Practice experiences for school reintegration: Endorsement for virtual reality with adolescents hospitalized for suicide-related crises.

This study applied qualitative methods and a user design approach to develop and iteratively refine a model for a virtual reality intervention designed to supplement standard inpatient treatment for adolescents hospitalized for suicide-related crises: the practice experiences for school reintegration (PrESR). The PrESR model allows patients to practice therapeutic skills within an immersive school environment to increase skill knowledge and skill use and to improve school reintegration. Adolescents previously hospitalized for suicide-related thoughts and behaviors (n = 13), hospital professionals with experience providing supports to hospitalized adolescents (n = 7), and school professionals with experience supporting adolescents with suicide-related risks (n = 12) completed focus group and/or one-on-one interviews to inform the development of the PrESR model. Transcribed interviews were analyzed using content analysis, and structured feedback was analyzed by calculating frequencies. Participating adolescents were between the ages of 13 and 18, identifying their race as White (61%), Asian (7.7%), American Indian and Black (7.7%), or Black (7.7%; note that 15.4% preferred not to answer) and their ethnicity as Hispanic (23%) or non-Hispanic (77%). Adolescents identified their gender as girl or woman (46%), boy or man (38%), or "some other way" (15%). A majority of adolescent and professional participants endorsed the PrESR as holding the potential to promote skill learning. Feedback addressed improvements to scenarios and skills; safety concerns, constraints to consider, and barriers to implementation; and information to include in the treatment manual. Findings also informed the types of difficulties adolescents face in schools and the potential feasibility of a virtual reality intervention to enhance standard inpatient care of adolescents hospitalized for suicide-related crises. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Automated Analysis of Preceptor Comments: A Pilot Study Using Sentiment Analysis to Identify Potential Student Issues in Experiential Education.

OBJECTIVE: The purpose of this paper is to describe a sentiment analysis program that aids in identifying pharmacy students at risk for progression issues by automatically scoring preceptor comments as positive or negative. METHODS: An R-based program to analyze advanced pharmacy practice experiences and introductory pharmacy practice experiences midpoint evaluation of preceptor comments was piloted in phase 1 by comparing the sentiment analysis algorithm results to human coding. The algorithm was refined in phase 2. In phase 3, the validation phase, the final sentiment analysis algorithm analyzed all midpoint student evaluations (n = 1560). Sentiment scores were generated for each preceptor comment, and correlations were performed between sentiment scores and the quantitative scoring provided on the assessment. RESULTS: In phase 1, agreement between faculty coders and sentiment analysis was 96%, and in phase 2, agreement between the final codes and sentiment analysis was 92.4% once keywords were added to the sentiment dictionary. In phase 3, a total of 3919 comments from 1560 evaluations were analyzed, and overall, the sentiment analysis results aligned with the quantitative data. CONCLUSION: This sentiment analysis algorithm was accurate in capturing positive and negative comments corresponding to pharmacy student performance. Given the accuracy of this preliminary validation for flagging preceptor comments, there are numerous implications when considering the use of sentiment analysis in pharmacy education. Using a sentiment analysis program minimizes the number of qualitative preceptor comments needing review by experiential faculty, as this program can aid in identifying students at risk of progression issues.

Faculty Process for Reviewing and Utilizing a School's Course Evaluation Comments.

OBJECTIVE: This study aimed to explore faculty engagement with qualitative comments from course evaluations. METHODS: Course faculty from the University of North Carolina Eshelman School of Pharmacy were recruited via email to participate in a 30-minute interview session. Previous course evaluation comments were adapted to create a de-identified mock evaluation. Six interviews were conducted via Zoom, consisting of a think-aloud protocol based on the mock course evaluation followed by a cognitive interview focused on goals and current utilization of comments, and common patterns and issues sought by faculty. Interview transcripts were manually cleaned and de-identified. Transcripts were inductively coded by 1 researcher using MAXQDA. RESULTS: Three overarching themes were identified: general faculty process for reviewing comments (ie, how faculty perceive and analyze comments), comments utilization for course change (ie, how faculty utilize comments in making course changes), and faculty analysis strategy (ie, faculty approach to locating common patterns in evaluation comments). The most common subthemes included usefulness of comments, methods for tracking comment patterns, and challenges with the large number of comments each semester. CONCLUSION: Faculty provided useful insight and feedback regarding the current state of the course evaluation process that can be used to improve the structure, organization, and utilization of course evaluations by faculty. These findings could inform the creation of the course evaluation comment automated analysis program in the next stage of an ongoing project.

Simulating patterns of life: More representative time-activity patterns that account for context.

BACKGROUND: Complex contributions of environment to health are intimately connected to human behavior. Modeling of human behaviors and their influences helps inform important policy decisions related to critical environmental and public health challenges. A typical approach to human behavior modeling involves generating daily schedules based on time-activity patterns of individual humans, simulating 'agents' with these schedules, and interpreting patterns of life that emerge from the simulation to inform a research question. Current behavior modeling, however, rarely incorporates the context that surrounds individuals' truly broad scope of activities and influences on those activities. OBJECTIVES: We describe in detail a range of elements involved in generating time-activity patterns and connect work in the social science field of behavior modeling with applications in exposure science and environmental health. We propose a framework for behavior modeling that takes a systems approach and considers the broad scope of activities and influences required to simulate more representative patterns of life and thus improve modeling that underlies understanding of environmental contributions to health and associated decisions to promote and protect public health. METHODS: We describe an agent-based modeling approach reliant on generating a population's schedules, filtering the schedules, simulating behavior using the schedules, analyzing the emergent patterns, and interrogating results that leverages general empirical information in a systems context to inform fit-for-purpose action. DISCUSSION: We propose a centralized and standardized program to codify behavior information and generate population schedules that researchers can select from to simulate human behavior and holistically characterize human-environment interactions for a variety of public health applications.

Patient Interaction Involving Older Adults: Provider vs. Caregiver Expectations.

This paper presents a study of the interaction between healthcare providers (HCPs) and older patients and their caregivers. The paper first presents results from a rapid review and narrative synthesis using PubMed and Google Scholar of HCP/patient/caregiver interactions involving older patients; these results then informed the design of a survey administered to HCPs and caregivers using a range of scenarios and their ratings of appropriateness of different responses, to explore where expectations align or differ between HCPs and caregivers. In analyzing ratings, the research found HCPs and caregivers generally approach the older adult encounter with similar expectations, but differences for specific situations are informative. HCPs appear to better recognize when there is a need to show empathy, as when a patient is frustrated or anxious. HCPs, overall, offer more calming responses, especially in embarrassing, upsetting, or worrying situations. For older patients of advanced age, HCPs value engagement with patients more than caregivers, but HCPs are more aligned with caregivers in their ratings of how to engage caregivers. Compared to caregivers, HCPs focus more on simplifying the description of treatment rather than using thorough explanations when a patient expresses hesitancy or avoidance. The results from this work suggest that having a fuller understanding of the different participants' expectations may improve communication and identify potential pitfalls. A better understanding may also lead to changes in how students in the healthcare fields are trained; having better insight into this relationship will prepare them for interacting with older patients while addressing the needs of caregivers.

A Concept Mapping Activity to Enhance Pharmacy Students' Metacognition and Comprehension of Fundamental Disease State Knowledge.

Objective. To examine the impact of pre-class concept mapping activities on pharmacy students' ability to self-assess their degree of foundational disease state knowledge and predict their pre-class quiz performance.Methods. Second year pharmacy students in a problem-based learning course were responsible for self-directed learning of foundational knowledge for 14 disease states. After completing their independent pre-class reading, students worked in groups to create concept maps for which feedback was provided for four laboratory sessions, worked in groups to create concept maps but received no formal feedback for three laboratory sessions, and did not engage in any formal group activity for seven laboratory sessions. The day following each session, prior to the formal in-class discussion, students were asked to predict the number of questions they could answer correctly on a quiz covering foundational knowledge and then completed the quiz. Quiz performance was compared based on the three conditions, and bias and absolute bias were calculated to evaluate students' metacognitive skills.Results. There was no difference in pharmacy students' metacognition based on the conditions, as reflected by inaccuracy between predicted and actual quiz scores. However, when students had engaged in concept mapping the previous day, their quiz performance was significantly higher than when they had not.Conclusion. Concept mapping did not improve pharmacy students' metacognitive skills but did have a small effect on their quiz performance. More research is needed to tease apart the roles of concept mapping, group activity, and feedback in altering pharmacy students' quiz performance and metacognitive skills.

Interactive Narrative Simulation as a Method for Preceptor Development.

(1) Background: This proof-of-concept study assessed an interactive web-based tool simulating three challenging non-academic learning situations-student professionalism, cross-cultural interactions, and student well-being-as a means of preceptor development. (2) Methods: Three scripts focused on professionalism, cross-cultural interactions, and student well-being were developed and implemented using a commercial narrative tool with branching dialog. Delivered online, this tool presented each challenge to participants. Participants had up to four response options at each turn of the conversation; the choice of response influenced the subsequent conversation, including coaching provided at the resolution of the situation. Participants were invited to complete pre-activity, immediate post-activity, and one-month follow-up questionnaires to assess satisfaction, self-efficacy, engagement, and knowledge change with the tool. Knowledge was assessed through situational judgment tests (SJTs). (3) Results: Thirty-two pharmacist preceptors participated. The frequency of participants reflecting on challenging learning situations increased significantly one-month post-simulation. Participants affirmatively responded that the tool was time-efficient, represented similar challenges they encountered in precepting, was easily navigable, and resulted in learning. Self-efficacy with skills in managing challenging learning situations increased significantly immediately post-simulation and at a one-month follow-up. Knowledge as measured through SJTs was not significantly changed. (4) Conclusions: Preceptors found an interactive narrative simulation a relevant, time-efficient approach for preceptor development for challenging non-academic learning situations. Post-simulation, preceptors more frequently reflected on challenging learning situations, implying behavior change. Self-efficacy and self-report of knowledge increased. Future research is needed regarding knowledge assessments.

Testing of a Program to Automatically Analyze Students' Concept Maps.

Concept maps are graphical representations of how various concepts relate to one another. Assessment of concept maps developed by students in the pharmacy curriculum helps to evaluate student understanding of course material. However, providing feedback on concept maps can be time-consuming and often requires the grader to be a content expert. The purpose of this study was to develop and validate a software program to provide students with feedback on their concept map performance. Student maps for four different disease states were compared against expert concept maps. The analysis of the program compared favorably to a manual assessment of student maps for the maps' complexity and content but did not correlate for their organization. The value of using a software program to quickly and efficiently analyze concept maps is discussed.

Identifying Priority Student Leadership and Professionalism Attributes Among Faculty, Preceptors, and Students via Modified Delphi.

Objective. To identify and build consensus on priority leadership and professionalism attributes for pharmacy student development among faculty, preceptors, and students.Methods. One hundred individuals (27 faculty members, 30 preceptors, 43 students) were invited to participate in a three-round, modified Delphi. Published literature on leadership and professionalism informed the initial attribute list. In the first round, participants reviewed and provided feedback on this list. In the second round, participants prioritized attributes as highly important, important, or less important for pharmacy student development. Leadership and professionalism attributes that achieved an overall consensus (a priori set to ≥80.0%) of being highly important or important for pharmacy student development were retained. In the third round, participants rank ordered priorities for leadership and professionalism attributes.Results. Fifteen leadership and 20 professionalism attributes were included in round one while 21 leadership and 21 professionalism attributes were included in round two. Eleven leadership and 13 professionalism attributes advanced to round three. Consensus was reached on the top four leadership attributes (adaptability, collaboration, communication, integrity) and five professionalism attributes (accountability, communication, honor and integrity, respect for others, trust). Differences were observed for certain attributes between faculty members, preceptors, and/or students.Conclusion. The modified Delphi technique effectively identified and prioritized leadership and professionalism attributes for pharmacy student development. This process facilitated consensus building and identified gaps among stakeholders (ie, faculty, preceptors, students). Identified gaps may represent varying priorities among stakeholders and/or different opportunities for emphasis and development across classroom, experiential, and/or cocurricular settings.

Toward Preventing Post-Traumatic Stress Disorder: Development and Testing of a Pilot Predeployment Stress Inoculation Training Program.

The objective of this pilot study was to design, develop, and evaluate a predeployment stress inoculation training (PRESIT) preventive intervention to enable deploying personnel to cope better with combat-related stressors and mitigate the negative effects of trauma exposure. The PRESIT program consisted of three predeployment training modules: (1) educational materials on combat and operational stress control, (2) coping skills training involving focused and relaxation breathing exercises with biofeedback, and (3) exposure to a video multimedia stressor environment to practice knowledge and skills learned in the first two modules. Heart rate variability assessed the degree to which a subset of participants learned the coping skills. With a cluster randomized design, data from 351 Marines randomized into PRESIT and control groups were collected at predeployment and from 259 of these who responded to surveys on return from deployment. Findings showed that the PRESIT group reduced their physiological arousal through increased respiratory sinus arrhythmia during and after breathing training relative to controls. Logistic regression, corrected for clustering at the platoon level, examined group effects on post-traumatic stress disorder (PTSD) as measured by the Post-traumatic Stress Checklist after controlling for relevant covariates. Results showed that PRESIT protected against PTSD among Marines without baseline mental health problems. Although limited by a small number of participants who screened positive for PTSD, this study supports the benefits of PRESIT as a potential preventive strategy in the U.S. military personnel.

PHIT for duty, a mobile approach for psychological health intervention.

The goal of this effort is to support prevention of psychological health problems through innovation in mobile personal health assessment and self-help intervention (SHI). For the U.S. military, we are developing and evaluating a field-deployable personalized application, PHIT for DutyTM, to help build resilience in healthy troops and support prevention in high-risk personnel. PHIT for Duty is delivered using any smartphone or tablet with optional nonintrusive physiological and behavioral sensors for health status monitoring. The application integrates a suite of health assessments with an intelligent advisor that recommends, tailors, and presents self-help advisories. PHIT for Duty is intended for secondary prevention of psychological health problems in persons who have been exposed to psychological trauma and may be showing some symptoms of distress, but have not been diagnosed with any psychological disease or disorder.

Approaches to the primary prevention of posttraumatic stress disorder in the military: a review of the stress control literature.

Numerous studies are underway, using data collected from clinical studies and data collected from surveys of combat troops, to determine the most efficacious treatment options for those diagnosed with posttraumatic stress disorder (PTSD). In contrast, little is known about the effectiveness of predeployment training in preventing or mitigating the impact of combat-related stressors on the development of PTSD. We conducted a comprehensive review of literature pertaining to primary prevention efforts to stem the advent of PTSD and other combat and operational stress injuries in military populations using databases from the peer-reviewed literature as well as online searches and colleague referrals. Results show that, as with treatment for PTSD, the most promising preventive approaches appear to utilize exposure strategies, especially those in conjunction with education and stress reduction skills training.

Deficits in behavioral inhibition predict treatment engagement in prison inmates.

Many inmates do not respond favorably to standard treatments routinely offered in prison. Executive cognitive functioning and emotional regulation may play a key role in treatment responsivity. During intake into treatment, inmates (N = 224) were evaluated for executive functioning, emotional perception, stress reactivity (salivary cortisol), IQ, psychological and behavioral traits, prior drug use, child and family background, and criminal histories and institutional behavior. Outcome measures included program completion, treatment readiness, responsivity and gain, and the Novaco Reaction to Provocation Questionnaire. Relative deficits in behavioral inhibition significantly predicted treatment outcomes, more so than background, psychological, or behavioral variables, and other neurocognitive and emotional regulatory measures. Future replications of these results have potential to improve assessment and treatment of offenders who are otherwise intractable.

Virtual simulation-enhanced triage training for Iraqi medical personnel.

Triage, establishing the priority of care among casualties in disaster management, is generally practiced using constructive tabletop or live exercises. Actual disasters involving multiple casualties occur rarely, offering little opportunity for gaining experience and competency assessment. When they do occur, response needs to be rapid and well-learned. In the Iraqi medical education environment where the need for triage is immediate, but the ability to stage practice is nearly impossible, blending didactic learning with simulation-based triage offers an alternative training methodology.

Mediators of the stress-substance-use relationship in urban male adolescents.

Exposure to chronic or severe acute stressors throughout the lifespan has been linked with numerous negative behavioral, emotional, cognitive, and physical consequences. Adolescence is considered to be a particularly vulnerable period given that the brain is experiencing dramatic developmental change during this time. The present study examined a sample of adolescents (N=125) considered to be at high risk for stress exposures and drug use by virtue of their environment and low income levels to identify possible neurocognitive (i.e., impulsivity, delay of gratification, emotional perception, and risky decision-making) and social competency mechanisms that may mediate this relationship. Using Mplus, a mediational model was tested using full information maximum likelihood estimates. Risky decision-making and poor social competency skills were related to previous stressful experiences; however, only social competencies mediated the effect of stressors on reports of past year marijuana, alcohol, and polydrug use. As such, stress appears to exert its negative impact through alterations in abilities to generate and execute prosocial decisions and behaviors. Interventions that directly address the effects of stress on social competencies may be especially important for children who have experienced adversity including those exposed to parental divorce, parental psychopathology, neglect or abuse, parental death, and poverty.

Informed consent procedures: an experimental test using a virtual character in a dialog systems training application.

Researchers are generally trained to administer informed consent by studying approved guidelines, but still can fail to satisfactorily answer questions from potential participants. An application using a virtual character allowed novice participants to practice administering informed consent. This character was designed to behave as a potential participant for a study and asked many of the questions research participants typically ask, such as queries about the study itself, the sponsor, timing, selection procedures, confidentiality, voluntariness, benefits and risks, and contact information. The user responded to the character's queries as if speaking with a true potential research participant. The application was effective even after only brief usage. In a laboratory experiment, novice participants who practiced with the virtual character were later more effective in conducting informed consent interviews with a human interviewee than those who were trained only with written materials. Thus, simulated learning-by-doing improved informed consent skills. Implications for related health dialog applications are discussed.

Neurocognitive skills moderate urban male adolescents' responses to preventive intervention materials.

The present experiment was designed to determine whether individual variation in neurobiological mechanisms associated with substance abuse risk moderated effects of a brief preventive intervention on social competency skills. This study was conducted in collaboration with the ongoing preventive intervention study at Johns Hopkins University Prevention Intervention Research Center (JHU PIRC) within the Baltimore City Public Schools. A subsample (N = 120) of male 9th grade students was recruited from the larger JHU study population. Approximately half of the participants had a current or lifetime diagnosis of CD while the other half had no diagnosis of CD or other reported problem behaviors. Measures of executive cognitive function (ECF), emotional perception and intelligence were administered. In a later session, participants were randomly assigned to either an experimental or control group. The experimental group underwent a facilitated session using excerpted materials from a model preventive intervention, Positive Adolescent Choices Training (PACT), and controls received no intervention. Outcomes (i.e., social competency skills) were assessed using virtual reality vignettes involving behavioral choices as well as three social cognition questionnaires. Poor cognitive and emotional performance and a diagnosis of CD predicted less favorable change in social competency skills in response to the prevention curriculum. This study provides evidence for the moderating effects of neurocognitive and emotional regulatory functions on ability of urban male youth to respond to preventive intervention materials.

The virtual pediatric standardized patient application: formative evaluation findings.

This paper presents formative (i.e., not final project) evaluation data from the use of a responsive virtual human training application by medical students rotating through Pediatrics and by Pediatric medical educators. We are encouraged by the evaluation results and believe the iterative development strategies employed and the subsequent refinements in the scenarios will lead to important instructional and assessment tools for medical educators.

Psychometric properties of virtual reality vignette performance measures: a novel approach for assessing adolescents' social competency skills.

This study examined the psychometric properties of performance measures for three novel, interactive virtual reality vignette exercises developed to assess social competency skills of at-risk adolescents. Performance data were collected from 117 African-American male 15-17 year olds. Data for 18 performance measures were obtained, based on adolescents' interaction with a provocative virtual teenage character. Twelve of the 18 performance measures loaded on two factors corresponding to emotional control and interpersonal communication skills, providing support for their factorial validity. The internal reliability coefficients for the two multi-item measures were 0.88 and 0.91, respectively. Additional analyses with established measures of three psychosocial factors (beliefs supporting aggression, aggressive conflict-resolution style and hostility) and behavioral criteria (e.g., self-reported behavioral misconduct and drug use) provided limited support for the construct and criterion-related validity of the performance measures. Study findings suggest that the virtual reality vignette exercises may represent a promising approach for assessing adolescents' social competency skills.