Planning and managing a complex multisite study in the age of technology

A 2-year long, multisite research study that evaluated cardiopulmonary resuscitation skill decay among nursing students was conducted at 10 schools of nursing across the United States. The study was conducted in two phases and required carefully timed sessions for skill performance. Multisite studies in nursing education need to be carefully planned. Time delays should be anticipated with processes and Institutional Review Board protocols across sites. All team members were trained and consistently supported during the entire study. While challenges and obstacles were identified, innovative solutions were implemented that assisted the research team to successfully complete the study. The use of new and existing technology allowed the team to surmount many of the challenges encountered in this study. The purpose of this article is to describe the logistics, processes, challenges, and lessons learned related to conducting a complex multisite study.

Motor learning outcomes of handrim wheelchair propulsion during active spinal cord injury rehabilitation in comparison with experienced wheelchair users

PURPOSE

To investigate changes in wheelchair propulsion technique and mechanical efficiency across first five weeks of active inpatient spinal cord injury rehabilitation and to compare the outcomes at discharge with experienced wheelchair users with spinal cord injury.

METHODS

Eight individuals with recent spinal cord injury performed six weekly submaximal exercise tests. The first and last measurement additionally contained a wheelchair circuit and peak graded exercise test. Fifteen experienced individuals performed all above-mentioned tests on one occasion.

RESULTS

Mechanical efficiency and propulsion technique did not change during the five weeks of inpatient rehabilitation. Peak power output during peak graded test and performance time on the wheelchair circuit improved between the first and the last week. No difference in propulsion technique, peak power output, and performance time was found between the persons with a recent injury and the experienced group. Mechanical efficiency was higher after the correction for the difference in relative power output in the experienced group.

CONCLUSION

The group with a recent injury did not improve mechanical efficiency and propulsion technique over the period of active rehabilitation, despite significant improvements on the wheelchair circuit and in work capacity. The only significant difference between the groups was found in mechanical efficiency.Implications for rehabilitationThe lack of time-dependent changes in mechanical efficiency and propulsion technique in the group with a recent spinal cord injury, combined with the lack of differences in technique, work capacity and on the wheelchair circuit between the groups, suggest that important adaptations of motor learning may happen even earlier in rehabilitation and emphasize that the group in active rehabilitation was relatively skilled.Standardized observational analyses of handrim wheelchair propulsion abilities during early spinal cord injury rehabilitation provide detailed understanding of wheelchair technique, skill as well as wheelchair propulsion capacity.Measurement of external power output is critical to interpretation of gross efficiency, propulsion technique, and capacity.Wheelchair quality and body weight - next to wheelchair fitness and skill - require careful consideration both in early rehabilitation as well as in the chronic phase of spinal cord injury.

Interindividual differences in gray and white matter properties are associated with early complex motor skill acquisition

Brain circuits mediate but also constrain experience-induced plasticity and corresponding behavioral changes. Here we tested whether interindividual behavioral differences in learning a challenging new motor skill correlate with variations in brain anatomy. Young, healthy participants were scanned using structural magnetic resonance imaging (T1-weighted MPRAGE, n = 75 and/or diffusion-weighted MRI, n = 59) and practiced a complex whole-body balancing task on a seesaw-like platform. Using conjunction tests based on the nonparametric combination (NPC) methodology, we found that gray matter volume (GMV) in the right orbitrofrontal cortex was positively related to the subjects' initial level of proficiency and their ability to improve performance during practice. Similarly, we obtained a strong trend toward a positive correlation between baseline fractional anisotropy (FA) in commissural prefrontal fiber pathways and later motor learning. FA results were influenced more strongly by radial than axial diffusivity. However, we did not find unique anatomical correlates of initial performance and learning to rate. Our findings reveal structural predispositions for successful motor skill performance and acquisition in frontal brain structures and underlying frontal white matter tracts. Together with previous results, these findings support the view that structural constraints imposed by the brain determine subsequent behavioral success and underline the importance of structural brain network constitution before learning starts.

Co-adaptive Training Improves Efficacy of a Multi-Day EEG-Based Motor Imagery BCI Training

Motor imagery (MI) based brain computer interfaces (BCI) detect changes in brain activity associated with imaginary limb movements, and translate them into device commands. MI based BCIs require training, during which the user gradually learns how to control his or her brain activity with the help of feedback. Additionally, machine learning techniques are frequently used to boost BCI performance and to adapt the decoding algorithm to the user's brain. Thus, both the brain and the machine need to adapt in order to improve performance. To study the utility of co-adaptive training in the BCI paradigm and the time scales involved, we investigated the performance of two groups of subjects, in a 4-day MI experiment using EEG recordings. One group (control, n = 9 subjects) performed the BCI task using a fixed classifier based on MI data from day 1. In the second group (experimental, n = 9 subjects), the classifier was regularly adapted based on brain activity patterns during the experiment days. We found that the experimental group showed a significantly larger change in performance following training compared to the control group. Specifically, although the experimental group exhibited a decrease in performance between days, it showed an increase in performance within each day, which compensated for the decrease. The control group showed decreases both within and between days. A correlation analysis in subjects who had a notable improvement in performance following training showed that performance was mainly associated with modulation of power in the α frequency band. To conclude, continuous updating of the classification algorithm improves the performance of subjects in longitudinal BCI training.

Gaze Behavior in Basketball Free Throws Developed in Constant and Variable Practice

There are a limited number of studies focusing on the mechanisms explaining why variable practice gives an advantage in a novel situation and constant practice in performance in trained conditions. We hypothesized that this may be due to the different gaze behavior that is developed under different conditions. Twenty participants, randomly assigned to two different groups, practiced basketball free throws for three consecutive days, performing 100 throws per day. The constant group (n = 10) practiced at a free throw distance (4.57 m) only. The variable practice group (n = 10) randomly performed 20 shots per five throw distances (3.35, 3.96, 4.57, 5.18, and 5.79 m) on each day, also accumulating 100 shots per day. We analyzed the total gaze fixation duration, a number of fixations, and the average fixation duration on a basketball rim in a pretest and posttest at the 4.57 m distance. We computed a linear mixed model with test (pretest–posttest), group (constant–variable), and test × group interaction in order to analyze the total fixation duration and number of fixations. The average fixation duration was analyzed with a repeated measure two-way ANOVA, with practice conditions as a between-participants factor and test type as a within-participants factor. We found that the total fixation duration increased significantly in the posttest, regardless of the practice conditions (p < 0.001, effect size = 0.504). The number of fixations also increased significantly in the posttest (p = 0.037, effect size = 0.246). The average fixation duration increased in both groups; however, insignificantly. We also did not find any significant differences between groups. Our results suggest that variable and constant practice conditions may lead to the development of similar gaze behavior.

Assessing likelihood of using the Bruininks-Oseretsky test of motor proficiency to predict preclinical performance of dental students

Objective

The acquisition of motor skills is a key competency for the practice of dentistry, and innate abilities have been shown to influence motor performance. Thus, finding the most efficient manual dexterity tests may predict performance of dental students. The current study used the Bruininks-Oseretsky Test of Motor Proficiency, to assess motor skills of first year (D1) and second year (D2) dental students.

Materials and methods

Three fine motor subsets of the BOT-2-fine motor precision, fine motor integration, and manual dexterity-were administered to D1 and D2 dental students in 2017 and 2018. The BOT-2 subset scores of D1 students were compared with those of D2 students, who had preclinical dental experiences. For D2 students, we tested for correlations between BOT-2 subset scores and performance scores in a preclinical operative dentistry course.

Results

No differences were found between D1 and D2 students for any BOT-2 subtest scores (all Ps > .09). No correlations were found between total scores of each BOT-2 subtest and the operative dentistry course for D2 students (all Ps > .20).

Conclusions

Our results suggested the BOT-2 was not predictive of manual skills of dental applicants or preclinical dental students. Although we assumed students would perform well with instruction, practice, and feedback, we were unable to determine whether innate abilities influenced acquisition of manual dexterity skills. More research about the acquisition of technical clinical skills in dentistry is required.

Lessons From the Experts: The Effect of a Cognitive Processing Intervention During Deliberate Practice of a Complex Task

Deliberate practice is defined as an activity that is highly relevant to improving performance. It is effortful, challenging, not inherently enjoyable, or immediately rewarding and underpinned by advanced cognitive processing. The authors examine the effect of increasing cognitive processing during deliberate practice on skill learning in intermediate-level performers using a novel approach and quasi-experimental design. Two matched groups of intermediate-level Gaelic football players practiced a kick they identified as being most relevant to improving performance during an acquisition phase and pre-, post-, and retention tests. During acquisition, participants rated practice for cognitive effort and enjoyment. An intervention group engaged in structured cognitive processing before, during, and after the kicking practice sessions, whereas a control group did not. Both groups improved kicking accuracy across pre-, post-, and retention tests; however, the intervention group improved accuracy significantly more than the control group. The intervention group rated practice greater for mental effort compared with the control group, while both groups rated practice low for enjoyment. The intervention group increased reflection and evaluation to a greater degree following practice compared with the control group. Findings highlight the value of applying the principles of deliberate practice and increasing cognitive processing to expedite learning in intermediate-level performers, with implications for skill learning across many professional domains.

Examining the Pathway to Motor Skill Competence in a Mastery Motivational Climate: An Appreciative Inquiry

Purpose: This study followed a strengths-based approach to identify the pathway children follow as they develop from novice to skillful learners during a mastery-motivational physical education setting. Method: Eleven 4-year-old children (nine boys) participated in a motor activity program delivered twice weekly across 26 weeks. The teacher participated in monthly 30-45-min interviews that sought to identify the critical moments of the program as it had progressed to that point in time. Photographic images of the children's experiences in the climate acted as prompts during interviews. Interview transcripts were subject to a deductive analysis in which the ideas of "what was working well" and "what the future might look like" were the initial categories. Results: Interview and photo analyses revealed that the children moved through three phases on their pathway towards mastery. In phase 1, "captivation" and "exploration," the children presented the teacher with challenges in developing the managerial system. In phase 2, "cooperation" and "consolidation," there was significantly less task modification and more time in deliberate practice. In phase 3, "dedication" and "collaboration," the children began to actively seek out the teacher as a resource to help them learn. Conclusions: The identification of critical teaching behaviors during the program adds support for our contention that the teacher is a critical component in helping children advance along the pathway of mastery when placed in an autonomy-supportive climate. These are allowing time for exploration and experiencing freedom, adding structure, and helping students learn to manage themselves.

Comparing skill acquisition under varying onsets of differential reinforcement: A preliminary analysis

The purpose of the current study was to evaluate the effect of implementing differential reinforcement at different times relative to the onset of teaching new skills to learners with autism spectrum disorder. Specifically, we first determined the most efficient differential reinforcement arrangement for each participant. Using the most efficient arrangement, we evaluated if differential reinforcement from the immediate onset, early onset, or late onset is the most efficient for learners to acquire a new skill. Three children diagnosed with autism spectrum disorder who have a history of receiving intervention based on the principles of applied behavior analysis participated in this study. The immediate onset of differential reinforcement resulted in the most efficient instruction in 6 of 7 comparisons. The results are discussed in light of previous studies and suggestions for future research are provided.

Optimizing Performative Skills in Social Interaction: Insights From Embodied Cognition, Music Education, and Sport Psychology

Embodied approaches to cognition conceive of mental life as emerging from the ongoing relationship between neural and extra-neural resources. The latter include, first and foremost, our entire body, but also the activity patterns enacted within a contingent milieu, cultural norms, social factors, and the features of the environment that can be used to enhance our cognitive capacities (e.g., tools, devices, etc.). Recent work in music education and sport psychology has applied general principles of embodiment to a number of social contexts relevant to their respective fields. In particular, both disciplines have contributed fascinating perspectives to our understanding of how skills are acquired and developed in groups; how musicians, athletes, teachers, and coaches experience their interactions; and how empathy and social action participate in shaping effective performance. In this paper, we aim to provide additional grounding for this research by comparing and further developing original themes emerging from this cross-disciplinary literature and empirical works on how performative skills are acquired and optimized. In doing so, our discussion will focus on: (1) the feeling of being together, as meaningfully enacted in collective musical and sport events; (2) the capacity to skillfully adapt to the contextual demands arising from the social environment; and (3) the development of distributed forms of bodily memory. These categories will be discussed from the perspective of embodied cognitive science and with regard to their relevance for music education and sport psychology. It is argued that because they play a key role in the acquisition and development of relevant skills, they can offer important tools to help teachers and coaches develop novel strategies to enhance learning and foster new conceptual and practical research in the domains of music and sport.

Identifying the Essential Portions of the Skill Acquisition Process Using Item Response Theory

OBJECTIVE

Item response theory (IRT) was originally developed to make performance assessments more accurate. However, IRT analysis of the intraoperative performance of surgical trainees could help identify the elements that the trainees find difficult during the skill acquisition process. The aim of this study was to identify the essential portions of the skill acquisition process of a surgical procedure using the IRT.

DESIGN

The 24-item assessment checklist was used to evaluate a recorded intra-operative performance of a laparoscopic inguinal hernia repair. The scores were analyzed using IRT to calculate the difficulty and discrimination level of each item.

SETTING

Fifteen institutes.

PARTICIPANTS

Thirty surgical trainees.

RESULTS

A total of 123 assessments were analyzed. The item analysis showed the procedure specific item "traction of peritoneum (difficulty: -0.45; discrimination: 19.37)" and generic items "instrument handling (difficulty: -0.59; discrimination: 3.82)" and "flow of procedure (difficulty: 0.09; discrimination: 3.27)" to be key elements in the skill acquisition process of the procedure.

CONCLUSIONS

Key elements in the skill acquisition process of the procedure were quantitatively identified by applying the IRT analysis. This could lead to the use of IRT in designing and developing a more effective training curriculum.

Reciprocal intralimb transfer of skilled isometric force production

Motor control theories propose that the same motor plans can be employed by different effectors (e.g., the hand and arm). Skills learned with one effector can therefore "transfer" to others, which has potential applications in clinical situations. However, evidence from adaptation suggests this effect is not reciprocal; learning can be generalized from proximal to distal effectors (e.g., arm to hand), but not from distal to proximal effectors (e.g., hand to arm). We propose that skill learning may not follow the same pattern, because it relies on multiple learning processes beyond error detection and correction. Participants learned a skill task involving the production of isometric forces. We assessed their ability to perform the task with the hand and arm. One group then trained to perform the task using only their hand, whereas a second group trained using only their arm. In a final assessment, we found that participants who trained with either effector improved their skill in performing the task with both their hand and arm. There was no change in a control group that did not train between assessments, indicating that gains were related to the training, not the multiple assessments. These results indicate that in contrast to adaptation, motor skills can generalize from both proximal to distal effectors and from distal to proximal effectors. We propose this is due to differences in the processes underlying skill acquisition as compared with adaptation. NEW & NOTEWORTHY Prior research indicates that motor learning transfers from proximal to distal effectors, but not vice versa. However, this work focused on adapting existing behavior; we questioned whether different results would occur during learning of new motor skills. We found that the benefits of training on a skill task with either the hand or arm transferred across both effectors. This highlights important differences between adaptation and skill learning, and may allow therapeutic benefits for patients with impairments in specific effectors.

Differences between Elite and Semi-Elite Australian Football Conceptualised through the Lens of Ecological Dynamics

This study explored the differences in match play between elite and semi-elite Australian football (AF) conceptualised through the lens of ecological dynamics. We sampled naturalistic constraints from match play across two AF competitions (elite and semi-elite) and heuristically classified them into task, environmental and individual classes. Data was extracted from 22 Australian Football League (AFL) games, and 18 semi-elite AF games, with a total of six constraints being sampled from each game. Match play within the AFL generated a greater percent of total disposals in general play within a processing time of 0–1s (d = 1.24 (0.64–1.80)), a greater opposition density surrounding the ball carrier (d = 0.82 (0.26–1.37)), and more disposals being performed while running (dynamic; d = 0.89 (0.33–1.45)). This data highlights differences with regards to the informational sources available to players across both competition standards to inform their movement choices. Specifically, a greater proportion of disposals within the AFL appear to be shaped by pronounced temporal and spatial constraints relative to a semi-elite competition. Coaches are encouraged to consider these results when developing representative training activities for both AFL and prospective AFL players.

A training intervention for home care nurses in cross-cultural communication: An evaluation study of changes in attitudes, knowledge and behaviour

AIMS

To assess whether a training intervention in cross-cultural communication can positively impact attitudes, knowledge and behaviour and to investigate possible dependencies between these components.

DESIGN

(Controlled) longitudinal multimethod evaluation.

METHODS

A training based on theoretical considerations and informed by semi-standardized interviews with home care nurses was developed and evaluated. Participants rated their cross-cultural attitudes, knowledge and behaviour and answered case vignettes assessing their knowledge before and after this training. Shift observations assessed behaviourial aspects at t1 and t2. Data were collected between June 2016-March 2017 and between April 2017-November 2017. Analyses of variance and multiple linear regression models were employed.

RESULTS

The training showed promising tendencies with cross-cultural attitudes, knowledge and behaviour with diverging results for initially quite high self-reports showing positive but mostly not significant developments and objective assessments mostly showing significant positive changes. There were significant associations between self-reported cross-cultural behaviour at t1 and objective cross-cultural knowledge at t2, whereas self-rated and objectively assessed knowledge showed no significant associations. Shift observations showed significant positive developments in participants' communication behaviour.

CONCLUSION

Our study shows the importance of using different methods and targeting different outcomes areas to rate impacts of (cross-cultural) training interventions. Future studies should consider challenging conditions in home care nursing affecting the success of interventions and investigate mechanisms of skill acquisition in nursing.

IMPACT

This is one of very few studies using multi-method approach to evaluate a cross-cultural competency intervention and simultaneously assess cross-cultural attitudes, knowledge and behaviour including possible dependencies between these aspects.

How actual motor competence and perceived motor competence influence motor-skill engagement of a novel cycling task

In early childhood, factors that contribute to motor-skill engagement (MSE) are unknown. Our aim was to explore the relationships between actual and perceived motor competence and their influences on MSE on a balance bike (bike with no pedals). A secondary aim was to investigate whether MSE had an effect on ability on a balance bike. This study comprised of 45 children (29% female) aged 4.5 ± 0.5 years. MSE was assessed using distance travelled on a balance bike over an 8-week period. Actual motor competence was assessed using the Movement Assessment Battery for Children, second edition. Perceived motor competence was assessed using the Pictorial Scale of Perceived Movement Skill Competence. Ability on a balance bike was measured using timed trials on a specifically designed track. Pearson product-moment correlations were used to assess relationships between actual and perceived motor competence and ability on a balance bike. Linear regressions were used to examine whether actual or perceived motor competence or ability on a balance bike predicted MSE. Repeated measures ANOVA was used to examine whether there was a difference in ability on a balance bike between three MSE groups over 8 weeks. No relationships were found, and none of the variables predicted MSE. There was a significant difference between the MSE groups on ability on a balance bike over time (P = 0.019). Investigating the contributors to MSE on a novel cycling task during early childhood provides knowledge to ensure children are given the best opportunities for practice and acquisition of skills.

Creating Appropriate Training Environments to Improve Technical, Decision-Making, and Physical Skills in Field Hockey

PURPOSE

The purpose of this study was to determine the influence of eight different small-sided games (SSG) on physical, technical, and decision-making demands of training environments in U14 field hockey.

METHODS

A total of 13 participants played eight different training games consisting of two 7.5-minute halves, where number of players (three per side or six per side) and/or field characteristics (normal game, cage hockey game, possession game, and two-goals game) was manipulated. Match performance was determined by using notational analysis, and physical demands were determined by using GPS analyses.

RESULTS

Findings revealed that lowering the number of players increased the number of technical actions performed per player and the physical demands of the SSG. Findings of the field characteristics manipulation revealed that the possession game forced players to control the ball more as a team, which resulted in more passes (+4.82 passes) and fewer dribbles (-1.48 dribbles) and tackles (-0.69 tackles) compared to the normal game. The two-goals game led to players scoring more goals (+0.61 goals) compared to the normal game, while the cage hockey game increased passing (+1.46 passes) and physical demands (+7.32 meters per minute) compared to the normal game.

CONCLUSION

It can be concluded from these findings that coaches and trainers are able to promote a change in playing behavior, and in turn the development of skills, by manipulating specific constraints of the training environment.

A Perceptual Framework for Conservative Treatment and Rehabilitation of Ankle Sprains: An Evidence-Based Paradigm Shift

Lateral ankle sprains are the most common injuries sustained during physical activity. The epidemiologic trends associated with chronic ankle instability (CAI) suggest that current rehabilitation approaches may be inadequate. We sought to synthesize best-practices evidence for the rehabilitation of patients with acute ankle sprains and CAI through the integration of emerging paradigms in perception, the dynamics of skill acquisition, and the biopsychosocial model of function, disability, and health. From the best available evidence, 4 key factors emerged for effective treatment and rehabilitation strategies: pain reduction, external ankle support for up to 1 year, progressive return to motion, and coordination training. We combined these factors into a meta-theoretical framework that centers on the perceptual interdependence of the cellular, local, and global functioning levels by linking insights from the body-self neuromatrix, the dynamics of skill acquisition, and the biopsychosocial model. Based on the best-practice recommendations from systematic reviews, ankle-sprain rehabilitation represents a multidimensional phenomenon governed by perception. The impairments, activity limitations, and participation restrictions associated with CAI may be linked to perceptual-interdependence alterations. Pain and edema reduction, the use of external ankle support for up to 1 year, progressive return to motion, and coordination training foster enhanced perceptual interdependence from cells to society. Using the perceptual-interdependence framework for ankle-sprain rehabilitation, we offer new insights for charting the course of effective strategies for enhancing function, reducing disability, and preventing the long-term sequelae associated with CAI.

Flow Experiences During Visuomotor Skill Acquisition Reflect Deviation From a Power-Law Learning Curve, but Not Overall Level of Skill

Flow is a state of "optimal experience" that arises when skill and task demands match. Flow has been well studied in psychology using a range of self-report and experimental methods; with most research typically focusing on how Flow is elicited by a particular task. Here, we focus on how the experience of Flow changes during task skill development. We present a longitudinal experimental study of learning, wherein participants (N = 9) play a novel steering-game task designed to elicit Flow by matching skill and demand, and providing clear goals and feedback. Experimental design involves extensive in-depth measurement of behavior, physiology, and Flow self-reports over 2 weeks of 40 game trials in eight sessions. Here we report behavioral results, which are both strikingly similar and strong within each participant. We find that the game induces a near-constant state of elevated Flow. We further find that the variation in Flow across all trials is less affected by overall performance improvement than by deviation of performance from the expected value predicted by a power law model of learning.

Physical Education Pedagogies Built upon Theories of Movement Learning: How Can Environmental Constraints Be Manipulated to Improve Children's Executive Function and Self-Regulation Skills?

Physical education in schools has been marginalised across the globe, and as a result, children are missing out on opportunities to develop and acquire the foundation skills needed to lead a physically active life. The squeeze on physical education in schools, particularly in some western countries (United Kingdom, Australia and America), has been justified on the grounds that core subjects such as English and mathematics need more curriculum time, as this will lead to higher cognitive and academic performance. The aim of this paper is to highlight how physical education lessons in early childhood, underpinned by either of two major theories of motor learning, can support teachers in the creation of learning environments, as well as guide their pedagogical practice to facilitate children's development of key cognitive skills, in particular executive function and self-regulation skills. These skills are crucial for learning and development and have been found to be a higher predictor of academic achievement than IQ. They also enable positive behaviour and allow us to make healthy choices for ourselves and others, therefore providing further evidence that the development of movement skills has the potential to secure positive attitudes and outcomes towards physical activity across the lifespan.

The application of inertial measurement units and functional principal component analysis to evaluate movement in the forward 3½ pike somersault springboard dive

Based on technological and analytical advances, the capability to more accurately and finitely examine biomechanical and skill characteristics of movement has improved. The purpose of this study was to use Inertial Measurement Units (IMUs) and Functional Principal Components Analysis (fPCA) to examine the role of movement variability (assessed via angular velocity), on 2 divers (1 international level; 1 national) performing the forward 3½ pike somersault dive. Analysis of angular velocity curves during ive-flight identified 5 fPCs, accounting for 96.5% of movement variability. The national diver's scatter plots and standard deviation of fPC scores illustrated larger magnitudes of angular velocity variability across dive flight. For fPC1 and fPC3, magnitudes of SD variability were 282.6 and 201.5, respectively. The international diver illustrated more consistent angular velocity profiles, with clustering of fPCs scores (e.g., fPC1 & 3 = SD's of 75.2 & 68.0). To account for lower variability in the international diver, the ability to better coordinate movement sequences and functionally utilise feedback in response to initiation of the somersault position is highlighted. Overall, findings highlight how both IMUs and fPCA can more holistically and finitely examine the biomechanical and skill characteristics of movement sequences with the capability to inform athlete development.

Applications of Future Technologies to Detect Skill Decay and Improve Procedural Performance

Medical simulation training has progressed in its use of incorporating various technologies to provide quality training interfaces from novices to experts. The purpose of this paper is to explore modeling, simulation and visualization training technology interfaces to improve precision learning, rigorous, objective assessment, and performance improvement feedback for clinical procedural skill training and sustainment. Technologies to include augmented reality (AR), haptic technology and computer vision will be defined and clarified. It is believed that by exploring the combination of using AR, haptics and computer vision technologies it is possible to develop a fully immersive learning system that can automate mentoring while detecting and measuring gross and fine motor skills. Such a system can be used to predict or delay the onset of skills decay (SD) by capturing rigorous, objective measures, and human performance metrics that can provide feedback to individual performers for skills improvement in real time.

The validity and reliability of the Basketball Jump Shooting Accuracy Test

The aim of this study was to examine the content validity, construct validity and reliability of the newly developed Basketball Jump Shooting Accuracy Test (BJSAT). Basketball athletes from different playing levels (State Basketball League [SBL], n = 30, age: 22.7 ± 6.1 yr; SBL Division I, n = 11, age: 20.6 ± 2.1 yr) completed four separate trials of the BJSAT with each trial consisting of shot attempts from two- and three-point distances at pre-determined court locations. Each shot attempt was scored utilising a criteria where higher scores were given when greater accuracy was exhibited. The BJSAT detected a significant, large difference in accuracy between two- and three-point shots (d = 0.99, p < 0.01). Relative reliability across the repeated trials was rated as moderate for all athletes (intraclass correlation coefficient [ICC] = 0.71, p < 0.01) and good for the SBL athletes (ICC = 0.78, p < 0.01). Absolute reliability for all athletes was above the acceptable benchmark (coefficient of variation = 16.2%); however superior to skill tests available in the literature. In conclusion, the BJSAT is sensitive to two- and three-point shooting accuracy and can reliably assess jump shooting accuracy in basketball athletes.

Early patterns of skill acquisition and immigrants' specialization in STEM careers

We provide empirical evidence of immigrants' specialization in skill acquisition well before entering the US labor market. Nationally representative datasets enable studying the academic trajectories of immigrant children, with a focus on high-school course-taking patterns and college major choice. Immigrant children accumulate skills in ways that reinforce comparative advantages in nonlanguage intensive skills such as mathematics and science, and this contributes to their growing numbers in science, technology, engineering, and math (STEM) careers. These results are compatible with well-established models of skill formation that emphasize dynamic complementarities of investments in learning.

Training to Proficiency in the WHO Hand Hygiene Technique

OBJECTIVES

Hand hygiene is critical to patient safety, but low performance in terms of the quantity and quality of hand hygiene is often reported. Training-to-proficiency is common for other clinical skills, but no proficiency-based training program for hand hygiene has been reported in the literature. This study developed a proficiency-based training program to improve hand hygiene quality in line with World Health Organization (WHO) guidelines and assessed the amount of training required to reach proficiency. The training was delivered as part of a 5-day induction for students on the Physician Assistant online program.

METHODS

A total of 42 students used a simulator to objectively measure hand hygiene technique over a 5-day period. Proficiency was achieved when students demonstrated all 6 steps of the WHO technique in less than 42 seconds. The students also completed a postintervention questionnaire.

RESULTS

The average training episode lasted 2.5 minutes and consisted of 4.5 hand hygiene exercises. The average student completed 5 training episodes (1 per day) taking a total of 17 minutes. A total of 40% (17) of the students achieved proficiency within the 5 days. Proficiency was strongly correlated with the number of training exercises completed (r = 0.79, P < .001) and the total time spent training (r = 0.75, P < .001). Linear regression predicted that the 32 hand hygiene exercises or a total of 23-minute training were required to achieve proficiency.

CONCLUSIONS

This is the first study to develop a train-to-proficiency program for hand hygiene quality and estimate the amount of training required. Given the importance of hand hygiene quality to preventing health care-associated infections (HAIs), medical education programs should consider using proficiency-based training in hand hygiene technique.

Exploring the Effectiveness of Immersive Video for Training Decision-Making Capability in Elite, Youth Basketball Players

Decision-making is an essential capability for success in team sport athletes. Good decision-making is underpinned by perceptual-cognitive skills that allow athletes to assess the environment and choose the correct choice from a number of alternatives. Previous research has demonstrated that decision-making can be trained "off-line" by exposing athletes to gameplay scenarios and having them make decisions based on the information presented to them. These scenarios are typically presented on television monitors or using life-size projections but recent advances in immersive video capabilities provide opportunities to improve the fidelity of training by presenting a realistic, 360° view of the competition environment. The purpose of this study was to assess the effectiveness of immersive video training and whether training would improve decision-making performance in elite, youth basketball players (male and female). A training group completed 10 or 12 immersive video (360° video presented in a head-mounted display) training sessions in which they viewed and responded to gameplay scenarios across 3-weeks while the control group only participated in their usual training routine. Performance was assessed on an immersive video test and during small-sided games (SSG). The male training group had a large, non-significant improvement on immersive test score (+4.0 points) and in the SSG (+5.8 points) compared to the male control group (+0.3 points and +1.0 points, respectively). While both the female control group (+9.7 points) and training group (7.4 points) had large improvements in the immersive training test, only the female control improved their performance in the SSG (+6.9 points). Despite the mixed findings, there may be benefit for using immersive video for training decision-making skill in team sports. The implications of these findings (e.g., gender of the actors used to create stimuli, variety of scenarios presented) and the limitations of the experiment are discussed.