Norming a Written Communication Rubric in a Graduate Health Science Course.

BACKGROUND: There is growing interest in the use of rubrics to assess written work. This study aimed to determine whether or not the norming of a written communication rubric improved scoring consistency among clinical faculty in a critical thinking course. The benefits of a formalized norming process are described. METHODS: Faculty-raters were trained to apply the rubric to a signature assignment while participating in calibration workshops. For each rubric criterion, faculty examined whether or not heightened congruence in scoring resulted from the training. Inter-rater reliability was determined after raters independently scored de-identified essays. RESULTS: Pre-workshop intra-class correlations (ICCs) were acceptable (i.e., >0.7) for three of five rubric criteria. Post-workshop ICCs for only two criteria were acceptable: disciplinary conventions, and sources and evidence. Rater attrition and lag-time between calibration and post-workshop activities likely contributed to reduced consistency. DISCUSSION: The rubric was useful for discriminating writing proficiency. Norming led to revision of the signature assignment, the rubric design, and a need for writing workshops. These changes will result in better student preparation for composing evidence-informed essays. Less-rigid approaches are worthy of future exploration.

Norming a VALUE rubric to assess graduate information literacy skills.

OBJECTIVE: The study evaluated whether a modified version of the information literacy Valid Assessment of Learning in Undergraduate Education (VALUE) rubric would be useful for assessing the information literacy skills of graduate health sciences students. METHODS: Through facilitated calibration workshops, an interdepartmental six-person team of librarians and faculty engaged in guided discussion about the meaning of the rubric criteria. They applied the rubric to score student work for a peer-review essay assignment in the "Information Literacy for Evidence-Based Practice" course. To determine inter-rater reliability, the raters participated in a follow-up exercise in which they independently applied the rubric to ten samples of work from a research project in the doctor of physical therapy program: the patient case report assignment. RESULTS: For the peer-review essay, a high level of consistency in scoring was achieved for the second workshop, with statistically significant intra-class correlation coefficients above 0.8 for 3 criteria: "Determine the extent of evidence needed," "Use evidence effectively to accomplish a specific purpose," and "Access the needed evidence." Participants concurred that the essay prompt and rubric criteria adequately discriminated the quality of student work for the peer-review essay assignment. When raters independently scored the patient case report assignment, inter-rater agreement was low and statistically insignificant for all rubric criteria (kappa=-0.16, p>0.05-kappa=0.12, p>0.05). CONCLUSIONS: While the peer-review essay assignment lent itself well to rubric calibration, scorers had a difficult time with the patient case report. Lack of familiarity among some raters with the specifics of the patient case report assignment and subject matter might have accounted for low inter-rater reliability. When norming, it is important to hold conversations about search strategies and expectations of performance. Overall, the authors found the rubric to be appropriate for assessing information literacy skills of graduate health sciences students.

Motivation of fitness center participants toward resistance training.

There is a need to better understand the behavior and sense of motivation of fitness center participants. The purpose of this study was to assess whether or not demographic characteristics and health self-determinism (intrinsic or extrinsic motivation) of fitness center participants were predictive of their levels of resistance training. A cross-sectional design was used; participants were recruited via the Internet to complete an online survey. There were 185 participants (age = 39.1 +/- 11.3 years) in the study. The majority of respondents reported having carried out levels of resistance training that met national health organization recommendations. Regression analysis of the data revealed that health self-determinism predicted quantity of resistance training reported (p = 0.014), whereas demographics did not. Being intrinsically motivated to health self-determinism predicted meeting national resistance training recommendations compared to participants extrinsically motivated (p = 0.007). For those who work with fitness center participants, our findings are useful by identifying participants as a predominantly intrinsically motivated group of people that performs adequate quantities of resistance training; the methodology employed in this study can be used to identify participants in need of increased levels of resistance training and heightened sense of motivation to do so.

Effect of a computerized body mass index prompt on diagnosis and treatment of adult obesity.

BACKGROUND: In obese adults, physicians often fail to identify obesity and recommend treatments for it. We sought to determine whether a computerized body mass index (BMI) chart prompt would increase the likelihood that patients of family physicians would be diagnosed with obesity and referred for obesity treatment. METHODS: A total of 846 obese patients of 37 family physicians were randomly assigned to either have a patient's BMI chart prompt placed in their electronic medical record (intervention group) or not have a BMI prompt (comparison group) placed in the record. We then examined patient medical records for evidence of an obesity diagnosis and referral for specific obesity treatments. We also measured whether the presence of comorbidities in obese patients influenced the likelihood of diagnoses and treatments by the physicians. RESULTS: Obese patients of physicians who had a BMI chart prompt in their medical records were significantly more likely than obese patients of physicians who did not receive a BMI chart prompt to receive a diagnosis of obesity (16.6% versus 10.7%; P=.016). Patients of physicians who were provided with a BMI chart prompt were also more likely than patients of physicians who did not get a chart prompt to receive a referral for diet treatment (14.0% versus 7.3%, P=.002) and exercise (12.1% versus 7.1%, P=.016). Of the obesity comorbidities, only obstructive sleep apnea (OSA) was a predictor of a patient being diagnosed with obesity (OR=.49, 95% CI=0.281, 0.869, P=.014). CONCLUSIONS: Inclusion of a computerized BMI chart prompt increased the likelihood that physicians would diagnose obesity in obese patients and refer them for treatment.

Health risk of bathing in Southern California coastal waters.

Urbanized areas often discharge large volumes of contaminated waste into coastal waters, which may pose a health risk to bathers at nearby beach areas. In this investigation the authors estimated the number of gastrointestinal and respiratory illness episodes associated with the microbial contamination of coastal waters among bathers at Southern California beaches from 2000 through 2004. Bathers at the 67 beaches along the 350-km coastline of Southern California were the study population in this investigation. The authors' estimates were derived from a simulation model, which utilized water quality, beach attendance, and bathing-rate data, along with the three concentration-response relationships that underlie US Environmental Protection Agency, World Health Organization, and European Union marine water-quality guidelines. Given the absence of a general surveillance program to monitor these illnesses in Southern California, simulation modeling provides an established method to derive health risk estimates, despite additional analytic uncertainty that may accompany modeling-based analyses. An estimated 689,000 to 4,003,000 gastrointestinal illness episodes and 693,000 respiratory illness episodes occurred each year. The majority of illnesses (57% to 80%) occurred during the summer season as a result of large seasonal increases in beach attendance and bathing rates. As 71% of gastroenteritis episodes were estimated to occur when the water quality was considered safe for bathing, California's marine water-contact standards may be inadequate to protect the health of bathers.

Web-based investigation of water associated illness in marine bathers.

Internet-based methods of disease investigation have proven useful for drinking water and foodborne illness but have not been applied to recreational water illness (RWI) in marine bathers. We analyzed responses to a web-based survey posted by Surfrider Foundation over the period 1996-2005. Subjects (n=1895) were recruited by self-selection via website visitation. Complaints were screened to meet inclusion criteria (n=1190). Demographic characteristics of respondents were assessed as well as the types and severity of their symptoms. Geographic information systems (GIS) were used to examine spatial patterns in survey data. Illness complaints were commonly received in summer from heavily used California beaches. A strong correlation was observed between water quality impairment and the number of illness complaints in coastal counties (r=0.96, p<0.01). Respondents most commonly complained of gastrointestinal symptoms, infections of the sinuses and other upper respiratory ailments. Certain severe symptoms, such as high fevers, severe vomiting and/or diarrhea, seizures, swollen glands, and infections that did not heal properly were also reported. Approximately one-third of respondents sought the care of a physician for their symptoms; however, less than 1% reported being hospitalized. Our findings concerning the nature of the described symptoms as well as the observed seasonal and spatial patterns in the data are consistent with previously published findings of RWI in ocean bathers exposed to sewage and urban runoff. This method of rapid RWI data collection over the web could easily be adopted by health agencies for coordinated disease surveillance.

Evaluation of recreational health risk in coastal waters based on enterococcus densities and bathing patterns.

We constructed a simulation model to compute the incidences of highly credible gastrointestinal illness (HCGI) in recreational bathers at two intermittently contaminated beaches of Orange County, California. Assumptions regarding spatial and temporal bathing patterns were used to determine exposure levels over a 31-month study period. Illness rates were calculated by applying previously reported relationships between enterococcus density and HCGI risk to the exposure data. Peak enterococcus concentrations occurred in late winter and early spring, but model results showed that most HCGI cases occurred during summer, attributable to elevated number of exposures. Approximately 99% of the 95,010 illness cases occurred when beaches were open. Model runs were insensitive to 0-10% swimming activity assumed during beach closure days. Comparable illness rates resulted under clustered and uniform bather distribution scenarios. HCGI attack rates were within federal guidelines of tolerable risk when averaged over the study period. However, tolerable risk thresholds were exceeded for 27 total days and periods of at least 6 consecutive days. Illness estimates were sensitive to the functional form and magnitude of the enterococcus density-HCGI relationships. The results of this study contribute to an understanding of recreational health risk in coastal waters.