Feedback Workshops Research Articles

Evaluation and Feedback Workshop Increases the Interrater Reliability of Medical Student Evaluations

INTRODUCTION: Clinical evaluations often account for greater than 50% of a medical student's final obstetrics–gynecology clerkship grade. However, clinical evaluations suffer from poor reliability and validity. This study aims to increase interrater reliability of resident clinical evaluations of third-year medical students using a single educational seminar. METHODS: Obstetrics–gynecology residents participated in a 4-hour seminar focused on introduction and application of a grading rubric. Participants completed a pre- and postseminar grading exercise using standardized descriptions of student performance. Interrater reliability pre- and postseminar was calculated using the Wilcoxon signed-rank test. Six months postseminar, we identified 14 students whose grade summaries included at least three evaluations completed by study participants. The interrater reliability between scores assigned by test participants compared with those in a control group was calculated using analysis of variance. Statistics were analyzed using STATA and SPSS software. RESULTS: Test participants demonstrated less variance, and hence greater interrater reliability, between their evaluations of standardized students immediately after the seminar, particularly in the domains of medical knowledge (z=0.01), clinical reasoning (z=0.03), and skills (z=0.01). There was no significant change in the final assigned grade (z=0.09). At 6 months, test participants demonstrated significantly less variability in their evaluation of clinical skills than those in a control group (P=.003) and trended toward less variability in assessments of teamwork (P=.058), clinical reasoning and problem-solving (P=.064), and professionalism (P=.075). CONCLUSIONS: A brief, intensive seminar specifically targeting application of a grading rubric can increase interrater reliability of resident evaluations of student clinical performance. Future research should focus on expanding rubric training to faculty and assessing longevity of such intervention.

Jointly thinking the post-dam future: exchange of local and scientific knowledge on the lakes of the Lower Rufiji, Tanzania

A large dam is planned at Stiegler’s Gorge in Tanzania. The change in the Rufiji River flood pattern will affect downstream ecosystems. This paper concentrates on the highly productive floodplain lakes that play a vital role in local livelihoods. A participatory monitoring system with village-based observers collected water level, rainfall, fisheries and food data from 2001 to 2011. Water balances of the lakes show dependence on the Rufiji River flood, with varying vulnerability. With the dam design flood of 2500 m3 s-1, lakes with a high threshold and small catchment will dry out quickly. Lakes with a lower threshold and substantial catchment are more robust but may still dry out during prolonged local drought. Analysis of rainfall (1923–2012) indicates a recent decrease. The data were analysed through feedback workshops with local observers, government technical staff and researchers. Through this collaborative approach, local capacity in preparing for the post-dam future was enhanced.Editor D. Koutsoyiannis; Guest editor M. AcremanCitation Duvail, S., Mwakalinga, A.B., Eijkelenburg, A., Hamerlynck, O., Kindinda, K., and Majule, A., 2014. Jointly thinking the post-dam future: exchange of local and scientific knowledge on the lakes of the Lower Rufiji, Tanzania. Hydrological Sciences Journal, 59 (3–4), 713–730.

Performances in Contradiction: Facilitating a Neosophistic Creative Writing Workshop

This article examines the ways that creative writing instructors may willingly (or unintentionally) suppress contradiction and indeterminacy in workshop feedback conversations. By suggesting that contradiction and indeterminacy may be fruitful and dynamic sites to investigate craft practice, aesthetics, and authorship, the essay argues for a reassessment of the way teachers facilitate workshop. In addition to drawing on experience in the classroom, the author suggests that workshop become a site where rhetorical and artistic invention are intermeshed in the sophistic pedagogical tradition of antilogikê and dissoi logoi (rhetorical strategies emphasising contradiction and doubt, rather than certainty). The concept of antilogikê is connected to workshop pedagogy through an analysis of William Covino's Magic, Rhetoric, and Literacy: An Eccentric History of the Composing Imagination. In the book, Covino suggests that generative magic (rather than arresting magic) provides a lens to analyse language and institutional structures. Using the sophistic concept of antilogikê from Andrea Greenbaum's Emancipatory Movements in Composition: The Rhetoric of Possibilities and Covino's analysis of magic, the essay argues that teachers can better encourage the development of apprentice writers by facilitating conversations in the sophistic, rather than the Socratic tradition.

Stitching toward empowerment: A case study of Tabiro Ladies’ Club

Abstract In the developing world, women are more likely than men to work in poorly paid occupations in the informal sector. Women are responding to this inequality by forming and joining co-operatives. Women-only co-operatives offer members the opportunity for employment and empowerment through income generating opportunities and capacity building. A case study was conducted on an informal women-only embroidery handicraft co-operative located in the Mpigi District of Uganda to explore the relationship between co-operatives and empowerment. Semi-structured interviews were conducted with 30 members of the Tabiro Ladies’ Club, in addition to key informant interviews, participant observation, and a feedback workshop. Members of the Tabiro Ladies’ Club experienced empowerment at the personal, collective, and relational level. Empowerment effects that the women experienced included direct economic benefits, social capital and recognition, and capacity development. Hindrances included economic struggles within the household and the club and difficulties arose from being unregistered with the Ugandan government as a co-operative.

Maximising the value from the elective experience: post-elective workshops

Medical electives are important facets of Global Health education of UK medical students, preparing them for work in an increasingly globalised world. However, their explicit educational value is unclear, and is often lost because of inadequate preparation and review procedures. Aiming to capitalise on this unique personal and professional development opportunity, which Newcastle University students undertake in their fourth year, a pilot feedback workshop was designed in which 42 final-year students gave 10-15-minute reflective presentations to subgroups of between six and eight peers, followed by an opportunity for questions, discussion and feedback. Feedback was sought from individual questionnaires and then there was open discussion with the whole group. Despite the participants' variable satisfaction with the pre-elective procedures, all felt that the elective itself was valuable and enjoyable, and, moreover, all enjoyed and benefited from debriefing in this workshop format. This pilot was successful. Simple, inexpensive workshops are to be recommended for overcoming perceived staffing and timetabling barriers to Global Health education, and affording students the maximum personal and professional benefit from their own, and each others' medical electives.

Aptitud clínica de médicos internos de pregrado en el manejo de Diabetes mellitus tipo 2

evaluar la aptitud clínica de los médicos internos de pregrado ( mip ) en Diabetes mellitus tipo 2 ( dmt 2) antes y después de una estrategia educativa. estudio cuasi experimental realizado de junio de 2008 a febrero de 2009 en una unidad de medicina familiar de Acapulco, Guerrero, México. Se evaluaron a 39 mip en rotación por el servicio de Medicina Familiar. Las variables estudiadas fueron: nivel de aptitud en dmt 2 antes y después de una intervención educativa consistente en un taller de retroalimentación en la resolución de casos. Los datos se procesaron en los programas spss 17 para Windows y Stata 10. El análisis se realizó con las pruebas de Wilcoxon, Kruskal-Wallis y Spearman. La valoración de la aptitud clínica incluyó: conocimientos generales e identificación de factores de riesgo, clasificación, diagnóstico y tratamiento de dmt 2. antes de la estrategia educativa el nivel de aptitud de los mip en dmt 2 fue muy bajo con 33 médicos (84.62%) y bajo con seis mip (15.38%). Posterior a la intervención se logró un nivel medio con cuatro mip (10.26%), bajo con 14 mip (35.90%) y muy bajo con 21 mip (53.85%). Se encontró una diferencia estadísticamente significativa en el nivel de aptitud general de los mip en dmt 2 después de la intervención; se aplicó la prueba de Wilcoxon con p = 0.018. el nivel de aptitud clínica de los mip en dmt 2 mostró un avance significativo después de la estrategia educativa. evaluate the clinical competence of undergraduate internal physicians ( uip ) in Diabetes mellitus type 2 ( dmt 2) before and after of an educational strategy. a quasi-experimental study carried on from June 2008 to February 2009 in a Family Medicine Unit from Acapulco, Guerrero, Mexico. There were evaluated 39 uip in rotation by the Family Medicine service. The variables studied were: level of ability in dmt 2 before and after an educational intervention consisting of a feedback workshop in the resolution of cases. Data were processed in the spss 17 program for Windows and Stata 10. The analysis was performed with the Wilcoxon, Kruskal-Wallis and Spearman tests. The evaluation of clinical skills included: General knowledge and identification of risk factors, classification, diagnosis and treatment of dmt 2. before the educational strategy the level of competence of the uip in dmt 2 was very low 33 doctors (84.62%) and low with six uip (15.38%). Subsequent to the intervention was a mid-level with four uip (10.26%), low with 14 uip (35.90%) and very low 21 uip (53.85%). A statistically significant difference was found in the level of general competence of the uip in dmt 2 after the intervention; the Wilcoxon test was applied with p = 0.018. the level of clinical competence of the uip in dmt 2 showed a significant progress after the educational strategy. avaliar as habilidades clínicas de estudantes de medicina ( mip ) para cuidar de pacientes com diabetes mellitus tipo 2 ( dm 2), antes e depois de uma estratégia educacional. estudo quasi-experimental, realizado a partir de junho de 2008 até fevereiro de 2009, em uma unidade de medicina de família de Acapulco, Guerrero, México. 39 mip foram avaliados durante a rotação pelo serviço de Medicina Geral e Familiar. As variáveis estudadas foram: nível de proficiência em dm 2 antes e após uma intervenção educativa consistente numa oficina de feedback na resolução de casos. Os dados foram processados no spss 17 para Windows e Stata 10. A análise foi realizada por meio de testes de Wilcoxon, Kruskal-Wallis e Spearman. A avaliação da competência clínica incluiu: conhecimento geral e identificação de fatores de risco, classificação, diagnóstico e tratamento de dm 2. antes da estratégia educativa o nível de aptidão do mip em dm 2 foi muito baixa 33 médicos (84.62%) e baixa, com seis mip (15.38%). Após a intervenção, houve um nível médio, com quatro mip (10.26%), com baixa de 14 mip (35.90%) e muito baixo 21 mip (53.85%). Encontramos uma diferença estatisticamente significativa no nível de aptidão geral do mip em dm 2 após a intervenção; foi aplicado o teste de Wilcoxon, com p = 0.018. o nível de aptidão clínica do mip em dm 2 mostrou progressos significativos após a estratégia educacional.

Applying the trigger review method after a brief educational intervention: potential for teaching and improving safety in GP specialty training?

BackgroundThe Trigger Review Method (TRM) is a structured approach to screening clinical records for undetected patient safety incidents (PSIs) and identifying learning and improvement opportunities. In Scotland, TRM participation can inform GP appraisal and has been included as a core component of the national primary care patient safety programme that was launched in March 2013. However, the clinical workforce needs up-skilled and the potential of TRM in GP training has yet to be tested. Current TRM training utilizes a workplace face-to-face session by a GP expert, which is not feasible. A less costly, more sustainable educational intervention is necessary to build capability at scale. We aimed to determine the feasibility and impact of TRM and a related training intervention in GP training.MethodsWe recruited 25 west of Scotland GP trainees to attend a 2-hour TRM workshop. Trainees then applied TRM to 25 clinical records and returned findings within 4-weeks. A follow-up feedback workshop was held.Results21/25 trainees (84%) completed the task. 520 records yielded 80 undetected PSIs (15.4%). 36/80 were judged potentially preventable (45%) with 35/80 classified as causing moderate to severe harm (44%). Trainees described a range of potential learning and improvement plans. Training was positively received and appeared to be successful given these findings. TRM was valued as a safety improvement tool by most participants.ConclusionThis small study provides further evidence of TRM utility and how to teach it pragmatically. TRM is of potential value in GP patient safety curriculum delivery and preparing trainees for future safety improvement expectations.

P6.062 QUALIAIDS: Quality of Ambulatory Health Services Who Attend People Living with HIV/AIDS in Brazil

BackgroundBetween 2007 and 2012, there was an increase of 14% of Specialized Care Services for people living with HIV/AIDS (PLHIV), totaling 724. A decade ago the Qualiaids evaluates the quality...

DESIGN WORKSHOP FOR ONTARIO ENGINEERING COMPETITION

The annual Ontario Engineering Competition (OEC) challenges participants from Ontario engineering schools to identify solutions to challenges experienced by the engineering profession. The competition includes six competition categories: Junior Team Design, Senior Team Design, Parliamentary Debate, Engineering Communications, Consulting Engineering, and Innovative Design. OEC is the regional competition to qualify for the Canadian Engineering Competition (CEC), with the top two placing teams in each category qualifying to participate in the CEC. The University of Waterloo (UW) has held internal competitions to select the debate and technical speaking competitors for many years. The competitors for the innovative design are selected based on a brief proposal. Several years ago, the Engineering Society introduced the Waterloo Engineering Competition (WEC), held twice annually in the Spring and Fall, to select teams to compete in the Junior Team Design, Senior Team Design, and Consulting categories for OEC. In an attempt to provide more guidance to the WEC winners prior to their participation in OEC, the six winning teams were invited to participate in a design workshop. A discussion of the design workshop and student feedback for the past two years will be discussed. A comparative study between the two workshop offerings will be used for future improvements of the WEC and pre-OEC workshop.

What Does an Executive Coaching Intervention Add Beyond Facilitated Multisource Feedback? Effects on Leader Self‐Ratings and Perceived Effectiveness

AbstractMultisource ratings and feedback are now central components of many leader development programs. Research evaluating the outcomes of multisource feedback (MSF) underscores the importance of facilitation strategies that help leaders to interpret and use their feedback throughout the development process. Scholars and practitioners have recommended executive coaching as one such facilitation strategy. However, there is little empirical basis to substantiate the benefits of executive coaching beyond other less costly strategies, most notably feedback workshops with groups of leaders. This quasi‐experiment followed 469 managers from a large government agency participating in a 15‐month leader development program. Changes over time in MSF ratings of leadership behaviors and effectiveness were compared for two groups of leaders. The first group of uncoached managers participated in a feedback workshop shortly after the premeasure MSF, and the second group participated in the feedback workshop plus several sessions with an executive coach thereafter. Results indicated that managers in both groups improved similarly as rated by direct reports, peers, and supervisors, whereas only those managers who received the executive coaching improved according to self‐ratings. Specifically, the executive coaching intervention had a unique positive effect on managers' self‐rated involvement, consistency, and mission‐focused leadership behaviors. These findings are discussed in light of “psychometric” and self‐efficacy perspectives, and in relation to exploratory regression analyses linking managers' self‐ratings to others' ratings of their effectiveness at the conclusion of the program.

Development of a methodology for understanding and enhancing safety culture in Air Traffic Management

There is increasing interest in applying the concept of safety culture in Air Traffic Management (ATM). Using a mixed methods approach, this paper describes the development of a safety culture management toolkit that uses questionnaires and safety culture feedback workshops. The development process involved four phases. Phase 1 involved a review of the safety culture literature from 2001 to 2005 to identify relevant safety culture themes. Phase 2 involved conducting interviews with personnel (n=52) from four geographically disparate European Air Navigation Service Providers (ANSPs) to validate and identify themes relevant to ATM. Follow-up focus groups (n=3) consolidated the themes, and developed a preliminary set of questionnaire items; Phase 3 involved piloting a safety culture survey instrument with ATM staff (n=537) in four countries. Construct validity of the questionnaire was tested using both Exploratory and Confirmatory factor analysis (EFA, CFA). Substantial refinement of the item set was required to establish a consistent model, and a second sample (n=883) was surveyed to replicate the model. Phase 4 involved conducting feedback workshops with ANSP personnel in study locations (n=7) in order to further validate the themes identified in the questionnaire. These were used to develop qualitative insights (e.g. specific safety problems and solutions) relating to the results of the questionnaire at each ANSP. The study aimed to develop a bespoke quantitative measurement instrument (and qualitative feedback tool) with construct and discriminant validity, and the ability to consistently measure safety culture in ANSPs throughout Europe, and facilitate safety improvements in air traffic management. This aim was partially achieved, and although the safety culture toolkit was perceived as useful for exploring and highlighting safety issues at a local ANSP level, further work is required. This will involve developing the tool to ensure it operates consistently in different national and cultural setting, and designing metrics for testing the criterion validity of the safety culture toolkit.

A 5-year review of an educational program focused on meeting the needs of patients with advanced breast cancer.

87 Background: Women living with advanced breast cancer have distinct often unmet needs, even compared to other women with breast cancer. For the past five years, the Cancer Support Community has been committed to delivering Frankly Speaking About Cancer: Advanced Breast Cancer, a comprehensive psychosocial education program created for women with metastatic breast cancer and their families. The program’s clinically facilitated evidence-based education workshops have reached 2,690 attendees since its inception in 2006. The workshop provides valuable information about current treatments, clinical trials, side-effect management, and social and emotional challenges of an advanced breast cancer diagnosis. Workshop outcomes are analyzed annually, informing program content and ensuring the program is meeting the needs of those served. As the program enters its sixth year, data were consolidated across years to investigate how the program has been meeting the needs of these women and their loved ones. Methods: 1,827 workshop attendees since the program’s beginning have completed evaluations (68% response rate) which included assessing levels of pre- and post-workshop knowledge about advanced breast cancer, patient-provider communication, and general workshop feedback. Results: 64.9% of respondents were survivors, 78.5% were Caucasian, and the average age was 56. Most workshop respondents (89.6%) reported gaining a high or very high level of knowledge about advanced breast cancer, with significant increases compared with pre-workshop levels (p <.01). Most reported intent to increase communication with their clinical team following the workshop. A majority reported feeling better equipped to ask questions to their health care team (92.1%), and discuss the possibility of clinical trials with their healthcare team (77.7%). Furthermore, 90% of attendees felt confident that after the workshop they could speak knowledgably about side effects of cancer treatment with their doctor, a key issue in regards to quality of life. Conclusions: Taken together, the data indicate the continued relevance of this program for those affected by advanced breast cancer.

The effect of communication skills training by video feedback method on clinical skills of interns of Isfahan University of medical sciences compared to didactic methods

Background: Effective communication is essential to the practice of high-quality medicine. There are methodological challenges in communication skills training. This study was performed in order to assess the educational benefits of communication skills training by video feedback method versus traditional formats such as lectures on clinical skills. Methods: This study was performed in 2005–2006 at Isfahan University of Medical Sciences. Forty medical students were involved in this study. We had 20 medical students in each group. Both groups first participated in communication skills classes and then their communication skills were evaluated with an objective structured clinical examination (OSCE1). Then group 1 participated in a video feedback workshop and their communication skills were evaluated by OSCE2 two months after the course. The communication skills of group 2 were re-evaluated by OSCE2 after two months. The score of OSCE1 and OSCE2 of both groups were compared. Results were analysed using SPSS 11.5. Results: The mean score of communication skills in OSCE1 of both groups were compared and the results showed that there was no significant difference between the both groups ( p = 0.53). Group 1 had significantly higher communication skills scores in OSCE2 after the video feedback workshop compared to the communication skill scores of the group without intervention ( p = 00). The mean score of history taking, physical exam and diagnosis and treatment in OSCE1 and OSCE2 in the case group were compared by paired t-test and the results showed that there was significant difference ( p = 0.00). Conclusion: Our training intervention was effective in producing significant changes in medical students’ clinical competence as well as the students’ skills in history taking, physical exam and diagnosis and treatment. Video feedback was more effective than traditional didactic methods such as lectures. Repetition of feedback using videotaped performance may be useful to improve communication skills for medical interviews. Despite the potential difficulties, video recording remains a most valuable tool for communication skills training.

Tourism in a post-conflict situation of fragility

Whilst there are studies of tourism development in sub-Saharan Africa, almost none explicitly explore tourism in post-conflict societies. This study, co-authored between an African ‘insider’ and European ‘outsiders’, analyses tourism development challenges in Burundi, a ‘situation of fragility’ emerging from a 12-year civil war. Framed by hopeful tourism’s co-created knowledge, the field research had unique access to powerful elites and remote communities and encompasses interviews with a wide range of stakeholders (including the President of the Republic), field observations, and a feedback workshop. The paper identifies challenges to sustainable tourism development in one of the world’s poorest countries and evaluates tourism in a post-conflict situation of fragility under the themes of institution- and state-building and post-conflict challenges and transitional justice.

An academic development model for fostering innovation and sharing in curriculum design

This paper outlines an academic development process based around a two- or three-day workshop programme called a Course Design Intensive (CDI). The CDI process aims to foster collaboration and peer support in curriculum development and bring about pedagogic innovation and positive experiences for both tutors and learners. Bringing participants together in multi-disciplinary teams enables critical review and cross-fertilisation of ideas within and across teams. The paper draws on an in-depth evaluation undertaken over a five-year period. Data were analysed from reports, workshop feedback and in-depth interviews with nine CDI participants from six programme teams. The CDI approach appears to legitimise and support time out for staff to work collaboratively and reflectively on new modes of delivery, such as e-learning for blended and distance courses. Its success, however, is contingent on a variety of factors, especially the agency of key staff members. We critique the workshop model and discuss the benefits, limitations and critical success factors.

Monitoring physical functioning as the sixth vital sign: evaluating patient and practice engagement in chronic illness care in a primary care setting--a quasi-experimental design

BackgroundIn Canada, one in three adults or almost 9 million people report having a chronic condition. Over two thirds of total deaths result from cardiovascular disease, diabetes, cancer and respiratory illness and 77% of persons ≥65 years have at least one chronic condition. Persons with chronic disease are at risk for functional decline; as a result, there is an increased awareness of the significance of functional status as an important health outcome. The purpose of this study was to determine whether patients who receive a multi-component rehabilitation intervention, including online monitoring of function with feedback and self-management workshops, showed less functional decline than case matched controls who did not receive this intervention. In addition, we wanted to determine whether capacity building initiatives within the Family Health Team promote a collaborative approach to Chronic Disease Management.MethodsA population-based multi-component rehabilitation intervention delivered to persons with chronic illnesses (≥ 44 yrs) (n = 60) was compared to a group of age and sex matched controls (n = 60) with chronic illnesses receiving usual care within a primary healthcare setting. The population-based intervention consisted of four main components: (1) function-based individual assessment and action planning, (2) rehabilitation self-management workshops, (3) on-line self-assessment of function and (4) organizational capacity building. T-tests and chi-square tests were used for continuous and categorical variables respectively in baseline comparison between groups.ResultsTwo MANOVA showed significant between group differences in patient reported physical functioning (Λ = 0.88, F = (2.86) = 5.97. p = 0.004) and for the physical performance measures collectively as the dependent variable (Λ = 0.80, F = (6.93) = 3.68. p = 0.0025). There were no within group differences for the capacity measures.ConclusionIt is feasible to monitor physical functioning as a health outcome for persons with chronic illness in primary care. The timeline for this study was not sufficient to show an increase in the capacity within the team; however there were some differences in patient outcomes. The short timeline was likely not sufficient to build the capacity required to support this approach.Trial registrationNCT00859638

Training Researchers on Data Management: A Scalable, Cross-Disciplinary Approach

This article describes the curriculum, implementation, and results of the research data management training offered by the University of Minnesota (UMN) Libraries. The UMN Libraries have offered the workshop titled, “Creating a Data Management Plan for Your Grant Application,” to more than 300 researchers and faculty since late 2010. With University partnerships, this training satisfies the requirement for the continuing education component to maintain PI eligibility. Based on workshop feedback, the authors conclude that academic libraries can provide support to researchers with federal mandates to share their research data by providing timely, discussion-based training and resources on how to create a data management plan. The unanticipated benefits for library staff education and professional development on this topic are explored.

“How am I doing?” Teaching medical students to elicit feedback during their clerkships

Aim: This study seeks to explore formative feedback during clerkships from the student perspective and to determine whether a modest intervention aimed at students can impact their attitudes or behavior regarding feedback interactions.Background: Multiple studies document medical student dissatisfaction with a lack of feedback from attending physicians and housestaff regarding their performance during their clerkship rotations. While feedback is essential to skill building, and feedback-seeking a necessary component of self-awareness, studies indicate that little progress has been made in understanding or addressing these student concerns.Methods: Participants included the entire third-year class of a medical school (n = 189). They were surveyed about their attitudes and experience with regard to receiving feedback during clerkships using both Likert-type questions and open-ended questions. Half of the class was assigned to receive a brief intervention, a workshop dealing with the nature of feedback and ways to actively elicit it from housestaff and attendings.Results: Qualitative results indicated that students initially conceived of feedback as a linear process, from instructor to student, and they felt both the lack of time on the ward and instructors’ apparent inapproachability were major barriers in receiving feedback. The group of students who attended the feedback workshop reported a positive change in their attitude toward obtaining feedback and a significant increase in their feedback-seeking behavior.Conclusions: Students can learn to assume a more active role in their learning interactions with instructors during their clerkships.

Maximising student preparation for clinical teaching placements

With the increasing emphasis on ambulatory health care, clinical educators need to ensure that students are sufficiently prepared to maximise learning opportunities during placements in ambulatory settings. This study focuses on third-year medical students entering urban or rural clinical placements at an Australian graduate entry medical school. All rural and a subset of urban students received intensive training in taking Papanicolaou (Pap) smears prior to starting the clinical placement. Training involved gynaecological teaching associates, active practice and real-time feedback. Evaluation included workshop feedback, reflection on effectiveness during the placement, and comparison of trained and untrained students' recorded clinical experience of taking Pap smears. Students given pre-placement training praised their learning experience, and on average took more Pap smears during their placement than did their untrained peers. The difference, however, did not reach statistical significance. The pre-placement teaching workshop on a difficult skill was popular and worthy of further study regarding other challenging clinical skills.

Barriers to climate change adaptation in the Netherlands

Review of recent literature on adaptation to climate change and general literature on policy processes shows that there are a large number of barriers that hamper the development and implementation of climate change adaptation strategies. To reduce and manage the number of barriers and combine both streams of literature, we propose seven clusters of barriers to adaptation. Little is known, however, about the relative importance of these barriers to climate change adaptation policies and practices. An online survey was conducted between March 2010 and July 2010 among 264 scientists, policymakers, and private actors from different sectors and levels who are involved in climate change adaptation projects and programmes in the Netherlands. The survey aimed to gather their experiences with, and perceptions of, the barriers identified in the literature and encountered in their daily work. Both climate-related and non-climate-related barriers were included in the survey. Data were subjected to both qualitative and quantitative analysis. A survey feedback workshop was organized to discuss the results with several of the survey respondents. Results of this study revealed that respondents considered conflicting timescales as the most important cluster of barriers to adaptation. Other highly ranked barriers include conflicting interests; lack of financial resources; unclear division of tasks and responsibilities; uncertain societal costs and future benefits; and fragmentation within and between scales of governance. Furthermore, the analysis demonstrated that scales matter in understanding the barriers to adaptation: actors from lowlevels of governance seem to consider the barriers as more severe than actors from high levels of governance.