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Scholars have questioned the effectiveness of reflective practice for gaining professional awareness or attaining professional development. In addition, the prevalence of inadequate comprehensive framework for pre-service teachers' reflective practice and insufficient support of teacher educators have been noted in the literature. Against these backdrops, the present study attempted to demonstrate how reflecting on reflections, a form of reflective practice, of Critical Incidents (CIs) contributes to building pre-service TESOL teachers' professional awareness. The study involved ten pre-service teachers (PSTs) in reflecting on reflections of CIs during the teaching practicum. Following the interpretive phenomenological approach, the study unfolded the CIs associated with pedagogical factors, including passive participation of the students, students' late arrival in the classroom, disobedience to teachers' instructions, the chaotic environment in the classroom, students' rude behavior, and disruption caused by technical glitches, and CIs associated with intrapersonal and interpersonal factors, comprising students' emotional exhaustion and unprofessional behaviors by senior teachers. Subsequently, it illustrated how PSTs cultivated their professional awareness through reflecting on reflections of CIs. The study presented a reflective practice framework applicable to pre-service and in-service teacher education programs. It also provided practical suggestions for pre-service and novice teachers to address and overcome the CIs. Teacher educators and trainers can harness the findings to prepare PSTs to conduct interactive and productive English language classes. [ABSTRACT FROM AUTHOR]

Despite recognizing the importance of critical incidents (CIs) in teachers' professionalism, there is a need for more research on novice teachers' CIs, especially emotional CIs. This study describes the emotional CIs of a novice language teacher during her first year of teaching by relying on Schutz et al.'s (in: Schutz, Hong, Francis (eds) Research on teacher identity: Mapping challenges and innovations, Springer, 2018) conceptual framework and Zembylas' (Journal of Research in Science Teaching 39:79–103, 2002) three-dimensional framework of intrapersonal, interpersonal, and intergroup levels of teacher emotions. Data were collected from semi-structured interviews, observational field notes, stimulated recall interviews, and online narratives. The teacher's intrapersonal emotional CIs dominantly influenced her current functioning to eschew creating similar negative experiences for her students. The interpersonal emotional CIs created tensions that largely influenced her claimed identity as a professional teacher. The intergroup emotional CIs made her develop negative perceptions about certain ethnic groups and educational stakeholders. Moreover, the findings indicate that while the teacher could function agentively at the classroom level, her limited agency at the institutional level created tensions in her identity as a professional teacher. The study portrays how novices negotiate and construct their professional identity based on emotional CIs, shows how such CIs accelerate novice teacher attrition, and provides implications for reducing the emotional gap between policymakers and novice teachers. [ABSTRACT FROM AUTHOR]

Copyright of Report: Zeitschrift für Weiterbildungsforschung is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

There is an increasing emphasis on assessing student learning outcomes from study abroad experiences, but this assessment often focuses on a limited range of outcomes and assessment methods. We argue for shifting to assessing student learning processes in study abroad and present the critical incident technique as one approach to achieve this goal. We demonstrate this approach in interviews with 79 students across a range of global engineering programs, through which we identified 173 incidents which were analyzed to identify common themes. This analysis revealed that students described a wide range of experiences and outcomes from their time abroad. Students' experiences were messy and complex, making them challenging to understand through typical assessment approaches. Our findings emphasize the importance of using a range of assessment approaches and suggest that exploring students' learning processes in addition to learning outcomes could provide new insights to inform the design of study abroad programs. [ABSTRACT FROM AUTHOR]

The social adjustment process is a prominent factor in the literature on the transition to higher education (HE). This vast body of research, however, has predominantly focussed on academically oriented first-year higher education (FYHE) contexts, leaving professionally oriented programs (providing vocational education that prepares students for a particular occupation) rather underexamined. Therefore, this study set out to explore what first-year students in professional HE contexts perceive to be the most important social experiences associated with their adjustment process in the first semester of FYHE. Furthermore, this study examines the extent to which the uncovered key experiences associated with social adjustment are reported at different times. Hereto, drawing on the critical incidents technique, qualitative data were collected from 104 purposively selected freshmen, enrolled in a Flemish (Dutch-speaking part of Belgium) university college which offers professional HE programs, such as social work and nursing. At the start of the second semester of FYHE, these respondents completed 'reflective logs' wherein they reflected on three critical social experiences during their first semester in HE. Firstly, a qualitative content analysis revealed that students report on five overarching themes: (1) dealing with the unknown, (2) establishing a first connection, (3) establishing a deeper connection, (4) support from peers and others, and (5) loneliness. Secondly, a quantitative analysis of code occurrence suggests that these five uncovered themes seem to be more significant at different times in the first semester of FYHE. Implications of the findings for the development of guidance and coaching initiatives are discussed. [ABSTRACT FROM AUTHOR]

Background: Areas of activity with many intersections pose an increased risk for errors and critical incidents. Therefore, procedures for acute pain therapy are potentially associated with an increased risk for adverse patient outcomes.Objective: The aim was to identify and grade the risk of critical incidents in the context of acute pain management.Material and Methods: The register of the nationwide reporting system critical incident reporting system of the Professional Association of German Anesthesiologists, the German Society for Anesthesiology and Intensive Care Medicine and the Medical Center for Quality in Medicine (CIRSmedical Anesthesiology) was screened for incidents concerning pain management. Out of 5365 cases reported nationwide up to 24 March 2020, 508 reports with the selection criterion "pain" could be identified and reviewed and 281 reports (55%) were included in a systematic analysis.Results: Of the 281 reports most came from anesthesiology departments (94%; 3% from surgery departments and 3% from other departments). The reported cases occurred most frequently on normal wards but a relevant proportion of the reports concerned intermediate and intensive care units or areas covered by a pain service (PS). Based on the description of the incident in the report, an involvement of the PS could be assumed for 42% of the cases. In terms of time, most of the events could be assigned to normal working hours (90%) and working days (84%; weekends 16%). The analyzed reports related to parenteral administration of analgesics (40%) and central (40%) or peripheral regional anesthesia procedures (23%) and 13% of the reports related to patient-controlled intravenous analgesia (PCIA; multiple answers possible). Most of the events were caused by technical errors, communication deficits and deviations from routine protocols. A relevant number of the cases were based on mix-ups in the administration route, the dosage, or the active agent. About one third of the sources of error were of an organizational nature, 59% of the cases posed a possible vital risk and in 16% of cases patients had vital complications. The risk grading by risk matrix resulted in an extremely high risk in 7%, a high risk in 62%, a moderate risk in 25% and a low risk in 6% of the cases. Comparing risk assessment of events with involvement of different analgesic methods, multiple medication, combination of analgesic methods or involvement of PS showed no significant differences. Likewise, no differences could be identified between the risk assessments of events at different superordinate cause levels. If more than one overriding cause of error had an impact, initially no higher risk profile was found.Conclusion: Incidents in the context of acute pain management can pose high risks for patients. Incidents or near-incidents are mostly related to mistakes and lack of skills of the staff, often due to time pressure and workload as well as to inadequate organization. [ABSTRACT FROM AUTHOR]

Universities have been promoting study abroad programmes for a long time to improve intercultural competence. However, the mere exposure to cultural differences while studying abroad does not ensure intercultural competence, unless study abroad students' reflective processes are explicitly targeted. The article presents the results of a short intervention grounded in the problem-based approach aimed at improving intercultural competence in study abroad students. Students were assigned to three conditions: a video-log condition (in which they have to narrate a critical incident occurred to them), a reflection-induced video-logs (in which they were prompted to reflect on the video-logs produced), and an active control condition. The reflection-induced video-log intervention improved students' perceived proficiency in Italian and perceived opportunities for cultural reflection, but it did not contribute to improve students' applicable and conceptual knowledge of intercultural competence. [ABSTRACT FROM AUTHOR]

Police officers are subjected, daily, to critical incidents and work-related stressors that negatively impact nearly every aspect of their personal and professional lives. They have resisted openly acknowledging this for fear of being labeled. This research examined the deleterious outcomes on the mental health of police officers, specifically on the correlation between years of service and change in worldviews, perception of others, and the correlation between repeated exposure to critical events and experiencing Post-Traumatic Symptoms. The Cumulative Career Traumatic Stress Questionnaire- Revised (Marshall in J Police Crim Psychol 21(1):62−71, 2006) was administered to 408 current and prior law enforcement officers across the United States. Significant correlations were found between years of service and traumatic events; traumatic events and post-traumatic stress symptoms; and traumatic events and worldview/perception of others. The findings from this study support the literature that perpetual long-term exposure to critical incidents and traumatic events, within the scope of the duties of a law enforcement officer, have negative implications that can impact both their physical and mental wellbeing. These symptoms become exacerbated when the officer perceives that receiving any type of service to address these issues would not be supported by law enforcement hierarchy and could, in fact, lead to the officer being declared unfit for duty. Finally, this research discusses early findings associated with the 2017 Law Enforcement Mental Health and Wellness Act and other proactive measures being implemented within law enforcement agencies who are actively working to remove the stigma associated with mental health in law enforcement. [ABSTRACT FROM AUTHOR]

The Covid-19 pandemic has precipitated dramatic changes in education systems around the world and pre-service teacher preparation programs have been notably impacted by the associated difficulties and constraints. Due to lockdown of universities and schools, practicum placements had to shift from in-person to virtual learning environments. However, being a practical classroom activity, practicum posed particular challenges that prompted teacher educators to make adjustments in their pedagogical strategies to meet the course requirements. The present study reports on the first cycle of an action research project undertaken to respond to the practicum crisis caused by the Covid-19 restrictions. Conducted with eleven practicum students, this research investigated whether engaging student teachers in vicarious experiences of critical incidents through Kolb's experiential learning cycle via a collaborative virtual application could create meaningful learning. The results indicated that the intervention process had the characteristics of active, constructive, authentic, intentional, and collaborative, and as well it led to improvements in practicum students' domain-specific knowledge and skills. Despite a few number of concerns raised, which will be utilized to refine the future implementations of the first action plan, the practicum students reported that this experience supported them during remote practicum and contributed positively to their development. Drawing on the results of the study, a series of rationales for the use of virtual vicarious experiences of critical incidents during Covid-19 and beyond are provided. [ABSTRACT FROM AUTHOR]

Understanding the antecedents of social entrepreneurship is critical for unleashing the potential of social entrepreneurship and thus for tackling social problems. While research has provided valuable insights into imprinting of the conventional entrepreneur, research on differences between social and conventional entrepreneurship suggests that social entrepreneurs evolve differently. Using survey data of 148 social entrepreneurs, we draw on the concepts of imprinting and critical incident recognition as a framework for understanding how social entrepreneur's childhood experiences and parental exposure to social entrepreneurship affect social entrepreneurial activity in adulthood. First, our results suggest that social entrepreneurs are imprinted by their childhood experiences but not by parental exposure to social entrepreneurship. Second, imprints tend to persist over time when they are linked to critical incidents regarding social entrepreneurship. These insights contribute to a deeper understanding of imprinting mechanisms in social entrepreneurship contexts and highlight the importance of making examples of social entrepreneurship tangible to children. [ABSTRACT FROM AUTHOR]

Supplying public transport systems with high levels of service quality is fundamental for retaining users and attracting new ones. Policies that improve transit service quality will ultimately lead to more sustainable travel patterns. Measuring overall service quality implies measuring the quality of several specific attributes and is prevalently evaluated through the perceptions of users, using satisfaction rates. In this study, we demonstrate that there is a further element that can influence users' perceptions, the so-called critical incidents (CI), defined as encounters that are particularly satisfying or dissatisfying. The concept is not restricted to ratings of the predefined product or service attributes, because customers who experience CI remember them well and can usually describe the experience. We implement a framework that includes CI and is innovative for several reasons. Firstly, we introduce attribute-specific (e.g. reliability, safety, comfort) CI to explain attribute-specific satisfaction levels, and then we model these with latent constructs allowing for measurement error in recalling the CI. We also demonstrate that using an Ordinal-Probit approach leads to more accurate results than its numerical counterpart, the latter possibly presenting biased results. Finally, we present a full Structural Equation Multiple Cause Multiple Indicator (SEM-MIMIC) model, which corrects for heterogeneity in the perceptions of users regarding satisfaction with the various service attributes, with the overall service, and with loyalty. For these purposes, we analyse an extensive database (96,763 interviewed passengers) derived from Customer Satisfaction Surveys in the railway services offered in the hinterland of Milan. Our main contribution to the literature is that we show that the occurrence of a CI has a substantial negative impact on passenger satisfaction for all service attributes. As it is a policy-related variable, it can be managed directly by the public transport (PT) administrators. To better plan and improve PT services, avoiding CI in specific items should be the strategy to follow. On the other hand, reliability, and added-value services are the primary service attributes that have a positive effect on satisfaction with the overall service and, in turn, on loyalty. Our model can be useful for PT administrators as it sheds light on how to improve the service according to users' preferences, and by considering the differences among user categories. [ABSTRACT FROM AUTHOR]

This study examined the challenges and critical psychosocial needs of Syrian refugee families with young children in Western Canada, and the role of cultural brokering in facilitating their psychosocial adaptation. Using a community-based participatory research approach and an adapted critical incident method, the study involved nine Arabic-speaking cultural brokers who were working with Syrian refugee families using holistic supports during early resettlement. Data collected through focus groups and semi-structured interviews are presented in five illustrative case studies, and reveal that Syrian families struggled with feeling safe and secure in Canada, adjusting to the changing roles in the family, and trying to find meaning in their lives. These struggles were attributed to families' overall challenges navigating various domains of integration (i.e., health, social services, and education), resulting in a heavy reliance on cultural brokers for social linking and bonding activities (Ager & Strang, Journal of Refugee Studies, 21, 166–191, 2008), including connecting families to needed supports and helping family members build relationships with one another. Challenges faced by families mapped onto the five psychosocial needs of Silove's (Intervention, 11, 237–248, 2013) Adaptation after Persecution and Trauma (ADAPT) conceptual framework as well as most of the core domains of Ager and Strang's (Journal of Refugee Studies, 21, 166–191, 2008) Social Integration framework. This study provides evidence for the use of both of these frameworks in further studies involving Syrian refugee populations; they proved useful for understanding how families, over time, can develop necessary skills to engage on their own in linking activities with various Canadian institutions and bridging activities with communities at large. [ABSTRACT FROM AUTHOR]

While previous research has assumed that intense leader anger displays result in negative consequences, researchers have recently started to outline their potential for prompting followers to improve their performance. We explain these conflicting positions by demonstrating that leaders’ anger intensity positively affects both deviance and work effort through triggering anger and anxiety in followers. We conducted two critical incident studies, replicating our results with different methodologies and controlling for potential alternative explanations. In line with theories on reciprocal emotions, supervisor-directed deviance became more likely with higher leader anger intensity because followers reacted with correspondingly more anger. However, in line with theories on complementary emotions, leaders’ anger intensity was also positively related to followers’ work effort due to followers’ anxiety. These results were replicated when taking leaders’ anger appropriateness into account as a potential moderator of the deviance-related path and when controlling for followers’ feelings of guilt (an alternative explanation for followers’ work effort). Our paper provides evidence that intense anger displays increase followers’ work effort but also cautions leaders to show these, as the work effort caused by them is based on followers’ intimidation and likely to be accompanied by deviant reactions. By considering the affective reactions triggered in followers, our paper integrates diverging theoretical perspectives on followers’ reactions to leaders’ anger intensity. Moreover, it is one of the first to disentangle the interpersonal effects that different expressions of the same emotion may have. [ABSTRACT FROM AUTHOR]

Education authorities in Australia are calling for valid tools to help assess prospective teachers’ non-academic attributes, with a particular need for identifying those attributes necessary for effective teaching in specific contexts. With the New South Wales (NSW) Department of Education, we aimed to develop a scenario-based tool to help assess the non-academic attributes necessary for beginning teachers working in rural and remote settings. Using a situational judgement test (SJT) methodology, we worked with experienced teachers (n = 19) to develop scenario-based items, which were then reviewed by school principals (n = 13). The teachers also adapted items previously developed and piloted in the UK. Next, prospective NSW teachers (n = 99) tried 32 new and adapted items targeting four clusters of attributes: empathy and communication, resilience and adaptability, organisation and planning, and culture and context. Item quality analyses revealed 22 acceptable items. We conclude by suggesting SJTs for promoting non-academic growth of prospective and beginning teachers. [ABSTRACT FROM AUTHOR]

While study success and completion rates are important issues in educational policy, research highlights the particular relevance of the first year in higher education (HE) for students' future academic performance and achievement. In Germany, the recent reform of degree programmes appears to have created new challenges related to students' transition to HE, yet little is known about the specific requirements students perceive as critical for their first-year experience. The present study, therefore, seeks to explore the first-year challenges in German HE from the student perspective focusing on the nexus of the individual and institutional factors relevant for successful transition. Following the critical incident technique, data collection consisted of semi-structured interviews with 25 students from all six faculties of a German university. We employed the qualitative content analysis to examine first-year challenges in terms of the critical requirements emerging from the interviews. First, the thematic analysis of the data resulted in identifying a broad range of personal, organisational, content-related and social requirements students perceived as critical for transition to HE. Second, the quantitative analysis of code occurrence suggested that personal and organisational requirements are most relevant from the students' perspectives. Finally, the single-case analysis of the interviews disclosed that individual students experience an accumulation of first-year challenges revealing the interconnectedness of critical requirements. In sum, the findings offer a systematic overview of the first-year challenges as well as provide detailed insights on how the interplay of institutional and individual factors contributes to the transition to HE. [ABSTRACT FROM AUTHOR]

Entrepreneurship education is a growing field of research within vocational education. During the last decade, an increasing number of empirical studies have been conducted on the impact of entrepreneurship education courses (EECs). Yet studies on entrepreneurship education still lack evidence on how to prepare entrepreneurs to handle dynamism and risks appropriately as well as how to identify and address entrepreneurial challenges and upcoming crises. This paper presents an EEC that intends to step into these gaps using a case-oriented learning environment that concentrates on critical incidents in the postformation phase. Preliminary studies identified these incidents as entrepreneurial challenges that typically emerge in young start-ups and threaten to lead to severe financial crises. The design of the EEC is systematically based on educational research. The EEC offers future entrepreneurs opportunities to develop entrepreneurial competence by experiencing the critical incidents that occur in the everyday working life of a young entrepreneur of a fictional model company. The participants are encouraged to slip into the entrepreneur's shoes, to identify emerging problems, and to reflect on solutions. The evaluation shows that the seminar was perceived as fruitful and supportive. Based on self-ratings this EEC is an intervention that women in particular seem to benefit from. The paper provides fruitful ideas to specify aims and to design EECs in the realm of risk management in the postformation phase. [ABSTRACT FROM AUTHOR]

This article presents a study designed to investigate and map the trajectories of brand love. Consumers described experiences related to the initiation and evolution of their relationships with their most loved brand. Participants were asked to graphically trace the course of their feelings toward their currently most loved brand and to recall the events that influenced those feelings. The paths toward brand love followed five distinct trajectories, labeled as 'slow development,' 'liking becomes love,' 'love all the way,' 'bumpy road,' and 'turnabout.' The formative experiences shaping these trajectories often include individual, personal, and private experiences that are largely outside any marketer's control. [ABSTRACT FROM AUTHOR]

The article discusses the travel behavior changes in the older people, depending on the incidents related to the public transport. It reports on the study of the negative and positive incidents in the public transport environment, conducted with participants from the Stockholm and its capital Sweden. The most negative incidents were found in the areas of station, ticketing and on-board, whereas maintenance of elevators, escalators and driving behavior were found as facilitating factors.

This paper presents a new lens for analyzing written reflections on the teaching experiences of pre-service [science] teachers. The lens, which borrows heavily from Activity Theory, allows science education researchers and teacher educators to identify tensions, disturbances, conflicts, and contradictions within teachers' written reflections as a means to help the participants situate their successes and challenges within the activity systems in which they operate. This paper describes the process through which the lens was crafted, defines the key constructs comprising the lens, applies the lens to the analysis of two purposefully selected reflection documents, and then considers the affordances of the lens. It also discusses how the insights gained from this lens have lead to new ways of facilitating reflection in pre-service science teachers, including the use of Kenneth Snelson's tensegrity sculptures as a metaphor for the goal of reflection. Finally, it connects the tensions identified in the individual reflections of two pre-service science teachers to broader issues being addressed in science education. [ABSTRACT FROM AUTHOR]

The aim of the study is to examine several combinations of risk factors known to the police - i.e., perpetrator and situational characteristics of the incidents - leading to two possible outcomes in domestic hostage and barricade incidents (HBI): autoaggressive and heteroaggressive behaviors from the perpetrator. Using a series of conjunctive analyses on a sample of 534 hostage and barricade incidents, results show that, depending on the specific combination of factors, the likelihood of violence could very much vary, suggesting that the checklist approach is not adequate for risk assessment in hostage and barricade incidents. HIGH-RISK represents a decision support system that can be easily integrated to any crisis-intervention structure (CIS) or police unit dealing with hostage and barricade incidents. [ABSTRACT FROM AUTHOR]

Psychological distress is a well-known complication in rheumatoid arthritis (RA), but knowledge regarding emotions and their relationship to participation restrictions is scarce. The objective of the study was to explore emotions related to participation restrictions by patients with early RA. In this study, 48 patients with early RA, aged 20-63 years, were interviewed about participation restrictions using the critical incident technique. Information from transcribed interviews was converted into dilemmas and linked to International Classification of Functioning, Disability, and Health (ICF) participation codes. The emotions described were condensed and categorized. Hopelessness and sadness were described when trying to perform daily activities such as getting up in the mornings and getting dressed, or not being able to perform duties at work. Sadness was experienced in relation to not being able to continue leisure activities or care for children. Examples of fear descriptions were found in relation to deteriorating health and fumble fear, which made the individual withdraw from activities as a result of mistrusting the body. Anger and irritation were described in relation to domestic and employed work but also in social relations where the individual felt unable to continue valued activities. Shame or embarrassment was described when participation restrictions became visible in public. Feelings of grief, aggressiveness, fear, and shame are emotions closely related to participation restrictions in everyday life in early RA. Emotions related to disability need to be addressed both in clinical settings in order to optimize rehabilitative multi-professional interventions and in research to achieve further knowledge. [ABSTRACT FROM AUTHOR]

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This study uses a hostage negotiation setting to demonstrate how a team of strategic police officers can utilize specific coping strategies to minimize uncertainty at different stages of their decision-making in order to foster resilient decision-making to effectively manage a high-risk critical incident. The presented model extends the existing research on coping with uncertainty by (1) applying the RAWFS heuristic (Lipshitz and Strauss in Organ Behav Human Decis Process 69:149-163, ) of individual decision-making under uncertainty to a team critical incident decision-making domain; (2) testing the use of various coping strategies during 'in situ' team decision-making by using a live simulated hostage negotiation exercise; and (3) including an additional coping strategy ('reflection-in-action'; Schön in The reflective practitioner: how professionals think in action. Temple Smith, London, ) that aids naturalistic team decision-making. The data for this study were derived from a videoed strategic command meeting held within a simulated live hostage training event; these video data were coded along three themes: (1) decision phase; (2) uncertainty management strategy; and (3) decision implemented or omitted. Results illustrate that, when assessing dynamic and high-risk situations, teams of police officers cope with uncertainty by relying on 'reduction' strategies to seek additional information and iteratively update these assessments using 'reflection-in-action' (Schön ) based on previous experience. They subsequently progress to a plan formulation phase and use 'assumption-based reasoning' techniques in order to mentally simulate their intended courses of action (Klein et al. ), and identify a preferred formulated strategy through 'weighing the pros and cons' of each option. In the unlikely event that uncertainty persists to the plan execution phase, it is managed by 'reduction' in the form of relying on plans and standard operating procedures or by 'forestalling' and intentionally deferring the decision while contingency planning for worst-case scenarios. [ABSTRACT FROM AUTHOR]

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Patient-controlled analgesia (PCA) is a common and effective means of managing post-operative pain. We sought to identify factors that may lead to critical incidents (CIs) in patient safety when using PCA in our institution. An observational study of prospectively collected data of patients who received PCA from 2002 to 2006 was performed. All CIs were documented and analysed by staff members of the acute pain service (APS). Cause analysis of CIs was undertaken to determine if measures can be instituted to prevent recurrence of similar events. Over eight thousand patients (8,240) received PCA. Twenty-seven CIs were identified. Eighteen were due to programming errors. Other CIs included co-administration of opioids and oversedation. In our institution, the largest contributory factor to CIs with PCAs was programming error. Strategies to minimize this problem include better education and surveillance. [ABSTRACT FROM AUTHOR]

An intelligent security systems engineering approach is used to analyze fire and explosive critical incidents, a growing concern in urban communities. A feed-forward back-propagation neural network models the damages arising from these critical incidents. The overall goal is to promote fire safety and sustainable security. The intelligent security systems engineering prediction model uses a fully connected multilayer neural network and considers a number of factors related to the fire or explosive incident including the type of property affected, the time of day, and the ignition source. The network was trained on a large number of critical incident records reported in Toronto, Canada between 2000 and 2006. Our intelligent security systems engineering approach can help emergency responders by improving critical incident analysis, sustainable security, and fire risk management. [ABSTRACT FROM AUTHOR]

This paper describes the development of a situational judgment test (SJT) based on single-response options developed directly from critical incidents and reports a study that tested the SJT’s concurrent validity against ratings of job performance. Situational judgment test items were developed from critical incidents provided by administrators of volunteer agencies. Volunteers who worked at another agency completed the SJT and a self-report personality test. Supervisors rated their job performance on three dimensions. Situational judgment test scores representing procedural knowledge about work effort were significantly correlated with ratings of work effort performance ( r = .28). Conscientiousness was correlated with work effort knowledge ( r = .26), but not with work effort performance ( r = −.02). These results provide some preliminary evidence that a single-response SJT format based upon critical incidents can produce valid measures of procedural knowledge and might be a useful alternative to the traditional multiple-response format. This paper presents a novel way to construct SJTs using single-response options that are less laborious to develop than the multiple-response options in traditional SJT formats. Results of the validity study suggest that this new single-response format can predict job performance and encourage further research on the viability of this approach. [ABSTRACT FROM AUTHOR]

Early residency is a crucial time in the professional development of physicians. As interns assume primary care for their patients, they take on new responsibilities. The events they find memorable during this time could provide us with insight into their developing professional identities. To evaluate the most critical events in the lives of interns. Forty-one internal medicine residents at one program participated in a two-day retreat in the fall of their first year. Each resident provided a written description of a recent high point, low point, and patient conflict. We used a variant of grounded theory to analyze these critical incidents and determine the underlying themes of early internship. Independent inter-rater agreement of >90% was achieved for the coding of excerpts. The 123 critical incidents were clustered into 23 categories. The categories were further organized into six themes: confidence, life balance, connections, emotional responses, managing expectations, and facilitating teamwork. High points were primarily in the themes of confidence and connections. Low points were dispersed more generally throughout the conceptual framework. Conflicts with patients were about negotiating the expectations inherent in the physician–patient relationship. The high points, low points, and conflicts reported by early residents provide us with a glimpse into the lives of interns. The themes we have identified reflect critical challenges interns face the development of their professional identity. Program directors could use this process and conceptual framework to guide the development and promotion of residents’ emerging professional identities. [ABSTRACT FROM AUTHOR]

Teachers’ reflections are often narrowly focused on technical questions (‘how to’) and less on the underlying moral, political and emotional aspects of their functioning. However, for a better understanding of teaching practice it is important to uncover beliefs and values that usually remain implicit. Meeting with others is considered crucial for enhancing the quality of teachers’ reflections. However, little is known about how any beneficial effects of such meetings are brought about. We explored the relationship between medical teachers’ interactions and collaborative reflection processes during peer meetings. Five experienced teachers and a teacher trainer participated in the study. Three peer meetings were videotaped and transcribed. Teachers’ interactions and collaborative reflective processes were analysed. The interactions promoted reflection not only on technical questions but also on moral, political, and emotional issues. ‘Guiding/directing’, ‘proposing an alternative’ and ‘exploring an alternative’ appeared to be the principal interactions. The results may be useful for teachers and trainers who are considering organising and/or improving peer meetings. [ABSTRACT FROM AUTHOR]

In order to optimise safety within the paediatric intensive care unit (PICU), it is essential to optimise organisation, identify problem areas and implement standards and guidelines for safe practice (with appropriate monitoring). Organisational issues have a major impact on safety: the introduction and-recently-centralisation of paediatric intensive care, the appointment of dedicated paediatric intensivists, nursing staffing, handovers, rounds, the number of work hours and night shifts with the associated problems of disturbed circadian rhythms. The technique of voluntary, anonymous, non-punitive critical incident reporting has the potential to identify incidents and latent errors before they become self-evident through a major incident. This systems approach focuses on organisational and communication problems. Standards and guidelines may help in weighing up the benefits and risks of invasive procedures, and interventional studies have shown that implementation of standards and guidelines can improve outcome. Mortality prediction models enable us to monitor quality of care and, thus, to investigate the best ways of organising intensive care and monitoring the effects of changes in practice. [ABSTRACT FROM AUTHOR]

Neonatal and paediatric intensive care has improved the prognosis for seriously sick infants and children. This has happened because of a pragmatic approach focused on stabilisation of vital functions and immense technological advances in diagnostic and therapeutic procedures. However, the belief that more medical care must inevitably lead to improved health is increasingly being questioned. This issue is especially relevant in developing countries where the introduction of highly specialised paediatric intensive care may not lead to an overall fall in child mortality. Even in developed countries, the complexity and availability of therapeutics and invasive procedures may put seriously ill children at additional risk. In both developing and industrialised countries the use of safe and simple procedures for appropriate periods, particular attention to drug prescription patterns and selection of appropriate aims and modes of therapy, including non-invasive methods, may minimise the risks of paediatric intensive care. [ABSTRACT FROM AUTHOR]

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The aim of this study is to explore student's perceptions of incidents in tutorial groups and their perceptions of the tutor's role in these incidents. This study investigated the differences between three types of perceptions: the perceptions of the occurrence of critical incidents in tutorial groups, the perceptions of whether these incidents inhibit tutorial group functioning and the expectations students have of the role of the tutor with respect to these incidents. Variations in these student perceptions were also investigated for different training levels. The subjects consisted of a stratified random sample of 200 students from first, second, third and fourth year at the Medical School of the University of Maastricht. We used a questionnaire that consisted of a list of 36 statements and related descriptions of critical incidents in the tutorial group. Six potential success inhibitors (lack of elaboration, lack of interaction, unequal participation, lack of cohesion, difficult personalities and lack of motivation) were assumed to underlie the statements of the questionnaire. Students were asked to rate each incident on a five-point Likert scale for the three types of perceptions. The major finding of this study was that there are significant differences between the three types of student perceptions. We also found that there are significant differences between perceptions of students in each of the four academic years. We conclude that all potential success inhibitors play a role in explaining dysfunctional tutorial groups. Motivational influences seem to have a particularly strong impact on tutorial group function. [ABSTRACT FROM AUTHOR]

Objectives: To establish a preliminary list of critical incidents (CIs) associated with mechanical ventilation and to describe a CI reporting method. Design: A list of CIs was established based on a consensus among ICU caregivers. The list was compared to CIs collected prospectively during a predefined study period. Setting: The clinical observations were conducted in two intensive care units. Patients: All patients receiving mechanical ventilation were included. Measurements and results: The list of CIs included death and 62 other CI types categorized as immediately life-threatening, secondarily life-threatening, or non-life-threatening. The observational study identified 527 CIs in 137 patients. Virtually all non-life-threatening CIs were ascribed to failure to comply with safety rules or to equipment failure and 40% of life-threatening CIs to the course of the disease or to patient-related factors. The match between CI types on the list and CI types observed in the ICUs was excellent. Conclusions: Use of our reporting method to create a CI database in a multicenter study including ICUs with varying recruitment patterns may help to identify markers suitable for routine continuous use as part of a quality-assurance program. [ABSTRACT FROM AUTHOR]

First year MFT students engaged in a journaling project, selecting one event daily which captured something about being a student, including the process of therapy, consultation, and supervision, that struck them as important in terms of their professional development. On reflection, the students saw therapeutic success and professional confidence as systemic products of a variety of contextual factors: transient and enduring aspects of the self and the client, faculty, peer, and family influences, and treatment setting and program factors. Students and faculty experienced this formative self study as valuable and believe that it should be done at the beginning, middle, and end of an educational program and the results shared with both faculty and students. [ABSTRACT FROM AUTHOR]

Objective: To examine the occurrence of critical incidents (CIs) in order to improve quality of care.Design: Prospective survey.Setting: Multidisciplinary, neonatal-pediatric intensive care unit (ICU) of a non-university, teaching children's hospital.Patients: Four hundred and sixty-seven admissions over a 1-year period.Methods: A CI is any event which could have reduced, or did reduce, the safety margin for the patient. Comprehensive, anonymous, non-punitive CI monitoring was undertaken. CI severity with respect to actual patient harm was graded: major (score 3), moderate (2) or minor (1). The system approach incorporates the philosophy that errors are evidence of deficiencies in systems, not in people. We undertook 2-monthly analyses of CIs.Results: There were 211 CI reports: 30 % major, 25 % moderate, 45 % minor. The CI categories were management/environment 29 %, drugs 29 %, procedures 18 %, respiration 14 %, equipment dysfunction 7 %, nosocomial infections 3 %. The respiratory CIs were the most severe, the drug-related CIs the least severe (score mean, SD: 2.9, 0.26 vs 1.4, 0.76; p < 0.001). However, 20 out of 62 drug-related CIs were potentially life-threatening. Thirteen percent of drug CIs were decimal point errors. Eleven of the 29 respiratory CIs were accidental extubations (2.6/100 ventilator days). CIs were most often precipitated by consultants (32 %), followed by residents (23 %, over-represented in drug CIs, 22/62) and specialized nurses (21 %). Doctors had a greater proportion of major CIs than nurses (p < 0.01). Fifty percent of the CIs were detected by routine checks. The most important method of detection was patient inspection (44 %), alarms accounted for only 10 %. Contributing factors were human errors (63 %), communication failure (14 %), organizational problems (10 %), equipment dysfunction (7 %) and milieu (3 %).Conclusions: CIs are very common in pediatric intensive care. Knowledge of them is a precious source for quality improvement through changes in the system. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the usefulness of critical-incident reports in facilitating reflective learning and the types of experiences that learners found meaningful on a general medicine service. DESIGN: Team members wrote about their most meaningful patient of the month and what was learned from the patient. They shared their narratives during teaching rounds at the end of each month. The written reports were collected and subjected to qualitative thematic analysis. SETTING: General medicine teaching service of an academic medical center. PATIENTS/PARTICIPANTS: Medical students, residents, and attending physicians. MEASUREMENTS AND MAIN RESULTS: Ninety-eight reports were collected over 10 months and subjected to thematic analysis. Reports were coded for six major themes, with a mean of 2.09 themes per narrative. The number of reports containing each theme was 47 for biomedical, 46 for communication with patients and families, 38 for psychosocial, 32 for the physician's role, 30 for personal feelings, and 14 for ethics. Communication issues constituted the theme most frequently reported by third-year students; biomedical and psychosocial themes by interns; biomedical by supervising residents; and the physician's role by attending physicians. Reports from men and women contained a similar mean number (men 2.101; women 2.128) and distribution of themes. CONCLUSIONS: The critical-incident technique promoted reflection on the meaning of clinical experiences. Qualitative thematic analysis revealed the diversity of meaningful experiences on a general medicine service and the high frequency of nonbiomedical themes. This study suggests that reflective exercises can provide a window into the experience of students and residents. [ABSTRACT FROM AUTHOR]

Objective: Many studies (outcome, epidemiological) have tested the hypothesis that pulse oximetry and capnography affect the outcome of anesthetic care. Uncontrollable variables in clinical studies make it difficult to generate statistically conclusive data. In the present study, we eliminated the variability among patients and operative procedures by using a full-scale patient simulator. We tested the hypothesis that pulse oximetry and capnography shorten the time to diagnosis of critical incidents.Methods: A simulator was programmed to represent a patient undergoing medullary nailing of a fractured femur under general anesthesia and suffering either malignant hyperthermia, a pneumothorax, a pulmonary embolism or an anoxic oxygen supply. One hundred thirteen anesthesiologists were randomly assigned to one of two groups of equal size, one with access to pulse oximetry and capnography data and the other without. Each anesthesiologist was further randomized to one of the four critical incidents. Each anesthetic procedure was videotaped. The time to correct diagnosis was measured and analyzed.Results: Based on analysis of 91 of the subjects, time to diagnosis was significantly shorter (median of 432 s vs. >480 s) for the anoxic oxygen supply scenario (p = 0.019) with pulse oximetry and capnography than without. No statistical difference in time to diagnosis was obtained between groups for the other three critical incidents.Conclusions: Simulation may offer new approaches to the study of monitoring technology. However, the limitations of current simulators and the resources required to perform simulator-based research are impediments to wide-spread use of this tool. [ABSTRACT FROM AUTHOR]