Competence In Technical Skills Research Articles

Indonesia-Germany cooperation in efforts to improve vocational education levels: Analysis of the Ausbildung program

The quality of Indonesian human resources still needs improvement to compete in the international world. Currently, the international market requires a lot of competence in technical skills in the vocational field. For this reason, Indonesia focuses on developing vocational training and education. This demand was not fulfilled because Indonesian vocational graduates did not have the right skills. With abundant but ineffective resources, Indonesia must learn much from other countries, including Germany. The output of this international collaboration is the Ausbildung program or Apprenticeship Training. This article seeks to reveal how Indonesian-Germany cooperation in vocational education impacts the two countries by using a qualitative method of reviewing documents and interviews with relevant sources. Findings from this article's cooperation opens up new opportunities for exploiting intellectual labor, which is neo-capitalism. In terms of salary, the wages received by Indonesian workers are far below the minimum wage that should be given to professional workers in Germany.

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.

Use of Hand-motion Analysis to Assess Competence and Skill Decay for Cardiac and Lung Point-of-care Ultrasound.

Assessment of competence in technical skills, including point-of-care ultrasound (POCUS), is required before a novice can safely perform the skill independently. Ongoing assessment of competence is also required because technical skills degrade over time, especially when they are infrequently performed or complex. Hand-motion analysis (HMA) is an objective assessment tool that has been used to evaluate competency in many technical skills. The purpose of this study was to demonstrate the feasibility and validity of HMA as an assessment tool for competence in both simple and complex technical skills as well as skill degradation over time. This prospective cohort study included 36 paramedics with no POCUS experience and six physicians who were fellowship trained in POCUS. The novices completed a 4-hour didactic and hands-on training program for cardiac and lung POCUS. HMA measurements, objective structured clinical examinations (OSCE), and written examinations were collected for novices immediately before and after training as well as 2 and 4months after training. Expert HMA metrics were also recorded. Expert HMA metrics for cardiac and lung POCUS were significantly better than those of novices. After completion of the training program, the novices improved significantly in all HMA metrics, knowledge test scores, and OSCE scores. Novices showed skill degradation in cardiac POCUS based on HMA metrics and OSCE scores while lung POCUS image acquisition skills were preserved. Novices deemed competent by OSCE score performed significantly better in HMA metrics than those not deemed competent. We have demonstrated that HMA is a feasible and valid tool for assessment of competence in technical skills and can also evaluate skill degradation over time. Skill degradation appears more apparent in complex skills, such as cardiac POCUS. HMA may provide a more efficient and reliable assessment of technical skills, including POCUS, when compared to traditional assessment tools.

Graduate training in psychotherapy: The importance of ongoing clinical activity for the training faculty

AbstractBackgroundPsychotherapy training is designed to help graduate students develop confidence and competence in their clinical skills.ApproachThe present manuscript explores three dimensions of an Aristotelian doctrine of knowledge as related to skill in psychotherapy.FindingsFirst, a psychotherapist should be knowledgeable about the background information pertaining to psychological theories and current research in the field. Typically, background information is covered in graduate courses and updated through continuing education opportunities for the licensed psychologists. Second, psychotherapists develop competence in technical skills used in psychotherapy sessions. For graduate students, competence in technical skills can be developed through the direct provision of clinical services in supervised placements. For faculty members, technical skills can be maintained through their involvement in ongoing clinical activities. Third, psychotherapy instructors need expertise in practical wisdom to guide clinical judgment and ethical reasoning skills. Expertise develops through years of practice.ConclusionsGraduate students are expected to develop background knowledge and basic competence in clinical skills. Furthermore, faculty members who teach graduate courses on psychological assessment, psychiatric diagnosis and psychological treatments can be expected to attain a level of expertise. Psychotherapy training is improved when faculty instructors have ongoing clinical experience and practical wisdom. The present manuscript confronts the problem and proposes several possible solutions.

Prioritizing research topics in regional anesthesia education.

To the editor Delivering regional anesthesia education is a formidable challenge. It requires evidence-based approaches to diverse topics such as teaching of theoretical knowledge, competency in technical skills,[1][1] professional behaviors, use of simulation,[2][2] curriculum design,[3][3] and

Evaluation of Technical Competency in Healthcare Simulation (E-TeCHS) tool: a modified Delphi study

BackgroundGraduates of simulation fellowship programmes are expected to have the ability to perform a variety of simulation specific skills at the time of graduation. Currently, simulation fellowship directors have access...

Hand motion analysis for assessment of nursing competence in ultrasound-guided peripheral intravenous catheter placement.

Objective measures such as hand motion analysis are needed to assess competency in technical skills, including ultrasound-guided procedures. Ultrasound-guided peripheral intravenous catheter placement has many potential benefits and is a viable skill for nurses to learn. The objective of this study was to demonstrate the feasibility and validity of hand motion analysis for assessment of nursing competence in ultrasound-guided peripheral intravenous placement. We conducted a prospective cohort study at a tertiary children's hospital. Participants included a convenience sample of nurses with no ultrasound-guided peripheral intravenous experience and experts in ultrasound-guided peripheral intravenous placement. Nurses completed hand motion analysis before and after participating in a simulation-based ultrasound-guided peripheral intravenous placement training program. Experts also completed hand motion analysis to provide benchmark measurements. After training, nurses performed ultrasound-guided peripheral intravenous placement in clinical practice and self-reported details of attempts. A total of 21 nurses and 6 experts participated. Prior to the hands-on training session, experts performed significantly better in all hand motion analysis metrics and procedure time. After completion of the hands-on training session, the nurses showed significant improvement in all hand motion analysis metrics and procedure time. Few nurses achieved hand motion analysis metrics within the expert benchmark after completing the hands-on training session with the exception of angiocatheter motion smoothness. In total, 12 nurses self-reported 38 ultrasound-guided peripheral intravenous placement attempts in clinical practice with a success rate of 60.5%. We demonstrated the feasibility and construct validity of hand motion analysis as an objective assessment of nurse competence in ultrasound-guided peripheral intravenous placement. Nurses demonstrated rapid skill acquisition but did not achieve expert-level proficiency.

Endoscopic management of Barrett's esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement.

Current practices for the management of Barrett's esophagus (BE) vary across Europe, as several national European guidelines exist. This Position Statement from the European Society of Gastrointestinal Endoscopy (ESGE) is an attempt to homogenize recommendations and, hence, patient management according to the best scientific evidence and other considerations (e.g. health policy). A Working Group developed consensus statements, using the existing national guidelines as a starting point and considering new evidence in the literature. The Position Statement wishes to contribute to a more cost-effective approach to the care of patients with BE by reducing the number of surveillance endoscopies for patients with a low risk of malignant progression and centralizing care in expert centers for those with high progression rates.Main statements MS1 The diagnosis of BE is made if the distal esophagus is lined with columnar epithelium with a minimum length of 1 cm (tongues or circular) containing specialized intestinal metaplasia at histopathological examination. MS2 The ESGE recommends varying surveillance intervals for different BE lengths. For patients with an irregular Z-line/columnar-lined esophagus of < 1 cm, no routine biopsies or endoscopic surveillance is advised. For BE ≥ 1 cm and < 3 cm, BE surveillance should be repeated every 5 years. For BE ≥ 3 cm and < 10 cm, the interval for endoscopic surveillance should be 3 years. Patients with BE with a maximum extent ≥ 10 cm should be referred to a BE expert center for surveillance endoscopies. Patients with limited life expectancy and advanced age should be discharged from endoscopic surveillance. MS3 The diagnosis of any degree of dysplasia (including "indefinite for dysplasia") in BE requires confirmation by an expert gastrointestinal pathologist. MS4 Patients with visible lesions in BE diagnosed as dysplasia or early cancer should be referred to a BE expert center. All visible abnormalities, regardless of the degree of dysplasia, should be removed by means of endoscopic resection techniques in order to obtain optimal histopathological staging MS5 All patients with a BE ≥ 10 cm, a confirmed diagnosis of low grade dysplasia, high grade dysplasia (HGD), or early cancer should be referred to a BE expert center for surveillance and/or treatment. BE expert centers should meet the following criteria: annual case load of ≥10 new patients undergoing endoscopic treatment for HGD or early carcinoma per BE expert endoscopist; endoscopic and histological care provided by endoscopists and pathologists who have followed additional training; at least 30 supervised endoscopic resection and 30 endoscopic ablation procedures to acquire competence in technical skills, management pathways, and complications; multidisciplinary meetings with gastroenterologists, surgeons, oncologists, and pathologists to discuss patients with Barrett's neoplasia; access to experienced esophageal surgery; and all BE patients registered prospectively in a database.

Structured and Modular Training Pathway for Robot-assisted Radical Prostatectomy (RARP): Validation of the RARP Assessment Score and Learning Curve Assessment

BackgroundUse of robot-assisted radical prostatectomy (RARP) for prostate cancer is increasing. Structured surgical training and objective assessment are critical for outcomes. ObjectiveTo develop and validate a modular training and assessment pathway via Healthcare Failure Mode and Effect Analysis (HFMEA) for trainees undertaking RARP and evaluate learning curves (LCs) for procedural steps. Design, setting, and participantsThis multi-institutional (Europe, Australia, and United States) observational prospective study used HFMEA to identify the high-risk steps of RARP. A specialist focus group enabled validation. Fifteen trainees who underwent European Association of Urology robotic surgery curriculum training performed RARP and were assessed by mentors using the tool developed. Results produced LCs for each step. A plateau above score 4 indicated competence. Outcome measurements and statistical analysisWe used a modular training and assessment tool (RARP Assessment Score) to evaluate technical skills. LCs were constructed. Multivariable Kruskal-Wallis, Mann-Whitney U, and κ coefficient analyses were used. Results and limitationsFive surgeons were observed for 42 console hours to map steps of RARP. HFMEA identified 84 failure modes and 46 potential causes with a hazard score ≥8. Content validation created the RARP Assessment Score: 17 stages and 41 steps. The RARP Assessment Score was acceptable (56.67%), feasible (96.67%), and had educational impact (100%). Fifteen robotic surgery trainees were assessed for 8 mo. In 426 RARP cases (range: 4–79), all procedural steps were attempted by trainees. Trainees were assessed with the RARP Assessment Score by their expert mentors, and LCs for individual steps were plotted. LCs demonstrated plateaus for anterior bladder neck transection (16 cases), posterior bladder neck transection (18 cases), posterior dissection (9 cases), dissection of prostatic pedicle and seminal vesicles (15 cases), and anastomosis (17 cases). Other steps did not plateau during data collection. ConclusionsThe RARP Assessment Score based on HFMEA methodology identified critical steps for focused RARP training and assessed surgeons. LCs demonstrate the experience necessary to reach a level of competence in technical skills to protect patients. Patient summaryWe developed a safety and assessment tool to gauge the technical skills of surgeons performing robot-assisted radical prostatectomy. Improvement was monitored, and measures of progress can be used in future to guide mentors when training surgeons to operate safely.

Board 378 - Research Abstract What Transfers? The Effects of Goal Orientation on Medical Students Self Regulated Learning of Suturing Skills Using Simulation (Submission #1095)

Introduction/Background Simulation-based medical education (SBME) has become a well-established component of contemporary curricula,1 yet we do not fully understand how trainees conceptualize their learning in this environment. Without evidence for how trainees think about their learning, some SBME instructional designs may be working against rather than supporting how trainees regulate their learning.2 Theories of self-regulated learning (SRL) suggest that a trainee’s goal orientation and the accuracy with which he self-monitors goal achievement are core learning processes.3,4 In particular, research in psychology has shown that process goals (i.e., focused on the mechanisms of performance) and outcome goals (i.e., focused on products of performance) influence learner’s conceptions and performance when learning.4,5 We studied the effects of different goal orientations (process vs. outcome) on learning outcomes and self-monitoring accuracy during suturing skills training. Methods Forty one medical students were randomly assigned to Outcome and Process goal groups. Participants completed a 25 trial acquisition session and returned two weeks later to complete a 10 trial retention session. On every third trial in both sessions, the participants self-assessed performance using a visual analogue scale. Two expert raters used the same scale to assess participants videotaped performances. We calculated inter-rater reliability and used the combined rater score in analyses of the groups’ performances. We evaluated the self-monitoring accuracy using Pearson’s correlation between expert and participant ratings. For data analysis, we used a repeated measures analysis of variance (trial by group) and t-tests to analyze performance and self-monitoring accuracy, respectively. Results While all participants improved from trial 1 to trial 25 (p<0.001), there were no significant group differences and no interaction between group and trial (all p>0.429). For the retention session, a significant group by trial interaction showed a benefit for the process goal group, only on the 10th and last trial (p=0.034). The t-test comparing the correlation coefficients reflecting participants self-monitoring accuracy showed that the process goal group was significantly better calibrated with expert evaluations during acquisition (r=0.86 vs. r=0.41, p=0.003) and was better calibrated, yet not significantly, during retention (r=0.42 vs. r=0.03, p=0.19). Conclusion We found that instructing trainees to set process or outcome goals during SRL did not lead to consistent performance differences during suturing skills training. However, trainees who set process goals during training had superior self-monitoring accuracy in both practice and retention sessions, which we suggest likely better prepares them for long-term lifelong learning. This study represents one of the first to investigate how SBME instructional design influences medical trainees conceptions both during training and over the long-term. We plan to study how to optimize self-monitoring accuracy further, while ensuring trainees maintain competence in technical skills.

Attending Feedback After Surgery

Attending Feedback After Surgery

Tackling technical skills competency: A surgical skills rating tool

BackgroundThe Accreditation Council for Graduate Medical Education common program requirements mandate a competency-based assignment of duties. To accomplish this, valid and reliable assessment tools must be developed to evaluate competence. This study evaluated a rating tool to assess competence in basic surgical suturing skills. MethodsA technical skills exercise consisting of the closure of three incisions, 3 cm long, was devised in 2006. The incisions were closed with simple stitches with two-handed knots, vertical mattress stitches with instrument knots, and a running stitch with one-handed knots. Fifteen min were allotted for completion. A rating instrument with 17 competency markers worth 1 point and a global 5-point Likert scale competency score was used to evaluate the performance. Twelve first-week post graduate year 1 surgical residents completed the exercise in 2006, and 16 final-month post graduate year 1 surgical residents completed it in 2011. All tasks were scored on video review by two independent raters. Statistical analysis included descriptive statistics, t-score analysis, rank sum analysis, Cohen's kappa coefficient, and Cronbach's alpha. ResultsThe mean total score (11.8 versus 13.9, P = 0.002) and median global competency rating (1 versus 3, P < 0.001) were lower for the first-week cohort. Cohen's kappa coefficient of inter-rater reliability was 0.77. Cronbach's alpha measure of internal consistency was 0.87. ConclusionThis rating form is a valuable tool to evaluate technical skill competency. Construct validity was demonstrated with improvement in total score and global rating. Excellent internal consistency and inter-rater reliability were also demonstrated. This form may be used to assess technical skill competency in an efficient skills exercise.

Principles of training in GI endoscopy

Principles of training in GI endoscopy

The XML Training Log (XTraLog): a prototype browser‐based instrument for assessment of competency in technical skills

The XML Training Log (XTraLog): a prototype browser‐based instrument for assessment of competency in technical skills

Predicting the Technical Competence of Surgical Residents

I describe an approach to predicting competence in technical skills for the purposes of resident selection. To demonstrate a predictive relationship, it is necessary to use measures that exhibit variation, reliability, and validity. There is little evidence that such measures are routinely used in the process of selecting residents. I argue that the selection of assessment instruments in the predictor domain must be guided by relevant theoretical considerations, while assessment in the surgical domain must make use of more objective and reliable instruments than is currently the practice. I present a brief summary of research on predicting operative technical competence.

Factors that influence women's technical skill development in outdoor adventure

This article provides a theoretical foundation for understanding women's technical skill development (TSD) in outdoor adventure. An examination of societal and biological factors influencing women's TSD focuses on gender role socialization, sense of competence, technical conditioning, sexism, spatial ability, and risk-taking. The article suggests leadership and instructional strategies for facilitating technical skill competency for women in outdoor education.

Legal standards of conduct for students and residents: implications for health professions educators.

Students and residents are responsible for providing much of the patient care in academic medical centers. Though experiential learning has been central to equipping students with the professional knowledge and skills needed in their careers, it raises significant medicolegal questions. One such question addresses the standard of care being provided by health care practitioners in training. Referred to as "standard of conduct" in a legal setting, the applicable standard for students and residents has been addressed by the courts on several occasions. Some early cases supported the notion that there is a special standard of conduct for students and interns, one that is lesser than that expected of fully licensed, certified practitioners. Cases since the late 1970s, however, indicate a trend away from that view, generally finding that any persons holding themselves to be practitioners, including students and residents, should be held to the standard of conduct of a practicing professional. Further, providers are being held to a national rather than a community-based standard of care, heightening the extent of the duty that all providers, including those still in training, have to their patients. A significant reason that students and residents are being held by the courts to the same standard of conduct as practicing professionals is that they are providing care under the supervision of licensed, experienced faculty. Case law indicates that while personnel in training have a duty to their patients to render care of a nationally recognized standard, supervising faculty have a parallel duty to those patients to provide adequate levels of supervision to ensure that such a standard be met, as well as to ensure that the care be in compliance with relevant policies and statutes. The findings discussed in this paper hold several implications for educators and administrators. First, faculty have a duty to maintain their knowledge bases and skill levels in accordance with nationally recognized standards in their professions in order to adequately fulfill their teaching and patient care responsibilities. Second, faculty have a duty to maintain an appropriate level of supervision during the provision of patient care. Administrators and educators also have supervisory responsibilities regarding the monitoring of pertinent policies and statutes to ensure the continued appropriateness of those documents and to foster compliance of all involved. Finally, alternative modes of education that would provide opportunities for students to develop competence in technical skills before using them on real patients (such as patient simulators) should be explored.

Knowledge, Attitudes, Technical Competence, and Blood Glucose Control of Type 1 Diabetic Patients During and After an Education Programme

Thirty-one Type 1 diabetic patients entered a 12-month education programme in which attitudes to diabetes, knowledge of diabetes, and technical competence were assessed using questionnaires and practical tests. A closely matched group of 25 control patients continued to receive routine clinic care. Patients completing the education programme showed improved blood glucose control (HbA1 decreased from 11.8 +/- 0.4% to 10.5 +/- 0.3%, mean +/- SE, p less than 0.01), whereas blood glucose control was not altered in the control group (HbA1 11.8 +/- 0.5% before and 11.6 +/- 0.4% after 12 months). Patients completing the education programme also showed greater knowledge (p less than 0.001), more favourable attitudes (p less than 0.03), and increased competence in technical skills (p less than 0.02) compared with the control group. Six months after completing the programme blood glucose control deteriorated (HbA1 11.0 +/- 0.4%, p less than 0.05), although knowledge, attitudes, and technical competence were unchanged. This might reflect the withdrawal of extrinsic motivation and attention provided during the programme. Thus consideration should be given to development of the patient's intrinsic motivation to prolong the benefits of diabetes education programmes.

Population planning in India: national and foreign priorities.

India depends heavily on foreign experts to formulate its population policy because those domestic political leaders involved in policy making are alienated from the masses—they hold to Western values, lack competence in technical skills, are reluctant to come to grips with urgent social problems, and have given way to pressure from powerful vested interests. National and foreign priorities are closely identified. Policy formulators have sidetracked the fight against the basic social and economic problems of the country and have identified population planning with a birth control that masquerades under the name of family planning. This has been a fundamental and almost fatal mistake. Because of this approach, all attempts at family planning have failed to bring their intended results, and it has not been possible to make a significant dent in India's population problem. A threshold level of social and economic development must be attained before any family planning program can begin to bring about a sustained drop in the birth rate. Family planning should be part of a broadly based integrated plan of social and economic development. This will require changes at the political, administrative, social and economic levels to allow development of suitable plans to effectively and expeditiously implement the social and economic development programs.