Diagnostic Competence Research Articles

Implementation strategy in collaboration with people with lived experience of mental illness to reduce stigma among primary care providers in Nepal (RESHAPE): protocol for a type 3 hybrid implementation effectiveness cluster randomized controlled trial

BackgroundThere are increasing efforts for the integration of mental health services into primary care settings in low- and middle-income countries. However, commonly used approaches to train primary care providers (PCPs) may not achieve the expected outcomes for improved service delivery, as evidenced by low detection rates of mental illnesses after training. One contributor to this shortcoming is the stigma among PCPs. Implementation strategies for training PCPs that reduce stigma have the potential to improve the quality of services.DesignIn Nepal, a type 3 hybrid implementation-effectiveness cluster randomized controlled trial will evaluate the implementation-as-usual training for PCPs compared to an alternative implementation strategy to train PCPs, entitled Reducing Stigma among Healthcare Providers (RESHAPE). In implementation-as-usual, PCPs are trained on the World Health Organization Mental Health Gap Action Program Intervention Guide (mhGAP-IG) with trainings conducted by mental health specialists. In RESHAPE, mhGAP-IG training includes the added component of facilitation by people with lived experience of mental illness (PWLE) and their caregivers using PhotoVoice, as well as aspirational figures. The duration of PCP training is the same in both arms. Co-primary outcomes of the study are stigma among PCPs, as measured with the Social Distance Scale at 6 months post-training, and reach, a domain from the RE-AIM implementation science framework. Reach is operationalized as the accuracy of detection of mental illness in primary care facilities and will be determined by psychiatrists at 3 months after PCPs diagnose the patients. Stigma will be evaluated as a mediator of reach. Cost-effectiveness and other RE-AIM outcomes will be assessed. Twenty-four municipalities, the unit of clustering, will be randomized to either mhGAP-IG implementation-as-usual or RESHAPE arms, with approximately 76 health facilities and 216 PCPs divided equally between arms. An estimated 1100 patients will be enrolled for the evaluation of accurate diagnosis of depression, generalized anxiety disorder, psychosis, or alcohol use disorder. Masking will include PCPs, patients, and psychiatrists.DiscussionThis study will advance the knowledge of stigma reduction for training PCPs in partnership with PWLE. This collaborative approach to training has the potential to improve diagnostic competencies. If successful, this implementation strategy could be scaled up throughout low-resource settings to reduce the global treatment gap for mental illness.Trial registrationClinicalTrials.gov, NCT04282915. Date of registration: February 25, 2020.

On building cytomorphology skills: Influence of slide reviewing habits on diagnostic competency in cytology.

ObjectivesThe specific aims of the study are to assess whether the amount of time a cytology learner spends reviewing slides correlates with increased diagnostic competency and to determine whether time spent reviewing slides immediately after the multi‐head sessions correlates with a higher level of proficiency. The paper also seeks to explore the impacts of the time of day at which slides were reviewed on diagnostic learning outcome.MethodsData obtained through the cytology laboratory screening logs were reviewed, and the number of hours per day and the times of the day at which the students were present at the glass slide library were tabulated and compared against each of the seven‐unit slide exam scores in the semester to explore possible relationships.ResultsThere was a positive linear relationship (r = 0.29) between the number of hours students spent in the laboratory reviewing cases and competency. When the students' unit diagnostic test scores were classified into low and high categories for each test, there was a significant correlation (P = 0.008) between a lack of time spent screening slides in the lab and the number of times a student was ranked at the bottom of the class. Our data do not support a recency effect nor a difference in test scores between those who reviewed cases in the morning vs in the afternoon.ConclusionsWhile educating and training a strong cytology workforce may be challenging, our study provides new insights and sheds light on the importance of spending time reviewing slides, and provides guidance for struggling students on how best to improve. Inside this month’s Cytopathology: The aims of this study are to assess whether the amount of time a cytology learner spent reviewing slides correlates with increased diagnostic competency, and to determine whether time spent reviewing slides immediately after the multi‐head sessions correlates with a higher level of proficiency. The paper also seeks to explore the impacts of the time of day at which slides were reviewed on diagnostic learning outcome.

Scaffolding pre-service biology teachers’ diagnostic competences in a video-based Learning environment: measuring the effect of different types of scaffolds

ABSTRACT Diagnosing is an important aspect of teachers’ professional competence. To successfully diagnose classroom situations, one has to apply pedagogical content knowledge (PCK) in diagnostic activities (DA). Simulated classroom situations with embedded scaffolding can be an effective way of practising skills needed to foster diagnostic competences. In an intervention study with pre-post-test design using the video-based learning environment DiKoBi, we investigated the effects of scaffolds on the diagnostic competences of 57 pre-service biology-teachers in an early stage of university education. For the intervention, we developed two types of scaffolds: one providing additional PCK (PCK-scaffold) and one focusing on the diagnostic activities (DA-scaffold). Pre-service teachers were divided into four groups depending on the type of scaffold they received during the intervention (PCK-, PCK + DA-, DA- and control group). Pre-service teachers receiving PCK-scaffolds showed statistically significantly higher diagnostic competences in the post-test than in the pre-test. This includes the PCK- as well as the PCK + DA-group. For the other two groups, no significant improvement can be reported. Thus, we assume that the diagnostic competences of pre-service biology teachers can effectively be fostered by including PCK-scaffolds in DiKoBi and hence a minimum of PCK is necessary for successfully diagnosing in simulated classroom situations.

Elaboration of Practical Diagnostic Competence in Context of Students’ Conceptions on Plant Nutrition

Dealing with students’ conceptions is one of the central elements of student-oriented teaching. In order to be able to organise learning processes efficiently, it is necessary to look at the learners in a differentiated way and to approach their conceptions individually. The first necessary step is the individual diagnosis of each student’s conceptions. This article presents a qualitative study (N=8) that focused on the development of drawing assignments for the diagnosis of conceptions on the topic of plant nutrition. Based on the Cognitive Metaphor Theory (CMT), features were identified that are beneficial for the diagnosis of the conceptions. To achieve this goal, it was crucial to reliably diagnose existing conceptions with valid assignments, which can also be carried out in schools. Research about task design and the proceeding diagnosis of conceptions in the light of the Conceptual Metaphor Theory have received little attention so far. This article therefore deals predominantly with the question about the design of assignments in the context of conceptual change. Based on this, guidelines were derived for the design of assignments for practical use in science education. This study represents the basis for developing a Moodle-based digital learning environment for working with students' conceptions on the topic of plant nutrition in schools.

DIAGNOSTIC COMPETENCE OF FUTURE OFFICERS - SPECIALISTS IN SPEAKING AND SPORT OF THE ARMED FORCES OF UKRAINE: CONCEPTS, CONTENTS AND CONTENTS

The article substantiates the concept of "diagnostic competence of future specialists in physical training and sports of the Armed Forces of Ukraine" and its content. The scientific approaches of foreign and domestic scientists to its definition are analyzed. In the field of physical training and sports), cognitive (theoretical knowledge of their diagnostic activities and practical knowledge of physical training and readiness of different categories of servicemen), methodical (practical mastery of methods, techniques, methods and tools of pedagogical diagnosis of physical training and readiness of different categories of servicemen) , individual and mental (professionally important diagnostic qualities: humanity, objectivity, principle, tolerance, tact, context, communication activity) and subjective (awareness and perception of oneself as a subject of diagnostic activities, as well as responsibility, autonomy, independence and professional subjectivity) components.Keywords: specialist in physical training and sports, diagnostic competence, officer, structure, components.

Diagnostic competence of future doctors of philosophy: understanding, structure and understanding

Diagnostic competence of future doctors of philosophy: understanding, structure and understanding

Implementation of Pedagogical Research into Statistical Courses to Develop Students’ Statistical Literacy

To participate fully in society, a person needs to critically evaluate statistical information. To be able to do this, it is appropriate to start developing the statistical literacy of young people in diverse levels in schools. In our article, we present a modified seminar on statistics for prospective humanities teachers. During the seminar, we planned a pedagogical experiment, the aim of which was to statistically verify the students’ own diagnostic competencies as prospective teachers of humanities. The statistical analysis confirmed that the implementation of real research into the course on statistics has a positive impact on the development of statistical literacy but does not change the attitude of students toward statistics and its use in the future teaching practice.

The effects of a specialized staff training on trauma-sensitivity in professionals working with patients with a psychotic disorder: A pilot study

ABSTRACT Background Studies show that the trauma-sensitivity of professionals working with patients with psychosis is insufficient. As a result, trauma-related problems remain undetected and untreated, which may impede recovery in this group. This study explored the effects of a specialised staff training on six trauma-sensitivity factors (i.e. knowledge, credibility, expected burden, harm expectancy, diagnostic competency and organizational support), self-reported trauma-sensitive behaviour and objective indicators of trauma-sensitive behaviour in medical files. Method Professionals (N = 56) rated the six trauma-sensitivity factors and their own trauma-sensitive behaviour at pre-training, post-training and at 6- and 12-months follow-up. Changes in indicators of trauma-sensitive behaviours were assessed by a review of medical files (N = 97). Results The specialized training increased knowledge, crediblity and experienced diagnostic compentence. The training decreased burden and harm expectancies, and enhanced self-reported trauma-sensitive behaviour. However, this positive change could not be objectified by indicators of trauma-sensitive behaviour in medical files. Discussion These findings support the notion that specialised training has a positive effect on increasing trauma-sensitivity and decreasing burden and harm expectancies, but not necessarily on observable trauma-sensitive behaviour. In addition to training staff, structural implementation and organisational support are argued to be essential to attain actual behaviour change.

Evaluation of Pathology Residency Training Curriculum and Practice in the Hubei Province of China.

The pathology residency program began in China in 2014. There has been no competency assessment on training programs in the Hubei province of China. To evaluate the current residency training curriculum and resident performance in Hubei Province. A 37-question online questionnaire was designed to cover general demographic information, diagnostic competency, expectations of ideal caseload for gross and preview, teaching patterns, examinations, research activities, weak points, and other topics in pathology practice. A total of 166 participants, including 62 postgraduate year (PGY) 2, 49 PGY3, and 55 new practicing pathologists, responded to the survey. PGY3 residents were found to be more competent than PGY2 in diagnostic competency. Forty-five of 55 new practicing pathologists (81.8%) reported that they could sign out cases independently, whereas 10 of 55 (18.2%) were found to still need transitional time for learning before working independently. Some residents could sign out cytopathology cases and gained knowledge in immunohistochemistry and histochemical staining, while some residents did not receive adequate training in molecular pathology. The ideal caseloads for gross and preview during residency were greater than 5000 and 7000, respectively. Nonneoplastic diseases, neuropathology, dermatopathology, hematopathology, and soft tissue pathology were considered difficult subspecialties in pathology practice. While residents trained in Hubei Province have met the basic requirements for qualified pathologists, more efforts need to be made in many areas, such as well-structured training curriculum and better-designed proficiency examinations. The findings of this study are of great importance to prioritizing training in the future.

Diabetic foot ulcer, antimicrobial remedies and emerging strategies for the treatment

According to the International Diabetes Federation's 2015 study, diabetes affects over 415 million people globally (5 million of whom die each year), and the incidence of diabetes is expected to climb to over 640 million (1 in 10) by 2040. (IDF 2015). Diabetes foot ulcers (DFU) are one of the most significant diabetic health consequences. Antimicrobial treatments, such as dressings, topical therapies, medicines, drugs, debridement procedures, molecular, cellular, and gene therapies, plant extracts, antimicrobial peptides, growth factors, devices, ozone, and energy-based therapies, would be the focus of this study. Scopus, Web of Science, Bentham Science, Science Direct, and Google Scholar were among the sources used to compile the English-language publications on DFU. DFU treatment requires a multidisciplinary approach that includes the use of proper diagnostic tools, competence, and experience. To prevent amputations, this starts with patient education and the use of new categories to steer treatment. New diagnostic methods, such as the 16S ribosomal DNA sequence in bacteria, should become available to acquire a better knowledge of the microbiota in DFUs.

Diagnostic cases in pre-service teacher education: effects of text characteristics and empathy on text-based cognitive models

In teacher education, case-based learning with text-based cases is an efficient method to foster pre-service teachers’ diagnostic competence. To adaptively utilize text-based cases, knowledge about effects of text characteristics and empathy on processing text-based diagnostic information is needed, but still scarce. Our study focuses on effects of two text characteristics, text style and text subject, and of empathy on the accuracy of case-based cognitive models. We examined this experimentally. 391 pre-service teachers read a case in psycho-narrative or externally focalised style (text style) about test anxiety or dyscalculia (text subject). We measured self-reported state- and trait-empathy and assessed cognitive models with a recognition and verification test. Regression analyses showed no main effects of text characteristics, trait- and state-empathy, but moderation effects of text style and affective (but not cognitive) state-empathy. We draw implications for adaptively designing text-based cases and possible mechanisms of how empathy is involved in diagnostic judgement formation.

The psychologist’s diagnostic competences in issuing psychological and judicial opinions in divorce cases involving children

Divorce cases where divorcing spouses have minor children pose a particular challenge for psychologists and lawyers. The court decides on important matters regarding the child and the family, but formally does not have sufficient knowledge of the psychological functioning of family members, and the decision is based on a psychological and judicial opinion. The psychologist does not make legally binding decisions regarding the family, but acts as an expert with so-called special information in selected areas of psychology, which allows preparing a psychological and judicial opinion on the functioning of the family to support the court’s decision-making process. Particular diagnostic competence of a psychologist: knowledge, skills and ethical attitude increase the likelihood of accurate and reliable psychological diagnosis and contribute to making the psychological and judicial opinion more useful to the court. The article presents selected legal and psychological issues related to the role of a psychologist and the process of diagnosing in providing psychological and judicial opinion on divorce matters where the partners are parents of minor children. It presents the psychologist’s diagnostic competences: (a) knowledge, including the knowledge of research areas important in making psychological diagnoses and specific issues (including the concept of resilience, parentification, parental alienation, the child’s adaptation, conflict between partners, the child’s best interest clause as a principle of family law, evidence-based diagnosis), basic legal principles on divorce, the status of an expert psychologist and psychological and judicial opinion, as well as other provisions which are not source of law in the form of guidelines and standards; (b) skills relating to effective planning and execution of multi-person diagnosis, the construction of the psychological and judicial opinion, the selection of diagnostic tools, the presentation of hypotheses, transparent and comprehensive data analysis and the formulation of conclusions; (c) an ethical attitude taking into account the special status of the psychologist and diagnostic relationship in divorce matters, taking into account ethical dilemmas and separateness of diagnosis conducted out of court.

Cognitive and Motivational Person Characteristics as Predictors of Diagnostic Performance: Combined Effects on Pre-Service Teachers\u2019 Diagnostic Task Selection and Accuracy

The acquisition of diagnostic competences is an essential goal of teacher education. Thus, evidence on how learning environments facilitate pre-service teachers’ acquisition of corresponding competences is important. In teacher education, approximations of practice (such as simulations) are discussed as being learning environments that can support learners in activating acquired knowledge in authentic situations. Simulated diagnostic interviews are recommended to foster teachers’ diagnostic competences.The conceptualization of diagnostic competences highlights the importance of cognitive and motivational characteristics. Motivational learning theories predict that the activation of acquired knowledge in learning situations may be influenced by motivational characteristics such as individual interest. Although teachers’ diagnostic competences constitute an increasing research focus, how cognitive and motivational characteristics interact when shaping the diagnostic process and accuracy in authentic learning situations remains an open question.To address this question, we report on data from 126 simulated diagnostic one-on-one interviews conducted by 63 pre-service secondary school mathematics teachers (students simulated by research assistants), studying the combined effects of interest and professional knowledge on the diagnostic process and accuracy. In addition to the main effect of content knowledge, interaction effects indicate that participants’ interest plays the role of a “door-opener” for the activation of knowledge during simulation-based learning. Thus, the results highlight the importance of both, cognitive and motivational characteristics. This implies that simulation-based learning environments should be designed to arouse participants’ interest to support their learning or to support less interested learners in activating relevant knowledge.

Interpretation of Students\u2019 Errors as Part of the Diagnostic Competence of Pre-Service Primary School Teachers

Understanding students’ thinking and learning processes is one of the greatest challenges teachers face in the classroom. Misconceptions and errors have the potential to be a rich source of information for identifying students’ thinking and reasoning processes. However, empirical studies show that pre-service teachers (PSTs) and teachers find it challenging to focus their interpretations and pedagogical decisions on students’ thinking processes when they identify students’ mathematical errors.Based on the theoretical approach of noticing, the study described in this paper examines primary PSTs’ diagnostic competence in error situations before and after they participated in a seminar sequence implemented at several Chilean universities. Our analyses focus on PSTs’ competence with regard to formulating hypotheses about the causes of students’ errors. The proposed hypotheses were categorized into those that attributed errors to students’ lack of conceptual understanding, those that explained errors in terms of lack of procedural understanding, and those that assumed a failure of instructional strategies. In addition, the relationships between PSTs’ diagnostic competence, their beliefs and university learning opportunities were examined. The results indicate that PSTs’ diagnostic competence in error situations and the changes of this competence were related to PSTs’ beliefs, practical experiences, and learning opportunities. Overall, the findings suggest that it is possible to promote changes on PSTs’ diagnostic competence during initial teacher education. The paper concludes with implications for teacher education and future research.

Diagnostic competence and its formation in future specialists in pedagogical theory

Diagnostic competence and its formation in future specialists in pedagogical theory

Investigating secondary pre-service teachers as teachers and learners of mathematical modeling

Abstract There is a growing attention around the preparation of pre-service teachers (PSTs) as both learners and teachers of mathematical modeling. Current literature focuses on preparing PSTs as learners of modeling, and we extend current work by examining how PSTs integrate their understanding of modeling into the work of teaching. This study follows two groups of PSTs, concurrently enrolled in a modeling course and a secondary methods of teaching course, as they completed a joint unit of instruction in which they designed, refined and enacted a modeling lesson in a secondary classroom. We explore how PSTs build understanding across learning opportunities with respect to four modeling competencies: theoretical, task related, teaching and diagnostic. Our findings indicate that PSTs were able to grow across all four competencies. Theoretical competencies developed from time spent working with modeling tasks as learners and working collaboratively with instructors and peers. Task related and teaching competencies took time to develop as PSTs often wrestled with their conceptions of modeling as learners with existing conceptions of teaching and task design. Diagnostic competencies developed from structured time to reflect on lesson enactment and changes that could be made to best support student learning. Overall, we found that PSTs benefit from engaging in modeling tasks as learners and in enacting components of teaching modeling lessons.

FORMATION OF DIAGNOSTIC COMPETENCE OF A BIOLOGU TEACHER

In the article a place and role of diagnostic competence of teacher of biology are reasonable at modern general school. Due to diagnostics of pedagogical process a teacher finds out not only the changes of the state of substantial descriptions of student, signs of personality, and also individualities of participants of pedagogical co-operation, forecast changes, or rejections of the state of her participants. It is proved that diagnostic competence is the teacher’s ability to determine the level of student development, analyze the facts and establish patterns, reasons that contribute to such changes, the ability to make a prognostic plan for further pedagogical interaction to develop participants in the pedagogical process. Diagnostic control and interaction ensure the effectiveness of the learning process. The teacher has to analyze carefully the information he receives from the student. The feedback helps to determine how effectively the learning process is progressing, what personal qualities are developing in this case, and how well the skills are improving. Methods of educational diagnostics of student activity are as follows: analysis and assessment of knowledge; type and nature of educational products in accordance with the target settings of the teacher (scope and degree of creativity, level of independence, originality, comparison of differences with previous works). Activation of attention of the pedagogical community to diagnostic competence of the teacher nowadays is not casual. Today introduction of fundamentally new pedagogical technologies, principles of construction of the educational process, respectively, and diagnostic competence is becoming the norm for every teacher.
 Keywords: diagnosis; assessment; control; testing; competency approach; competencies; feedback; biology; genetics.

TRAINING OF SOCIAL WORK SPECIALISTS FOR THE PROFESSIONAL ACTIVITY ON SOCIAL SERVICES PROVISION

The problem of training of social work specialists for the professional activity on social services provision has been actualized in the article. The purpose of training social workers in Ukraine is to form a highly educated, highly humane, comprehensively developed personality, who have a high culture and generally meets the qualification characteristic of the profession. The purpose of the article is to characterize the content of professional activity of social work specialists in social services provision. Research methods applied: analysis of scientific literature, normative-legal documents in order to clarify the essence of key concepts of the research; synthesis, comparison and generalization – for determination of the areas of work of a social work specialist in the local community; system-generalizing method – for formulation of competencies and conclusions based on research results; prognostic – for determination of the prospects of improving the system of training social work specialists to provide the social services in the community. The professional activity of a social worker is based on international ethical standards, taking into account the uniqueness of each client, their capabilities and rights, awareness of responsibility for their behavior in a particular situation, the purpose of such activity should be restoring the ability of clients (citizens of the community) to overcome difficult life circumstances on their own. The training of future social work specialists in the higher educational institution is to be aimed at forming their readiness to realization of the functions of professional activity. This readiness is manifested in the formation of relevant competencies, which we will identify and analyze through the prism of the functions of the professional activity of social work specialist in the process of providing social services. It is determined that diagnostic, prognostic, transformative, designing, communicative, organizational, human rights, preventive, psychotherapeutic, promotional, social and pedagogical and social competencies should be formed for performing the functions of professional activity of social work specialists in providing social services. The list of presented functions with the relevant competencies of a social work specialist can be supplemented depending on the purpose, tasks, forms, methods of social work in the process of providing social services in the local community.

A clinical reasoning curriculum for medical students: an interim analysis

Diagnostic error is a critical patient safety issue that can be addressed in part through teaching clinical reasoning. Medical schools with clinical reasoning curricula tend to emphasize general reasoning concepts (e.g., differential diagnosis generation). Few published curricula go beyond teaching the steps in the diagnostic process to address how students should structure their knowledge to optimize diagnostic performance in future clinical encounters or to discuss elements outside of individual cognition that are essential to diagnosis. In 2016, the University of California, San Francisco School of Medicine launched a clinical reasoning curriculum that simultaneously emphasizes reasoning concepts and intentional knowledge construction; the roles of patients, families, interprofessional colleagues; and communication in diagnosis. The curriculum features a longitudinal thread beginning in first year, with an immersive three week diagnostic reasoning (DR) course in the second year. Students evaluated the DR course. Additionally, we conducted an audit of the multiyear clinical reasoning curriculum using the Society to Improve Diagnosis in Medicine-Macy Foundation interprofessional diagnostic education competencies. Students rated DR highly (range 4.13-4.18/5 between 2018 and 2020) and reported high self-efficacy with applying clinical reasoning concepts and communicating reasoning to supervisors. A course audit demonstrated a disproportionate emphasis on individual (cognitive) competencies with inadequate attention to systems and team factors in diagnosis. Our clinical reasoning curriculum led to high student self-efficacy. However, we stressed cognitive aspects of reasoning with limited instruction on teams and systems. Diagnosis education should expand beyond the cognitive- and physician-centric focus of most published reasoning courses.

A call to action: next steps to advance diagnosis education in the health professions

Improving diagnosis-related education in the health professions has great potential to improve the quality and safety of diagnosis in practice. Twelve key diagnostic competencies have been delineated through a previous initiative. The objective of this project was to identify the next steps necessary for these to be incorporated broadly in education and training across the health professions. We focused on medicine, nursing, and pharmacy as examples. A literature review was conducted to survey the state of diagnosis education in these fields, and a consensus group was convened to specify next steps, using formal approaches to rank suggestions. The literature review confirmed initial but insufficient progress towards addressing diagnosis-related education. By consensus, we identified the next steps necessary to advance diagnosis education, and five required elements relevant to every profession: 1) Developing a shared, common language for diagnosis, 2) developing the necessary content, 3) developing assessment tools, 4) promoting faculty development, and 5) spreading awareness of the need to improve education in regard to diagnosis. The primary stakeholders, representing education, certification, accreditation, and licensure, in each profession must now take action in their own areas to encourage, promote, and enable improved diagnosis, and move these recommendations forward.