A systematic scoping review of group reflection in medical education.

BACKGROUND: Reviewing experiences and recognizing the impact of personal and professional views and emotions upon conduct shapes a physician's professional and personal development, molding their professional identity formation (PIF). Poor appreciation on the role of reflection, shortages in trained tutors and inadequate 'protected time' for reflections in packed medical curricula has hindered its integration into medical education. Group reflection could be a viable alternative to individual reflections; however, this nascent practice requires further study. METHODS: A Systematic Evidence Based Approach guided Systematic Scoping Review (SSR in SEBA) was adopted to guide and structure a review of group reflections in medical education. Independent searches of articles published between 1st January 2000 and 30th June 2022 in bibliographic and grey literature databases were carried out. Included articles were analysed separately using thematic and content analysis, and combined into categories and themes. The themes/categories created were compared with the tabulated summaries of included articles to create domains that framed the synthesis of the discussion. RESULTS: 1141 abstracts were reviewed, 193 full-text articles were appraised and 66 articles were included and the domains identified were theories; indications; types; structure; and benefits and challenges of group reflections. CONCLUSIONS: Scaffolded by current approaches to individual reflections and theories and inculcated with nuanced adaptations from other medical practices, this SSR in SEBA suggests that structured group reflections may fill current gaps in training. However, design and assessment of the evidence-based structuring of group reflections proposed here must be the focus of future study.

All "wrapped" up in reflection: supporting metacognitive awareness to promote students' self-regulated learning.

Self-regulated learning (SRL) is the process of utilizing effective strategies to acquire knowledge or skills and is influenced by motivation, metacognitive processing, and study-related behaviors. We hypothesized that by using survey tools that allow reflection on and refinement of students' study strategies, we could nurture metacognitive skill development, encourage positive motivation and study-related behaviors, and hence promote academic success. Undergraduate students in a semester-long, second-year biology course were provided with resources to promote SRL and three survey instruments that encouraged them to create study plans and reflect on the effectiveness of their study strategies. Using a student-partnered approach, we sought to investigate the role of metacognition, motivation, and study-related behaviors on academic performance by (i) identifying the self-regulated learning strategies most utilized by students, (ii) investigating the role of reflection in enhancing metacognitive processing and academic performance, and (iii) understanding whether students created and/or modified their study strategies as an outcome of self-regulation. Survey responses allowed us to understand the repertoire of study strategies used by students. Our analyses suggest that students demonstrated metacognitive skill development through the use of the resources and reflection instruments, as they accurately reported on the effectiveness of their study strategies and indicated future plans to shift study-related behaviors from passive to active reviewing techniques. Students across the grade spectrum perceived the reflection instruments as beneficial in identifying areas of improvement and developing long-term study habits, suggesting that these instruments were effective in promoting metacognitive skill development for a variety of student learners. We conclude that supporting students with resources that promote SRL and providing opportunities for timely reflection can promote metacognitive skill development, a key feature of academic success.

Nonlinear beamforming for intracardiac echocardiography: a comparative study.

Intracardiac echocardiography (ICE) enables cardiac imaging with a wide field of view, deep imaging depth, and high frame rate during surgery. However, strong sidelobe and grating lobe artifacts created by the ultra-compact transducer degrade its image quality, making diagnosis and monitoring of treatment difficult. Conventionally, aperture apodization algorithms are often used to suppress sidelobe and grating lobe artifacts at the expense of lateral resolution, which is undesirable in ICE. In this study, we present comparative results of the beamforming methods specifically in ICE application. We demonstrate and compare five nonlinear beamforming algorithms in ICE: nonlinear pth root delay and sum (NL-p-DAS), nonlinear pth root spectral magnitude scaling (NL-p-SMS), delay-and-sum with coherence factors (DAS + SCF), delay and sum with apodization (DAS + apodization) and delay and sum (DAS). Phantom and ex-vivo experiment compare the performance of each algorithm in static and dynamic conditions. DAS + SCF shows the best lateral resolution, and all four algorithms improve the image contrast and sidelobe suppression over conventional DAS. NL-p-SMS stands out for the best axial resolution and suppression of grating lobe artifacts. For motion tracking, NL-p-SMS shows better temporal resolution than other methods. Overall, all the beamforming algorithms other than DAS showed improved image quality. Among them, NL-p-SMS, which has a high temporal resolution, showed the potential for providing more accurate information regards movement tracking. Supplementary Information: The online version contains supplementary material available at 10.1007/s13534-024-00352-9.

Obstacles in Basic Health Service When Dealing with COVID-19: A Reflection for Improvement.

Background & Aims: COVID-19 has been in control since mass vaccination and other coordinated efforts have been conducted. The WHO has even made an announcement to stop the public health emergency of international concern (PHEIC) toward COVID-19. Because of the very massive impacts of COVID-19, it is necessary to have a reflection toward what we have gone through to obtain information from inside the health service by interviewing the health officers who were the frontliners in fighting the disease during the pandemic. This research attempts to reveal the practical experiences of the officers when the COVID-19 pandemic took place. Methods: This research conducted in-depth interviews with the Heads of Puskesmas (a Public Health Center) and the staff of Puskesmas in Medan. The total sample number of informants is 30 people. The data were managed by preparing the suitable themes with the inductive approach. Results: There are three main themes obtained from the analysis results. Those three themes are 1) the condition of Puskesmas, 2) the impacts of the health service, and 3) the COVID-19 control. Those three themes show the fundamental problems affecting the efforts to overcome COVID-19. It is revealed that funding, personnel quantity, and bureaucracy cause the effort to overcome COVID-19 to have been impeded. Meanwhile, based on external factors, the officers had to deal with negative issues on COVID-19. Therefore, whether we like it or not to admit the fact, the health service has not been conducted maximally. Conclusion: It is necessary to have comprehensive revision and change to evaluate the condition of health service, particularly in Puskesmas. A wider and deeper reflection is required so that the pandemic preparation in the future can be improved further.

Addressing a Critical Voice in Clinical Practice: Experiences of Nursing Students, Teachers, and Supervisors-A Qualitative Study.

AIM: Our goal was to explore how power asymmetry manifests within the relationships between students, teachers, and supervisors, and how it influences students' ability for critical reflection. DESIGN: This study has an explorative qualitative design. METHODS: Thirty in-depth interviews with nursing students (15), teachers (9), and supervisors (6) were conducted in addition to 16 observations of mid-term assessments during clinical practice. The analysis was conducted using Braun and Clarke's thematic analysis. RESULTS: The students described being a student as a balancing act between humility, conforming to the supervisor's expectations, and speaking their minds. The view expressed by the teachers and supervisors is that training for the nursing profession is closely linked to the students' ability to act independently. Due to the supervisors' hierarchical position, however, students are hesitant to voice any criticism regarding insufficient supervision or unsatisfactory performance of clinical tasks while at the same time being evaluated on their ability to critically reflect on their own and others' clinical performance. This study was prospectively registered with the Norwegian Centre for Research Data on the 15th of August 2017 with the registration number 54821.

Does the Cognitive Reflection Test Work with Chinese College Students? Evidence from a Time-Limited Study.

The cognitive reflection test (CRT) is an experiment task commonly used in Western countries to test intuitive and analytical thinking styles. However, the validity of this task for Chinese participants has not been explored. Therefore, this study recruited Chinese college students to finish CRT tasks with various experimental designs. To gauge the accuracy of the CRT tasks, 438 Chinese college students first completed online questionnaires. Participants were then invited to participate in an offline laboratory with the same experimental settings. Finally, time pressure was used to strictly control intuition and analytical thinking to explore the performance of Chinese college students on CRT tasks. The results show that of the three experiments, Chinese college students had the highest accuracy in the offline test, and the CRT's intuitive conflict problem still applies to Chinese students under the time-limited condition. This study demonstrates the validity of the CRT in China and proves that time pressure is an effective method for identifying individuals with strong logic ability.

Sex Differences in Cognitive Reflection: A Meta-Analysis.

The current study presents a meta-analytic review of the differences between men and women in cognitive reflection (CR). The study also explores whether the type of CR test (i.e., numerical tests and verbal tests) moderates the relationship between CR and sex. The results showed that men score higher than women on CR, although the magnitude of these differences was small. We also found out that the type of CR test moderates the sex differences in CR, especially in the numerical tests. In addition, the results showed that the length of numerical tests (i.e., number of items) does not affect the differences between men and women in CR. Finally, the implications of these results are discussed, and future research is suggested.

Breast Tomographic Ultrasound: The Spectrum from Current Dense Breast Cancer Screenings to Future Theranostic Treatments.

This review provides unique insights to the scientific scope and clinical visions of the inventors and pioneers of the SoftVue breast tomographic ultrasound (BTUS). Their >20-year collaboration produced extensive basic research and technology developments, culminating in SoftVue, which recently received the Food and Drug Administration's approval as an adjunct to breast cancer screening in women with dense breasts. SoftVue's multi-center trial confirmed the diagnostic goals of the tissue characterization and localization of quantitative acoustic tissue differences in 2D and 3D coronal image sequences. SoftVue mass characterizations are also reviewed within the standard cancer risk categories of the Breast Imaging Reporting and Data System. As a quantitative diagnostic modality, SoftVue can also function as a cost-effective platform for artificial intelligence-assisted breast cancer identification. Finally, SoftVue's quantitative acoustic maps facilitate noninvasive temperature monitoring and a unique form of time-reversed, focused US in a single theranostic device that actually focuses acoustic energy better within the highly scattering breast tissues, allowing for localized hyperthermia, drug delivery, and/or ablation. Women also prefer the comfort of SoftVue over mammograms and will continue to seek out less-invasive breast care, from diagnosis to treatment.

How does guided group reflection work to support professional identity formation in postgraduate medical education: A scoping review.

PURPOSE: In postgraduate medical education, guided group reflection is often applied to support professional identity formation. However, little is known about how guided group reflection is shaped and how it works. Our scoping review synthesizes existing evidence about various approaches for guided group reflection, their aims, components and potential working mechanisms. METHODS: We conducted a scoping review using JBI (Joanna Briggs Institute) guidelines for conducting scoping reviews. We searched PubMed, PsycINFO, EMBASE and ERIC databases for all research articles published in English or Dutch in an iterative team approach. The articles were extracted and summarized quantitatively and qualitatively. RESULTS: We included 71 papers (45 primary research papers and 26 non-empirical papers including program descriptions, theoretical concepts and personal experiences). We identified a diversity of approaches for guided group reflection (e.g. Balint groups, supervised collaborative reflection and exchange of experiences), applied in a variety of didactic formats and aims. We distilled potential working mechanisms relating to engagement in reflection, group learning and the supervisor's role. CONCLUSIONS: There are significant knowledge gaps about the aims and underlying mechanisms of guided group reflection. Future systematic research on these topics is needed to understand the effectiveness of educational methods, that can help facilitate learning conditions to best shape professional identity formation (PIF) in educational curricula.

A Qualitative Study of Biomedical Engineering Student Critical Reflection During Clinical Immersion Experiences.

Purpose: Clinical immersion experiences provide engineering students with opportunities to identify unmet user needs and to interact with clinical professionals. These experiences have become common features of undergraduate biomedical engineering curricula, with many published examples in the literature. There are, however, few or no published studies that describe rigorous qualitative analysis of biomedical engineering student reflections from immersion programs. Methods: Fifteen reflection prompts that align with program learning goals were developed and structured based on the DEAL model for critical reflection. Undergraduate participants in a summer immersion program responded to these prompts throughout five weeks of clinical rotations. Data from two summer cohorts of participants (n = 20) were collected, and thematic analysis was performed to characterize student responses. Results: Students reported learning about key healthcare topics, such as medical insurance, access to healthcare (and lack thereof), stakeholder perspectives, and key medical terminology and knowledge. Most reflections also noted that students could apply newly gained medical knowledge to biomedical engineering design. Further, clinical immersion provided students with a realistic view of the biomedical engineering profession and potential areas for future professional growth, with many reflections identifying the ability to communicate with a variety of professionals as key to student training. Some students reflected on conversations with patients, noting that these interactions reinvigorated their passion for the biomedical engineering field. Finally, 63% of student reflections identified instances in which patients of low socioeconomic status were disadvantaged in health care settings. Conclusions: Clinical immersion programs can help close the gap between academic learning and the practical experience demands of the field, as design skills and product development experience are becoming increasingly necessary for biomedical engineers. Our work initiates efforts toward more rigorous analysis of students' reactions and experiences, particularly around socioeconomic and demographic factors, which may provide guidance for continuous improvement and development of clinical experiences for biomedical engineers.

Glossiness perception and its pupillary response.

Recent studies have revealed that pupillary response changes depend on perceptual factors such as subjective brightness caused by optical illusions and luminance. However, the manner in which the perceptual factor that is derived from the glossiness perception of object surfaces affects the pupillary response remains unclear. We investigated the relationship between the glossiness perception and pupillary response through a glossiness rating experiment that included recording the pupil diameter. We prepared general object images (original) and randomized images (shuffled) that comprised the same images with randomized small square regions as stimuli. The image features were controlled by matching the luminance histogram. The observers were asked to rate the perceived glossiness of the stimuli presented for 3,000 ms and the changes in their pupil diameters were recorded. Images with higher glossiness ratings constricted the pupil size more than those with lower glossiness ratings at the peak constriction of the pupillary responses during the stimulus duration. The linear mixed-effects model demonstrated that the glossiness rating, image category (original/shuffled), variance of the luminance histogram, and stimulus area were most effective in predicting the pupillary responses. These results suggest that the illusory brightness obtained by the image regions of high-glossiness objects, such as specular highlights, induce pupil constriction.

Dynamic mucus secretion in ventral surfaces of toe pads of the tree frog (Dryophytes japonica).

The tree frog is a prominent amphibian among terrestrial vertebrates known for its ability to adhere to various surfaces through the capillary forces of water in the microchannels between micropillars on its disc-shaped toe pads, a phenomenon known as wet adhesion. However, the secretion pattern of mucus on the attachment surface of living tree frog toe pads and the distribution of active mucus pores (AMPs) have not yet been fully elucidated. In this study, we utilized synchrotron X-ray micro-computed tomography and interference reflection microscopy to obtain the spatial distribution of the entire population of ventral mucus glands on the toe pads of living tree frogs and the real-time mucus secretion patterns from the ventral mucus pores on the contact surface under different environmental conditions. We observed that the number and secretion frequency of AMPs on the toe pad are regulated according to environmental conditions. Such dynamic mucus secretion on the tree frog's toe pad could contribute to the understanding of capillary force regulation for wet adhesion and the development of adhesive surfaces by mimicking the mucus-secreting toe pad.

Students' perceptions of social issues in biology courses.

Students' scientific literacy may be improved by the integration of social issues into biology courses, enabling them to make informed decisions on social issues in the context of their scientific knowledge. Additionally, this may allow students to recognize the connection between science and society. Although there are a number of benefits with having students learn about social issues in biology courses, most undergraduate courses may follow a traditional curriculum, which emphasizes the scientific content without framing it in a social context. Here, we investigated whether undergraduate students have been exposed to social issues in previous biology courses and examined how their perceptions changed before and after taking a biology course that incorporated social issues. In surveys, most students reported having no exposure to social issues in biology courses. Most students, especially females and persons excluded because of their ethnicity or race (PEERs), agreed with the integration of social issues in biology courses before taking the course. Students found reflection essays to be a useful tool in allowing them to think and share their thoughts on social issues as well as relate the course content to their personal lives. These results highlight students' interest in learning about social issues from a scientific perspective and how reflection essays may be used to practice applying their knowledge to real-world issues.

Surface Chemistry of a [C2C1Im][OTf] (Sub)Wetting Layer on Pt(111): A Combined XPS, IRAS, and STM Study.

The concept of a solid catalyst with an ionic liquid layer (SCILL) is a promising approach to improve the selectivity of noble metal catalysts in heterogeneous reactions. In order to understand the origins of this selectivity control, we investigated the growth and thermal stability of ultrathin 1-ethyl-3-methylimidazolium trifluormethanesulfonate [C2C1Im][OTf] films on Pt(111) by infrared reflection absorption spectroscopy (IRAS) and X-ray photoelectron spectroscopy (XPS) in time-resolved and temperature-programmed experiments. We combined these spectroscopy experiments with scanning tunneling microscopy (STM) to obtain detailed insights into the orientation and adsorption geometry of the ions in the first IL layer. Furthermore, we propose a mechanism for the thermal evolution of [C2C1Im][OTf] on Pt(111). We observe an intact IL layer on the surface at temperatures below 200 K. Adsorbed [C2C1Im][OTf] forms islands, which are evenly distributed over the surface. The [OTf]- anion adsorbs via the SO3 group, with the molecular axis perpendicular to the surface. Anions and cations are arranged next to each other, alternating on the Pt(111) surface. Upon heating to 250 K, we observe changes in geometry and structural distribution. Whereas at low temperature, the ions are arranged alternately for electrostatic reasons, this driving force is no longer decisive at 250 K. Here, a phase separation of two different species is discernible in STM. We propose that this effect is due to a surface reaction, which changes the charge of the adsorbates. We assume that the IL starts to decompose at around 250 K, and thus, pristine IL and decomposition products coexist on the surface. Also, IRAS and XPS show indication of IL decomposition. Further heating leads to increased IL decomposition. The reaction products associated with the anions are volatile and leave the surface. In contrast, the cation fragments remain on the surface up to temperatures above 420 K.

Reconstitution of Neuronal Motor Traffic on Septin-Associated Microtubules.

Reconstitution of intracellular transport in cell-free in vitro assays enables the understanding and dissection of the molecular mechanisms that underlie membrane traffic. Using total internal reflection fluorescence (TIRF) microscopy and microtubules, which are immobilized to a functionalized glass surface, the kinetic properties of single kinesin molecules can be imaged and analyzed in the presence or absence of microtubule-associated proteins. Here, we describe methods for the in vitro reconstitution of the motility of the neuronal kinesin motor KIF1A on microtubules associated with heteromeric septin (SEPT2/6/7) complexes. This method can be adapted for various neuronal septin complexes and kinesin motors, leading to new insights into the spatial regulation of neuronal membrane traffic by microtubule-associated septins.

S-LIGHT: Synthetic Dataset for the Separation of Diffuse and Specular Reflection Images.

Several studies in computer vision have examined specular removal, which is crucial for object detection and recognition. This research has traditionally been divided into two tasks: specular highlight removal, which focuses on removing specular highlights on object surfaces, and reflection removal, which deals with specular reflections occurring on glass surfaces. In reality, however, both types of specular effects often coexist, making it a fundamental challenge that has not been adequately addressed. Recognizing the necessity of integrating specular components handled in both tasks, we constructed a specular-light (S-Light) DB for training single-image-based deep learning models. Moreover, considering the absence of benchmark datasets for quantitative evaluation, the multi-scale normalized cross correlation (MS-NCC) metric, which considers the correlation between specular and diffuse components, was introduced to assess the learning outcomes.

Crossed Andreev reflection in normal-superconductor-normal junction based on Kekulé-Y patterned graphene.

We theoretically study the crossed Andreev reflection (CAR) of the normal metal-superconductor-normal metal (NSN) heterojunction based on Kekulé-Y patterned graphene with two doping types, i.e.nSnandnSpconfigurations. It is found that the enhanced CAR is more likely to occur in thenSpjunction rather than thenSnjunction. To be concrete, the almost perfect CAR occurs in a large range of incident angle in the single Dirac cone phase when the incident energy is inside the gap of the nonlinear band. Furthermore, the roles of the length of superconductor and pseudospin-valley coupling on conductance are also evaluated.

Thinking about default enrollment lowers vaccination intentions and public support in G7 countries.

Policymakers often face a conundrum between being transparent about policies and ensuring that those policies are effective. This challenge is particularly relevant for behavioral nudges, which are not usually disclosed. Rather than avoiding transparency, we suggest that policymakers encourage citizens to reflect on nudges to help them understand their own views and align those views with their behaviors. Using data from an online survey experiment with 24,303 respondents in G7 countries, we examine the impact of reflection on a hypothetical default nudge policy for COVID-19 booster appointments. Contrary to expectations, participants say they would be less likely to get the booster when automatically enrolled compared with a control condition. Similarly, encouraging citizens to think about the status quo (baseline) policy also reduces intentions for boosters. These interventions have no effect on approval of the policy. Further, encouraging people to think about automatic enrollment decreases approval of the policy and further decreases their intentions to get vaccinated. These findings suggest that reflection on a nudge can increase backlash from a nudge and also elicit policy disapproval, thereby aligning policy support with behavioral intentions.

Navigating the Hidden Curriculum: Reflections from Graduates of a Multidisciplinary Postgraduate Diploma in Pediatric Palliative Care.

Discovering some of the impact of the hidden curriculum (HC) while doing a postgraduate diploma in pediatric palliative care (PPC) in South Africa (SA), six graduates reflected on their formal and informal learning. To navigate the HC the transformative learning theory is used as a bridge connecting the formal and informal learning between interprofessional education where diversity is an enabler to enhance learning outcomes and shift perspectives to enhance patient care. The graduates were guided through the stages of the competency model to reflect on their learning experience. The authors believe that the experiential lessons reflected on, both clinical and psychosocial, can assist with not only strengthening the particular multidisciplinary needs of students, but also to align the HC and formal curricula. These lessons can also aid toward upscaling the need for PPC education in the SA context.

The importance of creating the right conditions for group intervision sessions among medical residents- a qualitative study.

BACKGROUND: The burnout rates among residents urge for adequate interventions to improve resilience and prevent burnout. Peer reflection, also called group intervision sessions, is a potentially successful intervention to increase the resilience of young doctors. We aimed to gain insight into the perceived added value of intervision sessions and the prerequisite conditions to achieve this, according to residents and intervisors. Our insights might be of help to those who think of implementing intervision sessions in their institution. METHODS: An explorative, qualitative study was performed using focus groups and semi-structured interviews with both residents (n = 8) and intervisors (n = 6) who participated in intervision sessions in a university medical center in the Netherlands. The topic list included the perceived added value of intervision sessions and factors contributing to that. The interviews were transcribed verbatim and coded using NVivo. Thematic analysis was subsequently performed. RESULTS: According to residents and intervisors, intervision sessions contributed to personal and professional identity development; improving collegiality; and preventing burn-out. Whether these added values were experienced, depended on: (1) choices made during preparation (intervisor choice, organizational prerequisites, group composition, workload); (2) conditions of the intervision sessions (safety, depth, role of intervisor, group dynamics, pre-existent development); and (3) the hospital climate. CONCLUSIONS: Intervision sessions are perceived to be of added value to the identity development of medical residents and to prevent becoming burned out. This article gives insight in conditions necessary to reach the added value of intervision sessions. Optimizing preparation, meeting prerequisite conditions, and establishing a stimulating hospital climate are regarded as key to achieve this.