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<p><strong>Introduction: </strong>McMaster University’s orthopaedic surgery residency program implemented the OSCE as an assessment tool in 2010; this study evaluates the first four OSCEs administered to residents. The OSCEs were composed of knowledge-testing stations, which are normally not included in this testing format, and performance-testing stations. Recruiting enough faculty evaluators challenged the ability to feasibly implement this examination format. Knowledge-testing stations were incorporated since they do not require evaluators to be present. Reliability was assessed, and the correlation between knowledge-testing station scores and performance-testing station scores was determined. The ability of the OSCE to discriminate between residents in different post-graduate years (PGYs) was assessed. Residents’ acceptability of the OSCE was also assessed. <strong>Methods: </strong>Reliability was assessed using generalizability theory. The correlation of knowledge-testing and performance-testing station scores was measured with Pearson’s r. A two-way ANOVA was used to analyze whether the OSCE can discriminate between residents in different PGYs. An exit survey was administrated after each OSCE to assess acceptability. <strong>Results: </strong>The generalizability estimates of each OSCE ranged from 0.71 to 0.87. The disattenuated correlation between knowledge- and performance-testing stations for senior residents was 1.00, and 0.89 for junior residents. A significant effect of year of residency was found for the October 2010 OSCE in the ANOVA (F(1,30) = 11.027, p = 0.005), but the remaining OSCEs did not replicate this finding. In general, residents felt that they were able to present an accurate portrayal of themselves in the OSCEs and that the examination covered appropriate topics. <strong>Discussion: </strong>The OSCEs were reliable and acceptable to residents. The high correlations between knowledge- and performance-testing station scores suggest that the examination can be made more feasible by including knowledge-testing stations. The small sample sizes made significant differences difficult to detect between levels of training, resulting in inconclusive evidence for this construct validation measure.</p> / Master of Science (MSc)

This study tested the construct validity of a preschool measure of executive function (Behavior Rating Inventory of Executive Function; BRIEF-P) through support of convergent and discriminant validity using the multitrait-multimethod validation process. Convergent validity was examined through teacher ratings of executive function and Attention-Deficit/Hyperactivity Disorder (ADHD) and through the measurement of executive function on a performance measure. Determination of discriminant validity was attempted through teacher ratings of executive function and anxious/shy behaviors and through performance measures of visuospatial processing. Participants were placed in one of two groups: a control group/no diagnosis (n = 21) or an ADHD Group (n = 14). Group comparisons were conducted using t-tests and chi-square analysis and determined group differences related to gender, ethnic background, IQ, and age. An Analysis of covariance, controlling for gender, indicated significantly higher teacher ratings of preschool-age children with ADHD than without ADHD on the BRIEF-P. Pearson correlations suggest a strong relationship between similar constructs utilizing same method procedures and a moderate relationship measuring the same construct between measures. Discriminant validity was unable to be established due to non significant relationships between the same trait/between methods and different trait/between methods correlations. However, the small number of participants (n = 35) and poor teacher return rate of questionnaires (control n = 7; ADHD n = 14) may have affected the results of this study. There were several other limitations of this study, including the design of the study and the extended length of time to complete the study. / School Psychology

Working memory (WM) has been closely linked to learning and achievement in children (Gathercole et al., 2004). The Forchelli Following Directions Task (FFDT) is a 15-item group-administered screener designed to assess working memory ability in school-aged children. The FFDT was developed to address the need for early identification of children with working memory difficulty. It specifically focuses on the need for easily administered and ecologically valid assessment. The FFDT was developed based on tasks cited in research to assess WM. The measure was developed across three iterations after receiving continual review from research experts in working memory and a group of three elementary school teachers. It also was piloted by three elementary school children to assess group-administration considerations. Participants in the validation study were 70 elementary school students 5 to 10 years of age spanning kindergarten to third grade were recruited from schools in the greater Philadelphia area. Participants were administered the group-administered working memory screener and completed individually administered measures of working memory, the WISC-IV Digit Span and Spatial Span, for comparison. Parents and teachers also completed behavior rating scales (i.e., BRIEF) measuring working memory. The FFDT demonstrated a sufficient Alpha's coefficient, indicating internal consistency. Significant Pearson correlations were found between existing measures of WM and the FFDT, indicating that the FFDT measures WM ability to a similar extent. The FFDT demonstrated good sensitivity to age and grade, as well. Further, the results of a ROC analysis comparing the identification of WM difficulty on the FFDT to existing measures of WM demonstrated a low to moderate effect. Overall, results indicate that the FFDT exhibited good reliability and validity. The anecdotal support of elementary school teachers and time efficiency of the task compared to existing WM measures also suggests good ecological validity. This study also demonstrated the utility of the FDDT in populations within a Response to Intervention (RtI) framework. Further research will be challenged to investigate the FFDT further scrutinize the construct validity and demonstrate significance in a larger, more representative sample of students. / School Psychology

This thesis draws on the 2014 Ontario Child Health Study (2014 OCHS) to address four contemporary and policy-relevant issues associated with measuring child and adolescent mental health need and children’s mental health service use in the general population. The first and second papers focus on the development and evaluation of instruments to measure child mental disorder. The first paper develops a simple, brief symptom checklist used to measure child mental disorder conceptualized as a dimensional phenomenon, a core concept in the 2014 OCHS. The second focuses on a briefer version of this checklist to measure child mental disorder dimensionally in general and clinical populations for the purposes of assessing and monitoring children’s mental health need. The third and fourth papers use these measures as the basis for assessing children’s mental health need in evaluations of policy-relevant health service questions. The third paper focuses on a substantive question about area-level variation in children’s unmet need for mental health services using 2014 OCHS data linked to government administrative data and 2016 Census data. The fourth paper estimates the extent to which child mental health service expenditures in 2014-15 were allocated according to children’s mental health need. Together, these papers respond to the need for simple, brief, self-report measures of child and adolescent mental disorders and show how these types of measures, in combination with administrative government data sources can advance our knowledge about policy and funding decisions in children’s mental health services research in Ontario. / Thesis / Doctor of Philosophy (PhD) / The goals of this thesis are to address issues relating to: (1) measuring child and adolescent mental health need using brief, self-report problem checklists and (2) using these measures to answer questions about children’s mental health service use and service expenditures in the general population in Ontario. The individual manuscripts in this thesis respond to the need for simple, brief, self-report measures of child and adolescent mental disorders and advance our knowledge about policy and funding decisions in children’s mental health services research in Ontario.

Introduction: Wearable technologies play an important contemporary role in the measurement of physical activity (PA) and promotion of human health across the lifespan, including for young people (i.e., children, adolescents, and young adults). As new objective wearable technologies continue to develop, standardized approaches to documenting validation parameters (i.e., measures of accuracy, precision, and bias) are needed to ensure confidence and comparability in step-defined PA. Purpose: To produce validity parameters for step counting wearable technologies during treadmill walking in young people 6-20 years of age Methods: 120 participants completed 5-minute treadmill bouts from13.4 to 134.1 m·min-1. Participants wore eight technologies (two at the arm/wrist, four at the waist, one on the thigh, and one on the ankle) while steps were directly observed. Speed, wear location, and age -specific measures of accuracy (mean absolute percent error; MAPE), precision (correlation coefficient, standard deviation; SD, coefficient of variation; CoV), and bias (percent error; PE) were computed and cataloged. Results: Speed and wear location had a significant effect on accuracy and bias measures for wearable technologies (pConclusion: While the analyses indicate the significance of speed and wear location on wearable technology performance, the useful and comprehensive validity reference values cataloged herein will help optimize measurement of PA in youth. Future research should continue to rigorously validate new wearable technologies as they are developed, and also extend these standardized reference values developed in the laboratory to the free-living environment.