Models for intensive care training. A European perspective.

The diversity of European culture is reflected in its healthcare training programs. In intensive care medicine (ICM), the differences in national training programs were so marked that it was unlikely that they could produce specialists of equivalent skills. The Competency-Based Training in Intensive Care Medicine in Europe (CoBaTrICE) program was established in 2003 as a Europe-based worldwide collaboration of national training organizations to create core competencies for ICM using consensus methodologies to establish common ground. The group's professional and research ethos created a social identity that facilitated change. The program was easily adaptable to different training structures and incorporated the voice of patients and relatives. The CoBaTrICE program has now been adopted by 15 European countries, with another 12 countries planning to adopt the training program, and is currently available in nine languages, including English. ICM is now recognized as a primary specialty in Spain, Switzerland, and the UK. There are still wide variations in structures and processes of training in ICM across Europe, although there has been agreement on a set of common program standards. The combination of a common "product specification" for an intensivist, combined with persisting variation in the educational context in which competencies are delivered, provides a rich source of research inquiry. Pedagogic research in ICM could usefully focus on the interplay between educational interventions, healthcare systems and delivery, and patient outcomes, such as including whether competency-based program are associated with lower error rates, whether communication skills training is associated with greater patient and family satisfaction, how multisource feedback might best be used to improve reflective learning and teamworking, or whether increasing the proportion of specialists trained in acute care in the hospital at weekends results in better patient outcomes.

Quality assurance of simulated patient feedback in communication training for fourth-year medical students

Introduction In our program, simulated patients (SPs) give feedback to medical students in the course of communication skills training. To ensure effective training, quality control of the SPs’ feedback should be implemented. At other institutions, medical students evaluate the SPs’ feedback for quality control (Bouter et al., 2012). Thinking about implementing quality control for SPs’ feedback in our program, we wondered whether the evaluation by students would result in the same scores as evaluation by experts. Methods Consultations simulated by 4th-year medical students with SPs were video taped including the SP’s feedback to the students (n=85). At the end of the training sessions students rated the SPs’ performance using a rating instrument called Bernese Assessment for Role-play and Feedback (BARF) containing 11 items concerning feedback quality. Additionally the videos were evaluated by 3 trained experts using the BARF. Results The experts showed a high interrater agreement when rating identical feedbacks (ICCunjust=0.953). Comparing the rating of students and experts, high agreement was found with regard to the following items: 1. The SP invited the student to reflect on the consultation first, Amin (= minimal agreement) 97% 2. The SP asked the student what he/she liked about the consultation, Amin = 88%. 3. The SP started with positive feedback, Amin = 91%. 4. The SP was comparing the student with other students, Amin = 92%. In contrast the following items showed differences between the rating of experts and students: 1. The SP used precise situations for feedback, Amax (=maximal agreement) 55%, Students rated 67 of SPs’ feedbacks to be perfect with regard to this item (highest rating on a 5 point Likert scale), while only 29 feedbacks were rated this way by the experts. 2. The SP gave precise suggestions for improvement, Amax 75%, 62 of SPs’ feedbacks obtained the highest rating from students, while only 44 of SPs’ feedbacks achieved the highest rating in the view of the experts. 3. The SP speaks about his/her role in the third person, Amax 60%. Students rated 77 feedbacks with the highest score, while experts judged only 43 feedbacks this way. Conclusion Although evaluation by the students was in agreement with that of experts concerning some items, students rated the SPs’ feedback more often with the optimal score than experts did. Moreover it seems difficult for students to notice when SPs talk about the role in the first instead of the third person. Since precision and talking about the role in the third person are important quality criteria of feedback, this result should be taken into account when thinking about students’ evaluation of SPs’ feedback for quality control. Bouter, S., E. van Weel-Baumgarten, and S. Bolhuis. 2012. Construction and Validation of the Nijmegen Evaluation of the Simulated Patient (NESP): Assessing Simulated Patients’ Ability to Role-Play and Provide Feedback to Students. Academic Medicine: Journal of the Association of American Medical Colleges

Individual Video Training iVT - Development of a National Infrastructure for Video-Supported Learning

Introduction: Video‐Supported Learning is particularly effective when it comes to skills and behaviors. Video registration of patient‐physician interviews, class room instruction or practical skills allow it to learners themselves, their peers, and their tutors to assess the quality of the learner's performance, to give specific feedback, and to make suggestions for improvement. Methods: In Switzerland, four pedagogical universities and two medical faculties joined to initiate the development of a national infrastructure for Video Supported Learning. The goal was to have a system that is simple to use, has most steps automated, provides the videos over the Internet, and has a sophisticated access control. Together with SWITCH, the national IT‐Support‐Organisation for Swiss Universities, the program iVT (Individual Video Training) was developed by integrating two preexisting technologies. The first technology is SWITCHcast, a podcast system. With SWITCHcast, videos are automatically uploaded to a server as soon as the registration is over. There the videos are processed and converted to different formats. The second technology is the national Single Logon System AAI (Authentification and Authorization Infrastructure) that enables iVT to link each video with the corresponding learner. The learner starts the registration with his Single Logon. Thus, the video can unambiguously be assigned. Via his institution's Learning Management System (LMS), the learner can access his video and give access to his video to peers and tutors. Results: iVT is now used at all involved institutions. The system works flawlessly. In Bern, we use iVT for the communications skills training in the forth and sixth year. Since students meet with patient actors alone, iVT is also used to certify attendance. Students are encouraged to watch the videos of the interview and the feedback of the patient actor. The offer to discuss a video with a tutor was not used by the students. Discussion: We plan to expand the use of iVT by making peer assessment compulsory. To support this, annotation capabilities are currently added to iVT. We also want to use iVT in training of practical skills, again for self as well as for peer assessment.  At present, we use iVT for quality control of patient actor's performance.

Case Study of Applied LIP Approach/Activities in the Philippines The Training Services Enhancement Project for Rural Life Improvement (TSEP-RLI) Experience

TSEP-RLI was a technical cooperation project jointly conducted by GOP thru DA-Agricultural Training Institute (ATI) and GOJ thru JICA aimed at institutionalizing the training program for Rural Life Improvement (RLI) at the (ATI). As expected, farmers, fisherfolk, women, youth and extension agents were provided with efficient and effective training services from ATI leading to the improvement of quality of life in the rural areas through efforts of human resource development. The ATI- Bohol was chosen as the model center where participatory trials and various activities of the project were undertaken for five years. These activities were participatory surveys and data collection of on-farm and off-farm productive activities; planning workshop for RLI; feedbacking of survey results and action plans to the community and the Local Government Units (LGUs), and signing of Memorandum of Agreement between the Project and participating LGUs. The above activities were done to facilitate the planning and development of most effective and necessary rural life improvement activities, to confirm the willingness of the people to support and participate and to formalize the partnership between the Project and the LGUs. Since the concept of rural life covers a vast range of activities, a consensus had been reached that the total aspects of rural life be grasped in three spheres, namely, Production & Livelihood (P/L), Rural Living Condition (RLC) and Community Environment (C/E). The RLI for Ubi (Yam) Growers was one of the pilot activities undertaken in two pilot barangays and the target beneficiaries were members of the Rural Improvement Club (RIC- a group of organized women) with the LGU of the Municipality of Corella as the implementing partner. During the planning workshop, the barangay residents articulated their desire to promote production and processing of ubi (sphere on P/L - as the entry point), lack of nutritious food was one of the identified problem (sphere on RLC- expansion point) and environmental degradation such as deforestation, and soil erosion was another problem articulated by the community people (sphere on C/E- expansion point). Major activities that were undertaken namely, Ubi cooking contest, cooking/processing seminar, training courses on entrepreneurial development, ubi production and storage technology, packaging and product design, human resource development and simplified bookkeeping motivated the beneficiaries as well as developed and enhanced their skills & capabilities while strengthening their associations. Their participation to the 5 ubi festivals and other related activities had brought some impacts on their economic and rural life improvement activities. The seven principles of TSEP-RLI include the participatory process, holistic approach, dialogical approach, bottom -up training needs assessment, demand-driven approach, cost sharing approach and collaborative implementation with other agencies including LGUs and the community.

Learning curves of basic laparoscopic psychomotor skills in SINERGIA VR simulator

Purpose: Surgical simulators are currently essential within any laparoscopic training program because they provide a low-stakes, reproducible and reliable environment to acquire basic skills. The purpose of this study is to determine the training learning curve based on different metrics corresponding to five tasks included in SINERGIA laparoscopic virtual reality simulator. Methods: Thirty medical students without surgical experience participated in the study. Five tasks of SINERGIA were included: Coordination, Navigation, Navigation and touch, Accurate grasping and Coordinated pulling. Each participant was trained in SINERGIA. This training consisted of eight sessions (R1–R8) of the five mentioned tasks and was carried out in two consecutive days with four sessions per day. A statistical analysis was made, and the results of R1, R4 and R8 were pair-wise compared with Wilcoxon signed-rank test. Significance is considered at P value <0.005. Results: In total, 84.38% of the metrics provided by SINERGIA and included in this study show significant differences when comparing R1 and R8. Metrics are mostly improved in the first session of training (75.00% when R1 and R4 are compared vs. 37.50% when R4 and R8 are compared). In tasks Coordination and Navigation and touch, all metrics are improved. On the other hand, Navigation just improves 60% of the analyzed metrics. Most learning curves show an improvement with better results in the fulfillment of the different tasks. Conclusions: Learning curves of metrics that assess the basic psychomotor laparoscopic skills acquired in SINERGIA virtual reality simulator show a faster learning rate during the first part of the training. Nevertheless, eight repetitions of the tasks are not enough to acquire all psychomotor skills that can be trained in SINERGIA. Therefore, and based on these results together with previous works, SINERGIA could be used as training tool with a properly designed training program.

Soft Skills: A Comparative Analysis Between Online and Classroom Teaching

Currently the Spanish universities are making a great effort to effectively incorporate the development and assessment of generic skills in their training programs. Information and communications technologies (ICT) offer a wide range of possibilities but create uncertainty among teachers about the process and results. It is considered of interest to conduct a study to analyze the extent to which social skills like commitment, communication and teamwork are acquired by students and teachers. It seeks to ascertain the influence of the learning context, online or classroom training, in the development of these personal skills among the participants in the sample. For this study two universities have been chosen, Universidad a Distancia de Madrid (UDIMA) offering online training environment, and Universidad Politécnica de Madrid (UPM) with classroom training modality. A total of 257 individuals, 230 students and 27 teachers have answered the survey called Evalsoft. This instrument was designed in the project with the same name by a research team from Universidad Complutense of Madrid (UCM). Some interesting conclusions can be highlighted: it is in the online context where there are higher levels of commitment and teamwork than in the classroom modality; teachers have higher social skills that students and these improve with age. Sex and the training program appear to influence these social skills.

Modified Dialectical Behavior Therapy Program Applied Within a Time-Limited Corrections Setting

Dialectical Behavioral Therapy (DBT) is an empirically supported therapy developed to treat individuals with Borderline Personality Disorder that has sustained efficacy following completion of the treatment (Linehan, 1993; Van Den Bosch et al., 2005). The core concepts of DBT include mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance, which seek to foster more functional ways of interacting with others, coping with distress, and managing difficult emotions. Using a standard DBT format in a corrections setting can be difficult due to the population's multifaceted composition. The Denver County Jail is a unique corrections setting because it contains a unit specifically developed for male inmates with mental health issues. A corrections modified, time-limited DBT curriculum was developed to fit the needs of this unique population. During the course of the group, staff appeared to be accepting of the group material and initial feedback from inmates and officers was positive.

Satisfaction of clinical nurses with the formation of a university tutorial program

Degree in nursing from the Universitat Jaume I (UJI) maintains the continuity of learning with an integrated learning methodology (theory, simulated practice and clinical practice). The objective of this methodology is to achieve consistency between the knowledge, abilities and skills acquired in the classroom, laboratory and clinic to ensure skills related. Reference Nurse is a key figure in this process, you receive accredited training on Educational Methods, assessment of competence, and Evidence-Based Practice that plays the role of evaluating in conjunction with the subjects. It does not perceive economic remuneration. The main objective of this study is to determine the level of satisfaction of clinical nurses on the Nurses Training Program Reference in UJI (Castellon- Spain). A cross sectional study was performed and conducted on 150 nurses. 112 questionnaires were completed, collected and analysed at the end of training. The survey consists of 12 items measured with the Likert scale with 5 levels of response and two open questions regarding the positive and negative aspects of the course and to add in this formation. The training is always performed by the same faculty and it's used four sessions of 2012. We perform a quantitative analysis of the variables under study using measures of central tendency. The completion rate of the survey is 95.53% (n=107). Anonymity rate of 54,14% The overall satisfaction level of training was 3.65 (SD = 0.89) on 5 points. 54.2% (n = 58) of the reference nurses made a contribution in the open questions described in the overall results. The overall satisfaction level can be considered acceptable. It is considered necessary to elaborate a specific survey to detect areas of improvement of nurse training program reference and future recruitment strategies. The main objective of the present work is the selection and integration of different methodologies among those applicable within the framework of the European Higher Education Area to combine teaching methods with high implication from both lecturers and students.

Training operations in small departments : student manual /

Designed to provide the student [i.e. the training officer] with the essential tools and skills to lead and manage a training program in a small department.

Training school personnel to implement a universal school-based prevention of depression program under real-world conditions

The present study evaluated the impact of a universal prevention of depression program [the Resourceful Adolescent Program (RAP)] when implemented under real-world conditions in a school setting. Prior research has found the RAP program to be beneficial for high-school students when the program was implemented by university staff selected, trained, and supervised by a research team. The present study evaluated the RAP program when implemented by existing school personnel. Separately, we measured the impact of a training program for facilitators, the quality of subsequent program implementation, and the student's response to the RAP Program. Results showed that, in response to the training program, facilitators believed they had acquired the knowledge and confidence to implement the program and that the quality of program implementation was acceptable. The study did not demonstrate a beneficial impact of the RAP program for the students. The results raise important questions regarding the extent of training and ongoing supervision facilitators require if the beneficial outcomes for students are to be maintained when interventions are implemented under real-world conditions in school settings. (C) 2004 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.

An examination of learning processes during critical incident training: Implications for the development of adaptable trainees

Three experiments are reported that examined the process by which trainees learn decision-making skills during a critical incident training program. Formal theories of category learning were used to identify two processes that may be responsible for the acquisition of decision-making skills: rule learning and exemplar learning. Experiments I and 2 used the process dissociation procedure (L. L. Jacoby, 1998) to evaluate the contribution of these processes to performance. The results suggest that trainees used a mixture of rule and exemplar learning. Furthermore, these learning processes were influenced by different aspects of training structure and design. The goal of Experiment 3 was to develop training techniques that enable trainees to use a rule adaptively. Trainees were tested on cases that represented exceptions to the rule. Unexpectedly, the results suggest that providing general instruction regarding the kinds of conditions in which a decision rule does not apply caused them to fixate on the specific conditions mentioned and impaired their ability to identify other conditions in which the rule might not apply. The theoretical, methodological, and practical implications of the results are discussed.

Does anticipation training affect drivers' risk taking?

Skill and risk taking are argued to be independent and to require different remedial programs. However, it is possible to contend that skill-based training could be associated with an increase, a decrease, or no change in fisk-taking behavior. In 3 experiments, the authors examined the influence of a skill-based training program (hazard perception) on the fisk-taking behavior of car drivers (using video-based driving simulations). Experiment 1 demonstrated a decrease in risk taking for novice drivers. In Experiment 2, the authors examined the possibilities that the skills training might operate through either a nonspecific reduction in risk taking or a specific improvement in hazard perception. Evidence supported the latter. These findings were replicated in a more ecological context in Experiment 3, which compared advanced and nonadvanced police drivers.

An investigation of the relationships between selected characteristics and leadership outcomes of Athletic Training Education Program directors

There is currently no evidence describing what characteristics make an Athletic Training Program Director (PD) an effective leader. An influx of accredited programs resulted in a rapid increase in the demand for PDs, yet training and preparation for these positions has failed to evolve. Although Certified Athletic Trainers (ATs) are trained in specific content areas, they may not always be prepared for the administrative and leadership responsibilities associated with the role of PD (Leone, 2008). This dissertation examined the relationships between selected characteristics and leadership outcomes of Athletic Training Program Directors. Each PD participants (n=27) completed a demographic questionnaire to obtain the leader's academic preparation, accreditation experience and leadership training history. Each participant also completed the Multifactor Leadership Questionnaire (MLQ) to obtain leadership styles, behaviors, and outcomes. Overall, the PDs reported utilizing transformational leadership most often and passive avoidant leadership least often. There was no significant difference between PDs with master's and doctorate degrees on overall leadership outcome. However, participants with a doctorate degree scored significantly different on the effectiveness component of the leadership outcome compared with participants with a master's degree. Those participants who have completed academic coursework on leadership scored significantly different on the leadership outcome compared to those who have not completed academic coursework on leadership. Findings from this study indicate that changes to the current requirements for the role of PD may be warranted. Consideration should be given to increasing the minimum degree requirement and requiring academic coursework on leadership. Future research may be useful in determining specific degree guidelines and types and amounts of leadership training that would be beneficial to Athletic Training PDs.

Training civic bridge builders: Outcomes of community leadership development programs

As rural communities experience rapid economic, demographic, and political change, program interventions that focus on the development of community leadership capacity could be valuable. Community leadership development programs have been deployed in rural U.S. communities for the past 30 years by university extension units, chambers of commerce, and other nonprofit foundations. Prior research on program outcomes has largely focused on trainees’ self-reported change in individual leadership knowledge, skills, and attitudes. However, postindustrial leadership theories suggest that leadership in the community relies not on individuals but on social relationships that develop across groups akin to social bridging. The purpose of this study is to extend and strengthen prior evaluative research on community leadership development programs by examining program effects on opportunities to develop bridging social capital using more rigorous methods. Data from a quasi-experimental study of rural community leaders (n = 768) in six states are used to isolate unique program effects on individual changes in both cognitive and behavioral community leadership outcomes. Regression modeling shows that participation in community leadership development programs is associated with increased leadership development in knowledge, skills, attitudes, and behaviors that are a catalyst for social bridging. The community capitals framework is used to show that program participants are significantly more likely to broaden their span of involvement across community capital asset areas over time compared to non-participants. Data on specific program structure elements show that skills training may be important for cognitive outcomes while community development learning and group projects are important for changes in organizational behavior. Suggestions for community leadership program practitioners are presented.

Variabilidade da frequência cardíaca após treinamento concorrente : comparação entre homens e mulheres de meia-idade = Heart rate variability after concurrent training : comparison between middle-aged men and women

Universidade Estadual de Campinas . Faculdade de Educação Física