Novice Clinicians Research Articles

Auditory-Perceptual Assessments of Cough: Characterizing Rater Reliability and the Effects of a Standardized Training Protocol

Introduction: Auditory-perceptual assessments of cough are commonly used by speech-language pathologists working with people with swallowing disorders with emerging evidence beginning to demonstrate their validity; however, their reliability among novice clinicians is unknown. Therefore, the primary aim of this study was to characterize the reliability of auditory-perceptual assessments of cough among a group of novice clinicians. As a secondary aim, we assessed the effects of a standardized training protocol on the reliability of auditory-perceptual assessments of cough. Methods: Twelve novice clinicians blindly rated ten auditory-perceptual cough descriptors for 120 cough audio clips. Standardized training was then completed by the group of clinicians. The same cough audio clips were then re-randomized and blindly rated. Reliability was analyzed pre- and post-training within each clinician (intra-rater), between each unique pair of raters (dyad-level inter-rater), and for the entire group of raters (group-level inter-rater) using intraclass correlation coefficients and Cohen’s Kappa. Results: Pre-training reliability was greatest for measures of strength, effectiveness, and normality and lowest when judging the type of expiratory maneuver (cough, throat clear, huff, other). The measures that improved the most with training were ratings of perceived crispness, amount of voicing, and type of expiratory maneuver. Intra-rater reliability coefficients ranged from 0.580 to 0.903 pre-training and 0.756–0.904 post-training. Dyad-level inter-rater reliability coefficients ranged from 0.295 to 0.745 pre-training and 0.450–0.804 post-training. Group-level inter-rater reliability coefficients ranged from 0.454 to 0.919 pre-training and 0.558–0.948 post-training. Conclusion: Reliability of auditory-perceptual assessments varied across perceptual cough descriptors, but all appeared within the range of what has been historically reported for auditory-perceptual assessments of voice and visual-perceptual assessments of swallowing and cough airflow. Reliability improved for most cough descriptors following 30–60 min of standardized training. Future research is needed to examine the validity of auditory-perceptual assessments of cough by assessing the relationship between perceptual cough descriptors and instrumental measures of cough effectiveness to better understand the role of perceptual assessments in clinical practice.

Introduction to the Perspectives Forum on the Topic of Meta-Therapy in Speech-Language Pathology

Introduction to the <i>Perspectives</i> Forum on the Topic of Meta-Therapy in Speech-Language Pathology

Tactile misfit detection ability at the implant-abutment interface of internal connection dental implants: an in-vitro study

Objective The aim of this in-vitro study was to investigate the tactile assessment ability at the implant impression-taking stage. Methods Thirty clinicians (18 novices, 12 experts) were included for a tactile fit assessment by using a used/new probe (tip diameter 100 µm/20 µm). Six implant replicas and related impression copings of two internal connection implant systems were used, each with a perfect fit (0 µm) and defined vertical micro gaps of 8, 24, 55, 110 and 220 µm at the interface. Statistical analysis was performed using descriptive methods and non-parametric tests with a focus on specificity (ability to detect perfect fit), sensitivity (ability to detect misfit), and predictive values. P-values <5% were considered statistically significant. Results The tactile assessment showed a mean total sensitivity for the Straumann and Nobel Biocare systems of 83% and 80% with a used probe, and 91% and 92% with a new probe, respectively. The mean total specificities were 33% and 20% with a used probe and 17% and 3% with a new probe, respectively. No statistical significance was observed between novice and expert clinicians concerning their tactile assessment ability. Conclusions The ability to detect a perfect fit (specificity) with a probe was very poor for both implant systems and impaired with the use of a new probe. The use of a new probe improved the gap detection ability (sensitivity) significantly at the expense of the specificity. A combination of additional chairside techniques with training and calibration could improve clinicians’ ability to correctly assess the fit/misfit at the implant-abutment interface.

Using Deep Learning to Detect the Presence and Location of Hemoperitoneum on the Focused Assessment with Sonography in Trauma (FAST) Examination in Adults.

Abdominal ultrasonography has become an integral component of the evaluation of trauma patients. Internal hemorrhage can be rapidly diagnosed by finding free fluid with point-of-care ultrasound (POCUS) and expedite decisions to perform lifesaving interventions. However, the widespread clinical application of ultrasound is limited by the expertise required for image interpretation. This study aimed to develop a deep learning algorithm to identify the presence and location of hemoperitoneum on POCUS to assist novice clinicians in accurate interpretation of the Focused Assessment with Sonography in Trauma (FAST) exam. We analyzed right upper quadrant (RUQ) FAST exams obtained from 94 adult patients (44 confirmed hemoperitoneum) using the YoloV3 object detection algorithm. Exams were partitioned via fivefold stratified sampling for training, validation, and hold-out testing. We assessed each exam image-by-image using YoloV3 and determined hemoperitoneum presence for the exam using the detection with highest confidence score. We determined the detection threshold as the score that maximizes the geometric mean of sensitivity and specificity over the validation set. The algorithm had 95% sensitivity, 94% specificity, 95% accuracy, and 97% AUC over the test set, significantly outperforming three recent methods. The algorithm also exhibited strength in localization, while the detected box sizes varied with a 56% IOU averaged over positive cases. Image processing demonstrated only 57-ms latency, which is adequate for real-time use at the bedside. These results suggest that a deep learning algorithm can rapidly and accurately identify the presence and location of free fluid in the RUQ of the FAST exam in adult patients with hemoperitoneum.

Beyond the Stuttering Toolbox: The Concept of Meta-Therapy

Purpose:The purpose of this clinical focus article is to describe how meta-therapy applies to stuttering treatment.Method:We briefly summarize the concept ofmeta-therapy, which was first introduced by Helou (2017) in the context of behavioral voice therapy. We then apply basic meta-therapy principles to stuttering, with the goal of helping novice clinicians leverage their clinical dialogue to improve effectiveness and efficiency in the treatment setting. Examples of effective clinical dialogues are presented within the basic goal-based structure of meta-therapy.Conclusion:The application of meta-therapy approaches in stuttering treatment should improve outcomes and increase efficiency.

Building Expertise in the Workplace: Occupational Therapists Learning Upper Limb Hypertonicity Practice

Introduction: Increasingly, novice occupational therapists are working in private practice. It is important to understand how to build clinical experience in complex practice areas. Upper limb hypertonicity management is a complex practice area requiring advanced workplace training. This study aimed to identify the teaching and learning processes that assist occupational therapists to acquire this expertise. Methods: Five hospital occupational therapists received 1.5-3 years of apprentice-style training in a specialist hypertonicity clinic. In-depth semi-structured interviews explored their experience. Qualitative Description was used to analyse the data. Results: Participants found that knowledge needed to be applied to practice and then revisited in a cyclical way to deepen their understanding and build their clinical skills. They benefited from having responsibilities graded and repeated opportunities for hands-on learning of embodied knowledge. Producing comprehensive progress notes and teaching colleagues and students were useful learning tools. Learning with a group of colleagues involved observation of the expert, intensive correction and guidance, and group discussion, reflection and questioning to build expertise. Conclusion: Workplaces need to intentionally support novice clinicians to gain expertise in complex practice areas using pedagogically sound training techniques. Continuous workplace training is needed to promote expertise in the face of changing healthcare funding policies.

87 An Augmented Reality Burn Management Application to Guide Care in Austere Environments

Abstract Introduction Novel medical technologies are necessary to support virtual health in low bandwidth environments. When tele-mentoring is not possible, advanced clinical decision support tools can deliver essential medical knowledge to assist novice clinicians. These tools can fill knowledge gaps in specialty fields, like burn. We developed the Augmented Reality Burn Assist Manager (ARBAM), a novel, comprehensive augmented reality (AR)-based burn management platform to address key tasks in burn care. Methods A randomized 2x2 cross-over design was used to investigate if ARBAM could enhance a user’s ability to care for a simulated burn patient as compared to standard clinical practice guidelines (CPGs). We developed the software for use on a mixed reality, head-mounted device. Participants were clinicians with little to no burn care experience, and were asked to complete 4 key tasks, twice each, using either paper copies of the Joint Trauma System’s CPGs and supplemental worksheets first (Paper) or our AR technology. Tasks included calculating burn size (TBSA), performing medication dosage calculations (MC), managing a burn fluid resuscitation (FR), and performing a simulated escharotomy (EC). All tasks were evaluated for completion time and accuracy. Cross-over analysis of treatment effects used a two-sided, two-sample t-test or Wilcoxon Rank-Sum test as appropriate. Results Eleven participants were randomized: 5 started with Paper and 6 started with AR. Time to perform FR was statistically different (p&amp;lt; 0.05) with AR taking less time than Paper (4.8 vs. 7.0 mins, respectively). FR clinical performance was also better in the AR group with a mean accuracy score of 99% vs. 52% for Paper (p&amp;lt; 0.001). EC completion times were not clinically or statistically different. However, EC accuracy was 93% for AR compared to 55% for Paper (p&amp;lt; 0.001). Although not statistically different, MC performance accuracy was considerably better for AR (91%) than for Paper (66%). No differences between groups were observed for TBSA or MC completion times nor TBSA accuracy. Conclusions Compared to traditional tools, AR may enhance a clinician's ability to complete key tasks in the initial management of a burn patient. This technology may be helpful during disasters when tele-mentoring is not available. Limitations of this study include a small sample size, limited user training on the AR device, and potential carry-over effects. Therefore, generalizations cannot be made about wide-scale usage. Nonetheless, this study showed that AR may be helpful in managing lifesaving burn tasks. Applicability of Research to Practice ARBAM may enhance decision making by novice clinicians when caring for burn patients. Our data demonstrate the potential for AR-based support tools to improve burn care delivery and reduce error rates for novice clinicians, which could lead to reductions in morbidity and mortality. Future research is needed to investigate how AR technology can be used for other lifesaving interventions.

Effectiveness of videoconferencing psychotherapy delivered by novice clinicians in a training clinic.

Effectiveness of videoconferencing psychotherapy delivered by novice clinicians in a training clinic.

Impact assessment of the Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery

BackgroundResearch impact is an emerging measure of research achievement alongside traditional academic outputs such as publications. We present the results of applying the Framework to Assess the Impact from Translational health research (FAIT) to the Centre for Research Excellence (CRE) in Stroke Rehabilitation and Brain Recovery (CRE-Stroke, 2014–2019) and report on the feasibility and lessons from the application of FAIT to a CRE rather than a discrete research project.MethodsData were gathered via online surveys, in-depth interviews, document analysis and review of relevant websites/databases to report on the three major FAIT methods: the modified Payback Framework, an assessment of costs against monetized consequences, and a narrative account of the impact generated from CRE-Stroke activities. FAIT was applied during the last 4 years of CRE-Stroke operation.ResultsWith an economic investment of AU$ 3.9 million over 5 years, CRE-Stroke delivered a return on investment that included AU$ 18.8 million in leveraged grants, fellowships and consultancies. Collectively, CRE-Stroke members produced 354 publications that were accessed 470,000 times and cited over 7220 times. CRE-Stroke supported 26 PhDs, 39 postdocs and seven novice clinician researchers. There were 59 capacity-building events benefiting 744 individuals including policy-makers and consumers. CRE-Stroke created research infrastructure (including a research register of stroke survivors and a brain biobank), and its global leadership produced international consensus recommendations to influence the stroke research landscape worldwide. Members contributed to the Australian Living Stroke Guidelines: four researchers’ outputs were directly referenced. Based only on the consequences that could be monetized, CRE-Stroke returned AU$ 4.82 for every dollar invested in the CRE.ConclusionThis case example in the developing field of impact assessment illustrates how researchers can use evidence to demonstrate and report the impact of and returns on research investment. The prospective application of FAIT by a dedicated research impact team demonstrated impact in broad categories of knowledge-gain, capacity-building, new infrastructure, input to policy and economic benefits. The methods can be used by other research teams to provide comprehensive evidence to governments and other research funders about what has been generated from their research investment but requires dedicated resources to complete.

Brief training in ultrasound equipsnovice clinicians to accurately and reliably measure jugular venous pressure in obese patients.

Measurement of jugular venous pressure (JVP) by novice clinicians can be unreliable, particularly when evaluating obese patients. Measurement of JVP using ultrasound (uJVP) is simple to perform and provides accurate measurements. This study evaluated whether students and residents inexperienced with ultrasound could rapidly be taught to measure JVP using ultrasound in obese patients with the same accuracy as cardiologists measuring JVP via physical examination. Additionally, this study also evaluated the correlation between qualitative and quantitative JVP assessment. This prospective, blinded study compared uJVP measurements performed by novice clinicians after brief training to JVP measurements performed by cardiologists (cJVP) on physical examination. Association between uJVP and cJVP was assessed using linear correlation, agreement and bias were assessed using the Bland-Altman analysis and inter-rater reliability of uJVP was assessed using intraclass correlation coefficient (ICC). The association between qualitative and quantitative JVP assessment was assessed using linear correlation. Novice clinicians (n=16) obtained 34 measurements from 26 patients (mean BMI 35.5) and reported moderate-to-high confidence in all measurements. uJVP correlated well with cJVP (r=0.73) with an average error of 0.06 cm. The estimated uJVP ICC was 0.83 (95% CI=0.44, 0.96). Qualitative uJVP had only a moderate correlation (r=0.63) to quantitative uJVP. Novice clinicians often have difficulty assessing JVP on physical examination, particularly in obese patients. Our findings show a high degree of correlation between JVP measurements performed by novice clinicians using ultrasound compared with JVP measurements made by experienced cardiologists on physical examination. Furthermore, novice clinicians were able to be trained quickly, their measurements were determined to be accurate and precise and they expressed moderate-to-high confidence in their results. After brief training, novice clinicians were able to accurately assess JVP in obese patients as compared to measurements made by experienced cardiologists on physical examination. Results suggest that ultrasound may greatly improve novice clinicians' JVP assessment accuracy, particularly in obese patients.

Usability of the IDDEAS prototype in child and adolescent mental health services: A qualitative study for clinical decision support system development.

Child and adolescent mental health services (CAMHS) clinical decision support system (CDSS) provides clinicians with real-time support as they assess and treat patients. CDSS can integrate diverse clinical data for identifying child and adolescent mental health needs earlier and more comprehensively. Individualized Digital Decision Assist System (IDDEAS) has the potential to improve quality of care with enhanced efficiency and effectiveness. We examined IDDEAS usability and functionality in a prototype for attention deficit hyperactivity disorder (ADHD), using a user-centered design process and qualitative methods with child and adolescent psychiatrists and clinical psychologists. Participants were recruited from Norwegian CAMHS and were randomly assigned patient case vignettes for clinical evaluation, with and without IDDEAS. Semi-structured interviews were conducted as one part of testing the usability of the prototype following a five-question interview guide. All interviews were recorded, transcribed, and analyzed following qualitative content analysis. Participants were the first 20 individuals from the larger IDDEAS prototype usability study. Seven participants explicitly stated a need for integration with the patient electronic health record system. Three participants commended the step-by-step guidance as potentially helpful for novice clinicians. One participant did not like the aesthetics of the IDDEAS at this stage. All participants were pleased about the display of the patient information along with guidelines and suggested that wider guideline coverage will make IDDEAS much more useful. Overall, participants emphasized the importance of maintaining the clinician as the decision-maker in the clinical process, and the overall potential utility of IDDEAS within Norwegian CAMHS. Child and adolescent mental health services psychiatrists and psychologists expressed strong support for the IDDEAS clinical decision support system if better integrated in daily workflow. Further usability assessments and identification of additional IDDEAS requirements are necessary. A fully functioning, integrated version of IDDEAS has the potential to be an important support for clinicians in the early identification of risks for youth mental disorders and contribute to improved assessment and treatment of children and adolescents.

Simulation-based Ultrasound Curriculum for Novice Clinicians to Assess Neonatal Endotracheal Tube Position.

To evaluate the efficacy of a simulation-based mastery curriculum to train clinicians with limited-to-no sonography experience how to use ultrasound (US) to assess neonatal endotracheal tube (ETT) positioning. In a single-centered, prospective, educational study, 29 neonatology clinicians participated in a simulation-based mastery curriculum composed of a didactic lecture, followed by a one-on-one simulation session using a newly designed, three-dimensional (3D) printed US phantom model of the neonatal trachea and aorta. After mastery training, clinicians were evaluated with a performance checklist on their skills obtaining US images and assessing ETT positioning in the US phantom model. They also completed pre- and postcurriculum knowledge assessment tests and self-assessment surveys. The data were analyzed using Wilcoxon signed rank tests and repeated measures analysis of variance. The mean checklist score improved significantly during three attempts (mean difference: 2.6552; 95% confidence interval [CI]: 2.2578-3.0525; P < 0.0001). The mean time to perform US decreased significantly from the first to third attempt (mean difference: -1.8276 min; 95% CI: -3.3391 to - 0.3161; P = 0.0196). In addition, there was a significant improvement in median knowledge assessment scores (50% vs. 80%; P < 0.0001) and survey ratings on knowledge and self-efficacy (P < 0.0001). Clinicians with limited-to-no sonography experience demonstrated improved knowledge and skill acquisition in using US to assess ETT positioning through simulation-based mastery training. The use of 3D modeling enhances simulation experiences and optimizes the quality of training during limited opportunities to achieve procedural competency in a controlled environment before further application into the clinical setting.

The utility of chest x-ray and lung ultrasound in the management of infants and children presenting with severe pneumonia in low-and middle-income countries: A pragmatic scoping review

Chest x-ray (CXR) is commonly used (when available) to support clinical management decisions for child pneumonia and provide a reference standard for diagnosis in research studies. However, its diagnostic and technical limitations for both purposes are well recognised. Recent evidence suggests that lung ultrasound (LUS) may have diagnostic utility in pneumonia. This systematic scoping review of research on the utility of CXR and LUS in the management of severe childhood pneumonia aims to inform pragmatic guidelines for low- and middle-income countries (LMICs) and identify gaps in knowledge. We included peer-reviewed studies published between 2000 and 2020 in infants and children aged from one month to nine years, presenting with severe pneumonia. CXR studies were limited to those from LMICs, while LUS studies included any geographic region. LUS and CXR articles were mapped into the following themes: indications, role in diagnosis, role in management, impact on outcomes, and practical considerations for LMIC settings. 85 articles met all eligibility criteria, including 27 CXR studies and 58 LUS studies. CXR studies were primarily observational and examined associations between radiographic abnormalities and pneumonia aetiology or outcomes. The most consistent finding was an association between CXR consolidation and risk of mortality. Difficulty obtaining quality CXR images and inter-reader variability in interpretation were commonly reported challenges. Research evaluating indications for CXR, role in management, and impact on patient outcomes was very limited. LUS studies primarily focused on diagnostic accuracy. LUS had higher sensitivity for identification of consolidation than CXR. There are gaps in knowledge regarding diagnostic criteria, as well as the practical utility of LUS in the diagnosis and management of pneumonia. Most LUS studies were conducted in HIC settings with experienced operators; however, small feasibility studies indicate that good inter-operator reliability may be achieved by training of novice clinicians in LMIC settings. The available evidence does not support the routine use of CXR or LUS as essential tools in the diagnosis and initial management of severe pneumonia. Further evaluation is required to determine the clinical utility and feasibility of both imaging modalities in low-resource settings.

The experience and role of mentorship for paediatric occupational therapists.

Within Australia, the introduction of the National Disability Insurance Scheme has led to a growth in paediatric occupational therapists working in community settings. This growth has increased the demand for support from more senior paediatric occupational therapists to novice clinicians. Mentoring has long been valued by occupational therapists as a means to provide this support. Despite its apparent benefit, there is limited research on the contribution of mentoring as distinct from supervision, and its impact on mentees' skills and confidence in providing care. This study examined the contribution of mentorship to the development of professional capability in paediatric occupational therapy practice from the perspective of mentors and mentees. Interpretive description methodology was used. In-depth interviews were conducted with nine mentors and eight mentees from three Australian states. Data were analysed inductively and thematically. All participants reflected on the challenges presented by the complexity of practice, requiring a knowledge base that mentees perceived they did not possess. The essential nature of non-judgemental, emotional support allowed mentees to feel safe to discuss their concerns when they were often overwhelmed by practice. Mentorship was viewed as capacity building, building competence by scaffolding clinical reasoning and supporting theory to practice translation while developing resilience to cope with complexity. Study participants reported that successful mentorship assisted novice practitioners to integrate knowledge and skills required for complex clinical and professional reasoning. The emotional support provided through the relationship supported novice therapists to build their confidence and resilience while promoting professional identity and socialisation into the profession. The study raised questions related to how the profession best supports novice paediatric therapists in the current employment contexts, and the need to review how bodies of knowledge relevant to paediatrics are brought together to be used by both novice clinicians and senior therapists, who support them, for translation to effective practice.

Assessing Intracranial Pressure Visualizations Displayed on ICU Bedside Physiologic Monitors

Neurocritical care is considered a complex socio-technical environment where clinicians deal with large amounts of data and need to make timely decisions to provide optimal care for patients, improve outcomes, and reduce mortality. Intracranial pressure (ICP) is one of the key physiologic indicators clinicians track to minimize the risk of secondary brain injury. The understanding and teaching of pathophysiologic ICP trends is perceived as challenging to both novice and advanced clinicians. We propose new ICP visualizations with the goal of facilitating a better understanding of ICP concepts on bedside physiologic monitors to support complex decision-making. We have conducted interviews with clinicians to receive feedback on preliminary designs. Interviews revealed that the staff physician appreciated visualizations with more depth and with calculated parameters to describe the raw data. Contrarily, the trainees and nurses saw the most value in visualizations that were less abstract and easier to interpret.

Novice Accuracy in Ultrasound and Stethoscope Study (NAUSS).

The purpose of this noninferiority study was the accurate determination of valvular heart disease, using bedside echocardiogram as compared to stethoscope, by a novice clinician examiner. We conducted a single university, single program study to investigate the use of bedside ultrasound in the hands of a novice clinical user, defined as someone with fewer than 2 years of clinical education. We enrolled 8 examinees with evidence of valvular heart disease to be assessed by 13 subjects. Descriptive statistics revealed echocardiogram accuracy of 56% compared to 44% accuracy with stethoscope, though not statistically significant. Interestingly, 31% of subjects obtained equal measures with both instruments. Correlation proficiency between both modalities was also observed. There is no statistically significant difference in novice examiner diagnostic accuracy using point-of-care echocardiograms for examination of valvular heart disease when compared with a stethoscope.

Clinical Accuracy of the Lateral-Anterior Drawer Test for Diagnosing Posterior Cruciate Ligament Rupture

BackgroundCommonly used clinical posterior cruciate ligament (PCL) tests present with diagnostic weaknesses requiring alternative clinical tests. The Lateral-Anterior Drawer test (LAD-test) is a suggested alternative that previously demonstrated concurrent validity in situ. Further in vivo LAD-test clinical accuracy examination is required prior to any recommendation for clinical adoption. Thus, this case–control study aims to (1) investigate the LAD-test’s in vivo interrater and intra-rater reliability; (2) establish LAD-test concurrent validity against MRI as the reference standard; and (3) examine the correspondence between examiners’ professional working experience and LAD-test diagnostic accuracy.MethodsThree examiners with different professional experience levels, blindfolded during testing, and blinded from subjects’ identity, medical history, and reference test outcome performed all LAD-testing twice per subject. Reliability analyses included percent agreement, Fleiss’ kappa and Cohen’s kappa coefficients with 95% Confidence Intervals (CIs) and prevalence-adjusted bias-adjusted kappa (PABAK) calculations. Validation parameters included sensitivity, specificity, likelihood ratios (LR + ; LR-), and predictive values (PPV; NPV) each accompanied by 95%CIs; each tester’s percent agreement with the MRI; and their Youden Index.ResultsThe study sample was comprised of 31 subjects of which 14 had a history of unilateral full-thickness PCL-rupture. Their 14 contralateral knees and both knees of 17 healthy subjects served as controls. In vivo LAD-test performance did not produce any negative ramifications for the tested subjects. Interrater reliability was moderate (test-1: Fleiss’κ = 0.41; 95% CI 0.40;0.41; test-2:Fleiss’κ = 0.51; 95% CI 0.50;0.51). Pairwise examiner’s LAD-test outcome agreement ranged from 74 to 89%. Pairwise interrater reliability was fair-to-substantial (κ = 0.27 to κ = 0.65) with moderate-to-substantial PABAK (0.48–0.77). Intra-rater reliability was substantial-to-almost perfect (PABAK 0.65–0.97). Sensitivity and specificity ranged from 57 to 86% and 83 to 98%, respectively. The advanced and novice clinicians’ Youden Indexes were acceptable. The same examiners’ positive likelihood ratios revealed important and relative important effects, respectively. Positive predictive values were considerable for the advanced and novice clinicians, while negative predictive values were high for all examiners.ConclusionOverall, the study results suggested LAD-test practicability. In vivo LAD-test performance did not produce any negative ramifications for the tested subjects. In subjects presenting with a chronic PCL-deficiency (i.e., > 3 months since initial injury), the LAD-test’s clinical accuracy was comparable-to-superior to other commonly used clinical PCL-tests. Future studies to establish the LAD-test’s usefulness in isolation as well as in combination with other clinical tests for acute PCL-rupture diagnostics are warranted.Trial registration numberDRKS00013268 (09. November 2017).

Flexion-rotation test and C0–C2 axial rotation test. Are they equally reliable for novice clinicians?

ObjectiveTo analyse the inter- and intra-examiner reliability for the neck flexion-rotation test and the C0–C2 axial rotation test when applied in asymptomatic subjects by two novice physiotherapists. DesignRepeated measures reliability study design. The study was approved by the Research Ethics Committee of [X], in compliance with the Declaration of Helsinki (CSEULS-PI: 004/2020). Methods32 asymptomatic adults were included, recruited by convenience sampling. Two sessions were scheduled for each subject, with an intersession break of 30 min. Two inexperienced raters blinded to their own previous and peer results performed three movements to both sides using the flexion-rotation test and the C0–C2 axial rotation test in randomised order of rater, test and direction. A third researcher collected the data measured by inertial sensors and displayed to the Pro Motion Capture software. ResultsBoth raters showed good-excellent intra-examiner reliability (ICC(2,3) ranging from 0.88 to 0.94) and moderate to good inter-examiner reliability (ICC(2,3) ranging from 0.58 to 0.86) to measure the rotation ROM with the FRT. The C0–C2 axial rotation test resulted in poor to moderate intra-examiner reliability (ICC(2,3) ranging from 0.33 to 0.74) and poor inter-examiner reliability using (ICC(2,3) ranging from 0.16 to 0.37). ConclusionAlthough performed by novice raters, the FRT showed good to excellent intra and inter-examiner reliability. Results for the C0–C2 axial rotation test were less reliable. We suggest that novice physiotherapists use the FRT instead of the C0–C2 axial rotation test in order to determine C1–C2 dysfunction.

The Newport Quinsy Simulator.

The junior otolaryngologist is responsible for recognition and drainage of the peritonsillar abscess. Although other simulators have been proposed, there is still a need for an accessible, educationally useful, low-cost peritonsillar abscess simulator to build skills and confidence in the novice. The peritonsillar abscess simulator was constructed from basic disposable healthcare equipment and a party balloon. Evaluation of this Newport Quinsy Simulator was performed by expert and novice clinicians, who provided feedback in the form of Likert scales and free-text qualitative responses. Overall, 24 clinicians evaluated the simulator. All felt the simulator was useful for the novice otolaryngologist, and represented the key anatomy and motor skills needed to drain a peritonsillar abscess. Qualitative evaluation highlighted the educational usefulness of the simulator as a peritonsillar abscess training device. The Newport Quinsy Simulator is affordable, accessible, easy to use and educationally valuable to the novice otolaryngologist.

Creating Community and Exploring Identity: Integrating a Virtual "Museum Tour" Into Intern Orientation.

Each July, interns join new training programs, often in unfamiliar places with limited social support. Program orientations are typically designed to assist interns in not only acquiring the necessary knowledge and skills to be effective novice clinicians, but also often contain elements designed to foster socialization and begin developing a shared culture. The COVID-19 pandemic, however, has had a substantial impact on trainees; a recent study indicated that medical students believe their preparation for intern year was unfavorably impacted by the pandemic.1 Many residency orientations have transitioned to the virtual environment, creating unique challenges and opportunities for innovation. While knowledge and skills can be taught via online didactics and virtual procedure labs, facilitating the assimilation of shared attitudes, values, and socialization presents a challenge within standard educational paradigms in virtual environments.We implemented a virtual 2-hour “museum tour” drawing upon established techniques from art-based pedagogies. Art-based education has had demonstrated effects on creating psychological safety, leveling traditional hierarchies, discovering a common language, and clarifying group values, while enhancing observation skills and critical thinking. Session objectives were to facilitate navigation of identity transitions, enhance observation and reflection skills, build collective values, and inspire a sense of belonging and community. We conducted the session 4 times (for each incoming intern class in July 2020 and July 2021 at 2 emergency medicine residency programs). Sessions were facilitated by 1 to 2 clinical faculty with training in art museum–based education, using images curated from online collections of local museums or murals in each program's corresponding city. Participants completed a presession art-mediated reflection on their hopes and concerns about starting residency. The session began with a personal responses tour, wherein participants choose and share an image that resonates with them from a curated virtual gallery, to create space for acknowledging existing identities and forging personal connections among the group. We subsequently facilitated an open-ended discussion of a single work of art using a structured facilitation approach (Visual Thinking Strategies) that encourages collaborative meaning-making and exploration of new perspectives. Next, we transitioned the context from personal to professional by asking participants to “diagnose” and “interview” a portrait as though it were a patient, allowing them to practice close-looking, reasoning, and reflection on biases. We concluded the session with an art-mediated group discussion of professional identity, which mirrored the discussion of personal identity at the start of the session.Eighty-one percent (44 of 54) of participants completed an institutional review board–exempt post-session evaluation. Residents reported that the activity allowed them to reflect on their identity, role as a physician, and biases, while getting to know their colleagues and cities better. One participant concluded, “I learned that I am nervous and excited about my new journey starting residency and it's ok to have anxiety and lean on my class/faculty…I hope to become the best physician I can be by growing collectively with my class and not being afraid to be vulnerable or wrong.” Free text responses commonly described how the session facilitated a shared experience within a supportive community, forged bonds with co-interns, and highlighted the importance of bringing an open-minded approach to interactions with patients and colleagues (Table). Participants said they enjoyed how the session created a safe space for self-reflection and vulnerability: “It made me think a lot about my internal bias and initial impressions of images. The discussion…with my classmates reminded me that I am not alone and in a safe space to discuss my fears about starting residency.” Almost all (91%, 40 of 44) agreed they wished to see more arts- and humanities-based sessions in residency education.The virtual “museum tour” represents a low-cost, replicable approach to easing the transition to residency while building a sense of community. It also represents a means to ensure humanities education is accessible to residents at orientation and beyond. This is especially important since the Association of American Medical Colleges has deemed the arts and humanities as integral to medical education and has identified a paucity of humanities curricula in graduate medical education. Faculty seeking to replicate this activity should partner with local museum educators and artists while ensuring that selected art originates from local institutions and is representative of diverse subjects, media, and artists.