Changing the face of nursing: reducing ethnic and racial disparities in health

This article reports on findings from a Nursing Diversity Workforce grant, BEST (Becoming Excellent Students in Transition to Nursing), designed to assist students from minority and educationally disadvantaged backgrounds to become culturally competent registered nurses. A program of retention strategies that included peer and faculty tutoring, counseling, and financial support helped to remove barriers to success in nursing. All but 3 of the enrolled students either have graduated or are on track to doing so. Most graduates are practicing in the city where they are helping to reduce health disparities through their contributions to improved health care for vulnerable populations.

Effective literacy instruction for adults with specific learning disabilities: implications for adult educators

Adults with learning disabilities (LD) attending adult basic education, GED programs, or community colleges are among the lowest performers on measures of literacy. For example, on multiple measures of reading comprehension, adults with LD had a mean reading score at the third grade level, whereas adults without LD read at the fifth grade level. In addition, large numbers of adults perform at the lowest skill levels on quantitative tasks. Clearly, significant instructional challenges exist for adults who struggle with literacy issues, and those challenges can be greater for adults with LD. In this article, the literature on adults with LD is reviewed, and evidenced-based instructional practices that significantly narrow the literacy achievement gap for this population are identified. Primary attention is given to instructional factors that have been shown to affect literacy outcomes for adults with LD. These factors include the use of explicit instruction, instructional technology, and intensive tutoring in skills and strategies embedded in authentic contexts.

On the importance of a cognitive processing perspective: an introduction

Children with learning problems require early intervention. If it is evidence based and implemented with integrity and intensity, it will accelerate the academic progress of many students. This is the hope and expectation of the many supporters of responsiveness-to-intervention (RTI). A minority of children, however, will not respond sufficiently to such intervention because of learning disorders like specific learning disabilities (SLD). Some RTI models do not include research-backed methods to identify these children, nor do RTI practitioners often produce the data necessary to develop individualized instruction for them. The authors suggest practitioners go beyond typical RTI assessment data documenting responsiveness/ unresponsiveness to conduct comprehensive evaluations of these most difficult-to-teach students and to include in their evaluations carefully chosen cognitive measures. This special issue presents the work of teams of researchers, which suggests that cognitive and neuropsychological assessments can provide information to further understand SLD, which in turn can guide development of promising interventions.

Effects of bottom-up and top-down intervention principles in emergent literacy in children at risk of developmental dyslexia: a longitudinal study

This longitudinal study focused on the effects of two different principles of intervention in children at risk of developing dyslexia from 5 to 8 years old. The children were selected on the basis of a background questionnaire given to parents and preschool teachers, with cognitive and functional magnetic resonance imaging results substantiating group differences in neuropsychological processes associated with phonology, orthography, and phoneme-grapheme correspondence (i.e., alphabetic principle). The two principles of intervention were bottom-up (BU), "from sound to meaning", and top-down (TD), "from meaning to sound." Thus, four subgroups were established: risk/BU, risk/TD, control/BU, and control/TD. Computer-based training took place for 2 months every spring, and cognitive assessments were performed each fall of the project period. Measures of preliteracy skills for reading and spelling were phonological awareness, working memory, verbal learning, and letter knowledge. Literacy skills were assessed by word reading and spelling. At project end the control group scored significantly above age norm, whereas the risk group scored within the norm. In the at-risk group, training based on the BU principle had the strongest effects on phonological awareness and working memory scores, whereas training based on the TD principle had the strongest effects on verbal learning, letter knowledge, and literacy scores. It was concluded that appropriate, specific, data-based intervention starting in preschool can mitigate literacy impairment and that interventions should contain BU training for preliteracy skills and TD training for literacy training.

A randomized, controlled trial of computer-assisted cognitive remediation for schizophrenia

OBJECTIVE

There is considerable interest in cognitive remediation for schizophrenia. Our study aimed to evaluate, in a large sample of patients with schizophrenia, the interest of a computer-assisted cognitive remediation program on cognitive performances of patients as well as in clinical and functional outcome.

METHOD

Seventy-seven patients with remitted schizophrenia were randomly assigned to 14 2-hours individual sessions of computer-assisted cognitive remediation (n=39) or a control condition (n=38). Remediation was performed using RehaCom ® software. Four procedures were chosen to train four cognitive functions involved in different stages of the information processing: attention/concentration, working memory, logic, and executive functions. Primary outcomes were remediation exercise metrics, neuropsychological composites (episodic memory, working memory, attention, executive functioning, and processing speed), clinical and community functioning measures.

RESULTS

Cognitive performances concerning Attention/vigilance, verbal working memory and verbal learning memory and reasoning/problem solving improved significantly in the remediation condition when no difference was reported in the control condition between the 2 assessments. However, there were no significant benefits of cognitive remediation on non-verbal working memory and learning and speed of processing or functional outcome measures.

CONCLUSIONS

Cognitive remediation for people with schizophrenia was effective in improving performance, but the benefits of training did not generalize to functional outcome measures. Long term follow-up studies are needed to confirm the maintenance of such improvements.

A framework to teach self-reflection for the remedial resident

BACKGROUND

Regardless of the area of deficiency, be it in knowledge, skills or attitudes, residents requiring remediation are rarely self-identified. This illustrates a diminished ability for self-reflection. Self-reflection is a cornerstone of adult education. During the remediation process, the remediation curriculum needs to emphasize self-reflection.

AIMS

How can one structure self-reflection in a remediation curriculum?

METHODS

This article describes how to adapt and apply environmental scanning for remedial residents.

RESULTS

Environmental scanning is a rigorous and well-developed business approach that can be adapted for personal continuous quality improvement to foster self-reflection in medical trainees. There are often already existing tools which can form the foundation for regular reflection in medical education using an environmental scanning structure.

CONCLUSIONS

Environmental scanning can be thought of as a structured approach to internal and external reflections.

The effects of the fast track preventive intervention on the development of conduct disorder across childhood

The impact of the Fast Track intervention on externalizing disorders across childhood was examined. Eight hundred-ninety-one early-starting children (69% male; 51% African American) were randomly assigned by matched sets of schools to intervention or control conditions. The 10-year intervention addressed parent behavior-management, child social cognitive skills, reading, home visiting, mentoring, and classroom curricula. Outcomes included psychiatric diagnoses after grades 3, 6, 9, and 12 for conduct disorder, oppositional defiant disorder, attention deficit hyperactivity disorder, and any externalizing disorder. Significant interaction effects between intervention and initial risk level indicated that intervention prevented the lifetime prevalence of all diagnoses, but only among those at highest initial risk, suggesting that targeted intervention can prevent externalizing disorders to promote the raising of healthy children.

The state of educational intervention research as viewed through the lens of literacy intervention

The characteristics of educational intervention research are reviewed: Educational intervention research is inspired by diverse theories, targeted at a variety of simple to very complex interventions, and includes a variety of methods and measurements. Some interventions have been studied much more than others, with the more studied ones often summarized in meta-analyses and other integrative reviews. The study of some of the more complex interventions pose new ethical challenges. Although some intervention research impacts educational practice and policy, much more could and probably should.

Fostering reading comprehension in fifth grade by explicit instruction in reading strategies and peer tutoring

BACKGROUND

Research reveals that explicit reading strategies instruction and engaging students in interaction about texts promote students' reading comprehension ability. The present intervention study combines both aspects.

AIMS

The study examines the educational benefits of explicit reading strategies instruction, followed by practice in (a) teacher-led whole-class activities (STRAT), (b) reciprocal same-age (STRAT + SA), or (c) cross-age peer tutoring activities (STRAT + CA) on fifth graders' reading comprehension achievement.

SAMPLE

Twenty-two fifth-grade teachers and their 454 students from 19 different schools throughout Flanders (Belgium) participated.

METHOD

A quasi-experimental pretest post-test retention test design was used with three experimental (STRAT, STRAT + SA, and STRAT + CA) and a matched control group. The experimental interventions were implemented during an entire school year.

RESULTS

Multilevel analysis revealed that the STRAT and STRAT + CA condition made a significantly larger pretest to retention test progress than the control group. The significant major progress was especially situated from pretest to post-test, during which the intervention took place. Concerning the STRAT + SA condition no significant differences with regard to the control group were detected. Pairwise comparisons of the experimental conditions indicated that the STRAT + CA condition's progress from pretest to retention test also exceeded the STRAT + SA condition's advancement significantly.

CONCLUSION

The study corroborated the efficacy of the STRAT and STRAT + CA conditions' interventions as feasible tools to enhance fifth graders' reading comprehension achievement.

Reflect for success: recommendations for mentors managing failing students

Failing a student nurse for not meeting clinical competency on a practice placement can be a distressing and traumatic event for both student and community nurse mentor. This paper describes how a reflective model can be used to support practitioners' to come to terms with the decision and action of failing a student and dealing with the aftermath of the final interview.

A meta-analysis of morphological interventions: effects on literacy achievement of children with literacy difficulties

This study synthesizes 79 standardized mean-change differences between control and treatment groups from 17 independent studies, investigating the effect of morphological interventions on literacy outcomes for students with literacy difficulties. Average total sample size ranged from 15 to 261 from a wide range of grade levels. Overall, morphological instruction showed a significant improvement on literacy achievement (d = 0.33). Specifically, its effect was significant on several literacy outcomes such as phonological awareness (d = 0.49), morphological awareness (d = 0.40), vocabulary (d = 0.40), reading comprehension (d = 0.24), and spelling (d = 0.20). Morphological instruction was particularly effective for children with reading, learning, or speech and language disabilities, English language learners, and struggling readers, suggesting the possibility that morphological instruction can remediate phonological processing challenges. Other moderators were also explored to explain differences in morphological intervention effects. These findings suggest students with literacy difficulties would benefit from morphological instruction.

Understanding attention-deficit/hyperactivity disorder from childhood to adulthood

Attention deficit/hyperactivity disorder (ADHD) is among the most common neurobehavioral disorders requiring treatment in children and adolescents. The disorder is often chronic, with prominent symptoms and impairment spanning into adulthood. It is often associated with co-occurring disorders, including disruptive, mood, anxiety, and substance abuse disorders. The diagnosis of ADHD is clinically established by review of symptoms and impairment. The biological underpinning of the disorder is supported by genetic, neuroimaging, neurochemistry, and neuropsychological data. All aspects of an individual's life need to be considered in the diagnosis and treatment of ADHD. Multimodal treatment includes educational, family, and individual support. Psychotherapy alone and in combination with medication is helpful for treating patients with ADHD and comorbid disorders. Pharmacotherapy, including stimulants, noradrenergic agents, α-agonists, and antidepressants, plays a fundamental role in the long-term management of ADHD.

A scholastic appeals process for dental hygiene student remediation and retention

A scholastic appeals process tailoring individualized remediation for dental hygiene students not meeting academic standards was assessed retrospectively (1999-2008) to evaluate retention and academic failure rates, nature of academic problems, type of remediation, and success of recommendations. Academic records of students (n=55) not meeting academic standards and/or withdrawing were reviewed. Overall retention (92.7 percent) ranged from 86.7 percent to 96.6 percent. Of the fifty-five students whose records were reviewed, six students (10.91 percent) withdrew for medical/personal reasons, and forty-nine (89.1 percent) petitioned for individualized remediation. The number and percentage of students in each category of reasons are as follows: four (7.5 percent) preclinical; thirty-seven (69.8 percent) clinical; eight (15.1 percent) academic/clinical/personal reasons; and four (7.5 percent) academic dishonesty. The options approved were the following: continue in the program with grade below C- (n=3), summer clinical course with individualized contract (n=11), or independent study course during the academic year plus the summer course (n=13), all without delaying graduation; repeating a course with a one-semester delay in graduation (n=7); and auditing/repeating multiple courses with a one-year delay in graduation (n=3). Twelve students were dismissed after denial of a petition requesting remediation or second failure. The scholastic appeals process was successful for 75.5 percent (n=37) of the students who petitioned after failing to meet academic standards, thereby contributing to the 92.7 percent overall retention rate. Student-specific remediation plans based on individual academic appeals are viable options for ensuring success.

Assessment and remediation for physicians with suspected performance problems: an international survey

INTRODUCTION

Little is known about the overall appropriateness and value of the various programs available internationally for assessment and remediation for individual physicians whose performance in their clinical practice has been identified as giving cause for concern.

METHOD

A questionnaire was e-mailed to members of the International Physicians Assessment Coalition and/or the Coalition for Physician Enhancement--organizations that were thought to provide this type of assessment (n = 20). Questions covered the aims, organization, methods, and outcomes of assessment programs and associated remediation.

RESULTS

Responses came from 15 regulatory bodies, universities, not-for-profits, and health service organizations in 5 countries. The assessment programs and remediation activities identified were small in scale. Their focus ranged from a narrow concern with identifying and repairing specific knowledge and skills deficits to a wider interest in the biopsychosocial functioning of the physician as a whole. Both "diagnosis" and "treatment" of problems focused on the individual physician. Less attention was given to broader systems or contextual factors that might impact performance. Although progress through remediation was carefully monitored, none of the programs undertook regular systematic follow-up to ascertain the success of their interventions in the longer term.

DISCUSSION

This field of activity is characterized by the use of sophisticated methods for measuring performance/competence, but provision of remediation is more patchy and variable. The small scale of these programs raises questions about the relationship between scale of provision and potential need for remediation. Gaps in information about impact and outcomes mean that the overall impact and value of this type of assessment and remediation is hard to determine.

The role of working memory and fluency practice on the reading comprehension of students who are dysfluent readers

The authors investigated whether practice in reading fluency had a causal influence on the relationship between working memory (WM) and text comprehension for 155 students in Grades 2 and 4 who were poor or average readers. Dysfluent readers were randomly assigned to repeated reading or continuous reading practice conditions and compared with untreated dysfluent and fluent readers on posttest measures of fluency, word identification, vocabulary, and reading comprehension. Three main findings emerged: (a) The influence of WM on text comprehension was not related to fluency training, (b) dysfluent readers in the continuous-reading condition had higher posttest scores than dysfluent readers in the other conditions on measures of text comprehension but not on vocabulary, and (c) individual differences in WM better predicted posttest comprehension performance than word-attack skills. In general, the results suggested that although continuous reading increased comprehension, fluency practice did not compensate for WM demands. The results were interpreted within a model that viewed reading comprehension processes as competing for a limited supply of WM resources that operate independent of fluency.

Developmental disabilities and behavioral problems among school children in the Western Cape of South Africa

AIM

This descriptive cross-sectional study estimates the frequencies and kinds of potential developmental disabilities (DD) and behavior problems (BP) among children in grades R and 1 who attend a primary public school in rural Western Cape Province, South Africa.

METHODS

Data were collected on 174 children aged 5.1-8.8 years using the Ten Question Screener (10QS) and the Developmental Behaviors Checklist-Short form.

RESULTS

For the entire sample, 42% (n=73) screened positive for 1 or more possible DD on the 10SQ. Twenty-one percent (n=36) screened positive for one or more possible DDs. Thirty-six percent (n=63) of the sample scored above the cutoff for a behavioral problem that may be clinically significant. For this group the proportion of females (n=36, 39%) was slightly higher than males (n=28, 35%).

CONCLUSION

The percent of possible DDs and BP among children in grades R and 1 is higher than the number of learners with special needs reported by the Principal for the entire school (18.7%). The findings from this study suggest that there may be more learners than formally designated who have special educational needs that may benefit from special educational programs (e.g. speech, occupational, language, etc.). There may be a need for expanded remedial educational and behavioral services in this school and elsewhere in the district.

What clinical learning contracts reveal about nursing education and patient safety

While it is widely accepted that adopting a systems perspective is important for understanding and addressing patient safety issues, nurse educators typically address these issues from the perspective of individual student performance. In this study, the authors explored unsafe patient care events recorded in 60 randomly selected clinical learning contracts initiated for students in years 2, 3, and 4 of the undergraduate nursing program at the University of Manitoba. The contracts had been drawn up for students whose nursing care did not meet clinical learning objectives and standards or whose performance was deemed unsafe. Using qualitative content analysis, the authors categorized data pertaining to 154 unsafe patient care events recorded in these contracts.Thirty-seven students precipitated these events. Most events were related to medication administration (56%) and skill application (20%). A breakdown of medication administration events showed that the highest number were errors related to time (33%) and dosage (24%). International students and male students were responsible for a higher number of events than their numbers in the sample would lead one to expect. The findings support further study related to patient safety and nursing education.

Proofreading using an assistive software homophone tool: compensatory and remedial effects on the literacy skills of students with reading difficulties

The present study investigated the effects of using an assistive software homophone tool on the assisted proofreading performance and unassisted basic skills of secondary-level students with reading difficulties. Students aged 13 to 15 years proofread passages for homophonic errors under three conditions: with the homophone tool, with homophones highlighted only, or with no help. The group using the homophone tool significantly outperformed the other two groups on assisted proofreading and outperformed the others on unassisted spelling, although not significantly. Remedial (unassisted) improvements in automaticity of word recognition, homophone proofreading, and basic reading were found over all groups. Results elucidate the differential contributions of each function of the homophone tool and suggest that with the proper training, assistive software can help not only students with diagnosed disabilities but also those with generally weak reading skills.

Enhancing the reading fluency and comprehension of children with reading disabilities in an orthographically transparent language

Breznitz (2006) demonstrated that Hebrew-speaking adults with reading disabilities benefited from a training in which reading rate was experimentally manipulated. In the present study, the authors examine whether silent reading training enhances the sentence reading rate and comprehension of children with reading disabilities and whether results found in Hebrew equally apply to an orthographically transparent language. Training results of 59 Dutch children with reading disabilities and normally achieving children show that children with reading disabilities are able to increase their sentence reading rate with high comprehension levels when pushed to do so with accelerated reading training. Posttest results show that transfer to routine reading is less strong for both accelerated and unaccelerated reading. Only accelerated training allows children with reading disabilities to read at high speed while maintaining high comprehension levels.

Clerkship directors' practices with respect to preparing students for and using the National Board of Medical Examiners Subject Exam in medicine: results of a United States and Canadian Survey

PURPOSE

Clerkship directors' practices regarding the National Board of Medical Examiners (NBME) subject exam in medicine are important in enhancing educational evaluation policy. The study's purpose was to determine clerkship directors' use of the subject exam in medicine and related learning activities in the context of curricula and outcomes of the directors' internal medicine clerkships.

METHOD

The authors conducted a survey of directors of internal medicine clerkships in 2007. They performed descriptive statistical and multivariate analyses on all responses.

RESULTS

Of 110 clerkship directors, 82 responded to the survey, for an overall response rate of 75%. Eighty-eight percent of the clerkship directors required the NBME subject examination in medicine. The mean minimum passing score was 62 (SD = 4.2); this score was not adjusted throughout the academic year, and it contributed 20% to 25% of the final grade. Most (89%) clerkships allowed students a retake after a failed first attempt. Most clerkship directors prepared students for the NBME subject exam in their programs through some combination of lectures, independent self-study, and review sessions with exam-preparation review books. However, 42% of clerkship directors lacked a specific strategy for a retake after a failure.

CONCLUSION

Clerkship directors' use of the NBME subject exam in medicine is high. Most allow a retake after a first failure, and a combination of strategies is currently provided to help students prepare. A need exists to develop remediation plans for students who fail the exam. This report may serve as a reference for curricular and programmatic clerkship decisions.

Consequences within medical schools for students with poor performance on a medical school standardized patient comprehensive assessment

PURPOSE

Medical schools increasingly employ comprehensive standardized patient assessments to ensure medical students' clinical competence. The consequences of poor performance on the assessment and the institutional factors associated with imposing consequences are unknown.

METHOD

In 2006, the investigators surveyed 122 U.S. medical school curriculum deans about comprehensive assessments using standardized patients after core clerkships, with questions about exam characteristics, institutional commitment to the examination (years of experience, exam infrastructure, clerkship director involvement), academic consequences of failing the assessment, and satisfaction with remediation.

RESULTS

Ninety-three of 122 (76%) deans responded. Eighty-two (88%) conducted a comprehensive assessment in years three or four of medical school. Of those, required remediation was the only consequence of failing employed by 61 schools (74%), and only 39 (47%) required retesting for graduation. Participants were somewhat satisfied with (mean 3.45 out of maximum 5, SD 1.08) and confident in (3.37, SD 1.17) their remediation process. Satisfaction and confidence were associated with requiring remediation (P = .003) and retesting (P < .001), but experience with the exam, exam infrastructure, and clerkship director involvement were not. No school demographic characteristics or measures of institutional commitment were related to external reporting of students' comprehensive assessment scores.

CONCLUSIONS

Despite the prevalence of comprehensive assessments, schools attach few academic consequences to poor performance. Educators are only moderately satisfied with their efforts to remediate poor performers. However, schools with greater trust in their remediation process than other schools are more likely to enforce consequences of poor performance.