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1.  How Safe Do Teenagers Behave on Facebook? An Observational Study 
PLoS ONE  2014;9(8):e104036.
The substantial use of social network sites by teenagers has raised concerns about privacy and security. Previous research about behavior on social network sites was mostly based on surveys and interviews. Observational research overcomes problems inherent to this research method, for example social desirability. However, existing observational research mostly focuses on public profiles of young adults. Therefore, the current observation-study includes 1050 public and non-public Facebook-profiles of teenagers (13–18) to investigate (1) what kind of information teenagers post on their profile, (2) to what extent they protect this information using privacy-settings and (3) how much risky information they have on their profile. It was found that young people mostly post pictures, interests and some basic personal information on their profile. Some of them manage their privacy-settings as such that this information is reserved for friends' eyes only, but a lot of information is accessible on the friends-of-friends' pages. Although general risk scores are rather low, more detailed analyses show that teenagers nevertheless post a significant amount of risky information. Moreover, older teenagers and girls post more (risky) information while there are no differences in applying privacy settings. We found no differences in the Facebook behavior of teenagers enrolled in different education forms. Implications of these results are discussed.
doi:10.1371/journal.pone.0104036
PMCID: PMC4146465  PMID: 25162234
2.  Does reflection have an effect upon case-solving abilities of undergraduate medical students? 
BMC Medical Education  2012;12:75.
Background
Reflection on professional experience is increasingly accepted as a critical attribute for health care practice; however, evidence that it has a positive impact on performance remains scarce. This study investigated whether, after allowing for the effects of knowledge and consultation skills, reflection had an independent effect on students’ ability to solve problem cases.
Methods
Data was collected from 362 undergraduate medical students at Ghent University solving video cases and reflected on the experience of doing so. For knowledge and consultation skills results on a progress test and a course teaching consultation skills were used respectively. Stepwise multiple linear regression analysis was used to test the relationship between the quality of case-solving (dependent variable) and reflection skills, knowledge, and consultation skills (dependent variables).
Results
Only students with data on all variables available (n = 270) were included for analysis. The model was significant (Anova F(3,269) = 11.00, p < 0.001, adjusted R square 0.10) with all variables significantly contributing.
Conclusion
Medical students’ reflection had a small but significant effect on case-solving, which supports reflection as an attribute for performance. These findings suggest that it would be worthwhile testing the effect of reflection skills training on clinical competence.
doi:10.1186/1472-6920-12-75
PMCID: PMC3492041  PMID: 22889271
3.  Assessing basic life support skills without an instructor: is it possible? 
BMC Medical Education  2012;12:58.
Background
Current methods to assess Basic Life Support skills (BLS; chest compressions and ventilations) require the presence of an instructor. This is time-consuming and comports instructor bias. Since BLS skills testing is a routine activity, it is potentially suitable for automation. We developed a fully automated BLS testing station without instructor by using innovative software linked to a training manikin. The goal of our study was to investigate the feasibility of adequate testing (effectiveness) within the shortest period of time (efficiency).
Methods
As part of a randomised controlled trial investigating different compression depth training strategies, 184 medicine students received an individual appointment for a retention test six months after training. An interactive FlashTM (Adobe Systems Inc., USA) user interface was developed, to guide the students through the testing procedure after login, while Skills StationTM software (Laerdal Medical, Norway) automatically recorded compressions and ventilations and their duration (“time on task”). In a subgroup of 29 students the room entrance and exit time was registered to assess efficiency. To obtain a qualitative insight of the effectiveness, student’s perceptions about the instructional organisation and about the usability of the fully automated testing station were surveyed.
Results
During testing there was incomplete data registration in two students and one student performed compressions only. The average time on task for the remaining 181 students was three minutes (SD 0.5). In the subgroup, the average overall time spent in the testing station was 7.5 minutes (SD 1.4). Mean scores were 5.3/6 (SD 0.5, range 4.0-6.0) for instructional organisation and 5.0/6 (SD 0.61, range 3.1-6.0) for usability. Students highly appreciated the automated testing procedure.
Conclusions
Our automated testing station was an effective and efficient method to assess BLS skills in medicine students. Instructional organisation and usability were judged to be very good. This method enables future formative assessment and certification procedures to be carried out without instructor involvement.
Trial registration
B67020097543
doi:10.1186/1472-6920-12-58
PMCID: PMC3461425  PMID: 22824338
Automated testing; Basic Life Support; Cardiopulmonary resuscitation; Self-directed learning
4.  Using video-cases to assess student reflection: Development and validation of an instrument 
BMC Medical Education  2012;12:22.
Background
Reflection is a meta-cognitive process, characterized by: 1. Awareness of self and the situation; 2. Critical analysis and understanding of both self and the situation; 3. Development of new perspectives to inform future actions. Assessors can only access reflections indirectly through learners’ verbal and/or written expressions. Being privy to the situation that triggered reflection could place reflective materials into context. Video-cases make that possible and, coupled with a scoring rubric, offer a reliable way of assessing reflection.
Methods
Fourth and fifth year undergraduate medical students were shown two interactive video-cases and asked to reflect on this experience, guided by six standard questions. The quality of students’ reflections were scored using a specially developed Student Assessment of Reflection Scoring rubric (StARS®). Reflection scores were analyzed concerning interrater reliability and ability to discriminate between students. Further, the intra-rater reliability and case specificity were estimated by means of a generalizability study with rating and case scenario as facets.
Results
Reflection scores of 270 students ranged widely and interrater reliability was acceptable (Krippendorff’s alpha = 0.88). The generalizability study suggested 3 or 4 cases were needed to obtain reliable ratings from 4th year students and ≥ 6 cases from 5th year students.
Conclusion
Use of StARS® to assess student reflections triggered by standardized video-cases had acceptable discriminative ability and reliability. We offer this practical method for assessing reflection summatively, and providing formative feedback in training situations.
doi:10.1186/1472-6920-12-22
PMCID: PMC3426495  PMID: 22520632
5.  Results of a survey by the European Society of Radiology (ESR): undergraduate radiology education in Europe—influences of a modern teaching approach 
Insights into Imaging  2012;3(2):121-130.
Objectives
The purpose of the present study is to determine in what way a conventional versus a modern medical curriculum influences teaching delivery in formal radiology education.
Methods
A web-based questionnaire was distributed by the ESR to radiology teaching staff from 93 European teaching institutions.
Results
Early exposure to radiology in pre-clinical years is typically reported in institutions with a modern curriculum. The average number of teaching hours related to radiology is similar in both curriculum types (60 h). Radiology in modern curricula is mainly taught by radiologists, radiology trainees (50%), radiographers (20%) or clinicians (17%). Mandatory clerkships are pertinent to modern curricula (55% vs. 41% conventional curriculum), which start in the first (13% vs. 4% conventional curriculum) or second year of the training (9% vs. 2% conventional curriculum). The common core in both curricula consists of radiology examinations, to work with radiology teaching files, to attend radiology conferences, and to participate in multidisciplinary meetings.
Conclusion
The influence of a modern curriculum on the formal radiology teaching is visible in terms of earlier exposure to radiology, involvement of a wider range of staff grades and range of profession involved in teaching, and radiology clerkships with more active and integrated tasks.
Main Message
• This study looks at differences in the nature of formal radiology teaching.
doi:10.1007/s13244-012-0149-0
PMCID: PMC3314734  PMID: 22696038
Radiology; Teaching; Undergraduate
6.  Factors confounding the assessment of reflection: a critical review 
BMC Medical Education  2011;11:104.
Background
Reflection on experience is an increasingly critical part of professional development and lifelong learning. There is, however, continuing uncertainty about how best to put principle into practice, particularly as regards assessment. This article explores those uncertainties in order to find practical ways of assessing reflection.
Discussion
We critically review four problems: 1. Inconsistent definitions of reflection; 2. Lack of standards to determine (in)adequate reflection; 3. Factors that complicate assessment; 4. Internal and external contextual factors affecting the assessment of reflection.
Summary
To address the problem of inconsistency, we identified processes that were common to a number of widely quoted theories and synthesised a model, which yielded six indicators that could be used in assessment instruments. We arrived at the conclusion that, until further progress has been made in defining standards, assessment must depend on developing and communicating local consensus between stakeholders (students, practitioners, teachers, supervisors, curriculum developers) about what is expected in exercises and formal tests. Major factors that complicate assessment are the subjective nature of reflection's content and the dependency on descriptions by persons being assessed about their reflection process, without any objective means of verification. To counter these validity threats, we suggest that assessment should focus on generic process skills rather than the subjective content of reflection and where possible to consider objective information about the triggering situation to verify described reflections. Finally, internal and external contextual factors such as motivation, instruction, character of assessment (formative or summative) and the ability of individual learning environments to stimulate reflection should be considered.
doi:10.1186/1472-6920-11-104
PMCID: PMC3268719  PMID: 22204704

Results 1-6 (6)