Independent Instructor Research Articles

Kalıpyargı Tehditinin Kardiopulmoner Resüsitasyon Performansı Üzerine Etkisi: Bir Randomize Kontrollü Manken Çalışması

Objective: Stereotype threat (ST) can lead to decreased performance when individuals face the possibility of confirming negative stereotypes associated with their group. During the Coronavirus disease 2019 (COVID-19) pandemic, non-Intensive Care Unit physicians (non-ICUp) were assigned to work in ICUs. However, social media emphasized the inadequacy of knowledge and skills among these physicians. Given the negative judgments, the study aimed to evaluate the cardiopulmonary resuscitation (CPR) performances of these physicians and investigate the effect of ST. Methods: A total of 63 non-ICUp and 53 Intensive Care Unit physicians (ICUp) physicians working in COVID-19 ICUs were randomly assigned to control and experimental groups. In the experimental group, ST was manipulated by presenting the study’s aim as measuring the difference in CPR performances between ICUp and non-ICUp physicians. The control group received no information. Participants were videotaped while performing a standard CPR scenario and evaluated by independent instructors and mannequin scores. Results: Overall CPR scores were higher among ICUp. Non-ICUp performed better in the ST condition regarding effective chest compression (p=.02) and correct compression rates per minute (p=.02) compared to the control condition. However, ICUp had lower scores for correctly placing chest compressions in the ST condition (p=.03). Conclusion: The higher CPR performance among ICUp was expected. However, the hypothesis suggesting lower performance for non-ICUp under ST conditions was not supported. Inconsistent results regarding the ST effect could be influenced by moderating factors such as task difficulty, knowledge about the existing stereotype, and motivation to perform well. The interaction between the physicians’ specialty and situational factors highlights the importance of creating realistic training environments that simulate high-pressure situations, ultimately contributing to the development of competent and confident healthcare professionals. Future research should further explore the impact of ST-based training on interactions and performance among different healthcare professionals. Keywords: Stereotype threat, intensive care unit, cardiopulmonary resuscitation, CovId-19

Comparing the Outcomes of Virtual Reality-Based Serious Gaming and Lecture-Based Training for Advanced Life Support Training: Randomized Controlled Trial.

Simulation-based Advanced Cardiac Life Support (ACLS) or Advanced Life Support (ALS) training for health care professionals is important worldwide for saving lives. Virtual reality (VR)-based serious gaming can be an alternative modality to be used as a part of simulation-based ALS training. The aim of this study is to investigate whether a VR-based ALS serious game module can replace classroom-based ALS lectures, the latter being part of existing conventional ALS training protocols in addition to skills training. Participants were students from Acibadem Mehmet Ali Aydinlar University's Vocational School for Anesthesiology (N=29) randomly divided into 2 groups with 15 (conventional training group) and 14 (VR-based training group) participants each. Participants in the conventional training group had to complete the pretest consisting of multiple-choice questions at the beginning of the study. Afterward, they took part in an interactive classroom-based ALS lecture. The next step involved skills training with task trainers to teach them compression skills. Following this, the conventional training group was divided into Code Blue teams, each consisting of 5 participants for the simulation session. Two independent instructors evaluated video recordings in terms of technical and nontechnical skills. The score acquired from the manikin-based simulation session was considered the main performance indicator in this study to measure the learning outcome. A similar workflow was used for the VR-based training group, but this group was trained with the VR-based ALS serious game module instead of the theoretical lecture. The final stage of the study involved completing the posttest consisting of multiple-choice questions. A preference survey was conducted among the study participants. Mann-Whitney U and Wilcoxon signed-rank tests were used to analyze the 2 groups' performances in this study. The improvement in posttest results compared with pretest results was significant in the conventional training group (P=.002). Hands-on technical scores of the conventional training group were higher than those of the VR-based training group during manikin-based simulation, but total scores, including those for technical and crisis resource management skills, acquired from the manikin-based simulation session did not reveal any significant difference between the 2 groups. The results of the VR preference survey revealed that the majority of the participants prefer VR-based serious game-based training instead of classroom lectures. Although hands-on technical scores of the conventional training group during the manikin-based simulation session were higher than those of the VR-based training group, both groups' total performance scores, including those for technical and crisis resource management skills, did not differ significantly. The preference survey reveals that the majority of the participants would prefer a VR-based ALS serious gaming module instead of lecture-based training. Further studies are required to reveal the learning outcome of VR-based ALS serious gaming. ClinicalTrials.gov NCT05798910; https://clinicaltrials.gov/study/NCT05798910.

Use of simulation models when developing and testing hospital evacuation plans: a tool for improving emergency preparedness

BackgroundIn recent decades, analyses of hospitals evacuations have generated valuable knowledge. Unfortunately, these evacuation case studies often lack crucial details and policies that would be helpful in evacuation preparedness. The aim of this study was to use a simulation model to illustrate how it can aid emergency planners in the development, testing, and revising of hospitals evacuation plans. This study includes evacuation exercises at two emergency hospitals in Region Stockholm, Sweden.MethodsA scientifically validated simulation system for “table top” exercises was used for interactive training of hospital medical staff, prehospital staff and collaborating agencies. All participants acted in their usual professionals’ roles. The exercises were run in real-time and mirrored actual hospital resources with the aid of moveable magnetic symbols illustrating patients, staff and transport, presented on whiteboards. During the exercises, observers and independent instructors documented actions taken and post-exercise surveys were conducted to obtain reactions and compare results.ResultsThe simulation system allowed the emergency planner to test the whole evacuation process, making it possible to train and evaluate the important functions of management, coordination, and communication. Post-exercise surveys explored participants perception of the exercises. Analysis of open-ended questions included areas for improvement and resulted in five main categories: (1) management and liaison; (2) communication; (3) logistics; (4) medical care and patient prioritisation; and (5) resource utilisation.ConclusionsThis study has shown that “table top” exercises using a validated simulation system can serve to guide emergency planners when developing evacuation plans, procedures, and protocols as well in training of all medical staff. The system also served to train adaptive thinking, leadership, communication, and clarification of critical functions.

Video based learning vs instructor led training for optimizing personal protective equipment use to prevent Covid-19 infection - a comparative study.

To evaluate two different types of education and training aids to improve compliance with guidelines related to personal protective equipment in healthcare workers. The quasi-experimental study was conducted at the Department of Gynaecology and Obstetrics, Combined Military Hospital, Rawalpindi, from July 1 to December 31, 2020, and comprised healthcare personnel who were divided into two equal groups. Group A received weekly instructor-led training session of donning and doffing for two hours. Group B was assigned to watch 30-min training videos weekly. After one month, an independent instructor evaluated both the groups using validated checklists, with maximum score 8 for donning and 14 for doffing. Data was analysed using SPSS 22. Of the 60 subjects, 34(56.6%) were females and 26(43.3%) were males. There were 30(50%) subjects in group A with a mean age of 35.35±5.67years, and the remaining 30(50%) were n group B with a mean age of 33.12±4.13 years. There was no significant difference in donning and doffing scores between the groups (p>0.05). Both types of education and training aids could be used to improve compliance with guidelines related to personal protective equipment in healthcare workers.

Virtual Deliberate Practice Module for Tracheostomy Change Training: An Application of Educational Design Research.

BackgroundThe pandemic poses challenges for in-person procedural skills training. We developed a virtual module for teaching hands-on tracheostomy skills.ObjectiveTo develop and evaluate a virtual module prototype grounded in deliberate practice using tracheostomy change as an example.MethodsAfter identifying desirable features of a virtual module by surveying stakeholders, we designed a prototype using VoiceThread, a multimedia-based collaborative learning platform. We created an asynchronous module accessible to learners for repeated skill practice and for video upload of individual performance on a tracheostomy task trainer using personal devices. This virtual module provided a four-step coaching (demonstration, deconstruction, formulation, and performance) to practice tracheostomy change. Two instructors reviewed the learners’ performance videos, providing timely feedback for further refinement of skills.ResultsSixty-four residents completed the module, System Usability Scale, and self-efficacy survey. All residents rated the module, with a mean System Usability Scale score of 68.6 ± 18.4 (maximum score of 100). Two independent instructors rated performance videos using a 12-item checklist with mean interobserver agreement of 88.1% (standard deviation, 9.7) and mean performance checklist score (n = 40) of 10.1 (standard deviation, 1.2) out of 12. After training, residents reported high confidence in their ability to list and perform procedural steps, with improvement in median (interquartile range) comfort levels from 1 (1–2) to 4 (3–4) out of 5 (P < 0.0001).ConclusionWe developed an asynchronous deliberate practice module on a virtual platform using tracheostomy change as an example. Residents evaluated the module favorably using system usability and learner self-efficacy surveys with improvement of skills.

POLITICAL EFFECT IN MERDEKA BELAJAR EDUCATION ERA OF THE COVID-19 PANDEMIC

Political influence in education is like compulsory instruction, while it is difficult to create without astute individuals. Even the brightest individuals have to be framed through school. Education is directly or by implication influenced by government issues. The amalgamation of instructions and governance issues is plural. For a while, teaching can shape people who participate in political life. The reason for the school is to make students mentally minded and have great personalities. The training framework must produce millennial students who can compete in the modern-based 4.0 era. Therefore, the educational framework in Pamekasan continues to improve and change. Changes in schooling began with Nadiem Makarim's discourse, who proposed the development of "Merdeka Belajar". Nadiem's opportunity aims to make independent instructors have an essential meaning for academic units or schools for educators and their students to have the chance to advance, adapt freely, and be creative, especially during this coronavirus pandemic.

Enfarte agudo do miocárdio no YouTube – Is it all fake news?

Introduction and objectivesThe Internet is a fundamental aspect of health information. However, the absence of quality control encourages misinformation. We aim to assess the relevance and quality of acute myocardial infarction videos shared on YouTube (www.youtube.com) in Portuguese. MethodsWe analyzed 1,000 videos corresponding to the first 100 search results on YouTube using the following terms (in Portuguese): “cardiac + arrest”; “heart + attack”; “heart + thrombosis”; “coronary + thrombosis”; “infarction – brain”, “myocardial + infarction” and “acute + myocardial + infarction”. Irrelevant (n=316), duplicated (n=345), without audio (n=24) or non‐Portuguese (n=106) videos were excluded. Included videos were assessed according to source, topic, target audience and scientific inaccuracies. Quality of information was assessed using The Health on the Net Code (HONCode from 0 to 8) and DISCERN (from 0 to 5) scores – the higher the score, the better the quality. Results242 videos were included. The majority were from independent instructors (n=95, 39.0%) and were addressed to the general population (n=202, 83.5%). One third of the videos (n=79) contained inaccuracies while scientific society and governmental/health institution videos had no inaccuracies. The mean video quality was poor or moderate; only one video was good quality without any inaccuracies. Governmental/health institutions were the source with the best quality videos (HONCode 4±1, DISCERN 2±1). ConclusionsOne third of the videos had irrelevant information and one third of the relevant ones contained inaccuracies. The average video quality was poor; therefore it is important to define strategies to improve the quality of online health information.

Comparison of Online to Face‐To‐Face Instruction for Anatomy Review in a Third‐Year Clinical Course

Objective Online/computer-assisted learning has been used extensively in medical education in stand-alone and hybrid formats. Because of time restraints, the online format may be ideal for providing foundational review material in clinical courses, but the effectiveness of the online format for review purposes in this setting has not been adequately investigated. This project compared student learning and satisfaction delivered by two different methods in a special populations course for third-year doctor of chiropractic students. The two methods of delivery were: 1) a face-to-face lecture (F2FL) on pediatric spinal anatomy, and 2) an online learning module (OLM) covering the same material. Methods This study was approved by the institutional IRB. A cohort comparison, mixed methods study design compared student learning and satisfaction of a pediatric spinal anatomy review delivered through a F2FL (n=22) and OLM (n=18) in two successive 2019 (pre-COVID) course offerings. Previously validated pre- and post-tests for the material were given to the students one week prior and one week following the intervention (either F2FL or week-long availability of the OLM). An instructor not affiliated with the course completed a “Similarity of Material Assessment” that evaluated the similarity of content in each method of delivery. Identical tests were given to each group. In addition, a survey assessing the method of delivery, comfort with technology, and preference of F2FL vs. OLM of review material, was completed by both groups immediately following administration of the post-test. Differences between pre-and post-test results were assessed using repeated measures ANOVA with F2FL and OLM as groups and pre-and post-test results as repeated measures. Results The content presented to the F2FL and OLM groups was judged to be the same by the independent instructor. Testing results showed an improvement with both groups from pre- to post-test [F2FL 54.6%, p<0.0001 vs. OLM 48.9%, p<0.0001 (OLM 52.35%, p<0.0001 with one dramatic outlier removed)], with no significant difference between test results between the F2FL and OLM groups [p=0.53 (p=0.82 with outlier removed)]. The survey showed: 83.3% of OLM students felt the online method was effective and 88.9% would prefer the material to be presented online; 80% of the F2F group thought the lecture was engaging/effective and 60% would have preferred to have the material presented online. Conclusions The OLM was found to be as effective as the F2FL for the content assessed, and students were highly satisfied with the online method of instruction of the anatomy review material. This strategy could potentially be applied to provide additional review materials fundamental to other clinical courses. The OLM method allows for the material to be developed and given by content experts while also freeing valuable in-class time to be used for more experiential learning in clinical courses.

Kinerja Instruktur Pendidikan Dan Pelatihan Keterampilan Pada Panti Sosial Bina Remaja Majar Tabela Kota Palangka Raya

This research aims to find out, describe and analyze the performance of educational instructors and skills training at the youth community Development of Majar Tabela City Palangka Raya. While the research method used is qualitative. Researchers want to describe and analyze the performance of educational instructors and skill training at the Majar Tabela Youth Development Community in the six (6) Aspects of quality, quantity, timeliness, cost-effectiveness, need for supervision and Interpersonal impact. Data sources consist of primary data sources, which are interviews with 4 (four) instructors, 2 (two) Students/clients, and the head of Sub administration representing the head of Youth Development (PSBR) Majar Tabela, while the secondary data source is Official document of the Youth Development Community (PSBR) Majar Tabela.&#x0D; The results showed that the instructor's performance was still less than optimal. This can be seen from the quantity aspect is still a lack of instructors there are at least 6 (six) to 8 (eight) people, while the one is now only 4 (four) instructors. Then, from the need for supervision aspect, there are still less independent instructors, especially with regards to the creation of reports and learning evaluations. This is because the instructor is newly recruited so that it is still less experienced in making reports and evaluation activities. Thus causing the timeliness aspect is also impacted by delays in making activity reports. Therefore, the head of Youth Development Social Orphanage (PSBR) Majar Tabela City Palangka Raya is 1) increasing the number of instructors who are experienced in their field, both in the field of automotive and sewing, 2) provide technical guidance to the new instructor So that it can be independent (need for supervision) and timeliness in making final reports as well as evaluation of activities, and 3) reviewing the honor of the instructor to improve the instructor's commitment to improve the performance of instructors.

Research, teaching, and ‘other’: what determines job placement of economics Ph.D.s?

ABSTRACTThis article examines job placement for Economics Ph.D.s seeking junior-level positions using a data set constructed from job candidate vitas, public websites, and queries to programme directors. Based upon multinomial logit estimation, being from highly ranked graduate institutions and having high quality publications has a significantly positive effect on placement at a top 20 academic institution or Doctoral-level institution. Teaching experience – as a teaching assistant (TA) or independent instructor – has a significantly positive effect on placement, but only for institutions ranked below the top 60, Masters and Baccalaureate institutions, and non-tenure track academic positions. We find little evidence on the effect of teaching in tenure track hires for departments with Doctoral programmes or mid-tier prestige. Moreover, teaching experience has a significantly negative effect on placement in the top group of academic institutions in Economics.

Comparison of the Macintosh laryngoscope and blind intubation via the iGEL for Intubation With C-spine immobilization: A Randomized, crossover, manikin trial

IntroductionEndotracheal intubation (ETI) using a Macintosh laryngoscope (MAC) requires the head to be positioned in a modified Jackson position, slightly reclined and elevated. Intubation of trauma patients with an injured neck or spine is therefore difficult, since the neck usually cannot be turned or is already immobilized in order to prevent further injury. The iGEL supraglottic airway seems optimal for such conditions due to its blind insertion without the need of a modified Jackson position. MethodsProspective, randomized, crossover study in 46 paramedics. Participants performing standard intubation and blind intubation via iGEL supraglottic airway device in three airway scenarios: Scenario A – normal airway; Scenario B - manual inline cervical immobilization, performed by an independent instructor; scenario C: cervical immobilization using a standard Patriot cervical extraction collar. ResultsIn Scenario A, nearly all participants performed ETI successfully both with MAC and iGEL (100% vs. 95.7%). The time to intubation (TTI) using the MAC and iGEL amounted to 19 [IQR, 18–21]s vs. 12 [IQR, 11–13]s (P<0.001). Head extension angle as well as tooth compression were significantly better with the iGEL compared to the MAC (P<0.001). In scenario B and C, the results with the iGEL were significantly better than with MAC for all analyzed variables (TTI, success of first intubation attempt, head extension angle, tooth compression and VAS scores). ConclusionWe showed that blind intubation with the iGEL supraglottic airway was superior to ETI performed by paramedics in a simulated cervical immobilization scenario in a manikin in terms of success rate, time to definite tube placement, head extension angle, tooth compression, and rating.

Analysis of Postdoctoral Training Outcomes That Broaden Participation in Science Careers.

Postdoctoral training is an optimal time to expand research skills, develop independence, and shape career trajectories, making this training period important to study in the context of career development. Seeding Postdoctoral Innovators in Research and Education (SPIRE) is a training program that balances research, teaching, and professional development. This study examines the factors that promote the transition of postdocs into academic careers and increase diversity in science, technology, engineering, and mathematics. Data indicate that SPIRE scholars (n = 77) transition into faculty positions at three times the national average with a greater proportion of underrepresented racial minorities (URMs) and females represented among SPIRE scholars. Logistic regression models indicate that significant predictors are the intended career track at the start of the postdoctoral training and the number of publications. Factors necessary for successful transition are teaching experience as independent instructors, professional development opportunities, and the experience of balancing teaching with research. Scholars' continued commitment to increasing diversity in their faculty roles was demonstrated by their attainment of tenure-track positions at minority-serving institutions, continued mentorship of URMs, and engagement with diversity initiatives. These results suggest that a postdoctoral program structured to include research, teaching, and diversity inclusion facilitates attainment of desired academic positions with sustained impacts on broadening participation.

Board #102 - Research Abstract Comparing Standard Vs. Video-Based Teaching For Ultrasound-Guided Internal Jugular Central Venous Catheter Access For 4th Year Medical Students (Submission #8825)

Hypothesis Small group instruction of procedural skills is faculty intensive, and presents challenges when multiple instructors are required to train large numbers of learners. At our institution, incoming residents who want vascular access privileges undergo a protocolized ultrasound guided central line training program. Senior medical students have requested similar training, but faculty resources are not adequate to accommodate the large number of interested students. To meet student needs, we developed a self-directed video-based learning module to teach the skill of ultrasound guided internal jugular access (US-IJ) to our institutional standards. The objective of this study is to evaluate the efficacy of teaching US-IJ using high quality video compared to standard faculty led US-IJ teaching. The video enables learners to self-pace with the ability to rewind, pause, and fast-forward individual video segments. Methods Randomized controlled trial in the simulation center of an academic center, during a four-week senior medical student capstone course in March 2014. Each student completed a peripheral US IV training session and an online module. Subjects were randomly assigned to either faculty-led (standard) or video-guided (intervention) three-hour teaching sessions using vascular access manikins and ultrasound machines. Intervention group used an interactive video detailing procedural steps, following a standard checklist (55 items) established by our institution. The intervention group had the chance to interact with a faculty at the end of their session to address specific questions only. At the conclusion of each session, all students independently completed a video-recorded performance station of US-IJ placement. Two faculty instructors scored videos based on the checklist. Scores were compared using t-test. An independent instructor scored 20% of each group to calculate inter-rater reliability. Results Thirty-two MS-IV were enrolled in the study, 16 in each group. Five students were excluded (four did not attend and one encountered ultrasound recording failure). Fourteen students in the video group and 13 students in the standard group were included. The intervention group performed significantly more checklist items correctly (90%, 95%CI 86.5-93%) than did the standard group (81%, 95% CI 77.6-84.2%). (P = 0.0003) Conclusion US-IJ training using self-directed high quality video guided instruction may be superior to standard, faculty-guided instruction. Use of video eliminates instructional variability, decreases the demand on faculty time, and enables individual learners to work at their own pace. Furthermore, a larger number of learners can be accommodated. This is crucial in places where having continuous, standard, and high-quality instruction is considered a challenging problem. We recommend a larger study of vascular access training using video guidance be conducted. Disclosures The CLASS Center has received support in the form of equipment loans from Karl Storz. Claudia Ranniger owns stock in Intuitive Surgical (manufacturer of DaVinci Robot).

319 Comparing Standard versus Video-Based Teaching for Ultrasound-Guided Internal Jugular Central Venous Catheter Access for Fourth-Year Medical Students

319 Comparing Standard versus Video-Based Teaching for Ultrasound-Guided Internal Jugular Central Venous Catheter Access for Fourth-Year Medical Students

Assessing online resources for an engineering course in numerical methods

AbstractTo determine, improve, and refine the quality of the online resources for an engineering course in numerical methods, three assessment instruments were used to gather feedback from (1) the independent instructors of the numerical methods course, (2) the students who use the majority of the resources, and (3) the general students worldwide who use resources on an as‐per‐need basis. The findings of this study provide strong evidence that the use of the website modules is a valued aide to most students. The availability of information in multiple modes and formats, at any time, for the students provides them with accessible and convenient learning material that enhances traditional methods. In addition, the analyses of the open‐ended items by both faculty reviewers and students provided insights into how a website used in a technical course such as Numerical Methods can be effectively organized and implemented to enhance further student learning. Results from the instructor surveys found highest ratings for the perceptions of the degree of helpfulness the modules provided in supplementing student readings and with class presentations, while the results from student surveys found highest ratings in the technological domain. © 2010 Wiley Periodicals, Inc. Comput Appl Eng Educ 20: 426–433, 2012

Graduate Students as Independent Instructors: Seven Things to Know about Teaching Your Own Course while in Graduate School

AbstractDespite being responsible for a large percentage of undergraduate instruction, graduate students often receive little preparation for their first solo teaching assignments (J. D. Nyquist et al., Change 31 (3): 18, 1999). Furthermore, the existing literature on pedagogy fails to address the unique challenges faced by graduate students who are asked to serve as course instructors rather than teaching assistants. This article presents seven pieces of advice intended to better prepare the predoctoral graduate student to assume the role of the professor before assuming the title. By understanding the attitudes of undergraduate students toward graduate instructors, preparing in advance to handle the mistakes that novice teachers often make, and recognizing the correlation between outward confidence and student perceptions of instructor quality, graduate students can derive the most benefit from a stressful and time-consuming assignment. Most important, graduate instructors can learn to effectively manage the time spent on teaching duties to ensure that other responsibilities such as coursework, qualifying exams, and dissertation research do not suffer.

Improving course evaluations to improve instruction and complex learning in higher education

Recent research has touted the benefits of learner-centered instruction, problem-based learning, and a focus on complex learning. Instructors often struggle to put these goals into practice as well as to measure the effectiveness of these new teaching strategies in terms of mastery of course objectives. Enter the course evaluation, often a standardized tool that yields little practical information for an instructor, but is nonetheless utilized in making high-level career decisions, such as tenure and monetary awards to faculty. The present researchers have developed a new instrument to measure teaching and learning quality (TALQ). In the current study of 464 students in 12 courses, if students agreed that their instructors used First Principles of Instruction and also agreed that they experienced academic learning time (ALT), then students were about 5 times more likely to achieve high levels of mastery of course objectives and 26 times less likely to achieve low levels of mastery, according to independent instructor assessments. TALQ can measure improvements in use of First Principles in teaching and course design. The feedback from this instrument can assist teachers who wish to implement the recommendation made by Kuh et al. (2007) that universities and colleges should focus their assessment efforts on factors that influence student success.

Assessing Student Learning and Perceptions in an Upper-level General Education Requirement Argumentation Course

This project addressed the difficulties of teaching argument skills, a staple of liberal education, to a mixture of Communication majors and non-majors taking the course for General Education Requirement (GER) credit. The design uses independent instructor comparison of students’ preand post-test performances, students’ comparative self-evaluation of their preand post-test performances, as well as students’ reflections on their learning in response to a separate questionnaire and independent instructor assessment of their performance in arguing those reflective claims, to analyze learning processes in an upper-level argumentation course. The results include specific content concepts and course and instructor strategies that both majors and non-majors credit for improvements in their argument skills, suggestions for assessing whether GER courses meet their learning outcome goals, and analysis of the importance of attending to students’ own perceptions of and justifications for changes (or lack thereof) in their performances on tasks tied to liberal learning outcomes.