Developing and validating a multi-criteria decision analytic tool to assess the value of cancer clinical trials: evaluating cancer clinical trial value

BACKGROUND

Demonstrating safety and efficacy of new medical treatments requires clinical trials but clinical trials are costly and may not provide value proportionate to their costs. As most health systems have limited resources, it is therefore important to identify the trials with the highest value. Tools exist to assess elements of a clinical trial such as statistical validity but are not wholistic in their valuation of a clinical trial. This study aims to develop a measure of clinical trials value and provide an online tool for clinical trial prioritisation.

METHODS

A search of the academic and grey literature and stakeholder consultation was undertaken to identify a set of criteria to aid clinical trial valuation using multi-criteria decision analysis. Swing weighting and ranking exercises were used to calculate appropriate weights of each of the included criteria and to estimate the partial-value function for each underlying metric. The set of criteria and their respective weights were applied to the results of six different clinical trials to calculate their value.

RESULTS

Seven criteria were identified: 'unmet need', 'size of target population', 'eligible participants can access the trial', 'patient outcomes', 'total trial cost', 'academic impact' and 'use of trial results'. The survey had 80 complete sets of responses (51% response rate). A trial designed to address an 'Unmet Need' was most commonly ranked as the most important with a weight of 24.4%, followed by trials demonstrating improved 'Patient Outcomes' with a weight of 21.2%. The value calculated for each trial allowed for their clear delineation and thus a final value ranking for each of the six trials.

CONCLUSION

We confirmed that the use of the decision tool for valuing clinical trials is feasible and that the results are face valid based on the evaluation of six trials. A proof-of-concept applying this tool to a larger set of trials with an external validation is currently underway.

On NFPs with high social impact that avoid concentrating on a few activities

Background: An influential piece of literature on effective altruism insists that not-for-profit organizations (NFPs) should concentrate their investments on a few activities to maximize their social return on investment (SROI) ratio. However, this creates greater risk for an NFP than building a portfolio of investments in activities. This study investigates whether it is desirable for executives and contributors of NFPs to build a portfolio rather than maximize the expected SROI ratio, and if so, how to build one. Solving these questions will help the chief financial officers (CFOs) of NFPs, who serve as their agents, fulfill their obligations to contributors, who are their principals, and will help advisors provide better services for their contributors, their clients. Methods: Data were collected from a ranking of NFPs, then non-parametric tests were performed on this ranking and the Herfindahl-Hirschman Index (HHI). Results: The HHI are between 2013 and 2688. The results of non-parametric tests do not deny that rank and HHI are independent of each other. Most of the NFPs' investments in activities were in accord with their core competencies. Conclusions: It was found that successful executives build portfolios. The findings of this study should be sufficiently practical in helping NFP executives and contributors decide whether to build portfolios, and if so, how.

The experiences of preparation and engagement of educators in teaching e-portfolio

INTRODUCTION

A teaching e-portfolio is used to organize the collation and presentation of documents about teaching for the development and evaluation of educators. The current study was aimed at describing teaching e-portfolio components at Shahid Sadoughi University of Medical Sciences. As well, we examined the performance and experience of educators in engaging in the teaching e-portfolio.

MATERIALS AND METHODS

This study was conducted at Shahid Sadoughi University in 2018-2022 in three main stages: (1) Development of the teaching e-portfolio; (2) Implementing teaching e-portfolio, and evaluating teaching documentation quantitatively; and (3) Exploration of educators' experiences by a conventional content analysis introduced by Graneheim and Lundman. The teaching e-portfolio was developed from the perspective of the components, domains, and criteria of scholarship of teaching and learning. The teaching e-portfolio documented the educational activities of educators in 12 areas, including philosophy of education (1 activity), curriculum planning (4 activities), evaluation (7 activities), teaching and learning (1 activity), e-learning (1 activity), professional development in education (1 activity), scholarly activities (2 activities), mentoring and counseling (3 activities), educational leadership (2 activities), education research (6 activities), education reform project (1 activity), and production of scholarship of teaching and learning (13 activities). The educators recorded the documentation of educational activities in their teaching e-portfolio. Their documentation was reviewed by two peers. The reviewers delivered constructive feedback to improve the educators' performance. The quantitative performance of educators in different activities in teaching e-portfolio was examined by descriptive tests (frequency and percentage). The experiences of educators were explored by the conventional content analysis approach which was introduced by Graneheim and Lundman.

RESULTS

In the present study, 148 educators registered in the teaching e-portfolio. A total of 1488 documents of educational activities were registered in the e-portfolio from 2018 to 2022, and 55.24% of the activities received feedback in the peer review process. The experience of participants was categorized into a theme "fear and hope in utilizing teaching e-portfolio". This theme consisted of three categories: "motivational roadmap for personal and professional development in the future", "concern about the consequences of continuous monitoring", and "restriction of resources and capability as resistance sources".

CONCLUSION

The current study showed that the participation of educators in a teaching e-portfolio was at an acceptable level. Support systems and educational policies played an effective role in guiding educators to participate in educational development activities. The educators perceived the teaching e-portfolio as a two-faceted tool. Teaching e-portfolio can provide a road map for their personal and professional development to achieve excellent teaching. As well, the teaching e-portfolio was recognized as a tool for continuous performance monitoring and detection of the inefficiency of teaching quality activities. This perception, along with limited resources such as time, weak technological literacy, and difficulty in working with electronic devices and systems, led to resistance from educators to involve in teaching e-portfolio.

Standardizing Research Training: a Pilot Curriculum Within a Hematology/Oncology Fellowship Program

While scholarly activity is recognized as critical in cancer education, there is an outstanding need for methods to define research learning competencies and tools for formal research productivity and competency assessment. We piloted and studied a novel educational initiative within the University of Wisconsin Hematology/Oncology fellowship program, establishing a professional learning community (PLC) of research mentors and developing a formative evaluation tool, a research portfolio. We developed a PLC engaged in reflective conversations about intended learning outcomes and effective instructional strategies. Subsequently, a research portfolio was piloted with four first-year Hematology/Oncology fellows at the start of the 2020 academic year in which trainees document, critically evaluate, and reflect upon the knowledge, skills, confidence, and productivity acquired during research training. We employed surveys to evaluate the initiative. Seven Hematology/Oncology fellows (7/12, 58%) completed pre-intervention and six-month interim evaluation surveys, with 43% (3/7) identifying an increased confidence in quality of research training strategies following the pilot initiation. All four first-year fellows that piloted the research portfolio (4/4, 100%) completed interim evaluation surveys that demonstrated benefits of the research portfolio including self-reflection and goal setting. Research portfolio scoring correlated with other markers of academic success, suggesting its potential to predict research success. Our data suggest that bringing together a community of research mentors to generate shared learning goals and develop the framework for a formative evaluation portfolio may meet critical needs research training needs in cancer education. Given promising results, we aim to create a new educational tool for research training.

Continuity of Care Within a Single Patient Support Program for Patients with Rheumatoid Arthritis Prescribed Second or Later Line Advanced Therapy

INTRODUCTION

Guidelines suggest patients with rheumatoid arthritis (RA) inadequately controlled by tumor-necrosis-factor-inhibitors (TNFis) may benefit from switching to Janus-kinase-inhibitors (JAKis); however, care coordination and access can be complicated. Disruptions in transitioning to JAKi treatment could lead to disease flares requiring hospitalization; however, transitioning between products within the same patient support program (PSP) services aimed at ensuring continuity of care may minimize disruptions.

METHODS

A retrospective, longitudinal cohort study of adult patients with RA newly prescribed JAKi following TNFi treatment in the Symphony Health claims database. Patients with baseline TNFi use and ≥ 6 months of data before (baseline) and after (follow-up) the initial JAKi claim (approved or denied) were included. Cohorts were defined by transitions between products within the same PSP [adalimumab (ADA) and upadacitinib (UPA)] or not. Disruptions were defined as gap in care ≥ 15 days due to failure/delay in receiving coverage approval or picking up an approved prescription. Disruptions followed by JAKi dispense were considered temporary and those without permanent. Odds ratios (ORs) of disruption and hospitalization were estimated from logistic regressions controlling for patient characteristics and treatment history.

RESULTS

A total of 2371 patients were included: 317 transitioning from ADA-UPA, 321 TNFi-UPA, 860 ADA-another JAKi, and 873 another TNFi-another JAKi. Temporary and permanent disruptions increased odds of hospitalization by 47% and 123% (both p < 0.05). Temporary disruption rates were lowest for ADA-UPA patients (19%) compared to other TNFi-UPA (25%; OR = 1.46), ADA-other JAKi (29%; OR = 1.59), and other TNFi-other JAKi (31%; OR = 1.74), all p < 0.05. For transitions to UPA, temporary disruptions were lower for patients using the PSP (17%) versus not (24%; OR = 1.45, p < 0.05). No differences were found for permanent disruptions.

CONCLUSION

Disruptions for patients with RA transitioning from TNFi to JAKi treatment are associated with increased hospitalization rates. Transitioning between drugs within the same PSP could lower the risk of disruption.

[Portfolio-based learning in surgery : Making competencies "visible"]

BACKGROUND

Due to an increasing competence orientation of medical studies, surgical curricula are being adapted in many places. In addition to surgical knowledge and practical skills, these should also teach competencies in differential diagnostics and treatment. The teaching of surgical knowledge through lectures and seminars and the demonstration of practical skills, e.g., through the use of logbooks in the Bock Practical Surgery (BP), only allows limited active engagement with surgical competencies on differential diagnostics and treatment. A reflection-based portfolio allows, through the independent written elaboration of surgical topics, an active engagement with the competencies and promises a higher learning effect. In the context of the implementation of such a portfolio as part of the proof of activity in BP, the effects on the acquisition of competencies and on the way of learning were investigated.

MATERIAL AND METHODS

Using a mixed methods approach, we compared competence acquisition using a reflection-based portfolio with learning using a logbook. Students conducted a self-assessment of competencies using questionnaire surveys before and after the BP. Through focus group interviews with discussions among students using a guideline, we explored the different ways of acquiring competencies. In addition, the examination and evaluation results of both cohorts were compared.

RESULTS AND DISCUSSION

Students' self-assessed competency acquisition and examination and evaluation results showed no differences when comparing the two cohorts. During the focus group interviews, we were able to show that in the perception of the students, surgical competencies can be made more visible and thus more explicit with the help of a reflection-based portfolio. In addition, self-regulated learning was promoted without neglecting practical skills. Students demanded greater supervision and guidance by mentors in both groups.

How does portfolio use affect self-regulated learning in clinical workplace learning: What works, for whom, and in what contexts?

INTRODUCTION

Portfolio use to support self-regulated learning (SRL) during clinical workplace learning is widespread, but much is still unknown regarding its effectiveness. This review aimed to gain insight in the extent to which portfolio use supports SRL and under what circumstances.

METHODS

A realist review was conducted in two phases. First, stakeholder interviews and a scoping search were used to formulate a program theory that explains how portfolio use could support SRL. Second, an in-depth literature search was conducted. The included papers were coded to extract context-mechanism-outcome configurations (CMOs). These were synthesized to answer the research question.

RESULTS

Sixteen papers were included (four fulfilled all qualitative rigor criteria). Two primary portfolio mechanisms were established: documenting as a moment of contemplation (learners analyze experiences while writing portfolio reports) and documentation as a reminder of past events (previous portfolio reports aid recall). These mechanisms may explain the positive relationship between portfolio use and self-assessment, reflection, and feedback. However, other SRL outcomes were only supported to a limited extent: formulation of learning objectives and plans, and monitoring. The partial support of the program theory can be explained by interference of contextual factors (e.g., system of assessment) and portfolio-related mechanisms (e.g., mentoring).

DISCUSSION

Portfolio research is falling short both theoretically-in defining and conceptualizing SRL-and methodologically. Nevertheless, this review indicates that portfolio use has potential to support SRL. However, the working mechanisms of portfolio use are easily disrupted. These disruptions seem to relate to tensions between different portfolio purposes, which may undermine learners' motivation.

Shaping the right conditions in programmatic assessment: how quality of narrative information affects the quality of high-stakes decision-making

BACKGROUND

Programmatic assessment is increasingly being implemented within competency-based health professions education. In this approach a multitude of low-stakes assessment activities are aggregated into a holistic high-stakes decision on the student's performance. High-stakes decisions need to be of high quality. Part of this quality is whether an examiner perceives saturation of information when making a holistic decision. The purpose of this study was to explore the influence of narrative information in perceiving saturation of information during the interpretative process of high-stakes decision-making.

METHODS

In this mixed-method intervention study the quality of the recorded narrative information was manipulated within multiple portfolios (i.e., feedback and reflection) to investigate its influence on 1) the perception of saturation of information and 2) the examiner's interpretative approach in making a high-stakes decision. Data were collected through surveys, screen recordings of the portfolio assessments, and semi-structured interviews. Descriptive statistics and template analysis were applied to analyze the data.

RESULTS

The examiners perceived less frequently saturation of information in the portfolios with low quality of narrative feedback. Additionally, they mentioned consistency of information as a factor that influenced their perception of saturation of information. Even though in general they had their idiosyncratic approach to assessing a portfolio, variations were present caused by certain triggers, such as noticeable deviations in the student's performance and quality of narrative feedback.

CONCLUSION

The perception of saturation of information seemed to be influenced by the quality of the narrative feedback and, to a lesser extent, by the quality of reflection. These results emphasize the importance of high-quality narrative feedback in making robust decisions within portfolios that are expected to be more difficult to assess. Furthermore, within these "difficult" portfolios, examiners adapted their interpretative process reacting on the intervention and other triggers by means of an iterative and responsive approach.

Evaluating the utility of an international webinar as a platform to educate students and doctors on the UK core surgical training portfolio

BACKGROUND

Core Surgical Training (CST) is a competitive two-year postgraduate training program in the UK that is scored based on three equally weighted stations: management, clinical and portfolio. Preparing a surgical portfolio can start in medical school, however, there is limited guidance on what forms a competitive portfolio with the majority of advice coming from university resources and national societies which are variable throughout the country. Our aim was to assess the utility of a webinar to educate students and doctors on the CST portfolio to address this disparity.

METHODS

Pre- and post-event questionnaires that included demographic data, 10-point Likert scales to self-report confidence on the understanding of the CST portfolio and its domains, and questions on utilising webinars were distributed to attendees. Pre- and post-event responses were paired, and scores were assessed for normality via the Shapiro-Wilk test; the Mann-Whitney U test was used to assess statistical significance. Cohen's d effect sizes were calculated to report standardised differences between pre-and post-event scores.

RESULTS

A total of 177 participants from over 24 countries responded to both questionnaires. A statistically significant improvement in awareness of how to score maximum points was demonstrated across all nine CST domains (p < 0.0001). Regardless of whether they were UK-based or international, approximately half of the participants stated a preference for a webinar over an in-person format. Interestingly, most attendees did not feel that their university had provided them with adequate information on preparing for a surgical career with over half of the attendees stating that they had to attend events by external organisations to obtain such information.

CONCLUSIONS

This study has demonstrated that a webinar can be effectively utilised to educate students and doctors on the various domains of the CST portfolio and how to maximise points in each section. Such events could address the variability of university resources and national societies across the country and provide equal opportunities for students. Further studies that directly compare webinars with in-person events and investigate long-term outcomes, such as success in CST applications, are required.

A qualitative descriptive enquiry of nursing students' experiences of utilising a portfolio as an assessment tool in nursing and midwifery education

BACKGROUND

The use of a portfolio as an assessment tool in nursing and midwifery education is still a relatively new phenomenon. Institutions of higher education should therefore continuously explore the experiences of nursing students in the use of a portfolio in clinical nursing education. In Namibia little research exists on the perspectives of nursing students on the use of a portfolio as an assessment tool.

PURPOSE

The purpose of the study was to explore nursing students' experiences with portfolio as an assessment tool in nursing and midwifery education.

METHOD

The study used the qualitative approach, with an explorative, descriptive, and contextual design. Fifteen (15) undergraduate nursing students participated in this study, using a snowball sampling technique. Data was collected through semi-structured interviews. Data was analysed using thematic analysis for recurring themes.

RESULTS

The following four themes emerged: understanding of a portfolio, positive experiences, negative experiences, and effective portfolio utilisation.

CONCLUSION

The results revealed nursing students' positive and negative experiences, with suggestions for improvement. The findings may help identify strengths and weaknesses in portfolio usage for assessment purposes in nursing and midwifery education. This study recommended well-articulated plans and actions from students, clinical instructors, lecturers, faculty management teams, and the nurses in practice facilities, to address the challenges identified.

A novel fuzzy dominant goal programming for portfolio selection with systematic risk and non-systematic risk

In this paper, we consider a fuzzy portfolio selection problem with systematic risk and non-systematic risk simultaneously. These two kinds of risks are measured by beta coefficient and random error variance obtained by Sharp Single Index Model. The total risk as the objective of portfolio decision is obtained by weighting the two kinds of risk. Among them, the weight of systematic risk \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\lambda$$\end{document}λ is regarded as the degree of investors' attention to system risk in economic sense. In addition, the fuzzy return and the degree of diversification are measured by triangular fuzzy number and entropy, respectively. And they are also considered the goal of investment decisions. Hence, a tri-objective portfolio is proposed in this paper. For the fuzzy objectives in the model, a goal programming method based on fuzzy dominance is proposed, which can help investors better capture the ideal point of fuzzy returns according to their risk preference. Finally, combined with the systematic impact of COVID-19 on the financial market, we make an empirical analysis based on our proposed model. The results show that the total risk will be on the high side when \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\lambda$$\end{document}λ value is too large or too small. That means paying too much or little attention to the systematic risk will lead investors to bear more risk. In addition, when investors ignore the systematic risk; that is, the \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\lambda$$\end{document}λ value is low, and investors will concentrate their funds in the same industry.

Nested dynamic network data envelopment analysis models with infinitely many decision making units for portfolio evaluation

Portfolio performance evaluation is a major data envelopment analysis (DEA) application in the finance field. Most proposed DEA approaches focus on single-period portfolio performance assessment based on aggregated historical data. However, such an evaluation setting may result in the loss of valuable information in past individual time periods, and violate real-world portfolio managers' and investors' decision making, which generally involves multiple time periods. Furthermore, to our knowledge, all proposed DEA approaches treat the financial assets comprising a portfolio as a "black box": thus there is no information about their individual performance. Moreover, ideal portfolio evaluation models should enable the target portfolio to compare with all possible portfolios, i.e., enabling full diversification of portfolios across all financial assets. Hence, this research aims at developing nested dynamic network DEA models, an additive model being nested within a slacks-based measure (SBM) DEA model, that explicitly utilizes the information in each individual time period to fully and simultaneously measure the multi-period efficiency of a portfolio and its comprised financial assets. The proposed nested dynamic network DEA models, referred to as NDN DEA models, are linear programs with conditional value-at-risk (CVaR) constraints, and infinitely many decision making units (DMUs). In conducting the empirical study, this research applies the NDN DEA models to a real-world case study, in which Markov chain Monte Carlo Bayesian algorithms are used to obtain future performance forecasts in today's highly volatile investment environments.

Nested dynamic network data envelopment analysis models with infinitely many decision making units for portfolio evaluation

Portfolio performance evaluation is a major data envelopment analysis (DEA) application in the finance field. Most proposed DEA approaches focus on single-period portfolio performance assessment based on aggregated historical data. However, such an evaluation setting may result in the loss of valuable information in past individual time periods, and violate real-world portfolio managers' and investors' decision making, which generally involves multiple time periods. Furthermore, to our knowledge, all proposed DEA approaches treat the financial assets comprising a portfolio as a "black box": thus there is no information about their individual performance. Moreover, ideal portfolio evaluation models should enable the target portfolio to compare with all possible portfolios, i.e., enabling full diversification of portfolios across all financial assets. Hence, this research aims at developing nested dynamic network DEA models, an additive model being nested within a slacks-based measure (SBM) DEA model, that explicitly utilizes the information in each individual time period to fully and simultaneously measure the multi-period efficiency of a portfolio and its comprised financial assets. The proposed nested dynamic network DEA models, referred to as NDN DEA models, are linear programs with conditional value-at-risk (CVaR) constraints, and infinitely many decision making units (DMUs). In conducting the empirical study, this research applies the NDN DEA models to a real-world case study, in which Markov chain Monte Carlo Bayesian algorithms are used to obtain future performance forecasts in today's highly volatile investment environments.

Multi-agent reinforcement learning approach for hedging portfolio problem

Developing a hedging strategy to reduce risk of losses for a given set of stocks in a portfolio is a difficult task due to cost of the hedge. In Vietnam stock market, cross-hedge is involved hedging a long position of a stock because there is no put option for the stock. In addition, only VN30 stock index futures contracts are traded on Hanoi Stock Exchange. Inspired by recently achievement of deep reinforcement learning, we explore feasibility to construct a hedging strategy automatically by leveraging cooperative multi-agent in reinforcement learning techniques without advanced domain knowledge. In this work, we use 10 popular stocks on Ho Chi Minh Stock Exchange, and VN30F1M (VN30 Index Futures contracts within one month settlement) to develop a stock market simulator (including transaction fee, tax, and settlement date of transactions) for reinforcement learning agent training. We use daily return as input data for training process. Results suggest that the agent can learn trading and hedging policy to make profit and reduce losses. Furthermore, we also find that our agent can protect portfolios and make positive profit in case market collapses systematically. In practice, this work can help Vietnam's stock market investors to improve performance and reduce losses in trading, especially when the volatility cannot be controlled.

Portfolio frontier analysis: Applying mean-variance analysis to health technology assessment for health systems under pressure

The COVID-19 pandemic is challenging how healthcare technologies are evaluated, as new, more dynamic methods are required to test the cost effectiveness of alternative interventions during use rather than before initial adoption. Currently, health technology assessment (HTA) tends to be static and a priori: alternatives are compared before launch, and little evaluation occurs after implementation. We suggest a method that builds upon the current pre-launch HTA procedures by conceptualizing a mean-variance approach to the continuous evaluation of attainable portfolios of interventions in health systems. Our framework uses frontier analysis to identify the desirability of available health interventions so decision makers can choose diverse portfolios based upon information about expected returns and risks. This approach facilitates the extension of existing methods and assessments beyond the traditional concern with pre-adoption data, a much-needed innovation given the challenges posed by COVID-19.

[Flap harvest training on a new ultrarealistic simulation model: In-training operator feedback about a pulsating reperfused and reventilated cadaver Simlife®]

INTRODUCTION

The anatomical subject is still a key element to learn complex procedures in plastic surgery. We present here the evaluation of an in-training operator on a SIMLIFE® model, hyper realistic model consisting in human bodies donated to science equipped with pulsating recirculation and reventilation device.

MATERIAL AND METHODS

From February 2019 to October 2019, 8 forearm flaps with radial proximal pedicle were harvested by the learner on a SIMLIFE® model. Conditions were as close as possible to the operating room : asepsy, sterile draping, assistant and instrumentation including electrocoagulation.

RESULTS

The procedure was decomposed in 13 distinct steps. Mean total surgery time was 90,5±11,62minutes. There was only one case of arterial pedicle lesion resulting in major blood leak. Bleeding was measured by fake blood loss from the SIMLIFE® console. Mean intraoperatoy bleeding was 171±108 milliliters. We review pros and cons of this new technology particulary suited for complex plastic and reconstructive surgery training.

CONCLUSION

Using SIMLIFE® technology we have a new mean to train for complex procedures in plastic and reconstructive surgery. This new technology could be applied to numerous other surgical procedures. Broader applications are still limited by cost and cadaver use legislation.

Development of a portfolio framework for implementation of an outcomes-based healthcare professional education curriculum using a modified e-Delphi method

Background

The explicit declaration of Entrustable Professional Activities (EPA) and milestones are an essential component of a competency based medical education curricula. The present study attempts to develop a portfolio framework to document them for adaptation in any healthcare professional education curriculum development.

Methods

A modified e-Delphi method was used after incorporation of a study group of medical education experts (MEDEX-G). Consensus was defined as 75% agreement. Both qualitative and quantitative data was collected and analysed to conduct three rounds of the Delphi.

Results

The draft template was prepared by the core faculty of medical education centre. The final template was approved by the experts after 03 iterations of anonymous online voting and presentation of summary results by the moderator. The final template lists out the milestones of each EPA separately with provision for expected expertise and level, suggestive teaching learning activities and assessments, reflections by the students and feedback by facilitator for each EPA.

Conclusion

The MEDEX-G consensus template is an important development to encourage the adoption of portfolios in a competency based medical education curriculum. It can be freely adopted by various healthcare professional education bodies in various disciplines.

Entrustable Professional Activities (EPAs) and milestones for MD sports medicine: A proposed portfolio

BACKGROUND

Sports Medicine is an upcoming postgraduate speciality in India. A MD Sports Medicine specialist is expected to contribute in the prevention of sports injuries, sportsmen training and enhancement of performance apart from being involved in planning of conduct of sports events amongst many other roles and responsibilities. This requires hands-on training and acquisition of skill sets required to perform these roles. The National Medical Council of India highlights the need for a competency based curriculum and has laid down guidelines for the course. There was a felt need to develop Entrustable Professional Activities (EPAs) and milestones based on the prescribed curricula and develop a portfolio for continuous monitoring of the achievement of these EPAs.

METHODS

A five step model was done by experts in the field to prepare the EPAs, milestones and portfolio. This consisted of faculty development, identification of the EPAs and milestones and portfolio preparation.

RESULTS

114 EPAs and 961 milestones were identified by the subject experts. The portfolio was developed with the help of specialists and faculty of the field of sports medicine, and medical educationists.

CONCLUSION

Post graduate medical education is mandated to be competency based. A portfolio has been developed in the current exercise for use in a competency based post-graduate curriculum in sports medicine. This will help in the better implementation of CBME in the country.

The new pan-European post-specialty training curriculum in Paediatric and Adolescent Gynaecology

Interest in the field of Paediatric and Adolescent Gynaecology (PAG) has increased substantially over the last decade. Currently there is minimal consensus on how to interpret and validate professional experience, medical knowledge and surgical skills for doctors (accredited in Obstetrics and Gynaecology) who have an interest in and wish to achieve sub-specialisation in PAG. The challenge for the future of PAG is to create a framework of guidelines and references which in turn culminates in improvement and harmonisation in PAG healthcare delivery. The development of a post-specialty training curriculum in PAG for accredited practitioners was a logical next step after EBCOG introduced the PACT curriculum for OBGYN trainees. The guiding principle in the development of the PAG curriculum has been to strive for harmonisation in teaching and training in PAG within Europe. The new EURAPAG curriculum is divided in 17 chapters which in turn have been subdivided into medical and surgical sections plus a baseline skills section. The content has been determined through a consensus procedure amongst European gynaecologists and trainees. The medical chapters involve pathology that requires conservative treatment, prevention, education or lifestyle adjustment. The chapters that are both medical and surgical have a surgical (alternative) treatment ranging from vaginal procedures to advanced hysteroscopic and laparoscopic procedures and laparotomy. Currently, the framework for any medical education is workplace based competency training. Specific tools have been developed for workplace based assessments, such as direct observation (DO) of clinical task performance, Objective Structured Assessment of Technical Skills (OSATS), mini-clinical evaluation exercise (Mini-CEX) or case-based discussion (CBD). To measure progress in this PAG post-specialty training curriculum, the subspecialty trainee will be required to maintain and update a portfolio of experience and competency.

Leveraging a required e-portfolio course to meet multiple needs: Student assessment, curriculum improvement, and accreditation

BACKGROUND

Learning portfolios enable student pharmacists to connect program outcomes and related learning experiences to future practice as healthcare providers. Assessment programs also require data to inform decisions regarding curriculum quality and maintain program accreditation. Our goal was to create a portfolio meeting multiple needs, including learning improvement, curricular assessment, and accreditation.

EDUCATIONAL ACTIVITY

In this required, longitudinal, learning e-portfolio course, students upload artifacts and reflect on how the corresponding learning experiences link to program outcomes and their own continuous professional development. Baseline and annual self-assessment ratings and guided reflections document progress toward learning outcome attainment. Individualized formative feedback from pharmacist reviewers develops student capacity for reflection, improves ability to assess their own strengths and weaknesses, and promotes lifelong learning. De-identified quantitative and qualitative data is shared with stakeholders for purposes of improvement.

CRITICAL ANALYSIS OF THE EDUCATIONAL ACTIVITY

Through deliberate design of the course, a corresponding plan for assessment, and modification of portfolio software platform reporting capabilities, the program has been able to acquire rich quantitative and qualitative data regarding individual student and cohort performance. This has enabled us to review these data to make improvements in individual learning experiences and make informed decisions regarding curricular effectiveness and accreditation requirements as part of the collegiate assessment plan. This course provides a wealth of opportunity for student growth and generation of assessment data, but it is best suited for programs with ample support resources to maintain its integrity as designed.

The dynamics of volatility spillovers between oil prices and stock market returns at the sector level and hedging strategies: evidence from Pakistan

This study investigates the transmission of volatility between OPEC-oil and sector stock returns in Pakistan. The issue of volatility spillovers across the oil and sector stocks is a crucial part of risk management and portfolio designs, as all firms are not expecting to be equally affected by changes in oil price. Empirically, we estimate a bivariate VAR-GARCH model using daily data sampled from January 1, 2003 to December 29, 2017. We also analyze the optimal weights and hedge ratios for oil-stock portfolio holdings based on our model results. Our findings reveal that negative and significant spillover effects from the oil market to agriculture, energy, and machinery sector stocks are present. However, our findings show that volatility spillover effects are insignificant from stock returns to oil. The findings of the study illustrate that development of stock market will motivate highly polluting firms to invest more in renewable and clean energy, which will help reduce carbon emissions.

Ten caveats of learning analytics in health professions education: A consumer's perspective

A group of 22 medical educators from different European countries, gathered in a meeting in Utrecht in July 2019, discussed the topic of learning analytics (LA) in an open conversation and addressed its definition, its purposes and potential risks for learners and teachers. LA was seen as a significant advance with important potential to improve education, but the group felt that potential drawbacks of using LA may yet be under-exposed in the literature. After transcription and interpretation of the discussion's conclusions, a document was drafted and fed back to the group in two rounds to arrive at a series of 10 caveats educators should be aware of when developing and using LA, including too much standardized learning, with undue consequences of over-efficiency and pressure on learners and teachers, and a decrease of the variety of 'valid' learning resources. Learning analytics may misalign with eventual clinical performance and can run the risk of privacy breaches and inescapability of documented failures. These consequences may not happen, but the authors, on behalf of the full group of educators, felt it worth to signal these caveats from a consumers' perspective.

Student perspectives on competency-based portfolios: Does a portfolio reflect their competence development?

INTRODUCTION

Portfolio-based assessments require that learners' competence development is adequately reflected in portfolio documentation. This study explored how students select and document performance data in their portfolios and how they perceive these data to be representative for their competence development.

METHODS

Students uploaded performance data in a competency-based portfolio. During one clerkship period, twelve students also recorded an audio diary in which they reflected on experiences and feedback that they perceived to be indicants of their competence development. Afterwards, these students were interviewed to explore the extent to which the performance documentation in the portfolio corresponded with what they considered illustrative evidence of their development. The interviews were analyzed using thematic analysis.

RESULTS

Portfolios provide an accurate but fragmented picture of student development. Portfolio documentation was influenced by tensions between learning and assessment, student beliefs about the goal of portfolios, student performance evaluation strategies, the learning environment and portfolio structure.

DISCUSSION

This study confirms the importance of taking student perceptions into account when implementing a competency-based portfolio. Students would benefit from coaching on how to select meaningful experiences and performance data for documentation in their portfolios. Flexibility in portfolio structure and requirements is essential to ensure optimal fit between students' experienced competence development and portfolio content.

[Male to female sex reassignment surgery with a new surgical simulation device using a human perfused cadaver SIMLIFE®: New paradigm in transsexual surgery education ?]

INTRODUCTION

In 2015, we reported our experience with the learning curve in genital reassignment surgery and highlighted a four-step learning concept.

CLINICAL CASE

In this article, we present our first vaginoplasty performed on a humanoid model SIMLIFE®, a human body associated with a pulsating circulation device and a ventilation device.

RESULTS

The surgical technique included 14 steps. The total surgical time was 182minutes. There was no intraoperative complication, and there was no damage to the urethra or rectum. The intraoperative bleeding measured by the loss of operative fluid was 280mL. We discuss the advantages of this technology perfectly adapted to transsexual surgery.

CONCLUSION

We demonstrated the feasibility of vaginoplasty performed on a humanoid model SIMLIFE® and highlighted improvement of the surgical skills with this model. This technology could find many other surgical applications. However, it faces cost constraints and legislation on corpses.

Development and validation of a portfolio assessment system for medical schools in Korea

PURPOSE

Consistent evaluation procedures based on objective and rational standards are essential for the sustainability of portfolio-based education, which has been widely introduced in medical education. We aimed to develop and implement a portfolio assessment system, and to assess its validity and reliability.

METHODS

We developed a portfolio assessment system from March 2019 to August 2019 and confirmed its content validity through expert assessment by an expert group comprising 2 medical education specialists, 2 professors involved in education at medical school, and a professor of basic medical science. Six trained assessors conducted 2 rounds of evaluation of 7 randomly selected portfolios for the “Self-Development and Portfolio II” course from January 2020 to July 2020. These data are used inter-rater reliability was evaluated using intra-class correlation coefficients (ICCs) in September 2020.

RESULTS

The portfolio assessment system is based on the following process; assessor selection, training, analytical/comprehensive evaluation, and consensus. Appropriately trained assessors evaluated portfolios based on specific assessment criteria and a rubric for assigning points. In the analysis of inter-rater reliability, the first round of evaluation grades was submitted, and all assessment areas except “goal-setting” showed a high ICC of 0.81 or higher. After the first round of assessment, we attempted to standardize objective assessment procedures. As a result, all components of the assessments showed close correlations, with ICCs of 0.81 or higher.

CONCLUSION

We confirmed that when assessors with an appropriate training conduct portfolio assessment based on specified standards through a systematic procedure, the results are reliable.

A case study - Implementing a registered nurse professional recognition program across a Queensland hospital and health service

Ongoing advancement and documentation of professional development is required to maintain nursing registration and competency to practise in Australia and many other countries. All Australian registered nurses are required to undertake a minimum of 20 h of continuing professional development annually and demonstrate competence to practice; this is a criterion for nursing registration. Many health care organisations nationally and internationally develop programs to support such processes, assisting nurses to formally document their ongoing education and commitment to best practice, and clearly demonstrate their ongoing continuing professional development. Such programs align with the MAGNET ® principles of providing structural empowerment, exemplary professional practice and new knowledge, innovations and improvements. This study describes the implementation, evaluation and impact of the registered nurse professional recognition program undertaken by one Hospital and Health Service in South East Queensland using Donabedian's structure, process outcome framework. The registered nurse professional recognition program was implemented to invest in and develop the nursing workforce by providing an opportunity for registered nurses to assess and document their professional skills, knowledge and expertise that are critical to the provision of safe and cost-effective patient and family-centred care.

Use of an e‑portfolio mapping tool: connecting experiences, analysis and action by learners

Reflective practice is an important characteristic of a knowledgeable health professional. Reflection is needed to maintain professional competence, practice-based learning, and an improvement focused attitude. Yet, learners struggle with reflective practice activities as they are perceived as challenging and time consuming. We used the idea of concept mapping to design an e‑portfolio tool that supports learners with their reflective practice activities. The purpose of this article is to demonstrate the design and rationale of e‑portfolio mapping and how this tool could be used to support reflective practice activities.Following the stepwise approach typical for the reflective cycle, two types of maps were designed, a trigger map and a competency map. In a trigger map, the learner reflects on a concrete learning or feedback experience. In a competency map the learner interprets and synthesizes several previous trigger maps which ultimately leads to the formulation of new learning objectives. The e‑portfolio mapping tool can be a useful and supportive tool to foster learners' reflective skills and provide mentors with in-depth insight into the students' learning and reflection processes.

Development and initial validation of a dual-purpose questionnaire capturing mentors' and mentees' perceptions and expectations of the mentoring process

BACKGROUND

In health profession education, learners are often coached by mentors for development of competencies, self-direction of learning and professionalism. It is important that the mentee-mentor relationship is aligned in terms of mutual expectations.

METHODS

A dual-purpose questionnaire capturing both the mentor and mentee perceptions on the actual and preferred mentoring functions was designed and validated, by performing a principal component analysis (PCA) using the data of mentees (n = 103) and mentors (n = 23) of a medical course. As a proof of concept, alignment of needs and changes in the mentoring perceptions in mentee groups of different years were determined.

RESULTS

PCA showed that specific sets of questions addressed important elements in the mentoring process, such as self-direction of learning and reflection (Scale 1), guidance of behavioural change (Scale 4), addressing personal issues and professional identity development (Scale 3 and 5) and how the mentor and mentee presents oneself in the mentoring relationship (Scale 2). Mentors and mentees perceived comparable situations as critical for an effective mentoring process, such as mentor presence and guidance of reflection, although there was also evidence of gaps, such as perception of cultural issues. By comparison of the mentee groups in the different years of the program, the dynamic or evolving nature of the mentor process became evident, mentees experienced more emphasis by the mentor on reflection (Scale 1), at a constant level of mentor presence (Scale 2).

CONCLUSION

Given the individualized, context-specific, and dynamic nature of mentoring, programmes would benefit from a regular evaluation of mentoring practices, e.g. by using questionnaires, in order to facilitate organizational revisions and further development of the mentoring competencies.

Evaluation of a portfolio-based course on self-development for pre-medical students in Korea

PURPOSE

We have developed and operated a portfolio-based course aimed at strengthening pre-medical students' capabilities for self-management and self-improvement. In order to determine the effectiveness of the course and to establish future operational strategies, we evaluated the course and the students' learning experience.

METHODS

The subjects of this study were 97 students of a pre-medical course "Self-development and portfolio I" in 2019. Their learning experience was evaluated through the professor's assessment of portfolios they had submitted, and the program was evaluated based on the responses of 68 students who completed a survey. The survey questionnaire included 32 items. Descriptive statistics were reported for quantitative data, including the mean and standard deviation. Opinions collected from the open-ended question were grouped into categories.

RESULTS

The evaluation of students' portfolios showed that only 6.2% of the students' portfolios were well-organized, with specific goals, strategies, processes, and self-reflections, while most lacked the basic components of a portfolio (46.4%) or contained insufficient content (47.4%). Students' responses to the survey showed that regular portfolio personality assessments (72.1%), team (64.7%), and individual (60.3%) activities were felt to be more appropriate as educational methods for this course, rather than lectures. Turning to the portfolio creation experience, the forms and components of the portfolios (68.2%) and the materials provided (62.2%) were felt to be appropriate. However, students felt that individual autonomy needed to be reflected more (66.7%) and that this course interfered with other studies (42.5%).

CONCLUSION

The findings of this study suggest that standardized samples, guidelines, and sufficient time for autonomous portfolio creation should be provided. In addition, education on portfolio utilization should be conducted in small groups in the future.

From aggregation to interpretation: how assessors judge complex data in a competency-based portfolio

While portfolios are increasingly used to assess competence, the validity of such portfolio-based assessments has hitherto remained unconfirmed. The purpose of the present research is therefore to further our understanding of how assessors form judgments when interpreting the complex data included in a competency-based portfolio. Eighteen assessors appraised one of three competency-based mock portfolios while thinking aloud, before taking part in semi-structured interviews. A thematic analysis of the think-aloud protocols and interviews revealed that assessors reached judgments through a 3-phase cyclical cognitive process of acquiring, organizing, and integrating evidence. Upon conclusion of the first cycle, assessors reviewed the remaining portfolio evidence to look for confirming or disconfirming evidence. Assessors were inclined to stick to their initial judgments even when confronted with seemingly disconfirming evidence. Although assessors reached similar final (pass-fail) judgments of students' professional competence, they differed in their information-processing approaches and the reasoning behind their judgments. Differences sprung from assessors' divergent assessment beliefs, performance theories, and inferences about the student. Assessment beliefs refer to assessors' opinions about what kind of evidence gives the most valuable and trustworthy information about the student's competence, whereas assessors' performance theories concern their conceptualizations of what constitutes professional competence and competent performance. Even when using the same pieces of information, assessors furthermore differed with respect to inferences about the student as a person as well as a (future) professional. Our findings support the notion that assessors' reasoning in judgment and decision-making varies and is guided by their mental models of performance assessment, potentially impacting feedback and the credibility of decisions. Our findings also lend further credence to the assertion that portfolios should be judged by multiple assessors who should, moreover, thoroughly substantiate their judgments. Finally, it is suggested that portfolios be designed in such a way that they facilitate the selection of and navigation through the portfolio evidence.

Optimising the introduction of multiple childhood vaccines in Japan: A model proposing the introduction sequence achieving the highest health gains

BACKGROUND

Many countries struggle with the prioritisation of introducing new vaccines because of budget limitations and lack of focus on public health goals. A model has been developed that defines how specific health goals can be optimised through immunisation within vaccination budget constraints.

METHODS

Japan, as a country example, could introduce 4 new pediatric vaccines targeting influenza, rotavirus, pneumococcal disease and mumps with known burden of disease, vaccine efficacies and maximum achievable coverages. Operating under budget constraints, the Portfolio-model for the Management of Vaccines (PMV) identifies the optimal vaccine ranking and combination for achieving the maximum QALY gain over a period of 10 calendar years in children <5 years old. This vaccine strategy, of interest and helpful for a healthcare decision maker, is compared with an unranked vaccine selection process.

RESULTS

Results indicate that the maximum QALY gain with a fixed annual vaccination budget of 500 billion Japanese Yen over a 10-year period is 72,288 QALYs using the optimal sequence of vaccine introduction (mumps [1st], followed by influenza [2nd], rotavirus [3rd], and pneumococcal [4th]). With exactly the same budget but without vaccine ranking, the total QALY gain can be 20% lower.

CONCLUSION

The PMV model could be a helpful tool for decision makers in those environments with limited budget where vaccines have to be selected for trying to optimise specific health goals.

Mapping patent classifications: portfolio and statistical analysis, and the comparison of strengths and weaknesses

The Cooperative Patent Classifications (CPC) recently developed cooperatively by the European and US Patent Offices provide a new basis for mapping patents and portfolio analysis. CPC replaces International Patent Classifications (IPC) of the World Intellectual Property Organization. In this study, we update our routines previously based on IPC for CPC and use the occasion for rethinking various parameter choices. The new maps are significantly different from the previous ones, although this may not always be obvious on visual inspection. We provide nested maps online and a routine for generating portfolio overlays on the maps; a new tool is provided for “difference maps” between patent portfolios of organizations or firms. This is illustrated by comparing the portfolios of patents granted to two competing firms—Novartis and MSD—in 2016. Furthermore, the data is organized for the purpose of statistical analysis.

Reflective practice in health care and how to reflect effectively

Reflective practice is a paper requirement of your career progression in health care. However, if done properly, it can greatly improve your skills as a health care provider. This article provides some structure to reflective practice to allow a health care provider to engage more with reflective practice and get more out of the experience.

How to succeed at medical interviews

Few people truly relish being interviewed. But as a professional, you will go through a number of interviews in your life that will affect your career progression. In this article, we provide some tips on how best to prepare for a medical interview, both in terms of your portfolio and interview practice. Advice is also given on how to maximize performance during the interview and gain the most from reflection afterwards.

Do portfolios have a future?

While portfolios have seen an unprecedented surge in popularity, they have also become the subject of controversy: learners often perceive little gain from writing reflections as part of their portfolios; scholars question the ethics of such obligatory reflection; and students, residents, teachers and scholars alike condemn the bureaucracy surrounding portfolio implementation in competency-based education. It could be argued that mass adoption without careful attention to purpose and format may well jeopardize portfolios' viability in health sciences education. This paper explores this proposition by addressing the following three main questions: (1) Why do portfolios meet with such resistance from students and teachers, while educators love them?; (2) Is it ethical to require students to reflect and then grade their reflections?; (3) Does competency-based education empower or hamper the learner during workplace-based learning? Twenty-five years of portfolio reveal a clear story: without mentoring, portfolios have no future and are nothing short of bureaucratic hurdles in our competency-based education programs. Moreover, comprehensive portfolios, which are integrated into the curriculum and much more diverse in content than reflective portfolios, can serve as meaningful patient charts, providing doctor and patient with useful information to discuss well-being and treatment. In this sense, portfolios are also learner charts that comprehensively document progress in a learning trajectory which is lubricated by meaningful dialogue between learner and mentor in a trusting relationship to foster learning. If we are able to make such comprehensive and meaningful use of portfolios, then, yes, portfolios do have a bright future in medical education.

Targeted selection of brownfields from portfolios for sustainable regeneration: User experiences from five cases testing the Timbre Brownfield Prioritization Tool

Prioritizing brownfields for redevelopment in real estate portfolios can contribute to more sustainable regeneration and land management. Owners of large real estate and brownfield portfolios are challenged to allocate their limited resources to the development of the most critical or promising sites, in terms of time and cost efficiency. Authorities worried about the negative impacts of brownfields - in particular in the case of potential contamination - on the environment and society also need to prioritize their resources to those brownfields that most urgently deserve attention and intervention. Yet, numerous factors have to be considered for prioritizing actions, in particular when adhering to sustainability principles. Several multiple-criteria decision analysis (MCDA) approaches and tools have been suggested in order to support these actors in managing their brownfield portfolios. Based on lessons learned from the literature on success factors, sustainability assessment and MCDA approaches, researchers from a recent EU project have developed the web-based Timbre Brownfield Prioritization Tool (TBPT). It facilitates assessment and prioritization of a portfolio of sites on the basis of the probability of successful and sustainable regeneration or according to individually specified objectives. This paper introduces the challenges of brownfield portfolio management in general and reports about the application of the TBPT in five cases: practical test-uses by two large institutional land owners from Germany, a local and a regional administrative body from the Czech Republic, and an expert from a national environmental authority from Romania. Based on literature requirements for sustainability assessment tools and on the end-users' feedbacks from the practical tests, we discuss the TBPT's strengths and weaknesses in order to inform and give recommendations for future development of prioritization tools.

Acknowleding attributes that enable the career academic nurse to thrive in the tertiary education sector: A qualitative systematic review

OBJECTIVE

To optimise the career development in early career academic nurses by providing an overview of the attributes necessary for success.

BACKGROUND

Evidence of early prospective career planning is necessary to optimise success in the tertiary sector. This is particularly important for nurse academics given the profession's later entry into academia, the ageing nursing workforce and the continuing global shortage of nurses.

DESIGN

A qualitative systematic review.

METHODS

Academic Search Complete, CINAHL, Medline, ERIC, Professional Development Collection and Google Scholar databases were searched; resulting in the inclusion of nine qualitative nurse-only focussed studies published between 2004 and 2014. The studies were critically appraised and the data thematically analysed.

RESULTS

Three abilities were identified as important to the early career academic nurse: a willingness to adapt to change, an intention to pursue support and embodying resilience. These abilities give rise to attributes that are recommended as key to successful academic career development for those employed on a continuing academic basis.

CONCLUSIONS

The capacity to rely on one's own capabilities is becoming seen as increasingly important. It is proposed that recognition of these attributes, their skilful application and monitoring outlined in the review are recommended for a successful career in academia.

Non-medical prescribing assessment - An evaluation of a nationally agreed multi method approach

In the United Kingdom, legislation permits nurses and allied health professionals to prescribe for patients within their care. Preparation for this role includes learning, teaching and assessment that is embedded in practice, supervised by a designated medical practitioner (DMP) and evidenced in a reflective learning in practice portfolio.

AIM

The objectives were to explore; (1) which assessment in the practice portfolio was ranked most valuable in terms of achieving safe, effective prescribing practice and, (2) whether a practice based assessment (SDEP) was an acceptable alternative to an Observed Simulated Clinical Examination (OSCE).

METHODS

Online surveys were conducted and follow up semi structured telephone interviews were conducted across 5 universities in Scotland with students, DMPs and line managers.

RESULTS

Students ranked the learning log most valuable and DMPs and line managers ranked the SDEP most valuable. Survey and follow up interviews suggested that the portfolio provided the opportunity to develop prescribing skills and knowledge relevant to their specific clinical speciality. There was agreement amongst all participants that clinical assessment in the practice portfolio effectively enable non-medical prescribing students to evidence prescribing competence.

SUMMARY

The novel use of the SDEP and reflective summary offers a viable alternative to an OSCE and was viewed as one of the most valued components of the assessment strategy.

Anticipating mismatches of HIT investments: Developing a viability-fit model for e-health services

OBJECTIVES

Albeit massive investments in the recent years, the impact of health information technology (HIT) has been controversial and strongly disputed by both research and practice. While many studies are concerned with the development of new or the refinement of existing measurement models for assessing the impact of HIT adoption (ex post), this study presents an initial attempt to better understand the factors affecting viability and fit of HIT and thereby underscores the importance of also having instruments for managing expectations (ex ante).

METHODS

We extend prior research by undertaking a more granular investigation into the theoretical assumptions of viability and fit constructs. In doing so, we use a mixed-methods approach, conducting qualitative focus group discussions and a quantitative field study to improve and validate a viability-fit measurement instrument.

RESULTS

Our findings suggest two issues for research and practice. First, the results indicate that different stakeholders perceive HIT viability and fit of the same e-health services very unequally. Second, the analysis also demonstrates that there can be a great discrepancy between the organizational viability and individual fit of a particular e-health service.

CONCLUSION

The findings of this study have a number of important implications such as for health policy making, HIT portfolios, and stakeholder communication.

Continuing professional development: best practices

Continuing professional development (CPD) involves not only educational activities to enhance medical competence in medical knowledge and skills, but also in management, team building, professionalism, interpersonal communication, technology, teaching, and accountability. This paper aims at reviewing best practices to promote effective CPD. Principles and guidelines, as already defined by some professional societies and world organizations, are emphasized as core actions to best enhance an effective lifelong learning after residency. The personal learning plan (PLP) is discussed as the core of a well-structured CPD and we describe how it should be created. Fundamental CPD principles and how they are integrated in the framework of every physician's professional life will be described. The value of systematic and comprehensive CPD documentation and assessment is emphasized. Accreditation requirements and professional relationships with commercial sponsors are discussed.

Healthy aging diets other than the Mediterranean: a focus on the Okinawan diet

The traditional diet in Okinawa is anchored by root vegetables (principally sweet potatoes), green and yellow vegetables, soybean-based foods, and medicinal plants. Marine foods, lean meats, fruit, medicinal garnishes and spices, tea, alcohol are also moderately consumed. Many characteristics of the traditional Okinawan diet are shared with other healthy dietary patterns, including the traditional Mediterranean diet, DASH diet, and Portfolio diet. All these dietary patterns are associated with reduced risk for cardiovascular disease, among other age-associated diseases. Overall, the important shared features of these healthy dietary patterns include: high intake of unrefined carbohydrates, moderate protein intake with emphasis on vegetables/legumes, fish, and lean meats as sources, and a healthy fat profile (higher in mono/polyunsaturated fats, lower in saturated fat; rich in omega-3). The healthy fat intake is likely one mechanism for reducing inflammation, optimizing cholesterol, and other risk factors. Additionally, the lower caloric density of plant-rich diets results in lower caloric intake with concomitant high intake of phytonutrients and antioxidants. Other shared features include low glycemic load, less inflammation and oxidative stress, and potential modulation of aging-related biological pathways. This may reduce risk for chronic age-associated diseases and promote healthy aging and longevity.

"Portfolios" as a method of assessment in medical education

Portfolios are increasingly used in postgraduate medical education and in gastroenterology training as an assessment tool, as documentation of competence, a database of procedure experience (for example endoscopy experience) and for revalidation purposes. In this paper the educational theory behind their use is described and the evidence for their use is discussed.

Evaluation of an eportfolio for the assessment of clinical competence in a baccalaureate nursing program

This paper reports a study undertaken to evaluate the implementation of an electronic portfolio (eportfolio) tool for the assessment of clinical competence in a Bachelor of Science in Nursing program. Baccalaureate nursing programs increasingly use information and communications technologies to support student learning, assess and record progress. Portfolio based practice assessment and electronic portfolios represent growing trends to enhance learning via student reflection and self-identification of further learning needs. Using an action-research process, a mixed-methods evaluation strategy explored the efficacy of the eportfolio in its second year of use. Website tracking analytics and descriptive statistics were used to explore trends in eportfolio usage. Instructor and student surveys and focus groups were carried out at the end of the second year. Instructors valued the eportfolios convenience, improved transparency, an improved ability to track student progress, enhanced theory-practice links, and the competency based assessment framework. Students valued accessibility and convenience, but expressed concerns over assessment data openness and processes for standardization. Both groups felt that the eportfolio navigation required simplification. Electronic portfolios represent a technological evolution from paper-based clinical assessment systems. Although there appear to be many student and instructor advantages in using eportfolios, to maximize successful implementation, clinical teachers require additional training in this new pedagogic approach. Strategies to assist an institutional culture shift towards more transparent assessment processes may also need consideration.

Portfolio: a comprehensive method of assessment for postgraduates in oral and maxillofacial surgery

Post graduate learning and assessment is an important responsibility of an academic oral and maxillofacial surgeon. The current method of assessment for post graduate training include formative evaluation in the form of seminars, case presentations, log books and infrequently conducted end of year theory exams. End of the course theory and practical examination is a summative evaluation which awards the degree to the student based on grades obtained. Oral and maxillofacial surgery is mainly a skill based specialty and deliberate practice enhances skill. But the traditional system of assessment of post graduates emphasizes their performance on the summative exam which fails to evaluate the integral picture of the student throughout the course. Emphasis on competency and holistic growth of the post graduate student during training in recent years has lead to research and evaluation of assessment methods to quantify students' progress during training. Portfolio method of assessment has been proposed as a potentially functional method for post graduate evaluation. It is defined as a collection of papers and other forms of evidence that learning has taken place. It allows the collation and integration of evidence on competence and performance from different sources to gain a comprehensive picture of everyday practice. The benefits of portfolio assessment in health professions education are twofold: it's potential to assess performance and its potential to assess outcomes, such as attitudes and professionalism that are difficult to assess using traditional instruments. This paper is an endeavor for the development of portfolio method of assessment for post graduate student in oral and maxillofacial surgery.

Effect of portfolio assessment on student learning in prenatal training for midwives

The tendency to use portfolios for evaluation has been developed with the aim of optimizing the culture of assessment. The present study was carried out to determine the effect of using portfolios as an evaluation method on midwifery students' learning and satisfaction in prenatal practical training. In this prospective cohort study, all midwifery students in semester four (n=40), were randomly allocated to portfolio and routine evaluation groups. Based on their educational goals, the portfolio groups prepared packages which consisted of a complete report of the history, physical examinations, and methods of patient management (as evaluated by a checklist) for women who visited a prenatal clinic. During the last day of their course, a posttest, clinical exam, and student satisfaction form were completed. The two groups' mean age, mean pretest scores, and their prerequisite course that they should have taken in the previous semester were similar. The mean difference in the pre and post test scores for the two groups' knowledge and comprehension levels did not differ significantly (P>0.05). The average scores on questions in Bloom's taxonomy 2 and 3 of the portfolio group were significantly greater than those of the routine evaluation group (P=0.002, P=0.03, respectively). The mean of the two groups' clinical exam scores was significantly different. The portfolio group's mean scores on generating diagnostic and therapeutic solutions and the ability to apply theory in practice were higher than those of the routine group. Overall, students' satisfaction scores in the two evaluation methods were relatively similar. Portfolio evaluation provides the opportunity for more learning by increasing the student's participation in the learning process and helping them to apply theory in practice.

A Student Portfolio: The Golden Key to Reflective, Experiential, and Evidence-based Learning

INTRODUCTION

In 2003, the College of Health Sciences, Makerere University, changed its curriculum from a traditional one to a student-centred problem-based/community-based type for all undergraduate students. Since then, radiography students have been using a logbook to record their learning experiences. However, the logbook shows only a daily record of numbers of examinations done, with neither increased understanding nor reflection. The purpose of this study was to assess the effectiveness of a student portfolio as a tool for showing evidence of learning and devise a practical portfolio assessment strategy.

METHODS

This was a descriptive cross-sectional study involving both radiography students and teachers. Self-administered questionnaires and focus group discussions were used to collect information on portfolios. SPSS was used for quantitative data and chi-square to test significance and also multivariate analysis. For qualitative data, thematic analysis was used.

RESULTS

Initially, the students did not know about portfolios. Only 33.3% of the teachers competently knew about them. There was general confusion between a portfolio and a logbook. After implementation, respondents said that the student learning experiences were now evident through the portfolio work. We discovered that assessing the entire portfolio content was not practical, but rather assessing few selected items using an oral interview was more feasible and sustainable.

CONCLUSIONS

With portfolios, students reflect on what they learn, which is not possible with a logbook only. Carefully selecting manageable portfolio content and assessing the portfolio work are the major factors that can sustain the process.

Use of Portfolio-based Learning and Assessment in Community-based Field Curriculum

Portfolio-based learning is recognized in medical education. It helps students to assess themselves as per the key learning objectives and outcomes expected out of them. The faculty could also get feedback regarding individual student's progress toward learning outcomes and facilitate the students achieve the same. This article addresses the process of portfolio development and assesses from students feedbacks, if portfolio-based learning is an improvement over record-based study in community-based field studies. The results of this study shows that involving students in framing objectives, developing a mechanism for self-introspection and self-assessment by the students and a mechanism by which faculty can monitor each student's progress toward the defined objectives can significantly enhance the learnability of the students.