Apprenticeship-based Training Research Articles

The rise of the simulator-based training method in gastrointestinal endoscopy training and currently available simulators.

The apprenticeship-based training method (ABTM) is highly effective for gastrointestinal (GI) endoscopic training. However, the conventional ABTM has significant issues. Although many supplementary training methods (TMs) have been developed and utilized, they cannot entirely replace the ABTM, which remains the major TM strategy. Currently, new TM construction is crucial and necessary due to financial constraints, difficulty of obtaining sufficient training time due to patient safety-related regulations, and catastrophic damage caused by disasters such as the coronavirus disease 2019 pandemic. The simulator-based TM (SBTM) is widely accepted as an alternative to the ABTM, owing to the SBTM's advantages. Since the 1960s, many GI endoscopy training simulators have been developed and numerous studies have been published on their effectiveness. While previous studies have focused on the simulator's validity, this review focused on the accessibility of simulators that were introduced by the end of 2021. Although the current SBTM is effective in GI endoscopic education, extensive improvements are needed to replace the ABTM. Incorporating simulator-incorporated TMs into an improved ABTM is an attempt to overcome the incompleteness of the current SBTM. Until a new simulator is developed to replace the ABTM, it is desirable to operate a simulator-integrated and well-coordinated TM that is suitable for each country and institution.

What’s load got to do with it? A cognitive-ergonomic training model of simultaneous interpreting

ABSTRACT The study of ergonomics has the potential to improve human performance not only in occupational sectors, but also in educational settings, where they can influence learning performance. It has long been acknowledged that instructional design can have direct effects on learning outcomes, provided it considers the underlying cognitive architecture of the learner. Relevant design features include the sequencing of tasks and the provision of cues using different types of media. The cognitive ergonomics (CE) of a learning environment, therefore, address the interaction among the key features of instructional design, the learning content, and the learner. Starting from the premise that simultaneous interpreting (SI) is a complex cognitive activity likely to generate high levels of intrinsic load in traditional apprenticeship-based training models, the primary research focus of this paper is to describe a training model built on CE-based multimodal activities. These activities are described in terms of their CE design that aims at making available the necessary cognitive resources for germane processing and promoting the acquisition of schemas through practice.

Legacy of COVID‐19 – the opportunity to enhance surgical services for patients with colorectal disease

The COVID-19 crisis has undoubtedly taken a toll on the care of patients with colorectal disease. Elective services, be that face to face contact, endoscopy or operating all but ceased during the pandemic.

Apprenticeship-based training in neurogastroenterology and motility

ABSTRACTIntroduction: Although neurogastroenterology and motility (NGM) disorders affect 50% of patients seen in clinics, many gastroenterologists receive limited NGM training. One-month apprenticeship-based NGM training has been provided at ten centers in the USA for a decade, however, outcomes of this training are unclear. Our goal was to describe the effectiveness of this program from a trainees perspective.Areas covered: We describe the training model, learning experiences, and outcomes of one-month apprenticeship-based training in NGM at a center of excellence, using a detailed individual observer account and data from 12 consecutive trainees that completed the program. During a one-month training period, 302 procedures including; breath tests (BT) n = 132, anorectal manometry (ARM) n = 29 and esophageal manometry (EM) n = 28, were performed. Post-training, all trainees (n = 12) knew indications for motility tests, and the majority achieved independence in basic interpretation of BT, EM and ARM. Additionally, in a multiple-choice NGM written-test paper, trainees achieved significant improvements in test scores post-training (P = 0.003).Expert commentary: One-month training at a high-volume center can facilitate rapid learning of NGM and the indications, basic interpretation and utility of motility tests. Trainees demonstrate significant independence, and this training model provides an ideal platform for those interested in sub-specialty NGM.

Practice Transfer in Organizations: The Role of Governance Mode for Internal and External Fit

This study leverages multinational corporations (MNCs) as a research context to advance our understanding of the relationship between internal and external fit over the course of the transfer of organizational practices. While internal fit describes the important condition that a practice should be aligned with organizational goals and must gain support internally, external fit refers to an additional condition for successful transfer, namely, that a particular practice must gain and sustain support and legitimacy in the environment. Studying two German MNCs transferring apprenticeship-based training to foreign operations in the United States, this paper starts from the key observation that organizations can use different governance modes to organize the transfer process: they may either go it alone and organize transfer in a hierarchy mode, or they may partner up with other organizations and form an interorganizational network for transfer. Using rich qualitative data, this paper finds that different governance modes affect the ability to attain internal and external fit by revealing a critical trade-off: while hierarchy helps create internal fit, it comes with significant additional costs to attain external fit; conversely, using the network mode facilitates the creation of external fit, but involves making compromises that reduce internal fit. Based on these findings, I theorize that different governance modes (hierarchy versus network) work through distinct processes (autonomous versus collaborative), driven by unique mechanisms (inward versus outward orientation), to influence outcomes in terms of internal and external fit. The study contributes to the literature by shifting attention to the implications of different governance modes for transfer processes.

Measures of Trainee Performance in Advanced Endoscopy: A Systematic Review

Introduction: The diversity, technical skills and risk inherent to advanced endoscopy techniques contribute to complex training curricula and steep learning curves. Since trainees develop endoscopy skills at different rates, there has been a shift towards competency-based training and certification. Validated endoscopy performance measures for trainees are therefore necessary. The aim of this systematic review was to describe and critically assess the existing evidence regarding measures of performance for trainees in advanced endoscopy. Methods: A systematic review of the literature from January 1980 to January 2016 was carried out using the MEDLINE, EMBASE, CENTRAL, and ISI Web of knowledge databases. MeSH terms related to ‘advanced endoscopy’ and ‘performance’ were applied to a highly sensitive search strategy. The main outcomes were face, content, and construct validity, as well as reliability. Results: The literature search yielded 1,662 studies and 77 met the inclusion criteria after abstract and full-text review (endoscopic retrograde cholangiopancreatography (ERCP) = 23, endoscopic ultrasound (EUS) = 30, colonoscopic polypectomy (CP) = 11, balloon assisted enteroscopy (BAE) = 7, luminal stenting = 3, radiofrequency ablation (RFA) = 2, and endoscopic muscosal resection (EMR) = 1). Good validity and reliability were found for measurement tools of overall performance in ERCP, EUS and CP, with applications for both patient-based and simulator training models. A number of technical skills were also shown to be valid measures of performance. These include: selective biliary cannulation, sphincterotomy, biliary stent placement, stone extraction and procedure time for ERCP; pancreatic solid mass T-staging, EUS-guided fine needle aspiration (EUS-FNA) procedure time, number of EUS-FNA passes and puncture precision for EUS; procedure time and en bloc resection rate for CP; retrograde fluoroscopy time for BAE; and mean number of endoscopy sessions required to achieve complete eradication of intestinal metaplasia (CIEM) for RFA. The evidence for EMR and luminal stenting is of insufficient quality to make recommendations. Conclusion: We have identified valid and readily available performance measures for advanced endoscopy trainees for ERCP, EUS, CP, BAE and RFA procedures. These tools should be considered in advanced endoscopy training programs wishing to move away from apprenticeship-based training and towards competency-based learning with the help of patient-based and simulator tools.

Legitimizing the apprenticeship practice in a distant environment: Institutional entrepreneurship through inter-organizational networks

This paper asks how Multinational Enterprises (MNEs) engage in institutional entrepreneurship to successfully transfer the organizational practice of apprenticeship-based training from Continental Europe to the distant host environment of the United States. In our case study, we highlight the important role of inter-organizational networks to coordinate engagement with the cognitive, normative, and regulative pillars of host country institutions. This networked form of institutional entrepreneurship involves the formation of inter-organizational networks for the purpose of bringing about institutional change collaboratively. In the process of transferring apprenticeship, a particular vision of workforce training was created, support gathered, and institutional change was sustained locally around the issue of training. We argue further that networked institutional entrepreneurship is a useful strategic tool to overcome the particular kind of institutional distance between the institutional settings of more coordinated market economies (CMEs) and more liberal market-oriented economies (LMEs). We contribute to existing knowledge by showing how practice transfer is shaped by particular kinds of institutional distance, and highlighting the role of inter-organizational networks as a way of governing collective agency associated with institutional entrepreneurship and the emergence of new local proto-institutions.

Repairing reforms and transforming professional practices: a mixed-methods analysis of surgical training reform

Although much has been written on changing professionalism, only limited attention has been given to the way in which professionals themselves give shape to new requirements in everyday professional practice. This article investigates the understudied reform of postgraduate medical education. The reform takes in a shift from apprenticeship-based training based on “learning-by-doing” and socialization to time-restricted, streamlined, competency-based training programs based on competency-based training and standardized performance assessment. We deploy a mixed-methods study design of surgical training reform in the Netherlands (2011-2012) to examine how surgeons and surgical residents give shape to changes in education as well as in the wider hospital context, and how this impact on surgical training from a micro perspective. Informed by sociological literatures on medical education and changing professionalism, this article reveals how the reform is repaired in everyday training practice. This repair work, as a form of institutional work, goes beyond restoring disrupted institutional arrangements in order to restore the status quo as is often argued. Instead, it involves acting with the reform; seeking feasible solutions that preserve old values and related practices while adopting new requirements that reconfigure institutionalized arrangements in professional training practices.

On the borders: surgeons and their activities in the Venetian State (1540-1640).

Through the biographies of a dynasty of practitioners who were active in some of the mountainous villages of the Venetian Terraferma the article brings to light unknown aspects of the professional world of surgeons. Their activities were profoundly influenced by the economic and geographic peculiarities of the territory where they lived and worked. Provincial towns and their territories offered professional opportunities both to licensed and to non-university trained practitioners. However, it was generally in small villages, especially those situated in border areas and part of the main commercial networks, that surgeons preferred to establish their practices, thus supplementing the medical services supplied by the town. Normally their knowledge was largely empirical and was transmitted from father to son. The apprenticeship-based training does not appear alternative to the academic education typical of learned practitioners: much evidence points to the existence of ‘scientific autodidacts’, self-taught practitioners who possessed and read medical texts or had attended academic courses, even if only in part. Practising surgery in this area was a highly mobile activity, stretching from the village to the neighbouring valleys, and even to areas outside the boundaries of the city and across the border of the Venetian state. Surgeons, furthermore, were able to transfer their skills and knowledge across a range of different occupations such as shoemakers, leather workers and tailors, a fact that confirms their close ties with the local artisan milieu.

PTU-072 A UK standardised cystic duct identification technique will help to mitigate the effect of human error and improve systematic training

IntroductionLaparoscopic cholecystectomy is a visual discipline and biliary tract anatomy is deduced by visual clues from a displayed image on a TV Screen where errors stemming from visual illusions and...

Resident education and quality of gross tissue examination practices of benign uteri

IntroductionIn the USA, most anatomical pathology residency training is based on an apprenticeship model in which residents learn directly by watching more senior personnel and then performing the examination. The...