Doctoral Dissertations (FHSCI)

Permanent URI for this collectionhttps://hdl.handle.net/10155/1651

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    Optimizing training designs and elevating reporting standards in simulation-based medical education
    (2024-09-01) Elliott, Leanne K.; Wattie, Nick
    Introduction: This thesis explores key elements of simulation-based education for healthcare professionals, focusing on protocol reporting, technical skill retention/transfer, and training microstructures. Study 1 developed and assessed new protocol reporting and evaluation tools (PRT and PET) to measure the quality of reporting (QOR) in simulation studies. Using a modified Delphi method, the PRT and PET were created and applied alongside the TIDieR Checklist and CONSORT Statement to evaluate 17 randomized controlled trials. Results revealed significant differences in QOR scores across the tools, highlighting strengths and areas for improvement in reporting practices. The PRT and PET have the potential to enhance QOR, enable accurate study replication, and assist in the identification of optimal training designs. Study 2 examined the long-term impact of a simulation-based mastery learning (SBML) curriculum versus a competency-based curriculum on pediatric emergency medicine (PEM) physicians’ video laryngoscopy (VL) skill retention and transfer six months post-training. A multidisciplinary panel set a minimum passing score (MPS) of 32/36 (89%) using the Mastery Angoff method. The mastery group outperformed the competency group in skill retention and transfer, suggesting that SBML better sustains VL skills amongst PEM physicians. Study 3 analyzed the microstructures of competency-based and mastery-based training interventions for VL. Behavior coding software determined that mastery learners took longer to reach their MPS, engaged in more partial versus whole practice trials, spent more time verbalizing preparatory steps and aftercare plans, and received more feedback from their instructor compared to learners in the competency group. These differences likely contributed to differences in VL skill learning, as observed in Study 2. Conclusions: This thesis emphasizes the importance of the microstructure in simulation-based training interventions. Detailed and accurate reporting and evaluation of training microstructures is necessary for the advancement of the field, and the newly developed PRT and PET provide a means to do so. The microstructure of the SBML intervention more effectively facilitated VL skill learning, compared to the competency-based intervention. These findings offer valuable insights for educators, researchers, and program facilitators in medical education.
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    Exploring the lived experience of aging among older adults who are chronically homeless
    (2024-09-01) Peters, Volletta M.; Sun, Winnie
    A rise in the number of older adults in Canada living longer and healthier lives has been lauded as a medical and public health success. In response, the Canadian government developed directives promoting healthy aging and aging in place. Missing from these directives is a subset of older adults, many of whom are entering homelessness later in life and are aging with chronic homelessness. While there is an increasing number of studies focusing on older adults who are homeless, there remains a dearth of scholarly literature on those experiencing chronic homelessness. Due to the lack of empirical data, it is challenging to devise solutions to address the healthcare, social support and housing gaps experienced by older adults who are homeless. The purpose of this interpretative phenomenological study was to explore the conceptualization of older adults who were chronically homeless, and their lived experiences related to aging. The study was guided by the social constructivism philosophical paradigm to more fully understand how the participants constructed and applied meaning to their lived experiences of the phenomenon. During 3 months of fieldwork, I met with 18 older adults who were chronically homeless and purposefully selected from study settings that provided homeless services. Data collection included semistructured interviews and unstructured observations. Through member checking, participants reviewed and confirmed their transcribed interview notes. The data were transcribed, summarized and analyzed using phenomenological analysis. Six significant themes and 21 related subthemes emerged from the data. The major themes included: (a) suddenly, everything gets taken away from you; (b) physiological and psychosocial changes in the past five years; (c) aging describes life; (d) COVID-19 changed everything; (e) experiences with healthcare and social services; and (f) participants recommendations to address current needs and fill healthcare, housing and social service gaps. Despite their desire to move out of the homeless shelters into permanent housing, participants were hampered by a lack of material and immaterial resources. Policymakers and decision-makers in healthcare, social services, and housing can utilize the findings to fill public policy and service gaps that contribute to and perpetuate homelessness among older adults.
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    Attention-Deficit/Hyperactivity Disorder (ADHD) and the influence of multisensory processes and sensorimotor integration on motor performance
    (2022-07-01) McCracken, Heather; Yielder, Paul; Murphy, Bernadette
    This thesis sought to investigate how adult Attention-Deficit/Hyperactivity Disorder (ADHD) influences processes relating to motor learning, sensory integration, and somatosensory processing. ADHD is associated with difficulties in motor control, including alterations to neural structure and function. However, it is unknown how these characteristics may influence motor control in adulthood. Results from study one suggests that those with ADHD exhibit an attenuation of neural activity in Brodmann area (BA) 2, right-hemispheric parietal lobe, in response to multisensory input. This may be reflective of alterations related to attentional resources and sensory processing when multiple simultaneous inputs are presented, as is the case during a multisensory condition. Differing activation within BA 2 provides important insight into the functioning of audiovisual multisensory processing in adults with ADHD. The second study, which utilized short-latency median nerve somatosensory evoked potentials (SEPs) paired with a novel visuomotor paradigm, yielded results of differing N18 and N30 SEP peak responses in those with ADHD. This suggests alterations to olivary-cerebellar-M1 processing and SMI when acquiring new motor skills, particularly those that are dependent on visuomotor input. Study three employed a novel force-matching motor paradigm and median nerve SEPs. Results indicated differential changes in the N18 SEP peak response after performing the novel force-matching task, suggesting a reduction in olivary-cerebellar-M1 inhibition. Finally, study 4 used source localization techniques to assess neural generator activity in response to median nerve stimulation after both visuomotor and force-matching motor paradigms. The ADHD group exhibited greater activation within BA 31 at post measures after performing the force-matching task, when compared to their baseline activity. This increased activity at post-measure may reflect activation of the Default Mode Network (DMN) and attentional changes, both of which are noted to be implicated in ADHD. As a whole, these findings provide a further understanding of the neurophysiological characteristics associated with ADHD, and their implications for motor control.