Development and validation of an instrument to assess and improve clinical consultation skills

Context: Development of medical students’ consultation skills with patients is at the core of the UK General Medical Council’s 'Tomorrow’s Doctors' guide (2009). Teaching and assessment of these skills must therefore be a core component of the medical undergraduate curriculum. The Calgary Cambridge guide to the medical interview and the Leicester Assessment Package (LAP) provide a foundation for teaching and assessment, but both have different strengths. Objective: To develop and validate a comprehensive set of generic consultation competencies. Design: The Calgary Cambridge guide to the medical interview was revised to include ‘clinical reasoning’, ‘management’, ‘record keeping’ and ‘case presentation’. Each section was populated with competencies generated from Tomorrow’s Doctors (2009), the LAP and the Calgary Cambridge guide to the medical interview. A Delphi validation study was conducted with a panel drawn from hospital and general practice clinical tutors from eight UK medical schools. Main outcome measures: A priori consensus standards for inclusion (or exclusion) of an element were: at Stage 1 =70% agreement (or disagreement) that the item should be included; at Stage 2 =50% agreement (or disagreement) that the item should be included. If more than 10% of respondents suggested a thematically similar new item (or rewording of an existing item) in Stage 1, it was included in Stage 2. Results: The design stage resulted in a set of 9 categories of consultation skills with 58 component competencies. In the Delphi study all the competencies reached 70% agreement for inclusion, with 24 suggested amendments, all of which achieved consensus for inclusion at Stage 2. Conclusion: We have developed a Generic Consultation Skills assessment framework (GeCoS) through a rigorous initial development and piloting process and a multi-institutional and multi-speciality Delphi process. GeCoS is now ready for use as a tool for teaching, formative and summative assessment in any simulated or workplace environment in the hospital or community clinical setting

Decision support in Down’s syndrome screening using multi-criteria decision analysis: a pilot study

Background: the aim of the study was to develop and pilot use of a decision support system (DSS) to help women choose the option that best respects their personal values among the different screening/diagnostic tests for Down’s syndrome. Methods: value-bearing considerations were elicited through qualitative interviews. Ten women post-birth and ten health professionals working in the Obstetric Department at UC LH were interviewed. Performance data for the various possible screening strategies on these attributes were entered into a Multi-criteria Decision Analytic model using the Annalisa implementation. Participants piloted the DSS, entering necessary weights for the attributes and observing the resulting scores. Main outcome measures were DSS clarity, usefulness and feasibility in a clinical setting. Results: most participants found the DSS valuable because it stimulated women to seek information about testing and helped them focus on the main issues affecting their decisions. Annalisa proved a user-friendly DSS that helps women understand the issues around Down’s screening and diagnosis. There was unanimity that its use should be complementary to health professionals’ consultation. Most favoured offering it before consultation so that women could be better informed about options before attending the antenatal booking. Conclusions: the overall positive comments confirm that a user-friendly decision analysis-based support system can be a valuable instrument at supporting health decisions in this area. Further research is needed to assess whether the intention to make an informed choice is always best addressed by a decision support system, or these remain useful tools only to women more inclined to seek information anyhow

Intelligent flight control systems

The capabilities of flight control systems can be enhanced by designing them to emulate functions of natural intelligence. Intelligent control functions fall in three categories. Declarative actions involve decision-making, providing models for system monitoring, goal planning, and system/scenario identification. Procedural actions concern skilled behavior and have parallels in guidance, navigation, and adaptation. Reflexive actions are spontaneous, inner-loop responses for control and estimation. Intelligent flight control systems learn knowledge of the aircraft and its mission and adapt to changes in the flight environment. Cognitive models form an efficient basis for integrating 'outer-loop/inner-loop' control functions and for developing robust parallel-processing algorithms

Analysis of pilot control strategy

Methods for nonintrusive identification of pilot control strategy and task execution dynamics are presented along with examples based on flight data. The specific analysis technique is Nonintrusive Parameter Identification Procedure (NIPIP), which is described in a companion user's guide (NASA CR-170398). Quantification of pilot control strategy and task execution dynamics is discussed in general terms followed by a more detailed description of how NIPIP can be applied. The examples are based on flight data obtained from the NASA F-8 digital fly by wire airplane. These examples involve various piloting tasks and control axes as well as a demonstration of how the dynamics of the aircraft itself are identified using NIPIP. Application of NIPIP to the AFTI/F-16 flight test program is discussed. Recommendations are made for flight test applications in general and refinement of NIPIP to include interactive computer graphics

Beyond translation: Adapting a performance-task-based assessment of critical thinking ability for use in Rwanda

Critical thinking is frequently proposed as one of the most important learning outcomes of a university education. However, to date, it has been difficult to ascertain whether university students in low-income contexts are improving in their critical thinking skills, because the limited studies in this domain have relied on instruments developed in Western contexts, despite the clear dangers of such an approach. Cultural bias in assessment can best be overcome by explicitly developing tests for use in specific contexts. However, resource constraints often prevent this possibility. An alternative strategy is to adapt an existing instrument for use in a particular context. Although adaptation is the norm for high-stakes cross-cultural assessments, it is often not attempted for single country research studies. This may be due to an assumption that adaptation is excessively technical or will add significantly to a study timeline. In this article, which relies on data from a recent study in Rwanda, we present a methodology for adapting a performance-task-based assessment of critical thinking. Our experience with this methodology suggests that small teams can adapt instruments in a relatively short time frame, and that the benefits of doing so far outweigh any cost

Quality and denoising in real-time functional magnetic resonance imaging neurofeedback: A methods review

First published: 25 April 2020Neurofeedback training using real-time functional magnetic resonance imaging (rtfMRI-NF) allows subjects voluntary control of localised and distributed brain activity. It has sparked increased interest as a promising non-invasive treatment option in neuropsychiatric and neurocognitive disorders, although its efficacy and clinical significance are yet to be determined. In this work, we present the first extensive review of acquisition, processing and quality control methods available to improve the quality of the neurofeedback signal. Furthermore, we investigate the state of denoising and quality control practices in 128 recently published rtfMRI-NF studies. We found: (a) that less than a third of the studies reported implementing standard real-time fMRI denoising steps, (b) significant room for improvement with regards to methods reporting and (c) the need for methodological studies quantifying and comparing the contribution of denoising steps to the neurofeedback signal quality. Advances in rtfMRI-NF research depend on reproducibility of methods and results. Notably, a systematic effort is needed to build up evidence that disentangles the various mechanisms influencing neurofeedback effects. To this end, we recommend that future rtfMRI-NF studies: (a) report implementation of a set of standard real-time fMRI denoising steps according to a proposed COBIDAS-style checklist (https://osf.io/kjwhf/), (b) ensure the quality of the neurofeedback signal by calculating and reporting community-informed quality metrics and applying offline control checks and (c) strive to adopt transparent principles in the form of methods and data sharing and support of open-source rtfMRI-NF software. Code and data for reproducibility, as well as an interactive environment to explore the study data, can be accessed at https://github. com/jsheunis/quality-and-denoising-in-rtfmri-nf.LSH‐TKI, Grant/Award Number: LSHM16053‐SGF; Philips Researc

Piloting the ECHO e-Skills and Training Toolkit

Besides many benefits, ICT technologies are faced with cyber threats. Organ-izations of today, therefore, face many challenges that require technical, sit-uation awareness, and problem-solving related e-skills from a wide level of organizational actors. Business survival depends on how well an organization can implement new IT and take advantage of the opportunities offered by this new IT. Cybersecurity is a pressing issue in modern society. It affects busi-nesses, personal lives, and critical infrastructures. There is a growing need for proficiently cyber-trained personnel to protect society and its organizations and systems. The ECHO E-skills and Training Toolkit was piloted with a team of higher education business ICT teachers. First, the team supervisors chose and valued the most relevant Technical, Situation awareness, and Problem-solving re-lated e-skills. These choices were then given to the pilot test group to discuss and adjust. This pilot study shows that the ECHO E-skills and Training Toolkit can be used to benefit any organization that wishes to assess the e-skills of its personnel and training gaps