Keeping it real! Enhancing realism in standardised patient OSCE stations

Background: Objective structured clinical examinations (OSCEs) are a
commonly used method of assessing clinical competency in healthcare education. They can providean opportunity to observe candidates interacting with patients.
There are many challenges in using real patients in OSCEs, and increasingly standardised patients are being used as a preference. However, by using standardised patients there is a risk of making the encounter arti?cial and removed from actual clinical practice.
Context: Efforts made in terms of cognitive, auditory, visual, tactile, psychological and emotional cues can minimise the differences between a simulated
and real clinical scenario. However, a number of factors, including feasibility, cost and usability, need to be considered if such techniques are to be practicable
within an OSCE framework.
Innovation: This article describes a series of techniques that have been used in our institution to enhance the realism of a standardised patient encounter in an
OSCE. Efforts in preparing standardised patient roles, and how they portray these roles, will be considered. A wide variety of equipment can also be used in
combination with a patient and the surrounding environment, which can further enhance the authenticity of the simulated scenario.
Implications: By enhancing the realism in simulated patient OSCE encounters, there is potential to trigger more authentic conscious responses from candidates and implicit reactions that the candidates themselves may be less
aware of. Furthermore, using such techniques may allow faculty members to select scenarios that were previously not thought possible in an OSCE

Effects of amisulpride, risperidone and chlorpromazine on auditory and visual latent inhibition, prepulse inhibition, executive function and eye movements in healthy volunteers.

In view of the evidence that cognitive deficits in schizophrenia are critically important for long-term outcome, it is essential to establish the effects that the various antipsychotic compounds have on cognition, particularly second-generation drugs. This parallel group, placebo-controlled study aimed to compare the effects in healthy volunteers (n = 128) of acute doses of the atypical antipsychotics amisulpride (300 mg) and risperidone (3 mg) to those of chlorpromazine (100 mg) on tests thought relevant to the schizophrenic process: auditory and visual latent inhibition, prepulse inhibition of the acoustic startle response, executive function and eye movements. The drugs tested were not found to affect auditory latent inhibition, prepulse inhibition or executive functioning as measured by the Cambridge Neuropsychological Test Battery and the FAS test of verbal fluency. However, risperidone disrupted and amisulpride showed a trend to disrupt visual latent inhibition. Although amisulpride did not affect eye movements, both risperidone and chlorpromazine decreased peak saccadic velocity and increased antisaccade error rates, which, in the risperidone group, correlated with drug-induced akathisia. It was concluded that single doses of these drugs appear to have little effect on cognition, but may affect eye movement parameters in accordance with the amount of sedation and akathisia they produce. The effect risperidone had on latent inhibition is likely to relate to its serotonergic properties. Furthermore, as the trend for disrupted visual latent inhibition following amisulpride was similar in nature to that which would be expected with amphetamine, it was concluded that its behaviour in this model is consistent with its preferential presynaptic dopamine antagonistic activity in low dose and its efficacy in the negative symptoms of schizophrenia.

Auditory hallucinations in dissociative identity disorder and schizophrenia with and without a childhood trauma history: Similarities and differences.

Little is known about similarities and differences in voice hearing in schizophrenia and dissociative identity disorder (DID) and the role of child maltreatment and dissociation. This study examined various aspects of voice hearing, along with childhood maltreatment and pathological dissociation in 3 samples: schizophrenia without child maltreatment (n = 18), schizophrenia with child maltreatment (n = 16), and DID (n = 29). Compared with the schizophrenia groups, the DID sample was more likely to have voices starting before 18, hear more than 2 voices, have both child and adult voices and experience tactile and visual hallucinations. The 3 groups were similar in that voice content was incongruent with mood and the location was more likely internal than external. Pathological dissociation predicted several aspects of voice hearing and appears an important variable in voice hearing, at least where maltreatment is present.

Sensing Spaces:A Body-oriented Architectural Design Education

The contemporary dominance of visuality has turned our understanding of space into a mode of unidirectional experience that externalizes other sensual capacities of the body while perceiving the built environment. This affects not only architectural practice but also architectural education when an introduction to the concept of space is often challenging, especially for the students who have limited spatial and sensual training. Considering that an architectural work is not perceived as a series of retinal pictures but as a repeated multi-sensory experience, the problem definitions in the design studio need to be disengaged from the dominance of a ‘focused vision’ and be re-constructed in a holistic manner. A method to address this approach is to enable the students to refer to their own sensual experiences of the built environment as a part of their design processes. This paper focuses on a particular approach to the second year architectural design teaching which has been followed in the Department of Architecture at Izmir University of Economics for the last three years. The very first architectural project of the studio and the program, entitled ‘Sensing Spaces’, is conducted as a multi-staged design process including ‘sense games, analyses of organs and their interpretations into space’. The objectives of this four-week project are to explore the sense of space through the design of a three-dimensional assembly, to create an awareness of the significance of the senses in the design process and to experiment with re-interpreted forms of bodily parts. Hence, the students are encouraged to explore architectural space through their ‘tactile, olfactory, auditory, gustative and visual stimuli’. In this paper, based on a series of examples, architectural space is examined beyond its boundaries of structure, form and function, and spatial design is considered as an activity of re-constructing the built environment through the awareness of bodily senses.

Web-assisted first-year undergraduate teaching in engineering

A software system, recently developed by the authors for the efficient capturing, editing, and delivery of audio-visual web lectures, was used to create a series of lectures for a first-year undergraduate course in Dynamics. These web lectures were developed to serve as an extra study resource for students attending lectures and not as a replacement. A questionnaire was produced to obtain feedback from students. The overall response was very favorable and numerous requests were made for other lecturers to adopt this technology. Despite the students' approval of this added resource, there was no significant improvement in overall examination performance

Auditory observation of stepping actions can cue both spatial and temporal components of gait in Parkinson's disease patients

Objectives: A common behavioural symptom of Parkinson’s disease (PD) is reduced step length (SL). Whilst sensory cueing strategies can be effective in increasing SL and reducing gait variability, current cueing strategies conveying spatial or temporal information are generally confined to the use of either visual or auditory cue modalities, respectively. We describe a novel cueing strategy using ecologically-valid ‘action-related’ sounds (footsteps on gravel) that convey both spatial and temporal parameters of a specific action within a single cue.
Methods: The current study used a real-time imitation task to examine whether PD affects the ability to re-enact changes in spatial characteristics of stepping actions, based solely on auditory information. In a second experimental session, these procedures were repeated using synthesized sounds derived from recordings of the kinetic interactions between the foot and walking surface. A third experimental session examined whether adaptations observed when participants walked to action-sounds were preserved when participants imagined either real recorded or synthesized sounds.
Results: Whilst healthy control participants were able to re-enact significant changes in SL in all cue conditions, these adaptations, in conjunction with reduced variability of SL were only observed in the PD group when walking to, or imagining the recorded sounds.
Conclusions: The findings show that while recordings of stepping sounds convey action information to allow PD patients to re-enact and imagine spatial characteristics of gait, synthesis of sounds purely from gait kinetics is insufficient to evoke similar changes in behaviour, perhaps indicating that PD patients have a higher threshold to cue sensorimotor resonant responses.

Processing of short auditory stimuli:The rapid audio sequential presentation paradigm (RASP)

Human listeners seem to be remarkably able to recognise acoustic sound sources based on timbre cues. Here we describe a psychophysical paradigm to estimate the time it takes to recognise a set of complex sounds differing only in timbre cues: both in terms of the minimum duration of the sounds and the inferred neural processing time. Listeners had to respond to the human voice while ignoring a set of distractors. All sounds were recorded from natural sources over the same pitch range and equalised to the same duration and power. In a first experiment, stimuli were gated in time with a raised-cosine window of variable duration and random onset time. A voice/non-voice (yes/no) task was used. Performance, as measured by d', remained above chance for the shortest sounds tested (2 ms); d's above 1 were observed for durations longer than or equal to 8 ms. Then, we constructed sequences of short sounds presented in rapid succession. Listeners were asked to report the presence of a single voice token that could occur at a random position within the sequence. This method is analogous to the "rapid sequential visual presentation" paradigm (RSVP), which has been used to evaluate neural processing time for images. For 500-ms sequences made of 32-ms and 16-ms sounds, d' remained above chance for presentation rates of up to 30 sounds per second. There was no effect of the pitch relation between successive sounds: identical for all sounds in the sequence or random for each sound. This implies that the task was not determined by streaming or forward masking, as both phenomena would predict better performance for the random pitch condition. Overall, the recognition of familiar sound categories such as the voice seems to be surprisingly fast, both in terms of the acoustic duration required and of the underlying neural time constants.

Using Audio-visual Presentation to Teach Global Mindedness in Social Work Education

Direct experience of social work in another country is making an increasingly important contribution to internationalising the social work academic curriculum together with the cultural competency of students. However at present this opportunity is still restricted to a limited number of students. The aim of this paper is to describe and reflect on the production of an audio-visual presentation as representing the experience of three students who participated in an exchange with a social work programme in Pune, India. It describes and assesses the rationale, production and use of video to capture student learning from the Belfast/Pune exchange. We also describe the use of the video in a classroom setting with a year group of 53 students from a younger cohort. This exercise aimed to stimulate students’ curiosity about international dimensions of social work and add to their awareness of poverty, social justice, cultural competence and community social work as global issues. Written classroom feedback informs our discussion of the technical as well as the pedagogical benefits and challenges of this approach. We conclude that some benefit of audio-visual presentation in helping students connect with diverse cultural contexts, but that a complementary discussion challenging stereotyped viewpoints and unconscious professional imperialism is also crucial.