Learning,Testing, and the Evaluation of Learning Environments in Medicine: Global Performance Assessment in Medical Education

Changes in the profession of medicine are creating the demand for a substantive reexamination of current practices in medical education. Many of the major issues in addressing this challenge are structural and political rather than scientific; here we address one critical scientific issue that will be important to (though not by itself adequate for) guiding such changes. The factor we address is the development of a global performance assessment: a standardized mechanism to assess individual skills and abilities that can be used to evaluate alternative educational interventions. We discuss the issues involved in developing such a system, and describe a set of principles for defining desired outcomes and developing assessment tools, including (a) wide clinical scope, (b) direct relationship to actual clinical performance, (c) reliability and repeatability, and (d) non-longitudinal measurement. We discuss the role of simulation, reflective practice, and portfolios of work in developing such a system, and argue that whatever form such metrics take, a system of global performance assessment will develop from close collaboration between clinicians and educators with innovative ways of thinking about performance and expertise.     

Acute cardiovascular responses to interval exercise: A systematic review and meta-analysis

ABSTRACT

Interval exercise training is increasingly recommended to improve health and fitness; however, it is not known if cardiovascular risk is different from continuous exercise protocols. This systematic review with meta-analyses assessed the effect of a single bout of interval exercise on cardiovascular responses that indicate risk of cardiac fibrillation and infarction compared to continuous exercise. Electronic databases Medline, CINAHL, Embase, Scopus and Cochrane were searched. Key inclusion criteria were: (1) intervals of the same intensity and duration followed by a recovery period and (2) reporting at least one of blood pressure, heart rate variability, arterial stiffness or function. Cochrane Risk of Bias tool and GRADE approach were used. Meta-analyses found that systolic blood pressure responses to interval exercise did not differ from responses to continuous exercise immediately (MD 8 mmHg [95% CI ?32, 47], p = 0.71) or at 60 min following exercise (MD 0 mmHg [95% CI ?2, 1], p = 0.79). However, reductions in diastolic blood pressure and flow-mediated dilation with interval exercise were observed 10–15 min post-exercise. The available evidence indicates that interval exercise does not convey higher cardiovascular risk than continuous exercise. Further investigation is required to establish the safety of interval exercise for clinical populations.     

Power training in elite young soccer players: Effects of using loads above or below the optimum power zone

ABSTRACT

This study aimed to examine the effects of two jump squat (JS) training programs involving different loading ranges in under-20 soccer players during a preseason period. Twenty-three elite young soccer players performed sprint speed (at 5-, 10-, and 20-m), change-of-direction (COD) speed, JS peak-power (PP), and countermovement jump (CMJ) tests pre and post four weeks of training. Athletes were pair-matched in two groups according to their optimum power loads (OPL) as follows: lower than OPL (LOPL; athletes who trained at a load 20% lower than the OPL) and higher than OPL (HOPL; athletes who trained at a load 20% higher than the OPL). Magnitude-based inferences were used to compare pre- and post-training measures. Meaningful increases in the PP JS were observed for both groups. Likely and possible improvements were observed in the 5- and 10-m sprint velocity in the LOPL group. Meanwhile, possible and likely improvements were observed in the CMJ, 5- and 10-m sprint velocity, and COD speed in the HOPL group. Overall, both training schemes induced positive changes in athletic performance. Soccer coaches and sport scientists can implement the JS OPL-based training schemes presented here, either separately or combined, to improve the physical performance of youth soccer players.     

Uncovering the Evidence: Faculty Perceptions of Distance Library Services

Usage statistics are a regular part of assessment but the lack of context leaves librarians pondering the reasons for fluctuations in use. Through development of an online survey, we examined faculty perceptions, knowledge, and use of distance library services to support online courses. Responses provided much needed context and helped to determine priorities and direction for services. While this survey was a useful marketing tool, results emphasized that the greatest need was for ongoing communication with faculty to increase awareness of services provided.     

Connecting Cline Library with Tribal Communities: A Case Study

ABSTRACT

One of the six strategic planning goals of Northern Arizona University (NAU) is to strengthen its relationship with Native Americans and to become one of the nation's leading universities serving Native American students. Considering its close geographic proximity to several tribal communities—particularly the Navajo Nation, which represents 44% of Native American Students at NAU—several programmatic and collection management activities have been instituted at the university's Cline Library as a response to this broader university goal. The library's outreach efforts, though, extend beyond the university's Native American student population and include activities designed to collaborate with tribal communities in a more direct and inclusive manner. Furthermore, incorporating concepts of critical librarianship into the library's teaching, learning, and public programming helps provide a progressive theoretical framework for improving relationships between the university and Native American communities. This case study provides an overview of existing programmatic and policy-based initiatives at the library and discusses where improvements could be made to help foster a closer and more meaningful relationship with Native American students, faculty, and patrons.     

The Relationship Between Retention and College Counseling for High‐Risk Students

The author used an archival study to explore the relationship between college counseling and retention. The cohort for this study was a college's 2006 class of full‐time, 1st‐year students (N = 429). The results of chi‐square analyses and regression analyses indicated (a) a significant difference in retention between high‐risk and low‐risk students who used counseling services (CS) and (b) that a student's risk for dropout did not vary significantly over time based on risk level or CS use.     

A Counselling Framework for Caribbean Children and Families Who Have Experienced Migratory Separation and Reunion

This paper presents research findings on childrens’ responses to migratory separation and later reunion in Caribbean families and the needs of these families when parents migrate and leave their children behind. Implications of this type of separation on children, parents and surrogate caregivers are discussed. The challenges that counsellors in both the ‘sending’ and host countries face working with this population are also examined and suggestions made for psychosocial intervention and guidelines for counselling in both societies. The need for culturally competent counsellors to work with the growing population of immigrants in North America and Europe is indicated.     

A conceptual model of taste receptors

Of all the senses, that of taste is perhaps the hardest to define and quantify and elucidation of the underlying mechanisms is unrespondingly difficult. This article describes a conceptual model — at the molecular level — for the four basic taste modalities, using apparent specific volume as a fundamental parameter. It also considers possible practical applications.