Assessment Of Clinical Performance Research Articles

Development of a validated assessment tool for medical students using simulated patients: an 8-year panel survey

BackgroundThe use of simulated patients (SPs) to assess medical students’ clinical performance is gaining prominence, underscored by patient safety perspective. However, few reports have investigated the validity of such assessment. Here, we examined the validity and reliability of an assessment tool that serves as a standardized tool for SPs to assess medical students’ medical interview.MethodsThis longitudinal survey was conducted at Keio University School of Medicine in Japan from 2014 to 2021. To establish content validity, the simulated patient assessment tool (SPAT) was developed by several medical education specialists from 2008 to 2013. A cohort of 36 SPs assessed the performance of 831 medical students in clinical practice medical interview sessions from April 2014 to December 2021. The assessment’s internal structure was analyzed using descriptive statistics (maximum, minimum, median, mean, and standard deviation) for the SPAT’s 13 item total scores. Structural validity was examined with exploratory factor analysis, and internal consistency with Cronbach’s alpha coefficients. The mean SPAT total scores across different SPs and scenarios were compared using one way analysis of variance (ANOVA). Convergent validity was determined by correlating SPAT with the post-clinical clerkship obstructive structured clinical examination (post-CC OSCE) total scores using Pearson’s correlation coefficient.ResultsOf the 831 assessment sheets, 36 with missing values were excluded, leaving 795 for analysis. Thirty-five SPs, excluding one SP who quit in 2014, completed 795 assessments, for a response rate of 95.6%. Exploratory factor analysis revealed two factors, communication and physician performance. The overall Cronbach’s alpha coefficient was 0.929. Significant differences in SPAT total scores were observed across SPs and scenarios via one-way ANOVA. A moderate correlation (r =.212, p <.05) was found between SPAT and post-CC OSCE total scores, indicating convergent validity.ConclusionsEvidence for the validity of SPAT was examined. These findings may be useful in the standardization of SP assessment of the scenario-based clinical performance of medical students.

How AI challenges the medical device regulation: patient safety, benefits, and intended uses

Abstract This article examines whether the EU Medical Device Regulation (MDR) adequately addresses the novel risks of AI-based medical devices (AIaMDs), focusing on AI medical imaging tools. It examines two questions: first, does the MDR effectively deal with issues of adaptability, autonomy, bias, opacity, and the need of trustworthiness of AIaMD? Second, does the manufacturer’s translation of the MDR’s requirements close a discrepancy between an AIaMDs’ expected benefit and the actual clinical utility of assessing device safety and effectiveness beyond the narrow performance of algorithms? While the first question has previously received attention in scholarly literature on regulatory and policy tensions on AIaMD generally, and work on future technical standard setting, the second has been comparatively overlooked. We argue that effective regulation of AIaMD requires framing notions of patient safety and benefit within the manufacturer’s articulation of the device’s intended use, as well as reconciling tensions. These tensions are on (i) patient safety and knowledge gaps surrounding fairness, (ii) trustworthiness and device effectiveness, (iii) the assessment of clinical performance, and (iv) performance updates. Future guidance needs to focus on the importance of translated benefits, including nuanced risk framing and looking at how the limitations of AIaMD inform the intended purpose statement in the MDR.

Leveraging Electronic Health Record Data and Measuring Interdependence in the Era of Precision Education and Assessment.

The era of precision education is increasingly leveraging electronic health record (EHR) data to assess residents' clinical performance. But precision in what the EHR-based resident performance metrics are truly assessing is not fully understood. For instance, there is limited understanding of how EHR-based measures account for the influence of the team on an individual's performance-or conversely how an individual contributes to team performances. This study aims to elaborate on how the theoretical understandings of supportive and collaborative interdependence are captured in residents' EHR-based metrics. Using a mixed methods study design, the authors conducted a secondary analysis of 5 existing quantitative and qualitative datasets used in previous EHR studies to investigate how aspects of interdependence shape the ways that team-based care is provided to patients. Quantitative analyses of 16 EHR-based metrics found variability in faculty and resident performance (both between and within resident). Qualitative analyses revealed that faculty lack awareness of their own EHR-based performance metrics, which limits their ability to act interdependently with residents in an evidence-informed fashion. The lens of interdependence elucidates how resident practice patterns develop across residency training, shifting from supportive to collaborative interdependence over time. Joint displays merging the quantitative and qualitative analyses showed that residents are aware of variability in faculty's practice patterns and that viewing resident EHR-based measures without accounting for the interdependence of residents with faculty is problematic, particularly within the framework of precision education. To prepare for this new paradigm of precision education, educators need to develop and evaluate theoretically robust models that measure interdependence in EHR-based metrics, affording more nuanced interpretation of such metrics when assessing residents throughout training.

Facilitating clinical use of the Amsterdam Instrumental Activities of Daily Living Questionnaire: Normative data and a diagnostic cutoff value.

The Amsterdam Instrumental Activities of Daily Living Questionnaire (A-IADL-Q) is well validated and commonly used to assess difficulties in everyday functioning regarding dementia. To facilitate interpretation and clinical implementation across different European countries, we aim to provide normative data and a diagnostic cutoff for dementia. Cross-sectional data from Dutch Brain Research Registry (N = 1,064; mean (M) age = 62 ± 11 year; 69.5% female), European Medial Information Framework-Alzheimer's Disease 90 + (N = 63; Mage = 92 ± 2 year; 52.4% female), and European Prevention of Alzheimer's Dementia Longitudinal Cohort Study (N = 247; Mage = 63 ± 7 year; 72.1% female) were used. The generalized additive models for location, scale, and shape framework were used to obtain normative values (Z-scores). The beta distribution was applied, and combinations of age, sex, and educational attainment were modeled. The optimal cutoff for dementia was calculated using area under receiver operating curves (AUC-ROC) and Youden Index, using data from Amsterdam Dementia Cohort (N = 2,511, Mage = 64 ± 8 year, 44.4% female). The best normative model accounted for a cubic-like decrease of IADL performance with age that was more pronounced in low compared to medium/high educational attainment. The cutoff for dementia was 1.85 standard deviation below the population mean (AUC = 0.97; 95% CI [0.97-0.98]). We provide regression-based norms for A-IADL-Q and a diagnostic cutoff for dementia, which help improve clinical assessment of IADL performance across European countries.

Cognitive-Motor Dual-Task Performance of the Landing Error Scoring System.

The Landing Error Scoring System (LESS) is a common assessment used to determine biomechanical landing errors. However, this assessment is completed as a single motor task, which does not require additional attentional resources. It is unclear if the LESS can be used to detect cognitive-motor interference (i.e., dual-task cost) in biomechanical errors associated with lower extremity injury. To determine if the LESS is a suitable clinical assessment of dual-task performance in uninjured females and to evaluate whether specific landing criteria are more affected by an additional cognitive load than others. Observational Cross-Sectional Design. Setting: University research laboratory. Twenty uninjured, physically active females participated. Intervention(s): Participants performed the LESS under three different conditions: baseline landing with no cognitive distraction (Single), a visual-based dual-task (Visual), and a number-based dual-task (Number). Mean sagittal, frontal, and total LESS scores were compared between conditions using a one-way repeated measures analysis of variance with Tukey post hoc corrections. Cohen's d effect sizes with 95% confidence intervals were used to determine the magnitude of differences. The frequency of errors for each individual LESS item under the three conditions were compared using Chi-Squared analyses. Participants exhibited greater sagittal plane (P=.013, d=0.91 [0.26, 1.56]) and total (P=.008, d=1.03 [0.37, 1.69]) errors during the Visual condition compared to the Single condition. Frontal plane errors were significantly greater during the Number condition compared to the Single condition (P=.008, d=1.03 [0.37, 1.69]). The frequency of errors observed for each LESS item did not statistically differ between conditions (all P>.05). The LESS was able to detect a dual-task cost in landing errors during both the Visual and Number conditions. We recommend developing clinically-oriented solutions to incorporate similar dual- task paradigms in traditional injury risk reduction programs.

Clinical trial and performance evaluation of the Wantai HBsAg (CMIA) diagnostic kit for screening blood donors in China

In China, according to the ‘Technical Operating Procedures for Blood Stations (2019 Edition),’ blood stations are authorized to utilize Chemiluminescence Immunoassay (CLIA) to detect pathogen markers linked with transfusion-transmissible infections. However, currently, there is no approved CLIA reagent for the screening of blood-borne diseases in China, specifically for the detection of Hepatitis B surface antigen. The objective of this research project is to conduct a comprehensive evaluation of the performance of the Wantai Chemiluminescent Microparticle Hepatitis B surface antigen reagent. This study evaluates the performance of the Wantai Chemiluminescent Microparticle Immunoassay (CMIA) on the Wan200 + analyzer in screening for Hepatitis B Surface Antigen (HBsAg) in blood samples. The clinical trial component of this evaluation is included as part of the documentation submitted to the National Medical Products Administration (NMPA) of China for the approval of blood screening reagents. The evaluation plan of this study encompasses two main components: clinical trials and performance assessment. We adopted a controlled trial design, utilizing the WanTai Chemiluminescent Microparticle Immunoassay (CMIA) on the Wan200 + analyzer and the Enzyme-Linked Immunosorbent Assay (ELISA) to screen for Hepatitis B Surface Antigen (HBsAg) in routine blood donor samples and reference serum panel samples. To ensure the accuracy of the screening, we additionally employed Abbott's ELISA reagents and HBV DNA for validation. The assessment primarily focused on key performance indicators such as sensitivity, specificity, and analytical sensitivity. Moreover, this clinical trial data has been included as part of the submission to China's National Medical Products Administration (NMPA). In the clinical trials of this study, a total of 10,470 blood donor samples underwent simultaneous testing using both CMIA and ELISA methods. Across two clinical trials, there was remarkable concordance between CMIA and the two ELISA reagents, with Kappa values exceeding 0.82. Among the 269 samples that were double-reactive in the enzyme immunoassay (ELISA) tests, CMIA exhibited a 100% reactivity detection rate. However, CMIA produced 14 and 6 false-positive results in the respective clinical trials, resulting in specificities of 99.73% and 99.89%. In contrast, the specificities for Wantai ELISA and Xin Chuang ELISA were both greater than 99.94%.When testing samples in the gray zone serum plates, CMIA's detection limit significantly exceeded that of the two ELISA assays. CMIA had a detection cutoff of 0.05 IU/mL, while the two ELISA reagents had cutoffs of 0.1 IU/mL and 0.09 IU/mL, respectively. CMIA's detection limits for the adr and adw subtypes were 0.05 IU/mL, and for the ay subtype, it was 0.1 U/mL. The detection limit for 10 HBV mutant samples was 0.5 U/mL. In 165 cases where ELISA tested negative but HBV DNA tested positive, CMIA detected 5 HBsAg-positive samples. This study evaluated the performance of the Wantai CMIA in screening for HBsAg among blood donors. The results demonstrate outstanding performance of CMIA in both clinical trials and performance assessments, detecting all true positive samples with a sensitivity of 100%. It exhibits excellent concordance with the two ELISA assays. Of particular note is its superiority in early detection of HBsAg in the screening of early-stage hepatitis B infections, reducing the window period compared to ELISA. CMIA achieves a specificity exceeding 99.73% for negative blood donors, aligning with the European Union's standards for blood screening assay specificity. In summary, Wantai's CMIA displays high sensitivity and specificity in blood donor screening, making it suitable for screening blood donors in China.

An action research to introduce direct observation of procedural skills (DOPS) as clinical skill performance assessment tool during medical internship in the department of surgery, Debre Tabor University, Debre Tabor, Ethiopia, 2023

An action research to introduce direct observation of procedural skills (DOPS) as clinical skill performance assessment tool during medical internship in the department of surgery, Debre Tabor University, Debre Tabor, Ethiopia, 2023

Screening instruments for early identification of unmet palliative care needs: a systematic review and meta-analysis

BackgroundThe early detection of individuals who require palliative care is essential for the timely initiation of palliative care services. This systematic review and meta-analysis aimed to (1) Identify the screening...

Development and Validity and Reliability Determination of the Bayley III Examiner Clinical Performance Assessment Instrument

Development and Validity and Reliability Determination of the Bayley III Examiner Clinical Performance Assessment Instrument

Assessor discomfort and failure to fail in clinical performance assessments

BackgroundAssessment of trainee performance in the workplace is critical to ensuring high standards of clinical care. However, some supervisors find the task to be challenging, and may feel unable to deliver their true judgement on a trainee’s performance. They may ‘keep MUM’ (that is, keep mum about undesirable messages) and fail to fail an underperforming trainee. In this study, we explore the effect of discomfort on assessors.MethodsUsing a survey method, supervisors of trainees in the Australasian College of Dermatologists were asked to self-report experiences of discomfort in various aspects of trainee workplace assessment and for their engagement in MUM behaviours including failure to fail.ResultsSixty-one responses were received from 135 eligible assessors. 12.5% of assessors self-reported they had failed to fail a trainee and 18% admitted they had grade inflated a trainee’s score on a clinical performance assessment in the previous 12-month period. Assessors who reported higher levels of discomfort in the clinical performance assessment context were significantly more likely to report previously failing to fail a trainee. The study did not reveal significant associations with assessor demographics and self-reports of discomfort or MUM behaviours.ConclusionsThis study reveals the impact of assessor discomfort on the accuracy of assessment information and feedback to trainees, including as a contributing factor to the failure to fail phenomenon. Addressing assessor experience of discomfort offers one opportunity to impact on the complex and multifactorial issue that failure to fail represents.

Relation Between Cognitive Assessment and Clinical Physical Performance Measures After Mild Traumatic Brain Injury

ObjectivesTo investigate the relation between cognitive and motor performance in individuals with mild traumatic brain injury (mTBI) and examine differences in both cognitive and motor performance between adults after mTBI and healthy controls. DesignMulti-center, cross-sectional study. SettingThree institutional sites (Courage Kenny Research Center, Minneapolis, MN, Oregon Health & Science University, Portland, OR, and University of Utah, Salt Lake City, UT). ParticipantsData were collected from 110 participants (N=110), including those with mTBI and healthy controls, who completed cognitive and physical performance assessments. InterventionsNot applicable. Outcome MeasuresCognitive assessments involved the Automated Neuropsychological Assessment Metrics to evaluate domains of attention, memory, reaction time, processing speed, and executive function. Physical performance was evaluated through clinical performance assessments, such as the 1-min walk test, the modified Illinois Agility Test, the Functional Gait Assessment Tool, the High-Level Mobility Assessment Tool, a complex turning course, and a 4-Item Hybrid Assessment of Mobility for mTBI. Participants also completed additional trials of the 1-min walk test, modified Illinois Agility Test, and complex turning course with a simultaneous cognitive task. ResultsIndividuals with mTBI performed worse on cognitive assessments, as well as several of the physical performance assessments compared with healthy controls. Complex tasks were more strongly related to cognitive assessments compared with simple walking tasks. ConclusionsCombining complex motor tasks with cognitive demands may better demonstrate functional performance in individuals recovering from mTBI. By understanding the relation between cognitive and physical performance in individuals recovering from mTBI, clinicians may be able to improve clinical care and assist in return to activity decision-making.

P245 - Uromonitor-V2®: Clinical Validation and Performance Assessment of a Urinary Biomarker for Recurrence in Non-Muscle Invasive Bladder Cancer Patients

P245 - Uromonitor-V2®: Clinical Validation and Performance Assessment of a Urinary Biomarker for Recurrence in Non-Muscle Invasive Bladder Cancer Patients

B-133 Beckman Coulter’s DxC 500 AU Clinical Chemistry Analyzer, Assessed by Six Sigma Metrics, Meets and Exceeds the Demands of CLIA 2024 Performance Specifications

Abstract Background The analytical Sigma-metric is a quality assessment tool, derived from the well-known Six Sigma management approach, and has been employed in Clinical Chemistry Assay performance assessments for over two decades. The analytical Sigma-metric, for an analyte or test in the clinical laboratory, is calculated using three variables that are routinely available; imprecision (CV), inaccuracy (bias) and total allowable error (TEa), all expressed as percentages or all in units. A range of assays were assessed for Sigma-metric performance including ISE chemistries for urine and serum, IgG serum and CSF, CRP serum and Glucose serum, urine and CSF, on the Beckman Coulter DxC 500 AU. The Beckman Coulter DxC 500 AU clinical chemistry analyzer* is the latest system from Beckman Coulter. It is a fully automated, random-access analyzer, designed for low to medium volume laboratories, with a throughput of 800 tests/h including ISEs. Methods To assess the 6-sigma performance of the assays on the DxC 500 AU, the standard analytical equation was used; Sigma metric = (TEa-|Bias|)/CV. Precision data was generated following the CLSI EP05 guideline, utilizing the 20-day protocol with test samples at various levels tested twice a day with a minimum of 2 h between runs. Relative bias was determined through a method comparison study tested, following the CLSI EP09-A3 guideline, between the DxC 500 AU and the DxC 700 AU, and evaluated a minimum of 100 samples completed over a minimum of 3 days. Bias was calculated at various levels across the dynamic range utilizing both Passing-Bablok and Deming regression models. The 6-sigma performance was assessed against total error (TE) goals from various sources including the new CLIA 2024 performance criteria for serum, Royal College of Pathologists of Austral-Asia (RCPA) ALP for urine assays, and in one case, the Wisconsin State Lab of Hygiene (WSLH) goal for a CSF analyte. Results Urine applications for ISEs and Glucose all demonstrated &amp;gt;6-sigma performance. The glucose CSF demonstrated &amp;gt;5-sigma performance while the IgG CSF assay demonstrated &amp;gt;3-sigma performance. For the serum applications, all assays demonstrated &amp;gt;4-sigma performance, with CRP, glucose and chloride demonstrating &amp;gt;6-Sigma, IgG &amp;gt;4-sigma and potassium and sodium &amp;gt;5-sigma. Through the use of Westgard Sigma Rules, this indicates that most assays do not require extensive multi-rule monitoring, but instead can rely on fewer rules with wider control limits. Conclusion Excellent performance has been demonstrated for the assays evaluated, with all urine applications performing at &amp;gt;6-sigma and serum assay at &amp;gt;4-sigma, and CSF assays performing at &amp;gt;3-sigma. Sigma-metric analysis confirms the instrument will meet or exceed adherence to the coming, tighter CLIA 2024 performance specifications. Further, QC for these assays can be optimized to reduce the number of rules, levels, and runs implemented for routine monitoring. The resulting optimized process enables the laboratory to produce quality results efficiently with increased confidence for proper test interpretation. *Product In development. Pending clearance by the United States Food and Drug Administration and achievement of CE compliance. Not currently available for in vitro diagnostic use.

A model for remote remediation to address communication deficits identified during clinical placement

Clinical case problem: Effective communication is vital for the successful transmission of information and has been attributed to better patient outcomes, patient satisfaction, and patient safety. Deficits in soft skills, such as communication, can be challenging to address due to a lack of standardized remediation strategies. This case report describes a student identified for inadequate communication skills during an intermediate clinical experience. To prepare the student for future clinical experiences, the faculty developed a comprehensive remote remediation plan. Case description: A four-step remote communication remediation plan was developed and implemented utilizing optimal-fidelity patient simulations. As the remediation occurred during a global pandemic limiting in-person contact, the scenarios were based on telehealth encounters and included faculty debriefing. A challenging communication component was embedded within each simulation. Outcomes including a communication survey to assess verbal and nonverbal skills, student self-reflection, and clinical performance assessment post-remediation demonstrating the transfer of newly acquired skills were used to evaluate the effectiveness of the intervention. Implications: The remote remediation was effective. Careful planning ensured that all deficiencies were targeted using multiple teaching modalities. This remediation plan may be adapted to target other soft skill development and implemented for formative or remedial training, based on learning objectives and student needs.

Evaluation of acute asthma management among emergency doctors using simulation-based assessment.

Assessment of asthma management competency using conventional methods remains challenging. This study aimed to explore the baseline knowledge, diagnosis accuracy and clinical management accuracy of acute asthma among emergency doctors using simulation-based assessment. We conducted a cross-sectional study involving 65 emergency department medical officers at a tertiary center. Participants were evaluated using 2 components: knowledge assessment of acute asthma and clinical performance assessment. Knowledge was evaluated using a standardized knowledge questionnaire. Clinical performance in managing acute asthma was assessed using a simulated acute asthma scenario and a standardized asthma management checklist using real-time assessments. The mean knowledge score was 14.69 ± 2.16. No significant differences were found in diagnosis and management accuracy in relation to knowledge (H = 0.644, P = .725, df = 6; H = 1.337, P = .512, df = 2). Acute-asthma attacks of all severities were poorly assessed, with accuracies of 27.3, 41.9, and 20.1% in mild, moderate, severe, and life-threatening cases, respectively. However, all participants provided high-quality treatment (accuracy = 82.3%) regardless of severity. Knowledge score does not influence the ability to differentiate asthma severity and management accuracy according to established asthma guidelines. The overall treatment accuracy was high, regardless of the severity of asthma. However, assessment of acute asthma requires further refinement.

CIRCumcision learning experience using simulation: A pilot learning platform for safe neonatal circumcision training offered either virtually or in person

BackgroundTo our knowledge, no formal training combining didactic learning, simulation, and hands-on performance is available for practitioners performing neonatal circumcision. The absence of structured training may result in avoidable complications such as bleeding and penile injury. Herein, we present the results of a pilot neonatal circumcision training platform, offered either virtually or in person.Material and methodsCIRCLES (CIRCumcision Learning Experience using Simulation) consist of 1. online didactic learning; 2. live simulation practice (in person or virtual coaching), and 3. clinical performance. Outcome measures included pre- and post-knowledge scores, self-efficacy questionnaires, and skill assessments of simulation and clinical performance (Likert rating). Face validity for training success was determined by an 80% passing score on the knowledge test and &amp;gt; 75% (mostly independent) performance.ResultsFor this pilot, we restricted enrolment to seven pediatric residents and one nurse practitioner. Wilcoxon Sum Rank test for non-parametric paired samples for pre-and post-knowledge tests showed a median increase of 20 points in post-knowledge tests (p=0.011). Upon completion of the simulation training, all participants (8/8) have chosen to perform circumcision with the GOMCO clamp. Both in-person (4/4) and virtual participants (4/4) performed &amp;gt;75% of simulation and clinical circumcision independently. Post-training self-efficacy Z scores were higher than pre-training scores, except for the management of bleeding.ConclusionThe pilot CIRCLES learning shows face validity for both in-person and virtual training for neonatal circumcision. We plan to extend this platform to include more trainees and to offer them to established practitioners. The availability of formal training may ultimately reduce adverse outcomes.

Assessing artificial intelligence enabled liquid-based cytology for triaging HPV-positive women: a population-based cross-sectional study.

Cytology-based triaging is commonly used to manage the care of women with positive human papillomavirus (HPV) results, but it suffers from subjectivity and a lack of sensitivity and reproducibility. The diagnostic performance of an artificial intelligence-enabled liquid-based cytology (AI-LBC) triage approach remains unclear. Here, we compared the clinical performance of AI-LBC, human cytologists and HPV16/18 genotyping at triaging HPV-positive women. HPV-positive women were triaged using AI-LBC, human cytologists and HPV16/18 genotyping. Histologically confirmed cervical intraepithelial neoplasia grade 2/3 or higher (CIN2+/CIN3+) were accepted as thresholds for clinical performance assessments. Of the 3514 women included, 13.9% (n = 489) were HPV-positive. The sensitivity of AI-LBC was comparable to that of cytologists (86.49% vs 83.78%, P = 0.744) but substantially higher than HPV16/18 typing at detecting CIN2+ (86.49% vs 54.05%, P = 0.002). While the specificity of AI-LBC was significantly lower than HPV16/18 typing (51.33% vs 87.17%, P < 0.001), it was significantly higher than cytologists at detecting CIN2+ (51.33% vs 40.93%, P < 0.001). AI-LBC reduced referrals to colposcopy by approximately 10%, compared with cytologists (51.53% vs 60.94%, P = 0.003). Similar patterns were also observed for CIN3+. AI-LBC has equivalent sensitivity and higher specificity compared with cytologists, with more efficient colposcopy referrals for HPV-positive women. AI-LBC could be particularly useful in regions where experienced cytologists are few in number. Further investigations are needed to determine triaging performance through prospective designs.

Vision impairment is common in non-hospitalised patients with post-COVID-19 syndrome

ABSTRACT Clinical relevance Vision-related problems can be part of longstanding sequelae after COVID-19 and hamper the return to work and daily activities. Knowledge about symptoms, visual, and oculomotor dysfunctions is however scarce, particularly for non-hospitalised patients. Clinically applicable tools are needed as support in the assessment and determination of intervention needs. Background The purpose of this study was to evaluate vision-related symptoms, assess visual and oculomotor function, and to test the clinical assessment of saccadic eye movements and sensitivity to visual motion in non-hospitalised post-COVID-19 outpatients. The patients (n = 38) in this observational cohort study were recruited from a post-COVID-19 clinic and had been referred for neurocognitive assessment. Methods Patients who reported vision-related symptoms reading problems and intolerance to movement in the environment were examined. A structured symptom assessment and a comprehensive vision examination were undertaken, and saccadic eye movements and visual motion sensitivity were assessed. Results High symptom scores (26–60%) and prevalence of visual function impairments were observed. An increased symptom score when reading was associated with less efficient saccadic eye movement behaviour (p < 0.001) and binocular dysfunction (p = 0.029). Patients with severe symptoms in visually busy places scored significantly higher on the Visual Motion Sensitivity Clinical Test Protocol (p = 0.029). Conclusion Vision-related symptoms and impairments were prevalent in the study group. The Developmental Eye Movement Test and the Visual Motion Sensitivity Clinical Test Protocol showed promise for clinical assessment of saccadic performance and sensitivity to movement in the environment. Further study will be required to explore the utility of these tools.

Do personal and behavioural characteristics of physiotherapy students predict performance during training and course completion?

BackgroundSpecific personal and behavioural characteristics are required for competent health care practice. Research investigating relationships between these characteristics and course performance of health professions students is expanding, yet little research is conducted within the undergraduate physiotherapy student population. This study aimed to explore the relationships between personality, approaches to learning, and coping strategies of undergraduate physiotherapy students and their performance in academic, clinical and in-course assessment tasks and course progression.MethodsParticipants from six cohorts of undergraduate physiotherapy students (commencing years 2012–2017, 66% response rate) completed questionnaires measuring personality (NEO-FFI-3), approaches to learning (RASI) and coping strategies (Brief COPE). Correlation and multiple regression analysis were conducted to investigate relationships between scores on written examinations, in-course assessment tasks and assessments of clinical performance. Mann–Whitney U test was used to compare subgroups on these measures in those who completed or did not complete the course.ResultsConscientiousness and a strategic approach to learning predicted higher scores in written examinations, and for most clinical and in-course assessments with conscientiousness being a stronger predictor. A lack of purpose (surface) learning approach was predictive of lower clinical placement scores. Non-course completers had higher scores for lack of purpose (surface) approach to learning and lower scores for the coping strategies of support seeking and humour.ConclusionsThis study confirms the importance of conscientiousness and a strategic learning approach on the academic and clinical performance of undergraduate physiotherapy students. Identifying learners with a surface learning approach and low support seeking coping strategies could assist in providing support to students at risk of poor performance and minimising attrition.

Using simulation for assessment: the example of OSCE in medical students

Training of health sciences students is based on the acquisition of clinical skills. Tools assessing the application of theoretical knowledge through written examinations or the tools evaluating student's performance at patient bedsides are characterized by a low reliability. The Objective Structured Clinical Examination (OSCE) was developed to address the lack of reliability and standardization of traditional forms of the assessment of clinical performance.