Novice Group Research Articles

Identifying the Gap Between Novices and Experts in Fiberoptic Scope Control.

Fiberoptic intubation (FOI) is key in managing difficult airways. Good scope control increases efficiency and patient safety. Understanding the gap between novices and experts in scope control would help medical educators develop a feedback-based teaching approach for novices. We designed and used a checklist for evaluating the gap in fiberoptic scope control between novices and experts. Twelve first-year anesthesiology residents (novice group) attended a lecture, followed by hands-on practice with a fiberoptic scope on a manikin. Five staff anesthesiologists (expert group) only did the hands-on practice. After practice, each participant was video-recorded while conducting an FOI on the manikin. Two senior anesthesiologists developed and used a 7-item checklist to assess the FOIs. Checklist scores and total times for FOIs were compared between groups using the Mann-Whitney U test. Internal consistency of the checklist items, interrater reliability, and the relationship between checklist score and total time for FOI were assessed with Cronbach alpha, Cohen kappa, and the Pearson correlation coefficient, respectively. Experts had higher checklist scores than novices (P = .0016). The item with the lowest success rate for novices (50%) was keeping the scope straight. Novices spent more time on the FOI than experts (P = .0005). Cronbach alpha, Cohen kappa, and the Pearson correlation coefficient were 0.8699, 0.75, and -0.9454, respectively. Our checklist was used to detect differences in fiberoptic scope control skills between novices and experts. With a video-based assessment method, it can be used to develop a feedback-based teaching method for fiberoptic scope control.

Novice vs expert inter-rater reliability of the balance error scoring system in children between the ages of 5 and 14

BackgroundThe Balance Error Scoring System (BESS) is a tool to measure balance, however, no studies have shown its reliability between novice and expert raters. Research QuestionWhat is the inter-rater reliability of BESS measurements when performed by novice raters compared to experts, and does completion of a focused, online training module increase the inter-rater reliability among novice raters? MethodsIn this reliability study, 5 novice volunteers were asked to independently rate BESS tests from 50 random prerecorded BESS videos of normal healthy subjects aged 5–14. Novice raters regraded the same 50 videos after receiving a formal training. The novices’ scores before and after the formal training were compared to one another and then the scores were compared to 4 expert scores. Intraclass correlation (ICC) with 95 % confidence intervals or percent agreements were calculated and compared across groups. ResultsFor the total BESS score, novice raters showed good reliability (ICC 0.845) which did not change with a formal training (ICC 0.846). Expert raters showed excellent reliability (ICC 0.929). Poor to moderate reliability was noted in the foam stance-single leg in the untrained novice and trained novice group (ICCs 0.452 and 0.64 L respectively). SignificanceBESS testing by novice raters with only written instruction and no formal training yields good inter-rater reliability. In contrast, BESS testing by expert raters yields excellent reliability. A focused training for novice raters conferred a small improvement in the reliability of the scoring of the single leg stance on foam condition but not a significant difference to the overall BESS score. While novices demonstrated promising reliability for overall BESS scores, optimizing clinical research using the BESS with expert raters show the highest reliability.

Expert Tool Users Show Increased Differentiation between Visual Representations of Hands and Tools.

The idea that when we use a tool we incorporate it into the neural representation of our body (embodiment) has been a major inspiration for philosophy, science, and engineering. While theoretically appealing, there is little direct evidence for tool embodiment at the neural level. Using functional magnetic resonance imaging (fMRI) in male and female human subjects, we investigated whether expert tool users (London litter pickers: n = 7) represent their expert tool more like a hand (neural embodiment) or less like a hand (neural differentiation), as compared with a group of tool novices (n = 12). During fMRI scans, participants viewed first-person videos depicting grasps performed by either a hand, litter picker, or a non-expert grasping tool. Using representational similarity analysis (RSA), differences in the representational structure of hands and tools were measured within occipitotemporal cortex (OTC). Contrary to the neural embodiment theory, we find that the experts group represent their own tool less like a hand (not more) relative to novices. Using a case-study approach, we further replicated this effect, independently, in five of the seven individual expert litter pickers, as compared with the novices. An exploratory analysis in left parietal cortex, a region implicated in visuomotor representations of hands and tools, also indicated that experts do not visually represent their tool more similar to hands, compared with novices. Together, our findings suggest that extensive tool use leads to an increased neural differentiation between visual representations of hands and tools. This evidence provides an important alternative framework to the prominent tool embodiment theory.SIGNIFICANCE STATEMENT It is commonly thought that tool use leads to the assimilation of the tool into the neural representation of the body, a process referred to as embodiment. Here, we demonstrate that expert tool users (London litter pickers) neurally represent their own tool less like a hand (not more), compared with novices. Our findings advance our current understanding for how experience shapes functional organization in high-order visual cortex. Further, this evidence provides an alternative framework to the prominent tool embodiment theory, suggesting instead that experience with tools leads to more distinct, separable hand and tool representations.

Nursing Students' Eating Habits, Subjective, and Mediterranean Nutrition Knowledge During the COVID-19 Pandemic

BackgroundMediterranean nutrition knowledge, healthy eating habits, and subjective nutritional knowledge are crucially important to nursing students’ health. The study strives to examine, during the COVID-19 pandemic period: (a) nursing students' eating habits and their subjective nutritional knowledge according to three groups: novice, advanced, and senior; and (b) subjective knowledge and its role as a mediator between Mediterranean nutritional knowledge and nursing students’ eating habits.MethodsA cross-sectional study design with a convenience sample consisting of 212 university nursing students. Participants volunteered to complete a questionnaire that examined their eating habits, subjective nutritional knowledge, and Mediterranean diet knowledge. The university's institutional review board provided permission to conduct the current study.ResultsNursing students from the novice group had better eating habits than the advanced and senior groups, and no significant differences were found between the advanced and senior groups regarding eating habits. Additionally, Mediterranean nutritional knowledge had a positive indirect effect on eating habits through subjective nutritional knowledge. Therefore, subjective nutritional knowledge partially mediated the relationship between Mediterranean nutritional knowledge and eating habits.ConclusionFirst, especially for the advanced and senior groups, it is important to create opportunities for learning via seminars, symposia, and webinars. Interprofessional teams, such as clinical nutritionists or a registered certified dietitian and nursing student, can engage with important, authentic information. Second, since subjective nutritional knowledge was found to be a partial mediator, it may be assumed that there are other mediating variables that we did not examine in this study. Therefore, it is necessary to conduct further research to examine other factors that can serve as mediators for eating habits, in addition to subjective knowledge, especially during COVID-19 times.

Stress Inoculation Training (SIT-NORCAL), Part 2: A Pilot Study Among Explosive Ordnance Disposal Special Warfare Enablers.

Despite being a well-supported strategy, Stress Inoculation Training (SIT) has not been fully incorporated in the advancement of human performance among most military personnel. The RAND Study recommendations for maximizing SIT's potential within high-risk/ high-intensity occupational groups were used in designing the Core Training protocol targeting psychological performance, SIT-NORCAL (Part 1). The current project (Part 2) sought to further develop the protocol as a health and human performance hybrid through quality improvement analysis of the content, process, and measurement elements for use in the human performance context. Evidence-based/evidence-driven methodologies were used in collaborative design tailored to the unique needs of special warfare enablers specializing in Explosive Ordnance Disposal (n = 17). The resultant three-phase training was conducted with a novice group (n = 10) using standardized measurements of collaboration, human performance, and adaptive capabilities on identified training targets. Process elements demonstrated high feasibility, resulting in high collaboration and trainee satisfaction. Significant improvements in psychological performance targets were observed pre- to post-training, and during an Adaptive Environmental Simulation designed by unit members. Two weeks post-training, unit members (n = 5) responded to an actual crash of an F-16 aircraft; measurements indicated maintenance of skill set from training to real-world events. Deployment of the elements in the SIT-NORCAL protocol demonstrated early feasibility and positive training impact on occupationally relevant skills that carried over into real-world events.

Navigation-assisted anchor insertion in shoulder arthroscopy: a validity study

BackgroundThis study aimed to compare conventional and navigation-assisted arthroscopic rotator cuff repair in terms of anchor screw insertion.MethodsThe surgical performance of five operators while using the conventional and proposed navigation-assisted systems in a phantom surgical model and cadaveric shoulders were compared. The participating operators were divided into two groups, the expert group (n = 3) and the novice group (n = 2). In the phantom model, the experimental tasks included anchor insertion in the rotator cuff footprint and sutures retrieval. A motion analysis camera system was used to track the surgeons’ hand movements. The surgical performance metric included the total path length, number of movements, and surgical duration. In cadaveric experiments, the repeatability and reproducibility of the anchor insertion angle were compared among the three experts, and the feasibility of the navigation-assisted anchor insertion was validated.ResultsNo significant differences in the total path length, number of movements, and time taken were found between the conventional and proposed systems in the phantom model. In cadaveric experiments, however, the clustering of the anchor insertion angle indicated that the proposed system enabled both novice and expert operators to reproducibly insert the anchor with an angle close to the predetermined target angle, resulting in an angle error of < 2° (P = 0.0002).ConclusionThe proposed navigation-assisted system improved the surgical performance from a novice level to an expert level. All the experts achieved high repeatability and reproducibility for anchor insertion. The navigation-assisted system may help surgeons, including those who are inexperienced, easily familiarize themselves to of suture anchors insertion in the right direction by providing better guidance for anchor orientation.Level of evidenceA retrospective study (level 2).

Group Differences and Similarities in Mental Representation Structure of Tennis Serve.

A large number of studies have examined expertise and gender-related differences in the mental representation of motor skills in different sports, like throwing technique in judo, front loop in sailing, and integration of routines in the mental movement representation in volleyball. Also, tactical behavioral studies were conducted in futsal and football. In addition, studies were also carried out to support the motor learning process through mental training in golf. The Structural Dimensional Analysis-Motoric (SDA-M) method was also used in the medical sector for the rehabilitation of stroke patients. So far, few studies have investigated differences in the mental representation of a specific motor skill by experienced athletes of other related sports. The goal of the present study is to examine group differences and similarities in the mental representation of the tennis serve between experienced tennis, badminton, and handball athletes as well as a control group without any sport experience. We want to assess the quality of mental representation of technical-related overhead motion task expertise. For this purpose, we used the SDA-M to measure the mental representation of the tennis serve of four different groups (tennis, badminton, and handball athletes and a group of novices). As expected, badminton and handball athletes showed functionally well-structured representations, which were similar to the structure of the group of tennis athletes. Novices showed an unstructured mental representation. These outcomes confirm the relationship between mental representation and performance in the development of overhead motion. Furthermore, the results emphasize the importance of mental representations as an essential developmental aspect in learning motor skills, especially in learning technical-related motor skills.

Impact of a multi-media digital tool on identifying construction hazards under the UK construction design and management regulations

Research has shown that up to half of construction accidents in the UK had a link with design. The UK’s Construction, Design and Management Regulations, (CDM, 2015) place duties on designers of construction projects to consider the health and safety implications of their designs. However, the majority of designers fail to recognise the impact on health and safety that they can make. Previous work shows that visual methods have been used to develop shared mental models of construction safety and health hazards in construction and design teams. Potentially, these methods could also include links to alternative construction processes that may be utilized by designers to reduce the inherent hazards in the design, thereby enhancing their knowledge of construction and maintenance processes from the very people who are affected by the designs. The study reported in this paper aims to improve how designers involved in construction projects learn about how their design influences the management of occupational health and safety at the construction stage. The proposed approach involves the development of a multi-media digital tool for educating and assisting designers on typical design-related hazards. This prototype tool was used in an intervention study with novice and experienced designers, split evenly between experimental and control groups. These groups were assessed via a novel hazard test using fictitious Computer Aided Design (CAD) drawings. The results showed all experimental groups outperformed control groups, with the novice groups demonstrating the greatest increase in both hazards spotted and quality of alternative options recommended. Current research in this area promotes automated design systems for designers using Building Information Modelling (BIM). However, the research presented here advocates keeping the ‘human’ in control while supplementing designers’ knowledge with tacit knowledge gained from interaction from the developed digital tool, so that they can make informed design decisions potentially leading to safer designs.

Validity evidence of a task trainer for normal and difficult lumbar puncture: A cross-sectional study.

Validation of the anatomically complex configurations of the Lumbar Puncture Simulator II (KYOTO KAGAKU CO., LTD., 15 Kitanekoya-cho Fushimi-ku Kyoto, Japan 612-8388) have not been reported. Previous validation of the normal anatomic configuration has been reported. This study aims to evaluate evidence for construct and content validity of 4 interchangeable lumbar puncture (LP) complex anatomic configurations of this simulator.We performed a cross-sectional study between April 2018 and May 2019. Novice volunteer medical students and expert physicians who had performed over 30 LP procedures performed sequential LP procedures on each of 4 simulated interchangeable anatomic LP puncture blocks (normal, obesity, geriatric, combined geriatric/obesity). Primary outcome measures compared between groups for each LP procedure were return of cerebrospinal fluid within 5 minutes and a calculated performance score. Subjective face validity and content validity 5-point Likert questionnaires were completed by participants.35 novice (n = 19) and expert (n = 16) subjects completed 140 procedures. Significant differences were found between novice and expert groups for both cerebrospinal fluid success rates and performance scores for normal (P = .001/P = .001) geriatric (P = .005/P = .002) and obesity (P = .003/P = < .001) configurations. There were no differences for the geriatric/obesity configuration. Expert median score of simulator realism (face validity) was 4 (range 3–4); median score of utility as a training tool (content validity) was 4 (range 4–5).We provide evidence for construct validity for each of the complex LP configurations, except combined geriatric/obesity. Expert physicians found the simulator sufficiently realistic to effectively teach LP skills.

An expert advantage in detecting unfamiliar visual signals in noise

Diagnostic radiologists are experts in discriminating and classifying medical images for clinically significant anomalies. Does their perceptual expertise confer an advantage in unfamiliar visual tasks? Here, this issue was investigated by comparing the performance of 10 radiologists and 2 groups of novices on the ability to detect novel visual signals: band-limited textures in noise. Observers performed a yes/no detection task in which texture spatial frequency and external noise levels were varied. The task was performed on two consecutive days. Contrast thresholds and response bias were measured. Contrast thresholds of radiologists were superior to the control groups in all stimulus conditions on both days. Performance improved by an equivalent amount for all groups across days. Response bias differed consistently across stimulus conditions and days but not across groups. The difference in thresholds between the radiologists and control groups suggests that experience in diagnostic medical imaging produces perceptual skills that that transfer beyond the trained domain.

Effect of Music on the Efficiency of Performing a Microsurgical Arterial Anastomosis: A Prospective Randomized Study

Introduction Music is commonly played in operating rooms. Because microsurgery demands utmost concentration and precise motor control, we conducted the present study to investigate a potentially beneficial impact of music on performing a microsurgical anastomosis.Materials and Methods We included a novice group (15 inexperienced medical students) and a professional group (15 experienced microsurgeons) in our study. Simple randomization was performed to allocate participants to the music-playing first or music-playing second cohort. Each participant performed two end-to-end anastomoses on a chicken thigh model. Participant demographics, their subjective preference for work environment (music/no music), and time to completion were noted. The performance of the participants was assessed using the Stanford Microsurgery and Resident Training (SMaRT) scale by an independent examiner, and the final anastomoses were evaluated according to the anastomosis lapse index.Results Listening to music had no significant effect on time to completion, SMaRT scale, and anastomosis lapse index scores in both novice and professional cohorts. However, the subjective preference to work while listening to music correlated with high SMaRT scale scores within the professional cohort (p = 0.044).Conclusion Playing their preferred music in the operating room improves the performance scores of surgeons, but only if they subjectively appreciate working with background music.

Effect of shooting experience on executive function: differences between experts and novices.

BackgroundExecutive function (EF) plays an important role in controlling human actions. Shooting is a closed motor skill, characterized by high anti-interference ability and high mental intensity. However, the beneficial effects of closed exercises such as shooting on EF remain unclear.MethodsWe utilized an expert-novice paradigm and the Flanker task to examine the EF of shooting athletes. Participants were assigned into the novice group, expert group, or control group, based on the level of training and competition experience. Reaction time (RT) and accuracy of performance across the three groups were compared.ResultsFor the simple task, the control group showed a longer RT than the novice group, for all three inter-stimulus interval (ISI) conditions. Significant differences between the control and the expert groups were observed only at 300-ms and 400-ms ISIs. For the complex task, the control group exhibited a higher RT than the novice and expert groups at the 300- and 400-ms ISIs.ConclusionsThe self-control during performing closed motor skills in the environment determines that shooters have proficient anti-interference ability. This ability is uncorrelated with task type, but most likely is affected by reserved task response time.

The Usefulness of a 180° Rotatable Monitor for an Assistant to Overcome the Hand-Eye Discordance in Laparoscopic Colorectal Surgery.

PurposeHand-eye discordance during laparoscopic colon surgery is an obstacle to the assistant. We evaluated the usefulness of a 180° rotatable laparoscopic monitor for the colorectal surgery assistant to overcome hand-eye discordance.MethodsTwenty-six residents of the department of surgery (novice group, n=13; experienced group, n=13) participated in this study. They performed grasping a ring and transferring it to standing bars on a laparoscopic training kit under the conventional view and a 180° rotated monitor view. We defined successful performance when this procedure was completed in 3 minutes.ResultsThe number of successful performance was higher under the 180° rotated monitor view than under the conventional view monitor (6.88±2.79 vs. 0.92±0.80, p<0.01). Under the 180° rotated monitor view, the experienced group had a higher number of successful performances than the novice group (8.31±2.59 vs. 5.46±2.26, p=0.009). However, no statistically significant difference was found between the two groups under the conventional view (1.23±0.93 vs. 0.62±0.51, p=0.091).ConclusionThis study shows the usefulness of a 180° rotated monitor view to overcome hand-eye discordance, which adversely affects the laparoscopic performance of the colorectal surgery assistant.

Evaluation of Hybrid-Training Box for Laparoscopic Cholecystectomy

Background: The training box is a simple tool for practice, but it does not use real tissue. The Hybrid-Training box for laparoscopic cholecystectomy simulator (LCS) was used in the laparoscopic cholecystectomy (LC) training. Objective: To evaluate its face validity and construct validity. Materials and Methods: Between January 2017 and December 2017, 30 participants were divided into two groups, an experienced group (EG) and a novice group (NV). There were 15 participants in each group, and each was asked to perform LC using the LCS. Face validity was evaluated after task completion using a questionnaire with scores ranging from one (very bad or unrealistic) to five (excellent or very realistic) on a five-point Likert scale. Operative time and accidental tearing of the gallbladder were used to evaluate construct validity. Results: The participants in the EG were staff working in general surgery, and subjects in the NV were third- and fourth-year surgical residents. Face validity showed no significant difference on the Likert scale in terms of resembling reality or haptic feedback from tissue (23.6±2.8, 21.7±3.8, p=0.13). The mean operative time of the EG was 15±2.4 minutes while that of the NV was 32±4.1 minutes (p&lt;0.01), and more errors in the form of accidental perforation of gallbladder during LC were found in the NV (67%, 13%, p&lt;0.001). Conclusion: The LCS is an all-in-one simulator that provides effective skill training for LC. The frozen pig gallbladder added realism and was convenient to use. Keywords: Simulator, Laparoscopic cholecystectomy, Training model

Assessment of technical skill in hip fracture surgery using the postoperative radiograph

AimsTo develop a core outcome set of measurements from postoperative radiographs that can be used to assess technical skill in performing dynamic hip screw (DHS) and hemiarthroplasty, and to validate these against Van der Vleuten’s criteria for effective assessment.MethodsA Delphi exercise was undertaken at a regional major trauma centre to identify candidate measurement items. The feasibility of taking these measurements was tested by two of the authors (HKJ, GTRP). Validity and reliability were examined using the radiographs of operations performed by orthopaedic resident participants (n = 28) of a multicentre randomized controlled educational trial (ISRCTN20431944). Trainees were divided into novice and intermediate groups, defined as having performed < ten or ≥ ten cases each for DHS and hemiarthroplasty at baseline. The procedure-based assessment (PBA) global rating score was assumed as the gold standard assessment for the purposes of concurrent validity. Intra- and inter-rater reliability testing were performed on a random subset of 25 cases.ResultsIn total, 327 DHS and 248 hemiarthroplasty procedures were performed by 28 postgraduate year (PGY) 3 to 5 orthopaedic trainees during the 2014 to 2015 surgical training year at nine NHS hospitals in the West Midlands, UK. Overall, 109 PBAs were completed for DHS and 80 for hemiarthroplasty. Expert consensus identified four ‘final product analysis’ (FPA) radiological parameters of technical success for DHS: tip-apex distance (TAD); lag screw position in the femoral head; flushness of the plate against the lateral femoral cortex; and eight-cortex hold of the plate screws. Three parameters were identified for hemiarthroplasty: leg length discrepancy; femoral stem alignment; and femoral offset. Face validity, content validity, and feasibility were excellent. For all measurements, performance was better in the intermediate compared with the novice group, and this was statistically significant for TAD (p < 0.001) and femoral stem alignment (p = 0.023). Concurrent validity was poor when measured against global PBA score. This may be explained by the fact that they are measuring difference facets of competence. Intra-and inter-rater reliability were excellent for TAD, moderate for lag screw position (DHS), and moderate for leg length discrepancy (hemiarthroplasty). Use of a large multicentre dataset suggests good generalizability of the results to other settings. Assessment using FPA was time- and cost-effective compared with PBA.ConclusionFinal product analysis using post-implantation radiographs to measure technical skill in hip fracture surgery is feasible, valid, reliable, and cost-effective. It can complement traditional workplace-based assessment for measuring performance in the real-world operating room . It may have particular utility in competency-based training frameworks and for assessing skill transfer from the simulated to live operating theatre.Cite this article: Bone Joint Open 2020;1-9:594–604.

Effects of Short-Term Core Stability Training on Dynamic Balance and Trunk Muscle Endurance in Novice Olympic Weightlifters.

Our primary objective was to investigate the effects of short-term core stability training on dynamic balance and trunk muscle endurance in novice weightlifters learning the technique of the Olympic lifts. Our secondary objective was to compare dynamic balance and trunk muscle endurance between novice and experienced weightlifters. Thirty novice (NOV) and five experienced (EXP) weightlifters participated in the study. Mediolateral (ML) and anteroposterior (AP) dynamic balance and trunk muscle endurance testing were performed a week before (Pre) and after (Post) a 4-week core stability training program. In the NOV group, there was an improvement of both dynamic balance (ML and AP, p = 0.0002) and trunk muscle endurance (p = 0.0002). In the EXP group, there was no significant difference between Pre and Post testing conditions, except an increase in muscle endurance in the right-side plank (p = 0.0486). Analysis of the results showed that experienced lifters were characterized by more effective dynamic balance and greater core muscle endurance than their novice peers, not only before the training program but after its completion as well. In conclusion, the applied short-term core stability training improved dynamic balance and trunk muscle endurance in novice weightlifters learning the Olympic lifts. Such an exercise program can be incorporated into a training regime of novice weightlifters to prepare them for technically difficult tasks of the Olympic snatch and clean and jerk.

One-surgeon basketing technique for stone extraction during flexible ureteroscopy for urolithiasis: A comparison between novice and expert surgeons.

To determine the safety and efficacy of the one-surgeon basketing technique for stone extraction during flexible ureteroscopy when carried out by novice surgeons under instructor guidance. We retrospectively compared perioperative results, complications and the "stone-free" rate (defined as ≤2mm fragments on kidney-ureter-bladder imaging 1month after flexible ureteroscopy) between experienced (groupA, n=50) and novice (groupB, n=50) surgeons using the one-surgeon basketing technique. Baseline patients' characteristics were similar between the two groups. There were no significant differences between groupsA and B in operative time (mean 76min vs 85min, P=0.46), stone-free rate (98% vs 92%, P=0.36), postoperative fever events (4% vs 4%, P=1.00) and postoperative hospital stay (24h vs 24h, P=1.00). Clavien-Dindo gradeIIIa complications (ureter injury) were only observed in two cases (4%) in groupB. The one-surgeon basketing technique for the extraction of stone fragments during flexible ureteroscopy might be safely and effectively carried out by surgeons with no prior experience under proper guidance.

Muscle modes of the equestrian rider at walk, rising trot and canter.

Equestrian sports have been a source of numerous studies throughout the past two decades, however, few scientists have focused on the biomechanical effects, including muscle activation, that the horse has on the rider. Because equitation is a sport of two (the horse-human dyad), we believe there is a need to fill in the knowledge gap in human biomechanics during riding. To investigate the differences between novice and advanced riders at a neuromuscular level we characterized the motor output of a set of riders’ key muscles during horse riding. Six recreational riders (24 ± 7 years) and nine professional riders (31 ± 5 years) from the Spanish Classical School of Riding (Lipica) volunteered to take part in this study. Riders’ upper body, core and lower limb muscles were monitored and synchronized with inertial data from the left horse’s leg at walk, rising trot and canter. We used principal component analysis to extract muscle modes. Three modes were identified in the advanced group whereas five modes were identified in the novice group. From the novice group, one mode united dorsal and ventral muscles of the body (reciprocal mode). Advanced riders showed higher core muscles engagement and better intermuscular coordination. We concluded that advanced horse riding is characterized by an ability to activate muscles contralaterally but not reciprocally (dorsal-ventral contraction). In addition, activating each muscle independently with different levels of activation, and the ability to quickly decrease overall muscle activity is distinctive of advanced riders.

Construct validity of the SurgForce system for objective assessment of laparoscopic suturing skills.

Laparoscopic surgery requires a new set of skill to be learned by the surgeons, of which the most relevant is tissue manipulation. Excessive forces applied to the tissue can cause rupture during manipulation or ischemia when confronting both sides of the tissue. The aim of this study is to establish the construct validity of the SurgForce system for objective assessment of advanced laparoscopic skills, based on the force signal generated during suture tasks, and the development of force parameters for evaluating tissue handling interaction. The SurgForce system, a tissue handling training device that measures dynamic force, was used to capture the force generated by surgeons with different levels of laparoscopic experience. For construct validity, 37 participants were enrolled in this study: 19 medical students, 12 residents of surgical specialties and 6 expert surgeons. All participants performed an intracorporeal knotting suture task over a synthetic tissue pad with a laparoscopic box-trainer. The force performance of the participants was analyzed using 11 force-based parameters with the application of the SurgForce system. Statistical analysis was performed between novice, intermediate, and expert groups using a Kruskal-Wallis test, and between the pairs of groups using a Mann-Whitney U-test. Overall, 9 of the 11 force-related parameters showed significant differences between the three study groups. Results between the pairs of groups presented significant differences in 5 force parameters proposed. Construct validity results demonstrated that the SurgForce system was able to differentiate force performance between surgeons with different levels of laparoscopic experience. The SurgForce system was successfully validated. This force system showed its potential to measure the force exerted on tissue for objective assessment of tissue handling skills in suturing tasks. Furthermore, its compact design allows the use of this device in conventional laparoscopic box-trainers.

An Interprofessional Simulation-Based Orientation Program for Transitioning Novice Nurses to Critical Care Roles in the Emergency Department: Pilot Implementation and Evaluation

The emergency department (ED) relies on high-functioning teams to deliver consistent and safe patient care. Experts recommend that both emergency physicians and ED nurses participate in team training. However, there are currently no nationally accepted curricula for either profession to embed this training in their professional development, particularly for health workers who are novice or transitioning into critical care roles. An interprofessional educator team designed and embedded a series of simulation scenarios within a novel orientation program for novice nurses transitioning to critical care roles in the ED to teach clinical and teamwork skills for conjoint groups of resident physician and novice nurse learners. The team created four interprofessional simulations to represent the acuity and breadth of patient populations in the ED critical care bays. To date, the team has conducted 24 two-week orientation sessions for 48 nurses and 51 resident physicians. Overall mean scores for the Debriefing Assessment for Simulation in Healthcare (DASH) instrument from nursing participants in the first 18 sessions were high. Qualitative evaluation data from both nurses and physicians demonstrated a positive impact of the simulations and provided insight into respective roles, identities, and priorities across professions. Participant feedback led to iterative steps in refinement of the simulations, including adjustments in debriefings and logistics of the orientation program. A team-based interprofessional simulation program was found to be feasible and acceptable for practicing novice physicians and nurses as part of a nursing critical care orientation program in the ED. Future work will assess the program's long-term impact on teamwork and safety in the actual clinical environment.