Cross-cultural clinical competence and post-graduate teaching: any impact(s) on doctors?

Context: Cross-cultural clinical competence (CCC) requires a mixtureof "knowledge" (K), "attitude" (A) and "skills" (S), in order to develop theability to give quality care to patients of different cultures. Theseattributes allow, while providing medical care, consideration of thepatient's medical, social, cultural and language needs. The LausanneUniversity Medical Policlinic (PMU) provides approximately 30000consultations per year to migrant patients and over the past five yearshas implemented a training course on CCC that focuses on trialogue,stereotypes and administrative procedures for the healthcare ofmigrants.Method: A quantitative survey of 18 new residents, was carried outusing a validated questionnaire, the "Multicultural AssessmentQuestionnaire" (the MAQ, 16 questions on K, A and S) to evaluate theimpact of CCC training. The questionnaire was distributed before theCCC course (J-1), three days after (J+3) and three months later (J+90).A descriptive univariate analysis of the difference in MAQ scoresbetween the times J-1 - J+3 and J-1 - J+90 was made. Three FocusGroups were conducted, at three months, to explore residents' thoughtsabout the course.Results: A significant increase was observed in global performancedeclared by residents. Following the intervention, the score of the MAQincreased from 31.4 points to 38.0 points at three days (p = 0.004) andto 37.7 points at three months (p = 0.003). This increase was mostnoticeable in the field of acquiring K: total score J-1: 118, J+3: 189,J+90: 190 (difference J-1 - J+3 and J-1 - J+90: p <0.005). There was nosignificant difference in acquiring A (J-1: 222, J+3: 228, J+90: 229), andS increases in a significant way at first (J-1: 222, J+3: 265, J-1 - J+3:p = 0.035), then comes back to the start value (J+90: 217). The residentswere interested by the course which they felt provides useful informationfor clinical practice. They had a great number of expectations in varyingfields (medical anthropology, cultural differences, epidemiology, etc.),hoping a "ready-made" solution for the approach of migrant patients.Conclusions: A unique training of CCC at the post-graduate level,upgraded K, and to a lesser extent A and S, for these 18 residents. Theywere interest and they had many expectations. Subsequent coursesshould consolidate these acquisitions. Future study should demonstratethe impact on patients' clinical outcome.

Teaching fundamentals of computing theory: a constructivist approach

A Fundamentals of Computing Theory course involves different topics that are core to the Computer Science curricula and whose level of abstraction makes them difficult both to teach and to learn. Such difficulty stems from the complexity of the abstract notions involved and the required mathematical background. Surveys conducted among our students showed that many of them were applying some theoretical concepts mechanically rather than developing significant learning. This paper shows a number of didactic strategies that we introduced in the Fundamentals of Computing Theory curricula to cope with the above problem. The proposed strategies were based on a stronger use of technology and a constructivist approach. The final goal was to promote more significant learning of the course topics.

Teaching cross-cultural competence and CLIL: a CLIL approach in International Relations University Courses

International relations professionals need cross-cultural competence and English language communication skills to function in the international arena (Graddol 1997). English language communication skills are necessary not only to communicate with foreign colleagues (Bocanegra-Valle 2014) but also to access the vast amount of knowledge transmitted in English over the internet (Ku, Zussman 2010). This work reports the use of CLIL and cross-cultural training in the University of Messina International Relations Advanced Degree Program as a method to raise students’ level of English as quickly as possible while giving them the essential intercultural skills for work in the international field. The researchbased course program combined cross-cultural communication training (Storti, 1997; Lewis, 1999; Gannon, 2004, Harris and Moran, 2007; U.S Peace Corps Training Handbook 2012,) and intercultural competence skill development (Bennett, 1998). Two objectives were proposed: 1) develop cross-cultural communication competence; 2) bring students up to a B2 level as fast as possible. The final exam demonstrated significant growth in the areas of cross-cultural competence as well as an increase in European Common Framework level ranging from .5 to 1.0 depending on the student. Students expressed their belief that what they had learned would be useful for their future career. Combining CLIL with intercultural competence building seems to be effective in meeting two objectives: increasing English language fluency and developing cross-cultural communication competence. More research is recommended to further document this method for increasing English communication proficiency while developing interculturally competent international professionals.

English as a medium of instruction in teaching other languages: attitudes and practices

Internationalisation of HE and emergence of English as a global academic lingua franca used by people who share neither a common native tongue nor cultural and educational background have not only offered more opportunities but also raised challenges. According to recent European surveys, the percentage of pupils attaining the level of independent user in English varies from 14% to 82%, which evidences the potential and the complexity for English as a medium of instruction at tertiary level. This study aims to present the model of foreign language instruction at Vytautas Magnus University where one third of 30 languages are taught through English. It investigates the attitudes and practices of teachers in delivering their English-medium language courses by discussing the questions whether teaching other languages through English is psychologically, culturally and educationally preferable for teachers and students, whether it can limit the content taught and require a special methodology, how the teaching process changes with multiple languages used in the classroom and what level of English is necessary for teachers and students to ensure high quality of English-medium language teaching. The study is based on qualitative methodology with 12 language teachers participating as respondents. The results reveal areas in need of improvement.

Introducing online teaching in Humanities: A case study about the acceptance of online activities by the academic staff of classical languages

The purpose of this paper is to show the perceptions of the academic staff of classical languages (ancient Greek and Latin) concerning use of online activities during their courses. The study was carried out in three countries: Greece (three major Universities), Spain (University of Barcelona) and the United States (University of California, Berkeley) with the participation of thirty-three academic instructors. Depending on the level of use and acceptance of the ICT and following G. Moore¿s classification, we separated the participating academics in three groups: the conservatives, the mainstream and the early adopters. The fact that the smallest group is the third clearly shows the necessity for teachers¿ preparation and training before introducing innovative projects in the classroom. Since the starting point for the application of innovation in the classroom is the teacher, policy makers should focus on helping them become conscious of changes in teaching methods and include their opinion during the design of innovative projects.

Introducing online teaching in Humanities: A case study about the acceptance of online activities by the academic staff of classical languages

The purpose of this paper is to show the perceptions of the academic staff of classical languages (ancient Greek and Latin) concerning use of online activities during their courses. The study was carried out in three countries: Greece (three major Universities), Spain (University of Barcelona) and the United States (University of California, Berkeley) with the participation of thirty-three academic instructors. Depending on the level of use and acceptance of the ICT and following G. Moore¿s classification, we separated the participating academics in three groups: the conservatives, the mainstream and the early adopters. The fact that the smallest group is the third clearly shows the necessity for teachers¿ preparation and training before introducing innovative projects in the classroom. Since the starting point for the application of innovation in the classroom is the teacher, policy makers should focus on helping them become conscious of changes in teaching methods and include their opinion during the design of innovative projects.

Coneixement lingüístic i matemàtic d'escolars de nivel sociocultural baix en programes d'immersió = Linguistic and mathematic knowledge in pupils of low sociocultural level in immersiom programmes

This piece of research compares knowledge of Catalan, Castilian and mathematics, as well as the attitudes to these two languages, of a sample of non-Catalan speaking pupils of low sociocultural level in their fourth year of primary school. Some of the pupils had followed an immersion programme in Catalan, whereas others had approached Catalan through their habitual language (Castilian). The findings show that not only did the immersion pupils obtain significantly better results in L2 (Catalan), but their mother tongue (Castilian) competence was undiminished and their performance on the mathematics test was superior to that of the other group. Moreover, the findings indicate that in pupils starting out from less favourable conditions (a low sociocultural level and a low I.Q.) the effect of the educational approach variable is greater than in other cases

Estimation of lung cancer diagnosis and treatment costs based on a patient-level analysis in Catalonia (Spain)

Background: Assessing of the costs of treating disease is necessary to demonstrate cost-effectiveness and to estimate the budget impact of new interventions and therapeutic innovations. However, there are few comprehensive studies on resource use and costs associated with lung cancer patients in clinical practice in Spain or internationally. The aim of this paper was to assess the hospital cost associated with lung cancer diagnosis and treatment by histology, type of cost and stage at diagnosis in the Spanish National Health Service. Methods: A retrospective, descriptive analysis on resource use and a direct medical cost analysis were performed. Resource utilisation data were collected by means of patient files from nine teaching hospitals. From a hospital budget impact perspective, the aggregate and mean costs per patient were calculated over the first three years following diagnosis or up to death. Both aggregate and mean costs per patient were analysed by histology, stage at diagnosis and cost type. Results: A total of 232 cases of lung cancer were analysed, of which 74.1% corresponded to non-small cell lung cancer (NSCLC) and 11.2% to small cell lung cancer (SCLC); 14.7% had no cytohistologic confirmation. The mean cost per patient in NSCLC ranged from 13,218 Euros in Stage III to 16,120 Euros in Stage II. The main cost components were chemotherapy (29.5%) and surgery (22.8%). Advanced disease stages were associated with a decrease in the relative weight of surgical and inpatient care costs but an increase in chemotherapy costs. In SCLC patients, the mean cost per patient was 15,418 Euros for limited disease and 12,482 Euros for extensive disease. The main cost components were chemotherapy (36.1%) and other inpatient costs (28.7%). In both groups, the Kruskall-Wallis test did not show statistically significant differences in mean cost per patient between stages. Conclusions: This study provides the costs of lung cancer treatment based on patient file reviews, with chemotherapy and surgery accounting for the major components of costs. This cost analysis is a baseline study that will provide a useful source of information for future studies on cost-effectiveness and on the budget impact of different therapeutic innovations in Spain.

Del papel a la pantalla y del aula a la nube: ideas para dinamizar la expresión escrita en secundaria = From paper to the screen and from the classroom to the cloud: ideas to energise written expression at secondary level

The spread of sociocultural focuses and critical literacy studies, which offer an holistic perspective on communicative skills, has reached our country at a time when the commonest environment for writing is the internet, and information technologies have transformed writing with new channels, genres, forms of preparation and languages. Thanks to these changes, educational programmes now include new concepts of literacy related to knowledge and the use of digital environments. This paper explores the impact of introducing these new communicative environments to teaching written expression at secondary level and puts forward some ideas to link learning how to write to present communicative contexts and established practices. Without forgetting the achievements of recent decades, we need to bring about a series of changes to bring new learned writing practices to class and leave behind others we had championed as necessary when the goal was to move beyond exclusively linguistic or grammatical approaches

In pursuit of an intercultural dimension in EFL-teaching : exploring cognitions among Finland-Swedish comprehensive school teachers

This thesis is about the educational purpose of foreign language teaching (FLT) in an increasingly internationalised world.The past 20-30 years have witnessed a fundamental rethinking of the aims of FLT, entailing a shift in emphasis from linguistic competence over communicative competence to intercultural competence. The growing emphasis on cultural issues, called for by research and international curricular documents, places new demandson language teachers. The overall aim of this study is to deepen the knowledge about the attitudes of teachers at the upper level of the Finland-Swedish comprehensive school towards the treatment of culture in English foreign language (EFL) teaching. The questions in focus are: 1) How do teachers interpret the concept"culture" in EFL-teaching?, 2) How do they specify the cultural objectives of their teaching? and 3) What do they do to attain these objectives? The thesis strives to reveal whether or not language teaching today can be describedas intercultural, in the sense that culture is taught with the aim of promotingintercultural understanding, tolerance and empathy. This abductive and largely exploratory study is placed within a constructivist and sociocultural framework,and is inspired by both phenomenography and hermeneutics. It takes its starting-point in language didactics, and can also be regarded as a contribution to teacher cognition research. The empirical data consists of verbatim transcribed interviews with 13 Finland-Swedish teachers of English at grades 7-9. The findings are presented according to three orientations and reviewed with reference to the 2004 Finnish National Framework Curriculum. Within the cognitive orientation, "culture" is perceived as factual knowledge, and the teaching of cultureis defined in terms of the transmission of knowledge, especially about Britain and the USA (Pedagogy of Information). Within the action-related orientation, "culture" is seen as skills of a social and socio-linguistic nature, andthe teaching aims at preparing the students for contacts with people from the target language areas (Pedagogy of Preparation). Within the affective orientation, which takes a more holistic approach, "culture" is seen as a bi-directional perspective. Students are encouraged to look at their own familiar culture from another perspective, and learn to empathise with and show respect for otherness in general, not just concerning representatives of English-speaking countries (Pedagogy of Encounter). Very few of the interviewed teachers represent the third approach, which is the one that can be characterised as truly intercultural. The study indicates that many teachers feel unsure about how to teach culture in an appropriate and up-to-date manner. This is attributed to, among other things, lack of teacher insights as well as lack of time and adequate material. The thesis ends with a set of recommendations as to how EFL could be developed ina more intercultural direction.

Thinking Outside the Box: Enhancing Science Teaching by Combining (Instead of Contrasting) Laboratory and Simulation Activities

The focus of the present work was on 10- to 12-year-old elementary school students’ conceptual learning outcomes in science in two specific inquiry-learning environments, laboratory and simulation. The main aim was to examine if it would be more beneficial to combine than contrast simulation and laboratory activities in science teaching. It was argued that the status quo where laboratories and simulations are seen as alternative or competing methods in science teaching is hardly an optimal solution to promote students’ learning and understanding in various science domains. It was hypothesized that it would make more sense and be more productive to combine laboratories and simulations. Several explanations and examples were provided to back up the hypothesis. In order to test whether learning with the combination of laboratory and simulation activities can result in better conceptual understanding in science than learning with laboratory or simulation activities alone, two experiments were conducted in the domain of electricity. In these experiments students constructed and studied electrical circuits in three different learning environments: laboratory (real circuits), simulation (virtual circuits), and simulation-laboratory combination (real and virtual circuits were used simultaneously). In order to measure and compare how these environments affected students’ conceptual understanding of circuits, a subject knowledge assessment questionnaire was administered before and after the experimentation. The results of the experiments were presented in four empirical studies. Three of the studies focused on learning outcomes between the conditions and one on learning processes. Study I analyzed learning outcomes from experiment I. The aim of the study was to investigate if it would be more beneficial to combine simulation and laboratory activities than to use them separately in teaching the concepts of simple electricity. Matched-trios were created based on the pre-test results of 66 elementary school students and divided randomly into a laboratory (real circuits), simulation (virtual circuits) and simulation-laboratory combination (real and virtual circuits simultaneously) conditions. In each condition students had 90 minutes to construct and study various circuits. The results showed that studying electrical circuits in the simulation–laboratory combination environment improved students’ conceptual understanding more than studying circuits in simulation and laboratory environments alone. Although there were no statistical differences between simulation and laboratory environments, the learning effect was more pronounced in the simulation condition where the students made clear progress during the intervention, whereas in the laboratory condition students’ conceptual understanding remained at an elementary level after the intervention. Study II analyzed learning outcomes from experiment II. The aim of the study was to investigate if and how learning outcomes in simulation and simulation-laboratory combination environments are mediated by implicit (only procedural guidance) and explicit (more structure and guidance for the discovery process) instruction in the context of simple DC circuits. Matched-quartets were created based on the pre-test results of 50 elementary school students and divided randomly into a simulation implicit (SI), simulation explicit (SE), combination implicit (CI) and combination explicit (CE) conditions. The results showed that when the students were working with the simulation alone, they were able to gain significantly greater amount of subject knowledge when they received metacognitive support (explicit instruction; SE) for the discovery process than when they received only procedural guidance (implicit instruction: SI). However, this additional scaffolding was not enough to reach the level of the students in the combination environment (CI and CE). A surprising finding in Study II was that instructional support had a different effect in the combination environment than in the simulation environment. In the combination environment explicit instruction (CE) did not seem to elicit much additional gain for students’ understanding of electric circuits compared to implicit instruction (CI). Instead, explicit instruction slowed down the inquiry process substantially in the combination environment. Study III analyzed from video data learning processes of those 50 students that participated in experiment II (cf. Study II above). The focus was on three specific learning processes: cognitive conflicts, self-explanations, and analogical encodings. The aim of the study was to find out possible explanations for the success of the combination condition in Experiments I and II. The video data provided clear evidence about the benefits of studying with the real and virtual circuits simultaneously (the combination conditions). Mostly the representations complemented each other, that is, one representation helped students to interpret and understand the outcomes they received from the other representation. However, there were also instances in which analogical encoding took place, that is, situations in which the slightly discrepant results between the representations ‘forced’ students to focus on those features that could be generalised across the two representations. No statistical differences were found in the amount of experienced cognitive conflicts and self-explanations between simulation and combination conditions, though in self-explanations there was a nascent trend in favour of the combination. There was also a clear tendency suggesting that explicit guidance increased the amount of self-explanations. Overall, the amount of cognitive conflicts and self-explanations was very low. The aim of the Study IV was twofold: the main aim was to provide an aggregated overview of the learning outcomes of experiments I and II; the secondary aim was to explore the relationship between the learning environments and students’ prior domain knowledge (low and high) in the experiments. Aggregated results of experiments I & II showed that on average, 91% of the students in the combination environment scored above the average of the laboratory environment, and 76% of them scored also above the average of the simulation environment. Seventy percent of the students in the simulation environment scored above the average of the laboratory environment. The results further showed that overall students seemed to benefit from combining simulations and laboratories regardless of their level of prior knowledge, that is, students with either low or high prior knowledge who studied circuits in the combination environment outperformed their counterparts who studied in the laboratory or simulation environment alone. The effect seemed to be slightly bigger among the students with low prior knowledge. However, more detailed inspection of the results showed that there were considerable differences between the experiments regarding how students with low and high prior knowledge benefitted from the combination: in Experiment I, especially students with low prior knowledge benefitted from the combination as compared to those students that used only the simulation, whereas in Experiment II, only students with high prior knowledge seemed to benefit from the combination relative to the simulation group. Regarding the differences between simulation and laboratory groups, the benefits of using a simulation seemed to be slightly higher among students with high prior knowledge. The results of the four empirical studies support the hypothesis concerning the benefits of using simulation along with laboratory activities to promote students’ conceptual understanding of electricity. It can be concluded that when teaching students about electricity, the students can gain better understanding when they have an opportunity to use the simulation and the real circuits in parallel than if they have only the real circuits or only a computer simulation available, even when the use of the simulation is supported with the explicit instruction. The outcomes of the empirical studies can be considered as the first unambiguous evidence on the (additional) benefits of combining laboratory and simulation activities in science education as compared to learning with laboratories and simulations alone.

Using Moodle to provide added value in the teaching of a software development course

The rate of adoption and use of learning management systems to support teaching and learning processes in academic institutions is growing rapidly. Universities are acquiring systems with functionalities that can match with their specific needs and requirements. Moodle is one of the most popular and widely deployed learning management systems in academic institutions today. However, apart from the system, universities tend to maintain other applications for the purpose of supplementing their teaching and learning processes. This situation is similar to Lappeenranta University of Technology (LUT), which is our case study in this project. Apart from Moodle, the university also maintains other systems such as Oodi, Noppa and Uni portal for the purpose of supporting its educational activities. This thesis has two main goals. The first goal is to understand the specific role of Moodle at LUT. This information is fundamental in assessing whether Moodle is needed in the university’s current teaching and learning environment. The second aim is to provide insights to teachers and other departmental stakeholders on how Moodle can provide added value in the teaching of a software development course. In response to this, a Moodle module for a software development course is created and the underlying features are tested. Results of the constructive work proposed some improvements through (i) the use of Moodle for in-class surveys, (ii) transfer of grades from Moodle to Oodi, (iii) use of Moodle in self-study courses and MOOCs, (iv) online examinations, and (v) Moodle integrations with third party applications. The proposed items were then evaluated for their utility through interviews of five expert interviews. The final results of this work are considered useful to LUT administration and management specifically on ways that Moodle can bring changes to the university at managerial, economical and technical level. It also poses some challenges on platform innovations and research.

Building the ‘Digital’ Library: Routes to Managing our Institutional Digital Learning, Teaching and Research Assets Together

Presentation at Open Repositories 2014, Helsinki, Finland, June 9-13, 2014

Clinical, epidemiological, and microbiological characteristics of bacteremia caused by high-level gentamicin-resistant Enterococcus faecalis

Enterococcus spp bacteremia is associated with high mortality and the appearance of high-level gentamicin resistance (HLGR) created additional challenges for the treatment of these infections. We evaluated the epidemiological and clinical characteristics of patients with bacteremias caused by HLGR and non_HLGR Enterococcus faecalis isolates at a teaching hospital in the State of São Paulo, Brazil. Patients with bacteremia due to E. faecalis diagnosed between January 1999 and December 2003 were included in the study. We collected clinical, epidemiological, and microbiological data from medical records. Banked isolates were typed using pulsed-field gel electrophoresis. We identified 145 cases of E. faecalis bacteremia: 66 (45.5%) were caused by HLGR isolates and 79 (54.5%) by non_HLGR. In the univariate analysis, patients with HLGR infection were older, had higher rates of bladder catheterization, and more often had treatment with cephalosporin, quinolone, and/or carbapenem compared with patients with non_HLGR infection (P < 0.05). Multivariate analysis indicated that older age, hematological malignancy, and previous use of vancomycin were independently associated with HLGR (P < 0.05). Mortality rates were not significantly different among patients with HLGR (50%) and non_HLGR (43%) infections (P = 0.40). Of the 32 genotyped isolates, 16 were distributed into 6 main electrophoresis patterns and 16 others had distinct patterns. E. faecalis bacteremia is associated with high mortality and is frequently caused by HLGR isolates at this teaching hospital. The variability among genotyped isolates suggests that endogenous infections, rather than patient-to-patient transmission of E. faecalis, are more common at this institution.

Future operational-tactical level warfare : challenges and opportunities for the defence of Finland

Finnish Defence Studies is published under the auspices of the National Defence College, and the contributions reflect the fields of research and teaching of the College. Finnish Defence Studies will occasionally feature documentation on Finnish Security Policy. Views expressed are those of the authors and do not necessarily imply endorsement by the National Defence College.