National Training Program Research Articles

Improvement of Cancer Detection on Mammograms via BREAST Test Sets

Breast Screen Reader Assessment Strategy (BREAST) is an innovative training and research program for radiologists in Australia and New Zealand. The aim of this study is to evaluate the efficacy of BREAST test sets in improving readers' performance in detecting cancers on mammograms. Between 2011 and 2018, 50 radiologists (40 fellows, 10 registrars) completed three BREAST test sets and 17 radiologists completed four test sets. Each test set contained 20 biopsy-proven cancer and 40 normal cases. Immediate image-based feedback was available to readers after they completed each test set which allowed the comparison of their selections with the truth. Case specificity, case sensitivity, lesion sensitivity, the Receiver Operating Characteristic (ROC) Area Under the Curve (AUC) and Jackknife Free-Response Receiver Operating Characteristic (JAFROC) Figure of Merit (FOM) were calculated for each reader. Kruskal-Wallis test was utilized to compare scores of the radiologist and registrars across all test-sets whilst Wilcoxon signed rank test was to compare the scores between pairs of test sets. Significant improvements in lesion sensitivity ranging from 21% to 31% were found in radiologists completing later test sets compared to first test set (p ≤ 0.01). Eighty three percent of radiologists achieved higher performance in lesion sensitivity after they completed the first read. Registrars had significantly better scores in the third test set compared to the first set with mean increases of 79% in lesion sensitivity (p = 0.005) and 37% in JAFROC (p = 0.02). Sixty percent and 100% of registrars increased their scores in lesion sensitivity in the second and third reads compared to the first read while the percentage of registrars with higher scores in JAFROC was 80%. Introduction of BREAST into national training programs appears to have an important impact in promoting diagnostic efficacy amongst radiologists and radiology registrars undergoing mammographic readings.

Integrated interdisciplinary simulation programmes: an essential addition to national and regional cardiothoracic surgical training and education programmes.

Integrated interdisciplinary simulation programmes: an essential addition to national and regional cardiothoracic surgical training and education programmes.

Prevalence of stress and its determinants among residents enrolled in China Standardized Training Program for Resident Doctor (C-STRD) program: A cross-sectional study.

BackgroundIt has been widely understood that well-trained doctors are crucial for a high-quality public health system and safe patient care. Thus, in 2011, China initiated its first national residency training program, called the China Standardized Training for Resident Doctor (C-STRD), for medical graduates to prepare qualified doctors for the medical care system with increasing demands. So far, no studies have specifically address the prevalence of stress and its determinants among residents enrolled in the C-STRD.Participants and methodsThe research is performed in two stages. In stage I, the authors conducted a pilot study and met 112 C-STRD residents in person. Based on the preliminary data, a revised questionnaire was adopted in stage II, during which the authors conducted a multi-institutional, cross-sectional survey of 340 participants from 11 hospitals in Shanghai in a self-administered manner.ResultsThe results showed that C-STRD residents were overall under severe stress as their mean PSS score was 27.5 ± 4.9, which was higher than the threshold of high stress (PSS = 20). Specifically, the PSS score for the residents with Bachelor (MB), Master (MM) and Doctoral of Medicine (MD) educational degree were 26.6 ± 4.1, 27.8 ± 3.5 and 27.1 ± 5.2, respectively (P>0.05). Their stress was mainly associated with their financial income status and workload, as these two factors caused more severe burden than other listed stressors (P<0.05). Specially, the residents indicated that their montly payroll amout were as low as $590.2 ± 127 while no benefit package and allowance were given. Surprisingly, wage arrears up to 5.3 month were reported by 36 (10%) participants. Workload survey showed the residents has high work intensity and inadequate rest. Since no stress management program was provided, the majority of residents tended to cope their stress with unhealthy strategies, such as mesmerizing in TV/computer (88.2%) and overeating (59.7%).ConclusionThe C-STRD residents are at high risk of perceived stress. Although there was a difference in perception of stress for workload and career future among different educational degree owners, low financial income is the major stressor among all C-STRD residents. Unhealthy stress management strategies were adopted by all residents due to lack of appropriate stress-relieving intervention.

The problem of “difficult airways” — multicenter studies of Federation of anaesthesiologists and reanimatologists to analyze current clinical practice and review the training system in the Russian Federation. Review

“Difficult airways” situations continue to be one of the main causes of anesthetic mortality and morbidity. Current requirements of patient safety during anesthesia determine the need for the necessary equipment and compliance with existing clinical guidelines. The situation with the equipment of hospitals in the Russian Federation with different airway devices and medical equipment, as well as the approaches used by anesthesiologists are regularly reviewed by the FAR Committee of Difficult Airways by distributing a questionnaire. During the last 10 years there has been a positive trend in the level of hospital equipment with supraglottic airways, there has been an increase in the awareness of specialists about the existing clinical guidelines. An updated version of the survey was developed to examine the current situation in the Russian Federation, to analyze the effectiveness of the approaches used to solve the problem of “difficult airways” and to evaluate the role of the existing recommendations of the FAR. The role of the human factor is decisive in the development of a significant part of critical situations during anesthesia. A modern training program for clinical residents in anesthesiology should include training in upper airways assessment, performing basic maneuvers of airways management, working out techniques for using various devices, as well as using existing algorithms of actions during “difficult airways” situations. The ability to apply theoretical knowledge and act requires training in a high-fidelity simulation and subsequent analysis of residentʹs performance. The newly developed survey is devoted to the analysis of the situation with airways management training in the clinical residency. Based on the results of the survey, it is planned to develop a draft national airways management training program for anesthesia residents.

Practice and Consideration on National Training Program Sending Teachers to the Countryside for Training

Practice and Consideration on National Training Program Sending Teachers to the Countryside for Training

The National Pediatric Surgery Simulation Program in France: A tool to develop resident training in pediatric surgery

Background/PurposeTo implement resident curriculum in France based on theoretical teaching and bed side training, the national council known as the “Collège Hospitalier et Universitaire de Chirurgie Pédiatrique” examined the relevance and feasibility of systematically introducing simulation program in the pediatric surgery resident training. Material and methodsA national simulation training program was developed and took place in a 2-day session organized in 7 simulation centers in France. The program included technical (laparoscopic/suturing technique on low-fidelity models) and nontechnical (6 scenarios for standardized consultation, and a team work scenario based on errors prevention in the operative room) skills. Evaluation of the program (Likert scale from 1 (bad) to 5 (excellent) and notation on 20 points) concerned trainees and trainers. Results40 residents (95% of all pediatric surgery French residents) attended with a ratio of trainees/trainer of ½. The training objectives earned a score of 4.46/5. The pedagogical value of the seminar scored 4.7/5, teaching quality 17.95/20, and the overall seminar score was 17.35/20. ConclusionThis program, unique nationally, was assessed very favorably by the participating residents and by the involved trainers. To our knowledge, it represents the first mandatory national simulation training program included within a surgical training model. Level of evidenceLevel IV.

Implementing MH-TIPS: A Growing Need for Mental Health Services for School-Age Children.

The number of children diagnosed with mental and behavioral health issues is increasing each year. Early identification and intervention for these issues are vital to improving long-term outcomes. School nurses are among the frontline healthcare providers for school-age children, screening and coordinating care for multiple physical and mental health conditions. This article describes the implementation of a national mental health online training program at a local district. Outcomes of the implementation project and implications for school nurses are discussed.

The Swedish national principal training programme: a programme in constant change

ABSTRACTIn the mid-1970s, a systematic national principal training programme was introduced in Sweden. The aim was to guarantee better-equipped principals in their mission to lead and develop schools in accordance with national steering documents. Since then, the programme has been subjected to changes, but its focus has remained the same. The three-year programme is currently directed at already-employed principals whose efforts are estimated to consume about 20% of their working time. Six universities provide the programme with content that corresponds to thirty higher-education credits. Consequently, the academy has to balance its fundamental role as a critical independent institution and its mission to provide an education that is crucial in the educational steering system. This article presents an historical overview of the programme’s development as well as the current programme’s design and challenges, and it discusses the expected future demands for change.

Kids Save Lives in Greece: National Training Program of SchoolChildren in Cardiopulmonary Resuscitation – Preliminary results

Kids Save Lives in Greece: National Training Program of SchoolChildren in Cardiopulmonary Resuscitation – Preliminary results

Methadone Prescription Patterns among Pain Physicians in Colombia

Background: Chronic pain is a disease with serious consequences for people, physicians, and health care systems. Chronic opioid usage is one of the therapy strategies. Methadone is among the available opioids in Colombia and it is characterized by unique pharmacological properties and increased mortality reports because of overdose and cardiovascular complications. Appropriate monitoring and prescribing patterns of methadone are associated with complications similar to chronic management with other opioids. Aim: To describe methadone prescribing patterns among Colombian pain physicians and compare them to the accepted recommendations by the international scientific community. Materials and Methods: An electronic structured survey was applied to pain specialist physicians identified through major pain study associations and national training programs. Results: Respondents of the survey are mostly experienced university certified physicians and anesthesiologists with clinical training working at university hospitals. Most of them perceive chronic opioid therapy as an effective strategy for pain relief and functional outcomes despite the lack of empirical support. Most of them know clinical practice guidelines but are not applying them despite this matter. Conclusions: We must enhance education for prescribers in order to improve patient safety. The recommended clinical practice guidelines are poorly applied by Colombian doctors. The results of this study must be cautiously assessed.

UK nationals who received their medical degrees abroad: selection into, and subsequent performance in postgraduate training: a national data linkage study

ObjectivesTo compare the likelihood of success at selection into specialty training for doctors who were UK nationals but obtained their primary medical qualification (PMQ) from outside the UK (‘UK overseas...

Adult training in the digital age

AbstractDigital technologies will both create new jobs and replace existing ones. To cope with increasing labor market dynamics in the digital age, workers will have to become more mobile across jobs, occupations, and industries. The relative importance of their job-specific skills will decrease while that of their general skills applicable to various occupations will increase. The G20 should establish national adult training programs that focus on improving workers’ general skills, specifically their theoretical, non-cognitive, and digital skills. These general skills will enable workers to work with technology instead of competing with it, thereby increasing their job mobility and employability.

Perceptions of Study Leave amongst Neurosurgical Trainees

This article was migrated. The article was not marked as recommended. BackgroundThere is a paucity of studies in medical education literature addressing the educational value of study leave to doctors in training. The aims of this study were to establish the utilisation of study leave by neurosurgical trainees, to explore the perceived benefits and barriers to taking study leave, and to evaluate to what extent trainees support a more standardised approach to study leave allocation.MethodsIndividual interviews were conducted with 10 neurosurgical trainees, selected from each stage of training - Early (ST1-3), Intermediate (ST4-6) and Final (ST7-8). Qualitative data were coded and an inductive approach was used for thematic analysis.ResultsNeurosurgical trainees at all stages of training perceive study leave offers a wealth of opportunities for learning and professional development. However, there is a striking mismatch between the utility of study leave and the practical uptake, which is partly due to the reported opportunity cost of sacrificing clinical training.There was consensus that combining standardised courses with flexible opportunities for trainees to pursue individual interests and educational needs could enhance the potential educational value of study leave.ConclusionsThe findings demonstrate the critical value of study leave and support the role of standardised national training programme "boot camps", mapped to the curriculum. These can deliver knowledge and technical skills using high fidelity simulation models, thereby increasing educational yield from study leave.

Propagation properties of chirped Airy vortex beams with x-polarization through uniaxial crystals**Project supported by the National Natural Science Foundation of China (Grant Nos. 11775083 and 11374108), the National Training Program of Innovation and Entrepreneurship for Undergraduates, China, and Special Funds for the Cultivation of Guangdong College Students’ Scientific and Technological Innovation, China (Grant No. pdjh2017b0137).

The propagation dynamics of a chirped Airy vortex (CAiV) beam with x-polarization in uniaxial crystals orthogonal to the optical axis is studied analytically and numerically. The effect of the ratio of extraordinary and ordinary refractive indices, the chirp parameter, as well as the propagation distance is analyzed, which shows that the focused position of the CAiV beams can be controlled through changing the ratio of the extraordinary and ordinary refractive indices. In addition, with the propagation distance increasing, the asymmetry of the intensity and the angular momentum of the CAiV beam during propagation becomes much more visible. The variation of the chirp parameters can change the attenuation velocity of the vortex as well.

Neurosurgery in East Africa: Innovations.

In the last 10 years, considerable work has been done to promote and improve neurosurgical care in East Africa with the development of national training programs, expansion of hospitals and creation of new institutions, and the foundation of epidemiologic and cost-effectiveness research. Many of the results have been accomplished through collaboration with partners from abroad. This article is the third in a series of articles that seek to provide readers with an understanding ofthe development of neurosurgery in East Africa (Foundations), the challenges that arise in providing neurosurgical care in developing countries (Challenges), and an overview of traditional and novel approaches to overcoming these challenges to improve healthcare inthe region (Innovations). In this article, we describe the ongoing programs active in East Africa and their current priorities, and we outline lessons learned and what is required to create self-sustained neurosurgical service.

Efficient ternary organic solar cells with high absorption coefficient DIB-SQ as the third component**Project supported by the National Natural Science Foundation of China (Grant Nos. 61675017, 61377029, and 61705161) and the National Training Program of Innovation and Entrepreneurship for Undergraduates, China (Grant No. 170170010).

A series of organic solar cells (OSCs) are prepared with PTB7:PC71BM as the host materials and DIB-SQ as the third component. The power conversion efficienty (PCE) of OSCs can be improved from 6.79% to 7.92% by incorporating 6 wt% DIB-SQ into donors, resulting from the enhanced short circuit current density (JSC) and fill factor (FF). The increased JSC of the optimized ternary OSCs should be attributed to the enhanced photon harvesting of teranry active layer by incorporating DIB-SQ. Meanwhile, FF of the optimized ternary OSCs should be due to the optimied phase separation. The open circuit voltage (VOC) of tenray OSCs can be maintained at a constant of 0.75 V, indicating that all photogenerated holes willl be transported along the channels formed by PTB7.

Improving skills and education in intensive care medicine

In the last decade two main undertakings have transformed education across all medical specialities, namely: (I) the introduction of teaching and assessing “soft skills”; (II) the global use of digital education and digitalised health care delivery. This review will look at the impact of these two events in teaching competencies in the field of intensive care medicine (ICM). ICM is a relatively new discipline and training in ICM is variable across Europe. The framework of competency based training in ICM in Europe has been defined by the Competency Based Training programme in ICM for Europe and outside regions (CoBaTrICE, www.cobatrice.org) in some countries and by local National Training Programs in others. There are also some European countries that still use traditional training methods and do not undertake competency based training. Whilst traditional training methods have been criticized, the implementation of competency based training has never been followed by international research to prove its benefit. In the CoBaTrICE curriculum, there are several competences that relate to professionalism, leadership and soft skills. Communication, professionalism, negotiation and team working are all essential skills to the intensive care doctor. This review will suggest new methodologies and areas for development in teaching and assessing soft skills. The digital era represents the second challenge in education in ICM. Learning with the aid of technology seems beneficial and this might relate to the fact that adults learn (andragogy) best using spontaneous learning. Digital education mediated by several tools (blogs, webinars, social media) can facilitate spontaneous learning and thus adult education. Challenges of digitalised education are related to quality control issues, rapid adoption of literature into clinical practice without the presence of a systematic rigorous peer review process. Finally, research has highlighted the benefit of technologies that help clinicians to manage the exponential growth in medical information. Clinical decision support systems (CDSSs) can improve the quality of patient care and improve patient safety. This review will explore improvements and projects relating to use of CDSSs in the field of ICM.

Construction and effect evaluation of training and assessment system for new nurses in the internet age

Objective To establish a standardized training and assessment system for new nurses in the internet age and investigate the application effect of the system on the standardized training of new nurses. Methods From March 2015 to March 2017, a standardized training program was formulated based on national training program for new nurses. Nursing training massive open online courses (MOOC) were constructed in the cooperation with software company. A scientific and efficient system for the management, training and assessment of new nurses was established depended on nursing management system and educational network platform. A number of 97 nurses recruited in 2014 were served as control group and trained with traditional training methods between March 2015 and March 2016. Another 96 nurses recruited in 2015 were acted as observation group and treated with standardized training based on the new system in the internet age between March 2016 and March 2017. The training and assessment effects of new nurses were compared between two groups. Results The perfect rate of personal information and participation rate of training of nurses in the observation group were 97.83% and 100.00%, which were significantly higher than those in the control group (χ2=7.158, 7.034; P<0.01) . The training time of nurses in the observation group was (21.45±2.87) h, which was shorter than the control group's (35.12±3.75) h (t=28.479, P<0.01) . The excellent and good rates for the theoretical exam of new nurses in the observation group were 17.39% and 56.52% and the excellent and good rates for operation examination and clinical practice ability examination of new nurses in observation group were 11.96% and 69.56%, which were significantly higher than those of the control group (Z=-3.736, -4.000; P<0.01) . The satisfaction rate of new nurses to the training and assessment in the observation group was 97.82%, which was higher than that of the control group (82.47%) . The difference was statistically significant (χ2=14.808, P<0.01) . Conclusions The standardized training and assessment system using MOOC for new nurses in the internet age could improve the effectiveness of standardized training and satisfaction for new nurses, which is beneficial to the improvement of the nursing training quality and management benefit. Key words: Inservice training; Internet; New nurse; Massive open online course; Assessment

Continuous training and certification in neonatal resuscitation in remote areas using a multi-platform information and communication technology intervention, compared to standard training: A randomized cluster trial study protocol

Background: About 10% of all newborns may have difficulty breathing and require support by trained personnel. In Peru, 90% of deliveries occur in health facilities. However, there is not a national neonatal resuscitation and certification program for the public health sector. In addition, the Andes and the Amazon regions concentrate large rural remote areas, which further limit the implementation of training programs and the accomplishment of continuous certification. Neonatal resuscitation training through the use of information, communication and technology (ICT) tools running on computers, tablets or mobile phones, may overcome such limitations. This strategy allows online and offline access to educational resources, paving the way to more frequent and efficient training and certification processes. Objective: To evaluate the effects of a neonatal resuscitation training and certification program that uses a multi-platform ICT (MP-ICT) strategy on neonatal health care in remote areas. Methods: We propose to conduct the study through a cluster-randomized trial, where the study and analysis unit is the health care facility. Eligible facilities will include primary and secondary health care level facilities that are located in provinces with neonatal mortality rates higher than 15 per 1,000 live births. We will compare the proportion of newborns with a heart rate ≥100 beats per minute at two minutes after birth in health care facilities that receive MP-ICT training and certification implementation, with those that receive standard training and certification. Discussion: We expect that the intervention will be shown as more effective than the current standard of care. We are prepared to include it within a national neonatal resuscitation training and certification program to be implemented at national scale together with policymakers and other key stakeholders. Trial registration: ClinicalTrials.gov Nº NCT03210194 Status of the study: This study is enrolling participants by invitation only. Study protocol version 1.1 – March 31st, 2017

Fishing at Arapus-Mangaasi, Efate, Vanuatu (2800–2200 BP): New methodological approaches and results

The Arapus-Mangaasi site, located on the north-west coast of the island of Efate, Vanuatu, and first settled around 2800 BP, was excavated between 1999 and 2003 within the framework of a joint Australian National University-Vanuatu National Museum research and training program. The site yielded not only a range of cultural material that allowed the re-interpretation of the Central Vanuatu ceramic sequence but also well-preserved faunal remains, including a substantial number of fish bones. The present study focuses on the analysis of the ichthyofauna recovered in the area of Arapus and on the assessment of the most efficient identification protocol with a view to obtain precise faunal data leading to the characterisation of the fishing economy. Out of a total of 8080 fish remains, 2387 were taxonomically identified. The general assemblage is composed of 23 families of marine fishes, belonging to the Teleostei and Elasmobranchii groups, and dominated by surgeonfishes (Acanthuridae), parrotfishes (Scaridae), and groupers (Serranidae). The study of vertebrae allowed the identification of most acanthurids and hence proved to be essential in obtaining a detailed inventory of the fish spectrum. The assemblage composition highlights the presence of a large variety of inshore and reef-associated taxa, likely to have been caught by means of polyvalent and broad-spectrum fishing gear, possibly mass capturing devices, such as nets or traps, combined with angling and/or spearing. The results also suggest an opportunistic exploitation of ichthyofaunal resources during the Arapus period (2800 BP) and a probable decrease in the consumption of fish from the beginning of the Erueti period (2800–2200 BP) onwards.