The current global emphasis on appropriate standards for medical education and greater civic engagement by higher educational institutions, and the value of electrocardiography as diagnostic aid stimulated the researcher to perform this study. Globally electrocardiography is an essential exit-level core competency of undergraduate medical programmes. Although an outcome-based curriculum was introduced by the UFS School of Medicine in 2000, certain aspects of competencybased education (such as the registration and interpretation of an electrocardiogram) can be adapted and included in outcome-based curricula. Prior to the commencement of this study, a preliminary literature review revealed that little research had been performed with regard to the use of electrocardiography as a learning task in community settings in the preclinical phase of medical curricula. The overall goal of the study was to facilitate the transition between electrocardiography teaching and learning in the preclinical and clinical phases of the UFS medical curriculum. The problem that initiated the research was that more information was required regarding the practicability of implementing electrocardiography teaching and learning in community settings during semesters four and five of the UFS undergraduate M.B.,Ch.B. curriculum. To address the problem, two research questions were formulated concerning the generic, context-specific and task-specific issues that inform decisions regarding community-based electrocardiography learning during semesters four and/or five of the UFS undergraduate medical curriculum and the attitudes and opinions of a purposive sample of Faculty members regarding community-based electrocardiography learning in semesters four and/or five. To answer the research questions, two research objectives were pursued regarding the identification of the principal issues and challenges that inform decisions regarding the feasibility of introducing community-based tasks in the preclinical phase of a South African undergraduate M.B.,Ch.B. curriculum and the collection of quantitative and qualitative information from a purposive sample of personnel employed at the UFS Faculty of Health Sciences. The first part of the study consisted of a comprehensive literature review, which assisted the researcher to identify applicable key aspects for inclusion in the interview schedule used for the empirical study. The survey was performed with a view to later formulating an effective strategy to facilitate the transition between the electrocardiography learning provided in the preclinical and clinical phases of the UFS M.B.,Ch.B. curriculum and possibly incorporate four additional hours of community-based learning in phase II of the curriculum. Ninety-two (92) per cent of the persons in the sample consented to participate in the study and a pilot study was conducted, to improve the reliability, validity and trustworthiness of the study. The data collected from the interviews was analysed and a description and discussion of the research findings were documented. Based on the literature review and the responses of the interviewees, several prominent conclusions were reached. Important faculty-related and communityrelated key issues and challenges were identified, and intervieweesâ favourable responses regarding CBL, task-based CBL and CB ECG learning in the UFS undergraduate medical curriculum indicated that further related research is justified. Intervieweesâ responses with regard to the practicability of implementing CB ECG learning in the preclinical phase were moderately favourable and useful recommendations were made. Of significance to the planning of future research studies was that twenty-six per cent more respondents supported the implementation of CB electrocardiography learning during the clinical phase of the curriculum than was the case for the preclinical phase. These research findings can assist with decisions as to whether future (more comprehensive and potentially more costly) research projects are justified. The appropriate implementation of electrocardiography, as community-based learning task during the preclinical and/or clinical phases, can contribute to a greater degree of community engagement and an improvement in the quality of electrocardiography learning in the UFS undergraduate curriculum. This should therefore benefit all the stakeholders involved.

The first two years of higher education is critical in creating a foundation for future academic success as this is the time with the highest gain in knowledge, namely the development of critical thinking and cognitive development (Reason, Terenzini & Domingo 2006:150). Experiences during this stage will influence future academic performance. In South Africa, as many as 33% of enrolled students do not proceed beyond the first year of study (CHE 2013:44). Factors that influence academic performance of first-year students include individual, organisational, environmental and academic programme factors. These factors are often interconnected (James 2007:2; Krumrei-Mancuso, Newton, Kim & Wilcocs 2013:248-253; Reason et al. 2006:149,167; Yates 2012:46-49). The extent to which a specific factor will influence an individual student is affected by the individualâs perspective and experience of such a factor. The strengths and weaknesses of a curriculum - as perceived by students - will affect academic performance, among other factors (Henzi, Davis, Jasinevicius & Hendricson 2007:642-645). Against this background, the problem that was addressed was the poor academic performance of students in module MEF153 (Structure and development of the body) in the first year of the Programme for Professional Medicine (MBChB), in the School of Medicine, Faculty of Health Sciences, University of the Free State. The question that had arisen was: âWhich factors, within the curriculum of the first-year undergraduate medical programme module MEF153, influence the academic performance of students in this module?â An investigation was done by the researcher to identify factors contributing to the poor academic performance of students in the module MEF153. Therefore the aim of the study that was pursued was to investigate studentsâ perspectives regarding the importance of the various factors affecting their academic performance in their first year of study in the module MEF153. Research was conducted with the goal of making recommendations for changes to the curriculum of module MEF153. This was deemed necessary to improve the academic performance of first-year medical students in the module, without the lowering of academic standards. To answer the research question and in order to achieve the aim, the objectives pursued included conceptualising and contextualizing factors affecting studentsâ academic performance through conducting a literature survey. The presence and relevance of these factors within module MEF153 were determined through the analysis of module MEF153. Emphasis was placed on the curriculum, module structure and layout, educational strategies and methods, study content, assessment methods and finally, the time available for this module. A questionnaire was composed from these factors. The studentsâ perception of the importance of factors affecting academic performance in module MEF153 was then evaluated by means of the questionnaire and statistical analysis of data. The research approach used was a descriptive survey with quantitative and qualitative methodologies. All students registered for the module MEF153, and present on the day of data collection were included. The prevalence and perceived importance of factors affecting academic performance was determined by means of voluntary participation in an anonymous and confidential self-administered questionnaire completed by numerous research participants. The questionnaire contained questions with reference to demographic- and personal information, curriculum and programme characteristics and educational information such as teaching and learning methods used in this module. Quantitative data on the perceived importance and effect of factors on academic performance were recorded with the aid of questions and a Likert scale. Qualitative data were gathered through open-ended questions in the questionnaire. The results of the quantitative data were reported as frequencies and percentages or medians for each factor evaluated and discussed. The major findings from this study were that all factors, except âpersonal interracial relationsâ, investigated for their possible effect on academic performance, are perceived to have an effect of median = 5 or more on academic performance on a scale from 0 to 10 where 10 = most important. Except for nine factors, the majority of participants reported a positive effect on academic performance for factors investigated. The factors that reported a majority negative effect on academic performance included financial cost of studies; workload of the undergraduate medical programme; workload of module MEF153; load of independent study in module MEF153; difficulty of content in module MEF153; difficulty of language in resources used in module MEF153; number of assessment opportunities in module MEF153; volume of content assessed per assessment opportunity; and stress associated with assessment in module MEF153. The qualitative data presented and discussed here were classified in themes and categories for each question. It provided further insight and understanding of the quantitative results. These results show that the undergraduate medical programme and module MEF153 manage most factors in such a way that it contributes positively to academic performance for the majority of participants in this study. It also identifies areas that negatively influence the academic performance of the majority of participants. Furthermore, it emphasises the diverse effect of each factor on academic performance among participants. This knowledge can be used to address problematic areas of the curriculum to improve academic performance. It can also be used to improve academic development and support activities to address shortcoming in skills among students.

There is growing interest in the use of simulation for surgical skills training and evaluation. The purpose of this study was to assess whether training to proficiency with the FLS laparoscopic simulator would result in improved performance in the operating room (OR). GOALS, a validated tool, was used to measure clinical operating room performance. Nineteen junior residents underwent baseline FLS-testing and GOALS evaluation during elective laparoscopic cholecystectomy. Those with GOALS scores≤15 were randomly assigned to training (n=9) or control (n=8) groups. An FLS proficiency-based curriculum was used in the training group. Scoring on FLS and in the OR was repeated at the end of the study period. Evaluators were blinded to randomization status. Sixteen residents completed the study. There were no differences in baseline simulator or OR scores. After training, simulator scores were higher in the training compared to control group. At the final assessment, the training group improved their OR performance significantly more than the control. The observed improvement was from novice to intermediate level of residency. These results show the transferability of basic laparoscopic skills gained on a physical simulator to the OR and emphasize the value of lapa roscopic simulators for training purposes. / Il y a un intérêt grandissant pour l'utilisation de la simulation à des fins de formation et d'évaluation des compétences de chirurgie. Le but de cette étude consistait à déterminer si une formation menant jusqu'à la compétence, effectuée sur le simulateur FLS, produirait un meilleur rendement en salle d'opération. Le rendement clinique a été mesuré à l'aide de GOALS, un outil validé. Initialement, dix-neuf résidents juniors ont subi un test FLS ainsi qu'une évaluation GOALS effectuée en salle d'opération pendant l'exécution d'une cholécystectomie par laparoscopie non urgente. Les résidents ayant un score GOALS ≤ 15 ont été répartis au hasard entre le groupe de formation (n=9) et le groupe témoin (n=8). Le groupe de formation a suivi un programme centré sur la compétence en matière de FLS. Les scores FLS et les scores en salle d'opération on été évalués de nouveau à la fin de la période d'étude. Les évaluations ont été effectuées en aveugle. Seize résidents ont terminé l'étude. Aux tests initiaux, aucune différence n'a été constatée entre les scores FLS et les scores en salle d'opération. Après la formation, les scores FLS étaient plus élevés chez le groupe de formation comparativement au groupe témoin. À l'évaluation finale, le groupe de formation avait amélioré sa performance en salle d'opération de façon significative comparativement au groupe témoin. L'amélioration observée s'est traduite par un passage du niveau de résidence novice au niveau intermédiaire. Ces résultats démontrent que les compétences de base en laparoscopie acquises à l'aide d'un simulateur peuvent être transférées en salle d'opération. De plus, ils soulignent la valeur des simulateurs de laparoscopie en tant qu'outils de formation.

Thesis (Ph. D.)--University OF MICHIGAN.

Thesis (Ph. D.)--University OF MICHIGAN.

DISSERTATION (PH.D.)--THE UNIVERSITY OF MICHIGAN

The purpose of this study was to assess factors that are related to excellence among surgeons. The sample included 33 highly proficient surgeons involved in high- and low-mortality-risk surgery, seven of whom were known by reputation as "elite". A framework developed by researchers in athletics was used to examine how surgeons perform their best in challenging elective procedures. Individual in-depth interviews were carried out to determine their mental readiness before, during and after surgery. This provided a quantitative and qualitative analysis of mental readiness. These findings were compared with Orlick's "Theory of Human Excellence" which is based on results from world-class athletics and other high-performance domains. Common elements of success were found which included: commitment, belief, positive images, mental readiness, full focus, distraction control, and constructive evaluation. Major performance blocks were identified which interfered with optimal performance. Characteristics which distinguished certain groups of surgeons were identified. This investigation confirmed that there were many similarities in mental preparation procedures and perspectives engaged in by top surgeons and top athletes. Practical recommendations for mental training were provided relevant to excellence in the surgical arena.

This qualitative exploratory case study focused on how nursing staff perceived a complex transformational change within a large tertiary care teaching hospital. In an effort to improve the understanding of transformational learning and change, this study examined a change that required nursing staff to critically reflect on their practice and if necessary change their values, beliefs and attitudes. The objectives of the transformational innovation were to increase professional accountability and authority by changing the decision-making of nursing staff to a more autonomous process. The structural changes introduced included implementation of unit councils and primary nursing. Study data consisted of documentation collected over a three and a half year period during the implementation of the transformational change. During the analysis, similar phrases were coded and categorized and then re-categorized into major patterns or ideas reflecting perceptions of the innovation, transformational learning process, and outcomes of the change. Results describe the concerns, learning needs, and system considerations that influenced staff when implementing a transformational change. The results of this study will be of interest to administrators and educators as they prepare staff for future challenges.

Comment peut-on enrichir le travail des infirmieres et promouvoir la satisfaction au travail? A l'hopital general d'Ottawa, le comite sur la documentation de la demarche de soins a developpe un outil de documentation qui combine la phase de la cueillette des donnees, des diagnostics infirmiers et la phase intervention. Nous utilisons le cadre theorique le plus disponible et le plus connu dans la mesure de l'effet d'une restructuration des taches: le modele des dimensions des taches d'Hackman & Oldham (1980). L'hypothese de cette recherche est qu'il existe des differences significatives entre le groupe experimental qui utilise le nouveau plan de soins du patient, considere comme un enrichissement de la tache de l'infirmiere, et le groupe controle utilisant l'ancien plan de soins. Cette difference significative est mesurable par le biais du pointage de motivation potentielle, des dimensions principales de la tache, des etats psychologiques et des resultats en fonction du travail de l'infirmiere qui sont mesures en periode pre et post-test. On observe pour le gyoupe controle une baisse significative de la moyenne du pointage de motivation potentielle entre la periode pre et post-test alors que le groupe experimental exprime une tendance a la hausse. Les facteurs extrinseques agissent negativement sur la motivation et la satisfaction des groupes controle et experimental. Par contre, il semble que l'activite d'enrichissement d'une partie de la tache de l'infirmiere ait permis de prevenir une baisse de motivation dans le groupe experimental. En general, l'implication theorique la plus importante de ces differentes analyses est qu'il existe des interactions entre la demarche de soins et le pointage de motivation potentielle. Les resultats nous procurent une certaine evidence en faveur de la restructuration des taches. Les changements qu'on apporte a la structure du travail peuvent conduire a des reactions favorables face aux taches. (Abstract shortened by UMI.)

An important aspect of the prevention and possible elimination of tuberculosis (TB) in Canada relates to the screening practices of primary care physicians. There is good evidence that screening for TB is under-utilized by physicians in Canada and other industrialized countries. This thesis was conducted to determine: (1) family physicians' knowledge and beliefs about the prevention of tuberculosis, (2) their awareness and use of TB screening guidelines circulated by the Ottawa-Carleton Health Department, (3) the perceived barriers to screening and, (4) to identify factors associated with primary care physicians knowledge and beliefs about the prevention of tuberculosis. Predictor variables included gender, year of graduation, certification, practice setting, whether a physician lived in a developing country, whether a physician practiced medicine in a developing country and the percentage of persons from developing countries in physicians' practices. Family physicians had a moderate level of knowledge about the prevention of tuberculosis which varied according to the specific components of screening. Younger physicians and practitioners with a higher proportion of clients from developing countries were more knowledgeable about screening for tuberculosis. Only 13% of the total variability in physicians' knowledge however, was explained by the regression model containing these two explanatory variables. Physicians' self-efficacy beliefs also varied according to specific aspects of screening. Self-confidence about prescribing INH and managing INH therapy was low. Only 48% of the sample believed that patient compliance with INH therapy was good. With respect to barriers to screening, 60% of physicians felt that reimbursement for TB screening was inadequate, 30% cited language/cultural problems with clients, 90% felt that more continuing medical education (CME) programs were needed and 65% were in favor of a central TB screening clinic. Awareness of tuberculosis prevention and treatment guidelines circulated by the Ottawa-Carleton Health Department was low. (Abstract shortened by UMI.)