Direct Observation of Clinical Skills Feedback Scale: Development and Validity Evidence

Construct: This article describes the development and validity evidence behind a new rating scale to assess feedback quality in the clinical workplace. Background: Competency-based medical education has mandated a shift to learner-centeredness, authentic observation, and frequent formative assessments with a focus on the delivery of effective feedback. Because feedback has been shown to be of variable quality and effectiveness, an assessment of feedback quality in the workplace is important to ensure we are providing trainees with optimal learning opportunities. The purposes of this project were to develop a rating scale for the quality of verbal feedback in the workplace (the Direct Observation of Clinical Skills Feedback Scale [DOCS-FBS]) and to gather validity evidence for its use. Approach: Two panels of experts (local and national) took part in a nominal group technique to identify features of high-quality feedback. Through multiple iterations and review, 9 features were developed into the DOCS-FBS. Four rater types (residents n = 21, medical students n = 8, faculty n = 12, and educators n = 12) used the DOCS-FBS to rate videotaped feedback encounters of variable quality. The psychometric properties of the scale were determined using a generalizability analysis. Participants also completed a survey to gather data on a 5-point Likert scale to inform the ease of use, clarity, knowledge acquisition, and acceptability of the scale. Results: Mean video ratings ranged from 1.38 to 2.96 out of 3 and followed the intended pattern suggesting that the tool allowed raters to distinguish between examples of higher and lower quality feedback. There were no significant differences between rater type (range = 2.36–2.49), suggesting that all groups of raters used the tool in the same way. The generalizability coefficients for the scale ranged from 0.97 to 0.99. Item-total correlations were all above 0.80, suggesting some redundancy in items. Participants found the scale easy to use (M = 4.31/5) and clear (M = 4.23/5), and most would recommend its use (M = 4.15/5). Use of DOCS-FBS was acceptable to both trainees (M = 4.34/5) and supervisors (M = 4.22/5). Conclusions: The DOCS-FBS can reliably differentiate between feedback encounters of higher and lower quality. The scale has been shown to have excellent internal consistency. We foresee the DOCS-FBS being used as a means to provide objective evidence that faculty development efforts aimed at improving feedback skills can yield results through formal assessment of feedback quality.     

A sex difference in the response to fasting

We determined whether women and men would alter their pattern of food intake after they had deprived themselves of food. We found that women consumed 12% less food after fasting and that men ate 28% more food after fasting. Serving more food on the test day did not increase food intake of women. Women, who ate at a nearly constant rate (linear eaters), consumed less food than those eating at an initially high speed which decreased over the course of the meal (decelerated eaters). Women decreased their food intake after fasting as their eating pattern became more linear. After fasting, men increased their food intake, and the rate at which they ate became more decelerated. Food intake of both women and men was normalized after fasting by providing feedback that encouraged them to eat according to the pattern they showed in the non-fasted condition. The results support the hypothesis that linear eating, and the dieting that elicits linear eating, are risk factors for the development of the abnormal linear eating pattern that characterizes patients with anorexia nervosa. The data also provide additional support for the use of behavioral feedback to normalize the pattern of eating for individuals who have difficulty maintaining their body weight.     

Woulda, coulda, shoulda: the evaluation and the impact of the alternative outcome

The alternative outcome refers to the outcome of the unselected option in decision-making tasks, which has significant influence on the chosen outcome evaluation. Most paradigms have presented the alternative outcome either after or simultaneous with the chosen outcome, which complicates the observation on the brain activity associated with the alternative outcome. To circumvent this perceived shortcoming, we modified the classic paradigm designed by Yeung and Sanfey (2004) such that the alternative outcome was presented before the chosen outcome in each trial while an electroencephalogram was recorded. The feedback-related negativity (FRN) elicited by the positive alternative outcome was larger than that elicited by the negative alternative outcome, suggesting that the participants evaluated the positive alternative outcome as negative feedback. Moreover, the FRN and the P3 elicited by the chosen outcome were influenced by the valence of the alternative outcome. The current study reveals that the alternative outcome is treated as important information even though it is economically neutral.     

Promoting Self-Efficacy in Minimally Invasive Surgery Training

Many surgeons continue to actively pursue surgical approaches that are less invasive for their patients. This pursuit requires the surgeon to adapt to new instruments, techniques, technologies, knowledge bases, visual perspectives, and motor skills, among other changes. The premise of this paper is that surgeons adopting minimally invasive approaches are particularly obligated to maintain an accurate perception of their own competencies and learning needs in these areas (ie, self-efficacy). The psychological literature on the topic of self-efficacy is vast and provides valuable information that can help assure that an individual develops and maintains accurate self-efficacy beliefs. The current paper briefly summarizes the practical implications of psychological research on self-efficacy for minimally invasive surgery training. Specific approaches to training and the provision of feedback are described in relation to potential types of discrepancies that may exist between perceived and actual efficacy.     

The effects of frequency altered feedback on the reading processes of adults with reading disorders

Various factors have been shown to influence the reading comprehension of reading disordered individuals including altered auditory feedback. This study investigated the influence of frequency altered feedback (FAF) on the reading comprehension and decoding accuracy of reading disordered and normal reading adults. Participants consisted of 30 college students with normal and disordered reading abilities. Percentage accuracy data was collected for both comprehension and decoding. Results indicate that FAF has an enhancing effect on the oral reading comprehension of reading disordered adults whereas it has a detrimental effect on the reading comprehension of normal reading adults. FAF had no effect on decoding accuracy for either group.     

Homeostasis of Brain Dynamics in Epilepsy: A Feedback Control Systems Perspective of Seizures

In an effort to understand basic functional mechanisms that can produce epileptic seizures, some key features are introduced in coupled lumped-parameter neural population models that produce “seizure”-like events and dynamics similar to the ones during the route of the epileptic brain towards seizures. In these models, modified from existing ones in the literature, internal feedback mechanisms are incorporated to maintain the normal low level of synchronous behavior in the presence of coupling variations. While the internal feedback is developed using basic feedback systems principles, it is also functionally equivalent to actual neurophysiological mechanisms such as homeostasis that act to maintain normal activity in neural systems that are subject to extrinsic and intrinsic perturbations. Here it is hypothesized that a plausible cause of seizures is a pathology in the internal feedback action; normal internal feedback quickly regulates an abnormally high coupling between the neural populations, whereas pathological internal feedback can lead to “seizure”-like high amplitude oscillations. Several external seizure-control paradigms, that act to achieve the operational objective of maintaining normal levels of synchronous behavior, are also developed and tested in this paper. In particular, closed-loop “modulating” control with predefined stimuli, and closed-loop feedback decoupling control are considered. Among these, feedback decoupling control is the consistently successful and robust seizure-control strategy. The proposed model and remedies are consistent with a variety of recent observations in the human and animal epileptic brain, and with theories from nonlinear systems, adaptive systems, optimization, and neurophysiology. The results from the analysis of these models have two key implications, namely, developing a basic theory for epilepsy and other brain disorders, and the development of a robust seizure-control device through electrical stimulation and/or drug intervention modalities.

Feedback‐related potentials are sensitive to sequential order of decision outcomes in a gambling task

The feedback negativity (FN) has been repeatedly linked to expectancies about decision outcomes. Sequential outcome order is likely to influence such expectancies but has been widely disregarded. We therefore investigated whether the three‐trial order of decision outcomes in a gambling task influences the FN as well as the P200 and P300. All three deflections were not only influenced by the outcome valence of the current trial but also by the outcomes of the two preceding trials. In detail, the FN and P300 to any current trial outcome were largest when the outcomes in the two preceding trials had an opposite valence. The P200 was highest in the context of two directly preceding wins, indicating that it may reflect representations of local outcome history. Our findings demonstrate that neural systems involved in decision outcome processing dynamically and continuously integrate the local outcome history for the evaluation of present outcomes.     

Acute noise stress impairs feedback processing

We examined the impact of acute noise stress on the feedback-related negativity (FRN) and whether this effect depended on stressor predictability. Participants performed a gambling task in a silence and a noise condition with either predictable or unpredictable noise. FRN amplitude was measured in three ways, either neglecting (mean amplitude) or correcting for overlap with other components (base-to-peak; mean amplitude minus average mean amplitude of surrounding peaks). Notably, results differed between measures. Valence and magnitude both affected the FRN. These effects were additive on the mean amplitude and base-to-peak measures, but interactive on the mean amplitude corrected for both peaks measure. Acute noise stress specifically modulated valence and magnitude effects on the FRN, although evidence differed between measures as to whether valence and/or magnitude were processed differently. These findings indicate that acute stress impairs cognitive control by the anterior cingulate cortex. Stressor predictability added little to the explanation of effects.     

反馈式家庭干预对婴幼儿语言和认知发育的影响

目的：探讨反馈式家庭应答行为干预对婴幼儿语言和认知功能发育的促进作用。方法选取于我院成功分娩且身体健康的1岁婴幼儿42名为研究对象,均行反馈式家庭应答行为干预,持续时间为6个月,采用自身对照法对比分析干预前后婴幼儿语言和认知功能发育情况。结果反馈式家庭应答行为干预可行性和有效性高,儿童言语次数以及儿童发起对话轮换数随着年龄的增长呈逐渐增高趋势,不同年龄段比较差异总体上具有统计学意义(P<0.05)。成人-儿童对话轮换数与成人语言字词数、儿童言语字词数呈显著正相关(r=0.728, P=0.0006;r=0.788,P=0.0004);婴幼儿智力发育指数(MDI)得分随着年龄的增长而逐渐升高,组间比较差异具有显著统计学意义(t=5.3188,P=0.0000)。儿童言语字词数和儿童发起的对话轮换数与MDI呈正相关(r=0.523, P=0.0002;r=0.568,P=0.0001)。精神运动发育指数PDI评分无明显增高,干预前后比较差异无统计学意义(t=0.4180,P=0.6770)。结论反馈式家庭应答行为干预可行性高,且能促进儿童语言和认知功能健康快速发育,具有极其重要的临床应用价值和意义。     

Seven cervical sensorimotor control tests measure different skills in individuals with chronic idiopathic neck pain

BackgroundSensorimotor control is commonly reported in neck pain research and rapidly gaining interest in clinical practice. Joint position error (conventional and torsion), postural balance, subjective visual vertical, head tilt response, The Fly®, smooth pursuit neck torsion and head steadiness are tests that have been reported to assess cervical sensorimotor control. However, it is unknown whether clinicians could use one test, or a test battery, to appropriately assess cervical sensorimotor control and improve efficiency. Our main research question is: Do seven cervical sensorimotor control tests measure unique or similar characteristics of sensorimotor control in individuals with chronic idiopathic neck pain?MethodsPrinciple components factor analysis. Data from seven cervical sensorimotor control tests of 50 participants with chronic idiopathic neck pain were included. Individual factors, potentially related to sensorimotor control, were determined by Eigen values >1.00 and inspection of a loading plot. Items with loadings ≥0.40 were considered satisfactory for inclusion in a factor.ResultsAll cervical sensorimotor control tests were found to measure unique skills. Four factors were isolated with two, postural balance and head steadiness, accounting for most of the variance across tests. The remaining two factors, continuous movement accuracy and perceived verticality, contributed less to the observed variance.ConclusionPostural balance and head steadiness were the major underlying factors explaining cervical sensorimotor control in the current sample. However, our results imply that all seven tests are independent and measure different skills. It is not possible to recommend a test battery for clinical practice, as all tests measure unique skills which appear to be independent of each other.