Fellow Participants Research Articles

Participation in medical college activities: a case study of the Australasian experience.

Medical Colleges rely on the volunteer labour of their Fellows to undertake their key functions. In the Australasian context, there is anecdotal evidence to suggest that Fellow participation is declining. The purpose of this paper is to examine the main factors that influence Fellows' participation in the activities of a Medical College. The authors conducted three focus groups with Fellows who exhibit varying levels of participation with the Medical College in 2012. The research identified individual and organisational factors which influence the propensity of Fellows to volunteer their time to the Medical College. At an individual level, Fellows cite a number of factors which motivate them to volunteer their time to the Medical College, including: altruistic reasons; giving back to the profession and community; and the benefits that Fellow's receive from their participation in College activities, including enhancing their status within the profession. However, Fellows also report issues of work-family integration, balancing Medical College and work-related responsibilities as factors precluding them from participating in Medical College activities. Fellows also noted several factors related to the operation of the Medical College which inhibited their participation in the Medical College, including the perceived exclusivity of the Medical College, a lack of service orientation towards Fellows, a lack of recognition of the work of Fellows and a perceived lack of advocacy on the part of the Medical College. This paper highlights that the participation of Fellows in their Medical Colleges is essential to maintaining quality standards and the effective operation of Australasian healthcare. These preliminary results indicate that there are several factors which discourage Fellow participation in Medical College activities, suggesting a need for Medical Colleges to develop strategies to address these issues.

A5004 - A Challenge Between Trainee Education and Patient Safety: Does Fellow Participation Impact Postoperative Outcomes Following Bariatric Surgery?

A5004 - A Challenge Between Trainee Education and Patient Safety: Does Fellow Participation Impact Postoperative Outcomes Following Bariatric Surgery?

Building trust through public service co-production

Purpose – Co-production of public service delivery is believed to foster trust among users, but little empirical work is devoted to this assumption. Public sector organizations have therefore little knowledge about the conditions that determine whether co-production leads to trust. The paper aims to discuss these issues. Design/methodology/approach – A longitudinal mixed method is used, following participants of a co-produced activation programme over time (n=60). Quantitative methods are employed to investigate changes in trust levels, whereas qualitative methods are used to explain these changes and explore conditions for trust-building. Findings – After a half year, trust in the service provider, trust in local government and generalized trust decreased significantly among co-producing participants. Particularly, a decrease in trust in fellow participants strongly related to decreases in trust in the service provider and generalized trust. Qualitative evidence indicate that motivation during the co-production decreased, as well as personal control. Organizational support and user commitment show to be important conditions for building trust. Research limitations/implications – The study draws upon a small sample, limiting possibilities for statistical analysis. Also, comparison with other types of service delivery is required to safely assign the effects to co-production. Originality/value – Longitudinal studies on co-production are rarely performed. Additionally, the findings indicate a more critical approach to the effects of co-production, which are often assumed to be positive for the public sector and citizens.

Effects of mediated social touch on affective experiences and trust.

This study investigated whether communication via mediated hand pressure during a remotely shared experience (watching an amusing video) can (1) enhance recovery from sadness, (2) enhance the affective quality of the experience, and (3) increase trust towards the communication partner. Thereto participants first watched a sad movie clip to elicit sadness, followed by a funny one to stimulate recovery from sadness. While watching the funny clip they signaled a hypothetical fellow participant every time they felt amused. In the experimental condition the participants responded by pressing a hand-held two-way mediated touch device (a Frebble), which also provided haptic feedback via simulated hand squeezes. In the control condition they responded by pressing a button and they received abstract visual feedback. Objective (heart rate, galvanic skin conductance, number and duration of joystick or Frebble presses) and subjective (questionnaires) data were collected to assess the emotional reactions of the participants. The subjective measurements confirmed that the sad movie successfully induced sadness while the funny movie indeed evoked more positive feelings. Although their ranking agreed with the subjective measurements, the physiological measurements confirmed this conclusion only for the funny movie. The results show that recovery from movie induced sadness, the affective experience of the amusing movie, and trust towards the communication partner did not differ between both experimental conditions. Hence, feedback via mediated hand touching did not enhance either of these factors compared to visual feedback. Further analysis of the data showed that participants scoring low on Extraversion (i.e., persons that are more introvert) or low on Touch Receptivity (i.e., persons who do not like to be touched by others) felt better understood by their communication partner when receiving mediated touch feedback instead of visual feedback, while the opposite was found for participants scoring high on these factors. The implications of these results for further research are discussed, and some suggestions for follow-up experiments are presented.

Prevalence of Advanced Colorectal Adenomas in Patients Undergoing Screening Colonoscopy in a Safety-net Hospital

Introduction: Advanced colorectal adenomas are important precancerous lesions and include adenomas>9mm in size, tubulovillous histology, and high grade dysplasia. The aim of this study is to measure the prevalence of adenomas and advanced adenomas in patients undergoing screening colonoscopy, and to compare the prevalence in African Americans and other racial groups. Methods: We performed a retrospective analysis of all asymptomatic patients who underwent screening colonoscopy between July 1st 2009 and June 30th 2014. Patients with history of polyps, positive FOBT, diagnostic, or incomplete/inadequate colonoscopies were excluded. Data about patients' age, race, gender, quality of colon preparation, fellow participation (none, first, second, and third year), adenoma detection, size, location and histology were analyzed. Logistic regression was used to calculate the crude and adjusted odds ratios for the association of colonic findings with African Americans compared to other racial groups. Results: A total of 7171 screening colonoscopies were performed during the study period. 6448 patients (90%) had an adequate and complete examination, 632 patients (8.8%) had an inadequate/poor colon preparation, and 48 patients (0.7%) had failed cecal intubation. Among patients with adequate and complete examination, 2326 (36%) were men and 4122 (64%) women. Mean age was 58 years. The majority of patients were African Americans (n=5691, 88.4%), followed by white (n=334, 5.2%), Hispanic (n=213, 3.3%) and Asian (n=105, 1.6%). The overall prevalence of adenomas was 32.3%, and that of advanced adenomas was 8.3%. Overall, African Americans had similar rates of advanced adenomas compared to other racial groups (adjusted OR 1.15, 95% CI 0.9-1.5). There was a higher rate of high grade dysplasia/ cancer in African Americans compared with other racial groups (1.4% Vs. 0.5%, adjusted OR 2.9, 95% CI 1.1-8). Rates of nonadvanced adenomas, adenomas>9mm, and adenomas with tubulovillous histology were similar among both groups (table 1). The distribution of adenomas in the proximal and distal colon was similar in both groups. Conclusion: The overall prevalence of advanced adenomas was similar between African Americans and other racial groups. However, the prevalence of adenomas with dysplasia/cancer was significantly higher in African Americans. This supports the need for special efforts to improve colorectal cancer screening participation rates in African Americans.Table 1: Prevalence of advanced adenomas among African Americans and other racial groups

Does Fellow Participation Impact the Radiation Exposure Time (RET) During Endoscopic Retrograde Cholangiopancreaticography (ERCP)?

Does Fellow Participation Impact the Radiation Exposure Time (RET) During Endoscopic Retrograde Cholangiopancreaticography (ERCP)?

Changing a ‘culture’ of corruption: Evidence from an economic experiment in Italy

Empirical evidence demonstrates that bribery, extortion and graft are often the outgrowths of a deeper ‘culture of corruption’ which has proved disconcertingly resilient in the face of public sector reforms. This article investigates whether changing collective beliefs about how ‘most people in society’ will behave can reform prevailing cultural practices. Employing an economic experiment involving northern and southern Italian university students, this study shows that (costly) honest behavior can be sustained by conditional beliefs about the honesty of others. I also hypothesize that, given southern Italians’ reputation for corruption, informing participants that they are interacting with southerners should increase the level of bribery in the experiment. However, surprisingly, I find the opposite effect: when exposed to information about the identity of their fellow participants, southern Italians are not only less corrupt, but they are also more likely to believe that their counterparts are less corrupt. I discuss several explanations which may account for these unexpected findings. Overall, the paper provides theoretical foundations and experimental support for how new cultural practices might emerge.

Resident and Fellow Participation in Breast Surgery: An American College of Surgeons NSQIP Clinical Outcomes Analysis

In our present health and medical education system, participation of residents and fellows is under increasing scrutiny regarding their role in surgery and the outcomes of the procedure. Our goal was to perform a clinical outcomes analysis investigating resident and fellow participation in breast surgery. Early postoperative complication rates and total operation times for partial and simple mastectomy cases were gathered from the ACS-NSQIP database. The cases were divided based on the training level of the participating resident surgeon: junior (post-graduate year [PGY] 1 to 2), senior (PGY 3 to 5), fellow (PGY > 5), as well as an attending only group (no resident present). We compared the clinical outcomes of each group with the attending only group. Statistical analysis included odds ratios and regression analysis that analyzed the correlation between years in training vs complication rate, and years in training vs total operation time. A total of 13,254 cases were identified, and residents participated in 64% of them. There was no statistically significant difference in rate of complications between any of the trainee groups when compared with the attending only group. However, total operative times were correlated with training year levels and found to be significantly lower with each year of training (R(2)= 0.53, p= 0.025 for partial mastectomy; R(2)= 0.45, p= 0.046 for complete mastectomy). Resident/fellow participation does not negatively affect early postoperative breast surgery outcomes, and complication rates are unrelated to the training level of the participating resident/fellow surgeon.

Using the Jigsaw Technique to Teach Clinical Controversy in a Clinical Skills Course

To evaluate the effectiveness and student perception of the jigsaw technique to engage students in a clinical controversy exercise and to assess student engagement level during each step of the process. Students were assigned individual readings pertaining to the controversy surrounding the drug oxybutynin switching from prescription to nonprescription. They met with an expert group and teaching groups during mandatory laboratory time and worked together to formulate a recommendation on the appropriateness of nonprescription conversion for a drug. A quiz taken individually was used to measure effectiveness. Student perception and level of engagement was assessed using surveys. The jigsaw technique was successful in teaching the concepts involved in the clinical controversy. Group members rated themselves and fellow participants' level of engagement as high during both the expert group and teaching group sessions. Most students reported they learned about the same or more with the jigsaw technique compared to another cooperative learning technique used in the curriculum.

What makes a cMOOC community endure? Multiple participant perspectives from diverse cMOOCs

Imagine the challenge of being immersed in a dynamic learning network where you play brinkmanship with being overwhelmed by a plethora of information, comments, and conversations on a topic of intense interest to you. Through adept facilitation, the comments and encouragement of fellow participants, and your own perseverance, you develop a network of personal connections which serve as metaphorical flying buttresses creating enough stability that you are able to learn in a new, yet profoundly meaningful way – the connectivist massive open online course (cMOOC) way. Through the lens of autoethnography, five seasoned educators collaboratively reflect on their motivation for participating in their initial cMOOC. They analyze their lived experience, what they found most engaging, and most importantly, they grapple with why cMOOC communities often endure past official end-dates. This article attempts to provide insight into the thrill and depth of learning and connection possible through participation in cMOOCs.

The effects of a participatory approach on the adoption of agricultural technology: Focusing on the social network structure in rural Ethiopia

This study empirically examined the effects of the participatory approach on the adoption of new crop varieties and agricultural practices. Particularly, we focused on the social network structure and examined how the introduced technologies diffused through networks in rural Ethiopia. Our empirical results indicate that if farmers knew and trusted fellow participants, the probability of adopting a new maize variety increased by 25 percentage points. However, this network had no statistical impact on the diffusion of new agricultural practices. We conclude that the participatory approach has great potential in the adoption of new crop varieties through the social networks of farmers in Ethiopia.

Abstract W P364: Advanced Stroke Life Support: Making a Difference in Stroke Care

Background and Purpose: A Comprehensive Stroke Center provides many opportunities for interactions with smaller facilities. Needs identified by our community facility partners was a standardized and effective neurological assessment of the stroke patient that could be performed by all staff and staff stroke education. Investigation into the Advanced Stroke Life Support (ASLS) course provided information that would serve as a blueprint to resolve both education needs. Method: Six staff members were certified as ASLS Instructors. ASLS course has been provided using didactic and hands on participation for scoring of patients with the Miami Emergency Neurologic Deficit (MEND) exam and stroke education. Participants were given a pre-test at the beginning of the educational experience, followed by a post test at the conclusion of class. Lectures included overview of five major stroke syndromes, basic MEND exam knowledge and scoring requirements, followed by review of treatment options and care provided once hospitalized. The learning opportunity was enhanced by interactive hands on session by each participant through performing the MEND exam on fellow participants and scoring of the MEND exam on scenario based test patients. Use of the interactive practice session with immediate feedback from instructors was key elements of student satisfaction and perceived learning during the educational experience. Results: Initial class evaluations and changes in pre and post test scores indicate an increase in participant stroke knowledge. 47 of 50 failed the pre-test with scores ranging from 35 to 85. Upon posttest all participants passed with scores ranging from 80 to 100. There was an increase in proficiency using the MEND exam from the initial practice session to use during the test patient scenarios. Additional survey results will be obtained using post class value analysis survey at least three months after class completion to demonstrate participants’ ability to apply knowledge to practice setting. Conclusion: Completion of ASLS course provides an increase of stroke knowledge that promotes application of information learned to care of stroke patients in practice settings.

Camera activism in contemporary People's Republic of China: provocative documentation, first person confrontation, and collective force in Ai Weiwei's Lao Ma Ti Hua

Ai Weiwei's film Lao Ma Ti Hua (aka Disturbing the Peace, 2009) is one of the most influential activist documentaries that emerged during the aftermath of Sichuan earthquake in 2009. The film relates to Ai's ‘Public Citizen Investigation Project’, which gathers many volunteers to explore the substandard ‘tofu construction’ of school buildings that took thousands of children's lives when they collapsed in the earthquake. In August 2009, Ai's group went to Chengdu court to support another independent investigator, writer, and environmentalist Tan Zuoren who was prosecuted for subversion of state power. The night before the trial, Ai was beaten by secret security agents and the group was stopped from going to the court. The film subsequently records the group searching for an official explanation from the authorities. Whilst acknowledging the power of the film in constructing a collective political subjectivity, and the discursive effect through screenings and discussions raised, this paper focuses on the very action of proactive, activist documentation of one's witness to engage with fellow participants as well as viewer followers through digital camera. Under the theoretical framework of participatory culture, I propose the term camera activism to understand the camera-enabled individual participation into activism as a form of socio-political intervention. The paper also analyses some of Ai's problematic actions as a charismatic celebrity, which sometimes overshadow and obscure the complexity of resistance by Chinese individuals within China, thereby neglecting full recognition of the complex collective forces which support Ai. Nevertheless, ‘camera activism’ demonstrated in the making of Lao Ma Ti Hua reflects, and has the potential to reshape, the political landscape in twenty-first century China. The cinematic highlight of ‘I’, confronting and eye-witnessing what happens through the utilization of digital technologies positions ‘camera activism’ as an important part of China's iGeneration cinema culture.

Identity Construction and Sustained Participation in an Open Source Software Project

The viability of open productions depends critically on their ability to attract and retain voluntary contributors. This study shifts attention from the principal focus of existing research, on ex-ante motivations – intrinsic and extrinsic – for this voluntary participation, to examine the nature of contributions over time and the consequences for sustaining participation. We suggest that participant retention is critically impacted by the social dynamics of open productions through the progressive socialization and legitimation of participants in the course of their work. Individuals construct their identity profiles as specialists or generalists by narrowly focusing or widely dispersing their efforts across knowledge domains. Drawing from the literature on the sociology of categories, we argue that the expertise of specialist contributors is more easily evaluated by fellow participants, aiding integration and fostering sustained participation. However, we propose a moderating mechanism inherent in the c...

Work inclusion: self-perceived change in work ability among persons in occupational rehabilitation

Purpose : The aim of the study was to explore self-perceived change in work ability among persons attending occupational rehabilitation programs. Method : We interviewed 17 persons 6 months after they had attended an inpatient occupational rehabilitation program in Norway. At the time of the interview, five participants worked full time, six worked reduced hours, and six were not working. Data were analyzed by use of the systematic text condensation method. Results : Self-perceived change in work ability during and after the rehabilitation program was influenced by the development of the participants’ self-understanding and coping strategies, interaction with the workplace, support from actors outside the workplace, and social insurance regulations. The participants increased their self-understanding and coping strategies after being challenged on self-understanding and learning through counseling from rehabilitation professionals, through interaction with fellow participants, or through experiences from physical activities. After the program, the participants’ interaction with their surroundings influenced their self-perceived work ability in different ways, depending on whether they were working or not. Those who were working experienced their interaction with the workplace, and support from other actors, as a positive contribution to their work ability. Those not working described problems in their interaction with the workplace, such as lack of workplace support or conflicts, and lack of support from actors outside the workplace, that had a negative influence on their work ability. Conclusions : Self-understanding and coping strategies, interaction with the workplace, support from actors outside the workplace, and social insurance regulations were intertwined categories, influencing each other and consequently the participants’ self-perceived work ability during and after occupational rehabilitation. Keywords: Occupational rehabilitation; return to work; work ability; self-understanding; coping; social interaction; qualitative research (Published: 27 March 2015) Citation: Vulnerable Groups & Inclusion. http://dx.doi.org/10.3402/vgi.v6.26624

This nonviolent stuff'll get you killed: how guns made the civil rights movement possible

Visiting Martin Luther King Jr. at the peak of the Montgomery, Alabama bus boycott, journalist William Worthy almost sat on a loaded pistol. Just for self defense, King assured him. It was not the only weapon King kept for such a purpose; one of his advisors remembered the reverend's Montgomery, Alabama home as an arsenal. Like King, many ostensibly civil rights activists embraced their constitutional right to selfprotection--yet this crucial dimension of the Afro-American freedom struggle has been long ignored by history. In This Nonviolent Stuff'll Get You Killed, civil rights scholar Charles E. Cobb Jr. describes the vital role that armed self-defense played in the survival and liberation of black communities in America during the Southern Freedom Movement of the 1960s. In the Deep South, blacks often safeguarded themselves and their loved ones from white supremacist violence by bearing--and, when necessary, using--firearms. In much the same way, Cobb shows, nonviolent civil rights workers received critical support from black gun owners in the regions where they worked. Whether patrolling their neighborhoods, garrisoning their homes, or firing back at attackers, these courageous men and women and the weapons they carried were crucial to the movement's success. Giving voice to the World War II veterans, rural activists, volunteer security guards, and self-defense groups who took up arms to defend their lives and liberties, This Nonviolent Stuff'll Get You Killed lays bare the paradoxical relationship between the nonviolent civil rights struggle and the Second Amendment. Drawing on his firsthand experiences in the civil rights movement and interviews with fellow participants, Cobb provides a controversial examination of the crucial place of firearms in the fight for American freedom.

Humanism and professionalism education for pediatric hematology-oncology fellows: A model for pediatric subspecialty training.

Humanism and professionalism are virtues intrinsic to the practice of medicine, for which we lack a standard, evidence-based approach for teaching and evaluation. Pediatric hematology-oncology (PHO) fellowship training brings new and significant stressors, making it an attractive setting for innovation in humanism and professionalism training. We electronically surveyed a national sample of PHO fellows to identify fellows' educational needs in humanism and professionalism. Next, we developed a case-based, faculty-facilitated discussion curriculum to teach this content within pilot fellowship programs. We assessed whether fellowships would decide to offer the curriculum, feasibility of administering the curriculum, and satisfaction of fellow and faculty participants. Surveys were completed by 187 fellows (35%). A minority (29%) reported that their training program offers a formal curriculum in humanism and/or professionalism. A majority desires more formal teaching on balancing clinical practice and research (85%), coping with death/dying (85%), bereavement (78%), balancing work and personal life (75%), navigating challenging relationships with patients (74%), and depression/burn out (71%). These six topics were condensed into four case-based modules, which proved feasible to deliver at all pilot sites. Ten fellowship programs agreed to administer the novel curriculum. The majority (90%) of responding fellows and faculty reported the sessions touched on issues important for training, stimulated reflective communication, and were valuable. Pediatric hematology-oncology fellows identify numerous gaps in their training related to humanism and professionalism. This curriculum offers an opportunity to systematically address these educational needs and can serve as a model for wider implementation. Pediatr Blood Cancer 2015;62:335-340. © 2014 Wiley Periodicals, Inc.

Factors Associated With Number of Duodenal Samples Obtained in Suspected Celiac Disease in a Community Setting

Introduction: To investigate the contributing factors to the number of biopsies obtained at the time of endoscopy when celiac disease (CD) could be considered as a diagnosis. Methods: In a retrospective study, data was collected from two community hospitals from January 1, 2008 to February 11, 2013. Patients were selected with gastrointestinal manifestations of CD defined by the American College of Gastroenterology (ACG). Three cohorts of subjects were studied: non-celiac disease (NCD), CD or cannot exclude celiac disease (CECD) patients, that were pathologically defined by the modified Marsh 3a criteria. With each cohort the relationship was evaluated for the numbers of samples obtained with respect to endoscopic features, pre-endoscopic ICD-9 diagnoses, patient status (inpatient versus outpatient), the participation of a gastroenterology fellow, endoscopist experience as well as patient demographics. Findings were analyzed in SPSS-15 using univariate and multivariate analysis. Results: 5,997 patients met inclusion criteria. Forty-two patients in the CD cohort and 62 were in CECD group. 67.8% of subjects were females, 92.2% of subjects were over the age of 20 and 58.9% were found to be Caucasian. 77.7% of the endoscopies performed in the outpatient setting. The yield of CD diagnosis increased up to 3 specimens from 0.29% to 1.84%, with maximum diagnostic yield at 6 specimens at 13.63%. The yield for CECD diagnosis increased from 2.35% to 3.13% up to 4 specimens and then tapered to 2.27% at 6 samples. In the subgroup analysis, in the NCD group, endoscopic features, patient demographics, pre-endoscopic ICD-9 diagnosis, endoscopy setting and fellow participation statistically impacted the number of biopsies that were obtained (p values less than 0.001). In the CD group, only the endoscopic feature variable statistically impacted the number of biopsies obtained with p value of 0.041. In the CECD cohort, only the pre-endoscopic diagnosis variable statistically impacted the number of biopsies obtained with p value of 0.001. Further, a greater rate of CD diagnosis was observed for gastroenterologists who had the least amount of experience, while the rate of CECD diagnosis was higher for gastroenterologists with 26 or more years of experience. Conclusion: The goal is to minimize CECD cohort by following ACG endoscopic protocol with diagnostic yield of CD increasing with 6 or more biopsy specimens, while more will be diagnosed with CECD diagnosis when up to 4 biopsies are obtained. Decreasing CECD can be achieved by identifying variables that affect compliance. The variables identified within this study show a concrete relationship between the number of samples obtained and the final diagnosis.

Evaluation of the Physical Activity and Public Health Course for Researchers.

From 1995-2013, an 8-day Physical Activity and Public Health Course for Researchers has been offered yearly in the United States. In 2013, an evaluation quantified time that fellows spent in different course offerings, surveyed fellows on course impact, documented grant funding, and identified fellow participation on leading physical activity-related journals. The number of fellows that attended the course ranged from 20 per year to 35 per year. Fellows who participated in the web survey (n = 322) agreed that the course: met their expectations (99%), had a positive impact on the physical activity research or practice work they did (98%), and helped increase their professional networking in the field (93%). Following the course, 73% of fellows had further contact with course faculty and 71% had further contact with other fellows. From the National Institutes of Health, 117 grants were awarded to 82 fellows (21% of eligible fellows). Out of 14 journals reviewed, 11 had at least 1 fellow on their staff as editor, associate editor, or editorial board member. The Physical Activity and Public Health Course for Researchers helps address a training need by providing instruction and building capacity in the US and abroad for conducting research on physical activity and public health.

Milgram's Unpublished Obedience Variation and its Historical Relevance

In May 1962, Milgram ran the last experimental condition of his obedience experiments in which participants brought a friend to the laboratory. This article reports on previously unpublished findings from this “Bring‐a‐Friend” condition. First, if a participant questions the experimental procedure before administering a punishment more than 10 times to his fellow participant or to his friend, he will succeed in opposing the experimenter's demands to complete the experiment. Early resistance predicts participants’ successful defiance. Second, when the friend is in the role of learner, participants who resist either early or late consequently lessen the number of times they administer the demanded punishment. Having to punish a friend shortens the period of cooperation between reluctant participants and experimenter. These findings are then related to the case of Carl Lutz saving Jews from deportation to their death during WWII.