The Critical Friends Group: An Innovative Way to Build Intercultural Competence Among Student and Faculty Groups

Introduction Few physicians involved in medical education are likely to have had formal training in teaching. One pedagogical method that can enhance relationships, thus improve teaching and learning is the Critical Friends Group (CFG). The CFG is a collegial support team that offers improved understanding of others. Unconditional high regard for team members frames the interactions in the CFG. These teams could be used to reduce bias and enhance intercultural competence among student CFGs and faculty CFGs. [See PDF for complete abstract]

Re-thinking resuscitation: leaving blood pressure cosmetics behind and moving forward to permissive hypotension and a tissue perfusion-based approach

Definitions of shock and resuscitation endpoints traditionally focus on blood pressures and cardiac output. This carries a high risk of overemphasizing systemic hemodynamics at the cost of tissue perfusion. In line with novel shock definitions and evidence of the lack of a correlation between macro- and microcirculation in shock, we recommend that macrocirculatory resuscitation endpoints, particularly arterial and central venous pressure as well as cardiac output, be reconsidered. In this viewpoint article, we propose a three-step approach of resuscitation endpoints in shock of all origins. This approach targets only a minimum individual and context-sensitive mean arterial blood pressure (for example, 45 to 50 mm Hg) to preserve heart and brain perfusion. Further resuscitation is exclusively guided by endpoints of tissue perfusion irrespectively of the presence of arterial hypotension ('permissive hypotension'). Finally, optimization of individual tissue (for example, renal) perfusion is targeted. Prospective clinical studies are necessary to confirm the postulated benefits of targeting these resuscitation endpoints.

Models for intensive care training. A European perspective.

The diversity of European culture is reflected in its healthcare training programs. In intensive care medicine (ICM), the differences in national training programs were so marked that it was unlikely that they could produce specialists of equivalent skills. The Competency-Based Training in Intensive Care Medicine in Europe (CoBaTrICE) program was established in 2003 as a Europe-based worldwide collaboration of national training organizations to create core competencies for ICM using consensus methodologies to establish common ground. The group's professional and research ethos created a social identity that facilitated change. The program was easily adaptable to different training structures and incorporated the voice of patients and relatives. The CoBaTrICE program has now been adopted by 15 European countries, with another 12 countries planning to adopt the training program, and is currently available in nine languages, including English. ICM is now recognized as a primary specialty in Spain, Switzerland, and the UK. There are still wide variations in structures and processes of training in ICM across Europe, although there has been agreement on a set of common program standards. The combination of a common "product specification" for an intensivist, combined with persisting variation in the educational context in which competencies are delivered, provides a rich source of research inquiry. Pedagogic research in ICM could usefully focus on the interplay between educational interventions, healthcare systems and delivery, and patient outcomes, such as including whether competency-based program are associated with lower error rates, whether communication skills training is associated with greater patient and family satisfaction, how multisource feedback might best be used to improve reflective learning and teamworking, or whether increasing the proportion of specialists trained in acute care in the hospital at weekends results in better patient outcomes.

Can you see me thinking (about my answers)? Using eye-tracking to illuminate developmental differences in monitoring and control skills and their relation to performance

This study focuses on relations between 7- and 9-year-old children’s and adults’ metacognitive monitoring and control processes. In addition to explicit confidence judgments (CJ), data for participants’ control behavior during learning and recall as well as implicit CJs were collected with an eye-tracking device (Tobii 1750). Results revealed developmental progression in both accuracy of implicit and explicit monitoring across age groups. In addition, efficiency of learning and recall strategies increases with age, as older participants allocate more fixation time to critical information and less time to peripheral or potentially interfering information. Correlational analyses, recall performance, metacognitive monitoring, and controlling indicate significant interrelations between all of these measures, with varying patterns of correlations within age groups. Results are discussed in regard to the intricate relationship between monitoring and recall and their relation to performance.

Quality assurance of simulated patient feedback in communication training for fourth-year medical students

Introduction In our program, simulated patients (SPs) give feedback to medical students in the course of communication skills training. To ensure effective training, quality control of the SPs’ feedback should be implemented. At other institutions, medical students evaluate the SPs’ feedback for quality control (Bouter et al., 2012). Thinking about implementing quality control for SPs’ feedback in our program, we wondered whether the evaluation by students would result in the same scores as evaluation by experts. Methods Consultations simulated by 4th-year medical students with SPs were video taped including the SP’s feedback to the students (n=85). At the end of the training sessions students rated the SPs’ performance using a rating instrument called Bernese Assessment for Role-play and Feedback (BARF) containing 11 items concerning feedback quality. Additionally the videos were evaluated by 3 trained experts using the BARF. Results The experts showed a high interrater agreement when rating identical feedbacks (ICCunjust=0.953). Comparing the rating of students and experts, high agreement was found with regard to the following items: 1. The SP invited the student to reflect on the consultation first, Amin (= minimal agreement) 97% 2. The SP asked the student what he/she liked about the consultation, Amin = 88%. 3. The SP started with positive feedback, Amin = 91%. 4. The SP was comparing the student with other students, Amin = 92%. In contrast the following items showed differences between the rating of experts and students: 1. The SP used precise situations for feedback, Amax (=maximal agreement) 55%, Students rated 67 of SPs’ feedbacks to be perfect with regard to this item (highest rating on a 5 point Likert scale), while only 29 feedbacks were rated this way by the experts. 2. The SP gave precise suggestions for improvement, Amax 75%, 62 of SPs’ feedbacks obtained the highest rating from students, while only 44 of SPs’ feedbacks achieved the highest rating in the view of the experts. 3. The SP speaks about his/her role in the third person, Amax 60%. Students rated 77 feedbacks with the highest score, while experts judged only 43 feedbacks this way. Conclusion Although evaluation by the students was in agreement with that of experts concerning some items, students rated the SPs’ feedback more often with the optimal score than experts did. Moreover it seems difficult for students to notice when SPs talk about the role in the first instead of the third person. Since precision and talking about the role in the third person are important quality criteria of feedback, this result should be taken into account when thinking about students’ evaluation of SPs’ feedback for quality control. Bouter, S., E. van Weel-Baumgarten, and S. Bolhuis. 2012. Construction and Validation of the Nijmegen Evaluation of the Simulated Patient (NESP): Assessing Simulated Patients’ Ability to Role-Play and Provide Feedback to Students. Academic Medicine: Journal of the Association of American Medical Colleges

Critical indicators associated with negative performance in a selectively manned unit

Introduction. Selectively manned units have a long, international history, both military and civilian. Some examples include SWAT teams, firefighters, the FBI, the DEA, the CIA, and military Special Operations. These special duty operators are individuals who perform a highly skilled and dangerous job in a unique environment. A significant amount of money is spent by the Department of Defense (DoD) and other federal agencies to recruit, select, train, equip and support these operators. When a critical incident or significant life event occurs, that jeopardizes an operator's performance; there can be heavy losses in terms of training, time, money, and potentially, lives. In order to limit the number of critical incidents, selection processes have been developed over time to “select out” those individuals most likely to perform below desired performance standards under pressure or stress and to "select in" those with the "right stuff". This study is part of a larger program evaluation to assess markers that identify whether a person will fail under the stresses in a selectively manned unit. The primary question of the study is whether there are indicators in the selection process that signify potential negative performance at a later date. ^ Methods. The population being studied included applicants to a selectively manned DoD organization between 1993 and 2001 as part of a unit assessment and selection process (A&S). Approximately 1900 A&S records were included in the analysis. Over this nine year period, seventy-two individuals were determined to have had a critical incident. A critical incident can come in the form of problems with the law, personal, behavioral or family problems, integrity issues, and skills deficit. Of the seventy-two individuals, fifty-four of these had full assessment data and subsequent supervisor performance ratings which assessed how an individual performed while on the job. This group was compared across a variety of variables including demographics and psychometric testing with a group of 178 individuals who did not have a critical incident and had been determined to be good performers with positive ratings by their supervisors.^ Results. In approximately 2004, an online pre-screen survey was developed in the hopes of preselecting out those individuals with items that would potentially make them ineligible for selection to this organization. This survey has aided the organization to increase its selection rates and save resources in the process. (Patterson, Howard Smith, & Fisher, Unit Assessment and Selection Project, 2008) When the same prescreen was used on the critical incident individuals, it was found that over 60% of the individuals would have been flagged as unacceptable. This would have saved the organization valuable resources and heartache.^ There were some subtle demographic differences between the two groups (i.e. those with critical incidents were almost twice as likely to be divorced compared with the positive performers). Upon comparison of Psychometric testing several items were noted to be different. The two groups were similar when their IQ levels were compared using the Multidimensional Aptitude Battery (MAB). When looking at the Minnesota Multiphasic Personality Inventory (MMPI), there appeared to be a difference on the MMPI Social Introversion; the Critical Incidence group scored somewhat higher. When analysis was done, the number of MMPI Critical Items between the two groups was similar as well. When scores on the NEO Personality Inventory (NEO) were compared, the critical incident individuals tended to score higher on Openness and on its subscales (Ideas, Actions, and Feelings). There was a positive correlation between Total Neuroticism T Score and number of MMPI critical items.^ Conclusions. This study shows that the current pre-screening process is working and would have saved the organization significant resources. ^ If one was to develop a profile of a candidate who potentially could suffer a critical incident and subsequently jeopardize the unit, mission and the safety of the public they would look like the following: either divorced or never married, score high on the MMPI in Social Introversion, score low on MMPI with an "excessive" amount of MMPI critical items; and finally scores high on the NEO Openness and subscales Ideas, Feelings, and Actions.^ Based on the results gleaned from the analysis in this study there seems to be several factors, within psychometric testing, that when taken together, will aid the evaluators in selecting only the highest quality operators in order to save resources and to help protect the public from unfortunate critical incidents which may adversely affect our health and safety.^

Community health workers: The critical link to sustainable, healthy societies in low-resource settings---A model for the Baylor Shoulder to Shoulder Foundation

Community health workers (CHWs) can serve as a bridge between healthcare providers and communities to positively impact social determinants of health and, thus, the overall health of the population. The potential to effect lasting change is particularly significant within resource-poor settings with limited access to formally trained health care providers such as the small, rural village of Santa Ana Intibucá, Honduras and surrounding areas—located on the geographically and politically isolated border of Honduras and El Salvador. The Baylor Shoulder to Shoulder Foundation (BSTS) works in conjunction with Santa Ana's volunteer health committee to bring a health brigade that has provided health care and public health projects to the area at least twice a year since 2001. They have also hired a full-time Honduran physician, a Honduran in-country administrative director, and built a clinic; yet, no community health worker program exists. This CHW program model is the response to a clear need for a CHW program within the area served by BSTS and presents a CHW program model specific to Santa Ana Intibucá and surrounding areas to be implemented by BSTS. Methods used to develop this model include reviewing the literature for recommendations from leading authorities as well as successfully implemented CHW programs in comparable regions. This information was incorporated into existing knowledge and materials currently being used in the area. Using the CHW model proposed here, each brigade, in conjunction with the communities served, can help develop new modules to respond to the specific health priorities of the region at that time, incorporating consistent modes of contact with the local physician and the CHWs to provide refresher courses, training in new topics of interest, and to be reminded of the importance of community health workers' role as the critical link to healthy societies. With cooperation, effort, and support, the brigade can continue to help integrate a sustainable CHW system in which communities may be able to maximize the care they receive while also learning to care for their own health and the future of their communities.^

Aprender a ser docentes con el cine de Miyazaki

El presente artículo plantea la incorporación del cine como argumento válido para la formación del profesorado. Consideramos que el cine incluye suficientes mecanismos para involucrar la educación en artes visuales, la educación en medios, y la educación musical. Entre los directores más relevantes del panorama internacional, proponemos la figura de Hayao Miyazaki. Este creador japonés ha sabido atraer a públicos de todas las edades y culturas a lo largo de su dilatada carrera profesional. La calidad técnica de los trabajos de Miyazaki va acompañada de una serie de valores que resultan muy válidos para incorporar acciones educativas de respeto al medio natural y a las tradiciones culturales. Pensamos que los maestros de educación primaria han de estar preparados para fomentar este tipo de valores entre el alumnado. Tanto la educación artística como el cine son entornos muy atractivos para lograrlo. Hemos observado y analizado a un grupo de estudiantes de grado de Maestro de primaria mientras miraban la película Ponyo en el acantilado. Planteamos un mayor uso del cine como recurso educativo (Ambrós y Breu, 2007; Fedorov, 2010). Animamos al profesorado y al alumnado a realizar nuevas lecturas críticas y personales del cine, indagando más allá del conocimiento del medio como mero entretenimiento (Clarembeaux, 2010; Hernández, 2000; Huerta, 2006)

A model of career training in international contexts

Este artículo describe un modelo para la capacitación de practicantes de orientación ocupacional en contextos internacionales. Este modelo utiliza un enfoque de "compromiso activo" y se fundamenta en los siguientes factores: 1. Relativos a Competencia/Habilidad; 2. Aprendizaje Experimental; 3. Desafío de Fortaleza; 4. Pensamiento Crítico; 5. Intervenciones y Procesos Dinámicos; y 6. Aprendizaje e Innovación Integradas. También se incluye un debate sobre otras cuestiones prácticas relativas a la capacitación.

Aprender a ser docentes con el cine de Miyazaki

El presente artículo plantea la incorporación del cine como argumento válido para la formación del profesorado. Consideramos que el cine incluye suficientes mecanismos para involucrar la educación en artes visuales, la educación en medios, y la educación musical. Entre los directores más relevantes del panorama internacional, proponemos la figura de Hayao Miyazaki. Este creador japonés ha sabido atraer a públicos de todas las edades y culturas a lo largo de su dilatada carrera profesional. La calidad técnica de los trabajos de Miyazaki va acompañada de una serie de valores que resultan muy válidos para incorporar acciones educativas de respeto al medio natural y a las tradiciones culturales. Pensamos que los maestros de educación primaria han de estar preparados para fomentar este tipo de valores entre el alumnado. Tanto la educación artística como el cine son entornos muy atractivos para lograrlo. Hemos observado y analizado a un grupo de estudiantes de grado de Maestro de primaria mientras miraban la película Ponyo en el acantilado. Planteamos un mayor uso del cine como recurso educativo (Ambrós y Breu, 2007; Fedorov, 2010). Animamos al profesorado y al alumnado a realizar nuevas lecturas críticas y personales del cine, indagando más allá del conocimiento del medio como mero entretenimiento (Clarembeaux, 2010; Hernández, 2000; Huerta, 2006)

A model of career training in international contexts

Este artículo describe un modelo para la capacitación de practicantes de orientación ocupacional en contextos internacionales. Este modelo utiliza un enfoque de "compromiso activo" y se fundamenta en los siguientes factores: 1. Relativos a Competencia/Habilidad; 2. Aprendizaje Experimental; 3. Desafío de Fortaleza; 4. Pensamiento Crítico; 5. Intervenciones y Procesos Dinámicos; y 6. Aprendizaje e Innovación Integradas. También se incluye un debate sobre otras cuestiones prácticas relativas a la capacitación.

Aprender a ser docentes con el cine de Miyazaki

El presente artículo plantea la incorporación del cine como argumento válido para la formación del profesorado. Consideramos que el cine incluye suficientes mecanismos para involucrar la educación en artes visuales, la educación en medios, y la educación musical. Entre los directores más relevantes del panorama internacional, proponemos la figura de Hayao Miyazaki. Este creador japonés ha sabido atraer a públicos de todas las edades y culturas a lo largo de su dilatada carrera profesional. La calidad técnica de los trabajos de Miyazaki va acompañada de una serie de valores que resultan muy válidos para incorporar acciones educativas de respeto al medio natural y a las tradiciones culturales. Pensamos que los maestros de educación primaria han de estar preparados para fomentar este tipo de valores entre el alumnado. Tanto la educación artística como el cine son entornos muy atractivos para lograrlo. Hemos observado y analizado a un grupo de estudiantes de grado de Maestro de primaria mientras miraban la película Ponyo en el acantilado. Planteamos un mayor uso del cine como recurso educativo (Ambrós y Breu, 2007; Fedorov, 2010). Animamos al profesorado y al alumnado a realizar nuevas lecturas críticas y personales del cine, indagando más allá del conocimiento del medio como mero entretenimiento (Clarembeaux, 2010; Hernández, 2000; Huerta, 2006)

A model of career training in international contexts

Este artículo describe un modelo para la capacitación de practicantes de orientación ocupacional en contextos internacionales. Este modelo utiliza un enfoque de "compromiso activo" y se fundamenta en los siguientes factores: 1. Relativos a Competencia/Habilidad; 2. Aprendizaje Experimental; 3. Desafío de Fortaleza; 4. Pensamiento Crítico; 5. Intervenciones y Procesos Dinámicos; y 6. Aprendizaje e Innovación Integradas. También se incluye un debate sobre otras cuestiones prácticas relativas a la capacitación.

Design of a training tool for improving the use of hand-held detectors in humanitarian demining

Purpose – The purpose of this paper is to introduce the design of a training tool intended to improve deminers' technique during close-in detection tasks. Design/methodology/approach – Following an introduction that highlights the impact of mines and improvised explosive devices (IEDs), and the importance of training for enhancing the safety and the efficiency of the deminers, this paper considers the utilization of a sensory tracking system to study the skill of the hand-held detector expert operators. With the compiled information, some critical performance variables can be extracted, assessed, and quantified, so that they can be used afterwards as reference values for the training task. In a second stage, the sensory tracking system is used for analysing the trainee skills. The experimentation phase aims to test the effectiveness of the elements that compose the sensory system to track the hand-held detector during the training sessions. Findings – The proposed training tool will be able to evaluate the deminers' efficiency during the scanning tasks and will provide important information for improving their competences. Originality/value – This paper highlights the need of introducing emerging technologies for enhancing the current training techniques for deminers and proposes a sensory tracking system that can be successfully utilised for evaluating trainees' performance with hand-held detectors.

La planta Miralles: representación y pensamiento en la arquitectura de Enric Miralles

Resulta imposible disociar la evolución de la arquitectura de Enric Miralles de lo que fue el desarrollo de un sistema de representación propio. Partiendo de una posición heredada de su formación en la Escuela de Arquitectura de Barcelona y de su práctica en el estudio Viaplana-Piñón, donde adquiere el gusto por la precisión en el dibujo técnico, la delineación sobre papel vegetal o el grafismo constituido exclusivamente a base de líneas del mismo grosor, Miralles pronto evoluciona hacia un método caracterizado por un personal uso del sistema diédrico, vinculado a una concepción fragmentaria de la planta de arquitectura y del espacio mismo. Miralles proyectará por fragmentos de planta, asignándoles una geometría característica para diferenciarlos entre sí y desarrollar su espacialidad y sección con cierta autonomía, a través de planos y maquetas independientes. Gran parte de la arquitectura que elabora con Carme Pinós, en solitario o con Benedetta Tagliabue, estará compuesta por colecciones de piezas heterogéneas herederas de los fragmentos de la planta original, que encajan entre sí no en base a esquemas clásicos de integración subordinada o jerárquica, sino a través de posiciones relativas de yuxtaposición o superposición, caracterizadas por una ausencia de compacidad en la solución de conjunto. Este sistema de representación se apoya por tanto en la geometría como mecanismo de diferenciación por piezas, se basa en la fragmentación del diédrico desde la fragmentación de la planta, y en la falta de compacidad como soporte de pensamiento separativo. Un sistema que se define como “planta Miralles”, término que incluye todas las técnicas de representación empleadas por el arquitecto, desde planos a maquetas, pero que enfatiza la importancia estratégica de la planta como origen y guía del proyecto de arquitectura. La tesis se estructura en los tres primeros capítulos como un corolario de las categorías enunciadas, explicando, en orden cronológico a través de los proyectos, la evolución de la geometría, la utilización del diédrico, y el impacto de la falta de compacidad en la obra construida. Mientras que estos capítulos son globales, se refieren a la trayectoria de este método en su totalidad, el cuarto y último es un estudio de detalle de su aplicación en un proyecto particular, el Ayuntamiento de Utrecht, a través de los dibujos originales de Miralles. Tanto en la explicación global como en el estudio de detalle de este sistema de representación, la tesis pone de manifiesto su instrumentalidad en el pensamiento de esta arquitectura, argumentando que ésta no podría haber sido desarrollada sin la existencia del mismo. La relación entre representación y pensamiento es por tanto un tema capital para explicar esta obra. No obstante, hasta la fecha, las referencias al mismo en la bibliografía disponible no han pasado de ser una colección de opiniones dispersas, incapaces de construir por sí mismas un cuerpo estructurado y coherente de conocimiento. Se ha insistido sobremanera en el análisis y contextualización de los proyectos individuales, y poco en el estudio de la técnica proyectual utilizada para pensarlos y llevarlos a cabo. En definitiva, se han priorizado los resultados frente a los procesos creativos, existiendo por tanto un inexplicable vacío teórico respecto a un tema de gran importancia. Este vacío es el marco donde se inserta la necesidad de esta tesis doctoral. La investigación que aquí se presenta explica el origen y evolución del sistema de representación de Enric Miralles, desde su etapa como estudiante en la Escuela de Arquitectura de Barcelona hasta los últimos proyectos que elabora con Benedetta Tagliabue, así como el estudio de sus consecuencias en la obra construida. Termina concluyendo que su desarrollo es paralelo al de la arquitectura de Miralles, poniendo de manifiesto su vinculación y mutua interdependencia. ABSTRACT It is impossible to dissociate the evolution of the architecture of Enric Miralles from the development of his own system of representation. Starting from a position inherited from his training at the Barcelona School of Architecture and his practice at the office of Viaplana-Piñón, where he acquires a liking for precision in drafting and a graphic style based exclusively on lines of the same thickness, Miralles soon moves into a method defined by a customized use of the dihedral system, connected to a fragmented conception of the floorplan and space itself. Breaking up the floorplan into multiple fragments, Miralles will design an architecture where each of them has a unique shape and geometry, developing their sections and spatial qualities with a certain degree of autonomy within the whole, through separate plans and models. Many of the projects he designs with Carme Pinós, individually or with Benedetta Tagliabue, will consist of collections of heterogeneous pieces, heirs of the original floorplan fragments, which do not fit together according to classical principles of subordinate or hierarchical integration, but based on relative positions of juxtaposition or superposition that lead to a lack of compactness in the overall scheme. This system of representation is thus based on the use of geometry as a way of differentiating architectural pieces, on the fragmentation of the dihedral system from the fragmentation of the floorplan, and on a lack of compactness as a device of separative thinking. This system is defined as “Miralles plan”, a term that includes all techniques of representation used by the architect, from plans to models, and that emphasizes the particular importance of the floorplan as the guiding force of the design process. The first three chapters of the thesis have been structured as a corollary of these categories, explaining, in chronological order through Miralles’ projects, the evolution of geometry, the customization of the dihedral system, and the impact of the lack of compactness on the built work. While these three chapters are global, for they refer to the overall evolution of this system, the fourth and last one is a case study of its application to a particular project, the Utrecht Town Hall, through Miralles’ original drawings. Both in the global and particular explanations of this system of representation, the thesis highlights its instrumentality in the process of thinking this architecture, arguing that it could not have been designed without its parallel development. The relationship between thinking and representation is therefore a key issue to explain this architecture. However, to date, existing references to it in the available literature have not evolved from a collection of scattered opinions, unable to build for themselves a structured and coherent body of knowledge. Great emphasis has been put on the critical contextualization of this architecture through the analysis of the projects themselves, but little on the study of the design technique used to think and carry them out. Results have been prioritized over creative processes, existing therefore an inexplicable theoretical void on an issue of great importance. This void is the conceptual framework where the need for this thesis is inserted. This research explains the origin and evolution of Enric Miralles’ system of representation, from his time as student at the Barcelona School of Architecture to the last projects he designed with Benedetta Tagliabue, as well as the study of its impact on the built work. It concludes that the development of this system runs parallel to that of the architecture it is used for, making it explicit its indissolubility and mutual interdependence.