Preliminary Outcomes from a Group-Based Teacher Training of Trial-Based Functional Analysis

The trial-based functional analysis (FA) is a useful alternative to the traditional FA in contexts in which it is challenging to establish environmental control for extended periods of time. Previous researchers have demonstrated that others can be trained to conduct trial-based FAs with high procedural fidelity by providing a didactic presentation, small group instruction, and then a performance evaluation. However, one barrier to replicating this training sequence is that didactic presentations are not standardized and presentations can vary considerably across different groups of trainers or researchers. We designed an automated didactic presentation with video models embedded throughout for trainers and researchers to use when training others to conduct trial-based FAs. The purpose of this study was to evaluate the effect of this presentation on participant fidelity to trial-based FA procedures. Results demonstrate improved fidelity following the presentation. However, the presentation alone was insufficient to establish consistently high levels of fidelity across all conditions for all participants. Thus, additional training components are required when teaching others to conduct trial-based FAs.

This study examined the effects of a self-instruction package comprised of a task analysis data sheet, detailed written instructions, and a small group performance feedback training on the training of 12 undergraduate students to conduct trial-based functional analyses (TBFAs). In contrast to previous research, training omitted technical language and did not include didactic instruction on the principles of applied behavior analysis or the underlying rationale for functional analysis methodology. Although the self-instruction package produced significant increases in performance and reliable data collection on the targeted problem behavior, small group performance feedback training was necessary to achieve mastery across all trial types. Results offer a socially valid training package to teach paraprofessionals to assist Board Certified Behavior Analysts® in conducting TBFAs in applied settings.

BackgroundThe Otago Exercise Programme is an effective intervention for falls prevention. However, there is limited evidence in relation to studies that compare efficacy for falls prevention when delivered Otago Exercise Programme in a group or individual format in a primary care context.ObjectiveTo compare the Otago Exercise Programme delivered as a group vs. individual format for community dwelling older adults, over a one year period. The hypothesis was that neither format would be inferior to the other.MethodsDesign:A four-year multicentre, randomized, non-inferiority clinical trial, with two arms— Otago Exercise Programme group training and individual Otago exercise training. Setting(s): 21 primary healthcare centers. Participants: A sample size of 728 participants was established. Participants were aged between 65 and 80 years; living in the community; able to walk independently; and agreed to take part in the study and provided signed informed consent. Intervention: The Otago Exercise Programme was delivered mainly by nurses in primary care, with five face to face sessions, and a reinforcement 6 months later. Participants were encouraged to exercise at home between face to face sessions. Data collection: at baseline and after 6 and 12 months from October 2017 to 2020. Primary outcome: people who reported at least one fall. Secondary outcomes: number of falls, cause of falls, consequences and assistance, adherence and satisfaction. Group allocation was blinded to the researchers involved in analysis. Reporting: Consolidated Standards of Reporting Trials recommendations for the Statement for Randomized Trials of Nonpharmacologic Treatments.ResultsEight hundred twenty-seven participants were randomized (226 were allocated in group training and 272 in individual training). The analysis of the proportion of people who reported at least one fall and number of falls showed no differences between individual and group training. Assessment of the equivalence between the interventions at 12 months showed that the confidence interval for the difference of people who reported at least one fall was found to be within the equivalence limit of 10% considered. However, in those participants with a previous history of falls, group format showed potentially greater benefit. The participants in individual training presented higher scores on the Exercise Adherence Rating Scale test. No differences were found in satisfaction between the groups.ConclusionsThe group Otago Exercise Programme is equivalent to individually delivered Otago Exercise Programme in terms of prevention of falls over a 12-month follow up. Adherence was higher in individual training. Implications: Healthcare professionals could offer either Otago Exercise Programme format dependent on patient preference and be confident that that standardized intervention provides patient benefit.Trial RegistrationClinicalTrials.gov (NCT03320668). Data registration 31/10/2017.

A prospective randomized parallel-group study was performed to assess the effectiveness of group and individual educational training of patients of the fundamentals of medical knowledge to control risk factors. The study included 365 patients with high and very high cardiovascular risk; 150 had group training; 150 had individual training; 65 were a control group, follow-up period was 3 years. Blood pressure, body mass index (BMI), fat to muscle ratio (bioimpedance method, Body Composition Monitor BF511), physical activity (Walking style III pedometer), blood lipids, glucose, glycosylated hemoglobin, quality of life (SF-36 Health Status Survey questionnaire), eating habits, and compliance to medical therapy (Morisky-Green questionnaire) were evaluated before and after completion of the training. The composite endpoint was assessed (myocardial infarction, stroke, cardiovascular death, hospitalizations due to worsening of heart failure, urgent revascularization). Educational hours were the same in both groups, but in the “Individual group” patients had “face to face” visits with a medical specialists. All patients kept an individual diary. Statistical processing was performed using the SPSS 17 (IBM) package. Results In both training groups, a significant decrease in blood pressure and an increase of patients with the target blood pressure were found. After completing the educational course, the level of compliance to drug treatment in the “group training” had scored of 3.2 [1.5–3.5]; 3.5 [2.5–3.75] in the “individual training” group, and 2.0 [1.0–3.0] in the control group. Initially, the number of patients with the targeted blood pressure level was 63 (42.0%) and 67 (44.6%) persons in the “group training” and “individual training” groups; this parameter after training completion was 134 (89.3%, p=0.0001) in “group training” and 121 (80.6%, p=0.0001) in “individual training”. Patients undergoing “group training” did not have their blood lipids changed significantly. In the course of “individual training”, statistically significant decreases in total cholesterol by 21.1% (p=0.031), LDL cholesterol by 20.1% (p=0.04) and an increase in HDL cholesterol by 11% (p=0.03) were observed. A significant decrease in BMI (by 7.1%, p=0.011) and fat tissue content (10.2%, p=0.013) were observed only after “individual training”. Eating habits and smoking rate did not change significantly in the groups. An increase in physical activity was detected only in “individual training” group. Risk of cardiovascular events was lower “individual training” group (OR-0,32; CI 95% 0,12–0,84; p=0,02). Conclusion Both individual and group educational courses did not lead to a change in eating habits, but had significant effect on blood pressure. More significant effect of individual training compared to group training was found on blood lipids, physical activity and quality of life. A decrease in cardiovascular events was noted only in the “individual training” group. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): L.T. Mala National Institute of Therapy NAMSU

In recent decades, digital stress management training, typically targeted at individuals, has gained increasing attention in health promotion. While these interventions show on average moderate to high effects on stress and other mental health outcomes, their use and acceptance in practice are often low. In contrast, group training may have advantages over these shortcomings. However, despite its widespread use in traditional non-digital health promotion, there is little evidence for digital training delivered in groups. This study's aim was to explore the feasibility of live, online stress management training delivered in a group format and compare it to Internet-based training targeting individuals. Employees (N = 62), recruited from an open access website, were randomized into either group or individual training. Group training consisted of seven weekly online appointments led by a trainer and conducted via videoconference. Individual training consisted of seven web-based sessions which included written feedback provided by an e-coach after each session. The primary outcome was perceived stress eight weeks after training initiation. Feasibility was analyzed in terms of participants' satisfaction, adherence, and perceived benefits of both training formats, assessed via both written questionnaires and interviews. Participants in group training [Cohen's d = 0.9 (95% confidence interval: 0.4 to 1.5)] and individual training [1.3 (0.6 to 2.0)] both experienced statistically-significant reductions in stress, with no significant difference between the two training formats [0.25 (-0.32 to 0.83); p = 0.579]. Full adherence rates were 70% in the group training and 50% in the individual training. Participants were satisfied with both formats, appreciating the social support and personal contact of the group setting, while appreciating the time flexibility and personal contact with an e-coach offered through individual training. This pilot study showed promising effects for the acceptance and health-related effectiveness of stress management training delivered in a group setting via videoconference. The findings highlight the value of personal contact with a coach and peers for positive user experiences during digital stress management interventions. https://drks.de/search/en/trial/DRKS00024965, DRKS00024965.

BackgroundCognitive flexibility refers to the capacity to shift between conceptual representations particularly in response to changes in instruction and feedback. It enables individuals to swiftly adapt to changes in their environment and has significant implications for learning. The present study focuses on investigating changes in cognitive flexibility following an intervention programme—Structure Learning training.MethodsParticipants are pseudo-randomised to either the Training or Control group, while matched on age, sex, intelligence and cognitive flexibility performance. In the Training group, participants undergo around 2 weeks of training (at least 13 sessions) on Structure Learning. In the Control group, participants do not have to undergo any training and are never exposed to the Structure Learning task. The effects of Structure Learning training are investigated at both the behavioural and neural level. We measured covariates that can influence an individual’s training performance before the training phase and outcome measures that can potentially show training benefits after the training phase. At the behavioural level, we investigated outcomes in both cognitive and social aspects with a primary focus on executive functions. At the neural level, we employed a multimodality approach and investigated potential changes to functional connectivity patterns, neurometabolite concentration in the frontal brain regions, and brain microstructure and myelination. DiscussionWe reported the development of a novel training programme based on Structure Learning that aims to hone a general learning ability to potentially achieve extensive transfer benefits across various cognitive constructs. Potential transfer benefits can be exhibited through better performance in outcome measures between Training and Control participants, and positive associations between training performance and outcomes after the training in Training participants. Moreover, we attempt to substantiate behavioural findings with evidence of neural changes across different imaging modalities by the Structure Learning training. Trial registrationNational Institutes of Health U.S. National Library of Medicine ClinicalTrials.gov NCT05611788. Registered on 7 November 2022. Protocol version: 11 May 2023.

This study attempted to investigate pre-service and in-service EFL teachers’ levels of knowledge in content, pedagogy, and technology in relation to their gender, Internet access at school, and technology training in Saudi Arabia. The Technological, Pedagogical, and Content Knowledge (TPACK) framework was utilized to (1) examine pre-service and in-service EFL teachers’ levels of TPACK; (2) investigate the differences between pre-service and in-service EFL teachers’ levels of TPACK; (3) scrutinize whether gender, Internet access at school, and technology training had any significant effect on pre-service EFL teachers’ levels of TPACK; and (4) analyze whether gender, Internet access at school, and technology training had any significant effect on in-service EFL teachers’ levels of TPACK. The participants in this study were (111) EFL pre-service teachers and (106) EFL in-service teachers. The descriptive statistical analysis (mean and standard deviation) revealed that the pre-service teachers’ overall level of TPACK was moderate scoring highest in TK, TPK, and TCK and lowest in CK and PK respectively. On the other hand, the in-service teachers’ overall level of TPACK was moderate scoring highest in CK, PK, and PCK and lowest in TK, TPK, and TCK respectively. The inferential statistical analysis (t-test) indicated a statistically significant difference between pre-service and in-service teachers’ levels of TPACK. All the seven sub-domains of TPACK were significant, with pre-service teachers scoring higher in TK, TCK, and TPK while in-service teachers scoring higher in CK, PK, PCK, and TPACK. The inferential analysis also showed that gender, Internet access at school, and technology training had a significant effect on both pre-service and in-service EFL teachers’ levels of TPACK. The study concluded that both pre-service teacher education programs and in-service teacher training courses need to focus on the connections and interactions between content, pedagogy, and technology in order to help EFL teachers integrate technology effectively into their teaching process. The study recommended investigating other factors that might be predictive of teachers’ levels of TPACK.

Analysing declarative and procedural knowledge in sport makes it possible to evaluate the students’ acquisitions in the learning process. This study aimed to compare the acquisition of declarative and procedural knowledge after the implementation of several intervention programmes in school basketball, according to the methodology and prior experience of the students. A total of 55 students from the sixth year of primary education took part in the study, distributed into three groups. Each group participated in a different intervention programme: tactical games approach (TGA), direct instruction (DI) or service teacher’s basketball unit (STBU). The level of knowledge was measured using the Test of Declarative and Procedural Knowledge in Basketball (TDPKB). A descriptive analysis was performed to determine the participants’ characteristics. A factorial ANOVA was subsequently applied in two phases (pre-test and post-test) for independent samples to compare the level of knowledge among the different groups, and a t-test for related samples was performed to compare the pre–post knowledge level within each group. Then, a factorial ANOVA and a test of repeated measures were carried out to determine the effect of the methodology and experience on the students’ knowledge. The results indicate that the TGA, DI and STBU intervention programmes induced improvements in the levels of declarative and procedural knowledge in all the groups, with the students who participated in the TGA programme achieving higher levels of declarative knowledge. Finally, the effect of the absence of practical experience was identified as a determining factor for improvement. The students who had not previously practised basketball achieved higher levels of knowledge with the TGA intervention programme.

Purpose: In science education, it is among the most important purposes that students become primarily scientific literate individuals. Scientific literacy is associated with deep understanding of “Nature of Science [NOS] and scientific inquiry processes. At this point, teachers' adequate level content knowledge about the nature of science gain importance because of responsibility of their students' getting contemporary understanding of the nature of science. In this study, it is aimed to determine and compare the status of pre-service science teachers and Science and Technology teachers' content knowledge about the nature of science. Method: This study is a descriptive model in which qualitative research techniques are used. In 2009-2010 education year, 89 pre-service teachers who are studying in 4th class in one of the leading universities in science education in Turkey and 64 Science and Technology teachers who are working in small city in Turkey participated in the study. The situation of the knowledge of the participants about the nature of science is determined using “Views about Nature of Science (BDYG) questionnaire which is adapted to Turkish from “VOSTS (Views on Science-Technology-Society). In order to analyze the answers of participants to the questions in BDYG questionnaire, every questionnaire item placed under every question is encoded by 10 field experts as Realistic , Has Merit and Naive . After every item that pre-service and in-service science teachers chose in BDYG questionnaire is analyzed, frequencies and percentages for each item are calculated in accordance with the descriptive analysis. Results and Suggestion: According to the results of the analysis, pre-service science and in-service teachers conducted in research are found to have a certain level of content knowledge about the nature of science. However, that level of knowledge they have about the nature of science does not sufficiently represent a contemporary vision at an adequate level. Moreover, as one of the most important results of the research, widespread realistic and naive views of the in-service teachers resulted from BDYG questionnaire are quite parallel with pre-service teachers in same categories. The realistic views that participants have in high percentage and that are parallel to each other are on tentativeness of scientific mistakes in scientific studies, “precision and uncertainty in scientific knowledge, “influence of society on scientist and “defining science. Besides, both participant groups have same level naive views on “characteristics of hypothesis, theories and laws, “the epistemological status of laws, hypotheses and theories and “the nature of scientific models issues. In this context, it is thought that both groups should take field education about nature of science. This education, for pre-service science teachers, can be through lessons related to science and nature of science which are given in their university education and for in service teachers, through in-service education and seminars from which every teacher can get benefit. Key Words: Content knowledge about the nature of science, Pre-service science teacher, Science and Technology teacher

Converting left-handers to their non-dominant right hand was previously widespread, particularly for handwriting. The present study aimed to explore the extent to which adult, converted left-handers can learn writing with their dominant left hand during a 2-year training program. Eleven converted left-handers participated in the training. Handwriting kinematics were assessed at regular intervals (seven sessions) and compared to those of 11 innate left-handed controls matched for age, gender, and overall handedness score for basic (Finger, Wrist, Circle) and complex (Sentence, Copy) handwriting tasks. Regarding basic tasks in the training group, we found rapid increases in left and right-hand frequency and no significant differences between both hands at any time point, indicating successful hand transfer. After 24 months, training participants significantly surpassed controls for writing frequency in basic tasks with their left hand. For complex tasks, we identified significant increases in the training groups’ left-hand writing frequency and duration between the first and last session. While training participants’ left-hand writing remained significantly slower than their right-hand writing, statistics confirmed final differences between hands only for the duration of the Sentence task. Importantly, left-hand writing in the training group was characterized by lower frequency, lower automaticity, and prolonged duration after 24 months compared to innate left-handers. With training participants’ left-hand writing skills significantly increasing for complex tasks and no final statistically significant differences between hands for frequency and automaticity, the program was considered effective. Nevertheless, within 2 years, training participants did not reach innate left-handers handwriting proficiency for complex tasks. Underlying reasons may be various, such as a non-optimal training program, a sensitive period for learning to write, irreversible neural changes during conversion in childhood, age-related decline of motor learning capacity, or retrograde interference between right- and left-hand writing.

In this paper, we present the results of an empirical study examining the achievements of Slovenian elementary school students in arithmetic, with a particular focus on decimal numbers at the levels of basic and conceptual, procedural and problem-solving knowledge. The study aimed to determine whether there are differences or correlations between students' achievements in decimal numbers at these levels of knowledge and whether performance at one level can predict performance at another. Based on an empirical non-experimental study involving 100 Slovenian elementary school students, the findings revealed significant correlations and statistically significant differences between students' achievements at the levels of basic, conceptual, procedural and problem-solving knowledge of decimal numbers. Furthermore, performance at the levels of basic and conceptual, and procedural knowledge were found to predict performance in problem-solving tasks, and vice versa. The study's results indicate that gaps in basic and conceptual or procedural knowledge are reflected in difficulties when solving complex problems, where success often depends on the accuracy of intermediate steps within the solution process.

Aims and objectivesThis study aimed to evaluate Tai Chi group training among patients with chronic heart failure (CHF) aged 70 years and older.BackgroundPhysical activity is recommended for CHF treatment. Tai Chi is found to be beneficial to different patient groups, although few studies focus on older patients with CHF.DesignA mixed methods study. Participants were randomly assigned to Tai Chi training twice a week for 16 weeks (N = 25) or control (N = 20). Quantitative data were collected at baseline, at the end of the training period and 6 months after training, assessing self‐rated fatigue and quality of life, natriuretic peptides and physical performance. Individual qualitative interviews were conducted with participants (N = 10) in the Tai Chi training group.ResultsNo statistical differences between the Tai Chi training group and the control group in quality of life or natriuretic peptides was found. After 16 weeks, the training group tended to rate more reduced activity and the control group rated more mental fatigue. Participants in the training group rated increased general fatigue at follow‐up compared with baseline. Qualitative interviews showed that Tai Chi training was experienced as a new, feasible and meaningful activity. The importance of the leader and the group was emphasized. Improvements in balance were mentioned and there was no physical discomfort.ConclusionTai Chi was experienced as a feasible and meaningful form of physical exercise for patients with CHF aged over 70 years despite lack of achieved health improvement. Further investigations, using feasibility and meaningfulness as outcome variables seems to be useful.

The purpose of this study was to develop and evaluate an interactive Web-based training module for electrosurgery and use of an electrosurgical device. The training module consists of a theoretical part, a device tutorial, and an assessment. For evaluation, participants were recruited at the surgical departments from a university hospital and a non-university teaching hospital and were divided into a training group and a control group. All participants performed the same theoretical and practical tests. The training participants first completed the module before they performed the tests. The control participants immediately performed the tests. Results were compared between the training and control participants. To evaluate face validity, the training participants filled out a questionnaire on their opinion about the module. In total, 39 participants were enrolled in the study: 20 in the training group and 19 in the control group. The training group answered significantly more theoretical questions correctly (15.7 versus 9.7; P<.001) and made significantly fewer errors in the practical test (2.2 versus 5.6; P=.007). The participants in the training group rated the usefulness and characteristics of the module with high marks. All of them indicated the module to be of additive value to surgical training programs. Training with an interactive Web-based module has a positive effect on both theoretical and practical competence regarding electrosurgery and use of an electrosurgical device. This module was rated positively by the participants and was indicated to be a useful addition to surgical training programs.

BackgroundAntenatal breastfeeding training is defined as the provision of breastfeeding information during pregnancy, which can be given in various ways, such as individual training and group training. The inclusion of fathers in this educational approach is associated with the initiation of breastfeeding, exclusive breastfeeding and duration of breastfeeding. However, studies involving fathers are limited. This randomized controlled study aimed to compare the effects of individual and group training given to parents and those of normal hospital practices on mothers’ breastfeeding self-efficacy and fathers' attitudes toward breastfeeding.MethodsThe study was conducted randomly in a training and research hospital between March 2014 and September 2014 and included 180 people. Of them, 90 were prospective mothers who were in the third trimester of their pregnancy and were living with their husbands and received service from the obstetrics outpatient clinic of the hospital. The expecting mothers and their husbands were randomly assigned to three groups: individual training, group training and control group. After randomization, prospective mothers and fathers in all groups received training. In the first week, sixth week, and fourth month after delivery, the mothers’ breastfeeding self-efficacy and breastfeeding attitudes as well as the attitudes of the fathers' toward breastfeeding were evaluated.ResultsThere were no differences between the groups in terms of variables such as age, education status, family type, breastfeeding education status, and mode of delivery. There were significant differences between the scores obtained from the Breastfeeding Self-Efficacy Scale and its subscales in all three groups during the postpartum period (p <0.05). The highest scale scores were obtained at the postpartum fourth month in the individual training and control groups and at the postpartum sixth week in the group training group. There were differences between the scores obtained by the mothers and fathers during the postpartum process from the Iowa Infant Feeding Attitude Scale (p<0.05).ConclusionThe analysis of all the results indicates that breastfeeding education given to parents in the antenatal period increases their breastfeeding self-efficacy and provides them with a positive attitude toward breastfeeding. However, further research is needed to determine whether individual or group training contributes to the development of breastfeeding self-efficacy and attitudes.

AudienceTargeted audience could be learners in medical field with basic knowledge of point-of-care ultrasound (POCUS), pulmonary and emergency medicine for example, medical students, emergency medicine residents (1st–3rd year), emergency physicians at all level of trainings, or emergency medicine physician’s assistants.IntroductionPoint-of-care ultrasound (POCUS) is rapidly becoming an essential part of emergency medicine and patient care .1,2 POCUS can provide more detailed clinical information when used in conjunction with a physical examination, overall aiding clinicians’ decision-making capacity.3 POCUS also proves a cost-effective tool in reducing the number of advanced imaging studies ordered and unnecessary patient radiation exposure.3,4 Performing POCUS has also proved beneficial for patient satisfaction because it increases the amount of face-to-face time spent with the patient while also providing live imaging interpretation during the emergency department visits .3,5,6 POCUS-Pulmonary can also create a safer environment for both medical staff and patients during the COVID-19 pandemic.6 Performing POCUS-Pulmonary on suspected COVID-19 patients can limit the number of patients receiving thoracic CT studies to confirm COVID-19 related pneumonia.6,7 Performing POCUS-Pulmonary reduces the number of patients transferred between the radiology department and the emergency department, significantly reduces overall possible COVID-19 exposures, and reduces equipment cleaning time.6 Given the overall reduction of advanced imaging studies ordered, CT scanners would be more readily available for critical care patients, such as trauma or other hemodynamic instability.6 Emergency providers practicing in rural areas with limited resources may benefit from the use of POCUS -Pulmonary, facilitating better patient care at decreased exposure-rate, cleaning cost, and overall increase in patient satisfaction given more bedside patient-provider communication.6–8 POCUS-Pulmonary is a crucial clinical skill for emergency medicine providers everywhere.6,8 Clinicians should be able to perform POCUS-Pulmonary, interpret image findings, and develop a treatment plan promptly.9Educational ObjectivesBy the end of performing the Zombie Cruise Ship Virtual Escape Room, learners will be able to: 1) recognize sonographic signs of A-line, B-line, Barcode sign, Bat sign, Seashore Sign, Plankton sign, Jellyfish Sign, Lung point, lung lockets, and Lung pulse; 2) differentiate sonographic findings of pneumothorax, hemothorax, pneumonia, COVID 19 pneumonia, pulmonary edema, and pleural effusion from normal lung findings; 3) distinguish pneumonia from atelectasis by recognizing dynamic air bronchogram; and 4) recognize indications for performing POCUS pulmonary such as dyspnea, blunt trauma, fall, cough and/or heart failure.Educational MethodsThis group-based learning program was designed for use in virtual meetings, lectures, and in small-group learning activities, such as didactic and EM conferences. A Google form was used to create a virtual escape room for learners in which they had to take quizzes to advance to the next level. Learners may enact teamwork through discussion and group effort, or respond individually to ultrasound pulmonary questions.Research MethodsLearners will take pre and post-test assessment to compare the learners POCUS-Pulmonary knowledge before and after small group, virtual escape room learning. All participants in the virtual escape room game are given a pre and post-test assessment comprised of seventeen total questions: two questions asking the participant's training level, and fifteen POCUS-Pulmonary questions. Pre and Post-test questions are identical; however, the participants' answers to the pre-test assessment are not revealed to them on completion. Instead, participants receive a letter grade on completing the pre-test assessment. Participants complete the pre and post-test assessments over fifteen minutes allotted before and after the virtual escape room. Upon completing the post-test assessment, a letter grade and the correct answers were given to the participants.ResultsTwenty-four emergency medicine resident physicians (PGY 1–3)) participated in the Zombie Cruise Ship Escape Room pre-test, while a total of twenty-three resident physicians participated in the post-test assessment. The pre-test data showed an average of 10.33 points, compared to post-test data, which showed 11.91 points. There was an improvement of two points on the median score with a median pre-test score of 10 vs. the post-test median of 12.DiscussionThe virtual zombie cruise ship experience proved a practical and useful tool in increasing overall participants' interest in POCUS pulmonary during the COVID-19 pandemic. Participants had higher retention after actively discussing and researching the most up-to-date clinical information during the virtual and inperson small group meetings. The game encouraged participants to make decisions quickly. This pace created a fun competition between participants who genuinely enjoyed the learning experience even during the COVID-19 pandemic via Zoom/Google Meet virtual conferences. By creating a virtual escape learning tool, learners can experience teamwork-based learning without concern for group size limitations during the pandemic.TopicsSonographic findings of pneumothorax, hemothorax, pneumonia, COVID-19 pneumonia, pulmonary edema, pleural effusion, normal lung, A-line, lack of A-line, presence of B-line, Lung sliding, M mode, dynamic air bronchogram, lung rockets, Bar code Sign, Bat Sign, lung pulse, lung point, hepatization, Seashore Sign, Plankton Sign, Jellyfish Sign, and subpleural pulmonary consolidation