Post-training Performance Research Articles

A Multimodal Intervention Improves Postanesthesia Care Unit Handovers.

Failures of communication are a major contributor to perioperative adverse events. Transitions of care may be particularly vulnerable. We sought to improve postoperative handovers. We introduced a multimodal intervention in an adult and a pediatric postanesthesia care unit (PACU) to improve postoperative handovers between anesthesia providers (APs) and PACU registered nurses (RNs). The intervention included a standardized electronic handover report form, a didactic webinar, mandatory simulation training focused on improving interprofessional communication, and post-training performance feedback. Trained, blinded nurse observers scored PACU handovers during 17 months using a structured tool consisting of 8 subscales and a global score (1-5 scale). Multivariate logistic regression assessed the effect of the intervention on the proportion of observed handovers receiving a global effectiveness rating of ≥3. Four hundred fifty-two clinicians received the simulation-based training, and 981 handovers were observed and rated. In the adult PACU, the estimated percentages of acceptable handovers (global ratings ≥3) among AP-RN pairs, where neither received simulation-based training (untrained dyads), was 3% (95% confidence interval, 1%-11%) at day 0, 10% (5%-19%) at training initiation (day 40), and 57% (33%-78%) at 1-year post-training initiation (day 405). For AP-RN pairs where at least one received the simulation-based training (trained dyads), these percentages were estimated to be 18% (11%-28%) and 68% (57%-76%) on days 40 and 405, respectively. The percentage of acceptable handovers was significantly greater on day 405 than it was on day 40 for both untrained (P < 0.001) and trained dyads (P < 0.001). Similar patterns were observed in the pediatric PACU. Three years later, the unadjusted estimate of the probability of an acceptable handover was 87% (72%-95%) in the adult PACU and 56% (40%-72%) in the pediatric PACU. A multimodal intervention substantially improved interprofessional PACU handovers, including those by clinicians who had not undergone formal simulation training. An effect appeared to be present >3 years later.

Hedges as a Task-Based Training for Composition-Industrial Students

This research article would turn over an attempt made to investigate why certain composition students could not interact with employing some hedging structures (usually defined as claim-mitigating markers). This inability would negatively affect developing confidence required to enhancing written and oral communication when using English with others. Two main reasons behind the students’ inability to use most of the types of hedging structures have been found out to be their failure to recognize the hedge functional constrains due to the issue that hedges are not incorporated as an essential subject in their composition textbooks and the focus of teaching them has been on their syntactic and semantic functions—not on their pragmatic one. This situation has cogently been supported by means of further research and analyzing the students’ performance reflected on their academic quizzes. This article would also subsume a suggestive methodology given to a sample of Jubail-Industrial-College students to cope with hedging structures where they received condensed training dealing with defining hedges, usage motivation, and a concise taxonomy under the power of a blend of socio-pragmatic strategies. The training would be found to reflect a positive feedback confirmed by the analysis of their post-training performance which has revealed some improvement. Practical recommendations would follow the findings, which could be up for discussion.

Training to improve manual control in 7–8 and 10–12 year old children: Training eliminates performance differences between ages

Many children have difficulty producing movements well enough to improve in perceptuo-motor learning. We have developed a training method that supports active movement generation to allow improvement in a 3D tracing task requiring good compliance control. We previously tested 7–8year old children who exhibited poor performance and performance differences before training. After training, performance was significantly improved and performance differences were eliminated. According to the Dynamic Systems Theory of development, appropriate support can enable younger children to acquire the ability to perform like older children. In the present study, we compared 7–8 and 10–12year old school children and predicted that younger children would show reduced performance that was nonetheless amenable to training. Indeed, the pre-training performance of the 7–8year olds was worse than that of the 10–12year olds, but post-training performance was equally good for both groups. This was similar to previous results found using this training method for children with DCD and age-matched typically developing children. We also found in a previous study of 7–8year old school children that training in the 3D tracing task transferred to a 2D drawing task. We now found similar transfer for the 10–12year olds.

Learning to predict is spared in mild cognitive impairment due to Alzheimer's disease.

Learning the statistics of the environment is critical for predicting upcoming events. However, little is known about how we translate previous knowledge about scene regularities to sensory predictions. Here, we ask whether patients with mild cognitive impairment due to Alzheimer's disease (MCI-AD) that are known to have spared implicit but impaired explicit recognition memory are able to learn temporal regularities and predict upcoming events. We tested the ability of MCI-AD patients and age-matched controls to predict the orientation of a test stimulus following exposure to sequences of leftwards or rightwards oriented gratings. Our results demonstrate that exposure to temporal sequences without feedback facilitates the ability to predict an upcoming stimulus in both MCI-AD patients and controls. Further, we show that executive cognitive control may account for individual variability in predictive learning. That is, we observed significant positive correlations of performance in attentional and working memory tasks with post-training performance in the prediction task. Taken together, these results suggest a mediating role of circuits involved in cognitive control (i.e. frontal circuits) that may support the ability for predictive learning in MCI-AD.

Impact of a simulation training curriculum on technical and nontechnical skills in colonoscopy: a randomized trial

GI endoscopy simulation-based training augments early clinical performance; however, the optimal manner by which to deliver training is unknown. We aimed to validate a simulation-based structured comprehensive curriculum (SCC) designed to teach technical, cognitive, and integrative competencies in colonoscopy. Single-blinded, randomized, controlled trial. Endoscopic simulation course at an academic hospital. Thirty-three novice endoscopists were allocated to an SCC group or self-regulated learning (SRL) group. The SCC group received a curriculum consisting of 6 hours of didactic lectures and 8 hours of virtual reality simulation-based training with expert feedback. The SRL group was provided a list of desired objectives and was instructed to practice on the simulator for an equivalent time (8 hours). Clinical transfer was assessed during 2 patient colonoscopies using the Joint Advisory Group Direct Observation of Procedural Skills (JAG DOPS) scale. Secondary outcome measures included differences in procedural knowledge, immediate post-training simulation performance, and delayed post-training (4-6 weeks) performance during an integrated scenario test on the JAG DOPS communication and integrated scenario global rating scales. There was no significant difference in baseline or post-training performance on the simulator task. The SCC group performed superiorly during their first and second clinical colonoscopies. Additionally, the SCC group demonstrated significantly better knowledge and colonoscopy-specific performance, communication, and global performance during the integrated scenario. We were unable to measure SRL participants' effort outside of mandatory training. In addition, feedback metrics and number of available simulation cases are limited. These results support integration of endoscopy simulation into a structured curriculum incorporating instructional feedback and complementary didactic knowledge as a means to augment technical, cognitive, and integrative skills acquisition, as compared with SRL on virtual reality simulators. ( NCT01991522.)

Feedback valence affects auditory perceptual learning independently of feedback probability.

Previous studies have suggested that negative feedback is more effective in driving learning than positive feedback. We investigated the effect on learning of providing varying amounts of negative and positive feedback while listeners attempted to discriminate between three identical tones; an impossible task that nevertheless produces robust learning. Four feedback conditions were compared during training: 90% positive feedback or 10% negative feedback informed the participants that they were doing equally well, while 10% positive or 90% negative feedback informed them they were doing equally badly. In all conditions the feedback was random in relation to the listeners’ responses (because the task was to discriminate three identical tones), yet both the valence (negative vs. positive) and the probability of feedback (10% vs. 90%) affected learning. Feedback that informed listeners they were doing badly resulted in better post-training performance than feedback that informed them they were doing well, independent of valence. In addition, positive feedback during training resulted in better post-training performance than negative feedback, but only positive feedback indicating listeners were doing badly on the task resulted in learning. As we have previously speculated, feedback that better reflected the difficulty of the task was more effective in driving learning than feedback that suggested performance was better than it should have been given perceived task difficulty. But contrary to expectations, positive feedback was more effective than negative feedback in driving learning. Feedback thus had two separable effects on learning: feedback valence affected motivation on a subjectively difficult task, and learning occurred only when feedback probability reflected the subjective difficulty. To optimize learning, training programs need to take into consideration both feedback valence and probability.

Influencing factors for the performance of trainees after hands-on training of endoscopic retrograde cholangiopancreatography

To evaluate the performance of trainees after finishing hands-on training of endoscopic retrograde cholangiopancreatography (ERCP) at our hospital. Questionnaire was distributed to 46 trainees of ERCP training over the past 5 years. And the effects of training duration, case volume and hospital facilities on ERCP performance were examined. A total of 41 valid questionnaires (89.1%) were retrieved. And 34 trainees (82.9%) worked at tertiary medical centers. The mean training duration was 8.9 months. Compared with trainees with less annual ERCP volume (TL) (< 4 cases per month, n = 23), trainees with more volume (TM) (≥ 4 cases per month, n = 18) had a higher rate of successful cannulation and precut by a needle knife (both P < 0.05). More endoscopists could perform ERCP and more duodenoscopes were stocked at hospitals of TM compared with TL (both P < 0.05). The results of trainee self-evaluation showed that the major influencing factors of post-training ERCP performance were hospital supports, handling capacity and case volume. After hands-on training, the trainee performance of ERCP is influenced by such multiple factors as handling capacity and hospital supports, etc.

The effects of aquatic trunk exercise on gait and muscle activity in stroke patients: a randomized controlled pilot study.

[Purpose] The purpose of this study was to investigate the relationship between muscle activity and gait function following aquatic trunk exercise in hemiplegic stroke patients. [Subjects and Methods] This study’s participants included thirteen hemiplegic patients (ten males and three females). The aquatic therapy consisted of administering concentrative aquatic therapy for four weeks in a therapeutic pool. Gait parameters were measured using a gait analysis system adjusted to each subject’s comfortable walking speed. Electromyographic signals were measured for the rectus abdominis, external abdominal oblique, transversus abdominis/internal-abdominal oblique, and erector spine of each patients. [Results] The pre- and post-training performances of the transversus abdominis/internal-abdominal oblique were compared statistically. There was no statistical difference between the patients’ pre- and post-training values of maximal voluntary isometric contraction of the rectus abdominis, but the external abdominal oblique values tended to improve. Furthermore, gait factors improved significantly in terms of walking speeds, walking cycles, affected-side stance phases, affected-stride lengths, and stance-phase symmetry indices, respectively. [Conclusion] These results suggest that the trunk exercise during aquatic therapy may in part contribute to clinically relevant improvements in muscle activities and gait parameters.

Effects of user training with electronically-modulated sound transmission hearing protectors and the open ear on horizontal localization ability

Objective: To determine if training with electronically-modulated hearing protection (EMHP) and the open ear results in auditory learning on a horizontal localization task. Design: Baseline localization testing was conducted in three listening conditions (open-ear, in-the-ear (ITE) EMHP, and over-the-ear (OTE) EMHP). Participants then wore either an ITE or OTE EMHP for 12, almost daily, one-hour training sessions. After training was complete, participants again underwent localization testing in all three listening conditions. A computer with a custom software and hardware interface presented localization sounds and collected participant responses. Study sample: Twelve participants were recruited from the student population at Virginia Tech. Audiometric requirements were 35 dBHL at 500, 1000, and 2000 Hz bilaterally, and 55 dBHL at 4000 Hz in at least one ear. Results: Pre-training localization performance with an ITE or OTE EMHP was worse than open-ear performance. After training with any given listening condition, including open-ear, performance in that listening condition improved, in part from a practice effect. However, post-training localization performance showed near equal performance between the open-ear and training EMHP. Auditory learning occurred for the training EMHP, but not for the non-training EMHP; that is, there was no significant training crossover effect between the ITE and the OTE devices. Conclusion: It is evident from this study that auditory learning (improved horizontal localization performance) occurred with the EMHP for which training was performed. However, performance improvements found with the training EMHP were not realized in the non-training EMHP. Furthermore, localization performance in the open-ear condition also benefitted from training on the task.

Practice improves performance on a coronary anastomosis simulator, attending surgeon supervision does not

Enthusiasm for simulation early in cardiothoracic surgery training is growing, yet evidence demonstrating its utility is limited. We examined the effect of supervised and unsupervised training on coronary anastomosis performance in a randomized trial among medical students. Forty-five medical students were recruited for this single-blinded, randomized controlled trial using a low-fidelity simulator. After viewing an instructional video, all participants attempted an anastomosis. Subsequently, the participants were randomized to 1 of 3 groups: control (n=15), unsupervised training (n=15), or supervised training with a cardiothoracic surgeon or fellow (n=15). Both the supervised and unsupervised groups practiced for 1 hour per week. After 4 weeks, the participants repeated the anastomosis. All pre- and posttraining performances were videotaped and rated independently by 3 cardiothoracic surgeons blinded to the randomization. All raters scored 13 assessment items on a 1 to 5 (low-high) scale along with an overall pass/fail rating. After the training period, all 3 groups showed significant improvements in composite scores (control: +0.52 ± 0.69 [P=.014], unsupervised: +1.05 ± 0.48 [P<.001], and supervised: +1.10 ± 0.84 [P<.001]). Compared with control group, both supervised (P=.005) and unsupervised trainees (P=.005) demonstrated a significant improvement. Between the supervised and unsupervised groups there were no statistically significant differences in composite scores. Practice on low-fidelity simulators enabled trainees to improve on a broad range of skills; however, the additional effect of attending-level supervision is limited. In an era of increasing staff surgeon responsibilities, unsupervised practice may be sufficient for inexperienced trainees.

A Comparative Effect of Soccer Training in Small Playfield and Regular Official Size Playfield in the Selected Physical Fitness Parameters

The purpose of the present study was to determine the effect of training in small size playfield and regular official size playfield in the selected physical fitness parameters. Sixty-six districts level male soccer players (age 17-25) of Assam were divided into three unequated group in equal number. Two experimental groups, Group-A and Group-B had gone through the 12 weeks training programme consist of general conditioning, techno-tactical (special conditioning) training and game practice progressively for two- and half-hour par day, five days per week in Small Playfield (SP) and Regular Official Size Playfield (ROSP) respectively and Control Group-C did not participate to any special training programme. The selected physical fitness parameters were measured before and immediately after completion of the training progrmme. To find out the pre and post training performance and significance differences among the groups the collected data were analyzed statistically through T-test, Analysis of Variance (ANOVA) and Analysis of Co-variance (ANCOVA). The level of significance was observed at 0.05 level of confidence. The finding shows that the selected physical fitness parameters (Speed, t= 8.10 > 2.08; Explosive Leg Strength, t= 3.49 > 2.08); Agility, t= 3.22 > 2.08; Eye-leg Coordination, t= 3.60 > 2.08; Cardiovascular Endurance, t= 5.76 > 2.08) of Group-A (SP) were improved significantly. In case of Group- B (ROSP) there were significant improvement of Speed (t= 6.49 > 2.08), Explosive Leg Strength (t= 2.87 > 2.08), and Cardiovascular Endurance (t=7.94 > 2.08). There also significant differences were found between pre-test and post-test means of composite scores of selected physical fitness parameters in both the experimental group A and B (t= 6.81 and 6.53 > 2.08). Insignificant difference was found in the pre-test means of three selected groups as the obtained F-value of 0.072 is less than that of tabulated F-value of 3.144 for the d.f. of 2/63 at 0.05 level and significant difference was found in the post-test means and adjusted means of three selected groups as the F-Value 32.10 and 181.256 are quite higher than the tabulated F-value of 3.144 and 3.146 respectively at 0.05 level of confidence.

Immediate effects of alpha/theta and sensory-motor rhythm feedback on music performance

This is one of a series of investigations comparing two EEG-neurofeedback protocols – Alpha/theta (A/T) and Sensory-Motor Rhythm (SMR) – for performance enhancement in the Arts, here with the focus on music. The original report (Egner and Gruzelier, 2003) established a beneficial outcome for elite conservatoire musicians following A/T training in two investigations. Subsequently this A/T advantage was replicated for both advanced instrumental and novice singing abilities, including improvisation, while SMR training benefited novice performance only (Gruzelier, Holmes et al., 2014). Here we report a replication of the latter study in university instrumentalists who as before were novice singers with one design change — post-training performances were conducted within the tenth final session instead of on a subsequent occasion. As before expert judges rated the domains of Creativity/Musicality, Communication/Presentation and Technique. The proximity to training of the music performances within the last session likely compromised gains from A/T learning, but perhaps reinforced the impact of SMR training efficacy. In support of validation there was evidence of strong within- and across-session A/T learning and positive linear trends for across-session SMR/theta and SMR/beta-2 ratio learning. In support of mediation learning correlated with music performance. The A/T outcome was markedly discrepant from previous studies and should dispel any impression that the hypnogogic state itself is transferred to the performance context. The effects of SMR ratio training are consistent with an impact on lower-order abilities required in novice performance such as sustained attention and memory, and benefiting all three domains of music assessment.

Training Compliance Control Yields Improvements in Drawing as a Function of Beery Scores

Many children have difficulty producing movements well enough to improve in sensori-motor learning. Previously, we developed a training method that supports active movement generation to allow improvement at a 3D tracing task requiring good compliance control. Here, we tested 7–8 year old children from several 2nd grade classrooms to determine whether 3D tracing performance could be predicted using the Beery VMI. We also examined whether 3D tracing training lead to improvements in drawing. Baseline testing included Beery, a drawing task on a tablet computer, and 3D tracing. We found that baseline performance in 3D tracing and drawing co-varied with the visual perception (VP) component of the Beery. Differences in 3D tracing between children scoring low versus high on the Beery VP replicated differences previously found between children with and without motor impairments, as did post-training performance that eliminated these differences. Drawing improved as a result of training in the 3D tracing task. The training method improved drawing and reduced differences predicted by Beery scores.

A novel, online social cognitive training program for young adults with schizophrenia: A pilot study

BackgroundPervasive social cognition deficits are evident early in the course of schizophrenia and are directly linked to functional outcome, making them an important target for intervention. Here, we tested the feasibility of use, and initiated the evaluation of efficacy, of a novel, neuroplasticity-based online training program (SocialVille) in young adults with schizophrenia. MethodsSchizophrenia patients (n=17) completed 24 hours of online SocialVille game play either from home or at a clinic, over a 6–10 week period. We examined training feasibility, gains on the SocialVille exercises relative to matched healthy controls (n=17), and changes on measures of social cognition, social functioning, global functioning and motivation. ResultsSubjects adhered to training requirements, and rated SocialVille in the medium to high range in satisfaction, enjoyment, and ease of use. Subjects demonstrated significant, large improvements on the speeded SocialVille tasks, and small to moderate improvements on the working memory tasks. Post-training performance on the SocialVille tasks were similar to initial performance of the healthy controls. Subjects also showed improvements on standard measures of social cognition, social functioning, and motivation. No improvements were recorded for emotion recognition indices of the MSCEIT, or on quality of life scales. ConclusionThis study provides an initial proof of concept for online social cognition training in schizophrenia. This form of training demonstrated feasibility and resulted in within-subject gains in social functioning and motivation. This pilot study represents a first step towards validating this training approach; randomized controlled trials, now underway, are designed to confirm and extend these findings.

Supramodal processing optimizes visual perceptual learning and plasticity

Multisensory interactions are ubiquitous in cortex and it has been suggested that sensory cortices may be supramodal i.e. capable of functional selectivity irrespective of the sensory modality of inputs (Pascual-Leone and Hamilton, 2001; Renier et al., 2013; Ricciardi and Pietrini, 2011; Voss and Zatorre, 2012). Here, we asked whether learning to discriminate visual coherence could benefit from supramodal processing. To this end, three groups of participants were briefly trained to discriminate which of a red or green intermixed population of random-dot-kinematograms (RDKs) was most coherent in a visual display while being recorded with magnetoencephalography (MEG). During training, participants heard no sound (V), congruent acoustic textures (AV) or auditory noise (AVn); importantly, congruent acoustic textures shared the temporal statistics – i.e. coherence – of visual RDKs. After training, the AV group significantly outperformed participants trained in V and AVn although they were not aware of their progress. In pre- and post-training blocks, all participants were tested without sound and with the same set of RDKs. When contrasting MEG data collected in these experimental blocks, selective differences were observed in the dynamic pattern and the cortical loci responsive to visual RDKs. First and common to all three groups, vlPFC showed selectivity to the learned coherence levels whereas selectivity in visual motion area hMT+ was only seen for the AV group. Second and solely for the AV group, activity in multisensory cortices (mSTS, pSTS) correlated with post-training performances; additionally, the latencies of these effects suggested feedback from vlPFC to hMT+ possibly mediated by temporal cortices in AV and AVn groups. Altogether, we interpret our results in the context of the Reverse Hierarchy Theory of learning (Ahissar and Hochstein, 2004) in which supramodal processing optimizes visual perceptual learning by capitalizing on sensory-invariant representations — here, global coherence levels across sensory modalities.

Muscle quality index improves with resistance exercise training in older adults

IntroductionSarcopenia is currently best described as an age-related decline in skeletal muscle mass and function. However, no consensus exists as to how to best quantify muscle function in older adults. The muscle quality index (MQI) was recently recommended as an ideal evidence-based assessment of functional status in older adults. Nevertheless, the usefulness of MQI to assess physical function is limited by whether it is reflective of muscle qualitative changes to an intervention. Thus, the purpose of this investigation was to determine whether MQI changes in response to resistance exercise training and detraining and how such changes correspond to other recommended measures of physical function proposed by suggested definitions of sarcopenia. MethodsTwenty-five older adults (70.6±6.1y; BMI=28.1±5.4kg·m−2) completed a 6-week resistance training program in a wait-list controlled, cross-over design. MQI was determined as power output from timed sit to stand (STS), body mass, and leg length. Gait speed, hand grip strength, get-up-and-go and lean body mass (LBM) were evaluated before and after exercise training and detraining. MQI and functional changes to training and detraining were evaluated with repeated measures ANOVA and clinical interpretations of magnitude based inferences. ResultsShort term resistance training significantly and clinically improved MQI (203.4±64.31 to 244.3±82.92W), gait time (1.85±0.36 to 1.66±0.27s) and sit to stand performance (13.21±2.51 to 11.05±1.58s). Changes in LBM and hand grip strength were not significant or clinically meaningful. De-training for 6-weeks did not result in significant changes in any measure from post-training performance.

Improving Reading Strategy for Comprehension: ?Does Recall Compete with Working Memory Manipulation??

We investigated whether reading comprehension could be improved by strategic updating of working memory during reading, by providing upper elementary students with working memory consolidation training. We report data from ten fifth-grade students, half of which underwent strategic reading comprehension intervention. Response time data indicated that training in consolidating verbal information increased automaticity of recall. However, this improvement negatively correlated with post-training performance on Backward Digit Span, indicating possible tradeoffs between resource allocation toward the component of executive function moderating maintenance/recall, or toward the component moderating manipulation of working memory content

Set Shifting Training with Categorization Tasks

The very few cognitive training studies targeting an important executive function, set shifting, have reported performance improvements that also generalized to untrained tasks. The present randomized controlled trial extends set shifting training research by comparing previously used cued training with uncued training. A computerized adaptation of the Wisconsin Card Sorting Test was utilized as the training task in a pretest-posttest experimental design involving three groups of university students. One group received uncued training (n = 14), another received cued training (n = 14) and the control group (n = 14) only participated in pre- and posttests. The uncued training group showed posttraining performance increases on their training task, but neither training group showed statistically significant transfer effects. Nevertheless, comparison of effect sizes for transfer effects indicated that our results did not differ significantly from the previous studies. Our results suggest that the cognitive effects of computerized set shifting training are mostly task-specific, and would preclude any robust generalization effects with this training.

The effect of a skipped dose (placebo) of methylphenidate on the learning and retention of a motor skill in adolescents with Attention Deficit Hyperactivity Disorder

Individuals with Attention Deficit Hyperactivity Disorder (ADHD) have difficulties in achieving optimal performance in many everyday and academic tasks, deficits attributed to impaired skill acquisition and procedural memory consolidation. We tested the effect of a skipped dose of methylphenidate (MPH) on learning a movement sequence and its subsequent consolidation into procedural memory in adolescents with ADHD. A crossover double-blind design with placebo was used. Sixteen male adolescents, 16–18 years-old, with ADHD and taking MPH formulations on a daily basis, were trained on performing a 5-element sequence of finger-to-thumb opposition movements. Participants took part in two study conditions, 2 months apart. In each condition a different movement sequence was trained and tested. Participants trained on the task either with active medication or placebo on the day of training, crossed-over between study conditions. Learning effects, speed and accuracy, were assessed within-session, during a 24-h memory consolidation phase. Retention was tested by 2 weeks post-training. There were robust gains in performance both within-session and during the 24-h consolidation phase, in both conditions. However, the discontinuation of MPH on the day of training significantly reduced performance speed, with no loss of accuracy. By 2 weeks, post-training performance was comparable. Adolescents with ADHD who are treated daily but skip a dose of MPH show significant slowing of performance relative to their own performance on medication. However, on a background of daily treatment a skipped dose has no deleterious effect on memory consolidation and retention.

Performance Assessment Through Pre- and Post-training Evaluation of Continuing Medical Education Courses in Prevention and Management of Cardio-Vascular Diseases in Primary Health Care Facilities of Armenia

To assess the difference of pre- and post-training performance evaluation of continuing medical education (CME) courses in cardio-vascular diseases (CVD) management among physicians at primary health care facilities of Armenian regions we conducted an evaluation survey. 212 medical records were surveyed on assessment of performance before and after the training courses through a self-employed structured questionnaire. Analysis of survey revealed statistically significant differences (p < 0.05) in a number of variables: threefold increased recording of lipids and body mass index (p = 0.001); moderate increased recording of comorbidities and aspirin prescription (p < 0.012); eightfold increased recording of dyslipidemia management plan, twofold increased recording for CVD management plan and fivefold increased recording for CVD absolute risk (p = 0.000). Missing records of electrocardiography and urine/creatinine analyses decreased statistically significantly (p < 0.05). Statistically significant decrease was observed in prescription of thiazides and angiotensin receptor blockers/angiotensin converting enzyme inhibitors (p < 0.005), while prescription of statins and statins with diet for dyslipidemia management showed increased recording (p < 0.05). Similarly, we observed increased records for counseling of rehabilitation physical activity (p = 0.006). In this survey most differences in pre- and post-evaluation of performance assessment may be explained by improved and interactive training modes, more advanced methods of demonstration of modeling. Current findings may serve a basis for future planning of CME courses for physicians of remote areas facing challenges in upgrading their knowledge, as well as expand the experience of performance assessment along with evaluation of knowledge scores.