Yadira Roa Romero

Background: Core Entrustable Professional Activities (EPAs) have been defined to specify the performance expectations for entering residents worldwide. The content of these EPAs was elaborated and validated primarily via medical expert consent approaches. The present study aims to collect empirical information on the actual task performance and supervision level of entering residents as a complementary methodological approach to enhance the content validity of a set of institutional EPAs.Methods: In the summers of 2017 and 2018, Charité medical graduates (n = 720) received a post-graduation survey by mail. The questionnaire covered the performance of Core EPAs, Core procedures and more advanced EPAs. Graduates were asked how frequently they had performed the respective EPAs since the start of residency and under what level of supervision. We expected the large majority of graduates (> 75%) to have performed the Core EPAs and procedures under at least indirect supervision.Results: In total, 215 graduates (30%) returned the questionnaire, and 131 (18%) surveys could be included in the data analysis. The majority of participants were female (63%) and worked in hospitals (50%) or in university medical centres (30%) across various medical disciplines. Among the Core EPAs, 10 out of 11 tasks had been performed by more than 75% of graduates since the start of residency, 9 under indirect supervision. Regarding the Core procedures, only 3 out of 13 procedures had been performed by the large majority of graduates under indirect supervision, and 10 procedures had not been carried out by at least one-third of participants. Among the 5 advanced EPAs, none of 5 had been performed by more than 75% of the participants since the start of residency, and 4 had been carried out by 50% under indirect supervision.Conclusions: The results of this study largely and complementarily confirm the validity of the defined Core EPAs representing realistic expectations for entry into residence at our institution. The low actual performance rate of Core procedures serves to stimulate an institutional discussion on their adjustment to better match the workplace reality.

Our brain generates predictions about forthcoming stimuli and compares predicted with incoming input. Failures in predicting events might contribute to hallucinations and delusions in schizophrenia (SZ). When a stimulus violates prediction, neural activity that reflects prediction error (PE) processing is found. While PE processing deficits have been reported in unisensory paradigms, it is unknown whether SZ patients (SZP) show altered crossmodal PE processing. We measured high-density electroencephalography and applied source estimation approaches to investigate crossmodal PE processing generated by audiovisual speech. In SZP and healthy control participants (HC), we used an established paradigm in which high- and low-predictive visual syllables were paired with congruent or incongruent auditory syllables. We examined crossmodal PE processing in SZP and HC by comparing differences in event-related potentials and neural oscillations between incongruent and congruent high- and low-predictive audiovisual syllables. In both groups event-related potentials between 206 and 250 ms were larger in high- compared with low-predictive syllables, suggesting intact audiovisual incongruence detection in the auditory cortex of SZP. The analysis of oscillatory responses revealed theta-band (4–7 Hz) power enhancement in high- compared with low-predictive syllables between 230 and 370 ms in the frontal cortex of HC but not SZP. Thus aberrant frontal theta-band oscillations reflect crossmodal PE processing deficits in SZ. The present study suggests a top-down multisensory processing deficit and highlights the role of dysfunctional frontal oscillations for the SZ psychopathology.

The formation of coherent multisensory percepts requires integration of stimuli across the multiple senses. Patients with schizophrenia (ScZ) often experience a loss of coherent perception and hence, they might also show dysfunctional multisensory processing. In this high-density electroencephalography study we investigated the neural signatures of the McGurk illusion, as a phenomenon of speech-specific multisensory processing. In the McGurk illusion lip movements are paired with incongruent auditory syllables, which can induce a fused percept. In ScZ patients and healthy controls we compared neural oscillations and event-related potentials (ERPs) to congruent audiovisual speech stimuli and McGurk illusion trials, where a visual /ga/ and an auditory /pa/ was often perceived as /ka/. There were no significant group differences in illusion rates. However, we found larger short latency ERPs to McGurk illusion compared with congruent trials in controls, whereas they were reduced in ScZ patients, indicating an early audiovisual processing deficit. Moreover, we observed stronger suppression of medio-central alpha-band power (8-10 Hz, 550-700 ms) in response to McGurk illusion compared with control trials in the control group. The reversed pattern was found in SCZ patients. Within groups, alpha-band suppression was negatively correlated with the McGurk illusion rate in ScZ patients, while the correlation tended to be positive in controls. The topography of alpha-band effects suggests an involvement of auditory and/or frontal structures. Our study suggests that early ERPs and later alpha-band oscillations reflect abnormal multisensory processing of the McGurk illusion in schizophrenia.

The McGurk illusion is a prominent example of audiovisual speech perception and the influence that visual stimuli can have on auditory perception. In this illusion, a visual speech stimulus influences the perception of an incongruent auditory stimulus, resulting in a fused novel percept. In this high-density electroencephalography (EEG) study, we were interested in the neural signatures of the subjective percept of the McGurk illusion as a phenomenon of speech-specific multisensory integration. Therefore, we examined the role of cortical oscillations and event-related responses in the perception of congruent and incongruent audiovisual speech. We compared the cortical activity elicited by objectively congruent syllables with incongruent audiovisual stimuli. Importantly, the latter elicited a subjectively congruent percept: the McGurk illusion. We found that early event-related responses (N1) to audiovisual stimuli were reduced during the perception of the McGurk illusion compared with congruent stimuli. Most interestingly, our study showed a stronger poststimulus suppression of beta-band power (13–30 Hz) at short (0–500 ms) and long (500–800 ms) latencies during the perception of the McGurk illusion compared with congruent stimuli. Our study demonstrates that auditory perception is influenced by visual context and that the subsequent formation of a McGurk illusion requires stronger audiovisual integration even at early processing stages. Our results provide evidence that beta-band suppression at early stages reflects stronger stimulus processing in the McGurk illusion. Moreover, stronger late beta-band suppression in McGurk illusion indicates the resolution of incongruent physical audiovisual input and the formation of a coherent, illusory multisensory percept.