Medical students' perceptions of their development of ‘soft skills' Part II : The development of ‘soft skills' through ‘guiding and growing'

BackgroundThis paper reports on medical students' views on the ways in which their ‘soft skills' were developed. It is the result of a study on soft skills among two groups of students before and after curriculum reform at the School of Medicine of the University of Pretoria. One of the aims of the reform was to provide more teaching and learning opportunities for the development of soft skills. Soft skills include professional interpersonal and social skills, communication skills, and professional and ethical attitudes.MethodsAs symbolic interactionism was used as the theoretical framework to guide the research, qualitative methods were used to collect the data. A purposive-theoretical sample of 42 final-year medical students from the traditional curriculum and 49 from the reformed curriculum was recruited. Data were collected by means of focus groups, individual in-depth interviews and autobiographical sketches. ResultsThe same categories of comments emerged from the data collected from the study participants from both the traditional and the reformed curriculum. The students ascribed their behaviour related to soft skills to personality and innate features. They had varying opinions on whether soft skills could be taught, but there was as a strong feeling that teaching should focus on principles and guidelines for dealing with difficult situations. They believed that, in the end, they should take responsibility for their own development of soft skills. Most participants felt they could at least grow through exposure to teaching activities and the observation of role models. They also indicated that they had developed their soft skills and constructed their own identity through their interaction with others. Their definition of situations was shaped by their interactions with doctors and educators, fellow students and other health professionals. Interaction with patients was considered the most important. For both groups of students their third year was a watershed, as it is the first year of more intensive patient contact and the beginning of serious learning from interaction with patients. The views on the development of soft skills differed very little between the traditional and reformed curriculum groups, except that students who had followed the reformed curriculum felt more prepared through the increased teaching and training efforts. Further consideration needs to be given to the intention of the changed curriculum compared to the actual effect. The way in which the participants in the study described their development of soft skills could be categorised as a complex interplay between ‘being' and ‘becoming'. Instead of using the word ‘acquisition' of soft skills, ‘development' seemed to be more appropriate. The metaphor of ‘guiding' and ‘growing' also captures the development of these skills better than the terms ‘teaching' and ‘learning'.ConclusionTeaching activities in the clinical years should be adapted with a view to facilitating the students' professional growth. New models for the development of medical educators should be created and institutional barriers should be investigated.For full text, click here: SA Fam Pract 2006;48(8):15-15

The conceptualisation of "soft skills" among medical students before and after curriculum reform

Objective: This paper reports on the conceptualisation of "soft skills" as part of a study carried out among two groups of undergraduate medical students before and after curriculum reform at the School of Medicine of the University of Pretoria. Congruent with a call from the World Psychiatric Association, the curriculum reform that was undertaken aimed, inter alia, to place more emphasis on soft skills, including professional interpersonal and social skills, communication skills, and professional and ethical attitudes. Methods: Qualitative methods were used to arrive at a descriptive comparison of the conceptualisation of soft skills by final-year medical students of the traditional curriculum with those of final-year students who had followed the reformed curriculum. A purposive-theoretical sampling method was followed; 42 students from the traditional curriculum and 49 from the reformed curriculum were sampled. Data were collected from seven focus groups, 16 individual interviews, and 23 essays (autobiographical sketches). Results: Both groups of students revealed conceptualisations of soft skills that were similar in kind. The themes they pinpointed were the doctor-patient relationship; relationships with other professionals; being a good listener; explaining things to patients; using good communication skills; establishing rapport with patients from different cultural backgrounds; having a professionally correct attitude; being really interested in patients' well being; having empathy; coping with patients, managing difficult situations, and being ethical and professional. However, the traditional curriculum students offered fewer examples and described fewer experiences that exemplified their soft skills. Students following the reformed curriculum gave rich accounts of their conceptualisation in terms of their own experiences and practical examples of how soft skills had been or could be used, particularly in difficult interpersonal situations. Moreover, they came up with helpful ways of dealing with difficult situations, which surpassed the suggestions offered by the students following the traditional curriculum. Conclusion: The educational and training efforts of the reformed curriculum are associated with an adeptness on the part of the students at applying soft skills to the demands of difficult clinical situations. Keywords: soft skills, interpersonal skills, doctor-patient relationship, professional socialisation South African Psychiatry Review Vol. 9(1) 2006: 33-3

Medical students on the value of role models for developing 'soft skills' - "That's the way you do it

Objective: The Soft Skills Project examined the professional development of medical students at the University of Pretoria, especially their doctor-patient interaction skills and professional socialisation. This paper reports on one of the findings of the project, namely the importance that medical students attach to role models in the development of soft skills. Methods: We used a qualitative method with symbolic interactionism and grounded theory as framework. Fourty two final-year students from the last cohort following the traditional curriculum at the University of Pretoria in 2001, and 49 final years from the first cohort following the reformed curriculum in 2002 were recruited. Data were collected by applying focus groups, in-depth, individual interviews, as well as autobiographical sketches. Data were captured by means of audio tape recordings, transcripts of the tapes, researchers' field notes, and written accounts by students, and were analysed by using a general inductive approach. Results: There were no striking differences between the comments of the two groups. Students considered registrars to be the most influential role models in the clinical teaching context, followed by specialist consultants. Their idea of a good role model was a clinically and academically competent doctor that cared about patients, had good interpersonal skills, and who could inspire students. Students needed and appreciated good role models to help them to develop their own soft skills. They expected guidance and behavioural examples from clinical teachers. Although there were competent role models, the students were exposed to poor role models. Poor role models mainly affect students negatively. Students tend to imitate and perpetuate unacceptable behaviour. Furthermore, poor role models have a negative emotional effect on students and are detrimental to their moral and learning environment. Sometimes, poor role models have a paradoxical positive effect in the sense that they inform students how not to behave. Conclusion: Medical schools and medical doctors working with medical students should be consciously aware of the importance of role models both when allocating clinical teachers to students, and while performing duties with students. It is especially necessary to realise that poor role modelling has important detrimental effects on students. Therefore, an attempt should be made to ensure that not only clinical examination skills, but also soft skills, are demonstrated at the bedside. Measures to ensure adequate exposure of students to positive role models could include: staff development; the identification of good role models to guide registrars; and a reallocation of tasks, where possible, to increase the exposure of students to the ‘natural' role models. Keywords: soft skills, role models, medical students, professionalism South African Psychiatry Review Vol. 9(1) 2006: 28-3

Accuracy of genomic breeding values in multi-breed dairy cattle populations

<p>Abstract</p> <p>Background</p> <p>Two key findings from genomic selection experiments are 1) the reference population used must be very large to subsequently predict accurate genomic estimated breeding values (GEBV), and 2) prediction equations derived in one breed do not predict accurate GEBV when applied to other breeds. Both findings are a problem for breeds where the number of individuals in the reference population is limited. A multi-breed reference population is a potential solution, and here we investigate the accuracies of GEBV in Holstein dairy cattle and Jersey dairy cattle when the reference population is single breed or multi-breed. The accuracies were obtained both as a function of elements of the inverse coefficient matrix and from the realised accuracies of GEBV.</p> <p>Methods</p> <p>Best linear unbiased prediction with a multi-breed genomic relationship matrix (GBLUP) and two Bayesian methods (BAYESA and BAYES_SSVS) which estimate individual SNP effects were used to predict GEBV for 400 and 77 young Holstein and Jersey bulls respectively, from a reference population of 781 and 287 Holstein and Jersey bulls, respectively. Genotypes of 39,048 SNP markers were used. Phenotypes in the reference population were de-regressed breeding values for production traits. For the GBLUP method, expected accuracies calculated from the diagonal of the inverse of coefficient matrix were compared to realised accuracies.</p> <p>Results</p> <p>When GBLUP was used, expected accuracies from a function of elements of the inverse coefficient matrix agreed reasonably well with realised accuracies calculated from the correlation between GEBV and EBV in single breed populations, but not in multi-breed populations. When the Bayesian methods were used, realised accuracies of GEBV were up to 13% higher when the multi-breed reference population was used than when a pure breed reference was used. However no consistent increase in accuracy across traits was obtained.</p> <p>Conclusion</p> <p>Predicting genomic breeding values using a genomic relationship matrix is an attractive approach to implement genomic selection as expected accuracies of GEBV can be readily derived. However in multi-breed populations, Bayesian approaches give higher accuracies for some traits. Finally, multi-breed reference populations will be a valuable resource to fine map QTL.</p

Use of partial least squares regression to impute SNP genotypes in Italian Cattle breeds

Background The objective of the present study was to test the ability of the partial least squares regression technique to impute genotypes from low density single nucleotide polymorphisms (SNP) panels i.e. 3K or 7K to a high density panel with 50K SNP. No pedigree information was used. Methods Data consisted of 2093 Holstein, 749 Brown Swiss and 479 Simmental bulls genotyped with the Illumina 50K Beadchip. First, a single-breed approach was applied by using only data from Holstein animals. Then, to enlarge the training population, data from the three breeds were combined and a multi-breed analysis was performed. Accuracies of genotypes imputed using the partial least squares regression method were compared with those obtained by using the Beagle software. The impact of genotype imputation on breeding value prediction was evaluated for milk yield, fat content and protein content. Results In the single-breed approach, the accuracy of imputation using partial least squares regression was around 90 and 94% for the 3K and 7K platforms, respectively; corresponding accuracies obtained with Beagle were around 85% and 90%. Moreover, computing time required by the partial least squares regression method was on average around 10 times lower than computing time required by Beagle. Using the partial least squares regression method in the multi-breed resulted in lower imputation accuracies than using single-breed data. The impact of the SNP-genotype imputation on the accuracy of direct genomic breeding values was small. The correlation between estimates of genetic merit obtained by using imputed versus actual genotypes was around 0.96 for the 7K chip. Conclusions Results of the present work suggested that the partial least squares regression imputation method could be useful to impute SNP genotypes when pedigree information is not available

Within- and across-breed genomic prediction using whole-genome sequence and single nucleotide polymorphism panels

International audienceBackground Currently, genomic prediction in cattle is largely based on panels of about 54k single nucleotide polymorphisms (SNPs). However with the decreasing costs of and current advances in next-generation sequencing technologies, whole-genome sequence (WGS) data on large numbers of individuals is within reach. Availability of such data provides new opportunities for genomic selection, which need to be explored.MethodsThis simulation study investigated how much predictive ability is gained by using WGS data under scenarios with QTL (quantitative trait loci) densities ranging from 45 to 132 QTL/Morgan and heritabilities ranging from 0.07 to 0.30, compared to different SNP densities, with emphasis on divergent dairy cattle breeds with small populations. The relative performances of best linear unbiased prediction (SNP-BLUP) and of a variable selection method with a mixture of two normal distributions (MixP) were also evaluated. Genomic predictions were based on within-population, across-population, and multi-breed reference populations.ResultsThe use of WGS data for within-population predictions resulted in small to large increases in accuracy for low to moderately heritable traits. Depending on heritability of the trait, and on SNP and QTL densities, accuracy increased by up to 31 %. The advantage of WGS data was more pronounced (7 to 92 % increase in accuracy depending on trait heritability, SNP and QTL densities, and time of divergence between populations) with a combined reference population and when using MixP. While MixP outperformed SNP-BLUP at 45 QTL/Morgan, SNP-BLUP was as good as MixP when QTL density increased to 132 QTL/Morgan.ConclusionsOur results show that, genomic predictions in numerically small cattle populations would benefit from a combination of WGS data, a multi-breed reference population, and a variable selection method

Increased RPA1 gene dosage affects genomic stability potentially contributing to 17p13.3 duplication syndrome

A novel microduplication syndrome involving various-sized contiguous duplications in 17p13.3 has recently been described, suggesting that increased copy number of genes in 17p13.3, particularly PAFAH1B1, is associated with clinical features including facial dysmorphism, developmental delay, and autism spectrum disorder. We have previously shown that patient-derived cell lines from individuals with haploinsufficiency of RPA1, a gene within 17p13.3, exhibit an impaired ATR-dependent DNA damage response (DDR). Here, we show that cell lines from patients with duplications specifically incorporating RPA1 exhibit a different although characteristic spectrum of DDR defects including abnormal S phase distribution, attenuated DNA double strand break (DSB)-induced RAD51 chromatin retention, elevated genomic instability, and increased sensitivity to DNA damaging agents. Using controlled conditional over-expression of RPA1 in a human model cell system, we also see attenuated DSB-induced RAD51 chromatin retention. Furthermore, we find that transient over-expression of RPA1 can impact on homologous recombination (HR) pathways following DSB formation, favouring engagement in aberrant forms of recombination and repair. Our data identifies unanticipated defects in the DDR associated with duplications in 17p13.3 in humans involving modest RPA1 over-expression

The impact of genetic relationship information on genomic breeding values in German Holstein cattle

<p>Abstract</p> <p>Background</p> <p>The impact of additive-genetic relationships captured by single nucleotide polymorphisms (SNPs) on the accuracy of genomic breeding values (GEBVs) has been demonstrated, but recent studies on data obtained from Holstein populations have ignored this fact. However, this impact and the accuracy of GEBVs due to linkage disequilibrium (LD), which is fairly persistent over generations, must be known to implement future breeding programs.</p> <p>Materials and methods</p> <p>The data set used to investigate these questions consisted of 3,863 German Holstein bulls genotyped for 54,001 SNPs, their pedigree and daughter yield deviations for milk yield, fat yield, protein yield and somatic cell score. A cross-validation methodology was applied, where the maximum additive-genetic relationship (<it>a</it>_<it>max</it>) between bulls in training and validation was controlled. GEBVs were estimated by a Bayesian model averaging approach (BayesB) and an animal model using the genomic relationship matrix (G-BLUP). The accuracy of GEBVs due to LD was estimated by a regression approach using accuracy of GEBVs and accuracy of pedigree-based BLUP-EBVs.</p> <p>Results</p> <p>Accuracy of GEBVs obtained by both BayesB and G-BLUP decreased with decreasing <it>a</it>_{<it>max </it>}for all traits analyzed. The decay of accuracy tended to be larger for G-BLUP and with smaller training size. Differences between BayesB and G-BLUP became evident for the accuracy due to LD, where BayesB clearly outperformed G-BLUP with increasing training size.</p> <p>Conclusions</p> <p>GEBV accuracy of current selection candidates varies due to different additive-genetic relationships relative to the training data. Accuracy of future candidates can be lower than reported in previous studies because information from close relatives will not be available when selection on GEBVs is applied. A Bayesian model averaging approach exploits LD information considerably better than G-BLUP and thus is the most promising method. Cross-validations should account for family structure in the data to allow for long-lasting genomic based breeding plans in animal and plant breeding.</p

Short-term efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomised placebo-controlled trials.

BACKGROUND: Treatment efficacy of physical agents in osteoarthritis of the knee (OAK) pain has been largely unknown, and this systematic review was aimed at assessing their short-term efficacies for pain relief. METHODS: Systematic review with meta-analysis of efficacy within 1-4 weeks and at follow up at 1-12 weeks after the end of treatment. RESULTS: 36 randomised placebo-controlled trials (RCTs) were identified with 2434 patients where 1391 patients received active treatment. 33 trials satisfied three or more out of five methodological criteria (Jadad scale). The patient sample had a mean age of 65.1 years and mean baseline pain of 62.9 mm on a 100 mm visual analogue scale (VAS). Within 4 weeks of the commencement of treatment manual acupuncture, static magnets and ultrasound therapies did not offer statistically significant short-term pain relief over placebo. Pulsed electromagnetic fields offered a small reduction in pain of 6.9 mm [95% CI: 2.2 to 11.6] (n = 487). Transcutaneous electrical nerve stimulation (TENS, including interferential currents), electro-acupuncture (EA) and low level laser therapy (LLLT) offered clinically relevant pain relieving effects of 18.8 mm [95% CI: 9.6 to 28.1] (n = 414), 21.9 mm [95% CI: 17.3 to 26.5] (n = 73) and 17.7 mm [95% CI: 8.1 to 27.3] (n = 343) on VAS respectively versus placebo control. In a subgroup analysis of trials with assumed optimal doses, short-term efficacy increased to 22.2 mm [95% CI: 18.1 to 26.3] for TENS, and 24.2 mm [95% CI: 17.3 to 31.3] for LLLT on VAS. Follow-up data up to 12 weeks were sparse, but positive effects seemed to persist for at least 4 weeks after the course of LLLT, EA and TENS treatment was stopped. CONCLUSION: TENS, EA and LLLT administered with optimal doses in an intensive 2-4 week treatment regimen, seem to offer clinically relevant short-term pain relief for OAK