A model of engagement in reflective writing-based portfolios: Interactions between points of vulnerability and acts of adaptability.

BACKGROUND: Portfolios are widely used for meeting new accreditation standards in the age of competency-based medicine. However, the method of learning through portfolio has been suggested to be vulnerable. AIM: The aim of this study was to explore conditions affecting the experience of teaching and learning from the perspective of both students and mentors in a reflective writing-based portfolio initiative. METHOD: Using mixed-methods rooted in grounded theory, 139 students and 13 mentors completed questionnaires, 23 students participated in four focus groups and 9 mentors in individual interviews. RESULTS: The overarching theme in our data was student-mentor engagement. Our results confirm previous literature describing portfolio as a vulnerable method of learning, extend this concept by identifying and categorizing specific points of vulnerability, and contribute new knowledge regarding acts of adaptability, which serve to strengthen the student-mentor relationship. CONCLUSION: Engagement is central to the success of portfolio and is shaped by a dynamic interaction between points of vulnerability and acts of adaptability. We propose a model of engagement in portfolio that can be used for faculty development to optimize student-mentor engagement.

Factors in client-clinician interaction that influence hearing aid adoption.

The influence of client-clinician interactions has not been emphasized in hearing health care, despite the extensive evidence of the impact of the provider-patient interaction on health outcomes. The purpose of this study was to identify factors in the client-clinician interaction that may influence hearing aid adoption. Thirteen adults who had received a hearing aid recommendation within the previous 3 months and 10 audiologists participated in a study to generate, sort, and rate the importance of factors in client-clinician interaction that may influence the hearing aid purchase decision. A concept mapping approach was used to define meaningful clusters of factors. Quantitative analysis and qualitative interpretation of the statements resulted in eight concepts. The concepts in order of their importance are (a) Ensuring client comfort, (b) Understanding and meeting client needs, (c) Client-centered traits and actions, (d) Acknowledging client as an individual, (e) Imposing undue pressure and discomfort, (f) Conveying device information by clinician, (g) Supporting choices and shared decision making, and (h) Factors in client readiness. Two overarching themes of client-centered interaction and client empowerment were identified. Results highlight the influence of the client-clinician interaction in hearing aid adoption and suggest the possibility of improving hearing aid adoption by empowering clients through a client-centered interaction.

Adaptation of the BKB-SIN test for use as a pediatric aided outcome measure.

BACKGROUND: There is a need for objective pediatric hearing aid outcome measurement and thus a need for the evaluation of outcome measures. We explored a commercially available pediatric sentence-in-noise measure adapted for use as an aided outcome measure. PURPOSE: The purposes of the current study were (1) to administer an adapted BKB-SIN (Bamford-Kowal-Bench Speech-in-Noise test) to adults and children who have normal hearing and children who use hearing aids and (2) to evaluate the utility of this adapted BKB-SIN as an aided, within-subjects outcome measure for amplification strategies. RESEARCH DESIGN: We used a mixed within and between groups design to evaluate speech recognition in noise for the three groups of participants. The children who use hearing aids were tested under the omnidirectional, directional, and digital noise reduction (DNR) conditions. Results from each group were compared to each other, and we compared results of each aided condition for the children who use hearing aids to evaluate the test utility as an aided outcome measure. STUDY SAMPLE: The study sample consisted of 14 adults with normal hearing (aged 22-28 yr) and 15 children with normal hearing (aged 6-18 yr), recruited through word of mouth, and 14 children who use hearing aids (aged 9-16 yr) recruited from local audiology clinics. DATA COLLECTION AND ANALYSIS: List pairs of the BKB-SIN test were presented at 50 dB HL as follows: four list pairs to each participant with normal hearing, four list pairs in the omnidirectional condition, and two list pairs in the directional and DNR conditions. Children who use hearing aids were fitted bilaterally with laboratory devices and completed the BKB-SIN test aided. Data were plotted as mean percent of key words correct at each signal-to-noise ratio (SNR). Further, we conducted an analysis of variance for group differences and within-groups for the three aided conditions. RESULTS: Adult participants outperformed children with normal hearing, who outperformed the children who use hearing aids. SNR-50 (signal-to-noise ratio at which listener can obtain a speech recognition score of 50% correct) scores demonstrated reliability of the adapted test implementation. The BKB-SIN test measured significant differences in performance for omnidirectional versus directional microphone conditions but not between omnidirectional and DNR conditions. CONCLUSIONS: We conclude that the adapted implementation of the BKB-SIN test can be administered reliably and feasibly. Further study is warranted to develop norms for the adapted implementation as well as to determine if an adapted implementation can be sensitive to age effects. Until such norms are developed, clinicians should refrain from comparing results from the adapted test to the test manual norms and should instead use the adapted implementation as a within-subject measure.