Education, College of

Validity and Feasibility of the Minicard Workplace Direct Observation Tool in a Single Training Program

Thu, 21 Feb 2013 06:00:00 GMT

Validity and Feasibility of the Minicard Workplace Direct Observation Tool in a Single Training Program Purpose. To collect validity and feasibility evidence for use of the Minicard direct observation tool for assessment of competence of internal medicine residents. Method. Retrospective cohort analysis of validity evidence and feasibility of the Minicard from 2006-2011 in one institution, including content (settings, observation rates, independent raters), response process (scoring distributions), internal structure (factor analysis), relationships (to time in training, OSCE and medical knowledge exams) and consequences (qualitative analysis of action plans), as well as feasibility (time and financial costs). Results. 3715 direct observations were analyzed from 80 faculty observers rating 73 residents. Residents averaged 28 (SD 8.4) observations per year from 9 (SD 4.1) independent observers. Scoring distributions used the entire rating scale. Confirmatory factor analysis identified a three-factor fit representing medical knowledge, communication and professionalism (χ2(51)= 107, p<0.05; TLI = 0.97; CFI = 0.98; RMSEA = 0.025). Individual resident scores increased significantly each month. Minicard communication scores correlated weakly with overall OSCE communication Z-scores (r=.11, p<0.001), and Minicard applied medical knowledge average score correlated weakly with in-training exam Z-score of that year (r=.07, p=.02). Action plan reviews identified action-oriented feedback in 50%, observational feedback in 11%, minimal feedback in 9% and no recorded plan in 30%. Observation times averaged 15.6 (SD: 9.5) minutes. Conclusion. This study demonstrates validity and feasibility evidence for a direct observation system for residents that can produce a broad range of observations, a wide range of scores and substantial formative feedback.

Experiences and Practices of General Education Teachers Supporting Students with Emotional Disturbance

Thu, 21 Feb 2013 06:00:00 GMT

Experiences and Practices of General Education Teachers Supporting Students with Emotional Disturbance This study describes the classroom practices of middle school general education teachers working with students with and without emotional disturbance (ED), including the predictability of those teacher behaviors for both groups of students. The data collected in this study describe the ways in which the beliefs and experiences of this group of teachers aligns with their observed behaviors when working with students with and without ED. Seven seventh and eighth grade literacy, math, and social science general education teachers, and 14 seventh and eighth grade students with and without ED participated in this study. Teachers’ instructional and classroom management interactions with target students was coded across 600 minutes of systematic, direct observation. Descriptive statistics were calculated for each teacher, specific to the target students. Additionally, lag sequential analysis was run to identify conditional probabilities for specific teacher and student behaviors. Teachers also completed a single Likert survey about their beliefs when working with students with ED. Data from surveys and observations describe the ways in which teachers' beliefs and experiences align to their classroom behaviors. The results of this study show similar rates of opportunities to respond and use of instructional groupings, as well as low levels of teacher responses, for students with and without ED. Where teacher behavior are different for both groups of student—including rates of praise, use of corrective actions, and predictability of feedback—the patterns that emerge are mostly consistent with existing research: teachers used low levels of praise, are more likely to have negative interactions with students with ED, and have unpredictable feedback for students (Van Acker, Grant, & Henry, 1996; Wehby, Symons, & Shores, 1995). The data collected and analyzed in this study suggest that, for all students, what has proven successful in general education classrooms is not being effectively implemented. Implications for teacher practices and future research are also explored.

Recognition and Management of Uncertainty in the Transitions of Patient Care

Thu, 21 Feb 2013 06:00:00 GMT

Recognition and Management of Uncertainty in the Transitions of Patient Care Purpose Effective patient-care handovers between interns must be comprehensive enough to allow the receiving intern to construct a complete mental model of the patient’s current status, future care plan, and anticipated clinical events. Recipients of an effective handover should feel that no essential content has been omitted, and there is little uncertainty about that content, to be able to care effectively for their patients during a given shift. The purpose of this study was to determine the degree to which receiving interns, supervisory residents (SR) and nurses perceived missing handover content and intern uncertainty about that content. We also examined consequences of, and intern responses to, missing content and/or uncertainty. Methods Over a 3-month period in 2012, 9 night-shift interns, their 13 supervisory residents (SRs), and the nurses caring for their patients completed anonymous, constructed quantitative, and free-text surveys on 3 patients-cases per night, for 3 nights per week. The responses of these three parties with regard to intern missing patient information (content) and intern uncertainty (lack of understanding, relevance or contextual meaning) were triangulated and analyzed using McNemar’s Test for correlated proportions. Cross-covering SR responses were compared to primary-team SR responses to assess the influence of cross-coverage using Fisher’s exact test. The type of content missing, the perceived implications or consequences of that missing content, the nature of intern uncertainty and the actions taken in response to that uncertainty were reviewed by non-study participant faculty and residents; themes and exemplar responses were independently derived and reported. Results Data for 82 complete survey sets was collected during the study period. Handover content was considered missing by interns and/or their supervisory residents 33% of the time. Supervisory residents and interns agreed on the presence or absence of missing content 74% of the time. When they disagreed, interns were 3.2 times more likely to report missing content than their supervisory residents (McNemar’s Test, p = 0.013). Content was considered missing by interns and/or nurses 30% of the time. Nurses and interns agreed on the presence or absence of missing content 77% of the time. When they disagreed, interns were 5 times more likely to report missing content than nurses (McNemar’s Test p = 0.004). Uncertainty was reported by interns and/or their supervisory residents 39% of the time. Supervisory residents and interns agreed on the presence or absence of uncertainty 73% of the time. When they disagreed, interns were 4.5 times more likely to be uncertain than their supervisory residents reported they were (McNemar Test p = 0.002). There was no difference in the rate of uncertainty-reporting nor in the rate of resource-seeking between primary team and cross-covering supervisory residents (Fisher’s exact test p = 0.56 and p = 0.38 respectively). When interns recognized uncertainty, their recognition was prompted during the handover 48% of the time and during patient-care activities 39% of the time. Supervisory residents noticed intern uncertainty during handovers 40% of the time and during patient-care activities 40% of the time. Conclusion Supervisory residents and nurses were frequently unaware that interns felt they were missing handover content. Intern uncertainty about the nature of handover content also went underappreciated by supervisory residents and nurses, resulting in a suboptimal shared mental model of the team’s patients

A Study of African American Student Trust and Engagement in High School

Thu, 21 Feb 2013 06:00:00 GMT

A Study of African American Student Trust and Engagement in High School This study explored the significance of African American students’ trust of teachers and its impact on student engagement in school. It also focused on the potential impact of teachers’ race on student-teacher trust relationships. Research for this study used a cross-sectional approach. Interviews were conducted with 22 students of various engagement levels in the 9th and 11th grades and with 9 administrators, all from 3 predominately African American high schools. The study also draws on documents on community characteristics, discipline, and student achievement. Students’ reports about trust relationships varied in terms of the quality of the relationships they shared with teachers. Those students with high quality trust relationships spoke of how their trust relationships with their teachers were supportive and important to their life at schools. Some saw a connection between trust and paying attention in class and becoming more involved in sports and activities. Most of these students were high-engaged. Most low-engaged students, on the other hand, did not report high-quality trust relationships with their teachers. Most of these students did not experience trust relationships with their teachers in the same way as their high-engaged counterparts. Teachers’ race was not found to play a significant role in these relationships for either high- or low-engaged African American students.