Hours Of Skills Training Research Articles

Skills-Building Programs to Reduce Child Marriage in Bangladesh: A Randomized Controlled Trial

PurposeChild marriage is the norm in Bangladesh, leading to lifelong negative consequences. Evidence on sustainable child marriage programs is scant. Our study aimed to evaluate the impact of three community-based skills-building programs to delay child marriage among adolescent girls in rural Bangladesh. MethodsThe study used a cluster randomized controlled trial design with four arms—ARM1 offered educational support, ARM2 promoted gender rights awareness, ARM3 offered livelihoods training, and ARM4 was a control area. All adolescent girls were offered 144 hours of skills training in village centers over 18 months. Among 11,609 baseline survey respondents, 91% were successfully included in the endline analysis. Program impact was assessed using discrete time hazard models. ResultsThe program reduced child marriages (<18) significantly in all arms relative to control—(adjusted hazard ratio [AHR]: .75; 95% confidence interval [CI]: .60–.92) for the education arm, (AHR: .72; 95% CI: .59–.88) for the gender arm, and (AHR: .70; 95% CI: .56–.87) for the livelihoods arm. Program participants were younger and more likely to be in school and faced lower risk of marriage relative to nonparticipants. In the gender and livelihoods arm, nonparticipants had lower risk of child marriage relative to the control group significant at the 10% level. ConclusionsThe study demonstrates it is possible to reduce the prevalence of child marriage in a relatively short period of time by working with communities to implement holistic programs to build skills among girls. The program had similarly large impact and did not depend on the type of skills offered.

Surgical Skills Acquisition: Performance of Students Trained in a Rural Longitudinal Integrated Clerkship and Those From a Traditional Block Clerkship on a Standardized Examination Using Simulated Patients

ObjectivesRural longitudinal integrated clerkship (LIC) programs for third-year medical students provide strong educational curricula and can nurture interest in rural surgical practice. Students learn technical skills in an apprenticeship model. Variability in instruction and patient experiences across sites, coupled with a lack of simulation facilities, raise some concerns about technical skill development. To explore the adequacy of skills acquisition for students in the University of Minnesota Rural Physician Associate Program (RPAP), this study compared RPAP students’ performance on a scenario-based Objective Structured Assessment of Technical Skills (OSATS) with that of traditional surgery block clerkship students (Course 7500). Design, Setting, and ParticipantsThis is a nonexperimental post-only study. All enrolled students (n = 254) completed the OSATS examination. Students in the Course 7500 (n = 222) completed 15 hours of simulation skills training and supervised practice during their 6-week clerkship. RPAP students (n = 32) completed 3 hours of skills training before their 9-month rural assignment. Both groups had access to comprehensive online materials. Mean OSATS checklist, global rating, and total scores were compared at the end of training using t tests (p < 0.05). Self-reported OR and clinical experiences were explored. ResultsBoth groups did well on the OSATS. There were no statistical differences in completion time, checklist scores, mean global ratings, or total scores. RPAP students reported significantly more days in the OR, surgery cases, and first assists. Experience with OSATS tasks reported by RPAP students during clinical rotations correlated with their OSATS performance. ConclusionThis study supports the viability of the LIC model for fundamental skills acquisition when augmented with introductory simulation skills training and online resources. It also suggests that simulation fills a training gap for students in a traditional surgery block clerkship program. It opens a dialog about the potential partnership of surgery departments with rural LICs to address rural general surgery shortages. Further research in this aspect is needed.