Baptist Hospital and the State of North Carolina: Alleged Malfeasance and Whistleblowing Aftermath

Do you know what choices you would make if faced with an ethical dilemma? This fact-based case includes situations and issues that a real citizen considered when faced with the knowledge that his employer may have been overbilling the state of North Carolina for health care. Professionals, especially those in accounting and finance positions, are likely to face serious dilemmas in the course of their careers. These situations may require them to choose between honoring a confidentiality clause in an employment contract and acting according to ethical and professional values. This case provides facts gathered from an actual case in which an individual faced this particular challenge. By working through the case, students should develop an appreciation of the pressures and personal ethical challenges they are likely to face in the workplace. By engaging in discussion and role play, students will be more likely to recognize these issues when they occur, and will have already developed critical thinking skills to help them develop a plan of action.

Head movement synchrony in social interactions of patients with schizophrenia indicates symptoms, cognition and social functioning

Background: Disturbed interpersonal communication is a core problem in schizophrenia. Patients with schizophrenia often appear disconnected and "out of sync" when interacting with others. This may involve perception, cognition, motor behavior, and nonverbal expressiveness. Although well-known from clinical observation, mainstream research has neglected this area. Corresponding theoretical concepts, statistical methods, and assessment were missing. In recent research, however, it has been shown that objective, video-based measures of nonverbal behavior can be used to reliably quantify nonverbal behavior in schizophrenia. Newly developed algorithms allow for a calculation of movement synchrony. We found that the objective amount of movement of patients with schizophrenia during social interactions was closely related to the symptom profiles of these patients (Kupper et al., 2010). In addition and above the mere amount of movement, the degree of synchrony between patients and healthy interactants may be indicative of various problems in the domain of interpersonal communication and social cognition. Methods: Based on our earlier study, head movement synchrony was assessed objectively (using Motion Energy Analysis, MEA) in 378 brief, videotaped role-play scenes involving 27 stabilized outpatients diagnosed with paranoid-type schizophrenia. Results: Lower head movement synchrony was indicative of symptoms (negative symptoms, but also of conceptual disorganization and lack of insight), verbal memory, patients’ self-evaluation of competence, and social functioning. Many of these relationships remained significant even when corrected for the amount of movement of the patients. Conclusion: The results suggest that nonverbal synchrony may be an objective and sensitive indicator of the severity of symptoms, cognition and social functioning.

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).

Quality Control for SP Performance Regarding Patient Portrayal in a High-Stakes OSCE

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 SP’s 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. Methods SP trainers from all five Swiss medical faculties collected and prioritized quality criteria for patient portrayal. Items were revised with the partners 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. Both, 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). FAIR_OSCE The list of items to assess the quality of the simulation by SPs was primarily developed and used to provide formative feedback to the SPs in order to help them to improve their performance. It was therefore named “Feedbackstruckture for the Assessment of Interactive Role play in Objective Structured Clinical Exams (FAIR_OSCE). It was also used to assess the quality of patient portrayal during the exam. The results were calculated for each of the five faculties individually. Formative evaluation was given to the five faculties with individual feedback without revealing results of other faculties other than overall results. Results High quality of 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. In example the rate of completely correct reaction in medical tests increased from 88% to 95%. 95% completely correct reactions together with 4% sufficient reactions add up to 99% of the reactions meeting the requirements of the exam. SP educators using the instrument reported an augmentation of SPs performance induced by the use of the instrument. Disadvantages mentioned were high concentration needed to explicitly observe all criteria and cumbersome handling of the paper-based forms. Conclusion We were able to document a very high quality of SP performance in our exam. The data also indicate that our training is effective. We believe that the high concentration needed using the instrument is well invested, considering the observed augmentation of performance. The development of an iPad based application for the form is planned to address the cumbersome handling of the paper.

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

Nonverbal synchrony in social interactions of patients with schizophrenia indicates socio-communicative deficits

Background Disordered interpersonal communication can be a serious problem in schizophrenia. Recent advances in computer-based measures allow reliable and objective quantification of nonverbal behavior. Research using these novel measures has shown that objective amounts of body and head movement in patients with schizophrenia during social interactions are closely related to the symptom profiles of these patients. In addition to and above mere amounts of movement, the degree of synchrony, or imitation, between patients and normal interactants may be indicative of core deficits underlying various problems in domains related to interpersonal communication, such as symptoms, social competence, and social functioning. Methods Nonverbal synchrony was assessed objectively using Motion Energy Analysis (MEA) in 378 brief, videotaped role-play scenes involving 27 stabilized outpatients diagnosed with paranoid-type schizophrenia. Results Low nonverbal synchrony was indicative of symptoms, low social competence, impaired social functioning, and low self-evaluation of competence. These relationships remained largely significant when correcting for the amounts of patients‘ movement. When patients showed reduced imitation of their interactants’ movements, negative symptoms were likely to be prominent. Conversely, positive symptoms were more prominent in patients when their interaction partners’ imitation of their movements was reduced. Conclusions Nonverbal synchrony can be an objective and sensitive indicator of the severity of patients’ problems. Furthermore, quantitative analysis of nonverbal synchrony may provide novel insights into specific relationships between symptoms, cognition, and core communicative problems in schizophrenia.

Video-based quantification of body movement indicates negative symptoms: a replication

Objective: In schizophrenia, abnormalities in nonverbal behaviors have always been considered as highly relevant. However, due to methodological limitations, nonverbal behavior was rarely quantified objectively. Recent methodological advances now allow a quantification of body movement from ordinary video recordings. We showed that patients’ objectively measured amount of movement in social role-play interactions was closely associated with their symptom profiles (Kupper, Ramseyer, Hoffmann, & Tschacher, Schizophrenia Research 2010). In the present study, a replication of these results in the context of semi-standardized PANSS (Positive and Negative Syndrome Scale) interviews was intended. Methods: 17 patients with schizophrenia were analyzed during the initial 15-min sequence of a videotaped PANSS interview using Motion Energy Analysis (MEA). The amount of patients’ movement was then correlated with their PANSS symptom scores. Results: Sizeable and significant correlations between negative symptoms and reduced movements (r = -.68, p<0.01) and reduced movement speed (r = -.80, p<0.001) were found. Moreover, cognitive symptoms were related to reduced movement speed (r = -.70, p<.01). Conclusion: Negative symptoms were reliably indicated by patients’ nonverbal behavior in psychopathology interviews. Hence, the main result of our earlier study, examining patients’ nonverbal behavior in role play tests, was replicated for the less structured interactions in psychopathological interviews. Results could encourage the use of MEA in a wide range of videotaped social interactions of patients with schizophrenia and other psychiatric disorders.

Efficient list-generation techniques for scheduling assessment centers

Human resources managers often conduct assessment centers to evaluate candidates for a job position. During an assessment center, the candidates perform a series of tasks. The tasks require one or two assessors (e.g., managers or psychologists) that observe and evaluate the candidates. If an exercise is designed as a role-play, an actor is required who plays, e.g., an unhappy customer with whom the candidate has to deal with. Besides performing the tasks, each candidate has a lunch break within a prescribed time window. Each candidate should be observed by approximately half the number of the assessors; however, an assessor may not observe a candidate if they personally know each other. The planning problem consists of determining (1) resource-feasible start times of all tasks and lunch breaks and (2) a feasible assignment of assessors to candidates, such that the assessment center duration is minimized. We present a list-scheduling heuristic that generates feasible schedules for such assessment centers. We propose several novel techniques to generate the respective task lists. Our computational results indicate that our approach is capable of devising optimal or near-optimal schedules for real-world instances within short CPU time.

A heuristic approach for scheduling assessment centers

Human resources managers often use assessment centers to evaluate candidates for a job position. During an assessment center, the candidates perform a series of exercises. The exercises require one or two assessors (e.g., managers or psychologists) that observe and evaluate the candidate. If an exercise is designed as a role-play, an actor is required as well which plays, e.g., an unhappy customer with whom the candidate has to deal with. Besides performing the exercises, the candidates have a lunch break within a prescribed time window. Each candidate should be observed by approximately half the number of the assessors. Moreover, an assessor cannot be assigned to a candidate if they personally know each other. The planning problem consists of determining (1) resource-feasible start times of all exercises and lunch breaks and (2) a feasible assignment of assessors to candidates, such that the assessment center duration is minimized. We propose a list-scheduling heuristic that generates feasible schedules for such assessment centers. We develop novel procedures for devising an appropriate scheduling list and for incorporating the problem-specific constraints. Our computational results indicate that our approach is capable of devising optimal or near-optimal solutions to real-world instances within short CPU time.

El aprendizaje partiendo de situaciones simuladas: una alternativa educativa

Un grupo de profesores, preocupados por la formación teórica que se imparte a los alumnos, así como por el solapamiento que a veces se producen en los contenidos de distintas asignaturas, intentan hacer una modificación de su enseñanza. En este artículo mostramos la experiencia llevada a cabo en tercero de Enfermería, por dos profesores que decidieron integrar las asignaturas de Intervención Comunitaria en Enfermería y Enfermería en Salud Mental y Psiquiatría, llamándola para evitar confusiones Enfermería Integrada. La idea fundamental que yace en este proyecto es partir de situaciones que han vivido los alumnos en sus prácticas y analizar cómo las resolvieron y las dificultades encontradas. La metodología empleada ha sido la de estudios de casos o situaciones simuladas (role play ) para, a partir de aquí, ir introduciendo la teoría que necesitarían los alumnos para hacer frente a las situaciones que se puedan encontrar.

La aplicación del componente pragmático funcional en un manual sueco de español publicado tras el currículo Lgy 2011

El objetivo de esta monografía es el de analizar el modo en el que un manual didáctico para la enseñanza del español en el contexto educativo sueco de bachillerato aplica y desarrolla la competencia pragmática funcional en sus propuestas didácticas. Para la realización de dicho análisis usaremos como instrumento de medida, por una parte, las actividades de simulación, escenario y role-play que propone Sánchez Sarmiento (2005), y que se dirigen a la activación de la competencia pragmática de los estudiantes de lenguas extranjeras y, por otra, los criterios de transacciones e interacciones de colaboración para el desarrollo de la competencia pragmática funcional que se recogen en el §.5 del Marco Común Europeo de Referencia para las lenguas: aprendizaje, enseñanza, evaluación (MCER, 2002). La hipótesis de la que parte este estudio postula que el manual que analizamos (Caminando 5, Natur & Kultur, 2013), a pesar de estar compuesto de propuestas didácticas en las que se presentan el componente pragmático funcional, no enuncia de forma explícita el trabajo con ella, no conduce ni a su activación ni a su desarrollo, su frecuencia de aparición en el manual es irregular, y las actividades que forman parte de sus propuestas didácticas no proponen reflexiones metapragmáticas sobre los propios contenidos pragmáticos de la lengua. La investigación que hemos desarrollado confirma que, aunque en algunas propuestas didácticas del manual  se proponen actividades que activan y desarrollan algunos de los criterios de transacción e interacción colaborativa del MCER (2002), su tratamiento resulta poco exhaustivo y su explicitación es escasa. Sin embargo, se puede constatar que el manual representa un acercamiento a los principios metodológicos de los enfoques comunicativos y que su explotación didáctica, aunque no de forma explícita, conduce, en parte, al trabajo con algunos de los criterios pragmáticos funcionales que se proponen en el MCER (2002).

Individualist and collectivist norms: when it's ok to go your own way

We conducted two studies to investigate the influence of group norms endorsing individualism and collectivism on the evaluations of group members who display individualist or collectivist behaviour. It was reasoned that, overall, collectivist behaviour benefits that group and would be evaluated more positively than would individualist behaviour. However, it was further predicted that this preference would be attenuated by the specific content of the group norm. Namely when norms prescribed individualism, we expected that preferences for collectivist behaviour over individualist behaviour would be attenuated, as individualist behaviour would, paradoxically, represent normative behaviour. These predictions were supported across two studies in which we manipulated norms of individualism and collectivism in an organizational role-play. Furthermore, in Study 2, we found evidence for the role of group identification in moderating the effects of norms. The results are discussed with reference to social identify theory and cross-cultural work on individualism and collectivism. Copyright (C) 2002 John Wiley Sons, Ltd.

Bridging the divide between theory and practice. Experiential learning approaches for tourism and hospitality education

Experiential learning approaches such as role-play have been found to be valuable methods of bridging the divide between academic knowledge and practical skills, a problem often cited in tourism and hospitality management education. Such approaches have been found to contribute towards deeper learning by enhancing students' interest, motivation, participation, knowledge and skill development. This paper reports on the implementation of an experiential learning approach designed to encourage and facilitate deeper learning approaches, with the contributing aims of providing students with a more interesting learning experience and a broader set of skills for future employment.

FILMAR OPERÁRIOS: ENTRE A AÇÃO POLÍTICA E A COMUNICAÇÃO ALTERNATIVA NA REALIZAÇÃO DOCUMENTAL NAS DÉCADAS DE 1970/1980 São Bernardo

Estudo sobre a realização de documentários no contexto do movimento sindical brasileito dos anos 1970 e 1980. O objetivo é analisar os processos cinematográficos de realização, embates e jogos de representação nas narrativas sobre os trabalhadores industriais urbanos nos documentários realizados por cineastas que se propuseram a intervir e representar os novos movimentos sociais que ressurgem no contexto da abertura política brasileira. O recorte de análise é a imagem do trabalhador urbano dentro ou fora do contexto de greve, símbolo máximo da sua representação política, ressurgimento e impacto social. A metodologia consiste na codificação dos elementos narrativos visuais e na análise de conteúdo para, posteriormente, através do confronto entre as declarações colhidas em entrevistas com seus realizadores, verificar de que forma essas imagens construíram um discurso sobre o trabalhador que acabou sendo utilizado como instrumentos de comunicação alternativa e afirmação de identidade pelos próprios envolvidos.

Intercultural training for international placements

Despite its increasing popularity, much intercultural training is not developed with the same level of rigour as training in other areas. Further, research on intercultural training has brought inconsistent results about the effectiveness of such training. This PhD thesis develops a rigorous model of intercultural training and applies it to the preparation of British students going on work/study placements in France and Germany. It investigates the reasons for inconsistent training success by looking at the cognitive learning processes in intercultural training, relating them to training goals, and by examining the short- and long-term transfer of intercultural training into real-life encounters with people from other cultures. Two cognitive trainings based on critical incidents were designed for online delivery. The training content relied on cultural practice dimensions from the GWBE study (House, Hanges, Javidan, Dorfman & Gupta, 2004). Of the two trainings, the 'singlemode training' aimed to develop declarative knowledge, which is necessary to analyse and understand other cultures. The 'concurrent training' aimed to develop declarative and procedural knowledge, which is needed to develop skills for dealing with difficult situations in a culturally appropriate way. Participants (N-48) were randomly assigned to one of the two training conditions. Declarative learning appeared as a process of steady knowledge increase, while procedural learning involved cognitive re-categorisation rather than knowledge increase. In a negotiation role play with host-country nationals directly after the online training, participants of the concurrent training exhibited a more initiative negotiation style than participants of the single-mode training. Comparing cultural adjustment and performance of training participants during their time abroad with an untrained control group, participants of the concurrent training showed the qualitatively best development in adjustment and performance. Besides intercultural training, multicultural personality traits were assessed and proved to be a powerful predictor of adjustment and, indirectly, of performance abroad.