ORCID Profile
0000-0002-8936-9538
Current Organisation
University of Queensland
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Publisher: Informa UK Limited
Date: 03-2018
DOI: 10.2147/AMEP.S144449
Publisher: Springer Science and Business Media LLC
Date: 20-09-2003
DOI: 10.1007/S00134-003-2014-6
Abstract: To determine the effect of different mattresses on cardiopulmonary resuscitation performance and establish whether emergency deflation of an inflatable mattress improves the quality of resuscitation. Randomised controlled cross-over trial performed in a general ICU PARTICIPANTS: Critical care staff from a general ICU. Cardiopulmonary resuscitation on a manikin on the floor or on a bed with a standard foam mattress and inflated and deflated pressure redistributing mattresses. Maximal compression force was measured at different bed heights. Compression depth, duty cycle and rate and percentage correct expired air ventilation were recorded on a manikin. Compression depth was significantly lower on the foam (35.2 mm), inflated (37.2 mm) and deflated mattress (39.1 mm) than the floor (44.2 mm). There were no clinically important differences in duty cycle or compression rate. The quality of ventilation was poor on all surfaces. Maximal compression force declined as bed height increased. Resuscitation performance is adversely affected when performed on a bed (irrespective of mattress type) compared to the floor. There were no differences between the inflated and deflated mattresses, although the deflation process did not adversely affect performance. This study does not support the routine deflation of an inflated mattress during resuscitation and questions the potential benefits from using a backboard. The finding that bed height affects maximal compression forces, challenges the recommendation that cardiopulmonary resuscitation be performed with the bed at middle-thigh level and requires further investigation.
Publisher: Springer Science and Business Media LLC
Date: 07-06-2011
Publisher: Informa UK Limited
Date: 22-11-2021
Publisher: Springer Science and Business Media LLC
Date: 03-2010
DOI: 10.1007/S10459-009-9163-5
Abstract: Judgments made by the assessors observing consultations are widely used in the assessment of medical students. The aim of this research was to study judgment accuracy and confidence and the relationship between these. Assessors watched recordings of consultations, scoring the students on: a checklist of items attributes of consultation a passmark scale and lastly their confidence in this last judgment. Then they were interviewed using stimulated recall to explain their rationale for scoring and confidence. Twenty-three staff assessors watched two consultations. Assessor confidence and accuracy were least for those student performances perceived near the passmark standard. The difference between confidence and accuracy, over-confidence, was greatest at this level, although at the extremes under-confidence was found. In the interviews the assessors were aware of a variety of factors that they perceived affected their scoring and confidence. As in other contexts confidence and accuracy vary and over-confidence increases the more difficult the judgments. However, this study also demonstrated under-confidence for less difficult judgments. The perception that more information would help, may improve confidence but not necessarily accuracy, so increasing over-confidence.
Publisher: Informa UK Limited
Date: 18-04-2022
Publisher: Wiley
Date: 14-12-2020
DOI: 10.1111/MEDU.14424
Publisher: BMJ
Date: 21-03-1998
Abstract: Prostate cancer (PCa) is one of the most fatal diseases in male patients with high bone metastatic potential. Bone metastasis severely shortens overall survival and brings skeletal-related events (SREs) which reduces the life quality of patients, and this situation is currently regarded as irreversible and incurable. The progression and metastasis of PCa are found to be closely associated with inflammatory cytokines and chemokines. As pivotal members of inflammatory cytokines, Interleukin-1 (IL-1) family plays a crucial role in this process. Elevated expression of IL-1 family was detected in PCa patients with bone metastasis, and accumulating evidences proved that IL-1 family could exert vital effects on the progression and bone metastasis of many cancers, while some members have dual effects. In this review, we discuss the role of IL-1 family in the bone metastasis of PCa. Furthermore, we demonstrate that many members of IL-1 family could act as pivotal biomarkers to predict the clinical stage and prognosis of PCa patients. More importantly, we have elucidated the role of IL-1 family in the bone metastasis of PCa, which could provide potential targets for the treatment of PCa bone metastasis and probable directions for future research.
Publisher: Informa UK Limited
Date: 2001
DOI: 10.1080/014215901300353922
Abstract: Legal challenges relating to assessment results are increasing around the world. Until recently such challenges were not possible in the UK. With changes to the law, including the Human Rights Act, it is now possible for an Examining Body to have its assessment process challenged. Defending an assessment tool is potentially easy but not being prepared could lead to embarrassing defeat, with significant costs and damages to pay. Judgement may be made as to what constitutes appropriate methods of evaluating and the levels that assessments must attain. There are more questions than answers as to what will happen and who will be the true beneficiaries of potential and real challenges.
Publisher: Wiley
Date: 21-09-2012
Publisher: Wiley
Date: 09-2009
Publisher: Wiley
Date: 12-01-2017
DOI: 10.1111/MEDU.13206
Abstract: Measuring appropriateness of certainty of responses in a progress test using descriptors authentic to practice as reflection-in-action builds on existing theories of self-monitoring. Clinicians making decisions require the ability to accurately self-monitor, including certainty of being correct. Inappropriate certainty could lead to medical error. Self-assessment and certainty of assessment performance have been measured in a variety of ways. Previous work has shown that those with less experience are less accurate in self-assessment, but such studies looked at self-assessment using methods less authentic to clinical practice. This study investigates how correctness varies with certainty, allowing for experience and performance. Students in Years 2-5 were certain of their responses to two iterations of a progress test during one calendar year. Analyses compared correctness for certainty of response, test number, student year cohort and performance level, defined by criterion scores. The odds of a correct response increased with student certainty for all subsets allowing for year group and ability, including student subsets with less experience and subsets in lower-performance groups. Unlike previous work showing poorer accuracy of self-assessment for those with less experience or ability, we postulate that our finding of similar increases in correctness with increasing certainty even in the less experienced and lower performance groups, relates to certainty descriptors being worded in a way that is authentic to clinical practice, and in turn related to reflection-in-action.
Publisher: Springer Science and Business Media LLC
Date: 14-09-2019
DOI: 10.1186/S12909-019-1801-X
Abstract: There is a significant body of literature that indicates that the number of options for single-best answer multiple choice questions (MCQs) can be reduced from five to three or four without adversely affecting the quality of the questions and tests. Three or four options equates to two or three distractors respectively. Whilst these arguments may be true when focusing on psychometric aspects of questions, we should also focus on educational and clinical authenticity aspects of questions. I present reasons for MCQs in tests to have a variable number of options which will usually be more than three, four, or five. These include: decisions related to broad clinical scenarios cannot be limited to a small number of options options lists should include all possible combinations of option elements and options that are rarely chosen can provide information regarding students and/or for students. Finally, given computer based delivery, longer option lists are not impractical for examinees. In the contexts that are appropriate, it is time to consider a move to adopting appropriate and variable numbers of MCQ options and not be limited to MCQs with three, four or five options.
Publisher: University of Otago Library
Date: 28-04-2017
Publisher: Informa UK Limited
Date: 2006
DOI: 10.1080/01421590600568421
Abstract: Career progression during undergraduate and early postgraduate years is currently determined by successfully passing examinations. Both academic factors (secondary school examination results, learning style and training opportunities) and non-academic factors (maturity, ethnic origin, gender and motivation) have been identified as predicting examination outcome. Few studies have examined organization skills. Disorganized medical students are more likely to perform poorly in end-of-year examinations but this observation has not been examined in junior doctors. This study asked whether organization skills relate to examination outcome amongst junior doctors taking the clinical Part II examination for the Membership of the Royal College of Physicians (Practical Assessment of Clinical Examination Skills). The study was conducted prospectively at four consecutive clinical courses that provided clinical teaching and practice to prepare trainees for the examination. Arrival time at registration for the course was the chosen surrogate for organization skills. Trainees were advised that they should arrive promptly at 8.00 a.m. for registration and it was explained that the course would start at 8.30 a.m. Recorded arrival times were compared with the pass lists published by the Royal College of Physicians. The mean arrival time was 8.17 a.m. A total of 81 doctors (53.3%) passed the examination with a mean arrival time of 8.14 a.m. However, 71 doctors failed the exam and arrived, on average, six minutes later than doctors who passed (p?=?0.006). Better-prepared junior doctors were more likely to pass the final examination. Arriving on time represents a composite of several skills involved in the planning of appropriate travel arrangements and is therefore a valid marker of organization skills and preparation. This novel study has shown that good time-keeping skills are positively associated with examination outcome.
Publisher: University of Otago Library
Date: 07-07-2023
Abstract: Assessment in the health professions is transforming. The widespread dominance of a reductionist measurement-based approach over the past 50 years is shifting towards a preference for more authentic assessment designed to promote and support learning. Assessment as a series of in idual barriers, each to be surmounted, is being discarded in favour of systems of assessment designed to scaffold learner development and ensure sufficient opportunities for achievement. The intentions of these changes are to avoid the negative impacts of previous assessment approaches, such as strategic gaming, unhealthy competition and a predominance of book study, over immersion in clinical environments. However, unintended outcomes need to be considered when planning such transformative assessment change—both for those engaged in incremental evolutionary change and for those taking a more rapid or revolutionary approach. We explore three key features of programmatic assessment: longitudinal use of multiple assessment formats, a focus on assessment for learning and collation of data by attribute for decision making. We highlight the intended and possible unintended outcomes related to these features from the perspective of evolutionary and revolutionary approaches to change. We postulate that careful consideration of unintended outcomes is essential when planning significant assessment redesigns in health professional education. Anticipating unintended outcomes might also provide both the motivation and rationale to advance assessment practice into the next 50 years—particularly in the areas of enhancements in technology and collaborations across and between education providers.
Publisher: Springer Science and Business Media LLC
Date: 30-05-2019
Publisher: Informa UK Limited
Date: 28-12-2019
Publisher: Wiley
Date: 31-05-2002
Publisher: Wiley
Date: 02-2011
DOI: 10.1111/J.1754-9485.2010.02224.X
Abstract: We aimed to evaluate the number and nature of incidental findings in CT chest scans in the context of a study of the pulmonary effects of cannabis. Three hundred fifty-seven participants were recruited: 78 cannabis-only smokers, 92 tobacco-only smokers, 106 smokers of cannabis and tobacco and 81 never smokers. All participants underwent a high-resolution CT scan of their thorax. Two radiologists read the scans. Associations between abnormalities and age, sex, tobacco and cannabis smoking status were expressed as odds ratios (OR) with 95% confidence interval. Seventy-six findings requiring referral or further investigations were found in 71/357 (19.9%) of participants. In multivariate analyses, only older age, OR (per decade) 2.1 (1.4 to 3.0), was associated with a respiratory abnormality on the CT scan. A total of 37/76 (48.7%) of the abnormalities detected were extra-pulmonary, with findings observed across a wide range of organ systems. Only older age, OR (per decade) 1.7 (1.2 to 2.5), was associated with a non-respiratory abnormality. The common occurrence of abnormal findings requiring referral or further investigations raises practical, ethical and medico-legal issues which need to be carefully considered in research programmes utilising chest CT scanning.
Publisher: Springer Science and Business Media LLC
Date: 19-03-2021
DOI: 10.1186/S12909-021-02574-2
Abstract: Challenge, sometimes perceived as stress, may be beneficial or detrimental to learning but the circumstances when it may be beneficial are not clear. This study looks at the association of challenge with perceived learning and how this might be influenced by affect, context or the type of learning. The participants, medical students in their first years of experiential clinical exposure, rated specified learning episodes (LEs) on the perceived learning (low to high), challenge (low to high) and affect (feeling positive to negative). Such learning episodes were self-identified or identified by course organisers. Correlations, using Kendall’s tau-b test, were conducted to explore the associations among learning, challenge and affect. In the second stage the types of LEs were then thematically classified in order to determine those that were positive for learning and challenging and/or associated with positive affect. There were positive correlations between perceived learning and challenge, and between perceived learning and affect for both types of LEs. The circumstances in which challenge (stress) promoted learning were authentic environments, authentic tasks and simulated clinical activities most requiring a degree of social interaction. Challenge and positive affect are beneficial in the perception of discrete learning, but are two separate constructs. Ideally both challenge and affect need to operate alongside authentic supportive clinical activities, that by their nature involve others, to maximise perceived learning.
Publisher: Informa UK Limited
Date: 2009
DOI: 10.1080/01421590802146018
Abstract: Marking of multiple choice type examinations often just takes account of the correct responses. This may encourage guessing of incorrect and potentially unsafe responses. Ideally responses should contain a high proportion of correct, unsafe and the use of 'don't know' response rather than incorrect. This study explored the effect of instructions on responses. Fourth- and fifth-year students sitting for an optional multiple choice examination were randomized to receive one of four instruction options: number-correct marking (the control group) alert to unsafe mark deduction for unsafe or correction for guessing. A total of 210 students sat the test. For the fourth-year cohort, compared with the control group, being alerted to unsafe and mark deduction for unsafe or incorrect responses were associated with graduated increases in the use of 'don't know' and reductions in incorrect responses. For the fifth-year cohort, there were no differences in responses between options. The fifth-year cohort, gave more correct, and fewer incorrect, unsafe and 'don't know' responses. Both the year group and instructions had an effect. Being alerted to potentially unsafe responses, even when there is no mark deduction penalty, had an effect, although mark deduction still had the greatest effect. Assessment instructions may give subliminal messages that have important consequences.
Publisher: Informa UK Limited
Date: 05-11-2012
Publisher: Wiley
Date: 08-2019
DOI: 10.1111/TCT.13081
Abstract: The undergraduate curriculum tends to focus on how in iduals can cope with stress especially when transitioning from the classroom to the clinical workplace environment. Often this carries the message that stress is bad, yet little attention has been paid to the influence of one's belief regarding the value of stress for learning. Because stress is often perceived as bad, we chose to use the term 'challenge' in exploring the associations amongst belief of the value of challenge, the challenge experienced, the perceived learning, affect and staff support. At the end of each clinical module within a medical curriculum, medical students rated the perceived learning, degree of challenge, affect, support and the value of challenge for learning. The value and associations amongst these variables were analysed. The challenge for students varied according to the type of module. Students generally considered that challenge promoted rather than hindered learning. The level of challenge experienced may influence the perception of the value of challenge for learning. However, when challenge was regarded as beneficial, this was strongly, positively associated with perceived learning, positive affect and support. Students who believe challenge is positive also perceive that such challenges promote learning. Likewise students who regard challenge as negative are less likely to learn from such challenges. The positive relationship between the belief of the value of challenge with affect and support may have positive implications for well-being. It is contended that curriculum planners should acknowledge the potential positive influence of stressors in clinical education and that challenge can be seen as valuable when there is student support and measures associated with maintaining a positive affect.
Publisher: Informa UK Limited
Date: 2006
Publisher: Informa UK Limited
Date: 09-11-2017
Publisher: Informa UK Limited
Date: 28-06-2013
Publisher: Wiley
Date: 20-11-2012
Publisher: Wiley
Date: 21-04-2021
DOI: 10.1111/MEDU.14534
Abstract: Assessment of healthcare professionals should be authentic to clinical practice. As clinicians regularly use resources in practice, similar resources should be available to those sitting assessment. There is limited information on the impacts of open‐book (resource) assessments on standard setting for use in high‐stakes assessments. This research aims to explore the effects on standard setting and student perceptions when open vs closed resources are available in high‐stakes assessment of medical students. Students sat multiple‐choice question (MCQ) examinations under both closed‐ and open‐resource conditions in a randomised crossover design. A standard setting panel set pass‐marks for both closed‐ and open‐resource conditions of delivery, and we compared these pass‐marks with each other and with actual performance. Students responded to a survey on perceptions of open‐resource assessments. The pass‐mark was set higher when panellists considered open‐resource conditions compared to closed conditions (59% vs 47%), but actual student performance showed no difference in scores between the two conditions. The net effect was that the pass rate was higher for closed than open‐resource conditions (71% vs 34%). Open‐resource conditions increased the time to complete the questions. The students perceived that open resource was more authentic but was more time‐consuming and would require different preparation. Regarding the acceptability of including open resources in high‐stakes assessment, the responses of students were mixed. Pass standards based solely on judgements by panellists experienced in closed‐resource conditions might not be applicable under open conditions. Questions vary in how much time accessing resources may take and the degree of assistance in selecting the correct answer. A programme of assessment could be constructed to include both closed‐ and open‐resource condition assessments depending on the questions’ content and format. Open‐resource conditions may promote assessment preparation that focuses more on seeking and evaluating resources rather than learning facts.
Publisher: Wiley
Date: 13-05-2001
DOI: 10.1046/J.1365-2923.2001.00895.X
Abstract: To develop new methods of evaluating face validity in the context of a revised final professional examination for medical undergraduates, organized on three sites, over 2 days. The opinion of the students and examiners was surveyed by Likert-style questionnaires, with additional open comments. Expert opinion was gathered from external examiner reports and a recent Quality Assurance Agency (QAA) Subject Review Report. The questionnaires had an overall response rate of 84%. Internal reliability, assessed by comparing responses to appropriate questions, was good with an equivalence of 45% (weighted kappa 0.54) for the students and 33% (weighted kappa 0.41) for the assessors. There was little evidence of inconsistency between days or sites. The majority of the opinions from the students, examiners and external experts were positive. Negative comments related to time pressure and case mix. The measurement of face validity proved feasible and valuable and will assist in the further development of the course and the examination.
Publisher: Springer Science and Business Media LLC
Date: 06-10-2020
DOI: 10.1186/S12909-020-02250-X
Abstract: Self-monitoring is an important component of clinical practice. It is underpinned by the framework of self-efficacy which is concerned with judgments of how well one believes one can achieve or perform a task. This research aimed to develop criteria for adequate self-monitoring, then to measure patterns of self-monitoring, and to explore how these patterns relate to a student’s year in a medical course and to patterns of knowledge. Analysis of in iduals’ levels of correctness in answering assessment items and their certainty in correctness may be used to inform assessments of ability to self-monitor. Two criteria were proposed and applied to define adequate self-monitoring. Firstly, increasing proportions correct with increasing levels of certainty. Secondly, having a proportion correct for high certainty responses that was not lower than cohort levels. Student responses in progress tests comprising multiple-choice questions (MCQs) and associated certainty were analysed. Criteria for the presence of adequate self-monitoring and for adequate knowledge were applied to the results of each of four tests conducted over 2 years, and used to categorise patterns of self-monitoring and knowledge. Data from 3 year group cohorts totalling 737 students were analysed. The majority (58%) of students demonstrated adequate knowledge and met both criteria for adequate self-monitoring across all four tests. The most advanced year group cohort had the highest rates of adequate knowledge and the highest rates of meeting both self-monitoring criteria. The patterns of self-monitoring were the same as the patterns of knowledge across the four tests for 454 students, but for the remaining 283 the patterns of self-monitoring and knowledge differed. Analysis of responses to item level certainty has informed development of a definition of adequate self-monitoring that may be applied to in idual student’s responses from a single test, and to track the adequacy of a student’s self-monitoring over time. Patterns of self-monitoring tend to match patterns of knowledge, but not in all cases, suggesting the self-monitoring measure could provide additional information about student ability.
No related grants have been discovered for Michael Tweed.