Validating a theory of planned behavior questionnaire for assessing changes in professional behaviors of medical students.

Introduction: Teaching professionalism is a fundamental aspect of medical undergraduate education, delivering important domains of professional attitudes, ethics, and behaviors. The effects of educational interventions can be assessed by measuring the change in such domains, but validated assessment tools for these professionalism domains are lacking. In this study, we constructed and conducted expert validation of a modified theory of planned behavior (TPB) questionnaire to assess changes in professional behaviors (PBs) in medical students. Methods: To validate that, we modified an existing TPB questionnaire, and an 18-item questionnaire was subjected to expert panel evaluation using the content validation method. The clarity and relevance of items were assessed using a four-point rating scale (i.e., 1 = not relevant to 4 = highly relevant). Ratings of experts and free-text comments were analyzed. Quantitative evaluation of relevance and clarity was undertaken through analyses of the Item-level Content Validity Index (I-CVI) and Scale-level Content Validity Index (S-CVI). A qualitative assessment of the comments of experts was conducted to refine items, any disagreements were discussed, and a consensus decision was developed among authors for item changes. Results: Quantitative evaluation of the Item-level Content Validity Index (I-CVI) scored 0.9-1 for relevance and 0.7-1 for clarity. Qualitative evaluation resulted in (i) changes to the wording of items (e.g., choices such as "worthless/worthwhile" were replaced with "not important/important"); and (ii) suggestion of the addition of social media in the construct of subjective norms. Discussion: The proposed tool exhibits content validity and can assess TPB constructs in professionalism education. This study of content validity may help to ensure the modified TPB questionnaire accurately measures the TPB constructs, ensuring its effectiveness in accurately measuring the TPB constructs for PB in diversified educational medical institutions.

Understanding medical professionalism using express team-based learning; a qualitative case-based study.

Medical Professionalism (MP) defined as values, behaviours and attitudes that promote professional relationships, public trust and patient safety is a vital competency in health profession education. MP has a distinctive uniqueness due to cultural, contextual, conceptual, and generational variations. There is no standard instructional strategy to probe the understanding of MP in a cohesive, structured, interactive manner. This study aimed to investigate undergraduate medical students' understanding of MP using express team-based learning (e-TBL) at both campuses of Royal College of Surgeons Ireland (RCSI). Using the key principles of a sociocultural theoretical lens in adult learning theory, we designed e-TBL as a context-learning-based educational strategy. We conducted three e-TBL sessions on cross-cultural communication and health disparities, a reflective report on clinical encounters, and professionalism in practice. We collected, collated, and analyzed the student experiences qualitatively using data gathered from team-based case discussions during e-TBL sessions. A dedicated working group developed very short-answer questions for the individual readiness assurance test (IRAT) and MP-based case scenarios for team discussions. In this adapted 4-step e-TBL session, pre-class material was administered, IRAT was undertaken, and team-based discussions were facilitated, followed by facilitator feedback. A qualitative inductive thematic analysis was performed, which generated subthemes and themes illustrated in excerpts. Our thematic analysis of data from 172 students (101 from Bahrain and 71 from Dublin) yielded four unique themes: incoming professional attitudes, transformative experiences, sociological understanding of professionalism, and new professional identity formation. This qualitative study provides a deeper understanding of medical students' perceptions of medical professionalism. The generated themes resonated with divergent and evolving elements of MP in an era of socioeconomic and cultural diversity, transformative experiences, and professional identity formation. The core elements of these themes can be integrated into the teaching of MP to prepare fit-to-practice future doctors.

Influence of the Multi-Mission Radioisotope Thermoelectric Generator (MMRTG) on the local atmospheric environment.

A survey around a recently-fueled MMRTG in the terrestrial atmosphere finds a warm air plume with a characteristic updraft velocity of ~1 m/s and a temperature rise of ~4 â€‹K. Additionally, a roughly hundredfold enhancement in ion density to ~70,000/cm3 in the vicinity (<~1 â€‹m) of the generator was observed: air electrical conductivity was measured to be ~10-13 â€‹S/m. No evidence of ozone production was detected. These observations inform the electrical charging environment and possible local perturbation to meteorological measurements on Mars or Titan on MMRTG-powered landers or rovers. On Mars, the effects of any electrical conductivity enhancement are likely small, but on Titan they may be significant.

The 'connectaholic' behind the curtain: medical student use of computer devices in the clinical setting and the influence of patients.

BACKGROUND: The use of mobile devices such as tablets and laptops by students to support their learning is now ubiquitous. The clinical setting is an environment, which lends itself to the use of mobile devices as students are exposed to novel clinical scenarios that may require rapid location of information to address knowledge gaps. It is unknown what preferences students have for these devices and how they are used in the clinical environment. METHODS: In this study we explored medical students' choices and their use of different devices in their first year of clinical attachments. We sought to evaluate learners' experiences with these devices using a mixed methods approach. All students newly entered into the clinical years were given the option of a MacBook Air or iPad. We surveyed these students using an online survey tool followed by individual semi-structured interviews to explore survey findings in more depth. RESULTS: Students owned a multitude of devices however their preferences were for the 11 in. MacBook Air Laptop over the iPad mini. Students made constant use of online information to support their clinical learning, however three major themes emerged from the interview data: connection and devices (diverse personal ownership of technology by students and how this is applied to source educational materials), influence and interaction with patients (use of any device in a clinical setting) and influence and interaction with staff. In general students preferred to use their device in the absence of patients however context had a significant influence. CONCLUSIONS: These mobile devices were useful in the clinical setting by allowing access to online educational material. However, the presence of patients, and the behaviour of senior teaching staff significantly influenced their utilisation by students. Understanding the preferences of students for devices and how they use their preferred devices can help inform educational policy and maximise the learning from online educational content.

Design and Evaluation of a New National Pharmacy Internship Program in Ireland.

Objective. To design, deliver, and evaluate a National Pharmacy Internship Program that met the educational requirements of pharmacy graduates to register as competent pharmacists and earned graduates a master's level degree. Methods. The National Pharmacy Internship Program was designed as a 12-month, full-time, blended-learning, competency-based program leading to a master's degree. Intern performance was assessed academically and by pharmacy preceptor (tutor) appraisals. Interns who demonstrated competency were invited to sit for the Professional Registration Examination (PRE). Feasibility and performance were evaluated and a longitudinal approach allowed intern and preceptor views to be compared to the former preregistration year. Results. Overall performance in the PRE was good and relatively consistent with almost all interns proceeding to register as pharmacists. Interns believed that the program had enabled them to develop the knowledge, skills, and overall competencies required for future independent practice as a pharmacist. Preceptors considered the program to have built on prior learning and provided a sufficiently rounded experience for professional practice. Preceptors also stated that the program was an improved educational experience over the former, less structured, preregistration training. Conclusion. The National Pharmacy Internship Program was perceived to be an improvement on the previous preregistration year. The program quality assured pharmacy education outcomes at the entry-to-practice level on a national basis, and uniquely recognized the students' accomplishment by awarding them a master's degree.

Preparedness of newly qualified doctors in Ireland for prescribing in clinical practice.

AIM: The aim of the study was to investigate the level of preparedness of newly qualified Irish-trained doctors for prescribing, and to investigate their attitudes towards prescribing and prescribing education, through a national survey. METHODS: A 29-item online survey was distributed to 686 newly qualified doctors 1 month prior to the completion of their first year of clinical practice (internship). Only graduates from Irish medical schools were included. RESULTS: The response rate was 20.4% (n = 140; female : male 56%:44%). The majority of respondents felt confident in prescription writing (89%), medication history taking (81%) and accessing drug information in the hospital setting (80%). Only 58% of respondents felt confident in drug dose calculation, and 35% felt confident in preparing and administering drugs. When asked if their undergraduate medical education had prepared them for prescribing in clinical practice, 28% of respondents agreed. Confidence that their undergraduate education had prepared them was associated with receiving formal training in prescribing skills (P = 0.0045; 27% vs. 0%). Thirty-seven per cent of respondents agreed that they felt stressed about prescribing medications. CONCLUSION: This survey of newly qualified doctors in Ireland found that only 28% of respondents agreed that their undergraduate medical education had prepared them for prescribing, which was comparable to a previous survey of UK medical students and graduates. Investigating confidence and preparedness for prescribing provides important insights for educators. Dedicated teaching of prescribing, with an emphasis on practical training and assessment, may help graduates to feel more prepared for the challenges of prescribing in the clinical setting.

A descriptive survey study of violence management and priorities among psychiatric staff in mental health services, across seventeen european countries.

BACKGROUND: In mental health services what is commonplace across international frontiers is that to prevent aggressive patients from harming themselves, other patients or staff, coercive measures and foremost, violence management strategies are required. There is no agreement, recommendations or direction from the EU on which measures of coercion should be practiced across EU countries, and there is no overall one best practice approach. METHODS: The project was conceived through an expert group, the European Violence in Psychiatry Research Group (EViPRG). The study aimed to incorporate an EU and multidisciplinary response in the determination of violence management practices and related research and education priorities across 17 European countries. From the EVIPRG members, one member from each country agreed to act as the national project coordinator for their country. Given the international spread of respondents, an eDelphi survey approach was selected for the study design and data collection. A survey instrument was developed, agreed and validated through members of EVIPRG. RESULTS: The results included a total of 2809 respondents from 17 countries with 999 respondents who self-selected for round 2 eDelphi. The majority of respondents worked in acute psychiatry, 54% (n = 1511); outpatient departments, 10.5% (n = 295); and Forensic, 9.3% (n = 262). Other work areas of respondents include Rehabilitation, Primary Care and Emergency. It is of concern that 19.5% of respondents had not received training on violence management. The most commonly used interventions in the management of violent patients were physical restraint, seclusion and medications. The top priorities for education and research included: preventing violence; the influence of environment and staff on levels of violence; best practice in managing violence; risk assessment and the aetiology and triggers for violence and aggression. CONCLUSION: In many European countries there is an alarming lack of clarity on matters of procedure and policy pertaining to violence management in mental health services. Violence management practices in Europe appear to be fragmented with no identified ideological position or collaborative education and research. In Europe, language differences are a reality and may have contributed to insular thinking, however, it must not be seen as a barrier to sharing best practice.

Syncopation affects free body-movement in musical groove.

One of the most immediate and overt ways in which people respond to music is by moving their bodies to the beat. However, the extent to which the rhythmic complexity of groove-specifically its syncopation-contributes to how people spontaneously move to music is largely unexplored. Here, we measured free movements in hand and torso while participants listened to drum-breaks with various degrees of syncopation. We found that drum-breaks with medium degrees of syncopation were associated with the same amount of acceleration and synchronisation as low degrees of syncopation. Participants who enjoyed dancing made more complex movements than those who did not enjoy dancing. While for all participants hand movements accelerated more and were more complex, torso movements were more synchronised to the beat. Overall, movements were mostly synchronised to the main beat and half-beat level, depending on the body-part. We demonstrate that while people do not move or synchronise much to rhythms with high syncopation when dancing spontaneously to music, the relationship between rhythmic complexity and synchronisation is less linear than in simple finger-tapping studies.

Out of sight, out of mind: Do repeating students overlook online course components?

E-Learning is becoming an integral part of undergraduate medicine, with many curricula incorporating a number of online activities and resources, in addition to more traditional teaching methods. This study examines physical attendance, online activity, and examination outcomes in a first-year undergraduate medical program. All 358 students who completed the Alimentary System module within the first semester of the program were included, 30 of whom were repeating the year, and thus the module. This systems-based, multidisciplinary module incorporated didactic lectures, cadaveric small group tutorials and additional e-Learning resources such as online histology tutorials. Significant differences were demonstrated in physical attendance and utilization of online resources between repeating students and those participating in the module for the first time. Subsequent analyses confirmed that physical attendance, access of online lecture resources, and utilization of online histology tutorials were all significantly correlated. In addition, both physical attendance and utilization of online resources significantly correlated with summative examination performance. While nonattendance may be due to a variety of factors, our data confirm that significant differences exist in both physical attendance and online activity between new entrants and repeating students, such that all students repeating a module or academic year should be routinely interviewed and offered appropriate supports to ensure that they continue to engage with the program. While the development of complex algorithmic models may be resource intensive, using readily available indices from virtual learning environments is a straightforward, albeit less powerful, means to identify struggling students prior to summative examinations. Anat Sci Educ 9: 555-564. © 2016 American Association of Anatomists.

Music, empathy and cultural understanding.

In the age of the Internet and with the dramatic proliferation of mobile listening technologies, music has unprecedented global distribution and embeddedness in people's lives. It is a source of intense experiences of both the most intimate and solitary, and public and collective, kinds - from an individual with their smartphone and headphones, to large-scale live events and global simulcasts; and it increasingly brings together a huge range of cultures and histories, through developments in world music, sampling, the re-issue of historical recordings, and the explosion of informal and home music-making that circulates via YouTube. For many people, involvement with music can be among the most powerful and potentially transforming experiences in their lives. At the same time, there has been increasing interest in music's communicative and affective capacities, and its potential to act as an agent of social bonding and affiliation. This review critically discusses a considerable body of research and scholarship, across disciplines ranging from the neuroscience and psychology of music to cultural musicology and the sociology and anthropology of music, that provides evidence for music's capacity to promote empathy and social/cultural understanding through powerful affective, cognitive and social factors; and explores ways in which to connect and make sense of this disparate evidence (and counter-evidence). It reports the outcome of an empirical study that tests one aspect of those claims, demonstrating that 'passive' listening to the music of an unfamiliar culture can significantly change the cultural attitudes of listeners with high dispositional empathy; presents a model that brings together the primary components of the music and empathy research into a single framework; and considers both some of the applications, and some of the shortcomings and problems, of understanding music from the perspective of empathy.

Peer interviewing in medical education research: experiences and perceptions of student interviewers and interviewees.

BACKGROUND: Interviewing is one of the main methods used for data collection in qualitative research. This paper explores the use of semi-structured interviews that were conducted by students with other students in a research study looking at cultural diversity in an international medical school. Specifically this paper documents and gives 'voice' to the opinions and experiences of interviewees and interviewers (the peers and the communities) on the value of peer interviewing in the study and outlines (1) the preparation made to address some of the foreseen challenges, (2) the challenges still faced, and (3) the benefits of using peer interviews with respect to the research study, the individual and the institution. METHODS: Peer interviewing was used as part of a two-year phased-study, 2012-2013, which explored and then measured the impact of cultural diversity on undergraduate students in a medical higher education institution in Ireland. In phase one 16 peer interviewers were recruited to conduct 29 semi-structured interviews with fellow students. In order to evaluate the peer interviewing process two focus group discussions were he ld and an online survey conducted. RESULTS: Key findings were that substantial preparations in relation to training, informed consent processes and addressing positionality are needed if peer-interviewing is to be used. Challenges still faced included were related to power, familiarity, trust and practical problems. However many benefits accrued to the research, the individual interviewer and to the university. CONCLUSIONS: A more nuanced approach to peer interviewing, that recognises commonalities and differences across a range of attributes, is needed. While peer interviewing has many benefits and can help reduce power differentials it does not eliminate all challenges. As part of a larger research project and as a way in which to get 'buy-in' from the student body and improve a collaborative research partnership peer interviewing was extremely useful.

An Improved Process for the Preparation of an α,α-Difluorosulfonylisoxazoline Herbicide.

An efficient synthesis of a difluorosulfone-containing herbicide has been achieved by selective reductive silylation of a symmetrical bis(trifluoromethyl)-1,2,3-triazole. Subsequently, a fluoride-induced reaction led to a difluoromethyl anion equivalent, which was reacted with a sulfur electrophile leading ultimately to the key difluorosulfide moiety.

Determining the role of a national objective assessment of surgical skills in gynecological oncology: an e-Delphi methodology.

OBJECTIVE: The aim of this study is to determine a national consensus on the role of an objective assessment of technical surgical skills in gynecological oncology (GO). METHODS: After approval was obtained from Society of Gynecologic Oncology of Canada, A panel of 20 GO leaders was assembled, representing all GO fellowship programs, and was asked to participate in an anonymous group and respond to an online 49-item questionnaire using a modified Delphi methodology. RESULTS: Ninety-five percent (n = 19) of those invited to participate did so. Seventeen of the panelists (89.5%) believed there was no sufficiently standardized technical skills assessment for GO fellows, whereas 18 responders (95%) believed that fellows should be objectively assessed on more than 1 occasion during their training. Consensus was predefined as Cronbach α greater than 0.8. The panel agreed on what procedures should be objectively assessed with a Cronbach α of 0.967. An overall Cronbach α of 0.993 was achieved after a single Delphi round. CONCLUSIONS: We achieved consensus on the possible components and logistics of a skills assessment process among a group of highly experienced GO trainers in Canada. This study provides the basis for further investigation and debate on the potential value, necessity, and feasibility of an assessment of advanced surgical and nonsurgical skills of GO trainees.

Syncopation, body-movement and pleasure in groove music.

Moving to music is an essential human pleasure particularly related to musical groove. Structurally, music associated with groove is often characterised by rhythmic complexity in the form of syncopation, frequently observed in musical styles such as funk, hip-hop and electronic dance music. Structural complexity has been related to positive affect in music more broadly, but the function of syncopation in eliciting pleasure and body-movement in groove is unknown. Here we report results from a web-based survey which investigated the relationship between syncopation and ratings of wanting to move and experienced pleasure. Participants heard funk drum-breaks with varying degrees of syncopation and audio entropy, and rated the extent to which the drum-breaks made them want to move and how much pleasure they experienced. While entropy was found to be a poor predictor of wanting to move and pleasure, the results showed that medium degrees of syncopation elicited the most desire to move and the most pleasure, particularly for participants who enjoy dancing to music. Hence, there is an inverted U-shaped relationship between syncopation, body-movement and pleasure, and syncopation seems to be an important structural factor in embodied and affective responses to groove.

Crossmodal interactions in the perception of expressivity in musical performance.

In musical performance, bodily gestures play an important role in communicating expressive intentions to audiences. Although previous studies have demonstrated that visual information can have an effect on the perceived expressivity of musical performances, the investigation of audiovisual interactions has been held back by the technical difficulties associated with the generation of controlled, mismatching stimuli.With the present study, we aimed to address this issue by utilizing a novel method in order to generate controlled, balanced stimuli that comprised both matching and mismatching bimodal combinations of different expressive intentions. The aim of Experiment 1 was to investigate the relative contributions of auditory and visual kinematic cues in the perceived expressivity of piano performances, and in Experiment 2 we explored possible crossmodal interactions in the perception of auditory and visual expressivity. The results revealed that although both auditory and visual kinematic cues contribute significantly to the perception of overall expressivity, the effect of visual kinematic cues appears to be somewhat stronger. These results also provide preliminary evidence of crossmodal interactions in the perception of auditory and visual expressivity. In certain performance conditions, visual cues had an effect on the ratings of auditory expressivity, and auditory cues had a small effect on the ratings of visual expressivity.

Current practice in the management of wound odour: an international survey.

AIM: To determine from a multi-disciplinary and international perspective current practice in the management of wound odour. BACKGROUND: Malodour is cited by patients and carers as one of the most distressing and socially isolating aspects of their wounds. The absence of a standardised approach to assessment and management underscores the need to collect baseline data to support guideline development. DESIGN: On-line survey. METHODS: A study specific questionnaire in English, Spanish, Italian and German was emailed to wound care organisations worldwide, palliative and oncology nursing organisations, and known contacts with a special interest in wound management, for distribution to members between December 2011 and February 2012. RESULTS: 1444 people from 36 countries responded. 12% assess odour with descriptive words being the most frequent form of assessment. Charcoal and silver based dressings were the most frequently used odour management agents, yet, only 48.4% and 23% respectively reported these as being very effective. Antimicrobial agents were cited as most effective but were not the most frequently used. 8% use aromatherapy oils direct to the wound, and 74% combine a range of dressings to try and manage odour. Odour, pain and exudate management were the greatest wound management challenges facing patients and clinicians. 46.7% of respondents encounter patients with MFW on a monthly basis and 89% agreed there is a need to develop guidelines in this area. CONCLUSION: A 'trial and error' approach to odour management exists with low overall satisfaction with current practice. There is a need for research and education on means to assess odour and odour management options.

Toward a wiki guide for obstetrics and gynecology trainees in Ireland.

BACKGROUND: The present paper describes the implementation of a novel, web-based, comprehensive national information hub for trainees in obstetrics and gynecology in Ireland. This was a unique development in the context of an entire medical specialty and was aligned with the communication strategy of the governing professional body. To date, trainee doctors working in Ireland undergo an incoherent and inconsistent new-staff induction and handover. In the healthcare setting, staff integration can have a major impact on the quality of patient care. METHODS: A free wiki software platform (PBworks) was used for the website, and freely available software (Google Analytics) was used to determine user interaction and level of engagement. RESULTS: In the first year, 442 user visits were recorded. The average duration of site visits was 4 minutes 39 seconds, which compared favorably with the 4-minute duration for visits to Wikipedia. CONCLUSION: The project was successful as a proof concept and in practice. Other medical faculties have expressed an interest in adopting the concept and developing it for their trainees. The concept is widely applicable to other countries, with the negligible cost relevant to resource-poor areas.

Medical students' knowledge, perceptions, and interest in complementary and alternative medicine.

BACKGROUND: Complementary and alternative medicine (CAM) is a growing industry in the health care system. In Ireland, to date there has not been a study that evaluates the knowledge of, interest in, and attitude of Irish medical students toward CAM. OBJECTIVES: This research can serve as a pilot study to inform Irish medical schools on the need to introduce CAM into the medical curriculum. MATERIALS AND METHODS: The survey instrument was a modified design based on previously published studies carried out in other geographical areas. All medical students within the undergraduate and graduate entry programs (GEP) at the Royal College of Surgeons in Ireland were invited to participate in the study. SPSS software was used to analyze the results of the questionnaires. RESULTS: The survey completion rate was 20.1%. A majority of students (78.4%) thought that CAM knowledge is important for their future career as physicians. Approximately 65% of students reported that they have not acquired sufficient knowledge about CAM from medical school, and 50.2% of students believe CAM should be incorporated into the medical curriculum. Preclinical years (49.4%) were suggested as the most appropriate time to learn about CAM. Knowledge of CAM modalities was generally rated as minimal or none by students. Among the 15 CAM modalities incorporated in the survey, massage, acupuncture, and meditation received the highest interest from students. Students who believe in a religion had a higher interest in CAM (p<0.05). In terms of their personal view, massage, spirituality, and acupuncture received the highest positive responses. Attitudes toward CAM were positive from students. Lower willingness to use CAM was seen in clinical students (p<0.05). CONCLUSIONS: It is important for the faculty of Irish medical schools to consider the possibility of integrating CAM education into the conventional medical curriculum in a systematic manner to better prepare students in their future career.