Developing a team-based assessment strategy: direct observation of interprofessional team performance in an ambulatory teaching practice

Background: High functioning interprofessional teams may benefit from understanding how well (or not so well) a team is functioning and how teamwork can be improved. A team-based assessment can provide team insight into performance and areas for improvement. Though individual assessment via direct observation is common, few residency programs in the United States have implemented strategies for interprofessional team (IPT) assessments. Methods: We piloted a program evaluation via direct observation for a team-based assessment of an IPT within one Internal Medicine residency program. Our teams included learners from medicine, pharmacy, physician assistant and psychology graduate programs. To assess team performance in a systematic manner, we used a Modified McMaster-Ottawa tool to observe three types of IPT encounters: huddles, patient interactions and precepting discussions with faculty. The tool allowed us to capture team behaviors across various competencies: roles/responsibilities, communication with patient/family, and conflict resolution. We adapted the tool to include qualitative data for field notes by trained observers that added context to our ratings. Results: We observed 222 encounters over four months. Our results support that the team performed well in measures that have been iteratively and intentionally enhanced – role clarification and conflict resolution. However, we observed a lack of consistent incorporation of patient-family preferences into IPT discussions. Our qualitative results show that team collaboration is fostered when we look for opportunities to engage interprofessional learners. Conclusions: Our observations clarify the behaviors and processes that other IPTs can apply to improve collaboration and education. As a pilot, this study helps to inform training programs of the need to develop measures for, not just individual assessment, but also IPT assessment.

CORRELATION BETWEEN LOW BACK PAIN DUE TO FATTY DEGENERATION AND SEX AND AGE: STUDY BY MRI

ABSTRACT Objective: To correlate low back pain caused by fatty degeneration, visualized by magnetic resonance imaging (MRI), with sex and age. Methods: With a timeframe of 2015 to 2020, data on sex and age of fifty symptomatic patients with low back pain were collected from medical records and correlated with MRI analyses showing the occurrence of fatty infiltration in the paraspinal and erector muscles. Three trained observers, using the classification of Goutallier et al. (1994), analyzed five lumbar levels and the degree of injury. The Kolmogorov-Smirnov, Shapiro Wilk, Student's t, Mann-Whitney and Spearman correlation tests were used, all with a 5% significance level. Results: Among the cases, the L5-S1 level was found in all the images, with a prevalence of 46% of grades 1 and 2 and 24% in the five lumbar levels. Severity was present in a small portion (8%) of the injuries. There was a predominance of 78% women, with significantly more severe injuries in relation to the number of levels (p < 0.001) and injuries of a higher degree (p < 0.001). The age range was 14 to 38 years (mean = 26.70 ± 5.70 years), showing a significant and moderate correlation between the number of levels reached and a greater degree of degeneration (p < 0.001). Conclusion: Fatty degeneration as a cause of low back pain was significantly more severe in women in terms to the number of levels and the higher degree of injury. The number of levels and the severity of fatty degeneration were not correlated with the patient's age. Level of evidence II; Retrospective Study.

Newly learned novel cues to location are combined with familiar cues but not always with each other

Mature perceptual systems can learn new arbitrary sensory signals (novel cues) to properties of the environment, but little is known about the extent to which novel cues are integrated into normal perception. In normal perception, multiple uncertain familiar cues are combined, often near-optimally (reliability-weighted averaging), to increase perceptual precision. We trained observers to use abstract novel cues to estimate horizontal locations of hidden objects on a monitor. In Experiment 1, four groups of observers each learned to use a different novel cue. All groups benefitted from a suboptimal but significant gain in precision using novel and familiar cues together after short-term training (3 x ~1.5 hour sessions), extending previous reports of novel-familiar cue combination. In Experiment 2, we tested whether two novel cues may also be combined with each other. One pair of novel cues could be combined to improve precision but the other could not, at least not after three sessions of repeated training. Overall, our results provide extensive evidence that novel cues can be learned and combined with familiar cues to enhance perception, but mixed evidence for whether perceptual and decision-making systems can extend this ability to the combination of multiple novel cues with only short-term training.

What has the COVID-19 pandemic taught us about conducting patient and public involvement remotely? Insights from a series of digital meeting observations

Background During the COVID-19 pandemic many work tasks are being done remotely through digital meetings, including PPI in research. Yet, some PPI activities have been paused or cancelled altogether during the pandemic. In this commentary, we share our insights from observing digital meetings with researchers and public contributors, representing vulnerable groups. Additionally, we discuss how remote PPI activities can be understood and improved. Main body As part of a PPI evaluation project, live observations were conducted by two trained observers, using a semi‐structured observation protocol developed to objectively assess aspects of group dynamics in PPI research meetings with public contributors with experience of seeking refuge and parents facing economic hardship. This project’s data collection is ongoing and the insights in this commentary is based on the observers’ discussion. We discuss these insights through the lens of the Media Richness Theory, stating that the choice of media we communicate through should be guided by what kind of information we want to communicate to each other. The more complex the information is, the richer the media tool needs to be. For example, information in a text message is more easily misinterpreted than information given in person. This is because meeting in person gives us more information, for example through body language and tone of voice. Based on our experiences from observing digital research meetings, we give suggestions on how to improve digital meetings with public contributors. A few key points are: actively choosing which media to use; being prepared to guide contributors to the chosen media in a way that is suitable for them; and the increased importance of the person chairing the meeting to actively include all participants. Conclusions We reach the conclusion that digital meetings with public contributors is possible, but that researchers need to make a commitment and actively work to solve practical issues. Finally, the format and structure of digital meetings should be co-created together with public contributors.

Ride in Peace: How Cycling Infrastructure Types Affect Traffic Conflict Occurrence in Montréal, Canada

Urban cycling is increasingly common in many North American cities and has the potential to address key challenges of urban mobility, congestion, air pollution and health. However, lack of safety is often cited by potential bike users as the most important deterrent to cycling. This study aimed to evaluate the effect of cycling facility type on traffic conflict likelihood. Four participants recorded a total of 87 h (1199 km) of video, which was reviewed by trained observers to identify and characterize traffic conflicts, yielding 465 conflicts with vehicles and 209 conflicts with pedestrians. Bootstrapped generalized additive logit regressions (GAM) were built to predict traffic conflict likelihood. Results show that while cycling on an off-street bike path effectively reduces the likelihood of conflict with a vehicle, it increases the probability of conflict with a pedestrian. Bike lanes were associated with an increase in the likelihood of a conflict with a vehicle. Decision makers should favor physically segregated and clearly marked cyclist-only facilities to ensure safe and efficient conditions for commuter cyclists.

COVID-19 personal protective behaviors during mass events: Lessons from observational measures in Wales, UK.

Within the context of reopening society in the summer of 2021, as the UK moved away from ’lockdown,’ the Government of Wales piloted the return on organised ‘mass gatherings’ of people at a number of test events. Behavioral observations were made at two of the test events to support this process. The research was particularly interested in four key factors: How (1) context within a venue, (2) environmental design, (3) staffing and social norms, and (4) time across an event, affected personal protective behaviors of social distancing, face covering use, and hand hygiene. Data collection was undertaken by trained observers across the above factors. Findings suggest that adherence of attendees was generally high, but with clear indications that levels were shaped in a systematic way by the environment, situational cues, and the passage of time during the events. Some instances of large-scale non-adherence to personal protective behaviors were documented. Overall, there were three main situations where behavioral adherence broke down, under conditions where: (1) staff were not present; (2) there was a lack of environmental signalling (including physical interventions or communications); and (3) later into the events when circumstances were less constrained and individuals appeared less cognitively vigilant. Behavioral observations at events can add precision and identify critical risk situations where/when extra effort is required. The findings suggest a liberal paternal approach whereby state authorities, health authorities and other key organisations can help nudge individuals towards COVID-safe behaviors. Finally, an individual’s intentions are not always matched by their actions, and so behavioral insights can help identify situations and contexts where people are most likely to require additional support to ensure COVID-19 personal protective behaviors are followed and hence protecting themselves and others.

Autism spectrum disorder screening in Chinese-language preschools

This study examined the reliability and validity of the 13-item Classroom Observation Scale as used by teachers and non-clinically trained observers to identify children who more likely than their peers to have autism spectrum disorder in less-resourced preschools. A total of 534 children (ages 2;10 to 4;5, Mean = 3;8) from nine Chinese-language preschools serving families from lower-middle to middle socioeconomic backgrounds in Hong Kong were observed in their first preschool year using the Classroom Observation Scale. The 75 screen-positive children and 55 randomly selected typically developing peers were clinically assessed for autism spectrum disorder 1 year later. The Classroom Observation Scale as used by teachers and non-clinically trained researchers helped to identify preschoolers who were later diagnosed with autism spectrum disorder with odds ratios of 3.11 and 8.66, respectively. This study provided further evidence on the versatility and ecological validity of the Classroom Observation Scale for use by preschool teachers and observers with little or no clinical training in the early identification of children with autism spectrum disorder in community settings. Lay abstract The 13-item Classroom Observation Scale is an autism spectrum disorder screening tool for teachers and non-clinically trained observers to make real-time observation of children’s peer interaction (or the lack thereof) in regular preschool classrooms. The Classroom Observation Scale was originally developed in English and validated with ethnically diverse preschoolers at English-speaking international schools serving families from middle to middle-upper socioeconomic backgrounds in Hong Kong. These private schools can usually afford a higher teacher–student ratio, which is not typical for most preschools. This study, therefore, investigated whether the Classroom Observation Scale is ecologically valid when used by Chinese teachers with teacher–student ratios typically found in less-resourced preschools. We found that the Classroom Observation Scale reliably helped observers with little or no clinical training—research assistants with just a few hours of Classroom Observation Scale training and preschool teachers with an hour of briefing—to identify children in their first year of Chinese-language preschool who were more likely than their peers to have autism spectrum disorder. Reliability estimates of Classroom Observation Scale-Teacher and Classroom Observation Scale-Researcher in this study were comparable to those for the original English Classroom Observation Scale. Our results provided further evidence on the versatility and ecological validity of the Classroom Observation Scale for use by preschool teachers and non-clinically trained observers in the early identification of children with autism spectrum disorder in community settings.

Development and Validation of a Test for the Classification of Horses as Broken or Unbroken

Regulation EC 1/2005 has stricter rules for transportation of unbroken (untamed) vs. broken (tamed) horses, but does not provide adequate tools for their identification. This study aimed to develop and validate such a tool. A behavioural test (Broken/Unbroken Test (BUT)) based on approaching, haltering, and leading was applied to 100 horses. Physiological and additional behavioural data were also collected, and the horses’ status (broken/unbroken) was assessed by the expert who administered the BUT. Each horse’s behaviour during the BUT was scored by four trained observers blinded to the horse’s history. The BUT score showed excellent inter-observer, intra-observer, and test–retest reliability (all intraclass correlation coefficients (ICCs) > 0.75). It was also negatively associated with respiratory rate, avoidance distance, and time needed to approach, halter, and lead the horse (p < 0.05 for all). The optimal BUT score cut-off for discrimination between broken and unbroken horses (gold standard: expert judgment) showed 97.8% sensitivity and 97.3% specificity. There was almost perfect agreement between BUT-based and expert classification of horses (ICC = 0.940). These findings confirm the BUT’s construct and criterion validity. The BUT could provide officials with a feasible, reliable, and valid tool to identify a horse’s broken/unbroken status and, consequently, direct stakeholders towards correct transport procedures.

Confocal Laser Microscopy for in vivo Intraoperative Application: Diagnostic Accuracy of Investigator and Machine Learning Strategies

<b><i>Background:</i></b> Confocal laser microscopy (CLM) is one of the optical techniques that are promising methods of intraoperative in vivo real-time tissue examination based on tissue fluorescence. However, surgeons might struggle interpreting CLM images intraoperatively due to different tissue characteristics of different tissue pathologies in clinical reality. Deep learning techniques enable fast and consistent image analysis and might support intraoperative image interpretation. The objective of this study was to analyze the diagnostic accuracy of newly trained observers in the evaluation of normal colon and peritoneal tissue and colon cancer and metastasis, respectively, and to compare it with that of convolutional neural networks (CNNs). <b><i>Methods:</i></b> Two hundred representative CLM images of the normal and malignant colon and peritoneal tissue were evaluated by newly trained observers (surgeons and pathologists) and CNNs (VGG-16 and Densenet121), respectively, based on tissue dignity. The primary endpoint was the correct detection of the normal and cancer/metastasis tissue measured by sensitivity and specificity of both groups. Additionally, positive predictive values (PPVs) and negative predictive values (NPVs) were calculated for the newly trained observer group. The interobserver variability of dignity evaluation was calculated using kappa statistic. The F1-score and area under the curve (AUC) were used to evaluate the performance of image recognition of the CNNs’ training scenarios. <b><i>Results:</i></b> Sensitivity and specificity ranged between 0.55 and 1.0 (pathologists: 0.66–0.97; surgeons: 0.55–1.0) and between 0.65 and 0.96 (pathologists: 0.68–0.93; surgeons: 0.65–0.96), respectively. PPVs were 0.75 and 0.90 in the pathologists’ group and 0.73–0.96 in the surgeons’ group, respectively. NPVs were 0.73 and 0.96 for pathologists’ and between 0.66 and 1.00 for surgeons’ tissue analysis. The overall interobserver variability was 0.54. Depending on the training scenario, cancer/metastasis tissue was classified with an AUC of 0.77–0.88 by VGG-16 and 0.85–0.89 by Densenet121. Transfer learning improved performance over training from scratch. <b><i>Conclusions:</i></b> Newly trained investigators are able to learn CLM images features and interpretation rapidly, regardless of their clinical experience. Heterogeneity in tissue diagnosis and a moderate interobserver variability reflect the clinical reality more realistic. CNNs provide comparable diagnostic results as clinical observers and could improve surgeons’ intraoperative tissue assessment.

The composite face effect is robust against perceptual misfit

The composite face effect—the failure of selective attention toward a target face half—is frequently used to study mechanisms of feature integration in faces. Here we studied how this effect depends on the perceptual fit between attended and unattended halves. We used composite faces that were rated by trained observers as either a seamless fit (i.e., close to a natural and homogeneous face) or as a deliberately bad quality of fit (i.e., unnatural, strongly segregated face halves). In addition, composites created by combining face halves randomly were tested. The composite face effect was measured as the alignment × congruency interaction (Gauthier and Bukach Cognition, 103, 322–330 2007), but also with alternative data analysis procedures (Rossion and Boremanse Journal of Vision, 8, 1–13 2008). We found strong but identical composite effects in all fit conditions. Fit quality neither increased the composite face effect nor was it attenuated by bad or random fit quality. The implications for a Gestalt account of holistic face processing are discussed.