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Diagnostic reasoning is considered to be based on the interaction between analytical and non-analytical cognitive processes. Gut feelings, a specific form of non-analytical reasoning, play a substantial role in diagnostic reasoning by general practitioners (GPs) and may activate analytical reasoning. In GP traineeships in the Netherlands, trainees mostly see patients alone but regularly consult with their supervisors to discuss patients and problems, receive feedback, and improve their competencies. In the present study, we examined the discussions of supervisors and their trainees about diagnostic reasoning in these so-called tutorial dialogues and how gut feelings feature in these discussions. 17 tutorial dialogues focussing on diagnostic reasoning were video-recorded and transcribed and the protocols were analysed using a detailed bottom-up and iterative content analysis and coding procedure. The dialogues were segmented into quotes. Each quote received a content code and a participant code. The number of words per code was used as a unit of analysis to quantitatively compare the contributions to the dialogues made by supervisors and trainees, and the attention given to different topics. The dialogues were usually analytical reflections on a trainee’s diagnostic reasoning. A hypothetico-deductive strategy was often used, by listing differential diagnoses and discussing what information guided the reasoning process and might confirm or exclude provisional hypotheses. Gut feelings were discussed in seven dialogues. They were used as a tool in diagnostic reasoning, inducing analytical reflection, sometimes on the entire diagnostic reasoning process. The emphasis in these tutorial dialogues was on analytical components of diagnostic reasoning. Discussing gut feelings in tutorial dialogues seems to be a good educational method to familiarize trainees with non-analytical reasoning. Supervisors need specialised knowledge about these aspects of diagnostic reasoning and how to deal with them in medical education. © The Author(s) 2014.

Objective: The aim of this study was to investigate the prevalence of substance use of German apprentices in vocational schools, considering sociodemographic characteristics and vocational field. Methods: Cross-sectional study of 5688 first year apprentices. These were 5001 apprentices from 34 schools of the Dual System and 687 students from 15 vocational schools of the social and health sector. Sociodemographic characteristics and prevalence of tobacco, alcohol, cannabis, other illegal drugs, and pharmaceuticals were assessed. There was also a screening for problematic alcohol and cannabis use. The paper-pencil survey was conducted by trained research staff in 7 German federal states from September to December 2012. Results: Half of the apprentices (49.9%) used tobacco in the 30 days prior to questioning, 40.7% reported daily smoking. Alcohol use in the past 30 days was reported by 68.9%, 45.0% of the sample had a positive screening result for problematic alcohol use. Prevalence rates for the use of cannabis and other illegal drugs in the last 30 days were 7.5% and 2.6%, taking pharmaceuticals was reported by 20.7%. Significant correlates of substance use were gender and socio-economic status. Differences between vocational clusters were also found, with higher average rates in service-based and commercial-technical professions. However, these differences could mostly be explained by sociodemographic differences in the composition of the vocational clusters. Conclusions: Use of psychotropic substances is a widespread activity in German apprentices. Prevalence rates are higher than in the same age total population. The highest proportion of variance was explained by differences in gender and socio-economic status. © Georg Thieme Verlag KG Stuttgart New York ISSN 0941-3790.

BACKGROUND Trainee psychiatristscanfind themselves in interactions wherethere is practically nocollaboration with patients, their relatives, members of the treatment team and supervisors. A psychiatrist needs to be competent in establishing working relationships in complex situations and should be proficient in safeguarding professional boundaries.AIM To evaluate the interaction skills training for first-year psychiatrist in residence at hospitals and clinics forming part of the East Netherlands Consortium.METHODS All trainee psychiatrists in residence were asked to complete two evaluation forms concerning the suitability of the skills training course, the first directly after the course ended and the second at follow-up i to 3 years later.RESULTS Thetrainingwasratedhighlydirectlyafterthetraining(n=42,average7.8)(scaleo-io) andatfollow-up (n=23, average 7.7) (scale 0-10). 17 of the 23 respondents at follow-up stated that they felt the need for a refresher training course.CONCLUSION The interaction skills training is greatly appreciated and satisfies the need of first-year psychiatrists to acquire the competence and skills that are important in complex situations.

Background: In a professional learner-centered(ness) educational environment, communication and alignment of expectations about teaching are indispensable. Professional education of residents could benefit from an analysis and comparison of teachers' and residents' educational expectations and beliefs. Our purpose is to identify success factors and barriers related to aligning expectations and beliefs and building a supportive professional learner-centered educational environment.Methods. We conducted semi-structured individual interviews with teachers and semi-structured focus groups with residents. A single interview format was used to make it possible to compare the results. Data were analysed using a qualitative software package (AtlasTi). Data analysis steps were followed by the author team, which identified four domains of good teaching: personal traits, knowledge, relationships and teaching qualities.Results: Teachers and residents agreed about the importance of personal professional characteristics like being a role model and having an open and enthusiastic attitude. They all thought that having a specific knowledge base was essential for teaching. Approaching residents as adult learners was found to be an important element of the learner-centred environment and it was agreed that teachers should take practical experiences to a higher level. However, teachers and residents had different expectations about the practical consequences of being a role model, adult learning, coaching and openness, and the type of knowledge that was needed in the professional development program. Communication about different expectations appeared to be difficult.Conclusions: Teachers and residents agreed on a conceptual level about expectations and beliefs regarding good teaching, but disagreed on an executive level. According to the residents, the disagreement about good teaching was not the biggest barrier to creating alignment and a supportive professional relationship; instead, it was the absence of a proper dialogue regarding issues about expectations and beliefs. © 2014van Roermund et al.; licensee BioMed Central Ltd.

The purpose of this study was to determine working conditions for children working at industry sites in Turkey. This descriptive study was conducted between May and June 2010 and included 249 workers 18 years or younger working at a Kahramanmaras industry site. Study data demonstrated that 33.3% of the children were 18 years old, 32.9% were working in a mechanics store, 82.3% were working 9 to 12 hours a day, 68.7% were earning a weekly wage of 55 to 100 Turkish Liras, and only 22 were using annual leave. These children started working under the age determined by law; they entered into the work force and quit school. Also, it was found that working conditions were suboptimal and no auditing was instituted in many workplaces. © © American Association of Occupational Health Nurses, Inc.

Objective: To better understand the characteristics and experiences of psychologists and trainees with disabilities. Method: An invitation to participate in a survey of psychologists and psychology trainees with disabilities was sent to professional listservs related to psychology and/or disability. Fifty-six trainees and psychologists with doctoral training in clinical, counseling, school, or rehabilitation psychology completed the survey. Over half (57.1%) were practicing psychologists and 42.9% were current trainees. The most commonly reported disabilities were physical, sensory, and chronic health. Results: The majority of the participants reported experiencing disability-related discrimination during their training, and less than one third had received mentorship from psychologists with disabilities. Less than half of respondents disclosed their disability to a university disability services office, and many relied on informal accommodations alone. Most participants did not disclose their disability during the graduate school, internship, or postdoctoral application processes. Conclusions: Professional psychology programs and training sites should work to remove barriers and provide support for trainees with disabilities, especially during preinternship doctoral training. Programs should not expect disability services offices to provide all support for students with disabilities, especially support related to clinical training. © 2014 American Psychological Association.

This paper reports on how teachers within health sciences education translate outcome-based education (OBE) into practice when they design courses. The study is an empirical contribution to the debate about outcome- and competency-based approaches in health sciences education. A qualitative method was used to study how teachers from 14 different study programmes designed courses before and after OBE was implemented. Using an interpretative approach, analysis of documents and interviews was carried out. The findings show that teachers enacted OBE either to design for more competency-oriented teaching–learning, or to further detail knowledge and thus move towards reductionism. Teachers mainly understood the outcome-based framework as useful to support students’ learning, although the demand for accountability created tension and became a bureaucratic hindrance to design for development of professional competence. The paper shows variations of how teachers enacted the same outcome-based framework for instructional design. These differences can add a richer understanding of how outcome- or competency-based approaches relate to teaching–learning at a course level. © 2014, Springer Science+Business Media Dordrecht.

Purpose Although most agree that supportive learning environments (LEs) are essential for effective medical education, an accurate assessment of LE quality has been challenging for educators and administrators. Two previous reviews assessed LE tools used in the health professions; however, both have shortcomings. The primary goal of this systematic review was to explore the validity evidence for the interpretation of scores from LE tools. Method The authors searched ERIC, PsycINFO, and PubMed for peer-reviewed studies that provided quantitative data on medical students' and/ or residents' perceptions of the LE published through 2012 in the United States and internationally. They also searched SCOPUS and the reference lists of included studies for subsequent publications that assessed the LE tools. From each study, the authors extracted descriptive, sample, and validity evidence (content, response process, internal structure, relationship to other variables) information. They calculated a total validity evidence score for each tool. Results The authors identified 15 tools that assessed the LE in medical school and 13 that did so in residency. The majority of studies (17; 61%) provided some form of content validity evidence. Studies were less likely to provide evidence of internal structure, response process, and relationship to other variables. Conclusions Given the limited validity evidence for scores from existing LE tools, new tools may be needed to assess medical students' and residents' perceptions of the LE. Any new tools would need robust validity evidence testing and sampling across multiple institutions with trainees at multiple levels to establish their utility.

Objective: As the next step in competency-based medical education, the Pediatrics Milestone Project seeks to provide a learner-centered approach to training and assessment. To help accomplish this goal, this study sought to determine how pediatric residents understand, interpret, and respond to the Pediatrics Milestones. Methods: Cognitive interviews with 48 pediatric residents from all training levels at 2 training programs were conducted. Each participant reviewed one Pediatrics Milestone document (PMD). Eight total Pediatrics Milestones, chosen for their range of complexity, length, competency domain, and primary author, were included in this study. Six residents, 2 from each year of residency training, reviewed each PMD. Interviews were transcribed and coded using inductive methods, and codes were grouped into themes that emerged. Results: Four major themes emerged through coding and analysis: 1) the participants' degree of understanding of the PMDs is sufficient, often deep; 2) the etiology of participants' understanding is rooted in their experiences; 3) there are qualities of the PMD that may contribute to or detract from understanding; and 4) participants apply their understanding by noting the PMD describes a developmental progression that can provide a road map for learning. Additionally, we learned that residents are generally comfortable being placed in the middle of a series of developmental milestones. Two minor themes focusing on interest and practicality were also identified. Conclusions: This study provides initial evidence for the Pediatrics Milestones as learner-centered documents that can be used for orientation, education, formative feedback, and, ultimately, assessment. © 2013 by Academic Pediatric Association.

Background: Successful transition to practice programs that use competency-based assessment require the involvement of all staff, especially those undertaking the preceptor role. Methods: Qualitative data were collected using interview methods. Participants were 14 newly employed nurses and 7 preceptors in the child and family community health service in South Australia. Participant narratives were recorded electronically, transcribed, and thematically analyzed using the paradigm of critical social science. Results: Five themes were identified that describe enablers as well as barriers to applying a flexible transition to practice program using competency-based assessment. These included flexibility in the program design, flexibility on the part of preceptors, flexibility to enable recognition of previous learning, flexibility in the assessment of competencies, and flexibility in workload. Conclusion: To ensure successful application of a transition to practice program using competency-based assessment, preceptors must understand the flexible arrangements built into the program design and have the confidence and competence to apply them. © SLACK Incorporated.