Perfectionnement du corps professoral fondé sur les compétences : évolutions tirées des enseignements de la formation médicale fondée sur les compétences

Faculty development in medical education is often delivered in an ad hoc manner instead of being a deliberately sequenced program matched to data-informed individual needs. In this article, the authors, all with extensive experience in Faculty Development (FD), present a competency-based faculty development (CBFD) framework envisioned to enhance the impact of FD.  Steps and principles in the CBFD framework reflect the lessons learned from competency-based medical education (CBME) with its foundational goal to better train physicians to meet societal needs.  The authors see CBFD as a similar framework, this one to better train faculty to meet educational needs.  CBFD core elements include: articulated competencies for the varied educational roles faculty fulfill, deliberately designed curricula structured to build those competencies, and an assessment program and process to support individualized faculty learning and professional growth.  The framework incorporates ideas about where and how CBFD should be delivered, the use of coaching to promote reflection and identity formation and the creation of communities of learning. As with CBME, the CBFD framework has included the important considerations of change management, including broad stakeholder engagement, continuous quality improvement and scholarship. The authors have provided examples from the literature as well as challenges and considerations for each step. Dans l’enseignement médical, le perfectionnement du corps professoral se fait souvent de façon ad hoc et non dans le cadre d’un programme structuré en fonction des besoins individuels définis sur la base de données. Dans cet article, les autrices, qui ont toutes une vaste expérience en matière de perfectionnement du corps professoral (PCP), présentent un cadre pour le perfectionnement fondé sur les compétences (PCPFC) visant à renforcer les effets du PCP. Les étapes et les principes de ce cadre reflètent les enseignements tirés de la formation médicale fondée sur les compétences (FMFC), dont l’objectif fondamental est de former les médecins de façon à ce qu’ils puissent répondre aux besoins de la société. De manière analogue, le cadre PCPFC viserait à mieux former le corps professoral pour qu’il puisse répondre aux besoins éducatifs. Les éléments centraux du cadre comprennent la définition des compétences pour chacun des rôles que les enseignants remplissent, la création de programmes de formation structurés et axés sur le développement de ces compétences et l’élaboration d’un programme d’évaluation ainsi qu’un processus pour soutenir de manière individualisée l’apprentissage et la croissance professionnelle des enseignants. Le cadre présente des idées sur les modalités des formations de PCPFC, sur l’environnement dans lequel elles interviennent, sur l’utilisation du coaching pour promouvoir la réflexion et la construction d’identité et sur la création de communautés d’apprentissage. Tout comme la FMFC, le cadre du PCPFC répond aux importants enjeux liés à la gestion du changement, y compris l’engagement des parties prenantes, l’amélioration continue de la qualité et la recherche. Les autrices proposent des exemples tirés de la littérature scientifique et passent en revue les défis et les points importants à considérer pour chaque étape

Ambulatory teaching: Do approaches to learning predict the site and preceptor characteristics valued by clerks and residents in the ambulatory setting?

BACKGROUND: In a study to determine the site and preceptor characteristics most valued by clerks and residents in the ambulatory setting we wished to confirm whether these would support effective learning. The deep approach to learning is thought to be more effective for learning than surface approaches. In this study we determined how the approaches to learning of clerks and residents predicted the valued site and preceptor characteristics in the ambulatory setting. METHODS: Postal survey of all medical residents and clerks in training in Ontario determining the site and preceptor characteristics most valued in the ambulatory setting. Participants also completed the Workplace Learning questionnaire that includes 3 approaches to learning scales and 3 workplace climate scales. Multiple regression analysis was used to predict the preferred site and preceptor characteristics as the dependent variables by the average scores of the approaches to learning and perception of workplace climate scales as the independent variables. RESULTS: There were 1642 respondents, yielding a 47.3% response rate. Factor analysis revealed 7 preceptor characteristics and 6 site characteristics valued in the ambulatory setting. The Deep approach to learning scale predicted all of the learners' preferred preceptor characteristics (β = 0.076 to β = 0.234, p < .001). Valuing preceptor Direction was more strongly associated with the Surface Rational approach (β = .252, p < .001) and with the Surface Disorganized approach to learning (β = .154, p < 001) than with the Deep approach. The Deep approach to learning scale predicted valued site characteristics of Office Management, Patient Logistics, Objectives and Preceptor Interaction (p < .001). The Surface Rational approach to learning predicted valuing Learning Resources and Clinic Set-up (β = .09, p = .001; β = .197, p < .001). The Surface Disorganized approach to learning weakly negatively predicted Patient Logistics (β = -.082, p = .003) and positively the Learning Resources (β = .088, p = .003). Climate factors were not strongly predictive for any studied characteristics. Role Modeling and Patient Logistics were predicted by Supportive Receptive climate (β = .135, p < .001, β = .118, p < .001). CONCLUSION: Most site and preceptor characteristics valued by clerks and residents were predicted by their Deep approach to learning scores. Some characteristics reflecting the need for good organization and clear direction are predicted by learners' scores on less effective approaches to learning

The impact of prolonged disorders of consciousness on the occupational life of family members

The impact of vegetative state (VS) and minimally conscious states (MCSs) on an individual is devastating. VS and MCSs may be transitional towards recovery, but may become permanent. Although devastating for the individual the nature of these conditions also has a profound effect on the family. This study examined the impact on the family member and the changes in the individuals’ occupation. Six participants (spouses, partners or parents) were recruited to the study. Mixed methods were adopted to meet the requirements of the research and participants. Data were collected at 6 and 12 months post-injury, using time diaries, a questionnaire and semi-structured interviews. At 6 months post-injury the greatest amount of carers’ time was allocated to occupations involving the person in a Disorder of Consciousness and less time to social and leisure activities. Participants had difficulty viewing the future, lacked the desire or capacity to engage in previously enjoyed activities. At 12 months those impacts were still evident although changing. The transition to balanced occupational activity is slow, requiring a number of catalysts to change. A conceptual framework for a return to balance is provided, and guidance on advice from family members to families in a similar situation is given

A detailed clinical and molecular survey of subjects with nonsyndromic USH2A retinopathy reveals an allelic hierarchy of disease-causing variants.

Defects in USH2A cause both isolated retinal disease and Usher syndrome (ie, retinal disease and deafness). To gain insights into isolated/nonsyndromic USH2A retinopathy, we screened USH2A in 186 probands with recessive retinal disease and no hearing complaint in childhood (discovery cohort) and in 84 probands with recessive retinal disease (replication cohort). Detailed phenotyping, including retinal imaging and audiological assessment, was performed in individuals with two likely disease-causing USH2A variants. Further genetic testing, including screening for a deep-intronic disease-causing variant and large deletions/duplications, was performed in those with one likely disease-causing change. Overall, 23 of 186 probands (discovery cohort) were found to harbour two likely disease-causing variants in USH2A. Some of these variants were predominantly associated with nonsyndromic retinal degeneration ('retinal disease-specific'); these included the common c.2276 G>T, p.(Cys759Phe) mutation and five additional variants: c.2802 T>G, p.(Cys934Trp); c.10073 G>A, p.(Cys3358Tyr); c.11156 G>A, p.(Arg3719His); c.12295-3 T>A; and c.12575 G>A, p.(Arg4192His). An allelic hierarchy was observed in the discovery cohort and confirmed in the replication cohort. In nonsyndromic USH2A disease, retinopathy was consistent with retinitis pigmentosa and the audiological phenotype was variable. USH2A retinopathy is a common cause of nonsyndromic recessive retinal degeneration and has a different mutational spectrum to that observed in Usher syndrome. The following model is proposed: the presence of at least one 'retinal disease-specific' USH2A allele in a patient with USH2A-related disease results in the preservation of normal hearing. Careful genotype-phenotype studies such as this will become increasingly important, especially now that high-throughput sequencing is widely used in the clinical setting.European Journal of Human Genetics advance online publication, 4 February 2015; doi:10.1038/ejhg.2014.283

Optical design of the Off-plane Grating Rocket Experiment

The Off-plane Grating Rocket Experiment (OGRE) is a soft X-ray spectroscopy suborbital rocket payload scheduled for launch in Q3 2020 from Wallops Flight Facility. The payload will serve as a testbed for several key technologies which can help achieve the desired performance increases for the next generation of X-ray spectrographs and other space-based missions: monocrystalline silicon X-ray mirrors developed at NASA Goddard Space Flight Center, reflection gratings manufactured at The Pennsylvania State University, and electron-multiplying CCDs developed by the Open University and XCAM Ltd. With these three technologies, OGRE hopes to obtain the highest-resolution on-sky soft X-ray spectrum to date. We discuss the optical design of the OGRE payload

The Off-plane Grating Rocket Experiment (OGRE) system overview

The Off-plane Grating Rocket Experiment (OGRE) is a sub-orbital rocket payload that will make the highest spectral resolution astronomical observation of the soft X-ray Universe to date. Capella, OGRE’s science target, has a well-defined line emission spectrum and is frequently used as a calibration source for X-ray observatories such as Chandra. This makes Capella an excellent target to test the technologies on OGRE, many of which have not previously flown. Through the use of state-of-the-art X-ray optics, co-aligned arrays of off-plane reflection gratings, and an X-ray camera based around four Electron Multiplying CCDs, OGRE will act as a proving ground for next generation X-ray spectrometers

African Americans and Land Loss in Texas: Government Duplicity and Discrimination Based on Race and Class

African American Farmers and Land Loss in Texas, surveys the ways that discrimination at the local, state, and national levels constrained minority farmers during the twentieth century. It considers the characteristics of small-scale farming that created liabilities for landowners regardless of race, including state and federal programs that favored commercial and agribusiness interests. In addition to economic challenges African American farmers had to negotiate racism in the Jim Crow South. The Texas Agricultural Extension Service, the state branch of the USDA\u27s Extension Service, segregated in 1915. The Negro division gave black farmers access to information about USDA programs, but it emphasized their subordinate position relative to white farmers. The Civil Rights Act of 1964 did not reverse decades of racial discrimination. Instead, USDA officials relied on federalism, a theory as old as the Constitution, to justify their tolerance of civil rights violations in Texas and elsewhere. Then, special needs legislation passed during the 1970s and 1980s did not realize its potential to serve ethnically diverse and economically disadvantaged rural Texans. Discrimination based on race combined with a bias toward commercial production. This crippled most black farmers and led to their near extinction

Biological monitoring of pesticide exposures in residents living near agricultural land

<p>Abstract</p> <p>Background</p> <p>There is currently a lack of reliable information on the exposures of residents and bystanders to pesticides in the UK. Previous research has shown that the methods currently used for assessing pesticide exposure for regulatory purposes are appropriate for farm workers <abbrgrp><abbr bid="B1">1</abbr></abbrgrp>. However, there were indications that the exposures of bystanders may sometimes be underestimated. The previous study did not collect data for residents. Therefore, this study aims to collect measurements to determine if the current methods and tools are appropriate for assessing pesticide exposure for residents living near agricultural fields.</p> <p>Methods/design</p> <p>The study will recruit owners of farms and orchards (hereafter both will be referred to as farms) that spray their agricultural crops with certain specified pesticides, and which have residential areas in close proximity to these fields. Recruited farms will be asked to provide details of their pesticide usage throughout the spray season. Informed consenting residents (adults (18 years and over) and children(aged 4-12 years)) will be asked to provide urine samples and accompanying activity diaries during the spraying season and in additionfor a limited number of weeks before/after the spray season to allow background pesticide metabolite levels to be determined. Selected urine samples will be analysed for the pesticide metabolites of interest. Statistical analysis and mathematical modelling will use the laboratory results, along with the additional data collected from the farmers and residents, to determine systemic exposure levels amongst residents. Surveys will be carried out in selected areas of the United Kingdom over two years (2011 and 2012), covering two spraying seasons and the time between the spraying seasons.</p> <p>Discussion</p> <p>The described study protocol was implemented for the sample and data collection procedures carried out in 2011. Based on experience to date, no major changes to the protocol are anticipated for the 2012 spray season although the pesticides and regional areas for inclusion in 2012 are still to be confirmed.</p