Post-training Scores Research Articles

Embodied conversational agents for multimodal automated social skills training in people with autism spectrum disorders

Social skills training, performed by human trainers, is a well-established method for obtaining appropriate skills in social interaction. Previous work automated the process of social skills training by developing a dialogue system that teaches social communication skills through interaction with a computer avatar. Even though previous work that simulated social skills training only considered acoustic and linguistic information, human social skills trainers take into account visual and other non-verbal features. In this paper, we create and evaluate a social skills training system that closes this gap by considering the audiovisual features of the smiling ratio and the head pose (yaw and pitch). In addition, the previous system was only tested with graduate students; in this paper, we applied our system to children or young adults with autism spectrum disorders. For our experimental evaluation, we recruited 18 members from the general population and 10 people with autism spectrum disorders and gave them our proposed multimodal system to use. An experienced human social skills trainer rated the social skills of the users. We evaluated the system’s effectiveness by comparing pre- and post-training scores and identified significant improvement in their social skills using our proposed multimodal system. Computer-based social skills training is useful for people who experience social difficulties. Such a system can be used by teachers, therapists, and social skills trainers for rehabilitation and the supplemental use of human-based training anywhere and anytime.

Will a Short Training Session Improve Multiple‐Choice Item‐Writing Quality by Dental School Faculty? A Pilot Study

Faculty members are expected to write high-quality multiple-choice questions (MCQs) in order to accurately assess dental students' achievement. However, most dental school faculty members are not trained to write MCQs. Extensive faculty development programs have been used to help educators write better test items. The aim of this pilot study was to determine if a short workshop would result in improved MCQ item-writing by dental school faculty at one U.S. dental school. A total of 24 dental school faculty members who had previously written MCQs were randomized into a no-intervention group and an intervention group in 2015. Six previously written MCQs were randomly selected from each of the faculty members and given an item quality score. The intervention group participated in a training session of one-hour duration that focused on reviewing standard item-writing guidelines to improve in-house MCQs. The no-intervention group did not receive any training but did receive encouragement and an explanation of why good MCQ writing was important. The faculty members were then asked to revise their previously written questions, and these were given an item quality score. The item quality scores for each faculty member were averaged, and the difference from pre-training to post-training scores was evaluated. The results showed a significant difference between pre-training and post-training MCQ difference scores for the intervention group (p=0.04). This pilot study provides evidence that the training session of short duration was effective in improving the quality of in-house MCQs.

Recovery-based Training in Mental Health: Effects on Staff Knowledge and Attitudes to Recovery

ABSTRACTThis longitudinal study describes the effects of recovery-based training on staff knowledge and attitudes to recovery. Mental health staff (n = 101) completed the study questionnaire (the Recovery Knowledge Inventory (RKI-20) and Recovery Attitudes' Questionnaire (RAQ-16)) before training and after six months. On the RKI, significant changes between pre- and post-training scores (p < 0.01) were found. On the RAQ, the scores showed significant changes in Factors 1 (p < 0.001) and 2 (p < 0.009). The results indicate a significant difference in confidence using a recovery model of care following training suggesting that recovery-based training positively affects staff knowledge and attitudes to recovery overall.

Rape Aggression Defense: Unique Self-Efficacy Benefits for Survivors of Sexual Trauma.

Self-defense training is consistently linked to psychological benefits for survivors of sexual trauma, yet little is known about how training may uniquely benefit survivors compared with their nonsurvivor peers enrolled in the same course. Path analysis was used to examine how history of sexual trauma impacts pre- and post-training scores on three domains of self-efficacy using a national sample of Rape Aggression Defense (RAD) participants. All participants reported significant increases in self-efficacy domains, and sexual trauma history significantly predicted pre-training interpersonal self-efficacy and post-training self-defense self-efficacy, suggesting that self-defense training confers benefits for survivors above and beyond benefits for other participants.

Long-Term Skills Retention After Obstetric Simulation Training for Skilled-Birth Attendants in Rural Rwanda [9D

INTRODUCTION: The World Health Organization advocates for the presence of attendants at every birth skilled at managing normal pregnancies and obstetrical complications. We aimed to evaluate the long-term skills retention gained by skilled birth attendants (SBAs) who completed a spontaneous vaginal delivery (SVD) and postpartum hemorrhage (PPH) simulation-training program. METHODS: A pre-post intervention study was conducted with a convenience sample of SBAs in rural Rwanda. Two separate groups of SBAs underwent initial simulation training with pre- and immediate post-testing. Group A had training in February 2013. Group B had training in February 2014. Simulation drills to assess skill retention were conducted in September 2015 for both groups. Participants were scored on communication, evaluation, and management skills. Median scores were calculated and the Wilcoxon signed-rank sum test compared the pre-training, post-training, and retention scores. RESULTS: 68% (13/19) of SBAs in Group A and 53% (8/15) SBAs in Group B were available for the skill-retention evaluation. There were no demographic, experiential, or educational differences between groups. After training, both groups showed immediate improvement in almost all the areas evaluated. At 2 years, Group A showed significant falls in their scores in three of the areas evaluated while group B at 1 year demonstrated a decline in only one of the areas evaluated. CONCLUSION: Simulation training is an effective method for acquisition of SVD and PPH skills in low resource settings. Most skills were retained 1 year after the initial training, but lost after 2 years, which suggests that training should be conducted on a yearly basis.

Comparing Written and Planned Training On Anxiety among Patients Undergoing Orthopedic Surgery

Introduction and objectives: The prevalence of preoperative state anxiety is an unavoidable complication. Aside from its type and scope, the surgical operation is considered as a severe stressful situation for patients. Considering the importance of reducing the state anxiety in patients undergoing surgery, there are different methods, one of which is patient education; therefore the aim of the current study was compare the effect of written and planned training on the state anxiety among patients undergoing orthopedic surgery.Method: In this study, 81 patients candidate for orthopedic surgery were selected using convenience sampling and were randomly divided into 3 groups, including planned training, pamphlet and control groups. All patients answered 20 questions-State-Traits Anxiety Inventory (STAI) Questionnaire the day before surgery and the intervention was later carried out in the planned training and pamphlet groups. Then the effect of preoperative state anxiety was re-evaluated about half an hour after training in three groups. For data analysis, in addition to mean and standard deviation, independent t-test and ANOVA were used in Spss16.Results: The results of comparing pre- and post-training mean score of the state anxiety in three groups showed that the mean score of state anxiety reached from 50.41 to 41.03, 52.41 to 44.37 and 45.04 to 50.56 in planned, pamphlet and control groups, respectively. ANOVA test showed that there is a significant difference in this comparison. The results of Tukey's test also revealed that the mean score of state anxiety in the planned and pamphlet groups was lower significantly than the control group (p&lt;0.05).Conclusion: Based on research findings, the planned training method was more effective in decreasing state anxiety among patients compared to the pamphlet group before orthopedic surgery. Therefore, considering the fact that nurses play an important role in examining and relieving the state anxiety among patients and spend more time with patients undergoing surgery compared with other members of the healthcare team, therefore, the planned training method must be considered to ensure effective support to reduce the preoperative state anxiety among patients.

Multidisciplinary In Situ Simulation-Based Training as a Postpartum Hemorrhage Quality Improvement Project.

Postpartum hemorrhage is a common obstetric emergency affecting 3 to 5% of deliveries, with significant maternal morbidity and mortality. Effective management of postpartum hemorrhage requires strong teamwork and collaboration. We completed a multidisciplinary in situ postpartum hemorrhage simulation training exercise with structured team debriefing to evaluate hospital protocols, team performance, operational readiness, and real-time identification of system improvements. Our objective was to assess participant comfort with managing obstetric hemorrhage following our multidisciplinary in situ simulation training exercise. This was a quality improvement project that utilized a comprehensive multidisciplinary in situ postpartum hemorrhage simulation exercise. Participants from the Departments of Obstetrics and Gynecology, Anesthesia, Nursing, Pediatrics, and Transfusion Services completed the training exercise in 16 scenarios run over 2 days. The intervention was a high fidelity, multidisciplinary in situ simulation training to evaluate hospital protocols, team performance, operational readiness, and system improvements. Structured debriefing was conducted with the participants to discuss communication and team functioning. Our main outcome measure was participant self-reported comfort levels for managing postpartum hemorrhage before and after simulation training. A 5-point Likert scale (1 being very uncomfortable and 5 being very comfortable) was used to measure participant comfort. A paired t test was used to assess differences in participant responses before and after the simulation exercise. We also measured the time to prepare simulated blood products and followed the number of postpartum hemorrhage cases before and after the simulation exercise. We trained 113 health care professionals including obstetricians, midwives, residents, anesthesiologists, nurse anesthetists, nurses, and medical assistants. Participants reported a higher comfort level in managing obstetric emergencies and postpartum hemorrhage after simulation training compared to before training. For managing hypertensive emergencies, the post-training mean score was 4.14 compared to a pretraining mean score of 3.88 (p = 0.01, 95% confidence interval [CI] = 0.06-0.47). For shoulder dystocia, the post-training mean score was 4.29 compared to a pretraining mean score of 3.66 (p = 0.001, 95% CI = 0.41-0.88). For postpartum hemorrhage, the post-training mean score was 4.35 compared to pretraining mean score of 3.86 (p = 0.001, 95% CI = 0.36-0.63). We also observed a decrease in the time to prepare simulated blood products over the course of the simulation, and a decreasing trend of postpartum hemorrhage cases, which continued after initiating the postpartum hemorrhage simulation exercise. Postpartum hemorrhage remains a leading cause of maternal morbidity and mortality in the United States. Comprehensive hemorrhage protocols have been shown to improve outcomes related to postpartum hemorrhage, and a critical component in these processes include communication, teamwork, and team-based practice/simulation. As medicine becomes increasingly complex, the ability to practice in a safe setting is ever more critical, especially for low-volume, high-stakes events such as postpartum hemorrhage. These events require well-functioning teams and systems coupled with rapid assessment and appropriate clinical action to ensure best patient outcomes. We have shown that a multidisciplinary in situ simulation exercise improves self-reported comfort with managing obstetric emergencies, and is a safe and effective way to practice skills and improve systems processes in the health care setting.

Couples' voluntary HIV counseling and testing provider training evaluation, Zambia.

SummaryWith the expansion of couples’ voluntary HIV counseling and testing (CVCT) in urban Zambia, there is a growing need to evaluate CVCT provider trainings to ensure that couples are receiving quality counseling and care. We evaluated provider knowledge scores, pre- and post-training and predictors of pre- and post-training test scores. Providers operating in 67 government clinics in four Copperbelt Province cities were trained from 2008 to 2013 in three domains: counseling, rapid HIV laboratory testing and data management. Trainees received pre- and post-training tests on domain-specific topics. Pre- and post-training test scores were tabulated by provider demographics and training type, and paired t-tests evaluated differences in pre- and post-training test scores. Multivariable ANCOVA determined predictors of pre- and post-training test scores. We trained 1226 providers, and average test scores increased from 68.8% pre-training to 83.8% post-training (p < 0.001). Test scores increased significantly for every demographic group and training type (p < 0.001) with one exception—test scores did not significantly increase for those receiving counseling or data management training who had less than a high school education. In multivariable analysis, higher educational level and having a medical background were predictive of a higher pre-test score; higher pre-test scores and having a medical background were predictive of higher post-test scores. Pre- and post-test assessments are critical to ensure quality services, particularly as task-shifting from medical to lay staff becomes more common. Assessments showed that our CVCT trainings are successful at increasing knowledge, and that those with lower education may benefit from repeat trainings.

"Evita Una Muerte, Esta en Tus Manos" Program: Bystander First Aid Training for Terrorist Attacks.

The latest terrorist attacks in Europe and in the rest of the world, and the military experience in the most recent conflicts leave us with several lessons learned. The most important is that the fate of the wounded rests in the hands of the one who applies the first dressing, because the victims usually die within the first 10 minutes, before professional care providers or police personnel arrive at the scene. A second lesson is that the primary cause of preventable death in these types of incidents involving explosives and firearms is massive hemorraghe. There is a need to develop a training oriented to citizens so they can identify and use available resources to avoid preventable deaths that occur in this kind of incidents, especially massive hemorrhage. A 7-hour training intervention program was developed and conducted between January and May 2017. Data were collected from participants' answers on a multiple-choice test before and after undertaking the training. Improved mean score for at least 75% of a group's members on the posttraining test was considered reflective of adequate knowledge. A total of 173 participants (n = 74 men [42.8%]; n = 99 women [57.2%]) attended the training. They were classified into three groups: a group of citizens/ first responders with no prior health training, a group of health professionals, and a group of nursing students. Significant differences (ρ < .05) between mean pre- and post-training test scores occurred in each of the three groups. There was a clear improvement in the knowledge of the students after the training when pre- and post-training test scores were compared within the three groups. The greatest improvement was seen in the citizens/first responders group.

Impact of cardiopulmonary resuscitation training in 1st year of MBBS

Background: The present medical education system fails to inculcate appropriate skills and competence to the students to serve the community. As the world is moving toward the system of “need-based education,” the training of the undergraduates should be oriented toward acquiring practical skills to prepare them to confidently deal with emergency situations in future. Objectives: The objective of this study is to estimate the impact of cardiopulmonary resuscitation (CPR) training in the 1st year of MBBS. Materials and Methods: The study included 150 MBBS 1st year students. The students were given formal training of CPR which included the lecture followed by a hands-on training of CPR on mannequins. The pre-and post-training assessment of the students was done using questionnaire. Assessment of the skill was done by direct observation of the procedure on a mannequin by a checklist. Results: The average pre-training score was 6.39 ± 2.11 and post-training score was 16.56 ± 1.89. The post-training scores of the student were remarkably better than the pre-training score (P < 0.001). According to the results of the assessment of skill by direct observation, students scored better initially in the first part, i.e., knowledge section and the score in the second part, i.e., skill demonstration improved gradually with practice. Conclusion: Training the MBBS students about CPR in 1st year itself is very useful and productive. Training the future health care provider in younger age and preparing them for the emergencies will lead to major reform in the health education system.

Peningkatan Kemampuan Bercerita Tenaga Medis Sebagai Bentuk Profesionalisme Pelayanan Terhadap Hospitalisasi Pasien Anak

This article aims at describing the story telling training process for the medical professionals in Muhammadiyah Hospital of Surabaya and Siti Khodijah Hospital of Sidoarjo. Based on the preliminary study, the training is one of the best solutions to enhance the hospiltals’ professional service since the hospitals face similar problem of hospitalization. Other than that, the service is particularly for the pediatric patients who suffer psychological trauma of hospitalization. The training was carried out through three stages of pre-activity, activity, and evaluation. Through the comparison between pre and post-training test toward the trained pediatric nurses of Muhammadiyah Hospital of Surabaya, the result confirmed that the mean of the post-training score was increased significantly from 55.8(pre-training score) to 84 (post-training score). The second result which is got from the pediatric nurses of Siti Khodijah Hospital shows the sharp increase. The mean of pre-training score was 39.9, and the mean of the post-training score was 88.8. Through interviewing with the participants and the managements of both hospitals, it can be concluded that the training gained positive responses from the hospital management, the pediatric nurses and the patients as well.

Centralized, capacity-building training of Lichtenstein hernioplasty in Brazil

BackgroundIn Brazil, access to healthcare varies widely by community. Options for repair of surgically correctable conditions, such as inguinal hernias, are limited. A training program was instituted to expand access to Lichtenstein hernioplasty. MethodsBetween September, 2014 and September, 2015, 3 orders of training series took place in São Paulo, Brazil. Participating surgeons received training and assessments from expert trainers using the Operative Performance Rating Scale (OPRS). Those who completed training successfully were invited to become trainers. OPRS scores were compared between training series. Outcomes were documented up to 6 months post-training. ResultsThe 3 orders of training series resulted in 45 surgeons trained and 213 hernias repaired. Eleven trainees subsequently became trainers. Mean post-training OPRS scores were 4.4 (scale of 5) and did not vary significantly between training series. The overall complication rate was 4.7%, with no hernia recurrences or reoperations at 6 months. ConclusionsCompetency-based training generates a regional network of surgeons proficient in Lichtenstein hernioplasty. Each training session progressively expands patient access to high quality operations in underserved communities in Brazil.

Efficacy of Tailored Clinic Trainings to Improve Knowledge of Men Who Have Sex with Men Health Needs and Reduce Homoprejudicial Attitudes in South Africa.

An urgent need exists for training on men who have sex with men (MSM) health needs at public health clinics across Africa. There is also a need to consider the impact of specific training for clinicians and clinic support staff, both of whom come into contact with MSM. Consideration must also be given to the relationship between two key outcomes of such training: increased knowledge regarding MSM and their health and reductions in homoprejudicial attitudes. This article explores the impact of training for clinicians and clinic support staff in the Western Cape, South Africa (n = 196), where some training modules were undertaken by both groups and some modules only by clinicians. Participants were evaluated at baseline and post-training on MSM knowledge and homoprejudicial attitudes. After training, both clinicians and clinic support staff showed an increase in knowledge and a reduction in homoprejudicial attitude scores, with similar proportional improvements for both groups. Additional trainings for clinicians also resulted in significant improvements in their knowledge. However, reductions in homoprejudicial attitudes were related to the type of knowledge obtained. A threshold effect in post-training knowledge scores of 9 or greater on sensitivity material significantly increased the likelihood of a reduction in homoprejudicial attitudes. These findings show that training for both types of clinic workers is important and effective, but facilitators should be mindful of complex relationships between knowledge and homoprejudicial attitudes.

Advanced Patient-Centered Communication for Health Behavior Change: Motivational Interviewing Workshops for Medical Learners.

Medical settings are critical access points for behavior change counseling, and lifestyle behavior change is considered a key component of chronic disease management. The Association of American Medical Colleges recommends that future physicians be competent in shared decision making and patient-centered behavioral guidance to prevent illness and improve patient self-management of chronic disease. Motivational interviewing (MI) is a patient-centered, directive method of communication to enhance behavior change. Specific teachable strategies underlie the collaborative MI communication style that aims to reduce discord and build motivation for change. We present our three-session 12-hour MI curriculum as an advanced form of patient-centered communication. Each session includes presession assignment, large-group interactive lecture, and small-group activities for practice. An interdisciplinary team consisting of medical educators and health behavior change research-educators who are also members of the Motivational Interviewing Network of Trainers created the submission. The purpose of this resource is to provide medical educators with a short curriculum that incorporates materials and learning activities to promote skill in MI. In addition to positive feedback from student evaluations including the areas of relevance to training and self-rated skills improvement, preliminary pre- and posttraining scores from the medical students show significant improvement in expression of empathy and the ratio of reflections to questions. Implementation of the curriculum allows learners the opportunity to practice evidence-based communication that promotes intrinsic motivation for health behavior change in patients, a key treatment focus in chronic disease management.

Gender based Analysis of using Virtual Learning Environment

Objectives: To perform a gender analysis on the usage of Virtual Learning Environment (VLE) of simulation based e-learning in the field of Software Engineering in specific reference to the dynamic complexity, a modeling framework for Software Engineering Simulation based e-Learning Environment (SESeLE) tool is needed and has been proposed. Method/Statistical Analysis: A questionnaire based survey has been carried out twice on the learners enrolled in Computers and Information Technology based courses at tertiary levels in and around the city of Chandigarh in north India. The learners were provided an interactive single-learner environment of the SESeLE which was accessible through the internet by using a standard web-browser. In all, 392 students of tertiary level were included as subjects and were made to respond twice on the issues like their practical knowledge of software handling, interest and knowledge in software project management and impact of e-learning on their knowledge in software project management through questionnaire survey. The questionnaire was first got filled up from the subjects without any exposure to the SESeLE and subsequently after a training session on the SESeLE. ANOVA test was performed to find out the significant differences in various learning styles on post-training test scores overall and in both male and female students as well. Findings: This study is unique and one of its own kind. It has been used to analyse the impact of using VLE tools by the learners/students on their learning and also for the gender analysis on various parameters. The web based learning style has been found to be the most preferred learning style among female students and the second most preferred style of learning among male students. Reading textbooks was not significantly popular among female students as compared to male students. About half of the students agreed to participate in any kind of seminar on software project management. The post-training test score on the knowledge about typical patterns observed in software project management issues has been found to be significantly higher from pre-training test scores. No significant difference has been found among the average response of the male and female students on all issues related to their Interest in Software Project Management. The post-training test scores of male and female students on both the issues of simple and difficult software project management were significantly different; the pre- and post-training test scores of the students on both the issues were different significantly; and lastly, significant difference was found between the post-training test scores on both the issues among students categorized according to their preferred choice of learning. Application/Improvements: It will be interesting to evaluate, in future, the effectiveness of SESeLE for the learners.

Learning Outcome Measurement in Nurse Participants After Disaster Training.

The National Disaster Health Consortium is an interprofessional disaster training program. Using the Hierarchical Learning Framework of Competency Sets in Disaster Medicine and Public Health, this program educates nurses and other professionals to provide competent care and leadership within the interprofessional team. This study examined outcomes of this training. Training consisted of a combination of online and on-site training. Learning outcomes were measured by using the Emergency Preparedness Information Questionnaire (EPIQ) pre/post training and participant performance during live functional exercises with the use of rubrics based on Homeland Security Exercise and Evaluation principles. A total of 64 participants completed the EPIQ before and after training. The mean EPIQ pre-training score of 154 and mean post-training score of 81 (reverse-scored) was found to be statistically significant by paired t-test (P<0.001). Performance was evaluated in the areas of triage, re-triage, surge response, and sheltering. Greater than 90% of the exercise criteria were either met or partially met. Participants successfully achieved overall objectives in all scenarios. Disaster response requires nurses and other providers to function in interprofessional teams. Educational projects, like the National Disaster Health Consortium program, offer the potential to address the need for a standardized, interprofessional disaster training curriculum to promote positive outcomes. (Disaster Med Public Health Preparedness. 2016;page 1 of 6).

The effect of peer-group size on the delivery of feedback in basic life support refresher training: a cluster randomized controlled trial.

BackgroundStudents are largely providing feedback to one another when instructor facilitates peer feedback rather than teaching in group training. The number of students in a group affect the learning of students in the group training. We aimed to investigate whether a larger group size increases students’ test scores on a post-training test with peer feedback facilitated by instructor after video-guided basic life support (BLS) refresher training. Students’ one-rescuer adult BLS skills were assessed by a 2-min checklist-based test 1 year after the initial training.MethodsA cluster randomized controlled trial was conducted to evaluate the effect of student number in a group on BLS refresher training. Participants included 115 final-year medical students undergoing their emergency medicine clerkship. The median number of students was 8 in the large groups and 4 in the standard group. The primary outcome was to examine group differences in post-training test scores after video-guided BLS training. Secondary outcomes included the feedback time, number of feedback topics, and results of end-of-training evaluation questionnaires.ResultsScores on the post-training test increased over three consecutive tests with instructor-led peer feedback, but not differ between large and standard groups. The feedback time was longer and number of feedback topics generated by students were higher in standard groups compared to large groups on the first and second tests. The end-of-training questionnaire revealed that the students in large groups preferred the smaller group size compared to their actual group size.ConclusionsIn this BLS refresher training, the instructor-led group feedback increased the test score after tutorial video-guided BLS learning, irrespective of the group size. A smaller group size allowed more participations in peer feedback.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0682-5) contains supplementary material, which is available to authorized users.

Evaluating a training programme at Viet Duc University Hospital in Vietnam.

Vietnam's nursing competency standards (VNCS) were issued in 2012 as the legal framework on which the continuous nursing training programme are designed and developed. The study aimed to assess the knowledge, skills, and attitudes as well as the confidence of nurses regarding wound care at Viet Duc University Hospital before and after a new educational intervention. A comparative descriptive study was carried out in 2014 at Viet Duc University Hospital. The study reviewed knowledge, skills, attitude and confidence among nurses working in seven clinical departments. The data collection tools included a 48-knowledge-item self-administered questionnaire, a sixteen-item skills set, and attitude-item observation sheet and a thirteen confidence level-item observation sheet, adapted for the field of wound care. Data were loaded into Epidata version 3.1 and analysed with SPSS version 16.0. The mean pre-training knowledge, skill, attitude and confidence scores were (117.78±24.94), (53.61±10.26), (54.39±8.02) and (1.18-3.59), respectively, while the corresponding post-training scores were (148.68±16.54), (62.33±8.40), (60.80±8.75) and (1.50-4.15) p<0.0001. This was the first cohort to undergo the new training programme and has shown promising initial results; however, it also demonstrates that the training content, while leading to positive changes, does in some areas need to be further developed and then disseminated across the hospital to all nurses who provide direct wound care for patients.

Retention of skills 2 years after completion of a postpartum hemorrhage simulation training program in rural Rwanda

ObjectiveTo evaluate the long-term retention of skills gained by rural physicians who completed a postpartum hemorrhage simulation-training program. MethodsA quasi-experimental pre–post intervention study enrolled a convenience sample of generalist physicians in rural Rwanda. Participants underwent initial simulation training including pre- and post-training testing in February 2012. Simulation drills to assess skill retention were conducted in March 2014. Participants were scored based on their communication, evaluation, and management skills. Median scores and inter-quartile ranges were calculated and the Wilcoxon signed-rank sum test was used to compare the pre-training, post-training, and retention scores. Physician confidence was assessed using a survey. ResultsIn total, 11 physicians were enrolled; eight were available for the 2-year skill-retention evaluation. Significant improvements were observed when comparing participants’ pre-training and post-training communication (P=0.03), evaluation (P=0.05), and management (P=0.02) scores, and there were no changes between participants’ post-training and 2-year communication (P>0.99), evaluation (P=0.16), and management (P=0.46) scores. There were no differences in the self-reported confidence measures across the duration of the study. ConclusionSimulation training is an effective method for teaching postpartum hemorrhage-management skills to generalist physicians in rural areas and skills are retained for at least 2 years. Further studies could determine the optimal time intervals for refresher training.

Study on female breast cancer imaging screening consultation network in Guangdong Province, China.

This study aimed to construct breast cancer image screening consultation network (BISCN) that connects all levels of medical institutions in Guangdong Province. Fourteen hospitals in different cities and counties (districts) of Guang-dong were selected for breast cancer screening with imaging (breast X-ray, ultrasound, and MRI). "Breast Imaging Reporting and Data System (BI-RADS)" was taken as reference to build up image data base of breast cancer screening and BISCN that is an internet-based network platform. BISCN quality control was performed to improve the diagnostic accuracy and collaboration of members. In 2011, the BISCN members underwent breast imaging diagnosis training and conducted a questionnaire survey. BISCN allowed quick, synchronous, and accurate communication and feedback of diagnostic imaging in breast cancer among all levels of medical institutions and improved the ability of breast cancer screening in the province, as well as the detection rate of early breast cancer throughout the province, especially in the grassroot units. The survey results showed that the trainees' understanding situation of the training contents before training was 2.02 ± 1.75 points. Through the study, the participants considered that the teaching contents could solve the daily diagnose problems (2.91 ± 0.70 points), the post-training scores were improved (2.88 ± 1.23 points), and highly satisfactory with the teaching contents (2.81 ± 0.53 points). All students passed the examination and were qualified for the future. BISCN is of good feasibility in construction and applicability in management by raising diagnosis level of breast cancer in Guangdong Province.