Deliberate practice and acquisition of expert performance: a general overview

Outcomes of postgraduate fellowships and residencies for nurse practitioners: An integrative review

BACKGROUND

In 2011, the Institute of Medicine published a report on the future of nursing, which recommended nurse practitioner postgraduate training in the form of fellowships or residencies. Since then, the number of postgraduate programs has grown, but data is still scarce regarding their efficacy and benefits.

AIM

The goal of this integrative review is to synthesize available literature regarding the outcomes of nurse practitioner postgraduate fellowships and/or residencies on clinical competence and perceived readiness to practice.

METHODS

CINAHL, PubMed, and citation searching were used to search relevant subject headings, MeSH headings, and keywords related to fellowships and residencies for nurse practitioners, resulting in 11 articles being included based on inclusion and exclusion criteria. Synthesis was completed using the Garrard Matrix method to identify common themes among the studies.

RESULTS

Eight quasi-experimental and three cross-sectional studies were included in this review. Programs included multiple areas of focus, including primary care, critical care, and pediatric acute care. Common themes among the studies were an increased level of preparedness, reduced turnover, and greater job satisfaction.

CONCLUSIONS

The major theme found among the studies was an increased confidence and preparedness to practice. Minor themes include increased job satisfaction and decreased intent to quit.

A comparison of perceptual-cognitive skills in expert and non-expert sports officials: a systematic review and meta-analysis

Introduction

The purpose of this study is to systematically compare and assess the differences in perceptual-cognitive skills between expert and non-expert sports officials, and further explore the potential differences caused by different types of sports officials, in order to provide a more comprehensive understanding of the perceptual-cognitive skills of sports officials.

Methods

Relevant literature published before 31 December 2022 was searched in four English databases. Review Manager 5.4 and Stata 12.0 software were used for meta-analysis and bias test.

Results

Expert sports officials are significantly more accurate in their decision-making than non-expert sports officials, and exhibit a large amount of effect size (SMD = 1.09; 95%CI: 0.52, 1.66; P < 0.05). Expert sports officials had significantly fewer number of fixations than non-expert sports officials and showed a moderate amount of effect size (SMD = 0.71; 95%CI: 1.25, 0.17; P < 0.05). Expert sports officials' duration of fixation (SMD = 0.23; 95%CI: 0.25, 0.71; P = 0.35) were not significantly different from non-expert sports officials.

Discussion

It can be seen that there are differences in the Perceptual-cognitive skills of expert and non-expert sports officials. Decision-making accuracy can serve as an important indicator for distinguishing the perceptual-cognitive skills of expert and non-expert sports officials. Number of fixations can serve as important indicators to differentiate the perceptual-cognitive skills of monitors.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=418594, identifier: CRD42023418594.

Interdisciplinary training program for pediatric cardiorespiratory arrest using rapid cycle deliberate practice: A descriptive cross-sectional study

BACKGROUND

cardiorespiratory arrest (CRA) is a severe public health concern, and clinical simulation has proven to be a beneficial educational strategy for training on this topic.

OBJECTIVE

To describe the implementation of a program for pediatric cardiac arrest care using rapid-cycle deliberate practice (RCDP), the quality of the technique employed, and participants' opinions on the methodology.

DESIGN AND SETTING

This descriptive cross-sectional study of pre- and post-performance training in cardiopul monary resuscitation (CPR) techniques and reaction evaluation was conducted in a hospital in São Paulo.

METHODS

Multidisciplinary groups performed pediatric resuscitation in a simulated scenario with RCDP mediated by a facilitator. The study sample included professionals working in patient care. During the simulation, the participants were evaluated for their compliance with the CRA care algorithm. Further, their execution of chest compressions was assessed pre- and post-intervention.

RESULTS

In total, 302 professionals were trained in this study. The overall quality of CPR measured pre-intervention was inadequate, and only 26% had adequate technique proficiency, whereas it was 91% (P < 0.01) post-intervention. Of the participants, 95.7% responded to the final evaluation and provided positive comments on the method and their satisfaction with the novel simulation. Of these, 88% considered that repetition of the technique used was more effective than traditional simulation.

CONCLUSIONS

The RCDP is effective for training multidisciplinary teams in pediatric CPR, with an emphasis on the quality of chest compressions. However, further studies are necessary to explore whether this trend translates to differential performances in practical settings.

Impact of Longitudinal Mechanical Ventilation Curriculum on Decay of Knowledge

Background

Prior evidence suggests that critical care trainees and attendings may have trouble recognizing common, potentially life-threatening mechanical ventilation (MV) waveform asynchronies. Although dedicated workshops may improve knowledge in MV, this knowledge may be prone to decay over time. Longitudinal, preceptorial-based curriculums may prevent this decay in knowledge.

Objective

To determine if the addition of a year-long, longitudinal MV preceptorial curriculum to a two-part, small-group, simulation-based education block curriculum reduces decay in MV knowledge compared with the education block curriculum alone.

Methods

This was a multicenter prospective cohort study including 123 first-year fellows from 12 critical care fellowship programs who completed a two-part simulation-based education block (control) after the first and sixth months of fellowship. Fellows from one of these programs also participated in a year-long preceptorial curriculum (intervention). MV waveform examination scores over time during fellowship were compared between control versus intervention groups.

Results

Mean test scores increased for both control and intervention groups after the education block courses at Months 1 and 6 of fellowship. Mean (standard deviation) test scores at Month 12 were higher for the intervention group than the control group (89.3 [14.8] vs. 47.7 [21.4]; P < 0.0001). Between 6 months and 3 years of fellowship, there was a significant decay in test scores for the control group (slope estimate [standard error], -13.4 [1.7]; P < 0.0001). However, there was no significant decay in test scores for the intervention group (slope estimate, -2.0 [4.7]; P = 0.67; difference in slope estimates, 11.4 [5.0]; P = 0.02).

Conclusion

The ability of critical care fellows to identify MV waveform asynchronies declines over fellowship training, despite a dedicated two-part, simulation-based MV educational curriculum. The addition of an MV preceptorial course decreased decay of MV knowledge over the course of fellowship training.

Pistol shooting performance under pressure: Longitudinal changes in gaze behavior of male and female Army cadets

We found evidence that Army cadets improved their gaze behavior and performance across time under high and low pressure in a shooting task. The purpose of the study was to determine if male and female cadets developed an optimal quiet eye (QE) onset, a longer QE duration, and decreased pupil diameter variability (PDV) over time under low (LP) and high pressure (HP) conditions. The study was carried out over four sessions, with intervals of 4.5 months. During each session, 16 men and 12 women, first-year cadets of The Brazilian Army Academy, performed ten pistol shots under counterbalanced LP and HP conditions. The cadets shot in the upright position and wore an eye-tracker. Shooting accuracy improved and did not differ for men and women in the LP condition, however during HP the women performed more poorly than the men in session 1 but improved to a level similar to the men in session 4. QE duration Pre (aiming) did not differ during LP, while during HP QE Post (execution) increased across the session for men and women. QE onset 2 (execution) occurred earlier for the men than women during LP, while during HP the women improved to a level similar to the men in sessions 3 and 4. PDV declined across sessions for men and women with the lowest values in sessions 3 and 4. The findings are discussed within social facilitation theory, which states the context of training affects the rate at which improvements in motor skills occur. The results show that women cadets can improve their shooting performance, quiet eye duration, quiet eye onset and pupil diameter variability to a level similar to men if three to four LP and HP training sessions are scheduled across approximately 12-18 months.

Making goals count: A theory-informed approach to on-shift learning goals

Supervisors often ask emergency medicine trainees for their learning goals at the start of a clinical shift, though they may do so without considering the reasons for this practice. Recognizing the underlying rationale for voicing on-shift learning goals and proactively considering solutions for some of the associated challenges can help learners and supervisors employ this practice to its full potential. Goal articulation is rooted in educational principles such as self-regulated learning, targeted performance feedback, and collaborative relationships between learner and supervisor. Despite the potential for on-shift learning goals to augment learning, there are numerous barriers that make it challenging for learners and supervisors alike to create or follow up on meaningful goals. Learner-related challenges include uncertainty about how to develop goals within an unpredictable clinical environment and creating goals too narrow or broad in scope. Supervisor-related challenges include difficulties integrating direct observation into the clinical workflow and a desire to avoid negative feedback. The learning environment also presents inherent challenges, such as lack of longitudinal supervisor-learner relationships, time constraints, space limitations, and incentives for learners to conceal their knowledge gaps. The authors discuss these challenges to effective on-shift learning goals and propose solutions that target the learner's approach, the supervisor's approach, and the learning environment itself.

Vascular Anastomoses and Dissection: A Six-Part Simulation Curriculum for Surgical Residents

Introduction

As surgical technologies grow, so too do demands on surgical trainees to master increasing numbers of skill sets. With the rise of endovascular surgery, trainees have fewer opportunities to practice open vascular techniques in the operating room. Simulation can bridge this gap. However, existing published open vascular simulation curricula are basic or based on expensive models.

Methods

We iteratively developed an open vascular skills curriculum for second-year surgery residents comprising six 2-hour sessions. We refined the curriculum based on feedback from learners and faculty. The curriculum required skilled facilitators, vascular instruments, and tissue models. We evaluated the latest iteration with a survey and by assessing participants' technical skills using the Objective Structured Assessment of Technical Skills (OSATS) form.

Results

Over the past 10 years, 101 residents have participated in the curriculum. Nine of 13 residents who participated in the latest curricular iteration completed the survey. All respondents rated the sessions as excellent and strongly agreed that they had improved their abilities to perform anastomoses with tissue and prosthetic. Facilitators completed 18 OSATS forms for residents in the fifth and sixth sessions of the latest iteration. Residents scored well overall, with a median 26.5 (interquartile range: 24-29) out of a possible score of 35, with highest scores on knowledge of instruments.

Discussion

This simulation-based curriculum facilitates open vascular surgical skill acquisition among surgery residents. The curriculum allows residents to acquire critical vascular skills that are challenging to learn in an increasingly demanding operative setting.

An At-Home Laparoscopic Curriculum for Junior Residents in Surgery, Obstetrics/Gynecology, and Urology

Introduction

Laparoscopic surgery requires significant training, and prior studies have shown that surgical residents lack key laparoscopic skills. Many educators have implemented simulation curricula to improve laparoscopic training. Given limited time for dedicated, in-person simulation center practice, at-home training has emerged as a possible mechanism by which to expand training and promote practice. There remains a gap in published at-home laparoscopic curricula employing embedded feedback mechanisms.

Methods

We developed a nine-task at-home laparoscopic curriculum and an end-of-curriculum assessment following Kern's six-step approach. We implemented the curriculum over 4 months with first- to third-year residents.

Results

Of 47 invited residents from general surgery, obstetrics/gynecology, and urology, 37 (79%) participated in the at-home curriculum, and 25 (53%) participated in the end-of-curriculum assessment. Residents who participated in the at-home curriculum completed a median of six of nine tasks (interquartile range: 3-8). Twenty-two residents (47%) responded to a postcurriculum survey. Of these, 19 (86%) reported that their laparoscopic skills improved through completion of the curriculum, and the same 19 (86%) felt that the curriculum should be continued for future residents. Residents who completed more at-home curriculum tasks scored higher on the end-of-curriculum assessment (p = .009 with adjusted R 2 of .28) and performed assessment tasks in less time (p = .004 with adjusted R 2 of .28).

Discussion

This learner-centered laparoscopic curriculum provides guiding examples, spaced practice, feedback, and graduated skill development to enable junior residents to improve their laparoscopic skills in a low-stakes, at-home environment.

Expertise in surgical neuro-oncology. Results of a survey by the EANS neuro-oncology section

Introduction

Technical advances and the increasing role of interdisciplinary decision-making may warrant formal definitions of expertise in surgical neuro-oncology.

Research question

The EANS Neuro-oncology Section felt that a survey detailing the European neurosurgical perspective on the concept of expertise in surgical neuro-oncology might be helpful.

Material and methods

The EANS Neuro-oncology Section panel developed an online survey asking questions regarding criteria for expertise in neuro-oncological surgery and sent it to all individual EANS members.

Results

Our questionnaire was completed by 251 respondents (consultants: 80.1%) from 42 countries. 67.7% would accept a lifetime caseload of >200 cases and 86.7% an annual caseload of >50 as evidence of neuro-oncological surgical expertise. A majority felt that surgeons who do not treat children (56.2%), do not have experience with spinal fusion (78.1%) or peripheral nerve tumors (71.7%) may still be considered experts. Majorities believed that expertise requires the use of skull-base approaches (85.8%), intraoperative monitoring (83.4%), awake craniotomies (77.3%), and neuro-endoscopy (75.5%) as well as continuing education of at least 1/year (100.0%), a research background (80.0%) and teaching activities (78.7%), and formal interdisciplinary collaborations (e.g., tumor board: 93.0%). Academic vs. non-academic affiliation, career position, years of neurosurgical experience, country of practice, and primary clinical interest had a minor influence on the respondents' opinions.

Discussion and conclusion

Opinions among neurosurgeons regarding the characteristics and features of expertise in neuro-oncology vary surprisingly little. Large majorities favoring certain thresholds and qualitative criteria suggest a consensus definition might be possible.

Construct validation of a novel synthetic tendon model used for assessing surgeon performance in a simulated core suture tendon repair technique

BACKGROUND

The strength of tendon repair is dependent on the quality of the core suture. Organic and synthetic materials have been used to simulate tendon repair for training; however, no model has undergone construct validation.

OBJECTIVES

To determine the construct validity of a novel synthetic tendon repair model.

METHODS

Synthetic silicone tendon models were used to simulate adult Achilles tendon (AT) and digital flexor tendon (FT). Participants were categorised into novice, intermediate, and advanced groups based on prior surgical experience. Participants repaired tendons using the modified Kessler technique. A validated motion analysis system was used to measure the duration, path length, and movement count during the simulated task. A global rating score was also used to assess the performance.

RESULTS

All participants in the novice (n = 12), intermediate (n = 8) and advanced (n = 11) groups completed the tasks. The results (mean±standard deviation) were duration (872 ± 335, 492 ± 257 and 357 ± 40 s), path length (9493 ± 3173, 6668 ± 1740 and 4672 ± 1228 cm), movement count (4974 ± 673, 4228 ± 259 and 3962 ± 69) and global rating (39 ± 13, 61 ± 14, 81 ± 5), respectively. The Kruskal-Wallis test was significant for all outcome measures (p < 0.01). Significant differences in duration and movement count were identified post-hoc in the AT model for each experience group (p < 0.05), and between novice and intermediate participants for FT repair (p < 0.04). Global rating was significantly different between all groups and was highly correlated with motion metrics (p < 0.01).

CONCLUSION

The results support construct validity of this novel simulated tendon repair model. The global rating scores may allow wide utility of this simulation. This model provides a valid and safe environment for surgical trainees to practice tendon repair with several cost, ethical and logistical benefits over animal tendon use. 248/250.

The MIDAS touch: Frameworks for procedural model innovation and validation

Background

Simulation-based procedural practice is crucial to emergency medicine skills training and maintenance. However, many commercial procedural models are either nonexistent or lacking in key elements. Simulationists often create their own novel models with minimal framework for designing, building, and validation. We propose two interlinked frameworks with the goal to systematically build and validate models for the desired educational outcomes.

Methods

Simulation Academy Research Committee and members with novel model development expertise assembled as the MIDAS (Model Innovation, Development and Assessment for Simulation) working group. This working group focused on improving novel model creation and validation beginning with a preconference workshop at 2023 Society for Academic Emergency Medicine Annual Meeting. The MIDAS group sought to (1) assess the current state of novel model validation and (2) develop frameworks for the broader simulation community to create, improve, and validate procedural models.

Findings

Workshop participants completed 17 surveys for a response rate of 100%. Many simulationists have created models but few have validated them. The most common barriers to validation were lack of standardized guidelines and familiarity with the validation process.We have combined principles from education and engineering fields into two interlinked frameworks. The first is centered on steps involved with model creation and refinement. The second is a framework for novel model validation processes.

Implications

These frameworks emphasize development of models through a deliberate, form-follows-function methodology, aimed at ensuring training quality through novel models. Following a blueprint of how to create, test, and improve models can save innovators time and energy, which in turn can yield greater and more plentiful innovation at lower time and financial cost. This guideline allows for more standardized approaches to model creation, thus improving future scholarship on novel models.

Implementation of Virtual Interactive Cases for Pharmacy Education: A Single-Center Experience

Patient case simulation software are described in pharmacy education literature as useful tools to improve skills in patient assessment (including medication history-taking and physical assessment), clinical reasoning and communication, and are typically well-received by students and instructors. The virtual interactive case (VIC) system is a web-based software developed to deliver deliberate practice opportunities in simulated patient encounters across a spectrum of clinical topics. This article describes the implementation and utilization of VIC in the undergraduate curriculum at one Canadian pharmacy school. Methods: At our facility, the use of VIC was integrated across the training spectrum in the curriculum, including core and elective didactic courses and practice labs, experiential learning, interprofessional education, and continuing education. Its use was evaluated through student and instructor surveys and qualitative student interviews). VIC is easy to navigate and created a positive and realistic learning environment. Students identified that it enhanced their ability to identify relevant patient information, accurately simulated hospital pharmacy practice and thereby helped them to prepare for their upcoming experiential courses. The use of VIC has expanded beyond its original intended purpose for individual student practice to become a valuable addition to pharmacy undergraduate education. Future plans include ongoing development of cases and exploration of further uses of VIC within the didactic curriculum, for remediation in experiential courses, and for pharmacist continuing education.

Teaching Before, During, and After a Surgical Resuscitation

Teaching during a surgical resuscitation can be difficult due to the infrequency of these events. Furthermore, when these events do occur, the trainee can experience cognitive overload and an overwhelming amount of stress, thereby impairing the learning process. The emergent nature of these scenarios can make it difficult for the surgical educator to adequately teach. Repeated exposure through simulation, role play, and "war games" are great adjuncts to teaching and preparation before crisis. However, surgical educators can further enhance the knowledge of their trainees during these scenarios by using tactics such as talking out loud, targeted teaching, and debriefing.

Randomized controlled trial of the CMR immersive virtual reality (IVR) headset training compared to e-learning for operating room configuration of the CMR versius robot

Robotic surgery offers potential advantages over laparoscopic procedures, but the training for configuring robotic systems in the operating room remains underexplored. This study seeks to validate immersive virtual reality (IVR) headset training for setting up the CMR Versius in the operating room. This single-blinded randomized control trial randomised medical students with no prior robotic experience using an online randomiser. The intervention group received IVR headset training, and the control group, e-learning modules. Assessors were blinded to participant group. Primary endpoint was overall score (OS): Likert-scale 1-5: 1 reflecting independent performance, with increasing verbal prompts to a maximum score of 5, requiring physical assistance to complete the task. Secondary endpoints included task scores, time, inter-rater reliability, and concordance with participant confidence scores. Statistical analysis was performed using IBM SPSS Version 27. Of 23 participants analysed, 11 received IVR and 12 received e-learning. The median OS was lower in the IVR group than the e-learning group 53.5 vs 84.5 (p < 0.001). VR recipients performed tasks independently more frequently and required less physical assistance than e-learning participants (p < 0.001). There was no significant difference in time to completion (p = 0.880). Self-assessed confidence scores and assessor scores differed for e-learning participants (p = 0.008), though not IVR participants (p = 0.607). IVR learning is more effective than e-learning for preparing robot-naïve individuals in operating room set-up of the CMR Versius. It offers a feasible, realistic, and accessible option in resource-limited settings and changing dynamics of operating theatre teams. Ongoing deliberate practice, however, is still necessary for achieving optimal performance. ISCRTN Number 10064213.

Awareness of somatisation disorder among Swedish physicians at emergency departments: a cross-sectional survey

BACKGROUND

Somatisation is a highly prevalent psychiatric syndrome in both women and men, in which psychological distress is manifested in physical symptoms without a medical explanation. Many patients with somatisation disorder are high healthcare utilisers, particularly at emergency departments. Unnecessary investigations and diagnostic operations occur frequently, which cause both patient suffering and a significant burden on the healthcare system. Emergency department physicians' awareness of somatisation and its manifestations has not previously been studied. This study aimed to investigate awareness about somatisation disorder among physicians working at emergency departments in western Sweden, and to explore differences between gender, specialty, and work experience.

METHODS

A web-based, cross-sectional survey consisting of six dichotomous questions about somatisation disorder was conducted, in December 2021 - January 2022, among licensed physicians of various specialties working at emergency departments in western Sweden. Descriptive analyses and comparative analyses were performed to investigate differences between gender, type of specialty, and years of practice. Data were analysed using chi2 tests and Fisher's exact test.

RESULTS

Of the 526 eligible physicians who received the survey, 241 responded; response rate 45.8%. The majority of the respondents (56.4%) were women, and most (35.3%) were specialised in obstetrics/gynaecology. Average years of work experience was 11.1 (SD 8.7) years. Although 71% of respondents were aware of the diagnosis, only 7% knew the diagnostic criteria and only 6% had ever diagnosed a patient with somatisation disorder. Female physicians were more aware of underlying factors than their male colleagues (55.7% vs. 38.2%; p = .010). Type of specialty or years of practice did not affect awareness.

CONCLUSIONS

Awareness of somatisation disorder is low among physicians working at emergency departments in western Sweden. The findings suggest a need to increase awareness and knowledge and provide training in diagnosing the condition, to ensure correct decisions and optimal patient management. Clinical guidelines need to be developed to support diagnosis, investigation, and treatment, in Sweden as well as internationally.

Improving Health Professional Recognition and Response to Child Maltreatment and Intimate Partner Violence: Protocol for Two Mixed Methods Pilot Randomized Controlled Trials

BACKGROUND

The optimal educational approach for preparing health professionals with the knowledge and skills to effectively recognize and respond to family violence, including child maltreatment and intimate partner violence, remains unclear. The Violence, Evidence, Guidance, and Action (VEGA) Family Violence Education Resources is a novel intervention that can be completed via self-directed learning or in a workshop format; both approaches focus on improving health professional preparedness to address family violence.

OBJECTIVE

Our studies aim to determine the acceptability and feasibility of conducting a randomized controlled trial to evaluate the effectiveness of the self-directed (experimental intervention) and workshop (active control) modalities of VEGA, as an adjunct to standard education, to improve learner (Researching the Impact of Service provider Education [RISE] with Residents) and independent practice (RISE with Veterans) health professional preparedness, knowledge, and skills related to recognizing family violence in their health care encounters.

METHODS

The RISE with Residents and RISE with Veterans research studies use embedded experimental mixed methods research designs. The quantitative strand for each study follows the principles of a pilot randomized controlled trial. For RISE with Residents, we aimed to recruit 80 postgraduate medical trainees; for RISE with Veterans, we intended to recruit 80 health professionals who work or have worked with Veterans (or their family members) of the Canadian military or the Royal Canadian Mounted Police in a direct service capacity. Participants complete quantitative assessments at baseline, after intervention, and at 3-month follow-up. A subset of participants from each arm also undergoes a qualitative semistructured interview with the aim of describing participants' perceptions of the value and impact of each VEGA modality, as well as research burden. Scores on potential outcome measures will be mapped to excerpts of qualitative data via a mixed methods joint display to aid in the interpretation of findings.

RESULTS

We consented 71 individuals to participate in the RISE with Residents study. Data collection was completed on August 31, 2023, and data are currently being cleaned and prepared for analysis. As of January 15, 2024, we consented 34 individuals in the RISE with Veterans study; data collection will be completed in March 2024. For both studies, no data analysis had taken place at the time of manuscript submission. Results will be disseminated through peer-reviewed publications; academic conferences; and posting and sharing of study summaries and infographics on social media, the project website, and via professional network listserves.

CONCLUSIONS

Reducing the impacts of family violence remains a pressing public health challenge. Both research studies will provide a valuable methodological contribution about the feasibility of trial methods in health professions education focused on family violence. They will also contribute to education science about the differences in the effectiveness of self-directed versus facilitator-led learning strategies.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05490121, https://clinicaltrials.gov/study/NCT05490121; ClinicalTrials.gov NCT05490004, https://clinicaltrials.gov/study/NCT05490004.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/50864.

Development and assessment of a loop ligation simulator for laparoscopic appendectomy

OBJECTIVE

Loop ligation of the appendix is a challenging surgical skill and well suited to be trained in a simulator. We aimed to develop an affordable and easy-to-build simulator and test its training effect.

DESIGN AND PARTICIPANTS

Different materials were tested, and the best training modality was identified by researching the literature. The developed simulator training was tested on 20 surgical novices.

RESULTS

A video was produced including an instruction on how to build the simulator and a step-by-step tuition on how to ligate the appendix. The Peyton approach was utilized to guide learners. Training with the simulator leads to reliable skill acquisition. All participants improved significantly in completing the task successfully during the structured learning.

CONCLUSION

We succeeded in developing a simulator for loop ligation of the appendix during laparoscopic appendectomy. Participants significantly improve in handling the loops. The transferability of the skill learned during simulation to the operating room will be subject of a follow-up study.

The developmental activities of women's professional pathway cricketers

The growth of investment in women's cricket has led to the development of new professional pathways. However, there is lack of specific evidence to support the development of these athletes. This study aimed to take a first step in understanding the participation histories of female cricketers selected into English women's professional academies. 84 players completed the Participation History Questionnaire (PHQ) to capture details of activities engaged in across development, including milestones, cricket activity, and engagement in other sport activities. There were relative age effects where players' birthdate distributions differed from national norms (X2 = 8.451, p = .003, V = 0.227), and more players than expected attended independent schools (X2 = 7.980, p = .005, V = 0.232). Participants engaged in cricket informally before coach led training, have siblings (particularly brothers) interested in cricket and often played boy's cricket before engaging in the girl's or women's game. Developmental activities were characterised by early engagement, high levels of diversification, and very low levels of play compared to high levels of formal practice and match play. These findings have implications for the advancement of talent identification and development policies and processes in women's cricket.

Impact of teaching on use of mechanical chest compression devices: a simulation-based trial

BACKGROUND

The use of mechanical chest compression devices on patients in cardiac arrest has not shown benefits in previous trials. This is surprising, given that these devices can deliver consistently high-quality chest compressions without interruption. It is possible that this discrepancy is due to the no-flow time (NFT) during the application of the device. In this study, we aimed to demonstrate a reduction in no-flow time during cardiopulmonary resuscitation (CPR) with mechanical chest compression devices following 10 min of structured training in novices.

METHODS

270 medical students were recruited for the study. The participants were divided as a convenience sample into two groups. Both groups were instructed in how to use the device according to the manufacturer's specifications. The control group trained in teams of three, according to their own needs, to familiarise themselves with the device. The intervention group received 10 min of structured team training, also in teams of three. The participants then had to go through a CPR scenario in an ad-hoc team of three, in order to evaluate the training effect.

RESULTS

The median NFT was 26.0 s (IQR: 20.0-30.0) in the intervention group and 37.0 s (IQR: 29.0-42.0) in the control group (p < 0.001). In a follow-up examination of the intervention group four months after the training, the NFT was 34.5 s (IQR: 24.0-45.8). This represented a significant deterioration (p = 0.015) and was at the same level as the control group immediately after training (p = 0.650). The position of the compression stamp did not differ significantly between the groups. Groups that lifted the manikin to position the backboard achieved an NFT of 35.0 s (IQR: 27.5-42.0), compared to 41.0 s (IQR: 36.5-50.5) for the groups that turned the manikin to the side (p = 0.074).

CONCLUSIONS

This simulation-based study demonstrated that structured training can significantly reduce the no-flow time when using mechanical resuscitation devices, even in ad-hoc teams. However, this benefit seems to be short-lived: after four months no effect could be detected.

Sparking Virtuous Cycles: A Longitudinal Study of Subjective Well-Being and Grit During Early Adolescence

In cross-sectional research, subjective well-being and grit are found to be positively correlated. Their mutually reinforcing effects are particularly relevant for youth entering early adolescence because, during this developmental period, both well-being and grit have been shown to predict consequential outcomes later in life. However, their mutual relation has not yet been investigated in early adolescence. This study, therefore, examined the possibility of a virtuous cycle linking subjective well-being and grit during early adolescence. Self-report questionnaires of grit and subjective well-being were completed by N = 5291 children in China (47.6% girls; initial Mage = 9.69, SDage = 0.59) on six occasions over 3 academic years. In random-intercept cross-lagged panel models (RI-CLPMs), within-person changes in grit predicted within-person changes in subjective well-being 6 months later, and vice versa. Notably, analyses revealed an asymmetry in this cycle: paths from subjective well-being to grit were stronger and more reliable than the converse. Likewise, facet-level analyses showed that the predictive power of the perseverance component (of grit) and the affective component (of subjective well-being), respectively, was greater than the passion and cognitive components, respectively. These findings highlight the potential of boosting happiness for catalyzing positive youth development and, in addition, foreground the utility of studying these composite constructs at the facet level.

Modified cadaver technique to simulate contaminated airway scenarios to train medical providers in suction-assisted laryngoscopy and airway decontamination

Simulation training plays a vital role in modern medical education, fostering safe skill development. Task-trainer manikin and cadaveric airway management training (CAMT) offer realistic airway management practice. Simulation allows learners the opportunity to manage high-risk, low-frequency scenarios, including difficult airways and massive airway contamination, common in emergent airway management. The suction-assisted laryngoscopy and airway decontamination (SALAD) technique was developed to address massive airway contamination. This paper describes two methods to simulate massive airway contamination utilizing cadavers. We detail our techniques for both esophageal and nasopharyngeal delivery of simulated airway contaminant. Nasopharyngeal delivery was less invasive and required less time to set up. Utilizing cadavers to simulate massive airway contamination in CAMT provides learners with tools to manage airway complications effectively, enhancing readiness for complex airway challenges while promoting patient safety in clinical practice.

Does a blended learning implementation package enhance HIV index case testing in Malawi? A protocol for a cluster randomised controlled trial

INTRODUCTION

Index case testing (ICT) is an evidence-based approach that efficiently identifies persons in need of HIV treatment and prevention services. In Malawi, delivery of ICT has faced challenges due to limited technical capacity of healthcare workers (HCWs) and clinical coordination. Digitisation of training and quality improvement processes presents an opportunity to address these challenges. We developed an implementation package that combines digital and face-to-face modalities (blended learning) to strengthen HCWs ICT skills and enhance quality improvement mechanisms. This cluster randomised controlled trial will assess the impact of the blended learning implementation package compared with the standard of care (SOC) on implementation, effectiveness and cost-effectiveness outcomes.

METHODS AND ANALYSIS

The study was conducted in 33 clusters in Machinga and Balaka districts, in Southern Malawi from November 2021 to November 2023. Clusters are randomised in a 2:1 ratio to the SOC versus blended learning implementation package. The SOC is composed of: brief face-to-face HCW ICT training and routine face-to-face facility mentorship for HCWs. The blended learning implementation package consists of blended teaching, role-modelling, practising, and providing feedback, and blended quality improvement processes. The primary implementation outcome is HCW fidelity to ICT over 1 year of follow-up. Primary service uptake outcomes include (a) index clients who participate in ICT, (b) contacts elicited, (c) HIV self-test kits provided for secondary distribution, (d) contacts tested and (e) contacts identified as HIV-positive. Service uptake analyses will use a negative binomial mixed-effects model to account for repeated measures within each cluster. Cost-effectiveness will be assessed through incremental cost-effectiveness ratios examining the incremental cost of each person tested.

ETHICS AND DISSEMINATION

The Malawi National Health Science Research Committee, the University of North Carolina and the Baylor College of Medicine Institutional Review Boards approved the trial. Study findings will be disseminated through peer-reviewed journals and conference presentations.

TRIAL REGISTRATION NUMBER

NCT05343390.

Smart haptic gloves for virtual reality surgery simulation: a pilot study on external ventricular drain training

Smart haptic gloves are a new technology emerging in Virtual Reality (VR) with a promise to enhance sensory feedback in VR. This paper presents one of the first attempts to explore its application to surgical training for neurosurgery trainees using VR-based surgery simulators. We develop and evaluate a surgical simulator for External Ventricular Drain Placement (EVD), a common procedure in the field of neurosurgery. Haptic gloves are used in combination with a VR environment to augment the experience of burr hole placement, and flexible catheter manipulation. The simulator was integrated into the training curriculum at the 2022 Canadian Neurosurgery Rookie Bootcamp. Thirty neurosurgery residents used the simulator where objective performance metrics and subjective experience scores were acquired. We provide the details of the simulator development, as well as the user study results and draw conclusions on the benefits added by the haptic gloves and future directions.

Graduate Medical Education in Pathology: A Scoping Review

CONTEXT.—

Pathologists have produced a substantial body of literature on graduate medical education (GME). However, this body of literature is diverse and has not yet been characterized.

OBJECTIVE.—

To chart the concepts, research methods, and publication patterns of studies on GME in pathology.

DATA SOURCES.—

This was a systematic scoping review covering all literature produced since 1980 in the PubMed and Embase databases.

CONCLUSIONS.—

Research on GME in pathology is evenly dispersed across educational topics. This body of literature would benefit from research based on theory, stronger study designs, and studies that can provide evidence to support decisions on educational policies.

Training for excellence: using a multimodal videoconferencing platform to coach surgeons and improve intraoperative performance

INTRODUCTION

Continuing Professional Development opportunities for lifelong learning are fundamental to the acquisition of surgical expertise. However, few opportunities exist for longitudinal and structured learning to support the educational needs of surgeons in practice. While peer-to-peer coaching has been proposed as a potential solution, there remains significant logistical constraints and a lack of evidence to support its effectiveness. The purpose of this study is to determine whether the use of remote videoconferencing for video-based coaching improves operative performance.

METHODS

Early career surgeon mentees participated in a remote coaching intervention with a surgeon coach of their choice and using a virtual telestration platform (Zoom Video Communications, San Jose, CA). Feedback was articulated through annotating videos. The coach evaluated mentee performance using a modified Intraoperative Performance Assessment Tool (IPAT). Participants completed a 5-point Likert scale on the educational value of the coaching program.

RESULTS

Eight surgeons were enrolled in the study, six of whom completed a total of two coaching sessions (baseline, 6-month). Subspecialties included endocrine, hepatopancreatobiliary, and surgical oncology. Mean age of participants was 39 (SD 3.3), with mean 5 (SD 4.1) years in independent practice. Total IPAT scores increased significantly from the first session (mean 47.0, SD 1.9) to the second session (mean 51.8, SD 2.1), p = 0.03. Sub-category analysis showed a significant improvement in the Advanced Cognitive Skills domain with a mean of 33.2 (SD 2.5) versus a mean of 37.0 (SD 2.4), p < 0.01. There was no improvement in the psychomotor skills category. Participants agreed or strongly agreed that the coaching programs can improve surgical performance and decision-making (coaches 85%; mentees 100%).

CONCLUSION

Remote surgical coaching is feasible and has educational value using ubiquitous commercially available virtual platforms. Logistical issues with scheduling and finding cases aligned with learning objectives continue to challenge program adoption and widespread dissemination.

First-Person Point-of-View Instructional Video on Lumbar Puncture Procedure

OBJECTIVES

Tutorial videos filmed from a first-person point of view (FP-POV) are generally well received. Pediatric residents are expected to be competent in performing the lumbar puncture (LP). The educational effectiveness of a FP-POV in lumbar puncture procedure training for resident physicians has yet to be evaluated. We compared a FPPOV LP video with a standard in-person demonstration of the LP.

METHODS

We designed an assigned cohort study to compare a FP-POV procedural instructional video of a simulated pediatric LP to the standard in-person procedure demonstration.After the intervention, residents completed an LP observed by one of two blinded reviewers who assessed the procedure using a modified, published assessment tool.Participants completed preintervention and postintervention surveys to rate self-confidence and usefulness of the FP-POV educational method. The data was analyzed using a Wilcoxon Rank sum test. z Scores were calculated on the raw assessment scores.

RESULTS

Eighteen first year pediatric residents participated, nine in each group. The median modified assessment tool score was 17 in the FP-POV group (min, 14; max, 17; IQR:, 1.5) and 14 in the standard demonstration group (min, 6; max, 17; IQR, 4.5), with the higher score being more successful. There was a statistical difference between the assessment scores between the 2 groups (z score = 2.18, P = 0.04). Postintervention survey data demonstrated relative satisfaction with the FPPOV educational method.

CONCLUSIONS

This study supports the educational effectiveness of a FP-POV procedure tutorial.Future studies with a larger sample size are needed.

Capstone Simulation: A Multipatient Simulation for Senior Emergency Medicine Residents

Introduction

Emergency medicine (EM) trainees must learn to manage multiple patients simultaneously using task-switching. While prior work has demonstrated that multipatient scenarios can be an effective teaching tool for task-switching, few studies have shown how simulation can be used to assess residents' ability to manage multiple patients effectively. The goal of this curriculum was to provide a formative assessment of core EM skills by employing a series of simulations designed to require frequent task-switching.

Methods

This exercise consisted of three simulation scenarios running in sequence. The first scenario involved medical resuscitation and advanced cardiac life support, the second required learners to manage two patients involved in a trauma using advanced trauma life support, and the final scenario tested learners' ability to communicate bad news. Faculty observers used scenario-specific checklists to identify gaps in content knowledge, communication skills, and task-switching abilities during reflective debriefs. These checklists were analyzed to identify trends. All participants were sent a postsession evaluation. Items omitted by >50% of participants were flagged for review.

Results

Flagged items included asking for finger-stick glucose, verbalizing a backup intubation plan, specifying type of blood products, and asking for team input. Nine of 12 participants completed the postsession evaluation, noting that they agreed or strongly agreed the simulation was relevant and promoted reflection on task-switching skills.

Discussion

This simulation provides educators with a tool to facilitate reflective feedback with senior EM learners regarding their core resuscitation, leadership, and task-switching skills and could be further adapted to promote deliberate practice.

Twelve Tips for using Learning Curves in Health Professions Education Research

Learning curves can be used to design, implement, and evaluate educational interventions. Attention to key aspects of the method can improve the fidelity of this representation of learning as well as its suitability for education and research purposes. This paper addresses when to use a learning curve, which graphical properties to consider, how to use learning curves quantitatively, and how to use observed thresholds to communicate meaning. We also address the associated ethics and policy considerations. We conclude with a best practices checklist for both educators and researchers seeking to use learning curves in their work.

Big five personality and recreation specialization are related to satisfaction with life in birders

Personality traits and recreation specialization are related to an individual's satisfaction with life. In addition, previous research has identified relationships between personality traits and recreational specialization. However, little is known about the interrelationship of the two variables in relation to life satisfaction. In this study, we addressed these relationships in birdwatchers. 555 birders (Mage = 49.11 years, SDage = 17.14; 380 males, 170 females, 2 diverse, 3 without answer) from German-speaking countries filled out an online survey. The participants rated the BFI-10, a global assessment of life satisfaction, and three dimensions of recreation specialization (skill/knowledge, behavior, commitment). Satisfaction with life was positively correlated with extraversion, agreeableness, and conscientiousness, and negatively with neuroticism. Concerning recreation specialization, positive relationships between satisfaction with life and skill/knowledge as well as behavior were found; especially the dimension of skill/knowledge was positively related to conscientiousness and negatively to neuroticism. Openness was negatively related to the three dimensions of recreation specialization. The mediation analyses showed that skill/knowledge is directly and indirectly related to satisfaction with life. Birding as active outdoor activity has positive relationship with life satisfaction, and this seems to be mainly based on the cognitive component, with a high knowledge related to a higher life satisfaction.

Personal protection equipment: Preliminary evidence of effectiveness from a three-phase simulation program

Background

Healthcare providers carry the occupational risk of being exposed to pathogens. Personal Protection Equipment (PPE) requires proficiency whenever used. Yet, evidence shows significant errors and variation in competency when applying PPE.

Objective

In this study, we developed a three-phase intervention to promote PPE proficiency.

Methods

Education and assessment of participants' PPE knowledge and skills occurred at a large academic university in Western Canada. Participants first completed an online module; second, they experienced one-on-one coaching and deliberate practice with infection control professionals; and third, participants managed a COVID-19 clinical simulation scenario. The measured outcomes include a 15-item pre- and post-knowledge test and a pre- and post-skills assessment of donning and doffing behaviors. These behaviors were observed from video recordings and were assessed using two standardized checklists.

Results

Knowledge and donning/doffing post-test scores (11.73, 0.95, and 0.96, respectively) were significantly higher after completing all three phases of the educational intervention, p < .001.

Conclusions

An online module alone is insufficient for PPE knowledge and skill development. Rather, a module followed by practice and simulation allows learners to gain proficiency.

Developing Decision-Making Expertise in Professional Sports Staff: What We Can Learn from the Good Judgement Project

Success within performance sports is heavily dependent upon the quality of the decisions taken by educated and experienced staff. Multi-disciplinary teams (MDTs) typically collate voluminous data, and staff typically undergo extensive and rigorous technical and domain-specific training. Although sports professionals operate in sometimes volatile, uncertain, complex and ambiguous decision-making environments, a common assumption seems to be that education and experience will automatically lead to enhanced and effective decision-making capabilities. Accordingly, there are few formal curriculums, in coaching or sports science contexts, focussed on translating the extensive research on judgement and decision-making expertise to professional sports staff. This article aims to draw on key research findings to offer insights and practical recommendations to support staff working within professional performance contexts. Through this distillation, we hope to enhance understanding of the factors underpinning effective decision-making in dynamic, high-stakes professional sporting environments. Broadly, the conclusions of this research demonstrate that decision-making efficacy is enhanced through application of three specific strategies: (i) Design of more engaging professional cultures harnessing the power of collectives encouraging diverse opinions and perspectives, and fostering and promoting collaborative teamwork, (ii) education specifically targeting debiasing training, designed to counter the most common cognitive pitfalls and biases and, (iii) the implementation of evaluation strategies integrating rigorous testing and real-time feedback.

Novice residents' endotracheal intubation skill retention on a simulated mannequin after rotating at an anaesthesiology department: a randomized controlled study

OBJECTIVE

To compare the endotracheal intubation skill retention of the McGRATH™ MAC video laryngoscope with that of the Macintosh laryngoscope in first-year residents rotating at an anaesthesiology department.

METHODS

This randomized controlled study enrolled first-year residents who completed a 2-month rotation at an anaesthesiology department. Each rotation group was randomly assigned to the Macintosh laryngoscope (ML) or McGRATH™ MAC video laryngoscope (MML) group. Endotracheal intubation skills were evaluated on a mannequin after the rotation and at 3 and 6 months later. The primary endpoint was the time required for intubation. The secondary endpoint was the percentage of glottic opening (POGO) score.

RESULTS

Forty-six residents participated in this study and were assigned to the ML group (n = 23) or the MML group (n = 23). There were no significant differences between the sex, age and the number of endotracheal intubation procedures performed between the two groups. The time required for intubation was significantly shorter in the MML group compared with the ML group. The POGO scores did not show any significant differences between the two groups.

CONCLUSION

Compared with endotracheal intubation training using the Macintosh laryngoscope, the McGRATH™ MAC video laryngoscope shortened the intubation procedure and its effect remained even after 6 months.

TRIAL REGISTRATION

UMIN-CTR Clinical Trials, UMIN000036643, URL: https://www.umin.ac.jp.

Automated Video Debriefing Using Computer Vision Techniques

INTRODUCTION

Within any training event, debriefing is a vital component that highlights areas of proficiency and deficiency, enables reflection, and ultimately provides opportunity for remediation. Video-based debriefing is desirable to capture performance and replay events, but the reality is rife with challenges, principally lengthy video and occlusions that block line of sight from camera equipment to participants.

METHODS

To address this issue, researchers automated the editing of a video debrief, using a system of person-worn cameras and computer vision techniques. The cameras record a simulation event, and the video is processed using computer vision. Researchers investigated a variety of computer vision techniques, ultimately focusing on the scale invariant feature transform detection method and a convolutional neural network. The system was trained to detect and tag medically relevant segments of video and assess a single exemplar medical intervention, in this case the application of a tourniquet.

RESULTS

The system tagged medically relevant video segments with 92% recall and 66% precision, resulting in an F1 (harmonic mean of precision and recall) of 72% (N = 23). The exemplar medical intervention was successfully assessed in 39.5% of videos (N = 39).

CONCLUSION

The system showed suitable accuracy tagging medically relevant video segments, but requires additional research to improve medical intervention assessment accuracy. Computer vision has the potential to automate video debrief creation to augment existing debriefing strategies.

Early Success is not a Prerequisite for Success at the Adult Age in Spanish Sprinters

The aim of the study was to describe the relationship between success in junior and senior categories in sprint events. An observational and longitudinal analysis was carried out using rankings of the Royal Spanish Athletics Federation database. We analysed 547 sprinters (238 women and 309 men) from their U14 to senior stage who ranked in top-20 on at least one occasion during the period 2004 to 2021. The first entry in top-20 occurred mostly in U14 (44.4%, 243), and the frequency was progressively lower: 26.7% (146) in U16; 20.8% (114) in U18; 5.1% (28) in U20; 2% (11) in U23; and 0.9% (5) in the senior category. A similar tendency was observed in male and female athletes. Only 3.8% (9) of top-20 U14 athletes reached the senior elite stage, increasing this percentage in subsequent categories: 7.4% (15) in U16; 10.6% (24) in U18; 20.9% (32) in U20, and 31.4% (32) from U23 to the senior category. Data from female athletes showed higher maintenance of top-20 status from early categories to senior age. We conclude that even though the first entry into the national top-20 in sprint events occurs early in most cases, success in these initial stages is not a prerequisite for reaching top-20 positions in the senior category.

Becoming a neurosurgeon in France: A qualitative study from the trainees' perspective

Introduction

The training of neurosurgeons is evolving in a world of socio-professional changes, including the technological revolution, administrative pressure on stakeholders, reduced working hours, geographical heterogeneity, generational changes, to name but a few.

Research question

This qualitative study aimed to explore experiences and feedback of French neurosurgical trainees concerning their training.

Material and methods

The grounded theory approach was used with 23 neurosurgical trainees' interviews. Inclusion was continued until data saturation. Six researchers (an anthropologist, a psychiatrist, and four neurosurgeons) thematically and independently analyzed data collected through anonymized interviews.

Results

Data analysis identified three superordinate themes: (1) The Trainee-Senior Dyad, where the respondents describe a similar bipolarity between trainees and faculty (trainees oscillating between those who fit into the system and those who are more reluctant to accept hierarchy, faculty using an ideal pedagogy while others refuse to help or invest in training); (2) The difficulty to learn (describing pressure exercised on trainees that can alter their motivation and degrade their training, including the impact of administrative tasks); (3) A pedagogy of empowerment (trainee' feelings about the pertinent pedagogy in the OR, ideal sequence to progress, progressive empowerment especially during the shifts, and stress of envisioning themselves as a senior neurosurgeon).

Discussion and conclusion

Respondents emphasize the heterogeneity of their training both intra- and inter-university-hospital. Their critical analysis, as well as the formalization of their stress to become autonomous seniors, can be an important link with the reforms and optimizations currently being carried out to improve and standardize the training of young French neurosurgeons.

Training to Transition: Using Simulation-Based Training to Improve Resident Physician Confidence in Hospital Discharges

Introduction

Hospital discharge is a highly critical and complex process that is prone to medical errors, poor communication, and ineffective synchronization of transitional teams. Improving safety during postacute care transitions has become a national focus. Simulation-based training is an underutilized method of instruction for medical resident transitions of care education.

Methods

As an integral part of a transitions curriculum, 36 PGY 1 residents from internal medicine and transitional year residency programs underwent a discharge simulation utilizing a trained simulated participant (SP) and a lay caregiver. The objective of the training was to implement a simulation-based education intervention to improve transition practices and discharge communication in graduate medical education. A faculty observer used a case-specific discharge rubric to standardize feedback to the resident and observed the resident navigate the electronic medical record (EMR) for discharge orders. Pretest and posttest surveys assessing resident attitudes and confidence regarding specific areas of the discharge process were distributed to all participating residents for completion.

Results

Thirty-six internal medicine and transitional year residents (100%) completed an observed discharge simulation with an SP and a separate encounter with the EMR discharge navigator. All 36 residents (100%) completed the pretest survey, and 23 (63%) completed the postsurvey evaluation. Postsurvey results showed residents agreed (92%, p < .05) that the simulation increased their confidence in safely discharging a patient.

Discussion

Simulation encounters are an effective adjunct to postacute care transition education.

Improving surgical skills with feedback: directly-observed versus video-recorded practice

OBJECTIVE

This study aimed to compare two methods of feedback: verbal face-to-face feedback after direct observation (F2F-feedback) versus electronic-written feedback after observation of recorded-VDO of student's performance (VDO-feedback), in terms of effectiveness in improving skill, effects on motivation and satisfaction.

BACKGROUND

Medical schools are responsible for teaching and ensuring proficiency of basic surgical skills. Feedback is effective in developing psychomotor skills; by providing information of learner's current performance, how to improve, and enhancing motivation.

MATERIALS AND METHOD

Fifty-eight medical students (3rd- 4th year) were trained to perform vertical mattress suture in small groups. Then, during 6-week period of self-directed practice, students were randomized into group1 VDO-feedback (male:female = 21:8) and group 2 F2F-feedback (male:female = 20:9). Feedbacks were provided once every 2 weeks (Week2, Week4). End-of-rotation OSCE was at Week6, and retention tested was at Week8. Performance checklist (Cronbach's Alpha 0.72) was used to assess skill at 4 timepoints; pre- and post- small group learning, OSCE, and retention phase. Questionnaire was used to assess motivation, learning strategies and satisfaction (Cronbach's Alpha 0.83).

RESULT

After in-class learning, further significant improvement of skills could be gained by both F2F- and VDO- feedbacks (p < 0.0001). Both could similarly retain skill for at least 4 weeks later without additional practice. Self-efficacy, test anxiety, and cognitive strategies scores were significantly increased in both groups (p < 0.05). Extrinsic motivation was increased in VDO-feedback group. No difference in satisfaction between groups was observed.

DISCUSSION AND CONCLUSION

VDO-feedback could be alternative to F2F-feedbacks for basic surgical skill training when limitation for simultaneous meeting of teacher and students occurs.

TRIAL REGISTRATION

This study has been registered to Thai Clinical Trial Registry (WHO International Clinical Trial Registry Platform) on 11/07/2023 (TCTR20230711005).

Use of Simulation to Train Uncertified Hospital Orderlies in India

BACKGROUND

In India, orderlies are unlicensed hospital assistants instructed to perform delegated tasks under supervision by a licensed health-care giver. They receive on-the-job training, unlike certified nursing assistants. In this study, we have integrated a simulation session in our hospital orderly training program to promote the safe transfer of patients using a low-fidelity mannequin.

METHODS

We conducted an interventional study with a mixed methodology in which 280 orderlies were immersed in a simulation session of transferring a mannequin from a bed to either a wheelchair or stretcher. An observer completed a prevalidated 18-item checklist assessing the team's performance on a 3-point global rating scale. Quantitative analysis of the data was done using a Paired t-test of the mean scores of the pre- and posttest. Posttraining, the participants completed a satisfaction questionnaire. Structured interviews with their ward in-charges were conducted 3-month posttraining, and the data were analyzed by thematic coding.

RESULTS

The pre- and posttest scores of team performances for both groups were 33.22 and 45.3, respectively, indicating a statistically significant difference (P < 0.001). Posttraining, the session evaluation revealed that 100% of participants strongly agreed (mean score = 5) that the training was beneficial. The structured interviews revealed improvement in communication and patient interaction without much change in other skills. They found that, overall, this simulation-based training promoted the safe transfer of patients.

DISCUSSION

Improvement in the team performance scores shows the effectiveness of this methodology in ensuring the secure transfer of patients, as well as better teamwork and communication. The results demonstrate that low-fidelity, low-cost simulation can be used effectively to create a formal training program for hospital orderlies.

Learning tools used to translate resilience in healthcare into practice: a rapid scoping review

BACKGROUND

Historically, efforts to improved healthcare provisions have focussed on learning from and understanding what went wrong during adverse events. More recently, however, there has been a growing interest in seeking to improve healthcare quality through promoting and strengthening resilience in healthcare, in light of the range of changes and challenges to which healthcare providers are subjected. So far, several approaches for strengthening resilience performance have been suggested, such as reflection and simulation. However, there is a lack of studies that appraise the range of existing learning tools, the purposes for which they are designed, and the types of learning activities they comprise. The aim of this rapid scoping review is to identify the characteristics of currently available learning tools designed to translate organizational resilience into healthcare practice.

METHODS

A rapid scoping review approach was used to identify, collect, and synthesise information describing the characteristics of currently available learning tools designed to translate organizational resilience into healthcare practice. EMBASE and Medline Ovid were searched in May 2022 for articles published between 2012 and 2022.

RESULTS

The review identified six different learning tools such as serious games and checklists to guide reflection, targeting different stakeholders, in various healthcare settings. The tools, typically, promoted self-reflection either individually or collaboratively in groups. Evaluations of these tools found them to be useful and supportive of resilience; however, what constitutes resilience was often difficult to discern, particularly the organizational aspect. It became evident from these studies that careful planning and support were needed for their successful implementation.

CONCLUSIONS

The tools that are available for review are based on guidelines, checklists, or serious games, all of which offer to prompt either self-reflection or group reflections related to different forms of adaptations that are being performed. In this paper, we propose that more guided reflections mirroring the complexity of resilience in healthcare, along with an interprofessional collaborative and guided approach, are needed for these tools to be enacted effectively to realise change in practice. Future studies also need to explore how tools are perceived, used, and understood in multi-site, multi-level studies with a range of different participants.

Use of a Composed Simulator by Veterinarian Non-Experts in Minimally Invasive Surgery for Training and Acquisition of Surgical Skills for Laparoscopic Ovariectomy in Dogs

This study aims to assess the acquisition of surgical skills for laparoscopic ovariectomy (LOE) in dogs by veterinary surgeons with no experience in minimally invasive surgery using the CALMA Veterinary Lap-trainer simulator (CVLTS) in an experimental and analytical setting. Veterinary surgeons with no experience in minimally invasive surgery (MIS) (experimental, n = 5), and MIS experts (experts, n = 3) were evaluated. Experimental and expert group participants watched an instructional video (initial time) before practicing the LOE on uterine tissues and ovaries freshly reconstituted after elective ovariohysterectomy (initial time evaluation). Then, the experimental group practiced five training sessions on the composite simulator with permanent feedback and then performed the LOE again (final time evaluation). Surgical performances in initial and final evaluations were video recorded and further evaluated by three external MIS experts using Global objective assessment of laparoscopic skills (GOALS) and LOE-specific rating scales (SRSs) in a double-blinded schedule. In addition, a hands movement assessment system (HMAS) attached to the back of the hands was used to quantitatively measure completion time, angularity, and movement smoothness. Data were analyzed with one-factor ANOVA and Tukey's contrast test. No statistically significant differences were found between the novice group's performance after training and the expert group's performance according to the GOALS (p < 0.01) and SRS (p < 0.05) scores. Moreover, the novices had significantly improved time, number of movements, and angularity in the final time compared with the initial time (p < 0.05), with no significant differences compared to the expert group (p > 0.05). LOE training using a composed simulator resulted in significantly improved laparoscopic skills and time, number, and angularity of movements data, providing evidence of the usefulness and reliability of CVLTS in training LOE.

Are we talking about practice? A randomized study comparing simulation-based deliberate practice and mastery learning to self-guided practice

OBJECTIVES

Simulation-based technical skills training is now ubiquitous in medicine, particularly for high acuity, low occurrence (HALO) procedures. Mastery learning and deliberate practice (ML + DP) are potentially valuable educational methods, however, they are resource intensive. We sought to compare the effect of deliberate practice and mastery learning versus self-guided practice on skill performance of the rare, life-saving procedure, a bougie-assisted cricothyroidotomy (BAC).

METHODS

We conducted a multi-center, randomized study at five North American emergency medicine (EM) residency programs. We randomly assigned 176 EM residents to either the ML + DP or self-guided practice groups. Three blinded airway experts independently evaluated BAC skill performance by video review before (pre-test), after (post-test) and 6-12 months (retention) after the training session. The primary outcome was post-test skill performance using a global rating score (GRS). Secondary outcomes included performance time and skill performance at the retention test.

RESULTS

Immediately following training, GRS scores were significantly higher as mean performance improved from pre-test, (22, 95% CI = 21-23) to post-test (27, 95% CI = 26-28), (p < 0.001) for all participants. However, there was no difference between the groups on GRS scores (p = 0.2) at the post-test or at the retention test (p = 0.2). At the retention test, participants in the ML + DP group had faster performance times (66 s, 95% CI = 57-74) compared to the self-guided group (77 s, 95% CI = 67-86), (p < 0.01).

CONCLUSIONS

There was no significant difference in skill performance between groups. Residents who received deliberate practice and mastery learning demonstrated an improvement in skill performance time.

Use of an online gaming tool, the Veterinary DialogueTrainer, for teaching clinical communication skills to bovine veterinary practitioners

Effective clinical communication is essential for bovine veterinary practitioners to establish and maintain positive client relationships. When applied properly in herd health consultancy, it increases client satisfaction and adherence to veterinary advice, and improves patient health and welfare. Although communication skills are often taught by providing feedback on simulated conversations, this has limitations, including time constraints, subjective assessments, and cost. The Veterinary DialogueTrainer (VDT) is an online serious game platform using 'digital role-play' with avatars, recently developed to enhance and assess learning outcomes, improve use of learned skills, and increase cost-effectiveness of communication training. The objective was to evaluate its suitability and applicability. Finnish (n = 24) and Swedish (n = 21) bovine veterinarians participated in communication training using VDT for training and assessment. Participants completed the provided scenario at least twice. After playing a bovine health communication simulation, participants received their scores and feedback on selected conversation options. VDT scores measured multiple aspects of communication on a 0-100% scale, based on motivational interviewing methodology and Calgary-Cambridge guidelines. Mean (±SD) number of attempts participants played the scenario was 4.1 (±2.6, Finland) and 3.9 (±1.3, Sweden), with highest total score reached after a mean of 3.5 (±2.1, Finland) and 3.1 (±1.1, Sweden) attempts. On the first attempt, 39 participants (87%) scored <50% of the highest possible score, whereas most (n = 34, 76%) achieved a higher score on the second attempt. Mean total score increased from 15 (±14) to 77% (±33) for Finish participants and from 40 (±22.0) to 87% (±19.4) for Swedish participants. The majority (n = 33, 73%) of participants reached a score >80% after 4.0 (±1.6, Finland) or 2.8 (±1.0, Sweden) attempts. Net Promoter Score of the training was +89 (Finland), +88 (Finland) and + 83 (Sweden) on a scale from -100 to +100, indicating that most participants were very likely to recommend the training to other veterinarians. Use of VDT increased communication skills scores but whether it will improve communication skills in practice requires further study. We concluded there is a likely benefit of using the VDT in teaching and monitoring veterinary communication competencies and preparing for offline role-plays and real-life conversations in veterinary practice.

Individual differences in musical ability among adults with no music training

Good musical abilities are typically considered to be a consequence of music training, such that they are studied in samples of formally trained individuals. Here, we asked what predicts musical abilities in the absence of music training. Participants with no formal music training (N = 190) completed the Goldsmiths Musical Sophistication Index, measures of personality and cognitive ability, and the Musical Ear Test (MET). The MET is an objective test of musical abilities that provides a Total score and separate scores for its two subtests (Melody and Rhythm), which require listeners to determine whether standard and comparison auditory sequences are identical. MET scores had no associations with personality traits. They correlated positively, however, with informal musical experience and cognitive abilities. Informal musical experience was a better predictor of Melody than of Rhythm scores. Some participants (12%) had Total scores higher than the mean from a sample of musically trained individuals (⩾6 years of formal training), tested previously by Correia et al. Untrained participants with particularly good musical abilities (top 25%, n = 51) scored higher than trained participants on the Rhythm subtest and similarly on the Melody subtest. High-ability untrained participants were also similar to trained ones in cognitive ability, but lower in the personality trait openness-to-experience. These results imply that formal music training is not required to achieve musician-like performance on tests of musical and cognitive abilities. They also suggest that informal music practice and music-related predispositions should be considered in studies of musical expertise.