Guidelines: The do's, don'ts and don't knows of direct observation of clinical skills in medical education.

IntroductionDirect observation of clinical skills is a key assessment strategy in competency-based medical education. The guidelines presented in this paper synthesize the literature on direct observation of clinical skills. The goal is to provide a practical list of Do's, Don'ts and Don't Knows about direct observation for supervisors who teach learners in the clinical setting and for educational leaders who are responsible for clinical training programs.MethodsWe built consensus through an iterative approach in which each author, based on their medical education and research knowledge and expertise, independently developed a list of Do's, Don'ts, and Don't Knows about direct observation of clinical skills. Lists were compiled, discussed and revised. We then sought and compiled evidence to support each guideline and determine the strength of each guideline.ResultsA final set of 33 Do's, Don'ts and Don't Knows is presented along with a summary of evidence for each guideline. Guidelines focus on two groups: individual supervisors and the educational leaders responsible for clinical training programs. Guidelines address recommendations for how to focus direct observation, select an assessment tool, promote high quality assessments, conduct rater training, and create a learning culture conducive to direct observation.ConclusionsHigh frequency, high quality direct observation of clinical skills can be challenging. These guidelines offer important evidence-based Do's and Don'ts that can help improve the frequency and quality of direct observation. Improving direct observation requires focus not just on individual supervisors and their learners, but also on the organizations and cultures in which they work and train. Additional research to address the Don't Knows can help educators realize the full potential of direct observation in competency-based education

Evaluating surgical skills from kinematic data using convolutional neural networks

The need for automatic surgical skills assessment is increasing, especially because manual feedback from senior surgeons observing junior surgeons is prone to subjectivity and time consuming. Thus, automating surgical skills evaluation is a very important step towards improving surgical practice. In this paper, we designed a Convolutional Neural Network (CNN) to evaluate surgeon skills by extracting patterns in the surgeon motions performed in robotic surgery. The proposed method is validated on the JIGSAWS dataset and achieved very competitive results with 100% accuracy on the suturing and needle passing tasks. While we leveraged from the CNNs efficiency, we also managed to mitigate its black-box effect using class activation map. This feature allows our method to automatically highlight which parts of the surgical task influenced the skill prediction and can be used to explain the classification and to provide personalized feedback to the trainee.Comment: Accepted at MICCAI 201

Evolution of structure and local magnetic fields during crystallization of HITPERM glassy alloys studied by in situ diffraction and nuclear forward scattering of synchrotron radiation

Evolution of structure and local magnetic fields in Fe1 xCox 76Mo8Cu1B15 HITPERM metallic glass ribbons with various amounts of Co x 0, 0.25, 0.5 were studied in situ using diffraction and nuclear forward scattering of synchrotron radiation. It was found that crystallization for all three glasses proceeds in two stages. In the first stage, bcc Fe,Co nanocrystals are formed, while in the second stage additional crystalline phases evolve. For all three glasses, the crystallization temperatures at the wheel side were found to be lower than at the air side of the ribbon. The crystallization temperatures were found to decrease with increasing Co content. The lattice parameters of the bcc nanocrystals decrease up to about 550 C and then increase pointing to squeezing Mo atoms out of the nanograins or to interface effects between the nanocrystals and the glassy matrix. Nuclear forward scattering enabled separate evaluation of the contributions that stem from structurally different regions within the investigated samples including the newly formed nanocrystals and the residual amorphous matrix. Even minor Co content x 0.25 has a substantial effect not only upon the magnetic behaviour of the alloy but also upon its structure. Making use of hyperfine magnetic fields, it was possible to unveil structurally diverse positions of Fe atoms that reside in a nanocrystalline lattice with different number of Co nearest neighbour

Recent Data to the Distribution of Western Corn Rootworm (Diabrotica virgifera virgifera LeConte) in Hungary

The Hungarian plant protection organization has been performing western corn rootworm moni- toring over the past four years.In 1998 three different trapping activities were carried out at 150 monitoring sites.Hungarian pheromone traps and Multigard ®(yellow sticky)traps were used from July 1 to September 30.The number of catches and the average catches/trap in 1998 were lower than the catch numbers in 1997. In 1998,the pest spread to a lesser degree than in 1997

Strengthening Âhkamêyimo among Indigenous youth: The social determinants of health, justice, and resilience in Canada’s north

The wellbeing of Indigenous youth living in Canada’s northern communities continues to lag behind the rest of the Canadian population. To a large extent, these health inequities are perpetuated by processes of colonisation that significantly impact the social determinants of health in Canada’s Indigenous north. The purpose of this article is to review the history of colonisation and its impacts on the wellbeing of Indigenous youth in Canada’s north, as well as processes of resilience that have helped Indigenous youth live healthy lives despite social challenges. Academic articles published between 2000 and 2016 outlining resilience from Indigenous perspectives are reviewed in the contexts of Canada’s Indigenous north. Analysis focuses on what insights about resilience emerge from Indigenous communities, particularly as they related to the health inequities of circumpolar regions. The concept of Âhkamêyimo is discussed and how systems of Indigenous knowledge offer important insights into resilience in general, and can be utilised in health promotion, education, and prevention programs targeting Indigenous youth in northern Canada. We conclude that attention should be turned toward issues of social justice and health equity that are desperately needed in order to create healthy environments whereby Indigenous youth within northern Canadian communities can be assisted to flourish

An Ecosystem-Scale Model for the Spread of a Host-Specific Forest Pathogen in the Greater Yellowstone Ecosystem

The introduction of nonnative pathogens is altering the scale, magnitude, and persistence of forest disturbance regimes in the western United States. In the high-altitude whitebark pine (Pinus albicaulis) forests of the Greater Yellowstone Ecosystem (GYE), white pine blister rust (Cronartium ribicola) is an introduced fungal pathogen that is now the principal cause of tree mortality in many locations. Although blister rust eradication has failed in the past, there is nonetheless substantial interest in monitoring the disease and its rate of progression in order to predict the future impact of forest disturbances within this critical ecosystem. This study integrates data from five different field-monitoring campaigns from 1968 to 2008 to create a blister rust infection model for sites located throughout the GYE. Our model parameterizes the past rates of blister rust spread in order to project its future impact on high-altitude whitebark pine forests. Because the process of blister rust infection and mortality of individuals occurs over the time frame of many years, the model in this paper operates on a yearly time step and defines a series of whitebark pine infection classes: susceptible, slightly infected, moderately infected, and dead. In our analysis, we evaluate four different infection models that compare local vs. global density dependence on the dynamics of blister rust infection. We compare models in which blister rust infection is: (1) independent of the density of infected trees, (2) locally density-dependent, (3) locally density-dependent with a static global infection rate among all sites, and (4) both locally and globally density-dependent. Model evaluation through the predictive loss criterion for Bayesian analysis supports the model that is both locally and globally density-dependent. Using this best-fit model, we predicted the average residence times for the four stages of blister rust infection in our model, and we found that, on average, whitebark pine trees within the GYE remain susceptible for 6.7 years, take 10.9 years to transition from slightly infected to moderately infected, and take 9.4 years to transition from moderately infected to dead. Using our best-fit model, we project the future levels of blister rust infestation in the GYE at critical sites over the next 20 years

The Interpersonal Skills of Community-Engaged Scholarship: Insights From Collaborators Working at the University of Saskatchewan’s Community Engagement Office

Perhaps more clearly than other research approaches, community-based research or engaged scholarship involves both technical skills of research expertise and scientific rigor as well as interpersonal skills of relationship building, effective communication, and moral ways of being. In an academic age concerned with scientific precision, cognitive skills, quantification, and reliable measurements, the interpersonal skills required for research—and particularly community-based research and engaged scholarship—demand growing importance and resources in contemporary discourse and practice. Focused around the University of Saskatchewan’s Community Engagement Office located in the inner city of Saskatoon, Saskatchewan, the authors draw on over 50 years of collective experience to offer critical reflections on the notion of interpersonal skills in community-engaged scholarship that manifest particularly in place-based contexts of Indigenous community partnerships. Overall, we argue that discourse and practice involving community-engaged scholarship must pay attention to the notion of interpersonal skills in various aspects and across multiple dimensions and disciplines. This approach is crucial to ensure that research is done effectively and ethically, that good quality data are produced from such research, that subtle, systematic forms of micro-aggression and oppression are minimized, and that community voices and knowledge have a meaningful and significant place in scholarship activities

Long-term clinical effects of ventricular pacing reduction with a changeover mode to minimize ventricular pacing in a general pacemaker population

AIM: Right ventricular pacing (VP) has been hypothesized to increase the risk in heart failure (HF) and atrial fibrillation (AF). The ANSWER study evaluated, whether an AAI-DDD changeover mode to minimize VP (SafeR) improves outcome compared with DDD in a general dual-chamber pacemaker population. METHODS AND RESULTS: ANSWER was a randomized controlled multicentre trial assessing SafeR vs. standard DDD in sinus node disease (SND) or AV block (AVB) patients. After a 1-month run-in period, they were randomized (1 : 1) and followed for 3 years. Pre-specified co-primary end-points were VP and the composite of hospitalization for HF, AF, or cardioversion. Pre-specified secondary end-points were cardiac death or HF hospitalizations and cardiovascular hospitalizations. ANSWER enrolled 650 patients (52.0% SND, 48% AVB) at 43 European centres and randomized in SafeR (n = 314) or DDD (n = 318). The SafeR mode showed a significant decrease in VP compared with DDD (11.5 vs. 93.6%, P < 0.0001 at 3 years). Deaths and syncope did not differ between randomization arms. No significant difference between groups [HR = 0.78; 95% CI (0.48-1.25); P = 0.30] was found in the time to event of the co-primary composite of hospitalization for HF, AF, or cardioversion, nor in the individual components. SafeR showed a 51% risk reduction (RR) in experiencing cardiac death or HF hospitalization [HR = 0.49; 95% CI (0.27-0.90); P = 0.02] and 30% RR in experiencing cardiovascular hospitalizations [HR = 0.70; 95% CI (0.49-1.00); P = 0.05]. CONCLUSION: SafeR safely and significantly reduced VP in a general pacemaker population though had no effect on hospitalization for HF, AF, or cardioversion, when compared with DDD