Validation of a mobile fNIRS device for measuring working memory load in the prefrontal cortex

Functional near-infrared spectroscopy (fNIRS) is a neuroimaging technique that measures cortical blood flow to infer neural activation. Traditionally limited to laboratory settings due to high costs and complex operation, recent advancements have introduced mobile fNIRS devices, significantly broadening the scope of potential research participants. This study validates the use of the Mendi, a two-channel mobile fNIRS system, for measuring prefrontal oxyhemoglobin concentration changes during an n-back task. We manipulated task difficulty through different n-back levels (one-back versus three-back), revealing increased oxyhemoglobin concentrations in the prefrontal cortex during the more demanding three-back task compared to the one-back task. This finding demonstrates the Mendi's ability to distinguish between low and high cognitive task loads. Behavioural data, showing a decrease in accuracy under high load conditions, further corroborates these neuroimaging findings. Our study validates the Mendi mobile fNIRS system as an effective tool for assessing working memory load and underscores its potential in enhancing neuroscientific research accessibility. The user-friendly and cost-effective nature of mobile fNIRS systems like the Mendi opens up neuroscientific research to a diverse set of participants, enabling the investigation of neural processes in real-world environments across a variety of demographic groups.

Coherent charge oscillations in a bilayer graphene double quantum dot

The coherent dynamics of a quantum mechanical two-level system passing through an anti-crossing of two energy levels can give rise to Landau-Zener-Stückelberg-Majorana (LZSM) interference. LZSM interference spectroscopy has proven to be a fruitful tool to investigate charge noise and charge decoherence in semiconductor quantum dots (QDs). Recently, bilayer graphene has developed as a promising platform to host highly tunable QDs potentially useful for hosting spin and valley qubits. So far, in this system no coherent oscillations have been observed and little is known about charge noise in this material. Here, we report coherent charge oscillations and [Formula: see text] charge decoherence times in a bilayer graphene double QD. The charge decoherence times are measured independently using LZSM interference and photon assisted tunneling. Both techniques yield [Formula: see text] average values in the range of 400-500 ps. The observation of charge coherence allows to study the origin and spectral distribution of charge noise in future experiments.

Quantifying Simulated Contamination Deposition on Healthcare Providers Using Image Analysis

INTRODUCTION

Simulation-based research has played an important role in improving care for communicable diseases. Unfortunately, few studies have attempted to quantify the level of contamination in these simulation activities. We aim to assess the feasibility and provide validity evidence for using integrated density values and area of contamination (AOC) to differentiate various levels of simulated contamination.

METHODS

An increasing number of simulated contamination spots using fluorescent marker were applied on a manikin chest to simulate a contaminated healthcare provider. An ultraviolet light was used to illuminate the manikin to highlight the simulated contamination. Images of increasing contamination levels were captured using a camera with different exposure settings. Image processing software was used to measure 2 outcomes: (1) natural logarithm of integrated density; and (2) AOC. Mixed-effects linear regression models were used to assess the effect of contamination levels and exposure settings on both outcome measures. A standardized "proof-of-concept" exercise was set up to calibrate and formalize the process for human subjects.

RESULTS

A total of 140 images were included in the analyses. Dose-response relationships were observed between contamination levels and both outcome measures. For each increment in the number of contaminated simulation spots (ie, simulated contaminated area increased by 38.5 mm 2 ), on average, log-integrated density increased by 0.009 (95% confidence interval, 0.006-0.012; P < 0.001) and measured AOC increased by 37.8 mm 2 (95% confidence interval, 36.7-38.8 mm 2 ; P < 0.001), which is very close to actual value (38.5 mm 2 ). The "proof-of-concept" demonstration further verified results.

CONCLUSIONS

Integrated density and AOC measured by image processing can differentiate various levels of simulated, fluorescent contamination. The AOC measured highly agrees with the actual value. This method should be optimized and used in the future research to detect simulated contamination deposited on healthcare providers.

Exploring the construct of anticipatory stress in finding a job after residency training through cognitive interviewing: Implications for learner well-being and health workforce planning

Background: Anticipatory stress (AS) is denoted by concern about future events for which there is little control. Most AS research has been physiological studies such as measuring salivary cortisol levels. Medical learners may experience AS regarding employment after residency, however AS a psychological construct across career stages has not previously been studied. The objective of this study is to explore the psychological construct of employment AS in medical students, residents, and former Program Directors (PDs). Methods: Participants were recruited from a large Canadian medical school via purposive sampling. Semi-structured interviews with n=21 participants (six medical students, nine residents, and six PDs) were transcribed verbatim, and coded by two independent reviewers using thematic analysis. Results: Participants agreed that financial, family, and geographical factors exacerbate AS, and it is mitigated by flexibility, social support, and being proactive. External support, job market saturation, and differences between medical specialities also influence AS. Perspectives unique to participant groups included: medical students reflecting on a hidden curriculum and preoccupation with proximal issues over distal concerns of employment; residents experiencing competing residency program demands; former PDs finding that resident competency, yearly hiring fluctuations, and existing stress impact AS. Consequences of AS include physical and psychological manifestations, performance anxiety, and pursuing additional training. Conclusions: Perceptions of AS vary by medical career stage. Individual, program and systems-level changes can help manage and address the underlying cause of AS: an unreliable job market for physicians. Correcting the mismatch between residency positions and job openings may be a proactive, preventative approach.

Particle-hole symmetry protects spin-valley blockade in graphene quantum dots

Particle-hole symmetry plays an important role in the characterization of topological phases in solid-state systems¹. It is found, for example, in free-fermion systems at half filling and it is closely related to the notion of antiparticles in relativistic field theories². In the low-energy limit, graphene is a prime example of a gapless particle-hole symmetric system described by an effective Dirac equation^3,4 in which topological phases can be understood by studying ways to open a gap by preserving (or breaking) symmetries^5,6. An important example is the intrinsic Kane-Mele spin-orbit gap of graphene, which leads to a lifting of the spin-valley degeneracy and renders graphene a topological insulator in a quantum spin Hall phase⁷ while preserving particle-hole symmetry. Here we show that bilayer graphene allows the realization of electron-hole double quantum dots that exhibit near-perfect particle-hole symmetry, in which transport occurs via the creation and annihilation of single electron-hole pairs with opposite quantum numbers. Moreover, we show that particle-hole symmetric spin and valley textures lead to a protected single-particle spin-valley blockade. The latter will allow robust spin-to-charge and valley-to-charge conversion, which are essential for the operation of spin and valley qubits.

A Tale of Four Programs: How Residents Learn About Quality Improvement during Postgraduate Medical Education at the University of Calgary

Phenomenon: Quality Improvement (QI) has become increasingly incorporated into competency frameworks for physician learners over the past two decades. As contemporary medical education adapts competency-based models of training, learners will be required to demonstrate competency in QI. There is a need to explore how various residency programs are currently teaching QI, including how residents might participate in experiential QI activities, and the various outcomes of these strategies. Approach: A collective case study examined how residents in four postgraduate programs at a single academic institution have learned about QI since the formal integration of QI as a cross-cutting competency. Data from surveys, interviews, observations, and archival records were collected in order to develop a comprehensive understanding of each case in its real-life context and explore current and historical trends and patterns within and across the four programs. Findings: Teaching and resident involvement in QI projects increased across all four programs since its formal integration into the national physician competency framework. Two programs had a longitudinal, hybrid QI curriculum involving didactic and experiential components. Two programs had didactic-alone QI curricula, with minimal resident engagement in applied QI activities. Between-program differences were quantified with regards to learning climate, safety climate, QI knowledge, skills, and attitudes, attitudes toward research during residency, and quality of mentorship for scholarly activities. Residents in programs with experiential learning reported higher knowledge, skills, and attitudes toward QI were motivated to lead improvement efforts in their future practice. Residents in programs with didactic-only QI teaching perceived that the historical operationalization of the scholarly project as research was a barrier to their involvement in QI, as it was not valued or legitimized in their academic and clinical contexts. Common barriers and facilitators to engagement with QI across all programs included time, mentorship, motivation, and competing demands such as feeling pressure to conduct research in order to obtain competitive fellowship positions or employment. Common across all programs was the perception of the residency scholarly project requirement as a "checkbox." Associations were quantified between the constructs of learning climate with safety culture, and safety culture with QI knowledge, skills, and attitudes. Insights: While hybrid QI curricula with experiential learning remains an effective curriculum strategy, tensions between research and QI may be a critical barrier to learner engagement in experiential activities. In addition to providing learners with support, time, mentorship, and explicitly communicating the value QI by the program, the local safety culture may impact QI learning beyond the core curriculum. Reconceptualization of the scholarly project requirements to normalize QI activities and recognizing the potential influence of the local organizational culture on QI learning and how trainees can positively or negatively shape these cultures warrants consideration.

A realist synthesis of quality improvement curricula in undergraduate and postgraduate medical education: what works, for whom, and in what contexts?

BACKGROUND

With the integration of quality improvement (QI) into competency-based models of physician training, there is an increasing requirement for medical students and residents to demonstrate competence in QI. There may be factors that commonly facilitate or inhibit the desired outcomes of QI curricula in undergraduate and postgraduate medical education. The purpose of this review was to synthesise attributes of QI curricula in undergraduate and postgraduate medical education associated with curricular outcomes.

METHODS

A realist synthesis of peer-reviewed and grey literature was conducted to identify the common contexts, mechanisms, and outcomes of QI curricula in undergraduate and postgraduate medical education in order to develop a programme theory to articulate what works, for whom, and in what contexts.

RESULTS

18854 records underwent title and abstract screening, full texts of 609 records were appraised for eligibility, data were extracted from 358 studies, and 218 studies were included in the development and refinement of the final programme theory. Contexts included curricular strategies, levels of training, clinical settings, and organisational culture. Mechanisms were identified within the overall QI curricula itself (eg, clear expectations and deliverables, and protected time), in the didactic components (ie, content delivery strategies), and within the experiential components (eg, topic selection strategies, working with others, and mentorship). Mechanisms were often associated with certain contexts to promote educational and clinical outcomes.

CONCLUSION

This research describes the various pedagogical strategies for teaching QI to medical learners and highlights the contexts and mechanisms that could potentially account for differences in educational and clinical outcomes of QI curricula. Educators may benefit from considering these contexts and mechanisms in the design and implementation of QI curricula to optimise the outcomes of training in this competency area.

Cost-effectiveness analysis of workplace-based distributed cardiopulmonary resuscitation training versus conventional annual basic life support training

Context

Although distributed cardiopulmonary resuscitation (CPR) practice has been shown to improve learning outcomes, little is known about the cost-effectiveness of this training strategy. This study assesses the cost-effectiveness of workplace-based distributed CPR practice with real-time feedback when compared with conventional annual CPR training.

Methods

We measured educational resource use, costs, and outcomes of both conventional training and distributed training groups in a prospective-randomised trial conducted with paediatric acute care providers over 12 months. Costs were calculated and reported from the perspective of the health institution. Incremental costs and effectiveness of distributed CPR training relative to conventional training were presented. Cost-effectiveness was expressed as an incremental cost-effectiveness ratio (ICER) if appropriate. One-way sensitivity analyses and probabilistic sensitivity analysis were conducted.

Results

A total of 87 of 101 enrolled participants completed the training (46/53 in intervention and 41/48 in the control). Compared with conventional training, the distributed CPR training group had a higher proportion of participants achieving CPR excellence, defined as over 90% guideline compliant for chest compression depth, rate and recoil (control: 0.146 (6/41) vs intervention 0.543 (25/46), incremental effectiveness: +0.397) with decreased costs (control: $C266.50 vs intervention $C224.88 per trainee, incremental costs: −$C41.62). The sensitivity analysis showed that when the institution does not pay for the training time, distributed CPR training results in an ICER of $C147.05 per extra excellent CPR provider.

Conclusion

Workplace-based distributed CPR training with real-time feedback resulted in improved CPR quality by paediatric healthcare providers and decreased training costs, when training time is paid by the institution. If the institution does not pay for training time, implementing distributed training resulted in better CPR quality and increased costs, compared with conventional training. These findings contribute further evidence to the decision-making processes as to whether institutions/programmes should financially adopt these training programmes.

Development and psychometric evaluation of an instrument to measure knowledge, skills, and attitudes towards quality improvement in health professions education: The Beliefs, Attitudes, Skills, and Confidence in Quality Improvement (BASiC-QI) Scale

INTRODUCTION

Health professionals are increasingly expected to foster and lead initiatives to improve the quality and safety of healthcare. Consequently, health professions education has begun to integrate formal quality improvement (QI) training into their curricula. Few instruments exist in the literature that adequately and reliably assess QI-related competencies in learners without the use of multiple, trained raters in the context of healthcare. This paper describes the development and psychometric evaluation of the Beliefs, Attitudes, Skills, and Confidence in Quality Improvement (BASiC-QI) instrument, a 30-item self-assessment tool designed to assess knowledge, skills, and attitudes towards QI.

METHODS

Sixty first-year medical student participants completed the BASiC-QI and the Quality Improvement Knowledge Application Tool (QIKAT-R) prior to and immediately following a QI program that challenged learners to engage QI concepts in the context of their own medical education. Measurement properties of the BASiC-QI tool were explored through an exploratory factor analysis and generalizability study. Convergent validity was examined through correlations between BASiC-QI and QIKAT-R scores.

RESULTS

Psychometric evaluation of BASiC-QI indicated reliability and validity evidence based on internal structure. Analyses also revealed that BASiC-QI scores were positively correlated with the scores from the QIKAT-R, which stands an indicator of convergent validity.

CONCLUSION

BASiC-QI is a multidimensional self-assessment tool that may be used to assess beliefs, attitudes, skills, and confidence towards QI. In comparison with existing instruments, BASiC-QI does not require multiple raters or scoring rubrics, serving as an efficient, reliable assessment instrument for educators to examine the impact of QI curricula on learners.

Reducing physician voiding cystourethrogram ordering in children with first febrile urinary tract infection: evaluation of a purposefully sequenced educational intervention

BACKGROUND

Physicians often fail to implement clinical practice guidelines. Our aim was to evaluate whether a purposefully sequenced, multifaceted educational intervention would increase physician adherence to a guideline for voiding cystourethrogram (VCUG) use following first urinary tract infection (UTI) in young children.

METHODS

Using a single centre, pretest-posttest design, we compared the proportion of guideline adherent VCUG orders and the VCUG ordering rate before and after three educational interventions (interactive lecture, clinical pathway, faxed reminder) selected and sequenced according to the PRECEDE (Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation) health promotion model.

RESULTS

One hundred and nine physicians ordered 219 VCUGs for 219 children. Following the interventions, there was an increase in the monthly proportion of adherent VCUGs ordered by pediatricians (analysis of variance (ANOVA) F(2,29) = 3.38, p = .048) and non-pediatricians (ANOVA F(2,28) = 14.71, p < .001). Also, pediatricians decreased their monthly VCUG ordering rate (linear trend incidence rate ratio 0.74, 95% confidence interval (CI) [0.54, 0.99]). Pediatricians were more likely to adhere with the guideline than were non-pediatricians (odds ratio 2.91, 95% CI [1.5, 5.5]).

CONCLUSION

Exposure to purposefully sequenced educational interventions based on the PRECEDE model was associated with increased adherence to guideline recommendations.

Effects of transcranial direct-current stimulation on laparoscopic surgical skill acquisition

Background

Changes in medical education may limit opportunities for trainees to gain proficiency in surgical skills. Transcranial direct-current stimulation (tDCS) can augment motor skill learning and may enhance surgical procedural skill acquisition. The aim of this study was to determine the effects of tDCS on simulation-based laparoscopic surgical skill acquisition.

Methods

In this double-blind, sham-controlled randomized trial, participants were randomized to receive 20 min of anodal tDCS or sham stimulation over the dominant primary motor cortex, concurrent with Fundamentals of Laparoscopic Surgery simulation-based training. Primary outcomes of laparoscopic pattern-cutting and peg transfer tasks were scored at baseline, during repeated performance over 1 h, and again at 6 weeks. Intent-to-treat analysis examined the effects of treatment group on skill acquisition and retention.

Results

Of 40 participants, those receiving tDCS achieved higher mean(s.d.) final pattern-cutting scores than participants in the sham group (207·6(30·0) versus 186·0(32·7) respectively; P = 0·022). Scores were unchanged at 6 weeks. Effects on peg transfer scores were not significantly different (210·2(23·5) in the tDCS group versus 201·7(18·1) in the sham group; P = 0·111); the proportion achieving predetermined proficiency levels was higher for tDCS than for sham stimulation. Procedures were well tolerated with no serious adverse events and no decreases in motor measures.

Conclusion

The addition of tDCS to laparoscopic surgical training may enhance skill acquisition. Trials of additional skills and translation to non-simulated performance are required to determine the potential value in medical education and impact on patient outcomes. Registration number: NCT02756052 (https://clinicaltrials.gov/).

Implementing economic evaluation in simulation-based medical education: challenges and opportunities

CONTEXT

Simulation-based medical education (SBME) is now ubiquitous at all levels of medical training. Given the substantial resources needed for SBME, economic evaluation of simulation-based programmes or curricula is required to demonstrate whether improvement in trainee performance (knowledge, skills and attitudes) and health outcomes justifies the cost of investment. Current literature evaluating SBME fails to provide consistent and interpretable information on the relative costs and benefits of alternatives.

CONTENT

Economic evaluation is widely applied in health care, but is relatively scarce in medical education. Therefore, in this paper, using a focus on SBME, we define economic evaluation, describe the key components, and discuss the challenges associated with conducting an economic evaluation of medical education interventions. As a way forward to the rigorous and state of the art application of economic evaluation in medical education, we outline the steps to gather the necessary information to conduct an economic evaluation of simulation-based education programmes and curricula, and describe the main approaches to conducting an economic evaluation.

CONCLUSION

A properly conducted economic evaluation can help stakeholders (i.e., programme directors, policy makers and curriculum designers) to determine the optimal use of resources in selecting the modality or method of assessment in simulation. It also helps inform broader decision making about allocation of scarce resources within an educational programme, as well as between education and clinical care. Economic evaluation in medical education research is still in its infancy, and there is significant potential for state-of-the-art application of these methods in this area.

Reducing the impact of intensive care unit mattress compressibility during CPR: a simulation-based study

BACKGROUND

The depth of chest compression (CC) during cardiac arrest is associated with patient survival and good neurological outcomes. Previous studies showed that mattress compression can alter the amount of CCs given with adequate depth. We aim to quantify the amount of mattress compressibility on two types of ICU mattresses and explore the effect of memory foam mattress use and a backboard on mattress compression depth and effect of feedback source on effective compression depth.

METHODS

The study utilizes a cross-sectional self-control study design. Participants working in the pediatric intensive care unit (PICU) performed 1 min of CC on a manikin in each of the following four conditions: (i) typical ICU mattress; (ii) typical ICU mattress with a CPR backboard; (iii) memory foam ICU mattress; and (iv) memory foam ICU mattress with a CPR backboard, using two different sources of real-time feedback: (a) external accelerometer sensor device measuring total compression depth and (b) internal light sensor measuring effective compression depth only. CPR quality was concurrently measured by these two devices. The differences of the two measures (mattress compression depth) were summarized and compared using multilevel linear regression models. Effective compression depths with different sources of feedback were compared with a multilevel linear regression model.

RESULTS

The mean mattress compression depth varied from 24.6 to 47.7 mm, with percentage of depletion from 31.2 to 47.5%. Both use of memory foam mattress (mean difference, MD 11.7 mm, 95%CI 4.8-18.5 mm) and use of backboard (MD 11.6 mm, 95% CI 9.0-14.3 mm) significantly minimized the mattress compressibility. Use of internal light sensor as source of feedback improved effective CC depth by 7-14 mm, compared with external accelerometer sensor.

CONCLUSION

Use of a memory foam mattress and CPR backboard minimizes mattress compressibility, but depletion of compression depth is still substantial. A feedback device measuring sternum-to-spine displacement can significantly improve effective compression depth on a mattress.

TRIAL REGISTRATION

Not applicable. This is a mannequin-based simulation research.

Validating MMI scores: are we measuring multiple attributes?

The multiple mini-interview (MMI) used in health professional schools' admission processes is reported to assess multiple non-cognitive constructs such as ethical reasoning, oral communication, or problem evaluation. Though validation studies have been performed with total MMI scores, there is a paucity of information regarding how well MMI scores differentiate the constructs being measured, the relationship between MMI scores (construct or total) and personality characteristics, and how well MMI scores (construct or total) predict future performance in practice. Results from these studies could assist with MMI station development, rater training, score interpretation, and resource allocation. The purpose of this study was to investigate the validity of MMI construct scores (oral communication and problem evaluation), and their relationship to personality measures (emotionality and extraversion) and specific scores from standardized clinical communications interviews (building the relationship and explaining and planning). Confirmatory factor analysis results support a two factor MMI model, however the correlation between these factors was .87. Oral communication MMI scores significantly correlated with extraversion (r c = .25, p < .05), but MMI scores were not related to emotionality. Scores for building a relationship were significantly related to MMI oral communication scores, (r c = .46, p < .001) and problem evaluation scores (r c = .43, p < .001); scores for explaining and planning were significantly related to MMI problem evaluation scores (r c = .36, p < .01). The results provide validity evidence for assessing multiple non-cognitive attributes during the MMI process and reinforce the importance of developing MMI stations and scoring rubrics for attributes identified as important for future success in school and practice.

Using network analysis to explore if professional opinions on Japanese encephalitis risk factors in Nepal reflect a socio-ecological system perspective

Japanese encephalitis (JE) is the leading cause of viral encephalitis in Asia and a significant public health problem in Nepal. Its epidemiology is influenced by factors affecting its amplifying hosts (pigs), vectors (mosquitoes), and dead-end hosts (including people). While most control efforts target reduced susceptibility to infection either by vaccination of people or pigs or by reduced exposure to mosquitoes; the economic reality of Nepal makes it challenging to implement standard JE control measures. An ecohealth approach has been nominated as a way to assist in finding and prioritizing locally relevant strategies for JE control that may be viable, feasible, and acceptable. We sought to understand if Nepalese experts responsible for JE management conceived of its epidemiology in terms of a socio-ecological system to determine if they would consider ecohealth approaches. Network analysis suggested that they did not conceive JE risk as a product of a socio-ecological system. Traditional proximal risk factors of pigs, mosquitoes, and vaccination predominated experts' conception of JE risk. People seeking to encourage an ecohealth approach or social change models to JE management in Nepal may benefit from adopting social marketing concepts to encourage and empower local experts to examine JE from a socio-ecological perspective.

Bronchial collapse during bronchoalveolar lavage in horses is an indicator of lung inflammation

REASONS FOR PERFORMING STUDY

The bronchoalveolar lavage (BAL) procedure can return variable volumes of fluid, possibly depending on the presence of bronchial collapse during fluid aspiration and on the severity of lung inflammation.

OBJECTIVES

We tested the hypothesis that horses with bronchial collapse during BAL are at higher risk of having severe lung inflammation.

STUDY DESIGN

Prospective field study.

METHODS

Bronchial collapse was graded using a new simple scoring method (0, 1 or 2) during a standardised BAL procedure in the field on 131 horses with normal, mild/moderate or severe lower airway inflammation on cytology of BAL fluid.

RESULTS

Of the 131 horses, 37 (28%), 55 (42%) and 39 (30%) horses had bronchial collapse scores of 0, 1 and 2, respectively. There was a difference in collapse scores between all the BAL inflammation categories (P<0.001). Severe collapse had a positive predictive value of 0.95 for both mild/moderate and severe BAL inflammation, with a prevalence of 63% and 20%, respectively. The BAL fluid return volume in the horses with severe collapse scores was lower than volumes in the partial (score 1/2) and no collapse (score 0/2) groups (P<0.001). The BAL fluid volume was negatively correlated with BAL neutrophil percentage (P<0.001).

CONCLUSIONS

Airway collapse during BAL is associated with airway inflammation and neutrophilia.

POTENTIAL RELEVANCE

During a standardised BAL procedure, clinicians can expect lung inflammation in horses that have bronchial collapse and bronchial collapse in horses with lung inflammation. Lung inflammation may be a contributing factor in the mechanism of bronchial collapse during BAL in horses.

What should we be selecting for? A systematic approach for determining which personal characteristics to assess for during admissions

BACKGROUND

Admission committees are responsible for creating fair, defensible, reliable, and valid processes that assess those attributes considered important for professional success. There is evidence for the continuing use of academic ability as a selection criterion for health professional schools; however, there is little evidence for the reliability and validity of measures currently in place to assess personal characteristics. The Ontario Veterinary College (OVC) initiated a review of its admissions criteria in order to implement an evidence-based method to determine which characteristics veterinary stakeholders consider important to assess for admission.

METHODS

Eleven characteristics were identified by the OVC Admissions Committee and a survey was sent to all licensed veterinarians in Ontario (n=4,068), OVC students (n=450), and OVC faculty, interns and residents (n=192). A paired comparison method was used to identify the relative rank order of the characteristics, and multivariate analysis of variance with post hoc analyses was used to determine between group differences in the returned survey data.

RESULTS

Surveys were returned from 1,312 participants (27.86% response rate; female 59.70%). The relative rank of the characteristics was reasonably consistent among participant groups, with ethical behaviour, sound judgment, communication, and critical and creative thinking being ranked as the top four. However, the importance of certain characteristics like communication and empathy were perceived differently by groups. For instance, females scored communication (F(1, 1289) = 20.24, p < .001, d = .26) and empathy (F(1, 1289) = 55.41, p < .001, d = 0.42) significantly higher than males, while males scored knowledge of profession (F(1, 1289) = 12.81, p < .001, d = 0.20), leadership (F(1, 1289) = 10.28, p = .001, d = 0.18), and sound judgment (F(1, 1289) = 13.56, p < .001, d = 0.21) significantly higher than females.

CONCLUSIONS

The data from the paired comparison method provide convergent evidence for the characteristics participant groups identify as most important in determining who should be admitted to a veterinary program. The between group analyses provides important information regarding characteristics most important to various subgroups; this has implications for what characteristics are selected for at admission as well as on who is selecting for them.

Leadership competencies for medical education and healthcare professions: population-based study

OBJECTIVE

To identify and empirically investigate the dimensions of leadership in medical education and healthcare professions.

DESIGN

A population-based design with a focus group and a survey were used to identify the perceived competencies for effective leadership in medical education.

SETTING

The focus group, consisting of five experts from three countries (Austria n=1; Germany n=2; Switzerland n=2), was conducted (all masters of medical education), and the survey was sent to health professionals from medical schools and teaching hospitals in six countries (Austria, Canada, Germany, Switzerland, the UK and the USA).

PARTICIPANTS

The participants were educators, physicians, nurses and other health professionals who held academic positions in medical education. A total of 229 completed the survey: 135 (59.0%) women (mean age=50.3 years) and 94 (41.0%) men (mean age=51.0 years).

MEASURES

A 63-item survey measuring leadership competencies was developed and administered via electronic mail to participants.

RESULTS

Exploratory principal component analyses yielded five factors accounting for 51.2% of the variance: (1) social responsibility, (2) innovation, (3) self-management, (4) task management and (5) justice orientation. There were significant differences between physicians and other health professionals on some factors (Wilk's λ=0.93, p<0.01). Social responsibility was rated higher by other health professionals (M=71.09) than by physicians (M=67.12), as was innovation (health professionals M=80.83; physicians M=76.20) and justice orientation (health professionals M=21.27; physicians M=20.46).

CONCLUSIONS

The results of the principal component analyses support the theoretical meaningfulness of these factors, their coherence, internal consistency and parsimony in explaining the variance of the data. Although there are some between-group differences, the competencies appear to be stable and coherent.

A review of student evaluation of teaching: applications to veterinary medical education

Student evaluation of teaching is ubiquitous to teaching in colleges and universities around the world. Since the implementation of student evaluations in the 1970s in the US, considerable research has been devoted to their appropriate use as a means of judging the effectiveness of teaching. The present article aims to (1) examine the evidence for the reliability, validity, and utility of student ratings; (2) provide seven guidelines for ways to identify effective instruction, given that the purpose of student evaluation is to assess effective teaching; and (3) conclude with recommendations for the integration of student ratings into the continuous evaluation of veterinary medical education.

A generalizability analysis of a veterinary school Multiple Mini Interview: effect of number of interviewers, type of interviewers, and number of stations

BACKGROUND

The number of Multiple Mini Interview (MMI) stations and the type and number of interviewers required for an acceptable level of reliability for veterinary admissions requires investigation.

PURPOSE

The goal is to investigate the reliability of the 2009 MMI admission process at the University of Calgary.

METHODS

Each applicant (n = 103; female = 80.6%; M age = 23.05 years, SD = 3.96) participated in a 7-station MMI. Applicants were rated independently by 2 interviewers, a faculty member, and a community veterinarian, within each station (total interviewers/applicant N = 14). Interviewers scored applicants on 3 items, each on a 5-point anchored scale.

RESULTS

Generalizability analysis resulted in a reliability coefficient of G = 0.79. A Decision study (D-study) indicated that 10 stations with 1 interviewer would produce a G = 0.79 and 8 stations with 2 interviewers would produce a G = 0.81; however, these have different resource requirements. A two-way analysis of variance showed that there was a nonsignificant main effect of interviewer type (between faculty member and community veterinarian) on interview scores, F(1, 1428) = 3.18, p = .075; a significant main effect of station on interview scores, F(6, 1428) = 4.34, p < .001; and a nonsignificant interaction effect between interviewer-type and station on interview scores, F(6, 1428) = 0.74, p = .62.

CONCLUSIONS

Overall reliability was adequate for the MMI. Results from the D-study suggest that the current format with 7 stations provides adequate reliability given that there are enough interviewers; to achieve the same G-coefficient 1 interviewer per station with 10 stations would suffice and reduce the resource requirements. Community veterinarians and faculty members demonstrated an adequate level of agreement in their assessments of applicants.

The Coordinators of Psychiatric Education (COPE) Residency In-Training Exam: a preliminary psychometric assessment

OBJECTIVE

The Coordinators of Psychiatric Education (COPE) Residency In-Training Exam is a formative exam for Canadian psychiatric residents that was reconstructed using assessment best practices. An assessment of psychometric properties was subsequently performed on the exam to ensure preliminary validity and reliability.

METHODS

An exam blueprint was developed based on the 2007 Royal College objectives for psychiatric training. A minimum pass level was established using a modified Angoff method. The exam was administered to all Canadian psychiatric residents in postgraduate years 2 to 5 with test reliability (Cronbach alpha) and item analysis performed. Exam validity was assessed through blueprint adherence and cross-year resident performance analysis.

RESULTS

Four hundred two exams were suitable for analysis. The overall mean score for all residents was 69.6% (SD=8.5) with significant differences in total scores between each of the postgraduate year groups, with consistently better performance with increasing time in residency. Cronbach alpha was 0.79.

CONCLUSION

The present study provides preliminary support that the reconstructed COPE Residency In-Training Exam demonstrates adequate reliability and validity, including showing the capacity to discriminate between levels of training.

Assessment of first-year veterinary students' clinical skills using objective structured clinical examinations

The DVM program at the University of Calgary offers a Clinical Skills course each year for the first three years. The course is designed to teach students the procedural skills required for entry-level general veterinary practice. Objective Structured Clinical Examinations (OSCEs) were used to assess students' performance on these procedural skills. A series of three OSCEs were developed for the first year. Content was determined by an exam blueprint, exam scoring sheets were created, rater training was provided, a mock OSCE was performed with faculty and staff, and the criterion-referencing Ebel method was used to set cut scores for each station using two content experts. Each station and the overall exam were graded as pass or fail. Thirty first-year DVM students were assessed. Content validity was ensured by the exam blueprint and expert review. Reliability (coefficient α) of the stations from the three OSCE exams ranged from 0.0 to 0.71. The three exam reliabilities (Generalizability Theory) were, for OSCE 1, G=0.56; OSCE 2, G=0.37; and OSCE 3, G=0.32. Preliminary analysis has suggested that the OSCEs demonstrate face and content validity, and certain stations demonstrated adequate reliability. Overall exam reliability was low, which reflects issues with first-time exam delivery. Because this year was the first that this course was taught and this exam format was used, work continues in the program on the teaching of the procedural skills and the development and revision of OSCE stations and scoring checklists.

Using standardized essays in the veterinary medicine admissions process: are the ratings reliable and valid?

The reliability and validity of using essays for veterinary medical school admissions requires investigation. We explored the reliability and construct validity of a structured essay station in the 2009 admission process at the University of Calgary Faculty of Veterinary Medicine. One hundred three applicants (female=80.6%, male=19.4%; mean age=23.05 years, SD=3.96) participated. Each applicant wrote a one-hour supervised essay (750 words). Essays were rated independently by two randomly assigned raters (n=16). Raters scored essays on four items, each on a five-point anchored scale. Nine essays were scored by all raters to perform a decision study. Generalizability analysis resulted in a reliability coefficient of 0.55. The decision study indicated that three raters and four items produces a G of 0.68. Essay score correlated with interview score (r=0.30, p<0.01) but not with GPA (r=0.05, p=ns). Overall reliability was adequate and higher than what has been reported for unsupervised written submissions. Results from the decision study suggest that three raters with four items provide adequate reliability. Correlations with interviews and grade point average provide evidence of construct validity. A time-limited essay with a clear scoring protocol results in adequate reliability and some validity.

Aptitude, achievement and competence in medicine: a latent variable path model

To develop and test a latent variable path model of general achievement, aptitude for medicine and competence in medicine employing data from the Medical College Admission Test (MCAT), pre-medical undergraduate grade point average (UGPA) and demographic characteristics for competence in pre-clinical and measures of competence (United States Licensure Examination {USMLE} Steps 1, 2, and 3). Data were gathered on 839,710 participants from 1991 to 2000 on demographic and school variables, UGPA, MCAT subtest scores and Steps 1, 2, and 3 of the United Stated Licensure Examination (USMLE). However, subsets of the total 839,710 participants included in the database were used for various analyses and the testing of a latent variable path model (LVPA). A number of preliminary descriptive and inferential techniques were used to confirm previous hypotheses and stated relationships amongst the variables of interest to the present study. Through development and testing of a latent variable path model, three latent variables measured by UGPA (general achievement), subscales of the MCAT (aptitude for medicine), and Steps 1, 2, and 3 of the USMLE (competence in medicine) were identified which resulted in a comparative fit index = .932 of the model to a large sample (n = 20,714). In a confirmatory latent variable path model we were able to identify theoretical constructs, aptitude for medicine, general achievement, and competence in medicine and their interrelationships. These are distinct but interrelated latent variables.

Medical school curricula: do curricular approaches affect competence in medicine?

BACKGROUND AND OBJECTIVES

US medical school curricula continually undergo reform. The effect of formal curricular approaches (course organization and pedagogical techniques) on competence in medicine as measured by the United States Medical Licensing Examinations (USMLE) Step 1, 2, and 3 is not fully understood. The purpose of this study was to investigate the effects of formal curricular approaches in a latent variable path analysis model of achievement-aptitude-competence in medicine.

METHODS

Using Association of American Medical Colleges (AAMC) and USMLE longitudinal data (1994-2004) for 116 medical schools, structural equation modeling was used to study latent variable path models assessing the impact of curriculum on competence in medicine (n=9,332).

RESULTS

A latent variable path model consisting of three latent variables measured by undergraduate grade point average (general achievement), Medical College Admission Test subscores (aptitude for medicine), and USMLE Step 1-3 (competence in medicine) was used to assess the impact of curriculum on competence in medicine. Two models were tested; one resulted in a Comparative Fit Index=.931 with a path coefficient of 0.04 from curriculum to competence in medicine. While there was a good fit of the data to the final model, the type of school curriculum did not significantly influence competence in medicine since it accounted for less than 1% of the variation in student performance on the USMLE.

CONCLUSIONS

Various formal curricular approaches have little differential effect on students' performance on the USMLE.

Validity, reliability, and defensibility of assessments in veterinary education

In this article, we provide an introduction to and overview of issues of validity, reliability, and defensibility related to measurement of student performance in veterinary medical education. Validity has to do with the extent to which the instrument measures whatever it is supposed to measure, reliability has to do with the consistency of measurement, and defensibility deals with the appropriate standards of the assessment procedure. An explanation of the methods that can be used to determine reliability and validity are given and examples of how they have been used in recent research findings are provided. Veterinary educators should have an understanding of each of these concepts because evaluation of veterinary students and performance measures provides evidence of utility of assessment tools, informs teaching practices, and can guide curriculum development and revision.

Assessment of applicants to the veterinary curriculum using a multiple mini-interview method

This study describes the development, implementation, and psychometric assessment of the multiple mini-interview (MMI) for the inaugural class of veterinary medicine applicants at the University of Calgary Faculty of Veterinary Medicine (UCVM). The MMI is a series of approximately five to 12 10-minute interviews that consist of situational events. Applicants are given a scenario and asked to work through an issue or behavioral-type questions that are meant to assess one attribute (e.g., empathy) at a time. This structure allows for multiple assessments of the applicants by trained interviewers on the same questions. MMI scenario development was based on a review of the noncognitive attributes currently assessed by the 31 veterinary schools across Canada and the United States and the goals and objectives of UCVM. The noncognitive attributes of applicants (N=110) were assessed at five stations, by two interviewers within each station, on three items using a standardized rating form on an anchored 1-5 scale. The method was determined to be reliable (G-coefficient=0.88) and demonstrated evidence of validity. The MMI score did not correlate with grade-point average (r=0.12, p=0.22). While neither the applicants nor interviewers had participated in an MMI format before, both groups reported the process to be acceptable in a post-interview questionnaire. This analysis provides preliminary evidence of the reliability, validity, and acceptability of the MMI in assessing the noncognitive attributes of applicants for veterinary medical school admissions.

Xenon anesthesia impairs hepatic oxygenation and perfusion in healthy pigs

BACKGROUND

Over the last 15 years, there has been growing interest in the noble gas xenon as a new inhalational anesthetic. This is due to its favorable pharmacological properties such as short onset and offset, as well as its hemodynamic stability. However, most volatile anesthetics appear to play an important role in the multi-factorial etiology of perioperative liver injury by decreasing liver blood flow with a subsequent reduction of hepatic oxygen supply. However, the effects of the anesthetic gas xenon on hepatic perfusion and oxygenation have not been completely investigated.

METHODS

Following ethical approval, 18 anesthetized and acutely monitored pigs were randomly assigned to the two following groups: 9 animals received xenon anesthesia in increasing inspiratory concentrations of 0%, 20%, 50%, and 65% in addition to their basic intravenous anesthesia; 9 animals served as a control group. Measurement points for systemic and regional hemodynamic and oxygenation parameters were performed 30 min after changing the xenon concentration.

RESULTS

Xenon elicited dose-dependent systemic hemodynamic changes such that the mean arterial pressure did not change, while the heart rate and cardiac output decreased by about 30%, thereby indicating an increase in the systemic vascular resistance. Portal venous blood flow decreased, while hepatic arterial blood flow was unchanged. The oxygen supply of the liver was reduced, but not the rate of indocyanine plasma disappearance from the liver. Furthermore, the increase of liver surface pO2 to systemic hyperoxia was absent, and hepatic lactate uptake was reduced.

CONCLUSION

Xenon, in addition to basic intravenous anesthesia, elicited a decrease in heart rate and cardiac output and an increase in mean arterial pressure. Similar to volatile anesthetics, xenon does reduce portal venous flow and influences hepatic tissue oxygenation. In contrast, hepatic arterial blood flow remains stable in the presence of xenon, and no changes in the hepatic arterial buffer responses were evident. Xenon does affect hepatic perfusion and oxygenation.

How much do differences in medical schools influence student performance? A longitudinal study employing hierarchical linear modeling

BACKGROUND

Medical school curricula have undergone considerable change in the past half century. There is little evidence, however, for the impact of various curricula and educational policies on student learning once incoming performance and the nonrandom nature of students nested within schools has been accounted for.

PURPOSE

To investigate effects of school variables on United States Medical Licensing Examination (USMLE) Step 1-3 scores over an 11-year period (1994-2004).

METHODS

Using Association of American Medical Colleges and USMLE longitudinal data for 116 medical schools, hierarchical linear modeling was used to study the effects of school variables on Step 1-3.

RESULTS

Mean unadjusted between school variance was 14.74%, 10.50%, and 11.25%, for USMLE Step 1-3. When student covariates were included, between-school variation was less than 5%. The variance accounted for in student performance by the student covariates ranged from 27.58% to 36.51% for Step 1,16.37% to 24.48% for Step 2 and 19.22% to 25.32% for Step 3.The proportion of the between-school variance that was accounted for by the student covariates ranged between 81.22% and 88.26% for Step 1, 48.44% and 79.77% for Step 2, and 68.41% and 80.78% for Step 3 [corrected]. School-level variables did not consistently predict for adjusted mean school Step performance.

CONCLUSIONS

Individual student differences account for most of the variation in USMLE performance with small contributions from between-school variation and even smaller contribution from curriculum and educational policies.

Patients' self-evaluation after 4-12 weeks following xenon or propofol anaesthesia

BACKGROUND AND OBJECTIVE

The aim of this study was to assess postoperative patients' self-evaluation after xenon anaesthesia compared to total intravenous anaesthesia with propofol.

METHODS

160 patients aged 18-60 yr, ASA I-II undergoing elective surgery took part in this randomised-controlled trial. After approval by the local Ethics Committee and as soon as the patients had given their written informed consent, they were randomly allocated to either the xenon (n = 80) or propofol (n = 80) group. In both groups remifentanil was used as opioid. The postoperative patients' self-evaluation was assessed with a double-blind telephone poll. Early spatial orientation, patients' self-evaluation of anaesthesia, choice of the same anaesthesia for future operations and recall of uncomfortable feelings after anaesthesia were determined.

RESULTS

116 Patients were analysed, 63 in the xenon and 53 in the propofol group. The two study groups were comparable with respect to age, weight, height, gender and ASA classification. The two groups indicated similar values in the early spatial orientation at the onset of recovery and thereafter. Patients' self-evaluation of anaesthesia with main emphasis at high marks and repetition of the same anaesthesia if necessary were similar in both groups. Recalls of uncomfortable feelings were comparable but not for postoperative pain and appetite/thirst which appeared with a significantly higher incidence in the xenon group.

CONCLUSIONS

Patients' self-evaluation and memory of early spatial orientation following xenon anaesthesia are comparable to propofol.

Randomized controlled trial of the haemodynamic and recovery effects of xenon or propofol anaesthesia

BACKGROUND

There is limited clinical experience with xenon in a large number of patients. We present intra- and postoperative haemodynamic and recovery data comparing xenon and total intravenous anaesthesia with propofol.

METHODS

A total of 160 patients aged 18-60 years (ASA I and II) undergoing elective surgery took part in this prospective non-blinded randomized controlled trial. After local ethics committee approval and written informed consent, patients were allocated randomly to either the xenon or the propofol group. Anaesthesia was induced with propofol and remifentanil and was maintained with xenon at 60% (minimal alveolar concentration 0.95) or with propofol 0.1-0.12 mg kg(-1) min(-1). Remifentanil was titrated to clinical need in both groups.

RESULTS

The two study groups were comparable with respect to age, weight, height, gender and ASA classification. Baseline in heart rate and systolic arterial pressure (SAP) were comparable in both groups. Following induction, SAP initially decreased but returned to baseline values over 15 min in the xenon group and differed significantly from the propofol group. Heart rate decreased significantly only in the xenon group and remained at stable values. Occurrence and duration of hypertension, hypotension and bradycardia showed no significant difference between groups. Patient recovery time in the post-anaesthetic care unit and recovery from anaesthesia was similar in the two groups.

CONCLUSIONS

After induction the xenon/opioid regimen maintains systolic blood pressure at baseline levels and a low heart rate. No differences between groups were found in haemodynamic stability during anaesthesia. Recovery from xenon anaesthesia was similar to that observed in the propofol group.

Effects of xenon anaesthesia on intestinal oxygenation in acutely instrumented pigs

BACKGROUND

Xenon is a narcotic gas that might be able to replace volatile anaesthetics or nitrous oxide due to its favourable pharmacological properties, such as providing haemodynamic stability. Intestinal oxygenation is affected by most volatile anaesthetics as a result of cardiodepressive effects. Reducing oxygenation of the gut might be a factor leading to perioperative organ dysfunction. This animal study was designed to assess the effects of xenon on intestinal oxygenation.

METHODS

After ethical approval, 24 anaesthetized, acutely instrumented pigs were randomly assigned to three groups: nine animals received xenon anaesthesia with inspiratory concentrations of 0, 20, 50 and 65% in addition to their basic i.v. anaesthesia, nine animals served as a study control group, and five animals were used to assess model stability. Measurement of systemic and regional haemodynamic and oxygenation parameters was made 30 min after changing the xenon concentration.

RESULTS

Xenon elicited dose-dependent systemic haemodynamic changes: heart rate and cardiac output decreased by 30%, while mean arterial pressure was stable. Superior mesenteric artery blood flow was lower in the xenon group. Vascular resistance of the superior mesenteric artery increased. The small intestinal oxygen supply decreased with increasing xenon concentration; the mucosal tissue oxygen partial pressure decreased but did not reach hypoxic (<5 mm Hg) values. Serosal tissue oxygen partial pressure was maintained.

CONCLUSIONS

Xenon, in addition to basic i.v. anaesthesia, elicited a decrease in cardiac output and maintained mean arterial pressure. Intestinal oxygenation was maintained, although regional macrohaemodynamic perfusion decreased. Xenon does not impair intestinal oxygenation under physiological conditions.

Xenon, a modern anaesthesia gas

Xenon is an interesting anesthetic as it appears to lack negative inotropicy and vasodilatation, giving great advantages to both patients with limited cardiovascular reserve or those who require hemodynamic stability. It has low toxicity and is not teratogenic. Xenon gives rapid induction and recovery, due to its low blood/gas partition coefficient (0.15), and has a MAC of 63%. Several vitro studies showed that Xenon may protect neural cells against ischaemic injury. Its low blood solubility can take to diffusion hypoxia if Xenon is not substituted by 100% oxygen at the end of anesthesia. It has been shown that, compared to other anesthetic regimens, Xenon anesthesia produces the highest regional blood flow in the brain, liver, kidney and intestine. In conclusion, the most important positive effects of Xenon are cardiovascular stability, cerebral protection and favourable pharmacokinetics. Negative points are high cost and the limited number of ventilators supplying Xenon.

Increased airway resistance during xenon anaesthesia in pigs is attributed to physical properties of the gas

BACKGROUND

In this study we investigated the effects of the physical properties of xenon on respiratory mechanisms in pigs.

METHODS

With institutional approval, 10 female pigs (mean 25.2 (SD 2.5) kg) were anaesthetized with thiopental, remifentanil, and pancuronium. Gas flow and pressure were recorded continuously at the proximal end of the tracheal tube during constant flow ventilation for control, with 100% oxygen (control), followed by 1.5% isoflurane in 70/30% nitrogen/oxygen, 1.0% isoflurane in 70/30% nitrous oxide/oxygen, and 70/30% xenon/oxygen in random order. Compliance (C) and resistance (R) were calculated using a single compartment model. Resistance was corrected for gas viscosities eta and also for densities pho and viscosities eta as (pho*eta)(1/2) to compare assumptions of laminar and mixed flow in the airways.

RESULTS

With constant flow ventilation, xenon increases inspiratory pressure compared with other gas mixtures. There were no significant differences in resistance, corrected for laminar or mixed flow, between the gas mixtures. Xenon anaesthesia did not affect compliance.

CONCLUSIONS

The increase in airway pressure observed with xenon anaesthesia is attributed completely to its higher density and viscosity. Therefore, determination of airway resistance must take into account the physical properties of the gas. Xenon does not exert any major effect on airway diameter.

Hosts manipulated by one parasite incur additional costs from infection by another parasite

Manipulation of host phenotype by parasites often serves to increase the predation rate of definitive hosts on intermediate hosts. For intermediate hosts, the indirect consequences of manipulation may extend beyond the direct increase in predation, however. Metacercariae of the trematode Curtuteria australis encyst in the foot of New Zealand cockles, Austrovenus stutchburyi, and stunt its growth, rendering cockles incapable of burrowing into the sediments. Here, we show that cockles manipulated by C. australis are 5 times more likely to be infected by the castrating sporocysts of another trematode than normal, nonmanipulated cockles. Our results indicate that the consequences for C. australis-manipulated cockles are far more important than a simple increase in the risk of predation and that indirect repercussions of manipulation can be as severe as direct ones.