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The authors reflect on the dire state of motor learning at the time of Brooks’s book and consider reasons why research was resurrected in the 1980s and flourished in the ensuing years. In so doing, they provide an overview of the various research topics that have been studied, discuss the influence of motor learning on other fields of study, and consider the future of motor learning research both within and outside the academic study of kinesiology.

For many of those working in maritime industries, it is very common to be exposed to harsh environments, such as cold water, on a regular basis. We conducted a scoping review on peer reviewed, published papers to summarize the literature on the topic cold water exposure and non-freezing cold water injuries in the maritime industries. First, industry experts were consulted, then a PICO model was created to define the search terms for the review. The initial search produced 690 abstract. Of these abstracts, 14 were considered to be relevant to the review. The scoping review findings illustrated the lack of research that currently exists in relation to cold water exposure in the maritime industries. Within the available, albeit limited, literature, evidence suggests that there are several cold-water injuries that occur in the maritime industries. These include occupational dermatosis, Raynaud’s phenomena, finger blanching, and hand numbness. Performance decrements were also reported. The current gaps include a lack of documentation of minor and non-fatal injuries, the amount of exposure, and training protocols. There is a need to improve cold-water training regulations for those working in the maritime industries and for proper injury documentation, both of which can significantly benefit safety.

Virtual reality (VR) simulation training for helicopter search and rescues (SAR) hoist operators is very uncommon in comparison to the availability of pilot simulation training. SAR hoist operators...

PURPOSE: This study was intended to determine the effect of skin cooling on breath-hold duration and predicted emergency air supply duration during immersion.METHODS: While wearing a helicopter transport suit with a dive mask, 12 subjects (29 ± 10 yr, 78 ± 14 kg, 177 ± 7 cm, 2 women) were studied in 8 and 20°C water. Subjects performed a maximum breath-hold, then breathed for 90 s (through a mouthpiece connected to room air) in five skin-exposure conditions. The first trial was out of water for Control (suit zipped, hood on, mask off). Four submersion conditions included exposure of the: Partial Face (hood and mask on); Face (hood on, mask off); Head (hood and mask off); and Whole Body (suit unzipped, hood and mask off).RESULTS: Decreasing temperature and increasing skin exposure reduced breath-hold time (to as low as 10 ± 4 s), generally increased minute ventilation (up to 40 ± 15 L · min−1), and decreased predicted endurance time (PET) of a 55-L helicopter underwater emergency breathing apparatus. In 8°C water, PET decreased from 2 min 39 s (Partial Face) to 1 min 11 s (Whole Body).CONCLUSION: The most significant factor increasing breath-hold and predicted survival time was zipping up the suit. Face masks and suit hoods increased thermal comfort. Therefore, wearing the suits zipped with hoods on and, if possible, donning the dive mask prior to crashing, may increase survivability. The results have important applications for the education and preparation of helicopter occupants. Thermal protective suits and dive masks should be provided.Madu VC, Carnahan H, Brown R, Ennis K-A, Tymko KS, Hurrie DMG, McDonald GK, Cornish SM, Giesbrecht GG. Skin cooling on breath-hold duration and predicted emergency air supply duration during immersion. Aerosp Med Hum Perform. 2020; 91(7):578–585.

In emergencies at sea, it is crucial that the crew members remember emergency tasks. Although these practical skills are occasionally trained for, some are not routinely practiced and it is expected that performance of these skills will degrade over time. This program evaluation addresses whether characteristics can predict performance of marine emergency skills. Specifically, during relearning of two equipment preparation and donning tasks included in marine emergency duties refresher (MED-R) courses. The time since an individual had completed prerequisite training, the type of course (for Officers or Ratings), and the age of the individual were hypothesized to be significant predictors of performance patterns in this initial cohort of trainees. While very few trainees produced errors during an immersion suit task, more than half of trainees produced errors during a breathing apparatus task. The relationships between the predictors and breathing apparatus task error scores were statistically reliable, and 7% of the variance in performance is accounted for. Future research questions should focus on understanding additional factors that may aid in predicting relearning performance. Comparison of the two tasks examined, which differed in complexity, provides support for the role of task difficulty in theoretical understanding of differences in relearning of movement skills. In terms of practice, we can conclude that the individual factor of age and the training factors of timing and level can aid in predicting relearning performance. Further study of additional individual and training factors can bolster our ability to predict relearning outcomes, leading to effective and efficient training decisions.

Correct rope rescue techniques are critical for safey. These tasks can be anxiety provoking yet it is not clear how anxiety affects learning. An anxious environment was created by practising diffic...

Cold exposure causes impairments in manual performance and therefore has implications for the safety and performance of individuals who perform occupational and survival skills in cold environments. The existing body of literature on the effects of cold exposure on manual performance has provided a foundation of knowledge regarding how cold exposure impacts safety and performance. The purpose of this review is to provide an updated summary of the literature, identify gaps in the literature based on task classifications, and to discuss how optimizing training might be a meaningful way of enhancing the safety and performance of cold environment workers. Our review found that there is a limited amount of research on how to optimize training for cold environments. Our review also found that the current body of research is primarily based on findings from tasks that are biased towards motor or cognitive demands, but not both, and that most tasks studied are low in complexity. Based on these identified gaps in the literature, we discuss how concepts from the motor learning literature can inform future research to help determine the best methods for training in the cold. We also discuss how a more comprehensive understanding of the effects of cold exposure on manual performance could be developed by performing research that uses a broader range of tasks that vary based on both task complexity and the cognitive and motor demands. Research that addresses these issues could help to enhance the safety and performance of those who work in cold environments.

Assessment is critical to support pediatric endoscopy training. Although trainee engagement in assessment is encouraged, the use of self-assessment and its accuracy among pediatric endoscopists is not well described. We aimed to determine the self-assessment accuracy of novice, intermediate, and experienced pediatric endoscopists.Novice (performed50 previous colonoscopies), intermediate (50-500), and experienced (1000) pediatric endoscopists from 3 North American academic teaching hospitals each performed a clinical colonoscopy. Endoscopists were assessed in real-time by 2 experienced endoscopists using the Gastrointestinal Endoscopy Competency Assessment Tool for Pediatric Colonoscopy (GiECATKIDS). In addition, participants self-assessed their performance using the same instrument. Self-assessment accuracy between the externally assessed and self-assessed scores was evaluated using absolute difference scores, intraclass correlation coefficients, and Bland-Altman analyses.Forty-seven endoscopists participated (21 novices, 16 intermediates, and 10 experienced). Overall, there was moderate agreement of externally assessed and self-assessed GiECATKIDS total scores with an intraclass correlation coefficient of 0.72 (95% confidence interval, 0.55-0.83). The absolute difference scores among the 3 groups were significantly different (P = 0.005), with experienced endoscopists demonstrating a more accurate self-assessment compared to novices (P = 0.003). Bland-Altman plots revealed that novice endoscopists' self-assessed scores tended to be higher than their externally assessed scores, indicating they overestimated their performance.We found that endoscopic experience was positively associated with self-assessment accuracy among pediatric endoscopists. Novices were inaccurate in assessing their endoscopic competence and were prone to overestimation of their performances. Our findings suggest novices may benefit from targeted interventions aimed at improving their insight and self-awareness.

BACKGROUND: Helicopter hoist operators are highly skilled and critical crewmembers in search and rescue. However, hoist operator training programs are relatively underdeveloped in comparison to helicopter pilot training. It is critical that this simulator teaches the necessary skills for high-level performance given the dangers associated with helicopter hoist operation. As a result, we sought to validate and identify critical aspects of skilled hoisting.METHODS: Through expert consultation, we identified several measures of hoist operation, such as mission time, cable plumb, cable tension, cable hand position, and cable displacement. We compared hoist performance between experienced and novice hoist operators in a simulated hoisting mission with two levels of difficulty (with and without wind). The experienced group (eight men/one woman) was composed of nine active or former military hoist operators who were working in commercial search and rescue. The novice group was composed of seven subjects (two men/five women) from the general population and had no previous experience with hoisting operations or the simulator.RESULTS: We found that experienced hoist operators had faster mission time, similar cable plumb, lower tension, and less variable hand position. Further, experienced hoist operators pulled the cable inward in the wind while novice hoist operators pushed the cable away.DISCUSSION: These findings suggests that this simulator captures performance differences between skill levels and, as a result, is a first step supporting the use of this simulator for hoist operator training.King MT, Lenser S, Rogers D, Carnahan H. Helicopter hoist performance in novice and experienced hoist operators. Aerosp Med Hum Perform. 2020; 91(6):496–500.

This project aimed to evaluate the effects of ambient lighting during practice and performance of simulated helicopter escape sequences. Participants were randomized to one of the following groups to practice a standard helicopter underwater escape sequence: Light (with room lights on), Dark (with room lights off), or Graduated (in the light for the first half and then in the dark for the second half of the trials). Following practice, participants had a minimum of 30 min break, followed by retention testing in the dark and then in the light. Dependent measures included accuracy and movement time. Results indicated that participants performed more accurately during the dark retention trial than during the light retention trial. This could be due to increased arousal elicited by performance in the dark or, alternatively, may suggest that performance of helicopter escape sequences is not visually mediated. Based on findings, it appears that training in the light is suitable for potential performance in the dark.

Multi-day training courses, designed to prepare groups of people to respond should a critical situation arise, include a range of knowledge and skill competencies. Due to infrequent requirements to perform these skills outside of training, and the importance of correct execution in critical situations, understanding the retention, and forgetting of such skills is an important consideration for industry. In an effort to determine the optimal training contexts and optimal retraining period for skills included in multi-day training course, a review of the literature in healthcare, military, and marine and offshore safety and survival contexts provides a body of knowledge regarding the retention, and decay of complex knowledge and skills taught in contexts relevant to multi-day course formats. The present review has identified task factors to consider including the influence of characteristics such as task difficulty, type of skill, and the specificity of training to the work domain. Factors related to the learner include the skill level attained during training, the amount a practice received and subsequent on-the-job exposure to specific skills. There are also indications that for some tasks, we can expect retention of skills for 6 months at best. The authors recommend experimental studies designed to gain understanding of specific training factors during original, refresher, and non-training time periods, which can benefit later retention of potentially life-saving skills taught in multi-day training courses.

Using Delphi methodology, we created measurement instruments for specific training tasks included in Marine Emergency Duties training. Six Marine and Offshore Safety and Survival instructors rated ...

The aim of this study was to determine the hemodynamic and neuroendocrinological responses to different levels and protocols of artificial gravity, especially in comparison to what is expected during a moderate bout of exercise. Ten male participants were exposed to artificial gravity using two different protocols: the first was a centrifugation protocol that consisted of a constant phase of 2 Gz for 30 minutes, and the second consisted of an intermittent phase of 2 Gz for two minutes, separated by resting periods for three minutes in successive order. Near infrared spectroscopy (oxyhemoglobin and deoxyhemoglobin) at the prefrontal cortex, Musculus biceps brachii, and Musculus gastrocnemius, as well as heart rate and blood pressure were recorded before, during, and after exposure to artificial gravity. In order to determine effects of artificial gravity on neuroendocrinological parameters (brain-derived neurotrophic factor, vascular endothelial growth factor, and insulin-like growth factor 1), blood samples were taken before and after centrifugation. During the application of artificial gravity the concentration of oxyhemoglobin decreased significantly and the concentration of deoxyhemoglobin increased significantly in the prefrontal cortex and the Musculus biceps brachii muscle. Participants exposed to the continuous artificial gravity profile experienced peripheral pooling of blood. No changes were observed for brain-derived neurotrophic factor, vascular endothelial growth factor, or insulin-like growth factor 1. Intermittent application of artificial gravity may represent a better-tolerated presentation for participants as hemodynamic values normalize during resting periods. During both protocols, heart rate and arterial blood pressure remained far below what is experienced during moderate physical activity.

Objective The aim of this study was to investigate the combined effect of cold and moisture on manual performance and tactile sensitivity. Background People working in the ocean environment often perform manual work in cold and wet conditions. Although the independent effects of cold and moisture on hand function are known, their combined effect has not been investigated. Method Participants completed sensory (Touch-Test, two-point discrimination) and motor (Purdue Pegboard, Grooved Pegboard, reef knot untying) tests in the following conditions: dry hand, wet hand, cold hand, and cold and wet hand. Results For the Purdue Pegboard and knot untying tasks, the greatest decrement in performance was observed in the cold-and-wet-hand condition, whereas the decrements seen in the cold-hand and wet-hand conditions were similar. In the Grooved Pegboard task, the performance decrements exhibited in the cold-and-wet-hand condition and the cold-hand condition were similar, whereas no decrement was observed in the wet-hand condition. Tactile sensitivity was reduced in the cold conditions for the Touch-Test but not the two-point discrimination test.The combined effect of cold and moisture led to the largest performance decrements except when intrinsic object properties helped with grasp maintenance. The independent effects of cold and moisture on manual performance were comparable. Application Tools and equipment for use in the cold ocean environment should be designed to minimize the effects of cold and moisture on manual performance by including object properties that enhance grasp maintenance and minimize the fine-dexterity requirements.

Conflicting viewpoints regarding the role of errors produced during practice of motor skills raise questions regarding errors in low-stakes simulation of high-stakes performance contexts. Current knowledge regarding the relationship between errors in practice and later sport performance is based on novice performers and relatively simple, drill-like sport skills. The purpose of this study was to describe the relationship between errors produced during volleyball scrimmage in practice (low-stakes simulation) and in gameplay (high-stakes performance). These contexts represent ecologically valid, complex sport situations. Results indicated that players with high error scores during scrimmage were more likely to produce high error scores in gameplay, even when player skill, position and sex were accounted for.

With increased development in Arctic regions (e.g., oil and gas, tourism, fisheries, shipping) the risk to the people in this region in case of emergency needs to be mitigated. Search and rescue in the Arctic is a critical but often ignored aspect of safe development in the Arctic. However, the logistics and training of Arctic SAR are very unique when compared to other regions. In this chapter we will review how the harsh environment of working in Arctic regions affects the ability of rescue technicians to perform the technical skills required for search and rescue. The chapter will be built around a 2013 investigative report of the death of a Canadian Forces Search and Rescue Technician that occurred on a mission near Nunavut. We will review the main points made by the investigative report and extrapolate what was learned about human factors issues related to working in Arctic regions that has application to all human activities in this region. The need for emergency procedures that are designed for Arctic operations will also be addressed. In summary, literature will be reviewed and based on this, recommendations for training, equipment and operational procedures will be made.

Purpose A number of studies has well described central cardiovascular changes caused by changing gravity levels as they occur e.g. during parabolic flight. limited data exists describing the effect of microgravity on the cerebrovascular system and brain perfusion. Methods In this study middle cerebral artery velocity (MCAv) of 16 participants was continuously monitored on a second-by-second basis during 15 consecutive parabolas (1G, 1,8G, 0G, 1,8G) using doppler ultrasound. Simultaneously central cardiovascular parameters (heart rate, mean arterial blood pressure, cardiac output) were assessed. Results Results revealed an immediate reaction of central cardiovascular parameters to changed gravity levels. In contrast, changes in MCAv only initially were in accordance with a normal cerebral autoregulation. Whereas all of the measured central cardiovascular parameters seemed to have reached a steady state after approximately 8 s of microgravity, MCAv, after an initial decrease with the onset of microgravity, increased again during the second half of the microgravity phase. Conclusion It is concluded that this increase in MCAv during the second half of the microgravity period reflects a decrease of cerebrovascular resistance caused by a pressure driven increased venous outflow and/or a contraction of precapillary sphincters in order to avoid hyperperfusion of the brain.

Humans have a sophisticated set of neural structures for cutaneous thermoception. Sufficiently cold temperatures are thought to evoke pain and motivation to resolve disturbed homeostasis, while cool but not painful temperatures are evaluated as cold but do not cause thermoregulatory behaviour. Brain networks for innocuous and noxious cold temperature have been proposed but a quantitative meta-analysis comparing the two has never been conducted. As a result, we sought to perform activation likelihood estimation analysis of the brain activity associated with innocuous and noxious cold exposure. Combining data from 33 data sets revealed that innocuous cold exposure activates the posterior insular, middle/orbital and posterior parietal cortices while noxious cold activates the thalamus, putamen, and right anterior insula cortex. Both conditions respectively show greater activation in these areas and no areas are common between conditions. Our results confirm the long-standing hypothesis that noxious cold is encoded in the right anterior insula, but contradicts the selective importance of the posterior insula for cool somatosensory processing.

The ability to withstand cold temperatures and perform motor tasks in cold environments is a requirement in various industries. This study aimed to determine whether being read a mindfulness passag...

Previous studies showed a decrease in reaction time during the weightlessness phase of a parabolic flight. This effect was found to be stronger with increasing task complexity and was independent of previous experience of weightlessness as well as anti-nausea medication. Analysis of event related potentials showed a decreased amplitude of the N100-P200 complex in weightlessness but was not able to distinguish a possible effect of task complexity. The present study aimed to extend this previous work, by comparing behavioral (reaction time) and neurological (event related potentials analysis) performance to a simple (oddball) and a complex (mental arithmetic + oddball) task during weightlessness. 28 participants participated in two experiments. 11 participants performed a simple oddball experiment in the 1G and 0G phases of a parabolic flight. 17 participants were presented a complex arithmetic task in combination with an oddball task during the 1G and 0G phases of a parabolic flight. Reaction time as well as event related potentials (ERP) were assessed. Results revealed a reduced reaction time (p .05) for the complex task during 0G. No gravity effects on reaction time were found for the simple task. In both experiments a reduction of typical ERP amplitudes was noticeable in weightlessness. It is assumed that the weightlessness induced fluid shift to the brain is positively affecting neuro-behavioral performance.

Despite the well-described physiological response to cold, little is known about how to best train persons to perform motor tasks in cold conditions. It is unclear if principles of training specificity would apply to motor skill training when cold because cold exposure reduces tactile sensitivity and cognitive function, which may reduce rather than enhance training efficacy. The purpose of this study is to determine whether training in the cold facilitates performance in the cold. To do this, we investigated the effect of cold or thermoneutral training on performance of the Grooved Pegboard Task. Twenty persons (11M, 9F, mean age 31.2 ± 5.44 years) visited the lab on two separate days and were randomly assigned to either a cold (5M, 5F) or thermoneutral (6M, 4F) training group. On day one, participants were tested at baseline and then performed 20 repetitions of the task according to their respective group assignment. Prior to each task repetition during training, the cold training group immersed their hand in cold water (2 °C) while the thermoneutral group immersed their hand in thermoneutral water (34 °C). Following training, participants were tested once again (immediate retention test). During testing, participants performed the task twice; once after immersing their hands in cold water and once after immersing their hands in thermoneutral water. On day two, delayed retention tests were performed. Time to completion and number of errors were recorded during testing. There were no differences in time to completion at delayed retention tests between thermoneutral and cold-trained groups (p = 0.434). The incidence of errors was significantly less in the cold-trained group than the thermoneutral training group at delayed retention testing (p = 0.035). The main finding of this study was that dexterity but not speed was improved by cold training. Further research is required but the findings presented here suggest that industries that require motor tasks in the cold could benefit from training employees in cold conditions.

Item does not contain fulltext Changes in gravity conditions have previously been reported to influence brain hemodynamics as well as neuronal activity. This paper attempts to identify a possible link between changes in brain blood flow and neuronal activity during microgravity. Middle cerebral artery flow velocity (MCAv) was measured using Doppler ultrasound. Brain cortical activity (i.e., cortical current density) was measured using electroencephalography. Finger blood pressure was recorded and exported to generate beat-by-beat systolic (SBP), diastolic (DBP) and mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), and cerebrovascular conductance index (CVCi). Seventeen participants were evaluated under normal gravity conditions and microgravity conditions, during 15 bouts of 22-s intervals of weightlessness during a parabolic flight. Although MAP decreased and CO increased, MCAv remained unchanged in the microgravity condition. CVCi as the quotient of MCAv and MAP increased in microgravity. Cortical current density showed a global decrease. Our data support earlier data reporting a decrease in the amplitude of event-related potentials recorded during microgravity. However, the general decrease in neural excitability in microgravity seems not to be dependent on hemodynamic changes.

Sound application of clinical reasoning (CR) by the physical therapist is critical to achieving optimal patient outcomes. As such, it is important for institutions granting certification in orthopaedic manual physical therapy (OMPT) to ensure that the assessment of CR is sufficiently robust. At present, the dearth of validated instruments to assess CR in OMPT presents a serious challenge to certifying institutions. Moreover, the lack of documentation of the development process for instruments that measure CR pose additional challenges. The purpose of this study is to evaluate the sensibility of a newly developed instrument for assessing written responses to a test of CR in OMPT; a ‘pilot’ phase that examines instrument feasibility and acceptability. Using a sequential mixed-methods approach, Canadian OMPT examiners were recruited to first review and use the instrument. Participants completed a sensibility questionnaire followed by semi-structured interviews, the latter of which were used to elaborate on questionnaire responses regarding feasibility and acceptability. Eleven examiners completed the questionnaire and interviews. Questionnaire results met previously established sensibility criteria, while interview data revealed participants' (dis)comfort with exerting their own judgment and with the rating scale. Quantitative and qualitative data provided valuable insight regarding content validity and issues related to efficiency in assessing CR competence; all of which will ultimately inform further psychometric testing. While results suggest that the new instrument for assessing clinical reasoning in the Canadian certification context is sensible, future research should explore how rater judgment can be utilized effectively and the mental workload associated with appraising clinical reasoning.

Studies of self-controlled practice have shown benefits when learners controlled feedback schedule, use of assistive devices and task difficulty, with benefits attributed to information processing and motivational advantages of self-control. Although haptic assistance serves as feedback, aids task performance and modifies task difficulty, researchers have yet to explore whether self-control over haptic assistance could be beneficial for learning. We explored whether self-control of haptic assistance would be beneficial for learning a tracing task. Self-controlled participants selected practice blocks on which they would receive haptic assistance, while participants in a yoked group received haptic assistance on blocks determined by a matched self-controlled participant. We inferred learning from performance on retention tests without haptic assistance. From qualitative analysis of open-ended questions related to rationales for/experiences of the haptic assistance that was chosen/provided, themes emerged regarding participants’ views of the utility of haptic assistance for performance and learning. Results showed that learning was directly impacted by the frequency of haptic assistance for self-controlled participants only and view of haptic assistance. Furthermore, self-controlled participants’ views were significantly associated with their requested haptic assistance frequency. We discuss these findings as further support for the beneficial role of self-controlled practice for motor learning.

To investigate the effect of hand immersion duration on manipulative ability and tactile sensitivity.Individuals in maritime settings often work with hands that have been immersed in water. Although research has shown that hand immersion duration differentially impacts skin adhesion and tactile sensitivity, the effect of hand immersion on manipulative ability has not been directly tested. Given how critical manipulative ability is for the safety and performance of those working at sea, the effect of hand immersion duration on manual performance was investigated.Tests of manipulative ability (Purdue Pegboard, Grooved Pegboard, reef knot untying) and tactile sensitivity (Touch-Test) were completed following no-exposure, short-exposure, and long-exposure hand immersions in thermoneutral water.Compared to the no immersion condition, the Purdue Pegboard performance was reduced in both immersion conditions (short exposure, -11%; long exposure, -8%). A performance decrement was only observed in the short exposure condition (+15% in time to complete task) for the reef knot untying task. There were no statistical differences in the Grooved Pegboard or Touch-Test scores between exposure conditions.Immersing the hands in water decreases manipulative ability except for when object properties reduce the slipperiness between the hand and object.Manual performance in a wet environment may be conserved by designing tools and objects with edges and textures that can offset the slipperiness of wet hands. To maintain safety, the time requirements for working with wet hands needs to be considered.

Colonoscopy performance is typically assessed by a supervisor in the clinical setting. There are limitations of this approach, however, because it allows for rater bias and increases supervisor workload demand during the procedure. Video-based assessment of recorded procedures has been proposed as a complementary means by which to assess colonoscopy performance. This study sought to investigate the reliability, validity, and feasibility of video-based assessments of competence in performing colonoscopy compared with live assessment.Novice (50 previous colonoscopies), intermediate (50-500), and experienced (1000) endoscopists from 5 hospitals participated. Two views of each colonoscopy were videotaped: an endoscopic (intraluminal) view and a recording of the endoscopist's hand movements. Recorded procedures were independently assessed by 2 blinded experts using the Gastrointestinal Endoscopy Competency Assessment Tool (GiECAT), a validated procedure-specific assessment tool comprising a global rating scale (GRS) and checklist (CL). Live ratings were conducted by a non-blinded expert endoscopist. Outcomes included agreement between live and blinded video-based ratings of clinical colonoscopies, intra-rater reliability, inter-rater reliability and discriminative validity of video-based assessments, and perceived ease of assessment.Forty endoscopists participated (20 novices, 10 intermediates, and 10 experienced). There was good agreement between the live and video-based ratings (total, intra-class correlation [ICC] = 0.847; GRS, ICC = 0.868; CL, ICC = 0.749). Intra-rater reliability was excellent (total, ICC = 0.99; GRS, ICC = 0.99; CL, ICC = 0.98). Inter-rater reliability between the 2 blinded video-based raters was high (total, ICC = 0.91; GRS, ICC = 0.918; CL, ICC = 0.862). GiECAT total, GRS, and CL scores differed significantly among novice, intermediate, and experienced endoscopists (P .001). Video-based assessments were perceived as "fairly easy," although live assessments were rated as significantly easier (P .001).Video-based assessments of colonoscopy procedures using the GiECAT have strong evidence of reliability and validity. In addition, assessments using videos were feasible, although live assessments were easier.

The purpose of this study was to compare how fish harvesters who have years of chronic cold water exposure, differ from controls, with no history of cold exposure, on tests of sensation, motor performance and cold tolerance. Twelve fish harvesters and eight controls performed the following tests in both room temperature and cold conditions: VonFrey touch, grooved pegboard, manual dexterity, maximum cold exposure, and a discomfort rating. During the room temperature test, fish harvesters had a statistically higher VonFrey touch score than controls indicating decrements to their sense of touch. Results showed no statistically significant findings between groups for either of the motor performance, maximum cold exposure or discomfort tests. Findings suggest that chronic cold water exposure does not appear to lead to an adaptation to working in the cold, but instead can lead to non-freezing cold exposure injury.

Researchers in the domain of haptic training are now entering the long-standing debate regarding whether or not it is best to learn a skill by experiencing errors. Haptic training paradigms provide fertile ground for exploring how various theories about feedback, errors and physical guidance intersect during motor learning. Our objective was to determine how error minimizing, error augmenting and no haptic feedback while learning a self-paced curve-tracing task impact performance on delayed (1 day) retention and transfer tests, which indicate learning. We assessed performance using movement time and tracing error to calculate a measure of overall performance – the speed accuracy cost function. Our results showed that despite exhibiting the worst performance during skill acquisition, the error augmentation group had significantly better accuracy (but not overall performance) than the error minimization group on delayed retention and transfer tests. The control group’s performance fell between that of the two experimental groups but was not significantly different from either on the delayed retention test. We propose that the nature of the task (requiring online feedback to guide performance) coupled with the error augmentation group’s frequent off-target experience and rich experience of error-correction promoted information processing related to error-detection and error-correction that are essential for motor learning.

This study investigates the influence that the amount of exposure has on the persistence of sensorimotor memories. Participants acquired memories of an unexpectedly heavy object in one of four groups that varied in the number lifts of the object they each performed. All participants followed this acquisition period with retention lifts immediately and after 2-second and 10-second intervals, as well as after 15 minutes and 24 hours. Grasp force profiles were evaluated for the maintenance of memory-dependent adaptations. A lack of any group effects indicates that the quantity of exposure offers the sensorimotor memory system no temporal advantage in the maintenance of short-term representations. The results are discussed in light of the possibility that, within a short time frame, only the information from the preceding lift has functional relevance to the current lift.

Self-assessment is important for life-long learning and a recommended assessment method for endoscopy skills. Prior literature has not investigated self-assessment accuracy of colonoscopic competence in the clinical setting. This study aimed to determine the self-assessment accuracy of novice, intermediate, and experienced endoscopists.Novice (performed 50 previous colonoscopies), intermediate (50-500), and experienced (1000) endoscopists from 5 hospitals each performed a clinical colonoscopy. Video recordings of procedures were independently assessed by 2 blinded expert endoscopists by using the Gastrointestinal Endoscopy Competency Assessment Tool (GiECAT). Externally assessed and self-assessed GiECAT scores were defined as the mean of the 2 video-based ratings and as participants' own assigned ratings, respectively. Self-assessment accuracy between the externally assessed and self-assessed scores was evaluated by using absolute difference scores, intraclass correlation coefficients, and the Bland-Altman analysis.Twenty novice, 10 intermediate, and 10 experienced endoscopists participated. There was moderate agreement of externally assessed and self-assessed GiECAT scores, with an intraclass correlation coefficient of 0.65 (95% confidence interval, 0.44-0.80). The absolute difference scores among the 3 groups were significantly different (P = .002), with experienced endoscopists demonstrating a more accurate self-assessment ability compared with novices (P = .002). Bland-Altman plots suggest that novice and experienced endoscopists tend to overrate and underrate their clinical competence, respectively; no specific trends were associated with intermediates.Participants demonstrated moderate self-assessment accuracy of clinical competence. Endoscopist experience was positively associated with self-assessment accuracy; novices demonstrated lower self-assessment accuracy compared with experienced endoscopists. Moreover, novices tended to overestimate their performances. Novice endoscopists may benefit from targeted interventions to improve self-assessment accuracy.

Development and evaluation of Point of Care Ultrasound (PoCUS) skill is a resource intensive undertaking. Current practice involves expert supervision of trainees performing numerous practice scans in the clinical setting. Computer augmented training represents the potential for significant reduction in resources utilization. Multiple ultrasound training simulators exist however of unclear value in teaching image generation skills. This paper describes the concept of using a standard ultrasound machine and human subjects, combined with image processing and depth sensing technologies, to develop a realistic PoCUS training tool. In addition to the concept, we describe the initial data collection experiment and preliminary work integrating ultrasound imagery and probe movement. Operator assessment metrics explored in this paper include image quality, stability, and acquisition time, demonstrate good potential to differentiate between novice and experienced sonographers.

Clinical reasoning (CR) represents one of the core components of clinical competence in Orthopaedic Manual Physical Therapy (OMPT). While education standards have been developed to guide curricular design, assessment of CR has not yet been standardized. Without theory-informed and rigorously developed measures, the certification of OMPTs lacks credibility and is less defensible. The purpose of this study was to use a theory-informed approach to generate assessment criteria for developing new assessment tools to evaluate CR in OMPT.A list of assessment criteria was generated based on international education standards and multiple theoretical perspectives. A modified Delphi method was used to gain expert consensus on the importance of these assessment criteria for the assessment of CR in OMPT. The OMPTs from 22 countries with experience in assessing CR were invited to participate in three rounds of online questionnaires to rate their level of agreement with these criteria. Responses were tabulated to analyze degree of consensus and internal consistency.Representatives from almost half of the OMPT member organizations (MO) participated in three rounds of the Delphi. High levels of agreement were found among respondents regarding the importance and feasibility of most assessment criteria. There was high internal consistency among items within the proposed item subgroupings.A list of assessment criteria has been established that will serve as a framework for developing new assessment tools for CR assessment in OMPT. These criteria will be important for guiding the design of certification processes in OMPT as well as other episodes of CR assessment throughout OMPT training.

Validated assessment tools are required to support competency-based education. We aimed to assess the reliability and validity of the Gastrointestinal Endoscopy Competency Assessment Tool for Pediatric Colonoscopy (GiECATKIDS), an instrument developed by 41 North American experts using Delphi methodology.GiECATKIDS consists of a 7-item global rating scale (GRS) and an 18-item checklist (CL). An attending physician assessed 104 colonoscopies performed at 3 North American hospitals by 56 endoscopists, including 25 novices (50 previous procedures), 21 intermediates (50-250), and 10 advanced endoscopists (500). Another observer rated procedures to assess interrater reliability using intraclass correlation coefficient (ICC). Test-retest reliability was measured with ICC comparing endoscopists' first and second procedure scores. Discriminative validity was examined by comparing experience level with scores. Concurrent validity was assessed by correlating scores with colonoscopy experience, cecal and terminal ileal intubation rates, and physician global assessment.Interrater reliability of the GiECATKIDS was high (total: ICC = 0.88; GRS: ICC = 0.79; CL: ICC = 0.89). Test-retest reliability was excellent (total: ICC = 0.94; GRS: ICC = 0.94; CL: ICC = 0.84). GiECATKIDS total, GRS, and CL scores differed significantly among novice, intermediate, and advanced endoscopists (P 0.001). There was a significant positive correlation (P 0.001) between scores and number of previous colonoscopies (total: ρ = 0.91, GRS: ρ = 0.92, CL: ρ = 0.84), cecal intubation rate (total: ρ = 0.82, GRS: ρ = 0.85, CL: ρ = 0.77), ileal intubation rate (total: ρ = 0.82, GRS: ρ = 0.82, CL: ρ = 0.80), and physician global assessment (total: ρ = 0.95, GRS: ρ = 0.94, CL: ρ = 0.89).The GiECATKIDS demonstrates strong reliability and validity as a measure of performance of pediatric colonoscopy that can be used to support training and assessment.

Purpose: To review the literature on simulation-based learning experiences and to examine their potential to have a positive impact on physiotherapy (PT) learners' knowledge, skills, and attitudes in entry-to-practice curricula. Method: A systematic literature search was conducted in the MEDLINE, CINAHL, Embase Classic+Embase, Scopus, and Web of Science databases, using keywords such as physical therapy, simulation, education, and students. Results: A total of 820 abstracts were screened, and 23 articles were included in the systematic review. While there were few randomized controlled trials with validated outcome measures, some discoveries about simulation can positively affect the design of the PT entry-to-practice curricula. Using simulators to provide specific output feedback can help students learn specific skills. Computer simulations can also augment students' learning experience. Human simulation experiences in managing the acute patient in the ICU are well received by students, positively influence their confidence, and decrease their anxiety. There is evidence that simulated learning environments can replace a portion of a full-time 4-week clinical rotation without impairing learning. Conclusions: Simulation-based learning activities are being effectively incorporated into PT curricula. More rigorously designed experimental studies that include a cost–benefit analysis are necessary to help curriculum developers make informed choices in curriculum design.