The telehealth skills, training, and implementation project: an evaluation protocol

Background: Telehealth appears to be an ideal mechanism for assisting rural patients and doctors and medical students/registrars in accessing specialist services. Telehealth is the use of enhanced broadband technology to provide telemedicine and education over distance. It provides accessible support to rural primary care providers and medical educators. A telehealth consultation is where a patient at a general practice, with the assistance of the general practitioner or practice nurse, undertakes a consultation by videoconference with a specialist located elsewhere. Multiple benefits of telehealth consulting have been reported, particularly those relevant to rural patients and health care providers. However there is a paucity of research on the benefits of telehealth to medical education and learning.

Objective: This protocol explains in depth the process that will be undertaken by a collaborative group of universities and training providers in this unique project.

Methods: Training sessions in telehealth consulting will be provided for participating practices and students. The trial will then use telehealth consulting as a real-patient learning experience for students, general practitioner trainees, general practitioner preceptors, and trainees.

Results: Results will be available when the trial has been completed in 2015.

Conclusions: The protocol has been written to reflect the overarching premise that, by building virtual communities of practice with users of telehealth in medical education, a more sustainable and rigorous model can be developed. The Telehealth Skills Training and Implementation Project will implement and evaluate a theoretically driven model of Internet-facilitated medical education for vertically integrated, community-based learning environments

Learning from triads: training undergraduates in counselling skills

Background: Research has shown that counselling skills training in undergraduate programmes is effective. However, there is potential that premature intimacy and disclosures during triad work may impact on relationships which must be maintained out-with the counselling component of the course. Little research has examined individual pedagogical practices within training. Aim: The aim of this research was to explore the experience of the practical skills training component of a counselling course for a cohort of undergraduate students, and the impact of this learning experience. The objective being an evaluation of the use of this approach for this group and of the impact of personal sharing within cohorts of undergraduates. Method: Semi-structured interviews focusing on the experience of skills training and self-disclosure during training were carried out on 12 undergraduates taking counselling skills modules as part of their BSc Psychology and Counselling degree. Thematic analysis was carried out on the interview transcripts. Results: As a result of engagement in skills training and acting as ‘clients’ for one another, individuals perceived the formation of a positive group identity with implicit ‘rules’, but also an impact of training on relationships within the group which relied on the ability to maintain boundaries and personal identities with peers, and this influenced the learning experience. The ability to manage their engagement on the programme was dependent on ongoing support and guidance from tutors. Discussion: While this pedagogical approach appears appropriate for facilitating learning and potentially provides a rich learning journey for undergraduate students, tutors must act proactively to ensure a safe learning environment.

Training in and assessment of the procedural skills required to perform peripheral nerve blockade

The training and ongoing education of medical practitioners has undergone major changes in an incremental fashion over the past 15 years. These changes have been driven by patient safety, educational, economic and legislative/regulatory factors. In the near future, training in procedural skills will undergo a paradigm shift to proficiency based progression with associated requirements for competence-based programmes, valid, reliable assessment tools and simulation technology. Before training begins, the learning outcomes require clear definition; any form of assessment applied should include measurement of these outcomes. Currently training in a procedural skill often takes place on an ad hoc basis. The number of attempts necessary to attain a defined degree of proficiency varies from procedure to procedure. Convincing evidence exists that simulation training helps trainees to acquire skills more efficiently rather than relying on opportunities in their clinical practice. Simulation provides a safe, stress free environment for trainees for skill acquisition, generalization and transfer via deliberate practice. The work described in this thesis contributes to a greater understanding of how medical procedures can be performed more safely and effectively through education. The effect of feedback, provided to novices in a standardized setting on a bench model, based on knowledge of performance was associated with an increase in the speed of skill acquisition and a decrease in error rate during initial learning. The timing of feedback was also associated with effective learning of skill. A marked attrition of skills (independent of the type of feedback provided) was demonstrable 24 hrs after they have first been learned. Using the principles of feedback as described above, when studying the effect of an intense training program on novices of varied years of experience in anaesthesia (i.e. the present training programmes / courses of an intense training day for one or more procedures). There was a marked attrition of skill at 24 hours with a significant correlation with increasing years of experience; there also appeared to be an inverse relationship between years of experience in anaesthesia and performance. The greater the number of years of practice experience, the longer it required a learner to acquire a new skill. The findings of the studies described in this thesis may have important implications for the trainers, trainees and training bodies in the design and implementation of training courses and the formats of delivery of changing curricula. Both curricula and training modalities will need to take account of characteristics of individual learners and the dynamic nature of procedural healthcare.

How Do Trainees Rate the Impact of a Short Cognitive Behavioural Training Programme on their Knowledge and Skills?

Background: A strong evidence base for cognitive behavioural therapy has led to CBT models becoming available within mainstream mental health services. As the concept of stepped care develops, new less intensive mental health interventions such as guided self-help are emerging, delivered by staff not trained to the level of accredited Cognitive Behavioural Therapists. Aim: The aim of this study was to determine how mental health staff evaluated the usefulness of a short training programme in CBT concepts, models and techniques for routine clinical practice.
Method: A cohort of mental health staff (n = 102) completed pre- and posttraining self-report questionnaires measuring trainee perceptions of the impact of a short training programme on knowledge and skills. Mentors and managers were also asked to comment on perceived impact of the training.
Results: Trainees and mentors reported perceived gains in knowledge and skills posttraining and at 1-year follow-up. Managers and trainees reported perceived improvements in skills and practice. Conclusion: A short Cognitive Behavioural skills programme can enable mental health staff to integrate basic CB knowledge and skills into routine clinical practice.

Acquisition of suture skills during medical graduation by instructor-directed training: A randomized controlled study comparing senior medical students and faculty surgeons

Due to shortage of time and limited availability of faculty surgeons to teach basic surgical skills during medical graduation, the search for alternative ways of simulated training with feedback is needed. The purpose of this study was to compare the simulated teaching of suture skills to novice medical students by senior medical students and by experienced faculty surgeons. Forty-eight novice medical students were randomly assigned to three practice conditions on bench model (n = 16): self-directed suture training (control), senior medical student-directed suture skills' training, or experienced faculty surgeon-directed suture skills' training. Pre- and post-tests were applied. Global Rating Scale with blinded evaluation and self-perceived confidence based on Likert scale were used to assess all suture performances in pre- and post-training. Effect size was also calculated. The analysis made after training showed that the students who received feedback from the instructors had better performance based on the Global Rating Scale (all p < 0.0000) and felt more confident to carry out sutures (all p < 0.0000) when compared to the control. There was no significant difference (all p > 0.05) between the student-directed teaching and faculty-directed teaching groups. The magnitude of the effect (instructor-directed training suture) was considered large (>0.80) in all measurements. The acquisition of suture skills after student-directed training was similar to the training supervised by faculty surgeon, and the increase in suture performances of trainees that received instructor administered training was superior to self-directed learning. © 2013 Springer-Verlag Italia.

An innovative blended learning approach using virtual patients as preparation for skills laboratory training: perceptions of students and tutors

BACKGROUND Currently only a few reports exist on how to prepare medical students for skills laboratory training. We investigated how students and tutors perceive a blended learning approach using virtual patients (VPs) as preparation for skills training. METHODS Fifth-year medical students (N=617) were invited to voluntarily participate in a paediatric skills laboratory with four specially designed VPs as preparation. The cases focused on procedures in the laboratory using interactive questions, static and interactive images, and video clips. All students were asked to assess the VP design. After participating in the skills laboratory 310 of the 617 students were additionally asked to assess the blended learning approach through established questionnaires. Tutors' perceptions (N=9) were assessed by semi-structured interviews. RESULTS From the 617 students 1,459 VP design questionnaires were returned (59.1%). Of the 310 students 213 chose to participate in the skills laboratory; 179 blended learning questionnaires were returned (84.0%). Students provided high overall acceptance ratings of the VP design and blended learning approach. By using VPs as preparation, skills laboratory time was felt to be used more effectively. Tutors perceived students as being well prepared for the skills laboratory with efficient uses of time. CONCLUSION The overall acceptance of the blended learning approach was high among students and tutors. VPs proved to be a convenient cognitive preparation tool for skills training.

Evaluation of Medical Students’ Attitudes and Performance of Basic Surgery Skills in a Training Program Using Fresh Human skin, Excised During Body Contouring Surgeries

BACKGROUND: Learning surgical skills in the operating room may be a challenge for medical students. Therefore, more approaches using simulation to enable students to develop their practical skills are required. OBJECTIVES: We hypothesized that (1) there would be a need for additional surgical training for medical students in the pre-final year, and (2) our basic surgery skills training program using fresh human skin would improve medical students' surgical skills. DESIGN: We conducted a preliminary survey of medical students to clarify the need for further training in basic surgery procedures. A new approach using simulation to teach surgical skills on human skin was set up. The procedural skills of 15 randomly selected students were assessed in the operating room before and after participation in the simulation, using Objective Structured Assessment of Technical Skills. Furthermore, subjective assessment was performed based on students' self-evaluation. The data were analyzed using SPSS, version 21 (SPSS, Inc., Chicago, IL). SETTING: The study took place at the Inselspital, Bern University Hospital. PARTICIPANTS: A total of 186 pre-final-year medical students were enrolled into the preliminary survey; 15 randomly selected medical students participated in the basic surgical skills training course on the fresh human skin operating room. RESULTS: The preliminary survey revealed the need for a surgical skills curriculum. The simulation approach we developed showed significant (p < 0.001) improvement for all 12 surgical skills, with mean cumulative precourse and postcourse values of 31.25 ± 5.013 and 45.38 ± 3.557, respectively. The self-evaluation contained positive feedback as well. CONCLUSION: Simulation of surgery using human tissue samples could help medical students become more proficient in handling surgical instruments before stepping into a real surgical situation. We suggest further studies evaluating our proposed teaching method and the possibility of integrating this simulation approach into the medical school curriculum.

A 3D virtual medical imaging suite : bridging the academic-clinical training boundary

Aims The Medical Imaging Training Immersive Environment (MITIE) system is a recently developed virtual reality (VR) platform that allows students to practice a range of medical imaging techniques. The aim of this pilot study was to harvest user feedback about the educational value of the application and inform future pedagogical development. This presentation explores the use of this technology for skills training and blurring the boundaries between academic learning and clinical skills training. Background MITIE is a 3D VR environment that allows students to manipulate a patient and radiographic equipment in order to produce a VR-generated image for comparison with a gold standard. As with VR initiatives in other health disciplines (1-6) the software mimics clinical practice as much as possible and uses 3D technology to enhance immersion and realism. The software was developed by the Medical Imaging Course Team at a provider University with funding from a Health Workforce Australia “Simulated Learning Environments” grant. Methods Over 80 students undertaking the Bachelor of Medical Imaging Course were randomised to receive practical experience with either MITIE or radiographic equipment in the medical radiation laboratory. Student feedback about the educational value of the software was collected and performance with an assessed setup was measured for both groups for comparison. Ethical approval for the project was provided by the university ethics panel. Results This presentation provides qualitative analysis of student perceptions relating to satisfaction, usability and educational value as well as comparative quantitative performance data. Students reported high levels of satisfaction and both feedback and assessment results confirmed the application’s significance as a pre-clinical training tool. There was a clear emerging theme that MITIE could be a useful learning tool that students could access to consolidate their clinical learning, either during their academic timetables or their clinical placement. Conclusion Student feedback and performance data indicate that MITIE has a valuable role to play in the clinical skills training for medical imaging students both in the academic and the clinical environment. Future work will establish a framework for an appropriate supporting pedagogy that can cross the boundary between the two environments. This project was possible due to funding made available by Health Workforce Australia.

Workplace training and generic and technical skill development in the Australian construction industry

- Purpose The purpose of this paper is to investigate the current skills gap in both generic and skill areas within the construction industry in Queensland, Australia. - Design/methodology/approach An internet-based survey was administered to collect the opinions of construction employees about the workplace-training environment and their perceptions towards training. The survey intended to address the following research questions, specifically in relation to the construction industry. - Findings The survey results reveal that whilst overall participation in workplace training is high, the current workplace training environments do not foster balanced skill development. The study reveals that in the current absence of a formal and well-balanced training mechanism, construction workers generally resort to their own informal self-development initiatives to develop the needed role-specific theoretical knowledge. - Research limitations/implications The findings of the research are based on the data primarily collected in the construction industry in Queensland, Australia. The data are limited to a single Tier 2 construction company. - Practical implications The findings of this study can be utilised to suggest improvements in the current (or develop new) workplace training initiatives. - Social implications The research suggests that workplace training has positive relationship with career growth. The results suggest that in the construction industry, employees are generally well aware of the importance of workplace training in their career development and they largely appreciate training as being a critical factor for developing their capacity to perform their roles successfully, and to maintain their employability. - Originality/value This paper is unique as it investigates the current skills gap in both generic and skill areas within the construction industry in Queensland, Australia. So far no work has been undertaken to identify and discusses the main method of workplace learning within the Tier 2 industry in the context of Queensland Australia.

Higher education, professionalism and skills in the built environment: the impact of the new urban agenda on teaching and learning

In the mid-to-late 1990s, the New Urban Agenda initiated a rethinking of urban development strategies placing a greater focus on regeneration of central urban spaces. The skills and competencies required by urban planners and built environment professionals to successfully implement regeneration schemes tend to differ from those required for greenfield development. The working paper summarises skills and competencies required by urban regeneration practitioners and how they are delivered through public and/or private sector providers at present. The role of the newly established regional Centres of Excellence and the professional bodies of the Built Environment professions in defining skills and educational requirements and providing training are explored. An analysis of supply and demand of skills training reveals that there is a mismatch rather than a lack of provision. The report draws on a conference where research findings were presented and discussed. It concludes with suggestions for improving the skills provision at the local government as well as community level. Skills audits were found useful tools in defining training needs. A set of sample workshop programmes outline flexible, tailor-made approaches guaranteed to address specific and identified needs.

Teaching Principled negotiation skills to parents and their children : the impact of parental involvement /

This study explored the impact of training parents and children concurrently in principled negotiation skills for the purpose of developing negotiation skills and problem solving abilities in children. A second experimental group was utilized to determine the viability of negotiation skills training of junior elementary students for the purpose of improving problem solving and conflict resolving abilities. The student population in each experimental group was trained using The Program for Young Negotiators (Curhan, 1996). A control group was also established using the remaining grade four and five students attending the participating school. These students did not receive training as part of this study. Student group distribution was as follows: Experimental group 1 (students with parent participant) consisted of 10 (5 grade five and 5 grade 4 students), Experimental group 2 students without parent participant) consisted of 48 (20 grade 4 and 28 grade 5 students), and the Control group 3 (55 grade 4 and 5 students). The impact of training was measured using the Five Factor Negotiation Scale developed for use with the Program for Young Negotiators (Curhan, 1996). This measure was employed as a pre- and post-test questionnaire to the total student population, (113 students) to determine levels of ability in each of the key elements of negotiation, personal initiative, collaboration, communication, conflict based perspective taking, and conflict resolution approach (Nakkula & Nikitopoulos, unpublished). This measure has a coefficient alpha of .75 which is acceptable for this type of affective instrument. As well, open ended ability questions designed to measure ability, knowledge, and behaviour as they relate to negotiation skill application were given to the total student population, (113 students). Finally, journals were maintained by the students in both experimental groups, and informal feedback discussions were held with students and parents participating in the study.The intent of using both qualitative and quantitative measures was to provide an overall perspective of student abilities as they related to principled negotiation skills. While the quantitative measures were from the student perspective, more qualitative information was sought from parents and teachers through informal interviews, discussions, and use of confidential feedback cards. For analysis purposes, the ability questions were randomly selected for Experimental group 2 and Control group 3 in an effort to balance the groups more equitably with Experimental group 1. The findings of this study indicate that students of the junior elementary school age can be taught how to perceive conflict in a more constructive way. However, they are not as likely to use their skills when the conflict is with a sibling as they are with a peer, a teacher, or a parent. While no statistically significant differences between mean scores for Experimental groups 1 and 2 exist some subtle differences are noted. Overall, increases in mean scores for grade 4 students exceeded the increases for grade 5 students within Experimental group 1 . The implication being that younger students benefit more from having a parent trained in principled negoUation skills than older students. The skill level of a parent in principled negotiation can not be underesUmated. Without a consistent and effective role model the likelihood of developing student skill level to a point of automaticity is greatly reduced. Enough so that perhaps the emphasis should be placed on training parents more so than the students.

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 risk taking behavior. In 3 experiments, the authors examined the influence of a skill-based training program (hazard perception) on the risk 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.

Education and training futures in horticulture and horticultural science

Horticultural knowledge and skills training have been with humankind for some 10,000 to 20,000 years. With permanent settlement and rising wealth and trade, horticulture products and services became a source of fresh food for daily consumption, and a source of plant material in developing a quality environment and lifestyle. The knowledge of horticulture and the skills of its practitioners have been demonstrated through the advancing civilizations in both eastern and western countries. With the rise of the Agricultural Revolutions in Great Britain, and more widely across Continental Europe in the 17th and 18th centuries, as well as the move towards colonisation and early migration to the New Worlds, many westernised countries established the early institutions that would provide education and training in agriculture and horticulture. Today many of these colleges and universities provide undergraduate, postgraduate and vocational and technical training that specifically targets horticulture and/or horticultural science with some research and teaching institutions also providing extension and advisory services to industry. The objective of this chapter is to describe the wider pedagogic and educational context in which those concerned with horticulture operate, the institutional structures that target horticulture and horticultural science education and training internationally; examine changing educational formats, especially distance education; and consider strategies for attracting and retaining young people in the delivery of world-class horticultural education. In this chapter we set the context by investigating the horticultural education and training options available, the constraints that prevent young people entering horticulture, and suggest strategies that would attract and retain these students. We suggest that effective strategies and partnerships be put in place by the institution, the government and most importantly the industry to provide for undergraduate and postgraduate education in horticulture and horticultural science; that educational and vocational training institutions, government, and industry need to work more effectively together to improve communication about horticulture and horticultural science in order to attract enrolments of more and talented students; and that the horticulture curriculum be continuously evaluated and revised so that it remains relevant to future challenges facing the industries of horticulture in the production, environmental and social spheres. These strategies can be used as a means to develop successful programs and case studies that would provide better information to high school career counsellors, improve the image of horticulture and encourage greater involvement from alumni and the industries in recruitment, provide opportunities to improve career aspirations, ensure improved levels of remuneration, and promote the social features of the profession and greater awareness and recognition of the profession in the wider community. A successful career in horticulture demands intellectual capacities which are capable of drawing knowledge from a wide field of basic sciences, economics and the humanities and integrating this into academic scholarship and practical technologies.

Can an online tutorial pass the test for library instruction? An evaluation and comparison of library skills instruction methods for first year students at Deakin University

An online, interactive tutorial, Smart Searcher, was introduced at Deakin University as part of the Iibrary's information skills program in late 2000. As liaison librarians responsible for library skills training we wanted to compare and evaluate this mode of instruction with our normal face-to-face delivery of library instruction. This study found that students with face-to-face instruction did, in fact, gain higher posttest mean scores than students completing the online tutorial. Also, students attending these library sessions felt more confident about their library skills than those in the online tutorial only session.

Mature workers, training and using TLM frameworks

Mature workers have been at the centre of policies aimed at encouraging higher workforce participation, longer working life and enhanced savings for retirement. Low mature age workforce participation rates reflect labour market withdrawal in the face of multiple barriers to participation for many. Their apparent voluntary joblessness conceals the fact that mature workers endure longer periods of unemployment, discrimination, redundancy and other barriers to employment (hence the drift to 'early retirement'). The policy dilemma is not just about addressing discrimination barriers, access to appropriate retraining or skills enhancement for mature workers, but what this tells us about lifelong learning as a means of managing and mitigating risk. The mismatch between work opportunities/skills shortages and the low education and skills base of many mature workers, means it is simplistic to think that working longer might be a short term way to address skills shortages; without an enormous investment in the current ageing cohort. Drawing on Transitional Labour Market (TLM) theory and European reform agendas, this article argues that the link between investment in lifelong education/ skills training and stronger labour market participation needs attention; not just for current cohorts of excluded or underemployed mature workers but to position strategically for future generations.