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.

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.

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.

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.

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.

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.

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.

Video-assisted patient education to modify behavior: a systematic review.

OBJECTIVE: To evaluate the efficacy of video-assisted patient education to modify behavior. METHODS: Fourteen databases were searched for articles published between January 1980 and October 2013, written in English or German. Behavioral change as main outcome had to be assessed by direct measurement, objective rating, or laboratory data. RESULTS: Ten of the 20 reviewed studies reported successful behavioral modification in the treatment group. We discerned three different formats to present the information: didactic presentation (objective information given as verbal instruction with or without figures), practice presentation (real people filmed while engaged in a specific practice), narrative presentation (real people filmed while enacting scenes). Seven of the ten studies reporting a behavioral change applied a practice presentation or narrative presentation format. CONCLUSION: The effectiveness of video-assisted patient education is a matter of presentation format. Videos that only provide spoken or graphically presented health information are inappropriate tools to modify patient behavior. Videos showing real people doing something are more effective. PRACTICE IMPLICATIONS: If researchers wish to improve a skill, a model patient enacting the behavior seems to be the best-suited presentation format. If researchers aim to modify a more complex behavior a narrative presentation format seems to be most promising.

The effect of videotaping students' interviews with patients for interview skill education.

BACKGROUND: The importance of communication between patients and physicians has been proven in many previous studies. The authors analyzed the effect of interview skill education through videotapes which recorded students' interviews with real patients in the outpatient department of family medicine. METHODS: This study was conducted with all students who chose the elective course of family medicine and one randomly selected student every week from an 'infectious internal medicine' class at Dongguk University Ilsan Hospital during the period from December 2008 to March 2011. All students performed a preliminary examination of a new patient at the outpatient department of family medicine. All consultations were videotaped. Feedback to the student was given on the same day by viewing the videotape together. After feedback, all students performed another preliminary examination of one new patient at the department of family medicine the same week. Three family medicine residents scored all videotapes using 10-item interview skill checklists. Many parts of the checklists were modified using the Arizona Clinical Interview Rating Scales. RESULTS: Thirty-three students participated. Of 10 items, nine showed increased scores after feedback. There was a significant change in four items after feedback: 'type of question' (before 2.36 ± 0.60, after 2.73 ± 0.72), 'timeline' (before 2.82 ± 0.68, after 3.18 ± 0.73), 'positive verbal reinforcement' (before 2.24 ± 0.56, after 2.61 ± 0.90), and the total score (before 21.70 ± 2.62, after 23.39 ± 3.13) (P < 0.05). CONCLUSION: Giving feedback to medical school students on medical interview skills using videotapes of students' preliminary consultations with real patients in outpatient settings, was effective in improving the interview areas of 'type of question,' 'timeline,' 'positive verbal reinforcement,' and the total interview scores.

Breaststroke learning through the use of videotape feedback / Aprendizagem do nado peito através do fornecimento de feedback de videoteipe

People from all age groups and social backgrounds have always sought to learn swimming. However, the swimming learning process is usually considered repetitive and tiring, requiring the teacher to use methods that motivate students to join the practice without ignoring the need for improvement in their performance. This study assessed motivation during a breaststroke learning process in students who received videotape feedback, verbal feedback, and who did not receive any feedback during practice. Thirty-seven swimming inexperienced students were divided into three groups: Video (n=13), which received videotape feedback; Verbal (n=15), which received verbal feedback; and Control (n=9), which did not receive any feedback during experimental phases (pre-test, acquisition (5 days), post-test and retention). Participants completed a questionnaire based on Likert scale for motivation assessment. Scores were given to their performance by a swimming teacher to assess breaststroke learning during each experimental phase. Results of motivation assessment showed that students who received feedback (videotape or verbal) felt more motivated during practice than those who did not receive any feedback. Regarding the breaststroke learning, all participants improved their performance along experimental phases, but, during the retention one, Verbal group's performance was considered superior to the Control group's performance. This study concluded that the use of videotape and verbal feedback has motivational results on breaststroke learning, and that it is effective in the learning process.

Pessoas de todas as idades e contextos sociais sempre buscaram aprender a nadar. Porém, o processo de ensino da natação é frequentemente reconhecido como repetitivo e cansativo, exigindo do professor a aplicação de métodos que motivem os alunos a aderirem à prática sem desconsiderar melhorias no desempenho. Assim, este estudo avaliou a motivação e a aprendizagem do nado peito de participantes que receberam feedback de videoteipe, que receberam feedback verbal e que não receberam feedback durante a prática. Trinta e sete participantes inexperientes em natação foram divididos entre os grupos Vídeo (n=13) que recebeu feedback de videoteipe, Verbal (n=15) que recebeu feedback verbal e Controle (n=9) que não recebeu feedback durante as fases experimentais: pré-teste, aquisição (5 dias), pós-teste e retenção. Para avaliação da motivação, os participantes responderam um questionário baseado em escala Likert. Para avaliação da aprendizagem, foram atribuídas notas ao desempenho dos participantes nas fases experimentais por uma professora de natação. Os resultados referentes à avaliação da motivação mostraram que participantes que receberam feedback (videoteipe ou verbal) se sentiram mais motivados durante a prática do que os que não receberam. Quanto à avaliação da aprendizagem, todos os participantes melhoraram seu desempenho ao longo das fases experimentais, mas na fase de retenção o desempenho dos participantes do grupo Verbal foi considerado superior ao do grupo Controle. Pôde-se concluir que a utilização de feedback de videoteipe e verbal tem efeito motivacional na aprendizagem do nado peito quando comparada com ausência de fornecimento de feedback e é eficiente para aprendizagem.

Assessing the quality of interdisciplinary rounds in the intensive care unit.

PURPOSE: Interdisciplinary rounds (IDRs) in the intensive care unit (ICU) are increasingly recommended to support quality improvement, but uncertainty exists about assessing the quality of IDRs. We developed, tested, and applied an instrument to assess the quality of IDRs in ICUs. MATERIALS AND METHODS: Delphi rounds were done to analyze videotaped patient presentations and elaborated together with previous literature search. The IDR Assessment Scale was developed, statistically tested, and applied to 98 videotaped patient presentations during 22 IDRs in 3 ICUs for adults in 2 hospitals in Groningen, The Netherlands. RESULTS: The IDR Assessment Scale had 19 quality indicators, subdivided in 2 domains: "patient plan of care" and "process." Indicators were "essential" or "supportive." The interrater reliability of 9 videotaped patient presentations among at least 3 raters was satisfactory (κ = 0.85). The overall item score correlations between 3 raters were excellent (r = 0.80-0.94). Internal consistency in 98 videotaped patient presentations was acceptable (α = .78). Application to IDRs demonstrated that indicators could be unambiguously rated. CONCLUSIONS: The quality of IDRs in the ICU can be reliably assessed for patient plan of care and process with the IDR Assessment Scale.

The Effect of Videotaping Students' Interviews with Patients for Interview Skill Education / 가정의학회지

BACKGROUND: The importance of communication between patients and physicians has been proven in many previous studies. The authors analyzed the effect of interview skill education through videotapes which recorded students' interviews with real patients in the outpatient department of family medicine. METHODS: This study was conducted with all students who chose the elective course of family medicine and one randomly selected student every week from an 'infectious internal medicine' class at Dongguk University Ilsan Hospital during the period from December 2008 to March 2011. All students performed a preliminary examination of a new patient at the outpatient department of family medicine. All consultations were videotaped. Feedback to the student was given on the same day by viewing the videotape together. After feedback, all students performed another preliminary examination of one new patient at the department of family medicine the same week. Three family medicine residents scored all videotapes using 10-item interview skill checklists. Many parts of the checklists were modified using the Arizona Clinical Interview Rating Scales. RESULTS: Thirty-three students participated. Of 10 items, nine showed increased scores after feedback. There was a significant change in four items after feedback: 'type of question' (before 2.36 +/- 0.60, after 2.73 +/- 0.72), 'timeline' (before 2.82 +/- 0.68, after 3.18 +/- 0.73), 'positive verbal reinforcement' (before 2.24 +/- 0.56, after 2.61 +/- 0.90), and the total score (before 21.70 +/- 2.62, after 23.39 +/- 3.13) (P < 0.05). CONCLUSION: Giving feedback to medical school students on medical interview skills using videotapes of students' preliminary consultations with real patients in outpatient settings, was effective in improving the interview areas of 'type of question,' 'timeline,' 'positive verbal reinforcement,' and the total interview scores.

Development and evaluation of a video discharge education program focusing on mother-infant interaction for mothers of premature infants.

PURPOSE: This study was done to develop a video discharge education program focusing on mother-infant interaction to facilitate the development of maternal role confidence for mothers of premature infants. METHODS: The process of the program was based on the Network-based Instructional System Design suggested by Jung (1999). For the content of the program, needs and concerns of mothers of premature infants found on web sites and existing literature were analyzed. Based on this content, the scenario and the video were developed. Nurses and mothers of premature infants participated in the process of testing the content validity, scenario development, and evaluation of final video production. The final video has two parts and lasts 21 minutes. The first part focuses on mother-premature infant interaction and the second part focuses on health management of infants. RESULTS: Eleven mothers of premature infants participated in the evaluation of the appropriateness of the video as a teaching method and for educational content. They reported that the content on mother-infant interaction, maternal sensitivity, and maternal role confidence was especially beneficial. CONCLUSION: The findings indicate that video program is effective for education on maternal-premature infant interaction and the use of video in practical settings is strongly recommended.

Development and Evaluation of a Video Discharge Education Program focusing on Mother-infant Interaction for Mothers of Premature Infants

PURPOSE: This study was done to develop a video discharge education program focusing on mother-infant interaction to facilitate the development of maternal role confidence for mothers of premature infants. METHODS: The process of the program was based on the Network-based Instructional System Design suggested by Jung (1999). For the content of the program, needs and concerns of mothers of premature infants found on web sites and existing literature were analyzed. Based on this content, the scenario and the video were developed. Nurses and mothers of premature infants participated in the process of testing the content validity, scenario development, and evaluation of final video production. The final video has two parts and lasts 21 minutes. The first part focuses on mother-premature infant interaction and the second part focuses on health management of infants. RESULTS: Eleven mothers of premature infants participated in the evaluation of the appropriateness of the video as a teaching method and for educational content. They reported that the content on mother-infant interaction, maternal sensitivity, and maternal role confidence was especially beneficial. CONCLUSION: The findings indicate that video program is effective for education on maternal-premature infant interaction and the use of video in practical settings is strongly recommended.

Avaliação da consulta médica realizada por ingressantes na residência de Pediatria / Assessment of medical consultations performed by incoming residents in Pediatrics

Diversos autores relatam que a consulta médica se associa a melhores resultados quando se adota como referencial o modelo centrado no paciente. OBJETIVO: Avaliar se os médicos ingressantes na residência de Pediatria realizam consultas ambulatoriais segundo pressupostos do modelo centrado no paciente. MÉTODO: Em 2007, no início de seu estágio de ambulatório, dez residentes foram selecionados aleatoriamente para serem filmados durante a realização de uma consulta. Adotando-se como referencial teórico pressupostos do modelo centrado no paciente, os dados foram analisados por meio de metodologia qualitativa, por meio da técnica exploratória, com três juízes independentes. RESULTADOS: A maioria dos residentes explora precocemente a primeira queixa referida pelos pais, assumindo-a como principal; não explora outras queixas; decide e faz orientações terapêuticas de modo não compartilhado; conversa pouco com as crianças; cria longos momentos de silêncio durante a consulta; não explica o exame físico e às vezes utiliza o prontuário como a principal fonte de informação. CONCLUSÃO: Os residentes realizam consultas sem a inclusão da perspectiva dos pais e, portanto, não atendem segundo pressupostos do modelo centrado no paciente.

Various authors have reported that medical consultations produce better results when based on the patient-centered model. OBJECTIVE: The objective of this study was to evaluate whether incoming residents in pediatrics conducted outpatient consultations according to the patient-centered model. METHODS: In 2007, ten residents in the early stage of their outpatient rotation were randomly selected to be filmed during a consultation. With the patient-centered model as the theoretical reference, the data were analyzed by means of a qualitative methodology using an exploratory technique, with three independent judges. RESULTS: The majority of the residents: explored the first complaint reported by the patient's parents too early, assuming that it was the principal complaint; failed to explore other complaints; made decisions and provided treatment instructions without sharing the process; spoke little with the children; left long periods of silence during the consultation; failed to explain the physical examination to the parents; and sometimes used the patient chart as their principal source of information. CONCLUSION: Residents conducted consultations without including the parents'perspective and thus failed to meet the central premises of the patient-centered model.

Correlations of clinical assessment tools with written examinations.

PURPOSE: Despite the goal of medical education, which is 'training to be a primary care physician,' only written examinations (WEs) generally have been used to assess medical student ability. We assessed clinical competence using the CPX (clinical performance examination), PA (portfolio assessment), VMA (video-monitoring assessment), CGD (case group discussion), and PCP (primary clinical practice) during students' clerkships in family medicine and correlated these clinical assessment tools with WEs. Also, we correlated these tools with each other to determine the feasibility of each as a replacement of the other tools. METHODS: Thirty-nine fourth year students at University of Ulsan College of Medicine took part in their clerkship in family medicine for 2 weeks during the first session of 2005. They took 1 CPX, 2 VMAs, 6 CGDs, and 2 PCPs and were required to submit their portfolios at the end of the clerkship. We evaluated the correlations of these tools and WEs by the overall scores of each class year and in each subject. RESULTS: The CPX, VMA, and PCP showed no significant correlation,while PA showed strong correlation with 4th year students' overall WEs. The CGD showed strong correlation with all overall scores and with almost all subjects. In addition, the PA correlated significantly with CGD. CONCLUSION: New clinical assessment tools, such as CPX, PA, and VMA, have no significant correlation with WE, even though these tools closely correspond with real clinical practice. Therefore, these tools should be considered as complementary instruments to better assess clinical competence.