Perspectives on Medical Education最新文献

{"title":"A Qualitative Textual Analysis of Feedback Comments in ePortfolios: Quality and Alignment with the CanMEDS Roles","authors":"Sofie Van Ostaeyen, M. Embo, Tijs Rotsaert, Orphée De Clercq, T. Schellens, Martin Valcke","doi":"10.5334/pme.1050","DOIUrl":"https://doi.org/10.5334/pme.1050","url":null,"abstract":"Introduction: Competency-based education requires high-quality feedback to guide students’ acquisition of competencies. Sound assessment and feedback systems, such as ePortfolios, are needed to facilitate seeking and giving feedback during clinical placements. However, it is unclear whether the written feedback comments in ePortfolios are of high quality and aligned with the current competency focus. Therefore, this study investigates the quality of written feedback comments in ePortfolios of healthcare students, as well as how these feedback comments align with the CanMEDS roles. Methods: A qualitative textual analysis was conducted. 2,349 written feedback comments retrieved from the ePortfolios of 149 healthcare students (specialist medicine, general practice, occupational therapy, speech therapy and midwifery) were analysed retrospectively using deductive content analysis. Two structured categorisation matrices, one based on four literature-derived feedback quality criteria (performance, judgment, elaboration and improvement) and another one on the seven CanMEDS roles (Medical Expert, Communicator, Collaborator, Leader, Health Advocate, Scholar and Professional), guided the analysis. Results: The minority of the feedback comments (n = 352; 14.9%) could be considered of high quality because they met all four quality criteria. Most feedback comments were of moderate quality and met only two to three quality criteria. Regarding the CanMEDS roles, the Medical Expert role was most frequently represented in the feedback comments, as opposed to the roles Leader and Health Advocate. Discussion: The results highlighted that providing high-quality feedback is challenging. To respond to these challenges, it is recommended to set up individual and continuous feedback training.","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"4 3","pages":"584 - 593"},"PeriodicalIF":3.6,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138947549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Does a Group Reflection Intervention (Schwartz Rounds) Work within Healthcare Undergraduate Settings? A Realist Review","authors":"Duncan Hamilton, Cath Taylor, J. Maben","doi":"10.5334/pme.930","DOIUrl":"https://doi.org/10.5334/pme.930","url":null,"abstract":"Introduction: Schwartz Rounds (“Rounds”) are a confidential group reflection forum, increasingly adopted to support pre-registration healthcare students. This realist review aims to understand what the available literature and key informant interviews can tell us about Rounds in this setting, asking what works, for whom, in what circumstances, and why? Methods: Published literature discussing Rounds in undergraduate settings were analysed using realist methods to describe how, for whom and in which contexts Rounds work. Four key informants were interviewed using realist methods, to further develop, test and refine a programme theory of Rounds in undergraduate settings. Results: We identified five core features and five contextual adaptations. Core: Rounds provide a reflective space to discuss emotional challenges; Rounds promote an open and humanised professional culture; Rounds offer role-modelling of vulnerability, enabling interpersonal connectedness; Rounds are impactful when focused on emotional and relational elements; Rounds offer reflective insights from a wide range of perspectives. Contextual adaptations: Rounds allow reflection to be more engaging for students when they are non-mandatory; perceptions of safety within a Round varies based on multiple factors; adapting timing and themes to students’ changing needs may improve engagement; resonance with stories is affected by clinical experience levels; online adaptation can increase reach but may risk psychological safety. Discussion: Schwartz Rounds are a unique intervention that can support healthcare students through their pre-registration education. The five “core” and five “contextual adaptation” features presented identify important considerations for organisations implementing Rounds for their undergraduates.","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":" 21","pages":"550 - 564"},"PeriodicalIF":3.6,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138961542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Will ChatGPT’s Free Language Editing Service Level the Playing Field in Science Communication?: Insights from a Collaborative Project with Non-native English Scholars","authors":"L. Lingard, Madawa Chandritilake, Merel De Heer, J. Klasen, Fury Maulina, Francisco M. Olmos-Vega, Christina St-Onge","doi":"10.5334/pme.1246","DOIUrl":"https://doi.org/10.5334/pme.1246","url":null,"abstract":"ChatGPT has been widely heralded as a way to level the playing field in scientific communication through its free language editing service. However, such claims lack systematic evidence. A writing scholar (LL) and six non-native English scholars researching health professions education collaborated on this Writer’s Craft to fill this gap. Our overarching aim was to provide experiential evidence about ChatGPT’s performance as a language editor and writing coach. We implemented three cycles of a systematic procedure, describing how we developed our prompts, selected text for editing, incrementally prompted to refine ChatGPT’s responses, and analyzed the quality of its language edits and explanations. From this experience, we offer five insights, and we conclude that the optimism about ChatGPT’s capacity to level the playing field for non-native English writers should be tempered.\u0000In the writer’s craft section we offer simple tips to improve your writing in one of three areas: Energy, Clarity and Persuasiveness. Each entry focuses on a key writing feature or strategy, illustrates how it commonly goes wrong, teaches the grammatical underpinnings necessary to understand it and offers suggestions to wield it effectively. We encourage readers to share comments on or suggestions for this section on Twitter, using the hashtag: #how’syourwriting?","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":" 984","pages":""},"PeriodicalIF":3.6,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138960398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"It is Challenging to Shift the Norm: Exploring how to Anticipate and Address Microaggressions in Clinical Learning Environments","authors":"J. Sukhera, Tess M. Atkinson, Justin L. Bullock","doi":"10.5334/pme.1251","DOIUrl":"https://doi.org/10.5334/pme.1251","url":null,"abstract":"Purpose: Increased attention to improving a culture of belonging in clinical learning environments has led to various approaches to addressing microaggressions. However, most approaches in the literature focus on responding or reacting to microaggressions with insufficient attention to building trust before microaggressions might occur. Research on microaggressions in clinical learning environments suggests anticipatory or pre-emptive conversations about microaggressions may foster greater trust. In this study, the authors explored how diverse participants perceived the experience of anticipatory conversations about potential microaggressions. Overall, the authors sought to gain a deeper understanding of how pre-emptive and anticipatory conversations may influence an organization’s approach to addressing microaggressions in clinical learning environments. Methods: The authors utilized constructivist grounded theory methodology and conducted individual qualitative interviews with 21 participants in an academic department within a larger health sciences center in the United States. Results: Findings suggest that anticipatory conversations about microaggressions were challenging due to existing norms in dynamic clinical learning and working environments. Participants shared that the idea of anticipating microaggressions elicited dissonance. Conversations about microaggressions could potentially be facilitated through leaders who role model vulnerability, organizational supports, and an individualized approach for each team member and their role within a complex hierarchical organization. Discussion: Anticipating and addressing microaggressions in clinical learning environments holds tremendous potential, however, any conversations about personal identity remain challenging in medical and healthcare environments. This study suggests that any attempts to address microaggressions requires attention to cultural norms within healthcare environments and the ways that hierarchical organizations can constrain individual agency.","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":" 91","pages":"575 - 583"},"PeriodicalIF":3.6,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138961156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automating the Identification of Feedback Quality Criteria and the CanMEDS Roles in Written Feedback Comments Using Natural Language Processing","authors":"Sofie Van Ostaeyen, Loic De Langhe, Orphée De Clercq, M. Embo, T. Schellens, M. Valcke","doi":"10.5334/pme.1056","DOIUrl":"https://doi.org/10.5334/pme.1056","url":null,"abstract":"Introduction: Manually analysing the quality of large amounts of written feedback comments is time-consuming and demands extensive resources and human effort. Therefore, this study aimed to explore whether a state-of-the-art large language model (LLM) could be fine-tuned to identify the presence of four literature-derived feedback quality criteria (performance, judgment, elaboration and improvement) and the seven CanMEDS roles (Medical Expert, Communicator, Collaborator, Leader, Health Advocate, Scholar and Professional) in written feedback comments. Methods: A set of 2,349 labelled feedback comments of five healthcare educational programs in Flanders (Belgium) (specialistic medicine, general practice, midwifery, speech therapy and occupational therapy) was split into 12,452 sentences to create two datasets for the machine learning analysis. The Dutch BERT models BERTje and RobBERT were used to train four multiclass-multilabel classification models: two to identify the four feedback quality criteria and two to identify the seven CanMEDS roles. Results: The classification models trained with BERTje and RobBERT to predict the presence of the four feedback quality criteria attained macro average F1-scores of 0.73 and 0.76, respectively. The F1-score of the model predicting the presence of the CanMEDS roles trained with BERTje was 0.71 and 0.72 with RobBERT. Discussion: The results showed that a state-of-the-art LLM is able to identify the presence of the four feedback quality criteria and the CanMEDS roles in written feedback comments. This implies that the quality analysis of written feedback comments can be automated using an LLM, leading to savings of time and resources.","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"83 s369","pages":"540 - 549"},"PeriodicalIF":3.6,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138995320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Twitter as a Mechanism of Knowledge Translation in Health Professions Education: An Exploratory Content Analysis.","authors":"Catherine M Giroux, Lauren A Maggio, Conchita Saldanha, André Bussières, Aliki Thomas","doi":"10.5334/pme.1053","DOIUrl":"https://doi.org/10.5334/pme.1053","url":null,"abstract":"<p><strong>Introduction: </strong>Social media may facilitate knowledge sharing within health professions education (HPE), but whether and how it is used as a mechanism of knowledge translation (KT) is not understood. This exploratory study aimed to ascertain what content has been shared on Twitter using #MedEd and how it is used as a mechanism of KT.</p><p><strong>Methods: </strong>Symplur was used to identify all tweets tagged with #MedEd between March 2021 - March 2022. A directed content analysis and multiple cycles of coding were employed. 18,000 tweets were identified, of which 478 were included. Studies sharing high quality HPE information; relating to undergraduate, postgraduate, or continuing education; referring to an evidence source; and posted in English or French were included.</p><p><strong>Results: </strong>Diverse content was shared using #MedEd, including original tweets, links to peer-reviewed articles, and visual media. Tweets shared information about new educational approaches; system, clinical, or educational research outcomes; and measurement tools. #MedEd appears to be a mechanism of diffusion (n = 296 tweets) and dissemination (n = 164 tweets). It is less frequently used for knowledge exchange (n = 13 tweets) and knowledge synthesis (n = 5 tweets). No tweets demonstrated the ethically sound application of knowledge.</p><p><strong>Discussion: </strong>It is challenging to determine whether and how #MedEd is used to promote the uptake of knowledge into HPE or if it is even possible for Twitter to serve these purposes. Further studies exploring how health professions educators use the knowledge gained from Twitter to inform their educational or clinical practices are recommended.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"12 1","pages":"529-539"},"PeriodicalIF":3.6,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10723015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138812678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intersectionality in Medical Education: A Meta-Narrative Review.","authors":"Maham Rehman, Divya Santhanam, Javeed Sukhera","doi":"10.5334/pme.1161","DOIUrl":"10.5334/pme.1161","url":null,"abstract":"<p><strong>Introduction: </strong>Despite increasing attention to improving equity, diversity, and inclusion in academic medicine, a theoretically informed perspective to advancing equity is often missing. Intersectionality is a theoretical framework that refers to the study of the dynamic nature of social categories with which an individual identifies and their unique localization within power structures. Intersectionality can be a useful lens to understand and address inequity, however, there is limited literature on intersectionality in the context of medical education. Thus, we explored how intersectionality has been conceptualized and applied in medical education.</p><p><strong>Methods: </strong>We employed a meta-narrative review, analyzing existing literature on intersectionality theory and frameworks in medical education. Three electronic databases were searched using key terms yielding 32 articles. After, title, abstract and full-text screening 14articles were included. Analysis of articles sought a meaningful synthesis on application of intersectionality theory to medical education.</p><p><strong>Results: </strong>Existing literature on intersectionality discussesthe role of identity categorization and the relationship between identity, power, and social change. There are contrasting narratives on the practical application of intersectionality to medical education, producing tensions between how intersectionality is understood as theory and how it is translated in practice.</p><p><strong>Discussion: </strong>A paucity in literature on intersectionality in medical education suggests that there is a risk intersectionality may be understood in a superficial manner and considered a synonym for diversity. Drawing explicit attention to its core tenets of reflexivity, transformational identity, and analysis of power is important to maintain fidelity to how intersectionality is understood in broader critical social science literature.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"12 1","pages":"517-528"},"PeriodicalIF":3.6,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10637289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89720034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contradictions and Opportunities: Reconciling Professional Identity Formation and Competency-Based Medical Education.","authors":"Robert Sternszus, Natasha Khursigara Slattery, Richard L Cruess, Olle Ten Cate, Stanley J Hamstra, Yvonne Steinert","doi":"10.5334/pme.1027","DOIUrl":"10.5334/pme.1027","url":null,"abstract":"<p><p>The widespread adoption of Competency-Based Medical Education (CBME) has resulted in a more explicit focus on learners' abilities to effectively demonstrate achievement of the competencies required for safe and unsupervised practice. While CBME implementation has yielded many benefits, by focusing explicitly on what learners are doing, curricula may be unintentionally overlooking who learners are becoming (i.e., the formation of their professional identities). Integrating professional identity formation (PIF) into curricula has the potential to positively influence professionalism, well-being, and inclusivity; however, issues related to the definition, assessment, and operationalization of PIF have made it difficult to embed this curricular imperative into CBME. This paper aims to outline a path towards the reconciliation of PIF and CBME to better support the development of physicians that are best suited to meet the needs of society. To begin to reconcile CBME and PIF, this paper defines three contradictions that must and can be resolved, namely: (1) CBME attends to behavioral outcomes whereas PIF attends to developmental processes; (2) CBME emphasizes standardization whereas PIF emphasizes individualization; (3) CBME organizes assessment around observed competence whereas the assessment of PIF is inherently more holistic. Subsequently, the authors identify curricular opportunities to address these contradictions, such as incorporating process-based outcomes into curricula, recognizing the individualized and contextualized nature of competence, and incorporating guided self-assessment into coaching and mentorship programs. In addition, the authors highlight future research directions related to each contradiction with the goal of reconciling 'doing' and 'being' in medical education.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"12 1","pages":"507-516"},"PeriodicalIF":3.6,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10637293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89720033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Analysis of Written and Numeric Scores in End-of-Rotation Forms from Three Residency Programs.","authors":"Lauren M Anderson, Kathleen Rowland, Deborah Edberg, Katherine M Wright, Yoon Soo Park, Ara Tekian","doi":"10.5334/pme.41","DOIUrl":"10.5334/pme.41","url":null,"abstract":"<p><strong>Introduction: </strong>End-of-Rotation Forms (EORFs) assess resident progress in graduate medical education and are a major component of Clinical Competency Committee (CCC) discussion. Single-institution studies suggest EORFs can detect deficiencies, but both grades and comments skew positive. In this study, we sought to determine whether the EORFs from three programs, including multiple specialties and institutions, produced useful information for residents, program directors, and CCCs.</p><p><strong>Methods: </strong>Evaluations from three programs were included (Program 1, Institution A, Internal Medicine: n = 38; Program 2, Institution A, Anesthesia: n = 9; Program 3, Institution B, Anesthesia: n = 11). Two independent researchers coded each written comment for relevance (specificity and actionability) and orientation (praise or critical) using a standardized rubric. Numeric scores were analyzed using descriptive statistics.</p><p><strong>Results: </strong>4869 evaluations were collected from the programs. Of the 77,434 discrete numeric scores, 691 (0.89%) were considered \"below expected level.\" 71.2% (2683/3767) of the total written comments were scored as irrelevant, while 3217 (85.4%) of total comments were scored positive and 550 (14.6%) were critical. When combined, 63.2% (n = 2379) of comments were scored positive and irrelevant while 6.5% (n = 246) were scored critical and relevant.</p><p><strong>Discussion: </strong><1% of comments indicated below average performance; >70% of comments scored irrelevant. Critical, relevant comments were least frequently observed, consistent across all 3 programs. The low rate of constructive feedback and the high rate of irrelevant comments are inadequate for a CCC to make informed decisions. The consistency of these findings across programs, specialties, and institutions suggests both local and systemic changes should be considered.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"12 1","pages":"497-506"},"PeriodicalIF":3.6,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10624145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71487641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining the Effect of Virtual Learning on Canadian Pre-Clerkship Medical Student Well-Being During the COVID-19 Pandemic.","authors":"Nikita Ollen-Bittle,&nbsp;Asaanth Sivajohan,&nbsp;Joshua Jesin,&nbsp;Majid Gasim,&nbsp;Christopher Watling","doi":"10.5334/pme.1184","DOIUrl":"https://doi.org/10.5334/pme.1184","url":null,"abstract":"<p><strong>Introduction: </strong>The restrictions of the COVID-19 pandemic resulted in the broad and abrupt incorporation of virtual/online learning into medical school curricula. While current literature explores the effectiveness and economic advantages of virtual curricula, robust literature surrounding the effect of virtual learning on medical student well-being is needed. This study aims to explore the effects of a predominantly virtual curriculum on pre-clerkship medical student well-being.</p><p><strong>Methods: </strong>This study followed a constructivist grounded theory approach. During the 2020-2021 and 2021-2022 academic years, students in pre-clerkship medical studies at Western University in Canada were interviewed by medical student researchers over Zoom. Data was analyzed iteratively using constant comparison.</p><p><strong>Results: </strong>We found that students experiencing virtual learning faced two key challenges: 1) virtual learning may be associated with an increased sense of social isolation, negatively affecting wellbeing, 2) virtual learning may impede or delay the development of trainees' professional identity. With time, however, we found that many students were able to adapt by using protective coping strategies that enabled them to appreciate positive elements of online learning, such as its flexibility.</p><p><strong>Discussion: </strong>When incorporating virtual learning into medical education, curriculum developers should prioritize optimizing existing and creating new ways for students to interact with both peers and faculty to strengthen medical student identity and combat feelings of social isolation.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"12 1","pages":"488-496"},"PeriodicalIF":3.6,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10624142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71487644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}