Collaboration matters: A randomized controlled trial of patient-clinician collaboration in suicide risk assessment and intervention.

BACKGROUND: Clinician collaboration can help high-risk individuals to manage their suicidal crises. However, limited research has directly examined how higher patient-clinician collaboration during assessment and intervention can effectively reduce suicidal ideation. This novel randomized clinical trial compared a high vs. low level of patient-clinician collaboration by pairing commonly used assessment (Structured Interview vs. Narrative Assessment) and intervention approaches (Safety Planning Intervention vs. Crisis Response Planning). We hypothesized that the interventions involving higher (than lower) patient-clinician collaboration during assessment (Narrative Assessment) or intervention (Crisis Response Planning) would lead to larger reductions in suicidal ideation. METHODS: Eighty-two participants with a history of suicide ideation and/or attempts were randomly assigned to one of the four interventions varying in patient-clinician collaboration. After attrition, sixty-six participants completed the study. Suicidal ideation via ecological momentary assessment was measured 14 days before and 14 days after treatment. RESULTS: Although the severity of suicidal ideation decreased in all groups, the two groups that included highly collaborative assessment had larger pre-post reductions in suicidal ideation (Narrative Assessment+Safety Plan; dwithin = 0.26, and Narrative Assessment+Crisis Response Plan; dwithin = 0.19) than the groups that included a checklist-based assessment (Structured Interview). LIMITATIONS: Longer follow-up periods with a larger sample would have provided an understanding of the durability of intervention effects. CONCLUSION: Results suggest that the inclusion of higher patient-clinician collaboration techniques during suicide risk assessment can effectively reduce suicidal thoughts. Thus, clinician-led collaborative risk assessment approaches can enhance the effects of safety planning-type interventions among patients with elevated risk for suicide versus checklist-based assessment approaches.

Novel In-Training Evaluation Report in an Internal Medicine Residency Program: Improving the Quality of the Narrative Assessment.

OBJECTIVE: To determine whether incorporating our novel in-training evaluation report (ITER), which prompts each resident to list at least three self-identified learning goals, improved the quality of narrative assessments as measured by the Narrative Evaluation Quality Instrument (NEQI). METHODS: A total of 1468 narrative assessments from a single institution from 2017 to 2021 were deidentified, compiled, and sorted into the pre-intervention form arm and post-intervention form arm. Due to limitations in our residency management suite, incorporating learning goals required switching from an electronic form to a hand-deliver form. Comments were graded by two research personnel utilizing the NEQI's scale of 0-12, with 12 representing the maximum quality for a comment. The outcome of the study was the mean difference in NEQI score between the electronic pre-intervention period and paper post-intervention period. RESULTS: The mean NEQI score for the pre-intervention period was 2.43 ± 3.34, and the mean NEQI score for the post-intervention period was 3.31 ± 1.71, with a mean difference of 0.88 (p < 0.001). In the pre-intervention period, 46% of evaluations were submitted without a narrative assessment (scored as a zero) while 1% of post-intervention period evaluations had no narrative assessment. Internal consistency reliability, as measured by Ebel's intraclass correlation coefficient (ICC), showed high agreement between the two raters (ICC = 0.92). CONCLUSIONS: Our findings suggest that implementing a timely, hand-delivered paper ITER that incorporates resident learning goals can lead to overall higher-quality narrative assessments.

Preparing Effective Narrative Evaluations for the Medical School Performance Evaluation (MSPE).

Introduction: In 2016, the AAMC Medical School Performance Evaluation (MSPE) Task Force issued recommendations to standardize the MSPE but did not address the quality of the written narratives in that document. Narrative evaluations are hampered by code words, polite rhetoric, and bias to the detriment of students. To address this, the AAMC's Group on Student Affairs and Group on Educational Affairs convened an expert group to consider the state of narratives in the MSPE and develop resources to improve their quality. Methods: A series of interactive workshops was developed and presented at an AAMC webinar and national meetings. A presentation outlining challenges and possible approaches to improvement was followed with large-group discussion and/or small-group breakout activity to analyze and improve upon sample clinical comments and create summary clerkship paragraphs. The initial webinar used polling questions and free-text prompts to gather feedback for future workshops. Anonymous survey responses were collected at the end of each subsequent workshop to determine perceived effectiveness and potential utility at participants' institutions. Results: Over 680 administrators, faculty, and staff participated in the webinar or in one of four national-level workshops. Respondents agreed that the modules would be useful in faculty development and wanted to replicate their learning at their own institutions for overall better impact on the quality of MSPE narratives. Discussion: This resource addresses an important gap in the medical education literature. A variety of stakeholders affirmed that these workshops have value in training writers to improve their narrative comments for the MSPE.

Concordance of Narrative Comments with Supervision Ratings Provided During Entrustable Professional Activity Assessments.

BACKGROUND: Use of EPA-based entrustment-supervision ratings to determine a learner's readiness to assume patient care responsibilities is expanding. OBJECTIVE: In this study, we investigate the correlation between narrative comments and supervision ratings assigned during ad hoc assessments of medical students' performance of EPA tasks. DESIGN: Data from assessments completed for students enrolled in the clerkship phase over 2 academic years were used to extract a stratified random sample of 100 narrative comments for review by an expert panel. PARTICIPANTS: A review panel, comprised of faculty with specific expertise related to their roles within the EPA program, provided a "gold standard" supervision rating using the comments provided by the original assessor. MAIN MEASURES: Interrater reliability (IRR) between members of review panel and correlation coefficients (CC) between expert ratings and supervision ratings from original assessors. KEY RESULTS: IRR among members of the expert panel ranged from .536 for comments associated with focused history taking to .833 for complete physical exam. CC (Kendall's correlation coefficient W) between panel members' assignment of supervision ratings and the ratings provided by the original assessors for history taking, physical examination, and oral presentation comments were .668, .697, and .735 respectively. The supervision ratings of the expert panel had the highest degree of correlation with ratings provided during assessments done by master assessors, faculty trained to assess students across clinical contexts. Correlation between supervision ratings provided with the narrative comments at the time of observation and supervision ratings assigned by the expert panel differed by clinical discipline, perhaps reflecting the value placed on, and perhaps the comfort level with, assessment of the task in a given specialty. CONCLUSIONS: To realize the full educational and catalytic effect of EPA assessments, assessors must apply established performance expectations and provide high-quality narrative comments aligned with the criteria.

Avaliação de narrativas orais de crianças: uma revisão de literatura / Evaluación de narrativas orales de niños: una revisión de la literatura / Evaluation of Children's Oral Narratives: A Literature Review

Existe pouco consenso sobre o que constitui um bom reconto de uma história e como avaliar essa importante habilidade linguística. Este estudo revisou artigos publi-cados entre 2010 e 2018 que avaliaram narrativas orais de histórias por crianças, a fim de mapear e sistematizar as medidas qualitativas e quantitativas empregadas. Ini-cialmente os estudos analisados foram classificados de acordo com o uso de uma de quatro metodologias amplas: avaliações padronizadas, gramática narrativa, unidades-C e protocolos de pontuação de narrativa. No entanto, um exame mais detalhado mostrou que essa classificação geral obscureceu o fato de que as medidas específicas podiam não ser equivalentes entre estudos. Para melhorar esse esquema conceitual, as medidas específicas foram organizadas em novas categorias, baseadas em dimensões diferentes do desempenho da narrativa oral de histórias, como fluência, coesão e inclusão de elementos psicológicos. A aplicação desse novo esquema classificatório aos estudos publicados entre 2010 e 2018 revelou que as medidas específicas da qualidade narrativa variam ampla e ortogonalmente aos métodos mais gerais empregados, o que explica parte da confusão conceitual e metodológica presente na literatura sobre avaliação de habilidades narrativas orais. Espera-se que esse novo esquema de classificação possa ajudar a dissipar parte dessa confusão e melhorar a comparabilidade e a replicabilidade dos estudos

Hay poco consenso sobre lo que constituye un buen recuento de una historia y cómo evaluar esta importante habilidad lingüística. El presente estudio revisó artículos publicados entre 2010 y 2018 que evaluaron narrativas orales de historias contadas por niños para mapear y sistematizar las medidas cualitativas y cuantitativas empleadas. Inicialmente, los estudios analizados se clasificaron de acuerdo con el uso de una de cuatro metodologías amplias: evaluaciones estandarizadas, gramática narrativa, unidades-C y protocolos de puntuación narrativa. Sin embargo, un examen más detallado mostró que esta clasificación general ocultaba el hecho de que las medidas específicas podrían no ser equivalentes entre los estudios. Para mejorar este esquema conceptual, las medidas específicas fueron organizadas en nuevas categorías, basadas en diferentes dimensiones del desempeño de la narrativa oral de historias como la fluidez, la cohesión y la inclusión de elementos psicológicos. La aplicación de este nuevo esquema de clasificación a los estudios publicados entre 2010 y 2018 reveló que las medidas específicas de calidad narrativa varían amplia y ortogonalmente a los métodos más generales empleados, lo que explica parte de la confusión conceptual y metodológica presente en la literatura sobre la evaluación de las habilidades narrativas orales. Se espera que este nuevo esquema de clasificación pueda ayudar a disipar parte de esta confusión y a mejorar la comparabilidad y la replicabilidad de los estudios

There has been little consensus on what constitutes a good retelling of a story and how to assess this essential language skill. This study reviewed studies between 2010 and 2018 that assessed children ́s retellings of stories to map and systematize the qualitative and quan-titative measures employed. Initially, studies were clas-sified according to the use of one of four broad method-ologies: standardized assessments, narrative grammar, C-Units, and narrative scoring protocols. However, closer examination showed that this general classifica-tion obscured the fact that the specific measures might not be equivalent between one study and another. To improve this conceptual scheme, the specific measures were organized into new categories, based on different dimensions of retelling performance, such as fluency, cohesion, and inclusion of psychological elements. The application of this new classificatory scheme to studies between 2010 and 2018 revealed that the specific measures of narrative quality vary broadly and orthog-onally to the more general methods employed, which explains part of the conceptual and methodological confusion present in the literature on assessment of narrative oral skills. It is hoped this new classification scheme can help to dispel some of this confusion and improve comparability and replicability

The effect of gender dyads on the quality of narrative assessments of general surgery trainees.

BACKGROUND: Prior studies have shown that gender can influence how learners are assessed and the feedback they receive. We investigated the quality of faculty narrative comments in general surgery trainee evaluation using trainee-assessor gender dyads. METHODS: Narrative assessments of surgical trainees at the University of British Columbia were collected and rated using the McMaster Narrative Comment Rating Scale (MNCRS). Variables from the MNCRS were inputted into a generalized linear mixed model to explore the impact of gender dyads on the quality of narrative feedback. RESULTS: 2,469 assessments were collected. Women assessors tended to give higher-quality comments (p's < 0.05) than men assessors. Comments from men assessors to women trainees were significantly more positive than comments from men assessors to men trainees (p = 0.02). Men assessors also tended to give women trainees more reinforcing than corrective comments than to men trainees (p < 0.01). CONCLUSIONS: There are significant differences in the quality of faculty feedback to trainees by gender dyads. A range of solutions to improve and reduce differences in feedback quality are discussed.

Narrative Assessments with First Grade Spanish-English Emergent Bilinguals: Spontaneous versus Retell Conditions.

This study used qualitative analyses to investigate similarities and differences in narrative production across two task conditions for four first grade Spanish-English emergent bilingual children. Task conditions were spontaneous story generation and retelling using the same story. Spanish stories from two children were compared on the basis of similarity in vocabulary, while English stories from two children were compared on the basis of similarity in overall discourse skills. Results show that when the total number of words used was similar across English narratives, the retell included more different words and higher quality story structure than the spontaneous story. When overall discourse scores in the Spanish examples were similar, the spontaneous story required more words than the retell, but also included more central events and greater detail. Yet, the retell included more advanced narrative components. This study contributes to our understanding of narrative skills in young Spanish-English bilinguals across task conditions.

Constructing narratives to describe video events using aided communication.

Narratives are a pervasive form of discourse and a rich source for exploring a range of language and cognitive skills. The limited research base to date suggests that narratives generated using aided communication may be structurally simple, and that features of cohesion and reference may be lacking. This study reports on the analysis of narratives generated in interactions involving aided communication in response to short, silent, video vignettes depicting events with unintended or unexpected consequences. Two measures were applied to the data: the Narrative Scoring Scheme and the Narrative Analysis Profile. A total of 15 participants who used aided communication interacted with three different communication partners (peers, parents, professionals) relaying narratives about three video events. Their narratives were evaluated with reference to narratives of 15 peers with typical development in response to the same short videos and to the narratives that were interpreted by their communication partners. Overall, the narratives generated using aided communication were shorter and less complete than those of the speaking peers, but they incorporated many similar elements. Topic maintenance and inclusion of scene-setting elements were consistent strengths. Communication partners offered rich interpretations of aided narratives. Relative to the aided narratives, these interpreted narratives were typically structurally more complete and cohesive and many incorporated more elaborated semantic content. The data reinforce the robust value of narratives in interaction and their potential for showcasing language and communication achievements in aided communication.

Integrated narrative assessment exemplification: a leukaemia case history.

BACKGROUND AND AIM: In the Integrated Narrative Nursing Assessment (INNA), the Evidence-Based Nursing Model is integrated with the Narrative-Based Nursing Model. The INNA makes use of quantitative instruments, arising from the natural sciences as well as of qualitative ones, arising from the human achieving results of standardization and reproducibility, as well as of customization and uniqueness. Accordingly, the purpose of this work is to exemplify the thinking process of and the method adopted by a nurse adopting an integrated narrative assessment in the evaluation of a patient. METHOD: The patient suffered from acute myeloid leukaemia, treated with chemotherapy. Her nurse worked in a haematology ward in a North Italy Hospital. The nurse had previous experience in conducting the assessment according to INNA. Based on patient's characteristics, the nurse chose to use the narration (to explore needs from their subjective perception) and the scales (to measure them objectively) among the various assessment instruments provided by the INNA. RESULTS: The resultant integrated outcomes helped the nurse to have a comprehensive overview of the person's health-care needs and their connections. These outcomes derive from the integration of narrative information with those obtained from the scales, which in this paper have shown consistent results. CONCLUSION: It is very difficult to reach this complexity by considering qualitative and quantitative assessment strategies as mutually foreclosing, given that both emerged as being very useful in identifying, understanding and measuring the needs of the assisted person. Then they both could be used to design a customized intervention, encouraging new connections between disease, illness, sickness and everyday life.

Use of narratives to assess language disorders in an inpatient pediatric psychiatric population.

A large proportion of child psychiatry patients have undiagnosed language disorders. Adequately developed language is critical for psychotherapy and cognitive-behavioral therapies. This study investigated (1) whether assessment of oral narratives would identify language impairments in this population undetected by assessment of only core language abilities, and (2) the extent to which measures of cognition, working memory, emotional distress, and social function differentially predict core language and narrative development. Results showed that (1) more than twice as many children were identified with language impairment when both narrative and core language assessment were used, and (2) core language comprehension and complex verbal working memory were the strongest predictors of narrative production, while core language comprehension, a less complex working-memory task, and social skills best predicted narrative comprehension. Emotional distress did not predict either. The results emphasize the importance of evaluating child psychiatry patients' language, using both core language and narrative measures.