An analysis of teachers’ instructions and feedback at a contemporary dance university

BackgroundGiven the demands posed by excessive practice quantities in modern dance, physical and mental health can be compromised. Therefore, there is a need to consider how quality of practice may be improved and possibly even reduce training times. Sports literature has shown that instructions and feedback given by coaches can have an effect on the quality of training and influence self-regulation and the performance of athletes. However, currently little is known about the use of instructions and feedback by dance teachers. The aim of the current study was, therefore, to examine the type of instructions and feedback given by dance teachers during various dance classes.MethodsA total of six dance teachers participated in this study. Video and audio recordings were made of six dance classes and two rehearsals at a contemporary dance university. The dance teacher’s coaching behavior was analyzed using the modified Coach Analysis and Intervention System (CAIS). Additionally, feedback and instructions were also examined in terms of their corresponding focus of attention. Absolute numbers, as well as times per minute (TPM) rates were calculated for each behavior before, during, and after an exercise. Absolute numbers were also used to calculate ratios of positive-negative feedback and open-closed questions.ResultsMost feedback comments were given after an exercise (472 out of 986 total observed behaviors). Improvisation had the highest positive-negative feedback ratio (29) and open-closed questions ratio (1.56). Out of the focus of attention comments, internal focus of attention comments were used most frequently (572 out of 900).Discussion/conclusionThe results make clear that there is a large variability in instructions and feedback over teachers and classes. Overall, there is room for improvement toward a higher positive-negative feedback ratio, a higher open-closed question ratio and producing more comments eliciting an external focus of attention

Increasing confidence and changing behaviors in primary care providers engaged in genetic counselling.

BackgroundScreening and counseling for genetic conditions is an increasingly important part of primary care practice, particularly given the paucity of genetic counselors in the United States. However, primary care physicians (PCPs) often have an inadequate understanding of evidence-based screening; communication approaches that encourage shared decision-making; ethical, legal, and social implication (ELSI) issues related to screening for genetic mutations; and the basics of clinical genetics. This study explored whether an interactive, web-based genetics curriculum directed at PCPs in non-academic primary care settings was superior at changing practice knowledge, attitudes, and behaviors when compared to a traditional educational approach, particularly when discussing common genetic conditions.MethodsOne hundred twenty one PCPs in California and Pennsylvania physician practices were randomized to either an Intervention Group (IG) or Control Group (CG). IG physicians completed a 6 h interactive web-based curriculum covering communication skills, basics of genetic testing, risk assessment, ELSI issues and practice behaviors. CG physicians were provided with a traditional approach to Continuing Medical Education (CME) (clinical review articles) offering equivalent information.ResultsPCPs in the Intervention Group showed greater increases in knowledge compared to the Control Group. Intervention PCPs were also more satisfied with the educational materials, and more confident in their genetics knowledge and skills compared to those receiving traditional CME materials. Intervention PCPs felt that the web-based curriculum covered medical management, genetics, and ELSI issues significantly better than did the Control Group, and in comparison with traditional curricula. The Intervention Group felt the online tools offered several advantages, and engaged in better shared decision making with standardized patients, however, there was no difference in behavior change between groups with regard to increases in ELSI discussions between PCPs and patients.ConclusionWhile our intervention was deemed more enjoyable, demonstrated significant factual learning and retention, and increased shared decision making practices, there were few differences in behavior changes around ELSI discussions. Unfortunately, barriers to implementing behavior change in clinical genetics is not unique to our intervention. Perhaps the missing element is that busy physicians need systems-level support to engage in meaningful discussions around genetics issues. The next step in promoting active engagement between doctors and patients may be to put into place the tools needed for PCPs to easily access the materials they need at the point-of-care to engage in joint discussions around clinical genetics

Impact of a Randomized Controlled Educational Trial to Improve Physician Practice Behaviors Around Screening for Inherited Breast Cancer

BACKGROUND: Many primary care physicians (PCPs) are ill-equipped to provide screening and counseling for inherited breast cancer. OBJECTIVE: To evaluate the outcomes of an interactive web-based genetics curriculum versus text curriculum for primary care physicians. DESIGN: Randomized two-group design. PARTICIPANTS: 121 California and Pennsylvania community physicians. INTERVENTION: Web-based interactive genetics curriculum, evaluated against a control group of physicians who studied genetics review articles. After education, physicians interacted with an announced standardized patient (SP) at risk for inherited breast cancer. MAIN MEASURES: Transcripts of visit discussions were coded for presence or absence of 69 topics relevant to inherited breast cancer. KEY RESULTS: Across all physicians, history-taking, discussions of test result implications, and exploration of ethical and legal issues were incomplete. Approximately half of physicians offered a genetic counseling referral (54.6 %), and fewer (43.8 %) recommended testing. Intervention physicians were more likely than controls to explore genetic counseling benefits (78.3 % versus 60.7 %, P = 0.048), encourage genetic counseling before testing (38.3 % versus 21.3 %, P = 0.048), ask about a family history of prostate cancer (25.0 % versus 6.6 %, P = 0.006), and report that a positive result indicated an increased risk of prostate cancer for male relatives (20.0 % versus 1.6 %, P = 0.001). Intervention-group physicians were less likely than controls to ask about Ashkenazi heritage (13.3 % versus 34.4 %, P = 0.01) or to reply that they would get tested when asked, “What would you do?” (33.3 % versus 54.1 %, P = 0.03). CONCLUSIONS: Physicians infrequently performed key counseling behaviors, and this was true regardless of whether they had completed the web-based interactive training or read clinical reviews