Development and evaluation of a simulation-based transition to clerkship course.

BACKGROUND: Transition to clerkship courses bridge the curricular gap between preclinical and clinical medical education. However, despite the use of simulation-based teaching techniques in other aspects of medical training, these techniques have not been adequately described in transition courses. We describe the development, structure and evaluation of a simulation-based transition to clerkship course. APPROACH: Beginning in 2012, our institution embarked upon an extensive curricular transformation geared toward competency-based education. As part of this effort, a group of 12 educators designed, developed and implemented a simulation-based transition course. The course curriculum involved seven goals, centered around the 13 Association of American Medical Colleges Core Entrustable Professional Activities for entering residency. Instructional techniques included high-fidelity simulation, and small and large group didactics. Student competency was determined through a simulation-based inpatient-outpatient objective structured clinical examination, with real-time feedback and remediation. The effectiveness of the course was assessed through a mixed methods approach involving pre- and post-course surveys and a focus group. EVALUATION: Of 166 students, 152 (91.6%) completed both pre- and post-course surveys, and nine students participated in the focus group. Students reported significant improvements in 21 out of 22 course objectives. Qualitative analysis revealed three key themes: learning environment, faculty engagement and collegiality. The main challenge to executing the course was procuring adequate faculty, material and facility resources. REFLECTION: This simulation-based, resource-heavy transition course achieved its educational objectives and provided a safe, supportive learning environment for practicing and refining clinical skills.

A cross-national study of the population-level association between alcohol consumption and suicide rates.

INTRODUCTION: The objective of this study was to explore the association between population-level alcohol consumption and cross-national suicide rates. Suicide mortality rates vary substantially by nation, as do the level and character of alcohol consumption. Only a few prior studies examined this association, however, and they used a small number of nations and failed to test for the multiple hypothesized pathways through which any association may operate. MATERIAL AND METHODS: We obtained data from the World Health Organization for a sample of 83 nations. Controlling for potential structural covariates, we tested four theoretical mechanisms through which population-level alcohol consumption may influence national suicide rates. RESULTS: Results showed no evidence of threshold effects, nor were risky national drinking patterns associated with higher suicide rates. We found evidence for the most common explanation that total per capita consumption is linearly associated with suicide rates. Our other findings, however, suggested this linear association masks more complex beverage-specific effects. Per capita wine consumption was not associated with male or female suicide rates, per capita spirits consumption was associated with both male and female suicide rates, per capita beer consumption was associated with male suicide rates, and per capita consumption of "other" alcohol types was associated with female suicide rates. DISCUSSION AND CONCLUSIONS: Testing for only a linear association between total alcohol consumption and suicide rates fails to tell the whole story. Further research requires exploration of beverage-specific effects and other potential mechanisms, and consideration of national alcohol policies to reduce suicide rates.

Bring a gun to a gunfight: armed adversaries and violence across nations.

We use homicide data and the International Crime Victimization Survey to examine the role of firearms in explaining cross-national variation in violence. We suggest that while gun violence begets gun violence, it inhibits the tendency to engage in violence without guns. We attribute the patterns to adversary effects-i.e., the tendency of offenders to take into account the threat posed by their adversaries. Multi-level analyses of victimization data support the hypothesis that living in countries with high rates of gun violence lowers an individual's risk of an unarmed assault and assaults with less lethal weapons. Analyses of aggregate data show that homicide rates and gun violence rates load on a separate underlying factor than other types of violence. The results suggest that a country's homicide rate reflects, to a large extent, the tendency of its offenders to use firearms.

The effects of visual and cognitive distractions on operational and tactical driving behaviors.

OBJECTIVE: This study tested the effects of two fundamental forms of distraction, including visual-manual and cognitive-audio distraction, with comparison under both operational and tactical driving. Strategic control remains for future study. BACKGROUND: Driving is a complex control task involving operational, tactical, and strategic control. Although operational control, such as lead-car following, has been studied, the influence of in-vehicle distractions on higher levels of control, including tactical and strategic, remains unclear. METHOD: Two secondary tasks were designed to independently represent visual-manual and cognitive-audio distractions, based on multiple resource theory. Drivers performed operational vehicle control maneuvers (lead-car following) or tactical control maneuvers (passing) along with the distraction tasks in a driving simulator. Response measures included driving performance and visual behavior. RESULTS: Results revealed drivers' ability to accommodate either visual or cognitive distractions in following tasks but not in passing. The simultaneous distraction condition led to the greatest decrement in performance. CONCLUSION: Findings support the need to assess the impacts of in-vehicle distraction on different levels of driving control. Future study should investigate driver distraction under strategic control.

The effect of poverty and social protection on national homicide rates: Direct and moderating effects.

Social protection is the ability of a government to insulate its citizens from the problems associated with poverty and market forces that negatively affect their quality of life. Prior research shows that government policies that provide social protection moderate the influence of inequality on national homicide rates. Recent research, however, reveals a strong association between poverty and national homicide rates. Further, theory and evidence suggest that social protection policies are meant to aid in providing a subsistence level of living, and thus to alleviate the vagaries of poverty not inequality. To this point, however, no studies have examined the potentially moderating effect of social protection on the strength of the association between poverty and homicide rates cross-nationally. We do so in the present study. Employing data for the year 2004 from a sample of 30 nations, we estimate a series of weighted least squares regression models to test three hypotheses: the association between poverty and homicide will remain significant and positive when controlling for social protection, social protection will have a significant negative direct effect on national homicide rates, and social protection will diminish the strength of the poverty-homicide association. The results provided evidence supporting all three hypotheses. We situate our findings in the cross-national empirical literature on social structure and homicide and discuss our results in the theoretical context of social protection.

Driver distraction and performance effects of highway logo sign design.

Driver distraction and safety concerns have been identified for new highway logo sign configurations. This study assessed driver perception of logo signs and distraction under nine-panel, overflow-combination, or standard six-panel formats. A nine-panel sign has nine business panels within a single sign; a six-panel sign has six panels within a sign; an overflow-combination consists of a standard six-panel sign and a six-panel sign displaying two different services (e.g., food and gas). In this study, twenty-four participants searched for target food business logos while driving in a high-fidelity driving simulation under each signage condition. Gas and lodging signs were also displayed along the road in conventional six-panel formats. Dependent variables included signal detection, visual attention allocation, and vehicle control measures. Experiment results showed nine-panel signs drew greater visual attention and produced lower average speed than overflow-combination signs, and produced a lower speeding percentage compared to six-panel signs. However, there was no evidence the new configurations (nine-panel and overflow) caused substantive performance changes with safety implications. This study suggested the use of nine-panel and overflow-combination logo signs may be suitable for interchanges where there are more than six qualifying businesses in a category in terms of driver performance and safety.

Effect of visual displays and locations on laparoscopic surgical training task.

The number of minimally invasive surgical (MIS) procedures has substantially increased since its introduction due to health and recovery benefits for patients. However, there are potential performance issues in MIS for surgeons due to perceptual processing demands associated with supporting technologies. Monitor location has been identified as a major factor influencing performance in these types of procedures. This study examined the effect of multiple monitors on performance during a laparoscopic surgical training task (peg transfer among instruments). Twenty-four novice subjects were exposed to different monitor conditions including a default position, a biomechanically compatible position, and a position collocated with the operating surface as well as the combination of the latter two. Subjective rankings and cognitive workload were also assessed. Results revealed a significant effect of monitor position on task time when compared to subjects' baseline training task time using the default monitor setup. Collocating the monitor with the operating surface was shown to be superior in terms of task time. There were no significant differences among monitor positions in terms of perceived workload. The results of this study provide an applicable guide for the design of MIS setups in the operating room to promote surgeon performance.

Auditory perception in individuals with Friedreich's ataxia.

INTRODUCTION: Friedreich's ataxia (FRDA) is an inherited ataxia with a range of progressive features including axonal degeneration of sensory nerves. The aim of this study was to investigate auditory perception in affected individuals. METHODS: Fourteen subjects with genetically defined FRDA participated. Two control groups, one consisting of healthy, normally hearing individuals and another comprised of subjects with sensorineural hearing loss, were also assessed. Auditory processing was evaluated using structured tasks designed to reveal the listeners' ability to perceive temporal and spectral cues. Findings were then correlated with open-set speech understanding. RESULTS: Nine of 14 individuals with FRDA showed evidence of auditory processing disorder. Gap and amplitude modulation detection levels in these subjects were significantly elevated, indicating impaired encoding of rapid signal changes. Electrophysiologic findings (auditory brainstem response, ABR) also reflected disrupted neural activity. Speech understanding was significantly affected in these listeners and the degree of disruption was related to temporal processing ability. Speech analyses indicated that timing cues (notably consonant voice onset time and vowel duration) were most affected. CONCLUSION: The results suggest that auditory pathway abnormality is a relatively common consequence of FRDA. Regular auditory evaluation should therefore be part of the management regime for all affected individuals. This assessment should include both ABR testing, which can provide insights into the degree to which auditory neural activity is disrupted, and some functional measure of hearing capacity such as speech perception assessment, which can quantify the disorder and provide a basis for intervention.