OBJECTIVE: To investigate how audio-biofeedback during the instruction of partial weight-bearing affected adherence, compared to traditional methods, in older adults; and to investigate the influence of individual characteristics.
METHODS: The primary outcome measure of this randomised controlled trial was the amount of load, measured as the ground reaction force, on the partial weight-bearing leg. The secondary outcome was the influence of individual characteristics on the amount of load. Included were healthy volunteers 60 years of age or older without gait impairment. Participants were randomly allocated to one of two groups; blinding was not possible. Partial weight-bearing of 20 kg was trained using crutches with audio-biofeedback (intervention group) or a bathroom scale (control group). The degree of weight-bearing was measured during six activities with sensor insoles. A mean load between 15 and 25 kg was defined as adherent.
RESULTS: There was no statistically significant difference in weight-bearing between the groups for all activities measured. For the sit-stand-sit activity, weight-bearing was within the adherence range of 15-25 kg (audio-biofeedback: 21.7 ± 16.6 kg; scale: 22.6 ± 13 kg). For standing, loading was below the lower threshold (10 ± 7 vs. 10 ± 10 kg). Weight-bearing was above the upper threshold for both groups for: walking (26 ± 11 vs. 34 ± 16), step-up (29 ± 18 vs. 34 ± 20 kg) and step-down (28 ± 15 vs. 35 ± 19 kg). Lower level of cognitive function, older age, and higher body mass index were correlated with overloading.
CONCLUSIONS: Audio-biofeedback delivered no statistically significant benefit over the scale method. Lower cognitive function, older age and higher body mass index were associated with overloading.
BACKGROUND: Not applicable due not being a clinical trial and due to the cross-sectional design (one measurement point, no health intervention, no change in health of a person).

To work with a psychological therapies service to implement a recovery plan, as required by a government body, aimed at improving patient outcomes (effectiveness) and decreasing practitioner variability (equity). A case-study utilizing components of a learning health system, including nationally mandated patient outcome data, comprising three 18-month phases: (1) retrospective baseline; (2) improving patient outcomes (management-led); and (3) reducing practitioner variability (clinician-led). Primary analyses focused on 35 practitioners (NPR = 35) who were constant across the three phases and their patients in each phase (NPA = 930, 1226, 1217, respectively). Reliable improvement rates determined patient outcomes and multilevel modeling yielded practitioner effects. To test generalizability, results were compared to the whole practitioner sample for each phase: (1) NPR = 81, NPA = 1982; (2) NPR = 80, NPA = 2227; (3) NPR = 74, NPA = 2267. Ethical approval was granted by the Health Research Authority. Patient outcomes improved in successive phases for both the core and whole practitioner samples with the largest impact occurring in the management-led intervention. Practitioner variability decreased in successive phases in both the core and whole practitioner samples except in the management-led intervention of the whole sample. Compared with the management-led intervention, the practitioner-led intervention yielded a decrease in practitioner effect exceeding 60% in the core sample and approaching 50% in the whole sample. The implementation of multiple components of a learning health system can lead to improvements in both the effectiveness and equity of a psychological therapy service.

BACKGROUND: The purpose was to investigate the psychometric features of the Feedback Quality Instrument (FQI) in medical students, emphasizing the instrument\'s utility for evaluating the quality of feedback provided in clinical contexts and the importance of performing so for medical trainees.
METHODS: The Persian version of the FQI was evaluated for content validity through a focus group of medical education experts. The questionnaire\'s face, content, and construct validity were assessed using Confirmatory Factor Analysis, internal consistency, and inter-rater reliability. The questionnaire was revised and pilot-tested, with medical students\' feedback in different clinical situations. The data was analyzed using AMOS26.
RESULTS: The content validity index equaled 0.88(> 0.79). The content validity ratio representing the proportion of participants who agreed on a selected item was 0.69(> 0.42). According to experts, item 25 is the only modified item, while items 23 and 24 are presented as one item. For reliability, Cronbach alpha was equaled to 0.98.
CONCLUSIONS: The Persian version of the Feedback Quality Instrument (FQI) was valid, reliable, and fair in assessing feedback quality in medical students, providing valuable insights for other institutions. Establishing a basis for systematically analyzing how certain educator behaviors affect student outcomes is practical.

BACKGROUND: Self-Regulated Learning (SRL) is key in developing healthcare professionals and lifelong learner. iCARE (internalization of Critical thinking, Assessment, Reflection to Empower learning) model was designed to enhance nursing students\' SRL.
OBJECTIVE: This study investigated the effects of iCARE on nursing students\' reflective practice, SRL, self-efficacy and skill performance as compared to conventional group reflection.
METHODS: A quasi-experimental exploratory study was employed on 49 final-year nursing students in a tertiary acute hospital. The iCARE group (n = 24) received guided daily reflective journal with weekly feedback while the group reflection group (n = 25) received group reflection. Both were facilitated by clinical instructors. Participants\' SRL score, self-efficacy level and skill performance were measured pre- and post- training. End of posting reflective journal between group was compared. Their experience and perception on both facilitation methods were obtained using questionnaires. Quantitative data were summarised and analysed using Chi-Square test and t-test. Theme coding and content analysis were used to analyse the qualitative responses.
RESULTS: Compared to group reflection group, the iCARE group reported a statistically significant improvement in SRL score, reflective practice, skill performance and self-efficacy in skill performance after a four-week clinical posting. Participants from both groups perceived that reflection helped them learn from peers and experience, enhanced their performance and motivated them to learn. Three unique themes emerged only from the iCARE group: iCARE helped to developed SRL; application of assessment, planning, implementation and evaluation (APIE) improved clinical reasoning; iCARE improved the use of feedback.
CONCLUSIONS: The findings demonstrated the effect of the iCARE model in enhancing the development of nursing students\' reflective practice, SRL and clinical learning outcomes. The design of iCARE model that embeds SRL instructions, APIE framework and SRL focused feedback can promote cognitive and metacognitive development as well as skill performance.

BACKGROUND: Although history taking is fundamental for diagnosing medical conditions, teaching and providing feedback on the skill can be challenging due to resource constraints. Virtual simulated patients and web-based chatbots have thus emerged as educational tools, with recent advancements in artificial intelligence (AI) such as large language models (LLMs) enhancing their realism and potential to provide feedback.
OBJECTIVE: In our study, we aimed to evaluate the effectiveness of a Generative Pretrained Transformer (GPT) 4 model to provide structured feedback on medical students\' performance in history taking with a simulated patient.
METHODS: We conducted a prospective study involving medical students performing history taking with a GPT-powered chatbot. To that end, we designed a chatbot to simulate patients\' responses and provide immediate feedback on the comprehensiveness of the students\' history taking. Students\' interactions with the chatbot were analyzed, and feedback from the chatbot was compared with feedback from a human rater. We measured interrater reliability and performed a descriptive analysis to assess the quality of feedback.
RESULTS: Most of the study\'s participants were in their third year of medical school. A total of 1894 question-answer pairs from 106 conversations were included in our analysis. GPT-4\'s role-play and responses were medically plausible in more than 99% of cases. Interrater reliability between GPT-4 and the human rater showed \"almost perfect\" agreement (Cohen κ=0.832). Less agreement (κ<0.6) detected for 8 out of 45 feedback categories highlighted topics about which the model\'s assessments were overly specific or diverged from human judgement.
CONCLUSIONS: The GPT model was effective in providing structured feedback on history-taking dialogs provided by medical students. Although we unraveled some limitations regarding the specificity of feedback for certain feedback categories, the overall high agreement with human raters suggests that LLMs can be a valuable tool for medical education. Our findings, thus, advocate the careful integration of AI-driven feedback mechanisms in medical training and highlight important aspects when LLMs are used in that context.

Background The National Medical Commission (NMC) of India has redesigned the graduate medical education program to equip Indian medical graduates with essential information, skills, attitudes, values, and responsiveness as physicians in their initial interactions with the community. Central to this initiative is the Attitude, Ethics, and Communication (AETCOM) module, designed as a guide for educators and institutions to implement a comprehensive, long-term program. This aims to ensure that students develop competency as clinicians, leaders, team players, communicators, lifelong learners, and professionals. Objectives The aim of this study is to evaluate students\' perceptions of the AETCOM modules during their first year. Methodology This cross-sectional study was conducted at BLDE (Deemed to be University), Vijayapura, India, utilizing self-administered, semi-structured questionnaires for data collection. The study included second- and third-year medical students, with all respondents who submitted their responses being included in the study. The total sample size comprised 123 students. Results Ninety-eight percent of the students agreed that the NMC had taken excellent initiative with the AETCOM module and found its duration sufficient. They suggested that the teaching-learning techniques should include more interactive sessions. Conclusions Feedback from the AETCOM module is crucial for enhancing its effectiveness, and it should be gathered from all medical colleges to propose necessary improvements.

UNASSIGNED: Feedback is a fundamental aspect of aphasia treatments. However, learning from feedback is a cognitively demanding process. At the most basic level, individuals must detect feedback and extract outcome-related information (i.e., feedback processing). Neuroanatomical and neuropsychological differences associated with post-stroke aphasia may influence feedback processing and potentially how people with aphasia (PWA) respond to feedback-based treatments. To better understand how post-stroke aphasia affects feedback-based learning, the current study leverages event-related potentials (ERPs) to (1) characterize the relationship between feedback processing and learning, (2) identify cognitive skills that are associated with feedback processing, and (3) identify behavioural correlates of feedback-based learning in PWA.
UNASSIGNED: Seventeen PWA completed a feedback-based novel word learning task. Feedback processing was measured using the feedback-related negativity (FRN), an ERP hypothesized to reflect the detection and evaluation of outcomes communicated via feedback. Individuals also completed neuropsychological assessments of language (phonological processing, verbal short-term memory) and executive functioning.
UNASSIGNED: PWA elicited an FRN that was sensitive to feedback valence. The magnitude of the FRN was not associated with novel word learning but was strongly correlated with performance on another feedback-based task, the Berg Card Sort. Cognitive variables (information updating, selective attention) but not language variables were associated with novel word learning.
UNASSIGNED: For PWA, feedback processing may be associated with learning in some but not all feedback-based contexts. These findings may inform future research in determining which variables moderate the relationship between feedback processing and learning with the long-term goal of identifying how feedback can be modified to support successful learning during aphasia rehabilitation.

Stem cells often rely on signals from a niche, which in many tissues adopts a precise morphology. What remains elusive is how niches are formed and how morphology impacts function. To address this, we leverage the Drosophila gonadal niche, which affords genetic tractability and live-imaging. We have previously shown mechanisms dictating niche cell migration to their appropriate position within the gonad and the resultant consequences on niche function. Here, we show that once positioned, niche cells robustly polarize filamentous actin (F-actin) and non-muscle myosin II (MyoII) toward neighboring germ cells. Actomyosin tension along the niche periphery generates a highly reproducible smoothened contour. Without contractility, niches are misshapen and exhibit defects in their ability to regulate germline stem cell behavior. We additionally show that germ cells aid in polarizing MyoII within niche cells and that extrinsic input is required for niche morphogenesis and function. Our work reveals a feedback mechanism where stem cells shape the niche that guides their behavior.

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OBJECTIVE: To promote public speaking skills, a pediatrics residency program developed a longitudinal public speaking curriculum grounded in deliberate practice and reflective practice.
METHODS: Residents delivered annual presentations and received formal feedback. Audience evaluation forms from 2005-2017 were included for analysis. The form used 5-point scales (5= best) for specific presentation elements (clarity, eye contact/body language, pace, succinct text, minimally distracting delivery, clear conclusion, appropriate learning objectives, achieving learning objectives, and answering questions) and for overall quality. Longitudinal changes in scores were analyzed with paired t tests.
RESULTS: Overall, 5,771 evaluations of 276 presentations given by 97 residents were analyzed. Between post-graduate year (PGY)-1 and PGY-3 presentations, mean overall rating increased from 4.38 to 4.59 (P<.001, d=0.51). The median percentage of 5-point scores increased from 50.0% (IQR, 24.3%-65.4%) to 72.5% (IQR, 53.3%-81.2%). Eight of 9 specific elements showed significant increases (median effect size 0.55). Residents whose initial presentations ranked in the bottom quartile had larger improvements than residents initially ranked in the top quartile.
CONCLUSIONS: After pediatric residents participated in a public speaking curriculum with targeted objectives, formal feedback, and repeated practice, their public speaking skills improved. Public speaking curricula can and should be adopted more broadly in graduate medical education.