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PubMed1993

Introducing the Objective Structured Clinical Examination to a family practice residency program.

BACKGROUND: The Objective Structured Clinical Examination (OSCE) is a multiple station examination where examinees are expected to demonstrate mastery of a competency within a specified time at each station. It is commonly used to evaluate medical students and is less often used in residency programs. This paper describes the process of introducing a 12-station OSCE to a university-based family practice residency program. METHODS: The examination evaluated cognitive, psychomotor, and behavioral competencies in 31 residents. The 10-minute stations included: two simulated patients; two skills demonstrations; six modified essay questions, four in response to a written scenario and two in response to a video trigger; and two rest stations. Feedback was given in a large group at the conclusion of the examination. RESULTS: Construct validity was demonstrated by increasing scores with training year; concurrent validity was demonstrated by significant correlations of the OSCE scores with the American Board of Family Practice in-training examination scores and the residents' monthly rotation evaluation scores. Reliability was demonstrated by significant correlation between the scores of the OSCE and its subsets. CONCLUSIONS: As a method of formative evaluation, the OSCE had an overall positive response from residents and faculty.

Clinical Competence↗

PubMed1996

Detecting psychological distress: can general practitioners improve their own performance?

BACKGROUND: Many studies have suggested that general practitioners fail to detect a substantial minority of their patients who are psychologically distressed, and there is concern about the possible sequelae of this. Individual patients may suffer unresolved problems, and there are potential costs to the health service in consequent recurrent consultations, inappropriate referrals or treatment. Educational interventions based on small groups led by facilitators have been shown to alter the consultation behaviours of general practitioners that are known to be related to accurate detection of psychological distress. AIM: This controlled study aimed to show that, by utilizing a brief self-directed educational intervention focusing on detection of psychological distress, general practitioners can improve their performance significantly. For this purpose, a new educational intervention was designed: the second aim of the study was thus to assess the effectiveness of this specific intervention. METHOD: An educational intervention was designed which focused on skills relevant to detecting psychological distress, using the principles of reflection on general practitioner performance and consultation skill work. It was designed to be used by individual general practitioners without outside support, using a combination of written background material, feedback on performance and analysis of video material. The effectiveness of the intervention was tested by comparing a trial and control cohort of general practitioners, using detection rates as an outcome measure. RESULTS: The detection rate of the general practitioners who underwent the intervention improved significantly compared with their performance before intervention and with that of the control group. CONCLUSION: General practitioners can improve their ability to detect psychological distress in their patients utilizing this self-directed educational approach.

Adult↗

PubMed2006

Program development of reminiscence group work for ageing people with intellectual disabilities.

BACKGROUND: The goal of this study was to adapt a narrative reminiscence program for the special needs of ageing people with mild/moderate intellectual disabilities. Research has shown that stimulating reminiscence in the elderly can be a meaningful activity, and holds promise for positive effects on well-being. METHOD: In the first stage (10 weeks), the program was developed with 1 group. Evaluation and adjustments to the program were made based on video recordings, the researcher's log, and feedback from participants and support workers. Formative evaluation was performed by means of a within-group analysis. In the second stage (3 weeks), the program was introduced to 6 other groups. Interviews with professional support workers were subjected to a cross-case analysis. RESULTS: The final program consists of 13 sessions covering different reminiscence themes. The success of reminiscence group work relies on (a) well-prepared and structured sessions, (b) adequate use of visual triggers, and (c) facilitating, coaching and moderating. CONCLUSION: The program was perceived as a valuable and meaningful activity by all participants. Although reminiscence group work is not therapeutic in nature, it may have therapeutic use for ageing people with intellectual disabilities, and in this sense is worth evaluating.

Adaptation, Psychological↗

PubMed1990

Teaching the teachers at Leicester: the general practice approach.

This article describes a systematic induction programme devised for newly appointed lecturers in general practice. The programme aims to help them develop skills in both teaching and assessment and to encourage self-appraisal. The progress of participants is monitored by direct observation and video-recording with the regular provision of feedback a prominent characteristic. All the lecturers have found participation in the programme an effective way of developing their teaching capabilities.

Education, Medical↗

PubMedDate not supplied

Young children's use of video as a source of socially relevant information.

Although prior research clearly shows that toddlers have difficulty learning from video, the basis for their difficulty is unknown. In the 2 current experiments, the effect of social feedback on 2-year-olds' use of information from video was assessed. Children who were told "face to face" where to find a hidden toy typically found it, but children who were given the same information by a person on video did not. Children who engaged in a 5-min contingent interaction with a person (including social cues and personal references) through closed-circuit video before the hiding task used information provided to find the toy. These findings have important implications for educational television and use of video stimuli in laboratory-based research with young children.

Attention↗

PubMed2003

Frontolimbic response to negative feedback in clinical depression.

Functional neuroimaging suggests that limbic regions of the medial frontal cortex may be abnormally active in individuals with depression. These regions, including the anterior cingulate cortex, are engaged in both action regulation, such as monitoring errors and conflict, and affect regulation, such as responding to pain. The authors examined whether clinically depressed subjects would show abnormal sensitivity of frontolimbic networks as they evaluated negative feedback. Depressed subjects and matched control subjects performed a video game in the laboratory as a 256-channel EEG was recorded. Speed of performance on each trial was graded with a feedback signal of A, C, or F. By 350 ms after the feedback signal, depressed subjects showed a larger medial frontal negativity for all feedback compared with control subjects with a particularly striking response to the F grade. This response was strongest for moderately depressed subjects and was attenuated for subjects who were more severely depressed. Localization analyses suggested that negative feedback engaged sources in the anterior cingulate and insular cortices. These results suggest that moderate depression may sensitize limbic networks to respond strongly to aversive events.

Adult↗

PubMed1999

Nurses' self-reflection via videotaping to improve communication skills in health counseling.

The purpose of this qualitative research was to describe nurses' opinions of their communication skills in health counseling situations and to analyze the levels of reflectivity in their evaluations according to Mezirow. Nineteen nurses participated in the research on a voluntary basis and evaluated their interaction with patients on video on two occasions half a year apart. Nurses gave verbal feedback in an interview immediately after videotaping, after which they read education materials, watched their counseling on video and wrote an evaluation of their communication skills. Transcribed audiotaped interviews and written evaluations were analyzed using content analysis. Nurses said that they were able to use familiar language, to listen and to encourage patients to express their feelings and ask questions. Nurses gave little feedback on nonverbal communication. They wanted to develop their listening skills and their ability to encourage patients to ask and express their feelings. They also wanted to improve their preparations for counseling sessions. On Mezirow's scale, nurses' evaluations weighted heavily towards the lower levels of reflectivity. Only one nurse's evaluations were on the sixth level and no evaluations were on the seventh level. The results indicated a need for training programs dealig with communication skills and self-reflection. Using the videotape and self-reflection were found to be good methods to enhance the quality of health counseling.

Adolescent↗

PubMed1997

WCALive: broadcasting a major medical conference on the Internet.

Live video and sound from the 11th World Congress of Anaesthesiology in Sydney, Australia were broadcast over the Internet using the CuSeeme software package as part of an ongoing evaluation of Internet-based telecommunication in the delivery of Continuing Medical Education (CME). This was the first time such a broadcast had been attempted from a medical convention. The broadcast lasted for four days, during which a functioning combination of computer hardware and software was established. Technical issues relating to broadcast of these real time signals over ISDN links and the Internet itself were addressed. Over 200 anaesthetists from around the world were able to 'attend' the plenary sessions via the Internet. Evidenced by feedback received audio reception was quite good. Video reception was less successful for those receiving the broadcast via a modem based Internet connection. The received signal in such circumstances was adequate to provide a video presence of the speaker but inadequate to allow details of 35 mm slides to be visualised. We conclude that this technology will be of use in the delivery of CME materials to remote areas provided simultaneous viewing of high resolution still images is possible using another medium, such as the World Wide Web.

Anesthesiology↗

PubMed2006

[Video laryngoscopy for modified rapid sequence induction of anaesthesia: Sellick manoever with and without video laryngoscopic control].

BACKGROUND: There is evidence that cricoid pressure, one of the key elements of rapid sequence induction (RSI) in patients at risk of aspiration, can distort the glottic view obtained by direct laryngoscopy (DL) and consequently impair or delay endotracheal intubation (ETI). The fact that cricoid pressure is applied by an assistant "blindly", i.e. without any visual feedback, is believed to be a contributing factor. Video laryngoscopy (VIL) offers the advantage that both the anaesthetist and the assistant can follow laryngoscopy. This could be useful for ETI during RSI. METHODS: We used VIL for a simulated RSI in 170 adult patients randomised to either video laryngoscopy-guided application of cricoid pressure (group I) or conventional, i.e. "blind", application of cricoid pressure (group II). Time to ETI was compared between groups. The laryngoscopy view obtained by VIL was compared with the view of conventional DL obtained before, in all patients. RESULTS: Time to ETI did not differ between groups (p=0.2): 25.1+/-14.2 s (group I) vs. 23.7+/-12.1 s (group II). Laryngoscopy scores were significantly better for VIL than conventional DL (p<0.001). CONCLUSIONS: Visualisation of the larynx during RSI can be improved using VIL. Time to ETI is not decreased by use of video laryngoscopy-guided application of cricoid pressure.

Adolescent↗

PubMed2001

Effects of 12-week shooting training and mode of feedback on shooting scores among novice shooters.

The mode of feedback has been shown to have an effect on motor skill learning. This study investigated effects of an intensive 12-week shooting training period, and of the mode of feedback on scores in standing and running target shooting among 30 novices with limited shooting experience. They were divided into one control (no training) and three training groups. One out of the three training groups received only KR (knowledge of results) while the two other groups received KR+KP (knowledge of performance). One of the KR+KP groups received additional visual feedback (FB-II group), which included videos, graphic and written materials about kinematic and kinetic characteristics of their respective shooting techniques compared to performance of international level shooters. Each training group improved their scores in the running target shooting. There were no significant differences between the three training groups in improvements of sum scores (performance outcome). The current study showed that among novice shooters both KR alone and KR+KP improved running target shooting outcome, and that KR and KP together did not lead to a significantly better shooting performance than KR alone.

Adult↗

PubMed2004

Do clinical clerks provide candidates with adequate formative assessment during Objective Structured Clinical Examinations?

CONTEXT: Various research studies have examined the question of whether expert or non-expert raters, faculty or students, evaluators or standardized patients, give more reliable and valid summative assessments of performance on Objective Structured Clinical Examinations (OSCEs). Less studied has been the question of whether or not non-faculty raters can provide formative feedback that allows students to take advantage of the educational opportunity that OSCEs provide. This question is becoming increasingly important, however, as the strain on faculty resources increases. METHODS: A questionnaire was developed to assess the quality of feedback that medical examiners provide during OSCEs. It was pilot tested for reliability using video recordings of OSCE performances. The questionnaires were then used to evaluate the feedback given during an actual OSCE in which clinical clerks, residents, and faculty were used as examiners on two randomly selected test stations. RESULTS: The inter-rater reliability of the 19-item feedback questionnaire was 0.69 during the pilot test. The internal consistency was found to be 0.90 during pilot testing and 0.95 in the real OSCE. Using this form, the feedback ratings assigned to clinical clerks were significantly greater than those assigned to faculty evaluators. Furthermore, performance on the same OSCE stations eight months later was not impaired by having been evaluated by student examiners. DISCUSSION: While evidence of mark inflation within the clinical clerk examiners should be addressed with examiner training, the current results suggest that clerks are capable of giving adequate formative feedback to more junior colleagues.

Adult↗

PubMed1995

Training obstetricians and midwives to present screening tests: evaluation of two brief interventions.

The objective of this study was to assess the effects of two brief training interventions to improve obstetricians' and midwives' explanations to patients of a routine prenatal screening test. Health professionals were randomly allocated to one of two intervention groups or a control group. Information-giving about the test and communication skills were assessed at baseline, post-training and 3-month follow-up from audiotaped consultations. Both intervention groups received a 1-h training session involving small group discussions focused around a video. In addition, one group received individual feedback on their baseline and post-training consultations. Twenty-six midwives and nine obstetricians completed the study according to the protocol. Changes between baseline and post-training, and between baseline and follow-up, were computed. Information-giving and communication skills improved significantly in subjects receiving training and feedback on their performance, with the greatest improvements occurring before feedback was given. Those receiving training without feedback significantly improved their communication skills and showed some improvement in information-giving. These results show that modest improvements in communication can be made with relatively brief training. Greater and more sustained improvements may be found if all staff were trained, and trained on a regular basis.

Communication↗

PubMed1999

Initial clinical experience with a video-based patient positioning system.

PURPOSE: To report initial clinical experience with an interactive, video-based patient positioning system that is inexpensive, quick, accurate, and easy to use. METHODS AND MATERIALS: System hardware includes two black-and-white CCD cameras, zoom lenses, and a PC equipped with a frame grabber. Custom software is used to acquire and archive video images, as well as to display real-time subtraction images revealing patient misalignment in multiple views. Two studies are described. In the first study, video is used to document the daily setup histories of 5 head and neck patients. Time-lapse cine loops are generated for each patient and used to diagnose and correct common setup errors. In the second study, 6 twice-daily (BID) head and neck patients are positioned according to the following protocol: at AM setups conventional treatment room lasers are used; at PM setups lasers are used initially and then video is used for 1-2 minutes to fine-tune the patient position. Lateral video images and lateral verification films are registered off-line to compare the distribution of setup errors per patient, with and without video assistance. RESULTS: In the first study, video images were used to determine the accuracy of our conventional head and neck setup technique, i.e., alignment of lightcast marks and surface anatomy to treatment room lasers and the light field. For this initial cohort of patients, errors ranged from sigma = 5 to 7 mm and were patient-specific. Time-lapse cine loops of the images revealed sources of the error, and as a result, our localization techniques and immobilization device were modified to improve setup accuracy. After the improvements, conventional setup errors were reduced to sigma = 3 to 5 mm. In the second study, when a stereo pair of live subtraction images were introduced to perform daily "on-line" setup correction, errors were reduced to sigma = 1 to 3 mm. Results depended on patient health and cooperation and the length of time spent fine-tuning the position. CONCLUSION: An interactive, video-based patient positioning system was shown to reduce setup errors to within 1 to 3 mm in head and neck patients, without a significant increase in overall treatment time or labor-intensive procedures. Unlike retrospective portal image analysis, use of two live-video images provides the therapists with immediate feedback and allows for true 3-D positioning and correction of out-of-plane rotation before radiation is delivered. With significant improvement in head and neck alignment and the elimination of setup errors greater than 3 to 5 mm, margins associated with treatment volumes potentially can be reduced, thereby decreasing normal tissue irradiation.

Algorithms↗

PubMed1994

Learning about sex outside the gutter: attitudes toward a computer sex-expert system.

In an ongoing research program investigating the utility of Sexpert, an expert computer system designed to counsel couples about their sexual relationships, we tested whether sexually active couples' attitudes concerning computerized sexual counseling could be affected by interacting with Sexpert. Eighty-one young heterosexual couples drawn from the university and general community were assigned to one of three sources of feedback about couple sexual functioning (Sexpert, a video, a self-help book) or a control condition. Attitudes toward all counseling sources used in the study were assessed through semantic differential and similarity-dissimilarity questionnaires. Subjects in the Sexpert condition showed significant improvements in their attitudes toward computerized sexual counseling and evaluated Sexpert significantly better and more similar to a human therapist as a result of exposure. Subjects in the other three conditions showed no significant changes in attitudes. This study provides strong evidence for the acceptability of a computerized sex-expert system.

Adolescent↗

PubMed2004

Enhanced accuracy in novel mirror drawing after repetitive transcranial magnetic stimulation-induced proprioceptive deafferentation.

When performing visually guided actions under conditions of perturbed visual feedback, e.g., in a mirror or a video camera, there is a spatial conflict between visual and proprioceptive information. Recent studies have shown that subjects without proprioception avoid this conflict and show a performance benefit. In this study, we tested whether deafferentation induced by repetitive transcranial magnetic stimulation (rTMS) can improve mirror tracing skills in normal subjects. Hand trajectory error during novel mirror drawing was compared across two groups of subjects that received either 1 Hz rTMS over the somatosensory cortex contralateral to the hand or sham stimulation. Mirror tracing was more accurate after rTMS than after sham stimulation. Using a position-matching task, we confirmed that rTMS reduced proprioceptive acuity and that this reduction was largest when the coil was placed at an anterior parietal site. It is thus possible, with rTMS, to enhance motor performance in tasks involving a visuoproprioceptive conflict, presumably by reducing the excitability of somatosensory cortical areas that contribute to the sense of hand position.

Adolescent↗

PubMed2002

Development of a Web-based question database for students' self-assessment.

OBJECTIVE: Computer-based testing (CBT) for the purpose of the national licensure examination has increased interest among medical students in this modality of testing. The advent of Web-based question-delivery systems for self-assessment and learning has made it possible for students to practice this technology and participate in self-directed learning. Test Pilot(TM) is a Web-based program that provides a fast and easy tool for the development and deployment of online testing. Our objectives for introducing the program were to (1) develop a large database of questions for students' practice and self-assessment; (2) include multimedia tools such as illustrations and short videos to enhance learning; (3) provide a feedback tool for clerkship and site directors regarding student performance; and (4) evaluate this tool in terms of students' frequency of use, students' satisfaction, and its potential effectiveness in enhancing learning. DESCRIPTION: The Obstetrics and Gynecology clerkship at the University of Michigan is held at four different sites. In the past, students have been provided with access to floppy disks that contain about 500 self-assessment questions. These questions have been reformatted, updated, and transferred to Test Pilot. Visual illustrations have been added to the questions along with more varied formats, including extended matching, fill-in, and essay questions. The questions are divided into ten-question quizzes. The students get immediate feedback after answering each question and a summary of performance at the end of each quiz. Security, access, and analysis are facilitated because the questions and responses are stored centrally. In addition, Test Pilot captures information regarding individual and collective students' performances. At the end of the rotation, students fill out a form evaluating the Test Pilot program and comparing it with the quiz disks. In addition, we are collecting data regarding the actual use of Test Pilot, which will be compared with the students' surveys and final exam scores. DISCUSSION: Test Pilot has many benefits, including access control, immediate feedback, automated scoring, interactive learning, and data analysis. The enhancement of material permitted by a Web-based system increases the depth and variety of the learning experience by adding perceptual dimensions. Test Pilot also provides the clerkship director with the capability to obtain improved measurements of student performance and captures the student's self-learning and testing process. It can potentially identify weaknesses or inconsistencies across the different sites and recognize students who may need additional help early in the rotation. Over a one-year period, most students have switched from the quiz disks to Test Pilot. The students reported satisfaction with the Web-based format and found it user friendly. They especially liked the immediate feedback. The students have requested more questions and multimedia options be added. We plan to continue the development and assessment of this learning tool.

Databases, Factual↗

PubMed1990

Reaching in the dark: enhanced responses in posterior parietal cortex.

In order to assess the relative importance of visual input to area 7 reach-related neuronal activity, a monkey was trained to reach to visual targets displayed on a video-monitor, both with and without visual feedback. Visual feedback was removed by having the monkey reach in darkness to a previously illuminated target. Of 19 reach-related cells recorded in area 7 both in the light and the dark, ten showed an enhancement of discharge in the dark. These included area 7b cells sensitive to screen contact and area 7a cells active during reach. Dark enhancement of active somatic responsiveness may partially compensate for the loss of visual guidance.

Animals↗

PubMed1998

[Efficacy of a training technique concerning clinical interview skills associated with psychodiagnostic ability of the physician].

OBJECTIVE: To evaluate the efficacy of a training technique to improve clinical interview skills connected with Primary Care doctors' psycho-diagnostic ability: visual contact, posture, verbal and non-verbal ways of advancing the interview, verbal interruptions and questions with a psychological content. DESIGN: The doctors were randomly divided into two groups. A before-and-after design with blind evaluations was used. SETTING: University postgraduate Internal Medicine Course. MATERIAL: 20 doctors. INTERVENTIONS: Step-by-step training with feedback, using role-play and video-recording (experimental) was compared with a self-administered teaching programme (self-training). MEASUREMENTS AND RESULTS: Skills were measured by video-recordings of a patient interview one month before and one month after the intervention. The Observation Scale of Doctor's Skills was used. In the second evaluation, the experimental group differed from the self-training group in visual contact, posture and non-verbal ways of advancing the interview. CONCLUSIONS: The efficacy of a training technique in improving non-verbal active listening skills was shown. It was valuable as a support to the psycho-diagnostic ability of the doctor.

Adult↗