Pretest Confidence Research Articles

PIRADS for Rad Oncs: A Multidisciplinary Educational Lecture to Improve Prostate MRI Interpretation for Radiation Oncology Residents

Background The Prostate Imaging Reporting and Data System (PIRADS) reported on multiparametric magnetic resonance imaging (mpMRI) is a standard assessment in the diagnostic workup for patients with prostate adenocarcinoma. Therapeutically, mpMRI and PIRADS lesions are increasingly utilized in radiation oncology target delineation for definitive treatment with either external beam radiation therapy or brachytherapy. Though imaging interpretation is an integral component of radiation oncology, formal education is limited. Here we report on an educational lecture created with radiology colleagues to increase knowledge and confidence in mpMRI and PIRADS. Methods An educational lecture was created to summarize the aims and limitations of the PIRADS version 2.1 and to review the relationship of mpMRI, PIRADS scoring, and the dominant intraprostatic lesion (DIL). Educational materials were reviewed by a radiology fellow specialized in body MRI and two faculty radiation oncologists; a radiology fellow also attended the lecture. Radiation oncology residents from three institutions participated in the lecture and completed a pre-lecture (pre-test) and post-lecture (post-test) survey. The surveys assessed the participants' confidence and knowledge in PIRADS and mpMRI. Confidence was assessed using Likert scales ranging from 1-5. The knowledge assessment portion consisted of true/false, dichotomous choice, and multiple choice questions. Statistical Analysis: Likert confidence ratings pre- and post-lecture were averaged separately for each participant. A Wilcoxon Signed Rank test was performed to compare average confidence ratings. A paired sample t-test was performed to compare pre-lecture and post-lecture raw scores of the knowledge assessment section. All statistical analysis was performed using IBM SPSS Statistics for Mac, Version 28.0. (Armonk, NY: IBM Corp). Results 13 participants completed a pre-test survey and attended the lecture. 11/13 (85%) of participants completed a post-test survey. The median pre-test confidence score was 1.6 (Range 1-4), indicating that participants did not feel confident in PIRADS interpretation and mpMRI. The median knowledge assessment pre-test score was 58.3% and significantly improved by 43% after the lecture, with a median post-test score of 83.3% (Range 50%-100%, p<0.001). Participant median confidence score increased to 4.1 (Range 2-5, p=0.003) suggesting increased confidence in interpreting PIRADS and mpMRI. Discussion Radiation oncology residents do not feel confident in PIRADS scoring and imaging interpretation on mpMRI. Formal educational lectures can improve resident comfort and knowledge in PIRADS, and multidisciplinary lectures in collaboration with radiology colleagues should be encouraged. The Prostate Imaging Reporting and Data System (PIRADS) reported on multiparametric magnetic resonance imaging (mpMRI) is a standard assessment in the diagnostic workup for patients with prostate adenocarcinoma. Therapeutically, mpMRI and PIRADS lesions are increasingly utilized in radiation oncology target delineation for definitive treatment with either external beam radiation therapy or brachytherapy. Though imaging interpretation is an integral component of radiation oncology, formal education is limited. Here we report on an educational lecture created with radiology colleagues to increase knowledge and confidence in mpMRI and PIRADS. An educational lecture was created to summarize the aims and limitations of the PIRADS version 2.1 and to review the relationship of mpMRI, PIRADS scoring, and the dominant intraprostatic lesion (DIL). Educational materials were reviewed by a radiology fellow specialized in body MRI and two faculty radiation oncologists; a radiology fellow also attended the lecture. Radiation oncology residents from three institutions participated in the lecture and completed a pre-lecture (pre-test) and post-lecture (post-test) survey. The surveys assessed the participants' confidence and knowledge in PIRADS and mpMRI. Confidence was assessed using Likert scales ranging from 1-5. The knowledge assessment portion consisted of true/false, dichotomous choice, and multiple choice questions. Statistical Analysis: Likert confidence ratings pre- and post-lecture were averaged separately for each participant. A Wilcoxon Signed Rank test was performed to compare average confidence ratings. A paired sample t-test was performed to compare pre-lecture and post-lecture raw scores of the knowledge assessment section. All statistical analysis was performed using IBM SPSS Statistics for Mac, Version 28.0. (Armonk, NY: IBM Corp). 13 participants completed a pre-test survey and attended the lecture. 11/13 (85%) of participants completed a post-test survey. The median pre-test confidence score was 1.6 (Range 1-4), indicating that participants did not feel confident in PIRADS interpretation and mpMRI. The median knowledge assessment pre-test score was 58.3% and significantly improved by 43% after the lecture, with a median post-test score of 83.3% (Range 50%-100%, p<0.001). Participant median confidence score increased to 4.1 (Range 2-5, p=0.003) suggesting increased confidence in interpreting PIRADS and mpMRI. Radiation oncology residents do not feel confident in PIRADS scoring and imaging interpretation on mpMRI. Formal educational lectures can improve resident comfort and knowledge in PIRADS, and multidisciplinary lectures in collaboration with radiology colleagues should be encouraged.

The Effectiveness of Smartphones Video to Improve Skill Performance and Confidence of Student Nurses in Performing Hygiene Care

Self Confidence is a crucial component for students to achieve effective clinical performance. Lacking confidence may affect clinical skills performance which later can cause consequences in the safety of care delivered by the student nurses. This study proposes a method to use video on smartphones in teaching hygiene care nursing procedures. This study aimed to evaluate the effects of video of hygiene care on the skills and confidence of nursing students. The main contributions of video using smartphones have a great potential to provide clinical nursing education that is accessible, relevant, and supports patient safety. This study used a quasi-experimental, pre- test, and post-test design. Seventy-one students divide into thirty-six students in the control group and thirty-five students in the intervention group. The intervention group used a validated video on hygiene care on a smartphone, and the control group only used their nursing procedure book. Both groups were assessed for confidence level using the Confidence Scale and for the skill using Skill Performance Checklist as a pre-test. The same group of students were reassessed after a four-week intervention for post-test. Using descriptive analysis, independent t-test, and paired t-test. Pre-test confidence score, no significant difference in mean in both groups compared to a post-test confidence score. There is a substantial difference between the control and intervention groups. The mean confidence score between the pre-test and the post-test was significantly different (p &lt;0.001,95% CI of the mean difference (-10.038, -9.229). After the test, the total skill performance score improved from the total skill performance score before the test with a mean difference of -29.789. The mean Skill Performance Score before and after was significantly different (p &lt;0.001, 95% CI of the mean difference (-31.515, -28.063). The creation of video in the study serves as a roadmap for future research, particularly electronic learning in nursing education and other hospitals.

Adaptive change in simulation education: Comparison of effectiveness of a communication skill curriculum on death notification using in person methods versus a digital communication platform.

Mandates to social distance and "shelter in place" during the COVID-19 pandemic necessitated the exploration of new academic content delivery methods. Digital communication platforms (DCP; e.g., Zoom) were widely used to facilitate content delivery, yet little is known about DCP's capacity or effectiveness, especially for simulation. The objective was to compare the experience, outcomes, and resources required to implement a simulation-based communication skill curriculum on death notification to a cohort of learners using in-person versus DCP delivery of the same content. We used the GRIEV_ING mnemonic to train students in death notification techniques either in person or utilizing a DCP. For all learners, three measures were collected: knowledge, confidence, and performance. Individual learners completed knowledge and confidence assessments pre- and postintervention. All performance assessments were completed by standardized patients (SPs) in real time. Wilcoxon rank-sum test was used to identify differences in individual and between-group performances. Thirty-four learners participated (N=34), 22 in person and 12 via DCP. There was a statistically significant improvement in both groups for all three measures: knowledge, confidence, and performance. Between-group comparisons revealed a difference in pretest confidence but no differences between groups in knowledge or performance. More preparation and prior planning were required to set up the DCP environment than the in-person event. The in-person and DCP delivery of death notification training were comparable in their ability to improve individual knowledge, confidence, and performance. Additional preparation time, training, and practice with DCPs may be required for SPs, faculty, and learners less familiar with this technology.

Athletic Training Educators' Knowledge and Confidence About Competency-Based Education

Context: The knowledge and confidence of athletic training educators regarding competency-based education are not known. While there may be a role for this model of education within athletic training, it is important to gain an understanding of the familiarity current educators have with competency-based education. Objective: To assess current athletic training educators' knowledge and confidence regarding competency-based education. Design: Cross-sectional. Setting: Online survey instrument. Patients or Other Participants: A total of 163 respondents (19.2% response rate) from a convenience sample of 849 athletic training educators. Main Outcome Measure(s): Demographic information was collected. Participants completed a multiple-choice knowledge assessment along with pre- and posttest confidence ratings. Results: Composite knowledge scores were low with an average of 3.25 ± 1.9 correct responses out of 8 (40.6%). Average confidence scores were 2.8/4.0 ± 0.6 pretest and 2.0/4.0 ± 0.7 posttest. No significant relationships were found between composite knowledge score and years of experience as an athletic trainer or years of experience as an educator. Further, participants scored similarly with respect to composite knowledge, pretest confidence, and posttest confidence regardless of highest degree attained, program type, or recent participation in continuing education on competency-based education. Conclusions: Current athletic training educators demonstrated an overall lack of familiarity with competency-based education and reported average pre- and posttest confidence scores. While there may be merit in exploring the opportunities for a competency-based model in athletic training education, efforts should first ensure that educators are familiar with the concepts.

Undergraduate Nursing Students’ Caring Behaviors: A Cross-Sectional Study

This cross-sectional, comparative descriptive design study aimed to compare self-reports of perceived caring, measured by the Caring Behaviors Inventory-16 Student Version, in a convenience sample of undergraduate nursing students across three levels of the curriculum, second, third, and fourth years. The study evaluated their confidence in providing nursing care with a professional confidence Visual Analog Scale. Combined perceived caring and confidence scores increased on posttest and differed at a statistically significant level between pretest and posttest. Pretest and posttest perceived caring scores differed significantly among the three curriculum levels, for pretest confidence, but not for posttest senior level confidence. Convergent validity testing revealed a weak association between perceived caring and confidence in providing nursing care for patients. Cronbach’s alpha for the CBI-16 Student Version established beginning reliability. Perceived caring may be unintentionally part of a hidden curriculum through student experiences with patients, registered nurses, and faculty who model caring behaviors.

Calibration of confidence and assessed clinical skills competence in undergraduate paediatric OSCE scenarios: a mixed methods study

BackgroundThe relationship between confidence and competence in clinical skills development is complex but important. This study aims to determine undergraduate paediatric student confidence in performing three common paediatric clinical skills framed as Objective Structured Clinical Examination (OSCE) scenarios and to compare this with subsequent assessed performance. The study also aims to explore possible barriers to successful paediatric skills completion.MethodsA mixed-methods study was conducted on medical students. Cross-sectional questionnaire data relating to confidence in performing a number of paediatric skills were compared with assessed paediatric skills competency. Focus groups were carried out to identify themes in paediatric skills completion to triangulate this data.ResultsEighty-five medical students participated in the study. Students had high levels of pre-test confidence in their ability to perform paediatrics skills. However agreement between pre-test confidence and subsequent task performance was poor and students had significantly greater belief in their skills ability than was subsequently demonstrated. Focus groups identified paediatric skills complexity, conflicting teaching and having limited supervised skills opportunities and as being possible contributory factors to this discrepancy.ConclusionsStudent paediatric skills confidence is not matched by performance. The reasons for this are diverse but mostly modifiable. A major factor is the lack of supervised skills experience with appropriate feedback to support students in learning to calibrate their confidence against their competence. A number of recommendations are made including the introduction of formative assessment opportunities.

A prospective study evaluating the impact of cartridge-based nucleic acid amplification test (CBNAAT) on the management of tuberculosis in a low-resource high-burden Indian rural setting.

Background:The cartridge-based nucleic acid amplification test (CBNAAT) Xpert MTB/RIF is more sensitive than smear microscopy for the diagnosis of tuberculosis (TB). It is also more expensive, costing 1450 INR as compared to 10 INR per smear.Objectives:We conducted a prospective study to evaluate the impact of CBNAAT results on patient management in our low-resource, high-burden Indian rural setting.Materials and Method:Between February and July 2017, clinicians were asked to complete one questionnaire at the time of CBNAAT request and another when reviewing the result. The first questionnaire, “Form 1,” concerned pretest treatment status and asked clinicians to rate their confidence in the diagnosis. “Form 2” concerned postresult treatment and investigation plan.Results:Over the study period, 206 CBNAATs were requested. Form 1 was not completed for 85 patients and 21 were excluded leaving 100 in the main analysis. MTB was detected (MTB-D) in 60 of 100 (60%) of samples tested. At the time of CBNAAT request, 56 of 100 (56%) of patients were already on treatment, this being empirical in 34 of 100 (34%). Despite this, 17 of 60 (28.3%) of MTB-D results occurred in patients not yet started on treatment. Postresult treatment status was available for 94 of 100 CBNAATs (55 MTB-D and 39 MTB-ND). Following an MTB-D result, all 17 patients not on treatment started and all 38 on so already continued. Following an MTB Not Detected (MTB-ND) result, 26 of 27 (96.3%) of patients not yet on treatment remained so, but only 2 of 12 (16.7%) already on treatment stopped. Even where the clinician's pretest confidence in TB was low, 9of 30 (30%) of CBNAAT results were MTB-D.Conclusion:In a low-resource high-burden setting, CBNAAT may have greatest impact where the clinician's pretest confidence in TB is low and empirical treatment has not been started. This is because MTB-D results will lead to appropriate initiation of treatment and MTB-ND results may enable clinicians to hold-off treatment.

Predictors of Normal Electrodiagnostic Testing in the Evaluation of Suspected Carpal Tunnel Syndrome

Electrodiagnostic studies (electromyography and nerve conduction velocity; EMG/NCV) are used to confirm the diagnosis of carpal tunnel syndrome (CTS) and to evaluate its severity. We investigated the hypothesis that normal electrodiagnostic median nerve testing is predicted by 1) Physician pre-test confidence in the diagnosis of CTS, and 2) Puzzling patient factors. One hundred and forty consecutive patients who underwent electrodiagnostic testing to evaluate for possible CTS were reviewed retrospectively. Both physician confidence in the diagnosis of CTS and puzzling patient factors (heightened illness concern, disproportionate complaints, and vague/nonanatomical/noncharacteristic symptoms) were recorded. Electrodiagnostic testing was used as the reference standard for diagnosis of CTS. Electrodiagnostic testing confirmed CTS in 115 patients and was within normal limits in 25 patients. Low physician confidence in the diagnosis of CTS was highly predictive of a normal electrodiagnostic test (p < 0.001), with high sensitivity (97%), moderate specificity (40%), and high overall accuracy (87%). Puzzling patient factors were moderately predictive of normal electrodiagnostic testing (p < 0.001), with low sensitivity (16%), high specificity (96%), and high overall accuracy (81%). The best multivariable model retained younger age, negative Phalen's test, and low physician confidence as the best predictors of normal electrodiagnostic testing and explained 35% of the variation in test results. A model with low confidence alone explained 19% of the variation in test results. Physician intuition as recorded in the medical record in terms of puzzlement and low confidence are very specific and accurate predictors of normal electrodiagnostic testing in the setting of suspected carpal tunnel syndrome.

English

The purpose of the present research was to investigate the effects of physical education lessons planned in accordance with cooperative learning approach on secondary school students’ problem solving skills. The research was conducted on 48 students studying at Konya/Selcuklu Ažehit Mustafa Cuhadar Secondary School in fall semester of 2015-2016 school year. The research utilized an experiment (24 students) and a control (24 students) group. In order to investigate the effects of physical education lessons planned in accordance with cooperative learning approach on students’ problem solving skills, “Problem Solving Inventory for Primary School Children” developed by Serin et al. (2010) was implemented. Data were analysed on statistics software, using Mann Whitney-U and Wilcoxon Signed Rank tests. According to the findings obtained in the present study, there are not any significant differences between experiment and control groups in terms of pre-test confidence in problem solving skill, self-control, and avoidance and total score averages (p>0.05). There are significant differences between control group pre-test and post-test scores in all dimensions and total scores, in favour of post-test (p<0.05). There are significant differences between experiment group pre-test and post-test scores in all dimensions and total scores, in favour of post-test (p<0.05). There are significant differences between experiment and control groups’ post-test scores in all sub-dimensions and total scores (p<0.05). Obtained findings showed that, problem solving skills of the experiment group students, on who cooperative learning approach was conducted, significantly increased more than control group students, on whom traditional methods were conducted, and the difference between these two groups was significant. Key words: Cooperative learning, problem solving skills, physical education lesson.

P240 Assessing the Accuracy and Confidence of Chest X-Ray Reporting by Medical Doctors

IntroductionThe reporting of CXRs for medical patients admitted to hospital vary across Europe. Our local policy is that all admission x-rays are reported but this may not be available at...

Medical ethics curriculum for surgical residents: Results of a pilot project

This study sought to develop and evaluate a medical ethics curriculum designed specifically for surgical residents. The learning needs of surgical residents relevant to ethics were determined by using a structured literature review and synthesis strategy. We identified 5 primary areas of importance for ethics education for surgical residents: withdrawing and withholding treatment, advance directives, do-not-resuscitate orders, informed consent, and communicating bad news. Learning objectives were developed, and teaching plans were designed for four 90-minute interactive teaching episodes on the basis of adult learning principles. We surveyed residents using a published survey instrument modified for surgery to identify residents' beliefs about the usefulness of ethics training, confidence in addressing ethical issues, and factual knowledge of ethics questions. Twenty surgical residents at a single institution completed the pretest and posttest close-ended surveys. Results showed that although 88% had formal ethics exposure in medical school, 93% considered ethics education at the resident level to be a "very important" or "important" topic. Residents' confidence in addressing ethical issues showed statistically significant improvement between pretest and posttest surveys for 13 of 23 items. There were no statistically significant linear relationships between postgraduate year of residency and the pretest confidence items or the number of correct responses on the pretest multiple-choice items. Despite the prevalence of ethics education during medical school, surgical residents welcome formal instruction on numerous ethical issues pertinent to surgical practice. A focused curriculum can be developed that has a measurable impact on residents' confidence in addressing ethical issues.

Interval estimation of scale parameters following a pre-test for two exponential distributions

If two censored samples come from the exponential distributions with identical scale parameters, it is advantageous to pool the two samples to construct a confidence interval for the scale parameter. In practice, when it is uncertain whether these two samples come from the distributions with identical scale parameters, a preliminary test may be used to partially resolve the uncertainty. A confidence interval for the scale parameter following a preliminary test concerning the equality of scale parameters is investigated. This interval is referred to as a pre-test confidence interval. The expected length of the pre-test confidence interval is shorter than that of the usual confidence interval. The coverage probability of the pre-test confidence interval is less than the nominal level. However, at some selected levels of significance, the coverage probability of the pre-test confidence interval is only slightly less than the nominal level but the maximum reduction in expected length is substantial.

Interval estimation of error variance following a preliminary test in one–way random model

A confidence interval for the error variance following a preliminary test in the oneway random model is investigated. This interval is referred to as a pre-test confidence interval. The expected length of the pre-test confidence interval is shorter than that of the usual confidence interval. The coverage probability of the pre–test confidence interval is less than the nominal level. However, at some selected levels of significance, the coverage probability of the pre-test confidence interval is only slightly less than the nominal level but the maximum reduction in expected length is substantial