Group Level Assessment Methodology as a Liberating Structure Within Qualitative and Participatory Research.

Group level assessment (GLA) is a qualitative and participatory research-to-action methodology designed to engage a large group of relevant participants throughout the research process. As originally conceived, a single GLA session is led by a trained facilitator who guides the participants through seven structured steps: climate setting, generating, appreciating, reflecting, understanding, selecting, and action. The purpose of this manuscript is to describe the 25-year trajectory and uses, contributions as a liberating structure, and adaptations of GLA.

The outsider phenomenon and the need to belong.

The outsider phenomenon is an existential pathology interrelated with the need to belong. It is a group related experience that has developmental foundations. W. R. D. Fairbairn (1952), was one of the first psychoanalysts who systematically challenged Freudian theory, and located the human experience within social relationships. Fairbairn (1935) suggested that the family is the first social group, leading to affiliations with important groups external to the family. This paper extrapolates from Fairbairn's ideas about schizoid character, which is an interpersonal experience, to group experiences in a family and with identity groups. Fairbairn's notions about the unavoidable activation of schizoid processes may help us understand what makes the outsider experience so pervasive.

The role of groups during individual development and within the clinical dyad.

The author proposes that group identifications have been under-appreciated by individual psychodynamic psychotherapists in their conceptualization of normative individual development. He identifies the routes by which the child begins to internalize small and large groups during the early years of identity formation. Through individual therapy vignettes, the author suggests modifications to customary technique so that developmental shortcomings in group attachment security can be shored up. He offers some guidelines for the individual therapist so that group experiences are accounted for as the clinical narrative is written. Finally, he distinguishes patients who may require additional group-level interventions to address their avoidance of group participation.

Large-group simulation as a learning method to promote interprofessional collaboration and older adults' patient centered-care.

AIMS: This study described the influence of a large-group simulation on social and health care students´ working life competence concerning interprofessional collaboration (IPC) and patient centered-care. METHODS AND RESULTS: The target group (n = 319) was social and health care students from several different degree programs taking part in a large-group simulation concerning older people´s oral health as a part of his comprehensive well-being and health. Data were collected with a questionnaire containing background questions, statements about interprofessional practice and open-ended questions about learning experiences. The number of respondents was 257, including 51 oral health care students (OHCS). The data were analyzed using descriptive and statistical methods and content analysis. Working life competencies covers the overall social and collaborative skills which health-care professionals need in their work. They were reported to be improved in IPC and patient-centered care (PCC). The main described learning experiences in open responses included appreciating different professionals' competencies and the importance of interprofessional decision-making, interpersonal communication competence and patient-centered attitudes in care provision. CONCLUSION: The large-group simulation is a good model for educating larger student groups simultaneously and it functioned well in improving understanding of IPC and PCC among older adults.

Online interactive medical neuroimaging exercise to identify human brain structures.

A persisting need remains for developing methods for inspiring and teaching undergraduate medical students to quickly learn to identify the hundreds of human brain structures, tracts and spaces that are clinically relevant (viewed as three-dimensional volumes or two-dimensional neuroimages), and to accomplish this with the option of virtual on-line methods. This notably includes teaching the essentials of recommended diagnostic radiology to allow students to be familiar with patient neuroimages routinely acquired using magnetic resonance imaging (MRI) and computed tomography (CT). The present article includes a brief example video plus details a clinically oriented interactive neuroimaging exercise for first year medical students (MS1s) in small groups, conducted with instructors either in-person or as an entirely online virtual event. This "find-the-brain-structure" (FBS) event included teaching students to identify brain structures and other regions of interest in the central nervous system (and potentially in head and neck gross anatomy), which are traditionally taught using brain anatomy atlases and anatomical specimens. The interactive, small group exercise can be conducted in person or virtually on-line in as little as 30 min depending on the scope of objectives being covered. The learning exercise involves coordinated interaction between MS1s with one or several non-clinical faculty and may include one or several physicians (clinical faculty and/or qualified residents). It further allows for varying degrees of instructor interaction online and is easy to convey to instructors who do not have expertise in neuroimaging. Anonymous pre-event survey (n = 113, 100% response rate) versus post-event surveys (n = 92, 81% response rate) were attained from a cohort of MS1s in a neurobiology course. Results showed multiple statistically significant group-level shifts in response to several of the questions, showing an increase in MS1 confidence with reading MRI images (12% increase shift in mean, p < 0.001), confidence in their approaching physicians for medical training (9%, p < 0.01), and comfort levels in working online with virtual team-based peers and with team-based faculty (6%, p < 0.05). Qualitative student feedback revealed highly positive comments regarding the experience overall, encouraging this virtual medium as a desirable educational approach.

Remembering Jimmy Carter and his Contribution to the Role of Psychoanalysis in World Affairs.

In February 2023 98-year-old former President Jimmy Carter entered hospice care and began spending his remaining time at home with his family. This paper describes his personal, and The Carter Center's financial, support for applying psychoanalytic approaches to understanding and calming large-group conflicts in Estonia and Albania and helping to enrich psychoanalytic knowledge of large-group psychology.

Remembering Gorbachev.

Since the middle of last century the so-called "rational actor" models in international and domestic affairs (von Rochau, 1853) supported the assumption that a political leader's decision-making is logical and unaffected by psychological factors. In 1993 eight psychoanalytically oriented psychiatrists formed a team to study political leaders' personality characteristics and the psychodynamics of their decision-making processes. They met twice a year for five years and studied political leaders with obsessional, paranoid, schizoid, narcissistic and depressive personality organizations (Volkan, Akhtar, Dorn, Kafka, Kernberg, Olsson, Rogers, & Shanfield, 1998). Today academicians dealing with political issues are more aware that the personality of a political leader plays a crucial role in his or her attempts to maintain a stable relationship with his or her "followers" as well as in dealing with domestic and international issues. On February 2022, Russia launched an invasion of Ukraine. Vladimir Putin's psychological issues in starting this invasion already have been examined through psychoanalytic angles (Ihanus, 2022; Volkan & Javakhishvili, 2022). On August 30, 2022, Mikhail Gorbachev died. A political leader with Gorbachev's personality would not start a new war, a new horrifying event with brutality against civilians, children and innocent.

Faculty and Students' Perceptions About Online Teaching Styles of Faculty in Large Group Lectures.

Introduction: An unprecedented disruption in medical education worldwide was caused due to the Covid 19 pandemic. Online teaching has become one of the primary forms of education. In this paper, we aimed to understand the faculty and students' perceptions about the teaching styles adopted by the faculty during online large group teaching from two universities in the United Arab Emirates. Patients and Methods: This is a cross-sectional opinion survey-based study. A pre-validated teaching style inventory in higher education (TSIHE) questionnaire was emailed to the students and faculty involved in large group online learning and teaching activities during the lock-down period of the COVID 19 pandemic from two different medical Universities in the United Arab Emirates. A total of 423 students and 57 faculty participated in the study. Descriptive and Inferential statistics were used to analyze the data. Results: There was a significant difference between the faculty and students on the perception of faculty online teaching styles. The difference was significant in teacher-student interaction and teacher structuring styles. In contrast, faculty and students' perceptions were comparable for decision-making negotiation and behavioral control teaching styles. Conclusion: The study found that there was a significant perception differences between the faculty and students on the faculty teaching style during online large group teaching. Importantly, faculty perceived that they were more emotionally attached and more flexible in teacher-student interaction and teaching structuring during online teaching than the student perceived.

The Leader's Hypnotic Influence and the Creation of Alternate Reality.

Psychoanalysis has traditionally been an insular practice by analysts in their offices sequestered from any outside intrusion. However, in recent years a demand for psychoanalytic perspectives on the underlying dynamics of political figures and social phenomena has arisen. Media representatives have increasingly approached psychoanalysts for insight into such conditions as narcissistic personality disorder, compulsive lying, delusional thinking, when attempting to understand the irrational machinations of authoritarian leaders. Here, we will not be investigating the individual psyche, but rather the relationship between psyche and the culture of the populace (i.e., the polis). This paper considers the complex underlying dynamics of leaders' hypnotic influence and the creation of an alternate reality.

A look at Albert Einstein's question "why war?" with a focus on large-group psychology.

There are observable realistic factors - economic, legal and political - that contribute to initiating and maintaining international conflicts, including starting wars. Behind such factors there are also various psychological elements. This paper recalls correspondence between Albert Einstein and Sigmund Freud and Freud's pessimistic response to the question "Why War?" and explores this question from the point of view of large-group psychology. The term "large group" describes thousands or millions of people, most of whom never see or even know about each other as individuals, but who share many of the same sentiments and the same realistic or fantasied ancestral history. This paper defines a concept, "large-group identity", and describes how protecting it plays a key role in maintaining and even initiating war-like situations or wars. This paper also considers the psychological make-up of a decision-maker with political power who encourages war.

Effective online large-group teaching in health professions education.

Online large-group teaching (OLGT), employed to reach a large group of learners in separate physical locations, allows asynchronous learning and facilitates social distancing. While online large-groups can be a powerful and resource-lean means of health professions education, it has challenges and potential pitfalls that may affect the learning process and outcomes. Through a sociomateriality framework, this article describes strategies for effective online large-group teaching in health professions education in three key strands. Firstly, to optimize learning, OLGT sessions should match learning needs with appropriate OLGT platforms, incorporate strategies to sustain learner attention, and accommodate learners of different abilities. Secondly, to develop a learning culture, OLGT must not only focus on cognitive aspects of learning but also build a community of practice, nurture digital professionalism and professional identity. Thirdly, we discuss the avoidance of pitfalls such as cognitive overload of both tutors and learners, technical issues and security risks, mitigating inequities in access to online learning, and the use of program evaluation to plan for sustained improvements. We conclude with a case vignette that discusses the challenges of OLGT and the application of the above strategies in a teaching scenario.

CASCADE your teaching session!

Medical education has seen a shift toward interactive teaching in small groups that actively involves students in learning. However, didactic teaching, despite drawbacks such as student isolation and low stimulation of critical thinking, is still a very commonly used teaching method. For didactic teaching to be effective, teachers must possess strategies and skills that enable them to teach effectively in large groups and increase students' knowledge retention. This can be achieved if class sessions are planned in advance with the aim of making them interactive and engaging with all students. In the following article, I write about my experiences using the CASCADE method, an acronym of the words "create," "assess," "sequence," "charisma," "activate," "discussion," and "e-device," which creates interactive didactic sessions.

Using a Mock Rounds Model and Neurology Patients to Teach Neurological Exam Skills in a Medical Neurobiology Course.

First-year medical student groups rotated through classrooms, each containing a Neurology patient and physician, as a "Neuro Day" event to make direct clinical connections with the basic sciences. Inspired by post-graduate Clerkships, this event provided timely first-hand experiences focusing on pathological neurologic exam findings. Qualitative and quantitative data were collected from end-of-course surveys. The results show how the event served to reinvigorate enthusiasm for learning Clinical Neurobiology outside the traditional lecture environment and could empower patients as educators within a teaching community.

Effective Large Group Teaching for General Surgery.

Large group settings display no signs of disappearing. Most surgeons charged with this education have received no formal training. Lecturing remains the most common method of educating large groups. Even though factors required for an excellent lecture are known, their inconsistent application results in variation of effectiveness. Long-standing principles of rhetoric and recent advances in neuroscience, cognitive science, learning models, and teaching theory play a role in achieving effectiveness. This article makes recommendations for creating and delivering lectures, including active learning opportunities and modern innovations in information technology supporting teaching methods. Effective lecturing skills are acquired by persistent deliberate practice.

TRAUMA, PREJUDICE, LARGE-GROUP IDENTITY AND PSYCHOANALYSIS.

Escaping Nazi annexation of Austria, Sigmund Freud and his family left there in 1938 to live the rest of their lives in exile in the house now known as the Freud Museum in London. This paper is based upon the author's Holocaust Day Memorial Lecture delivered virtually at this museum on January 27, 2021, which marked the 75th anniversary of the liberation of Auschwitz-Birkenau, the largest Nazi death camp. Besides remembering those who were lost during World War II, the content of this paper includes a description of different types of massive traumas, with a focus on disasters at the hand of the Other, and their impact on individuals and large groups. Sigmund Freud's ideas about relationships between communities and countries with adjoining territories, as well as large-group psychology, are updated, and individuals' and large groups' needs to grasp onto large-group identities is explained and illustrated with case reports.

Optimizing Multidisciplinary Simulation in Medical School for Larger Groups: Role Assignment by Lottery and Guided Learning.

PURPOSE: Medical school simulations are often designed for a limited number of students to maximize engagement and learning. To ensure that all first-year medical students who wished to join had an opportunity to participate, we designed a novel method for larger groups. PATIENTS AND METHODS: We devised a low technology "Orchestra Leader's" chart approach to prominently display students' roles, chosen by lottery. During simulation, the chart was mounted on an intravenous pole and served as a group organizational tool. A course instructor prompted students using the chart to accomplish the course objectives in a logical order. Real-life cardiologists and gastroenterologists provided the students with expert subspecialty consultation. We analyzed 125 anonymous student evaluation ratings for 3 years (2017-2019) with a range of 8 to 19 students per laboratory session. RESULTS: Our 2017-2019 larger group sessions were all rated as excellent (1.26, Mean, SD ±.510) on the Likert scale where 1.0 is excellent and 5.0 is poor. There were no statistically significant differences in overall ratings among the 2017, 2018 and 2019 sessions. The subspecialists were uniformly rated as excellent. Verbatim free-text responses demonstrated resounding student appreciation for the role assignment by lottery method. CONCLUSION: We designed a novel, "Orchestra Leader's" chart approach for accommodating larger groups in a multidisciplinary simulation laboratory using role assignment by lottery, roles depicted on an organizational chart, and expert instructor prompting. Our consistently excellent ratings suggest that our methods are useful for achieving well-rated larger group simulation laboratories.

Large-group one-session treatment: Feasibility and efficacy in 138 individuals with phobic fear of flying.

Recent research suggests that exposure-based large-group one-session treatments (LG-OSTs) may represent useful and efficient treatment options for different types of phobic fear. Although there are effective single session- and small group-interventions for the treatment of clinically relevant Fear of Flying (FoF), no LG-OST for this type of phobic fear has been realized so far. The present study aimed to investigate feasibility and efficacy of an LG-OST for the treatment of clinically relevant FoF. Two months after an initial diagnostics to assess FoF severity and confirm the underlying diagnoses (89% specific flight phobia; 10% agoraphobia), 138 patients attended the LG-OST consisting of psychoeducation, imparting of a breathing technique and a joint 2 ½ hour exposure flight in a chartered airplane (Airbus A320). FoF again was assessed at pre- and post-treatment as well as at 6-months follow-up with the latter again containing clinical diagnostics. Only a small decrease in FoF emerged in the pre-treatment interval. From pre-to post-treatment however, substantial reductions in FoF were observed with a large mean 'intention-to-treat' effect size of Cohen's d = 1.42 that remained stable over time (mean d = 1.44). At follow-up, 71% of the patients were rated as fully (55%) or partially remitted (16%). Also concerning the treatment of clinically relevant FoF, a LG-OST proved feasible and effective. Therefore, LG-OST can be regarded as a highly efficient and promising treatment tool which in terms of efficiency combines the advantages of one-session individual and group treatments.

Effects of seminar teaching method versus lecture-based learning in medical education: A meta-analysis of randomized controlled trials.

PURPOSE: The aim of this review is to explore the effects of the seminar teaching method versus lecture-based learning (LBL) in the education of medical students by meta-analysis. METHOD: Data and information available on PubMed, Cochrane Library, EMBASE, MEDLINE, China National Knowledge Infrastructure, WanFang Data, China Science Periodical Database, and Chinese BioMedical were searched and examined from the inception up to January 2020. Randomized controlled trials (RCTs) that investigated the effects of the seminar teaching method versus LBL in medical education were included. RESULTS: A total of 16 RCTs were included, with a total sample size of 1122 medical students. The seminar teaching method significantly improved knowledge scores (SMD = 1.38, 95%CI 0.92-1.84; p < 0.001) and skill scores (SMD = 1.46, 95%CI 1.00-1.91; p < 0.001) and the seminar teaching method significantly improved teaching effects, including active learning ability, learning interest, scientific innovation, and independent thinking ability, expression and communication ability, clinical thinking ability, teamwork, teacher-student interaction, and classroom atmosphere. CONCLUSIONS: This meta-analysis showed that the seminar teaching method is an effective method for improving knowledge scores, skill scores, active learning ability, student collaboration, classroom atmosphere, and interaction between teachers and students.

Large-group, asynchronous, interprofessional simulation: Identifying roles and improving communication with student pharmacists and student nurses.

BACKGROUND: Accreditation standards for health professions training programs continue to require interprofessional education (IPE) activities. Therefore, it is important for faculty collaboration to satisfy these requirements and provide meaningful, mutually beneficial opportunities for students to participate and learn. The medication use process is an integral component of nursing and pharmacy education. When feasible, asynchronous IPE activities that promote medication administration safety and facilitate equal contribution from involved students should be introduced into respective curricula. INTERPROFESSIONAL EDUCATIONAL ACTIVITY: This study employed a retrospective, pretest-posttest design to measure confidence, satisfaction, and communication. The asynchronous simulation included first-year (junior) student nurses (n = 126) and first year (P1) student pharmacists (n = 152). The simulation focused on the role-related knowledge, skills, and attitudes required to accurately call-in, retrieve, and fill a prescription. Details regarding design, setting, participants, facilitation of the simulation, and barriers overcome are described. DISCUSSION: Descriptive statistics are provided for satisfaction and confidence, with changes in confidence analyzed using binomial probability confidence intervals. This IPE simulation was an efficient and effective model for introducing students to the specific activity of communicating prescriptions among key members of the interprofessional team. IMPLICATIONS: Students reported increased confidence and satisfaction with this activity, which supports future iterations of the asynchronous simulation.

12 tips for effective questioning in medical education.

Questioning is one of the most frequently used and powerful teaching strategies across levels and settings in medical education. Although the concept of asking questions may seem like a simple practice, many medical educators lack pedagogical training. When effectively executed, questioning can elicit positive outcomes in learner participation, concentration, and understanding of content. When used incorrectly, questioning can leave learners feeling singled out and not in a position to learn, or worse - threatened or humiliated. There is a lot of literature in medical education about what ineffective questioning looks like, but little about how to enact effective questioning, such as what kind of questions should be asked and how to design those questions to improve learning. The following twelve tips will help medical educators be purposeful and effective as they plan, ask, and analyze questions in classroom or clinical settings.