Medical Education Podcast: The view from over there: reframing the OSCE through the experience of standardised patient raters

Podcast

Rapid prototyping applied to a new development in moulds for rotational moulding

The aim of this work has been to adapt and apply the advantages of rapid prototyping and electroforming technologies to try to achieve an innovative mould design for rotational moulding. The new innovative design integrates an electroformed shell, manufactured starting from a rapid prototyping mandrel, with different designed standard aluminium tools. The shell holder enables mould assembly with high precision manufacture of a shell in a few minutes. The overall mould cost is significantly decreased because it is only necessary to manufacture one or two shells each time; however, the rest of the elements of the mould are standard and usable for an infinite number of shells, depending on size.

Access and utilisation of maternity care for disabled women who experience domestic abuse: a systematic review

Background: Although disabled women are significantly more likely to experience domestic abuse during pregnancy than non-disabled women, very little is known about how maternity care access and utilisation is affected by the co-existence of disability and domestic abuse. This systematic review of the literature explored how domestic abuse impacts upon disabled women’s access to maternity services.

Methods: Eleven articles were identified through a search of six electronic databases and data were analysed to identify: the factors that facilitate or compromise access to care; the consequences of inadequate care for pregnant women’s health and wellbeing; and the effectiveness of existing strategies for improvement.

Results: Findings indicate that a mental health diagnosis, poor relationships with health professionals and environmental barriers can compromise women’s utilisation of maternity services. Domestic abuse can both compromise, and catalyse, access to services and social support is a positive factor when accessing care. Delayed and inadequate care has adverse effects on women’s physical and psychological health, however further research is required to fully explore the nature and extent of these consequences. Only one study identified strategies currently being used to improve access to services for disabled women experiencing abuse.

Conclusions: Based upon the barriers and facilitators identified within the review, we suggest that future strategies for improvement should focus on: understanding women’s reasons for accessing care; fostering positive relationships; being women-centred; promoting environmental accessibility; and improving the strength of the evidence base.

The student experience in Objective Structured Clinical Examinations (OSCEs): phenomenological analysis

Background and purpose
The dominant psychometric discourse of OSCEs may lead to unexpected problems, such as a checklist-based student performance1 which under emphasises the clinical relationship with student and standardised patient (SP). Such encounters can be dehumanising for SPs2 and have implications for what students learn about relational skills through the assessment process. In this study we explore medical students’ experiences of undertaking OSCEs using a phenomenological frame.
Methodology
Interpretative phenomenological analysis is a form of qualitative methodology which has strong resonance with existentialism and focuses on the lived experience without significant reference to external political or discursive
forces.
Six 4th year undergraduate medical students from Queen’s University Belfast were recruited in December 2013. Maximum variation sampling was used. Students were interviewed by a researcher in the week prior to the
OSCE and then again in the week following the OSCE in Jan 2014. Interviews were minimally structured in order to be open to respondents, rather than adhering to a fixed topic guide, but focussed on participants’ experiences, thoughts and feelings about taking part in OSCEs. Interviews were audio-recorded and
transcribed. Students were also asked to complete a short diary entry in the days prior to the OSCEs and another immediately following. Diary entries were written, emailed or audio-recorded at student’s preference.
Results
Transcripts are currently being analysed by interpretative phenomenological analysis. Preliminary analysis has demonstrated the significance of students’ relationships within the OSCE triad (student, SP and examiner); the effect of the immediate examination environment; realism versus roleplay; students’ perceptions of the purpose of assessment; and coping mechanisms.
Full results will be available by the time of the conference.
Conclusion and Discussion
Understanding the student experience in OSCEs is a crucial step in understanding the complex construction of relationships within the OSCE triad. The focus in OSCEs is typically on standardisation and reliability, but in exploring social interactions we may refocus attention on their inherent potential for learning and effects on both students and patients.
References
1. Hodges B. Medical education and the maintenance of incompetence. Med Teach 2006;28(8):690-6
2. Johnston JL, Lundy G, McCullough M, Gormley GJ. The view from over there: reframing the OSCE through the experience of standardised patient
raters. Med Educ 2013;47(9):899-909

A Framework for Prototyping and Reasoning about Distributed Systems

A framework supporting fast prototyping as well as tuning of distributed applications is presented. The approach is based on the adoption of a formal model that is used to describe the orchestration of distributed applications. The formal model (Orc by Misra and Cook) can be used to support semi-formal reasoning about the applications at hand. The paper describes how the framework can be used to derive and evaluate alternative orchestrations of a well know parallel/distributed computation pattern; and shows how the same formal model can be used to support generation of prototypes of distributed applications skeletons directly from the application description.

Adding metadata to Orc to support reasoning about grid programs

Following earlier work demonstrating the utility of Orc as a means of specifying and reasoning about grid applications we propose the enhancement of such specifications with metadata that provide a means to extend an Orc specification with implementation oriented information. We argue that such specifications provide a useful refinement step in allowing reasoning about implementation related issues ahead of actual implementation or even prototyping. As examples, we demonstrate how such extended specifications can be used for investigating security related issues and for evaluating the cost of handling grid resource faults. The approach emphasises a semi-formal style of reasoning that makes maximum use of programmer domain knowledge and experience.

The Value and Contribution of Qualitative Research to Inform Nurse Education and Policy in Response to the Child’s Experience of Hospital

The aim of this article is to consider the value of qualitative research to inform nurse education and policy for the hospitalized child and young person (CYP). The theoretical issues and tensions inherent in qualitative research with children and young people’s nursing are presented in conjunction with a discussion and analysis of how the epistemological and ontological concepts underpin and guide research. It is then followed by an exploration of their influence on enabling nurses to understand the CYP’s perspective, before finally leading to an analysis of the impact on the development of policy and research.