Train the paediatric colonoscopy trainer course: Assessment of perceived value in improving colonoscopy teaching practice

OBJECTIVES

Endoscopy teaching practice is variable, which inevitably affects the training provided. There is only one Train the Paediatric Colonoscopy Trainer (TPCT) course in the UK. Informal feedback has been positive, but its practical value has never been formally assessed. We aim to assess the practical value of the TPCT course and how attendees perceive their teaching practice compared to nonattendees.

METHODS

A questionnaire based on the TPCT course learning aims and objectives was distributed to two groups of consultant paediatric gastroenterologists who teach colonoscopy in the UK; those who had attended the course (participants) and those who had not (controls).

RESULTS

The 41 completed responses were received. Overall, responses indicated participants of the TPCT course rated their confidence and knowledge in teaching practices as higher than controls (4.27 vs. 3.56 p = < 0.001). There was a statistically significant difference in all areas: set (4.21 vs. 3.71 p = 0.011), dialogue (4.29 vs. 3.55 p = < 0.001) and closure (4.37 vs. 3.6 p = < 0.001) with those who attended the TPCT course giving higher ratings. There was evidence of increased understanding of key concepts such as using standardised language, conscious competence, dual task interference and performance enhancing feedback.

CONCLUSION

Attending a TPCT course results in a higher perceived level of knowledge in fundamental teaching principles and confidence in colonoscopy teaching skills.

Is ball-possession style more physically demanding than counter-attacking? The influence of playing style on match performance in professional soccer

In soccer, the offensive style of play describes characteristic behavioral features of the players at team level during the offensive phase of matches. This study aimed to investigate the effect of offensive playing style (i.e., while in ball possession) on physical and technical match performance during offensive play as well as success-related factors. The sample consisted of official tracking and event data of 153 matches of the 2020/21 German Bundesliga season. For every team in every match an offensive playing style coefficient was calculated to locate teams on a continuum between ball possession and counter-attacking style. This calculation contains 11 technical and physical performance parameters and has already been validated. In addition, dependent physical (e.g., sprinting distance), technical (e.g., passes), and success-related (e.g., goals) variables were examined. A separate linear mixed model was calculated for each dependent variable. While teams with lower playing style coefficient values (= counter-attacking style) covered more high-intensity (p ≤ 0.01; R2 = 0.13) and sprinting distances per second in possession (p ≤ 0.01; R2 = 0.14), teams with higher playing style coefficient values (= ball possession style) were physically more demanded over a whole match (e.g., more accelerations (p ≤ 0.01; R2 = 0.69), decelerations (p ≤ 0.01; R2 = 0.69), high-intensity (p ≤ 0.01; R2 = 0.36), sprint distance (p = 0.03; R2 = 0.08)). Furthermore, teams with higher playing style coefficient values played more horizontal passes (p ≤ 0.01; R2 = 0.73) and revealed better passing success rates (p ≤ 0.01; R2 = 0.17). In contrast, teams with lower playing style coefficient values played more long passes (p < 0.01; R2 = 0.58). The influence of the playing style coefficient on success-related variables was smaller (p ≤ 0.36; R2 = 0.10-0.13). Concluding, offensive playing style affects physical and technical match performance, but has limited influence on success. Hence, coaches can use the findings to optimize training contents to prepare players for the physical demands of a match.

Stress Levels in Handball Coaching-Case Study: Preliminary Analysis of the Differences between Training and Match

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

How Coaches Can Improve Their Teams' Match Performance-The Influence of In-Game Changes of Tactical Formation in Professional Soccer

The tactical formation has been shown to influence the match performance of professional soccer players. This study aimed to examine the effects of in-game changes in tactical formation on match performance and to analyze coach-specific differences. We investigated three consecutive seasons of an elite team in the German Bundesliga which were managed by three different coaches, respectively. For every season, the formation changes that occurred during games were recorded. The match performance was measured on a team level using the variables "goals," "chances," and "scoring zone" entries (≙successful attacking sequence) for the own/opposing team. Non-parametric tests were used to compare the 10 min before with the 10 min after the formation change, as well as games with and without formation change. In the 10 min after the formation change, the team achieved more goals/chances/scoring zone entries than in the 10 min before the formation change (mean ES = 0.52). Similarly, the team conceded fewer opposing goals/chances/scoring zone entries in the 10 min after the formation change (mean ES = 0.35). Furthermore, the results indicate that the success of the respective formation change was dependent on the responsible coach. Depending on the season, the extent of the impacts varied (season 1: mean ES = 0.71; season 2: mean ES = 0.26; and season 3: mean ES = 0.22). Over all three seasons, the formation changes had a positive effect on the match performance of the analyzed team, highlighting their importance in professional soccer. Depending on the season, formation changes had varying impacts on the performance, indicating coach-specific differences. Therefore, the quality of the formation changes of the different coaches varied. The provided information can support coaches in understanding the effects of their in-game decisions.

Association of Thoroughbred Racehorse Workloads and Rest Practices with Trainer Success

Understanding the relationship between the training practices of Thoroughbred racehorses and race performance is important to ensure advice given to trainers for injury prevention or management is practical and consistent. We assessed associations between intended volume and speed of gallop training (i.e., typical workloads for horses free of injury or other performance limiting conditions) and rest practices on official trainer career and previous season success rates (rate of wins and places, prizemoney per start). Sixty-six Australian Thoroughbred trainers were surveyed. Multivariable negative binomial regression models were employed for the outcomes career and previous season wins and places, and linear regression models for prizemoney per start. Intended training workload was not associated with prizemoney. Pre-trial total galloping distances (≥13.3 m/s) between 7500 m and 15,000 m were associated with a higher rate of career wins, and previous season wins and places per start (p < 0.05). Slow-speed (13.3-14.3 m/s) galloping distance to trial between 5000 m to 12,500 m was associated with higher rate of career placings per start, with reduced performance over 12,500 m (p = 0.003). Greater time between race starts was associated with a greater rate of previous season wins and prizemoney per start until three weeks between starts, with decline in performance thereafter (p < 0.05). Greater frequency of rest breaks was associated with greater prizemoney per start earnt in the previous season (p ≤ 0.01). These results suggest that modifications to training programs aimed at injury prevention, such as avoiding long galloping distances, should not adversely affect trainer success.

[Development of Self Training Device for Lung Function Compliance Guided by Meridians]

OBJECTIVE

To develop a self deep breathing training device which can improve lung function compliance and blood oxygen saturation.

METHODS

The device consists of four parts:flow tube, measuring cylinder, mobile phone holder and meridian guidance audio-visual synthesis training software. The flow tube measures the flow rate of inhaled gas, the metering cylinder measures the total amount of inhaled gas, and the mobile phone rack is equipped with a mobile phone storing the meridian guidance audio-visual synthesis training software.

RESULTS

The device is reasonable in structure and flexible in operation, which can meet the requirements of self deep inspiration training under the guidance of training module.

CONCLUSIONS

Deep inspiration training under the guidance of guidance training module can form "deep and slow" abdominal breathing, and then improve lung function.

Mental Well-Being or Ill-Being through Coaching in Adult Grassroots Sport: A Systematic Mapping Review

There is convincing evidence on the effects of sport and exercise on mental health and well-being. Less evidence is provided about how to achieve these benefits in the context of grassroots sport coaching. We systematically reviewed the scientific literature of three databases to narratively synthesize the current knowledge about which coaching-related factors influence well-being or ill-being, and how to promote mental health in adult athletes through sport coaches. The review includes 52 studies with different methodological and theoretical approaches and mental health outcomes. The wide range of themes were mapped and synthesized within two clusters, i.e., coaching behavior, antecedents, and context; and coach–athlete relationship and social support. The results highlight the importance of the promotion of empowering environments, autonomy-supportive coaching behavior, and coach–athlete relationship quality that relate to the satisfaction of basic psychological needs. The review also calls for a critical perspective, in the sense that the coaching context and working environment may not be empowering and supportive to the well-being of coaches and consequently to the athletes, and that coaches who want to provide autonomy-supportive environments may face various obstacles. Finally, the review synthesizes recommendations for the training of coaches, as one piece of a holistic mental health promotion.

French translation and validation of the interprofessional facilitation scale for simulation

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

Karnataka telemedicine mentoring and monitoring program for complete integration of psychiatry in the general health care

The National Mental Health Survey of India reported a higher prevalence and treatment gap of psychiatric disorders among the general population. Task shifting is one of the important solutions to meet this requirement. The prevalence of psychiatric disorders among primary care is about 30%-50%. Digitally driven primary care psychiatry program (PCPP) designed to innovate different module to upscale the skills of primary care doctors (PCDs) in live consultation of PCDs in their general patients. To exponential coverage of PCDs, Karnataka Telemedicine Mentoring and Monitoring (KTM) Program is been implemented across all districts of Karnataka. It is the training of trainer version of PCPP where psychiatrists serving in District Mental Health Program of all districts of Karnataka become trainers to implement of two digital modules (Telepsychiatric On-Consultation Training and Collaborative Video Consultations) of PCPP with the target to train all PCDs of Karnataka. This paper aims to provide a glimpse of this innovative KTM program and current progress with a preliminary analysis of translational quotient indicating skill transfer and retention.

[The MOOC, a democratization of knowledge]

How can the use of information and communication technologies for education improve learning and enrich knowledge? In what way and how can training systems such as the massive open online course contribute to the acquisition of new knowledge and the construction of professional skills? Within what limits? These questions are now being addressed to trainers and all healthcare professionals.

A Low-Cost Insertion Trainer for Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emergency procedure designed to treat non-compressible torso hemorrhage. Because this is a high-acuity low-occurrence event, it is difficult to train providers on the procedure and difficult for trained providers to stay proficient. Our primary objective was to develop a low-cost, high-fidelity teaching model to increase emergency medicine (EM) resident knowledge, confidence, and proficiency in performing REBOA. We utilized readily available materials to allow for ease of replication and cost-effectiveness. The aorta was simulated by a bicycle tire inner tube, and the femoral artery was simulated by natural rubber tubing. Once connected, these simulated vascular structures were threaded through a plastic torso mold and filled with simulated blood. Participants then performed the REBOA procedure with very little time required for reset between participants. After completing the training using our model, participants completed a survey rating aspects of the session on a five-point Likert scale. Participants included 21 EM residents from all levels of training. Participants rated the fidelity of the REBOA insertion trainer very highly (mean = 4.05, SD 0.67) and felt that the training was overall very useful (mean = 4.29, SD 0.56). Comments regarding the model were universally positive. We present a novel low-cost REBOA task trainer that is easy to build, reusable, and portable, and can be utilized either in a hospital or austere training environment.

A Novel Tube Thoracostomy Simulation Model for the Deployed or Resource-Limited Environment

Tube thoracostomy placement is a critical, life-saving procedure often performed in the setting of trauma for the treatment of intrathoracic injury, such as hemothorax or pneumothorax. It also represents a high-acuity low-occurrence (HALO) event for many medical providers who may have limited opportunities for practice and mastery, particularly those in austere or resource-limited environments, such as in the deployed setting. Simulation offers opportunities for practicing the techniques required to properly perform and master the procedure. Finding affordable and accessible models for training, however, still represents a significant obstacle for many medical providers. We present a novel tube thoracostomy simulation model assembled from low cost and readily available materials. 

HYBRID: Ambulatory Robotic Gait Trainer with Movement Induction and Partial Weight Support

Robotic exoskeletons that induce leg movement have proven effective for lower body rehabilitation, but current solutions offer limited gait patterns, lack stabilization, and do not properly stimulate the proprioceptive and balance systems (since the patient remains in place). Partial body weight support (PBWS) systems unload part of the patient’s body weight during rehabilitation, improving the locomotive capabilities and minimizing the muscular effort. HYBRID is a complete system that combines a 6DoF lower body exoskeleton (H1) with a PBWS system (REMOVI) to produce a solution apt for clinical practice that offers improves on existing devices, moves with the patient, offers a gait cycle extracted from the kinematic analysis of healthy users, records the session data, and can easily transfer the patient from a wheelchair to standing position. This system was developed with input from therapists, and its response times have been measured to ensure it works swiftly and without a perceptible delay.

[Training and construction of leadership skills]

To fulfil the objectives set out for nursing teams, synergy needs to be created between managerial leadership and clinical leadership. The desire must be present, but specific skills also need to be developed both in nursing training and management training.

Expert consensus on a train-the-trainer curriculum for robotic colorectal surgery

AIM

Robotic techniques are being increasingly used in colorectal surgery. There is, however, a lack of training opportunities and structured training programmes. Robotic surgery has specific problems and challenges for trainers and trainees. Ergonomics, specific skills and user-machine interfaces are different from those in traditional laparoscopic surgery. The aim of this study was to establish expert consensus on the requirements for a robotic train-the-trainer curriculum amongst robotic surgeons and trainers.

METHOD

This is a modified Delphi-type study involving 14 experts in robotic surgery teaching. A reiterating 19-item questionnaire was sent out to the same group and agreement levels analysed. A consensus of 0.8 or higher was considered to be high-level agreement.

RESULTS

Response rates were 93-100% and most items reached high levels of agreement within three rounds. Specific requirements for a robotic faculty development curriculum included maximizing dual-console teaching, theatre team training, nontechnical skills training, patient safety, user-machine interface training and telementoring.

CONCLUSION

A clear need for the development of a train-the-trainer curriculum has been identified. Further research is needed to assess feasibility, effectiveness and clinical impact of a robotic train-the-trainer curriculum.

The REAL CRIC Trainer: Instructions for Building an Inexpensive, Realistic Cricothyrotomy Simulator With Skin and Tissue, Bleeding, and Flash of Air

BACKGROUND

Surgical cricothyrotomy is a rare procedure but it must be mastered by any physician who is involved in advanced airway management. Lack of experience and practice, the high-stress nature of a "can't intubate, can't oxygenate" emergency, and the unavailability of realistic simulators all contribute to physician hesitance and inaptitude while employing cricothyrotomy during difficult and failed airways. The REAL CRIC Trainer was created to alleviate some of the barriers surrounding a surgical airway. It is designed to provide the user an affordable, easy to replicate, reusable, and extremely realistic experience in cricothyrotomy to prepare for this rare event.

DISCUSSION

The REAL CRIC Trainer uses a 3-dimensional printed tracheal model that is covered with pork belly skin, replicating human neck tissue. Red dyed normal saline is connected to the pork belly using intravenous tubing to simulate bleeding as an incision is made into the porcine skin. A bag-valve-mask connected to an endotracheal tube and to the trachea model will simulate breathing and replicate the puff of air experienced as the cricothyroid membrane is pierced with a scalpel. This simulator is cost effective and easy to replicate. Detailed step-by-step instructions are provided so that physicians working in any specialty involved in advanced airway management can easily recreate this trainer.

CONCLUSIONS

This simulator makes it practical for physicians in a variety of clinical settings to incorporate its use into regular practice sessions, thereby assuring that physicians are ready to perform an emergent cricothyrotomy if necessary.

[Five-year experience with Train-the-Trainer courses for general practice trainers - a qualitative and quantitative analysis]

BACKGROUND

A Train-The-Trainer course (TTT course) for general practice trainers was developed as part of the program Verbundweiterbildung^plus Baden-Württemberg. The course included aspects of training such as organizational and legal knowledge as well as didactic skills for trainers in 9.5 teaching units (45minutes each). The present article analyzes the evaluation of the course and considers possible future developments for TTT courses in Germany.

METHODS

An evaluation tool was used covering aspects such as information, relevance for daily work, opportunities for participant engagement in the seminars and working environment as well as didactic competencies among teachers. Within five years, 256 trainers participated in a TTT course and received an evaluation sheet. Data were analyzed descriptively.

RESULTS

249 evaluation sheets were included (response rate 97 %). Overall, the participants were (very) satisfied with the course in general, its organization, the exchange with colleagues and the teaching units. The participants used the free text mode to give positive feedback; in particular, teaching units in organizational and legal regulations as well as practical feedback training to strengthen professionalism were evaluated positively. Suggestions for improvements included follow-up courses or a deepening of understanding of course contents.

CONCLUSION

The participants gave a very positive overall rating and claimed to have benefited from the course contents. Future projects should address further qualifications of general practice trainers and facilitate the exchange with colleagues on an ongoing basis.

Development of training-related health care software by a team of clinical educators: their experience, from conception to piloting

The difficulties of producing useful, bespoke, and affordable information technology systems for large health care organizations are well publicized, following several high-profile endeavors in the UK. This article describes the experience of a small group of clinical radiologists and their collaborators in producing an information technology system - from conception to piloting. This system, called Trainee Tracker, enables automated target date recalculation of trainee milestones, depending on their work patterns and other individual circumstances. It utilizes an automated email alert system to notify the educational supervisors and trainees of approaching and elapsed target dates, in order to identify trainees in difficulty early and address their training needs accordingly. The challenges and advantages, both common to and contrasting with larger-scale projects, are also considered. The benefits of the development team's "agile" approach to software development and the lessons learned will be of interest to medical educators, particularly those with expertise in e-portfolios and other training-related software.

Development of a novel iPad-based laparoscopic trainer and comparison with a standard laparoscopic trainer for basic laparoscopic skills testing

INTRODUCTION

We developed the iTrainer (iT) as a portable laparoscopic trainer, which incorporates the iPad tablet. We then compared the iT with a standard pelvic trainer (SPT) to assess surgical skills as well as its image quality, resolution, brightness, comfort, and overall performance.

MATERIALS AND METHODS

We designed and constructed the iT to be compatible with the Apple iPad 3 and standard laparoscopic instruments. Participants were assigned to perform the thread-the-loops task on both trainers and were prospectively randomized to start on either the iT or the SPT. Each participant was allowed a 2-minute warm-up before the 2-minute testing period. We scored participants using the product of skill quality (0-4 scale) and quantity of loops threaded (0-10 scale). Participants then rated each trainer on image quality, resolution, brightness, comfort, and overall performance on a 5-point Likert scale.

RESULTS

A total of 45 subjects including 10 undergraduates, 10 medical students, 10 general surgery and urology residents, and 15 experts (fellows and attending surgeons) participated in this study. There was no significant difference between thread-the-loops task scores completed on the iT when compared with the SPT for all groups tested (p > 0.05) with the exception of the medical student group, who performed better on the SPT (p < 0.05). On evaluation of each trainer, participants rated the iT as having superior image quality and resolution when compared with the SPT (p < 0.05) but rated the SPT higher in overall performance (p < 0.05). Brightness and comfort were rated similarly for both trainers.

CONCLUSIONS

We have demonstrated face validity and criterion validity for the thread-the-loops task on the iT. The iT rated superior in image quality and resolution but inferior in overall performance compared with the SPT. The iT provides trainees a unique advantage over SPT as an additional resource to laparoscopic training as it is inexpensive, portable, and can be readily available for training.

Comparison of high- and low equipment fidelity during paediatric simulation team training: a case control study

BACKGROUND

High-fidelity patient simulators in team training are becoming popular, though research showing benefits of the training process compared to low-fidelity models is rare. We explored in situ training for paediatric teams in an emergency department using a low-fidelity model (plastic doll) and a high-fidelity paediatric simulator, keeping other contextual factors constant. The goal was to study differences in trainees' and trainers' performance along with their individual experiences, during in situ training, using either a low-fidelity model or a high-fidelity paediatric simulator.

METHODS

During a two-year period, teams involved in paediatric emergency care were trained in groups of five to nine. Each team performed one video-recorded paediatric emergency scenario. A case control study was undertaken in which 34 teams used either a low-fidelity model (n = 17) or a high-fidelity paediatric simulator (n = 17). The teams' clinical performances during the scenarios were measured as the time elapsed to prescribe as well as deliver oxygen. The trainers were monitored regarding frequency of their interventions. We also registered trainees' and trainers' mental strain and flow experience.

RESULTS

Of 225 trainees' occasions during 34 sessions, 34 trainer questionnaires, 163 trainee questionnaires, and 28 videos, could be analyzed. Time to deliver oxygen was significantly longer (p = 0.014) when a high-fidelity simulator was used. The trainees' mental strain and flow did not differ between the two types of training. The frequency of trainers interventions was lower (p < 0.001) when trainees used a high-fidelity simulator; trainers' perceived mental strain was lower (<0.001) and their flow experience higher (p = 0.004) when using high-fidelity simulator.

CONCLUSIONS

Levels of equipment fidelity affect measurable performance variables in simulation-based team training, but trainee s' individual experiences are similar. We also note a reduction in the frequency of trainers' interventions in the scenarios as well as their mental strain, when trainees used a high-fidelity simulator.

The laparoscopic-ring simulation trainer

Regardless of the level of experience, surgeons need convenient times and locations to practice laparoscopic skills. Although attendance at formal courses is essential for continuing surgical education, reinforcement is still needed by other means to allow surgeons to learn new operations as they advance. A method is presented here that allows surgeons to practice laparoscopic skills while following their own time schedules. Novice surgeons can also benefit from this method by practicing basic laparoscopic skills in a cost-effective simulated operative environment. The Borinquen Ring pelvic trainer was originally described in 1993. It is now reintroduced along with an additional device called a Tissue Suspender to create a new laparoscopic simulation training system. Instruction is provided for the use of these 2 devices in practicing basic surgical skills. Different simulation models are used to substitute for human organs and vessels. These consist of both artificial and animal tissue specimens.