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Context The collegiate athletic setting has been described as having high workloads and working demands. The extensive time commitment required of athletic trainers working in this setting has been identified as a precursor to work-family conflict (WFC) and work-family guilt (WFG). Although individualized, experiences in the work-life interface can largely be affected by organizational factors (ie, elements specific to the workplace). Staff size and patient load may influence the athletic trainer's feelings of WFC and WFG, yet these factors have not been directly studied. Objective To examine organizational factors and experiences of WFC and WFG among collegiate athletic trainers. Design Cross-sectional study. Setting Collegiate setting. Patients or Other Participant(s) A total of 615 (females = 391, gender variant or nonconforming = 1, males = 222, preferred not to answer = 1) athletic trainers responded to an online survey. The average age of participants was 33 ± 9 years, and they were Board of Certification certified for 10 ± 8 years. A total of 352 participants (57.2%) worked in National Collegiate Athletic Association Division I, 99 in Division II (16.1%), and 164 in Division III (26.7%). Main Outcome Measure(s) Participants responded to demographic and workplace characteristic questions (organizational infrastructure, staff size, and number of varsity-level athletic teams). They completed WFC and WFG scales that have been previously validated and used in the athletic trainer population. Results Work-family conflict and WFG were universally experienced among our participants, with WFC scores predicting WFG scores. Participants reported more time-based conflict than strain- or behavior-based conflict. No differences in WFC and WFG scores were found among organizational infrastructures. Weak positive correlations were present between staff size and WFC scores and WFG scores. The number of athletic teams was not associated with WFC or WFG scores. Conclusions Organizational factors are an important component of the work-life interface. From an organizational perspective, focusing on improving work-life balance for the athletic trainer can help mitigate experiences with WFC and WFG.

Context Mindfulness practices are effective for injury or illness recovery, decreasing stress and anxiety, and strengthening emotional resilience. They are also beneficial for health care professionals' wellbeing and improving patient outcomes and safety. However, mindfulness has not been studied in athletic trainers. Objective To investigate athletic trainers' use of mindfulness practices and their perceptions of its importance for self-care and patient or client care. Design Cross-sectional study. Setting All athletic training practice settings. Patients and Other Participants A total of 547 athletic trainers who were currently practicing completed the survey. Main Outcome Measure(s) We developed an 18-item survey that measured use (1 = never to 6 = very frequently) and perceptions (1 = strongly disagree to 7 = strongly agree) of mindfulness practices. Mann-Whitney U or Kruskal-Wallis tests with post hoc pairwise comparisons were performed to assess differences in use (P < .05). A related-samples Wilcoxon signed rank test was calculated to assess differences in participants' perceptions between self-care and patient or client care. Results Overall, 86% (n = 471) of respondents reported involvement in some form of mindfulness practice, with females (median [interquartile range] = 4 [2–5] versus males: 3 [2–4]; P < .002), those not in a committed relationship (4 [2–5] versus those in such a relationship: 3 [2–4]; P = .048), and those without children in the home (4 [2–5] versus those with children in the home: 3 [2–4]; P = .040) describing the highest frequency of use for self-care. Females (4 [2–4] versus males: 3 [2–4]; P < .001), those without children in the home (3 [2–4] versus those with children in the home: 3 [2–4]; P = .036), and those in emerging (4 [2–4]; P = .003) or collegiate (3 [2–4]; P = .006) settings most frequently incorporated mindfulness into patient or client care. Overall frequency of use for self-care was higher than for patient or client care (4 = occasionally [2–4] versus 3 = rarely [2–4]; P < .001). Mindfulness practices were perceived as more important for self-care than for patient or client care (6 [5–7] versus 5 [5–6]; P < .001). Conclusions Athletic trainers perceived mindfulness practices as more important for personal wellbeing and used them, albeit occasionally, more for self-care than for patient or client care. Differences in gender, relationship status, children, and setting were observed. Mindfulness-based interventions for athletic trainer wellbeing and patient-centered care and implementation barriers should be explored.

Insomnia is a threat to the well-being and combat readiness of military service members. Brief Behavioral Treatment for Insomnia (BBTI) is effective in treating insomnia, but the treatment schedule is difficult to implement in the Military Health System due to shorter appointment windows than what is offered in civilian settings. In the present study, 23 behavioral health providers were trained in a version of BBTI adapted for use within the Military Health System. Training was conducted remotely via a 2-day webinar, followed by 12 weekly telephone consultations with a trainer. Surveys were conducted before and after the 2-day webinar, and after the consultation period. Training led to increases in target knowledge scores and self-rated confidence in administering BBTI. All providers reported implementing the treatment with multiple patients during the 12-week period, and all providers reported that the intervention was more effective than their usual treatment method. All behavioral health providers also reported that they were likely to use BBTI in the future when treating patients with insomnia, and that they would advertise their BBTI skills to primary care providers to encourage insomnia referrals. Although conducted with a small sample size, the current study gives provisional support for (a) feasibility of implementing the adapted version of BBTI within the Military Health System and (b) feasibility of training the adapted BBTI to behavioral health providers via remote learning methodology. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

COVID-19 has accelerated a reliance on virtual technology for the delivery of postgraduate surgical education. We sought to develop a regional teaching programme with robust quality assurance. Webinars were delivered on a weekly basis by subspecialty experts using Zoom™ augmented with interactive polling software. Trainee feedback comprised Likert item rating on content and delivery, free text comments and self-assessed confidence levels using visual analogue scale (VAS) scores. A focus group was also convened and transcripts assessed with grounded theory analysis. Likert items revealed 442 (93.2%) positive responses regarding content and 642 (96.7%) positive responses regarding trainer delivery. There were statistically significant improvements in VAS scores across all programme content. Key themes from the focus group analysis were the pragmatics of delivering online education, issues surrounding trainer interactivity in the virtual world, the identification of the FRCS as a driving factor and a desire for case-based content and pre-learning of information (the 'flipped classroom'). We are continuing to be reactive to trainee feedback in developing our online learning programme which will also include a regional Moodle-based virtual learning environment (VLE), the subject of future educational research in our region.

Objectives In Austria a national train-the-trainer programme (TTT) has been developed, implemented and evaluated with the aim of training and certifying participants for developing, implementing and delivering communication skills training (CST) for health professionals. Methods The programme included 5 in-person courses, application homework with feedback, peer work, and regular trainer network meetings. Global satisfaction with training and changes in self-efficacy among TTT-participants and their learners in the CST delivered as practice projects were evaluated. Results 18 participants have graduated from the TTT-pilot. 98 people took part in the 9 CST delivered by TTT-participants. Participants’ satisfaction has been rated very positively both for TTT and CST. At post-programme/post-training, statistically significant improvement was observed in self-efficacy for the TTT-participants and for the CST-participants. Additionally, valuable suggestions for programme/training improvement were identified. Conclusions This programme is an important step to sustainably improving CST in Austria. To guarantee high quality and consistency, a set of standards for certification have been developed for TTT and CST. Practice implications Implementation of best practices in training trainers and communication skills teaching can be guided by a structured approach. Those wanting to implement similar programmes can benefit from strengths and suggestions for improvement identified in this national project.

Transurethral resection (TURP) and photoselective vaporization of the prostate (PVP) constitute established surgical options to treat benign prostate hyperplasia. We investigated the current literature for simulators that could be used as a tool for teaching urologists alone or within the boundaries of a course or a curriculum. A literature search was performed using PubMed, Scopus, EMBASE, and Cochrane Central Register of Controlled Trials—CENTRAL. Search terms included: Simulat*, train*, curricull*, transurethral, TUR*, vaporesect*, laser. The efficacy of different simulators and the impact of different devices, curricula and courses in training and trainee learning curves were the primary endpoints. Thirty-one studies are selected and presented. Validated virtual reality TURP simulators are the UW VR, PelvicVision, Uro-Trainer, and TURPsim™. Validated synthetic TURP models are Dr. K. Forke's TURP trainer, Bristol TURP trainer, different tissue prostate models, and 3D-printed phantoms. The Myo Sim PVP and the GreenLightTM are sufficiently validated PVP simulators. Several TURP and PVP training curricula have been developed and judged as applicable. Finally, the TURP modules of the European Urology Residents Education Programme (EUREP) Hands-on Training course and the Urology Simulation Bootcamp Course (USBC) are the most basic annual TURP courses identified in the international literature. Simulators and courses or curricula are valuable learning and training TURP/PVP tools. The existent models seem efficient, are not always adequately evaluated and accepted. As part of training curricula and training courses, the use of training simulators can significantly improve quality for young urologists' education and clinical practice.

Background Mobile health apps have the potential to promote adherence to headache management through the use of evidence-based behavior change techniques (e.g., self-monitoring). While many headache management apps exist, the extent to which these apps include behavior change techniques remains unknown. Thus, the present study systematically evaluated the content and quality of commercially available headache management apps. Methods Headache apps were identified using a systematic search in the Apple App and Google Play stores. A total of 55 apps were evaluated using the taxonomy of behavior change techniques and app quality using the Mobile App Rating Scale. Results Headache management apps included 0–14 behavior change techniques (Mean [M] = 5.89) and 0–8 headache management behavior change techniques (M = 4.29). App quality ranged from 2.84–4.67 (M = 3.73) out of 5.00. Three apps, Migraine Trainer, Easeday: Headache & Migraine, and PainScale, included the highest number of overall and headache management behavior change techniques along with good quality scores. Conclusions While randomized controlled trials are necessary to determine the efficacy of individual headache apps, most existing apps include evidence-based headache management behavior change techniques. Headache apps often focus on either self-monitoring or stress management via relaxation training, suggesting that patients’ needs should be used to inform app selection.

Purpose: Due to the small space environment, the learning curve of pediatric laparoscopic procedures is steep and requires excellent procedural skills. These are mainly gained through an apprenticeship on real patients. Computer-based virtual reality (VR) simulators offer a safe, cost-effective, and configurable training environment free from ethical and patient safety issues. Materials and Methods: We have developed a prototype VR simulator for core manual skills training for pediatric laparoscopic hernia repair. The simulator currently consists of a hernia suturing task on a virtual nonanatomic trainer at a real pediatric scale. Results: A simulation realism validation study was carried out by obtaining subjective feedback (face and content validity) through a questionnaire from 36 pediatric surgeons. The overall simulation realism was on average marked 3.08 on a 5-point Likert scale (1: “very unrealistic” and 5: “very realistic”). The participants were most satisfied with the visual realism (3.33) and most critical about the behavior of virtual tissue. The simulator showed good content validity; its usefulness as a training tool for hernia repair, suturing in general, and in learning fundamental laparoscopic skills was marked 3.61, 3.64, and 3.89, respectively. Conclusions: VR simulation of pediatric laparoscopic procedures can contribute to surgical training and improve the educational experience without putting our youngest patients at risk. This simulator is a first prototype, and the initial results indicate that it provides promising foundations for further development. More formal and larger studies such as construct validity and transfer of skills are envisaged as the prototype is developed further.

Context Socioeconomic status (SES) is a significant predictor of morbidity and mortality across health outcomes. Limited information exists on how school SES affects athletic training practice when a certified athletic trainer (AT) is present at secondary schools. Objective To describe contact frequencies and service rates provided by ATs for injuries among secondary school student-athletes and how these differ by school SES. Design Cross-sectional study. Setting The number of athletic training facility (ATF) visit days and AT services were collected from 77 secondary schools. Schools were separated into 3 school SES groups: affluent (n = 31), average (n = 29), and disadvantaged (n = 17). Patients or Other Participants Secondary school student-athletes who participated in ≥1 of 12 boys' or 11 girls' sports, visited the ATF during the 2014–2015 through 2018–2019 academic years, and received athletic or nonathletic injury care. Main Outcome Measure(s) Contact frequencies were expressed as ATF visit days per injury, AT services per injury, and AT services per ATF visit day. Rates for service type used were expressed as the total count over reported athlete-exposures. Results The ATs documented 1191 services. Affluent and average SES school communities provided more contact frequencies for injury-related care than did disadvantaged school communities, particularly in AT services per injury (7.10 ± 13.08 versus average: 9.30 ± 11.60 and affluent: 9.40 ± 12.20; P = .020). Affluent school communities supplied greater rates of services in 5 of the 11 service groups reported. No differences were observed among school SES groups in therapeutic exercise. Conclusions Our findings reflect that AT practice characteristics may have differed by school SES, but these differences did not appear to result in less medical care. Given the complexity and widespread effects of SES, future investigators should use a complex method to determine SES and aim to identify how SES may affect secondary school student-athletes in ways other than AT practice characteristics.

Background: Girls with a mild intellectual disability generally receive less sexuality education than their non-disabled peers, while their needs for sexual knowledge are possibly greater. This study aimed to evaluate the effect and process of a new sexuality education programme (Girls' Talk+), focused on sexual health among girls with a mild intellectual disability in the Netherlands. Methods: A mixed methods approach was applied, using participant questionnaires (n = 249), logs written by trainers (n = 17) and interviews with trainers (n = 10). Descriptive statistics and linear regression models were used to analyse the quantitative data. Several coding phases were used to analyse the interviews. Results and conclusions: This study provides some indication that Girls' Talk+ has positive results on improving knowledge, attitude, and self-efficacy in relation to sexual health as well as trainer and participant satisfaction with the programme.

Paediatric trainees receive formal support through the Royal College of Paediatrics and Child Health (RCPCH) in the form of clinical and educational supervision. While this is important, there is evidence to suggest that junior trainees learn the most from their colleagues on the shop floor through peer mentoring rather than in supervisor meetings.1 In 2014, the Paediatric Family Project was set up within the London Deanery to provide peer-mentoring support for first year paediatric specialty trainees (STs). Every new ST1 trainee, ‘the child’, is matched with a volunteer ST4 or above, ‘the parent,’ forming a ‘family’. This mirrors the system used throughout many universities and provides a more informal support service. A yearly survey is sent out to all participants and changes are made according to the responses. This article will discuss the role of peer mentoring within paediatric training, drawing on experience and evidence from the Paediatric Family Project, before providing advice for the reader on how to run a successful peer-mentoring programme. The RCPCH defines peer mentoring as a mentoring relationship between individuals who are: ‘equal in age, experience and rank’.1 In the workplace, this typically manifests as senior trainees providing peer mentorship for junior trainees. This differs from clinical and educational supervision. The RCPCH uses the General Medical Council definition of a supervisor: ‘a trainer who is selected and appropriately trained to be responsible for the overall supervision and management of a specified trainee’s educational progress.’2 Formal supervision is often constrained by time limitations and the need to address specific portfolio-based outcomes. Mentorship is usually mentee led, meaning that the mentee takes the responsibility …

Objective: This work presents the development and validation of an interactive simulation training platform for the minimally invasive repair of pectus excavatum, otherwise known as the Nuss procedure. Methods: The challenges and implications of developing both an all-virtual and an all-physical version of the simulator are investigated in a training context. A hybrid system is then developed that integrates virtual and physical constituents and a haptic interface to reproduce the primary steps of the procedure and to satisfy clinically relevant prerequisites for its training system. Furthermore, this work carries out a study to investigate the system's face, content, and construct validity. Results: Objective and subjective evaluations of the system demonstrate its utility for surgical training and establish various levels of its validity. Conclusion: A hybrid virtual/physical configuration of the trainer can efficiently and realistically reproduce the primary steps of the procedure. Significance: Outside of this work, a simulation and training platform for the Nuss procedure is not available. This system was developed in close collaboration with the pioneers of this surgical technique.

Context Where a person lives can have a significant effect on health. Limited access to health care, food insecurity, lack of affordable housing, and violence increase a person's likelihood of poor health. Athletic trainers (ATs) can contribute to identifying and improving the determinants of health that affect student-athletes. Objectives (1) What were the current perceptions ATs had about the health behaviors (specifically mental health and substance use) of high school student-athletes? (2) What were the barriers that ATs experienced when providing health services to high school student-athletes? (3) How did the developed environment affect the health behaviors and barriers that ATs observed? Design Qualitative study. Setting Online survey. Patients or Other Participants Certified National Athletic Trainers' Association members employed in the secondary school setting. Main Outcome Measure(s) Demographics of ATs were collected, and the ATs' perceptions of the health of student-athletes across developed environments, prevalence of mental health issues, tobacco and substance use, barriers to health care services, and housing and food insecurities among student-athletes were surveyed. Descriptive statistics for the outcome measures were reported. Results A total of 7600 electronic surveys were distributed to the ATs and 911 responded (females = 62%, average age = 36 years, average experience = 12.5 years). The school setting was identified by 82.5% as public and the environment as suburban by 43.7%, rural by 30.1%, and urban by 26.1%. Participants perceived a high average prevalence of mental health concerns (32%), e-cigarette use (31.7%), and marijuana use (26.9%) among student-athletes. Significant perceived barriers to health included limited access to transportation, poverty, and housing and food insecurities. Conclusions This study highlights the health disparities and barriers ATs observed when addressing the health care needs of student-athletes. Understanding the determinants of health in order to identify the causes of health disparities may better prepare ATs to manage the health needs of underserved student-athletes.

Objective Our goal is to improve the wellness of our Family Medicine residents now and in the future by educating them on more efficient use of our electronic health record (EHR). Resident physician burnout is a significant problem and is correlated with time spent using an EHR after work hours. Family physicians have the highest rate of burnout of all specialties, and the EHR is a significant contributor to this burnout. Studies have shown that increased EHR education can improve job satisfaction. Method Over 5 months, we provided weekly brief (15 minute) educational sessions covering 6 topics twice and a one-hour individualized meeting of each resident physician with an EHR trainer. We evaluated our intervention with wellness surveys and objective measures of EHR efficiency both pre and post intervention. We further evaluated efficiency by comparing pre and post-intervention values of the following: average keystrokes, mouseclicks, accelerator use, minutes per encounter and percent closed encounters at month’s end. Results Resident questionnaires showed lessons increased knowledge and intention to use EHR accelerators, but this was not statistically significant. Analysis of objective data showed most efficiency metrics worsened, though most not to a degree that was statistically significant. Residents reported subjective increases in efficiency, and paired data from wellness surveys showed an overall decrease in burnout post-intervention vs. baseline. Conclusions Much of the data in this pilot study does not reach statistical significance, but is highly suggestive that increased EHR training can improve at least perceived efficiency and thereby resident wellness.

In the past few years, self-tracking technologies have been celebrated for the possibilities they offer to ‘optimize’ fitness and wellbeing, yet also criticized for being rigid and isolating. In this article, we identify complex tracking arrangements that consist of a variety of data and multiple modalities of tracking emplaced within arrangements of actors and objects (digital/analog tracking devices and data output). We inquire into how these arrangements afford care. Based on our ethnographic research of gym culture in Denmark, we find that individuals make the technologies ‘work’ for them in ways that shield them from bodily or emotional distress. Fitness practitioners combine digital tracking technologies with analog methods and enrol other human actors in recording, interpreting, questioning and tinkering with their data; in other words, they perform data work in ways that mend or prevent ruptures and brokenness and thus afford ‘care’. We highlight the role of the personal trainer, who often complements or salvages the outputs of digital technologies. We argue that tracking has the capacity to afford care and wellness when it is emplaced within socialities and when actors are able to exercise their capacities and knowledge in ways that mitigate the data outputs.

Children diagnosed with autism spectrum disorder are often taught using discrete trial instruction. Because of low trainer-to-staff ratios commonly found in human service settings, research is needed to find an efficient method to train staff to implement discrete trial instruction with little to no in-vivo training by a qualified trainer. One such technique is observing and rating the behavior of another individual. The resulting improvement in the observer's own behavior is referred to as the observer effect. The purpose of the present study was to assess the effects of conducting behavioral observations and ratings on staff implementation of discrete trial instruction. Staff trainees viewed videos of the implementation of each step, rated the accuracy of implementation, and conducted the procedure with a confederate consumer. The procedure was effective, and the effects extended to novel skills.

Background In hospitals globally, patient centred communication is difficult to practice, and interpreters are underused. Low uptake of interpreters is commonly attributed to limited interpreter availability, time constraints and that interpreter-medicated communication in healthcare is an aberration. In Australia’s Northern Territory at Royal Darwin Hospital, it is estimated around 50% of Aboriginal patients would benefit from an interpreter, yet approximately 17% get access. Recognising this contributes to a culturally unsafe system, Royal Darwin Hospital and the NT Aboriginal Interpreter Service embedded interpreters in a renal team during medical ward rounds for 4 weeks in 2019. This paper explores the attitudinal and behavioural changes that occurred amongst non-Indigenous doctors and Aboriginal language interpreters during the pilot. Methods This pilot was part of a larger Participatory Action Research study examining strategies to achieve culturally safe communication at Royal Darwin Hospital. Two Yolŋu and two Tiwi language interpreters were embedded in a team of renal doctors. Data sources included interviews with doctors, interpreters, and an interpreter trainer; reflective journals by doctors; and researcher field notes. Inductive thematic analysis, guided by critical theory, was conducted. Results Before the pilot, frustrated doctors unable to communicate effectively with Aboriginal language speaking patients acknowledged their personal limitations and criticised hospital systems that prioritized perceived efficiency over interpreter access. During the pilot, knowledge of Aboriginal cultures improved and doctors adapted their work routines including lengthening the duration of bed side consults. Furthermore, attitudes towards culturally safe communication in the hospital changed: doctors recognised the limitations of clinically focussed communication and began prioritising patient needs and interpreters who previously felt unwelcome within the hospital reported feeling valued as skilled professionals. Despite these benefits, resistance to interpreter use remained amongst some members of the multi-disciplinary team. Conclusions Embedding Aboriginal interpreters in a hospital renal team which services predominantly Aboriginal peoples resulted in the delivery of culturally competent care. By working with interpreters, non-Indigenous doctors were prompted to reflect on their attitudes which deepened their critical consciousness resulting in behaviour change. Scale up of learnings from this pilot to broader implementation in the health service is the current focus of ongoing implementation research.

In Portugal, requirements for selection and training of General Practice trainers vary across the different regions of the country. The aim of our study was to assess the satisfaction of general practice trainees with their trainers of the Lisbon and Tagus Valley Regional Health Administration.General Practice trainees were the target population for our cross-sectional, exploratory study. The authors developed a 16-item questionnaire based on the existing literature. The questions covered the following domains: patient safety, learning environment, trainer's feedback, the trainee/trainer relationship, assessment of educational progress and continuous professional development of trainers. Items were scored on a 5-point Likert-type scale. Data was collected at a meeting in October 2018 attended by General Practice trainees.A total of 384 questionnaires were distributed, with a response rate of 59.9%. The majority of respondents were female (79.9%) and all years of specialty training were represented. Our study shows that 60.4% of General Practice trainees from the Lisbon and Tagus Valley Regional Health Administration are very satisfied with the teaching skills of their trainers. However, there was lower satisfaction with trainer's continuous professional development, trainer's feedback, and monitoring of educational progress. The majority (57.4%) of respondents did not give feedback to their supervisors about their teaching performance, mostly because they do not feel comfortable doing so or because they have not considered this.The findings show a high degree of satisfaction of the general practice trainees with their trainers of the Lisbon and Tagus Valley Regional Health Administration. The high response rate attained is one of the strengths of the study. The authors make some suggestions for improvement of domains with lower satisfaction levels. Unfortunately, it is difficult to extrapolate the findings nationwide due to the differences between the training programmes of the different regions.Although there is a high level of satisfaction, there is still potential for improvement, including the expansion of training programmes for trainers.Introdução: Em Portugal, os requisitos para seleção e formação de orientadores em Medicina Geral e Familiar variam nas diferentes regiões do país. Este estudo pretendeu estudar a satisfação dos internos de Medicina Geral e Familiar com os orientadores de formação da Administração Regional de Saúde de Lisboa e Vale do Tejo. Material e Métodos: Os internos de Medicina Geral e Familiar foram a população alvo do nosso estudo transversal e exploratório. As autoras desenvolveram um questionário de 16 itens com base na literatura existente. As perguntas abrangeram os seguintes domínios: segurança do doente, ambiente de aprendizagem, feedback dos orientadores de formação, relação interno/orientador de formação, avaliação do progresso educacional e desenvolvimento profissional contínuo dos orientadores de formação. Os itens foram pontuados numa escala do tipo Likert de cinco pontos. Os dados foram recolhidos numa reunião de internos em outubro de 2018. Resultados: Foram distribuídos 384 questionários com uma taxa de resposta de 59,9%. A maioria dos entrevistados era do sexo feminino (79,9%) e todos os anos de internato foram representados. O nosso estudo mostra que 60,4% dos internos de Medicina Geral e Familiar da Administração Regional de Saúde de Lisboa e Vale do Tejo estão muito satisfeitos com as competências pedagógicas dos orientadores de formação. No entanto, houve menor satisfação nos domínios do desenvolvimento profissional contínuo dos orientadores de formação, feedback dos orientadores e monitorização do progresso educacional. A maioria (57,4%) dos entrevistados não dá feedback ao seu orientador sobre o desempenho pedagógico, principalmente porque não se sente à vontade ou porque nunca considerou fazê-lo. Discussão: Os resultados revelam um elevado grau de satisfação dos internos de Medicina Geral e Familiar com os respetivos orientadores de formação da Administração Regional de Saúde de Lisboa e Vale do Tejo. A elevada taxa de respostas alcançada é um dos pontos fortes do estudo. Os autores propõem algumas sugestões de melhoria para os domínios que obtiveram menor grau de satisfação. Infelizmente, é difícil extrapolar os resultados a nível nacional devido às diferenças entre os programas de formação das diferentes regiões. Conclusão: Embora exista um alto nível de satisfação, ainda há potencial para melhoria, incluindo a expansão de programas de formação para orientadores de formação.

Background The role of simulation-based training in coronary artery bypass grafting remains undefined. Barriers to simulator use include clinical and personal obligations, insufficient materials, and lack of mentorship. The purpose of this study was to implement a longitudinal, residency-wide coronary anastomosis simulation curriculum. Methods A prospective observational study was conducted from 2018 to 2019 at a single academic center. All residents of the Thoracic Surgery training program participated. Each participant was provided a low-fidelity coronary anastomosis simulator, high-quality instruments, and faculty mentor. Formal assessments were held quarterly, and residents were encouraged to practice alone and with their mentor. Baseline and follow-up metrics were compared with simple descriptive statistics. Results Seventeen residents and 12 faculty participated in the study. Residents demonstrated increased use of the simulator, with 21% participating in independent practice at baseline and 82% in the fourth quarter (P = .02). The median score on the Thoracic Surgery Directors Association Vessel Anastomosis Assessment improved from 42 out of 65 at baseline to 54 out of 65 in the fourth quarter (P = .04), and mean anastomosis time was reduced by 5 minutes 6 seconds (P = .02). Over 12 months, junior residents demonstrated a mean reduction in anastomosis time of 6 minutes 36 seconds, and senior residents decreased anastomosis time by 3 minutes 6 seconds (P = .02). Conclusions Providing residents with a low-fidelity coronary anastomosis trainer with high-quality instruments and a faculty mentor improved rates of independent practice, Thoracic Surgery Directors Association assessment scores, and anastomosis time. Our next step is validating the coronary simulator curriculum by measuring improvement of resident performance in the operating room.

To investigate medical and nursing students' education on hand hygiene, their attitude on hand hygiene education and how this education influences their hand hygiene knowledge and practices.Hospital-acquired infections are associated with prolonged hospitalisation and mortality. The most effective measure for their control is healthcare workers' hand hygiene compliance. Since medical and nursing students constitute the future healthcare workers, our study focuses on them.Cross-sectional study METHODS: This study was conducted during the academic year 2016-2017, using a modified World Health Organisation questionnaire. Our sample consisted of 132 medical and 111 nursing students from National and Kapodistrian University of Athens, Greece. In data analysis, the Mann-Whitney and Fisher's exact tests were applied to compare differences in continuous variables and proportions in categorical variables, respectively. Knowledge and practices overall scores were calculated per student group. Multiple linear regression analyses were performed to assess the influence of potential confounders on these scores.We found that 73.1% of medical and 98.2% of nursing students had received relevant education, which was reported as "only theoretical" by 77.4% of the former and as "hands-on and theoretical" by 88.1% of the latter group. Besides the risk of infection, knowledge acquired in lectures and trainer's behaviour were also considered very influential factors shaping hand hygiene attitude in both groups. Overall, medical students reported better hand hygiene practices than nursing ones (69.9% and 59.7%, respectively; p 0.001). The opposite finding was observed regarding their overall knowledge on hand hygiene (57.2% of medical versus 60.4% of nursing students, p = 0.04). The majority of students (86.6% of all participants; p 0.001) supported the inclusion of compulsory hand hygiene education in their curriculum. Compulsory education and seminars were assessed as the most effective measures to increase hand hygiene compliance (71.4% of all students).In our study, medical students scored better in practices questions than nursing students; this did not apply for the knowledge score. The majority of students supported the inclusion of compulsory education on hand hygiene principles in their Departments' curricula, highlighting compulsory education and seminars as the most effective measures to increase compliance with hand hygiene.

Stress plays a significant role in competitions and in the training of sports participants, and coaches are no exception. To better cope with stressful situations, close monitoring of coaches’ stress levels before, during, and after training and competitions is recommended. According to studies, the use of cortisol (C) and alpha-amylase (AA) as biomarkers for monitoring acute stress is recommended. Therefore, the aim of our study was to compare HR, salivary C and AA, and STAI scores before, during, and after handball matches and training sessions. The study examined one professional handball coach, aged 37, in stress markers (salivary cortisol (C) and alpha-amylase (AA) concentrations), heart rate (HR), and the State-Trait Anxiety Inventory (STAI) scores in five matches/training sessions in the First Qatar Handball League. Statistical analysis included the calculation of descriptive statistic parameters, Mann–Whitney U test for differences between match–training time points, and the effect size analysis (Cohen’s d) to calculate the magnitude of differences between match–training time points. Presented markers (C and AA) had statistically stronger reactions before, during, and after the matches than the corresponding time points of the training sessions, similar to HR data and STAI scores. Results indicate that, before and during the matches, the analyzed markers of stress increased, which might lead to the conclusion that coaches are more anxious than frightened before and during matches. Thus, stress-coping strategies for handball coaches should be more focused on stress anticipation and anxiety control.

Objective To review the literature on work-life interfaces in the sport industry, focusing on athletic trainers, coaches, athletes, and other sport personnel. Data Sources Studies were identified using SPORTDiscus, PsychINFO, and Google Scholar. Search terms included work-family balance, work-life balance, work-family conflict, work-life conflict, work-family enrichment, and work-life enrichment. These search terms were used in different combinations and configurations in the search process. Study Selection Included studies were peer-reviewed journal articles, with primary data collection, and published in English. In the articles, researchers also examined some aspect of the work-family interface in relation to the sport industry. Data Extraction The initial searches returned 110 articles. Of these, 21 articles were removed for a lack of focus on the sport industry, for being a duplicate, or for focusing outside the work-life interface in sport. A total of 89 articles remained for a full analysis. An additional 20 articles were then removed because the authors either did not collect primary data or focused outside our study purpose. Therefore, 69 articles were included in the review. Data Synthesis The theoretical framework, study population, population region, methods, article focus, and findings from the articles were recorded. Articles were then grouped based on the study population focus (eg, athletic trainer, coach, or other). Conclusions The results suggested that investigators' primary interests were athletic trainers and coaches, primarily with respect to work-life balance and work-life conflict. Less attention was paid to international participants, athletes, and topics related to work-life enrichment. The field will continue to progress as more populations and perspectives are studied. Furthermore, an additional emphasis on positive organizational behaviors, such as work-life enrichment and life-work enrichment, will move the literature forward and answer useful questions with both theoretical and practical outcomes.

Physical training in Parkinson disease improves motor performance, alleviates nonmotor symptoms, and enhances cognition and quality of life. Nonetheless, adherence to exercise is low and travel costs and time may limit participation and compliance. Training at home can help avoid these burdens and, as needed during the recent global pandemic (COVID-19), reinforce social distancing and reduce the risk of infection. However, training at home requires motivation and self-control and telerehabilitation is time-consuming for both patient and therapist. In recent years, there is growing use of virtual reality and exergaming to increase motivation and adherence for exercising with evidence of improvements in mobility and balance after using virtual reality in the clinic. Here, a novel telerehabilitation training program using a treadmill-virtual reality system for simultaneous training of two patients with Parkinson disease in their homes is described. Remote monitoring software enabled visual and auditory communication with the two patients, allowing the trainer to adapt the settings remotely and provide feedback. Participants received weekly training sessions over 1 yr. The findings show high adherence to training, increased walking duration throughout the sessions, and increased patient confidence, gait speed, and mobility. Training multiple participants simultaneously was feasible, enabling an individualized treatment approach while conserving therapist time.

Objective To develop an assessment instrument that can be used as a comprehensive feedback record to convey to a trainer the non-technical aspects of skill acquisition and training. Methods The instrument was developed across three rounds. In Round 1, 6 endourological consultants undertook a modified Delphi process. Round 2 included 10 trainers who assessed each question’s relevance and practicability. Round 3 involved a pilot study with fifteen urology residents who participated in a technical skills simulation session with the incorporation of the instrument. We report the content, face, and construct validity, and the internal consistency of an NTS instrument for trainers. Results The instrument had a consistent and a high positive average for each of the 4 sections of the instrument, regardless of the type of user. Positive Spearman’s correlation coefficients (0.02 to .64) for content validity and Cronbach’s alpha (a = 0.70) indicated good validity and moderate reliability of the instrument. Conclusion We propose a novel NTS instrument for trainers during a simulation. This instrument can be used for benchmarking the quality of technical skills simulation training.

Purpose To examine the fidelity of our model of laparoscopic inguinal hernia repair (LIHR) in boys and evaluate its value in resident training programs and the learning of basic laparoscopy skills. Methods We created a simulation model with inexpensive, easy-to-obtain equipment. Study participants from 34 university hospital departments received a user manual and an evaluation questionnaire (11 items rated on a 5-point Likert scale). We considered that the evaluation was positive when the median overall score was 4 or over. We compared the results for residents (n = 26) vs. expert surgeons (n = 29) (t tests). Results The duration of the procedure was significantly longer among the residents (30.0 ± 16.8 min) than among the expert surgeons (20.5 ± 11.7 min; p = 0.01). In both groups, the participants rated the model favorably with regard to the overall impression (median score: 4.0 ± 1.0), realism (4.0 ± 0.9), ease of access to the required equipment (5.0 ± 0.6), the quality of the user manual (5.0 ± 0.6), ease of assembly (5.0 ± 0.8), ease of the procedure (5.0 ± 0.8), value in resident training programs (4.0 ± 0.9), and value in learning basic laparoscopy skills (5.0 ± 0.8)). The evaluation was positive (4.0 ± 0.9). Conclusion Our low-cost model was an effective teaching and training tool for LIHR and basic laparoscopy skills. Level of Evidence Level IV.

Supplemental Digital Content is available in the text., Problem The most effective way to train clinicians to safely don and doff personal protective equipment (PPE) and perform aerosol-generating procedures (AGPs), such as intubations, is unknown when clinician educators are unavailable, as they have been during the COVID-19 pandemic. Proper PPE and airway management techniques are critical to prevent the transmission of respiratory illnesses such as COVID-19. Approach In March 2020, the authors implemented a structured train-the-trainers curriculum to teach PPE techniques and a modified airway management algorithm for suspected COVID-19 patients. A single emergency medicine physician trainer taught 17 subsequent emergency medicine and critical care physician trainers the proper PPE and airway management techniques. The initial trainer and 7 of the subsequent trainers then instructed 99 other emergency medicine resident and attending physicians using in situ simulation. Trainers and learners completed retrospective pre–post surveys to assess their comfort teaching the material and performing the techniques, respectively. Outcomes The surveys demonstrated a significant increase in the trainers’ comfort in teaching simulation-based education, from 4.00 to 4.53 on a 5-point Likert scale (P < .005), and in teaching the airway management techniques through simulation, from 2.47 to 4.47 (P < .001). There was no difference in the change in comfort level between those learners who were taught by the initial trainer and those who were taught by the subsequent trainers. These results suggest that the subsequent trainers were as effective in teaching the simulation material as the initial trainer. Next Steps Work is ongoing to investigate clinician- and patient-specific outcomes, including PPE adherence, appropriate AGP performance, complication rate, and learners’ skill retention. Future work will focus on implementing similar train-the-trainers strategies for other health professions, specialties, and high-risk or rare procedures.

This study aimed to translate the Interprofessional Facilitation Scale in French and validate its use for interprofessional simulation training. Experts translated the items into French and then back translated them into English. Data used for the validation were collected from interprofessional simulation trainings. Experts and observers found the scale's content validity was suitable. A principal component analysis was conducted. The Kaiser-Meyer-Olkin test value was 0.88 and two factors were identified, that explained 59.9% of the variance. They were labeled: (a) Opportunity of Interprofessional Learning and (b) Psychological Safety. The Cronbach's alpha measure of internal consistency was 0.91. The learning simulation environment explained the structure of the scale. This study provides evidence that the French version of Interprofessional Facilitation Scale can be used in the context of interprofessional simulation training.

BACKGROUND: Avoidable human error is a significant cause of transfusion adverse events. Adequately trained, laboratory staff in blood establishments and blood banks, collectively blood facilities, are key in ensuring high-quality transfusion medicine (TM) services. Gaps in TM education and training of laboratory staff exist in most African countries. We assessed the status of the training and education of laboratory staff working in blood facilities in Africa. STUDY DESIGN AND METHODS: A cross-sectional study using a self-administered pilot-tested questionnaire was performed. The questionnaire comprised 26 questions targeting six themes. Blood facilities from 16 countries were invited to participate. Individually completed questionnaires were grouped by country and descriptive analysis performed. RESULTS: Ten blood establishments and two blood banks from eight African countries confirmed the availability of a host of training programs for laboratory staff; the majority of which were syllabus or curriculum-guided and focused on both theoretical and practical laboratory skills development. Training was usually preplanned, dependent on student and trainer availability and delivered through lecture-based classroom training as well as formal and informal on the job training. There were minimal online didactic and self-directed learning. Teaching of humanistic values appeared to be lacking. CONCLUSION: We confirmed the availability of diverse training programs across a variety of African countries. Incorporation of virtual learning platforms, rather than complete reliance on didactic, in-person training programs may improve the education reach of the existing programs. Digitalization driven by the coronavirus disease 2019 pandemic may provide an opportunity to narrow the knowledge gap in low- and middle-income countries (LMICs).

Introduction United States Air Force Academy (USAFA) cadets are at risk for sustaining concussions; however, several factors inhibit disclosure. We aimed to better understand the role of social support in concussion disclosure. Methods and Materials We used a mixed methods approach with an electronic survey and interviews. The survey used a 9-point Likert scale (1 = strongly disagree and 9 = strongly agree) to assess concussion disclosure. Survey items asked cadets whom they felt most comfortable disclosing a concussion or bell-ringer/ding to, how quickly they would seek medical attention for a suspected concussion or bell-ringer/ding, whether cadets would be generally supportive/unsupportive of another cadet disclosing a concussion to medical staff, and whether other cadets important to them would be generally supportive/unsupportive if they reported a concussion to medical staff. Two multivariate linear regressions, one for concussion and one for bell-ringers/dings, were calculated to determine whether cadet choice of the person they felt most comfortable disclosing a concussion or bell-ringer/ding to predicted whether they would immediately seek medical attention for either condition. Choice of person included Air Officer Commanding (AOC)/Academy Military Trainer (AMT), upper classmen, cadet who had recovered from a concussion, cadet, closest friend, teammate, and squadmate. Descriptive analyses assessed whether cadets felt supported or unsupported by other cadets and by those who were important to them concerning concussion reporting. Thirty-four semi-structured interviews were conducted with cadets to explore their views on concussion disclosure. Results Increased comfort with disclosing a suspected concussion to an AOC/AMT had higher agreement seeking medical attention (β = 0.28, P Conclusions Our results suggested that cadets felt comfortable reporting a suspected concussion or bell-ringer/ding to various peers and that those peers would be supportive of that choice, indicating social support. Future interventions should include educating cadets that peers may come to them, especially if they are AOCs/AMTs or squadmates.

Surgical training has a long history of unique educational approaches and communities of practice, historically driven by exclusion of surgeons from the medical world.1 The Hippocratic Oath sworn by physicians states ‘I will not use the knife, not even on sufferers from stone, but will withdraw in favour of such men as are engaged in this work’, which permits an understanding of how surgical practice previously split from the medical profession and with no authoritative institution adopted an apprenticeship-type training.2 This apprenticeship model still plays a prominent role in modern-day resident training in the operating room, particularly with regard to the development of meaningful personal interactions between the trainee and the trainer, and trust when performing and assisting in delicate aspects of a procedure.1 However, structured surgical training in England began to take form following the Calman reforms in the 1990s, which called for extensive trainee assessments including the introduction of surgical membership examinations, and the Modernising Medical Careers movement in 2005 and the Shape of Training report in 2013, which defined postgraduate competencies required at each stage of training.3–5 The most recent change to surgical training in England was the introduction of the Improving Surgical Training pilot, which emphasises the importance of long-term attachments to trained and committed supervisors to improve the development of surgical skills.5 Through these reforms surgical training has evolved to include standardised training as part of an Intercollegiate Surgical Curriculum Programme in the form of workplace-based assessments, including case-based discussions, direct observations of procedural skills and multisource multidisciplinary feedback assessments.3 The recording and assessment of these supervised learning events forms a curriculum which allows for the evaluation of both technical and non-technical competencies of the learner and generates a benchmark for surgical trainees to progress in seniority.3 This …

Ever-developing changes to the working hours of junior doctors by the European Working Time Directive, the junior doctor contract of 2019 and most recently the COVID-19 pandemic have impacted the professional identity of doctors. There has been little investigation into its influence on the multifaceted aspects of postgraduate medical training, which feeds into how trainees consider themselves professionally and the concept of professional identity or ‘being a doctor’. A review of the medical, socio-political and educational literature reveals that the impact on the professional identity development of trainees is influenced by several perspectives from the trainee, trainer and the public. Gross reduction in working hours has no doubt decreased the raw volume of clinical experiences. However, to counteract this, smarter learning processes have evolved, including narrative reflection, supervised learning events, and a greater awareness of coaching and training among trainers.

Elliptical trainers and steppers are proposed as useful exercise modalities in the rehabilitation of injured runners due to the reduced stress on muscles and joints when compared to running. This study compared the physiological responses to submaximal running (treadmill) with exercise on the elliptical trainer and stepper devices at three submaximal but identical workloads. Authors had 18 trained runners (male/female: N = 9/9, age: mean ± SD = 23 ± 3 years) complete randomized maximal oxygen consumption tests on all three modalities. Submaximal tests of 3 min were performed at 60%, 70%, and 80% of peak workload individually established for each modality. Breath-by-breath oxygen consumption, heart rate, fuel utilization, and energy expenditure were determined. The value of maximal oxygen consumption was not different between treadmill, elliptical, and stepper (49.3 ± 5.3, 48.0 ± 6.6, and 46.7 ± 6.2 ml·min−1·kg−1, respectively). Both physiological measures (oxygen consumption and heart rate) as well as carbohydrate and fat oxidation differed significantly between the different exercise intensities (60%, 70%, and 80%) but did not differ between the treadmill, elliptical trainer, and stepper. Therefore, the elliptical trainer and stepper are suitable substitutes for running during periods when a reduced running load is required, such as during rehabilitation from running-induced injury.

INTRODUCTION Transforming administrative health care data into meaningful metrics has been critical to the implementation of the Department of Defense's Primary Care Behavioral Health (PCBH) program. METHODS Data from clinical encounters with PCBH providers are used to develop metrics of program performance collaboratively. Metrics focus on describing the PCBH program and patients, provider fidelity to the model, and provider performance. These metrics form two key deliverables: a monitoring dashboard for program managers and a training dashboard for expert trainers conducting site visits. RESULTS Behavioral health consultants (BHCs) conducted nearly 200,000 encounters with more than 100,000 unique patients in fiscal year 2019 at more than 170 locations in 6 countries and 37 states. Administrative data derived from these encounters were used to create a variety of metrics that describe practice and performance at both the provider and program levels. These metrics are delivered through a variety of analytic products to stakeholders who use that information to make data-driven decisions about program direction and provider training. DISCUSSION We discuss examples of program management decisions and expert trainer actions based on these dashboards, highlighting the benefits of continued collaboration between analysts and program managers. Specifically, excerpts from several dashboards illustrate how penetration and productivity metrics yield specific, tailored action plans to improve care delivery and provider performance. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

In a time of instability caused by adolescence, sport may represent a resource to prevent future individual and social problems. Within the complex relationships developed in social sports contexts, the figure of the coach can be fundamental for the development of a beneficial environment. The objective of the research was to investigate the relationship between the teaching methods and leadership profile of the coach and outcomes on the perception of positive development of young people participating in an after school sports program. In total participated, 910 adolescents (14.0 ± 1.8 years) and 57 coaches (45.57 ± 7.25 years) in 37 public schools in the city of Curitiba, in the state of Paraná-Brazil. Ordinal logistic regression was used to verify the independent associations between the variables sex, category, sport, trainer methodology, perception of the coaches, and perception of the athletes with the tertiles of the scores of each developmental characteristic of the young athletes (personal and social skills, cognitive skills, goal setting, and initiative). Odds ratios (OR) were obtained with a 95% confidence interval (95%CI), adopting p < 0.05. The small sized games method were positively associated with cognitive skills and goal setting. Positive associations were also found between athletes’ perceptions of the leadership profile of coaches with: personal and social skills (instructor, democratic behaviour, social support, and positive feedback), cognitive skills (instructor, democratic behaviour, and social support), goal setting (instructor, social support, and positive feedback), and initiative (instructor and positive feedback). In addition, the athletes’ perception of the coaches’ autocratic behaviour was inversely associated with personal and social skills and goal setting. For the evaluated program, the results suggest the choice, on the part of the coaches, of small sized games, combined with a democratic, affective, motivating leadership profile that provides instructions on technical skills and game strategies. The combination of the designated psych-pedagogical aspects is correlated to the positive development of young people through team sports.

Introduction: Flexible bronchoscopic intubation (FBI) is an important technique in managing an anticipated difficult airway, yet it is rarely performed and has a steep learning curve. We aim to evaluate if the integration of virtual reality gaming application into routine FBI training for emergency department doctors would be more effective than traditional teaching methods. Methods: We conducted a randomised controlled trial to compare self-directed learning using the mobile application, Airway Ex* in the intervention group versus the control group without use of the mobile application. All participants underwent conventional didactic teaching and low-fidelity simulation with trainer’s demonstration and hands-on practice on a manikin for FBI. Participants randomised to the intervention arm received an additional 30 minutes of self-directed learning using Airway Ex, preloaded on electronic devices while the control arm did not. The primary outcome was time taken to successful intubation. Results: Forty-five physicians (20 junior and 25 senior physicians) were enrolled, with male predominance (57.8%, 26/45). There was no difference in time taken to successful intubation (median 48 seconds [interquartile range, IQR 41–69] versus 44 seconds [IQR 37–60], P=0.23) between the control and intervention groups, respectively. However, the intervention group received better ratings (median 4 [IQR 4–5]) for the quality of scope manipulation skills compared to control (median 4 [IQR 3–4], adjusted P=0.03). This difference remains significant among junior physicians in stratified analysis. Conclusion: Incorporating virtual reality with traditional teaching methods allows learners to be trained on FBI safely without compromising patient care. Junior physicians appear to benefit more compared to senior physicians. Keywords: Airway management, emergency medicine, intubation, simulation education, virtual reality

INTRODUCTION The traditions of surgical education have changed little over the years. However, the increasing focus on patient safety and duty hour restrictions mandates that residents start developing complex skill sets earlier to ensure they graduate with procedural competency. Surgical training is poised to exploit high-fidelity simulation technology to mitigate these pressures. METHODS By revisiting principles of adult learning theory, the authors created a "bootcamp-style" cleft lip curriculum that sought to (1) maximize educational impact and (2) pilot a high-fidelity procedural trainer permitting resident operative autonomy as part of that curriculum. Trainees participated in small group educational sessions comprised of a standard cleft didactic lecture, augmented by instructional video. Participants immediately processed knowledge from the lecture/video by "operating" on the simulator, allowing opportunities for questions and self-reflection, completing the learning cycle. A self-assessment survey was taken before and after each component of the session, including a self-confidence survey to conclude the session. Anthropometric measures of lip/nasal symmetry were assessed. RESULTS Sixteen trainees participated in the program. Little increase in self-assessed knowledge/skill was seen after the lecture, but significant increases in most aspects of cleft lip repair were seen after simulation. The greatest increase in self-assessment was seen for the program as a whole, with significant differences across all aspects of the self-assessment. Higher levels of training were associated with both higher self-assessment scores and better lip symmetry. Regardless of level of training, all participants strongly agreed that simulation helped them actively engage in learning and should be a required aspect of training, whereas 94% (n = 15) thought simulation was much more effective than standard preparation alone. CONCLUSIONS This pilot curriculum illustrates a mechanism to incorporate lessons from adult learning theory into plastic surgery training using a high-fidelity simulator for deliberate practice of cleft lip repair. Further evaluation is warranted to determine whether this didactic model can accelerate the acquisition of the complex skill set required for cleft lip repair and other surgical procedures.

Objectives Workplace-based assessments (WPBAs) have become embedded in the training and assessment of UK medical trainees since the onset of the 21st century. When first introduced WPBA required a significant adjustment in both trainees' and educators' training behaviour, and was met with scepticism in some quarters. In this study, we aimed to evaluate how trainees' perceptions of WPBAs have evolved over a 10-year period, as experience with them has increased. Design Two online questionnaires were constructed and distributed to UK trainees. The first was distributed in 2008, the second in 2018. Questions related to trainees' perception of WPBAs as a learning process and as a reflection of their competence. Setting and participants All UK medical trainees were eligible to respond. In 2008, 482 trainees from 96 hospitals completed the questionnaire. In 2018, 356 trainees from 103 hospitals completed the questionnaire. Main outcome measures Data were analysed both quantitatively and qualitatively. A comparison between the numbers of each WPBA modality completed in 2008 and 2018 was assessed using chi-squared test. Comparisons of Likert scale values between 2008 and 2018 were assessed using unpaired t-test. Thematic analysis was carried out on free-text answers. Results The number of forms completed per participant increased significantly from 2008 to 2018. In 2008, forms were most commonly completed immediately after a learning observation (34%). In 2018, forms were most commonly completed between 1 week and 1 month after observation (58%). In 2018, significantly fewer WPBAs were followed by an educational/beneficial discussion in comparison to 2008 data. The most common free-text theme in the 2008 data set was ‘supervisor issues’ whereas in 2018 the most commonly noted theme was ‘limited educational benefit’. Conclusions Our study suggests trainees' perspectives of WPBAs have not changed in the 10 years since implementation. Trainees do not perceive WPBA as an accurate reflection of their competency but instead as a ‘tick-box’ bureaucratic exercise to enable career progression. Development of educator training and trainer and trainee job-planning is required to ensure that WPBAs are genuinely educational activities that offer an accurate reflection of trainees' medical competence.

Context Many survey-based methods have been used to explore concussion-reporting behavior. However, because the decision to report or conceal a concussion is likely multifactorial, this may narrow the findings, as the surveys were largely designed by the researchers. Objective To explore student-athletes' perspectives regarding factors that may influence the reporting of sport-related concussion. Design Qualitative study. Setting National Collegiate Athletic Association Division I athletics. Patients or Other Participants We conducted 17 semistructured interviews with student-athletes who had sustained 1 or more concussions while attending a large university (men = 4, women = 13, age = 20.9 ± 1.3 years). Data Collection and Analysis After data saturation and member checks, a 5-cycle analytic process was completed: topical review, literature review, data collection and summarizing using a codebook developed by a 3-person research team, linking of findings to current research, and final interpretations. Results We discovered 3 themes. Participants discussed concussion perceptions by describing their understanding of a concussion, their own injury experiences, and their perceptions of symptom severity and duration. Regarding reporting behavior, participants described an order of individuals with whom they would speak, symptoms present in order to report (eg, feeling different from normal), immediate reactions, and influential factors for mitigating short- and long-term consequences. Lastly, participants discussed the value of support systems, such as how coaches can both positively and negatively influence reporting and athletic trainer involvement. Conclusions Participants often drew from their own concussion experiences in naming common concussion signs and symptoms. Additionally, they indicated that both short- and long-term health consequences influenced and deterred their seeking care and that their support systems, including coaches and athletic trainers, played a role in their concussion experience. Research is needed to determine if using student-athletes' own words to describe a concussion and incorporating student-athletes' support systems, especially coaches and athletic trainers, is effective in increasing concussion reporting.

Background Ensuring the highest quality of surgical training remains a challenge as demands on health service provision rise. This study aimed to explore the differences and potential conflicts between service provision and dedicated training activity provided by surgical trainees, and recommend solutions. Methods Participants were drawn from the Association of Surgeons in Training (ASiT) national council. Nominal Group Technique (NGT) was employed by members of the ASiT executive addressing 3 key domains (1) defining differences between training and service tasks, (2) impact of service-provision on training and (3) ways to improve training. A two-round Delphi process was conducted via electronic survey to ASiT council. Consensus was considered achieved for any statement where 80% or more of respondents indicated agreement. Results 47 statements were generated through NGT which were put to the Delphi process. Consensus was reached on a total of 24/47 statements. Educational or training tasks were identified as being activities which progressed a trainee's skill set, could be tailored to a trainee's own ability, and involved acting as a trainer to more junior colleagues. The negative impact of excess service provision included training quality, trainee mental health, and surgical trainee recruitment. Potential measures to improve training included increasing hospital staffing and resources, protected training times, trainee-specific or competency-based learning and training or incentivising trainers. Conclusion This trainee-based study provides several consensus recommendations on the characteristics that define surgical training and how a balance between service provision and training can potentially be achieved. Policy makers and health systems may be guided by these to ensure high quality training and a satisfied workforce.

Seated postural abilities are critical to functional independence and participation in children with cerebral palsy, Gross Motor Functional Classification System (GMFCS) levels III-IV. In this proof-of-concept study, we investigated the feasibility of a motor learning–based seated postural training with a robotic Trunk-Support-Trainer (TruST) in a longitudinal single-subject-design (13y, GMFCS IV), and its potential effectiveness in a group of 3 children (6-14y, GMFCS III-IV). TruST is a motorized-cable driven belt placed on the child’s trunk to exert active-assistive forces when the trunk moves beyond stability limits. TruST-intervention addresses postural-task progression by tailoring the assistive-force fields to the child’s sitting balance to train trunk control during independent short-sitting posture. TruST-intervention consisted of 2 training blocks of 6 2hour-sessions per block (3 sessions per week). Pelvic strapping was required in the 1(st) block to prevent falls. As primary outcomes, we used the modified functional reach test, gross motor function measure-item set (GMFM-IS), Box & Blocks, and postural kinematics. After TruST-intervention children did not require pelvic strapping to prevent a fall, improved trunk stability during reaching (baseline = 5.49cm, 1week post-training = 16.38cm, 3mos follow-up = 14.63cm, p < 0.001) and increased their sitting workspace (baseline = 127.55cm(2), 1week post-training, = 409.92cm(2), 3mos follow-up = 270.03cm(2), p < 0.001). Three children also improved in the GMFM-IS. In summary, our novel robotic TruST-intervention is feasible and can effectively maximize functional independent sitting in children with CP GMFCS III-IV.

BACKGROUND Tennis is an open-skill sport in which the athletes have a short period of time to elaborate all the information coming from the surrounding environment and produce a motor answer based on them. The aim of this study was divided in two hypotheses: (1) to assess if belonging to a certain category, athlete or non-athlete, older or younger, can affect the development of reaction time on children and (2) if a protocol based on visual training (VT) of 6 weeks could improve the motor performance on the field in young tennis players using FitLight Trainer. METHODS In this evidence a group of young children (N=40) have been tested on light board through reaction test then some young tennis players (N=15, age: 7-12 years old) were taken as reference for the second hypothesis. They were divided in two groups: 7 of them were in the group Under-10 (U10) while 8 in a second group (U12). They performed a VT protocol once a week for at least 40 minutes for 6 weeks. They were tested at baseline (T0) and follow-up (T6) to evaluate the reaction time, time in specific lateral shift and precision about forehand and backhand. RESULTS The development of reaction time of the athletes is principally caused by their growth (p

Context Secondary school administrators fulfill many leadership roles, including creating and implementing policies to help ensure the safety of athletic programs. However, few researchers have examined principals' awareness and perceptions of the athletic trainer's (AT's) role. Objective To explore secondary school principals' knowledge of the roles and responsibilities of ATs and perceptions of athletic training. Design Concurrent mixed-methods study. Setting Cross-sectional online questionnaire. Patients or Other Participants Principals (n = 686; age = 48.1 ± 7.8 years, time in position = 7.1 ± 5.8 years) represented public secondary schools across the United States. Main Outcome Measure(s) The web-based questionnaire was composed of demographics, various quantitative items assessing knowledge and perceived value of ATs, and open-ended questions. Descriptive statistics summarized demographic data. Select quantitative measures are reported as count responses and overall percentages. Responses to open-ended questions were analyzed inductively. Results We obtained a 5% response rate (686 of 13 517). Approximately 93% (n = 637) of responding principals considered an AT to be a trusted source of medical information. The most frequently selected skills they believed ATs were qualified to perform were injury prevention (99.1%), first aid/wound care (96.5%), and therapeutic intervention (91.4%). Sixty-three percent (n = 430) of participants considered an AT to be extremely valuable to student-athlete health and safety. Our results indicated that secondary school principals had a vague understanding of AT “training” and appreciated the immediacy of care ATs could provide. They also appeared to use decentralized hiring practices. Conclusions Secondary school principals identified ATs as a trusted source of medical information and recognized the role ATs played in the immediate care of athletic-related injuries. However, principals had a limited understanding of the qualifications and educational requirements of ATs. Future professional advocacy efforts targeting this stakeholder group should highlight all medical services an AT provides and emphasize the AT's value in schools that sponsor athletics programs.

Objective Examine the concordance of perceived operative autonomy between attendings and resident trainees. Design Faculty and trainees rated trainee operative autonomy using the 4-level Zwisch scale over a variety of cases and training years. The respective ratings were then compared to explore the effects of experience, gender, case complexity, trainee, trainer, and other covariates to perceived autonomy. Setting This study was conducted over 14 general surgery programs in the United States, members of the Procedural Learning and Safety Collaborative. Participants Participants included faculty and categorical trainees from 14 general surgery programs. Results A total of 8681 observations was obtained. The sample included 619 unique residents and 457 different attendings. A total of 598 distinct procedures was performed. In 60% of the cases, the autonomy ratings between trainees and attendings were concordant, with only 3.5% of cases discrepant by more than 1 level. An autonomy perception gap was modeled based on the discrepancy between the trainee and attending Zwisch ratings for the same case. The mean Zwisch score expected for a trainee was lower than the attending across all scenarios. Trainees were more likely to perceive relatively more autonomy in the second half of the year. The autonomy perception gap decreased with increasing case complexity. As trainees gained experience, the perception gap increased with trainees underestimating autonomy. Conclusions Trainees and attendings generally demonstrated concordance on autonomy perception scores. However, in 40% of cases, a perception gap exists between trainee and attending with the trainee generally underestimating autonomy. The gap worsens as the trainee progresses through residency. This perception gap suggests that attendings and trainees could be better aligned on teaching goals and expectations.

Purpose In laparoscopic surgery training, experts guide novice physicians to desired instrument positions or indicate relevant areas of interest. These instructions are usually given via verbal communication or using physical pointing devices. To facilitate a sterile work flow and to improve training, new guiding methods are needed. This work proposes to use optical see-through augmented reality to visualize an interactive virtual pointer on the laparoscopic. Methods After an interdisciplinary development, the pointer’s applicability and feasibility for training was evaluated and it was compared to a standard condition based on verbal and gestural communication only. In this study, ten surgical trainees were guided by an experienced trainer during cholecystectomies on a laparoscopic training simulator. All trainees completed a virtual cholecystectomy with and without the interactive virtual pointer in alternating order. Measures included procedure time, economy of movement and error rates. Results Results of standardized variables revealed significantly improved economy of movement (p = 0.047) and error rates (p = 0.047), as well as an overall improved user performance (Total z-score; p = 0.031) in conditions using the proposed method. Conclusion The proposed HoloPointer is a feasible and applicable tool for laparoscopic surgery training. It improved objective performance metrics without prolongation of the task completion time in this pre-clinical setup.

A discussion of five prevalent tensions in phenomenological interviewing and ways to diminish them. A rigorous interviewer training program for novices is presented, grounded in the philosophy of Merleau-Ponty, and delivered in the context of a transdisciplinary phenomenology research group that provides constructive critique and mentoring.Discussion Paper.Personal experience as a trainer of novice researchers for over 25 years, and classic and contemporary literature on phenomenological research methodology and interview technique.Phenomenological methodology is one of the most widely used research approaches across the globe in nursing and other human science disciplines. Current nursing literature contains reports in which a phenomenological approach is espoused, but the procedures are not consistent with the tenets of phenomenological philosophy. In particular, problems related to interview technique are evident. Interview training is essential for development of skill in eliciting comprehensive descriptions of the phenomena of concern to nurses, such as chronic pain and spiritual distress. Enhancing nurses' understanding of these phenomena ultimately impacts the provision of sensitive and compassionate care.Tensions in phenomenological interviewing can be diminished by trainee grounding in phenomenological philosophy, bracketing and pilot interviews, constructive peer critique, and guidance of research mentors.Problems in interview technique indicate the need to provide novice interviewers with rigorous training. A richly evocative interview is critical for powerful, credible, phenomenological research. This paper makes a unique contribution by identifying five tensions confronting the phenomenological interviewer, and ways to diminish them. Principles of the interviewer training program can be replicated in other locales by supervisors of student research in nursing and other human sciences.目标: 现象学采访中五种常见的紧张关系及其消除方法的讨论。以梅洛-庞蒂的哲学为基础,在跨学科现象学研究小组的背景下,提供建设性的批评和指导,为初学者提供了严格的采访者培训计划。 设计: 讨论性论文。 数据来源: 拥有作为新手研究人员培训师25年以上的个人经验,以及借助有关于现象学研究方法和采访技巧的经典和当代文献。 对护理的启示: 现象学方法是护理学和其他人文科学学科中应用最广泛的研究方法之一。目前的护理文献中有一些报道支持现象学的方法,但是这些方法并不符合现象学哲学的原则。尤其是采访技巧方面的问题,尤为显著。采访培训对于培养全面描述护士关注的现象(如慢性疼痛和精神痛苦)的技能至关重要。提高护士对这些现象的了解最终影响到提供敏感而富有同情心的护理。 结论: 现象学采访中的紧张关系可以通过受训者扎根于现象学哲学、括号和试验性采访、建设性的同行批评和研究导师的指导而得到缓解。 影响: 采访技巧方面的问题表明,需要为采访新手提供严格的培训。富有启发性的采访对于强有力、可信、现象学研究至关重要。本文通过识别现象学采访者所面临的五种紧张关系,以及消除紧张的方法,提供具有独特贡献度的观点。采访者培训计划的原则可以供其他地方由护理和其他人文科学领域的学生研究主管照搬使用。.

OBJECTIVE: Develop and describe a set of low-cost hemorrhoidectomy task trainer prototypes in the setting of inadequate junior resident surgical skill preparation for anorectal cases. DESIGN: This is a study comparing expert and novice performance and opinions. Three task trainers were developed to simulate dissecting, knot-tying, and suturing in a confined space, like the anus. Participants were asked to dissect the peel off of an orange, tie seven 2-handed knots on a weight, and close a defect in a piece of felt with a running stitch. An 8 oz mason jar was used to simulate the confined space. in an 8oz mason jar. Participants were asked to fill out a 5-point Likert-based evaluation regarding the skills. The primary outcome was time to complete each task in seconds. Secondary outcome measures were number of errors associated with each task, subjective achievability of tasks, and utility of tasks for improving surgical skills. SETTING: General surgery residency program at a safety-net academic center PARTICIPANTS: Forty subjects participated in this study. There were 20 experts (seven attending surgeons, thirteen PGY-1 - PGY-5 surgical residents) and 20 novices (eleven 3rd and nine 4th year medical students). RESULTS: Experts knot-tied (59s vs 140s, p

With telehealth gaining acceptance as a service delivery method, behavior analysts are now providing services to individuals worldwide. This review highlights the cultural adaptations used in ABA-based telehealth treatments for individuals with ASD outside of the United States. Nine studies met our inclusion criteria and the data were synthesized narratively. All studies reported some type of cultural adaptation, with most studies reporting changes made to the service delivery method. This included using translated materials; training in the language of the client; and matching the trainer in birthplace, ethnicity, or gender with the participants. The adaptations described in published research can serve as a resource for behavior analysts who have interest in global telehealth services. However, given the emerging nature of this area of research, it is challenging to know which adaptations are necessary to achieve optimal outcomes. The review concludes with ideas for research development in this area.

ObjectiveAnaphylaxis is a severe, potentially fatal allergic reaction best treated with intramuscular epinephrine via epinephrine auto-injectors (AAIs). Our published concerns over laceration injuries to young children associated with AAIs led to this service evaluation of the two administration methods: swing and jab (S&J) and place and press (P&P), to determine potential laceration risk.DesignA trainer EpiPen was used with facepaint placed in the needle indentation which would record the length of movement of the AAI. The two different methods ‘administered’ were alternated. Children were asked to move their leg to simulate a withdrawal reaction. Age, whether they moved, and length of paint mark were recorded.SettingOutpatients waiting area in Noah’s Ark Children’s Hospital, Cardiff.ParticipantsChildren aged 5–11 with no prior knowledge of AAI use.InterventionNo intervention was implemented.Results135 children (mean age 8 years; range 5–11 years) were asked to participate; measurements were taken from 100 children. 50 children moved for one or both methods. For those that moved, S&J mean paint length=8.3 mm (SD 17.4, 95% CI 3.4 to 13.3), P&P mean=3.5 mm (SD 11.0, 95% CI 0.4 to 6.6). Mean difference between methods was 4.8 mm (SD 10.1, 95% CI 1.9 to 7.7). Slightly more children moved for S&J (44) compared with 38 for P&P.ConclusionsS&J produces more movement and longer paint marks than P&P. The risk of laceration when administering an EpiPen to young children may be lower by using the more controlled P&P. We feel it is advisable to teach P&P instead in children below 11 years of age.

Background Technological progress has enabled the provision of personalised feedback across multiple dimensions of physical activity that are important for health. Whether this multidimensional approach supports physical activity behaviour change has not yet been examined. Our objective was to examine the effectiveness of a novel digital system and app that provided multidimensional physical activity feedback combined with health trainer support in primary care patients identified as at risk of chronic disease. Methods MIPACT was a parallel-group, randomised controlled trial that recruited patients at medium (≥10 and n = 120) received personal multidimensional physical activity feedback using a customised digital system and web-app for 3 months plus five health trainer-led sessions. All participants received standardised information regarding physical activity. Control group participants (n = 84) received no further intervention. The primary outcome was device-based assessment of physical activity at 12 months. Results Mean intervention effects were: moderate-vigorous physical activity: -1.1 (95% CI, − 17.9 to 15.7) min/day; moderate-vigorous physical activity in ≥10-min bouts: 0.2 (− 14.2 to 14.6) min/day; Physical Activity Level (PAL): 0.00 (− 0.036 to 0.054); vigorous physical activity: 1.8 (− 0.8 to 4.2) min/day; and sedentary time: 10 (− 19.3 to 39.3) min/day. For all of these outcomes, the results showed that the groups were practically equivalent and statistically ruled out meaningful positive or negative effects (>minimum clinically important difference, MCID). However, there was profound physical activity multidimensionality, and only a small proportion (5%) of patients had consistently low physical activity across all dimensions. Conclusion In patients at risk of cardiovascular disease and/or type II diabetes, MIPACT did not increase mean physical activity. Using a sophisticated multidimensional digital approach revealed enormous heterogeneity in baseline physical activity in primary care patients, and practitioners may need to screen for low physical activity across dimensions rather than rely on disease-risk algorithms that are heavily influenced by age. Trial registration This trial is registered with the ISRCTN registry (ISRCTN18008011; registration date 31 July 2013).

Joint dislocations account for a small but important portion of all athletic injuries, with most occurring at the glenohumeral, patellofemoral, and interphalangeal joints. Athletic trainers are responsible for managing acute joint-dislocation injuries, which may include performing closed-reduction techniques when appropriate. To achieve optimal patient outcomes, the clinician should be formally trained and skilled in performing various techniques and familiar with the evidence supporting the selection of each technique. In this clinical review, we outline general reduction procedures and then summarize and synthesize the existing literature on common closed-reduction techniques for glenohumeral-, patellofemoral-, and interphalangeal-joint dislocations. When appropriate, the content has been adapted to be specific to the athletic trainer's scope of practice.