A seven-year review (2011-17) of the work-based assessment component of Malta’s Specialist Training Programme in Family Medicine

Background: Work-based assessment (WBA) within Malta’s Specialist Training Programme in Family Medicine is recorded using the ‘One-to-One Appraisal’ form in the General Practitioner (GP) Trainee Educational ePortfolio. -- Objectives: The postgraduate training coordinators in family medicine review the above annually to see where the WBA is operating well and to identify where improvements are required. -- Method: The ‘One-to-One Appraisal’ involves the completion of a scoring system (selecting one score from ‘needs further development’: 1-2-3; ‘competent’: 4-5-6; and ‘excellent’: 7-8-9) for twelve competency areas. The educational portfolio is reviewed using objective requirements listed in the form ‘Review of the GP Trainee Educational Portfolio’. -- Results: The review of educational portfolios revealed commendable practices including detailed educational plans and case-logs, a general trend of adherence to time frames, and high attendance rates for group-teaching sessions. While One-to-One Appraisal documents were filled in satisfactorily, the issue of remarkably high average scoring was encountered. Moreover disparities were seen between scores and comments in some of the ‘GP trainee interim review by GP trainer’ forms. Deficiencies were outlined in clinical supervision time, mainly during family medicine government placements, while incomplete adherence to placement requirements was noticed. -- Conclusion: A significant amount of quality work was carried out by the GP trainees under their trainers’ supervision. Two main areas of improvement were however outlined – the need for refining the GP trainers’ score allocation and the importance of regular review of the portfolio by both trainees and trainers, with the prompt flagging of persisting unresolved issues to the training coordinators.peer-reviewe

Work-based assessment within Malta’s specialist training programme in family medicine

The Specialist Training Programme in Family Medicine (STPFM) – Malta was drawn up by the Malta College of Family Doctors in 2006, approved by Malta’s Specialist Accreditation Committee, and launched in 2007 by the Primary Health Care Department and the Malta College of Family Doctors. This article regarding the work-based assessment of specialist training in family medicine in Malta was prepared by consulting various local / international documents and publications that are related to general practice / family medicine and its teaching, appraisal and assessment. Assessment of family doctors should consider their actual performance of different tasks in diverse settings of daily practice; this is carried out on-site by direct observation of the practitioner at the work-place (work-based assessment) using different methods.peer-reviewe

Specialist training in family medicine in Malta during 2007-2012 : a comparative evaluation of the first and fifth years of the programme

As a result of Malta’s entry to the European Union in 2004, Family Medicine was recognised as a speciality and subsequently a three-year programme of Specialist Training was launched in 2007 by the Primary Health Care Department and the Malta College of Family Doctors. By 2012, three cohorts of GP trainees had completed the training programme. Evaluation is important in ensuring quality and success in provision of teaching programmes in general, and family-doctor training in particular. While evaluation and improvement of the programme is performed on an ongoing basis, a comparison of the trainees’ evaluations of the first (2007-8) and fifth (2011-2) years of the training programme was carried out in order to identify areas where consolidation or further improvement was needed. Evaluation forms are completed by trainees after each post in family or hospital practice and after each group-teaching session. The information from these forms is transcribed into MS Excel to enable quantitative and qualitative analysis. The feedback given during the period 2007 – 2008 was compared with that given during 2011 – 2012. During the first and fifth years of the training programme, GP trainees were 80-90% satisfied with the effectiveness of the training provided during the family practice posts, and over 90% satisfied with the presentation, content and relevance of the teaching provided during the group teaching sessions. Their overall satisfaction with the effectiveness of training in the other specialities improved from 53-92% to 65-95%. While GP trainees’ satisfaction with their training generally remained high or improved, specific areas were identified in family medicine and hospital placements where changes for improvement are merited.peer-reviewe

Empowering the continuing professional development of general practitioner trainers in Malta through educational needs assessment

Background It has been recommended that GP trainers in Malta undergo continuing professional development (CPD) in education and assessment through participation in regular meetings. Aim To encourage GP trainers to organise on-going CPD activities, and thus improve the training they provide, through an assessment of their educational needs. Method In 2015, two UK questionnaires used to evaluate specialist training provided by GP trainers were consulted in the development of online surveys for completion by current and recent GP trainees and trainers in Malta. The information collected was presented to two small groups of trainers for categorisation using an ‘urgent/important/ less urgent/less important’ grid. Results In reply to the question ‘What are your current development needs?’, the top answers from trainers included developing teaching skills, keeping abreast with medical knowledge, and regular meetings with other GP trainers to discuss problems and share experiences. The trainees’ top answers to the question ‘What should the GP trainer do differently?’ were ‘nothing’, being up-to-date regarding guidelines, and providing “examoriented” feedback. The most important and urgent recommendations made during the trainers’ small group meetings included regular peer-support meetings between GP trainers to share teaching experiences and discuss problems, regular updates regarding guidelines and protocols recommended for exams, and more examoriented training to be provided to trainees. Conclusion The educational needs assessment carried out provided useful information that enabled the set-up of regular CPD meetings for GP trainers in Malta, thus meeting their educational needs and hopefully benefiting the quality of training provided to GP trainees.peer-reviewe

Temporal characterization of individual harmonics of an attosecond pulse train by THz streaking

We report on the global temporal pulse characteristics of individual harmonics in an attosecond pulse train by means of photo-electron streaking in a strong low-frequency transient. The scheme allows direct retrieval of pulse durations and first order chirp of individual harmonics without the need of temporal scanning. The measurements were performed using an intense THz field generated by tilted phase front technique in LiNbO_3 . Pulse properties for harmonics of order 23, 25 and 27 show that the individual pulse durations and linear chirp are decreasing by the harmonic order

Comparing GP trainees’ evaluations of placements within Malta’s Specialist Training Programme in Family Medicine before and after a COVID-19 pandemic related break in training

BACKGROUND: Malta’s Specialist Training Programme in Family Medicine lasts for three years, made up of three six-month training posts in family medicine interspersed with other-speciality placements lasting eighteen months in all. As a result of the COVID-19 pandemic, all training was suspended from 23 March to 5 July 2020.OBJECTIVE: A comparison of GP trainees’ evaluations of their training placements during the six-month periods before and after the training break was carried out to identify if and how training was affected by the pandemic and what corrective measures or improvements were needed.METHOD: Training placements are evaluated by GP trainees through online forms on their ePortfolio. The information from these forms was transcribed into Microsoft Excel to enable quantitative and qualitative analysis. Feedback given for posts during October 2019 to March 2020 (i.e. prior to the COVID-19 enforced break in training) was compared with that given during July-December 2020.RESULTS: GP trainees were satisfied overall with the teaching provided during the family practice and other-speciality posts. Post-break satisfaction ratings in government health centres rose while those for private general practice declined, both as a consequence of the pandemic. While a post-break drop in satisfaction ratings for Paediatrics was attributed to the pandemic, similar declines for Taster and Orthopaedics posts were unrelated.CONCLUSION: The COVID-19 pandemic affected teaching in government practice positively through reducing patient numbers, which allowed a better training environment. Private practice was affected negatively by the pandemic, namely through limited clinical scenarios for teaching. The post-break drop in ratings for Paediatrics also was attributed to the pandemic which reduced outpatient attendance, doctor-patient interaction and consultation dynamics.RECOMMENDATION: Training during placements within the STPFM can be improved and safeguarded from negative factors such as a pandemic if administrators endeavour to enhance the educational environment.peer-reviewe

Ordinal patterns in epileptic brains: Analysis of intracranial EEG and simultaneous EEG-fMRI

Epileptic seizures are associated with high behavioral stereotypy of the patients. In the EEG of epilepsy patients characteristic signal patterns can be found during and between seizures. Here we use ordinal patterns to analyze EEGs of epilepsy patients and quantify the degree of signal determinism. Besides relative signal redundancy and the fraction of forbidden patterns we introduce the fraction of under-represented patterns as a new measure. Using the logistic map, parameter scans are performed to explore the sensitivity of the measures to signal determinism. Thereafter, application is made to two types of EEGs recorded in two epilepsy patients. Intracranial EEG shows pronounced determinism peaks during seizures. Finally, we demonstrate that ordinal patterns may be useful for improving analysis of non-invasive simultaneous EEG-fMR

Single-Trial Recognition of Video Gamer’s Expertise from Brain Haemodynamic and Facial Emotion Responses

With an increase in consumer demand of video gaming entertainment, the game industry is exploring novel ways of game interaction such as providing direct interfaces between the game and the gamers’ cognitive or affective responses. In this work, gamer’s brain activity has been imaged using functional near infrared spectroscopy (fNIRS) whilst they watch video of a video game (League of Legends) they play. A video of the face of the participants is also recorded for each of a total of 15 trials where a trial is defined as watching a gameplay video. From the data collected, i.e., gamer’s fNIRS data in combination with emotional state estimation from gamer’s facial expressions, the expertise level of the gamers has been decoded per trial in a multi-modal framework comprising of unsupervised deep feature learning and classification by state-of-the-art models. The best tri-class classification accuracy is obtained using a cascade of random convolutional kernel transform (ROCKET) feature extraction method and deep classifier at 91.44%. This is the first work that aims at decoding expertise level of gamers using non-restrictive and portable technologies for brain imaging, and emotional state recognition derived from gamers’ facial expressions. This work has profound implications for novel designs of future human interactions with video games and brain-controlled games

Quality improvement through evaluation of GP trainers’ continuing professional development in Malta

BACKGROUND: Mandatory trainer continuing professional development (CPD) sessions were held during 2019 for each GP trainer actively involved in the Specialist Training Programme in Family Medicine – Malta.OBJECTIVE: GP trainer CPD sessions were evaluated to improve the quality of the provided CPD that was intended to refine their assessment skills.METHOD: Participants were sent a link to an electronic feedback form to complete anonymously using Google Forms. The responses were exported into Microsoft Excel to enable analysis, both quantitatively and qualitatively using item content analysis.RESULTS: Twenty-six GP trainers completed the feedback questionnaire, giving a response rate of 46%. Positive comments were made regarding the relevance and group dynamics of the sessions (marked as 3 or more out of 5) and the ensuing discussion and interaction (81%). Moreover, 42% stated that they would not change anything about the CPD sessions, while 23% gave different comments about their timing. Educational needs identified by participants ranged from technical help (42%) to providing trainee guidance (35%) and self-development (12%). While 38% of respondents wanted further training in assessment and marking, 27% wished to broaden training to include other teaching topics.CONCLUSION: Since the 2019 trainers’ CPD sessions were well-received, it was proposed that in 2020 the topic of assessment should be tackled in more depth, with fine-tuning made of the sessions’ facilitation and timing. Trainer CPD sessions to be held after 2020 could incorporate further recommended topics that are set at different levels for participants with varying levels of knowledge and skills.peer-reviewe