Discovering Stick-Slip-Resistant Servo Control Algorithm Using Genetic Programming

The stick-slip is one of negative phenomena caused by friction in servo systems. It is a consequence of complicated nonlinear friction characteristics, especially the so-called Stribeck effect. Much research has been done on control algorithms suppressing the stick-slip, but no simple solution has been found. In this work, a new approach is proposed based on genetic programming. The genetic programming is a machine learning technique constructing symbolic representation of programs or expressions by evolutionary process. In this way, the servo control algorithm optimally suppressing the stick-slip is discovered. The GP training is conducted on a simulated servo system, as the experiments would last too long in real-time. The feedback for the control algorithm is based on the sensors of position, velocity and acceleration. Variants with full and reduced sensor sets are considered. Ideal and quantized position measurements are also analyzed. The results reveal that the genetic programming can successfully discover a control algorithm effectively suppressing the stick-slip. However, it is not an easy task and relatively large size of population and a big number of generations are required. Real measurement results in worse control quality. Acceleration feedback has no apparent impact on the algorithms performance, while velocity feedback is important.

Specificity of early-career general practitioners’ problem formulations in patients presenting with dizziness: a cross-sectional analysis

ObjectivesDizziness is a common and challenging clinical presentation in general practice. Failure to determine specific aetiologies can lead to significant morbidity and mortality. We aimed to establish frequency and associations of general practitioner (GP) trainees’ (registrars’) specific vertigo provisional diagnoses and their non-specific symptomatic problem formulations.DesignA cross-sectional analysis of Registrar Clinical Encounters in Training (ReCEnT) cohort study data between 2010 and 2018. ReCEnT is an ongoing, prospective cohort study of registrars in general practice training in Australia. Data collection occurs once every 6 months midtraining term (for three terms) and entails recording details of 60 consecutive clinical consultations on hardcopy case report forms. The outcome factor was whether dizziness-related or vertigo-related presentations resulted in a specific vertigo provisional diagnosis versus a non-specific symptomatic problem formulation. Associations with patient, practice, registrar and consultation independent variables were assessed by univariate and multivariable logistic regression.SettingAustralian general practice training programme. The training is regionalised and delivered by regional training providers (RTPs) (2010–2015) and regional training organisations (RTOs) (2016–2018) across Australia (from five states and one territory).ParticipantsAll general practice registrars enrolled with participating RTPs or RTOs undertaking GP training terms.Results2333 registrars (96% response rate) recorded 1734 new problems related to dizziness or vertigo. Of these, 546 (31.5%) involved a specific vertigo diagnosis and 1188 (68.5%) a non-specific symptom diagnosis. Variables associated with a non-specific symptom diagnosis on multivariable analysis were lower socioeconomic status of the practice location (OR 0.94 for each decile of disadvantage, 95% CIs 0.90 to 0.98) and longer consultation duration (OR 1.02, 95% CIs 1.00 to 1.04). A specific vertigo diagnosis was associated with performing a procedure (OR 0.52, 95% CIs 0.27 to 1.00), with some evidence for seeking information from a supervisor being associated with a non-specific symptom diagnosis (OR 1.39, 95% CIs 0.92 to 2.09; p=0.12).ConclusionsAustralian GP registrars see dizzy patients as frequently as established GPs. The frequency and associations of a non-specific diagnosis are consistent with the acknowledged difficulty of making diagnoses in vertigo/dizziness presentations. Continuing emphasis on this area in GP training and encouragement of supervisor involvement in registrars’ diagnostic processes is indicated.

Unprofessional behaviour of GP residents and its remediation: a qualitative study among supervisors and faculty

Background Lapses in professionalism have profound negative effects on patients, health professionals, and society. The connection between unprofessional behaviour during training and later practice requires timely identification and remediation. However, appropriate language to describe unprofessional behaviour and its remediation during residency is lacking. Therefore, this exploratory study aims to investigate which behaviours of GP residents are considered unprofessional according to supervisors and faculty, and how remediation is applied. Methods We conducted eight semi-structured focus group interviews with 55 broadly selected supervisors from four Dutch GP training institutes. In addition, we conducted individual semi-structured interviews with eight designated professionalism faculty members. Interview recordings were transcribed verbatim. Data were coded in two consecutive steps: preliminary inductive coding was followed by secondary deductive coding using the descriptors from the recently developed ‘Four I’s’ model for describing unprofessional behaviours as sensitising concepts. Results Despite the differences in participants’ professional positions, we identified a shared conceptualisation in pinpointing and assessing unprofessional behaviour. Both groups described multiple unprofessional behaviours, which could be successfully mapped to the descriptors and categories of the Four I’s model. Behaviours in the categories ‘Involvement’ and ‘Interaction’ were assessed as mild and received informal, pedagogical feedback. Behaviours in the categories ‘Introspection’ and ‘Integrity’, were seen as very alarming and received strict remediation. We identified two new groups of behaviours; ‘Nervous exhaustion complaints’ and ‘Nine-to-five mentality’, needing to be added to the Four I’s model. The diagnostic phase of unprofessional behaviour usually started with the supervisor getting a ‘sense of alarm’, which was described as either a ‘gut feeling’, ‘a loss of enthusiasm for teaching’ or ‘fuss surrounding the resident’. This sense of alarm triggered the remediation phase. However, the diagnostic and remediation phases did not appear consecutive or distinct, but rather intertwined. Conclusions The processes of identification and remediation of unprofessional behaviour in residents appeared to be intertwined. Identification of behaviours related to lack of introspection or integrity were perceived as the most important to remediate. The results of this research provide supervisors and faculty with an appropriate language to describe unprofessional behaviours among residents, which can facilitate timely identification and remediation.

Evaluating the impact of a national strategic leader development programme for UK doctors: myth-busting, mind-changing, mood-enhancing

BackgroundThe drive towards engaging UK doctors in clinical leadership and management has involved many initiatives at various levels.MethodsThis paper reports on the findings of an in-depth evaluation of a national medical leadership programme for doctors in the late stages of specialty or general practitioner (GP) training or have just become consultants or GPs.ResultsThe evaluation clearly demonstrates the impact of this programme and the benefits for the individuals and organisations involved, particularly around stimulating a shift in mood and a major mindset shift in what medical leadership is (and is not) and what they can achieve as medical leaders. The programme structure and activities allowed participants to learn from a range of senior decision-makers about policy and strategic developments and processes. However, the evaluation also highlighted that some pervasive myths still exist around medical leadership and management which, if not addressed, will hamper efforts to fully engage doctors in taking on strategic leadership roles.ConclusionClinical leadership programmes are valuable, but must be carefully managed to extract the full value from them.

The professional resilience of mid-career General Practitioners (GPs) in the UK: a qualitative study

Background: With a continued crisis of increasing workload and reduced workforce in General Practice, supporting resilience is a key strategy for sustaining the profession for the future. Aim: How do GPs perceive professional resilience and what workplace factors influence it? Design and setting: A UK based qualitative study of the perspectives of GPs currently practicing in the UK with least five years’ experience after completion of GP training. Method: Participants were recruited using convenience sampling, including social media forums and underwent semi-structured interviews (n = 27). Data were analysed using thematic analysis. Results: Participants offered definitions of and influences on resilience which largely fit with existing research but in addition may result in GPs being perceived as obstructive, or that resilience may be a ‘surface act’. GPs agree that the current focus on methods of improving resilience does help support them but there is significantly more to be done in this field. Social media activity aiming at GP support may be counterproductive. Reduction of clinical working hours is a common strategy to improve resilience. Conclusion: That GPs feel to improve resilience they need to work fewer clinical hours may have huge implications for a workforce already in crisis; and ultimately for the healthcare of the UK population. Urgent research is needed to formulate a bespoke assessment for measuring GP resilience to assess potential interventions and identify GPs at risk of mental ill-health or leaving the profession.

Perspective of General Practitioners Toward Their Supervisors from the Recent Ten Years in China

Objectives:Doctors who wish to be the general practitioners (GPs) need to attend and complete general practice residents training in China. As in the early stage of the standardized GP training system, the GP training supervisors play an important role. This study aims to explore how the GP residents’ perspective towards GP supervisors and what factors affect the satisfaction tendency, and to offer some suggestions by the implication drawn from this study.Design:A quantitative and qualitative mixed study was conduct in the study . First, in the quantitative research, we adopt a survey by collecting training satisfaction through questionnaires, and extract and analyze the factors which influence the training satisfaction. Next, in the qualitative analysis, we conduct in-depth semi-structured interviews using the qualitative research criteria (COREQ)––a 32-item checklist for interviews. Participants:There are 1172 GPs whose time to start training varies from 2008 to 2017 in the quantitative survey while 100 of them filtered by stratified random sampling and extreme answers to the quantitative survey (less than 5% of the total sample) are chosen for the qualitative research to dig into the details. Specifically, the stratified random sampling is based on the resident's grade, region, and training basement level (city level or county level ), and the extreme answers refer to “extremely good” and “extremely bad” answers from the early 1172 participants comprehensive survey. Consequently, 30 extreme-answer participants were found and the left 70 were selected by stratified random sampling. According to the final implementation, participants meet the needs of information collection and sample estimation.Results:The results show that the satisfaction towards GP theoretical training supervisors, GP hospital-based training supervisors , and GP community-based training supervisors was different. From the average and long-term perspective, the prioritize of satisfaction is :GP theoretical training supervisors> GP community-based training supervisors > GP hospital-based training supervisors.GP hospital-based training supervisors need to improve GP concept, teaching methods and consciousness. GP community-based training supervisors need to improve their teaching methods, clinical theoretical knowledge and practice ability.Conclusions: On one hand ,GP supervisors team in China has been gradually settled up. On the other hand, the satisfaction tendency of residents toward GP supervisors are quite different, GP supervisors team need to be promoted and strengthened.

Learning needs, preferred learning methods and learning challenges of first five general practitioners in NHS Scotland: a qualitative study

ObjectivesTo identify the learning needs and preferred learning methods of First5 general practitioners (GPs) in National Health Service (NHS) Scotland.DesignQualitative research study using grounded theory methods. First5 GPs were interviewed in small focus groups or individual interviews in-person, or over the telephone depending on their preference.SettingGeneral practice in NHS Scotland.ParticipantsGPs, within the first 5 years of completion of GP training, who were working in NHS Scotland.ResultsThirty-eight First5s were recruited to the study. Participants recognised that gaps in their GP training became apparent in independent practice. Some of this related to NHS appraisal and revalidation, and with the business of general practice. They were interested in learning from an older generation of GPs but perceived that preferred learning methods differed. First5 GPs were less reliant on reading journals to change their practice, preferring to find learning resources that allowed them to gain new knowledge quickly and easily. There were considerations about resilience and of the challenges of learning in remote and rural areas of NHS Scotland. This related to travel costs and time, and to accessibility of learning courses. Participants appreciated collective learning and commented about the logistics and costs of learning.ConclusionsPreferred learning methods and learning resources differ with First5 GPs compared with those who have been in practice for some years. Learning providers need to recognise this and take these differences into account when planning and preparing learning in the future.