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Abnormal effort-based decision-making represents a potential mechanism underlying motivational deficits (amotivation) in psychotic disorders. Previous research identified effort allocation impairment in chronic schizophrenia and focused mostly on physical effort modality. No study has investigated cognitive effort allocation in first-episode psychosis (FEP).
Cognitive effort allocation was examined in 40 FEP patients and 44 demographically-matched healthy controls, using Cognitive Effort-Discounting (COGED) paradigm which quantified participants’ willingness to expend cognitive effort in terms of explicit, continuous discounting of monetary rewards based on parametrically-varied cognitive demands (levels N of N-back task). Relationship between reward-discounting and amotivation was investigated. Group differences in reward-magnitude and effort-cost sensitivity, and differential associations of these sensitivity indices with amotivation were explored.
Patients displayed significantly greater reward-discounting than controls. In particular, such discounting was most pronounced in patients with high levels of amotivation even when N-back performance and reward base amount were taken into consideration. Moreover, patients exhibited reduced reward-benefit sensitivity and effort-cost sensitivity relative to controls, and that decreased sensitivity to reward-benefit but not effort-cost was correlated with diminished motivation. Reward-discounting and sensitivity indices were generally unrelated to other symptom dimensions, antipsychotic dose and cognitive deficits.
This study provides the first evidence of cognitive effort-based decision-making impairment in FEP, and indicates that decreased effort expenditure is associated with amotivation. Our findings further suggest that abnormal effort allocation and amotivation might primarily be related to blunted reward valuation. Prospective research is required to clarify the utility of effort-based measures in predicting amotivation and functional outcome in FEP.
Photonic crystal surfaces represent a class of resonant optical structures that are capable of supporting high intensity electromagnetic standing waves with near-field and far-field properties that can be exploited for high sensitivity detection of biomolecules and cells. While modulation of the resonant wavelength of a photonic crystal by the dielectric permittivity of adsorbed biomaterials enables label-free detection, the resonance can also be tuned to coincide with the excitation wavelength of common fluorescent tags - including organic molecules and semiconductor quantum dots. Photonic crystals are also capable of efficiently channeling fluorescent emission into a preferred direction for enhanced extraction efficiency. Photonic crystals can be designed to support multiple resonant modes that can perform label free detection, enhanced fluorescence excitation, and enhanced fluorescence extraction simultaneously on the same device. Because photonic crystal surfaces may be inexpensively produced over large surface areas by nanoreplica molding processes, they can be incorporated into disposable labware for applications such as pharmaceutical high throughput screening. In this talk, the optical properties of surface photonic crystals will be reviewed and several applications will be described, including results from screening a 200,000-member chemical compound library for inhibitors of protein-DNA interactions, gene expression microarrays, and high sensitivity of protein biomarkers.
Agents that block the renin–angiotensin system (RAS) improve glucoregulation in the metabolic syndrome disorder. We evaluated the effects of egg white hydrolysate (EWH), previously shown to modulate the protein abundance of RAS component in vivo, on glucose homeostasis in diet-induced insulin-resistant rats. Sprague–Dawley rats were fed a high-fat diet (HFD) for 6 weeks to induce insulin resistance. They were then randomly divided into four groups receiving HFD or HFD supplemented with different concentrations of EWH (1, 2 and 4 %) for another 6 weeks in the first trial. In the second trial, insulin-resistant rats were divided into two groups receiving only HFD or HFD+4 % EWH for 6 weeks. Glucose homeostasis was assessed by oral glucose tolerance and insulin tolerance tests. Insulin signalling and protein abundance of RAS components, gluconeogenesis enzymes and PPARγ were evaluated in muscle, fat and liver. Adipocyte morphology and inflammatory markers were evaluated. In vivo administration of EWH increased insulin sensitivity, improved oral glucose tolerance (P < 0·0001) and reduced systemic inflammation (P < 0·05). EWH potentiated insulin-induced Akt phosphorylation in muscle (P = 0·0341) and adipose tissue (P = 0·0276), but minimal differences in the protein abundance of tissue RAS components between the EWH and control groups were observed. EWH treatment also reduced adipocyte size (P = 0·0383) and increased PPARγ2 protein abundance (P = 0·0237). EWH treatment yielded positive effects on the inflammatory profile, glucose tolerance, insulin sensitivity and adipocyte differentiation in HFD-induced insulin resistance rats. The involvement of local RAS activity requires further investigation.
Introduction: CanadiEM.org is a multi-author open access medical education website which aims to improve emergency care in Canada by building an online community of practice for healthcare practitioners and providing them with high quality, freely available educational resources. It is used by physicians, allied health professionals, and trainees globally. Junior (medical student and/or resident) Editors are key members of the community who are mentored to advance their academic skills and knowledge for their careers and the healthcare field. The program also aims to increase the sustainability of the CanadiEM project by supporting the creation and publishing of online content. We aimed to assess the impact and efficacy of this program while discovering ways to improve it. Methods: The experience of all current and previous Junior Editors were assessed through a survey developed by the authorship team for this purpose. The survey consisted of 48 questions, including 15 multiple choice questions rated using a Likert Scale, 10 open-ended questions, and 23 demographic or binary yes/no questions. The participants' perceptions of their experience, desire for future involvement, and opinions regarding implementation of the program at other medical education websites were assessed using open-ended qualitative questions. These responses were thematically analyzed. Results: A total of 28 Junior Editors responded (71.7% of those surveyed). They listed their responsibilities as uploading/copyediting posts, authorship of posts, infographic creation, social media promotion, authorship of podcast summaries, editing of podcasts, and logo design. Results revealed a positive experience across all domains, with participants citing a better experience when compared to previous similar roles. 85.7% (24/28) stated they achieved their expectations from the program, and 82.1% (23/28) would incorporate this program into another medical education website if given the opportunity. Conclusion: Junior Editors reported positive experiences across all responsibilities, with particular value placed on digital and authorship skills development, inspiration for future FOAMed, research engagement, and mentorship/networking. Through collaboration with current team members, we will implement improvement initiatives. Based upon these results, we believe that the Junior Editor model may also be viable within other medical education communities.
Introduction: In July 2018, Emergency Medicine (EM) transitioned to the Royal College of Physicians and Surgeons of Canada's (RCPSC) Competence by Design (CBD) training framework. In anticipation of CBD implementation, we conducted a nation-wide needs assessment of EM faculty and senior residents to understand their attitudes towards CBD, workplace-based assessments (WBA) and overall educational needs. Methods: A multi-site, cross-sectional digital survey was conducted in winter 2018 with a sample of EM faculty and senior residents across RCPSC EM programs in Canada. Recruitment was via program director nomination. Survey domains included baseline perceptions about CBD, attitudes toward implementation, perceived/prompted and unperceived faculty development needs. Microsoft Excel was used to calculate descriptive statistics. This study was reviewed by the Hamilton Integrated Research Ethics Board.A multi-site, cross-sectional digital survey was conducted in winter 2018 with a sample of EM faculty and senior residents across RCPSC EM programs in Canada. Recruitment was via program director nomination. Survey domains included baseline perceptions about CBD, attitudes toward implementation, perceived/prompted and unperceived faculty development needs. Microsoft Excel was used to calculate descriptive statistics. This study was reviewed by the Hamilton Integrated Research Ethics Board. Results: Between February-April 2018, 47 participants (40 faculty, 7 residents) completed the survey (58.8% response rate). Most respondents (89.4%) thought learner feedback should be provided on each shift; 55.3% believed they provided adequate feedback. Time constraints, learner disinterest and fear of assessment repercussions were the top three barriers to providing good feedback. A majority of respondents (78.7%) thought that the ED provided above average opportunities for direct observation and 91.5% were confident of incorporating WBAs into their practice. 44.7% reported that CBD will not impact patient care; 17.0% perceived it may have a negative impact. 55.3% felt that CBD will lead to improved feedback for trainees. The top areas for faculty development were: feedback delivery, completing WBAs, resident promotion decisions, and receiving feedback on teaching. Only 25.5% were interested in learning about CBD, although the average of correct responses on the CBD knowledge test was 44.6%. Conclusion: EM is well-situated to transition to CBD given clinicians’ positive attitudes towards feedback, direct observation, WBAs, and opportunities for direct observation. Threats to CBD implementation are concerns about effects on patient care and trainee education, and skepticism regarding effects on feedback quality. Faculty development should concentrate on further developing clinical teaching and supervision skills, focusing on feedback and WBAs.
Introduction: Today's emergency department sees healthcare system pressures manifest through longer wait times, increased costs, and provider burnout. In the face of questionable sustainability, there is a greater role for training future innovators and entrepreneurs in healthcare. However, there is currently little formal education or mentorship in these areas. The aim of this scoping review was to identify the current and ideal educational practices to foster innovative and entrepreneurial mindsets, with specific interest amongst emergency medicine trainees. Methods: Using a scoping review methodology, the relationship between healthcare and entrepreneurship was explored. OVID, PubMed and Google Scholar were searched using the keywords “entrepreneurship”, “health education” and “health personnel”, on March 8th, 2018. Results were screened by title, abstract and full text by a team of three calibrated researchers, based upon pre-defined exclusion and inclusion criteria. The final list of papers was reviewed using an extraction tool to identify demographics, details of the paper, and its attitudes and perceptions towards entrepreneurship and innovation. Results: After screening, 59 papers were identified for qualitative analysis. These papers ranged from 1970-2018, mainly from the USA (n = 36). Most papers were commentaries/opinions (n = 35); 11 papers described specific innovations. Entrepreneurship was viewed positively in 45 papers, negatively in 2 papers, and mixed in 12 papers. Common specialties discussed were surgery (n = 9), internal medicine (n = 3), and not specified (n = 44). Emergency medicine was described in one paper. Major themes were: entrepreneurial environment (n = 29), funding and capital (n = 12), idea generation (n = 9), and teaching entrepreneurship (n = 6). Of the 11 innovation papers, the discussion was focused on educational (n = 6) or system (n = 5) innovations. These innovations related to surgery (n = 1), public health (n = 1) and palliative care (n = 1). None of these innovations were specific to emergency medicine. Conclusion: This review indicates a small number of programs focused on promoting innovation and entrepreneurship amongst trainees, but no programs specific to the emergency department. There may be benefit for educators in emergency medicine to consider how to foster a greater innovative spirit in our speciality, so our next generation of physicians can help tackle problems affecting patient care.
Introduction: Emergency department (ED) crowding and increased patient load has been shown to have an impact on physician decision making and patient mortality. As the volumes in Canadian EDs increase, so does the need to effectively prepare new learners for the challenges ahead. This study aims to determine which level of training varying teaching techniques should be employed to educate Emergency Medicine (EM) residents about ED management and flow in the age of competency based medical education. Methods: We designed a survey that contained a previously derived list of ED flow and management teaching strategies. We piloted and edited the survey based on feedback from operations and educational experts. A total of 21 teaching techniques were included in the final survey ranging from didactic teaching sessions to experiential techniques such as residents running the department with supervision. Then, we invited members of the Royal College of Physicians and Surgeons of Canada EM specialty committee, the Canadian Association of Emergency Physicians Education Scholarship Section, and the Canadian EM Simulation Educators Collaborative to participate in our survey. We analysed the results using simple descriptive statistics. Results: A total of 21 EM (38% female, 62% male) educators from 11 programs (78% of Royal College Training sites) responded to the survey, representing 7/10 provinces, with a mean years-in-practice of 15.2 years (SD 9.7). All respondents were involved in resident education; 66% had a current formal educational role, such as Program Director. Results showed a universal trend towards teaching flow and management skills later in residency. Participants endorsed 35.93% of teaching strategies for the “Core of discipline” and 39.65% for the “Transition to practice” stages of training. Didactic and observational techniques were occasionally considered acceptable at earlier training stages, whereas experiential teaching techniques were skewed towards the later stages of residency. Conclusion: EM educators from across Canada believe that most teaching techniques for flow are better suited for the later stages of residency training, with didactic techniques more suitable earlier on. This work will inform faculty development on managerial/leadership skills teaching in the ED.
Innovation Concept: Mass Casualty Incidents (MCI) are complex events that most paramedics encounter only a few times in their careers. Triaging and managing multiple patients during an incident requires different skills than typically practiced by prehospital providers. Simulation and drills can provide an opportunity to practice those skills, but are costly and resource intensive while only allowing a few providers to be in a triage or leadership role. It is important to find engaging and less expensive methods for teaching MCI triage and initial scene management. Methods: The authors have developed and are testing a card game based on the previously published GridlockED board game. The game was developed utilizing an iterative process previously described. This game was tested with paramedics as well as other emergency medicine learners to determine usability, engagement, fidelity, as well as usefulness in teaching MCI triage and patient-flow concepts. Curriculum, Tool or Material: The card game provides a focused learning experience to allow providers to practice initial triage of multiple injured patients as well as manage patient flow from the scene to area hospitals when faced with limited prehospital resources and capabilities. Players work together in various simulated scenarios to correctly triage injured patients and send them to the correct healthcare facility. Conclusion: Serious gaming has gained momentum in medical education. Developing novel curriculae around low frequency, high stakes situations using a game like TriagED may hold the key to ensure prehospital care providers are trained for these incidents. In the future, games which integrate an element of Incident Command or receiving hosptials (e.g. full integration with GridlockED game) may help to further explore the relationship between scene management and patient flow within receiving hospitals.
Introduction: In 2016, a team at McMaster began developing GridlockED, an educational (or “serious”) board game designed to teach medical learners about patient flow in the emergency department. As serious board games are a relatively new phenomenon in medical education, there is little data on how marketed games are actually used once received by end-users. In this study our goal was to better understand the demographics and game usage for purchasers of the GridlockED board game, which will inform the further improvement or expansion of the game. Methods: Individuals who expressed interest in purchasing gridlockED via our online storefront were sent an anonymous online survey via Google Form. The survey collected demographic and qualitative data with a focus on the respondent's role in medicine, how they have used GridlockED, who they have played GridlockED with, and what changes or additions to GridlockED they would like to see. We also asked about changes for a potential mass-market version of the game targeted towards non-medical individuals. Individuals who did not purchase the game were asked about their barriers to purchase. We received an exemption for this study from our institutional review board. Results: 42 responses (out of 300 individuals on our mailing list, 14% response rate) were collected. Responding purchasers were from 16 different roles in healthcare and 11 different countries. The top 5 roles were: EM trainee, Community EM MD, Academic EM MD, Physicians from other specialties, and EM program director. The majority of respondents were Canadian (38%), with America (21%), New Zealand (10%), and Turkey (7%) the only other countries to have more than 2 respondents. 50% reported having played the game, with the most common use cases being for fun (76%), for teaching trainees (33%) or training with colleagues (19%). For those who did not purchase, price was the largest barrier (81%). 50% of respondents expressed interest in a disaster scenario expansion pack, with 33% interested in set lesson plans. Conclusion: GridlockED attracted interest from a wide range of medical professionals, both in terms or role and location. Users mainly reported using the game for fun, with fewer users using the game for teaching/training purposes. The main barrier to purchase was the game's price.
Introduction: GridlockED is an educational (or “serious”) game recently developed by a team at McMaster to teach medical learners about patient flow in the emergency department (ED). Beyond patient flow, we were cognizant that the game could provide additional learning opportunities for learners. The goal of this program evaluation project was to investigate workshop attendees’ experiences and identify what areas they found most educational. Methods: A GridlockED board game workshop was developed and delivered in several locations over the fall of 2018. Workshops targeted medical learners and were organized by local emergency medicine interest groups. After a standardized video-based introduction to the game concept and rules, the learners played GridlockED for approximately 90 minutes. After the play session, learners completed an anonymous survey consisting of 7-point Likert scale questions about their experience. They were also asked to identify the learning domains for which GridlockED was developed (Patient Flow, Communication and Teamwork, and ED Basics), and were asked via free-text to identify learning objectives from their experience. We received an exemption for this study from our institutional review board. Results: We had 25 respondents (24 medical students and 1 resident). Trainees rated GridlockED as both enjoyable to play and as a meaningful educational experience, with an average rating of 6.56 (SD 0.94) for enjoyability and 6.44 (0.92) for education. When asked what targeted learning domain was most helpful, 45% of students identified patient flow, 37% teamwork and communication, and only 18% ED basics. When asked to identify their top three areas of learning in open-ended responses, students actually identified resource management most frequently (48%), with improved communication skills (40%) as the second most prominent learning objective. Other interesting self-identified learning points were: a greater appreciation of the role of various providers (24%), the unpredictability of ED care (12%), and how things can go wrong (12%). Conclusion: Medical learners find GridlockED to be both enjoyable and educational. In our targeted areas of learning they found patient flow to be the most educational, but self-identified multiple other areas for learning. Students identified resource management and communication as key areas of learning, suggesting that future workshops might be designed specifically to teach these skills.
Solid solutions of cadmium sulf ide and cadmium selenide prepared by several methods at temperature in excess of 1000°C in inert atmosphere are described. The compositions of these solid solutions varied widely, ranging from pure cadmium sulfide to pure cadmium selenide.
Films of solid solutions have been successfully prepared by the vacuum deposition on various substrates using a procedure previously reported. Conditions for the depositions have been investigated to prevent noticeable alteration of the composition of the solid solution dur ing vacuum deposit ion. Films of various thicknesses have been prepared to date.
Determination of film thicknesses have been carried out by the fluorescence method based on the elements existing in these solid solutions. Chemical analysis in which specimens were consumed have also been used primarily for the construction of calibration curves. X-ray fluorescence intensity versus film thickness are established for films of 0, 25, 50, 77, and 100 percent by weight of cadmium selenide up to 10.00 microns thick on aluminum substrates. Thickness determinations using selenium Kα and cadmium Kα spectra give accuracies of 0.200 ± 0.05 to 10.00 ± 0.40 microns depending on film thickness and composition. Correction factors are given for films on substrates other than aluminum.
Procedures have been established for the determinat ion of both composition and film thickness based on fluorescence intensity data. There is a relationship between the fluorescence intensity and appearance when deposited films are not of the same thickness. Correlation of these phenomena will be demonstrated.
The humble pendulum is often invoked as the archetype of a simple, gravity driven, oscillator. Under ideal circumstances, the oscillation frequency of the pendulum is independent of its mass and swing amplitude. However, in most real-world situations, the dynamics of pendulums is not quite so simple, particularly with additional interactions between the pendulum and a surrounding fluid. Here we extend the realm of pendulum studies to include large amplitude oscillations of heavy and buoyant pendulums in a fluid. We performed experiments with massive and hollow cylindrical pendulums in water, and constructed a simple model that takes the buoyancy, added mass, fluid (nonlinear) drag and bearing friction into account. To first order, the model predicts the oscillation frequencies, peak decelerations and damping rate well. An interesting effect of the nonlinear drag captured well by the model is that, for heavy pendulums, the damping time shows a non-monotonic dependence on pendulum mass, reaching a minimum when the pendulum mass density is nearly twice that of the fluid. Small deviations from the model’s predictions are seen, particularly in the second and subsequent maxima of oscillations. Using time-resolved particle image velocimetry (TR-PIV), we reveal that these deviations likely arise due to the disturbed flow created by the pendulum at earlier times. The mean wake velocity obtained from PIV is used to model an extra drag term due to incoming wake flow. The revised model significantly improves the predictions for the second and subsequent oscillations.
Introduction: Emergency medicine clinicians (physicians, nurses, paramedics, physician assistants) utilize podcasts for learning. However, their versatility produces variability in the ways they are used (e.g. their speed can be increased or decreased, unrelated activities can be performed simultaneously, or they can be accompanied by active learning methods). This study investigated how and why podcasts are used by an international cohort of clinicians. Methods: An international sample of medical students, residents, physicians, nurses, physician assistants, and paramedics was recruited to complete a survey hosted on FluidSurveys software using social media (Twitter and Facebook), direct contact from our international authorship group, infographics, and a study website (https://METRIQstudy.org/). Participants who indicated interest in the study were sent an email containing the study survey. Reminder emails were sent every 5-10 days a maximum of three times. Results: 462 clinicians expressed interest and 397 completed the survey (86.0% completion rate). Participants hailed from 34 countries (38.8% Canada, 30% United States, 31.2% outside of North America) and a majority (61.9%) were physicians. Approximately half (45.8%) of the participants listened to podcasts weekly. Podcasts were used to learn core material (75.1%), refresh memory (72.3%), or review new literature (75.8%). Most listened on iPhones (61%) and the native Apple App (66.1%). The preferred Android apps were Pocket Casts (22.8%) and Google Play (18.5%). Many listened to podcasts while driving (72.3%). Active learning techniques such as pausing, repeating segments, taking notes, or listening to a podcast more than once were rarely used (1/4 of the time or less) by the majority of participants. Conclusion: This study describes how and why medical education podcasts are used by emergency medicine clinicians and should inform both podcast producers and future research investigating the impact of various listening habits on retention. Further analysis of the data will elucidate differences in listening habits
Introduction: Competency-based workplace assessments are important in clinical training. However, feedback and assessment are still often perceived as unsatisfactory, particularly in busy settings such as emergency departments. Currently, little is known about how attending staff physicians sense of self may interface with the processes they use to assess and give feedback to trainees. We aimed to understand how attendings perceive their roles when tasked with conducting assessments and providing feedback to trainees. Methods: We conducted semi-structured, individual interviews with attendings (n=16) who used McMAP (McMaster Modular Assessment Program), a workplace-based assessment system at McMaster Universitys Royal College Emergency Medicine program. Attendings were recruited using snowball sampling. Data were interpreted using thematic analysis, sensitized to the dramaturgical lens and rater cognition frameworks. Results: Attendings identified themselves using three distinct but intimately connected roles when assessing trainee performance: the doctor that ensures the safety and well-being of patients; the coach (educator) that empowers, guides, and supports the next generation of medical doctors; and the assessor that formally assesses a trainees progression through the residency program. These roles are influenced by clinical training and experience, teaching experience and context. Conclusion: The ways in which attendings assess and provide feedback to trainees involve a complex and dynamic process that is influenced by their perceived roles as a doctor, coach, and assessor. Understanding the way attendings view and juggle their roles may provide insight into potentially new approaches to assessment and feedback. Results and implications will be discussed.
Introduction: Cognitive processing theories postulate that decision making depends on both fast and slow thinking. Experienced physicians (EPs) make diagnoses quickly and with less effort by using fast, intuitive thinking, whereas inexperienced medical students rely on slow, analytical thinking. This study used a cognitive task analysis to examine EPs cognitive processes and ability to provide knowledge translation to learners. Methods: A novel mind mapping approach was used to examine how EPs translate their clinical reasoning to learners, when evaluating a patient for a possible venous thromboembolism (VTE). Nine EPs were interviewed and shown two different videos of a medical student patient interview (randomized from six possible videos). Results: EPs were asked to demonstrate their clinical approach to the scenario using a mind map, assuming they were teaching a learner in the Emergency Department. EPs were later re-interviewed to examine response stability, and given the opportunity to make clarifying or substantive mind map modifications. Maps were broken into component pieces and analyzed using mixed-methods techniques. A mean of 15.7 component pieces were identified within each mind map (standard deviation (SD) 7.8). Maps were qualitatively coded, with a mean of 2.8 clarifying amendments (e.g. adding a time course caveat) (SD 1.5-5.75) and 4.4 substantive modifications (e.g. changing the flow of the map) (SD 2-5). Conclusion: Resulting mind maps displayed significant heterogeneity in teaching points and the degree to which EPs used slow thinking. EPs frequently made fast thinking jumps, although learners could prompt slow thinking by questioning unclear points. This is particularly important as learners engage in cognitive apprenticeship throughout their training. An improved understanding of EPs cognitive processes through mind mapping will allow learners to improve their own clinical reasoning (Merrit et al., 2017). Educating EPs on these processes will allow modification of their teaching styles to better suit learners.
Introduction: The GridlockED game is a serious game aimed at teaching junior learners about flow and organization in the emergency department(ED). With serious games, the mechanism of learning is thought to be via the gameplay experience. Objectives built into gameplay are aimed at teaching players about a specific concept; in this case, we hoped to teach players about interprofessional collaboration and basic mechanics that drive flow in the ED. However, before a player can be taught, he or she must be engaged and have a positive gameplay experience. From the GridlockED gameplay, we aim to explore how a players gameplay experience related to observed actions while playing the game, including participating in decision making and keeping the team organized. Methods: From April-August 2017, participants were invited to play 4 turns of a GridlockED game session. They were video recorded during gameplay. After playing the game, they were surveyed using the previously derived Game Experience Questionnaire (GEQ) to measure their gameplay experience. The videos were reviewed by two research team members (SH, EJ), tallying various observed game actions. We conducted Pearson correlation between players GEQ total score and their observed actions. Results: A total of 32 participants (13 attendings, 5 senior residents, 10 junior residents, and 4 nurses) played the game. The average total GEQ was 67.2/132 (SD=10.7), suggesting most players had a moderately good gameplay experience. The total GEQ score correlated with component subscores within the questionnaire. Overall observed activity correlated well with each observed action subtype. However, the GEQ total score did not correlate significantly with the total observed action (Pearsons r=0.18,p=0.32). GEQ total score was found to be moderately correlated to an observation that a player participated in determining strategy during gameplay (r=0.36,p=0.04). There was a moderate negative correlation between determining strategy during gameplay and teaching about the game (r=-0.37,p=0.04) or emergency medicine concepts (r=-0.47,p<0.01). Conclusion: The GEQ is internally consistent, but does not have a strong relationship to observed actions, suggesting that game experience does not necessarily correlate with observable actions. This suggests that players may be intellectually stimulated or engaged without necessarily completing any observable actions during gameplay.
Introduction: Online medical education resources are widely used in emergency medicine (EM), but strategies to assess quality remain elusive. We previously derived the Medical Education Translational Resources: Impact and Quality (METRIQ) 8 instrument to evaluate quality in medical education blog posts. Methods: As part of a subsequent validation study (The METRIQ Blog Study), a mixed-methods usability analysis was performed to obtain user feedback on the quality assessment instrument in order to improve its clarity and reliability. Participants in the METRIQ Study were first asked to rate five blog posts using the METRIQ-8 Score. They then evaluated the METRIQ-8 instruments ease of use and likelihood of being recommended to others using a 7-point Likert scale and free text comments. Participants were also asked to flag and comment on items within the score that they felt were unclear. Global usability ratings were summarized using median scores or percent rated unclear. We used ANOVA to test associations between ease of use and demographic factors. A thematic analysis was performed on the comments. Results: 309 EM medical students, residents, and attendings completed the survey. Global ratings were generally very favorable (median 2 [IQR 2-3], with 7 being the lowest score) for ease of use and likelihood of recommendation, and did not vary by participants country of origin, frequency of blog use, or learner level. Participants stated that the score was structured, systematic, and straightforward. They found it useful for junior learners and for guiding blog creation. Four questions in the score (questions 2, 4, 5, and 7) were identified by 10% of subjects to be unclear. Thematic analysis of comments identified suggested four main themes for improving the score: adding clearer definitions with marking rubrics; shortening the 7-point scale; adding items evaluating blog post presentation and utility; and, rephrasing the wording of certain questions for clarity. Conclusion: A mixed methods usability analysis of the METRIQ-8 instrument for assessing blog quality was globally well received by EM medical students, residents, and attendings. Qualitative analyses revealed multiple areas to improve the instruments clarity and usability. The METRIQ score is a promising instrument for evaluating the quality of blogs; further development and testing is needed to improve its utility.