Improve Skill Acquisition Research Articles

Just-in-time adaptive interventions: A novel approach for enhancing skill utilization and acquisition in cognitive behavioral therapy for eating disorders.

The most widely researched treatment for bulimia nervosa (BN) and binge-eating disorder (BED) is cognitive behavioral therapy (CBT), a present-focused, active, skill-oriented treatment. However, despite the success of CBT, many patients fail to achieve sufficient rates of skill utilization (i.e., the frequency with which a patient practices or uses therapeutic skills) or adequate skill acquisition (i.e., the ability to successfully perform a skill learned in treatment) by the end of treatment and outcomes suffer as a result. One method for improving skill acquisition and utilization in patients with BN or BED could be the augmentation of in-person treatment with just-in-time adaptive interventions (JITAIs), which use smartphone technology to deliver real-time interventions during app-identified moments of need. The current article discusses how novel JITAI systems that utilize machine learning or other predictive algorithms could be used to detect momentary risk for eating disordered behavior and provide tailored interventions to enhance outcomes. We will consider technologies that may help reduce patient burden and suggest avenues for future research on developing acceptable and effective JITAIs that can be used as an adjunct to CBT protocols.

Deliberate practice using validated metrics improves skill acquisition in performance of ultrasound-guided peripheral nerve block in a simulated setting

Study objectivesThe aim of this study was to compare the effects of deliberate vs. self-guided practices (both using validated metrics) on the acquisition of needling skills by novice learners. DesignRandomized Controlled Study. SettingSimulation lab, Department of Anesthesia, St.Vincent's Hospital, Dublin. SubjectsEighteen medical students. InterventionsStudents were assigned to either (i) deliberate practice (n = 10) or (ii) self-guided practice (n = 8) groups. After completion of a ‘learning phase’, subjects attempted to perform a predefined task, which entailed advancing a needle towards a target on a phantom gel under ultrasound guidance. Subsequently, all subjects practiced this task using predefined metrics. Only subjects in the deliberate practice group had an expert anesthesiologist during practice. Immediately after completing ‘practice phase’, all subjects attempted to perform the same task, and, on the following day, made two further attempts in succession. Two trained consultant anesthesiologists assessed a video of each performance independently using the pre-defined metrics. MeasurementsNumber of procedural steps completed and number of errors made. Main resultsCompared with novices who self-guided their practice using metrics, those who undertook expert-supervised deliberate practice using metrics completed more steps (performance metrics) immediately after practice (median [range], 14.5 [12–15] vs. 3 [1–10], p < 0.0001) and 24 h later (15 [12–15] vs. 4.5 [1–11], p < 0.0001 and 15 [11–15] vs. 4 [2–14], p < 0.0001). They also made fewer errors immediately after practice (median [range], 0 [0–0] vs. 5 [3–8], p < 0.0001) and 24 h later, (0 [0–3] vs. 6.5 [3–8], p < 0.0001 and 0 [0–3] vs. 4 [2–7], p < 0.0001). ConclusionCombining deliberate practice with metrics improved acquisition of needling skills.

Somatosensory electrical stimulation improves skill acquisition, consolidation, and transfer by increasing sensorimotor activity and connectivity.

The interaction between the somatosensory and motor systems is important for normal human motor function and learning. Enhancing somatosensory input using somatosensory electrical stimulation (SES) can increase motor performance, but the neuronal mechanisms underlying these effects are largely unknown. With EEG, we examined whether skill acquisition, consolidation, and interlimb transfer after SES was related to increased activity in sensorimotor regions, as assessed by the N30 somatosensory evoked potential or rather increased connectivity between these regions, as assessed by the phase slope index (PSI). Right- and left-hand motor performance and EEG measures were taken before, immediately after, and 24 h ( day 2) after either SES ( n = 12; 5 men) or Control ( n = 12; 5 men). The results showed skill acquisition and consolidation in the stimulated right hand immediately after SES (6%) and on day 2 (9%) and interlimb transfer to the nonstimulated left hand on day 2 relative to Control (8%, all P < 0.05). Increases in N30 amplitudes correlated with skill acquisition while PSI from electrodes that represent the posterior parietal and primary somatosensory cortex to the electrode representing the primary motor cortex correlated with skill consolidation. In contrast, interlimb transfer did not correlate with the EEG-derived neurophysiological estimates obtained in the present study, which may indicate the involvement of subcortical structures in interlimb transfer after SES. In conclusion, weak peripheral somatosensory inputs in the form of SES improve skill acquisition, consolidation, and interlimb transfer that coincide with different cortical adaptations, including enhanced N30 amplitudes and PSI. NEW & NOTEWORTHY The relationship between adaptations in synaptic plasticity and motor learning following somatosensory electrical stimulation (SES) is incompletely understood. Here, we used for the first time a multifactorial approach that examined skill acquisition, consolidation, and interlimb transfer following 20 min of SES. In addition, we quantified sensorimotor integration and the magnitude and direction of connectivity with EEG. Following artificial electrical stimulation, increases in sensorimotor integration and connectivity were found to correlate with skill acquisition and consolidation, respectively.

Easy-to-learn cardiopulmonary resuscitation training programme: a randomised controlled trial on laypeople's resuscitation performance.

Simplifying the learning of cardiopulmonary resuscitation (CPR) is advocated to improve skill acquisition and retention. A simplified CPR training programme focusing on continuous chest compression, with a simple landmark tracing technique, was introduced to laypeople. The study aimed to examine the effectiveness of the simplified CPR training in improving lay rescuers' CPR performance as compared to standard CPR. A total of 85 laypeople (aged 21-60 years) were recruited and randomly assigned to undertake either a two-hour simplified or standard CPR training session. They were tested two months after the training on a simulated cardiac arrest scenario. Participants' performance on the sequence of CPR steps was observed and evaluated using a validated CPR algorithm checklist. The quality of chest compression and ventilation was assessed from the recording manikins. The simplified CPR group performed significantly better on the CPR algorithm when compared to the standard CPR group (p < 0.01). No significant difference was found between the groups in time taken to initiate CPR. However, a significantly higher number of compressions and proportion of adequate compressions was demonstrated by the simplified group than the standard group (p < 0.01). Hands-off time was significantly shorter in the simplified CPR group than in the standard CPR group (p < 0.001). Simplifying the learning of CPR by focusing on continuous chest compressions, with simple hand placement for chest compression, could lead to better acquisition and retention of CPR algorithms, and better quality of chest compressions than standard CPR.

The Effectiveness of Medical Simulation in Teaching Medical Students Critical Care Medicine

We aimed to assess effectiveness of simulation for teaching medical students critical care medicine and to assess which simulation methods were most useful. We searched AMED, EMBASE, MEDLINE, Education Resources Information Centre, British Education Index, Australian Education Index, and bibliographies and citations, in July 2013. Randomized controlled trials comparing effectiveness of simulation with another educational intervention, or no teaching, for teaching medical students critical care medicine were included. Assessments for inclusion, quality, and data extraction were duplicated and results were synthesized using meta-analysis.We included 22 randomized control trials (n = 1325). Fifteen studies comparing simulation with other teaching found simulation to be more effective [standardized mean difference (SMD) = 0.84; 95% confidence interval (CI) = 0.43 to 1.24; P < 0.001; I = 89%]. High-fidelity simulation was more effective than low-fidelity simulation, and subgrouping supported high-fidelity simulation being more effective than other methods. Simulation improved skill acquisition (SMD = 1.01; 95% CI = 0.49 to 1.53) but was no better than other teaching in knowledge acquisition (SMD = 0.41; 95% CI = -0.09 to 0.91).

Critical conversations in gynecologic oncology: Pilot study of communication skills training for fellows and advanced practice providers.

29 Background: Good communication is crucial to good patient care. Gynecologic oncology providers often face challenging communication scenarios, including giving serious news and discussing goals of care. Communication skills training (CST) has been shown to improve skill acquisition among providers of multiple specialties, but it has not been described in providers from gynecologic oncology or any surgical oncology specialty. Methods: We conducted a two-day CST workshop, based on the VitalTalk© model, with four faculty members (2 gynecologic oncologists and 2 palliative care physicians) and 10 gynecologic oncology provider participants (5 fellows and 5 advanced practice providers). Using didactics, demonstrations and practice sessions with simulated patients we focused on giving serious news and discussing goals of care. Pre and immediate post-workshop surveys evaluated acceptability of the workshop, perceived impact of preparedness to address challenging communication scenarios and anticipated impact on clinical practice. We compared pre and post-workshop prevalence of score of 4 or 5 out of 5 on a Likert scale for preparedness to handle 14 challenging communication scenarios. Results: Participants reported statistically significant increase in preparedness to handle 13 out of 14 challenging communication scenarios. Among those 13 topics, magnitude of improvement in proportion of participants rating preparedness 4 or 5 out of 5 ranged from 40-100% (all p &lt; 0.05). All participants would recommend the course to others and all strongly agreed that this training should be required of all gynecologic oncology clinicians. Conclusions: Participants felt strongly that the workshop provided high quality education relevant to their practice. As a result of the workshop, participants reported statistically significantly increased preparedness to handle challenging communication scenarios. CST is feasible and has high perceived effectiveness for clinicians in the primarily surgical oncologic specialty of gynecologic oncology.

The use of head-mounted display eyeglasses for teaching surgical skills: A prospective randomised study

PurposeTo investigate whether ‘surgeon's eye view’ videos provided via head-mounted displays can improve skill acquisition and satisfaction in basic surgical training compared with conventional wet-lab teaching. MethodsA prospective randomised study of 14 medical students with no prior suturing experience, randomised to 3 groups: 1) conventional teaching; 2) head-mounted display-assisted teaching and 3) head-mounted display self-learning. All were instructed in interrupted suturing followed by 15 minutes' practice. Head-mounted displays provided a ‘surgeon's eye view’ video demonstrating the technique, available during practice. Subsequently students undertook a practical assessment, where suturing was videoed and graded by masked assessors using a 10-point surgical skill score (1 = very poor technique, 10 = very good technique). Students completed a questionnaire assessing confidence and satisfaction. ResultsSuturing ability after teaching was similar between groups (P = 0.229, Kruskal-Wallis test). Median surgical skill scores were 7.5 (range 6–10), 6 (range 3–8) and 7 (range 1–7) following head-mounted display-assisted teaching, conventional teaching, and head-mounted display self-learning respectively. There was good agreement between graders regarding surgical skill scores (rho.c = 0.599, r = 0.603), and no difference in number of sutures placed between groups (P = 0.120). The head-mounted display-assisted teaching group reported greater enjoyment than those attending conventional teaching (P = 0.033). Head-mounted display self-learning was regarded as least useful (7.4 vs 9.0 for conventional teaching, P = 0.021), but more enjoyable than conventional teaching (9.6 vs 8.0, P = 0.050). ConclusionsTeaching augmented with head-mounted displays was significantly more enjoyable than conventional teaching. Students undertaking self-directed learning using head-mounted displays with pre-recorded videos had comparable skill acquisition to those attending traditional wet-lab tutorials.

Capacity to improve fine motor skills in Williams syndrome.

Individuals with Williams syndrome (WS) are known to have difficulties in carrying out fine motor movements; however, a detailed behavioural profile of WS in this domain is still missing. It is also unknown how great the capacity to improve these skills with focused and extensive practice is. We studied initial performance and learning capacity in a sequential finger tapping (FT) task in WS and in typical development. Improvement in the FT task has been shown to be sleep dependent. WS subjects participating in the current study have also participated in earlier polysomnography studies, although not directly related to learning. WS participants presented with great individual variability. In addition to generally poor initial performance, learning capacity was also greatly limited in WS. We found indications that reduced sleep efficiency might contribute to this limitation. Estimating motor learning capacity and the depth of sleep disorder in a larger sample of WS individuals might reveal important relationships between sleep and learning, and contribute to efficient intervention methods improving skill acquisition in WS.

Targeting alertness to improve cognition in older adults: A preliminary report of benefits in executive function and skill acquisition

Efficient self-regulation of alertness declines with age exacerbating normal declines in performance across multiple cognitive domains, including learning and skill acquisition. Previous cognitive intervention studies have shown that it is possible to enhance alertness in patients with acquired brain injury and marked attention impairments, and that this benefit generalizes to improvements in more global cognitive functions. In the current preliminary studies, we sought to test whether this approach, that targets both tonic (over a period of minutes) and phasic (moment-to-moment) alertness, can improve key executive functioning declines in older adults, and enhance the rate of skill acquisition. The results of both Experiments 1 and 2 demonstrate that, compared to active control (AC) training, alertness training significantly enhanced performance in several validated executive function measures. In Experiment 2, alertness training significantly improved skill acquisition compared to AC training in a well-characterized speed of processing (SOP) task, with the largest benefits shown in the most challenging SOP blocks. The results of the current study suggest that targeting intrinsic alertness through cognitive training provides a novel approach to improve executive functions in older adults and may be a useful adjunct treatment to enhance benefits gained in other clinically validated treatments.

Is There Bias against Simulation in Microsurgery Training?

Background While other surgical specialties have embraced virtual reality simulation for training and recertification, microsurgery has lagged. This study aims to assess the opinions of microsurgeons on the role of simulation in microsurgery assessment and training. Methods We surveyed faculty members of the American Society of Reconstructive Microsurgery to ascertain opinions on their use of simulation in training and opinions about the utility of simulation for skills acquisition, teaching, and skills assessment. The 21-question survey was disseminated online to 675 members. Results Eighty-nine members completed the survey for a 13.2% response rate. Few microsurgeons have experience with high-fidelity simulation, and opinions on its utility are internally inconsistent. Although 84% of respondents could not identify a reason why simulation would not be useful, only 24% believed simulation is a useful measure of clinical performance. Nearly three-fourths of respondents were skeptical that simulation would improve their skills. Ninety-four percent had no experience with simulator-based assessment. Conclusion Simulation has been shown to improve skills acquisition in microsurgery, but our survey suggests that unfamiliarity may foster bias against the technology. Failure to incorporate simulation may adversely affect training and may put surgeons at a disadvantage should these technologies be adopted for recertification by regulatory agencies.

Learning with Technology: Video Modeling with Concrete-Representational-Abstract Sequencing for Students with Autism Spectrum Disorder.

The purpose of this study was to determine the effectiveness of a video modeling intervention with concrete-representational-abstract instructional sequence in teaching mathematics concepts to students with autism spectrum disorder (ASD). A multiple baseline across skills design of single-case experimental methodology was used to determine the effectiveness of the intervention on the acquisition and maintenance of addition, subtraction, and number comparison skills for four elementary school students with ASD. Findings supported the effectiveness of the intervention in improving skill acquisition and maintenance at a 3-week follow-up. Implications for practice and future research are discussed.

Validation of a Novel Virtual Reality Training Curriculum for Robotic Cardiac Surgery: A Randomized Trial.

Robotic cardiac surgery training has relied entirely on classical methods of surgical teaching. We sought to evaluate the impact of a virtual reality (VR) simulation curriculum to improve skill acquisition in robotic cardiac surgery. We randomly assigned 20 surgical trainees to undergo a 9-exercise VR curriculum on a robotic surgical simulator or a control group that received no additional training. The trainees were then evaluated in a blinded fashion by assessing their de-identified video recordings of the following: (1) standardized robotic internal thoracic artery harvest and (2) mitral valve annuloplasty performed in porcine models, using a validated time-based scoring system and an objective intraoperative scoring tool. Postintervention assessments were compared to baseline. Trainees randomized to the VR group were faster than the control group for both the internal thoracic artery harvest (957.3 ± 98.9 vs. 749.1 ± 171.9; P = 0.004) and mitral annuloplasty (580.4 ± 14.4 vs. 463.8 ± 86.4; P < 0.001) and scored significantly higher with the intraoperative scoring tool (22.8 ± 2.7 vs. 11.0 ± 4.5; P < 0.001). Additionally, the VR group achieved a proficiency level similar to our experts for both time-based scores (P = 0.624 and P = 0.967), and the intraoperative assessment (P = 0.110), whereas the control group was not able to meet this level of proficiency for any of the primary outcomes. The average duration of training to successfully complete all required tasks was 9.3 hours. We have demonstrated that a VR simulation curriculum can significantly improve the efficiency and quality of learning in robotic cardiac surgery. Further evaluation of this curriculum is required for its widespread implementation in surgical training (ClinicalTrials.gov, NCT#02357056).

Neurosurgical Assessment of Metrics Including Judgment and Dexterity Using the Virtual Reality Simulator NeuroTouch (NAJD Metrics).

Advances in computer-based technology has created a significant opportunity for implementing new training paradigms in neurosurgery focused on improving skill acquisition, enhancing procedural outcome, and surgical skills assessment. NeuroTouch is a computer-based virtual reality system that can generate output data known as metrics from operator performance during simulated brain tumor resection. These measures of quantitative assessment are used to track and compare psychomotor performance during simulated operative procedures. Data output from the NeuroTouch system is recorded in a comma-separated values file. Data mining from this file and subsequent metrics development requires the use of sophisticated software and engineering expertise. In this article, we introduce a system to extract a series of new metrics using the same data file using Excel software. Based on the data contained in the NeuroTouch comma-separated values file, 13 novel NeuroTouch metrics were developed and classified. Tier 1 metrics include blood loss, tumor percentage resected, and total simulated normal brain volume removed. Tier 2 metrics include total instrument tip path length, maximum force applied, sum of forces utilized, and average forces utilized by the simulated ultrasonic aspirator and suction instrument along with pedal activation frequency of the ultrasonic aspirator. Advanced tier 2 metrics include instrument tips average separation distance, efficiency index, ultrasonic aspirator path length index, coordination index, and ultrasonic aspirator bimanual forces ratio. This system of data extraction provides researchers expedited access for analyzing the data files available for NeuroTouch platform to assess the multiple psychomotor and cognitive neurosurgical skills involved in complex surgical procedures.

Emergency medicine residents' beliefs about contributing to an online collaborative slideshow.

Collaborative writing applications (CWAs), such as the Google DocsTM platform, can improve skill acquisition, knowledge retention, and collaboration in medical education. Using CWAs to support the training of residents offers many advantages, but stimulating them to contribute remains challenging. The purpose of this study was to identify emergency medicine (EM) residents' beliefs about their intention to contribute summaries of landmark articles to a Google DocsTM slideshow while studying for their Royal College of Physicians and Surgeons of Canada (RCPSC) certification exam. Using the Theory of Planned Behavior, the authors interviewed graduating RCPSC EM residents about contributing to a slideshow. Residents were asked about behavioral beliefs (advantages/disadvantages), normative beliefs (positive/negative referents), and control beliefs (barriers/facilitators). Two reviewers independently performed qualitative content analysis of interview transcripts to identify salient beliefs in relation to the defined behaviors. Of 150 eligible EM residents, 25 participated. The main reported advantage of contributing to the online slideshow was learning consolidation (n=15); the main reported disadvantage was information overload (n=3). The most frequently reported favorable referents were graduating EM residents writing the certification exam (n=16). Few participants (n=3) perceived any negative referents. The most frequently reported facilitator was peer-reviewed high-quality scientific information (n=9); and the most frequently reported barrier was time constraints (n=22). Salient beliefs exist regarding EM residents' intention to contribute content to an online collaborative writing project using a Google DocsTM slideshow. Overall, participants perceived more advantages than disadvantages to contributing and believed that this initiative would receive wide support. However, participants reported several barriers that need to be addressed to increase contributions. Our intention is for the beliefs identified in this study to contribute to the design of a theory-based questionnaire to explore determinants of residents' intentions to contribute to an online collaborative writing project. This will help develop implementation strategies for increasing contributions to other CWAs in medical education.

Role of virtual reality simulation in endoscopy training.

Recent advancements in virtual reality graphics and models have allowed virtual reality simulators to be incorporated into a variety of endoscopic training programmes. Use of virtual reality simulators in training programmes is thought to improve skill acquisition amongst trainees which is reflected in improved patient comfort and safety. Several studies have already been carried out to ascertain the impact that usage of virtual reality simulators may have upon trainee learning curves and how this may translate to patient comfort. This article reviews the available literature in this area of medical education which is particularly relevant to all parties involved in endoscopy training and curriculum development. Assessment of the available evidence for an optimal exposure time with virtual reality simulators and the long-term benefits of their use are also discussed.

Improving the skills training of the junior medical students can junior medical students attain a comparable skills competence to senior students?

Context: The system-based curriculum adopted at Alzaeim Alazhari University (AAU) (Sudan), entails integration of basic sciences, clinical knowledge and skills training during preclerkship period. Aim: The aim of this study was to illustrate how the utilization of the clinical skills laboratory (CSL) may improve the skills acquisition of preclerkship students and be assessed by Objective Structured Clinical Examination (OSCE). Settings and Design: clinical skills laboratory of the faculty of medicine AAU For the evaluation of the skills competency of junior medical students a case-controlled design was selected Subjects and Methods: All the required tools and materials were prepared. The skills required established. Groups of 10 students attended four sessions of 2 h in the CSL. The skills consisted from different procedural stations. Skills were taught and practiced on manikins, simulated patients and peer examinations. The competency of the junior students and a control group of senior students were evaluated by an OSCE. S tatistical Analysis Used: The results of the OSCE of the subjects (junior students) and control (senior students) were analyzed using SPSS version 13 as a software. All the values of the descriptive statistical analysis were expressed as percentages (mean ± standard deviation). P ≥0.05 was considered as significant. Results: Junior students scored higher in two procedural stations and the overall score. Senior students obtained higher marks in physical examination and images interpretation stations. Higher scores of junior students in the procedural stations are because they used hands-on skills and senior students learned through observation. Conclusions: Junior students trained in the CSL, can attain comparable skills competency to senior students. They can outperform senior students in procedural skills. This confirms that CSL training can improve skills acquisition.

Prospective Social Entrainment: Imitation Interventions in Children With Autism

Imitation provides the basis for acquiring knowledge, as well as providing a foundation for the development of reciprocal social skills. Children with autism spectrum disorders (ASD) do not naturally imitate others, and it is hypothesized that deficits in imitation may impede their ability to develop both academically and socially. Early imitation intervention studies, using traditional direct teaching (e.g., teacher-directed discrete trial training), focused on the learning function of imitation and were successful in improving skill acquisition but had little impact on the development of socially successful interactions. More recently, imitation interventions have targeted reciprocal or synchronous imitation (e.g., child-directed reciprocal imitation training), focused on the social function of imitation and have resulted in gains in imitation abilities and concomitant improvements in social engagement. This article explores imitation deficits in individuals with ASD, describes basic and applied research focusing on improving imitation skills, discusses implications for clinical intervention, and provides a synthesis of the current literature within the framework of prospective cognition.

Airway management: a survey of training and practices of Nigerian anesthetists.

Airway management is an integral part of anesthetist's training and clinical practice. Studies have suggested that opportunities for anesthesia trainees to learn and practice endotracheal intubation have decreased over time. We sought to examine the current training and practices of airway management by anesthetists practicing in Nigeria. A structured questionnaire was administered to delegates at an annual conference of the Nigerian Society of Anaesthetists. A total of 49 respondents participated in the survey. The data were analyzed using Statistical Package for Social Sciences (SPSS) version 16.0, the results are presented in appropriate statistical tools, and the findings discussed. The response rate was 82%. Majority of the respondents (61%) had attended a course on airway management. Many of the respondents (54%) had less than 10 years of experience in anesthesia. Majority (69%) of the respondents were from teaching hospitals. All the respondents had access to laryngeal mask airways (LMAs) and 85% of respondents could use them very well. Fiberoptic bronchoscope (FOB) was available to 51% of the respondents and only 22% of them were conversant with its use, while 31% admitted that they needed more training. Majority (71%) of the respondents had received formal training in airway management, some of a short duration (47%). Majority of our respondents had good knowledge of routine airway management using LMAs. Though FOBs may be available in some of the teaching hospitals, very few anesthetists are conversant with its use. There is increased use of simple airway devices with deskilling in complex airway management. Resource limitation means that very few individuals have access to training with novel airway techniques. There is need to increase funding of anesthesia training and services in order to improve skill acquisition and practice of airway management.

Effect of Communication Skills Training for Residents and Nurse Practitioners on Quality of Communication With Patients With Serious Illness

Communication about end-of-life care is a core clinical skill. Simulation-based training improves skill acquisition, but effects on patient-reported outcomes are unknown. To assess the effects of a communication skills intervention for internal medicine and nurse practitioner trainees on patient- and family-reported outcomes. Randomized trial conducted with 391 internal medicine and 81 nurse practitioner trainees between 2007 and 2013 at the University of Washington and Medical University of South Carolina. Participants were randomized to an 8-session, simulation-based, communication skills intervention (N = 232) or usual education (N = 240). Primary outcome was patient-reported quality of communication (QOC; mean rating of 17 items rated from 0-10, with 0 = poor and 10 = perfect). Secondary outcomes were patient-reported quality of end-of-life care (QEOLC; mean rating of 26 items rated from 0-10) and depressive symptoms (assessed using the 8-item Personal Health Questionnaire [PHQ-8]; range, 0-24, higher scores worse) and family-reported QOC and QEOLC. Analyses were clustered by trainee. There were 1866 patient ratings (44% response) and 936 family ratings (68% response). The intervention was not associated with significant changes in QOC or QEOLC. Mean values for postintervention patient QOC and QEOLC were 6.5 (95% CI, 6.2 to 6.8) and 8.3 (95% CI, 8.1 to 8.5) respectively, compared with 6.3 (95% CI, 6.2 to 6.5) and 8.3 (95% CI, 8.1 to 8.4) for control conditions. After adjustment, comparing intervention with control, there was no significant difference in the QOC score for patients (difference, 0.4 points [95% CI, -0.1 to 0.9]; P = .15) or families (difference, 0.1 [95% CI, -0.8 to 1.0]; P = .81). There was no significant difference in QEOLC score for patients (difference, 0.3 points [95% CI, -0.3 to 0.8]; P = .34) or families (difference, 0.1 [95% CI, -0.7 to 0.8]; P = .88). The intervention was associated with significantly increased depression scores among patients of postintervention trainees (mean score, 10.0 [95% CI, 9.1 to 10.8], compared with 8.8 [95% CI, 8.4 to 9.2]) for control conditions; adjusted model showed an intervention effect of 2.2 (95% CI, 0.6 to 3.8; P = .006). Among internal medicine and nurse practitioner trainees, simulation-based communication training compared with usual education did not improve quality of communication about end-of-life care or quality of end-of-life care but was associated with a small increase in patients' depressive symptoms. These findings raise questions about skills transfer from simulation training to actual patient care and the adequacy of communication skills assessment. clinicaltrials.gov Identifier: NCT00687349.

Application of formative assessment in basic life support education and its reflection

Objective To investigate the effect of formative assessment on skill acquisition of basic life support （BLS） among medical students. Methods Totally 206 undergraduates were ran- domized into control group （C group） and interventional group （F group）. A BLS lecture was given in both groups. And then, 45 min BLS training and BLS skill assessment （after training） were given in C group. Undergraduates in F group received BLS skill assessment （formative assessment） before training, and 15 min feedback was delivered based on the assessment, then 30 rain BLS training was conducted. Skills assessment was conducted again in F group after the training. Student＇s-t-test was used to compare the difference of skills between the two groups and P〈0.05 signifies statistically sig- nificant differences. Results Score of F group （85.2±7.3） were higher than that in C group （68.2 ± 13.2）, with statistical difference. Conclusion A formative assessment could significantly improve skill acquisition of BLS among medical students. Key words: Basic life support; Simulation-based medical education; Formative assessment