Entrustable professional activities and facets of competence in a simulated workplace-based assessment for advanced medical students.

Background: Competence-based assessment formats in medical education usually focus on individual facets of competence (FOCs). The concept of 'Entrustable Professional Activities' (EPAs) encompasses supervisors' decisions on which level of supervision a trainee requires to perform a professional activity including several FOCs. How the different FOCs as perceived by clinician raters contribute to entrustment decisions is yet unclear.Objective: How do FOC perceptions relate to entrustment-decisions?Methods: Sixty-seven advanced medical students participated in an assessment simulating the first day of a resident physician. Participants were rated by supervisors for seven FOCs and twelve EPAs.Results: There was a positive correlation between FOC and EPA scores. Each EPA displayed a different correlation pattern with FOC ratings.Discussion: For most EPAs high levels of entrustment were associated with high ratings for selected FOCs. The results are in alignment with the assumption that each EPA encompasses a different set of FOCs.Conclusions: In our simulated workplace-based assessment, entrustment decisions for EPAs reflect the FOCs observed in a trainee. Thus, assessment of FOCs alongside with EPA ratings could add to the understanding of factors contributing to entrustment decisions.

Exploring Self-Paced Embodiable Neurofeedback for Post-stroke Motor Rehabilitation.

Neurofeedback-guided motor-imagery training (NF-MIT) has been proposed as a promising intervention following upper limb motor impairment. In this intervention, paretic stroke patients receive online feedback about their brain activity while conducting a motor-imagery (MI) task with the paretic limb. Typically, the feedback provided in NF-MIT protocols is an abstract visual signal based on a fixed trial. Here we developed a self-paced NF-MIT paradigm with an embodiable feedback signal (EFS), which was designed to resemble the content of the mental act as closely as possible. To this end, the feedback was delivered via an embodiable, anthropomorphic robotic hand (RH), which was integrated into a closed-looped EEG-based brain-computer interface (BCI). Whenever the BCI identified a new instance of a hand-flexion or hand-extension imagination by the participant, the RH carried out the corresponding movement with minimum delay. Nine stroke patients and nine healthy participants were instructed to control RH movements as accurately as possible, using mental activity alone. We evaluated the general feasibility of our paradigm on electrophysiological, subjective and performance levels. Regarding electrophysiological measures, individuals showed the predicted event-related desynchronization (ERD) patterns over sensorimotor brain areas. On the subjective level, we found that most individuals integrated the RH into their body scheme. With respect to RH control, none of our participants achieved a high level of control, but most managed to control the RH actions to some degree. Importantly, patients and controls achieved similar performance levels. The results support the view that self-paced embodiable NF-MIT is feasible for stroke patients and can complement classical NF-MIT.

The Senses of Agency and Ownership: A Review.

Usually, we do not question that we possess a body and act upon the world. This pre-reflective awareness of being a bodily and agentive self can, however, be disrupted by different clinical conditions. Whereas sense of ownership (SoO) describes the feeling of mineness toward one's own body parts, feelings or thoughts, sense of agency (SoA) refers to the experience of initiating and controlling an action. Although SoA and SoO naturally coincide, both experiences can also be made in isolation. By using many different experimental paradigms, both experiences have been extensively studied over the last years. This review introduces both concepts, with a special focus also onto their interplay. First, current experimental paradigms, results and neurocognitive theories about both concepts will be presented and then their clinical and therapeutic relevance is discussed.

Rubber Hand Illusion Increases Pain Caused by Electric Stimuli.

The rubber hand illusion (RHI) has been shown to alter the experience of pain, although studies have yielded inconsistent results. In this experiment we tested the influence of the RHI on the intensity of pain caused by electric stimuli. Electric stimuli were delivered to participants' experimental and control hands before RHI induction (control condition) and afterward (experimental condition), in a procedure that was double-blind with respect to location and strength of noxious stimulation. All hands were covered during the stimulation to avoid the analgesic effect of seeing one's own body part. The perceived location of the hand and of pain were measured after each trial in the experimental condition. The results showed that noxious stimuli were experienced as more painful on the hand under the illusion. In addition, in the experimental condition the perceived location of noxious stimulation applied to the experimental hand drifted toward the rubber hand. Our data suggest that the link between bodily illusions and pain could be modulated by uncertainty about location of pain and the affected body part. Future studies should aim to determine which aspects of altered body awareness lead to pain sensitization. PERSPECTIVE: We show that the RHI can change the perceived location of pain and increase pain ratings caused by electric stimuli. Our data suggest that the link between bodily illusions and pain could be modulated by uncertainty about location of pain and the affected body part.