Search

BackgroundImproving recovery from acute symptoms and preventing relapse are two significant challenges in severe mental illness. We developed a personalized smartphone-based app to monitor symptoms in real time and validated its acceptance, reliability, and validity. ObjectiveTo assess (i) acceptability of continuous monitoring to SMI patients and health professionals over 3 months; (ii) impact of active self-monitoring on positive psychotic symptoms assessed at 6 and 12 weeks; and (iii) the feasibility of detecting early warning signs of relapse. MethodsThe active symptom monitoring smartphone app was built into an end-to-end system in two NHS Trusts to enable real-time symptom self-monitoring and detection by the clinical team of early signs of relapse in people with severe mental illness. We conducted an open randomized controlled trial of active symptom monitoring compared to usual management to assess: (i) acceptability and safety of continuous monitoring over 3 months; (ii) impact of active self-monitoring on positive psychotic symptoms assessed at 6 and 12 weeks; (iii) feasibility of detecting early warning signs of relapse communicated to the healthcare staff via an app streaming data to the electronic health record. Eligible participants with a Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) diagnosis of schizophrenia and related disorders, and a history of relapse within the previous two years were enrolled from an early intervention team and a community mental health team. ResultsOf 181 eligible patients, 81 (45%) consented and were randomized to either active symptom monitoring or management as usual. At 12 weeks, 90% (33/36) of those in the active monitoring group continued to use the system and exhibited an adherence rate (defined as responding to >33% of alerts) of 84% (30/36}. Active symptom monitoring was associated with no difference on the empowerment scale in comparison to the usual management group at 12 weeks. The pre-planned intent-to-treat analysis of the primary outcome, a positive score on the Positive and Negative Syndrome Scale (PANSS) scale, showed a significant reduction in the active symptom monitoring group over 12 weeks in the early intervention center. Alerts for personalized early warning signs of relapse were built into the workflows of both NHS Trusts, and 100% of health professional staff used the system in a new digital workflow. Qualitative analyses supported the acceptability of the system to participants and staff. ConclusionsThe active smartphone monitoring system is feasible and was accepted by users in a 3-month study of people with severe mental illness, with surprisingly high levels of adherence. App use was associated with psychotic symptom improvement in recent-onset participants, but not those with longstanding illness, supporting the notion of improved self-management. When built into clinical management workflows to enable personalized alerts of symptom deterioration, the app has demonstrated utility in promoting earlier intervention for relapse. Trial RegistrationISRCTN Registry ISRCTN88145142; http://www.isrctn.com/ISRCTN88145142

Examiners' judgements play a critical role in competency-based assessments such as objective structured clinical examinations (OSCEs). The standardised nature of OSCEs and their alignment with regulatory accountability assure their wide use as high-stakes assessment in medical education. Research into examiner behaviours has predominantly explored the desirable psychometric characteristics of OSCEs, or investigated examiners' judgements from a cognitive rather than a sociocultural perspective. This study applies cultural historical activity theory (CHAT) to address this gap in exploring examiners' judgements in a high-stakes OSCE. Based on the idea that OSCE examiners' judgements are socially constructed and mediated by their clinical roles, the objective was to explore the sociocultural factors that influenced examiners' judgements of student competence and use the findings to inform examiner training to enhance assessment practice. Seventeen semi-structured interviews were conducted with examiners who assessed medical student competence in progressing to the next stage of training in a large-scale OSCE at one Australian university. The initial thematic analysis provided a basis for applying CHAT iteratively to explore the sociocultural factors and, specifically, the contradictions created by interactions between different elements such as examiners and rules, thus highlighting the factors influencing examiners' judgements. The findings indicated four key factors that influenced examiners' judgements: examiners' contrasting beliefs about the purpose of the OSCE; their varying perceptions of the marking criteria; divergent expectations of student competence; and idiosyncratic judgement practices. These factors were interrelated with the activity systems of the medical school's assessment practices and the examiners' clinical work contexts. Contradictions were identified through the guiding principles of multi-voicedness and historicity. The exploration of the sociocultural factors that may influence the consistency of examiners' judgements was facilitated by applying CHAT as an analytical framework. Reflecting upon these factors at organisational and system levels generated insights for creating fit-for-purpose examiner training to enhance assessment practice.

Purpose: This research presents a profile of the current skills and competencies that underpin construction management programmes' (CMP) curricula within United Kingdom (UK) higher education institutes (HEIs). In doing so, the work: synthesises disparate taught provisions across a range of HEIs; conducts a cross-comparative analysis between these provisions and engenders wider discourse and new insight into the consistency of current higher education practice. Design/methodology/approach: Both interpretivism and pragmatism are adopted to analyse secondary data sourced from construction management undergraduate programmes in the UK inductive reasoning and inferential analysis (i.e. quantitative rank correlation, text/data mining and qualitative inquiry) are utilised to help underscore the current technical and interpersonal skills and competencies noted within the programmes and develop new theories on curriculum shortfalls and inadequacies. Findings: Research findings demonstrate that the specific content of CMP are bespoke and tailored by the programme teaching team at each individual HEI; albeit, all programmes reviewed are in congruence regards the importance of broad technical and interpersonal themes. However, the degree to which these themes are publicly presented differ from the curricular and institutional documentation; specifically, a more "technical-based skill" image is being portrayed publicly whilst "interpersonal skills" are doing the heavy curriculum lifting. Hence, the foundational curriculum skills and competencies are firmly rooted in a sense of employability and career preparedness; a balance of technical and interpersonal skills. Identification of these skills and competencies provides a springboard for supplementary research to augment curriculum development. Originality/value: This research constitutes the first attempt to conduct a cross-comparative analysis of descriptive metadata contained with curriculum development documents sourced from various UK HEIs. Emergent findings unearth the key skills and competencies that serve as the curriculum's foundation but also question whether a more consistent approach to construction management education should be sought.

This research first contextualises curriculum development in higher education institutions (HEIs) before focusing specifically on construction management programmes in order to engender wider polemic discourse and new insights into current provisions. The overarching epistemology adopts both interpretivist and pragmatist philosophical stances, couched within inductive reasoning, to critically analyse extant literature as a secondary data source, with each publication representing a unit of analysis. Thematic groupings of research activity are then clustered and interconnections between researchers and research themes are identified using bibliometrics. The findings illustrate that while curriculum development in HEIs has received increasing scrutiny and attention, there is a notable lack of connectivity among the studies conducted. This lack of a cohesive body of knowledge is exacerbated by the prevailing academic notion of 'individualism and self' vis-a-vis the 'collective team'. This leads to an emergent working hypothesis, namely, that bespoke curriculum development occurs within an 'every person for themselves' mentality. Cumulatively, these issues reported upon serve to illustrate a fundamental absence of a clear agenda for curriculum development in construction management programmes. In turn, this finding underscores the urgent need for a more prominent collaborative and global community of practice to optimise future educational provisions.

Although the principles behind assessment "for" and "as" learning are well-established, there can be a struggle when reforming traditional assessment "of" learning to a program which encompasses assessment "for" and "as" learning. When introducing and reporting reforms, tensions in faculty may arise because of differing beliefs about the relationship between assessment and learning and the rules for the validity of assessments. Traditional systems of assessment "of" learning privilege objective, structured quantification of learners' performances, and are done "to" the students. Newer systems of assessment promote assessment "for" learning, emphasise subjectivity, collate data from multiple sources, emphasise narrative-rich feedback to promote learner agency, and are done "with" the students. This contrast has implications for implementation and evaluative research. Research of assessment which is done to students typically asks, "what works", whereas assessment that is done "with" the students focuses on more complex questions such as "what works, for whom, in which context, and why?" We applied such a critical realist perspective drawing on the interplay between structure and agency, and a systems approach to explore what theory says about introducing programmatic assessment in the context of pre-existing traditional approaches. Using a reflective technique, the internal conversation, we developed four factors that can assist educators considering major change to assessment practice in their own contexts. These include enabling positive learner agency and engagement; establishing argument-based validity frameworks; designing purposeful and eclectic evidence-based assessment tasks; and developing a shared narrative that promotes reflexivity in appreciating the complex relationships between assessment and learning.

A growing body of psychology-based scholarship identifies emerging adulthood as a distinct, transitional stage of life and work characterized by several features, wherein relatively little is known regarding moral development. This study is part of a 3-year, longitudinal project involving recent graduates across six U.S. universities who studied journalism and media-related fields. Guided by emerging adulthood, moral psychology, and media exemplar research, this study analyzes results for 110 graduates who completed an online survey regarding their personality traits, virtuous character, moral reasoning, and ethical ideology. It constitutes the first detailed portrait of moral identity of emerging adults in media-related fields.