Browsing by Author "Mutcheson, Brock"
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- Diagnostic Modeling of Intra-Organizational Mechanisms for Supporting Policy ImplementationMutcheson, Brock (Virginia Tech, 2016-06-28)The Virginia Guidelines for Uniform Performance Standards and Evaluation Criteria for Teachers represented a significant overhaul of conventional teacher evaluation criteria in Virginia. The policy outlined seven performance standards by which all Virginia teachers would be evaluated. This study explored the application of cognitive diagnostic modeling to measure teachers' perceptions of intra-organizational mechanisms available to support educational professionals in implementing this policy. It was found that a coarse-grained, four-attribute compensatory, re-parameterized unified model (C-RUM) fit teacher perception data better and had lower standard errors than the competing finer-grained models. The Q-matrix accounted for the complex loadings of items to the four theoretically and empirically driven mechanisms of implementation support including characteristics of the policy, teachers, leadership, and the organization. The mechanisms were positively, significantly, and moderately correlated which suggested that each mechanism captured a different, yet related, component of policy implementation support. The diagnostic profile estimates indicated that the majority of teachers perceived support on items relating to "characteristics of teachers." Moreover, almost 60% of teachers were estimated to belong to profiles with perceived support on "characteristics of the policy." Finally, multiple group multinomial log-linear models (Xu and Von Davier, 2008) were used to analyze the data across subjects, grade levels, and career status. There was lower perceived support by STEM teachers than non-STEM teachers who have the same profile, suggesting that STEM teachers required differential support than non-STEM teachers. The precise diagnostic feedback on the implementation process provided by this application of diagnostic models will be beneficial to policy makers and educational leaders. Specifically, they will be better prepared to identify strengths and weaknesses and target resources for a more efficient, and potentially more effective, policy implementation process. It is assumed that when equipped with more precise diagnostic feedback, policy makers and school leaders may be able to more confidently engage in empirical decision making, especially in regards to targeting resources for short-term and long-term organizational goals subsumed within the policy implementation initiative.
- The DoCTRINE Guidelines: Defined Criteria To Report INnovations in EducationBlanco, Maria; Prunuske, Jacob; DiCorcia, Mark; Learman, Lee A.; Mutcheson, Brock; Huang, Grace C. (Lippincott Williams & Wilkins, 2022-05-01)Purpose: Reporting guidelines assist authors in conducting and describing their research in alignment with evidence-based and expert-determined standards. However, published research-oriented guidelines do not capture all of the components that must be present in descriptions of educational innovations in health professions education. The authors aimed to create guidelines for educational innovations in curriculum development that would be easy for early-career educators to use, support reporting necessary details, and promote educational scholarship. Method: Beginning in 2017, the authors systematically developed a reporting checklist for educational innovations in curriculum development, called Defined Criteria To Report INnovations in Education (DoCTRINE), and collected validity evidence for its use according to the 4 inferences of Kane's framework. They derived the items using a modified Delphi method, followed by pilot testing, cognitive interviewing, and interrater reliability testing. In May-November 2019, they implemented DoCTRINE for authors submitting to MedEdPORTAL, half of whom were randomized to receive the checklist (intervention group). The authors scored manuscripts using DoCTRINE while blinded to group assignment, and they collected data on final editorial decisions. Results: The final DoCTRINE checklist consists of 19 items, categorized into 5 components: introduction, curriculum development, curriculum implementation, results, and discussion. The overall interrater agreement was 0.91. Among the 108 manuscripts submitted to MedEdPORTAL during the study period, the mean (SD) total score was higher for accepted than rejected submissions (16.9 [1.73] vs 15.7 [2.24], P =.006). There were no significant differences in DoCTRINE scores between the intervention group, who received the checklist, and the control group, who did not. Conclusions: The authors developed DoCTRINE, using systematic approaches, for the scholarly reporting of educational innovations in curriculum development. This checklist may be a useful tool for supporting the publishing efforts of early-career faculty.
- Evaluating Rescuer Performance in Response to Opioid Overdose in a Community Setting: Evidence for Medically Appropriate Process MeasuresEdwards, G. Franklin III; Mierisch, Cassandra; Strauss, Allison; Mutcheson, Brock; Coleman, Keel; Horn, Kimberly; Parker, Sarah H. (Elsevier, 2023-02)Overdose education and naloxone distribution (OEND) programs are widely accepted to reduce opioid overdose deaths. However, there is currently no validated instrument to evaluate the skills of learners completing these programs. Such an instrument could provide feedback to OEND instructors and allow researchers to compare different educational curricula. The aim of this study was to identify medically appropriate process measures with which to populate a simulation-based evaluation tool. Researchers conducted interviews with 17 content experts, including healthcare providers and OEND instructors from south-central Appalachia, to collect detailed descriptions of the skills taught in OEND programs. Researchers used three cycles of open coding, thematic analysis, and consulted currently available medical guidelines to identify thematic occurrences in qualitative data. There was consensus among content experts that the appropriate nature and sequence of potentially lifesaving actions during an opioid overdose is dependent on clinical presentation. Isolated respiratory depression requires a distinct response compared to opioid-associated cardiac arrest. To accommodate these different clinical presentations, raters populated an evaluation instrument with the detailed descriptions of overdose response skills, such as naloxone administration, rescue breathing, and chest compressions. Detailed descriptions of skills are essential to the development of an accurate and reliable scoring instrument. Furthermore, evaluation instruments, such as the one developed from this study, require a comprehensive validity argument. In future work, the authors will integrate the evaluation instrument in high-fidelity simulations, which are safe and controlled environments to study trainees’ application of hands-on skills, and conduct formative assessments.
- Investigating Academic and Psychosocial Outcomes of First-Generation African American Postsecondary Students who completed Early College Access Programming: A Qualitative Case StudyWitcher, Angelica W. (Virginia Tech, 2020-12-17)This qualitative bounded case study examines both the benefits and challenges faced by first-generation African American students who have completed early college access programming (ECAP). Not all children have equal access to higher education, therefore educators have been trying to bridge the gap in education for years. Due to socio-economic challenges in society, there has been a colossal increase in the need for diversity and inclusion within postsecondary institutions. Students from various ethnicities and backgrounds bring different experiences to education and the education learned through those various experiences are valuable. Inequalities in college access experienced by first-generation African American students is the lens for this study. This study addresses the effectiveness of early college access and its effects on first-generation African American students' postsecondary academic and psychosocial outcomes. Driven by critical race theory, this study analyzed student perceptions of their participation in ECAP and whether it supported their academic achievement in college. The study consisted of 10 interviews with Achievable Dream alumni enrolled in six universities across the Commonwealth of Virginia. Results were analyzed using inductive coding to identify components that affect academic achievement. Findings suggest that participation in early college access programming established an educational foundation which led to positive outcomes in academic achievement throughout postsecondary education. In addition to positive outcomes, barriers to achieving academic success were also identified.
- Medical Students' Motivation-Related Perceptions in an Anatomy Course: A Mixed Methods Study to Inform Course Design and InstructionHolt Foerst, Emily Mary (Virginia Tech, 2022-03-10)Student motivation in medical education courses is essential for the development of life-long medical knowledge. Researchers have demonstrated that student learning in anatomy courses, fundamental to students' future medical learning, has suboptimal long-term outcomes. The purpose of this study was to investigate how medical students' motivation-related perceptions and course effort were different during the academic year through varied course content and elements of instruction. The study was guided by the MUSIC Model of Motivation theoretical framework and nested in the pragmatic paradigm. First-year medical students enrolled at a small, public allopathic medical school in the southeastern United States were surveyed and interviewed regarding their course perceptions. Quantitative data from 18 students and qualitative data from 14 students indicated that students' motivation-related perceptions and effort do vary over different course content and elements of instruction. Students consistently reported lower motivation-related perceptions and effort for prerecorded lectures, whereas they reported more positive motivation-related perceptions and effort for cadaver dissection. Results also indicated variability in motivation-related perceptions and effort among specific block content areas (e.g., musculoskeletal, cardiovascular, abdominopelvic). Study findings resulted in a variety of suggestions for course instructors on how anatomy course design and instructional practices could be intentionally adjusted in the interest of fostering student motivation and engagement. Implications for course design and instruction included general course guidance (e.g., clinical relevance, clear and broad understanding of course usefulness), prerecorded lecture recommendations (e.g., catalogued for easy reference, short and focused, effective use of visual and verbal elements), and cadaver lab instruction guidance (e.g., faculty and upper-level student engagement, student preparation expectations).
- People with active opioid use disorder as first responders to opioid overdoses: Improving implementation intentions to administer naloxoneEdwards, George Franklin III (Virginia Tech, 2023-08-08)The ongoing opioid crisis presents a significant public health challenge particularly for people who use opioids (PWUO). Naloxone is an opioid antagonist crucial to reducing opioid overdose mortality. Inconsistencies exist among PWUO in obtaining, carrying, discussing, and administering naloxone. Using sequential mixed methods, this study was aimed at investigating the use of implementation intentions on naloxone use among PWUO. Semi-structured interviews were conducted with 83 PWUO to gather individual experiences with using naloxone and contextual details regarding its use. An essentialist thematic analysis with inductive coding revealed valuable insights into where, for whom, and when naloxone is implemented. The analysis identified major themes such as caring for others' needs, knowledge gaps, reinforcement through overdose experiences, duality of overdose and compassion, and stigma. Minor themes related to syringe services program implementation and drug use were identified. Building on these qualitative findings a quantitative analysis determined the impact of implementation intentions on naloxone implementation. Participants were randomly assigned to develop implementation intentions or goal intentions for the use of naloxone. Follow-up surveys assessed changes in participants' intentions to obtain, carry, discuss, and administer naloxone and their actual implementation over a 6-month period. At the 3-month follow-up the experimental condition exhibited statistically significant positive intentions to obtain naloxone and engage in discussions about naloxone in social contexts of drug use. Changes in the magnitude of naloxone implementation were observed at the 3- and 6-month timepoints. Specifically, the self-reported discussion of naloxone showed noticeable changes in implementation frequency over time. This suggests that while implementation intentions may not have statistically significant effects on the use of naloxone it had some influence on the frequency of discussing naloxone prior to drug use. This work makes a valuable contribution to the existing literature because of its attempt to apply the Theory of Planned Behavior and implementation intentions in a novel way. Though the experimental hypothesis was not supported statistically significant observations were made for some behaviors at the 3-month follow-up. The pragmatic nature of the setting enhances the relevance of the findings and provides valuable insights for future interventions supporting PWUO.
- A Pilot Study Assessment of Medical Student Knowledge and System Citizenship Attitudes Pertaining to Health Systems ScienceMusick, David W.; Mutcheson, Brock; Trinkle, David B. (Dove Press, 2023-05-23)Background and Purpose: Health system science (HSS) has been described as the third pillar of medical education. We introduced a new health system science and interprofessional practice (HSSIP) curriculum, and measured students’ HSS knowledge and attitudes concerning health system citizenship. Methods: This pilot study involved first-year (M1) and fourth-year (M4) medical students in two cohorts across 2 years. Only M1 students in the second cohort participated in the new HSSIP curriculum. We compared student performance on a new National Board of Medical Examiners (NBME) HSS subject exam, and student attitudes toward system citizenship via a new attitudinal survey. Results: Fifty-six eligible fourth-year students (68%) and 70 (76%) study eligible first-year students participated in the study. NBME HSS exam performance by M4 students was statistically significantly higher than M1 students for both cohorts, with moderate to large effect sizes. Exam performance for M1 students not experiencing the HSS curriculum was higher than for M1 students who received HSS curricular content. Attitudes toward HSS by M4 versus M1 students were statistically significantly different on several survey items with moderate effect sizes. Scale internal consistency for the HSS attitude survey was strong (0.83 or higher). Discussion: There were differences among M4 and M1 medical students concerning knowledge of and attitudes toward HSS, with performance on the NBME subject exam similar to a national sample. Exam performance by M1 students was likely impacted by class size and other factors. Our results support the need for increased attention to HSS during medical education. Our health system citizenship survey has potential for further development and cross-institutional collaboration.
- Studying Moral Distress (MD) and Moral Injury (MI) Among Inpatient and Outpatient Healthcare Professionals During the COVID-19 PandemicWhitehead, Phyllis B.; Haisch, Carl E.; Hankey, Maria S.; Mutcheson, Brock; DeWitt, Sarah A.; Stewart, Christi A.; Stewart, Jonathan D.; Bath, Jennifer L.; Boone, Sherry M.; Jileaeva, Ilona; Faulks, Emily R.; Musick, David W. (2023-10-09)Background: COVID-19 increased moral distress (MD) and moral injury (MI) among healthcare professionals (HCPs). MD and MI were studied among inpatient and outpatient HCPs during March 2022. Objectives: We sought to examine (1) the relationship between MD and MI; (2) the relationship between MD/MI and pandemic-related burnout and resilience; and (3) the degree to which HCPs experienced pandemic-related MD and MI based on their background. Methods: A survey was conducted to measure MD, MI, burnout, resilience, and intent to leave healthcare at 2 academic medical centers during a 4-week period. A convenience sample of 184 participants (physicians, nurses, residents, respiratory therapists, advanced practice providers) completed the survey. In this mixed-methods approach, researchers analyzed both quantitative and qualitative survey data and triangulated the findings. Results: There was a moderate association between MD and MI (r = .47, P < .001). Regression results indicated that burnout was significantly associated with both MD and MI (P = .02 and P < .001, respectively), while intent to leave was associated only with MD (P < .001). Qualitative results yielded 8 sources of MD and MI: workload, distrust, lack of teamwork/collaboration, loss of connection, lack of leadership, futile care, outside stressors, and vulnerability. Conclusions: While interrelated conceptually, MD and MI should be viewed as distinct constructs. HCPs were significantly impacted by the COVID-19 pandemic, with MD and MI being experienced by all HCP categories. Understanding the sources of MD and MI among HCPs could help to improve well-being and work satisfaction.