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PubMed2006

Competency-based healthcare management education: the Saint Louis University experience.

As a follow up to a school-wide initiative to create a common set of competencies for all degree programs in the Saint Louis University School of Public Health, in January 2000 the Department of Health Management and Policy (HMP, renamed from the Department of Health Administration in 2002) began a process to develop a competency-based curriculum for its Master of Health Administration (MHA) degree program with the goal of establishing a foundation for systematically measuring the learning outcomes of its students as they progressed through the program. This article describes how the department developed a set of competencies most appropriate for graduate training in healthcare management, how it incorporated these into its overall MHA program curriculum and content, and how effective this approach has been in measuring student progress in mastering these competencies over the first two years of this initiative. The problems and challenges encountered during this process are discussed, as are the next steps for effectively using competencies to assess healthcare management program learning outcomes. Our experience provides a model for other healthcare management programs considering using an outcomes approach for curriculum development and assessment.

Competency-Based Education↗
PubMed1997

Effects of menstrual cycle moods and symptoms on academic performance: a study of senior secondary school students.

BACKGROUND: Menstrual cycle moods and symptoms may well play a discernible role in the academic performance of some post-pubescent adolescent female students. AIMS: It was expected that menstrually related moods and symptoms would have both negative and positive influences on academic learning outcomes, and that the magnitude of these effects would be directly proportional to the salience of such moods and symptoms across the monthly cycle. SAMPLES: The sample comprised 427 post-pubescent female students (Years 10, 11, and 12) attending a number of senior secondary schools within the Melbourne metropolitan area, Australia. METHODS: Given the sensitivity of conducting such a study, combined with the logistical difficulties of obtaining prospective data within school settings, retrospective Menstrual Distress Questionnaire (MDQ) scores were related to the previous end-of-year academic grades across a wide range of 18 senior school subjects. Despite the conservative design constraints and associated data analyses (correlations were not corrected for attenuation), some systematic effects were observed. RESULTS: At the premenstrual, menstrual, and intermenstrual phases, moods and symptoms significantly predicted grades in 14 per cent, 7 per cent, and 13 per cent of instances, respectively. Although most significant relationships were negative, scores on the MDQ Arousal scale for the intermenstrual phase positively predicted grades in English Literature, (general) Mathematics, Art and Craft, History, Mathematics 1, and Study of Society. CONCLUSIONS: Evidently, menstrual cycle variables play a small, but discernible role on academic learning outcomes, contributing both positively and negatively to performance. Future, prospective studies are now needed to provide a more definitive account of menstrual cycle influences on academic performance.

Achievement↗
PubMed2000

What are the criteria that mentors use to make judgements on the clinical performance of student mental health nurses? An exploratory study of the formal written communication at the end of clinical nursing practice modules.

Issues concerning the assessment of student nurse performance in clinical practice have pre-occupied nurse educationalists for some time and continue to pose problems. The debate in the nursing literature tends to revolve around two seemingly mutually exclusive positions related to competence vs. learning outcomes. These are views that seem to be held by academics with little reference to clinical nurses who have responsibility for the assessment of student performance in clinical practice. This paper adds to the wider debate on clinical assessment by reporting on a small research study that explored the written comments that 150 mentors made in relation to the performance of student mental health nurses following periods of clinical practice. An extensive literature review is provided in order to place the debate in context, followed by a brief outline of the research study, its findings, discussion and conclusion. This analysis of findings demonstrates that student learning is of major concern to mentors, and that the assessment of student performance in clinical practice is not restricted by pre-determined behavioural learning outcomes. Personal characteristics of students exert a great influence on judgements about clinical performance. This paper does not offer solutions to the search for the perfect clinical assessment, but it does call for an increased dialogue between educationalists and mentors to discuss the implications of this research for the development of an appropriate clinical assessment tool.

Adult↗
PubMed2001

Eliminating disparities in perinatal outcomes--lessons learned.

The disparity between blacks and whites in perinatal health ranges from a 2.3-fold excess risk among black women for preterm delivery and infant mortality to a 4-fold excess risk among black women for maternal mortality. To stimulate concerted public health action to address such racial and ethnic disparities in health, the national Healthy People objectives call for elimination of all health disparities by the year 2010. Eliminating health disparities requires a greater understanding of the factors that contribute to their development. This commentary summarizes the state of the science of reducing such disparities and proposes a framework for using the results of qualitative studies on the social context of pregnancy to understand, study, and address disparities in infant mortality and preterm delivery. Understanding the social context of African American women's lives can lead to an improved understanding of the etiology of preterm birth, and can help identify promising new interventions to reduce racial and ethnic disparities in preterm delivery.

Black or African American↗
PubMedDate not supplied

Changes in speech and language development of a young child after decannulation.

UNLABELLED: This report reviews the speech and language development of a child who, as result of complete subglottic stenosis, was aphonic from birth until 2 years and 11 months of age at which time laryngotracheal reconstruction provided normal respiration. The boy had congenital subglottic stenosis requiring neonatal tracheostomy. The congenital subglottic stenosis progressed to complete subglottic stenosis during the neonatal period. The child's speech and language development was monitored for a 24-week period following airway reconstruction. LEARNING OUTCOMES: The reader will learn about and be able to describe: (1) the speech and language development of a child who was aphonic from birth until 35 months of age, (2) the effects of surgical repair of a tracheotomy on the child's speech and language development, (3) the likely importance of babbling in speech and language development.

Aphonia↗
PubMedDate not supplied

Learning from outcome studies. Toward a comprehensive biological-psychosocial understanding of schizophrenia.

According to results from three major European long-term outcome studies on schizophrenia, from other comparable studies, and from additional investigations on rehabilitation and on the influence of psychosocial factors, long-term evolution of schizophrenia is much more variable and considerably better than hitherto admitted. On this basis, the author presents a comprehensive biological-psychosocial evolutionary model of schizophrenia in three phases, centered around the vulnerability- and information-processing hypotheses. Long-term evolution of schizophrenia cannot be sufficiently represented by a linear organic process mainly determined by genetic factors. Environmental and, in particular, psychosocial factors, also seem to play an important role. Vicious biological-psychosocial circles with multiple feedback effects can lead to non-linear escalating processes. Chronic states appear to be the result of complex interactions between preexisting vulnerability and autoprotective counterregulations on a biological, psychological and social level. Some therapeutic consequences and possible future developments of these concepts are presented.

Humans↗
PubMedDate not supplied

Phonemic characteristics of apraxia of speech resulting from subcortical hemorrhage.

UNLABELLED: Reports describing subcortical apraxia of speech (AOS) have received little consideration in the development of recent speech processing models because the speech characteristics of patients with this diagnosis have not been described precisely. We describe a case of AOS with aphasia secondary to basal ganglia hemorrhage. Speech-language symptoms consistent with subcortical AOS and aphasia are reported as well as description of the patient's speech characteristics using broad phonemic transcription. Significantly more phoneme substitution errors were observed than other types of errors and these occurred significantly more often in the initial rather than the medial or final positions of words. No differences were observed in the number of errors produced for the various types of phonemes included in this analysis. These findings challenge the hypothesis that speech motor planning disorders are uniquely the result of cortical damage. They also argue against the notion that subcortical AOS is indistinguishable from the cortical syndrome. LEARNING OUTCOMES: The reader will learn (1) the phonemic characteristics of AOS due to subcortical brain damage, (2) the similarities and differences between AOS due to cortical versus subcortical lesions, and (3) the implications of these patterns for current models of speech motor processing.

Aged↗
PubMedDate not supplied

Sign language iconicity and its influence on the ability to describe the function of objects.

UNLABELLED: We examined the influence of sign language iconicity on children's ability to describe the function of objects. Forty-eight hearing preschoolers were divided into three groups and asked to describe the function of 15 high and 15 low iconic signs. We questioned the Hearing/Verbal (H/V) group verbally, Hearing/Verbal + Sign (H/V+S) group verbally with objects simultaneously signed, and the Hearing/Sign (H/S) group with objects signed without voice. Ten deaf children (D/S) were also tested using sign language. H/S and D/S performed significantly better on high than low iconic items. Nine signs were sufficiently iconic to aid function identification by sign naïve hearing children. Results suggest that certain highly iconic signs may contribute to performance on tests administered in sign language. LEARNING OUTCOMES: The reader will learn about sign language iconicity and its influence on the ability of hearing and deaf children to perform on object function questions.

Analysis of Variance↗
PubMedDate not supplied

Is the information about a test important? Applying the methods of evidence-based medicine to the clinical examination of swallowing.

UNLABELLED: A hotly debated topic in oropharyngeal dysphagia is the Clinical Swallowing Examination's (CSE) importance in clinical practice. That debate can profit from the application of evidence-based medicine's (EBM) principles and procedures. These can guide both appropriate data collection and interpretation as will be demonstrated in the present report. The study's purpose from which data for this report are drawn was to determine the relationship among signs elicited by a CSE and aspiration on a subsequent videofluoroscopic swallowing examination (VFSE). Sensitivity, specificity; positive and negative predictive values (NPV); likelihood ratios; and post-test probabilities for a variety of signs in isolation and in combinations are reported. These data, if judiciously selected and interpreted contribute to the clinician's knowledge about whether to follow a CSE with a VFSE and about what to expect if the VFSE is completed. LEARNING OUTCOMES: (1) Clinicians will learn how to use EBM principles in conjunction with clinical assessments of swallowing to enhance patient care. (2) Clinicians will learn how to identify combinations of patient signs during he CSE to predict VFSE performance.

Adult↗
PubMedDate not supplied

Recent advances in the treatment of stuttering: a theoretical perspective.

UNLABELLED: Prolonged speech and its variants are widely used in the behavioral treatment of stuttering. Unlike these approaches, which depend on clinician-prescribed speech pattern changes, two behavioral treatment regimens, one for children and another for adults, recently developed at the Australian Stuttering Research Center, promote self-monitoring of speech as a means of controlling stuttering. In these programs, the clients themselves modify their speech in subtle and variable ways to gain control over stuttering and, in that, they appear to be similar to a well-known experimental technique for suppressing stutters known as response contingent stimulation. The present paper provides an integrated explanation for the effectiveness of both clinician-directed as well as client-initiated speech pattern modifications and, in the process, develops a new model of stuttering. It also shows why client-generated speech patterns changes potentially produce faster and more lasting improvement than those changes prescribed by a clinician. LEARNING OUTCOMES: The reader will learn about: (1) two hypothesized methods of preparing utterance motor plans--speech concatenation and speech construction; (2) how behavioral treatment programs make use of speech construction to promote fluency in persons who stutter; (3) why therapy procedures based on cognitively driven speech construction produce faster and superior results than those based on motorically driven speech construction; and (4) the empirical evidence that suggests that speech concatenation is the source of stuttering.

Adult↗
PubMed2006

Some empirical observations about early stuttering: a possible link to language development.

UNLABELLED: This article suggests a possible link between incipient stuttering and early difficulty in language formulation. The hypothesis offers a unifying explanation of an array of empirical observations. Among these observations are the following: early stuttering occurs only on the first word of a syntactic structure; stuttering does not appear to be influenced by word-related factors; early stuttering seldom occurs on one-word utterances; the earliest age at which stuttering is reported is 18 months, with the beginning of grammatical development; the age at which most onset of stuttering is reported, 2-5 years, coincides with the period during which children acquire syntax; considerable spontaneous recovery takes place at the time most children have mastered syntax; incipient stuttering is influenced by the length and grammatical complexity of utterances; young children who stutter may be somewhat deficient in language skills; boys who stutter outnumber girls. LEARNING OUTCOMES: The reader will learn about a number of empirical observations about incipient stuttering and how they may be explained by a syntax-based hypothesis about its etiology.

Age of Onset↗
PubMed2006

Satisfaction with communicative participation as defined by adults with multiple sclerosis: a qualitative study.

PURPOSE: This study examined satisfaction with communicative participation as reported by adults with multiple sclerosis (MS). METHOD: Eight community-dwelling adults with MS participated in semi-structured interviews. They were asked to discuss their satisfaction with their communication in a variety of situations. Interviews were analyzed using a constant comparative method of qualitative description. RESULTS: Themes derived included: Comfort, consisting of Ease and Confidence; Success of the Outcome, including Function is Achieved and A Connection is Made; and Personal Meaning of Participation, including Personal Preferences, Comparison with the Past, and Thinking about One's Own Communication. CONCLUSIONS: Participants described multiple facets of satisfaction with communicative participation. Some of the dimensions were similar to those in existing assessment instruments such as levels of ease or difficulty with performance. Participants did not talk about frequency of activities as a key part of their satisfaction. Implications for identifying intervention targets and treatment outcome measurements are provided. LEARNING OUTCOMES: The reader should be able to: 1) define communicative participation and identify key elements of this construct; 2) identify the issues that were most relevant to satisfaction with communicative participation with participants with MS; and 3) identify reasons for greater emphasis on the subjective viewpoint of people with communication disorders in measurement of treatment outcomes.

Adult↗
PubMed2006

The role of the amygdala and rostral anterior cingulate in encoding expected outcomes during learning.

Successful passive avoidance learning is thought to require the use of learned stimulus-reinforcement associations to guide decision making [Baxter, M.G., Murray, E.A., 2002. The amygdala and reward. Nature Reviews. Neuroscience 3, 563-573]. The current experiment investigated the neural correlates of successful passive avoidance learning in 19 healthy adults. Behaviorally, subjects showed a distinct pattern of performance: early indiscriminate responding to stimuli (pre-criterion performance), followed by relatively rapid learning before a plateau of successful performance (post-criterion performance). Neural responses to post-criterion correct responses were compared with neural responses to both incorrect responses and pre-criterion correct responses. Post-criterion correct responding was associated with increased activation in regions including rostral anterior cingulate, insula, caudate, hippocampal regions, and the amygdala.

Adult↗
PubMedDate not supplied

Articulation in Prader-Willi syndrome.

UNLABELLED: This study investigated articulation in 13 individuals with Prader-Willi syndrome (PWS), chronological age from 7; 0 to 29; 5, total IQ from 38 to 83. To elicit a speech sample a picture-naming test was used. Pictures were chosen so that, when named correctly, they yield a sample containing instances of all Dutch single speech sounds and clusters in all permissible syllable positions. All samples were transcribed phonetically by a stringent transcription procedure, and reliability of the transcription was assessed both by an intra-observer and inter-observer reliability check. The transcribed speech samples were subjected to several analyses as to characterize articulation from different perspectives. It was found that articulation in persons with PWS is usually impaired. Results suggest that the overall error rate is a function of IQ, and that with increasing age, phonological problems gradually resolve while phonetic difficulties become more evident. LEARNING OUTCOMES: The reader will learn about (1) clinical characteristics, etiology, incidence, and prevalence of Prader-Willi syndrome; (2) speech and language difficulties in Prader-Willi syndrome; (3) articulation characteristics in Prader-Willi syndrome.

Adolescent↗
PubMedDate not supplied

Analysis of intentional communication in severely handicapped children with Cornelia-de-Lange syndrome.

UNLABELLED: Intentional communicative acts were assessed in 13 children with Cornelia-de-Lange syndrome (CdLS) with a severe mental disability and compared to a control group of Down and 5p (Cri-du-Chat (CdC)) syndrome children. The mean number of intentional communicative acts were significantly lower. Analysis of play behaviors revealed that the differences were specific for the communicative domain. They are part of a general behavioral characteristic of CdLS children with a severe mental disability which can be described as a lack of communication, emotional reactions and motility. A syndrome-specific low rate of communicative initiatives indicates a special problem for designing intervention programs which depend on opportunities for facilitating strategies. LEARNING OUTCOMES: The reader will learn about the behavioral phenotype of CdLS, distinctive communication problems and qualities of play behavior which are relevant for planning educational interventions in children with this syndrome.

Child↗
PubMedDate not supplied

Second formant transitions in fluent speech of persistent and recovered preschool children who stutter.

UNLABELLED: This study investigated frequency change and duration of the second formant (F2) transitions in perceptually fluent speech samples recorded close to stuttering onset in preschool age children. Comparisons were made among 10 children known to eventually persist in stuttering, 10 who eventually recovered from stuttering, and 10 normally fluent controls. All were enrolled in the longitudinal Stuttering Research Project at the University of Illinois. Subjects fluently repeated standard experimental sentences. The same 36 perceptually fluent target segments (syllables embedded in words) from each subject's repeated sentences were analyzed. The syllables were divided into three phonetic categories based on their initial consonant: bilabial, alveolar, and velar placement. The frequency change and duration of F2 transitions were analyzed for each of the target CV segments. F2 transition onset and offset frequencies and their interval (duration) were measured for each utterance. Data indicate that near stuttering onset, children whose stuttering eventually persisted demonstrated significantly smaller frequency change than that of the recovered group. It is suggested that the F2 transitions should continue to be investigated as a possible predictor of stuttering pathways. LEARNING OUTCOMES: (1) Readers will learn about studies regarding second formant transition related to stuttering. (2) Readers will learn about differences between children who persist in stuttering and those who recover from stuttering. (3) Readers will learn about research concerned with early identification of risk criteria in persistent stuttering.

Child, Preschool↗
PubMed2003

The importance of active involvement in learning: a qualitative study on learning results and learning processes in different traineeships.

INTRODUCTION: In order to gain more insight into learning in different traineeships we sought students' opinions on their experiences. METHOD: 24 students of Maastricht University, the Netherlands, were interviewed: 8 medical students, and 16 students in the mental health science programme of the Faculty of Health Sciences (8 research trainees (MHS-res.) and 8 trainees in mental health care practice (MHS-prac.). Students' perceptions about instructive, difficult and less instructive learning experiences were recorded on audiotape. The literal transcripts of the interviews were analysed and categorised. RESULTS: The most frequently mentioned learning process was "learning by doing" followed by "actively overcoming gaps in knowledge and skills". These processes occurred with instructive and difficult experiences. Other processes were "learning by seeing things in practice" and "preparation and evaluation". Learning outcomes were categorised as learning about: working, professional competences and personal growth. Most frequently mentioned - in most cases with difficult experiences - were "professional knowledge and skills", "learning about personal growth" and "learning about working". The latter was mentioned most often by MHS-res. students. Medical students' responses suggested that they occasionally perceived the clerkship environment as stressful. DISCUSSION AND CONCLUSIONS: Although the small sample size precludes any firm conclusions, the overwhelming impression is that students prefer being actively involved in their learning process. In addition, traineeships appear to introduce students to professional working life the hard way. Investigating how teachers and supervisors can stimulate active learning and facilitate the introduction to professional practice might be subjects for fruitful further investigation.

Adult↗