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

Analysis of iodine-129 in environmental materials: Quality assurance and applications

The long-lived radionuclide 129I (T 1/2 = 15.7 My) occurs in the nature in very low concentrations. Since the middle of our century the environmental levels of 129I have been dramatically changed as a consequence of civil and military use of nuclear fission. Its investigation in environmental materials is of interest for environmental surveillance, retrospective dosimetry and for the use as a natural and man-made fracers of environmental processes. We are comparing two analytical methods which presently are capable of determining 129I in environmental materials, namely radiochemical neutron activation analysis (RNAA) and accelerator mass spectrometry (AMS). Emphasis is laid upon the quality control and detection capabilities for the analysis of 129I in environmental materials. Some applications are discussed.

Quality assurance plan for a vaccine preventable diseases surveillance program

Public health surveillance programs for vaccine preventable diseases (VPD) need functional quality assurance (QA) in order to operate with high quality activities to prevent preventable communicable diseases from spreading in the community. Having a functional QA plan can assure the performance and quality of a program without putting excessive stress on the resources. A functional QA plan acts as a check on the quality of day-to-day activities performed by the VPD surveillance program while also providing data that would be useful for evaluating the program. This study developed a QA plan that involves collection, collation, analysis and reporting of information based on standardized (predetermined) formats and indicators as an integral part of routine work for the vaccine preventable disease surveillance program at the City of Houston Department of Health and Human Services. The QA plan also provides sampling and analysis plans for assessing various QA indicators, as well as recommendations to the Houston Department of Health and Humans Services for implementation of the QA plan. The QA plan developed for VPD surveillance in the City of Houston is intended to be a low cost system that could serve as a template for QA plans as part of other public health programs not only in the city or the nation, but could be adapted for use anywhere across the globe. Having a QA plan for VPD surveillance in the City of Houston would serve well for the funding agencies like the CDC by assuring that the resources are being expended efficiently, while achieving the real goal of positively impacting the health and lives of the recipient/target population. ^

Development and Implementation of the Use of Optically Stimulated Luminescent Detectors in the Radiological Physics Center Anthropomorphic Quality Assurance Phantoms

The Radiological Physics Center (RPC) uses both on-site and remote reviews to credential institutions for participation in clinical trials. Anthropomorphic quality assurance (QA) phantoms are one tool the RPC uses to remotely audit institutions, which include thermoluminescent dosimeters (TLDs) and radiochromic film. The RPC desires to switch from TLD as the absolute dosimeter in the phantoms, to optically stimulated luminescent dosimeters (OSLDs), but a problem lies in the angular dependence exhibited by the OSLD. The purpose of this study was to characterize the angular dependence of OSLD and establish a correction factor if necessary, to provide accurate dosimetric measurements as a replacement for TLD in the QA phantoms. A 10 cm diameter high-impact polystyrene spherical phantom was designed and constructed to hold an OSLD to study the angular response of the dosimeter under the simplest of circumstances for both coplanar and non-coplanar treatment deliveries. OSLD were irradiated in the spherical phantom, and the responses of the dosimeter from edge-on angles were normalized to the response when irradiated with the beam incident normally on the surface of the dosimeter. The average normalized response was used to establish an angular correction factor for 6 MV and 18 coplanar treatments, and for 6 MV non-coplanar treatments specific to CyberKnife. The RPC pelvic phantom dosimetry insert was modified to hold OSLD, in addition to the TLD, adjacent to the planes of film. Treatment plans of increasing angular beam delivery were developed, three in Pinnacle v9.0 (4-field box, IMRT, and VMAT) and one in Accuray’s MultiPlan v3.5.3 (CyberKnife). The plans were delivered to the pelvic phantom containing both TLD and OSLD in the target volume. The pelvic phantom was also sent to two institutions to be irradiated as trials, one delivering IMRT, and the other a CyberKnife treatment. For the IMRT deliveries and the two institution trials, the phantom also included film in the sagittal and coronal planes. The doses measured from the TLD and OSLD were calculated for each irradiation, and the angular correction factors established from the spherical phantom irradiations were applied to the OSLD dose. The ratio of the TLD dose to the angular corrected OSLD dose was calculated for each irradiation. The corrected OSLD dose was found to be within 1% of the TLD measured dose for all irradiations, with the exception of the in-house CyberKnife deliveries. The films were normalized to both TLD measured dose and the corrected OSLD dose. Dose profiles were obtained and gamma analysis was performed using a 7%/4 mm criteria, to compare the ability of the OSLD, when corrected for the angular dependence, to provide equivalent results to TLD. The results of this study indicate that the OSLD can effectively be used as a replacement for TLD in the RPC’s anthropomorphic QA phantoms for coplanar treatment deliveries when a correction is applied for the dosimeter’s angular dependence.

Quality assurance for precast plants and treatment of imperfections for architectural facades

Quality is the threshold or minimum level required to satisfy the consumer´s demands. In construction the quality is objective, and established by standards. It is very difficult to establish the costs of “no quality” in construction. Each precast unit shall be traceable to a specific set of quality control records.

Long-term quality assurance of fMRI and MRS on a 3.0T clinical scanner

Functional MRI (fMRI) and Magnetic Resonance Spectroscopy (MRS) are being increasingly used in clinical protocols. Subsequenly it is crucial to develop a routine quality assurance protocol (QA)of both techniques. This work describes a long-term variability study, as apart of the QA of fMRI and MRS on our institution clinical 3.0 T MR scanner.

A constraint-based approach to quality assurance in service choreographies.

Knowledge about the quality characteristics (QoS) of service com- positions is crucial for determining their usability and economic value. Ser- vice quality is usually regulated using Service Level Agreements (SLA). While end-to-end SLAs are well suited for request-reply interactions, more complex, decentralized, multiparticipant compositions (service choreographies) typ- ically involve multiple message exchanges between stateful parties and the corresponding SLAs thus encompass several cooperating parties with interde- pendent QoS. The usual approaches to determining QoS ranges structurally (which are by construction easily composable) are not applicable in this sce- nario. Additionally, the intervening SLAs may depend on the exchanged data. We present an approach to data-aware QoS assurance in choreographies through the automatic derivation of composable QoS models from partici- pant descriptions. Such models are based on a message typing system with size constraints and are derived using abstract interpretation. The models ob- tained have multiple uses including run-time prediction, adaptive participant selection, or design-time compliance checking. We also present an experimen- tal evaluation and discuss the benefits of the proposed approach.

Quality assurance systems in the production and marketing of fresh peaches.

Due to the fast rate of peach post-harvest ripening, damage due to mechanical handling, externally appreciated as bruises and soft areas, is a real problem that leads to an early harvesting and poor quality of the fruits, as perceived by the consumers. More and more, the European consumer asks for good taste and freshness of fruits and vegetables, and these quality factors are not included in standards, nor in most of the producers' practices. Fruit processing and marketing centres (co-operatives) are increasingly interested in adopting quality controls in their processes. ISO 9000 procedures are being applied in some food areas, primarily milk and meat processors, but no generalised procedures have been developed until the present time to be applied to fresh product processes. All different peach and nectarine varieties that are harvested and handled in Murcia cooperatives and sold in a large supermarket in Madrid were analysed during the whole 1997 season (early May to late August). A total number of 78 samples of 25 fruits (co-operative) or 10 fruits (market), were tested in the laboratory for mechanical, optical, chemical and tasting quality. The variability and relationships between all these quality parameters are presented and discussed, and sampling unit sizes which would be advisable for quality control are calculated.

Determining the effectiveness of three software evaluation techniques through informal aggregation

An accepted fact in software engineering is that software must undergo verification and validation process during development to ascertain and improve its quality level. But there are too many techniques than a single developer could master, yet, it is impossible to be certain that software is free of defects. So, it is crucial for developers to be able to choose from available evaluation techniques, the one most suitable and likely to yield optimum quality results for different products. Though, some knowledge is available on the strengths and weaknesses of the available software quality assurance techniques but not much is known yet on the relationship between different techniques and contextual behavior of the techniques. Objective: This research investigates the effectiveness of two testing techniques ? equivalence class partitioning and decision coverage and one review technique ? code review by abstraction, in terms of their fault detection capability. This will be used to strengthen the practical knowledge available on these techniques.

Are team personality and climate related to satisfaction and software quality? Aggregating results from a twice replicated experiment

Research into software engineering teams focuses on human and social team factors. Social psychology deals with the study of team formation and has found that personality factors and group processes such as team climate are related to team effectiveness. However, there are only a handful of empirical studies dealing with personality and team climate and their relationship to software development team effectiveness. Objective We present aggregate results of a twice replicated quasi-experiment that evaluates the relationships between personality, team climate, product quality and satisfaction in software development teams. Method Our experimental study measures the personalities of team members based on the Big Five personality traits (openness, conscientiousness, extraversion, agreeableness, neuroticism) and team climate factors (participative safety, support for innovation, team vision and task orientation) preferences and perceptions. We aggregate the results of the three studies through a meta-analysis of correlations. The study was conducted with students. Results The aggregation of results from the baseline experiment and two replications corroborates the following findings. There is a positive relationship between all four climate factors and satisfaction in software development teams. Teams whose members score highest for the agreeableness personality factor have the highest satisfaction levels. The results unveil a significant positive correlation between the extraversion personality factor and software product quality. High participative safety and task orientation climate perceptions are significantly related to quality. Conclusions First, more efficient software development teams can be formed heeding personality factors like agreeableness and extraversion. Second, the team climate generated in software development teams should be monitored for team member satisfaction. Finally, aspects like people feeling safe giving their opinions or encouraging team members to work hard at their job can have an impact on software quality. Software project managers can take advantage of these factors to promote developer satisfaction and improve the resulting product.