Attrition Of Skills Research Articles

Challenges of Clinical Education: From the Perspective of Clinical Instructors and Clinical Staffs at Dire Dawa University, Dire Dawa, Ethiopia, Qualitative Study.

To explore the challenges of clinical education from the perspective of clinical instructors and clinical staff at Dire Dawa University College of Health Science. An institutional-based phenomenological qualitative study was conducted. Clinical instructors and staff provided data through in-depth interviews and key informant discussions, which were facilitated by a semistructured tool and a voice recorder. A total of 17 participants, including 11 in-depth interviews (IDIs) with clinical instructors (including two key informants) and six IDIs with clinical staff were included in this study. A purposive sampling method was used to select study participants, and the data were analyzed thematically using the computer-assisted qualitative data analysis software Atlas.ti7. The thematic analysis with an inductive approach involves six steps: familiarization, coding, generating themes, reviewing themes, defining and naming themes, and writing. Clinical instructors and clinical staff noted a number of challenges in clinical education, including insufficient medical equipment, low incentives, clinical site repetition, unfavorable clinical practice sites, lack of communication from instructors, skill attrition, lack of orientation for instructors and students, client/patient unwelcomingness, uncooperative healthcare workers, and poor university cooperation. The aforementioned issues contributed to the quality of clinical education and its desired impact, as outlined in this research. A multidisciplinary and collaborative effort is needed to address these challenges.

132 Faculty Procedural Skills in Academic Emergency Medicine: A Multisite Survey

Emergency physicians must be competent to perform numerous procedures. It is unclear if clinical practice alone is sufficient to maintain procedural skills, particularly for academic faculty who supervise trainees. Formal assessment of procedural skills beyond training is uncommon. There is a paucity of literature on faculty skills attrition or their preferences for skills maintenance. The faculty procedural skills (FPS) survey sought to determine faculty attitudes, beliefs and experience with procedures to inform programming aimed at skills maintenance. This was a multisite, cross-sectional study of emergency medicine (EM) and pediatric EM (PEM) physician faculty at five large US academic EM departments. Subjects were board certified or board eligible in EM or PEM and provided both clinical care and supervision of trainees. Subjects completed the FPS survey online which consisted of three sections: (1) respondent characteristics and experience performing and supervising EM procedures; (2) degree of confidence performing critical procedures; and (3) attitudes about skills attrition and learning preferences. Internal consistency of each survey section was calculated using Cronbach’s alpha. Items related to beliefs and attitudes were graded on a 5-point scale (strongly disagree to strongly agree), with higher values representing greater agreement. Response agreement (with 95% confidence interval [CI]) was calculated by combining “strongly disagree” with “disagree” and “strongly agree” with “agree” responses. A total of 186 faculty completed the survey (44% response rate). Scale reliability was good (Cronbach’s alpha performance = 0.82; supervision = 0.86; confidence = 0.85). All respondents agreed that ongoing procedural skills training is important for the clinical practice of EM. The majority of respondents agreed: that faculty should have opportunities to retrain for uncommon procedures (98%, 95% CI: ±2%); that skills attrition is a concerning problem (91%, 95% CI: ± 4.1%); that skills attrition is a patient safety issue (89%, 95% CI: ± 4.5%); that attrition was more likely in academic settings (93%, 95% CI: ± 3.7%); that faculty should be required to demonstrate procedural competence (83%, 95% CI: ± 5.4%). The majority of respondents (73%, 95% CI: ± 6.4%) personally experienced procedural skill attrition and a similar number (68%, 95% CI: ± 6.7%) observed it in peers. The most preferred method for skills maintenance was simulation (83%, 95% CI: ± 5.4%). The most preferred learning environment was in groups with peers (89%, 95% CI: ± 4.5%). A majority of faculty reported skills attrition, both personally and observed in peers. Respondents also overwhelmingly agreed they should be competent to perform procedures for which they are credentialed. These findings raise questions about the need for technical skill competency assessments for continued clinical practice. Faculty preferred simulation-based learning and peer environments for skills maintenance. Further study is needed to determine the attitudes, beliefs, and experiences of non-academic emergency physicians with procedural skills attrition.

Impact of Surgical Experience on Operative Mortality After Reoperative Cardiac Surgery

Learning curves and skill attrition with aging have been reported to impair outcomes in select surgical subspecialties, but their role in complex cardiac surgery remains unknown. From 1986 to 2019, 2314 patients underwent reoperative cardiac surgery: coronary artery bypass grafting (n= 543), valve (n= 1527), or combined coronary artery bypass grafting and valve (n= 244). Thirty-four different surgeons in practice between 1 and 39 years were included. Standardized mortality ratio (observed-to-expected) was determined for all surgeons in each post-training year of experience. Risk-adjusted cumulative sum change-point analysis was used to define five distinct career phases: 0 to 4 years, 5 to 8 years, 9 to 17 years, 18 to 28 years, and 29 to 39 years. With 5 to 8 years and 18 to 28 years of experience, standardized mortality ratio was near unity (0.95 and 1.05, respectively) and lowest with 9 to 17 years of experience (0.78, P= .03). In the youngest experience group (0 to 4 years), observed and expected mortality were both highest, and standardized mortality ratio was elevated at 1.29, which approached statistical significance (P= .059). In the oldest experience group (29 to 39 years), expected mortality was low compared with most other groups but observed mortality increased, yielding a significantly elevated standardized mortality ratio at 1.53 (P= .032). Standardized mortality ratios with reoperative cardiac surgery were highest early and late in a surgeon's career and lowest in mid career. As surgeons gain experience, outcomes improve through the first two career decades, then stabilize in the third decade before declining in the fourth decade.

Management of Patients with Neurotrauma by Trauma Surgeons: Need of the Hour

AbstractTrauma-related deaths in excess of 1 million occur annually in India, more than half of which are attributable to head injury. There are just 1,400 certified neurosurgeons in India, and only 300 new trainees are inducted every year. More than 80% of India’s specialist doctors live in urban India. There is evidence that patients travel hundreds of kilometers to seek a neurosurgeon; needless to say, golden hour of trauma is surely lost in this time. Scarcity of neurosurgeons is a problem in the developed world too. Government of India is building a national network of trauma centers for better trauma care. However, neurosurgeon availability at these centers remains a cause of concern. In dire need of neurotrauma management and scarcity of neurosurgeons, management of neurotrauma by trauma and general surgeons is the best available option. Such management policies have already been tested successfully in both developed (Germany, Sweden) and developing world (Nepal). There is evidence on patient safety and good outcome in neurotrauma management by trauma surgeons. Refresher training of 1 week every 2 years has been recommended to prevent skill attrition after 2-week neurotrauma training led by a neurosurgeon. Uninterrupted run of 3-year trauma surgery residency program at JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India, incorporating in-house neurotrauma training is a testimony to need and utility of this approach. A “readily available neurosurgeon when needed” is a scarce resource in most parts of world. Therefore, trauma surgeon is best suited to deliver timely care in neurotrauma and tackle this “hidden epidemic.”

Structured curriculum delivery in undergraduate physiotherapy education: A qualitative study

CONTEXT: Physiotherapy curriculum has undergone a major change in the past several years. Over time in addition to content, some of the skills are given less importance, resulting in attrition of skills with increase in theoretical knowledge. AIMS: The aim of this study is to assess the feasibility and response to a structured method of curriculum delivery SETTINGS AND DESIGN: The study was conducted at College of Physiotherapy in Karnataka. The study design is qualitative. SUBJECTS AND METHODS: Method of data collection for Phases I and III was through interviews using both in-depth interviews and focus group discussions. For Phase II, a multi-step Delphi approach was undertaken. STATISTICAL ANALYSIS USED: Triangulation was performed from the interview output, and the codes and themes were extracted. Trustworthiness of emergent themes was assessed through interviews conducted on a different cohort of faculty members and students. RESULTS: Predetermined themes that were assessed are ease of integration of subject from student's point of view and carryover of theoretical knowledge and skills in to the clinical work. The new themes that emerged after Phase I were that practical classes were important in all subjects and vertical and horizontal integrations of subjects are required. Phase II consisted of development of manuals and checklists. Phase III results revealed that the new system assisted teachers in delivering uniform knowledge across batches and helps students to understand the relevance of subjects studied. REFLECTIONS: Comments from Phase III are indicative of the achievement of the goals identified in Phase I through the methods described in Phase II.

A STUDY OF ENGLISH RETENTION BY JAPANESE COLLEGE STUDENTS OVER SUMMER VACATION

Remarkable research efforts have been made to the studies of second language acquisition. Consequently, we know fairly well about how people acquire languages. Based on the obtained data and findings, enormous amounts of time, energy, and also funding have been invested to develop second language learning in terms of curriculum, teaching materials, methodology and so on. At present, with the analogy of first language acquisition, we tend to regard the process of second language learning solely as the cumulative one. Considering that language learning is a process of going back and forth, we should see what is lost as well as what is acquired. However, very little attention seems to have been paid to the maintenance of second language skills once attained and also the probable process of retention and forgetting of the functional command of second language skills once they are no longer used or when no language instruction is given. The study of the language skill attrition, in other words, loss of proficiency in one or more skills in one's native or second language, is relatively new in the field of applied linguistics and began to gain greater attention quite recently. Very little systematic research has been done yet: the period of time for each skill to begin to decline, the order of loss in specific linguistic features, and also the avoiding loss or restoring the lost skills. The present paper concerns with the retention of English by Japanese college students over summer vacation. As Smythe et al. (1973: 400) mention, the beginning of each school term the foreign language teacher, like all teachers whose subject matter is of cumulative characters, is faced with the possibility that students may have forgotten part of what they have learned in previous courses. The idea of this sort is generally accepted but little research evidence seems to assure if all features of foreign language skills are lost at the same rate or which sets of knowledge and skills are more likely to be retained o~ lost after instruction. The research findings concerned with these areas would be able to suggest a great deal about how to teach after summer vacation. In this paper, my discussion will be organized: (1) a brief review of language attrition studies over summer vacation, (2) a small research on forgetting and retaining of some knowledge and skills (listening comprehension, structure, vocabulary, and reading comprehension) involving college level population, and (3) a consideration of the relevance of language attrition research for various aspects of teaching and learn: ing English_

Can hiring subsidies benefit the unemployed?

Long-term unemployment can lead to skill attrition and have detrimental effects on future employment prospects, particularly following periods of economic crises when employment growth is slow and cannot accommodate high levels of unemployment. Addressing this problem requires the use of active labor market policies targeted at the unemployed. In this context, hiring subsidies can provide temporary incentives for firms to hire unemployed workers and, when sensibly targeted, are a very cost-effective and efficient means of reducing unemployment, during both periods of economic stability and recovery.

Educational and Clinical Impact of Advanced Trauma Life Support (ATLS) Courses: A Systematic Review

We aimed to systematically review the literature on the educational impact of Advanced Trauma Life Support (ATLS) courses and their effects on death rates of multiple trauma patients. All Medline, Pubmed, and the Cochrane Library English articles on the educational impact of ATLS courses and their effects on trauma mortality for the period 1966-2012 were studied. All original articles written in English were included. Surveys, reviews, editorials/letters, and other trauma courses or models different from the ATLS course were excluded. Articles were critically evaluated regarding study research design, statistical analysis, outcome, and quality and level of evidence. A total of 384 articles were found in the search. Of these, 104 relevant articles were read; 23 met the selection criteria and were critically analyzed. Ten original articles reported studies on the impact of ATLS on cognitive and clinical skills, six articles addressed the attrition of skills gained through ATLS training, and seven articles addressed the effects of ATLS on trauma mortality. There is level I evidence that ATLS significantly improves the knowledge of participants managing multiple trauma patients, their clinical skills, and their organization and priority approaches. There is level II-1 evidence that knowledge and skills gained through ATLS participation decline after 6 months, with a maximum decline after 2 years. Organization and priority skills, however, are kept for up to 8 years following ATLS. Strong evidence showing that ATLS training reduces morbidity and mortality in trauma patients is still lacking. It is highly recommended that ATLS courses should be taught for all doctors who are involved in the management of multiple trauma patients. Future studies are required to properly evaluate the impact of ATLS training on trauma death rates and disability.

Training Zambian traditional birth attendants to reduce neonatal mortality in the Lufwanyama Neonatal Survival Project (LUNESP)

ObjectiveTo provide relevant details on how interventions in the Lufwanyama Neonatal Survival Project (LUNESP) were developed and how Zambian traditional birth attendants (TBAs) were trained to perform them. MethodsThe study tested 2 interventions: a simplified version of the American Academy of Pediatrics’ neonatal resuscitation protocol (NRP); and antibiotics with facilitated referral (AFR). ResultsKey elements that enabled the positive study result were: focusing on common and correctible causes of mortality; selecting a study population with high unmet public health need; early community mobilization to build awareness and support; emphasizing simplicity in the intervention technology and algorithms; using a traditional training approach appropriate to students with low literacy rates; requiring TBAs to demonstrate their competence before completing each workshop; and minimizing attrition of skills by retraining and reassessing the TBAs regularly throughout the study. ConclusionAn effective NRP training model was created that is suitable for community-based neonatal interventions, in research or programmatic settings, and by practitioners with limited obstetric skills and low rates of literacy.Clinicaltrials.govNCT00518856.

Evaluation of the University of Virginia Leadership in Academic Medicine Program

Background: Developing effective transformational leaders is essential for a diverse and complex academic medical system. The purpose of this study is to elicit faculty perspectives on their leadership skills before and after participation in a Leadership in Academic Medicine (LAM) Program. Summary: The two-part study consisted of a prospective Pre- and Immediate Post-LAM Survey distributed to 32 participants in the 2008 Program and a Long-Term Post-LAM Survey distributed to 110 prior participants (2004–2007). Both surveys were designed to assess participant leadership perspectives and career outcomes. Institutional Review Board approval was obtained. Data were analyzed quantitatively and qualitatively. All participants reported improved leadership skills, but the percentages were lower for Long-Term Post-LAM participants than for the Immediate Post-LAM participants. In addition, although 58% of Immediate Post-LAM women, compared with 19% of Immediate Post-LAM men (p < .05), were actively seeking leadership roles, this was reversed in the long-term group (26% of women vs. 66% of men; p < .05). Conclusions: Although the benefits of LAM participation are sustained for some years, there is a need for reinforcement to prevent skill attrition. That lower percentages of Long-Term Post-LAM women had leadership aspirations requires further study.

Escaping the unemployment trap: The case of East Germany

This paper addresses the question of why high unemployment rates tend to persist even after their proximate causes have been reversed (e.g., after wages relative to productivity have fallen). We suggest that the longer people are unemployed, the greater is their cumulative likelihood of falling into a low-productivity trap, through the attrition of skills and work habits. We develop a model along these lines, which allows us to bridge the gap between high macroeconomic employment persistence versus relatively high microeconomic labor market flow numbers. We calibrate the model for East Germany and examine the effectiveness of three employment policies in this context: (i) a weakening of workers' position in wage negotiations due to a drop in the replacement rate or firing costs, leading to a fall in wages, (ii) hiring subsidies, and (iii) training subsidies. We show that the employment effects of these policies depend crucially on whether low-productivity traps are present.

Escaping the Unemployment Trap: The Case of East Germany

This paper addresses the question of why high unemployment rates tend to persist even after their proximate causes have been reversed (e.g., after wages relative to productivity have fallen). We suggest that the longer people are unemployed, the greater is their cumulative likelihood of falling into a low-productivity trap, through the attrition of skills and work habits. We develop a model along these lines, which allows us to bridge the gap between high macroeconomic employment persistence versus relatively high microeconomic labor market flow numbers. We calibrate the model for East Germany and examine the effectiveness of three employment policies in this context: (i) a weakening of workers’ position in wage negotiations due to a drop in the replacement rate or firing costs, leading to a fall in wages, (ii) hiring subsidies, and (iii) training subsidies. We show that the employment effects of these policies depend crucially on whether low-productivity traps are present.

Do factors other than trauma volume affect attrition of ATLS-acquired skills?

We previously demonstrated that trauma patient volume affects attrition rate of Advanced Trauma Life Support (ATLS)-acquired skills. This study assesses the possible roles of age, gender, and practice specialty on attrition of these skills over 8 years. Cognitive (assessed by the 40-item Multiple Choice Question Examination [MCQE]) and clinical (assessed by four trauma Objective Structured Clinical Examination [OSCE] stations) skills performance were compared among physicians who completed the ATLS course 0 months, 6 months, 2 years, 4 years, 6 years, and 8 years previously. The physicians were further divided into the following groups: age < 32 years (n = 72) or 32 years or older (n = 72), gender (41 women and 103 men), and specialty (54 surgeons, 90 nonsurgeons, and 22 general surgeons). Multivariate analysis of variance was used for statistical comparison over time and unpaired t tests for between-group comparisons for each time period, with p < 0.05 being considered statistically significant. Regarding age, MCQE decreased from 82.3 +/- 2.8% to 62.7 +/- 3.0% (mean +/- SD) for age < 32 and from 84.1 +/- 3.6% to 62.8 +/- 2.1% for age 32 or older (p = not significant). Overall OSCE score (maximum, 20) decreased similarly for age < 32 (18.0 +/- 0.4 to 13.6 +/- 2.0) and age > 32 or older (18.0 +/- 0.3 to 12.4 +/- 1.3). Decrease in Priorities and Organized Approach scores also showed no differences between the groups. Regarding gender, MCQE decreased similarly in both groups (women, 81.5 +/- 2.2% to 64.4 +/- 2.4%; men, 83.3 +/- 3.2% to 64.1 +/- 4.2%) and so did OSCE, Priorities, and Organized Approach scores. Regarding specialty, surgeons (83.0 +/- 3.1% to 66.1 +/- 4.5%), nonsurgeons (82.9 +/- 3.2% to 63.3 +/- 3.9%), and general surgeons (82.5 +/- 3.5% to 63.8 +/- 5.3%) showed similar decreases in MCQE scores. Overall OSCE scores and Priority and Approach scores decreased similarly in all specialty groups. When trauma volume was controlled, there was still no difference in attrition rate between surgeons and nonsurgeons. Trauma patient volume is the most critical determinant of attrition rate of ATLS-acquired skills. Gender, age (at time of taking the course), and practice specialty do not alter this attrition rate.

Is attrition of advanced trauma life support acquired skills affected by trauma patient volume?

Background: We assessed the effect of trauma volume on skills attrition among physicians completing the advance trauma life support (ATLS) course. Methods: Cognitive (40 item multiple choice question [MCQ] examination) and clinical (4 objective structured clinical examinations [OSCE] trauma stations) performances were compared among physicians who completed the ATLS course, subdividing them into groups treating more than 50 and fewer than 50 trauma patients per year. Both groups had 12 physicians from six periods (n = 144) related to time of course completion: immediate (0), 6 months, 2 years, 4 years, 6 years, and 8 years after ATLS. OSCE scores (maximum standardized: 20), the degree of adherence to priorities (priority score: range 1 to 7), the degree of organized approach (approach score: range from 1 to 5) were compared. Results: The mean precourse MCQ scores (59.4% to 62.4%) were similar for both groups. Immediate and progressive cognitive skill attrition and detailed clinical skill attrition were worse in the low volume group. Global skills (organized approach and adherence to priorities) were preserved similarly for at least 8 years in all groups. Conclusions: Our data suggest that trauma volume affects trauma skills attrition.

First language acquisition in a second language submersion environment

ABSTRACTIn the present paper a linguistic description is given of the process of first language acquisition of Turkish children aged 4 to 8 in a Dutch submersion environment in the Netherlands. On the basis of the assumption that language development involves the acquisition of distinct subskills in differential patternings, the development of lexical, morphosyntactic, and pragmatic abilities have been investigated separately. Furthermore, these longitudinal data are compared with cross-sectional language data of five- and seven-year-old children in Turkey. This comparison was made in order to be able to interpret whether the Turkish language skills of native Turkish-speaking children in the Netherlands were showing delay, stagnation, or attrition of skills. The overall results suggest that in the age range of 4 to 8 years the acquisition of first language skills by Turkish children in the Netherlands can best be characterized as stagnated.