally and internationally. We recognise our perspectives will differ as a consequence of our global context, institutional culture, individual characteristics and educational experiences. (Note that individual characteristics are also known as protected characteristics in some countries). Then, we outline challenges and opportunities associated with inclusive assessment, drawing on evidence within our contexts, acknowledging that our understanding of inclusive assessment research is limited to publications in English and currently tilted to publications from the Global North. In the final section, we then offer recommendations for championing inclusion, focussing firstly on assessment designs, and then broader considerations to organise collective action. Our article is unapologetically practical; the deliberate divergence from a theoretical piece is with the intent that anyone who reads this paper might enact even one small change progressing towards more inclusive assessment practices within their context.