Reliability and validity of the post COVID-19 condition stigma questionnaire: A prospective cohort study.

Background: Many of the 10-20% percent of COVID-19 survivors who develop Post COVID-19 Condition (PCC, or Long COVID) describe experiences suggestive of stigmatization, a known social determinant of health. Our objective was to develop an instrument, the Post COVID-19 Condition Stigma Questionnaire (PCCSQ), with which to quantify and characterise PCC-related stigma. Methods: We conducted a prospective cohort study to assess the reliability and validity of the PCCSQ. Patients referred to our Post COVID-19 Clinic in the Canadian City of Edmonton, Alberta between May 29, 2021 and May 24, 2022 who met inclusion criteria (attending an academic post COVID-19 clinic; age ≥18 years; persistent symptoms and impairment at ≥ 12 weeks since PCR positive acute COVID-19 infection; English-speaking; internet access; consenting) were invited to complete online questionnaires, including the PCCSQ. Analyses were conducted to estimate the instrument's reliability, construct validity, and association with relevant instruments and defined health outcomes. Findings: Of the 198 patients invited, 145 (73%) met inclusion criteria and completed usable questionnaires. Total Stigma Score (TSS) on the PCCSQ ranged from 40 to 174/200. The mean (SD) was 103.9 (31.3). Cronbach's alpha was 0.97. Test-retest reliability was 0.92. Factor analysis supported a 6-factor latent construct. Subtest reliabilities were >0.75. Individuals reporting increased TSS occurred across all demographic groups. Increased risk categories included women, white ethnicity, and limited educational opportunities. TSS was positively correlated with symptoms, depression, anxiety, loneliness, reduced self-esteem, thoughts of self-harm, post-COVID functional status, frailty, EQ5D5L score, and number of ED visits. It was negatively correlated with perceived social support, 6-min walk distance, and EQ5D5L global rating. Stigma scores were significantly increased among participants reporting employment status as disabled. Interpretation: Our findings suggested that the PCCSQ is a valid, reliable tool with which to estimate PCC-related stigma. It allows for the identification of patients reporting increased stigma and offers insights into their experiences. Funding: The Edmonton Post COVID-19 Clinic is supported by the University of Alberta and Alberta Health Services. No additional sources of funding were involved in the execution of this research study.

Clinical Instructors' Experiences Working with and Assessing Students Who Perform below Expectations in Physical Therapy Clinical Internships.

Purpose: Clinical education is an integral component of the curriculum of all physical therapy (PT) entry-to-practice programmes in Canada. The literature indicates that working with and assessing students performing below expectations (SPBE) can be procedurally and emotionally difficult. Our study aimed to explore the experiences of clinical instructors (CIs) and the decision-making process involved when supervising SPBE in PT. Method: A total of 19 in-depth, semi-structured interviews were conducted with CIs, transcribed, and coded using qualitative thematic analysis. Results: Four factors appeared to be important for CIs when they were deciding how to assess SPBE: (1) features of student performance, (2) factors related to the CIs, (3) academic and clinical facility influencers, and (4) strategies and available resources. Concerns about safety and professional behaviour, a student's clinical reasoning skills, and a lack of progression were key factors that CIs considered in recommending a final grade. CIs were more likely to recommend a failing grade if there was a series of repeated incidents rather than an isolated incident. Conclusions: We make several recommendations for the student, CI, and facilities to consider to better support and facilitate the process of working with SPBE in PT clinical education.

Objectif : la formation clinique fait partie intégrante des tous les programmes d'accès à la pratique en physiothérapie au Canada. Selon les publications, il peut être difficile sur le plan technique et affectif de travailler avec des étudiants dont le rendement est inférieur aux attentes (ÉRIA) et de les évaluer. La présente étude visait à explorer les expériences des moniteurs cliniques (MC) et les processus décisionnels en cause lors de la supervision d'ÉRIA en physiothérapie. Méthodologie : Au total, les chercheurs ont procédé à 19 entrevues semi-structurées approfondies avec des MC, qu'ils ont transcrites et codées au moyen d'une analyse thématique qualitative. Résultats : quatre facteurs semblent importants pour les MC lorsqu'ils décident comment évaluer les ÉRIA : 1) caractéristiques du rendement des étudiants, 2) facteurs liés aux MC, 3) influenceurs de l'établissement universitaire et clinique et 4) stratégies et ressources disponibles. Les inquiétudes quant à la sécurité et au comportement professionnel, les capacités de raisonnement clinique de l'étudiant et le manque de progression étaient des facteurs clés pour les MC au moment de recommander une note finale. Ceux-ci étaient plus susceptibles de recommander une note d'échec devant une série d'incidents répétés que devant un incident isolé. Conclusions : les chercheurs font plusieurs recommandations pour les étudiants, les MC et les établissements afin de mieux soutenir et de faciliter le processus de travail avec les ÉRIA dans le cadre de la formation clinique en physiothérapie.

Conditions-Based Learning Theory as a Framework for Comparative-Effectiveness Reviews: A Worked Example.

Phenomenon: An evidence-informed era of medical education encourages the generation and use of comparative-effectiveness reviews, yet the reviews often conclude, curiously, that all instructional approaches are equally effective. Approach: We used a conditions-based learning theory to structure a review of the comparative-effectiveness literature on electrocardiogram instruction. We searched MEDLINE, EMBASE (Ovid), ERIC (Ovid), PsycINFO (Ovid), and CINAHL (EBSCO) from inception to June 2016. We selected prospective studies that examined the effect of instructional interventions on participants' knowledge and skill with electrocardiogram interpretation. Two reviewers extracted information on the quality of the studies, the effect of instruction on the acquisition of knowledge and skill, and instructional quality. Instructional quality is an index of the extent to which instruction incorporates 4 practices of Gagne's conditions-based learning theory: presenting information, eliciting performance, providing feedback, and assessing learning. Findings: Twenty-five studies (3,286 participants) evaluating 47 instructional interventions were synthesized. The methodological quality of most studies was moderate. Instructional quality varied: All interventions presented information and assessed learning, but fewer than half elicited performances or provided feedback. Instructional interventions that incorporated all 4 components improved trainees' abilities considerably more than those that incorporated 3 or fewer; respectively, standardized mean difference (SMD) = 2.80, 95% confidence interval (CI) [2.05, 3.55], versus SMD = 1.44, 95% CI [1.18, 1.69]. Studies that compared "innovative" to "traditional" types of instruction did not yield a significant pooled effect: SMD = 0.18, 95% CI [-0.09, 0.45]. Insights: The use of a conditions-based learning theory to organize the comparative-effectiveness literature reveals differences in the instructional impact of different instructional approaches. It overturns the unlikely, but common, conclusion that all approaches are equally effective.

A neural marker of medical visual expertise: implications for training.

Researchers have identified a component of the EEG that discriminates visual experts from novices. The marker indexes a comprehensive model of visual processing, and if it is apparent in physicians, it could be used to investigate the development and training of their visual expertise. The purpose of this study was to determine whether a neural marker of visual expertise-the enhanced N170 event-related potential-is apparent in the EEGs of physicians as they interpret diagnostic images. We conducted a controlled trial with 10 cardiologists and 9 pulmonologists. Each participant completed 520 trials of a standard visual processing task involving the rapid evaluation of EKGs and CXRs-indicating-lung-disease. Ostensibly, each participant is expert with one type of image and competent with the other. We collected behavioral data on the participants' expertise with EKGs and CXRs and electrophysiological data on the magnitude, latency, and scalp location of their N170 ERPs as they interpreted the two types of images. Cardiologists demonstrated significantly more expertise with EKGs than CXRs, and this was reflected in an increased amplitude of their N170 ERPs while reading EKGs compared to CXRs. Pulmonologists demonstrated equal expertise with both types of images, and this was reflected in equal N170 ERP amplitudes for EKGs and CXRs. The results suggest provisionally that visual expertise has a similar substrate in medical practice as it does in other domains that have been studied extensively. This provides support for applying a sophisticated body of literature to questions about training and assessment of visual expertise among physicians.

Improving residents' handovers through just-in-time training for structured communication.

In a recent quality assurance project we learned that nearly half of the handovers we examined were characterized as unsatisfactory by our residents, who provided examples in which their anxiety had been piqued and patient care had been affected. These reports substantiated a growing body of literature on the relationship between the quality of handover and the quality of patient care, so we sought to improve the quality and consistency of the in-hosptial handovers undertaken by our internal medicine residents. Senior residents attended morning report for three consecutive month long blocks and evaluated the quality of the handovers using an observational protocol comprised of 16 aspects of effective handover. During the first block, the resident observed a median of eight of the 16 practices occurring across the 46 handovers, and a large amount of variability. At the beginning of the subsequent block we presented a concise introduction to a structured handover procedure (SBARR). The median quality of the subsequent 33 handovers rose to 11, and the variability decreased considerably. In the next block we refined the SBARR orientation to focus on the errors observed in the previous blocks, and the improvement in the quality and variability was sustained. The minor change, which requires few resources to sustain, had a favourable impact on the quality of our residents' in-hospital handovers.

The Effect of Restricting Residents' Duty Hours on Patient Safety, Resident Well-Being, and Resident Education: An Updated Systematic Review.

BACKGROUND: Despite 25 years of implementation and a sizable amount of research, the impact of resident duty hour restrictions on patients and residents still is unclear. Advocates interpret the research as necessitating immediate change; opponents draw competing conclusions. OBJECTIVE: This study updates a systematic review of the literature on duty hour restrictions conducted 1 year prior to the implementation of the Accreditation Council for Graduate Medical Education's 2011 regulations. METHODS: The review draws on reports catalogued in MEDLINE and PreMEDLINE from 2010 to 2013. Interventions that dealt with the duty hour restrictions included night float, shortened shifts, and protected time for sleep. Outcomes were patient care, resident well-being, and resident education. Studies were excluded if they were not conducted in patient care settings. RESULTS: Twenty-seven studies met the inclusion criteria. Most frequently, the studies concluded that the restrictions had no impact on patient care (50%) or resident wellness (47%), and had a negative impact on resident education (64%). Night float was the most frequent means of implementing duty hour restrictions, yet it yielded the highest proportion of unfavorable findings. CONCLUSIONS: This updated review, including 27 recent applicable studies, demonstrates that focusing on duty hours alone has not resulted in improvements in patient care or resident well-being. The added duty hour restrictions implemented in 2011 appear to have had an unintended negative impact on resident education. New approaches to the issue of physician fatigue and its relationship to patient care and resident education are needed.

A workshop to introduce residents to effective handovers.

BACKGROUND: Patient safety is associated with the quality of handover, yet many residents train in settings that lack a formal procedure for handover. Thus, they have few opportunities to observe or participate in effective practices. The purpose of our project was to design an educational experience that would introduce residents to the essentials of an effective handover. CONTEXT: Through a review of the literature, conversations with our residents and teaching doctors, and needs analysis survey, we determined that a formal, didactic, large group, face-to-face educational experience focusing on lower-level educational objectives would meet the needs of our learners. INNOVATION: Our curriculum development culminated in a 90-minute, multifaceted workshop comprising a brief introduction to handover, a dramatisation of effective and ineffective practices, and a role-play activity, followed by a debriefing session. IMPLICATIONS: Objective, constructed response tests, administered before and after the workshop, suggested that the workshop provided residents with the knowledge that a good handover is structured, free of distraction and prioritised. Some of the misconceptions that were apparent at the beginning of the workshop, however, were unchanged by the learning activities.

Learning to detect, categorize, and identify skin lesions: a meta-analysis.

IMPORTANCE: Educators use a variety of practices to train laypersons, medical students, residents, and primary care providers to diagnose skin lesions. Researchers have described these methods for decades, but there have been few attempts to catalog their scope or effectiveness. OBJECTIVE: To determine the scope and effectiveness of educational practices to improve the detection, categorization, and identification of skin lesions. DATA SOURCES: Literature indexed in MEDLINE, EMBASE, CINAHL, ERIC, PsycINFO, and BIOSIS Previews from inception until April 1, 2014, using terms cognate with skin disease, diagnosis, and education. STUDY SELECTION: Studies in which the educational objective was operationalized as the ability to detect, categorize, or identify skin lesions, and the intervention was evaluated through comparisons of participants' abilities before and after the intervention. DATA EXTRACTION AND SYNTHESIS: Information about trainees, educational practices, educational outcomes, and study quality was extracted; it was synthesized through meta-analysis using a random effects model. Effect sizes were calculated by dividing the differences between preintervention and postintervention means by the pooled standard deviation (ie, standardized mean difference [SMD]). Heterogeneity was assessed using an I2 statistic. MAIN OUTCOMES AND MEASURES: Pooled effect size across all studies and separate effect sizes for each of the educational practices. RESULTS: Thirty-seven studies reporting 47 outcomes from 7 educational practices met our inclusion criteria. The pooled effect of the practices on participants' abilities was large, with an SMD of 1.06 (95% CI, 0.81-1.31) indicating that posttest scores were approximately 1 SD above pretest scores. Effect sizes varied categorically between educational practices: the dermatology elective (SMD = 1.64; 95% CI, 1.17-2.11) and multicomponent interventions (SMD = 2.07; 95% CI, 0.71-3.44) had large effects; computer-based learning (SMD = 0.64; 95% CI, 0.36-0.92), lecture (SMD = 0.59; 95% CI, 0.28-0.90), pamphlet (SMD = 0.47; 95% CI, -0.11 to 1.05), and audit and feedback (SMD = 0.58; 95% CI, 0.10-1.07) had moderate effects; and moulage had a small effect (SMD = 0.15; 95% CI, -0.26 to 0.57). CONCLUSIONS AND RELEVANCE: A number of approaches are used to improve participants' abilities to diagnose skin lesions; some are more effective than others. The most effective approaches engage participants in a number of coordinated activities for an extended period, providing learners with the breadth of knowledge and practice required to change the mechanisms underlying performance.

Surveying the orientation learning needs of clinical nursing instructors.

The purpose of this study was to describe the knowledge and skills nurses need to be successful clinical instructors. A formal learning needs assessment was conducted to measure the orientation learning needs of new part-time clinical nursing faculty at one university. An existing, validated learning needs instrument was modified and administered online. The respondents (n=44; 16.6%) unanimously identified five essential learning needs for nursing clinical instructors, thus providing sound justification upon which to base an instructor orientation program. From these results, essential content for an orientation workshop to be followed by an online orientation course is outlined. Future research is needed to evaluate the outcomes of clinical instructor orientation; that is, whether participants have acquired the knowledge and skills needed to competently facilitate student learning in the clinical setting.

Theory-based research of high fidelity simulation use in nursing education: a review of the literature.

In this article, we explore the extent to which theory-based research is informing our understanding of high-fidelity simulation use in nursing education. We reviewed the primary literature archived in the Cumulative Index of Nursing and Applied Health Literature (CINAHL) and Proquest Dissertation and Theses for empirical reports using the key terms high-fidelity simulation and nursing from the years 1989 to 2009. Of the articles that matched our inclusion criteria: 45% made no use of theory; 45% made minimal use; and 10% made adequate use. We argue that theory-based research could bring coherence and external validity to this domain.