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

The role of aerobic fitness on session rating of perceived exertion in futsal players

Purpose: The aim of this study was to verify the influence of aerobic fitness (VO(2)max) on internal training loads, as measured by the session rating of perceived exertion (session-RPE) method. Methods: Nine male professional outfield futsal players were monitored for 4 wk of the in-season period with regards to the weekly accumulated session-RPE, while participating in the same training sessions. Single-session-RPE was obtained from the product of a 10-point RPE scale and the duration of exercise. Maximal oxygen consumption was determined during an incremental treadmill test. Results: The average training load throughout the 4 wk period varied between 2,876 and 5,035 arbitrary units. Technical-tactical sessions were the predominant source of loading. There was a significant correlation between VO(2)max (59.6 +/- 2.5 mL.kg(-1).min(-1)) and overall training load accumulated over the total period (r = -0.75). Conclusions: The VO(2)max plays a key role in determining the magnitude of an individual's perceived exertion during futsal training sessions.

The influence of peripheral afferent signals on the rating of perceived exertion and time to exhaustion during exercise at different intensities

This study determined which peripheral variables would better predict the rating of perceived exertion (RPE) and time to exhaustion (TE) during exercise at different intensities. Ten men performed exercises at first lactate threshold (LT1), second lactate threshold (LT2), 50% of the distance from LT1 to LT2 (TT(50%)), and 25% of the distance from LT2 to maximal power output (TW(25%)). Lactate, catecholamines, potassium, pH, glucose, (V) over dotO(2), VE, HR, respiratory rate (RR) and RPE were measured and plotted against the exercise duration for the slope calculation. Glucose, dopamine, and noradrenaline predicted RPE in TT(50%) (88%), LT2 (64%), and TW(25%) (77%), but no variable predicted RPE in LT1. RPE (55%), RPE+HR (86%), and RPE+RR (92% and 55%) predicted TE in LT1, TT(50%), LT2, and TW(25%), respectively. At intensities from TT(50%) to TW(25%), variables associated with brain activity seem to explain most of the RPE slope, and RPE (+HR and+RR) seems to predict the TE.

The rating of perceived exertion predicts intermittent vertical jump demand and performance

The aims of this study were (a) to assess the ability of the rating of perceived exertion (RPE) to predict performance (i.e. number of vertical jumps performed to a fixed jump height) of an intermittent vertical jump exercise, and (b) to determine the ability of RPE to describe the physiological demand of such exercise. Eight healthy men performed intermittent vertical jumps with rest periods of 4, 5, and 6s until fatigue. Heart rate and RPE were recorded every five jumps throughout the sessions. The number of vertical jumps performed was also recorded. Random coefficient growth curve analysis identified relationships between the number of vertical jumps and both RPE and heart rate for which there were similar slopes. In addition, there were no differences between individual slopes and the mean slope for either RPE or heart rate. Moreover, RPE and number of jumps were highly correlated throughout all sessions (r=0.97-0.99; P0.001), as were RPE and heart rate (r=0.93-0.97; P0.001). The findings suggest that RPE can both predict the performance of intermittent vertical jump exercise and describe the physiological demands of such exercise.

Construct and concurrent validation of omni-kayak rating of perceived exertion scale

This study tested the concurrent and construct validity of a newly developed OMNI-Kayak Scale, testing 8 male kayakers who performed a flatwater load-incremented ""shuttle"" test over a 500-m course and 3 estimation-production trials over a 1,000-m course. Velocity, blood lactate concentration, heart rate, and rating of perceived exertion (RPE), using the OMNI-Kayak RPE Scale and the Borg 6-20 Scale were recorded. OMNI-Kayak Scale RPE was highly correlated with velocity, the Borg 6-20 Scale RPE, blood lactate, and heart rate for both load-incremented test (rs=.87-.96), and estimation trials (rs=.75-.90). There were no significant differences among velocities, heart rate and blood lactate concentration between estimation and production trials. The OMNI-Kayak RPE Scale showed concurrent and construct validity in assessing perception of effort in flatwater kayaking and is a valid tool for self-regulation of exercise intensity.

Low carbohydrate diet affects the oxygen uptake on-kinetics and rating of perceived exertion in high intensity exercise

The aim of this study was to determine if the carbohydrate (CHO) availability alters the rate of increase in the rating of perceived exertion (RPE) during high intensity exercise and whether this would be associated with physiological changes. Six males performed high intensity exercise after 48 h of controlled, high CHO (80%) and low CHO (10%) diets. Time to exhaustion was lower in the low compared to high CHO diet. The rate of increase in RPE was greater and the VO(2) slow component was lower in the low CHO diet than in the control. There was no significant condition effect for cortisol, insulin, pH, plasma glucose, potassium, or lactate concentrations. Multiple linear regression indicated that the total amplitude of VO(2) and perceived muscle strain accounted for the greatest variance in the rate of increase in RPE. These results suggest that cardiorespiratory variables and muscle strain are important afferent signals from the periphery for the RPE calculations.

Educational characteristics of students with high or low self-concept

In response to methodological concerns associated with previous research into the educational characteristics of students with high or low self-concept, the topic was re-examined using a significantly more representative sample and a contemporary self-concept measure. From an initial screening of 515 preadolescent, coeducational students in 18 schools, students significantly high or low in self-concept were compared using standardized tests in reading, spelling, and mathematics, and teacher interviews to determine students' academic and nonacademic characteristics. The teachers were not informed of the self-concept status of the students. Compared to students with low self-concept, students with high self-concept were rated by teachers as being more popular, cooperative, and persistent in class, showed greater leadership, were lower in anxiety, had more supportive families, and had higher teacher expectations for their future success. Teachers observed that students with low self-concept were quiet and withdrawn, while peers with high self-concept were talkative and more dominating with peers. Students with lower self-concepts were also lower than their peers in reading, spelling, and mathematical abilities. The findings support the notion that there is an interactive relationship between self-concept and achievement. (C) 1998 John Wiley & Sons, Inc.

Social competence and peer interactions of students with intellectual disability in an inclusive high school

This paper reports descriptive information on the relationship between social competence and the amount and type of peer interaction for nine adolescents with intellectual disability attending a regular high school. Each adolescent's social competence was assessed using the AAMR Adaptive Behavior Scale-School (2nd edn) (ABS-S:2). Naturalistic observations were conducted to obtain information on the amount and type of peer interaction. Data were analysed to determine the relationship between social competence and peer interactions. Social competence was not consistently correlated with the amount of peer interaction. Results from the naturalistic observations showed individual differences in patterns of peer interaction with a tendency towards more frequent interactions with peers who also had intellectual disabilities. These data suggest that social competence did not significantly influence the amount and type of peer interaction. Implications for facilitating peer interactions between adolescents with and without intellectual disability are discussed.

Laboratory diagnosis of amebiasis in a sample of students from southeastern Brazil and a comparison of microscopy with enzyme-linked immunosorbent assay for screening of infections with Entamoeba sp.

Introduction: Epidemiological studies on amebiasis have been reassessed since Entamoeba histolytica and E. dispar were first recognized as distinct species. Because the morphological similarity of these species renders microscopic diagnosis unreliable, additional tools are required to discriminate between Entamoeba species. The objectives of our study were to compare microscopy with ELISA kit (IVD®) results, to diagnose E. histolytica infection, and to determine the prevalence of amebiasis in a sample of students from southeastern Brazil. Methods: In this study, diagnosis was based on microscopy due to its capacity for revealing potential cysts/trophozoites and on two commercial kits for antigen detection in stool samples. Results: For 1,403 samples collected from students aged 6 to 14 years who were living in Divinópolis, Minas Gerais, Brazil, microscopy underestimated the number of individuals infected with E. histolytica/E. dispar (5.7% prevalence) compared with the ELISA kit (IVD®)-based diagnoses (15.7% for E. histolytica/E. dispar). A comparison of the ELISA (IVD®) and light microscopy results returned a 20% sensitivity, 97% specificity, low positive predictive value, and high negative predictive value for microscopy. An ELISA kit (TechLab®) that was specific for E. histolytica detected a 3.1% (43/1403) prevalence for E. histolytica infection. Conclusions: The ELISA kit (IVD®) can be used as an alternative screening tool. The high prevalence of E. histolytica infection detected in this study warrants the implementation of actions directed toward health promotion and preventive measures.

A new perspective of students allocation satisfaction in engineering courses in Portugal

Publicado em "AIP Conference Proceedings" Vol. 1648