Driving lesson or driving test?:A metaphor to help faculty separate feedback from assessment

Although there is consensus in the medical education world that feedback is an important and effective tool to support experiential workplace-based learning, learners tend to avoid the feedback associated with direct observation because they perceive it as a high-stakes evaluation with significant consequences for their future. The perceived dominance of the summative assessment paradigm throughout medical education reduces learners’ willingness to seek feedback, and encourages supervisors to mix up feedback with provision of ‘objective’ grades or pass/fail marks. This eye-opener article argues that the provision and reception of effective feedback by clinical supervisors and their learners is dependent on both parties’ awareness of the important distinction between feedback used in coaching towards growth and development (assessment for learning) and reaching a high-stakes judgement on the learner’s competence and fitness for practice (assessment of learning). Using driving lessons and the driving test as a metaphor for feedback and assessment helps supervisors and learners to understand this crucial difference and to act upon it. It is the supervisor’s responsibility to ensure that supervisor and learner achieve a clear mutual understanding of the purpose of each interaction (i.e. feedback or assessment). To allow supervisors to use the driving lesson—driving test metaphor for this purpose in their interactions with learners, it should be included in faculty development initiatives, along with a discussion of the key importance of separating feedback from assessment, to promote a feedback culture of growth and support programmatic assessment of competence

Urinary 1-Hydroxypyrene Levels in Workers Exposed to Polycyclic Aromatic Hydrocarbon from Rubber Wood Burning

AbstractBackgroundUrinary 1-hydroxypyrene (1-OHP) was selected as a biomarker of polycyclic aromatic hydrocarbons (PAHs) to explore the accumulation level in the bodies of workers at rubber smoke sheet factories in southern Thailand.MethodsSpot urine samples were taken from four groups of workers from June 2006 to November 2007. The nonexposure or control groups included habitual cigarette smokers and nonsmokers. The other two groups were workers exposed to particle-bound PAHs from rubber wood smoke and they were nonsmokers. All spot urine samples were analyzed for 1-OHP and creatinine levels.ResultsThe mean ± standard deviation urinary 1-OHP in the control group of habitual smokers and the nonsmokers was 0.24 ± 0.16 μmol/mol creatinine and not-detected to 0.14 μmol/mol creatinine, respectively. In the workers, the 1-OHP levels on workdays had no significant difference from the 1-OHP levels on the days off. The yearly average 1-OHP level was 0.76 ± 0.41 μmol/mol creatinine whereas the average 1-OHP level during 10 consecutive workdays was 1.06 ± 0.29 μmol/mol creatinine (p > 0.05).ConclusionThe urinary 1-OHP levels of workers exposed to PAHs were high. The accumulation of 1-OHP in the body was not clear although the workers had long working hours with few days off during their working experience. Therefore, a regular day off schedule and rotation shift work during high productive RSS should be set for RSS workers

Patterns in clinical students’ self-regulated learning behavior: a Q-methodology study

Students feel insufficiently supported in clinical environments to engage in active learning and achieve a high level of self-regulation. As a result clinical learning is highly demanding for students. Because of large differences between students, supervisors may not know how to support them in their learning process. We explored patterns in undergraduate students' self-regulated learning behavior in the clinical environment, to improve tailored supervision, using Q-methodology. Q-methodology uses features of both qualitative and quantitative methods for the systematic investigation of subjective issues by having participants sort statements along a continuum to represent their opinion. We enrolled 74 students between December 2014 and April 2015 and had them characterize their learning behavior by sorting 52 statements about self-regulated learning behavior and explaining their response. The statements used for the sorting were extracted from a previous study. The data was analyzed using by-person factor analysis to identify clusters of individuals with similar sorts of the statements. The resulting factors and qualitative data were used to interpret and describe the patterns that emerged. Five resulting patterns were identified in students' self-regulated learning behavior in the clinical environment, which we labelled: Engaged, Critically opportunistic, Uncertain, Restrained and Effortful. The five patterns varied mostly regarding goals, metacognition, communication, effort, and dependence on external regulation for learning. These discrete patterns in students' self-regulated learning behavior in the clinical environment are part of a complex interaction between student and learning context. The results suggest that developing self-regulated learning behavior might best be supported regarding individual students' need

Using a Smartphone App and Coaching Group Sessions to Promote Residents' Reflection in the Workplace

Item does not contain fulltextPROBLEM: Reflecting on workplace-based experiences is necessary for professional development. However, residents need support to raise their awareness of valuable moments for learning and to thoughtfully analyze those learning moments afterwards. APPROACH: From October to December 2012, the authors held a multidisciplinary six-week postgraduate training module focused on general competencies. Residents were randomly assigned to one of four conditions with varying degrees of reflection support; they were offered (1) a smartphone app, (2) coaching group sessions, (3) a combination of both, or (4) neither type of support. The app allowed participants to capture in real time learning moments as a text note, audio recording, picture, or video. Coaching sessions held every two weeks aimed to deepen participants' reflection on captured learning moments. Questionnaire responses and reflection data were compared between conditions to assess the effects of the app and coaching sessions on intensity and frequency of reflection. OUTCOMES: Sixty-four residents participated. App users reflected more often, captured more learning moments, and reported greater learning progress than nonapp users. Participants who attended coaching sessions were more alert to learning moments and pursued more follow-up learning activities to improve on the general competencies. Those who received both types of support were most alert to these learning moments. NEXT STEPS: A simple mobile app for capturing learning moments shows promise as a tool to support workplace-based learning, especially when combined with coaching sessions. Future research should evaluate these tools on a broader scale and in conjunction with residents' and students' personal digital portfolios

Outcome measurement instruments for peripheral vascular malformations and an assessment of the measurement properties: a systematic review

© 2019, The Author(s). Purpose: The Outcome measures for vascular malformation (OVAMA) group reached consensus on the core outcome domains for the core outcome set (COS) for peripheral vascular malformations (venous, lymphatic and arteriovenous malformations). However, it is unclear which instruments should be used to measure these domains. Therefore, our aims were to identify all outcome measurement instruments available for vascular malformations, and to evaluate their measurement properties. Methods: With the first literature search, we identified outcomes and instruments previously used in prospective studies on vascular malformations. A second search yielded studies on measurement properties of patient- and physician-reported instruments that were either developed for vascular malformations, or used in prospective studies. If the latter instruments were not specifically validated for vascular malformations, we performed a third search for studies on measurement properties in clinically similar diseases (vascular or lymphatic diseases and benign tumors). We assessed the methodological quality of these studies following the Consensus-based Standards for the selection of health Measurement Instruments methodology, and evaluated the quality of the measurement properties. Results: The first search yielded 27 studies, none using disease-specific instruments. The second and third search included 22 development and/or validation studies, concerning six instruments. Only the Lymphatic Malformation Function Instrument was developed specifically for vascular malformations. Other instruments were generic QoL instruments developed and/or partly validated for clinically similar diseases. Conclusions: Additional research on measurement properties is needed to assess which instruments may be included in the COS. This review informs the instrument selection and/or the development of new instruments. Systematic review registration: PROSPERO, 42017056242

Intracoronary infusion of mononuclear cells after PCI-treated myocardial infarction and arrhythmogenesis: is it safe?

To reduce long-term morbidity after revascularised acute myocardial infarction, different therapeutic strategies have been investigated. Cell therapy with mononuclear cells from bone marrow (BMMC) or peripheral blood (PBMC) has been proposed to attenuate the adverse processes of remodelling and subsequent heart failure. Previous trials have suggested that cell therapy may facilitate arrhythmogenesis. In the present substudy of the HEBE cell therapy trial, we investigated whether intracoronary cell therapy alters the prevalence of ventricular arrhythmias after 1 month or the rate of severe arrhythmogenic events (SAE) in the first year. In 164 patients of the trial we measured function and infarct size with cardiovascular magnetic resonance (CMR) imaging. Holter registration was performed after 1 month from which the number of triplets (3 successive PVCs) and ventricular tachycardias (VT, ≥4 successive PVCs) was assessed. Thirty-three patients (20%) showed triplets and/or VTs, with similar distribution amongst the groups (triplets: control n = 8 vs. BMMC n = 9, p = 1.00; vs. PBMC n = 10, p = 0.67. VT: control n = 9 vs. BMMC n = 9, p = 0.80; vs. PBMC n = 11, p = 0.69). SAE occurred in 2 patients in the PBMC group and 1 patient in the control group. In conclusion, intracoronary cell therapy is not associated with an increase in ventricular arrhythmias or SAE