Variable trajectory: a systematic review, analytic synthesis and construct domain consolidation of international measures of competence in doctors and medical students

ABSTRACT Background Competence is assessed throughout a doctor’s career. Failure to identify and manage impaired competence can have critical consequences. Consistent conceptualisation and accurate measurement of this construct is imperative. Therefore, the objective of this review was to identify and evaluate measures used to assess competence in doctors and medical students. Methods A systematic search of the published literature was undertaken between December 2019 and February 2020 for articles reporting on the measurement of competence in doctors and/or medical students. Searches were conducted in the PsychSOURCE, US National Library of Medicine National Institutes of Health, MEDLINE (PubMed), The Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science electronic databases. Citation screening and forward citation tracking of included studies was carried out to identify any further relevant papers for inclusion. One thousand one-hundred and thirty-six potentially relevant articles were screened. An analytic synthesis approach was implemented to the identification, organization and interpretation of homogenous study and measure characteristics. Results Twelve competence domains were identified from the 153 identified measures. Knowledge and Procedural competence domains were the dominant focus of publications reporting current medical practice, but less so in research-based studies which more frequently assessed interpersonal, psychological, physiological and ethical competencies. In the 105 included articles, the reporting of measurement instrument quality was varied, with comprehensive reporting only present in 53.6% of measures; validation for some of the measures was particularly limited. Discussion Whilst this review included a considerable number of publications reporting the measurement of competence in doctors and medical students, the heterogeneity of the measures and variation of findings limit the ability to evaluate their validity and generalisability. However, this review presents a resource for researchers and medical educators which may inform operational practice and future research. Keywords: Competence · Doctor · Medical student · Physician · Performanc

Evidence for Spinodal Decomposition in Nuclear Multifragmentation

Multifragmentation of a ``fused system'' was observed for central collisions between 32 MeV/nucleon 129Xe and natSn. Most of the resulting charged products were well identified thanks to the high performances of the INDRA 4pi array. Experimental higher-order charge correlations for fragments show a weak but non ambiguous enhancement of events with nearly equal-sized fragments. Supported by dynamical calculations in which spinodal decomposition is simulated, this observed enhancement is interpreted as a ``fossil'' signal of spinodal instabilities in finite nuclear systems.Comment: 4 pages, 4 figures, to be published in Phys. Rev. Letter

Response of CsI(Tl) scintillators over a large range in energy and atomic number of ions (Part I): recombination and delta -- electrons

A simple formalism describing the light response of CsI(Tl) to heavy ions, which quantifies the luminescence and the quenching in terms of the competition between radiative transitions following the carrier trapping at the Tl activator sites and the electron-hole recombination, is proposed. The effect of the delta rays on the scintillation efficiency is for the first time quantitatively included in a fully consistent way. The light output expression depends on four parameters determined by a procedure of global fit to experimental data.Comment: 28 pages, 6 figures, submitted to Nucl. Inst. Meth.

Measurements of sideward flow around the balance energy

Sideward flow values have been determined with the INDRA multidetector for Ar+Ni, Ni+Ni and Xe+Sn systems studied at GANIL in the 30 to 100 A.MeV incident energy range. The balance energies found for Ar+Ni and Ni+Ni systems are in agreement with previous experimental results and theoretical calculations. Negative sideward flow values have been measured. The possible origins of such negative values are discussed. They could result from a more important contribution of evaporated particles with respect to the contribution of promptly emitted particles at mid-rapidity. But effects induced by the methods used to reconstruct the reaction plane cannot be totally excluded. Complete tests of these methods are presented and the origins of the ``auto-correlation'' effect have been traced back. For heavy fragments, the observed negative flow values seem to be mainly due to the reaction plane reconstruction methods. For light charged particles, these negative values could result from the dynamics of the collisions and from the reaction plane reconstruction methods as well. These effects have to be taken into account when comparisons with theoretical calculations are done.Comment: 27 pages, 15 figure

Multifragmentation process for different mass asymmetry in the entrance channel around the Fermi energy

The influence of the entrance channel asymmetry upon the fragmentation process is addressed by studying heavy-ion induced reactions around the Fermi energy. The data have been recorded with the INDRA 4pi array. An event selection method called the Principal Component Analysis is presented and discussed. It is applied for the selection of central events and furthermore to multifragmentation of single source events. The selected subsets of data are compared to the Statistical Multifragmentation Model (SMM) to check the equilibrium hypothesis and get the source characteristics. Experimental comparisons show the evidence of a decoupling between thermal and compresional (radial flow) degrees of freedom in such nuclear systems.Comment: 28 pages, 15 figures, article sumitted to Nuclear Physics

Impact of two myostatin (MSTN) mutations on weight gain and lamb carcass classification in Norwegian White Sheep (Ovis aries)

<p>Abstract</p> <p>Background</p> <p>Our aim was to estimate the effect of two <it>myostatin </it>(<it>MSTN</it>) mutations in Norwegian White Sheep, one of which is close to fixation in the Texel breed.</p> <p>Methods</p> <p>The impact of two known <it>MSTN </it>mutations was examined in a field experiment with Norwegian White Sheep. The joint effect of the two <it>MSTN </it>mutations on live weight gain and weaning weight was studied on 644 lambs. Carcass weight gain from birth to slaughter, carcass weight, carcass conformation and carcass fat classes were calculated in a subset of 508 lambs. All analyses were carried out with a univariate linear animal model.</p> <p>Results</p> <p>The most significant impact of both mutations was on conformation and fat classes. The largest difference between the genotype groups was between the wild type for both mutations and the homozygotes for the c.960delG mutation. Compared to the wild types, these mutants obtained a conformation score 5.1 classes higher and a fat score 3.0 classes lower, both on a 15-point scale.</p> <p>Conclusions</p> <p>Both mutations reduced fatness and increased muscle mass, although the effect of the frameshift mutation (c.960delG) was more important as compared to the 3'-UTR mutation (c.2360G>A). Lambs homozygous for the c.960delG mutation grew more slowly than those with other <it>MSTN </it>genotypes, but had the least fat and the largest muscle mass. Only c.960delG showed dominance effects.</p

Communitarian perspectives on social enterprise

Concepts of social enterprise have been debated repeatedly, and continue to cause confusion. In this paper, a meta-theoretical framework is developed through discussion of individualist and communitarian philosophy. Philosophers from both traditions build social theories that emphasise either consensus (a unitarist outlook) or diversity (a pluralist outlook). The various discourses in corporate governance reflect these assumptions and create four distinct approaches that impact on the relationship between capital and labour. In rejecting the traditional discourse of private enterprise, social enterprises have adopted other approaches to tackle social exclusion, each derived from different underlying beliefs about the purpose of enterprise and the nature of governance. The theoretical framework offers a way to understand the diversity found within the sector, including the newly constituted Community Interest Company (CIC).</p