Toward a science of exceptional achievement: attaining superior performance through deliberate practice

Embracing virtual reality in rehabilitation of post-stroke aphasia

About one-third of stroke survivors experience aphasia, i.e., language dysfunction caused by brain damage. Aphasia affects not only a person's ability to communicate, but it often leads to the inability to return to work, loss of close relationships, diminished quality of life, negative self-perception, and depression. Yet persons with aphasia are globally underserved due to limited access to resources, which limits their chance for recovery. Immersive virtual reality (VR) has the potential to solve this problem and deliver efficient, personalized treatments to millions of people worldwide who need access to rehabilitation services or more flexibility in treatment delivery. To reduce the global burden of stroke experts recommend taking bold, pragmatic actions across all four pillars of stroke quadrangle-surveillance, prevention, acute care, and rehabilitation. Embracing immersive VR-based rehabilitation of poststroke aphasia would be one step in that direction.

More than one way to improve a CAT: Outcomes and reflections on two iterations of the Queen Square Intensive Comprehensive Aphasia Programme

Background

The field of human expert performance teaches us that high quality, high-dose guided practice is required to make large gains in cognitively driven acts. The same also seems to be true for people with acquired brain injury, yet therapy services for people with aphasia (PWA) have traditionally not been designed with this in mind. Intensive Comprehensive Aphasia Programmes (ICAPs) are one way to address the chronic under-dosing of therapy that most PWA experience.

Aims

There are several ways to deliver an ICAP; here we describe two iterations of our Queen Square ICAP. There was a 20-month COVID-induced pause between the Year 1 (Y1) and Year 2 (Y2) ICAP groups. We analyse ICAP-induced changes in both groups of PWA on a series of key outcome measures that span the International Classification of Functioning, Disability and Health, covering language impairment and function as well as mood and social participation.

Methods & Procedures

Forty-six PWA took part in Y1 and 44 in Y2. The PWA were all in the chronic stage post stroke and varied in aphasia severity from mild to severe, with the Y2 group being more impaired than Y1. Quantitative data was collected before and after the ICAP. The Y2 therapy team provided independent reflections on their experiences of delivering an ICAP.

Outcomes & Results

ICAP-related changes in outcome measures (impairment, function and goal attainment) were generally comparable for the Y1 and Y2 groups, with both groups' speech production abilities improving the most. Both groups made clinically and statistically significant gains on the main quality of life measure. Participation in the ICAP made a big difference to PWAs' self-confidence ratings. Their mood ratings also improved significantly, although they were not, on average, in the depressed range at baseline (directly pre-ICAP). All improvements achieved in both groups were maintained at the 3-month follow-up, highlighting the lasting effects that ICAPs can provide.

Conclusions

Evidence continues to accrue that ICAPs are an efficient way of increasing the dose of expert coaching required for people with chronic aphasia to make clinically meaningful improvements in their communicative abilities and quality of life. The main challenge remaining is convincing health-care providers to invest in them.

Behavioral and neural underpinnings of empathic characteristics in a Humanitude-care expert

Background

Humanitude approaches have shown positive effects in elderly care. However, the behavioral and neural underpinnings of empathic characteristics in Humanitude-care experts remain unknown.

Methods

We investigated the empathic characteristics of a Humanitude-care expert (YG) and those of age-, sex-, and race-matched controls (n = 13). In a behavioral study, we measured subjective valence and arousal ratings and facial electromyography (EMG) of the corrugator supercilii and zygomatic major muscles while participants passively observed dynamic facial expressions associated with anger and happiness and their randomized mosaic patterns. In a functional magnetic resonance imaging (MRI) study, we measured brain activity while participants passively observed the same dynamic facial expressions and mosaics. In a structural MRI study, we acquired structural MRI data and analyzed gray matter volume.

Results

Our behavioral data showed that YG experienced higher subjective arousal and showed stronger facial EMG activity congruent with stimulus facial expressions compared with controls. The functional MRI data demonstrated that YG showed stronger activity in the ventral premotor cortex (PMv; covering the precentral gyrus and inferior frontal gyrus) and posterior middle temporal gyrus in the right hemisphere in response to dynamic facial expressions versus dynamic mosaics compared with controls. The structural MRI data revealed higher regional gray matter volume in the right PMv in YG than in controls.

Conclusion

These results suggest that Humanitude-care experts have behavioral and neural characteristics associated with empathic social interactions.

Powerlessness Also Corrupts: Lower Power Increases Self-Promotional Lying

The popular maxim holds that power corrupts, and research to date supports the view that power increases self-interested unethical behavior. However, we predict the opposite effect when unethical behavior, specifically lying, helps an individual self-promote: lower rather than higher power increases self-promotional lying. Drawing from compensatory consumption theory, we propose that this effect occurs because lower power people feel less esteemed in their organizations than do higher power people. To compensate for this need to view themselves as esteemed members of their organizations, lower power individuals are more likely to inflate their accomplishments. Evidence from four studies supports our predictions: compared with those with higher power, executives with lower power in their organizations were more likely to lie about their work achievements (Study 1, n = 230); graduate students with lower power in their Ph.D. studies were more likely to lie about their publication records (Study 2, n = 164); and employees with lower power were more likely to lie about having signed a business contract (Studies 3 and 4). Mediation analyses suggest that lower power increased lying because lower power individuals feel lower esteem in their organizations (Study 3, n = 562). Further supporting this mechanism, a self-affirmation intervention reduced the effect of lower power on self-promotional lying (Study 4, n = 536). These converging findings show that, when lies are self-promotional, lower power can be more corruptive than higher power.

Best Practices for Remediation in Pulmonary and Critical Care Medicine Fellowship Training

Background

Remediation of struggling learners in pulmonary and critical care fellowship programs is a challenge, even for experienced medical educators.

Objective

This evidence-based narrative review provides a framework program leaders may use to address fellows having difficulty achieving competency during fellowship training.

Methods

The relevant evidence for approaches on the basis of each learner’s needs is reviewed and interpreted in the context of fellowship training in pulmonary medicine and critical care. Issues addressed include bias in fellow assessments and remediation, the impacts of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, the specific challenges of pulmonary and critical care fellowship programs, a brief review of relevant legal issues, guidance on building and leveraging program resources, and a discussion of learner outcomes.

Results

This results in a concise, evidence-based toolkit for program leaders based around four pillars: early identification, fellow assessment, collaborative intervention, and reassessment. Important concepts also include the need for documentation, clear and written communication, and fellow-directed approaches to the creation of achievable goals.

Conclusion

Evidence-based remediation helps struggling learners in pulmonary and critical care fellowship to improve their ability to meet Accreditation Council for Graduate Medical Education (ACGME) milestones.

Factors affecting expert performance in bid evaluation: An integrated approach

Experts play a crucial role in underpinning decision-making in most management situations. While recent studies have disclosed the impacts of individuals’ inherent cognition and the external environment on expert performance, these two-dimensional mechanisms remain poorly understood. In this study, we identified 14 factors that influence expert performance in a bid evaluation and applied cross-impact matrix multiplication to examine the interdependence of the factors. The results indicate that the two dimension-related factors affect each other within a person–environment system, and a poor situation perception gives rise to the deviation of expert performance. Expert performance can be improved if external supervision and expertise are strengthened through deliberate practices. The study proposes a new expert performance research tool, elucidates its mechanism in bid evaluation from a cognitive psychology perspective, and provides guidelines for its improvement in workplace contexts.

Learning practices of experienced healthcare teams and dyads in acute care settings: a scoping review

OBJECTIVES

To map the evidence on learning practices currently used by experienced healthcare teams and dyads. The hypothesis is that through reviewing the literature we will identify the number and array of current learning practices. Through the lens of collaboration, the authors' goal is to map current practice to guide future research, policy and practice.

SETTING

The review included studies from North America, Europe, Australasia and Asia. All studies were conducted in acute care settings such as operating rooms, emergency rooms, intensive care units and simulation centres.

PARTICIPANTS

The participants were experienced healthcare professionals who work in acute care settings of any age or any sex. The group was interprofessional including two or more disciplines and/or professions. Characteristics of the participants who were excluded were students, novices, healthcare professionals who work in non-acute care settings and single profession studies.

PRIMARY AND SECONDARY OUTCOME MEASURES

Aligned to the protocol quantitative and qualitative analyses were conducted. Thematic analysis was used to evaluate and categorise the study findings. Secondary outcome measures were the different types of learning practices used together to produce excellence.

RESULTS

Most empirical studies were qualitative studies (46%), 31% were mixed methods and 23% were quantitative studies. There were also 24 reviews and 10 commentaries. The most frequent learning practices were structured observation and case scenarios (21%) followed by audio/video analysis and surveys (17%). Next was interviews and didactic presentations (12%) followed by prebriefing/debriefing and checklists (11%). Other learning practices accounted for less than 10%. Overall, 84 of the 86 publications, examined learning practices of teams larger than two participants.

CONCLUSIONS

While the quality of studies was high, and there was a broad range of empirical studies, reviews and commentaries, there was no consensus on best practice in determining which learning practices to use and measurement of the effect of these practices.

Tracking Changes in Students' Online Self-Regulated Learning Behaviors and Achievement Goals Using Trace Clustering and Process Mining

Success in online and blended courses requires engaging in self-regulated learning (SRL), especially for challenging STEM disciplines, such as physics. This involves students planning how they will navigate course assignments and activities, setting goals for completion, monitoring their progress and content understanding, and reflecting on how they completed each assignment. Based on Winne & Hadwin’s COPES model, SRL is a series of events that temporally unfold during learning, impacted by changing internal and external factors, such as goal orientation and content difficulty. Thus, as goal orientation and content difficulty change throughout a course, so might students’ use of SRL processes. This paper studies how students’ SRL behavior and achievement goal orientation change over time in a large (N = 250) college introductory level physics course taught online. Students’ achievement goal orientation was measured by repeated administration of the achievement goals questionnaire-revised (AGQ-R). Students’ SRL behavior was measured by analyzing their clickstream event traces interacting with online learning modules via a combination of trace clustering and process mining. Event traces were first divided into groups similar in nature using agglomerative clustering, with similarity between traces determined based on a set of derived characteristics most reflective of students’ SRL processes. We then generated causal nets for each cluster of traces via process mining and interpreted the underlying behavior and strategy of each causal net according to the COPES SRL framework. We then measured the frequency at which students adopted each causal net and assessed whether the adoption of different causal nets was associated with responses to the AGQ-R. By repeating the analysis for three sets of online learning modules assigned at the beginning, middle, and end of the semester, we examined how the frequency of each causal net changed over time, and how the change correlated with changes to the AGQ-R responses. Results have implications for measuring the temporal nature of SRL during online learning, as well as the factors impacting the use of SRL processes in an online physics course. Results also provide guidance for developing online instructional materials that foster effective SRL for students with different motivational profiles.

Levels of Gnostic Functions in Top Karate Athletes-A Pilot Study

High-quality sensory perception and body scheme (somatognosis) are important aspects for sport performance. This study compares stereognosis, body scheme, and kinesthesia in a group of 36 competitive karate athletes against a control group of 32 general population participants. The stereognosis Petrie test, two body scheme tests, and three kinesthesia tests served as outcome measurement tools. No significant difference was found in the stereognosis Petrie test, for the dominant (p = .389) or the nondominant (p = .791) hand, nor in the kinesthesia test (dominant, p = .661 and nondominant, p = .051). Karate athletes performed significantly better in the body scheme tests, that is, fist width estimation (p = .024) and shoulder width estimation (p = .019), as well as in karate-specific kinesthesia tests, that is, single punch (p = .010) and triple punch (p = .001). This study confirms competitive karate athletes have significantly better somatognosis, and better accuracy when performing quick dynamic movements compared with the general population.

One Hospital's Response to the Institute of Medicine Report, "Dying in America"

BACKGROUND

In response to the Institute of Medicine (IOM) report, Dying in America, we undertook an institution wide effort to improve the experience of patients and families facing serious illness by engaging leadership and developing a program to promote the practice of generalist palliative care.

MEASURES

The impact of the program was measured with process measures related to its' three parts.

INTERVENTION

We developed a three-part generalist palliative care program that focuses on 1) instructional design, 2) advance care planning, and 3) engagement.

OUTCOMES

Over four years, the program trained 51 interprofessional clinicians in a two-week intensive palliative care course and 1,541 interprofessional clinicians in a 90-150 min skills-based training. Clinicians documented 15,791 serious illness conversations. Zoom community engagement sessions were attended by 411 live viewers, and subsequently, 1918 YouTube views. Additionally, we report on the impact of the COIVD-19 crisis on our efforts. Early in the pandemic, over two months, 464 interprofessional clinicians documented 5,168 conversations with patients.

CONCLUSION/LESSONS LEARNED

A broad based strategy resulted wide institutional engagement with serious illness care.

Proctored preceptorship model for learning eTEP repair for inguinal hernia for general surgery residents

BACKGROUND

Enhanced-view total extra-peritoneal (eTEP) inguinal hernia repair is a technically demanding procedure with a steep learning curve.

AIM

Examine the feasibility and effectiveness of an instructor approach to teaching residents how to perform laparoscopic eTEP independently following a dedicated course of individual teaching.

METHODS

Prospective analysis of eTEP procedures performed by residents between March 2018 and September 2020. Six residents dispersed into three groups-Group A: two junior residents, Group B: two mid-level residents and Group C: two senior residents. All residents performed a unilateral IHR comprised of five core steps. Data reviewed for each procedure included the time of each step, total time and autonomy degree as assessment for every step: 1st degree-dependent (physical assistance), 2nd degree-partially dependent (vocal assistance) and 3rd degree-independent. Early and late procedures were divided at 50% of cases.

RESULTS

Participants performed 44 procedures (220 steps). Late procedures presented with a significant improvement in all degrees of autonomy (1st degree p = 0.002, 2nd degree p = 0.007 and 3rd degree p < 0.0001) and in every step (Step 1 p = 0.015, Step 2 p = 0.006, Step 3 p < 0.0001, Step 4 p < 0.0001, Step 5 p = 0.002). There was no significant difference in surgery duration between early and late procedures (p = 0.32). At early procedures, junior residents needed significantly higher rates of physical intervention (1st degree) compared to the senior residents (p = 0.004). Conversely, there was no significant difference in 2nd degree of autonomy (p = 0.46), 3rd degree (p = 0.06) and surgery duration (p = 0.16). The last three procedures performed by all participants had no significant difference between the seniority groups in autonomy (1st degree p = 0.1, 2nd degree p = 0.18 and 3rd degree p = 0.1).

CONCLUSION

Dedicated course with an individual instructor's approach is effective in achieving competence, autonomy and confidence in performing eTEP in a short time.

Simulation Improves Internal Medicine Resident Confidence With Defibrillation, Cardioversion, and Transcutaneous Pacemaker Use

Introduction

While many graduate medical education programs require residents to be certified in advanced cardiac life support, this does not cover all aspects of cardiac stabilization in patients with a pulse. Residents are often on the front lines of providing care to patients with life-threatening dysrhythmias. Our residents expressed a lack of confidence in their ability to provide this care.

Methods

A convenience sample of internal medicine, preliminary medicine, and transitional year residents from our large community-based tertiary care hospital participated in our survey and training. We utilized a pre-post survey method of our residents’ confidence in domains that are critical to caring for patients requiring cardiac resuscitation and stabilization. Our pre-post survey was a modified Likert scale. Our training consisted of a 1-hour faculty-led hands-on training session focused on these critical domains in our hospital’s simulation suites. Follow-up survey data were collected immediately after the training and at six and 11 months after the training using mean confidence across all five domains as the study variable.

Results

Resident mean confidence in the five domains (placing leads and pads, manipulating defibrillator controls, performing defibrillation, performing synchronized cardioversion, and performing transcutaneous pacemaker use) increased immediately after our training compared to before the training (p<0.001). This increase in confidence from before the training was sustained at six and 11 months after the training (p=0.001 and p=0.002, respectively). Confidence was lower at six and 11 months than immediately after training (p=0.01 and p=0.004, respectively).

Conclusion

Our project showed that simulation-based training was effective in improving our trainee’s confidence in providing care to patients with life-threatening dysrhythmias. As with previous studies in simulation, confidence degradation was seen over time and likely mirrors skill degradation in these low-frequency encounters. As such, future aims include identification of ideal time intervals between training.

Word learning dogs (Canis familiaris) provide an animal model for studying exceptional performance

Exceptional performance is present in various human activities but its origins are debated and challenging to study. We report evidence of exceptional performance and qualitative variation in learning object-names in dogs. 34 naïve family dogs and 6 knowledgeable individuals that knew multiple toy names, found in 2 years of search around the Globe, were exposed to 3 months of training to learn two novel toy-names and were tested in two-way choice tests. Only 1 naïve and all 6 knowledgeable dogs passed the tests. Additionally, only these dogs learned at least 10 new toy names over the 3 months, showing qualitative variation in this capacity. Although previous object-name knowledge could provide an explanation for the superior performance of the knowledgeable dogs, their rarity and the absence of previous training of this skill point to exceptional giftedness in these individuals, providing the basis to establish dogs as a model-species for studying talent.

Are the advantages of chess expertise on visuo-spatial working-memory capacity domain specific or domain general?

Chess experts have repeatedly demonstrated exceptional recall of chessboards, which is weakened by disruption of the chessboard. However, chess experts still perform better than novices when recalling such disrupted chessboards, suggesting a somewhat generalized expertise effect. In the current study, we examined the extent of this generalized expertise effect on early processing of visuo-spatial working memory (VSWM), by comparing 14 chess experts (Elo rating > 2000) and 15 novices on a change-detection paradigm using disrupted chessboards, where attention had to be selectively deployed to either visual or spatial features, or divided across both features. The paradigm differed in the stimuli used (domain-specific chess pieces vs. novel visual shapes) to evaluate domain-general effects of chess expertise. Both experts and novices had greater memory discriminability for chess stimuli than for the unfamiliar stimuli, suggesting a salience advantage for familiar stimuli. Experts, however, demonstrated better memory discriminability than novices not only for chess stimuli presented on these disrupted chessboards, but also for novel, domain-general stimuli, particularly when detecting spatial changes. This expertise advantage was greater for chessboards with supra-capacity set sizes. For set sizes within the working-memory capacity, the expertise advantage was driven by enhanced selective attention to spatial features by chess experts when compared to visual features. However, any expertise-related VSWM advantage disappeared in the absence of the 8 × 8 chessboard display, which implicates the chessboard display as an essential perceptual aspect facilitating the "expert memory effect" in chess, albeit one that might generalize beyond strictly domain-relevant stimuli.

Delineating the Benefits of Arts Education for Children's Socioemotional Development

In this paper, we argue that in order for the study of arts education to continue to advance, we must delineate the effects of particular forms of arts education, offered in certain contexts, on specific domains of children’s socioemotional development. We explain why formulating precise hypotheses about the effects of arts education on children’s socioemotional development requires a differentiated definition of each arts education program or activity in question, as well as a consideration of both the immediate and broader contexts in which that program or activity occurs. We then offer the New Victory Theater’s Schools with Performing Arts Reach Kids (SPARK) program as an illustrative example of how these considerations allow for the refinement of hypotheses about the impact of arts education on children’s socioemotional development.

Skull Base Training and Mentorship

OBJECTIVE

To review teaching and mentoring techniques of experienced skull base surgeons and educators STUDY DESIGN:: Expert commentary.

SETTING

8th Quadrennial International Conference on vestibular schwannoma and other CPA tumors, panel on teaching, and mentoring.

MAIN OUTCOME MEASURES

Experiences and opinions of experienced skull base surgeons, both neurosurgeons and neurotologists, presented and discussed at the conference.

CONCLUSIONS

Obtaining surgical mastery is essential for the teachers of skull base surgery. Hard work and practice with immediate and constant feedback on performance is an essential component to success. Creating a patient-centered culture that encourages academic achievement is an accelerator for success of a training program. Both the mentor and the mentee must play an intentional and active role to maximize learning.

The learning curve of retinal detachment surgery

Purpose

To investigate the learning curve of vitreoretinal (VR) surgeons beginning training in retinal detachment (RD) surgery.

Methods

The files of all consecutive patients undergoing VR surgery for uncomplicated RD between Jan 2005 und Mar 2020 were retrospectively reviewed. Successful outcome was defined as no retinal redetachment within 3 months after surgery.

Results

Ten surgeons started their VR career during this period. Together, these 10 surgeons performed 3786 RD operations (mean 379; median 251; range 71–1053). Primary success rate after one operation was 90% (3420 of 3786). When starting to operate retinal detachments, VR surgeons had a primary success rate of about 80%. Redetachment rates steadily decreased and stabilized at just under 10% after about 200 operations. Beginners needed more than twice the time for the procedure compared to experienced surgeons. The individual learning curves varied widely. In our series, female surgeons seem to have a faster learning curve.

Conclusion

RD surgery performed by VR surgeons in training had acceptable results. With increasing experience, success rates continuously improve reaching stable levels after approximately 200 operations. The training of VR surgeons requires considerable resources.

Disaster Day: A Simulation-Based Disaster Medicine Curriculum for Novice Learners

BACKGROUND

Mass casualty and multi-victim incidents have increased in recent years due to a number of factors including natural disasters and terrorism. The Association of American Medical Colleges (AAMC) recommends that medical students be trained in disaster preparedness and response. However, a majority of United States medical students are not provided such education.

OBJECTIVE

The goal of this study was to evaluate the effectiveness of a 1 day, immersive, simulation-based Disaster Day curriculum.

SETTINGS AND DESIGN

Learners were first and second year medical students from a single institution.

MATERIALS AND METHODS

Our education provided learners with information on disaster management, allowed for application of this knowledge with hands-on skill stations, and culminated in near full-scale simulation where learners could evaluate the knowledge and skills they had acquired.

STATISTICAL ANALYSIS USED

To study the effectiveness of our Disaster Day curriculum, we conducted a single-group pretest-posttest and paired analysis of self-reported confidence data.

RESULTS

A total of 40 first and second year medical students participated in Disaster Day as learners. Learners strongly agreed that this course provided new information or provided clarity on previous training, and they intended to use what they learned, 97.6% and 88.4%, respectively.

CONCLUSIONS

Medical students' self-reported confidence of key disaster management concepts including victim triage, tourniquet application, and incident command improved after a simulation-based disaster curriculum. This Disaster Day curriculum provides students the ability to apply concepts learned in the classroom and better understand the real-life difficulties experienced in a resource limited environment.

A Bayesian Account of Generalist and Specialist Formation Under the Active Inference Framework

This paper offers a formal account of policy learning, or habitual behavioral optimization, under the framework of Active Inference. In this setting, habit formation becomes an autodidactic, experience-dependent process, based upon what the agent sees itself doing. We focus on the effect of environmental volatility on habit formation by simulating artificial agents operating in a partially observable Markov decision process. Specifically, we used a "two-step" maze paradigm, in which the agent has to decide whether to go left or right to secure a reward. We observe that in volatile environments with numerous reward locations, the agents learn to adopt a generalist strategy, never forming a strong habitual behavior for any preferred maze direction. Conversely, in conservative or static environments, agents adopt a specialist strategy; forming strong preferences for policies that result in approach to a small number of previously-observed reward locations. The pros and cons of the two strategies are tested and discussed. In general, specialization offers greater benefits, but only when contingencies are conserved over time. We consider the implications of this formal (Active Inference) account of policy learning for understanding the relationship between specialization and habit formation.

A brief social-belonging intervention in college improves adult outcomes for black Americans

Could mitigating persistent worries about belonging in the transition to college improve adult life for black Americans? To examine this question, we conducted a long-term follow-up of a randomized social-belonging intervention delivered in the first year of college. This 1-hour exercise represented social and academic adversity early in college as common and temporary. As previously reported in Science, the exercise improved black students' grades and well-being in college. The present study assessed the adult outcomes of these same participants. Examining adult life at an average age of 27, black adults who had received the treatment (versus control) exercise 7 to 11 years earlier reported significantly greater career satisfaction and success, psychological well-being, and community involvement and leadership. Gains were statistically mediated by greater college mentorship. The results suggest that addressing persistent social-psychological concerns via psychological intervention can shape the life course, partly by changing people's social realities.

Music Making and Neuropsychological Aging: A Review

Aging is associated with a decline in social understanding and general cognition. Both are integral to wellbeing and rely on similar brain regions. Thus, as the population ages, there is a growing need for knowledge on the types of activities that maintain brain health in older adulthood. Active engagement in music making might be one such activity because it places a demand on brain networks tapping into multisensory integration, learning, reward, and cognition. It has been hypothesized that this demand may promote plasticity in the frontal and temporal lobes by taxing cognitive abilities and, hence, increase resistance to age-related neurodegeneration. We examine research relevant to this hypothesis and note that there is a lack of intervention studies with a well-matched control condition and random assignment. Thus, we discuss potential causal mechanisms underlying training-related neuropsychological changes, and provide suggestions for future research. It is argued that although music training might be a valuable tool for supporting healthy neuropsychological aging and mental wellbeing, well-controlled intervention studies are necessary to provide clear evidence.

Role of Peer Learning in Students' Skill Acquisition and Interest in Plastic Surgery

Supplemental Digital Content is available in the text.

Although the number of plastic surgery residency positions increased over the past decade, interest among Canadian medical students experienced the opposite trajectory. The aim of this study was to assess the effect of a low intensity, basic surgical skills workshop on medical students’ confidence and interest in surgery in general, and plastic surgery in particular.

Simulation in Neurocritical Care: Past, Present, and Future

Simulation-based medical education is a technique that leverages adult learning theory to train healthcare professionals by recreating real-world scenarios in an interactive way. It allows learners to emotionally engage in the assessment and management of critically ill patients without putting patients at risk. Learners are encouraged to work at the edge of their expertise to promote growth and are provided with feedback to nurture development. Thus, the training is targeted to the learner, not the patient. Despite its origins as a teaching tool for neurological diseases, simulation-based medical education has been historically abandoned by neurocritical care educators. In contrast, other critical care educators have embraced the technique and built an impressive foundation of literature supporting its use. Slowly, neurocritical care educators have started experimenting with simulation-based medical education and sharing their results. In this review, we will investigate the historical origins of simulation in the neurosciences, the conceptual framework supporting the technique, current applications, and future directions.

The neurocognitive gains of diagnostic reasoning training using simulated interactive veterinary cases

The present longitudinal study ascertained training-associated transformations in the neural underpinnings of diagnostic reasoning, using a simulation game named “Equine Virtual Farm” (EVF). Twenty participants underwent structural, EVF/task-based and resting-state MRI and diffusion tensor imaging (DTI) before and after completing their training on diagnosing simulated veterinary cases. Comparing playing veterinarian versus seeing a colorful image across training sessions revealed the transition of brain activity from scientific creativity regions pre-training (left middle frontal and temporal gyrus) to insight problem-solving regions post-training (right cerebellum, middle cingulate and medial superior gyrus and left postcentral gyrus). Further, applying linear mixed-effects modelling on graph centrality metrics revealed the central roles of the creative semantic (inferior frontal, middle frontal and angular gyrus and parahippocampus) and reward systems (orbital gyrus, nucleus accumbens and putamen) in driving pre-training diagnostic reasoning; whereas, regions implicated in inductive reasoning (superior temporal and medial postcentral gyrus and parahippocampus) were the main post-training hubs. Lastly, resting-state and DTI analysis revealed post-training effects within the occipitotemporal semantic processing region. Altogether, these results suggest that simulation-based training transforms diagnostic reasoning in novices from regions implicated in creative semantic processing to regions implicated in improvised rule-based problem-solving.

Development of a structured virtual reality curriculum for laparoscopic appendicectomy

BACKGROUND

Laparoscopic appendicectomy (LA) is a common surgical emergency procedure mainly performed by trainees. The aim was to develop a step-wise structured virtual reality (VR) curriculum for LA to allow junior surgeons to hone their skills in a safe and controlled environment.

METHODS

A prospective randomized study was designed using a high-fidelity VR simulator. Thirty-five novices and 25 experts participated in the assessment and their performances were compared to assess construct validity. Learning curve analysis was performed.

RESULTS

Five of the psychomotor tasks and all appendicectomy tasks showed construct validity. Learning was demonstrated in the majority of construct-valid tasks. A novel goal-directed VR curriculum for LA was constructed.

CONCLUSIONS

A step-wise structured VR curriculum for LA is proposed with a framework which includes computer generated metrics and supports deliberate practice, spacing intervals, human instruction/feedback and assessment. Future study should test the feasibility of its implementation and transferability of acquired skill.

Prospective Trial of Low-Fidelity Deliberate Practice of Aortic and Coronary Anastomoses (TECoG 002)

OBJECTIVE

We sought to examine the feasibility of a home practice curriculum of vascular anastomosis in cardiovascular surgery using a low-fidelity simulation platform and to examine its effectiveness in skill acquisition in senior surgical trainees.

DESIGN

We organized a multicenter prospective randomized study of senior residents and fellows, who were oriented to a low-fidelity cardiac simulator and an 8-week curriculum of independent practice of aortic and coronary anastomosis. "Treatment" trainees received a simulator and the curriculum. Control trainees received only their usual operative experience. The groups then crossed over; all were studied for 16 weeks in total. Video skill assessments were captured at 0, 8, and 16 weeks and were scored by one blinded investigator using the Joint Council on Thoracic Surgery Education Assessment tool. A post-hoc survey was distributed to invited participants following study completion.

SETTING

University of Minnesota Department of Surgery, Mayo Clinic Department of Cardiovascular Surgery, and the University of Texas Health Science Center at Houston. Participants used the simulator in offices, call rooms, and their homes.

PARTICIPANTS

Program participation in the study was solicited through the Thoracic Education Cooperative Group. Four institutions expressed interest and a total of 29 trainees were invited to the study and randomized. Of these, 12 (38%) completed the curriculum and submitted the requisite 3 sets of videos (6 treatment, 6 control). All were senior residents and fellows in general and cardiothoracic surgery.

RESULTS

No significant differences were detected in assessment scores before and after the curriculum nor before or after the control period in the overall or postgraduate year-stratified populations. Participant case numbers during the study did not have a significant effect on assessment scores. Randomized participants reported strong interest in deliberate practice of technical skills but identified competing clinical and personal obligations and significant barriers to simulation.

CONCLUSIONS

Considerable variability in performance existed among participants who completed the study, but overall, the curriculum alone was insufficient to improve simulator Joint Council on Thoracic Surgery Education scores compared to those not undergoing the curriculum. Among senior residents and fellows, provision of a practice curriculum and simulator for repeated practice is feasible but clinical and personal responsibilities were barriers to repetitive practice.

Deliberate Practice as an Effective Remediation Strategy for Underperforming Medical Students Focused on Clinical Skills: a Prospective Longitudinal Study

BACKGROUND

It is critical to develop remedial education for underperforming medical students, but little is known about how to create an effective remediation program. Deliberate practice (DP) is a structured and reflective activity that is designed to optimize performance. Here we applied the concept of DP to create remedial education to improve the clinical practices of medical students. We also analyzed the effectiveness of the remediation program.

METHODS

Based on the expert performance approach of DP, we designed a 4-week remedial program for clinical performance that included feedback and reflection. There were 74 student participants in this program from 2014 to 2017. Their clinical performance was re-evaluated after completion, and changes in their clinical performance scores were analyzed.

RESULTS

Students who completed the remediation program showed significant improvements in clinical performance scores (P < 0.001). Most students found the program to be instructive and helpful for improving their clinical performance. They reported that role play with peers was the most helpful for improving their skills.

CONCLUSION

The DP-based remediation program improved the clinical performance of failing medical students. This remediation program should continue to be offered to underperforming students to ensure that medical school graduates are competent.

Genetic predictors of match performance in sub-elite Australian football players: A pilot study

The current study aimed to determine whether previously identified candidate polymorphisms were associated with match performance in sub-elite Australian Rules Football (ARF) players. The genotypes of thirty players were analysed along with 3x1-kilometre time trial results, ARF-specific skill assessments (handball and kicking), and match performance (direct game involvements) per minute (DGIs/min) to investigate if there was a relationship between any of the variables. Results support previous findings that aerobic time trials are a significant predictor of DGIs/min in sub-elite ARF players. Significant associations were found for genotypes ADRB2 CC (p = .001), PPARGC1A AA (p = .001), PPARGC1A AG (p < .001), ACE ID (p < .001), COMT AA (p = .003), BDNF AG (p = .008), ADRB1 CC (p = .018) and ADRB3 CC (p = .010) and the 3x1-kilometre time trials (p < .001). In the current study, a variant in the DRD2 gene was a strong predictor of handball possessions during a match. Significance was seen for variants in the BDNF and COMT genes when the kicking and handball skill test results were combined and used in a linear mixed model to predict DGIs/min, suggesting a potential relationship with motor learning. The confirmation of genetic predictors of player performance in a team sport, such as ARF, suggests a portion of the physiological mechanisms of skill and ARF-specific talent may be explained by the expression of a specific number of genes.

The Effectiveness of Bioskills Training for Simulated Lumbar Pedicle Screw Placement

STUDY DESIGN

Prospective randomized study.

OBJECTIVES

To define the impact of an inexpensive, user-friendly, and reproducible lumbar pedicle screw instrumentation bioskills training module and evaluation protocol.

METHODS

Participants were randomized to control (n = 9) or intervention (n = 10) groups controlling for level of experience (medical students, junior resident, or senior resident). The intervention group underwent a 20-minute bioskills training module while the control group spent the same time with self-directed study. Pre- and posttest performance was self-reported (Physician Performance Diagnostic Inventory Scale [PPDIS]). Objective outcome scores were obtained from a blinded fellowship-trained attending orthopedic spine surgeon using Objective Structured Assessment of Technical Skills (OSATS) and Objective Pedicle Instrumentation Score metrics. In addition, identification of pedicle breach and breach anatomic location was measured pre- and posttest in lumbar spine models.

RESULTS

The intervention group showed a 30.8% improvement in PPDIS scores, compared with 13.4% for the control group (P = .01). The intervention group demonstrated statistically significant 66% decrease in breaches (P = .001) compared with 28% decrease in the control group (P = .06). Breach identification demonstrated no change in accuracy of the control group (incorrect identification from 32.2% pre- to posttest 35%; P = .71), whereas the intervention group's improvement was statistically significant (42% pre- to posttest 36.5%; P = .0047).

CONCLUSIONS

We conclude that a concise lumbar pedicle screw instrumentation bioskills training session can be a useful educational tool to augment clinical education.

Maximizing Cellular Adaptation to Endurance Exercise in Skeletal Muscle

The application of molecular techniques to exercise biology has provided novel insight into the complexity and breadth of intracellular signaling networks involved in response to endurance-based exercise. Here we discuss several strategies that have high uptake by athletes and, on mechanistic grounds, have the potential to promote cellular adaptation to endurance training in skeletal muscle. Such approaches are based on the underlying premise that imposing a greater metabolic load and provoking extreme perturbations in cellular homeostasis will augment acute exercise responses that, when repeated over months and years, will amplify training adaptation.

Walking Children Through a Minefield: How Professionals Experience Exploring Adverse Childhood Experiences

Understanding the challenges of professionals in addressing child adversity is key to improving the detection, protection, and care of exposed children. We aimed to synthesize findings from qualitative studies of professionals' lived experience of addressing child adversity. Through a systematic search, we identified eight qualitative studies and synthesized them using metaethnography. We generated three themes, "feeling inadequate," "fear of making it worse," and "facing evil," and one overarching metaphor, "walking children through a minefield." The professionals felt that they lacked the means necessary to explore child adversity, that they were apprehensive of worsening the child's situation, and that their work with child adversity induced emotional discomfort. This metasynthesis indicated that the professionals' efficiency in exploring abuse relied upon their ability to manage emotional and moral distress and complexity. To support children at risk, we propose developing professionals' ability to build relationships, skills in emotion regulation, and proficiency in reflective practice.

The Effectiveness of Bioskills Training for Simulated Open Lumbar Laminectomy

STUDY DESIGN

Randomized, prospective study within an orthopedic surgery resident program at a large urban academic medical center.

OBJECTIVES

To develop an inexpensive, user-friendly, and reproducible lumbar laminectomy bioskills training module and evaluation protocol that can be readily implemented into residency training programs to augment the clinical education of orthopedic and neurosurgical physicians-in-training.

METHODS

Twenty participants comprising senior medical students and orthopedic surgical residents. Participants were randomized to control (n = 9) or intervention (n = 11) groups controlling for level of experience (medical students, junior resident, or senior resident). The intervention group underwent a 40-minute bioskills training module, while the control group spent the same time with self-directed study. Pre- and posttest performance was self-reported by each participant (Physician Performance Diagnostic Inventory Scale [PPDIS]). Objective outcome scores were obtained from a blinded fellowship-trained attending orthopedic spine surgeon using Objective Structured Assessment of Technical Skills (OSATS) and Objective Decompression Score metrics.

RESULTS

When compared with the control group, the intervention group yielded a significant mean improvement in OSATS (P = .022) and PPDIS (P = .0001) scores. The Objective Decompression Scores improved in the intervention group with a trend toward significance (P = .058).

CONCLUSIONS

We conclude that a concise lumbar laminectomy bioskills training session can be a useful educational tool for to augment clinical education. Although no direct clinical correlation can be concluded from this study, the improvement in trainee's technical and procedural skills suggests that Sawbones training modules can be an efficient and effective tool for teaching fundamental spine surgical skills outside of the operating room.

Predictors of laparoscopic simulation performance among practicing obstetrician gynecologists

BACKGROUND

While simulation training has been established as an effective method for improving laparoscopic surgical performance in surgical residents, few studies have focused on its use for attending surgeons, particularly in obstetrics and gynecology. Surgical simulation may have a role in improving and maintaining proficiency in the operating room for practicing obstetrician gynecologists.

OBJECTIVE

We sought to determine if parameters of performance for validated laparoscopic virtual simulation tasks correlate with surgical volume and characteristics of practicing obstetricians and gynecologists.

STUDY DESIGN

All gynecologists with laparoscopic privileges (n = 347) from 5 academic medical centers in New York City were required to complete a laparoscopic surgery simulation assessment. The physicians took a presimulation survey gathering physician self-reported characteristics and then performed 3 basic skills tasks (enforced peg transfer, lifting/grasping, and cutting) on the LapSim virtual reality laparoscopic simulator (Surgical Science Ltd, Gothenburg, Sweden). The association between simulation outcome scores (time, efficiency, and errors) and self-rated clinical skills measures (self-rated laparoscopic skill score or surgical volume category) were examined with regression models.

RESULTS

The average number of laparoscopic procedures per month was a significant predictor of total time on all 3 tasks (P = .001 for peg transfer; P = .041 for lifting and grasping; P < .001 for cutting). Average monthly laparoscopic surgical volume was a significant predictor of 2 efficiency scores in peg transfer, and all 4 efficiency scores in cutting (P = .001 to P = .015). Surgical volume was a significant predictor of errors in lifting/grasping and cutting (P < .001 for both). Self-rated laparoscopic skill level was a significant predictor of total time in all 3 tasks (P < .0001 for peg transfer; P = .009 for lifting and grasping; P < .001 for cutting) and a significant predictor of nearly all efficiency scores and errors scores in all 3 tasks.

CONCLUSION

In addition to total time, there was at least 1 other objective performance measure that significantly correlated with surgical volume for each of the 3 tasks. Higher-volume physicians and those with fellowship training were more confident in their laparoscopic skills. By determining simulation performance as it correlates to active physician practice, further studies may help assess skill and individualize training to maintain skill levels as case volumes fluctuate.

A Novel Multiplayer Screen-Based Simulation Experience for African Learners Improved Confidence in Management of Postpartum Hemorrhage

Introduction

Postpartum hemorrhage (PPH) remains a global challenge, affecting thirteen million women each year. In addition, PPH is a leading cause of maternal mortality in Asia and Africa. In the U.S.A., care of critically ill patients is often practiced using mannequin-based simulation. Mannequin-based simulation presents challenges in global health, particularly in low- or middle-income countries. We developed a novel multiplayer screen-based simulation in a virtual world enabling the practice of team coordination with PPH. We used this simulation with learners in Mulago, Uganda. We hypothesized that a multiplayer screen-based simulation experience would increase learner confidence in their ability to manage PPH.

Methods

The study design was a simple pre- and a post-intervention survey. Forty-eight interprofessional subjects participated in one of nine 1-h simulation sessions using the PPH software. A fifteen-question self-assessment administered before and after the intervention was designed to probe the areas of learning as defined by Bloom and Krathwohl: affective, cognitive, and psychomotor.

Results

Combined confidence scores increased significantly overall following the simulation experience and individually in each of the three categories of Bloom’s Taxonomy: affective, cognitive, and psychomotor.

Conclusion

We provide preliminary evidence that multiplayer screen-based simulation represents a scalable, distributable form of learning that may be used effectively in global health education and training. Interestingly, despite our intervention being screen-based, our subjects showed improved confidence in their ability to perform psychomotor tasks. Although there is precedent for mental rehearsal improving performance, further research is needed to understand this finding.

Construction and validation of a surgical skills assessment tool for general surgery residency program

OBJECTIVE

To develop and validate an instrument for measuring the acquisition of technical skills in conducting operations of increasing difficulty for use in General Surgery Residency (GSR) programs.

METHODS

we built a surgical skills assessment tool containing 11 operations in increasing levels of difficulty. For instrument validation we used the face validity method. Through an electronic survey tool (Survey MonKey®) we sent a questionnaire to Full and Emeritus members of the Brazilian College of Surgeons--CBC--all bearers of the CBC Specialist Title.

RESULTS

Of the 307 questionnaires sent we received 100 responses. For the analysis of the data collected we used the Cronbach's alpha test. We observed that, in general, the overall alpha presented with values near or greater than 0.70, meaning good consistency to assess their points of interest.

CONCLUSION

The evaluation instrument built was validated and can be used as a method of assessment of technical skill acquisition in the General Surgery Residency programs in Brazil.

Long-Term Prognostic Validity of Talent Selections: Comparing National and Regional Coaches, Laypersons and Novices

In most sports, the development of elite athletes is a long-term process of talent identification and support. Typically, talent selection systems administer a multi-faceted strategy including national coach observations and varying physical and psychological tests when deciding who is chosen for talent development. The aim of this exploratory study was to evaluate the prognostic validity of talent selections by varying groups 10 years after they had been conducted. This study used a unique, multi-phased approach. Phase 1 involved players (n = 68) in 2001 completing a battery of general and sport-specific tests of handball ‘talent’ and performance. In Phase 2, national and regional coaches (n = 7) in 2001 who attended training camps identified the most talented players. In Phase 3, current novice and advanced handball players (n = 12 in each group) selected the most talented from short videos of matches played during the talent camp. Analyses compared predictions among all groups with a best model-fit derived from the motor tests. Results revealed little difference between regional and national coaches in the prediction of future performance and little difference in forecasting performance between novices and players. The best model-fit regression by the motor-tests outperformed all predictions. While several limitations are discussed, this study is a useful starting point for future investigations considering athlete selection decisions in talent identification in sport.

Identifying the Micro-relations Underpinning Familiarity Detection in Dynamic Displays Containing Multiple Objects

We identified the important micro-relations that are perceived when attempting to recognize patterns in stimuli consisting of multiple dynamic objects. Skilled and less-skilled participants were presented with point light display sequences representing dynamic patterns in an invasion sport and were subsequently required to make familiarity based recognition judgments in three different conditions, each of which contained only a select number of features that were present at initial viewing. No differences in recognition accuracy were observed between skilled and less-skilled participants when just objects located in the periphery were presented. Yet, when presented with the relative motions of two centrally located attacking objects only, skilled participants were significantly more accurate than less-skilled participants and their recognition accuracy improved further when a target object was included against which these relative motions could be judged. Skilled participants can perceive and recognize global patterns on the basis of centrally located relational information.

Balancing the Needs of Patients and Learners in Surgery

In this commentary, we explore the need for academic physicians to balance the needs of their patients and of learners during surgery. We approach this discussion from the perspective of the duty of care to the patient and reflect on methods to respect this duty of care but still maximize the educational experience of the learner without jeopardizing the patient's health. We also identify pedagogical methods to facilitate this balance, both in routine situations and during unforeseen events.

The Future of Plastic Surgery Resident Education

The challenge of the current graduate medical education environment requires in plastic surgery acceptance of those contemporary pressures that cannot be substantially modified and address of those that can be successfully met. To do so implies an examination of conference didactics, intraoperative teaching, and a valid assessment of resident performance.

Deliberate Practice as a Theoretical Framework for Interprofessional Experiential Education

OBJECTIVE

The theory of deliberate practice has been applied to many skill-based performance activities. The primary aim of this project was to integrate synergistic principles from deliberate practice and consensus-derived competencies for interprofessional education into a framework upon which educational models to advance interprofessional experiential education (IEE) might be built.

METHODS

CINAHL, ERIC, and MEDLINE databases were searched using the keywords "deliberate practice" and "interprofessional education," both individually and in combination. Relevant articles were selected from the catalog based on support for the premise of the project. Defining characteristics of deliberate practice were distilled with particular emphasis on their application to the Interprofessional Education Collaborative's (IPEC) core competencies. Recommendations for IEE development were identified through the synthesis of deliberate practice principles and IPEC competencies.

RESULTS

There is a high degree of synergy between deliberate practice principles and IPEC competencies. Our synthesis of the literature yielded a cyclical four-step process to advance IEE: (1) implement an IEE plan guided by the student's strengths/weaknesses and in consideration of the collaborative practice skills they wish to develop, (2) engage in IPE experiences that will challenge targeted skills according to the IEE plan, (3) embed frequent opportunities for student reflection and preceptor/team feedback within IEE plan, and (4) revise the IEE plan and the IPE experience based on insights gained during step 3.

CONCLUSION

The cyclical four-step process synthesized through this literature review may be used to guide the development of new IEE models. The purposeful development of IEE models grounded in a theory that has already been operationalized in other skill-based performance areas is an important step to address expanding accreditation standards throughout the health professions mandating interprofessional education for pre-licensure health professional students.

Conclusions about interventions, programs, and approaches for improving executive functions that appear justified and those that, despite much hype, do not

The 'Executive Functions' (EFs) of inhibitory control, working memory, and cognitive flexibility enable us to think before we act, resist temptations or impulsive reactions, stay focused, reason, problem-solve, flexibly adjust to changed demands or priorities, and see things from new and different perspectives. These skills are critical for success in all life's aspects and are sometimes more predictive than even IQ or socioeconomic status. Understandably, there is great interest in improving EFs. It's now clear they can be improved at any age through training and practice, much as physical exercise hones physical fitness. However, despite claims to the contrary, wide transfer does not seem to occur and 'mindless' aerobic exercise does little to improve EFs. Important questions remain: How much can EFs be improved (are benefits only superficial) and how long can benefits be sustained? What are the best methods for improving EFs? What about an approach accounts for its success? Do the answers to these differ by individual characteristics such as age or gender? Since stress, sadness, loneliness, or poor health impair EFs, and the reverse enhances EFs, we predict that besides directly train EFs, the most successful approaches for improving EFs will also address emotional, social, and physical needs.