Validation of an Acoustic-Based Framework of Speech Motor Control: Assessing Criterion and Construct Validity Using Kinematic and Perceptual Measures

Purpose This study investigated the criterion (analytical and clinical) and construct (divergent) validity of a novel, acoustic-based framework composed of five key components of motor control: Coordination, Consistency, Speed, Precision, and Rate. Method Acoustic and kinematic analyses were performed on audio recordings from 22 subjects with amyotrophic lateral sclerosis during a sequential motion rate task. Perceptual analyses were completed by two licensed speech-language pathologists, who rated each subject's speech on the five framework components and their overall severity. Analytical and clinical validity were assessed by comparing performance on the acoustic features to their kinematic correlates and to clinician ratings of the five components, respectively. Divergent validity of the acoustic-based framework was then assessed by comparing performance on each pair of acoustic features to determine whether the features represent distinct articulatory constructs. Bivariate correlations and partial correlations with severity as a covariate were conducted for each comparison. Results Results revealed moderate-to-strong analytical validity for every acoustic feature, both with and without controlling for severity, and moderate-to-strong clinical validity for all acoustic features except Coordination, without controlling for severity. When severity was included as a covariate, the strong associations for Speed and Precision became weak. Divergent validity was supported by weak-to-moderate pairwise associations between all acoustic features except Speed (second-formant [F2] slope of consonant transition) and Precision (between-consonant variability in F2 slope). Conclusions This study demonstrated that the acoustic-based framework has potential as an objective, valid, and clinically useful tool for profiling articulatory deficits in individuals with speech motor disorders. The findings also suggest that compared to clinician ratings, instrumental measures are more sensitive to subtle differences in articulatory function. With further research, this framework could provide more accurate and reliable characterizations of articulatory impairment, which may eventually increase clinical confidence in the diagnosis and treatment of patients with different articulatory phenotypes.

Newly qualified midwives’ perceptions of their level of midwifery clinical competence during community service in KwaZulu-Natal, South Africa

Background: There are links between the inadequate numbers of competent midwives and high maternal mortality ratios and neonatal mortality rates which highlights the significance of job-ready, newly qualified midwives who can display clinical competence. The South African Nursing Council regulated mandatory community service, as a supportive year to develop clinical competence.Aim: To explore and describe newly qualified midwives’ perceived level of midwifery clinical competence during community service.Setting: Both the event of the pandemic and the distribution of the potential participants across various geographical settings necessitated planning for data collection in real and online settings convenient to them.Method: Non-probability purposive sampling was utilized to select and invite the post community service, newly qualified midwives (N = 65), of the select university, who underwent community service in 2018 and experienced exposure to maternity care settings in the eThekwini District (n = 23). Data were collected through five focus groups and analysed through Elo and Kyngas’ content analysis.Results: Three categories emerged: transitioning from the sheltered education environment to the real practice world, support in practice: disparate realities and interception of mentorship. Six subcategories accompanied the categories.Conclusion: Newly qualified midwives’ clinical confidence and competence transitioning from the safe academic environment to the authentic accountable clinical setting hinges on mentorship and welcoming, non-stigmatising supportive relationships that facilitate the integration of previous learnings into community service practice.Contribution: The study allows for audibility and awareness of the transitioning midwives’ perceptions highlighting the significance to maternity staff and policy makers, of supportive relationships and structures.

Health care practitioners’ confidence assessing lupus-related rashes in patients of color

Background: Patients with skin of color (P-SOC) are disproportionately burdened by lupus and often have worse disease outcomes than white patients. This is partly because educational materials underrepresent P-SOC, thereby promoting unconscious bias and clinical deficiencies among practitioners. Purpose: We sought to measure providers' confidence in diagnosing the cutaneous manifestations of lupus (i.e., lupus-related rashes) in P-SOC and to assess which factors influenced their confidence. Research Design: We created and distributed a survey that gathered information about participants' personal characteristics, clinical specialty, training, and current practice as well as measuring their confidence assessing lupus-related rashes in various skin tones. Study Sample: Practitioners from the fields of rheumatology, dermatology, and internal medicine in the greater St. Louis area (Missouri, USA) participated in the survey. Analysis: We compared practitioners' mean confidence levels assessing lupus-related rashes in patients with fair skin and P-SOC with a linear mixed effects model and used univariate and multivariate linear regression models to determine if the aforementioned factors correlated with confidence. Results: Participants' mean confidence in diagnosing lupus-related rashes in P-SOC was significantly lower than assessing such findings in patients with fair skin ( p = .009). Several factors correlated with confidence level at a univariate level; however, the multivariate model revealed experience as the only factor significantly associated with confidence ( p = .001). Conclusions: Providers report significantly less confidence assessing lupus-related rashes in P-SOC than in patients with fair skin. Our analysis demonstrates that experience positively correlates with confidence and suggests that interventions which enhance practitioners' exposure to and experience with these rashes in P-SOC can improve clinical confidence as well as patient outcomes.

A qualitative evaluation of a 'covid responder' scheme for medical students

Background The first UK wave of COVID-19 led to the temporary suspension of medical school placements. Medical students were offered paid employment through a COVID Responder Scheme (CRS). We aimed to qualitatively assess the experience of those who participated in this scheme in comparison to traditional clinical attachments. Summary of work A bespoke questionnaire was designed to explore key themes identified through theme selection, literature review and consensus. Following piloting and validation, the questionnaire was circulated to students recruited to the CRS. A grounded theory analytic framework was used to analyse data. A modified-Delphi consensus process was used to reach a consensus on ‘what makes you feel most valued as a medical student’. Summary of results 36 students (46.2% response rate) responded. 86.1% of respondents felt their contribution was worthwhile. 65% reported being significantly more integrated into a team than in their university attachments. Concerns prior to starting CRS work included availability of PPE and the ability to contribute effectively, but refreshingly these concerns did not present as challenges. The steep learning curve of experiential learning alongside virtual teaching commitments proved difficult to juggle when facing physical, mental and emotional fatigue from long hours working busy clinical shifts. Respondents cited the educational benefit of the CRS throughout the survey. Recognition and commendation were highly effective in providing a sense of value ahead of renumeration. 44.4% of respondents were concerned about their future training and a reduction in clinical exposure. Discussion The majority of respondents reported CRS work as worthwhile, with reasons including increased responsibility for patient care and a sense of contribution to the clinical team. This in turn led to autonomous practice and task accountability, which further integrated them into the team and developed their clinical confidence. A student’s sense of value was strongly linked to being identified in emotional responses from colleagues and patients ahead of financial renumeration, suggesting scope for improvement within unpaid attachments / rotations. Conclusion There is an opportunity to take value from the COVID-19 medical student experience to improve undergraduate medical education through and beyond the pandemic.

Efficacy of a fully remote primary lecture series at an academic hematology and oncology fellowship program.

11031 Background: 615 fellows began training in American combined hematology/oncology fellowship programs in July 2020. These new fellows face a steep learning curve. The coronavirus pandemic has significantly affected how we learn, with programs having to convert most collective learning to a completely virtual format. Research on the efficacy of introductory lecture series in academic hematology/oncology programs is limited especially regarding virtual formats. We introduced a virtual introductory lecture series with the goal of increasing the clinical confidence and knowledge base of first-year fellows. Methods: A once weekly remotely-delivered two-hour primer series was designed with lectures given by both third-year fellows and faculty from July-August 2020. Fellows were asked to complete pre & post-test evaluations of each lecture. Evaluations included a combination of knowledge-based questions & self-reported confidence assessment. Results: 14 fellows were assigned pre- and post-tests in the study. 1 fellow was excluded due to lack of participation. A total of 123 paired pre and post-tests were compared. Data analysis was performed with SPSS v 24.0 using the paired samples t-test. Pre and post-tests were graded on a scale of 0-100. The pre to post mean difference compares the mean test result of the post tests to that of the corresponding pretests. Questions were divided into 2 groups. The 1st group tested the fellow’s medical knowledge regarding the pathology while the 2nd group tested the comfort in the management, diagnosis and treatment. In the statistical analysis, these questions were defined as “Knowledge” and “Comfort” accordingly, the sum as “Complete”. A statistically significant improvement in post-test knowledge for fellows of all years was noted with a pre to post test mean difference of 12.52, P <.0001. The difference was more pronounced among 1st year fellows with a pre to post test mean difference of 16.84, P <.0001. A similar improvement was seen for the comfort in management questions. The post-test comfort pre to post test mean difference was 10.48, P <.0001 for fellows of all years and 6.70, P <.0001 for first year fellows. Conclusions: A remotely-delivered introductory lecture series for fellows in a hematology/oncology training program increases both clinical knowledge and clinical confidence in fellows of all years of training.[Table: see text]

643 Near-Peer Surgical Teaching for Junior Doctors: A 16-Month Retrospective Analysis

Introduction Surgical departments across the UK are having to mitigate service demands, budget constraints and changes to work patterns with their statutory duty to provide high-quality training and education. Securing consultant-led teaching has also become increasingly difficult leading to the rise of near-peer teaching. We evaluate the long-term effectiveness of near-peer surgical teaching for junior doctors. Method We developed a rolling 12-week trainee-led didactic surgical education programme for Foundation doctors and Core Surgical Trainees. Junior doctors delivered teaching to peers with registrar input; session and supervision feedback was recorded using 5-point scales and free-text responses. Results 42 junior doctors responded to our end-of-programme feedback surveys covering December 2018 to April 2020. The overall programme (8.83±1.08/10), relevance (4.62±0.58/5), presentation quality (4.60±0.50/5) and supervisor knowledge (4.81±0.40/5) were rated highly by respondents. Attendees also reported significant improvements in subject knowledge (3.72±0.92/5 to 4.50±0.56/5, P &lt; 0.0001), clinical confidence, presentation and teaching skills. Conclusions Our near-peer teaching programme addressed the educational needs of junior doctors and developed their presentation and organisational skills. Supervision and input from registrars facilitated discussion and reinforced key concepts. The success of this programme highlights the role that trainees can play in designing, developing, and leading an effective surgical teaching programme.

Musculoskeletal Education: An Assessment of the Value of the American Academy of Pediatrics Musculoskeletal Boot Camp Course in Improving Clinical Confidence of Pediatricians Managing Common Musculoskeletal Conditions

In 2016, the American Academy of Pediatrics Section on Orthopaedics established an annual Musculoskeletal (MSK) Boot Camp course to fill the gaps in MSK knowledge, performance, and outcomes for pediatricians and primary care doctors. A standardized one-day curriculum of key MSK topics was developed including short lectures, hands-on workshops, debates, live webinars, and Q&A sessions. A survey was created to evaluate attendee confidence related to diagnosing 20 common MSK conditions in children and adolescents at the beginning and end of the course. Confidence in diagnosing the conditions was gauged using a 6-point Likert-type scale. A two-sample t test was used to compare overall confidence score pre- and post-seminar. In addition, each subtopic was analyzed. The average pre-seminar confidence score was 3.92 versus 4.86 post-seminar. All categories demonstrated a statistically increased confidence score post-seminar ( P < .0001). Live MSK continuing education for pediatricians is effective in improving confidence in clinical practice.

Senior BSN students’ confidence, comfort, and perception of readiness for clinical practice: the impacts of COVID-19

Objectives The Coronavirus Disease 2019 (COVID-19) has impacted overall nursing education program requirements, classroom delivery of theory hours, as well as clinical and laboratory learning opportunities for students. The aims of this study were to explore the impacts of COVID 19 on the students’ perceptions of readiness for practice and their preparation for the NCLEX exam and initial clinical practice. Methods A cross-sectional descriptive design was used to investigate the impact of COVID-19 on senior BSN students’ preparation for NCLEX and future careers. The Casey-Fink Readiness for Practice Survey was used to investigate the perceptions of the BSN students’ clinical confidence and readiness for practice. Results Students reported substantial impacts of COVID-19 on their clinical experiences, their ability to practice skills and procedures, their preparations for NCLEX exam, and their nursing career. The most significant confidence concerns noted from this study seemed to center on handling multiple patient assignments, calling the physician, responding to a change in patient condition, and treating a dying patient. Conclusions Healthcare experts expect that the impact of COVID-19 may last until 2022. More research is needed to understand the impact of COVID-19 on nursing education and transition to nursing practice. While clinical confidence and readiness for practice are essential topics, more research is needed to investigate the psychological and physiological impacts of COVID-19 on nurses, nursing students, nursing preceptors, and faculty members.