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Three-Year Family Medicine Residency Program Use of the ACGME Core Competencies to Assess Physician Competency: A Scoping Review
No full textPoor patient satisfaction during care has been linked to the inadequate evaluation of resident knowledge during residency training programs. The Accreditation Council for Graduate Medicine Education (ACGME) set guidelines for resident education in the accredited medical training programs, that describes the required areas in which a resident must indicate competence in order to be deemed capable of autonomous practice, termed the ACGME Core Competencies. To evaluate the usefulness of the ACGME Core Competencies in terms of resident competence, I completed a literary synthesis in the form of a scoping review. This review aims to examine the extant literature on the tools utilized in the evaluation of family medicine resident performance during residency. The results indicated that direct observation is most commonly used to evaluate resident competency, while multisource evaluations, including the use of peer reviews and patients, provided constructive feedback and demonstrated improvements in resident performance and patient care satisfaction. A standardized evaluation tool for resident performance during residency training is needed to successfully analyze resident capabilities, as all residents should be held to the same assessment standards. Further research may reveal what multisource assessment methods should be recommended for the standardized assessment of resident competence during training nationwide
Testing Charge-, Sign- and Energy-Dependence of Cosmic-Ray Solar Modulation with AMS-02 observations during cycle 24
No full textOur basic theoretical understanding of the sources of cosmic rays and their propagation through the interstellar medium is hindered by the Sun, that through the solar wind affects the observed cosmic-ray spectra.This effect is known as solar modulation. However recently released cosmic-ray data and publicly available measurements of the solar wind properties from ACS and the Wilcox observatory allow us to test the analytical modeling of the time-, charge- and energy-dependence of solar modulation. Using the well established time-dependence of solar modulation we establish evidence for its charge and energy dependence
Retrospective Application of the PRODIGY Risk Prediction Model in Patients Experiencing Postoperative Adverse Respiratory Events
No full textBackground: Postoperative respiratory depression is a major contributor to patient morbidity and mortality. Historically, postoperative opioid-induced respiratory depression (POIRD) has been shown to be difficult to predict, leading to increased patient morbidity and mortality. The Prediction of Opioid-Induced Respiratory Depression in Patients Monitored by Capnography (PRODIGY) model is a novel risk prediction tool. It has been shown to be quick and effective for predicting opioid-induced respiratory depression and utilizes five patient characteristics in its scoring system (age, sex, previous opioid use, sleep disordered breathing, and chronic heart failure).
Purpose: This quality improvement project aimed to determine if the PRODIGY risk prediction model would be a valid predictor of POIRD in the adult, inpatient, postsurgical population at a single, large, academic medical center. Additionally, this project aimed to identify timeframes for naloxone administration as well as surgical specialties where naloxone was used more frequently in the postoperative period.
Methods: This quality improvement project consisted of a retrospective chart review of 47 adult, inpatient, postsurgical patients who had received parenteral opioids and naloxone after anesthesia was concluded. PRODIGY risk scores were determined and then subsequently categorized as low-, intermediate-, or high-risk for developing POIRD. Timeframes for naloxone administration were analyzed and a median time was established. Surgical specialties were grouped and analyzed for increased frequency of naloxone administration.
Results: After application of the PRODIGY risk prediction model, 31 (66%) of patients were categorized as high-risk for developing POIRD. Additionally, 42 (89.4%) of 47 total patients were categorized as intermediate- or high-risk for developing POIRD. Only 5 (10.6%) patients were categorized as low-risk. The median timeframe when naloxone was administered after conclusion of anesthesia was 23.4 hours. The surgical specialties with increased incidence of naloxone administration (>10%) were cardiac surgery (17%), general surgery (14.9%), orthopedic surgery (14.9%), endoscopy (14.9%), vascular surgery (10.6%), and neuro-spine surgery (10.6%).
Conclusion: The PRODIGY risk prediction model was effective in predicting POIRD in adult, inpatient, postsurgical patients who had received parenteral opioids and naloxone following anesthesia at this single, large, academic medical center. This risk prediction tool may be utilized preoperatively to identify high-risk patients, establish opioid-sparing anesthetic techniques, and implement appropriate postoperative monitoring (continuous pulse oximetry and capnography). Confirmation that the median timeframe for naloxone administration was within 24 hours after surgery further supports the use of continuous monitoring in high-risk patients for at least 24 hours after anesthesia is concluded
Understanding The Role Of Curriculum Pacing In Relation To At-Risk Student Locus Of Control
No full textThe purpose of the study was to explore the possibility of mitigating school drop out of at-risk students by self-pacing of curriculum in an alternative institution. To accomplish this goal, I interviewed seven students and five staff members comprising three teachers and two administrators, a total of twelve interviewees to solicit their opinions on the issues at hand. Purposeful sampling was used to identify participants who were "information rich" to conduct my interviews. I used a qualitative case study to research the causes of failure of at-risk students and the solutions to at-risk student school dropout. Participants were asked to tell the impact of self-pacing on students' locus of control, and if there was any relationship between at-risk students' use of self-pacing and their experience of test-taking. They were also to explain if there was any relationship between at-risk student self-pacing and their feelings about school dropout. The responses revealed five themes; the barriers to academic success which included childbearing/nursing mothers, law enforcement issues, behavioral issues, homelessness, and jobs/employment. Another theme that emerged was that the students saw the alternative school as the last opportunity for them to succeed. That alternative schools offer many options and levels of support and there is variability of success in alternative schools. The final theme was what I called intervention synergism, meaning that when several options or treatments are prescribed, there is a likelihood that one or two of the options would be able to address the issues confronting the students at-risk
An Investigation of Vague Narration and Reader Interpretation
No full textThis thesis project explores how narrators impact a reader’s interpretation of a story. Specifically, it investigates how a homodiegetic, externally-focalized, first-person narrator—a “vague” narrator, one that provides little internal detail or thought, leaving personal details unknown to the reader—causes individual readers to interpret a story differently. By researching this type of narration, this project provides new insight into how that narration influences the way a story is told. Further, it sheds light on the way readers perceive a story through narration, and how that perception can be skewed in order to encourage reader inference. These findings contribute to the larger discussion of the relationship between readers and narration, and will benefit those who study how reader experience influences the way a story is read, as well as those employing narrative techniques to write fiction
Pediatric Nurse Practitioners’ Developmental Screening Practices for Children Ages Birth to Three
No full textDevelopmental screening is the process of using a validated screening tool to identify children at risk of delay. Studies have examined the developmental screening practices of pediatric primary care providers. However, no studies to date have explored the pediatric nurse practitioner (PNP) perspective. The specific purpose of this study was to gain information about the developmental screening practices of PNPs. Furthermore, the study explored how perceptions of their knowledge, skills, and attitudes regarding developmental screening may contribute to their screening behaviors. A qualitative grounded theory study was conducted using a purposive sampling of primary care pediatric nurse practitioners who care for young children. Six in-depth interviews were completed using a virtual platform. Strauss and Corbin’s (1990, 2008) inductive approach to data analysis was used to code and interpret the data. A substantive theory of advancing screening competencies for young children’s optimal development emerged from the data supported by six themes related to program and practice knowledge, skills, and attitudes. The themes included (1) developing awareness, (2) integrating connections, (3) taking an active role, (4) creating opportunities, (5) balancing learning expectations, vi and (6) understanding role and responsibilities. The PNPs in this study perceived that as they gain developmental screening experience, they continuously develop interrelated knowledge, skills, and attitude attributes, which contribute to advancing competencies and ultimately lead to more effective screening behaviors that support young children’s optimal development. The PNPs in this study followed the American Academy of Pediatrics’ developmental screening and surveillance guidelines for general and autism screening using standardized screening tools. They identified areas of program improvement related to developmental screening as additional preparation to work with diverse populations and increased opportunities to utilize the entire screening process. The study’s PNPs identified current developmental screening facilitators as physicians, parents, and self-directed. They identified screening challenges as time, practice processes, and parents. The nurse practitioner workforce who care for young children is underrepresented in the literature. Additional research is needed to compare screening practices between pediatricians, family medicine physicians, and family and pediatric nurse practitioners to understand their screening practices and continue to improve developmental screening rates for young children
Work in progress: Promoting the use of standards by faculty through improved access
No full textTechnical standards can provide an effective instructional scaffold for undergraduate engineering coursework, and exposing engineering students to appropriate standards is one of the requirements for program accreditation by the Accreditation Board of Engineering and Technology (ABET). However, providing access to standards can be challenging for academic libraries due to their expense and the restrictions imposed by publishers on borrowing these documents from other libraries. As a first step towards improving access to standards for students and faculty at Oakland University (OU), the use of standards by faculty in their teaching and research is investigated via survey research. It is hoped that this study will not only provide guidance on which standards are the highest priority for access by our affiliates, but will also yield insight into how standards are being integrated into coursework in the engineering curriculum at OU