Outcome Evaluations Research Articles

Supporting Birthing People and Supporting Doulas: The Impact of the COVID-19 Pandemic on a Community-Based Doula Organization in San Francisco.

Beginning in March 2020, health care systems in the United States restricted the number of support people who could be present during pregnancy-related care to reduce the spread of COVID-19. We aimed to describe how SisterWeb, a community-based doula organization that employs Black, Pacific Islander, and Latinx doulas in San Francisco, California, adapted to the COVID-19 pandemic. As part of process and outcome evaluations conducted through an academic-community partnership, we interviewed SisterWeb doulas, mentors, and leaders in 2020, 2021, and 2022 (n=26 interviews). We identified preliminary themes using the Rapid Assessment Process and then conducted thematic analysis of data related to COVID-19. SisterWeb leadership remained committed to safeguarding doulas by shifting to virtual support until doulas were onboarded as benefitted employees. Doulas reported hospital policies impacted clients' pregnancy-related care. Initially, doulas adapted to virtual support by connecting with clients more frequently through phone and text. When permitted to meet in person, doulas adjusted to client preference. Finally, as the pandemic impacted doulas' well-being, they turned to mentors for emotional support. This analysis contributes to a growing body of literature describing doulas' experiences during the pandemic. By shifting to virtual support, SisterWeb leaders prioritized the health, safety, and financial stability of doulas, who were members of communities disproportionately impacted by COVID-19. Our findings suggest that public health guidance, organizational COVID-19 precautions, and hospital policies hindered SisterWeb's goal of ensuring clients receive equitable medical care. In addition, we found that emotional support for doulas is vital to their work.

북한이탈주민 대상 건강교육 중재연구의 개발·수행·평가

This scoping review identified trends in research on health education interventions for North Korean defectors in South Korea and analyzed the intervention process to provide evidence for developing future interventions. The scoping review followed PRISMA-ScR guidelines, and the PRECEDE-PROCEED model was used to analyze the design, implementation, and evaluation of health education interventions. The review included eight studies out of 459 identified through five databases from January 1997 to December 2022. The trend showed that studies were scarce and quantitative–focused. Therefore, it is necessary to promote research and overcome methodological limitations to improve the research quality. The process analysis found that interventions need to be tailored to the specific needs of North Korean defectors, considering enabling and reinforcing factors to translate knowledge into healthy behavior. The evaluation phase should employ a variety of methods and strengthen both process and outcome evaluations. Lastly, interventions should pursue integrated health education to provide continuous health information and counseling channels. The results of this review can be utilized to improve the design, implementation, and evaluation of health education interventions and settlement support for the health of North Korean defectors in South Korea.

Effects of prototype shoes for knee osteoarthritis in female adults – Evaluations of gait, clinical outcome, and body composition

Effects of prototype shoes for knee osteoarthritis in female adults – Evaluations of gait, clinical outcome, and body composition

Intervention Programs for Intimate Partner Violence: Insights From Professionals

This qualitative study explores available intimate partner violence (IPV) intervention programs offered in Saskatchewan, Canada, a province with a substantial rural population and a high rate of IPV. Given these unique circumstances, it was necessary to investigate what IPV interventions are currently available and if professionals who work at these programs feel these programs are effectively meeting the needs of men who have perpetrated IPV and working toward reducing rates of IPV in the province. Interview respondents represented IPV intervention programs based in mental health, community corrections, and community-based organizations. Taken together, information shared by the professionals who work at these IPV intervention programs provides an overview of the current state of intervention programs offered in Saskatchewan, including the extent to which interventions align with the Principles of Effective Intervention (PEI). Findings include differences in the delivery of IPV interventions in rural communities and highlight challenges in delivering group interventions for clients who perpetrate different types of IPV, have different criminogenic needs, and have varying levels of risk. Findings inform recommendations for policy and practice, including the need for training for IPV intervention professionals, increased public awareness about IPV interventions, and incorporation of the PEI. Findings also inform recommendations for research, including longitudinal evaluations of outcomes for participants from various programs that incorporate data from multiple sources.

A scoping review of the clinical application of machine learning in data-driven population segmentation analysis.

Data-driven population segmentation is commonly used in clinical settings to separate the heterogeneous population into multiple relatively homogenous groups with similar healthcare features. In recent years, machine learning (ML) based segmentation algorithms have garnered interest for their potential to speed up and improve algorithm development across many phenotypes and healthcare situations. This study evaluates ML-based segmentation with respect to (1) the populations applied, (2) the segmentation details, and (3) the outcome evaluations. MEDLINE, Embase, Web of Science, and Scopus were used following the PRISMA-ScR criteria. Peer-reviewed studies in the English language that used data-driven population segmentation analysis on structured data from January 2000 to October 2022 were included. We identified 6077 articles and included 79 for the final analysis. Data-driven population segmentation analysis was employed in various clinical settings. K-means clustering is the most prevalent unsupervised ML paradigm. The most common settings were healthcare institutions. The most common targeted population was the general population. Although all the studies did internal validation, only 11 papers (13.9%) did external validation, and 23 papers (29.1%) conducted methods comparison. The existing papers discussed little validating the robustness of ML modeling. Existing ML applications on population segmentation need more evaluations regarding giving tailored, efficient integrated healthcare solutions compared to traditional segmentation analysis. Future ML applications in the field should emphasize methods' comparisons and external validation and investigate approaches to evaluate individual consistency using different methods.

Comparison of Work Patterns Between Physicians and Advanced Practice Practitioners in Primary Care and Specialty Practice Settings

ImportanceDespite the increasing involvement of advanced practice practitioners (APPs; ie, nurse practitioners and physician assistants) in care delivery across specialties, the work patterns of APPs compared with physicians and how they are integrated into care teams have not been well characterized.ObjectiveTo characterize differences between physicians and APPs across specialty types related to days with appointments, visit types seen, and time spent using the electronic health record (EHR).Design, Setting, and ParticipantsThis nationwide, cross-sectional study used EHR data from physicians and APPs (ie, nurse practitioners and physician assistants) at all US institutions that used Epic Systems’ EHR between January and May 2021. Data analysis was performed from March 2022 to April 2023.Main Outcomes and MeasuresAppointment scheduling patterns, percentage of new and established and level of evaluation and management (E/M) visits, and EHR use metrics per day and week.ResultsThe sample consisted of 217 924 clinicians across 389 organizations, including 174 939 physicians and 42 985 APPs. Although primary care physicians were more likely than APPs to have more than 3 days per week with appointments (50 921 physicians [79.5%] vs 17 095 APPs [77.9%]), this trend was reversed for medical (38 645 physicians [64.8%] vs 8124 APPs [74.0%]) and surgical (24 155 physicians [47.1%] vs 5198 APPs [51.7%]) specialties. Medical and surgical specialty physicians saw 6.7 and 7.4 percentage points, respectively, more new patient visits than did their APP counterparts, whereas primary care physicians saw 2.8 percentage points fewer new patient visits than did APPs. Physicians saw a greater percentage of level 4 or 5 visits across all specialties. Medical and surgical physicians spent 34.3 and 45.8 fewer minutes per day, respectively, using the EHR than did APPs in their specialties, whereas primary care physicians spent 17.7 minutes per day more. These differences translated to primary care physicians spending 96.3 minutes more per week using the EHR than APPs, whereas medical and surgical physicians spent 149.9 and 140.7 fewer minutes, respectively, than did their APP counterparts.Conclusions and RelevanceThis cross-sectional, national study of clinicians found significant differences in visit and EHR patterns for physicians compared with APPs across specialty types. By underscoring the different current usage of physicians vs APPs across specialty types, this study helps place into context the work and visit patterns of physicians compared with APPs and serves as a foundation for evaluations of clinical outcomes and quality.

A Multi-State Outcome Evaluation of Correctional Officer Training Academies: A Pretest-Posttest Design

Correctional officers are expected to fill a variety of roles in a complex social environment fraught with understaffing, underfunding, and overcrowding. To prepare officers for this highly stressful work, states rely on training academy instruction. Although other fields (e.g., policing) have extensively researched the quality of academy instruction, the field of corrections lags behind with no outcome evaluations to date. Using a pretest-posttest design, we analyzed responses from surveys of 519 trainees across 3 state training academies (one southern and two midwestern states) distributed before and after training. Dependent sample t-tests were used to examine the extent to which officers gain confidence in their core functions and the social skills necessary to navigate work in the prison environment. Results indicated that although officers gain confidence in their core skills and leadership over the course of training, they do not gain confidence in interpersonal skills or teamwork. Given the varied social backgrounds of those serving time in prison, it is crucial for officers to gain the social skills necessary to respond to conflict stemming from racial, religious, and gender identity differences. Based on these results, explicit diversity and interaction-based training may help ameliorate these concerns.

Lessons learned from evaluating complete streets project outcomes with emerging data sources

ABSTRACT Complete Streets projects can bring multifaceted benefits but before-and-after analysis regarding their mobility and accessibility outcomes is quite limited in practice. This study used emerging data sources to conduct longitudinal project outcome evaluations. Two projects from Louisiana were selected as case studies for demonstration. The two projects did not induce heavier congestion in a pilot analysis region. One project with sidewalks/bike lanes contributes to traffic calming in an urban context, while the other project consisting only of a widened shoulder marked for bicycle use may raise speeding concerns in a rural context. Both projects are likely to bring accessibility benefits as they attract more businesses and longer visits. The authors also noted data source and outcome measure challenges in different contexts. The proposed evaluation approach and identified data gaps will benefit the private sector in diversifying/improving their data products and facilitate the public sector in making more data-driven decisions.

Evaluation of community-based health promotion interventions in children and adolescents in high-income countries: a scoping review on strategies and methods used

BackgroundIn recent decades, community-based interventions have been increasingly adopted in the field of health promotion and prevention. While their evaluation is relevant for health researchers, stakeholders and practitioners, conducting these evaluations is also challenging and there are no existing standards yet. The objective of this review is to scope peer-reviewed scientific publications on evaluation approaches used for community-based health promotion interventions. A special focus lies on children and adolescents’ prevention.MethodsA scoping review of the scientific literature was conducted by searching three bibliographic databases (Medline, EMBASE, PsycINFO). The search strategy encompassed search terms based on the PCC (Population, Concept, Context) scheme. Out of 6,402 identified hits, 44 articles were included in this review.ResultsOut of the 44 articles eligible for this scoping review, the majority reported on studies conducted in the USA (n = 28), the UK (n = 6), Canada (n = 4) and Australia (n = 2). One study each was reported from Belgium, Denmark, Germany and Scotland, respectively. The included studies described interventions that mostly focused on obesity prevention, healthy nutrition promotion or well-being of children and adolescents. Nineteen articles included more than one evaluation design (e.g., process or outcome evaluation). Therefore, in total we identified 65 study designs within the scope of this review. Outcome evaluations often included randomized controlled trials (RCTs; 34.2%) or specific forms of RCTs (cluster RCTs; 9.8%) or quasi-experimental designs (26.8%). Process evaluation was mainly used in cohort (54.2%) and cross-sectional studies (33.3%). Only few articles used established evaluation frameworks or research concepts as a basis for the evaluation.ConclusionFew studies presented comprehensive evaluation study protocols or approaches with different study designs in one paper. Therefore, holistic evaluation approaches were difficult to retrieve from the classical publication formats. However, these publications would be helpful to further guide public health evaluators, contribute to methodological discussions and to inform stakeholders in research and practice to make decisions based on evaluation results.

Effectiveness of a teaching methodology based on the theory of historical thinking through active methods and digital resources in Spanish adolescents

Twenty-first century education is firmly committed to training young people in new competencies that are transferable to a variety of life situations. Historical thinking as a methodological theory is emerging in a large number of countries. In thinking historically, the skills of the historians are used, so that the sources of the past can be interpreted and the generation of effective historical narratives can be enhanced. This study aims to compare the general perception of the teaching of history between two groups of baccalaureate students, with respect to the effectiveness and transferability of learning historical thinking. Specifically, the existing perception of the implementation of historical thinking competencies is collected after the pre- and post-evaluation of a unit plan developed with 93 students. A quantitative method was used, namely a quasi-experimental design with a non-equivalent control group. The results indicate a substantial improvement in the responses observed in the experimental group, compared to those obtained in the control group. This impact is associated with the didactic methodology implemented with both groups, which showed notable changes in the perception of the theory of historical thinking, as well as in the use of other digital resources and active methods. For the future, it is imperative to transfer these first indications to controlled evaluations of academic outcomes to consolidate the academic status of competency-based teaching in secondary education levels.

Exploring the potential of theory-based evaluation to strengthen marine spatial planning practice

Marine spatial planning (MSP) is an approach to ocean management with an increasingly global reach. However, existing evaluation strategies have yet to ascertain the extent to which MSP achieves social, ecological, and economic goals to benefit coastal environments and human communities. Here, we experiment with a theory-based approach as a means of overcoming long-standing obstacles to MSP evaluation. We developed and applied an eight-step evaluation protocol to five diverse cases of MSP, focusing on the evaluative feasibility of the protocol as we moved from identifying objectives to assessing the sustainability of outcomes. We found evidence that theory-based evaluation (operationalized via theories of change) can bridge quantitative outcome and qualitative process evaluations, two essential approaches that on their own produce incomplete pictures of MSP. Our work suggests that a theory-based approach can enhance opportunities to incorporate diverse knowledge sources and data types into outcome evaluations and thus better capture complex social, political, and historical dimensions that are difficult to quantify but critical to MSP success. We also uncovered likely challenges to implementing theory-based evaluation for MSP, including the apparent data- and time-intensive nature of the approach. We found that applying theory-based evaluation is difficult for plans lacking well-defined goals, objectives, and intended outcomes and that increased documentation of planning motivations and the planning process are needed to rigorously evaluate MSP. Ultimately, we join others in the marine conservation and management fields who are optimistic about theory-based evaluation. Our evaluation protocol provides a first step towards a practical guide to accelerate the use of this assessment approach.

Hockey Fans in Training (Hockey FIT): Rationale, design, and baseline characteristics from a cluster randomized controlled trial in men with overweight or obesity

BackgroundPrevious research highlights the need for effective lifestyle interventions for men. Hockey Fans in Training (Hockey FIT) was developed as a pragmatic healthy lifestyle program tailored to men with overweight or obesity. This paper overviews the rationale, program details, and design of a recently completed cluster randomized controlled trial (RCT) of Hockey FIT. Participant engagement and baseline characteristics are also described. MethodsThe RCT evaluated the effectiveness, cost-effectiveness, and implementation of Hockey FIT. Forty-two sites in Canada and the United States were randomized to either the Hockey FIT intervention group or wait-list control group. Participants were men, aged 35–65 years, with a body mass index (BMI) ≥27 kg/m2. Hockey FIT is a group-based, off-ice, in-person healthy lifestyle program, including both a 3-month active phase and a 9-month minimally-supported phase. Outcomes were assessed at baseline, 3, and 12 months. The primary outcome was weight loss at 12 months. ResultsThe design of the cluster RCT incorporates evaluations of participant health outcomes, program implementation, and broader healthcare system impact. In the RCT, 1397 participants were assessed for eligibility and 997 were enrolled. Most participants heard about the program through social media or hockey team emails. Participants averaged 49 years of age, had BMI values of 35.3 kg/m2, were predominately white, and had varying levels of education. ConclusionThe intended audience for Hockey FIT was recruited successfully, however, targeted recruitment to better engage diverse populations is warranted. This paper affords a useful outline for evaluating future lifestyle interventions tailored to men.This trial was registered on August 17, 2018 with ClinicalTrials.gov (identifier: NCT03636282).

Understanding generation Z consumers’ revisit intentions to robotic service restaurants

PurposeThe purpose of this paper is to investigate the influencing factors of generation Z (Gen Z) consumers’ revisit intentions to robotic restaurants in the post-pandemic times.Design/methodology/approachUsing a sample of Gen Z consumers with dining experiences in an Indian restaurant using service robots, the study empirically tests a research framework based on stimulus–organism–response theory.FindingsThe study explains how Gen Z consumer’s perceptions of functional attributes (i.e. perceived usefulness and perceived ease of use), socio-emotional attribute (i.e. perceived safety) and relational attribute (i.e. trust) shape their attitude, which in turn leads to their evaluations of performance outcomes and intention to revisit the robotic restaurants. The findings also indicate that perceived risk reduction of viral infection moderates the impact of performance outcomes on revisit intention.Originality/valueDue to the outbreak of COVID-19 pandemic, the changing preferences of consumers have resulted in an increase in demand for restaurants offering robotic services. To support the long-term viability of service robots in restaurant services, the current study investigates what elements of service robots can determine consumers’ intentions to revisit the robotic restaurants during post-pandemic times.

Project ECHO for Cancer Care: a Scoping Review of Provider Outcome Evaluations.

The Project ECHO model of telementoring has been used for the past 10years to expand access to specialized cancer care. This scoping review identifies evidence for the model's ability to improve provider outcomes, synthesizing findings from existing studies within Moore et al.'s (2009) framework for continuing medical education outcomes. We search two large research databases and a collection maintained by Project ECHO staff for articles that focus on cancer ECHO programs, involve primary data collection, and were published between December 1, 2016, and November 30, 2021. We identified 25 articles for inclusion in our scoping review. Most articles reported results for outcomes related to program participation: attendance, satisfaction, and learning. Yet, just under half reported changes in provider practices. Results demonstrate widespread participation and improved learning resulting from ECHO programs focused on cancer care. There is also evidence of improved practices related to HCV vaccination and palliative care. We highlight examples of best practices as well as opportunities to improve provider outcome evaluations for cancer ECHO programs.

Exploration of Maternal and Fetal Toxicity Risks for Metronidazole-Related Teratogenicity and Hepatotoxicity through an Assessment in Albino Rats.

Metronidazole is the primary antimicrobial drug for treating acute and chronic vaginal pathogens during pregnancy; however, there has been insufficient research on placental disorders, early pregnancy loss, and preterm birth. Here, the potential activity of metronidazole on pregnancy outcomes was investigated. 130 mg/kg body weight of metronidazole was orally given individually to pregnant rats on gestation days 0-7, 7-14, and 0-20. Pregnancy outcome evaluations were carried out on gestation day 20. It was demonstrated that metronidazole could induce maternal and fetal hepatotoxicity. There is a significant increase in the activities of maternal hepatic enzymes (ALT, AST, and ALP), total cholesterol, and triglycerides compared with the control. These biochemical findings were evidenced by maternal and fetal liver histopathological alterations. Furthermore, metronidazole caused a significant decrease in the number of implantation sites and fetal viability, whereas it caused an increase in fetal lethality and the number of fetal resorptions. In addition, a significant decrease in fetal weight, placental weight, and placental diameter was estimated. Macroscopical examination revealed placental discoloration and hypotrophy in the labyrinth zone and the degeneration of the basal zone. The fetal defects are related to exencephaly, visceral hernias, and tail defects. These findings suggest that the administration of metroniazole during gestation interferes with embryonic implantation and fetal organogenesis and enhances placental pathology. We can also conclude that metronidazole has potential maternal and fetal risks and is unsafe during pregnancy. Additionally, it should be strictly advised and prescribed, and further consideration should be given to the associated health risks.

The Effects of Immersive Virtual Reality Applications on Enhancing the Learning Outcomes of Undergraduate Health Care Students: Systematic Review With Meta-synthesis.

Immersive virtual reality (IVR) applications are gaining popularity in health care education. They provide an uninterrupted, scaled environment capable of simulating the full magnitude of sensory stimuli present in busy health care settings and increase students' competence and confidence by providing them with accessible and repeatable learning opportunities in a fail-safe environment. This systematic review aimed to evaluate the effects of IVR teaching on the learning outcomes and experiences of undergraduate health care students compared with other teaching methods. MEDLINE, Embase, PubMed, and Scopus were searched (last search on May 2022) for randomized controlled trials (RCTs) or quasi-experimental studies published in English between January 2000 and March 2022. The inclusion criteria were studies involving undergraduate students majoring in health care, IVR teaching, and evaluations of students' learning outcomes and experiences. The methodological validity of the studies was examined using the Joanna Briggs Institute standard critical appraisal instruments for RCTs or quasi-experimental studies. The findings were synthesized without a meta-analysis using vote counting as the synthesis metric. A binomial test with P<.05 was used to test for statistical significance using SPSS (version 28; IBM Corp). The overall quality of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation tool. A total of 17 articles from 16 studies totaling 1787 participants conducted between 2007 and 2021 were included. The undergraduate students in the studies majored in medicine, nursing, rehabilitation, pharmacy, biomedicine, radiography, audiology, or stomatology. The IVR teaching domains included procedural training (13/16, 81%), anatomical knowledge (2/16, 12%), and orientation to the operating room setting (1/16, 6%). The quality of the 75% (12/16) of RCT studies was poor, with unclear descriptions of randomization, allocation concealment, and outcome assessor blinding procedures. The overall risk of bias was relatively low in the 25% (4/16) of quasi-experimental studies. A vote count showed that 60% (9/15; 95% CI 16.3%-67.7%; P=.61) of the studies identified similar learning outcomes between IVR teaching and other teaching approaches regardless of teaching domains. The vote count showed that 62% (8/13) of the studies favored using IVR as a teaching medium. The results of the binomial test (95% CI 34.9%-90%; P=.59) did not show a statistically significant difference. Low-level evidence was identified based on the Grading of Recommendations Assessment, Development, and Evaluation tool. This review found that undergraduate students had positive learning outcomes and experiences after engaging with IVR teaching, although the effects may be similar to those of other forms of virtual reality or conventional teaching methods. Given the identification of risk of bias and low level of the overall evidence, more studies with a larger sample size and robust study design are required to evaluate the effects of IVR teaching. International prospective register of systematic reviews (PROSPERO) CRD42022313706; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=313706.

Validation of HCL-33 in screening for bipolar disorder in patients with depressive episode

IntroductionHypomania Check List 33 (HCL-33) constitutes a self-rating questionnaire for lifetime history of hypomanic symptoms, used in patients who present with depressive symptoms and a further screening for bipolar disorder is required.Objectives- Translation and cultural adaptation of HCL-33- Measuring psychometric abilities, gender and age differences in scoreMethodsIn order to culturally adapt, standardize and validate the instrument for the Albanian context, the reliability and validity of the HCL-33 was examined using an sample of 99 patients, of whom 22 were diagnosed as bipolar disorder but all presented with a depressive episode.In order to reach reliability, internal consistency analyses were performed.ResultsThe factor analysis yielded two factor, with an internal consistency of .838 and .736 from the Cronbach’s alphas, with a total alpha of .765, falling within the “good to excellent” range.Furthermore, Albanian norm scores and cut-off scores have been generated for the Albanian version of HCL-33. The article provides evidence regarding the psychometric propërties and utility of HCL-33 in the Albanian adult population for clinical assessment, outcome evaluations and research purposes. With a cut-off value of 16, sensitivity was 73% and specificity was 53%, with a prevalence of 22% and positivie predictive value of 30% and negative predictive value 87%.Gender differences were not relevant in the total scoring, but there was a positive correlation between age an HCL-33 scoring (r(n=99)=.243, p≤.01), especially with Factor II (r(n=99)=.211, p≤.05).ConclusionsThe article provides evidence regarding the psychometric properties and utility of HCL-33 in the Albanian adult population as a screening tool for bipolar disorder in patients presenting with a depressive episode.Disclosure of InterestNone Declared

Action research with projects to facilitate students to study research and prepare research proposals during the Covid-19 pandemic

ABSTRACT Knowledge and skills in the field of research are key requirements for the successful completion of studies for students, including prospective teachers. However, the outbreak of the COVID-19 coronavirus has made it difficult for students to conduct research in the usual ways. This study aims to apply project-based learning through action research to teach students educational research methods and to help them prepare research plans that are adaptive to classroom situations. This is achieved through the provision of learning resources to teach research theory, followed by the implementation of action research to write research proposals and evaluations of learning outcomes. Learning resources were systematically arranged to support online learning to teach research methods, and effective action research led students to learn actively and develop educational research plans. Competence in the field of research was achieved. Student learning outcomes sequentially for assignment scores (M = 88.38 ± 3.00), final project scores (M = 88.20 ± 3.55), and posttest (M = 92.06 ± 2.17) were all high. Project-based learning is shown to be effective in guiding students to learn actively by utilizing available learning resources. It motivates students to learn independently and can be applied to achieve competency targets in both normal and abnormal learning situations, such as those experienced during the COVID-19 pandemic.

Multiple cases in case-based learning: A qualitative description study.

Case-based learning is widely used in health professions education to improve clinical learning, but little is known about how best to approach multiple cases in this active learning strategy. Our study explored dental student views of multiple case-based learning in oral pathology. Qualitative description informed the study design. Data were collected through semi-structured, individual interviews with twenty-one third- and fourth-year dental students who participated in multiple case-based learning seminars. Data were analysed using inductive, manifest thematic analysis. Themes were identified at approach and case levels. Approach-level themes included preparing students for clinical practice and board exams and maximising exposure (e.g., to lesions/conditions), knowledge application, and engagement within the time allotted for the learning session. Case-level themes included using challenging but manageable cases, linking cases to lecture content, providing the necessary clinical information to solve the cases, and ensuring that cases were authentic and common with non-typical presentations. Aspects of themes encompassed definitions of case characteristics, benefits, conditions of implementation, and recommendations for improvement. Cases should be considered individually, collectively, purposefully, and contextually in multiple case-based learning. Evaluations of learning and behavioural outcome are needed to further establish the effectiveness of approaches and case characteristics in multiple case-based learning.

Elementary School Teachers’ Competence in the Implementation of Learning Evalution

This study aims to describe the competence of SD/MI level teachers in the learning evaluation process. This is intended as an effort to classify the form of assessment of elementary age children. This study uses a qualitative approach with the method of literature study. Sources of data and study analysis materials are relevant scientific works including books, articles and proceedings. This study concludes that a teacher is required to be able to carry out assessments and evaluations of learning processes and outcomes and to utilize the results of these assessments and evaluations in an effort to take reflective action to improve the quality of learning. Evaluation is interpreted as a systematic process carried out to assess an object based on certain criteria and prerequisites. Some of the evaluation principles needed as a guide in evaluation activities include; valid, objective, fair, integrated, open, comprehensive and continuous, systematic, based on criteria, and accountable. The overall evaluation includes 3 aspects, namely (1) cognitive aspects which are closely related to the ability to think, (2) psychomotor aspects related to physical activity, and (3) affective aspects including character, behavior such as attitudes, interests, self-concept, values and morals.