Sustained impact of a short small group course with systematic feedback in addition to regular clinical clerkship activities on musculoskeletal examination skills-a controlled study.

BACKGROUND The discrepancy between the extensive impact of musculoskeletal complaints and the common deficiencies in musculoskeletal examination skills lead to increased emphasis on structured teaching and assessment. However, studies of single interventions are scarce and little is known about the time-dependent effect of assisted learning in addition to a standard curriculum. We therefore evaluated the immediate and long-term impact of a small group course on musculoskeletal examination skills. METHODS All 48 Year 4 medical students of a 6 year curriculum, attending their 8 week clerkship of internal medicine at one University department in Berne, participated in this controlled study. Twenty-seven students were assigned to the intervention of a 6×1 h practical course (4-7 students, interactive hands-on examination of real patients; systematic, detailed feedback to each student by teacher, peers and patients). Twenty-one students took part in the regular clerkship activities only and served as controls. In all students clinical skills (CS, 9 items) were assessed in an Objective Structured Clinical Examination (OSCE) station, including specific musculoskeletal examination skills (MSES, 7 items) and interpersonal skills (IPS, 2 items). Two raters assessed the skills on a 4-point Likert scale at the beginning (T0), the end (T1) and 4-12 months after (T2) the clerkship. Statistical analyses included Friedman test, Wilcoxon rank sum test and Mann-Whitney U test. RESULTS At T0 there were no significant differences between the intervention and control group. At T1 and T2 the control group showed no significant changes of CS, MSES and IPS compared to T0. In contrast, the intervention group significantly improved CS, MSES and IPS at T1 (p < 0.001). This enhancement was sustained for CS and MSES (p < 0.05), but not for IPS at T2. CONCLUSIONS Year 4 medical students were incapable of improving their musculoskeletal examination skills during regular clinical clerkship activities. However, an additional small group, interactive clinical skills course with feedback from various sources, improved these essential examination skills immediately after the teaching and several months later. We conclude that supplementary specific teaching activities are needed. Even a single, short-lasting targeted module can have a long lasting effect and is worth the additional effort.

Italo-Swiss "Chalk and blackboard interactive 2-day workshop"-participants feedback

Ten "chalk and blackboard interactive workshops" have taken place between 2011 and 2015 in Southern Switzerland or Italy. Students, residents and expert pediatricians meet during 2 days and discuss 10-15 cases. Pediatricians promote reasoning, provide supporting information and correct statements. Emphasis is placed on history taking and examination, and on all participants being involved in a stimulating atmosphere. Thirty-seven participants were asked, ≥3 months after workshop-completion, to evaluate the workshop and a recent teaching session. Thirty answered and scored the workshop as excellent (N = 24) or above average (N = 6). The scores assigned to the workshop were higher (P < 0.001) than those assigned to the lecture-based teaching.

Entwicklung eines deutschsprachigen Fragebogens zur Durchführung von Multisource-Feedback in der ärztlichen Weiterbildung

Fragestellung/Einleitung: Multisource-Feedback (MSF) ist ein anerkanntes Instrument zur Überprüfung und Verbesserung der ärztlichen Tätigkeit [1]. Es beinhaltet Feedback, das von MitarbeiterInnen verschiedener Tätigkeitsbereiche und verschiedener Hierarchiestufen gegeben wird. Das Feedback wird anonym mithilfe eines Fragebogens gegeben, der verschiedene Kriterien der ärztlichen Kompetenz beschreibt. Das Feedback wird anschlieβend für die zu beurteilenden ÄrztInnen in einem Gespräch von einer/m SupervisorIn zusammengefasst. Bislang existiert kein deutschsprachiger Fragebogen für Multisource-Feedback für die ärztliche Tätigkeit. Unsere Zielsetzung war es daher, einen deutschsprachigen Fragebogen zu erstellen und diesen bzgl. relevanter Validitätskriterien zu untersuchen. Methoden: Zur Erstellung des Fragebogens sammelten wir die beste verfügbare Evidenz der entsprechenden Literatur. Wir wählten einen validierten englischen Fragebogen, der bereits in der Weiterbildung in Groβbritannien angewendet wird [2] und den wichtigsten Kriterien entspricht. Dieser wurde übersetzt und in einigen Bereichen erweitert, um ihn sprachlichen Gegebenheiten und lokalen Bedürfnissen anzupassen. Bezüglich der Validität wurden zwei Kriterien untersucht: Inhaltsvalidität (content validity evidence) und Antwortprozesse (response process validity evidence). Um die Inhaltsvalidität zu untersuchen, wurde in einer Expertenrunde diskutiert, ob der übersetzte Fragebogen die erwarteten Kompetenzen widerspiegelt. Im Anschluss wurden die Antwortprozesse mithilfe eines sog. „think-alouds“ mit ÄrztInnen in Weiterbildung und ihren AusbilderInnen untersucht. Ergebnisse: Der resultierende Fragebogen umfasst 20 Fragen. Davon sind 15 Items den Bereichen „Klinische Fähigkeiten“, „Umgang mit Patienten“, „Umgang mit Kollegen“ und „Arbeitsweise“ zuzuordnen. Diese Fragen werden auf einer fünfstufigen Likert-Skala beantwortet. Zusätzlich bietet jede Frage die Möglichkeit, einen Freitext zu besonderen Stärken und Schwächen der KandidatInnen aufzuführen. Weiterhin gibt es fünf globale Fragen zu Stärken und Verbesserungsmöglichkeiten, äuβeren Einflüssen, den Arbeitsbedingungen und nach Zweifeln an der Gesundheit oder Integrität des Arztes/ der Ärztin. In der Expertenrunde wurde der Fragebogen als für den deutschsprachigen Raum ohne Einschränkungen anwendbar eingeschätzt. Die Analyse der Antwortprozesse führte zu kleineren sprachlichen Anpassungen und bestätigt, dass der Fragebogen verständlich und eindeutig zu beantworten ist und das gewählte Konstrukt der ärztlichen Tätigkeit vollständig umschreibt. Diskussion/Schlussfolgerung: Wir entwickelten einen deutschsprachigen Fragebogen zur Durchführung von Multisource-Feedback in der ärztlichen Weiterbildung. Wir fanden Hinweise für die Validität dieses Fragebogens bzgl. des Inhalts und der Antwortprozesse. Zusätzliche Untersuchungen zur Validität wie z.B. die durch den Fragebogen entstehenden Auswirkungen (consequences) sind vorgesehen. Dieser Fragebogen könnte zum breiteren Einsatz von MSF in der ärztlichen Weiterbildung auch im deutschsprachigen Raum beitragen. This is an Open Access article distributed under the terms of the Creative Commons Attribution License. You are free: to Share - to copy, distribute and transmit the work, provided the original author and source are credited. See license information at http://creativecommons.org/licenses/by-nc-nd/3.0/.

Improving residency training with the help of multisource feedback: Generation of a model of influencing factors

Background: Feedback is considered to be one of the most important drivers of learning. One form of structured feedback used in medical settings is multisource feedback (MSF). This feedback technique provides the opportunity to gain a differentiated view on a doctor’s performance from several perspectives using a questionnaire and a facilitating conversation, in which learning goals are formulated. While many studies have been conducted on the validity, reliability and feasibility of the instrument, little is known about the impact of factors that might influence the effects of MSF on clinical performance. Summary of Work: To study under which circumstances MSF is most effective, we performed a literature review on Google Scholar with focus on MSF and feedback in general. Main key-words were: MSF, multi-source-feedback, multi source feedback, and feedback each combined with influencing/ hindering/ facilitating factors, effective, effectiveness, doctors-intraining, and surgery. Summary of Results: Based on the literature, we developed a preliminary model of facilitating factors. This model includes five main factors influencing MSF: questionnaire, doctor-in-training, group of raters, facilitating supervisor, and facilitating conversation. Discussion and Conclusions: Especially the following points that might influence MSF have not yet been sufficiently studied: facilitating conversation with the supervisor, individual aspects of doctors-in-training, and the causal relations between influencing factors. Overall there are only very few studies focusing on the impact of MSF on actual and long-term performance. We developed a preliminary model of hindering and facilitating factors on MSF. Further studies are needed to better understand under which circumstances MSF is most effective. Take-home messages: The preliminary model might help to guide further studies on how to implement MSF to use it at its full potential.

The unstable CO2 feedback cycle on ocean planets

Ocean planets are volatile-rich planets, not present in our Solar system, which are thought to be dominated by deep, global oceans. This results in the formation of high-pressure water ice, separating the planetary crust from the liquid ocean and, thus, also from the atmosphere. Therefore, instead of a carbonate-silicate cycle like on the Earth, the atmospheric carbon dioxide concentration is governed by the capability of the ocean to dissolve carbon dioxide (CO2). In our study, we focus on the CO2 cycle between the atmosphere and the ocean which determines the atmospheric CO2 content. The atmospheric amount of CO2 is a fundamental quantity for assessing the potential habitability of the planet's surface because of its strong greenhouse effect, which determines the planetary surface temperature to a large degree. In contrast to the stabilizing carbonate-silicate cycle regulating the long-term CO2 inventory of the Earth atmosphere, we find that the CO2 cycle feedback on ocean planets is negative and has strong destabilizing effects on the planetary climate. By using a chemistry model for oceanic CO2 dissolution and an atmospheric model for exoplanets, we show that the CO2 feedback cycle can severely limit the extension of the habitable zone for ocean planets.

Motivational interviewing and feedback for college drinkers: Handling missing values with complete case analysis and multiple imputation

Objective: In this secondary data analysis, three statistical methodologies were implemented to handle cases with missing data in a motivational interviewing and feedback study. The aim was to evaluate the impact that these methodologies have on the data analysis. ^ Methods: We first evaluated whether the assumption of missing completely at random held for this study. We then proceeded to conduct a secondary data analysis using a mixed linear model to handle missing data with three methodologies (a) complete case analysis, (b) multiple imputation with explicit model containing outcome variables, time, and the interaction of time and treatment, and (c) multiple imputation with explicit model containing outcome variables, time, the interaction of time and treatment, and additional covariates (e.g., age, gender, smoke, years in school, marital status, housing, race/ethnicity, and if participants play on athletic team). Several comparisons were conducted including the following ones: 1) the motivation interviewing with feedback group (MIF) vs. the assessment only group (AO), the motivation interviewing group (MIO) vs. AO, and the intervention of the feedback only group (FBO) vs. AO, 2) MIF vs. FBO, and 3) MIF vs. MIO.^ Results: We first evaluated the patterns of missingness in this study, which indicated that about 13% of participants showed monotone missing patterns, and about 3.5% showed non-monotone missing patterns. Then we evaluated the assumption of missing completely at random by Little's missing completely at random (MCAR) test, in which the Chi-Square test statistic was 167.8 with 125 degrees of freedom, and its associated p-value was p=0.006, which indicated that the data could not be assumed to be missing completely at random. After that, we compared if the three different strategies reached the same results. For the comparison between MIF and AO as well as the comparison between MIF and FBO, only the multiple imputation with additional covariates by uncongenial and congenial models reached different results. For the comparison between MIF and MIO, all the methodologies for handling missing values obtained different results. ^ Discussions: The study indicated that, first, missingness was crucial in this study. Second, to understand the assumptions of the model was important since we could not identify if the data were missing at random or missing not at random. Therefore, future researches should focus on exploring more sensitivity analyses under missing not at random assumption.^

The Comprehensive Assessment of Leadership for Learning: A Next Generation Formative Evaluation and Feedback System

Recent developments in federal policy have prompted the creation of state evaluation frameworks for principals and teachers that hold educators accountable for effective practices and student outcomes. These changes have created a demand for formative evaluation instruments that reflect current accountability pressures and can be used by schools to focus school improvement and leadership development efforts. The Comprehensive Assessment of Leadership for Learning (CALL) is a next generation, 360-degree on-line assessment and feedback system that reflect best practices in feedback design. Some unique characteristics of CALL include a focus on: leadership distributed throughout the school rather than as carried out by an individual leader; assessment of leadership tasks rather than perceptions of leadership practice; a focus on larger complex systems of middle and high school; and transparency of assessment design. This paper describes research contributing to the design and validation of the CALL survey instrument.

A Mobile Feedback System for Integrated E-health Platforms to improve Self-Care and Compliance of Diabetes Mellitus Patients

Exploiting the full potential of telemedical systems means using platform based solutions: data are recovered from biomedical sensors, hospital information systems, care-givers, as well as patients themselves, and are processed and redistributed in an either centralized or, more probably, decentralized way. The integration of all these different devices, and interfaces, as well as the automated analysis and representation of all the pieces of information are current key challenges in telemedicine. Mobile phone technology has just begun to offer great opportunities of using this diverse information for guiding, warning, and educating patients, thus increasing their autonomy and adherence to their prescriptions. However, most of these existing mobile solutions are not based on platform systems and therefore represent limited, isolated applications. This article depicts how telemedical systems, based on integrated health data platforms, can maximize prescription adherence in chronic patients through mobile feedback. The application described here has been developed in an EU-funded R&D project called METABO, dedicated to patients with type 1 or type 2 Diabetes Mellitus

Knowledgeable Feedback via a Cast of Virtual Characters with Different Competences

DynaLearn (http://www.DynaLearn.eu) develops a cognitive artefact that engages learners in an active learning by modelling process to develop conceptual system knowledge. Learners create external representations using diagrams. The diagrams capture conceptual knowledge using the Garp3 Qualitative Reasoning (QR) formalism [2]. The expressions can be simulated, confronting learners with the logical consequences thereof. To further aid learners, DynaLearn employs a sequence of knowledge representations (Learning Spaces, LS), with increasing complexity in terms of the modelling ingredients a learner can use [1]. An online repository contains QR models created by experts/teachers and learners. The server runs semantic services [4] to generate feedback at the request of learners via the workbench. The feedback is communicated to the learner via a set of virtual characters, each having its own competence [3]. A specific feedback thus incorporates three aspects: content, character appearance, and a didactic setting (e.g. Quiz mode). In the interactive event we will demonstrate the latest achievements of the DynaLearn project. First, the 6 learning spaces for learners to work with. Second, the generation of feedback relevant to the individual needs of a learner using Semantic Web technology. Third, the verbalization of the feedback via different animated virtual characters, notably: Basic help, Critic, Recommender, Quizmaster & Teachable agen

Towards a ground navigation system based in visual feedback provided by a mini UAV

This paper addresses initial efforts to develop a navigation system for ground vehicles supported by visual feedback from a mini aerial vehicle. A visual-based algorithm computes the ground vehicle pose in the world frame, as well as possible obstacles within the ground vehicle pathway. Relying on that information, a navigation and obstacle avoidance system is used to re-plan the ground vehicle trajectory, ensuring an optimal detour. Finally, some experiments are presented employing a unmanned ground vehicle (UGV) and a low cost mini unmanned aerial vehicle (UAV).

All-optical logic gates with 1550nm Fabry-Perot and distributed feedback semiconductor laser amplifiers

The optical bistability occurring in laser diode amplifiers is used to design an all-optical logic gate capable to provide the whole set of logic functions. The structure of the reported logic gate is based on two connected 1550nm laser amplifiers (Fabry-Perot and distributed feedback laser amplifiers).

Instabilities In hybrid optical bistable devices with nonlinear feedback

As we have shown,several output conditions can be obtained from a hybrid optical bistable device when twisted nematic liquid crystal cells are employed as nonlinear elements.

A Web-based Support System for Providing Effective Monitoring, Feedback and Evaluation in Project Management Education

This work introduces a web-based learning environment to facilitate learning in Project Management. The proposed web-based support system integrates methodological procedures and information systems, allowing to promote learning among geographically-dispersed students. Thus, students who are enrolled in different universities at different locations and attend their own project management courses, share a virtual experience in executing and managing projects. Specific support systems were used or developed to automatically collect information about student activities, making it possible to monitor the progress made on learning and assess learning performance as established in the defined rubric.

Dynamic gamma frequency feedback coupling between higher and lower order visual cortices underlies perceptual completion in humans

To perceive a coherent environment, incomplete or overlapping visual forms must be integrated into meaningful coherent percepts, a process referred to as ?Gestalt? formation or perceptual completion. Increasing evidence suggests that this process engages oscillatory neuronal activity in a distributed neuronal assembly. A separate line of evidence suggests that Gestalt formation requires top-down feedback from higher order brain regions to early visual cortex. Here we combine magnetoencephalography (MEG) and effective connectivity analysis in the frequency domain to specifically address the effective coupling between sources of oscillatory brain activity during Gestalt formation. We demonstrate that perceptual completion of two-tone ?Mooney? faces induces increased gamma frequency band power (55?71 Hz) in human early visual, fusiform and parietal cortices. Within this distributed neuronal assembly fusiform and parietal gamma oscillators are coupled by forward and backward connectivity during Mooney face perception, indicating reciprocal influences of gamma activity between these higher order visual brain regions. Critically, gamma band oscillations in early visual cortex are modulated by top-down feedback connectivity from both fusiform and parietal cortices. Thus, we provide a mechanistic account of Gestalt perception in which gamma oscillations in feature sensitive and spatial attention-relevant brain regions reciprocally drive one another and convey global stimulus aspects to local processing units at low levels of the sensory hierarchy by top-down feedback. Our data therefore support the notion of inverse hierarchical processing within the visual system underlying awareness of coherent percepts.

Noise-induced attractor annihilation in the delayed feedback logistic map

We study dynamics of the bistable logistic map with delayed feedback, under the influence of white Gaussian noise and periodic modulation applied to the variable. This system may serve as a model to describe population dynamics under finite resources in noisy environment with seasonal fluctuations. While a very small amount of noise has no effect on the global structure of the coexisting attractors in phase space, an intermediate noise totally eliminates one of the attractors. Slow periodic modulation enhances the attractor annihilation.