On-site Training Research Articles

School-based mathematics teacher professional learning: A theoretical position on the lesson study approach

This theoretical paper focuses on how school-based continuous professional development (CPD) for mathematics teachers in schools located in disadvantaged areas can be carried out using the lesson study approach. School-based CPD is based on the notion that teachers need real-time and on-site professional training tailored to improve the instructional practices unique to their school and classroom contexts. The paper seeks to address the research question: How can a lesson study [or research lesson] be used in the school-based CPD of mathematics teachers in schools located in disadvantaged areas? Empirical evidence from lesson study research suggests that it is an effective tool for CPD activities because it is school-centred, focuses on learner learning, and draws on the collective and collaborative experiences of teachers working in the same school mathematics department. Therefore, this paper significantly contributes to theoretical and practical debates on school-based CPD activities in schools located in disadvantaged areas, using lesson study. Further research would necessitate a focus on understanding how the social learning processes within school-based CPD can be linked to school contexts.Keywords: continuous professional development; lesson study; mathematics noticing; research lesson

Onsite training of clinicians on new techniques to improve cervical cancer prevention in sub-Saharan Africa

Cervical cancer remains a leading cause of death in African women.[1][1] While screening and treatment of cervical pre-cancerous lesions are highly effective preventive strategies, most women in Africa have never...

Bridging the Gap in Training and Clinical Practice in Sub-Saharan Africa

As medical knowledge and innovation reaches new heights, there is a growing gap in medical advancements between low- and middle-income countries (LMICs) and high-income countries (HICs). The former has lack of basic health care and preventive or diagnostic services for early cancer while the latter has access to novel diagnostic and therapeutic modalities. Key to overcoming this disparity is finding ways to bridge this divide across distances and continental divides through innovative technology and sharing of knowledge by committed individuals and through public private partnerships. Many initiatives that include onsite and online training programs for regional healthcare providers have shown that the gap in medical training between HICs and LMICs can be narrowed. The following article shines a light on this disparity and provides exemplary case studies of ways in which this gap between LMICs and HICs can be bridged.

A program utilizing community pharmacists to improve diabetes education in the Kingdom of Saudi Arabia.

The aim of this program was to demonstrate that retail community pharmacists could successfully recruit, engage and counsel people with diabetes by serving as a trusted source of diabetes information. We evaluated the outcomes of this clinical program in preparation for a wider roll out. Joslin Diabetes Center collaborated with Nahdi Medical Company, a large retail pharmacy chain in Saudi Arabia, to offer a 'Let's Talk About Diabetes' (LTAD) program. LTAD consists of four 1: 1 counselling sessions, approximately 20 min each, scheduled over a 2-4 month period with a focus on medications, lab results, glucose monitoring and doctor visits. Twenty-five pharmacists completed diabetes education certification and intensive on-site training to deliver the LTAD program. The 25 program pharmacists in 11 locations enrolled 2639 individual customers into the program. Of these, 1582 participated in at least one session and 1137 (71.9%) participated in at least one LTAD session and completed follow-up surveys. There were 380 customers with paired HbA1C results which demonstrated a reduction from 8.50% (69 mmol/mol) to 7.32% (56 mmol/mol) (P < 0.001). There were improvements in diabetes awareness, attitudes towards diabetes and medication adherence. The evaluation of this community program suggests that a pharmacy-led diabetes education program is feasible in Saudi Arabia.

Inter- and Intraoperator Variability in Measurement of On-Site CT-derived Fractional Flow Reserve Based on Structural and Fluid Analysis: A Comprehensive Analysis.

To measure the inter- and intraobserver variability among operators of varying expertise in conducting CT-derived fractional flow reserve (CT FFR) measurements on-site by using structural and fluid analysis and to evaluate differences in reproducibility between two different training methods for end users. This retrospective analysis of the prospectively enrolled cohort included 22 symptomatic patients who underwent both 320-detector row coronary CT angiography and catheter-derived fractional flow reserve (FFR) within 90 days. Thirteen operators of varying expertise were assigned to one of two training arms: arm 1, on-site training by a specialist in CT FFR technology; arm 2, self-training through use of written materials. After the training, all 13 operators reviewed the CT data and measured CT FFR in 24 vessels in 22 patients. Inter- and intraoperator variability and agreements between CT FFR and catheter-derived FFR measurements were evaluated. The overall intraclass correlation coefficient (ICC) among operators was 0.71 (95% confidence interval: 0.58, 0.83) with a mean absolute difference (± standard deviation) of 0.027 ± 0.022. The operators in arm 2 showed greater interoperator differences than those in arm 1 (0.031 ± 0.024 vs 0.023 ± 0.018; P = .024). Among operators who recalculated CT FFR, the mean CT FFR value did not significantly differ between the first and second calculations (ICC, 0.66; 95% confidence interval: 0.46, 0.87), with the medical specialists producing the lowest intraoperator variability (0.053 ± 0.060). The overall correlation coefficient between CT FFR and catheter FFR was r = 0.61, with a mean absolute difference of 0.096 ± 0.089. Good reproducibility of CT FFR values calculated on-site on the basis of structural and fluid analysis was observed among operators of varying expertise. Face-to-face training sessions may cause less variability.© RSNA, 2019Supplemental material is available for this article.

A Smart Substation Training Platform based on Primary Equipment Simulator

A training scheme based on combination of virtual substation primary equipment real secondary devices is proposed for smart substation accident management. The primary equipment simulator is implemented through communication between 3D cartoon server and simulated switch controller. Electronic current and voltage transformer is simulated by EMTDC transient model and FPGA+DSP terminal controller. A smart substation on-site training environment is established for the substation O&M personnel.

S9B-02 SESSION 9B: FACE RESEARCH - PART II USING AUGMENTED REALITY TO REMOTELY TEACH CLEFT SURGERY: BUILDING LONG- TERM INTERNATIONAL CAPACITY AND SUSTAINABILITY

Introduction: Building capacity and long-term sustainability for global cleft care requires continued presence. Augmented Reality (AR) is a novel technology that permits a remote yet “hands-on” virtual interactive presence. A 2014 multi-center proof-of-concept investigation demonstrated AR is safe, reliable, and accurate/precise. Here, we investigate AR’s efficacy in building capacity/sustainability of comprehensive cleft care at one international center. Methods: A 12-month AR-based curriculum was designed and approved by the Ministry of Health in Trujillo, Peru. Global Smile Foundation and PROXIMIE, L.L.C. provided logistical/technical partnerships; grant support was provided by CPF and PSF. Three semi-annual site visits engaged Peruvian colleagues in evidence-based didactics, on-site cleft surgery, and familiarization with the AR platform. Each month, AR was used to remotely guide cleft repairs in Trujillo, Peru. Quarterly assessments by Peruvian and U.S. surgeons utilized Lickert Surveys and VAS Questionnaires. Results: Two surgeons were recruited, serving a population of over 3,000,000. Neither had specialized cleft training. Mulliken’s technique for unilateral/bilateral nasolabial repair was taught during site visits and remote sessions. Sustained gains in seven areas of cleft care were demonstrated by self-reporting and by assessment of the remote surgeon. Site visits preferentially augmented capacity for anatomic diagnosis, principles of repair, and intra-operative decision-making. Remote sessions preferentially developed capacity for cleft anthropometry, operative anatomy, and operative efficiency. 18 months after completion of AR-based curriculum, no child with cleft lip required transfer to tertiary care center (Lima, Peru) because of diagnosis or severity of cleft lip; 6 patients were transferred for treatment of additional congenital anomalies. Conclusion: A curriculum combining on-site training and AR-based “hands-on” remote teaching can build sustained capacity of comprehensive cleft care in under-resourced international areas. Specific needs assessments and established partnerships/trust are pre-requisites. We plan to next test the efficacy of an AR-based curriculum in developing sustained international capacity for NasoAlveolar Molding (NAM).

DESARROLLO DE UN PROGRAMA SEMIPRESENCIAL PARA DOCENCIA ONLINE: PROCESO Y RESULTADOS

In this study, we outline the different steps and strategies followed to develop an online formation program aimed to higher education teachers. The aim of this program is to provide with teaching competencies to face the challenges of the next decade’s classroom, with a special focus on the role of digital technology in learning environments, through a combination of a self-managed course with a guided on-site training with real cases. A multicultural, multidisciplinary team conceives this blended learning format, which applies a storytelling approach for content generation and communication. A detailed description of the different factors and stages followed to undertake the project is presented, together with a series of recommendations to face similar activities in the applied teaching and educational innovation field. Specifically, the importance of an appropriate project design, management and timing is stressed. In this way, we contribute with the diffusion of an innovative, hybrid program to develop digital competences in higher education practitioners and a selection of criteria to undertake other supranational projects that count on a wide reach and follow a didactical approach.

Reinvigorating postpartum intrauterine contraceptive device use in Pakistan: an observational assessment of competency-based training of health providers using low-cost simulation models

BackgroundImproved training approaches have the potential to overcome barriers to the use of postpartum intrauterine devices (PPIUDs) in Pakistan, including a shortage of female providers who are able to insert the device. This study assessed the effectiveness and acceptability of a competency-based onsite training approach that employed a newly developed anatomic model (the Mama-U) to train doctors and midwives on postpartum family planning (PPFP) and the insertion of PPIUDs.MethodsAn observational, mixed methods study conducted training evaluations and knowledge and skills assessments with 11 trainers and 88 doctors and midwives who participated in eight PPIUD training sessions. Two months later, follow-up interviews and clinical assessments were conducted with 20 providers, and interviews and a focus group discussion were conducted with 85 married women who received a PPIUD from a trained provider.ResultsThe training significantly improved provider knowledge (p < 0.001), and follow-up assessments showed that clinical skills were retained for at least two months post-training. After training, 81.8% of providers were confident in their ability to provide PPIUD services, and midwives and doctors had similar PPIUD insertion skills. However, midwives were more likely than doctors to meet all 10 key requirements during PPIUD counseling sessions (63.9% versus 13.3%, p = 0.004). Providers found the Mama-U model to be a useful tool for client counseling as well as training and skills practice, and clients agreed. Trainers identified the low cost, light weight, and portability of the Mama-U model as advantages over the conventional training model and noted that its abstract shape reduced embarrassment among trainers, providers, and clients.ConclusionsCompetency-based training with the Mama-U model can improve the quality of PPIUD counseling and PPIUD insertion services and has the potential to extend PPFP/PPIUD service delivery to midwives working in rural Pakistan. The portable, low-cost Mama-U permits onsite, on-the-job PPIUD insertion training that is tailored to the local setting; it is also well suited for the continuing practice that providers need to maintain their skills. Further research is needed to confirm the usefulness and cost-effectiveness of the Mama-U at scale and in other settings.

Methods, New Software Tools, and Best Practices for Developing High-quality Training Data for Machine Learning-based Image Analysis in Biodiversity Research

Recent progress in using deep learning techniques to automate the analysis of complex image data is opening up exciting new avenues for research in biodiversity science. However, potential applications of machine learning methods in biodiversity research are often limited by the relative scarcity of data suitable for training machine learning models. Development of high-quality training data sets can be a surprisingly challenging task that can easily consume hundreds of person-hours of time. In this talk, we present the results of our recent work implementing and comparing several different methods for generating annotated, biodiversity-oriented image data for training machine learning models, including collaborative expert scoring, local volunteer image annotators with on-site training, and distributed, remote image annotation via citizen science platforms. We discuss error rates, among-annotator variance, and depth of coverage required to ensure highly reliable image annotations. We also discuss time considerations and efficiency of the various methods. Finally, we present new software, called ImageAnt (currently under development), that supports efficient, highly flexible image annotation workflows. ImageAnt was created primarily in response to the challenges we discovered in our own efforts to generate image-based training data for machine learning models. ImageAnt features a simple user interface and can be used to implement sophisticated, adaptive scripting of image annotation tasks.

Overcoming Barriers in the Implementation of Programs for Breast and Cervical Cancers in Cali, Colombia: A Pilot Model.

Breast and cervical cancers are leading causes of mortality among women in Latin America. Colombia has universal health care and a government-sponsored 10-year cancer control plan focused on prevention, early detection, and treatment. However, many administrative and social barriers have hindered its success, and a majority of patients are diagnosed at a late stage. Established in 2012, Partners for Cancer Care and Prevention (PFCCAP) works to decrease the burden of these cancers by mitigating the obstacles women face during their cancer diagnosis and treatment. Through community outreach meetings with medical personnel, hospital directors, and government officials, PFCCAP identified major barriers, including lack of trained health care personnel, few centers with adequate screening equipment, and a fragmented health system with significant administrative delays and poor continuity of care. Its solution included monthly teleconferences, biannual on-site training, quality control programs, and improved access to screening equipment. PFCCAP also initiated a patient navigation project. After implementation of the PFCCAP plan of action, from 2012 to 2018, the average time from initial consult to biopsy decreased from 65 to 20 days; from biopsy to diagnosis, 33 to 4 days; and from diagnosis to surgery, 121 to 60 days. To date, more than 1,500 women have benefited from this initiative, which has expanded to other regions. Overall, PFCCAP is creating centers of excellence in strategically located hospitals and promoting the implementation of national guidelines. Although several barriers still exist, PFCCAP is helping to implement an efficient health care model that can be replicated in other underserved populations.

Effect of Health Education Program on Knowledge and Practice of Workers Regarding Occupational Health Hazards at Sugar Factory

Background: The workers are exposed to workplace hazards arising from various activities involved in sugar production. Aim: study aims to assess effect of health education program on knowledge and practice of workers regarding occupational health hazards at sugar factory. Design: Quasi-experimental design was utilized for this study with pre/posttest. Sample: A purposive sample with number of 130 workers according to specific criteria. Setting: The present study was carried out in Minia sugar factory in Abu Korkas district, Tools: Data were collected using three tools; the first tool included questions related to demographic characteristics, health history, health habit and occupational health services. The second tool is a questionnaire regarding knowledge of workers about occupational health hazards and the third tool is a self-reported practice questionnaire about using workers personal protective equipment and most commonly first aid in the factory. Results: the mean age was 44.7 ± 8.7, 37.7% years. All workers of the study sample had poor knowledge about occupational health hazards and unsatisfactory self-reported practice regarding personal protective equipment and first aids. Conclusion: post implementation of health education program the workers knowledge and self-reported practice improved. Recommendation: on-site training programs for workers have to be implemented to improve their working skills. Training programs should include awareness about safety measures and orientation regarding work hazards and how to avoid work related injuries as well as first aid measures.

1270-P: Improving ABC Targets through a Quality Improvement Initiative in China

Strong scientific evidence supports the benefits of ABC control (A1c &amp;lt;7%, blood pressure &amp;lt;140/80 mmHg, and LDL cholesterol &amp;lt;100 mg/dL) in reducing complications. A recent national multicenter study in China showed that the percentage of Chinese patients with type 2 diabetes who met recommended targets for A1c, BP and LDL in 2010 was 5.4%. A diabetes clinic in a Chinese tertiary hospital conducted a pilot quality improvement project from January to November 2018 to enhance ABC outcomes. Doctors and nurses from the clinic participated in biweekly video case conferences with Joslin Diabetes Center clinicians (endocrinologist and a certified diabetes educator). They also received bi-monthly on-site training, each lasting 10 days, from visiting U.S. clinicians. A1c, blood pressure and cholesterol levels collected from patients receiving routine care in the diabetes clinic from the first half of 2018 were compared with those collected in the second half of 2018. There were 1,036 patients who had at least one visit at each of these periods, and 683 patients of them (65.9%) had A1c, BP and LDL measured during these two periods. Paired comparisons were done by paired t-test (continuous variables) or McNemar’s test (dichotomous variables) using SAS version 9.4. The mean age of the patients was 54.7±11.9 years, with 53.8% female, and 95.3% with T2DM. There was a significant increase in the patients who achieved composite A1c, BP and LDL goal from 6.8 to 10.0% (p=0.048). The percentage of patients attaining the BP goal increased from 54.6 to 63.5% (p=0.0016). The systolic pressure decreased from 137.8 ± 20.2 to 133.3 ± 19.4 mmHg (p&amp;lt;0.0001). The LDL cholesterol decreased from 107.5 ± 34.0 to 97.5 ± 34.4 mg/dL (p&amp;lt;0.0001), and resulted in an increase in the percentage of individuals meeting the LDL goal, from 24.5% to 32.9% (p=0.0012). Interventions through regular case-based video conferences, complemented by live coaching from diabetes specialists, have the potential to improve clinical outcomes for patients with diabetes in China. Disclosure K. Lau: None. L. Yunxia: None. L. Yi: None. C. Li: None. Y. Zhengguo: None. D.M. Pober: None. L. Zhang: None. R.A. Gabbay: Advisory Panel; Self; HealthReveal, Hygieia, Lark, Onduo LLC. Consultant; Self; Sanofi. W.C. Hsu: Consultant; Self; Onduo LLC.

Nursing Students' Knowledge of Hand Hygiene and Hand Hygiene Compliance Rate during On-site Clinical Training

Nursing Students' Knowledge of Hand Hygiene and Hand Hygiene Compliance Rate during On-site Clinical Training

An analysis of Structural Relationships among Job Characteristics, Satisfaction and Education Performance in Long-term on-site Training

An analysis of Structural Relationships among Job Characteristics, Satisfaction and Education Performance in Long-term on-site Training

Hidden Devices in the School Setting: What the School Nurse Needs to Know About Vagus Nerve Stimulation.

The Specialized Health Needs Interagency Collaboration (SHNIC) program at the Kennedy Krieger Institute is a community-based program that provides on-site training and technical assistance to safely manage the integration of children with special health needs into educational and community settings. SHNIC frequently receives seizure education requests throughout the school year, specifically regarding vagus nerve stimulation. Vagus nerve stimulation involves an implanted medical device used to deliver electrical pulses to the vagus nerve for additional seizure management. The school nurse needs to understand the purpose and function of the hidden medical device, including the parameters for use of the device and magnet, safety considerations, and side effects. SHNIC has developed educational materials specific to vagus nerve stimulation to aid the school nurse in providing staff training, developing care plans, and creating a safe school experience for students with special health needs.

Improving the quality of hospital care provided for asthma out-patients in a country in turmoil: a report from Syria.

In low resources settings, especially during periods of turmoil, asthma care becomes emergency-oriented, and adherence to international asthma management guidelines such as long-term inhaled corticosteroids (ICS) prescription is limited. The role of education for inhaler technique to guarantee treatment efficacy is neglected and follow up is hampered by war-related displacement. In Syria, asthma care is not included in primary care, and frequently, internal medicine general hospital outpatient clinics are the first contact. The main objective of our study was to evaluate the adequacy of prescription of controller medications (ICS/LABA) by residents on initial contact with patients, and the effect of regular onsite personalized supervision and coaching by a trainer pulmonologist on improving their practice. The second objective was to evaluate the efficacy of mobile training for inhaler technique, and asthma mobile follow up. We developed an audit form to assess initial prescription of ICS/LABA by residents. Filled forms were reviewed by a trainer pulmonologist for compliance with international guidelines. When discrepancies were noted, onsite training was provided. Auditing of new presenting asthma patients is continual to evaluate improvement of initial prescription by the same residents. In parallel, video-mobile education of patients for inhaler technique, and mobile interviewing follow up were tested. Implementation of these strategies resulted in improved adherence of residents to ICS dosing guidelines (P=0.002), optimal inhaler technique by patients, and efficacy of mobile follow up. WHO programs for CRD in developing countries, especially in regions of conflict and war, should include auditing of care by residents with onsite coaching by trainer pulmonologists, and mobile education for technology of inhaler and patient follow up.

The Paediatric electronic Persistent Pain Outcomes Collaboration (PaedePPOC): establishment of a binational system for benchmarking children's persistent pain services.

Chronic or persistent pain is a growing global health problem. Effective management of pain emerging in childhood may prevent long-term health and vocational consequences. Internationally, paediatric pain services are a limited resource and, as such, must strive to improve equity, outcomes, and value for money. The Paediatric electronic Persistent Pain Outcomes Collaboration (PaedePPOC) is a binational paediatric outcome measurement centre that aims to measure, benchmark, and improve children's specialist pain services in Australasia. This study documents the establishment of PaedePPOC and presents baseline and initial outcome data. Binational consensus meetings determined the measures. Governance structures, collection protocols, information technology, site-specific logistics, and onsite training were achieved within 18 months. Children and parents complete baseline and progress questionnaires. Seven of 10 Australasian services provided data to PaedePPOC, with 1432 patients enrolled until June 2018. At baseline, patients were 12.4 ± (3.0) years, 68% female, 93% Australian-born, and 5% Aboriginal and/or Torres Strait Islander people. Most had moderate-severe functional disability and impaired quality of life, with pain affecting school attendance and employment. Opioid-containing medicines were used often or daily by 16%. Patients completing outcome measures at treatment end reported clinically significant improvement in pain intensity (49% of patients), functional ability (59%), and quality of life (69%). The PaedePPOC initiative has been successfully integrated into children's pain services, yielding timely point-of-care information to support clinicians and families, and valuable binational and service data to inform quality improvement and future sector planning.

Assessing safe food handling knowledge and practices of food service managers in Doha, Qatar.

The aim of this cross-sectional study was to assess safe food handling practices, food safety knowledge, and adherence to implementation of Hazard Analysis and Critical Control Point among 53 food safety managers working in randomly selected food service establishments in Qatar. Face-to-face interviews with the managers at each participating food service establishment were conducted using a survey consisting of 40 questions in October-December 2015. In addition to the survey questionnaire, a checklist was used to determine the implementation of Hazard Analysis and Critical Control Point by observing actual practices applied at each food service establishment. About 66 and 68% of managers had college degree and were trained on Hazard Analysis and Critical Control Point, respectively. Results also showed that casual sit-in and fine dine-in restaurants were the only food service establishments that consistently kept records on safe food handling practices (100%), followed by fast-food food service establishments (36%). Managers' training and education level were highly correlated with the probability of their employees receiving food safety training. This first assessment on food safety knowledge and practices in Qatar demonstrated that training and education are important factors that directly impact the food safety culture in food service establishments. These findings may help government agencies establish guidelines for compulsory on-site training of food handlers for effective food safety practices in food service establishments in Qatar where the fast growing demography has led to a rapid growth in food service establishment in different cuisines leading to heterogeneity in food safety practices.

Strengthening laboratory surveillance of viral pathogens: Experiences and lessons learned building next-generation sequencing capacity in Ghana

ObjectiveTo demonstrate the feasibility of applying next-generation sequencing (NGS) in medium-resource reference laboratories in Africa to enhance global disease surveillance. MethodsA training program was developed to support implementation of NGS at Noguchi Memorial Institute for Medical Research (NMIMR), University of Ghana. The program was divided into two training stages, first at the Centers for Disease Control and Prevention (CDC) in Atlanta, GA, followed by on-site training at NMIMR for a larger cohort of scientists. ResultsSelf-assessment scores for topics covered during the NGS training program were higher post-training relative to pre-training. During the NGS Training II session at NMIMR, six enterovirus isolates from acute flaccid paralysis cases in Ghana were successfully sequenced by trainees, including two echovirus 6, two echovirus 11 and one echovirus 13. Another genome was an uncommon type (EV-B84), which has not been reported in Africa since its initial discovery from a Côte d’Ivoire specimen in 2003. ConclusionsThe success at NMIMR provides an example of how to approach transferring of NGS methods to international laboratories. There is great opportunity for collaboration between institutes that have genomics expertise to ensure effectiveness and long-term success of global NGS capacity building programs.