Career choice in medicine

Background: Career Choice in Medicine is an important and problematic topic. Medical education has been framed as professional identity development, yet career choice has not been viewed as a matter of identity. My primary aim was to offer new insights by exploring career choice using Figured Worlds theory, a socio-cultural theory of identity. Graduate retention is a challenge for many countries, including Ireland. My secondary aim was to address a gap in the data on postgraduate trainees in Ireland and to use the Irish case to illustrate points transferable to other contexts. Methodology & Methods: This was a predominantly qualitative Mixed Methods programme of research. My qualitative studies were oriented towards social constructionism. I collated existing data from the Royal College of Physicians of Ireland (RCPI) and HSE-MET to describe trainees and their career paths. I surveyed Basic Specialist Training trainees (n=333) about their career plans. I surveyed new trainees (n=527) about their expectations of training and all RCPI trainees about their experiences of training (n=1246). I conducted semi-structured interviews with 18 medical students and doctors. A subgroup (n=6) provided longitudinal data. Figured Worlds theory and Gee’s discourse tools were used for analysis. Results: I have used the case of medical training and career choice in Ireland to explain how social, political and cultural context, and day to day experiences in the cultural world of medicine, shaped doctors’ career choices. My qualitative findings described a unifying model of career choice, consisting of priming, exposure, positioning and open-endedness, which can guide the design of interventions to shape and support career choice. Conclusion: My original contribution has been to demonstrate the fruitfulness of framing career choice in terms of identity development. This represents a turn in the conversation about career choice, which brings new starting points and moves the dialogue forward.

To what extent does the Health Professions Admission Test-Ireland predict performance in early undergraduate tests of communication and clinical skills? – An observational cohort study

Background: Internationally, tests of general mental ability are used in the selection of medical students. Examples include the Medical College Admission Test, Undergraduate Medicine and Health Sciences Admission Test and the UK Clinical Aptitude Test. The most widely used measure of their efficacy is predictive validity.A new tool, the Health Professions Admission Test- Ireland (HPAT-Ireland), was introduced in 2009. Traditionally, selection to Irish undergraduate medical schools relied on academic achievement. Since 2009, Irish and EU applicants are selected on a combination of their secondary school academic record (measured predominately by the Leaving Certificate Examination) and HPAT-Ireland score. This is the first study to report on the predictive validity of the HPAT-Ireland for early undergraduate assessments of communication and clinical skills. Method. Students enrolled at two Irish medical schools in 2009 were followed up for two years. Data collected were gender, HPAT-Ireland total and subsection scores; Leaving Certificate Examination plus HPAT-Ireland combined score, Year 1 Objective Structured Clinical Examination (OSCE) scores (Total score, communication and clinical subtest scores), Year 1 Multiple Choice Questions and Year 2 OSCE and subset scores. We report descriptive statistics, Pearson correlation coefficients and Multiple linear regression models. Results: Data were available for 312 students. In Year 1 none of the selection criteria were significantly related to student OSCE performance. The Leaving Certificate Examination and Leaving Certificate plus HPAT-Ireland combined scores correlated with MCQ marks.In Year 2 a series of significant correlations emerged between the HPAT-Ireland and subsections thereof with OSCE Communication Z-scores; OSCE Clinical Z-scores; and Total OSCE Z-scores. However on multiple regression only the relationship between Total OSCE Score and the Total HPAT-Ireland score remained significant; albeit the predictive power was modest. Conclusion: We found that none of our selection criteria strongly predict clinical and communication skills. The HPAT- Ireland appears to measures ability in domains different to those assessed by the Leaving Certificate Examination. While some significant associations did emerge in Year 2 between HPAT Ireland and total OSCE scores further evaluation is required to establish if this pattern continues during the senior years of the medical course.

Characteristics of the wave energy resource at the Atlantic marine energy test site

The wave energy industry is progressing towards an advanced stage of development, with consideration being given to the selection of suitable sites for the first commercial installations. An informed, and accurate, characterisation of the wave energy resource is an essential aspect of this process. Ireland is exposed to an energetic wave climate, however many features of this resource are not well understood. This thesis assesses and characterises the wave energy resource that has been measured and modelled at the Atlantic Marine Energy Test Site, a facility for conducting sea trials of floating wave energy converters that is being developed near Belmullet, on the west coast of Ireland. This characterisation process is undertaken through the analysis of metocean datasets that have previously been unavailable for exposed Irish sites. A number of commonly made assumptions in the calculation of wave power are contested, and the uncertainties resulting from their application are demonstrated. The relationship between commonly used wave period parameters is studied, and its importance in the calculation of wave power quantified, while it is also shown that a disconnect exists between the sea states which occur most frequently at the site and those that contribute most to the incident wave energy. Additionally, observations of the extreme wave conditions that have occurred at the site and estimates of future storms that devices will need to withstand are presented. The implications of these results for the design and operation of wave energy converters are discussed. The foremost contribution of this thesis is the development of an enhanced understanding of the fundamental nature of the wave energy resource at the Atlantic Marine Energy Test Site. The results presented here also have a wider relevance, and can be considered typical of other, similarly exposed, locations on Ireland’s west coast.

Finding optimal alternatives based on efficient comparative preference inference

Choosing the right or the best option is often a demanding and challenging task for the user (e.g., a customer in an online retailer) when there are many available alternatives. In fact, the user rarely knows which offering will provide the highest value. To reduce the complexity of the choice process, automated recommender systems generate personalized recommendations. These recommendations take into account the preferences collected from the user in an explicit (e.g., letting users express their opinion about items) or implicit (e.g., studying some behavioral features) way. Such systems are widespread; research indicates that they increase the customers' satisfaction and lead to higher sales. Preference handling is one of the core issues in the design of every recommender system. This kind of system often aims at guiding users in a personalized way to interesting or useful options in a large space of possible options. Therefore, it is important for them to catch and model the user's preferences as accurately as possible. In this thesis, we develop a comparative preference-based user model to represent the user's preferences in conversational recommender systems. This type of user model allows the recommender system to capture several preference nuances from the user's feedback. We show that, when applied to conversational recommender systems, the comparative preference-based model is able to guide the user towards the best option while the system is interacting with her. We empirically test and validate the suitability and the practical computational aspects of the comparative preference-based user model and the related preference relations by comparing them to a sum of weights-based user model and the related preference relations. Product configuration, scheduling a meeting and the construction of autonomous agents are among several artificial intelligence tasks that involve a process of constrained optimization, that is, optimization of behavior or options subject to given constraints with regards to a set of preferences. When solving a constrained optimization problem, pruning techniques, such as the branch and bound technique, point at directing the search towards the best assignments, thus allowing the bounding functions to prune more branches in the search tree. Several constrained optimization problems may exhibit dominance relations. These dominance relations can be particularly useful in constrained optimization problems as they can instigate new ways (rules) of pruning non optimal solutions. Such pruning methods can achieve dramatic reductions in the search space while looking for optimal solutions. A number of constrained optimization problems can model the user's preferences using the comparative preferences. In this thesis, we develop a set of pruning rules used in the branch and bound technique to efficiently solve this kind of optimization problem. More specifically, we show how to generate newly defined pruning rules from a dominance algorithm that refers to a set of comparative preferences. These rules include pruning approaches (and combinations of them) which can drastically prune the search space. They mainly reduce the number of (expensive) pairwise comparisons performed during the search while guiding constrained optimization algorithms to find optimal solutions. Our experimental results show that the pruning rules that we have developed and their different combinations have varying impact on the performance of the branch and bound technique.

Novel processes, test structures and characterisation for future germanium technologies

In order to widely use Ge and III-V materials instead of Si in advanced CMOS technology, the process and integration of these materials has to be well established so that their high mobility benefit is not swamped by imperfect manufacturing procedures. In this dissertation number of key bottlenecks in realization of Ge devices are investigated; We address the challenge of the formation of low resistivity contacts on n-type Ge, comparing conventional and advanced rapid thermal annealing (RTA) and laser thermal annealing (LTA) techniques respectively. LTA appears to be a feasible approach for realization of low resistivity contacts with an incredibly sharp germanide-substrate interface and contact resistivity in the order of 10 -7 Ω.cm2. Furthermore the influence of RTA and LTA on dopant activation and leakage current suppression in n+/p Ge junction were compared. Providing very high active carrier concentration > 1020 cm-3, LTA resulted in higher leakage current compared to RTA which provided lower carrier concentration ~1019 cm-3. This is an indication of a trade-off between high activation level and junction leakage current. High ION/IOFF ratio ~ 107 was obtained, which to the best of our knowledge is the best reported value for n-type Ge so far. Simulations were carried out to investigate how target sputtering, dose retention, and damage formation is generated in thin-body semiconductors by means of energetic ion impacts and how they are dependent on the target physical material properties. Solid phase epitaxy studies in wide and thin Ge fins confirmed the formation of twin boundary defects and random nucleation growth, like in Si, but here 600 °C annealing temperature was found to be effective to reduce these defects. Finally, a non-destructive doping technique was successfully implemented to dope Ge nanowires, where nanowire resistivity was reduced by 5 orders of magnitude using PH3 based in-diffusion process.

The Quick Mild Cognitive Impairment (Qmci) screen: developing a new screening test for mild cognitive impairment and dementia

Introduction: Identifying mild cognitive impairment (MCI) is challenging. Few short instruments have sufficient sensitivity and specificity for use in busy clinical practice. This thesis explores the development, psychometric evaluation and validation of a new short (3–5 min) cognitive screening instrument, designed to screen for MCI and early dementia, called the Quick Mild Cognitive Impairment (Q