Training Outcomes Research Articles

Implementation and Clinical Outcomes of Blood Flow Restriction Training on Adults With Cerebral Palsy: A Case Series.

Cerebral palsy (CP) is a congenital neurological disorder that causes musculoskeletal weakness and biomechanical dysfunctions. Strength training guidelines recommend at least 70% of 1-repetition maximum to increase muscle strength and mass. However, individuals with CP may not tolerate such high exercise intensity. Blood flow restriction (BFR) can induce similar gains in strength and muscle mass using loads as low as 20% to 30% 1-repetition maximum. This case series described the safety, feasibility, and acceptability of BFR in adults with CP and examined changes in muscle mass and strength. Three male participants with gross motor function classification system level 3 CP underwent strength training using a periodized 8-week BFR protocol. Outcomes included: Safety via blood pressure during and post-BFR exercises in addition to adverse event tracking; Feasibility via number of support people and time-duration of BFR exercises; Acceptability via rate of perceived discomfort (0-10) and qualitative interviews; Muscle Mass via ultrasonographic cross-sectional area of the quadriceps and hamstring; and Strength via (1) 3-repetition maximum in the leg press and knee extension, (2) isometric knee flexor and extensor muscle force measured with a hand-held dynamometer, and (3) 30-second sit-to-stand test. Participants replaced 2 exercises from their current regimen with seated knee extension and leg press exercises using progressively higher limb occlusion pressure and exercise intensity. Limb occlusion pressure started at 60%, by week 4 progressed to 80%, and then remained constant. The exercise repetition scheme progressed from fixed nonfailure repetition sets to failure-based repetition sets. Blood pressure never exceeded safety threshold, and no adverse events were reported. The BFR training was time-consuming and resource-intensive, but well-tolerated by participants (rate of perceived discomfort with a mean value of 5.8, 100% protocol adherence). Strength, as measured by 3-repetition maximum testing and 30-second sit-to-stand test, increased, but isometric muscle force and muscle mass changes were inconsistent. Blood flow restriction may be an effective means to increase strength in adults with CP who cannot tolerate high-intensity resistance training. Future research should compare BFR to traditional strength training and investigate mediators of strength changes in this population. for more insights from the authors (see the Video, Supplemental Digital Content available at: http://links.lww.com/JNPT/A473 ).

Hand functioning in progressive multiple sclerosis improves with tDCS added to daily exercises: A home-based randomized, double-blinded, sham-controlled clinical trial

Background: Many individuals with progressive multiple sclerosis (PMS) are challenged by reduced manual dexterity and limited rehabilitation options. Transcranial direct current stimulation (tDCS) during motor training can improve rehabilitation outcomes. We developed a protocol for remotely supervising tDCS to deliver sessions of stimulation paired with training at home. Objective: This study evaluated the effectiveness of at-home tDCS paired with manual dexterity training for individuals with PMS. Methods: Sixty-five right-hand dominant participants with PMS and hand impairment were randomized to receive either active or sham M1-SO tDCS paired with manual dexterity training over 4 weeks. Clinical outcomes were measured by the changes in Nine-Hole Peg Test (9-HPT) and Dellon-Modified-Moberg-Pick-Up Test (DMMPUT). Results: The intervention had high rates of adherence and completion (98% of participants completed at least 18 of 20 sessions). The active tDCS group demonstrated significant improvement for the left hand compared with baseline in 9-HPT (−5.85 ± 6.19 vs −4.23 ± 4.34, p = 0.049) and DMMPUT (−10.62 ± 8.46 vs −8.97 ± 6.18, p = 0.049). The active tDCS group reported improvements in multiple sclerosis (MS)-related quality of life (mean increase: 5.93 ± 13.04 vs −0.05 ± −8.27; p = 0.04). Conclusion: At-home tDCS paired with manual dexterity training is effective for individuals with PMS, with M1-SO tDCS enhancing training outcomes and offering a promising intervention for improving and preserving hand dexterity.

The efficiency of residency training and health outcomes in China: Based on two-stage DEA and cluster analysis

To address the residency training performance and further explore its determinants, with the help of a unique dataset, our study calculated the efficiency of residency training and health outcomes in 18 Chinese tertiary hospitals from 2020 to 2021 using a two-stage data envelopment analysis (DEA) model given the two-stage characteristics of vocational training and clinical practice of residents. The results showed that the efficiency of the sample hospitals in both residency training and medical service provision was high, there are approximately 1/3 hospitals of sub-efficient in each stage, but the number of efficient units for assessing the residency training performance was slightly less than that for assessing the health outcome performance. All the decision-making units (DMUs) were clustered into four groups through K-means cluster analysis according to efficiency results. The results showed that there was an obvious inconsistency between the teaching goals and the health outcome goals of Chinese public hospitals. In some hospitals, the low residency pass rate resulted in the low efficiency in stage 1, while the redundant inputs in beds resulted in the low efficiency in stage 2. Residency training hospitals should strengthen their synergistic management in programs of residency training and health outcomes.

Age-related differences in olfactory training outcomes: A prospective cohort study.

While olfactory function decreases with age, it is unknown how age affects olfactory training (OT) efficacy. This study compared OT in two cohorts of subjects: aged ≤50 (younger cohort) and aged 51+ (older cohort) with olfactory dysfunction (OD) primarily from COVID-19 infection. Subjects with OD primarily secondary to COVID-19 infection were prospectively recruited and enrolled into an OT registry. Baseline data were collected and they were provided with a training kit and asked to complete OT at home twice daily for 6 months. Participants were asked to follow-up at 3 and 6 months during training for olfactory testing and quality-of-life surveys (Sino-Nasal Outcomes Test-22 [SNOT-22] and Questionnaire of Olfactory Disorders Negative Statements [QoD-NS]). Fifty-six participants completed OT (younger cohort: n=26, older cohort: n=30). There were no significant differences between cohorts' Affordable Rapid Olfactory Measurement Array (AROMA), QoD-NS, or SNOT-22 scores at any time point. Both cohorts showed significant AROMA score improvement of more than 16 points from baseline to 3 months (younger cohort: p=0.001; older cohort: p=0.008). The younger cohort had significant improvements in QoD-NS (p=0.008) and SNOT-22 (p=0.042) between baseline and 3 months while the older cohort improved from 3 to 6 months (QoD-NS: p=0.027, SNOT-22: p=0.049). Both cohorts demonstrated similar significant improvement in olfactory function after 3 months of OT. The timeline of subjective improvement was different between cohorts, with younger patients experiencing earlier improvement.

Pelatihan Pembuatan Pupuk Organik Cair dari Kotoran Sapi sebagai Upaya Pengurangan Limbah di Desa Petiyintunggal, Kecamatan Dukun, Kabupaten Gresik

Petiyintunggal Village, located on the western border of Gresik Regency, is predominantly inhabited by farmers and livestock breeders. Cattle raising is a common side activity among the residents. The livestock farming in Petiyintunggal Village is managed traditionally, focusing primarily on the sale of fattened livestock for daily needs, without addressing the environmental impact of accumulated cow dung. To address these issues, the UNISDA 2024 Thematic Real Work Lecture team conducted counseling and training on processing cow dung into beneficial products, specifically liquid organic fertilizer. This training was held in Petiyintunggal Village, Dukun District, Gresik Regency, coordinated with local farmer groups and youth organizations (Karang Taruna). The primary objective was to enhance the community's capacity to produce liquid organic fertilizer as an alternative to chemical fertilizers, utilizing cow dung waste for sustainable farming practices. The training outcomes demonstrated a significant increase in participants' knowledge and skills, approximately 80%, in processing cow dung into liquid organic fertilizer, along with positive feedback and high enthusiasm from the participants.

WP6.14 - Automated analysis of operative video in surgical training: Scoping review

Abstract Aims There is an increasing availability of operative video for use in surgical training. Emerging technologies can now assess video footage and automatically generate metrics that could be harnessed to improve the assessment of operative performance. This scoping review explores the current application of automated video analytics in surgical training. Methods PubMed, Scopus, Web of Science and the Cochrane database were searched to identify studies which applied automated video analytics to trainee-performed operations. Search terms included ‘trainee’, ‘video analytics’ and ‘education’. Two reviewers independently screened and extracted data on the methods of analysis, metrics generated and application to training. The Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Review (PRISMA-ScR) guidelines were followed. Results Thirteen studies were identified. Computer vision tracking was the most common method of video analysis. Metrics were generated for processes (e.g. movement of instruments) and outcomes (e.g. intraoperative phase duration). Two studies generated metrics to assess critical safety elements (e.g. critical view of safety in laparoscopic cholecystectomy). Automated metrics were able to differentiate between different skill levels (e.g. consultant vs. trainee) and correlated with traditional methods of assessment. There was a lack of longitudinal application to training and only one qualitative study reported the experience of trainees using automated video analytics. Conclusion Automated video analytics is an emerging field which provides an objective assessment of operative performance. Gathering evidence to demonstrate the impact of long-term use on training outcomes is a priority for future research.

Adaptive decision-making with deep Q-network for heterogeneous unmanned aerial vehicle swarms in dynamic environments

With the continuous advancement of Unmanned Aerial Vehicle (UAV) swarm technology, the field of adaptive decision-making for heterogeneous UAV swarms across a spectrum of tasks is rapidly emerging as a focal point of research. This domain holds significant importance for enhancing the operational efficiency and responsiveness of UAV swarms in complex and dynamic environments. This paper addresses this challenge by introducing an innovative adaptive task decision-making method, which leverages Deep Q-Network (DQN) algorithms, specifically tailored to meet the unique requirements of heterogeneous UAV swarms. We initially construct a mathematical model that transforms the intricate swarm decision-making issues into a standard Markov Decision Process (MDP), and meticulously design the state space, action space, reward function, and state transition function to cater to the decision-making needs of UAV swarms. Utilizing this model, we further integrate a hybrid experience replay mechanism, coupled with DQN algorithms for offline training, enabling the efficient transformation of training outcomes into a network model that is directly applicable to real-time online decision-making. This approach markedly enhances the decision-making adaptability and dynamic adaptability of UAV swarms when confronted with a variety of tasks. During the offline training phase, we also employ a hybrid experience replay mechanism and target network approximation techniques to bolster the network's stability and training efficiency, ensuring high reliability in online decision-making. Comparative simulations with existing DQN algorithms reveal the distinct superiority of our method in addressing adaptive task decision-making challenges. Moreover, through 1000 comprehensive simulation experiments, we further validate the stability and effectiveness of our method across diverse task environments, providing a solid theoretical foundation and technical support for the practical application and proliferation of UAV swarm technology.

Implementation of the psycho-existential symptom assessment scale in palliative care: Qualitative analysis of stakeholders perspectives

ObjectivesTo explore 1) perspectives of feasibility, acceptability, integration and sustainability of the Psycho-existential Symptom Assessment Scale (PeSAS); 2) barriers and benefits of PeSAS in its real-world performance; and 3) clinician confidence and perceived competency in using PeSAS. MethodsThirty-one key stakeholders from nine palliative care services who participated in the implementation of the PeSAS were purposefully sampled and participated in semi-structured interviews. Data was managed using the Determinants Framework. ResultsBenefits of PeSAS were a common language enhancing communication, identifying symptoms of psycho-existential distress, initiating referral, providing acknowledgement for previously unrecognised distress and enhancing patient agency. Key barriers were the availability of skilled clinicians, patient characteristics such as delirium and phase of illness, avoidance of confronting end-of-life conversations, information technology resourcing, and reduced engagement due to language, culture and health literacy. ConclusionScreening using the PeSAS is feasible and acceptable once clinicians are adequately trained to administer it. Our study highlights the benefits of qualitative enquiry in developing and implementing new interventions. Practice ImplicationsThe identification and management of psycho-existential symptoms should be part of routine practice in palliative care. However, adequate staff training, resourcing, referral pathways and implementation process and outcome assessments are important to ensure sustainability.

Psychological needs, self-efficacy, motivation, and resistance training outcomes in a 16-week barbell training program for adults.

Despite extensive research on the relationship between psychological factors and aerobic training, there remains a gap in understanding these relationships within resistance training (RT), particularly barbell-based RT. This study aimed to examine the associations between basic psychological needs, behavioral regulation, self-efficacy, and a longitudinal barbell-based RT program for adults. Forty-three adults (M age = 45.09 ± 10.72) were recruited from the Competitive Edge resistance training program at a medical fitness center in Northwest Montana. The study followed an 18-week schedule: 8 weeks of training, 1 week of active recovery, and 8 additional weeks of training. The results reveal several significant findings. First, the basic psychological need for competence significantly increased from baseline (M = 5.06) to post-program (M = 5.30), (p = 0.017). Second, the composite score of the BREQ-3 significantly predicting muscular strength improvements in the deadlift (β = 3.64, p = 0.039). Third, both mastery (p = 0.021) and resilience (p = 0.007) self-efficacy subscales increased from baseline to post-program. Fourth, exploratory analyses indicated that the reasons to exercise scale predicted increases in muscular endurance with the weight management (β = 10.016, p = 0.046) and solitude (β = 6.792, p = 0.037) subscales. These findings highlight the importance of psychological factors in predicting strength outcomes and muscular endurance, suggesting that psychological interventions may complement physical training to maximize benefits. This research contributes valuable insights into how psychological factors influence training outcomes, potentially guiding future interventions and program designs to better support strength development and endurance in resistance training contexts.

How to deliver gender diversity education to men: Training algorithms to the rescue

AbstractGender diversity training is typically provided to mix‐gender audiences. This one‐size‐fits‐all approach may be suboptimal because information about gender bias and inequity is often received differently along gender lines: men are less likely than women to believe it. We argue for tailoring gender diversity training via implementing segmentation and tailoring algorithms in training systems. To develop our theorizing, we integrate a learner‐centric approach to diversity training with principles of jiu jitsu persuasion theory. This leads us to test a new approach to diversity training that involves dynamic adaptation and tailoring the training to learners. Specifically, we first identify two distinct segments of men—believers and skeptics—and develop a user‐friendly segmentation algorithm that segments men, in real time, using only five items (Study 1). We then use the algorithm to assign segments of men trainees to tailored or non‐tailored training and show that presenting skeptic men with a tailored message improves training reactions and increases intentions to support gender diversity efforts (Study 2). Thus, we show that dynamic adaptation and tailoring successfully explain training outcomes, particularly for trainees who are skeptical of the diversity message. Practically, our study demonstrates the functionality and value of segmentation algorithms for organizations' training systems.

Development of Sand Court Training Program to Enhance Physical Fitness and Skills in Novice Badminton

Background and Aims: The creation of a sand court training program presents a special chance for inexperienced badminton players to improve their abilities and physical condition. Because sand offers resistance, players must move and footwork with more effort, which increases their agility and endurance. The uneven surface also forces players to hone their technique, which improves balance and coordination—two skills necessary for winning the game. Thus, this study aims to investigate the effects of sand court training programs on the physical fitness and skills of novice badminton students, particularly in comparison to traditional synthetic court training. Methodology: The sample group consisted of 10 first-year students from Guangdong University of Business Studies, comprising 5 males and 5 females, all of whom had no prior experience in badminton training. Purposive sampling was employed to ensure participants had consistent backgrounds in badminton skill training. The primary tool utilized in this study was a sand court badminton training plan designed by experts, rather than questionnaire surveys. T-test statistical analysis was employed to analyze participants' physical fitness and skill test results before and after the training. Results: After 8 weeks of sand court training, participants showed significant improvements in both physical fitness (including balance, endurance, explosiveness, flexibility, and speed) and badminton skills (including serving accuracy, smashing accuracy, blocking accuracy, footwork, and defense). In comparison to traditional synthetic court training, sand court training provided participants with more challenges and better training outcomes. Conclusion: This study demonstrates that sand court training effectively enhances the physical fitness and badminton skills of beginners. Therefore, compared to traditional synthetic court training, sand court training offers superior training effects, providing a new perspective on badminton training methods and highlighting the potential value of incorporating sand court training into training programs.

Impact of Panvascular Disease on Exercise Capacity and Clinical Outcomes in Patients with Heart Failure with Reduced Ejection Fraction

BackgroundThe aim of this study was to assess the impact of panvascular disease (PVD) on quality of life (QOL), exercise capacity, and clinical outcomes, in patients with heart failure (HF) with reduced ejection fraction (HFrEF). MethodsWe performed a post hoc analysis of the Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION; NCT00047437). Patients with PVD were defined as those having coronary heart disease, stroke, or peripheral vascular disease at baseline. Multivariable Cox proportional hazard models were constructed to evaluate the effect of PVD on the primary endpoint (all-cause mortality or hospitalization) and secondary endpoints (all-cause mortality, cardiovascular (CV) mortality or CV hospitalization, and CV mortality or HF hospitalization). Generalized estimating-equation models were constructed to evaluate the effect of PVD on QOL (Kansas City Cardiomyopathy Questionnaire score) and exercise capacity (peak oxygen consumption and 6-minute walk test distance). ResultsOf 2119 patients with chronic HFrEF, 1202 (56.7%) had comorbid PVD. PVD was associated significantly with reduced exercise capacity (P < 0.001). Patients with PVD had a higher risk of all-cause mortality or hospitalization (hazard ratio [HR] 1.15, 95% confidence interval [CI]: 1.02-1.29), CV mortality or CV hospitalization (HR 1.22, 95% CI: 1.07-1.39), and CV mortality or HF hospitalization (HR 1.25, 95% CI: 1.05-1.48), compared with the risk for patients without PVD. Aerobic exercise training did not significantly improve the prognosis of HFrEF patients, in either the PVD or the non-PVD subgroups. ConclusionsPVD may adversely affect the QOL, exercise capacity, and prognosis of patients with chronic HFrEF.

Focus on proficiency levels is necessary when virtual reality simulator software is updated–a randomized trial

BackgroundVirtual reality simulators are an integral part of modern surgical training and allow novice surgeons to acquire basic laparoscopic skills that are transferable to the operation room without compromising patient safety. The gold standard training method is proficiency-based training, where all trainees practice until a pre-defined proficiency level is reached. Simulator software versions are regularly updated to increase the quality of the simulator experience, but the impact of software updates used in conjunction with existing proficiency levels is unknown. MethodsTwenty surgical novices were randomized to simulator training on the LapSim® virtual reality simulator using either a 2019-version (new software group) or a 2016-version (old software group) of the simulator software. All participants practiced until reaching the proficiency level established for the old software. After 3-5 weeks, all participants returned and practiced to proficiency again using the old software. ResultsThe mean time to proficiency for the new software group was 183 minutes (SD: 43) versus 285 minutes (SD: 26) for the old software group (p<0.001). During the follow-up test, participants from the new software group spent 189 minutes (SD: 61) versus 91 minutes (SD: 50) (p=0.001) for the old software group to reach proficiency again. ConclusionUpdating simulator software without updating the proficiency levels creates the risk of changing the amount of training necessary to reach proficiency. Updates of simulator software for virtual reality simulators must lead to a critical re-evaluation of the previously established proficiency levels to ensure optimal outcomes of simulation-based training.

Development and Implementation of a Novel Emergency Department Based Procedure Team for Inpatient Hospital Procedures

BackgroundEmergency medicine (EM) demands proficiency in a broad set of procedural skills for emergency physicians (EPs). However, there is a literature gap on integrating EM expertise into procedure teams, especially in inpatient settings ObjectivesThis study aims to outline the development and implementation of a novel ED-based procedure team for inpatient care MethodsThis retrospective study conducted between June 6, 2022 and December 31, 2023, describes the development and implementation of an ED-based procedure team. Key procedures included central lines, arterial lines, and non-tunneled dialysis catheters, with specific guidelines to ensure safety and consistency ResultsDuring the study, the procedure team conducted 525 procedures. Midline insertions and paracentesis were the most common. The team performed an average of 27.3 procedures per month. Additional provider hours needed to complete the procedures averaged 4.8 per month and showed a trend toward stabilization over time. Financially, the team secured reimbursements for 516 cases at $98 per case, observing a positive trend in gross payments ConclusionsThe ED Procedure team has played a pivotal role in delivering essential bedside procedures for the patient, demonstrating improvements in provider proficiency, resident training, and favorable revenue outcomes. The interdepartmental collaborative and well-coordinated efforts have ensured the timely completion of necessary procedures.

UIEDP: Boosting underwater image enhancement with diffusion prior

Underwater image enhancement (UIE) aims to generate clear images from low-quality underwater images. Due to the unavailability of clear reference images, researchers often synthesize them to construct paired datasets for training deep models. However, these synthesized images may sometimes lack quality, adversely affecting training outcomes. To address this issue, we propose to boost UIE with Diffusion Prior (UIEDP). It is a novel framework treating UIE as a posterior distribution sampling process of clear images conditioned on degraded underwater inputs. Specifically, UIEDP combines a pre-trained diffusion model capturing natural image priors with any existing UIE algorithm, leveraging the latter to guide conditional generation. The diffusion prior mitigates the drawbacks of inferior synthetic images, resulting in higher-quality image generation. Extensive experiments have demonstrated that our UIEDP yields significant improvements across various metrics, especially no-reference image quality assessment. And the generated enhanced images also exhibit a more natural appearance.

Training effectiveness evaluation: Advancing a Kirkpatrick model based composite framework

The present study aims at ideating a quantitative protocol to evaluate effectiveness of training programmes especially meant for farmers, farm women, and rural youth. The specific objective was to develop a robust framework for measuring the effectiveness of rural training programmes organized by the Farmers Training Centres (FTCs) of India. Kirkpatrick’s training evaluation model provides us the foundation to design a four-dimensional composite framework based on range-based indicator normalization, principal component analysis based indicator weight estimation, and rank correlation based framework sensitivity testing. We used cross-sectional primary data generated through household survey and personal interviews with randomly selected one thousand trainees to test and validate our proposed protocol. Applying it on our evaluation target we find that the degree of effectiveness of the training programmes varies; one in every four training programmes may not be effective. Trainees’ reactions on various aspects of the training programmes may have positive and significant influence on learning. Training outcomes may be linked with the trainees’ post-training changes in behaviour. A sensitivity test confirms that the proposed framework is not susceptible to changes in weighting schemes, implying robustness of indicator selection. The findings offer dissection of individual training programmes guiding policy decisions for a training organization. The proposed framework enriches the Kirkpatrick’s training evaluation model by offering standardized indicators for training effectiveness evaluation.

Outcomes of the Iluko orthography trainings as an extension activity of the college of teacher education

Outcomes of the Iluko orthography trainings as an extension activity of the college of teacher education

Comparison of intelligent virtual reality first-aid training outcomes among individuals with different demographic characteristics.

To compare the outcomes of intelligent first-aid training based on virtual reality (VR) among individuals with different demographic characteristics. A total of 50 nonmedical professional volunteers from Nanchang were conveniently sampled in March 2021. All participants underwent intelligent VR first-aid training, and a comparative analysis was conducted by dividing them into different groups based on demographic characteristics. Male participants had a lower chest compression interruption time compared to female participants (7.40 ± 0.50 vs. 8.04 ± 0.56, t = -4.231, p < 0.001). Additionally, male participants had a higher proportion of compressions with correct compression depth (81.33 ± 1.24 vs. 79.78 ± 1.48, t = 4.038, p < 0.001), higher mean ventilation volume (518.11 ± 1.50 vs. 516.61 ± 2.17, t = 2.881, p = 0.006), and higher theoretical knowledge test score (8.74 ± 0.59 vs. 8.00 ± 0.43, t = 4.981, p < 0.001). There were statistically significant differences in the mean chest compression frequency (110.38 ± 5.74 vs. 105.00 ± 4.78 vs. 107.80 ± 5.97, F = 5.187, p = 0.009) among participants with different educational backgrounds. Pairwise comparisons showed that technical degree holders had a higher mean chest compression frequency than bachelor's degree holders, whereas no statistically significant difference was observed between master's degree holders and bachelor's degree holders. The outcomes of first-aid training differ among participants of different genders and with different educational backgrounds. With all participants meeting the training qualifications, it is believed that the application of intelligent VR first-aid training platforms can improve the first aid capabilities of the public.

Strengthening Islamic Education Leadership: An Analysis of School-Based Management Training Follow-up Programs

This study explains the approaches used by the Institute for Research and Community Development Studies in School-Based Management (SBM) training for Islamic elementary schools in Magelang Regency. The data in this qualitative study were collected through observation techniques, interviews, and document studies obtained from training facilitators, principals, supervisors, school boards, and training organizing committees. Furthermore, the data were analyzed using qualitative techniques. The results of the study show that the leadership enculturation approach was used in training to strengthen the leadership of Islamic elementary schools. The leadership enculturation approach was adjusted to the stages of SBM training as follows: 1) Partnership leadership enculturation was used to strengthen school leadership in preparing follow-up plans after SBM training. 2) Mentoring collaborative leadership enculturation was used to strengthen school leadership in schools’ action implementation. 3) Evaluative leadership enculturation was used to strengthen school leadership in measuring and assessing the training process, training outcomes, and the impact of change on schools. The school leadership enculturation approach adjusted to the training stages can be used to ensure the implementation of SBM in schools after training.

How do care workers learn to care for people with dementia living in care homes? A model of informal learning

Purpose This paper describes a model of “Learning to care” derived from a study exploring how care workers in care homes learn to care for people living with dementia. The “Learning to care” model is primarily informal in nature in which influences such as formalised training and organisational culture impact care outcomes indirectly rather than directly. Design/methodology/approach This study used a focused, critical ethnographic approach in two care homes in England resulting in 63 h of observation of care of people living with advanced dementia, 15 semi-structured interviews and 90 in-situ ethnographic interviews with care staff. Findings The findings reveal a three-level model of learning to care. At the level of day-to-day interactions is a mechanism for learning that is wholly informal and follows the maxim “What Works is What Matters”. Workers draw on resources and information within this process derived from their personal experiences, resident influences and care home cultural knowledge. Cultural knowledge is created through a worker’s interactions with colleagues and the training they receive, meaning that these organisational level influences affect care practice only indirectly via the “What Works is What Matters” mechanism. Originality/value This study makes an original contribution by explaining the nature of day-to-day informal learning processes as experienced by care workers and those living with dementia in care homes. In particular, it illuminates the specific mechanisms by which organisational culture has an effect on care practice and the limitations of formal training in influencing such practice.