One-off Training Research Articles

920 Regular Formal Surgical Skills Training for Undergraduates - an Easy Way to Increase Enthusiasm for Postgraduate Surgical Training?

Abstract Aim Despite the publication of a clearly defined surgical curriculum by the Royal College of Surgeons of England, the availability of surgical training opportunities at medical school remains highly variable [1]. While one-off training days can increase students’ surgical skills confidence, we wanted to explore the effect of a regular skills course on students’ skills confidence, and the effect this had on their willingness to attend theatre lists and purse surgical training after graduation. Method We designed a 6-session training program covering the Basic Surgical Skills curriculum produced by the RCS. It also included robotic surgery simulation. The course was run twice due to high demand for places. Core trainees were recruited to help supervise the course. The course was sponsored by both ASiT and Medtronic and was free for attendees. Results The course received excellent feedback. Free text sections highlighted how regular skills training allowed for consolidating learning. Attendees were significantly more likely to feel confident in performing all the techniques covered after the course (Chi Squared, p < 0.05). 16/17 attendees (94.1%) candidates agreed that the course filled a gap in what teaching is provided by the medical school, and all attendees felt more confident attending theatre lists after attending the course. Of note, most students agreed the course had increased their inclination towards a surgical career (12/17 70.2%.). Conclusions The course highlights the importance of regular surgical skills teaching. It also highlights an important knock-on effect of making students more confident attending lists, and more likely to pursue surgical careers.

The good practices for implementation of cyber security education for school children

The increasing use of the Internet calls upon the need for adequate cyber security awareness to better face the risk and dangers connected with the online environment. This research presents an experiment that revealed the cyber security awareness of children at Czech primary schools. They were tested for their skills to distinguish different online risks. After the pre-testing children received training and with the time delay they filled in very similar questionnaires. The re-testing measured how well the children retained the training and their ability to use the skills in the virtual environment. The results show only a moderate level of cyber security awareness at the initial testing. The one-off training had only an insignificant impact on their online behavior. The research reveals an important finding. One-off training does not affect their responsive online behavior and is not a suitable solution for effectively improving online safety skills. The task is to involve cyber security awareness education in the whole educational process. Based on the literature and conducted research this paper provides a set of recommendations for the designers of the cyber security school curriculum.

Curriculum-Based Asymmetric Multi-Task Reinforcement Learning.

We introduce CAMRL, the first curriculum-based asymmetric multi-task learning (AMTL) algorithm for dealing with multiple reinforcement learning (RL) tasks altogether. To mitigate the negative influence of customizing the one-off training order in curriculum-based AMTL, CAMRL switches its training mode between parallel single-task RL and asymmetric multi-task RL (MTRL), according to an indicator regarding the training time, the overall performance, and the performance gap among tasks. To leverage the multi-sourced prior knowledge flexibly and to reduce negative transfer in AMTL, we customize a composite loss with multiple differentiable ranking functions and optimize the loss through alternating optimization and the Frank-Wolfe algorithm. The uncertainty-based automatic adjustment of hyper-parameters is also applied to eliminate the need of laborious hyper-parameter analysis during optimization. By optimizing the composite loss, CAMRL predicts the next training task and continuously revisits the transfer matrix and network weights. We have conducted experiments on a wide range of benchmarks in multi-task RL, covering Gym-minigrid, Meta-world, Atari video games, vision-based PyBullet tasks, and RLBench, to show the improvements of CAMRL over the corresponding single-task RL algorithm and state-of-the-art MTRL algorithms. The code is available at: https://github.com/huanghanchi/CAMRL.

Accelerating Organizational Change to Build Mentorship Culture in Zambian Universities.

Strong cultures of mentorship and research remain underdeveloped at many African universities, threatening future knowledge generation essential for health and development on the continent. To address these challenges, a mentorship program was developed in 2018 at the University of Zambia with an aim to enhance the institutional culture of mentorship and to build institutional capacity through an innovative 'train the trainer' faculty development model. In this study, we documented perceptions of lived experiences related to mentorship culture by following trainers and trainees and their mentees over two years. We analyzed these perceptions to assess changes in institutional attributes regarding mentorship. We identified positive change in institutional culture towards mentorship, and this change appeared sustainable over time. However, a slight decrease in indicators for year two emphasizes the need for a continued culture of learning rather than assuming that one-off training will be sufficient to change culture.

Phlebological compression bandaging competence: comparing performance of nurses before and after one-off training

To investigate the differences in applying phlebological compression bandaging (PCB) in nurses before and after one-off training, and to compare the performance of subgroups. Participants received training teaching the correct application of PCB. Participants' competence was measured using the newly developed control score of compression bandaging (CCB score) before and after training, one and three months later. Subgroup analyses compared participants (work setting, wound certification, PCBs applied per week). In total, 47 participants took part (mean age 40.7 years, 85.1% female, 59.6% outpatient nurses, 59.6% >10 years' working experience, 55.3% with a wound certificate). The CCB score improved after training. In all subgroups, the score differed significantly over time (p≤0.002 in all cases) except for participants applying the highest number of PCBs (p=0.241). In hospital-based participants, the CCB score three months after training was considerably, but non-significantly, higher than before training (2.84 versus 4.21, respectively; p=0.068). In participants working in outpatient settings, with and without a wound certificate, and applying a low (<5) and medium (5-10) number of PCBs per week, the CCB score remained significantly higher than before training (p≤0.011 in all cases). All subgroups benefited from training, mostly significantly, and maintained gains in competence for three months. Frequently applying these skills may improve performance. Previously published results showed that ideal pressure-related parameters are rarely achieved. Regular training should be offered, including the use of pressure-measuring devices, allowing nurses to gain experience and develop deeper understanding of correct PCB application.

A Learning Approach for Efficient Multicast Beamforming Based on Determinantal Point Process

The problem of single-group multicast beamforming (SMBF) is well-known NP-hard. It motivates the pursuit of computationally efficient near-optimal solutions. Due to multicasting, the multicast group is bottlenecked by the user(s) with the minimum received signal-to-noise ratio (SNR). This paper provides an in-depth interpretation of the SMBF problem from the multicasting point of view and proposes to solve it in two steps: i) select the bottlenecking users by a machine learning approach based on determinantal point process (DPP), and ii) design the beamformer for the selected users. The DPP model jointly considers the magnitudes and directions of users’ channel vectors, and thus enables an efficient selection of the bottlenecking users. Moreover, for a specific channel model, the DPP model is only associated with network size and each takes a one-off training cost, thus can be used as a codebook. The proposed DPP-based subset selection is incorporated adaptively into two fast beamforming algorithms, i.e., the QR decomposition algorithm and the successive beamforming (SB) algorithm. They specifically design the beamformers for the selected users by leveraging channel orthogonalization therein. Numerical results demonstrate the superiority of the proposed QR-DPP and SB-DPP algorithms in terms of the performance-complexity compromise and their robustness to different scenarios.

Combating fake news, disinformation, and misinformation: Experimental evidence for media literacy education

This study investigated the effect of media and information literacy (MIL) on the ability to identify fake news, disinformation and misinformation, and sharing intentions. The experimental approach was selected to study both the control group and experimental group made up of a total of 187 respondents. Comparative analysis of the two groups revealed that although more respondents in the experimental group were able to identify the inauthenticity of information presented to them, some of the respondents in the control group were also able to do the same, even though they did not receive MIL training. Conversely, some respondents in the experimental group, even though they were trained in MIL, could not determine the inauthenticity of information, possibly because the one-off training given to them did not allow them to assimilate all the information in one sitting. Nonetheless, the results of the bivariate correlation computation showed that MIL trained respondents were more likely to determine authenticity or otherwise of information and less likely to share inaccurate stories. This means that when MIL increases, sharing of fake news decreases. This is yet another evidence that MIL enables information consumers to make informed judgments about quality information. It is recommended that MIL is incorporated into mainstream educational modules and consistently revised to reflect the demands of the times. MIL programs must also consider how to effectively reach those without formal education. Actors within the information, communications, and media ecology must contribute to their quota in making information consumers more discerning with the right MIL sensitisation.

Bayesian Active Meta-Learning for Reliable and Efficient AI-Based Demodulation

Two of the main principles underlying the life cycle of an artificial intelligence (AI) module in communication networks are adaptation and monitoring. Adaptation refers to the need to adjust the operation of an AI module depending on the current conditions; while monitoring requires measures of the reliability of an AI module's decisions. Classical frequentist learning methods for the design of AI modules fall short on both counts of adaptation and monitoring, catering to one-off training and providing overconfident decisions. This paper proposes a solution to address both challenges by integrating meta-learning with Bayesian learning. As a specific use case, the problems of demodulation and equalization over a fading channel based on the availability of few pilots are studied. Meta-learning processes pilot information from multiple frames in order to extract useful shared properties of effective demodulators across frames. The resulting trained demodulators are demonstrated, via experiments, to offer better calibrated soft decisions, at the computational cost of running an ensemble of networks at run time. The capacity to quantify uncertainty in the model parameter space is further leveraged by extending Bayesian meta-learning to an active setting. In it, the designer can select in a sequential fashion channel conditions under which to generate data for meta-learning from a channel simulator. Bayesian active meta-learning is seen in experiments to significantly reduce the number of frames required to obtain efficient adaptation procedure for new frames.

Information Literacy, Diversity, and One-Shot “Pedagogies of the Practical”

This essay examines the information literacy one-shot in conjunction with similar one-off training approaches often found in diversity education. Through this lens, we interrogate the ways that superficial approaches to complex issues such as mis- or disinformation and racism inhibit the kinds of engagement and (un)learning that transformative pedagogy requires as well as the structural conditions that give rise to such approaches. We find that information literacy and diversity one-shots emerged within the neoliberal turn in higher education and share a common philosophical foundation in liberalism and a belief that educated publics will come to consensus in the interest of the social good; they are based in narratives of individual deficiency, empowerment, and self-work. They are “pedagogies of the practical,” practices that ultimately fail to challenge white supremacist structures in higher education. Because education is about affect, emotion, and beliefs as well as knowledge, transactional one-shots can never truly be transformational or liberatory. We conclude by considering the role of affect in teaching and learning, and how “pedagogies of emotion” might help us to better address power and race in the information literacy classroom.

Impact of a National Peer-Led Training Program to Increase Brief Physical Activity Advice Given to Patients by Health Care Professionals.

The benefits of physical activity for preventing and managing long-term health conditions are well established and health care professionals could promote physical activity to patients. The current study aims to evaluate the impact of the Clinical Champions Physical Activity Training Program. Health care professionals attend a one-off in-person training session delivered by a trained Clinical Champion. Attendees at the Clinical Champions Physical Activity Training Program were asked to complete a baseline survey prior to the training session and follow-up surveys 4 and 12 weeks posttraining. A total of 5945 training attendees completed the baseline survey. A total of 1859 and 754 participants completed 4- and 12-week follow-up (31.3% and 12.7% response rate, respectively). Significant increases in confidence to deliver brief physical activity advice and knowledge of physical activity guidelines were reported at 12 weeks (P < .001). The perceived frequency of physical activity discussions with patients significantly increased (P < .001). Twelve weeks after training, fewer barriers in promoting physical activity were reported. The evaluation of the Clinical Champions Physical Activity Training Program demonstrated an increase in knowledge of physical activity guidelines, levels of confidence, and frequency of delivery of brief physical activity advice to patients. Further research is required to determine if this impact translates into changes to patients' physical activity behavior.

Collaborative Inquiries into Teaching English Practical Skills via a Critical Friends Group

From a sociocultural perspective, professional learning sites for teachers need to go beyond the boundaries of one-off training course to the situation-specific learning activities and on-going dialogues or collaboration among teachers within their community. Critical friends groups are one of the collaborative learning forms, which involve a small group of teachers within a shared teaching context and friendship to interact and develop professionally. However, limited empirical evidence was found about the learning process of those who are in their first years of teaching, known as novice teachers. This case study was carried out to investigate how five EFL novice teachers at a university in Vietnam made professional inquiries collaboratively in a critical friends group (CFG) in order to learn to teach English language skills. It aims at exploring the five teachers’ attitudes towards and constraints of their CFG experience. The data were collected through non-participant observations of discussions on a Messenger chat room of the CFG for three months and semi-structured interviews with the five teachers. The results reveal that the five novice teachers highly valued their collaborative learning opportunities with their critical friends in their process of learning to teach English language skills at a tertiary level while a number of hindrances were noticed in their learning within the CFG. Based on the findings of the research, it is recommended that CFGs or other collaborative forms of professional learning need to be encouraged among teachers, particularly those starting their teaching career.

An evolutional SVM method based on incremental algorithm and simulated indicator diagrams for fault diagnosis in sucker rod pumping systems

Fault diagnosis of the sucker rod pumping system (SRPS) is a challenging problem in the oil industry. Recently, the computer-aided indicator diagram (ID) recognition techniques are becoming useful measurements to help engineers monitor the wells. However, the slow variation of SRPS state makes it difficult for a well to experience all the fault conditions. Using the IDs collected from other oil wells as training data will lead to a large difference between the distribution of training data and target data because of the interference information including noise and system operation characteristics in IDs. Moreover, the different occurrence probability of each fault leads to the imbalance of training data, therefore the fault tolerance of the diagnosis models will result in lower accuracy in identifying the fault IDs with less training samples. In addition, due to one-off training, the parameters of diagnostic model are always fixed resulting in lack of adaptive ability. To address this issue, an evolutional support vector machine (SVM) method for SRPS diagnosis is proposed. First, to obtain balanced training data with similar distribution to the target data, a novel model describing the working process of SRPS under various fault conditions is established. Subsequently, the static apparent stiffness feature and its extraction algorithm is proposed to fully retain the fault information of SRPS in IDs. Then, the incremental SVM is used to construct the diagnosis model based on generated IDs. At last, the proposed method is verified experimentally through the system parameters and IDs of many wells collected from oilfields, and then some conventional techniques are employed in the comparison studies. The obtained results show that the accuracy of the diagnosis model trained by simulated IDs is 11.2% higher than that trained by collected IDs. Besides, the parameters of proposed diagnosis model can be continuously evolved to improve the diagnosis accuracy and generalization ability. Furthermore, the proposed diagnosis model also has advantages in training efficiency and memory consumption.

Increasing competence in compression therapy for venous leg ulcers through training and exercise measured by a newly developed score-Results of a randomised controlled intervention study.

Compression therapy with short-stretch bandages is the most common treating option for patients with venous leg ulcers in the decongestion phase in Germany. This randomised controlled intervention study examined whether a training is suitable to sustainably improve the skills of health care professionals. Altogether 55 nurses from hospitals and outpatient care participated. They were randomly assigned to case and control groups. Participants' abilities to properly apply a compression bandaging were assessed before and after a training session as well as after 1 and 3 months using a newly developed score (CCB score) based on six control parameters (CPs): padding, starting point, heel inclusion, heart direction, pressure at forefoot (A) and calf base (B1). After training, a significant increase in competence was observed, which only decreased non-significantly over the observation period: The average CCB score was 2.796 at V0, 4.89 at V1, 4.88 at V2, and 4.66 at V3. The CPs for pressure at A and B1 were met by a maximum of 42.6 and 43.6%, respectively, at all timepoints. The CP starting point was fulfilled by at least 61.7% after training, the CPs heart direction, heel and underpadding by at least 89.4, 96.4, and 97.9%, respectively. As a result of our study, it can be concluded that training improves the ability of users to apply compression bandagings, but one-off training does not appear to be suitable to improve the ability to apply compression bandagings with a therapy-relevant pressure. Therefor more training especially with pressure measuring devices would be necessary.

The impact of mindfulness training on performance in a group decision-making task: Evidence from an experimental study.

It is widely assumed that mindfulness training will lead to a range of benefits, from improved attentional capacities to better decision-making. Indeed, many large corporations have begun to provide workplace mindfulness training with the aim of improving group-based decision-making. Yet, there has been little empirical work testing the effects of mindfulness training on complex group-based task performance. In a randomised experimental study (N = 332), we examine the effects of two different durations of mindfulness training on strategic decision-making using the classic NASA survival task, assessing individual and then group performance. We expected that a longer training duration (seven daily sessions) would be associated with better group performance relative to a "one-off" training session. We did not find such an association: groups in the longer training condition made slightly, but not significantly, more errors than groups in the one-off condition. We did not find any differences across training conditions when examining individual performance. Our findings should be interpreted in light of numerous studies demonstrating the benefits of even short durations of mindfulness practice on cognitive performance. We conclude that our lengthier mindfulness training duration did not confer measurable benefits over a one-off training session at either the individual or the group level on a strategic decision-making task.

Virtual reality simulator improves the acquisition of basic arthroscopy skills in first-year orthopedic surgery residents

IntroductionArthroscopy training using a virtual reality (VR) simulator is said to improve the training of orthopedic surgery residents, although it has never been evaluated in a large representative population of first-year residents. HypothesisWe hypothesized that first-year residents who train on a VR simulator would improve their basic arthroscopy skills more than residents who use other training methods. The primary aim was to compare various arthroscopy-learning techniques after 6 months of training. Population and methodsThe study population consisted of 107 first-year residents who were tested twice on a VR arthroscopy simulator (December 2017 and June 2018). The residents were divided into three groups: no specific arthroscopy training (A), non-specific and one-off arthroscopy training (B), 6 months of VR arthroscopy simulator training (C). During the testing, they had to perform the Periscoping exercise (orientation of angled scope) and the Catch the Stars Glenohumeral exercise (extraction of loose bodies). The parameters analyzed were time (s), camera alignment relative to horizontal (%), camera path length (cm) and grasper path length (cm). ResultsAfter 6 months, there was a significant difference between groups during the Periscoping exercise in the time (A: 137.8 s; B: 126.7 s; C: 92.2 s) (p<0.0001), camera alignment (A: 93%; B: 98%; C: 97%) (p=0.0028), camera path length (A: 116.9cm; B: 112.5cm; C: 67.3cm) (p<0.0001) and during the Catch the Stars Glenohumeral exercise in the time (A: 112.2 s; B: 103 s; C: 61.4 s) (p<0.0001), camera path length (A: 46.3cm; B: 40.9cm; C: 32.9cm) (p<0.0153) and grasper path length (A: 146.4cm; B: 142.2cm; C: 95.8cm) (p<0.0001). DiscussionThe residents who participated in the VR arthroscopy simulator training program for 6 months had better results when performing practical exercises and standard arthroscopy tasks than those who did not receive any training or only received only one-off training. Their final performance indicated technical mastery that the other residents had not achieved. Level of EvidenceII, Prospective, comparative, non-randomized study.

THE EDUCATOR’S PERSPECTIVE: KNOWLEDGE, ATTITUDE AND PRACTICES ON OCCUPATIONAL SAFETY AND HEALTH AT SCHOOL AMONG PRIMARY AND SECONDARY SCHOOL TEACHERS

Introduction: School can be considered as a relatively moderate risk working environment due to the various hazards assembled in the school. Nevertheless, Occupational Safety and Health (OSH) training is yet to formally inclusive into teachers’ training module, and the current one-off or ad-hoc OSH training mainly targeted among school students. The different OSH awareness exists among teacher and student have hinder the provision of sustainable and effective safety and health training program at school levels. Objective: To assess the knowledge, attitude and practice among primary and secondary school teachers towards OSH at the school environment. Method: A cross-sectional survey carried out at three (3) primary schools and three (3) secondary schools after stratified random sampling. School teachers from these schools were randomly selected among those who had at least one year work experience as permanent teacher at the current school through the fishbowl technique. A structured questionnaire was used and total 136 teachers were assessed on their knowledge, attitude and practices on OSH at schools. Result: Study found that primary and secondary school teachers have different knowledge, attitude and practices of OSH at school levels. Overall, the knowledge level of secondary school teacher (62.1% of high to medium knowledge levels) are higher than the primary school teachers (41.1% of high to medium knowledge levels); at the same time, 93.1% of secondary school teachers show positive attitude while 88.5% of primary school teachers show positive attitude on safety and health atschools. In general, OSH practice level among the primary (88.5%) and secondary school teachers (86.2%) are atrelatively good levels. Besides, there is positive association with knowledge and attitude on OSH behavior among primary school teachers. Apart of this, there is positive but relatively weak association with knowledge and practices and knowledge and attitudes among primary and secondary school teachers. Conclusion: Considering the background differences between primary and secondary school teachers, a sustainable OSH learning mechanism should be planned and designed together with OSH practitioners and Ministry of Education to achieve a sustainable safety and healthy sound school environment for teacher to work and for students to learn.

Creating a climate for learning-experiences of educating existing and future decision-makers about climate change

Climate change is one of the most serious issues to affect modern society. What originated as a scientific question has evolved into a complex political and social issue. The policy context recognises the pivotal role of education in encouraging effective engagement and behavioural responses to projected climate changes. It is relatively easy to nod assent to the principles of climate change education and engagement, but harder to deliver. This paper explores experiences of educating and engaging current and future decision makers, namely pupils, teachers, charity workers, small business owners and councillors on the subject of climate change in Wales. It draws conclusions about the existing climate for learning as well as the potential for overcoming challenges associated with information needs of these existing and future decision-makers. It considers the broader issue of whether current climate change information and education frameworks are fit for purpose and able to support effective climate change mitigation and adaptation activities. The findings suggest that many climate change communications from international organisations are not being received or understood at local levels, indicating a need for further and simpler ‘translation’ of science. Despite a strong formal education system in Wales, there are variations in basic skills (such as map reading and graph interpretation), required for simple climate change science interpretation. Finally, our results point to a need for climate literacy to be gained through interactive long-term learning rather than one-off training, particularly given some of the entrenched views of the older age groups involved in the study.

Evaluating student learning outcomes in oral health knowledge and skills.

To evaluate whether a set of oral health resources designed for workforce training was relevant for students undertaking an entry-level nursing or aged care qualification. Oral health is one of the most neglected aspects of nursing care experienced by older people. Despite efforts to improve aged care worker oral health knowledge and skills, one-off training and rapid staff turnover have hindered the success of workplace programmes. Inadequate oral health content in entry-level nursing and aged care qualifications has perpetuated this. Kirkpatrick's training and evaluation model was used to evaluate the resources developed by a project called Building Better Oral Health Communities. Students used them as prescribed study materials and completed pre- and postintervention questionnaires. Educators were interviewed to obtain their feedback. Quantitative data were analysed using descriptive and inferential statistics. Qualitative data were collated according to relevance to learning, presentation style and interest. Evaluation showed high levels of student and educator satisfaction. Student learning outcomes demonstrated consistently positive attitudes and significant self-reported improvements in oral health knowledge and skills. Irrespective of course type, students gained similar levels of oral health knowledge and skills following use of the resources. Nurses and care workers must be able to provide consistent standards of oral health care as a fundamental part of caring for patients. Validated as an effective learning and teaching package, it is recommended that these resources be used to strengthen the oral health content of entry-level nursing and aged care qualifications. Building the oral health capacity of nurses and care workers is one way of reversing oral health neglect and improving the quality of care provided to older people.

Psychosocial Care for Injured Children: Worldwide Survey among Hospital Emergency Department Staff

To examine emergency department (ED) staff's knowledge of traumatic stress in children, attitudes toward providing psychosocial care, and confidence in doing so, and also to examine differences in these outcomes according to demographic, professional, and organizational characteristics, and training preferences. We conducted an online survey among staff in ED and equivalent hospital departments, based on the Psychological First Aid and Distress-Emotional Support-Family protocols. Main analyses involved descriptive statistics and multiple regressions. Respondents were 2648 ED staff from 87 countries (62.2% physicians and 37.8% nurses; mean years of experience in emergency care was 9.5 years with an SD of 7.5 years; 25.2% worked in a low- or middle-income country). Of the respondents, 1.2% correctly answered all 7 knowledge questions, with 24.7% providing at least 4 correct answers. Almost all respondents (90.1%) saw all 18 identified aspects of psychosocial care as part of their job. Knowledge and confidence scores were associated with respondent characteristics (eg, years of experience, low/middle vs high-income country), although these explained no more than 11%-18% of the variance. Almost all respondents (93.1%) wished to receive training, predominantly through an interactive website or one-off group training. A small minority (11.1%) had previously received training. More education of ED staff regarding child traumatic stress and psychosocial care appears needed and would be welcomed. Universal education packages that are readily available can be modified for use in the ED.

The experience of learning to speak up: a narrative inquiry on newly graduated registered nurses.

To explore the process of learning to speak up in practice among newly graduated registered nurses. Speaking up is an important aspect of communication to ensure patient safety within a healthcare team. However, nurses have reported being hesitant about speaking up or being unable to be heard, despite adopting various safety tools. A power differential could be a factor in their hesitation to speak up. While a large number of new graduates are employed in the lower rungs of the hospital hierarchy to resolve local and global nursing shortages, the process of their learning to speak up remains under-explored. The narrative concept of experience is addressed through the three-dimensional space of a narrative inquiry. Eighteen new graduates were recruited. Stories of experiences of speaking up emerged naturally during repeated unstructured interviews and ongoing email conversations with three participants. The complex process of learning to speak up is schematically represented. Three interrelated narrative threads were identified: (1) learning to speak up requires more than one-off training and safety tools, (2) mentoring speaking up in the midst of educative and miseducative experiences and (3) making public spaces safe for telling secret stories. Speaking up requires ongoing mentoring to see new possibilities for sustaining professional identities in the midst of miseducative experiences under the potential shaping of the Chinese culture and generational differences. Appreciative inquiry might be a new approach that can be used to promote positive cultural changes to encourage newly graduated registered nurses to learn to speak up to ensure patient safety. Cultivating a safe and open culture of communication and mentoring new graduates to speak up will benefit patient safety now and in the future by helping to retain committed patient advocates who could mentor future generations.