Progress In Skills Research Articles

The Cataract Surgery Learning Curve: Quantitatively Tracking a Single Resident's Operative Actions Throughout Their Training

To track operative phases of cataract surgery over a resident's training to measure action times and frequencies as a surrogate for competency and skill progression. An n=1 panel study. Cataract surgery video recordings performed by a single resident between 2021-2022 were collected. Only full-length videos of adequate quality without supervisor intervention were included. The start and end times of 19 distinct operative phases of cataract surgery were manually labeled by a trained annotator. Timeseries analysis was employed to measure the direction and magnitude of trends in the resident's surgical timing for each action across their first year of training. The dataset comprised 100 videos spread across the resident's sixth to 760th cases. The median total time was 11.6 minutes (IQR 10.1-14.4 minutes), with overall speed increasing at a rate of 43.4 seconds for every 10 videos (95% CI 35.1, 52.7 seconds). Nine operative phases significantly decreased in time throughout training. The main incision, phacoemulsification, and hydrodissection had the greatest improvements in speed relative to their average procedural time. There was an average of 26.9 distinct operative actions (excluding idle periods) in each video (range 20-50). This is the first study to quantitatively track operative times and frequencies across all relevant actions in cataract surgery and derive learning curves for each. Consistent with previous works, it was found that a basic level of surgical competency was achieved after performing 80 cases. In addition, results from this study indicated that the next level in skill advancement towards surgical finesse occurs after 300 cases.

The Application of YouTube Media in Learning Speaking: Students’ Perceptions

English has an important role as a global language, especially in the era of globalization. To master English, there are four types of proficiency skills such as listening, speaking, reading, and writing. Speaking is the simplest form of communication in life. However, the teaching techniques in Indonesia used by teachers are generally unattractive and monotonous. Students are only provided with textbooks and conventional materials; therefore, it affects students' opportunities to improve their speaking skills. This study aimed to determine students' perceptions of YouTube as a learning media to improve English-speaking skills. This study used a mixed method which cover quantitative and qualitative designs. Thus, the instruments include the questionnaires distributed via Google Form to 215 of the 11th grade students of State Senior High School No. 58 Jakarta and interview for selected students. The result showed that there were five aspects of student perceptions such as: convenience, motivation, progress, activity, and variation. The largest percentage value was obtained by variation aspect in positive perception of 58.37%. The students' perception of YouTube as a learning media was then positive. In addition, YouTube had a positive impact by proving students’ progress in English-speaking skills.

Surgical residents' approach to training: are elements of deliberate practice observed?

Background: Deliberate practice research has consistently shown that intense, concentrated, goal-oriented practice in a focused domain, such as medicine, can improve skill development and performance. To date, little is known about how surgical residents approach their surgical training, how they evaluate their current weaknesses, and how they plan to transition from one milestone to another. Without knowledge of residents' role in their development, educators miss the opportunity to optimize progression of these lifelong learning skills. Therefore, the purpose of this study was to gain a better understanding of how surgical residents approach their surgical training from the perspective of the surgical residents themselves and to explore if elements of deliberate practice are observed. Methods: Eight surgical trainees participated in one of two focus groups depending on their training level (five junior residents; three senior residents). With the exploratory nature of this research, a focus group methodology was utilized. Results: By employing both deductive and inductive thematic analysis techniques, three themes were extracted from the data: learning resources and strategies, role of a junior/senior, and approaching weaknesses. Conclusions: Although elements of deliberate practice were discussed, higher functioning is necessary to achieve performance excellence, leading to improved patient outcomes.

Video Analysis of Otologic Instrument Movement During Resident Mastoidectomies.

To measure surgical instrument movement during resident mastoidectomies and identify metrics that correlate with experience. Retrospective case series. Tertiary care center. Ten postgraduate year (PGY) 2, 6 PGY3, 7 PGY4, and 19 PGY5 recordings of mastoidectomy performed by otolaryngology residents. One-minute intraoperative recordings of mastoidectomies performed during cochlear implantation were collected. Drill and suction-irrigator motion were analyzed with sports motion tracking software. Mean instrument speed, angle, and angular velocity were calculated. Mann-Whitney U tests compared mean instrument metrics between PGY levels. Change in drill speed for seven residents between their PGY2 to PGY5 years was individually analyzed. Mean drill speed was significantly greater for PGY5 residents compared with PGY2s (2.9 versus 1.8 cm/s, p = 0.001). Compared with PGY2 residents, suction speed was greater as a PGY5 (1.2 versus 0.9 cm/s; p = 0.201) and significantly greater as a PGY4 (1.5 versus 0.9 cm/s, p = 0.039). Of the seven residents individually analyzed, group mean drill speed increased by 0.4 cm/s, yearly. Drill and suction-irrigator movement during the second minute of drilling of a cortical mastoidectomy seems to increase with resident level. Objective video analysis is a potential adjunct for differentiating novices from more experienced surgeons and monitoring surgical skills progress.

Why and how to implement an electronic resident's surgical logbook to improve operating-room training? First 5-year feedback from a French center.

The evaluation of general surgery residents' operating room (OR)-training and technical skills progression may be difficult in the absence of a standardized evaluation tool. The aim of this study was to evaluate the impact of the implementation of an electronic "surgical logbook" for general surgery residents. A prospective single center study was conducted between May 2015 and October 2020. An electronic logbook was filled by all residents immediately after each surgical procedure and data were prospectively collected and analyzed. Fifty-five students (34 men/21 women) reported their participation to 6917 surgical procedures, which corresponded to 55.5% of all procedures performed in our department. Residents performed the entire procedure as the operating surgeon in 28.5% of cases (n=1963), parts of the procedure as operating surgeon in 32.5% of cases (n=2230) and as operating-assistant in 38.5% (n=2672). Residents were more likely an operating surgeon for the entire procedure when they were assisted by a fellow or a practicing physician than an associate professor or a clinical professor (P<0.001). There was no significant difference in the major morbidity rate between different resident's contribution to the procedure (P=0.14). We present here a simple, useful and cost efficient tool which offers easy data collection and reporting that could help improve OR-training, OR-supervision and certification at a local or national level.

Exploring Abizard's Early Language Acquisition

This study analyzes the language development of a three-year-old child, Abizard Naufal Muttaqin, focusing on phonological, morphological, and semantic aspects. Data is collected through observation and video recording using a descriptive qualitative research approach. The study shows that Abizard's language development is typical for his age, with notable progress in phonological and morphological skills. However, his semantic skills require further development. Effective strategies for supporting language learning in early childhood are provided, such as reading to children, encouraging verbal communication, and providing a rich language environment. The study emphasizes the importance of supporting language development in early childhood and contributes to the existing knowledge on language acquisition. Parents and educators can use these findings to help children develop their language skills.

Graphogame intervention as a tool for early diagnosis of reading difficulties in Spanish-speaking children with developmental language disorder

GraphoGame is a computer-based game that trains grapheme-to-phoneme associations and has been shown to benefit reading acquisition in different languages and countries. In transparent languages, such as Spanish, learning grapheme-to-phoneme associations is of great importance when learning to read, and GraphoGame can help children at risk of developing reading difficulties overcome their struggles. Children with developmental language disorder (DLD) are at high risk of developing reading difficulties, and they are therefore an interesting target group for a study on the effects of using GraphoGame as an intervention tool, as well as a tool for early diagnosis of later reading difficulties. Using generalised linear mixed models, this article explores the progress made in GraphoGame and reading-related skills by children with DLD – with and without comprehension difficulties – and their typically developing (TD) classmates in kindergarten or first grade. Fifty-nine children were included in the current study (16 TD and 43 DLD; mean age = 6.4 years, SD = 0.7 years). By testing children before and after six weeks of GraphoGame intervention, changes in their performance at letter recognition, pseudoword recognition and phonological awareness are studied. In addition to the differences due to oral language skills (expressive and receptive), how the children perform in GraphoGame and whether the progress in the aforementioned reading-related skills is predictive of reading status in second grade (good or poor readers) are examined. After six weeks of GraphoGame intervention, all children improved at all of the assessed reading-related skills, regardless of the test (letter recognition, phonological awareness and pseudoword recognition). Additionally, the children with DLD with comprehension difficulties made less progress in GraphoGame than the other two groups. The same was found for the children who were classified as poor readers in second grade: none of the poor readers reached the highest levels of the game. Finally, performance at the first level of GraphoGame mildly correlated with reading fluency, as assessed one year after the intervention. Future studies should consider larger populations, as well as the long-term effect of interventions such as the one studied here.

Dysembryoplastic neuroepithelial tumour - a reversible cause of neuroregression in children

Dysembryoplastic Neuroepithelial Tumour (DNET) is a rare brain tumour commonly involving the temporal lobe and presenting with intractable seizures. However, neuroregression as a presenting feature of DNET is uncommon. We report a case of a 12-year-old boy with DNET arising from the parietal lobe presenting with intractable seizures &amp; neuroregression. The child was subjected to neurosurgical resection of the lesion following which he made a full recovery. A review after surgery showed his epilepsy under control with good progress in scholastic, social adaptive and motor skills. This is the third report in literature of DNET surgery producing epilepsy control and reversing milestone regression. This demonstrates Epilepsy Surgery as a powerful tool in combatting neuro-regression secondary to lesional epilepsy.

Leading by example

Amy Purt, who is currently a nursery manager and Level 4 early years advanced practitioner, is undergoing a BA Hons Early Childhood Studies degree, and tells us how passionate she is about training and continuous professional development. Amy discusses leading by example, and this is certainly clear when it comes to continuous progression of knowledge and skills! It is also fantastic to read how well supported Amy felt throughout her journey in the early years from some brilliant staff teams and leaders, it is evident that this has really supported the love for early years and lifelong learning that Amy radiates!

Modelling Improper Integrals, a Case Study

Background: University students show little clarity in applying content related to improper integrals due to a lack of meaning that does not allow them to connect them with the environment and everyday life problems. Objective: To recognise improper integrals as a mathematical tool with multiple applications inside and outside mathematics. Design: Qualitative action research. Setting and participants: University engineering students. Data collection and analysis: A proposal was designed and applied to articulate mathematical modelling by using software, where a sequence of ten selected situations involving this type of integrals was experimented and solved. Results: The importance of modelling as a didactic-dynamic resource is highlighted because it helps students to reach and understand real situations involving improper integrals in different contexts. Conclusions: Despite the numerous errors detected in the students, this strategy made it possible to demonstrate that they developed mathematical competencies, which was manifested in the progress of advanced mathematical thinking skills.

Milestones 2.0 for Competency-Based Assessment of Radiation Oncology Medical Residents

<h3>Purpose/Objective(s)</h3> Radiation Oncology Milestones 1.0 was developed in 2011 to standardize competency-based assessment of radiation oncology medical residents using the Accreditation Council of Graduate Medical Education's (ACGME) 6 core competencies. However, its implementation across programs varied because the language was too complex, the sub-competencies lacked a clear progression between levels, and there were no directions for standardized use across programs. We hypothesized that the milestones could be revised to simplify the language, clarify expectations, and describe sequential clinical skill development while providing more guidance on implementation. <h3>Materials/Methods</h3> The ACGME assembled a 9-member volunteer working group to compose Milestones 2.0 for Radiation Oncology using a modified Delphi method consisting of multiple asynchronous small-group meetings interspersed with four web-based synchronous whole-group meetings until consensus was reached for each competency. New sub-competencies retained the ordinal 5-level scale from Milestones 1.0 where level 1 reflects expectations at the beginning of the post-graduate 2-year, level 4 describes competencies expected at graduation, and level 5 describes features displayed by the top 10% of residents. Additionally, the committee composed a supplemental guide that expounds on the implementation of Milestones 2.0. <h3>Results</h3> In Milestones 2.0, all sub-competencies were simplified by limiting the criteria for each level to a maximum of three descriptors and requiring the sub-competencies to chart a clear progression of advancing resident development across levels. Research was omitted from all competencies since it did not reflect a natural progression in clinical skills. Within the core competencies, disease-site specific Patient Care sub-competencies were revised to describe patient-centric care. For Medical Knowledge, Radiation Biology and Physics were grouped into Applied Sciences and Evidence-Based Foundations of Radiation Oncology was added. The descriptions for the remaining sub-competencies were condensed. The supplemental guide includes examples of different levels of resident competence and encourages the addition of program-specific examples to create a shared model among evaluators. <h3>Conclusion</h3> Milestones 2.0 simplifies competency-based assessment of radiation oncology medical residents, emphasizes skills needed for patient care, and provides additional guidance on implementation for programs. As it is put into practice in July 2022, we will continue to identify challenges with implementation and to design improvements.

Collaborative simulation rotation with integrated cardiothoracic and vascular surgery junior residents accelerates technical skill progression

ObjectiveIntegrated cardiothoracic surgery (CTS) and vascular surgery (VS) residents must achieve operative independence in fewer years compared with residents in traditional training paradigms. Developing a strong foundation early in training from which to build technical skills is of paramount importance. We hypothesized that intensive simulation performed by CTS and VS junior residents would accelerate technical skill progression and improve confidence. MethodsIn July 2021, 7 post-graduate year (PGY)-1 and 5 PGY-2 residents from integrated CTS and VS programs at a single institution participated in a collaborative simulation rotation. Training included low-fidelity vascular anastomoses, high-fidelity cadaver operative simulation, and core surgical tasks. Residents rated confidence levels before and after training. Performance during end-to-end and end-to-side vascular anastomoses (pre- and post-simulation) were evaluated for: respect for tissue, time and motion, needle handling, needle angles, and knot tying. ResultsEnd-to-end anastomosis scores increased from 10.4 to 19 (p < .001); completion times reduced from 10.8 to 8.7 min (p = .02). End-to-side anastomosis scores increased from 11.4 to 14.6 (p < .001); completion time was unchanged at 8.8 vs. 8.9 min. Trainee confidence level increased for these core tasks: knot tying (3.4 vs 4.1, p = .03), end-to-end anastomosis (2.1 vs 3.6, p < .01), end-to-side anastomosis (1.9 vs 3.3, p < .01), Castroviejo needle driver handling (2.7 vs 3.8, p < .01), ultrasound guided vascular access (2.4 vs 3.5, p = .01), bronchoscopy (1.8 vs 3.1, p = .01), and chest tube placement (1.9 vs 3.1, p < .01). ConclusionsDedicated collaborative simulation focusing on technical skills relevant to both CTS and VS trainees accelerates skills progression and increases resident confidence.

Data Fusion Technique for E-Learning Evaluation Based on Evidence Theory

To reduce the risk of viral infection during the coronavirus pandemic, all academic institutions have turned to online learning in recent years. The evolution of online classes presents new obstacles for academic specialists, particularly in underdeveloped nations where participants have limited access to technological gadgets. Even while some elements of online and traditional on-campus learning are comparable, online learning requires more factors to analyze, such as student evaluation. Because of the various surroundings that participants are exposed to during online education, the topic of electronic learning environments must be discussed. It calls for the development of new methodologies and procedures for assessing participants’ knowledge and skill development. Based on evidentiary theory and the data fusion idea, this research provides a new technique to evaluate participation. Because it is versatile in simulating the wide spectrum of uncertainty inherent in natural contexts, evidential theory is progressively spreading. The approach suggested is appropriate for dealing with all forms of online courses. Furthermore, it enables educators to improve academic performance by providing continuous participant feedback. After exposing participants’ weaknesses, the instructor can redirect learning processes. The experimental findings of three online university courses demonstrate the efficacy of this strategy.

Pediatric language assessments via telehealth: A systematic review

Introduction Assessment is crucial in the identification of children with potential delays/disorders and allows speech-language pathologists the opportunity to provide early intervention when indicated. For this reason, inaccessibility to formal assessments can be detrimental to the development and progression of overall communication skills for children with language disorders. The COVID-19 pandemic highlighted the need for increased telehealth services and how the provision of these remote services offers a much-needed alternative to face-to-face services for both clinicians and families. Method A systematic procedure involving online literature searches in four electronic databases was employed to identify studies for inclusion in this review. Inclusion criteria were as follows: (1) preschool or elementary pediatric participants, and (2) involve the delivery of language-based assessments via telehealth. Additionally, the search was limited to studies written in English, dated 2010 and newer, and published in peer-reviewed journals. Results The results of the systematic review showed there was no significant difference between standard scores and behavioral ratings for both face-to-face and telehealth assessments. The studies reviewed determined that telehealth delivery was feasible and presented adequate reliability with high levels of agreement between assessment scores obtained via telehealth and face-to-face. Conclusion Current research suggests that there is no significant difference between remote and face-to-face assessment administration. Additional research is needed to examine the feasibility and reliability of conducting language-based assessments via telehealth in bilingual children, children younger than four years of age, and in different environments, such as schools or clinics.

A Pilot Program: Remote Summer Program to Improve Opportunity and Mentorship Among Underrepresented Students Pursuing Orthopaedic Surgery.

We received 115 applications, and a total of 17 students participated in the program (14.8%). Nine faculty mentors were matched with 1 or 2 students each. The program delivered a curriculum from June-August 2021 consisting of (1) weekly instructional courses on research-related topics led by a content expert; (2) weekly faculty lectures discussing topics including orthopaedic topics, diversity in medicine, leadership, and work-life balance; and (3) a research experience paired with a faculty mentor and peer mentor. We surveyed students to measure skill progression, satisfaction, and overall program evaluation. Preprogram/postprogram evaluation, midprogram check-in, and student feedback surveys were collected. Program participants represented a range of race and ethnic backgrounds, research experience levels, and various geographic locations across the United States. The cohort included a high rate of female (42%) and Black (35%) participants. On average, postprogram survey scores indicated that participants believed that the summer program improved their research skills (9.6 of 10), improved their orthopaedic interest (8.9 of 10), and improved mentorship and networking (9.1 of 10). For feedback surveys, 14 respondents of 15 total responses (93%) felt they were adequately matched to their faculty mentor. Twelve (80%) felt they had realistic deliverables for research projects within the 8-week program. Thirteen (87%) indicated they contributed to an abstract or manuscript as a coauthor. Our findings indicate that students improved their research skills, interest, and confidence to pursue orthopaedic residency and mentorship/networks in the field. The long-term goal is to improve the accessibility and quality of mentorship for underrepresented students in order to foster an equitable pathway into the field of orthopaedic surgery.

A Creative Medical Investigation: Bridging the Soft Skill Gap

ABSTRACT The refinement of soft skills is essential to the success of athletic training students. Yet, more work is needed to identify desirable educational techniques to support the progression of soft skills in athletic training education. The current study identified professional athletic training students’ (10 students; 21.2 ± 2.1 years) perceptions of the five-part creative medical investigation (CMI) and described how the CMI could contribute to clinical reasoning, collaboration, and reflection, along with integrating soft skills with hard skills. The consensual qualitative research (CQR) approach utilized semi-structured interviews after the five CMI parts. Three qualitative researchers conducted CQR analysis after all interviews were complete. The researchers independently coded the interview transcripts and met to triangulate common themes; member checks were conducted to validate the findings. A 10-month follow-up survey evaluated the long-term effects of the CMI on selected subdomains of clinical reasoning. Five themes were identified from the consensual qualitative analysis. This CMI (1) Facilitated clinical reasoning, (2) Encouraged collaboration and reflection, (3) Promoted soft and hard skill integration, (4) Improved student confidence, (5) Enjoyed by the students. The follow-up survey indicated that students agreed (4.1–4.5 out of 5) this CMI leads to improvement in clinical reasoning subdomains. The current CMI facilitated desirable soft skills and integrated soft skills with hard skills through an enjoyable experience. Thus, the CMI might be a desirable educational technique with long-term implications to support the progression of soft skills in health care education.

Nurturing Students’ Academic Research writing through Experiential Learning: Work-based Teaching for Research Skill Development

Experiential or work-based learning is deemed essential for the completion of formal higher education qualifications, in particular postgraduate degrees. The aim of these research degrees is to develop the intellectual capacity of individuals to become independent researchers. This target is achieved by teaching courses on research methods. The current study is exploratory in nature that aims to explore change in the knowledge and skills of students through the experiential instruction method. Thirty students from a doctoral program were included as a sample of the study. Continuous feedback was taken from students through social media tools. The focus of feedback was targeting the dimensions of engagement of students in the research course. The discourse analysis of WhatsApp chat was used to analyze the data. In addition to this, further interviews were carried out to understand the progression and improvement in research skills.

Measuring advanced motor skills in children with cerebral palsy: development of normative data and percentile curves for the Challenge-20 assessment.

The Challenge-20 is an assessment of advanced motor skills of children with cerebral palsy. The purpose of this study was to develop age-related norms and percentile curves for the Challenge-20 with typically developing children ( n = 150, 7 through 11 years), and compare Challenge-20 scores of independently ambulatory children with CP, Gross Motor Function Classification System level I ( n = 135) and II ( n = 56) to these age norms. Younger TD children (7 years) scored lowest, and older children (11 years) scored highest on the Challenge-20 , showing similar developmental trajectories. Challenge-20 scores of 15% of children in GMFCS level I were situated above the lower 2.5th percentile curve of the typically developing children's Challenge-20 growth curve, that is, overlapping into the typically developing child zone. The Challenge-20 is sensitive to the progression of advanced gross motor skills in typically developing children. Children with cerebral palsy, GMFCS I follow similar, albeit lower, Challenge score trajectory to that of typically developing children, and in some cases come close to lower level abilities of typically developing children. The reference values with typically developing children extend the Challenge-20 's utility when assessing advanced gross motor skill of independently ambulatory children with cerebral palsy for physiotherapy intervention and physical activity planning and open the door to re-thinking more about advanced gross motor interventions for children with cerebral palsy in GMFCS levels I and II given their potential to progress along the developmental trajectory.

The factors affecting the critical thinking skills among nursing students – an integrative literature review

Abstract Aim. Review and analysis of available articles focused on factors affecting development of nursing students critical thinking. Material and methods. Integrative review of articles published between 2011 and 2021, available in the electronic databases PubMed, Scopus, Web of Science and EBSCO. Searching was based on keywords “critical thinking”, “nursing”, “nursing care”, “nursing education” which were connected by Boolean logic operators “and” as well as “or”. Results. There are several factors significant to advancement of critical thinking. Prevalent teaching methods, which promote development of critical thinking, constitute active learning strategies, concept mapping, simulation, problem-based learning, case study and learning methods based on evidence. Moreover, cultural and individual factors like empathy, emotional intelligence and caring behaviour show a significant relationship with critical thinking. Conclusions. Critical thinking represents an important meta-competence for nurses. Critical thinking contributes to adequate gathering of the information about patient, selection of those and formulating accurate diagnoses, progression of problem-solving skills and making decisions, improves communication with the patient. Analysis of relevant literature made it possible to indicate factors affecting critical thinking.

A Review of Rabies Treatment Methods in Ancient Iran

Rabies is a fatal viral disease affecting warm-blooded mammals (bats, carnivores, and ruminants) and even humans. The virus is usually transmitted between humans or other animals through the bite of infected animals. However, there are unusual ways to share the virus, such as organ transplants. Rabies has been known in the ancient world since about 2300 BC. Dogs were commonly known as the leading carriers of the disease. There were strange methods that were sometimes mixed with superstition and thought to treat or prevent rabies effectively. In ancient Iran, rabies was endemic. Scientists such as Avicenna (Ibn Sina, 980-1037 AD), Rhazes (Abu Bakr Al-Razi, 964-864 AD), Al-Biruni (970-1050 AD), Jorjani (1042-1136 AD), and Akhawyni Bokhari (913-971 AD) have described rabies, transmission, and treatment methods. This study aimed to present the development history of treatment methods against rabies based on ancient Iran's culture, civilization, and knowledge and examine its progress and development of practical skills against rabies.