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Educating surgeons is a time‐consuming process. In addition to theoretical knowledge, the practical tasks of surgical procedures must be mastered. Translation of such knowledge from mentor to mentee may be efficiently done by surgical telementoring (ST). This is a review on surgical telementoring. Recent technological advances have made this tool in surgical education more available and applicable but future applications of ST have to be wisely guided by high‐quality trials.

BACKGROUND AND OBJECTIVES Hospitals prepare for emergencies, but the impact on transfusion staff is rarely discussed. We describe the transfusion response to four major incidents (MIs) during a 6-month period. Three events were due to terrorist attacks, and the fourth was the Grenfell Tower fire. The aim of this paper was to share the practical lessons identified. METHODS This was a retrospective review of four MIs in 2017 using patient administration systems, MI documentation and post-incident debriefs. Blood issue, usage and adverse events during the four activation periods were identified using the Laboratory Information Management System (TelePath). RESULTS Thirty-four patients were admitted (18 P1, 4 P2, 11 P3 and 1 dead). Forty-five blood samples were received: 24 related to nine MI P1 patients. Four P1s received blood components, three with trauma and one with burns, and 35 components were issued. Total components used were six red blood cells (RBC), six fresh frozen plasma (FFP) and two cryoprecipitate pools. Early lessons identified included sample labelling errors (4/24). Errors resolved following the deployment of transfusion staff within the emergency department. Components were over-ordered, leading to time-expiry wastage of platelets. Careful staff management ensured continuity of transfusion services beyond the immediate response period. Debriefing sessions provided staff with support and enabled lessons to be shared. CONCLUSIONS Transfusion teams were involved in repeated incidents. The demand for blood was minimal. Workload was related to sample handling rather than component issue. A shared situational awareness would improve stock management. A laboratory debriefing system offered valuable feedback for service improvement, staff training and support.

Introduction The aim of this teaching review was to obtain feedback from graduates of the Orthodontic Therapy course from the School of Dental Science, Trinity College Dublin, which was established in 2014. Materials and methods A focus group, comprising of one to two graduates from each of the five years of the orthodontic therapy course, convened to obtain feedback. Thematic analysis was used to analyse the feedback transcribed from the focus group. Results Multiple themes emerged including enthusiasm, commitment, educational support, peer support and satisfaction. The graduates found the course challenging but very rewarding, helped by support from the university, mentors and peers. Satisfaction was very high from all participants with 100% reporting they would recommend the course. Suggestions emerged regarding the delivery of specific didactic components of the course and increased engagement with the specialist orthodontic mentors to ensure teaching is standardised for all trainees. Conclusion The course is rated very highly by the graduates and completion of this training has had a positive impact on their job satisfaction. Members of the focus group provided constructive feedback on the delivery of the course, which will contribute to its refinement for future trainees.

BACKGROUND Chairside teaching is one of the teaching-learning methods in clinical dental education in which direct care is provided to patients. When students have been deemed competent in carrying out procedures on a dental phantom, they need clinical experience on patients, with guidance and constructive feedback from clinical teachers. Constructive feedback is an important learning platform in helping students analyse the strong and the weak aspects of their performance in order to identify required improvements. This study aimed to explore the practice of giving constructive feedback in chairside teaching. METHOD A qualitative method with a case study design. Data were collected through in-depth interviews and focus group discussions (FGDs) with clinical teachers and students in clinical rotation. Data triangulation was carried out by observing the practice of giving constructive feedback in chairside teaching and document analysis from January to April 2019. Results of the in-depth interviews and FGDs were transcribed verbatim and analysed using a thematic analysis approach. RESULT In-depth interviews with five programme coordinators and FGDs with two groups of clinical teachers (N = 8 and N = 6) and two clinical student groups (N = 8 each). Three main themes emerged in this study: ways to provide feedback, challenges on feedback provision and challenges on feedback follow-up. CONCLUSION Differences in perception between clinical teachers and students were identified, influenced by students' interactions with the learning environment. Interventions are to be encouraged that involve teachers, students and institutions, and the interactions amongst the three.

Purpose The study investigators hypothesized that Point of Care Ultrasound (POCUS) training through bolus didactic and workshop experiences may be sufficient for trainees to learn the cognitive aspects, while an extended period of exposure with formative feedback is responsible for developing the psychomotor skills critical for POCUS. Methods The investigators studied trainees over the course of an academic year. They compared trainees' performance on written (cognitive) and observed image acquisition (psychomotor) exams at baseline and at each subsequent quarter, using a stepped-wedge design. They performed linear regression analysis to determine which variables contributed to knowledge and psychomotor skill development. Results Twenty-six trainees met the study requirements and participated in the POCUS curriculum. Participating in a POCUS rotation was consistently associated with an increase in psychomotor scores. There was no consistent variable to predict an increase in trainee's score on written knowledge assessments. Conclusions Extended exposure to POCUS over a 4-week rotation with direct and indirect formative feedback can explain difference in scores on psychomotor skills assessments. Trainees scored similarly on the written assessment with or without a POCUS rotation. Training through didactic and workshop experiences may be sufficient to learn the cognitive aspects, but not psychomotor skills required for POCUS.

Objective To evaluate the impact of an immediate ultrasound feedback intervention on trainee accuracy in vaginal-examination-based assessment of fetal head position. Methods This was a prospective cohort study conducted at a single tertiary care center. Six third-year and six fourth-year residents in an obstetrics and gynecology residency training program were the study subjects. The third-year residents underwent a training intervention in which they assessed fetal head position by transvaginal digital examination and then received immediate feedback through ultrasound demonstration of the actual position. All examinations were performed in women with a singleton gestation ≥ 35 weeks and cervical dilation ≥ 8 cm, following rupture of membranes. The comparison groups were third-year residents before, during and after training and fourth-year residents who were not exposed to the training intervention. The primary outcome was the difference in accuracy of fetal-head-position assessment on vaginal examination by third-year residents before and after ultrasound feedback training. Univariate and multivariate analyses were performed to identify factors associated with digital examination accuracy. Results Overall, 390 examinations were performed. The accuracy of fetal-head-position assessments of third-year residents was 55% (53/96) before training, 65% (74/114) during training and 70% (63/90) after training, while that of fourth-year residents who did not undergo training was 52% (47/90) (P = 0.04). Fourth-year residents who did not undergo ultrasound training demonstrated similar baseline accuracy to that of third-year residents pretraining (52% (47/90) vs 55% (53/96), P = 0.68), but had significantly lower accuracy than had the third-year residents post-training (52% (47/90) vs 70% (63/90); P = 0.01). Multivariable analysis revealed a positive association between ultrasound feedback training and the ability to assess accurately fetal head position. After adjusting for the variables included in the final model, examinations performed by third-year residents pretraining and those performed by fourth-year residents who did not undergo training were less likely to be accurate than those performed by third-year residents post-training (adjusted odds ratio, 0.48 (95% CI, 0.26-0.91) and 0.42 (95% CI, 0.22-0.80), respectively). Conclusion Immediate ultrasound feedback training increased trainee accuracy in vaginal assessment of fetal head position in labor. Its integration into obstetric training programs should be considered. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Several studies have examined the efficacy of behavior analytic coaching strategies in sports to increase performance fluency. Rock climbing is a multifaceted sport requiring mastery of several complex behavior chains in order to successfully navigate climbing surfaces. To date, most investigations have focused on the physiological aspects of rock climbing, as opposed to training specific rock-climbing movements. In this replication and extension, researchers used a multiple baseline design across skills to examine an expert video modeling plus video and verbal feedback training package on foundational rock-climbing skills of novice adult climbers. Results demonstrated that all participants showed an increase in accurate performance for all three skills that were targeted in the intervention.

BACKGROUND: It is widely accepted that the therapeutic alliance (TA) is a mediator of psychotherapy effects, but evidence is sparse that the TA is an actual mechanism of behavior change. The purpose of this study was to provide the first systematic evidence regarding the TA as a mechanism of change in the treatment of alcohol use disorder (AUD). METHODS: Participants were 155 adult men and women presenting for individual outpatient treatment of AUD. Each was randomly assigned to one of 6 experienced therapists, who did or did not receive over 3 study phases post-session participant feedback on his/her ratings of the TA. All participants received a 12-session version of cognitive behavioral therapy for AUD. Participants rated the TA by use of the California Psychotherapy Alliance Scale (CALPAS) and reported their daily alcohol consumption between-sessions and for one year post-treatment by use of the Timeline Followback Interview. Multilevel statistical models that partitioned within- and between-participant effects and between-therapist effects were run to test the effects of feedback condition on the alliance and alcohol use, and the effects of the alliance on alcohol use. RESULTS: The study’s main hypotheses that feedback causes an enhanced therapeutic alliance, and that the alliance is associated with better alcohol use outcomes, were not supported. CONCLUSIONS: Several methodological and substantive reasons for the pattern of findings are suggested, as well as directions for future research that would advance study of the TA as a mechanism of change in psychotherapy and in studying therapist effects on outcomes in general.

BACKGROUND: Although it has been traditionally assumed that dysregulation of psychological processes in smokers results from activity within specific brain regions, an emerging view regards such dysregulation as attributable to aberrant communication between distinct brain regions. These processes can be measured during appropriate task paradigms such as the learning from errors task. This study aims to elucidate interactions between brain regions underlying the process of learning from errors, punishment and sensitivity to reward in dependent smokers. METHODS: Functional MRI data from 23 age-matched dependent smokers (8 females, mean age = 25.48, SD = 4.46) and 23 controls (13 females, mean age = 24.83, SD = 5.99) were analysed during a feedback-based associative learning task. Functional connectivity between the dorsal anterior cingulate cortex, nucleus accumbens and reward/sensorimotor areas was investigated during a feedback learning task. RESULTS: Behaviourally, smokers exhibited lower error correction rates and were less sensitive to punishment magnitude. Smokers showed increased functional connectivity between dorsal anterior cingulate cortex/nucleus accumbens seed regions and numerous reward-related target regions including the putamen, anterior cingulate and orbitofrontal cortex. CONCLUSIONS: Reduced learning from errors and widespread aberrant functional connectivity contribute to the emerging functional characterisation of dependent smokers and may bear significant implications when considering the efficacy of smoking interventions.

Visual perception involves the rapid formation of a coarse image representation at the onset of visual processing, which is iteratively refined by late computational processes. These early versus late time windows approximately map onto feedforward and feedback processes, respectively. State-of-the-art convolutional neural networks, the main engine behind recent machine vision successes, are feedforward architectures. Their successes and limitations provide critical information regarding which visual tasks can be solved by purely feedforward processes and which require feedback mechanisms. We provide an overview of recent work in cognitive neuroscience and machine vision which highlights the possible role of feedback processes for both visual recognition and beyond. We conclude by discussing important open questions for future research.

Background Training in clinical medicine involves exposure to complex ethical and emotional situations. Reflection aids in the development of personal belief systems and improves self-awareness. Students may be reluctant to participate when reflection is mandatory and may be concerned about retaliation when the facilitator has a role in evaluations. Near-peers are institutional equals with more experience than the participants and may be well suited to facilitate reflection. Methods A quarterly near-peer-facilitated reflective writing workshop (RWW) was implemented in the mandatory clinical curriculum at a single institution. Qualitative feedback forms were solicited and were analysed through an iterative and inductive consensus process. An end-of-year web-based survey was distributed to test the hypotheses generated from our analysis of the feedback forms. Results There were 82 responses (80%) to the web-based survey and 266 (65%) feedback forms were collected. Although few students reported using writing as a coping mechanism, the RWW was viewed favourably, with 62% indicating that they would attend if optional. The structured prompts aided reflection. Students reported a higher likelihood of discussing difficult topics (doubts about medicine as a career, personal shortcomings, harassment and burnout) in sessions led by a near-peer than by a faculty member. The workshop created a safe space to reflect, increased a sense of camaraderie and helped normalise experiences. [The workshop] humanised the clinical experience, gave new perspective and reminded students of their positive personal accomplishments DISCUSSION: The near-peer-facilitated RWW is a novel intervention aimed at developing reflective practice and coping with the challenges of entering clinical medicine. It is highly structured and has been incorporated into the mandatory curriculum. It was well received by students, is generalisable and is easily implementable.

Background Doctors are at an increased risk of suicide compared with the general population, and there is a current lack of formal education on suicide prevention for peers and colleagues. This educational project aimed to increase suicide awareness for medical students through simulation. Methods A simulation scenario was designed centred around a junior doctor (a qualified doctor who has not yet completed specialist postgraduate training) disclosing thoughts of suicide. The scenario and debriefing were designed using learning objectives and constructive alignment theory. Senior medical students participated in the scenario, which was followed by a facilitated debriefing and the provision of a framework for discussing suicide with a colleague. Quantitative and qualitative student feedback was collected and analysed. A simulation scenario was designed centred around a junior doctor colleague found distressed at work and disclosing thoughts of suicide RESULTS: A total of 35 students participated in the simulation over six sessions. Feedback indicated that students felt this subject was important and that the learning objectives had been achieved. Discussion This simulation scenario focusing on suicide awareness for senior medical students has provided opportunity for open discussion and reflection on the topic and has increased the awareness and understanding of suicidality in colleagues. This is one step in the direction of preventing further deaths by suicide in health professionals.

Summary Background Building financial management capacity is increasingly important in low‐ and middle‐income countries to help communities take ownership of development activities. Yet, many community members lack financial knowledge and skills. Methods We designed and conducted financial management trainings for 83 members from 10 community groups in rural Zambia. We conducted pre‐training and post‐training tests and elicited participant feedback. We conducted 28 in‐depth interviews over 18 months and reviewed financial records to assess practical application of skills. Results The training significantly improved knowledge of financial concepts, especially among participants with secondary education. Participants appreciated exercises to contextualize financial concepts within daily life and liked opportunities to learn from peers in small groups. Language barriers were a particular challenge. After trainings, sites successfully adhered to the principles of financial management, discussing the benefits they experienced from practicing accountability, transparency, and accurate recordkeeping. Conclusion Financial management trainings need to be tailored to the background and education level of participants. Trainings should relate financial concepts to more tangible applications and provide time for active learning. On‐site mentorship should be considered for a considerable time. This training approach could be used in similar settings to improve community oversight of resources intended to strengthen developmental initiatives.

Although reviewing dental students' clinical competency assessments is an important aspect of instruction, finding time to give individual feedback to each student poses a challenge for faculty members, and some students may prefer to receive feedback from a peer. The aim of this study was to explore dental students' perceived value of feedback on their performance in a simulated patient care activity from either a faculty member or a peer. Participants were third- and fourth-year dental students who had completed two years of interprofessional instruction and a videotaped objective structured clinical examination (OSCE) with standardized patients. Participants in two cohorts were randomly assigned to a faculty or peer feedback group. Cohort one (2015-16) consisted of 66 students: 21 in faculty-led groups, and 45 in peer-led groups. Cohort two (2017) consisted of 60 students: 17 in faculty-led groups, and 43 in peer-led groups. In both types of pairings, the protocol consisted of jointly observing a video recording of student performance in the simulated patient encounter and discussing questions about the student's performance in non-technical competencies such as communication, patient safety, scope of practice, and conflict resolution. For cohort two, prior to the feedback sessions, students in the peer feedback groups received a 60-minute training on providing constructive feedback. All 126 students in the two cohorts completed an evaluation questionnaire after the experience. The results showed that students in both types of feedback sessions perceived value in the feedback and believed it enhanced their skills. However, students rated faculty feedback significantly higher (p

Background The established medical hierarchy, dramatic expansion of scientific knowledge and emphasis on value-based health care means that graduating physicians need to know how to manage and lead positive change. There is a critical gap in the teaching of these skills in undergraduate medical education. Methods Our medical school developed a first-year medical student competency-based leadership curriculum that focused on: leading yourself; teams and teamwork; influence and communication; problem solving; and systems thinking. The course used four methods of teaching leadership: experiential learning; targeted development; reflection; and feedback. The formal curriculum included topics such as developing a leadership agenda, challenging conversations and negotiations. The informal curriculum (learning outside of the structured curriculum) included applying leadership in co-curricular and extracurricular activities (e.g. in a student-run free clinic). Students recorded leadership experiences using a novel reflective assessment tool, obtained multi-source feedback and then articulated a plan for improvement. Results Course evaluations noted that only one-third of first-year students responded that the curriculum developed skills in communication, and the ability to problem-solve, apply systems thinking and build teams. Students self-reported that they were often building, leading and managing productive teams, and applying influence and communication. The multi-source feedback assessment revealed that students, on average, were rated as competent to proficient. Discussion Creating a robust curriculum for medical students in the first year is challenging. Student reactions ranged from affirming to critical. The next steps will focus on increasing interactive teaching and on helping students understand why, where and how leadership is important.

BACKGROUND Patient education videos are an effective medium of communication to improve patient knowledge. Developing patient-centered communication requires a reflection on the social dynamics and economic realities of patients, aspects that are essential for the professional development of students, but often not overtly present in the curriculum. We tasked medical students to develop patient education videos and were interested in their experience of the process, including how this medium facilitated reflection on health care in the country. METHODS Groups of students conceptualised and then made a 2-minute video educating patients on pharmacotherapy, aimed at the layperson. We adapted an existing tool for developing and assessing public communication material to design a marking rubric, and collected student feedback. RESULTS Students conveyed universal factual therapeutic information in a uniquely South African context, using depictions that patients could relate to, and framed the information within the social circumstances of patients. The videos addressed various therapeutic topics, including some not covered in the module, and demonstrated that students were able to apply classroom knowledge in the health care environment. Students relayed complex concepts through visually innovative and easy-to-understand ways. Students conveyed universal factual therapeutic information in a uniquely South African context DISCUSSION: Health care practitioners should be responsive to the needs of their patients, which demands a sensitivity to local imperatives, social dynamics and economic realities. Although the principles of patient-centredness are taught in the curriculum, the depth of understanding evident in the videos demonstrated emergent learning from the hidden curriculum. Students can be architects of their own learning in creative and meaningful ways.

Creating an optimal clinical learning environment poses a challenge to health professions educators. To evaluate and improve the clinical learning environment, it is necessary to understand students' experiences of their environment and the factors they perceive as having an impact on their learning. The aim of this explorative qualitative study was to examine University of Otago Faculty of Dentistry students' perceptions of their clinical learning environment to gain insights into how learning outcomes could be enhanced. In 2015, all approximately 600 students at all levels of the Bachelor of Oral Health and Bachelor of Dental Surgery degrees at the University of Otago, Dunedin, New Zealand, were invited to participate in focus groups. Focus groups facilitated by the faculty education research fellow and another researcher employed for the project were conducted during the second half of the academic year. Transcribed data were analyzed using a general inductive approach. Twenty-one students from all levels of the two programs attended one of six confidential focus groups. Three broad themes were evident in the results from all groups: feedback processes, assessments and grading, and tutor interactions. In the focus groups, students expressed dissatisfaction regarding current feedback practices, types of feedback to benefit learning, consistency in the grading system, and impact of different educators' teaching styles on learning. These results indicated a need for further research and curricular efforts to promote good student-teacher relationships in the clinical learning environment, which are paramount for creating an optimal teaching and learning environment and enhancing student outcomes.

Introduction Progress testing is a special form of longitudinal and feedback‐oriented assessment. Even though well established in human medical curricula, this is not the case in dental education. The aim was the prospective development and implementation of the first reported German‐language Dental Progress Test (DPT) for the undergraduate dental curriculum at the Medical University of Graz, Austria. Material and methods Participation in DPT was compulsory for all dental students in terms 7‐12 (years 4‐6). Three tests, each consisting of 100 items out of a pool of 375, were administered within 3 consecutive terms in 2016 and 2017. Rasch analyses were used to evaluate the questionnaire and identify misfitting items. Results In the item responses, 59.7% were “correct,” 27.0% were “false” and 13.3% were answered with “don't know,” with similar results at all 3 time points. The assumption of parallel ICC was met (T1: χ2 = 51.071, df = 74, P = .981; T2: χ2 = 57.044, df = 67, P = .802; T3: χ2 = 58.443, df = 72, P = .876) and item difficulties for the thematic fields were similarly distributed across the latent dimensions. Conclusion The newly introduced DPT is appropriate for testing dental students and is well balanced for the tested target group.

BACKGROUND: Emerging adulthood is a period of heightened vulnerability for problematic alcohol use. Considerable research has been devoted to reducing alcohol risks in college student populations, though far less effort has focused on their noncollege-attending peers. Research targeting nonstudent emerging adults is critical as this group is at risk for experiencing alcohol-related harms. Consequently, the main objective of the present randomized study was to examine the preliminary efficacy of a brief personalized feedback intervention (PFI) tailored for nonstudent at-risk drinkers. We also examined the influence of gender on intervention outcomes. Finally, we explored participant acceptability of the intervention. METHODS: Participants were 164 (65.9% men) emerging adults (M age = 21.98, SD = 2.02) recruited from the community. They were randomly assigned to either a 50-minute, in-person PFI or an assessment-only control group and were assessed over 9 months post-intervention. RESULTS: Results showed that for short-term change (1-month), the PFI condition reduced drinking significantly more than controls. For longer-term change (1-month to 9-month), both conditions continued to show gradual decline in consumption. The groups did not differ in alcohol-related problems and the intervention was equally effective for both women and men. Regarding acceptability, participants were extremely satisfied with the intervention, perceived the information to be personally relevant, and thought it provided them a new way of looking at their own drinking. CONCLUSIONS: Overall, the present research advanced knowledge regarding an understudied and at-risk group of drinkers. This is among one of the first randomized study to evaluate a brief intervention tailored to the needs of nonstudent emerging adults based on prior formative research with this group. Our data supports PFI as a promising intervention approach for nonstudent drinkers in the community. Ultimately, this line of research aims to reduce alcohol-related health disparities associated with inequities in education.

Aim To evaluate the effectiveness of clinical audit-feedback cycle as an educational tool in improving the technical quality of root canal therapy (RCT) and compliance with record keeping performed by dental undergraduates. Methods Clinical audit learning was introduced in Year 3 of a 5-year curriculum for dental undergraduates. During classroom activities, students were briefed on clinical audit, selected their audit topics in groups of 5 or 6 students, and prepared and presented their audit protocols. One chosen topic was RCT, in which 3 different cohorts of Year 3 students conducted retrospective audits of patients' records in 2012, 2014 and 2015 for their compliance with recommended record keeping criteria and their performance in RCT. Students were trained by and calibrated against an endodontist (κ ≥ 0.8). After each audit, the findings were reported in class, and recommendations were made for improvement in performance of RCT and record keeping. Students' compliance with published guidelines was presented and their RCT performances in each year were compared using the chi-square test. Results Overall compliance with of record keeping guidelines was 44.1% in 2012, 79.6% in 2014 and 94.6% in 2015 (P = .001). In the 2012 audit, acceptable extension, condensation and the absence of mishap were observed in 72.4, 75.7% and 91.5%; in the 2014 audit, 95.1%, 64.8% and 51.4%; and in 2015 audit, 96.4%, 82.1% and 92.8% of cases, respectively. In 2015, 76.8% of root canal fillings met all 3 technical quality criteria when compared to 48.6% in 2014 and 44.7% in 2012 (P = .001). Conclusion Clinical audit-feedback cycle is an effective educational tool for improving dental undergraduates' compliance with record keeping and performance in the technical quality of RCT.

Objectives Although trainees and trainers find feedback interactions beneficial, difficulties in giving and receiving feedback are reported. Few studies have explored what drives trainees to seek feedback. This study explores how workplace-based assessments (WBAs) influence the ways surgical trainees seek feedback and feedback interactions. Methods Utilising a template analysis approach, we conducted 10 focus groups with 42 surgical trainees from four regions across the UK. Data were independently coded by three researchers, incorporating three a priori themes identified from a previous quantitative study. Further themes emerged from exploration of these data. The final template, agreed by the three researchers, was applied to all focus group transcripts. The themes were linked in a diagrammatical form to allow critical exploration of the data. Results Trainees’ perceptions of the purpose of WBA for learning or an assessment of learning, and their relationship with their trainer impacted upon how trainees chose to use WBA. Perceiving WBA as a test led trainees to ‘play the game’: seek positive and avoid negative feedback through WBA. Perceiving WBA as a chance to learn led trainees to seek negative feedback. Some trainees sought negative feedback outside WBA. Negative feedback was more important for changing practice compared with positive feedback, which enabled trainees to ‘look good’ but had less of an effect on changing clinical practice. The timing of feedback relative to WBA was also important, with immediate feedback being more beneficial for learning; however, delayed feedback was still sought using WBA. Discussion Trainees’ perceptions of the purpose of WBA and their relationship with their trainer informed when they chose to seek feedback. Trainees who perceived WBA as a test were led to ‘play the game’ by seeking positive and avoiding negative feedback. Outside of WBA, trainees sought negative feedback, which was most important for change in practice.

Title A qualitative study to explore the issues for patients and students when giving feedback on the communication of dental students. Objectives The Department of Health and National Institute for Health Research are committed to involving patients in improving clinical education, research and service delivery. Yet, there is a limited body of evidence on the perceptions of patients when asked to be involved in this way, and specifically when asked to provide feedback on the communication skills of dental students. This study seeks to address this gap and heighten the understanding of the issues faced by patients when asked to be involved in clinical education. Methods Data were collected using focus groups with dental students (n=10) and patients (n=8) being treated by these students. Both groups were asked about their thoughts, feelings and beliefs about patients being asked to provide feedback on the communication skills of dental students. Data analysis involved inductive thematic analysis of transcribed audio recordings. Results Four themes emerged from the data: “legitimacy,” “co-educators,” “maintaining the equilibrium of the patient-student relationship” and the “timing of patient feedback.” Support for involving patients in giving feedback on students’ communication skills was established, with patients considering they were best placed to comment on the communication skills of dental students. Patients and students do not want to provide feedback alone and want support to assist them, especially if feedback was negative. Issues of anonymity, confidentiality and ownership of the feedback process were worrisome, and the positioning of patient feedback in the programme was seen as critical. Conclusions Patients and students are willing to engage in patient feedback on students’ communication skills, and with support and training, the concerns around this are not insurmountable and the benefits could potentially profit both groups. These findings have resonance with other healthcare educators when using patients as educators in the development of communication skills.

Aim The aim of this study was to test the mediating role of the satisfaction of dental students' basic psychological needs of autonomy, competence and relatedness on the association between learning climate, feedback and student motivation. The latter was based on the self-determination theory's concepts of differentiation of autonomous motivation, controlled motivation and amotivation. Methods A cross-sectional correlational study was conducted where 924 students completed self-reported questionnaires measuring motivation, perception of the learning climate, feedback and basic psychological needs satisfaction. Descriptive statistics, Cronbach's alpha scores and bivariate correlations were computed. Mediation of basic needs on each predictor-outcome association was tested based on a series of regression analyses. Finally, all variables were integrated into one structural equation model, controlling for the effects of age, gender and year of study. Results Cronbach's alpha scores were acceptable (.655 to .905). Correlation analyses showed positive and significant associations between both an autonomy-supportive learning climate and the quantity and quality of feedback received, and students' autonomous motivation, which decreased and became negative when correlated with controlled motivation and amotivation, respectively. Regression analyses revealed that these associations were indirect and mediated by how these predictors satisfied students' basic psychological needs. These results were corroborated by the structural equation analysis, in which data fit the model well and regression paths were in the expected direction. Conclusion An autonomy-supportive learning climate and the quantity and quality of feedback were positive predictors of students' autonomous motivation and negative predictors of amotivation. However, this was an indirect association mediated by the satisfaction of students' basic psychological needs. Consequently, supporting students' needs of autonomy, competence and relatedness might lead to optimal types of motivation, which has an important influence on dental education.

SummaryBackground Most doctors are not observed in the actual practice of medicine after they complete training. Direct observation and feedback are seen as invaluable in learning in most other professions, at formative stages of medical training and in other aspects of academic medicine, yet are not performed at the level of the independently practicing clinician. Creating an opportunity for faculty member development based on observation of clinical practice is needed for continued growth and competence as a clinician. Methods Independently practicing clinicians within our practice volunteered to both observe and be observed by a colleague in clinical practice, and then both give and receive feedback. Pairs of clinicians with similar experience levels were created. The person being observed set the ground rules for feedback to promote a safe environment. Results Most respondents found both observing and being observed useful, comfortable experiences, which were better than most other continuing professional development (CPD) initiatives. Both observing and being observed seemed to lead to reflection on practice and a change in practice by most participants. Most respondents would like to participate again. Both observing and being observed seemed to lead to reflection on practice Discussion Next steps include expanding the programme within our group and to other departments within our institution. There is potential to use this programme as a model for CPD credit. An intradepartmental programme in which participants receive CPD credit for the observation of their practice of medicine could meet the primary goal of CPD, ensuring doctors are competent and continue to develop in an efficient, meaningful and cost-effective way.

We replicated and extended previous research on the use of auditory feedback to decrease toe walking exhibited by 3 children with autism. After pretreatment screening analyses suggested that toe walking occurred independent of social consequences, we attached squeakers to the heels of each participants' shoes. The squeakers provided auditory feedback when participants walked appropriately (i.e., with a heel-to-toe gait). For all participants, the auditory feedback itself produced increases in appropriate walking. For 1 participant, this feedback was sufficient to reduce toe walking to clinically acceptable levels; however, for 2 other participants, delivery of edible items paired with the auditory feedback was necessary. Intervention effects maintained when the schedule for edible delivery was thinned for all participants. In addition, for 2 participants, effects maintained when the intervention was implemented in a different setting and with a different person with no edibles or a thin schedule of edibles.

Belief updating entails the incorporation of new information about the environment into internal models of the world. Bayesian inference is the statistically optimal strategy for performing belief updating in the presence of uncertainty. An important open question is whether the use of cognitive strategies that implement Bayesian inference is dependent upon motivational state and, if so, how this is reflected in electrophysiological signatures of belief updating in the brain. Here, we recorded the EEG of participants performing a simple reward learning task with both monetary and nonmonetary instructive feedback conditions. Our aim was to distinguish the influence of the rewarding properties of feedback on belief updating from the information content of the feedback itself. A Bayesian updating model allowed us to quantify different aspects of belief updating across trials, including the size of belief updates and the uncertainty of beliefs. Faster learning rates were observed in the monetary feedback condition compared to the instructive feedback condition, while belief updates were generally larger, and belief uncertainty smaller, with monetary compared to instructive feedback. Larger amplitudes in the monetary feedback condition were found for three ERP components: the P3a, the feedback-related negativity, and the late positive potential. These findings suggest that motivational state influences inference strategies in reward learning, and this is reflected in the electrophysiological correlates of belief updating.

Background Action plans have been shown to be important in changing behaviour. In learners, action plans have been proposed as a mechanism by which feedback leads to an increase in expertise: feedback leads to action plans, which lead to changes in learning behaviours and finally to improvement. Little is known about the extent to which students are able to make specific actions plans that relate to the feedback they are given, however. We explored whether medical students created action plans after being given feedback, the quality of those plans and whether the action plans were related to the feedback given. Action plans have been shown to be important in changing behaviour METHODS: We collected data from a communication session for Year-1 medical students on the feedback they were given and the action plans they made for improvement. Results Most students (185/196, 94%) made one or more action plans, but only 31/196 (16%) made one or more action plans that were directly related to the feedback given to them. Conclusions Although educators may include action planning in education, students are not making specific enough action plans to effect change. Future work should include support for students in making better-quality action plans. …students are not making specific enough action plans to effect change.

Current literature on feedback suggests that clinical preceptors lead feedback conversations that are primarily unidirectional, from preceptor to student. While this approach may promote clinical competency, it does not actively develop students' competency in facilitating feedback discussions and providing feedback across power differentials (ie, from student to preceptor). This latter competency warrants particular attention given its fundamental role in effective health care team communication and its related influence on patient safety. Reframing the feedback process as collaborative and bidirectional, where both preceptors and students provide and receive feedback, maximizes opportunities for role modeling and skills practice in the context of a supportive relationship, thereby enhancing team preparedness. We describe an initiative to introduce these fundamental skills of collaborative, bidirectional feedback in the nurse-midwifery education program at the University of California, San Francisco.

Context It has long been understood that assessment is an important driver for learning. However, recently, there has been growing recognition that this powerful driving force of assessment has the potential to undermine curricular efforts. When the focus of assessment is to categorise learners into competent or not (i.e. assessment of learning), rather than being a tool to promote continuous learning (i.e. assessment for learning), there may be unintended consequences that ultimately hinder learning. In response, there has been a movement toward constructing assessment not only as a measurement problem, but also as an instructional design problem, and exploring more programmatic models of assessment across the curriculum. Progress testing is one form of assessment that has been introduced, in part, to attempt to address these concerns. However, in order for any assessment tool to be successful in promoting learning, careful consideration must be given to its implementation. Objective The purpose of this paper is to consider the implications of implementing progress testing within practice, and how this might promote or impede learning in the three phases of assessment (pre-test, pure-test and post-test). Methods We will examine the literature on how assessment drives learning and how this might apply to progress testing. We will also explore the distinction between assessment of learning and assessment for learning, including ways in which they overlap and differ. We end by discussing how the properties of an assessment tool can be harnessed to optimise learning. Conclusions Progress tests are one potential solution to the problem of removing (or at least lessening) the sting associated with assessment. If implemented with careful thought and consideration, progress tests can be used to support the type of deep, meaningful and continuous learning that we are trying to instill in our learners.

Context Clinical reasoning is an essential skill, the foundations of which should be acquired during undergraduate medical education. Student performance in clinical reasoning can be assessed using key feature examinations. However, within a paradigm of test-enhanced learning, such examinations may also be used to enhance long-term retention of procedural knowledge relevant to clinical reasoning. Objectives This study tested the hypothesis that repeated testing with key feature questions is more effective than repeated case-based learning in fostering clinical reasoning. Methods In this randomised crossover trial, Year 4 medical students attended 10 weekly computer-based seminars during which patient case histories covering general medical conditions were displayed. The presentation format was switched between groups every week. In the control condition, students studied long case narratives. The intervention condition used the same content but augmented case presentation with a sequence of key feature questions. Using a within-subjects design, student performance on intervention and control items was assessed at 13 weeks (exit examination) and 9 months (retention test) after the first day of term. Results A total of 87 of 124 eligible students provided complete data for the longitudinal analysis (response rate: 70.2%). In the retention test, mean ± standard deviation student scores on intervention items were significantly higher than those on control items (56.0 ± 25.8% versus 48.8 ± 24.7%; p

SummaryBackground Natural disasters strike communities that have varied degrees of preparedness, both physical and psychological. Rural communities may be particularly vulnerable as they often do not have the infrastructure or resources to prepare in advance. The psychological impact of a natural disaster is amplified in learners who may be temporary members of the community and therefore cannot draw on personal support during the crisis. They may turn to their clinical preceptors for guidance. Context The Slave Lake fire (population 6782) in May 2011 and the High River flood (population 12 920) in June 2013 are examples of natural disasters that have occurred in rural Alberta, Canada. At the time of these critical incidents, three medical students and one family medicine resident from the two provincial medical schools were participating in rotations in these communities. Innovation Although disasters occur rarely, there is a need for guidelines for preceptors from the learner perspective. Accordingly, using a modified Delphi approach, we captured the experiences of learners that were then refined into two themes, each containing three recommendations: considerations for action during a natural disaster and considerations for action after the acute crisis has passed. Although disasters occur rarely, there is a need for guidelines for preceptors from the learner perspective Implications Our recommendations provide suggestions for practical solutions that build on the usual expectations of mentors and may benefit the student–teacher relationship at the time of a disaster and beyond. They are meant to initiate discussion regarding further study aimed towards creating recommendations for preceptor response that may cross disciplines.

Introduction Peer assessment and feedback is encouraged to enhance students' learning. The aim of this study was to quantitatively and qualitatively analyse pre-clinical and clinical dental students' written peer feedback provided as part of a continuous, formative and structured peer assessment protocol. Materials and methods A total of 309 Year-2 and Year-5 dental students were invited to participate in a peer assessment and peer feedback protocol. Consenting volunteer students were trained to observe each other whilst working in the skills laboratory (Year-2) and in the dental clinic (Year-5). Subsequently, they followed a structured protocol of peer assessment and peer feedback using specially designed work-based forms during a complete academic year. The content of their written feedback was coded according to the UK General Dental Council domain, sign (positive or negative), specificity (task specific or general), and grouped into themes. Results A total of 108 participants (40 Year-2 and 68 Year-5) completed 1169 peer assessment work-based forms (516 pre-clinical and 653 clinical); 94% contained written feedback. The large majority (82%) of Year-2 feedback represented the clinical domain, 89% were positive, 77% were task specific, and they were grouped into 14 themes. Year-5 feedback was related mostly to Management and Leadership (37%) and Communication (32%), 64% were positive, 75% task specific, and they were clustered into 24 themes. Discussion The content of the feedback showed notable differences between Year-2 and Year-5 students. Senior students focused more on Communication and Management and Leadership skills, whilst juniors were more concerned with clinical skills. Year-5 students provided 13% negative feedback compared to only 2% from Year-2. Regulatory focus theory is discussed to explain these differences. Both groups provided peer feedback on a wide and different range of themes. However, four themes emerged in both groups: efficiency, infection control, time management and working speed. Conclusion A structured peer assessment framework can be used to guide pre-clinical and clinical students to provide peer feedback focused on different domains, and on contrasting signs and specificities. It can also present an opportunity to complement tutors' feedback.

Summary Background The use of simulated patients (SPs) within undergraduate medical curricula is an established and valued learning opportunity. Within the context of simulation, it is imperative to capture feedback from all participants within the simulation activity. The Simulated Patient Candidate Evaluation (SPaCE) tool was developed to deliver SP feedback following a simulation activity. SpaCE is a closed feedback tool that allows SPs to rate a student's performance, using a five-point Likert scale, in three domains: attitude; interaction skills; and management. This research study examined the value of the SPaCE tool and how it contributes to the overall feedback that a student receives. Methods Classical test theory was used to determine the reliability of the SPaCE tool. An evaluation of all SP responses was conducted to observe trends in scoring patterns for each question. Qualitative data were collected via a free-text questionnaire and subsequent focus group discussion. It is imperative to capture feedback from all participants within the simulation activity Results Classical test theory determined that the SPaCE tool had a reliability co-efficient of 0.89. A total of 13 SPs replied to the questionnaire. A thematic analysis of all questionnaire data identified that the SPaCE tool provides a structure that allows patient feedback to be given effectively following a simulation activity. These themes were discussed further with six SPs who attended the subsequent focus group session. Discussion The SPaCE tool has been shown to be a reliable closed feedback tool that allows SPs to discriminate between students, based on their performance. The next stage in the development of the SPaCE tool is to test the wider applicability of this feedback tool.

The aim of this study was to investigate if a videotaped feedback method enhanced teaching and learning outcomes in a preclinical operative laboratory setting for novice learners. In 2013, 60 dental students at a dental school in India were randomly assigned to two groups: control (n=30) and experimental (n=30). The control group prepared a Class II tooth preparation for amalgam after receiving a video demonstration of the exercise. The experimental group received the same video demonstration as the control group, but they also participated in a discussion and analysis of the control groups' videotaped performance and then performed the same exercise. The self-evaluation scores (SS) and examiner evaluation scores (ES) of the two groups were compared using the unpaired t-test. The experimental group also used a five-point Likert scale to rate each item on the feedback form. The means of SS (13.65±2.43) and ES (14.75±1.97) of the experimental group were statistically higher than the means of SS (11.55±2.09) and ES (11.60±1.82) of the control group. Most students in the experimental group perceived that this technique enhanced their learning experience. Within the limits of this study, the videotaped feedback using both ideal and non-ideal examples enhanced the students' performance.

Background Simulated patients (SPs) are often used in dietetics for the teaching and assessment of communication skills. The present study aimed to determine the impact of a SP encounter on communication skills in undergraduate preclinical dietetic students in the context of the resources required for delivering this educational strategy. Methods This observational study collected assessment data from four cohorts of third-year dietetic students to examine the effect of participation in SP-embedded Objective Structured Clinical Exams. Students completed two SP interviews, 2 weeks apart, and communication skills were measured on both occasions. A subgroup of students received a video of their SP encounter. Differences between the two SP interview scores were compared to assess the impact of the SP encounter on communication skills. The required staff and resources were described. Results Data were collected involving 215 students. Out of 30 marks, there was a modest mean (SD) improvement in communication skills from the first to the second SP interview of 2.5 (4.2) (P < 0.01). There was an association between student ability and improvement in communication skills, with failing students demonstrating the greatest improvement between SP encounters. There were no observed benefits for the subset of students who received videos. Conclusions Providing repeat SP interview opportunities results in only modest improvement in communication skills for most students. The use of SPs needs to be considered in context of the substantial costs and resources involved and tailored to student ability.

Aims To evaluate the effect of multifaceted interventions using the Achievable Benchmark of Care (ABC) method for improving the technical quality of diabetes care in primary care settings. Methods We conducted a 1‐year cluster randomized controlled trial in 22 regions divided into an intervention group (IG) or control group (CG). Physicians in the IG received a monthly report of their care quality, with the top 10% quality of diabetes care scores for all physicians being the achievable benchmark. The change in quality‐of‐care scores between the IG and CG during follow‐up was analysed using a generalized linear model considering clustering. Results A total of 2199 patients were included. Their mean (sd) age was 56.5 ± 5.9 years and the mean (sd) HbA1c level was 56.4 ± 13.3 mmol/mol (7.4 ± 1.2%). The quality‐of‐care score in the CG changed from 50.2%‐point at baseline to 51%‐point at 12 months, whereas the IG score changed from 49.9%‐point to 69.6%‐point, with statistically significant differences between the two groups during follow‐up [the effect of intervention was 19.0%‐point (95% confidence interval 16.7%‐ to 21.3%‐point; P < 0.001)]. Conclusions Multifaceted intervention, measuring quality‐of‐care indicators and providing feedback regarding the quality of diabetes care to physicians with ABC, was effective for improving the technical quality of care in patients with Type 2 diabetes in primary care settings. (Trial Registration: umin.ac.jp/ctr as UMIN000002186), What's new? The effect of the Achievable Benchmark of Care (ABC) method in improving the quality of care has not been extensively studied in the field of diabetes care.We evaluated the effect of multifaceted interventions using the ABC method to improve the technical quality of diabetes care in a prospective, cluster randomized controlled trial in primary care settings in Japan.This study provided information on the strategies for improving the technical quality of diabetes care in primary care settings.

Summary Background In longitudinal integrated clerkships (LICs), the continuous preceptor and student relationship over time creates opportunities for more in-depth teaching approaches than shorter preceptorships allow. We identify student perceptions of the most effective teaching practices and develop tips for LIC preceptors. Methods The first four third-year medical student classes completing the Asheville LIC of the University of North Carolina School of Medicine (UNC SOM) formed the subject group. Between June and August 2013, a trained research assistant (AS) conducted semi-structured interviews with all 27 UNC SOM Asheville LIC students. Interviews were transcribed and coded by thematic analysis. Results All 27 (100%) students participated in the interviews. We identified seven main themes of successful precepting practices: enhance teaching; create bring-backs (learning topics to bring back to preceptors); support patient ownership; structure clinic; improve feedback; engage learners; and develop a relationship. These themes were condensed into nine preceptor tips for teaching in LICs. Conclusions The longitudinal relationship of preceptor and student in LIC models affords specific, important opportunities for teaching and learning. The concise list of LIC preceptor tips can be used by preceptors to further optimise their teaching in the LIC setting. We identify student perceptions of the most effective teaching practices and develop tips for LIC preceptors

Summary Background In Serious Games (SGs), educational content is integrated into a game so that learning is intrinsic to play, thereby motivating players and improving engagement. SGs enable learning by developing situated understanding in users and by enabling players to practise safe clinical decision making; however, the use of SGs in medical education is not well established. Aims: We aimed to design a game-based resource to teach clinical decision making to medical students, and to assess user perceptions of educational value, usability and the role for SGs in undergraduate training. Methods An SG focusing on the acute management of tachyarrhythmias was developed. Third- and fourth-year medical students at the medical school were invited to use and evaluate the game using questionnaires and focus groups. Results We invited 479 students, and 281 accessed the game. Only 47 students completed the questionnaire and 31 students participated in the focus groups. The data suggest that SGs: (1) can allow students to rehearse taking responsibility for decision making; (2) are fun and motivational; (3) have a role in revising and consolidating knowledge; and (4) could be formative assessment tools. Serous Games enable learning by developing situated understanding in users Conclusions SGs could be employed as adjuvant learning resources to develop students’ skills and knowledge. Further empirical research is required to assess the added value of games in medical education.

SummaryBackground Medical trainees often do not receive structured teaching during in-patient rounds. Objective To assess whether the addition of a collaborative team learning technique would improve the learning experience on a general medicine in-patient team. Methods Eight learners participated in this pilot study. Learning teams consisted of internal medicine residents and third-year medical students on a general medicine in-patient rotation. The experimental curriculum covered four common topics: cardiac stress testing; syncope; pneumonia; and valvular heart disease. Sessions had the following format: (1) each learner answered five self-assessment questions using an immediate feedback technique; (2) learners were divided into groups of two or three to discuss their answers; (3) the teaching doctor led a discussion to clarify and summarise, and also distributed a handout delineating key learning points. Control sessions consisted of the usual teaching rounds. Learners were e-mailed a daily online survey asking them to rate the rounds and handouts on a Likert scale. Medical trainees often do not receive structured teaching during in-patient rounds Results All of the learners rated the collaborative team learning intervention as either ‘excellent’ or ‘very good’. Learners also indicated that they found the take-away handout valuable, and positive responses were also noted in the survey comments. Discussion A novel collaborative team learning technique resulted in high ratings of teaching rounds by medical residents and medical students. Learners found the sessions engaging, high yield, and educationally valuable. This interactive discussion-based teaching method could be used to enhance the learning experience during teaching rounds on medical, surgical and subspecialty services.

Summary Background An increasing emphasis on accountability led to the development of the Intercollegiate Surgical Curriculum Project (ISCP) in the UK. A major feature of ISCP was a focus on competence with the institution of formative assessments to aid learning and provide portfolio evidence. Case-based discussions (CBDs) are one of the main formative assessments used at all stages of training. The aim of this study was to review the use of CBDs by surgical trainees to determine if and when they are useful, and whether they are perceived as being used correctly. Methods Semi-structured interviews were carried out with both higher and core surgical trainees. Inductive reasoning principles were used to analyse and interpret the responses to open questions. Common themes were determined and thematic analysis was carried out. Results Forty-two surgical trainees (21 core and 21 higher trainees) were interviewed. Core trainees felt that CBDs were more likely to be used correctly, and both groups thought that they were a positive feature of training. Few stated that they were used to shape training needs. Positive themes identified included the provision of feedback, identifying learning portfolio evidence and encouraging reflection. Negative themes included a ‘tick-box’ mentality and that the value was diminished by a lack of engagement with the process from trainers. Case-based discussions are one of the main formative assessments used at all stages of training Conclusion Trainees regarded CBDs as a positive feature allowing the discussion of complicated cases, and encouraging higher thinking and reflection; however, concerns were raised regarding their implementation, which has led to a diminishing of their value.

Summary Background During peer assessment activities, students are often required to provide feedback to their peers. The quality of such feedback can be perceived by recipients to be superior, and better received, than feedback given by academic staff. The aim of this study was to investigate students’ views on receiving verbal feedback from their peers during their formative long case examination. Methods During 2013, year–4 students (n = 48) were assessed on their formative long case presentation and discussion by a student examiner, alongside an academic co-examiner. The student examinee was then provided with verbal feedback by both the student examiner and the academic co-examiner. To gain insight into students’ views on receiving feedback from their peers, two focus groups were held. Students are often required to provide feedback to their peers Results Of the 48 participants, 35 per cent (17/48) attended focus groups. Students did not like receiving peer feedback during the scheduled examination time, in the presence of the academic co-examiner. They did value peer feedback, but preferred to receive this in a relaxed environment, after the examination. Conclusion In the formative examination, students perceived the feedback given by their peer co-examiner to be less constructive, less accurate and less helpful than the feedback given by the academic co-examiner. These findings may have implications for the feedback process for future iterations of the formative long case examination.

Difficulties falling asleep are common among adolescents, especially during times of stress. Adolescents may thus benefit from brief techniques (15 min) that decrease pre-sleep cognitive-emotional arousal and sleep-onset latency. The present study used a 3 (intervention: mindfulness bodyscan mp3, constructive worry, control) by 3 (time: baseline, week 1, week 2) mixed-model design on a school-based sample of adolescents (N = 232; Mage = 15.9 ± 0.8 years, range = 14-18 years; 19% male), and a sub-sample of adolescents with prolonged sleep-onset latency (i.e. ≥30 min; N = 119; Mage = 16.9 ± 0.9 years; 21% male). It was expected that the 15-min pre-recorded breath-based mindfulness bodyscan, and constructive worry, would decrease sleep-onset latency and pre-sleep arousal similarly over time, relative to the control condition. A significant interaction was observed among adolescents with prolonged sleep-onset latency, who completed ≥3 days for at least 1 week (p = .001), where mindfulness decreased sleep-onset latency relative to constructive worry and the control. Neither technique changed pre-sleep worry or cognitive-emotional arousal, or associated daytime functioning (both the whole sample and sub-sample). A pre-recorded mp3 breath-based mindfulness bodyscan technique is a promising means by which adolescents with prolonged sleep-onset latency can decrease sleep-onset latency. This simple tool has potential for scalable dissemination by stakeholders (e.g. teachers), unqualified to treat adolescent sleep difficulties. Future studies are needed to determine whether benefits may extend to academic performance and mental health, if performed for a longer time period with increased compliance.