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Comparison of standardized patients and faculty in teaching medical interviewing.

PURPOSE: This randomized controlled study compared the interviewing skills of first-year medical students receiving feedback primarily from standardized patients (SPs) with those of students receiving feedback primarily from faculty. METHOD: All 154 first-year students at the University of Oklahoma College of Medicine in 1993-94 were video-taped to assess baseline and post-instruction interviewing skills. All the students, randomized to one of three study groups, attended two four-hour workshops on interviewing skills. Instruction in the groups was as similar as possible except in the matter of who provided feedback. Two rating systems were used to rate the videotaped interviews for performances of targeted skills. RESULTS: Complete, usable data were available for 120 (78%) of the students. Skill ratings using the Arizona Clinical Interview Rating Scale were significantly higher for the "types of questions used" and "use of empathy" items in the SP-led feedback group. No significant difference in ratings was detected among the groups as measured by the Rotor Interactional Analysis System. CONCLUSION: The SPs were at least as effective as the faculty in effecting behavioral changes in the first-year medical students' interviewing skills.

Education, Medical, Undergraduate↗

Use of Video-Projected Structured Clinical Examination (ViPSCE) instead of the traditional oral (Viva) examination in the assessment of final year medical students.

CONTEXT & BACKGROUND: Assessment of medical students using the traditional oral (viva) system has been marred by being highly subjective, non-structured, and biased. The use of the objective structured clinical examination (OSCE) would circumvent these disadvantages. The OSCE is, however, costly and time-consuming particularly if used for assessment of large numbers of students. The need for another form of examination that enjoys the advantages of the OSCE while avoiding its disadvantages in the face of limited resources has been the inspiration behind this innovative approach. OBJECTIVES: (1) To identify the characteristics of the new Video-Projected Structured Clinical Examination (ViPSCE). (2) To compare the acceptability of ViPSCE and OSCE by students and tutors. (3) To compare the time-effectiveness of ViPSCE and OSCE. METHODS: We used a slide video projection to assess the surgical knowledge, problem solving and management abilities of 112 final year medical students at Alazhari University, Khartoum, Sudan. Students completed evaluation forms at the end of the examination. RESULTS: The administration of the ViPSCE was smooth and straightforward. Feedback of the students showed that they preferred the ViPSCE to both traditional oral (viva) examination and OSCE. The examination time was 2 hours using video projection compared to the 6 hours that it used to take a class of 112 students to complete a classical OSCE. CONCLUSION: The ViPSCE is a better replacement for the traditional oral exam. It is much less time- consuming than traditional OSCE.

Attitude of Health Personnel↗

[The objective structured clinical examination in postgraduate pediatric training. The first Danish experiences].

To evaluate the usefulness of an objective structured clinical examination (OSCE) for identifying weaknesses of the educational program and for providing feedback to trainees in paediatrics an 8-station OSCE was given. Ten residents on different levels of training participated. Stations covered a wide spectrum of clinical situations and included three video-recordings of patients. Skills in history-taking, examination, listing of differential diagnoses, planning of work-up as well as in communication and counselling were assessed. Verbal as well as written feedback was provided to all the trainees. In five trainees skills in examination were relatively weak, and subsequently it was possible to implement improvements in the educational program. Strengths and weaknesses of the educational program can be identified, but the benefits of the OSCE should be balanced with the extra workload and logistical difficulties.

Clinical Competence↗

Effects of picture referencing on PVC chair, love seat, and settee assemblies by students with mental retardation.

This study examined the effects of two indirect corrective feedback procedures on the assembly skills of five secondary students with moderate mental retardation. Picture and video referencing conditions, during which the experimenters pointed to a picture or video screen following a performance error and requested the student do the step again, were more effective than assembly photographs, sequenced pictures, sequenced pictures and modeling, and video modeling conditions. Picture referencing enabled each participant to independently assemble a 13-step, 31-piece chair that required assembly of 45 loose, assembled, or loose and assembled parts. Following the introduction of picture referencing across two more complex tasks, four students independently completed more complex love seat and settee assemblies in fewer trials than required during their initial chair assembly. This article discusses the self-correction and self-management implications.

Adolescent↗

Teaching and learning speech and language therapy skills: the effectiveness of classroom as clinic in speech and language therapy student education.

BACKGROUND: Terms such as 'clinical intuition' have often been applied to the practice of speech and language therapy. Various authors have aimed to make the process of therapy practice more explicit, and it is argued that recently developed descriptive/analytic frameworks have the potential to engender the critical mindset necessary for student speech and language therapists to become good reflective practitioners, with the potential for enhancing clinical education. AIMS: To investigate whether and how aspects of clinical skills education could be usefully addressed in an academic, as opposed to a clinical, setting. The study aimed to address the question of whether use of an interaction analysis system, in conjunction with video observation, and 'practice simulation' in a teaching-learning programme could be shown to have a positive impact on: (1) students' perceptions of their own understanding and practice of therapy, and their perceptions of themselves as self-reflective practitioners; and whether (2) this was borne out by students' ability to observe and interpret therapeutic interaction, as measured by (i) an objective written assessment; (ii) an objective video observation assessment; and (iii) assessment of their abilities in clinical practice. METHODS & PROCEDURES: Thirty-six students from City University took part in an experimental, placebo-controlled study using a deferred intervention design. Assessments designed to reflect changes resulting from the teaching-learning curriculum were carried out pre- and post-intervention with experimental and control groups. Quantitative and qualitative results were obtained. OUTCOMES & RESULTS: The intervention programme was found to have had a significant impact on students' perceptions of their understanding of therapy, but not on their perceptions of their practice of therapy. The experimental group scored significantly better on a written assessment of 'interpretation of therapy interaction', but were no better than the control group on a 'Video observation' assessment. Owing to attrition and the poor quality of videos submitted for assessment, it was not possible to measure changes in actual clinical practice. Qualitative feedback from the teaching-learning programme suggests that students generally found the approach to be beneficial. CONCLUSIONS: While there were some encouraging results, it is still uncertain whether addressing the actual practice of therapy in an academic setting gives 'added value' to the work carried out on clinical placements. However, there is no doubt that bringing this type of programme under the umbrella of an academic institution would greatly increase the consistency of teaching and the range of experiences available to students.

Adult↗

Why people continue to play online games: in search of critical design factors to increase customer loyalty to online contents.

As people increasingly play online games, numerous new features have been proposed to increase players' log-on time at online gaming sites. However, few studies have investigated why people continue to play certain online games or which design features are most closely related to the amount of time spent by players at particular online gaming sites. This study proposes a theoretical model using the concepts of customer loyalty, flow, personal interaction, and social interaction to explain why people continue to play online network games. The study then conducts a large-scale survey to validate the model. Finally, it analyzes current online games to identify design features that are closely related to the theoretical concepts. The results indicate that people continue to play online games if they have optimal experiences while playing the games. This optimal experience can be attained if the player has effective personal interaction with the system or pleasant social interactions with other people connected to the Internet. Personal interaction can be facilitated by providing appropriate goals, operators and feedback; social interaction can be facilitated through appropriate communication places and tools. This paper ends with the implications of applying the study results to other domains such as e-commerce and cyber communities.

Communication↗

Student field performances: how valid are your preceptors' evaluations?

Developing relevant performance standards and rating criteria and preparing preceptors for the role of evaluator are critical to establishing valid student field performance evaluations and providing assurance to educational institutions that graduating students truly are competent and ready to assume an entry-level position. Using scripted, pre-scored video case studies in conjunction with written guidelines for rating the performance standards and providing specific feedback to explain rationale can significantly improve interrater agreement between preceptors.

Educational Measurement↗

A program of interventions designed to increase mammography rates in women ages 50 years and older for an underserved racial minority.

Although breast cancer mortality rates have declined among white women nationally, rates have increased among African-American women. In an effort to increase the use of screening mammography in African-American women in Philadelphia, intervention strategies were developed to target this segment of the population which included an educational program delivered by members of the community with a video as the core component; educational mailings with a prepaid return postcard; posters with tear-off, prepaid postcards; and publilc service messages. The educational program with the video was delivered at 77 sites in Philadelphia attended by 4,481 people. Postcards validated by mammography centers were returned by 454 women in the targeted population. It was difficult to obtain feedback from members of the targeted population who either presented or attended and educational session but the small sample that responded specified that they appreciated having African-Americans featured in the video.

Black or African American↗

[Vocalab: a new software for voice evaluation and therapy].

When handling vocal pathologies, speech therapists need tools to visualise voice and speech, in order to correlate personal auditory analysis with accurate data. Vocalab2 is a spectral analysis tool designed for speech therapists, developed in partnership with INSA Toulouse, France. Vocalab is a simple and user-friendly tool with important features to be used during evaluation and therapy. The software is based on a set of phoniatric data and sophisticated real-time signal analysis (Fourier transform, fundamental detection). One of the key tools of Vocalab2 is the real-time spectrum for visualising, differentiating and comparing every cord approximation and speech movement. Animations are proposed for illustrating most phonemes, and videos related to folding cords in the case of pathologic and normal sound production are also proposed. An extensive test has been conducted during 18 month, with important feedback that has considerably improved the tool. The satisfaction ratio is around 8/10.

Acoustics↗

A new generation videokymography for routine clinical vocal fold examination.

OBJECTIVE: This study aims to introduce a new-generation videokymographic system, which provides simultaneous laryngoscopic and kymographic image, for routine clinical vocal fold examination. STUDY DESIGN: The authors explored a new imaging method for diagnosis and evaluation of voice disorders. METHODS: The new-generation videokymographic system includes two charge-coupled device image sensors, a color area image sensor, and a monochromic high-speed line-scan image sensor. The high-speed line-scan image sensor is used to capture the kymogram, and the color area image sensor is used to obtain the laryngoscopic image. The two images can be displayed simultaneously on a video monitor or stored in a standard video recorder. Three subjects with nonpathologic voice were investigated in detail with the new videokymographic system. RESULTS: The high-quality laryngoscopic image and kymogram can be used directly for clinical purposes with no further postprocessing. The scan position of the kymogram is always indicated in the laryngoscopic image, which provides feedback for the operator to easily locate the expected scanning position. All varieties of vocal fold vibration, including irregular vibrations, phonation onset and offset, can be observed with the presented method. The continuous kymogram of the vocal fold vibration can be retrieved from a kymographic image sequence for quantitative analysis. CONCLUSIONS: The new-generation videokymography provides a simple, quick means to investigate vocal fold vibration, especially for voice disorders. It can emerge as an important tool for routine clinical vocal fold examination.

Data Display↗

Real-time gesture recognition by learning and selective control of visual interest points.

For the real-time recognition of unspecified gestures by an arbitrary person, a comprehensive framework is presented that addresses two important problems in gesture recognition systems: selective attention and processing frame rate. To address the first problem, we propose the Quadruple Visual Interest Point Strategy. No assumptions are made with regard to scale or rotation of visual features, which are computed from dynamically changing regions of interest in a given image sequence. In this paper, each of the visual features is referred to as a visual interest point, to which a probability density function is assigned, and the selection is carried out. To address the second problem, we developed a selective control method to equip the recognition system with self-load monitoring and controlling functionality. Through evaluation experiments, we show that our approach provides robust recognition with respect to such factors as type of clothing, type of gesture, extent of motion trajectories, and individual differences in motion characteristics. In order to indicate the real-time performance and utility aspects of our approach, a gesture video system is developed that demonstrates full video-rate interaction with displayed image objects.

Algorithms↗

The Medical Interaction Process System (MIPS): an instrument for analysing interviews of oncologists and patients with cancer.

The increase in communication skills training for doctors has led to the need for more effective means of evaluation. Analysis of video and audiotaped consultations using systems of interaction analysis can provide the trainee with in-depth feedback about their communication skills. Most interaction process systems were designed for use in primary care and recent research has questioned the applicability of these systems in medical specialties such as oncology. We describe the development of a new instrument, the Medical Interaction Process System (MIPS) for use in teaching communication skills and empirical research in medical encounters, particularly, between doctors and patients with cancer. A comparison of the MIPS and comparable behaviour categories of another widely used system (the Roter Interaction Analysis System) was made to test convergent validity. Pearson correlation coefficients suggested a good level of concurrence between the two systems. Intercoder reliability tests were carried out between two coders at two separate time periods. Both of these indicated good reliability for the majority of categories. The two major advantages of the MIPS over other coding systems are: (1) the system allows for sequential and parallel coding, thus avoiding major coding conflicts and (2) the design of the coding sheet results in a multidimensional view of the consultation without data loss. We believe that the MIPS yields useful information for teaching doctors communication skills and also provides an objective method for evaluating the effectiveness of communication skills courses.

Humans↗

Development of colonoscopy teaching simulation.

After 17 years of prototyping, a first release version of the St Mark's Hospital teaching simulator is in final preparation. Advances in computer processing power and graphics cards make it possible to achieve real-time processing of colon and endoscope characteristics and a simulated endoscopic view at an acceptable cost. Realistic feel or "force feedback" for all instrument controls and shaft movements is incorporated. To make the simulator more than a "video game", a package of teaching and assessment features is to be incorporated, including interactive animated graphics to explain particular endoscope loops and situations and the variations of colonic anatomy that are typically encountered. Simulation should spare patients from being used for the early phases of training and should speed up and quantify the learning process. Simulators may introduce even experienced endoscopists to some of the advanced options available in current or future endoscopes or accessories, as well as the use of imminent new technology such as the magnetic imaging system.

Colonoscopy↗

The development and usability of 'The Genetics Navigator': a digital solution for adult and paediatric clinical genetics services.

Clinical genetic services address diverse genetic testing needs, but there is no comprehensive digital solution to meet this variety. We aimed to develop and test the usability of the Genetics Navigator (GN), a platform designed to enhance genetic services for paediatric and adult patients. The GN prototype was created with input from a patient and clinician advisory board, informed by prior research. Usability testing involved genetics patients (N = 14), parents of paediatric patients (N = 4), and the general public (N = 10). Participants provided feedback using the 'think aloud' method when using the platform. We used the System Usability Scale (SUS) for quantitative evaluation. Qualitative data were coded by platform section, item, and identified key areas for improvement. Building on the Genetics Adviser platform, we added video and written content for various genetic conditions and patient groups, including pre-test education, counselling, decision support, history collection, post-test result disclosure, and management. Key feedback during rounds of usability testing emphasized the need for a supportive design, seamless workflow, and engaging experience of the tool. The tool was modified to reflect the feedback, and the GN achieved an average SUS score of 87.7 ± 10.9 (N = 28), indicating above-average usability. Future research will evaluate its clinical and cost-effectiveness in a randomized trial.

Humans↗

HEAL: an instructional design model applied to an online clerkship in family medicine.

OBJECTIVE: The potential of distance learning technology to deliver educational programs in which instruction and evaluation are of a consistent and high standard across multiple settings is hampered by a lack of instructional design models. In response, we developed the HEAL (Heuristic for Electronic Asynchronous Learning) model for designing online curricula. DESCRIPTION: HEAL is based on the theories that learning is facilitated by independent problem solving, investigation, and discovery (heuristics); collaboration between students fosters learning; and the proven educational cycle of practice, feedback, and reflection is integral to the interrelated domains of skill development and personal awareness.(1) The HEAL model is defined by synergistic online learning activities integrated with real patient care. It is applicable to all medical education levels. We applied this innovative design template to an online curriculum that augments our conventional six-week third-year clerkship. Our students, who were placed in distant family physician offices, needed more interaction and learning from peers and faculty. The three elements of HEAL, and implementation in the "online clerkship," are: (1) Didactic modules teach and illustrate concepts. Students study modules (HTML pages) on management of diabetes (DM), and complete five modules on evidence-based medicine (EBM). They do EBM literature searches reviewed online by peers, faculty, and librarians, who provide feedback. (2) A problem-based case discussion promotes application of concepts from modules (horizontal curricular integration). Students view streamed video of a patient with a history suggestive of diabetes, review her medical chart online, and suggest evidence-based management in an asynchronous discussion group. The case progresses weekly to mimic 12 months of continuity of care. (3) A collaborative journal activity explores the results of applying elements one and two to real patients (vertical integration). Additional elements advance reflection, professionalism, and medical humanism. Participation in the journal discussion group, stimulated by online readings, enhances self-awareness, informs psychosocial aspects of element 2, and promotes generalization of learning objectives to real patients. We use BlackBoard software. Students log in two to three times per week. Faculty who are trained in online moderation facilitate the threaded discussion groups and provide feedback. DISCUSSION: Students in alternating clerkship blocks complete the online clerkship. Their performance is compared with that of students who complete a face-to-face diabetes curriculum, but no curriculum on EBM or medical humanism. After nearly a year (105 students), compared with the non-online group, students completing the online clerkship demonstrated greater gains in reported EBM skills from preto post-clerkship, larger increases in mean score (from pre to post) on a medical-humanism aptitude scale, and higher scores on a post-clerkship diabetes management assessment (all comparisons p <.05). The online clerkship will become a permanent part of our clerkship and we have begun to use HEAL to design other online courses, including continuing education courses.

Clinical Clerkship↗

Automatic detection and segmentation of robot-assisted surgical motions.

Robotic surgical systems such as Intuitive Surgical's da Vinci system provide a rich source of motion and video data from surgical procedures. In principle, this data can be used to evaluate surgical skill, provide surgical training feedback, or document essential aspects of a procedure. If processed online, the data can be used to provide context-specific information or motion enhancements to the surgeon. However, in every case, the key step is to relate recorded motion data to a model of the procedure being performed. This paper examines our progress at developing techniques for "parsing" raw motion data from a surgical task into a labelled sequence of surgical gestures. Our current techniques have achieved >90% fully automated recognition rates on 15 datasets.

Artificial Intelligence↗

Local positive feedback by calcium in the propagation of intracellular calcium waves.

In many types of eukaryotic cells, the activation of surface receptors leads to the production of inositol 1,4,5-trisphosphate and calcium release from intracellular stores. Calcium release can occur in complex spatial patterns, including waves of release that traverse the cytoplasm. Fluorescence video microscopy was used to view calcium waves in single mouse neuroblastoma cells. The propagation of calcium waves was slowed by buffers that bind calcium quickly, such as BAPTA, but not by a buffer with slower on-rate, EGTA. This shows that a key feedback event in wave propagation is rapid diffusion of calcium occurring locally on a scale of < 1 micron. The length-speed product of wavefronts was used to determine that calcium acting in feedback diffuses at nearly the rate expected for free diffusion in aqueous solution. In cytoplasm, which contains immobile Ca2+ buffers, this rate of diffusion occurs only in the first 0.2 ms after release, within 0.4 micron of a Ca2+ release channel mouth. Calcium diffusion from an open channel to neighboring release sites is, therefore, a rate-determining regenerative step in calcium wave propagation. The theoretical limitations of the wave front analysis are discussed.

Animals↗

[Emergency medicine online course--integrating into curriculum of computer-based training].

Emergency medicine is characterized by rapid decision making to help patients in life-threatening situations. Teaching these skills requires a high level of interaction between medical students and the lecturer. We designed, implemented, and evaluated a generic computer-based training (CBT) system to provide a more active way of learning emergency medicine. The content of the training program is adapted to the knowledge of third year medical students and is focused on basic skills and real-world problems. The teacher presents the case with authentic video sequences and slides. The cases are classified into four groups: heart (e.g., myocardial infarction), respiration (e.g., asthma bronchiale), trauma (e.g., car accident), and loss of consciousness (e.g., coma). Within a realistic time frame, the students have to answer free text and multiple choice questions on a work-station. All answers given by the students are processed anonymously by the CBT system via a central server and displayed on a large video screen, thus enabling a detailed discussion without intimidation of individual students. This interactive technique allows for immediate feedback from the lecturer based on the specific knowledge of his group and his own experience. The IT concept, which is scalable to many subjects, is based on state of the art internet technology and therefore suitable for teleteaching. A major design objective for the program was a self-explaining and robust user interface. The system has been in routine use since 1998. We designed an evaluation form consisting of 21 items focused on subjective rating of learning success, acceptance of CBT, and technical feasibility. We analyzed forms from 138 students and found high scores for acceptance and learning success (median 5 on a 6-point scale). user problems with the program were denied (median 1 on a 6-point scale). Computer-based training with Internet technology can provide a successful method for interactive teaching of emergency medicine and is well accepted by students.

Computer Graphics↗