Amount Of Clinical Experience Research Articles

Level of Agreement in Subjective Selection of Gingival Colour

Background and Objectives: Primary outcome: To assess the level of agreement between the objective and subjective methods for recording gingival colour in each area of the gingiva. Secondary outcome: To compare performance of the subjective visual method of gingival colour selection by a male observer and a female observer. Materials and Methods: A chromatic study was conducted on a total of 101 participants, in five gingival zones, from the free gingival margin to the mucogingival line, using a SpectroShade Micro spectrophotometer for the objective method and 21 ad hoc ceramic gingival shade tabs for the subjective method. A man and a woman of the same age, with the same amount of clinical experience in dentistry, selected the tab that most resembled the colour of participants’ gingiva. The “chromatic error” was then assessed by calculating the colour difference (using the Euclidean and CIEDE2000 formulae) between the CIELAB coordinates of the shade tab selected and the objective coordinates of the gingiva. The unweighted Kappa coefficient was used to calculate the level of agreement between observers. Results: For the male observer, the mean chromatic errors varied between ΔEab* 10.3 and 13.1 units, while for the female observer, the mean errors varied between ΔEab* 11.1 and 12.8: these differences were not statistically significant. Similarly, no statistically significant differences were found between the mean chromatic errors for the five gingival zones in either the male operator (p = 0.100) or the female operator (p = 0.093). The minimum level of agreement (unweighted Kappa) between the observers ranged from 0.1 to 0.4. Conclusions: Subjective selection of gingival colour was very inaccurate, by both the male observer and the female observer, for any area of the gingiva, with no differences identified between them. The level of agreement between the observers was low. These findings suggest that gingival colour should not be determined using solely subjective methods, given that the chromatic errors significantly exceeded the clinical acceptability threshold for gingiva (4.1 units for ΔEab* and 2.9 units for ΔE00). Both observers showed a tendency to select gingival shade tabs that were redder and bluer than the objective colours.

Psychological impact of the COVID-19 pandemic on training of postgraduate year 1 doctors in Singapore.

Psychological impact of the COVID-19 pandemic on training of postgraduate year 1 doctors in Singapore.

Predictors of clinical reasoning in neurological localisation: A study in internal medicine residents

Introduction: Clinical reasoning is the cognitive process of weighing clinical information together with past experience to evaluate diagnostic and management dilemmas. There is a paucity of literature regarding predictors of clinical reasoning at the postgraduate level. We performed a retrospective study on internal medicine residents to determine the sociodemographic and experiential correlates of clinical reasoning in neurological localisation, measured using validated tests. Methods: We recruited 162 internal medicine residents undergoing a three-month attachment in neurology at the National Neuroscience Institute, Singapore, over a 2.5 year period. Clinical reasoning was assessed on the second month of their attachment via two validated tests of neurological localisation–Extended Matching Questions (EMQ) and Script Concordance Test (SCT). Data on gender, undergraduate medical education (local vs overseas graduates), graduate medical education, and amount of clinical experience were collected, and their association with EMQ and SCT scores evaluated via multivariate analysis. Results: Multivariate analysis indicated that local graduates scored higher than overseas graduates in the SCT (adjusted R2 = 0.101, f2 = 0.112). Being a local graduate and having more local experience positively predicted EMQ scores (adjusted R2 = 0.049, f2 = 0.112). Conclusion: Clinical reasoning in neurological localisation can be predicted via a two-factor model–undergraduate medical education and the amount of local experience. Context specificity likely underpins the process.

The working alliance, beliefs about the supervisor, and counseling self-efficacy: Applying the relational efficacy model to counselor supervision.

There is need for closer examination of how counselors' efficacy beliefs develop and function within actual counseling or supervisory relationships. We adapted Lent and Lopez's (2002) model of relational efficacy beliefs to the context of counseling supervision, examining possible linkages of counselors' self-efficacy to beliefs about how their supervisor perceives their (counselors') efficacy (termed relation-inferred self-efficacy [RISE]), beliefs about the supervisor's efficacy (other-efficacy), and perceptions of the supervisory working alliance. Two hundred forty graduate student counselors completed the relational efficacy belief measures in relation to a particularly challenging client on their caseloads. Path analysis findings suggested that the hypothesized model provided good fit to the data. In particular, counselors' RISE beliefs regarding their supervisors were well-predicted by the supervisory working alliance, other-efficacy beliefs about the supervisor, amount of clinical experience, and perceived client distress level. RISE beliefs (along with amount of clinical experience), in turn, predicted counselors' self-efficacy. In addition, the strength of the relationship between RISE and counselor self-efficacy was moderated by other-efficacy, suggesting that supervisors' clinical credibility, from the perspective of their supervisees, plays an important role in their ability to promote the efficacy of their supervisees. (PsycINFO Database Record

The Optimal Time to Institute Interprofessional Education in the Medical School Curriculum

Modern healthcare occurs in a dynamic and complex environment that requires providers to work together, collaborate, and quickly adapt to the continuously changing work environment. To prepare providers to meet these demands, practical healthcare and academia establish interprofessional education (IPE) opportunities for healthcare professions. Educational psychologists and philosophers who propone constructivism as a theory of learning argue that “each of us perceives the world through the prism of our own unique experience” (Jean Piaget, Lev Vygotsky, John Dewey, Jerome Bruner, and John Locke) that determines how ready we are to accept or reject given concepts or constructs. This makes the appropriate timing to institute IPE in healthcare curricula very important. No current literature in the realm of IPE collaboration has determined an ideal time to introduce IPE into health education (Curran et al. in J Interprof Care 24:41–52, 4). In our project, we have assessed where in the curriculum medical students had the most positive attitude toward IPE and, more importantly, when they were ready to learn from other healthcare professions, and when they were ready to teach the other professions. In addition, we examined potential confounding factors such as behavioral traits, medical specialty of preference, prior academic degree or working experience in another healthcare profession, amount of clinical experience, and previous IPE exposure. Since none of the existing instruments were suitable to achieve this goal, we developed a 27-item Academic Interprofessional Education Attitude Scale (AIPEAS) survey instrument. This instrument has been piloted and validated at the University of South Dakota Sanford School of Medicine (USD SSOM). At the time of the survey administration, there were 71 first-year, 61 second-year, 58 third-year, and 65 fourth-year students enrolled at USD SSOM. To enhance the response rate, the survey was administered in the last 2 weeks of November and first 2 weeks of December when students did not have major exams or clinical evaluations. One hundred thirty-five out of 254 students replied (135/254, 53.14% response rate), and their profiles closely represented the entire medical school student body. This study found that medical students younger than 25 years, who were females and were in the first or second year of medical school, had significantly more positive attitudes toward IPE. This discovery supported prior research findings conducted by other investigators (Pollard et al. Health Soc Care Community 12(4):346–58, 2004; Anderson and Thorpe J Interprof Care 22(3):263–82, 2008). Among all medical specialties, primary care and family medicine in particular, along with the group of undecided specialty, demonstrated the highest mean attitude toward IPE scores. These findings agree with the previous studies that showed correlation between medical specialties and personality traits (Borges and Osmon J Vocat Behav 58:22–35, 5). The University of South Dakota Sanford School of Medicine conducted a survey-based study to determine the best timing to institute interprofessional education in medical school curriculum. According to the obtained data, the majority of students responded that the first year of the medical school curriculum was the best time to initiate IPE. While the entire attitude toward IPE was positive, female students were more enthusiastic about it than their male counterparts. Also, students younger than 25 years had more positive attitudes toward IPE than their elder schoolmates. Since many healthcare accreditation agencies require students to be involved in the IPE activities throughout their educational curricula, this survey and its findings could be an important tool in designing such curricula (Dominguez et al. J Interprof Care 29:1–6, 2014).

Case Mis‐Conceptualization in Psychological Treatment: An Enduring Clinical Problem

Case conceptualization, an integral component of mental health treatment, aims to facilitate therapeutic gains by formulating a clear picture of a client's psychological presentation. However, despite numerous attempts to improve this clinical activity, it remains unclear how well existing methods achieve their purported purpose. Case formulation is inconsistently defined in the literature and implemented in practice, with many methods varying in complexity, theoretical grounding, and empirical support. In addition, many of the methods demand a precise clinical acumen that is easily influenced by judgmental and inferential errors. These errors occur regardless of clinicians' level of training or amount of clinical experience. Overall, the lack of a consensus definition, a diversity of methods, and susceptibility of clinicians to errors are manifestations of the state of crisis in case conceptualization. This article, the 2nd in a series of 5 on thematic mapping, argues the need for more reliable and valid models of case conceptualization.

Training safer orthopedic surgeons

Background and purpose — Virtual-reality (VR) simulation in orthopedic training is still in its infancy, and much of the work has been focused on arthroscopy. We evaluated the construct validity of a new VR trauma simulator for performing dynamic hip screw (DHS) fixation of a trochanteric femoral fracture.Patients and methods — 30 volunteers were divided into 3 groups according to the number of postgraduate (PG) years and the amount of clinical experience: novice (1–4 PG years; less than 10 DHS procedures); intermediate (5–12 PG years; 10–100 procedures); expert (> 12 PG years; > 100 procedures). Each participant performed a DHS procedure and objective performance metrics were recorded. These data were analyzed with each performance metric taken as the dependent variable in 3 regression models.Results — There were statistically significant differences in performance between groups for (1) number of attempts at guide-wire insertion, (2) total fluoroscopy time, (3) tip-apex distance, (4) probability of screw cutout, and (5) overall simulator score. The intermediate group performed the procedure most quickly, with the lowest fluoroscopy time, the lowest tip-apex distance, the lowest probability of cutout, and the highest simulator score, which correlated with their frequency of exposure to running the trauma lists for hip fracture surgery.Interpretation — This study demonstrates the construct validity of a haptic VR trauma simulator with surgeons undertaking the procedure most frequently performing best on the simulator. VR simulation may be a means of addressing restrictions on working hours and allows trainees to practice technical tasks without putting patients at risk. The VR DHS simulator evaluated in this study may provide valid assessment of technical skill.

Could clinical experience during clerkship enhance students' clinical performance?

BackgroundMedical students learn and practice various clinical skills during clinical clerkship. Patient encounters are important for developing clinical thinking, communication skills, and professional attitude. We investigated whether the amount of clinical experience during clerkship correlated with students’ clinical competency and students’ perception of effectiveness of their clerkship on it.MethodsFourth year medical students undertook the Objective Structured Clinical Examinations (OSCE) in August 2012. Students provided the number of patients for whom they took medical histories or performed physical examinations during clerkship and provided feedback as to whether or not the clinical clerkship was helpful in preparing OSCE. The correlation between the OSCE score and number of patients was analyzed.ResultsOne hundred thirty students completed the questionnaire (86.6%). OSCE scores correlated with the total number of patients encountered for physical examinations (correlation coefficient, 0.274; p = 0.0105). Cumulative 3-year GPAs were positively correlated with OSCE scores (correlation coefficient, 0.330; p = 0.0001). Most (92.3%) answered that their clinical clerkship was helpful in preparing them for the OSCE; however, only 20% felt that their clinical clerkship was most helpful. Others felt that role playing (38.46%) or the guide book (33.84%) was most helpful.ConclusionsThe amount of clinical experience during the students’ clerkship had a small but positive relationship with students’ clinical performance. Further research to elucidate the influence of clinical experience on clinical competency is needed.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6920-14-209) contains supplementary material, which is available to authorized users.

Review of medication errors in a mother-child University Hospital Center

Summary Introduction Insulin is used for the treatment of diabetes since at least one century. Taking into account this high amount of clinical experience, the computerization of the drug use process, the creation of clinical decision tools and robotization, it is surprising that insulin is still considered a high risk medication. Materials and methods Descriptive and retrospective study. The main objective was to describe incidents and accidents that occurred with insulin in a mother-child University Hospital Center. Preventive and corrective measures are discussed. Results A total of 94 incidents and accidents that occurred with insulin were identified in the incidents and accidents registry of our center, between November 9th 2010 and November 8th, 2012. Insulin-related events represented 1.5% (94/6242) of the total number of events that involved at least one medication. Almost all (95% – 89/94) of events were accidents, but no accident caused permanent consequences to the patient. Conclusion Preliminary actions were identified as necessary in order to improve the management of insulin use in our center.

A clinical test of lumbopelvic control: Development and reliability of a clinical test of dissociation of lumbopelvic and thoracolumbar motion

LBP is often associated with changes in motor control. Some subgroups of LBP have been argued to have a compromised ability to dissociate lumbopelvic movement from that of the thoracolumbar junction. Clinical methods to evaluate this task may aid identification of this LBP subgroup and determine the utility of this information to guide clinical interventions. The study aimed to develop a clinical test to assess the ability to dissociate lumbopelvic movement from that of the thoracolumbar junction, and to evaluate the inter-rater reliability of the test in individuals with and without low back pain (LBP) when performed by experienced and novice therapists. A clinical scale was developed to characterise quality of performance of lumbopelvic motion with limited motion at the thoracolumbar junction. Inter-tester repeatability was measured in three experiments. Test outcomes for pain-free controls were compared between three assessors with different amounts of clinical experience. Test scores for LBP participants were compared between two assessors, and between assessments undertaken from video recordings. Agreement between assessors was tested with weighted Kappa Coefficient. The test had acceptable reliability in pain-free and LBP participants, but was better when undertaken by experienced therapists. Kappa index ranged from 0.81 to 0.66 for live assessments, and 0.62 for video assessments. The results showed that the test is reliable when performed by experienced assessors. The test can assess thoracolumbar movements in different groups of individuals.

Clonidine in paediatric anaesthesia

^ Ghosh SM, Agarwala RB, Pandey M, et al. Efficacy of low-dose caudal clonidine in reduction of an indication for which it is rarely used today. Since the early 1990s, clonidine has become increasingly popular with paediatric anaesthetists as a sedative agent, as an additive to neuraxial and peripheral nerve blocks, for miscellaneous indications such as the prevention of post-operative agitation and for the treatment of postoperative shivering. Although in adults clonidine is used primarily to achieve haemodynamic stability and a blunted stress response, in children the primary focus is on the quality of recovery from anaesthesia. In both groups, clonidine is used for prolongation of a regional block. A considerable amount of clinical experience with the compound now exists in both adults and children.

Is length of experience an appropriate criterion to identify level of expertise?

Clinical experience plays an important role in the development of expertise, particularly when coupled with reflection on practice. There is debate, however, regarding the amount of clinical experience that is required to become an expert. Various lengths of practice have been suggested as suitable for determining expertise, ranging from five years to 15 years. This study aimed to investigate the association between length of experience and therapists’ level of expertise in the field of cerebral palsy with upper limb hypertonicity using an empirical procedure named Cochrane–Weiss–Shanteau (CWS). The methodology involved re-analysis of quantitative data collected in two previous studies. In Study 1, 18 experienced occupational therapists made hypothetical clinical decisions related to 110 case vignettes, while in Study 2, 29 therapists considered 60 case vignettes drawn randomly from those used in Study 1. A CWS index was calculated for each participant's case decisions. Then, in each study, Spearman's rho was calculated to identify the correlations between the duration of experience and level of expertise. There was no significant association between these two variables in both studies. These analyses corroborated previous findings of no association between length of experience and judgemental performance. Therefore, length of experience may not be an appropriate criterion for determining level of expertise in relation to cerebral palsy practice.

Is length of experience an appropriate criterion to identify level of expertise?

Clinical experience plays an important role in the development of expertise, particularly when coupled with reflection on practice. There is debate, however, regarding the amount of clinical experience that is required to become an expert. Various lengths of practice have been suggested as suitable for determining expertise, ranging from five years to 15 years. This study aimed to investigate the association between length of experience and therapists’ level of expertise in the field of cerebral palsy with upper limb hypertonicity using an empirical procedure named Cochrane–Weiss–Shanteau (CWS). The methodology involved re-analysis of quantitative data collected in two previous studies. In Study 1, 18 experienced occupational therapists made hypothetical clinical decisions related to 110 case vignettes, while in Study 2, 29 therapists considered 60 case vignettes drawn randomly from those used in Study 1. A CWS index was calculated for each participant's case decisions. Then, in each study, Spearman's rho was calculated to identify the correlations between the duration of experience and level of expertise. There was no significant association between these two variables in both studies. These analyses corroborated previous findings of no association between length of experience and judgemental performance. Therefore, length of experience may not be an appropriate criterion for determining level of expertise in relation to cerebral palsy practice.

Promoting Professional Development: Three Phases of Articulation in Nursing Education and Practice

In this article the authors present the evolution of career ladders in nursing education and practice and discuss their development, maturation, and institutionalization in three phases over a span of forty years. In phase one, academic career ladders were spiral staircases, complex, confusing, and poorly articulated entry and exit pathways. Phase two saw the maturation of career ladders across all levels of nursing education and practice. In phase three, academic and clinical career ladders, built upon theoretical perspectives, have enriched academic programs and clinical practice and increasingly are being integrated into the curriculum, clinical advancement programs, and the magnet hospital movement. The authors conclude by discussing continuing questions, such as the amount of clinical experience needed in an educational program and the amount of clinical practice needed before seeking an advanced degree. They highlight the need for more research and dialogue about the amount, type, and measurement of clinical work and argue that these studies are needed to better inform decisions about professional legislation, accreditation, certification, education, healthcare outcomes, and future-oriented career ladders.

Overview of Commercially Available Femtosecond Lasers in Refractive Surgery

To report on four different commercially available femtosecond laser systems used in refractive surgery. Four systems were analyzed: Ziemer DaVinci system, Zeiss VisuMax, IntraLase FS laser, and 20/10 Perfect Vision FEMTEC. The DaVinci system attracts attention with its concept of low laser pulse energy and flexible mirror arm as a beam delivery. The low pulse energy makes it compact and robust, because only an oscillator as a laser source is required. Another important feature of the low energy pulses is the reduced bubble formation during the cutting process. The smaller the bubbles, the more precise the cut can be positioned. However, the compact setup limits the system in its flexibility in cutting geometry. The VisuMax also uses the new generation of femtosecond technology, which should make it more immune to environmental and temperature changes. However, it is a bulky system, and the patient has to be moved to the excimer laser system after the flap is created. The IntraLase is the laser with the most clinical experience by far, which should be an important issue in terms of safety and technical support. On the other hand, it uses older femtosecond laser technology. This technology is sensitive to changes in temperature or humidity, which can be an important factor if the surgical environment is not air conditioned. The 20/10 Perfect Vision FEMTEC system is comparable with the IntraLase with respect to its technical parameters. However, no data are available about the amount of clinical experience. Although the systems are based on the same principle of photodisruption in corneal tissue, differences exist regarding the concept of these devices.

Factors Influencing Candidates’ Choice of a Pediatric Dental Residency Program

The goal of this study was to identify the factors and program characteristics that influenced the program ranking decisions of applicants to pediatric dentistry residency programs. A questionnaire was sent to the first-year resident class in 2005 with a response rate of 69.2 percent (n=260). Approximately 55 percent were female (104/180) and 61 percent were non-His-panic white (110/180). The respondents reported that they applied to an average of nine programs, of which five were ranked. Most applicants were interested in a program that had a hospital component with a duration of two years. A program's ability to prepare the resident for an academic career was a minimal influence for 48.6 percent (87/179), and 57.5 percent (103/179) were not interested in a master's or Ph.D. degree. Factors associated with program ranking included modern clinical facilities, high ratio of dental assistants and faculty to residents, availability of assistants for sedation and general anesthesia cases, availability of a salary or stipend, and amount of clinical experience. Important non-clinical factors included hospitality during the interview, geographic location, and perceived reputation of the program. Opportunity to speak with the current residents in private, observing the interaction between residents and faculty, and touring the facilities were also highly considered. These findings may help program directors tailor their interviews and programs to suit the needs of applicants.

Potential and limitations of bacterial-mediated cancer therapy

Bacterial-based tumor-targeted therapy is an area of growing interest and holds promise for the treatment of solid tumors. Upon systemic administration, various types of non-pathogenic obligate anaerobes and facultative anaerobes have been shown to infiltrate and selectively replicate within solid tumors. The tumor specificity is based upon the unique physiology of solid tumors, which is often characterized by regions of hypoxia and necrosis. Prokaryotic vectors can be safely administered and their potential to deliver therapeutic proteins has been demonstrated in a variety of preclinical models. Although the amount of clinical experience with bacterial vectors is limited to date, the available data clearly demonstrated the feasibility of bacterial-mediated therapy in humans. There are several issues however that are still unknown and remain major challenges. In this review, using Clostridium and modified Salmonella as prototypical agents, we will discuss the major advantages, challenges and shortcomings of bacterial systems for tumor-specific therapy. In addition, we will highlight the requirements needed to advance the approach into clinical trials.

An evaluation of the level of moral development of clinical nurses in Korea

An evaluation of the level of moral development of clinical nurses in Korea

Physician knowledge of herbal toxicities and adverse herb-drug interactions.

To determine how knowledgeable physicians are regarding the toxic effects and drug interactions of herbal remedies. An anonymous voluntary demographic survey and 16-question, multiple-choice quiz was distributed at educational meetings of emergency medicine and internal medicine physicians. The primary outcome measures were to determine whether significant associations existed between quiz scores and the amount of clinical experience, or between quiz scores and self-assessed familiarity with the topic of herbal toxicities and adverse herb-drug interactions. A total of 142 surveys and quizzes were completed by 59 attending physicians, 57 resident physicians, and 26 medical students. The mean subject score on the quiz was only slightly higher than would have occurred from random guessing. Neither the amount of the subjects' clinical experience, nor their self-assessed familiarity with herbal toxicities and drug interactions correlated significantly with the score on the quiz. The physicians and medical students surveyed had little training in herbal toxicities and drug interactions. They generally rated their familiarity with these topics as 'poor', and their scores on the quiz bore out this assessment as correct. Educational efforts might improve physician knowledge of the adverse effects of herbal remedies.

Sonicaid FetalCare: fetal heart rate analysis

Advances in technology over the past 30 years enable us to assess fetal health using safe and non-invasive ultrasound techniques. One such technique is fetal heart rate monitoring, and in pregnancies where there is fetal compromise the fetal heart rate contains crucial information with regard to the optimum timing of delivery. The features of the fetal heart rate are well understood, but numerous studies have shown that expert assessment of traces is prone to inconsistency. In addition, when junior or inexperienced staff review traces important features may not be noticed, with the danger that critical decisions are delayed. Computer analysis of the fetal heart rate using Sonicaid FetalCare or the care analysis built into Sonicaid fetal monitors is therefore a welcome and much-needed way of standardizing interpretation to the highest standards. Such analysis captures an enormous amount of clinical experience and in effect brings it to the bedside.