Participant Confidence Research Articles

Lokakarya Pembelajaran II 2023: Mewujudkan Pendidikan yang Berkualitas dengan P5

Community service activities aim to improve understanding and implementation of the Pancasila “P5” Student Profile Consolidation Project; and independent research program at Lhokseumawe City. Involving teachers, supervisors and principals from different educational institutions, the program includes preparation, implementation, evaluation, and monitoring phases. The support team of the Generation III driving school has planned intensive training and prepared comprehensive educational materials, including the purchase of necessary equipment. Implementation involves participants in trainings, discussions, workshops, and practices, enabling them to apply P5 and the Merdeka curriculum in everyday learning contexts. Evaluation results showed increased participants' understanding and confidence in applying the concept. Monitoring includes the development of supplementary materials, ongoing training, and monitoring of P5 implementation. This program has a positive impact on participants, preparing them for P5 and the Merdeka program. Ongoing collaboration between the Class III driving school support team and participating educational institutions will ensure continuous improvement in the quality of education in Lhokseumawe City.

A83Assessment of the Use of Assorted Methods of Scenario Presentation in Communication Skills Simulation

FY2 doctors in Greater Glasgow and Clyde (GGC) participate in simulation-based learning [1] to improve communication skills in difficult consultations. COVID-19 pandemic restrictions from 2020 – 2022 meant actors could not be present in person for this. Scenarios were therefore adapted to run as remote consultations - two were conducted using Zoom video calls and one by telephone with professional actors, and one ward-based manikin scenario with faculty as actors. We compared the effectiveness of the session, and of each scenario, in improving confidence in communication. Questionnaires were completed before and after simulation. Confidence levels were assessed using a Likert Scale (1 – 5) for each scenario. Participants were also asked to rank each scenario (1 – 4) for engagement, realism and relevance to practice at the end of the session, and for which of the three Intended Learning Objectives (ILOs) for each scenario they had gained most information. Over 10 days, 126 FY2s (6 - 8 per group) and 23 Faculty members participated. 92 completed questionnaires were obtained. ‘Take Forward Messages’ (TFM) from scenario debriefs from 12 groups were correlated with the ILOs. Overall, there was a significant improvement in confidence in dealing with difficult communication scenarios after the session; (mean ± SEM) score pre 2.87 ± 0.11, post 3.69 ± 0.08, p < 0.01. These values did not differ significantly from 2019 when actors were present in person. When asked to rank which scenario was most effective in different aspects, the case on how to deal with an angry patient (Zoom video call) performed best overall ( Scenario Quality Assessment and Improvement in Participant Confidence Levels Zoom and telephone consultations, and manikin-based scenarios can be used to provide effective simulation sessions to improve communication skills. Perception of scenario quality does not always correlate with success in achieving the learning objectives. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

A71Evaluation of a co-produced Simulation Based Perinatal Mental Health Programme

NHS England’s Long-Term Plan for Mental Health highlights need to develop PNMH services and train staff ensuring service user involvement [1]. Women experiencing PNMH disorders often initially present to non-specialist healthcare professionals (NSHCP), meaning that they need specific training in assessment and management of PNMH disorders. A co-produced and co-facilitated simulation-based training programme in perinatal mental health was developed in 2019 by Sussex Partnership Specialist Perinatal Service in conjunction with University Hospital’s Sussex Simulation team. Primary Aim: Evaluate self-reported changes in confidence and competence of learners attending perinatal mental-health (PNMH) simulation training across multiple domains relating to assessment and management of PNMH problems. Secondary Aims: Evaluate impact of service user co-facilitation on PNMH simulation training; Assess whether participant demographics reflect training’s target professional groups. Service User Consultants (SUCs) were employed as faculty members and trained in simulation facilitation alongside professional faculty. Scenarios were developed in a multidisciplinary workshop, and aligned to the Health Education England (HEE) Competency framework in PNMH. Courses were co-facilitated by a Perinatal Psychiatrist and SUC. Data on participants’ confidence and knowledge across the competency framework domains was collated using a survey monkey questionnaire, pre and post-course. 242 responses were collected from participants from more than ten different staff groups e.g. junior doctors, (18%), health visitors (17%) & midwives (26%). Participant confidence improved significantly across all training domains. 93.5% of participants graded contribution of SUCs either useful or very-useful. 99.2% found the simulation training useful or very-useful, with all participants agreeing their future practice would consequently change. The simulation-based training programme increased confidence and understanding of NSHCPs from across the PNMH care pathway, on a number of domains set by HEE PNMH competency framework. Participants were overwhelmingly in support of SUC involvement in the provision of valuable training which resembled real-life clinical encounters via scenarios.

Evaluation of a Physical Therapist-Delivered Technology Literacy Algorithm and Protocol for Older Adults: A Pilot Study.

Introduction Technology literacy is the ability to comfortably understand, use, and navigate digital devices. It is considered a "super social determinant of health", and yet 39% of adults aged 65+ report not using a smartphone, and 25% of seniors still lack internet access. The purpose of this study was to examine the applicability of a physical therapist-delivered clinical assessment tool related to technological literacy and to identify relationships between technology utilization and perceptions related to sociodemographic factors in community-dwelling older adults. Methods A prospective mixed-methods observational-descriptive study where physical therapists (PTs) administered a newly designed technology literacy algorithm to older adults and evaluated the results of the algorithm. A convenience sample of 30 participants aged 65 and older was evaluated for their technology literacy. The exclusion criteria were if the person had a vision deficit, lived in a nursing home or extended care facility, was unable to fluently read and understand the English language, or was not willing to have an in-home visit by a licensed PT. After informed consent was obtained, the participant completed a Past Experience with Technology Questionnaire assessing participant confidence with technology usage and a demographic questionnaire. A PT data collector visited participants' homes and administered a novel technology literacy algorithm. The PTs also provided subjective feedback after patient visits as to their perceptions of the algorithm. Inferential statistics were performed for key variables, including a Kruskal-Wallis test being utilized for variables with three or more levels and a two-sample Wilcoxon test being utilized for variables with two levels. The binary results were evaluated with chi-squared tests. Trends in distribution and measures of central tendency were analyzed for demographic data. Statistical significance was set at P<0.05 with a confidence interval of 95%. Results Participants (n=30) were evenly distributed with regard to age, and 66% of people had a college degree. Most were female, of the white race, and retired. There were statistically significant relationships between older age and decreased comfort level with using the internet (P=0.30) and sending messages (P=0.31), with individuals 80+ years old having a mean confidence of 6.78 out of 10. A statistically significant relationship was also found between higher income and increased confidence in browsing the internet (P = 0.07). Most qualitative data from physical therapist experiences included positive trends such as ease of use, efficiency, and confidence instilled. Constructive feedback included a lack of resources to assist with more advanced technology-related needs and recommendations to refine the algorithm when advanced needs were identified. Conclusion Technology literacy is a vital component of accessing health and medical care and maximizing the quality of that care, especially in the older adult population. The tools created may assist clinicians with identifying and addressing issues related to technology in older adults. This may help a patient navigate health issues that require the use of technology in their home. This study provided evidence that a PT-administered algorithm may be feasible to address technology literacy issues in the homes of older adults.

Cultural awareness immersion and introduction to social determinants of health: The 360-degree difference

Background and objectives: To address the need for innovative educational activities which focus on the Asian American population, and focuses on the Social Determinants of Health (SDOH) and culturally competent care, an immersive, interactive 360-degree video simulation-based educational activity (SBE) was implemented by nursing faculty at a Midwest university. The specific aims of the project were to a) assess changes in participants knowledge and skills as related to SDOH, cultural awareness, and health literacy with the Asian American population; b) participant confidence, and c) assess the usefulness, and ease of use, of 360-degree video simulation.Methods: A single group pretest-posttest design was used in this SBE activity with a convenience sample of 83 undergraduate baccalaureate nursing students at one university.Results: The SBE activity improved overall knowledge and confidence. Furthermore, the majority of participants perceived the SBE activity as useful and that the 360-degree video technology was easy to use.Conclusions: The results contribute to limited literature exploring outcomes of 360-degree video simulation with a focus on the Asian American population and SDOH, cultural competence, and health literacy. Implementing such SBE activities into nursing curriculums is critical to address health disparities and increase knowledge and skill in clinical practice for undergraduate nursing students when serving vulnerable and underrepresented populations.

A pedagogic evaluation comparing face to face and online formats of a multi-professional offender personality disorder (OPD) higher education training programme

PurposeThe aim of this paper is to provide an overview of a novel offender personality disorder (OPD) higher education programme and the research evaluation results collected over a three-year period. Data from Phase 1 was collected from a face-to-face mode of delivery, and Phase 2 data collected from the same programme was from an online mode of delivery because of the COVID-19 pandemic.Design/methodology/approachIn Phase 1, three modules were developed and delivered in a fully face-to-face format before the pandemic in 2019–2020 (n = 52 student participants). In 2020–2021 (n = 66 student participants), training was adapted into a fully online mode of delivery in Phase 2. This mixed-methods study evaluated participant confidence and compassion. Pre-, post- and six-month follow-up questionnaires were completed. Qualitative interviews were conducted across both phases to gain in-depth feedback on this programme (Phase 1: N = 7 students, Phase 2: N = 2 students, N = 5 leaders). Data from Phase 1 (face-to-face) and Phase 2 (online) are synthesised for comparison.FindingsIn Phase 1 (N = 52), confidence in working with people with personality disorder or associated difficulties improved significantly, while compassion did not change. In Phase 2 (N = 66), these results were replicated, with statistically significant improvements in confidence reported. Compassion, however, was reduced in Phase 2 at the six-month follow-up. Results have been integrated and have assisted in shaping the future of modules to meet the learning needs of students.Research limitations/implicationsFurther research into the impact of different modes of delivery is important for the future of education in a post-pandemic digitalised society. Comparisons of blended learning approaches were not covered but would be beneficial to explore and evaluate in the future.Practical implicationsThis comparison provided informed learning for consideration in the development of non-related educational programmes and, hence, was of use to other educational providers.Originality/valueThis paper provides a comparison of a student-evaluated training programme, thus providing insights into the impact of delivering a relational-focused training programme in both face-to-face and online distance learning delivery modes. From this pedagogic research evaluation, the authors were able to derive unique insights into the outcomes of this programme.

Development and Feasibility of a Primary Care Provider Training Intervention to Improve Atrial Fibrillation Management

The disparities in atrial fibrillation (AF) care are partially attributed to inadequate access to providers with specialized training in AF. Primary care providers (PCPs) are often the sole providers of AF care in under-resourced regions. As such, we sought to create a virtual education intervention for PCPs and to evaluate its impact on the use of stroke risk reduction strategies in patients with AF. A multidisciplinary team mentored PCPs on AF management over 6months using a virtual case-based training format. Surveys of participant knowledge and confidence in AF care were compared before and after the intervention. Hierarchical logistic regression modeling was used to evaluate change in oral anticoagulation (OAC) therapy in the patients seen by participants before or after training. Of 41 participants trained, 49% worked in family medicine, 41% internal medicine, and 10% general cardiology. Participants attended a mean of 14 1-hour sessions. Overall, the appropriate use of OAC (for CHA2DS2-VASc score ≥1 man, ≥2 women) increased from 37% to 46% (p <0.001) comparing the patients seen before (n=1,739) versus after (n=610) intervention. The factors independently associated with appropriate OAC use included participant training (odds ratio [OR] 1.4, p=0.002) and participant competence in AF management. The factors associated with decreased OAC use included patient age (OR 0.8 per 10year, p=0.008) and nonwhite race (OR 0.7, p=0.028). Provider knowledge and confidence in AF care improved (p <0.001). In conclusion, we show that a virtual PCP training intervention improves the use of stroke risk reduction therapy in outpatients with AF and could be a widely scalable intervention to improve AF care in under-resourced communities.

Impact of an evidence-based training for educators on bystander intervention for the prevention of violence against LGBTI+ youth

Research shows that teachers and educators receive scarce scientific evidence-based training and tools to implement effective strategies to stop and prevent violence against LGBTI+ youth in educational institutions. Nonetheless, no data examines pedagogical contents and training initiatives that are providing these professionals with effective strategies and skills. This paper will cover this gap by gathering data on the impact of training workshops that were carried out in five European countries as part of a REC programme project. These workshops were designed to train educators in formal and non-formal contexts about scientific evidence-based content aimed at reaching social impact, such as bystander intervention and the dialogic model of violence prevention. As part of the training, they participated in the debate of a scientific article first hand, thus engaging with direct research. The content, organisation and instruments for data collection were co-created with relevant end-users and researchers who engaged at different meetings in an Advisory Committee. Aimed at collecting the impact of this training, 208 online pre- and post-questionnaires, and 12 semi-structured interviews were analysed. Results show that participants gain knowledge and confidence empowering themselves as active agents in the problem. Thanks to this co-creative and community science approach, participants affirmed they are thinking of applying upstander actions in their working contexts. The trust in the rigour of the content and the interest sparked towards science are also expressed.

The Efficacy and Cost-Effectiveness of a Simulation-Based Primary Care Procedural Skills Training Program for Advanced Practice Providers.

The purpose of this program evaluation was to investigate the efficacy of simulation-based primary care procedural skills training to increase participant confidence, knowledge, and skill in performing the procedures included in the training and to evaluate the cost-effectiveness of the training. A retrospective, within-subjects analysis of the change in perceived confidence, skill, and knowledge in procedure performance after the simulation-based primary care procedural skills training program measured by pretraining and post-training Likert scale surveys and change in clinical procedure performance frequency for abscess incision and drainage and laceration repair up to 6 months before and 6 months after the training in the outpatient setting was performed. Participants self-reported higher median confidence, perceived skill, and perceived knowledge of all procedures included in the training course, with statistically significant increases for all procedures. A mean increase in laceration repairs in the clinical setting of 10% after training was found. Higher median performance of abscess incision and drainage after training (median = 20.00%, n = 25) compared with before training (median = 0.00%, n = 25) and a mean increase in performance of abscess incision and drainage in the clinical setting of 6% after training was found, but increases were not statistically significant. Participation in a 2-day simulation-based primary care procedural skills training program was an effective method to increase confidence, perceived skill, and knowledge of outpatient procedures among practicing providers. Further evaluation to establish return on investment is needed, because statistically significant increases in clinical procedure performance were unable to be demonstrated.

O.2.1-5 Knowledge, use and confidence in physical activity guidelines and assessment in recently graduated doctors from Irish medical schools: a cross sectional survey

Abstract Purpose Approximately 54% of the adult population in Ireland do not meet National Physical Activity Guidelines. Doctors play a key role in supporting people to be more active but may lack knowledge, skills and confidence to promote physical activity. The aim of this study was to explore knowledge and confidence in relation to physical activity counselling in recent medical graduates in Ireland. Methods Medical doctors who graduated from Irish medical programmes in the past 5 years and currently had patient contact were asked to complete an online survey between April and November 2022. The survey was shared with medical graduates through social media, alumni groups, and relevant professional and social networks. The survey included a minimal number of questions about participant demographics and education, questions relating to participants' knowledge and confidence of physical activity guidelines and counselling, and questions relating to education and training on physical activity. The responses were downloaded to Excel and data such as mean, standard deviation, frequency and percentage, were analyzed to summarize participant responses. Results Among the 95 responses, the majority were from graduates of Direct Entry Medicine Programmes who were currently working as Senior House Officers in either Ireland or Australia. Key findings indicated that 76% of participants were unaware of the Irish Physical Activity Guidelines and 60.76% are unaware of the Making Every Contact Count Framework. The majority wanted to receive training on physical activity at undergraduate level (73%) and postgraduate level (61%). With regards to physical activity knowledge for counselling, a majority of responders rated their knowledge between 5,6 and 7 out of 10. Similarly, a majority of responders rated their confidence in prescribing between 4,5, and 6 out of 10 (1 being not confident and 10 being extremely confident). The top three subjects participants wanted training on were: Physical Activity Guidelines, Counselling, and Assessment. Conclusions Findings indicate a gap in the teaching and assessment of physical activity in undergraduate medical curricula in Ireland. However, there is demand among recent graduates for training on physical activity. Future studies should be done among a larger sample in order to strengthen confidence in our findings.

Hospital Testing of the Effectiveness of Co-Designed Educational Materials to Improve Patient and Visitor Knowledge and Confidence in Reporting Patient Deterioration

Co-designed educational materials could significantly improve the likelihood of patients and visitors (consumers) escalating care through hospital systems. The objective was to investigate patients' and visitors' knowledge and confidence in recognizing and reporting patient deterioration in hospitals before and after exposure to educational materials. A multimethod design involved a convenience sample of patients and visitors at a South Australian hospital. Knowledge and confidence of participants to report patient deterioration was assessed using a validated questionnaire. Baseline group was surveyed, and a second group was surveyed after exposure to a poster and on-hold message relating to consumer-initiated escalation-of-care. Nominal data were examined using chi-square analysis, and ordinal data using the Mann-Whitney U test. Open-ended questions were examined using thematic analysis. A total of 407 participants completed the study, 203 undertook the baseline survey, and 204 the postintervention survey. Respondents exposed to the educational materials reported significantly higher recognition of responsibility to report concerns about patient deterioration compared to controls (86.3% vs. 73.1%; p = 0.007). Respondents exposed to the educational materials also had better ability to identify signs that a patient was becoming sicker compared to controls (77.5% vs. 71.3%, p = 0.012). Four overarching themes emerged from the questions: patient/visitor understanding of key messages, patient/visitor recognition of deterioration, patient/visitor response to deterioration and patient/visitor recommendations. Following educational interventions, patients and visitors report improved awareness of their role in recognizing and responding to clinical deterioration. They advise additional active interventions and caution that the materials should accommodate language, cultural, and disability needs.

Clinical Learning Environment of the "Nursing of Childbearing Family" Course from the Students' Perspectives: An Observational Prospective Study

Introduction: The clinical environment, which includes "simulation labs, educators, teaching hospital, and clinical staff," serves as an active pedagogical strategy that helps students translate their knowledge into technical skills and foster critical thinking. However, this strategy needs a periodic evaluation from students' perspectives to be updated with technological advancements. Objective: This study aims to evaluate the clinical learning environment of the "Nursing the Childbearing Family" course from the students' perspectives. Materials and Methods: A study with an observational prospective design was conducted at simulation labs of the Childbearing Family c.ourse, School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA. A convenient sample of 62 students (84.93% participation rate) willingly took part in this investigation. A structured questionnaire comprising 54 questions (50 multiple-choice and 4 open-ended questions) was used to students' perspectives and clinical learning environment. Descriptive (frequency, percentage, mean, and standard deviation) and inferential statistics (the Pearson test and paired t test) were used to describe and compare the mean scores of the student's performances before and after receiving the simulation training labs. Results: A total of 62 BSc nursing students (with a 100% response rate) enrolled in the Childbearing and Family Nursing course during the academic year took part in this study. The participants' mean ± age was 20.75 ± 0.97 years. Most of the study standards indicators of comparing students' perspectives before and after clinical training reflected a statistically significant difference (P&lt;0.05). Notably, a significant relationship was observed between the students' views regarding the clinical site and clinical instructors (r= -0.641, P=0.001). Conclusion: Most students held positive perspectives toward the four standards of students' clinical site, students' view of their clinical instructor, effective working relationships between the university and the clinical site, and students' perspectives of the simulation labs before and after the clinical training were positively significant. However, some views underscored the need for more coverage on some topics, such as obstetric emergencies, breech position, and amniotic fluid embolism. Therefore, the current study confirmed that assessing the clinical environment instilled more confidence in participants to go beyond the course procedures and seek more complex scenarios.

Visual displays for communicating scientific uncertainty in influenza forecasts

We offer a general method for testing the usability of visual displays communicating scientific uncertainty, illustrated with publicly available results from CDC's influenza forecasts. The heavy toll of seasonal influenza has prompted major investments in improving these forecasts, making them a focus of machine learning research. However, little research has been devoted to how well users can understand and use these forecasts to inform decisions under uncertainty. Our approach extends psychological theory to experimental tasks posing hypothetical, but realistic decisions using alternative displays based on actual forecasts. Based on Tversky's theory of conceptual-spatial congruence, we predicted actual and perceived usability of four displays (bar chart, tree map, PDF, and 90% confidence interval). Participants (N = 301, recruited on Amazon MTurk) were randomly assigned to use one of four displays for four decision tasks, created to reflect our extension of the theory. We evaluated participants' comprehension, confidence, and judgments of perceived helpfulness, when the display and the decision were congruent or non-congruent. Participants had better comprehension with the most familiar display (bar chart), for all four decisions. However, they did not perceive that display as more helpful or have greater confidence in their responses to it. Participants who reported greater familiarity with a display performed more poorly, despite expressing greater confidence and rating it as more helpful. We discuss the need to evaluate performance, as well as ratings, and the opportunities to extend theoretical frameworks to specific contexts.

318 Advancing Surgery in Africa Through Education, Mentorship and Research; the Surgery Interest Group of Africa (SIGAf)

Abstract Aim Peer-to-peer surgical education has improved remarkably over the last decade with the aid of interest groups and charity organisations such as ASiT, IncisioN, NANSIG, and StarSURG. Despite these advances, there remains a lack of collaborative interest groups tailored to improving surgical education in Africa. The Surgery Interest Group of Africa (SIGAf) was established in response, and this study assesses its benefits in research, education, and mentorship. Method Feedback data from over 20 virtual sessions grouped into six categories over seven months in 2022 were analysed in this study. The categories included the surgical conference (Exposure to African Surgery), Career talks, Surgical lecture series, Exam preparation lectures, Research and audit lectures and Journal club activities. Data on participant confidence levels, helpfulness, engagement, and interest in the lecture content were examined using a 5-point Likert scale. Results 705 responses were recorded across the six categories. The participants’ confidence level increased from an indeterminate pre-session to a statistically significant fairly confident level post-session. The attendees perceived the conference, career talks, lecture series, and journal club activities as helpful and had the highest level of interest. The surgical conference, career talk and surgical lecture series all had a reasonably good engagement. Conclusions This study has shown that the virtual sessions held by the Surgery Interest Group of Africa aimed at advancing surgery across the continent through education, mentorship, and research have achieved reasonable success.

Strategies For Safety: A Mixed Method Study of Communication, Teamwork and Health Professional Attitudes When Implementing Multidisciplinary Simulation in The Emergency Department

The Emergency Department (ED) team delivers care to critically unwell patients. Within this, there are a range of complexities and responsibilities identified. Technical skills can be taught in lectures and books; however, the newly evolving phenomenon of focusing on non-technical medical skills has advanced over time. Using non-technical skills, such as communication and human factors, can influence the team's functioning, which could potentially influence a positive outcome of a critical care event. This study explores whether multidisciplinary simulation training, focusing on non-technical skills, can improve participants’ communication and teamwork and if regular simulation practice can influence healthcare staff attitudes towards embedding a regular simulation program at a local site. A convergent mixed method approach was used to determine staff attitude towards a newly implemented simulation programin the hospital ED. Data was collected over six weeks. The quantitative component measured teamwork and communication with Guise’s validated and reliable tool, the Clinical Teamwork Scale (CTS). Further data using a developed evaluation survey provided participant feedback pre and post-simulation. Thirty-two participants, sixteen nurses and sixteen doctors, were surveyed. The results could suggest a trend of a positive outlook towards implementing a regular simulation practice. However, further analysis would be required. A common theme was participant confidence post-simulation practice and willingness to participate in future simulations. Baseline opinions from all participants were positive. The study has generated valuable insight towards staff attitudes toward MDT simulation in the ED setting. The evidence can further support the implementation of a regular simulation program.

Balance-Associated Tests Contribute to Predicting the Need for Ambulatory Assistive Devices (AAD) among Community-Dwelling Older Adults.

This study aims to analyze the use of ambulatory assistive devices (AAD) in relation to balance-associated tests and assist medical staff in providing professional objective reference values for older adults on whether to use AAD. Older adults (n = 228) were recruited from the local community to participate in this study. Participants were divided into the AAD-use group and the non-AAD-use group. Four balance-associated tests and scales were applied to predict the relationship between balance function and the use of AAD in older adults. They were used to assess the participant's balance function and confidence in maintaining balance and were considered the most reliable measures of balance. There were significant differences in the Berg Balance Scale (BBS) score and Timed Up and Go Test (TUGT) among the subjects in the AAD-use group and non-AAD-use group (p < 0.001). The ROC curve analysis presented the following cut-off values for balance tests and scales: 23.62 s for the TUGT test and 41.5 points for the BBS score. For example, if the TUGT score is greater than 23.62 s and the BBS score is below 41.5 points, AAD is recommended for older adults to maintain balance and prevent falls. These objective reference standards may be useful in guiding medical personnel to determine whether older adults need to use AAD. In future studies, we hope to include more participants for subgroup analysis, investigating different types of AAD and their effects on older adults.

Psychodynamic-based virtual reality cognitive training system with personalized emotional arousal elements for mild cognitive impairment patients

Background and objectiveMild cognitive impairment (MCI) is a serious threat to the physical health and quality of life of the elderly, as well as a heavy burden on families and society. The current computer-based rehabilitation training ignores the role of emotions in cognitive impairment rehabilitation, making it difficult to improve patient engagement and efficiency. To address this, a psychodynamics-based cognitive rehabilitation training method with personalized emotional arousal elements was proposed using virtual reality technology. MethodsOur proposed method contains four training tasks, which cover (audiovisual memory, attention & processing, working memory, abstract & Logic, spatial pathfinding) and six positive emotional arousal elements (sensory feedback, achievement system, multiplayer interaction, score comparison, relaxation scenarios, and peaceful videos) to motivate participants to persist during cognitive training continuously and maintain a positive mental attitude toward training. The six emotional arousal elements were divided into two personalized combinations—full combination and half combination—based on the results of the pre-assessment and were dynamically distributed throughout both the training tasks and post-training. ResultsFifteen participants with MCI were recruited to complete the proposed experiment and validate the effectiveness of the system. They were first asked to complete two assessments (e.g., the big five scale and the positive and negative affect scale) to investigate their personalities. Based on the results of the assessments, they were provided with a full or half combination of arousal elements in the training tasks and post-training. Finally, the acceptability of the system and task experience were assessed using questionnaires. Notably, there was a significant increase in training scores for participants who completed a six-week training period (66.7%, 33.4%, and 25.0% for attention and processing, working memory, and abstraction and logic, respectively). The results show that positive emotional arousal had a positive effect on the MCI participants. The training tasks and arousal elements can improve cognitive function and enhance the confidence and engagement of participants. There were no significant differences in cognitive domain training scores between the two groups. ConclusionsThis personalized cognitive training system has the potential to serve as a convenient solution for complementary treatment of MCI.

Saliency-Enhanced Content-Based Image Retrieval for Diagnosis Support in Dermatology Consultation: Reader Study.

Previous research studies have demonstrated that medical content image retrieval can play an important role by assisting dermatologists in skin lesion diagnosis. However, current state-of-the-art approaches have not been adopted in routine consultation, partly due to the lack of interpretability limiting trust by clinical users. This study developed a new image retrieval architecture for polarized or dermoscopic imaging guided by interpretable saliency maps. This approach provides better feature extraction, leading to better quantitative retrieval performance as well as providing interpretability for an eventual real-world implementation. Content-based image retrieval (CBIR) algorithms rely on the comparison of image features embedded by convolutional neural network (CNN) against a labeled data set. Saliency maps are computer vision-interpretable methods that highlight the most relevant regions for the prediction made by a neural network. By introducing a fine-tuning stage that includes saliency maps to guide feature extraction, the accuracy of image retrieval is optimized. We refer to this approach as saliency-enhanced CBIR (SE-CBIR). A reader study was designed at the University Hospital Zurich Dermatology Clinic to evaluate SE-CBIR's retrieval accuracy as well as the impact of the participant's confidence on the diagnosis. SE-CBIR improved the retrieval accuracy by 7% (77% vs 84%) when doing single-lesion retrieval against traditional CBIR. The reader study showed an overall increase in classification accuracy of 22% (62% vs 84%) when the participant is provided with SE-CBIR retrieved images. In addition, the overall confidence in the lesion's diagnosis increased by 24%. Finally, the use of SE-CBIR as a support tool helped the participants reduce the number of nonmelanoma lesions previously diagnosed as melanoma (overdiagnosis) by 53%. SE-CBIR presents better retrieval accuracy compared to traditional CBIR CNN-based approaches. Furthermore, we have shown how these support tools can help dermatologists and residents improve diagnosis accuracy and confidence. Additionally, by introducing interpretable methods, we should expect increased acceptance and use of these tools in routine consultation.

Use of Simulation-Based Mastery Learning Curriculum to Improve Difficult Conversation Skills Among Anesthesiologists: A Pilot Study.

Breaking bad news (BBN) is an important clinical task for physicians. Unfortunately, there is no standard method to teach and assess these skills of anesthesiologists. Although anesthesiology has become a relatively safe medical specialty, complications still occur that require disclosure to patients and their families. Disclosure of bad news can be a significant source of stress for clinicians, especially for those who have low confidence in their BBN skills. Anesthesiologists' skills in BBN can be improved with simulation-based mastery learning (SBML), an intense form of competency-based learning. An SBML curriculum was developed using the SPIKES (Situation, Perception, Invitation, Knowledge, Emotion, Summarize) framework for BBN and the NURSE (Naming, Understanding, Respecting, Supporting, Exploring) statements for expressing empathy. A pretest-posttest study was conducted from March 2020 to June 2022 to evaluate anesthesiologists' performance in BBN. Participants completed a 2-hour curriculum consisting of a pretest, didactic session, deliberate practice with feedback, and a posttest. Anesthesiologists were assessed using a 16-item skills checklist. Six anesthesiology attendings and 14 anesthesiology fellows were enrolled in the study. Three of 20 participants met the minimum passing score (MPS) at the time of their pretest. All study participants met the MPS on their first posttest (P < .001). The median participant confidence in BBN significantly increased (3 to 4, P < .001). Overall course satisfaction in the curriculum was high, with a median score of 5. Our study demonstrates that a BBN SBML curriculum for anesthesiologists significantly improved communication skills and confidence in a simulated environment. Because only 3 participants met the MPS before training, our results suggest that anesthesiologists could benefit from further education to gain effective communication skills and that SBML training may be effective to achieve this result.

516 Ultrasound Cannulation Training: A Hit or a Miss

Abstract As a junior doctor, familiarisation with ultrasound skills can be very useful. This reduces stress for patients from multiple access attempts, as well as preserving venous access. In our District General Hospital (DGH), there was no teaching on ultrasound-guided venous access available. Our aim was to create a formal training programme on ultrasound-guided venous access for junior doctors. Discussions were held with the medical education team at our DGH in order to understand how to organise a formal teaching programme. The interest of junior doctors was gathered through informal discussion. Those interested were then asked to complete pre and post-course evaluation forms. Data was gathered on experience using ultrasound, confidence (out of 5) in performing ultrasound cannulation before and after the session, and usefulness of the session. Of the 16 participants, only 81% (n=13) filled in the pre-session form, therefore data was only analysed from these individuals. 54% of participants (n=7) had previous experience using an ultrasound machine. 100% (n=13) felt more confident performing ultrasound-guided venous access after attending the session. The average confidence score pre versus post-session was 1.69/5 vs 4.08/5. This programme has the potential to improve confidence in procedural skills amongst junior doctors whilst also minimising the stress for patients of multiple access attempts. Though the sample obtained was small, it is clear to see increased confidence in participants, regardless of prior experience. The results from this study will be critical in continuing this training programme in our hospital and hopeful roll out to a wider audience.