Using High-fidelity Medical Simulation to Assess Critical Thinking in Medical Students

Problem Graduating competent physicians is an imperative societal need. The development of critical thinking skills during medical school is important to meet this societal need and for the care of ill patients. Research shows this skill is key in decreasing medical errors, which in turn decreases cost. (Norman and Eva, 2010) Missing from the literature is a method to assess critical thinking in the setting of caring for the critically ill patient. This instrumental case study tests medical simulation as a method of assessing critical thinking, which incorporates all six competency domains, by looking at the assessment environment, summative patient experience, and participant\u27s reflection on the case and environment. Method A qualitative instrumental case study design was used to evaluate twelve senior medical students\u27 critical thinking skills in the setting of identified competency domains. A single simulation patient encounter was administered to each student and data collected from the videotape of the encounter, their written documentation, and oral presentation of the case, mimicking the real-life scenario. The participants were also asked five questions regarding this case. These data were analyzed and presented in narrative format. Results The analysis revealed six major themes: assessment environment, coalescence of knowledge and skills, decision-making and deep thinking/reasoning, integrative experience, lack of depth in thought process, and safe environment. This research identified gaps in the students\u27 knowledge, skill, and behaviors of competency domains as they apply to critical thinking. Despite all students successfully completing medical school, errors were made in their individual care of the simulated patient. Four cases ended in death of the patient. The documentation of their patient encounter also lacked sufficient detail to allow other medical professionals to understand the issues during the case. The students\u27 opinion of the patient encounter was positive. Several students noted they had not had similar encounters as the sole provider of patient care. The experience gave them the opportunity to apply what they had learned and reflect on their gaps in knowledge. Conclusions The ability for physicians to think critically is key in reducing medical errors. An effective instrument to assess critical thinking as it applies to competency is high-fidelity medical simulation. In addition, allowing senior medical students to manage the case as the physician in charge exposes knowledge, skills, and behaviors of critical thinking, making these processes accessible for assessment

ExoMol molecular line lists - XVII The rotation-vibration spectrum of hot SO3_3

Sulphur trioxide (SO$_3$) is a trace species in the atmospheres of the Earth and Venus, as well as well as being an industrial product and an environmental pollutant. A variational line list for $^{32}$S$^{16}$O$_{3}$, named UYT2, is presented containing 21 billion vibration-rotation transitions. UYT2 can be used to model infrared spectra of SO$_3$ at wavelengths longwards of 2 $\mu$m ($\nu < 5000$ cm$^{-1}$) for temperatures up to 800 K. Infrared absorption cross sections are also recorded at 300 and 500 C are used to validate the UYT2 line list. The intensities in UYT2 are scaled to match the measured cross sections. The line list is made available in electronic form as supplementary data to this article and at \url{www.exomol.com}.Comment: 15 pages, 10 figures, 9 tables MNRAS submitte

La enseñanza de los Principios de Economía: propuesta para un enfoque multiparadigmático

Professors Knoedler and Underwood discuss the concern over the decline in the number of economic majors as well as overall the enrolments in economics. For many “mainstream” economic educators this problem obey to the fact that academic economics tend to grant lower grades on average to students, or to the relaxation that business programs have in their entry requirements. The authors attribute the problem to the abstraction and the exclusion that teaching Principles of Economics has. They propose a restatement of this course using a multi-paradigmatic approach that takes into account the ideas of economic thinkers outside the mainstream. Thus, students will overcome their dissatisfaction and they will have a more realistic view of the economy, which will help them to develop and exercise their critical thinking skills.teaching of Economics, principles of economics, general education, multi-paradigmatic approach

Considering Vermont\u27s Future in a Changing Climate: The First Vermont Climate Assessment

The Vermont Climate Assessment (VCA) paints a vivid picture of a changing climate in Vermont and calls for immediate strategic planning to sustain the social, economic and environmental fabric of our state. The VCA is the first state-scale climate assessment in the country and speaks directly to the impacts of climate change as they pertain to our rural towns, cities and communities, including impacts on Vermont tourism and recreation, agriculture, natural resources and energy

An investigation into the history and practice of teaching law as an examination subject in schools

Historical aspects of teaching Law as a school subject are considered in outline in the Prologue to this Thesis. Part 1 discusses the extent to which it is appropriate to teach Law as an examination subject in schools today. This is followed in Part II by an extensive examination of what kind of law may be taught as evidenced by the provision of G.C.E., G.C.S.E. and alternative syllabi. Methodology and pupil perceptions are discussed in Part III, whilst the possibility of truly professional teaching of Law at school level is examined in Part IV. In the final Part, an attempt is made to decide whether Law in schools is - or should be - an end in itself or merely a stepping stone to further study of the subject at a higher level. Finally, the Epilogue seeks to answer to the question as to whether Law has a future as a school examination subject

Remixing Rasmussen: the evolution of Accimaps within systemic accident analysis

Throughout Jens Rasmussen’s career there has been a continued emphasis on the development of methods, techniques and tools for accident analysis and investigation. In this paper we focus on the evolution and development of one specific example, namely Accimaps and their use for accident analysis. We describe the origins of Accimaps followed by a review of 26 studies which have applied and adapted Accimaps over the period 200-2015 to a range of domains and types of accident. Aside from demonstrating the versatility and popularity of the method, part of the motivation for the review of the use of Accimaps is to address the question of what constitutes a sound, usable, valid and reliable approach to systemic accident analysis. The findings from the review demonstrate continuity with the work carried out by Rasmussen, as well as significant variation (e.g., changes to the Accimap, used of additional theoretical and practice-oriented perspectives on safety). We conclude the paper with some speculations regarding future extension and adaptation of the Accimap approach including the possibility of using hybrid models for accident analysis

Seagrass Health Modeling and Prediction with NASA Science Data

Previous research has demonstrated that MODIS data products can be used as inputs into the seagrass productivity model developed by Fong and Harwell (1994). To further explore this use to predict seagrass productivity, Moderate Resolution Imaging Spectroradiometer (MODIS) custom data products, including Sea Surface Temperature, Light Attenuation, and Chlorophyll-a have been created for use as model parameter inputs. Coastal researchers can use these MODIS data products and model results in conjunction with historical and daily assessment of seagrass conditions to assess variables that affect the productivity of the seagrass beds. Current monitoring practices involve manual data collection (typically on a quarterly basis) and the data is often insufficient for evaluating the dynamic events that influence seagrass beds. As part of a NASA-funded research grant, the University of Mississippi, is working with researchers at NASA and Radiance Technologies to develop methods to deliver MODIS derived model output for the northern Gulf of Mexico (GOM) to coastal and environmental managers. The result of the project will be a data portal that provides access to MODIS data products and model results from the past 5 years, that includes an automated process to incorporate new data as it becomes available. All model parameters and final output will be available through the use National Oceanic and Atmospheric Administration?s (NOAA) Environmental Research Divisions Data Access Program (ERDDAP) tools as well as viewable using Thematic Realtime Environmental Distributed Data Services (THREDDS) and the Integrated Data Viewer (IDV). These tools provide the ability to create raster-based time sequences of model output and parameters as well as create graphs of model parameters versus time. This tool will provide researchers and coastal managers the ability to analyze the model inputs so that the factors influencing a change in seagrass productivity can be determined over time

Protection of cells from salinity stress by extracellular polymeric substances in diatom biofilms.

Diatom biofilms are abundant in the marine environment. It is assumed (but untested) that extracellular polymeric substances (EPS), produced by diatoms, enable cells to cope with fluctuating salinity. To determine the protective role of EPS, Cylindrotheca closterium was grown in xanthan gum at salinities of 35, 50, 70 and 90 ppt. A xanthan matrix significantly increased cell viability (determined by SYTOX-Green), growth rate and population density by up to 300, 2,300 and 200%, respectively. Diatoms grown in 0.75% w/v xanthan, subjected to acute salinity shock treatments (at salinities 17.5, 50, 70 and 90 ppt) maintained photosynthetic capacity, Fq'/Fm', within 4% of pre-shock values, whereas Fq'/Fm' in cells grown without xanthan declined by up to 64% with hypersaline shock. Biofilms that developed in xanthan at standard salinity helped cells to maintain function during salinity shock. These results provide evidence of the benefits of living in an EPS matrix for biofilm diatoms