Virtual patient design : exploring what works and why : a grounded theory study

Objectives: Virtual patients (VPs) are online representations of clinical cases used in medical education. Widely adopted, they are well placed to teach clinical reasoning skills. International technology standards mean VPs can be created, shared and repurposed between institutions. A systematic review has highlighted the lack of evidence to support which of the numerous VP designs may be effective, and why. We set out to research the influence of VP design on medical undergraduates. Methods: This is a grounded theory study into the influence of VP design on undergraduate medical students. Following a review of the literature and publicly available VP cases, we identified important design properties. We integrated them into two substantial VPs produced for this research. Using purposeful iterative sampling, 46 medical undergraduates were recruited to participate in six focus groups. Participants completed both VPs, an evaluation and a 1-hour focus group discussion. These were digitally recorded, transcribed and analysed using grounded theory, supported by computer-assisted analysis. Following open, axial and selective coding, we produced a theoretical model describing how students learn from VPs. Results: We identified a central core phenomenon designated ‘learning from the VP’. This had four categories: VP Construction; External Preconditions; Student–VP Interaction, and Consequences. From these, we constructed a three-layer model describing the interactions of students with VPs. The inner layer consists of the student's cognitive and behavioural preconditions prior to sitting a case. The middle layer considers the VP as an ‘encoded object’, an e-learning artefact and as a ‘constructed activity’, with associated pedagogic and organisational elements. The outer layer describes cognitive and behavioural change. Conclusions: This is the first grounded theory study to explore VP design. This original research has produced a model which enhances understanding of how and why the delivery and design of VPs influence learning. The model may be of practical use to authors, institutions and researchers

Mongolians in the Genetic Landscape of Central Asia: Exploring the Genetic Relations among Mongolians and Other World Populations

Genetic data on North Central Asian populations are underrepresented in the literature, especially autosomal markers. In the present study we use 812 single nucleotide polymorphisms that are distributed across all the human autosomes and that have been extensively studied at Yale to examine the affinities of two recently collected, samples of populations: rural and cosmopolitan Mongolians from Ulaanbaatar and nomadic, Turkic-speaking Tsaatan from Mongolia near the Siberian border. We compare these two populations to one another and to a global set of populations and discuss their relationships to New World populations. Specifically, we analyze data on 521 autosomal loci (single SNPs and multi-SNP haplotypes) studied on 57 populations representing all the major geographical regions of the world. We conclude that the North Central Asian populations we study are genetically distinct from all other populations in our study and may be close to the ancestral lineage leading to the New World populations

Obstetricians presenting amniocentesis to pregnant women : Practice observed

The aim of this study is to describe how obstetricians present amniocentesis to women eligible because of their age and hence increased likel a hood of having a child with Down’s syndrome and other chromosome abnormalities. Routine antenatal consultations between 25 women and 17 doctors were tape recorded. Presentations focused upon the risks of fetal abnormality, and the risks of pregnancy loss following amniocentesis. The word risk was used to denote probability and frequently used in conjunction with words to denote value. Although obstetricians frequently presented probabilistic information, this tended to be presented in a binary fashion, that is, as denoting either high or low risk. Equivalent probabilities were described as low in connection with fetal loss, and high in connection with Down’s syndrome. The probabilities of these two events were contrasted on half of the occasions when they were presented. Implicit in obstetricians’ presentations of amniocentesis was an assumption that all women would or should undergo the procedure. Information concerning the range of conditions detected at routine amniocentesis were infrequently mentioned and never described. The results of this descriptive study illustrate that information germane to decisions of whether to undergo amniocentesis is frequently presented in such a way as to encourage uptake of the test, rather than to foster informed decision-making.O objectivo deste estudo é descrever como os obstetras apresentam a amniosintese a mulheres que por causa da idade, têm uma probabilidade elevada de ter uma criança com sindrome de Down, ou com outra anormalidade cromossómica. Consultas de rotina prénatal foram gravadas entre 25 mulheres e 17 médicos. A apresentação do teste focou-se em relação aos riscos de anomalia fetal, e aos riscos de perda do feto a seguir a amniosintese. A palavra «risco» foi usada para designar probabilidade e foi frequentemente usada em conjunto com palavras para designar valor. Ainda que os obstetras tenham apresentado frequentemente informação probabilistica, esta foi apresentada de forma binária, isto é, designando alto ou baixo risco. Da mesma maneira, as probabilidades foram descritas como baixas em relação à perda do feto, e altas em relação ao sindrome de Down. As probabilidades destes dois eventos foram contrastadas em metade das ocasiões em que foram apresentadas. Na apresentação da amniosintese feita pelos obstetras, estava implicita a suposição de que todas as mulheres deviam ser submetidas ao teste. Informação relativa ao leque de possiveis anomalias detectáveis pela amniosintese, não foi mencionada frequentemente, e as anomalias nunca foram descritas. OS resultados deste estudo descritivo ilustram que a informação relevante para a tomada de decisão relativa a realização da amniosintese, é frequentemente apresentada de forma a favorecer a realização do teste, em vez de fornecer a informação necessária a tomada de decisão sobre a realização do mesmo

Triadic Peer Review in Scenario-based Assessments: Case Study

In undergraduate medical education, students are expected to achieve competence in procedural skills (e.g. suturing a wound, inserting a urinary catheter). In the United Kingdom, most medical schools have clinical skills laboratories in which students practise technical procedural skills on simulated models before performing them under supervision on real patients. Although traditionally the focus of assessment, technical skill is just one component of the procedure and when students work in clinical settings they need to be able to integrate technical with communication skills and to respond to contextual stimuli (e.g. interruptions by staff, equipment unavailable)

Correlates of Suicide Ideation and Attempt among Youth Living in the Slums of Kampala

While suicidal behavior is recognized as a growing public health problem world-wide, little is known about the prevalence and risk factors for suicidal behaviors among street and slum youth in Africa, and in Uganda, specifically. The number of youth who live on the streets and in the slums of Kampala appears to be growing rapidly, but their mental health needs have not been documented, which has hampered resource allocation and service implementation. This study of youth, ages 14–24, was conducted in May and June of 2011, to assess the prevalence and correlates of suicidal behavior. Participants (N = 457) were recruited for a 30-minute interviewer-administered survey through eight drop-in centers operated by the Uganda Youth Development Link for youth in need of services. Bivariate and multivariate logistic regression analyses were computed to determine associations between psychosocial correlates and suicide ideation and suicide attempt. Reporting both parents deceased Adj.OR = 2.36; 95% CI: 1.23–4.52), parental neglect due to alcohol use (Adj.OR = 2.09; 95% CI: 1.16–3.77), trading sex for food, shelter or money (Adj.OR = 1.95; 95% CI: 1.09–3.51), sadnesss (Adj.OR = 2.42; 95% CI: 1.20–4.89), loneliness (Adj.OR = 2.67; 95% CI: 1.12–6.40) and expectations of dying prior to age 30 (Adj.OR = 2.54; 95% CI: 1.53–4.23) were significantly associated with suicide ideation in multivariate analyses. Parental neglect due to alcohol use (Adj.OR = 2.04; 95% CI: 1.11–3.76), sadness (Adj.OR = 2.42; 95% CI: 1.30–7.87), and expectations of dying prior to age 30 (Adj.OR = 2.18; 95% CI: 1.25–3.79) were significantly associated with suicide attempt in multivariate analyses. Given the dire circumstances of this vulnerable population, increased services and primary prevention efforts to address the risk factors for suicidal behavior are urgently needed