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Context As electronic health records ( EHRs) are adopted by teaching hospitals, educators must examine how this change impacts trainee development. Objectives We investigate this influence by studying clinician experiences of a hospital's move from paper charts to an EHR. We ask: how does each chart modality present conceptions of time and data interconnections? How do these conceptions affect clinical reasoning? Methods This two-phase, longitudinal study employed constructivist grounded theory. Data were collected at a paediatric teaching hospital before (Phase 1), during and after (Phase 2) the transition from a paper chart to an EHR system. Data collection consisted of field observations (146 hours involving 300 health care providers, 22 patients and 32 patient family members), think-aloud ( n = 13) and think-after ( n = 11) sessions, interviews ( n = 39) and document retrieval ( n = 392). Theories of rhetorical genre studies and visual rhetoric informed analysis. Results In the paper flowsheet, clinicians recorded and viewed patient data in chronologically organised displays that emphasised data interconnections. In the EHR flowsheet, clinicians viewed and recorded individual data points that were largely chronologically and contextually isolated. Clinicians reported that this change resulted in: (i) not knowing the patient's evolving status; (ii) increased cognitive workload, and (iii) loss of clinical reasoning support mechanisms. Conclusions Understanding how patient data are interconnected is essential to clinical reasoning. The use of EHRs supports this goal because the EHR is a tool for collecting dispersed data; however, these collections often deconstruct data interconnections. Where the paper flowsheet emphasises chronology and interconnectedness, the EHR flowsheet emphasises individual data values that are largely independent of time and other patient data. To prepare trainees to work with EHRs, the ways of thinking and acting that were implicitly learned through the use of paper charts must be made explicit. To support clinical reasoning, medical educators should provide lessons in connectivity - the chronologically framed data interconnections upon which clinicians rely to provide patient care. [ABSTRACT FROM AUTHOR]

Background: Health professions education curricula are undergoing reform towards social accountability (SA), defined as an academic institution's obligation to orient its education, service and research to respond to societal needs. However, little is known about how or which educational experiences transform learners and the processes behind such action. For example, those responsible for the development and implementation of undergraduate medical education (UGME) programs can benefit from a deeper understanding of educational approaches that foster the development of competencies related to SA. The purpose of this paper was to learn from the perspectives of the various partners involved in a program's delivery about what curricular aspects related to SA are expressed in a UGME program. Methods: We undertook a qualitative descriptive study at a francophone Canadian university. Through purposive convenience and snowball sampling, we conducted 16 focus groups (virtual) with the following partners: (a) third‐ and fourth‐year medical students, (b) medical teachers, (c) program administrators (e.g., program leadership), (d) community members (e.g., community organisations) and (e) patient partners. We used inductive thematic analysis to interpret the data. Results: The participants' perspectives organised around four key themes including (a) the definition of a future socially accountable physician, (b) socially accountable educational activities and experiences, (c) characteristics of a socially accountable MD program and (d) suggestions for curriculum improvement and implementation. Conclusions: We extend scholarship about curricular activities related to SA from the perspectives of those involved in teaching and learning. We highlight the relevance of experiential learning, engagement with community members and patient partners and collaborative approaches to curriculum development. Our study provides a snapshot of what are the sequential pathways in fostering SA among medical students and therefore addresses a gap between knowledge and practice regarding what contributes to the implementation of educational approaches related to SA. We emphasise the need for educational innovation and research to develop and align assessment methods with teaching and learning related to SA. This study delves into how a medical training fosters socially accountable physicians. Findings underscore the importance of experiential learning, community engagement, and collaborative curriculum development. #MedEd #SocialAccountability [ABSTRACT FROM AUTHOR]

Introduction: The OSCE is a sociomaterial assemblage—a meshing together of human and material components producing multiple effects. Materials matter because they shape candidate performance, with potentially calamitous career consequences if materials influence performance unjustly. Although the OSCE literature refers to materials, few papers study the sociomateriality of OSCEs. Therefore, we explored OSCE stakeholders' talk about sociomaterial assemblages to better understand their importance for candidate performance. Methods: We conducted 15 focus groups with OSCE candidates (n = 42), examiners (n = 20) and simulated patients (n = 17) after an Australian postgraduate nursing OSCE. Sociomateriality informed our team‐based framework analysis of data. Results: Participants identified a multiplicity of OSCE materials (objects, technologies and spaces) thought to matter for candidate performance. Candidates' unfamiliarity with materials and missing or malfunctioning materials were reported to yield numerous negative impacts (eg cognitive overload, negative affect, time‐wasting), thereby adversely affecting candidate performance. Both examiners and candidates made micro‐adjustments to sociomaterial assemblages during the OSCE in order to make it work (eg candidates saying what they would do rather than doing it). Sometimes, such tinkering extended so far that sociomaterial assemblages were ruptured (eg examiners ignoring rubrics to help pass candidates), potentially influencing OSCE standardisation. Discussion: Our novel empirical study extends previous conceptual work by illustrating wide‐ranging sociomaterial assemblages influencing OSCE candidate performance. Further research is now needed employing sociomaterial approaches to further elucidate sociomaterial entanglements in diverse OSCEs. We encourage OSCE stakeholders to become more attuned to the productive nature of materials within all stages of OSCE design and implementation. The authors demonstrate the extent to which materials really matter in shaping candidate performance in OSCEs [ABSTRACT FROM AUTHOR]

Context: Goals of care (GoC) discussions occur amongst patients, family members and clinicians in order to establish plans of care and are invaluable aspects of end‐of‐life care. In previous research, medical learners have reported insufficient training and emotional distress about end‐of‐life decision making, but most studies have focused on postgraduate trainees and have been quantitative or have evaluated specific educational interventions. None have qualitatively explored medical students' experiences with GoC discussions, their perceptions of associated hidden curricula, and the impacts of these on professional identity formation (PIF), the individualised developmental processes by which laypersons evolve to think, act and feel like, and ultimately become, medical professionals. Methods: Using purposive sampling at one Canadian medical school, individual semi‐structured interviews were conducted with 18 medical students to explore their experiences with GoC discussions during their core internal medicine clerkship. Interviews were audiorecorded, transcribed and anonymised. Concurrently with data collection, transcripts were analysed iteratively and inductively using interpretative phenomenological analysis, a qualitative research approach that allows the rich exploration of subjective experiences. Results: Participants reported minimal support and supervision in conducting GoC discussions, which were experienced as ethically challenging, emotionally powerful encounters exemplifying tensions between formal and hidden curricula. Role modelling and institutional culture were key mechanisms through which hidden curricula were transmitted, subverting formal curricula in doing so and contributing to participants' emotional distress. Participants' coping responses were generally negative and included symptoms of burnout, the pursuit of standardisation, rationalisation, compartmentalisation and the adaptation of previously held, more idealised professional identities. Conclusions: GoC discussions in this study were often led by inexperienced medical students and impacted negatively on their PIF. Through complex emotional processes, they struggled to reconcile earlier concepts of physician identities with newly developing ones and often reluctantly adopted suboptimal professional behaviours and attitudes. Improved education about GoC discussions is necessary for patient care and may represent concrete and specific opportunities to influence students' PIF positively. The research described in this paper illustrates how leading goals‐of‐care discussions as a very junior learner can lead to emotional distress and have negative impacts on professional identity development. [ABSTRACT FROM AUTHOR]

Medical Education 2012: 46: 748-756 Context Capacity-building programmes in low-income countries (LICs) are subject to a tension between the requirement to best train workers to fulfil national needs and the requirement to meet international expectations of their students, academics and institutions. This paper presents a theoretical framework developed from a case study of an undergraduate degree programme in Malawi and explores how national needs and international expectations can be managed in health profession settings in LICs to ensure successful curriculum development. Methods An inductive qualitative methodology, grounded theory, combined with open-ended interviews with students, graduates, tutors and external stakeholders in the programme, was used to develop a theoretical framework. Results A total of 22 interviews were performed; their analysis conceptualised the tension between national needs and international expectations, and resulted in 12 codes, in four categories: competing and advancing agendas; processes of collaboration; developing a programme or professional identity, and perceptions of programme change. Conclusions This study describes a conceptual framework highlighting three particular areas for analysis to aid in understanding how to best manage competing agendas. These areas refer to, respectively, the significance of international expectations, the organisational climate, and the development of a professional identity. [ABSTRACT FROM AUTHOR]

Medical Education 2012: 46: 795-806 Context Many academic medical centres (AMCs) have introduced institutional policies, changed processes of care and implemented new technologies to improve health care quality. The impact of such changes on medical education has received little attention. We examine the impact of computerised provider order entry (CPOE) on the educational experiences of medical trainees who work and train in AMCs. Methods We conducted semi-structured interviews of postgraduate trainees and attending physicians in internal medicine at five AMCs (two with CPOE, three without CPOE). Trainees routinely rotate from CPOE to non-CPOE AMCs, whereas some attending physicians work at both types of AMC and are therefore well positioned to reflect on differences between CPOE and non-CPOE learning environments. Data collection and analysis used grounded theory methods. We sampled purposively until we achieved theoretical saturation. Results Our study included 11 residents and six attending physicians. Computerised provider order entry had both positive and negative impacts on five aspects of postgraduate training: (i) learning (better for medication interactions and availability of learning resources; worse for learning medication doses); (ii) teaching (more medication information available to enhance case discussions; fewer face-to-face teaching opportunities); (iii) feedback (improved ability to observe medication ordering behaviours to inform feedback; less provision of direct feedback); (iv) clinical supervision (facilitates efficient and safe supervision from a distance; may impede trainee independence), and (v) trainee assessment (increased opportunity to assess clinical decision-making and organisational skills). Conclusions We identify five key educational themes that are positively and negatively impacted by CPOE. These themes form a conceptual framework that could be applied to define the educational impact of other health care quality and patient safety practices. This will help educators to identify educational opportunities and protect the safety of the training experience of residents in AMCs. [ABSTRACT FROM AUTHOR]

Objectives Undergraduate medical students are prone to struggle with learning in clinical environments. One of the reasons may be that they are expected to self-regulate their learning, which often turns out to be difficult. Students' self-regulated learning is an interactive process between person and context, making a supportive context imperative. From a socio-cultural perspective, learning takes place in social practice, and therefore teachers and other hospital staff present are vital for students' self-regulated learning in a given context. Therefore, in this study we were interested in how others in a clinical environment influence clinical students' self-regulated learning. Methods We conducted a qualitative study borrowing methods from grounded theory methodology, using semi-structured interviews facilitated by the visual Pictor technique. Fourteen medical students were purposively sampled based on age, gender, experience and current clerkship to ensure maximum variety in the data. The interviews were transcribed verbatim and were, together with the Pictor charts, analysed iteratively, using constant comparison and open, axial and interpretive coding. Results Others could influence students' self-regulated learning through role clarification, goal setting, learning opportunities, self-reflection and coping with emotions. We found large differences in students' self-regulated learning and their perceptions of the roles of peers, supervisors and other hospital staff. Novice students require others, mainly residents and peers, to actively help them to navigate and understand their new learning environment. Experienced students who feel settled in a clinical environment are less susceptible to the influence of others and are better able to use others to their advantage. Conclusions Undergraduate medical students' self-regulated learning requires context-specific support. This is especially important for more novice students learning in a clinical environment. Their learning is influenced most heavily by peers and residents. Supporting novice students' self-regulated learning may be improved by better equipping residents and peers for this role. [ABSTRACT FROM AUTHOR]

Context While medical curricula were traditionally almost entirely comprised of bioscientific knowledge, widely accepted competency frameworks now make clear that physicians must be competent in far more than biomedical knowledge and technical skills. For example, of the influential CanMEDS roles, six are conceptually based in the social sciences and humanities (SSH). Educators frequently express uncertainty about what to teach in this area. This study concretely identifies the knowledge beyond bioscience needed to support the training of physicians competent in the six non-Medical Expert CanMEDS roles. Methods We interviewed 58 non-clinician university faculty members with doctorates in over 20 SSH disciplines. We abstracted our transcripts (meaning condensation, direct quotations) resulting in approximately 300 pages of data which we coded using top-down (by CanMEDS role) and bottom-up (thematically) approaches and analysed within a critical constructivist framework. Participants and clinicians with SSH PhDs member-checked and refined our results. Results Twelve interrelated themes were evident in the data. An understanding of epistemology, including the constructed nature of social knowledge, was seen as the foundational theme without which the others could not be taught or understood. Our findings highlighted three anchoring themes ( Justice, Power, Culture), all of which link to eight more specific themes concerning future physicians' relationships to the world and the self. All 12 themes were cross-cutting, in that each related to all six non-Medical Expert CanMEDS roles. The data also provided many concrete examples of potential curricular content. Conclusions There is a definable body of SSH knowledge that forms the academic underpinning for important physician competencies and is outside the experience of most medical educators. Curricular change incorporating such content is necessary if we are to strengthen the non-Medical Expert physician competencies. Our findings, particularly our cross-cutting themes, also provide a pedagogically useful mechanism for holistically teaching the underpinnings of physician competence. We are now implementing our findings into medical curricula. [ABSTRACT FROM AUTHOR]

Context We developed, implemented and evaluated an evidence-based programme of feedback designed to address limitations identified in the current literature. Objectives We sought to advance understanding about how and why feedback processes might be more effective in clinical education. Methods Three faculty members and nine first-year internal medicine residents participated in the pilot programme. To counter challenges identified in the literature, feedback was based on direct observation, grounded in longitudinal faculty-resident relationships, and devoid of summative assessment. We used a qualitative case study design to address three research questions: (i) What benefits did the participants describe? (ii) What elements of the programme facilitated these benefits? (iii) What were the limitations and challenges of the programme? Collected data included audiotapes of interactions between faculty members and residents, field notes written during observations, and semi-structured interviews and focus groups with resident participants. Data analysis moved cyclically and iteratively through inductive and deductive analysis. Results Residents described benefits relating to their ways of working (clinical skills), ways of learning (accountability for learning) and ways of feeling (emotional well-being). According to participants, specific elements of the programme that achieved these benefits included the direct observation of authentic clinical work, the longitudinal relationship with a faculty member and the emergence of feedback as a conversation between the faculty member and learner. Conclusions We conclude that the conditions established within our pilot feedback programme influenced the learning culture for first-year internal medicine residents by grounding direct observation in authentic clinical work and setting the observations in the context of a longitudinal, non-assessment-based relationship between a faculty member and resident. These conditions appeared to influence residents' participation in the feedback process, their ways of approaching their daily clinical work, their emotional well-being and their engagement in their own learning. [ABSTRACT FROM AUTHOR]

Context Good preparation for surgical procedures has been linked to better performance and enhanced learning in the operating theatre. Mental imagery is increasingly used to enhance performance in competitive sport and there has been recent interest in applying this in surgery. Objectives This study aims to identify the mental imagery components of preoperative preparation in orthopaedic trauma surgery and to locate these practices in existing socio-material theory in order to produce a model useful for surgical skills training. Methods Semi-structured interviews were conducted with nine orthopaedic surgeons. Participants were identified by personal recommendation as regularly performing complex trauma operations to a high standard, and by affiliation to an international instruction course in trauma surgery. Interviews were audio-recorded and transcripts were independently analysed using thematic analysis. Results Analysis revealed that surgeons interact intensively with multiple colleagues and materials during their preparatory activities. Such interactions stimulate mental imagery in order to build strategy and rehearse procedures, which, in turn, stimulate preparatory interactions. Participants identified the discussion of a preoperative 'plan' as a key engagement tool for training junior surgeons and as a form of currency by which a trainee may increase his or her participation in a procedure. Conclusions Preoperative preparation can be thought of as a socio-material ontology requiring a surgeon to negotiate imaginal, verbal and physical interactions with people, materials and his or her own mental imagery. Actor-network theory is useful for making sense of these interactions and for allowing surgeons to interrogate their own preparative processes. We recommend supervisors to use a form of preoperative plan as a teaching tool and to encourage trainees to develop their own preparatory skills. The ability of a trainee to demonstrate sound preparation is an indicator of readiness to perform a procedure. [ABSTRACT FROM AUTHOR]

Context Given that the staffing of rural facilities represents an international challenge, the support, training and development of students of rural origin at institutions of higher learning ( IHLs) should be an integral dimension of health care provisioning. International studies have shown these students to be more likely than students of urban origin to return to work in rural areas. However, the crisis in formal school education in some countries, such as South Africa, means that rural students with the capacity to pursue careers in health care are least likely to access the necessary training at an IHL. In addition to challenges of access, throughput is relatively low at IHLs and is determined by a range of learning experiences. Insight into the storied educational experiences of health care professionals ( HCPs) of rural origin has the potential to inform the training and development of rural-origin students. Methods Six HCPs of rural origin were purposively selected. Using a narrative inquiry approach, data were generated from long interviews and a range of arts-based methods to create and reconstruct the storied narratives of the six participants. Codes, categories and themes were developed from the reconstructed stories. Reid's four-quadrant model of learning theory was used to focus on the learning experiences of one participant. Results Alternative learning spaces were identified, which were made available through particular social spaces outwith formal lecture rooms. These offered opportunities for collaboration and for the reconfiguring of the participants' agency to be, think and act differently. Through the practices enacted in particular learning spaces, relationships of caring, sharing, motivating and mentoring were formed, which contributed to personal, social, academic and professional development and success. Conclusions Learning spaces outwith the formal lecture theatre are critical to the acquisition of good clinical skills and knowledge in the development of socially accountable HCPs of rural origin. [ABSTRACT FROM AUTHOR]

Context Electives commonly represent a valued, enjoyed and formative part of medical training. However, there is little empirical evidence about students' preparedness, practices and perceptions of medical electives in resource-poor settings. Exploring what students do, why and under what circumstances is therefore worthwhile. Objectives This study aimed to evaluate students' views on the processes, outcomes and impacts of medical electives in three low-income countries. Methods A qualitative study using purposeful sampling and semi-structured interviews was conducted. Participants were 29 Western students on medical electives at seven host sites in sub-Saharan Africa. A framework approach was used to analyse 872 minutes of audio-recorded data. Results Students were highly positive about their experiences and seemed aware of their clinical limitations. Pre-departure training offered by some institutions was beneficial, but the content was perceived to be of little clinical relevance. Language barriers were the main challenges faced by students, even in places where English was the second language. Students who stayed longer, were nearer qualification or were based in rural units (rather than teaching centres) contributed more to patient care. Supervision was considered adequate but this appeared to be judged in a local context. Deliberate inappropriate practice was not encountered, but on occasion misunderstanding arose over the student's status. Conclusions Students who undertake electives in resource-poor countries appear to have clearly thought out and positive intentions, but current systems cause concern with reference to student activities and staff time, and require improvement. Instead of focusing on education benefits alone, students (and their sending institutions) need to consider other approaches through which host communities can more clearly benefit. Effective pre-departure preparation should become a requirement. [ABSTRACT FROM AUTHOR]

CONTEXT Major influences on learning about medical professionalism come from the hidden curriculum. These influences can contribute positively or negatively towards the professional enculturation of clinical students. The fact that there is no validated method for identifying the components of the hidden curriculum poses problems for educators considering professionalism. The aim of this study was to analyse whether a cultural web, adapted from a business context, might assist in the identification of elements of the hidden curriculum at a UK veterinary school. METHODS A qualitative approach was used. Seven focus groups consisting of three staff groups and four student groups were organised. Questioning was framed using the cultural web, which is a model used by business owners to assess their environment and consider how it affects their employees and customers. The focus group discussions were recorded, transcribed and analysed thematically using a combination of a priori and emergent themes. RESULTS The cultural web identified elements of the hidden curriculum for both students and staff. These included: core assumptions; routines; rituals; control systems; organisational factors; power structures, and symbols. Discussions occurred about how and where these issues may affect students' professional identity development. CONCLUSIONS The cultural web framework functioned well to help participants identify elements of the hidden curriculum. These aspects aligned broadly with previously described factors such as role models and institutional slang. The influence of these issues on a student's development of a professional identity requires discussion amongst faculty staff, and could be used to develop learning opportunities for students. The framework is promising for the analysis of the hidden curriculum and could be developed as an instrument for implementation in other clinical teaching environments. [ABSTRACT FROM AUTHOR]

Medical Education 2012: 46: 894-902 Objectives Enculturation is a normal and continuing part of human development. This study examined how medical graduates perceive the process of enculturation after graduation. Methods We conducted a qualitative study of the values of medical graduates associated with Sydney Medical School to identify processes that contribute to the ongoing process of enculturation. Results Two processes contributing to the process of enculturation were identified. Participants were aware of having passively absorbed the explicit and implicit culture of medicine, and of having actively sought to assimilate (or to avoid assimilating) the medical culture. The processes of enculturation were particularly evident in relation to three major concerns: competence; patient-centredness, and self-care. Conclusions The participants in this study demonstrated the capacity to reflect on and differentiate between two types of enculturation: absorption and assimilation. They were aware of the impacts of enculturation with respect to three main sets of values that are, respectively, epistemic, interpersonal and personal. Faculty development programmes might benefit from paying explicit attention to the process of enculturation and its influence on learning and practice. [ABSTRACT FROM AUTHOR]

Medical Education 2011: 45: 1220-1229 Objectives Medical students must develop not only their professional identity but also inclusive social attitudes for effective medical practice in the future. This study explores the elements that contribute to medical students' sense of professional identity and investigates the concept of social exclusivity and how this might relate to students' development of their identity as medical professionals. Methods The study is based on qualitative data gathered in telephone interviews with 13 medical students enrolled in Years 1 or 3 at an undergraduate medical school at a university in Australia. The questions were open-ended and asked students about their experiences in medical school, sense of identity and social connections. Results Two main components contributed to a strong sense of professional identity in medical students: professional inclusivity and social exclusivity. Students experienced professional inclusivity when they attended clinical placements and when they were treated as future medical professionals by lecturers, doctors and patients. Social exclusivity was demonstrated by participants' perceptions of themselves as socially separate from non-medical students and isolated from students in other disciplines. Students described a sense of peer unity and a shared sense of identity as medical students within the medical school. Conclusions It is important to understand how students develop their sense of identity as medical professionals and the ways in which medical education and clinical placements can influence this professional identity. Although this study noted a very strong sense of social exclusivity in its findings, there were also high levels of intra-discipline inclusivity. These results suggest that there is a reciprocal and reinforcing relationship between student experiences of professional inclusivity and social exclusivity that creates a defined sense of professional identity. [ABSTRACT FROM AUTHOR]

Medical Education 2011: : 625-635 The objectives of this study were to determine the extent to which clinician-educators agree on definitions of critical thinking and to determine whether their descriptions of critical thinking in clinical practice are consistent with these definitions. Ninety-seven medical educators at five medical schools were surveyed. Respondents were asked to define critical thinking, to describe a clinical scenario in which critical thinking would be important, and to state the actions of a clinician in that situation who was thinking critically and those of another who was not. Qualitative content analysis was conducted to identify patterns and themes. The definitions mostly described critical thinking as a process or an ability; a minority of respondents described it as a personal disposition. In the scenarios, however, the majority of the actions manifesting an absence of critical thinking resulted from heuristic thinking and a lack of cognitive effort, consistent with a dispositional approach, rather than a lack of ability to analyse or synthesise. If we are to foster critical thinking among medical students, we must reconcile the way it is defined with the manner in which clinician-educators describe critical thinking - and its absence - in action. Such a reconciliation would include consideration of clinicians' sensitivity to complexity and their inclination to exert cognitive effort, in addition to their ability to master material and process information. [ABSTRACT FROM AUTHOR]

Medical Education 2011: : 389-399 Death and dying occur in almost all areas of medicine; it is essential to equip doctors with the knowledge, skills and attitudes they need to care for patients at the end of life. Little is known about what doctors learn about end-of-life care while at medical school and how they learn to care for dying patients in their first year as doctors. We carried out a qualitative study using face-to-face interviews with a purposive sample of 21 newly qualified doctors who trained in different medical schools. Data were analysed using a constant comparative approach. Two main groups of themes emerged. The first pertained to medical school experiences of end-of-life care, including: lack of exposure; a culture of 'clerking and signs'; being kept and keeping away from dying patients; lack of examinations; variable experiences, and theoretical awareness. The second group of themes pertained to the experiences of recently qualified doctors and included: realising that patients really do die; learning by doing; the role of seniors; death and dying within the hospital culture; the role of nursing staff, and the role of the palliative care team. Undergraduate medical education is currently failing to prepare junior doctors for their role in caring for dying patients by omitting to provide meaningful contact with these patients during medical school. This lack of exposure prevents trainee doctors from realising their own learning needs, which only become evident when they step onto the wards as doctors and are expected to care for these patients. Newly qualified doctors perceive that they receive little formal teaching about palliative or end-of-life care in their new role and the culture within the hospital setting does not encourage learning about this subject. They also report that they learn from 'trial and error' while 'doing the job', but that their skills and knowledge are limited and they therefore seek advice from those outside their usual medical team, mainly from nursing staff and members of palliative care teams. [ABSTRACT FROM AUTHOR]