Learning approaches used by students in an undergraduate emergency medical care programme

Background. Students may primarily use either a deep learning approach (DLA) or surface learning approach (SLA) in response to their perceptions of the intrinsic and extrinsic factors within a given  learning environment. By determining the learning approaches of students, one can provide important information on how they learn within an educational programme – information that can be used for various applications with regard to future structure and presentation of programme content.Objectives. To determine which learning approaches (DLA or SLA) were being used by students in the Bachelor of Emergency Medical Care programme at the University of Johannesburg, South Africa, in each academic year of study. Further objectives were to determine which intrinsic and extrinsic factors  influenced these choices and to assess whether learning approaches differed significantly between  academic years of study.Methods. This study was conducted using a quantitative design and a validated 20-question survey  instrument. Data analysis was primarily descriptive, but also focused on whether there was a significant difference in learning approaches between the four years of study.Results. Seventy students participated in the study, giving an overall response rate of 85%. Results showed that most students predominantly used a DLA, and that there was no significant difference between the four academic years of study with regard to the predominant learning approach. More students appeared to be influenced to use a DLA by extrinsic factors than intrinsic factors.Conclusion. Further research is needed to determine why students choose SLAs or DLAs, and the  influence of the educational environment on this process

Peer-assisted learning in the prehospital educational setting in South Africa

Abstract:Clinical learning is an important component of health professions training. Peer-assisted learning (PAL) involves students who work in the clinical learning domain, often with their peers. There is a paucity of literature related to PAL in the South African (SA) context. Objectives. To explore the perspectives of SA prehospital emergency care personnel regarding PAL. Methods. A cross-sectional design used a purpose-designed online survey to gather data from qualified prehospital emergency care personnel. Participation was invited by emailing persons registered on a privately managed database. The questionnaire was available for 2 months after the initial email had been sent. The questionnaire used Likert-type scales to measure participant perceptions of specific aspects related to PAL. An open-ended question gathered data on participant perceptions of PAL. Results. Participants recognised PAL as a contributor to improved theoretical and practical academic performance, increased confidence, better debriefing and creating a platform for future relationships, both professionally and socially. Most participants reported a positive relationship with their PAL partners. The presence of a PAL partner made participants more comfortable during hostile or unsafe situations. Conclusions. PAL was positively viewed by participants and the environment created by PAL was perceived to enhance learning, debriefing and confidence and to improve theoretical and practical assessment results. We recommend that students are included in the PAL partner allocation process. Further research should include PAL in a larger spread of health professions in the African setting

AIMED AT ITCHEDD : A proof-of-concept study to evaluate a mnemonic-based approach to clinical reasoning in the emergency medical care educational setting

Abstract: Mnemonics are used as memory aids for teaching, learning and practice in a variety of educational contexts and domains. Mnemonics are commonly used to assist in the recall of critical components of complex or important clinical processes. The AIMED AT ITCHEDD mnemonic was designed to assist students to recall and apply steps associated with a structured clinical decision-making process. Objective. To obtain the views and opinions of a sample of educators and students regarding the perceived value of AIMED AT ITCHEDD. Method. A prospective, purposive design was followed, making use of an online questionnaire that consisted of 18 Likert-type questions, together with areas allowing for open, written comments. A total of 47 responses were received. Quantitative data from the closed questions were descriptively analysed. Thematic analysis was conducted on the narratives provided to determine emerging themes. Results. Despite concerns being raised relating to its length, AIMED AT ITCHEDD was seen as a valuable tool for clinical teaching, learning and practice by the majority of respondents. Conclusion. As a process mnemonic, AIMED AT ITCHEDD is perceived as having the potential to guide both students and practitioners with the critical thinking and decision-making processes associated with patient assessment, diagnosis and management. Further research is required to assess and quantify the extent to which the application of AIMED AT ITCHEDD improves clinical performance

How Reliable Is Ki-67 Immunohistochemistry in Grade 2 Breast Carcinomas? A QA Study of the Swiss Working Group of Breast- and Gynecopathologists

Adjuvant chemotherapy decisions in breast cancer are increasingly based on the pathologist's assessment of tumor proliferation. The Swiss Working Group of Gyneco- and Breast Pathologists has surveyed inter- and intraobserver consistency of Ki-67-based proliferative fraction in breast carcinomas. Methods Five pathologists evaluated MIB-1-labeling index (LI) in ten breast carcinomas (G1, G2, G3) by counting and eyeballing. In the same way, 15 pathologists all over Switzerland then assessed MIB-1-LI on three G2 carcinomas, in self-selected or pre-defined areas of the tumors, comparing centrally immunostained slides with slides immunostained in the different laboratoires. To study intra-observer variability, the same tumors were re-examined 4 months later. Results The Kappa values for the first series of ten carcinomas of various degrees of differentiation showed good to very good agreement for MIB-1-LI (Kappa 0.56–0.72). However, we found very high inter-observer variabilities (Kappa 0.04–0.14) in the read-outs of the G2 carcinomas. It was not possible to explain the inconsistencies exclusively by any of the following factors: (i) pathologists' divergent definitions of what counts as a positive nucleus (ii) the mode of assessment (counting vs. eyeballing), (iii) immunostaining technique, and (iv) the selection of the tumor area in which to count. Despite intensive confrontation of all participating pathologists with the problem, inter-observer agreement did not improve when the same slides were re-examined 4 months later (Kappa 0.01–0.04) and intra-observer agreement was likewise poor (Kappa 0.00–0.35). Conclusion Assessment of mid-range Ki-67-LI suffers from high inter- and intra-observer variability. Oncologists should be aware of this caveat when using Ki-67-LI as a basis for treatment decisions in moderately differentiated breast carcinomas

Incorporating field wind data to improve crop evapotranspiration parameterization in heterogeneous regions

Accurate parameterization of reference evapotranspiration ( ET0) is necessary for optimizing irrigation scheduling and avoiding costs associated with over-irrigation (water expense, loss of water productivity, energy costs, and pollution) or with under-irrigation (crop stress and suboptimal yields or quality). ET0 is often estimated using the FAO-56 method with meteorological data gathered over a reference surface, usually short grass. However, the density of suitable ET0 stations is often low relative to the microclimatic variability of many arid and semi-arid regions, leading to a potentially inaccurate ET0 for irrigation scheduling. In this study, we investigated multiple ET0 products from six meteorological stations, a satellite ET0 product, and integration (merger) of two stations’ data in Southern California, USA. We evaluated ET0 against lysimetric ET observations from two lysimeter systems (weighing and volumetric) and two crops (wine grapes and Jerusalem artichoke) by calculating crop ET ( ETc) using crop coefficients for the lysimetric crops with the different ET0. ETc calculated with ET0 products that incorporated field-specific wind speed had closer agreement with lysimetric ET, with RMSE reduced by 36 and 45% for grape and Jerusalem artichoke, respectively, with on-field anemometer data compared to wind data from the nearest station. The results indicate the potential importance of on-site meteorological sensors for ET0 parameterization; particularly where microclimates are highly variable and/or irrigation water is expensive or scarce

Reference evapotranspiration in the irrigated perimeters of the state of Sergipe

O conhecimento da evapotranspiração de referência (ETo) é essencial no manejo de irrigação de culturas agrícolas em todo o mundo. Neste trabalho se utilizaram dados meteorológicos diários de evaporação do tanque "Classe A", temperaturas máximas e mínimas, insolação, velocidade do vento a 2 m de altura e umidade relativa do ar, referentes ao período de 1989 a 1993, coletados em quatro perímetros irrigados do Estado de Sergipe, para estimativa da ETo com base nos métodos do Tanque Classe "A", Radiação Solar, Hargreaves & Samani, Linacre e Penman-Monteith (FAO/56). Comparam-se os valores diários da ETo para a região estudada, através dos quais, quando comparados com o modelo de Penman-Monteith (FAO/56) se obtiveram os melhores desempenhos com os métodos que utilizam a radiação solar como dado de entrada no modelo. O método do Tanque Classe "A" não apresentou desempenho satisfatório em nenhum perímetro irrigado estudado. _________________________________________________________________________________________ ABSTRACT: The knowledge of reference evapotranspiration (ETo) is essential for the irrigation scheduling of crops throughout the world. This work used daily meteorological data of Class A pan evaporation, maximum and minimum air temperatures, insolation, wind speed at 2 m above surface and relative humidity from 1989 to 1993 for four irrigated perimeters of Sergipe. These data were used for estimating ETo based on the following methods: Class A pan evaporation, Solar Radiation, Hargreaves & Samani, Linacre and Penman-Monteith (FAO/56). The daily values of ETo were compared to those obtained by FAO Penman-Monteith method in order to choose the best method of estimating ETo for the region. The best performance was obtained for those models which used the solar radiation as the data input. The Class A pan evaporation method did not show favorable performance in any irrigated perimeter