A method to quantify residents\u27 jargon use during counseling of standardized patients about cancer screening

Background Jargon is a barrier to effective patient-physician communication, especially when health literacy is low or the topic is complicated. Jargon is addressed by medical schools and residency programs, but reducing jargon usage by the many physicians already in practice may require the population-scale methods used in Quality Improvement. Objective To assess the amount of jargon used and explained during discussions about prostate or breast cancer screening. Effective communication is recommended before screening for prostate or breast cancer because of the large number of false-positive results and the possible complications from evaluation or treatment. Participants Primary care internal medicine residents. Measurements Transcripts of 86 conversations between residents and standardized patients were abstracted using an explicit-criteria data dictionary. Time lag from jargon words to explanations was measured using “statements,” each of which contains one subject and one predicate. Results Duplicate abstraction revealed reliability κ = 0.92. The average number of unique jargon words per transcript was 19.6 (SD = 6.1); the total jargon count was 53.6 (SD = 27.2). There was an average of 4.5 jargon-explanations per transcript (SD = 2.3). The ratio of explained to total jargon was 0.15. When jargon was explained, the average time lag from the first usage to the explanation was 8.4 statements (SD = 13.4). Conclusions The large number of jargon words and low number of explanations suggest that many patients may not understand counseling about cancer screening tests. Educational programs and faculty development courses should continue to discourage jargon usage. The methods presented here may be useful for feedback and quality improvement efforts

Acoustic mechanisms of a species-based discrimination of the chick-a-dee call in sympatric black-capped (Poecile atricapillus) and mountain chickadees (P. gambeli)

Previous perceptual research with black-capped and mountain chickadees has demonstrated that these species treat each other’s namesake chick-a-dee calls as belonging to separate, open-ended categories. Further, the terminal dee portion of the call has been implicated as the most prominent species marker. However, statistical classification using acoustic summary features suggests that all note-types contained within the chick-a-dee call should be sufficient for species classification. The current study seeks to better understand the note-type based mechanisms underlying species-based classification of the chick-a-dee call by black-capped and mountain chickadees. In two, complementary, operant discrimination experiments, both species were trained to discriminate the species of the signaler using either entire chick-a-dee calls, or individual note-types from chick-a-dee calls. In agreement with previous perceptual work we find that the D note had significant stimulus control over species-based discrimination. However, in line with statistical classifications, we find that all note-types carry species information. We discuss reasons why the most easily discriminated note-types are likely candidates to carry species-based cues.Publisher PDFPeer reviewe

Pediatric residents\u27 use of jargon during counseling about newborn genetic screening results

OBJECTIVE. The goal was to investigate pediatric residents’ usage of jargon during discussions about positive newborn screening test results. METHODS. An explicit-criteria abstraction procedure was used to identify jargon usage and explanations in transcripts of encounters between residents and standardized parents of a fictitious infant found to carry cystic fibrosis or sickle cell hemoglobinopathy. Residents were recruited from a series of educational workshops on how to inform parents about positive newborn screening test results. The time lag from jargon words to explanations was measured by using “statements,” each of which contained 1 subject and 1 predicate. RESULTS. Duplicate abstraction revealed reliability K of 0.92. The average number of unique jargon words per transcript was 20; the total jargon count was 72.3 words. There was an average of 7.5 jargon explanations per transcript, but the explained/ total jargon ratio was only 0.17. When jargon was explained, the average time lag from the first usage to the explanation was 8.2 statements. CONCLUSION. The large number of jargon words and the small number of explanations suggest that physicians’ counseling about newborn screening may be too complex for some parents

Child Health Providers\u27 Precautionary Discussion of Emotions During Communication about Results of Newborn Genetic Screening

Objective To demonstrate a quantitative abstraction method for Communication Quality Assurance projects to assess physicians\u27 communication about hidden emotions after newborn genetic screening. Design Communication quality indicator analysis. Setting Standardized parent encounters performed in practicing physicians\u27 clinics or during educational workshops for residents. Participants Fifty-nine pediatrics residents, 53 pediatricians, and 31 family physicians. Intervention Participants were asked to counsel standardized parents about a screening result; counseling was recorded, transcribed, and parsed into statements (each with 1 subject and 1 predicate). Pairs of abstractors independently compared statements with a data dictionary containing explicit-criteria definitions. Outcome Measures Four groups of precautionary empathy behaviors (assessment of emotion, anticipation/validation of emotion, instruction about emotion, and caution about future emotion), with definitions developed for both definite and partial instances. Results Only 38 of 143 transcripts (26.6%) met definite criteria for at least 1 of the precautionary empathy behaviors. When partial criteria were counted, this number increased to 80 of 143 transcripts (55.9%). The most common type of precautionary empathy was the instruction about emotion behavior (eg, don\u27t be worried ), which may sometimes be leading or premature. Conclusions Precautionary empathy behaviors were rare in this analysis. Further study is needed, but this study should raise concerns about the quality of communication services after newborn screening

The effect of classwide peer tutoring on the skill performance and fitness levels of students with disabilities in an elementary physical education inclusion class

This single subject study used an ABAB research design to investigate the effect of classwide peer tutoring (CWPT) on the skill performance and fitness levels of students with disabilities. Data was collected from nine students with disabilities who are members of a fourth grade physical education inclusion class. During the baseline phases of this study, students received instruction through whole-class direct instruction provided by the physical education teacher. During the intervention phases of this study, students participated in CWPT sessions. Skill performance in this study was determined through students demonstrating skill cues while shooting towards a target. Fitness levels were measured through the use of the Pacer Test, a cardiovascular endurance measurement. Students with disabilities were paired with typically developing peers in their same class and they took turns serving in the roles of tutor and tutee. The results of this research study suggest that students with disabilities showed an increase in skill performance and fitness levels as the result of using CWPT. Participant satisfaction surveys indicate a high level of enjoyment and satisfaction with CWPT

Experimental Investigation of Transonic Shock Oscillations on NACA 0018 at Incidence

A NACA 0018 airfoil model with a 3-inch chord was mounted into the trisonic wind tunnel at the National Center for Physical Acoustics at the University of Mississippi. Tunnel runs were conducted with the angle of incidence increasing from 0 degrees to 6 degrees at 1 degree increments, while the Mach number was held steady at 0.73. High-speed schlieren images were recorded at a sample rate of 4,000 Hz. A Matlab code was developed to display the spatial power spectral density distribution in the region of the shock. This code calculated the frequency spectrum at regular points along the range of shock motion and plotted the spatial distribution of frequency spectra across all the points. This identified the location of the high-amplitude frequencies, which indicated the precise range of the shock motion as well as its dominant oscillation frequency. It was found that, for each degree increase, the frequency of oscillations increased by approximately 10.8 Hz. This is equivalent to a reduced frequency increase of 0.0205 per degree

Improving Communication between Doctors and Parents after Newborn Screening

Background: Newborn screening (NBS) enables early treatment, and some consider it a natural vehicle for genetic screening. Bioethicists argue for caution since families of infants with carrier status can develop psychosocial complications. This paper describes the methods and feasibility of Wisconsin’s statewide project for quality improvement of communication and psychosocial outcomes after NBS. Methods: When NBS identifies carrier status for cystic fibrosis or sickle cell, we contact primary care providers (PCPs), answer questions, and invite them to rehearse informing the parents. Three months later, we telephone the parents, assess knowledge and psychosocial outcomes, provide counseling, and assist with self-referral to further resources. Afterward, evaluation surveys are provided to the parents, to be returned anonymously. Results: Birthing facilities provided accurate PCP names for 73% of 817 infants meeting inclusion criteria; we identified PCPs for 21% more. We reached 47.3% of PCPs in time to invite a rehearsal; 60% of these accepted. We successfully called 50.2% of eligible parents; 61% recalled a PCP explanation, and 48.5% evaluated the explanation favorably. Evaluations by parents with limited health literacy were less favorable. Conclusion: It is feasible to follow parents for psychosocial outcomes after NBS. Preliminary data about communication is mixed, but further data will describe psychosocial outcomes and investigate outcomes’ associations with communication

Building Productive Relationships: District Leaders’ Advice to Researchers

Expectations for the role of research in educational improvement are high. Meeting these expectations requires productive relationships between researchers and practitioners. Few studies, however, have systematically explored the ways researchers can build stronger, more productive relationships with practitioners. This study seeks to identify such strategies by examining district leaders’ views of how researchers might work with practitioners in more effective, beneficial, and collaborative ways. Through an analysis of 147 interviews with 80 district leaders in three urban school districts, we identify several key pieces of advice highlighted by district leaders for researchers. For researchers, these findings reveal potential strategies for shaping the design, conduct, and communication of their research in order to ensure its usefulness for practitioners.