Length Of Training Research Articles

Training the healthcare workforce to support task-shifting and viral hepatitis elimination: a global review of English language online trainings and in-person workshops for management of hepatitis B and C infection

BackgroundAchieving World Health Organization (WHO) targets for viral hepatitis elimination will require simplification and decentralisation of care, supported through task-shifting and training of non-specialist frontline healthcare workers. To inform development of national health worker trainings in viral hepatitis, we review and summarise available online and workshop trainings for management of hepatitis B virus (HBV) and hepatitis C virus (HCV).MethodsWe performed a systematic search of PubMed, Embase, Web of Science, conference abstracts, and grey literature using Google to identify online and in-person workshop trainings for health workers focused on HBV and/or HCV. Additional trainings were identified through a WHO regional network. We included online trainings written in English and in-person workshops developed for low-and-middle-income countries (LMICs). Available curricula are summarised together with key operational features (e.g. training length, year developed/updated, developing institution) and programmatic features (e.g. content, mechanism for self-assessment, use of clinical case studies).ResultsA total of 30 trainings met our inclusion criteria (10 online trainings; 20 in-person workshops). 50% covered both HBV and HCV, 13% HBV alone and 37% HCV alone. Among online trainings, only 2 (20%) were specifically developed or adapted for LMICs; 70% covered all aspects of hepatitis care, including prevention, assessment, and treatment; 9 (90%) included guidance on when to refer to specialists, and 6 (60%) included modules on management in specific populations (e.g., people who inject drugs [PWID], prisoners, and children). Online trainings used different formats including text-based modules, narrated slide-sets, and interactive web-based modules. Most workshops (95%) were targeted towards non-specialty providers, and 50% were an integral part of a national strategy for viral hepatitis elimination. Workshop length ranged from several hours to multiple sessions over the course of months, and many were part of a blended educational model, which included other opportunities for ongoing learning (e.g., telementorship).ConclusionThis compendium of online and in-person workshop trainings for HBV and HCV is a useful resource for national hepatitis programmes developing training curricula for non-specialists. Additional online training curricula are needed for use in LMICs, and additional materials are needed to address management challenges in key populations, such as PWID.

Aerodynamic characteristics of fully enclosed sound barrier induced by the passing trains with 400 km/h

The fully enclosed sound barrier (FESB) has excellent sound reduction effect, but the relatively closed space will make train-induced wind effect more obvious. This study aims to quantify the aerodynamic characteristics on FESB during the trains passing through using a computational fluid dynamic (CFD) method, considering the effects of opening spacing ΔH, train length, and trains passing each other. An overset grid approach is applied to stimulate the relative motion between the train and the FESB, which is verified by correlated test data. The results demonstrate that compression and expansion waves induced by passing trains are the primary sources of pressure fluctuations within the FESB. Implementing a pressure relief scheme with a top opening, which modifies the propagation law of pressure fluctuations inside the FESB, can effectively mitigate the train-induced aerodynamic effects on the structure. Moreover, the head-wave effect on the FESB is less affected by the train length in such schemes. When the opening spacing ΔH value exceeds 1.5 m, the peak-to-peak pressure ΔPH induced by a train passing by gradually reaches a stable state, and there exists a perfectly negative exponential relationship between the aerodynamic force per unit length of FESB and the opening spacing ΔH. However, the train-induced aerodynamic effect on the FESB is amplified when two trains pass each other. In pressure relief scheme with ΔH of 1.5 m, compared to the ΔF observed on the near and far line sides during a single train passing by, those obtained during trains meeting operation are found to be 0.66 times and 2.64 times higher.

Leadership Development Strategies in Interprofessional Healthcare Collaboration: A Rapid Review.

Contemporary healthcare practitioners require leadership skills for a variety of professional roles related to improved patient/client outcomes, heightened personal and professional development, as well as strengthened interprofessional collaboration and teamwork. The aim of this study is to systematically catalogue literature on leadership in healthcare practice and education to highlight the leadership characteristics and skills required by healthcare practitioners for collaborative interprofessional service delivery and the leadership development strategies found to be effective. A rapid review was conducted. The Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) diagram shows that the 11 databases, yielded 465 records. A total of 147 records were removed during the initial screening phase. The remaining 318 records were uploaded onto Rayyan, an online collaborative review platform. Following abstract level screening, a further 236 records were removed with 82 records meeting the eligibility criteria at full text level, of which 42 were included in the data extraction. The Mixed Methods Appraisal Tool (MMAT) was used for quality appraisal. Results showed variability in methodologies used, representing various healthcare disciplines with a range in population size (n = 6 to n = 537). Almost half of the results reported on new programs, with interprofessional collaboration and teamwork being the most frequently mentioned strategies. The training content, strategies used as well as the length of training varied. There were five outcomes which showed positive change, namely skills, knowledge, confidence, attitudes, and satisfaction. This rapid review provided an evidence-base, highlighted by qualitative, quantitative, and mixed methods research, which presents distinct opportunities for curriculum development by focusing on both content and the methods needed for leadership programs. Anchoring this evidence-base within a systematic search of the extant literature provides increased precision for curriculum development.

Full scale experimental tests to evaluate the train slipstream in tunnels

The train slipstream, i.e. the air velocity induced by the train, is one of the most important aerodynamic effects connected to railway vehicles because it has a direct impact on the safety of passengers on the platform and track workers along the railway line. In recent years, a lot of studies were performed to understand the development of this phenomenon in open field, and specific EU standards, the EN 14067–4 and the TSI were issued. Instead, only few studies have been carried out to analyse the train slipstream in confined spaces (as tunnels, line sections with acoustic barriers, etc.), even though the first results of these analyses have shown that the confinement of the air causes more severe conditions regarding the speed of the air flow. This work aims at studying, through a full-scale experimental campaign, the effects on the air flow speed caused by the train passage. The effects of different train parameters (i.e. train type and length, etc.) and infrastructure parameters (i.e. geometry variations) were analysed. Lastly, the results of a specific test considering the presence of a stationary train inside the tunnel while another train is passing are described, to simulate scenarios of ordinary railway traffic.

Statistical Analysis of Train Derailment Severity for Unit Trains Versus Manifest Trains

Using freight trains is a cost-effective and safe method for transporting numerous products over long distances. However, freight train derailments have significant consequences. Derailment severity, measured by the number of cars derailed per derailment, is an important risk factor. Based on prior literature and Federal Railroad Administration data, this research analyzes and estimates derailment severity of freight railroad transportation using a statistical method: the Truncated Geometric (TG) model. The methodology accounts for three train types: manifest train, loaded unit train, and empty unit train. Train length, speed, and gross tonnage per car are the input features, and the output variable is the number of cars derailed in a derailment incident. The TG model quantifies the influence of these factors contributing to derailment severity and estimates train derailment severity with a performance of the mean square error (MSE) of 68.91 and mean absolute error (MAE) of 6.05. When data outliers such as abnormally high or low severity are excluded, the MSE drops to 36.82 and the MAE drops to 4.22. Overall, the results indicate that the train derailment severity estimation performance based on the given factors is satisfactory. With all other factors being equal, a loaded unit train is likely to derail more cars than a manifest train and an empty unit train. When data outliers are excluded, there is no significant difference between manifest trains and empty unit trains as regards derailment severity, and both are less likely to derail than a loaded unit train.

Effects of plyometric training on technical skill performance among athletes: A systematic review and meta-analysis.

The literature has proven that plyometric training (PT) improves various physical performance outcomes in sports. Even though PT is one of the most often employed strength training methods, a thorough analysis of PT and how it affects technical skill performance in sports needs to be improved. This study aimed to compile and synthesize the existing studies on the effects of PT on healthy athletes' technical skill performance. A comprehensive search of SCOPUS, PubMed, Web of Science Core Collection, and SPORTDiscus databases was performed on 3rd May 2023. PICOS was employed to establish the inclusion criteria: 1) healthy athletes; 2) a PT program; 3) compared a plyometric intervention to an active control group; 4) tested at least one measure of athletes' technical skill performance; and 5) randomized control designs. The methodological quality of each individual study was evaluated using the PEDro scale. The random-effects model was used to compute the meta-analyses. Subgroup analyses were performed (participant age, gender, PT length, session duration, frequency, and number of sessions). Certainty or confidence in the body of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Thirty-two moderate-high-quality studies involving 1078 athletes aged 10-40 years met the inclusion criteria. The PT intervention lasted for 4 to 16 weeks, with one to three exercise sessions per week. Small-to-moderate effect sizes were found for performance of throwing velocity (i.e., handball, baseball, water polo) (ES = 0.78; p < 0.001), kicking velocity and distance (i.e., soccer) (ES = 0.37-0.44; all p < 0.005), and speed dribbling (i.e., handball, basketball, soccer) (ES = 0.85; p = 0.014), while no significant effects on stride rate (i.e., running) were noted (ES = 0.32; p = 0.137). Sub-analyses of moderator factors included 16 data sets. Only training length significantly modulated PT effects on throwing velocity (> 7 weeks, ES = 1.05; ≤ 7 weeks, ES = 0.29; p = 0.011). The level of certainty of the evidence for the meta-analyzed outcomes ranged from low to moderate. Our findings have shown that PT can be effective in enhancing technical skills measures in youth and adult athletes. Sub-group analyses suggest that PT longer (> 7 weeks) lengths appear to be more effective for improving throwing velocity. However, to fully determine the effectiveness of PT in improving sport-specific technical skill outcomes and ultimately enhancing competition performance, further high-quality research covering a wider range of sports is required.

Computerized cognitive interventions for adults with ADHD: A systematic review and meta-analysis.

Treatments for adults with attention-deficit hyperactivity disorder (ADHD) are understudied, compared to children and adolescents with the same condition. In this systematic review and random-effects meta-analysis, we aim to evaluate the outcomes of computerized cognitive training (CCT) interventions in randomized controlled trials (RCTs) including adults with ADHD. Cognitive outcomes and ADHD symptom severity were analyzed separately. In addition, the Cattell-Horn-Carroll (CHC) theory of cognitive abilities was used to categorize outcome variables into subdomains, which were analyzed separately in a subsequent analysis. The results revealed a small positive change in overall cognitive functioning, a measure of all cognitive outcomes in each study, for individuals who took part in CCT compared to controls (k = 9, Hedge's g = 0.235, 95% CI [0.002, 0.467], p = 0.048, τ² = 0.000, I² = 0.000). However, neither symptom severity nor specific cognitive outcomes (executive functioning, cognitive speed, or working memory) showed a significant improvement. We analyzed the risk of bias in the chosen studies and discuss the findings in terms of effect size. It is concluded that CCT has a small positive effect in adults with ADHD. Due to the lack of heterogeneity in intervention designs across the included studies, increased heterogeneity in future studies could help inform clinicians about the aspects of CCT, such as training type and length, that are most beneficial for this group. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A Novel Learning-Based Estimation Scheme for Communication Over Impulsive Noise Channels

This paper proposes a novel statistical hybrid neural network (S-HNN) based estimation of impulse noise infested wireless communication channels. Spatial fading characteristics are found using a convolutional neural network (CNN), while long short-term memory (LSTM) network extracts temporal information over subsequent time horizons. Finite lag samples are employed to extract the channel gain distribution based on multiple recycling of the CNN-LSTM network. The proposed S-HNN framework for orthogonal frequency division multiplexed (OFDM) communication channel with subcarrier spacing of 15 kHz, sampling rate of 15.36 MHz, IFFT size of 1024, and various pilot density deployments is shown to outperform the existing state-of-the-art channel estimation techniques in terms of 50% reduced training length and nearly 49% saving in training time.

Rapid, automated, and experimenter-free touchscreen testing reveals reciprocal interactions between cognitive flexibility and activity-based anorexia in female rats.

Anorexia nervosa has among the highest mortality rates of any psychiatric disorder and is characterized by cognitive inflexibility that persists after weight recovery and contributes to the chronic nature of the condition. What remains unknown is whether cognitive inflexibility predisposes individuals to anorexia nervosa, a question that is difficult to address in human studies. Our previous work using the most well-established animal model of anorexia nervosa, known as activity-based anorexia (ABA) identified a neurobiological link between cognitive inflexibility and susceptibility to pathological weight loss in female rats. However, testing flexible learning prior to exposure to ABA in the same animals has been thus far impossible due to the length of training required and the necessity of daily handling, which can itself influence the development of ABA. Here, we describe experiments that validate and optimize the first fully-automated and experimenter-free touchscreen cognitive testing system for rats and use this novel system to examine the reciprocal links between reversal learning (an assay of cognitive flexibility) and weight loss in the ABA model. First, we show substantially reduced testing time and increased throughput compared to conventional touchscreen testing methods because animals engage in test sessions at their own direction and can complete multiple sessions per day without experimenter involvement. We also show that, contrary to expectations, cognitive inflexibility measured by this reversal learning task does not predispose rats to pathological weight loss in ABA. Instead, rats that were predisposed to weight loss in ABA were more quickly able to learn this reversal task prior to ABA exposure. Intriguingly, we show reciprocal links between ABA exposure and cognitive flexibility, with ABA-exposed (but weight-recovered) rats performing much worse than ABA naïve rats on the reversal learning task, an impairment that did not occur to the same extent in rats exposed to food restriction conditions alone. On the other hand, animals that had been trained on reversal learning were better able to resist weight loss upon subsequent exposure to the ABA model. We also uncovered some stable behavioral differences between ABA susceptible versus resistant rats during touchscreen test sessions using machine learning tools that highlight possible predictors of anorectic phenotypes. These findings shed new light on the relationship between cognitive inflexibility and pathological weight loss and provide targets for future studies using the ABA model to investigate potential novel pharmacotherapies for anorexia nervosa.

The journey of becoming a congenital heart surgeon: Too long, too costly, too unpredictable

ObjectiveThe pathway to become a congenital heart surgeon (CHS) is challenging and unpredictable. Previous voluntary manpower surveys have shed partial light on this problem but have not included all trainees. We believe that this arduous journey merits more attention. MethodsTo examine the real-life challenges of recent participants in Accreditation Council for Graduate Medical Education–accredited CHS training programs, we conducted phone interviews with all graduates of approved programs from 2021 to 2022. This institutional review board approved survey focused on issues including preparation, length of training, debt burden, and employment. ResultsAll 22 (100%) graduates during the study period were interviewed. Age at fellowship completion was a median 37 years (range, 33-45 years). Pathways to fellowship included traditional general surgery with adult cardiac (43%), abbreviated general surgery (“4 + 3,” 19%) and integrated-6 (38%). Time spent on any pediatric related rotation before CHS fellowship was a median 4 months (range, 1-10 months). During CHS fellowship, graduates reported medians of 100 (range, 75-170) total cases and 8 (range, 0-25) neonatal cases as the primary surgeon. Debt burden at completion was a median of $179,000 (range, $0-$550,000). Maximal financial compensation during training before and during CHS fellowship were medians of $65,000 (range, $50,000-$100,000) and $80,000 (range, $65,000-$165,000), respectively. Six (27.3%) are currently in roles in which they cannot practice independently (5 [22.7%] faculty instructors, 1 [4.5%] CHS clinical fellowship). Median salary in first job is $450,000 (range, $80,000-$700,000). ConclusionsGraduates of CHS fellowships are old, and training is highly variable. Aptitude screening and pediatric-focused preparation are minimal. Debt burden is onerous. Further attention to refining training paradigms and compensation are justified.

A MHz X-ray diffraction set-up for dynamic compression experiments in the diamond anvil cell.

An experimental platform for dynamic diamond anvil cell (dDAC) research has been developed at the High Energy Density (HED) Instrument at the European X-ray Free Electron Laser (European XFEL). Advantage was taken of the high repetition rate of the European XFEL (up to 4.5 MHz) to collect pulse-resolved MHz X-ray diffraction data from samples as they are dynamically compressed at intermediate strain rates (≤103 s-1), where up to 352 diffraction images can be collected from a single pulse train. The set-up employs piezo-driven dDACs capable of compressing samples in ≥340 µs, compatible with the maximum length of the pulse train (550 µs). Results from rapid compression experiments on a wide range of sample systems with different X-ray scattering powers are presented. A maximum compression rate of 87 TPa s-1 was observed during the fast compression of Au, while a strain rate of ∼1100 s-1 was achieved during the rapid compression of N2 at 23 TPa s-1.

Technology-based solutions for behavior monitoring: lessons learned

IntroductionChildren’s behavior is indicative of adaptation to early-age development. Adaptive difficulties linked to behavioral difficulties are frequent among school-aged children having a multi-level impact. Five key approaches have been used therapeutically while systematic behavior monitoring has been used to evaluate the efficacy of different interventions. The inherent barriers of traditional monitoring tools have led to the need to design and implement new approaches.MethodsFour case study series (S1–S4) focused on vulnerable populations are described. Eight participants with different medical backgrounds underwent an intervention, either cognitive training (BrainHQ) (seven out of eight) or operant conditioning strategies. Targeted behaviors were monitored in six out of eight participants using the WHAAM application which could also measure the effectiveness of the intervention applied, while emotional fluctuations were evaluated in two out of eight participants using AffectLecture. Moreover, a 5th pilot study (S5) is included focusing on the early detection and management of ADHD using a serious game-based platform.ResultsIn S1, monitoring highlighted that BrainHQ training resulted in positive changes in all but one of the behaviors in Case 1. Studies that exploited the AffectLecture application indicated that emotional state was improved after training, and it was positively correlated with performance in cognitive exercises. The performance in cognitive training was positively correlated with the emotional state before training in S2 but not in S3. A positive correlation between the change in emotional state and performance was mentioned only in S3. Educational and social benefits as well as a positive correlation between the performance and the length of training were reported in both studies. Operant conditioning strategies in S4 resulted in positive behavioral effects in most participants. Preliminary analysis of S5 indicated that the platform has a considerable capacity to discriminate users based on their in-game patterns as ADHD or non-ADHD.DiscussionThe mixture of studies presented in this article incorporates different technological solutions for monitoring or intervening in developmental disorders and behavioral difficulties. Despite the inherent inhomogeneity of such an endeavor, they all highlight the positive prospects of using technology to enhance the educational arsenal of facing behavioral and learning difficulties.

Postgraduate training of neurosurgeons. From a five-month specialization to a six-year residency. Past. The present day. Future

ResumeNeurosurgery training in the countries of the European Union, America and Asia lasts from 5 to 7 years and involves acquiring knowledge not only in clinical, but also in scientific activities. Taking into account the need to use high-tech methods for the treatment of neurosurgical diseases, the duration of 3-year internship training, as is customary in Ukraine, is insufficient. The analysis of historical and modern approaches to teaching neurosurgery by professional communities in the USA and the European Union allows for the development of a modern training program in the specialty "neurosurgery" in terms of content and duration. The sample training program at the residency was reviewed after all comments and suggestions were received and approved at the meetings of the Department of Neurosurgery of the Shupyk National Healthcare University of Ukraine, the State Institution «Romodanov Neurosurgery Institute NAMS of Ukraine» and the Ukrainian Neurosurgical Association by a group of experts in the specialty «Neurosurgery».It is important to select candidates for residency ‒ successful study, knowledge of a foreign language, taking into account communication skills. The order for residency is determined by the Ministry of Health of Ukraine, no more than 10 residents can be applied per year, regardless of the form of payment. After completing the residency, 2 years of work experience in state or communal health care institutions, military hospitals is mandatory.It is to justify the need for quality training of neurosurgeons in accordance with the standards of the European Union. The introduction of a single standard for the training of neurosurgeons in Ukraine, which takes into account the best domestic and foreign experience, will make it possible to raise the level of domestic neurosurgery and integrate it into the world system of medical education. A significant increase in the length of training in a neurosurgery residency (up to 6 years) is necessary for the full-fledged development of a specialist neurosurgeon.

Using Responsive Feedback in Scaling a Gender Norms-Shifting Adolescent Sexual and Reproductive Health Intervention in the Democratic Republic of Congo.

Growing Up GREAT! (GUG) is a sexual and reproductive health (SRH) program for adolescents aged 10-14 years in Kinshasa, Democratic Republic of the Congo (DRC). The multilevel program takes an ecological approach to foster community examination of gender inequitable norms and to increase adolescents' SRH knowledge, skills, and gender-equitable attitudes. GUG design, piloting, and scale-up were informed by a theory of change and responsive feedback mechanisms (RFMs) during piloting and scale-up. The program engaged stakeholders via quarterly learning meetings to review monitoring data, evaluation results, and practice-based knowledge and to subsequently identify challenges and develop solutions. The program commissioned rapid research on specific intervention elements to improve implementation and documented scale-up learnings using the World Health Organization/ExpandNet framework. RFMs used in the pilot period allowed the program to address community concerns by intensifying orientation activities with parents and schools, shifting the calendar of activities to increase male engagement, and increasing facilitator training length to improve facilitation quality. Using RFMs during scale-up prompted further adaptations for program sustainability, including recommendations for task-shifting from NGO facilitators to community health workers. GUG used RFMs from pilot through scale-up to foster a learning culture among local partners, implementers at headquarters, and global research partners. Using responsive feedback (RF) enabled timely response to the evolving implementation context, resulting in strategic program adaptations that fostered increased community support of the project. Other successes due, at least in part, to this RF approach include incorporation of the program into DRC's national adolescent health strategy, and rapid response to the COVID-19 pandemic in educational strategies for program beneficiaries.

Two Stage Beamforming in Massive MIMO: A Combinatorial Multi-Armed Bandit Based Approach

In frequency division duplex (FDD) massive multi-input multi-output (MIMO), the two-stage beamforming (TSB) using channel covariance matrices (CCM) can significantly reduce the downlink training length (DTL) and channel feedback. However, the overhead to estimate the CCM is large. In this paper, a combinatorial multi-armed bandit (CMAB) based TSB scheme is proposed without requirement of CMM. Particularly, the problem of the pre-beamforming matrix design is transformed into a CMAB problem. We consider the pre-beamforming matrix design in each slot as the arm selection in the CMAB, and convert the problem of the arm selection into a 0-1 integer linear programming problem, which can be solved by the branch-and-bound method. During the training process, the maximum likelihood method is used to detect the power of angle spectrum, and the angle range of each user is determined adaptively. We prove that the regret grows logarithmically with time, such that the proposed scheme converges towards the optimal action. Finally, simulation results demonstrate that the proposed scheme can significantly improve the spectral efficiency.

Exploring the concerns of second-degree dental students on entering specialist OMFS training and their attitudes towards the second-degree curriculum

Within the UK, oral and maxillofacial surgery (OMFS) is a competitive specialty with a rigorous training programme that currently requires dual degrees in both medicine and dentistry. Training in OMFS can present various challenges in terms of finances, length of training, and work-life balance. The current study explores the concerns of second-degree dental students in trying to obtain an OMFS specialty training post, as well as their views on the second-degree curriculum. An online survey was distributed via social media to second-degree dental students across the UK and 51 responses were received. Respondents cited a lack of publications (29%), specialty interviews (29%), and the OMFS logbook (29%) as the primary concerns about securing a higher training post. Eighty-eight per cent felt there were elements of repetition within the second degree for which competencies had already been achieved, and 88% agreed with streamlining the curriculum within the second degree. We propose that the second degree should incorporate ways to build the OMFS ST1/ST3 portfolio as part of a tailored curriculum, removing or condensing the repetitive elements, and instead emphasising areas of concern for trainees such as research, operative experience, and interview guidance. Second-degree students should be provided with mentors with an interest in research and academia to provide guidance and promote early interest in academia.

Investigating Black/African-American Medical Student Interest in Neurology as a Profession (P6-2.001)

Investigating Black/African-American Medical Student Interest in Neurology as a Profession (P6-2.001)

EEG mismatch responses in a multimodal roving stimulus paradigm provide evidence for probabilistic inference across audition, somatosensation, and vision.

The human brain is constantly subjected to a multimodal stream of probabilistic sensory inputs. Electroencephalography (EEG) signatures, such as the mismatch negativity (MMN) and the P3, can give valuable insight into neuronal probabilistic inference. Although reported for different modalities, mismatch responses have largely been studied in isolation, with a strong focus on the auditory MMN. To investigate the extent to which early and late mismatch responses across modalities represent comparable signatures of uni- and cross-modal probabilistic inference in the hierarchically structured cortex, we recorded EEG from 32 participants undergoing a novel tri-modal roving stimulus paradigm. The employed sequences consisted of high and low intensity stimuli in the auditory, somatosensory and visual modalities and were governed by unimodal transition probabilities and cross-modal conditional dependencies. We found modality specific signatures of MMN (~100-200 ms) in all three modalities, which were source localized to the respective sensory cortices and shared right lateralized prefrontal sources. Additionally, we identified a cross-modal signature of mismatch processing in the P3a time range (~300-350 ms), for which a common network with frontal dominance was found. Across modalities, the mismatch responses showed highly comparable parametric effects of stimulus train length, which were driven by standard and deviant response modulations in opposite directions. Strikingly, P3a responses across modalities were increased for mispredicted stimuli with low cross-modal conditional probability, suggesting sensitivity to multimodal (global) predictive sequence properties. Finally, model comparisons indicated that the observed single trial dynamics were best captured by Bayesian learning models tracking unimodal stimulus transitions as well as cross-modal conditional dependencies.

Four- and three-year emergency medicine residency graduates perform similarly in their first year of practice compared to experienced physicians

IntroductionUnited States emergency medicine (EM) post-graduate training programs vary in training length, either 4 or 3 years. However, it is unknown if clinical care by graduates from the two curricula differs in the early post-residency period. MethodsWe performed a retrospective observational study comparing measures of clinical care and practice patterns between new graduates from 4- and 3-year EM programs with experienced new physician hires as a reference group. We included emergency department (ED) encounters from a national EM group (2016–19) between newly hired physicians from 4- and 3- year programs and experienced new hires (>2 years' experience) during their first year of practice with the group. Primary outcomes were at the physician-shift level (patients per hour and relative value units [RVUs] per hour) and encounter-level (72-h return visits with admission/transfer and discharge length of stay [LOS]). Secondary outcomes included discharge opioid prescription rates, test ordering, computer tomography (CT) use, and admission/transfer rate. We compared outcomes using multivariable linear regression models that included patient, shift, and facility-day characteristics, and a facility fixed effect. We hypothesized that experienced new hires would be most efficient, followed by new 4-year graduates and then new 3-year graduates. ResultsWe included 1,084,085 ED encounters by 4-year graduates (n = 39), 3-year graduates (n = 70), and experienced new hires (n = 476). There were no differences in physician-level and encounter-level primary outcomes except discharge LOS was 10.60 min (2.551, 18.554) longer for 4-year graduates compared to experienced new hires. Secondary outcomes were similar among the three groups except 4- and 3-year new graduates were less likely to prescribe opioids to discharged patients, −3.70% (−5.768, −1.624) and − 3.38% (−5.136, −1.617) compared to experienced new hires. ConclusionsIn this sample, measures of clinical care and practice patterns related to efficiency, safety, and flow were largely similar between the physician groups; however, experienced new hires were more likely to prescribe opioids than new graduates. These results do not support recommending a specific length of residency training in EM.

Resident Visit Productivity and Attitudes About Continuity According to 3 Versus 4 Years of Training in Family Medicine: A Length of Training Study.

Training models in the Length of Training Pilot (LOTP) vary. How innovations in training length affect patient visits and resident perceptions of continuity is unknown. We analyzed resident in-person patient encounters (2013-2014 through 2018-2019) for each postgraduate year (PGY) and total visits at graduation derived from the Accreditation Council for Graduate Medical Education reports for each LOTP program. We collected data on residents' perceptions of continuity from annual surveys (2015-2019). We analyzed continuous variables using independent samples t tests with unequal variance and categorical variables using χ2 tests in comparing 3-year (3YR) versus 4-year (4YR) programs. PGY-1 and PGY-2 residents in 4YR programs saw statistically more patients than their counterparts in 3YR programs. In PGY3, 3YR program residents had statistically higher visit volume compared to 4YR program residents. Visits conducted in PGY4 ranged from 832 to 884. The additional year of training resulted in approximately 1,000 more total patient visits. Most residents in 3YR and 4YR programs rated their continuity clinic experience as somewhat or very adequate (range 86.3% to 93.7%), which did not statistically differ according to length of training. Resident visits were significantly different at each PGY level when comparing 3YR and 4YR programs in the LOTP and the additional year of training resulted in about 1,000 more total visits. Resident perspectives on the adequacy of their continuity clinic experience appeared to not be affected by length of training. Future research should explore how the volume of patient visits performed in residency affects scope of practice and clinical preparedness.