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"Humans"

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Background: Eye-gaze metrics derived from areas of interest (AOIs) have been suggested to be effective for surgical skill assessment. However, prior research is mostly based on static images and simulated tasks that may not translate to complex and dynamic surgical scenes. Therefore, eye-gaze metrics must advance to account for changes in the location of important information during a surgical procedure. Methods: We developed a dynamic AOI generation technique based on eye gaze collected from an expert viewing surgery videos. This AOI updated as the gaze of the expert moved with changes in the surgical scene. This technique was evaluated through an experiment recruiting a total of 20 attendings and residents to view 10 videos associated with and another 10 without adverse events. Results: Dwell time percentage (i.e., gaze duration) inside the AOI differentiated video type (U = 13508.5, p < 0.001) between videos with the presence (Mdn = 16.75) versus absence (Mdn = 19.95) of adverse events. This metric also differentiated participant group (U = 14029.5, p < 0.001) between attendings (Mdn = 15.45) and residents (Mdn = 19.80). This indicates that our dynamic AOIs reflecting the expert eye gaze was able to differentiate expertise, and the presence of unexpected adverse events. Conclusion: This dynamic AOI generation technique produced dynamic AOIs for deriving eye-gaze metrics that were sensitive to expertise level and event characteristics. © 2018, Springer Science+Business Media, LLC, part of Springer Nature.

Purpose: Studies examining longitudinal associations between socioeconomic factors and quality of life (QoL) in cancer patients are rare. This study investigates changes in QoL over a 6-month period. Methods: Four hundred forty-two cancer patients (mean age 64, SD = 11, 70% male) completed standardized questionnaires at the beginning (t1) and end (t2) of their hospital stay and 3 (t3) and 6 months (t4) thereafter. QoL was assessed with the EORTC QLQ-C30 core questionnaire. Mixed effect models were employed to analyze individual changes in QoL in relation to socioeconomic status (education, income, job status) over the four timepoints. Age, sex, cohabitation, disease and treatment factors, and comorbidity were included as covariates in the models. Results: Income was a predictive factor for QoL. Patients with a low income had 8.8 percentage points (PP) lower physical, 4.9 PP lower emotional, and 11.4 PP lower role functioning. They also had 6.6 PP lower global QoL. Lower social functioning (6.2 PP) was found in patients with higher education or university degrees compared with those who were less educated or had not undergone an apprenticeship. Income also influenced trajectories of role functioning. There was no evidence that primary or secondary education and job type were related to QoL. Conclusions: The fact that income is negatively associated with many aspects of quality of life should be considered during and after treatment with a focus on patients with special needs. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature.

Education and employment programs may be effective at reducing problem behaviors among at-risk young adults. This pilot study evaluated whether participants in a Conservation Corps program (N = 100) showed changes in antisocial behavior, gang membership, and substance use during the program. Participants were young adults between 18 and 24 years who were predominantly male (60%) and ethnic minority (62% Latino; 31% African American). Over the course of the 22-week program, participants showed significant decreases in self-reported antisocial behavior and gang involvement, and approximately 28% earned a high school diploma. However, only 61% completed the program, and subgroup analyses suggested that decreased gang membership and antisocial behaviors were mostly driven by program completers. These limited pilot results suggest that the Conservation Corps offers vulnerable young adults opportunities for education advancement and a possible pathway to criminal desistance. However, education and employment programs should make retention a priority. © The Author(s) 2019.

In Germany there is a threat of a shortage of junior general practitioners (GPs). One third of currently employed GPs are 60 years and older. Every year, 1700 GPs leave the profession, while only about 1350 new GP-specialist approvals are issued. The Advisory Council on the Assessment of Developments in the Health Care Sector estimates that there will be around 20,000 unmet replacement needs by 2025. By 2017, 2600 GP seats were already vacant. Based on the results of the KarMed study, this paper examines the questions as to how many residents intend to become general practitioners after graduation and how they develop during postgraduate training. Furthermore, the consequences of the increasing proportion of female physicians in primary care in terms of the possible volume of work will be investigated. Finally, measures that could reduce a possible personnel shortage are discussed. The attractiveness of general practice has increased considerably during residency over the last six years of observation. The preference for GP work is linked to parenthood. More female doctors strive for part-time work and an employment contract instead of a private practice. On this basis, it can be estimated that the volume of work performed by these female GPs will be half that of the traditional (male) working model in private practice. The forecasted numbers of new recruits are unlikely to be sufficient to cover the demand for GP care in Germany. Possible effective measures would be, for example, the introduction of a gatekeeper system, creation of multi-professional centers, a quota system for access to postgraduate training of specialists, a reformed national planning of GP supply in the country, and a shortening and flexibilization of postgraduate training for general practice. © 2019, The Author(s).

The existing structure of physician education has developed in siloed stages, with consecutive degrees and certifications and progressively longer training programs. As further fragmentation of health care and training systems will not improve the quality of care and education, the authors argue that a new vision of education, training, and practice as a continuum is needed. They advocate for a model of competency-based medical education that merges with competency-based medical practice. In this system, education and training will result in individual, dynamic portfolios of valid entrustable professional activities (EPAs) for which physicians are certified. Physicians can maintain and renew that entrustment as long as the EPAs remain within their scope of practice. Entrustment occurs initially during training but is then granted for new activities as physicians' careers evolve. This model accounts for the need to keep pace with changes in population health needs and expectations of competence over time. It de-emphasizes the divides between the stages of training and views the continuum from undergraduate medical education until retirement as a whole. Key obligations of self-regulating medical professionals include both the reception and the provision of supervision from and for others, respectively. Learning must be embedded in practice to address expectations regarding new knowledge and skills as they evolve with scientific and technological advances. Entrusting physicians to deliver effective and safe care, based on their performance of the requisite EPAs without supervision, should ensure that they provide high-value, quality care to patients. © © 2019 by the Association of American Medical Colleges.

Background: Hairdressing apprentices are at high risk for developing occupational contact dermatitis. Objectives: The objective of this study was to analyse whether there are differences in skin health, skin protection and health-related quality of life between apprentices from two Croatian regions (Zagreb and Dalmatia). Materials and methods: Final-year hairdressing apprentices from Zagreb (n = 101) and Dalmatia (n = 77) were enrolled in the study. Clinical examination of hands was performed by use of the Osnabrück Hand Eczema Severity Index. Transepidermal water loss (TEWL) was measured on forearm and hand. A history of self-reported skin symptoms, work-related exposure to skin hazards and health-related quality of life were assessed with validated questionnaires. Results: Apprentices from Zagreb reported having been engaged in practical work more days per month than Dalmatian apprentices (median 12 days vs 8 days, respectively, P < 0.001), and washing their hands >20 times per day more frequently (28% vs 10%, respectively, P = 0.004), and consequently more frequently having dry hands (37% vs 16%, respectively, P = 0.002), and significantly higher TEWL values on the hand and forearm, which was confirmed by the results obtained with multiple linear regression models. Conclusions: A higher extent of exposure to skin hazards was related to poorer skin barrier function, which confirms the need for improvement of appropriate safety practices in hairdressing schools. © 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Aim: Many factors affect learning outcomes, however studies comparing the effectiveness of different clinical teaching methods are limited. We utilize the list of influences on educational achievement compiled by John Hattie to inform a meta-analysis of learning effect sizes (ESs) associated with teaching-learning factors (TLFs) in clinical education. Methods: A literature search was conducted in PubMed to identify articles examining clinically relevant TLFs. Selection criteria were applied to identify learner-focused studies, with subsequent categorization by study design (pretest–posttest or controlled group). The Cohen’s ES (d) for each TLF was extracted and a pooled ES determined. Results: From 3454 studies, 132 suitable articles enabled analysis of 16 TLFs’ ESs. In general, ESs derived from pretest–posttest data were larger than those from controlled group designs, probably due to learner maturation effect. The TLFs of mastery learning, small group learning and goal settings possessed the largest ESs (d ≥ 0.8), while worked examples, play programs, questioning, concept mapping, meta-cognitive strategies, visual-perception programs and teaching strategies demonstrated ESs between 0.4 and 0.8. Conclusions: This is the first study to provide a rigorous and comprehensive overview of the effectiveness of TLFs in clinical education. We discuss the practical traits shared by effective TLFs which may assist teaching design. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.

Objective: The study objective was to enhance clinical skills among undergraduate students majoring in clinical medicine in performing physical examination by establishing a novel platform for peer assessment of clinical skills. Methods: A total 126 Year 2012 students majoring in medicine and receiving traditional training were assigned to the control group, and 126 Year 2013 students receiving instruction via the peer assessment platform of clinical skills were allocated to the study group. Scores of the physical examination, paper exam, and peer assessment were compared using a t-test, and we performed linear correlation analysis of the data. Results: Scores of the physical examination and peer assessment among Year 2013 students (the study group) were significantly higher than those in the control group. Paper exam scores in the study group were also significantly higher than those in the controls. The three assessment scores did not differ significantly according to sex. Conclusions: The peer assessment platform can not only improve medical students’ skills and capabilities in physical examination, it can also enhance their theoretical knowledge of basic clinical principles. We determined that sex was not related to the assessment scores obtained by medical students. © The Author(s) 2019.

This article seeks to explain one of the sensibilities or dispositions that novices learn in the process of becoming financiers, namely, to be a contrarian. We will review investment pitches from an American undergraduate collegiate investment fund, interviews with some members of the club, and field notes from a few of their outings, and treat instances of their contrariness as moments in their process of going from non-investors to investors, moments in which they experiment with and learn new social habits, identities and practices. Moreover, we connect this contrariness with a much longer tradition in the formation of an identity and subjectivity as an investor. More than any simple technology of thought to be deployed in a particular situation, contrarianism is a thoroughgoing mode of framing and understanding life, both in investment contexts and beyond, which we suggest was born between the 1880s and 1940s and has persisted in various forms to this day. This paper offers two instances of how someone becomes contrary, and suggests that contrarianism may be a fairly typical way for humans to make sense of financial markets. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.