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King M, Sanli E, Mugford K, Martina S, Brown R, Carnahan H. Evaluation of the Helicopter Emergency Breathing Apparatus on Egress Performance. Aerosp Med Hum Perform 2020; 91:962-965. [PMID: 33243340 DOI: 10.3357/amhp.5704.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND: Emergency helicopter landing at sea is dangerous. Specialized training, known as helicopter underwater escape training (HUET), prepares occupants to quickly exit the helicopter, which often inverts and sinks. In most jurisdictions, helicopter occupants are equipped with a helicopter underwater egress breathing apparatus (HUEBA) to provide sufficient air for escape. HUET trainees report that the HUEBA is easy to use, but it is well known that learners are often overconfident in their judgement of learning. To better understand how the HUEBA affects HUET sequence performance, we investigated whether using the HUEBA influences the sequence movement time and number of errors.METHODS: Twelve participants (7 men and 5 women, mean age 25.33 9.57 SD) with no prior experience with HUET performed consecutive trials of the HUET sequence, 5 with the HUEBA and 5 without the HUEBA. Video of each trial recorded the total movement time and enabled movement time analyses of each component of the sequence: crossing arms, tucking the head, pushing the window, inserting the regulator, and releasing the seatbelt. These recordings were also used to score performance errors according to a checklist.RESULTS: Analyses revealed that using a HUEBA increased the total movement time and time to release the seatbelt by 0.36 and 0.39 s, respectively, in comparison to without the HUEBA.DISCUSSION: Our study illustrates that using the HUEBA during the HUET sequence increases total movement time and time to release the seatbelt. However, this difference is marginal and unlikely to have practical significance during underwater escape.King M, Sanli E, Mugford K, Martina S, Brown R, Carnahan H. Evaluation of the helicopter emergency breathing apparatus on egress performance. Aerosp Med Hum Perform. 2020; 91(12):962965.
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Madu VC, Carnahan H, Brown R, Ennis KA, Tymko KS, Hurrie DMG, McDonald GK, Cornish SM, Giesbrecht GG. Skin Cooling on Breath-Hold Duration and Predicted Emergency Air Supply Duration During Immersion. Aerosp Med Hum Perform 2020; 91:578-585. [PMID: 32591034 DOI: 10.3357/amhp.5433.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE: This study was intended to determine the effect of skin cooling on breath-hold duration and predicted emergency air supply duration during immersion.METHODS: While wearing a helicopter transport suit with a dive mask, 12 subjects (29 ± 10 yr, 78 ± 14 kg, 177 ± 7 cm, 2 women) were studied in 8 and 20°C water. Subjects performed a maximum breath-hold, then breathed for 90 s (through a mouthpiece connected to room air) in five skin-exposure conditions. The first trial was out of water for Control (suit zipped, hood on, mask off). Four submersion conditions included exposure of the: Partial Face (hood and mask on); Face (hood on, mask off); Head (hood and mask off); and Whole Body (suit unzipped, hood and mask off).RESULTS: Decreasing temperature and increasing skin exposure reduced breath-hold time (to as low as 10 ± 4 s), generally increased minute ventilation (up to 40 ± 15 L · min-1), and decreased predicted endurance time (PET) of a 55-L helicopter underwater emergency breathing apparatus. In 8°C water, PET decreased from 2 min 39 s (Partial Face) to 1 min 11 s (Whole Body).CONCLUSION: The most significant factor increasing breath-hold and predicted survival time was zipping up the suit. Face masks and suit hoods increased thermal comfort. Therefore, wearing the suits zipped with hoods on and, if possible, donning the dive mask prior to crashing, may increase survivability. The results have important applications for the education and preparation of helicopter occupants. Thermal protective suits and dive masks should be provided.Madu VC, Carnahan H, Brown R, Ennis K-A, Tymko KS, Hurrie DMG, McDonald GK, Cornish SM, Giesbrecht GG. Skin cooling on breath-hold duration and predicted emergency air supply duration during immersion. Aerosp Med Hum Perform. 2020; 91(7):578-585.
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Abstract
BACKGROUND: Helicopter hoist operators are highly skilled and critical crewmembers in search and rescue. However, hoist operator training programs are relatively underdeveloped in comparison to helicopter pilot training. It is critical that this simulator teaches the necessary skills for high-level performance given the dangers associated with helicopter hoist operation. As a result, we sought to validate and identify critical aspects of skilled hoisting.METHODS: Through expert consultation, we identified several measures of hoist operation, such as mission time, cable plumb, cable tension, cable hand position, and cable displacement. We compared hoist performance between experienced and novice hoist operators in a simulated hoisting mission with two levels of difficulty (with and without wind). The experienced group (eight men/one woman) was composed of nine active or former military hoist operators who were working in commercial search and rescue. The novice group was composed of seven subjects (two men/five women) from the general population and had no previous experience with hoisting operations or the simulator.RESULTS: We found that experienced hoist operators had faster mission time, similar cable plumb, lower tension, and less variable hand position. Further, experienced hoist operators pulled the cable inward in the wind while novice hoist operators pushed the cable away.DISCUSSION: These findings suggests that this simulator captures performance differences between skill levels and, as a result, is a first step supporting the use of this simulator for hoist operator training.King MT, Lenser S, Rogers D, Carnahan H. Helicopter hoist performance in novice and experienced hoist operators. Aerosp Med Hum Perform. 2020; 91(6):496-500.
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Klein T, Sanders M, Wollseiffen P, Carnahan H, Abeln V, Askew CD, Claassen JA, Schneider S. Transient cerebral blood flow responses during microgravity. Life Sci Space Res (Amst) 2020; 25:66-71. [PMID: 32414494 DOI: 10.1016/j.lssr.2020.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 02/23/2020] [Accepted: 03/07/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE A number of studies has well described central cardiovascular changes caused by changing gravity levels as they occur e.g. during parabolic flight. limited data exists describing the effect of microgravity on the cerebrovascular system and brain perfusion. METHODS In this study middle cerebral artery velocity (MCAv) of 16 participants was continuously monitored on a second-by-second basis during 15 consecutive parabolas (1G, 1,8G, 0G, 1,8G) using doppler ultrasound. Simultaneously central cardiovascular parameters (heart rate, mean arterial blood pressure, cardiac output) were assessed. RESULTS Results revealed an immediate reaction of central cardiovascular parameters to changed gravity levels. In contrast, changes in MCAv only initially were in accordance with a normal cerebral autoregulation. Whereas all of the measured central cardiovascular parameters seemed to have reached a steady state after approximately 8 s of microgravity, MCAv, after an initial decrease with the onset of microgravity, increased again during the second half of the microgravity phase. CONCLUSION It is concluded that this increase in MCAv during the second half of the microgravity period reflects a decrease of cerebrovascular resistance caused by a pressure driven increased venous outflow and/or a contraction of precapillary sphincters in order to avoid hyperperfusion of the brain.
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Affiliation(s)
- Timo Klein
- VasoActive Research Group, School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore DC, QLD, Australia; Institute of Movement and Neuroscience, German Sport University Cologne, Cologne, Germany
| | - Marit Sanders
- Department of Geriatric Medicine, Radboud Alzheimer Centre, Radboud University Medical Center, Donders Institute for Brain, Nijmegen, The Netherlands
| | - Petra Wollseiffen
- Institute of Movement and Neuroscience, German Sport University Cologne, Cologne, Germany
| | - Heather Carnahan
- Offshore Safety and Survival Centre, Marine Institute, Memorial University of Newfoundland, Canada
| | - Vera Abeln
- VasoActive Research Group, School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore DC, QLD, Australia
| | - Christopher D Askew
- VasoActive Research Group, School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore DC, QLD, Australia
| | - Jurgen Ahr Claassen
- Department of Geriatric Medicine, Radboud Alzheimer Centre, Radboud University Medical Center, Donders Institute for Brain, Nijmegen, The Netherlands
| | - Stefan Schneider
- VasoActive Research Group, School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore DC, QLD, Australia; Institute of Movement and Neuroscience, German Sport University Cologne, Cologne, Germany; Offshore Safety and Survival Centre, Marine Institute, Memorial University of Newfoundland, Canada.
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King M, Carnahan H. Revisiting the brain activity associated with innocuous and noxious cold exposure. Neurosci Biobehav Rev 2019; 104:197-208. [DOI: 10.1016/j.neubiorev.2019.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/29/2019] [Accepted: 06/14/2019] [Indexed: 12/25/2022]
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Wollseiffen P, Klein T, Vogt T, Abeln V, Strüder HK, Stuckenschneider T, Sanders M, Claassen JAHR, Askew CD, Carnahan H, Schneider S. Neurocognitive performance is enhanced during short periods of microgravity-Part 2. Physiol Behav 2019; 207:48-54. [PMID: 31029651 DOI: 10.1016/j.physbeh.2019.04.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/06/2019] [Accepted: 04/24/2019] [Indexed: 11/29/2022]
Abstract
Previous studies showed a decrease in reaction time during the weightlessness phase of a parabolic flight. This effect was found to be stronger with increasing task complexity and was independent of previous experience of weightlessness as well as anti-nausea medication. Analysis of event related potentials showed a decreased amplitude of the N100-P200 complex in weightlessness but was not able to distinguish a possible effect of task complexity. The present study aimed to extend this previous work, by comparing behavioral (reaction time) and neurological (event related potentials analysis) performance to a simple (oddball) and a complex (mental arithmetic + oddball) task during weightlessness. 28 participants participated in two experiments. 11 participants performed a simple oddball experiment in the 1G and 0G phases of a parabolic flight. 17 participants were presented a complex arithmetic task in combination with an oddball task during the 1G and 0G phases of a parabolic flight. Reaction time as well as event related potentials (ERP) were assessed. Results revealed a reduced reaction time (p < .05) for the complex task during 0G. No gravity effects on reaction time were found for the simple task. In both experiments a reduction of typical ERP amplitudes was noticeable in weightlessness. It is assumed that the weightlessness induced fluid shift to the brain is positively affecting neuro-behavioral performance.
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Affiliation(s)
- Petra Wollseiffen
- Institute of Movement and Neurosciences, German Sport University Cologne, Germany
| | - Timo Klein
- Institute of Movement and Neurosciences, German Sport University Cologne, Germany; School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore, Australia
| | - Tobias Vogt
- Institute of Professional Sport Education and Sport Qualifications, German Sport University Cologne, Germany
| | - Vera Abeln
- Institute of Movement and Neurosciences, German Sport University Cologne, Germany
| | - Heiko K Strüder
- Institute of Movement and Neurosciences, German Sport University Cologne, Germany
| | - Tim Stuckenschneider
- Institute of Movement and Neurosciences, German Sport University Cologne, Germany
| | - Marit Sanders
- Department of Geriatric Medicine, Radboud Alzheimer Centre, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Jurgen A H R Claassen
- Department of Geriatric Medicine, Radboud Alzheimer Centre, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Christopher D Askew
- School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore, Australia
| | - Heather Carnahan
- School of Maritime Studies, Offshore Safety and Survival Centre, Marine Institute, Memorial University of Newfoundland, Canada
| | - Stefan Schneider
- Institute of Movement and Neurosciences, German Sport University Cologne, Germany; School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore, Australia; School of Maritime Studies, Offshore Safety and Survival Centre, Marine Institute, Memorial University of Newfoundland, Canada.
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Affiliation(s)
- Mariam T. Baghdady
- Discipline of Oral and Maxillofacial Radiology, Faculty of Dentistry and Fellow, Wilson Centre, Faculty of Medicine; University of Toronto
| | - Heather Carnahan
- Department of Occupational Science and Occupational Therapy, and Scientist, Wilson Centre, Faculty of Medicine; University of Toronto, as well as Director, Centre for Ambulatory Care Education, Women's College Hospital
| | - Ernest W.N. Lam
- Discipline of Oral and Maxillofacial Radiology, Director of Oral and Maxillofacial Radiology Graduate Program, and Dr. Lloyd and Mrs. Kay Chapman Chair in Clinical Sciences, Faculty of Dentistry; University of Toronto
| | - Nicole N. Woods
- Department of Surgery, and Scientist, Wilson Centre, Faculty of Medicine; University of Toronto
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Scaffidi MA, Grover SC, Carnahan H, Yu JJ, Yong E, Nguyen GC, Ling SC, Khanna N, Walsh CM. A prospective comparison of live and video-based assessments of colonoscopy performance. Gastrointest Endosc 2018; 87:766-775. [PMID: 28859953 DOI: 10.1016/j.gie.2017.08.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 08/20/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Colonoscopy performance is typically assessed by a supervisor in the clinical setting. There are limitations of this approach, however, because it allows for rater bias and increases supervisor workload demand during the procedure. Video-based assessment of recorded procedures has been proposed as a complementary means by which to assess colonoscopy performance. This study sought to investigate the reliability, validity, and feasibility of video-based assessments of competence in performing colonoscopy compared with live assessment. METHODS Novice (<50 previous colonoscopies), intermediate (50-500), and experienced (>1000) endoscopists from 5 hospitals participated. Two views of each colonoscopy were videotaped: an endoscopic (intraluminal) view and a recording of the endoscopist's hand movements. Recorded procedures were independently assessed by 2 blinded experts using the Gastrointestinal Endoscopy Competency Assessment Tool (GiECAT), a validated procedure-specific assessment tool comprising a global rating scale (GRS) and checklist (CL). Live ratings were conducted by a non-blinded expert endoscopist. Outcomes included agreement between live and blinded video-based ratings of clinical colonoscopies, intra-rater reliability, inter-rater reliability and discriminative validity of video-based assessments, and perceived ease of assessment. RESULTS Forty endoscopists participated (20 novices, 10 intermediates, and 10 experienced). There was good agreement between the live and video-based ratings (total, intra-class correlation [ICC] = 0.847; GRS, ICC = 0.868; CL, ICC = 0.749). Intra-rater reliability was excellent (total, ICC = 0.99; GRS, ICC = 0.99; CL, ICC = 0.98). Inter-rater reliability between the 2 blinded video-based raters was high (total, ICC = 0.91; GRS, ICC = 0.918; CL, ICC = 0.862). GiECAT total, GRS, and CL scores differed significantly among novice, intermediate, and experienced endoscopists (P < .001). Video-based assessments were perceived as "fairly easy," although live assessments were rated as significantly easier (P < .001). CONCLUSIONS Video-based assessments of colonoscopy procedures using the GiECAT have strong evidence of reliability and validity. In addition, assessments using videos were feasible, although live assessments were easier.
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Affiliation(s)
- Michael A Scaffidi
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Samir C Grover
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Heather Carnahan
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Jeffrey J Yu
- Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elaine Yong
- Division of Gastroenterology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Geoffrey C Nguyen
- Division of Gastroenterology, Mount Sinai Hospital University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Simon C Ling
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nitin Khanna
- Division of Gastroenterology, St. Joseph's Health Centre, University of Western Ontario, London, Ontario, Canada
| | - Catharine M Walsh
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Scaffidi MA, Grover SC, Carnahan H, Khan R, Amadio JM, Yu JJ, Dargavel C, Khanna N, Ling SC, Yong E, Nguyen GC, Walsh CM. Impact of experience on self-assessment accuracy of clinical colonoscopy competence. Gastrointest Endosc 2018; 87:827-836.e2. [PMID: 29122599 DOI: 10.1016/j.gie.2017.10.040] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 10/19/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Self-assessment is important for life-long learning and a recommended assessment method for endoscopy skills. Prior literature has not investigated self-assessment accuracy of colonoscopic competence in the clinical setting. This study aimed to determine the self-assessment accuracy of novice, intermediate, and experienced endoscopists. METHODS Novice (performed <50 previous colonoscopies), intermediate (50-500), and experienced (>1000) endoscopists from 5 hospitals each performed a clinical colonoscopy. Video recordings of procedures were independently assessed by 2 blinded expert endoscopists by using the Gastrointestinal Endoscopy Competency Assessment Tool (GiECAT). Externally assessed and self-assessed GiECAT scores were defined as the mean of the 2 video-based ratings and as participants' own assigned ratings, respectively. Self-assessment accuracy between the externally assessed and self-assessed scores was evaluated by using absolute difference scores, intraclass correlation coefficients, and the Bland-Altman analysis. RESULTS Twenty novice, 10 intermediate, and 10 experienced endoscopists participated. There was moderate agreement of externally assessed and self-assessed GiECAT scores, with an intraclass correlation coefficient of 0.65 (95% confidence interval, 0.44-0.80). The absolute difference scores among the 3 groups were significantly different (P = .002), with experienced endoscopists demonstrating a more accurate self-assessment ability compared with novices (P = .002). Bland-Altman plots suggest that novice and experienced endoscopists tend to overrate and underrate their clinical competence, respectively; no specific trends were associated with intermediates. CONCLUSION Participants demonstrated moderate self-assessment accuracy of clinical competence. Endoscopist experience was positively associated with self-assessment accuracy; novices demonstrated lower self-assessment accuracy compared with experienced endoscopists. Moreover, novices tended to overestimate their performances. Novice endoscopists may benefit from targeted interventions to improve self-assessment accuracy.
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Affiliation(s)
- Michael A Scaffidi
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Samir C Grover
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Heather Carnahan
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, Toronto, Ontario, Canada
| | - Rishad Khan
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer M Amadio
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey J Yu
- The Wilson Centre, University of Toronto, Toronto, Ontario, Canada
| | - Callum Dargavel
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nitin Khanna
- Division of Gastroenterology, St. Joseph's Health Centre, University of Western Ontario, Toronto, Ontario, Canada
| | - Simon C Ling
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada; Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Elaine Yong
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Gastroenterology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Geoffrey C Nguyen
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Catharine M Walsh
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada; Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; The Wilson Centre, University of Toronto, Toronto, Ontario, Canada
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Abstract
UNLABELLED Objective The aim of this study was to investigate the combined effect of cold and moisture on manual performance and tactile sensitivity. Background People working in the ocean environment often perform manual work in cold and wet conditions. Although the independent effects of cold and moisture on hand function are known, their combined effect has not been investigated. Method Participants completed sensory (Touch-Test, two-point discrimination) and motor (Purdue Pegboard, Grooved Pegboard, reef knot untying) tests in the following conditions: dry hand, wet hand, cold hand, and cold and wet hand. Results For the Purdue Pegboard and knot untying tasks, the greatest decrement in performance was observed in the cold-and-wet-hand condition, whereas the decrements seen in the cold-hand and wet-hand conditions were similar. In the Grooved Pegboard task, the performance decrements exhibited in the cold-and-wet-hand condition and the cold-hand condition were similar, whereas no decrement was observed in the wet-hand condition. Tactile sensitivity was reduced in the cold conditions for the Touch-Test but not the two-point discrimination test. CONCLUSION The combined effect of cold and moisture led to the largest performance decrements except when intrinsic object properties helped with grasp maintenance. The independent effects of cold and moisture on manual performance were comparable. Application Tools and equipment for use in the cold ocean environment should be designed to minimize the effects of cold and moisture on manual performance by including object properties that enhance grasp maintenance and minimize the fine-dexterity requirements.
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Affiliation(s)
- Matthew Ray
- Marine Institute of Memorial University, St. John's, Canada
| | | | - Robert Brown
- Marine Institute of Memorial University, St. John's, Canada
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Abstract
Motor learning is facilitated when knowledge of results (KR) is presented in accordance with a goal-centred bandwidth (i.e. when the error exceeds a tolerance limit about a movement goal). However, under different conditions of the bandwidth procedure the frequency with which KR is provided is also affected—the wider the goal-centred tolerance limits, the lower the frequency of KR. Since low-KR frequency conditions also have been shown to facilitate motor learning, it is not known whether the bandwidth KR effect is a unique phenomenon in motor learning or is simply due to differences in the frequency of KR. In the present study we partitioned the effects due to bandwidth KR from the effects due to KR frequency using a yoking procedure. Results from the acquisition performance trials indicated that bandwidth procedures exerted both error reduction and performance stabilization influences on motor behaviour that exceeded the effects of the relative frequency control procedures. Bandwidth procedures further resulted in better performance consistency during retention than the relative frequency conditions. These findings were discussed in terms of how KR about movement error and KR about the correctness of movement affect the learning of motor skill.
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Williams CK, Tseung V, Carnahan H. Self-Control of Haptic Assistance for Motor Learning: Influences of Frequency and Opinion of Utility. Front Psychol 2017; 8:2082. [PMID: 29255438 PMCID: PMC5723017 DOI: 10.3389/fpsyg.2017.02082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 11/15/2017] [Indexed: 11/16/2022] Open
Abstract
Studies of self-controlled practice have shown benefits when learners controlled feedback schedule, use of assistive devices and task difficulty, with benefits attributed to information processing and motivational advantages of self-control. Although haptic assistance serves as feedback, aids task performance and modifies task difficulty, researchers have yet to explore whether self-control over haptic assistance could be beneficial for learning. We explored whether self-control of haptic assistance would be beneficial for learning a tracing task. Self-controlled participants selected practice blocks on which they would receive haptic assistance, while participants in a yoked group received haptic assistance on blocks determined by a matched self-controlled participant. We inferred learning from performance on retention tests without haptic assistance. From qualitative analysis of open-ended questions related to rationales for/experiences of the haptic assistance that was chosen/provided, themes emerged regarding participants' views of the utility of haptic assistance for performance and learning. Results showed that learning was directly impacted by the frequency of haptic assistance for self-controlled participants only and view of haptic assistance. Furthermore, self-controlled participants' views were significantly associated with their requested haptic assistance frequency. We discuss these findings as further support for the beneficial role of self-controlled practice for motor learning.
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Affiliation(s)
- Camille K. Williams
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Victrine Tseung
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Heather Carnahan
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John’s, NL, Canada
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Abstract
OBJECTIVE To investigate the effect of hand immersion duration on manipulative ability and tactile sensitivity. BACKGROUND Individuals in maritime settings often work with hands that have been immersed in water. Although research has shown that hand immersion duration differentially impacts skin adhesion and tactile sensitivity, the effect of hand immersion on manipulative ability has not been directly tested. Given how critical manipulative ability is for the safety and performance of those working at sea, the effect of hand immersion duration on manual performance was investigated. METHOD Tests of manipulative ability (Purdue Pegboard, Grooved Pegboard, reef knot untying) and tactile sensitivity (Touch-Test) were completed following no-exposure, short-exposure, and long-exposure hand immersions in thermoneutral water. RESULTS Compared to the no immersion condition, the Purdue Pegboard performance was reduced in both immersion conditions (short exposure, -11%; long exposure, -8%). A performance decrement was only observed in the short exposure condition (+15% in time to complete task) for the reef knot untying task. There were no statistical differences in the Grooved Pegboard or Touch-Test scores between exposure conditions. CONCLUSION Immersing the hands in water decreases manipulative ability except for when object properties reduce the slipperiness between the hand and object. APPLICATION Manual performance in a wet environment may be conserved by designing tools and objects with edges and textures that can offset the slipperiness of wet hands. To maintain safety, the time requirements for working with wet hands needs to be considered.
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Affiliation(s)
- Matthew Ray
- Marine Institute of Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Elizabeth Sanli
- Marine Institute of Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Robert Brown
- Marine Institute of Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Kerri Ann Ennis
- Marine Institute of Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Heather Carnahan
- Marine Institute of Memorial University, St. John's, Newfoundland and Labrador, Canada
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Sanli EA, Slauenwhite J, Carnahan H. The relationship between error production when performing motor skills in high and low-stakes situations. Theoretical Issues in Ergonomics Science 2017. [DOI: 10.1080/1463922x.2016.1269845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Elizabeth A. Sanli
- Ocean Safety Research, Offshore Safety and Survival Centre, Marine Institute, Memorial University, St. John's, NL, Canada
| | - John Slauenwhite
- School of Human Kinetics and Recreation, Memorial University, St. John's, NL, Canada
| | - Heather Carnahan
- Ocean Safety Research, Offshore Safety and Survival Centre, Marine Institute, Memorial University, St. John's, NL, Canada
- School of Human Kinetics and Recreation, Memorial University, St. John's, NL, Canada
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Williams CK, Tremblay L, Carnahan H. It Pays to Go Off-Track: Practicing with Error-Augmenting Haptic Feedback Facilitates Learning of a Curve-Tracing Task. Front Psychol 2017; 7:2010. [PMID: 28082937 PMCID: PMC5183591 DOI: 10.3389/fpsyg.2016.02010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 12/12/2016] [Indexed: 11/29/2022] Open
Abstract
Researchers in the domain of haptic training are now entering the long-standing debate regarding whether or not it is best to learn a skill by experiencing errors. Haptic training paradigms provide fertile ground for exploring how various theories about feedback, errors and physical guidance intersect during motor learning. Our objective was to determine how error minimizing, error augmenting and no haptic feedback while learning a self-paced curve-tracing task impact performance on delayed (1 day) retention and transfer tests, which indicate learning. We assessed performance using movement time and tracing error to calculate a measure of overall performance – the speed accuracy cost function. Our results showed that despite exhibiting the worst performance during skill acquisition, the error augmentation group had significantly better accuracy (but not overall performance) than the error minimization group on delayed retention and transfer tests. The control group’s performance fell between that of the two experimental groups but was not significantly different from either on the delayed retention test. We propose that the nature of the task (requiring online feedback to guide performance) coupled with the error augmentation group’s frequent off-target experience and rich experience of error-correction promoted information processing related to error-detection and error-correction that are essential for motor learning.
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Affiliation(s)
- Camille K Williams
- Rehabilitation Sciences Institute, University of Toronto, Toronto ON, Canada
| | - Luc Tremblay
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto ON, Canada
| | - Heather Carnahan
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's NL, Canada
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Abstract
The purpose of this investigation was to describe the strategies used by individuals when motor systems controlling locomotion and prehension must be used simultaneously to perform a task. Subjects were required to perform five tasks: walk normally, walk and pick up a small object, walk and pick up a large object, pick up a small object from a stationary standing position, and pick up a large object while standing. The grasping and walking movements were videotaped and the frequencies of various behaviors were observed (type of grasp, location of contact with the object, support leg during contact with the object, timing of gaze toward object). Characteristics of the grasp were influenced by object size, not by whether the subject was walking. Gaze was shifted to the object before initiation of reach and this pattern was not influenced by size of the object or movement of the subject. Finally, subjects preferred using an ipsilateral support leg while generating the reach, which is a deviation from normal gait patterns. Findings indicate that the motor control system may be hierarchically organized in such a way that stability of the lower limbs supersedes the control of the movement patterns of an upper limb.
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Affiliation(s)
- D L Cockell
- Department of Kinesiology, University of Waterloo, Ontario, Canada
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Yeung E, Kulasagarem K, Woods N, Dubrowski A, Hodges B, Carnahan H. Validity of a new assessment rubric for a short-answer test of clinical reasoning. BMC Med Educ 2016; 16:192. [PMID: 27461249 PMCID: PMC4962495 DOI: 10.1186/s12909-016-0714-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 07/23/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND The validity of high-stakes decisions derived from assessment results is of primary concern to candidates and certifying institutions in the health professions. In the field of orthopaedic manual physical therapy (OMPT), there is a dearth of documented validity evidence to support the certification process particularly for short-answer tests. To address this need, we examined the internal structure of the Case History Assessment Tool (CHAT); this is a new assessment rubric developed to appraise written responses to a short-answer test of clinical reasoning in post-graduate OMPT certification in Canada. METHODS Fourteen physical therapy students (novices) and 16 physical therapists (PT) with minimal and substantial OMPT training respectively completed a mock examination. Four pairs of examiners (n = 8) participated in appraising written responses using the CHAT. We conducted separate generalizability studies (G studies) for all participants and also by level of OMPT training. Internal consistency was calculated for test questions with more than 2 assessment items. Decision studies were also conducted to determine optimal application of the CHAT for OMPT certification. RESULTS The overall reliability of CHAT scores was found to be moderate; however, reliability estimates for the novice group suggest that the scale was incapable of accommodating for scores of novices. Internal consistency estimates indicate item redundancies for several test questions which will require further investigation. CONCLUSION Future validity studies should consider discriminating the clinical reasoning competence of OMPT trainees strictly at the post-graduate level. Although rater variance was low, the large variance attributed to error sources not incorporated in our G studies warrant further investigations into other threats to validity. Future examination of examiner stringency is also warranted.
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Affiliation(s)
- Euson Yeung
- Department of Rehabilitation Sciences, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7 Canada
- The Wilson Centre for Research in Education, University Health Network, Toronto, Canada
| | - Kulamakan Kulasagarem
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- The Wilson Centre for Research in Education, University Health Network, Toronto, Canada
| | - Nicole Woods
- Department of Surgery, University of Toronto, Toronto, Canada
- The Wilson Centre for Research in Education, University Health Network, Toronto, Canada
| | - Adam Dubrowski
- Division of Emergency Medicine, Memorial University of Newfoundland, St John’s, Canada
| | - Brian Hodges
- Faculty of Medicine, University of Toronto, Toronto, Canada
- Wilson Centre for Research in Education Richard and Elizabeth Currie Chair in Health Professions Education Research, University Health Network, Toronto, Canada
| | - Heather Carnahan
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St John’s, Canada
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Walsh CM, Ling SC, Khanna N, Grover SC, Yu JJ, Cooper MA, Yong E, Nguyen GC, May G, Walters TD, Reznick R, Rabeneck L, Carnahan H. Gastrointestinal Endoscopy Competency Assessment Tool: reliability and validity evidence. Gastrointest Endosc 2016; 81:1417-1424.e2. [PMID: 25753836 DOI: 10.1016/j.gie.2014.11.030] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 11/12/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Rigorously developed and validated direct observational assessment tools are required to support competency-based colonoscopy training to facilitate skill acquisition, optimize learning, and ensure readiness for unsupervised practice. OBJECTIVE To examine reliability and validity evidence of the Gastrointestinal Endoscopy Competency Assessment Tool (GiECAT) for colonoscopy for use within the clinical setting. DESIGN Prospective, observational, multicenter validation study. Sixty-one endoscopists performing 116 colonoscopies were assessed using the GiECAT, which consists of a 7-item global rating scale (GRS) and 19-item checklist (CL). A second rater assessed procedures to determine interrater reliability by using intraclass correlation coefficients (ICCs). Endoscopists' first and second procedure scores were compared to determine test-retest reliability by using ICCs. Discriminative validity was examined by comparing novice, intermediate, and experienced endoscopists' scores. Concurrent validity was measured by correlating scores with colonoscopy experience, cecal and terminal ileal intubation rates, and physician global assessment. SETTING A total of 116 colonoscopies performed by 33 novice (<50 previous procedures), 18 intermediate (50-500 previous procedures), and 10 experienced (>1000 previous procedures) endoscopists from 6 Canadian hospitals. MAIN OUTCOME MEASUREMENTS Interrater and test-retest reliability, discriminative, and concurrent validity. RESULTS Interrater reliability was high (total: ICC=0.85; GRS: ICC=0.85; CL: ICC=0.81). Test-retest reliability was excellent (total: ICC=0.91; GRS: ICC=0.93; CL: ICC=0.80). Significant differences in GiECAT scores among novice, intermediate, and experienced endoscopists were noted (P<.001). There was a significant positive correlation (P<.001) between scores and number of previous colonoscopies (total: ρ=0.78, GRS: ρ=0.80, CL: Spearman's ρ=0.71); cecal intubation rate (total: ρ=0.81, GRS: Spearman's ρ=0.82, CL: Spearman's ρ=0.75); ileal intubation rate (total: Spearman's ρ=0.82, GRS: Spearman's ρ=0.82, CL: Spearman's ρ=0.77); and physician global assessment (total: Spearman's ρ=0.90, GRS: Spearman's ρ=0.94, CL: Spearman's ρ=0.77). LIMITATIONS Nonblinded assessments. CONCLUSION This study provides evidence supporting the reliability and validity of the GiECAT for use in assessing the performance of live colonoscopies in the clinical setting.
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Affiliation(s)
- Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada; Wilson Centre, University of Toronto, Toronto, Ontario, Canada
| | - Simon C Ling
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Nitin Khanna
- Division of Gastroenterology, St. Joseph's Health Centre, University of Western Ontario, London, Ontario, Canada
| | - Samir C Grover
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey J Yu
- Wilson Centre, University of Toronto, Toronto, Ontario, Canada
| | - Mary Anne Cooper
- Division of Gastroenterology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elaine Yong
- Division of Gastroenterology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Geoffrey C Nguyen
- Division of Gastroenterology, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gary May
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Thomas D Walters
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Richard Reznick
- Faculty of Health Sciences, Queen's University Kingston, Ontario, Canada
| | - Linda Rabeneck
- Division of Gastroenterology, Mount Sinai Hospital, Toronto, Ontario, Canada; Cancer Care Ontario, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Heather Carnahan
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
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Hao Y, Bala K, McRae M, Carnahan H, Borschel GH, Ho ES. Establishing expert consensus on the evaluation of pediatric upper extremity function. J Hand Ther 2016; 28:151-6; quiz 157. [PMID: 25449718 DOI: 10.1016/j.jht.2014.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 08/27/2014] [Accepted: 09/05/2014] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Consensus statement. INTRODUCTION There is a lack of consensus in the literature on the measures of pediatric upper extremity (UE) function for musculoskeletal conditions. PURPOSE To establish expert consensus on utility, satisfaction and importance of functional outcome measures in children with UE musculoskeletal conditions, across International Classification of Functioning, Disability and Health (ICF) domains. METHODS Using Delphi Consensus Methodology, expert panelists completed three rounds of questionnaires. RESULTS Agreement on Body Functions and Structure, Activity, and Participation outcome measures was determined (α, ICC range = 0.86-0.96). Mean satisfaction of measures in the respective domains was between 6.93 and 7.94. The Activity domain had lowest satisfaction, however there was consensus it was the most important. DISCUSSION Consensus on relative importance, but low satisfaction in the Activity domain suggests a need for better outcomes in this domain. CONCLUSIONS Findings report the status of outcome measure utility and use in pediatric UE function. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Yumiko Hao
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada; Department of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Katie Bala
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Matthew McRae
- Division of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Heather Carnahan
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Gregory H Borschel
- Department of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Division of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada; Program in Physiology and Experimental Medicine, The Hospital for Sick Children Research Institute, Toronto, ON, Canada; Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Emily S Ho
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada; Department of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, ON, Canada.
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Yeung E, Woods N, Dubrowski A, Hodges B, Carnahan H. Establishing assessment criteria for clinical reasoning in orthopedic manual physical therapy: a consensus-building study. J Man Manip Ther 2015; 23:27-36. [PMID: 26309379 DOI: 10.1179/2042618613y.0000000051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES Clinical reasoning (CR) represents one of the core components of clinical competence in Orthopaedic Manual Physical Therapy (OMPT). While education standards have been developed to guide curricular design, assessment of CR has not yet been standardized. Without theory-informed and rigorously developed measures, the certification of OMPTs lacks credibility and is less defensible. The purpose of this study was to use a theory-informed approach to generate assessment criteria for developing new assessment tools to evaluate CR in OMPT. METHODS A list of assessment criteria was generated based on international education standards and multiple theoretical perspectives. A modified Delphi method was used to gain expert consensus on the importance of these assessment criteria for the assessment of CR in OMPT. The OMPTs from 22 countries with experience in assessing CR were invited to participate in three rounds of online questionnaires to rate their level of agreement with these criteria. Responses were tabulated to analyze degree of consensus and internal consistency. RESULTS Representatives from almost half of the OMPT member organizations (MO) participated in three rounds of the Delphi. High levels of agreement were found among respondents regarding the importance and feasibility of most assessment criteria. There was high internal consistency among items within the proposed item subgroupings. DISCUSSION A list of assessment criteria has been established that will serve as a framework for developing new assessment tools for CR assessment in OMPT. These criteria will be important for guiding the design of certification processes in OMPT as well as other episodes of CR assessment throughout OMPT training.
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Affiliation(s)
| | | | | | | | - Heather Carnahan
- University of Toronto, Toronto, Canada ; Memorial University of Newfoundland, St John's, Canada
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Yeung E, Kulasegaram K, Woods N, Hodges B, Carnahan H. Development of a new assessment rubric for a short-answer test of clinical reasoning in orthopaedic manual physical therapy (OMPT). Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mori B, Carnahan H, Herold J. Use of Simulation Learning Experiences in Physical Therapy Entry-to-Practice Curricula: A Systematic Review. Physiother Can 2015; 67:194-202. [PMID: 25931672 DOI: 10.3138/ptc.2014-40e] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To review the literature on simulation-based learning experiences and to examine their potential to have a positive impact on physiotherapy (PT) learners' knowledge, skills, and attitudes in entry-to-practice curricula. METHOD A systematic literature search was conducted in the MEDLINE, CINAHL, Embase Classic+Embase, Scopus, and Web of Science databases, using keywords such as physical therapy, simulation, education, and students. RESULTS A total of 820 abstracts were screened, and 23 articles were included in the systematic review. While there were few randomized controlled trials with validated outcome measures, some discoveries about simulation can positively affect the design of the PT entry-to-practice curricula. Using simulators to provide specific output feedback can help students learn specific skills. Computer simulations can also augment students' learning experience. Human simulation experiences in managing the acute patient in the ICU are well received by students, positively influence their confidence, and decrease their anxiety. There is evidence that simulated learning environments can replace a portion of a full-time 4-week clinical rotation without impairing learning. CONCLUSIONS Simulation-based learning activities are being effectively incorporated into PT curricula. More rigorously designed experimental studies that include a cost-benefit analysis are necessary to help curriculum developers make informed choices in curriculum design.
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Affiliation(s)
- Brenda Mori
- Department of Physical Therapy ; Centre for Faculty Development, Faculty of Medicine, University of Toronto at the Li Ka Shing International Healthcare Education Centre of St. Michael's Hospital, Toronto, Ont
| | - Heather Carnahan
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St John's
| | - Jodi Herold
- Postgraduate Medical Education, Faculty of Medicine, University of Toronto
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Yeung E, Woods N, Dubrowski A, Hodges B, Carnahan H. Sensibility of a new instrument to assess clinical reasoning in post-graduate orthopaedic manual physical therapy education. ACTA ACUST UNITED AC 2014; 20:303-12. [PMID: 25456273 DOI: 10.1016/j.math.2014.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 07/24/2014] [Accepted: 10/03/2014] [Indexed: 02/07/2023]
Abstract
Sound application of clinical reasoning (CR) by the physical therapist is critical to achieving optimal patient outcomes. As such, it is important for institutions granting certification in orthopaedic manual physical therapy (OMPT) to ensure that the assessment of CR is sufficiently robust. At present, the dearth of validated instruments to assess CR in OMPT presents a serious challenge to certifying institutions. Moreover, the lack of documentation of the development process for instruments that measure CR pose additional challenges. The purpose of this study is to evaluate the sensibility of a newly developed instrument for assessing written responses to a test of CR in OMPT; a 'pilot' phase that examines instrument feasibility and acceptability. Using a sequential mixed-methods approach, Canadian OMPT examiners were recruited to first review and use the instrument. Participants completed a sensibility questionnaire followed by semi-structured interviews, the latter of which were used to elaborate on questionnaire responses regarding feasibility and acceptability. Eleven examiners completed the questionnaire and interviews. Questionnaire results met previously established sensibility criteria, while interview data revealed participants' (dis)comfort with exerting their own judgment and with the rating scale. Quantitative and qualitative data provided valuable insight regarding content validity and issues related to efficiency in assessing CR competence; all of which will ultimately inform further psychometric testing. While results suggest that the new instrument for assessing clinical reasoning in the Canadian certification context is sensible, future research should explore how rater judgment can be utilized effectively and the mental workload associated with appraising clinical reasoning.
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Affiliation(s)
- Euson Yeung
- Graduate Department of Rehabilitation Sciences, University of Toronto, Canada; The Wilson Centre for Research in Education, University Health Network, Toronto, Canada.
| | - Nicole Woods
- The Wilson Centre for Research in Education, University Health Network, Toronto, Canada
| | - Adam Dubrowski
- Division of Emergency Medicine, Memorial University of Newfoundland, St John's, Canada
| | - Brian Hodges
- Faculty of Medicine, University of Toronto, Canada; Vice-President Education, University Health Network, Canada; Wilson Centre for Research in Education Richard and Elizabeth Currie Chair in Health Professions Education Research, Toronto, Canada
| | - Heather Carnahan
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St John's, Canada
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Cooper MA, Tinmouth JM, Yong E, Walsh CM, Carnahan H, Grover SC, Ritvo P. Surgical residents' perceptions on learning gastrointestinal endoscopy: more hours and more standardization wanted. J Surg Educ 2014; 71:899-905. [PMID: 25168711 DOI: 10.1016/j.jsurg.2014.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 04/15/2014] [Accepted: 05/29/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Gastrointestinal endoscopy is a complex task that involves an interaction of cognitive and manual skills. There is no consensus on the optimal way to teach endoscopy. We sought to evaluate our formal endoscopy curriculum for general surgery trainees to improve the effectiveness and quality of the endoscopy teaching in this program. DESIGN We conducted focus group sessions over a 2-year period. Participants were general surgery residents, who are at the end of their endoscopy training rotation. The goal was to obtain the opinions and perceptions of trainees actively involved in learning endoscopy. SETTING University-based general surgery residency. PARTICIPANTS Second-year general surgery residents. RESULTS A total of 24 residents participated in 7 focus group sessions over 2 years. Four central themes emerged that included training structure and expectations, development of endoscopy competence, teaching approaches and teaching tools, and recommendations for improvement of the training experience. CONCLUSIONS An assessment of the themes led to the following concrete suggestions for improvement: the development of an algorithmic approach to endoscopy for the novice learner, consideration to introduce additional experience in endoscopy later in the 5-year surgery program, and consideration to incorporate a train-the-trainer curriculum for faculty that teach endoscopy.
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Affiliation(s)
- Mary Anne Cooper
- Division of Gastroenterology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
| | - Jill M Tinmouth
- Division of Gastroenterology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Elaine Yong
- Division of Gastroenterology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada; The Wilson Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Heather Carnahan
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Samir C Grover
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Paul Ritvo
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada; Research, Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada
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Baghdady MT, Carnahan H, Lam EWN, Woods NN. Dental and dental hygiene students' diagnostic accuracy in oral radiology: effect of diagnostic strategy and instructional method. J Dent Educ 2014; 78:1279-1285. [PMID: 25179924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
There has been much debate surrounding diagnostic strategies and the most appropriate training models for novices in oral radiology. It has been argued that an analytic approach, using a step-by-step analysis of the radiographic features of an abnormality, is ideal. Alternative research suggests that novices can successfully employ non-analytic reasoning. Many of these studies do not take instructional methodology into account. This study evaluated the effectiveness of non-analytic and analytic strategies in radiographic interpretation and explored the relationship between instructional methodology and diagnostic strategy. Second-year dental and dental hygiene students were taught four radiographic abnormalities using basic science instructions or a step-by-step algorithm. The students were tested on diagnostic accuracy and memory immediately after learning and one week later. A total of seventy-three students completed both immediate and delayed sessions and were included in the analysis. Students were randomly divided into two instructional conditions: one group provided a diagnostic hypothesis for the image and then identified specific features to support it, while the other group first identified features and then provided a diagnosis. Participants in the diagnosis-first condition (non-analytic reasoning) had higher diagnostic accuracy then those in the features-first condition (analytic reasoning), regardless of their learning condition. No main effect of learning condition or interaction with diagnostic strategy was observed. Educators should be mindful of the potential influence of analytic and non-analytic approaches on the effectiveness of the instructional method.
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Affiliation(s)
- Mariam T Baghdady
- Dr. Baghdady is Assistant Professor of Oral and Maxillofacial Radiology, Department of Diagnostic Sciences, Faculty of Dentistry, Kuwait University and Assistant Professor of Oral and Maxillofacial Radiology, Faculty of Dentistry, University of Toronto; Dr. Carnahan is Professor, School of Human Kinetics and Recreation, Memorial University of Newfoundland; Dr. Lam is Head of the Discipline of Oral and Maxillofacial Radiology, Director of Oral and Maxillofacial Radiology Graduate Program, and Dr. Lloyd and Mrs. Kay Chapman Chair in Clinical Sciences, Faculty of Dentistry, University of Toronto; and Dr. Woods is Assistant Professor, Department of Surgery, Faculty of Medicine and Scientist, Wilson Centre, Department of Surgery, Faculty of Medicine, University of Toronto.
| | - Heather Carnahan
- Dr. Baghdady is Assistant Professor of Oral and Maxillofacial Radiology, Department of Diagnostic Sciences, Faculty of Dentistry, Kuwait University and Assistant Professor of Oral and Maxillofacial Radiology, Faculty of Dentistry, University of Toronto; Dr. Carnahan is Professor, School of Human Kinetics and Recreation, Memorial University of Newfoundland; Dr. Lam is Head of the Discipline of Oral and Maxillofacial Radiology, Director of Oral and Maxillofacial Radiology Graduate Program, and Dr. Lloyd and Mrs. Kay Chapman Chair in Clinical Sciences, Faculty of Dentistry, University of Toronto; and Dr. Woods is Assistant Professor, Department of Surgery, Faculty of Medicine and Scientist, Wilson Centre, Department of Surgery, Faculty of Medicine, University of Toronto
| | - Ernest W N Lam
- Dr. Baghdady is Assistant Professor of Oral and Maxillofacial Radiology, Department of Diagnostic Sciences, Faculty of Dentistry, Kuwait University and Assistant Professor of Oral and Maxillofacial Radiology, Faculty of Dentistry, University of Toronto; Dr. Carnahan is Professor, School of Human Kinetics and Recreation, Memorial University of Newfoundland; Dr. Lam is Head of the Discipline of Oral and Maxillofacial Radiology, Director of Oral and Maxillofacial Radiology Graduate Program, and Dr. Lloyd and Mrs. Kay Chapman Chair in Clinical Sciences, Faculty of Dentistry, University of Toronto; and Dr. Woods is Assistant Professor, Department of Surgery, Faculty of Medicine and Scientist, Wilson Centre, Department of Surgery, Faculty of Medicine, University of Toronto
| | - Nicole N Woods
- Dr. Baghdady is Assistant Professor of Oral and Maxillofacial Radiology, Department of Diagnostic Sciences, Faculty of Dentistry, Kuwait University and Assistant Professor of Oral and Maxillofacial Radiology, Faculty of Dentistry, University of Toronto; Dr. Carnahan is Professor, School of Human Kinetics and Recreation, Memorial University of Newfoundland; Dr. Lam is Head of the Discipline of Oral and Maxillofacial Radiology, Director of Oral and Maxillofacial Radiology Graduate Program, and Dr. Lloyd and Mrs. Kay Chapman Chair in Clinical Sciences, Faculty of Dentistry, University of Toronto; and Dr. Woods is Assistant Professor, Department of Surgery, Faculty of Medicine and Scientist, Wilson Centre, Department of Surgery, Faculty of Medicine, University of Toronto
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Baghdady MT, Carnahan H, Lam EW, Woods NN. Dental and Dental Hygiene Students’ Diagnostic Accuracy in Oral Radiology: Effect of Diagnostic Strategy and Instructional Method. J Dent Educ 2014. [DOI: 10.1002/j.0022-0337.2014.78.9.tb05799.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Mariam T. Baghdady
- Department of Diagnostic Sciences; Faculty of Dentistry; Kuwait University and Assistant Professor of Oral and Maxillofacial Radiology; Faculty of Dentistry; University of Toronto
| | - Heather Carnahan
- School of Human Kinetics and RecreationMemorial University of Newfoundland; Oral and Maxillofacial Radiology Graduate Program
| | | | - Nicole N. Woods
- Department of Surgery; Faculty of Medicine and Scientist; Wilson Centre; Department of Surgery; Faculty of Medicine; University of Toronto
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Isaranuwatchai W, Brydges R, Carnahan H, Backstein D, Dubrowski A. Comparing the cost-effectiveness of simulation modalities: a case study of peripheral intravenous catheterization training. Adv Health Sci Educ Theory Pract 2014; 19:219-32. [PMID: 23728476 DOI: 10.1007/s10459-013-9464-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 05/20/2013] [Indexed: 05/26/2023]
Abstract
While the ultimate goal of simulation training is to enhance learning, cost-effectiveness is a critical factor. Research that compares simulation training in terms of educational- and cost-effectiveness will lead to better-informed curricular decisions. Using previously published data we conducted a cost-effectiveness analysis of three simulation-based programs. Medical students (n = 15 per group) practiced in one of three 2-h intravenous catheterization skills training programs: low-fidelity (virtual reality), high-fidelity (mannequin), or progressive (consisting of virtual reality, task trainer, and mannequin simulator). One week later, all performed a transfer test on a hybrid simulation (standardized patient with a task trainer). We used a net benefit regression model to identify the most cost-effective training program via paired comparisons. We also created a cost-effectiveness acceptability curve to visually represent the probability that one program is more cost-effective when compared to its comparator at various 'willingness-to-pay' values. We conducted separate analyses for implementation and total costs. The results showed that the progressive program had the highest total cost (p < 0.001) whereas the high-fidelity program had the highest implementation cost (p < 0.001). While the most cost-effective program depended on the decision makers' willingness-to-pay value, the progressive training program was generally most educationally- and cost-effective. Our analyses suggest that a progressive program that strategically combines simulation modalities provides a cost-effective solution. More generally, we have introduced how a cost-effectiveness analysis may be applied to simulation training; a method that medical educators may use to investment decisions (e.g., purchasing cost-effective and educationally sound simulators).
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Affiliation(s)
- Wanrudee Isaranuwatchai
- Centre for Excellence in Economic Analysis Research, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
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Walsh CM, Ling SC, Khanna N, Cooper MA, Grover SC, May G, Walters TD, Rabeneck L, Reznick R, Carnahan H. Gastrointestinal Endoscopy Competency Assessment Tool: development of a procedure-specific assessment tool for colonoscopy. Gastrointest Endosc 2014; 79:798-807.e5. [PMID: 24321390 DOI: 10.1016/j.gie.2013.10.035] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 10/17/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Ensuring competence remains a seminal objective of endoscopy training programs, professional organizations, and accreditation bodies; however, no widely accepted measure of endoscopic competence currently exists. OBJECTIVE By using Delphi methodology, we aimed to develop and establish the content validity of the Gastrointestinal Endoscopy Competency Assessment Tool for colonoscopy. DESIGN An international panel of endoscopy experts rated potential checklist and global rating items for their importance as indicators of the competence of trainees learning to perform colonoscopy. After each round, responses were analyzed and sent back to the experts for further ratings until consensus was reached. MAIN OUTCOME MEASUREMENTS Consensus was defined a priori as ≥80% of experts, in a given round, scoring ≥4 of 5 on all remaining items. RESULTS Fifty-five experts agreed to be part of the Delphi panel: 43 gastroenterologists, 10 surgeons, and 2 endoscopy managers. Seventy-three checklist and 34 global rating items were generated through a systematic literature review and survey of committee members. An additional 2 checklist and 4 global rating items were added by Delphi panelists. Five rounds of surveys were completed before consensus was achieved, with response rates ranging from 67% to 100%. Seven global ratings and 19 checklist items reached consensus as good indicators of the competence of clinicians performing colonoscopy. LIMITATIONS Further validation required. CONCLUSION Delphi methodology allowed for the rigorous development and content validation of a new measure of endoscopic competence, reflective of practice across institutions. Although further evaluation is required, it is a promising step toward the objective assessment of competency for use in colonoscopy training, practice, and research.
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Affiliation(s)
- Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada; The Wilson Centre, University of Toronto, Toronto, Ontario, Canada
| | - Simon C Ling
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Nitin Khanna
- Division of Gastroenterology, St. Joseph's Health Centre, University of Western Ontario, Toronto, Ontario, Canada
| | - Mary Anne Cooper
- Division of Gastroenterology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Samir C Grover
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gary May
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Thomas D Walters
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Linda Rabeneck
- Cancer Care Ontario, Queen's University, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Richard Reznick
- Faculty of Health Sciences, Queen's University, Toronto, Ontario, Canada
| | - Heather Carnahan
- Centre for Ambulatory Care Education, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada; The Wilson Centre, University of Toronto, Toronto, Ontario, Canada
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Abstract
Recent developments in neurorehabilitation have spawned numerous new robotic rehabilitation therapies. However, many of the concepts upon which these therapies are based are not fully understood and it may be necessary to explore some of the motor learning principles that apply to the use of haptics for motor learning in non-clinical scenarios/populations. We conducted a review of studies that utilized a haptic training paradigm teaching healthy participants to perform a motor skill involving the upper extremities. We discuss studies in the context of four important motor learning concepts: performance versus learning, feedback, observational learning, and functional task difficulty. Additionally, we note that the proliferation of research in haptic training has led to an extensive vocabulary of terms, some of which may be misnomers or redundant. We propose a classification of terms describing haptic training in an effort to provide clarity and further contextualize the studies. We believe that making connections to motor learning principles and clarifying meanings will facilitate a fuller understanding of the outcomes of studies in basic science research and allow for more directed applications of these training techniques to clinical populations.
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Li J, Grierson L, Wu MX, Breuer R, Carnahan H. [Quantitative research on operation behavior of acupuncture manipulation]. Zhongguo Zhen Jiu 2014; 34:247-251. [PMID: 24843965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To explore a method of quantitative evaluation on operation behavior of acupuncture manipulation and further analyze behavior features of professional acupuncture manipulation. METHODS According to acupuncture basic manipulations, Scales for Operation Behavior of Acupuncture Basic Manipulation was made and Delphi method was adopted to test its validity. Two independent estimators utilized this scale to assess operation behavior of acupuncture manipulate among 12 acupuncturists and 12 acupuncture-novices and calculate interrater reliability, also the differences of total score of operation behavior in the two groups as well as single-step score, including sterilization, needle insertion, needle manipulation and needle withdrawal, were compared. RESULTS The validity of this scale was satisfied. The inter-rater reliability was 0. 768. The total score of operation behavior in acupuncturist group was significantly higher than that in the acupuncture-novice group (13.80 +/- 1.05 vs 11.03 +/- 2.14, P < 0.01). The scores of needle insertion and needle manipulation in the acupuncturist group were significantly higher than those in the acupuncture-novice group (4.28 +/- 0.91 vs 2.54 +/- 1.51, P < 0.01; 2.56 +/- 0.65 vs 1.88 +/- 0.88, P < 0.05); however, the scores of sterilization and needle withdrawal in the acupuncturist group were not different from those in the acupuncture-novice group. CONCLUSION This scale is suitable for quantitative evaluation on operation behavior of acupuncture manipulation. The behavior features of professional acupuncture manipulation are mainly presented with needle insertion and needle manipulation which has superior difficulty, high coordination and accuracy.
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Baghdady M, Carnahan H, Lam EWN, Woods NN. Test-enhanced learning and its effect on comprehension and diagnostic accuracy. Med Educ 2014; 48:181-8. [PMID: 24528400 DOI: 10.1111/medu.12302] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 05/08/2013] [Accepted: 07/04/2013] [Indexed: 05/16/2023]
Abstract
CONTEXT In health professions education, tests have traditionally been used to assess the skills and knowledge of learners. More recently, research in psychology and education has shown that tests can also be used to enhance student memory; a phenomenon called the 'testing effect'. Much of the research in this domain has focused on enhancing rote memory of simple facts, and not on the deeper comprehension and application of complex theoretical knowledge necessary to diagnose and manage patients. The purpose of this study was to examine the effects of testing on students' comprehension of the basic science mechanisms and diagnostic accuracy. METHODS Undergraduate dental and dental hygiene students (n = 112) were taught the radiographic features and pathophysiology underlying four intrabony abnormalities. Participants were divided into two groups: the test-enhanced (TE) condition and the study (ST) condition. Following the learning phase, the TE condition group completed an interventional test that tested the basic science mechanisms and the ST condition group was given additional study passages without being tested. Participants in both groups then completed a diagnostic test and a memory test immediately after the learning phase and 1 week later. RESULTS A main effect of testing condition was found. The participants in the TE condition group outperformed those in the ST condition group on immediate and delayed testing. Unlike the diagnostic test, the memory test showed no difference between the groups. CONCLUSION The inclusion of the basic science test appears to have improved the students' understanding of the underlying disease mechanisms learned and also improved their performance on a test of diagnostic accuracy.
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Affiliation(s)
- Mariam Baghdady
- Discipline of Oral and Maxillofacial Radiology, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada; The Wilson Centre, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Oral and Maxillofacial Radiology, Department of Diagnostic Sciences, Faculty of Dentistry, Kuwait University, Kuwait
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Safir O, Williams CK, Dubrowski A, Backstein D, Carnahan H. Self-directed practice schedule enhances learning of suturing skills. Can J Surg 2014; 56:E142-7. [PMID: 24284153 DOI: 10.1503/cjs.019512] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Most preoperative surgical training programs experience challenges with the availability of expert surgeons to teach trainees. Some research suggests that trainees may benefit from being allowed to actively shape their learning environments, which could alleviate some of the time and resource pressures in surgical training. The purpose of this study was to investigate the effects of self-directed or prescribed practice schedules (random or blocked) on learning suturing skills. METHODS Participants watched an instructional video for simple interrupted, vertical mattress and horizontal mattress suturing then completed a pretest to assess baseline skills. Participants were assigned to 1 of 4 practice groups: self-directed practice schedule, prescribed blocked practice schedule, prescribed random practice schedule or matched to the self-directed group (control). Practice of the skill was followed by a delayed (1 h) posttest. Improvement from pretest to posttest was determined based on differences in performance time and expert-based assessments. RESULTS Analyses revealed a significant effect of group for difference in performance time of the simple interrupted suture. Random practice did not show the expected advantage for skill learning, but there was an advantage of self-directed practice. CONCLUSION Self-directed practice schedules may be desirable for optimal learning of simple technical skills, even when expert instruction is available. Instructors must also take into account the interaction between task difficulty and conditions of practice to develop ideal training environments.
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Affiliation(s)
- Oleg Safir
- The Department of Surgery, University of Toronto, Toronto, Ont
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Abstract
Abstract
Trainees could benefit from practicing orthotic fabrication on simulated hands with joint deformities. As a first step toward such training, we explored the use of a nonpathological model hand. Twenty-one participants were randomized into one of two groups that practiced using a person’s right hand or a model right hand. One week later, all participants returned for a transfer test in which they made one orthosis on a person’s left hand. All participants’ performance and orthoses were evaluated using a validated checklist and a global rating scale (GRS). Fabrication time for each orthosis also was recorded. The GRS score and fabrication time changed significantly over the course of practice. Trainees who practiced with the model hand made better orthoses during practice and on the transfer test, as measured with the checklist’s final product subscore. Instructional and contextual factors that may affect trainees’ performance and learning are discussed.
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Affiliation(s)
- Eric Hagemann
- Eric Hagemann, MSc, is Graduate, Graduate Department of Rehabilitation Science, University of Toronto, Toronto, Ontario
| | - Camille K. Williams
- Camille K. Williams, MHSc, is Doctoral Candidate, Graduate Department of Rehabilitation Science; and Fellow, Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario
| | - Pat McKee
- Pat McKee, MSc, OT Reg. (Ont.), OT(C), is Associate Professor, Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario
| | - Andonia Stefanovich
- Andonia Stefanovich, MScOT, is Graduate, Department of Occupational Science and Occupational Therapy, University of Toronto, and Occupational Therapist, N Zaraska and Associates, Toronto, Ontario
| | - Heather Carnahan
- Heather Carnahan, PhD, is Professor and Dean of Human Kinetics and Recreation at Memorial University of Newfoundland, St. John's, Newfoundland A1C 5S7 Canada. At the time of the study, she was Professor, Department of Occupational Science and Occupational Therapy, and Scientist, The Wilson Centre for Research in Education, University of Toronto, Ontario;
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Schwellnus H, Carnahan H. Peer-coaching with health care professionals: what is the current status of the literature and what are the key components necessary in peer-coaching? A scoping review. Med Teach 2014; 36:38-46. [PMID: 24094039 DOI: 10.3109/0142159x.2013.836269] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Peer-coaching has been used within the education field to successfully transfer a high percentage of knowledge into practice. In recent years, within health care, it has been the subject of interest as a method of both student training and staff continuing education as well as a format for knowledge translation. AIMS To review the literature from health care training and education to determine the nature and use of peer-coaching. METHOD Due to the status of the literature, a scoping review methodology was followed. From a total of 137 articles, 16 were found to fit the inclusion criteria and were further reviewed. RESULTS The review highlights the state of the literature concerning peer-coaching within health care and discusses key aspects of the peer-coaching relationship that are necessary for success. CONCLUSIONS Most research is being conducted in the domains of nursing and medicine within North America. The number of studies has increased in frequency over the past 10 years. Interest in developing the potential of peer-coaching in both health care student education and continuing clinical education of health care professionals has grown. Future directions for research in this quickly developing area are included.
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Li J, Grierson L, Wu MX, Breuer R, Zhou B, Carnahan H. [Research on action features of acupuncturist experts' acupuncture needle twirling skills]. Zhen Ci Yan Jiu 2013; 38:415-419. [PMID: 24308192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To observe the features of acupuncture needle twirling manipulations in order to promote the development of objective and quantitative performance standards of acupuncture manipulation. METHODS Twelve expert acupuncturists and 12 novices were enrolled in this study. Everyone of them was instructed to perform 10 trials of the uniform reinforcing and reducing technique of acupuncture on an artificial skin-pad that was mounted to a six-axis force transducer and each subject had his or her dominant hand index finger affixed with an infrared light emitting diode for acquiring parameters of acupuncture needle manipulation. The force transducer was used to measure the force the participant applied as they held an acupuncture needle to stimulate the skin-pad, and at the mean time, an optoelectric camera was employed to measure the position of the diode. RESULTS In comparison with the expert acupuncturist group, the straggling coefficient of needle-twirling frequency was significantly bigger in the novice group (P < 0.01), suggesting a higher consistency in the trial-by-trial needle-twirling operation of the expert acupuncturists. Comparison of the needle-twirling force showed that the force values of the Z-axis in both expert group and novice group were considerably higher than those of the X-axis and Y-axis in the same one group (P < 0.01). The time of pre-needle-twirling of the novice group was markedly longer than that of the expert group (P < 0.01), suggesting a skilled operation technique of the expert acupuncturists. No significant differences were found between the expert acupuncturist group and novice group in the needle-twirling amplitude, frequency, force and total operation time (P > 0.05). CONCLUSION Movement frequency consistency and temporal efficiency are the action features of expert acupuncturists in performing the uniform reducing-reinforcing twirling skill, which differentiates the performances of experts from novices. The assessment and training of this acupuncture skill should focus on these kinematic features.
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Affiliation(s)
- Jing Li
- Department of Sports & Health, Nanjing Sport Institute, Nanjing 210014, China.
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Schwellnus H, Carnahan H, Kushki A, Polatajko H, Missiuna C, Chau T. Writing forces associated with four pencil grasp patterns in grade 4 children. Am J Occup Ther 2013; 67:218-27. [PMID: 23433277 DOI: 10.5014/ajot.2013.005538] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE. We investigated differences in handwriting kinetics, speed, and legibility among four pencil grasps after a 10-min copy task. METHOD. Seventy-four Grade 4 students completed a handwriting assessment before and after a copy task. Grip and axial forces were measured with an instrumented stylus and force-sensitive tablet. We used multiple linear regression to analyze the relationship between grasp pattern and grip and axial forces. RESULTS. We found no kinetic differences among grasps, whether considered individually or grouped by the number of fingers on the barrel. However, when grasps were grouped according to the thumb position, the adducted grasps exhibited higher mean grip and axial forces. CONCLUSION. Grip forces were generally similar across the different grasps. Kinetic differences resulting from thumb position seemed to have no bearing on speed and legibility. Interventions for handwriting difficulties should focus more on speed and letter formation than on grasp pattern.
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Affiliation(s)
- Heidi Schwellnus
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, Quebec, Canada
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Baghdady MT, Carnahan H, Lam EWN, Woods NN. Integration of basic sciences and clinical sciences in oral radiology education for dental students. J Dent Educ 2013; 77:757-763. [PMID: 23740912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Educational research suggests that cognitive processing in diagnostic radiology requires a solid foundation in the basic sciences and knowledge of the radiological changes associated with disease. Although it is generally assumed that dental students must acquire both sets of knowledge, little is known about the most effective way to teach them. Currently, the basic and clinical sciences are taught separately. This study was conducted to compare the diagnostic accuracy of students when taught basic sciences segregated or integrated with clinical features. Predoctoral dental students (n=51) were taught four confusable intrabony abnormalities using basic science descriptions integrated with the radiographic features or taught segregated from the radiographic features. The students were tested with diagnostic images, and memory tests were performed immediately after learning and one week later. On immediate and delayed testing, participants in the integrated basic science group outperformed those from the segregated group. A main effect of learning condition was found to be significant (p<0.05). The results of this study support the critical role of integrating biomedical knowledge in diagnostic radiology and shows that teaching basic sciences integrated with clinical features produces higher diagnostic accuracy in novices than teaching basic sciences segregated from clinical features.
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Affiliation(s)
- Mariam T Baghdady
- Toronto General Hospital, Faculty of Dentistry, University of Toronto, Wilson Centre, Toronto, Ontario, Canada.
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Abstract
Background Little is known with regard to how acupuncture skills are optimally taught, learnt and evaluated despite clear evidence that technical skill acquisition is important to trainee success in health professions. Objectives This study reports an investigation of the sensorimotor aspects of the acupuncture lifting-thrusting skill in order to highlight the important kinematic and kinetic features of the action. The study also explores the role of perceptual acuity in accurate acupuncture performance. Methods Twelve novice and 12 expert acupuncturists watched a standardised video demonstrating the mild reinforcing and reducing technique of lifting-thrusting on an acupuncture point and then performed 10 trials of the technique on an artificial skin pad mounted on a six-axis force transducer with an infrared light-emitting diode affixed to the index finger of their dominant hand. The force transducer measured the force applied by participants as they needled the acupuncture point while an optoelectric camera measured the position of the diode. Subsequently, the participants engaged in two tests of general perceptual acuity. Results Repeated measures analyses of variance indicated that experts are more consistent in their trial-by-trial amplitude (p=0.03) and lifting-thrusting velocity (p=0.029) than novices. Measures of perceptual acuity revealed no differences between novices and experts. Conclusions Movement amplitude and velocity consistency are the action features of the mild reinforcing and reducing lifting-thrusting skill that differentiate the performances of experts from novices. The acquisition of acupuncture expertise is a function of extended practice rather than any inherent perceptual ability.
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Affiliation(s)
- Jing Li
- Department of Sports and Health, Nanjing Sport Institute, Nanjing, Jiangsu Province, China
- Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Nanjing, Jiangsu Province, China
- Wilson Centre, University of Toronto, Toronto, Ontario, Canada
| | | | - Mary X Wu
- Wilson Centre, University of Toronto, Toronto, Ontario, Canada
- Toronto School of Traditional Chinese Medicine, Toronto, Ontario, Canada
| | - Ronny Breuer
- The Shiatsu School of Canada and the SSC Acupuncture Institute, Toronto, Ontario, Canada
| | - Heather Carnahan
- Wilson Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
- Centre for Ambulatory Care Education, Women's College Hospital, Toronto, Ontario, Canada
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Abstract
BACKGROUND Since a disproportionate amount of medical education still occurs in hospitals, there are concerns that medical school graduates are not fully prepared to deliver efficient and effective care in ambulatory settings to increasingly complex patients. AIMS To understand the current extent of scholarship in this area. METHOD A scoping review was conducted by searching electronic databases and grey literature sources for articles published between 2001 and 2011 that identified key challenges and models of practice for undergraduate teaching of ambulatory care. Relevant articles were charted and assigned key descriptors, which were mapped onto Canadian recommendations for the future of undergraduate medical education. RESULTS Most of the relevant articles originated in the United States, Australia, or the United Kingdom. Recommendations related to faculty development, learning contexts and addressing community needs had numerous areas of scholarly activity while scholarly activity was lacking for recommendations related to inter-professional practice, the use of technology, preventive medicine, and medical leadership. CONCLUSIONS Systems should be established to support education and research collaboration between medical schools to develop best practices and build capacity for change. This method of scoping the field can be applied using best practices and recommendations in other countries.
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Affiliation(s)
- Camille K Williams
- Graduate Department of Rehabilitation Science, University of Toronto, 200 Elizabeth Street, Toronto,Ontario, Canada.
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Yeung E, Dubrowski A, Carnahan H. Simulation-augmented education in the rehabilitation professions: A scoping review. International Journal of Therapy and Rehabilitation 2013. [DOI: 10.12968/ijtr.2013.20.5.228] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Euson Yeung
- Physiotherapist and a lecturer in the department of Physical Therapy at the University of Toronto, Canada
| | - Adam Dubrowski
- Education Scientist at the Learning Institute, Hospital for Sick Children, Canada
| | - Heather Carnahan
- Director of the Centre for Ambulatory Care Education at Women's College Hospital, and BMO Chair in Health Professions Education at the Wilson Centre, Canada
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Hui Y, Safir O, Dubrowski A, Carnahan H. What skills should simulation training in arthroscopy teach residents? A focus on resident input. Int J Comput Assist Radiol Surg 2013; 8:945-53. [DOI: 10.1007/s11548-013-0833-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 03/11/2013] [Indexed: 10/27/2022]
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Williams CK, Carnahan H. Development and validation of tools for assessing use of personal protective equipment in health care. Am J Infect Control 2013; 41:28-32. [PMID: 22704736 DOI: 10.1016/j.ajic.2012.01.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 01/18/2012] [Accepted: 01/18/2012] [Indexed: 01/26/2023]
Abstract
BACKGROUND Incorrect use of personal protective equipment (PPE) may lead to the spread of infectious agents among health care workers and patients. Although novel education programs show promise, there is no standard evaluation for the competencies developed during training. METHODS A Delphi methodology was used in which checklist and global rating items for evaluating the performance of PPE skills involving gloves, gowns, masks, eye protection, and hand hygiene were generated and iteratively distributed to a panel of experts. The panel rated the importance of each item until agreement was reached, and the relevant items were used to form the Tools for Assessment of PPE Skills (TAPS), comprising 3 checklist sections (hand hygiene, donning, and doffing) and a global rating scale. Newly trained and experienced PPE users participated in experiments to evaluate the reliability, construct validity, and responsiveness of TAPS. RESULTS TAPS demonstrated interobserver reliability, and its global rating scale differentiated the performance of newly trained users and experienced users and was sensitive to changes in performance over time. CONCLUSIONS Pending further validation studies, the TAPS may facilitate the development and evaluation of educational programs to support learning and retention of PPE skills, leading to enhanced patient and health care worker safety.
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Affiliation(s)
- Camille K Williams
- Graduate Department of Rehabilitation Science, and Wilson Centre for Research in Education, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Leung R, Zeller R, Walker K, Krauel K, Mihailidis A, Agur A, Carnahan H, Wang D, Zabjek K. Towards the development of a haptic simulator of surgical gestures in orthopaedic spine surgery. Stud Health Technol Inform 2013; 184:254-260. [PMID: 23400166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The objective of the present work is to develop a haptic system that will permit the demonstration of a proof of concept for the simulation of haptic effects typical of pediatric spine surgery. The first phase of this project focused on the development of a custom haptic system, and was followed by evaluation with experienced orthopedic surgeons. Initial findings demonstrate promise of this approach for further development into an advanced haptic system.
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Affiliation(s)
- Regina Leung
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Canada.
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Schwellnus H, Carnahan H, Kushki A, Polatajko H, Missiuna C, Chau T. Effect of Pencil Grasp on the Speed and Legibility of Handwriting in Children. Am J Occup Ther 2012; 66:718-26. [DOI: 10.5014/ajot.2012.004515] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. Pencil grasps other than the dynamic tripod may be functional for handwriting. This study examined the impact of grasp on handwriting speed and legibility.
METHOD. We videotaped 120 typically developing fourth-grade students while they performed a writing task. We categorized the grasps they used and evaluated their writing for speed and legibility using a handwriting assessment. Using linear regression analysis, we examined the relationship between grasp and handwriting.
RESULTS. We documented six categories of pencil grasp: four mature grasp patterns, one immature grasp pattern, and one alternating grasp pattern. Multiple linear regression results revealed no significant effect for mature grasp on either legibility or speed.
CONCLUSION. Pencil grasp patterns did not influence handwriting speed or legibility in this sample of typically developing children. This finding adds to the mounting body of evidence that alternative grasps may be acceptable for fast and legible handwriting.
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Affiliation(s)
- Heidi Schwellnus
- Heidi Schwellnus, PhD, is Postdoctoral Fellow, Bloorview Research Institute, Toronto, Ontario
| | - Heather Carnahan
- Heather Carnahan, PhD, is Professor, Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario
| | - Azadeh Kushki
- Azadeh Kushki, PhD, is Junior Research Scientist, Bloorview Research Institute, Toronto, Ontario
| | - Helene Polatajko
- Helene Polatajko, PhD, is Professor, Graduate Department of Rehabilitation Science, University of Toronto, Toronto, Ontario
| | - Cheryl Missiuna
- Cheryl Missiuna, PhD, is Professor, School of Rehabilitation Science, and Director, CanChild, Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario
| | - Tom Chau
- Tom Chau, PhD, is Vice President, Research and Director, Bloorview Research Institute, and Professor, Institute of Biomaterials and Biomedical Engineering, University of Toronto, 150 Kilgour Road, Toronto, ON M4G 1R8 Canada;
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Stefanovich A, Williams C, McKee P, Hagemann E, Carnahan H. Development and Validation of Tools for Evaluation of Orthosis Fabrication. Am J Occup Ther 2012; 66:739-46. [DOI: 10.5014/ajot.2012.005553] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
This study is the first phase of research aimed at developing new educational approaches to enhance occupational therapy students’ orthosis fabrication skills. Before the effectiveness of training can be determined, a method for evaluating performance must be established. Using the Delphi method, we developed a global rating scale and checklist for evaluating technical competence when fabricating metacarpophalangeal (MCP) joint–stabilizing orthoses. To determine the reliability and validity of these tools, three evaluators used them to assess and score orthotic fabrication performance by experienced and student occupational therapists. The results suggest that these measurement tools are valid and reliable indicators of the technical skills involved in fabricating an MCP joint–stabilizing orthosis. Future studies should focus on building on these tools to evaluate communication skills, technical skills for making other types of orthoses, and effectiveness of training programs.
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Affiliation(s)
- Andonia Stefanovich
- Andonia Stefanovich, MScOT, is Graduate, Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, and Occupational Therapist, N Zaraska and Associates, Toronto, ON
| | - Camille Williams
- Camille Williams, MHSc, is PhD candidate, Graduate Department of Rehabilitation Science, and Fellow, Wilson Centre for Research in Education, University of Toronto, Toronto, ON
| | - Pat McKee
- Pat McKee, MSc, OT Reg.(Ont.), OT(C), is Associate Professor, Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON
| | - Eric Hagemann
- Eric Hagemann, MSc, is Graduate, Graduate Department of Rehabilitation Science, University of Toronto, Toronto, ON
| | - Heather Carnahan
- Heather Carnahan, PhD, is Professor, Department of Occupational Science and Occupational Therapy; Scientist, Wilson Centre for Research in Education, University of Toronto; and Director, Centre for Ambulatory Care Education, Women’s College Hospital, 160-500 University Avenue, Toronto, ON M5G 1V7, Canada;
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Schwellnus H, Cameron D, Carnahan H. Which to Choose: Manuscript or Cursive Handwriting? A Review of the Literature. Journal of Occupational Therapy, Schools, & Early Intervention 2012. [DOI: 10.1080/19411243.2012.744651] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
BACKGROUND Traditionally, training in gastrointestinal endoscopy has been based upon an apprenticeship model, with novice endoscopists learning basic skills under the supervision of experienced preceptors in the clinical setting. Over the last two decades, however, the growing awareness of the need for patient safety has brought the issue of simulation-based training to the forefront. While the use of simulation-based training may have important educational and societal advantages, the effectiveness of virtual reality gastrointestinal endoscopy simulators has yet to be clearly demonstrated. OBJECTIVES To determine whether virtual reality simulation training can supplement and/or replace early conventional endoscopy training (apprenticeship model) in diagnostic oesophagogastroduodenoscopy, colonoscopy and/or sigmoidoscopy for health professions trainees with limited or no prior endoscopic experience. SEARCH METHODS Health professions, educational and computer databases were searched until November 2011 including The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Scopus, Web of Science, Biosis Previews, CINAHL, Allied and Complementary Medicine Database, ERIC, Education Full Text, CBCA Education, Career and Technical Education @ Scholars Portal, Education Abstracts @ Scholars Portal, Expanded Academic ASAP @ Scholars Portal, ACM Digital Library, IEEE Xplore, Abstracts in New Technologies and Engineering and Computer & Information Systems Abstracts. The grey literature until November 2011 was also searched. SELECTION CRITERIA Randomised and quasi-randomised clinical trials comparing virtual reality endoscopy (oesophagogastroduodenoscopy, colonoscopy and sigmoidoscopy) simulation training versus any other method of endoscopy training including conventional patient-based training, in-job training, training using another form of endoscopy simulation (e.g. low-fidelity simulator), or no training (however defined by authors) were included. Trials comparing one method of virtual reality training versus another method of virtual reality training (e.g. comparison of two different virtual reality simulators) were also included. Only trials measuring outcomes on humans in the clinical setting (as opposed to animals or simulators) were included. DATA COLLECTION AND ANALYSIS Two authors (CMS, MES) independently assessed the eligibility and methodological quality of trials, and extracted data on the trial characteristics and outcomes. Due to significant clinical and methodological heterogeneity it was not possible to pool study data in order to perform a meta-analysis. Where data were available for each continuous outcome we calculated standardized mean difference with 95% confidence intervals based on intention-to-treat analysis. Where data were available for dichotomous outcomes we calculated relative risk with 95% confidence intervals based on intention-to-treat-analysis. MAIN RESULTS Thirteen trials, with 278 participants, met the inclusion criteria. Four trials compared simulation-based training with conventional patient-based endoscopy training (apprenticeship model) whereas nine trials compared simulation-based training with no training. Only three trials were at low risk of bias. Simulation-based training, as compared with no training, generally appears to provide participants with some advantage over their untrained peers as measured by composite score of competency, independent procedure completion, performance time, independent insertion depth, overall rating of performance or competency error rate and mucosal visualization. Alternatively, there was no conclusive evidence that simulation-based training was superior to conventional patient-based training, although data were limited. AUTHORS' CONCLUSIONS The results of this systematic review indicate that virtual reality endoscopy training can be used to effectively supplement early conventional endoscopy training (apprenticeship model) in diagnostic oesophagogastroduodenoscopy, colonoscopy and/or sigmoidoscopy for health professions trainees with limited or no prior endoscopic experience. However, there remains insufficient evidence to advise for or against the use of virtual reality simulation-based training as a replacement for early conventional endoscopy training (apprenticeship model) for health professions trainees with limited or no prior endoscopic experience. There is a great need for the development of a reliable and valid measure of endoscopic performance prior to the completion of further randomised clinical trials with high methodological quality.
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Affiliation(s)
- Catharine M Walsh
- Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Canada.
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Schwellnus H, Carnahan H, Kushki A, Polatajko H, Missiuna C, Chau T. Effect of pencil grasp on the speed and legibility of handwriting after a 10-minute copy task in Grade 4 children. Aust Occup Ther J 2012; 59:180-7. [DOI: 10.1111/j.1440-1630.2012.01014.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Heidi Schwellnus
- Graduate Department of Rehabilitation Science; University of Toronto; Toronto; Ontario; Canada
| | - Heather Carnahan
- Department of Occupational Science and Occupational Therapy; University of Toronto; Toronto; Ontario; Canada
| | - Azadeh Kushki
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital; Toronto; Ontario; Canada
| | - Helene Polatajko
- Graduate Department of Rehabilitation Science; University of Toronto; Toronto; Ontario; Canada
| | - Cheryl Missiuna
- School of Rehabilitation Science, Director, CanChild, Centre for Childhood Disability Research; McMaster University; Toronto; Ontario; Canada
| | - Tom Chau
- Canadian Research Chair in Paediatric Rehabilitation Engineering; Bloorview Research Institute; Toronto; Ontario; Canada
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Grierson LEM, Barry M, Kapralos B, Carnahan H, Dubrowski A. The role of collaborative interactivity in the observational practice of clinical skills. Med Educ 2012; 46:409-416. [PMID: 22429177 DOI: 10.1111/j.1365-2923.2011.04196.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
CONTEXT Video-based observational practice can extend simulation-based learning outside the training space. This study explores the value of collaborative feedback provided during observational practice to the acquisition of clinical skills. METHODS Nursing students viewed a video demonstrating the proper ventrogluteal injection technique before performing a videotaped pre-test trial on a simulator. They were then assigned randomly to one of three observational practice groups: a group that observed the expert demonstration (EO group); a group that viewed the expert demonstration, self-assessed their individual pre-test and contrasted their self-assessments with expert feedback (ESO group), and a group that observed the expert demonstration, self-assessed and contrasted their assessments with those of an expert, and formed a community that engaged in peer-to-peer feedback (ESPO group). The observation of all videos, the provision of assessments and all networking occurred via an Internet-mediated network. After 2 weeks, participants returned for post-tests and transfer tests. RESULTS The pre-test-post-test analyses revealed significant interactions (global rating scale: F((2,22)) =4.00 [p =0.033]; checklist: F((2,22)) =4.31 [p =0.026]), which indicated that post-test performance in the ESPO group was significantly better than pre-test performance. The transfer analyses revealed main effects for both the global rating scale (F((2,23)) =6.73; p =0.005) and validated checklist (F((2,23)) =7.04; p =0.004) measures. Participants in the ESPO group performed better on the transfer test than those in the EO group. CONCLUSIONS The results suggest that video-based observational practice can be effective in extending simulation-based learning, but its effectiveness is mediated by the amount of time the learner spends engaged in the practice and the type of learning activities the learner performs in the observational practice environment. We speculate that increasing collaborative interactivity supports observational learning by increasing the extent to which the educational environment can accommodate learners' specific needs.
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Cheung JJH, Rojas D, Weber B, Kapralos B, Carnahan H, Dubrowski A. Evaluation of tensiometric assessment as a measure of skill degradation. Stud Health Technol Inform 2012; 173:97-101. [PMID: 22356965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This pilot study explored the use of tensiometry as a measure of retention of knot tying skills. Medical students learned a one-handed square knot tying technique. Their final performances were video recorded and these videos were uploaded on to a website. Students were divided into two groups: an observational learning group that had access to videos before a retention test, and a control group that did not. After a two-week retention period, all students came back and performed one more trial to test the amount of retention of the skill. Tensiometry was used to measure strengths of the knots before and after the retention period. The scores showed no significant difference between the groups (p>0.308) or tests (p>0.737). We interpret the results to suggest that tensiometry is not sensitive enough to detect degradation in the performance of fundamental clinical skills as they are forgotten after being taught.
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