Effect Of Training Level Research Articles

Spatiotemporal inflection points in human running: Effects of training level and athletic modality.

The effect of the different training regimes and histories on the spatiotemporal characteristics of human running was evaluated in four groups of subjects who had different histories of engagement in running-specific training; sprinters, distance runners, active athletes, and sedentary individuals. Subjects ran at a variety of velocities, ranging from slowest to fastest, over 30 trials in a random order. Group averages of maximal running velocities, ranked from fastest to slowest, were: sprinters, distance runners, active athletes, and sedentary individuals. The velocity-cadence-step length (V-C-S) relationship, made by plotting step length against cadence at each velocity tested, was analyzed with the segmented regression method, utilizing two regression lines. In all subject groups, there was a critical velocity, defined as the inflection point, in the relationship. In the velocity ranges below and above the inflection point (slower and faster velocity ranges), velocity was modulated primarily by altering step length and by altering cadence, respectively. This pattern was commonly observed in all four groups, not only in sprinters and distance runners, as has already been reported, but also in active athletes and sedentary individuals. This pattern may reflect an energy saving strategy. When the data from all groups were combined, there were significant correlations between maximal running velocity and both running velocity and step length at the inflection point. In spite of the wide variety of athletic experience of the subjects, as well as their maximum running velocities, the inflection point appeared at a similar cadence (3.0 ± 0.2 steps/s) and at a similar relative velocity (65-70%Vmax). These results imply that the influence of running-specific training on the inflection point is minimal.

Development of ascale to measure intrapersonal factors influencing speaking up in the operating room.

IntroductionThis paper reports on the development of a scale to measure intrapersonal factors (IPF) that may influence speaking up behaviour in the operating room.MethodsParticipants were postgraduate year 2, 3, and 4 anaesthesiology residents and practising faculty anaesthesiologists at a large quaternary care academic hospital. Based on a literature review, the authors constructed the initial scale. Exploratory factor analysis was conducted to identify the underlying factor structure for the scale. A set of one-way ANOVAs and multiple ordinal regressions were carried out to provide additional validity evidence for the new scale.ResultsExploratory factor analysis indicated a three-factor solution accounting for 73% of the variance. The self-efficacy subscale included four items (Cronbach’s α = 0.86), and the social outcome expectations (Cronbach’s α = 0.86) and assertive attitude (Cronbach’s α = 0.67) subscales contained three items each. The effect of training level was significantly associated with self-efficacy (p < 0.001) and assertive attitude subscale scores (p < 0.001). Multiple ordinal regressions indicated that IPF predicted participants’ likelihood of speaking up in various hypothetical scenarios.DiscussionOur analyses provided initial evidence for the validity and reliability of a 10-item IPF scale. This instrument needs to be validated in other cohorts.

Effect of Training Level on a Visuomotor Balance Task in Youth with Previous Sport-Related Concussion.

INTRODUCTION: The demands of sport require the integration of cognition and sensory inputs to produce more complex, goal-directed movement. Howell and colleagues (1) revealed that the differences in balance control between athletes with or without previous concussion were greater in youth compared young adults during dual-task gait. PURPOSE: 1) To determine if a novel visuomotor dynamic balance task can objectively identify differences between youth hockey players with/without sport-related concussion (SRC); and 2) If there are balance control differences between players who participate in minor hockey and private hockey academy training. METHODS: Youth hockey players (N=47; age=12-17 years), who reported previous SRC (n=17) and CONTROL (n=30). Group 1 was from a minor hockey team (SRC1=4; CONTROL1=12) and group 2 a private hockey academy (SRC2=13, CONTROL2=18). Participants stood in single support on a Nintendo Wii Balance board sampled at 100Hz and performed a lower limb reaching task with their non-stance foot. Five FitLights were arranged on the floor anteriorly at +60°, +30°, and 0° and were used as Go(GREEN)/No-Go(RED) stimuli. Balance control was assessed using RMS velocity of COP (vCOP) in anterior-posterior (A/P) and medial-lateral (M/L) planes. RESULTS: There were significant differences for both A/P vCOP (SRC= 8.04cm/s; CONTROL= 11.04cm/s, p <.05) and M/L vCOP (SRC= 6.27cm/s; CONTROL= 7.72cm/s, p <.05), as the SRC group performed the task slower than CONTROL There were no significant differences between SRC1 and SRC2 in vCOP A/P (p=0.50) or M/L (p=0.26) likewise for CONTROL1 and CONTROL2 vCOP A/P (p=0.88) and M/L (p=0.97). CONCLUSION: The assessment of a visuomotor dynamic balance task can objectively identify youth athletes with previous history of SRC regardless of training levels. Incorporating cognitive-motor tasks may help to improve balance control deficits in youth post-SRC and ensure true readiness for return-to-sport. 1. Howell DR, Osternig LR, Chou LS. Adolescents demonstrate greater gait balance control deficits after concussion than young adults. The American journal of sports medicine. 2015 Mar;43(3):625-32.

The effect of training level on complications after free flap surgery of the head and neck

ObjectivesAnalyze postoperative complications after free flap surgery based on PGY training level. MethodsData on free flap surgeries of the head and neck performed from 2005 to 2013 was collected from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Cases identifying the status of resident participation in the surgery and the PGY level were included. ResultsThere were 582 cases with primary surgeon data available. 63 cases were performed with a junior resident, 211 were performed with the assistance of a senior resident, 279 cases were performed with a fellow, and 29 cases were performed by an attending alone without resident involvement. The overall complication rate was 55.2%. There was no statistically significant difference in the rate of complications between groups (47.6%, 59.7%, 53.0%, 58.6%, p=0.277). After controlling for all confounding variables using multivariate analysis there was no significant difference in morbidity, mortality, readmissions, and reoperation amongst the groups. Furthermore, when comparing resident versus fellow involvement using multivariate analysis there were no significant differences in morbidity (OR=0.768[0.522–1.129]), mortality (OR=1.489[0.341–6.499]), readmissions (OR=1.018[0.458–2.262]), and reoperation (OR=0.863[0.446–1.670]). ConclusionResident and fellow participation in microvascular reconstructive cases does not appear to increase 30-day rates of medical, surgical, or overall complications.

Effect of training level and blood flow restriction on thermal parameters: Preliminary study

Training with blood flow restriction could lead to an effect on skin temperature. Additionally, this effect could be higher in people with lower physical fitness level due to their lower capacity of heat loss. The aim of this preliminary study was therefore to evaluate the effects of training experience on the acute and chronic thermal skin responses after performing exercise with and without blood flow restriction. The study included ten men, of these, five were trained. All subjects performed tests and re-tests for maximum strength (1 repetition maximum) through unilateral leg extensions (right thigh at 45±6.7kg and left thigh at 45.5±8.1kg, p>0.05). The protocol consisted of four sets to concentric failure, with one-minute rest intervals between sets at an intensity corresponding to 40% of 1 RM. There were 7-day intervals between experimental sessions (150mmHg versus unrestricted flow restriction). The thermal images were made before the protocol (pre), immediately after the end of the series (post), and 24h afterward (post 24h). When comparing temperature variation (Δ exercise and Δ 24h) between groups, it was observed that the trained participants showed a greater drop in temperature 24h after exercise with 150mmHg restriction (confidence interval: 95% of Δ 24h [−0.2 to −0.9°C]) compared to untrained subjects (p=0.006 and ES>1.5, confidence interval: 95% Δ 24h [−0.1 to 0.6°C].) In conclusion, this preliminary study showed that training experience interferes with the chronic cutaneous thermal temperature of the anterior thigh when strength training associated with blood flow restriction 150mmHg was performed.

A Smartphone-based Decision Support Tool Improves Test Performance Concerning Application of the Guidelines for Managing Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy.

The American Society of Regional Anesthesia and Pain Medicine (ASRA) consensus statement on regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy is the standard for evaluation and management of these patients. The authors hypothesized that an electronic decision support tool (eDST) would improve test performance compared with native physician behavior concerning the application of this guideline. Anesthesiology trainees and faculty at 8 institutions participated in a prospective, randomized trial in which they completed a 20-question test involving clinical scenarios related to the ASRA guidelines. The eDST group completed the test using an iOS app programmed to contain decision logic and content of the ASRA guidelines. The control group completed the test by using any resource in addition to the app. A generalized linear mixed-effects model was used to examine the effect of the intervention. After obtaining institutional review board's approval and informed consent, 259 participants were enrolled and randomized (eDST = 122; control = 137). The mean score was 92.4 ± 6.6% in the eDST group and 68.0 ± 15.8% in the control group (P < 0.001). eDST use increased the odds of selecting correct answers (7.8; 95% CI, 5.7 to 10.7). Most control group participants (63%) used some cognitive aid during the test, and they scored higher than those who tested from memory alone (76 ± 15% vs. 57 ± 18%, P < 0.001). There was no difference in time to completion of the test (P = 0.15) and no effect of training level (P = 0.56). eDST use improved application of the ASRA guidelines compared with the native clinician behavior in a testing environment.

The effect of training level on opioid utilization efficiency

Study ObjectiveThis study focuses on residents' ability to predict opioid administration requirements and if improvement is made as learners progress. Residents request opioid from the pharmacy at the start of the day based on clinical assignment. Unused and wasted opioids are returned at the end of the day. The labor and cost associated with this process are not trivial nor is the risk of excess opioid access. We examined if estimation of daily opioid use by residents increased in accuracy as progression through the program occurred. Materials and MethodsWe conducted a retrospective analysis in the setting of the operating room examining pharmacy opioid usage. The measurements included the number of vials requested, the number of vials dispensed, and the number of vials returned. Information was stratified in our database by the level of training.The set inclusion criterion was any surgery performed in the operating rooms that required the use of opioids. The exclusion criteria included anesthesia that required a regional block, cardiac surgeries, emergent cases, and obstetric cases. Main ResultsA total of 104 opioid requests were made that met our criteria. Comparing CA-1 and CA-3 residents and CA-2 and CA-3 residents, a statistically significant difference exists between the number of vials requested and the number returned. Our data show a statistically significant difference in efficiency as residents progress from their CA-1 year to CA-3 year. ConclusionIn summary, our findings support the idea that residents are able to better predict opioid requirements for cases as they progress through training. Closely monitoring such patterns can serve a useful educational purpose and allow for identification of misuse. Improvement in cost-effective care and limiting waste while working in a complex integrated health care environment are additional benefits.

Assessment of a mitral valve replacement skills trainer: A simplified, low-cost approach

Simulated mitral valve replacement may aid in the assessment of technical skills required for adequate performance in the operating room. We sought to design and assess a mitral valve replacement training station that is low-cost, nonperishable, portable, and reproducible as a first step in developing a mitral valve surgical skills curriculum. Nineteen physicians (7 general surgery residents, 8 cardiothoracic surgery residents, and 4 attending cardiothoracic surgeons) underwent simulated mitral valve replacement testing. Simulated mitral valve replacement was performed on a training station consisting of a replaceable "mitral annulus" inside a restrictive "left atrium." Eight components of performance were graded on a 5-point scale. A composite score (100 point maximum) was calculated by weighting the grades by procedural time. The effect of training level was evaluated using analysis of variance and post hoc Tukey honestly significant difference. The speed of simulated mitral valve replacement varied among general surgery residents, cardiothoracic surgery residents, and attending cardiothoracic surgeons (52.9 ± 9.0 vs 32.8 ± 4.7 vs 28.0 ± 3.5 minutes, respectively; F=25.3; P<.001). Level of training significantly affected all 8 evaluation components (P<.001). Composite scores increased with level of training (general surgery residents 32.9 ± 11.4, cardiothoracic surgery residents 65.1 ± 11.5, and attending cardiothoracic surgeons 88.3 ± 7.8 of a possible 100 points; F=35.7; P<.001). Cardiothoracic surgery residents who reported having performed 10 to 50 mitral valve replacements as the primary surgeon had a composite score of 65.0 ± 2.8 (P<.01 compared with attending cardiothoracic surgeons). Simulated mitral valve replacement can be performed using this simple, affordable, portable setup. Performance scores correlate with level of training and experience, but residents who performed 10 to 50 mitral valve replacements still failed to reach attending-level proficiency. This training simulator may facilitate skills practice and evaluation of competency in cardiac surgery trainees.

Is the structure of anatomy curriculum adequate for safe medical practice?

Introduction Anatomy has been considered a core subject within the medical education curriculum. In the current setting of ever-changing diagnostic and treatment modalities, the opinion of both students and trainers is crucial for the design of an anatomy curriculum which fulfils the criteria required for safe medical practice. Methods Medical students, trainees and specialist trainee doctors and specialists from the London (England) area were surveyed to investigate the how curriculum changes have affected the relevance of anatomical knowledge to clinical practice and to identify recommendations for optimum teaching methods. The survey employed 5-point Likert scales and multiple-choice questions. Where the effect of training level was statistically significant ( p < 0.05), post-hoc analysis was carried out using Mann–Whitney U tests. Significance levels were modified according to the Bonferroni method. Results Two hundred and twenty-eight individuals completed the survey giving a response rate of 53%. Medical students, trainees and specialists all agreed (mean Likert score 4.51, 4.79, 4.69 respectively) that knowledge of anatomy is important for medical practice. Most of the trainees (88.4%) and specialists (81.3%) used dissection to learn anatomy, but only 61.4% of medical students used this approach. Dissection was the most commonly recommended approach for learning anatomy across all the groups (41.7%–69.3%). Conclusions Knowledge of anatomy is perceived to be important for safe clinical practice. Anatomy should be taught with other relevant system or clinical modules. Newer tools for anatomy teaching need further validation before incorporation into the curriculum.

Use of an Objective Structured Clinical Examination (OSCE) for the assessment of physician performance in the ultrasound evaluation of trauma.

A reliable means of assessing physician competency in performing ultrasound (US) is critical for training and credentialing. Objective Structured Clinical Examinations (OSCE) have been used successfully to assess clinical competency in other areas of surgical education but have not been applied previously to trauma ultrasound training. The objectives of this study were to assess physician performance in the focused abdominal sonography in trauma (FAST) examination by using a specifically designed OSCE, and to determine whether the OSCE detects differences in two determinants of competency (knowledge acquisition and clinical interpretation skills). Eighty-two physicians in surgery (n = 49) and emergency medicine (n = 33) at a Level I trauma center were evaluated. All participated in a FAST course consisting of didactic sessions on US physics, indications, and technique, FAST examination videos, and a hands-on session with human models. The OSCE consisted of two parts: written examination that assessed factual knowledge, and videotape of real-time US examinations that assessed interpretation skills. The OSCE was administered before and after the FAST course. Significant improvements in postcourse OSCE scores were observed for factual knowledge (52.5 +/- 2.0 vs. 87.5 +/- 1.1, p < 0.001) and interpretation skills (27.2 +/- 1.4 vs. 62.9 +/- 1.3, p < 0.007). Scores for US interpretation were significantly lower than those for factual knowledge at both precourse (27.2 +/- 1.4 vs. 52.5 - 2.0, p < 0.001) and postcourse (62.9 +/- 1.3 vs. 87.5 +/- 1.1, p < 0.01). No performance differences were observed between surgeons and emergency medicine physicians and no effect of training level on test scores was observed. Knowledge acquisition and US interpretation skills can be assessed reliably with a specifically designed OSCE. Although both skills improved after participation in a FAST course, US interpretation scores were consistently lower than those for factual knowledge. This study supports the use of the objective structured clinical examination in both the design of ultrasound teaching programs and the assessment of physician competency.

EVALUATION OF WINE QUALITY USING A SMALL‐PANEL HEDONIC SCALING METHOD

ABSTRACTA hedonic scoring method for evaluating wines with a small panel was examined for reliability, effects of training level and agreement with a traditional 20‐point scoring technique. The method was found to differentiate among qualities of 14 domestic Sauvignon Blanc wines with good reliability. Four panels were tested, three with a high degree of experience in wine judging and a fourth consisting of fine wine consumers with no special training. The three experienced panels agreed well about the wines’ quality scores. Mean panel scores were less highly correlated (although still positive) with the untrained panel, which showed higher variability and lower reliability. Mean scores from the hedonic method were correlated at r =+0.94 with mean scores from a 20‐point quality judging procedure. The small panel hedonic method is suitable for generating quality scores for consumer guidance in large scale wine surveys, as are commonly found in popular wine periodicals.

Effects of Training Level and Locus of N-R Transitions on Resistance to Discrimination

Four groups of 10 rats were trained on a successive brightness differential conditioning problem. Two groups received transitions from nonrewarded (N) trials to rewarded (R) trials (N-R transitions) within S+ and two groups received transitions from N in S− to R in S+ (S−S+ transitions). Half of the rats in each condition experienced those transitions from the outset of training; the remaining rats first learned the discrimination under conditions that precluded N-R or S−S+ transitions and subsequently those transitions were introduced. N-R transitions in S+ and S−S+ transitions experienced from the outset of training, and N-R transitions in S+ introduced after the discrimination had been learned, all had a like effect on discrimination and retarded discrimination compared with the late introduction of S−S+ transitions into the situation.

Effects of training level, type of training, and awareness on the establishment of mental set in anagram solving.

Effects of training level, type of training, and awareness on the establishment of mental set in anagram solving.

Effects of training level on reversal and extradimensional shifts

Reversal (RS) and extradimensional (EDS) shift groups were subdivided into undertrained (UT), criterion trained (CT), and overtrained (OT) conditions. Results indicated: (1) The RS was learned faster than the EDS in both the CT and OT conditions, but Ss in the UT conditions did not differ. (2) Ss in the UT condition took longer to learn the RS than Ss in either the CT or OT conditions, but no significant difference was found between the CT vs OT conditions. (3) The EDS group did not differ significantly with training level. The ORE was demonstrated, but the hypothesis that this ORE might be explained in terms of the increased awareness of incidental cues which has been found in OT was not supported.

Effect of Training Level at the Time of Introduction of Delay on Runway Performance

Three intra-runway delay durations (0, 15, and 45 sec.) were combined factorially with three training levels (0, 15, and 75 trials) to determine the effect of the level of training at the time of delay introduction on performance. Three models, each with different predictions concerning the effect of training on performance after delay introduction, were evaluated. First, the frustration-drive model was unable to account for either the decremental effects of delay, or the fact that high training groups were more affected by delay and recovered more slowly. Second, delay of reinforcement theory while predicting decremental effects was unable to account for their temporal course and spatial distribution in the runway. Especially detrimental to this theory was complete recovery from the effects of delay in spite of continued delay. Third, the novelty-reactions model, while failing to account for the specific nature of the decremental effects of delay and training level on performance, was able to handle the fact that decrements did take place and recovery did occur and was less rapid for high training groups. Of the three models this latter was considered to be most compatible with the results.