The intersection of professionalism and interprofessional care: development and initial testing of the interprofessional professionalism assessment (IPA).

Valid assessment of interprofessional education and collaborative practice (IPECP) is challenging. The number of instruments that measure various aspects of IPECP, or in various sites is growing, however. The Interprofessional Professionalism Assessment (IPA) measures observable behaviors of health care professionals-in-training that demonstrate professionalism and collaboration when working with other health care providers in the context of people-centered care. The IPA instrument was created by the Interprofessional Professionalism Collaborative (IPC), a national group representing 12 entry-level health professions and one medical education assessment organization. The instrument was created and evaluated over several years through a comprehensive, multi-phasic process: 1) development of construct and observable behaviors, 2) instrument design, expert review and cognitive interviews, and 3) psychometric testing. The IPA contains 26 items representing six domains of professionalism (altruism and caring, excellence, ethics, respect, communication, accountability), and was tested by 233 preceptors rating health profession learners in the final year of their practical training. These preceptors represented 30 different academic institutions across the U.S., worked in various types of practice sites, and evaluated learners representing 10 different entry-level health professions. Exploratory factor analysis suggested four factors (communication, respect, excellence, altruism and caring) using 21 items with the least amount of missing data, and confirmed, for the most part, a priori expectations. Internal consistency reliability coefficients for the entire instrument and its four subscales were high (all greater than 0.9). Psychometric results demonstrate aspects of the IPA's reliability and validity and its use across multiple health professions and in various practice sites.

Feasibility of implementing a standardized multisource feedback program in the graduate medical education environment.

BACKGROUND: Multisource feedback (MSF) is emerging as a central assessment method for several medical education competencies. Planning and resource requirements for a successful implementation can be significant. Our goal is to examine barriers and challenges to a successful multisite MSF implementation, and identify the benefits of MSF as perceived by participants. METHODS: We analyzed the 2007-2008 field trial implementation of the Assessment of Professional Behaviors, an MSF program of the National Board of Medical Examiners, conducted with 8 residency and fellowship programs at 4 institutions. We use a multimethod analysis that draws on quantitative process indicators and qualitative participant experience data. Process indicators include program attrition, completion of implementation milestones, number of participants at each site, number of MSF surveys assigned and completed, and adherence to an experimental rater training protocol. Qualitative data include communications with each program and semistructured interviews conducted with key field trial staff to elicit their experiences with implementation. RESULTS: Several implementation challenges are identified, including communication gaps and difficulty scheduling implementation and training workshops. Participant interviews indicate several program changes that should enhance feasibility, including increasing communication and streamlining the training process. CONCLUSIONS: Multisource feedback is a complex educational intervention that has the potential to provide users with a better understanding of performance expectations in the graduate medical education environment. Standardization of the implementation processes and tools should reduce the burden on program administrators and participants. Further study is warranted to broaden our understanding of the resource requirements for a successful MSF implementation and to show how outcomes change as MSF gains broader acceptance.

The quality of written comments on professional behaviors in a developmental multisource feedback program.

BACKGROUND: Written feedback on professional behaviors is an important part of medical training, but little attention has been paid to the quality of written feedback and its expected impact on learning. A large body of research on feedback suggests that feedback is most beneficial when it is specific, clear, and behavioral. Analysis of feedback comments may reveal opportunities to improve the value of feedback. METHOD: Using a directed content analysis, the authors coded and analyzed feedback phrases collected as part of a pilot of a developmental multisource feedback program. The authors coded feedback on various dimensions, including valence (positive or negative) and whether feedback was directed at the level of the self or behavioral performance. RESULTS: Most feedback comments were positive, self-oriented, and lacked actionable information that would make them useful to learners. CONCLUSIONS: Comments often lack effective feedback characteristics. Opportunities exist to improve the quality of comments provided in multisource feedback.

Effective elution of RDX and TNT from particles of Comp B in surface soil.

During live fire training exercises, large amounts of explosives are consumed. Low order detonations of high explosive payloads result in the patchy dispersal of particles of high explosive formulations over large areas of firing range soils. Dissolution of explosives from explosive formulation particles into soil pore water is a controlling factor for transport, fate, and effects of explosive compounds. We developed an empirical method to evaluate soils based on functionally defined effective dissolution rates. An automated Accelerated Solvent Extractor was used to determine the effective elution rates under controlled conditions of RDX and TNT from soil columns containing particles of Comp B. Contrived soils containing selected soil geosorbants and reactive surfaces were used to quantitatively determine the importance of these materials. Natural soils from training ranges of various soil types were also evaluated. The effects of geosorbants on effective elution rates were compound- and sorbent-specific. TNT elution was less than that of RDX and was greatly slowed by humic acid. Iron and iron-bearing clays reduced the effective elution rates of both RDX and TNT. This empirical method is a useful tool for directly generating data on the potential for explosives to leach from firing range soils, to identify general bulk soil characteristics that can be used to predict the potential, and to identify means to engineer soil treatments to mitigate potential transport.

Post-Katrina fecal contamination in Violet Marsh near New Orleans.

Fecal material entrained in New Orleans flood waters was pumped into the local environment. Violet Marsh received water pumped from St. Bernard Parish and the Lower Ninth Ward. Sediment core samples were collected from canals conducting water from these areas to pump stations and from locations within Violet Marsh. Viable indicator bacteria and fecal sterols were used to assess the levels of fecal material in sediment deposited after the levee failures and deeper sediments deposited before. Most of the cores had fecal coliform levels that exceed the biosolids criterion. All of the cores had fecal sterols that exceeded the suggested environmental quality criterion. Our data show both a long history of fecal contamination in Violet Marsh and an increase in fecal loading corresponding to the failure of the levee system. The work was performed as part of the Interagency Performance Evaluation Task Force investigation into the consequences of the failures of the New Orleans levee system.