Targeting the school environment to enable participation: A scoping review.

BACKGROUND: Children with special educational needs experience limited levels of participation at school; their participation is influenced by the physical and social environment. Interventions that have been applied in school environments are described in the literature. AIMS: To illustrate the main features of interventions targeting school environments to support participation of children with special educational needs in mainstream education. MATERIALS AND METHODS: A scoping review using a qualitative, thematic analysis was conducted in May 2021. RESULTS: We included a total of 20 articles. We found that intervention features contributed to children's participation and targeted social and physical school environments. The majority of the intervention features focussed on applying supportive teaching methods to enable individual children's participation. A small number of interventions described a systemic holistic approach that involved changes to the school environment. In these interventions, different professionals such as occupational therapists collaborated with teachers to adapt the school environment. CONCLUSIONS AND SIGNIFICANCE: A shift from individual child-focussed to environment-focussed approaches that target all children's participation could impact classroom setup and teachers' roles. Occupational therapists' expertise in matching school environments and task requirements with individual children's needs could be valuable in their collaboration with schools to support this transition.

Exploring residents' perceptions of PA and NP roles and barriers to collaboration.

OBJECTIVE: Developing competencies for interprofessional collaboration, including understanding other professionals' roles on interprofessional teams, is an essential component of medical education. This study explored resident physicians' perceptions of the clinical roles and responsibilities of physician assistants (PAs) and NPs in the clinical learning environment. METHODS: Using a constructivist grounded theory approach, semistructured interviews were conducted with 15 residents in one academic setting. Transcripts were analyzed using an iterative approach to inductive coding. RESULTS: Participants typically perceived PAs' and NPs' roles as being "like a resident," less commonly as independent clinicians, and rarely as collaborators. Barriers to understanding PA and NP roles and perceiving them as collaborators included the lack of preparatory instruction about PAs and NPs, the hierarchical structure of medical education, and inadequate role modeling of interprofessional collaboration. CONCLUSIONS: This study suggests that barriers in the clinical learning environment and the structure of medical education itself may impede residents' learning about PAs and NPs and how to collaborate with them.

Advancing quality culture in health professions education: experiences and perspectives of educational leaders.

The concept of quality culture has gained increased attention in health professions education, drawing on insights that quality management processes and positive work-related attitudes of staff in synergy lead to continuous improvement. However, the directions that guide institutions from quality culture theory to educational practice have been missing so far. A prospective qualitative case study of three health professions education programmes was conducted to explore how a quality culture can be enhanced according to the experiences and perspectives of educational leaders. The data collection was structured by an appreciative inquiry approach, supported with vignette-based interviews. A total of 25 participants (a selection of course coordinators, bachelor coordinators and directors of education) reflected on quality culture themes to learn about the best of what is (Discover), envision positive future developments (Dream), identify actions to reach the desired future (Design), and determine how to support and sustain improvement actions (Destiny) within their own educational setting. The results are presented as themes subsumed under these four phases. The experiences and perspectives of educational leaders reveal that peer learning in teams and communities, attention to professional development, and embedding support- and innovation networks, are at the heart of quality culture enhancement. An emphasis on human resources, (inter)relations and contextual awareness of leaders stood out as quality culture catalysts. Educational leaders are therefore encouraged to especially fuel their networking, communication, coalition building, and reflection competencies.

Student participation in the design of learning and teaching: Disentangling the terminology and approaches.

Background: Students are ever more involved in the design of educational practices, which is reflected in the growing body of literature about approaches to student participation. Similarities and differences between these approaches often remain vague since the terms are used interchangeably. This confusing and fragmented body of literature hampers our understanding the process and outcomes of student participation and choosing the most suitable approach for it. Method: We identified the three most frequently used terms related to the design of learning and teaching - design-based research (DBR), participatory design (PD), and co-creation - and disentangled the terminology by focusing on relevant definitions, aims, involvement of students, outcomes, and related terminology. Results: Differences between the approaches to student participation can be found in the degree to which students are the central actors and the degree to which the design is informed by educational theory. Conclusion: It is important to align the level of student participation with the purpose of the approach.

Medical professionalism frameworks across non-Western cultures: A narrative overview.

BACKGROUND: Medical professionalism is context-specific, but most literature on professionalism stems from Western countries. This study is about benchmarking of different frameworks on professionalism and interpreting the commonalities and discrepancies of understanding professionalism across different cultures. We need to study the cultural underpinning of medical professionalism to graduate future "global" practitioners who are culturally sensitive enough to recognize differences (and also similarities) of expectations of patients in various contexts. AIM: This study aims at describing culture specific elements of three identified non-Western frameworks of professionalism, as well as their commonalities and differences. METHOD: A narrative overview was carried out of studies that address professionalism in non-Western cultures in the period 2002-2014. RESULTS: Out of 143 articles on medical professionalism, only four studies provided three structured professionalism frameworks in non-Western contexts. Medical professionalism attributes in non-Western cultures were influenced by cultural values. Out of the 24 identified attributes of professionalism, 3 attributes were shared by the three cultures. Twelve attributes were shared by at least two cultures, and the rest of the attributes were unique to each culture. CONCLUSIONS: The three frameworks provided culture-specific elements in a unique conceptual framework of medical professionalism according to the region they originated from. There is no single framework on professionalism that can be globally acknowledged. A culture-oriented concept of professionalism is necessary to understand what the profession is dedicated to and to incorporate the concept into the medical students' and physicians' professional identity formation.

Pathophysiology and treatment of edema following femoropopliteal bypass surgery.

Substantial lower-limb edema affects the majority of patients who undergo peripheral bypass surgery. Edema has impairing effects on the microvascular and the macrovascular circulation, causes discomfort and might delay the rehabilitation process of the patient. However, the pathophysiology of this edema is not well understood. The Cochrane Library and Medline were used to retrieve literature on edema following peripheral bypass surgery. Factors other than local wound healing alone are suggested in the literature to play a role, given the severity and duration of this edema. Hyperemia, microvascular permeability, reperfusion-associated inflammation and lymphatic disruptions are likely to facilitate the development of edema. Preventive methods could be lymphatic-sparing surgery, intraoperative antioxidative therapy and postoperative elevation. Successful treatment strategies to reduce postoperative edema are based on lymph massage and external compression. In conclusion, the pathophysiology of edema following peripheral surgery is not fully understood, although reperfusion-associated inflammation and lymphatic disruptions are likely to play a crucial role. When future less-invasive techniques prove to be successful, postoperative edema might be minimized. Until then, a careful lymphatic-sparing dissection should be executed when performing a peripheral bypass reconstruction. Postoperatively, the use of compression stockings and leg elevation are currently the golden standards.

Ruptured abdominal aortic aneurysm: endovascular or open approach in a Dutch general hospital.

AIM: We compared the outcomes of 56 patients with a ruptured abdominal aortic aneurysm (RAAA) who underwent either open repair or emergency endovascular aneurysm repair (eEVAR) in a general hospital. It seems feasible that the availability of eEVAR for treatment of RAAA could lead to a decrease in hospital mortality. METHODS: We analyzed all admitted patients with a RAAA, between January 2006 and April 2008, eEVAR is compared to open repair. We studied 30 days mortality, intensive care unit stay, hospital stay, total blood loss and complications. RESULTS: Fifteen eEVAR procedures (26.8%) were performed. Mortality in the eEVAR-group was 26%, in the open repair-group 46%. Mean intensive care unit stay was 3.9 days and 4.8 days in the eEVAR-group and open repair-group, respectively. Mean hospital stay was 13 days and 10.5 days. The average blood loss was 210cc and 2760cc. The amount of blood products for transfusion was significantly higher in the open repair. Overall complication rate was not significantly different in both treatment groups. CONCLUSION: Treatment in a Dutch general hospital of a RAAA with an eEVAR procedure has a lower mortality in comparison to the open repair. Therefore, whenever possible the eEVAR is the preferred treatment method.

Exploring the validity and reliability of a questionnaire for evaluating veterinary clinical teachers' supervisory skills during clinical rotations.

BACKGROUND: Feedback to aid teachers in improving their teaching requires validated evaluation instruments. When implementing an evaluation instrument in a different context, it is important to collect validity evidence from multiple sources. AIM: We examined the validity and reliability of the Maastricht Clinical Teaching Questionnaire (MCTQ) as an instrument to evaluate individual clinical teachers during short clinical rotations in veterinary education. METHODS: We examined four sources of validity evidence: (1) Content was examined based on theory of effective learning. (2) Response process was explored in a pilot study. (3) Internal structure was assessed by confirmatory factor analysis using 1086 student evaluations and reliability was examined utilizing generalizability analysis. (4) Relations with other relevant variables were examined by comparing factor scores with other outcomes. RESULTS: Content validity was supported by theory underlying the cognitive apprenticeship model on which the instrument is based. The pilot study resulted in an additional question about supervision time. A five-factor model showed a good fit with the data. Acceptable reliability was achievable with 10-12 questionnaires per teacher. Correlations between the factors and overall teacher judgement were strong. CONCLUSIONS: The MCTQ appears to be a valid and reliable instrument to evaluate clinical teachers' performance during short rotations.

Reliability and reproducibility of a clinical application of a simple technique for repeated circumferential leg measurements.

OBJECTIVE: The aim of this study is to determine the reliability and reproducibility of repeated tape measurements to assess the leg circumference during a long period. METHODS: A tape measure is a simple instrument that is applicable in the presence of oedema. Measurements were performed by four observers on 11 volunteers. Four measurements were done in the first week (short term), a fifth measurement at two weeks (medium term) and a sixth measurement was done at 12 weeks (long term). RESULTS: The short-, medium- and long-term intra-class correlation coefficients for repeated measurements were 0.90, 0.89 and 0.78, respectively. The short-term and long-term reproducibility indices equalled 4.4% and 6.5%. If only a single observer would be involved, the short-term intra-class correlation coefficients would improve to 0.94 (reproducibility index 3.3%). CONCLUSION: Tape measurements have been proved to be a reliable and reproducible method to asses the lower limb circumference.

Evaluation of A-V impulse technology as a treatment for oedema following polytetrafluoroethylene femoropopliteal surgery in a randomised controlled trial.

OBJECTIVE: To investigate the efficacy of A-V impulse technology (A-V) for oedema prevention and treatment following PTFE femoropopliteal surgery. DESIGN: Prospective randomized clinical trial. MATERIALS: 36 patients undergoing PTFE femoropopliteal bypass reconstructions, either being treated postoperatively with a compression stocking (CS) (Group-1, n = 19) or with A-V (Group-2, n = 17). METHODS: Patients in treatment group-1 used a CS postoperatively during 1 week day and night, patients in group-2 were treated with A-V postoperatively at night during one week. The lower leg circumference was measured preoperatively and at five postoperative time points. RESULTS: Limb circumference has increased postoperatively on day 1 (CS 1.5%/A-V 1.4%), on day 4 (5.7%/6.3%), on day 7 (6.6%/6.1%), on day 14 (7.9%/7.7%) and on day 90 (5.8%/5.2%). Differences between treatment groups were not significant. A re-operation gives a significant 3.9% increase in circumference as compared to a first operation (95% CI: 1.5-6.4%; p = 0.002). CONCLUSION: No significant differences were found in the extent of developed edema between the groups following PTFE femoropopliteal bypass surgery. A redo peripheral bypass operation results in significantly more postoperative oedema than a first-time performed bypass operation.

Does a faculty development programme improve teachers' perceived competence in different teacher roles?

BACKGROUND: Changing concepts of education have led many medical schools to adopt student-centred approaches to teaching, requiring different teaching competencies than more traditional approaches. AIMS: The aim of this study was to investigate whether participation in a faculty development (FD) programme had a positive effect on veterinary medical teachers' perceptions of their competence in seven different teaching roles. METHOD: All teaching staff of a veterinary medical school (251) were invited to complete a questionnaire asking about their perceived competence in seven teaching roles. A stepwise multiple linear regression analysis examined the effect of the completion of a FD programme on perceived teaching competence. RESULTS: There was a significant positive effect of the FD programme on teachers' perceived competence in majority of the teaching roles at issue. CONCLUSIONS: FD appeared to have a positive effect on the perceived competence of veterinary medical teachers. Further research should investigate whether FD actually results in improved teaching performance.

Clinical supervisors' perceived needs for teaching communication skills in clinical practice.

BACKGROUND: Lack of faculty training is often cited as the main obstacle to post-graduate teaching in communication skills. AIMS: To explore clinical supervisors' needs and perceptions regarding their role as communication skills trainers. METHODS: Four focus group discussions were conducted with clinical supervisors from two in-patient and one out-patient medical services from the Geneva University Hospitals. Focus groups were audio taped, transcribed verbatim and analyzed in a thematic way using Maxqda software for qualitative data analysis. RESULTS: Clinical supervisors said that they frequently addressed communication issues with residents but tended to intervene as rescuers, clinicians or coaches rather than as formal instructors. They felt their own training did not prepare them to teach communication skills. Other barriers to teach communication skills include lack of time, competing demands, lack of interest and experience on the part of residents, and lack of institutional priority given to communication issues. Respondents expressed a desire for experiential and reflective training in a work-based setting and emphasised the need for a non-judgmental learning atmosphere. CONCLUSIONS: Results suggest that organisational priorities, culture and climate strongly influence the degree to which clinical supervisors may feel comfortable to teach communication skills to residents. Attention must be given to these contextual factors in the development of an effective communication skills teaching program for clinical supervisors.

Surgical removal of an infected aortic endoprosthesis using a wire cutter.

The purpose of this study is to report a new method of removing an infected endoprosthesis from the abdominal aorta using a wire cutter. A 65-year-old man with a ruptured abdominal aortic aneurysm was admitted to our hospital. He was treated with an endovascular abdominal endoprosthesis and discharged one week later. Three months after placement, the patient returned with an infection of the aortic endoprosthesis. The endoprosthesis had been fixed with barbs and hooks above the renal arteries and was surgically explanted by using a wire cutter to cut the hooks. The bare suprarenal stent was left in place. The patient was discharged one month after stent removal, and was treated with oral antibiotics for another ten weeks. At one year follow-up the patient showed no clinical, biochemical, or radiological signs of infection. In conclusion, infected endoprostheses should be surgically removed according to the medical literature. We recognize that removing a Zenith endoprostheses requires a dangerous operation because the hooks of the bare stent are engaged into the supra-renal aorta. This case report documents a new technique to safely remove an infected endoprosthesis with the help of a wire cutter.

Educational approaches aimed at preparing students for professional veterinary practice.

Changes in society and dissatisfaction with current educational practices have led to changes in undergraduate veterinary curricula. New approaches that are thought to better prepare students for future professional veterinary practice are being introduced. One such change is a transition from conventional teacher-centred curricula to student-centred curricula. In student-centred curricula, students are actively involved in learning and teachers not only transmit knowledge but help students to obtain a deep understanding. Furthermore, learning within these curricula takes place in a multi-disciplinary context which is more relevant for the future of the profession. Another change is that more emphasis is put on training in academic skills, for instance, by establishing research internships. Finally, a new emphasis is being placed on training in more generic competencies, such as communication and business skills. These changes are assumed to better suit the profile of veterinary students today and in the future and to better prepare them for future veterinary practice.

Perceptions of problem-based learning (PBL) group effectiveness in a socially-culturally diverse medical student population.

INTRODUCTION: A key aspect of the success of a PBL curriculum is the effective implementation of its small group tutorials. Diversity among students participating in tutorials may affect the effectiveness of the tutorials and may require different implementation strategies. AIMS: To determine how students from diverse backgrounds perceive the effectiveness of the processes and content of the PBL tutorials. This study also aims to explore the relationship between students' perceptions of their PBL tutorials and their gender, age, language, prior educational training, and secondary schooling. MATERIALS/METHODS: Data were survey results from 244 first-year student-respondents at the Nelson Mandela School of Medicine at the University of KwaZulu-Natal in South Africa. Exploratory factor analysis was conducted to verify scale constructs in the questionnaire. Relationships between independent and dependent variables were investigated in an analysis of variance. RESULTS: The average scores for the items measured varied between 3.3 and 3.8 (scale value 1 indicated negative regard and 5 indicated positive regard). Among process measures, approximately two-thirds of students felt that learning in a group was neither frustrating nor stressful and that they enjoyed learning how to work with students from different social and cultural backgrounds. Among content measures, 80% of the students felt that they learned to work successfully with students from different social and cultural groups and 77% felt that they benefited from the input of other group members. Mean ratings on these measures did not vary with students' gender, age, first language, prior educational training, and the types of schools they had previously attended. DISCUSSION AND CONCLUSION: Medical students of the University of KwaZulu-Natal, regardless of their backgrounds, generally have positive perceptions of small group learning. These findings support previous studies in highlighting the role that small group tutorials can play in overcoming cultural barriers and promoting unity and collaborative learning within diverse student groups.

Endovascular aneurysm repair with Zenith graft. Complications caused by leg extensions.

AIM: A large amount of Zenith endovascular stent complications is due to problems with the leg extensions. This kind of complication has never been reported in literature. The aim of this study was to monitor the complications of endovascular abdominal aneurysm repair (EVAR) performed with the Zenith endovascular graft occurred in the Amphia Ziekenhuis in Breda to see how many recurrences were due to leg extension. METHODS: The study enrolled all patients (N.=66) treated with the Zenith endograft in the period between October 2000 and September 2006. Mortality, complications and the number of reinterventions were analysed. Average age of the patients was 73.4 years, average follow-up was 24.5 months and average aneurysm size was 61.5 mm. Radiologic follow-up was performed by computed tomography scans and X-rays. RESULTS: Postoperative mortality rate was 0%. The overall mortality rate during follow-up was 3%. Ten patients required a total number of 12 reinterventions (15%). The average time for reintervention was 10 months after the primary operation. Mortality, complication and reintervention rates were comparable with those reported in the literature, but 75% of these reinterventions were related to the leg extensions. CONCLUSION: Authors observed that nine out of 12 complications which required reintervention were due to problems with one of the leg extensions. This is the first study that specifies clearly the percentage of problems with leg extensions in EVAR (75%). When placing a Zenith endovascular graft extra attention should be paid to optimal placement of the leg extensions.

Can students differentiate between PBL tutors with different tutoring deficiencies?

Many medical schools evaluate the performance of their tutors by using questionnaires. One of the aims of these evaluations is to provide tutors with diagnostic feedback on strong and weak aspects of their performance. Although everyone will agree that students are able to distinguish between poor and excellent tutors, one can question whether students are also able to differentiate between tutors with different tutoring deficiencies--tutors who perform badly on a specific key aspect of their performance. The aim of this study was to investigate to what degree students are able to differentiate between tutors with different tutoring deficiencies, how effective tutors are with different deficiencies and what kind of tips students give for improvement of a tutor's behaviour. Based on students' ratings on a tutor evaluation questionnaire, tutors were ranked in groups with different deficiencies and the average overall tutor performance score was computed for each group with a particular deficiency. In addition, students' tips for improvement given in the open-ended question at the end of the questionnaire were analysed. The results demonstrated that on average one out of five tutors showed a deficiency on only one key aspect. Tutors who did not stimulate students towards active learning were perceived as least effective. Furthermore, students' tips for improvement could be categorized into four groups: tutors who do not evaluate adequately, tutors who are too directive, tutors who are too passive and tutors who lack content knowledge. The results of this study demonstrate that students are not only able to distinguish between poor and excellent tutors, but are also able to diagnose tutors with different tutoring deficiencies and are able to provide tutors with specific feedback to improve their performance.

Providing physicians with feedback on how they supervise students during patient contacts.

In this descriptive study an instrument is presented that has been developed to provide physicians with feedback about their strengths and weaknesses in facilitating student learning during patient contacts. The instrument is strongly theory based, i.e. it is based on current general theories of context-bound learning environments, and forms of facilitation promoting transfer of knowledge to actual professional practice. In addition, it has been developed in cooperation with physicians supervising students during patient contacts. The authors have shown how physicians can be provided with individualized feedback on their performance in supervising students during patient contacts.

From quality assurance to total quality management: how can quality assurance result in continuous improvement in health professions education?

CONTEXT: Quality assurance is a hot topic in many institutes for higher education. Quality assurance is a cyclic process, consisting of three steps: measuring, judging and improving. Many institutes in higher education collect data about the quality of their educational programme on a regular basis and with proper frequency, but these evaluative data are not always used to improve the quality of the programme. PURPOSE: The aim of this article is to demonstrate which conditions need to be fulfilled to ensure that quality assurance is a cyclic process resulting in continuous improvement. CONCLUSIONS: Quality assurance can only be successful, i.e. result in continuous improvement, if three conditions are met: the evaluation activities are carried out in (1). a systematic and (2). structural fashion and (3). are integrated in the organization's regular work patterns. Parts of the system for quality assurance at the Maastricht Medical School are presented to demonstrate how the three conditions can be realized in practice.

Students' perceptions of relationships between some educational variables in the out-patient setting.

BACKGROUND: Medical education uses the cognitive apprenticeship model of student learning extensively. Students rotate among different hospitals and out- patient clinics where they are exposed to a range of professionally relevant contexts. Here they learn to think and act in different domains under the supervision of experts. Previous research has shown that these learning situations involve little teaching. Students see a narrow range of patient problems and feedback is limited. The aim of this study is to investigate relationships among some educational variables in the out-patient clinic. METHOD: This paper provides a theoretical model that specifies the factors influencing the effectiveness of student rotations at out-patient clinics. The model makes distinctions between input variables, such as organizational quality, number of students contemporaneously involved and available space, and process variables, such as patient mix and supervision, and the output variable of the effectiveness of rotations in out-patient clinics. RESULTS: The model was tested against empirical data from evaluative surveys and showed a reasonable fit. The model offers suggestions for improving the learning environment of clinical rotations. DISCUSSION: The strength of this study lies in its process evaluation perspective which investigates interactions between intervening variables rather than the influence of particular variables in isolation from other variables.