The Use of Clinical Reasoning Skills in the Setting of Uncertainty: A Case of Trial Femoral Head Migration

Clinical skills and medical knowledge enable physicians to overcome the uncertainty of emergent and rare clinical scenarios. Recently, a growing emphasis on evidence-based medicine (EBM) has flooded medical curricula of universities across the globe with guideline-based material, and while it has given teachers and students new tools to improve medical education, clinical reasoning must be reaffirmed in its capacity to provide physicians with the ability to solve unexpected clinical scenarios. Anatomical education in medical school should have two main objectives: to acquire anatomical knowledge and to develop the skill of applying that knowledge in clinical scenarios. The authors present a clinical scenario in which an unexpected and rare complication occurred during a routine elective hip replacement surgery. The general surgeon presiding over the case, also an anatomy professor, solved the problem using clinical reasoning and anatomical knowledge. It was a clear example of how clinical reasoning is key in approaching unprecedented, rare, or unknown complications. The intention of this scenario is to remind colleagues and medical schools that, although EBM is the standard, educators must uphold sound clinical reasoning to best prepare health care providers for their careers.     

‘For older folks like me,these things are over us…’: The challenge of embedding tablet computers in everyday life within a geriatric hospital in Uruguay

ABSTRACT

Much research has focused on the introduction of information and communication technology (ICTs) into the lives of older people, but it has generally understood them as external factors who act as a sort of independent variable that impacts the seniors’ lives. There remains a dearth of empirical research into how aging and technology are co-constructed, namely, research that focuses on older people’s relationship to technology as a socio-technical network. We therefore contribute to this field by analyzing the development and establishment of a network in a geriatric hospital in Montevideo, Uruguay. Uruguay has been developing a one-tablet computer-per low-income-senior policy since 2015. In this research, we deployed a qualitative ethnographic research comprised of semi-structured interviews, jottings, and field notes where we explore the adoption of tablets within the corresponding actor-network. Our findings suggest that objectively, not only was the establishment of the sociotechnical network rife with complexities, disruptions, and fissures, but subjectively, seniors in the hospital were heavily influenced by their self-perception of the potentialities of ICTs.     

An improved robust stabilization method for discrete-time fuzzy systems with time-varying delays

This note focuses on the robust stabilization of discrete-time fuzzy uncertain systems with time-varying delays under a delayed nonparallel distributed compensation scheme. The key idea is twofold: first, the linear matrix inequalities (LMI) proposed here are shown to generalize some previous similar results available in recent literature, and second, the design of control parameters is decoupled from the proposed fuzzy-basis dependent Lyapunov–Krasovskii functional (FBDLKF) by means of Finsler?s lemma. Finally, a numerical example is provided to illustrate the effectiveness of this method.     

Comparison of anxiety levels of students in introductory earth science and geology courses

Students in geology and earth science courses were not anxious about taking these courses as measured by the State-Triat Anxiety Inventory. Students in each course were split into two grade groups. It was shown that students whose grades were in the higher group had low anxiety, which continued to be reduced during the course. Students in the lower grade group had high anxiety, which increased during the course. There was no difference between anxiety scores of males and females. In general, students who planned to elect additional courses had lower state anxiety and higher grades than students who did not plan to elect additional courses in geology and earth science.     

From resource to document: scaffolding content and organising student learning in teachers’ documentation work on the teaching of series

We examine teachers’ use of resources as they prepare to teach the topic of numerical series of real numbers, in order to identify how their personal relationship with mathematical content—and its teaching—interacts with their use of a commonly used textbook. We describe this interplay between textbook and personal relationship, a term coined in the Anthropological Theory of the Didactic (ATD, Chevallard, 2003), in terms of documentation work (resources, aims, rules of action, operational invariants), a key construct from the documentational approach (DA, Gueudet & Trouche, in Educational Studies in Mathematics, 71, 199–218, 2009). We do so in the case of five post-secondary teachers who use the same textbook as a main resource for teaching the topic. Documentational analysis of interviews with the teachers led to the identification of their aims and rules of action (the what and how of their resource use as they organise their teaching of the topic) as well as the operational invariants (the why for this organisation of their teaching). We describe the teachers’ documentation work in two sets of aims/rules of action: scaffolding mathematical content (series as a stepping stone to learning about Taylor polynomials and Maclaurin series), and organising student learning about series through drill exercises, visualisation, examples, and applications. Our bridging (networking) of theoretical constructs originating in one theoretical framework (personal relationship, ATD) with the constructs of a different, yet compatible, framework (documentation work, DA) aims to enrich the latter (teachers’ documentation work) with the individual agency (teachers’ personal relationships with the topic) provided by the former.     

The influence of high-stakes testing on teacher self-efficacy and job-related stress

In the United States, teachers’ job-related stress and self-efficacy levels across all grades are influenced in some manner by the demands of high-stakes testing. This sequential mixed-methods study aimed at examining the dynamics among assigned subject matter, teacher job-related stress, and teacher self-efficacy in a large south-eastern Texas school district. Quantitative data were collected via the High Stakes Testing on Self-Efficacy and Teacher Stress Survey from a convenience sample of 145 teachers, while qualitative data were gathered during focus-group sessions at the elementary, middle and high school levels. Findings indicated that assigned subject matter did not influence teacher self-efficacy, but did influence teachers’ job-related stress. Additionally, a relationship was found to exist between teacher job-related stress and teacher self-efficacy. Teachers reported lack of time, modifications to curriculum, and testing of special education populations as contributions to their job-related stress, and school leadership and educational triage as impacting their teacher self-efficacy.     

A Complex Systems Network Approach to Quantifying Peer Effects: Evidence From Ghanaian Preprimary Classrooms

Research on classroom peer effects has focused nearly exclusively on high-income countries and on academic skills. Little is known about peer effects in low-income countries and whether effects differ under different educational environments (e.g., teacher-directed versus child-centered, conditions of concentrated advantage or disadvantage). Based on a data set of Ghanaian preprimary classrooms in the Greater Accra Region collected in the 2015–2016 school year, we use complex system networks with multilevel modeling to study the presence and magnitude of peer effects. Results corroborated small statistically significant effects on academic and nonacademic skills (d = .06–.10). Peer effects on literacy were larger for children in public schools, who are relatively more disadvantaged than their private school counterparts. Teacher-directivity intensity did not moderate peer effects.     

Preschool Self-Regulation and Preacademic Skills as Mediators of the Long-Term Impacts of an Early Intervention

This study explores children's early academic and self-regulatory skills as potential pathways through which a preschool enrichment program—the Chicago School Readiness Project (CSRP)—may contribute to low-income children's long-term outcomes (N = 466; M_age at baseline = 4.10 years). We find that CSRP's impact on high school grades may be partially explained by early gains in vocabulary and math skills. Although impacts on high school executive function (EF) were more equivocal, our results suggest that early improvements in math skills attributable to the intervention may, in turn, predict long-term gains in EF skills. These results complement the existing literature on preschool fade out, while also shedding light on the cross-domain relations between academic and self-regulatory skills.     

Argumentation and indigenous knowledge: socio-historical influences in contextualizing an argumentation model in South African schools

This forum considers argumentation as a means of science teaching in South African schools, through the integration of indigenous knowledge (IK). It addresses issues raised in Mariana G. Hewson and Meshach B. Ogunniyi’s paper entitled: Argumentation-teaching as a method to introduce indigenous knowledge into science classrooms: opportunities and challenges. As well as Peter Easton’s: Hawks and baby chickens: cultivating the sources of indigenous science education; and, Femi S. Otulaja, Ann Cameron and Audrey Msimanga’s: Rethinking argumentation-teaching strategies and indigenous knowledge in South African science classrooms. The first topic addressed is that implementation of argumentation in the science classroom becomes a complex endeavor when the tensions between students’ IK, the educational infrastructure (allowance for teacher professional development, etc.) and local belief systems are made explicit. Secondly, western styles of debate become mitigating factors because they do not always adequately translate to South African culture. For example, in many instances it is more culturally acceptable in South Africa to build consensus than to be confrontational. Thirdly, the tension between what is “authentic science” and what is not becomes an influencing factor when a tension is created between IK and western science. Finally, I argue that the thrust of argumentation is to set students up as “scientist-students” who will be considered through a deficit model by judging their habitus and cultural capital. Explicitly, a “scientist-student” is a student who has “learned,” modeled and thoroughly assimilated the habits of western scientists, evidently—and who will be judged by and held accountable for their demonstration of explicit related behaviors in the science classroom. I propose that science teaching, to include argumentation, should consist of “listening carefully” (radical listening) to students and valuing their language, culture, and learning as a model for “science for all”.