Use Of Direct Observation Research Articles

Evaluating Mobile Application as Assistive Technology to Improve Students with Learning Disabilities for Communication, Personal Care and Physical Function

This study addresses the challenges faced by Malaysian students with learning disabilities, emphasizing the critical role of assistive technology (AT), particularly Augmentative and Alternative Communication (AAC) within mobile applications. Focusing on the Smart-App, the research explores its efficacy in supporting students in learning and establishing routines for activities of daily living (ADLs). Four preschool students aged five to six attending a specialized institution, with the use of direct observation and an adapted checklist methodology to assess their personal care, physical function, and communication aspects. Smart-App's shows significant impact on communication, enhancing two-way communication through visual schedules and AAC features. In personal care, the app facilitated ADLs, such as handwashing and tooth brushing, emphasizing a sequential click-through approach. Additionally, the oral hygiene module served as an effective pedagogical tool. In terms of physical function, Smart-App contributed to toilet training and identified challenges in specific physical activities. The study contributes substantively to the discourse on AT in education, underscoring the potential of Smart-App as a valuable tool for enhancing ADLs and fostering independence among students with learning disabilities.

Efektivitas Penilaian Anekdot untuk Mengukur Capaian Pembelajaran Kognitif Anak Usia Dini

This study aims to evaluate the use of anecdotal assessment in measuring the cognitive learning achievement of early childhood children in the context of the Merdeka curriculum at the Integrated Early Childhood Education Citra Bakti. The method applied is qualitative descriptive with data collection techniques through interviews and documentation. Primary data sources include interview results and observations of children's and teachers' activities, while secondary sources consist of documented planning and assessments previously conducted. Data analysis was performed descriptively. The research findings indicate that at the Integrated Early Childhood Education Citra Bakti, the Merdeka curriculum is implemented using anecdotal assessment, covering achievements in religious values, morals, identity, and literacy. The effectiveness of anecdotal assessment is proven in evaluating the learning achievements of early childhood children in the Merdeka curriculum, providing a comprehensive overview of social, emotional, and cognitive development aspects. This approach is in line with the principles of the Merdeka curriculum, which focuses on developing the creativity, independence, and uniqueness of each child. The use of direct observation in anecdotal assessment also provides opportunities for educators to better understand the individual needs and interests of children. By analyzing children's activity anecdotes, educators can provide more accurate responses to their individual needs and interests, allowing for the development of appropriate learning strategies that support the holistic development of children.

Competency Assessment of General Surgery Trainees: A Perspective From the Global South, in a CBME-Naive Context

Before proceeding with local implementation of competency-based medical education-related assessment practices designed and evaluated in the Global North, we sought to challenge the assumption that this would be perceived as both necessary and acceptable in our context where training and assessment is based on a traditional, knowledge-focused approach. The aim of this study was to determine the perspectives of general surgery trainees and consultants towards the assessment of competence, how this has been achieved previously, and how it should be performed in the future at the University of Cape Town (UCT), South Africa. Semi-structured interviews were conducted with consultants and trainees. Interviews were transcribed and then analyzed using a Reflexive Thematic Analysis approach. Ten consultants (5 senior and 5 junior) and 10 trainees (5 South African and 5 international) from the Division of General Surgery at UCT in August 2022. Five unique themes were developed: (1) Assessment of competence is essential, (2) competence includes multiple domains of practice, (3) a surgeon must be able to operate, (4) previously used methods were inadequate to assess competence, and (5) frequent assessment with feedback is desired. The themes were considered in the context of Situated Learning Theory, particularly Communities of Practice and their role in the training for, and authentic assessment of, competence in general surgery trainees. Participants described a need to develop and implement a new competency assessment program for general surgery training in this context, which is aligned with described competency-based medical education principles. Thoughtful integration of the formative and summative use of direct observation in the workplace, with a clear emphasis on procedural ability and the provision of high-quality feedback, may enhance the successful implementation of a strategy for competency-based assessment in general surgery training programs.

The Challenges of Building Sustainable Cities in Cameroon: Health Issues Associated with a Rapid Urban Population Increase in Buea Municipality.

Rapid urbanization compounded by urban poverty is one of the main challenges facing many Sub-Saharan African countries. The Buea municipality is the 10th largest city in Cameroon and equally faces such problems brought about by unplanned development in the past four decades. In 2020, the population growth rate in Buea rose to 42% compared to 5.6% in 2005, especially in the peri-urban areas. This resulted in direct and indirect pressures on available resources. Since 2019, Buea has been hosting close to 100,000 Internally Displaced Persons (IDPs) fleeing from the conflict between the defense and security forces and the separatist groups operating in the South West and North West Regions. Consequently, this expansion of urban agglomerations in Buea brings about challenges for the urbanites whose standard of living within the urban space is affected. This article seeks to qualitatively examine how this rapid urbanization has contributed to this recurrence of cholera outbreak since 2019 and the effects on the healthcare system and measures that are in place to mitigate this outbreak. In addressing these issues, the study administered in-depth phone Interviews with medical practitioners at Buea Regional Hospital, which is the main Cholera Treatment Centre in Buea. It also conducted in-depth phone interviews with public health experts at the South West Regional Delegation of Public Health and Buea Council personnel incharge of hygiene and sanitation. The study also made use of direct observation of the researcher on the field during sensitization campaigns in the affected communities in Buea. Base on the results the influx of IDPs have stress the already existing sanitation and shortage/rationing of water in the town. The study also found out that governance and cultural issues are equally associated to the problem of recurrence of the cholera disease in Buea Municipality.

Diagnosis, Treatment, and Prevention of Tuberculosis Among People Experiencing Homelessness in the United States: Current Recommendations.

Tuberculosis (TB) is a public health problem, especially among people experiencing homelessness (PEH). The Advisory Council for the Elimination of Tuberculosis issued recommendations in 1992 for TB prevention and control among PEH. Our goal was to provide current guidelines and information in one place to inform medical and public health providers and TB programs on TB incidence, diagnosis, and treatment among PEH. We reviewed and synthesized diagnostic and treatment recommendations for TB disease and latent TB infection (LTBI) as of 2022 and information after 1992 on the magnitude of homelessness in the United States, the incidence of TB among PEH, the role of public health departments in TB case management among PEH, and recently published evidence. In 2018, there were 1.45 million estimated PEH in the United States. During the past 2 decades, the incidence of TB was >10 times higher and the prevalence of LTBI was 7 to 20 times higher among PEH than among people not experiencing homelessness. TB outbreaks were common in overnight shelters. Permanent housing for PEH and the use of rapid TB diagnostic tests, along with isolation and treatment, reduced TB exposure among PEH. The use of direct observation enhanced treatment adherence among PEH, as did involvement of social workers to help secure shelter, food, safety, and treatment for comorbidities, especially HIV and substance use disorders. Testing and treatment for LTBI prevented progression to TB disease, and shorter LTBI regimens helped improve adherence. Federal agencies and the National Health Care for the Homeless Council have helpful resources. Improvements in TB diagnosis, treatment, and prevention among PEH are possible by following existing recommendations and using client-centered approaches.

ICRE Top Research Abstracts

ICRE Top Research Abstracts

Does BDS Produce Antisemitic Disruption to Student Government and Jewish Student Life? An Analysis of Pro-BDS Resolutions at Ohio State University and the Exclusion of Jewish Students on Campus

Abstract The proliferation of debates and resolutions related to the “Boycott, Divestment, and Sanctions” movement at US colleges and universities raises questions about the relation­ship between the objectives of Israel- and Palestine-related student activism with that of student governments and their nature and purpose within campus life. This study makes use of direct observation by the first author of two debates held at Ohio State University (OSU) in January 2018 and December 2018 over resolutions proposed to the university’s Undergraduate Student Government (USG) to adopt a pro-BDS platform. The authors examine the recognition and non-recognition of Jewish students’ right to perceive and identify racism and exclusion within these contexts. The authors further examine whether purported goals of inclusion, constructive dialogue and conflict resolution are benefited by contemporary BDS resolution debates, concluding that such goals-in addition to the formal purpose and function of student governments-are ill-served by the process, con­tent, and outcomes of debates in the form taken at OSU.

Evaluation and Enhancement of a Comprehensive Controlled Substances Management Process at an Academic Medical Center

Purpose: Controlled substances management is highly regulated, and requires institutions to have processes in place to maintain a closed-loop. This study was conducted to comprehensively evaluate the current state of controlled substances management, propose optimization opportunities, and implement steps to align the medication use process (MUP) to a defined desired state. Methods: This evaluation was conducted in 2 phases. In phase 1, the current state of controlled substances management was assessed in order to develop a gap analysis tool and failure mode and effects analysis (FMEA). In phase 2, a work group was assembled to address opportunities within the FMEA. The work group prioritized opportunities using the risk priority number (RPN), and formulated action steps to align processes with the defined desired state. Results: Through the literature evaluation, a desired state, consisting of 86 segments, was defined and compared with a gap analysis tool. Direct observation of the MUP allowed for development of 13 process maps depicting current state. Of the 86 segments, it was determined the study institution had a compliance rate of 62%. The remaining 38% correlated with 55 actionable process opportunities that were included in the FMEA. To date, 31 of the 55 (56%) opportunities have been successfully addressed by the work group. Conclusion: Use of direct observation to formulate a gap analysis tool and FMEA is an effective modality to evaluate controlled substances processes. These tools allow for pharmacy departments to identify and prioritize opportunities to optimize controlled substances management within an academic medication center

Training Public Sector Clinicians in Competency-Based Clinical Supervision: Methods, Curriculum, and Lessons Learned.

This article describes an initiative to train public sector clinicians in competency-based clinical supervision. It was delivered as an 18-session course taught online to clinicians employed in departments of behavioral health in nine Southern California counties. The curriculum was co-constructed by a team of clinical supervision scholars and leaders who then served as instructors. Each two-hour meeting addressed a specific topic for which a training video had been prepared, usually featuring a member of the training team who had expertise in that topic. The second part of each meeting focused on a class member’s supervision case presentation. Those presentations revealed 35 themes; the four most frequently occurring were: developing supervisees’ clinical competencies, addressing countertransference and parallel process, balancing clinical and administrative supervisory roles, and addressing record keeping/paperwork. Participants’ pre-to-post supervisory self-efficacy changes demonstrated a moderate effect size (Cohen’s d = .46) for the training, with the greatest pre- to post-training changes being in the use of technology, multicultural competencies (awareness of oppression, bias, and stereotyping in clinical work and in clinical supervision), and contracting. They reported that the strengths of the course included an inclusive learning environment and opportunities to reflect on and apply new knowledge and skills, though they also reported struggling with the assignments and the course platform software. Lessons learned reflected the use of technology in this online program, the importance of obtaining buy-in from agency decision makers and being prepared to address challenges related to the use of direct observation in supervision, gatekeeping, and enacting the simultaneous roles of administrative and clinical supervisor.

A phenomenological investigation of patients\u2019 experiences during direct observation in residency: busting the myth of the fly on the wall

Direct observation (DO) of residents by supervisors is a highly recommended educational tool in postgraduate medical education, yet its uptake is poor. Residents and supervisors report various reasons for not engaging in DO. Some of these relate to their interaction with patients during DO. We do not know the patient perspectives on these interactions, nor, more broadly, what it is like to be a patient in a DO situation. Understanding the patient perspective may lead to a more complete understanding of the dynamics in DO situations, which may benefit patient wellbeing and improve the use of DO as an educational tool. We conducted a phenomenological interview study to investigate the experience of being a patient in a DO situation. Our analysis included multiple rounds of coding and identifying themes, and a final phase of phenomenological reduction to arrive at the essential elements of the experience. Constant reflexivity was at the heart of this process. Our results provide a new perspective on the role of the supervisor in DO situations. Patients were willing to address the resident, but sought moments of contact with, and some participation by, the supervisor. Consequently, conceptions of DO in which the supervisor thinks she is a fly on the wall rather than a part of the interaction, should be critically reviewed. To that end, we propose the concept of participative direct observation in workplace learning, which also acknowledges the observer’s role as participant. Embracing this concept may benefit both patients’ wellbeing and residents’ learning.

Ten ways to get a grip on designing and implementing a competency-based medical education training program.

BackgroundGlobally there is a move to adopt competency-based medical education (CBME) at all levels of the medical training system. Implementation of a complex intervention such as CBME represents a marked paradigm shift involving multiple stakeholders.MethodsThis article aims to share tips, based on review of the available literature and the authors’ experiences, that may help educators implementing CBME to more easily navigate this major undertaking and avoid “black ice” pitfalls that educators may encounter.ResultsCareful planning prior to, during and post implementation will help programs transition successfully to CBME. Involvement of key stakeholders, such as trainees, teaching faculty, residency training committee members, and the program administrator, prior to and throughout implementation of CBME is critical. Careful and selective choice of key design elements including Entrustable Professional Activities, assessments and appropriate use of direct observation will enhance successful uptake of CBME. Pilot testing may help engage faculty and learners and identify logistical issues that may hinder implementation. Academic advisors, use of curriculum maps, and identifying and leveraging local resources may help facilitate implementation. Planned evaluation of CBME is important to ensure choices made during the design and implementation of CBME result in the desired outcomes.ConclusionAlthough the transition to CBME is challenging, successful implementation can be facilitated by careful design and strategic planning.

Comparing the use of direct observation, standardized patients and exit interviews in low- and middle-income countries: a systematic review of methods of assessing quality of primary care.

Clinical records in primary healthcare settings in low- and middle-income countries (LMIC) are often lacking or of too poor quality to accurately assess what happens during the patient consultation. We examined the most common methods for assessing healthcare workers’ clinical behaviour: direct observation, standardized patients and patient/healthcare worker exit interview. The comparative feasibility, acceptability, reliability, validity and practicalities of using these methods in this setting are unclear. We systematically review and synthesize the evidence to compare and contrast the advantages and disadvantages of each method. We include studies in LMICs where methods have been directly compared and systematic and narrative reviews of each method. We searched several electronic databases and focused on real-life (not educational) primary healthcare encounters. The most recent update to the search for direct comparison studies was November 2019. We updated the search for systematic and narrative reviews on the standardized patient method in March 2020 and expanded it to all methods. Search strategies combined indexed terms and keywords. We searched reference lists of eligible articles and sourced additional references from relevant review articles. Titles and abstracts were independently screened by two reviewers and discrepancies resolved through discussion. Data were iteratively coded according to pre-defined categories and synthesized. We included 13 direct comparison studies and eight systematic and narrative reviews. We found that no method was clearly superior to the others—each has pros and cons and may assess different aspects of quality of care provision by healthcare workers. All methods require careful preparation, though the exact domain of quality assessed and ethics and selection and training of personnel are nuanced and the methods were subject to different biases. The differential strengths suggest that individual methods should be used strategically based on the research question or in combination for comprehensive global assessments of quality.

Use of Direct In-Person Observation in the Care of Hospitalized Older Adults with Cognitive Impairment: A Systematic Review.

Hospitalized older adults with cognitive impairment (CI) due to dementia and/or delirium may require individualized care strategies such as direct observation to mitigate safety concerns and manage behavioral symptoms. Despite common use of direct observation as a strategy, little is known about its practice and outcomes. A systematic review was conducted to identify, appraise, and synthesize literature on direct observation among hospitalized older adults with CI. The search yielded 16 eligible studies, with four describing current practices, nine reporting quality improvement efforts to broaden direct observation, and three focusing on direct observation reduction. Strength of evidence across studies was weak, limited in scope, and lacking clarity in definitions, indications for use and discontinuation, and documentation. Overall, findings highlight differing views on direct observation and the need for future, rigorous evaluation of approaches (e.g., nursing autonomy in initiating and discontinuing observation) to better align direct observation with patient needs. [Journal of Gerontological Nursing, 46(5), 23-30.].

Being There: The Importance of Direct Observation in Resident Assessment.

There are many methods to assess resident competency. In this report the author describes an experience that strongly suggests the superiority of direct observation compared to other methods. Literature comparing direct observation to other methods is cited. In addition ways to create time for direct observation and how to promote wider use of direct observation are discussed

Effect of use of direct observation of procedural skills for assessment for learning in Obstetrics and Gynaecology postgraduate students at Medical University, Bhutan: a prospective study

Introduction: Direct Observation of Procedural Skills (DOPS) is a valuable method to evaluate procedural skills. The aim of this study was to explore the effect of DOPS as an assessment method and its effect on their learning in Obstetrics and Gynecology Postgraduate students. Methods: Five residents and four faculty members from the department of Obstetrics and Gynecology, Khesar Gyalpo University of Medical Sciences of Bhutan participated in this study. A validated checklist was adopted, from which five core areas of DOPS were utilized for this study. The two skills selected for this study were Pap smear and Intra Uterine Contraceptive Device (IUCD) insertion. The acquired data were analyzed by descriptive statistics (frequency, percent and mean). Results: The results showed that student’s initial mean score was 4/9, which increased to nearly 8/9 in third attempt. Practically, all faculty members and students believed that DOPS was effective in facilitating students’ learning. Some of the students thought that repeated exposure to DOPS reduced their level of stress. Conclusions: It may be stated that DOPS is effective in facilitating students’ learning and clinical skills. Keywords: Assessment; DOPS; learning; Obstetrics and Gynecology; WPBA.

Occupational risks surveillance in informal vendors from Maputo: Experience of the use of direct observation for its monitoring

Over 90% of employment in Mozambique is informal. Given scarce resources and difficulties with monitoring informal employment, little is known about exposure to occupational hazards among informal workers in this country. Direct observation is a simple, easy, economical and rapid method for monitoring and obtaining data. We describe our experience with the use of direct observation of occupational hazards among informal street vendors in Maputo. Results reveal a high percentage of vendors are exposed to occupational hazards without any form of protection. Direct observation is a good method for monitoring occupational risks in exploratory phases of research or as a complementary method to quantitative data collection.

Comparing resident-patient encounters and case presentations in a family medicine clinic.

Oral case presentations following resident-patient interactions provide the primary mechanism by which faculty supervisors assess resident competence. However, the extent to which these presentations capture the content and quality of resident-patient communication during the encounter remains unknown. We aimed to determine whether: (i) the resident-patient encounter content matched information conveyed in the case presentation; (ii) the quality of resident-patient communication was accurately conveyed, and (iii) supervisors addressed effective and ineffective communication processes. A total of 22 pairs of resident-patient encounters and family medicine resident case presentations were video- or audiorecorded, transcribed and compared for content. Resident-patient communication was assessed using adapted versions of the Calgary-Cambridge Guide to the Medical Interview and Explanation and Planning Scale. Interviews and presentations contained largely congruent content, but social history and the patient's perspective were consistently excluded from case presentations. Although six of 19 specific communication skills were used in over 80% of resident encounters, the effective use of communication skills was widely variable. In most presentations, the quality of resident-patient communication was not explicitly conveyed to the supervisor. Although resident presentations provided 'cues' about communication issues, supervisors rarely responded. This study lends support to direct observation in workplace-based learning of communication skills. When content areas such as the patient's perspective and education are excluded, supervisors cannot address them. In addition, presentations provided minimal insight about the quality of resident-patient encounters and limited the ability to address communication skills. These skills could be enhanced by attending to communication cues during case presentations, making increased use of direct observation and feedback, and promoting faculty development to address these missed teaching opportunities.

Demographic-specific Validity of the Cancer Prevention Study-3 Sedentary Time Survey.

This study examined the 1-yr test-retest reliability and criterion validity of sedentary time survey items in a subset of participants from a large, nationwide prospective cohort. Participants included 423 women and 290 men age 31 to 72 yr in the Cancer Prevention Study-3. Reliability was assessed by computing Spearman correlation coefficients between responses from prestudy and poststudy surveys. Validity was assessed by comparing survey-estimated sedentary time with a latent variable representing true sedentary time estimated from the 7-d diaries, accelerometry, and surveys through the method of triads. Sensitivity analyses were restricted to 566 participants with an average of 14+ h of diary and accelerometer data per day for 7 d per quarter. Reliability estimates for total sitting time were moderate or strong across all demographic strata (Spearman ρ ≥ 0.6), with significant differences by race (P = 0.01). Reliability estimates were strongest for the TV-related sedentary time item (Spearman ρ, 0.74; 95% confidence interval, 0.70-0.77). The overall validity coefficient (VC) for survey-assessed total sedentary time was 0.62 (95% confidence interval, 0.55-0.69), although VC varied by age group and activity level (P < 0.05). However, VC were similar across groups (P < 0.05) when restricting to highly compliant participants in a sensitivity analysis. The Cancer Prevention Study-3 sedentary behavior questionnaire has acceptable reliability and validity for ranking or categorizing participants according to sedentary time. Acceptable reliability and validity estimates persist across various demographic subgroups.

13 - The Use of Direct Observation and an Individualized Simulation Workshop is Associated with Improved Resident Confidence in Bag Mask Ventilation and Intubation Skills

13 - The Use of Direct Observation and an Individualized Simulation Workshop is Associated with Improved Resident Confidence in Bag Mask Ventilation and Intubation Skills

Students’ Preferences towards Techniques Used by Lecturer in Teaching Pronunciation

&lt;p&gt;&lt;em&gt;This study is aimed to explore techniques used by the lecturer in teaching pronunciation to EFL university students. In addition, the students’ preferences towards the techniques used by the lecturer are also pointed out by the use of direct observation to the classroom and semi-structured interview to the students. As a result, Oral Drill and Modeling appear to be the most techniques used by the lecturer and get the students’ preference in 20%. Meanwhile, the use of Real Object only appears once along the researchers’ observation which also takes 20% of the students’ preference. The last result which is obtained by the researchers is that the use of games attracts the students’ attention with 40% of preference. Interestingly, the students promote positive attitudes when the lecturer is applying the games to have them practice their pronunciation. They feel enjoyable and can acquire the pronunciation subject easier. Those findings imply that an evaluative assessment is needed in order to gain better quality of the students’ English pronunciation and reflect what technique seems to give more significant effect to the students’ production in pronunciation.&lt;/em&gt;&lt;strong&gt;&lt;em&gt;&lt;/em&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;br /&gt;&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;