1
|
Kong W, Oud M, Habraken SJM, Huiskes M, Astreinidou E, Rasch CRN, Heijmen BJM, Breedveld S. SISS-MCO: large scale sparsity-induced spot selection for fast and fully-automated robust multi-criteria optimisation of proton plans. Phys Med Biol 2024; 69:055035. [PMID: 38224619 DOI: 10.1088/1361-6560/ad1e7a] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/15/2024] [Indexed: 01/17/2024]
Abstract
Objective.Intensity modulated proton therapy (IMPT) is an emerging treatment modality for cancer. However, treatment planning for IMPT is labour-intensive and time-consuming. We have developed a novel approach for multi-criteria optimisation (MCO) of robust IMPT plans (SISS-MCO) that is fully automated and fast, and we compare it for head and neck, cervix, and prostate tumours to a previously published method for automated robust MCO (IPBR-MCO, van de Water 2013).Approach.In both auto-planning approaches, the applied automated MCO of spot weights was performed with wish-list driven prioritised optimisation (Breedveld 2012). In SISS-MCO, spot weight MCO was applied once for every patient after sparsity-induced spot selection (SISS) for pre-selection of the most relevant spots from a large input set of candidate spots. IPBR-MCO had several iterations of spot re-sampling, each followed by MCO of the weights of the current spots.Main results.Compared to the published IPBR-MCO, the novel SISS-MCO resulted in similar or slightly superior plan quality. Optimisation times were reduced by a factor of 6 i.e. from 287 to 47 min. Numbers of spots and energy layers in the final plans were similar.Significance.The novel SISS-MCO automatically generated high-quality robust IMPT plans. Compared to a published algorithm for automated robust IMPT planning, optimisation times were reduced on average by a factor of 6. Moreover, SISS-MCO is a large scale approach; this enables optimisation of more complex wish-lists, and novel research opportunities in proton therapy.
Collapse
Affiliation(s)
- W Kong
- Department of Radiotherapy, Erasmus MC Cancer Institute, Erasmus University Medical Center , Rotterdam, The Netherlands
| | - M Oud
- Department of Radiotherapy, Erasmus MC Cancer Institute, Erasmus University Medical Center , Rotterdam, The Netherlands
| | - S J M Habraken
- Department of Radiotherapy, Erasmus MC Cancer Institute, Erasmus University Medical Center , Rotterdam, The Netherlands
- HollandPTC, Delft, The Netherlands
| | - M Huiskes
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - E Astreinidou
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - C R N Rasch
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
- HollandPTC, Delft, The Netherlands
| | - B J M Heijmen
- Department of Radiotherapy, Erasmus MC Cancer Institute, Erasmus University Medical Center , Rotterdam, The Netherlands
| | - S Breedveld
- Department of Radiotherapy, Erasmus MC Cancer Institute, Erasmus University Medical Center , Rotterdam, The Netherlands
| |
Collapse
|
2
|
Keuning MC, Lambert B, Nieboer P, Huiskes M, Diemers AD. Perceptions and Guiding Strategies to Regulate Entrusted Autonomy of Residents in the Operating Room: A Systematic Literature Review. Journal of Surgical Education 2024; 81:93-105. [PMID: 37838573 DOI: 10.1016/j.jsurg.2023.09.008] [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] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 12/24/2022] [Accepted: 09/11/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVE To provide a systematic literature review of intraoperative entrusted autonomy for surgical residents. Specifically, perceptions from residents and supervising surgeons, supervising behavior and influencing factors on intraoperative teaching and learning are analyzed. BACKGROUND Increasing demands on surgical training and the need for effective development of technical skills, amplify the importance of making the most of intraoperative teaching and learning opportunities in the operating room. It is critical for residents to gain the greatest benefit from every surgical case and to achieve operative competence. METHODS A systematic literature search identified 921 articles from 2000 to 2022 that addressed surgical education/training, intraoperative supervision/teaching, autonomy and entrustment. 40 studies with heterogeneous designs and methodologies were included. RESULTS Four themes were established in the analysis: patient safety, learner, learning environment and supervising surgeon. The patient is identified as the primary responsibility during intraoperative teaching and learning. Supervisors continuously guard patient safety as well as the resident's learning process. Ideal intraoperative learning occurs when the resident has optimal entrusted autonomy during the procedure matching with the current surgical skills level. A safe learning environment with dedicated time for learning are prerequisites for both supervising surgeons and residents. Supervising surgeons' own preferences and confidence levels also play an important role. CONCLUSIONS This systematic literature review identifies patient safety as the overriding principle for supervising surgeons when regulating residents' entrusted autonomy. When the supervisor's responsibility toward the patient has been met, there is room for intraoperative teaching and learning. In this process the learner, the learning environment and the supervising surgeon's own preferences all intertwine, creating a triangular responsibility. This review outlines the challenge of establishing an equilibrium in this triangle and the broad arsenal of strategies supervising surgeons use to keep it in balance.
Collapse
Affiliation(s)
- Martine C Keuning
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, The Netherlands.
| | - Bart Lambert
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Patrick Nieboer
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Mike Huiskes
- Center for Language and Cognition Groningen, University of Groningen, Groningen, The Netherlands
| | - Agnes D Diemers
- Lifelong Learning, Education and Assessment Research Network (LEARN), University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
3
|
Knol ASL, Huiskes M. [The techniques of the therapist: a conversation analytic perspective on language in psychotherapy]. Tijdschr Psychiatr 2023; 65:146-150. [PMID: 36951769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
BACKGROUND During the interactional exchange with their patients, psychotherapists continuously assess the applicability of therapeutic interventions and how to linguistically shape these. Therapists choose on the spot which tools to use for the treatment of the patient. AIM To answer the questions which interactional techniques psychotherapists apply, how these constitute towards the joint construction of meaning and what their consequences are for the role of the therapist. METHOD We used the method of conversation analysis in order to investigate the therapist’s actions and practices of speaking in a systematic manner. RESULTS In our analyses, we identified different types of techniques such as mirroring, reformulating, completion proffers and silences. These techniques varied in their openness, directiveness and in the degree to which they were transformative. CONCLUSION The spectrum of therapeutic interventions ranges from open and less transformative towards more directive and transformative practices of speaking. During the different interactional phases, therapists strategically vary in the application of these types of interventions and therefore also in their role as interlocutor.
Collapse
|
4
|
van Braak M, Huiskes M, Veen M. When and how teachers intervene in group discussions on experiences from practice in postgraduate medical education: an interactional analysis. Adv Health Sci Educ Theory Pract 2022; 27:965-988. [PMID: 35723769 PMCID: PMC9606080 DOI: 10.1007/s10459-022-10122-w] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 05/08/2022] [Indexed: 06/15/2023]
Abstract
Medical educators constantly make decisions on when and how to intervene. Current literature provides general suggestions about types of teacher interventions. Our study aims to specify that knowledge by describing in detail the actions teachers do when intervening, the interactional consequences of those actions, and how these relate to teacher roles in group discussions. We collected all first teacher interventions (n = 142) in 41 videorecorded group discussions on experiences from practice at the Dutch postgraduate training for General Practice. We analyzed the interventions using Conversation Analysis. First, we described the timing, manner, actions, and interactional consequences of each intervention. Next, we inductively categorized actions into types of actions. Finally, we analyzed the distribution of these types of actions over the group discussion phases (telling, exploration, discussion, conclusion). First teacher interventions were done at observably critical moments. Actions done by these interventions could be categorized as moderating, expert, and evaluating actions. Moderating actions, commonly done during the telling and exploration phase, are least directive. Expert and evaluator actions, more common in the discussion phase, are normative and thus more directive. The placement and form of the actions done by teachers, as well as their accounts for doing those, may hint at a teacher orientation to intervene as late as possible. Since the interventions are occasioned by prior interaction and responded to in different ways by residents, they are a collaborative interactional accomplishment. Our detailed description of how, when and with what effect teachers intervene provides authentic material for teacher training.
Collapse
Affiliation(s)
- Marije van Braak
- Erasmus Medical Centre, Rotterdam, The Netherlands.
- Utrecht University, Trans 10, 3512 JK, Utrecht, The Netherlands.
| | - Mike Huiskes
- Rijksuniversiteit Groningen, Groningen, The Netherlands
| | - Mario Veen
- Erasmus Medical Centre, Rotterdam, The Netherlands
| |
Collapse
|
5
|
Nieboer P, Huiskes M, Cnossen F, Stevens M, Bulstra SK, Jaarsma DADC. Explicit teaching in the operating room: Adding the why to the what. Med Educ 2022; 56:202-210. [PMID: 34612530 PMCID: PMC9297931 DOI: 10.1111/medu.14675] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 09/14/2021] [Accepted: 09/29/2021] [Indexed: 06/13/2023]
Abstract
CONTEXT Residents need their supervisors in the operating room to inform them on how to use expertise in present and future occasions. A few studies hint at such explicit teaching behaviour, however without explaining its underlying mechanisms. Understanding and improving explicit teaching becomes more salient nowadays, as access of residents to relevant procedures is decreasing, while end-terms of training programs remain unchanged: high quality patient care. OBJECTIVES A structured analysis of (1) the practices supervisors use for explicit teaching and (2) how supervisors introduce explicit teaching in real time during surgical procedures. METHODS An observational qualitative collection study in which all actions of nine supervisor-resident dyads during a total hip replacement procedure were videotaped. Interactions in which supervisors explicitly or implicitly inform residents how to use their expertise now and in future occasions were included for further analysis, using the iterative inductive process of conversation analysis. RESULTS 1. Supervisors used a basic template of if/then rules for explicit teaching, which they regularly customised by adding metaphors, motivations, and information about preference, prevalence and consequence. 2. If/then rules are introduced by supervisors to solve a (potential) problem in outcome for the present patient in reaction to local circumstances, for example, what residents said, did or were about to do. CONCLUSIONS If/then rules add the why to the what. Supervisors upgrade residents' insights in surgical procedures (professional vision) and teach the degree of individual freedom and variation of their expert standards for future occasions. These insights can be beneficial in improving supervisors' teaching skills.
Collapse
Affiliation(s)
- Patrick Nieboer
- Department of Orthopedic SurgeryUniversity Medical Center GroningenGroningenThe Netherlands
| | - Mike Huiskes
- Center for Language and CognitionUniversity of GroningenGroningenThe Netherlands
| | - Fokie Cnossen
- Department of Artificial Intelligence, Bernouilli Institute of Mathematics, Computer Science and Artificial IntelligenceUniversity of GroningenGroningenThe Netherlands
| | - Martin Stevens
- Department of Orthopedic SurgeryUniversity Medical Center GroningenGroningenThe Netherlands
| | - Sjoerd K. Bulstra
- Department of Orthopedic SurgeryUniversity Medical Center GroningenGroningenThe Netherlands
| | - Debbie A. D. C. Jaarsma
- Center for Research and Innovation in Medical EducationUniversity Medical Center GroningenGroningenThe Netherlands
| |
Collapse
|
6
|
Nieboer P, Huiskes M, Cnossen F, Stevens M, Bulstra SK, Jaarsma DADC. The Supervisor's Toolkit: Strategies of Supervisors to Entrust and Regulate Autonomy of Residents in the Operating Room. Ann Surg 2022; 275:e264-e270. [PMID: 32224741 DOI: 10.1097/sla.0000000000003887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify what strategies supervisors use to entrust autonomy during surgical procedures and to clarify the consequences of each strategy for a resident's level of autonomy. BACKGROUND Entrusting autonomy is at the core of teaching and learning surgical procedures. The better the level of autonomy matches the learning needs of residents, the steeper their learning curves. However, entrusting too much autonomy endangers patient outcome, while entrusting too little autonomy results in expertise gaps at the end of training. Understanding how supervisors regulate autonomy during surgical procedures is essential to improve intraoperative learning without compromising patient outcome. METHODS In an observational study, all the verbal and nonverbal interactions of 6 different supervisors and residents were captured by cameras. Using the iterative inductive process of conversational analysis, each supervisor initiative to guide the resident was identified, categorized, and analyzed to determine how supervisors affect autonomy of residents. RESULTS In the end, all the 475 behaviors of supervisors to regulate autonomy in this study could be classified into 4 categories and nine strategies: I) Evaluate the progress of the procedure: inspection (1), request for information (2), and expressing their expert opinion (3); II) Influence decision-making: explore (4), suggest (5), or declare the next decision (6); III) Influence the manual ongoing action: adjust (7), or stop the resident's manual activity (8); IV) take over (9). CONCLUSIONS This study provides new insights into how supervisors regulate autonomy in the operating room. This insight is useful toward analyzing whether supervisors meet learning needs of residents as effectively as possible.
Collapse
Affiliation(s)
- Patrick Nieboer
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Mike Huiskes
- Center for Language and Cognition, University of Groningen, Groningen, The Netherlands
| | - Fokie Cnossen
- Department of Artificial Intelligence, Bernouilli Institute of Mathematics, Computer Science and Artificial Intelligence, University of Groningen, Groningen, The Netherlands
| | - Martin Stevens
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sjoerd K Bulstra
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Debbie A D C Jaarsma
- Center for Research and Innovation in Medical Education, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
7
|
van Braak M, Giroldi E, Huiskes M, Diemers AD, Veen M, van den Berg P. A participant perspective on collaborative reflection: video-stimulated interviews show what residents value and why. Adv Health Sci Educ Theory Pract 2021; 26:865-879. [PMID: 33590384 PMCID: PMC8338865 DOI: 10.1007/s10459-020-10026-7] [Citation(s) in RCA: 3] [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] [Received: 09/03/2019] [Accepted: 12/23/2020] [Indexed: 05/28/2023]
Abstract
The potential of reflection for learning and development is broadly accepted across the medical curriculum. Our understanding of how exactly reflection yields its educational promise, however, is limited to broad hints at the relation between reflection and learning. Yet, such understanding is essential to the (re)design of reflection education for learning and development. In this qualitative study, we used participants' video-stimulated comments on actual practice to identify features that do or do not make collaborative reflection valuable to participants. In doing so, we focus on aspects of the interactional process that constitute the educational activity of reflection. To identify valuable and less valuable features of collaborative reflection, we conducted one-on-one video-stimulated interviews with Dutch general practice residents about collaborative reflection sessions in their training program. Residents were invited to comment on any aspect of the session that they did or did not value. We synthesized all positively and negatively valued features and associated explanations put forward in residents' narratives into shared normative orientations about collaborative reflection: what are the shared norms that residents display in telling about positive and negative experiences with collaborative reflection? These normative orientations display residents' views on the aim of collaborative reflection (educational value for all) and the norms that allegedly contribute to realizing this aim (inclusivity and diversity, safety, and efficiency). These norms are also reflected in specific educational activities that ostensibly contribute to educational value. As such, the current synthesis of normative orientations displayed in residents' narratives about valuable and less valuable elements of collaborative reflection deepen our understanding of reflection and its supposed connection with educational outcomes. Moreover, the current empirical endeavor illustrates the value of video-stimulated interviews as a tool to value features of educational processes for future educational enhancements.
Collapse
Affiliation(s)
- Marije van Braak
- Erasmus Medical Center, Dr. Molewaterplein 40, P.O. Box 2040, 3015 GD, Rotterdam, The Netherlands.
| | | | - Mike Huiskes
- Rijksuniversiteit Groningen, Groningen, The Netherlands
| | - Agnes D Diemers
- University Medical Center Groningen, Groningen, The Netherlands
| | - Mario Veen
- Erasmus Medical Center, Dr. Molewaterplein 40, P.O. Box 2040, 3015 GD, Rotterdam, The Netherlands
| | - Pieter van den Berg
- Erasmus Medical Center, Dr. Molewaterplein 40, P.O. Box 2040, 3015 GD, Rotterdam, The Netherlands
| |
Collapse
|
8
|
Nieboer P, Huiskes M, Cnossen F, Stevens M, Bulstra SK, Jaarsma DADC. Fingerprints of Teaching Interactions: Capturing and Quantifying How Supervisor Regulate Autonomy of Residents in the Operating Room. J Surg Educ 2021; 78:1197-1208. [PMID: 33358759 DOI: 10.1016/j.jsurg.2020.12.010] [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: 11/10/2020] [Accepted: 12/13/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Supervisors and residents agree that entrusted autonomy is central to learning in the Operating Room (OR), but supervisors and residents hold different opinions about entrustment: residents regularly experience that they receive insufficient autonomy while supervisors feel their guiding is not appreciated as teaching. These opinions are commonly grounded on general experiences and perceptions, instead of real-time supervisors' regulatory behaviors as procedures unfold. To close that gap, we captured and analyzed when and to what level supervisors award or restrain autonomy during procedures. Furthermore, we constructed fingerprints, an instrument to visualize entrustment of autonomy by supervisors in the OR that allows us to reflect on regulation of autonomy and discuss teaching interactions. DESIGN All interactions between supervisors and residents were captured by video and transcribed. Subsequently a multistage analysis was performed: (1) the procedure was broken down into 10 steps, (2) for each step, type and frequency of strategies by supervisors to regulate autonomy were scored, (3) the scores for each step were plotted into fingerprints, and (4) fingerprints were analyzed and compared. SETTING University Medical Centre Groningen (the Netherlands). PARTICIPANTS Six different supervisor-resident dyads. RESULTS No fingerprint was alike: timing, frequency, and type of strategy that supervisors used to regulate autonomy varied within and between procedures. Comparing fingerprints revealed that supervisors B and D displayed more overall control over their program-year 5 residents than supervisors C and E over their program-year 4 residents. Furthermore, each supervisor restrained autonomy during steps 4 to 6 but with different intensities. CONCLUSIONS Fingerprints show a high definition view on the unique dynamics of real-time autonomy regulation in the OR. One fingerprint functions as a snapshot and serves a purpose in one-off teaching and learning. Multiple snapshots of one resident quantify autonomy development over time, while multiple snapshots of supervisors may capture best teaching practices to feed train-the-trainer programs.
Collapse
Affiliation(s)
- Patrick Nieboer
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, the Netherlands.
| | - Mike Huiskes
- Center for Language and Cognition, University of Groningen, Groningen, the Netherlands
| | - Fokie Cnossen
- Department of Artificial Intelligence, Bernouilli Institute of Mathematics, Computer Science and Artificial Intelligence, University of Groningen, Groningen, the Netherlands
| | - Martin Stevens
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Sjoerd K Bulstra
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Debbie A D C Jaarsma
- Center for Research & Innovation in Medical Education, University Medical Center Groningen, Groningen, the Netherlands
| |
Collapse
|
9
|
Nieboer P, Huiskes M. [New perspectives on apprenticeship learning]. Ned Tijdschr Geneeskd 2021; 164:D5283. [PMID: 33914424] [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: 06/12/2023]
Abstract
Apprenticeships models are the cornerstone of learning in the medical profession for centuries now. Although we know that apprenticeships are effective in medical workplaces, its precise mechanisms remain tacit and implicit. However, decreasing exposure to relevant learning experiences forces us to develop an understanding of teaching and learning in apprenticeships. Central to the learning in apprenticeships are entrustment of autonomy and supply of expertise by the supervisors. Supervisors perform risk-assessments to estimate how much autonomy can be entrusted to their residents continuously. Such assessments are particular challenging to supervisors when the margins for error are narrow, for instance during complex tasks of surgical procedures. In this perspective we present our insights regarding the teaching and learning during surgical procedures. We demonstrate how supervisors and residents can apply insights in teaching and learning to optimize the learning process during complex tasks.
Collapse
Affiliation(s)
- Patrick Nieboer
- Universitair Medisch Centrum Groningen, afd. orthopedie, Groningen
- Contact: Patrick Nieboer
| | - Mike Huiskes
- Rijksuniversiteit Groningen, Centrum voor taal en cognitie, Groningen
| |
Collapse
|
10
|
Nieboer P, Cnossen F, Stevens M, Huiskes M, Bulstra SK, Jaarsma DA. Residents Think in the "Now" and Supervisors Think Ahead in the Operating Room. A Survey Study About Task Perception of Residents and Supervising Surgeons. J Surg Educ 2021; 78:104-112. [PMID: 32624449 DOI: 10.1016/j.jsurg.2020.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/09/2020] [Accepted: 06/14/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Progressive autonomous task performance is the cornerstone of teaching residents in the operating room, where they are entrusted with autonomy when they meet their supervisors' preferences. To optimize the teaching, supervisors need to be aware of how residents experience parts of the procedure. This study provides insight into how supervisors and residents perceive different tasks of a single surgical procedure. DESIGN In this qualitative survey study a cognitive task analysis (CTA) of supervisors and residents for the 47 tasks of an uncemented total hip arthroplasty was executed. Both groups rated the level of attention they would assign to each task and were asked to explain attention scores of 4 or 5. SETTING University Medical Centre Groningen (the Netherlands) and its 5 affiliated teaching hospitals. PARTICIPANTS Seventeen supervising surgeons and 21 residents. RESULTS Normal attention (median attention score 3) was assigned by supervisors to 34 tasks (72.3%) and by residents to 35 tasks (74.5 %). Supervisors rated 12 tasks (25.6%) and residents 9 tasks (19.1%) with a median attention score of 4. In general, supervisors associated high attention with patient outcome and prevention of complications, while residents associated high attention with "effort." CONCLUSIONS Supervisors and residents assigned attention to tasks for different reasons. Supervisors think ahead and emphasize patient outcome and prevention of complications when they indicate high attention, while residents think in the "now" and raise attention to execute the tasks themselves. The results of this study allow residents and supervisors to anticipate preferences: residents are able to appreciate why supervisors increase attention to specific tasks, and supervisors obtain information on which tasks require individual guidance of residents. This information can contribute to improve the learning climate in the operating room and task-specific procedural training.
Collapse
Affiliation(s)
- Patrick Nieboer
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, the Netherlands.
| | - Fokie Cnossen
- Department of Artificial Intelligence, Bernouilli Institute of Mathematics, Computer Science and Artificial Intelligence, University of Groningen, Groningen, the Netherlands
| | - Martin Stevens
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Mike Huiskes
- Center for Language and Cognition, University of Groningen, Groningen, the Netherlands
| | - Sjoerd K Bulstra
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Debbie Adc Jaarsma
- Center for Research and Innovation in Medical Education, University Medical Center Groningen, Groningen, the Netherlands
| |
Collapse
|
11
|
Knol ASL, Koole T, Desmet M, Vanheule S, Huiskes M. How Speakers Orient to the Notable Absence of Talk: A Conversation Analytic Perspective on Silence in Psychodynamic Therapy. Front Psychol 2020; 11:584927. [PMID: 33364999 PMCID: PMC7750524 DOI: 10.3389/fpsyg.2020.584927] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022] Open
Abstract
Silence has gained a prominent role in the field of psychotherapy because of its potential to facilitate a plethora of therapeutically beneficial processes within patients’ inner dynamics. This study examined the phenomenon from a conversation analytical perspective in order to investigate how silence emerges as an interactional accomplishment and how it attains interactional meaning by the speakers’ adjacent turns. We restricted our attention to one particular sequential context in which a patient’s turn comes to a point of possible completion and receives a continuer by the therapist upon which a substantial silence follows. The data collection consisted of 74 instances of such post-continuer silences. The analysis revealed that silence (1) can retroactively become part of a topic closure sequence, (2) can become shaped as an intra-topic silence, and (3) can be explicitly characterized as an activity in itself that is relevant for the therapy in process. Only in this last case, the absence of talk is actually treated as disruptive to the ongoing talk. Although silence is often seen as a therapeutic instrument that can be implemented intentionally and purposefully, our analysis demonstrated how it is co-constructed by speakers and indexically obtains meaning by adjacent turns of talk. In the ensuing turns, silence indeed shows to facilitate access to the patient’s subjective experience at unconscious levels.
Collapse
Affiliation(s)
- A S L Knol
- Center for Language and Cognition Groningen, University of Groningen, Groningen, Netherlands.,Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Tom Koole
- Center for Language and Cognition Groningen, University of Groningen, Groningen, Netherlands.,Health Communication Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Mattias Desmet
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Stijn Vanheule
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Mike Huiskes
- Center for Language and Cognition Groningen, University of Groningen, Groningen, Netherlands
| |
Collapse
|
12
|
Huiskes M, Kierkels R, Van Bruggen I, Holmström M, Gruselius H, Fredriksson A, Berggren K, Both S, Langendijk J, Löfman F, Korevaar E. PO-1462: Automated robust planning for IMPT in oropharyngeal cancer patients using machine learning. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01480-8] [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: 11/16/2022]
|
13
|
Knol ASL, Huiskes M, Koole T, Meganck R, Loeys T, Desmet M. Reformulating and Mirroring in Psychotherapy: A Conversation Analytic Perspective. Front Psychol 2020; 11:318. [PMID: 32194480 PMCID: PMC7066200 DOI: 10.3389/fpsyg.2020.00318] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/10/2020] [Indexed: 11/13/2022] Open
Abstract
The conversational actions of reformulating and mirroring constitute some of the core intervention techniques of psychotherapy. The purpose of the present study was to investigate the way in which therapists in cognitive-behavioral (CBT) and psychodynamic therapy (PDT) use reformulating and mirroring strategies to return patients’ prior talk and how their differential usage can be viewed in light of the respective manualized recommendations. A mixed methods approach was applied using qualitative data that derived from a RCT. The data collection consisted of 200 excerpts assembled from both treatment conditions. The method of Conversation Analysis was used to determine the practices that accomplished instances of reformulating and mirroring, and to examine their distinct implications for subsequent talk. The quantitative analysis revealed that cognitive-behavioral therapists are significantly more likely to use reformulations, which is in harmony with what is suggested in CBT’s treatment manuals. Psychodynamic therapists’ frequent use of transformative formulations is, by contrast, unexpected in regard to the suggestions of the treatment protocol, as these interventions steer toward topical closure. Compared to the CBT condition, psychodynamic therapists were still significantly more likely to rely on mirroring strategies, which are in line with PDT’s theoretical preference. Our findings raise the question whether alleged differences in treatment styles, as they are imposed by RCT methodology, are actually tangible in manual-guided clinical practice.
Collapse
Affiliation(s)
- A S L Knol
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium.,Center for Language and Cognition Groningen, University of Groningen, Groningen, Netherlands
| | - Mike Huiskes
- Center for Language and Cognition Groningen, University of Groningen, Groningen, Netherlands
| | - Tom Koole
- Center for Language and Cognition Groningen, University of Groningen, Groningen, Netherlands.,Health Communication Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Reitske Meganck
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Tom Loeys
- Department of Data-analysis, Ghent University, Ghent, Belgium
| | - Mattias Desmet
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| |
Collapse
|
14
|
Nieboer P, Huiskes M. The regulation of learning in clinical environments: A comment on 'Beyond the self'. Med Educ 2020; 54:179-181. [PMID: 31912557 PMCID: PMC7065238 DOI: 10.1111/medu.14055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 12/23/2019] [Accepted: 01/02/2020] [Indexed: 06/02/2023]
Abstract
In this commentary, the authors highlight the importance of analyzing real time social interactions to discover strategies clinical students and residents use to self‐ and co‐regulate their learning.
Collapse
Affiliation(s)
- Patrick Nieboer
- Department of Orthopaedic SurgeryUniversity Medical Centre GroningenGroningenthe Netherlands
| | - Mike Huiskes
- Centre for Language and CognitionUniversity of GroningenGroningenthe Netherlands
| |
Collapse
|
15
|
Nieboer P, Huiskes M, Cnossen F, Stevens M, Bulstra SK, Jaarsma DADC. Recruiting expertise: how surgical trainees engage supervisors for learning in the operating room. Med Educ 2019; 53:616-627. [PMID: 30900304 DOI: 10.1111/medu.13822] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/10/2018] [Accepted: 01/10/2019] [Indexed: 06/09/2023]
Abstract
CONTEXT For centuries now, the operating room (OR) has been the environment in which surgical trainees come to master procedures. Restricted working hours and insufficient levels of autonomy at the end of their training necessitate a shift towards alternative effective learning strategies. Self-regulated learning is a promising strategy by which surgical trainees can learn more with fewer exposures. However, the challenge is to understand how surgical trainees regulate their learning in the clinical context of the OR. OBJECTIVES The purpose of this study is to identify and understand the strategies of surgical trainees in engaging their supervisors for learning purposes and how these strategies contribute to effective learning. METHODS Total hip replacement procedures performed by four surgical trainees and their supervisors were videotaped. Using the iterative inductive process of conversation analysis, each verbal initiative to engage the supervisor was identified, analysed ('why that now') and categorised. RESULTS Surgical trainees used a range of practices to engage supervisors and recruit expertise, ranging from explicit recruitment to implicit hints. We identified four major categories. Surgical trainees: (i) invite the supervisor to provide an evaluation of the ongoing task; (ii) express an evaluation of the ongoing task and then explicitly invite the supervisor to provide an evaluation; (iii) express an evaluation of the ongoing task and then invite the supervisor to provide confirmation, and (iv) express an evaluation of the ongoing task without engaging the supervisor. CONCLUSIONS Surgical trainees recruit expertise from supervisors using practices of four different categories. Trainees' actions are provoked by the moment at which they experience insufficient expertise and are focused on the task at hand in the immediate present. Supervisors can and do elaborate on these requests to provide explicit teaching. Insight into these practices provides tools for reflection on OR learning, proficiency assessment and deliberation to adapt guidance in the real time of the procedure.
Collapse
Affiliation(s)
- Patrick Nieboer
- Department of Orthopaedic Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - Mike Huiskes
- Centre for Language and Cognition, University of Groningen, Groningen, the Netherlands
| | - Fokie Cnossen
- Department of Artificial Intelligence, Bernouilli Institute of Mathematics, Computer Science and Artificial Intelligence, University of Groningen, Groningen, the Netherlands
| | - Martin Stevens
- Department of Orthopaedic Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - Sjoerd K Bulstra
- Department of Orthopaedic Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - Debbie A D C Jaarsma
- Centre for Research and Innovation in Medical Education, University Medical Centre Groningen, Groningen, the Netherlands
| |
Collapse
|
16
|
Jager M, Huiskes M, Metselaar J, Knorth EJ, De Winter AF, Reijneveld SA. Therapists' continuations following I don't know-responses of adolescents in psychotherapy. Patient Educ Couns 2016; 99:1778-1784. [PMID: 27247134 DOI: 10.1016/j.pec.2016.05.016] [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] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 04/12/2016] [Accepted: 05/16/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE In psychotherapy clients' I don't know-responses (IDK-responses) to therapists' questions are typically considered to be non-cooperating behaviors. How therapists actually handle these behaviors remains unclear. This study therefore aims to assess client-therapist interactions following IDK-responses. METHODS Data were collected in a Dutch child and adolescent mental healthcare service by observing Dialectical Behavior Therapy aimed at adolescents with severe emotional distress. Eighteen individual psychotherapy sessions involving two therapists with six clients were video-recorded and transcribed. Stand-alone IDK-responses were selected (n=77) and analyzed using conversation analysis. RESULTS Adolescents' IDK-responses led to varying actions of therapists. We identified five categories of continuations after IDK-responses: no IDK-related continuation; redoing of the question; proposing a candidate answer; employing therapy-specific techniques; and meta-talk on the problematic nature of the IDK-response. CONCLUSIONS Therapists treat IDK-responses not just as non-cooperative behavior on the part of the client; IDK-responses are also used as a starting point to collaboratively enhance clients' insights in their own thoughts, emotions, and behaviors. PRACTICE IMPLICATIONS After IDK-responses therapists can use a variety of continuation strategies with varying therapeutic functions. These strategies can be embedded in training of therapists to deal with potentially non-cooperative behavior.
Collapse
Affiliation(s)
- Margot Jager
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, The Netherlands.
| | - Mike Huiskes
- Center for Language and Cognition Groningen (CLCG), University of Groningen, The Netherlands
| | - Janneke Metselaar
- Department of Special Needs Education and Youth Care, University of Groningen,The Netherlands
| | - Erik J Knorth
- Department of Special Needs Education and Youth Care, University of Groningen,The Netherlands
| | - Andrea F De Winter
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Sijmen A Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, The Netherlands
| |
Collapse
|
17
|
Groenewold R, Bastiaanse R, Nickels L, Huiskes M. Perceived liveliness and speech comprehensibility in aphasia: the effects of direct speech in auditory narratives. Int J Lang Commun Disord 2014; 49:486-497. [PMID: 24655365 DOI: 10.1111/1460-6984.12080] [Citation(s) in RCA: 3] [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] [Indexed: 06/03/2023]
Abstract
BACKGROUND Previous studies have shown that in semi-spontaneous speech, individuals with Broca's and anomic aphasia produce relatively many direct speech constructions. It has been claimed that in 'healthy' communication direct speech constructions contribute to the liveliness, and indirectly to the comprehensibility, of speech. AIMS To examine the effects of the occurrence of direct speech constructions on the perceived liveliness and speech comprehensibility of narratives produced by individuals with and without aphasia. METHODS & PROCEDURES Thirty-seven naive listeners rated 30 speech fragments with and without direct speech from ten speakers with and ten speakers without aphasia. The fragments originated from semi-structured interviews. The raters scored the perceived liveliness and the perceived comprehensibility of these fragments. OUTCOMES & RESULTS For both groups of speakers, fragments containing direct speech constructions received higher scores for liveliness than fragments without direct speech constructions. However, no effect of direct speech was found on perceived comprehensibility. CONCLUSIONS & IMPLICATIONS This is the first research to demonstrate that communication is perceived as more lively when it contains direct speech than when it does not, but yet is not more comprehensible. Individuals with Broca's and anomic aphasia are known to produce regularly direct speech constructions in elicited narratives. Given that liveliness is known to increase listeners' involvement and to help listeners stay focused, we suggest that this relative increase in direct speech by aphasic speakers may reflect a strategy to increase not only the liveliness of their discourse, but also listener focus and involvement.
Collapse
Affiliation(s)
- Rimke Groenewold
- Center for Language and Cognition Groningen, University of Groningen, Groningen, the Netherlands; ARC Centre of Excellence in Cognition and its Disorders (CCD) and Department of Cognitive Science, Macquarie University, Sydney, NSW, Australia
| | | | | | | |
Collapse
|
18
|
Borgsteede S, Bruggeman R, Hoefnagel R, Huiskes M, van Puijenbroek E. Tamsulosin and hyperglycaemia in patients with diabetes. Neth J Med 2010; 68:141-143. [PMID: 20308713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
|
19
|
|