Differences In Performance Scores Research Articles

Mastery Learning in Preclinical Endodontics Using Customized 3D-Printed Tooth Models for Deliberate Practice: An Application of Educational Design Research

IntroductionThis study, conducted within an educational design research (EDR) framework, assessed the use of customized 3D-printed tooth models at various difficulty levels to enhance mastery learning and deliberate practice in preclinical endodontic training. MethodsThe EDR was conducted in a preclinical endodontic training involving 42 third-year students. The study focused on developing and evaluating 3D-printed tooth models customized into 3 difficulty levels to facilitate mastery learning for the access opening procedure on upper anterior teeth. To promote deliberate practice, we ensured ample availability of these models. The evaluation combined quantitative analysis, using Friedman and Wilcoxon Signed-Rank tests to assess practice volume and performance, with qualitative feedback from interviews and focus groups, analyzed via content analysis. ResultsThere was a significant reduction in practice time across the different model levels, with students using an average of 1.5–1.8 models per level. No significant differences in performance scores were observed across levels and natural tooth (P = .333). Feedback highlighted the models' educational value in enhancing dental training, indicating their effectiveness in improving learning experiences and skill development in endodontic education. ConclusionsThe innovative design of a 3D-printed tooth model system, which features 3 levels of difficulty and was developed within an EDR framework, allowed for tailored learning progressions and ample practice opportunities. This significantly enhanced the endodontic training experience and skill development by providing varied and realistic challenges.

A Pilot Randomized Controlled Trial of Augmented Reality Just-in-Time Guidance for the Performance of Rugged Field Procedures.

Medical resuscitations in rugged prehospital settings require emergency personnel to perform high-risk procedures in low-resource conditions. Just-in-Time Guidance (JITG) utilizing augmented reality (AR) guidance may be a solution. There is little literature on the utility of AR-mediated JITG tools for facilitating the performance of emergent field care. The objective of this study was to investigate the feasibility and efficacy of a novel AR-mediated JITG tool for emergency field procedures. Emergency medical technician-basic (EMT-B) and paramedic cohorts were randomized to either video training (control) or JITG-AR guidance (intervention) groups for performing bag-valve-mask (BVM) ventilation, intraosseous (IO) line placement, and needle-decompression (Needle-d) in a medium-fidelity simulation environment. For the interventional condition, subjects used an AR technology platform to perform the tasks. The primary outcome was participant task performance; the secondary outcomes were participant-reported acceptability. Participant task score, task time, and acceptability ratings were reported descriptively and compared between the control and intervention groups using chi-square analysis for binary variables and unpaired t-testing for continuous variables. Sixty participants were enrolled (mean age 34.8 years; 72% male). In the EMT-B cohort, there was no difference in average task performance score between the control and JITG groups for the BVM and IO tasks; however, the control group had higher performance scores for the Needle-d task (mean score difference 22%; P = .01). In the paramedic cohort, there was no difference in performance scores between the control and JITG group for the BVM and Needle-d tasks, but the control group had higher task scores for the IO task (mean score difference 23%; P = .01). For all task and participant types, the control group performed tasks more quickly than in the JITG group. There was no difference in participant usability or usefulness ratings between the JITG or control conditions for any of the tasks, although paramedics reported they were less likely to use the JITG equipment again (mean difference 1.96 rating points; P = .02). This study demonstrated preliminary evidence that AR-mediated guidance for emergency medical procedures is feasible and acceptable. These observations, coupled with AR's promise for real-time interaction and on-going technological advancements, suggest the potential for this modality in training and practice that justifies future investigation.

From tradition to innovation: a comparison of the traditional 4-step approach versus a blended learning modification for technical skills teaching

BackgroundThis experimental study was performed to evaluate the role of blended learning for technical skill teaching on the European Trauma Course (ETC). While online modules are extensively used for theoretical teaching, their role in skills training remains less well explored. The ETC currently relies on the established 4-step technique for teaching technical skills. However, the required large cohort of skilled instructors and the time intensity prove increasingly challenging in a current climate of staff shortages and funding constraints. This study assesses if blended learning, combining pre-course online elements with face-to-face training matches the effectiveness of the traditional 4-step approach whilst being more time-efficient.MethodsIn a randomised, multi-centre trial, the conventional face-to-face 4-step technique for teaching a skill of medium complexity, the application of a pelvic binder, was compared with an innovative blended approach. It was hypothesised that the blended approach was non-inferior for skill performance measured after the teaching session and after two days (skill retention) with the time needed for teaching and student/teacher satisfaction as secondary outcomes.ResultsNinety participants, divided into 44 traditional and 46 blended method students, were analysed. Independent-samples t-test showed no significant difference in performance scores and non-inferiority of the blended approach with a half of one standard deviation margin. A statistically significant difference in mean retention scores favored the blended approach. A Mann–Whitney U Test revealed no significant difference in candidate satisfaction levels but a statistically significant difference in instructors' satisfaction levels in favour of the blended approach. Analysis with Welch' t-test demonstrated that the face-to-face teaching time needed for the blended approach was significantly shorter (by 6 min).ConclusionsThe integration of a blended approach with the 4-step technique for teaching pelvic binder application in the ETC streamlined teaching without compromising skill acquisition quality. This innovative approach addresses traditional limitations and shows promise in adapting medical education to modern learning and teaching demands. We suggest that blended learning could also be applied for other skills taught on life support courses.Trial registration: University of Dundee (Schools of Medicine and Life sciences Research Ethics Committee, REC number 22/59, 28th June 2022).

Comparison of Academic, Administrative and Community Rater Scores at a Multiple Mini Interview Using Generalisability Theory

Multiple Mini Interviews (MMIs) are sampling approaches that use multiple short stations to select prospective students for professional programmes. Each station uses different interview scenarios and raters to effectively assess candidates’ noncognitive skills. This study compared the performances of three sets of raters; academic, administrative staff, and community members, in an MMI for student selection using performance comparisons and Generalisability Theory to estimate the different sources of variance and generalisability (reliability) coefficients. The study aims to analyse the differences in performance scores from these raters and their psychometric projections on reliability with different samples of raters and stations. Eleven candidates participated in the 10-station MMI, each with an eight-minute duration, two minutes of preparation, and an academic assessment using a marking rubric. The entire interview was video recorded. The administrative staff and community members watched the videos independently and graded all candidates’ performances using the same marking rubric. Generalisability and Decision studies were used to analyse the collected data. Community members were the strictest, while academics were the most lenient. There were statistically significant differences between rater categories in six stations. The generalisability coefficient of 0.85 of onerater results from the Decision study suggested good reliability of the 10-station MMI. The Decision study found that generalisability coefficients improved more with an increasing number of raters rather than number of stations. Four stations contributed to unreliability in each rater category and a combination of the rater categories. Information on number of stations, number of raters, and type of rater combination required to achieve good reliability enabled informed decisions on the process and implementation of the MMI. The station simulation that influenced unreliability helped us improve station writing and identify focus areas for training and development.

Evaluating Educational Performance of Postgraduate Students Based on the Tennessee Academic Audit Model

Background: The importance of improving quality and performance in higher education has led various universities to turn to effective methods of educational evaluation, such as auditing. Objectives: The present study evaluated the academic performance of the Tabriz Faculty of Management and Medical Informatics postgraduate students, an Iranian Center of Excellence in Health Management based on the Tennessee Academic Audit Model. Methods: This descriptive-cross sectional study was conducted in 2019 with the participation of educational managers and faculty members of the same faculties in two phases consisting of self-assessment and external evaluation. After contextualization, the Tennessee comprehensive higher education audit checklist was used. Data were studied descriptively, and the results were reported as frequency (percentage) and mean ± standard deviation. Analysis of variance (ANOVA) and Tukey’s post hoc tests were used to evaluate the significance of the difference in academic performance between the educational groups. t-test was also used to evaluate the difference in performance scores in self-assessment and external evaluation phases. A P-value < 0.05 was considered significant. Results: The participants’ performance in the self-assessment phase was moderate (total score: 5.32), and their performance in the external evaluation phase was weak (total score: 2.75). The best and the worst self-assessment scores were in the dimensions of “overall assessment” and “follow-up of previous academic audits,” respectively. In the external evaluation, the dimensions of “contributions to the program and university goals” and “follow-up of previous academic audits” had the best and worst performance scores, respectively. Conclusions: The results demonstrated that the Tabriz Faculty of Management and Medical Informatics of the Medical School needs to improve in terms of international standards. Therefore, managers and policymakers are required to implement interventions to address this gap.

Background music of varying tempi produces differing facial emotional expressions and performance in music-majors and non-majors as they complete a reading comprehension test

This study examined how music major and non-music major participants’ performances and emotional expressions differed when exposed to background music of varying tempi while completing a reading comprehension task. Two questions were addressed: (1) What effect does background music of varying tempi have on the performance of music and non-music majors while completing a reading comprehension task? and (2) What real-time expressed emotions and self-report measures may predict the reading comprehension scores between music and non-music majors? A total of 34 participants completed a reading comprehension task under each of three musical test conditions while facial-muscular emotion software analyzed their facial expressions, to understand the effect on performance. Results indicated that music majors displayed significantly different ( p < .05) emotional expressions of joy and contempt, which corresponded to no significant differences in performance scores, in comparison to non-majors, whose performance varied greatly across the background music test conditions that were given. These findings support the growing literature surrounding the possible effects of music training and how differences between trained and non-musicians may be understood through emotion detection software.

Surgically Treated Pectoralis Major Tears Impact the Play and Performance of National Football League Athletes

Purpose: To evaluate the return-to-play rate and performance level changes in National Football League (NFL) athletes after a surgically treated pectoralis major muscle (PMM) tear.Methods: A descriptive epidemiologic study was conducted. All NFL players from 1933 to 2013 were reviewed for surgically treated PMM tears. Age at injury, height, weight, body mass index, date of injury, position played, draft selection, and total seasons played were recorded. Return to play was assessed for the entire cohort, as well as by position. Performance analysis before and after injury was also conducted for the entire cohort, as well as by position and draft selection. Data analysis was performed with the paired-samples t test, with P < .05 considered statistically significant.Results: Our review of 80 NFL seasons from 1933 to 2013 provided a total of 55 instances of PMM tears. All instances occurred between the time frame of 2004 and 2012. After exclusions, 24 instances unique to 24 NFL athletes were confirmed by 2 separate investigators and these athletes were included as our final study cohort. Of the 24 players identified to have a surgically repaired PMM tear, 20 (83%) returned to play. The mean return-to-play period was 302 ± 128 days. The mean difference in performance scores before versus after PMM injury was 171.33 and was statistically significant, with P = .0330.Conclusions: In this study, there was an 83% return-to-play rate after surgical repair of PMM tears. Although we found a statistically significant decrease in player performance after surgery, this difference was no longer seen after players were stratified by position type and draft selection.Level of Evidence: Level IV, therapeutic case series.

The relationship between decision-making autonomy and training on facility-level management performance of primary health care facilities in Odisha, India

Background: Primary health care quality remains poor in many countries, despite its importance for universal health coverage. Evidence shows that better management of primary health care facilities improves service quality, and that facility managers’ autonomy and training levels can augment their management performance. In India, there is scant research in this area. Research questions include: 1) What is the effect of facility-level autonomy on management performance and is the effect modified by management training? 2) Which aspects of facility management are most sensitive to facility-level autonomy and is the effect augmented by management training? Methods: Using a multi-stage, regionally representative survey of health facilities in Odisha (n=396), a validated tool was used to measure management performance. An “autonomy score” was created to understand which facility management decisions are within a manager’s capacity. Multivariable linear regressions were used to assess the association of decision-making autonomy and management training with performance scores. Results: The mean performance score across all facilities was 0.657 (SD = 0.148) on a 0-1 scale; the mean autonomy score was 0.619 (SD = 0.305). Autonomy scores were not associated with a significant difference in performance scores; however, management training had an independent positive association with the human resources and monitoring domains of facility management. Conclusion: In Odisha, India management training may improve management performance, and targeted training initiatives may strengthen a primary care facility’s ability to retain staff and monitor performance. Our data did not demonstrate a significant association between decision-making autonomy and management performance, highlighting a need for further study on how decision-making autonomy may augment a manager’s ability to leverage their skills to improve facility outcomes. In summary, neither management training nor decision-making autonomy alone will sufficiently improve primary care management but targeting the improvement of management training may improve a subset of performance outcomes.

EFFECT OF GOOGLE CLASSROOM APPLICATION ON UNDERGRADUATE STUDENTS’ SCORES IN EDUCATIONAL TECHNOLOGY IN UNIVERSITY OF CALABAR, NIGERIA

Purpose: The study examined the effect of Google Classroom Application on undergraduate students’ scores in Educational Technology in the University of Calabar, Nigeria.&#x0D; Methodology: Two null hypotheses were formulated to guide the study, Quasi-experimental research design using pre-test posttest non-randomized control group design was adopted for the study. The population is made up of al undergraduates offering Educational Technology as a course in the University of Calabar. A sample of 160 year two students of educational technology comprising of 85 female and 75 male were purposively sampled for the study. The Google Classroom Application and Educational Technology Performance Test (ETPT) were the instruments used for data collection. The results of the study were analyzed using Analysis of Covariance (ANCOVA).&#x0D; Findings: The results revealed that there is a significant difference in undergraduates students’ scores in educational technology taught with the Google Classroom Application and those taught using expository method, there was also a significant difference in performance scores between male and female students taught using Google Classroom Application,.&#x0D; Unique contribution to theory, practice and policy: It was therefore recommended Google Classroom Application should be used always to promote students’ academic performance in educational technology and that Lecturers should equally upgrade their skills on the utilization of Google classroom and other technological applications to stay afloat with 21st century skills online units best global practices.

Impact of educational instruction on medical student performance in simulation patient.

This study aimed to evaluate the effects, and timing of, a video educational intervention on medical student performance in manikin-based simulation patient encounters. This prospective mixed-methods study was conducted as part of the University of Toledo College of Medicine and Life Sciences undergraduate medical curriculum. One hundred sixty-six students second-year students participated in two simulations on a single day in September 2021. A 7-minute video intervention outlining the clinical diagnostic approach to pulmonary complaints was implemented. Students were randomized into 32 groups which were divided into two cohorts. One received the video prior to simulation-1 (n=83) and the other between simulation-1 and simulation-2 (n=83). Each simulation was recorded and assessed using a 44-point standardized checklist. Comparative analysis to determine differences in performance scores was performed using independent t-tests and paired t-tests. Independent t-tests revealed the video-prior cohort performed better in simulation-1 (t(30)= 2.27, p= .03), however in simulation-2 no significant difference was observed between the cohorts. Paired t-test analysis revealed the video-between cohort had significant improvement from simulation-1 to simulation-2 (t(15)= 3.06, p = .01); no significant difference was found for the video-prior cohort. Less prompting was seen in simulation-2 among both the video-prior (t(15)= -2.83, p= .01) and video-between cohorts (t(15)= -2.18, p= .04). Simulation training, and targeted educational interventions, facilitate medical students to become clinically competent practitioners. Our findings indicate that guided video instruction advances students' clinical performance greater than learning through simulation alone. To confirm these findings, similar investigations in other clinical training exercises should be considered.

Nationwide Acute Stroke Care Quality and Disparity in Korea: Focusing on the Type of Healthcare Facilities and the Socioeconomic Status of Patients

Background: The quality ofstroke care has a significantimpact onmortality and complications. The purpose ofthisstudy wasto investigate the difference in the quality of acute stroke treatment according to the type of healthcare facility and the socioeconomic status of patients.Methods: Thisstudy used Health Insurance Review and Assessment Service’s Healthcare Quality Assessment for Stroke 2013 data and included 10,399 cases from 201 healthcare facilities. Quality of care was categorized from grade 1 (best group) to grade 5 (worst group) according to performance scores using 10 processindicators.Results: The mean performance score was 91.5. Only 31% of all patients received treatment at grade 1 hospitals while 10% received treatment at grade 3 or lower hospitals. The difference in performance score by the type of healthcare facility existed (tertiary hospitals: 94.3, general hospitals: 88.7).Ofthe 159 general hospitals, 66 hospitals provided grade 3 orlower quality care.NHI patients used more tertiary hospitalsthan MA patients(51% vs. 38%), and MA patientswere more likely to use general hospitals providing grade 3 or lower quality care (11% vs. 21%).Conclusions: This study showed that some general hospitals provided low quality stroke care, and MA patients were more likely to use those hospitals. In order to increase the quality and equity of stroke treatment, a strategy to gather patients at healthcare facilitiesthat provide appropriate medicalservices will be needed.

Emergency clinician participation and performance in the Centers for Medicare & Medicaid Services Merit-based Incentive Payment System.

The Merit-based Incentive Payment System (MIPS) is the largest national pay-for-performance program and the first to afford emergency clinicians unique financial incentives for quality measurement and improvement. With little known regarding its impact on emergency clinicians, we sought to describe participation in the MIPS and examine differences in performance scores and payment adjustments based on reporting affiliation and reporting strategy. We performed a cross-sectional analysis using the Centers for Medicare & Medicaid Services 2018 Quality Payment Program (QPP) Experience Report data set. We categorized emergency clinicians by their reporting affiliation (individual, group, MIPS alternative payment model [APM]), MIPS performance scores, and Medicare Part B payment adjustments. We calculated performance scores for common quality measures contributing to the quality category score if reported through qualified clinical data registries (QCDRs) or claims-based reporting strategies. In 2018, a total of 59,828 emergency clinicians participated in the MIPS-1,246 (2.1%) reported as individuals, 43,404 (72.5%) reported as groups, and 15,178 (25.4%) reported within MIPS APMs. Clinicians reporting as individuals earned lower overall MIPS scores (median [interquartile range {IQR}]=30.8 [15.0-48.2] points) than those reporting within groups (median [IQR]=88.4 [49.3-100.0]) and MIPS APMs (median [IQR]=100.0 [100.0-100.0]; p<0.001) and more frequently incurred penalties with a negative payment adjustment. Emergency clinicians had higher measure scores if reporting QCDR or QPP non-emergency medicine specialty set measures. Emergency clinician participation in national value-based programs is common, with one in four participating through MIPS APMs. Those employing specific strategies such as QCDR and group reporting received the highest MIPS scores and payment adjustments, emphasizing the role that reporting strategy and affiliation play in the quality of care.

Otoskills training during covid-19 pandemic: a before-after study

BackgroundThe ongoing COVID-19 pandemic has disrupted the surgical training of residents. There is a real concern that trainees will not be able to meet their training requirements. Low-fidelity surgical simulation appears to be an alternative for surgical training. The educational benefits of repeating ossiculoplasty simulations under a microscope have never been evaluated. With this study we aimed to evaluate the differences in performance scores and on a global rating scale before and after training on an ossiculoplasty simulator.MethodsIn this quasi-experimental, prospective, single-centre, before-after study with blinded rater evaluation, residents performed five microscopic ossiculoplasty tasks with a difficulty gradient (sliding beads onto rods, the insertion of a partial prosthesis, the insertion of a total prosthesis, and the insertion of a stapedotomy piston under microscopic or endoscopic surgery) before and after training on the same simulator. Performance scores were defined for each task, and total performance scores (score/min) were calculated. All data were collected prospectively.ResultsSix out of seven intermediate residents and 8/9 novices strongly agreed that the simulator was an effective training device and should be included in the ENT residency program. The mean effect of training was a significant increase in the total performance score (+ 0.52 points/min, [95 % CI, 0.40–0.64], p < 0.001), without a significant difference between novice and intermediate residents.ConclusionsThis preliminary study shows that techniques for middle-ear surgery can be acquired using a simulator, avoiding any risk for patients, even under lockdown measures.

Mastery Learning Ensures Correct Personal Protective Equipment Use in Simulated Clinical Encounters of COVID-19.

IntroductionThe correct use of personal protective equipment (PPE) limits transmission of serious communicable diseases to healthcare workers, which is critically important in the era of coronavirus disease 2019 (COVID-19). However, prior studies illustrated that healthcare workers frequently err during application and removal of PPE. The goal of this study was to determine whether a simulation-based, mastery learning intervention with deliberate practice improves correct use of PPE by physicians during a simulated clinical encounter with a COVID-19 patient.MethodsThis was a pretest-posttest study performed in the emergency department at a large, academic tertiary care hospital between March 31–April 8, 2020. A total of 117 subjects participated, including 56 faculty members and 61 resident physicians. Prior to the intervention, all participants received institution-mandated education on PPE use via an online video and supplemental materials. Participants completed a pretest skills assessment using a 21-item checklist of steps to correctly don and doff PPE. Participants were expected to meet a minimum passing score (MPS) of 100%, determined by an expert panel using the Mastery Angoff and Patient Safety standard-setting techniques. Participants that met the MPS on pretest were exempt from the educational intervention. Testing occurred before and after an in-person demonstration of proper donning and doffing techniques and 20 minutes of deliberate practice. The primary outcome was a change in assessment scores of correct PPE use following our educational intervention. Secondary outcomes included differences in performance scores between faculty members and resident physicians, and differences in performance during donning vs doffing sequences.ResultsAll participants had a mean pretest score of 73.1% (95% confidence interval [CI], 70.9–75.3%). Faculty member and resident pretest scores were similar (75.1% vs 71.3%, p = 0.082). Mean pretest doffing scores were lower than donning scores across all participants (65.8% vs 82.8%, p<0.001). Participant scores increased 26.9% (95% CI of the difference 24.7–29.1%, p<0.001) following our educational intervention resulting in all participants meeting the MPS of 100%.ConclusionA mastery learning intervention with deliberate practice ensured the correct use of PPE by physician subjects in a simulated clinical encounter of a COVID-19 patient. Further study of translational outcomes is needed.

Learning progress of fathers compared to mothers in auditory-verbal rehabilitation: A pilot study

ABSTRACT Fathers’ participation in early intervention services for children who are deaf or hard of hearing has increased, but few studies have examined the learning progress of skills learned in these sessions. The aim of this study was to compare the competence patterns of fathers and mothers in implementing auditory-verbal therapy (AVT) practices, and to investigate how the parents’ behaviours changed over time when interacting with their children. Five fathers were matched with mothers with respect to children's chronological age, hearing loss degree, and length of enrolment in AVT. Teaching and behavioural skills of fathers and mothers were rated by children's AV therapists at 3-month intervals. Differences in performance scores and learning progress in AVT skills utilisation between fathers and mothers were explored. Fathers showed greater improvement than mothers in the reinforcement domain from Time 2 to Time 3. However, no statistically significant difference in performance scores between fathers and mothers was detected at any time point, nor was there a significant difference in skill progress rate between fathers and mothers. Results suggest that fathers and mothers are equally suited to serving as their children's language facilitators. Fathers can grow positively in both teaching and parenting behaviours through systematic learning to achieve performance levels comparable to mothers’ in learning early intervention techniques for speech and hearing.

Surgical Release of the Adductor Longus With or Without Sports Hernia Repair Is a Useful Treatment for Recalcitrant Groin Strains in the Elite Athlete.

Background:Chronic strain and/or tendinopathy of the adductor longus tendon can be a cause of long-standing groin pain in the elite athlete, resulting in significant time lost from competition. Accurate diagnosis and treatment can expedite return to play.Purpose/Hypothesis:To evaluate return to sport and performance in National Collegiate Athletic Association (NCAA) Division I football players and National Football League (NFL) players following adductor longus release with or without sports hernia repair. We hypothesized that adductor release will be an effective method of treatment for recalcitrant groin/adductor pain in these athletes.Study Design:Case series; Level of evidence, 4.Methods:A cohort study was performed of all NFL players and NCAA Division I college athletes who had undergone an adductor longus tendon release with or without sports hernia repair by 1 of 2 fellowship-trained orthopaedic surgeons between May 1999 and January 2013. All patients reported groin pain below the inguinal ligament and localized to their adductor longus. Symptoms lasted longer than 10 weeks and limited their ability to effectively perform during sport, as assessed by their coach and self-assessment. Questionnaires were given to all 26 patients to assess long-term surgical outcomes. A subgroup analysis was performed for NFL players, in which “performance scores” were calculated according to individual player statistics while playing. Scores obtained before the diagnosis of chronic adductor longus tendinopathy or strain were compared with those after surgery. Patients with prior abdominal or pelvic surgery, radiographic evidence of degenerative joint disease of the hip, labral tears or femoral acetabular impingement, prostatic or urinary tract disease, or nerve entrapment of the ilioinguinal, genitofemoral, or lateral femoral cutaneous nerves were excluded from the study.Results:A total of 32 athletes underwent an adductor longus tenotomy during the study period. Of these patients, 28 were college- or professional-level athletes who underwent an adductor longus tenotomy, with a mean ± SD follow-up time of 6.2 ± 4.2 years (range, 12-178 months). Of the 32 patients, 20 had a concomitant sports hernia repair in addition to an adductor longus tenotomy. Thirty-one patients (97%) were able to return to their previous sport, and 30 (94%) were able to return at their previous level of play. Thirty patients (94%) reported that they were satisfied with their decision to have surgery. No player complained of weakness or a decrease in running speed or power. Mean return to play was 12 weeks from date of surgery. In the subgroup analysis of 16 NFL players, there were no statistically significant differences for the pre- versus postoperative comparisons of the athlete performance scores (P = .74) and the percentage of the games started versus played (P = .46). After separation of players who had a concomitant hernia repair from players who did not, there was no statistically significant difference in performance scores or percentages of games started.Conclusion:In this study of elite athletes, adductor longus tenotomy with or without a concomitant sports hernia repair provided overall acceptable and excellent results. Athletes were able to return to their previous level of athletic competition and performance with consistent relief of groin pain. Return to play in an NFL game averaged 12 weeks following surgery.

Comparing the effect of standardized patient-based education and feedback lecture on midwives' knowledge and practice in counseling screening for fetal malformations.

INTRODUCTION:Midwifery screening is one of the duties of midwives according to national guidelines. It is possible to increase midwives' knowledge and practice through effective education. The aim of this study was to compare the effect of standardized patient-based education and feedback lecture on midwives' knowledge and practice in screening counseling for fetal malformations.METHODS:This quasi-experimental, two-group study (standardized patient-based training and feedback lecture) was performed on 67 midwives (licensed by the office) in Mashhad in 2018. Midwives' knowledge and practice before and 2 weeks after training (a 4-h training program) were assessed by the Objective Structured Clinical Examination and a questionnaire. The data were analyzed by the SPSS software version 16 using Mann–Whitney, Chi-square, Wilcoxon and independent t-test while P < 0.05 considered as a significant level.RESULTS:Before intervention, the total score of knowledge and practice showed no statistically significant difference between the two groups (P > 0.05). After intervention, knowledge score in feedback lecture group was statistically significantly higher than that of standard patient group (P < 0.001). In addition, there was no statistically significant difference in performance scores between the two groups after intervention (P = 0.761).CONCLUSION:Both educational methods can increase midwives' knowledge and practice in fetal screening counseling. However, in raising midwives' awareness, feedback lecture group was more effective than standard patient group.

Development and validation of a general and easy assessable scoring system for laparoscopic skills using a virtual reality simulator.

ObjectivesTo develop and validate a scoring system for laparoscopic skills for five specific tasks on a virtual reality simulator.Study designA longitudinal, experimental, non-randomised study including 30 gynecologists and gynecological trainees at three hospitals. The participants were categorized as inexperienced (Group 1), moderately experienced (Group 2), and experienced (Group 3).The study participants performed ten repetitions of three basic skill tasks, a salpingectomy and a laparoscopic supracervical hysterectomy on a virtual reality simulator. Assessment of skills was based on time, error parameters and economy of movements measured by the simulator. We used the results (mean and SD for each parameter in all tasks) of the four last repetitions performed by the experienced gynecologists as the basic for the scoring system. Performance equal to, and higher than, this mean score gave 2 points. A decrease of 1 SD from the mean gave 1 point. Every score below gave 0 points. The mean score for the inexperienced, moderately experienced and experienced study participants was compared.ResultsThe mean scores in Task 1 were 3.4 (SD 0.6) in Group 1, 3.4 (SD 0.6) in Group 2 and 5.1 (SD 1.1) in Group 3, respectively. There was a statistically significant difference in score between Group 1 and 3 (p = 0.01), and group 2 and 3 (p = 0.01). In Task 2 no statistical significant differences were found. In Task 3, the total mean scores were 1.7 (SD 0.7) in Group 1, 1.9 (SD 0.9) in Group 2 and 2.8 (SD 0.5) in Group 3, respectively. The difference in score between study groups was statistically significant when comparing Group 1 and Group 3 (p < 0.01) and Group 2 and Group 3 (p = 0.02).In Task 4, the difference in used time between group 1 and 3 was statistically significant (p = 0.03). In task 5 there was a significant difference in performance score between group 1 and 3 (p = 0.01).ConclusionsThere was significant difference in scores between the experienced and the inexperienced gynecologist in four out of five tasks.The scoring system is easy assessable and can be used for summative and formative feedback in proficiency-based assessment.

A Didactic Community Pharmacy Course to Improve Pharmacy Students’ Clinical Skills and Business Management Knowledge

Objective. To create, implement and evaluate a Doctor of Pharmacy (PharmD) course on clinical services in community pharmacy settings. Methods. A 2-credit hour elective course was offered to second- and third-year pharmacy (P2 and P3) students. The course was developed using integrated course design principles. Community pharmacists were featured prominently in the course. Student performance on quizzes was evaluated and compared between groups (2014 and 2015 cohort). A survey with a pretest posttest design was used to assess students' self-rated knowledge and self-efficacy. Results. Twenty students enrolled in the elective course and 18 students completed the pre/post survey. There was no difference in performance scores on each of the three quizzes between students in the 2014 and 2015 courses. There was a significant increase seen for knowledge of the majority of course competencies. Students indicated improvement in their confidence to perform a variety of clinical services after course completion. Conclusion. Participation in this elective course allowed students to improve their knowledge of community pharmacy practice competencies and increased their ability to deliver clinical services in community pharmacy settings.

The Difference in Clinical Outcomes After Anterior Cervical Fusion, Disk Replacement, and Foraminotomy in Professional Athletes.

Retrospective case series. To compare postoperative outcomes of professional athletes treated for cervical disk herniation after anterior cervical discectomy and fusion (ACDF) and posterior foraminotomy (PF), or total disk replacement (TDR). ACDF, PF, and TDR have all led to excellent outcomes in the general population but the unique demands in the professional athlete necessitate specific study. Athletes of 4 major American professional sports leagues-National Football League, Major League Baseball, National Hockey League and National Basketball Association-diagnosed with cervical disk herniation and managed operatively were identified. Athletes were grouped into cohorts based on operation type. Athlete performance outcome measures were calculated based on sport-specific statistics and assessed as a percentage change after surgery to standardize comparison across sports. A total of 101 professional athletes were identified (ACDF=86, PF=13, and TDR=2). The PF cohort had a significantly greater return to play rate and shortest time to return after surgery (P=0.03 and P=0.04, respectively). However, the reoperation rate at the index level was significantly higher in PF athletes compared with ACDF (46.2% vs. 5.8%; P<0.001) over the study follow-up period (average, 13.5 y). There was no significant difference in performance score after surgery for all surgical cohorts (P=0.41) and among cohorts (P=0.41). When analyzed by sport only baseball athletes experienced a significant decrease in performance after surgery (P=0.049). ACDF and PF are both viable options with excellent outcomes in professional athletes. PF allows a significantly higher rate and quicker return to play but portends a higher risk for reoperation compared with ACDF. TDR results are limited in our cohort and require further study to determine professional athlete outcomes. Level IV.