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Workshop digital wall screenshot @ 0330hrs on July 25, 2014

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Workshop digital wall screenshot @ 0330hrs on July 25, 2014

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Research Question: Family Presence during Adult CPR: Attitudes of Healthcare Professionals in an Emergency Medicine Setting in an Asian Hospital

Approach: Focus Group Discussions

2 ED Residents, 2 ED nurses (1 senior 1 junior), 2 ED Physicians

Questions

1) How often have you experienced having a relative present while peforming an Adult CPR in porportion to total Adult CPRs you participated in?

2) How did the relative behave (what they were doing?) during the CPR?

3) What is your response to the relative's behavior?

4)

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Focus Grp Discussion :

Possible Questions are:

1) What are the views of Internal Medicine Residents about Patient Safety

1)What are the views and factors that influence  Internal Medicine Residents' decision to attend  Patient  Safety Workshops?

2) What factors would contribute to Internal Medicine Residents attending Patient Safety Workshops?

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Title: What are the perceptions of Internal Medicine residents to Work Place Based Assessments (WPBA)?

Population: IM residents (All)

- purposeful sampling

Data collection: Pre-assessment through different years of residents and their perceived problems with WPBA via survey monkeys

Focus group discussions of 6 residents

Engagement Question:

1) What types of WPBA have you been regularly using?

Exploration Questions:

2) What do you think are the purposes of these WPBA?

3) How do you feel about doing these WPBA?

4) What aspects of these WPBA do you think will help you in your career?

5) What do you perceive as the current barriers to these WPBA?

E

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Research Question: Family Presence during Adult CPR: Attitudes of Healthcare Professionals in an Emergency Medicine Setting in an Asian Hospital

Approach: Focus Group Discussions

2 ED Residents, 2 ED nurses (1 senior 1 junior), 2 ED Physicians

Questions

1) How often have you experienced having a relative present while peforming an Adult CPR in porportion to total Adult CPRs you participated in?

2) How did the relative behave (what they were doing?) during the CPR?

3) What is your response to the relative's behaviour?

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Patient Safety and Quality

Main Research Question Would   Internal Medicine Residents be interested to attend a Patient Safety Workshop? (45 respondents)

Option 1

Study the separate groups  who responded yes, no and not sure.

Sample the 3 groups.

Query : Do we ask different question to the different groups?

or do we have an open ended question to all group instead of sub-grouping into yes, no and unsure group.

Alternatively, interview all 45 residents?

1.What are your views about patient safety ?

(follow on questions depend on literature review on what trends )

2. What are your views of patient safety for practice ?

3.Tell me more about it?

(Query 1 : Can this be done by questionnaire or do you need to do a face to face interview ?

Query 2 : Concern is respondent may only respond with a politically correct response when facing an interviewer as opposed to an anonymous questionnaire?

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I am Yingjie, Physiotherapist of 6 years in NUH. I learnt about research methods in my undergraduate but are mainly focus on quantitative research. I hope to learn more about qualitative methods as I realise it is an essential to recognise and include patients' voice in the midst of research.

I have 2 topics in mind and they are:

1) To find out if patient's pre-operative depression/catastrophizing traits affect post-operative functional outcome (10meter walk test) for Total knee replacement patients.

2) To find out if allowing freedom to walk with walking aids in the ward will improve mood or QOL for total knee replacement patients

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PPT slides for today's workshop

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---------------------

"Message to workshop participants -

Thank you for signing up for this workshop. My presentations on the topics for the workshop will be based on the material on this website. The pre-reading for the workshop, and presentations will be given entirely from the website below.

http://padlet.com/dnrgohps/eLearningWall

The overview of the program for this workshop is displayed graphically below.

Please explore the content, and reflect on the engagement process as well.

May I invite you to post comments, and questions on the "add your comments" section in this blog below. Please also post in the comments section how you currently use; or are thinking of using eLearning or Technology Enhanced Learning in your own teaching.

Alternatively, I have also set up a "digital wall" for all workshop participants, and faculty to record and share their thoughts (see website/link below). You all have permission/digital rights to post and modify your contributions at any time. Please make use of this digital wall - and please title your contribution, include your name; then share your thoughts; pose questions; share documents, videos, links, or any other contribution you feel would add to the discussion.

http://padlet.com/dnrgohps/eLearningWall

All you need to do is to double click on any clear space on the digital wall on the website above. You do not need to log-in or sign up. And you can modify your post, add to, or delete the post at any time.

_________________

As a specific pre-workshop task, please answer the following questions about yourself, by making a post on the digital wall http://padlet.com/dnrgohps/eLearningWall BEFORE the workshop (by Friday, the week before the workshop please).

1. Tell us a little about yourself (please also identify yourself/give name)

a. background - current clinical, educational or administrative practice, number of years active, practice setting
b. experience and training in eLearning/technology enhanced learning - e.g. pick up as you go along, workshops, courses, formal training (Masters)
c. What barriers/challenges are you currently facing/have you encountered in integrating technology into teaching?

and

2. Share an educational project you intend to use eLearning for (current or planned/upcoming)

a. aim
b. how you intend or hope to use eLearning

___________________

For those of you who prefer traditional literature reviews and articles, please review the following before the workshop.

1. AMEE Guide 32: e-Learning in medical education
Part 1: Learning, teaching and assessment
http://informahealthcare.com/doi/abs/10.1080/01421590802108331
Rachel Ellaway & Ken Masters, Medical Teacher, 2008, 30: 455-473.

2. eLearning in clinical teaching
http://www.faculty.londondeanery.ac.uk/other-resources/files/BJHM_article%2012_%20e-learning.pdf
Ian Doherty, Judy McKimm
British Journal of Hospital Medicine, January 2010, Vol 71, No 1

3. What do we mean by web‐based learning? A systematic review of the variability of interventions
http://scholar.google.com/citations?view_op=view_citation&hl=en&user=RbXpT6kAAAAJ&citation_for_view=RbXpT6kAAAAJ:IWHjjKOFINEC
DA Cook, S Garside, AJ Levinson, DM Dupras, VM Montori
Medical education 44 (8), 765-774
2010

4. Instructional methods and cognitive and learning styles in web‐based learning: report of two randomised trials
http://scholar.google.com/citations?view_op=view_citation&hl=en&user=RbXpT6kAAAAJ&cstart=20&citation_for_view=RbXpT6kAAAAJ:Se3iqnhoufwC
DA Cook, MH Gelula, DM Dupras, A Schwartz
Medical education 41 (9), 897-905
2007

5. Time and learning efficiency in Internet-based learning: a systematic review and meta-analysis
http://scholar.google.com/citations?view_op=view_citation&hl=en&user=RbXpT6kAAAAJ&cstart=20&citation_for_view=RbXpT6kAAAAJ:HDshCWvjkbEC
DA Cook, AJ Levinson, S Garside
Advances in health sciences education 15 (5), 755-770
2010

6. Computer animations in medical education: a critical literature review
http://scholar.google.com/citations?view_op=view_citation&hl=en&user=RbXpT6kAAAAJ&cstart=20&citation_for_view=RbXpT6kAAAAJ:ULOm3_A8WrAC
JG Ruiz, DA Cook, AJ Levinson
Medical education 43 (9), 838-846
2009

7. Preparing for the changing role of instructional technologies in medical education
http://scholar.google.com/citations?view_op=view_citation&hl=en&user=RbXpT6kAAAAJ&cstart=20&citation_for_view=RbXpT6kAAAAJ:iH-uZ7U-co4C
BR Robin, SG McNeil, DA Cook, KL Agarwal, GR Singhal
Academic Medicine 86 (4), 435-439
2011

Lastly, please bring your personal WiFi/3G/4G enabled tablet or laptop to the workshop. You should have examples of your teaching content on the tablet or laptop. You will be using this tablet or laptop for the workshop activities.

Very best regards,

Poh Sun"

GOH Poh Sun
MBBS(Melb), FRCR(UK), FAMS(Singapore), MHPE(Maastricht)
Associate Professor and Senior Consultant
Department of Diagnostic Radiology
National University Hospital
National University Health System
Singapore
Email: dnrgohps@nus.edu.sg

Brief Bio:
Dr Goh is a clinician educator who currently devotes 80% of his time to clinical practice and postgraduate training; and 20% of time to educational research. This has been supplemented over the last three years by daily two to three hour early morning sessions focused on creating, curating and sharing (anonymised) case based educational teaching resources on a variety of digital and mobile learning platforms, from a digital repository currently containing over 5000 digital teaching and learning objects. 25/21/13: years of experience as a clinical radiologist/educator/technology enhanced learning practitioner.

"Passions - Technology enhanced learning, Education, Radiology. Technology as a tool, platform and enabler to support and augment face to face customised teaching and learning; with educational principles as the foundation; and radiology as my academic and clinical focus."

http://sg.linkedin.com/pub/poh-sun-goh/22/45b/b16 (LinkedIn profile)
http://www.slideshare.net/dnrgohps/documents and http://www.slideshare.net/dnrgohps/presentations
(Education presentations and papers)

How Learning Works: Seven Research-Based Principles for Smart Teaching - Susan Ambrose et al. (2010), see links below

How The Brain Learns - David A. Sousa (2011), see links below

How People Learn - National Science Foundation (2004)

Helping Students Learn in a Learner-Centered Environment - Terry Doyle (2008), see links below

(the website is free, AND allows collaboration and brainstorming, while documenting discussions, and promoting sharing)

Can we build the perfect teacher?

Priced to sell - Is free the future?

The long tail

Social Sharing Companies such as Airbnb and Uber, which have a social mission and are also social marketplaces, are able to access all three social value drivers: Advocacy, Connection, and Collaboration. The revolutionary power of Airbnb and Uber comes from their ability to harness technology to create a social sharing platform that facilitates trust by creating transparency and dual accountability. This enables individuals to form weak ties (i.e. Bridging Social Capital) with one another, leading to the personal sharing of goods and/or services (i.e. Linking Social Capital) by Barbara Gray (on LinkedIn Post)

Video - How to land plane in an emergency (reflection exercise)

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eLearning workshop on Wednesday, 23rd July, 2014

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"Message to workshop participants - Thank you for signing up for this workshop. My presentations on the topics for the workshop will be based on the material on this website. The pre-reading for the workshop, and presentations will be given entirely from the website below.

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Palliative Care Consultant @ NCCS

My interest is ethics education and particularly the way ethics and new concepts are learned by adult learners.My hope is to gain some ideas as to first and for most the viability of this project and then if possible/ feasible- how to do this

Close supervision of learners led ethics publications is a new initiative by the Division of Palliative Care at the National Cancer Center Singapore (NCCS) focused upon increasing understanding and interest in palliative care and ethics at the end of life. This process has led to the publication of 13 learner led manuscripts pertaining to the ethics of palliative care, personhood at the end of life and amongst palliative care patients undergoing rehabilitation by registrars, medical officers, residents, medical students and social workers. Given the number of health care professionals involved in this process, 5 consultants in palliative care were also involved in this process to supervise the health care professionals (HCP)s.

To be clear unlike other subjects, introduction to ethical principles are often novel to most HCPs and require careful assimilation and reflection on the parts of the HCPs as well as the consultants who were tasked with supervising them. This raises the question as to how this new information is learned. To answer this we reviewed the manner that HCPs and consultants assimilated their new experiences. Based upon discussions with the medical students and medical officers on their respective experiences we worked on the premise that a schema based learning process underpinned the process. This assumption is backed by studies by Greenwood et al (2000), Murray- Garcia (2005), Auclair (2007), Hren et al (2011), Chalmers et al (2011) and Edwards et al (2012) which described similar instances.

As a result of theinitial information garnered we plan to interview all the HCPs and palliative care consultants in the ethics studies. The objectives are to understand how ethics information is assimilated by HCPs. We are also keen to see how the schema formed evolved in the face of new information and experiences.

We hope to interview my co-authors who are

Medical students

Medical officers

Palliative Care Consultants

Palliative Care social worker

Palliative Care

Occupational Therapists

5

2

5

2

1

Demographical and personal data to be acquired

Age

Sex

Race

Religion

Palliative experience

Place of medical training

Place of post graduate training

Place of undergraduate training

Would you consider yourself to hold mostly- Eastern, western or mixed values

At the time of starting this study what was your view of clinical practice – good, so so, bad

Would you say you were jaded or burnt out at the time

Interview Questions

1.  What was the motivation for being involved with a personhood study

2.  What did you feel that you would gain

3.  What did you first make of the term personhood when you were introduced to it

4.  What allowed you to come to this initial idea of personhood – what facets did you draw upon.

5.  Were there certain considerations that were particularly important in how you came to this initial idea

6.  Were you aware of the prevailing conceptions of personhood at the time and which resonated with your own conception most?

7.  What made you decide on that conception and how did it differ from the other prevailing conceptions

8.  Were there any factors that prejudiced your choice of one conception over the other prevailing conceptions

9.  In deciding on the framework- was there pressure to conform ie prof/tutor, data, experience

10.  Overtime how has this concept evolved and in what way

11.  Has it changed as a result of challenges to your beliefs and what did you do then

12.  How did you address any lapses or problems in the conception that you have picked

13.  How has it affected practice- education, communication, empathy, professionalism

14.  Any other positive or negative issues to this change

15.  Were you jaded or burnt out at the end of the study- why

Analysis

A thematic analysis and coding will be carried out of the audiotaped interviews

References

Auclair, F. 2007. Problem formulation by medical students: an observation studyBMC Medical Education 7:16 doi:10.1186/1472-6920-7-16.

Chalmers, P., Dunngalvin, A., Shorten, G. 2011. Reflective ability and moral reasoning in final year medical students: A semi-qualitative cohort study. Medical Teacher. 33, e281-289

Edwards, I., van Kessel, G., Jones, M., et al. 2012.  The development of moral judgment and organization of ethical knowledge in final year physical therapy students. Phyical Therapy Review. 17(3), 157-66.

Greenwood, J., Sullivan, J., Spence, K., et al. 2000.Nursing scripts and the organizational influences on critical thinking: report of a study of neonatal nurses' clinical reasoning. J Advanced Nursing 31(5), 1106-1114

Hren, D., Marusic, M., Marusic A. 2011. Regression of Moral Reasoning during Medical Education: Combined Design Study to Evaluate the Effect of Clinical Study Years.PLoS ONE 6(3): e17406. doi:10.1371/journal.pone.0017406

Murray- Garcia, J.L.,  Hargell, S., Garcia J.A., et al. 2005. Self-Reflection in Multicultural Training: Be Careful What You Ask For.Acad Med. 80:694–701.

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Your background, experience & training in educational research, goals that you set to achieve through the workshop.

My details :  I graduated with a MBBS , NUS (1988) n MMed(Public Health) , NUS 1996 n currently just embarked on a MPHE programme with Uni of Maastricht. After numerous hospital postings GS, Med n O nG during housemanship n then  Anaesthesia, A n E, MCHC , Polyclinic, Food n Nutrition then commenced on various admin posting in MOH n now working at NHGP HQ. Currently cover Clinical Services function with oversight over Infection Control , Vaccines n Interprofessional Collaboration.  With PCA in NHGP also Conduct Communication, Dr -Ptt Relationship n IPC n Way of Being Workshops n some editorial Function for a PCA e-bulletin  Plexus) ( Hv conducted research on Perception to Influenza n H1N1 Vaccine Uptake n on Impact of Blended Learning towards Readiness for Interprofessional Learning among Infection Control Teams)

·Share a project you intend to use qualitative research methods: Aims of the project, Study design, Barriers in implementing qualitative method

Proposed Topic : Perception of Patients n Healthcare Professionals on Whether there is Interprofessional Collaboration in Healthcare . Aim : to see two sides of an issue  . Study Design : Sampling a grp of patients managed by a chronic Disease team n then sample the healthcare team members . Method : Interview , Focus Grp Discussion . Barriers : whether will get institution n ethics approval in view that it will involve patients

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Soon Jian Tai Hasita/Research Coordinator/Singapore Eye Research Institute (SERI)

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Soon Jian Tai Hasita/Research Coordinator/Singapore Eye Research Institute (SERI)

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Hi, I am part of the Health Service Research (HSR) team at SERI for about one and a half years now.

I am involved in a number of qualitative studies and I learn on the job with the help of the research team.

Personally, I would like to know in depth in the qualitative data collection, sampling, coding and qualitative analysis such as what are the consideration when collecting the data, what type of data collection method is best used in what type of situation, what to take into consideration when sampling, how to code, how to analysis the codes and what kind of qualitative analysis can we perform. I do note that the purpose for answering questions about myself is part of the workshop outline hence prompting me to ask, is online semi structured questions a good way to collect data? I hope all these questions posted will be answered in this workshop.

I do have a few studies that I am helping out with, one being a interview/focus group method of data collection and the other is a RCT with questionnaires which we are planning to collect data to verify observations that were being made.

For the RCT study, we are planning to do a semi structured one to one interview/focus group as it is an option that we are familiar with. However, I would like to know more data collection methods before implementation additional procedures to the study.

So far, we have yet to implement the procedure but we have encounter difficulty in implementing as we are unsure of what is consider a rigor data collection and analysis. I do hope this workshop will assist us in implementation that is of worth value and contribution to the community.

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1a. Rakhee Yash Pal, A Consultant at NUH EMD

b. I have no formal experience and training in educational research mostly pick up as I go along

c. I hope to have better understanding and develop skills sufficient to put it to practice.

2. Working on a survey "Family Presence during Resuscitation: Attitudes of NUH Emergency Medicine Department Healthcare Staff"

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Tey Ching Siong  / Research coordinator - health services research, SERI

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Tey Ching Siong  / Research coordinator - health services research, SERI

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1. Tell us a little about yourself (please also identify yourself/give name)

Perhaps the youngest participant today. 2 years in clinical trail research, focusing on eye diseases related quality of life and health services.

Have no experience in educational research, only have some experience with qualitative research in healthcare field. No formal training but learning while working with senior authors

As I'm still optimizing my learning capacity with my current position, I would like to learn how to design a simple qualitative study for recording my observation  which I think all these ground work experiences are worth sharing.

2. Share an educational project you intend to use qualitative research methods on (current or planned/upcoming)

Current study: visual item banking using grounded theory for identifying different themes emerge from different eye conditions.

Planning: a small sample size indepth interview with low vision patient to explore common traits after participating a self management program

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Esther Tai, Senior Occupational Therapist, NUH, Rehab

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Esther Tai, Senior Occupational Therapist, NUH, Rehab

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Clinical/admin: Paeds

In charge of clinical education and mentoring for OT students.

Had attended 1 or 2 module in research during my Masters in Health Sciences. Had involved in some research projects, but mainly clinical related.

Hope to do some research on clinical education and mentoring.

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1. MD, ALCM

a. Involved in admin & research for UG Ortho matters encompassing curriculum, assessment, feedbacks, faculty development and med ed research; < 1 year

b. Not trained specifically in edu research other than attending pre-conf workshops at APMEC2014 and regularly held NUS-PRIME

c. To gain a better insight about educational research - study design (quantitative/qualitative/mix), ethics in edu research, summary of current focuses in med ed research, edu research grants available & details

2. Current:

- OSCE as assessment tool of psychomotor skills in Orthopaedics

- Effectiveness of videos on standardized clinical examination in Orthopaedics on student performance in OSCE

- Impact of E-learning (videos uploaded on IVLE) on student performance in Orthopaedics OSCE

Planning:

- Case analysis as an assessment tool for Orthopaedics

- Music in medical education

a. to determine whether a pilot music intervention (active/passive) improves student learning environment and exam performance

b. case-control ? voluntary (convenient sampling?)

c. issues of validity and reliability

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Chen Li Li/Principal Clinical Pharmacist

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Chen Li Li/Principal Clinical Pharmacist

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1a. Background - 6 years involvement in educating pharmacists in Ambulatory Care Pharmacy

1b. Experience and training in educational research - No formal training but had presented poster on education research at APMEC

1c. Personal/Academic Goal - To publish a peer review paper on education research

2a. Aim - Searching
for the Best Learning Environment for Gen-Y AHP in SGH using Reflective
Feedbacks

2b. Study Design - Qualitative Interview?

2c. No experience and training in qualitative research methods

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Clinical psychologist practicing in National Healthcare Group Polyclinics

No formal training in qualitative research

Conducted case studies for Master's thesis, to explore resilience factors of recovering drug addicts - guided by a manual written by Robert K. Yin

Goals: To learn more about qualitative methods:

(i) Qualitative approaches

How do we decide when to use qualitative method?

How do we decide which approach to employ?

Is there a need to formulate a hypothesis?

(ii) Sampling and determination of sample size
(iii) Methods of data collection

(iv) Methods of data processing and analysis

(v) Data reporting and discussion

(vi) Mixed method research

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Hi everyone

I am involved in teaching Geriatrics  to Undergraduates ( education director for Phase V Geriatrics ) and Postgraduates  in addition to core faculty role in  Internal Medicine Residency and Advanced Internal Medicine Senior Residency programme in NUH

I am  learning about  qualitative research methods  with prior patchy knowledge .

Education project details ( just started ) :

Aim : How do medical  students perceive the feedback they received from tutors?

Methodology :

Qualitative approach will be used by conducting focus group discussions facilitated by the Investigator . Each focus group will include 6-8 students from each year of our medical school . The discussion will be subsequently analysed through Atlas.ti - a qualitative data analysis software  to identify themes and then  compared with the traditional western models used

Barriers in implementing  qualitative  research methods :

less confident

confusion regarding the appropriate use of the various methods

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Joanne Kua/ Consultant Geriatrician- Tan Tock Seng Hospital

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Joanne Kua/ Consultant Geriatrician- Tan Tock Seng Hospital

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1i) Core faculty of NHG-AHPL residency programme; Programme coordinator for Phase V GRM rotation.

1ii) Attended Harvard Macy Institute's Health Professionals Education course organised by TTSH.

1iii) Learn about concepts and how to do qualitative research.

2. We just introduced reflective practice in our Phase V GRM rotation and i'm currently collecting feedback, both quantitative and qualitative.

Aim: To study whether reflective practice is useful and beneficial for Phase V GRM rotation.

Study design: Surveys post rotation

Reflective practice discussion

Reflective practice worksheet

Barriers: Not sure how to do qualitative research!

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Lecturer in clinical psychology (JCUS)

No formal training in qualitative research but considering using it to study patients' self management of chronic physical and mental  illness.

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Dr Julie George

Consultant, General Medicine,TTSH

Program director, Adv IM,NHG for 2 years

No training in Educational Research

I hope to be able to learn educational research and apply it in the years to come.

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Tran Le Giang / Hanoi Medical University

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Tran Le Giang / Hanoi Medical University

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Ravinder Singh / Senior Consultant-Tan Tock Seng Hospital

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Ravinder Singh / Senior Consultant-Tan Tock Seng Hospital

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Name: Ravinder Singh

Position: GM at TTSH, Consultant; interest diabetes and GDM.

Qualified: 1987

Experience: mainly clinical and teaching with some research several years ago, also mainly clinical: Gestational Diabetes (GDM) and Pre-eclampsia.
Currently: wish to set up some research projects at KK hospital, including:
- Comparing current Singapore and worldwide criteria for diagnosis of GDM and
outcomes
- Thyroid function in pregnancy and “normal” ranges  for Asian women.

Problems with setting up research at KK: finding juniors who are interested; access issues for junior doctors from TTSH regarding computers; getting too/from KK

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Jacqueline Ong Soo May / Consultant, National University Hospital

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Jacqueline Ong Soo May / Consultant, National University Hospital

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1.  Tell us a little about yourself (please also identify
yourself/give name)

Jacqueline Ong

i. background - current clinical, educational or administrative practice, number of years active, practice setting

Am currently a paediatrician working in NUH for the last 10 years; I’m also Core
Faculty for the Paediatric Residency.

ii. experience and training in educational research - e.g. pick up as you go along, workshops, courses, formal training (Masters, PhD)

I’m new to educational research but hoping to learn more and am currently part of
the Certificate in Medical Education programme.

iii. personal / academic goal that you are hoping this workshop helps you achieve

Qualitative research puzzles me! I hope this workshop clarifies the methodology and ideas for me.

2.  Share an educational project you intend to use qualitative research methods on (current or planned/upcoming)

This is a project  that I am planning – Title: Exploring residents’ perceptions and experience with a hybrid method of high fidelity simulation and standardized patient involvement .

I. Aim: To explore the residents’ perceptions and experience following the use of a standardized patient in a high fidelity simulation scenario.

ii. study design / how you intend or hope to answer your research question:

I plan to use a focus group interview to obtain the data.

iii. barriers you have encountered in implementing qualitative research methods:

unfamiliarity with methods and planning!

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Pham Bich Diep / Lecturer, Hanoi Medical University

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Pham Bich Diep / Lecturer, Hanoi Medical University

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1.Tell us a little about yourself (please also identify
yourself/give name)

My name is Diep, lecturer at Health Education and Promotion Department .

Background - current clinical, educational or administrative practice, number of years active, practice setting:

Economics background. Lecturer at Health Education and Promotion Department, lecturer at Institute of Preventive Medicine and Public Health, Hanoi Medical University.

I worked for Health Economics Department 5 years (from 2001 to 2006). Now I am working for Health Education and Promotion Department 8 years (from 2006 to present).

Experience and training in educational research - e.g. pick up
as you go along, workshops, courses, formal training (Masters, PhD).

I studied a master of Public Health in Australia and I am PhD candidate in Health Promotion Department, Maastricht University, The Netherlands.

Personal / academic goal that you are hoping this workshop helps you achieve
How to conduct qualitative research

2. Share an educational project you intend to use qualitative
research methods on (current or planned/upcoming)

Aim: To understanding why is big gender different in drinking behavior among students in Vietnam.

Study design / how you intend or hope to answer your research
question

Observational study and qualitative study

Barriers you have encountered in implementing qualitative
research methods

Methodology. I never do qualitative research, so I do not know how to start, what is the most important things that should consider at the starting point.

The process to conduct qualitative research; data analysis and writing report.

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Mastery training in diagnostic radiology

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Mastery training in diagnostic radiology

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The illustrated guide to a PhD

12 Tips for studying medical education at the doctoral level (uncorrected final version pdf)

12 Tips for studying medical education at the doctoral level (Medical Teacher, 2009)

Doctoral programs in HPE (Medical Teacher, 2013)

Writing a PhD Proposal (Maastricht)

PhD, EdD (IOE, London)

Fellowship in Medical Education (Chicago)

Doctor of Education (Harvard)

http://pritzker.uchicago.edu/about/MedicalEducationFellowship.shtml

http://chronicle.com/article/Interdisciplinary-Research-/46386/

Choosing the right research advisor

http://chronicle.com/article/Choosing-a-Research-Topic/45641/

http://chronicle.com/article/Keeping-Your-Research-Alive/46322/

How to get the most out of scientific conferences

http://chronicle.com/article/Getting-Published-as-a-Grad/46335/

http://chronicle.com/article/Staying-Ahead-of-Your-Compe/45630/

http://chronicle.com/article/Establishing-Your-Absence/45649/

http://chronicle.com/article/The-Need-for-Self-Promotion/45602/

http://chronicle.com/article/Giving-a-Job-Talk-in-the-Sc/45375/

http://chronicle.com/article/Is-the-Tenure-Path-the-Best/45696/

http://chronicle.com/article/Making-Science-Understandab/45661/

http://chronicle.com/article/When-Faculty-Consulting-Hel/45621/

How to get all-important teaching experience

http://www.stanford.edu/dept/CTL/Tomprof/index.shtml

http://phdmedicaleducation.blogspot.sg/

Reflections on Mastery Training in Diagnostic Radiology

1. What are the indicators of mastery? (learning objectives)
a. literature

Brettle, Barry & Smith, 2007 Jasinski, 2004

Kundel, Nodine, Conant & Weinstein, 2007
Mello-Thomas
b. survey / interview teaching staff (open or structured) - group discussion, questionnaire
i. open ended question (what are the indicators you would use to assess mastery?
list 3 or 5 indicators you would use to assess mastery?)
ii. rank these in order of usefulness / impact
iii. why did you select these indicators? (open ended discussion)
iv. some examples - knowledge base, years of experience, ability to recognize unusual
presentations, accuracy, completeness, speed, efficiency of search strategy,
effectiveness, confidence, error rates

2. How could this be assessed? ( for each area / topic)

a. with plain film cases
i. how many are required?
ii. what spectrum of cases / complexity of cases is required?

b. with cross sectional imaging

i. accurate selection of key images

ii. accurate description of key features on these key images

iii. speed and confidence in screening all images and identifying key images

3. How can we train for mastery?

a. role of "deliberate practice" (systematic case review, increasing complexity, with expert
guidance / feedback)

b. role of background reading / reflection on day to day clinical experience ("ad hoc"
case review)

How radiology experts think - and value of online case repositories

http://www.learningneuroradiology.blogspot.com/2011/10/how-radiology-experts-think-and-value.html

1. expertise in radiology is directly correlated with experience

2. case experience should be cumulative

3. case experience should include the full spectrum of the presentation of any given diagnosis

4. case experience should include material of increasing complexity

5. increasing complexity involves the review of cases showing typical, then less typical, less easily detectable features, with less associated features, or more confounding associated features, or more than one pathology, and progressively less or contradictory additional information

6. the radiology task is a simple three step process - see, recognize, diagnose

7. this requires perceptual learning or pattern recognition, categorical learning or the ability to list key features, and diagnostic reasoning or the ability to correlate with the clinical setting

8. experts use rapid holistic perception linked to experience, which are mental schemas or representations of the key features of a wide range of pathology

9. experts use rapid 200msec big picture perception to generate the most likely hypothesis, which then drives the deliberate search for key features

10. experts rapidly decide on whether a radiograph or scan is normal, or has a likely abnormality, and then use visual search and reasoning to confirm the diagnosis

11. online case repositories can accelerate the development of expertise, by widening the case experience of radiologists, beyond that of individual day to day direct experience, efficiently and effectively

12. the key is to use case material in a deliberate way (deliberate practice)

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<---------   My personal example, comparing quantitative educational research (left) with qualitative research (right) - Poh Sun   --------->

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<---------   My personal example, comparing quantitative educational research (left) with qualitative research (right) - Poh Sun   --------->

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The research question was investigated by the use of a quantitative experimental design - an independent groups (or between groups) design. 10 residents participated with a within subjects design allowing the 10 residents to take part in both the control and experimental conditions with crossover between the groups. Resident performance with 30 CXRs and 30 CT head scans was compared between the experimental and control group, in a pretest, practice and posttest phase each with 10 different cases, with all 30 cases examples from a single key clinical diagnostic category for each type of examination.

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Master Thesis - Master of Health Professions Education (MHPE), 2012

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The research question was investigated by the use of a quantitative experimental design - an independent groups (or between groups) design. 10 residents participated with a within subjects design allowing the 10 residents to take part in both the control and experimental conditions with crossover between the groups.

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Use of learning resources by residents in radiology (Qualitative)

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Use of learning resources by residents in radiology (Qualitative)

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Background literature

(google search - "learning preferences of residents in radiology")

Acad Rad 2007 Survey of residents use of textbooks, journals, internet

J Digit Imaging 2006 Radiologists' preference for just in time learning and full / pdf

Learning styles in radiology CAR report

RSNA 2012 poster Moving to the Digital Age of Radiology Education: A Survey of Learning Resources at an Academic Institution

Insights Imaging 2011 Radiology teaching for junior doctors: their expectations, preferences and suggestions for improvement

Radiographics 2001 Do Computers Teach Better? A Media Comparison Study for Case-based Teaching in Radiology

Acad Rad 2001 The case-based radiology teaching conference for residents: beneficial effect of previewing cases and using answer sheets

Radiology, 2005 Radiology Education in the Digital Era

AJR, 2013Worldwide Utilization of a Web-Based Learning Tool for Pediatric Radiology

RSNA 2003 An international web-based curriculum in paediatric radiology

Radiology Education: The Scholarship of Teaching and Learning 2004 Using the world wide web to develop competencies around the globe

Society of Thoracic Radiology Resident Curriculum Web Resource Initiative

Instruction for authors

Sample cases

American Journal of Neuroradiology Special Collections and Case Collections

Case of the week archive by diagnosis

Classic case archive pictorial index

eLearning resources for Radiology - Dr Jawad Khan, Radiology Registrar, Severn School of Radiology

R-ITI Radiology - Integrated Training Initiative

Journal of the American College of Radiology JACR Portal

Dreyfus 1980 5 stage model of the mental activities involved in directed skill acquisition (original paper PDF)

Novice to Expert: The Dreyfus Model of Skill Acquisition (table) 2005

Dreyfus model of skill acquisition, Wikipedia (see hyperlinked resources)

Krupinski 2013 Characterizing the development of visual search expertise in pathology residents viewing whole slide images

Crowley 2003 Development of Visual Diagnostic Expertise in Pathology - An Information-processing Study

Taylor 2007 A review of research into the development of radiologic expertise: Implications for computer based teaching

Vine 2012 Cheating experience: Guiding novices to adopt the gaze strategies of experts expedites the learning of technical laparoscopic skills

Clark 2012 The impact of different types of prior knowledge on science text comprehension

Qualitative Interview (Semi-structured)

The purpose of these interviews and related questionnaire is to allow me to develop a deeper understanding of your learning preferences and requirements as a radiologist-in-training, and to further refine the case based teaching and learning material that has been made available to you via the learning radiology blogs.These resources can be used as part of your radiology residency program. I have a long standing interest in the use of technology enhanced learning (eLearning) in medical education and radiology training, and these short evaluation sessions will focus the content and presentation of the case based online teaching and learning material to more closely match your training requirements and learning needs.

Please note that your responses to the following interview and questionnaire will be anonymised, and any dissemination, presentation or discussion of your response, or the aggregated responses of your peers will be anonymised. Our departmental postgraduate training committee members are aware that these discussions are taking place (HOD, PG training director, Neuroradiology section chief).

(for example, as I have discussions with each of you, your responses will be reflected in the questionnaire by anonymous symbols --> @, #, ~, %, ^, &, *, +, ?, !, <, > ...... all 30 plus MOs, residents/BSTs/ASTs in our department)

(example of radiology resident cohort - note that there is no correlation between list of residents and anonymised Q and A below, obtained at separate distant date from time of list above)

Semi-structured questions

Which year of radiology residency are you in?

Tell me about your professional experience before entering radiology?

How have you found the learning experience and training environment in the radiology department?

5; 4

How do you prefer to learn?

active + feedback;
exploratory;
exploratory;
try + feedback (%),
peer to peer (^)
lecture(&)
self-paced(*)
OTJ/JIT-->peer d/c-->answer/senior(+)
textbooks/1st principles/theory-->r/v cases, compare/reports, feedback on day to day
OTJ-->look up-->answer/senior(!)
lecture/face to face or video(<)
case review series(>)
case review+feedback, work thru then d/c with Con(1st)
case review/problem-->look up myself(##)

What experiences have you found most useful in your training?
d to day case discussion (3); range; hot seat tut/call, EMD-->independent, variety-->F/U, post call D/C
feedback (positive and negative, emotional cpt/accountability), informal case based sharing, QA sessions
no specific one, different strengths/purpose(!)
rv then d/c with consultant(<)
quiz and drill, FRCR sets (>)
quiz and drill, FRCR sets(##)

Why do you find these experiences helpful?
authentic, applicable, know what is needed/cognitive load(*), immediate feedback(>), how does C think(@@), identify weak areas-->look up(#)

Special requests ... i wish ...

annotation/arrows/answers/discussion/approach/what to look out for (@, #)
journal article access (~)

introductory course/orientation series (%)
one to one assigned supervisor/teacher (^)

more didactic lectures (&)

knowledge/resource/case repository (*)

more direct/immediate/more detailed feedback day to day

more reporting/more feedback

pre-screened day to day reporting list (!)

?(<)

short take home points like IDK HK (what is relevant, from experts, tips, take home, focus) (>)

work thru 5 or 6 cases, then rv with Con

?(##), long pause ... SGH style digital film library with short description

Questionnaire/Semi-structured interview

Which year of residency are you in?

How much experience have you had in neuroradiology?

- 6 weeks or less @, #, ~, %(2 scans), ^(<20 scans)
- 12 weeks + (12 to 18wks), ?, <(12 to 18)
- 18 weeks >
- 24 weeks &, ##(24 to 30)
- 30 weeks or more *, !, @@

How confident are you in accurately recognising and diagnosing neuroradiology problems that you might encounter

- On call?

1- not confident
2 - somewhat confident ~, +, ? (2 to 3, supplemented by 4 month NNI elective)
3 - confident that I will not miss anything major, will look up anything I don't recognise regularly &, !, <, >
4 - very confident, but will still look up anything I am not sure of not more than once to twice a day (*), @@(3.5), ##
5 - extremely confident, rarely encounter any conditions I do not recognise, rarely look up unusual conditions

- Day to day neuroradiology rotation?

1- not confident %
2 - somewhat confident ~ (2.5), ^, +(2.5), ?(2.5)
3 - confident that I will not miss anything major, will look up anything I don't recognise regularly &, !, <, >, @@, ##
4 - very confident, but will still look up anything I am not sure of not more than once to twice a day (*)
5 - extremely confident, rarely encounter any conditions I do not recognise, rarely look up unusual conditions

How well has your residency experiences prepared you for

- Call?

1 - not at all
2 - some preparation
3 - adequate preparation ~(3.5, includes self prep, review of EMD cases + reports), &, +, ?, !, >
4 - good preparation *, <, @@
5 - excellent preparation ##

- Day to day neuroradiology rotation?

1 - not at all
2 - some preparation +(2.5), ?(2.5), >
3 - adequate preparation &, !, <, @@
4 - good preparation *, ##
5 - excellent preparation

How well do you feel that review of thematic neuroradiology cases will prepare you for

- Call?

1 - not at all
2 - some preparation +(2.5)
3 - adequate preparation
4 - good preparation < (pic, rf, jit, spectrum), >, @@
5 - excellent preparation *, ?, !, ##

- Day to day neuroradiology rotation?

1 - not at all
2 - some preparation
3 - adequate preparation <(3 to 4)
4 - good preparation @, #, ^ if thematic, +(range), >, @@(4.5)
5 - excellent preparation ~ (mimics, ddx, range) %, *, ?, !, ##

Do feel that your neuroradiology training can be shortened by 20% by the deliberate use of these online cases?

Yes +, ? (5 for EMD, day to day confidence), !
No ## (day to day still importmant)
Maybe & (but will increase confidence from 3 to 4 for day to day, and call); *, <, >

How to you feel these cases should be organised and presented?

...... image / wide range / answer (*), (?), (!)
focus on common/centre of spectrum (<)
whole set (>)
X and Y axis, include DDx and examples, approach/process of problem solving
by anatomical location (##)

Please rate each of the following in their relative usefulness in your neuroradiology training?

5 point scale
1-not useful
2-somewhat useful
3-useful
4-very useful
5-extremely useful

Clinical experience/reporting

1-not useful
2-somewhat useful
3-useful ~ (day to day does not correlate with EMD)
4-very useful @, #
5-extremely useful

Weekly tutorials

4-very useful ~ (plain films)

@ 3,4 h and n, pit, neuro anat, cases / # h and n, pit, cases

Pre-call preparation sessions ~

1-not useful
2-somewhat useful
3-useful < (3 to 4)
4-very useful
5-extremely useful

FRCR 2A Lectures

1-not useful
2-somewhat useful
3-useful
4-very useful
5-extremely useful

Reading books/journals (hardcopy)

1-not useful ~ (time pressure)
2-somewhat useful
3-useful
4-very useful
5-extremely usefulReading journal articles(online)

Use of online databases (StatDx)

1-not useful
2-somewhat useful
3-useful ~ (3 to 4)
4-very useful
5-extremely useful

Use of online case repositories

1-not useful
2-somewhat useful @
3-useful
4-very useful #(comparison, n and abn, efficiency)
5-extremely useful

When you have a problem case currently, please list the order of actions you take to solve the problem? (from 1st to 4th)

Look up StatDx #(1) ~(2), %(1), ^(2), &(1), *(1), +(1), ?(joint 1), !(joint 1), <(1), >(1), @@(1), ##(2)
1-not useful
2-somewhat useful ~
3-useful @ (ddx - text descriptor), @@, ##
4-very useful # (anatomy), %, ^ (typical example, exemplar), &(access), ?(pic and comparison, DDx), !(key words), <(ddx, pict list, key points), > (match images, ddx)
5-extremely useful *, +

Ask someone @, # (2), ~ (1), ^(1), %(2), &(3), *(joint 2, variable), +(2), ?(2), !(3), <(2), >(3), @@(4), ##(1)
1-not useful
2-somewhat useful
3-useful *(3.5, depends on person), +, < (whoever is around), >
4-very useful # (reg and above), %(efficient), ^(4.5, answer/stat dx to match), &(AcC and above), ?(depends on problem, person, accessibility/pai sae), !, ##(4 to 5)
5-extremely useful @ (reg and above), @@

Do a literature/online search #(1), ~ (3), % (3), ^(3), &(2), *(joint 2 with ask someone), +(3), ?(joint 1), !(joint 1), <(3), >(2), @@(2) try to work out before asking, ##(Google)
1-not useful @
2-somewhat useful +, <, ##
3-useful % (3.5), ^ (3.5) - not useful unless understand basics, use for further reading, ?, !, >(google)
4-very useful #, &, *, @@(3.5)
5-extremely useful

Systematic reading of a textbook/ Look up textbook @(1), ~ (4), %(4), ^(4), &(4), *(4), +(4), ?(4), !(4), <(4), >(4), @@(3), ##(4)
1-not useful ~ (Keats)
2-somewhat useful #, &, +, !, >, @@
3-useful - @, % (3.5, framework) ^ (4.5, what is important, foundation, key ideas), < (not at work)
4-very useful (4.5, what is important, foundation, key ideas), ## (not routine/practical, tedius if not digital)
5-extremely useful

Attending courses and seminars @,# (not applicable), +(5), ?(5), !(5), <(5), >(5)
1-not useful
2-somewhat useful %(1.5, attended XR/CT reading course final year MBBS)
3-useful &(3.5, case review course), *(NNI annual), +(FRCR review course), ?(RadPath), <(RadPath - too wide/broad), > (IDK HK, case based, just right range/depth)
4-very useful ~ (RadPath in July 2013), ^(RadPath, July 2013, XR macro path correlation), !(IDKD), @@(ECR, NNI rv - common conditions/approach), ##(Resnick MSK, but diminishing return further from course)
5-extremely useful

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Use of learning resources by Residents in Radiology: Correlating individual learning preferences with Actual Use, Linking this with Clinical Performance Requirements (On the job Emergency and Outpatient Radiology Reporting), and Determining how this can guide the provision of a personalized educational profile with advice for effective and efficient learning strategies, and How this can help teachers more effectively and efficiently present online case based material to fulfil training objectives for competency, proficiency and mastery performance - Qualitative Interview (Semi-Structured), Grounded Theory Method

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Background literature (google search - "learning preferences of residents in radiology") Acad Rad 2007 Survey of residents use of textbooks, journals, internet J Digit Imaging 2006 Radiologists' preference for just in time learning and full / pdf Learning styles in radiology CAR report RSNA 2012 poster Moving to the Digital Age of Radiology Education: A Survey of Learning Resources at an Academic Institution Insights Imaging 2011 Radiology teaching for junior doctors: their expectations, preferences and suggestions for improvement Radiographics 2001 Do Computers Teach Better?

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For MEU Certificate in MHPE Program Participants

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For MEU Certificate in MHPE Program Participants

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Discussion Question
There are two paradigms for qualitative research such as deductive and inductive. Deductive paradigm starts with a theory, then collects data to test it. Inductive paradigm begins with observation, then attempts to explain by generalizing. Please describe a project by using one of the paradigm as framework.

No assignments for the workshop. But for their final projects, they are expected to collect qualitative data.

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1. Tell us a little about yourself (please also identify yourself/give name)

a. background - current clinical, educational or administrative practice, number of years active, practice setting

b. experience and training in educational research - e.g. pick up as you go along, workshops, courses, formal training (Masters, PhD)

c. personal / academic goal that you are hoping this workshop helps you achieve

and

2. Share an educational project you intend to use qualitative research methods on (current or planned/upcoming)

a. aim

b. study design / how you intend or hope to answer your research question

c. barriers you have encountered in implementing qualitative research methods

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Qualitative and Quantitative Research Literature

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Qualitative and Quantitative Research Literature

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curated by Dr Goh Poh Sun

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Qualitative and Quantitative Research Literature

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(google search "qualitative research in medical education") A (one page) guide to research paradigms relevant to medical education (Academ...

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Participant List: Qualitative Research Methods Workshop

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Participant List: Qualitative Research Methods Workshop

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Methodology tutorial - quantitative data analysis - EduTech Wiki

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The "red" student who uses the computer for very long hours will lead to a positive correlation and positive regression rate, whereas the "black" ones alone in the data suggest an inexistent correlation. Mean use of computers does not represent "typical" usage in this case, since the "red" one "pulls the mean upwards".

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Computer-assisted qualitative data analysis software - Wikipedia

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Computer Assisted/Aided Qualitative Data Analysis Software (CAQDAS) offers tools that assist with qualitative research such as transcription analysis, coding and text interpretation, recursive abstraction, content analysis, discourse analysis, grounded theory methodology, etc.

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Looking for targeted responses to your surveys?
Get the responses you need in minutes with SurveyMonkey Audience, our trusted panel of more than 175 million respondents from across the globe.

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SurveyMonkey: The World's Most Popular Free Online Survey Tool

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Use SurveyMonkey to drive your business forward by using our free online survey and forms tool to capture the voices and opinions of the people who matter most to you.

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by Dong Chaoyan

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1. "How People Learn" books ● How Learning Works: Seven Research-Based Principles for Smart Teaching - Susan Ambrose et al. (201...

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Qualitative Research Methods Workshop by MEU

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Qualitative Research Methods Workshop by MEU

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Qualitative research methods in medical education workshop flyer (pdf)

http://medicine.nus.edu.sg/meu/events/events.shtml#5May14

"Message to workshop participants -

Thank you for signing up for this workshop. My presentations on the topics for the workshop will be based on the material on this website. The presentations will be given entirely from this website.

Please explore the content, and reflect on the engagement process as well.

May I invite you to post comments, and questions on the "add your comments" section in this blog below. Please also post in the comments section how you currently use; or are thinking of using the qualitative research methods in your own educational activities.

I have also set up a "digital wall" for all workshop participants, and faculty to record and share their thoughts (see website/link below). You all have permission/digital rights to post and modify your contributions at any time. Please make use of this digital wall - and please title your contribution, include your name; then share your thoughts; pose questions; share documents, videos, links, or any other contribution you feel would add to the discussion.

http://padlet.com/dnrgohps/qualresearchMEU

All you need to do is to double click on any clear space on the digital wall on the website above. You do not need to log-in or sign up. And you can modify your post, add to, or delete the post at any time.
As a specific task, please answer the following questions about yourself, by making a post on the digital wall BEFORE the workshop (by Monday, July 21st before the workshop please).

1. Tell us a little about yourself (please also identify yourself/give name)

a. background - current clinical, educational or administrative practice, number of years active, practice setting

b. experience and training in educational research - e.g. pick up as you go along, workshops, courses, formal training (Masters, PhD)
c. personal / academic goal that you are hoping this workshop helps you achieve

2. Share an educational project you intend to use qualitative research methods on (current or planned/upcoming)

b. study design / how you intend or hope to answer your research question
c. barriers you have encountered in implementing qualitative research methods

GOH Poh Sun
MBBS(Melb), FRCR(UK), FAMS(Singapore), MHPE(Maastricht)
Associate Professor and Senior Consultant
Department of Diagnostic Radiology
National University Hospital
National University Health System
Singapore
Email: dnrgohps@nus.edu.sg

Brief Bio:
Dr Goh is a clinician educator who currently devotes 80% of his time to clinical practice and postgraduate training; and 20% of time to educational research. This has been supplemented over the last three years by daily two to three hour early morning sessions focused on creating, curating and sharing (anonymised) case based educational teaching resources on a variety of digital and mobile learning platforms, from a digital repository currently containing over 5000 digital teaching and learning objects. 25/21/13: years of experience as a clinical radiologist/educator/technology enhanced learning practitioner.

"Passions - Technology enhanced learning, Education, Radiology. Technology as a tool, platform and enabler to support and augment face to face customised teaching and learning; with educational principles as the foundation; and radiology as my academic and clinical focus."

http://sg.linkedin.com/pub/poh-sun-goh/22/45b/b16 (LinkedIn profile)
http://www.slideshare.net/dnrgohps/documents and http://www.slideshare.net/dnrgohps/presentations
(Education presentations and papers)
_____________

http://padlet.com/dnrgohps/qualresearchMEU

Qualitative and quantitative research literature

Application of key ideas to case studies below: one medical education presentation, and one workshop

1. survey participants before workshop

online survey - participant profile (age, background, training, current practice, experience, learning needs)

2. engage participants before, during and after workshop

online survey and feedback

invitation to submit comments or feedback

systematic follow-up interviews - one on one and focus groups

3. collaborative project discussions and projects

NUS Prime: Technology enhanced learning - three case studies

The case study as a research method

MEU workshop: Use of videos in medical education

Visual analytics (Slideshare)

http://www.visual-analytics.eu/

Mastering the information age with visual analytics

Mastering the information age - Solving problems with visual analytics (pdf)

The future of retail (Slidedeck) some common examples of current information presentation

Use of learning resources by residents in radiology 2013

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Qualitative research methods in medical education workshop on Thursday, 24 July 2014

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Qualitative research methods in medical education workshop flyer (pdf) http://medicine.nus.edu.sg/meu/events/events.shtml#5May14 "Message to workshop participants - Thank you for signing up for this workshop. My presentations on the topics for the workshop will be based on the material on this website. The presentations will be given entirely from this website.