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Ayalon L, Okun S, Cohn-Schwartz E, Sagi D. On Intergenerational Conflict and Solidarity at Times of Terror and War in Israel: The Case of Late-Life Physical Vulnerabilities and Emotional Resilience. Am J Geriatr Psychiatry 2024; 32:639-641. [PMID: 38350833 DOI: 10.1016/j.jagp.2024.01.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 02/15/2024]
Affiliation(s)
- Liat Ayalon
- Louis and Gabi Weisfeld School of Social Work (LA, SO), Bar Ilan University, Israel; Gerontology Department, Department of Epidemiology, Biostatistics, and Community Health Sciences, Faculty of Health Sciences (EC-S, DS), Ben-Gurion University, Beer-Sheba, Israel; Applied Gerontology internship, College of Law and Business (DS), Ramat Gan, Israel; AMCHA National Israeli Center for Psychosocial Support of Survivors of the Holocaust and the Second Generation (DS), Beer-Sheva, Israel.
| | - Sarit Okun
- Louis and Gabi Weisfeld School of Social Work (LA, SO), Bar Ilan University, Israel; Gerontology Department, Department of Epidemiology, Biostatistics, and Community Health Sciences, Faculty of Health Sciences (EC-S, DS), Ben-Gurion University, Beer-Sheba, Israel; Applied Gerontology internship, College of Law and Business (DS), Ramat Gan, Israel; AMCHA National Israeli Center for Psychosocial Support of Survivors of the Holocaust and the Second Generation (DS), Beer-Sheva, Israel
| | - Ella Cohn-Schwartz
- Louis and Gabi Weisfeld School of Social Work (LA, SO), Bar Ilan University, Israel; Gerontology Department, Department of Epidemiology, Biostatistics, and Community Health Sciences, Faculty of Health Sciences (EC-S, DS), Ben-Gurion University, Beer-Sheba, Israel; Applied Gerontology internship, College of Law and Business (DS), Ramat Gan, Israel; AMCHA National Israeli Center for Psychosocial Support of Survivors of the Holocaust and the Second Generation (DS), Beer-Sheva, Israel
| | - Doron Sagi
- Louis and Gabi Weisfeld School of Social Work (LA, SO), Bar Ilan University, Israel; Gerontology Department, Department of Epidemiology, Biostatistics, and Community Health Sciences, Faculty of Health Sciences (EC-S, DS), Ben-Gurion University, Beer-Sheba, Israel; Applied Gerontology internship, College of Law and Business (DS), Ramat Gan, Israel; AMCHA National Israeli Center for Psychosocial Support of Survivors of the Holocaust and the Second Generation (DS), Beer-Sheva, Israel
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Ayalon L, Cohn-Schwartz E, Sagi D. Global Conflict and the Plight of Older Persons: Lessons From Israel. Am J Geriatr Psychiatry 2024; 32:509-511. [PMID: 38135594 DOI: 10.1016/j.jagp.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Liat Ayalon
- Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel.
| | - Ella Cohn-Schwartz
- Gerontology Department, Department of Epidemiology, Biostatistics, and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheba, Israel
| | - Doron Sagi
- Gerontology Department, Department of Epidemiology, Biostatistics, and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheba, Israel; Applied Gerontology internship, College of Law and Business, Ramat Gan, Israel; AMCHA National Israeli Center for Psychosocial Support of Survivors of the Holocaust and the Second Generation, Israel
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Karnieli-Miller O, Divon-Ophir O, Sagi D, Pessach-Gelblum L, Ziv A, Rozental L. More Than Just an Entertainment Show: Identification of Medical Clowns' Communication Skills and Therapeutic Goals. Qual Health Res 2023; 33:25-38. [PMID: 36384326 PMCID: PMC9827496 DOI: 10.1177/10497323221139781] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Medical clowns (MCs) are trained professionals who aim to change the hospital environment through humor. Previous studies focused on their positive impact and began identifying their various skills in specific situations. When placed in pediatrics, MCs face various challenges, including approaching frustrated adolescents who are unwilling to cooperate with their care, dealing with their anxious parents, and communicating in a team in the presence of other health professionals. Research that systematically describes MCs' skills and therapeutic goals in meeting these challenges is limited. This article describes a qualitative, immersion/crystallization study, triangulating between 26 video-recorded simulations and 12 in-depth-semi-structured interviews with MCs. Through an iterative consensus-building process we identified 40 different skills, not limited to humor and entertainment. Four main therapeutic goals emerged: building a relationship, dealing with emotions, enhancing a sense of control, caring, and encouragement, and motivating treatment adherence. Mapping MCs' skills and goals enhances the understanding of MCs' role and actions to illustrate their unique caring practices. This clarification may help other healthcare professionals to recognize their practices and the benefits in involving them in care. Furthermore, other health professionals may apply some of the identified skills when faced with these challenges themselves.
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Affiliation(s)
| | | | | | | | - Amitai Ziv
- Tel Aviv
University, Tel Aviv, Israel
- Sheba Medical
Center, Israel
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Sagi D, Rudolf MCJ, Spitzer S. A social ecological approach to promote learning health disparities in the clinical years: impact of a home-visiting educational program for medical students. BMC Med Educ 2022; 22:698. [PMID: 36180860 PMCID: PMC9524119 DOI: 10.1186/s12909-022-03755-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND There is consensus that medical schools have a duty to educate students about social determinants of health (SDOH) and equip them with skills required to ameliorate health disparities. Although the National Academy of Medicine (NAM) urged the development of experiential long term programs, teaching is usually conducted in the pre-clinical years or as voluntary courses. ETGAR a required health disparities course, based on the social ecological model, was initiated to answer the NAM call. This study aimed to ascertain the course impact on students learning of SDOH and health disparities. METHODS Students during their first clinical year cared for four patients in their transition from hospital back home, one patient in each internal medicine, surgery, pediatrics and obstetrics/gynecology rotation. The students home-visited their patients after meeting them in hospital and preparing a plain language discharge letter. Training session prior to the course, a tutorial in each rotation, and structured feedback gave the educational envelope. Mixed methodology was employed to evaluate the course impact. Quantitative data collected by students during the home-visit: patients' characteristics and quality and safety of the transition back home using the Medication Discrepancy Tool and Care Transition Measure questionnaire. Stakeholders' views were collected via interviews and focus groups with students representing all affiliated hospitals, and interviews with heads of departments most involved in the course. RESULTS Three hundred six students in three academic years, between October 2016-July 2019, completed home visits for 485 disadvantaged patients with improvement in patients' knowledge of their treatment (3.2 (0.96) vs 3.8 (0.57), Z = -7.12, p < .0001) and identification of medication discrepancies in 42% of visits. Four themes emerged from the qualitative analysis: contribution to learning, experience-based learning, professional identity formation, and course implementation. CONCLUSIONS ETGAR was perceived to complement hospital-based learning, making students witness the interaction between patients' circumstances and health and exposing them to four patients' environment levels. It provided a didactic framework for promoting awareness to SDOH and tools and behaviors required to ameliorate their impact on health and health disparities. The course combined communication and community learning into traditionally bio-medical clinical years and serves as a model for how social-ecology approaches can be integrated into the curriculum.
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Affiliation(s)
- Doron Sagi
- Azrieli Faculty of Medicine, Bar-Ilan University, 8 Henrietta Szold, 1311502, Safed, Israel.
- MSR- The Israel Center for Medical Simulation, Sheba Medical Center, Tel-Hashomer, Israel.
| | | | - Sivan Spitzer
- Azrieli Faculty of Medicine, Bar-Ilan University, 8 Henrietta Szold, 1311502, Safed, Israel
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Azuri P, Divon-Ophir O, Zion R, Dekeyser Ganz F, Sagi D. Simulation as an Alternative to Women's Health Clinical Rotations for Ultra-Orthodox Men: A Pilot Study of Cultural Adjustment. Clin Simul Nurs 2022. [DOI: 10.1016/j.ecns.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sagi D, Spitzer-Shohat S, Schuster M, Daudi L, Rudolf MCJ. Teaching plain language to medical students: improving communication with disadvantaged patients. BMC Med Educ 2021; 21:407. [PMID: 34320965 PMCID: PMC8320047 DOI: 10.1186/s12909-021-02842-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 07/16/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Low health literacy underpins health inequality and leads to poor adherence to medical care and higher risk of adverse events and rehospitalization. Communication in plain language, therefore, is an essential skill for health professionals to acquire. Most medical education communication skill programs focus on verbal communication, while written communication training is scarce. ETGAR is a student delivered service for vulnerable patients after hospital discharge in which, amongst other duties, students 'translate' the medical discharge letters into plain language and share them with patients at a home visit. This study ascertains how this plain language training impacted on students' written communication skills using a tool designed for purpose. METHODS Students, in pairs, wrote three plain language discharge letters over the course of a year for patients whom they encountered in hospital. The students handed over and shared the letters with the patients during a post-discharge home visit. Structured feedback from course instructors was given for each letter. An assessment tool was developed to evaluate students' ability to tell the hospitalization narrative using plain and clear language. First and last letters were blindly evaluated for the entire cohort (74 letters; 87 students). RESULTS Students scored higher in all assessment categories in the third letters, with significant improvement in overall score 3.5 ± 0.8 vs 4.1 ± 0.6 Z = -3.43, p = 0.001. The assessment tool's reliability was high α = 0.797, it successfully differentiated between plain language categories, and its score was not affected by letter length or patient's medical condition. CONCLUSIONS Plain language discharge letters written for real patients in the context of experience-based learning improved in quality, providing students with skills to work effectively in an environment where poor health literacy is prevalent. ETGAR may serve as a model for learning written communication skills during clinical years, using the assessment tool for formative or summative evaluation.
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Affiliation(s)
- Doron Sagi
- Department of Population Health, Azrieli Faculty of Medicine, Bar-Ilan University, 8 Henrietta Szold, 1311502, Safed, Israel.
- MSR- The Israel Center for Medical Simulation, Ramat-Gan, Israel.
| | - Sivan Spitzer-Shohat
- Department of Population Health, Azrieli Faculty of Medicine, Bar-Ilan University, 8 Henrietta Szold, 1311502, Safed, Israel
- Center for Health and the Social Sciences, University of Chicago, Chicago, USA
| | - Michal Schuster
- Faculty of Humanities, University of the Free State, Bloemfontein, South Africa
| | - Ligat Daudi
- Department of Population Health, Azrieli Faculty of Medicine, Bar-Ilan University, 8 Henrietta Szold, 1311502, Safed, Israel
| | - Mary Catharine Joy Rudolf
- Department of Population Health, Azrieli Faculty of Medicine, Bar-Ilan University, 8 Henrietta Szold, 1311502, Safed, Israel
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Sagi D, Spitzer-Shohat S, Schuster M, Rier D, Rudolf MCJ. Learning social determinants of health through a home visiting course in the clinical years. Patient Educ Couns 2020; 103:2335-2341. [PMID: 32423836 DOI: 10.1016/j.pec.2020.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/02/2020] [Accepted: 05/01/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the impact of a new experience-based educational program aiming to teach social determinants of health (SDH) and health disparities, through a post-discharge home-visit conducted with patients recruited in hospital. METHODS 105 clinical-year students visited 177 patients living in disadvantaged circumstances. Their home-visit reports were analyzed employing mixed methodology. Content analysis was conducted for classifying issues raised by students, and quantitative analysis to compare reports by level of elaboration, gender and class. RESULTS Fifteen taxonomy items were identified. Social support and patients' medical conditions were most prevalent, followed by personal-related and community-related issues. Analysis demonstrated students' understanding of the relationship between SDH and patient health, and challenges patients face following discharge. Women and mixed couples provided more elaborate reports, which contained significantly greater critique of medical care. CONCLUSIONS Meeting patients both in hospital and at home enhanced awareness of SDH. Students learned to view the patient comprehensively, and to understand the diverse factors affecting their health. Students, who had essentially sole responsibility for the home-visit, successfully integrated their skills to take action when needed. PRACTICE IMPLICATIONS The ETGAR experience provided a means for effective learning about how social determinants impact on health.
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Affiliation(s)
- Doron Sagi
- Department of Population Health, Azrieli Faculty of Medicine, Bar-Ilan University, Israel; MSR- The Israel Center for Medical Simulation, Israel.
| | - Sivan Spitzer-Shohat
- Department of Population Health, Azrieli Faculty of Medicine, Bar-Ilan University, Israel; Center for Health and the Social Sciences, University of Chicago, United States
| | - Michal Schuster
- Faculty of hummanities, University of the Free State, South Africa
| | - David Rier
- Department of Sociology & Anthropology, Bar-Ilan University, Israel
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Cohn-Schwartz E, Sagi D, O'Rourke N, Bachner YG. The coronavirus pandemic and Holocaust survivors in Israel. ACTA ACUST UNITED AC 2020; 12:502-504. [DOI: 10.1037/tra0000771] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sagi D, Pessach-Gelblum L, Divon-Ophir O, Rubinstein R, Laufer S, Sela R, Ziv A. [SIMULATION AS A TRAINING AND ASSESSMENT TOOL FOR COMPETENCY BASED MEDICAL EDUCATION - A REGULATORY CHALLENGE]. Harefuah 2019; 158:674-679. [PMID: 31576716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Competency Based Medical Education (CBME) is an educational approach that occupies a central place in medical education. Medical education is accountable for the graduates' professional level, ensuring they are skilled and competent in all key areas of their profession. Adopting CBME underscores the importance of simulation-based training. Experiential training provides, among other things: standardization of training, controlled exposure to extreme events and soft skills, such as patient-caregiver communication and teamwork training. Unlike the traditional apprentice approach, accountability reinforces the choice of a preliminary encounter with simulated patients prior to real-life care, as a complimentary tool for improving patient safety. Incorporating a practical exam is self-evident in CBME because of the need to ensure that the examinees are competent to provide unsupervised safe and quality care. Implementation of a national CBME program, likewise, incorporating simulation into national training programs, requires involvement and supervision on health system regulators. In this paper, we describe simulation-based national training programs that to date integrate competency-based training in the various medical sectors. As national programs, they are implemented under the guidance and in cooperation with the regulators. On the one hand, CBME is a new approach and its implementation will require time and the cooperation of many stakeholders. On the other hand, simulation is an existing, well-established training and assessment tool that can be used as an anchor around which you can start building the competency-based training programs.
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Affiliation(s)
- Doron Sagi
- MSR- Israel Center for Medical Simulation
- Sheba Medical Center
| | | | | | - Ran Rubinstein
- MSR- Israel Center for Medical Simulation
- Sheba Medical Center
| | - Shay Laufer
- MSR- Israel Center for Medical Simulation
- Sheba Medical Center
| | - Rina Sela
- MSR- Israel Center for Medical Simulation
- Sheba Medical Center
| | - Amitai Ziv
- MSR- Israel Center for Medical Simulation
- Sheba Medical Center
- Sackler Faculty of Medicine, Tel-Aviv University
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Riskin A, Vashdi DR, Miller-Mor Attias R, Sagi D, Zangen S. [COMPETENCY-BASED TRAINING AS A WAY TO CREATE ORGANIZATIONAL CHANGE AND IMPROVE PROFESSIONALISM: A REVIEW OF THE PROCESS OF IMPLEMENTING A COMPETENCY-BASED MEDICAL EDUCATION (CBME) TRAINING PROGRAM IN NEONATOLOGY FELLOWSHIP IN ISRAEL]. Harefuah 2019; 158:669-673. [PMID: 31576715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Competency-based medical education (CBME) is a model aimed to address certain challenges and shortcomings attributed to the contemporary models of medical education and the medical profession in general. The CBME model has been used mainly in the education of undergraduate medical students with no continuation to residency, fellowship, or independent practice. In this review, we present a program based on the CBME model for the design and implementation of a new fellowship program in neonatology in Israel. As part of the program, we propose a mentorship program as a means to facilitate the implementation and acceptance of the program in the different wards. We designed assessment tools that can help the mentor track the fellow's development over time as well as to examine the impact of the proposed program on performance and on all stakeholders' satisfaction over time. We aim to evaluate the benefits and effectiveness of this CBME training not only on the fellows' abilities and performance outcomes, but also on the accompanying general organizational changes that can lead to general improvement in the neonatal profession in Israel.
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Affiliation(s)
- Arieh Riskin
- Department of Neonatology, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Dana R Vashdi
- Department of Public Administration and Policy, School of Political Sciences, University of Haifa, Israel
| | - Rotem Miller-Mor Attias
- Department of Public Administration and Policy, School of Political Sciences, University of Haifa, Israel
| | - Doron Sagi
- Assessment Unit, MSR Israel Center for Medical Simulation, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Shmuel Zangen
- Department of Neonatology, Barzilai Medical Center, Ashkelon, Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
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Friedman N, Sagi D, Ziv A, Shavit I. Pediatric residents' simulation-based training in patient safety during sedation. Eur J Pediatr 2018; 177:1863-1867. [PMID: 30215096 DOI: 10.1007/s00431-018-3241-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 11/29/2022]
Abstract
In Israeli emergency departments, pediatric residents are allowed to independently perform procedural sedation after training. Preparing the residents to practice unsupervised sedations requires participation in a simulation-based training in patient safety during sedation (STPSDS). The study objective was to evaluate participants' perception of knowledge and confidence from the STPSDS. We performed a retrospective analysis of participants' self-reported perception of knowledge acquisition. At the end of each course, participants were requested to rate, anonymously and independently, the training contribution to their knowledge and confidence using a four-point Likert scale. Between January 2010 and December 2017, 321 pediatric residents participated in 67 STPSDS courses; 315 completed the self-assessments. Participants' median responses of the training contribution were 4 (IQR 3-4) for overall knowledge, 4 (IQR 4-4) for understanding potential complications during sedation, 3 (IQR 3-4) for knowledge in managing adverse events, and 3 (IQR 2-4) for knowledge in practicing safe sedation. Median response for contribution to participants' confidence in performing sedation was 3 (IQR 3-4).Conclusion: We found that the STPSDS improved perception of knowledge and confidence among pediatric residents. Our findings suggest that this training has a valuable role in preparing pediatric residents to practice unsupervised sedations in the ED. What is Known: • In Israel, sedation-trained pediatric residents performed sedations in the Emergency Department • Successful completion of a simulation-based training in patient safety during sedation (STPSDS) is a mandatory requirement to perform unsupervised sedation. What is New: • The STPSDS improved perception of knowledge and confidence among pediatric residents. • This training may be valuable in preparing pediatric residents to practice unsupervised sedations.
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Affiliation(s)
- Nir Friedman
- Pediatric Emergency Department, Sheba Medical Center, Tel Hashomer, Israel.,Israel Center for Medical Simulation (MSR), Sheba Medical Center, Tel Hashomer, Israel
| | - Doron Sagi
- Israel Center for Medical Simulation (MSR), Sheba Medical Center, Tel Hashomer, Israel
| | - Amitai Ziv
- Israel Center for Medical Simulation (MSR), Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Itai Shavit
- Israel Center for Medical Simulation (MSR), Sheba Medical Center, Tel Hashomer, Israel. .,Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel. .,The Ruth and Bruce Rappaport, Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel. .,, Kibutz Maayan Tzvi, Israel.
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Hardoff D, Gefen A, Sagi D, Ziv A. Training Physicians toward a Dignifying Approach in Adolescents' Health Care: A Promising Simulation-Based Medical Education Program. Isr Med Assoc J 2016; 18:484-488. [PMID: 28471581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Human dignity has a pivotal role within the health care system. There is little experience using simulation-based medical education (SBME) programs that focus on human dignity issues in doctor-patient relationships. OBJECTIVES To describe and assess a SBME program aimed at improving physicians' competence in a dignifying approach when encountering adolescents and their parents. METHODS A total of 97 physicians participated in 8 one-day SMBE workshops that included 7 scenarios of typical adolescent health care dilemmas. These issues could be resolved if the physician used an appropriate dignifying approach toward the patient and the parents. Debriefing discussions were based on video recordings of the scenarios. The effect of the workshops on participants' approach to adolescent health care was assessed by a feedback questionnaire and on 5-point Likert score questionnaires administered before the workshop and 3 months after. RESULTS All participants completed both the pre-workshop and the feedback questionnaires and 41 (42%) completed the post-workshop questionnaire 3 months later. Practice and competence topics received significantly higher scores in post-workshop questionnaires (P < 0.001). A score of high to very high was given by 90% of physicians to the contribution of the workshop to participants understanding the dignifying approach, and by 70% to its influence on their communicative skills. CONCLUSIONS A one-day simulation-based workshop may improve physicians' communication skills and sense of competence in addressing adolescents' health care issues which require a dignifying approach toward both the adolescent patients and their parents. This dignity-focused methodology may be expanded to improve communication skills of physicians from various disciplines.
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Affiliation(s)
- Daniel Hardoff
- Israel Center for Medical Simulation, Sheba Medical Center, Tel Hashomer, Israel
| | - Assaf Gefen
- The Israel Institute for Democracy, Jerusalem, Israel
| | - Doron Sagi
- Israel Center for Medical Simulation, Sheba Medical Center, Tel Hashomer, Israel
| | - Amitai Ziv
- Israel Center for Medical Simulation, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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13
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Ben-Assuli O, Ziv A, Sagi D, Ironi A, Leshno M. Cost-Effectiveness Evaluation of EHR: Simulation of an Abdominal Aortic Aneurysm in the Emergency Department. J Med Syst 2016; 40:141. [PMID: 27114352 DOI: 10.1007/s10916-016-0502-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 04/18/2016] [Indexed: 11/24/2022]
Abstract
Health care organizations have installed electronic systems to increase efficiency in health care. Empirically assessing the cost-effectiveness of technologies to the health care system is a challenging and complex task. This study examined cost-effectiveness of additional clinical information supplied via an EHR system by simulating a case of abdominal aortic aneurysm devised and acted professionally by the Israel Center of Medical Simulation. We conducted a simulation-based study on physicians who were asked to treat a simulated patient for the prevalent medical scenario of hip and leg pain that actually corresponded to an abdominal aortic aneurysm. Half of the participating physicians from the Department of Emergency Medicine at Tel-Hashomer Hospital - Israel's largest - had access to an EHR system that integrates medical data from multiple health providers (community and hospitals) in addition to the local health record, and half did not. To model medical decision making, the results of the simulation were combined with a Markov Model within a decision tree. Cost-effectiveness was analyzed by comparing the effects of the admission/discharge decision in units of quality adjusted life years (QALYs) to the estimated costs. The results showed that using EHR in the ED increases the QALY of the patient and improves medical decision-making. The expenditure per patient for one QALY unit as a result of using the EHR was $1229, which is very cost-effective according to many accepted threshold values (less than all these values). Thus, using the EHR contributes to making a cost-effective decision in this specific but prevalent case.
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Affiliation(s)
| | - Amitai Ziv
- Sheba Medical Center, Tel-HaShomer, Israel.,Tel-Aviv University, Tel-Aviv, Israel
| | - Doron Sagi
- Sheba Medical Center, Tel-HaShomer, Israel
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Gat I, Pessach-Gelblum L, Givati G, Haim N, Paluch-Shimon S, Unterman A, Bar-Shavit Y, Grabler G, Sagi D, Achiron A, Ziv A. Innovative integrative bedside teaching model improves tutors' self-assessments of teaching skills and attitudes. Med Educ Online 2016; 21:30526. [PMID: 26894587 PMCID: PMC4759835 DOI: 10.3402/meo.v21.30526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 12/30/2015] [Accepted: 12/30/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Patient bedside is the ideal setting for teaching physical examination, medical interviewing, and interpersonal skills. Herein we describe a novel model for bedside teaching (BST) practiced during tutor training workshop and its resulting effect on practitioners' self assessment of teaching skills and perceptions. METHODS One-day tutor training workshop included theoretical knowledge supplementation regarding tutors' roles as well as implementing practical tools for clinical education, mainly BST model. The model, which emphasizes simultaneous clinical and communication teaching in a stepwise approach, was practiced by consecutive simulations with a gradual escalation of difficulty and adjusted instruction approaches. Pre- and post-workshop-adjusted questionnaires using a Likert scale of 1 to 4 were completed by participants and compared. RESULTS Analysis was based on 25 out of 48 participants who completed both questionnaires. Significantly improved teaching skills were demonstrated upon workshop completion (mean 3.3, SD 0.5) compared with pre-training (mean 2.6, SD 0.6; p<0.001) with significant increase in most examined parameters. Significantly improved tutor's roles internalization was demonstrated after training completion (mean 3.7, SD 0.3) compared with pre-workshop (mean 3.5 SD 0.5; p=0.002). DISCUSSION Successful BST involves combination of clinical and communication skills. BST model practiced during the workshop may contribute to improved teaching skills in this challenging environment.
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Affiliation(s)
- Itai Gat
- MSR-Israel Center for Medical Simulation, Sheba Medical Center, Tel Hashomer, Israel
- Pinchas Borenstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liat Pessach-Gelblum
- MSR-Israel Center for Medical Simulation, Sheba Medical Center, Tel Hashomer, Israel
| | - Gili Givati
- MSR-Israel Center for Medical Simulation, Sheba Medical Center, Tel Hashomer, Israel
- Department of Neurology, Sheba Medical Center, Tel Hashomer, Israel
| | - Nadav Haim
- MSR-Israel Center for Medical Simulation, Sheba Medical Center, Tel Hashomer, Israel
- Department of General Surgery, Sheba Medical Center, Tel Hashomer, Israel
| | - Shani Paluch-Shimon
- MSR-Israel Center for Medical Simulation, Sheba Medical Center, Tel Hashomer, Israel
- Pinchas Borenstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel
- Division of Oncology, Sheba Medical Centre, Tel Hashomer, Israel
| | - Avraham Unterman
- MSR-Israel Center for Medical Simulation, Sheba Medical Center, Tel Hashomer, Israel
| | - Yochay Bar-Shavit
- MSR-Israel Center for Medical Simulation, Sheba Medical Center, Tel Hashomer, Israel
| | - Galit Grabler
- MSR-Israel Center for Medical Simulation, Sheba Medical Center, Tel Hashomer, Israel
| | - Doron Sagi
- MSR-Israel Center for Medical Simulation, Sheba Medical Center, Tel Hashomer, Israel
| | - Anat Achiron
- MSR-Israel Center for Medical Simulation, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Amitai Ziv
- MSR-Israel Center for Medical Simulation, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;
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16
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Katkov M, Harris H, Sagi D. Order-disorder transition in visual perception. J Vis 2014. [DOI: 10.1167/14.10.1426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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17
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Harris H, Egan R, Gupta A, Minshew N, Bonneh Y, Heeger DJ, Sagi D, Behrmann M. Over-specific perceptual learning in ASD. J Vis 2014. [DOI: 10.1167/14.10.699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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18
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Reis S, Sagi D, Eisenberg O, Kuchnir Y, Azuri J, Shalev V, Ziv A. The impact of residents' training in Electronic Medical Record (EMR) use on their competence: report of a pragmatic trial. Patient Educ Couns 2013; 93:515-521. [PMID: 24011647 DOI: 10.1016/j.pec.2013.08.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 07/22/2013] [Accepted: 08/12/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Even though Electronic Medical Records (EMRs) are increasingly used in healthcare organizations there is surprisingly little theoretical work or educational programs in this field. This study is aimed at comparing two training programs for doctor-patient-computer communication (DPCC). METHODS 36 Family Medicine Residents (FMRs) participated in this study. All FMRs went through twelve identical simulated encounters, six pre and six post training. The experiment group received simulation based training (SBT) while the control group received traditional lecture based training. RESULTS Performance, attitude and sense of competence of all FMRs improved, but no difference was found between the experiment and control groups. FMRs from the experiment group evaluated the contribution of the training phase higher than control group, and showed higher satisfaction. CONCLUSION We assume that the mere exposure to simulation served as a learning experience and enabled deliberate practice that was more powerful than training. Because DPCC is a new field, all participants in such studies, including instructors and raters, should receive basic training of DPCC skills. PRACTICE IMPLICATION Simulation enhances DPCC skills. Future studies of this kind should control the exposure to simulation prior to the training phase. Training and assessment of clinical communication should include EMR related skills.
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Affiliation(s)
- Shmuel Reis
- Bar Ilan University Faculty of Medicine in the Galilee, Safed, Israel
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19
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Bonneh Y, Adini Y, Sagi D, Tsodyks M, Fried M, Arieli A. Microsaccade latency uncovers stimulus predictability: Faster and longer inhibition for unpredicted stimuli. J Vis 2013. [DOI: 10.1167/13.9.1342] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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20
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Sagi D. Perceptual learning in context. J Vis 2013. [DOI: 10.1167/13.9.1374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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21
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22
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Harris H, Gliksberg M, Sagi D. Specificity in texture learning is a result of uninterrupted stimulus repetition. J Vis 2012. [DOI: 10.1167/12.9.770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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23
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Sagi D, Bonneh Y. Perceptual properties of consciously unavailable stimuli. J Vis 2011. [DOI: 10.1167/11.15.74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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24
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Sagi D, Harris H. Perceptual learning viewed as a statistical modeling process - Is it all overfitting? J Vis 2011. [DOI: 10.1167/11.11.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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25
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26
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Sagi D, Censor N. Global resistance to local perceptual adaptation in texture discrimination. J Vis 2010. [DOI: 10.1167/9.8.854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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27
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Katkov M, Zak I, Gorea A, Sagi D. Interactions between decision criteria estimated using external noise methods. J Vis 2010. [DOI: 10.1167/9.8.839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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28
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Sagi D, Gorea A. On the fate of missed targets. J Vis 2010. [DOI: 10.1167/10.7.1366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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29
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Censor N, Sagi D. Practice little, gain much: Short training enables long-term resistance to perceptual deterioration. J Vis 2010. [DOI: 10.1167/8.6.974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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30
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Donner T, Sagi D, Bonneh Y, Heeger D. Distinct neural signatures of motion-induced blindness in human visual cortex. J Vis 2010. [DOI: 10.1167/8.6.538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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31
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Yehezkel O, Belkin M, Sagi D, Polat U. Binocular composition of monocular signals in perceptual grouping. J Vis 2010. [DOI: 10.1167/6.6.757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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32
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Censor N, Bonneh Y, Sagi D. Electrophysiological correlates of performance and learning in the backward-masked texture-discrimination task. J Vis 2010. [DOI: 10.1167/7.9.795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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33
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Bonneh Y, Sagi D, Cooperman A, Donner T, Heeger D, Fried M, Arieli A. Motion-induced blindness and microsaccades: Cause or effect? J Vis 2010. [DOI: 10.1167/9.8.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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34
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Katkov M, Sagi D. Lateral facilitation is largely due to internal response enhancement. J Vis 2010. [DOI: 10.1167/8.6.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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35
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Katkov M, Tsodyks M, Sagi D. The human contrast response function: overcoming experimental pitfalls. J Vis 2010. [DOI: 10.1167/7.9.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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36
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Katkov M, Tsodyks M, Sagi D. Separating signal from noise in visual discrimination. J Vis 2010. [DOI: 10.1167/3.9.609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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37
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Shani R, Sagi D. Attention uncovers peripheral collinear facilitation. J Vis 2010. [DOI: 10.1167/3.9.765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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38
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Bonneh Y, Cooperman A, Sagi D. Induced reappearance of invisible stimuli in motion induced blindness: uncovering interactions across the awareness boundary. J Vis 2010. [DOI: 10.1167/7.9.1010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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39
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Gorea A, Sagi D. Characterizing attention in terms of changes of decision criterion and sensitivity. J Vis 2010. [DOI: 10.1167/5.8.688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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40
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Sagi D, Adini Y, Tsodyks M, Technion AW. Context dependent learning in contrast discrimination: effects of contrast uncertainty. J Vis 2010. [DOI: 10.1167/3.9.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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41
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Katkov M, Gan T, Tsodyks M, Sagi D. Singularities in the inverse modeling of contrast discrimination and ways to avoid them. J Vis 2010. [DOI: 10.1167/5.8.455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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42
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43
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44
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Polat U, Sagi D. Modulation of the decision criterion by collinear lateral facilitation. J Vis 2010. [DOI: 10.1167/5.8.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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45
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Yehezkel O, Belkin M, Sagi D, Polat U. Adaptation to astigmatic lens: Effects on lateral interactions. J Vis 2010. [DOI: 10.1167/5.8.486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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46
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Gorea A, Sagi D. Using the unique criterion constraint to disentangle transducer nonlinearity from lack of noise constancy. J Vis 2010. [DOI: 10.1167/1.3.437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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47
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Freeman ED, Driver J, Sagi D. Attentional modulation of target-flanker lateral interactions persists with increasing flanker contrast. J Vis 2010. [DOI: 10.1167/2.7.452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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48
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Censor N, Bonneh Y, Arieli A, Sagi D. Early-vision brain responses which predict human visual segmentation and learning. J Vis 2009; 9:12.1-9. [PMID: 19757921 DOI: 10.1167/9.4.12] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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49
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Sagi D, Judelman A, Bonneh Y. Contrast detection thresholds of gabor strings: Configuration dependency. J Vis 2005. [DOI: 10.1167/5.8.725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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50
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Polat U, Bonneh Y, Ma-Naim T, Belkin M, Sagi D. Spatial interactions in amblyopia: Effects of stimulus parameters and amblyopia type. Vision Res 2005; 45:1471-9. [PMID: 15743616 DOI: 10.1016/j.visres.2004.12.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2004] [Revised: 11/25/2004] [Accepted: 12/02/2004] [Indexed: 11/16/2022]
Abstract
Adults with amblyopia were recently shown to perform abnormally in tasks requiring integration of local features into global percepts. Moreover, spatial interactions in amblyopic patients, though often found to be abnormal, showed marked variability. Here we measured collinear lateral interactions using Gabor patches in a large number of amblyopic (N=75) and normal subjects (N=25), testing four spatial frequencies (1.5, 3, 6, 9 cpd). We used the lateral masking paradigm, in which the contrast-detection threshold is measured in the presence of high-contrast flankers at different distances from a central target. Whereas in normal subjects spatial interaction patterns were evident across all spatial frequencies, amblyopic subjects showed abnormal spatial interactions and increasing deficiencies with increasing spatial frequencies. These abnormalities depended on the axis of astigmatism (in meridional amblyopia) and were more pronounced in strabismic than in anisometropic amblyopia. Spatial interactions were independent on the contrast-detection thresholds. Thus, adults with amblyopia might perform as well as normal observers for some stimulus parameters and abnormally for others. Our results indicate a close relationship between abnormal visual input to the visual cortex during development and abnormal functionality of the collinear spatial interactions in adults with amblyopia.
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Affiliation(s)
- U Polat
- Department of Medicine, Goldschleger Eye Research Institute, Tel-Aviv University, Sheba Medical Center, 52621 Tel-Hashomer, Israel.
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