Non-technical skills training to enhance patient safety.

Science.gov (United States)

Gordon, Morris

2013-06-01

  Patient safety is an increasingly recognised issue in health care. Systems-based and organisational methods of quality improvement, as well as education focusing on key clinical areas, are common, but there are few reports of educational interventions that focus on non-technical skills to address human factor sources of error. A flexible model for non-technical skills training for health care professionals has been designed based on the best available evidence, and with sound theoretical foundations.   Educational sessions to improve non-technical skills in health care have been described before. The descriptions lack the details to allow educators to replicate and innovate further.   A non-technical skills training course that can be delivered as either a half- or full-day intervention has been designed and delivered to a number of mixed groups of undergraduate medical students and doctors in postgraduate training. Participant satisfaction has been high and patient safety attitudes have improved post-intervention.   This non-technical skills educational intervention has been built on a sound evidence base, and is described so as to facilitate replication and dissemination. With the key themes laid out, clinical educators will be able to build interventions focused on numerous clinical issues that pay attention to human factor contributors to safety. © 2013 John Wiley & Sons Ltd.

Collaborative learning of clinical skills in health professions education

DEFF Research Database (Denmark)

Tolsgaard, Martin G.; Kulasegaram, Kulamakan M.; Ringsted, Charlotte V

2016-01-01

Objectives: This study is designed to provide an overview of why, how, when and for whom collaborative learning of clinical skills may work in health professions education. Why: Collaborative learning of clinical skills may influence learning positively according to the non-medical literature...... suggests that learning is dependent on cognitive co-construction, shared knowledge and reduced cognitive load. When and for whom: The literature on the collaborative learning of clinical skills in health science education is reviewed to support or contradict the hypotheses provided by the theories outlined...... above. Collaborative learning of clinical skills leads to improvements in self-efficacy, confidence and performance when task processing is observable or communicable. However, the effects of collaborative learning of clinical skills may decrease over time as benefits in terms of shared cognition...

Simulation-based medical education in clinical skills laboratory.

Science.gov (United States)

Akaike, Masashi; Fukutomi, Miki; Nagamune, Masami; Fujimoto, Akiko; Tsuji, Akiko; Ishida, Kazuko; Iwata, Takashi

2012-01-01

Clinical skills laboratories have been established in medical institutions as facilities for simulation-based medical education (SBME). SBME is believed to be superior to the traditional style of medical education from the viewpoint of the active and adult learning theories. SBME can provide a learning cycle of debriefing and feedback for learners as well as evaluation of procedures and competency. SBME offers both learners and patients a safe environment for practice and error. In a full-environment simulation, learners can obtain not only technical skills but also non-technical skills, such as leadership, team work, communication, situation awareness, decision-making, and awareness of personal limitations. SBME is also effective for integration of clinical medicine and basic medicine. In addition, technology-enhanced simulation training is associated with beneficial effects for outcomes of knowledge, skills, behaviors, and patient-related outcomes. To perform SBME, effectively, not only simulators including high-fidelity mannequin-type simulators or virtual-reality simulators but also full-time faculties and instructors as professionals of SBME are essential in a clinical skills laboratory for SBME. Clinical skills laboratory is expected to become an integrated medical education center to achieve continuing professional development, integrated learning of basic and clinical medicine, and citizens' participation and cooperation in medical education.

Effects of basic clinical skills training on objective structured clinical examination performance.

Science.gov (United States)

Jünger, Jana; Schäfer, Sybille; Roth, Christiane; Schellberg, Dieter; Friedman Ben-David, Miriam; Nikendei, Christoph

2005-10-01

The aim of curriculum reform in medical education is to improve students' clinical and communication skills. However, there are contradicting results regarding the effectiveness of such reforms. A study of internal medicine students was carried out using a static group design. The experimental group consisted of 77 students participating in 7 sessions of communication training, 7 sessions of skills-laboratory training and 7 sessions of bedside-teaching, each lasting 1.5 hours. The control group of 66 students from the traditional curriculum participated in equally as many sessions but was offered only bedside teaching. Students' cognitive and practical skills performance was assessed using Multiple Choice Question (MCQ) testing and an objective structured clinical examination (OSCE), delivered by examiners blind to group membership. The experimental group performed significantly better on the OSCE than did the control group (P < 0.01), whereas the groups did not differ on the MCQ test (P < 0.15). This indicates that specific training in communication and basic clinical skills enabled students to perform better in an OSCE, whereas its effects on knowledge did not differ from those of the traditional curriculum. Curriculum reform promoting communication and basic clinical skills are effective and lead to an improved performance in history taking and physical examination skills.

The Group Objective Structured Clinical Experience: building communication skills in the clinical reasoning context.

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Konopasek, Lyuba; Kelly, Kevin V; Bylund, Carma L; Wenderoth, Suzanne; Storey-Johnson, Carol

2014-07-01

Students are rarely taught communication skills in the context of clinical reasoning training. The purpose of this project was to combine the teaching of communication skills using SPs with clinical reasoning exercises in a Group Objective Structured Clinical Experience (GOSCE) to study feasibility of the approach, the effect on learners' self-efficacy and attitude toward learning communication skills, and the effect of providing multiple sources of immediate, collaborative feedback. GOSCE sessions were piloted in Pediatrics and Medicine clerkships with students assessing their own performance and receiving formative feedback on communication skills from peers, standardized patients (SPs), and faculty. The sessions were evaluated using a retrospective pre/post-training questionnaire rating changes in self-efficacy and attitudes, and the value of the feedback. Results indicate a positive impact on attitudes toward learning communication skills and self-efficacy regarding communication in the clinical setting. Also, learners considered feedback by peers, SPs, and faculty valuable in each GOSCE. The GOSCE is an efficient and learner-centered method to attend to multiple goals of teaching communication skills, clinical reasoning, self-assessment, and giving feedback in a formative setting. The GOSCE is a low-resource, feasible strategy for experiential learning in communication skills and clinical reasoning. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

A descriptive survey investigating pre-registration student nurses' perceptions of clinical skill development in clinical placements.

Science.gov (United States)

Stayt, Louise C; Merriman, Clair

2013-04-01

Clinical skill development is essential to nurse education. Clinical skills are frequently taught in higher education institutions using clinical simulation. It is unclear if clinical skills are subsequently consolidated and developed in clinical placements. The aim of this survey was to evaluate pre-registration student nurses perceptions of the frequency of opportunities to practise, the level of supervision and assessment of, clinical skills in their clinical placements. This was a cross-sectional survey design using an online, self-report questionnaire including a Likert-type scale and open ended comments. Four hundred and twenty one students, from all year groups, from a university in the south of England on a wide variety of clinical placements participated. Participants evaluated the frequency of opportunity to practise, level of supervision and assessment of and feedback on performance of specific clinical skills. Clinical skills evaluated were measurement of vital signs, aseptic non-touch technique, assisting with eating and drinking, and assisting with comfort and hygiene. Data were analysed utilising Statistical Package for the Social Sciences Version 19. The frequency of opportunities to practise skills in clinical placement was variable with some participants reporting that they never had opportunity to practise essential skills. Similarly the level of supervision and assessment was also inconsistent suggesting that participants frequently practised clinical skills unsupervised without being assessed as competent. Inconsistencies in clinical skill development may lead to graduates who are not work ready and as a result, insufficient clinical competence potentially leads to unsafe practice and poor patient care. This calls for stronger partnerships between educators and clinical areas and the prioritisation of mentor preparation and education as well as organisational support in terms of mentor workload planning. Copyright © 2012 Elsevier Ltd. All

Peer-assisted learning model enhances clinical clerk's procedural skills.

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Huang, Chia-Chang; Hsu, Hui-Chi; Yang, Ling-Yu; Chen, Chen-Huan; Yang, Ying-Ying; Chang, Ching-Chih; Chuang, Chiao-Lin; Lee, Wei-Shin; Lee, Fa-Yauh; Hwang, Shinn-Jang

2018-05-17

Failure to transfer procedural skills learned in a laboratory to the bedside is commonly due to a lack of peer support/stimulation. A digital platform (Facebook) allows new clinical clerks to share experiences and tips that help augment their procedural skills in a peer-assisted learning/teaching method. This study aims to investigate the effectiveness of the innovation of using the digital platform to support the transfer of laboratory-trained procedural skills in the clinical units. Volunteer clinical clerks (n = 44) were enrolled into the peer-assisted learning (PAL) group, which was characterized by the peer-assisted learning of procedural skills during their final 3-month clinical clerkship block. Other clerks (n = 51) did not join the procedural skills-specific Facebook group and served as the self-directed learning regular group. The participants in both the PAL and regular groups completed pre- and post-intervention self-assessments for general self-assessed efficiency ratings (GSER) and skills specific self-assessed efficiency ratings (SSSER) for performing vein puncture, intravenous (IV) catheter and nasogastric (NG) tube insertion. Finally, all clerks received the post-intervention 3-station Objective Structured Clinical Skills Examination (OSCE) to test their proficiency for the abovementioned three procedural skills. Higher cumulative numbers of vein punctures, IV catheter insertions and NG tube insertions at the bedside were carried out by the PAL group than the regular group. A greater improvement in GSERs and SSSERs for medical procedures was found in the PAL group than in the regular group. The PAL group obtained higher procedural skills scores in the post-intervention OSCEs than the regular group. Our study suggested that the implementation of a procedural skill-specific digital platform effectively helps clerks to transfer laboratory-trained procedural skills into the clinical units. In comparison with the regular self-directed learning

Simulation-guided cardiac auscultation improves medical students' clinical skills: the Pavia pilot experience.

Science.gov (United States)

Perlini, Stefano; Salinaro, Francesco; Santalucia, Paola; Musca, Francesco

2014-03-01

Clinical evaluation is the cornerstone of any cardiac diagnosis, although excessive over-specialisation often leads students to disregard the value of clinical skills, and to overemphasize the approach to instrumental cardiac diagnosis. Time restraints, low availability of "typical" cardiac patients on whom to perform effective bedside teaching, patients' respect and the underscoring of the value of clinical skills all lead to a progressive decay in teaching. Simulation-guided cardiac auscultation may improve clinical training in medical students and residents. Harvey(©) is a mannequin encompassing more than 50 cardiac diagnoses that was designed and developed at the University of Miami (Florida, USA). One of the advantages of Harvey(©) simulation resides in the possibility of listening, comparing and discussing "real" murmurs. To objectively assess its teaching performance, the capability to identify five different cardiac diagnoses (atrial septal defect, normal young subject, mitral stenosis with tricuspid regurgitation, chronic mitral regurgitation, and pericarditis) out of more than 50 diagnostic possibilities was assessed in 523 III-year medical students (i.e. at the very beginning of their clinical experience), in 92 VI-year students, and in 42 residents before and after a formal 10-h teaching session with Harvey(©). None of them had previously experienced simulation-based cardiac auscultation in addition to formal lecturing (all three groups) and bedside teaching (VI-year students and residents). In order to assess the "persistence" of the acquired knowledge over time, the test was repeated after 3 years in 85 students, who did not repeat the formal 10-h teaching session with Harvey(©) after the III year. As expected, the overall response was poor in the "beginners" who correctly identified 11.0 % of the administered cardiac murmurs. After simulation-guided training, the ability to recognise the correct cardiac diagnoses was much better (72.0 %; p

Simulation-based Mastery Learning Improves Cardiac Auscultation Skills in Medical Students

Science.gov (United States)

McGaghie, William C.; Cohen, Elaine R.; Kaye, Marsha; Wayne, Diane B.

2010-01-01

Background Cardiac auscultation is a core clinical skill. However, prior studies show that trainee skills are often deficient and that clinical experience is not a proxy for competence. Objective To describe a mastery model of cardiac auscultation education and evaluate its effectiveness in improving bedside cardiac auscultation skills. Design Untreated control group design with pretest and posttest. Participants Third-year students who received a cardiac auscultation curriculum and fourth year students who did not. Intervention A cardiac auscultation curriculum consisting of a computer tutorial and a cardiac patient simulator. All third-year students were required to meet or exceed a minimum passing score (MPS) set by an expert panel at posttest. Measurements Diagnostic accuracy with simulated heart sounds and actual patients. Results Trained third-year students (n = 77) demonstrated significantly higher cardiac auscultation accuracy compared to untrained fourth year students (n = 31) in assessment of simulated heart sounds (93.8% vs. 73.9%, p auscultation curriculum consisting of deliberate practice with a computer-based tutorial and a cardiac patient simulator resulted in improved assessment of simulated heart sounds and more accurate examination of actual patients. PMID:20339952

Developing an eBook-Integrated High-Fidelity Mobile App Prototype for Promoting Child Motor Skills and Taxonomically Assessing Children's Emotional Responses Using Face and Sound Topology.

Science.gov (United States)

Brown, William; Liu, Connie; John, Rita Marie; Ford, Phoebe

2014-01-01

Developing gross and fine motor skills and expressing complex emotion is critical for child development. We introduce "StorySense", an eBook-integrated mobile app prototype that can sense face and sound topologies and identify movement and expression to promote children's motor skills and emotional developmental. Currently, most interactive eBooks on mobile devices only leverage "low-motor" interaction (i.e. tapping or swiping). Our app senses a greater breath of motion (e.g. clapping, snapping, and face tracking), and dynamically alters the storyline according to physical responses in ways that encourage the performance of predetermined motor skills ideal for a child's gross and fine motor development. In addition, our app can capture changes in facial topology, which can later be mapped using the Facial Action Coding System (FACS) for later interpretation of emotion. StorySense expands the human computer interaction vocabulary for mobile devices. Potential clinical applications include child development, physical therapy, and autism.

Enhancing Higher Order Thinking Skills through Clinical Simulation

Science.gov (United States)

Varutharaju, Elengovan; Ratnavadivel, Nagendralingan

2014-01-01

Purpose: The study aimed to explore, describe and analyse the design and implementation of clinical simulation as a pedagogical tool in bridging the deficiency of higher order thinking skills among para-medical students, and to make recommendations on incorporating clinical simulation as a pedagogical tool to enhance thinking skills and align the…

Knowledge and skills of cancer clinical trials nurses in Australia.

Science.gov (United States)

Scott, Kathleen; White, Kate; Johnson, Catherine; Roydhouse, Jessica K

2012-05-01

  This paper is a report of the development and testing of a questionnaire measuring knowledge and skills of cancer clinical trials nurse in Australia.   The role of cancer clinical trials nurse, widely acknowledged as an integral member of the clinical research team, has evolved in recent years. Elements of the clinical trials nurse role in cancer have previously been described. To evaluate specific cancer clinical trials nurse educational and training needs, the development of a valid and reliable tool is required.   In 2009, a study was conducted in three stages. Stage I: questionnaire development and pilot testing; stage II: focus group; stage III: national survey. Internal consistency reliability testing and multi-trait analysis of item convergent/divergent validity were employed. Regression analysis was used to identify predictors of clinical trials nurse knowledge and skills.   The national survey was a 48-item questionnaire, measuring six clinical trial knowledge and seven skills sub-scales. Of 61 respondents, 90% were women, with mean age 43 years, 19 years as a Registered Nurse and 5 years as a cancer clinical trials nurse. Self-reported knowledge and skills were satisfactory to good. Internal consistency reliability was high (Cronbach's alpha: knowledge = 0·98; skills = 0·90). Criteria for item convergent/divergent validity were met. Number of years as cancer clinical trials nurse was positively related to self-reported knowledge and skills.   Preliminary data suggest that the national survey is reliable and valid. Data have contributed to better understanding the knowledge and skills of cancer clinical trials nurse in Australia and development of a postgraduate course in clinical trials. © 2011 Blackwell Publishing Ltd.

Utility of an Equine Clinical Skills Course: A Pilot Study.

Science.gov (United States)

Christensen, Bruce W; Danielson, Jared A

Recent publications have revealed inadequacies in the veterinary training of future equine practitioners. To help address this problem, a 2-week Equine Clinical Skills course was designed and implemented to provide fourth-year veterinary students with opportunities to have hands-on experience with common equine clinical skills using live animals and cadavers. Alumni and employers of alumni were surveyed to determine whether or not students participating in the course were more competent performing clinical skills during their first year post-graduation than those who had not participated in the course. Students who participated in the course were also surveyed before and after completing the course to determine whether or not their self-assessed skills improved during the course. Alumni who had taken the course rated their ability to perform the clinical skills more highly than alumni who had not taken the course. Similarly, students participating in the course indicated that they were significantly more able to perform the clinical skills after the course than when it began. Employers did not indicate a difference between the clinical skills of those who had taken the course and those who had not. Because this study involved a limited number of respondents from one institution, further studies should be conducted to replicate these findings and determine their generalizability.

Self-confidence of medical students in performing clinical skills acquired during their surgical rotation. Assessing clinical skills education in Kuwait.

Science.gov (United States)

Karim, Jumanah A; Marwan, Yousef A; Dawas, Ahmed M; Akhtar, Saeed

2012-12-01

To assess the self-confidence of clinical years` medical students in performing clinical skills/procedures. A cross-sectional study was conducted in April 2011 at the Department of Surgery, Faculty of Medicine, Health Sciences Center, Kuwait University, Safat, Kuwait. A questionnaire was used to collect data from students who had completed their surgical rotation of their first clinical year. The students reported their level of self-confidence in performing specific skills/procedures related to that rotation. Data were presented using frequencies and percentages. A total score of confidence was calculated for each student. The Mann-Whitney and Kruskal-Wallis tests were used to assess the association between the students` sociodemographic characteristics and confidence score. Of the 122 students invited to participate in the study, only 15 (12.3%) declined to comply. Most students reported high confidence level (more than 75%) in performing 7 of the 13 history taking/physical examination skills, and 2 of the 39 diagnostic/treatment procedure skills. The highest confidence level was in performing abdominal examination, while the lowest level was in care of Jackson-Pratt drain site and emptying the drain bulb. The total confidence score was significantly higher among males (p=0.021), and students with higher monthly income (p=0.002). Medical students appeared to have poor self-confidence in performing clinical skills/procedures. Curriculum planners should explore potential reasons, and methods for the improvement of confidence level among medical students in performing skills/procedures they were expected to learn during their surgical rotation.

Clinical skill development for community pharmacists.

Science.gov (United States)

Barnette, D J; Murphy, C M; Carter, B L

1996-09-01

The importance of establishing clinical pharmacy services in the community cannot be understated in light of current challenges to the traditional dispensing role as the primary service of the community pharmacist. Advancements in automated dispensing technology and declining prescription fee reimbursement are rapidly forcing pharmacists to seek alternative sources of revenue. Providing pharmaceutical care is a viable option to increase customer loyalty job satisfaction, and reimbursement. To support the development of clinical services, academic institutions are forming partnerships with individual community practitioners to overcome perceived educational and training barriers. The authors describe the design and development of two unique clinical skill development programs at the University of Illinois at Chicago. This paper also outlines the patient focused services that the participants have established upon completing the training. These programs successfully enhanced participants' therapeutic knowledge base and facilitated development of the clinical skills necessary for direct patient care.

Developing an eBook-Integrated High-Fidelity Mobile App Prototype for Promoting Child Motor Skills and Taxonomically Assessing Children’s Emotional Responses Using Face and Sound Topology

Science.gov (United States)

Brown, William; Liu, Connie; John, Rita Marie; Ford, Phoebe

2014-01-01

Developing gross and fine motor skills and expressing complex emotion is critical for child development. We introduce “StorySense”, an eBook-integrated mobile app prototype that can sense face and sound topologies and identify movement and expression to promote children’s motor skills and emotional developmental. Currently, most interactive eBooks on mobile devices only leverage “low-motor” interaction (i.e. tapping or swiping). Our app senses a greater breath of motion (e.g. clapping, snapping, and face tracking), and dynamically alters the storyline according to physical responses in ways that encourage the performance of predetermined motor skills ideal for a child’s gross and fine motor development. In addition, our app can capture changes in facial topology, which can later be mapped using the Facial Action Coding System (FACS) for later interpretation of emotion. StorySense expands the human computer interaction vocabulary for mobile devices. Potential clinical applications include child development, physical therapy, and autism. PMID:25954336

Negotiation skills for clinical research professionals

Directory of Open Access Journals (Sweden)

Sanjay Hake

2011-01-01

Full Text Available Negotiation as a skill is a key requirement for each and every job profile where dealing with multiple parties is involved. The important focus while negotiating should be on the interest then position. Key to every successful negotiation is advance planning, preparation, and patience as the objective is to create value and establish the terms on which parties with differing and often conflicting aims will co-operate. While preparing one should collect facts, know priorities, principles, identify common ground, decide on walk-away position, and try and identify the next best alternative. Negotiation is a set of skills that can be learned and practiced so that your ability to utilize relationship, knowledge, money, power, time, and personality to negotiate improves with each negotiation. In a successful negotiation, all parties win. Important thing to note is that not every negotiation involves money. Anytime you want something from someone else and anytime someone wants something from you, you are negotiating. Everything is negotiable and every day you negotiate with customers, suppliers, colleagues, your wife, and even your children. Negotiation is a game, and like any game it has its rules and tactics. Clinical Research professionals deal with various parties for different purposes at the same time; hence, they require excellent negotiation skills. Project Mangers and Clinical Research Associates are the two most important roles in clinical research industry who require negotiation skills as they deal with various internal and external customers and vendors.

Negotiation skills for clinical research professionals

Science.gov (United States)

Hake, Sanjay; Shah, Tapankumar

2011-01-01

Negotiation as a skill is a key requirement for each and every job profile where dealing with multiple parties is involved. The important focus while negotiating should be on the interest then position. Key to every successful negotiation is advance planning, preparation, and patience as the objective is to create value and establish the terms on which parties with differing and often conflicting aims will co-operate. While preparing one should collect facts, know priorities, principles, identify common ground, decide on walk-away position, and try and identify the next best alternative. Negotiation is a set of skills that can be learned and practiced so that your ability to utilize relationship, knowledge, money, power, time, and personality to negotiate improves with each negotiation. In a successful negotiation, all parties win. Important thing to note is that not every negotiation involves money. Anytime you want something from someone else and anytime someone wants something from you, you are negotiating. Everything is negotiable and every day you negotiate with customers, suppliers, colleagues, your wife, and even your children. Negotiation is a game, and like any game it has its rules and tactics. Clinical Research professionals deal with various parties for different purposes at the same time; hence, they require excellent negotiation skills. Project Mangers and Clinical Research Associates are the two most important roles in clinical research industry who require negotiation skills as they deal with various internal and external customers and vendors. PMID:21897886

Reading Skills of Students With Speech Sound Disorders at Three Stages of Literacy Development

Science.gov (United States)

Skebo, Crysten M.; Lewis, Barbara A.; Freebairn, Lisa A.; Tag, Jessica; Ciesla, Allison Avrich; Stein, Catherine M.

2015-01-01

Purpose The relationship between phonological awareness, overall language, vocabulary, and nonlinguistic cognitive skills to decoding and reading comprehension was examined for students at 3 stages of literacy development (i.e., early elementary school, middle school, and high school). Students with histories of speech sound disorders (SSD) with and without language impairment (LI) were compared to students without histories of SSD or LI (typical language; TL). Method In a cross-sectional design, students ages 7;0 (years; months) to 17;9 completed tests that measured reading, language, and nonlinguistic cognitive skills. Results For the TL group, phonological awareness predicted decoding at early elementary school, and overall language predicted reading comprehension at early elementary school and both decoding and reading comprehension at middle school and high school. For the SSD-only group, vocabulary predicted both decoding and reading comprehension at early elementary school, and overall language predicted both decoding and reading comprehension at middle school and decoding at high school. For the SSD and LI group, overall language predicted decoding at all 3 literacy stages and reading comprehension at early elementary school and middle school, and vocabulary predicted reading comprehension at high school. Conclusion Although similar skills contribute to reading across the age span, the relative importance of these skills changes with children’s literacy stages. PMID:23833280

Producing Competent Doctors - The Art and Science of Teaching Clinical Skills.

Science.gov (United States)

Dhaliwal, Upreet; Supe, Avinash; Gupta, Piyush; Singh, Tejinder

2017-05-15

For a doctor to provide medical care with competence, he must not only have knowledge but must also be able to translate that knowledge into action. It is his competence in clinical skills that will enable him to practice safely and effectively in the real world. To ensure acquisition of clinical skills, medical teachers must adopt teaching methods that prioritise observation, practice, feedback; and more practice. We try to elucidate the meaning of clinical skills, the challenges inherent in clinical skills training in India, training models that have shown success in practice and can be adopted in the Indian context, and various techniques to enhance skill-training, including the giving of feedback, which is a critically important component of skills development.

How does teaching clinical skills influence instructors' professional behaviour?

Directory of Open Access Journals (Sweden)

Yamani N

2004-07-01

Full Text Available Purpose: "Introduction to Clinical Medicine" in Isfahan University of Medical Sciences and Health Services is an initiative in which general practitioners work as instructors and have the opportunity to experience teaching in addition to clinical practice. Since teaching, affects both teacher and students, this study aims to assess the influence of teaching clinical skills on the instructors' psychological, social and professional behaviour. Methods: This was performed as a qualitative study. The research population consisted of instructors of “Introduction to Clinical Medicine” who were all general practitioners and acted as facilitator in small groups working on physical examination and case discussion. The data collecting tool was a semi-structured interview which was recorded on the tape. Then, the interviews were transcribed and confirmed by interviewees at the end. 10 instructors were interviewed. The data were analysed according to Colaizzi model. Results: After coding the data to 38 main subjects, they were classified into three main categories including professional, psychological and social effects. The influence of teaching on professional performance included performing a thorough and correct physical examination, taking a detailed and correct history, increasing decision making ability and increasing professional knowledge. Some of the psychological effects were increasing selfconfidence, job satisfaction and morale. The social effects of teaching were increasing social contacts, having a relationship with an academic environment and having a respectful job. Conclusion: Considering the positive effects of teaching on instructors, teaching clinical skills by general practitioners can increase general practitioners knowledge and clinical skills and improve their morale. It is recommended to train general practitioners both for teaching skills and clinical skills and consider this, as an opportunity for physicians’ continuing

Letter-sound processing deficits in children with developmental dyslexia: An ERP study.

Science.gov (United States)

Moll, Kristina; Hasko, Sandra; Groth, Katharina; Bartling, Jürgen; Schulte-Körne, Gerd

2016-04-01

The time course during letter-sound processing was investigated in children with developmental dyslexia (DD) and typically developing (TD) children using electroencephalography. Thirty-eight children with DD and 25 TD children participated in a visual-auditory oddball paradigm. Event-related potentials (ERPs) elicited by standard and deviant stimuli in an early (100-190 ms) and late (560-750 ms) time window were analysed. In the early time window, ERPs elicited by the deviant stimulus were delayed and less left lateralized over fronto-temporal electrodes for children with DD compared to TD children. In the late time window, children with DD showed higher amplitudes extending more over right frontal electrodes. Longer latencies in the early time window and stronger right hemispheric activation in the late time window were associated with slower reading and naming speed. Additionally, stronger right hemispheric activation in the late time window correlated with poorer phonological awareness skills. Deficits in early stages of letter-sound processing influence later more explicit cognitive processes during letter-sound processing. Identifying the neurophysiological correlates of letter-sound processing and their relation to reading related skills provides insight into the degree of automaticity during letter-sound processing beyond behavioural measures of letter-sound-knowledge. Copyright © 2016 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Heart sounds: are you listening? Part 1.

Science.gov (United States)

Reimer-Kent, Jocelyn

2013-01-01

All nurses should have an understanding of heart sounds and be proficient in cardiac auscultation. Unfortunately, this skill is not part of many nursing school curricula, nor is it necessarily a required skillfor employment. Yet, being able to listen and accurately describe heart sounds has tangible benefits to the patient, as it is an integral part of a complete cardiac assessment. In this two-part article, I will review the fundamentals of cardiac auscultation, how cardiac anatomy and physiology relate to heart sounds, and describe the various heart sounds. Whether you are a beginner or a seasoned nurse, it is never too early or too late to add this important diagnostic skill to your assessment tool kit.

Setting pass scores for clinical skills assessment.

Science.gov (United States)

Liu, Min; Liu, Keh-Min

2008-12-01

In a clinical skills assessment, the decision to pass or fail an examinee should be based on the test content or on the examinees' performance. The process of deciding a pass score is known as setting a standard of the examination. This requires a properly selected panel of expert judges and a suitable standard setting method, which best fits the purpose of the examination. Six standard setting methods that are often used in clinical skills assessment are described to provide an overview of the standard setting process.

Using systematically observed clinical encounters (SOCEs to assess medical students’ skills in clinical settings

Directory of Open Access Journals (Sweden)

George R Bergus

2010-11-01

Full Text Available George R Bergus1–3, Jerold C Woodhead4, Clarence D Kreiter2,51Performance Based Assessment Program, Office of Student Affairs and Curriculum, 2Department of Family Medicine, 3Department of Psychiatry, 4Department of Pediatrics, 5Office of Consultation and Research in Medical Education, Roy J and Lucille A Carver College of Medicine, The University of Iowa, Iowa City, IA, USAIntroduction: The Objective Structured Clinical Examination (OSCE is widely used to assess the clinical performance of medical students. However, concerns related to cost, availability, and validity, have led educators to investigate alternatives to the OSCE. Some alternatives involve assessing students while they provide care to patients – the mini-CEX (mini-Clinical Evaluation Exercise and the Long Case are examples. We investigated the psychometrics of systematically observed clinical encounters (SOCEs, in which physicians are supplemented by lay trained observers, as a means of assessing the clinical performances of medical students.Methods: During the pediatrics clerkship at the University of Iowa, trained lay observers assessed the communication skills of third-year medical students using a communication checklist while the students interviewed and examined pediatric patients. Students then verbally presented their findings to faculty, who assessed students’ clinical skills using a standardized form. The reliability of the combined communication and clinical skills scores was calculated using generalizability theory.Results: Fifty-one medical students completed 199 observed patient encounters. The mean combined clinical and communication skills score (out of a maximum 45 points was 40.8 (standard deviation 3.3. The calculated reliability of the SOCE scores, using generalizability theory, from 10 observed patient encounters was 0.81. Students reported receiving helpful feedback from faculty after 97% of their observed clinical encounters.Conclusion: The SOCE can

Dental student attitudes towards communication skills instruction and clinical application.

Science.gov (United States)

McKenzie, Carly T

2014-10-01

This study investigated dental students' attitudes towards communication skills instruction and clinical application and explored the impact of a one-semester course and year in school on students' attitudes, measured by the Communication Skills Attitude Scale. Demographic characteristics and self-assessment of communication skills were also analyzed. The study employed a pretest-posttest survey design combined with cross-sectional data. Participants were first- and fourth-year students at a U.S. dental school. Out of a possible 120 students, 106 (fifty-seven D1 and forty-nine D4) participated in the pretest, an 88 percent response rate; out of a possible 121 students, 115 (fifty-seven D1 and fifty-eight D4) participated in the posttest, a 95 percent response rate. In the results, D4 students consistently demonstrated less positive attitudes towards communication skills instruction and more negative attitudes regarding the importance of interpersonal skills in clinical encounters than did their D1 counterparts. A single communications course had no discernible effect on attitudes or self-assessments for either cohort. Females reported more positive attitudes towards clinical application of interpersonal skills than did males. Gender significantly interacted with two demographic variables: primary language and parent as health care professional. Female children of health care professionals reported poorer attitudes towards clinical communication skills training and application than did their male counterparts. Generally, parental occupation in health care moderated the decrease in positive attitudes over time towards clinical usefulness of communication skills. The D4 students rated their communication skills higher than did the D1 students. Students who demonstrated more positive attitudes towards communication skills training and application were more likely to say their own skills needed improvement.

A Model for Evaluating Student Clinical Psychomotor Skills.

Science.gov (United States)

And Others; Fiel, Nicholas J.

1979-01-01

A long-range plan to evaluate medical students' physical examination skills was undertaken at the Ingham Family Medical Clinic at Michigan State University. The development of the psychomotor skills evaluation model to evaluate the skill of blood pressure measurement, tests of the model's reliability, and the use of the model are described. (JMD)

Technology for enhancing chest auscultation in clinical simulation.

Science.gov (United States)

Ward, Jeffrey J; Wattier, Bryan A

2011-06-01

The ability to use an acoustic stethoscope to detect lung and/or heart sounds, and then to then communicate one's interpretation of those sounds is an essential skill for many medical professionals. Interpretation of lung and heart sounds, in the context of history and other examination findings, often aids the differential diagnosis. Bedside assessment of changing auscultation findings may also guide treatment. Learning lung and heart auscultation skills typically involves listening to pre-recorded normal and adventitious sounds, often followed by laboratory instruction to guide stethoscope placement, and finally correlating the sounds with the associated pathophysiology and pathology. Recently, medical simulation has become an important tool for teaching prior to clinical practice, and for evaluating bedside auscultation skills. When simulating cardiovascular or pulmonary problems, high-quality lung and heart sounds should be able to accurately corroborate other findings such as vital signs, arterial blood gas values, or imaging. Digital audio technology, the Internet, and high-fidelity simulators have increased opportunities for educators and learners. We review the application of these technologies and describe options for reproducing lung and heart sounds, as well as their advantages and potential limitations.

Setting Pass Scores for Clinical Skills Assessment

Directory of Open Access Journals (Sweden)

Min Liu

2008-12-01

Full Text Available In a clinical skills assessment, the decision to pass or fail an examinee should be based on the test content or on the examinees' performance. The process of deciding a pass score is known as setting a standard of the examination. This requires a properly selected panel of expert judges and a suitable standard setting method, which best fits the purpose of the examination. Six standard setting methods that are often used in clinical skills assessment are described to provide an overview of the standard setting process.

Revitalization of clinical skills training at the University of the Western Cape

Directory of Open Access Journals (Sweden)

J.D. Jeggels

2010-09-01

Full Text Available Most educational institutions that offer health related qualifications make use of clinical skills laboratories. These spaces are generally used for the demonstration and assessment of clinical skills. The purpose of this paper is to share our experiences related to the revitalization of skills training by introducing the skills lab method at the School of Nursing (SoN, University of the Western Cape (UWC. To accommodate the contextual changes as a result of the restructuring of the higher education landscape in 2003, the clinical skills training programme at UWC had to be reviewed. With a dramatic increase in the student numbers and a reduction in hospital beds, the skills lab method provided students with an opportunity to develop clinical skills prior to their placement in real service settings. The design phase centred on adopting a skills training methodology that articulates with the case-based approach used by the SoN. Kolb’s, experiential learning cycle provided the theoretical underpinning for the methodology. The planning phase was spent on the development of resources. Eight staff members were trained by our international higher education collaborators who also facilitated the training of clinical supervisors and simulated patients. The physical space had to be redesigned to accommodate audio visual and information technology to support the phases of the skills lab method. The implementation of the skills lab method was phased in from the first-year level. An interactive seminar held after the first year of implementation provided feedback from all the role players and was mostly positive. The results of introducing the skills lab method include: a move by students towards self-directed clinical skills development, clinical supervisors adopting the role of facilitators of learning and experiential clinical learning being based on, amongst others, the students’ engagement with simulated patients. Finally, the recommendations relate

Clinical skills temporal degradation assessment in undergraduate medical education.

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Fisher, Joseph; Viscusi, Rebecca; Ratesic, Adam; Johnstone, Cameron; Kelley, Ross; Tegethoff, Angela M; Bates, Jessica; Situ-Lacasse, Elaine H; Adamas-Rappaport, William J; Amini, Richard

2018-01-01

Medical students' ability to learn clinical procedures and competently apply these skills is an essential component of medical education. Complex skills with limited opportunity for practice have been shown to degrade without continued refresher training. To our knowledge there is no evidence that objectively evaluates temporal degradation of clinical skills in undergraduate medical education. The purpose of this study was to evaluate temporal retention of clinical skills among third year medical students. This was a cross-sectional study conducted at four separate time intervals in the cadaver laboratory at a public medical school. Forty-five novice third year medical students were evaluated for retention of skills in the following three procedures: pigtail thoracostomy, femoral line placement, and endotracheal intubation. Prior to the start of third-year medical clerkships, medical students participated in a two-hour didactic session designed to teach clinically relevant materials including the procedures. Prior to the start of their respective surgery clerkships, students were asked to perform the same three procedures and were evaluated by trained emergency medicine and surgery faculty for retention rates, using three validated checklists. Students were then reassessed at six week intervals in four separate groups based on the start date of their respective surgical clerkships. We compared the evaluation results between students tested one week after training and those tested at three later dates for statistically significant differences in score distribution using a one-tailed Wilcoxon Mann-Whitney U-test for non-parametric rank-sum analysis. Retention rates were shown to have a statistically significant decline between six and 12 weeks for all three procedural skills. In the instruction of medical students, skill degradation should be considered when teaching complex technical skills. Based on the statistically significant decline in procedural skills noted

A comparison of clinical communication skills between two groups of ...

African Journals Online (AJOL)

a comprehensive clinical model and a “golden thread” for communication skills in the ... sity, South Africa, based on the primary ..... Planning: shared decision making ... Explanation and planning. Incorporate clinical reasoning skills. Develop.

[Feedback in relation to training of practical clinical skills

DEFF Research Database (Denmark)

Hansen, C.S.; Ringsted, Charlotte Vibeke

2008-01-01

Feedback has been identified as an essential component of motor learning. However, feedback principles derived from motor learning theories cannot uncritically be applied to clinical skills training because this knowledge is based primarily on the study of very simple motor skills. Research...... into feedback in relation to clinical skills training is currently limited. Theories on motor learning can serve as the basis for designing research in this domain, especially the importance of including retention tests when measuring permanent learning outcomes Udgivelsesdato: 2008/10/27...

Attitudes of Portuguese medical residents' towards clinical communication skills.

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Loureiro, Elizabete; Severo, Milton; Ferreira, Maria Amélia

2015-08-01

To explore the attitudes and perceptions of Portuguese residents towards Clinical Communication Skills (CCS) and the need for complementary training. 78 medical residents responded to an on-line questionnaire which comprised demographic data, open-ended questions and a Portuguese version of the Communication Skills Attitude Scale (CSAS). Residents gave significantly higher scores (Pcommunication skills in general, compared to CSAS2 (attitudes towards the teaching/learning process of CCS). Residents doing their residency training in other parts of the country, other than the north, reveal a higher perception of insufficient training (72.7% vs. 38.7%, P=0.036). Residents showed more positive attitudes towards communication skills than towards the teaching/learning process. They admit to need more training in CCS in their residency year and highlight that the clinical cycle of undergraduate education should integrate these topics. Content analysis indicates that residents' perceptions are context-influenced. Integration of CCS in the undergraduate education, enhanced during post-graduate training. Training of clinical faculty and supervisors/tutors and the role that stakeholders have to play in order to promote continuous training in CCS; encourage patient-centeredness and reflective practice, as to facilitate transfer of acquired skills to clinical practice. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Design and Effectiveness of a Required Pre-Clinical Simulation-based Curriculum for Fundamental Clinical Skills and Procedures

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Daryl P. Lofaso

2011-12-01

Full Text Available For more than 20 years, medical literature has increasingly documented the need for students to learn, practice and demonstrate competence in basic clinical knowledge and skills. In 2001, the Louisiana State University Health Science Centers (LSUHSC School of Medicine – New Orleans replaced its traditional Introduction in to Clinical Medicine (ICM course with the Science and Practice of Medicine (SPM course. The main component within the SPM course is the Clinical Skills Lab (CSL. The CSL teaches 30 plus skills to all pre-clinical medical students (Years 1 and 2. Since 2002, an annual longitudinal evaluation questionnaire was distributed to all medical students targeting the skills taught in the CSL. Students were asked to rate their self- confidence (Dreyfus and Likert-type and estimate the number of times each clinical skill was performed (clinically/non-clinically. Of the 30 plus skills taught, 8 were selected for further evaluation. An analysis was performed on the eight skills selected to determine the effectiveness of the CSL. All students that participated in the CSL reported a significant improvement in self-confidence and in number performed in the clinically/non-clinically setting when compared to students that did not experience the CSL. For example, without CSL training, the percentage of students reported at the end of their second year self-perceived expertise as “novice” ranged from 21.4% (CPR to 84.7% (GU catheterization. Students who completed the two-years CSL, only 7.8% rated their self-perceived expertise at the end of the second year as “novice” and 18.8% for GU catheterization. The CSL design is not to replace real clinical patient experiences. It's to provide early exposure, medial knowledge, professionalism and opportunity to practice skills in a patient free environment.

Evaluation of Clinical and Communication Skills of Pharmacy Students and Pharmacists with an Objective Structured Clinical Examination.

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Urteaga, Elizabeth M; Attridge, Rebecca L; Tovar, John M; Witte, Amy P

2015-10-25

Objective. To evaluate how effectively pharmacy students and practicing pharmacists communicate and apply knowledge to simulations of commonly encountered patient scenarios using an objective structured clinical examination (OSCE). Design. Second-, third-, and fourth-year pharmacy students completed an OSCE as part of their required courses in 2012 and 2013. All students in both years completed identical OSCE cases. Licensed pharmacists were recruited to complete the OSCE and serve as controls in 2012. A survey assessed student perception and acceptance of the OSCE as well as student confidence in performance. Assessment. Licensed pharmacists had significantly higher clinical and communication skills scores than did pharmacy students. Student progression in communication and clinical skills improved significantly over time. Survey results indicated that students felt the OSCE was well-structured and assessed clinical skills taught in pharmacy school; 86% of students felt confident they could provide these skills. Conclusion. Objective structured clinical examinations can evaluate clinical competence and communication skills among professional students. Implementation of OSCEs may be an effective tool for assessment of the Center for the Advancement of Pharmacy Education domains.

Training auscultatory skills: computer simulated heart sounds or additional bedside training? A randomized trial on third-year medical students

Science.gov (United States)

2010-01-01

Background The present study compares the value of additional use of computer simulated heart sounds, to conventional bedside auscultation training, on the cardiac auscultation skills of 3rd year medical students at Oslo University Medical School. Methods In addition to their usual curriculum courses, groups of seven students each were randomized to receive four hours of additional auscultation training either employing a computer simulator system or adding on more conventional bedside training. Cardiac auscultation skills were afterwards tested using live patients. Each student gave a written description of the auscultation findings in four selected patients, and was rewarded from 0-10 points for each patient. Differences between the two study groups were evaluated using student's t-test. Results At the auscultation test no significant difference in mean score was found between the students who had used additional computer based sound simulation compared to additional bedside training. Conclusions Students at an early stage of their cardiology training demonstrated equal performance of cardiac auscultation whether they had received an additional short auscultation course based on computer simulated training, or had had additional bedside training. PMID:20082701

Speech sound disorder at 4 years: prevalence, comorbidities, and predictors in a community cohort of children.

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Eadie, Patricia; Morgan, Angela; Ukoumunne, Obioha C; Ttofari Eecen, Kyriaki; Wake, Melissa; Reilly, Sheena

2015-06-01

The epidemiology of preschool speech sound disorder is poorly understood. Our aims were to determine: the prevalence of idiopathic speech sound disorder; the comorbidity of speech sound disorder with language and pre-literacy difficulties; and the factors contributing to speech outcome at 4 years. One thousand four hundred and ninety-four participants from an Australian longitudinal cohort completed speech, language, and pre-literacy assessments at 4 years. Prevalence of speech sound disorder (SSD) was defined by standard score performance of ≤79 on a speech assessment. Logistic regression examined predictors of SSD within four domains: child and family; parent-reported speech; cognitive-linguistic; and parent-reported motor skills. At 4 years the prevalence of speech disorder in an Australian cohort was 3.4%. Comorbidity with SSD was 40.8% for language disorder and 20.8% for poor pre-literacy skills. Sex, maternal vocabulary, socio-economic status, and family history of speech and language difficulties predicted SSD, as did 2-year speech, language, and motor skills. Together these variables provided good discrimination of SSD (area under the curve=0.78). This is the first epidemiological study to demonstrate prevalence of SSD at 4 years of age that was consistent with previous clinical studies. Early detection of SSD at 4 years should focus on family variables and speech, language, and motor skills measured at 2 years. © 2014 Mac Keith Press.

A survey of clinical nursing skills in intellectual disability nursing

OpenAIRE

McKeon, Michael

2009-01-01

In this study the question asked is: what clinical nursing skills are predominantly used in intellectual disability nursing? A survey of the nursing needs of people with moderate to severe intellectual disability in both residential and community units was undertaken with a questionnaire.The measure was a Likert design scale ranging across: skills used more than once a day, skills used daily, skills used weekly, skills used monthly, skills very rarely used, and skills never used.The results o...

Walking the bridge: Nursing students' learning in clinical skill laboratories.

Science.gov (United States)

Ewertsson, Mona; Allvin, Renée; Holmström, Inger K; Blomberg, Karin

2015-07-01

Despite an increasing focus on simulation as a learning strategy in nursing education, there is limited evidence on the transfer of simulated skills into clinical practice. Therefore it's important to increase knowledge of how clinical skills laboratories (CSL) can optimize students' learning for development of professional knowledge and skills, necessary for quality nursing practice and for patient safety. Thus, the aim was to describe nursing students' experiences of learning in the CSL as a preparation for their clinical practice. Interviews with 16 students were analysed with content analysis. An overall theme was identified - walking the bridge - in which the CSL formed a bridge between the university and clinical settings, allowing students to integrate theory and practice and develop a reflective stance. The theme was based on categories: conditions for learning, strategies for learning, tension between learning in the skills laboratory and clinical settings, and development of professional and personal competence. The CSL prepared the students for clinical practice, but a negative tension between learning in CSL and clinical settings was experienced. However, this tension may create reflection. This provides a new perspective that can be used as a pedagogical approach to create opportunities for students to develop their critical thinking. Copyright © 2015 Elsevier Ltd. All rights reserved.

Parameterizing Sound: Design Considerations for an Environmental Sound Database

Science.gov (United States)

2015-04-01

associated with, or produced by, a physical event or human activity and 2) sound sources that are common in the environment. Reproductions or sound...Rogers S. Confrontation naming of environmental sounds. Journal of Clinical and Experimental Neuropsychology . 2000;22(6):830–864. 14 VanDerveer NJ

Registered nurses' clinical reasoning skills and reasoning process: A think-aloud study.

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Lee, JuHee; Lee, Young Joo; Bae, JuYeon; Seo, Minjeong

2016-11-01

As complex chronic diseases are increasing, nurses' prompt and accurate clinical reasoning skills are essential. However, little is known about the reasoning skills of registered nurses. This study aimed to determine how registered nurses use their clinical reasoning skills and to identify how the reasoning process proceeds in the complex clinical situation of hospital setting. A qualitative exploratory design was used with a think-aloud method. A total of 13 registered nurses (mean years of experience=11.4) participated in the study, solving an ill-structured clinical problem based on complex chronic patients cases in a hospital setting. Data were analyzed using deductive content analysis. Findings showed that the registered nurses used a variety of clinical reasoning skills. The most commonly used skill was 'checking accuracy and reliability.' The reasoning process of registered nurses covered assessment, analysis, diagnosis, planning/implementation, and evaluation phase. It is critical that registered nurses apply appropriate clinical reasoning skills in complex clinical practice. The main focus of registered nurses' reasoning in this study was assessing a patient's health problem, and their reasoning process was cyclic, rather than linear. There is a need for educational strategy development to enhance registered nurses' competency in determining appropriate interventions in a timely and accurate fashion. Copyright © 2016 Elsevier Ltd. All rights reserved.

Effects of an intensive clinical skills course on senior nursing students' self-confidence and clinical competence: A quasi-experimental post-test study.

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Park, Soohyun

2018-02-01

To foster nursing professionals, nursing education requires the integration of knowledge and practice. Nursing students in their senior year experience considerable stress in performing the core nursing skills because, typically, they have limited opportunities to practice these skills in their clinical practicum. Therefore, nurse educators should revise the nursing curricula to focus on core nursing skills. To identify the effect of an intensive clinical skills course for senior nursing students on their self-confidence and clinical competence. A quasi-experimental post-test study. A university in South Korea during the 2015-2016 academic year. A convenience sample of 162 senior nursing students. The experimental group (n=79) underwent the intensive clinical skills course, whereas the control group (n=83) did not. During the course, students repeatedly practiced the 20 items that make up the core basic nursing skills using clinical scenarios. Participants' self-confidence in the core clinical nursing skills was measured using a 10-point scale, while their clinical competence with these skills was measured using the core clinical nursing skills checklist. Independent t-test and chi-square tests were used to analyze the data. The mean scores in self-confidence and clinical competence were higher in the experimental group than in the control group. This intensive clinical skills courses had a positive effect on senior nursing students' self-confidence and clinical competence for the core clinical nursing skills. This study emphasizes the importance of reeducation using a clinical skills course during the transition from student to nursing professional. Copyright © 2017. Published by Elsevier Ltd.

The Dreyfus model of clinical problem-solving skills acquisition: a critical perspective.

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Peña, Adolfo

2010-06-14

The Dreyfus model describes how individuals progress through various levels in their acquisition of skills and subsumes ideas with regard to how individuals learn. Such a model is being accepted almost without debate from physicians to explain the 'acquisition' of clinical skills. This paper reviews such a model, discusses several controversial points, clarifies what kind of knowledge the model is about, and examines its coherence in terms of problem-solving skills. Dreyfus' main idea that intuition is a major aspect of expertise is also discussed in some detail. Relevant scientific evidence from cognitive science, psychology, and neuroscience is reviewed to accomplish these aims. Although the Dreyfus model may partially explain the 'acquisition' of some skills, it is debatable if it can explain the acquisition of clinical skills. The complex nature of clinical problem-solving skills and the rich interplay between the implicit and explicit forms of knowledge must be taken into consideration when we want to explain 'acquisition' of clinical skills. The idea that experts work from intuition, not from reason, should be evaluated carefully.

Clinical skill center: a review of present situation and importance in medical education curriculum

Directory of Open Access Journals (Sweden)

Haleh Talaei

2002-07-01

Full Text Available Clinical skill centers were designed in 1960, offers innovative, more effective clinical health care and treatment curriculum. Clinical skill center (CSC can provide a special facility for clinical and communication skills practice in a setting outside hospital wards in order to train students with enough confidence of confronting real patients. Learning clinical skills in these centers are not patient-dependent and by practicing on manikins and simulated models errors in real patients can be prevented. Moreover, possible feedback of this method can be used for evaluation and can improve quality and quantity of the education. This review intends to determine the purpose, undertaking, and structure of CSC. The study emphasizes the importance of integrating the clinical skill centers into the teaching curriculum of medical universities. Apparently, organizing clinical skill centers can play an important role for improving the quality and quantity of the educational system and consequently post-graduate performance. The authors recommend this program can be a solution for having both the knowledge and skill of diagnosis and treatment seasonal and rare diseases. Key words clinical skill center, medical education, curriculum

Evidence for the treatment of co-occurring stuttering and speech sound disorder: A clinical case series.

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Unicomb, Rachael; Hewat, Sally; Spencer, Elizabeth; Harrison, Elisabeth

2017-06-01

There is a paucity of evidence to guide treatment for children with co-occurring stuttering and speech sound disorder. Some guidelines suggest treating the two disorders simultaneously using indirect treatment approaches; however, the research supporting these recommendations is over 20 years old. In this clinical case series, we investigate whether these co-occurring disorders could be treated concurrently using direct treatment approaches supported by up-to-date, high-level evidence, and whether this could be done in an efficacious, safe and efficient manner. Five pre-school-aged participants received individual concurrent, direct intervention for both stuttering and speech sound disorder. All participants used the Lidcombe Program, as manualised. Direct treatment for speech sound disorder was individualised based on analysis of each child's sound system. At 12 months post commencement of treatment, all except one participant had completed the Lidcombe Program, and were less than 1.0% syllables stuttered on samples gathered within and beyond the clinic. These four participants completed Stage 1 of the Lidcombe Program in between 14 and 22 clinic visits, consistent with current benchmark data for this programme. At the same assessment point, all five participants exhibited significant increases in percentage of consonants correct and were in alignment with age-expected estimates of this measure. Further, they were treated in an average number of clinic visits that compares favourably with other research on treatment for speech sound disorder. These preliminary results indicate that young children with co-occurring stuttering and speech sound disorder may be treated concurrently using direct treatment approaches. This method of service delivery may have implications for cost and time efficiency and may also address the crucial need for early intervention in both disorders. These positive findings highlight the need for further research in the area and contribute to

Medical students' clerkship experiences and self-perceived competence in clinical skills.

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Katowa-Mukwato, P; Andrews, B; Maimbolwa, M; Lakhi, S; Michelo, C; Mulla, Y; Banda, S S

2014-01-01

In a traditional curriculum, medical students are expected to acquire clinical competence through the apprenticeship model using the Halstedian "see one, do one, and teach one, approach". The University of Zambia School of Medicine used a traditional curriculum model from 1966 until 2011 when a competence-based curriculum was implemented. To explore medical students' clerkships experiences and self-perceived competence in clinical skills. A cross-sectional survey was conducted on 5th, 6 th , and 7 th year medical students of the University of Zambia, School of Medicine two months prior to final examinations. Students were asked to rate their clerkship experiences with respect to specific skills on a scale of 1 to 4 and their level of self-perceived competence on a scale of 1 to 3. Skills evaluated were in four main domains: history taking and communication, physical examination, procedural, and professionalism, team work and medical decision making. Using Statistical Package for Social Scientist (SPSS), correlations were performed between experiences and self-perceived competence on specific skills, within domains and overall. Out of 197 clinical students 138 (70%) participated in the survey. The results showed significant increase in the proportion of students performing different skills and reporting feeling very competent with each additional clinical year. Overall correlations between experience and self-perceived competence were moderate (0.55). On individual skills, the highest correlation between experience and self-perceived competence were observed on mainly medical and surgical related procedural skills with the highest at 0.82 for nasal gastric tube insertion and 0.76 for endotracheal intubation. Despite the general improvement in skills experiences and self-perceived competence, some deficiencies were noted as significant numbers of final year students had never attempted common important procedures especially those performed in emergency situations

Developing advanced clinical practice skills in gastrointestinal consequences of cancer treatment.

Science.gov (United States)

Gee, Caroline; Andreyev, Jervoise; Muls, Ann

2018-03-08

This article explores the transition from a clinical nurse specialist (CNS) towards developing advanced clinical practice skills within a gastrointestinal consequences of cancer clinic. It presents data on the first 50 patients assessed by the CNS from a prospective service evaluation, demonstrating how this informed the nurse's future learning. There is high demand for advanced clinical practice skills to address unmet health needs and improve the quality, efficiency, and sustainability of healthcare services. However, a literature review found no literature on developing advanced clinical practice skills in this setting. Emerging themes from the service evaluation focused on barriers and enablers, ongoing support, organisational commitment and working in a multidisciplinary team. Blended learning provided both structured and opportunistic learning, embedding both formal and tacit knowledge, as roles require increasing flexibility. Clinical supervision and reflective practice were key in maintaining professional and peer support.

Clinical Skills Verification, Formative Feedback, and Psychiatry Residency Trainees

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Dalack, Gregory W.; Jibson, Michael D.

2012-01-01

Objective: The authors describe the implementation of Clinical Skills Verification (CSV) in their program as an in-training assessment intended primarily to provide formative feedback to trainees, strengthen the supervisory experience, identify the need for remediation of interviewing skills, and secondarily to demonstrating resident competence…

Clinical skills training in undergraduate medical education using a student-centered approach

DEFF Research Database (Denmark)

Tolsgaard, Martin Grønnebæk

2013-01-01

This thesis focuses on how to engage students in self-directed learning and in peer-learning activities to improve clinical skills training in undergraduate medical education. The first study examined the clinical skills teaching provided by student teachers compared to that provided by associate...... demonstrated remarkable advantages to peer-learning in skills-lab. Thus, peer-learning activities could be essential to providing high-quality medical training in the face of limited clinical teacher resources in future undergraduate medical education.......This thesis focuses on how to engage students in self-directed learning and in peer-learning activities to improve clinical skills training in undergraduate medical education. The first study examined the clinical skills teaching provided by student teachers compared to that provided by associate....... The Reporter-Interpreter-Manager-Educator framework was used to reflect this change and construct validity was explored for RIME-based evaluations of single-patient encounters. In the third study the effects of training in pairs--also known as dyad practice--examined. This study showed that the students...

Assessing Communication Skills of Medical Students in Objective Structured Clinical Examinations (OSCE)--A Systematic Review of Rating Scales.

Science.gov (United States)

Cömert, Musa; Zill, Jördis Maria; Christalle, Eva; Dirmaier, Jörg; Härter, Martin; Scholl, Isabelle

2016-01-01

Teaching and assessment of communication skills have become essential in medical education. The Objective Structured Clinical Examination (OSCE) has been found as an appropriate means to assess communication skills within medical education. Studies have demonstrated the importance of a valid assessment of medical students' communication skills. Yet, the validity of the performance scores depends fundamentally on the quality of the rating scales used in an OSCE. Thus, this systematic review aimed at providing an overview of existing rating scales, describing their underlying definition of communication skills, determining the methodological quality of psychometric studies and the quality of psychometric properties of the identified rating scales. We conducted a systematic review to identify psychometrically tested rating scales, which have been applied in OSCE settings to assess communication skills of medical students. Our search strategy comprised three databases (EMBASE, PsycINFO, and PubMed), reference tracking and consultation of experts. We included studies that reported psychometric properties of communication skills assessment rating scales used in OSCEs by examiners only. The methodological quality of included studies was assessed using the COnsensus based Standards for the selection of health status Measurement INstruments (COSMIN) checklist. The quality of psychometric properties was evaluated using the quality criteria of Terwee and colleagues. Data of twelve studies reporting on eight rating scales on communication skills assessment in OSCEs were included. Five of eight rating scales were explicitly developed based on a specific definition of communication skills. The methodological quality of studies was mainly poor. The psychometric quality of the eight rating scales was mainly intermediate. Our results reveal that future psychometric evaluation studies focusing on improving the methodological quality are needed in order to yield psychometrically

Feedback on students' clinical reasoning skills during fieldwork education.

Science.gov (United States)

de Beer, Marianne; Mårtensson, Lena

2015-08-01

Feedback on clinical reasoning skills during fieldwork education is regarded as vital in occupational therapy students' professional development. The nature of supervisors' feedback however, could be confirmative and/or corrective and corrective feedback could be with or without suggestions on how to improve. The aim of the study was to evaluate the impact of supervisors' feedback on final-year occupational therapy students' clinical reasoning skills through comparing the nature of feedback with the students' subsequent clinical reasoning ability. A mixed-method approach with a convergent parallel design was used combining the collection and analysis of qualitative and quantitative data. From focus groups and interviews with students, data were collected and analysed qualitatively to determine how the students experienced the feedback they received from their supervisors. By quantitatively comparing the final practical exam grades with the nature of the feedback, their fieldwork End-of-Term grades and average academic performance it became possible to merge the results for comparison and interpretation. Students' clinical reasoning skills seem to be improved through corrective feedback if accompanied by suggestions on how to improve, irrespective of their average academic performance. Supervisors were inclined to underrate high performing students and overrate lower performing students. Students who obtained higher grades in the final practical examinations received more corrective feedback with suggestions on how to improve from their supervisors. Confirmative feedback alone may not be sufficient for improving the clinical reasoning skills of students. © 2015 The Authors. Australian Occupational Therapy Journal published by Wiley Publishing Asia Pty Ltd on behalf of Occupational Therapy Australia.

Source of learning basic clinical skills by medical interns Tehran University of Medical Sciences

Directory of Open Access Journals (Sweden)

Meshkani Z

2004-07-01

Full Text Available Background: Effective clinical teaching is a major objective in general practitioner’s education at medical schools. Purpose: To identify the sources of clinical skills learning that medical student experience Methods: In this cross sectional study, interns of Tehran medical university who spent at least 12 months of their internship answered a questionnaire on the sources of clinical skills training. Chi2 test was used to examine the association of source of learning and students,’ specification such as sex, score of pre –internship exam, and marital status. Results: All 250 interns who were eligible participated. Over all 46.60% interns learned their clinical skills from residents or clinical teachers, 29.61% observed others performing the procedures, 16.25 learned the skills from hospital staff or nurses, 7.54% practiced their knowledge when confronted to an emergency situation Conclusion: Our results warrant a more attentive approach to clinical skills (specially procedural skills training Key words: LEARNING RESOURCES

Clinical Research Careers: Reports from a NHLBI Pediatric Heart Network Clinical Research Skills Development Conference

Science.gov (United States)

Lai, Wyman W.; Richmond, Marc; Li, Jennifer S.; Saul, J. Philip; Mital, Seema; Colan, Steven D.; Newburger, Jane W.; Sleeper, Lynn A.; McCrindle, Brain W.; Minich, L. LuAnn; Goldmuntz, Elizabeth; Marino, Bradley S.; Williams, Ismee A.; Pearson, Gail D.; Evans, Frank; Scott, Jane D.; Cohen, Meryl S.

2013-01-01

Background Wyman W. Lai, MD, MPH, and Victoria L. Vetter, MD, MPH. The Pediatric Heart Network (PHN), funded under the U.S. National Institutes of Health-National Heart, Lung, and Blood Institute (NIH–NHLBI), includes two Clinical Research Skills Development (CRSD) Cores, which were awarded to The Children's Hospital of Philadelphia and to the Morgan Stanley Children's Hospital of New York–Presbyterian. To provide information on how to develop a clinical research career to a larger number of potential young investigators in pediatric cardiology, the directors of these two CRSD Cores jointly organized a one-day seminar for fellows and junior faculty from all of the PHN Core sites. The participants included faculty members from the PHN and the NHLBI. The day-long seminar was held on April 29, 2009, at the NHLBI site, immediately preceding the PHN Steering Committee meeting in Bethesda, MD. Methods The goals of the seminar were 1) to provide fellows and early investigators with basic skills in clinical research 2) to provide a forum for discussion of important research career choices 3) to introduce attendees to each other and to established clinical researchers in pediatric cardiology, and 4) to publish a commentary on the future of clinical research in pediatric cardiology. Results The following chapters are compilations of the talks given at the 2009 PHN Clinical Research Skills Development Seminar, published to share the information provided with a broader audience of those interested in learning how to develop a clinical research career in pediatric cardiology. The discussions of types of clinical research, research skills, career development strategies, funding, and career management are applicable to research careers in other areas of clinical medicine as well. Conclusions The aim of this compilation is to stimulate those who might be interested in the research career options available to investigators. PMID:21167335

Pairing as an instructional strategy to promote soft skills amongst clinical dental students.

Science.gov (United States)

Abu Kasim, N H; Abu Kassim, N L; Razak, A A A; Abdullah, H; Bindal, P; Che' Abdul Aziz, Z A; Sulaiman, E; Farook, M S; Gonzalez, M A G; Thong, Y L; Ahmad, N A; Naimie, Z; Abdullah, M; Lui, J L; Abdul Aziz, A

2014-02-01

Training dentists today is challenging as they are expected to provide a wide range of dental care. In the provision of good dental care, soft skills are equally important as clinical skills. Therefore in dental education the development of soft skills are of prime concern. This study sought to identify the development of soft skills when dental students are paired in their clinical training. In this perception study, four open-ended items were used to elicit students' feedback on the appropriateness of using clinical pairing as an instructional strategy to promote soft skills. The most frequently cited soft skills were teamwork (70%) and communication (25%) skills. However, both negative and positive behaviours were reported. As for critical thinking and problem solving skills, more positive behaviours were reported for abilities such as to explain, analyze, find ideas and alternative solutions, and make decisions. Leadership among peers was not evident as leading without legitimate authority could be a hindrance to its development. If clinical pairing is to be used as an effective instructional strategy to promote soft skills amongst students, clear guidelines need to be developed to prepare students to work in a dental team and the use of appropriate assessment tools can facilitate the development of these soft skills. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The evolution of integration: innovations in clinical skills and ethics in first year medicine.

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Brunger, Fern; Duke, Pauline S

2012-01-01

Critical self-reflection, medical ethics and clinical skills are each important components of medical education but are seldom linked in curriculum development. We developed a curriculum that builds on the existing integration of ethics education into the clinical skills course to more explicitly link these three skills. The curriculum builds on the existing integration of clinical skills and ethics in first year medicine. It refines the integration through scheduling changes; adds case studies that emphasise the social, economic and political context of our province's patient population; and introduces reflection on the "culture of medicine" as a way to have students articulate and understand their own values and moral decision making frameworks. This structured Clinical Skills course is a model for successfully integrating critical self-reflection, reflection on the political, economic and cultural contexts shaping health and healthcare, and moral decision making into clinical skills training.

Take a Page from Your Coach's Play Book: Teaching Technical and Tactical Skills in Athletic Training

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Hawkins, Jeremy R.; Sharp, Elizabeth B.; Williams, Skip M.

2015-01-01

Context: The ability to demonstrate sound clinical reasoning is needed for a practicing athletic trainer. However, instruction on how to make a correct clinical decision may be deficient in many athletic training programs. Objective: To provide an overview of how to teach technical and tactical skills, using both a tradition and a nontraditional…

Educational climate seems unrelated to leadership skills of clinical consultants responsible of postgraduate medical education in clinical departments.

Science.gov (United States)

Malling, Bente; Mortensen, Lene S; Scherpbier, Albert J J; Ringsted, Charlotte

2010-09-21

The educational climate is crucial in postgraduate medical education. Although leaders are in the position to influence the educational climate, the relationship between leadership skills and educational climate is unknown. This study investigates the relationship between the educational climate in clinical departments and the leadership skills of clinical consultants responsible for education. The study was a trans-sectional correlation study. The educational climate was investigated by a survey among all doctors (specialists and trainees) in the departments. Leadership skills of the consultants responsible for education were measured by multi-source feedback scores from heads of departments, peer consultants, and trainees. Doctors from 42 clinical departments representing 21 specialties participated. The response rate of the educational climate investigation was moderate 52% (420/811), Response rate was high in the multisource-feedback process 84.3% (420/498). The educational climate was scored quite high mean 3.9 (SD 0.3) on a five-point Likert scale. Likewise the leadership skills of the clinical consultants responsible for education were considered good, mean 5.4 (SD 0.6) on a seven-point Likert scale. There was no significant correlation between the scores concerning the educational climate and the scores on leadership skills, r = 0.17 (p = 0.29). This study found no relation between the educational climate and the leadership skills of the clinical consultants responsible for postgraduate medical education in clinical departments with the instruments used. Our results indicate that consultants responsible for education are in a weak position to influence the educational climate in the clinical department. Further studies are needed to explore, how heads of departments and other factors related to the clinical organisation could influence the educational climate.

Developing optimal search strategies for detecting clinically sound prognostic studies in MEDLINE: an analytic survey

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Haynes R Brian

2004-06-01

Full Text Available Abstract Background Clinical end users of MEDLINE have a difficult time retrieving articles that are both scientifically sound and directly relevant to clinical practice. Search filters have been developed to assist end users in increasing the success of their searches. Many filters have been developed for the literature on therapy and reviews but little has been done in the area of prognosis. The objective of this study is to determine how well various methodologic textwords, Medical Subject Headings, and their Boolean combinations retrieve methodologically sound literature on the prognosis of health disorders in MEDLINE. Methods An analytic survey was conducted, comparing hand searches of journals with retrievals from MEDLINE for candidate search terms and combinations. Six research assistants read all issues of 161 journals for the publishing year 2000. All articles were rated using purpose and quality indicators and categorized into clinically relevant original studies, review articles, general papers, or case reports. The original and review articles were then categorized as 'pass' or 'fail' for methodologic rigor in the areas of prognosis and other clinical topics. Candidate search strategies were developed for prognosis and run in MEDLINE – the retrievals being compared with the hand search data. The sensitivity, specificity, precision, and accuracy of the search strategies were calculated. Results 12% of studies classified as prognosis met basic criteria for scientific merit for testing clinical applications. Combinations of terms reached peak sensitivities of 90%. Compared with the best single term, multiple terms increased sensitivity for sound studies by 25.2% (absolute increase, and increased specificity, but by a much smaller amount (1.1% when sensitivity was maximized. Combining terms to optimize both sensitivity and specificity achieved sensitivities and specificities of approximately 83% for each. Conclusion Empirically derived

Residency Programs and Clinical Leadership Skills Among New Saudi Graduate Nurses.

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Al-Dossary, Reem Nassar; Kitsantas, Panagiota; Maddox, P J

2016-01-01

Nurse residency programs have been adopted by health care organizations to assist new graduate nurses with daily challenges such as intense working environments, increasing patient acuity, and complex technologies. Overall, nurse residency programs are proven beneficial in helping nurses transition from the student role to independent practitioners and bedside leaders. The purpose of this study was to assess the impact of residency programs on leadership skills of new Saudi graduate nurses who completed a residency program compared to new Saudi graduate nurses who did not participate in residency programs. The study design was cross-sectional involving a convenience sample (n = 98) of new graduate nurses from three hospitals in Saudi Arabia. The Clinical Leadership Survey was used to measure the new graduate nurses' clinical leadership skills based on whether they completed a residency program or not. Descriptive statistics, correlation, and multiple linear regression analyses were conducted to examine leadership skills in this sample of new Saudi graduate nurses. A significant difference was found between residents and nonresidents in their leadership skills (t = 10.48, P = .000). Specifically, residents were significantly more likely to show higher levels of leadership skills compared to their counterparts. Attending a residency program was associated with a significant increase in clinical leadership skills. The findings of this study indicate that there is a need to implement more residency programs in hospitals of Saudi Arabia. It is imperative that nurse managers and policy makers in Saudi Arabia consider these findings to improve nurses' leadership skills, which will in turn improve patient care. Further research should examine how residency programs influence new graduate nurses' transition from student to practitioner with regard to clinical leadership skills in Saudi Arabia. Copyright © 2016 Elsevier Inc. All rights reserved.

Practical Clinical Training in Skills Labs: Theory and Practice

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Bugaj, T. J.

2016-08-01

Full Text Available Today, skills laboratories or “skills labs”, i.e. specific practical skill training facilities, are a firmly established part of medical education offering the possibility of training clinical procedures in a safe and fault-forging environment prior to real life application at bedside or in the operating room. Skills lab training follows a structured teaching concept, takes place under supervision and in consideration of methodological-didactic concepts, ideally creating an atmosphere that allows the repeated, anxiety- and risk-free practice of targeted skills.In this selective literature review, the first section is devoted to (I the development and dissemination of the skills lab concept. There follows (II an outline of the underlying idea and (III an analysis of key efficacy factors. Thereafter, (IV the training method’s effectiveness and transference are illuminated, before (V the use of student tutors, in the sense of peer-assisted-learning, in skills labs is discussed separately. Finally, (VI the efficiency of the skills lab concept is analyzed, followed by an outlook on future developments and trends in the field of skills lab training.

Factors shaping how clinical educators use their educational knowledge and skills in the clinical workplace: a qualitative study.

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Kumar, Koshila; Greenhill, Jennene

2016-02-18

In order to consolidate their educational knowledge and skills and develop their educational role, many clinicians undertake professional development in clinical education and supervision. It is well established that these educationally-focussed professional development activities have a positive impact. However, it is less clear what factors within the clinical workplace can shape how health professionals may use and apply their educational knowledge and skills and undertake their educational role. Looking through the lens of workplace affordances, this paper draws attention to the contextual, personal and interactional factors that impact on how clinical educators integrate their educational knowledge and skills into the practice setting, and undertake their educational role. Data were gathered via a survey of 387 clinical educators and semi-structured interviews with 12 clinical educators and 6 workplace managers. In this paper, we focus on analysing and reporting the qualitative data gathered in this study. This qualitative data were subject to a thematic analysis and guided by theoretical constructs related to workplace affordances. Three key themes were identified including contextual, personal and interactional factors. Contextual elements referred to organisational structures and systems that impact on participants' educational role, how participants' clinical education role was articulated and configured within the organisation, and how the organisation shaped the educational opportunities available to clinicians. Personal factors encompassed clinicians' personal motivations and goals to teach and be involved in education, develop their own educational skills and function as a role model for students. Interactional factors referred to the professional interactions and networks through which clinicians shared their educational knowledge and skills and further consolidated their profile as educational advocates in their workplace. There are a number of

OSCE vs. TEM: Different approaches to assess clinical skills of nursing students

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Prasuna Jelly

2017-01-01

Full Text Available Introduction: Nurses are trained with specific clinical skills, and objective structured clinical examination (OSCE could be a better approach to assess clinical skills of nursing students. Materials and Methods: A comparative study was conducted by observational checklist regarding antenatal care and opinionnaire on the usefulness of OSCE and tradition evaluation method (TEM was used to assess the clinical skills and to get opinion. Results: The mean score of OSCE was more than TEM and the difference was statistically significant (P < 0.001. The opinion of students regarding the usefulness of OSCE was higher than TEM. Conclusions: The study concluded that implementing OSCE will overweigh the advantages of the TEM.

Assessing nursing clinical skills competence through objective structured clinical examination (OSCE) for open distance learning students in Open University Malaysia.

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Oranye, Nelson Ositadimma; Ahmad, Che'an; Ahmad, Nora; Bakar, Rosnida Abu

2012-06-01

The objective structured clinical skills examination (OSCE) has over the years emerged as a method of evaluating clinical skills in most medical and allied professions. Although its validity and objectivity has evoked so much debate in the literature, little has been written about its application in non-traditional education systems such as in distance learning. This study examined clinical skills competence among practising nursing students who were enrolled in a distance learning programme. The study examined the effect of work and years of nursing practice on nurses' clinical skills competence. This study used observational design whereby nursing students' clinical skills were observed and scored in five OSCE stations. Two instruments were used for the data collection - A self-administered questionnaire on the students' bio-demographic data, and a check list on the clinical skills which the examiners rated on a four point scale. The findings revealed that 14% of the nurses had level four competence, which indicated that they could perform the tasks correctly and complete. However, 12% failed the OSCE, even though they had more than 10 years experience in nursing and post basic qualifications. Inter-rater reliability was 0.92 for the five examiners. Factor analysis indicated that five participant factors accounted for 74.1% of the variations in clinical skills performance. An OSCE is a necessary assessment tool that should be continuously applied in nursing education, regardless of the mode of the education program, the student's years of experience or his/her clinical placement. This study validates the need for OSCE in both the design of tertiary nursing degree programs and the assessment of nurses' clinical competency level.

A theory-based curriculum design for remediation of residents' communication skills.

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Leung, Fok-Han; Martin, Dawn; Batty, Helen

2009-12-01

Residents requiring remediation are often deficient in communication skills, namely clinical interviewing skills. Residents have to digest large amounts of knowledge, and then apply it in a clinical interview. The patient-centered approach, as demonstrated in the Calgary-Cambridge model and Martin's Map, can be difficult to teach. Before implementing a remediation curriculum, the theoretical educational underpinnings must be sound; curriculum evaluation is often expensive. Before establishing metrics for curriculum evaluation, a starting point is to perform a mental experiment to test theoretical adherence. This article describes an experiential remedial curriculum for communication skills. Educational theories of Kolb, Knowles, Bandura, and Bloom are used to design the curriculum into theory-based design components. Kolb's experiential cycle models the natural sequence of experiencing, teaching, and learning interviewing skills. A curriculum structured around this cycle has multiple intercalations with the above educational theories. The design is strengthened by appropriately timed use of education strategies such as learning contracts, taped interviews, simulations, structured reflection, and teacher role modeling. Importantly, it also models the form of the clinical interview format desired. Through understanding and application of contemporary educational theories, a program to remediate interviewing skills can increase its potential for success.

Interprofessional teamwork skills as predictors of clinical outcomes in a simulated healthcare setting.

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Shrader, Sarah; Kern, Donna; Zoller, James; Blue, Amy

2013-01-01

Teaching interprofessional (IP) teamwork skills is a goal of interprofessional education. The purpose of this study was to examine the relationship between IP teamwork skills, attitudes and clinical outcomes in a simulated clinical setting. One hundred-twenty health professions students (medicine, pharmacy, physician assistant) worked in interprofessional teams to manage a "patient" in a health care simulation setting. Students completed the Interdisciplinary Education Perception Scale (IEPS) attitudinal survey instrument. Students' responses were averaged by team to create an IEPS attitudes score. Teamwork skills for each team were rated by trained observers using a checklist to calculate a teamwork score (TWS). Clinical outcome scores (COS) were determined by summation of completed clinical tasks performed by the team based on an expert developed checklist. Regression analyses were conducted to determine the relationship of IEPS and TWS with COS. IEPS score was not a significant predictor of COS (p=0.054), but TWS was a significant predictor (pstudents' interprofessional teamwork skills are significant predictors of positive clinical outcomes. Interprofessional curricular models that produce effective teamwork skills can improve student performance in clinical environments and likely improve teamwork practice to positively affect patient care outcomes.

Instructor and Dental Student Perceptions of Clinical Communication Skills via Structured Assessments.

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McKenzie, Carly T

2016-05-01

The aim of this study was to use structured assessments to assess dental students' clinical communication skills exhibited during patient appointments. Fourth-year dental students (n=55) at the University of Alabama at Birmingham evaluated their own interpersonal skills in a clinical setting utilizing the Four Habits Coding Scheme. An instructor also assessed student-patient clinical communication. These assessments were used to identify perceived strengths and weaknesses in students' clinical communication. Both instructor assessments and student self-assessments pinpointed the following clinical communication skills as effective the most often: patient greeting, avoidance of jargon, and non-verbal behavior. There was also relative agreement between instructor assessments and student self-assessments regarding clinical communication skills that were rated as not effective most frequently: ensuring patient comprehension, identification of patient feelings, and exploration of barriers to treatment. These resulted pointed to strengths and weaknesses in the portion of the curriculum designed to prepare students for effective provider-patient communication. These results may suggest a need for the school's current behavioral science curriculum to better address discussion of potential treatment barriers and patient feelings as well as techniques to ensure patient comprehension.

Students' performance in the different clinical skills assessed in OSCE: what does it reveal?

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Sim, Joong Hiong; Abdul Aziz, Yang Faridah; Mansor, Azura; Vijayananthan, Anushya; Foong, Chan Choong; Vadivelu, Jamuna

2015-01-01

The purpose of this study was to compare students' performance in the different clinical skills (CSs) assessed in the objective structured clinical examination. Data for this study were obtained from final year medical students' exit examination (n=185). Retrospective analysis of data was conducted using SPSS. Means for the six CSs assessed across the 16 stations were computed and compared. Means for history taking, physical examination, communication skills, clinical reasoning skills (CRSs), procedural skills (PSs), and professionalism were 6.25±1.29, 6.39±1.36, 6.34±0.98, 5.86±0.99, 6.59±1.08, and 6.28±1.02, respectively. Repeated measures ANOVA showed there was a significant difference in the means of the six CSs assessed [F(2.980, 548.332)=20.253, pskill to be acquired by medical students before entering the workplace. Despite its challenges, students must learn the skills of clinical reasoning, while clinical teachers should facilitate the clinical reasoning process and guide students' clinical reasoning development.

Influence of Computerized Sounding Out on Spelling Performance for Children who do and not rely on AAC

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McCarthy, Jillian H.; Hogan, Tiffany P.; Beukelman, David R.; Schwarz, Ilsa E.

2015-01-01

Purpose Spelling is an important skill for individuals who rely on augmentative alternative communication (AAC). The purpose of this study was to investigate how computerized sounding out influenced spelling accuracy of pseudo-words. Computerized sounding out was defined as a word elongated, thus providing an opportunity for a child to hear all the sounds in the word at a slower rate. Methods Seven children with cerebral palsy, four who use AAC and three who do not, participated in a single subject AB design. Results The results of the study indicated that the use of computerized sounding out increased the phonologic accuracy of the pseudo-words produced by participants. Conclusion The study provides preliminary evidence for the use of computerized sounding out during spelling tasks for children with cerebral palsy who do and do not use AAC. Future directions and clinical implications are discussed. PMID:24512195

Pairing students in clinical assignments to develop collaboration and communication skills.

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Bartges, Mali

2012-01-01

Skillful collaboration and communication among healthcare team members are associated with favorable patient outcomes. Student nurses need opportunities for supervised development of these crucial and intertwined skills. The author describes the implementation of a practice-change project for simultaneously developing collaboration and communication skills by pairing prelicensure student nurses in clinical assignments. This easily adapted strategy increases options for faculty looking to stimulate student acquisition of these professional skills.

Using simulation pedagogy to teach clinical education skills: A randomized trial.

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Holdsworth, Clare; Skinner, Elizabeth H; Delany, Clare M

2016-05-01

Supervision of students is a key role of senior physiotherapy clinicians in teaching hospitals. The objective of this study was to test the effect of simulated learning environments (SLE) on educators' self-efficacy in student supervision skills. A pilot prospective randomized controlled trial with concealed allocation was conducted. Clinical educators were randomized to intervention (SLE) or control groups. SLE participants completed two 3-hour workshops, which included simulated clinical teaching scenarios, and facilitated debrief. Standard Education (StEd) participants completed two online learning modules. Change in educator clinical supervision self-efficacy (SE) and student perceptions of supervisor skill were calculated. Between-group comparisons of SE change scores were analyzed with independent t-tests to account for potential baseline differences in education experience. Eighteen educators (n = 18) were recruited (SLE [n = 10], StEd [n = 8]). Significant improvements in SE change scores were seen in SLE participants compared to control participants in three domains of self-efficacy: (1) talking to students about supervision and learning styles (p = 0.01); (2) adapting teaching styles for students' individual needs (p = 0.02); and (3) identifying strategies for future practice while supervising students (p = 0.02). This is the first study investigating SLE for teaching skills of clinical education. SLE improved educators' self-efficacy in three domains of clinical education. Sample size limited the interpretation of student ratings of educator supervision skills. Future studies using SLE would benefit from future large multicenter trials evaluating its effect on educators' teaching skills, student learning outcomes, and subsequent effects on patient care and health outcomes.

Learning clinical communication skills: outcomes of a program for professional practitioners.

Science.gov (United States)

Carvalho, Irene P; Pais, Vanessa G; Almeida, Susana S; Ribeiro-Silva, Raquel; Figueiredo-Braga, Margarida; Teles, Ana; Castro-Vale, Ivone; Mota-Cardoso, Rui

2011-07-01

To assess the effects of a communication skills program on professional practitioners' performance and self-confidence in clinical interviewing. Twenty-five health professionals took 3 months of basic communication skills followed by 3 months of advanced communication skills. An additional quarter dealt with self-awareness and communication in special situations. Participants' performances were evaluated in clinical interviews with standardized patients before, during and after the program by external observers and standardized patients, using standardized instruments. Participants assessed their own confidence in their communication skills before and after the program. Data were analysed using GLM repeated-measures procedures in SPSS. Basic communication skills and self-confidence improved throughout the 6 months; competencies declined but self-confidence continued to increase 4 months later. Compared with taking no course, differences were statistically significant after the 6 months (external observers only) and 4 months later (external observers and participants). The program effectively improved communication skills, although significantly only when assessed by external observers. Four months later, effects were significant in communication skills (external observers), despite the decline and in self-confidence. While periodical enrollment in programs for the practice of communication skills may help maintain performance, more knowledge on communication and self-awareness may enhance self-confidence. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Structured assessment of microsurgery skills in the clinical setting.

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Chan, WoanYi; Niranjan, Niri; Ramakrishnan, Venkat

2010-08-01

Microsurgery is an essential component in plastic surgery training. Competence has become an important issue in current surgical practice and training. The complexity of microsurgery requires detailed assessment and feedback on skills components. This article proposes a method of Structured Assessment of Microsurgery Skills (SAMS) in a clinical setting. Three types of assessment (i.e., modified Global Rating Score, errors list and summative rating) were incorporated to develop the SAMS method. Clinical anastomoses were recorded on videos using a digital microscope system and were rated by three consultants independently and in a blinded fashion. Fifteen clinical cases of microvascular anastomoses performed by trainees and a consultant microsurgeon were assessed using SAMS. The consultant had consistently the highest scores. Construct validity was also demonstrated by improvement of SAMS scores of microsurgery trainees. The overall inter-rater reliability was strong (alpha=0.78). The SAMS method provides both formative and summative assessment of microsurgery skills. It is demonstrated to be a valid, reliable and feasible assessment tool of operating room performance to provide systematic and comprehensive feedback as part of the learning cycle. Copyright 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Assessing Communication Skills of Medical Students in Objective Structured Clinical Examinations (OSCE) - A Systematic Review of Rating Scales

Science.gov (United States)

Cömert, Musa; Zill, Jördis Maria; Christalle, Eva; Dirmaier, Jörg; Härter, Martin; Scholl, Isabelle

2016-01-01

Background Teaching and assessment of communication skills have become essential in medical education. The Objective Structured Clinical Examination (OSCE) has been found as an appropriate means to assess communication skills within medical education. Studies have demonstrated the importance of a valid assessment of medical students’ communication skills. Yet, the validity of the performance scores depends fundamentally on the quality of the rating scales used in an OSCE. Thus, this systematic review aimed at providing an overview of existing rating scales, describing their underlying definition of communication skills, determining the methodological quality of psychometric studies and the quality of psychometric properties of the identified rating scales. Methods We conducted a systematic review to identify psychometrically tested rating scales, which have been applied in OSCE settings to assess communication skills of medical students. Our search strategy comprised three databases (EMBASE, PsycINFO, and PubMed), reference tracking and consultation of experts. We included studies that reported psychometric properties of communication skills assessment rating scales used in OSCEs by examiners only. The methodological quality of included studies was assessed using the COnsensus based Standards for the selection of health status Measurement INstruments (COSMIN) checklist. The quality of psychometric properties was evaluated using the quality criteria of Terwee and colleagues. Results Data of twelve studies reporting on eight rating scales on communication skills assessment in OSCEs were included. Five of eight rating scales were explicitly developed based on a specific definition of communication skills. The methodological quality of studies was mainly poor. The psychometric quality of the eight rating scales was mainly intermediate. Discussion Our results reveal that future psychometric evaluation studies focusing on improving the methodological quality are needed

Collaborative learning of clinical skills in health professions education: the why, how, when and for whom.

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Tolsgaard, Martin G; Kulasegaram, Kulamakan M; Ringsted, Charlotte V

2016-01-01

This study is designed to provide an overview of why, how, when and for whom collaborative learning of clinical skills may work in health professions education. Collaborative learning of clinical skills may influence learning positively according to the non-medical literature. Training efficiency may therefore be improved if the outcomes of collaborative learning of clinical skills are superior or equivalent to those attained through individual learning. According to a social interaction perspective, collaborative learning of clinical skills mediates its effects through social interaction, motivation, accountability and positive interdependence between learners. Motor skills learning theory suggests that positive effects rely on observational learning and action imitation, and negative effects may include decreased hands-on experience. Finally, a cognitive perspective suggests that learning is dependent on cognitive co-construction, shared knowledge and reduced cognitive load. The literature on the collaborative learning of clinical skills in health science education is reviewed to support or contradict the hypotheses provided by the theories outlined above. Collaborative learning of clinical skills leads to improvements in self-efficacy, confidence and performance when task processing is observable or communicable. However, the effects of collaborative learning of clinical skills may decrease over time as benefits in terms of shared cognition, scaffolding and cognitive co-construction are outweighed by reductions in hands-on experience and time on task. Collaborative learning of clinical skills has demonstrated promising results in the simulated setting. However, further research into how collaborative learning of clinical skills may work in clinical settings, as well as into the role of social dynamics between learners, is required. © 2015 John Wiley & Sons Ltd.

Use of online clinical videos for clinical skills training for medical students: benefits and challenges.

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Jang, Hye Won; Kim, Kyong-Jee

2014-03-21

Multimedia learning has been shown effective in clinical skills training. Yet, use of technology presents both opportunities and challenges to learners. The present study investigated student use and perceptions of online clinical videos for learning clinical skills and in preparing for OSCE (Objective Structured Clinical Examination). This study aims to inform us how to make more effective us of these resources. A mixed-methods study was conducted for this study. A 30-items questionnaire was administered to investigate student use and perceptions of OSCE videos. Year 3 and 4 students from 34 Korean medical schools who had access to OSCE videos participated in the online survey. Additionally, a semi-structured interview of a group of Year 3 medical students was conducted for an in-depth understanding of student experience with OSCE videos. 411 students from 31 medical schools returned the questionnaires; a majority of them found OSCE videos effective for their learning of clinical skills and in preparing for OSCE. The number of OSCE videos that the students viewed was moderately associated with their self-efficacy and preparedness for OSCE (p mobile devices; they agreed more with the statement that it was convenient to access the video clips than their peers who accessed the videos using computers (p students reported lack of integration into the curriculum and lack of interaction as barriers to more effective use of OSCE videos. The present study confirms the overall positive impact of OSCE videos on student learning of clinical skills. Having faculty integrate these learning resources into their teaching, integrating interactive tools into this e-learning environment to foster interactions, and using mobile devices for convenient access are recommended to help students make more effective use of these resources.

Midwifery students' experiences of learning clinical skills in Iran: a qualitative study.

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Ahmadi, Golnoosh; Shahriari, Mohsen; Keyvanara, Mahmood; Kohan, Shahnaz

2018-03-09

A qualitative study was used. Midwifery students from three universities in Iran participated. The study used a convenience sample of eighteen students. Data for this study was collected using semi-structured interviews (N=12) and focus groups (N=6). Data were recorded on a digital audio recorder and then transcribed. The qualitative data were analyzed using a content analysis approach. Six broad themes emerged from the analysis: Limited opportunities to experience skills, difficulties with course plan gaps, need for creating a supportive clinical environment, learning drives, confusion between different methods, and stress in the clinical setting. Short verbatim quotations from the participants were presented to provide evidence for the interpretation of data. The findings of this study have provided a clear picture of the factors and mechanisms involved in learning clinical skills by midwifery students. This study showed that students had some difficulties and concerns during learning of clinical midwifery skills. The findings of this study suggest that midwifery educators conduct further studies to tackle these issues in clinical skills learning. The findings of this study are subject to some limitations which are discussed.

Educational climate seems unrelated to leadership skills of clinical consultants responsible of postgraduate medical education in clinical departments

DEFF Research Database (Denmark)

Malling, Bente Vigh; Mortensen, Lene S.; Scherpbier, Albert J J

2010-01-01

The educational climate is crucial in postgraduate medical education. Although leaders are in the position to influence the educational climate, the relationship between leadership skills and educational climate is unknown. This study investigates the relationship between the educational climate...... in clinical departments and the leadership skills of clinical consultants responsible for education....

Progressive Tinnitus Management Level 3 Skills Education: A 5-Year Clinical Retrospective.

Science.gov (United States)

Edmonds, Catherine M; Ribbe, Cheri; Thielman, Emily J; Henry, James A

2017-09-18

The primary purpose of this study was to determine whether progressive tinnitus management Level 3 skills education workshops conducted at the Bay Pines and Boston Veterans Affairs hospitals result in consistent use of the presented tinnitus management strategies by patients 1-5 years after completing the workshops. In fiscal year (FY) 2015, the tinnitus workshop follow-up form was mailed to all veterans who completed the Level 3 workshops between FY 2010 and FY 2014. Data were compiled to determine which, if any, of the skills taught in the workshops were being used 1-5 years after completion of the workshops and the impact on quality-of-life indicators. All self-management skills were being utilized up to 5 years postcompletion; therapeutic sound was utilized the most. The majority of patients reported an improved ability to manage reactions to tinnitus and improved quality-of-life indicators. Over 90% of patients from both sites recommended the program to others with tinnitus. The self-management skills taught in the progressive tinnitus management Level 3 workshops are sustained over time even when limited resources prevent the full complement of workshops or the involvement of mental health services. The workshops can also be successfully implemented through remote delivery via videoconferencing (telehealth). https://doi.org/10.23641/asha.5370883.

Use of Quality Controlled AIRS Temperature Soundings to Improve Forecast Skill

Science.gov (United States)

Susskind, Joel; Reale, Oreste; Iredell, Lena

2010-01-01

on use of a Standard profile dependent threshold (Delta)T(p). These Standard thresholds were designed as a compromise between optimal use for data assimilation purposes, which requires highest accuracy (tighter Quality Control), and climate purposes, which requires more spatial coverage (looser Quality Control). Subsequent research using Version 5 sounding and error estimates showed that tighter Quality Control performs better for data assimilation proposes, while looser Quality Control better spatial coverage) performs better for climate purposes. We conducted a number of data assimilation experiments using the NASA GEOS-5 Data Assimilation System as a step toward finding an optimum balance of spatial coverage and sounding accuracy with regard to improving forecast skill. The model was run at a horizontal resolution of 0.5 degree latitude x 0.67 degree longitude with 72 vertical levels. These experiments were run during four different seasons, each using a different year. The AIRS temperature profiles were presented to the GEOS-5 analysis as rawinsonde profiles, and the profile error estimates (delta)T(p) were used as the uncertainty for each measurement in the data assimilation process.

Prepared for Practice? Interns’ Experiences of Undergraduate Clinical Skills Training in Ireland

Directory of Open Access Journals (Sweden)

M. Morris

2016-01-01

Full Text Available Background Many previous studies on internship have reported a lack of preparedness for the role. More recently in Ireland, medical schools have introduced formal clinical skills training programmes. This study sought to evaluate the impact, if any, of formal skills training in the medical training on intern's preparedness for practice. Methods The study utilized a survey approach followed by focus group discussions. The aim was to identify the skills that were taught and assessed in medical training and the skills that were actually required in their intern year. Results Most interns had received skills training in designated skills laboratories. No intern had received training in all skills advised in the European guidelines. Skills taught to all interns were intravenous cannulation, basic life support, and basic suture. Skills required from all interns were intravenous cannulation, phlebotomy, and arterial blood sampling. Removal of peripherally inserted central line (PICC lines, central lines, and chest drains were commonly requested but not taught. Senior staff underestimated skill abilities and expected failure. Conclusion These findings identify discordance between the skills taught and the skills required in the job. There is a need for standardization in the clinical skills training to ensure that all interns enter practice with equal competencies. Consideration should be given to experiential learning opportunities such as subintern programmes to consolidate learning and improve preparedness. Improvement in communications with senior clinicians is indicated to ensure that expectations are realistic and reflective of actual training.

An Investigation of Factors Influencing Nurses' Clinical Decision-Making Skills.

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Wu, Min; Yang, Jinqiu; Liu, Lingying; Ye, Benlan

2016-08-01

This study aims to investigate the influencing factors on nurses' clinical decision-making (CDM) skills. A cross-sectional nonexperimental research design was conducted in the medical, surgical, and emergency departments of two university hospitals, between May and June 2014. We used a quantile regression method to identify the influencing factors across different quantiles of the CDM skills distribution and compared the results with the corresponding ordinary least squares (OLS) estimates. Our findings revealed that nurses were best at the skills of managing oneself. Educational level, experience, and the total structural empowerment had significant positive impacts on nurses' CDM skills, while the nurse-patient relationship, patient care and interaction, formal empowerment, and information empowerment were negatively correlated with nurses' CDM skills. These variables explained no more than 30% of the variance in nurses' CDM skills and mainly explained the lower quantiles of nurses' CDM skills distribution. © The Author(s) 2016.

Students’ performance in the different clinical skills assessed in OSCE: what does it reveal?

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Joong Hiong Sim

2015-02-01

Full Text Available Introduction: The purpose of this study was to compare students’ performance in the different clinical skills (CSs assessed in the objective structured clinical examination. Methods: Data for this study were obtained from final year medical students’ exit examination (n=185. Retrospective analysis of data was conducted using SPSS. Means for the six CSs assessed across the 16 stations were computed and compared. Results: Means for history taking, physical examination, communication skills, clinical reasoning skills (CRSs, procedural skills (PSs, and professionalism were 6.25±1.29, 6.39±1.36, 6.34±0.98, 5.86±0.99, 6.59±1.08, and 6.28±1.02, respectively. Repeated measures ANOVA showed there was a significant difference in the means of the six CSs assessed [F(2.980, 548.332=20.253, p<0.001]. Pairwise multiple comparisons revealed significant differences between the means of the eight pairs of CSs assessed, at p<0.05. Conclusions: CRSs appeared to be the weakest while PSs were the strongest, among the six CSs assessed. Students’ unsatisfactory performance in CRS needs to be addressed as CRS is one of the core competencies in medical education and a critical skill to be acquired by medical students before entering the workplace. Despite its challenges, students must learn the skills of clinical reasoning, while clinical teachers should facilitate the clinical reasoning process and guide students’ clinical reasoning development.

Promoting fundamental clinical skills: a competency-based college approach at the University of Washington.

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Goldstein, Erika A; Maclaren, Carol F; Smith, Sherilyn; Mengert, Terry J; Maestas, Ramoncita R; Foy, Hugh M; Wenrich, Marjorie D; Ramsey, Paul G

2005-05-01

The focus on fundamental clinical skills in undergraduate medical education has declined over the last several decades. Dramatic growth in the number of faculty involved in teaching and increasing clinical and research commitments have contributed to depersonalization and declining individual attention to students. In contrast to the close teaching and mentoring relationship between faculty and students 50 years ago, today's medical students may interact with hundreds of faculty members without the benefit of a focused program of teaching and evaluating clinical skills to form the core of their four-year curriculum. Bedside teaching has also declined, which may negatively affect clinical skills development. In response to these and other concerns, the University of Washington School of Medicine has created an integrated developmental curriculum that emphasizes bedside teaching and role modeling, focuses on enhancing fundamental clinical skills and professionalism, and implements these goals via a new administrative structure, the College system, which consists of a core of clinical teachers who spend substantial time teaching and mentoring medical students. Each medical student is assigned a faculty mentor within a College for the duration of his or her medical school career. Mentors continuously teach and reflect with students on clinical skills development and professionalism and, during the second year, work intensively with them at the bedside. They also provide an ongoing personal faculty contact. Competency domains and benchmarks define skill areas in which deepening, progressive attention is focused throughout medical school. This educational model places primary focus on the student.

An Innovative Clinical Skills “Boot Camp” for Dental Medicine Residents

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Jenny Castillo

2017-05-01

Full Text Available During a 1-year hospital-based residency, dental residents are required to rotate through many departments including surgery, medicine, and emergency medicine. It became apparent that there was a gap between clinical skills knowledge taught in dental school curriculum and skills required for hospital-based patient care. In response, a simulation-based intensive clinical skill “boot camp” was created. The boot camp provided an intensive, interactive 3-day session for the dental residents. During the 3 days, residents were introduced to medical knowledge and skills that were necessary for their inpatient hospital rotations but were lacking in traditional dental school curriculum. Effectiveness of the boot camp was assessed in terms of knowledge base and comfort through presession and postsession surveys. According to resident feedback, this intensive introduction for the dental residents improved their readiness for their inpatient hospital-based residency.

Medical Students’ Clinical Skills Do Not Match Their Teachers’ Expectations: Survey at Zagreb University School of Medicine, Croatia

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Sičaja, Mario; Romić, Dominik; Prka, Željko

2006-01-01

Aim To evaluate self-assessed level of clinical skills of graduating medical students at Zagreb University School of Medicine and compare them with clinical skill levels expected by their teachers and those defined by a criterion standard. Method The study included all medical students (n = 252) graduating from the Zagreb University School of Medicine in the 2004-2005 academic year and faculty members (n = 129) teaching clinical skills. The participants completed anonymous questionnaire listing 99 clinical skills divided into nine groups. Students were asked to assess their clinical skills on a 0-5 scale, and faculty members were asked to assess the minimum necessary level of clinical skills expected from graduating medical students, using the same 0-5 scale. We compared the assessment scores of faculty members with students’ self-assessment scores. Participants were grouped according to their descriptive characteristics for further comparison. Results The response rate was 91% for students and 70% for faculty members. Students’ self-assessment scores in all nine groups of clinical skills ranged from 2.2 ± 0.8 to 3.8 ± 0.5 and were lower than those defined by the criterion standard (3.0-4.0) and those expected by teachers (from 3.1 ± 1.0 to 4.4 ± 0.5) (P<0.001 for all). Students who had additional clinical skills training had higher scores in all groups of skills, ranging from 2.6 ± 0.9 to 4.0 ± 0.5 (P<0.001 for all). Male students had higher scores than female students in emergency (P<0.001), neurology (P = 0.017), ear, nose, and throat (P = 0.002), urology (P = 0.003), and surgery skills (P = 0.002). Teachers’ expectations did not vary according to their sex, academic position, or specialty. Conclusion Students’ self-assessed level of clinical skills was lower than that expected by their teachers. Education during clinical rotations is not focused on acquiring clinical skills, and additional clinical

Forensic psychiatric nursing: skills and competencies: II clinical aspects.

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Mason, T; Coyle, D; Lovell, A

2008-03-01

This study reports on research undertaken to identify the skills and competencies of forensic psychiatric nurses working in secure psychiatric services in the UK. The rationale for this research is the lack of clarity in the role definition of nurses working in these environments and the specific content that may underscore the curriculum for training forensic nurses. Over 3300 questionnaires were distributed to forensic psychiatric nurses, non-forensic psychiatric nurses and other disciplines and information obtained on (1) the perceived clinical problems that give forensic nurses the most difficulty; (2) the skills best suited to overcome those problems; and (3) the priority aspects of clinical nursing care that needs to be developed. A 35% response rate was obtained with 1019 forensic psychiatric nurses, 110 non-forensic psychiatric nurses and 43 other disciplines. The results highlighted a 'top ten' list of main problems with possible solutions and main areas for development. The conclusions drawn include a focus on skills and competencies regarding the management of personality disorders and the management of violence and aggression.

Effectiveness of a Clinical Skills Workshop for drug-dosage calculation in a nursing program.

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Grugnetti, Anna Maria; Bagnasco, Annamaria; Rosa, Francesca; Sasso, Loredana

2014-04-01

Mathematical and calculation skills are widely acknowledged as being key nursing competences if patients are to receive care that is both effective and safe. Indeed, weaknesses in mathematical competence may lead to the administration of miscalculated drug doses, which in turn may harm or endanger patients' lives. However, little attention has been given to identifying appropriate teaching and learning strategies that will effectively facilitate the development of these skills in nurses. One such approach may be simulation. To evaluate the effectiveness of a Clinical Skills Workshop on drug administration that focused on improving the drug-dosage calculation skills of second-year nursing students, with a view to promoting safety in drugs administration. A descriptive pre-post test design. Educational. Simulation center. The sample population included 77 nursing students from a Northern Italian University who attended a 30-hour Clinical Skills Workshop over a period of two weeks. The workshop covered integrated teaching strategies and innovative drug-calculation methodologies which have been described to improve psychomotor skills and build cognitive abilities through a greater understanding of mathematics linked to clinical practice. Study results showed a significant improvement between the pre- and the post-test phases, after the intervention. Pre-test scores ranged between 0 and 25 out of a maximum of 30 points, with a mean score of 15.96 (SD 4.85), and a median score of 17. Post-test scores ranged between 15 and 30 out of 30, with a mean score of 25.2 (SD 3.63) and a median score of 26 (pstudy shows that Clinical Skills Workshops may be tailored to include teaching techniques that encourage the development of drug-dosage calculation skills, and that training strategies implemented during a Clinical skills Workshop can enhance students' comprehension of mathematical calculations. Copyright © 2013 Elsevier Ltd. All rights reserved.

Spanish-speaking patients' satisfaction with clinical pharmacists' communication skills and demonstration of cultural sensitivity.

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Kim-Romo, Dawn N; Barner, Jamie C; Brown, Carolyn M; Rivera, José O; Garza, Aida A; Klein-Bradham, Kristina; Jokerst, Jason R; Janiga, Xan; Brown, Bob

2014-01-01

OBJECTIVE To assess Spanish-speaking patients' satisfaction with their clinical pharmacists' communication skills and demonstration of cultural sensitivity, while controlling for patients' sociodemographic, clinical, and communication factors, as well as pharmacist factors, and to identify clinical pharmacists' cultural factors that are important to Spanish-speaking patients. DESIGN Cross-sectional study. SETTING Central Texas during August 2011 to May 2012. PARTICIPANTS Spanish-speaking patients of federally qualified health centers (FQHCs). MAIN OUTCOME MEASURE(S) A Spanish-translated survey assessed Spanish-speaking patients' satisfaction with their clinical pharmacists' communication skills and demonstration of cultural sensitivity. RESULTS Spanish-speaking patients (N = 101) reported overall satisfaction with their clinical pharmacists' communication skills and cultural sensitivity. Patients also indicated that pharmacists' cultural rapport (e.g., ability to speak Spanish, respectfulness) was generally important to Spanish speakers. Multiple linear regression analyses showed that cultural rapport was significantly related to satisfaction with pharmacists' communication skills and demonstration of cultural sensitivity. CONCLUSION Overall, patients were satisfied with pharmacists' communication skills and cultural sensitivity. Patient satisfaction initiatives that include cultural rapport should be developed for pharmacists who provide care to Spanish-speaking patients with limited English proficiency.

Student teachers can be as good as associate professors in teaching clinical skills

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Tolsgaard, Martin G; Gustafsson, Amandus; Rasmussen, Maria B

2007-01-01

AIM: The aim of this study is to compare student teachers and clinical associate professors regarding the quality of procedural skills teaching in terms of participants' technical skills, knowledge and satisfaction with the teaching. METHODS: This is an experimental, randomized, controlled study....... CONCLUSION: Trained student teachers can be as good as associate professors in teaching clinical skills. Udgivelsesdato: 2007-Sep...... comparing the teaching of student teachers and associate professors regarding participants' learning outcome and satisfaction with the teaching. Two skills are chosen for the experiment, i.v.-access and bladder catheterization. Learning outcome is assessed by a pre- and post testing of the participants...

Effects of additional team-based learning on students' clinical reasoning skills: a pilot study.

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Jost, Meike; Brüstle, Peter; Giesler, Marianne; Rijntjes, Michel; Brich, Jochen

2017-07-14

In the field of Neurology good clinical reasoning skills are essential for successful diagnosing and treatment. Team-based learning (TBL), an active learning and small group instructional strategy, is a promising method for fostering these skills. The aim of this pilot study was to examine the effects of a supplementary TBL-class on students' clinical decision-making skills. Fourth- and fifth-year medical students participated in this pilot study (static-group comparison design). The non-treatment group (n = 15) did not receive any additional training beyond regular teaching in the neurology course. The treatment group (n = 11) took part in a supplementary TBL-class optimized for teaching clinical reasoning in addition to the regular teaching in the neurology course. Clinical decision making skills were assessed using a key-feature problem examination. Factual and conceptual knowledge was assessed by a multiple-choice question examination. The TBL-group performed significantly better than the non-TBL-group (p = 0.026) in the key-feature problem examination. No significant differences between the results of the multiple-choice question examination of both groups were found. In this pilot study participants of a supplementary TBL-class significantly improved clinical decision-making skills, indicating that TBL may be an appropriate method for teaching clinical decision making in neurology. Further research is needed for replication in larger groups and other clinical fields.

Developing clinical piano improvisation skills

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Wigram, Anthony Lewis

2003-01-01

Teaching piano improvisation skills for use in clinical work relies on the development of a range of musical techniques and therapeutic methods that are combined and integrated. Simple musical styles of playing such as melody dialogues, two chord accompaniments, walking basses (tonal and atonal), 6...... skilful way of helping a client or group of clients move, or develop their musical expression (Wigram & Bonde 2002 pp 278-279). Frame-working is a method that offers a musical structure to the music of a client. This structure could have the goal of enhancing the music aesthetically, or guiding the client...

Transfer of communication skills training from workshop to workplace: the impact of clinical supervision.

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Heaven, Cathy; Clegg, Jenny; Maguire, Peter

2006-03-01

Recent studies have recognised that the communication skills learned in the training environment are not always transferred back into the clinical setting. This paper reports a study which investigated the potential of clinical supervision in enhancing the transfer process. A randomised controlled trial was conducted involving 61 clinical nurse specialists. All attended a 3-day communication skills training workshop. Twenty-nine were then randomised to 4 weeks of clinical supervision, aimed at facilitating transfer of newly acquired skills into practice. Assessments, using real and simulated patients, were carried out before the course, immediately after the supervision period and 3 months later. Interviews were rated objectively using the Medical Interview Aural Rating Scale (MIARS) to assess nurses' ability to use key skills, respond to patient cues and identify patient concerns. Assessments with simulated patients showed that the training programme was extremely effective in changing competence in all three key areas. However, only those who experienced supervision showed any evidence of transfer. Improvements were found in the supervised groups' use of open questions, negotiation and psychological exploration. Whilst neither group facilitated more disclosure of cues or concerns, those in the experimental group responded more effectively to the cues disclosed, reduced their distancing behaviour and increasing their exploration of cues. The study has shown that whilst training enhances skills, without intervention, it may have little effect on clinical practice. The potential role of clinical supervision as one way of enhancing the clinical effectiveness of communication skills training programmes has been demonstrated. PRACTISE IMPLICATIONS: This study raises questions about the effectiveness of training programmes which do not incorporate a transfer element, and provides evidence to support the need for clinical supervision for clinical nurse specialist.

The new vestibular stimuli: sound and vibration-anatomical, physiological and clinical evidence.

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Curthoys, Ian S

2017-04-01

The classical view of the otoliths-as flat plates of fairly uniform receptors activated by linear acceleration dragging on otoconia and so deflecting the receptor hair bundles-has been replaced by new anatomical and physiological evidence which shows that the maculae are much more complex. There is anatomical spatial differentiation across the macula in terms of receptor types, hair bundle heights, stiffness and attachment to the overlying otolithic membrane. This anatomical spatial differentiation corresponds to the neural spatial differentiation of response dynamics from the receptors and afferents from different regions of the otolithic maculae. Specifically, receptors in a specialized band of cells, the striola, are predominantly type I receptors, with short, stiff hair bundles and looser attachment to the overlying otoconial membrane than extrastriolar receptors. At the striola the hair bundles project into holes in the otolithic membrane, allowing for fluid displacement to deflect the hair bundles and activate the cell. This review shows the anatomical and physiological evidence supporting the hypothesis that fluid displacement, generated by sound or vibration, deflects the short stiff hair bundles of type I receptors at the striola, resulting in neural activation of the irregular afferents innervating them. So these afferents are activated by sound or vibration and show phase-locking to individual cycles of the sound or vibration stimulus up to frequencies above 2000 Hz, underpinning the use of sound and vibration for clinical tests of vestibular function.

Who Is the Preferred Tutor in Clinical Skills Training: Physicians, Nurses, or Peers?

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Abay, Ece Şükriye; Turan, Sevgi; Odabaşı, Orhan; Elçin, Melih

2017-01-01

Phenomenon: Clinical skills centers allow structured training of undergraduate medical students for the acquisition of clinical skills in a simulated environment. Physician, nurse, or peer tutors are employed for training in those centers. All tutors should have appropriate training about the methodology used in the clinical skills training. Many of the studies revealed the effectiveness of various types of tutors. The aim of our study was to evaluate medical students' satisfaction with clinical skills training, and their opinions about the differences in coaching skills among the physician, nurse, and peer tutors. This study was conducted with third-year students (467 students) in 2013-2014 academic year at Hacettepe University Faculty of Medicine. Participation rate was 85 % (397 students). The students attended the suturing skill training in groups of 40 students. First, a faculty member from the Department of Medical Education delivered a video demonstration and conducted discussion. After the demonstration, the students were divided into groups of 5-6 students. A physician, nurse, or a peer tutor facilitated each group. The students were asked to complete the Coaching Skills Evaluation Form after the practicum session. It contained 13 criteria for assessing the coaching skills. Additionally, the form included a question for rating the student's satisfaction with the tutor. The performance of the tutors at each step was rated on a three-point scale. Kruskal Wallis analysis was used to compare students' scores for their tutors. The students' satisfaction with tutors was high for all of the tutors. However, there was no difference between students' scores in suturing skill, and between physician, nurse, and peer tutors' coaching skills. Insights: In this study, we revealed that physician, nurse, and peer tutors were equally effective on the students' performances. They were also regarded as effective in their teaching role by students. But the most important

Using computer assisted learning for clinical skills education in nursing: integrative review.

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Bloomfield, Jacqueline G; While, Alison E; Roberts, Julia D

2008-08-01

This paper is a report of an integrative review of research investigating computer assisted learning for clinical skills education in nursing, the ways in which it has been studied and the general findings. Clinical skills are an essential aspect of nursing practice and there is international debate about the most effective ways in which these can be taught. Computer assisted learning has been used as an alternative to conventional teaching methods, and robust research to evaluate its effectiveness is essential. The CINAHL, Medline, BNI, PsycInfo and ERIC electronic databases were searched for the period 1997-2006 for research-based papers published in English. Electronic citation tracking and hand searching of reference lists and relevant journals was also undertaken. Twelve studies met the inclusion criteria. An integrative review was conducted and each paper was explored in relation to: design, aims, sample, outcome measures and findings. Many of the study samples were small and there were weaknesses in designs. There is limited empirical evidence addressing the use of computer assisted learning for clinical skills education in nursing. Computer assisted learning has been used to teach a limited range of clinical skills in a variety of settings. The paucity of evaluative studies indicates the need for more rigorous research to investigate the effect of computer assisted learning for this purpose. Areas that need to be addressed in future studies include: sample size, range of skills, longitudinal follow-up and control of confounding variables.

[Skills lab training in veterinary medicine. Effective preparation for clinical work at the small animal clinic of the University for Veterinary Medicine Hannover, Foundation].

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Engelskirchen, Simon; Ehlers, Jan; Kirk, Ansgar T; Tipold, Andrea; Dilly, Marc

2017-09-20

During five and a half years of studying veterinary medicine, students should in addition to theoretical knowledge acquire sufficient practical skills. Considering animal welfare and ethical aspects, opportunities for hands-on learning on living animals are limited because of the high annual number of students. The first German veterinary clinical-skills lab, established in 2013 at the University for Veterinary Medicine Hannover, Foundation (TiHo), offers opportunities for all students to learn, train and repeat clinical skills on simulators and models as frequently as they would like, until they feel sufficiently confident to transfer these skills to living animals. This study describes the establishment of clinical-skills lab training within the students' practical education, using the example of the small-animal clinic of the TiHo. Two groups of students were compared: without skills lab training (control group K) and with skills lab training (intervention group I). At the end of both the training and a subsequent 10-week clinical rotation in different sections of the clinic, an objective structured clinical examination (OSCE) was performed, testing the students' practical skills at 15 stations. An additional multiple-choice test was performed before and after the clinical rotation to evaluate the increased theoretical knowledge. Students of group I achieved significantly (p ≤ 0.05) better results in eight of the 15 tested skills. The multiple-choice test revealed a significant (p ≤ 0.05) gain of theoretical knowledge in both groups without any differences between the groups. Students displayed a high degree of acceptance of the skills lab training. Using simulators and models in veterinary education is an efficient teaching concept, and should be used continually and integrated in the curriculum.

Using Facebook to enhance commencing student confidence in clinical skill development: A phenomenological hermeneutic study.

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Watson, Bernadette; Cooke, Marie; Walker, Rachel

2016-01-01

The purpose of this study was to explore commencing nursing students' experience of Facebook as an adjunct to on-campus course delivery to determine its impact as a learning strategy for improving confidence in clinical skill development. Approaches supporting nursing students in the development of clinical skills have relied on 'real-life' clinical placements and simulated on-campus clinical laboratories. However students continue to report a lack of confidence in their clinical skills for practice. Social networking sites including Facebook are being used as a learning strategy to stimulate active and collaborative learning approaches. A hermeneutic phenomenological approach was used to provide an understanding of the experience of confidence in clinical skills development for nursing students. Data were collected through in-depth interviews with commencing students about their experience as learners using Facebook and their perceptions of the impact on their clinical skill development. Ten first-year student nurses at one university in south-east Queensland, Australia. Four themes emerged from the data including: 'We're all in this together'; 'I can do this'; 'This is about my future goals and success'; and, 'Real time is not fast enough!'. These themes provide new meaningful insights demonstrating students' sense of confidence in clinical skills was increased through engagement with a dedicated Facebook page. The findings of this study have relevance to academics in the design of learning strategies for clinical courses to further support student confidence and engagement through peer collaboration and active learning processes. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

Evaluation of clinical skills for first-year surgical residents using orientation programme and objective structured clinical evaluation as a tool of assessment

Directory of Open Access Journals (Sweden)

Pandya J

2010-01-01

Full Text Available Background: Postgraduate specialities require a combination of knowledge and clinical skills. The internship year is less structured. Clinical and practical skills that are picked up during training are not well regulated and the impact is not assessed. In this study, we assessed knowledge and skills using objective structured clinical examination (OSCE. Aim: To evaluate the clinical skills of new first-year surgical residents using orientation programme and OSCE as a tool for assessment. Settings and Design: Observational study. Materials and Methods: Twenty new first-year surgical residents (10 each in 2008 and 2009 participated in a detailed structured orientation programme conducted over a period of 7 days. Clinically important topics and skills expected at this level (e.g., suturing, wound care etc. were covered. The programme was preceded by an OSCE to test pre-programme knowledge (the "pre-test". The questions were validated by senior department staff. A post-programme OSCE (the "post-test" helped to evaluate the change in clinical skill level brought about by the orientation programme. Statistical Analysis: Wilcoxson matched-pairs signed-ranks test. Results: Passing performance was achieved by all participants in both pre- and post-tests. Following the orientation programme, significant improvement was seen in tasks testing the psychomotor and cognitive domains. (P = 0.0001 and P = 0.0401, respectively. Overall reliability of the OSCE was found to be 0.7026 (Cronbach′s coefficient alpha. Conclusions: This study highlighted the lacunae in current internship training, especially for skill-based tasks. There is a need for universal inclusion of structured orientation programmes in the training of first-year residents. OSCE is a reliable, valid and effective method for the assessment of clinical skills.

Developing a reference of normal lung sounds in healthy Peruvian children.

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Ellington, Laura E; Emmanouilidou, Dimitra; Elhilali, Mounya; Gilman, Robert H; Tielsch, James M; Chavez, Miguel A; Marin-Concha, Julio; Figueroa, Dante; West, James; Checkley, William

2014-10-01

Lung auscultation has long been a standard of care for the diagnosis of respiratory diseases. Recent advances in electronic auscultation and signal processing have yet to find clinical acceptance; however, computerized lung sound analysis may be ideal for pediatric populations in settings, where skilled healthcare providers are commonly unavailable. We described features of normal lung sounds in young children using a novel signal processing approach to lay a foundation for identifying pathologic respiratory sounds. 186 healthy children with normal pulmonary exams and without respiratory complaints were enrolled at a tertiary care hospital in Lima, Peru. Lung sounds were recorded at eight thoracic sites using a digital stethoscope. 151 (81%) of the recordings were eligible for further analysis. Heavy-crying segments were automatically rejected and features extracted from spectral and temporal signal representations contributed to profiling of lung sounds. Mean age, height, and weight among study participants were 2.2 years (SD 1.4), 84.7 cm (SD 13.2), and 12.0 kg (SD 3.6), respectively; and, 47% were boys. We identified ten distinct spectral and spectro-temporal signal parameters and most demonstrated linear relationships with age, height, and weight, while no differences with genders were noted. Older children had a faster decaying spectrum than younger ones. Features like spectral peak width, lower-frequency Mel-frequency cepstral coefficients, and spectro-temporal modulations also showed variations with recording site. Lung sound extracted features varied significantly with child characteristics and lung site. A comparison with adult studies revealed differences in the extracted features for children. While sound-reduction techniques will improve analysis, we offer a novel, reproducible tool for sound analysis in real-world environments.

An interview study of how clinical teachers develop skills to attend to different level learners.

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Chen, H Carrie; Fogh, Shannon; Kobashi, Brent; Teherani, Arianne; Ten Cate, Olle; O'Sullivan, Patricia

2016-06-01

One clinical teaching challenge is the engagement of learners at different levels. Faculty development offerings mostly address general strategies applicable to all learners. This study examined how clinical faculty members develop the skills to work with different level learners. We conducted semi-structured interviews with medical school faculty members identified as excellent clinical teachers teaching multiple levels of learners. They discussed how they developed their approach to teaching different level learners and how their teaching evolved over time. We performed thematic analysis of the interview transcripts using open and axial coding. We interviewed 19 faculty members and identified three themes related to development of teaching practices: teacher agency and work-based learning of teaching strategies, developmental trajectory of clinical teachers, and interplay between clinical confidence and teaching skills. Faculty members were proactive in using on-the-job experiences to develop their teaching practices. Their teaching practices followed a developmental trajectory towards learner centeredness, and this evolution was associated with the development of clinical skills and confidence. Learning skills to teach multi-level learners requires workplace learning. Faculty development should include workplace learning opportunities and use a developmental approach that accounts for the trajectory of teaching as well as clinical skills attainment.

Clinical skills assessment of procedural and advanced communication skills: performance expectations of residency program directors

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Langenau, Erik E.; Zhang, Xiuyuan; Roberts, William L.; DeChamplain, Andre F.; Boulet, John R.

2012-01-01

Background High stakes medical licensing programs are planning to augment and adapt current examinations to be relevant for a two-decision point model for licensure: entry into supervised practice and entry into unsupervised practice. Therefore, identifying which skills should be assessed at each decision point is critical for informing examination development, and gathering input from residency program directors is important. Methods Using data from previously developed surveys and expert panels, a web-delivered survey was distributed to 3,443 residency program directors. For each of the 28 procedural and 18 advanced communication skills, program directors were asked which clinical skills should be assessed, by whom, when, and how. Descriptive statistics were collected, and Intraclass Correlations (ICC) were conducted to determine consistency across different specialties. Results Among 347 respondents, program directors reported that all advanced communication and some procedural tasks are important to assess. The following procedures were considered ‘important’ or ‘extremely important’ to assess: sterile technique (93.8%), advanced cardiovascular life support (ACLS) (91.1%), basic life support (BLS) (90.0%), interpretation of electrocardiogram (89.4%) and blood gas (88.7%). Program directors reported that most clinical skills should be assessed at the end of the first year of residency (or later) and not before graduation from medical school. A minority were considered important to assess prior to the start of residency training: demonstration of respectfulness (64%), sterile technique (67.2%), BLS (68.9%), ACLS (65.9%) and phlebotomy (63.5%). Discussion Results from this study support that assessing procedural skills such as cardiac resuscitation, sterile technique, and phlebotomy would be amenable to assessment at the end of medical school, but most procedural and advanced communications skills would be amenable to assessment at the end of the first

Formative assessment of GP trainees' clinical skills.

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Wiener-Ogilvie, Sharon; Begg, Drummond

2012-03-01

Clinical skill assessment (CSA) has been an integral part of the Royal College of General Practitioners' membership examination (MRCGP) since 2008. It is an expensive, high-stakes examination with first time pass rates ranging from 76.4 to 81.3. In this paper we describe the South East Scotland Deanery, NHS Education Scotland, pilot of a formative clinical skills assessment (fCSA) using the principles of formative assessment and OSCE. The purpose of the study was to assess the acceptability of the fCSA and to examine whether trainees, identified during the fCSA as 'at risk of failing the MRCGP CSA exam', are more likely to fail the MRCGP CSA exam later on in the year. Trainees were assessed in four clinical skills stations under exam conditions. After each station they were given verbal feedback and subsequently both trainee and their trainer received written feedback. We assessed the value of the exercise through written feedback from trainees and trainers. Each trainee's performance in fCSA was triangulated with trainer assessment to identify 'flagged trainees'. We compared flagged and non-flagged trainees' performance in MRCGP CSA. Both trainees and trainers highly rated the fCSA. Overall 97% of non-flagged trainees have passed the RCGP CSA exam by May of that year in comparison to 80% of flagged trainees who have passed the RCGP CSA (P = 0.005). Trainers and trainees rated the fCSA as excellent and useful. We were able to demonstrate that the fCSA can be used to identify those trainees likely to fail the RCGP CSA. Contrary to reservations about the potential to demoralise trainees, the fCSA was viewed as a useful and a positive experience by both trainees and trainers. In addition, we suggest that feedback from fCSA was useful in triggering appropriate educational interventions. Early intervention with trainees who are predicted to fail the CSA has the potential to reduce deaneries overall fail rate. Preventing one trainee failure could save over £30 000.

The effect of student self-video of performance on clinical skill competency: a randomised controlled trial.

Science.gov (United States)

Maloney, Stephen; Storr, Michael; Morgan, Prue; Ilic, Dragan

2013-03-01

Emerging technologies and student information technology literacy are enabling new methods of teaching and learning for clinical skill performance. Facilitating experiential practice and reflection on performance through student self-video, and exposure to peer benchmarks, may promote greater levels of skill competency. This study examines the impact of student self-video on the attainment of clinical skills. A total of 60 Physiotherapy students (100%) consented to participate in the randomised controlled trial. One group (50%) was taught a complex clinical skill with regular practical tutoring, whilst the other group (50%) supplemented the tutoring with a self-video task aimed at promoting reflection on performance. Student skill performance was measured in an objective structured clinical examination (OSCE). Students also completed an anonymous questionnaire, which explored their perception of their learning experiences. Students received significantly higher scores in the OSCE when the examined clinical skill had been supplemented with a self-video of performance task (P = 0.048). Descriptive analysis of the questionnaires relating to student perceptions on the teaching methods identified that the self-video of performance task utilised contributed to improvement in their clinical performance and their confidence for future clinical practice. Students identified a number of aspects of the submission process that contributed to this perception of educational value. The novel results of this study demonstrate that greater clinical skill competency is achieved when traditional tutoring methods are supplemented with student self-video of performance tasks. Additional benefits included the ability of staff and students to monitor longitudinal performance, and an increase in feedback opportunities.

Clinical Skills Performed By Iranian Emergency Nurses: Perceived Competency Levels and Attitudes Toward Expanding Professional Roles.

Science.gov (United States)

Hassankhani, Hadi; Hasanzadeh, Firooz; Powers, Kelly A; Dadash Zadeh, Abbas; Rajaie, Rouzbeh

2018-03-01

Emergency nurses play an important role in the care of critically ill and injured patients, and their competency to perform clinical skills is vital to safe and effective patient care. The aim of this study was to evaluate the frequency of clinical skills performed and perceived competency levels among Iranian emergency nurses. In addition, attitudes toward expanding the professional roles of Iranian emergency nurses were also assessed. In this descriptive correlational study, 319 emergency nurses from 30 hospitals in northwest Iran participated. Data were collected using a self-report questionnaire. Descriptive statistics and Pearson's correlation coefficient were used to present the findings. Overall competency of the emergency nurses was 73.31 ± 14.2, indicating a good level of perceived competence. The clinical skills most frequently performed were in the domains of organizational and workload competencies (3.43 ± 0.76), diagnostic function (3.25 ± 0.82), and the helping role (3.17 ± 0.83). A higher level of perceived competence was found for skills within these domains. Less frequently, participants performed skills within the domains of effective management of rapidly changing situations (2.70 ± 0.94) and administering and monitoring therapeutic interventions (2.60 ± 0.97); a lower perceived level of competence was noted for these clinical skills. There was a significant correlation between frequency of performing clinical skills and perceived competency level (r = 0.651, P skills. This has implications for nurse managers and educators who may consider offering more frequent experiential and educational opportunities to emergency nurses. Expansion of nurses' roles could also result in increased experience in clinical skills and higher levels of competency. Research is needed to investigate nurses' clinical competence using direct and observed measures. Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

Teaching perceptual skills in clinical diagnostics using digital media

NARCIS (Netherlands)

Scheiter, Katharina; Jarodzka, Halszka

2011-01-01

Scheiter, K., & Jarodzka, H. (2011, May). Teaching perceptual skills in clinical diagnostics using digital media. Presentation at the 2nd International Conference “Research in Medical Education”: Shaping diamonds from bench to bedside, Universität Tübingen.

Impact of the site specialty of a continuity practice on students' clinical skills: performance with standardized patients.

Science.gov (United States)

Pfeiffer, Carol A; Palley, Jane E; Harrington, Karen L

2010-07-01

The assessment of clinical competence and the impact of training in ambulatory settings are two issues of importance in the evaluation of medical student performance. This study compares the clinical skills performance of students placed in three types of community preceptors' offices (pediatrics, medicine, family medicine) on yearly clinical skills assessments with standardized patients. Our goal was to see if the site specialty impacted on clinical performance. The students in the study were completing a 3-year continuity preceptorship at a site representing one of the disciplines. Their performance on the four clinical skills assessments was compared. There was no significant difference in history taking, physical exam, communication, or clinical reasoning in any year (ANOVA p< or = .05) There was a small but significant difference in performance on a measure of interpersonal and interviewing skills during Years 1 and 2. The site specialty of an early clinical experience does not have a significant impact on performance of most of the skills measured by the assessments.

Capacity-building in clinical skills of rehabilitation workforce in low- and middle-income countries

Directory of Open Access Journals (Sweden)

Fary Khan

2018-02-01

Full Text Available Objective: Despite the prevalence of disability in low-and middle-income countries, the clinical skills of the rehabilitation workforce are not well described. We report health professionals’ perspectives on clinical skills in austere settings and identify context-specific gaps in workforce capacity. Methods: A cross-sectional pilot survey (Pakistan, Morocco, Nigeria, Malaysia of health professionals’ working in rehabilitation in hospital and community settings. A situational-analysis survey captured assessment of clinical skills required in various rehabilitation settings. Responses were coded in a line-by-line process, and linked to categories in domains of the International Classification of Functioning, Disability and Health (ICF. Results: Respondents (n = 532 from Pakistan 248, Nigeria 159, Morocco 93 and Malaysia 32 included the following: physiotherapists (52.8%, nurses (8.8%, speech (5.3% and occupational therapists (8.5%, rehabilitation physicians (3.8%, other doctors (5.5% and prosthetist/orthotists (1.5%. The 10 commonly used clinical skills reported were prescription of: physical activity, medications, transfer-techniques, daily-living activities, patient/carer education, diagnosis/screening, behaviour/cognitive interventions, comprehensive patient-care, referrals, assessments and collaboration. There was significant overlap in skills listed irrespective of profession. Most responses linked with ICF categories in activities/participation and personal factors. Conclusion: The core skills identified reflect general rehabilitation practice and a task-shifting approach, to address shortages of health workers in low-and middle-income countries.

Tracing the evolution of chiropractic students’ confidence in clinical and patient communication skills during a clinical internship: a multi-methods study

Science.gov (United States)

2012-01-01

Background Anecdotal evidence points to variations in individual students’ evolving confidence in clinical and patient communication skills during a clinical internship. A better understanding of the specific aspects of internships that contribute to increasing or decreasing confidence is needed to best support students during the clinical component of their study. Methods A multi-method approach, combining two large-scale surveys with 269 students and three in-depth individual interviews with a sub-sample of 29 students, was used to investigate the evolution of change in student confidence during a 10-month long internship. Change in levels of confidence in patient communication and clinical skills was measured and relationship to demographic factors were explored. The interviews elicited students’ accounts and reflections on what affected the evolution of their confidence during the internship. Results At the start of their internship, students were more confident in their patient communication skills than their clinical skills but prior experience was significantly related to confidence in both. Initial confidence in patient communication skills was also related to age and prior qualification but not gender whilst confidence in clinical skills was related to gender but not age or prior qualification. These influences were maintained over time. Overall, students’ levels of confidence in patient communication and clinical skills confidence increased significantly over the duration of the internship with evidence that change over time in these two aspects were inter-related. To explore how specific aspects of the internship contributed to changing levels of confidence, two extreme sub-groups of interviewees were identified, those with the least increase and those with the highest increase in professional confidence over time. A number of key factors affecting the development of confidence were identified, including among others, interactions with clinicians

Tracing the evolution of chiropractic students' confidence in clinical and patient communication skills during a clinical internship: a multi-methods study.

Science.gov (United States)

Hecimovich, Mark; Volet, Simone

2012-06-19

Anecdotal evidence points to variations in individual students' evolving confidence in clinical and patient communication skills during a clinical internship. A better understanding of the specific aspects of internships that contribute to increasing or decreasing confidence is needed to best support students during the clinical component of their study. A multi-method approach, combining two large-scale surveys with 269 students and three in-depth individual interviews with a sub-sample of 29 students, was used to investigate the evolution of change in student confidence during a 10-month long internship. Change in levels of confidence in patient communication and clinical skills was measured and relationship to demographic factors were explored. The interviews elicited students' accounts and reflections on what affected the evolution of their confidence during the internship. At the start of their internship, students were more confident in their patient communication skills than their clinical skills but prior experience was significantly related to confidence in both. Initial confidence in patient communication skills was also related to age and prior qualification but not gender whilst confidence in clinical skills was related to gender but not age or prior qualification. These influences were maintained over time. Overall, students' levels of confidence in patient communication and clinical skills confidence increased significantly over the duration of the internship with evidence that change over time in these two aspects were inter-related. To explore how specific aspects of the internship contributed to changing levels of confidence, two extreme sub-groups of interviewees were identified, those with the least increase and those with the highest increase in professional confidence over time. A number of key factors affecting the development of confidence were identified, including among others, interactions with clinicians and patients, personal agency and

A digital peer-to-peer learning platform for clinical skills development.

Science.gov (United States)

Basnak, Jesse; Ortynski, Jennifer; Chow, Meghan; Nzekwu, Emeka

2017-02-01

Due to constraints in time and resources, medical curricula may not provide adequate opportunities for pre-clerkship students to practice clinical skills. To address this, medical students at the University of Alberta developed a digital peer-to-peer learning initiative. The initiative assessed if students can learn clinical skills from their peers in co-curricular practice objective structured clinical exams (OSCEs). A total of 144 first-year medical students participated. Students wrote case scenarios that were reviewed by physicians. Students enacted the cases in practice OSCEs, acting as the patient, physician, and evaluator. Verbal and electronic evaluations were completed. A digital platform was used to automate the process. Surveys were disseminated to assess student perceptions of their experience. Seventy-five percent of participants said they needed opportunities to practice patient histories and physical exams in addition to those provided in the medical school curriculum. All participants agreed that the co-curricular practice OSCEs met this need. The majority of participants also agreed that the digital platform was efficient and easy to use. Students found the practice OSCEs and digital platform effective for learning clinical skills. Thus, peer-to-peer learning and computer automation can be useful adjuncts to traditional medical curricula.

Perceived versus actual condom skills among clients at sexually transmitted disease clinics.

OpenAIRE

Langer, L M; Zimmerman, R S; Cabral, R J

1994-01-01

The primary aim of this study was to investigate whether individual self-reports of perceived ability to use a condom correctly correlated with the actual ability to do so. Participants in the study were 3,059 clients of a sexually transmitted disease clinic. The findings revealed that the participants' perceived self-efficacy with regard to using a condom effectively was a poor indicator of their clinically demonstrated skills using a penile model as scored on the 6-point Condom Skills Index...

Digital stethoscope as an innovative tool on the teaching of auscultatory skills.

Science.gov (United States)

Mesquita, Claudio Tinoco; Reis, Jader Costa dos; Simões, Luciana Silveira; Moura, Eduardo Cardoso de; Rodrigues, Gustavo Amarante; Athayde, Carolina Cunto de; Machado, Hugo Lima; Lanzieri, Pedro Gemal

2013-02-01

Physical cardiovascular examination, particularly cardiac auscultation, is one of the most difficult clinical skills for students during their medical training. Studies suggest that the use of technologies such as digital stethoscope increase the accuracy of clinical examination, however, its impact on the teaching of cardiac auscultation for undergraduate students of medicine is not known. The objective is to demonstrate the usefulness of the digital stethoscope compared to traditional methods as a tool in the teaching of auscultatory skills. nterventional, longitudinal, controlled, unicenter and randomized study. Thirty-eight medicine students were enrolled for a cardiovascular semiology course lasting eight weeks. The course program included lectures and bedside practice in Cardiology wards. In the practical lessons, the students were randomized into two groups: 1) (n = 21) digital stethoscope (Littmann® Model 3200, 3M); and 2) (n = 17) conventional stethoscopes. A pre-training evaluation was conducted through a test using the software Heart Sounds®, which was repeated after the course. The average scores were compared by paired T test and unpaired T test. It is observed that, at the end of the course, there was a significantly greater improvement in the group that used the digital stethoscope (51.9%) compared to the group using the conventional stethoscope (29.5%). Short-term interventions for cardiac semiology teaching are able to contribute significantly to improving proficiency in the identification of heart sounds. The use of digital stethoscope proved to be a positive factor in teaching these skills.

Musical aptitude and second language pronunciation skills in school-aged children: neural and behavioral evidence.

Science.gov (United States)

Milovanov, Riia; Huotilainen, Minna; Välimäki, Vesa; Esquef, Paulo A A; Tervaniemi, Mari

2008-02-15

The main focus of this study was to examine the relationship between musical aptitude and second language pronunciation skills. We investigated whether children with superior performance in foreign language production represent musical sound features more readily in the preattentive level of neural processing compared with children with less-advanced production skills. Sound processing accuracy was examined in elementary school children by means of event-related potential (ERP) recordings and behavioral measures. Children with good linguistic skills had better musical skills as measured by the Seashore musicality test than children with less accurate linguistic skills. The ERP data accompany the results of the behavioral tests: children with good linguistic skills showed more pronounced sound-change evoked activation with the music stimuli than children with less accurate linguistic skills. Taken together, the results imply that musical and linguistic skills could partly be based on shared neural mechanisms.

Developing a Reference of Normal Lung Sounds in Healthy Peruvian Children

Science.gov (United States)

Ellington, Laura E.; Emmanouilidou, Dimitra; Elhilali, Mounya; Gilman, Robert H.; Tielsch, James M.; Chavez, Miguel A.; Marin-Concha, Julio; Figueroa, Dante; West, James

2018-01-01

Purpose Lung auscultation has long been a standard of care for the diagnosis of respiratory diseases. Recent advances in electronic auscultation and signal processing have yet to find clinical acceptance; however, computerized lung sound analysis may be ideal for pediatric populations in settings, where skilled healthcare providers are commonly unavailable. We described features of normal lung sounds in young children using a novel signal processing approach to lay a foundation for identifying pathologic respiratory sounds. Methods 186 healthy children with normal pulmonary exams and without respiratory complaints were enrolled at a tertiary care hospital in Lima, Peru. Lung sounds were recorded at eight thoracic sites using a digital stethoscope. 151 (81 %) of the recordings were eligible for further analysis. Heavy-crying segments were automatically rejected and features extracted from spectral and temporal signal representations contributed to profiling of lung sounds. Results Mean age, height, and weight among study participants were 2.2 years (SD 1.4), 84.7 cm (SD 13.2), and 12.0 kg (SD 3.6), respectively; and, 47 % were boys. We identified ten distinct spectral and spectro-temporal signal parameters and most demonstrated linear relationships with age, height, and weight, while no differences with genders were noted. Older children had a faster decaying spectrum than younger ones. Features like spectral peak width, lower-frequency Mel-frequency cepstral coefficients, and spectro-temporal modulations also showed variations with recording site. Conclusions Lung sound extracted features varied significantly with child characteristics and lung site. A comparison with adult studies revealed differences in the extracted features for children. While sound-reduction techniques will improve analysis, we offer a novel, reproducible tool for sound analysis in real-world environments. PMID:24943262

Impact of Facilitated Asynchronous Distance Education on Clinical Skills Development of International Pharmacy Graduates

Science.gov (United States)

Austin, Zubin; Dean, Marie Rocchi

2006-01-01

The use of distance education for clinical skills development in the health professions has not been extensively described, due in part to the intensive nature of the relationship between the patient and practitioner. In the context of pharmacy practice, there are specific needs to develop new vehicles for clinical skills education due to growing…

Objective Structured Clinical Examination as an Assessment Tool for Clinical Skills in Dermatology.

Science.gov (United States)

Saceda-Corralo, D; Fonda-Pascual, P; Moreno-Arrones, Ó M; Alegre-Sánchez, A; Hermosa-Gelbard, Á; Jiménez-Gómez, N; Vañó-Galván, S; Jaén-Olasolo, P

2017-04-01

Objective Structured Clinical Evaluation (OSCE) is an excellent method to evaluate student's abilities, but there are no previous reports implementing it in dermatology. To determine the feasibility of implementation of a dermatology OSCE in the medical school. Five stations with standardized patients and image-based assessment were designed. A specific checklist was elaborated in each station with different items which evaluated one competency and were classified into five groups (medical history, physical examination, technical skills, case management and prevention). A total of 28 students were tested. Twenty-five of them (83.3%) passed the exam globally. Concerning each group of items tested: medical interrogation had a mean score of 71.0; physical examination had a mean score of 63.0; management had a mean score of 58.0; and prevention had a mean score of 58.0 points. The highest results were obtained in interpersonal skills items with 91.8 points. Testing a small sample of voluntary students may hinder generalization of our study. OSCE is an useful tool for assessing clinical skills in dermatology and it is possible to carry it out. Our experience enhances that medical school curriculum needs to establish OSCE as an assessment tool in dermatology. Copyright © 2016 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.

Sound as a supportive design intervention for improving health care experience in the clinical ecosystem: A qualitative study.

Science.gov (United States)

Iyendo, Timothy Onosahwo

2017-11-01

Most prior hospital noise research usually deals with sound in its noise facet and is based merely on sound level abatement, rather than as an informative or orientational element. This paper stimulates scientific research into the effect of sound interventions on physical and mental health care in the clinical environment. Data sources comprised relevant World Health Organization guidelines and the results of a literature search of ISI Web of Science, ProQuest Central, MEDLINE, PubMed, Scopus, JSTOR and Google Scholar. Noise induces stress and impedes the recovery process. Pleasant natural sound intervention which includes singing birds, gentle wind and ocean waves, revealed benefits that contribute to perceived restoration of attention and stress recovery in patients and staff. Clinicians should consider pleasant natural sounds perception as a low-risk non-pharmacological and unobtrusive intervention that should be implemented in their routine care for speedier recovery of patients undergoing medical procedures. Copyright © 2017 Elsevier Ltd. All rights reserved.

Using a Multimedia Tool to Improve Cardiac Auscultation Knowledge and Skills

Science.gov (United States)

Stern, David T; Mangrulkar, Rajesh S; Gruppen, Larry D; Lang, Angela L; Grum, Cyril M; Judge, Richard D

2001-01-01

OBJECTIVE Today's medical school graduates have significant deficits in physical examination skills. Medical educators have been searching for methods to effectively teach and maintain these skills in students. The objective of this study was to determine if an auscultation curriculum centered on a portable multimedia CD-ROM was effective in producing and maintaining significant gains in cardiac auscultatory skills. DESIGN Controlled cohort study PARTICIPANTS All 168 third-year medical students at 1 medical school in an academic medical center. INTERVENTIONS Students were tested before and after exposure to 1 or more elements of the auscultation curriculum: teaching on ward/clinic rotations, CD-ROM comprehensive cases with follow-up seminars, and a CD-ROM 20-case miniseries. The primary outcome measures were student performance on a 10-item test of auscultation skill (listening and identifying heart sound characteristics) and a 30-item test of auscultation knowledge (factual questions about auscultation). A subset of students was tested for attenuation effects 9 or 12 months after the intervention. RESULTS Compared with the control group (1 month clinical rotation alone), students who were also exposed to the CD-ROM 20-case miniseries had significant improvements in auscultation skills scores (P auscultation knowledge beyond the miniseries alone (P auscultation skills. Students' auscultation knowledge diminished one year after the intervention, but auscultation skills did not. CONCLUSION In addition to the standard curriculum of ward and conference teaching, portable multimedia tools may help improve quality of physical examination skills. PMID:11722691

Skills in clinical communication: Are we correctly assessing them at undergraduate level?

Directory of Open Access Journals (Sweden)

Alberto Zamora Cervantes

2014-07-01

Full Text Available Communicating with the patient in clinical practice refers to the way in which the doctor and the patient interact both verbally and nonverbally, in order to achieve a shared understanding of problems and solutions. Traditional learning and assessment systems are overwhelmed when it comes to addressing the complex and multi-dimensional problems of professional practice. Problem Based Learning (PBL has been put forward as an alternative to the mere reproduction of knowledge and pre-established patterns, enabling students to develop their own learning strategies to overcome problems in their future professional practice. The challenge is to determine how to assess the acquisition of clinical communication skills. The authors have recommended a summative assessment of clinical communication skills based on the combination of different methods. It highlights the importance of feedback-based formative assessment. This raises the need to develop and validate assessment scales in clinical communication at an undergraduate level. Based on this work, the authors put forward a "fanned out" assessment in terms of clinical communication skills in Medicine degrees, with the use of different instruments in a "spiraled" manner, where the greater the contact with clinical practice in the various degree and integral courses, the greater difficulty experienced, with the participation of all the stakeholders involved (self, hetero and peer assessment without precluding the involvement of patients (real or simulated in the design of assessment instruments.

SoleSound

DEFF Research Database (Denmark)

Zanotto, Damiano; Turchet, Luca; Boggs, Emily Marie

2014-01-01

This paper introduces the design of SoleSound, a wearable system designed to deliver ecological, audio-tactile, underfoot feedback. The device, which primarily targets clinical applications, uses an audio-tactile footstep synthesis engine informed by the readings of pressure and inertial sensors...... embedded in the footwear to integrate enhanced feedback modalities into the authors' previously developed instrumented footwear. The synthesis models currently implemented in the SoleSound simulate different ground surface interactions. Unlike similar devices, the system presented here is fully portable...

Utilizing visual art to enhance the clinical observation skills of medical students.

Science.gov (United States)

Jasani, Sona K; Saks, Norma S

2013-07-01

Clinical observation is fundamental in practicing medicine, but these skills are rarely taught. Currently no evidence-based exercises/courses exist for medical student training in observation skills. The goal was to develop and teach a visual arts-based exercise for medical students, and to evaluate its usefulness in enhancing observation skills in clinical diagnosis. A pre- and posttest and evaluation survey were developed for a three-hour exercise presented to medical students just before starting clerkships. Students were provided with questions to guide discussion of both representational and non-representational works of art. Quantitative analysis revealed that the mean number of observations between pre- and posttests was not significantly different (n=70: 8.63 vs. 9.13, p=0.22). Qualitative analysis of written responses identified four themes: (1) use of subjective terminology, (2) scope of interpretations, (3) speculative thinking, and (4) use of visual analogies. Evaluative comments indicated that students felt the exercise enhanced both mindfulness and skills. Using visual art images with guided questions can train medical students in observation skills. This exercise can be replicated without specially trained personnel or art museum partnerships.

Developing students' time management skills in clinical settings: practical considerations for busy nursing staff.

Science.gov (United States)

Cleary, Michelle; Horsfall, Jan

2011-06-01

In clinical settings, nursing staff often find themselves responsible for students who have varying time management skills. Nurses need to respond sensitively and appropriately, and to teach nursing students how to prioritize and better allocate time. This is important not only for developing students' clinical skills but also for shaping their perceptions about the quality of the placement and their willingness to consider it as a potential work specialty. In this column, some simple, practical strategies that nurses can use to assist students with improving their time management skills are identified. Copyright 2011, SLACK Incorporated.

Exploring the use of mobile technologies for the acquisition of clinical skills.

Science.gov (United States)

Clay, Collette A

2011-08-01

Mobile learning has the potential to supplement information communication technology (ICT), online learning and the traditional teaching and learning methods to educate practitioners in the clinical practice area. Following the development of several Post Graduate modules of learning for the theory and clinical skills required to undertake the Newborn Infant Physical Examination (NIPE), a small research study was undertaken to combine mobile learning and NIPE. The research study explored the hypothesis that mobile devices could be used in pedagogically effective ways to support and enhance the learning and acquisition of clinical skills in the clinical arena. Participants in the study each received a handheld mobile device (iPod) that had been loaded with several Reusable Learning Objects (RLO) outlining each aspect of the physical examination to be performed. At the end of the module (12 weeks in duration), each participant completed an evaluation questionnaire. Participants confirmed that mobile learning afforded flexibility in time and place of learning and captured their interest in the learning material. This study reports that the use of mobile technology for skill acquisition is creative and innovative, placing learning firmly in the hands of the learner. Copyright © 2010 Elsevier Ltd. All rights reserved.

[Assessment of clinical observation skills of last year medical students].

Science.gov (United States)

Steichen, O; Georgin-Lavialle, S; Grateau, G; Ranque, B

2015-05-01

Clinical examination skills are poorly evaluated by theoretical tests. We observed the clinical examination of real patients by 6th year medical students. Four internists involved in teaching activities defined 11 clinical examination items, with two objective performance criteria each. The students were evaluated in two internal medicine departments during the rotation preceding or following their national graduation test. Scores by item and by criterion and an overall score were calculated and correlated with their rank at the national graduation test. Thirty-two students were evaluated in one department and 18 in the other; each evaluation lasted approximately 30 minutes. The results were similar in both departments. Only 2 items got a score over 75% in this students' sample (acute respiratory failure, peripheral pulses); 4 items were satisfied at less than 50% (lymph nodes, right heart failure, liver failure, and attention). The mean overall score was 6.5/11 (standard deviation 1.5). National rankings were good (median 1605/8001, interquartile 453-3036) but uncorrelated with the global score (Spearman coefficient -0.13; P=0.39). Bedside evaluation of the students reveals substantial deficiencies, a few months or weeks before taking their position as residents. Several elementary skills are mastered by a minority of them (search for an asterixis, distended jugular veins, deep tendon reflexes), even among those successful at the national graduation test. Bedside evaluation of clinical examination skills should be more systematically performed. Copyright © 2014 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

Development of a tool to support holistic generic assessment of clinical procedure skills.

Science.gov (United States)

McKinley, Robert K; Strand, Janice; Gray, Tracey; Schuwirth, Lambert; Alun-Jones, Tom; Miller, Helen

2008-06-01

The challenges of maintaining comprehensive banks of valid checklists make context-specific checklists for assessment of clinical procedural skills problematic. This paper reports the development of a tool which supports generic holistic assessment of clinical procedural skills. We carried out a literature review, focus groups and non-participant observation of assessments with interview of participants, participant evaluation of a pilot objective structured clinical examination (OSCE), a national modified Delphi study with prior definitions of consensus and an OSCE. Participants were volunteers from a large acute teaching trust, a teaching primary care trust and a national sample of National Health Service staff. Results In total, 86 students, trainees and staff took part in the focus groups, observation of assessments and pilot OSCE, 252 in the Delphi study and 46 candidates and 50 assessors in the final OSCE. We developed a prototype tool with 5 broad categories amongst which were distributed 38 component competencies. There was > 70% agreement (our prior definition of consensus) at the first round of the Delphi study for inclusion of all categories and themes and no consensus for inclusion of additional categories or themes. Generalisability was 0.76. An OSCE based on the instrument has a predicted reliability of 0.79 with 12 stations and 1 assessor per station or 10 stations and 2 assessors per station. This clinical procedural skills assessment tool enables reliable assessment and has content and face validity for the assessment of clinical procedural skills. We have designated it the Leicester Clinical Procedure Assessment Tool (LCAT).

Qualified nurses' rate new nursing graduates as lacking skills in key clinical areas.

Science.gov (United States)

Missen, Karen; McKenna, Lisa; Beauchamp, Alison; Larkins, Jo-Ann

2016-08-01

The aim of this study was to explore perceptions of qualified nurses on the abilities of newly registered nursing graduates to perform a variety of clinical skills. Evidence from the literature suggests that undergraduate nursing programmes do not adequately prepare nursing students to be practice-ready on completion of their nursing courses. A descriptive quantitative design was used. Participants were recruited through the Australian Nursing and Midwifery Federation, Victorian branch. A brief explanation of the study and a link to the survey were promoted in their monthly e-newsletter. A total of 245 qualified nurses in the state of Victoria, Australia participated in this study. A survey tool of 51 clinical skills and open-ended questions was used, whereby participants were asked to rate new nursing graduates' abilities using a 5-point Likert scale. Overall participants rated new nursing graduates' abilities for undertaking clinical skills as good or very good in 35·3% of skills, 33·3% were rated as adequate and 31·4% rated as being performed poorly or very poorly. Of concern, essential clinical skills, such as critical thinking and problem solving, working independently and assessment procedures, were found to be poorly executed and affecting new registered nurses graduates' competence. The findings from this study can further serve as a reference for nursing education providers to enhance nursing curricula and work collaboratively with healthcare settings in preparing nurses to be competent, safe practitioners on completion of their studies. Identifying key areas in which new nursing graduates are not yet competent means that educational providers and educators from healthcare settings can focus on these skills in better preparing our nurses to be work ready. © 2016 John Wiley & Sons Ltd.

Standardized Patients Provide a Reliable Assessment of Athletic Training Students' Clinical Skills

Science.gov (United States)

Armstrong, Kirk J.; Jarriel, Amanda J.

2016-01-01

Context: Providing students reliable objective feedback regarding their clinical performance is of great value for ongoing clinical skill assessment. Since a standardized patient (SP) is trained to consistently portray the case, students can be assessed and receive immediate feedback within the same clinical encounter; however, no research, to our…

The speech perception skills of children with and without speech sound disorder.

Science.gov (United States)

Hearnshaw, Stephanie; Baker, Elise; Munro, Natalie

To investigate whether Australian-English speaking children with and without speech sound disorder (SSD) differ in their overall speech perception accuracy. Additionally, to investigate differences in the perception of specific phonemes and the association between speech perception and speech production skills. Twenty-five Australian-English speaking children aged 48-60 months participated in this study. The SSD group included 12 children and the typically developing (TD) group included 13 children. Children completed routine speech and language assessments in addition to an experimental Australian-English lexical and phonetic judgement task based on Rvachew's Speech Assessment and Interactive Learning System (SAILS) program (Rvachew, 2009). This task included eight words across four word-initial phonemes-/k, ɹ, ʃ, s/. Children with SSD showed significantly poorer perceptual accuracy on the lexical and phonetic judgement task compared with TD peers. The phonemes /ɹ/ and /s/ were most frequently perceived in error across both groups. Additionally, the phoneme /ɹ/ was most commonly produced in error. There was also a positive correlation between overall speech perception and speech production scores. Children with SSD perceived speech less accurately than their typically developing peers. The findings suggest that an Australian-English variation of a lexical and phonetic judgement task similar to the SAILS program is promising and worthy of a larger scale study. Copyright © 2017 Elsevier Inc. All rights reserved.

Instructional scaffolding to improve students' skills in evaluating clinical literature.

Science.gov (United States)

Dawn, Stefani; Dominguez, Karen D; Troutman, William G; Bond, Rucha; Cone, Catherine

2011-05-10

To implement and assess the effectiveness of an activity to teach pharmacy students to critically evaluate clinical literature using instructional scaffolding and a Clinical Trial Evaluation Rubric. The literature evaluation activity centered on a single clinical research article and involved individual, small group, and large group instruction, with carefully structured, evidence-based scaffolds and support materials centered around 3 educational themes: (1) the reader's awareness of text organization, (2) contextual/background information and vocabulary, and (3) questioning, prompting, and self-monitoring (metacognition). Students initially read the article, scored it using the rubric, and wrote an evaluation. Students then worked individually using a worksheet to identify and define 4 to 5 vocabulary/concept knowledge gaps. They then worked in small groups and as a class to further improve their skills. Finally, they assessed the same article using the rubric and writing a second evaluation. Students' rubric scores for the article decreased significantly from a mean pre-activity score of 76.7% to a post-activity score of 61.7%, indicating that their skills in identifying weaknesses in the article's study design had improved. Use of instructional scaffolding in the form of vocabulary supports and the Clinical Trial Evaluation Rubric improved students' ability to critically evaluate a clinical study compared to lecture-based coursework alone.

Medical education of attention: A qualitative study of learning to listen to sound.

Science.gov (United States)

Harris, Anna; Flynn, Eleanor

2017-01-01

There has been little qualitative research examining how physical examination skills are learned, particularly the sensory and subjective aspects of learning. The authors set out to study how medical students are taught and learn the skills of listening to sound. As part of an ethnographic study in Melbourne, 15 semi-structured in-depth interviews were conducted with students and teachers as a way to reflect explicitly on their learning and teaching. From these interviews, we found that learning the skills of listening to lung sounds was frequently difficult for students, with many experiencing awkwardness, uncertainty, pressure, and intimidation. However not everyone found this process difficult. Often those who had studied music reported finding it easier to be attentive to the frequency and rhythm of body sounds and find ways to describe them. By incorporating, distinctively in medical education, theoretical insights into "attentiveness" from anthropology and science and technology studies, the article suggests that musical education provides medical students with skills in sensory awareness. Training the senses is a critical aspect of diagnosis that needs to be better addressed in medical education. Practical approaches for improving students' education of attention are proposed.

A randomized controlled pilot trial comparing the impact of access to clinical endocrinology video demonstrations with access to usual revision resources on medical student performance of clinical endocrinology skills.

Science.gov (United States)

Hibbert, Emily J; Lambert, Tim; Carter, John N; Learoyd, Diana L; Twigg, Stephen; Clarke, Stephen

2013-10-03

Demonstrating competence in clinical skills is key to course completion for medical students. Methods of providing clinical instruction that foster immediate learning and potentially serve as longer-term repositories for on-demand revision, such as online videos demonstrating competent performance of clinical skills, are increasingly being used. However, their impact on learning has been little studied. The aim of this study was to determine the value of adjunctive on-demand video-based training for clinical skills acquisition by medical students in endocrinology. Following an endocrinology clinical tutorial program, 2nd year medical students in the pre-assessment revision period were recruited and randomized to either a set of bespoke on-line clinical skills training videos (TV), or to revision as usual (RAU). The skills demonstrated on video were history taking in diabetes mellitus (DMH), examination for diabetes lower limb complications (LLE), and examination for signs of thyroid disease (TE). Students were assessed on these clinical skills in an observed structured clinical examination two weeks after randomization. Assessors were blinded to student randomization status. For both diabetes related clinical skills assessment tasks, students in the TV group performed significantly better than those in the RAU group. There were no between group differences in thyroid examination performance. For the LLE, 91.7% (n = 11/12) of students randomized to the video were rated globally as competent at the skill compared with 40% (n = 4/10) of students not randomized to the video (p = 0.024). For the DMH, 83.3% (n = 10/12) of students randomized to the video were rated globally as competent at the skill compared with 20% (n = 2/10) of students not randomized to the video (p = 0.007). Exposure to high quality videos demonstrating clinical skills can significantly improve medical student skill performance in an observed structured clinical examination of these skills, when

Building consensus on clinical procedural skills for South African ...

African Journals Online (AJOL)

Background: The development of registrar training as part of the newly created speciality of family medicine in South Africa requires the development of a national consensus on the clinical procedural skills outcomes that should be expected of training programmes. Methods: This study utilized a Delphi technique to ...

Clinical program leadership: skill requirements for contemporary leaders.

Science.gov (United States)

Spallina, Joseph M

2002-01-01

With knowledge of these leadership requirements and a shrinking base of experienced managers, healthcare organizations and professional societies have little choice in their approach to prepare for the leadership development challenges of the future. Organizations will focus leadership development, training, and continuing management education on integrating business tools and skills into clinical program management. The management requirements for clinical programs will continue to grow in complexity and the number of qualified managers will continue to diminish, New approaches to solving this shortage will evolve. Professional, forprofit companies, healthcare provider organizations, and academic programs will develop clinical program management training tracks. Organizations that create solutions to this management imperative will maintain their competitive edge in the challenging times that will greet the industry in the future.

The outcomes and acceptability of near-peer teaching among medical students in clinical skills.

Science.gov (United States)

Khaw, Carole; Raw, Lynne

2016-06-12

To determine the outcomes and acceptability of final-year students tutoring in Clinical Skills to Years 1-2 students in a 4-week Medical Education elective. A paper-based survey with 14 questions requiring responses on a Likert-like scale and 2 questions with free-text responses was used to investigate Year 6 student-tutor (n=45) and Years 1-2 tutee (n=348) perceptions of near-peer teaching in Clinical Skills. The independent t-test compared mean responses from student-tutors and tutees, and thematic analysis of free-text responses was conducted. Tutee perceptions were significantly higher than student-tutor self-perceptions in small-group teaching and facilitation skills (p=0.000), teaching history-taking skills (p=0.046) and teaching physical examination skills (p=0.000). Perceptions in aspects of 'Confidence in tutoring' were not significantly different for student-tutors and tutees, with both having lowest perceptions for identifying and providing remediation for underperforming tutees. Student-tutors rated all areas of personal and professional development highly. Main themes emerging from analysis of student comments were the benefits to student-tutors, benefits to tutees and areas needing improvement, with outcomes of this near-peer teaching relating well to cognitive and social theories in the literature. Both student tutors and their tutees perceived near-peer teaching in Clinical Skills to be acceptable and beneficial with particular implications for Medical Education.

Curriculum content and assessment of pre-clinical dental skills: A survey of undergraduate dental education in Europe.

Science.gov (United States)

Field, J; Stone, S; Orsini, C; Hussain, A; Vital, S; Crothers, A; Walmsley, D

2018-05-01

Since 1981, the qualifications for various healthcare professionals across the European Union have enjoyed mutual recognition in accordance with the EU Directive 81/1057/EEC. Whilst the directive includes dental practitioners, it is recognised that significant variation exists in curriculum structure, content and scope of practice across institutions. This article aimed to explore pan-European practice in relation to curriculum content, teaching and learning strategies and assessment of pre-clinical dental skills. A request to complete an online questionnaire, in English, was sent electronically to skills leads at all Association of Dental Education in Europe member schools. The questionnaire collected information in relation to institution and country, regulatory requirements to demonstrate safety, details of specific pre-clinical skills courses, learning materials and teaching staff. Forty-eight institutions, from 25 European countries responded. Seven countries (n=7, 28%) reported no requirement to demonstrate student operative safety prior to patient treatment. Several core and operative clinical skills are common to the majority of institutions. The most commonly taught core skills related directly to the clinical environment such as cross-infection control and hand washing. The least common were skills that indirectly related to patient care, such as communication skills and working as a team. There are clear differences within European pre-clinical dental education, and greater efforts are needed to demonstrate that all European students are fit to practice before they start treating patients. Learning outcomes, teaching activities and assessment activities of pre-clinical skills should be shared collaboratively to further standardise curricula. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Improve your communication skills

CERN Document Server

Barker, Alan

2016-01-01

Excellent communication skills are vital in today's workplace. Whether keeping the interest of a large audience, impressing a potential employer or simply winning the argument at an important meeting, sounding the part is key. This fourth edition of Improve Your Communication Skills is full of practical advice on all aspects of verbal and non-verbal communication. It gives vital tips on improving conversations and building rapport with colleagues, learning the skills of persuasion, and writing effective emails, letters and reports. This editionincludes new information focusing on communicating across borders and virtual teams and a new chapter on managing difficult conversations."

Use of Authentic-Speech Technique for Teaching Sound Recognition to EFL Students

Science.gov (United States)

Sersen, William J.

2011-01-01

The main objective of this research was to test an authentic-speech technique for improving the sound-recognition skills of EFL (English as a foreign language) students at Roi-Et Rajabhat University. The secondary objective was to determine the correlation, if any, between students' self-evaluation of sound-recognition progress and the actual…

A digital peer-to-peer learning platform for clinical skills development.

Directory of Open Access Journals (Sweden)

Jesse Paul Basnak

2017-02-01

Conclusion: Students found the practice OSCEs and digital platform effective for learning clinical skills. Thus, peer-to-peer learning and computer automation can be useful adjuncts to traditional medical curricula.

The impact of case specificity and generalisable skills on clinical performance: a correlated traits-correlated methods approach.

Science.gov (United States)

Wimmers, Paul F; Fung, Cha-Chi

2008-06-01

The finding of case or content specificity in medical problem solving moved the focus of research away from generalisable skills towards the importance of content knowledge. However, controversy about the content dependency of clinical performance and the generalisability of skills remains. This study aimed to explore the relative impact of both perspectives (case specificity and generalisable skills) on different components (history taking, physical examination, communication) of clinical performance within and across cases. Data from a clinical performance examination (CPX) taken by 350 Year 3 students were used in a correlated traits-correlated methods (CTCM) approach using confirmatory factor analysis, whereby 'traits' refers to generalisable skills and 'methods' to individual cases. The baseline CTCM model was analysed and compared with four nested models using structural equation modelling techniques. The CPX consisted of three skills components and five cases. Comparison of the four different models with the least-restricted baseline CTCM model revealed that a model with uncorrelated generalisable skills factors and correlated case-specific knowledge factors represented the data best. The generalisable processes found in history taking, physical examination and communication were responsible for half the explained variance, in comparison with the variance related to case specificity. Conclusions Pure knowledge-based and pure skill-based perspectives on clinical performance both seem too one-dimensional and new evidence supports the idea that a substantial amount of variance contributes to both aspects of performance. It could be concluded that generalisable skills and specialised knowledge go hand in hand: both are essential aspects of clinical performance.

YouTube as a source of clinical skills education.

Science.gov (United States)

Duncan, Ian; Yarwood-Ross, Lee; Haigh, Carol

2013-12-01

YouTube may be viewed as a great 'time waster' but a significant amount of educative material can be found if the user is carefully selective. Interestingly, the growth of educational video on YouTube is closely associated to video viewership which increased from 22% to 38% between 2007 and 2009. This paper describes the findings of a study undertaken to assess the quality of clinical skills videos available on the video sharing site YouTube. This study evaluated 100 YouTube sites, approximately 1500 min or 25 h worth of content across 10 common clinical skill related topics. In consultation with novice practitioners, nurses in the first year of their university diploma programme, we identified ten common clinical skills that typically students would explore in more detail or would wish to revisit outside of the formal teaching environment. For each of these topics, we viewed each of the first 10 videos on the YouTube website. The videos were evaluated using a modification of the criteria outlined in Evaluation of Video Media Guideline. The topic with the biggest number of both postings and views was cardiopulmonary resuscitation and more specialist, nursing or health related topics such as managing a syringe driver or undertaking a pain assessment had less video content and lower numbers of viewers. Only one video out of the 100 analysed could be categorised as 'good' and that was the one in the Cannulation section. 60% of the CPR and venepuncture content was categorised as 'satisfactory'. There is a clear need for the quality of YouTube videos to be subjected to a rigorous evaluation. Lecturers should be more proactive in recommending suitable YouTube material as supplementary learning materials after appropriately checking for quality. Copyright © 2013 Elsevier Ltd. All rights reserved.

Influence of computerized sounding out on spelling performance for children who do and do not rely on AAC.

Science.gov (United States)

McCarthy, Jillian H; Hogan, Tiffany P; Beukelman, David R; Schwarz, Ilsa E

2015-05-01

Spelling is an important skill for individuals who rely on augmentative and alternative communication (AAC). The purpose of this study was to investigate how computerized sounding out influenced spelling accuracy of pseudo-words. Computerized sounding out was defined as a word elongated, thus providing an opportunity for a child to hear all the sounds in the word at a slower rate. Seven children with cerebral palsy, four who use AAC and three who do not, participated in a single subject AB design. The results of the study indicated that the use of computerized sounding out increased the phonologic accuracy of the pseudo-words produced by participants. The study provides preliminary evidence for the use of computerized sounding out during spelling tasks for children with cerebral palsy who do and do not use AAC. Future directions and clinical implications are discussed. We investigated how computerized sounding out influenced spelling accuracy of pseudowords for children with complex communication needs who did and did not use augmentative and alternative communication (AAC). Results indicated that the use of computerized sounding out increased the phonologic accuracy of the pseudo-words by participants, suggesting that computerized sounding out might assist in more accurate spelling for children who use AAC. Future research is needed to determine how language and reading abilities influence the use of computerized sounding out with children who have a range of speech intelligibility abilities and do and do not use AAC.

Should we use philosophy to teach clinical communication skills?

Science.gov (United States)

Gerber, Berna

2016-11-16

Effective communication between the doctor and patient is crucial for good quality health care. Yet, this form of communication is often problematic, which may lead to several negative consequences for both patients and doctors. Clinical communication skills have become important components of medical training programmes. The traditional approach is to teach students particular communication skills, such as listening to patients and asking open-ended questions. Despite their importance, such training approaches do not seem to be enough to deliver medical practitioners who are able and committed to communicate effectively with patients. This might be due to the pervasive negative influence of the medical profession's (mistaken) understanding of itself as a natural science on doctor-patient communication. Doctors who have been trained according to a positivist framework may consider their only responsibility to be the physical treatment of physical disorders. They may thus have little regard for the patient's psychological and social world and by extension for communication with the patient and/or their caregivers. To address this problem, I propose a curriculum, based on the academic field of philosophy, for teaching clinical communication.

Clinical skills-related learning goals of senior medical students after performance feedback.

Science.gov (United States)

Chang, Anna; Chou, Calvin L; Teherani, Arianne; Hauer, Karen E

2011-09-01

Lifelong learning is essential for doctors to maintain competence in clinical skills. With performance feedback, learners should be able to formulate specific and achievable learning goals in areas of need. We aimed to determine: (i) the type and specificity of medical student learning goals after a required clinical performance examination; (ii) differences in goal setting among low, average and high performers, and (iii) whether low performers articulate learning goals that are concordant with their learning needs. We conducted a single-site, multi-year, descriptive comparison study. Senior medical students were given performance benchmarks, individual feedback and guidelines on learning goals; each student was subsequently instructed to write two clinical skills learning goals. Investigators coded the learning goals for specificity, categorised the goals, and performed statistical analyses to determine their concordance with student performance level (low, average or high) in data gathering (history taking and physical examination) or communication skills. All 208 students each wrote two learning goals and most (n=200, 96%) wrote two specific learning goals. Nearly two-thirds of low performers in data gathering wrote at least one learning goal that referred to history taking or physical examination; one-third wrote learning goals pertaining to the organisation of the encounter. High performers in data gathering wrote significantly more patient education goals and significantly fewer history-taking goals than average or low performers. Only 50% of low performers in communication wrote learning goals related to communication skills. Low performers in communication were significantly more likely than average or high performers to identify learning goals related to improving performance in future examinations. The provision of performance benchmarking, individual feedback and brief written guidelines helped most senior medical students in our study to write specific

Technology-based strategies for promoting clinical reasoning skills in nursing education.

Science.gov (United States)

Shellenbarger, Teresa; Robb, Meigan

2015-01-01

Faculty face the demand of preparing nursing students for the constantly changing health care environment. Effective use of online, classroom, and clinical conferencing opportunities helps to enhance nursing students' clinical reasoning capabilities needed for practice. The growth of technology creates an avenue for faculty to develop engaging learning opportunities. This article presents technology-based strategies such as electronic concept mapping, electronic case histories, and digital storytelling that can be used to facilitate clinical reasoning skills.

Sound and sound sources

DEFF Research Database (Denmark)

Larsen, Ole Næsbye; Wahlberg, Magnus

2017-01-01

There is no difference in principle between the infrasonic and ultrasonic sounds, which are inaudible to humans (or other animals) and the sounds that we can hear. In all cases, sound is a wave of pressure and particle oscillations propagating through an elastic medium, such as air. This chapter...... is about the physical laws that govern how animals produce sound signals and how physical principles determine the signals’ frequency content and sound level, the nature of the sound field (sound pressure versus particle vibrations) as well as directional properties of the emitted signal. Many...... of these properties are dictated by simple physical relationships between the size of the sound emitter and the wavelength of emitted sound. The wavelengths of the signals need to be sufficiently short in relation to the size of the emitter to allow for the efficient production of propagating sound pressure waves...

Sound therapies for tinnitus management.

Science.gov (United States)

Jastreboff, Margaret M

2007-01-01

Many people with bothersome (suffering) tinnitus notice that their tinnitus changes in different acoustical surroundings, it is more intrusive in silence and less profound in the sound enriched environments. This observation led to the development of treatment methods for tinnitus utilizing sound. Many of these methods are still under investigation in respect to their specific protocol and effectiveness and only some have been objectively evaluated in clinical trials. This chapter will review therapies for tinnitus using sound stimulation.

Faculty Development for Fostering Clinical Reasoning Skills in Early Medical Students Using a Modified Bayesian Approach.

Science.gov (United States)

Addy, Tracie Marcella; Hafler, Janet; Galerneau, France

2016-01-01

Clinical reasoning is a necessary skill for medical students to acquire in the course of their education, and there is evidence that they can start this process at the undergraduate level. However, physician educators who are experts in their given fields may have difficulty conveying their complex thought processes to students. Providing faculty development that equips educators with tools to teach clinical reasoning may support skill development in early medical students. We provided faculty development on a modified Bayesian method of teaching clinical reasoning to clinician educators who facilitated small-group, case-based workshops with 2nd-year medical students. We interviewed them before and after the module regarding their perceptions on teaching clinical reasoning. We solicited feedback from the students about the effectiveness of the method in developing their clinical reasoning skills. We carried out this project during an institutional curriculum rebuild where clinical reasoning was a defined goal. At the time of the intervention, there was also increased involvement of the Teaching and Learning Center in elevating the status of teaching and learning. There was high overall satisfaction with the faculty development program. Both the faculty and the students described the modified Bayesian approach as effective in fostering the development of clinical reasoning skills. Through this work, we learned how to form a beneficial partnership between a clinician educator and Teaching and Learning Center to promote faculty development on a clinical reasoning teaching method for early medical students. We uncovered challenges faced by both faculty and early learners in this study. We observed that our faculty chose to utilize the method of teaching clinical reasoning in a variety of manners in the classroom. Despite obstacles and differing approaches utilized, we believe that this model can be emulated at other institutions to foster the development of clinical

Learning outcomes using video in supervision and peer feedback during clinical skills training

DEFF Research Database (Denmark)

Lauridsen, Henrik Hein; Toftgård, Rie Castella; Nørgaard, Cita

supervision of clinical skills (formative assessment). Demonstrations of these principles will be presented as video podcasts during the session. The learning outcomes of video supervision and peer-feedback were assessed in an online questionnaire survey. Results Results of the supervision showed large self......Objective New technology and learning principles were introduced in a clinical skills training laboratory (iLab). The intension was to move from apprenticeship to active learning principles including peer feedback and supervision using video. The objective of this study was to evaluate student...... learning outcomes in a manual skills training subject using video during feedback and supervision. Methods The iLab classroom was designed to fit four principles of teaching using video. Two of these principles were (a) group work using peer-feedback on videos produced by the students and, (b) video...

Nursing students' perceptions of factors influencing their learning environment in a clinical skills laboratory: A qualitative study.

Science.gov (United States)

Haraldseid, Cecilie; Friberg, Febe; Aase, Karina

2015-09-01

The mastery of clinical skills learning is required to become a trained nurse. Due to limited opportunities for clinical skills training in clinical practice, undergraduate training at clinical skills laboratories (CSLs) is an essential part of nursing education. In a sociocultural learning perspective learning is situated in an environment. Growing student cohorts, rapid introduction of technology-based teaching methods and a shift from a teaching- to a learning-centered education all influence the environment of the students. These changes also affect CSLs and therefore compel nursing faculties to adapt to the changing learning environment. This study aimed to explore students' perceptions of their learning environment in a clinical skills laboratory, and to increase the knowledge base for improving CSL learning conditions identifying the most important environmental factors according to the students. An exploratory qualitative methodology was used. Nineteen second-year students enrolled in an undergraduate nursing program in Norway participated in the study. They took the same clinical skills course. Eight were part-time students (group A) and 11 were full-time students (group B). Focus group interviews and content analysis were conducted to capture the students' perception of the CSL learning environment. The study documents students' experience of the physical (facilities, material equipment, learning tools, standard procedures), psychosocial (expectations, feedback, relations) and organizational (faculty resources, course structure) factors that affect the CSL learning environment. Creating an authentic environment, facilitating motivation, and providing resources for multiple methods and repetitions within clinical skills training are all important for improving CSL learning environments from the student perspective. Copyright © 2015 Elsevier Ltd. All rights reserved.

The role of musical aptitude and language skills in preattentive duration processing in school-aged children.

Science.gov (United States)

Milovanov, Riia; Huotilainen, Minna; Esquef, Paulo A A; Alku, Paavo; Välimäki, Vesa; Tervaniemi, Mari

2009-08-28

We examined 10-12-year old elementary school children's ability to preattentively process sound durations in music and speech stimuli. In total, 40 children had either advanced foreign language production skills and higher musical aptitude or less advanced results in both musicality and linguistic tests. Event-related potential (ERP) recordings of the mismatch negativity (MMN) show that the duration changes in musical sounds are more prominently and accurately processed than changes in speech sounds. Moreover, children with advanced pronunciation and musicality skills displayed enhanced MMNs to duration changes in both speech and musical sounds. Thus, our study provides further evidence for the claim that musical aptitude and linguistic skills are interconnected and the musical features of the stimuli could have a preponderant role in preattentive duration processing.

Statistical Analysis for Subjective and Objective Evaluations of Dental Drill Sounds.

Directory of Open Access Journals (Sweden)

Tomomi Yamada

Full Text Available The sound produced by a dental air turbine handpiece (dental drill can markedly influence the sound environment in a dental clinic. Indeed, many patients report that the sound of a dental drill elicits an unpleasant feeling. Although several manufacturers have attempted to reduce the sound pressure levels produced by dental drills during idling based on ISO 14457, the sound emitted by such drills under active drilling conditions may negatively influence the dental clinic sound environment. The physical metrics related to the unpleasant impressions associated with dental drill sounds have not been determined. In the present study, psychological measurements of dental drill sounds were conducted with the aim of facilitating improvement of the sound environment at dental clinics. Specifically, we examined the impressions elicited by the sounds of 12 types of dental drills in idling and drilling conditions using a semantic differential. The analysis revealed that the impressions of dental drill sounds varied considerably between idling and drilling conditions and among the examined drills. This finding suggests that measuring the sound of a dental drill in idling conditions alone may be insufficient for evaluating the effects of the sound. We related the results of the psychological evaluations to those of measurements of the physical metrics of equivalent continuous A-weighted sound pressure levels (LAeq and sharpness. Factor analysis indicated that impressions of the dental drill sounds consisted of two factors: "metallic and unpleasant" and "powerful". LAeq had a strong relationship with "powerful impression", calculated sharpness was positively related to "metallic impression", and "unpleasant impression" was predicted by the combination of both LAeq and calculated sharpness. The present analyses indicate that, in addition to a reduction in sound pressure level, refining the frequency components of dental drill sounds is important for creating a

Video-recorded simulated patient interactions: can they help develop clinical and communication skills in today's learning environment?

Science.gov (United States)

Seif, Gretchen A; Brown, Debora

2013-01-01

It is difficult to provide real-world learning experiences for students to master clinical and communication skills. The purpose of this paper is to describe a novel instructional method using self- and peer-assessment, reflection, and technology to help students develop effective interpersonal and clinical skills. The teaching method is described by the constructivist learning theory and incorporates the use of educational technology. The learning activities were incorporated into the pre-clinical didactic curriculum. The students participated in two video-recording assignments and performed self-assessments on each and had a peer-assessment on the second video-recording. The learning activity was evaluated through the self- and peer-assessments and an instructor-designed survey. This evaluation identified several themes related to the assignment, student performance, clinical behaviors and establishing rapport. Overall the students perceived that the learning activities assisted in the development of clinical and communication skills prior to direct patient care. The use of video recordings of a simulated history and examination is a unique learning activity for preclinical PT students in the development of clinical and communication skills.

Wiki Activities in Blended Learning for Health Professional Students: Enhancing Critical Thinking and Clinical Reasoning Skills

Science.gov (United States)

Snodgrass, Suzanne

2011-01-01

Health professionals use critical thinking, a key problem solving skill, for clinical reasoning which is defined as the use of knowledge and reflective inquiry to diagnose a clinical problem. Teaching these skills in traditional settings with growing class sizes is challenging, and students increasingly expect learning that is flexible and…

Conceptual Models and Guidelines for Clinical Assessment of Financial Capacity.

Science.gov (United States)

Marson, Daniel

2016-09-01

The ability to manage financial affairs is a life skill of critical importance, and neuropsychologists are increasingly asked to assess financial capacity across a variety of settings. Sound clinical assessment of financial capacity requires knowledge and appreciation of applicable clinical conceptual models and principles. However, the literature has presented relatively little conceptual guidance for clinicians concerning financial capacity and its assessment. This article seeks to address this gap. The article presents six clinical models of financial capacity : (1) the early gerontological IADL model of Lawton, (2) the clinical skills model and (3) related cognitive psychological model developed by Marson and colleagues, (4) a financial decision-making model adapting earlier decisional capacity work of Appelbaum and Grisso, (5) a person-centered model of financial decision-making developed by Lichtenberg and colleagues, and (6) a recent model of financial capacity in the real world developed through the Institute of Medicine. Accompanying presentation of the models is discussion of conceptual and practical perspectives they represent for clinician assessment. Based on the models, the article concludes by presenting a series of conceptually oriented guidelines for clinical assessment of financial capacity. In summary, sound assessment of financial capacity requires knowledge and appreciation of clinical conceptual models and principles. Awareness of such models, principles and guidelines will strengthen and advance clinical assessment of financial capacity. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Changes in communication skills of clinical residents through psychiatric training.

Science.gov (United States)

Yutani, Motoki; Takahashi, Megumi; Miyaoka, Hitoshi

2011-10-01

The objective of this study was to clarify whether the communication skills (CS) of clinical residents change before and after psychiatric training and, if so, what factors are related to the change. The 44 clinical residents who agreed to participate in this study were provided with an originally developed self-accomplished questionnaire survey on CS (communication skills questionnaire [CSQ]) and a generally used questionnaire on self-esteem, anxiety, and depressive mood considered to be related to CS at the start and end of a 2-month psychiatric training session. Statistical analysis was conducted for the 34 residents who completed both questionnaires. The CSQ score (t[32]: -2.17, P self-esteem and negatively with anxiety and depressive tendency. The amount of change in assertive CS score showed a weakly positive correlation with self-esteem. The results suggested that CS, including assertive CS and cooperative CS, were improved by the psychiatric training. Increasing self-esteem and reducing the tendency toward depression and anxiety are considered to be useful for further improving CS. © 2011 The Authors. Psychiatry and Clinical Neurosciences © 2011 Japanese Society of Psychiatry and Neurology.

Usefulness of bowel sound auscultation: a prospective evaluation.

Science.gov (United States)

Felder, Seth; Margel, David; Murrell, Zuri; Fleshner, Phillip

2014-01-01

Although the auscultation of bowel sounds is considered an essential component of an adequate physical examination, its clinical value remains largely unstudied and subjective. The aim of this study was to determine whether an accurate diagnosis of normal controls, mechanical small bowel obstruction (SBO), or postoperative ileus (POI) is possible based on bowel sound characteristics. Prospectively collected recordings of bowel sounds from patients with normal gastrointestinal motility, SBO diagnosed by computed tomography and confirmed at surgery, and POI diagnosed by clinical symptoms and a computed tomography without a transition point. Study clinicians were instructed to categorize the patient recording as normal, obstructed, ileus, or not sure. Using an electronic stethoscope, bowel sounds of healthy volunteers (n = 177), patients with SBO (n = 19), and patients with POI (n = 15) were recorded. A total of 10 recordings randomly selected from each category were replayed through speakers, with 15 of the recordings duplicated to surgical and internal medicine clinicians (n = 41) blinded to the clinical scenario. The sensitivity, positive predictive value, and intra-rater variability were determined based on the clinician's ability to properly categorize the bowel sound recording when blinded to additional clinical information. Secondary outcomes were the clinician's perceived level of expertise in interpreting bowel sounds. The overall sensitivity for normal, SBO, and POI recordings was 32%, 22%, and 22%, respectively. The positive predictive value of normal, SBO, and POI recordings was 23%, 28%, and 44%, respectively. Intra-rater reliability of duplicated recordings was 59%, 52%, and 53% for normal, SBO, and POI, respectively. No statistically significant differences were found between the surgical and internal medicine clinicians for sensitivity, positive predictive value, or intra-rater variability. Overall, 44% of clinicians reported that they rarely listened

The impacts of observing flawed and flawless demonstrations on clinical skill learning.

Science.gov (United States)

Domuracki, Kurt; Wong, Arthur; Olivieri, Lori; Grierson, Lawrence E M

2015-02-01

Clinical skills expertise can be advanced through accessible and cost-effective video-based observational practice activities. Previous findings suggest that the observation of performances of skills that include flaws can be beneficial to trainees. Observing the scope of variability within a skilled movement allows learners to develop strategies to manage the potential for and consequences associated with errors. This study tests this observational learning approach on the development of the skills of central line insertion (CLI). Medical trainees with no CLI experience (n = 39) were randomised to three observational practice groups: a group which viewed and assessed videos of an expert performing a CLI without any errors (F); a group which viewed and assessed videos that contained a mix of flawless and errorful performances (E), and a group which viewed the same videos as the E group but were also given information concerning the correctness of their assessments (FA). All participants interacted with their observational videos each day for 4 days. Following this period, participants returned to the laboratory and performed a simulation-based insertion, which was assessed using a standard checklist and a global rating scale for the skill. These ratings served as the dependent measures for analysis. The checklist analysis revealed no differences between observational learning groups (grand mean ± standard error: [20.3 ± 0.7]/25). However, the global rating analysis revealed a main effect of group (d.f.2,36 = 4.51, p = 0.018), which describes better CLI performance in the FA group, compared with the F and E groups. Observational practice that includes errors improves the global performance aspects of clinical skill learning as long as learners are given confirmation that what they are observing is errorful. These findings provide a refined perspective on the optimal organisation of skill education programmes that combine physical and observational practice

Promoting the self-regulation of clinical reasoning skills in nursing students.

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Kuiper, R; Pesut, D; Kautz, D

2009-10-02

The purpose of this paper is to describe the research surrounding the theories and models the authors united to describe the essential components of clinical reasoning in nursing practice education. The research was conducted with nursing students in health care settings through the application of teaching and learning strategies with the Self-Regulated Learning Model (SRL) and the Outcome-Present-State-Test (OPT) Model of Reflective Clinical Reasoning. Standardized nursing languages provided the content and clinical vocabulary for the clinical reasoning task. This descriptive study described the application of the OPT model of clinical reasoning, use of nursing language content, and reflective journals based on the SRL model with 66 undergraduate nursing students over an 8 month period of time. The study tested the idea that self-regulation of clinical reasoning skills can be developed using self-regulation theory and the OPT model. This research supports a framework for effective teaching and learning methods to promote and document learner progress in mastering clinical reasoning skills. Self-regulated Learning strategies coupled with the OPT model suggest benefits of self-observation and self-monitoring during clinical reasoning activities, and pinpoints where guidance is needed for the development of cognitive and metacognitive awareness. Thinking and reasoning about the complexities of patient care needs requires attention to the content, processes and outcomes that make a nursing care difference. These principles and concepts are valuable to clinical decision making for nurses globally as they deal with local, regional, national and international health care issues.

A Simulated Clinical Skills Scenario to Teach Interprofessional Teamwork to Health Profession Students

Directory of Open Access Journals (Sweden)

Eileen Adel Herge

2015-01-01

Full Text Available The Eastern Pennsylvania Delaware Geriatric Education Center developed an Interprofessional Clinical Skills Scenario (CSS to facilitate development of teamwork skills, specifically decision making, communication and collaboration, in health professions students in medicine, nursing, pharmacy, occupational and physical therapy programs. The case scenario provides students with the opportunity to practice communication and collaboration with a team and standardized patient and caregiver in a simulated clinical setting. The CSS was integrated into an existing occupational therapy course in 2011. Students were recruited by faculty from various schools (health professions, pharmacy, nursing, medicine throughout the university to participate in the CSS. The program evaluation included demographic assessment, process, and outcome measures. 166 students have participated in the CSS. Pre- and post-tests measured students' attitude toward healthcare teams. A Team Observation Tool was used by faculty and standardized patients/caregivers to evaluate student teams on communication, information sharing, and team interaction. A satisfaction survey was completed by the learners at the end of the CSS. This simulated Clinical Skills Scenario is a practical, interactive exercise that allows teams of interprofessional students to practice teamwork skills and patient-centered care with standardized patients and caregivers. Following a review of the learning activity and evaluation tools, the authors reflect on the effectiveness of the evaluation process for this CSS.

Exploring the Role and Skill Set of Physiotherapy Clinical Educators in Work-Integrated Learning

Science.gov (United States)

Edgar, Susan; Connaughton, Joanne

2014-01-01

Clinical educators are under increasing pressures in the workplace to provide quality education of healthcare students within varying supervision frameworks. Along with facilitating the teaching of clinical skills, clinical educators play a support role for students and so require more than expert clinical abilities in their vital position linking…

Concept Formation Skills in Long-Term Cochlear Implant Users

Science.gov (United States)

Castellanos, Irina; Kronenberger, William G.; Beer, Jessica; Colson, Bethany G.; Henning, Shirley C.; Ditmars, Allison; Pisoni, David B.

2015-01-01

This study investigated if a period of auditory sensory deprivation followed by degraded auditory input and related language delays affects visual concept formation skills in long-term prelingually deaf cochlear implant (CI) users. We also examined if concept formation skills are mediated or moderated by other neurocognitive domains (i.e., language, working memory, and executive control). Relative to normally hearing (NH) peers, CI users displayed significantly poorer performance in several specific areas of concept formation, especially when multiple comparisons and relational concepts were components of the task. Differences in concept formation between CI users and NH peers were fully explained by differences in language and inhibition–concentration skills. Language skills were also found to be more strongly related to concept formation in CI users than in NH peers. The present findings suggest that complex relational concepts may be adversely affected by a period of early prelingual deafness followed by access to underspecified and degraded sound patterns and spoken language transmitted by a CI. Investigating a unique clinical population such as early-implanted prelingually deaf children with CIs can provide new insights into foundational brain–behavior relations and developmental processes. PMID:25583706

Source Separation of Heartbeat Sounds for Effective E-Auscultation

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Geethu, R. S.; Krishnakumar, M.; Pramod, K. V.; George, Sudhish N.

2016-03-01

This paper proposes a cost effective solution for improving the effectiveness of e-auscultation. Auscultation is the most difficult skill for a doctor, since it can be acquired only through experience. The heart sound mixtures are captured by placing the four numbers of sensors at appropriate auscultation area in the body. These sound mixtures are separated to its relevant components by a statistical method independent component analysis. The separated heartbeat sounds can be further processed or can be stored for future reference. This idea can be used for making a low cost, easy to use portable instrument which will be beneficial to people living in remote areas and are unable to take the advantage of advanced diagnosis methods.

Training oncology and palliative care clinical nurse specialists in psychological skills: evaluation of a pilot study.

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Clark, Jane E; Aitken, Susan; Watson, Nina; McVey, Joanne; Helbert, Jan; Wraith, Anita; Taylor, Vanessa; Catesby, Sarah

2015-06-01

National guidelines in the United Kingdom recommend training Clinical Nurse Specialists in psychological skills to improve the assessment and intervention with psychological problems experienced by people with a cancer diagnosis (National Institute for Health and Clinical Excellence, 2004). This pilot study evaluated a three-day training program combined with supervision sessions from Clinical Psychologists that focused on developing skills in psychological assessment and intervention for common problems experienced by people with cancer. Questionnaires were developed to measure participants' levels of confidence in 15 competencies of psychological skills. Participants completed these prior to the program and on completion of the program. Summative evaluation was undertaken and results were compared. In addition, a focus group interview provided qualitative data of participants' experiences of the structure, process, and outcomes of the program. Following the program, participants rated their confidence in psychological assessment and skills associated with providing psychological support as having increased in all areas. This included improved knowledge of psychological theories, skills in assessment and intervention and accessing and using supervision appropriately. The largest increase was in providing psycho-education to support the coping strategies of patients and carers. Thematic analysis of interview data identified two main themes including learning experiences and program enhancements. The significance of the clinical supervision sessions as key learning opportunities, achieved through the development of a community of practice, emerged. Although this pilot study has limitations, the results suggest that a combined teaching and supervision program is effective in improving Clinical Nurse Specialists' confidence level in specific psychological skills. Participants' experiences highlighted suggestions for refinement and development of the program

Should we use philosophy to teach clinical communication skills?

Directory of Open Access Journals (Sweden)

Berna Gerber

2016-11-01

Full Text Available Effective communication between the doctor and patient is crucial for good quality health care. Yet, this form of communication is often problematic, which may lead to several negative consequences for both patients and doctors. Clinical communication skills have become important components of medical training programmes. The traditional approach is to teach students particular communication skills, such as listening to patients and asking open-ended questions. Despite their importance, such training approaches do not seem to be enough to deliver medical practitioners who are able and committed to communicate effectively with patients. This might be due to the pervasive negative influence of the medical profession’s (mistaken understanding of itself as a natural science on doctor–patient communication. Doctors who have been trained according to a positivist framework may consider their only responsibility to be the physical treatment of physical disorders. They may thus have little regard for the patient’s psychological and social world and by extension for communication with the patient and/or their caregivers. To address this problem, I propose a curriculum, based on the academic field of philosophy, for teaching clinical communication.

Should we use philosophy to teach clinical communication skills?

Science.gov (United States)

2016-01-01

Effective communication between the doctor and patient is crucial for good quality health care. Yet, this form of communication is often problematic, which may lead to several negative consequences for both patients and doctors. Clinical communication skills have become important components of medical training programmes. The traditional approach is to teach students particular communication skills, such as listening to patients and asking open-ended questions. Despite their importance, such training approaches do not seem to be enough to deliver medical practitioners who are able and committed to communicate effectively with patients. This might be due to the pervasive negative influence of the medical profession’s (mistaken) understanding of itself as a natural science on doctor–patient communication. Doctors who have been trained according to a positivist framework may consider their only responsibility to be the physical treatment of physical disorders. They may thus have little regard for the patient’s psychological and social world and by extension for communication with the patient and/or their caregivers. To address this problem, I propose a curriculum, based on the academic field of philosophy, for teaching clinical communication. PMID:28155325

Staff and students' perceptions and experiences of teaching and assessment in Clinical Skills Laboratories: interview findings from a multiple case study.

Science.gov (United States)

Houghton, Catherine E; Casey, Dympna; Shaw, David; Murphy, Kathy

2012-08-01

The Clinical Skills Laboratory has become an essential structure in nurse education and several benefits of its use have been identified. However, the literature identifies the need to examine the transferability of skills learned there into the reality of practice. This research explored the role of the Clinical Skills Laboratory in preparing nursing students for the real world of practice. This paper focuses specifically on the perceptions of the teaching and assessment strategies employed there. Qualitative multiple case study design. Five case study sites. Interviewees (n=58) included academic staff, clinical staff and nursing students. Semi-structured interviews. The Clinical Skills Laboratory can provide a pathway to practice and its authenticity is significant. Teaching strategies need to incorporate communication as well as psychomotor skills. Including audio-visual recording into assessment strategies is beneficial. Effective relationships between education institutions and clinical settings are needed to enhance the transferability of the skills learned. The Clinical Skills Laboratory should provide an authentic learning environment, with the appropriate use of teaching strategies. It is crucial that effective links between educators and clinical staff are established and maintained. Copyright © 2011 Elsevier Ltd. All rights reserved.

Preparing clinical laboratory science students with teaching skills.

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Isabel, Jeanne M

2010-01-01

Training clinical laboratory science (CLS) students in techniques of preparation and delivery of an instructional unit is an important component of all CLS education programs and required by the national accrediting agency. Participants of this study included students admitted to the CLS program at Northern Illinois University and enrolled in the teaching course offered once a year between the years of 1997 and 2009. Courses on the topic of "teaching" may be regarded by CLS students as unnecessary. However, entry level practitioners are being recruited to serve as clinical instructors soon after entering the workforce. Evaluation of the data collected indicates that students are better prepared to complete tasks related to instruction of a topic after having an opportunity to study and practice skills of teaching. Mentoring CLS students toward the career role of clinical instructor or professor is important to maintaining the workforce.

Do Simulation-Based Skill Exercises and Post-Encounter Notes Add Additional Value to a Standardized Patient-Based Clinical Skills Examination?

Directory of Open Access Journals (Sweden)

Michael D. Prislin

2011-01-01

Full Text Available Background. Standardized patient (SP clinical assessments have limited utility in assessing higher-level clinical competencies. This study explores the value of including simulation exercises and postencounter notes in an SP clinical skills examination. Methods. Two exercises involving cardiac auscultation and ophthalmic funduscopy simulations along with written post encounter notes were added to an SP-based performance examination. Descriptive analyses of students' performance and correlations with SP-based performance measures were obtained. Results. Students' abilities to detect abnormalities on physical exam were highly variable. There were no correlations between SP-based and simulation-derived measures of physical examination competency. Limited correlations were found between students' abilities to perform and document physical examinations and their formulation of appropriate differential diagnoses. Conclusions. Clinical simulation exercises add depth to SP-based assessments of performance. Evaluating the content of post encounter notes offers some insight into students' integrative abilities, and this appears to be improved by the addition of simulation-based post encounter skill exercises. However, further refinement of this methodology is needed.

Clinically speaking: A communication skills program for students from non-English speaking backgrounds.

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Miguel, Caroline San; Rogan, Fran; Kilstoff, Kathleen; Brown, Di

2006-09-01

This paper reports on the design, delivery and evaluation of an innovative oral communication skills program for first year students in a Bachelor of Nursing degree at an Australian university. This program was introduced in 2004 to meet the needs of first year undergraduate students from non-English speaking backgrounds who had experienced difficulties with spoken English while on clinical placement. The program consisted of early identification of students in need of communication development, a series of classes incorporated into the degree program to address students' needs, followed by a clinical placement block. This paper describes the structure of the program, discusses some of the major problems encountered by students in the clinical setting and presents some of the teaching strategies used to address these problems. Evaluations of the program suggest that students' communication skills and confidence improved, resulting in a more positive clinical experience for the majority of students.

Analyzing communication skills of Pediatric Postgraduate Residents in Clinical Encounter by using video recordings.

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Bari, Attia; Khan, Rehan Ahmed; Jabeen, Uzma; Rathore, Ahsan Waheed

2017-01-01

To analyze communication skills of pediatric postgraduate residents in clinical encounter by using video recordings. This qualitative exploratory research was conducted through video recording at The Children's Hospital Lahore, Pakistan. Residents who had attended the mandatory communication skills workshop offered by CPSP were included. The video recording of clinical encounter was done by a trained audiovisual person while the resident was interacting with the patient in the clinical encounter. Data was analyzed by thematic analysis. Initially on open coding 36 codes emerged and then through axial and selective coding these were condensed to 17 subthemes. Out of these four main themes emerged: (1) Courteous and polite attitude, (2) Marginal nonverbal communication skills, (3) Power game/Ignoring child participation and (4) Patient as medical object/Instrumental behaviour. All residents treated the patient as a medical object to reach a right diagnosis and ignored them as a human being. There was dominant role of doctors and marginal nonverbal communication skills were displayed by the residents in the form of lack of social touch, and appropriate eye contact due to documenting notes. A brief non-medical interaction for rapport building at the beginning of interaction was missing and there was lack of child involvement. Paediatric postgraduate residents were polite while communicating with parents and child but lacking in good nonverbal communication skills. Communication pattern in our study was mostly one-way showing doctor's instrumental behaviour and ignoring the child participation.

Exploring the use of high-fidelity simulation training to enhance clinical skills.

Science.gov (United States)

Ann Kirkham, Lucy

2018-02-07

The use of interprofessional simulation training to enhance nursing students' performance of technical and non-technical clinical skills is becoming increasingly common. Simulation training can involve the use of role play, virtual reality or patient simulator manikins to replicate clinical scenarios and assess the nursing student's ability to, for example, undertake clinical observations or work as part of a team. Simulation training enables nursing students to practise clinical skills in a safe environment. Effective simulation training requires extensive preparation, and debriefing is necessary following a simulated training session to review any positive or negative aspects of the learning experience. This article discusses a high-fidelity simulated training session that was used to assess a group of third-year nursing students and foundation level 1 medical students. This involved the use of a patient simulator manikin in a scenario that required the collaborative management of a deteriorating patient. ©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

A Survey of Established Veterinary Clinical Skills Laboratories from Europe and North America: Present Practices and Recent Developments.

Science.gov (United States)

Dilly, Marc; Read, Emma K; Baillie, Sarah

Developing competence in clinical skills is important if graduates are to provide entry-level care, but it is dependent on having had sufficient hands-on practice. Clinical skills laboratories provide opportunities for students to learn on simulators and models in a safe environment and to supplement training with animals. Interest in facilities for developing veterinary clinical skills has increased in recent years as many veterinary colleges face challenges in training their students with traditional methods alone. For the present study, we designed a survey to gather information from established veterinary clinical skills laboratories with the aim of assisting others considering opening or expanding their own facility. Data were collated from 16 veterinary colleges in North America and Europe about the uses of their laboratory, the building and associated facilities, and the staffing, budgets, equipment, and supporting learning resources. The findings indicated that having a dedicated veterinary clinical skills laboratory is a relatively new initiative and that colleges have adopted a range of approaches to implementing and running the laboratory, teaching, and assessments. Major strengths were the motivation and positive characteristics of the staff involved, providing open access and supporting self-directed learning. However, respondents widely recognized the increasing demands placed on the facility to provide more space, equipment, and staff. There is no doubt that veterinary clinical skills laboratories are on the increase and provide opportunities to enhance student learning, complement traditional training, and benefit animal welfare.

An assessment of student satisfaction with peer teaching of clinical communication skills.

Science.gov (United States)

Mills, Jonathan K A; Dalleywater, William J; Tischler, Victoria

2014-10-13

Peer teaching is now used in medical education with its value increasingly being recognised. It is not yet established whether students differ in their satisfaction with teaching by peer-teachers compared to those taught by academic or clinical staff. This study aimed to establish satisfaction with communication skills teaching between these three teaching groups. Students participated in a role-play practical facilitated either by clinicians, peer-teachers or non-clinical staff. A questionnaire was administered to first-year medical students after participating in a communication skills role-play session asking students to evaluate their satisfaction with the session. Data were analysed in SPSS 20. One hundred and ninety eight students out of 239 (83%) responded. Students were highly satisfied with the teaching session with no difference in satisfaction scores found between those sessions taught by peers, clinical and non-clinical staff members. 158 (80%) considered the session useful and 139 (69%) strongly agreed tutors facilitated their development. There was no significant difference in satisfaction scores based on tutor background. Satisfaction is as high when tutored by peer-teachers compared to clinicians or non-clinical staff. Constructive feedback is welcomed from a range of personnel. Final-year students could play an increasing role in the teaching of pre-clinical medical students.

Perception versus reality: a comparative study of the clinical judgment skills of nurses during a simulated activity.

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Fenske, Cynthia L; Harris, Margaret A; Aebersold, Michelle L; Hartman, Laurie S

2013-09-01

This study was conducted to determine how closely nurses' perceptions of their clinical judgment abilities matched their demonstrated clinical judgment skills during a simulation. Seventy-four registered nurses participated in a simulation using a video format. After the simulation, the nurses self-assessed their performance using the Lasater Clinical Judgment Rubric. This rubric was then used to rate the nurses' actual performance in the simulation activity. The study results showed a significant discrepancy between nurses' perceptions of their own clinical judgment abilities and their demonstrated clinical judgment skills. Age and length of nursing experience enhanced the difference between the findings of self-assessment and actual performance. Younger nurses and those with 1 year or less of nursing experience were significantly more likely to have self-assessed their abilities at a much higher level compared with their actual skills. Copyright 2013, SLACK Incorporated.

Clinical reasoning skills in final-year dental students: A qualitative cross-curricula comparison.

Science.gov (United States)

Nafea, E T; Dennick, R

2018-05-01

The aim of this research was to explore the perceptions of undergraduate dental students regarding clinical reasoning skills and also discover the influences of different curriculum designs on the acquisition of these skills by students. Eighteen final-year students from three different dental schools with varied curricula and cultures participated in the current research. The research used qualitative methodology. The study took place in 2013-2014. Interviews captured the participants' own understanding of clinical reasoning and its acquisition plus they "talked through" a clinical problem using a "think-aloud" technique. Thematic analysis was used to analyse the transcripts of the recorded interviews. Results obtained were related to curriculum structure. Unfamiliarity with the term clinical reasoning was common in students. Students from different schools used different strategies to reason when discussing clinical vignettes. Clinical reasoning process was dominated by pattern recognition. Students' behaviours seemed to be influenced by cultural factors. This research contributes to a greater understanding of how students learn, understand and apply dental clinical reasoning which will improve educational practices in the future. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Typewriting: Personal-Use Typewriting--A Sound Foundation

Science.gov (United States)

Ownby, Arnola; Rhea, Jeanine

1977-01-01

Because educators are recognizing the contributions that typewriting can make as a tool of communication, greater numbers of personal-use typewriting courses are being offered in which students will develop an effective skill for personal use, as well as gain a sound foundation for further study in a vocational course. The major issue is one of…

Curricular Innovation in the Surgery Clerkship: Can Assessment Methods Influence Development of Critical Thinking and Clinical Skills?

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McClintic, James A; Snyder, Clifford L; Brown, Kimberly M

2018-03-12

Although key clinical skills have been defined in the Core Entrustable Professional Activities, there is a need to improve medical school curricula with standardized training opportunities and assessments of these skills. Thus, we aimed to develop an innovative curriculum that emphasized critical thinking and clinical skills. We hypothesized that we would be able to observe measurable improvement on assessments of students' critical thinking and clinical skills after the implementation of the new curriculum. Prospective, Quasi-Experimental study with the use of historical controls. This study took place through the third-year surgical clerkship at the University of Texas Medical Branch at the Galveston, Houston, and Austin, Texas, locations. A total of 214 students taking the third-year surgical clerkship for the first time during the periods of interest were included. Although the students with traditional curriculum improved 9.5% on a short answer exam from preclerkship to postclerkship completion, the students with new curriculum improved by 40%. Students under the new curriculum performed significantly better on the Objective Structured Clinical Exam; however, their shelf scores were lower. Under this new curriculum and grading system, we demonstrated that students can be incentivized to improve critical thinking and clinical skills, but this needs to be balanced with knowledge-based incentives. Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

[Standardizing the manipulation procedure of acupuncture-moxibustion, reinforcing the training of' clinical skill: learning experience of Acupuncture-moxibustion Clinical Skills Training: Chapter of Commonly Used Needling and Moxibustion Techniques].

Science.gov (United States)

Tian, Hongfang; Yang, Chao; Tang, Jie; Qin, Qiuguo; Zhao, Mingwen; Zhao, Jiping

2015-07-01

The book Acupuncture-moxibustion Clinical Skills Training is one of "Twelfth Five-Year Plan" in novative teaching materials, which is published by People's Medical Publishing House. Through learning the first half of the book commonly used needling and moxibustion techniques, it is realized that the selection of book content is reasonable and much attention is paid to needling and moxibustion techniques; the chapter arrangement is well-organized, and the form is novel, which is concise and intuitive; for every technique, great attention is paid to standardize the manipulation procedure and clarify the technique key, simultaneously the safety of acupuncture and moxibustion is also emphasized. The characteristics of the book, including innovativeness, practicability, are highlighted, and it greatly helps to improve students' clinical skills and examination ability.

Analysis of the drilling sound in maxillo-facial surgery

DEFF Research Database (Denmark)

Hoffmann, Pablo F.; Gosselin, Florian; Taha, Farid

2009-01-01

Auditory feedback can have a great potential in surgical simulators that aim at training skills associated to the correct interpretation of acoustic information. Here, we present a preliminary analysis of the sound that is produced by the drilling procedure in a maxillo-facial surgery when...... performed by expert surgeons. The motivation of this work is to find relevant acoustic parameters that allow for an efficient synthesis method of the drilling sound and to set the basis of the audio component in the simulator so that expert surgical drilling can effectively be conveyed to users...

Clinical history and physical examination skills - A requirement for radiographers?

International Nuclear Information System (INIS)

Snaith, Beverly A.; Lancaster, Anne

2008-01-01

Radiographer's roles have evolved with their scope broadening over the last 20 years culminating in the development of advanced and consultant posts. Yet one development has not been embraced, despite being inherent in medicine and a common extension of nurse and other allied health professionals' roles, is that of clinical assessment. This article explores the evolving role of the radiographer and discusses whether this should include skills in clinical history taking and physical examination. Issues for education and development will be addressed together with examples of current and potential roles

Small Steps in Impacting Clinical Auscultation of Medical Students

Directory of Open Access Journals (Sweden)

Edem K. Binka MD

2016-09-01

Full Text Available The objective of this study was to determine if a training module improves the auscultation skills of medical students at the University of Maryland School of Medicine. Second-year medical students completed pretests on 12 heart sounds followed by a 45-minute training module on clinical auscultation, with retesting immediately after the intervention and during their third-year pediatrics clerkship. The control group consisted of third-year medical students who did not have the intervention. There was a 23% improvement in the identification of heart sounds postintervention (P < .001. Diastolic and valvular murmurs were poorly identified pre- and post intervention. There was a 6% decline in accuracy of the intervention group in the following academic year. The intervention group was superior to the control group at identifying the tested heart sounds (49% vs 43%, P = .04. The accuracy of second-year medical students in identifying heart sounds improved after a brief training module.

Effects of an experiential learning program on the clinical reasoning and critical thinking skills of occupational therapy students.

Science.gov (United States)

Coker, Patty

2010-01-01

This study examined the effects of participation in a 1-week, experiential, hands-on learning program on the critical thinking and clinical reasoning skills of occupational therapy students. A quasi-experimental, nonrandomized pre- and post-test design was used with a sample of 25 students. The students had completed three semesters of didactic lecture coursework in a master's level OT educational program prior to participation in a hands-on therapy program for children with hemiplegic cerebral palsy. Changes in critical thinking and clinical reasoning skills were evaluated using the following dependent measures: Self-Assessment of Clinical Reflection and Reasoning (SACRR) and the California Critical Thinking Skills Test (CCTST). Changes in pretest and posttest scores on the SACRR and the CCTST were statistically significant (p>0.05) following completion of the experiential learning program. This study supports the use of hands-on learning to develop clinical reasoning and critical thinking skills in healthcare students, who face ever more diverse patient populations upon entry-level practice. Further qualitative and quantitative investigations are needed to support the results of this study and determine which components of experiential learning programs are essential for developing clinical reasoning and critical thinking skills in future allied health professionals.

Implications of diadochokinesia in children with speech sound disorder.

Science.gov (United States)

Wertzner, Haydée Fiszbein; Pagan-Neves, Luciana de Oliveira; Alves, Renata Ramos; Barrozo, Tatiane Faria

2013-01-01

To verify the performance of children with and without speech sound disorder in oral motor skills measured by oral diadochokinesia according to age and gender and to compare the results by two different methods of analysis. Participants were 72 subjects aged from 5 years to 7 years and 11 months divided into four subgroups according to the presence of speech sound disorder (Study Group and Control Group) and age (6 years and 5 months). Diadochokinesia skills were assessed by the repetition of the sequences 'pa', 'ta', 'ka' and 'pataka' measured both manually and by the software Motor Speech Profile®. Gender was statistically different for both groups but it did not influence on the number of sequences per second produced. Correlation between the number of sequences per second and age was observed for all sequences (except for 'ka') only for the control group children. Comparison between groups did not indicate differences between the number of sequences per second and age. Results presented strong agreement between the values of oral diadochokinesia measured manually and by MSP. This research demonstrated the importance of using different methods of analysis on the functional evaluation of oro-motor processing aspects of children with speech sound disorder and evidenced the oro-motor difficulties on children aged under than eight years old.

Effectiveness of Standardized Patient Simulations in Teaching Clinical Communication Skills to Dental Students.

Science.gov (United States)

McKenzie, Carly T; Tilashalski, Ken R; Peterson, Dawn Taylor; White, Marjorie Lee

2017-10-01

The aim of this study was to investigate dental students' long-term retention of clinical communication skills learned in a second-year standardized patient simulation at one U.S. dental school. Retention was measured by students' performance with an actual patient during their fourth year. The high-fidelity simulation exercise focused on clinical communication skills took place during the spring term of the students' second year. The effect of the simulation was measured by comparing the fourth-year clinical performance of two groups: those who had participated in the simulation (intervention group; Class of 2016) and those who had not (no intervention/control group; Class of 2015). In the no intervention group, all 47 students participated; in the intervention group, 58 of 59 students participated. Both instructor assessments and students' self-assessments were used to evaluate the effectiveness of key patient interaction principles as well as comprehensive presentation of multiple treatment options. The results showed that students in the intervention group more frequently included cost during their treatment option presentation than did students in the no intervention group. The instructor ratings showed that the intervention group included all key treatment option components except duration more frequently than did the no intervention group. However, the simulation experience did not result in significantly more effective student-patient clinical communication on any of the items measured. This study presents limited evidence of the effectiveness of a standardized patient simulation to improve dental students' long-term clinical communication skills with respect to thorough presentation of treatment options to a patient.

Reaching national consensus on the core clinical skill outcomes for family medicine postgraduate training programmes in South Africa.

Science.gov (United States)

Akoojee, Yusuf; Mash, Robert

2017-05-26

Family physicians play a significant role in the district health system and need to be equipped with a broad range of clinical skills in order to meet the needs and expectations of the communities they serve. A previous study in 2007 reached national consensus on the clinical skills that should be taught in postgraduate family medicine training prior to the introduction of the new speciality. Since then, family physicians have been trained, employed and have gained experience of working in the district health services. The national Education and Training Committee of the South African Academy of Family Physicians, therefore, requested a review of the national consensus on clinical skills for family medicine training. A Delphi technique was used to reach national consensus in a panel of 17 experts: family physicians responsible for training, experienced family physicians in practice and managers responsible for employing family physicians. Consensus was reached on 242 skills from which the panel decided on 211 core skills, 28 elective skills and 3 skills to be deleted from the previous list. The panel was unable to reach consensus on 11 skills. The findings will guide training programmes on the skills to be addressed and ensure consistency across training programmes nationally. The consensus will also guide formative assessment as documented in the national portfolio of learning and summative assessment in the national exit examination. The consensus will be of interest to other countries in the region where training programmes in family medicine are developing.

Comparisons between physics-based, engineering, and statistical learning models for outdoor sound propagation.

Science.gov (United States)

Hart, Carl R; Reznicek, Nathan J; Wilson, D Keith; Pettit, Chris L; Nykaza, Edward T

2016-05-01

Many outdoor sound propagation models exist, ranging from highly complex physics-based simulations to simplified engineering calculations, and more recently, highly flexible statistical learning methods. Several engineering and statistical learning models are evaluated by using a particular physics-based model, namely, a Crank-Nicholson parabolic equation (CNPE), as a benchmark. Narrowband transmission loss values predicted with the CNPE, based upon a simulated data set of meteorological, boundary, and source conditions, act as simulated observations. In the simulated data set sound propagation conditions span from downward refracting to upward refracting, for acoustically hard and soft boundaries, and low frequencies. Engineering models used in the comparisons include the ISO 9613-2 method, Harmonoise, and Nord2000 propagation models. Statistical learning methods used in the comparisons include bagged decision tree regression, random forest regression, boosting regression, and artificial neural network models. Computed skill scores are relative to sound propagation in a homogeneous atmosphere over a rigid ground. Overall skill scores for the engineering noise models are 0.6%, -7.1%, and 83.8% for the ISO 9613-2, Harmonoise, and Nord2000 models, respectively. Overall skill scores for the statistical learning models are 99.5%, 99.5%, 99.6%, and 99.6% for bagged decision tree, random forest, boosting, and artificial neural network regression models, respectively.

Concept formation skills in long-term cochlear implant users.

Science.gov (United States)

Castellanos, Irina; Kronenberger, William G; Beer, Jessica; Colson, Bethany G; Henning, Shirley C; Ditmars, Allison; Pisoni, David B

2015-01-01

This study investigated if a period of auditory sensory deprivation followed by degraded auditory input and related language delays affects visual concept formation skills in long-term prelingually deaf cochlear implant (CI) users. We also examined if concept formation skills are mediated or moderated by other neurocognitive domains (i.e., language, working memory, and executive control). Relative to normally hearing (NH) peers, CI users displayed significantly poorer performance in several specific areas of concept formation, especially when multiple comparisons and relational concepts were components of the task. Differences in concept formation between CI users and NH peers were fully explained by differences in language and inhibition-concentration skills. Language skills were also found to be more strongly related to concept formation in CI users than in NH peers. The present findings suggest that complex relational concepts may be adversely affected by a period of early prelingual deafness followed by access to underspecified and degraded sound patterns and spoken language transmitted by a CI. Investigating a unique clinical population such as early-implanted prelingually deaf children with CIs can provide new insights into foundational brain-behavior relations and developmental processes. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Deficits in Letter-Speech Sound Associations but Intact Visual Conflict Processing in Dyslexia: Results from a Novel ERP-Paradigm

OpenAIRE

Bakos, Sarolta; Landerl, Karin; Bartling, Jürgen; Schulte-Körne, Gerd; Moll, Kristina

2017-01-01

The reading and spelling deficits characteristic of developmental dyslexia (dyslexia) have been related to problems in phonological processing and in learning associations between letters and speech-sounds. Even when children with dyslexia have learned the letters and their corresponding speech sounds, letter-speech sound associations might still be less automatized compared to children with age-adequate literacy skills. In order to examine automaticity in letter-speech sound associations and...

Foley Sounds vs Real Sounds

DEFF Research Database (Denmark)

Trento, Stefano; Götzen, Amalia De

2011-01-01

This paper is an initial attempt to study the world of sound effects for motion pictures, also known as Foley sounds. Throughout several audio and audio-video tests we have compared both Foley and real sounds originated by an identical action. The main purpose was to evaluate if sound effects...

Distant peer-tutoring of clinical skills, using tablets with instructional videos and Skype: A pilot study in the UK and Malaysia.

Science.gov (United States)

O'Donovan, James; Maruthappu, Mahiben

2015-05-01

To assess the feasibility and impact of using low-cost Android tablets to deliver video tutorials and remote online peer-tutoring for clinical skills between two countries. Nine junior medical students from Malaysia were paired with five senior medical students from the UK, who played the role of peer-tutors. Students from Malaysia were given a low-cost Android tablet from which they could access instructional video tutorials. At the end of each week, the peer-tutors would observe their peer-learners as they performed a clinical examination. Tutors would then provide individual feedback using a videoconferencing tool. Outcomes were assessed using Observed Structured Clinical Examination (OSCE) scores, post-study questionnaires and semi-structured interviews with participants. Peer-learners reported an increased confidence in clinical examination of 8.4 (±1.0) on a 10-point scale and all nine said they would recommend the scheme to their peers. Both peer-tutors and peer-learners were able to establish a strong rapport over video, rating it as 8.4 (±0.6) and 8.4 (±0.9), respectively. Peer-learners' rated the sound and video quality of the tablet as 7.0 (±1.1) but were less satisfied with the screen resolution of the tablet, rating this as 4.0 (±1.5). This preliminary pilot study presents an innovative, low cost approach to international medical education with significant potential for future development.

Exploring Clinical Rotation Competence Improvements after Interpersonal Skills Development in At-Risk Medical Students

Directory of Open Access Journals (Sweden)

Sri Linuwih Menaldi

2014-12-01

Full Text Available AbstractPrior to admission, medical students were subject to psychological tests to measure their logical thinking skills and personality, hence predicting their ability to complete their studies. The results showed 56,45% of medical students obtained recommendation category 4 (doubtful and 5 (not recommended, two categories which are considered to be at-risk group with a very small probability of completing their studies. These results predicted that students in the mentioned groups will have difficulties in achieving the clinical competence level required by the Indonesian Doctors’ Competency Standard (IDCS. The aim of the study was to investigate clinical competency achievement by at-risk medical students in the third year, after following interpersonal skills development training program on July 2011. This research used qualitative study design through psychological examination, written self-reflection and in-depth interview after the training. Interpersonal skills development training for at-risk medical students gave positive effects to theircharacter development for the helping profession. It was concluded that interpersonal skills training could help improve medical student’s achievement of clinical competence especially for at-risk group in their clinical rotations stage.Keywords: medical students, at-risk group, interpersonal skills, clinical competence AbstrakPada mahasiswa kedokteran yang baru masuk dilakukan pemeriksaan psikologis untuk memperoleh gambaran penalaran dan kepribadian untuk memprediksi kemampuan mahasiswa dalam menyelesaikan pendidikan. Berdasarkan pemeriksaan tersebut diperoleh 56,45% mahasiswa dengan hasil uji psikometrik kategori rekomendasi 4 (diragukan dan 5 (tidak disarankan yang disebut sebagai kelompok at-risk. Kelompok at risk memiliki peluang keberhasilan rendah untuk menyelesaikan pendidikan dan akan mengalami kesulitan mencapai kompetensi klinik sesuai Standar Kompetensi Dokter Indonesia. Tujuan

Transfer of communication skills to the workplace during clinical rounds: impact of a program for residents.

Science.gov (United States)

Liénard, Aurore; Merckaert, Isabelle; Libert, Yves; Bragard, Isabelle; Delvaux, Nicole; Etienne, Anne-Marie; Marchal, Serge; Meunier, Julie; Reynaert, Christine; Slachmuylder, Jean-Louis; Razavi, Darius

2010-08-26

Communication with patients is a core clinical skill in medicine that can be acquired through communication skills training. Meanwhile, the importance of transfer of communication skills to the workplace has not been sufficiently studied. This study aims to assess the efficacy of a 40-hour training program designed to improve patients' satisfaction and residents' communication skills during their daily clinical rounds. Residents were randomly assigned to the training program or to a waiting list. Patients' satisfaction was assessed with a visual analog scale after each visit. Transfer of residents' communication skills was assessed in audiotaped actual inpatient visits during a half-day clinical round. Transcripted audiotapes were analyzed using content analysis software (LaComm). Training effects were tested with Mann-Whitney tests and generalized linear Poisson regression models. Eighty-eight residents were included. First, patients interacting with trained residents reported a higher satisfaction with residents' communication (Median=92) compared to patients interacting with untrained residents (Median=88) (p=.046). Second, trained residents used more assessment utterances (Relative Risk (RR)=1.17; 95% Confidence intervals (95%CI)=1.02-1.34; p=.023). Third, transfer was also observed when residents' training attendance was considered: residents' use of assessment utterances (RR=1.01; 95%CI=1.01-1.02; p=.018) and supportive utterances (RR=0.99; 95%CI=0.98-1.00; p=.042) (respectively 1.15 (RR), 1.08-1.23 (95%CI), ptransfer of residents' communication skills learning to the workplace. Transfer was directly related to training attendance but remained limited. Future studies should therefore focus on the improvement of the efficacy of communication skills training in order to ensure a more important training effect size on transfer.

Self- and rater-assessed effectiveness of "thinking-aloud" and "regular" morning report to intensify young physicians' clinical skills.

Science.gov (United States)

Hsu, Hui-Chi; Lee, Fa-Yauh; Yang, Ying-Ying; Tsao, Yen-Po; Lee, Wen-Shin; Chuang, Chiao-Lin; Chang, Ching-Chih; Huang, Chia-Chang; Huang, Chin-Chou; Ho, Shung-Tai

2015-09-01

This study compared the effects of the "thinking aloud" (TA) morning report (MR), which is characterized by sequential and interactive case discussion by all participants, with "regular" MR for clinical skill training of young physicians. Between February 2011 and February 2014, young physicians [including postgraduate year-1 (PGY1) residents, interns, and clerks) from our hospital were sequentially enrolled and followed for 3 months. The self- and rater-assessed educational values of two MR models for building up clinical skills of young physicians were compared. The junior (intern and clerk) attendees had higher self-assessed educational values scores and reported post-training application frequency of skills trained by TA MR compared with the senior (PGY1 resident) attendees. Higher average and percentage of increased overall rater-assessed OSCE scores were noted among the regular MR senior attendees and TA MR junior attendees than in their corresponding control groups (regular MR junior attendees and TA MR senior attendees). Interestingly, regular MRs provided additional beneficial effects for establishing the "professionalism, consulting skills and organization efficiency" aspects of clinical skills of senior/junior attendees. Moreover, senior and junior attendees benefited the most by participating in seven sessions of regular MR and TA MR each month, respectively. TA MR effectively trains junior attendees in basic clinical skills, whereas regular MR enhances senior attendees' "work reports, professionalism, organizational efficiency, skills in dealing with controversial and professional issues." Undoubtedly, all elements of the two MR models should be integrated together to ensure patient safety and good discipline among young physicians. Copyright © 2015. Published by Elsevier Taiwan.

78 FR 13869 - Puget Sound Energy, Inc.; Puget Sound Energy, Inc.; Puget Sound Energy, Inc.; Puget Sound Energy...

Science.gov (United States)

2013-03-01

...-123-LNG; 12-128-NG; 12-148-NG; 12- 158-NG] Puget Sound Energy, Inc.; Puget Sound Energy, Inc.; Puget Sound Energy, Inc.; Puget Sound Energy, Inc.; Puget Sound Energy, Inc.; CE FLNG, LLC; Consolidated...-NG Puget Sound Energy, Inc Order granting long- term authority to import/export natural gas from/to...

Designing a clinical skills training laboratory with focus on video for better learning

DEFF Research Database (Denmark)

Lauridsen, Henrik Hein; Toftgård, Rie Castella; Nørgaard, Cita

resources of varying quality on the internet if this is not made available during teaching. The objective of this project was to design a new clinical skills laboratory with IT and video facilities to support learning processes. Methods Teaching principles were described before decisions on the design......Objective The principles of apprenticeship in clinical skills training are increasingly being challenged. First, most students are proficient in learning from visual multimedia and will expect this to be part of a modern university education. Second, students will often find visual teaching...... on a priori described teaching and learning designs related to active learning principles. This was a complex process involving teachers, IT-experts, e-learning specialists and a variety of university employees....

The Clinical anatomy of the physical examination of the abdomen: A comprehensive review.

Science.gov (United States)

Bilal, Muhammad; Voin, Vlad; Topale, Nitsa; Iwanaga, Joe; Loukas, Marios; Tubbs, R Shane

2017-04-01

Physical examination of the abdomen is an essential skill. Knowledge of its clinical anatomy and application is vital for making diagnoses. Misinterpretation of anatomy during examination can have serious consequences. This review addresses understanding of the anatomy, methodology, and complications of abdominal physical examination. It includes particular reference to modern technology and investigations. Physical examination is performed for diagnostic purposes. However, the art of physical examination is declining as more and more clinicians rely on newer technology. This can have regrettable consequences: negligence, waste of time and resources, and deterioration of clinical skills. With a sound knowledge of clinical anatomy, and realization of the importance of physical examination of the abdomen, clinician, and patients alike can benefit. Clin. Anat. 30:352-356, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Can the 'Assessment Drives Learning' effect be detected in clinical skills training? - Implications for curriculum design and resource planning

Science.gov (United States)

Buss, Beate; Krautter, Markus; Möltner, Andreas; Weyrich, Peter; Werner, Anne; Jünger, Jana; Nikendei, Christoph

2012-01-01

Purpose: The acquisition of clinical-technical skills is of particular importance for the doctors of tomorrow. Procedural skills are often trained for the first time in skills laboratories, which provide a sheltered learning environment. However, costs to implement and maintain skills laboratories are considerably high. Therefore, the purpose of the present study was to investigate students’ patterns of attendance of voluntary skills-lab training sessions and thereby answer the following question: Is it possible to measure an effect of the theoretical construct related to motivational psychology described in the literature – ‘Assessment drives learning’ – reflected in patterns of attendance at voluntary skills-lab training sessions? By answering this question, design recommendations for curriculum planning and resource management should be derived. Method: A retrospective, descriptive analysis of student skills-lab attendance related to voluntary basic and voluntary advanced skills-lab sessions was conducted. The attendance patterns of a total of 340 third-year medical students in different successive year groups from the Medical Faculty at the University of Heidelberg were assessed. Results: Students showed a preference for voluntary basic skills-lab training sessions, which were relevant to clinical skills assessment, especially at the beginning and at the end of the term. Voluntary advanced skills-lab training sessions without reference to clinical skills assessment were used especially at the beginning of the term, but declined towards the end of term. Conclusion: The results show a clear influence of assessments on students’ attendance at skills-lab training sessions. First recommendations for curriculum design and resource management will be described. Nevertheless, further prospective research studies will be necessary to gain a more comprehensive understanding of the motivational factors impacting students’ utilisation of voluntary skills

Improving Forecast Skill by Assimilation of Quality Controlled AIRS Version 5 Temperature Soundings

Science.gov (United States)

Susskind, Joel; Reale, Oreste

2009-01-01

The AIRS Science Team Version 5 retrieval algorithm has been finalized and is now operational at the Goddard DAAC in the processing (and reprocessing) of all AIRS data. The AIRS Science Team Version 5 retrieval algorithm contains two significant improvements over Version 4: 1) Improved physics allows for use of AIRS observations in the entire 4.3 micron CO2 absorption band in the retrieval of temperature profile T(p) during both day and night. Tropospheric sounding 15 micron CO2 observations are now used primarily in the generation of cloud cleared radiances R(sub i). This approach allows for the generation of accurate values of R(sub i) and T(p) under most cloud conditions. 2) Another very significant improvement in Version 5 is the ability to generate accurate case-by-case, level-by-level error estimates for the atmospheric temperature profile, as well as for channel-by-channel error estimates for R(sub i). These error estimates are used for Quality Control of the retrieved products. We have conducted forecast impact experiments assimilating AIRS temperature profiles with different levels of Quality Control using the NASA GEOS-5 data assimilation system. Assimilation of Quality Controlled T(p) resulted in significantly improved forecast skill compared to that obtained from analyses obtained when all data used operationally by NCEP, except for AIRS data, is assimilated. We also conducted an experiment assimilating AIRS radiances uncontaminated by clouds, as done operationally by ECMWF and NCEP. Forecast resulting from assimilated AIRS radiances were of poorer quality than those obtained assimilating AIRS temperatures.

Medical students' communication skills in clinical education: Results from a cohort study.

Science.gov (United States)

Bachmann, Cadja; Roschlaub, Silke; Harendza, Sigrid; Keim, Rebecca; Scherer, Martin

2017-10-01

To assess students' communication skills during clinical medical education and at graduation. We conducted an observational cohort study from 2007 to 2011 with 26 voluntary undergraduate medical students at Hamburg University based on video-taped consultations in year four and at graduation. 176 consultations were analyzed quantitatively with validated and non-validated context-independent communication observation instruments (interrater reliability ≥0.8). Based on observational protocols each consultation was also documented in free-text comments, salient topics were extracted afterwards. 26 students, seven males, were enrolled in the survey. On average, graduates scored higher in differential-diagnostic questioning and time management but showed deficiencies in taking systematic and complete symptom-oriented histories, in communication techniques, in structuring consultations and in gathering the patients' perspectives. Patient-centeredness and empathy were rather low at graduation. Individual deficiencies could barely be eliminated. Medical students were able to enhance their clinical reasoning skills and their time management. Still, various communication deficiencies in final year students became evident regarding appropriate history taking, communication skills, empathy and patient-centeredness. The necessity of developing a longitudinal communication curriculum with enhanced communication trainings and assessments became evident. A curriculum should ensure that students' communication competencies are firmly achieved at graduation. Copyright © 2017. Published by Elsevier B.V.

Identifying emotional intelligence skills of Turkish clinical nurses according to sociodemographic and professional variables.

Science.gov (United States)

Kahraman, Nilgün; Hiçdurmaz, Duygu

2016-04-01

This study aimed to identify the emotional intelligence skills of Turkish clinical nurses according to sociodemographic and professional variables. Emotional intelligence is "the ability of a person to comprehend self-emotions, to show empathy towards the feelings of others, and to control self-emotions in a way that enriches life." Nurses with a higher emotional intelligence level offer more efficient and professional care, and they accomplish more in their social and professional lives. We designed a descriptive cross-sectional study. The Introductory Information Form and the Bar-On emotional intelligence Inventory were used to collect data between 20th June and 20th August 2012. The study was conducted with 312 nurses from 37 hospitals located within the borders of the metropolitan municipality in Ankara. There were no significant differences between emotional intelligence scores of the nurses according to demographic variables such as age, gender, marital status, having children. Thus, sociodemographic factors did not appear to be key factors, but some professional variables did. Higher total emotional intelligence scores were observed in those who had 10 years or longer experience, who found oneself successful in professional life, who stated that emotional intelligence is an improvable skill and who previously received self-improvement training. Interpersonal skills were higher in those with a graduate degree and in nurses working in polyclinics and paediatric units. These findings indicate which groups require improvement in emotional intelligence skills and which skills need improvement. Additionally, these results provide knowledge and create awareness about emotional intelligence skills of nurses and the distribution of these skills according to sociodemographic and professional variables. Implementation of emotional intelligence improvement programmes targeting the determined clinical nursing groups by nursing administrations can help the increase in

Might as well jump: sound affects muscle activation in skateboarding.

Directory of Open Access Journals (Sweden)

Paola Cesari

Full Text Available The aim of the study is to reveal the role of sound in action anticipation and performance, and to test whether the level of precision in action planning and execution is related to the level of sensorimotor skills and experience that listeners possess about a specific action. Individuals ranging from 18 to 75 years of age--some of them without any skills in skateboarding and others experts in this sport--were compared in their ability to anticipate and simulate a skateboarding jump by listening to the sound it produces. Only skaters were able to modulate the forces underfoot and to apply muscle synergies that closely resembled the ones that a skater would use if actually jumping on a skateboard. More importantly we showed that only skaters were able to plan the action by activating anticipatory postural adjustments about 200 ms after the jump event. We conclude that expert patterns are guided by auditory events that trigger proper anticipations of the corresponding patterns of movements.

Might as well jump: sound affects muscle activation in skateboarding.

Science.gov (United States)

Cesari, Paola; Camponogara, Ivan; Papetti, Stefano; Rocchesso, Davide; Fontana, Federico

2014-01-01

The aim of the study is to reveal the role of sound in action anticipation and performance, and to test whether the level of precision in action planning and execution is related to the level of sensorimotor skills and experience that listeners possess about a specific action. Individuals ranging from 18 to 75 years of age--some of them without any skills in skateboarding and others experts in this sport--were compared in their ability to anticipate and simulate a skateboarding jump by listening to the sound it produces. Only skaters were able to modulate the forces underfoot and to apply muscle synergies that closely resembled the ones that a skater would use if actually jumping on a skateboard. More importantly we showed that only skaters were able to plan the action by activating anticipatory postural adjustments about 200 ms after the jump event. We conclude that expert patterns are guided by auditory events that trigger proper anticipations of the corresponding patterns of movements.

Understanding Adults' Strong Problem-Solving Skills Based on PIAAC

Science.gov (United States)

Hämäläinen, Raija; De Wever, Bram; Nissinen, Kari; Cincinnato, Sebastiano

2017-01-01

Purpose: Research has shown that the problem-solving skills of adults with a vocational education and training (VET) background in technology-rich environments (TREs) are often inadequate. However, some adults with a VET background do have sound problem-solving skills. The present study aims to provide insight into the socio-demographic,…

Online video in clinical skills education of oral medication administration for undergraduate student nurses: a mixed methods, prospective cohort study.

Science.gov (United States)

Holland, Agi; Smith, Fiona; McCrossan, Gill; Adamson, Elizabeth; Watt, Susan; Penny, Kay

2013-06-01

Improvements in the safety of the prescribing, dispensing and administration of medicines are identified as a priority across international healthcare systems. It is therefore essential that higher education institutions play their part in helping to meet this patient safety objective. New developments in clinical skills education which are aligned to emerging educational theory are available, but evaluations and supportive evidence are limited. To evaluate the use of an online best practice exemplar as an adjunct to the clinical skills teaching of oral medication administration to undergraduate student nurses. Mixed-methods prospective cohort design. Two intakes of undergraduate nursing students (n=168, n=154) undertaking a first year clinical skills based module at a British university. The Control group received standard teaching using lectures and skills classes facilitated by experienced clinical skills lecturers. The Intervention group received the standard teaching and unlimited access to an online video clip of medication administration. Performance and satisfaction were measured using module assessment results and a satisfaction questionnaire. Qualitative data were gathered using focus groups (n=16, n=20). The Intervention group was significantly (p=0.021) more likely to pass the assessment and rate their satisfaction with the teaching significantly higher (pTeaching and Time and when Classroom Learning was positive, the Transfer to Practice of the clinical skill was enhanced. An online video of a best practice exemplar as an adjunct to taught clinical skills sessions improves student assessment results and satisfaction ratings. The video was also reported to positively influence all themes identified in Classroom Learning and was perceived to promote the Transfer to Practice of teaching input. Copyright © 2012 Elsevier Ltd. All rights reserved.

Evaluating clinical simulations for learning procedural skills: a theory-based approach.

Science.gov (United States)

Kneebone, Roger

2005-06-01

Simulation-based learning is becoming widely established within medical education. It offers obvious benefits to novices learning invasive procedural skills, especially in a climate of decreasing clinical exposure. However, simulations are often accepted uncritically, with undue emphasis being placed on technological sophistication at the expense of theory-based design. The author proposes four key areas that underpin simulation-based learning, and summarizes the theoretical grounding for each. These are (1) gaining technical proficiency (psychomotor skills and learning theory, the importance of repeated practice and regular reinforcement), (2) the place of expert assistance (a Vygotskian interpretation of tutor support, where assistance is tailored to each learner's needs), (3) learning within a professional context (situated learning and contemporary apprenticeship theory), and (4) the affective component of learning (the effect of emotion on learning). The author then offers four criteria for critically evaluating new or existing simulations, based on the theoretical framework outlined above. These are: (1) Simulations should allow for sustained, deliberate practice within a safe environment, ensuring that recently-acquired skills are consolidated within a defined curriculum which assures regular reinforcement; (2) simulations should provide access to expert tutors when appropriate, ensuring that such support fades when no longer needed; (3) simulations should map onto real-life clinical experience, ensuring that learning supports the experience gained within communities of actual practice; and (4) simulation-based learning environments should provide a supportive, motivational, and learner-centered milieu which is conducive to learning.

Use of simulated patients to assess the clinical and communication skills of community pharmacists.

Science.gov (United States)

Weiss, Marjorie C; Booth, Anneka; Jones, Bethan; Ramjeet, Sarah; Wong, Eva

2010-06-01

To investigate the quality and appropriateness of Emergency Hormonal Contraception (EHC) supply from community pharmacies. Community pharmacies in the southwest of England during 2007. Two simulated patient ('mystery shopper') scenarios to each participating pharmacy, one where the supply of EHC would be appropriate (scenario 1) and one where there was a drug interaction between EHC and St John's Wort, and the supply inappropriate (scenario 2). Pharmacy consultations were rated using criteria developed from two focus groups: one with pharmacist academics and one with female university students. Feedback to pharmacists to inform their continuing professional development was provided. Scores on rating scales encompassing the clinical and communication skills of the participating community pharmacists completed immediately after each mystery shopper visit. 40 pharmacist visits were completed: 21 for scenario 1 and 19 for scenario 2. Eighteen pharmacists were visited twice. Five pharmacists visited for scenario 2 supplied EHC against professional guidance, although other reference sources conflicted with this advice. Pharmacies which were part of the local PGD scheme scored higher overall in scenario 1 (P = 0.005) than those not part of the scheme. Overall the communication skills of pharmacists were rated highly although some pharmacists used jargon when explaining the interaction for scenario 2. Formatively assessing communication skills in an integrative manner alongside clinical skills has been identified as an important part of the medical consultation skills training and can be incorporated into the routine assessment and feedback of pharmacy over-the-counter medicines advice.

A data-assimilative ocean forecasting system for the Prince William sound and an evaluation of its performance during sound Predictions 2009

Science.gov (United States)

Farrara, John D.; Chao, Yi; Li, Zhijin; Wang, Xiaochun; Jin, Xin; Zhang, Hongchun; Li, Peggy; Vu, Quoc; Olsson, Peter Q.; Schoch, G. Carl; Halverson, Mark; Moline, Mark A.; Ohlmann, Carter; Johnson, Mark; McWilliams, James C.; Colas, Francois A.

2013-07-01

Island Passage and Montague Strait entrance. During the latter part of the second week when surface winds were light and southwesterly, the mean surface flow at the Hinchinbrook Entrance reversed to weak outflow and a cyclonic eddy formed in the central Sound. Overall, RMS differences between ROMS surface currents and observed HF radar surface currents in the central Sound were generally between 5 and 10cm/s, about 20-40% of the time mean current speeds.The ROMS reanalysis is then validated against independent observations. A comparison of the ROMS currents with observed vertical current profiles from moored ADCPs in the Hinchinbrook Entrance and Montague Strait shows good qualitative agreement and confirms the evolution of the near surface inflow/outflow at these locations described above. A comparison of the ROMS surface currents with drifter trajectories provided additional confirmation that the evolution of the surface flow described above was realistic. Forecasts of drifter locations had RMS errors of less than 10km for up to 36h. One and two-day forecasts of surface temperature, salinity and current fields were more skillful than persistence forecasts. In addition, ensemble mean forecasts were found to be slightly more skillful than single forecasts. Two case studies demonstrated the system's qualitative skill in predicting subsurface changes within the mixed layer measured by ships and autonomous underwater vehicles. In summary, the system is capable of producing a realistic evolution of the near-surface circulation within PWS including forecasts of up to two days of this evolution. Use of the products provided by the system during the experiment as part of the asset deployment decision making process demonstrated the value of accurate regional ocean forecasts in support of field experiments.

Using video podcasting to enhance the learning of clinical skills: A qualitative study of physiotherapy students' experiences.

Science.gov (United States)

Hurst, Kay M

2016-10-01

Video podcasts, or vodcasts are increasingly used by a range of healthcare professions in the mastery of new skills. Little is known about the experiences of using vodcasts in physiotherapy education. Traditional pedagogic strategies have been employed in order to master those skills required for physiotherapy practice. There have been advances in the use of technology in medical education in the nursing, dentistry and medical fields. Vodcasts offer great versatility and potential when used as a pedagogical tool, embedded within a physiotherapy curriculum. To explore students' experiences of using technology enhanced learning, namely vodcasts, in the Physiotherapy curriculum to develop the learning of clinical skills. A series of focus groups were carried out with undergraduate and pre-registration physiotherapy students (n=31). Students valued the versatility and audio-visual nature of vodcasts; helpful in revising for practical examinations and practising their skills prior to, during and after taught skills classes. Watching and practising simultaneously allowed students to practice repeatedly and formulate a process for each skill. When learning a new skill, a combination of teaching and learning approaches was favoured, marrying traditional approaches with those that utilise technology. This study's findings add to the existing body of evidence in skills based teaching and support a multi-media, blended approach in those disciplines involved in the learning and teaching of clinical skills. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Practiced musical style shapes auditory skills.

Science.gov (United States)

Vuust, Peter; Brattico, Elvira; Seppänen, Miia; Näätänen, Risto; Tervaniemi, Mari

2012-04-01

Musicians' processing of sounds depends highly on instrument, performance practice, and level of expertise. Here, we measured the mismatch negativity (MMN), a preattentive brain response, to six types of musical feature change in musicians playing three distinct styles of music (classical, jazz, and rock/pop) and in nonmusicians using a novel, fast, and musical sounding multifeature MMN paradigm. We found MMN to all six deviants, showing that MMN paradigms can be adapted to resemble a musical context. Furthermore, we found that jazz musicians had larger MMN amplitude than all other experimental groups across all sound features, indicating greater overall sensitivity to auditory outliers. Furthermore, we observed a tendency toward shorter latency of the MMN to all feature changes in jazz musicians compared to band musicians. These findings indicate that the characteristics of the style of music played by musicians influence their perceptual skills and the brain processing of sound features embedded in music. © 2012 New York Academy of Sciences.

Getting fit for practice: an innovative paediatric clinical placement provided physiotherapy students opportunities for skill development.

Science.gov (United States)

Shields, Nora; Bruder, Andrea; Taylor, Nicholas F; Angelo, Tom

2013-06-01

Negative attitudes to disability among physiotherapy students in paediatric placements might be addressed by providing clinical placement opportunities for students early in their course. The aim of this qualitative research study was to explore what physiotherapy students reported learning from an innovative paediatric placement option. Qualitative research with in-depth interviews. Seventeen first and second year physiotherapy students (15 women, 2 men; mean age 19.9 (SD 1.4) years) who took part in the clinical education experience. The experience comprised a student-led progressive resistance training programme performed twice a week for 10 weeks at a community gymnasium with an adolescent with Down syndrome. In-depth interviews were completed after the 10-week programme and were audio-recorded, transcribed verbatim and independently coded by two researchers. Data were analysed using thematic analysis. Two themes emerged from the data, one about being a student mentor and the second about skill development and application. The physiotherapy students indicated the programme was a challenging yet rewarding experience, and that they gained an increased appreciation of disability. They reported developing and applying a range of communication, professional and physiotherapy specific skills. The results suggest that the clinical experience provided physiotherapy students with opportunities to learn clinical skills, generic professional skills, and better understand disability in young people. Many of the learning outcomes identified by the participating students align with desired graduate capabilities and required professional competencies. Copyright © 2012 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Effects of participation in a cross year peer tutoring programme in clinical examination skills on volunteer tutors' skills and attitudes towards teachers and teaching

Directory of Open Access Journals (Sweden)

Zamora Javier

2007-06-01

Full Text Available Abstract Background Development of students' teaching skills is increasingly recognised as an important component of UK undergraduate medical curricula and, in consequence, there is renewed interest in the potential benefits of cross-year peer tutoring. Whilst several studies have described the use of cross-year peer tutoring in undergraduate medical courses, its use in the clinical setting is less well reported, particularly the effects of peer tutoring on volunteer tutors' views of teachers and teaching. This study explored the effects of participation in a cross-year peer tutoring programme in clinical examination skills ('OSCE tutor' on volunteer tutors' own skills and on their attitudes towards teachers and teaching. Methods Volunteer tutors were final year MBChB students who took part in the programme as part of a Student Selected Component (SSC. Tutees were year 3 MBChB students preparing for their end of year 'OSCE' examination. Pre and post participation questionnaires, including both Likert-type and open response questions, were used. Paired data was compared using the Wilcoxon signed-rank test. All tests were two-tailed with 5% significance level. Results Tutors reflected their cohort in terms of gender but were drawn from among the more academically successful final year students. Most had previous teaching experience. They were influenced to participate in 'OSCE tutor' by a desire to improve their own teaching and associated generic skills and by contextual factors relating to the organisation or previous experience of the OSCE tutor programme. Issues relating to longer term career aspirations were less important. After the event, tutors felt that participation had enhanced their skills in various areas, including practical teaching skills, confidence in speaking to groups and communication skills; and that as a result of taking part, they were now more likely to undertake further teacher training and to make teaching a major part

Narrative Ability of Children With Speech Sound Disorders and the Prediction of Later Literacy Skills

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Wellman, Rachel L.; Lewis, Barbara A.; Freebairn, Lisa A.; Avrich, Allison A.; Hansen, Amy J.; Stein, Catherine M.

2012-01-01

Purpose The main purpose of this study was to examine how children with isolated speech sound disorders (SSDs; n = 20), children with combined SSDs and language impairment (LI; n = 20), and typically developing children (n = 20), ages 3;3 (years;months) to 6;6, differ in narrative ability. The second purpose was to determine if early narrative ability predicts school-age (8–12 years) literacy skills. Method This study employed a longitudinal cohort design. The children completed a narrative retelling task before their formal literacy instruction began. The narratives were analyzed and compared for group differences. Performance on these early narratives was then used to predict the children’s reading decoding, reading comprehension, and written language ability at school age. Results Significant group differences were found in children’s (a) ability to answer questions about the story, (b) use of story grammars, and (c) number of correct and irrelevant utterances. Regression analysis demonstrated that measures of story structure and accuracy were the best predictors of the decoding of real words, reading comprehension, and written language. Measures of syntax and lexical diversity were the best predictors of the decoding of nonsense words. Conclusion Combined SSDs and LI, and not isolated SSDs, impact a child’s narrative abilities. Narrative retelling is a useful task for predicting which children may be at risk for later literacy problems. PMID:21969531

Segmentation of heart sound recordings by a duration-dependent hidden Markov model

International Nuclear Information System (INIS)

Schmidt, S E; Graff, C; Toft, E; Struijk, J J; Holst-Hansen, C

2010-01-01

Digital stethoscopes offer new opportunities for computerized analysis of heart sounds. Segmentation of heart sound recordings into periods related to the first and second heart sound (S1 and S2) is fundamental in the analysis process. However, segmentation of heart sounds recorded with handheld stethoscopes in clinical environments is often complicated by background noise. A duration-dependent hidden Markov model (DHMM) is proposed for robust segmentation of heart sounds. The DHMM identifies the most likely sequence of physiological heart sounds, based on duration of the events, the amplitude of the signal envelope and a predefined model structure. The DHMM model was developed and tested with heart sounds recorded bedside with a commercially available handheld stethoscope from a population of patients referred for coronary arterioangiography. The DHMM identified 890 S1 and S2 sounds out of 901 which corresponds to 98.8% (CI: 97.8–99.3%) sensitivity in 73 test patients and 13 misplaced sounds out of 903 identified sounds which corresponds to 98.6% (CI: 97.6–99.1%) positive predictivity. These results indicate that the DHMM is an appropriate model of the heart cycle and suitable for segmentation of clinically recorded heart sounds

Residents' perceived needs in communication skills training across in- and outpatient clinical settings.

Science.gov (United States)

Junod Perron, Noelle; Sommer, Johanna; Hudelson, Patricia; Demaurex, Florence; Luthy, Christophe; Louis-Simonet, Martine; Nendaz, Mathieu; De Grave, Willem; Dolmans, Diana; Van der Vleuten, Cees

2009-05-01

Residents' perceived needs in communication skills training are important to identify before designing context-specific training programmes, since learrners' perceived needs can influence the effectiveness of training. To explore residents' perceptions of their training needs and training experiences around communication skills, and whether these differ between residents training in inpatient and outpatient clinical settings. Four focus groups (FG) and a self-administered questionnaire were conducted with residents working in in- and outpatient medical service settings at a Swiss University Hospital. Focus groups explored residents' perceptions of their communication needs, their past training experiences and suggestions for future training programmes in communication skills. Transcripts were analysed in a thematic way using qualitative analytic approaches. All residents from both settings were asked to complete a questionnaire that queried their sociodemographics and amount of prior training in communication skills. In focus groups, outpatient residents felt that communication skills were especially useful in addressing chronic diseases and social issues. In contrast, inpatient residents emphasized the importance of good communication skills for dealing with family conflicts and end-of-life issues. Felt needs reflected residents' differing service priorities: outpatient residents saw the need for skills to structure the consultation and explore patients' perspectives in order to build therapeutic alliances, whereas inpatient residents wanted techniques to help them break bad news, provide information and increase their own well-being. The survey's overall response rate was 56%. Its data showed that outpatient residents received more training in communication skills and more of them than inpatient residents considered communication skills training to be useful (100% vs 74%). Outpatient residents' perceived needs in communication skills were more patient

Exploring cultural and linguistic influences on clinical communication skills: a qualitative study of International Medical Graduates.

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Verma, Anju; Griffin, Ann; Dacre, Jane; Elder, Andrew

2016-06-10

International Medical Graduates (IMGs) are known to perform less well in many postgraduate medical examinations when compared to their UK trained counterparts. This "differential attainment" is observed in both knowledge-based and clinical skills assessments. This study explored the influence of culture and language on IMGs clinical communication skills, in particular, their ability to seek, detect and acknowledge patients' concerns in a high stakes postgraduate clinical skills examination. Hofstede's cultural dimensions framework was used to look at the impact of culture on examination performance. This was a qualitative, interpretative study using thematic content analysis of video-recorded doctor-simulated patient consultations of candidates sitting the MRCP(UK) PACES examination, at a single examination centre in November 2012. The research utilised Hofstede's cultural dimension theory, a framework for comparing cultural factors amongst different nations, to help understand the reasons for failure. Five key themes accounted for the majority of communication failures in station 2, "history taking" and station 4, "communication skills and ethics" of the MRCP(UK) PACES examination. Two themes, the ability to detect clues and the ability to address concerns, related directly to the overall construct managing patients' concerns. Three other themes were found to impact the whole consultation. These were building relationships, providing structure and explanation and planning. Hofstede's cultural dimensions may help to contextualise some of these observations. In some cultures doctor and patient roles are relatively inflexible: the doctor may convey less information to the patient (higher power distance societies) and give less attention to building rapport (high uncertainty avoidance societies.) This may explain why cues and concerns presented by patients were overlooked in this setting. Understanding cultural differences through Hofstede's cultural dimensions theory

Drama to promote non-verbal communication skills.

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Kelly, Martina; Nixon, Lara; Broadfoot, Kirsten; Hofmeister, Marianna; Dornan, Tim

2018-05-23

Non-verbal communication skills (NVCS) help physicians to deliver relationship-centred care, and the effective use of NVCS is associated with improved patient satisfaction, better use of health services and high-quality clinical care. In contrast to verbal communication skills, NVCS training is under developed in communication curricula for the health care professions. One of the challenges teaching NVCS is their tacit nature. In this study, we evaluated drama exercises to raise awareness of NVCS by making familiar activities 'strange'. Workshops based on drama exercises were designed to heighten an awareness of sight, hearing, touch and proxemics in non-verbal communication. These were conducted at eight medical education conferences, held between 2014 and 2016, and were open to all conference participants. Workshops were evaluated by recording narrative data generated during the workshops and an open-ended questionnaire following the workshop. Data were analysed qualitatively, using thematic analysis. Non-verbal communication skills help doctors to deliver relationship-centred care RESULTS: One hundred and twelve participants attended workshops, 73 (65%) of whom completed an evaluation form: 56 physicians, nine medical students and eight non-physician faculty staff. Two themes were described: an increased awareness of NVCS and the importance of NVCS in relationship building. Drama exercises enabled participants to experience NVCS, such as sight, sound, proxemics and touch, in novel ways. Participants reflected on how NCVS contribute to developing trust and building relationships in clinical practice. Drama-based exercises elucidate the tacit nature of NVCS and require further evaluation in formal educational settings. © 2018 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

The effect of short-term workshop on improving clinical reasoning skill of medical students.

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Yousefichaijan, Parsa; Jafari, Farshad; Kahbazi, Manijeh; Rafiei, Mohammad; Pakniyat, AbdolGhader

2016-01-01

Clinical reasoning process leads clinician to get purposeful steps from signs and symptoms toward diagnosis and treatment. This research intends to investigate the effect of teaching clinical reasoning on problem-solving skills of medical students. This research is a semi-experimental study. Nineteen Medical student of the pediatric ward as case group participated in a two-day workshop for training clinical reasoning. Before the workshop, they filled out Diagnostic Thinking Inventory (DTI) questionnaires. Fifteen days after the workshop the DTI questionnaire completed and "key feature" (KF) test and "clinical reasoning problem" (CRP) test was held. 23 Medical student as the control group, without passing the clinical reasoning workshop DTI questionnaire completed, and KF test and CRP test was held. The average score of the DTI questionnaire in the control group was 162.04 and in the case group before the workshop was 153.26 and after the workshop was 181.68. Compare the average score of the DTI questionnaire before and after the workshop there is a significant difference. The difference between average KF test scores in the control and the case group was not significant but between average CRP test scores was significant. Clinical reasoning workshop is effectiveness in promoting problem-solving skills of students.

Sound

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Robertson, William C

2003-01-01

Muddled about what makes music? Stuck on the study of harmonics? Dumbfounded by how sound gets around? Now you no longer have to struggle to teach concepts you really don t grasp yourself. Sound takes an intentionally light touch to help out all those adults science teachers, parents wanting to help with homework, home-schoolers seeking necessary scientific background to teach middle school physics with confidence. The book introduces sound waves and uses that model to explain sound-related occurrences. Starting with the basics of what causes sound and how it travels, you'll learn how musical instruments work, how sound waves add and subtract, how the human ear works, and even why you can sound like a Munchkin when you inhale helium. Sound is the fourth book in the award-winning Stop Faking It! Series, published by NSTA Press. Like the other popular volumes, it is written by irreverent educator Bill Robertson, who offers this Sound recommendation: One of the coolest activities is whacking a spinning metal rod...

Rapid application design of an electronic clinical skills portfolio for undergraduate medical students.

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Dornan, Tim; Lee, Catherine; Stopford, Adam; Hosie, Liam; Maredia, Neil; Rector, Alan

2005-04-01

The aim was to find how to use information and communication technology to present the clinical skills content of an undergraduate medical curriculum. Rapid application design was used to develop the product, and technical action research was used to evaluate the development process. A clinician-educator, two medical students, two computing science masters students, two other project workers, and a hospital education informatics lead, formed a design team. A sample of stakeholders took part in requirements planning workshops and continued to advise the team throughout the project. A university hospital had many features that favoured fast, inexpensive, and successful system development: a clearly defined and readily accessible user group; location of the development process close to end-users; fast, informal communication; leadership by highly motivated and senior end-users; devolved authority and lack of any rigidly imposed management structure; cooperation of clinicians because the project drew on their clinical expertise to achieve scholastic goals; a culture of learning and involvement of highly motivated students. A detailed specification was developed through storyboarding, use case diagramming, and evolutionary prototyping. A very usable working product was developed within weeks. "SkillsBase" is a database web application using Microsoft Active Server Pages, served from a Microsoft Windows 2000 Server operating system running Internet Information Server 5.0. Graphing functionality is provided by the KavaChart applet. It presents the skills curriculum, provides a password-protected portfolio function, and offers training materials. The curriculum can be presented in several different ways to help students reflect on their objectives and progress towards achieving them. The reflective portfolio function is entirely private to each student user and allows them to document their progress in attaining skills, as judged by self, peer and tutor assessment, and

Clinical Skills Verification in General Psychiatry: Recommendations of the ABPN Task Force on Rater Training

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Jibson, Michael D.; Broquet, Karen E.; Anzia, Joan Meyer; Beresin, Eugene V.; Hunt, Jeffrey I.; Kaye, David; Rao, Nyapati Raghu; Rostain, Anthony Leon; Sexson, Sandra B.; Summers, Richard F.

2012-01-01

Objective: The American Board of Psychiatry and Neurology (ABPN) announced in 2007 that general psychiatry training programs must conduct Clinical Skills Verification (CSV), consisting of observed clinical interviews and case presentations during residency, as one requirement to establish graduates' eligibility to sit for the written certification…

In vivo breast sound-speed imaging with ultrasound tomography

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Huang, Lianjie [Los Alamos National Laboratory; Li, Cuiping [KARMANOS CANCER INSTITUTE; Duric, Neb [KARMANOS CANCER INSTITUTE; Littrup, Peter [KARMONOS CANCER INSTITUTE

2009-01-01

We discuss a bent-ray ultrasound tomography algorithm with total-variation (TV) regularization. We have applied this algorithm to 61 in vivo breast datasets collected with our in-house clinical prototype for imaging sound-speed distributions in the breast. Our analysis showed that TV regularization could preserve sharper lesion edges than the classic Tikhonov regularization. Furthermore, the image quality of our TV bent-ray sound-speed tomograms was superior to that of the straight-ray counterparts for all types of breasts within BI-RADS density categories 1-4. For all four breast types from fatty to dense, the improvements for average sharpness (in the unit of (m{center_dot} s) {sup -1}) of lesion edges in our TV bent-ray tomograms are between 2.1 to 3.4 fold compared to the straight ray tomograms. Reconstructed sound-speed tomograms illustrated that our algorithm could successfully image fatty and glandular tissues within the breast. We calculated the mean sound-speed values for fatty tissue and breast parenchyma as 1422 {+-} 9 mls (mean{+-} SD) and1487 {+-} 21 mls, respectively. Based on 32 lesions in a cohort of 61 patients, we also found that the mean sound-speed for malignant breast lesions (1548{+-}17 mls) was higher, on average, than that of benign ones (1513{+-}27 mls) (one-sided pclinically, sound-speed tomograms can be used to assess breast density (, and therefore, breast cancer risk), as well as detect and help differentiate breast lesions. Finally, our sound-speed tomograms may also be a useful tool to monitor clinical response of breast cancer patients to neo-adjuvant chemotherapy.

Factors affecting acquisition of psychomotor clinical skills by student nurses and midwives in CHAM Nursing Colleges in Malawi: A qualitative exploratory study.

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Mwale, Omero Gonekani; Kalawa, Roselyn

2016-01-01

Acquisition of psychomotor clinical skills has been shown to improve the quality of care provided to patients when care providers are competent. The aim of this study was to explore students, nurses and tutors experience on factors affecting acquisition of psychomotor clinical skills. The study employed an exploratory qualitative research design. The population was students, clinical nurses and tutors from a nursing College and mission hospital in the southern region of Malawi. In depth interviews using a semi structured guide was used to collect data. Thematic analysis method was employed to analyze the collected data. Ethical principles of respect of human dignity, beneficence and justice were observed. The findings have shown that acquisition of psychomotor skills is affected by: student motivation, lack of resources, learning environment, knowledge gap between the qualified nurses and tutors, and role modeling. In principle when student nurses have acquired necessary skills the quality of care provided to patients improve. Basing on the findings of this study it is recommended that Student should be well prepared before clinical placement Nurses and tutors should also update their knowledge and clinical teaching skills for them to adequately guide students. The clinical arena should have adequate resources.

Transfer of communication skills to the workplace during clinical rounds: impact of a program for residents.

Directory of Open Access Journals (Sweden)

Aurore Liénard

2010-08-01

Full Text Available Communication with patients is a core clinical skill in medicine that can be acquired through communication skills training. Meanwhile, the importance of transfer of communication skills to the workplace has not been sufficiently studied. This study aims to assess the efficacy of a 40-hour training program designed to improve patients' satisfaction and residents' communication skills during their daily clinical rounds.Residents were randomly assigned to the training program or to a waiting list. Patients' satisfaction was assessed with a visual analog scale after each visit. Transfer of residents' communication skills was assessed in audiotaped actual inpatient visits during a half-day clinical round. Transcripted audiotapes were analyzed using content analysis software (LaComm. Training effects were tested with Mann-Whitney tests and generalized linear Poisson regression models.Eighty-eight residents were included. First, patients interacting with trained residents reported a higher satisfaction with residents' communication (Median=92 compared to patients interacting with untrained residents (Median=88 (p=.046. Second, trained residents used more assessment utterances (Relative Risk (RR=1.17; 95% Confidence intervals (95%CI=1.02-1.34; p=.023. Third, transfer was also observed when residents' training attendance was considered: residents' use of assessment utterances (RR=1.01; 95%CI=1.01-1.02; p=.018 and supportive utterances (RR=0.99; 95%CI=0.98-1.00; p=.042 (respectively 1.15 (RR, 1.08-1.23 (95%CI, p<.001 for empathy and 0.95 (RR, 0.92-0.99 (95%CI, p=.012 for reassurance was proportional to the number of hours of training attendance.The training program improved patients' satisfaction and allowed the transfer of residents' communication skills learning to the workplace. Transfer was directly related to training attendance but remained limited. Future studies should therefore focus on the improvement of the efficacy of communication skills

Validation of a clinical critical thinking skills test in nursing

OpenAIRE

Shin, Sujin; Jung, Dukyoo; Kim, Sungeun

2015-01-01

Purpose: The purpose of this study was to develop a revised version of the clinical critical thinking skills test (CCTS) and to subsequently validate its performance. Methods: This study is a secondary analysis of the CCTS. Data were obtained from a convenience sample of 284 college students in June 2011. Thirty items were analyzed using item response theory and test reliability was assessed. Test-retest reliability was measured using the results of 20 nursing college and graduate school stud...

Investigation of blended learning video resources to teach health students clinical skills: An integrative review.

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Coyne, Elisabeth; Rands, Hazel; Frommolt, Valda; Kain, Victoria; Plugge, Melanie; Mitchell, Marion

2018-04-01

The aim of this review is to inform future educational strategies by synthesising research related to blended learning resources using simulation videos to teach clinical skills for health students. An integrative review methodology was used to allow for the combination of diverse research methods to better understand the research topic. This review was guided by the framework described by Whittemore and Knafl (2005), DATA SOURCES: Systematic search of the following databases was conducted in consultation with a librarian using the following databases: SCOPUS, MEDLINE, COCHRANE, PsycINFO databases. Keywords and MeSH terms: clinical skills, nursing, health, student, blended learning, video, simulation and teaching. Data extracted from the studies included author, year, aims, design, sample, skill taught, outcome measures and findings. After screening the articles, extracting project data and completing summary tables, critical appraisal of the projects was completed using the Mixed Methods Appraisal Tool (MMAT). Ten articles met all the inclusion criteria and were included in this review. The MMAT scores varied from 50% to 100%. Thematic analysis was undertaken and we identified the following three themes: linking theory to practice, autonomy of learning and challenges of developing a blended learning model. Blended learning allowed for different student learning styles, repeated viewing, and enabled links between theory and practice. The video presentation needed to be realistic and culturally appropriate and this required both time and resources to create. A blended learning model, which incorporates video-assisted online resources, may be a useful tool to teach clinical skills to students of health including nursing. Blended learning not only increases students' knowledge and skills, but is often preferred by students due to its flexibility. Copyright © 2018 Elsevier Ltd. All rights reserved.

Providing specialist clinical skills in soft tissue and intra-articular injection through a postgraduate masters module.

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Stevenson, Kay; Waterfield, Jackie

2005-01-01

Current philosophy and policy changes in the National Health Service are encouraging healthcare practitioners to extend their clinical skills to create a more patient-centred approach thus allowing patients to be seen in a timely and more appropriate manner. This often requires further development of the practitioners' skills and knowledge. One approach to achieve this is through collaboration between employers and educational providers to ensure that educational experience is not only evidence based but also responsive to the needs of the current and future workforce. A postgraduate module was developed to raise critical and evaluative skills, as well as the technical skills of practitioners using injections in the management of joint and soft tissue pathology, while developing a professional responsibility towards injection practice. The module emphasized learning though experience by contextualizing the theoretical aspects of the module and by its student centred assessments. Further strengths of this module are that it has utilized academic and clinical expertise and knowledge to enable clinicians to gain additional skills and the multidisciplinary approach engendered good working practice Overall the module was evaluated positively by both tutors and students and not only met its aims but also addressed the current professional and policy issues around continuing professional development. Copyright (c) 2005 John Wiley & Sons, Ltd.

Developing an Evaluation Tool for Assessing Clinical Ethics Consultation Skills in Simulation Based Education: The ACES Project.

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Wasson, Katherine; Parsi, Kayhan; McCarthy, Michael; Siddall, Viva Jo; Kuczewski, Mark

2016-06-01

The American Society for Bioethics and Humanities has created a quality attestation (QA) process for clinical ethics consultants; the pilot phase of reviewing portfolios has begun. One aspect of the QA process which is particularly challenging is assessing the interpersonal skills of individual clinical ethics consultants. We propose that using case simulation to evaluate clinical ethics consultants is an approach that can meet this need provided clear standards for assessment are identified. To this end, we developed the Assessing Clinical Ethics Skills (ACES) tool, which identifies and specifies specific behaviors that a clinical ethics consultant should demonstrate in an ethics case simulation. The aim is for the clinical ethics consultant or student to use a videotaped case simulation, along with the ACES tool scored by a trained rater, to demonstrate their competence as part of their QA portfolio. The development and piloting of the tool is described.

Heart sound segmentation of pediatric auscultations using wavelet analysis.

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Castro, Ana; Vinhoza, Tiago T V; Mattos, Sandra S; Coimbra, Miguel T

2013-01-01

Auscultation is widely applied in clinical activity, nonetheless sound interpretation is dependent on clinician training and experience. Heart sound features such as spatial loudness, relative amplitude, murmurs, and localization of each component may be indicative of pathology. In this study we propose a segmentation algorithm to extract heart sound components (S1 and S2) based on it's time and frequency characteristics. This algorithm takes advantage of the knowledge of the heart cycle times (systolic and diastolic periods) and of the spectral characteristics of each component, through wavelet analysis. Data collected in a clinical environment, and annotated by a clinician was used to assess algorithm's performance. Heart sound components were correctly identified in 99.5% of the annotated events. S1 and S2 detection rates were 90.9% and 93.3% respectively. The median difference between annotated and detected events was of 33.9 ms.

An integrated 2-year clinical skills peer tutoring scheme in a UK-based medical school: perceptions of tutees and peer tutors

Science.gov (United States)

2018-01-01

Background Several benefits of peer tutoring in medical school teaching have been described. However, there is a lack of research on the perceptions of peer tutoring, particularly from tutees who partake in a long-term clinical skills scheme integrated into the medical school curriculum. This study evaluates the opinions of preclinical tutees at the end of a 2-year peer-tutored clinical skills program and peer tutors themselves. Methods A cross-sectional study was conducted in a UK-based medical school that primarily utilizes peer tutoring for clinical skills teaching. A questionnaire was designed to assess the views of preclinical tutees and peer tutors. Likert scales were used to grade responses and comment boxes to collect qualitative data. Results Sixty-five questionnaires were collected (52 tutees, 13 peer tutors). Seventy-nine percent of students felt satisfied with their teaching, and 70% felt adequately prepared for clinical placements. Furthermore, 79% believed that peer tutoring is the most effective method for clinical skills teaching. When compared to faculty teaching, tutees preferred being taught by peer tutors (63%), felt more confident (73%), and were more willing to engage (77%). All peer tutors felt that teaching made them more confident in their Objective Structured Clinical Examination performance, and 91% agreed that being a tutor made them consider pursuing teaching in the future. Thematic analysis of qualitative data identified 3 themes regarding peer tutoring: a more comfortable environment (69%), a more personalized teaching approach (34%), and variation in content taught (14%). Conclusion Preclinical tutees prefer being taught clinical skills by peer tutors compared to faculty, with the peer tutors also benefitting. Studies such as this, looking at long-term schemes, further validate peer tutoring and may encourage more medical schools to adopt this method as an effective way of clinical skills teaching. PMID:29922105

A Novel Clinical-Simulated Suture Education for Basic Surgical Skill: Suture on the Biological Tissue Fixed on Standardized Patient Evaluated with Objective Structured Assessment of Technical Skill (OSATS) Tools.

Science.gov (United States)

Shen, Zhanlong; Yang, Fan; Gao, Pengji; Zeng, Li; Jiang, Guanchao; Wang, Shan; Ye, Yingjiang; Zhu, Fengxue

2017-06-21

Clinical-simulated training has shown benefit in the education of medical students. However, the role of clinical simulation for surgical basic skill training such as suturing techniques remains unclear. Forty-two medical students were asked to perform specific suturing tasks at three stations with the different settings within four minutes (Station 1: Synthetic suture pad fixed on the bench, Station 2: Synthetic suture pad fixed on the standardized patient, Station 3: Pig skin fixed on the standardized patient); the OSATS (Objective Structured Assessment of Technical Skill) tool was used to evaluate the performance of students. A questionnaire was distributed to the students following the examination. Mean performance score of Station 3 was significant lower than that of Station 1 and 2 in the general performance including tissue handling, time, and motion. The suturing techniques of students at Station 2 and 3 were not as accurate as that at Station 1. Inappropriate tension was applied to the knot at Station 2 compared with Station 1 and 3. On the questionnaire, 93% of students considered clinical-simulated training of basic surgical skills was necessary and may increase their confidence in future clinical work as surgeons; 98% of students thought the assessment was more objective when OSATS tool was used for evaluation. Clinical simulation examination assessed with OSATS might throw a novel light on the education of basic surgical skills and may be worthy of wider adoption in the surgical education of medical students.

Teaching communication skills: beyond wishful thinking.

Science.gov (United States)

Junod Perron, Noelle; Sommer, Johanna; Louis-Simonet, Martine; Nendaz, Mathieu

2015-01-01

Communication skills tend to decline with time unless they are regularly recalled and practiced. However, most medical schools still deliver clinical communication training only during pre-clinical years although the clinical environment is considered to be ideal for acquiring and teaching clinical communication. The aim of this article is to review the barriers that prevent communication skills teaching and training from occurring in clinical practice and describe strategies that may help enhance such activities. Barriers occur at several levels: students, junior doctors and clinical supervisors sometimes have negative attitudes towards communication training; structured training in communication skills is often insufficient; clinical supervisors behave as poor role models and lack effective communication and teaching skills; finally, there are organisational constraints such as lack of time, competing priorities, weak hierarchy support and lack of positive incentives for using, training or teaching good communication skills in clinical practice. Given the difficulty of assessing transfer of communication skills in practice, only few studies describe successful educational interventions. In order to optimise communication skills learning in practice, there is need to: (1.) modify the climate and structure of the working environment so that that use, training and teaching of good communication skills in clinical practice becomes valued, supported and rewarded; (2.) extend communication skills training to any field of medicine; (3.) provide regular structured trainings and tailor them to trainees' needs. Practical implications of such findings are discussed at the end of this review.

Situated cognition and cognitive apprenticeship: a model for teaching and learning clinical skills in a technologically rich and authentic learning environment.

Science.gov (United States)

Woolley, Norman N; Jarvis, Yvonne

2007-01-01

The acquisition of a range of diverse clinical skills is a central feature of the pre-registration nursing curriculum. Prior to exposure to clinical practice, it is essential that learners have the opportunity to practise and develop such skills in a safe and controlled environment under the direction and supervision of clinical experts. However, the competing demands of the HE nursing curriculum coupled with an increased number of learners have resulted in a reduced emphasis on traditional apprenticeship learning. This paper presents an alternative model for clinical skills teaching that draws upon the principles of cognitive apprenticeship [Collins, A., Brown, J.S., Newman, S., 1989. Cognitive Apprenticeship: teaching the crafts of reading, writing and mathematics. In: Resnick, L.B. (Ed.) Knowing. Learning and Instruction: Essays in Honor of Robert Glaser. Lawrence Erlbaum Associates, New Jersey, pp. 453-494] and situated cognition within a technologically rich and authentic learning environment. It will show how high quality DVD materials illustrating clinical skills performed by expert practitioners have been produced and used in conjunction with CCTV and digital recording technologies to support learning within a pedagogic framework appropriate to skills acquisition. It is argued that this model not only better prepares the student for the time they will spend in the practice setting, but also lays the foundation for the development of a clinically competent practitioner with the requisite physical and cognitive skills who is fit for purpose [UKCC, 1999. Fitness for Practice: The UKCC Commission for Nursing and Midwifery Education. United Kingdom Central Council for Nursing Midwifery and Health Visiting, London].

Assessing the Clinical Skills of Dental Students: A Review of the Literature

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Taylor, Carly L.; Grey, Nick; Satterthwaite, Julian D.

2013-01-01

Education, from a student perspective, is largely driven by assessment. An effective assessment tool should be both valid and reliable, yet this is often not achieved. The aim of this literature review is to identify and appraise the evidence base for assessment tools used primarily in evaluating clinical skills of dental students. Methods:…

Noise detection in heart sound recordings.

Science.gov (United States)

Zia, Mohammad K; Griffel, Benjamin; Fridman, Vladimir; Saponieri, Cesare; Semmlow, John L

2011-01-01

Coronary artery disease (CAD) is the leading cause of death in the United States. Although progression of CAD can be controlled using drugs and diet, it is usually detected in advanced stages when invasive treatment is required. Current methods to detect CAD are invasive and/or costly, hence not suitable as a regular screening tool to detect CAD in early stages. Currently, we are developing a noninvasive and cost-effective system to detect CAD using the acoustic approach. This method identifies sounds generated by turbulent flow through partially narrowed coronary arteries to detect CAD. The limiting factor of this method is sensitivity to noises commonly encountered in the clinical setting. Because the CAD sounds are faint, these noises can easily obscure the CAD sounds and make detection impossible. In this paper, we propose a method to detect and eliminate noise encountered in the clinical setting using a reference channel. We show that our method is effective in detecting noise, which is essential to the success of the acoustic approach.

Tensions in learning professional identities - nursing students' narratives and participation in practical skills during their clinical practice: an ethnographic study.

Science.gov (United States)

Ewertsson, Mona; Bagga-Gupta, Sangeeta; Allvin, Renée; Blomberg, Karin

2017-01-01

Clinical practice is a pivotal part of nursing education. It provides students with the opportunity to put the knowledge and skills they have acquired from lectures into practice with real patients, under the guidance of registered nurses. Clinical experience is also essential for shaping the nursing students' identity as future professional nurses. There is a lack of knowledge and understanding of the ways in which students learn practical skills and apply knowledge within and across different contexts, i.e. how they apply clinical skills, learnt in the laboratory in university settings, in the clinical setting. The aim of this study was therefore to explore how nursing students describe, and use, their prior experiences related to practical skills during their clinical practice. An ethnographic case study design was used. Fieldwork included participant observations (82 h), informal conversations, and interviews ( n  = 7) that were conducted during nursing students' ( n  = 17) clinical practice at an emergency department at a university hospital in Sweden. The overarching theme identified was "Learning about professional identities with respect to situated power". This encompasses tensions in students' learning when they are socialized into practical skills in the nursing profession. This overarching theme consists of three sub-themes: "Embodied knowledge", "Divergent ways of assessing and evaluating knowledge" and "Balancing approaches". Nursing students do not automatically possess the ability to transfer knowledge from one setting to another; rather, their development is shaped by their experiences and interactions with others when they meet real patients. The study revealed different ways in which students navigated tensions related to power differentials. Reflecting on actions is a prerequisite for developing and learning practical skills and professional identities. This highlights the importance of both educators' and the preceptors' roles for

Using newly deceased patients in teaching clinical skills: its ethical and educational challenges.

Science.gov (United States)

Saber, Mahboobeh; Enjoo, Seyed Ali; Mahboudi, Ali; Tabei, Seyed Ziaadin

2018-04-01

The newly deceased patients have long been used in medical schools to teach clinical skills without any challenges as it helps to train skilled doctors. Nowadays, the use of moulages and simulators are common in teaching clinical skills since these tools provide the opportunity for frequent practice without any pain and injury. There are specific procedures which still require the use of cadavers. However, the increased significance of patient rights has generally challenged the practicality of using the deceased bodies for this purpose. This study was designed with the aim of determining to what extent clinical skill training is dependent on the recently deceased patients. This was a cross-sectional mixed-method triangulation design conducted in two phases. In the first phase, a researcher-made questionnaire was used to collect quantitative data of the medical students and residents. The data were used to assess the frequency of experience. In the second stage, semi-structured interviews were conducted with faculty members and fellows in order to evaluate the educational impact of this type of procedure and the influential factors. The quantitative data were analyzed using statistical software, and the qualitative codes were extracted following a content analysis. Finally, a comparative analysis was performed. Twenty five residents (26%) and seven medical students (14%) had the experience of performing procedures on the recently deceased patients for training purposes. About half of the residents and 33% of the medical students had observed their colleagues practicing procedures on cadavers. In the qualitative phase, the main categories included professional ethics, law and educational requirements. A relatively low number of medical students and residents had experienced procedures on the newly deceased patients. In this regard, ethical, religious and legal concerns might have played a part despite the desire to learn. It would be effective to direct these

Contributions of Emergent Literacy Skills to Name Writing, Letter Writing, and Spelling in Preschool Children

Science.gov (United States)

Puranik, Cynthia S.; Lonigan, Christopher J.; Kim, Young-Suk

2011-01-01

The purpose of this study was to examine which emergent literacy skills contribute to preschool children’s emergent writing (name-writing, letter-writing, and spelling) skills. Emergent reading and writing tasks were administered to 296 preschool children aged 4–5 years. Print knowledge and letter-writing skills made positive contributions to name writing; whereas alphabet knowledge, print knowledge, and name writing made positive contributions to letter writing. Both name-writing and letter-writing skills made significant contributions to the prediction of spelling after controlling for age, parental education, print knowledge, phonological awareness, and letter-name and letter-sound knowledge; however, only letter-writing abilities made a significant unique contribution to the prediction of spelling when both letter-writing and name-writing skills were considered together. Name writing reflects knowledge of some letters rather than a broader knowledge of letters that may be needed to support early spelling. Children’s letter-writing skills may be a better indicator of children’s emergent literacy and developing spelling skills than are their name-writing skills at the end of the preschool year. Spelling is a developmentally complex skill beginning in preschool and includes letter writing and blending skills, print knowledge, and letter-name and letter-sound knowledge. PMID:21927537

Online learning versus blended learning of clinical supervisee skills with pre-registration nursing students: A randomised controlled trial.

Science.gov (United States)

McCutcheon, Karen; O'Halloran, Peter; Lohan, Maria

2018-06-01

The World Health Organisation amongst others recognises the need for the introduction of clinical supervision education in health professional education as a central strategy for improving patient safety and patient care. Online and blended learning methods are growing exponentially in use in higher education and the systematic evaluation of these methods will aid understanding of how best to teach clinical supervision. The purpose of this study was to test whether undergraduate nursing students who received clinical supervisee skills training via a blended learning approach would score higher in terms of motivation and attitudes towards clinical supervision, knowledge of clinical supervision and satisfaction of learning method, when compared to those students who received an online only teaching approach. A post-test-only randomised controlled trial. Participants were a total of 122 pre-registration nurses enrolled at one United Kingdom university, randomly assigned to the online learning control group (n = 60) or the blended learning intervention group (n = 62). The blended learning intervention group participated in a face-to-face tutorial and the online clinical supervisee skills training app. The online learning control group participated in an online discussion forum and the same online clinical supervisee skills training app. The outcome measures were motivation and attitudes using the modified Manchester Clinical Supervision Scale, knowledge using a 10 point Multiple Choice Questionnaire and satisfaction using a university training evaluation tool. Statistical analysis was performed using independent t-tests to compare the differences between the means of the control group and the intervention group. Thematic analysis was used to analyse responses to open-ended questions. All three of our study hypotheses were confirmed. Participants who received clinical supervisee skills training via a blended learning approach scored higher in terms of motivation

A survey of clinical performance skills requirements in medical radiation technology

International Nuclear Information System (INIS)

Rowntree, P.A.; Veitch, J.D.

1993-01-01

This paper outlines the reasons behind carry out a study of clinical performance skills requirements and the method being used to gather data. It describes the changes which have occurred in radiographer education in Queensland, the broader impact brought about by changes in professional body requirements and the development of a Competency based Standards Document for the profession. The paper provides examples of the survey design and layout being developed for distribution to third year students in the Medical Imaging Technology major of the Bachelor of Applied Science (Medical Radiation Technology) Queensland University of Technology, graduates and clinical departments in Queensland. 1 tab., 1 fig

Decoding Skills Acquired by Low Readers Taught in Regular Classrooms Using Clinical Techniques. Research Report No. 35.

Science.gov (United States)

Gallistel, Elizabeth; Fischer, Phyllis

This study evaluated the decoding skills acquired by low readers in an experimental project that taught low readers in regular class through the use of clinical procedures based on a synthetic phonic, multisensory approach. An evaluation instrument which permitted the tabulation of specific decoding skills was administered as a pretest and…

Design of Wearable Breathing Sound Monitoring System for Real-Time Wheeze Detection

Directory of Open Access Journals (Sweden)

Shih-Hong Li

2017-01-01

Full Text Available In the clinic, the wheezing sound is usually considered as an indicator symptom to reflect the degree of airway obstruction. The auscultation approach is the most common way to diagnose wheezing sounds, but it subjectively depends on the experience of the physician. Several previous studies attempted to extract the features of breathing sounds to detect wheezing sounds automatically. However, there is still a lack of suitable monitoring systems for real-time wheeze detection in daily life. In this study, a wearable and wireless breathing sound monitoring system for real-time wheeze detection was proposed. Moreover, a breathing sounds analysis algorithm was designed to continuously extract and analyze the features of breathing sounds to provide the objectively quantitative information of breathing sounds to professional physicians. Here, normalized spectral integration (NSI was also designed and applied in wheeze detection. The proposed algorithm required only short-term data of breathing sounds and lower computational complexity to perform real-time wheeze detection, and is suitable to be implemented in a commercial portable device, which contains relatively low computing power and memory. From the experimental results, the proposed system could provide good performance on wheeze detection exactly and might be a useful assisting tool for analysis of breathing sounds in clinical diagnosis.

A model for educational feedback based on clinical communication skills strategies: beyond the "feedback sandwich".

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Milan, Felise B; Parish, Sharon J; Reichgott, Michael J

2006-01-01

Feedback is an essential tool in medical education, and the process is often difficult for both faculty and learner. There are strong analogies between the provision of educational feedback and doctor-patient communication during the clinical encounter. Relationship-building skills used in the clinical setting-Partnership, Empathy, Apology, Respect, Legitimation, Support (PEARLS)-can establish trust with the learner to better manage difficult feedback situations involving personal issues, unprofessional behavior, or a defensive learner. Using the stage of readiness to change (transtheoretical) model, the educator can "diagnose" the learner's stage of readiness and employ focused interventions to encourage desired changes. This approach has been positively received by medical educators in faculty development workshops. A model for provision of educational feedback based on communication skills used in the clinical encounter can be useful in the medical education setting. More robust evaluation of the construct validity is required in actual training program situations.

Predicting failing performance on a standardized patient clinical performance examination: the importance of communication and professionalism skills deficits.

Science.gov (United States)

Chang, Anna; Boscardin, Christy; Chou, Calvin L; Loeser, Helen; Hauer, Karen E

2009-10-01

The purpose is to determine which assessment measures identify medical students at risk of failing a clinical performance examination (CPX). Retrospective case-control, multiyear design, contingency table analysis, n = 149. We identified two predictors of CPX failure in patient-physician interaction skills: low clerkship ratings (odds ratio 1.79, P = .008) and student progress review for communication or professionalism concerns (odds ratio 2.64, P = .002). No assessments predicted CPX failure in clinical skills. Performance concerns in communication and professionalism identify students at risk of failing the patient-physician interaction portion of a CPX. This correlation suggests that both faculty and standardized patients can detect noncognitive traits predictive of failing performance. Early identification of these students may allow for development of a structured supplemental curriculum with increased opportunities for practice and feedback. The lack of predictors in the clinical skills portion suggests limited faculty observation or feedback.

Clinical psychomotor skills among left and right handed medical students: are the left-handed medical students left out?

Science.gov (United States)

Alnassar, Sami; Alrashoudi, Aljoharah Nasser; Alaqeel, Mody; Alotaibi, Hala; Alkahel, Alanoud; Hajjar, Waseem; Al-Shaikh, Ghadeer; Alsaif, Abdulaziz; Haque, Shafiul; Meo, Sultan Ayoub

2016-03-22

There is a growing perception that the left handed (LH) medical students are facing difficulties while performing the clinical tasks that involve psychomotor skill, although the evidence is very limited and diverse. The present study aimed to evaluate the clinical psychomotor skills among Right-handed (RH) and left-handed (LH) medical students. For this study, 54 (27 left handed and 27 right handed) first year medical students were selected. They were trained for different clinical psychomotor skills including suturing, laparoscopy, intravenous cannulation and urinary catheterization under the supervision of certified instructors. All students were evaluated for psychomotor skills by different instructors. The comparative performance of the students was measured by using a global rating scale, each selected criteria was allotted 5-points score with the total score of 25. There were no significant differences in the performance of psychomotor skills among LH and RH medical students. The global rating score obtained by medical students in suturing techniques was: LH 15.89 ± 2.88, RH 16.15 ± 2.75 (p = 0.737), cannulation techniques LH 20.44 ± 2.81, RH 20.70 ± 2.56 (p = 0.725), urinary catheterization LH 4.33 ± 0.96 RH 4.11 ± 1.05 (p = 0.421). For laparoscopic skills total peg transfer time was shorter among LH medical students compared to RH medical students (LH 129.85 ± 80.87 s vs RH 135.52 ± 104.81 s) (p = 0.825). However, both RH and LH students completed their procedure within the stipulated time. Among LH and RH medical students no significant difference was observed in performing the common surgical psychomotor skills. Surgical skills for LH or RH might not be a result of innate dexterity but rather the academic environment in which they are trained and assessed. Early laterality-related mentoring in medical schools as well as during the clinical residency might reduce the inconveniences faced by the left

[Simulation-based training and OR apprenticeship for medical students : A prospective, randomized, single-blind study of clinical skills].

Science.gov (United States)

Ott, T; Schmidtmann, I; Limbach, T; Gottschling, P F; Buggenhagen, H; Kurz, S; Pestel, G

2016-11-01

Simulation-based training (SBT) has developed into an established method of medical training. Studies focusing on the education of medical students have used simulation as an evaluation tool for defined skills. A small number of studies provide evidence that SBT improves medical students' skills in the clinical setting. Moreover, they were strictly limited to a few areas, such as the diagnosis of heart murmurs or the correct application of cricoid pressure. Other studies could not prove adequate transferability from the skills gained in SBT to the patient site. Whether SBT has an effect on medical students' skills in anesthesiology in the clinical setting is controversial. To explore this issue, we designed a prospective, randomized, single-blind trial that was integrated into the undergraduate anesthesiology curriculum of our department during the second year of the clinical phase of medical school. This study intended to explore the effect of SBT on medical students within the mandatory undergraduate anesthesiology curriculum of our department in the operating room with respect to basic skills in anesthesiology. After obtaining ethical approval, the participating students of the third clinical semester were randomized into two groups: the SIM-OR group was trained by a 225 min long SBT in basic skills in anesthesiology before attending the operating room (OR) apprenticeship. The OR-SIM group was trained after the operating room apprenticeship by SBT. During SBT the students were trained in five clinical skills detailed below. Further, two clinical scenarios were simulated using a full-scale simulator. The students had to prepare the patient and perform induction of anesthesia, including bag-mask ventilation after induction in scenario 1 and rapid sequence induction in scenario 2. Using the five-point Likert scale, five defined skills were evaluated at defined time points during the study period. 1) application of the safety checklist, 2) application of

Transferring clinical communication skills from the classroom to the clinical environment: perceptions of a group of medical students in the United kingdom.

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Brown, Jo

2010-06-01

To better understand the transfer of classroom-learned clinical communication skills (CCS) to the clinical environment of the hospital ward, where they are practiced and refined by students. The author first briefly presents the literature on clinical communication, provides an overview of the debates around the notion of transfer, and presents a sociocultural model of developmental transfer applied to CCS learning. Second, she describes a focus group and nine individual interviews carried out with 17 fourth-year medical students at one medical school in the United Kingdom in 2008. The goal was to elicit their views of CCS teaching, learning, and transfer of CCS to the clinical workplace. The findings are presented under the four main themes of transition, where students experienced the transition from the medical school to the hospital ward as a mixture of positive and negative impacts on transferring their CCS skills; the clinical culture, where senior doctors had the greatest impact on student learning and emergent clinical practice; clinical communication as a vehicle for professionalism and being a "good" doctor; and, finally, transfer mechanisms, where simulated practice with actors and the clinical history template were powerful learning tools. Findings indicate that more needs to be done to support, develop, and embed CCS into the professional practice of medical students in the clinical workplace. This may be achieved by greater collaboration of educators in the academic and clinical environments. Using the developmental transfer model applied to CCS learning may help foster this relationship.

Experiences of clinical teaching for dental core trainees working in hospital.

Science.gov (United States)

Mannion, C J; Brotherton, P

2014-07-11

There is recognition that the provision of excellence in education and training results in a skilled and competent workforce. However, the educational experiences of dental core trainees (DCT's) working in the hospital oral and maxillofacial surgery (OMFS) setting have not been previously investigated. In this paper, we examine DCT's learning experiences both 'formal' and 'non-formal' within the hospital setting of ward and clinic-based teaching. Are hospital dental core trainees receiving a meaningful educational experience? To conclude this paper, the authors recommend methods, based upon sound educational principles, to maximise the value of clinical sessions for teaching.

Assessment of first-year veterinary students' communication skills using an objective structured clinical examination: the importance of context.

Science.gov (United States)

Hecker, Kent G; Adams, Cindy L; Coe, Jason B

2012-01-01

Communication skills are considered to be a core clinical skill in veterinary medicine and essential for practice success, including outcomes of care for patients and clients. While veterinary schools include communication skills training in their programs, there is minimal knowledge on how best to assess communication competence throughout the undergraduate program. The purpose of this study was to further our understanding of the reliability, utility, and suitability of a communication skills Objective Structured Clinical Examination (OSCE). Specifically we wanted to (1) identify the greatest source of variability (student, rater, station, and track) within a first-year, four station OSCE using exam scores and scores from videotape review by two trained raters, and (2) determine the effect of different stations on students' communication skills performance. Reliability of the scores from both the exam data and the two expert raters was 0.50 and 0.46 respectively, with the greatest amount of variance attributable to student by station. The percentage of variance due to raters in the exam data was 16.35%, whereas the percentage of variance for the two expert raters was 0%. These results have three important implications. First, the results reinforce the need for communication educators to emphasize that use of communication skills is moderated by the context of the clinical interaction. Second, by increasing rater training the amount of error in the scores due to raters can be reduced and inter-rater reliability increases. Third, the communication assessment method (in this case the OSCE checklist) should be built purposefully, taking into consideration the context of the case.

A systematic review evaluating the impact of online or blended learning vs. face-to-face learning of clinical skills in undergraduate nurse education.

Science.gov (United States)

McCutcheon, Karen; Lohan, Maria; Traynor, Marian; Martin, Daphne

2015-02-01

To determine whether the use of an online or blended learning paradigm has the potential to enhance the teaching of clinical skills in undergraduate nursing. The need to adequately support and develop students in clinical skills is now arguably more important than previously considered due to reductions in practice opportunities. Online and blended teaching methods are being developed to try and meet this requirement, but knowledge about their effectiveness in teaching clinical skills is limited. Mixed methods systematic review, which follows the Joanna Briggs Institute User guide version 5. Computerized searches of five databases were undertaken for the period 1995-August 2013. Critical appraisal and data extraction were undertaken using Joanna Briggs Institute tools for experimental/observational studies and interpretative and critical research. A narrative synthesis was used to report results. Nineteen published papers were identified. Seventeen papers reported on online approaches and only two papers reported on a blended approach. The synthesis of findings focused on the following four areas: performance/clinical skill, knowledge, self-efficacy/clinical confidence and user experience/satisfaction. The e-learning interventions used varied throughout all the studies. The available evidence suggests that online learning for teaching clinical skills is no less effective than traditional means. Highlighted by this review is the lack of available evidence on the implementation of a blended learning approach to teaching clinical skills in undergraduate nurse education. Further research is required to assess the effectiveness of this teaching methodology. © 2014 John Wiley & Sons Ltd.

The effect of high-fidelity patient simulation on the critical thinking and clinical decision-making skills of new graduate nurses.

Science.gov (United States)

Maneval, Rhonda; Fowler, Kimberly A; Kays, John A; Boyd, Tiffany M; Shuey, Jennifer; Harne-Britner, Sarah; Mastrine, Cynthia

2012-03-01

This study was conducted to determine whether the addition of high-fidelity patient simulation to new nurse orientation enhanced critical thinking and clinical decision-making skills. A pretest-posttest design was used to assess critical thinking and clinical decision-making skills in two groups of graduate nurses. Compared with the control group, the high-fidelity patient simulation group did not show significant improvement in mean critical thinking or clinical decision-making scores. When mean scores were analyzed, both groups showed an increase in critical thinking scores from pretest to posttest, with the high-fidelity patient simulation group showing greater gains in overall scores. However, neither group showed a statistically significant increase in mean test scores. The effect of high-fidelity patient simulation on critical thinking and clinical decision-making skills remains unclear. Copyright 2012, SLACK Incorporated.

Psychomotor skills in medical ultrasound imaging: an analysis of the core skill set.

Science.gov (United States)

Nicholls, Delwyn; Sweet, Linda; Hyett, Jon

2014-08-01

Sonographers use psychomotor skills to perform medical ultrasound examinations. Psychomotor skills describe voluntary movements of the limb, joints, and muscles in response to sensory stimuli and are regulated by the motor neural cortex in the brain. We define a psychomotor skill in relation to medical ultrasound imaging as "the unique mental and motor activities required to execute a manual task safely and efficiently for each clinical situation." Skills in clinical ultrasound practice may be open or closed; most skills used in medical ultrasound imaging are open. Open skills are both complex and multidimensional. Visuomotor and visuospatial psychomotor skills are central components of medical ultrasound imaging. Both types of skills rely on learners having a visual exemplar or standard of performance with which to reference their skill performance and evaluate anatomic structures. These are imperative instructional design principles when teaching psychomotor skills. © 2014 by the American Institute of Ultrasound in Medicine.

A Clinic-Based Assessment for Evaluating Job-Related Social Skills in Adolescents and Adults with Autism.

Science.gov (United States)

Lerman, Dorothea C; White, Bridgette; Grob, Carolyn; Laudont, Courtney

2017-12-01

Many individuals with autism spectrum disorder (ASD) have difficulties obtaining and maintaining employment, yet little research has evaluated methods for assessing and improving critical vocational skills. In this study, we evaluated an assessment of job-related social skills for individuals with ASD by arranging conditions that simulated on-the-job experiences in a clinic setting. The experimenter contrived situations to assess a variety of social skills, including asking for help, asking for more materials, and responding to corrective feedback. A total of eight individuals, aged 16 to 32 years, participated. Results suggested that the assessment was useful for identifying specific social skills that could be targeted for intervention to increase success in the work environment. These findings add to the current literature by demonstrating an objective method for assessing a variety of job-related social skills under controlled, naturalistic conditions.

Understanding adults’ strong problem-solving skills based on PIAAC

OpenAIRE

Hämäläinen, Raija; De Wever, Bram; Nissinen, Kari; Cincinnato, Sebastiano

2017-01-01

Purpose Research has shown that the problem-solving skills of adults with a vocational education and training (VET) background in technology-rich environments (TREs) are often inadequate. However, some adults with a VET background do have sound problem-solving skills. The present study aims to provide insight into the socio-demographic, work-related and everyday life factors that are associated with a strong problem-solving performance. Design/methodology/approach The study builds...

Skills and attributes required by clinical nurse specialists to promote evidence-based practice.

Science.gov (United States)

Campbell, T Diane; Profetto-McGrath, Joanne

2013-01-01

The purposes of this article were to describe the challenges that clinical nurse specialists (CNS) face in their role and to examine how CNSs describe the skills and attributes that are needed to promote the use of evidence-based practice (EBP) in their workplaces. This article is based on findings from a dissertation regarding how CNSs promote EBP in a western Canadian province. A sequential explanatory participant selection mixed-methods design was used for this study. The study took place in a western Canadian province that has a population of 1 million people, with 42.7% of the population residing in the 2 largest cities. The sample was drawn from a provincial registered nurse database. The sample for the survey was 23, and for the interviews, there were 11 participants. The telephone survey contained 113 questions grouped into several subcategories. SPSS 18 was used to analyze the survey data. The semistructured interviews were conducted face to face, transcribed, and reviewed for recurrent themes. Interpretive description was used to analyze the themes. The major challenges faced by CNSs are role strain, lack of support and resources, and role ambiguity. The skills and attributes required to be a CNS are graduate preparation, clinical expertise, and people/communication skills. Clinical nurse specialists can improve patient outcomes by promoting EBP; to do so, they need to work in supportive contexts that give those in the CNS role a set of clear role expectations. There are challenges faced by CNSs in Canada, and there is a need to strengthen the CNS's role by standardizing the regulatory requirements at a national level.

Communication skills: an essential component of medical curricula. Part I: Assessment of clinical communication: AMEE Guide No. 51.

Science.gov (United States)

Laidlaw, Anita; Hart, Jo

2011-01-01

This AMEE Guide in Medical Education is Part 1 of a two part Guide covering the issues of Communication. This Guide has been written to provide guidance for those involved in planning the assessment of clinical communication and provides guidance and information relating to the assessment of various aspects of clinical communication; its underlying theory; its practical ability to show that an individual is competent and its relationship to students' daily performance. The advantages and disadvantages of assessing specific aspects of communication are also discussed. The Guide draws attention to the complexity of assessing the ability to communicate with patients and healthcare professionals, with issues of reliability and validity being highlighted for each aspect. Current debates within the area of clinical communication teaching are raised: when should the assessment of clinical communication occur in undergraduate medical education?; should clinical communication assessment be integrated with clinical skills assessment, or should the two be separate?; how important should the assessment of clinical communication be, and the question of possible failure of students if they are judged not competent in communication skills? It is the aim of the authors not only to provide a useful reference for those starting to develop their assessment processes, but also provide an opportunity for review and debate amongst those who already assess clinical communication within their curricula, and a resource for those who have a general interest in medical education who wish to learn more about communication skills assessment.

Emergency nurses' knowledge, attitude and clinical decision making skills about pain.

Science.gov (United States)

Ucuzal, Meral; Doğan, Runida

2015-04-01

Pain is the most common reason that patients come to the emergency department. Emergency nurses have an indispensable role in the management of this pain. The aim of this study was to examine emergency nurses' knowledge, attitude and clinical decision-making skills about pain. This descriptive study was conducted in a state and a university hospital between September and October 2012 in Malatya, Turkey. Of 98 nurses working in the emergency departments of these two hospitals, 57 returned the questionnaires. The response rate was 58%. Data were collected using the Demographic Information Questionnaire, Knowledge and Attitude Questionnaire about Pain and Clinical Decision Making Survey. Frequency, percentage, mean and standard deviation were used to evaluate data. 75.4% of participant nurses knew that patients' own statement about their pain was the most reliable indicator during pain assessment. Almost half of the nurses believed that patients should be encouraged to endure the pain as much as possible before resorting to a pain relief method. The results also indicate that most of nurses think that a sleeping patient does not have any pain and pain relief should be postponed as it can influence the diagnosis negatively. It is determined that the pain scale was not used frequently. Only 35.1% of nurses reported keeping records of pain. Despite all the recommendations of substantial past research the results of this study indicate that emergency nurses continue to demonstrate inadequate knowledge, clinical decision-making skills and negative attitudes about pain. Copyright © 2014 Elsevier Ltd. All rights reserved.

A predeployment trauma team training course creates confidence in teamwork and clinical skills: a post-Afghanistan deployment validation study of Canadian Forces healthcare personnel.

Science.gov (United States)

McLaughlin, Thomas; Hennecke, Peter; Garraway, Naisan Robert; Evans, David C; Hameed, Morad; Simons, Richard K; Doucet, Jay; Hansen, Daniel; Annand, Siobhan; Bell, Nathaniel; Brown, D Ross

2011-11-01

The 10-day Intensive Trauma Team Training Course (ITTTC) was developed by the Canadian Forces (CFs) to teach teamwork and clinical trauma skills to military healthcare personnel before deploying to Afghanistan. This article attempts to validate the impact of the ITTTC by surveying participants postdeployment. A survey consisting of Likert-type multiple-choice questions was created and sent to all previous ITTTC participants. The survey asked respondents to rate their confidence in applying teamwork skills and clinical skills learned in the ITTTC. It explored the relevancy of objectives and participants' prior familiarity with the objectives. The impact of different training modalities was also surveyed. The survey showed that on average 84.29% of participants were "confident" or "very confident" in applying teamwork skills to their subsequent clinical experience and 52.10% were "confident" or "very confident" in applying clinical knowledge and skills. On average 43.74% of participants were "familiar" or "very familiar" with the clinical topics before the course, indicating the importance of training these skills. Participants found that clinical shadowing was significantly less valuable in training clinical skills than either animal laboratory experience or experience in human patient simulators; 68.57% respondents thought that ITTTC was "important" or "very important" in their training. The ITTTC created lasting self-reported confidence in CFs healthcare personnel surveyed upon return from Afghanistan. This validates the importance of the course for the training of CFs healthcare personnel and supports the value of team training in other areas of trauma and medicine.

Sound algorithms

OpenAIRE

De Götzen , Amalia; Mion , Luca; Tache , Olivier

2007-01-01

International audience; We call sound algorithms the categories of algorithms that deal with digital sound signal. Sound algorithms appeared in the very infancy of computer. Sound algorithms present strong specificities that are the consequence of two dual considerations: the properties of the digital sound signal itself and its uses, and the properties of auditory perception.

46 CFR 7.20 - Nantucket Sound, Vineyard Sound, Buzzards Bay, Narragansett Bay, MA, Block Island Sound and...

Science.gov (United States)

2010-10-01

... 46 Shipping 1 2010-10-01 2010-10-01 false Nantucket Sound, Vineyard Sound, Buzzards Bay, Narragansett Bay, MA, Block Island Sound and easterly entrance to Long Island Sound, NY. 7.20 Section 7.20... Atlantic Coast § 7.20 Nantucket Sound, Vineyard Sound, Buzzards Bay, Narragansett Bay, MA, Block Island...

Faculty Development on Clinical Teaching Skills: An Effective Model for the Busy Clinician

Directory of Open Access Journals (Sweden)

Julie B. Damp

2016-01-01

Full Text Available Introduction The authors developed and evaluated a faculty development program on clinical teaching skills to address barriers to participation and to impact teaching behaviors. Methods Four one-hour workshops were implemented over five months. Evaluation included participant satisfaction and pre/post self-assessment. Pre/post faculty teaching ratings by trainees were compared. Results A total of 82% of faculty ( N = 41 attended. Participants rated workshops highly (mean, 4.43/5.00. Self-assessment of skills and comfort with teaching activities improved. A total of 59% of residents and 40% of fellows felt that teaching received from participating faculty was highly effective. The majority observed targeted teaching behaviors by the faculty. Teaching ratings improved after the workshops ( P = 0.042. Conclusion Our series of short workshops during a standing conference time was associated with increased self-assessed skill and comfort and an increase in faculty ratings on teaching evaluations. Effective faculty development programs can be implemented in flexible formats and overcome common barriers to participation.

Faculty Development on Clinical Teaching Skills: An Effective Model for the Busy Clinician

Science.gov (United States)

Damp, Julie B.; Dewey, Charlene M.; Wells, Quinn; Horn, Leora; Kroop, Susan F.; Mendes, Lisa

2016-01-01

Introduction The authors developed and evaluated a faculty development program on clinical teaching skills to address barriers to participation and to impact teaching behaviors. Methods Four one-hour workshops were implemented over five months. Evaluation included participant satisfaction and pre/post self-assessment. Pre/post faculty teaching ratings by trainees were compared. Results A total of 82% of faculty (N = 41) attended. Participants rated workshops highly (mean, 4.43/5.00). Self-assessment of skills and comfort with teaching activities improved. A total of 59% of residents and 40% of fellows felt that teaching received from participating faculty was highly effective. The majority observed targeted teaching behaviors by the faculty. Teaching ratings improved after the workshops (P = 0.042). Conclusion Our series of short workshops during a standing conference time was associated with increased self-assessed skill and comfort and an increase in faculty ratings on teaching evaluations. Effective faculty development programs can be implemented in flexible formats and overcome common barriers to participation. PMID:29349327

The Flipped Classroom for pre-clinical dental skills teaching - a reflective commentary.

Science.gov (United States)

Crothers, A J; Bagg, J; McKerlie, R

2017-05-12

A Flipped Classroom method for teaching of adult practical pre-clinical dental skills was introduced to the BDS curriculum in Glasgow during the 2015/2016 academic session. This report provides a commentary of the first year of employing this method - from the identification of the need to optimise teaching resources, through the planning, implementation and development of the method, with an early indication of performance.

Intelligent tutoring system for clinical reasoning skill acquisition in dental students.

Science.gov (United States)

Suebnukarn, Siriwan

2009-10-01

Learning clinical reasoning is an important core activity of the modern dental curriculum. This article describes an intelligent tutoring system (ITS) for clinical reasoning skill acquisition. The system is designed to provide an experience that emulates that of live human-tutored problem-based learning (PBL) sessions as much as possible, while at the same time permitting the students to participate collaboratively from disparate locations. The system uses Bayesian networks to model individual student knowledge and activity, as well as that of the group. Tutoring algorithms use the models to generate tutoring hints. The system incorporates a multimodal interface that integrates text and graphics so as to provide a rich communication channel between the students and the system, as well as among students in the group. Comparison of learning outcomes shows that student clinical reasoning gains from the ITS are similar to those obtained from human-tutored sessions.

A model linking clinical workforce skill mix planning to health and health care dynamics

Directory of Open Access Journals (Sweden)

McDonnell Geoff

2010-04-01

Full Text Available Abstract Background In an attempt to devise a simpler computable tool to assist workforce planners in determining what might be an appropriate mix of health service skills, our discussion led us to consider the implications of skill mixing and workforce composition beyond the 'stock and flow' approach of much workforce planning activity. Methods Taking a dynamic systems approach, we were able to address the interactions, delays and feedbacks that influence the balance between the major components of health and health care. Results We linked clinical workforce requirements to clinical workforce workload, taking into account the requisite facilities, technologies, other material resources and their funding to support clinical care microsystems; gave recognition to productivity and quality issues; took cognisance of policies, governance and power concerns in the establishment and operation of the health care system; and, going back to the individual, gave due attention to personal behaviour and biology within the socio-political family environment. Conclusion We have produced the broad endogenous systems model of health and health care which will enable human resource planners to operate within real world variables. We are now considering the development of simple, computable national versions of this model.

A model linking clinical workforce skill mix planning to health and health care dynamics.

Science.gov (United States)

Masnick, Keith; McDonnell, Geoff

2010-04-30

In an attempt to devise a simpler computable tool to assist workforce planners in determining what might be an appropriate mix of health service skills, our discussion led us to consider the implications of skill mixing and workforce composition beyond the 'stock and flow' approach of much workforce planning activity. Taking a dynamic systems approach, we were able to address the interactions, delays and feedbacks that influence the balance between the major components of health and health care. We linked clinical workforce requirements to clinical workforce workload, taking into account the requisite facilities, technologies, other material resources and their funding to support clinical care microsystems; gave recognition to productivity and quality issues; took cognisance of policies, governance and power concerns in the establishment and operation of the health care system; and, going back to the individual, gave due attention to personal behaviour and biology within the socio-political family environment. We have produced the broad endogenous systems model of health and health care which will enable human resource planners to operate within real world variables. We are now considering the development of simple, computable national versions of this model.

Alternating skills training and clerkships to ease the transition from preclinical to clinical training

NARCIS (Netherlands)

Van Hell, E.A.; Kuks, J.B.; Borleffs, J.C.; Cohen-Schotanus, J.

2011-01-01

Background: The transition from preclinical to clinical training is perceived as stressful with a high workload being the main difficulty. To ease this transition, we implemented a dual learning year, where just-in-time skills training and clerkships alternated. Aims: To examine the effect of the

The Integration of Psychomotor Skills in a Hybrid-PBL Dental Curriculum: The Clinical Clerkships.

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Walton, Joanne N.; MacNeil, M. A. J.; Harrison, Rosamund L.; Clark, D. Christopher

1998-01-01

Describes the restructuring of clinical clerkships at the University of British Columbia (Canada) dental school as part of a new, hybrid, problem-based learning (PBL) curriculum, focusing on strategies for integrating development of psychomotor skills. Methods of achieving both horizontal and vertical integration of competencies through grouping…

The sound of music: Differentiating musicians using a fast, musical multi-feature mismatch negativity paradigm

DEFF Research Database (Denmark)

Vuust, Peter; Brattico, Elvira; Seppänen, Miia

2012-01-01

to the other deviants in jazz musicians and left lateralization of the MMN to timbre in classical musicians. These findings indicate that the characteristics of the style/genre of music played by musicians influence their perceptual skills and the brain processing of sound features embedded in a musical......Musicians' skills in auditory processing depend highly on instrument, performance practice, and on level of expertise. Yet, it is not known though whether the style/genre of music might shape auditory processing in the brains of musicians. Here, we aimed at tackling the role of musical style....../genre on modulating neural and behavioral responses to changes in musical features. Using a novel, fast and musical sounding multi-feature paradigm, we measured the mismatch negativity (MMN), a pre-attentive brain response, to six types of musical feature change in musicians playing three distinct styles of music...

[Synchronous playing and acquiring of heart sounds and electrocardiogram based on labVIEW].

Science.gov (United States)

Dan, Chunmei; He, Wei; Zhou, Jing; Que, Xiaosheng

2008-12-01

In this paper is described a comprehensive system, which can acquire heart sounds and electrocardiogram (ECG) in parallel, synchronize the display; and play of heart sound and make auscultation and check phonocardiogram to tie in. The hardware system with C8051F340 as the core acquires the heart sound and ECG synchronously, and then sends them to indicators, respectively. Heart sounds are displayed and played simultaneously by controlling the moment of writing to indicator and sound output device. In clinical testing, heart sounds can be successfully located with ECG and real-time played.

Implementation of an Electronic Objective Structured Clinical Exam for Assessing Practical Skills in Pre-Professional Physiotherapy and Occupational Therapy Programs: Examiner and Course Coordinator Perspectives

Science.gov (United States)

Snodgrass, Suzanne J.; Ashby, Samantha E.; Rivett, Darren A.; Russell, Trevor

2014-01-01

Assessment of practical clinical skills is essential in the health fields. Objective Structured Clinical Exams (OSCEs), where examiners assess students performing clinical procedures on simulated patients (actors), are central to the evaluation of practical skills. However, traditional OSCEs require considerable time-investment to administer, and…

Clinical skills required of ophthalmic nurse practitioners in tertiary level public hospitals in the Western Cape Province

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U. Kyriacos

2009-09-01

Full Text Available Background: South Africa has a 32-year history of training ophthalmic nurse practitioners (ONPs. The role and required skills and competencies of ONPs are not well documented in the international literature and are also absent from South African publications, including South African Nursing Council publications. Aim: This study aims to inform curriculum development and human resource planning by reporting on the clinical skills expected of ONPs by members of multidisciplinary ophthalmology teams. Method: A limited survey was undertaken in the ophthalmology wards and outpatient departments of three tertiary level hospitals in the Western Cape Province. A researcher-designed structured self-completion questionnaire was distributed to 30 ophthalmology practitioners: doctors, nurses and technicians. Respondents were asked to indicate the expected clinical skills of ONPs. Findings: All questionnaires were completed. All respondents favoured ONPs taking histories and performing emergency eye irrigations. There was less support for more complex procedures, such as B-scans. One-third of respondents did not expect ONPs to have skills in eight key areas, including examination of the anterior chamber angle for glaucoma. No statistically significant differences were found between responses of doctors and nurses, with one exception: more nurses (15/18 than doctors (4/10 had confidence in the ONP undertaking basic eye examinations for ocular motility (Fisher‘s exact test, P = 0 .035. Conclusion: In the study settings, ONPs are not using their specialist skills to the full. Not all practitioners were receptive to ONPs using the skills that they had acquired during their postgraduate diploma, threatening the educational effectiveness of this initiative.

Effectiveness of a structured training program in psychotherapeutic skills used in clinical interviews for psychiatry and clinical psychology residents.

Science.gov (United States)

Fernandez-Liria, Alberto; Rodriguez-Vega, Beatriz; Ortiz-Sanchez, Deborah; Baldor Tubet, Isabel; Gonzalez-Juarez, Carlos

2010-01-01

The authors evaluated a training program based on a structured manual of psychotherapeutic skills, using a randomized controlled design. The experimental group consisted of 135 residents from 12 teaching units in Spain. To control the improvement in therapeutic skills that could be attributed to the training received during the residency, the authors compared the experimental group with a control group of 35 residents from three teaching units. Two types of assessment instruments were used: a paper-and-pencil questionnaire based on clinical cases and a videotape of a role-playing interview. Both were given before and after the experimental group attended the training program. The experimental group shows a statistically significant improvement compared with the control group in both measurements.

Promoting Assessment Efficacy through an Integrated System for Online Clinical Assessment of Practical Skills

Science.gov (United States)

Hay, Peter J.; Engstrom, Craig; Green, Anita; Friis, Peter; Dickens, Sue; Macdonald, Doune

2013-01-01

This paper presents evaluation outcomes from an externally funded research project involving the online clinical assessment of practical skills (eCAPS) using web-based video technologies within a university medical programme. eCAPS was implemented to trial this web-based approach for promoting the efficacy of "practical" skills…

Student self-reported communication skills, knowledge and confidence across standardised patient, virtual and traditional clinical learning environments.

Science.gov (United States)

Quail, Michelle; Brundage, Shelley B; Spitalnick, Josh; Allen, Peter J; Beilby, Janet

2016-02-27

Advanced communication skills are vital for allied health professionals, yet students often have limited opportunities in which to develop them. The option of increasing clinical placement hours is unsustainable in a climate of constrained budgets, limited placement availability and increasing student numbers. Consequently, many educators are considering the potentials of alternative training methods, such as simulation. Simulations provide safe, repeatable and standardised learning environments in which students can practice a variety of clinical skills. This study investigated students' self-rated communication skill, knowledge, confidence and empathy across simulated and traditional learning environments. Undergraduate speech pathology students were randomly allocated to one of three communication partners with whom they engaged conversationally for up to 30 min: a patient in a nursing home (n = 21); an elderly trained patient actor (n = 22); or a virtual patient (n = 19). One week prior to, and again following the conversational interaction, participants completed measures of self-reported communication skill, knowledge and confidence (developed by the authors based on the Four Habit Coding Scheme), as well as the Jefferson Scale of Empathy - Health Professionals (student version). All three groups reported significantly higher communication knowledge, skills and confidence post-placement (Median d = .58), while the degree of change did not vary as a function of group membership (Median η (2)  communication skill, knowledge and confidence, though not empathy, following a brief placement in a virtual, standardised or traditional learning environment. The self-reported increases were consistent across the three placement types. It is proposed that the findings from this study provide support for the integration of more sustainable, standardised, virtual patient-based placement models into allied health training programs for the training of

The role of deliberate practice in the acquisition of clinical skills

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Duvivier Robbert J

2011-12-01

Full Text Available Abstract Background The role of deliberate practice in medical students' development from novice to expert was examined for preclinical skill training. Methods Students in years 1-3 completed 34 Likert type items, adapted from a questionnaire about the use of deliberate practice in cognitive learning. Exploratory factor analysis and reliability analysis were used to validate the questionnaire. Analysis of variance examined differences between years and regression analysis the relationship between deliberate practice and skill test results. Results 875 students participated (90%. Factor analysis yielded four factors: planning, concentration/dedication, repetition/revision, study style/self reflection. Student scores on 'Planning' increased over time, score on sub-scale 'repetition/revision' decreased. Student results on the clinical skill test correlated positively with scores on subscales 'planning' and 'concentration/dedication' in years 1 and 3, and with scores on subscale 'repetition/revision' in year 1. Conclusions The positive effects on test results suggest that the role of deliberate practice in medical education merits further study. The cross-sectional design is a limitation, the large representative sample a strength of the study. The vanishing effect of repetition/revision may be attributable to inadequate feedback. Deliberate practice advocates sustained practice to address weaknesses, identified by (self-assessment and stimulated by feedback. Further studies should use a longitudinal prospective design and extend the scope to expertise development during residency and beyond.

National Clinical Skills Competition: an effective simulation-based method to improve undergraduate medical education in China.

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Jiang, Guanchao; Chen, Hong; Wang, Qiming; Chi, Baorong; He, Qingnan; Xiao, Haipeng; Zhou, Qinghuan; Liu, Jing; Wang, Shan

2016-01-01

The National Clinical Skills Competition has been held in China for 5 consecutive years since 2010 to promote undergraduate education reform and improve the teaching quality. The effects of the simulation-based competition will be analyzed in this study. Participation in the competitions and the compilation of the questions used in the competition finals are summarized, and the influence and guidance quality are further analyzed. Through the nationwide distribution of questionnaires in medical colleges, the effects of the simulation-based competition on promoting undergraduate medical education reform were evaluated. The results show that approximately 450 students from more than 110 colleges (accounting for 81% of colleges providing undergraduate clinical medical education in China) participated in the competition each year. The knowledge, skills, and attitudes were comprehensively evaluated by simulation-based assessment. Eight hundred and eighty copies of the questionnaires were distributed to 110 participating medical schools in 2015. In total, 752 valid responses were received across 95 schools. The majority of the interviewees agreed or strongly agreed that competition promoted the adoption of advanced educational principles (76.8%), updated the curriculum model and instructional methods (79.8%), strengthened faculty development (84.0%), improved educational resources (82.1%), and benefited all students (53.4%). The National Clinical Skills Competition is widely accepted in China. It has effectively promoted the reform and development of undergraduate medical education in China.

Problems in nonlinear acoustics: Scattering of sound by sound, parametric receiving arrays, nonlinear effects in asymmetric sound beams and pulsed finite amplitude sound beams

Science.gov (United States)

Hamilton, Mark F.

1989-08-01

Four projects are discussed in this annual summary report, all of which involve basic research in nonlinear acoustics: Scattering of Sound by Sound, a theoretical study of two nonconlinear Gaussian beams which interact to produce sum and difference frequency sound; Parametric Receiving Arrays, a theoretical study of parametric reception in a reverberant environment; Nonlinear Effects in Asymmetric Sound Beams, a numerical study of two dimensional finite amplitude sound fields; and Pulsed Finite Amplitude Sound Beams, a numerical time domain solution of the KZK equation.

PREFACE: Aerodynamic sound Aerodynamic sound

Science.gov (United States)

Akishita, Sadao

2010-02-01

The modern theory of aerodynamic sound originates from Lighthill's two papers in 1952 and 1954, as is well known. I have heard that Lighthill was motivated in writing the papers by the jet-noise emitted by the newly commercialized jet-engined airplanes at that time. The technology of aerodynamic sound is destined for environmental problems. Therefore the theory should always be applied to newly emerged public nuisances. This issue of Fluid Dynamics Research (FDR) reflects problems of environmental sound in present Japanese technology. The Japanese community studying aerodynamic sound has held an annual symposium since 29 years ago when the late Professor S Kotake and Professor S Kaji of Teikyo University organized the symposium. Most of the Japanese authors in this issue are members of the annual symposium. I should note the contribution of the two professors cited above in establishing the Japanese community of aerodynamic sound research. It is my pleasure to present the publication in this issue of ten papers discussed at the annual symposium. I would like to express many thanks to the Editorial Board of FDR for giving us the chance to contribute these papers. We have a review paper by T Suzuki on the study of jet noise, which continues to be important nowadays, and is expected to reform the theoretical model of generating mechanisms. Professor M S Howe and R S McGowan contribute an analytical paper, a valuable study in today's fluid dynamics research. They apply hydrodynamics to solve the compressible flow generated in the vocal cords of the human body. Experimental study continues to be the main methodology in aerodynamic sound, and it is expected to explore new horizons. H Fujita's study on the Aeolian tone provides a new viewpoint on major, longstanding sound problems. The paper by M Nishimura and T Goto on textile fabrics describes new technology for the effective reduction of bluff-body noise. The paper by T Sueki et al also reports new technology for the

Companion animal veterinarians' use of clinical communication skills.

Science.gov (United States)

McArthur, M L; Fitzgerald, J R

2013-09-01

To describe the communication techniques used by clients and veterinarians during companion animal visits in Australia. A cross-sectional descriptive study. A total of 64 veterinary consultations were audiotaped and analysed with the Roter Interaction Analysis System (RIAS); clients completed appointment level measures, including their satisfaction and perceptions of relational communication. Participants were 24 veterinarians and 64 clients. Statements intended to reassure clients were expressed frequently in the consultations, but in 59% of appointments empathy statements were not expressed towards either the client or the patient. In 10% of appointments, veterinarians did not used any open-ended questions. Overall client satisfaction was high and veterinarians' expressions of empathy directed to the client resulted in higher levels of client satisfaction. Clients' perceptions of relational communication were related to several veterinarian and client nonverbal scales. A focus on developing evidence-based clinical communication skills is expected to further enhance the veterinarian-client-patient relationship and associated clinical outcomes. Particular recommendations include the development of a broader emotion-handling repertoire, increased emphasis on the use of open-ended enquiry, including assessment of the client's perspective, as well as attention to aspects of nonverbal communication. The study provides preliminary evidence for the importance of verbal expressions of empathy during the companion animal consultation. © 2013 Australian Veterinary Association.

A prospective study evaluating cochlear implant management skills: development and validation of the Cochlear Implant Management Skills survey.

Science.gov (United States)

Bennett, R J; Jayakody, D M P; Eikelboom, R H; Taljaard, D S; Atlas, M D

2016-02-01

To investigate the ability of cochlear implant (CI) recipients to physically handle and care for their hearing implant device(s) and to identify factors that may influence skills. To assess device management skills, a clinical survey was developed and validated on a clinical cohort of CI recipients. Survey development and validation. A prospective convenience cohort design study. Specialist hearing implant clinic. Forty-nine post-lingually deafened, adult CI recipients, at least 12 months postoperative. Survey test-retest reliability, interobserver reliability and responsiveness. Correlations between management skills and participant demographic, audiometric, clinical outcomes and device factors. The Cochlear Implant Management Skills survey was developed, demonstrating high test-retest reliability (0.878), interobserver reliability (0.972) and responsiveness to intervention (skills training) [t(20) = -3.913, P = 0.001]. Cochlear Implant Management Skills survey scores range from 54.69% to 100% (mean: 83.45%, sd: 12.47). No associations were found between handling skills and participant factors. This is the first study to demonstrate a range in cochlear implant device handling skills in CI recipients and offers clinicians and researchers a tool to systematically and objectively identify shortcomings in CI recipients' device handling skills. © 2015 John Wiley & Sons Ltd.

Effects of nursing process-based simulation for maternal child emergency nursing care on knowledge, attitude, and skills in clinical nurses.

Science.gov (United States)

Kim, Sunghee; Shin, Gisoo

2016-02-01

Since previous studies on simulation-based education have been focused on fundamental nursing skills for nursing students in South Korea, there is little research available that focuses on clinical nurses in simulation-based training. Further, there is a paucity of research literature related to the integration of the nursing process into simulation training particularly in the emergency nursing care of high-risk maternal and neonatal patients. The purpose of this study was to identify the effects of nursing process-based simulation on knowledge, attitudes, and skills for maternal and child emergency nursing care in clinical nurses in South Korea. Data were collected from 49 nurses, 25 in the experimental group and 24 in the control group, from August 13 to 14, 2013. This study was an equivalent control group pre- and post-test experimental design to compare the differences in knowledge, attitudes, and skills for maternal and child emergency nursing care between the experimental group and the control group. The experimental group was trained by the nursing process-based simulation training program, while the control group received traditional methods of training for maternal and child emergency nursing care. The experimental group was more likely to improve knowledge, attitudes, and skills required for clinical judgment about maternal and child emergency nursing care than the control group. Among five stages of nursing process in simulation, the experimental group was more likely to improve clinical skills required for nursing diagnosis and nursing evaluation than the control group. These results will provide valuable information on developing nursing process-based simulation training to improve clinical competency in nurses. Further research should be conducted to verify the effectiveness of nursing process-based simulation with more diverse nurse groups on more diverse subjects in the future. Copyright © 2015 Elsevier Ltd. All rights reserved.

The role of peer assisted learning to improve the effectivity of clinical skill laboratory learning in dental education

Directory of Open Access Journals (Sweden)

Agus Ardinansyah

2016-06-01

Full Text Available Nowadays, the clinical skill learning in dental education has begun in pre-clinic, known as Clinical Skill Laboratory (CSL which needs human resources, many and expensive tools and manikins, and enough times for practise. One of the method used in CSL in dental education is PeerAssisted Learning (PAL defined as “the development of knowledge and skill through active help and support among status equals or match companions”. This paper aims is to explain the role of PAL method to improve the effectivity of CSL learning in dental education in preclinical stage. Reviewing on the relevant literatures regarding peer assisted learning on the implementation of the clinical skill laboratory in dental education. The effectivity of CSL learning needs close supervision and individual feedback, so enough tutors is important through the process. This PAL method considered to be helpfull with the increasing numbers of dental students and the limitation of staff faculty. This method is found feasible, well accepted by peer-tutors and students, and can be as effective as conventional learning method. This is also useful for peer-teacher because they more intrinsically motivated, have higher conceptual learning scores, and perceive themselves to be more actively engaged with the environment than students who learn in order to be tested.  However, there are several limitation of this method. The contact time between students and medical doctors may decrease significantlyand it does not seem to be generally qualified to transfer such complex procedures.It also needs peer-teachers training and a detailed manual. Questions concerning the cost-effectiveness and profitability of student tutor-guided technical skills training may thus arise. But one institution that implemented this method states that the majority of their tutors decided to continue their teaching activity in the skills lab and that these experienced tutors, in addition to established faculty staff

Nursing students' evaluation of a new feedback and reflection tool for use in high-fidelity simulation - Formative assessment of clinical skills. A descriptive quantitative research design.

Science.gov (United States)

Solheim, Elisabeth; Plathe, Hilde Syvertsen; Eide, Hilde

2017-11-01

Clinical skills training is an important part of nurses' education programmes. Clinical skills are complex. A common understanding of what characterizes clinical skills and learning outcomes needs to be established. The aim of the study was to develop and evaluate a new reflection and feedback tool for formative assessment. The study has a descriptive quantitative design. 129 students participated who were at the end of the first year of a Bachelor degree in nursing. After highfidelity simulation, data were collected using a questionnaire with 19 closed-ended and 2 open-ended questions. The tool stimulated peer assessment, and enabled students to be more thorough in what to assess as an observer in clinical skills. The tool provided a structure for selfassessment and made visible items that are important to be aware of in clinical skills. This article adds to simulation literature and provides a tool that is useful in enhancing peer learning, which is essential for nurses in practice. The tool has potential for enabling students to learn about reflection and developing skills for guiding others in practice after they have graduated. Copyright © 2017 Elsevier Ltd. All rights reserved.

[Clinical skills and outcomes of chair-side computer aided design and computer aided manufacture system].

Science.gov (United States)

Yu, Q

2018-04-09

Computer aided design and computer aided manufacture (CAD/CAM) technology is a kind of oral digital system which is applied to clinical diagnosis and treatment. It overturns the traditional pattern, and provides a solution to restore defect tooth quickly and efficiently. In this paper we mainly discuss the clinical skills of chair-side CAD/CAM system, including tooth preparation, digital impression, the three-dimensional design of prosthesis, numerical control machining, clinical bonding and so on, and review the outcomes of several common kinds of materials at the same time.

[Low level auditory skills compared to writing skills in school children attending third and fourth grade: evidence for the rapid auditory processing deficit theory?].

Science.gov (United States)

Ptok, M; Meisen, R

2008-01-01

The rapid auditory processing defi-cit theory holds that impaired reading/writing skills are not caused exclusively by a cognitive deficit specific to representation and processing of speech sounds but arise due to sensory, mainly auditory, deficits. To further explore this theory we compared different measures of auditory low level skills to writing skills in school children. prospective study. School children attending third and fourth grade. just noticeable differences for intensity and frequency (JNDI, JNDF), gap detection (GD) monaural and binaural temporal order judgement (TOJb and TOJm); grade in writing, language and mathematics. correlation analysis. No relevant correlation was found between any auditory low level processing variable and writing skills. These data do not support the rapid auditory processing deficit theory.

An open access database for the evaluation of heart sound algorithms.

Science.gov (United States)

Liu, Chengyu; Springer, David; Li, Qiao; Moody, Benjamin; Juan, Ricardo Abad; Chorro, Francisco J; Castells, Francisco; Roig, José Millet; Silva, Ikaro; Johnson, Alistair E W; Syed, Zeeshan; Schmidt, Samuel E; Papadaniil, Chrysa D; Hadjileontiadis, Leontios; Naseri, Hosein; Moukadem, Ali; Dieterlen, Alain; Brandt, Christian; Tang, Hong; Samieinasab, Maryam; Samieinasab, Mohammad Reza; Sameni, Reza; Mark, Roger G; Clifford, Gari D

2016-12-01

In the past few decades, analysis of heart sound signals (i.e. the phonocardiogram or PCG), especially for automated heart sound segmentation and classification, has been widely studied and has been reported to have the potential value to detect pathology accurately in clinical applications. However, comparative analyses of algorithms in the literature have been hindered by the lack of high-quality, rigorously validated, and standardized open databases of heart sound recordings. This paper describes a public heart sound database, assembled for an international competition, the PhysioNet/Computing in Cardiology (CinC) Challenge 2016. The archive comprises nine different heart sound databases sourced from multiple research groups around the world. It includes 2435 heart sound recordings in total collected from 1297 healthy subjects and patients with a variety of conditions, including heart valve disease and coronary artery disease. The recordings were collected from a variety of clinical or nonclinical (such as in-home visits) environments and equipment. The length of recording varied from several seconds to several minutes. This article reports detailed information about the subjects/patients including demographics (number, age, gender), recordings (number, location, state and time length), associated synchronously recorded signals, sampling frequency and sensor type used. We also provide a brief summary of the commonly used heart sound segmentation and classification methods, including open source code provided concurrently for the Challenge. A description of the PhysioNet/CinC Challenge 2016, including the main aims, the training and test sets, the hand corrected annotations for different heart sound states, the scoring mechanism, and associated open source code are provided. In addition, several potential benefits from the public heart sound database are discussed.

Promoting skill building and confidence in freshman nursing students with a "Skills-a-Thon".

Science.gov (United States)

Roberts, Susan T; Vignato, Julie A; Moore, Joan L; Madden, Carol A

2009-08-01

Freshman nursing students returning for their second semester after summer break benefited by reviewing previously learned clinical skills presented in a Skills-a-Thon. Skills stations were established and facilitated by faculty and senior students. Senior students were first trained in mentoring and specific steps in skills competencies. Freshman students demonstrated skills in various mock clinical situations including catheter insertion, sterile dressings, medications, and physical assessment. The strategy reinforced learning and provided an opportunity for students to experience risk-free skills performance among peers. Freshman students gained proficiency and appreciated guidance by senior students without the pressures of testing. Seniors benefited from a condensed version of the program to review their own skills prior to the event. Responses were positive, with students reporting improved performance and confidence with hands-on application in a non-threatening environment. Nursing faculty observed improvement in skill performance and competence, and plan to offer future events. Copyright 2009, SLACK Incorporated.

Computerized Respiratory Sounds: Novel Outcomes for Pulmonary Rehabilitation in COPD.

Science.gov (United States)

Jácome, Cristina; Marques, Alda

2017-02-01

Computerized respiratory sounds are a simple and noninvasive measure to assess lung function. Nevertheless, their potential to detect changes after pulmonary rehabilitation (PR) is unknown and needs clarification if respiratory acoustics are to be used in clinical practice. Thus, this study investigated the short- and mid-term effects of PR on computerized respiratory sounds in subjects with COPD. Forty-one subjects with COPD completed a 12-week PR program and a 3-month follow-up. Secondary outcome measures included dyspnea, self-reported sputum, FEV 1 , exercise tolerance, self-reported physical activity, health-related quality of life, and peripheral muscle strength. Computerized respiratory sounds, the primary outcomes, were recorded at right/left posterior chest using 2 stethoscopes. Air flow was recorded with a pneumotachograph. Normal respiratory sounds, crackles, and wheezes were analyzed with validated algorithms. There was a significant effect over time in all secondary outcomes, with the exception of FEV 1 and of the impact domain of the St George Respiratory Questionnaire. Inspiratory and expiratory median frequencies of normal respiratory sounds in the 100-300 Hz band were significantly lower immediately (-2.3 Hz [95% CI -4 to -0.7] and -1.9 Hz [95% CI -3.3 to -0.5]) and at 3 months (-2.1 Hz [95% CI -3.6 to -0.7] and -2 Hz [95% CI -3.6 to -0.5]) post-PR. The mean number of expiratory crackles (-0.8, 95% CI -1.3 to -0.3) and inspiratory wheeze occupation rate (median 5.9 vs 0) were significantly lower immediately post-PR. Computerized respiratory sounds were sensitive to short- and mid-term effects of PR in subjects with COPD. These findings are encouraging for the clinical use of respiratory acoustics. Future research is needed to strengthen these findings and explore the potential of computerized respiratory sounds to assess the effectiveness of other clinical interventions in COPD. Copyright © 2017 by Daedalus Enterprises.

Workplace-based communication skills training in clinical departments: Examining the role of collegial relations through positioning theory.

Science.gov (United States)

Møller, Jane Ege; Malling, Bente Vigh

2018-04-27

Studies suggest that the workplace is a key to understanding how clinical communication skills learning takes place and that medical communication skills need to be reinforced over time in order not to deteriorate. This study explored the perceptions of doctors in four hospital departments who participated in a workplace-based communication training project. Its specific focus was the relationship between collegial relations and learning communication skills. The study applied a qualitative design using an ethnographic methodology, i.e. interviews and observations. Positioning theory was used as the theoretical framework. Training communication skills with colleagues in the actual workplace setting was valued by the participants who experienced more sharing of communication challenges, previously understood as something private one would not share with colleagues. However, collegial relations were also barriers for providing critical feedback, especially from junior doctors to their seniors. The position as "colleague" both reinforced the communication skills training and hindered it. The communication skills educational model had a flat, non-hierarchical structure which disturbed the hierarchical structure of the workplace, and its related positions.

The impact of residency programs on new nurse graduates' clinical decision-making and leadership skills: a systematic review.

Science.gov (United States)

AL-Dossary, Reem; Kitsantas, Panagiota; Maddox, P J

2014-06-01

Health care institutions have adapted residency programs to help new graduate nurses to become fully competent and transition from a student nurse to an independent practicing nurse and a bedside leader. The study's aim is to review the literature on the impact of residency programs on new graduate nurses' clinical decision-making and leadership skills. An electronic search was conducted between 1980 and 2013 using databases of the scientific literature in Medline, PubMed, Cochrane EPOC, Cumulative Index to Nursing & Allied Health Literature database guide (CINAHL), and PsychInfo using a range of keywords. Information gathered was evaluated for relevance. Thirteen studies that met the inclusion criteria were used in this systematic review. In several studies considered in this review, residency programs were developed to improve new graduates skills and promote their transition into the nursing workforce. In fact, the transition programs reduced turnover in that first year of practice and promoted professional growth of the new graduate such as hand-on nursing skills, clinical decision-making and leadership skills, satisfaction, and retention. There is a need for effective residency programs that are designed to prepare new graduate nurses in providing safe, competent and effective patient care. © 2013.

Imagining Sound

DEFF Research Database (Denmark)

Grimshaw, Mark; Garner, Tom Alexander

2014-01-01

We make the case in this essay that sound that is imagined is both a perception and as much a sound as that perceived through external stimulation. To argue this, we look at the evidence from auditory science, neuroscience, and philosophy, briefly present some new conceptual thinking on sound...... that accounts for this view, and then use this to look at what the future might hold in the context of imagining sound and developing technology....

The Crucible simulation: Behavioral simulation improves clinical leadership skills and understanding of complex health policy change.

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Cohen, Daniel; Vlaev, Ivo; McMahon, Laurie; Harvey, Sarah; Mitchell, Andy; Borovoi, Leah; Darzi, Ara

2017-05-11

The Health and Social Care Act 2012 represents the most complex National Health Service reforms in history. High-quality clinical leadership is important for successful implementation of health service reform. However, little is known about the effectiveness of current leadership training. This study describes the use of a behavioral simulation to improve the knowledge and leadership of a cohort of medical doctors expected to take leadership roles in the National Health Service. A day-long behavioral simulation (The Crucible) was developed and run based on a fictitious but realistic health economy. Participants completed pre- and postsimulation questionnaires generating qualitative and quantitative data. Leadership skills, knowledge, and behavior change processes described by the "theory of planned behavior" were self-assessed pre- and postsimulation. Sixty-nine medical doctors attended. Participants deemed the simulation immersive and relevant. Significant improvements were shown in perceived knowledge, capability, attitudes, subjective norms, intentions, and leadership competency following the program. Nearly one third of participants reported that they had implemented knowledge and skills from the simulation into practice within 4 weeks. This study systematically demonstrates the effectiveness of behavioral simulation for clinical management training and understanding of health policy reform. Potential future uses and strategies for analysis are discussed. High-quality care requires understanding of health systems and strong leadership. Policymakers should consider the use of behavioral simulation to improve understanding of health service reform and development of leadership skills in clinicians, who readily adopt skills from simulation into everyday practice.

National Clinical Skills Competition: an effective simulation-based method to improve undergraduate medical education in China

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Guanchao Jiang

2016-02-01

Full Text Available Background: The National Clinical Skills Competition has been held in China for 5 consecutive years since 2010 to promote undergraduate education reform and improve the teaching quality. The effects of the simulation-based competition will be analyzed in this study. Methods: Participation in the competitions and the compilation of the questions used in the competition finals are summarized, and the influence and guidance quality are further analyzed. Through the nationwide distribution of questionnaires in medical colleges, the effects of the simulation-based competition on promoting undergraduate medical education reform were evaluated. Results: The results show that approximately 450 students from more than 110 colleges (accounting for 81% of colleges providing undergraduate clinical medical education in China participated in the competition each year. The knowledge, skills, and attitudes were comprehensively evaluated by simulation-based assessment. Eight hundred and eighty copies of the questionnaires were distributed to 110 participating medical schools in 2015. In total, 752 valid responses were received across 95 schools. The majority of the interviewees agreed or strongly agreed that competition promoted the adoption of advanced educational principles (76.8%, updated the curriculum model and instructional methods (79.8%, strengthened faculty development (84.0%, improved educational resources (82.1%, and benefited all students (53.4%. Conclusions: The National Clinical Skills Competition is widely accepted in China. It has effectively promoted the reform and development of undergraduate medical education in China.

Vulnerability to the Irrelevant Sound Effect in Adult ADHD.

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Pelletier, Marie-France; Hodgetts, Helen M; Lafleur, Martin F; Vincent, Annick; Tremblay, Sébastien

2016-04-01

An ecologically valid adaptation of the irrelevant sound effect paradigm was employed to examine the relative roles of short-term memory, selective attention, and sustained attention in ADHD. In all, 32 adults with ADHD and 32 control participants completed a serial recall task in silence or while ignoring irrelevant background sound. Serial recall performance in adults with ADHD was reduced relative to controls in both conditions. The degree of interference due to irrelevant sound was greater for adults with ADHD. Furthermore, a positive correlation was observed between task performance under conditions of irrelevant sound and the extent of attentional problems reported by patients on a clinical symptom scale. The results demonstrate that adults with ADHD exhibit impaired short-term memory and a low resistance to distraction; however, their capacity for sustained attention is preserved as the impact of irrelevant sound diminished over the course of the task. © The Author(s) 2013.

Looking is not seeing and listening is not hearing: effect of an intervention to enhance auditory skills of graduate-entry nursing students.

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Pellico, Linda Honan; Duffy, Thomas C; Fennie, Kristopher P; Swan, Katharine A

2012-01-01

Inspection/observation and listening/auscultation are essential skills for health care providers. Given that observational and auditory skills take time to perfect, there is concern about accelerated students' ability to attain proficiency in a timely manner. This article describes the impact of music auditory training (MAT) for nursing students in an accelerated master's entry program on their competence in detecting heart, lung, and bowel sounds. During the first semester, a two-hour MAT session with focused attention on pitch, timbre, rhythm, and masking was held for the intervention group; a control group received traditional instruction only. Students in the music intervention group demonstrated significant improvement in hearing bowel, heart, and lung sounds (p < .0001). The ability to label normal and abnormal heart sounds doubled; interpretation of normal and abnormal lung sounds improved by 50 percent; and bowel sounds interpretation improved threefold, demonstrating the effect of an adult-oriented, creative, yet practical method for teaching auscultation.

Time measurements with a mobile device using sound

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Wisman, Raymond F.; Spahn, Gabriel; Forinash, Kyle

2018-05-01

Data collection is a fundamental skill in science education, one that students generally practice in a controlled setting using equipment only available in the classroom laboratory. However, using smartphones with their built-in sensors and often free apps, many fundamental experiments can be performed outside the laboratory. Taking advantage of these tools often require creative approaches to data collection and exploring alternative strategies for experimental procedures. As examples, we present several experiments using smartphones and apps that record and analyze sound to measure a variety of physical properties.

Innovative approach using interprofessional simulation to educate surgical residents in technical and nontechnical skills in high-risk clinical scenarios.

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Nicksa, Grace A; Anderson, Cristan; Fidler, Richard; Stewart, Lygia

2015-03-01

The Accreditation Council for Graduate Medical Education core competencies stress nontechnical skills that can be difficult to evaluate and teach to surgical residents. During emergencies, surgeons work in interprofessional teams and are required to perform certain procedures. To obtain proficiency in these skills, residents must be trained. To educate surgical residents in leadership, teamwork, effective communication, and infrequently performed emergency surgical procedures with the use of interprofessional simulations. SimMan 3GS was used to simulate high-risk clinical scenarios (15-20 minutes), followed by debriefings with real-time feedback (30 minutes). A modified Oxford Non-Technical Skills scale (score range, 1-4) was used to assess surgical resident performance during the first half of the academic year (July-December 2012) and the second half of the academic year (January-June 2013). Anonymous online surveys were used to solicit participant feedback. Simulations were conducted in the operating room, intensive care unit, emergency department, ward, and simulation center. A total of 43 surgical residents (postgraduate years [PGYs] 1 and 2) participated in interdisciplinary clinical scenarios, with other health care professionals (nursing, anesthesia, critical care, medicine, respiratory therapy, and pharmacy; mean number of nonsurgical participants/session: 4, range 0-9). Thirty seven surgical residents responded to the survey. Simulation of high-risk clinical scenarios: postoperative pulmonary embolus, pneumothorax, myocardial infarction, gastrointestinal bleeding, anaphylaxis with a difficult airway, and pulseless electrical activity arrest. Evaluation of resident skills: communication, leadership, teamwork, problem solving, situation awareness, and confidence in performing emergency procedures (eg, cricothyroidotomy). A total of 31 of 35 (89%) of the residents responding found the sessions useful. Additionally, 28 of 33 (85%) reported improved confidence

Gateway to the Future. Skill Standards for the Bioscience Industry for Technical Workers in Pharmaceutical Companies, Biotechnology Companies, and Clinical Laboratories.

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Education Development Center, Inc., Newton, MA.

The Bioscience Industry Skills Standards Project (BISSP) is developing national, voluntary skill standards for technical jobs in biotechnology and pharmaceutical companies and clinical laboratories in hospitals, universities, government, and independent settings. Research with employees and educators has pinpointed three issues underscoring the…

Cultural competency and communication skills of dental students: clinical supervisors' perceptions.

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Mariño, R; Ghanim, A; Morgan, M; Barrow, S

2017-11-01

This study explored clinical supervisor's (CS) views and experiences of dental students' cultural competence (CC) at the Melbourne Dental School, The University of Melbourne, Australia. Additionally, this study explored CS insights into how CC could be taught. Semi-structured one-to-one interviews were organised with consenting CS. Interview topics included the following: the importance of CC, communication and rapport, the role of culture in oral health and the need for curriculum enhancement. Interviews were recorded, transcribed and thematically analysed to identify key areas using NVivo software. A total of 12 CS participated in this study. CS acknowledged the importance of CC and felt that it was important for good patient management. CS's definition of CC focused primarily on language and communication skills. CS felt that dental students were generally able to manage culturally diverse patients. However, CS indicated that additional training in this area would be beneficial. Concerns were raised about the students' ability to establish good rapport and communication, with CS highlighting areas such as misuse of interpreters and use of jargon. CS felt that clinical experience, confidence and a positive attitude are effective tools for overcoming cultural barriers. Furthermore, some CS also felt that cultural competency was a skill that is learnt through experience. For most CS, cultural competence was an important part of the clinician-patient exchange which would benefit from enhanced curriculum. They also highlighted areas where transcultural education could be improved. The majority of CS believed dental students managed culturally diverse patients well. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Sound radiation contrast in MR phase images. Method for the representation of elasticity, sound damping, and sound impedance changes

International Nuclear Information System (INIS)

Radicke, Marcus

2009-01-01

The method presented in this thesis combines ultrasound techniques with the magnetic-resonance tomography (MRT). An ultrasonic wave generates in absorbing media a static force in sound-propagation direction. The force leads at sound intensities of some W/cm 2 and a sound frequency in the lower MHz range to a tissue shift in the micrometer range. This tissue shift depends on the sound power, the sound frequency, the sound absorption, and the elastic properties of the tissue. A MRT sequence of the Siemens Healthcare AG was modified so that it measures (indirectly) the tissue shift, codes as grey values, and presents as 2D picture. By means of the grey values the sound-beam slope in the tissue can be visualized, and so additionally sound obstacles (changes of the sound impedance) can be detected. By the MRT images token up spatial changes of the tissue parameters sound absorption and elasticity can be detected. In this thesis measurements are presented, which show the feasibility and future chances of this method especially for the mammary-cancer diagnostics. [de

Objective Structured Clinical Examinations (OSCEs, psychiatry and the Clinical assessment of Skills and Competencies (CASCSame Evidence, Different Judgement

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Marwaha Steven

2011-05-01

Full Text Available Abstract Background The Objective Structured Clinical Examination (OSCE, originally developed in the 1970's, has been hailed as the "gold standard" of clinical assessments for medical students and is used within medical schools throughout the world. The Clinical assessment of Skills and Competencies (CASC is an OSCE used as a clinical examination gateway, granting access to becoming a senior Psychiatrist in the UK. Discussion Van der Vleuten's utility model is used to examine the CASC from the viewpoint of a senior psychiatrist. Reliability may be equivalent to more traditional examinations. Whilst the CASC is likely to have content validity, other forms of validity are untested and authenticity is poor. Educational impact has the potential to change facets of psychiatric professionalism and influence future patient care. There are doubts about acceptability from candidates and more senior psychiatrists. Summary Whilst OSCEs may be the best choice for medical student examinations, their use in post graduate psychiatric examination in the UK is subject to challenge on the grounds of validity, authenticity and educational impact.

Designing evidence-based medicine training to optimize the transfer of skills from the classroom to clinical practice: applying the four component instructional design model.

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Maggio, Lauren A; Cate, Olle Ten; Irby, David M; O'Brien, Bridget C

2015-11-01

Evidence-based medicine (EBM) skills, although taught in medical schools around the world, are not optimally practiced in clinical environments because of multiple barriers, including learners' difficulty transferring EBM skills learned in the classroom to clinical practice. This lack of skill transfer may be partially due to the design of EBM training. To facilitate the transfer of EBM skills from the classroom to clinical practice, the authors explore one instructional approach, called the Four Component Instructional Design (4C/ID) model, to guide the design of EBM training. On the basis of current cognitive psychology, including cognitive load theory, the premise of the 4C/ID model is that complex skills training, such as EBM training, should include four components: learning tasks, supportive information, procedural information, and part-task practice. The combination of these four components can inform the creation of complex skills training that is designed to avoid overloading learners' cognitive abilities; to facilitate the integration of the knowledge, skills, and attitudes needed to execute a complex task; and to increase the transfer of knowledge to new situations. The authors begin by introducing the 4C/ID model and describing the benefits of its four components to guide the design of EBM training. They include illustrative examples of educational practices that are consistent with each component and that can be applied to teaching EBM. They conclude by suggesting that medical educators consider adopting the 4C/ID model to design, modify, and/or implement EBM training in classroom and clinical settings.

An exploratory trial exploring the use of a multiple intelligences teaching approach (MITA) for teaching clinical skills to first year undergraduate nursing students.

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Sheahan, Linda; While, Alison; Bloomfield, Jacqueline

2015-12-01

The teaching and learning of clinical skills is a key component of nurse education programmes. The clinical competency of pre-registration nursing students has raised questions about the proficiency of teaching strategies for clinical skill acquisition within pre-registration education. This study aimed to test the effectiveness of teaching clinical skills using a multiple intelligences teaching approach (MITA) compared with the conventional teaching approach. A randomised controlled trial was conducted. Participants were randomly allocated to an experimental group (MITA intervention) (n=46) and a control group (conventional teaching) (n=44) to learn clinical skills. Setting was in one Irish third-level educational institution. Participants were all first year nursing students (n=90) in one institution. The experimental group was taught using MITA delivered by the researcher while the control group was taught by a team of six experienced lecturers. Participant preference for learning was measured by the Index of Learning Styles (ILS). Participants' multiple intelligence (MI) preferences were measured with a multiple intelligences development assessment scale (MIDAS). All participants were assessed using the same objective structured clinical examination (OSCE) at the end of semester one and semester two. MI assessment preferences were measured by a multiple intelligences assessment preferences questionnaire. The MITA intervention was evaluated using a questionnaire. The strongest preference on ILS for both groups was the sensing style. The highest MI was interpersonal intelligence. Participants in the experimental group had higher scores in all three OSCEs (pmultiple choice questions as methods of assessment. MITA was evaluated positively. The study findings support the use of MITA for clinical skills teaching and advance the understanding of how MI teaching approaches may be used in nursing education. Copyright © 2015 Elsevier Ltd. All rights reserved.

Factors Associated With Nursing Students' Resilience: Communication Skills Course, Use of Social Media and Satisfaction With Clinical Placement.

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Sigalit, Warshawski; Sivia, Barnoy; Michal, Itzhaki

The purpose of this study was to explore the (a) associations between students' personal and group resilience to their utilization of social networking platforms and formally taught communication skills, (b) students' personal and clinical characteristics that are related to personal and group resilience and the perceived helpfulness of communication course, and (c) factors that contribute to students' satisfaction with their clinical placement. Data were collected from 149 second year nursing students learning in a major university in the country of Israel with the use of a self-administered structured questionnaire. Students' satisfaction from their clinical placement was measured using 1 open-ended question, analyzed through qualitative methods. Results demonstrated positive correlations between students' use of social networking to their personal and group resilience (Pmedia use, religion, and clinical placement characteristics were related to resilience and to the perceived helpfulness of the communication course (P<.01). Students' satisfaction with their clinical placement was based primarily on the clinical instructors' personal and professional skills. In conclusion, social networking can and should be used as a learning tool to promote resilience among nursing students. Faculty and nurse managers should be aware of the central role of the clinical instructor and initiate collaborative and supporting initiatives. Copyright © 2016 Elsevier Inc. All rights reserved.

Identifying Culturally Competent Clinical Skills in Speech-Language Pathologists in the Central Valley of California

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Maul, Christine A.

2010-01-01

The purpose of this research was to identify specific clinical skills in speech-language pathologists (SLPs) that may constitute cultural competency, a term which currently lacks operational definition. Through qualitative interview methods, the following research questions were addressed: (1) What dominant themes, if any, can be found in SLPs'…

Development and implementation of an objective structured clinical examination to provide formative feedback on communication and interpersonal skills in geriatric training.

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O'Sullivan, Patricia; Chao, Serena; Russell, Matthew; Levine, Sharon; Fabiny, Anne

2008-09-01

Teaching and assessment of communication and interpersonal skills, one of the American Council for Graduate Medical Education-designated core competencies, is an important but difficult task in the training of physicians. Assessment of trainees offers an opportunity to provide explicit feedback on their skills and encourages learning. This article describes a pilot study in which clinician-educators affiliated with the geriatrics training programs at Beth Israel Deaconess Medical Center and Boston University Medical Center designed and piloted a novel Objective Structured Clinical Examination (OSCE) to assess the communication and interpersonal skills of medical, dental, and geriatric psychiatry fellows. The OSCE consisted of three stations where geriatricians and standardized patients evaluated candidates using specifically designed checklists and an abbreviated version of the Master Interview Rating Scale. Communication skills were assessed through performance of specific "real life" clinical tasks, such as obtaining a medical history, explaining a diagnosis and prognosis, giving therapeutic instructions, and counseling. Interpersonal skills were assessed through the effect of the communication between doctor and standardized patient on fostering trust, relieving anxiety, and establishing a therapeutic relationship. This pilot study demonstrated that the OSCE format of assessment provides a valid means of evaluating the communication and interpersonal skills of interdisciplinary geriatric trainees and provides a valuable forum for formative assessment and feedback. Given that geriatricians and non geriatricians involved in elder care both need communication and interpersonal skills, this novel OSCE can be used for assessment of these skills in trainees in diverse healthcare subspecialties.

Usability of Computerized Lung Auscultation-Sound Software (CLASS) for learning pulmonary auscultation.

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Machado, Ana; Oliveira, Ana; Jácome, Cristina; Pereira, Marco; Moreira, José; Rodrigues, João; Aparício, José; Jesus, Luis M T; Marques, Alda

2018-04-01

The mastering of pulmonary auscultation requires complex acoustic skills. Computer-assisted learning tools (CALTs) have potential to enhance the learning of these skills; however, few have been developed for this purpose and do not integrate all the required features. Thus, this study aimed to assess the usability of a new CALT for learning pulmonary auscultation. Computerized Lung Auscultation-Sound Software (CLASS) usability was assessed by eight physiotherapy students using computer screen recordings, think-aloud reports, and facial expressions. Time spent in each task, frequency of messages and facial expressions, number of clicks and problems reported were counted. The timelines of the three methods used were matched/synchronized and analyzed. The tasks exercises and annotation of respiratory sounds were the ones requiring more clicks (median 132, interquartile range [23-157]; 93 [53-155]; 91 [65-104], respectively) and where most errors (19; 37; 15%, respectively) and problems (n = 7; 6; 3, respectively) were reported. Each participant reported a median of 6 problems, with a total of 14 different problems found, mainly related with CLASS functionalities (50%). Smile was the only facial expression presented in all tasks (n = 54). CLASS is the only CALT available that meets all the required features for learning pulmonary auscultation. The combination of the three usability methods identified advantages/disadvantages of CLASS and offered guidance for future developments, namely in annotations and exercises. This will allow the improvement of CLASS and enhance students' activities for learning pulmonary auscultation skills.

Outcome measures and psychomotor skills related to shoulder conditions for clinical orthopedic training.

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Mahomed, Surreya; Al-Obaidi, Saud; Al-Zoabi, Baker

2008-01-01

This study was designed to assess the ability of physical therapy (PT) students to utilize selected outcome measures such as range of motion (ROM), pain and a number of psychomotor skills and to determine the efficacy of treatment they carried out during orthopedic clinical training. The clinical education booklets in orthopedics of all PT students over a 6-year period were reviewed. Students' application of psychomotor skills such as peripheral joint mobilizations (PJM), proprioceptive neuromuscular facilitation (PNF) techniques, therapeutic exercise techniques as well as utilization of basic outcome measures such as ROM and pain were analyzed with descriptive statistics and paired t test. A majority of students used PJM techniques (78.6%) and PNF techniques (58.6%). The paired t test indicated that treatment interventions used by the students were associated with improved shoulder joint ROM and decreased pain levels (p < 0.001). At the same time, therapeutic exercises were employed by the students after PJM and PNF. The most common 'comparable joint sign' was limitation in shoulder abduction ROM, which occurred in 44% of patients seen by the students. PT students' application of PJM, PNF, and therapeutic exercise improved ROM and decreased pain in patients with shoulder pathologies. (c) 2008 S. Karger AG, Basel.

New graduate nurse transition programs and clinical leadership skills in novice RNs.

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Chappell, Kathy B; Richards, Kathy C; Barnett, Scott D

2014-12-01

The objective of this study was to determine predictors of clinical leadership skill (CLS) for RNs with 24 months of clinical experience or less. New graduate nurse transition programs (NGNTPs) have been proposed as a strategy to increase CLS. CLS is associated with positive patient outcomes. Method used was hierarchical regression modeling to evaluate predictors of CLS among individual characteristics of RNs and characteristics of NGNTPs. Perceived overall quality of an NGNTP was the strongest predictor of CLS (R = 0.041, P < .01). Clinical experience and NGNTP characteristics accounted for 6.9% of the variance in CLS and 12.6% of the variance among RNs with assigned mentors (P < .01). RNs participating in NGNTPs for more than 24 weeks were 21 times more likely to remain employed within the organization when compared with NGNTPs of 12 weeks or less, a significant cost-benefit to the organization. Although perceived overall quality of a NGNTP was the strongest predictor of CLS, much of the variance in CLS remains unexplained.

Development of Prediction Tool for Sound Absorption and Sound Insulation for Sound Proof Properties

OpenAIRE

Yoshio Kurosawa; Takao Yamaguchi

2015-01-01

High frequency automotive interior noise above 500 Hz considerably affects automotive passenger comfort. To reduce this noise, sound insulation material is often laminated on body panels or interior trim panels. For a more effective noise reduction, the sound reduction properties of this laminated structure need to be estimated. We have developed a new calculate tool that can roughly calculate the sound absorption and insulation properties of laminate structure and handy ...

Evidence on Tips for Supporting Reading Skills at Home

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What Works Clearinghouse, 2018

2018-01-01

This document begins by providing four tips parents and care takers can use to supporting childrens' reading skills at home: (1) Have conversations before, during, and after reading together; (2) Help children learn how to break sentences into words and words into syllables; (3) Help children sound out words smoothly; and (4) Model reading…

Evaluating Success of Pediatric Dentistry Department at Mashhad Dental School (Iran in Clinical Skills Education from Students’ Perspectives

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Hosein Nematollahi

Full Text Available Introduction: Periodic evaluation of educational programs provides insight into the course and teaching effectiveness. Effective evaluation provides valuable information, which contributes to both student’s and course success. The purpose of this study was to evaluate the success of pediatric dentistry department at Mashhad dental school in clinical education from students’ perspectives.Materials & Methods: This cross-sectional study was conducted on 116 fifth and sixth grade undergraduate dental students in pediatric dentistry at Mashhad dental school. A questionnaire including 21 multiple choice questions about 7 parts of clinical skills in pediatric dentistry was given to each student. Data were analyzed by Mann-Whitney in SPSS software. Results: According to the study results, among 7 different clinical skills in pediatric dentistry including: examination, behavior management, prevention, injection, restoration, pulp treatment and space management, the highest success rate of pediatric dentistry department was in prevention and injection and the lowest success rate in space management and behavior control. Furthermore, from the students’ perspective, male students compared to female students mentioned a higher rate of success in choosing the type of restoration material for pediatric dentistry department (P=0. 041. Conclusion: This study showed that the students’ self-reported clinical skills in different parts of pediatric dentistry has been adequate. Students reported a lack of confidence in “behavior management” and “space management” which warrants greater emphasis in the undergraduate curriculum.

Tinnitus retraining therapy for patients with tinnitus and decreased sound tolerance.

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Jastreboff, Pawel J; Jastreboff, Margaret M

2003-04-01

Our experience has revealed the following: (1) TRT is applicable for all types of tinnitus, as well as for decreased sound tolerance, with significant improvement of tinnitus occurring in over 80% of the cases, and at least equal success rate for decreased sound tolerance. (2) TRT can provide cure for decreased sound tolerance. (3) TRT does not require frequent clinic visits and has no side effects; however, (4) Special training of health providers involved in this treatment is required for this treatment to be effective.

The impact of a structured clinical training course on interns' self-reported confidence with core clinical urology skills.

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Browne, C; Norton, S; Nolan, J M; Whelan, C; Sullivan, J F; Quinlan, M; Sheikh, M; Mc Dermott, T E D; Lynch, T H; Manecksha, R P

2018-02-01

Undergraduate training in core urology skills is lacking in many Irish training programmes. Our aim was to assess newly qualified doctors' experience and confidence with core urological competencies. A questionnaire survey covering exposure to urology and confidence with core clinical skills was circulated to all candidates. The group then attended a skills course covering male/female catheterisation, insertion of three-way catheters, bladder irrigation and management of long-term suprapubic catheters. The groups were re-surveyed following the course. Forty-five interns completed the pre-course questionnaire (group 1) and 27 interns completed the post-course questionnaire (group 2). 24/45 (53%) had no experience of catheter insertion on a patient during their undergraduate training. 26/45 (58%) were unsupervised during their first catheter insertion. 12/45 (27%) had inserted a female catheter. 18/45 (40%) had inserted a three-way catheter. 12/45 (27%) had changed a suprapubic catheter. 40/45 (89%) in group 1 reported 'good' or 'excellent' confidence with male urinary catheterisation, compared to 25/27 (92.5%) in group 2. 18/45 (40%) in group 1 reported 'none' or 'poor' confidence with female catheterisation, compared to 7/27 (26%) in group 2. 22/45 (49%) in group 1 reported 'none' or 'poor' confidence with insertion of three-way catheters, compared to 2/27 (7%) in group 2. 32/45 (71%) in group 1 reported 'none' or 'poor' confidence in changing long-term suprapubic catheters, falling to 3/27 (11%) in group 2. This study raises concerns about newly qualified doctors' practical experience in urology. We suggest that this course improves knowledge and confidence with practical urology skills and should be incorporated into intern induction.

Role of SimMan in teaching clinical skills to preclinical medical students

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Swamy Meenakshi

2013-02-01

Full Text Available Abstract Background Simulation training has potential in developing clinical skills in pre-clinical medical students, but there is little evidence on its effectiveness. Methods Twenty four first year graduate entry preclinical medical students participated in this crossover study. They were divided into two groups, one performed chest examination on each other and the other used SimMan. The groups then crossed over. A pretest, midtest and post-test was conducted in which the students answered the same questionnaire with ten questions on knowledge, and confidence levels rated using a 5 point Likert scale. They were assessed formatively using the OSCE marking scheme. At the end of the session, 23 students completed a feedback questionnaire. Data was analyzed using one-way ANOVA and independent t-test. Results When the two groups were compared, there was no significant difference in the pretest and the post-test scores on knowledge questions whereas the midtest scores increased significantly (P Mean confidence ratings increased from the pretest to midtest and then further in the post-test for both groups. Their confidence ratings increased significantly in differentiating between normal and abnormal signs [Group starting with SimMan, between pretest and midtest (P= 0.01 and group starting with peer examination, between midtest and post-test (P=0.02]. When the students’ ability to perform examination on each other for both groups was compared, there was a significant increase in the scores of the group starting with SimMan (P=0.007. Conclusions This pilot study demonstrated a significant improvement in the students’ knowledge and competence to perform chest examination after simulation with an increase in the student’s perceived levels of confidence. Feedback from the students was extremely positive. SimMan acts as a useful adjunct to teach clinical skills to preclinical medical students by providing a simulated safe environment and thus aids

Making fictions sound real - On film sound, perceptual realism and genre

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Birger Langkjær

2010-05-01

Full Text Available This article examines the role that sound plays in making fictions perceptually real to film audiences, whether these fictions are realist or non-realist in content and narrative form. I will argue that some aspects of film sound practices and the kind of experiences they trigger are related to basic rules of human perception, whereas others are more properly explained in relation to how aesthetic devices, including sound, are used to characterise the fiction and thereby make it perceptually real to its audience. Finally, I will argue that not all genres can be defined by a simple taxonomy of sounds. Apart from an account of the kinds of sounds that typically appear in a specific genre, a genre analysis of sound may also benefit from a functionalist approach that focuses on how sounds can make both realist and non-realist aspects of genres sound real to audiences.

Making fictions sound real - On film sound, perceptual realism and genre

Directory of Open Access Journals (Sweden)

Birger Langkjær

2009-09-01

Full Text Available This article examines the role that sound plays in making fictions perceptually real to film audiences, whether these fictions are realist or non-realist in content and narrative form. I will argue that some aspects of film sound practices and the kind of experiences they trigger are related to basic rules of human perception, whereas others are more properly explained in relation to how aesthetic devices, including sound, are used to characterise the fiction and thereby make it perceptually real to its audience. Finally, I will argue that not all genres can be defined by a simple taxonomy of sounds. Apart from an account of the kinds of sounds that typically appear in a specific genre, a genre analysis of sound may also benefit from a functionalist approach that focuses on how sounds can make both realist and non-realist aspects of genres sound real to audiences.

Integration of Health Coaching Concepts and Skills into Clinical Practice Among VHA Providers: A Qualitative Study.

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Collins, David A; Thompson, Kirsten; Atwood, Katharine A; Abadi, Melissa H; Rychener, David L; Simmons, Leigh Ann

2018-01-01

Although studies of health coaching for behavior change in chronic disease prevention and management are increasing, to date no studies have reported on what concepts and skills providers integrate into their clinical practice following participation in health coaching courses. The purpose of this qualitative study was to assess Veterans Health Administration (VHA) providers' perceptions of the individual-level and system-level changes they observed after participating with colleagues in a 6-day Whole Health Coaching course held in 8 VHA medical centers nationwide. Data for this study were from the follow-up survey conducted with participants 2 to 3 months after completing the training. A total of 142 responses about individual-level changes and 99 responses about system-level changes were analyzed using content analysis. Eight primary themes emerged regarding individual changes, including increased emphasis on Veterans' values, increased use of listening and other specific health coaching skills in their clinical role, and adding health coaching to their clinical practice.Four primary themes emerged regarding system-level changes, including leadership support, increased staff awareness/support/learning and sharing, increased use of health coaching skills or tools within the facility, and organizational changes demonstrating a more engaged workforce, such as new work groups being formed or existing groups becoming more active. Findings suggest that VHA providers who participate in health coaching trainings do perceive positive changes within themselves and their organizations. Health coaching courses that emphasize patient-centered care and promote patient-provider partnerships likely have positive effects beyond the individual participants that can be used to promote desired organizational change.

Self- and rater-assessed effectiveness of “thinking-aloud” and “regular” morning report to intensify young physicians' clinical skills

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Hui-Chi Hsu

2015-09-01

Conclusion: TA MR effectively trains junior attendees in basic clinical skills, whereas regular MR enhances senior attendees' “work reports, professionalism, organizational efficiency, skills in dealing with controversial and professional issues.” Undoubtedly, all elements of the two MR models should be integrated together to ensure patient safety and good discipline among young physicians.

An alternative respiratory sounds classification system utilizing artificial neural networks

Directory of Open Access Journals (Sweden)

Rami J Oweis

2015-04-01

Full Text Available Background: Computerized lung sound analysis involves recording lung sound via an electronic device, followed by computer analysis and classification based on specific signal characteristics as non-linearity and nonstationarity caused by air turbulence. An automatic analysis is necessary to avoid dependence on expert skills. Methods: This work revolves around exploiting autocorrelation in the feature extraction stage. All process stages were implemented in MATLAB. The classification process was performed comparatively using both artificial neural networks (ANNs and adaptive neuro-fuzzy inference systems (ANFIS toolboxes. The methods have been applied to 10 different respiratory sounds for classification. Results: The ANN was superior to the ANFIS system and returned superior performance parameters. Its accuracy, specificity, and sensitivity were 98.6%, 100%, and 97.8%, respectively. The obtained parameters showed superiority to many recent approaches. Conclusions: The promising proposed method is an efficient fast tool for the intended purpose as manifested in the performance parameters, specifically, accuracy, specificity, and sensitivity. Furthermore, it may be added that utilizing the autocorrelation function in the feature extraction in such applications results in enhanced performance and avoids undesired computation complexities compared to other techniques.

Sound Absorbers

Science.gov (United States)

Fuchs, H. V.; Möser, M.

Sound absorption indicates the transformation of sound energy into heat. It is, for instance, employed to design the acoustics in rooms. The noise emitted by machinery and plants shall be reduced before arriving at a workplace; auditoria such as lecture rooms or concert halls require a certain reverberation time. Such design goals are realised by installing absorbing components at the walls with well-defined absorption characteristics, which are adjusted for corresponding demands. Sound absorbers also play an important role in acoustic capsules, ducts and screens to avoid sound immission from noise intensive environments into the neighbourhood.

Computed tomography image of the mediastinal and axillary lymph nodes in clinically sound Rottweilers

Directory of Open Access Journals (Sweden)

Ana Carolina B. Fonseca Pinto

2013-03-01

Full Text Available Trough computed tomography (CT, it is possible to evaluate lymph nodes in detail and to detect changes in these structures earlier than with radiographs and ultrasound. Lack of information in the veterinary literature directed the focus of this report to normal aspects of the axillary and mediastinal lymph nodes of adult dogs on CT imaging. A CT scan of 15 normal adult male and female Rottweilers was done. To define them as clinically sound, anamnesis, physical examination, complete blood count, renal and hepatic biochemistry, ECG, and thoracic radiographs were performed. After the intravenous injection of hydrosoluble ionic iodine contrast medium contiguous 10mm in thickness thoracic transverse images were obtained with an axial scanner. In the obtained images mediastinal and axillary lymph nodes were sought and when found measured in their smallest diameter and their attenuation was compared to musculature. Mean and standard deviation of: age, weight, body length and the smallest diameter of the axillary and mediastinal lymph nodes were determined. Mean and standard deviation of parameters: age 3.87±2.03 years, weight 41.13±5.12, and body length 89.61±2.63cm. Axillary lymph nodes were seen in 60% of the animals, mean of the smallest diameter was 3.58mm with a standard deviation of 2.02 and a minimum value of 1mm and a maximum value of 7mm. From 13 observed lymph nodes 61.53% were hypopodense when compared with musculature, and 30.77% were isodense. Mediastinal lymph nodes were identified in 73.33% of the dogs; mean measure of the smallest diameter was 4.71mm with a standard deviation of 2.61mm and a minimum value of 1mm, and a maximum value of 8mm. From 14 observed lymph nodes 85.71% were isodense when compared with musculature and 14.28% were hypodense. The results show that it is possible to visualize axillary and mediastinal lymph nodes in adult clinically sound Rottweilers with CT using a slice thickness and interval of 10mm. The

Communication skills training in orthopaedics.

Science.gov (United States)

Lundine, Kristopher; Buckley, Richard; Hutchison, Carol; Lockyer, Jocelyn

2008-06-01

Communication skills play a key role in many aspects of both medical education and clinical patient care. The objectives of this study were to identify the key components of communication skills from the perspectives of both orthopaedic residents and their program directors and to understand how these skills are currently taught. This study utilized a mixed methods design. Quantitative data were collected with use of a thirty-item questionnaire distributed to all Canadian orthopaedic residents. Qualitative data were collected through focus groups with orthopaedic residents and semistructured interviews with orthopaedic program directors. One hundred and nineteen (37%) of 325 questionnaires were completed, twelve residents participated in two focus groups, and nine of sixteen program directors from across the country were interviewed. Both program directors and residents identified communication skills as being the accurate and appropriate use of language (i.e., content skills), not how the communication was presented (i.e., process skills). Perceived barriers to effective communication included time constraints and the need to adapt to the many personalities and types of people encountered daily in the hospital. Residents rarely have explicit training in communication skills. They rely on communication training implicitly taught through observation of their preceptors and clinical experience interacting with patients, peers, and other health-care professionals. Orthopaedic residents and program directors focus on content and flexibility within communication skills as well as on the importance of being concise. They value the development of communication skills in the clinical environment through experiential learning and role modeling. Education should focus on developing residents' process skills in communication. Care should be taken to avoid large-group didactic teaching sessions, which are perceived as ineffective.

The impact of expert- and peer feedback on communication skills of undergraduate dental students - a single-blinded, randomized, controlled clinical trial.

Science.gov (United States)

Krause, Felix; Schmalz, Gerhard; Haak, Rainer; Rockenbauch, Katrin

2017-12-01

To evaluate the effect of peer- and expert feedback on communication skills of undergraduate dental students. All students of the first clinical treatment course (n=46) were randomly assigned into two groups. For three times a medical-dental interview/consultation of each student with a real patient was videotaped. After every consultation the videos were assessed either by a person experienced in communication (expert group) or by a fellow student (peer group), giving the students feedback regarding their chairside performed communication skills. Before and after the feedback-interventions all students conducted an interview with simulated patients, which was rated using a validated global rating and analyzed statistically. Global ratings mean scores after feedback-intervention were significantly improved (p0.05). During this study students improved their communication skills in dentist-patient interactions. The communication experience of the feedback provider seems not to have any impact on the communication skills in undergraduate dental students. The clinical courses in dentistry offer the opportunity to implement peer-feedback interventions in real treatment situation as part of communication training to longitudinally improve communication skills. Copyright © 2017 Elsevier B.V. All rights reserved.

Making Sound Connections

Science.gov (United States)

Deal, Walter F., III

2007-01-01

Sound provides and offers amazing insights into the world. Sound waves may be defined as mechanical energy that moves through air or other medium as a longitudinal wave and consists of pressure fluctuations. Humans and animals alike use sound as a means of communication and a tool for survival. Mammals, such as bats, use ultrasonic sound waves to…

Collaborative and Bidirectional Feedback Between Students and Clinical Preceptors: Promoting Effective Communication Skills on Health Care Teams.

Science.gov (United States)

Myers, Kara; Chou, Calvin L

2016-11-01

Current literature on feedback suggests that clinical preceptors lead feedback conversations that are primarily unidirectional, from preceptor to student. While this approach may promote clinical competency, it does not actively develop students' competency in facilitating feedback discussions and providing feedback across power differentials (ie, from student to preceptor). This latter competency warrants particular attention given its fundamental role in effective health care team communication and its related influence on patient safety. Reframing the feedback process as collaborative and bidirectional, where both preceptors and students provide and receive feedback, maximizes opportunities for role modeling and skills practice in the context of a supportive relationship, thereby enhancing team preparedness. We describe an initiative to introduce these fundamental skills of collaborative, bidirectional feedback in the nurse-midwifery education program at the University of California, San Francisco. © 2016 by the American College of Nurse-Midwives.

Ichthyophonus in Puget Sound rockfish from the San Juan Islands archipelago and Puget Sound, Washington, USA

Science.gov (United States)

Halos, D.; Hart, S.A.; Hershberger, P.; Kocan, R.

2005-01-01

In vitro explant cultures identified Ichthyophonus in 10.9% of 302 Puget Sound rockfish Sebastes emphaeus sampled from five sites in the San Juan Islands archipelago and Puget Sound, Washington, in 2003. None of the infected fish exhibited visible lesions and only a single fish was histologically positive. Significantly more females were infected (12.4%) than males (6.8%), and while infected males were only detected at two of the five sites, infected females were identified at all sites, with no significant differences in infection prevalence. Genomic sequences of Ichthyophonus isolates obtained from Puget Sound rockfish, Pacific herring Clupea pallasii, and Yukon River Chinook salmon Oncorhynchus tshawytscha were identical in both the A and B regions of the small subunit 18S ribosomal DNA but were different from Ichthyophonus sequences previously isolated from four different species of rockfish from the northeastern Pacific Ocean. Ichthyophonus in Puget Sound rockfish may not have been previously detected because the infection is subclinical in this species and earlier investigators did not utilize in vitro techniques for diagnosis of ichthyophoniasis. However, since clinical ichthyophoniasis has recently been identified in several other species of northeast Pacific rockfishes, it is hypothesized that this either is an emerging disease resulting from changing marine conditions or the result of introduction by infected southern species that appear during periodic El Nin??o events. ?? Copyright by the American Fisheries Society 2005.

A Serious Game for Teaching Nursing Students Clinical Reasoning and Decision-Making Skills.

Science.gov (United States)

Johnsen, Hege Mari; Fossum, Mariann; Vivekananda-Schmidt, Pirashanthie; Fruhling, Ann; Slettebø, Åshild

2016-01-01

The aim of this study was to design and pilot-test a serious game for teaching nursing students clinical reasoning and decision-making skills in caring for patients with chronic obstructive pulmonary disease. A video-based serious game prototype was developed. A purposeful sample of six participants tested and evaluated the prototype. Usability issues were identified regarding functionality and user-computer interface. However, overall the serious game was perceived to be useful, usable and likable to use.

Ostomy Home Skills Program

Medline Plus

Full Text Available ... Congress Educational Program Events and Special Activities Resources Housing and Travel Exhibitors Media Information Clinical Congress 2017 ... Surgical Skills for Exposure in Trauma Advanced Trauma Life Support Advanced Trauma Operative Management Basic Endovascular Skills ...

[Implementation of bedside training and advanced objective structured clinical examination (OSCE) trial to learn and confirm about pharmacy clinical skills].

Science.gov (United States)

Tokunaga, Jin; Takamura, Norito; Ogata, Kenji; Setoguchi, Nao; Sato, Keizo

2013-01-01

Bedside training for fourth-year students, as well as seminars in hospital pharmacy (vital sign seminars) for fifth-year students at the Department of Pharmacy of Kyushu University of Health and Welfare have been implemented using patient training models and various patient simulators. The introduction of simulation-based pharmaceutical education, where no patients are present, promotes visually, aurally, and tactilely simulated learning regarding the evaluation of vital signs and implementation of physical assessment when disease symptoms are present or adverse effects occur. A patient simulator also promotes the creation of training programs for emergency and critical care, with which basic as well as advanced life support can be practiced. In addition, an advanced objective structured clinical examination (OSCE) trial has been implemented to evaluate skills regarding vital signs and physical assessments. Pharmacists are required to examine vital signs and conduct physical assessment from a pharmaceutical point of view. The introduction of these pharmacy clinical skills will improve the efficacy of drugs, work for the prevention or early detection of adverse effects, and promote the appropriate use of drugs. It is considered that simulation-based pharmaceutical education is essential to understand physical assessment, and such education will ideally be applied and developed according to on-site practices.

Abnormal sound detection device

International Nuclear Information System (INIS)

Yamada, Izumi; Matsui, Yuji.

1995-01-01

Only components synchronized with rotation of pumps are sampled from detected acoustic sounds, to judge the presence or absence of abnormality based on the magnitude of the synchronized components. A synchronized component sampling means can remove resonance sounds and other acoustic sounds generated at a synchronously with the rotation based on the knowledge that generated acoustic components in a normal state are a sort of resonance sounds and are not precisely synchronized with the number of rotation. On the other hand, abnormal sounds of a rotating body are often caused by compulsory force accompanying the rotation as a generation source, and the abnormal sounds can be detected by extracting only the rotation-synchronized components. Since components of normal acoustic sounds generated at present are discriminated from the detected sounds, reduction of the abnormal sounds due to a signal processing can be avoided and, as a result, abnormal sound detection sensitivity can be improved. Further, since it is adapted to discriminate the occurrence of the abnormal sound from the actually detected sounds, the other frequency components which are forecast but not generated actually are not removed, so that it is further effective for the improvement of detection sensitivity. (N.H.)

Multilingual Aspects of Speech Sound Disorders in Children. Communication Disorders across Languages

Science.gov (United States)

McLeod, Sharynne; Goldstein, Brian

2012-01-01

Multilingual Aspects of Speech Sound Disorders in Children explores both multilingual and multicultural aspects of children with speech sound disorders. The 30 chapters have been written by 44 authors from 16 different countries about 112 languages and dialects. The book is designed to translate research into clinical practice. It is divided into…

A Procedural Skills OSCE: Assessing Technical and Non-Technical Skills of Internal Medicine Residents

Science.gov (United States)

Pugh, Debra; Hamstra, Stanley J.; Wood, Timothy J.; Humphrey-Murto, Susan; Touchie, Claire; Yudkowsky, Rachel; Bordage, Georges

2015-01-01

Internists are required to perform a number of procedures that require mastery of technical and non-technical skills, however, formal assessment of these skills is often lacking. The purpose of this study was to develop, implement, and gather validity evidence for a procedural skills objective structured clinical examination (PS-OSCE) for internal…

Epilepsy, language, and social skills.

Science.gov (United States)

Caplan, Rochelle

2017-10-04

Language and social skills are essential for intrapersonal and interpersonal functioning and quality of life. Since epilepsy impacts these important domains of individuals' functioning, understanding the psychosocial and biological factors involved in the relationship among epilepsy, language, and social skills has important theoretical and clinical implications. This review first describes the psychosocial and biological factors involved in the association between language and social behavior in children and in adults and their relevance for epilepsy. It reviews the findings of studies of social skills and the few studies conducted on the inter-relationship of language and social skills in pediatric and adult epilepsy. The paper concludes with suggested future research and clinical directions that will enhance early identification and treatment of epilepsy patients at risk for impaired language and social skills. Copyright © 2017 Elsevier Inc. All rights reserved.

Sound Search Engine Concept

DEFF Research Database (Denmark)

2006-01-01

Sound search is provided by the major search engines, however, indexing is text based, not sound based. We will establish a dedicated sound search services with based on sound feature indexing. The current demo shows the concept of the sound search engine. The first engine will be realased June...

Patient-based not problem-based learning: An Oslerian approach to clinical skills, looking back to move forward

Directory of Open Access Journals (Sweden)

Franklyn-Miller A

2009-01-01

Full Text Available Context : There have been significant changes in the past decade in both the curriculum and its delivery, in undergraduate medical education. Many of these changes have been made simultaneously, preventing clear assessment of outcome measures. The move away from a pre-clinical science grounding, to an integrated ′problem-based learning (PBL approach′ has been widespread in many countries across the world. Purpose : One effect of these changes has been the way in which clinical skills, in particular history and examination are taught. By integrating clinical scenarios earlier in the undergraduate course, clinical skills are increasingly taught in tutorials. This approach, when used in the pre-clinical setting may have shortcomings in the development of the ability to construct a differential diagnosis. There has been little evidence that PBL improves problem-solving ability and this is critical to the differential diagnostic process. The concurrent decline in anatomical teaching and understanding contributes to this difficulty. Discussion : The authors outline a model which clinicians can re-emphasize to students and juniors based on the fundamentals of clinical practice. The apprenticeship is more important than ever in the days of small group learning. The relinquishing of the traditional model of undergraduate medicine is of concern. The effects of educational reform should be examined by further research into the competencies of graduates entering higher professional training, before it is accepted that this change has been for the better.

The sound manifesto

Science.gov (United States)

O'Donnell, Michael J.; Bisnovatyi, Ilia

2000-11-01

Computing practice today depends on visual output to drive almost all user interaction. Other senses, such as audition, may be totally neglected, or used tangentially, or used in highly restricted specialized ways. We have excellent audio rendering through D-A conversion, but we lack rich general facilities for modeling and manipulating sound comparable in quality and flexibility to graphics. We need coordinated research in several disciplines to improve the use of sound as an interactive information channel. Incremental and separate improvements in synthesis, analysis, speech processing, audiology, acoustics, music, etc. will not alone produce the radical progress that we seek in sonic practice. We also need to create a new central topic of study in digital audio research. The new topic will assimilate the contributions of different disciplines on a common foundation. The key central concept that we lack is sound as a general-purpose information channel. We must investigate the structure of this information channel, which is driven by the cooperative development of auditory perception and physical sound production. Particular audible encodings, such as speech and music, illuminate sonic information by example, but they are no more sufficient for a characterization than typography is sufficient for characterization of visual information. To develop this new conceptual topic of sonic information structure, we need to integrate insights from a number of different disciplines that deal with sound. In particular, we need to coordinate central and foundational studies of the representational models of sound with specific applications that illuminate the good and bad qualities of these models. Each natural or artificial process that generates informative sound, and each perceptual mechanism that derives information from sound, will teach us something about the right structure to attribute to the sound itself. The new Sound topic will combine the work of computer

Unsound Sound

DEFF Research Database (Denmark)

Knakkergaard, Martin

2016-01-01

This article discusses the change in premise that digitally produced sound brings about and how digital technologies more generally have changed our relationship to the musical artifact, not simply in degree but in kind. It demonstrates how our acoustical conceptions are thoroughly challenged...... by the digital production of sound and, by questioning the ontological basis for digital sound, turns our understanding of the core term substance upside down....

Customized Versus Noncustomized Sound Therapy for Treatment of Tinnitus: A Randomized Crossover Clinical Trial.

Science.gov (United States)

Mahboubi, Hossein; Haidar, Yarah M; Kiumehr, Saman; Ziai, Kasra; Djalilian, Hamid R

2017-10-01

To determine the effectiveness of a customized sound therapy and compare its effectiveness to that of masking with broadband noise. Subjects were randomized to receive either customized sound therapy or broadband noise for 2 hours per day for 3 months and then switched to the other treatment after a washout period. The outcome variables were tinnitus loudness (scored 0-10), Tinnitus Handicap Inventory (THI), Beck Anxiety Inventory (BAI), minimum masking levels (MML), and residual inhibition (RI). Eighteen subjects completed the study. Mean age was 53 ± 11 years, and mean tinnitus duration was 118 ± 99 months. With customized sound therapy, mean loudness decreased from 6.4 ± 2.0 to 4.9 ± 1.9 ( P = .001), mean THI decreased from 42.8 ± 21.6 to 31.5 ± 20.3 ( P tinnitus patients, and the results may be superior to broadband noise.

Determining the efficacy of social skills training in treatment of drug addiction in patients refering to Tehran Clinic

Directory of Open Access Journals (Sweden)

Hava Ramezani

2012-04-01

Full Text Available Background and Aim: The purpose of this study is to investigate the effect of group social skill training on drug abuse treatment prognosis.Materials & Methods :To achieve this goal, 20 available subjects residing at Tehran Clinic were selected. These subjects were randomly assigned into two experimental and control groups. The experimental group participated in ten 2-hour sessions and were trained social skills ,and the control group was in the waiting list. Measurement tools consisted of ACIS Questionnaire and laboratory test; Both experimental and control groups were subjected to pre and post tests. Data were analyzed using paired t test, independent t test, Mann-Whitney u test. Results: Results indicated that, the communication and interaction skills in experimental group had improved significantly in comparison with control group, also in the control group of a person suffering from lapse , but none of those two groups relapsed after 1- month follow up.Conclusion: According to our results it can be concluded that social skills training can be used as a suitable tool to increase communication and interaction skills.

Mapping symbols to sounds: electrophysiological correlates of the impaired reading process in dyslexia

Directory of Open Access Journals (Sweden)

Andreas eWidmann

2012-03-01

Full Text Available Dyslexic and control first grade school children were compared in a Symbol-to-Sound matching test based on a nonlinguistic audiovisual training which is known to have a remediating effect on dyslexia. Visual symbol patterns had to be matched with predicted sound patterns. Sounds incongruent with the corresponding visual symbol (thus not matching the prediction elicited the N2b and P3a event-related potential (ERP components relative to congruent sounds in control children. Their ERPs resembled the ERP effects previously reported for healthy adults with this paradigm. In dyslexic children, N2b onset latency was delayed and its amplitude significantly reduced over left hemisphere whereas P3a was absent. Moreover, N2b amplitudes significantly correlated with the reading skills. ERPs to sound changes in a control condition were unaffected. In addition, correctly predicted sounds, that is, sounds that are congruent with the visual symbol, elicited an early induced auditory gamma band response (GBR reflecting synchronization of brain activity in normal-reading children as previously observed in healthy adults. However, dyslexic children showed no GBR. This indicates that visual symbolic and auditory sensory information are not integrated into a unitary audiovisual object representation in them. Finally, incongruent sounds were followed by a later desynchronization of brain activity in the gamma band in both groups. This desynchronization was significantly larger in dyslexic children. Although both groups accomplished the task successfully remarkable group differences in brain responses suggest that normal-reading children and dyslexic children recruit (partly different brain mechanisms when solving the task. We propose that abnormal ERPs and GBRs in dyslexic readers indicate a deficit resulting in a widespread impairment in processing and integrating auditory and visual information and contributing to the reading impairment in dyslexia.

International perception of lung sounds: a comparison of classification across some European borders

OpenAIRE

Aviles Solis, Juan Carlos; Vanbelle, Sophie; Halvorsen, Peder Andreas; Francis, Nick; Cals, Jochem W L; Andreeva, Elena A; Marques, Alda; Piirila, Paivi; Pasterkamp, Hans; Melbye, Hasse

2017-01-01

Source at http://dx.doi.org/10.1136/bmjresp-2017-000250 Introduction: Lung auscultation is helpful in the diagnosis of lung and heart diseases; however, the diagnostic value of lung sounds may be questioned due to interobserver variation. This situation may also impair clinical research in this area to generate evidence-based knowledge about the role that chest auscultation has in a modern clinical setting. The recording and visual display of lung sounds is a method that is both repeatab...

Early Sound Symbolism for Vowel Sounds

Directory of Open Access Journals (Sweden)

Ferrinne Spector

2013-06-01

Full Text Available Children and adults consistently match some words (e.g., kiki to jagged shapes and other words (e.g., bouba to rounded shapes, providing evidence for non-arbitrary sound–shape mapping. In this study, we investigated the influence of vowels on sound–shape matching in toddlers, using four contrasting pairs of nonsense words differing in vowel sound (/i/ as in feet vs. /o/ as in boat and four rounded–jagged shape pairs. Crucially, we used reduplicated syllables (e.g., kiki vs. koko rather than confounding vowel sound with consonant context and syllable variability (e.g., kiki vs. bouba. Toddlers consistently matched words with /o/ to rounded shapes and words with /i/ to jagged shapes (p < 0.01. The results suggest that there may be naturally biased correspondences between vowel sound and shape.

Development of Sound Localization Strategies in Children with Bilateral Cochlear Implants.

Directory of Open Access Journals (Sweden)

Yi Zheng

Full Text Available Localizing sounds in our environment is one of the fundamental perceptual abilities that enable humans to communicate, and to remain safe. Because the acoustic cues necessary for computing source locations consist of differences between the two ears in signal intensity and arrival time, sound localization is fairly poor when a single ear is available. In adults who become deaf and are fitted with cochlear implants (CIs sound localization is known to improve when bilateral CIs (BiCIs are used compared to when a single CI is used. The aim of the present study was to investigate the emergence of spatial hearing sensitivity in children who use BiCIs, with a particular focus on the development of behavioral localization patterns when stimuli are presented in free-field horizontal acoustic space. A new analysis was implemented to quantify patterns observed in children for mapping acoustic space to a spatially relevant perceptual representation. Children with normal hearing were found to distribute their responses in a manner that demonstrated high spatial sensitivity. In contrast, children with BiCIs tended to classify sound source locations to the left and right; with increased bilateral hearing experience, they developed a perceptual map of space that was better aligned with the acoustic space. The results indicate experience-dependent refinement of spatial hearing skills in children with CIs. Localization strategies appear to undergo transitions from sound source categorization strategies to more fine-grained location identification strategies. This may provide evidence for neural plasticity, with implications for training of spatial hearing ability in CI users.

Effects of video-feedback on the communication, clinical competence and motivational interviewing skills of practice nurses: a pre-test posttest control group study.

NARCIS (Netherlands)

Noordman, J.; Weijden, T. van der; Dulmen, S. van

2014-01-01

Aims: To examine the effects of individual video-feedback on the generic communication skills, clinical competence (i.e. adherence to practice guidelines) and motivational interviewing skills of experienced practice nurses working in primary care. Background: Continuing professional education may be

Effects of video-feedback on the communication, clinical competence and motivational interviewing skills of practice nurses: a pre-test posttest control group study

NARCIS (Netherlands)

Noordman, J.; Weijden, T.T. van der; Dulmen, S. van

2014-01-01

AIMS: To examine the effects of individual video-feedback on the generic communication skills, clinical competence (i.e. adherence to practice guidelines) and motivational interviewing skills of experienced practice nurses working in primary care. BACKGROUND: Continuing professional education may be

Sound Art and Spatial Practices: Situating Sound Installation Art Since 1958

OpenAIRE

Ouzounian, Gascia

2008-01-01

This dissertation examines the emergence and development ofsound installation art, an under-recognized tradition that hasdeveloped between music, architecture, and media art practicessince the late 1950s. Unlike many musical works, which are concernedwith organizing sounds in time, sound installations organize sounds inspace; they thus necessitate new theoretical and analytical modelsthat take into consideration the spatial situated-ness of sound. Existingdiscourses on “spatial sound” privile...

A mentor development program for clinical translational science faculty leads to sustained, improved confidence in mentoring skills.

Science.gov (United States)

Feldman, Mitchell D; Steinauer, Jody E; Khalili, Mandana; Huang, Laurence; Kahn, James S; Lee, Kathryn A; Creasman, Jennifer; Brown, Jeanette S

2012-08-01

Mentorship is crucial for academic productivity and advancement for clinical and translational (CT) science faculty. However, little is known about the long-term effects of mentor training programs. The University of California, San Francisco (UCSF), Clinical and Translational Science Institute launched a Mentor Development Program (MDP) in 2007 for CT faculty. We report on an evaluation of the first three cohorts of graduates from the MDP. In 2010, all Mentors in Training (MITs) who completed the MDP from 2007 to 2009 (n= 38) were asked to complete an evaluation of their mentoring skills and knowledge; all MITs (100%) completed the evaluation. Two-thirds of MDP graduates reported that they often apply knowledge, attitudes, or skills obtained in the MDP to their mentoring. Nearly all graduates (97%) considered being a mentor important to their career satisfaction. Graduates were also asked about the MDP's impact on specific mentoring skills; 95% agreed that the MDP helped them to become a better mentor and to focus their mentoring goals. We also describe a number of new initiatives to support mentoring at UCSF that have evolved from the MDP. To our knowledge, this is the first evaluation of the long-term impact of a mentor training program for CT researchers. © 2012 Wiley Periodicals, Inc.

Sustained impact of a short small group course with systematic feedback in addition to regular clinical clerkship activities on musculoskeletal examination skills--a controlled study.

Science.gov (United States)

Perrig, Martin; Berendonk, Christoph; Rogausch, Anja; Beyeler, Christine

2016-01-28

The discrepancy between the extensive impact of musculoskeletal complaints and the common deficiencies in musculoskeletal examination skills lead to increased emphasis on structured teaching and assessment. However, studies of single interventions are scarce and little is known about the time-dependent effect of assisted learning in addition to a standard curriculum. We therefore evaluated the immediate and long-term impact of a small group course on musculoskeletal examination skills. All 48 Year 4 medical students of a 6 year curriculum, attending their 8 week clerkship of internal medicine at one University department in Berne, participated in this controlled study. Twenty-seven students were assigned to the intervention of a 6×1 h practical course (4-7 students, interactive hands-on examination of real patients; systematic, detailed feedback to each student by teacher, peers and patients). Twenty-one students took part in the regular clerkship activities only and served as controls. In all students clinical skills (CS, 9 items) were assessed in an Objective Structured Clinical Examination (OSCE) station, including specific musculoskeletal examination skills (MSES, 7 items) and interpersonal skills (IPS, 2 items). Two raters assessed the skills on a 4-point Likert scale at the beginning (T0), the end (T1) and 4-12 months after (T2) the clerkship. Statistical analyses included Friedman test, Wilcoxon rank sum test and Mann-Whitney U test. At T0 there were no significant differences between the intervention and control group. At T1 and T2 the control group showed no significant changes of CS, MSES and IPS compared to T0. In contrast, the intervention group significantly improved CS, MSES and IPS at T1 (p skills during regular clinical clerkship activities. However, an additional small group, interactive clinical skills course with feedback from various sources, improved these essential examination skills immediately after the teaching and several months later

Teaching pediatric communication skills to medical students.

Science.gov (United States)

Frost, Katherine A; Metcalf, Elizabeth P; Brooks, Rachel; Kinnersley, Paul; Greenwood, Stephen R; Powell, Colin Ve

2015-01-01

Delivering effective clinical pediatric communication skills training to undergraduate medical students is a distinct and important challenge. Pediatric-specific communication skills teaching is complex and under-researched. We report on the development of a scenario-based pediatric clinical communication skills program as well as students' assessment of this module. We designed a pediatric clinical communication skills program and delivered it five times during one academic year via small-group teaching. Students were asked to score the workshop in eight domains (learning objectives, complexity, interest, competencies, confidence, tutors, feedback, and discussion) using 5-point Likert scales, along with free text comments that were grouped and analyzed thematically, identifying both the strengths of the workshop and changes suggested to improve future delivery. Two hundred and twenty-one of 275 (80%) student feedback forms were returned. Ninety-six percent of students' comments were positive or very positive, highlighting themes such as the timing of teaching, relevance, group sizes, and the use of actors, tutors, and clinical scenarios. Scenario-based teaching of clinical communication skills is positively received by students. Studies need to demonstrate an impact on practice, performance, development, and sustainability of communications training.

Sound a very short introduction

CERN Document Server

Goldsmith, Mike

2015-01-01

Sound is integral to how we experience the world, in the form of noise as well as music. But what is sound? What is the physical basis of pitch and harmony? And how are sound waves exploited in musical instruments? Sound: A Very Short Introduction looks at the science of sound and the behaviour of sound waves with their different frequencies. It also explores sound in different contexts, covering the audible and inaudible, sound underground and underwater, acoustic and electronic sound, and hearing in humans and animals. It concludes with the problem of sound out of place—noise and its reduction.

Spectral analysis of bowel sounds in intestinal obstruction using an electronic stethoscope.

Science.gov (United States)

Ching, Siok Siong; Tan, Yih Kai

2012-09-07

To determine the value of bowel sounds analysis using an electronic stethoscope to support a clinical diagnosis of intestinal obstruction. Subjects were patients who presented with a diagnosis of possible intestinal obstruction based on symptoms, signs, and radiological findings. A 3M™ Littmann(®) Model 4100 electronic stethoscope was used in this study. With the patients lying supine, six 8-second recordings of bowel sounds were taken from each patient from the lower abdomen. The recordings were analysed for sound duration, sound-to-sound interval, dominant frequency, and peak frequency. Clinical and radiological data were reviewed and the patients were classified as having either acute, subacute, or no bowel obstruction. Comparison of bowel sound characteristics was made between these subgroups of patients. In the presence of an obstruction, the site of obstruction was identified and bowel calibre was also measured to correlate with bowel sounds. A total of 71 patients were studied during the period July 2009 to January 2011. Forty patients had acute bowel obstruction (27 small bowel obstruction and 13 large bowel obstruction), 11 had subacute bowel obstruction (eight in the small bowel and three in large bowel) and 20 had no bowel obstruction (diagnoses of other conditions were made). Twenty-five patients received surgical intervention (35.2%) during the same admission for acute abdominal conditions. A total of 426 recordings were made and 420 recordings were used for analysis. There was no significant difference in sound-to-sound interval, dominant frequency, and peak frequency among patients with acute bowel obstruction, subacute bowel obstruction, and no bowel obstruction. In acute large bowel obstruction, the sound duration was significantly longer (median 0.81 s vs 0.55 s, P = 0.021) and the dominant frequency was significantly higher (median 440 Hz vs 288 Hz, P = 0.003) when compared to acute small bowel obstruction. No significant difference was seen

Impact of postgraduate training on communication skills teaching: a controlled study.

Science.gov (United States)

Junod Perron, Noelle; Nendaz, Mathieu; Louis-Simonet, Martine; Sommer, Johanna; Gut, Anne; Cerutti, Bernard; van der Vleuten, Cees P; Dolmans, Diana

2014-04-14

Observation of performance followed by feedback is the key to good teaching of communication skills in clinical practice. The fact that it occurs rarely is probably due to clinical supervisors' perceived lack of competence to identify communication skills and give effective feedback. We evaluated the impact of a faculty development programme on communication skills teaching on clinical supervisors' ability to identify residents' good and poor communication skills and to discuss them interactively during feedback. We conducted a pre-post controlled study in which clinical supervisors took part to a faculty development program on teaching communication skills in clinical practice. Outcome measures were the number and type of residents' communication skills identified by supervisors in three videotaped simulated resident-patient encounters and the number and type of communication skills discussed interactively with residents during three feedback sessions. 48 clinical supervisors (28 intervention group; 20 control group) participated. After the intervention, the number and type of communication skills identified did not differ between both groups. There was substantial heterogeneity in the number and type of communication skills identified. However, trained participants engaged in interactive discussions with residents on a significantly higher number of communication items (effect sizes 0.53 to 1.77); communication skills items discussed interactively included both structural and patient-centered elements that were considered important to be observed by expert teachers. The faculty development programme did not increase the number of communication skills recognised by supervisors but was effective in increasing the number of communication issues discussed interactively in feedback sessions. Further research should explore the respective impact of accurate identification of communication skills and effective teaching skills on achieving more effective communication

Therapist facilitative interpersonal skills and training status: A randomized clinical trial on alliance and outcome.

Science.gov (United States)

Anderson, Timothy; Crowley, Mary Ellen J; Himawan, Lina; Holmberg, Jennifer K; Uhlin, Brian D

2016-09-01

Therapist effects, independent of the treatment provided, have emerged as a contributor to psychotherapy outcomes. However, past research largely has not identified which therapist factors might be contributing to these effects, though research on psychotherapy implicates relational characteristics. The present Randomized Clinical Trial tested the efficacy of therapists who were selected by their facilitative interpersonal skills (FIS) and training status. Sixty-five clients were selected from 2713 undergraduates using a screening and clinical interview procedure. Twenty-three therapists met with 2 clients for 7 sessions and 20 participants served in a no-treatment control group. Outcome and alliance differences for Training Status were negligible. High FIS therapists had greater pre-post client outcome, and higher rates of change across sessions, than low FIS therapists. All clients treated by therapists improved more than the silent control, but effects were greater with high FIS than low FIS therapists. From the first session, high FIS therapists also had higher alliances than low FIS therapists as well as significant improvements on client-rated alliance. Results were consistent with the hypothesis that therapists' common relational skills are independent contributors to therapeutic alliance and outcome.

Knowledge and critical thinking skills increase clinical reasoning ability in urogenital disorders: a Universitas Sriwijaya Medical Faculty experience

Directory of Open Access Journals (Sweden)

Irfannuddin Irfannuddin

2009-03-01

Full Text Available Aim Clinical reasoning is one of the essential competencies for medical practitioners, so that it must be exercised by medical students. Studies on quantitative evidence of factors influencing clinical reasoning abilicy of students are limited. The aim of this study was to determine the influence of knowledge and other factors on the clinical reasoning abiliry ofthe students, which can serve as reference to establish methods for learning ctinical reasoning.Methods This is a cross-sectional study on fourth semester students enrolled in the Competency-based Curriculum of the Medical Faculty, University of Sriwijaya. Data on clinical reasoning abilily and risk factors during urogenital blockwere collected inApril 2008, when the students have just completed the btock. Clinical reasoning abiliry was tested using the Script Concordance test and the risk factors were evaluated based on formative tests, block summative assessments, and student characteristics. Data were analyzed by Cox regression.Results The prevalence of low clinical reasoning ability of the 132 students was 38.6%. The group with low basic knowledge was found to have 63% risk ol low clinical reasoning abiliry when compared to those with high basic knowledge (adjusted RR = 1.63; 95% conidence intewal (Ct: 1.10 -2.42. When compared to students with high critical thinking skitls, those with lory critical thinking skills had 2.3 time to be low clinical reasoning abitity (adjusted RR : 2.30; 95% CI: 1.55 - 3.41.Conclusion Students with low critical thinking skills or with inadequate knowledge had a higher risk of low clinical reasoning ability. (Med J Indones 2009; 18: 53-9Keywords: clinical reasoning, basic knowledge, critical thinking, competency-based curriculum

What is Sound?

OpenAIRE

Nelson, Peter

2014-01-01

What is sound? This question is posed in contradiction to the every-day understanding that sound is a phenomenon apart from us, to be heard, made, shaped and organised. Thinking through the history of computer music, and considering the current configuration of digital communi-cations, sound is reconfigured as a type of network. This network is envisaged as non-hierarchical, in keeping with currents of thought that refuse to prioritise the human in the world. The relationship of sound to musi...

Broadcast sound technology

CERN Document Server

Talbot-Smith, Michael

1990-01-01

Broadcast Sound Technology provides an explanation of the underlying principles of modern audio technology. Organized into 21 chapters, the book first describes the basic sound; behavior of sound waves; aspects of hearing, harming, and charming the ear; room acoustics; reverberation; microphones; phantom power; loudspeakers; basic stereo; and monitoring of audio signal. Subsequent chapters explore the processing of audio signal, sockets, sound desks, and digital audio. Analogue and digital tape recording and reproduction, as well as noise reduction, are also explained.

Propagation of sound

DEFF Research Database (Denmark)

Wahlberg, Magnus; Larsen, Ole Næsbye

2017-01-01

properties can be modified by sound absorption, refraction, and interference from multi paths caused by reflections.The path from the source to the receiver may be bent due to refraction. Besides geometrical attenuation, the ground effect and turbulence are the most important mechanisms to influence...... communication sounds for airborne acoustics and bottom and surface effects for underwater sounds. Refraction becomes very important close to shadow zones. For echolocation signals, geometric attenuation and sound absorption have the largest effects on the signals....

Making fictions sound real

DEFF Research Database (Denmark)

Langkjær, Birger

2010-01-01

This article examines the role that sound plays in making fictions perceptually real to film audiences, whether these fictions are realist or non-realist in content and narrative form. I will argue that some aspects of film sound practices and the kind of experiences they trigger are related...... to basic rules of human perception, whereas others are more properly explained in relation to how aesthetic devices, including sound, are used to characterise the fiction and thereby make it perceptually real to its audience. Finally, I will argue that not all genres can be defined by a simple taxonomy...... of sounds. Apart from an account of the kinds of sounds that typically appear in a specific genre, a genre analysis of sound may also benefit from a functionalist approach that focuses on how sounds can make both realist and non-realist aspects of genres sound real to audiences....

Impact of postgraduate training on communication skills teaching: a controlled study

Science.gov (United States)

2014-01-01

Background Observation of performance followed by feedback is the key to good teaching of communication skills in clinical practice. The fact that it occurs rarely is probably due to clinical supervisors’ perceived lack of competence to identify communication skills and give effective feedback. We evaluated the impact of a faculty development programme on communication skills teaching on clinical supervisors’ ability to identify residents’ good and poor communication skills and to discuss them interactively during feedback. Methods We conducted a pre-post controlled study in which clinical supervisors took part to a faculty development program on teaching communication skills in clinical practice. Outcome measures were the number and type of residents’ communication skills identified by supervisors in three videotaped simulated resident-patient encounters and the number and type of communication skills discussed interactively with residents during three feedback sessions. Results 48 clinical supervisors (28 intervention group; 20 control group) participated. After the intervention, the number and type of communication skills identified did not differ between both groups. There was substantial heterogeneity in the number and type of communication skills identified. However, trained participants engaged in interactive discussions with residents on a significantly higher number of communication items (effect sizes 0.53 to 1.77); communication skills items discussed interactively included both structural and patient-centered elements that were considered important to be observed by expert teachers. Conclusions The faculty development programme did not increase the number of communication skills recognised by supervisors but was effective in increasing the number of communication issues discussed interactively in feedback sessions. Further research should explore the respective impact of accurate identification of communication skills and effective teaching

Sound sensitivity of neurons in rat hippocampus during performance of a sound-guided task

Science.gov (United States)

Vinnik, Ekaterina; Honey, Christian; Schnupp, Jan; Diamond, Mathew E.

2012-01-01

To investigate how hippocampal neurons encode sound stimuli, and the conjunction of sound stimuli with the animal's position in space, we recorded from neurons in the CA1 region of hippocampus in rats while they performed a sound discrimination task. Four different sounds were used, two associated with water reward on the right side of the animal and the other two with water reward on the left side. This allowed us to separate neuronal activity related to sound identity from activity related to response direction. To test the effect of spatial context on sound coding, we trained rats to carry out the task on two identical testing platforms at different locations in the same room. Twenty-one percent of the recorded neurons exhibited sensitivity to sound identity, as quantified by the difference in firing rate for the two sounds associated with the same response direction. Sensitivity to sound identity was often observed on only one of the two testing platforms, indicating an effect of spatial context on sensory responses. Forty-three percent of the neurons were sensitive to response direction, and the probability that any one neuron was sensitive to response direction was statistically independent from its sensitivity to sound identity. There was no significant coding for sound identity when the rats heard the same sounds outside the behavioral task. These results suggest that CA1 neurons encode sound stimuli, but only when those sounds are associated with actions. PMID:22219030

Adaptation and implementation of family-based treatment enhanced with dialectical behavior therapy skills for anorexia nervosa in community-based specialist clinics.