Qualitative Survey Study Research Articles

PRO114 Wilson Disease: Unmet NEEDS Emerging from the Italian Population - a Qualitative Survey Study

PRO114 Wilson Disease: Unmet NEEDS Emerging from the Italian Population - a Qualitative Survey Study

Informing the Development of a Digital Health Platform Through Universal Points of Care: Qualitative Survey Study.

BackgroundEpilepsy, multiple sclerosis (MS), and depression are chronic conditions where technology holds potential in clinical monitoring and self-management. Over 5 years, the Remote Assessment of Disease and Relapse - Central Nervous System (RADAR-CNS) consortium has explored the application of remote measurement technology (RMT) to the management and self-management of patients in these clinical areas. The consortium is large and includes clinical and nonclinical researchers as well as a patient advisory board.ObjectiveThis formative development study aimed to understand how consortium members viewed the potential of RMT in epilepsy, MS, and depression.MethodsIn this qualitative survey study, we developed a methodological tool, universal points of care (UPOC), to gather views on the potential use, acceptance, and value of a novel RMT platform across 3 chronic conditions (MS, epilepsy, and depression). UPOC builds upon use case scenario methodology, using expert elicitation and analysis of care pathways to develop scenarios applicable across multiple conditions. After developing scenarios, we elicited views on the potential of RMT in these different scenarios through a survey administered to 28 subject matter experts, consisting of 16 health care practitioners; 5 health care services researchers; and 7 people with lived experience of MS, epilepsy, or depression. Survey results were analyzed thematically and using an existing framework of factors describing links between design and context.ResultsThe survey elicited potential beneficial applications of the RADAR-CNS RMT system as well as patient, clinical, and nonclinical requirements of RMT across the 3 conditions of interest. Potential applications included recognition of early warning signs of relapse from subclinical signals for MS, seizure precipitant signals for epilepsy, and behavior change in depression. RMT was also thought to have the potential to overcome the problem of underreporting, which is especially problematic in epilepsy, and to allow the capture of secondary symptoms that are not generally collected in MS, such as mood.ConclusionsRespondents suggested novel and unanticipated uses of RMT, including the use of RMT to detect emerging side effects of treatment, enable behavior change for sleep regulation and activity, and offer a way to include family and other carers in a care network, which could assist with goal setting. These suggestions, together with others from this and related work, will inform the development of the system for its eventual application in research and clinical practice. The UPOC methodology was effective in directing respondents to consider the value of health care technologies in condition-specific experiences of everyday life and working practice.

Perceptions of Artificial Intelligence Among Healthcare Staff: A Qualitative Survey Study.

Objectives: The medical community is in agreement that artificial intelligence (AI) will have a radical impact on patient care in the near future. The purpose of this study is to assess the awareness of AI technologies among health professionals and to investigate their perceptions toward AI applications in medicine. Design: A web-based Google Forms survey was distributed via the Royal Free London NHS Foundation Trust e-newsletter. Setting: Only staff working at the NHS Foundation Trust received an invitation to complete the online questionnaire. Participants: 98 healthcare professionals out of 7,538 (response rate 1.3%; CI 95%; margin of error 9.64%) completed the survey, including medical doctors, nurses, therapists, managers, and others. Primary outcome: To investigate the prior knowledge of health professionals on the subject of AI as well as their attitudes and worries about its current and future applications. Results: 64% of respondents reported never coming across applications of AI in their work and 87% did not know the difference between machine learning and deep learning, although 50% knew at least one of the two terms. Furthermore, only 5% stated using speech recognition or transcription applications on a daily basis, while 63% never utilize them. 80% of participants believed there may be serious privacy issues associated with the use of AI and 40% considered AI to be potentially even more dangerous than nuclear weapons. However, 79% also believed AI could be useful or extremely useful in their field of work and only 10% were worried AI will replace them at their job. Conclusions: Despite agreeing on the usefulness of AI in the medical field, most health professionals lack a full understanding of the principles of AI and are worried about potential consequences of its widespread use in clinical practice. The cooperation of healthcare workers is crucial for the integration of AI into clinical practice and without it the NHS may miss out on an exceptionally rewarding opportunity. This highlights the need for better education and clear regulatory frameworks.

Remote training for combat medics during the COVID-19 era: lessons learnt for future crises?

BackgroundIn response to COVID-19, the UK government ordered strict social distancing measures. The UK Armed Forces followed these to protect the force and ensure readiness to respond to various tasking...

Residents Think in the “Now” and Supervisors Think Ahead in the Operating Room. A Survey Study About Task Perception of Residents and Supervising Surgeons

Progressive autonomous task performance is the cornerstone of teaching residents in the operating room, where they are entrusted with autonomy when they meet their supervisors' preferences. To optimize the teaching, supervisors need to be aware of how residents experience parts of the procedure. This study provides insight into how supervisors and residents perceive different tasks of a single surgical procedure. In this qualitative survey study a cognitive task analysis (CTA) of supervisors and residents for the 47 tasks of an uncemented total hip arthroplasty was executed. Both groups rated the level of attention they would assign to each task and were asked to explain attention scores of 4 or 5. University Medical Centre Groningen (the Netherlands) and its 5 affiliated teaching hospitals. Seventeen supervising surgeons and 21 residents. Normal attention (median attention score 3) was assigned by supervisors to 34 tasks (72.3%) and by residents to 35 tasks (74.5 %). Supervisors rated 12 tasks (25.6%) and residents 9 tasks (19.1%) with a median attention score of 4. In general, supervisors associated high attention with patient outcome and prevention of complications, while residents associated high attention with "effort." Supervisors and residents assigned attention to tasks for different reasons. Supervisors think ahead and emphasize patient outcome and prevention of complications when they indicate high attention, while residents think in the "now" and raise attention to execute the tasks themselves. The results of this study allow residents and supervisors to anticipate preferences: residents are able to appreciate why supervisors increase attention to specific tasks, and supervisors obtain information on which tasks require individual guidance of residents. This information can contribute to improve the learning climate in the operating room and task-specific procedural training.

Finding the Best Way to Deliver Online Educational Content in Low-Resource Settings: Qualitative Survey Study.

BackgroundThe reach of internet and mobile phone coverage has grown rapidly in low- and middle-income countries (LMICs). The potential for sharing knowledge with health care workers in low-resource settings to improve working practice is real, but barriers exist that limit access to online information. Burns affect more than 11 million people each year, but health care workers in low-resource settings receive little or no training in treating burn patients. Interburns' training programs are tailor-made to improve the quality of burn care in Asia, Africa, and the Middle East; the challenge is to understand the best way of delivering these resources digitally toward improved treatment and care of burn patients.ObjectiveThe aim of the study, funded by the National Institute for Health Research (NIHR), was to understand issues and barriers that affect health care worker access to online learning in low-resource settings in order to broaden access to Interburns' training materials and improve burn-patient care.MethodsA total of 546 participants of Interburns' Essential Burn Care (EBC) course held in Bangladesh, Nepal, Ethiopia, and the West Bank, the occupied Palestinian Territories, between January 2016 and June 2018 were sent an online survey. EBC participants represent the wide range of health care professionals involved with the burn-injured patient. A literature review was carried out as well as research into online platforms.ResultsA total of 207 of 546 (37.9%) participants of the EBC course did not provide an email address. Of the 339 email addresses provided, 81 (23.9%) “bounced” back. Surgeons and doctors were more likely to provide an email address than nurses, intern doctors, or auxiliary health care workers. A total of 258 participants received the survey and 70 responded, giving a response rate of 27.1%. Poor internet connection, lack of time, and limited access to computers were the main reasons for not engaging with online learning, along with lack of relevant materials. Computers were seen as more useful for holding information, while mobile phones were better for communicating and sharing knowledge. Health care workers in LMICs use mobile phones professionally on a daily basis. A total of 80% (56/70) felt that educational content on burns should be available through mobile apps.ConclusionsHealth care workers in low-resource settings face a variety of barriers to accessing educational content online. The reliance on email for sign-up to learning management systems is a significant barrier. Materials need to be relevant, localized, and easy to consume offline if necessary, to avoid costs of mobile phone data. Smartphones are increasingly used professionally every day for communication and searching for information, pointing toward the need for tailored educational content to be more available through mobile- and web-based apps.

Patients' Experiences and Attitudes of Using a Secure Mobile Phone App for Medical Photography: Qualitative Survey Study.

BackgroundPoint-of-care clinical photography using mobile devices is coming of age as a new standard of care for clinical documentation. High-quality cameras in modern smartphones facilitate faithful reproduction of clinical findings in photographs; however, clinical photographs captured on mobile devices are often taken using the native camera app on the device and transmitted using relatively insecure methods (eg, SMS text message and email) that do not preserve images as part of the electronic medical records. Native camera apps lack robust security features and direct integration with electronic health records (EHRs), which may limit patient acceptability and usefulness to clinicians. In March 2015, Mayo Clinic overcame these barriers by launching an internally developed mobile app that allows health care providers to securely capture clinical photographs and upload them to the EHR in a manner that is compliant with patient privacy and confidentiality regulations.ObjectiveThe study aimed to understand the perceptions, attitudes, and experiences of patients who were photographed using a mobile point-of-care clinical image capture app.MethodsThe study included a mail-out survey sent to 292 patients in Rochester, Minnesota, who were photographed using a mobile point-of-care clinical image capture app within a preceding 2-week period.ResultsThe surveys were completed by 71 patients who recalled being photographed. Patients were seen in 18 different departments, with the most common departments being dermatology (19/71, 27%), vascular medicine (17/71, 24%), and family medicine (10/71, 14%). Most patients (49/62, 79%) reported that photographs were taken to simply document the appearance of a clinical finding for future reference. Only 16% (10/62) of patients said the photographs were used to obtain advice from a specialist. Furthermore, 74% (51/69) of the patients said they would recommend medical photography to others and 67% (46/69) of them thought the photos favorably affected their care. Patients were largely indifferent about the device used for photography (mobile device vs professional camera; 40/69, 58%) or the identity of the photographer (provider vs professional photographer; 52/69, 75%). In addition, 90% (64/71) of patients found reuse of photographs for one-on-one learner education to be acceptable. Acceptability for other uses declined as the size of the audience increased, with only 42% (30/71) of patients deeming reuse on social media for medical education as appropriate. Only 3% (2/71) of patients expressed privacy or confidentiality concerns. Furthermore, 52% (33/63) of patients preferred to provide consent verbally, and 21% (13/63) of them did not think a specific consent process was necessary.ConclusionsPatient attitudes regarding medical photography using a secure EHR-integrated app were favorable. Patients perceived that photography improved their care despite the most common reason for photography being to simply document the appearance of a clinical finding for future reference. Whenever possible, health care providers should utilize secure EHR-integrated apps for point-of-care medical photography using mobile devices.

Insurance Customers' Expectations for Sharing Health Data: Qualitative Survey Study.

BackgroundInsurance organizations are essential stakeholders in health care ecosystems. For addressing future health care needs, insurance companies require access to health data to deliver preventative and proactive digital health services to customers. However, extant research is limited in examining the conditions that incentivize health data sharing.ObjectiveThis study aimed to (1) identify the expectations of insurance customers when sharing health data, (2) determine the perceived intrinsic value of health data, and (3) explore the conditions that aid in incentivizing health data sharing in the relationship between an insurance organization and its customer.MethodsA Web-based survey was distributed to randomly selected customers from a Finnish insurance organization through email. A single open-text answer was used for a qualitative data analysis through inductive coding, followed by a thematic analysis. Furthermore, the 4 constructs of commitment, power, reciprocity, and trust from the social exchange theory (SET) were applied as a framework.ResultsFrom the 5000 customers invited to participate, we received 452 surveys (response rate: 9.0%). Customer characteristics were found to reflect customer demographics. Of the 452 surveys, 48 (10.6%) open-text responses were skipped by the customer, 57 (12.6%) customers had no expectations from sharing health data, and 44 (9.7%) customers preferred to abstain from a data sharing relationship. Using the SET framework, we found that customers expected different conditions to be fulfilled by their insurance provider based on the commitment, power, reciprocity, and trust constructs. Of the 452 customers who completed the surveys, 64 (14.2%) customers required that the insurance organization meets their data treatment expectations (commitment). Overall, 4.9% (22/452) of customers were concerned about their health data being used against them to profile their health, to increase insurance prices, or to deny health insurance claims (power). A total of 28.5% (129/452) of customers expected some form of benefit, such as personalized digital health services, and 29.9% (135/452) of customers expected finance-related compensation (reciprocity). Furthermore, 7.5% (34/452) of customers expected some form of empathy from the insurance organization through enhanced transparency or an emotional connection (trust).ConclusionsTo aid in the design and development of digital health services, insurance organizations need to address the customers’ expectations when sharing their health data. We established the expectations of customers in the social exchange of health data and explored the perceived values of data as intangible goods. Actions by the insurance organization should aim to increase trust through a culture of transparency, commitment to treat health data in a prescribed manner, provide reciprocal benefits through digital health services that customers deem valuable, and assuage fears of health data being used to prevent providing insurance coverage or increase costs.

Preservice teachers’ views about the twenty-first century skills: A qualitative survey study in Turkey and Sweden

The purpose of this study was to investigate the views of preservice teachers from Turkey and Sweden about twenty-first century skills. The participants of the study were 197 preservice teachers fr ...

Measuring the Efficiency of Public Hospitals in Kuwait: A Two-Stage Data Envelopment Analysis and a Qualitative Survey Study

The recent drop in oil prices has challenged public sector financing in Kuwait. Technical and scale efficiency scores for fifteen public hospitals in Kuwait from 2010 to 2014 were estimated using a two-stage data envelopment analysis (DEA). Technical efficiency scores were regressed against institutional characteristics using Tobit regression to investigate the determinants of efficiency differences in hospitals. Semi-structured interviews were also carried out with fourteen public and private hospital managers to qualitatively explore their perceptions and experience about about factors affecting hospital efficiency.
 
 The mean technical efficiency score for all hospitals was 85.8%, an improvement of 2% since 2010. The mean pure technical efficiency score was 79.6%, improving from 75% in 2010 to 81.2% in 2014. The mean scale efficiency score was 91.8%, improving from 87.6% in 2010 to 94.2% in 2014. Only three hospitals were constantly technically and scale efficient. Tobit regression showed that hospital efficiency was significantly associated with the average length of patient stay. Hospitals with more than 400 beds were potentially more technically and scale efficient. The qualitative study revealed that external factors affecting efficiency commonly included implemention of legislative changes and decreasing bureaucracy, while internal factors included increasing bed capacity and improving qualifications and training of human resources.
 
 Most public hospitals in Kuwait were not technically and scale efficient, but improvements were observed. Potential factors that affected the efficiency of hospitals in Kuwait were identified. These findings are useful to decision-makers in Kuwait for developing strategies to improve public hospital efficiency.

Seventh Graders’ Statistical Literacy: an Investigation on Bar and Line Graphs

The aim of the current study was to investigate the statistical literacy of seventh grade students regarding the concepts of average and variation on bar and line graphs presented in alternative real-life contexts. To this end, the statistical literacy levels of the seventh grade students were initially determined. Subsequently, definitions, interpretations and evaluations generated by the students at varying levels of statistical literacy were examined in further depth. More specifically, a qualitative survey study was conducted with 164 seventh graders from two public middle schools in Ankara, Turkey. The data, collected by means of a-five-item instrument, were analyzed by utilizing the modified version of the six-hierarchical-level framework developed by Watson and Callingham (Statistics Education Research Journal, 2(2), 3–46, 2003). The findings revealed that most of the students’ statistical literacy levels were identified as either Level 3 or Level 4 in the framework with respect to the concept of average, and either Level 1 or Level 2 with respect to the concept of variation. Hence, it can be inferred that while many of the students could interpret average in the given contexts, they had difficulty in interpreting variation. Although definitions and evaluations related to both concepts were found difficult by seventh graders, the graphs, particularly bar graphs, which students were provided with, were observed to be helpful for students in their evaluation of variation. Additionally, students benefitted from some of the contexts they were provided while evaluating variation. Finally, the analysis revealed some discrepancies among students’ definitions and their interpretations or evaluations.

Assessment of the Impact of Rapid Point-of-Care CD4 Testing in Primary Healthcare Clinic Settings: A Survey Study of Client and Provider Perspectives.

Background: The high burden of disease in South Africa presents challenges to public health services. Point-of-care (POC) technologies have the potential to address these gaps and improve healthcare systems. This study ascertained the acceptability and impact of POC CD4 testing on patients’ health and clinical management. Methods: We conducted a qualitative survey study with patients (n = 642) and healthcare providers (n = 13) at the Lancers Road (experienced POC) and Chesterville (non-experienced POC) primary healthcare (PHC) clinics from September 2015 to June 2016. Results: Patients (99%) at Lancers and Chesterville PHCs were positive about POC CD4 testing, identifying benefits: No loss/delay of test results (6.4%), cost/time saving (19.5%), and no anxiety (5.1%), and 58.2% were ready to initiate treatment. Significantly more patients at Chesterville than Lancers Road PHC felt POC would provide rapid clinical decision making (64.7% vs. 48.1%; p < 0.0001) and better clinic accessibility (40.4% vs. 24.7%; p < 0.0001) respectively. Healthcare providers thought same-day CD4 results would impact: Clinical management (46.2%), patient readiness (46.2%), and adherence (23.0%), and would reduce follow-up visits (7.7%), while 38.5% were concerned that further tests and training (15.4%) were required before antiretroviral therapy (ART) initiation. Conclusion: The high acceptability of POC CD4 testing and the immediate health, structural, and clinical management benefits necessitates POC implementation studies.

Perceptions of artificial intelligence in healthcare: findings from a qualitative survey study among actors in France

BackgroundArtificial intelligence (AI), with its seemingly limitless power, holds the promise to truly revolutionize patient healthcare. However, the discourse carried out in public does not always correlate with the actual impact. Thus, we aimed to obtain both an overview of how French health professionals perceive the arrival of AI in daily practice and the perception of the other actors involved in AI to have an overall understanding of this issue.MethodsForty French stakeholders with diverse backgrounds were interviewed in Paris between October 2017 and June 2018 and their contributions analyzed using the grounded theory method (GTM).ResultsThe interviews showed that the various actors involved all see AI as a myth to be debunked. However, their views differed. French healthcare professionals, who are strategically placed in the adoption of AI tools, were focused on providing the best and safest care for their patients. Contrary to popular belief, they are not always seeing the use of these tools in their practice. For healthcare industrial partners, AI is a true breakthrough but legal difficulties to access individual health data could hamper its development. Institutional players are aware that they will have to play a significant role concerning the regulation of the use of these tools. From an external point of view, individuals without a conflict of interest have significant concerns about the sustainability of the balance between health, social justice, and freedom. Health researchers specialized in AI have a more pragmatic point of view and hope for a better transition from research to practice.ConclusionAlthough some hyperbole has taken over the discourse on AI in healthcare, diverse opinions and points of view have emerged among French stakeholders. The development of AI tools in healthcare will be satisfactory for everyone only by initiating a collaborative effort between all those involved. It is thus time to also consider the opinion of patients and, together, address the remaining questions, such as that of responsibility.

Acceptance and Expectations of Medical Experts, Students, and Patients Toward Electronic Mental Health Apps: Cross-Sectional Quantitative and Qualitative Survey Study.

BackgroundThe acceptability of electronic mental (e-mental) health apps has already been studied. However, the attitudes of medical experts, students, and patients taking into account their knowledge of and previous experiences with e-mental health apps have not been investigated.ObjectiveThe aim of this study was to explore the attitudes, expectations, and concerns of medical experts, including physicians, psychotherapists and nursing staff, students of medicine or psychology, and patients toward e-mental health apps when considering their knowledge of and former experiences with e-mental health apps.MethodsThis cross-sectional quantitative and qualitative survey was based on a self-developed questionnaire. A total of 269 participants were included (104 experts, 80 students, and 85 patients), and 124 eligible participants answered a paper version and 145 answered an identical online version of the questionnaire. The measures focused on existing knowledge of and experiences with e-mental health apps, followed by a question on whether electronic health development was generally accepted or disliked. Further, we asked about the expectations for an ideal e-mental health app and possible concerns felt by the participants. All items were either presented on a 5-point Likert scale or as multiple-choice questions. Additionally, 4 items were presented as open text fields.ResultsAlthough 33.7% (35/104) of the experts, 15.0% (12/80) of the students, and 41.2% (35/85) of the patients knew at least one e-mental health app, few had already tried one (9/104 experts [8.7%], 1/80 students [1.3%], 22/85 patients [25.9%]). There were more advocates than skeptics in each group (advocates: 71/104 experts [68.3%], 50/80 students [62.5%], 46/85 patients [54.1%]; skeptics: 31/104 experts [29.8%], 20/80 students [25.0%], 26/85 patients [30.6%]). The experts, in particular, believed, that e-mental health apps will gain importance in the future (mean 1.08, SD 0.68; 95% CI 0.94-1.21). When asked about potential risks, all groups reported slight concerns regarding data security (mean 0.85, SD 1.09; 95% CI 0.72-0.98). Patient age was associated with several attitudes toward e-mental health apps (future expectations: r=–0.31, P=.005; total risk score: r=0.22, P=.05). Attitudes toward e-mental health apps correlated negatively with the professional experience of the experts (rs(94)=–0.23, P=.03).ConclusionsAs opposed to patients, medical experts and students lack knowledge of and experience with e-mental health apps. If present, the experiences were assessed positively. However, experts show a more open-minded attitude with less fear of risks. Although some risks were perceived regarding data security, the attitudes and expectations of all groups were rather positive. Older patients and medical experts with long professional experience tend to express more skepticism.Trial RegistrationGerman Clinical Trials Register DRKS00013095; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00013095

Perceived Barriers and Facilitators to the use of Point-of-Care Ultrasound for Clinicians in Oregon

The use of Point-of-Care Ultrasound (POCUS) to provide clinical data beyond the history and physical examination is a relatively new practice for primary care providers and hospitalists. It takes many hours of dedicated ultrasound (US) training and practice to achieve POCUS proficiency; further, perceptions and attitudes of clinicians play a major role in adopting POCUS into daily clinical repertoire [1, 2]. Thus there are many possible barriers that could impede a clinician’s ability to develop the skillset to use POCUS in clinical practice. The state of Oregon encompasses vast rural and underserved areas where POCUS could be a useful resource to improve local patient care [3,4]. For this reason, a qualitative survey study was conducted to assess the perceived barriers of clinicians to the clinical incorporation of POCUS.&#x0D;

Documentation: Its Importance in Medical and Dental Health Sectors – A Questionnaire Based Qualitative Survey Study

Documentation: Its Importance in Medical and Dental Health Sectors – A Questionnaire Based Qualitative Survey Study

Consumer perception of plant-based proteins: The value of source transparency for alternative protein ingredients

Consumers in the ‘clean label’ trend are increasingly interested in knowing the ingredients of their food. There is also an emerging demand for more and diverse protein products as well as a trend towards plant-based foods. Food manufacturers consider reformulation of the ingredient lists of their products or innovation of new food products answering to these trends. However, they need to know how consumers perceive new alternative ingredients, such as alternative proteins, and how the exchange of ingredients affects overall product and subjective quality perception. An experimental quantitative and qualitative survey study among 495 consumers in Denmark explored how consumer ingredient perception carries over to product perception as well as how differences in one protein ingredient affects attitude and subjective quality perception for plant-based products containing protein. Results confirm the favourable view on protein as an ingredient. Among consumers who have experience with or an interest in plant-based food, specifying the protein origin leads to more favourable perception of the product. Potato protein emerges as particularly favourable in a number of subjective quality dimension, is freely associated with starch and well understood as providing texture. Findings suggest food manufacturers can improve product perception among the target market when highlighting the precise protein type in the ingredient list. Potato protein can be a worthwhile alternative protein to use as it leads to favourable consumer perception.

A Qualitative Survey Study of United States Burn Units: Pathways to a Career in Burn Surgery.

With current changes in training requirements, it is important to understand the venues in the United States for a general surgery (GS) and plastic surgery (PS) resident interested in pursuing a burn surgery career. The study aims to evaluate the pathways to a career in burn surgery and the current state of leadership. A cross-sectional study was conducted between August and September 2017. A 12-question survey was sent to all burn unit directors in the United States, asking about their background, who manages various aspects of burn care and the hiring requirements. Responses were received from 55 burn unit directors (47% response rate). Burn units are lead most commonly by physicians who received GS training (69%), but the majority either did not undergo fellowship training (31%) or completed a burn surgery fellowship (29%). While surgical care (GS = 51%, PS = 42%) and wound care (GS = 51%, PS = 42%) were predominantly managed by GS- or PS-trained burn teams, management of other aspects of burn care varied depending on the institution, demonstrating that a shift in burn care management. The desired hiring characteristics, including GS (67%) or PS residency (44%) and a burn surgery (55%), trauma surgery (15%), or critical care (44%) fellowship. Directors' training significantly influenced their preferences for hiring requirements. While leadership in burn surgery is dominated by GS-trained physicians, the surgical and wound care responsibilities are shared among PS and GS. Although one third of current directors did not undergo fellowship training, aspiring surgeons are advised to obtain a burn surgery and/or critical care fellowship.

Penggunaan Teknik Desentralisasi Sistematis Dalam Manajemen Stres Mahasiswa Program Studi Bimbingan dan Konseling Universitas Sultan Ageng Tirtayasa

Abstract Systematic decentralization is a technique to reduce emotional response by using relaxation methods. Decentralization techniques serve to reduce stress pressure experienced by individuals. The purpose of this study was to find out the use of systematic decentralization techniques in the management of stresses. The method in this study is qualitative descriptive, survey, and literature study. The research sample was 6th semester students of 2017/2018 Academic Year in Guidance and Counseling Study Program FKIP Sultan Ageng Tirtayasa University. The stages of implementing a relaxation treatment of decentralization techniques can be carried out, as follows: first stage, second stage and third stage. The results of the study show that systematic decentralization techniques can be used in managing stress in students. This can be seen from the results of interview analysis to students given relaxation treatment students with systematic decentralization techniques. Keyword : Systematic decentralization, stress management

Young children’s conceptions of computers, code, and the Internet

In the present paper, we report the findings of a qualitative survey study of 195 Finnish 5th and 6th grade students' pre-instructional conceptions of artificial intelligence (AI). An exploration of these initial conceptions provides insight into students' preliminary understanding of the topic and informs curriculum designers and teachers about misconceptions that might jeopardize student learning. The findings suggest that students' initial conceptions of AI are varied and often uninformed. For instance, references to the role of data in training AI applications were practically nonexistent. Instead, AI was often described as an anthropomorphic technology that possesses cognitive qualities equivalent to those of humans––a conception that notably resembles how AI is portrayed in the media. As a pedagogical implication, our findings suggest that it would be valuable to “demystify” AI by exploring its technical principles (i.e., the role of data) of the “human-like” AI solutions students encounter in their everyday lives.