An interpretive phenomenological analysis of formative feedback in anesthesia training: the residents' perspective.

BACKGROUND: Consistent formative feedback is cornerstone to competency-by-design programs and evidence-based approaches to teaching and learning processes. There has been no published research investigating feedback from residents' perspectives. We explored the value residents place on feedback in routine operating room settings, their experiences, and understanding of the role of feedback in their training and developing professional identity. METHODS: Interpretive phenomenological analysis of residents' experiences with feedback received in clinical settings involved two focus groups with 14 anesthesia residents at two time points. Analysis was completed in the context of a teaching hospital adapting to new practices to align with nationally mandated clinical competencies. Focus group conversations were transcribed and interpreted through the lens of a social constructivist approach to learning as a dynamic inter- and intra-personal process, and evidence-based assessment standards set by the International Test Commission (ITC). RESULTS: Residents described high quality feedback as consistent, effortful, understanding of residents' thought processes, and containing actionable advice for improvement. These qualities of effective evaluation were equally imperative for informal and formal evaluations. Residents commented that highest quality feedback was received informally, and formal evaluations often lacked what they needed for their professional development. CONCLUSION: Residents have a deep sense of what promotes their learning. Structured feedback tools were seen positively, although the most important determinants of their impact were faculty feedback- and broader evaluation-skills and motivations for both formal and informal feedback loops.

Implementing Electronic Discharge Communication Tools in Pediatric Emergency Departments: Multicountry, Cross-Sectional Readiness Survey of Nurses and Physicians.

BACKGROUND: Pediatric emergency departments (ED) in many countries are implementing electronic tools such as kiosks, mobile apps, and electronic patient portals, to improve the effectiveness of discharge communication. OBJECTIVE: This study aimed to survey nurse and physician readiness to adopt these tools. METHODS: An electronic, cross-sectional survey was distributed to a convenience sample of currently practicing ED nurses and physicians affiliated with national pediatric research organizations in Canada, Australia, and New Zealand. Survey development was informed by the nonadoption, abandonment, scale-up, spread, sustainability framework. Measures of central tendency, and parametric and nonparametric tests were used to describe and compare nurse and physician responses. RESULTS: Out of the 270 participants, the majority were physicians (61%, 164/270), female (65%, 176/270), and had 5 or more years of ED experience (76%, 205/270). There were high levels of consensus related to the value proposition of electronic discharge communication tools (EDCTs) with 82% (221/270) of them agreeing that they help parents and patients with comprehension and recall. Lower levels of consensus were observed for organizational factors with only 37% (100/270) agreeing that their staff is equipped to handle challenges with communication technologies. Nurses and physicians showed significant differences on 3 out of 21 readiness factors. Compared to physicians, nurses were significantly more likely to report that EDs have a responsibility to integrate EDCTs as part of a modern system (P<.001) and that policies are in place to guide safe and secure electronic communication (P=.02). Physicians were more likely to agree that using an EDCT would change their routine tasks (P=.04). One third (33%, 89/270) of participants indicated that they use or have used EDCT. CONCLUSIONS: Despite low levels of uptake, both nurses and physicians in multiple countries view EDCTs as a valuable support to families visiting pediatric ED. Leadership for technology change, unclear impact on workflow, and disparities in digital literacy skills require focused research effort.

The Role of Metacognitive Reading Strategies, Metacognitive Study and Learning Strategies, and Behavioral Study and Learning Strategies in Predicting Academic Success in Students With and Without a History of Reading Difficulties.

We examined the self-reported use of reading, study, and learning strategies in university students with a history of reading difficulties (HRD; n = 77) and with no history of reading difficulties (NRD; n = 295). We examined both between-groups differences in strategy use and strategy use as a predictive measure of academic success. Participants completed online questionnaires regarding reading history and strategy use. GPA and frequency of use of academic support services were also obtained for all students. University students with HRD reported a different profile of strategy use than their NRD peers, and self-reported strategy use was differentially predictive of GPA for students with HRD and NRD. For students with HRD, the use of metacognitive reading strategies and the use of study aids predicted academic success. Implications for university student services providers are discussed.

Decision-Making Quality in Parents Considering Adenotonsillectomy or Tympanostomy Tube Insertion for Their Children.

Importance: Shared decision making is a process in which clinicians and patients make health care decisions in a collaborative manner using the most up-to-date evidence, while considering patient values and preferences. Shared decision making is thought to have a positive influence on the decision-making process in medicine. Objective: To describe the level of decisional conflict and decisional regret experienced by parents considering surgery for their children and to determine relations among decisional conflict, decisional regret, and shared decision making. Design, Setting, and Participants: A prospective cohort study was conducted at an academic pediatric otolaryngology clinic. Participants included 126 parents of children younger than 6 years who underwent consultation for adenotonsillectomy or tympanostomy tube insertion. Main Outcomes and Measures: Parent participants completed the Shared Decision Making Questionnaire-Parent version, Decisional Conflict Scale (DCS), and Decisional Regret Scale (DRS). Surgeons completed the Shared Decision Making Questionnaire-Physician version. Results: This study included 126 parents; 102 women (mean [SD] age, 33.2 [5.1] years) and 24 men (mean [SD] age, 35.6 [6.3] years). Overall, 34 parents (26%) reported clinically significant decisional conflict. Only 1 parent experienced moderate to strong decisional regret; 28 parents (43.7%) had mild decisional regret. Both parent and physician ratings of shared decision making were significantly negatively correlated with total DCS scores. Parent SDM-Q-9 and total DCS scores were significantly negatively correlated (rs[118] = -0.582; P < .001). Similarly, physician SDM-Q-Doc and total DCS scores were also significantly negatively correlated (rs[118] = -0.221; P = .04). Only parent ratings of shared decision making were significantly negatively correlated with total DRS scores (rs[63] = -0.254; P = .045). Those parents with clinically significant decisional conflict had significantly higher DRS scores (P = .02). Conclusions and Relevance: Many parents experienced significant decisional conflict when making decisions about their child's elective surgical treatment. Parents who perceived themselves as being more involved in the decision-making process reported less decisional conflict and decisional regret. Future research should explore the influence of decision quality on health outcomes and develop methods to improve shared decision making.

Parents' decisional conflict, self-determination and emotional experiences in pediatric otolaryngology: A prospective descriptive-comparative study.

OBJECTIVE: The aim of this study was to describe the level of decisional conflict experienced by parents considering surgery for their children and to determine if personal characteristics and emotional experiences vary as a function of whether or not parents experienced clinically significant levels of decisional conflict. METHODS: Sixty consecutive parents of children who underwent surgical consultation for elective otolaryngological procedures were prospectively enrolled. Participants completed the Decisional Conflict Scale, Basic Needs Satisfaction Scale, and the Positive and Negative Affect Schedule-Revised. RESULTS: Eight participants (13.3%) scored over 25 on the Decisional Conflict Scale, a previously defined cut-off indicating clinically significant decisional conflict. Parents who experienced significant decisional conflict felt less autonomous and less related or connected to others as compared to those who did not report significant decisional conflict. In addition, parents who experienced significant decisional conflict reported more negative emotions and fewer positive emotions during the surgical consultation visit. However, parents who reported significant decisional conflict did not report feeling less competent. CONCLUSIONS: Parental decision-making on whether their child should undergo elective pediatric otolaryngological surgery is a personal and emotional process. Parents' characteristics and experiences should be acknowledged and supported during the surgical consultation. Future research should aim to normalize the decision-making experience for parents, and to allow surgeons to be aware of the importance of decisional needs.

Spinal dural arteriovenous fistula: correlation between radiological and clinical findings.

OBJECT: The pathophysiology of spinal dural arteriovenous fistulas (SDAVFs) results in perimedullary venous congestion and in turn central cord congestion. Clinically, this presents with progressive neurological dysfunctions that, if diagnosed in a timely fashion, can be at least halted and in part reversed. In SDAVFs, imaging features on MRI and digital subtraction angiography (DSA) have not been studied in conjunction with clinical findings. The primary purpose of the present study was to test if severity of clinical presentation varies in relation to imaging. METHODS: This retrospective cohort study identified 12 patients treated for SDAVF at the authors' institution. The extent of venous congestion and cord edema was quantified by the number of vertebral levels shown to be affected on DSA and MRI. A modified Aminoff-Logue Scale (ALS) score was assigned at the time of diagnosis and again after definitive therapy. The patients were divided into one of two groups: those with venous congestion < 7 and ≥ 7 vertebral levels seen on DSA and MRI and with central cord edema < 6 and ≥ 6 levels. A t-test was used to assess for a difference in the presenting ALS score between the groups. RESULTS: Patients with ≥ 7 levels of venous congestion reported greater functional disability (DSA: p ≤ 0.001, Cohen's d = 0.509; and MRI: p ≤ 0.001, d = 0.632). Patients with a greater extent of cord edema also reported worse functional disability (p ≤ 0.001, d = 2.31). There was a strong linear correlation between the post- and pretreatment ALS scores (R(2) = 0.86) for those with successful interventions (n = 9). CONCLUSIONS: In patients with an SDAVF, the severity of the neurological dysfunction may be predicted by the extent of DSA- and MRI-documented venous congestion and cord edema. There was a strong positive relationship between initial and posttreatment neurological dysfunction.