Effects of a skin type diversity seminar on undergraduate medical students' self-assessed competence in managing skin diseases in patients with skin of color.

BACKGROUND: Skin diseases in patients with skin of colour (Fitzpatrick skin types IV to VI) are underrepresented in dermatology training, which may lead to lower quality of care for these patients. To address this underrepresentation in medical education, a newly developed seminar on skin type diversity using an interactive teaching method was implemented in an undergraduate medical curriculum. This study examined the effects of a seminar on the self-assessed competence of medical students in managing skin conditions in patients with skin of colour. METHODS: A questionnaire survey was conducted among fourth-year undergraduate medical students at the University of Hamburg (Germany) between October 2023 and February 2024. Students' self-assessed competence was compared before and after the obligatory seminar (pre- and post-design). RESULTS: In total, 158 students participated in the survey. After the seminar, knowledge of the presentation of skin diseases in patients with skin of colour and the associated psychological burden, differences in the incidence of skin diseases in different skin types, and the ability to diagnose skin diseases in darker skin types increased. Most participants stated that they wanted to attend more courses on this topic. DISCUSSION: Appropriate courses for medical students can improve their competence in managing different skin diseases in patients with skin of colour. In the future, more attention should be paid to teaching the diversity of skin types in dermatology education.

Development of a self-assessment tool to address the functioning of community-dwelling older adults in general practice: a validation study of the EFA23 questionnaire.

BACKGROUND: Multimorbidity is increasingly prevalent among ageing patients, leading to reduced daily functioning. To address the challenges posed by multimorbidity in older adults, a person- and context-centred approach is needed. This study aimed to develop a questionnaire as a self-assessment tool for older adults focusing on functioning in general practice based on the International Classification of Functioning, Disability and Health (ICF). METHODS: A mixed-methods approach was employed in the development and validation of the German EFA23 (Erfassung Funktionaler Gesundheit im Alter - 23 Fragen; Assessing Functional Health in Old Age - 23 questions) questionnaire. Based on an ICF subset developed in a preparatory phase and consensus study, questionnaire items were formulated and tested in a qualitative pretest, followed by a validation study. A workshop with general practitioners (GPs) was held to develop a supplementary manual for GPs on how to interpret the questionnaire results and discuss them with the patients. RESULTS: A total of 69 items were developed and tested in the qualitative pretest with 15 respondents, resulting in 37 items for the validation study. The validation study, involving 237 older adults, showed the presence of one significant principal component. It demonstrated good internal consistency (Cronbach's alpha = 0.967) and construct validity, showing positive correlations with established assessment tools. Descriptive statistics showed differences between the means of self-assessment by patients and an external GP assessment. The final EFA23 questionnaire consists of 23 items assessing limitations in functioning. CONCLUSIONS: The EFA23 questionnaire can be used as a valid self-assessment instrument to measure functioning in older adults, supporting a person- and context-centred approach in general practice.

Exploring the Relationship Between Instagram Use and Self-Criticism, Self-Compassion, and Body Dissatisfaction in the Spanish Population: Observational Study.

BACKGROUND: The widespread use of online social networks, particularly among the younger demographic, has catalyzed a growing interest in exploring their influence on users' psychological well-being. Instagram (Meta), a visually oriented platform, has garnered significant attention. Prior research has consistently indicated that Instagram usage correlates with heightened levels of perfectionism, body dissatisfaction, and diminished self-esteem. Perfectionism is closely linked to self-criticism, which entails an intense self-scrutiny and is often associated with various psychopathologies. Conversely, self-compassion has been linked to reduced levels of perfectionism and stress, while fostering greater positive affect and overall life satisfaction. OBJECTIVE: This study investigates the relationship between Instagram usage (time of use and content exposure) and users' levels of self-compassion, self-criticism, and body dissatisfaction. METHODS: This study comprised 1051 adult participants aged between 18 and 50 years, either native to Spain or residing in the country for at least a decade. Each participant completed a tailored questionnaire on Instagram usage, along with abbreviated versions of the Self-Compassion Scale, the Body Shape Questionnaire, and the Depressive Experiences Questionnaire, spanning from January 23 to February 25, 2022. RESULTS: A positive correlation was observed between daily Instagram usage and self-criticism scores. Participants of all age groups who spent over 3 hours per day on Instagram exhibited higher self-criticism scores than users who spent less than 1 hour or between 1 and 3 hours per day. Contrary to previous findings, no significant relationship was detected between Instagram usage time and levels of self-compassion or body dissatisfaction. Furthermore, content centered around physical appearance exhibited a positive correlation with self-criticism and body dissatisfaction scores. Among younger participants (aged 18-35 years), those who primarily viewed beauty or fashion content reported higher self-criticism scores than those consuming science-related content. However, this association was not significant for participants aged 35-50 years. Conversely, individuals who predominantly engaged with sports or fitness or family or friends content exhibited higher levels of body dissatisfaction than those focusing on science-related content. No significant associations were observed between self-compassion scores and daily Instagram usage or most-viewed content categories. CONCLUSIONS: The findings of this study underscore the considerable impact of Instagram usage on self-criticism and body dissatisfaction-2 variables known to influence users' psychological well-being and be associated with various symptoms and psychological disorders.

Self-perception of voice and knowledge of vocal health and hygiene in Candomblé religious leaders in Brazil. / Autopercepção da voz e conhecimento em saúde e higiene vocal de líderes religiosos do Candomblé no Brasil.

PURPOSE: To verify possible complaints, voice and aerodigestive symptoms, singing voice handicap, and knowledge of vocal health and hygiene in Candomblé religious leaders in Brazil. METHODS: The study comprised 112 individuals who filled out a questionnaire with their identification and characterization, the stratified classification of their professional activities, and their self-perception of voice. Three self-assessment protocols - VoiSS, QSHV, and MSHI - were also used. RESULTS: The self-assessment of voice ranged from average to good. VoiSS mean total score was 23.04, which is above the cutoff. QSHV mean score was 23.54 points, which is near the cutoff. MSHI mean score (the perception of singing voice handicap) was 25.66 points. There was a substantially strong positive correlation between VoiSS and MSHI total scores (0.789; p<0.001). Women had higher limitation scores (p=0.012) and total scores (p=0.012) in VoiSS and higher handicap scores (p=0.038) in MSHI. Level I professionals - vocal elite (singers and actors) - had significantly higher QSHV scores than those in levels IV (p=0.010) and V (p=0.008). Most respondents had not visited an otorhinolaryngologist (89.29%) within the last year and had not been submitted to speech therapy (83.04%) for voice complaints. CONCLUSION: Candomblé leaders, particularly women, perceived voice symptoms and singing voice handicaps, with no relationship with their knowledge of vocal health and hygiene. Despite the complaints, most subjects reported not having visited health professionals responsible for voice care within the last year.

OBJETIVO: Verificar a autopercepção de sintomas vocais e aerodigestivos, desvantagem vocal no canto e o conhecimento em saúde e higiene vocal em líderes religiosos do Candomblé do Brasil. MÉTODO: Participaram deste estudo 112 indivíduos, que preencheram virtualmente um questionário de identificação, caracterização, classificação das atividades profissionais em níveis e autoavaliação vocal no momento atual, além de três protocolos de autoavaliação: Escala de Sinais e Sintomas (ESV), Questionário de Saúde e Higiene Vocal (QSHV) e Índice de Desvantagem para o Canto Moderno (IDCM). Foram utilizados os testes de correlação de Spearman, teste de Mann-Whitney e teste de Kruskal-Wallis. RESULTADOS: A autoavaliação vocal no momento atual variou de razoável a boa. A média do escore total na ESV foi de 23,04, acima da nota de corte. O QSHV apresentou valor médio de 23,54 pontos, próximo à nota de corte. O Índice de Desvantagem para o Canto Moderno (IDCM) mostrou média de 25,66 pontos. Houve correlação positiva de força substancial entre os escores totais da ESV e IDCM (0,789). Mulheres apresentaram maiores escores no ESV total e ESV limitação, além de maior escore no IDCM desvantagem. Profissionais do nível I - elite vocal (cantores e atores) apresentaram escores significativamente maiores para o QSHV que os profissionais do grupo IV (usuário não profissional não-vocal) e os do nível V (pessoas que estão fora do mercado de trabalho). A maioria dos respondentes não consultou Otorrinolaringologista (89,29%) no último ano e nem realizou fonoterapia (83,04%) por queixas vocais. CONCLUSÃO: Líderes do Candomblé apresentaram percepção de sintomas vocais e desvantagem vocal no canto, mais evidente nas mulheres, não havendo relação com o conhecimento de saúde e higiene vocal. Apesar da identificação de sintomas vocais, a maior parte dos sujeitos relatou não ter acessado profissionais de saúde responsáveis por esses cuidados com a voz no último ano.

Evaluating ChatGPT's Performance in the EU*US eHealth Work Foundational Curriculum Using the HITCOMP Self-Assessment Quiz.

This study investigated the performance of OpenAI's Chat Generative Pre-trained Transformer (ChatGPT) in responding to the EU*US eHealth Work Foundational Curriculum. This curriculum, a collaborative effort between European and U.S. institutions, provides an extensive framework for eHealth learning. The assessment involved 321 questions from the online Health Information Technology Competencies (HITCOMP) self-assessment quiz. Using GPT-3.5 model, the study presented each question three times to assess ChatGPT's consistency. Findings revealed an accuracy of 70.7%, indicating a reasonable grasp of eHealth topics, although performance was uneven across the 21 modules. These results underscore ChatGPT's potential in health information technology education and highlight the need for further model enhancements to fully encompass eHealth competencies.

Collaboration cognizance: Development of a self-assessment tool to measure intra-professional collaborative practices (IPCP) in postgraduate medical residents at tertiary care hospitals.

BACKGROUND: The ever-evolving healthcare system of today demands physicians who steer their roles as treatment providers, managers and collaborators. Professionals are highly interdependent due to increased complexity of health problems and risk of errors increases with transitions in care. In hospitals, the main workforce is postgraduate residents; therefore, intraprofessional collaboration amongst residents is essential. Several instruments are available to evaluate interprofessional collaboration amongst physicians, nurses and hospital teams but none specifically assessed intra-professional collaborative practices amongst residents working in tertiary care hospitals in multi-disciplinary teams. This study intends to develop and validate an instrument to self-assess intraprofessional collaborative practices in postgraduate residents undergoing residency in multiple specialties at tertiary care hospitals. APPROACH: This study on Instrument Development employed mixed method study design executed in two phases. In phase 1, six domains of intraprofessional collaborative practices were identified from literature and 35 items were developed. Fifteen experts participated in qualitative content validation and provided comments. To establish content validity in phase 2, content validity index (CVI) and content clarity average (CCA) were assessed by seventeen experts. Response process validity was established by cognitive interviewing of 5 postgraduate residents. Pilot testing was done on a sample of 407 residents. Cronbach's alpha was determined, and confirmatory factor analysis established construct validity. RESULTS: During phase 1, items were modified based on qualitative feedback from 15 experts. In round 2, CVI and CCA were determined based on responses of 17 experts. The items having an I-CVI greater than 0.90 were accepted and six items underwent modifications as their I-CVI fell between 0.78 and 0.90. Similarly, four items with a CCA of less than 2.4 were modified to increase clarity. Cognitive interviews of participants on 30 items resulted in the deletion of 1 item and changes in 5 items. The final instrument had 29 items categorized under six constructs. All items had good factor loadings during CFA, so none was deleted. Cronbach's Alpha α was 0.937. CONCLUSION: Intraprofessional collaborative practices in residents is a valid and reliable self-assessment tool comprising 29 items measuring six constructs. It may be used by residents to assess their collaborative practices and incorporated in curricula to help develop collaborative practices and their assessment during training of postgraduate residents.

Self-assessment, and not continuous training, improves basic open suturing skills.

BACKGROUND: To develop and maintain suturing skills, clinical exposure is important. When clinical exposure cannot be guaranteed, an adequate training schedule for suturing skills is required. This study evaluates the effect of continuous training, 'reflection before practice' and self-assessment on basic open suturing skills. METHODS: Medical students performed four basic suturing tasks on a simulation set up before ('pre-test') and after their surgical rotation ('after-test'). Participants were divided in three groups; the 'clinical exposure group' (n = 44) had clinical exposure during their rotation only, the 'continuous training group' (n = 16) completed a suturing interval training during their rotation and the 'self-assessment group' (n = 16) also completed a suturing interval training, but with the use of reflection before practice and self-assessment. Parameters measured by a tracking system during the suturing tasks and a calculated 'composite score' were compared between groups and test-moments. RESULTS: A significantly better composite score was found at the after-test compared to the pre-test for all groups for all basic suturing tasks (0.001 ≤ p ≤ 0.049). The self-assessment group scored better at the pre-test than the other two groups for all tasks, except for 'knot tying by hand' (0.004 ≤ p ≤ 0.063). However, this group did not score better at the after-test for all tasks, compared to the other two groups. This resulted in a smaller delta of time ('transcutaneous suture', p = 0.013), distance ('Donati suture' and 'intracutaneous suture', 0.005 ≤ p ≤ 0.009) or composite score (all tasks, except for knot tying by hand, 0.007 ≤ p ≤ 0.061) in the self-assessment group. CONCLUSION: Reflection before practice and self-assessment during continuous training of basic open suturing tasks, may improve surgical skills at the start of the learning curve.

Multimethods study to develop tools for competency-based assessments of implementation research training programmes in low and middle-income countries.

INTRODUCTION: Methods and validated tools for evaluating the performance of competency-based implementation research (IR) training programmes in low-middle-income countries (LMICs) are lacking. In this study, we developed tools for assessing the performance of IR training programmes based on a framework of IR core competencies in LMICs. METHODS: We developed self-assessment and objective-assessment tools drawing on the IR competency framework. We used exploratory factor analyses and a one-parameter logistic model to establish construct validity and internal consistency of the tools drawing on a survey conducted in 2020 with 166 trainees before and after an index IR course across five universities and LMICs under the Special Program for Research and Training in Tropical Diseases postgraduate IR training scheme. We conducted key informant interviews (KII) with 20 trainees and five trainers to reflect on the usefulness of the tools and framework for guiding IR training in LMICs. RESULTS: Two 16-item tools for self-assessment of IR knowledge and self-efficacy and a 40-item objective assessment tool were developed. The factor loadings of items in the self-assessment tools were 0.65-0.87 with Cronbach's alpha (α) of 0.97, and 0.77-0.91 with α of 0.98 for the IR knowledge and self-efficacy tools, respectively. The distribution of item difficulty in the objective-assessment tool was consistent before and after the index IR course. Pearson correlation coefficient (r) between the self-assessed and objectively assessed IR knowledge before the index IR course was low, r=0.27 (p value: <0.01), with slight improvements after the index IR course, r=0.43 (p value: <0.01). All KII respondents reported the assessment tools and framework were valid for assessing IR competencies. CONCLUSION: The IR competency framework and tools developed for assessing IR competencies and performance of IR training programmes in LMICs are reliable and valid. Self-assessment methods alone may not suffice to yield a valid assessment of performance in these settings.

The role of core self-evaluation between peer victimization and depression: A longitudinal multilevel moderated mediation model and the healthy context paradox in Chinese adolescents.

BACKGROUND: According to the healthy context paradox, the negative effects of peer victimization on core self-evaluation and depressive symptoms may vary in different levels of classroom-level victimization. However, previous studies have not investigated this issue using a longitudinal study design. OBJECTIVE: The present study used a longitudinal design to examine why and under what conditions peer victimization was associated with adolescents' depressive symptoms. METHOD: A large number of Chinese adolescents (Time 1: N = 4164, 50.3 % girls, Mage = 12.89, SDage = 0.77; Time 2: N = 4001, 50.4 % girls, Mage = 14.39, SDage = 0.75) were followed for one and a half years. RESULTS: Results showed that adolescents who were victimized in healthy contexts were more depressed and were at an increased risk of reporting more negative core self-evaluation than those victimized in unhealthy contexts. Moreover, core self-evaluation served as a mediator between peer victimization and depressive symptoms. LIMITATIONS: This study included two waves of data, which limited the exploration of dynamic relationships between peer victimization and depressive symptoms. In addition, the self-reported data weakened the objectivity of the results. Finally, this study neglected the effects of different dimensions of peer victimization on depressive symptoms. CONCLUSIONS: The healthy context paradox of peer victimization is identified in China, highlighting that future interventions of peer victimization should pay more attention to specific remaining victimized and self-devaluing individuals in healthy contexts.

Examination of reliability and validity of the Self-Assessment Burden Scale-Motor for community-dwelling older adults in Japan: a validation study.

Background: The aging society in Japan is progressing rapidly compared with that in the United States and European countries. Aging limits activities of daily living (ADL) in older adults, declining their lives and functions at home. Therefore, improving their ADL to effectively support their functioning at home for as long as possible is vital. Consequently, supporters need to have a common understanding, be promptly aware of the decline in ADL, and quickly introduce rehabilitation. The Functional Independence Measure (FIM) and Barthel Index (BI) are the main scales used to quantitatively assess ADL. However, previous studies have reported that FIM requires specialized knowledge for evaluation, and BI does not appropriately capture changes in ADL. The Self-Assessment Burden Scale-Motor (SAB-M) was developed as a scale for family caregivers to appropriately assess changes in ADL in older adults. Previous studies using the SAB-M have confirmed its reliability and validity in hospitalized patients as assessed by their family caregivers. Therefore, this study aimed to investigate the reliability and validity of the SAB-M among community-dwelling older adults as assessed by their family caregivers. Methods: This study included community-dwelling older adults who received home-visit rehabilitation at the first author's facility between October 2020 and December 2020 in Japan. Following previous studies, the SAB-M was used by family caregivers to assess 20 older adults twice for intra-rater reliability. Furthermore, 168 older adults were evaluated by family caregivers for internal consistency using the SAB-M. For criterion validity, the SAB-M was used for the assessment by family caregivers, and therapists used the FIM-Motor (FIM-M). This study used the weighted kappa, Cronbach's alpha, and Spearman's rank correlation coefficients for the statistical analysis of intra-rater reliability, internal consistency, and criterion validity, respectively. Results: The weighted kappa coefficient for the total score was 0.98 (p < 0.01) and individual item, it was 0.93 for feeding (p < 0.01), 0.91 for bathing (p < 0.01), 0.98 for dressing (p < 0.01), 0.94 for transfer (p < 0.01), 0.94 for walking/wheelchair (p < 0.01), 0.95 for stairs (p < 0.01), and 0.96 for bladder management (p < 0.01). The Cronbach's alpha was 0.93 for the seven items. The Spearman's rank correlation coefficient between the SAB-M and FIM-M scores was 0.91 (p < 0.01). Conclusion: The SAB-M has sufficient reliability and validity among community-dwelling older adults. Family caregivers can routinely assess changes in the ADL of community-dwelling older adults using the SAB-M, enabling them to promptly consider introducing rehabilitation when older adults' ADL declines. Therefore, implementing SAB-M helps older adults live and function at home for as long as possible.

A self-assessment maturity matrix to support large-scale change using collaborative networks in the New Zealand health system.

BACKGROUND: A maturity matrix can be a useful tool for organisations implementing large-system transformation (LST) initiatives in complex systems. Insights from implementation of a local LST initiative using collaborative networks, known as Alliances, highlighted a tool was needed to help health system leaders prompt discussions on how and where to focus their change efforts. In the New Zealand (NZ) health system, Alliances were introduced to integrate the planning and delivery of health care between primary and hospital care. METHODS: The aim of this research was to use insights from Alliance members to develop a learning tool that collaborative networks could use to assess and improve their readiness for change. We constructed a maturity matrix using the knowledge of senior NZ health system leaders, in a workshop setting. The maturity matrix was empirically tested and refined with three Alliances and with feedback from the NZ Ministry of Health Maori Health Strategy and Policy team. RESULTS: The maturity matrix described the 10 key elements that had been found to support successful implementation of LST initiatives in the NZ health system, along with success indicators and different stages of maturity from beginning to excellence. Testing of the maturity matrix with three Alliances suggested that it functioned as a learning tool and stimulated collective thinking and reflection. The Maori Health Strategy and Policy team commented on the importance of such a tool to increase health system leaders' responsiveness to improving Maori health outcomes. Comparisons with similar international matrices revealed common elements with ours. A strength of our maturity matrix is that it is specific to the NZ context and is the first practical tool to implement large-scale change in the health system that incorporates principles of the Government's treaty with Maori, the indigenous people of NZ. CONCLUSIONS: Through a regular self-assessment process, use of the maturity matrix may create feedback loops to support deliberate learning and knowledge sharing for senior health system leaders and collaborative networks. The maturity matrix fills an important gap in the NZ health system and contributes to implementation science literature internationally. OTHER: This study was approved by the Victoria University of Wellington Human Ethics Committee (Ethics Approval Number 27,356). The research was supported by the Victoria University of Wellington research grant (222,809) and from the University of Auckland Department of Medicine research fund (H10779).

Effects of patient-based self-assessed fatigue intervention on early postoperative ambulation following gynaecological oncology surgery: a randomised controlled non-inferiority trial.

OBJECTIVES: To assess the impact of a patient-based self-assessed fatigue intervention aimed at promoting early postoperative ambulation. DESIGN: Prospective randomised controlled trial. SETTING: Single-centre, conducted at the Obstetrics and Gynaecology Department of the Xiangyang Central Hospital, China. PARTICIPANTS: Eligible were adult patients undergoing elective gynaecologic oncologic surgery. INTERVENTIONS: The intervention group utilised a modified Borg Rating of Perceived Experience (RPE) scale for self-assessment of fatigue levels. The control group followed fixed-activity distance guidelines postoperatively. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the self-reported the time to first flatus postoperatively. Secondary outcomes encompassed the time to first defecation, incidence of moderate-to-severe abdominal distention, ileus, postambulation adverse events (nausea, vomiting and dizziness), patient satisfaction with early ambulation instructions, compliance with early ambulation and average hospital costs and length of stay. RESULTS: Between June 2021 and October 2022, 552 patients were enrolled. The self-assessed fatigue intervention group demonstrated non-inferior the time to first flatus compared with the fixed-activity distance assessment group (25.59±14.59 hours vs 26.10±14.19 hours, pnon-inferiority<0.001). Compliance with activity was higher in the intervention group (49.40% vs 36.02%, p<0.001), although it did not reach 50%. The intervention group also exhibited significantly higher mean hospital costs, length of stay and incidence of moderate-to-severe abdominal distention (p<0.001). CONCLUSIONS: The self-assessed fatigue intervention for early postoperative ambulation in gynaecologic oncology patients shows promise as an effective strategy; however, compliance is suboptimal. An intervention based on mandatory, yet reasonable, fixed-activity distance may represent the most viable current approach. Further research is warranted to confirm these findings. TRIAL REGISTRATION NUMBER: CTR2100046035.

Identifying training needs of practising community pharmacists in Jordan-a self-assessment study.

BACKGROUND: Being the professional membership body for pharmacists in Jordan, the Jordan Pharmacists Association (JPA) took the initiative to establish a training centre for practising pharmacists. This study aims to identify the self-assessed training priorities of community pharmacists in Jordan. METHODS: In the period between August and October 2022, an online self-administered questionnaire was distributed using a variety of participants' identification and recruitment approaches. The questionnaire targeted currently practising community pharmacists. Data were analysed descriptively and inferentially. RESULTS: In total, 470 community pharmacists participated in this study. Of 470 participants, 307 (65.3%) were employees, of which 206 were full-time employees. Results showed that only 97 (21%) had access to an in-house training programme or scheme. Self-assessment of training needs highlighted differences between the three competencies clusters. While administrative and managerial skills and competencies were more frequently prioritised on average than the other two clusters, interpersonal and communication skills were needed the least. Evidence showed a significant difference between female and male participants regarding the need for training addressing maternity and early childhood health training issues. Lastly, the role-based comparison showed that, compared to pharmacy owners, employees had a significantly higher need for training related to bookkeeping and taxation returns preparation and how to handle and manage records of narcotic and controlled medicines. CONCLUSIONS: If training and development programmes are tailored to address specific needs in administrative, clinical, and interpersonal competencies, community pharmacists have the potential to enhance public health, expand their role, provide patient-centred care, and support the national healthcare system.

The oncology ribbon of reflection: a novel tool to encourage trainee self-reflection.

The field of oncology presents a number of emotionally challenging situations for a trainee to navigate which might not have been previously encountered in training. With the assistance of a guide, reflecting on such situations can be helpful; however, no tool exists in the literature specifically for clinical oncology situations and tailored to provide trainees guidance through the reflective process. Consequently, we present a self-guided reflection tool design using four established reflection models and improved over three iterations of feedback.

Le domaine de l'oncologie présente un certain nombre de situations émotionnellement difficiles à gérer pour un stagiaire qui n'a peut-être jamais été confronté à de telles situations au cours de sa formation. Avec l'aide d'un guide, il peut être utile de réfléchir à ces situations. Cependant, il n'existe pas dans la littérature d'outil adapté aux situations cliniques en oncologie et conçu pour guider les stagiaires tout au long du processus de réflexion. Par conséquent, nous présentons un outil d'autoréflexion conçu à partir de quatre modèles de réflexion établis et amélioré au cours de trois rondes de rétroaction.

Vocal risk mapping in classical singers: an analysis of the self-perception of voice quality, vocal fatigue, and singing voice handicap. / Mapeamento do risco vocal em cantores eruditos: análise da autopercepção da qualidade da voz, fadiga vocal e desvantagem no canto.

PURPOSE: To map the vocal risk in professional classical singers, analyzing their self-assessment of voice and self-perception of singing voice handicap and vocal fatigue. METHODS: The study sample comprised of 52 professional classical choir singers, aged 31 to 72 years. They answered an online questionnaire in Google Forms, addressing their characterization, self-assessment of voice, the Voice Handicap Index-10 (VHI-10), Classical Singing Handicap Index (CSHI), and Vocal Fatigue Index (VFI). RESULTS: The mean self-assessment of voice was between "Good" and "Very good" (1.2). The mean total VHI-10 score was 1.35, which is below the cutoff. The mean total CSHI score was 10.04. The mean total VFI score was 10.83, near the cutoff value. Classical singers who use their voice to give examples to students in their classes had higher scores in VHI-10 (p = 0.013), VFI voice restriction (p = 0.011), and VFI total score (p = 0.015). Besides, classical singers who already visited a Speech-Language Pathologist for voice problems had higher scores in VFI voice restriction (p = 0.040) and VFI recovery with voice rest (p = 0.019), in addition to correlations between instrument scores. CONCLUSION: Professional classical singers did not have voice handicaps. However, their self-perception of vocal fatigue was more present when the singing voice was used, such as giving examples with their own voice in class. Having had voice problems and visited a Speech-Language Pathologist in the past led to a greater perception of vocal recovery with rest.

OBJETIVO: Mapear o risco vocal em cantores eruditos profissionais, analisando sua autoavaliação vocal e autopercepção de desvantagem vocal no canto e fadiga vocal. MÉTODO: Participaram deste estudo 52 cantores eruditos de coros profissionais, entre 31 e 72 anos, que preencheram online (Formulários Google) um questionário de caracterização, autoavaliação vocal, bem como os instrumentos Índice de Desvantagem Vocal 10 - IDV-10, Índice de Desvantagem para o Canto Clássico - IDCC e Índice de Fadiga Vocal - IFV. RESULTADOS: A média da autoavaliação vocal ficou entre "Boa" e "Muito boa" (1,2). A média do escore total do IDV-10 foi 1,35, abaixo da nota de corte. A média do escore total do IDCC foi 10,04. A média do escore total do IFV foi de 10,83, próxima da nota de corte. Cantores eruditos que, em suas aulas, dão exemplos aos alunos com a própria voz apresentam maiores escores nos instrumentos IDV-10 (p=0,013), IFV restrição vocal (p=0,011) e IFV escore total (p=0,015). Cantores eruditos que já procuraram fonoaudiólogo devido a problemas de voz apresentam maiores escores no IFV fator restrição vocal (p=0,040) e no IFV fator recuperação com repouso vocal (p=0,019), além de terem correlações entre os escores dos instrumentos. CONCLUSÃO: Cantores eruditos profissionais não apresentam desvantagem vocal. Porém, questões relacionadas à autopercepção de fadiga vocal se mostram mais presentes quando relacionadas às atividades de uso da voz cantada, como dar exemplos em aulas com a própria voz. Ter tido problema vocal e procurado fonoaudiólogo no passado proporciona maior percepção de recuperação vocal com repouso.

Clinical competency of nurses trained in competency-based versus objective-based education in the Democratic Republic of the Congo: a qualitative study.

BACKGROUND: Designing competency-based education (CBE) programmes is a priority in global nursing education for better nursing care for the population. In the Democratic Republic of the Congo (DRC), object-based education (OBE) remains mainstream in pre-service nursing education programmes. Recently, the Ministry of Health developed a self-assessment tool and quantitatively compared the clinical competency of CBE- and OBE-trained nurses. This study aimed to qualitatively triangulate the results of self-evaluation by exploring perception of supervisors, incumbent CBE-, and OBE-trained nurses in comparison with the competence of the two types of nurses, and to identify influential factors or barriers to their competence in clinical settings. METHODS: A qualitative descriptive approach with conventional content analysis was applied. Twenty interviews with clinical supervisors who oversaw both CBE- and OBE-trained nurses, 22 focus group discussions (FGDs) with CBE-trained nurses, and 21 FGDs with OBA-trained nurses currently working in health facilities were conducted. Participants of the FGDs were selected from the participants of the DRC self-assessment competency comparison study where there was no statistically significance between CBE- and OBE-trained nurses in the demographic characteristics. Data were analysed in terms of the competencies identified by the Ministry of Health. RESULTS: The supervisors recognised that the CBE-trained nurses had stronger competencies in professional communication, making decisions about health problems, and engaging in professional development, but were weak in clinical skills. This study identified challenges for supervisors in assuring standardised care in health facilities with OBE- and CBE-trained nurses, as well as barriers for CBE-trained nurses as a minority in the workplace in demonstrating their competencies. CONCLUSIONS: The study results support the Ministry of Health's policy to expand CBE in pre-service education programmes but reveal that its slow implementation impedes full utilisation of the acquired competencies at health facilities. Implementation could be accelerated by strengthening cooperation among the Ministry of Health's three human resource departments, and developing and implementing a well-planned, legally binding, long-term CBE reform strategy, including an approach to the Continuing Professional Development system.

Impact of self-assessment on dental student's performance in pre-clinical conservative dentistry course.

BACKGROUND: Self-assessment (SA) is an interactive course that endorses the accomplishment of learning objectives through learners' identification of insufficiencies in their didactic knowledge and pre-clinical skills. This study was planned to determine whether there is any improvement in the faculty assessment (FA) score following the implementation of SA in the Pre-clinical Conservative Dentistry Course. METHODS: Fifty-four first-semester dental students were given an introductory lecture followed by a demonstration for Class I Cavity Preparation in typhodont mandibular first molar. At the end of the demonstration, the Scoring Rubric (SR) was explained point-wise in the prepared cavities. During the next session, all students performed Class I cavity preparation and they were given an assessment sheet to enter their scores (SA1). All teeth were evaluated by the Grading Faculties in a blinded manner (FA1). Each participant was explained the difference in their respective SA1 from FA1 and their queries were resolved individually. During the next sessions, Students and Grading Faculties followed the same protocol and scores were recorded as SA2, FA2, SA3 and FA3. RESULTS: The mean score of SA1 was significantly higher than that of FA1 (p < 0.001). However, no significant difference was obtained between SA and FA in the second (p = 0.352) and third (p = 0.434) assessments. In contrast with first assessment, mean marks obtained in FA were higher compared to SA in both second and third assessments. There was a statistically significant improvement in mean marks obtained by the students over time (p < 0.001). CONCLUSION: SA endorsed student-faculty communication and enhanced student's poise and technical skills in operative pre-clinical dentistry.

Assessing readiness: the impact of an experiential learning entrustable professional activity-based residency preparatory course.

As medical schools move to integrate the Core Entrustable Professional Activities for Entering Residency (EPAs) into curricula and address the transition from student to resident, residency preparatory courses have become more prevalent. The authors developed an experiential learning EPA-based capstone course for assessment to determine impact on learner self-assessed ratings of readiness for residency and acquisition of medical knowledge. All fourth-year students from the classes of 2018-2020 completed a required course in the spring for assessment of multiple EPAs, including managing core complaints, performing basic procedures, obtaining informed consent, and providing patient handoffs. Learners selected between three specialty-based parallel tracks - adult medicine, surgery, or pediatrics. Students completed a retrospective pre-post questionnaire to provide self-assessed ratings of residency preparedness and comfort in performing EPAs. Finally, the authors studied the impact of the course on knowledge acquisition by comparing student performance in the adult medicine track on multiple choice pre- and post-tests. Four hundred and eighty-one students were eligible for the study and 452 (94%) completed the questionnaire. For all three tracks, there was a statistically significant change in learner self-assessed ratings of preparedness for residency from pre- to post-course (moderately or very prepared: adult medicine 61.4% to 88.6% [p-value < 0.001]; surgery 56.8% to 81.1% [p-value < 0.001]; pediatrics 32.6% to 83.7% [p-value 0.02]). A similar change was noted in all tracks in learner self-assessed ratings of comfort from pre- to post-course for all studied EPAs. Of the 203 students who participated in the adult medicine track from 2019-2020, 200 (99%) completed both the pre- and post-test knowledge assessments. The mean performance improved from 65.0% to 77.5% (p-value < 0.001). An experiential capstone course for the assessment of EPAs can be effective to improve learner self-assessed ratings of readiness for residency training and acquisition of medical knowledge.

Differences between resident self-assessments and faculty- assessments on Anesthesiology Milestones and associated factors: a cross-sectional study.

BACKGROUND: Accurate self-assessment is crucial for the professional development of physicians. There has been sparse data on the accuracy of self-assessments on Anesthesiology Milestones. The aim of this study was to investigate the differences between resident self-assessments and faculty-assessments on Anesthesiology Milestones and the associated factors. METHODS: This was a cross-sectional study conducted in a general tertiary university-affiliated hospital. We included anesthesia residents who were enrolled in the standardized residency training program in postgraduate year two and three at the time of the Milestone evaluation. We requested evaluations of competencies from both the Clinical Competency Committee faculty and the anesthesia residents themselves, utilizing the Chinese version of Anesthesiology Milestones in January 2023 and January 2024. The primary outcome was the differences between self- and faculty-assessments, calculated by subtracting the faculty-rated score from the self-rated score on each subcompetency. RESULTS: A total of 46 and 42 residents were evaluated in year 2023 and 2024, respectively. The self-rated sum score was significantly higher than that rated by faculty [mean (standardized deviation): 120.39 (32.41) vs. 114.44 (23.71), P = 0.008 in paired t test] with an intraclass correlation coefficient of 0.55 [95% confidence interval (CI): 0.31 to 0.70]. The Bland-Altman plots revealed significant overestimation in patient care (bias 0.32, 95% CI: 0.05 to 0.60), practice-based learning and improvement (bias 0.45, 95% CI: 0.07 to 0.84), and professionalism (bias 0.37, 95% CI: 0.02 to 0.72). Ratings from residents with master's degrees (mean difference: -1.06, 95% CI: -1.80 to -0.32, P = 0.005) and doctorate degrees (mean difference: -1.14, 95% CI: -1.91 to -0.38, P = 0.003) were closer to the faculty-assessments than residents with bachelor's degrees. Compared with patient care, the differences between self- and faculty- rated scores were smaller in medical knowledge (mean difference: -0.18, 95% CI: -0.35 to -0.02, P = 0.031) and interpersonal and communication skills (mean difference: -0.41, 95% CI: -0.64 to -0.19, P < 0.001) in the generalized estimating equation logistic regression model. CONCLUSIONS: This study revealed that residents tended to overestimate themselves, emphasizing the need to improve the accuracy of Milestones self-assessment. The differences between self- and faculty-assessments were associated with residents' degrees and domains of competency.

Testing for longitudinal bidirectional associations between self-compassion, self-criticism, and positive body image components.

Previous cross-sectional studies have reported associations between self-compassion, self-criticism, and positive body image, yet prospective studies establishing the temporal order of these relationships are missing. The present study sought to clarify the nature of these associations by investigating possible longitudinal bi-directional links between self-compassion, self-criticism, and three components of positive body image (body appreciation, functionality appreciation, and body image flexibility). Data were analyzed from 2982 adult women who completed survey instruments at baseline (T0), four-month follow-up (T1), and eight-month follow-up (T2). Attrition rate ranged from 0-56% across time-points. Cross-lagged panel models were computed to test for bidirectional associations. We found evidence of reciprocal, negative associations between self-criticism and the three components of positive body image across the three time-points. We also found evidence that T0 self-compassion predicted increased body image flexibility and functionality appreciation at T1 (paths were non-significant from T1 to T2), whereas T0 body appreciation predicted increased T1 self-compassion (but was non-significant from T1 to T2). Findings suggest that compassionate and uncritical ways of responding to the self may be relevant precursors and outcomes to positive body image, depending on the timing of assessment, highlighting viable targets for intervention.