The purpose of this grounded theory study is to define the process that nurse anesthesia program administrators use to determine if a student nurse anesthetist’s unsatisfactory clinical performance warrants intervention by the program. There is little room for error in anesthesia practice as mishaps typically result in significant injury and death. Students who exhibit unsatisfactory clinical performance may pose an immediate risk to patient safety as well as a future risk if allowed to progress in the program. The lack of guidance in the form of clearly articulated expectations and processes contribute to the emotional strain nurse anesthesia faculty and administrators experience when observing unsatisfactory clinical performance. From the data collected in the interviews with ten nurse anesthesia program administrators, a five-phase decision-making model entitled the Nurse Anesthesia Program Administrator Decision Making Model was developed. The five phases of the model include: receiving the feedback, validating the concern, assessing accountability and planning for remediation, removing the student from clinical training and moving to dismissal, and notifying the student of the decision. The guiding principle of this model is the importance of following institutional and program policies throughout the process. This study is intended to provide guidance to nurse anesthesia program administrators who are faced with a student demonstrating unsatisfactory clinical performance regarding what behaviors may require an intervention by the program.

"Our goal in this research is twofold: to develop clinical performance databases of cancer patients, and to conduct data mining and machine learning studies on collected patient records. We use these studies to develop models for predicting cancer patient medical outcomes. The clinical database is developed in conjunction with surgeons and oncologists at UMass Memorial Hospital. Aspects of the database design and representation of patient narrative are discussed here. Current predictive model design in medical literature is dominated by linear and logistic regression techniques. We seek to show that novel machine learning methods can perform as well or better than these traditional techniques. Our machine learning focus for this thesis is on pancreatic cancer patients. Classification and regression prediction targets include patient survival, wellbeing scores, and disease characteristics. Information research in oncology is often constrained by type variation, missing attributes, high dimensionality, skewed class distribution, and small data sets. We compensate for these difficulties using preprocessing, meta-learning, and other algorithmic methods during data analysis. The predictive accuracy and regression error of various machine learning models are presented as results, as are t-tests comparing these to the accuracy of traditional regression methods. In most cases, it is shown that the novel machine learning prediction methods offer comparable or superior performance. We conclude with an analysis of results and discussion of future research possibilities."

A pesquisa versa sobre o fenômeno da historicidade pessoal e a possibilidade de articulação dessa mesma historicidade. Ao discutir esse acontecimento no interior do contexto clínico, pretende-se contribuir para o avanço dos estudos no campo da Psicologia Clínica, mais especificamente, na abordagem de orientação fenomenológica e hermenêutica. Tomando como ponto de apoio a ideia de historicidade, tal como proposta pelo filósofo Martin Heidegger em Ser e tempo, como realização concreta da temporalidade do existir, buscamos compreender como um determinado modo de lidar com a história pessoal pode se esgotar, abrindo espaço para que um projeto existencial venha a alcançar mobilidade histórica. Ao pensarmos esta questão inserida no contexto clínico, a partir da relação entre terapeuta e paciente, torna-se relevante pensar o papel do terapeuta como aquele que sustenta um lugar de tensão com a medida do paciente, guardando um espaço de alteridade, um espaço do acontecimento de outra possibilidade. Para tanto, o trabalho se encaminha no sentido de agrupar referências teóricas do que foi produzido no campo da Psicologia fenomenológicohermenêutica, com ênfase na daseinsanálise de Ludwig Binswanger e Medard Boss. O que caracteriza propriamente este trabalho é partir das referências de Ser e tempo e do trabalho dos psiquiatras citados, somando a elas o pensamento tardio de Martin Heidegger, apresentando uma aplicabilidade diversa do que a pensada pelo autor, na medida em que busca fazer uma analogia entre as reflexões de Heidegger sobre a mobilidade histórica do mundo e a possibilidade da mobilidade histórica do paciente no contexto clínico / The research approaches the phenomenon of personal historicity and the possibility of articulation of this same historicity. In discussing this event within the clinical context, it is intended to contribute to the progress of studies in the field of clinical psychology, more specifically, in the phenomenological and hermeneutical approach. Taking the idea of historicity, as proposed by the philosopher Martin Heidegger in Being and Time, as a concrete realization of the temporality of being, we seek to understand how a certain way of dealing with personal history can be exhausted, opening space so an existential project can be able to reach historical mobility. When considering this matter inserted in the clinical context, from the relationship between therapist and patient, it becomes relevant to think of the role of the therapist as the one who holds a place of tension with the patient\'s measure, keeping a space of alterity, a space of occurrence of another possibility. To this end, this work is directed towards grouping theoretical references of what was produced in the field of phenomenological-hermeneutic psychology, with emphasis on the daseinsanalysis of Ludwig Binswanger and Medard Boss. What characterizes this work is to be based on the references of Being and Time and the work of the mentioned psychiatrists, adding to them the late work of Martin Heidegger, presenting a different applicability than the one thought by the author, in that it seeks to make an analogy between Heidegger\'s reflections on the historical mobility of the world and the possibility of historical mobility of the patient in the clinical context

Clinical performance assessment (CPA), which includes performance criteria, that define what students are expected to learn and practically demonstrate, is used to declare students competent by determining their level of skill. The purpose of this research was to explore student perceptions on the clinical assessment and how assessment contributed to enhancement of competency, and was driven by the question “How do oral hygiene students’ perceptions on clinical performance assessment (CPA) influence their learning experience?” A qualitative approach was followed, rooted in an interpretivist paradigm, using a case study design. The sample consisted of all 19 second-year oral hygiene students who wrote a narrative, and four of the 19 students with whom semi-structured interviews were held. Data was collected by asking the students to write the narratives, and after analysis thereof, the interviews were held. Data was analyzed throughout the data collection process, using a coding framework. The oral hygiene students understood that CPA tested their clinical skills as well as their theoretical knowledge, measures progression and improvement. They expressed negativity about the assessors' inconsistent use of performance criteria, inadequate feedback, and the unprofessional relationship of certain assessors with them. These issues led to frustration, confusion, and demotivation, and impacted negatively on students' learning and competency. Being humiliated in front of the patient or being shouted at led to demotivation. Students coped with assessment by adapting to what an assessor wanted, focusing on patient feedback, and just accepting the results. Students recommended that there be more feedback and discussion with the assessor about strengths and weaknesses. This was how they learned and became competent. They should be allowed to express an opinion and discuss issues with the assessor. / Dissertation (MEd)--University of Pretoria, 2008. / Curriculum Studies / unrestricted

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Researchers have studied memory recall of crisis-oriented or emotional events in non-educational settings. However, within the health care field, there has been a limited study of the the concept of recall of crisis oriented or emotional events in& health care education. Crisis-oriented events such as natural disasters, acts of bioterroism, and industrial accidents, have been reported to impact memory. Patient safety is a primary focus in anesthesia education, appropriate crisis management is imperative to quality anesthesia care. Due to the critical nature of anesthesia delivery, there is a strong, constant need to develop methods that will enhance, support, and improve current anesthesia practices that impact patient safety. Educational methodologies used by both clinical and didactic instructors that will improve teaching effectiveness need to be investigated to ensure that patient safety content is being delivered to nurse anesthesia students in a manner consistent with the American Association of Nurse Anesthetists (AANAs) Council on Accreditation's COAs) standards of care. Utilizing a simulated anesthesia crisis situation, this study compared the differences in cognitive imprinting and application to practice between two content delivery methods, the written case study and patient safety vignettes, in nurse anesthesia students. The control group was given a written case study which is considered a traditional method of content delivery. The treatment groups studied vignettes, which are short, realistic, simulated audio-visual videos that demonstrate content to be relayed. The research hypothesis studied the use of anesthesia crisis oriented vignettes as an educational tool to impact memory recall, thus potentially improving application to clinical practice. Hypotheses for the study were: Hypothesis 1 (Hl): Student anesthetists exposed to audio-visual vignettes will exhibit superior clinical performance during simulated apparatus-related crisis events, evidenced by higher group mean demonstration scores, when compared to a matched group exposed to written case studies. Hypothesis 2 (H2): Student anesthetists exposed to audio-visual vignettes will exhibit superior recall of apparatus related material, evidenced by higher group mean post-test scores, when compared to a matched group exposed to written case studies. Using the paired samples t-test and analysis of variance procedure (ANOVA), statistical findings were evaluated for significance. The different teaching methodologies were represented in the abbreviation of the variables studied. Two different crisis oriented events were presented in vignette format, a malfunctioning unidirectional expiratory valve and a malfunctioning suctioning apparatus. Variables that were studied include: clinical performance during the anesthesia machine checkout process by recreating the stuck expiratory valve and malfunctioning suction apparatus scenarios. Statistically, mixed results were obtained. The impact that the stuck expiratory valve vignette had on student recall and clinical performance was found to be insignificant. The impact resulting from exposure to the non-functioning suction apparatus vignette was found to be significant for both student recall and clinical performance. Other recall and clinical performance measures related to the non- functioning suction apparatus were also found to be significant. Conclusions: In this research study, memory and clinical performance were impacted when the anesthesia provider incorporated the correct anesthesia apparatus checkout process and crisis management skills into their practice. This research demonstrated that under the conditions of this study, teaching methodology impacted some areas of clinical performance. Due to the small sample size and because the clinical performance measurements tools were newly designed for this particular study, findings from this study cannot be generalized to any other group or population. However, the findings from this study merit further investigation into the potential use of vignettes as an educational methodology to impact clinical practice and improve patient safety.

Ph.D., Faculty of Health Sciences, University of the Witwatersrand, 2011 / INTRODUCTION: The University of the Witwatersrand (Wits) changed its medical curriculum in 2003 from a traditional, six-year curriculum to an integrated, problem-based, four year Graduate Entry Medical Programme (GEMP), preceded by two years of basic and medical sciences at university level or a suitable undergraduate degree. AIMS: To compare the preparedness for internship of Wits graduates from the old and new curricula on fifty seven items grouped into nine categories which were identified during the development and validation of a Model of the Competent South African Intern. METHODS: A stratified random sample of interns was drawn from the last graduates of the traditional curriculum and a matched sample of interns from the first graduates of the GEMP. Both quantitative and qualitative methods were used. For each sampled intern a supervisor, colleague and patient were selected by convenience sampling. A questionnaire was completed by interns, supervisors and colleagues followed by an interview to qualify responses at the extremes of the Likert-type scale and link them to curriculum learning opportunities. A semi- structured interview was conducted with patients and a global score allocated. The Cochran-Mantel-Haenszel Statistic for ordinal data was used. Comparisons were drawn between the competence of graduates from the traditional and GEMP curricula from the perspectives of interns, supervisors, colleagues and patients. Interview data were analysed using thematic analysis techniques. RESULTS: Significant differences were reported by interns in six of the nine categories. In one category, “fundamental theoretical knowledge” the GEMP graduates rated themselves significantly less prepared in the basic medical sciences (Pathology, Microbiology and Pathophysiology, p=0.01; Pharmacology, p<0.0001) but highly significantly better prepared in the theory of interpersonal communication, p<0.000001). The GEMP graduates rated themselves significantly better prepared in the other five categories, “medical problem solving” (p=0.009), “holistic patient management” (p=0.0004), “community health” (p=0.0002), “communication skills” (p=0.02) and “self directed learning” (p=0.0001). vii Supervisors reported significant differences in “teamwork” (p=0.045) and “personal attributes” (p=0.045) giving fewer low scores to the GEMP graduates. There were no significant differences between the category scores for colleagues. Qualitative analysis included vertical summaries of interview data and horizontal or comparative interpretations with quotations in order not to lose the voice of the interns, supervisors, colleagues and patients. DISCUSSION AND CONCLUSION: GEMP graduates rated themselves better prepared in those areas which had been identified as reasons for curriculum change but less prepared in specific basic medical sciences. Although these were not reported as significantly different by supervisors or colleagues they require attention. Other than this, according to the judgements of the informants, the competence of GEMP graduates was similar to that of traditional graduates in certain areas and significantly better in others, which appears to justify the major medical curriculum change undertaken at this University.

Background: previous studies have revealed that newly hired nurses experience stress and anxiety when entering a new clinical setting. Failure to support and prepare these nurses may affect their ability to deliver the required level of nursing care. Preceptorship is a time limited, organised clinical instructional programme, which promotes staff development, improves nursing education, reduces nursing shortages, promotes staff retention and decreases staff turnover. Little evidence expounds about how newly hired nurses perceive preceptorship. The impact of preceptorship on the clinical nursing care of newly hired experienced nurses has not been investigated or verified globally neither has it been investigated from a Saudi context. Aims and Objectives: the study aimed to explore the nature of preceptorship and its impact on clinical nursing care as perceived by the nurses who had taken part in a preceptorship programme in Saudi Arabia. The study elicited the participants' understanding and expectations of the preceptorship programme in an attempt to identify those factors that may be directly related to the success or failure of the programme. Furthermore, it aimed to examine the role of preceptorship in developing the clinical practice of newly hired experienced nurses. Methodology: a qualitative design based on the principles of naturalistic inquiry underpinned this study. Thirty national and international nurses of five different grades across wards in one Saudi hospital were first purposively and subsequently convenience sampled to take part in the study. Most participants were of international origin, possessing various levels of experience and education. Preceptees were younger and less experienced than other programme stakeholders. Data were generated using tape-recorded semi-structured individual and focus groups interviews. This action was also supported by a review of the hospital's preceptorship policy documents. All the interviews were transcribed verbatim and analysed concurrently using thematic analysis based on a constant comparative method. Findings and discussion: Six themes were derived from the interview data to generate an account of participants' experiences. Social learning theory was used as an explanatory framework for understanding the study's findings. Thus, preceptorship was seen as an important supportive, learning process, although inconsistencies were highlighted related to the participants' understanding and expectations of the programme. The duration of preceptorship was also contested with some needing longer than allocated. Hence, confusion arose regarding when preceptorship should begin and end due to ambiguities within the preceptorship policy documentation. Furthermore, participants perceived preceptorship had a mixed impact on clinical nursing care depending on preceptee/preceptor preparation and workload. Surprisingly recruitment was found to have the biggest impact on the success or failure of the preceptorship programme an unexpected and new finding highlighted by this study. Conclusion: preceptorship is important for the integration of newly hired experienced nurses into their new roles. The meaning of preceptorship as applied to each hospital needs to be defined and articulated clearly and concisely. In order to meet the objectives of preceptorship, policy documentation needs to be clearer, and recruitment processes need to be reviewed in order to match both preceptee experience and qualifications with organisational requirements.

Each radiography program has a system to collect important data from didactic and clinical settings in order to accurately assess the progress and success of students, provide the needed student intervention, and provide accreditation agencies with appropriate documentation that demonstrates student success in reaching program learning outcomes. The purpose of this research study was to determine the method of data collection and documentation used by radiography programs to evaluate student progress and to examine if MEDs play a role in evaluating and documenting student skills at the point of care. The majority of radiography programs in this study were using paper methods for data collection and program directors reported value in using MEDs in clinical education but revealed that barriers still exist and will need to be addressed in order to increase their usage in clinical education.