Opportunities to Increase Workplace Feedback: A Multi-institutional Examination

SIMPL Study of Surgical Feedback: Faculty Identity Outweighs Trainee Factors in Narrative Assessments.

Evaluating the effect of assessment form design on the quality of feedback in one Canadian ophthalmology residency program as an early adopter of CBME

Humanistic Buddhism has adopted more practical than theories and philosophy into our life. However, there are still weaknesses in teaching and learning Buddhism, especially in Buddhist schools in Asia and Asian American Communities. This study aims to develop mobile learning applications for humanistic Buddhism learning among young adults based on Phase 1(one) ADDIE Model, determine the behavioral acceptance and attitudes factors of mobile application to learn Humanistic Buddhism among youth. Methodology of study using ADDIE Model, finding of study indicates 28% of the respondents know the meaning of Humanistic Buddhism, 65% of the respondents were female respondents and 35% of the respondents were male, 78% of the respondents’ educational level were undergraduates. Attitude towards mobile learning, ‘I know the term of mobile learning’ 4.62 indicated that respondents had above moderate level in term of mobile learning whereas for the other item ‘I often stay focus in my mobile learning application’ 3.66 indicated that respondents had moderate level in staying focus in mobile learning applications. Mostly used application indicated that 59% of the respondents used Microsoft Team as a mobile learning application. Next, the purpose of use of mobile learning application ‘I use mobile learning applications to submit assignments’ 2.45 indicated that respondents below moderately agreed they use mobile learning applications to submit assignments. On the other hand, ‘I use mobile learning applications to participate in online classes’ 3.35 indicated that respondents moderately agreed they use mobile learning applications to participate in online classes. As for the mobile learning experiences, ‘I can access knowledge anywhere and anytime using the mobile learning applications’ 4.47 indicated that respondents below moderately agreed they can access knowledge anywhere and anytime using the mobile learning applications. The satisfaction toward mobile applications ‘rate your overall mobile learning experience’ 4.18 indicated that respondents had above moderate satisfaction on overall mobile learning experience. Apart from that, 30% of the respondents stated that connectivity to internet is poor which fits the biggest challenges of using mobile applications to learn. Hence, the goal of this study was to consider and comprehend the role of mobile learning in order to create new applications. It has given the results of an exploratory study of the knowledge of youth Buddhism toward concept of Humanistic Buddhism. This study showed that participants are open to adopting mobile learning and have a favorable view regarding it. As for future studies, it can be conducted with a sizable survey sample made up of teachers and administrators from all across the nation, as well as a variety of youth Buddhism.

تقييمُ تجربةِ التَّعلُّمِ الإلکترونيّ في ضوءِ مُتطلَّباتِ مُجتَمعِ المعرفةِ من وِجْهَةِ نظرِ أعضاءِ هيئةِ التدريسِ بجامعةِ الأميرةِ نورة بنت عبد الرحمن

The accelerated development of new technology, particularly on mobile application has increased teacher’s responsibility as a learning facilitator. Since technology is improving, many applications keep on coming into the market to fulfill user demands. Mobile learning application is very useful in enriching the mobile learning experience of children. However, some applications fail to assist and increase children knowledge on the subject they studied. Moreover, some children are not interested in mobile applications due to issues such as poor interfaces. In this paper, some previous studies on quality attributes used to evaluate mobile learning applications were reviewed. A systematic literature review approach was employed to search previous papers and studies on usability quality attributes, particularly for mobile learning applications. The search strategy identified numerous studies on usability for mobile learning applications for children. The result showed that the top four usability quality attributes are efficiency, effectiveness; learnability and user satisfaction. The studies reviewed showed that usability evaluations were conducted during implementation phase only, and evaluation is often built as a description of the case study. This study explored the current literatures on the subject matter and stimulates further studies that will lead to improved usability and design of mobile learning applications for children.

Association of Gender and Operative Feedback Quality in Surgical Residents

In the last decade, mobile learning applications have attracted a significant amount of attention. Huge investments have been made to develop educational applications that can be implemented on mobile devices. However, mobile learning applications have some limitations, such as storage space and battery life. Cloud computing provides a new idea to solve some limitations of mobile learning applications. However, there are other limitations, like scalability, that must be solved before mobile cloud learning can become completely operational. There are two main problems with scalability. The first occurs when the application server’s performance declines due to an increase in the number of requests, which affects usability. The second is that a decrease in the number of requests makes most application servers idle and therefore wastes money. These two problems can be avoided or minimized by provisioning auto-scaling techniques that permit the acquisition and release of resources dynamically to accommodate demand. In this paper, we propose an intelligent neuro-fuzzy reinforcement learning approach to solve the scalability problem in mobile cloud learning applications, and evaluate the proposed approach against some of the existing approaches via MATLAB. The large state space and long training time required to find the optimal policy are the main problems of reinforcement learning. We use fuzzy Q-learning to solve the large state space problem by grouping similar variables in the same state; there is then no need to use large look-up tables. The use of parallel learning agents reduces the training time needed to determine optimal policies. The experimental results prove that the proposed approach is able to increase learning speed and reduce the training time needed to determine optimal policies.

To assess the quality of narrative feedback given to surgical residents during the first 5 years of competency-based medical education implementation. Competency-based medical education requires ongoing formative assessments and feedback on learners' performance. We conducted a retrospective cross-sectional study using assessments of entrustable professional activities (EPAs) in the Surgical Foundations curriculum at Queen's University from 2017 to 2022. Two raters independently evaluated the quality of narrative feedback using the Quality of Assessment of Learning score (0-5). A total of 3900 EPA assessments were completed over 5 years. Of assessments, 57% (2229/3900) had narrative feedback documented with a mean Quality of Assessment of Learning score of 2.16 ± 1.49. Of these, 1614 (72.4%) provided evidence about the resident's performance, 951 (42.7%) provided suggestions for improvement, and 499/2229 (22.4%) connected suggestions to the evidence. There was no meaningful change in narrative feedback quality over time ( r = 0.067, P = 0.002). Variables associated with lower quality of narrative feedback include: attending role (2.04 ± 1.48) compared with the medical student (3.13 ± 1.12, P < 0.001) and clinical fellow (2.47 ± 1.54, P < 0.001), concordant specialties between the assessor and learner (2.06 ± 1.50 vs 2.21 ± 1.49, P = 0.025), completion of the assessment 1 month or more after the encounter versus 1 week (1.85 ± 1.48 vs 2.23 ± 1.49, P < 0.001), and resident entrusted versus not entrusted to perform the assessed EPA (2.13 ± 1.45 vs 2.35 ± 1.66; P = 0.008). The quality of narrative feedback was similar for assessments completed under direct and indirect observation (2.18 ± 1.47 vs 2.06 ± 1.54; P = 0.153). Just over half of the EPA assessments of surgery residents contained narrative feedback with overall fair quality. There was no meaningful change in the quality of feedback over 5 years. These findings prompt future research and faculty development.

Resident operative autonomy has been steadily decreasing. Whether this reduction in autonomy has been associated with changes in patient outcomes is unclear. To assess whether surgical procedures performed by residents without an attending surgeon scrubbed are associated with differences in patient outcomes compared with procedures performed by attending surgeons alone or by residents with the assistance of attending surgeons. This retrospective propensity score-matched cohort study analyzed 30-day outcomes among patients who received operations at US Veterans Affairs (VA) medical centers and were recorded within the VA Surgical Quality Improvement Program (VASQIP) database from July 1, 2004, to September 30, 2019. Among 1 797 056 operations recorded in the VASQIP during that period, 1 319 020 were eligible for inclusion. Operations performed by a surgical resident without an attending surgeon scrubbed (resident primary) were propensity score matched on a 1:1 ratio (based on year of procedure and patient age, race, sex, American Society of Anesthesiologists physical status classification, functional status, emergency status, inpatient status, presence of multiple comorbidities, and Current Procedural Terminology code) to operations performed by an attending surgeon only (surgeon primary) and operations performed by a resident with assistance from an attending surgeon (resident plus surgeon). Level of resident involvement. Thirty-day adjusted all-cause mortality. Among 1 319 020 surgical procedures included, 138 750 were performed by residents only, 308 724 were performed by surgeons only, and 871 546 were performed by residents and surgeons. For the 1 319 020 total cases, patients' mean (SD) age was 61.6 (12.9) years; 1 223 051 patients (92.7%) were male; and 212 315 (16.1%) were Black or African American, 63 817 (4.9%) were Hispanic, 830 704 (63.0%) were White, and 212 814 (16.1%) were of other or unknown race and ethnicity. Propensity score matching produced 101 130 pairs of resident-primary and surgeon-primary procedures and 137 749 pairs of resident-primary and resident plus surgeon procedures. Patient all-cause mortality and morbidity were no different among those who received surgeon-primary procedures (mortality: odds ratio [OR], 1.03 [95% CI, 0.95-1.12]; morbidity: OR, 1.01 [95% CI, 0.97-1.05]) vs resident plus surgeon procedures (mortality: OR, 1.03 [95% CI, 0.97-1.11]; all-cause morbidity: OR, 0.97 [95% CI, 0.95-1.00]). Resident-primary procedures had longer operative times than surgeon-primary procedures (median, 80 minutes [IQR, 50-123 minutes] vs 70 minutes [IQR, 41-114 minutes], respectively; P < .001) but shorter operative times than resident plus surgeon procedures (median, 71 minutes [IQR, 43-113 minutes] vs 73 minutes [IQR, 45-115 minutes]; P < .001). Hospital length of stay was unchanged among resident-primary vs surgeon-primary procedures (median, 4 days [IQR, 2-10 days] vs 4 days [IQR, 2-9 days]; P = .08) and statistically significantly shorter than resident plus surgeon procedures (median, 4 days [IQR, 1-9 days] vs 4 days [IQR, 2-10 days]; P < .001). In this cohort study, surgical procedures performed by residents alone were not associated with any changes in all-cause mortality or composite morbidity compared with those performed by attending surgeons alone or by residents with the assistance of attending surgeons. Given these findings and the importance of operative autonomy to prepare surgical residents for independent practice, efforts to increase autonomy are both safe and needed.

This meta-analysis investigated the association of C677T polymorphism in MTHFR gene with bone mineral density (BMD) and fracture risk. The results suggested that C677T polymorphism was marginally associated with fracture risk. In addition, this polymorphism was modestly associated with BMD of lumbar spine, femoral neck, total hip, and total body, respectively. The methylenetetrahydrofolate reductase (MTHFR) gene has been implicated in the regulation of BMD and, thus, may serve as a potential risk factor for the development of fracture. However, results have been inconsistent. In this study, a meta-analysis was performed to clarify the association of C677T polymorphism in MTHFR gene with BMD and fracture risk. Published literature from PubMed and EMBASE were searched for eligible publications. Pooled odds ratio (OR) or weighted mean difference (WMD) and 95% confidence interval (CI) were calculated using a fixed- or random-effects model. Twenty studies (3,525 cases and 17,909 controls) were included in this meta-analysis. The TT genotype of C677T polymorphism was marginally associated with an increased risk of fracture under recessive model (TT vs. TC + CC: OR = 1.23, 95% CI 1.04-1.47). Using this model, similar results were found among East Asians (OR = 1.40, 95% CI 1.07-1.83), female subpopulation (1.27, 95% CI 1.04-1.55), cohort studies (OR = 1.24, 95% CI 1.08-1.44), and subjects younger than aged 60 years (OR = 1.51, 95% CI 1.10-2.07). In addition, under homogeneous co-dominant model, there was a modest association of C677T polymorphism with BMD of lumbar spine (WMD = -0.017 g/cm(2); 95%CI, -0.030-(-0.005) g/cm(2)), femoral neck (WMD = -0.010 g/cm(2); 95% CI -0.017-(-0.003) g/cm(2)), total hip (WMD = -0.013 g/cm(2), 95% CI -0.022-(-0.004) g/cm(2)), and total body (WMD = -0.020 g/cm(2); 95% CI -0.027-(-0.013) g/cm(2)), respectively. This meta-analysis suggested that C677T polymorphism was marginally associated with fracture risk. In addition, this polymorphism was modestly associated with BMD of lumbar spine, femoral neck, total hip, and total body, respectively.

Background:The use of mobile learning applications has influenced students' digital literacy levels. The use of information technology as a learning medium, including mobile learning, can influence students' motivation to learn and make learning easier and faster. Using mobile learning applications can also increase students' digital literacy, especially in terms of connections. Research Objectives:The aims of this research are to identify the impact of using mobile learning applications on the development of students' digital literacy, assess students' abilities in using mobile learning applications, determine how the use of mobile learning applications is effective and efficient in increasing students' digital literacy, and assess the impact of using mobile learning applications on the development of digital literacy student. Method:The method used in this research is a quantitative method.This method is a way of collecting numerical data that can be tested. Data was collected through distributing questionnaires addressed to students. Furthermore, the data that has been collected from the results of distributing the questionnaire will be accessible in Excel format which can then be processed using SPSS. Results:From the research results, it can be seen thatMobile learning apps can help students learn more about digital literacy. This application can offer a variety of learning materials and information related to digital literacy, so that students can better understand and expand their knowledge. Conclusion:From this research, researchers can conclude that the impact of using mobile learning applications on the development of students' digital literacy can increase students' interest in learning, help them learn digital literacy and students' learning resilience.

Weill Cornell Medical College of Cornell University

General Surgical Resident Operative Autonomy vs Patient Outcomes: Are we Compromising Training without Net Benefit to Hospitals or Patients?

Magnesium sulphate halves the risk of eclampsia. There is no consensus on who to give magnesium sulphate prophylaxis because clinical tools are poor at identifying those at risk. Known prodromal symptoms such as headache, visual disturbance, or epigastric pain have modest associations with eclampsia. We set out to identify new prodromal symptoms of eclampsia. This case-control study prospectively recruited participants in South Africa and Pakistan who had eclampsia, preeclampsia, or normotensive pregnancies. We asked whether they experienced 20 neurological symptoms, within 7 days of the seizure for those who had eclampsia. The primary analysis was the likelihood of symptoms occurring before eclampsia, compared to being present with preeclampsia. 341 participants were recruited with eclampsia, 1,355 with preeclampsia and 389 with normotensive pregnancies. When comparing symptoms among those who had eclampsia versus preeclampsia, the odds ratios (OR) were 2.56 (95% confidence interval (CI) [1.81,3.62]; p < 0.001) for headache, 5.73 (95% CI [4.44,7.39]; p < 0.001) for visual disturbances and 2.25 (95% CI [1.76,2.89]; p < 0.001) for epigastric pain. We identified 10 symptoms with odds ratios over 10 for eclampsia. Odds ratios were 42.03 (95% CI [23.66,74.68]; p < 0.001) for twitching/jerking limbs (30.5% eclampsia versus 1% preeclampsia); 36.00 (95% CI [18.34,70.65]; p < 0.001) for affected hearing (21.1% versus 0.7%)' 33.60 (95% CI [21.39,52.78]; p < 0.001) for affected mind state (38.7% versus 1.8%); 33.12 (95% CI [19.46, 54.37]; p < 0.001) for impaired speech; 23.71 (95% CI [16.49,34.10]; p < 0.001) for feelings of doom; 26.59 (95% CI [7.82,90.41]; p < 0.001) for severe vertigo; 20.52 (95% CI [14.22,29.63]; p < 0.001) for confusion; 18.16 (95% CI [10.76,30.66]; p < 0.001) for jitters; 15.18 (95% CI [11.34,20.33]; p < 0.001) for difficulty concentrating; and 10.49 (95% CI [6.76,16.27]; p < 0.001) for weakness/paralysis. These symptoms were rare among normotensive pregnancies. Only 2.4% of women with eclampsia did not experience any prodromal symptoms. This study is limited by the fact that we asked about prodromal symptoms after the seizure happened, and the potential for recall bias. Ten prodromal symptoms exhibit far stronger associations with eclampsia than headache, visual disturbances, or epigastric pain. Eclampsia is uncommon without any prodromal symptoms. It may be useful to screen these symptoms among women with preeclampsia as part of clinical history taking to guide management. They could help direct magnesium sulphate prophylaxis to those with a higher risk of eclampsia.

A global assessment tool for evaluation of intraoperative laparoscopic skills