The professionalism disconnect: do entering residents identify yet participate in unprofessional behaviors?

BACKGROUND: Professionalism has been an important tenet of medical education, yet defining it is a challenge. Perceptions of professional behavior may vary by individual, medical specialty, demographic group and institution. Understanding these differences should help institutions better clarify professionalism expectations and provide standards with which to evaluate resident behavior. METHODS: Duke University Hospital and Vidant Medical Center/East Carolina University surveyed entering PGY1 residents. Residents were queried on two issues: their perception of the professionalism of 46 specific behaviors related to training and patient care; and their own participation in those specified behaviors. The study reports data analyses for gender and institution based upon survey results in 2009 and 2010. The study received approval by the Institutional Review Boards of both institutions. RESULTS: 76% (375) of 495 PGY1 residents surveyed in 2009 and 2010 responded. A majority of responders rated all 46 specified behaviors as unprofessional, and a majority had either observed or participated in each behavior. For all 46 behaviors, a greater percentage of women rated the behaviors as unprofessional. Men were more likely than women to have participated in behaviors. There were several significant differences in both the perceptions of specified behaviors and in self-reported observation of and/or involvement in those behaviors between institutions.Respondents indicated the most important professionalism issues relevant to medical practice include: respect for colleagues/patients, relationships with pharmaceutical companies, balancing home/work life, and admitting mistakes. They reported that professionalism can best be assessed by peers, patients, observation of non-medical work and timeliness/detail of paperwork. CONCLUSION: Defining professionalism in measurable terms is a challenge yet critical in order for it to be taught and assessed. Recognition of the differences by gender and institution should allow for tailored teaching and assessment of professionalism so that it is most meaningful. A shared understanding of what constitutes professional behavior is an important first step.

Measuring fast gene dynamics in single cells with time-lapse luminescence microscopy.

Time-lapse fluorescence microscopy is an important tool for measuring in vivo gene dynamics in single cells. However, fluorescent proteins are limited by slow chromophore maturation times and the cellular autofluorescence or phototoxicity that arises from light excitation. An alternative is luciferase, an enzyme that emits photons and is active upon folding. The photon flux per luciferase is significantly lower than that for fluorescent proteins. Thus time-lapse luminescence microscopy has been successfully used to track gene dynamics only in larger organisms and for slower processes, for which more total photons can be collected in one exposure. Here we tested green, yellow, and red beetle luciferases and optimized substrate conditions for in vivo luminescence. By combining time-lapse luminescence microscopy with a microfluidic device, we tracked the dynamics of cell cycle genes in single yeast with subminute exposure times over many generations. Our method was faster and in cells with much smaller volumes than previous work. Fluorescence of an optimized reporter (Venus) lagged luminescence by 15-20 min, which is consistent with its known rate of chromophore maturation in yeast. Our work demonstrates that luciferases are better than fluorescent proteins at faithfully tracking the underlying gene expression.

Measuring the Severity of Negative and Traumatic Events.

We devised three measures of the general severity of events, which raters applied to participants' narrative descriptions: 1) placing events on a standard normed scale of stressful events, 2) placing events into five bins based on their severity relative to all other events in the sample, and 3) an average of ratings of the events' effects on six distinct areas of the participants' lives. Protocols of negative events were obtained from two non-diagnosed undergraduate samples (n = 688 and 328), a clinically diagnosed undergraduate sample all of whom had traumas and half of whom met PTSD criteria (n = 30), and a clinically diagnosed community sample who met PTSD criteria (n = 75). The three measures of severity correlated highly in all four samples but failed to correlate with PTSD symptom severity in any sample. Theoretical implications for the role of trauma severity in PTSD are discussed.

A new instrument for measuring anticoagulation-related quality of life: development and preliminary validation.

BACKGROUND: Anticoagulation can reduce quality of life, and different models of anticoagulation management might have different impacts on satisfaction with this component of medical care. Yet, to our knowledge, there are no scales measuring quality of life and satisfaction with anticoagulation that can be generalized across different models of anticoagulation management. We describe the development and preliminary validation of such an instrument - the Duke Anticoagulation Satisfaction Scale (DASS). METHODS: The DASS is a 25-item scale addressing the (a) negative impacts of anticoagulation (limitations, hassles and burdens); and (b) positive impacts of anticoagulation (confidence, reassurance, satisfaction). Each item has 7 possible responses. The DASS was administered to 262 patients currently receiving oral anticoagulation. Scales measuring generic quality of life, satisfaction with medical care, and tendency to provide socially desirable responses were also administered. Statistical analysis included assessment of item variability, internal consistency (Cronbach's alpha), scale structure (factor analysis), and correlations between the DASS and demographic variables, clinical characteristics, and scores on the above scales. A follow-up study of 105 additional patients assessed test-retest reliability. RESULTS: 220 subjects answered all items. Ceiling and floor effects were modest, and 25 of the 27 proposed items grouped into 2 factors (positive impacts, negative impacts, this latter factor being potentially subdivided into limitations versus hassles and burdens). Each factor had a high degree of internal consistency (Cronbach's alpha 0.78-0.91). The limitations and hassles factors consistently correlated with the SF-36 scales measuring generic quality of life, while the positive psychological impact scale correlated with age and time on anticoagulation. The intra-class correlation coefficient for test-retest reliability was 0.80. CONCLUSIONS: The DASS has demonstrated reasonable psychometric properties to date. Further validation is ongoing. To the degree that dissatisfaction with anticoagulation leads to decreased adherence, poorer INR control, and poor clinical outcomes, the DASS has the potential to help identify reasons for dissatisfaction (and positive satisfaction), and thus help to develop interventions to break this cycle. As an instrument designed to be applicable across multiple models of anticoagulation management, the DASS could be crucial in the scientific comparison between those models of care.

Measuring the comprehensibility of Z specifications

The effects of natural language comments, meaningful variable names, and structure on the comprehensibility of Z specifications are investigated through a designed experiment conducted with a range of undergraduate and post-graduate student subjects. The times taken on three assessment questions are analysed and related to the abilities of the students as indicated by their total score, with the result that stronger students need less time than weaker students to complete the assessment. Individual question scores, and total score, are then analysed and the influence of comments, naming, structure and level of student's class are determined. In the whole experimental group, only meaningful naming significantly enhances comprehension. In contrast, for those obtaining the best score of 3/3 the only significant factor is commenting. Finally, the subjects' ratings of the five specifications used in the study in terms of their perceived comprehensibility have been analysed. Comments, naming and structure are again found to be of importance in the group when analysed as a whole, but in the sub-group of best performing subjects only the comments had an effect on perceived comprehensibility.

Measuring distributions of jump rates in disordered metal–hydrogen systems by nuclear magnetic relaxation

Monte Carlo calculations of the nuclear magnetic relaxation rate in a disordered metal–hydrogen system having a distribution of jump rates are reported. The calculations deal specifically with the spin-locked rotating-frame relaxation time T1ρ. The results demonstrate that the temperature variation of the rate is only weakly dependent on the distribution and it is therefore unlikely that the jump rate distribution can be extracted from relaxation measurements in which temperature is the main variable. It is shown that the alternative of measuring the relaxation rate over a wide range of spin-locking field strengths at a constant temperature can lead to an evaluation of the distribution.

Measuring similarity of software designs using graph matching for CBR

This paper examines different ways of measuring similarity between software design models for Case Based Reasoning (CBR) to facilitate reuse of software design and code. The paper considers structural and behavioural aspects of similarity between software design models. Similarity metrics for comparing static class structures are defined and discussed. A Graph representation of UML class diagrams and corresponding similarity measures for UML class diagrams are defined. A full search graph matching algorithm for measuring structural similarity diagrams based on the identification of the Maximum Common Sub-graph (MCS) is presented. Finally, a simple evaluation of the approach is presented and discussed.

A case study of the effectiveness of the electronic survey as a research tool for measuring students' experience of e-learning

This paper uses a case study approach to consider the effectiveness of the electronic survey as a research tool to measure the learner voice about experiences of e-learning in a particular institutional case. Two large scale electronic surveys were carried out for the Student Experience of e-Learning (SEEL) project at the University of Greenwich in 2007 and 2008, funded by the UK Higher Education Academy (HEA). The paper considers this case to argue that, although the electronic web-based survey is a convenient method of quantitative and qualitative data collection, enabling higher education institutions swiftly to capture multiple views of large numbers of students regarding experiences of e-learning, for more robust analysis, electronic survey research is best combined with other methods of in-depth qualitative data collection. The advantages and disadvantages of the electronic survey as a research method to capture student experiences of e-learning are the focus of analysis in this short paper, which reports an overview of large-scale data collection (1,000+ responses) from two electronic surveys administered to students using surveymonkey as a web-based survey tool as part of the SEEL research project. Advantages of web-based electronic survey design include flexibility, ease of design, high degree of designer control, convenience, low costs, data security, ease of access and guarantee of confidentiality combined with researcher ability to identify users through email addresses. Disadvantages of electronic survey design include the self-selecting nature of web-enabled respondent participation, which tends to skew data collection towards students who respond effectively to email invitations. The relative inadequacy of electronic surveys to capture in-depth qualitative views of students is discussed with regard to prior recommendations from the JISC-funded Learners' Experiences of e-Learning (LEX) project, in consideration of the results from SEEL in-depth interviews with students. The paper considers the literature on web-based and email electronic survey design, summing up the relative advantages and disadvantages of electronic surveys as a tool for student experience of e-learning research. The paper concludes with a range of recommendations for designing future electronic surveys to capture the learner voice on e-learning, contributing to evidence-based learning technology research development in higher education.

'Bowing from the heart': an investigation into discourses of professionalism and the work of caring for students in further education

Since their incorporation in 1993, further education (FE) colleges in England have been responsible for their own staffing and, faced with funding constraints as well as recruitment and retention targets, some have introduced a new category of staff referred to here as 'learning support workers' (LSWs). Though their employment conditions and specific duties vary considerably, LSWs' work often includes providing individual care for students. In this small-scale study, using semi-structured interviews, the perceptions of some teachers and LSWs about the nature of their relationships with each other and with students are investigated. The study is set broadly in the context of debates about the impact of public sector reform on FE colleges and teachers. A discourse analysis approach is adopted in discussion of the data. The authors conclude that although they are differently positioned in relation to traditional discourses of professionalism, both teachers and LSWs are perceived to be carrying out what Hochschild termed 'emotional labour'. The contradictory nature of emotional labour is also highlighted. Some of the implications of employing a new group of workers in FE are discussed.