Responding to the real problem of sustainable resuscitation skills with real assessment. Mixed-methods evaluation of an authentic assessment programme.

INTRODUCTION: The retention of resuscitation skills is a widespread concern, with a rapid decay in competence frequently following training. Meanwhile, training programmes continue to be disconnected with real-world expectations and assessment designs remain in conflict with the evidence for sustainable learning. This study aimed to evaluate a programmatic assessment pedagogy which employed entrustment decision and the principles of authentic and sustainable assessment (SA). METHODS: We conducted a prospective sequential explanatory mixed methods study to understand and address the sustainable learning challenges faced by final-year undergraduate paramedic students. We introduced a programme of five authentic assessments based on actual resuscitation cases, each integrating contextual elements that featured in these real-life events. The student-tutor consensus assessment (STCA) tool was configured to accommodate an entrustment scale framework. Each test produced dual student led and assessor scores. Students and assessors were surveyed about their experiences with the assessment methodologies and asked to evaluate the programme using the Ottawa Good Assessment Criteria. RESULTS: Eighty-four students participated in five assessments, generating dual assessor-only and student-led results. There was a reported mean score increase of 9% across the five tests and an 18% reduction in borderline or below scores. No statistical significance was observed among the scores from eight assessors across 420 unique tests. The mean student consensus remained above 91% in all 420 tests. Both student and assessor participant groups expressed broad agreement that the Ottawa criteria were well-represented in the design, and they shared their preference for the authentic methodology over traditional approaches. CONCLUSION: In addition to confirming local sustainability issues, this study has highlighted the validity concerns that exist with conventional resuscitation training designs. We have successfully demonstrated an alternative pedagogy which responds to these concerns, and which embodies the principles of SA, quality in assessment practice, and the real-world expectations of professionals.

Mental Health Gap Action Programme intervention Guide (mhGAP-IG) for Child and Adolescent Mental Health in Low- and Middle-Income Countries (LMIC): A Systematic Review.

BACKGROUND: The Mental Health Gap Action Programme (mhGAP) supports engagement of non-specialists in mental health services in Low- and Middle-Income countries. Given this aim, assessment of the effectiveness of approaches under its remit is warranted. AIMS: We evaluated mhGAP approaches relating to child and adolescent mental health, focusing on provider / child outcomes, and barriers / facilitators of implementation. METHODS: Thirteen databases were searched for reviews and primary research on mhGAP roll out for child and adolescent mental health. RESULTS: Twelve studies were reviewed. Provider-level outcomes were restricted to knowledge gains, with limited evidence of other effects. Child-level outcomes included improved access to care, enhanced functioning and socio-emotional well-being. Organisational factors, clients and providers? attitudes and expectations, and transcultural considerations were barriers. CONCLUSIONS: Further attention to the practical and methodological aspects of implementation of evaluation may improve the quality of evidence of the effectiveness of approaches under its remit.

Face-to-face versus distance learning of basic suturing skills in novice learners: a quantitative prospective randomized trial.

BACKGROUND AND AIM: Traditionally, practical skills are taught on face-to-face (F-F) basis. COVID-19 pandemic brought distance learning (DL) to the spotlight because of the social distancing mandates. We sought to determine the acceptability and effectiveness of DL of basic suturing in novice learners. METHODS: A prospective randomized controlled trial involving 118 students was conducted. Participants were randomized into two groups for learning simple interrupted suturing: F-F and DL-groups. Evaluation was conducted by two assessors using a performance checklist and a global rating tool. Agreement between the assessors was calculated, and performance scores of the participants were compared. Participants' satisfaction was assessed via a questionnaire. RESULTS: Fifty-nine students were randomized to the F-F group and 59 to the DL-group. Satisfactory agreement between the assessors was demonstrated. All participants were successful in placing three interrupted sutures, with no significant difference in the performance between the groups. 25(44.6%) of the respondents in the DL-group provided negative comments related to the difficulties of remotely learning visuospatial concepts, 16(28.5%) preferred the F-F approach. CONCLUSION: DL of basic suturing is as effective as the F-F approach in novice learners. It is acceptable by the students despite the challenges related to the remote learning of practical skills.

When the mask comes off: Mothers' experiences of parenting a daughter with autism spectrum condition.

LAY ABSTRACT: Parents of children with autism spectrum condition report increased stress and difficulties compared with parents of typically developing children. Our knowledge and understanding of how autism spectrum condition presents in autistic females is currently limited and parents of this population may experience challenges when raising their daughter. Given that mothers are often the main caregiver of a child with autism spectrum condition, they may have useful insights into the experiences of parenting a daughter with autism spectrum condition. Therefore, a qualitative study was undertaken to explore what mothers' experiences are of parenting a daughter with autism spectrum condition. Semi-structured interviews were conducted with 10 mothers of daughters with autism spectrum condition. The interviews were analysed using interpretative phenomenological analysis. Five main themes emerged from the qualitative study ('Girls have autism too', 'She's a chameleon', 'The impact of the diagnosis', 'Impact on mums' and 'Day-to-day life'). The findings of this study expand our current knowledge of the experiences and challenges faced by mothers raising a daughter with autism spectrum condition. Mothers hold a vast amount of knowledge on their daughters' autism spectrum condition which could inform the diagnostic process and clinical practice. Considering these results, it is important that clinicians support mothers and the family system around children with an autism spectrum condition diagnosis.

Resilience and protective factors among refugee children post-migration to high-income countries: a systematic review.

BACKGROUND: Increasing numbers of children have been forced to flee and seek asylum in high-income countries. Current research indicates that focussing on resilience and protective factors is an important long-term goal for positive mental health and psychological functioning of refugee children. METHODS: We performed a systematic review of quantitative literature regarding psychological and contextual factors that contribute to resilience in refugee children residing in high-income countries. Our procedure followed guidelines from the Centre for Reviews and Dissemination. RESULTS: We identified a number of protective factors as related to positive outcomes. They are drawn from several ecological domains and include age, self-esteem, maintenance of cultural identity, social support, belonging and safety and innovative social care services. A key overarching point reported by the studies we reviewed was that for refugee settlement specific policies and approaches to be beneficial, they were required to be embedded within a positive socially inclusive society. We also identified several limitations across the reported studies. CONCLUSION: The factors we identified would assist clinicians to adopt a resilience-focussed approach. However, a continued pre-occupation with psychopathology was evident across the studies, which we argue as holding back the development of resilience-focussed approaches.

Testing the Trower and Chadwick model of paranoia: Is 'poor-me' and 'bad-me' paranoia acting as a defence?

The study tested the predicted differences in phenomenology (self-esteem and depression) and insecurity of the subgroups of paranoia proposed by the Trower and Chadwick (1995) model of paranoia. Thirty-two inpatients experiencing persecutory delusions were assigned to either the poor me or bad me paranoid group. Questionnaire assessment of depression and self-esteem were conducted. A Dot Probe task measured detection latency (reaction time) to poor me words, bad me words and neutral words. The poor me and bad me groups displayed the predicted phenomenological differences. The dot probe task did not support the predicted insecurities of the Trower and Chadwick model, but unexpected significant results for the poor me subgroup may offer support for an alternative explanation of paranoia as an unstable phenomenon.