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A Standardized Patient (SP) is a trained actor who portrays a particular illness to provide training to medical students and professionals. SPs primarily use written scripts and additional paper-based training for preparation of practical and board exams. Many institutions use various methods for training such as hiring preceptors for reenactment of scenarios, viewing archived videos, and computer based training. Currently, the training that is available can be enhanced to improve the level of quality of standardized patients. The following research is examining current processes in standardized patient training and investigating new methods for clinical skills education in SPs. The modality that is selected for training can possibly affect the performance of the actual SP case. This paper explains the results of a study that investigates if there is a difference in the results of an SP performance assessment. This difference can be seen when comparing a virtual human modality to that of a pre-recorded human modality for standardized patient training. The sample population navigates through an interactive computer based training module which provides informational content on what the roles of an SP are, training objectives, a practice session, and an interactive performance assessment with a simulated Virtual Human medical student. Half of the subjects interact with an animated virtual human medical student while the other half interacts with a pre-recorded human. The interactions from this assessment are audio-recorded, transcribed, and then graded to see how the two modalities compare. If the performance when using virtual humans for standardized patients is equal to or superior to pre-recorded humans, this can be utilized as a part task trainer that brings standardized patients to a higher level of effectiveness and standardization. In addition, if executed properly, this tool could potentially be used as a part task trainer which could provide savings in training time, resources, budget, and staff to military and civilian healthcare facilities.

These studies investigated 1) mechanisms underlying the well-established reduction in orthostatic tolerance (OT) that occurs in humans during heat stress (HS) relative to normothermia (NT) with particular focus on determining factors contributing to the high degree of inter-individual variability in this phenomenon; and 2) influence of obesity on OT, and mechanisms underlying reduced OT, should it exist. In Study #1, OT was assessed during lower body negative pressure (LBNP), and quantified with a cumulative stress index (CSI). Differences in CSI (CSIdiff) between thermal conditions were used to categorize individuals most (LargeDiff) and least (SmallDiff) affected by HS (P<0.001). Cerebral perfusion [indexed as middle cerebral artery blood velocity (MCA Vm̳̳e̳a̳n̳)] was reduced during HS compared to NT (P<0.001); however, the magnitude of reduction did not differ between groups (P=0.51). In the initial stage of LBNP during HS (LBNP20), MCA Vm̳̳e̳a̳n̳ and end-tidal CO₂ (PETC̳O̳₂) were reduced, and heart rate (HR) was higher in the LargeDiff group compared to SmallDiff group (all P<0.05); yet, mean arterial pressure was similar (P=0.23) suggesting impaired mechanisms regulating MCA Vm̳̳e̳a̳n̳ may affect OT. In Study #2, mechanisms of cerebrovascular control were compared in LargeDiff and SmallDiff individuals. Although estimates of cerebral autoregulation (CA) and cerebrovascular reactivity to CO₂ were improved and reduced respectively, during HS compared to NT (all P<0.05), no relationship existed between CA or cerebral reactivity to hypocapnia and CSIdiff (all P>0.05). In Study #3, OT was lower in obese compared to non-obese individuals (P<0.01), and BMI was negatively correlated with CSI (R = -0.47; P < 0.01). HR was elevated at rest and in every level of LBNP (all P<0.05) in obese; yet, peak HR during LBNP was similar between groups (P=0.90). MCA Vm̳̳e̳a̳n̳ and cerebral vascular conductance were similar at rest and during LBNP (both P>0.05), and CA was similar between groups (P>0.05). In summary, a high HR prior to-, and a high HR and reduced MCA Vm̳̳e̳a̳n̳ at the onset of an orthostatic challenge result in reduced OT during HS in healthy individuals; however, reduced OT in obese is related to a higher %peak HR at rest. / text

This study examined the use of a simulated patient, or programmed patient, to train clinical psychology graduate students to be empathic and respectful in the psychotherapeutic relationship. Twenty-five subjects were given a 50-minute training session with a simulated patient, an alternate training which consisted of viewing a video tape or were no-attention control subjects. The video tape used for the alternate training consisted of the section of "Three Approaches to Psychotherapy" in which Carl Rogers interviews the client, Gloria, followed by a discussion of empathy and respect. Training with the simulated client consisted of interviewing the "client" and receiving feedback from her. Pre-post empathy and respect skills were evaluated with Carkhuff's 5-point scales. Subjects' responses to recorded client statements were judged by two trained raters. Interjudge agreement ranged from .66 to .74. Analysis of variance revealed no significant difference between increases in empathy and respect for the three experimental groups. Subjects with more than one year of graduate clinical training profited significantly more (p = .05) from both training experiences than did subjects with less than one year of training. There was also a significant interaction between experimental training received and level of clinical experience, inexperienced subjects scoring higher with the simulated patient than with the video tape training. More advanced subjects scored higher with the video training than with the simulated patient training. Interview data indicated that the training with the simulated patient was perceived as useful and, in the case of more-experienced subjects, as being superior to the training with the video tape. Possible difficulties with the measurement of empathy and respect are discussed. The use of simulated patients is reviewed and the selection and training of simulated patients discussed in some depth.

This research was carried out to further the theoretical and practical understanding of peer assisted learning in undergraduate physiotherapy clinical education. A quasi-experimental study, with both a control group and an experimental group, was developed to examine the effects of peer assisted learning on the cognitive, psychomotor and affective components of clinical competence.On a more specific level, the main aim of the study was to investigate two models of clinical learning used in physiotherapy: the individualistic and reciprocal peer coaching models. Differences in history taking, physical examination and clinical reasoning were studied by having individual students, and pairs of students, complete an assessment of a simulated patient followed by a clinical reasoning test. A conceptual framework illustrates the main theoretical implications of this study. This framework incorporated current knowledge about clinical reasoning in medicine and the allied health sciences, in particular, reasoning from a novice practitioner's perspective. The conceptual framework, however, was expanded to demonstrate how peer assisted learning can influence the knowledge, cognitive and metacognitive aspects of clinical reasoning and performance.The main findings of the study were that reciprocal peer coaching led to statistically significant improvements in performance and clinical reasoning in the experimental group. In most cases, positive effect size differences appeared in favour of the experimental group. Most noteworthy differences were in the areas of physical examination and overall thoroughness of the patient encounter. Subjects in the experimental group also outperformed subjects in the control group on the overall clinical reasoning test to a statistically significant degree. A similar outcome was also noted in terms of patient management, that is, the planning and ++ / development of treatment interventions. Low achieving students in the reciprocal peer coaching group outperformed low achieving students who worked independently. Qualitative differences in the learning atmosphere of both models were also reported by subjects. While the actual clinical reasoning process did not appear to differ across both groups, practical differences in the actual learning experience did appear. Students in the experimental group reported being less anxious than students in the control group. The reciprocal peer coaching process was also an effective means of creating a supportive learning environment. These results are consistent with the major conclusions in the literature. Specifically, that peer assisted learning methods can increase achievement in learners (Goldschmid & Goldschmid, 1976; Johnson et al., 1998; Milson & Laatsch, 1996; Riggio et al., 1991; Riggio et al., 1994; Topping, 1996).

Athletes who participate in sports where performance relies on repeated high-intensity efforts could benefit from creatine (Cr) ingestion due to an increased ability to perform and recover from high-intensity exercise bouts either during training or competition. However, few studies exist which have investigated the effects of acute short-term Cr supplementation on appropriately simulated soccer-specific performance.Aims. To determine the reproducibility of a 90 minute soccer-specific performance test and to subsequently examine the effects of acute short-term Cr ingestion (1 week) on soccer-specific physical performance. Study design. Two experimental designs were adopted for this thesis. For study one, a test-retest design was used to determine the reliability and validity of the Ball-sport Endurance And Sprint Test (BEAST). Two trials of the BEAST were performed, separated by five to seven days. For study two, a randomised, triple-blind, placebo-controlled experimental design was adopted to determine the efficacy of acute short-term Cr supplementation (seven days) on soccer-specific performance, using the BEAST protocol.Methods. Twenty male amateur soccer players volunteered to participate in the study. For study one, the test-retest reliability of several soccer-specific performance measures obtained during a modified version of the BEAST was quantified using the standard error of measurement (Van Cutsem, Duchateau, & Hainaut) (or typical error) (Hopkins, 2000), coefficient of variation (CV), and Intraclass Correlation Coefficient (ICC). For study two, the cohort was split and subjects randomly allocated to one of two groups (Cr supplementation and Placebo) on a matched-pair basis. The Cr group (mean age 25.4 ± 4.5 years, mean body-mass 79.3 ± 10.5 kg) ingested 20 g of Cr and 8 g of glucose powder per day for seven days, whereas the placebo (mean age 26.7 ± 4.6 years, mean body-mass 80.8 ± 8.6 kg) group ingested 20 g of corn-flour and 8 g of glucose per day for seven days. The effects of acute short-term Cr supplementation were analysed by repeated measures ANOVA. In addition, effect sizes (ES) were calculated and entered with the associated p-value into Hopkins' spreadsheet for determination of the ES confidence limits (95%) and the chances that the true effect was substantial (i.e. ES ≥ 0.2). Clinical/practical inferences were made accordingly.Results. Study 1: The BEAST protocol had good reliability (high ICC values, relatively low coefficients of variation, low noise to signal ratios) and face validity (HR, VO2, distances covered, duration, and movements performed in the BEAST were all similar to those reported in actual soccer matches). Study 2: Performance of the four major physical measures (12 m sprint, 20 m sprint, circuit time and vertical jump) during the BEAST deteriorated during the second half relative to the first half for both Cr and placebo groups, indicating a fatigue effect associated with the protocol. HR and body-mass values also decreased for both groups during the 90 minute protocol. However, there was no statistically significant differences between the groups for these four measures or for body-mass, HR or VO2max values, suggesting Cr had no substantial effect (relative to placebo) on improving physical performance (or reducing fatigue). When the effects were assessed for the whole 90 minute BEAST protocol, all effects showed a negative trend and, correspondingly, the chances of a detrimental effect were greater than the chances of a beneficial effect.Conclusions: The 90 minute BEAST protocol had good reliability and face validity making it a suitable soccer simulation and performance protocol with which to investigate the effects of Cr supplementation on soccer performance. However, no significant (statistical or clinical) effects of acute short-term Cr supplementation on soccer performance were observed suggesting its potential use as an ergogenic aid for soccer players is questionable.

Simulated learning environments are becoming a more popular format for the delivery of healthcare education. These environments include but are not limited to simulated online learning environments, serious games, task trainers, and, electronic mannequins. Presently there is a lack of understanding of how the learning environment impacts students’ disposition to engage in learning processes and how learner satisfaction with the environment impacts learning outcomes. This preliminary descriptive study utilizes methods such as traditional statistical analysis and Association Rule mining. This study will investigate how students perceptions of the simulative learning environment IPSims (Interprofessional Simulations) usability impacts learning outcomes, and how these environments may impact student disposition to engage in learning. The participants (n= 58) were undergraduate health science students studying at the University of Ontario Institute of Technology. The data analysis provides insight into how simulative learning environments can impact student engagement in learning processes. Study strengths and limitations are identified along with future considerations. / UOIT

The data used for the construction of genome maps is imperfect, therefore the mapping of a physically linear structure must take place in a very uneven feature space. As the number of genes to be ordered grows, it appears to be impractical to use exhaustive search techniques to find the optimal mapping. In this paper we compare genetic algorithms and simulated annealing, two methods that are widely believed to be well-suited to non-smooth feature spaces, and find that the genetic algorithm approach yields superior results. Here we present performance profiles of comparable implementations of both genetic algorithms and simulated annealing. We have translated the problem to a form comparable to the shortest-path problem and found that the ability of a genetic algorithm to combine different partial solutions seems to be responsible for its superiority over the simulated annealing method. This is because in the genome mapping problem, as in the Traveling Salesman Problem, good solutions tend to be rather sparse and because optimal subtours tend to be components of nearly optimal tours. / Graduation date: 1994

The numbers of atoms in a protein molecule are large, from 103 to 104. If we try to solve the positions of all atoms in a protein molecule, we usually can¡¦t get the result due to tremendous degrees of freedom. Here, we use the uniform cylinders to replace the helixes found in most protein molecules, and reduce the degrees of freedom dramatically. We also adapt Su¡¦s method to avoid the ¡§X-ray phase problem¡¨. In this thesis, we simulate the small angle X-ray diffraction data of atoms which uniformly confined in cylinders, and then using trying cylinders to simulate the real cylinders. Our study shows that we can find the cylinders¡¦ positions quite successfully and efficiently. Our approach provides a promising way to find out the helix structure of proteins.