Christy Boscardin

Early Identification of Reading Difficulties Using Heterogeneous Developmental Trajectories

Serious conceptual and procedural problems associated with current diagnostic methods call for alternative approaches to assessing and diagnosing students with reading problems. This study presents a new analytic model to improve the classification and prediction of childrens reading development. Growth mixture modeling was used to identify the presence of 10 different heterogeneous developmental patterns. In all, 411 children in kindergarten through Grade 2 from 3 elementary schools in Texas were administered measures of phonological awareness, word recognition, and rapid naming skills 4 times a year. The mean ages were 5.8 years (SD = 0.35) for the kindergartners, 6.9 years (SD = 0.39) for Grade 1, and 8.0 years (SD = 0.43) for Grade 2; the percentage of boys was 50%. The results indicate that precursor reading skills such as phonological awareness and rapid naming are highly predictive of word reading (word recognition) and that developmental profiles formed in kindergarten are directly associated with development in Grades 1 and 2. Students identified as having reading-related difficulties in kindergarten exhibited slower development of word recognition skills in subsequent years of the study.

Integrating Literacy and Science in Biology: Teaching and Learning Impacts of Reading Apprenticeship Professional Development

This study examined the effects of professional development integrating academic literacy and biology instruction on science teachers’ instructional practices and students’ achievement in science and literacy. The intervention consisted of 10 days of professional development in Reading Apprenticeship, an instructional framework integrating metacognitive inquiry routines into subject-area instruction to make explicit the tacit reasoning processes, problem-solving strategies, and textual features that shape literacy practices in academic disciplines. The study utilized a group-randomized, experimental design and multiple measures of teacher implementation and student learning and targeted groups historically unrepresented in the sciences. Hierarchical linear modeling procedures were used to estimate program impacts. Intervention teachers demonstrated increased support for science literacy learning and use of metacognitive inquiry routines, reading comprehension instruction, and collaborative learning structures compared to controls. Students in treatment classrooms performed better than controls on state standardized assessments in English language arts, reading comprehension, and biology.

Understanding trust as an essential element of trainee supervision and learning in the workplace

Clinical supervision requires that supervisors make decisions about how much independence to allow their trainees for patient care tasks. The simultaneous goals of ensuring quality patient care and affording trainees appropriate and progressively greater responsibility require that the supervising physician trusts the trainee. Trust allows the trainee to experience increasing levels of participation and responsibility in the workplace in a way that builds competence for future practice. The factors influencing a supervisor’s trust in a trainee are related to the supervisor, trainee, the supervisor–trainee relationship, task, and context. This literature-based overview of these five factors informs design principles for clinical education that support the granting of entrustment. Entrustable professional activities offer promise as an example of a novel supervision and assessment strategy based on trust. Informed by the design principles offered here, entrustment can support supervisors’ accountability for the outcomes of training by maintaining focus on future patient care outcomes.

Clinician Attitudes About Commercial Support of Continuing Medical Education: Results of a Detailed Survey

BACKGROUND Pharmaceutical and medical device company funding supports up to 60% of accredited continuing medical education (CME) costs in the United States. Some have proposed measures to limit the size, scope, and potential influence of commercial support for CME activities. We sought to determine whether participants at CME activities perceive that commercial support introduces bias, whether this is affected by the amount or type of support, and whether they would be willing to accept higher fees or fewer amenities to decrease the need for such funding. METHODS We delivered a structured questionnaire to 1347 participants at a series of 5 live CME activities about the impact of commercial support on bias and their willingness to pay additional amounts to eliminate the need for commercial support. RESULTS Of the 770 respondents (a 57% response rate), most (88%) believed that commercial support introduces bias, with greater amounts of support introducing greater risk of bias. Only 15%, however, supported elimination of commercial support from CME activities, and less than half (42%) were willing to pay increased registration fees to decrease or eliminate commercial support. Participants who perceived bias from commercial support more frequently agreed to increase registration fees to decrease such support (2- to 3-fold odds ratio). Participants greatly underestimated the costs of ancillary activities, such as food, as well as the degree of support actually provided by commercial funding. CONCLUSION Although the medical professionals responding to this survey were concerned about bias introduced from commercial funding of CME, many were not willing to pay higher fees to offset or eliminate such funding sources.

Relationship Between Opportunity to Learn and Student Performance on English and Algebra Assessments

The purpose of this study was to examine how various opportunity to learn (OTL) variables impact student outcomes and whether these effects are consistent across different subject areas. In this study, we examined the impact of OTL variables on student performance on English and algebra assessments. Despite the differences in the subject areas, 3 consistent findings emerged. First, we found a significant positive relationship between teacher expertise and student performance. Teacher expertise in this study is defined specifically as expertise and knowledge within the content areas covered in the standards and the district assessment, rather than overall expertise in the subject area. Our study also showed that content coverage was positively correlated with student performance in English and algebra. Finally, consistent with previous findings, our study indicated that the socioeconomic status of the classroom has a significant impact on student performance.

Exploring Benefits of Audience-Response Systems on Learning: A Review of the Literature

Electronic-response systems (ERS) or audience-response systems (ARS) can be powerful instructional tools. Since the earliest adoption of ARS in the mid-1960s, the technology has changed significantly, especially in recent years, with advances in wireless communications. Over the years, ARS has become more sophisticated, more userfriendly, and cheaper. Typical ARS technology now allows instructors to present questions to the audience, and individual audience members respond with a keypad; responses are then automatically tabulated and displayed in a variety of graphic formats on-screen for feedback to the group. The tool is similar to that of the TV show “Who Wants to Be a Millionaire?” where every member of the audience transmits his or her response, and the distribution of responses is displayed on-screen. According to a recent study, the diffusion of this instructional technology is so widespread now that almost all universities in the United States and over 3,000 schools at the primary and secondary levels are currently using ARS (1). To increase learner-engagement, medical education and health-profession education, in general, including many continuing medical education programs are increasingly turning to ARS as a tool to promote learner participation and create an interactive learning environment (2, 3). ARS claims to promote student participation and engagement through elicitation of content-understanding and creating a safer, anonymous environment for learners to participate freely without fear of embarrassment or being singled out. Also, the public display of the distribution of responses either reaffirms their understanding or can be used to help gauge the learner’s own responses against the group norm. The recent reviews of the literature have reported several benefits of using ARS (4–6). Although these reviews provided a comprehensive list of benefits and potential barriers for successful implementation of the technology in the classrooms, they lacked a theoretical framework to help synthesize the reported outcomes of using ARS. The purpose of this review is to provide a theoretical framework for understanding the context for the intended and unintended consequences of using ARS. Given that only a handful of studies was conducted using a randomized, controlled design with validated measures, this review focused on the themes emerging from the literature, rather than performing a systematic review for comparison of studies or summarize the findings with metaanalysis. The focus of the review is on types of outcomes reported and context for implementation of ARS, rather than a comparison of the magnitude and statistical significance of the findings. This thematic review presents the findings from the literature in the context of existing learning theories and assessment models to help build upon the previous literature reviews. Although use of ARS has grown rapidly over the last decade, reports on efficacy of the technology have mostly focused on perceived benefits to learners, with the exception of a small number of studies on knowledge-retention, which showed inconsistent results (6). Recent studies from both health-profession education and higher-education settings have reported significant improvement in learning and knowledge-retention (7, 8). However, a recent randomized, controlled study in the continuingmedical education (CME) setting failed to show improved knowledge-gain from ARS versus the traditional didactic lecture environment (9). Despite widespread adoption in certain fields (5, 10), there is limited systematic review of the impact of ARS on instruction and learning outcomes. The purpose of this paper is to provide a review of the literature to 1) evaluate the benefits and consequences of using ARS; 2) present existing theories and models that help provide context for the reported outcomes; and 3) offer recommendations for optimal utilization of this technology for instruction and learning.

Predicting failing performance on a standardized patient clinical performance examination: the importance of communication and professionalism skills deficits.

Background The purpose is to determine which assessment measures identify medical students at risk of failing a clinical performance examination (CPX). Method Retrospective case-control, multiyear design, contingency table analysis, n = 149. Results We identified two predictors of CPX failure in patient–physician interaction skills: low clerkship ratings (odds ratio 1.79, P = .008) and student progress review for communication or professionalism concerns (odds ratio 2.64, P = .002). No assessments predicted CPX failure in clinical skills. Conclusions Performance concerns in communication and professionalism identify students at risk of failing the patient–physician interaction portion of a CPX. This correlation suggests that both faculty and standardized patients can detect noncognitive traits predictive of failing performance. Early identification of these students may allow for development of a structured supplemental curriculum with increased opportunities for practice and feedback. The lack of predictors in the clinical skills portion suggests limited faculty observation or feedback.

Using tablets to support self-regulated learning in a longitudinal integrated clerkship.

Introduction The need to train physicians committed to learning throughout their careers has prompted medical schools to encourage the development and practice of self-regulated learning by students. Longitudinal integrated clerkships (LICs) require students to exercise self-regulated learning skills. As mobile tools, tablets can potentially support self-regulation among LIC students. Methods We provided 15 LIC students with tablet computers with access to the electronic health record (EHR), to track their patient cohort, and a multiplatform online notebook, to support documentation and retrieval of self-identified clinical learning issues. Students received a 1-hour workshop on the relevant features of the tablet and online notebook. Two focus groups with the students were used to evaluate the program, one early and one late in the year and were coded by two raters. Results Students used the tablet to support their self-regulated learning in ways that were unique to their learning styles and increased access to resources and utilization of down-time. Students who used the tablet to self-monitor and target learning demonstrated the utility of tablets as learning tools. Conclusions LICs are environments rich in opportunity for self-regulated learning. Tablets can enhance students’ ability to develop and employ self-regulatory skills in a clinical context.

Validation of a self-efficacy instrument and its relationship to performance of crisis resource management skills

Self-efficacy is thought to be important for resuscitation proficiency in that it influences the development of and access to the associated medical knowledge, procedural skills and crisis resource management (CRM) skills. Since performance assessment of CRM skills is challenging, self-efficacy is often used as a measure of competence in this area. While self-efficacy may influence performance, the true relationship between self-efficacy and performance in this setting has not been delineated. We developed an instrument to measure pediatric residents’ self-efficacy in CRM skills and assessed its content validity, internal structure, and relationship to other variables. After administering the instrument to 125 pediatric residents, critical care fellows and faculty, we performed an exploratory factor analysis within a confirmatory factor analysis as well as a known group comparison. The analyses specified four factors that we defined as: situation awareness, team management, environment management, and decision making. Pediatric residents reported lower self-efficacy than fellows and faculty in each factor. We also examined the correlation between self-efficacy and performance scores for a subset of 30 residents who led video recorded simulated resuscitations and had their performances rated by three observers. We found a significant, positive correlation between residents’ self-efficacy in situation awareness and environment management and their overall performance of CRM skills. Our findings suggest that in a specific context, self-efficacy as a form of self-assessment may be informative with regards to performance.

Assessment of Medical Students' Shared Decision-Making in Standardized Patient Encounters

BACKGROUNDShared decision-making, in which physicians and patients openly explore beliefs, exchange information, and reach explicit closure, may represent optimal physician–patient communication. There are currently no universally accepted methods to assess medical students’ competence in shared decision-making.OBJECTIVETo characterize medical students’ shared decision-making with standardized patients (SPs) and determine if students’ use of shared decision-making correlates with SP ratings of their communication.DESIGNRetrospective study of medical students’ performance with four SPs.PARTICIPANTSSixty fourth-year medical students.MEASUREMENTSObjective blinded coding of shared decision-making quantified as decision moments (exploration/articulation of perspective, information sharing, explicit closure for a particular decision); SP scoring of communication skills using a validated checklist.RESULTSOf 779 decision moments generated in 240 encounters, 312 (40%) met criteria for shared decision-making. All students engaged in shared decision-making in at least two of the four cases, although in two cases 5% and 12% of students engaged in no shared decision-making. The most commonly discussed decision moment topics were medications (n = 98, 31%), follow-up visits (71, 23%), and diagnostic testing (44, 14%). Correlations between the number of decision moments in a case and students’ communication scores were low (rho = 0.07 to 0.37).CONCLUSIONSAlthough all students engaged in some shared decision-making, particularly regarding medical interventions, there was no correlation between shared decision-making and overall communication competence rated by the SPs. These findings suggest that SP ratings of students’ communication skill cannot be used to infer students’ use of shared decision-making. Tools to determine students’ skill in shared decision-making are needed.