Proficiency In Technical Skills Research Articles

Integrated Laboratory Practices in the Question Papers

Laboratory classes are an essential part of an engineering course. Laboratory sessions are primarily designed to develop proficiency in technical skills, offer an opportunity to place theory in context, develop critical thinking skills and promote investigation-based learning. Laboratory experiences will help to develop as independent learners, researchers, critical thinkers, and generators of knowledge. There are several improvements that need to be implemented to improve student laboratory experiences. The purpose of this research is to integrate with end semester examination in view of requirements of the 21st century.This paper highlight the evaluation system which is robust and dynamic as compared to the traditional evaluation system. This research is based on the feedback collected from industrialists and academicians on the present examination system. The paper has come up with the result that 50 % of academicians are of the opinion that examination paper patterns should include the laboratory-based question. The paper highlights the curriculum design aspect related to the question paper setting. The paper brings some critical points related to the integration of laboratory conduct and evaluation system with end semester examination. Keywords:- laboratory work, Learner, Knowledge, Integration, Examination, Evaluation

Challenges in the transition to independent radiation oncology practice and targeted interventions for improvement.

Numerous radiation oncology residents and junior attendings have identified common weaknesses in residency training that hinder the transition from training to independent practice. Recurrent themes include not only general autonomy but also proficiency in technical skills, such as treatment plan review and image verification, and nontechnical skills, such as leadership, mentorship, and education. While multiple strategies to address these deficiencies have been investigated, many are not widely available or may be difficult to implement. We aim to summarize the frequently cited challenges in the transition to independent radiation oncology practice as well as the pertinent interventions that have been explored.

Perceived Barriers to the Development of Technical Skill Proficiency in Surgical Clerkship

Medical students are expected to achieve proficiency in a prescribed set of technical skills during surgical clerkship. However, available literature indicates students routinely report a lack of confidence and proficiency in these skills. Our study aims to identify barriers to technical skill development encountered by medical students during surgical clerkship with the goal of developing interventions to address these barriers. Three hundred and forty two medical students were surveyed about their experience learning and performing technical skills during surgical clerkship. Students reported confidence in skill performance and subjective barriers to achieving competency using forced-choice and free-text responses. Multivariate regression models identified factors independently associated with specific barriers and more frequent technical skills performance. Main and satellite campuses of a Medical Council of Canada accredited Canadian academic medical center. All third-year medical students. A total of 253 students (74%) responded to the survey. Following surgical clerkship, the only technical skills participants felt confident performing independently were sterile technique (96%) and basic suturing (52%). Interest in a surgical career, observership experience, gender, and medical campus site were independently associated with the frequency of skill performance. With respect to developing technical proficiency, commonly cited barriers included lack of suitable cases for student participation (35.0%), time constraints (33.4%), and lack of opportunities provided by both consultants (29.1%) and residents (24.7%). Female gender was independently associated with decreased resident instruction, decreased confidence in skill performance, and fewer opportunities to perform requisite skills. Students at satellite campuses reported fewer barriers. We identified (1) lack of suitable cases, (2) time constraints, and (3) failure to provide students opportunities as the most common barriers to technical skill proficiency. Female gender increased the perception of barriers, while there were fewer barriers perceived by students at satellite campuses. Skill-specific simulation training and other interventions may improve skill development in medical students given obstacles to developing proficiency in the clinical setting.

Podiatry Ankle Duplex Scan: Readily Learned and Accurate in Diabetes.

We aimed to train podiatrists to perform a focused duplex ultrasound scan (DUS) of the tibial vessels at the ankle in diabetic patients; podiatry ankle (PodAnk) duplex scan. Thirteen podiatrists underwent an intensive 3-hour long simulation training session. Participants were then assessed performing bilateral PodAnk duplex scans of 3 diabetic patients with peripheral arterial disease. Participants were assessed using the duplex ultrasound objective structured assessment of technical skills (DUOSATS) tool and an "Imaging Score". A total of 156 vessel assessments were performed. All patients had abnormal waveforms with a loss of triphasic flow. Loss of triphasic flow was accurately detected in 145 (92.9%) vessels; the correct waveform was identified in 139 (89.1%) cases. Participants achieved excellent DUOSATS scores (median 24 [interquartile range: 23-25], max attainable score of 26) as well as "Imaging Scores" (8 [8-8], max attainable score of 8) indicating proficiency in technical skills. The mean time taken for each bilateral ankle assessment was 20.4 minutes (standard deviation ±6.7). We have demonstrated that a focused DUS for the purpose of vascular assessment of the diabetic foot is readily learned using intensive simulation training.

Biomechanics of simulated versus natural cross-country sit skiing

The purpose of this study was to investigate the biomechanics of cross-country sit-skiing in simulated and natural skiing. Thirteen international level athletes participated in a ski ergometer test (simulated conditions) and a test on snow in a ski-tunnel (natural conditions) using their personal sit-ski. Tests in both conditions were performed at individual maximal speed. When comparing the two conditions the main results were: (1) maximal speed in simulated conditions was lower (p<0.05) but correlated well with the natural condition (r=0.79, p<0.001); (2) no differences in pole force variables were found; peak force (r=0.77, p<0.01) and average force (r=0.78, p<0.01) correlated well; (3) recovery time and time to peak did not differ and time to impact correlated with each other (r=0.88, p<0.01); (4) no differences were found in peak electromyography (EMG) and average EMG for Triceps, Pectoralis, and Erector Spinae; Rectus Abdominis did not differ in peak. EMG peak and average EMG of all muscles were correlated between the two conditions (r=0.65–0.94; p<0.05–0.01). Although some differences were observed, this study demonstrated that technical skill proficiency in natural and simulated cross-country skiing is comparable from a force production and muscle activation perspective.

LO103: Trauma Resuscitation Using in-situ Simulation Team Training (TRUST): using risk-informed simulation for team performance and human factors evaluation

Introduction / Innovation Concept: Trauma resuscitation requires a multidisciplinary team to perform at a high level within a dynamic, high-stakes environment. The unpredictable nature of trauma care increases the possibility for errors, often from underlying latent safety threats (LSTs). In-situ simulation (ISS) is a point-of-care training strategy that occurs within the patient care environment involving the actual healthcare team and provides a novel approach to team training and LST identification. Using ISS, critical events can be recreated providing an opportunity to explore and learn from past challenges. We developed and piloted a risk-informed, multidisciplinary ISS trauma training program to assess teamwork performance and identify LSTs within the trauma care environment. Methods: A comprehensive process was initiated to gain support from all stakeholders within the trauma program. Simulation cases were derived from a review of adverse events and unexpected deaths. Human factors experts aided with the integration of system- and process-related elements into the case design. ISS sessions involved all trauma team members. Debriefing after each session facilitated a team-based discussion and an opportunity for reflective practice and video recording was used for teamwork evaluation and process mapping. Curriculum, Tool, or Material: We conducted monthly, unannounced, multidisciplinary, high-fidelity ISS scenarios at a Canadian Level 1 trauma centre. The trauma team was activated by the usual notification process and care provided in the same manner as an actual trauma patient. A semi-structured debriefing followed each session with a focus on team performance and LST identification. Teamwork was measured using a previously validated tool, the Clinical Teamwork Scale. Findings were used to inform discussion at multidisciplinary trauma rounds as part of an iterative process of evaluation and implementation. Conclusion: This multidisciplinary ISS trauma training program offers a novel approach to team performance evaluation and LST identification. Using risk-informed scenarios combined with human factors analysis we are able identify knowledge and technical skill proficiency gaps, LSTs and integrate formative team assessment. An iterative process beginning with ISS followed by multidisciplinary rounds provides a robust framework for system-based changes to improve team performance and overall patient care.

Establishing validity and reliability of a movement awareness and technical skill (MATS) analysis instrument in soccer

Soccer performance analysis instruments generally provide a description of skill outcomes; however, there is limited understanding of the individual movements and skills that lead to an outcome such as a pass. We used a four step process to develop a valid and reliable instrument designed to assess movement awareness and technical skills (MATS) performed by soccer players when in possession of the ball. The first step was the establishment of performance indicators and operational definitions, followed by extensive pilot testing and observer training. The third step established face validity aligning Football Federation Australia’s national curriculum and the technical performance outcomes; and content validity was ensured by verification and critical feedback from an expert panel. Finally, reliability was established with high inter-coder (Kappa value >0.40; and Cronbach’s α = 0.98) and intra-coder reliability (Cronbach’s α = 0.83). From a practical perspective, the new soccer performance analysis instrument provides detailed information relating to player movement patterns, technical skill proficiency and skill breakdown. The data obtained coupled with reflective coaching practices may inform player feedback and future coaching strategies to develop player movement and technical skills.

Improving Laboratory Experiences in Engineering Education

Laboratory classes are integral part of an engineering course. Laboratory sessions are primarily designed to develop proficiency in technical skills, provide an opportunity to place theory in context, develop critical thinking skills and promote enquiry based learning. Laboratory experiences will be paramount in developing our students as independent learners, researchers, critical thinkers and generators of knowledge. There are several reforms need to be implemented to improve student laboratory experiences. This paper suggests some of the methods that can be implemented in engineering institutes. This paper also presents the study of usage of online tools and rubric based laboratory assessment methodology adopted in electronics engineering course.

The influence of learning activity on low-skilled workers’ skill improvement in the South Korean manufacturing industry

The main purpose of this study was to explore how low-skilled worker’s learning activity influences skill improvement. Using a unique 2007 Human Capital Corporate Panel data-set from the South Korean manufacturing industry, we operationalize skill improvement over time among low-skilled workers. A worker is classified as ‘low skilled’ if he or she has a low education level and poor technical skills. Regression models show that low-skilled workers’ informal learning positively influences their skill improvement. In contrast, we note that supervisors negatively influence skill improvement of low-skilled workers when measuring the change in technical skill proficiency. Quality circle programmes also have a positive influence on skill improvement. In conclusion, skills can be improved through planned interventions that increase collaboration on the job. The results from this study help to highlight the importance of designing learning interventions for low-skilled workers that take account of their underlying education and skills.

Establishing a surgical skills laboratory and dissection curriculum for neurosurgical residency training.

Surgical education has been forced to evolve from the principles of its initial inception, in part due to external pressures brought about through changes in modern health care. Despite these pressures that can limit the surgical training experience, training programs are being held to higher standards of education to demonstrate and document trainee competency through core competencies and milestones. One of the methods used to augment the surgical training experience and to demonstrate trainee proficiency in technical skills is through a surgical skills laboratory. The authors have established a surgical skills laboratory by acquiring equipment and funding from nondepartmental resources, through institutional and private educational grants, along with product donations from industry. A separate educational curriculum for junior- and senior-level residents was devised and incorporated into the neurosurgical residency curriculum. The initial dissection curriculum focused on cranial approaches, with spine and peripheral nerve approaches added in subsequent years. The dissections were scheduled to maximize the use of cadaveric specimens, experimenting with techniques to best preserve the tissue for repeated uses. A survey of residents who participated in at least 1 year of the curriculum indicated that participation in the surgical skills laboratory translated into improved understanding of anatomical relationships and the development of technical skills that can be applied in the operating room. In addition to supplementing the technical training of surgical residents, a surgical skills laboratory with a dissection curriculum may be able to help provide uniformity of education across different neurosurgical training programs, as well as provide a tool to assess the progression of skills in surgical trainees.

Face, content, and construct validity of four, inanimate training exercises using the da Vinci ® Si surgical system configured with Single-Site ™ instrumentation.

Validated training exercises are essential tools for surgeons as they develop technical skills to use robot-assisted minimally invasive surgical systems. The purpose of this study was to show face, content, and construct validity of four, inanimate training exercises using the da Vinci (®) Si surgical system configured with Single-Site (™) instrumentation. New (N = 21) and experienced (N = 6) surgeons participated in the study. New surgeons (11 Gynecology [GYN] and 10 General Surgery [GEN]) had not completed any da Vinci Single-Site cases but may have completed multiport cases using the da Vinci system. They participated in this study prior to attending a certification course focused on da Vinci Single-Site instrumentation. Experienced surgeons (5 GYN and 1 GEN) had completed at least 25 da Vinci Single-Site cases. The surgeons completed four inanimate training exercises and then rated them with a questionnaire. Raw metrics and overall normalized scores were computed using both video recordings and kinematic data collected from the surgical system. The experienced surgeons significantly outperformed new surgeons for many raw metrics and the overall normalized scores derived from video review (p < 0.05). Only one exercise did not achieve a significant difference between new and experienced surgeons (p = 0.08) when calculating an overall normalized score using both video and advanced metrics derived from kinematic data. Both new and experienced surgeons rated the training exercises as appearing, to train and measure technical skills used during da Vinci Single-Site surgery and actually testing the technical skills used during da Vinci Single-Site surgery. In summary, the four training exercises showed face, content, and construct validity. Improved overall scores could be developed using additional metrics not included in this study. The results suggest that the training exercises could be used in an overall training curriculum aimed at developing proficiency in technical skills for surgeons new to da Vinci Single-Site instrumentation.

Fellow or foe: the impact of fellowship training programs on the education of Canadian urology residents

Throughout North America, increasing emphasis is being placed on surgical fellowships. Surgical educators and trainees have raised concerns that the escalating focus on fellowships may threaten the educational mission of more novice trainees. Our objective was to collect opinions from multiple perspectives (faculty, fellows and residents) regarding fellowship structure, fellow selection and the impact of clinical fellowships on urology resident training. We anonymously surveyed 52 members of a major academic urology training program (University of Toronto) with established fellowship training programs for their opinions regarding fellowship structure, fellow selection, and the impact on resident training and education. The overall response rate was 88%. We identified significant differences of opinion among faculty, fellows and residents regarding fellowship structure, fellow selection and the impact on resident education. Specifically, faculty and fellows supported the addition of more fellows, felt that certain complex cases should be designated as "fellow cases" and that residents' research opportunities were not restricted. Residents felt that fellows "steal" operative cases, that performing operations with the fellow is not equivalent to performing operations with faculty alone and that fellowship candidates should perform an operation with division faculty as part of the application process. There was agreement that fellowship programs add value to residents' overall education, that fellows should participate in the call schedule and that fellows' role in the operating room needs to be better defined with respect to case volume and selection. Proficiency in technical skills, clinical knowledge, teaching and teamwork were cited as the most attractive characteristics of an effective clinical fellow. Residency and fellowship program directors must clearly define the role of the fellow and outline the limits of surgical practice, establish clear and consistent guidelines outlining responsibilities (operative, clinical and on-call), and open lines of communication to ensure that all opinions are recognized and addressed. Finally, they must select fellows with proficient technical skills, clinical knowledge, teaching ability and work ethic to ensure that they focus on "specialized" training.

Technical Skills Acquisition in Surgery-Bound Senior Medical Students: An Evaluation of Student Assertiveness

To prepare students pursuing surgical careers, we devised a senior subinternship curriculum supplement that focused on the acquisition of technical skills required of surgical residents. We hypothesized that more assertive students, those that accomplished more of the curriculum, would perform better on a technical skills Objective Structured Clinical Examination (OSCE). Senior medical students rotating on their first general surgery subinternship were administered a 6-station OSCE on the first day of their subinternship and again during the final week of the month-long rotation. A self-directed, 38-task "scavenger hunt" representing common intern level clinical skills, procedures, and patient care activities was provided to each student. The study was performed at Jefferson Medical College, a large, private medical school in Philadelphia, PA. Forty-nine senior students completed surgical subinternships between July 2009 and September 2010, and participated both in the pre-/post-OSCEs and the scavenger hunt. Students performed significantly better on the post-rotation OSCE than on the pre-rotation OSCE; 70.2% ± 8.1% vs. 60.4% ± 12.0%, p < 0.0001. Assertiveness scores from the "scavenger hunt" did not correlate with final OSCE scores (r = -0.328, p = 0.25), and were negatively correlated with the change between pre- and post-OSCE scores (r = -0.573, p < 0.04). Individual student assertiveness scores were determined by the number of tasks completed over the course of the rotation. As surgical education becomes more streamlined with evolving work hour restrictions, medical school education is playing an increasingly pivotal role in preparing students for internship. In our study, individual assertiveness in completing structured self-directed learning tasks did not directly predict the acquisition of proficiency in technical skills. We feel assertiveness is overshadowed by other factors that may carry more weight in terms of technical skills acquisition. Further studies are required to delineate these factors and ultimately enhance technical skills acquisition during medical school.

Teaching Others to Care: A Case for Using the Humanities in Nursing Education

Professional nurses practice in a complex environment, proficiency in technical skills, mastery of a broad body of nursing knowledge and the ability to utilize knowledge from other scientific disciplines must he coupled with a commitment of service to others, offered with understanding and compassion for a diverse community. This combination of knowledge, skill, and compassion are the ingredients that constitute the art of nursing, often referred to as the esthetic. This paper will discuss the art of nursing and explore some strategies to incorporate elements of the fine arts and humanities into professional ursing education.

The validity of take-home surgical simulators to enhance resident technical skill proficiency

Background It is unknown whether surgical residents who learn minimal-access surgery skills in an unstructured environment (ie, at home), will develop a technical skill set that rivals that of those trained in the more traditional, structured learning environment. Methods Seven surgery residents were provided structured learning through didactic and hands-on skills training sessions and consistent supervision throughout training. A second group of 7 residents participated in an unstructured learning curriculum of training without supervision. End points were determined at the end of training using a standardized simulator based on predetermined performance measures. Results Both groups achieved high task scores, with comparable scores on gesture proficiency, hand movement smoothness, instrument movement smoothness, errors, and time elapsed. There was no significant difference between group differences in final skills scores. Conclusions Unstructured learning is equally effective in delivering quality skills training when compared with structured training.

Framework for Systematic Training and Assessment of Technical Skills

K A s b he purpose of training programs for all medical specilities is to produce competent individuals who are able o meet the health-care needs of society. Recent editorils have commented on the crisis in medical education nd the requirement for defined competencies to assess erformance before new physicians begin independent edical practice. Effective since July 2002, the Acreditation Council for Graduate Medical Education ACGME) listed 6 categories of competence, defined as he ACGME Outcomes Project (Table 1). This article does not address the specific need for emonstration of proficiency in technical skills. This is ot an issue for the surgical specialities only but also for hysicians training in cardiology, anaesthesiology, gasrointestinal medicine, chest medicine, and intervenional radiology, together with allied health specialists. he introduction of new techniques and instruments to hese specialities requires training of not just residents, ut also of independent practitioners. This was clearly vident with the increased rate of complications associted with the introduction of laparoscopic cholecystecomy and has led to the development of training prorams at many centers around the globe. Although there is a transfer of skills to the trainee, urrent training programs have not been designed from background of scientific research to ensure the curriclum is valid, efficient, and competency based. The aim f a surgical residency program is to produce competent rofessionals, displaying the cognitive, technical, and ersonal skills required to meet the needs of society. ithin the context of surgical procedures, patients can xpect satisfactory outcomes in terms of cure, complicaion rates, and return to daily activities. Technical profi-