Just-in-time Training Research Articles

Abstract 306: Evaluating Layperson CPR Performance Supported by a Just-in-Time Video Compared to a Standard Training Course

Background: Just-in-time (JIT) video training has been proposed as an alternative to in-person CPR courses, with associated time and cost savings. Research Question: Does a JIT training video improve layperson performance of CPR? Aim: Measure CPR performance using a JIT video compared to the American Heart Association (AHA) HeartSaver® CPR AED Training course. Methods: A convenience sample of laypeople was randomized to perform CPR in a simulated scenario a) after participating in an AHA HeartSaver® course led by experienced instructors, b) with access to a JIT training video, or c) control, with no assistance or training. CPR quality was assessed by trained evaluators and objective performance assessed using Laerdal QCPR-enabled simulators. The primary outcome was performance of correct CPR. Results: Of 230 eligible subjects, 226 were randomized with no significant differences in baseline characteristics across groups. Prevalence of correct CPR was low, though significantly higher in the AHA group (AHA: 40%, 95%CI 28-51; JIT: 15%, 95%CI 8-26; control 10%, 95%CI 4-19). Overall, 94% of participants performed compressions within 1 minute, with no difference between groups. An AED was called for more frequently in the AHA group (47%) than the JIT (15%) or control (10%) groups. Flow fraction was significantly better in the AHA group (89%, IQR 77-99) compared to the JIT (75%, IQR 47-90) or control (49%, IQR 22-74) groups and compression rates of 100-120 were more frequent in the AHA (51%) and JIT groups (47%) compared to controls (27%). Conclusions: While correct performance of specific CPR skills varied in this sample, laypersons using a JIT training video performed as well as those taking an AHA HeartSaver® course on several key measures such as rapid chest compression and compression rate. JIT video training may be a viable option for supporting untrained bystander CPR performance, though further evaluation is needed to identify optimal strategies for implementation.

Rethinking Education in the Age of AI: The Importance of Developing Durable Skills in the Industry 4.0

This article discusses the pressing need to integrate artificial intelligence (AI) into education to facilitate customizable, individualized, and on-demand learning pathways. At the same time, while AI has the potential to expand the learner base and improve learning outcomes, the development of NACE Competencies and durable skills – communication, critical thinking, creativity, leadership, adaptability, and emotional intelligence - must be purposefully integrated in curriculum design now more than ever. Recent studies have shown that AI-driven learning pathways can achieve outcomes more quickly, but this comes at the cost of the development of durable skills. Therefore, traditional student-to-student and student-to-teacher interactions must be prioritized. As such, this study proposes a balanced approach to curriculum design to ensure the best outcomes for learners, where durable skill development is prioritized alongside subject-specific skills and rote memorization. Additionally, the article highlights the need for a combination of Just in Time Training (JITT) approaches, facilitated by AI technology, to reach the implementation of durable skills. The article concludes by questioning how to develop human skills in an increasingly AI-driven education system and emphasizes the importance of curriculum design and traditional learning approaches in creating a cohesive learning experience that develops durable skills in students. It is necessary to recognize that AI-driven education cannot replace the development of human skills, and that traditional interactions play a crucial role in developing these skills.

Just-in-time procedural training for pediatric emergency medicine trainees: A randomized educational interventional trial.

Pediatric requirements include procedural skills training such as peripheral intravenous (PIV) catheter placement and bag-mask ventilation (BMV). Clinical experiences may be limited and temporally remote from scheduled teaching. Just-in-time (JIT) training prior to utilization can promote skill development and mitigate learning decay. Our objective was to assess the impact of JIT training on pediatric residents' procedural performance, knowledge, and confidence with PIV placement and BMV. Residents received standardized baseline training in both PIV placement and BMV during scheduled educational programming. Between 3 and 6 months later, participants were randomized and received JIT training for either PIV placement or BMV. JIT training included a brief video and coached practice, totaling <5 min. Each participant was videotaped performing both procedures on skills trainers. Blinded investigators scored performance using skills checklists. Pre- and postintervention knowledge was assessed using multiple-choice and short-answer items, and confidence was reported using Likert scores. Seventy-two residents completed baseline training sessions: 36 were randomized to receive JIT training for PIV and 36 for BMV. Thirty-five residents in each cohort completed the curriculum. There were no significant differences between the cohorts with regard to demographics, baseline knowledge, or prior simulation experience. JIT training was associated with improved procedural performance for PIV (median 87% vs. 70%, p < 0.001) and for BMV (mean 83% vs. 57%, p < 0.001). Results remained significant after using regression models to adjust for differences in prior clinical experience. Improvements in knowledge or confidence were not associated with JIT training in either cohort. JIT training resulted in a significant improvement in resident procedural performance with PIV placement and BMV in a simulated environment. There were no differences in outcome with regard to knowledge or confidence. Future work might explore how the demonstrated benefit translates into the clinical setting.

Teaching with QR Codes: Accessible Technology for the Novice Educator

Quick response (QR) codes allow for quick and easy accessibility of just-in-time training (JiTT) for a variety of online materials. They are becoming more widely utilized to share educational materials, with potential vast applications for health professions education. In this article, we describe the development of a novel video-based equipment skills training curriculum incorporating QR codes and discuss the broader implications for educators.

Emergency Pediatric Intubations in an Urban Children's Hospital Before and After Just-in-Time Training for Video Laryngoscopy.

Objectives: The use of video laryngoscopy (VL) may augment emergency pediatric intubations outside the operating room (OR). Our objective was to describe the proportion of use and complications with VL before and after implementation of a VL just-in-time training (JITT).Study design: This study was a retrospective chart review of pediatric intubations performed outside the OR at a single women and children’s hospital from January 2015 to March 2020. Data were collected on patient age, intubation method, operator characteristics, adverse events, number of attempts, condition leading to intubation, and hospital location. Data were separated into pre-JITT (January 1, 2015 to April 31, 2018) and post-JITT (May 1, 2018 to March 1, 2020) periods. Descriptive statistics were used comparing pre- and post-JITT periods for VL use, and the complications of intubations with multiple attempts (IMAs) and intubations with one or more adverse events (AEs).Results: A total of 231 pediatric patients were intubated during the study period; 154 intubations in the pre-JITT and 77 intubations in the post-JITT periods. Pre- and post-JITT VL use was 17 (11%) and 17 (22%), respectively. With pre-JITT VL, there were four (23%) IMAs and zero (0%) intubation with one or more AE. With post-JITT VL, there were eight (47%) IMAs and one (6%) intubation with one or more AE.Conclusion: The proportion of emergency pediatric intubations using VL increased after the institution of a JITT. There was no significant change in IMAs and AEs. The infrequency of pediatric intubations makes drawing conclusions regarding the impact on IMAs and AEs challenging. JITT may increase VL use for emergency pediatric intubations outside the OR and may be considered for refresher training, especially during the coronavirus disease 2019 (COVID-19) pandemic.

Using a Critical Safety Behavior Scoring Tool for Just-in-Time Training for N95 Respirator Use.

Historically, health care workers (HCWs) have exhibited marginal adherence to proper N95 respirator use. During the COVID-19 pandemic, HCWs with little to no prior training on N95 respirator use are relying on N95s as their primary respiratory protection. There is a need for simple, effective, and easily implementable just-in-time training (JITT) interventions to improve N95 respirator-related safety behavior. This study investigated two JITT interventions. A pilot experimental pretest posttest study design was used to evaluate two training interventions for N95 respirator donning/doffing performance at a Midwestern hospital system. HCW participants were randomly assigned to an intervention: one used a 4-minute instructional video alone, while the other used the same video but added a video reflection intervention (participant watched and scored a video of their own performance). All performances were scored using a 10-point Critical Safety Behavior Scoring Tool (CSBST). Sixty-two HCWs participated (32 video alone, 30 video reflection). The two groups' CSBST scores were not significantly different at pretest. Averaged participant scores on the CSBST improved immediately following both interventions. Scores were significantly higher on the posttest for the reflective practice intervention (p<.05). Years of experience and frequency of N95 respirator use did not predict pre or post scores. We provide evidence to support the use of a time-efficient JITT intervention to improve HCW N95 respirator donning/doffing practices during the COVID-19 pandemic and beyond. Hospital safety professionals should consider this type of training for HCWs required to wear respiratory protection.

COVID-19 Medical-Religious Partnerships: Implementation of a Just-In-Time COVID-19 Training in Catholic Schools.

The concept of Just-In-Time Training (JITT) is to provide critical information specific to a public health crisis, allowing individuals to understand and respond to an urgent situation. The design of the JITT curriculum appropriate for school-aged children during the COVID-19 pandemic is vital, as every individual has a role to play in mitigating the spread of SARS-CoV-2. When working with various communities, considering culture and religion is essential, as aligning values and beliefs with the JITT curriculum’s objectives may significantly change the community’s behavior toward a public health crisis. In this narrative, we describe how a JITT curriculum for the COVID-19 pandemic, created in Maryland, US, and implemented in a Catholic school system, aligned with core Catholic social teachings. This alignment allowed for implementing and delivering the COVID-19 curriculum in Maryland’s Archdiocese Catholic school system, culminating in a medical-religious partnership that serves as a model for future public health crises.

Just-in-time clinical video review improves successful placement of Sengstaken-Blakemore tube by emergency medicine resident physicians: A randomized control simulation-based study.

Successful completion of life-saving procedures may benefit from a concise just-in-time (JIT) intervention. Video is an optimal medium for JIT training, but currently available video-based references are not optimized for a JIT format, especially in time-pressured situations prior to high-risk clinical contexts. We aimed to create and evaluate the efficacy of a brief video review of emergent Sengstaken-Blakemore tube (SBT) insertion for acutely decompensating variceal hemorrhage when used just prior to clinical performance in a simulated setting. We created a less than 3-minute audio-optional JIT training video on SBT insertion. We recruited emergency medicine resident physicians to participate in a simulation scenario in which they had to quickly place an SBT. Participants were randomized to either a 3-minute procedure review by any media they chose (control) or review of the JIT video (intervention). Performance on a checklist created by a multidisciplinary group of SBT experts (passing score > 18 and maximum=28) served as the primary outcome. We analyzed performance in checklist scores controlling level of training through a one-way analysis of covariance (ANCOVA). We analyzed rates of passing scores via a chi-square analysis. We randomized 32 participants to media review (control) or JIT video (intervention). The intervention group had an overall mean (±SD) performance of 19.8 (±9.0) and the control group had a mean (±SD) score of 6.6 (±7.4). After adjusting for postgraduate year, we found a significant difference in final checklist scores between the two groups (mean difference=12.8, 95% confidence interval [CI]= 7.6 to 18.0). Percentages of participants reaching a minimum passing score were two of 16 (12.5%) in the control group and 10 of 16 (62.5%) in the intervention group (odds ratio=11.7, 95% CI=9.9 to 13.5). Cohen's kappa indicated substantial agreement (κ=0.714) between reviewer scores. A readily available, focused, audio-optional JIT video increased performance for SBT insertion in a simulated setting. Future work may include testing of this format for more commonly performed emergency procedures and determination of effect on bedside performance in the clinical setting.

Just-in-Time Training Improves Accuracy of Citizen Scientist Wildlife Identifications from Camera Trap Photos

Citizen scientists can help professional scientists amass much larger datasets than would be possible without their input, but the quality of these data may impact their utility. Therefore, it is imperative to develop standard practices that maximize the accuracy of data produced by citizen scientists. One method increasingly used to improve data accuracy in citizen science-based projects is just-in-time training (JITT), in which volunteers are given on-demand resources to train them on the spot or in conjunction with the research they are performing. In this article, we examine whether JITT improves citizen scientist accuracy of subject identification, specifically wildlife identification from camera trap photos. Ninety-four participants with varying degrees of experience in biology were asked to identify photos from camera traps in Los Angeles, California set to capture photos of wildlife in an urban habitat. Without access to JITT, citizen scientists with no background in biology had lower accuracy than professional biologists (no background: mean = 51.8%, standard error [SE] = 6.0%; professional biologist: mean = 77.6%, SE = 2.1%). However, when participants with no background in biology received JITT, they were able to identify wildlife with a similar level of accuracy as professional biologists (no background: mean = 81.9%, SE = 3.6%; professional biologist: mean = 85.1%, SE = 2.5%). There was a significant interaction between biology background and training treatment (F-ratio = 7.61, <em>p</em> = 0.0009). The increase in accuracy of novice citizen scientists who received JITT was due primarily to fewer misidentifications of species overall but also to increased confidence in classification of species (participants selected the “Don’t Know” option less frequently). From these results, we conclude that the use of JITT can significantly improve subject identification accuracy for citizen scientists with no background in biology.

A Comprehensive Course for Teaching Emergency Cricothyrotomy.

This curriculum was developed for emergency medicine (EM) residents at the post-graduate year (PGY) 1-4 level, and attending EM physicians. It may be adapted for training of any healthcare provider or learner who might be required to perform an emergency cricothyrotomy, including emergency medical technicians, senior medical students, and advanced practice providers (ie, nurse practitioners and physician assistants); however, we did not specifically validate it for these providers. Emergency cricothyrotomy (EC) is a lifesaving surgical procedure, often the option of last resort, used to secure the airway when other methods of airway control have failed or are not feasible. It is a high-risk procedure since it is infrequently performed, but it is time-sensitive and critical for survival when needed.1,2 Time-sensitive procedural skills such as EC are subject to relatively rapid decay,3,4 and unlike other high-risk procedures, in which just-in-time training (JITT) may improve real time procedural performance, the extreme time sensitivity of cricothryotomy precludes JITT as a feasible educational intervention to improve EC performance.5 As such, clinicians must periodically review the essential concepts and practice the physical actions of the procedure in order to build and maintain familiarity with the steps involved and to develop and maintain the muscle memory necessary to perform it quickly and confidently. Previous studies have shown that simulation-based training improves both confidence and competence in the performance of the simulated procedures,6,7 and that small group learning situations are effective for procedural learning.8,9Commercially produced mannequins are available to simulate cricothyrotomy. However, being made of plastic materials, they suffer from unrealistic "tissue" feel that is radically different from that of biologic tissue.10,11 Additionally, because they are mass-produced, they tend to be fairly homogeneous in their anatomic representations, lacking the variability encountered in the human population.We developed an inexpensive procedure simulator using commercially available porcine byproduct that more closely mimics the feel of cricothyrotomy in real life, and a comprehensive curriculum for instruction in, or review of, EC, intended for implementation in a small-group format. This publication is intended to provide interested educators with a comprehensive suite of materials for teaching EC at their own institution. Included are instructions for how to construct the simulator, an EC case scenario with discussion points, a PowerPoint didactic module covering the fundamental concepts of EC, and sample course evaluation forms that may be implemented directly or adapted to meet institutional requirements. After completing this activity, the learner will be able to:correctly describe the indications for and contraindications to emergency cricothyrotomycorrectly describe and identify on the simulator the anatomic landmarks involved in emergency cricothyrotomycorrectly list the required equipment and the sequence of the steps for the "standard" and "minimalist" variations of the proceduredemonstrate proper technique when performing a cricothyrotomy on the simulator without prompts or pauses. Small group activity combining didactic learning, case-based learning, and procedural simulation. The didactic component may be delivered in an asynchronous learning or "flipped classroom" format. The cricothyrotomy simulator was initially pilot-tested on a group of emergency medicine attending faculty, who were asked to evaluate the simulator, with results demonstrating that it was felt to be superior to typical plastic mannequin simulators. This simulator was then subsequently integrated into our airway workshops teaching EC, which include hands-on practice, didactic, and discussion components. The content and delivery of these workshops were assessed by the learners via standardized evaluation forms after completion of each workshop, and the overall clinical relevance, appropriateness of content, and satisfaction with the workshop format were highly rated (mean score 4.87 on a 5-point scale, with 5 denoted as "Excellent"). The real-tissue model to simulate the procedure was well liked by course participants, and the learning environment was felt to be conducive to asking questions and discussion. Overall, the instructors and the learners felt that the workshops were effective in improving understanding of the procedure and increasing the comfort level and skill of the emergency physician learners in performing the procedure. Cricothyrotomy, cricothyroidotomy, emergency airway, surgical airway, failed airway, rescue airway, can't intubate can't ventilate, small group activity, simulation.

Strengthening and Expanding Child Services in Low Resource Communities: The Role of Task-Shifting and Just-in-Time Training.

In the United States, the demand for child mental health services is increasing, while the supply is limited by workforce shortages. These shortages are unlikely to be corrected without significant structural changes in how mental health services are provided. One strategy for bridging this gap is task-shifting, defined as a process by which services that are typically delivered by professionals are moved to individuals with less extensive qualifications or training. Although task-shifting can increase the size of the workforce, there are challenges related to training new workers. In this paper, we propose Just-In-Time Training (JITT) as one strategy for improving task-shifting efforts. We define JITT as on-demand training experiences that only include what is necessary, when it is necessary, to promote competent service delivery. We offer a proof of concept from our own work shifting counseling and academic support tasks from school mental health professionals to pre-baccalaureate mentors, citing lessons learned during our iterative process of JITT development. We conclude with a series of key considerations for scaling up the pairing of task-shifting and JITT, including expanding the science of JITT and anticipating how task-shifting and JITT would work within the context of dynamic mental health service systems.

An Efficient Model for Designing Medical Countermeasure Just-in-Time Training During Public Health Emergencies.

Rapidly training numerous staff and volunteers to distribute and dispense medical countermeasures is challenging because of limited resources and evolving information during public health emergencies. The Applied Learning and Development Team within the Division of State and Local Readiness at the Centers for Disease Control and Prevention (CDC) proposes just-in-time training (JITT) templates that can be rapidly customized and implemented early in any public health emergency. The proposed template model aligns with modular training design research to increase relevance and rapid deployment of training. Two case studies are described to demonstrate the potential for training templates to support medical countermeasure responses: (1) customization and implementation of a JITT to prepare staff to work on a CDC task force during the 2016-2017 Zika virus response and (2) a new modular, customizable course to teach the basics about working at a point-of-dispensing site. Flexible JITT templates in these cases reduce the burden on emergency planners and trainers, allowing for rapidly developed, customized training viable for all emergency responses.

Utilization of just-in-time training for nursing education using the LA Phonospirometry asthma tool

ABSTRACTObjective: Just-in-time training (JITT) has been used to teach and re-teach known medical techniques, but has not been used to teach novel techniques. We aimed to assess the performance retention of JITT on a novel asthma exacerbation severity assessment technique known as Los Angeles (LA) Phonospirometry. Methods: This was a prospective cohort study using a convenience sample of pediatric emergency department registered nurses (RNs) who were asked to watch a brief instructional digital video on LA Phonospirometry, and then asked to practice the technique on a research assistant (RA). A checklist was used to evaluate proficiency with the primary outcome being the number correct on the checklist. The secondary outcome included whether or not they could identify a common error demonstrated by the RA. RNs were re-tested after 4–6 months to assess skill retention. Results: Forty RNs were enrolled in the study and six were lost to follow-up. The mean time from the first to second testing was 5.4 months ± 0.5 months. The mean score of the first part of the checklist on the initial testing was 4.6 ± 0.7 and on second testing was 3.8 ± 1.5 (p = 0.008). This represented a drop in scores and thus minimal knowledge decay of 18% (from 91% to 73%). The mean values for number of errors picked up for the first test and second test were 1.3 and 1.5, respectively (p = 0.2). Conclusions: JITT demonstrated feasibility as a rapid instructional tool for RNs, with a limited decay in cognitive knowledge surrounding the LA Phonospirometry technique.

Training student pharmacists to administer emergency pediatric influenza vaccine: A comparison of traditional vs. just-in-time training

IntroductionThis study compared traditional training (TT) and just-in-time training (JITT) of P3 student pharmacists regarding interest, confidence, and comfort pre- and post-training (primary objective); and assessment and administration competency (secondary objective) during a simulated influenza vaccination clinic. MethodsStudent pharmacists were randomized 1:1 to receive either TT or JITT, completed pre- and post-training surveys assessing interest, confidence and comfort; and evaluated on performance during a simulated emergency infant vaccination. An infant manikin simulated a child <1 year of age, and an actor role-played the mother. All students received a briefing about the simulated mass vaccination prior to their performance assessment. Survey differences between groups were analyzed by ANOVA. The competency assessment was analyzed by a Chi-square or Fisher's exact test for individual steps and Student t-test for mean scores. ResultsPre-training interest was high and maintained post-training. Pre-training confidence and comfort levels were low and improved in both groups. Mean competency scores were comparable between the TT and JITT groups. Comparing groups, TT students more commonly missed proper injection site selection and care; while JITT missed distracting the infant and administration documentation. Discussion and conclusionsJITT for student pharmacists to learn skills required to immunize infants elicits similar outcomes (interest, confidence, comfort, and administration competency) as TT for emergency pediatric influenza vaccination.

The effect of step stool use and provider height on CPR quality during pediatric cardiac arrest: A simulation-based multicentre study.

We aimed to explore whether a) step stool use is associated with improved cardiopulmonary resuscitation (CPR) quality; b) provider adjusted height is associated with improved CPR quality; and if associations exist, c) determine whether just-in-time (JIT) CPR training and/or CPR visual feedback attenuates the effect of height and/or step stool use on CPR quality. We analysed data from a trial of simulated cardiac arrests with three study arms: No intervention; CPR visual feedback; and JIT CPR training. Step stool use was voluntary. We explored the association between 1) step stool use and CPR quality, and 2) provider adjusted height and CPR quality. Adjusted height was defined as provider height + 23 cm (if step stool was used). Below-average height participants were ≤ gender-specific average height; the remainder were above average height. We assessed for interaction between study arm and both adjusted height and step stool use. One hundred twenty-four subjects participated; 1,230 30-second epochs of CPR were analysed. Step stool use was associated with improved compression depth in below-average (female, p=0.007; male, p<0.001) and above-average (female, p=0.001; male, p<0.001) height providers. There is an association between adjusted height and compression depth (p<0.001). Visual feedback attenuated the effect of height (p=0.025) on compression depth; JIT training did not (p=0.918). Visual feedback and JIT training attenuated the effect of step stool use (p<0.001) on compression depth. Step stool use is associated with improved compression depth regardless of height. Increased provider height is associated with improved compression depth, with visual feedback attenuating the effects of height and step stool use.

Teaching Splinting Techniques Using a Just-in-Time Training Instructional Video.

Splinting is a multistep procedure that is seldom performed by primary care physicians. Just-in-time training (JITT) is an emerging teaching modality and can be an invaluable asset for infrequently performed procedures or in locations where teaching resources and trained professionals are limited. Our objective was to determine the utility of JITT for teaching medical students the short-arm (SA) volar splinting technique. This was a prospective randomized controlled pilot study. An instructional video on SA volar splinting was produced. Students viewed the video or had access to standard medical textbooks (control group) immediately before applying an SA volar splint. The students were assessed for the quality of the splint via a standard 6-point skills checklist. The times required for presplinting preparation and for completion of the splint were also measured. Just-in-time training group students scored higher on the splint checklist (mean [SD], 5.45 [1.06]; 95% confidence interval [CI], 4.99-5.92 vs mean [SD], 1.58 [1.12]; 95% CI, 1.04-2.12; P < 0.0001), had higher pass rates (73%; 95% CI, 53%-93% vs 0%; P < 0.0001), and required less time (minutes) for presplinting preparation (mean [SD], 7.86 [2.45]; 95% CI, 6.78-8.94 vs mean [SD], 9.89 [0.46]; 95% CI, 9.67-10.12; P < 0.0001) compared with the control group. No difference was seen in the time required to complete a splint, successful or not. In comparison with reading standard textbooks, watching a brief JITT instructional video before splinting yielded faster learning times combined with more successful procedural skills. The use of a JITT instructional video may have potential applications, including globally, as an alternative resource for teaching and disseminating procedural skills, such as SA volar splinting.

Improving education: just-in-time splinting video.

Just-in-time training (JITT) is an emerging concept in medical procedural education, but with few studies to support its routine use. Providing a brief educational intervention in the form of a digital video immediately prior to patient care may be an effective method to reteach knowledge for procedural techniques learned previously. Paediatric resident physicians were taught to perform a volar splint in a small workshop setting. Subsequently, they were asked to demonstrate their splinting proficiency by performing a splint on another doctor. Proficiency was scored on a five-point assessment tool. After 2-12months, participants were asked to demonstrate their splinting proficiency on one of the investigators, and were divided into the control group (no further instruction) and the intervention group, which viewed a 3-minute JITT digital video demonstrating the splinting technique prior to performing the procedure. Thirty subjects were enrolled between August 2012 and July 2013, and 29 of 30 completed the study. The retest splinting time was not significantly different, but if the JITT group included watching the video, the total time difference was statistically significant: 3.86minutes (control) versus 7.07minutes (JITT) (95% confidence interval: 2.20-3.90minutes). The average assessment score difference was 1.87 points higher for the JITT group, which was a statistically significant difference (95% confidence interval: 1.00-3.00). Just-in-time training is an emerging concept in medical procedural education JITT seems to be an effective tool in medical education for reinforcing previously learned skills. JITT may offer other possibilities for enhancing medical education.

Infection prevention and mass vaccination training for U.S. point of dispensing staff and volunteers: A national study

Points of dispensing (PODs) are deployed for medical countermeasure mass dispensing. However, infection prevention and vaccine administration pre-event training offered and just-in-time (JIT) education planned for POD workers have not been assessed. Disaster planners were sent an online questionnaire in 2013. McNemar tests compared training offered to staff versus volunteers and pre-event training versus JIT training. In total, 301 disaster planners participated. The most frequent pre-event training included hand hygiene (59.1% and 28.0%) and personal protective equipment (PPE) selection (52.1% and 24.1%) for staff and volunteers, respectively. Few provided pre-event training on the cold chain technique (14.8% and 5.1%) or smallpox vaccine administration (4.7% and 2.3%) for staff or volunteers. For all topics except smallpox vaccine administration, more staff than volunteers received pre-event training (P<.01). The most frequent planned JIT training includes hand hygiene (79.8% and 73.5%) and PPE selection (79.4% and 70.0%) to staff and volunteers. For all topics, more JIT education is planned for staff than volunteers (P<.001). More JIT training is planned than has been given pre-event for all topics (P<.001). More pre-event training is needed on infection prevention and vaccine administration to ensure safe and successful POD deployment.

TF-13 A Just-in-Time Training Module for Emergency Intubations

TF-13 A Just-in-Time Training Module for Emergency Intubations

Just-in-time training of dental responders in a simulated pandemic immunization response exercise.

The reauthorization of the Pandemic and All-Hazards Preparedness Act in 2013 incorporated the dental profession and dental professionals into the federal legislation governing public health response to pandemics and all-hazard situations. Work is now necessary to expand the processes needed to incorporate and train oral health care professionals into pandemic and all-hazard response events. A just-in-time (JIT) training exercise and immunization drill using an ex vivo porcine model system was conducted to demonstrate the rapidity to which dental professionals can respond to a pandemic influenza scenario. Medical history documentation, vaccination procedures, and patient throughput and error rates of 15 dental responders were evaluated by trained nursing staff and emergency response personnel. The average throughput (22.33/hr) and medical error rates (7 of 335; 2.08%) of the dental responders were similar to those found in analogous influenza mass vaccination clinics previously conducted using certified public health nurses. The dental responder immunization drill validated the capacity and capability of dental professionals to function as a valuable immunization resource. The ex vivo porcine model system used for JIT training can serve as a simple and inexpensive training tool to update pandemic responders' immunization techniques and procedures supporting inoculation protocols.