Hands-on Training Research Articles

Developing the University of Tartu in Estonia into a well-networked Patient Safety Research Centre (PATSAFE): A study protocol

Background Patient safety (PS) is a serious global public health problem affecting all countries. Estimates show that around 10 percent of the patients are harmed during hospital care, resulting in 23 million disability-adjusted life years lost per year. Experts emphasize research advancements as a key precondition for safer care. Aim The Patient Safety Research Centre (PATSAFE) project enhances the Institute of Clinical Medicine of the University of Tartu’s (ICM-UT) research potential and capacities in PS in order to improve and strengthen knowledge and skills in methods, techniques and experience for PS research. Methods A strategic partnership with Avedis Donabedian Research Institute in Spain, and IQ Healthcare in the Netherlands, both international leaders in PS research, enables the development of a long-lasting knowledge exchange, allowing the ICM-UT to capitalise on its current achievements and to overcome gaps in scientific excellence in the field of PS research. These twining activities will strengthen and raise the research profile of the ICM-UT academic staff and early-stage researchers (ESRs), by implementing the hands-on training on methods, techniques, and experience in PS research. The project also encourages the active participation of ESRs in PS research by increasing their soft skills, to ensure the continuity and sustainability of PS research in ICM-UT. Finally, development of the research strategy on PS contributes to the long-term sustainability of PS research in Estonia. To implement these activities, PATSAFE foresees a comprehensive strategy consisting of knowledge exchange, soft research skills capacity building, strategic planning, and strong dissemination and exploitation efforts. Expected results As a result of the project, ICM-UT will have the capacity to carry out PS research using the appropriate methodology and the competences to apply state-of-the-art evidence-based strategies for PS research.

RADYOTERAPİ TEKNİKERLİĞİ EĞİTİMİNDE UYGULAMALI EĞİTİMİN VE STAJIN ÖNEMİ

The purpose of this study was to assess the practical training provided by associate degree programs in radiotherapy education in the United States, as well as the preparedness of students for internships and their post-internship learning levels. A total of 317 participants, including both face-to-face and online students, as well as graduates of the radiotherapy program, completed a survey consisting of 68 questions. Of the participants, 66.2% were female (n=210) and 33.8% were male (n=107). Lab facilities are available at institutions where the majority of participants (70.3%) have received education. Binary logistic regression tests were used to investigate whether there was a difference between the pre- and post-internship status. It was statistically significant that interns who had experienced professional growth prior to the internship performed better in achieving such gains after the internship (p < 0.05). The rate of error among participants who underwent laboratory training was 58.4% lower, and the time it took for them to begin working with patients independently was 61.1% less compared to those who were trained in an educational institution with inadequate practical training. Our survey underscores the significance of both theoretical and hands-on training in the education of radiotherapy technicians. Starting internships with theoretical training in a laboratory environment reinforces students' knowledge and improves their success during the internship. This type of training also enhances self-confidence, strengthens their connection to their profession, and prepares them for professional life after graduation.

Hands-on Training Through the Ambulance for Monuments Project

In a race against time, the “Ambulance for Monuments” project is seeking the salvation from collapse or irredeemable decay of hundreds of endangered built-heritage treasures in Romania. One of the initiative’s main aims is informal education for young professionals through hands-on training. This is a kind of education which is lacking not just in Romania but in many Eastern European countries. Most of the volunteers are students and young practitioners from the fields of architecture, restoration, urban planning, engineering, archaeology, history, cultural tourism, etc., seeking to expand their knowledge and soft skills, acquiring competencies and meta-competencies while participating in a large interdisciplinary project.

PENINGKATAN TATA KELOLA ADMINISTRASI BERBASIS GOOGLE DRIVE PADA GERAKAN PEMUDA ANSOR PIMPINAN ANAK CABANG PERAK JOMBANG

This community service program focuses on mentoring and training for enhancing digital-based administrative skills through the Gerakan Pemuda Ansor (Ansor Youth Movement) at the Sub-Branch Leadership of Perak, Jombang Regency. The decision to conduct this training is based on the upcoming accreditation at each branch, in accordance with the decision letter from the XVIII Grand Conference number 15/KONBES-XVIII/VI/2012 regarding the accreditation of the Gerakan Pemuda Ansor Organization and the upcoming visitation by an assessment team from the Regional Board to the Jombang Branch Leadership. The objectives of this community service are as follows : To assist the officials in enhancing their digital administration skills, to provide new insights into the features of Google Drive as a digital storage medium.to foster collaborations with various stakeholders, especially Ansor's autonomous bodies, to introduce IAI Tribakti to the community, particularly in the Jombang region. The methods employed to achieve these objectives involve lectures and training sessions. Training-related materials are presented through lectures and discussions, followed by practical, hands-on training. The overall outcome of this community service program has been positive and satisfactory.

A 3D-Printed Forearm Trainer for the Practice of Ultrasound-Guided Arterial and Venous Line Placement

As sonography (US) continues to become a mainstay in medicine, both as a screening device and as a procedural tool, the use of task-based sonographic trainers (i.e., phantoms) in medical training has become increasingly necessary. This is especially true for what has been termed ‘the global use of US’, or the use of US as an imperative tool during structural planning and placement of peripheral and central lines within patients in emergency and hospital settings. However, despite the frequency and technicality of US-guided procedures involving arterial and venous line placement, the benefit of such hands-on US simulation training for employees and professional students alike is often outweighed by cost. The current market for US trainers displaying human forearm anatomy and branching vessels comes at a high price tag of over 2,000 USD per model. The authors’ experiment utilises 3D printing techniques and biodegradable ballistics gel to create a cost-effective, versatile, and yet realistic peripheral line simulator in order to cultivate real-time learning of arterial/venous arm anatomy, while providing mechanical practice for needle driving and US technique, all at a fraction of the commercial price.

Innovative Curriculum to Train Medical Students on Lateral Canthotomy and Cantholysis.

Orbital compartment syndrome (OCS) is an ocular emergency requiring prompt decompression with a lateral canthotomy and cantholysis (LCC) within 2 hours. This study evaluates the feasibility and effectiveness of a standardized LCC curriculum to train medical students to identify and treat OCS. This was a prospective, non-randomized, non-comparative cohort study of 39 novice first-year medical students with no prior LCC training who underwent a standardized LCC curriculum incorporating both didactic and hands-on procedural training. Didactic knowledge of orbital anatomy and OCS was evaluated with written pre- and post-knowledge testing. Expert performance criteria were determined by expert consensus based on the performance of three oculoplastic surgeons and were defined as correctly performing all 12 critical checklist steps of an LCC within 3 minutes twice consecutively on a Sonalyst LCC training system eye model. Utilizing the principles of mastery learning, participants learned how to perform an LCC in a classroom environment and were evaluated on a final test of proficiency in a training lane designed to simulate an austere military environment. Participants required a median of 3.0 practice iterations to achieve expert performance in the classroom environment. During the testing phase, all participants correctly identified the eye with OCS, and 77% (n = 30) of learners successfully performed an LCC at the expert level within their first attempt. The median completion time of those who passed on their first testing was 130 seconds. The mean LCC knowledge test scores significantly improved from 48.7% to 71.2% (P < .001). This study successfully developed a standardized LCC curriculum utilizing the principles of hands-on mastery learning to train novice learners to perform an LCC efficiently and effectively.

Virtual site visits in Construction Management education: A practical alternative to physical site visits

Construction site visits and hands-on experiences are among the important instruments for educators in construction engineering and management to provide students with valuable knowledge and more engaging learning experiences. However, in addition to its existing logistical challenges, the COVID-19 pandemic has made site visits even more inaccessible as in-person classes and site visits moved to distant learning or got canceled. In a distance education system, conducting a physical site visit is not an easy task. This study focuses on the use of virtual site visits in construction and experiencing virtual hands-on training using immersive videos. Three types of video formats were used as the main content delivery methods in this pilot study namely, 2D flat, 360-degree, and 180-degree 3D videos. This method was adopted and tested in two courses that were previously face-to-face, which were then shifted to an online format due to the COVID-19 pandemic. The use of immersive videos gave students who would not have the ability to experience a physical site visit, the opportunity to experience the construction site environment and receive educational direction during a pre-recorded, hands-on, immersive video project. The goal of this study is to understand students’ experience with the provided technology, necessary improvement, implications for future research, and the potential implementations of this technology. A costume set of questionnaires was designed to retrieve students’ feedback on their experience which includes a comparison of different content delivery methods and four other study measures: knowledge retention, sense of presence, user experience, and overall satisfaction. Multiple statistical analyses were conducted on the collected data to provide both descriptive details and further insight into the study parameters and their relationship with each other and between different parameters.

Virtual site visits in Construction Management education: A practical alternative to physical site visits (REDIRECT)

Construction site visits and hands-on experiences are among the important instruments for educators in construction engineering and management to provide students with valuable knowledge and more engaging learning experiences. However, in addition to its existing logistical challenges, the COVID-19 pandemic has made site visits even more inaccessible as in-person classes and site visits moved to distant learning or got canceled. In a distance education system, conducting a physical site visit is not an easy task. This study focuses on the use of virtual site visits in construction and experiencing virtual hands-on training using immersive videos. Three types of video formats were used as the main content delivery methods in this pilot study namely, 2D flat, 360-degree, and 180-degree 3D videos. This method was adopted and tested in two courses that were previously face-to-face, which were then shifted to an online format due to the COVID-19 pandemic. The use of immersive videos gave students who would not have the ability to experience a physical site visit, the opportunity to experience the construction site environment and receive educational direction during a pre-recorded, hands-on, immersive video project. The goal of this study is to understand students’ experience with the provided technology, necessary improvement, implications for future research, and the potential implementations of this technology. A costume set of questionnaires was designed to retrieve students’ feedback on their experience which includes a comparison of different content delivery methods and four other study measures: knowledge retention, sense of presence, user experience, and overall satisfaction. Multiple statistical analyses were conducted on the collected data to provide both descriptive details and further insight into the study parameters and their relationship with each other and between different parameters.

Introduction of Laboratory Endodontics: Evaluating the Perception of the Undergraduate Clinical Dental Students at a Nigerian University

Background: Root canal treatment (RCT) forms a part of the requirements for graduation for dental students. The students are expected to perform the procedure during their clinical training. However, most students are presented to the clinic without formal laboratory practical training.&#x0D; Aim: To introduce laboratory endodontic training and evaluate the perception of Nigerian undergraduate clinical dental students about the program.&#x0D; Methodology: A two-day hands-on training on RCT was done for a set of final-year dental students in the operative technique laboratory of the Department of Restorative Dentistry of the Institution. The training included taking the participants through all the steps involved in RCT. The participants performed all the stages of RCT on extracted lower molar teeth mounted on a phantom head with paraffin wax. Each student performed the two methods of biomechanical preparation taught: manual and rotary instrumentation, and later evaluated the training in terms of confidence and preparation for clinical exposure.&#x0D; Result: Twenty-one (53.9%) students within the age range of 23 to 30 years and a mean age of 25.4±1.7years completed the program. The majority, (81%) of the participants claimed the hands-on demonstration was very helpful in performing the procedure, and all submitted it will help their confidence during clinical exposure to RCT. The participants further suggested the incorporation of training into the regular school program.&#x0D; Conclusion: The laboratory endodontic hands-on training was accepted by all the participants, and it was opined that it will boost their confidence in performing the procedure in the clinic.

Attitudes of Asian and Polish Adolescents towards the Use of Ecological Innovations in CPR Training.

The potential use of manikins made of environmentally friendly materials (biodegradable or easily recycled) could be a milestone in promoting cardiac arrest awareness and mass resuscitation training without the threat of generating large amounts of unprocessable waste. The main aim of the study was to compare the attitude of young adults from Asia and Poland towards cardiopulmonary resuscitation training forms and to evaluate the innovative concept of an ecological resuscitation manikin; Methods: This was a survey-based study conducted during two events in Thailand and Poland in 2023; Results: A total of 226 questionnaires were included in the final analysis. Asian respondents were significantly more likely to choose traditional training than Polish participants (78% vs. 58%, respectively). A manikin that is mainly biodegradable was the most common choice across the entire study group. Young Asians were significantly more likely to choose a traditional stationary course, while Polish respondents were highly significantly more likely to opt for hybrid training (online with practical training provided at the student's home). In the total study group, young people from Poland and parts of Asia are most likely to participate in traditional on-site instructor-led training, but a comparison across groups showed a significant tendency for young Poles to choose a hybrid training option, i.e., a combination of online and hands-on training. Despite some differences, both study groups showed a strong interest in pro-environmental behavior and the use of more ecofriendly solutions than previously used in resuscitation training.

Evaluating the use of role-play simulations in teaching management of medical emergencies in the dental clinic

BackgroundPractical hands-on training is necessary for clinical competence in managing medical emergencies in the dental setting. Therefore, the King Abdulaziz University Faculty of Dentistry developed a role-play simulation-based clinical module for training clinical years (Years 4, 5, and 6) dental students in medical emergency management between 2016 and 2020. This study aimed to assess the knowledge and skills of years 4, 5, and 6 dental students before and after the completion of the role-play simulation-based medical emergency training module.MethodsA mandatory four-hour annual training module was designed consisting of a 45-minute lecture on the medical emergency basic action plan and overview, four hands-on stations, and six role-play simulation-based medical emergency stations. A 16-item multiple choice test was used to assess the knowledge of the students before and after the training module every academic year. An objective structured clinical exam (OSCE) on a medical emergency scenario was administered to the students graduating each year. The difference between the pre- and post-module test scores and the one-time OSCE pass/fail rate were analyzed statistically using appropriate tests.ResultsA total of 846 students participated in the study between 2017 and 2020: 275 once, 483 twice, 87 thrice, and one participated four times; in total, 1,506 assessments were conducted. Overall, the pre-test and post-test mean scores were 9.4 ± 3.0 and 13.5 ± 1.6, respectively. All students showed significant improvements in the post-test scores compared to the pre-test scores. Year 4 students showed the highest improvement, followed by Year 5 and Year 6. There was a statistically significant association between the pass/fail rate of the OSCE station and the number of times the module was taken.ConclusionsThe significant improvement in the scores of clinical year students in this study supports an annual mandate for all dental students to undergo simulation-based competency training in their clinical years. Teaching institutions are recommended to utilize simulation and hands-on instruction to teach medical emergency management.

Automated feedback for participants of hands-on cybersecurity training

Computer-supported learning technologies are essential for conducting hands-on cybersecurity training. These technologies create environments that emulate a realistic IT infrastructure for the training. Within the environment, training participants use various software tools to perform offensive or defensive actions. Usage of these tools generates data that can be employed to support learning. This paper investigates innovative methods for leveraging the trainee data to provide automated feedback about the performed actions. We proposed and implemented feedback software with four modules that are based on analyzing command-line data captured during the training. The modules feature progress graphs, conformance analysis, activity timeline, and error analysis. Then, we performed field studies with 58 trainees who completed cybersecurity training, used the feedback modules, and rated them in a survey. Quantitative evaluation of responses from 45 trainees showed that the feedback is valuable and supports the training process, even though some features are not fine-tuned yet. The graph visualizations were perceived as the most understandable and useful. Qualitative evaluation of trainees’ comments revealed specific aspects of feedback that can be improved. We publish the software as an open-source component of the KYPO Cyber Range Platform. Moreover, the principles of the automated feedback generalize to different learning contexts, such as operating systems, networking, databases, and other areas of computing. Our results contribute to applied research, the development of learning technologies, and the current teaching practice.

Feasibility and Accuracy of Nanopore Transcriptome Sequencing for Pediatric Acute Leukemia Lineage Classification in a Resource-Constrained Setting

Introduction: Gene expression profiling (GEP) has the potential to offer alternative approaches to conventional testing methodologies (flow cytometry, immunohistochemistry, karyotyping, and FISH) for cancer diagnostics. Possible advantages of this approach include unified protocols, automated analyses obviating high-end technical expertise, and perhaps lower training, capital, and skilled human resource requirements in comparison with complex traditional testing. These factors are of particular value in resource-constrained settings, where even leukemia lineage classification is unavailable or inconsistent in many locations, with critical implications for risk stratification and treatment selection. The goals of this study were to (a) ascertain and subsequently improve the accuracy of a lineage classifier in a different context than the pre-testing stage, and (b) determine feasibility of mRNA sequencing for cancer classification in a low-resource setting. The approach utilized PCR-amplified full-length cDNA sequencing using Oxford Nanopore Technologies (ONT) PCR-cDNA barcoding kit (SQK-PCB109) and MinION Mk1b. Methods: One hundred and ten pediatric acute leukemia specimens were collected and sequenced at Indus Hospital &amp; Health Network (IHHN), Karachi, Pakistan and analyzed at the University of North Carolina at Chapel Hill (UNC), USA. Specimens (isolated peripheral blood and / or bone marrow mononuclear cells), frozen in liquid nitrogen or Zymo DNA/RNA shield at -80 oC, were acquired from IHHN's pediatric biorepository. Specimen-associated data included clinical history, CBC, flow cytometry, FISH and karyotyping results from routine clinical testing at the IHHN's ISO 15189-accredited clinical laboratory. The study site did not have prior experience with NGS and did not require external hands-on training for this project. 100 ng of extracted RNA from each of 48 B-ALL, 30 T-ALL, 31 AML, and 1 mixed phenotype acute leukemia specimens was used to prepare libraries. Sequencing data were transferred to UNC and analyzed with an acute leukemia lineage classification algorithm. Results: Following delivery of reagents and equipment, a 6-week protocol optimization and self-training phase utilized open-source protocols and training videos. The next runs to sequence 110 specimens were completed in 4 months by 2 technical staff at the study site. Using a probability threshold for confident calling (&amp;gt;0.8), established during the development phase at UNC, 91 of 110 specimens (82.7%) were called with high confidence. Of the confident calls, 85 were correctly classified (42 B-ALL, 21 T-ALL, and 22 AML), representing an accuracy of 93.4%. The read N50 of confidently classified, concordant specimens ranged from 270 to 745. The total number of reads ranged from 10,000 to &amp;gt;900,000, while the number of aligned reads ranged from 5,000 to 1.5 million. On the other hand, 6 (6.6%) confidently called specimens were discordant. Of these, the mixed phenotype specimen was classified as AML, but mixed phenotype acute leukemia is not included in our training dataset. One misclassified T-ALL specimen had a read count below 10,000 - a threshold demonstrated in the development phase to be optimal for correct classification. Two additional misclassified samples had very low diversity of transcripts express, which is a quality indicator in development. Read counts of these specimens ranged from 22,000 to 311,000, while aligned reads were between 10,000 and 293,000. Further investigation of these discordant calls is ongoing. Low confidence calls (17% of total), with a classification probability between less than 0.8, were either concordant (13) or discordant (6). Further investigation and retesting of these specimens to ascertain reproducibility of low confidence calls has not been performed yet. Conclusions: Taken together, the approach tested - with automated analysis, limited space, training and technical staffing requirements - was feasible at the study site. It provides proof of concept for a low-cost, ONT sequencing based GEP approach for acute leukemia diagnostics whereby testing can be performed in peripheral laboratories while analysis can be centralized, even across continents. Next steps include (a) incorporating these data into a new training model with updated quality control parameters for the next validation run, and (b) developing the genomic subtype classification results.

Assessing the Feasibility, Acceptability, and Appropriateness of Implementation Strategies Developed to Support an Enhanced Oral Anticancer Agent Adherence Intervention in Academic, Rural Community, and Urban Community Cancer Settings

Background : Oral anticancer agents (OAAs) have changed oncologic treatment and improved patient outcomes in clinical trials (adherence ≥90%), but due to lack of monitoring, side effects, cost, and forgetfulness, benefits have not translated into practice where adherence rates are~ 40%. Our team designed an effective adherence intervention and worked with a stakeholder panel to develop implementation strategies. Overall, we developed 6 distinct strategies for adoption (data driven presentation for program leaders and formal agreement materials), implementation (motivational interviewing (MI) provider course and standard operating procedure (SOP)), and maintenance (key performance indicators (KPIs) and electronic health record (EHR)-integrated adherence assessment) using focus group discussions with clinicians and administrators. Here we use clinician surveys to assess feasibility, acceptability, and appropriateness of strategies. Methods : We administered surveysto establish feasibility, acceptability, and appropriateness of implementation strategies of a medication adherence intervention for OAAs. We adapted surveys using Weiner et. al.'s 2017 psychometric assessment of newly developed implementation outcomes that assigns 15 domains amongst constructs of feasibility, acceptability, and appropriateness to evaluate implementation effort success. The assessment was adapted to make it relevant to the OAA intervention. Participants were queried about feasibility (if it was possible, implementable, doable, easy), appropriateness (if it was a good match, good fit, applicable, suitable), or acceptability (if it was welcome, liked, showed acceptability). Participants rated agreement that implementation strategies exhibited domain characteristics using 5-point Likert scale- 1 (strongly disagree) to 5(strongly agree). Participants also answered open-ended questions by indicating their favorite aspects and suggested recommendations for each strategy. We pilot tested the survey with an advisory panel and edited it using feedback received prior to administration. We performed descriptive statistics for all findings. Results : We administered a survey to hematology and oncology clinicians (n=33) in academic medical centers (n=23), rural community-based centers (n=2), and urban community-based centers (n=7), (no response, n=1). Survey response rate was 31.4%. There were high rates of agreement on the feasibility of SOPs, data driven presentation, and EHR-integrated assessments with 89%, 82%, and 95% of participants indicating a score of ≥4 on a 5-point Likert scale, respectively. There were a moderate rates of agreement on feasibility of KPIs (75%), formal agreement materials (66%), and MI course (50%). There were high rates of agreement on the appropriateness of SOPs, data driven presentations, EHR-integrated assessments, and KPIs with 89%, 93%, 93%, and 82% of participants indicating a score of ≥4 on a 5-point Likert scale, respectively. There were moderate rates of agreement for the MI course (77%) and formal agreement materials (66%). There were high rates of acceptability on data driven presentations, EHR-integrated assessments, KPIs (94-98%), and moderate rates of acceptability on SOPs, formal agreement materials and MIs (67% for all items) as indicated by a score of ≥4 on a 5-point Likert scale. Strategy components that showed a high rate of agreement from participants for inclusion are summarized in Table 1. Participants' favorite part of the presentation was benefit explanation, but they wanted brevity. They appreciated formal agreement for strategic accountability but feared negative consequences. SOPs provides clear roles and helpful diagrams but no flexibility. Participants felt KPIs identify financial impact, but ED visits should be excluded. MI was found effective, but without the hands-on training component. Smart forms were needed for discrete data but difficult to operate. Conclusions :There were moderate to high levels of agreement on most strategies designed to mitigate barriers to implementation of an OAA intervention. Formal agreement materials and motivational interviewing course were shown to be less appropriate and feasible than other strategies. Efforts must be focused on maintaining brevity, highlighting benefit, and clearly defining clinician roles.

Toxicometabolomics as a tool for next generation environmental risk assessment.

Traditionally applied methodology in environmental risk assessment (ERA) has fallen out of step with technological advancements and regulatory requirements, challenging effectiveness and accuracy of the assessments. Extensive efforts have been focused towards a transition to a more data-driven and mechanistically-based next generation risk assessment. Metabolomics can produce detailed and comprehensive molecular insight into affected biochemical processes. Combining metabolomics with environmental toxicology can help to understand the mechanisms and/or modes of action underlying toxicity of environmental pollutants and inform adverse outcome pathways, as well as facilitate identification of biomarkers to quantify effects and/or exposure. This Technical Report describes the activities and work performed within the frame of the European Food Risk Assessment Fellowship Programme (EU-FORA), implemented at the section 'Environmental Chemistry and Toxicology' at the Department of Environmental Science at Aarhus University in Denmark with synergies to an ongoing H2020 RIA project 'EndocRine Guideline Optimisation' (ERGO). In accordance with the 'training by doing' principles of the EU-FORA, the fellowship project combined the exploration of the status of scientific discussion on methodology in ERA through literature study with hands-on training, using the metabolomics analysis pipeline established at Aarhus University. For the hands-on training, an amphibian metamorphosis assay (OECD test no.231) was used as a proof-of-concept toxicometabolomics study case. Both a targeted biomarker - and an untargeted metabolomics approach was applied.

Evaluating Autism diagnosis agreement between primary care physicians/practitioners and experts through ECHO Autism STAT

BackgroundEven though early intervention leads to improved outcomes for children with autism spectrum disorder (ASD), delays in diagnosis can have an impact on both children and families. ASD diagnostic practices have significantly evolved over time, in part, because of the lack of specialists to meet the demand. ECHO Autism STAT is one innovative model that increased the capacity of community primary care providers (PCPs) to reliably diagnose ASD within their own practices via hands-on training and virtual guidance and support from ASD specialists. The current study evaluated PCPs agreement with ECHO Autism experts in making independent clinical decisions related to ASD diagnosis in unambiguous cases. MethodAfter obtaining reliability on the STAT and attending 6 mo of ECHO Autism sessions, PCPs agreement with expert impressions was evaluated for (a) diagnosing unambiguous ASD and (b) identifying symptoms that met DSM-5 criteria. ResultsThe proportion of cases that achieved the highest PCP agreement score with ASD experts for overall ASD diagnostic impressions was 90% across all cases, 94% across unambiguous cases, and 84% across more complex cases. PCP agreement for DSM-5 symptom impressions was 79%, 87%, and 66% across all, unambiguous, and more complex cases, respectively. Results were significant for unambiguous cases when compared to more complex cases. ConclusionsPCPs can develop clinical expertise in the evaluation and diagnosis of young children with unambiguous ASD that is accurate and reliable. Development of this expertise can expand access for community-based diagnosis that is critical for early detection of ASD.

Mainstreaming Real Estate Education on Mandated Courses, Current Strategy and Structure: A Proximity Analysis

This study dived into the importance of mainstreaming real estate education in mandated courses and analyses the current strategies and structures utilized for this purpose. The goal of this proximity analysis was to determine the effectiveness of these strategies and structures in improving the knowledge and skillset of professionals in the field. The study used a mixed-methods approach, combining quantitative and qualitative data from various sources. The findings of this study provide insights into the current state of real estate education in mandated courses and suggest potential improvements to enhance the learning outcomes of professionals in the field. The study recommends the following to mainstream real estate education mandated courses and improve the education system: an online learning platform, more practical and hands-on training, mentorship programs, continuing education and professional development opportunities, and increased emphasis on real estate ethics and standards.

Healthcare professionals' perspectives on optimizing pain care-related education at a Canadian children's hospital: A qualitative study.

Pain affects all children and youth, yet acute and procedural pain remains undertreated in Canadian hospitals. To improve pain management practices in paediatric hospitals, it is necessary to understand how healthcare professionals (HCPs) wish for educational interventions to be designed to improve their pain management practice. Semi-structured interviews were conducted with 18 HCPs between October and December 2020. Snowball sampling was used to first recruit interested members from the hospital's Pediatric Pain Management Committee. Interviews were conducted per participant preference and included Zoom, telephone, and in-person interviews. Recruitment ceased when data were determined sufficiently rich. A thematic analysis of verbatim transcripts and reflexive field notes were used to create a data set focused on knowledge mobilization and clinical education. Three core themes were identified: (a) the necessity for just-in-time education for HCPs; (b) the availability of clinical pain champions to educate staff; and (c) the provision of resources to educate children and their families about available pain management interventions. Just-in-time education included suggestions for in-service training, hands-on training, and regular updates on the latest research. Pain champions, including clinical nurse educators, were stressed as being important in motivating staff to improve their pain management practices. Participants noted the lack of resources for patient and family education on pain management and suggested providing more multimodal resources and educational opportunities. Having local champions introduce pain management initiatives and just-in-time education positively impacts the implementation climate, which also helps HCPs provide evidence-based education and resources to patients and families.

Optimization of vocational education learning in pandemic times with a modified blended learning system and appropriate technology

The blended/hybrid learning system is a way that can be done today with adjustments to the conventional side with the application of health protocols. Utilizing and optimizing hybrid learning by modifying and utilizing appropriate technology will provide learning solutions during a pandemic. Hybrid learning does not have to be a monopoly and ignores conventional learning. Conventional learning must also be modified according to the protocol carefully so that it remains effective. The use of appropriate technology also needs to be specifically encouraged for teachers. ICT is a shared hope, although it is undeniable that for vocational training there must be hands-on practice and training. To optimize learning with various approaches, it must still lead to effectiveness, efficiency and relevance to the object of students. Learning in vocational education has characteristics that need to be studied in more detail so that quality is maintained. In this study, the choice of surveys on students for learning options with blended learning, with a comparison of 60% conventional and 40% ICT/Online, Appropriate Technology, and combinations obtained an average result of 22.5%, 17.75%, 13 .5 % and 6.25%, (a survey of students, students, teachers and lecturers for the even semester of 2020/2021) within the scope of Unima and its surroundings. The results of a survey of students, both students, students or teachers and lecturers show that there is no full readiness in choosing various alternatives, software and hardware readiness is still needed for students and teachers in particular so that the implementation of education can be more varied in choosing alternatives and achieving the desired goals. The conclusions of this study are: Online or blended learning cannot be applied optimally in Vocational High Schools / Vocational Schools, besides the reason that it still needs face-to-face practice and training, the infrastructure is still not supported. The results of the survey on student lecturers as a comparison are generally still constrained by many things, including facilities and human resources. On the other hand, in vocational education learning the whole process&#x0D; must consider practice or training which means there must be limited face-to-face or group meetings. Optimizing conventional learning according to the process and blended learning must pay attention to the readiness of students including the learning environment, namely external factors and students' mental readiness, internal. For optimization so that the quality of learning is not neglected, it is necessary to consider the existence of practice and training in subjects related to practice or which require training. Some suggestions are: There is a need for the role of the government, and education stakeholders if learning is still in a pandemic period. For students and teachers, it is necessary to have adequate support facilities. Various learnings can be done if there is an equitable fulfilment of educational infrastructure. Practice facilities in SMK need to be expanded so that the groups are getting smaller and reaching more students. The practicum package needs to be made simpler with adjustments according to the process. Keywords: Optimizing Learning during the Pandemic.

The use of simulation-based learning to increase the confidence level of oncology advanced practice providers when discussing palliative care.

265 Background: The increase in cancer cases globally has dramatically strengthened the need in introducing palliative care upon a cancer diagnosis. Oncology advanced practice providers (APPs) are essential in integrating palliative care concurrently with treatment. SinceAPPs have limited to no hands-on training in palliative care, they often feel unprepared and less confident in discussing palliative care with cancer patients, resulting in a gap in care. This can result in a decreased in quality of life (QoL), absence of symptom management, increased healthcare costs and usage of healthcare resources, increased emergency room visits and hospital admissions. This quality improvement (QI) project sought to increase the confidence level of APPs, when discussing palliative care using simulation-based training in an effort to address this educational gap and provide palliative care support alongside standard of care. Methods: The project utilized a sample of 15 APPs working in an academic outpatient oncology facility. Participants completed a pre-and post-survey consisting of 12 Likert-type questions to measure their confidence level in palliative care before and after the simulation training session. Simulation-based learning with standardized participants (SPs) was utilized to increase the confidence level of APPs in the outpatient oncology setting. A pancreatic cancer patient case was utilized for the simulation. The Wilcoxon’s signed-rank test was used to compare the results of the pre and post test scores. Results: The results showed positive changes between the pre- and post-survey results in confidence level. Post-survey results were statistically significant (p value of &lt; 0.05) and respondents reported greater confidence following the simulation-based training. Referrals also increased to palliative care post simulation. Conclusions: Palliative care simulation with SPs closed educational gaps and improved the APPs confidence levels when discussing palliative care with cancer patients. As a result, simulation-based learning is an effective strategy to train newly hired oncology APPs or enhance skill deterioration as needed to integrate palliative care concurrently with treatment as the standard for cancer patients. Furthermore, from this QI project, a computer-based module was developed for new oncology APPs onboarding to the organization. Future directions are to expand to non-oncology APPs that directly care for cancer patients.