Emergency Medicine Residents’ Self‐assessments Play a Critical Role When Receiving Feedback

Objectives Emergency medicine ( EM ) faculty often aim to improve resident performance by enhancing the quality and delivery of feedback. The acceptance and integration of external feedback is influenced by multiple factors. However, it is interpreted through the “lens” of the learner's own self‐assessment. Ideally, following an educational activity with feedback, a learner should be able to generate and act upon specific learning goals to improve performance. Examining the source of generated learning goals, whether from one's self‐assessment or from external feedback, might shed light on the factors that lead to improvement and guide educational initiatives. Using a standard oral board scenario, the objective of this study was to determine the effects that residents’ self‐assessment and specific feedback from faculty have on not only the generation of learning goals but also the execution of these goals for performance improvement. Methods In this cross‐sectional educational study at four academic programs, 72 senior EM residents participated in a standardized oral board scenario. Following the scenario, residents completed a self‐assessment form. Next, examiners used a standardized checklist to provide both positive and negative feedback. Subsequently, residents were asked to generate “ SMART ” learning goals (specific, measurable, attainable, realistic, and time‐bound). The investigators categorized the learning goals as stemming from the residents’ self‐assessments, feedback, or both. Within 4 weeks, the residents were asked to recall their learning goals and describe any actions taken to achieve those goals. These were grouped into similar categories. Descriptive statistics were used to summarize the data. Results A total of 226 learning goals were initially generated (mean ± SD  = 3.1 ± 1.3 per resident). Forty‐seven percent of the learning goals were generated by the residents’ self‐assessments only, while 27% were generated by the feedback given alone. Residents who performed poorly on the case incorporated feedback more often than high performers when generating learning goals. Follow‐up data collection showed that 62 residents recalled 89 learning goals, of which 52 were acted upon. On follow‐up, the numbers of learning goals from self‐assessment and feedback were equal (25% each, 13 of 52), while the greatest number of reportedly executed learning goals came from self‐assessments and feedback in agreement (40%). Conclusions Following feedback on an oral board scenario, residents generated the majority of their learning goals from their own self‐assessments. Conversely, at the follow‐up period, they recalled an increased number of learning goals stemming from feedback, while the largest proportion of learning goals acted upon stemmed from both feedback and self‐assessments in agreement. This suggests that educators need to incorporate residents’ self‐assessments into any delivered feedback to have the greatest influence on future learning goals and actions taken to improve performance. Resumen Objetivos El profesorado de Medicina de Urgencias y Emergencias ( MUE ) a menudo tiene el objetivo de mejorar el rendimiento del residente y mejorar la calidad y el aporte de retroalimentación al residente. La aceptación e integración de la retroalimentación externa están influidas por múltiples factores. Sin embargo, se interpreta a través de “los ojos” de la propia autoevaluación del alumno. Lo ideal sería que, tras una actividad formativa con retroalimentación, un alumno fuera capaz de generar y actuar por objetivos de aprendizaje específicos ( OAE ) para mejorar el rendimiento. La observación de la fuente de OAE generados, bien desde la autoevaluación de uno mismo o la retroalimentación externa, podría dar luz a los factores que permiten una vía de mejora y guiar las iniciativas formativas. A través del escenario de un examen oral clásico, el objetivo de este estudio fue determinar los efectos que la autoevaluación de los residentes y la retroalimentación específica del profesorado tienen, no sólo en la generación de OAE , sino también en la ejecución de estos objetivos en la mejora del rendimiento. Metodología En este estudio docente transversal de cuatro programas universitarios participaron 72 residentes avanzados de MUE en el escenario de un examen oral clásico. Tras el examen, los residentes completaron un formulario de autoevaluación. Después, los examinadores utilizaron una lista de comprobación estandarizada para proporcionar retroalimentación positiva y negativa. Posteriormente, se pidió a los residentes generar OAE “ SMART ” [Specific (específico), Measurable (cuantificable), Attainable (asequible), Realistic (realista), Time‐bound (tiempo determinado)]. Los investigadores clasificaron los OAE como derivados de las autoevaluaciones de los residentes y/o la retroalimentación. En las primeras cuatro semanas, se pidió a los residentes recordar sus OAE y describir cualquier acción llevada a cabo para conseguir aquellos objetivos. Éstos se agruparon en categorías similares. Se utilizó la estadística descriptiva para resumir los datos. Resultados Se generó un total de 226 OAE (media por residente 3,1; DE ±1,3). Un 47% de los OA se generaron sólo por las autoevaluaciones de los residentes y un 27% sólo por la retroalimentación. Los residentes que rindieron pobremente en el caso, incorporaron la retroalimentación más a menudo que los que tuvieron un rendimiento alto cuando se generaron los OAE . Los datos del seguimiento mostraron que 62 residentes recordaron 89 OAE , de los cuáles 52 se llevaron a cabo. En el seguimiento, el número de OAE de la autoevaluación y de la retroalimentación fue el mismo (25% cada uno, 13 de 52), mientras que el mayor número de OAE supuestamente llevados a cabo vino por igual de las autoevaluaciones y de la retroalimentación (40%). Conclusiones Tras la retroalimentación en un examen oral, los residentes generaron la mayoría de sus OAE desde sus propias autoevaluaciones. Al contrario, tras un periodo de seguimiento, recordaron un número mayor de OAE derivados de la retroalimentación, mientras que la mayor proporción de OAE llevados a cabo derivan por igual tanto de la retroalimentación como de la autoevaluación. Esto sugiere que los docentes necesitan incorporar la autoevaluación de los residentes en cualquier retroalimentación proporcionada con el fin de tener la mayor influencia en los futuros OAE y las acciones llevadas a cabo para mejorar su rendimiento.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/100309/1/acem12231.pd

Rounded layering transitions on the surface of ice

Understanding the wetting properties of premelting films requires knowledge of the film’s equation of state, which is not usually available. Here we calculate the disjoining pressure curve of premelting films, and perform a detailed thermodynamic characterization of premelting behavior on ice. Analysis of the density profiles reveals the signature of weak layering phenomena, from one to two and from two to three water molecular layers. However, disjoining pressure curves, which closely follow expectations from a renormalized mean field liquid state theory, show that there are no layering phase transitions in the thermodynamic sense along the sublimation line. Instead, we find that transitions at mean field level are rounded due to capillary wave fluctuations. We see signatures that true first order layering transitions could arise at low temperatures, for pressures between the metastable line of water/vapor coexistence and the sublimation line. The extrapolation of the disjoining pressure curve above water vapor saturation displays a true first order phase transition from a thin to a thick film consistent with experimental observations

Persistence of Resistant Staphylococcus epidermidis after Single Course of Clarithromycin

Short course of antimicrobial therapy can select resistant bacteria that persist for 4 years or longer

Modeling the impact of inclusion of family planning services in Ghana\u27s National Health Insurance scheme

While access to and uptake of modern family planning (FP) in Ghana has steadily risen over the last decade, the modern Contraceptive Prevalence Rate (mCPR) among all women reached only 22% in 2019 with 30% of women still reporting unmet need. To increase FP uptake via mitigation of cost barriers among women with unmet need, the Government of Ghana is seeking to integrate claims-based FP services into the National Health Insurance Scheme benefits package. The impact of these activities has the potential to be significant with the proportion of women accessing modern FP shifting dramatically to public facilities over the past decade. The Ghana Ministry of Health, the National Health Insurance Authority, Marie Stopes International Ghana, and the Population Council launched a pilot in nine districts from 2018–20. This report uses data from pilot activity to model four scenarios involving implementation of cost removal, demand generation, and long-acting reversible contraceptives training to estimate impact on mCPR. These are input into the Health Policy Project’s ImpactNow tool to obtain estimates of health and economic benefits, intended to inform decisions regarding scale-up of these activities across the country

Long-Range Architecture in a Viral RNA Genome

We have developed a model for the secondary structure of the 1058-nucleotide plus-strand RNA genome of the icosahedral satellite tobacco mosaic virus (STMV) using nucleotide-resolution SHAPE chemical probing of the viral RNA isolated from virions and within the virion, perturbation of interactions distant in the primary sequence, and atomic force microscopy. These data are consistent with long-range base pairing interactions and a three-domain genome architecture. The compact domains of the STMV RNA have dimensions of 10 to 45 nm. Each of the three domains corresponds to a specific functional component of the virus: The central domain corresponds to the coding sequence of the single (capsid) protein encoded by the virus, whereas the 5′ and 3′ untranslated domains span signals essential for translation and replication, respectively. This three-domain architecture is compatible with interactions between the capsid protein and short RNA helices previously visualized by crystallography. STMV is among the simplest of the icosahedral viruses but, nonetheless, has an RNA genome with a complex higher-order structure that likely reflects high information content and an evolutionary relationship between RNA domain structure and essential replicative functions

Towards an understanding of how appraisal of doctors produces its effects: a realist review

CONTEXT: Revalidation was launched in the UK to provide assurances to the public that doctors are up to date and fit to practice. Appraisal is a fundamental component of revalidation. Approximately 150 000 doctors are appraised annually, costing an estimated £97 million over 10 years. There is little understanding of the theory of how and why appraisal is supposed to produce its effects. A realist review of the literature was utilised to explore these issues, as they generate context-mechanism-outcome (CMO) configurations, resulting in the creation of theories of how and why appraisal of doctors produces its effects. METHODS: A programme theory of appraisal was created by convening stakeholders in appraisal and searching a database of research on appraisal of doctors. Supplementary searches provided literature on theories identified in the programme theory. Relevant sections of texts relating to the programme theory were extracted from included articles, coded in NVivo and synthesised using realist logic of analysis. A classification tool categorised the included articles' contributions to programme theory. RESULTS: One hundred and twenty-five articles were included. Three mechanisms were identified: dissonance, denial and self-affirmation. The dissonance mechanism is most likely to cause outcomes of reflection and insight. Important contexts for the dissonance mechanism include the appraiser being highly skilled, the appraisee's working environment being supportive and the appraisee having the right attitude. The denial mechanism is more likely to be enacted if the opposite of these contexts occurs and could lead to game-playing behaviour. A skilled appraiser was also important in triggering the self-affirmation mechanism, resulting in reflection and insight. The contexts, mechanisms and outcomes identified were, however, limited by a lack of evidence that could enable further refining of the CMO configurations. CONCLUSION: This review makes a significant contribution to our understanding of appraisal by identifying different ways that appraisal of doctors produces its effects. Further research will focus on testing the CMO configurations

The higher education impact agenda, scientific realism and policy change: the case of electoral integrity in Britain

Pressures have increasingly been put upon social scientists to prove their economic, cultural and social value through ‘impact agendas’ in higher education. There has been little conceptual and empirical discussion of the challenges involved in achieving impact and the dangers of evaluating it, however. This article argues that a critical realist approach to social science can help to identify some of these key challenges and the institutional incompatibilities between impact regimes and university research in free societies. These incompatibilities are brought out through an autobiographical ‘insider-account’ of trying to achieve impact in the field of electoral integrity in Britain. The article argues that there is a more complex relationship between research and the real world which means that the nature of knowledge might change as it becomes known by reflexive agents. Secondly, the researchers are joined into social relations with a variety of actors, including those who might be the object of study in their research. Researchers are often weakly positioned in these relations. Some forms of impact, such as achieving policy change, are therefore exceptionally difficult as they are dependent on other actors. Strategies for trying to achieve impact are drawn out such as collaborating with civil society groups and parliamentarians to lobby for policy change

Faculty verbal evaluations reveal strategies used to promote medical student performance

Background: Preceptors rarely follow medical students’ developing clinical performance over time and across disciplines. This study analyzes preceptors’ descriptions of longitudinal integrated clerkship (LIC) students’ clinical development and their identification of strategies to guide students’ progress. Methods: We used a common evaluation framework, reporter-interpreter-manager-educator, to guide multidisciplinary LIC preceptors’ discussions of students’ progress. We conducted thematic analysis of transcripts from preceptors’ (seven longitudinal ambulatory preceptors per student) quarterly group discussions of 15 students’ performance over one year. Results: All students’ clinical development progressed, although most experienced obstacles. Lack of structure in the history and physical exam commonly obstructed progression. Preceptors used templates for data gathering, and modeling or experiences in the inpatient setting to provide time and solidify structure. To advance students’ knowledge acquisition, many preceptors identified focused learning topics with their students; to promote application of knowledge, preceptors used reasoning strategies to teach the steps involved in synthesizing clinical data. Preceptors shared accountability for helping students advance as the LIC allowed them to follow students’ response to teaching strategies. Discussion: These results depict preceptors’ perceptions of LIC students’ developmental continuum and illustrate how multidisciplinary preceptors can use a common evaluation framework to identify strategies to improve performance and follow students’ performance longitudinally

Childhood traumatic experiences and mental health problems in sexually offending and non-sexually offending juveniles

OBJECTIVE: To examine the relationship between a history of childhood abuse and mental health problems in juveniles who sexually offended (JSOs) over and above general offending behavior. METHODS: A sample of 44 JSOs incarcerated in two juvenile detention centers in the Netherlands between May 2008 and March 2014 were examined for childhood abuse history (Childhood Trauma Questionnaire-Short Form) and mental health problems (Massachusetts Youth Screening Instrument-Version 2). Furthermore, the connection between childhood abuse and mental health problems in JSOs was compared to a sample of 44 propensity score matched juveniles who offended non-sexually (non-JSOs). RESULTS: In JSOs, sexual abuse was related to anger problems, suicidal ideation, and thought disturbance. These associations were significantly stronger in JSOs than in non-JSOs. CONCLUSIONS: Our results suggest that the relationship between childhood abuse and both internalizing and externalizing mental health problems is of more salience for understanding sexual offending than non-sexual offending, and should, therefore, be an important focus in the assessment and treatment of JSOs

Barriers to the uptake and use of feedback in the context of summative assessment

Despite calls for feedback to be incorporated in all assessments, a dichotomy exists between formative and summative assessments. When feedback is provided in a summative context, it is not always used effectively by learners. In this study we explored the reasons for this. We conducted individual interviews with 17 students who had recently received web based feedback following a summative assessment. Constant comparative analysis was conducted for recurring themes. The summative assessment culture, with a focus on avoiding failure, was a dominant and negative influence on the use of feedback. Strong emotions were prevalent throughout the period of assessment and feedback, which reinforced the focus on the need to pass, rather than excel. These affective factors were heightened by interactions with others. The influence of prior learning experiences affected expectations about achievement and the need to use feedback. The summative assessment and subsequent feedback appeared disconnected from future clinical workplace learning. Socio-cultural influences and barriers to feedback need to be understood before attempting to provide feedback after all assessments. A move away from the summative assessment culture may be needed in order to maximise the learning potential of assessments