Approaches to Ensure Quality Standards for Standardized/ Simulated Patient Performance in High Stakes Objective Structured Clinical Exams (OSCEs)

Introduction To meet the quality standards for high-stakes OSCEs, it is necessary to ensure high quality standardized performance of the SPs involved.[1] One of the ways this can be assured is through the assessment of the quality of SPs` performance in training and during the assessment. There is some literature concerning validated instruments that have been used to assess SP performance in formative contexts but very little related to high stakes contexts.[2], [3], [4]. Content and structure During this workshop different approaches to quality control for SPs` performance, developed in medicine, pharmacy and nursing OSCEs, will be introduced. Participants will have the opportunity to use these approaches in simulated interactions. Advantages and disadvantages of these approaches will be discussed. Anticipated outcomes By the end of this session, participants will be able to discuss the rationale for quality control of SPs` performance in high stakes OSCEs, outline key factors in creating strategies for quality control, identify various strategies for assuring quality control, and reflect on applications to their own practice. Who should attend The workshop is designed for those interested in quality assurance of SP performance in high stakes OSCEs. Level All levels are welcome. References Adamo G. 2003. Simulated and standardized patients in OSCEs: achievements and challenges:1992-2003. Med Teach. 25(3), 262- 270. Wind LA, Van Dalen J, Muijtjens AM, Rethans JJ. Assessing simulated patients in an educational setting: the MaSP (Maastricht Assessment of Simulated Patients). Med Educ 2004, 38(1):39-44. Bouter S, van Weel-Baumgarten E, Bolhuis S. Construction and validation of the Nijmegen Evaluation of the Simulated Patient (NESP): Assessing Simulated Patients' ability to role-play and provide feedback to students. Acad Med: Journal of the Association of American Medical Colleges 2012. May W, Fisher D, Souder D: Development of an instrument to measure the quality of standardized/simulated patient verbal feedback. Med Educ 2012, 2(1).

FAIR_OSCE – Feedback structure for assessment of interactive roleplay in Objective Structured Clinical Exams

Introduction Since the quality of patient portrayal of standardized patients (SPs) during an Objective Structured Clinical Exam (OSCE) has a major impact on the reliability and validity of the exam, quality control should be initiated. Literature about quality control of SPs’ performance focuses on feedback [1, 2] or completion of checklists [3, 4]. Since we did not find a published instrument meeting our needs for the assessment of patient portrayal, we developed such an instrument after being inspired by others [5] and used it in our high-stakes exam. Project description SP trainers from five medical faculties collected and prioritized quality criteria for patient portrayal. Items were revised twice, based on experiences during OSCEs. The final instrument contains 14 criteria for acting (i.e. adequate verbal and non-verbal expression) and standardization (i.e. verbatim delivery of the first sentence). All partners used the instrument during a high-stakes OSCE. SPs and trainers were introduced to the instrument. The tool was used in training (more than 100 observations) and during the exam (more than 250 observations). Outcome High quality of SPs’ patient portrayal during the exam was documented. More than 90% of SP performances were rated to be completely correct or sufficient. An increase in quality of performance between training and exam was noted. For example, the rate of completely correct reaction in medical tests increased from 88% to 95%. Together with 4% of sufficient performances these 95% add up to 99% of the reactions in medical tests meeting the standards of the exam. SP educators using the instrument reported an augmentation of SPs’ performance induced by the use of the instrument. Disadvantages mentioned were the high concentration needed to observe all criteria and the cumbersome handling of the paper-based forms. Discussion We were able to document a very high quality of SP performance in our exam. The data also indicates that our training is effective. We believe that the high concentration needed using the instrument is well invested, considering the observed enhancement of performance. The development of an iPad-based application for the form is planned to address the cumbersome handling of the paper.

Synchronous and Time-Lagged Effects between Occupational Self-Efficacy and Objective and Subjective Career Success: Findings from a Four-Wave and 9-Year Longitudinal Study

We integrated research on the dimensionality of career success into social-cognitive career theory and explored the positive feedback loop between occupational self-efficacy and objective and subjective career success over time (self-efficacy → objective success → subjective success → self-efficacy). Furthermore, we theoretically accounted for synchronous and time-lagged effects, as well as indirect reciprocity between the variables. We tested the proposed model by means of longitudinal structural equation modeling in a 9-year four-wave panel design, by applying a model comparison approach and indirect effect analyses (N = 608 professionals). The findings supported the proposed positive feedback loop between occupational self-efficacy and career success. Supporting our time-based reasoning, the findings showed that unfolding effects between occupational self-efficacy and objective career success take more time (i.e., time-lagged or over time) than unfolding effects between objective and subjective career success, as well as between subjective career success and occupational self-efficacy (i.e., synchronous or concurrently). Indirect effects of past on future occupational self-efficacy via objective and subjective career success were significant, providing support for an indirect reciprocity model. Results are discussed with respect to extensions of social-cognitive career theory and occupational self-efficacy development over time.

Protean and boundaryless career attitudes: relationships with subjective and objective career success

The protean and boundaryless career attitudes have gained special attention during the past years. Aprotean career attitude implies that aperson strives towards adevelopmental progression and self-fulfillment; aboundaryless career attitude is characterized by ahigh physical and/or psychological mobility. The aim of the present paper is twofold: First, we want to empirically investigate the relationship between protean and boundaryless career attitudes and subjective (i.e., career satisfaction and success in comparison with colleagues) and objective (i.e., promotions and salary) career success. Second, we want to integrate research on protean and boundaryless career attitudes with research on predictors of career success. We analyze the career attitudes-career success relationship with asample of 116 professionals. Our findings suggest that components of the protean career attitude are rather more related with subjective career success and that components of the boundaryless career attitude are more related with objective career success. Conclusions regarding the relevance of career attitudes for career success are drawn.

How do objective and subjective career success interrelate over time?

The present research is concerned with the direction of influence between objective and subjective career success. We conducted a prospective longitudinal study with five waves of measurement that covered a time span of 10 years. Participants were professionals working in different occupational fields (N=1,336). We modelled the changes in objective success (income, hierarchical position), in other-referent subjective success (subjective success as compared to a reference group), and in self-referent subjective success (job satisfaction) by means of latent growth curve analysis. Objective success influenced both the initial level and the growth of other-referent subjective success, but it had no influence on job satisfaction. Most importantly, both measures of subjective success and both their initial levels and their changes had strong influences on the growth of objective success. We conclude that the ‘objective success influences subjective success’ relationship is smaller than might be expected, whereas the ‘subjective success influences objective success’ relationship is larger than might be expected.

The longitudinal impact of self-efficacy and career goals on objective and subjective career success

The present research reports on the impact of occupational self-efficacy and of career-advancement goals on objective (salary, status) and subjective (career satisfaction) career attainments. Seven hundred and thirty four highly educated and full-time employed professionals answered questionnaires immediately after graduation, three years later, and seven years later. Controlling for discipline, GPA at master’s level, and gender, we found that occupational self-efficacy measured at career entry had a positive impact on salary and status three years later and a positive impact on salary change and career satisfaction seven years later. Career-advancement goals at career entry had a positive impact on salary and status after three years and a positive impact on status change after seven years, but a negative impact on career satisfaction after seven years. Women earned less than men, but did not differ from men in hierarchical status and in career satisfaction. Theoretical implications for socio-cognitive theorizing and for career-success research as well as applied implications for vocational behavior are discussed.

Reliable prediction of clinical outcome in patients with chronic HCV infection and compensated advanced hepatic fibrosis: a validated model using objective and readily available clinical parameters.

OBJECTIVE Reliable tools to predict long-term outcome among patients with well compensated advanced liver disease due to chronic HCV infection are lacking. DESIGN Risk scores for mortality and for cirrhosis-related complications were constructed with Cox regression analysis in a derivation cohort and evaluated in a validation cohort, both including patients with chronic HCV infection and advanced fibrosis. RESULTS In the derivation cohort, 100/405 patients died during a median 8.1 (IQR 5.7-11.1) years of follow-up. Multivariate Cox analyses showed age (HR=1.06, 95% CI 1.04 to 1.09, p<0.001), male sex (HR=1.91, 95% CI 1.10 to 3.29, p=0.021), platelet count (HR=0.91, 95% CI 0.87 to 0.95, p<0.001) and log10 aspartate aminotransferase/alanine aminotransferase ratio (HR=1.30, 95% CI 1.12 to 1.51, p=0.001) were independently associated with mortality (C statistic=0.78, 95% CI 0.72 to 0.83). In the validation cohort, 58/296 patients with cirrhosis died during a median of 6.6 (IQR 4.4-9.0) years. Among patients with estimated 5-year mortality risks <5%, 5-10% and >10%, the observed 5-year mortality rates in the derivation cohort and validation cohort were 0.9% (95% CI 0.0 to 2.7) and 2.6% (95% CI 0.0 to 6.1), 8.1% (95% CI 1.8 to 14.4) and 8.0% (95% CI 1.3 to 14.7), 21.8% (95% CI 13.2 to 30.4) and 20.9% (95% CI 13.6 to 28.1), respectively (C statistic in validation cohort = 0.76, 95% CI 0.69 to 0.83). The risk score for cirrhosis-related complications also incorporated HCV genotype (C statistic = 0.80, 95% CI 0.76 to 0.83 in the derivation cohort; and 0.74, 95% CI 0.68 to 0.79 in the validation cohort). CONCLUSIONS Prognosis of patients with chronic HCV infection and compensated advanced liver disease can be accurately assessed with risk scores including readily available objective clinical parameters.

From planetesimals to planets: volatile molecules

Context. Solar and extrasolar planets are the subject of numerous studies aiming to determine their chemical composition and internal structure. In the case of extrasolar planets, the composition is important as it partly governs their potential habitability. Moreover, observational determination of chemical composition of planetary atmospheres are becoming available, especially for transiting planets. Aims. The present works aims at determining the chemical composition of planets formed in stellar systems of solar chemical composition. The main objective of this work is to provide valuable theoretical data for models of planet formation and evolution, and future interpretation of chemical composition of solar and extrasolar planets. Methods. We have developed a model that computes the composition of ices in planets in different stellar systems with the use of models of ice and planetary formation. Results. We provide the chemical composition, ice/rock mass ratio and C:O molar ratio for planets in stellar systems of solar chemical composition. From an initial homogeneous composition of the nebula, we produce a wide variety of planetary chemical compositions as a function of the mass of the disk and distance to the star. The volatile species incorporated in planets are mainly composed of H2O, CO, CO2, CH3OH, and NH3. Icy or ocean planets have systematically higher values of molecular abundances compared to giant and rocky planets. Gas giant planets are depleted in highly volatile molecules such as CH4, CO, and N2 compared to icy or ocean planets. The ice/rock mass ratio in icy or ocean and gas giant planets is, respectively, equal at maximum to 1.01 ± 0.33 and 0.8 ± 0.5, and is different from the usual assumptions made in planet formation models, which suggested this ratio to be 2–3. The C:O molar ratio in the atmosphere of gas giant planets is depleted by at least 30% compared to solar value.

From stellar nebula to planetesimals

Context. Solar and extrasolar comets and extrasolar planets are the subject of numerous studies in order to determine their chemical composition and internal structure. In the case of planetesimals, their compositions are important as they govern in part the composition of future planets. Aims. The present works aims at determining the chemical composition of icy planetesimals, believed to be similar to present day comets, formed in stellar systems of solar chemical composition. The main objective of this work is to provide valuable theoretical data on chemical composition for models of planetesimals and comets, and models of planet formation and evolution. Methods. We have developed a model that calculates the composition of ices formed during the cooling of the stellar nebula. Coupled with a model of refractory element formation, it allows us to determine the chemical composition and mass ratio of ices to rocks in icy planetesimals throughout in the protoplanetary disc. Results. We provide relationships for ice line positions (for different volatile species) in the disc, and chemical compositions and mass ratios of ice relative to rock for icy planetesimals in stellar systems of solar chemical composition. From an initial homogeneous composition of the nebula, a wide variety of chemical compositions of planetesimals were produced as a function of the mass of the disc and distance to the star. Ices incorporated in planetesimals are mainly composed of H2O, CO, CO2, CH3OH, and NH3. The ice/rock mass ratio is equal to 1 ± 0.5 in icy planetesimals following assumptions. This last value is in good agreement with observations of solar system comets, but remains lower than usual assumptions made in planet formation models, taking this ratio to be of 2–3.

Consensus on the Need for a Hierarchical List of Patient-reported Pain Outcomes for Metaanalyses of Knee Osteoarthritis Trials: An OMERACT Objective.

OBJECTIVE Although protocol registration for systematic reviews is still not mandatory, reviewers should be strongly encouraged to register the protocol to identify the methodological approach, including all outcomes of interest. This will minimize the likelihood of biased decisions in reviews, such as selective outcome reporting. A group of international experts convened to address issues regarding the need to develop hierarchical lists of outcome measurement instruments for a particular outcome for metaanalyses. METHODS Multiple outcome measurement instruments exist to measure the same outcome. Metaanalysis of knee osteoarthritis (OA) trials, and the assessment of pain as an outcome, was used as an exemplar to assess how Outcome Measures in Rheumatology (OMERACT), the Cochrane Collaboration, and other international initiatives might contribute in this area. The meeting began with formal presentations of background topics, empirical evidence from the literature, and a brief introduction to 2 existing hierarchical lists of pain outcome measurement instruments recommended for metaanalyses of knee OA trials. RESULTS After discussions, most participants agreed that there is a need to develop a methodology for generation of hierarchical lists of outcome measurement instruments to guide metaanalyses. Tools that could be used to steer development of such a prioritized list are the COSMIN checklist (Consensus-based Standards for the selection of health status Measurement Instruments) and the OMERACT Filter 2.0. CONCLUSION We list meta-epidemiological research agenda items that address the frequency of reported outcomes in trials, as well as methodologies to assess the best measurement properties (i.e., truth, discrimination, and feasibility).

SOP: Parallel surrogate global optimization with Pareto center selection for computationally expensive single objective problems

This paper presents a parallel surrogate-based global optimization method for computationally expensive objective functions that is more effective for larger numbers of processors. To reach this goal, we integrated concepts from multi-objective optimization and tabu search into, single objective, surrogate optimization. Our proposed derivative-free algorithm, called SOP, uses non-dominated sorting of points for which the expensive function has been previously evaluated. The two objectives are the expensive function value of the point and the minimum distance of the point to previously evaluated points. Based on the results of non-dominated sorting, P points from the sorted fronts are selected as centers from which many candidate points are generated by random perturbations. Based on surrogate approximation, the best candidate point is subsequently selected for expensive evaluation for each of the P centers, with simultaneous computation on P processors. Centers that previously did not generate good solutions are tabu with a given tenure. We show almost sure convergence of this algorithm under some conditions. The performance of SOP is compared with two RBF based methods. The test results show that SOP is an efficient method that can reduce time required to find a good near optimal solution. In a number of cases the efficiency of SOP is so good that SOP with 8 processors found an accurate answer in less wall-clock time than the other algorithms did with 32 processors.

MBA Program Reputation: Objective Rankings for Students, Employers and Program Administrators

Widely publicized reports of fresh MBAs receiving multiple job offers with six-figure annual salaries leave a long-lasting general impression about the high quality of selected business schools. Business Week reports on a regular basis ranking of MBA programs based on subjective surveys of students and employers. This paper ranks MBA programs using objective data from three different points of view students, employers, and MBA program administrators.

Conversations between Anthropologists and Economists

Interdisciplinary citation patterns and other indicators of the flow and sharing of academic knowledge suggest that economists and anthropologists do not talk to each other. Previous studies of this puzzling trend have typically attributed the problem to methodological differences between the two disciplines. Although there are significant differences between economics and anthropology in behavioral assumptions and modes of inquiry, similar differences exist between them and other disciplines (some with much heavier volumes of cross-citations with economics or anthropology), suggesting that the source of the problem lies elsewhere. This paper considers the problem at a deeper level by examining systematic differences in the preferences, capabilities, and literary cultures of economists and anthropologists. Adopting a rhetorical perspective, I consider not the firms, households, or tribes as the principal objective of analysis in the two disciplines, but the conversations between these units. These conversations (through non-verbal as well as verbal media) can be grouped into two genres, based on the type of problem they aim to solve. Those in the first genre aim to solve the problem of interest--how to align the incentives of the parties involved. Those in the second genre deal with the problem of knowledge--how to align localized, and dispersed information. Economists are interested and capable of dealing with primarily, if not exclusively, the first genre, and anthropologists focus on the second. This difference has far reaching consequences for how economists and anthropologists conduct their own scholarly conversations with their own colleagues, why they are having difficulty talking to each other across disciplinary boundaries, and what can be done to change the patterns of communication.