Factors influencing the output of rural cataract surgical facilities in China: the SHARP study

Purpose: To identify factors associated prospectively with increased cataract surgical rate (CSR) in rural Chinese hospitals.

Methods: Annual cataract surgical output was obtained at baseline and 24 months later from operating room records at 42 rural, county-level hospitals. Total local CSR (cases/million population/y), and proportion of CSR from hospital and local competitors were calculated from government records. Hospital administrators completed questionnaires providing demographic and professional information, and annual clinic and outreach screening volume. Independent cataract surgeons provided clinical information and videotapes of cases for grading by two masked experts using the Ophthalmology Surgical Competency Assessment Rubric (OSCAR). Uncorrected vision was recorded for 10 consecutive cataract cases at each facility, and 10 randomly-identified patients completed hospital satisfaction questionnaires. Total value of international nongovernmental development organization (INGDO) investment in the previous three years and demographic information on hospital catchment areas were obtained. Main outcome was 2-year percentage change in hospital CSR.

Results: Among the 42 hospitals (median catchment population 530,000, median hospital CSR 643), 78.6% (33/42) were receiving INGDO support. Median change in hospital CSR (interquartile range) was 33.3% (-6.25%, 72.3%). Predictors of greater increase in CSR included higher INGDO investment (P = 0.02, simple model), reducing patient dissatisfaction (P = 0.03, simple model), and more outreach patient screening (P = 0.002, simple and multiple model).

Conclusions: Outreach cataract screening was the strongest predictor of increased surgical output. Government and INGDO investment in screening may be most likely to enhance output of county hospitals, a major goal of China's Blindness Prevention Plan.

Implications of aligning full registration of doctors with medical school graduation:a qualitative study of stakeholder perspectives

OBJECTIVES: The Shape of Training report recommended that full registration is aligned with medical school graduation. As part of a General Medical Council-funded study about the preparedness for practice of UK medical graduates, we explored UK stakeholders' views about this proposal using qualitative interviews (30 group and 87 individual interviews) and Framework Analysis.

SETTING: Four UK study sites, one in each country.Save

PARTICIPANTS: 185 individuals from eight stakeholder groups: (1) foundation year 1 (F1) doctors (n=34); (2) fully registered trainee doctors (n=33); (3) clinical educators (n=32); (4) undergraduate/postgraduate Deans, and Foundation Programme Directors (n=30); (5) other healthcare professionals (n=13); (6) employers (n=7); (7) policy and government (n=11); (8) patient and public representatives (n=25).

RESULTS: We identified four main themes: (1) The F1 year as a safety net: patients were protected by close trainee supervision and 'sign off' to prevent errors; trainees were provided with a safe environment for learning on the job; (2) Implications for undergraduate medical education: if the proposal was accepted, a 'radical review' of undergraduate curricula would be needed; undergraduate education might need to be longer; (3) Implications for F1 work practice: steps to protect healthcare team integration and ensure that F1 doctors stay within competency limits would be required; (4) Financial, structural and political implications: there would be cost implications for trainees; clarification of responsibilities between undergraduate and postgraduate medical education would be needed. Typically, each theme comprised arguments for and against the proposal.

CONCLUSIONS: A policy change to align the timing of full registration with graduation would require considerable planning and preliminary work. These findings will inform policymakers' decision-making. Regardless of the decision, medical students should take on greater responsibility for patient care as undergraduates, assessment methods in clinical practice and professionalism domains need development, and good practice in postgraduate supervision and support must be shared.

Abstract: Psychometric properties of two self-report clinical competence scales for nursing students.

Abstract: Psychometric properties of two self-report clinical competence scales for nursing students.
Background: It is important to assess the clinical competence of nursing students to gauge their professional development and educational needs. This can be measured by self-assessment tools. Anema and McCoy (2010) contended that the currently available measures need further psychometric testing.
Aim: To test the psychometric properties of Nursing Competencies Questionnaire (NCQ) and Self-Efficacy in Clinical Performance (SECP) clinical competence scales.

Method: A non-randomly selected sample of n=248 2nd year nursing students completed NCQ, SECP and demographic questionnaires (June and September 2013). Mokken Scaling Analysis (MSA) was used to test the structural validity and scale properties, convergent and discriminant validity and reliability were subsequently tested.

Results: The NCQ provided evidence of a unidimensional scale which had strong scale scalability coefficients Hs =0.581; but limited evidence of item rankability HT =0.367. MSA undertaken with the SECP scale identified two potential unidimensional scales the SECP28 and SECP7, each with adequate evidence of good/reasonable scalablity psychometric properties as a summed scale but no/very limited evidence of scale rankability (SECP28: Hs = 0.55, HT=0.211; SECP7: Hs = 0.61, HT=0.049). Analysis of between cohort differences and NCQ/ SECP scale scores produced evidence of convergent and discriminant validity and good internal reliability: NCQ α = 0.93, SECP28 α = 0.96, and SECP7 α=0.89.

Discussion: The NCQ was verified to have evidence of reliability and validity; however, as the SECP findings are new, and the sample small, with reference to Straat and colleagues (2014), the SECP results should be interpreted with caution and verified on a second sample.

Conclusions: Measurement of perceived self-competence could inform the development of nursing competence and could start early in a nursing programme. Further testing of the NCQ and SECP scales with larger samples and from different years is indicated.


References:
Anema, M., G and McCoy, JK. (2010) Competency-Based Nursing Education: Guide to Achieving Outstanding Learner Outcomes. New York: Springer.
Straat, JH., van der Ark, LA and Sijtsma, K. (2014) Minimum Sample Size Requirements for Mokken Scale Analysis Educational and Psychological Measurement 74 (5), 809-822.

Critical Success Factors of Construction Project Quality in Brunei Darussalam

This research concentrates on the critical success factors driving construction quality and the barriers that must be overcome to achieve quality in Brunei. It hopes to identify methods of quality improvement and clearly justify investment in this area of local industry. Over the past number of years, Brunei has attempted to diversify its industry from the dominant oil and gas sector into secondary sectors,
including construction. To date, very little research has been carried out in many areas of construction management that take into account the specific industry context in Brunei. A comprehensive literature review has been employed to enable a questionnaire to be constructed and distributed among Brunei construction
professionals. The results have been analyzed through mean testing. This analysis reveals that the key barriers to construction quality in Brunei relate to lack of skills, lack of clarity in responsibility and communication and poor commitment among the design team. The critical success factors include issues relating to competency, capability, commitment and effectiveness, primarily among managers and decision-makers. The results of this study will hopefully contribute to fill the knowledge gap related to construction management in the context of Brunei and facilitate movement towards improved techniques and strategies that will foster higher quality in construction. The findings can be generalised across similar
developing economies and it is suggested that in general, the management concepts governing construction quality remain similar across the borders of East and West.

Acute care teaching in the undergraduate nursing curriculum

AIM: To incorporate basic aspects of acute care into the undergraduate nursing programme by providing an opportunity for the development of knowledge and skills in the early recognition and assessment of deteriorating patients on general hospital wards.
BACKGROUND: Acute care initiatives implemented in the hospital setting to improve the identification and management of 'at risk' patients have focused on the provision of education for trained or qualified staff. However, to ensure student nurses are 'fit to practice' at the point of registration, it has been recommended that acute care theory and skills are incorporated into the undergraduate nursing curriculum.
PRACTICE DEVELOPMENT INITIATIVE: An 'Integrated Nursing Care' module was incorporated into year 3 of the undergraduate nursing programme to introduce students to acute care theory and practice. Module content focuses on the early detection and management of acute deterioration in patients with respiratory, cardiac, neurological or renal insufficiencies. We used a competency-based framework to ensure the application of theory to practice through the use of group seminars. High-fidelity patient-simulated clinical scenarios were a key feature. The United Kingdom Resuscitation Council Intermediate Life Support course is also an important component of the module.
CONCLUSIONS: Incorporating the Integrated Nursing Care module into the undergraduate nursing curriculum provides pre-registration students the opportunity to develop their knowledge and skills in acute care.
RELEVANCE TO CLINICAL PRACTICE: The provision of undergraduate education in care of the acutely ill patient in hospital is essential to improve nurses' competence and confidence in assessing and managing deteriorating patients in general wards at the point of registration.

The Role of Teacher Presence during Computer Supported Online Collaborative Sessions in an Adult Education Course.

The convenience sample for this study was taken from an A.E.C. (Attestation of Collegial Studies) Communication course of the Continuing Education Technical Support Program. A key component of this course competency is for students to develop the skill to write business letters for various purposes and to apply the three-step writing process during the crafting of the correspondence. This is achieved with a number of writing assignments which are carried out by students working in teams and completing the writing assignments out-of-class. the out-of-class work was convened using the PrimaryPad program to complete two of the writing assignments, which formed the basis of the research. This research uses a case study design that employed a repeated measures method with two conditions (teacher scaffolding vs. no teacher scaffolding). The possibility of an order effect was controlled for by using a counterbalancing of treatment design. A post-treatment questionnaire was used to gather descriptive statistics.

Desenvolvimento de indicadores de comunicação em cuidados farmacêuticos : estudo piloto da sua aplicabilidade em farmácias comunitárias europeias

Tese de mestrado, Cuidados Farmacêuticos, Universidade de Lisboa, Faculdade de Farmácia, 2013

Visual Literacy Standards in Higher Education: New Opportunities for Libraries and Student Learning

Visual literacy is essential for 21st century learners. Across the higher education curriculum, students are being asked to use and produce images and visual media in their academic work, and they must be prepared to do so. The Association of College and Research Libraries has published the Visual Literacy Competency Standards for Higher Education, which for the first time, outline specific visual literacy learning outcomes. These Standards present new opportunities for libraries to expand their role in student learning through standards-based teaching and assessment, and to contribute to campus-wide collaborative efforts to develop students’ skills and critical thinking with regard to visual materials.

Das disposições cosmopolitas à mobilidade como competência? Ensino superior, Programa Erasmus e mobilidade estudantil

Tradicionalmente, a promoção de disposições cosmopolitas tem sido um importante elemento formativo das elites portuguesas e, simultaneamente, um ingrediente diferenciador, num contexto de baixas taxas de escolarização da população. Após três décadas de intensa democratização da educação e de ampla generalização da experiência escolar, a situação mudou significativamente. Com a tendencial globalização das políticas educativas, a intensificação de acordos e parcerias inter-governamentais oferecem-se aos jovens estudantes novas oportunidades educativas, nomeadamente experiências escolares internacionais. O programa europeu de mobilidade estudantil Erasmus constitui, a este respeito, um exemplo particularmente pertinente. Poder-se-á então continuar a falar de cosmopolitismo como propriedade educativa restrita a um grupo social? Ou, pelo contrário, essa propriedade tende a generalizar-se em sociedades altamente escolarizadas? Por sua vez, as disposições cosmopolitas como elemento formativo parecem ter mudado de significado: será que a mobilidade que suporta a experiência cosmopolita se transforma em competência?

WebGIS applied to improve spatial knowledge of high school students

This research seeks to design and implement a WebGIS application allowing high school students to work with information related to the disciplinary competencies of the competency-teaching model, in Mexico. This paradigm assumes knowledge to be acquired through the application of new technologies and to link it with everyday life situations of students. The WebGIS provides access to maps regarding natural risks in Mexico, e.g. volcanism, seismic activities, or hurricanes; the prototype's user interface was designed with special emphasis on scholar needs for high school students.

A safe place /

This study is an effort to give voice to an experience. The experience in question is the decision of a student to trust a practitioner. The study also describes the features which led the student to believe that the practitioner would provide a "safe place" for interaction around matters of a delicate or personal nature. This study is the gift oftwo coauthors, each with a unique story which offers description of critical incidents, and what made these events meaningful. At the heart of the study is the potential for education and its professionals to provide safe places for students. Analysis of the data determines that a safe place involves two parties, one seeking a safe place and another who provides the safe place-in this study, the student and the practitioner. The student, with urgency, seeks a safe place to disclose personal information. In this urgency the student is confronted with features of control, comfort, respect, felt sense, and nonjudgemental listening. These features are the constitutive elements of a Safe Place. Capacity to recognize and construct safe places is a competency which the existing school lifeworld demands of today's practitioners. Understanding what are deemed to be safe places and how practitioners might work to create them are the extended outcomes of this study.

What nourishes the spirit of adolescents in the classroom? : a qualitative study into the gateways of adolescents' souls /

This thesis investigated the question, "What nourishes the adolescent spirit in the classroom?" Action research was conducted by the teacher of 16 grade 8 participants. By undergoing Kessler's (2000) "Passages Program," the students participated in 6 sessions which exposed them to a holistic intrapersonal curriculum. Student journal responses were documented after each session. The action researcher also kept journal reflections after each session. Upon completion of the 6 sessions, a postinterview was conducted which posed the research question. The research found that the adolescent spirit gets nourished through encouragement by the teacher, peers, and parents. This increases their competency, which increases their confidence, and ultimately their self-esteem goes up, which affects their selfconcept. In addition, the role of the teacher permeates every aspect of what nourishes the adolescent spirit in the classroom. In addition to the encouragement of the student, how a teacher teaches plays a vital role. A holistic approach to teaching provided the best atmosphere for the adolescent. It promoted creativity and choice, which stimulated the spirit of the adolescent. By working from a holistic philosophy, the teacher/action researcher created an environment conducive to teaching the whole person, which ultimately nourished the participants' spirit. The research highlighted that in order for this type of environment to exist the teacher needs to make a conscious and deliberate effort to look within and develop their inner self before they can begin to promote this type of classroom for the adolescents they teach. When teachers and students develop an inner life together, they can begin to work in harmony to achieve an atmosphere where the teaching and learning environment becomes one seamless transaction. Only then can one's whole potential be realized.

A social-cognitive model of monitoring and its relationship to behaviour in a naturalistic observation : development and individual differences

years 8 months) and 24 older (M == 7 years 4 months) children. A Monitoring Process Model (MPM) was developed and tested in order to ascertain at which component process ofthe MPM age differences would emerge. The MPM had four components: (1) assessment; (2) evaluation; (3) planning; and (4) behavioural control. The MPM was assessed directly using a referential communication task in which the children were asked to make a series of five Lego buildings (a baseline condition and one building for each MPM component). Children listened to instructions from one experimenter while a second experimenter in the room (a confederate) intetjected varying levels ofverbal feedback in order to assist the children and control the component ofthe MPM. This design allowed us to determine at which "stage" ofprocessing children would most likely have difficulty monitoring themselves in this social-cognitive task. Developmental differences were obselVed for the evaluation, planning and behavioural control components suggesting that older children were able to be more successful with the more explicit metacomponents. Interestingly, however, there was no age difference in terms ofLego task success in the baseline condition suggesting that without the intelVention ofthe confederate younger children monitored the task about as well as older children. This pattern ofresults indicates that the younger children were disrupted by the feedback rather than helped. On the other hand, the older children were able to incorporate the feedback offered by the confederate into a plan ofaction. Another aim ofthis study was to assess similar processing components to those investigated by the MPM Lego task in a more naturalistic observation. Together the use ofthe Lego Task ( a social cognitive task) and the naturalistic social interaction allowed for the appraisal of cross-domain continuities and discontinuities in monitoring behaviours. In this vein, analyses were undertaken in order to ascertain whether or not successful performance in the MPM Lego Task would predict cross-domain competence in the more naturalistic social interchange. Indeed, success in the two latter components ofthe MPM (planning and behavioural control) was related to overall competence in the naturalistic task. However, this cross-domain prediction was not evident for all levels ofthe naturalistic interchange suggesting that the nature ofthe feedback a child receives is an important determinant ofresponse competency. Individual difference measures reflecting the children's general cognitive capacity (Working Memory and Digit Span) and verbal ability (vocabulary) were also taken in an effort to account for more variance in the prediction oftask success. However, these individual difference measures did not serve to enhance the prediction oftask performance in either the Lego Task or the naturalistic task. Similarly, parental responses to questionnaires pertaining to their child's temperament and social experience also failed to increase prediction oftask performance. On-line measures ofthe children's engagement, positive affect and anxiety also failed to predict competence ratings.

Teachers' perspectives on the implementation of expectations-based curricula /

This qualitative study examines teachers' experiences implementing new standardized curricula in Ontario schools. This new curricula contained several policy changes and an expectations based format which directed what knowledge and skills students were to demonstrate in each subject. This level of specificity of subject-content served to control teachers in relation to curricula; however, data suggested that at the same time, teachers had enormous flexibility in terms of pedagogy. Four secondary teachers who were implementing a Grade 10 course in the 2000-2001 school year participated in the study. The qualitative framework supported the researcher's emphasis on examining the participants' perspectives on the implementation of expectation-based curricula. Data collected included transcripts from interviews conducted with teacher participants and a representative of the Ontario Ministry of Education and Training, field notes, and a research journal. Many of the factors often cited in the literature as influencing implementation practices were found to have affected the participants' experiences of curriculum implementation: time, professional development, and teachers' beliefs, particularly concerning students. In addition, the format of the policy documents proved to both control and free teachers during the implementation process. Participants believed that the number of specific expectations did not provide them an opportunity to add content to the curriculum; at the same time, teachers also noted that the general format of the policy document allowed them to direct instruction to match students' needs and their own teaching preferences. Alignment between teachers' beliefs about education and their understanding of the new curriculum affected the ways in which many participants adapted during the implementation process.

Enhancing personal effectiveness : the impacts of Costa Rica Outward Bound on students in an independent school in southwestern Ontario

This project examines students in a private school in southwestern Ontario on a 17 -day Costa Rica Outward Bound Rainforest multielement course. The study attempted to discover whether voluntary teenage participants could increase their self-perceptions of life effectiveness by participating in a 17-day expedition. A total of9 students participated in the study. The experimental design that was implemented was a mixed methods design. Participants filled in a Life Effectiveness Questionnaire (LEQ) at four predesignated times during the study. These time intervals occurred (a) before the trip commenced, (b) the first day of the trip, ( c) the last day of the trip, and (d) 1 month after the trip ended. Fieldnotes and recordings from informal group debriefing sessions were also used to gather information. Data collected in this study were analyzed in a variety of ways by the researcher. Analyses that were run on the data included the Friedman test for covariance, means, medians, and the Wilcoxon Pairs Test. The questionnaires were analyzed quantitatively, and the fieldnotes were analyzed qualitatively. Nonparametric statistical analysis was implemented as a result of the small group size of participants. Both sets of data were grouped and discussed according to similarities and differences. The data indicate that voluntary teenage participants experience significant changes over time in the areas of time management, social competency, emotional control, active initiative, and self-confidence. The types of outcomes from this study illustrate that Outward Bound-type opportunities should be offered to teenagers in Ontario schools as a means to bring about self-development.