Competency Evaluations Research Articles

Within-student variability in learning experiences, and teachers’ perceptions of students’ task-focus

In order to advance models of educational processes (intraindividual, intensive longitudinal), we propose a model in which we specify state and trait constructs, and an intraindividual variability construct. In our ecological momentary assessment study, we investigated how trait-level and intraindividual variability of students’ learning experiences (intrinsic and extrinsic motivation, task difficulty, effort exertion, help-seeking and competence evaluations) converged with teacher-reported student task-focus. 285 primary school students’ (Years 5 and 6) completed the Learning Experience Questionnaire using handheld computers, on average 13.6 learning episodes during one week (SD = 4.6; Range = 5-29; n episodes = 3,433), and these were linked with teacher-reports. We defined mean squared successive differences (MSSD) for each indicator. We specified uni- and multivariate models of state, trait and intraindividual variability constructs of students’ learning experiences using multilevel structural equation models (MSEM). Teacher reported task-focus converged with trait constructs (from |r| = .22 to .42), and with intrapersonal variability constructs (from r = -.12 to r = -.36), higher task-focus being associated with less variability. Intraindividual variability formed a higher-order construct, and teachers’ negative wording bias was also associated with variability. Overall, our study provides support for intraindividual variability as a construct in its own right, which has the potential to provide novel insight into students’ learning processes.

Determination of Competency to Stand Trial (Fitness to Plead): An Exploratory Study in Hong Kong

Competency to stand trial (CST) is related to the defendant's capacity to engage in a satisfactory level of participation in the court process. While the extant studies focus mainly on assessment-related issues such as assessment methods, guidelines for competency evaluations, and quality of competency evaluations, another area of considerable interest is the indicators of CST as well as legal decision-making relating to CST. This study canvasses some proposed indicators of CST from the literature and examines whether these psycho-legal abilities are relevant to finding a defendant incompetent to stand trial. Secondly, the study investigates factors likely to influence legal decision-making in competency determination. Using a cross-sectional survey and a self-report methodology, 197 participants from a legal Juris Doctoral course responded to measures of CST, punitiveness, and legal authoritarianism, anti-authoritarianism and egalitarianism. The results show that the majority of the items canvassed from the literature are considered relevant in finding the defendant incompetent to stand trial. With respect to factors influencing competent decision-making, females are more likely to regard defendants as incompetent. Additionally, participants with strong punishment-oriented attitudes (i.e. legal authoritarianism and punitiveness) are significantly more likely to find the defendant competent to stand trial, as opposed to those high in non-punishment-oriented attitudes (i.e. anti-authoritarianism and egalitarianism). The study concludes that biased legal decision-making can occur regardless of the background of the decision-makers, in this case participants undergoing legal training. The findings are discussed and implications of the study are proposed.

Fitness to stand trial evaluations in immigration proceedings.

In Canada, criminal defendants have the right to participate in their legal defense. Although this right is often interpreted as relating to defendants' physical presence, it also relates to their mental abilities. Fitness to stand trial (FST) refers to defendants' capacity to complete procedural duties and follow court proceedings. The criteria for FST (also known as competency to stand trial) were defined in 1992 in the revision of the Canadian Criminal Code (CCC). Although the ultimate decision regarding competency lies with the court, the decision is traditionally based on the recommendations of mental health professionals (although in Canada, the report must be written by a physician; CCC, s.672.1). FST evaluations are the most commonly conducted forensic mental health assessment (O'Shaughnessy, 2007; van der Wolf et al., 2010). Between 1992 and 2004, approximately 1,860 defendants were found unfit to proceed with their criminal cases (Latimer & Lawrence, 2006). Moreover, Latimer and Lawrence (2006) noted that requests for competency evaluations and the number of persons found unfit have been increasing since the standard's development in 1992.FST, as described by the CCC, is limited to criminal settings and does not directly apply in immigration proceedings. However, a similar criterion exists for those in this type of setting. The Immigration and Refugee Board (IRB) of Canada requires that those members who are responsible for hearing the case and making a decision designate a representative for examinees or detainees who are unable to appreciate the nature of the immigration proceedings (IRB, 2005). Despite the existence of this standard, there are few details and little empirical research to assist in its implementation. The lack of clear guidelines is juxtaposed with an increased burden on the part of the claimants in immigration proceedings, as they often complete these proceedings without legally trained representatives (Rehaag, 2011).Although understudied, the role of FST is especially important in immigration settings (e.g., asylum hearings), where the outcome of the trial may involve a risk of persecution or death. The amount of individuals in Canada who could potentially be impacted by policies relating to immigration proceedings is substantial. Between 2006 and 2011, approximately 1,162,900 foreign-born individuals immigrated to Canada, representing 3.5% of Canada's total population (Statistics Canada, 2013). There were 539,036 refugee claimants from 1995 to 2014 (Citizenship & Immigration Canada, 2014). Although the largest recent immigrant group originated from Asia, individuals from Africa, the Caribbean, Central America, and South America are also immigrating at high rates (Statistics Canada, 2013).Although the standard for fitness in immigration settings does not specify the existence of a mental disorder, the responsibilities associated with fitness are particularly precarious for those with mental health problems. Psychological symptoms could impact individuals' abilities to understand and work effectively on their cases. This is problematic as individuals involved in immigration proceedings are likely to be suffering from symptoms of mental illness (Gros & van Groll, 2015). Cultural factors associated with migration may contribute to the risk of mental disorders, particularly psychotic disorders (Anderson, Cheng, Susser, McKenzie, & Kurdyak, 2015). For example, Anderson and colleagues (2015) found that in Canada, immigrants from the Caribbean and Bermuda and refugees from East Africa and South Asia had high rates of schizophrenia. Even when treatment is available, these individuals might remain untreated. This would likely impact the rates of fitness. As a point of comparison, although the presence of mental illness is not sufficient cause in and of itself, in criminal settings, defendants with psychotic disorders or symptomatology are more likely to be found unfit to stand trial at the time of the evaluations (Cooper & Zapf, 2003; Latimer & Lawrence, 2006; Viljoen, Zapf, & Roesch, 2003). …

2015 개정 중학교 도덕과의 도덕적 보건 능력 제고를 위한 교수·학습 및 평가 방향

2015 개정 중학교 도덕과의 도덕적 보건 능력 제고를 위한 교수·학습 및 평가 방향

Functional Significance of Conflicting Age and Wealth Cross-Categorization: The Dominant Role of Categories That Violate Stereotypical Expectations.

The purpose of the current study was to identify the functional significance of conflicting stereotypes and to identify the dominant category in such conflicts. In the present research we examined the conflicting crossed categories of age and wealth with regard to warmth and competence perceptions. It was found (Pilot Study and Study 1) that the old-rich targets presented a conflicting stereotype group in the perception of warmth, whereas young-poor targets presented a conflicting stereotype group in the perception of competence. In addition, the old stereotype dominated the warmth evaluation of old-rich targets, whereas the poor stereotype dominated the competence evaluation of young-poor targets. In Study 2, participants provided warmth and competence evaluations after they learned about the targets' behaviors which demonstrated high or low warmth and high or low competence. The results suggest that for the warmth evaluation of the old-rich target the category that did not match the behavior (i.e., contradicted the stereotype expectation) was more salient and drove judgments. However, the effect of stereotype expectation violation was not found in the competence evaluation of the young-poor target. The results are discussed in terms of their implications for understanding factors that activate and inhibit stereotyped perceptions.

Emotional intelligence in surgery is associated with resident job satisfaction

BackgroundEmotional intelligence (EI) has been associated with improved work performance and job satisfaction in several industries. We evaluated whether EI was associated with higher measures of work performance and job satisfaction in surgical residents. MethodsWe distributed the validated Trait EI Questionnaire and job satisfaction survey to all general surgery residents at a single institution in 2015. EI and job satisfaction scores were compared with resident performance using faculty evaluations of clinical competency–based surgical milestones and standardized test scores including the United States Medical Licensing Examination (USMLE) and American Board of Surgery In-Training Examination (ABSITE). Statistical comparison was made using Pearson correlation and simple linear regression adjusting for postgraduate year level. ResultsThe survey response rate was 68.9% with 31 resident participants. Global EI was associated with scores on USMLE Step 2 (r = 0.46, P = 0.01) and Step 3 (r = 0.54, P = 0.01) but not ABSITE percentile scores (r = 0.06, P = 0.77). None of the 16 surgical milestone scores were significantly associated with global EI or EI factors before or after adjustment for postgraduate level. Global EI was associated with overall job satisfaction (r = 0.37, P = 0.04). Of the facets of job satisfaction, global EI was significantly associated with views of supervision (r = 0.42, P = 0.02) and nature of work (r = 0.41, P = 0.02). ConclusionsEI was associated with job satisfaction and USMLE performance but not ACGME competency–based milestones or ABSITE scores. EI may be an important factor for fulfillment in surgical training that is not currently captured with traditional in-training performance measures.

Robots Have Needs Too: How and Why People Adapt Their Proxemic Behavior to Improve Robot Social Signal Understanding

Human preferences of distance (proxemics) to a robot significantly impact the performance of the robot's automated speech and gesture recognition during face-to-face, social human-robot interactions. This work investigated how people respond to a sociable robot based on its performance at different locations. We performed an experiment in which the robot's ability to understand social signals was artificially attenuated by distance. Participants (N = 180) instructed the robot using speech and pointing gestures, provided proxemic preferences before and after the interaction, and responded to a questionnaire. Our analysis of questionnaire responses revealed that robot performance factors---rather than human-robot proxemics---are significant predictors of user evaluations of robot competence, anthropomorphism, engagement, likability, and technology adoption. Our behavioral analysis suggests that human proxemic preferences change over time as users interact with and come to understand the needs of the robot, and those changes improve robot performance.

Abstract: Trainee Selection and the Correlation between Cognitive and Technical Skill Evaluation

INTRODUCTION: The selection process for surgical trainees aims to identify those who will perform best during training and have the greatest potential as future surgeons. Better understanding the predictive relationship between interview performance, level of technical skill, and performance during training will allow optimization of the interview and evaluation process to identify the best candidates.1–3 MATERIALS AND METHODS: Three annual cohorts of Reconstructive Microsurgery fellows at the Department of Plastic Surgery at the University of Texas MD Anderson Cancer Center, comprising 20 trainees, were included in the study. At interview, subjects were rated using seven criteria, as well as given a score for overall impression. At the start and end of the fellowship, microsurgical technical skill was assessed both in the OR and laboratory using a validated tool. At the end of the fellowship there was a final evaluation of performance using criteria adapted from the six Accreditation Council for Graduate Medical Education (ACGME) core competencies. Scores at interview, technical skill assessment, and final evaluation scores were all compared in multiple ways to determine associations and predictive factors. RESULTS: Microsurgical skill assessment in the OR at the start of training correlated with all domains evaluated at interview, most closely with Plastic Surgery Training Experience. Microsurgical skill assessment in the OR at the end of training also correlated with scores on the majority of final assessment criteria based on ACGME core competencies, with the highest correlations with Patient Care and Medical Knowledge. Assessment of microsurgical skill in the laboratory at the start of the fellowship did not improve the predictive relationship between interview scores and ACGME core competency evaluations. CONCLUSION: Microsurgical technical skill in the OR tracked with all domains evaluated at interview, and also with the majority of ACGME core competency evaluations. These results validate the use of the current selection process in choosing candidates with the highest level of both cognitive and technical skill, and also support the effectiveness of the one-year microsurgical fellowship at improving microsurgical skill in all trainees. DISCLOSURE/FINANCIAL SUPPORT:None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. REFERENCES: 1. Selber JC, Chang EI, Liu J, Suami H, Adelman DM, Garvey P, Hanasono MM, Butler CE. Tracking the learning curve in microsurgical skill acquisition. Plast Reconstr Surg. 2012;130:550. 2. Selber JC, Tong W, Koshy J, Ibrahim A, Liu J, Butler C. Correlation between Trainee Candidate Selection Criteria and Subsequent Performance. J Am Coll Surg. 2014; 219:951–7. 3. Alrasheed T, Liu J, Hanasono MM, Butler CE, Selber JC. Robotic microsurgery: validating an assessment tool and plotting the learning curve. Plast Reconstr Surg. 2014;134:794–803.

Perceptual and Social Attributes Underlining Age-Related Preferences for Faces.

Although aesthetic preferences are known to be important in person perception and can play a significant role in everyday social decisions, the effect of the age of the observer on aesthetic preferences for faces of different ages has not yet been fully investigated. In the present study we investigated whether aesthetic preferences change with aging, with an age-related bias in favoring faces from one’s own age group. In addition, we examined the role of age on both the perceptual qualities and the social attributes of faces that may influence these aesthetic judgements. Both younger and older adult observers provided ratings to images of younger, middle-aged and older unfamiliar faces. As well as attractiveness, the rating dimensions included other perceptual (distinctiveness, familiarity) and social (competence, trustworthiness and dominance) factors. The results suggested a consistent aesthetic preference for youthful faces across all ages of the observers but, surprisingly, no evidence for an age-related bias in attractiveness ratings. Older adults tended to provide higher ratings of attractiveness, competence and trustworthiness to the unfamiliar faces, consistent with the positivity effect previously reported. We also tested whether perceptual factors such as face familiarity or distinctiveness affected aesthetic ratings. Only ratings of familiarity, but not distinctiveness, were positively associated with the attractiveness of the faces. Moreover, ratings of familiarity decreased with increasing age of the face. With regard to the social characteristics of the faces, we found that the age of the face negatively correlated with ratings of trustworthiness provided by all observers, but with the competence ratings of older observers only. Interestingly, older adults provided higher ratings of perceived competence and trustworthiness to younger than older faces. However, our results also suggest that higher attractiveness ratings, together with older aged faces, led to more positive evaluations of competence. The results are discussed within the context of an age-related decline in the differentiation of faces in memory. Our findings have important implications for a better understanding of age-related perceptual factors and cognitive determinants of social interactions with unfamiliar others across the adult lifespan.

Neuropsychologist Experts and Civil Capacity Evaluations: Representative Cases.

Clinical neuropsychologists accept more forensic referrals now and spend more time in forensic consulting than ever before. Recent surveys show weekly hours devoted to forensic consulting increased 97% in the past decade. During the same time period, the number of board certified neuropsychologists more than doubled. Under recently published Specialty Guidelines for Forensic Psychology, clinical neuropsychologists practice forensic psychology when applying scientific, technical, or specialized knowledge of neuropsychology to the law to assist in addressing legal, contractual, or administrative matters. Among those increasingly varied forensic referrals, clinical neuropsychologists are conducting more civil competency and capacity evaluations. Representative cases from three jurisdictions demonstrate how neuropsychologists provide expertize in matters involving testamentary capacity, contractual capacity, business judgments, and job capacity. Case presentations illustrate some of the strengths and weaknesses of neuropsychological evaluation of civil capacities. The article concludes with a "battle of experts" case involving five neuropsychologists with opposing opinions recently heard in a Federal Appellate court. Implications for neuropschology training and forensic competencies are considered. In offering quality services to the legal profession, neuropsychologists support the truth-seeking function of the judiciary, promote justice, protect the profession, and serve public policy.

Obesity Stigma and Negative Perceptions of Political Leadership Competence

This study investigated whether the leadership competence of an overweight candidate is affected by exposure to weight-stigmatizing and nonstigmatizing messages. Participants read one of four messages—a weight stigma, a health stigma, a competence, or a stigma-reducing message. Fat phobia, weight controllability, partisanship, political activism, and voting behaviors were also measured. Weight controllability bias interacted with the weight stigma message to produce lower evaluations of political leadership competence. Weight controllability also correlated with higher levels of fat phobia regardless of message exposure. The evidence suggests making stigmatizing comments in print/online against a candidate based on a physical characteristic like large size negatively biases public perceptions of political leadership competence. This study of negative competence evaluation directed toward a real politician confirms the findings of earlier experimental studies with fictitious fat politicians.

Competencia clínica del personal de enfermería especialista en salud pública para tratar enfermedades prevenibles por vacunación en segundo nivel, en Jalisco, México

IntroductionIn Mexico, health care of vaccine-preventable diseases is responsibility of nursing professionals. Don’t be known researches which reported competence evaluations of these professionals for care these diseases. ObjectiveTo evaluate clinical competence of public health nurses’ workers of second level hospitals from metropolitan zone of Guadalajara, Jalisco, Mexico, for management of vaccine-preventable diseases. Guadalajara is a second city in importance from Mexico. Material and methodsCross-sectional study. We studied a universe of 12 second level hospitals of social security where work 142 public health nurses. We design and validated an instrument that evaluate clinical competence in 5 dimensions: risk factors identification, clinical data identification, diagnosis tests interpretation, diagnosis integration, diagnosis, and control and therapeutic resources utilization; which classified competence level in 5 levels: randomly defined, low, medium, high and very high; with 80% reliability accord to Kuder-Richardson test. ResultsOne hundred and forty-two public health nurses, mean age 39.7±5.8 years, 85.7% females (n=122) and 14.3% males (n=52). Competence level randomly defined 3.5% (n=5), low 36.7% (n=52), medium 57.0% (n=81), high 2.8% (n=4), very high 0% (n=0). ConclusionIn the studied context, the clinical competence of public health nurses is inadequate. Intervention studies are required.

Anger and sadness as adaptive emotion expression strategies in response to negative competence and warmth evaluations

Previous literature suggested that anger and sadness may be necessary to restore social bonds in the face of immediate relationship threat. The present research compared the social effectiveness of expressing anger and sadness in response to a negative personal evaluation. Results indicated that target anger in response to a negative competence evaluation, and target sadness in response to a negative warmth evaluation, had the most positive effects on the evaluators' subjectively perceived persuasiveness of the targets' communication (Study 1) and on the subjectively perceived fluency of the interaction by both interaction partners (Study 2). Results are discussed in light of the social functionality of emotion expression and the importance of interpersonal emotion congruency with evaluation content.

The Assessment Method for the Strategic Potential of Personnel with the Example of JTI Kazakhstan

Purpose - The purpose of this article is to review the key features and benefits with different methods which is suitable for a particular organization (in this article JTI Kazakhstan) as well as for assessing the capacity of a staff and identification. Research design, data and methodology - Current approaches were used to assess a staff capacity and classify groups. By comparing each other and marked different application methods, this article developed the method for the employment of personal potential and control management process. Results - Through this analysis, assessing labor capacity functioned as an evaluation and assessment for employee competence. Examples suggested practical recommendations for assessing employees' labor potential. Conclusions - It is important not just to bring together several techniques but adapt the conditions with existing organization with the professionalism and experience of specialists in managing the evaluation process. In terms of the implementation of this task, it is necessary to have knowledge in the field of psychology as well as business processes, objectives, and specificities of companies including the relevant personal qualities.

The Buffalo Model: Shifting the Focus of Clinical Licensure Exams in Dentistry to Address Ethical Concerns Regarding Patient Care

Most jurisdictions grant dental licensure to graduating students following successful completion of a clinical exam. Testing agencies, which are independent of dental schools, nevertheless conduct their exams at school facilities. Patient participation in these exams raises ethical concerns regarding such issues as unlicensed providers' performing irreversible procedures with minimal supervision and graduates' limited accessibility to provide follow-up treatment. To address these concerns, a collaborative effort between University at Buffalo School of Dental Medicine faculty and testing agency personnel was launched. The aims of this article are to describe the development and implementation of the resulting Buffalo Model, to highlight ethical advantages in its application, and to identify areas of improvement to be addressed in future iterations. With the Buffalo Model, modifications were made to the traditional exam format in order to integrate the exam into the school curriculum, enabling candidates to take it at various points during their fourth year. In addition, after calibration of school faculty members, 98.5% of cases verified by faculty were accepted by the Commission on Dental Competency Assessments for use in the exam. In two cases, restorative treatment completed during the exam did not meet the school's competency standard. This new approach ameliorates ethical concerns associated with clinical licensure exams because treatment is provided only to patients of record within a sequenced treatment plan and timely and appropriate treatment is provided to all patients. The results of this first year of implementation also suggest that calibrated faculty members will not show bias in the selection of lesions or competency evaluations of candidates.

Emotion and Value in the Evaluation of Medical Decision-Making Capacity: A Narrative Review of Arguments.

Ever since the traditional criteria for medical decision-making capacity (understanding, appreciation, reasoning, evidencing a choice) were formulated, they have been criticized for not taking sufficient account of emotions or values that seem, according to the critics and in line with clinical experiences, essential to decision-making capacity. The aim of this paper is to provide a nuanced and structured overview of the arguments provided in the literature emphasizing the importance of these factors and arguing for their inclusion in competence evaluations. Moreover, a broader reflection on the findings of the literature is provided. Specific difficulties of formulating and measuring emotional and valuational factors are discussed inviting reflection on the possibility of handling relevant factors in a more flexible, case-specific, and context-specific way rather than adhering to a rigid set of operationalized criteria.

A Study of the Use of the TOEFL iBT® Test Speaking and Listening Scores for International Teaching Assistant Screening

AbstractAlthough the speaking section of the TOEFL iBT® test is used by many universities to determine if international teaching assistants (ITAs) have the oral proficiency necessary to be classroom instructors, relatively few studies have investigated the validity of using TOEFL iBT scores for ITA screening. The primary purpose of this study was to determine the effectiveness of using TOEFL iBT Speaking and Listening scores for ITAs in the context of an urban research university. This was accomplished by correlating the TOEFL iBT test scores with the scores obtained by prospective ITAs on local screening tests and student evaluations of ITAs' language and teaching competence and by using the TOEFL iBT test scores as predictors of ITA teaching performance as measured by student evaluations. Given that listening comprehension is an important aspect of instructional language competence, both TOEFL iBT Speaking and TOEFL iBT Listening scores were used as predictors. The development of ITAs' oral proficiency over a semester in an English‐speaking environment was also examined by comparing their TOEFL iBT Speaking and Listening scores at the beginning and at the end of their first semester as ITAs. The results indicate that TOEFL iBT Speaking and Listening scores correlate moderately with the local screening exam, but more importantly, the results indicate that TOEFL iBT Listening might be a better predictor of teaching competence. Although TOEFL iBT Speaking scores did not correlate with or predict the various measures of teaching competence, TOEFL iBT Listening scores did. In addition, the study found that ITAs living and teaching in an English‐speaking environment did make measurable gains in oral proficiency over the course of a 3‐month period. Although these gains were relatively small, and the listening score gains were not statistically significant, this is the first study that has actually tried to measure the improvement in ITAs' oral proficiency while living and studying (and sometimes teaching) on campus. The importance of this study goes beyond the local context. This is the first study to examine the relationship between TOEFL iBT Speaking and Listening scores and instructional performance of ITAs, thus serving as a validation study of the use of the TOEFL iBT test for ITA placement purposes. The study also offers insights into ITAs' development of oral proficiency once they are in an English‐speaking environment, which can serve as a basis for future ITA curriculum development.

Combating Grade Inflation in Nephrology Clinical Rotation Evaluations Using Faculty Education and a 5-Point Centered Rating Scale.

Background From 2010 to 2011, more than 70% of the clinical rotation competency evaluations for nephrology fellows in our program were rated "superior" using a 9-point Likert scale, suggesting some degree of "grade inflation." Objective We sought to assess the efficacy of a 5-point centered rotation evaluation in reducing grade inflation. Methods This retrospective cohort study of the impact of faculty education and a 5-point rotation evaluation on grade inflation was measured by superior item rating frequency and proportion of evaluations without superior ratings. The 5-point evaluation centered performance at the level expected for stage of training. Faculty education began in 2011-2012. The 5-point centered evaluation was introduced in 2012-2013 and used exclusively thereafter. A total of 68 evaluations, using the 9-point Likert scale, and 63 evaluations, using the 5-point centered scale, were performed after first-year fellow clinical rotations. Nine to 12 faculty members participated yearly. Results Faculty education alone was associated with fewer superior ratings from 2010-2011 to 2011-2012 (70.5% versus 48.3%, P = .001), declining further with 5-point centered scale introduction (2012-2013; 48.3% versus 35.6%; P = .012). Superior ratings declined with 5-point centered versus 9-point Likert scales (37.3% versus 59.3%, P = .001), specifically for medical knowledge, patient care, practice-based learning and improvement, and professionalism. On logistic regression, evaluations without superior scores were more likely for 5-point centered versus 9-point Likert scales (adjusted odds ratio [aOR] = 8.26; 95% CI 1.53-44.64; P = .014) and associated with faculty identifier (aOR= 1.18; 95% CI 1.03-1.35; P = .013), but not fellow identifier or training year quarter. Grade inflation was reduced with faculty education and the 5-point centered evaluation scale.

P031: Assessing differences between high- and low-performing resuscitation team leaders using gaze-tracking technology

Introduction: Crisis decision-making is an important responsibility of the resuscitation team leader but a difficult process to study. The purpose of this study was to evaluate visual and behavioural differences between team leaders with different objective performance scores using gaze-tracking technology. Methods: Twenty-eight emergency medicine residents in different stages of training completed four simulated resuscitation scenarios. Participants wore gaze-tracking glasses during each station. An outside expert blinded to participant training level assessed performances using a validated assessment tool for simulation scenarios. Several visual endpoints were measured, including time, frequency, order, and latency to observation of task-relevant and task-redundant items. Non-visual endpoints included behaviours such as summarizing, verbalizing concerns, and calling for definitive treatments, among others. Results: Preliminary findings suggest significant differences between high and low performers. High performers check vitals signs faster, and look at patients and vital signs more often than low performers. Low-performing leaders display a more fixed gaze when starting a scenario. Lastly, high performers summarize, verbalize concerns, predict and prepare for future steps, and call for definitive treatment more often than low performers. Conclusion: There are significant differences between high and low-performing resuscitation team leaders in terms of their visual and behavioural patterns. These differences identify potential focus points for competency evaluations, and may direct educational interventions that could facilitate more efficient development of expertise. The potential to study crisis decision-making behaviours and performances using the methods and metrics identified, both in simulated and real-world settings, is substantial.

Cultural Respect Encompassing Simulation Training: Being Heard About Health Through Broadband.

BackgroundCultural Respect Encompassing Simulation Training (CREST) is a learning program that uses simulation to provide health professional students and practitioners with strategies to communicate sensitively with culturally and linguistically diverse (CALD) patients. It consists of training modules with a cultural competency evaluation framework and CALD simulated patients to interact with trainees in immersive simulation scenarios. The aim of this study was to test the feasibility of expanding the delivery of CREST to rural Australia using live video streaming; and to investigate the fidelity of cultural sensitivity – defined within the process of cultural competency which includes awareness, knowledge, skills, encounters and desire – of the streamed simulations.Design and MethodsIn this mixed-methods evaluative study, health professional trainees were recruited at three rural academic campuses and one rural hospital to pilot CREST sessions via live video streaming and simulation from the city campus in 2014. Cultural competency, teaching and learning evaluations were conducted.ResultsForty-five participants rated 26 reliable items before and after each session and reported statistically significant improvement in 4 of 5 cultural competency domains, particularly in cultural skills (P<0.05). Qualitative data indicated an overall acknowledgement amongst participants of the importance of communication training and the quality of the simulation training provided remotely by CREST.ConclusionsCultural sensitivity education using live video-streaming and simulation can contribute to health professionals’ learning and is effective in improving cultural competency. CREST has the potential to be embedded within health professional curricula across Australian universities to address issues of health inequalities arising from a lack of cultural sensitivity training.Significance for public healthThere are significant health inequalities for migrant populations. They commonly have poorer access to health services and poorer health outcomes than the Australian-born population. The factors are multiple, complex and include language and cultural barriers. To address these disparities, culturally competent patient-centred care is increasingly recognised to be critical to improving care quality, patient satisfaction, patient compliance and patient outcomes. Yet there is a lack of quality in the teaching and learning of cultural competence in healthcare education curricula, particularly in rural settings where qualified trainers and resources can be limited. The Cultural Respect Encompassing Simulation Training (CREST) program offers opportunities to health professional students and practitioners to learn and develop communication skills with professionally trained culturally and linguistically diverse simulated patients who contribute their experiences and health perspectives. It has already been shown to contribute to health professionals' learning and is effective in improving cultural competency in urban settings. This study demonstrates that CREST when delivered via live video-streaming and simulation can achieve similar results in rural settings.