Maintenance Of Skills Research Articles

A Protocol for Culture and Characterization of Human Induced Pluripotent Stem Cells After Induction.

Human induced pluripotent stem cells (hiPSCs) are characterized by unlimited self-renewal and the capability to differentiate into all three germ layers, with the potential to further differentiate into all types of cells and tissues. Human iPSCs retain all genetic information from their original donors and can be developed into disease models to study disease pathophysiology, identify disease phenotypes and biomarkers, and evaluate therapeutic efficacy and toxicity for drug development. Human iPSCs can also be used to develop cell therapies and regenerative medicine. In the last decade, the technologies for hiPSC generation and differentiation have advanced rapidly. Human iPSC culture and propagation are tedious and require careful handling. High-quality hiPSCs are necessary for downstream applications. The methods, techniques, and skills for hiPSC maintenance and characterization are very different from those for immortalized cell lines. It can be a challenge for new laboratory staff, and sometimes even for experienced staff, to properly culture and maintain the high quality of these cells. Here, we describe a comprehensive set of protocols for hiPSC propagation under chemically defined and feeder-free culture conditions. These step-by-step protocols describe in detail all the reagents and experimental procedures needed to culture hiPSCs. The protocols also describe experimental methods for hiPSC characterization, including immunofluorescence staining and flow cytometric analysis with a panel of pluripotency markers, a teratoma formation assay for validation of in vivo pluripotency, and detection of Sendai virus to ensure elimination of the viral vectors. These protocols have been successfully used in our laboratory for hiPSC expansion and propagation, and this article provide a useful reference guide for laboratory staff to work on hiPSC culture. Published 2023. This article is a U.S. Government work and is in the public domain in the USA. Current Protocols published by Wiley Periodicals LLC. Basic Protocol 1: Propagation and cryopreservation of hiPSC cultures Basic Protocol 2: Recovery of cryopreserved hiPSCs Basic Protocol 3: Validation of pluripotency markers via immunocytochemical analysis Alternate Protocol: Determination of the expression of pluripotency markers via flow cytometry analysis Basic Protocol 4: Assessment of pluripotency via in vivo teratoma formation assay Basic Protocol 5: Confirmation of Sendai viral vector clearance via RT-PCR.

A Real-World Experience: Retrospective Review of Point-of-Care Ultrasound Utilization and Quality in Community Emergency Departments.

Point-of-care ultrasound (POCUS) is commonly used in the emergency department (ED) as a rapid diagnostic tool. Emergency medicine (EM) has been an early adopter of POCUS with indications expanding over the last 10 years. While the literature describes widespread use among academic sites, there is little data on clinical POCUS utilization at non-academic EDs. We sought to describe community emergency physician (EP) use of POCUS by quantifying the number and type of studies performed, characteristics of the performing physician, and quality metrics. Prior to the study period, all EPs underwent a standardized training and credentialing program. A retrospective review of all POCUS studies across 11 non-academic EDs from October 1, 2018-September 30, 2020 was performed by fellowship-trained physicians, who identified physician, exam type, and residency graduation year. The studies were then cross-referenced with quality review reports that assessed image acquisition, image interpretation, and image labeling. We performed descriptive statistics. During the study period, 5,099 POCUS studies were performed by 170 EPs. Exams most frequently performed were cardiac (24%), focused assessment of sonography in trauma (21.7%), and pregnancy (16.2%). Recent EM residency graduates (<10 years) were higher utilizers of POCUS with a group mean of 1.3 exams per 100 patients. Of the studies done, 86% had no quality issues. Community POCUS demonstrates a heavy focus on core exams performed by recent EM residency graduates with minimal quality issues after a standardized training program. This study is the first to quantify actual community POCUS use in multiple EDs and may impact credentialing and skills maintenance requirements.

Addressing the psychology of weight loss and maintenance: A feasibility study of the Skills for weight loss and Maintenance weight management programme.

Building on prior theory, we aimed to evaluate the feasibility and acceptability of integrating novel, weight loss maintenance strategies into existing weight management programmes. We also piloted recruitment and data collection procedures for future research. Two phases of action research nested within a single-arm feasibility study. The intervention was refined between phases using feedback from intervention fidelity analysis and qualitative exploration of patient and provider experiences. Changes in outcomes were assessed up to 18 months post-baseline. One hundred adults with a mean body mass index of 37 kg/m2 were offered the Skills for weight loss and Maintenance (SkiM) intervention. This included existing weight management programme content and additional weight loss maintenance techniques delivered fortnightly for 6 months in local community centres to groups of 11-15 people. Of the 100 participants, 65%, 58% and 56% provided data at 7, 12 and 18 months. Across both phases, the mean initial weight loss was 4.2 kg (95% CI: 2.4-5.9) and 3.1 kg at 18 months (95% CI: .8-5.5). In Phase 2, we observed better weight loss maintenance (.5 kg [13.2%] regain from 7 to 18 months, vs. 1.7 kg [36.2%] in Phase 1). Variation in outcomes, high early dropout rates and qualitative feedback indicated that, although delivery of the intervention and trial procedures was feasible and acceptable, there was scope to refine the intervention to engage a wider range of participants. Intervention fidelity was acceptable, particularly in Phase 2. The SkiM intervention seems promising, but more research is needed to improve recruitment and retention prior to further evaluation.

Assessing the Effects of Practitioner-Created and Implemented Video-Based Intervention to Teach Vocational Skills to Autistic Young Adults

This study evaluated the impact of training two practitioners to create and implement video-based intervention (VBI) to teach vocational skills to three autistic young adults in authentic workplace settings, via a multiple-probe single-case research design. A behavioral skills training (BST) package was used to train the practitioners to create and implement VBI. Practitioners’ fidelity of VBI creation and implementation was also evaluated via pretest-posttest. There was a functional relation between the practitioner-created and -implemented VBI and the autistic young adults’ vocational skill acquisition, with all three reaching 100% independent accuracy and demonstrating maintenance of the learned vocational skills. The practitioners also showed large increases in their fidelity of VBI creation and implementation from pretest to posttest, although their VBI creation performance decreased slightly at follow-up. All participants reported positive experiences with the VBI and rated it as socially valid.

Demonstration of Improved Banana (William-1 Variety) Production and Commercialization in Nyanghtom District of South Omo Zone, Southern Ethiopia

A demonstration of improved banana production and commercialization was conducted in the Nyanghtom district of the South Omo Zone to enhance the livelihoods of pastoralists and agro-pastoralists in the area. One improved banana variety (Wiliyams-1) was used for the demonstration and planted on one hectare of land after training was given for purposively selected 25 trial pastoral agro-pastoral research and extension groups and 7 nontrial agro-pastorals from land preparation to harvesting. Relevant data through individual interviews and measurement of agronomic parameters were collected. The collected data were analyzed by descriptive statistics and Likert scale measurement of agro-pastoral preference. Based on the results, the mean banana fruit produced was 28.4 ton ha–1 under agro-pastoral management and also agro-pastoral preference indicated that the variety Wiliyam-1 was the first choice of agro pastorals in all parameters except drought resistance. Cost-benefit analysis results indicated that the average net income obtained from banana production was 209,647 Ethiopian Birr ha–1. The cost-benefit ratio of 2.95:1 indicated that the benefit of production was nearly three times higher than the cost of production. However, agro-pastoral raised the frequent breakdown of water pumps, lack of operation and maintenance skills, and the high cost of fuel to operate generators and tractors were major bottlenecks to sustaining production. Therefore, strong efforts of respective stakeholders are needed to resolve irrigation water access problems for sustainable banana production and commercialization to ensure food security and improve the livelihoods of women and agro-pastorals.

Skills improvement needs of electronics work trade teachers in science and technical colleges in North East, Nigeria

The study determined the Skills improvement needs of electronics works trade teachers in science and technical colleges in North East, Nigeria. The study adopted descriptive survey research design. Two research questions was raised and answered and two corresponding hypotheses was tested at 0.05 level of significance. The population of the study consisted of 220 teachers of electronics works trade from 34 science and technical colleges, and 140 teachers was used as sample for the study. The instrument used for collection data was a 16 items structured questionnaire. The instrument was developed by the researchers after extensive literature review based on the specific objectives of the study. The instrument was validated by three research experts while the reliability index of 0.89 was obtained using Cronbach’s alpha. The findings of the study revealed that radio and electronic system repairs and maintenance, television repairs and maintenance skills improvement needs of electronics works trade teachers. The recommendations include among others that government and other training institution should improve skills of electronics work trade teachers in public science and technical colleges in television repairs and maintenance.

Identification of a partnership model between a university, for-profit, and not-for-profit organization to address health professions education and health inequality gaps through simulation-based education: A scoping review protocol.

Healthcare providers in rural and remote (R&R) areas of Canada do not have the same access to skills development and maintenance opportunities as those in urban areas. Simulation-based education (SBE) is an optimal technique to allow healthcare providers to develop and maintain skills. However, SBE is currently limited mainly to universities or hospital-based research laboratories in urban areas. The purpose of this scoping review is to identify a model, or components of a model, that outline how a university research laboratory can collaborate with a for profit and not-for-profit organization to facilitate the diffusion of SBE into R&R healthcare provider training. This scoping review will be guided by the methodological framework introduced by Arksey and O'Malley in 2005 and the Methodology for Joanna Briggs Institute Scoping Reviews. Ovid MEDLINE, PsycINFO, Scopus, Web of Science, and CINAHL will be searched for relevant articles published between 2000 and 2022, in addition to grey literature databases and manual reference list searches. Articles describing a partnership model or framework between academic institutions and non-profit organizations with a simulation or technology component will be included. Titles and abstracts will be screened, followed by a full-text screening of articles. Two reviewers will participate in the screening and data extraction process for quality assurance. Data will be extracted, charted, and summarized descriptively to report key findings on potential partnership models. This scoping review will provide an understanding on the extent of existing literature regarding the diffusion of simulators for healthcare provider training through a multi-institutional partnership. This scoping review will benefit R&R parts of Canada by identifying gaps in knowledge and determining a process to deliver simulators to train healthcare providers. Findings from this scoping review will be submitted for publication in a scientific journal.

"…with the third eye we can detect mistakes and correct them…'' Supportive supervision and the management of Clubfoot by Ponseti method: Qualitative experiences from Mwanza, Tanzania.

Supportive supervision is the key to health programs in the provision of quality care. Clubfoot or Congenital Talipes Equinovarus remains among the prevalent congenital musculoskeletal birth defects in Tanzania. In 2015, Tanzania introduced supportive supervision guidelines for clubfoot treatment. However, little is known about how supportive supervision helps maintain the skills of providers. To analyze the supportive supervision in maintaining the clinical skills of healthcare workers in clubfoot management in Mwanza, Tanzania. An exploratory qualitative case study employing in-depth interviews (IDIs) with healthcare providers, supervisors, and parents of children with clubfoot was conducted in Mwanza, Tanzania. Data were collected from 3 purposefully selected hospitals and 32 IDI were conducted with the selected participants between April and May 2021. A semi-structured interview guide was used to conduct the IDIs. Qualitative content analysis was used to analyze the data. Two categories were identified in this study. First "the contribution of supportive supervision" attributed by its purpose and the success brought by the supportive supervision. Second, "the maintenance of healthcare workers' skills was attributed to their willingness to learn and actively engage in supportive supervision, cooperation with clinics and clubfoot programmes, and material support. The findings of this study underscore the contribution of supportive supervision to maintaining skills in the management of clubfoot in Tanzania. The findings of this study highlight the importance of joint efforts to maintain quality service skills.

What Else Can Be Done by the Spinal Cord? A Review on the Effectiveness of Transpinal Direct Current Stimulation (tsDCS) in Stroke Recovery.

Since the spinal cord has traditionally been considered a bundle of long fibers connecting the brain to all parts of the body, the study of its role has long been limited to peripheral sensory and motor control. However, in recent years, new studies have challenged this view pointing to the spinal cord's involvement not only in the acquisition and maintenance of new motor skills but also in the modulation of motor and cognitive functions dependent on cortical motor regions. Indeed, several reports to date, which have combined neurophysiological techniques with transpinal direct current stimulation (tsDCS), have shown that tsDCS is effective in promoting local and cortical neuroplasticity changes in animals and humans through the activation of ascending corticospinal pathways that modulate the sensorimotor cortical networks. The aim of this paper is first to report the most prominent tsDCS studies on neuroplasticity and its influence at the cortical level. Then, a comprehensive review of tsDCS literature on motor improvement in animals and healthy subjects and on motor and cognitive recovery in post-stroke populations is presented. We believe that these findings might have an important impact in the future making tsDCS a potential suitable adjunctive approach for post-stroke recovery.

Solutions to Preventing Mistake in Building Electrical Installation and Maintenance In Urban Area Based on Skills Training

Electricity plays an important role in the functionality of a building. To ensure the required electrical competencies are met, it is essential to provide appropriate training. Therefore, this community service program based on the needs of the assisted village aimed at providing training to potential dropout youths, equipping them with skills in operating and maintaining building electrical installations, enhancing awareness regarding the importance of proper and correct electrical installations, and fostering energy-independent village. The training included several stages namely preliminary study, planning, implementation, mentoring, monitoring and evaluation. The results of the activity showed that the participants of the training obtained operational as well as building electrical system maintenance skills. These acquired competencies led to the improved standard of living, increased welfare, and the prevention of hazards resulting from errors in electrical installation and maintenance within the village of Giri Mekar. The outcome of this community service activity was that in the assisted village a number of skilled installer cadres had emerged, possessing skills in the operation and maintenance of building electrical installation systems.

LEARNING FROM SIMULATION IN HIGHER ORTHOPAEDIC TRAINING: ARE WE ON THE SAME PAGE?

Simulation use in training is rapidly becoming a mainstay educational tool seen to offer perceived benefits of a safe environment for repeated practice and learning from errors without jeopardising patient safety. However, there is currently little evidence addressing the trainees’ perspectives and attitudes of simulation training, particularly in comparison with trainers and the educational community.This study investigates orthopaedic trainees’ and trainers’ conceptions of learning from simulation-based training, exploring whether the orthopaedic community are ‘on the same page’, with respect to each other and the educational community. Qualitative research in the form of semi-structured interviews is used to identify commonalities and differences between trainee and trainer conceptions, based on respective experiences and expectations, and suggests ways of enhancing collaboration between stakeholders to achieve better alignment of conceptions.The research revealed that orthopaedic trainees and trainers conceive key themes in a similar manner: supporting the role of simulation in developing the ‘pre-trained novice’ as opposed to skill refinement or maintenance; attributing greater importance to non-technical rather than technical skills development using simulation; questioning the transferability to practice of learnt skills; and emphasising similar barriers to increased curriculum integration, including financing and scheduling. These conceptions are largely in contrast to those of the educational community, possibly due to differing conceptions of learning between the two communities, along with a lack of a common language in the discourse of simulation.There was some evidence of changing attitudes and positively emerging conceptions among the orthopaedic community, and capitalising on this by engaging trainers and trainees may help reconcile the differing conceptions and facilitate increasing simulation utilisation and curriculum integration. Developing a common language to make the educational more tangible to surgeons, bringing the educational closer to the surgical, may help maximise the educational benefit and shape the future of simulation use in surgical training.

Barriers and Facilitators to Point-of-Care Ultrasound Use in Rural Australia.

This study explores the barriers and facilitators to point-of-care ultrasound (POCUS) use and adoption in rural healthcare since POCUS is a useful resource for rural clinicians to overcome the challenges associated with limited on-site clinical support, such as limited diagnostic imaging services and infrastructure. A qualitative descriptive study was employed, interviews with ten rural clinicians were conducted, and the data were analysed using the Walt and Gilson health policy framework to guide interpretation. Barriers include a lack of standardised training requirements, the cost of the devices and challenges recouping the costs of purchase and training, difficulty with the maintenance of skills, and a lack of an effective method to achieve quality assurance. Coupling POCUS with telemedicine could address the issues of the maintenance of skills and quality assurance to facilitate increased POCUS use, leading to positive patient safety and social and economic implications.

Utilization of a novel mobile application, "HBB Prompt", to reduce Helping Babies Breathe skills decay.

Helping Babies Breathe (HBB) is a newborn resuscitation training program designed to reduce neonatal mortality in low- and middle-income countries. However, skills decay after initial training is a significant barrier to sustained impact. To test whether a mobile app, HBB Prompt, developed with user-centred design, helps improve skills and knowledge retention after HBB training. HBB Prompt was created during Phase 1 of this study with input from HBB facilitators and providers from Southwestern Uganda recruited from a national HBB provider registry. During Phase 2, healthcare workers (HCWs) in two community hospitals received HBB training. One hospital was randomly assigned as the intervention hospital, where trained HCWs had access to HBB Prompt, and the other served as control without HBB Prompt (NCT03577054). Participants were evaluated using the HBB 2.0 knowledge check and Objective Structured Clinical Exam, version B (OSCE B) immediately before and after training, and 6 months post-training. The primary outcome was difference in OSCE B scores immediately after training and 6 months post-training. Twenty-nine HCWs were trained in HBB (17 in intervention, 12 in control). At 6 months, 10 HCW were evaluated in intervention and 7 in control. In intervention and control respectively, the median OSCE B scores were: 7 vs. 9 immediately before training, 17 vs. 21 immediately after training, and 12 vs. 13 at 6 months after training. Six months after training, the median difference in OSCE B scores was -3 (IQR -5 to -1) in intervention and -8 (IQR -11 to -6) in control (p = 0.02). HBB Prompt, a mobile app created by user-centred design, improved retention of HBB skills at 6 months. However, skills decay remained high 6 months after training. Continued adaptation of HBB Prompt may further improve maintenance of HBB skills.

Clinical and Physician Factors Associated With Failed Operative Vaginal Delivery.

To examine clinical and physician factors associated with failed operative vaginal delivery among individuals with nulliparous, term, singleton, vertex (NTSV) births. This was a retrospective cohort study of individuals with NTSV live births with an attempted operative vaginal delivery by a physician between 2016 and 2020 in California. The primary outcome was cesarean birth after failed operative vaginal delivery, identified using linked diagnosis codes, birth certificates, and physician licensing board data stratified by device type (vacuum or forceps). Clinical and physician-level exposures were selected a priori, defined using validated indices, and compared between successful and failed operative vaginal delivery attempts. Physician experience with operative vaginal delivery was estimated by calculating the number of operative vaginal delivery attempts made per physician during the study period. Multivariable mixed effects Poisson regression models with robust standard errors were used to estimate risk ratios of failed operative vaginal delivery for each exposure, adjusted for potential confounders. Of 47,973 eligible operative vaginal delivery attempts, 93.2% used vacuum and 6.8% used forceps. Of all operative vaginal delivery attempts, 1,820 (3.8%) failed; the success rate was 97.3% for vacuum attempts and 82.4% for forceps attempts. Failed operative vaginal deliveries were more likely with older patient age, higher body mass index, obstructed labor, and neonatal birth weight more than 4,000 g. Between 2016 and 2020, physicians who attempted more operative vaginal deliveries were less likely to fail. When vacuum attempts were successful, physicians who conducted them had a median of 45 vacuum attempts during the study period, compared with 27 attempts when vacuum attempts were unsuccessful (adjusted risk ratio [aRR] 0.95, 95% CI 0.93-0.96). When forceps attempts were successful, physicians who conducted them had a median of 19 forceps attempts, compared with 11 attempts when forceps attempts were unsuccessful (aRR 0.76, 95% CI 0.64-0.91). In this large, contemporary cohort with NTSV births, several clinical factors were associated with operative vaginal delivery failure. Physician experience was associated with operative vaginal delivery success, more notably for forceps attempts. These results may provide guidance for physician training in maintenance of operative vaginal delivery skills.

Effectiveness of virtual reality technology in teaching pedestrian skills to children with intellectual disabilities

Pedestrian skills are important for children with intellectual disabilities to continue their daily lives independently. The aim of this study is to determine the effectiveness of virtual reality in the acquisition and maintenance of pedestrian skills for children with intellectual disabilities. In addition, the effect of virtual reality on participants generalizing their pedestrian skills to real environments has also been examined. In the study, social validity data were collected from the participants and their mothers regarding the results of the study. Three intellectual disabled children between the ages of 11 and 15 participated in the study. In the study, a multiple probe design with inter-participant probe trial, which is one of the single-subject research models, was used. It is seen that all participants learned pedestrian skills and continued the skills they learned one, three and five weeks after the completion of the instruction. In addition, all participants were able to generalize their skills to the real environment (pedestrian crossing and illuminated pedestrian crossing). When the social validity data collected from the participants and their mothers were examined, it was revealed that teaching with virtual reality applications is interesting and fun, in addition, it can be used for different educational purposes.

Craniotomies at an overseas military treatment facility: Maintaining readiness for the unit and the surgeon

IntroductionCraniotomy and craniectomy are common neurosurgical procedures with wide applications in both civilian and military practice. Skill maintenance for these procedures is required for military providers in the event they are called to support forward deployed service members suffering from combat and non-combat injuries. The presents investigation details the performance of such procedures at a small, overseas military treatment facility (MTF). Materials and methodsA retrospective review of craniotomy procedures performed at an overseas military treatment facility (MTF) over a 2-year period (2019–2021) was performed. Patient and procedural data were collected for all elective and emergent craniotomies including surgical indications, outcomes, complications, military rank, and impact on duty status and tour curtailment. ResultsA total of 11 patients underwent a craniotomy or craniectomy procedure with an average follow-up of 496.8 days (range 103–797). Seven of the 11 patients were able to undergo surgery, recovery, and convalesce without transfer to a larger hospital network or MTF. Of the 6 patients that were active duty (AD), one returned to full duty while three separated and two remain in partial duty status at latest follow-up. There were four complications in four patients with one death. ConclusionsIn this series, we demonstrate that cranial neurosurgical procedures can be performed safely and effectively while at an overseas MTF. There are potential benefits to the AD service members, their unit, and family as well as to the hospital treatment team and surgeon as this represents a clinical capability requisite to maintain trauma readiness for future conflicts.

AN ASSESSMENT OF THE TECHNICAL SKILLS OF STUDENTS IN THE ANAMBRA STATE: IMPLICATION FOR THE DEVELOPMENT ENTREPRENEURSHIP IN ANAMBRA STATE, NIGERIA

Technical and Vocational Education and Training (TVET) is essential in developing highly skilled workers to satisfy the requirements of various industries. An empirical study is required to assess students' technical competency in TVET programs. This is necessary to successfully equip students with technical abilities that satisfy their current job needs and professional expectations. In fact, very little is known about the technical abilities of college students attending technical schools. The present study evaluated students' technical skills at government technical colleges in Anambra State, Nigeria. Two hundred fifty-five students were purposively pooled from the government technical college located in different parts of Anambra State and participated in the study. They completed a questionnaire measuring technical skills in six dimensions. The result revealed a high technical competence outcome for material and application (75.5%), work planning (71%), practical knowledge (66.7%), and theoretical knowledge (59.4%). Also, the findings indicated low technical skills for equipment maintenance (15.6%) and workshop management (18.1%). The result has implications for the sustainability and development of TVET in Nigeria.

Impact of level 2 automation and ADHD symptomatology on young drivers’ attention maintenance

Attention Deficit Hyperactivity Disorder (ADHD) is a common mental disorder that affects drivers’ attention maintenance skills. Vehicle automation is another factor that has an increasingly important effect on drivers’ attention or concentration level during driving. This driving simulator study aimed to investigate how drivers’ glance behavior changed under different levels of vehicle automation and according to high or low ADHD symptomology. During the drive, participants were asked to complete a map task on a tablet while their glance behavior was recorded. Results imply that the participants tend to have a longer mean off-road glance duration and a larger long off-road glance ratio when they were under the L2 automation level compared to manual mode. ADHD symptomatology and the interaction between ADHD and vehicle automation were not found to be significant. These findings indicate that vehicle automation negatively impacts drivers’ attention maintenance skills. Future work would consider more kinds of secondary tasks that can assess the participants’ attention maintenance skills from various aspects.

Impact and effectiveness of a mandatory competency-based simulation program for pediatric emergency medicine faculty.

Pediatric emergency medicine physicians struggle to maintain their critical procedural and resuscitation skills. Continuing professional development programs incorporating simulation and competency-based standards may help ensure skill maintenance. Using a logic model framework, we sought to evaluate the effectiveness of a mandatory annual competency-based medical education (CBME) simulation program. The CBME program, evaluated from 2016 to 2018, targeted procedural, point-of-care ultrasound (POCUS) and resuscitation skills. Delivery of educational content included a flipped-classroom website, deliberate practice, mastery-based learning, and stop-pause debriefing. Participants' competence was assessed using a 5-point global rating scale (GRS; 3=competent, 5=mastery). Statistical process control charts were used to measure the effect of the CBME program on team performance during in situ simulations (ISS), measured using the Team Emergency Assessment Measure (TEAM) scale. Faculty completed an online program evaluation survey. Forty physicians and 48 registered nurses completed at least one course over 3 years (physician mean ± SD 2.2 ± 0.92). Physicians achieved competence on 430 of 442 stations (97.3%). Mean ± SD GRS scores for procedural, POCUS, and resuscitation stations were 4.34 ± 0.43, 3.96 ± 0.35, and 4.17 ± 0.27, respectively. ISS TEAM scores for "followed standards and guidelines" improved significantly. No signals of special cause variation emerged for the other 11 TEAM items, indicating skills maintenance. Physicians rated CBME training as highly valuable (mean question scores 4.15-4.85/5). Time commitment and scheduling were identified as barriers to participation. Our mandatory simulation-based CBME program had high completion rates and very low station failures. The program was highly rated and faculty improved or maintained their ISS performance across TEAM scale domains.

Using Integrated Intervention Strategies for Improvement of Health Behavior: A Case Study Across Community Health Service in Indonesia

Health behaviour in hypertension sufferers, a non-communicable disease (NCDs), becomes a serious health problem if it is not followed by good knowledge and treatment skills. Improvement of this condition requires several interventions that must be integrated but require scientific evidence. This research aims to prove scientifically and provide solutions to improve health behaviour problems at risk in society. We used some interventions that were applied and integrated with community health service based on a mutual agreement: health education, group therapy, and the promotion of physical exercise. The number of research subjects was 53 adults at risk of hypertension in Wedomartani Village, Sleman, Yogyakarta. Data collection was carried out in June-July 2022 and used interview and observation techniques using outcome indicators, knowledge level and health maintenance skills. The results showed an increase of 32.0% in knowledge and health maintenance of 36.0% for non-communicable disease prevention behaviour by making warm water therapy combined with basil leaf infusion to lower blood pressure. There is an increased understanding of the processing of meat ingredients and the calculation of healthy eating portions. Likewise, there was an increase in the subjects’ activity to participate in physical exercise activities for hypertension exercise. The result was a decreasing prevalence of hypertension -24.5%. This study concluded that the combination of the three intervention strategies that have been given could be a choice of solution to the problem of health behaviour in adults with a risk of hypertension.