Catch me if you can! How French adolescents seize social occasions and opportunities to be active

BACKGROUND

Following an ecological framework, the aim of this study was to highlight the way adolescents invested their time in opportunities to engage in moderate to vigorous physical activity (MVPA) according to whether they were profiled as more or less active. This study's innovation lies in the analysis of MVPA according to social occasions which are understood as opportunities to be active throughout the day (e.g. home, school, transport).

METHODS

PA data measured by accelerometry (ActiGraph GT3X) for seven consecutive days were compiled, with adolescents' social occasions during the week recorded in a daily digital diary (n = 135). The opportunity ratio of MVPA at each social time is the ratio between time spent in MVPA and the duration of a corresponding social occasion. Following the literature, participants were categorised into three profiles according to their reported amount of MVPA: HEPA active, minimally active and inactive. Non-parametric Wilcoxon signed rank and Kruskal Wallis tests were performed to determine the relative intensity of PA performed at different social occasions, and to investigate whether intensities differed between adolescents with various activity profiles.

RESULTS

Results showed that engagement in MVPA at different social occasions differed according to participant profiles. Mismatch was noticed between the opportunity ratio and the duration of the most and least favorable social occasions for MVPA. For all three profiles, the social occasion "physical education lesson" revealed an opportunity ratio of MVPA (23.6% vs 17.0% vs 13.8%) significantly higher than the overall opportunity ratio of the week (6.9% vs 2.9% vs 1.2%), but of lower duration. Conversely, "home" (5.3% vs 0.0% vs 0.0%) and "school" (outside of PE time) (2.4% vs 0.0% vs 0.0%) represented the two least opportune social occasions for PA in an adolescent's week.

CONCLUSIONS

Rethinking engagement with MVPA in the context of temporal opportunities would allow potential ways to intervene within an educational supervised setting to help young people adopt a physically active lifestyle at the end of the key period of adolescence. These results reinforced the importance of context in interventions for PA promotion, opening for "time education" in people.

[Survey on training in orthopedics/trauma surgery : Is Germany ready for a competence-based training?]

BACKGROUND AND OBJECTIVE

A high-quality advanced training is a key factor for good and safe patient treatment. Germany is currently revising the advanced training curricula and logbooks aiming to change the training into a competence-based training. The aim of this study was to analyze the day to day reality of orthopedic and trauma surgery advanced training in Germany based on the elements of the advanced training.

METHODS

In March 2020 an online survey on advanced training was carried out with 44 questions on the topics of advanced training curriculum, logbook, educational resources, evaluation, authorized trainer and distribution of working time .

RESULTS

A total of 237 persons completed the survey, of which 208 fulfilled the inclusion criteria. The respondents perceived a lack of clear standards in the advanced training curriculum and 25% did not receive structured learning resources in the form of simulations or courses. Mandatory annual process interviews were performed in only 58%. Most respondents valued the expertise of the trainers in orthopedic and trauma surgery, whereas they rated their competence in supervision and giving feedback as below average. Administrative work consumed 220 min of the daily working time and on average 60min remained per day for respondents to learn operative skills.

CONCLUSION

The survey revealed inconsistencies in the current advanced training curriculum and a lack of supervision and evaluation. The implementation of competence-based advanced training should therefore not only focus on a change of the curriculum but also on implementing competence-based training at all levels of training (learning resources, training, evaluation).

[Flap harvest training on a new ultrarealistic simulation model: In-training operator feedback about a pulsating reperfused and reventilated cadaver Simlife®]

INTRODUCTION

The anatomical subject is still a key element to learn complex procedures in plastic surgery. We present here the evaluation of an in-training operator on a SIMLIFE® model, hyper realistic model consisting in human bodies donated to science equipped with pulsating recirculation and reventilation device.

MATERIAL AND METHODS

From February 2019 to October 2019, 8 forearm flaps with radial proximal pedicle were harvested by the learner on a SIMLIFE® model. Conditions were as close as possible to the operating room : asepsy, sterile draping, assistant and instrumentation including electrocoagulation.

RESULTS

The procedure was decomposed in 13 distinct steps. Mean total surgery time was 90,5±11,62minutes. There was only one case of arterial pedicle lesion resulting in major blood leak. Bleeding was measured by fake blood loss from the SIMLIFE® console. Mean intraoperatoy bleeding was 171±108 milliliters. We review pros and cons of this new technology particulary suited for complex plastic and reconstructive surgery training.

CONCLUSION

Using SIMLIFE® technology we have a new mean to train for complex procedures in plastic and reconstructive surgery. This new technology could be applied to numerous other surgical procedures. Broader applications are still limited by cost and cadaver use legislation.

Orthopedic Residency in a Tertiary Care Hospital of India: Positives, Negatives and Perspectives for Change

BACKGROUND

Orthopaedic residency training is a 3-year period of preparation that converts a raw medical student into a proficient orthopaedic surgeon. Due to wide variations at different centers in India, the program in a tertiary hospital is presented, in an attempt to improve the overall levels of training.

MATERIALS AND METHODS

PGIMER has produced many good surgeons who are well settled across the country and the world. A survey of the postgraduates of the last 30 years was done to highlight the perceptions about the program. An overview of the program was also added to the narrative to highlight the positive aspects of the training.

RESULTS

132 Orthopaedic passed-out residents from PGIMER could be contacted. 97% of them rated their residency experience as excellent or good, and stated that they would recommend this program to new residents. Key points highlighted by them were the readiness of trainees for any surgical contingency after graduation, continuation of the mindset for research, and their prompt acceptability into their subsequent places of work due to their place of graduation.

DISCUSSION

Converting an orthopaedic resident into a competent surgeon involves knowledge upgrades and impartation of skills; these are not limited to the theory of orthopaedics, but involve the thought processes and the planning as a surgeon, the attitude towards patient management, and a continuously inquisitive scientific mind. The shortcomings and strengths of the residency program in PGIMER are discussed; international standard methodology limited to this institute like formal log books, mentorship program, hands-on skill development through courses, etc. is something that is recommended to be mandatory in all residency programs.

CONCLUSION

The PGIMER Orthopaedic residency program could act as a basic model for other Indian medical schools, with any appropriate modifications. Standardization of Orthopaedic residency programs could allow upgrading to International levels.

Logbooks alone are not enough: initial experience with implementing a logbook for medical students in a clinical internship in gynecology and obstetrics

BACKGROUND

Logbooks are being increasingly widely used as a means of improving medical education and further training. They will in all probability continue to be mandatory in the Practical Year (PJ) in Germany even after the upcoming amendment of the Medical Licensing Regulations (ÄAppO). However, there are different approaches to their design and use, and these are also currently undergoing considerable change. This study for the first time examines and discusses the influence of logbooks on students' evaluation of a gynecology internship.

METHODS

The study was based on a well-established two-part 1-week internship course, with initially unstructured morning classes on wards and duty areas, along with precisely planned afternoon classes with skills training by peer teachers and seminars supervised by duty-exempted physicians. The postgraduate lecturers were prepared for the introduction of the logbook in a special course, and the aim was to optimize morning classes by introducing learning objectives adapted to the respective locations. The effects over 38 weeks of practical training were examined in evaluations by 235 prospectively group-randomized students with and without logbooks (n = 166 and n = 66, respectively; three datasets were not evaluable).

RESULTS

In the cohort comparison, the logbook group responded significantly more positively toward the internship at the start of the course (P = 0.046). In the final evaluation, however, medical supervision during the entire internship was rated significantly more poorly (P = 0.007). The logbook cohort also considered that guidance based on learning objectives was significantly worse, as was the extent to which wards and duty areas were prepared for the students (P = 0.001 and P = 0.029).

CONCLUSIONS

Introducing a logbook to optimize clinical teaching in internships may raise expectations that cannot always be met. In addition to adapting the learning objectives to a general framework that is less favorable in comparison with the Practical Year, the least that is required appears to be simultaneous and continuous mentoring of the lecturers, as well as an increase in staffing resources.

Use of the eLogbook in surgical training in the United Kingdom: A nationwide survey and consensus recommendations from the Association of Surgeons in Training

INTRODUCTION

Accurate recording of operative cases is essential during training to demonstrate experience. However, indicative numbers delineating minimum desirable experience may incentivise exaggeration or misrepresentation of experience. This study aimed to determine perceptions of real-world eLogbook use among UK surgeons in training.

MATERIAL AND METHODS

An anonymous online questionnaire was disseminated electronically using a pre-planned yield-maximisation strategy, incorporating regional champions, email and social media. Evaluation employed mixed methods in a combined interpretation of quantitative and qualitative data from the questionnaire. Recommendations for development of the eLogbook were itemised from respondents' free text items and a modified Delphi process, conducted within the Council of the UK national trainee representative body, the Association of Surgeons in Training, determined the strength of each recommendation.

RESULTS

Analysis included 906 complete responses from training-grade surgeons (34.8% female) from all UK recognised specialties and all grades of training. More than two-thirds (68.5%) believed that overstatement or misrepresentation of case involvement occurs. A fifth (20.8%) reported witnessing trainees logging cases they had not actually participated in and almost a third (32.7%) had witnessed overstatement, yet few (15.1%) had raised such an issue with a supervisor. Most (85.2%) respondents had few or no eLogbook entries validated. More than a quarter of respondents felt pressure to overstate their involvement in cases (28.6%) and the number recorded (28.1%). Almost a third (31.5%) felt the required case number for completion of training was not achievable. Female trainees were less likely to feel well supervised (p = 0.022) and to perceive targets for completion of training were achievable (p = 0.005). Thematic analysis identified four key themes to explain logbook misuse: Pressure to achieve training milestones; eLogbook functionality issues; training deficiencies and probity.

CONCLUSIONS

Inaccurate operative recording was widely reported, primarily in response to perceived pressure to achieve targets for career progression. Operative logbooks may not be as accurate as intended. Consensus recommendations are made for improvement in the eLogbook and its use.

Who PACS a Punch? The Role of the Picture Archiving and Communication System/Radiology Information System (PACS/RIS) in Quantifying Experiential Learning in Radiology Residency

The clinical logbook is the currently accepted tool for evaluating experiential learning (EL) in postgraduate radiology training programs internationally. The role of the picture archiving and communication system/radiology information system (PACS/RIS) in defining the complete EL portfolio of radiology residents has not been explored. To conduct a PACS/RIS-based analysis of the comprehensive clinical outputs of radiology residents, and to correlate outputs with residency recruitment criteria and exit examination performance. Retrospective, customized searches of the institutional PACS/RIS were conducted to determine the clinical outputs of radiology residents completing a standardized 4-year training program at a single institution in a middle-income country. The association between outputs and prior-to-residency radiology experience, prior-to residency completion of the primary examination, and performance in the exit examination were determined. Fifteen residents were included. Average clinical output was 8286 cases, with a wide range (6268-10460). Total output was not associated with first-time exit examination success (p=0.16). Residents with prior radiology experience tended to greater success at first exit examination attempt (10/11, 91% versus 2/4, 50%; p=0.09), despite lower average outputs (8138 versus 8695). Outputs were not associated with prior completion of the radiology primary examination (8263 versus 8378; p=0.87). This first PACS/RIS-based analysis of the complete clinical outputs of any radiology residency training program provides important baseline educational data, with the potential to inform discourses on specialty training internationally. It demonstrates the potential for the modern PACS/RIS to supersede the traditional logbook and to serve as a comprehensive EL portfolio for radiology residents.

Do senior medical students meet recommended emergency medicine curricula requirements?

BACKGROUND

Emergency departments (EDs) offer a variety of learning opportunities for undergraduate medical students. It is however, difficult to evaluate whether they are receiving recommended training during their emergency medicine (EM) clerkship without identifying their clinical activities. We aimed to evaluate the clinical exposure of the final year medical students at our College during their EM clerkship.

METHODS

This is a retrospective analysis of prospectively collected student logbooks. 75 students rotated in a 4-week EM clerkship during 2015-2016. The students rotated in EDs of two hospitals. Each ED treats more than 120,000 cases annually. The students completed 12 eight-hours shifts. Presentations and procedures seen were compared with EM curriculum recommendations.

RESULTS

Five thousand one hundred twenty-two patient presentations and 3246 procedures were recorded in the logbooks, an average (SD) of 68.3 (17.6) patients and 46.1 (14.0) procedures. None of the students encountered all ten recommended presentations. Two students (2.6%) logged all nine procedure categories of the EM curriculum.

CONCLUSION

Recommended presentations and procedures of the EM clerkship were not fully encountered by all our students. Different settings vary in the availability and type of patients and procedures. Each clinical clerkship should tailor their teaching methods based on the available learning opportunities.

Assessment of sedentary behaviors and transport-related activities by questionnaire: a validation study

Background

Comprehensive assessment of sedentary behavior (SB) and physical activity (PA), including transport-related activities (TRA), is required to design innovative PA promotion strategies. There are few validated instruments that simultaneously assess the different components of human movement according to their context of practice (e.g. work, transport, leisure). We examined test-retest reliability and validity of the Sedentary, Transportation and Activity Questionnaire (STAQ), a newly developed questionnaire dedicated to assessing context-specific SB, TRA and PA.

Methods

Ninety six subjects (51 women) kept a contextualized activity-logbook and wore a hip accelerometer (Actigraph GT3X + ^TM) for a 7-day or 14-day period, at the end of which they completed the STAQ. Activity-energy expenditure was measured in a subgroup of 45 subjects using the double labeled water (DLW) method. Test-retest reliability was assessed using intra-class-coefficients (ICC) in a subgroup of 32 subjects who filled the questionnaire twice one month apart. Accelerometry was annotated using the logbook to obtain total and context-specific objective estimates of SB. Spearman correlations, Bland-Altman plots and ICC were used to analyze validity with logbook, accelerometry and DLW data validity criteria.

Results

Test-retest reliability was fair for total sitting time (ICC = 0.52), good to excellent for work sitting time (ICC = 0.71), transport-related walking (ICC = 0.61) and car use (ICC = 0.67), and leisure screen-related SB (ICC = 0.64-0.79), but poor for total sitting time during leisure and transport-related contexts. For validity, compared to accelerometry, significant correlations were found for STAQ estimates of total (r = 0.54) and context-specific sitting times with stronger correlations for work sitting time (r = 0.88), and screen times (TV/DVD viewing: r = 0.46; other screens: r = 0.42) than for transport (r = 0.35) or leisure-related sitting-times (r = 0.19). Compared to contextualized logbook, STAQ estimates of TRA was higher for car (r = 0.65) than for active transport (r = 0.41). The questionnaire generally overestimated work- and leisure-related SB and sitting times, while it underestimated total and transport-related sitting times.

Conclusions

The STAQ showed acceptable reliability and a good ranking validity for assessment of context-specific SB and TRA. This instrument appears as a useful tool to study SB, TRA and PA in context in adults.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3412-3) contains supplementary material, which is available to authorized users.

Development of a community pharmacy program in Iran with a focus on Logbook application

OBJECTIVE

Community pharmacy educational program needs to be completed because of gradual transition in pharmacist responsibilities from traditional roles such as dispensing and compounding medications to give professional patient-based care. To further develop the community pharmacy program, this study was designed to involve Logbook in pharmacy training courses.

METHODS

For this study, at first, Logbook for community pharmacy practice was designed to develop educational program of this course in Isfahan University of Medical Sciences. Thereafter, in a 6-month prospective study, this Logbook was incorporated to the pharmacy practice course of Doctor of Pharmacy (PharmD) educational program, and students' feedbacks were gained after final examination to improve the Logbook accordingly. Students described their opinions about different sections of this program as unnecessary, necessary, and necessary with revision.

FINDINGS

A total of 65 PharmD students were included in this study. More than 90% of the students gave complete answers to the evaluation of this pharmacy training program. The results showed that more than 70% of students considered this program of pharmacy training was necessary (with or without revisions) in PharmD courses. They recommended more time to be included for prescription reading and analyses during these courses.

CONCLUSION

Developing pharmacy training program by using Logbook which was presented in this study was considered necessary and efficient for PharmD students. However, it is a prototype system, and we are committed to using initial students and preceptors' feedbacks to improve Logbook in future courses.