Exploring examiner judgement of professional competence in rater based assessment.

Exercise physiology courses have transitioned to competency based, forcing Universities to rethink assessment to ensure students are competent to practice. This study built on earlier research to explore rater cognition, capturing factors that contribute to assessor decision making about students' competency. The aims were to determine the source of variation in the examination process and document the factors impacting on examiner judgment. Examiner judgement was explored from both a quantitative and qualitative perspective. Twenty-three examiners viewed three video encounters of student performance on an OSCE. Once rated, analysis of variance was performed to determine where the variance was attributed. A semi-structured interview drew out the examiners reasoning behind their ratings. Results highlighted variability of the process of observation, judgement and rating, with each examiner viewing student performance from different lenses. However, at a global level, analysis of variance indicated that the examiner had a minimal impact on the variance, with the majority of variance explained by the student performance on task. One anomaly noted was in the assessment of technical competency, whereby the examiner had a large impact on the rating, linked to assessing according to curriculum content. The thought processes behind judgement were diverse and if the qualitative results had been used in isolation, may have led to the researchers drawing conclusions that the examined performances would have yielded widely different ratings. However, as a cohort, the examiners were able to distinguish good and poor levels of competency with the majority of student competency linked to the varying ability of the student.

Assessment of Fundamental Movement Skills in Childhood Cancer Patients.

BACKGROUND: The improved treatment protocols and subsequent improved survival rates among childhood cancer patients have shifted the focus toward the long-term consequences arising from cancer treatment. Children who have completed cancer treatment are at a greater risk of delayed development, diminished functioning, disability, compromised fundamental movement skill (FMS) attainment, and long-term chronic health conditions. The aim of the study was to compare FMS of childhood cancer patients with an aged matched healthy reference group. METHODS: Pediatric cancer patients aged 5-8 years (n = 26; median age 6.91 years), who completed cancer treatment (<5 years) at the Sydney Children's Hospital, were assessed performing seven key FMS: sprint, side gallop, vertical jump, catch, over-arm throw, kick, and leap. Results were compared to the reference group (n = 430; 6.56 years). RESULTS: Childhood cancer patients scored significantly lower on three out of seven FMS tests when compared to the reference group. These results equated to a significantly lower overall score for FMS. CONCLUSIONS: This study highlighted the significant deficits in FMS within pediatric patients having completed cancer treatment. In order to reduce the occurrence of significant FMS deficits in this population, FMS interventions may be warranted to assist in recovery from childhood cancer, prevent late effects, and improve the quality of life in survivors of childhood cancer.

Parent feeding interactions and practices during childhood cancer treatment. A qualitative investigation.

In the general population it is evident that parent feeding practices can directly shape a child's life long dietary intake. Young children undergoing childhood cancer treatment may experience feeding difficulties and limited food intake, due to the inherent side effects of their anti-cancer treatment. What is not clear is how these treatment side effects are influencing the parent-child feeding relationship during anti-cancer treatment. This retrospective qualitative study collected telephone based interview data from 38 parents of childhood cancer patients who had recently completed cancer treatment (child's mean age: 6.98 years). Parents described a range of treatment side effects that impacted on their child's ability to eat, often resulting in weight loss. Sixty-one percent of parents (n = 23) reported high levels of stress in regard to their child's eating and weight loss during treatment. Parents reported stress, feelings of helplessness, and conflict and/or tension between parent and the child during feeding/eating interactions. Parents described using both positive and negative feeding practices, such as: pressuring their child to eat, threatening the insertion of a nasogastric feeding tube, encouraging the child to eat and providing home cooked meals in hospital. Results indicated that parent stress may lead to the use of coping strategies such as positive or negative feeding practices to entice their child to eat during cancer treatment. Future research is recommended to determine the implication of parent feeding practice on the long term diet quality and food preferences of childhood cancer survivors.

Breast and Prostate Cancer Survivor Responses to Group Exercise and Supportive Group Psychotherapy.

This study qualitatively examined an 8-week group exercise and counseling intervention for breast and prostate cancer survivors. Groups exercised 3 days per week, 50 minutes per session, performing moderate-intensity aerobic and resistance training. Groups also underwent 90-minute supportive group psychotherapy sessions once per week. Survivors discussed their experiences in focus groups post intervention. Transcripts were analyzed using interpretative phenomenological analysis. Survivors described how exercise facilitated counseling by creating mutual aid and trust, and counseling helped participants with self-identity, sexuality, and the return to normalcy. When possible, counselors and fitness professionals should create partnerships to optimally support cancer survivors.

Higher-intensity exercise helps cancer survivors remain motivated.

PURPOSE: The aim of the present study was to determine if exercise intensity impacts upon the psychosocial responses of breast and prostate cancer survivors to a rehabilitation program. METHODS: Eighty-seven prostate and 72 breast cancer survivors participated in an 8-week exercise and supportive group psychotherapy intervention (n = 84) or control (n = 75) group. Intervention participants were randomized to low-to-moderate intensity exercise (LIG; n = 44; 60-65 % VO2peak, 50-65 % one repetition maximum (1RM)) or moderate-to-high intensity exercise (HIG; n = 40; 75-80 % VO2peak, 65-80 % 1RM) while controls continued usual care. Before and after the 8 weeks, all participants completed the Functional Assessment of Cancer Therapy-Breast or -Prostate to assess quality of life (QOL) and Behavioural Regulations of Exercise Version 2 for exercise motivation. Intervention participants also completed a follow-up assessment 4 months post-intervention. RESULTS: All three groups improved in QOL from baseline to post-intervention, with no significant differences. From post-intervention to follow-up, the LIG and HIG similarly maintained QOL scores. Between baseline and post-intervention, both intervention arms improved their motivation to exercise compared to the controls (p = 0.004). At the 4-month follow-up, the HIG had maintained their overall exercise motivation (p < 0.001) and both domains of intrinsic motivation (identified regulation, p = 0.047; intrinsic regulation, p = 0.007); however, the LIG had regressed. CONCLUSIONS: The structured intervention was successful at improving autonomous exercise motivation, regardless of exercise intensity. However, only those participants who had exercised at a higher intensity sustained their improvement. Intervention participation did not improve QOL more than controls. IMPLICATIONS FOR CANCER SURVIVORS: Higher-intensity exercise is more likely to result in more sustainable increases in motivation to exercise among cancer survivors.

A comparison of training methods to increase neck muscle strength.

OBJECTIVE: To compare two neck strength training modalities. BACKGROUND: Neck injury in pilots flying high performance aircraft is a concern in aviation medicine. Strength training may be an effective means to strengthen the neck and decrease injury risk. METHODS: The cohort consisted of 32 age-height-weight matched participants, divided into two experimental groups; the Multi-Cervical Unit (MCU) and Thera-Band tubing groups (THER), and a control (CTRL) group. Ten weeks of training were undertaken and pre-and post isometric strength testing for all groups was performed on the MCU. Comparisons between the three groups were made using a Kruskal-Wallis test and effect sizes between the MCU and the THER groups and the THER and CTRL groups were also calculated. RESULTS: The MCU group displayed the greatest increase in isometric strength (flexion 64.4%, extension 62.9%, left lateral flexion 53.3%, right lateral flexion 49.1%) and differences were only statistically significant (p<0.05) when compared to the CTRL group. Increases in neck strength for the THER group were lower than that shown in the MCU group (flexion 42.0%, extension 29.9%, left lateral flexion 26.7%, right lateral flexion 24.1%). Moderate to large effect sizes were found between the MCU and THER as well as the THER and CTRL groups. CONCLUSIONS: This study demonstrated that the MCU was the most effective training modality to increase isometric cervical muscle strength. Thera-Band tubing did however, produce moderate gains in isometric neck strength.

Changes in cervical spine bone mineral density in response to flight training.

BACKGROUND: High magnitude loads and unusual loading regimes are two important determinants for increasing bone mass. Past research demonstrated that positive Gz-induced loading, providing high loads in an unaccustomed manner, had an osteogenic effect on bone. Another determinant of bone mass is that the bone response to loading is site specific. This study sought to further investigate the site specific bone response to loading, examining the cervical spine response, the site suspected of experiencing the greatest loading, to high performance flight. METHODS: Bone mineral density (BMD) and bone mineral content (BMC) was monitored in 9 RAAF trainee fighter pilots completing an 8-mo flight training course on a PC-9 and 10 age-height-weight-matched controls. RESULTS: At completion of the course, the pilots had a significant increase in cervical spine BMD and total body BMC. No significant changes were found for the control group. CONCLUSIONS: This study demonstrated that the physical environment associated with flight training may have contributed to a significant increase in cervical spine bone mass in the trainee PC-9 pilots. The increase in bone mass was possibly a response to the strain generated by the daily wearing of helmet and mask assembly under the influence of positive sustained accelerative forces.

Flight-training effect on the cervical muscle isometric strength of trainee pilots.

External stimulus/loading initiates adaptations within skeletal muscle. It has been previously found that the cervical area has the highest loading while performing flying maneuvers under +Gz. The first purpose of this study was to examine the neck muscle response to the physical environment associated with flight training, incorporating limited exposure to +Gz force, in a Pilatus PC-9 aircraft. The second purpose was to examine the short-term range of movement (ROM) response to flight training. Isometric cervical muscle strength and ROM was monitored in 9 RAAF pilots completing an 8-mo flight-training course at Pearce Airbase in Western Australia, and in 10 controls matched for gender, age, height, and weight. Isometric cervical muscle strength and ROM were measured at baseline and at 8 mo using the multi-cervical rehabilitation unit (Hanoun Medical, Downsview, Ontario, Canada). Results indicated that an increase in pilot neck strength was limited to flexion while in a neutral position. No strength changes were recorded in any other site in the pilots or for the controls. These findings suggest that short-term exposure to the physical environment associated with flight training had a limited significant effect on increasing isometric cervical muscle strength. No significant changes were observed in pilot ROM, indicating that short-term exposure to flight does not effect ROM.