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.

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.

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.

A review of error correction procedures during instruction for children with developmental disabilities

Error correction procedures are remedial strategies presented following an incorrect response that increases the probability that a correct response will occur in the future. Error correction is commonly used during skill acquisition programs for children with developmental disabilities; however, the specific strategy used may differ considerably. Recent comparative studies have examined the effect of numerous error correction procedures on the efficiency of acquisition for children with developmental disabilities. Despite considerable merit, minor procedural differences and unique terms for similar procedures likely affect comparisons across studies. Here, we clarify the procedures and findings of these studies and suggest areas of future research.

Emergence of Skilled Behaviors in Professional, Amateur and Junior Cricket Batsmen During a Representative Training Scenario

The aim of this study was to explore the emergence of skilled behaviors, in the form of actions, cognitions and emotions, between professional state level cricket batters and their lesser skilled counterparts. Twenty-two male cricket batsmen (n = 6 state level; n = 8 amateur grade club level, n = 8 junior state representative level) participated in a game scenario training session against right arm pace bowlers (n = 6 amateur senior club). The batsmen were tasked with scoring as many runs as possible during a simulated limited-overs game. The actions, cognitions, and emotions of each batsmen were recorded in situ with findings showing differences between state level players and those lesser skilled. State level batsmen played more scoring shots and scored more runs, underpinned by superior bat-ball contact and technical efficiency. Furthermore, the state player's cognitive evaluations of their own performance differed from junior batters, with more reported strategies based on an external outcome focus, such as where to score runs, rather than a focus on internal processes, such as making technical changes. State level batsmen also reported lower levels of nervousness compared with junior level batsmen. These results highlight the importance of viewing the emergence of skilled behavior as multi-faceted, rather than simply the acquisition of superior execution and technical proficiency.

How do paramedics learn and maintain the skill of tracheal intubation? A rapid evidence review

INTRODUCTION

Endotracheal intubation has been considered a core skill for all paramedics since the inception of the profession in the 1970s, and continues to be taught within the majority of pre-registration paramedic training programmes. However, the standards of both training and assessment of competence in intubation vary considerably between institutions; this has been compounded by reduced opportunities for supervised clinical practice within the operating theatre environment.The College of Paramedics' Airway Working Group commissioned a rapid evidence review, to inform a consensus statement on paramedic intubation, with the research question: How do paramedics learn and maintain the skill of tracheal intubation?

METHODS

Rapid evidence reviews are literature reviews that use methods to accelerate or streamline the traditional systematic review process. Randomised controlled trials, quasi-randomised controlled trials, prospective and retrospective observational studies, systematic reviews and qualitative studies, published from 1970 onwards, were all eligible for inclusion. The search was restricted to paramedics/paramedic students and learning/maintaining the skill of tracheal intubation.

RESULTS

A comprehensive search of CINAHL, MEDLINE and Google Scholar was undertaken. Ten papers were classed as sufficiently relevant for inclusion. They identified that there is no clear definition of a paramedic having 'learnt' the skill of intubation. Suggested measures include first-pass success of 90% for pre-hospital intubation, or a range of measures, such as intubation success and complication rates, laryngoscopy technique and decision-making. Intubation training should use a range of modalities, including didactic lectures, videos and practical sessions on multiple types of airway manikins. Supervision by experienced faculty is required.Little is known about how paramedics maintain their skill in intubation, given the lack of clinical opportunity. Yearly skills retraining can help, and can be enhanced by demonstrations/lectures from experienced faculty.

CONCLUSION

Further research is needed to understand how paramedics maintain their skill in intubation, given the limited opportunities to use the skill in a clinical setting and lack of opportunities with UK ambulance services for retraining.

Using an abbreviated assessment to identify effective error-correction procedures for individual learners during discrete-trial instruction

Previous research comparing the effectiveness of error-correction procedures has involved lengthy assessments that may not be practical in applied settings. We used an abbreviated assessment to compare the effectiveness of five error-correction procedures for four children with autism spectrum disorder or a developmental delay. During the abbreviated assessment, we sampled participants' responding with each procedure and completed the assessment before participants reached our mastery criterion. Then, we used the results of the abbreviated assessment to predict the most efficient procedure for each participant. Next, we conducted validation assessments, comparing the number of sessions, trials, and time required for participants to master targets with each procedure. Results showed correspondence between the abbreviated assessment and validation assessments for two of four participants and partial correspondence for the other two participants. Findings suggest that a brief assessment may be a useful tool for identifying the most efficient error-correction procedure for individual learners.

Temporal exploration in sequential movements shapes efficient neuromuscular control

The interaction of early and deliberate practice with genetic predisposition endows experts with virtuosic motor performance. However, it has not been known whether ways of practicing shape motor virtuosity. Here, we addressed this issue by comparing the effects of rhythmic variation in motor practice on neuromuscular control of the finger movements in pianists. With the use of a novel electromyography system with miniature active electrodes, we recorded the activity of the intrinsic hand muscles of 27 pianists while they played the piano and analyzed it by using a nonnegative matrix factorization algorithm and cluster analysis. The result demonstrated that practicing a target movement sequence with various rhythms reduced muscular activity, whereas neither practicing a sequence with a single rhythm nor taking a rest without practicing changed the activity. In addition, practice with rhythmic variation changed the patterns of simultaneous activations across muscles. This alteration of muscular coordination was associated with decreased activation of muscles not only relevant to, but also irrelevant to the task performance. In contrast, piano practice improved the maximum speed of the performance, the amount of which was independent of whether rhythmic variation was present. These results suggest that temporal variation in movement sequences during practice co-optimizes both movement speed and neuromuscular efficiency, which emphasizes the significance of ways of practice in the acquisition of motor virtuosity. NEW & NOTEWORTHY A key question in motor neuroscience is whether "ways of practicing" contribute to shaping motor virtuosity. We found both attenuation of activities and alteration of coordination of the intrinsic hand muscles of pianists, specifically through practicing a movement sequence with various rhythms. The maximum speed of the finger movements was also enhanced following the practice. These results emphasize the importance of ways of practicing in facilitating multiple skills: efficiency and speed.

Effects of Single Compared to Dual Task Practice on Learning a Dynamic Balance Task in Young Adults

Background: In everyday life, people engage in situations involving the concurrent processing of motor (balance) and cognitive tasks (i.e., “dual task situations”) that result in performance declines in at least one of the given tasks. The concurrent practice of both the motor and cognitive task may counteract these performance decrements. The purpose of this study was to examine the effects of single task (ST) compared to dual task (DT) practice on learning a dynamic balance task.

Methods: Forty-eight young adults were randomly assigned to either a ST (i.e., motor or cognitive task training only) or a DT (i.e., motor-cognitive training) practice condition. The motor task required participants to stand on a platform and keeping the platform as close to horizontal as possible. In the cognitive task, participants were asked to recite serial subtractions of three. For 2 days, participants of the ST groups practiced the motor or cognitive task only, while the participants of the DT group concurrently performed both. Root-mean-square error (RMSE) for the motor and total number of correct calculations for the cognitive task were computed.

Results: During practice, all groups improved their respective balance and/or cognitive task performance. With regard to the assessment of learning on day 3, we found significantly smaller RMSE values for the ST motor (d = 1.31) and the DT motor-cognitive (d = 0.76) practice group compared to the ST cognitive practice group but not between the ST motor and the DT motor-cognitive practice group under DT test condition. Further, we detected significantly larger total numbers of correct calculations under DT test condition for the ST cognitive (d = 2.19) and the DT motor-cognitive (d = 1.55) practice group compared to the ST motor practice group but not between the ST cognitive and the DT motor-cognitive practice group.

Conclusion: We conclude that ST practice resulted in an effective modulation of the trained domain (i.e., motor or cognitive) while only DT practice resulted in an effective modulation of both domains (i.e., motor and cognitive). Thus, particularly DT practice frees up central resources that were used for an effective modulation of motor and cognitive processing mechanisms.

Effect of Continuous Motion Parameter Feedback on Laparoscopic Simulation Training: A Prospective Randomized Controlled Trial on Skill Acquisition and Retention

OBJECTIVE

To investigate the effect of motion parameter feedback on laparoscopic basic skill acquisition and retention during a standardized box training curriculum.

DESIGN

A Lap-X Hybrid laparoscopic simulator was designed to provide individual and continuous motion parameter feedback in a dry box trainer setting. In a prospective controlled trial, surgical novices were randomized into 2 groups (regular box group, n = 18, and Hybrid group, n = 18) to undergo an identical 5-day training program. In each group, 7 standardized tasks on laparoscopic basic skills were completed twice a day on 4 consecutive days in fixed pairs. Additionally, each participant performed a simulated standard laparoscopic cholecystectomy before (day 1) and after training (day 5) on a LAP Mentor II virtual reality (VR) trainer, allowing an independent control of skill progress in both groups. A follow-up assessment of skill retention was performed after 6 weeks with repetition of both the box tasks and VR cholecystectomy.

SETTING

Muenster University Hospital Training Center, Muenster, Germany.

PARTICIPANTS

Medical students without previous surgical experience.

RESULTS

Laparoscopic skills in both groups improved significantly during the training period, measured by the overall task performance time. The 6 week follow-up showed comparable skill retention in both groups. Evaluation of the VR cholecystectomies demonstrated significant decrease of operation time (p < 0.01), path length of the left and right instrument, and the number of movements of the left and right instruments for the Hybrid group (all p < 0.001), compared to the box group. Similar results were found at the assessment of skill retention.

CONCLUSION

Simulation training on both trainers enables reliable acquisition of laparoscopic basic skills. Furthermore, individual and continuous motion feedback improves laparoscopic skill enhancement significantly in several aspects. Thus, training systems with feedback of motion parameters should be considered to achieve long-term improvement of motion economy among surgical trainees.

Scaling Constraints in Junior Tennis: The Influence of Net Height on Skilled Players' Match-Play Performance

PURPOSE

The net height in tennis (0.91 m) is approximately 50% of a professional tennis player's height. Children are also expected to play with this net height, even though it is approximately 70% of the average 10-year-old's height. This study examined the immediate effect of lowering net height on the performance characteristics of skilled junior tennis players aged 10 years and younger.

METHOD

Sixteen players were matched in 8 pairs of even tennis ability and same sex. Each pair played 25-min singles matches in 4 conditions that varied in net height (0.91 m, 0.78 m, 0.65 m, and 0.52 m). Match-play characteristics were analyzed via video replay.

RESULTS

Results showed that lowering the net height to 0.65 m and 0.52 m led to players adopting a more attacking style of play, as evidenced by a significant increase in the number of winners without a commensurate increase in errors and more shots struck inside the baseline. Lower nets also led to a greater percentage of successful first serves. The lowest net (0.52 m), however, reduced rally length significantly and therefore decreased hitting opportunities.

CONCLUSION

These results offer support for equipment scaling to enhance match-play performance for skilled junior tennis players. We propose that current net height recommendations for junior tennis should be revised.

Coach ratings of skills and their relations to practice, play and successful transitions from youth-elite to adult-professional status in soccer

Elite soccer players (~15 yr) from professional academies in the UK were rated on technical, tactical, physical and creative skills by coaches at time 1 (T1). Players estimated accumulated hours in soccer practice (coach-led activities) and play (self-led activities) during childhood. Coach-ratings were again collected 2.5 yr later (T2) for players that received a professional contract (~17 yr). Adult-professional status was determined at T3 (~ 20 yr). Skill ratings distinguished across the three "future" groups (academy-only, youth-professional only and adult-professional), for all but creative skill. For players that transitioned to youth-professional, medium sized correlations were noted between childhood practice amounts and technical and creative skill ratings at T1, although practice amounts correlated more strongly with skill ratings at T2. Play amounts were not related to any skills. Within groups of youth elite athletes, domain-specific play in childhood, and to a lesser degree practice, were generally not good discriminators of specific-skills. The effects of sport-specific practice on the development (and discriminability) of skills takes time to emerge. We consider the implications for talent development models and purported links between play and creativity.

Task experience influences coordinative structures and performance variables in learning a slalom ski-simulator task

The experiment investigated the progressions of the qualitative and quantitative changes in the movement dynamics of learning the ski-simulator as a function of prior-related task experience. The focus was the differential timescales of change in the candidate collective variable, neuromuscular synergies, joint motions, and task outcome as a function of learning over 7 days of practice. Half of the novice participants revealed in day 1 a transition of in-phase to anti-phase coupling of center of mass (CoM)-platform motion whereas the remaining novices and experienced group all produced on the first trial an anti-phase CoM-platform coupling. The experienced group also had initially greater amplitude and velocity of platform motion-a performance advantage over the novice group that was reduced but not eliminated with 7 days of practice. The novice participants who had an in-phase CoM-platform coupling on the initial trials of day 1 also showed the most restricted platform motion in those trials. Prior-related practice experience differentially influenced the learning of the task as evidenced by both the qualitative organization and the quantitative motion properties of the individual degrees of freedom (dof) to meet the task demands. The findings provide further evidence to the proposition that CoM-platform coupling is a candidate collective variable in the ski-simulator task that provides organization and boundary conditions to the motions of the individual joint dof and their couplings.

Multivariate Profiles of Selected versus Non-Selected Elite Youth Brazilian Soccer Players

This study determined whether a multivariate profile more effectively discriminated selected than non-selected elite youth Brazilian soccer players. This examination was carried out on 66 youth soccer players (selected, n = 28, mean age 16.3 ± 0.1; non-selected, n = 38, mean age 16.7 ± 0.4) using objective instruments. Multivariate profiles were assessed through anthropometric characteristics, biological maturation, tactical-technical skills, and motor performance. The Student’s t-test identified that selected players exhibited significantly higher values for height (t = 2.331, p = 0.02), lean body mass (t = 2.441, p = 0.01), and maturity offset (t = 4.559, p < 0.001), as well as performed better in declarative tactical knowledge (t = 10.484, p < 0.001), shooting (t = 2.188, p = 0.03), dribbling (t = 5.914, p < 0.001), speed – 30 m (t = 8.304, p < 0.001), countermovement jump (t = 2.718, p = 0.008), and peak power tests (t = 2.454, p = 0.01). Forward stepwise discriminant function analysis showed that declarative tactical knowledge, running speed –30 m, maturity offset, dribbling, height, and peak power correctly classified 97% of the selected players. These findings may have implications for a highly efficient selection process with objective measures of youth players in soccer clubs.

Landmark lecture on surgery: paediatric cardiothoracic surgery - training the next generation of congenital heart surgeons

Introduction Recent changes in surgical education have had an impact on our congenital training programmes. The mandate of the 8-hour workweek, a rapidly expanding knowledge base, and a host of other mandates has had an impact on the readiness of the fellows who are entering congenital programmes. To understand these issues completely, we interviewed the top congenital experts in the United States of America. The purpose of this paper is to share their insight and offer suggestions to address these challenges.

METHODS

We used a qualitative thematic analysis approach and performed phone interviews with the top five congenital experts in the United States of America.

RESULTS

Experts unanimously felt that duty-hour restrictions have negatively affected congenital training programmes in the following ways: current fellows do not seem as conditioned as fellows in the past, patient handoffs are not consistent with excellent performance, the mentor-mentee relationship has been affected by duty-hour restrictions, and fellows may be less prepared for real-world practice. Three positive themes emerged in response to duty-hour restrictions: fellows appear to be doing less menial task work, fellows are now better rested for learning, and we are attracting more individuals into the speciality. Experts agreed that congenital fellowships should be increased to 2 years. There was support for both the traditional and integrated residency pathways. Discussion We are in a new era of education and must work together to overcome the challenges that have arisen in recent years.

Expansion and Renormalization of Human Brain Structure During Skill Acquisition

Research on human brain changes during skill acquisition has revealed brain volume expansion in task-relevant areas. However, the large number of skills that humans acquire during ontogeny militates against plasticity as a perpetual process of volume growth. Building on animal models and available theories, we promote the expansion-renormalization model for plastic changes in humans. The model predicts an initial increase of gray matter structure, potentially reflecting growth of neural resources like neurons, synapses, and glial cells, which is followed by a selection process operating on this new tissue leading to a complete or partial return to baseline of the overall volume after selection has ended. The model sheds new light on available evidence and current debates and fosters the search for mechanistic explanations.

Feedback and motor skill acquisition using a haptic dental simulator

AIM

To investigate the effect of qualitatively different types of pedagogical feedback (FB) on the training, transfer and retention of basic manual dexterity dental skills using a virtual reality (VR) haptic dental simulator.

METHODS

Sixty-three participants (M = 22.7 years; SD = 3.4 years), with no previous dental training, were randomly allocated to one of three groups (n = 21 each). Group 1 received device-only feedback during the training phase, that is the visual display of the simulator (DFB); Group 2 received verbal feedback from a qualified dental instructor (IFB); and Group 3 received a combination of instructor and device feedback (IDFB). Participants completed four tasks during which feedback was given according to group allocation as well as two skills transfer tests. Skill retention was examined immediately after training, at 1 week and at 1 month post-test.

RESULTS

Statistically significant differences were found between the groups in overall performance (P < 0.001) and error (P = 0.006). Post hoc comparisons revealed the IDFB group produced substantially better performance and fewer errors in comparison with DFB and IFB training. This difference translated to improved performance in skill retention and generalisation of knowledge to novel tasks.

CONCLUSION

These data indicate that the acquisition and retention of basic dental motor skills in novice trainees is best optimised through a combination of instructor and visual display (VR)-driven feedback. The results have implications for the utility and implementation of VR haptic technology in dental education.