Confidence Survey Research Articles

COVID-19 and shortened integrated clinical experiences: impacts on acute care confidence and interpersonal communication

Purpose: Many doctor of physical therapy (DPT) programs limited student clinical experiences, including integrated clinical experiences (ICEs), in 2020 due to the restrictions of coronavirus disease 2019 (COVID-19) pandemic, without knowing how the abbreviated clinical exposure would influence student perceptions of psychomotor and interpersonal communication skill development. The purpose of this study was to determine if fewer ICEs resulted in a difference in acute care confidence or interpersonal communication skills for DPT students. Methods: Two cohorts of DPT students completed surveys aimed to measure acute care confidence (Acute Care Confidence Survey [ACCS]) and interpersonal communication skills (Interpersonal Communication Questionnaire [ICQ]) pre- and post- ICE. Students in one of the cohorts completed half of their second ICE experience because of unexpected curricular changes, effectively decreasing their ICEs by 25%. Data was analyzed using paired t-tests and two-way repeated measures ANOVAs. Results: There was a significant interaction on ACCS and ICQ by time. Students gained an average of approximately 440 points on the ACCS and 4.9 points on the ICQ over the course of both ICEs. However, there was not a statistically significant difference between cohort and either acute care confidence or interpersonal communication. Conclusion: Curricular changes resulting in fewer ICEs did not appear to significantly influence student confidence in the acute care environment or with interpersonal communication skills. Students gained self-confidence in acute care practice and improved communication skills when involved in hands-on ICEs. These improvements were not seen during portions of the curriculum that did not involve inpatient experiences.

Black and Hispanic American Findings from the 2021 Retirement Confidence Survey

The Retirement Confidence Survey (RCS) was conducted for its 31st year in 2021 to measure attitudes of American workers and retirees about issues surrounding retirement. The 2021 RCS included an oversample of Black and Hispanic Americans to allow for a closer analysis of the challenges they face in saving and preparing for retirement. This oversample allowed controlling for the disproportionately lower financial resources of Black and Hispanic Americans when examining their attitudes toward and preparations for retirement. Several important results emerged, including the need for more access to workplace retirement saving plans that provide one-on-one, personalized advice that builds on Black and Hispanic Americans’ comfort with having a connection to those providing them advice. In addition, financial service companies having more people who are similar to Black and Hispanic Americans and treating them fairly could improve their use of the financial system. A greater understanding of the importance of supporting family and friends that in particular Hispanic Americans feel when making financial decisions is needed, so that this obligation can be weighed against their own savings to build wealth that could result in a lesser need for supporting family members in the future. Obviously, higher incomes would help, but these issues arise even for those with higher incomes.

Developing and Implementing Noninvasive Ventilator Training in Haiti during the COVID-19 Pandemic.

BackgroundNoninvasive ventilation (NIV) is an important component of respiratory therapy for a range of cardiopulmonary conditions. The World Health Organization recommends NIV use to decrease the use of intensive care unit resources and improve outcomes among patients with respiratory failure during periods of high patient capacity from coronavirus disease (COVID-19). However, healthcare providers in many low- and middle-income countries, including Haiti, do not have experience with NIV. We conducted NIV training and evaluation in Port-au-Prince, Haiti.ObjectivesTo design and implement a multimodal NIV training program in Haiti that would improve confidence and knowledge of NIV use for respiratory failure.MethodsIn January 2021, we conducted a 3-day multimodal NIV training consisting of didactic sessions, team-based learning, and multistation simulation for 36 Haitian healthcare workers. The course included 5 didactic session and 10 problem-based and simulation sessions. All course material was independently created by the study team on the basis of Accreditation Council for Continuing Medical Education–approved content and review of available evidence. All participants completed pre- and post-training knowledge-based examinations and confidence surveys, which used a 5-point Likert scale.ResultsA total of 36 participants were included in the training and analysis, mean age was 39.94 years (standard deviation [SD] = 9.45), and participants had an average of 14.32 years (SD = 1.21) of clinical experience. Most trainees (75%, n = 27) were physicians. Other specialties included nursing (19%, n = 7), nurse anesthesia (3%, n = 1), and respiratory therapy (3%, n = 1). Fifty percent (n = 18) of participants stated they had previous experience with NIV. The majority of trainees (77%) had an increase in confidence survey score; the mean confidence survey score increased significantly after training from 2.75 (SD = 0.77) to 3.70 (SD = 0.85) (P < 0.05). The mean knowledge examination score increased by 39.63% (SD = 15.99%) after training, which was also significant (P < 0.001).ConclusionThis multimodal NIV training, which included didactic, simulation, and team-based learning, was feasible and resulted in significant increases in trainee confidence and knowledge with NIV. This curriculum has the potential to provide NIV training to numerous low- and middle-income countries as they manage the ongoing COVID-19 pandemic and rising burden of noncommunicable disease. Further research is necessary to ensure the sustainability of these improvements and adaptability to other low- and middle-income settings.

Learning from errors: Implementation of a resident-oriented radiology morbidity and mortality conference as an educational tool

PurposeOur diagnostic radiology (DR) program lacked a formalized, structured process for residents to learn from errors. Prior DR residency Accreditation Council for Graduate Medical Education (ACGME) survey results additionally demonstrated opportunity for improvement in resident evaluation, resources, and patient safety/teamwork. Our project's purpose was to implement and evaluate a new resident-oriented radiology morbidity and mortality (M&M) conference to enhance resident education. MethodsAll DR residents (n = 48) were surveyed regarding a new didactic M&M consisting of quarterly resident-led and faculty-moderated M&Ms. Cases for potential review were collected and stored in a REDCap database via an anonymous survey, from which resident-selected faculty curators would select 4–6 for presentation. Residents presented these cases and the group discussed applicable improvements. An anonymous survey of residents followed each conference. Relevant questions from ACGME survey data were extracted from the two years preceding the didactic M&M and the pilot year. ResultsBefore implementation, 86% of responding residents (n = 29; 60% of resident complement) supported the program, 90% expressed willingness to share their own mistakes, and 79% preferred faculty involvement. Respondents favored careful selection of faculty to promote education. At one year, 100% of respondents (n = 17; 35% of resident complement) approved of adding the didactic M&M and endorsed program continuance. All respondents expressed a willingness to share their own mistakes. There was also coincident improvement in ACGME survey data in the domains of evaluation, resources, and patient safety/teamwork. ConclusionWe designed and implemented a resident-oriented M&M conference that resulted in increased resident confidence and impacted ACGME survey results in evaluation, resources, and patient safety/teamwork. PrecisImplementation of a structured, resident-oriented radiology M&M conference can increase resident confidence and impact ACGME survey results in the domains of evaluation, resources, and patient safety/teamwork.

A modular simulation curriculum to teach endoscopic stenting to practicing surgeons: an "Into the fire" approach.

Flexible endoscopy is a valuable tool for the gastrointestinal (GI) surgeon, creating a need for effective and efficient training curricula in therapeutic endoscopic techniques for trainees and practicing providers. Here, we present a simulation-based modular curriculum using an "into the fire" approach with hands-on pre- and post-testing to teach endoscopic stenting to practicing surgeons. Three advanced flexible endoscopy courses were taught by expert surgical endoscopists from 2018 to 2019. The stenting module involved using self-expandable metal stents to manage simulated esophageal and gastroduodenal strictures on a non-tissue GI model. Based on the educational theories of inquiry-based learning, the simulation curriculum was designed with a series of pre-tests, didactics, mentored hands-on instructions, and post-tests. Assessments included a confidence survey, knowledge-based written test, and evaluation form specific to the hands-on performance of endoscopic stenting. Twenty-eight practicing surgeons with varying endoscopic experiences participated in the course. Most of the participants (67.9%) had completed over 100 upper endoscopic procedures and 57.1% were certified in Fundamentals of Endoscopic Surgery. After completing the modular curriculum, participant confidence survey scores improved from 11.4 ± 4.2 to 20.7 ± 4.0 (p < 0.001). Knowledge-based written test scores also improved from 7.1 ± 1.2 to 8.4 ± 0.9 (p < 0.001). In terms of technical performance, overall hands-on performance scores improved from 21.3 ± 2.7 to 28.9 ± 1.2 (p < 0.001) with significant improvement in each individual component of the assessment (all p values < 0.01) and the greatest improvement seen in equipment handling (88%) and flow of procedure (54%). Our modular simulation curriculum using an "into the fire" approach to teach endoscopic stenting is effective in improving learner knowledge, confidence, and hands-on performance of endoscopic stenting. This approach to simulation is effective, efficient, and adaptable to teaching practicing surgeons with varying levels of experience.

Productivity and Efficiency of a Department Resident Aesthetic Plastic Surgery Clinic.

There has been increasing demand for aesthetic surgery procedures in the United States, highlighting the critical importance of the competence of plastic surgery residents and rigorous methods of aesthetic surgery training. The objective of this study was to review procedures and outcomes from our plastic surgery resident aesthetic clinic. Outcomes and costs were compared to national averages and reports from the literature. A retrospective chart review identified all adult patients who presented to the Resident Aesthetic Surgery Clinic at NYU Langone Health in 2021. Patient demographics, comorbidities, procedural data, postoperative complications, revisions, and surgeon fees were compiled. A brief confidence survey was distributed to participating residents before and after their clinic rotation. Data were analyzed using IBM SPSS software (Armonk, NY). In 2021, 144/379 consultations led to an operation (38.0% conversion rate), resulting in 420 distinct surgical procedures. The majority (53.3%) of procedures involved the head and neck. Complication and revision rates were 5.5% and 1.0%, respectively, with surgeon fees consistently below the national average. Residents reported being significantly more confident performing face lifts, rhinoplasties, and aesthetic surgery in general following their clinic rotation. These data represent the largest annual reported study of plastic surgery resident aesthetic procedures and outcomes, demonstrating the high volume and productivity of the NYU Resident Aesthetic Surgery Clinic. These results further support resident aesthetic clinics as a robust training modality.

I'm not throwing away my shot: increasing covid-19 vaccine confidence and decreasing disinformation within campus communities through student advocacy

For the past two years, COVID-19 has held the world's attention. It's been challenging to get the world's citizens to reach herd immunity due to a lack of vaccine confidence. Although vaccines have been a very successful part of public health in recent and past decades, there has been much debate about the COVID-19 vaccine. Strategies must be implemented to address vaccine confidence and decrease disinformation as this can be extremely helpful in preventing infections and reducing the likelihood of transmission. Student advocacy may be helpful in restoring trust within the campus community. The study used a cross-sectional, descriptive design. The non-random sample included 85 students, faculty, and staff on the campus of a university in a southeastern state. Participants were recruited via flyers, at COVID-19 campus events, and by word of mouth. The Center for Control and Disease Prevention (CDC) Vaccine Confidence Survey Question Bank was used to measure vaccine confidence at baseline. The intervention consisted of exposing the campus community to factual COVID-19 through educational flyers, town hall meetings, TikTok® and other social media platforms. Upon completion of the study, the grant team created a video of their experiences with the vaccine, which was streamed to the campus community. Data were analyzed using descriptive statistics, frequencies and independent t-tests. Participants' ages ranged from 20-55 (M = 30; SD = 12.1), were mostly female (64.7%), and white (52.9%). More than three-fourths of the samples (76.4%) were students. Only 17.4% of the sample had a previous diagnosis of COVID-19. Nurses and local health officials were the most trusted sources of vaccine information. Due to being a state institution, we were not at liberty to discuss the vaccination status of the participants. However, many felt that people at their work or school (58.9%) or family or friends (64.7%) would not get the vaccine. The findings of this study support the need for innovative strategies to deliver factual COVID-19 vaccine information to the campus community. Most of the participants did practice social distancing and other preventative behaviors, but more than half felt that they had received inaccurate information about the vaccine or were not sure where to receive accurate information from. There is no single intervention to restore campus community confidence, but student advocacy was helpful in starting a discussion about COVID-19 vaccines and collecting necessary data to determine support for effective strategies.

A multi-centre early evaluation of the effectiveness of workshop teaching to improve the confidence of UK and Irish dental students when addressing patient mental health.

Background Dental practitioners can have low confidence when addressing patient mental health as part of wider patient management. This is increasingly relevant due to the rising prevalence of mental health conditions and the relationship that can exist between mental and oral health. Interactive workshop teaching on patient mental health may enhance the confidence of dental students when addressing mental health conditions in patients. This study trialled workshop teaching as an educational intervention in five UK and Irish dental schools.Methods A quantitative, scenario-based confidence survey to further establish the need for intervention, followed by delivery of a workshop intervention to volunteer participants. Pre- and post-workshop surveys were used to assess the effectiveness of the workshop.Results Survey data showed low confidence among dental students when addressing patient mental health. Workshop intervention improved dental student confidence on average from 2.3-3.7 on a five-point scale, with less than 0.5% likelihood that reported changes in confidence were due to chance.Discussion Low confidence of dental students addressing patient mental health scenarios echoed wider literature findings surrounding dental clinicians' ability to address patient mental health. This further demonstrated the need for educational intervention, with workshop effectiveness demonstrated within this paper.Conclusion Workshop teaching is an effective way to enhance dental student confidence when addressing patient mental health and should be considered for implementation in the Bachelor of Dental Surgery curriculum.

Implementation of clinical practice guidelines for low back pain: A case control cohort study of knowledge translation in a multi-site healthcare organization.

The benefits of clinical practice guideline (CPG) adoption for the management of patients with back pain are well documented. However, the gap between knowledge creation and implementation remains wide with few studies documenting the iterative process of comprehensive implementation in clinical settings. The objective of this study was to improve adherent physical therapy care according to CPG's for low back pain and describe the knowledge to action (K2A) process used in a rural healthcare organization. A prospective case control cohort design was used to evaluate physical therapy provider practice changes during an 18 month intervention. Four clinical sites were selected, two of which received multifaceted educational and process interventions tailored to feedback from ongoing K2A cycle outcomes. Overall program assessment included monthly charge code reports for adherence and a pre-post survey of confidence for guideline use. Pragmatic Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) criteria were used to complete the process evaluation. A significant difference (p< 0.001, mean difference 13.5, CI [8.5,18.5]) for charge code adherence favoured education site-1 over control site-2 after implementation. Adherence scores remained above target at both education sites 18 months after implementation. Survey differences were significant for confidence scores at education sites in use of the cognitive behavioural category, overall treatment category use and guideline communication. Process evaluation supported multifaceted interventions tailored to education sites with average cost measured by staff education time of 15.5h per therapist trained. This study extends the literature of guideline implementation by describing the unique cycles required for promoting provider behaviour change within a rural healthcare system. Adherence and confidence results suggest increased provider CPG use which was supported by the process evaluation. This study demonstrates the importance of multiple site comparisons, long-term reporting and standardized frameworks for assessment of real-world CPG implementation.

Utilizing High-fidelity Simulators in Improving Trainee Confidence and Competency in Code Management.

Introduction:Simulation training is central in preparing practitioners for code management that is free from patient harm.1 The purpose of this study was to determine if using a high-fidelity simulator in pediatric code education would improve trainee confidence and competency compared with the use of a traditional mannequin in the same setting.Methods:Fifty-third-year medical students participated in Pediatric Advanced Life Support code training, including a mock code scenario. Students were randomized into two groups and assigned to a simulator group: high-fidelity simulator (Group 1) or traditional mannequin (Group 2). To assess competency, trainees were evaluated using a checklist of required verbalized items or performed during the mock code scenario. To assess confidence, trainees completed pre- and postintervention confidence surveys, which were collected and compared.Results:Both Group 1 and Group 2 reported increased overall confidence in code management upon completion of their training. Although confidence increased universally, Group 1 reported increased confidence over that of Group 2 in three specific areas: ability to treat respiratory arrest, ability to run a code, and knowledge of the Pediatric Advanced Life Support algorithm. Group 1 also demonstrated increased competency in code management compared with Group 2 in four key code components: checking airway, checking breathing, checking pulses, and checking capillary refill.Conclusions:Trainee confidence increases after completion of Pediatric Advanced Life Support code training, regardless of simulator type utilized. However, trainees were more competent in code management when trained using a high-fidelity simulator compared with a traditional mannequin.

Examination of Turkish Mathematics Teachers Technology Integration Levels and Their Self-Confidence in TPACK

This study aims to investigate the technology integration levels of secondary education mathematics teachers and their self-confidence in TPACK in terms of technology components. The present study, which employed the convergent parallel design of a mixed method, enrolled 57 mathematics teachers. A questionnaire to obtain teachers' views and the TPACK confidence survey were used as data collection tools in the research. It was found that teachers have a moderate level of self-confidence and the majority of them integrated technology into their classes at the replacement level. It was also seen that TPACK self-confidence levels of the teachers did not differ according to their technology integration levels. However, in the TPACK component of the TPACK self-confidence of the participants, there was a significant difference in favor of those who agreed with the idea that students should use technological tools in classes. Similarly, it was found that mathematics teachers using more than one software in their classes had significantly higher TPACK self-confidence in all components. Consequently it can be said that technology integration levels of mathematics teachers reflected by their TPACK self-confident levels.

Novel Internal Medicine Residency Ultrasound Curriculum Led by Critical Care and Emergency Medicine Staff.

Point-of-care ultrasound (POCUS) is an integral aspect of critical care and emergency medicine curriculums throughout the country, but it has been slow to integrate into internal medicine residency programs. POCUS has many benefits for internal medicine providers, guiding diagnostic decisions and aiding in procedures. Additionally, POCUS is a convenient and portable resource specifically for internal medicine providers in the military when practicing in deployed or critical care settings. Critical care and emergency medicine clinicians are excellent resources to lead these courses. We sought to develop a new POCUS curriculum for internal medicine residents within the Naval Medical Center Portsmouth Internal Medicine Residency program with the support of emergency medicine and critical care medicine staff to lead and oversee the training. The project's aim was to increase internal medicine resident confidence with POCUS by 20% and proficiency with POCUS as evidenced by pretest and posttest analysis by 10%. The program consisted of a 2-day, 9-hour, introductory course, combining lecture with hands-on scanning taught by emergency medicine physicians who had completed emergency ultrasound fellowship-level training. This was followed by a longitudinal component of hands-on scanning throughout the academic year built into the residents' schedules. Emergency and critical care medicine ultrasound staff reviewed all studies for quality assurance (QA). The residents were given both precourse and post-course knowledge tests and confidence surveys, which utilized a 5-point Likert scale. The knowledge assessments were analyzed with a paired t-test, and the Likert scale data were analyzed using the Wilcoxon signed-rank test. The Naval Medical Center Portsmouth Institutional Review Board deemed this project nonhuman subjects' research. Twenty participants were enrolled, with 10 (50%) of those enrolled completing all course requirements. The average precourse knowledge assessment score was 76.60%, and postcourse assessment score was 80.95% (+4.35%, P = .33). The confidence survey scores were initially 73.33% and improved to 77.67% (+4.34%, P = .74). A curriculum comprised of a 9-hour workshop followed by a longitudinal hands-on experience can provide improvement in internal medicine resident POCUS knowledge and confidence. This model emphasizes the benefit of emergency and critical care cooperation for ultrasound training and provides an emphasis on medicine-relevant scans and longitudinal training.

Timing market confidence in the Chinese domestic security market

This paper analyzes Chinese mutual fund managers’ ability to time aggregate market confidence in China’s securities market. To measure aggregate market confidence in the Chinese market, we construct a Composite Investor Confidence Index (CICI) based on investor confidence surveys from institutional and individual investors. The study finds that managers successfully shift their fund exposure relative to shifts in the aggregate confidence level in the market. Additional analysis shows that top confidence timers outperform bottom confidence timers by more than 4% per year. The study also finds that mutual funds possessing confidence timing ability tend to be younger funds that are larger in size and have higher expense ratios. Our findings remain robust after controlling for market, liquidity and volatility timing, as well as confidence reaction.

Management of Common Infections in German Primary Care: A Cross-Sectional Survey of Knowledge and Confidence among General Practitioners and Outpatient Pediatricians.

Outpatient antibiotic use is closely related to antimicrobial resistance and in Germany, almost 70% of antibiotic prescriptions in human health are issued by primary care physicians (PCPs). The aim of this study was to explore PCPs, namely General Practitioners’ (GPs) and outpatient pediatricians’ (PDs) knowledge of guideline recommendations on rational antimicrobial treatment, the determinants of confidence in treatment decisions and the perceived need for training in this topic in a large sample of PCPs from southern Germany. Out of 3753 reachable PCPs, 1311 completed the survey (overall response rate = 34.9%). Knowledge of guideline recommendations and perceived confidence in making treatment decisions were high in both GPs and PDs. The two highest rated influencing factors on prescribing decisions were reported to be guideline recommendations and own clinical experiences, hence patients’ demands and expectations were judged as not influencing treatment decisions. The majority of physicians declared to have attended at least one specific training course on antibiotic use, yet almost all the participating PCPs declared to need more training on this topic. More studies are needed to explore how consultation-related and context-specific factors could influence antibiotic prescriptions in general and pediatric primary care in Germany beyond knowledge. Moreover, efforts should be undertaken to explore the training needs of PCPs in Germany, as this would serve the development of evidence-based educational interventions targeted to the improvement of antibiotic prescribing decisions rather than being focused solely on knowledge of guidelines.

Evaluating the Effectiveness of the Chemical-Mass Casualty Incident Response Education Module (C-MCIREM): A Pilot Simulation Study With a Before and After Design.

BackgroundWith the occurrence of a number of major disasters around the world, there is growing interest in chemical disaster medicine. In South Korea, there is a training program for mass casualty incidents (MCI) and backup by legal regulations by the Framework Act on the Management of Disasters and Safety. However, there is no program focusing on chemical disasters. Thus, the authors newly created a program, the Chemical-Mass Casualty Incident Response Education Module (C-MCIREM) in September 2019. This was a pilot study to verify the educational effect of the program.MethodA pre/post study was conducted of a chemical MCI training program based on simulation. A total of 25 representative and qualified participants were recruited from fire departments, administrative staff of public health centers, and healthcare workers of hospitals in the Gyeonggi-do province of South Korea. They participated in a one-day training program. A knowledge test and confidence survey were provided to participants just before training, and again immediately following the training online. The authors compared improvements of pre/post-test results. In the tabletop drill exercise, quantified qualitative analyses were used to measure the educational effect on the participants.ResultsIn the knowledge test, the mean (standard deviation) scores for all 25 participants at baseline and after training were 41.72 (15.186) and 77.96 (11.227), respectively (p < 0.001). In the confidence survey for chemical MCI response for all 25 participants, all the sub-items concerning personal protective equipment selection, antidote selection, antidote stockpiling and passing on knowledge to colleagues, zone setup and decontamination, and chemical triage were improved compared to the baseline score (p < 0.001). The tabletop exercise represented a prehospital setting and had 11 participants. The self-efficacy qualitative survey showed pre- and post-exercise scores of 64/100 and 84/100 respectively. For a hospital setting exercise, it had 14 participants. The survey showed pre/post-exercise scores of 26/100 and 73/100 respectively. Twenty-two (88%) participants responded to the final satisfaction survey, and their overall mean scores regarding willingness to recommend this training program to others, overall satisfaction with theoretical education, overall satisfaction with tabletop drill simulation, and opinion about whether policymakers need this training were all over 8 out of 10 respectively.ConclusionC-MCIREM, the newly created chemical MCI program, provided effective education to the selected 25 participants among Korean chemical MCI responders in terms of both knowledge and practice at a single pilot trial. Participants were highly satisfied with the educational material and their confidence in disaster preparedness was clearly improved. In order to prove the universal educational effect of this C-MCIREM in the future, more education is needed.

Dissemination of a Behavioral Health Home Model with Improved Physical Health and Wellness across Behavioral Health Settings

Research ObjectiveBehavioral Health Home Plus (BHHP) is an evidence‐based model to enhance physical health and wellness for individuals with serious mental illness (SMI) and chronic medical conditions. To better understand model effectiveness and best practices for dissemination, we implemented BHHP in 7 adult Opioid Treatment Programs (OTP) and 5 youth Residential Treatment Facilities (RTF).Study DesignWe utilized a hybrid study design to examine dissemination and support of BHHP through a 12‐month Learning Collaborative (LC) and outcomes via propensity‐score matched analyses. Mixed methods included semi‐structured staff interviews and confidence surveys to assess feasibility. Data were collected on involvement/confidence in managing physical health (survey) and utilization of primary/specialty care and unplanned healthcare (claims) over 18‐months.Population StudiedIn Pennsylvania's Medicaid HealthChoices program, behavioral health agencies serve as health homes with support and training in wellness by a behavioral health managed care organization, Community Care Behavioral Health of the UPMC Insurance Services Division. Enrollment into BHHP for OTP included adults (n = 689), average age 39.19 ± 9.99 years, 60% female and youth (n = 354) for RTF, average age 14.04 ± 2.52 years, 31% female. Propensity score matching was successful for OTP (n = 688) and RTF (n = 312) members.Principal FindingsProviders reported barriers (training time, staff turnover, workflow integration, family engagement) and facilitators (model resources, education on population‐specific health topics, learning from other sites implementation experiences) to implementation. At 18‐month follow up, over 70% of staff reported being highly confident in working with individuals on physical health and wellness; over 60% of service‐users reported being highly involved in working with their behavioral health provider on physical health and wellness, and 67% of OTP and 43% of RTF service‐users reported being highly confident in their ability to manage their physical health and wellness.Service utilization outcomes showed large decreases over 18 months in medically emergent care for OTP members while rates remained steady for the matched comparison group (p = 0.0055); a similar pattern was found for medications for physical health chronic conditions (p &lt; 0.0001). For OTP, more individuals remained connected to ambulatory substance use disorder services in the comparison group at 18 months. For RTF both intervention and comparison groups showed decreased behavioral health hospitalizations; however, a greater proportion of the intervention group remained connected to ambulatory psychiatric service at 18 months (62% v. 48%). The comparison group showed larger decreases in medically emergent care over time (p = 0.0186).ConclusionsSites have fully integrated the BHHP model into workflows and promote physical health and wellness amongst their complex and medically vulnerable populations. BHHP is associated with positive changes in service utilization outcomes but was comparable to matched comparison groups.Implications for Policy or PracticeHealth homes offer an opportunity for improved health outcomes for vulnerable populations with chronic conditions. The LC approach, which allows for full virtual implementation, is an effective and scalable approach to wide‐spread implementation and successful uptake of care models.Primary Funding SourcePatient‐Centered Outcomes Research Institute.

Child Sexual Exploitation: A Survey of Knowledge and Confidence of Healthcare Providers in Saskatchewan, Canada

Key Practitioner Messages Many human trafficking victims access healthcare, but most are not identified. Healthcare providers' overall knowledge in identifying commercially sexually exploited children was strong. Healthcare providers lack confidence in identifying and managing sexually exploited children.

Teaching EndoFLIP Impedance Planimetry to Practicing Endoscopists: An "Into the Fire" Approach to Simulation.

Background. There are growing interests from practicing endoscopists to implement the functional lumen imaging probe (FLIP) impedance planimetry system. We present a simulation-based curriculum using an "into the fire" approach with hands-on pre- and post-tests to teach the use of this technology. Methods. The curriculum consists of a series of pre-tests, didactic content, mentored hands-on instructions, and post-tests. Pre- and post-testing included a knowledge-based written test, a confidence survey, and an assessment form specific to the hands-on performance of FLIP. Result. Twenty-two practicing physicians completed the curriculum. After course completion, participants had improved knowledge-based written test scores from 6.8±1.7 to 8.9±0.9 (P<0.001), confidence scores from 10.0±5.9 to 22.1±2.6 (P<0.001), and hands-on performance score from 11.4±3.4 to 23.1±2.0 (P<0.001) with significant improvement in all components of the hands-on skills. Conclusion. Our simulation curriculum is effective in improving confidence, knowledge, and technical proficiency when teaching the use of FLIP to practicing physicians.

Utilising virtual environments for radiation therapy teaching and learning

IntroductionModern radiation therapy undergraduate education comprises the illustration of theoretical, technical concepts in a classroom setting, coupled with the acquisition of practical handling and patient communication skills within the clinical environment. In recent years, there has been renewed interest in the application of virtual environments to education, despite ongoing inconclusive evidence on the use of virtual environments for enhancing student educational achievement. Aim and objectivesThe aim of our research is to evaluate a custom-built 3D virtual radiation oncology department created within Second Life®, an online virtual world, as an alternative to traditional physical classroom-based didactic instruction, in tandem with a Virtual Environment for Radiotherapy Training (VERT) system, for the peer support and training of junior radiation therapy students in their first and second year of undergraduate studies. To achieve this aim, we investigated learning achievement outcomes, knowledge retention over a 2-week time interval and learner self-perceived confidence post-instruction, using both quantitative and qualitative analysis. MethodsInstitutional ethics approval was granted for an exempted review. Participants were currently enrolled undergraduate Year 1 and Year 2 students at our institution. Student participants were randomised into two groups; the control group attended a face-to-face classroom session centred on the illustration of theoretical, technical concepts, while the intervention group attended a virtual classroom session online on Second Life®, where similar content was delivered. Both groups then attended a VERT practical session to acquire practical handling and communication skills in radiation therapy. Upon completion of the sessions, confidence surveys, knowledge-based written and practical assessments were administered to the student participants. ResultsWe found that the instructional session conducted within the custom-built 3D virtual radiation oncology department in Second Life® compared to the traditional didactic classroom setting increased undergraduate Year 1 radiation therapy students’ perceived confidence to a greater extent compared to Year 2 students, in performing radiation therapy treatment procedures. In addition, our findings revealed that overall learning achievement outcomes and knowledge retention scores between Second Life® and non- Second Life® student participants were closely similar and statistically insignificant. Thematic analysis of the confidence survey questionnaires revealed that the students in general desired more clinical hands-on practice. DiscussionSecond Life® is equally effective in disseminating theoretical, technical course content delivery to undergraduate radiation therapy students. The use of virtual environments appears to have increased the perceived confidence of the Year 1 undergraduate students to a greater extent compared to the Year 2 undergraduates, suggesting that the adoption of virtual environments early in the students’ educational journey can have a positive effect on students’ learning experience. Conclusions and RecommendationsThe development and use of our custom-built Second Life® radiation oncology department provides a novel way of delivering remote, virtual training instruction to undergraduate radiation therapy students over traditional, didactic classroom instructional delivery. We recommend, based on the results of this pilot study, that future research can involve a larger study sample of undergraduate RT students, to explore both the short-term and long-term impact of virtual environments on student learning outcomes across their enrolled years of study. This would in turn mean progressive attempts to revamp our existing curricula structure, to deliberately incorporate the use of virtual environments, especially during early undergraduate years, towards enhanced modern RT education.

Classroom-Based Simulation: Participants and Observers Perceive High Psychological Fidelity and Improved Clinical Preparedness

Introduction. High-fidelity simulation-based learning experiences (SBLEs) can improve student confidence for clinical practice, but there are several barriers to incorporating these activities into physical therapy program curricula. Review of Literature. Studies have explored high-fidelity acute care SBLEs in simulation laboratories, but little is known about the effectiveness of low-cost classroom-based SBLES in physical therapy education. Additionally, there is a gap in the literature related to the role of the active observer during SBLEs in physical therapy education. The purpose of this study was to uncover student perspectives about participating as both participant and observer in classroom-based SBLEs and the impact of this experience on preparedness for acute care clinical practice. Subjects. Subjects included a convenience sample of first-year doctor of physical therapy (DPT) students. Methods. Students participated in a series of classroom-based SBLEs as part of a first-year DPT course. This mixed methods study included focus groups to qualitatively analyze student perspectives of classroom-based SBLEs and a pre–post quasi-experimental design to evaluate changes in perceived self-efficacy for acute care clinical practice before and after a series of classroom-based SBLEs using the Acute Care Confidence Survey (ACCS). Results. Quantitative data analysis (n = 60) revealed a statistically significant increase in perceived self-efficacy for the total ACCS (Z = −6.250, P &lt; .000) and all 4 subscales from presimulation to postsimulation. Qualitative data analysis (n = 22) revealed 4 primary themes related to participating in classroom-based SBLEs: (1) psychological fidelity—it felt real; (2) promotes clinical reasoning for participants and observers; (3) stimulates self-reflection and observational learning; and (4) fosters self-efficacy for future clinical practice. Conclusion. Classroom-based SBLEs can provide a high-fidelity and cost-effective means of exposing students to a range of clinical situations that engage all participants in experiential learning through both direct participation and active observation.