Assessing the Impact of the Hidden Curriculum on Interprofessional Development Among Medical Clerkship Students: A Mixed-Methods Action Research Analysis

Abstract Objectives: Following this presentation, participants will be able to: 1) describe the utility of assessing the “hidden curriculum” to determine lasting effects of pre-clinical exposure to an IPE curriculum during clinical training, 2) discuss the effectiveness of mixed methodology action research methods for evaluating interprofessional development, and 3) discuss the observed impact of the hidden curriculum during a third year clerkship on interprofessional understanding, Purpose and Background: Institutions implementing IPE at the pre-clinical level of training may be concerned about the lasting effect of this training during clinical clerkships due to the lack of clinical learning contexts where interprofessional collaborative care (IPCC) is occurring. It is unknown what impact preceptors and other contextual factors will have on students’ continued understanding and attitudes about IPCC during this highly formative experiential clinical portion of training. The construct of the hidden curriculum is an effective lens through which the nature of this impact can be examined. This study assessed attitudes of current third year medical students toward IPCC through the lens of the hidden curriculum, addressing the following research questions. Within the clinical context: 1) From where does the hidden curriculum related to IPCC emanate? 2) What is the nature of these implicit messages? 3) How does the congruence of preceptor attitudes about IPCC influence the maintenance, attenuation, or amplification of students’ attitudes about IPCC? Methods: A mixed methodology concurrent triangulation action design was used to assess the understanding of, and attitude change regarding, IPCC among current third year clerks who, in the prior year, had completed a year-long required pre-clinical interprofessional curriculum. Results and Relevance: Results indicated that positive attitudes toward IPCC matured during clinical training and that both positive and negative messages regarding IPCC emanate from multiple sources within the clinical milieu. Increased regard for some professions was observed; yet, messages received by students from medical residents about nursing were more complex. Student attitudes seem to mimic those of their faculty mentors. This study demonstrates the need to consider the construct of the hidden curriculum for evaluating contextual effects of clinical training sites on IPE outcomes. Additionally, participants will observe the benefits of examining curricular outcomes through a mixed methods action oriented design

Assessing a Rural Academic-Community Partnership Using Ripple Effect Mapping

As Area Health Education Centers (AHECs) expand their efforts to improve the distribution and diversity of the healthcare workforce, one common question is how these activities impact their local communities. Ripple Effect Mapping (REM) is an evaluation method designed to assess a program’s intended and unintended impacts, social capital, and partner reciprocity. This study used REM to uncover and explore the intended and unintended impact of a rural AHEC in a 14-county region. The findings of this study provide direction to the AHEC in relation to strengthening their partnerships, social capital, and improving the health workforce in their region

Primary Care Appointment Systems: Causes and Implications of Timely Arrivals

ABSTRACT The primary goal of this study was to identify potential factors that might contribute to patient punctuality issues, while also assessing the satisfaction of a proposed intervention. In addition, we aimed to learn more about the psychosocial and behavioral implications that patients face with regards to arriving on time for their primary care visits. A mixed-method research study was used to identify and quantify potential factors that might contribute to patient punctuality issues, while also assessing the satisfaction of a proposed intervention. In addition to possible factors that contribute to punctuality, we aimed to learn more about how patients are affected when they arrive late for appointments. Through qualitative assessment, we explored the psychosocial and behavioral implications that patients face with regards to arriving on time for their primary care appointments. A total of 524 individuals out of 1050 patients (50%) responded to the paper-based survey. Of the 524 adult respondents, we excluded 103 (19.7%) participants due to the missing data on either of their historical behavior patterns, future intentions for arrival, or their definition of appointment time. We analyzed the data for the remaining 421 eligible survey participants. In addition, seven of the eight patient interviews were transcribed and analyzed in order to identify themes using the patient’s own words to better understand the psychosocial and behavioral implications patients face on arriving to their appointment on time. Three primary themes emerge in the interviews related to the perception of arriving late to appointments at the FMC. The findings of this study indicate that regardless of patients’ interpretation of appointment time, they typically arrive 10-15 minutes before the appointment time. In addition, there is a significant connection between patients’ perceptions of historically arriving late to appointments and the intent to arrive very early to their future appointments. Combined with the qualitative results, this study suggests that most patients are motivated to be on time, in some cases seeing the idea of lateness as a contradiction of their own self-identity. The behavioral causes and implications of the findings are explained using the concept of Fear Appeals and the Protection Motivation Theory (PMT)

Primary Care Appointment Systems: Causes and Implications of Timely Arrivals

The primary goal of this study was to identify potential factors that might contribute to patient punctuality issues, while also assessing the satisfaction of a proposed intervention. In addition, we aimed to learn more about the psychosocial and behavioral implications that patients face with regards to arriving on time for their primary care visits. A mixed-method research study was used to identify and quantify potential factors that might contribute to patient punctuality issues, while also assessing the satisfaction of a proposed intervention. In addition to possible factors that contribute to punctuality, we aimed to learn more about how patients are affected when they arrive late for appointments. Through qualitative assessment, we explored the psychosocial and behavioral implications that patients face with regards to arriving on time for their primary care appointments. A total of 524 individuals out of 1050 patients (50%) responded to the paper-based survey. Of the 524 adult respondents, we excluded 103 (19.7%) participants due to the missing data on either of their historical behavior patterns, future intentions for arrival, or their definition of appointment time. We analyzed the data for the remaining 421 eligible survey participants. In addition, seven of the eight patient interviews were transcribed and analyzed in order to identify themes using the patient’s own words to better understand the psychosocial and behavioral implications patients face on arriving to their appointment on time. Three primary themes emerge in the interviews related to the perception of arriving late to appointments at the FMC. The findings of this study indicate that regardless of patients’ interpretation of appointment time, they typically arrive 10-15 minutes before the appointment time. In addition, there is a significant connection between patients’ perceptions of historically arriving late to appointments and the intent to arrive very early to their future appointments. Combined with the qualitative results, this study suggests that most patients are motivated to be on time, in some cases seeing the idea of lateness as a contradiction of their own self-identity. The behavioral causes and implications of the findings are explained using the concept of Fear Appeals and the Protection Motivation Theory (PMT)

Vega—A small, low cost, ground robot for nuclear decommissioning

From Wiley via Jisc Publications RouterHistory: received 2021-08-20, rev-recd 2021-11-03, accepted 2021-11-05, pub-electronic 2021-11-25Article version: VoRPublication status: PublishedFunder: Royal Academy of Engineering; Id: http://dx.doi.org/10.13039/501100000287Funder: Engineering and Physical Sciences Research Council; Id: http://dx.doi.org/10.13039/501100000266Abstract: This paper presents the Vega robot, which is a small, low cost, potentially disposable ground robot designed for nuclear decommissioning. Vega has been developed specifically to support characterization and inspection operations, such as 2D and 3D mapping, radiation scans and sample retrieval. The design and construction methodology that was followed to develop the robot is described and its capabilities detailed. Vega was designed to provide flexibility, both in software and hardware, is controlled via tele‐operation, although it can be extended to semi and full autonomy, and can be used in either tethered or untethered configurations. A version of the tethered robot was designed for extreme radiation tolerance, utilizing relay electronics and removing active electronic systems. Vega can be outfitted with a multitude of sensors and actuators, including gamma spectrometers, alpha/beta radiation sensors, LiDARs and robotic arms. To demonstrate its flexibility, a 5 degree‐of‐freedom manipulator has been successfully integrated onto Vega, facilitating deployments where handling is required. To assess the tolerance of Vega to the levels of ionizing radiation that may be found in decommissioning environments, its individual components were irradiated, allowing estimates to be made of the length of time Vega would be able to continue to operate in nuclear environments. Vega has been successfully deployed in an active environment at the Dounreay nuclear site in the UK, deployed in nonactive environments at the Atomic Weapons Establishment, and demonstrated to many other organizations in the UK nuclear industry including Sellafield Ltd, with the goal of moving to active deployments in the future

F.A.R.O.G. FORUM, Vol. 5 No. 5

Contains a supplément littéraire.https://digitalcommons.library.umaine.edu/francoamericain_forum/1063/thumbnail.jp

The Virgin River Basin Study: A Regional Approach to Multiobjective Planning for Water and Related Resources

A joint research effort by the Utah Water Research Laboratory and the Nevado Center for Water Resources Research applied two multiobjective planning models to the Virgin River Basin in order to test the efficiency and practicality of applying such tools in water resrouces planning. The surrogate Worth Trade-off (SWT) method couples mathematical optimization to quantify trade offs among noncommensurable objectives with interviews to compare public preferences with respect to these trade offs. PROPDEMM uses information on interest group objectives, balues, willingness to pay, influence, lebel of information, etc. to compare the political feasibility of alternative courses of action. Both models were applied to assess the difficulties in doing so and the usefulness of the results. The trade offs identified by the SWT method showed agricultural water use to be so dominant in the basin that slight adjustments in irrigation efficiency could supply all foreseeable needs for additional water for other uses, such trade offs to be too inconsequential to identify and compare public preferences, and other trade offs to be impossible because of the position taken by ecologists that any environmental change would destroy a rare species of minnow. Prior to analyzing a situation by the SWT method, the planner should make sure that the trade offs will be of a magnitude meaningful to the public and that the model selected will be sufficiently refined in analyzing small units in time and space to identify locally significant trade offs. PROPDEMM showed the politically most controversial trade off to be between construction of energy generating facilities and life support for the minnow, a controbersy that would probably be decided in favor of the environmentalist because of their power and non-openness to change. Improvements to the model to do a better job of interfacing environmental with social data were recommended. Social modeling in such low population areas was found to be restricted by laws against disclosure of private information because of the very small numbers of individuals living in many evaluation units

Human Embryonic and Fetal Mesenchymal Stem Cells Differentiate toward Three Different Cardiac Lineages in Contrast to Their Adult Counterparts

Mesenchymal stem cells (MSCs) show unexplained differences in differentiation potential. In this study, differentiation of human (h) MSCs derived from embryonic, fetal and adult sources toward cardiomyocytes, endothelial and smooth muscle cells was investigated. Labeled hMSCs derived from embryonic stem cells (hESC-MSCs), fetal umbilical cord, bone marrow, amniotic membrane and adult bone marrow and adipose tissue were co-cultured with neonatal rat cardiomyocytes (nrCMCs) or cardiac fibroblasts (nrCFBs) for 10 days, and also cultured under angiogenic conditions. Cardiomyogenesis was assessed by human-specific immunocytological analysis, whole-cell current-clamp recordings, human-specific qRT-PCR and optical mapping. After co-culture with nrCMCs, significantly more hESC-MSCs than fetal hMSCs stained positive for α-actinin, whereas adult hMSCs stained negative. Furthermore, functional cardiomyogenic differentiation, based on action potential recordings, was shown to occur, but not in adult hMSCs. Of all sources, hESC-MSCs expressed most cardiac-specific genes. hESC-MSCs and fetal hMSCs contained significantly higher basal levels of connexin43 than adult hMSCs and co-culture with nrCMCs increased expression. After co-culture with nrCFBs, hESC-MSCs and fetal hMSCs did not express α-actinin and connexin43 expression was decreased. Conduction velocity (CV) in co-cultures of nrCMCs and hESC-MSCs was significantly higher than in co-cultures with fetal or adult hMSCs. In angiogenesis bioassays, only hESC-MSCs and fetal hMSCs were able to form capillary-like structures, which stained for smooth muscle and endothelial cell markers.Human embryonic and fetal MSCs differentiate toward three different cardiac lineages, in contrast to adult MSCs. Cardiomyogenesis is determined by stimuli from the cellular microenvironment, where connexin43 may play an important role

Packages of Care for Dementia in Low- and Middle-Income Countries

In the fifth in a series of six articles on packages of care for mental disorders in low- and middle-income countries, Martin Prince and colleagues discuss the treatment of dementia