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Training general practitioners to teach psychiatric interviewing skills: an evaluation of group training.

Group teaching in problem-based interviewing based on video and audiotape feedback of the doctor's own consultations significantly improved the ability of experienced general practitioners to teach psychiatric skills to their trainees. When the GPs were randomly allocated to one of three further training experiences--video feedback of their tutorial sessions, discussion about how to teach and no further teaching, there were very few differences between the groups. The greatest impact on improving teaching skills was brought about by watching their own consultations in a group feedback setting.

Clinical Competence↗

EEG-based communication and control: short-term role of feedback.

When people learn to control the amplitudes of certain electroencephalogram (EEG) components (e.g., the 8-12 Hz mu-rhythm over sensorimotor cortex) and use them to move a cursor to a target on a video screen, feedback about performance is normally provided by cursor movement and by trial outcome (i.e., success or failure). We assessed the short-term effects of this feedback on EEG control. After subjects received initial training with feedback present, feedback was removed intermittently for periods of several minutes. Subjects still displayed EEG control when feedback was removed. Removal of cursor movement alone appeared to have effects comparable to removal of both cursor movement and trial outcome. These results show that, in the short-term at least, mu-rhythm control is not dependent on the sensory input provided by cursor movement. They also suggest that feedback can have inhibitory as well as facilitory effects on EEG control, and that these effects vary across subjects. This finding has implications for the design of training procedures.

Adult↗

[Effective didactic skills training for teachers in continuing medical education].

PURPOSE: To develop, test, evaluate and implement effective state-of-the-art teacher training in didactic skills and methods. The training concept should be designed and beneficial for medical teachers' postgraduate medical education (CME). MATERIALS AND METHODS: A 5-day workshop with 12 theoretical and 9 "hands-on" modules was designed and stepwise improved, according to the trainees' feedback. All trainees were trained in small groups (6 to 10 participants per workshop). The workshops consisted of mini-lectures, repeated micro teaching exercises and video-supported feedback concerning the following key-competencies: Communication of goals; methods to trigger interactivity; design of slides in power point presentations; effective feedback-techniques; and use of media, time-management, skills teaching, assessment methods (e. g. OSCE and others), evaluation and general presentation skills. The evaluation was based on two components: A) trainees' scores in two objective structured teaching exercises (OSTEs) at the beginning and end of workshop, with the ratings of 15 to 20 external observers checked for significant trends (Pearson's X2 test) in 17 given criteria for high teaching effectiveness; B) the trainees rated 20 teaching competencies in a retrospective "pre-post-analysis" (self-assessment questionnaire) at the end of each workshop and after 6 to 12 months later. RESULTS: The results revealed highly significant (p < 0.01) improvements in 13 of 16 OSTE-criteria and in 12 of 13 items of the pre-post-analysis, predominantly estimated to be "persistent." Overall, trainees; feedback has been highly encouraging to continue and broaden the program. The discussion covers potential factors for the training success as well as pitfalls and the controversial issue of fees. CONCLUSION: The designed 5-day training workshops to enhance didactic skills and teaching methods turned out to be highly effective and can be attended by all medical teachers with different teaching backgrounds and specialties. The training has been certified for CME-credits by the Academy of the Physicians' State Association of North Rhine-Westphalia.

Certification↗

Real-time automated tracking and trapping system for sperm.

We have developed a microscope system for real-time single sperm tracking with an automated laser tweezers escape power assay. Phase contrast images of swimming sperm are digitized to the computer at video rate. The custom algorithm creates a region of interest centered about a sperm in response to a mouse click and performs all subsequent tasks autonomously. Microscope stage movement responds to feedback from video analysis of swimming sperm to center the sperm with respect to the field of view. For escape power assays, sperm are automatically relocated to the laser trap focus where they are held for a user-defined duration at fixed power, or held as laser power is gradually reduced. The sperm's position is automatically monitored to measure the laser power at which the sperm escapes the trap. Sperm are tracked for extended durations before and after laser trap experiments. Motility measurements including the curvilinear velocity and the absolute position of the sperm relative to the cell chamber are calculated and written to the hard drive at video rate. Experimental throughput is increased over 30 times compared to off-line data analysis. The efficacy of the "track and trap" algorithm is validated through examples and comparisons with the manually collected data.

Animals↗

Teleoperator performance with varying force and visual feedback.

An experimental study was conducted to determine the effects of various forms of visual and force feedback on human performance for several "peg-in-hole"-type telemanipulation tasks. Each of six human test subjects used a master/slave manipulator during two experimental sessions. In one session the subjects performed the tasks with direct vision, where subtended visual angle, force feedback, task difficulty, and the interaction of subtended visual angle and force feedback made significant differences in task completion times. During the other session the tasks were performed using a video monitor for visual feedback, and video frame rate, force feedback, task difficulty, and the interaction of frame rate and force feedback were found to make significant differences in task times. An analysis between the direct and video viewing environments showed that apart from subtended visual angle and reduced frame rate, the video medium itself did not significantly affect task times relative to direct viewing.

Artificial Intelligence↗

Teaching and assessing behavioural techniques of applied relaxation for reduction of dental fear using a controlled chairside simulation model.

This paper describes a novel method of teaching and assessing relaxation techniques using a controlled chairside simulation model. 50 pre-clinical dental undergraduates provided an evaluation of the teaching model as part of their basic clinical skills teaching. Students were required to demonstrate applied relaxation techniques according to 2 pre-selected clinical vignettes. Inter-observer reliability of assessing student competence was calculated on a varied sample (n=9) using 2 independent observers and found to be adequate. The majority of the students viewed the teaching and assessment method as interesting and clinically relevant. However, a few students reported that the method was less advantageous than using a real patient. It is concluded that using vignettes as part of clinical training accompanied by video-based feedback provides a resourceful learning tool for pre-clinical teaching in the absence of patient contact.

Clinical Competence↗

A Technology-assisted approach to integrating healthcare in the community.

The fragmentary nature of healthcare provision in the United Kingdom presents particular problems for many patients with vascular disease. The management and organization of this disease are also costly for the National Health Service (NHS). Hence, so any attempt to keep hospital visits to the minimum while at the same time aiding effective treatment is to be welcomed. Information in the current NHS is stored in various places and access to it is restricted. There is no central, complete, patient record that is accessible to all healthcare professionals at the various levels of care. There is also no mechanism that allows the patient to interact with his or her local nurse and/or doctor/general practitioner (at primary-care level) involving the specialist/consultant (at secondary-care level). The concept and conduct of an ulcer care program for such patients are described in this paper. Nurse-led, this novel approach uses an innovative information technology system to bring together the isolated 'islands' of knowledge and information held by both the patient and healthcare professionals involved in their care. The technology described here combines both store and forward and real-time video. Informal feedback from patients, community nurses, doctors/general practitioners, and specialists/consultants suggests that such an approach is well received. However, we conclude with a discussion of the complexities involved in the interaction between technology and people and the implications for the management of healthcare.

Communication↗

An evaluation of a communication skills course for health visitor students.

This paper presents part of the findings of an extensive empirical evaluation of a communication skills training programme for health visitor students. The programme was designed to develop the health visitors' ability to communicate with clients. A wide range of interpersonal skills were addressed and the training format involved skill analysis, roleplay practice and video-recorded feedback. The method of evaluation included an appraisal of the health visitors' social behaviour in a roleplay of a home-visit to a pregnant client. Data were collected, both before and following training, in an attempt to assess changes in trainee behaviour. The analysis took the form of a detailed frequency measurement of behavioural elements of health visitor performance, and a global rating of social competence by independent judges. Results of the analyses indicated that 14 out of the 20 behavioural variables changed in the desired direction. Thus, for example, following training the health visitors used significantly more open questions and verbal encouragers, and significantly fewer multiple questions and interruptions when communicating with the client. They were also rated significantly higher on the rating scale for social competence following training. These findings would seem to suggest that the training programme had a considerable degree of success. The findings are discussed in terms of the implications for development of health visitors' social skills, the need for more sophisticated measures of social behaviour and for the formulation of a model of competent professional practice in this area.

Communication↗

Teaching interviewing with simulated patients.

The use of social-work students as simulated patients for teaching interviewing to general practice trainees, is described. The results of analysing the video-tape feedback for one such patient, with a small group of trainees, are given to illustrate the method used.

Education, Medical, Graduate↗

Altering shoppers' supermarket purchases to fit nutritional guidelines: an interactive information system.

This study reports the results of one effort to help supermarket shoppers alter food purchases to make purchases (and meals) that are lower in fat and higher in fiber. A prototype interactive information system using instructional video programs, feedback on purchases with specific goals for change, weekly programs, and the ability to track user interactions and intended purchases was evaluated. The major dependent measure was users' actual food purchases as derived from participants' highly detailed supermarket receipts. After a 5- to 7-week baseline phase, participants were randomly assigned to an experimental or control condition for the 7- to 8-week intervention phase. A follow-up phase began 5 to 8 weeks after participants completed the intervention and discontinued use of the system. The results indicated that experimental participants, when compared to control participants, decreased high fat purchases and increased high fiber purchases during intervention, with evidence for some maintenance of effect in follow-up. Plans for increasing the use and impact of the system are discussed.

Dietary Fats↗

Effects of ultrasound feedback on pregnancy anxiety, fetal activity, and neonatal outcome.

A group of pregnant women received video and verbal feedback during three ultrasound examinations. This group was compared with a no-feedback group on measures of pregnancy anxiety, fetal activity, and neonatal outcome. The feedback appeared to reduce pregnancy anxiety and fetal activity, particularly for the primiparous women. These women also experienced fewer obstetric complications and gave birth to neonates who were greater weight, more appropriate weight-for-length, less active and irritable, and showed better performance on the Brazelton neonatal behavior assessment.

Anxiety↗

Neurofeedback in adolescents and adults with attention deficit hyperactivity disorder.

Neurofeedback is being utilized more commonly today in treating individuals who have attention deficit hyperactivity disorder (ADHD). Neurofeedback, which is based on theories that recognize the organic basis of ADHD, utilizes biofeedback to guide individuals to regulate their brain activity. Neurofeedback relies on research that has demonstrated that most individuals who have ADHD, as compared to matched peers, have excess slow wave activity and reduced fast wave activity. It provides immediate feedback to the individual about his or her brain wave activity in the form of a video game, whose action is influenced by the individual's meeting predetermined thresholds of brain activity. Over several sessions of using the video and auditory feedback, individuals reduce their slow wave activity and/or increase their fast wave activity. Individuals who complete a course of training sessions often show reduced primary ADHD symptoms. Research has shown that neurofeedback outcomes compare favorably to those of stimulant medication.

Adolescent↗

The effect of nasopharyngoscopic biofeedback in patients with cleft palate and velopharyngeal dysfunction.

OBJECTIVE: To evaluate the immediate, long-term, and carry-over effects of nasopharyngoscopic biofeedback therapy in patients with cleft palate who exhibit velopharyngeal dysfunction (VPD). DESIGN: Pre- versus posttreatment and follow-up comparisons. SETTING: Cleft palate center of the Heidelberg University Hospital, Heidelberg, Germany. SUBJECTS: Eleven patients with VPD who had received conventional speech therapy without showing significant improvement. INTERVENTIONS: A four-stage feedback procedure. The patients watched and evaluated their velopharyngeal (VP) valving during speech by an endoscopic image displayed on a video monitor. Two feedback sessions took place for every target sound. MAIN OUTCOME MEASURES: Mean occurrence of VP closure during speech sound production on different linguistic levels. Patients' self-perception was assessed by a questionnaire and speech diary. RESULTS: Significant improvement and stability of VP closure was noted. Mean occurrence of VP closure was 5% before therapy, 91% after two biofeedback sessions, and 86% in the follow-up after 6 months. Velopharyngeal dysfunction associated with compensatory articulation proved to be equally well trained as VPD on sounds with good articulatory placement. No significant difference was observed in the degree of improvement between phoneme-specific VPD and generalized VPD. The transfer to the level of words and sentences was successful and showed significant stability. The stability of VP closure for vowels was less than the stability for fricatives and stop sounds. Patients gained improved auditory and kinesthetic self-perception of their articulation. CONCLUSIONS: Nasopharyngoscopic biofeedback therapy proves to be a quick and effective method to change VPD. It shows stable results and carry-over effects.

Adolescent↗

Evaluating the use of streaming video to support student learning in a first-year life sciences course for student nurses.

Streaming video was used to support the learning of first year student nurses on a Life Sciences module, as one of many innovations designed to increase the range of resources and support available to students. This paper describes the background to this innovation, the procedures adopted and the results of extensive evaluation. The use of streaming video was evaluated in three applications in the module. A total of 656 students used online directed-learning sessions that incorporated streamed video. Just over half of these students actually viewed the video streams. Their feedback showed that 32% found access easy, 59% enjoyed using the resources, and 25% were very confident that they learned from them. Different types of video were used, and embedded in diverse ways, but the results were consistent across the three applications. They suggest that streamed video can contribute to useful resources to support learning by student nurses but, for a variety of reasons, it may not appeal or be adequately accessible to all students at present.

Biological Science Disciplines↗

The utilization of visual feedback in the control of movement direction: evidence from a video aiming task.

The purpose of the present study was to establish the contribution of visual feedback in the correction of errors during movement execution (i.e., online) and the utilization of visual feedback from a completed movement in the programming of upcoming trials (i.e., offline). Participants performed 2 dimensional sweeping movements on a digitizing tablet through 1 of 3 targets, which were represented on a video monitor. The movements were performed with and without visual feedback under 4 criterion movement times (150, 250, 350, 450 msec). We analyzed the variability in directional error at 25%, 50%, 75%, and 100% of the distance between the home position and the target. There were significant differences in variability between visual conditions at each movement time. However, in the 150-msec condition, the form of the variability profiles did not differ between visual conditions, suggesting that the contribution of visual feedback was due to offline processes. In the 250-, 350-, and 450-msec conditions, there was evidence for both online and offline control, as the form of the variability profiles differed between the vision and no vision conditions.

Adolescent↗

Extrinsic feedback for motor learning after stroke: what is the evidence?

PURPOSE: There is little guidance on using extrinsic feedback to enhance motor learning after stroke. This narrative review synthesises research findings and identifies questions remaining to be answered. METHOD: A summary is given relating to the use of extrinsic feedback in healthy subjects. Then, research concerning content of feedback, feedback scheduling, and attentional focus is discussed in relation to patients with stroke. RESULTS: Though research is scarce, preliminary key findings were as follows: Patients' balance performance can improve from receiving visual feedback about weight distribution during practice; auditory feedback of force production may improve performance of sit-to-stand; providing feedback on less than 100% of trials, and giving summary or average feedback may enhance learning; instructions or feedback inducing an external focus may be more effective than those with an internal focus. Further research is needed concerning the relative benefits of verbal, visual, video and kinematic feedback; reduced feedback frequencies and summary feedback schedules; feedback delays, error estimation, and self-controlled feedback; and attentional focus of feedback. CONCLUSIONS: Although there are some indications that feedback might enhance motor learning after stroke, there are many areas as yet not examined and there is clearly a need for considerable research in this area.

Evidence-Based Medicine↗

Genome science: a video tour of the Washington University Genome Sequencing Center for high school and undergraduate students.

Sequencing of the human genome has ushered in a new era of biology. The technologies developed to facilitate the sequencing of the human genome are now being applied to the sequencing of other genomes. In 2004, a partnership was formed between Washington University School of Medicine Genome Sequencing Center's Outreach Program and Washington University Department of Biology Science Outreach to create a video tour depicting the processes involved in large-scale sequencing. "Sequencing a Genome: Inside the Washington University Genome Sequencing Center" is a tour of the laboratory that follows the steps in the sequencing pipeline, interspersed with animated explanations of the scientific procedures used at the facility. Accompanying interviews with the staff illustrate different entry levels for a career in genome science. This video project serves as an example of how research and academic institutions can provide teachers and students with access and exposure to innovative technologies at the forefront of biomedical research. Initial feedback on the video from undergraduate students, high school teachers, and high school students provides suggestions for use of this video in a classroom setting to supplement present curricula.

Feedback↗

The Observer Video-Pro: new software for the collection, management, and presentation of time-structured data from videotapes and digital media files.

The Observer Video-Pro is a system for collecting, managing, analyzing, and presenting observational data. It integrates The Observer software with time code and multimedia hardware components. It extends the functionality of a conventional real-time event recording program in various ways. Observational data can be collected, reviewed, and edited with synchronized display of the corresponding video images. For optimal visual feedback during coding, one can display the video image in a window on the computer screen. Video playback from either a VCR or a digital media file can be controlled by the computer, allowing software-controlled jog, shuttle, and search functions. Besides a wide range of VCRs, The Observer Video-Pro supports all major digital video file formats. The software allows the user to summarize research findings in numerical, graphical, or multimedia format. One can create a time--event plot for a quick glance at the temporal structure of the observed process, or run specific analysis procedures and generate reports with statistics. An Event Summary function is available for exploratory and qualitative analysis. Video material can be summarized in a Video Play List, which allows on-screen summary presentations or the creation of highlight compilations on tape, CD, or other media. Video images can be captured and saved as disk files, for use as illustrations in documents, slides for presentations, and so forth. In this paper we describe the design and operation of the system, illustrated with a case study from research on Repetitive Strain Injury (RSI).

Electronic Data Processing↗