Maintenance Of Skills Research Articles

An online survey of perspectives towards the impact of the covid-19 pandemic amongst caregivers of adolescents with ASD

Abstract Background The coronavirus disease (COVID-19) pandemic has had a negative impact on the health and mental health of adolescents and adolescents with autism spectrum disorders (ASD) and their caregivers, have been disproportionally affected. The purpose of this study was to investigate the impact of COVID-19 on Thai caregivers and adolescents with ASD. Methods This study used an online survey with closed and free text questions to investigate how the pandemic had impacted on social skills development and psychological variables, and perceived needs for support. The survey link was shared to parents via the Yuwaprasart Withayopathum Child and Adolescent Hospital and the social media platforms of known ASD stakeholder networks in Thailand. Binary logistic regression was used to investigate the relationships between sociodemographic characteristics, service use, and social skills problems experienced by adolescents during the pandemic. Content analysis was applied to analyse free-text data. Results A total of 376 caregivers of adolescents with ASD aged 10–19 years completed the survey, of which 364 were included in the analysis. In total, 38.7% of caregivers reported that during the pandemic the social skills of their adolescent family member had worsened. Most families reported that they were able to continue to access support from healthcare and educational services, albeit in different ways than pre-pandemic, during the acute stages of the pandemic which benefited the maintenance of ASD symptoms and social skills. Factors identified as reducing the odds of a worsening in social skills during the pandemic included; regular access to treatment for adolescents (odds ratio [OR] = 0.55, confidence interval 95% (CI) 0.32–0.98, p = 0.044), caregivers feeling that they had sufficient support from hospitals (OR = 0.46, 95% CI 0.26–0.81, p = 0.007) and older age of adolescents (OR = 0.53, CI 0.29–0.99, p = 0.047). The qualitative free text comments showed that the caregivers felt that greater information on managing adolescent behaviours, opportunities for adolescents to practice social skills, and the provision of greater emotional support and material assistance from healthcare professionals during the pandemic would have helped them to care for the adolescents with ASD. Conclusion Regular access to services, support from hospitals during the pandemic and older age in adolescence may have helped prevent the worsening of the social skills problems of adolescents with ASD.

Trainee's Perceptions on Simulation-Based Education and Its Impact on Transitioning to the Role of Medical Registrar: A Qualitative Study.

Background and aim In 2019, a three-year internal medicine training (IMT) program replaced the two-year core medical training program in the United Kingdom, incorporating the first year of medical registrar (MR) training into the same curriculum. In light of the considerable evidence supporting the effectiveness of simulation-based education (SBE) and the challenges inherent in transitioning, the design and delivery of SBE are now ideally positioned to facilitate this transition process and assess its impact. However, trainees' perceptions regarding the effectiveness of SBE in the IMT curriculum for transitioning to the MR role are not well-documented. This study aimed to explore and examine trainees' views on SBE in the IMT curriculum to prepare them to transition to the role of the MR. It sought to identify the critical qualities and skills that IMT trainees believe SBE should address to enable them to successfully fulfill the MR role, as well as to assess the extent to which internal medicine year three trainees perceive that SBE in its current form within the IMT curriculum has prepared them for the role of MR. Methods This qualitative study employed focus groups to explore individuals' perspectives on SBE in the IMTcurriculum and its role in preparing them for the transition to the MR position. Four focus groups were conducted, two with core trainees (CTs) and two with MRs. Sessions were recorded, transcribed verbatim, and analyzed using a thematic analysis approach. Results Eleven trainees participated in the study. Seven of them were CTs, with the remaining four in their first year as a MR. Six main themes emerged from the data, grouped into two main headings. The heading titled "Perceptions of SBE" included the themes "Valuable Teaching Tool," "A Squandered Resource," and "Avoid Over-Reliance." In contrast, the heading "Areas/Suggestions for Improving SBE" included the themes "Quantity and Scheduling," "Feedback," and "Draw on Others' Experiences." Conclusion The value of SBE was recognized, alongside the vital role of high-quality feedback. Other medical specialties and industries were highlighted for their effective implementation of SBE, offering a possible standard for educators involved in the IMT curriculum to pursue. There was a perception that SBE did not adequately supportthe ongoing maintenance of skills, placing considerable reliance on real-world clinical practice to fulfill this need. The limitations inherent in SBE were acknowledged, and educators are encouraged to explore ways to optimize the use of all educational tools at their disposal, which may include the formal introduction of a shadowing period for trainees.

Chest Compression Evaluation based on Pose Estimation

Correct and prompt performance of cardiopulmonary resuscitation yields improvements in mortality and social return rates. Chest compression, a vital cardiopulmonary resuscitation technique, requires regular re-education for skill maintenance. Training with a manikin is feasible for chest compression, but assessing proficiencies without an expert presents challenges. This study aims to facilitate autonomous chest compression training even without expert supervision based on pose estimation. Twenty subjects were recruited for the training and successive performance evaluation of chest compression on a sensor-equipped training manikin, and the corresponding videos were recorded simultaneously. A system was developed to analyze chest compression movements through pose estimation on recorded videos for evaluating interruption presence, compression count, compression tempo, compression depth, and compression recoil. Through comparing three pose estimation models, OpenPose demonstrated the best performance, achieving accuracy rates of 67.08%, 56.67%, 61.25%, 39.17%, and 33.75% for the detection of interruption presence, compression count, appropriate tempo count, appropriate depth count, and appropriate recoil count, respectively. Additionally, posture analysis during compression, unattainable with the sensor-equipped manikin, revealed effectiveness in shooting at a position shifted 45 degrees from the front. The proposed method may serve as a tool for completely automated CPR chest compression training, anticipating an increase in citizens proficient in cardiopulmonary resuscitation.

Benefits of Virtual Reality Training for Cardiopulmonary Resuscitation Skill Acquisition and Maintenance

Objectives To investigate the benefits of virtual reality (VR) first-aid training in acquiring cardiopulmonary resuscitation (CPR) skills. Methods A total of 100 non-medical professional volunteers from Nanchang were selected in March 2021 using the convenience sampling method. They were randomly divided into two groups: the VR training group (VR group) and the traditional simulation scenario training group (traditional group). The VR Group underwent immersive virtual reality CPR training with interactive feedback, while the Traditional Group received standard simulation-based CPR training using mannequins and instructor guidance. After training, relevant data were collected for comparative analysis. Results The study revealed that the VR group consistently outperforming the traditional group in theoretical knowledge test (cardiac arrest recognition, chest compressions, airway management, and artificial respiration) scores at 1, 3, 6, and 12 months post-training (p < 0.05). Similarly, the VR group showed superior performance in overall skills test scores and individual CPR quality metrics at all post-training assessments. The VR group scored higher in total skills, assessment, post-resuscitation assessment, chest compressions (at 1, 3, and 6 months), airway opening, and artificial respiration compared to the traditional group (p < 0.05). Despite these findings, both groups exhibited a gradual decrease in skills test scores over time. Conclusions Virtual reality training can significantly improve non-medical professional volunteers’ CPR knowledge and skill levels, helping them master and maintain these competencies. However, a decrease in CPR knowledge and skills among the participants over time was observed after VR training, suggesting the need for further retraining sessions.

PELATIHAN PERAWATAN KENDARAAN SEPEDA MOTOR BAGI MASYARAKAT DESA SIRNAJAYA

A motorcycle is an engine-driven two-wheeled vehicle composed of different parts that are subjected to different loads during operation, such as heat load, chemical load, impact, bump, twist, push-pull-bend force, friction, pressure. The precision of vehicle components will vary from their original and standard conditions over time such as becoming looser, weaker, or finer. To ensure it is always in top condition, cars require regular maintenance which can be done by a garage or by yourself. In improving the ability to maintain motorcycles and make an income through their own business, especially in the field of motorcycle maintenance services. Through this community service project, counseling on business management and training on motorcycle maintenance skills, including the correct adjustment and use of repair equipment, are provided. The service method applies socialization of motorcycle maintenance theory and direct assistance on how to perform motor vehicle maintenance for Sirnajaya Village youth. The results of this service activity are the increased knowledge, understanding, and abilities of the participants in the field of motorcycle maintenance and repair, besides that this service program supports the success of the community in establishing their own business.

Power Distribution Transformer Maintenance Skills Required byElectrical Engineering Technology Students ofPolytechnics inNorth-East Nigeria

Electric power distribution industry in North-East, Nigeria is faced with inadequate number of power transformer maintenance personnel which has led to numerous abandonment of broken down power transformers. Transformer faults have been blamed for many power outages of long duration in many towns and communities in North-East, Nigeria.It is against this backdrop that thisstudy determined the power distribution transformer maintenance skills required by Electrical Engineering Technology students of polytechnics in North-East Nigeria. Three research questions and three hypotheses guided the study which employed a descriptive survey research design. The population of the study was 144 comprising of 135 Electrical Engineering Technology Lecturers, 3 Power Transformer Maintenance Technicians and 6 Electric Power Distribution Company-Based Supervisors. The entire population was used hence, there was no sampling. The instrument used for data collection was a structured questionnaire titled: Power Distribution Transformer Maintenance Skills Required Questionnaire (PDTMSRQ) developed by the researchers. The instrument was validated by three experts and a reliability of 0.74 was obtained using Cronbach Alpha reliability method. Mean statistic was used to answer the research questions while ANOVA was used to test the two null hypotheses of the study at 0.05 level of significance. The findings of the study revealed that the Electrical Engineering Technology students of polytechnics in North-East Nigeria required preventive, predictive and corrective maintenance skills. The study recommended the following: Lecturers should encourage the students’ skill acquisition process by exposing them to various maintenance activities in order for them to imbibe the different methods of power transformer maintenance; Students should be trained to recognize sounds and sights of faulty equipment in order to predict the parts or components that needed replacement or repairs.

Assessment of an Airway Curriculum in a Pulmonary and Critical Care Fellowship Program.

Endotracheal intubations (EIs) in the intensive care unit are high-risk procedures often performed by pulmonary and critical care medicine (PCCM) providers. The Accreditation Council for Graduate Medical Education mandates PCCM fellows' competency in this procedure; however, the learning experiences vary across programs. After conducting a needs assessment, we developed a curriculum unique to our institution to supplement our fellows' existing EI experiences in the operating room and the intensive care unit. To assess the curriculum's short-term objectives: knowledge acquisition, maintenance, and practical skills 1 year after participation. We administered a survey to the graduating PCCM fellows for two consecutive years. We designed the comprehensive airway curriculum to include didactic lectures and simulation-based education. The knowledge acquisition and maintenance were measured by administering a 26-question knowledge survey before and after curriculum participation and after 1 year. The fellows also received a practical examination 1 year after participation. To compare knowledge survey scores, we used paired t tests and permutation tests. In the needs assessment, 56% of graduating fellows believed they were proficient in performing EI, whereas 33% were undecided and 11% believed they were unprepared. Most believed they would need more than two courses after graduation to be confident in independently performing EIs. Most will only occasionally have backup for EI from anesthesiology or emergency medicine in their future jobs. One identified barrier to learning EI was the lack of a formal curriculum. In the knowledge assessment, nine first-year fellows participated in the curriculum. The cohort's mean presurvey score was 13.0 (standard deviation [SD], 4.5) versus 18.6 (SD, 3.6) mean postsurvey score. One year after participation, the mean survey score was 17 (SD, 1.2). The postsurvey and 1-year postparticipation survey scores were significantly higher than the presurvey scores (P < 0.05). One year after participation, the practical examination showed most fellows retained skills in EI using ramped position, video and direct laryngoscopy, bag-mask ventilation, and oropharyngeal airway placement. The airway curriculum enhances fellows' knowledge acquisition and maintenance 1 year after participation. The practical examination 1 year after participation highlighted the skills retained and those still needing improvement.

The Role of Industrial Internship Activities to Improve Digital Competency of Engineering Students: Perception of Engineering Managers in Industry

Collaboration between the campus and the industrial world can bridge the gap that occurs between the campus and the industrial world, so that both can be integrated and synergized. This study qualitatively explored the contribution of maximizing work-integrated learning through industrial internships. The research findings from the perspective of three industry managers reveal that industrial internships can improve engineering students’ digital engineering competencies such as digital engineering observation and identification, basic and technical understanding of digital technology, work safety, predictive maintenance and programming skills to be ready to enter the workforce. The implications of the research reveal that through industrial internships students can learn from mistakes and challenges faced during industrial projects, for the development of their professional competencies. In addition, the experience and development of digital engineering competencies from the industrial world can be used as a reference for their final assignments, as well as enriching the quality of their research and academic reports, as it can bridge the gap between formal education and the demands in the ever-evolving world of work.

Research on Teaching Practice of Big Data Platform Deployment and Operation Course with Shipping Characteristics

In the era of big data, big data technology has been widely applied, and the operation and maintenance of big data platforms, as a crucial component supporting these applications, has gradually become an indispensable part of enterprise IT architecture. The demand for talents with big data platform operation and maintenance skills is increasing. For higher vocational education institutions, how to cultivate big data platform operation and maintenance talents that meet professional requirements has become an urgent problem to be solved. In order to satisfy the enterprise demand for big data platform operation and maintenance talents and enhance students' employment competitiveness, this paper discusses the teaching content and teaching organization practice of the "Big Data Platform Deployment and Operation" course. The course adopts a project-based teaching mode, integrating the project case of "Ship Shore Power Data Analysis System" into the theoretical knowledge and technical explanations at various stages of the course. At the same time, it deeply excavates the ideological and political elements of maritime power and green environmental protection contained in the project, constructs a teaching mode with obvious shipping characteristics, and improves the quality of talent cultivation.

Maintenance of CPR skills among nursing students trained using Resuscitation Quality Improvement® program

BackgroundThe Resuscitation Quality Improvement® (RQI) program is a competency-based approach that provides low dose, high frequency cardiopulmonary resuscitation (CPR) skills training. Limited research has evaluated its effectiveness with nursing students who need to be prepared to respond to cardiopulmonary emergencies despite their student status and to be competent in CPR as they transition into practice. ObjectiveThe objective of this multisite longitudinal study was to examine the maintenance of adult and infant compressions and ventilation skills by nursing students at 3 and 6 months following practice with real-time feedback using the RQI® program. MethodsThe effectiveness of brief practice of CPR skills at the RQI® simulation station on the maintenance of skills was analyzed with 238 nursing students from six universities across the United States. Participants completed three practice sessions, at baseline (month 0), 3 months, and 6 months. At baseline, they performed compressions and ventilation with a bag-valve mask on adult and infant manikins without feedback (pretest), followed immediately by a session integrating real-time, objective feedback (both audio and visual) on their performance. CPR practice on the manikins with feedback on performance was then repeated every 3 months. ResultsPracticing CPR skills at the RQI® simulation station every 3 months with real-time feedback enabled participants to maintain their compression and ventilation skills and improve them from baseline (month 0) to 6 months. There was no loss of skills among these participants. Median scores on the first attempt to compress and ventilate stayed above the minimum 75 % overall score that learners must achieve to be considered an adequate performance. ConclusionsThis study demonstrated that brief practice of CPR skills at the RQI® simulation station every 3 months with real-time feedback was highly effective for maintaining students’ competence in compressions and ventilation. Once the RQI® program is set up in a school, students could practice on their own as needed to maintain their skills.

Strengthening Community Capacity Through Tsunami Education Programs in the Mangrove Community of Kebumen

Coastal communities, such as the Mangrove Community of Kebumen, face significant risks from tsunamis due to their geographical location. This community service initiative aimed to enhance tsunami disaster preparedness through education and mangrove conservation. The objectives were to improve community knowledge on tsunami mitigation and to empower locals in mangrove planting and maintenance practices. The methodology involved a structured program conducted at Pantai Sawangan, Desa Puring, involving 30 participants from the mangrove community and local residents. The activities included pre-tests, educational sessions on tsunami mitigation and mangrove conservation, and post-tests to evaluate knowledge retention. Expert-led discussions highlighted the role of mangroves as natural barriers against tsunamis. Results showed a significant increase in participants' understanding of tsunami risks and mitigation strategies post-training. Participants actively engaged in practical sessions, demonstrating enhanced skills in mangrove planting and maintenance. Feedback indicated strong community support and a desire for continued educational initiatives. In conclusion, the program effectively improved community resilience through enhanced knowledge and practical skills in disaster preparedness and mangrove conservation. Continued socialization and educational programs are recommended to sustain community involvement and deepen understanding of disaster mitigation across diverse societal groups, ensuring long-term resilience against coastal hazards.

Wearable Technology and Its Influence on Motor Development and Biomechanical Analysis.

The convergence among biomechanics, motor development, and wearable technology redefines our understanding of human movement. These technologies allow for the continuous monitoring of motor development and the state of motor abilities from infancy to old age, enabling early and personalized interventions to promote healthy motor skills. For athletes, they offer valuable insights to optimize technique and prevent injuries, while in old age, they help maintain mobility and prevent falls. Integration with artificial intelligence further extends these capabilities, enabling sophisticated data analysis. Wearable technology is transforming the way we approach motor development and maintenance of motor skills, offering unprecedented possibilities for improving health, performance, and quality of life at every stage of life. The promising future of these technologies paves the way for an era of more personalized and effective healthcare, driven by innovation and interdisciplinary collaboration.

The role of health education in improving student health in Indonesian schools

Health plays an important role in supporting educational success, with healthy students tending to have better concentration, endurance and motivation to learn. To achieve this, schools implement health education programmes aimed at improving students' knowledge, attitudes and skills in maintaining and improving their health. The programme includes formal and informal activities integrated in the curriculum, extracurricular initiatives and school health projects. Effective health education holds the potential to address these issues. While existing research has shown that health education can improve students' knowledge, attitudes, and skills related to health, direct evidence of its effect on students' health remains limited. The implications of health education are profound, including improved health knowledge, positive attitudes toward health, and the development of vital health maintenance skills. Additionally, it fosters a healthy learning environment, which is conducive to improved academic outcomes. Future interventions may involve the development of tailored materials, the integration of technology, and collaborative endeavors across multiple stakeholders. In conclusion, health education is a potent tool for enhancing student well-being and, consequently, educational success. By addressing health challenges and promoting healthy behaviors, health education contributes significantly to creating a brighter and healthier future for students in Indonesia and beyond.

Surgical training; destination unknown?

Background A surgical fellowship allows both additional training as well as maintenance of surgical skills while searching for a steady job. As the presence of fellows usually does not results in a measurably higher productivity, fellowshipsmay be considered a form of disguised unemployment. The aim of this study is to evaluate the career flow of a surgical trainee to a staff position and to determine the number of surgeons working on temporary basis within the general surgery workforce in Flanders. Methods All surgeons graduated in Flanders between 2000 and 2022 were invited to fill out a web-based survey concerning their current and past employment. Reminders were sent out after 2 and 4 weeks. Statistical analysis was performed with SPSS version 27.0 (IBM Inc., Chicago, IL, USA.) Results Response rate was 64% (292/457) with 76% of respondents currently working as surgeons, 14% (38) as fellows and 10% working outside the surgical domain. Eighty-two percent of current fellows graduated in 2019 or later. Thirty-one percent of surgeons graduated in 2019 are still working as fellows. For surgeons graduated in 2020, 2021 and 2022 this is 45%, 80% and 90% respectively. Compared to staff surgeons the number of additional training years (2,8 ± 1,0 vs 2,2 ± 1,3; p = 0,009). and the number of applications (6,6 ± 5 vs 3,3 ± 3; p < 0,001) is significantly higher for current fellows Conclusion This study shows that disguised unemployment is present in the general surgical community in Flanders. The status of “fellow” should be incorporated in calculations concerning future needs of the surgical workforce in order to prevent open unemployment.

Nuclear Facilities Maintenance Culture Development Study

Maintenance is an essential part of the assets and facilities in the organization/company. This deserves serious attention because it is necessary for organizational/company resources, especially for aging nuclear facilities/installations. Maintenance is the main program used to manage company assets and facilities. A lack of asset and facility maintenance culture increases management and maintenance costs. A maintenance culture is needed to improve maintenance skills, tenacity, and perseverance. Maintenance culture is recognized as an essential aspect to improve the quality of maintenance work to maintain structures, systems, and components (SSC) so that they are ready for use at any time/when needed, as well as part of the implementation of aging management programs to extend the life of assets and facilities. This paper will discuss the development of the maintenance culture and review poor maintenance cultures and their solutions. This paper aims to develop a maintenance culture to prevent premature aging and extend the life of assets and facilities. Factors developing maintenance culture include leadership, communication, rewards and recognition, responsibility, rules and standards, empowerment, motivation, involvement, policies, work strategy and planning, teamwork, training and education, awareness, and organizational structure. Corruption, poor leadership, attitude problems, and lack of policy cause poor maintenance culture. The solution to a poor maintenance culture is selecting the right people, improving job skills and knowledge, repairing equipment, ensuring machine/equipment readiness, good planning, scheduling, and general organization, measuring performance, motivating and encouraging desire, and providing sufficient funding. Maintenance culture has an impact on facility performance. Keywords: maintenance culture, nuclear organization, assets, nuclear facility

Preliminary assessment of augmentative and alternative communication‐related stereotypy

AbstractImproving social communication and reducing challenging forms of restricted and repetitive behaviors (i.e., stereotypy) are often the focus of behavioral interventions for individuals with autism and other developmental disabilities. Interventions incorporating augmentative and alternative communication (AAC) systems are utilized to improve independent communication. However, using electronic AAC devices (e.g., iPads) may increase stereotypic behaviors (i.e., pressing the same icon on an AAC device two or more times within 2 s), which may impact the development and maintenance of communication skills. There is a shortage of research focusing on AAC‐related stereotypy, with only one study that includes a systematic assessment and treatment evaluation (Cook et al., 2017). The purpose of the current investigation was to conduct a functional analysis screening procedure that only included play and no‐interaction conditions to adequately assess the function of AAC‐related stereotypy. We sought to ask, how client‐specific modifications to functional assessment procedures affect the outcomes of functional assessments of AAC‐related stereotypy. Initial findings suggest that AAC‐related stereotypy is often automatically reinforced, but its occurrence can be sensitive to the presence/absence of specific environmental stimuli.

Technological support for lifelong learning: The application of a multilevel, person-centric framework

21st century career development is increasingly characterized by recurring participation in work-related skill learning, much of which is mediated by technology. However, integration of this technology into work-related lifelong learning contexts has been relatively atheoretical and non-systematic. Building on interdisciplinary adult learning research and our findings from several studies on an online graduate degree program in a high demand STEM field, we propose a multilevel, person-centric framework of adult learning processes related to: (1) knowledge and skill acquisition, (2) the development and maintenance of motivation and wellbeing over time, and (3) transfer of learning to career-related goals. For each level of the framework, we discuss issues related to the measurement and evaluation of learning. We outline affordances (i.e., functional benefits) of technology (including artificial intelligence) for supporting career-related learning at each level, and present future directions related to major gaps in the field's understanding of these affordances. Throughout the final section, we illustrate the implications of our framework with examples of its use in a research institute focused on AI adult learning technologies. Finally, we present guiding questions for researchers and practitioners interested in technology-mediated career-related learning.

Digital interventions using mobile technologies for life skills development of learners with autism spectrum disorder: a scoping review

Providing essential information for digital health human-computer interaction designers, this scoping review identified the most utilized features of digital evidence-based interventions in prototyped mobile technologies for autism spectrum disorder (ASD), to lay the groundwork for designing user-focused mobile assistive technologies for learners with ASD. The review systematically categorized the features and capabilities of mobile applications that teach, support, and maintain life skills. Synthesizing and analysing 42 studies using thematic analysis, it was found that mobile applications hold the potential to support the uniqueness and varying needs of learners with ASD. This is achieved through personalization in the user interface and user experience, coupled with customizations on learning content. The scoping review also found that mobile applications can assist learners with ASD by breaking down tasks into smaller steps, incorporating pictures, illustrations, videos, sounds, pre-recorded instructions, and just-in-time prompting. In a broader context, mobile technologies can not only enhance life skills learning but also contribute to routine-building for individuals with ASD. This is possible if interventions taught in school are continued at home and integrated with daily home activities, aiming to enhance learning, daily practice, and maintenance of life skills. Future work focuses on making evidence-based interventions readily available and accessible to learners, parents, caregivers, and educators to support the overall well-being of learners with ASD.

Procedural skill maintenance: What it means to physicians, how it motivates them, and what stops them from doing so

Introduction: Maintenance of procedural skills is crucial for paediatric emergency medicine (PEM) physicians to provide high-quality care. A study by Lin-Martore et al. (2021) in the US identified key themes in conceptualising procedural skill maintenance (PSM), its motivations, and barriers to maintenance. However, the difference in culture brings into question the validity of their findings in other contexts. To determine its applicability specifically in an Asian context, this study aims to replicate the study at KK’s Women and Children Hospital (KKH), focusing on PEM physicians. While the findings are limited to a single hospital, they provide valuable insights into challenges encountered by PEM physicians. Methods: A general qualitative approach was used through semi-structured interviews. Participants were recruited through email. Interviews were conducted via Zoom and subsequently de-identified and transcribed. The data was coded manually through thematic analysis, identifying key themes. Results: Fifteen PEM physicians were interviewed. Participants conceptualised PSM through technical aspects and measured competence through objective and subjective measures. General motivation themes found the (1) desire to provide optimal patient care, (2) procedural competence as part of the identity of a PEM physician who teaches and performs procedures, and (3) desire for choice when alternatives are present. Barriers included limited time, support, and opportunities. Conclusion: The study found that the themes from the original study are applicable in KKH, featuring SDT concepts prominently. Practical recommendations for KKH were proposed. Future research can focus on the challenges and gaps in maintaining procedural skills and develop strategies to improve PSM in PEM physicians. Keywords: Procedural Skill Maintenance, Singapore, Emergency Medicine, Qualitative, Paediatric Medicine

SIMPLE procedures: Survey of Internal Medicine Providers' Limitations and Experiences with procedures and medical procedure services.

In response to a decline in bedside procedures performed by hospitalists, some hospital medicine groups have created medical procedure services (MPSs) concentrating procedures under the expertise of trained hospitalist-proceduralists. To characterize the structure, breadth, and heterogeneity of academic medical center MPSs, as well as compare the procedural landscape for groups with and without an MPS. The Survey of Internal Medicine Providers' Limitations and Experienceswith Procedures and MPSs, is a cross-sectional study, conducted in the United States and Canada through a web-based survey administered from October 2022 to March 2023. We used convenience and snowball sampling to identify eligible study participants. The survey explored presence of MPS, procedure volumes, patient safety, and educational practices. For MPSs, we explored onboarding, staffing, skill maintenancy, funding, and barriers to growth. Forty institutions (response rate 97.5%), represented by members of the Procedural Research and Innovation for Medical Educators (PRIME) consortium participated in the survey. MPSs were found in 75% of the surveyed institutions. Most MPSs (97%) involved trainees and were staffed by internists (100%) who often had additional clinical duties (70%). The majority (83%) of MPSs used checklists and procedural safety guidelines, but only 53% had a standardized process for tracking complications. There was significant variability in determining procedural competency and supervising trainees. Groups with an MPS reported higher procedure volume compared to those without. MPSs were highly prevalent among the participating institutions, offered a broad array of bedside procedures, and often included trainees. There was a high variability in funding models, procedure volumes, patient safety practices, and skill maintenance requirements.