Assessment of Junior Doctor performance: a validation study

BACKGROUND: In recent years, Australia has developed a National Junior Doctor Curriculum Framework that sets out the expected standards and describes areas of performance for junior doctors and through this has allowed a national approach to junior doctor assessment to develop. Given the significance of the judgments made, in terms of patient safety, development of junior doctors, and preventing progression of junior doctors moving to the next stage of training, it is essential to develop and validate assessment tools as rigorously as possible. This paper reports on a validation study of the Junior Doctor Assessment Tool as used for PGY1 doctors to evaluate the psychometric properties of the instrument and to explore the effect of length of experience as a PGY1 on assessment scores. METHODS: This validation study of the Australian developed Junior Doctor Assessment Tool as it was used in three public and other associated hospitals in Western Australia for PGY1 across a two year period addressed two core aims, namely: (1) to evaluate the psychometric properties of the instrument; (2) to explore the effect of length of experience as a PGY1 on assessment scores. RESULTS: The highest mean scores were for professional behaviours, teamwork and interpersonal skills and the lowest were for procedures. Most junior doctors were assessed three or more times and scores were not different in the first rotation compared to subsequent rotations. While statistically significant, there appeared to be little practical influence on scores obtained by the number of times they were assessed. Principal component analysis identified two principal components of junior doctor performance are being assessed rather than the commonly reported three. A Cronbach Alpha of .883 was calculated for the 10 item scale. CONCLUSIONS: Now that the components of the tool have been analysed it will be more meaningful and potentially more influential to consider these factors on the potential educational impact of this assessment process for monitoring junior doctor development and progression

Private specificities can dominate the humoral response to self-antigens in patients with cryptogenic fibrosing alveolitis

BACKGROUND: The pathogenetic mechanisms that underlie the interstitial lung disease cryptogenic fibrosing alveolitis (CFA) may involve an immunological reaction to unidentified antigens in the lung, resulting in tissue damage. METHOD: In order to identify the range of target autoantigens, we used expression cloning, employing serum from an index patient as the probe against an expressed cDNA library that was derived from a tumour cell line. We screened over 5 × 10(5) recombinants and obtained sequence information on three antigens that had provoked strong responses with immunoglobulin heavy chain class switching, presumably as a consequence of T-cell recognition. RESULTS: All of the antigens were identifiable by comparison with sequence data from the US National Center for Biotechnology Information. Alanyl tRNA synthetase (ATS) was picked on six occasions; five of these incidences reflected independent recombination events, indicating that the library was not biased. Antibodies to ATS (anti-PL-12) represent the most common reactivity that defines the antisynthetase syndrome, which is typically expressed as polymyositis, dermatomyositis and interstitial lung disease (ILD). The index patient never showed symptoms other than those associated with alveolitis, even though sera obtained from him over a period of 2 years contained antibodies with the same specificity. Autoantibodies to ATS were never detected in serial bleeds from 11 other patients with CFA, and neither did we detect antibodies to the other two antigens identified from the serum of the index patient. CONCLUSION: The humoral response in patients with CFA can be dominated by autoantibodies with private specificities. This suggests that the antibodies are epiphenomenal and are a secondary feature of tissue damage induced by some other mechanism

A review of the prevalence of physical activity in health professional undergraduate, postgraduate, pre qualification courses and Continuous Professional Development activities

'Let's Make Scotland More Active' was published in 2003 by the then Scottish Executive and sets out the recommendations for increasing levels of physical activity (PA) within the population. One of the key strategy recommendations was that all patients coming into contact with primary care professionals should be offered screening and appropriate counselling for PA tailored to individual needs (paragraph 142). NHS Health Scotland has a range of existing and planned learning products and services aimed at influencing knowledge, attitudes and behaviour in the area of physical activity among the practitioner and wider health improvement workforces. These resources and services seek to encourage health professionals to increasingly deliver PA brief advice as an intervention in the care of their patients. However, it is not clear whether they are being used, or indeed the extent to which physical activity and its benefits are being taught to health professionals during undergraduate, post graduate and CPD training

Designing and implementing a skills program Using a clinically integrated, multi-professional approach: Using evaluation to drive curriculum change

The essential procedural skills that newly graduated doctors require are rarely defined, do not take into account pre-vocational employer expectations, and differ between Universities. This paper describes how one Faculty used local evaluation data to drive curriculum change and implement a clinically integrated, multi-professional skills program. A curriculum restructure included a review of all undergraduate procedural skills training by academic staff and clinical departments, resulting in a curriculum skills map. Undergraduate training was then linked with postgraduate expectations using the Delphi process to identify the skills requiring structured standardised training. The skills program was designed and implemented without a dedicated simulation center. This paper shows the benefits of an alternate model in which clinical integration of training and multi-professional collaboration encouraged broad ownership of a program and, in turn, impacted the clinical experience obtained

Artificial Intelligence (AI) Solutions In English Language Teaching: Teachers-Students Perceptions And Experiences

This literature research article explores the perceptions and experiences of teachers and students regarding Artificial Intelligence (AI) solutions in English language teaching. With the rapid advancements in AI technologies, there is a growing interest in leveraging these tools to enhance language learning experiences. Understanding the perspectives of teachers and students is crucial for successful implementation and to harness the potential benefits of AI in the field of English language education. The study adopts a mixed-methods research approach, incorporating both quantitative and qualitative methods. A survey was conducted to gather quantitative data on participants' attitudes, beliefs, and experiences related to AI integration. Additionally, in-depth interviews and focus group discussions were conducted to obtain qualitative insights and delve into participants' perceptions and challenges. The findings of the study reveal positive attitudes towards AI solutions in English language teaching, with participants highlighting the effectiveness of AI technologies in improving language skills and providing personalized instruction. The adaptive nature of AI tools was valued for its ability to cater to individual needs and offer immediate feedback. However, concerns were raised regarding technological readiness and the need for training and support in effectively utilizing AI solutions. These findings have implications for educators, policymakers, and curriculum developers, highlighting the need for technological readiness, teacher training, and support in implementing AI solutions effectively. By embracing the potential of AI while preserving the human element, English language teaching can benefit from personalized and adaptive learning experiences

Participation of women in HIV clinical trials: the IPEC-FIOCRUZ experience

Jordan E Lake1, Ruth K Friedman2, Cynthia B Cunha2, Sandra W Cardoso2, Valdilea G Veloso2, Judith S Currier1, Beatriz Grinsztejn21Division of Infectious Diseases, University of California at Los Angeles, Los Angeles, CA, USA; 2Fundação Oswaldo Cruz – Instituto de Pesquisa Clínica Evandro Chagas/IPEC, Rio de Janeiro, State of Rio de Janeiro, BrazilBackground: Fifty percent of people living with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) worldwide are female. In Brazil, for example, 240,000 women are infected with HIV, rates of infection in women have increased over the last two decades, and addressing HIV prevention and treatment for women at risk for, or living with, HIV/AIDS remains a challenge. To better address the needs of women living with HIV in Brazil, the Instituto de Pesquisa Clínica Evandro Chagas – Fundação Oswaldo Cruz (IPEC-FIOCRUZ) HIV Women’s Cohort was established in 1996 to study the natural history of women seeking HIV care. This analysis describes the characteristics of women in the cohort who participated in HIV clinical trials between 1999 and 2008.Methods: A total of 736 Women’s Cohort participants were in active follow-up and 665 participants from the Women’s Cohort were included in univariable and multivariable analyses to determine socioeconomic and sociodemographic factors associated with women’s participation in HIV clinical trials at our site.Results: Of the complete cohort, 23% participated in a clinical trial between January 1999 and July 2008. Odds of participation decreased for women who were younger than 35 years old, currently employed, had an HIV-positive sexual partner, and/or who reported a lifetime history of illicit drug use. Alternatively, the odds of participation increased for women who had more than 8 years of formal education, were living independently, and/or were married or cohabitating.Conclusion: The rate of participation in HIV clinical trials by women in the IPEC-Fiocruz Cohort was similar to other published cohorts, but identification of local risk factors and barriers to participation remains important. Our analysis offers a novel description of the factors associated with participation in HIV clinical trials among women in care at IPEC-FIOCRUZ in Rio de Janeiro, Brazil.Keywords: AIDS, Brazil, South America, clinical trial participation&nbsp

Contagion or Confusion? Why Conflicts Cluster in Space

Civil wars cluster in space as well as time. In this study, we develop and evaluate empirically alternative explanations for this observed clustering. We consider whether the spatial pattern of intrastate conflict simply stems from a similar distribution of relevant country attributes or whether conflicts indeed constitute a threat to other proximate states. Our results strongly suggest that there is a genuine neighborhood effect of armed conflict, over and beyond what individual country characteristics can account for. We then examine whether the risk of contagion depends on the degree of exposure to proximate conflicts. Contrary to common expectations, this appears not to be the case. Rather, we find that conflict is more likely when there are ethnic ties to groups in a neighboring conflict and that contagion is primarily a feature of separatist conflicts. This suggests that transnational ethnic linkages constitute a central mechanism of conflict contagion. © 2008 International Studies Association