Stress and value: the student perspective on utilizing real vs. actor patients in objective structured clinical examinations.

BACKGROUND: Studies have shown objective structured clinical examinations (OSCEs) to be one of the most reliable tools in assessing clinical performance; however in Pediatrics they primarily use manikins, simulators or parent actors which limits the comprehensiveness of the assessment. In our Pediatric Clerkship, medical students are evaluated using a standardized rubric during a clinical evaluation exercise (CEX) with real patients. This study assessed medical students' perceived stress levels and the educational value of the CEX compared an OSCE. We hypothesized there would be equal stress and value for students with the CEX experience compared to the OSCE. METHODS: Third year students anonymously completed questionnaires after required Pediatric CEX and Internal Medicine OSCE evaluations from July 2016-June 2017. The questionnaire included questions from the Intrinsic Motivation Inventory, a validated tool used to assess feelings of stress and perceived value of an exercise. RESULTS: A total of 147 and 145 questionnaires were completed after the CEX and OSCE. There were no differences between groups regarding levels of "nervousness" (p = 0.543) and "relaxation" (p = 0.055); students felt more "at ease" (p = 0.002) and less "pressure" (p < 0.001) during the CEX. Students perceived the CEX to be more useful and important to improve skills compared to the OSCE for the history taking, physical exam and interpersonal skills. CONCLUSIONS: Our results indicate that the CEX was associated with lower stress levels and had higher perceived value when compared to the OSCE. This study supports the usefulness of incorporating real patients into the clinical evaluation of medical students.

Robo-advisors and the financialization of lay investors.

The burgeoning financial technology scene in Singapore has seen the emergence of robo-advisors, which aim to disrupt traditional financial advisories by using algorithms to automate client advising and investment recommendations. Using an ecologies concept to explore how lay investors are articulated into global financial networks through robo advisors, this paper contributes to studies on the "financialization of everyday life". It argues that investors are rendered passive by the disciplinary tools of algorithms, contemporary finance theories and elements of robo-advisor platforms that feed into these sociotechnological assemblages. The state's role in embedding citizen investors in these human-machine relationships is considered. The fragmented landscape of free, nonprofessional online financial advice and the opaque qualities of investing algorithms make investor subject formation incomplete and uncertain, especially when markets are highly volatile. This paper explores how both financial inclusion and exclusion operate simultaneously in robo-advisors and argues that robo-advisors may weaken efforts to promote financial literacy and education.