Ongoing Feedback Research Articles

Development and Modification of a Mobile Health Program to Promote Postpartum Weight Loss in Women at Elevated Risk for Cardiometabolic Disease: Single-Arm Pilot Study.

BackgroundPregnancy complications in combination with postpartum weight retention lead to significant risks of cardiometabolic disease and obesity. The majority of traditional face-to-face interventions have not been effective in postpartum women. Mobile technology enables the active engagement of postpartum women to promote lifestyle changes to prevent chronic diseases.ObjectiveWe sought to employ an interactive, user-centered, and participatory method of development, evaluation, and iteration to design and optimize the mobile health (mHealth) Fit After Baby program.MethodsFor the initial development, a multidisciplinary team integrated evidence-based approaches for health behavior, diet and physical activity, and user-centered design and engagement. We implemented an iterative feedback and design process via 3 month-long beta pilots in which postpartum women with cardiometabolic risk factors participated in the program and provided weekly and ongoing feedback. We also conducted two group interviews using a structured interview guide to gather additional feedback. Qualitative data were recorded, transcribed, and analyzed using established qualitative methods. Modifications based on feedback were integrated into successive versions of the app.ResultsWe conducted three pilot testing rounds with a total of 26 women. Feedback from each pilot cohort informed changes to the functionality and content of the app, and then a subsequent pilot group participated in the program. We optimized the program in response to feedback through three iterations leading to a final version.ConclusionsThis study demonstrates the feasibility of using an interactive, user-centered, participatory method of rapid, iterative design and evaluation to develop and optimize a mHealth intervention program for postpartum women.Trial RegistrationClinicalTrials.gov NCT02384226; https://www.clinicaltrials.gov/ct2/show/NCT02384226

Measuring happiness increases happiness

Happiness has been an overarching goal of mankind at least since Aristotle spoke of Eudaimonia. However measuring happiness has been elusive and until now has almost exclusively been done by asking survey questions about self-perceived happiness. We propose a novel approach, tracking happiness and stress through changes in body signals with a smartwatch, the “Happimeter”. It predicts individual emotions from sensor data collected by an Android Wear smartwatch, such as acceleration, heartbeat, and activity. The Happimeter was used over three months in the innovation lab of a bank with 22 employees to measure individual happiness, activity, and stress. The participants were randomly divided into an experimental and a control group of similar size. Both groups wore the watch and entered their subjective happiness, activity and stress levels several times a day. The user-entered ratings were then used to train a machine learning system using the sensors of the smartwatch to subsequently automatically predict happiness, activity, and stress. The experimental group received ongoing feedback about their mood and which activity, sensor signals, or other people, made them happier or unhappier, while the control group did not get any feedback about their predicted and manually entered emotions. Just like in quantum physics we observed a “Heisenberg Effect”, where the participants made aware of their measurements changed their behavior: Members of the experimental group that received happiness feedback were 16% happier, and 26% more active than the control group at the end of the experiment. No effect was observed for stress.

Formal Training Efforts to Develop Simulation Educators: An Integrative Review.

Formal training for educators who use simulation-based education (SBE) is required by standards of best practice, simulation guidelines, regulatory, and accrediting bodies. Training efforts to establish educator competency for SBE are being offered. However, a systematic review of this body of literature has yet to be conducted. The purpose of this integrative review was to appraise formal training efforts of educators who use SBE. The aims were to summarize the training topics, describe the structure of training programs, and explore evaluation methods of educators. The New World Kirkpatrick Model guided the review. A PRISMA search approach yielded 2007 citations of which 38 met inclusion criteria. Analysis supports a formalized training process that uses a combination of didactic material, time for repetitive practice, and ongoing feedback with longitudinal and scaffolded delivery approaches. An identified gap in the literature is threshold levels for determining competency of educators. Recommendations for planning simulation training programs are provided.

Automated High-Frequency Observations of Physical Activity Using Computer Vision.

To test the validity of the Ecological Video Identification of Physical Activity (EVIP) computer vision algorithms for automated video-based ecological assessment of physical activity in settings such as parks and schoolyards. Twenty-seven hours of video were collected from stationary overhead video cameras across 22 visits in nine sites capturing organized activities. Each person in the setting wore an accelerometer, and each second was classified as moderate-to-vigorous physical activity or sedentary/light activity. Data with 57,987 s were used to train and test computer vision algorithms for estimating the total number of people in the video and number of people active (in moderate-to-vigorous physical activity) each second. In the testing data set (38,658 s), video-based System for Observing Play and Recreation in Communities (SOPARC) observations were conducted every 5 min (130 observations). Concordance correlation coefficients (CCC) and mean absolute errors (MAE) assessed agreement between (1) EVIP and ground truth (people counts+accelerometry) and (2) SOPARC observation and ground truth. Site and scene-level correlates of error were investigated. Agreement between EVIP and ground truth was high for number of people in the scene (CCC = 0.88; MAE = 2.70) and moderate for number of people active (CCC = 0.55; MAE = 2.57). The EVIP error was uncorrelated with camera placement, presence of obstructions or shadows, and setting type. For both number in scene and number active, EVIP outperformed SOPARC observations in estimating ground truth values (CCC were larger by 0.11-0.12 and MAE smaller by 41%-48%). Computer vision algorithms are promising for automated assessment of setting-based physical activity. Such tools would require less manpower than human observation, produce more and potentially more accurate data, and allow for ongoing monitoring and feedback to inform interventions.

Development and Preliminary Validity Evidence for the Direct Behavior Rating-Classroom Management (DBR-CM)

ABSTRACT Effective classroom management is of critical importance to the success of universal, Tier I supports and services. Unfortunately, teacher-reported deficits in classroom management training are well documented. In response, use of professional development activities such as consultation, coaching, and on-going performance feedback emphasizing skill-building have proliferated. The Direct Behavior Rating-Classroom Management (DBR-CM) was developed to facilitate screening and formative data collection to drive these activities. This study presents the background, development, and preliminary psychometric evidence for the DBR-CM. Specifically, this study examined inter-rater reliability and concurrent validity in support of the DBR-CM. Findings are promising with inter-rater reliability approaching or exceeding acceptable agreement levels and significant correlations noted between DBR-CM scores and concurrently completed measures of teacher classroom management behavior and perceived self-efficacy. Implications for use and future research are discussed, including further validation and refinement of the DBR-CM and its use within indirect, consultative service delivery.

A237 SHARED DECISION MAKING: DESIGN OF A PREGNANCY IN IBD DECISION AID (PIDA)

Abstract Background Given a significant proportion of women with inflammatory bowel disease (IBD) are of child-bearing age, the development of a pregnancy IBD decision aid would benefit patients and clinicians. Lack of IBD-specific reproductive knowledge has been associated with increased “voluntary childlessness” and may contribute to inappropriate medication changes during or after pregnancy. Decision aids support decision making in pregnancy in general, as well as in multiple other chronic diseases. However existing literature has not identified such a resource for women with IBD. Aims To develop a decision aid to improve decision making regarding preconception and pregnancy in IBD among women with IBD. Methods We followed the International Patient Decision Aids Standards (IPDAS). A steering committee of Canadian and Australian health care professionals with an interest in IBD management in pregnancy, in addition to patient representatives, was established. Themes chosen for discussion included inheritance, fertility, nutrition, medications, mode of delivery, breastfeeding, infant health. Initial patient and clinician focus groups were conducted and responses recorded with written/audio mediums. We developed an electronic PIDA draft that incorporates individualised information (type of IBD, pre-conception or pregnant, surgical history, medications) in personalized decision making. Further patient focus groups and interviews were conducted to obtain user opinion of the PIDA draft. Results In July 2017, patient and clinician focus groups were conducted at a Canadian site. Three patients (pre-conception) attended the focus group. Patient concerns - impact of disease and surgery on fertility and preterm delivery; impact of drug therapies on the fetus/ infant; impact of active disease on maternal and fetal/infant health. The clinician focus group included 3 IBD specialists, 2 IBD fellows, 2 IBD nurses, an obstetrician and a neonatal intensivist. Clinician concerns - absence of pre-conception counselling and lack of patient understanding about the impact of disease activity and IBD medication use in pregnancy. Additional patient feedback obtained through interviews (n=15) at two Canadian sites since March 2019 regarding the current electronic PIDA was positive, with comments about content, personalization, readability and unbiased presentation. Suggestions were made for inclusion of additional content such as impact of IBD on sexual function, laboratory changes during pregnancy, and timing of medications post-partum. Conclusions The pre and post PIDA design patient and clinician focus groups and interviews affirmed the role for PIDA. Main decisions considered necessary to address included ideal timing of conception pending disease activity, management of medications, and delivery methods. Ongoing user feedback will be obtained at Australian and Canadian sites during planned alpha testing. Funding Agencies WCHRI, Sinai Health System, UBC

The intrinsic value of formative assessment and feedback as learning tools in the acquisition and improvement of a practical legal skill

ABSTRACT Teaching a practical legal skill in a classroom setting can be challenging especially when the students are unlikely to have undertaken this type of practical task previously. The module considered in this research, Practical Legal Drafting, comprises taught sessions that first introduce the ‘rules’ of legal drafting and then allow the development of key skills. The module includes tutor led taught sessions, student in class group and individual activities, ongoing tutor verbal feedback in class, followed by a formative assessment, extensive specific individual written and generic online feedback, and finally face to face feedback on the formative assessment. The formative assessment is not a compulsory element of the module, the data for three academic years was analysed to determine whether those students who undertook the formative assessment were more successful in the summative assessment than those students who did not and whether it could therefore be said that this was evidence that the formative assessment was beneficial as a teaching tool. The student’s engagement with the feedback available on the Virtual Learning Environment was also assessed to determine whether any conclusions could be reached about the impact this may or may not have on student performance.

The benefits of executive coaching: voices from the C-suite

PurposeThe purpose of this paper is to provide readers with research findings based on qualitative data that describe the benefits of executive coaching from a sample of 70 senior business executives, all of whom have a personal executive coach. In addition, the paper provides readers with specific questions concerning their organizations’ approach to executive leadership development and the application of these potential benefits to their enterprise.Design/methodology/approachThe findings of this study are based on personal interviews with 30 executives and ten four-person focus groups in which both sets of participants were asked to describe personal and organizational benefits associated with their experiences in using executive coaches.FindingsInterviews and focus group findings converged around a number of benefits associated with effective executive coaching. These benefits included improved executive focus, better alignment of key leadership behaviors, candid and ongoing feedback, accountability for appropriate leader behaviors, improved emotional intelligence and ego control and personal support and encouragement, among others.Research limitations/implicationsThis qualitative study provides empirical evidence of the benefits of executive coaching from the perspective of senior business leaders. These findings provide researchers with specific criteria that can be tested and measured on a larger scale. The primary limitation of the study is the small sample size of only 70 executives.Practical implicationsThe findings of this research provide a compelling set of benefit trends that individual executives, boards of directors and organizations need to consider in the development of their senior leaders. Specific questions are included to guide practitioner’s thinking concerning executive coaching and its role in their organizations.Social implicationsThese findings make a compelling case that senior leaders can become more effective and can experience great benefits when they properly make use of an effective executive coach. The development of senior leaders using this tool can have a powerful impact on organizational performance and organization’s culture.Originality/valueA review of the literature will reveal that anecdotal evidence abounds, but there is limited empirical research chronicling the true benefits of executive coaching.

Projects of Consequence: Interdisciplinary WIL Projects Designed to Meet the Needs of Partners and Students

The focus of this paper is the design and development of an innovative project-based work-integrated learning (WIL) course that enables undergraduate students from all faculties to work in interdisciplinary teams with partner organisations from the public, private, and community sectors. Projects are co-designed with partners interested in students from multiple disciplines bringing insights to problems that might not otherwise be resourced by their organisation. These ‘projects of consequence’ are unstructured, ambiguous and complex, requiring student teams to synthesise their different disciplinary knowledge. Student learning is supported by course curriculum design that includes proven pedagogical practices such as: ongoing feedback from partners; students working in autonomous small teams; academic supervision of teamwork; learning support before and during project work; debriefing; providing a safe, supportive space to experiment with new ideas, embracing the prospect of failure and to develop resilience; all underpinned by reflection so as to process, understand and integrate students’ experiences. The versatility of the course design was demonstrated by the rapid change from face-to-face delivery to an entirely online learning environment in response to the COVID-19 pandemic. The challenges and adaptations include changes to the way student teams worked, the additional support needed by students, and adjustment in the mode of interactions with partners.

Abstract WP189: Application of a Continuous Quality Improvement Framework: Longitudinal Results From Year 1 of the Stroke Survivor to Survivor Program

In 2018, the Mission Lifeline North Dakota (ND) initiative adopted and began to implement Stroke Survivors Empowering Each Other, Inc.’s (SSEEO’s) Stroke Survivor to Survivor (SS2S) program. The SS2S program is a post-stroke support program that aims to facilitate survivors’ efforts to recover after stroke. Volunteers, who are themselves survivors, call participants monthly at least twice following discharge from the hospital and provide them with stroke-related resources and support. The adaptation and implementation of the Chicago-borne SS2S program in ND was embedded within a continuous quality improvement framework to ensure ongoing performance monitoring data could inform programmatic improvements as needed. Key questions: • How has the Chicago-borne SS2S program been adapted to fit the unique characteristics and environment of ND, while maintaining fidelity? • What are performance monitoring findings from the first three quarters of implementation? Between Oct 2018- Feb 2019, four of the six ND tertiary hospitals implemented the SS2S program. These hospitals provide monthly quantitative and qualitative data on program implementation. From Oct 2018 to May 2019, SS2S volunteers made 153 calls to survivors, with 57% (n = 87 of 153) of calls answered by a prospect, including stroke survivors (n=74) and their caregivers (n=13). Thirteen percent (n = 9 of 69) of stroke survivors calls required additional follow-up by hospital staff. SS2S volunteers mailed additional resources to stroke survivors for 48% percent of the calls where the prospect was reached (n= 33 of 69). Seventy percent (n = 48 of 69) of survivors reached were able to identify at least one sign of stroke. Preliminary results suggest that both volunteers and stroke survivors may benefit from the program. Importantly, performance monitoring data also identified opportunities for programmatic improvements. For example, these data informed edits to the volunteers’ phone scripts to clarify signs-of-stroke patient-education. Ongoing feedback from the hospitals have also informed improvements to the performance monitoring processes.

Micro-feedback skills workshop impacts perceptions and practices of doctoral faculty

BackgroundDoctoral supervision is a distinct form of supervision with clearly defined responsibilities. One of these is the delivery of effective face-to-face feedback to allow supervisees to improve upon their performances. Unfortunately, doctoral supervisors, especially of health sciences, are often not trained in supervisory skills and therefore practice mostly on a trial and error basis. Lack of understanding of the feedback process leads to incongruence in how supervisors and supervisees perceive feedback. However, standardized training practices like microteaching can allow supervisors to acquire effective feedback practices. In this study we employed a schematic approach of microteaching, that is micro-feedback, in a workshop to develop feedback skills of doctoral supervisors, and assessed the overall effectiveness of this training using the Kirkpatrick evaluation framework.MethodologyThis was a Quasi-experimental study with a repeated measures and a two-group separate sample pre-post test design. A micro-feedback skills workshop was organized to enhance feedback skills of doctoral supervisors using microteaching technique. The first two levels of the Kirkpatrick evaluation model were used to determine the workshop’s effectiveness. An informal Objective Structured Teaching Exercise (OSTE) was used to assess feedback skills of the supervisors, both before and after the workshop. A questionnaire was developed to compare pre-and post-workshop perceptions of the supervisors (n = 17) and their corresponding supervisees (n = 34) regarding the ongoing feedback practice.ResultsDespite the hectic schedule, most doctoral supervisors (17 of 24, 71%) were willing to undertake faculty development training. Participants indicated a high level of satisfaction with the workshop. A learning gain of 56% was observed on pre-post OSTE scores. Prior to the workshop, perceptions of how supervisees should be given the feedback differed significantly between supervisors and supervisees with an effect size difference of r = 0.30. After the workshop there was a negligible difference in perceptions between supervisors and supervisees (r = .001). Interestingly, supervisors shifted their perceptions more toward those that were originally held by the supervisees.ConclusionsThese findings suggest that well-designed and properly assessed structured programs such as micro-feedback workshops can improve how doctoral supervisors provide feedback to their supervisees and align supervisors’ perceptions of that feedback with those of their supervisees.

Improving POLST Utilization for Seriously Ill Patients at a Tertiary Care, Academic Oncologic Hospital (TH371B)

•Describe the barriers to implementation of the POLST paradigm.•Describe initial first steps at their own institutions to improve POLST documentation for critically ill oncology patients at a tertiary cancer center. Oncologic patients go through multiple heath care transitions at the end of life. Often, goals of care discussions are initiated but communication of the conversation across settings is challenging. The Physician Orders for Life Sustaining Treatment (POLST) offers the means to successfully communicate patient's preferences across care settings. We sought to improve the usage of the POLST for oncologic patients admitted to various oncologic units at a tertiary cancer center, specifically for patients who reported their preferences for end of life care to be No CPR (DNR). In our first PDSA cycle we conducted a survey of the oncologic Advance Practice Providers (APPs) regarding barriers to POLST completion. They reported lack of familiarity with the POLST, not completing the POLST at the time of the initial conversation and forgetting to do it before discharge. Based on this, we completed a brief education on how to complete the POLST. We also made POLST forms readily accessible for all staff. At the end of the first cycle, POLST completion rates increased from 23% to 32%. As part of our second cycle, we attempted to create reminders to encourage the APPs to complete POLSTs for DNR patients. We sent biweekly patient specific emails to the APPs identifying all the patients who were DNR. However, POLST completion rates did not increase. As part of the third cycle, we again brainstormed with the APPs about continued barriers; their biggest limitations were not knowing patient's preferences regarding other components of the POLST and having to pick up the conversation from another provider. We developed a brief communication tool to utilize the information they had to complete part of the POLST and leave the rest blank. After the last PDSA cycle, the POLST completion rates increased to 46%. Increasing POLST documentation is a multipronged approach utilizing education, frequent reminders and ongoing feedback.

\u201cBecoming myself\u201d: how participants in a longitudinal substance use disorder recovery study experienced receiving continuous feedback on their results

BackgroundBeing a participant in longitudinal follow-up studies is not commonly a factor considered when investigating useful self-change aspects for individuals attempting recovery from substance use disorder (SUD). This study reports on how ongoing monitoring, and feedback on data results in a longitudinal follow-up study of SUD recovery were perceived by individuals who had achieved long-term abstinence and social recovery.MethodsInterviewers with first-hand experience with the topic conducted interviews with 30 participants and analysed the data using a thematic analytic approach within an interpretative–phenomenological framework.ResultsAnalyses resulted in the following themes. 1) Ongoing short text messaging (SMS) monitoring: helped participants by offering recovery milestones and reminders of the past. 2) Feedback on data results helped participants track physical and cognitive recovery: “I am more like myself”. 3) Using feedback in treatment: understanding the importance of a functional brain to participants may help with long-term retention in treatment.ConclusionsSelf-changes that were challenging to detect on a day-to-day basis were available for reflection through longitudinal study participation, including ongoing monitoring and feedback on the results, allowing personal consolidation of change processes. Clinical services could benefit from continuing development and implementation of such technology for ongoing monitoring and feedback on assessments to motivate self-change in SUD recovery. The development of guidelines for providing the results of research assessments to individuals could help reduce attrition in research projects and support recovery and healthy choices for study participants.

28 QUALITY OF CARE INITIATIVE IMPROVES OUTCOMES FOR PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Abstract Introduction There is significant variation in processes and outcomes of care for patients with inflammatory bowel disease (IBD), suggesting opportunities to improve quality of care. Recent efforts to define quality measures for IBD have identified emergency room (ER) visits, hospitalizations, corticosteroid use, and opioid use as indicators of care quality. We hypothesized that IBD care could be improved through a structured quality improvement (QI) program. Methods We utilized the Breakthrough Series Collaborative approach developed by the Institute for Healthcare Improvement to improve care for adults with IBD. We identified primary and secondary drivers of urgent care need for patients including those at high risk for ER use, and a multi-stakeholder panel developed 19 practice change ideas that could influence those drivers. Between January 2018 and May 2019, clinical sites participating in a QI collaborative across the United States tested and implemented various change ideas, shared ongoing results during coached monthly webinars, and participated in 3 in-person meetings to learn QI methods and share best practices. Patient-reported outcomes (PROs) were collected at clinical visits, including recent ER use and hospitalizations, use of steroids and narcotics, and measures of care utilization. Providers rated whether patients were at high risk for urgent care needs. Site performance on key measures were monitored using statistical control charts, with assessment for common cause (due to chance) variation and special cause (non-random) variation. Results We collected data prospectively from 20,382 discrete visits at twenty-six participating clinical practices (14 academic/university, 12 private/community). Disease type included Crohn’s disease (58%), ulcerative colitis (39%), and other (3%); 54% were female. During the 15-month project period, improvement with special cause variation was noted across multiple measures. Collaborative-wide decreases were seen in ER utilization (18% to 14%, relative reduction of 22%; Figure), hospitalization (14% to 11%, relative reduction of 21%), steroid use (14% to 10%, relative reduction of 29%), and narcotic utilization (8% to 4%, relative reduction of 50%). Successful change ideas tested by sites included proactive maintenance of a “high risk” patient list, reserved outpatient visits for urgent needs, “morning-after” contact with patients who went to the ER, patient education about how and when to get help, and proactively scheduling earlier follow-up for high risk patients. Conclusions Outcomes of IBD care were improved using a structured QI program that facilitates small changes in practice structure, sharing of best practices across sites, and ongoing feedback. Spread of successful change ideas may facilitate broad improvement in IBD care and significant cost savings when applied to a large population. Changes in Key Measures Over Time Statistical Process Control Chart Showing Monthly Proportion of Patients Reporting Recent ER Utilization

P563 Shared decision-making in pregnancy in inflammatory bowel disease: Design of a pregnancy in IBD decision aid (PIDA)

Abstract Background A lack of IBD-specific reproductive knowledge has been associated with increased ‘voluntary childlessness’.Furthermore, a lack of patient and clinician knowledge may contribute to inappropriate medication changes during or after pregnancy that may lead to a flare of disease. Evidence exists for the benefit of decision aids to support decision-making in pregnancy in general, as well as in multiple other chronic disease; however, such a resource for pregnancy in IBD has not been identified. Methods Using International Patient Decision Aids Standards, we have commenced design of our Pregnancy in IBD Decision Aid (PIDA). A steering committee consisting of Canadian and Australian Healthcare professionals with an interest in IBD management in pregnancy, in addition to a patient representative was established. Initial patient and clinician focus groups were conducted. Themes prospectively chosen for discussion included inheritance, fertility, nutrition, medications, mode of delivery, breastfeeding, infant infections and vaccinations. We designed an electronic PIDA draft that incorporates individualised information (for example, type of IBD, pre-conception or pregnant, surgical history and current medications) in personalised decision-making. Further patient focus groups and interviews were conducted to obtain user opinion of the PIDA draft. Results In July 2017, patient and clinician focus groups were conducted at a Canadian site. Patient concerns regarding pregnancy included the impact of disease, previous surgical history on fertility, preterm delivery; the potential impact of current and past drug therapies on the fetus/ infant; and the negative impact of active disease on both maternal and fetal/infant health. Clinician concerns included the absence of pre-conception counselling and potential for lack of patient understanding about the impact of disease activity and IBD medication use in pregnancy. Patient feedback (n = 15) obtained through interviews at two Canadian and one Australian site regarding the current electronic PIDA draft was predominantly positive, with comments pertaining to the adequacy of content coverage, personalisation, readability and unbiased information presentation. Suggestions were made for inclusion of further content such as the impact of IBD on sexual function, expected laboratory changes and the timing of recommencement of medications post-partum. Conclusion The completion of pre and post-PIDA design focus groups and interviews affirmed the role for PIDA. Main decisions that were considered necessary to address included ideal timing of conception pending disease activity, management of medications and delivery methods. Ongoing user feedback is being obtained at Australian and Canadian sites currently.

Evaluating the Feasibility, Acceptability, and Effects of Deposit Contracts With and Without Daily Feedback to Promote Physical Activity.

Despite interest in financial incentive programs, evidence regarding the feasibility, acceptability, and effectiveness of deposit contracts (ie,use of participants' own money as a financial reward) for increasing physical activity (PA) is limited. Furthermore, evidence regarding the use of feedback within incentive programs is limited. To evaluate: (1)the feasibility and acceptability of deposit contracts for increasing objectively measured PA and (2)the effects of deposit contracts with or without ongoing feedback on PA. Participants (n = 24) were exposed to 3 conditions (1)self-monitoring, (2)incentive, and (3)incentive with feedback in an ABACABAC design, with the order of incentive conditions counterbalanced across participants. Effect sizes suggest that individuals had a modest increase in PA during the incentive conditions compared with self-monitoring. Presentation order moderated results, such that individuals exposed to incentives with feedback first performed more poorly across both incentive conditions. In addition, individuals often cited the deposit contract as a reason for not enrolling, and those who did participate reported inadequate acceptability of the incentives and feedback. Results suggest that while deposit contracts may engender modest increases in PA, this type of incentive may not be feasible or acceptable for promoting PA.

Assessment of Surgical Antibiotic Prophylaxis Compliance in Pediatrics: A Pre-post Quasi-experimental Study.

Data from rigorous evaluations of the impact of interventions on improving surgical antibiotic prophylaxis (SAP) compliance in pediatrics are lacking. Our objective was to assess the impact of a multifaceted intervention on improving pediatric SAP compliance in a hospital without an ongoing antimicrobial stewardship program. A multidisciplinary team at the Montreal Children's Hospital performed a series of interventions designed to improve pediatric SAP compliance in June 2015. A retrospective, quasi-experimental study was performed to assess SAP compliance before and following the interventions. Our study included patients under 18 years old undergoing surgery between April and September in 2013 (preintervention) and in 2016 (postintervention). A 10-week washout period was included to rigorously assess the persistence of compliance without ongoing interventions. SAP, when indicated, was qualified as noncompliant, partially compliant (adequate agent and timing) or totally compliant (adequate agent, dose, timing, readministration, duration). A total of 982 surgical cases requiring SAP were included in our primary analysis. The composite partial and total compliance increased from 51.4% to 55.8% [adjusted odds ratio 1.3; 95% confidence interval: 1.0-1.8; P = 0.06]. Although improvements in correct dose and readministration were significant, there was no significant improvement in correct timing, agent selection or duration. Our study demonstrated that overall SAP compliance did not significantly improve following a washout period, illustrating the importance of ongoing surveillance and feedback from an antimicrobial stewardship program. Our strict approach in evaluating the timing criterion may also explain the lack of a significant impact on SAP compliance.

Authentic Assessment: Portfolio-Based Assessment in Literacy Learning in Indonesian Schools

Comprehensive evaluation and emphasis on the student activity process as well as providing broad wiggle room for students is needed in learning assessment. Literacy assessment with such a model is necessary to improve students' literacy skills. One assessment model that puts pressure on student activity and provides ample space for everyone to respond to an assignment in its own way is the assessment of portfolio. This paper aims to explore portfolio assessments as part of an authentic assessment for use in literacy assessments. This research uses literart research study method to provide an overview of the use of portfolios in literacy assessments in Indonesian schools. Portfolio assessment on students’ literacy skills is carried out through Indonesian language learning, especially on the efficacy of writing. The portfolio assessment adopted uses models offered by Hamp-Lyons and Condon (2000) consisting of collection, selection, and reflection. Assessments are carried out by combining formative and summative assessments. To balance the summative aspects of portfolio assessment, several formative strategies can be adopted (Lee & Lam, 2009), including (1) ongoing teacher feedback, (2) conferences, and (3) peer reviews.

Are We Making an Impact? A Qualitative Program Assessment of the Resident Leadership, Well-being, and Resiliency Program for General Surgery Residents

After implementing a formal resident well-being and resiliency program in our surgery residency, we performed in-depth qualitative interviews to understand residents' perceptions of: (1) the impact and benefits, (2) the essential elements for success, and (3) the desired changes to the well-being program. The well-being program is structured to address mental, physical, and social aspects of resident well-being through monthly experiential sessions. All General Surgery residents participated in the program; content is delivered during residents' protected educational time. For this study, we conducted individual semistructured interviews: residents were asked for their feedback to understand the value, benefits, and drawbacks of program. Accreditation Council for Graduate Medical Education-accredited General Surgery residency program PARTICIPANTS: We used purposeful selection to maximize diversity in recruiting residents who had participated in program for at least 1 year. Recruitment continued until themes were saturated. Eleven residents were interviewed including 2 from each residency year. Residents reported benefits in 3 thematic spheres: (1) Culture/Community, (2) Communication/Emotional Intelligence, and (3) Work-Life Integration Skills. Key structural elements of success for a well-being program included a committed leader, a receptive department culture, occurrence during protected time, and interactive sessions that taught applicable life skills. In discussing opportunities for improvement, residents desired more faculty-level involvement. Some residents were skeptical of the benefit of time spent learning nontechnical skills; some wanted more emphasis placed on accountability to patients and work. Our qualitative assessment of a novel resident well-being program demonstrates reported benefits that reflect the intent of the program. Residents most benefited from sessions that were interactive, introduced readily applicable skills for their day-to-day lives, and included reinforcement of principles through experiential learning. Engagement of the department leadership is essential to the success of the program, as is ongoing feedback and modification to ensure that program is tailored to the needs of residents.

Confirming Deliberate Practice in Dietetics Education

Objective: To develop a valid and reliable instrument to define deliberate practice in dietetics education.Design: Instrument development.Setting: Dietetics education and supervision.Participants: Twenty-three Registered Dietitians participated in the preliminary item tryout phase of the project and a total of 323 participants launched the instrument link for construct validation.Main Outcome Measure(s): Fifty-five deliberate practice statements were tested for construct validation.Analysis: Face and content validity of the instrument, along with initial reliability estimated were tested in the preliminary item tryout phase. Exploratory factor analysis was utilized to determine construct validity of the instrument.Results: Initial reliability estimates were >.70 for most categories during the preliminary item tryout phase. Exploratory factor analysis resulted in a seven-factor solution with 32 items accounting for 59.72% of the shared variance.Conclusion and Implications: Deliberate practice can be defined with the following characteristics: (1) opportunities to practice skills and hone knowledge; (2) experiential practice to demonstrate innate talent; (3) skills focused on a high level of patient centered nutrition care; (4) frequent and ongoing feedback; (5) reading and understanding evidence based practice literature; (6) professional education and networking opportunities; and (7) a non-judgmental learning environment where the student is free to make mistakes. (Abstract word count = 200).