Exploring nurses' emotional reactions to and reporting of patient-on-nurse workplace violence: A mixed-methods study.

BACKGROUND: Workplace violence, including violent, intimidating, and disruptive acts, commonly occurs in healthcare settings. Type 2 workplace violence in nursing refers to patient/visitor behaviors directed toward clinicians, contributing to physical and psychological harm. Nurse victims often do not report these events to employers or law enforcement, making it challenging to address workplace violence. OBJECTIVES: Our research examined nurse reactions to Type 2 workplace violence by identifying what behaviors they perceived as aggressive and reportable. Specific aims included: 1) developing and testing video vignettes to portray realistic patient aggression scenarios; 2) identifying nurse understandings of aggressive events that prompt affective reactions, and; 3) examining clinical characteristics related to the nurse victim's likelihood to report. DESIGN: Through a sequential mixed-methods design, we qualitatively developed novel video vignettes portraying Type 2 workplace violence to experimentally examine how nurses interpreted them within a quantitative repeated measures survey. METHODS: Two expert nurse research panels (n = 10) created five vignettes, from which nurses (n = 282) completed a survey with 1382 unique responses. Analyses included descriptive statistics and repeated measures ANOVA/regression models. RESULTS: Video vignettes realistically portrayed workplace violence events, eliciting negative emotional responses among nurses that increased in magnitude with statistical significance as the level of displayed aggression escalated. Statistically significant factors influencing nurse reporting of workplace violence included; 1) the level of aggression displayed by the patient; 2) the level of harm received by the nurse; 3) whether the nurse felt the patient's actions were intentional, and; 4) the nurse's perceived frequency of exposure to workplace violence. CONCLUSIONS: Results suggested that nurse victims of Type 2 workplace violence experience depression, anger, fear, and anxiety, which may contribute to long-term mental health consequences. Findings also identified factors related to nurse reporting behaviors, which may help mitigate workplace violence in healthcare settings by informing research and promoting workplace practices that encourage reporting and safety. REGISTRATION: Not registered. TWEETABLE ABSTRACT: Nurse reactions to workplace violence: Video vignettes reveal escalating aggression's impact on reporting. #EndNurseAbuse #WorkplaceViolence.

Video recording emergency care and video-reflection to improve patient care; a narrative review and case-study of a neonatal intensive care unit.

As the complexity of emergency care increases, current research methods to improve care are often unable to capture all aspects of everyday clinical practice. Video recordings can visualize clinical care in an objective way. They can be used as a tool to assess care and to reflect on care with the caregivers themselves. Although the use of video recordings to reflect on medical interventions (video-reflection) has increased over the years, it is still not used on a regular basis. However, video-reflection proved to be of educational value and can improve teams' management and performance. It has a positive effect on guideline adherence, documentation, clinical care and teamwork. Recordings can also be used for video-reflexivity. Here, caregivers review recordings together to reflect on their everyday practice from new perspectives with regard to context and conduct in general. Although video-reflection in emergency care has proven to be valuable, certain preconditions have to be met and obstacles need to be overcome. These include gaining trust of the caregivers, having a proper consent-procedure, maintaining confidentiality and adequate use of technical equipment. To implement the lessons learned from video-reflection in a sustainable way and to continuously improve care, it should be integrated in regular simulation training or education. This narrative review will describe the development of video recording in emergency care and how video-reflection can improve patient care and safety in new ways. On our own department, the NICU at the LUMC, video-reflection has already been implemented and we want to further expand this. We will describe the use of video-reflection in our own unit. Based on the results of this narrative review we will propose options for future research to increase the value of video-reflection.

Sistematización de experiencias como método para la retroalimentación de la práctica educativa / Systematization of experiences as a method for feedback on educational practice

RESUMEN. El proceso de enseñanza-aprendizaje hace prioritario valorar las experiencias y perspectivas de los actores involucrados, para ello, es necesario promover la dialogicidad entre estudiantes y docentes, como una actividad de retroalimentación que oriente a la reflexión y análisis en busca de la adaptación y mejora del mismo. El objetivo del estudio fue valorar la práctica educativa sustentada en el enfoque de pensamiento complejo, a partir de la perspectiva estudiantil. El presente trabajo muestra los datos obtenidos a partir de sistematización de experiencias académicas desarrollada con 23 estudiantes del segundo semestre de Licenciatura en Educación Física, con respecto, al primer objeto de estudio del proyecto formativo implementado que atiende la asignatura Bases Psicopedagógicas en el semestre enero-junio 2018, para lo cual se atendieron tres fases procedimentales: reconstrucción, interpretación y potenciación de la experiencia. Haciendo uso de la videograbación y observación participante, se analizó como unidad de observación al pensamiento complejo y como unidades de análisis 1. La planeación analítica de clase compuesta por 2. Estrategias docentes innovadoras y 3. La metodología de evaluación. Los resultados muestran que los estudiantes manifiestan interés y motivación por las unidades de análisis 2 y 3, expresando que les favorecen las clases dinámicas y la valoración de su trabajo con un carácter formativo y no memorístico. En cuanto a la unidad de observación 1, manifestaron un dominio limitado acerca de la propuesta presentada por la docente. Se rescata su interés y satisfacción porque las asignaturas teóricas los sitúen en su realidad laboral.

ABSTRACT. In the teaching-learning process it becomes a priority to assess the experiences and perspectives of the actors involved, for this it is necessary to promote dialogue between students and teachers, as a feedback activity that guides reflection and analysis in search of adaptation and of the improvement of it. The objective was to assess the educational practice based on the complex thinking approach from the student perspective. The present work shows the data obtained from Systematization of Academic Experiences developed with 23 students of the second semester of the Degree in Physical Education, with respect to the first object of study of the formative project implemented that attends the subject Psychopedagogical Bases in the semester January -June 2018, for which three procedural phases were attended: reconstruction, interpretation and enhancement of the experience. Using video recording and participant observation, it was analyzed as a unit of observation to complex thinking and as units of analysis 1.The analytical class planning, 2. The teaching strategies implemented and 3. The evaluation methodology. The results show that the students express interest and motivation for the analysis units 2 and 3, expressing that they favor dynamic classes and the valuation of their work with a formative and non-memorial character. Regarding the observation unit 1, they expressed limited mastery of the proposal presented by the teacher. Their interest and satisfaction are rescued because the theoretical subjects place them in their work reality.

Evaluation of the effect of video tutorial training on improving pharmacy students' knowledge and skills about medication reconciliation.

OBJECTIVES: This study aimed to describe the effect of using an innovative teaching strategy using a video tutorial on enhancing students' knowledge about medication reconciliation, and skills in identifying medication discrepancies. METHODS: This is a one group pre-post interventional study that was conducted at the School of Pharmacy at Applied Science Private University. Sixty pharmacy students were invited to attend an educational sessions that involve watching a 6-minutes video tutorial. The first two levels of the Kirkpatrick's Model were used to evaluate the effectiveness of this training tool. Level 1 (Reaction) was assessed using a satisfaction questionnaire, while level 2 (Learning) was assessed using two criteria: 1) student acquired knowledge about medication reconciliation using a questionnaire and a knowledge score out of 13 was calculated for each student, and 2) student acquired skills in identifying medication discrepancies using a virtual case scenario. If the student was able to identify any of the four impeded discrepancies he/she rewarded 1 point for each identified discrepancy, but if they identified any incorrect discrepancy they scored a negative point. RESULTS: Among the 60 students who registered to participate in the study, 49 attended the educational training (response rate 81.6%). The majority of them (n=44, 89.8%) were satisfied with the training process. Before the video tutorial, students showed an overall low knowledge score [4.08/13.0, SD 1.81], and low ability to identify discrepancies [0.72 identified discrepancies out of 4.0, SD 1.1]. Following the video tutorial, the overall knowledge score was improved (p<0.001), and students were able to identify more discrepancies after watching the video (p<0.001). CONCLUSION: In conclusion, video education has shown itself to be an effective method to educate pharmacy students.. This visualized method can be applied to other areas within pharmacy education. We encourage the integration of videos within the learning process to enhance students' learning experience and to support the traditional learning provided by the teaching staff.

Preventing Error in the Operating Room: Five Teaching Strategies for High-Stakes Learning.

BACKGROUND: Effective communication in the operating room between the attending and resident surgeon is necessary to prevent surgical errors. Yet, existing studies do not describe what successful intraoperative teaching looks like and how it prevents errors. Our objective was to identify strategies for successful intraoperative teaching by comparing perspectives of the learner and teacher for the same moments. MATERIAL AND METHODS: We conducted a naturalistic inquiry by filming five live surgical teaching cases and analyzing more than 250 teaching exchanges, centered on steps with high likelihood for error. We interviewed each attending and resident, who separately viewed cued video clips, and asked how they made their teaching more visible. We compared answers, looking for common understandings of the same moment. Answers were coded, compared to each other, refined, and combined into larger themes. RESULTS: We identified five successful strategies for communicating avoidance of intraoperative errors: augmenting verbal instruction with small physical actions, pausing the surgical procedure to explain the larger picture, querying the residents' knowledge about specific steps, creating memorable coined names, and issuing highly specific commands. Strikingly, we found a significant example of miscommunication between the attending surgeon and resident that was a near-miss uterine perforation during a dilation and curettage. CONCLUSIONS: Attending surgeons are strategic in their intraoperative communications with learners, resulting in a scarcity of surgical errors when the resident is operating. We present real examples of five successful intraoperative teaching strategies. Successful intraoperative teaching relies heavily on tacit information, necessitating that attending and resident share a common understanding about the next step of the case.

Maintaining operative efficiency while allowing sufficient time for residents to learn.

BACKGROUND: Surgical residents desire independent operating experience but recognize that attendings have a responsibility to keep cases as short as possible. METHODS: We analyzed video and interviews of attending surgeons related to more than 400 moments in which the resident was the primary operator. We examined these moments for themes related to timing and pace. RESULTS: Our surgeons encouraged the residents to speed up when patient safety could be jeopardized by the case moving too slowly. In contrast, they encouraged the residents to slow down when performing a crucial step or granting independence. Attending surgeons encouraged speed through economical language, by substituting physical actions for words, and through the use of Intelligent Cooperation. Conversely, they encouraged slowing down via just-in-time mini-lectures and by questioning the trainee. CONCLUSIONS: We present recommendations for safe teaching in the operating room while simultaneously maintaining overall surgical flow. Teaching residents to operate quickly can save time and is likely based on an automaticity in teaching. Slowing a resident down is vital for trainee skill development and patient safety.

Is arthroscopic videotape a reliable tool for describing early joint tissue pathology of the knee?

BACKGROUND: The aim of this study was to assess the reliability of the videotape scoring system collected during knee arthroscopy for meniscal tears, and to test the consistency with intra-operative findings. METHODS: Fifty-seven patients undergoing arthroscopic treatment of meniscal tears were included in the analysis. The cartilage damage was assessed intra-operatively, at six sites, using the Outerbridge scoring system. The meniscal tears were graded according to the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification. The presence of synovial inflammation was scored, at four different sites, according to the macro-score method. The total cartilage, meniscal and synovial scores were calculated for each knee by the sum of the maximum grade of the lesions at each anatomic site. In order to assess the reliability of the arthroscopic scoring system, the videotapes recorded during the arthroscopy were reviewed by two independent observers one year after the surgery and compared with the scores completed by the surgeon during the operation. RESULTS: The total cartilage score showed substantial inter-rater and intra-rater reliability, and moderate consistency with the intra-operative score provided by the surgeon. The total meniscal score showed substantial inter-rater and intra-rater reliability, and good consistency with the intra-operative findings. The total synovial score showed substantial inter-rater agreement, substantial intra-rater reliability, and moderate consistency with intra-operative findings. CONCLUSIONS: The videotape scoring system provided a reliable and reproducible system for recording the intra-operative state of the whole joint pathology in patients undergoing arthroscopic treatment of meniscal tears.

Use of personal protective equipment among health care personnel: Results of clinical observations and simulations.

BACKGROUND: Very little is known about how health care personnel (HCP) actually use personal protective equipment (PPE). METHODS: The clinical PPE practices of 50 HCP from selected units at the University of Pittsburgh Medical Center (UPMC) Presbyterian Hospital were videotaped with HCP consent. For 2 PPE simulation sessions (simple and full-body sets), 82 HCP were recruited throughout the UPMC system. Simulation practices were videotaped and examined using fluorescent powder with ultraviolet lighting. All participants completed an electronic survey. For a follow-up evaluation simulation, 12 HCP were recruited among simulation participants. RESULTS: Among 130 total sessions from 65 participants, contamination occurred in 79.2% of simulations during the doffing process with various PPE items: simple set (92.3%) and full-body set (66.2%). Among 11 follow-up evaluation participants, contaminations still occurred in 82% after receiving individual feedback, but the overall contamination level was reduced. Using the contamination information gained during the simulation analysis, 66% of potential contamination was estimated for the clinical observation. Concerns and barriers in PPE use from HCP survey responses were as follows: time-consuming, cumbersomeness, and PPE effectiveness. CONCLUSIONS: Although HCP knew they were being videotaped, contamination occurred in 79.2% of the PPE simulations. Devising better standardized PPE protocols and implementing innovative PPE education are necessary to ensure HCP safety.

Longitudinal Faculty Development Program to Promote Effective Observation and Feedback Skills in Direct Clinical Observation.

Introduction: We developed a longitudinal faculty development program to maximize faculty training in direct clinical observation (DCO) and feedback, as there was a perceived need for higher quality of DCO and feedback. To achieve this, we created a behaviorally anchored DCO instrument and worked to improve faculty skills in this area. Methods: We describe an innovative model of faculty training that is learner centered and reinforces evidence-based principles of effective feedback that are introduced and then repeated in all sessions. The training centers on both peer-led observation of and feedback on faculty learners' recorded DCO feedback encounters, and is guided by our DCO instrument. Residents and faculty completed surveys to assess program impact. Qualitative responses were analyzed for themes. The Wilcoxon signed rank test was used to examine significance of difference in feedback quality before and after DCO faculty development education sessions. Results: Our faculty development program has been well received and had a significant impact on quality of faculty feedback, as rated by resident learners. Discussion: Our faculty development model is effective at growing faculty learners' DCO and feedback skills. Potential strengths of this program include the use of a behaviorally anchored DCO instrument, longitudinal and experiential faculty development, and use of small-group peer review of recorded faculty feedback encounters. We have found that when their learning needs are attended to, faculty learners cultivate a deep appreciation for principles of effective feedback. In fact, faculty feedback skills can be enhanced in the eyes of resident learners.

Maternal behavior as a predictor of sibling interactions during mealtimes.

Children who frequently experience encouragement or pressure to eat are more likely to exhibit less favorable eating behaviors and dietary outcomes. Siblings can encourage or pressure each other to eat during mealtimes, but the role of mothers in shaping sibling mealtime interactions is not understood. The objective of this study was to examine the association between the behavior of mothers and siblings during mealtimes. The associations of maternal presence and maternal engagement with children during mealtimes with encouragements to eat delivered by the child to his/her sibling were examined. Children aged 4-8years (n=73) were videotaped while eating a routine evening meal at home with one sibling present. Encouragement to eat delivered by the index child to the sibling, maternal presence, and non-food-related and food-related maternal engagement were coded from the videotapes. Poisson regression showed that maternal presence was associated with fewer encouragements to eat from the index child to the sibling (rate ratio (RR): 0.40, 95% confidence interval (CI): 0.26, 0.62). Each type of maternal engagement was independently associated with the number of encouragements to eat from the index child to the sibling: maternal engagement that was not food-related was associated with fewer encouragements to eat (RR: 0.62, 95% CI: 0.53, 0.73), while maternal engagement that was food-related was associated with more encouragements to eat (RR: 1.49, 95% CI: 1.22, 1.81). Future studies may explore how sibling interactions may mediate links between maternal behavior during mealtimes and children's health-related outcomes.

Sibling feeding behavior: Mothers as role models during mealtimes.

Siblings may act as caregivers and role models during mealtimes, and develop caregiving skills by observing and imitating the behavior of their mothers. The objective of this study was to examine the association between maternal feeding behaviors and encouragements to eat delivered from the sibling to the index child during mealtimes. Index children aged 4-8 years (n = 69) were videotaped while eating a routine evening meal at home with one sibling present. Encouragements to eat delivered from the sibling to the index child were coded from the videotapes. Mothers completed the Child Feeding Questionnaire and the Caregiver's Feeding Styles Questionnaire. Poisson regression was used to examine the association of maternal Pressure to Eat, Restriction, Monitoring, Verbal Direction, and Coercion with number of encouragements to eat delivered from the sibling to the index child. Models were adjusted for index child's age, sex, and race/ethnicity, and maternal education. Results showed that maternal Pressure to Eat (Rate Ratio (RR): 1.39, 95% confidence interval (CI): 1.19, 1.69), Restriction (RR: 1.31, 95% CI: 1.07, 1.60), Verbal Direction (RR: 2.04, 95% CI: 1.68, 2.47), and Coercion (RR: 1.58, 95% CI: 1.29, 1.92) were each positively associated with the number of encouragements to eat delivered from the sibling to the index child. Maternal Monitoring was not associated with the number of encouragements to eat delivered from the sibling to the index child (RR: 0.92, 97% CI: 0.78, 1.09). Findings suggest that maternal behavior during mealtimes may affect the index child indirectly by shaping the behavior of siblings. Since controlling feeding behaviors have been associated with greater child obesity risk, future studies may evaluate the compounded effect of experiencing controlling feeding behaviors from both mothers and siblings.

A multicenter, non-interventional study to evaluate patient-reported experiences of living with psoriasis.

BACKGROUND: Moderate to severe plaque psoriasis (with or without psoriatic arthritis) places significant burden on patients' lives. OBJECTIVE: Explore and document patients' experiences of living with psoriasis, including symptoms, treatments, impact on daily lives and patient-reported functioning. METHODS: In a US-based, non-interventional study, narrative interviews were conducted at baseline and again within 16 weeks. In interviews, patients with moderate to severe psoriasis indicated symptoms, ranked symptoms according to level of bother and indicated areas of their lives affected by psoriasis. Transcripts of interviews were coded for themes. Measurements of psoriasis severity including BSA, PGA and PASI were recorded. RESULTS: Symptoms reported most frequently included flaking/scaling (non-scalp areas), itching/scratching and rash, while the most bothersome symptoms were itching/scratching, flaking/scaling (non-scalp areas) and skin pain. Frequently reported impact areas were social and emotional. CONCLUSION: Broad-reaching interviews with patients with psoriasis show that these patients suffer in many aspects of their lives and in ways not indicated by typical psoriasis severity measures. Patients with psoriatic arthritis reported symptoms and disease-related complications at higher rates than those without arthritis. Physicians' explorations of the effect of psoriasis on patients' life events could aid in managing these patients.

Lifting Shadows off the End-of-Life Care: Hopes and Beliefs on Video Decision Support Tools for Advance Care Planning / 한국호스피스완화의료학회지

As advance care planning is taking center stage in the field of end-of-life care, various tools have been developed to aid in the often emotional and difficult decision-making process. Video decision support tools are one of the most promising means of assistance, of which the modus operandi is to provide more comprehensive and precise information of medical procedures to patients and their families, allowing them to make better informed decisions. Despite such value, some are concerned about its potential negative impact. For example, video footages of some procedures may be shocking and unpalatable to non-medical professionals, and patients and families may refuse the procedures. One approach to soften the sometimes unpleasant visual of medical procedures is to show less aggressive or more relaxing scenes. Yet another potential issue is that the objectivity of video decision support tools might be vulnerable to the very stakeholders who were involved in the development. Some might argue that having multiple stakeholders may function as checks and balances and provide collective wisdom, but we should provide more systematic guarantee on the objectivity of the visual decision aids. Because the decision of the modality of an individual's death is the last and most significant choice in one's life, no party should exert their influence on such a delicate decision. With carefully designed video decision support tools, our patients will live the last moments of their lives with dignity, as they deserve.

Videolaringoscopios: ¿la solución para el manejo de la vía aérea difícil o una estrategia más? Revisión no sistemática / Videolaryngoscopes: The solution for difficult airway management or just another strategy? Non-systematic review

Introduction: Difficult airway management remains a challenge and is a pillar of anesthesia training. At present, unsuccessful management of the difficult airway is a leading cause of complications in the practice of anesthesia, something that has led to regular updates to the management algorithms and the development of new technologies. Objectives: To review the current state of videolaryngoscopy and its impact on difficult airway management. Methods: With the keywords Videotape Recording; Laryngoscopy; Airway Management; Intubation; Intratracheal; Obesity; Anesthesia. A non-systematic review in the following databases was conducted: Pubmed/Medline, SciElo, LILACS). Results: Videolaryngoscopes are a new technology for the management of difficult airways that so far have not replaced the standard airway management algorithm devices. Its main impact is better visualization of the laryngeal structures. However, there are still controversies regarding the ease and success of tracheal intubation. Evidence of its usefulness in difficult airway management is weak. Conclusion: Knowledge of these devices and their limitations is an alternative in difficult airway scenario, but its real value and safety for the patient is still not defined and continues to be researched.

Introducción: el manejo de la vía área difícil continua siendo un reto y es uno de los pilares del entrenamiento en anestesia. En la actualidad, el manejo no exitoso de la vía aérea difícil representa una de las principales causas de complicación en el ejercicio de la anestesia que promueve la actualización regular de los algoritmos de manejo y al desarrollo de nuevas tecnologías. Objetivos: presentar el estado actual de los videolaringoscopios y su impacto en el manejo de la vía aérea. Métodos: con las palabras claves: Grabación en video Laringoscopia, Intubación intratraqueal; Vía aérea difícil; Obesidad; Anestesia; Emergencias se realizó una revisión no sistemática en bases de datos (PubMed/Medline, SciElo, Lilacs). Resultados: los videolaringoscopios son una tecnología adicional para el manejo de la vía aérea que hasta el momento no han demostrado sustituir los dispositivos estándares expuestos en el algoritmo de manejo de la vía aérea. Su principal impacto está determinado por la mejoría en la visualización de las estructuras de la laringe sin embargo aún hay controversias respecto a la facilidad y éxito de la intubación endotraqueal. La evidencia de su utilidad en el manejo exitoso de la vía aérea difícil es débil. Conclusiones: el conocimiento de estos dispositivos así como sus limitaciones constituye una alternativa en el escenario de la vía aérea difícil, pero su valor real y la seguridad que representa para el paciente aún no se han definido y continúa en investigación.

Effect of videotape for home instruction on the quality of life of tracheostomy patients: a randomized clinical trial.

Background: Nowadays, some of the patients, such as the patients with tracheostomy are taken care of at home. The quality of life of these cases may decrease due to the appearance of changes, limitations caused by tracheostomy and improper care. Objectives: This research was performed in order to discover the effect of videotape for home instruction on the quality of life of tracheostomy cases. Patients and Procedure: A quasi-empirical research was carried out on 80 cases by a tracheotomy in Amir Elm Hospital and the Imam Khomeini Medical Center in Tehran. Patients were randomized into two teams of invasion and check through the randomized block design method. At the time of discharge and after a routine training from the clinical staff, the two groups completed a questionnaire regarding the demographic information and the sf-36 quality of life. Then, the intervention team was given a CD containing the routine training for patient care to watch at home. After two months, the participants completed the sf-36 questionnaires again, and the data were entered into SPSS version 20. The information was investigated by using the statistical tests. Findings: The statistical investigation demonstrated that the comparison between the two groups after the intervention in the overall quality of life (p = 0.003) and all the concepts included: the physical role (p = 0.02), the mental role (p = 0.01), energy and fatigue (p = 0.03), motion health (p = 0.005), social functioning (p = 0.06), disorder (p = 0. 001), common health percentage (p = 0.002) and physical functioning (p = 0.001) in the arbitration team, being higher than in the check one. Conclusion: Using the videotape education additionally to routine care has a significant effect on the improvement of the quality of life in these patients. Therefore, the use of this method is recommended as a complementary program for tracheostomy patients.

Validity and reliability of global operative assessment of laparoscopic skills (GOALS) in novice trainees performing a laparoscopic cholecystectomy.

PURPOSE: Global Operative Assessment of Laparoscopic Skills (GOALS) assessment has been designed to evaluate skills in laparoscopic surgery. A longitudinal blinded study of randomized video fragments was conducted to estimate the validity and reliability of GOALS in novice trainees. METHODS: In total, 10 trainees each performed 6 consecutive laparoscopic cholecystectomies. Sixty procedures were recorded on video. Video fragments of (1) opening of the peritoneum; (2) dissection of Calot's triangle and achievement of critical view of safety; and (3) dissection of the gallbladder from the liver bed were blinded, randomized, and rated by 2 consultant surgeons using GOALS. Also, a grade was given for overall competence. The correlation of GOALS with live observation Objective Structured Assessment of Technical Skills (OSATS) scores was calculated. Construct validity was estimated using the Friedman 2-way analysis of variance by ranks and the Wilcoxon signed-rank test. The interrater reliability was calculated using the absolute and consistency agreement 2-way random-effects model intraclass correlation coefficient. RESULTS: A high correlation was found between mean GOALS score (r = 0.879, p = 0.021) and mean OSATS score. The GOALS score increased significantly across the 6 procedures (p = 0.002). The trainees performed significantly better on their sixth when compared with their first cholecystectomy (p = 0.004). The consistency agreement interrater reliability was 0.37 for the mean GOALS score (p = 0.002) and 0.55 for overall competence (p < 0.001) of the 3 video fragments. CONCLUSION: The validity observed in this randomized blinded longitudinal study supports the existing evidence that GOALS is a valid tool for assessment of novice trainees. A relatively low reliability was found in this study.

The modified gait abnormality rating scale in patients with a conversion disorder: a reliability and responsiveness study.

Individuals with conversion disorder have neurologic symptoms that are not identified by an underlying organic cause. Often the symptoms manifest as gait disturbances. The modified gait abnormality rating scale (GARS-M) may be useful for quantifying gait abnormalities in these individuals. The purpose of this study was to examine the reliability, responsiveness and concurrent validity of GARS-M scores in individuals with conversion disorder. Data from 27 individuals who completed a rehabilitation program were included in this study. Pre- and post-intervention videos were obtained and walking speed was measured. Five examiners independently evaluated gait performance according to the GARS-M criteria. Inter- and intrarater reliability of GARS-M scores were estimated with intraclass correlation coefficients (ICCs). Responsiveness was estimated with the minimum detectable change (MDC). Pre- to post-treatment changes in GARS-M scores were analyzed with a dependent t-test. The correlation between GARS-M scores and walking speed was analyzed to assess concurrent validity. GARS-M scores were quantified with good-to-excellent inter- (ICC = 0.878) and intrarater reliability (ICC = 0.989). The MDC was 2 points. Mean GARS-M scores decreased from 7 ± 5 at baseline to 1 ± 2 at discharge (t26 = 7.411, p < 0.001) and 85% of patients improved beyond the MDC. Furthermore, GARS-M scores and walking speed measurements were moderately correlated (r = -0.582, p = 0.004), indicating that the GARS-M has acceptable concurrent validity. Our findings provide evidence that the GARS-M scores are reliable, valid and responsive for quantifying gait abnormalities in patients with conversion disorder. GARS-M scores provide objective measures upon which treatment effects can be assessed.

Notes From the Field: Direct Observation Versus Rating by Videos for the Assessment of Central Venous Catheterization Skills.

Blinded assessments of technical skills using video-recordings may offer more objective assessments than direct observations. This study seeks to compare these two modalities. Two trained assessors independently assessed 18 central venous catheterization performances by direct observation and video-recorded assessments using two tools. Although sound quality was deemed adequate in all videos, portions of the video for wire handling and drape handling were frequently out of view (n = 13, 72% for wire-handling; n = 17, 94% for drape-handling). There were no differences in summary global rating scores, checklist scores, or pass/fail decisions for either modality (p > 0.05). Inter-rater reliability was acceptable for both modalities. Of the 26 discrepancies identified between direct observation and video-recorded assessments, three discrepancies (12%) were due to inattention during video review, while one (4%) discrepancy was due to inattention during direct observation. In conclusion, although scores did not differ between the two assessment modalities, techniques of video-recording may significantly impact individual items of assessments.

Self-assessment and goal-setting is associated with an improvement in interviewing skills.

PURPOSE: Describe the relationship between medical students' self-assessment and goal-setting (SAGS) skills and development of interviewing skills during the first-year doctoring course. METHOD: 157 first-year medical students completed three two-case standardized patient (SP) interviews. After each of the first two, students viewed videotapes of their interview, completed a SAGS worksheet, and reviewed a selected tape segment in a seminar. SAGS was categorized into good and poor quality and interviewing skills were rated by trained raters. RESULTS: SAGS improved over time (37% good week 1 vs. 61% good week 10). Baseline SAGS and interviewing skills were not associated. Initial SAGS quality was associated with change in interviewing skills - those with poor-quality SAGS demonstrated a decrease and those with good-quality SAGS demonstrated an increase in scores by 17 weeks (ANOVA F=4.16, p=0.024). For students whose SAGS skills were good at both week 1 and 10, interviewing skills declined in weeks 1-10 and then increased significantly at week 17. For those whose SAGS remained 'poor' in weeks 1-10, interviewing skills declined in weeks 10-17. CONCLUSIONS: In general, the quality of students' SAGS improved over time. Poor baseline SAGS skills and failure to improve were associated with a decrease in interviewing skills at 17 weeks. For students with better SAGS, interviewing skills increased at week 17. Improvement in SAGS skills was not associated with improved interviewing skills. Understanding structured self-assessment skills helps identify student characteristics that influence progressive mastery of communication skills and therefore may inform curriculum and remediation tailoring.