Rate Of Skill Acquisition Research Articles

Family-Centric Applied Behavior Analysis Promotes Sustained Treatment Utilization and Attainment of Patient Goals.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social communication difficulties and restricted repetitive behaviors or interests. Applied behavior analysis (ABA) has been shown to significantly improve outcomes for individuals on the autism spectrum. However, challenges regarding access, cost, and provider shortages remain obstacles to treatment delivery. To this end, parents were trained as parent behavior technicians (pBTs), improving access to ABA, and empowering parents to provide ABA treatment in their own homes. We hypothesized that patients diagnosed with severe ASD would achieve the largest gains in overall success rates toward skill acquisition in comparison to patients diagnosed with mild or moderate ASD. Our secondary hypothesis was that patients with comprehensive treatment plans (>25-40 hours/week) would show greater gains in skill acquisition than those with focused treatment plans (less than or equal to 25 hours/week). Methods: This longitudinal, retrospective chart review evaluated data from 243 patients aged two to 18 years who received at least three months of ABA within our pBT treatment delivery model. Patients were stratified by utilization of prescribed ABA treatment, age, ASD severity (per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), and treatment plan type (comprehensive vs. focused). Patient outcomes were assessed by examining success rates in acquiring skills, both overall and in specific focus areas (communication, emotional regulation, executive functioning, and social skills). Patients receiving treatment within the pBT model demonstrated significant progress in skill acquisition both overall and within specific focus areas, regardless of cohort stratification. Patients with severe ASD showed greater overall skill acquisition gains than those with mild or moderate ASD. In addition, patients with comprehensive treatment plans showed significantly greater gains than those with focused treatment plans. The pBT model achieved both sustained levels of high treatment utilization and progress toward patient goals. Patients showed significant gains in success rates of skill acquisition both overall and in specific focus areas, regardless of their level of treatment utilization. This study reveals that our pBT model of ABA treatment delivery leads to consistent improvements in communication, emotional regulation, executive functioning, and social skills across patients on the autism spectrum, particularly for those with more severe symptoms and those following comprehensive treatment plans.

Effects of Initial versus Frequent Preference Assessments on Skill Acquisition

AbstractPrevious researchers have demonstrated that using stimuli identified via daily brief preference assessments may produce more responding under concurrent-schedule arrangements than using stimuli identified via lengthy, pre-treatment preference assessments (DeLeon et al., 2001). To date, this has not been evaluated within the context of skill acquisition. Thus, the extent to which conducting daily brief preference assessments impacts the rate of skill acquisition during discrete trial instruction (DTI) remains unknown. The purpose of this study was to evaluate how frequent, pre-session preference assessments, influence the rate of skill acquisition relative to an initial preference assessment during DTI sessions for three children with autism spectrum disorder (ASD). Two of the three children acquired the targeted skills faster in the frequent preference assessment condition. The third participant showed no difference in the rate of skill acquisition.

Mimicking the Maestro: Exploring the Efficacy of a Virtual AI Teacher in Fine Motor Skill Acquisition

Motor skills, especially fine motor skills like handwriting, play an essential role in academic pursuits and everyday life. Traditional methods to teach these skills, although effective, can be time-consuming and inconsistent. With the rise of advanced technologies like robotics and artificial intelligence, there is increasing interest in automating such teaching processes. In this study, we examine the potential of a virtual AI teacher in emulating the techniques of human educators for motor skill acquisition. We introduce an AI teacher model that captures the distinct characteristics of human instructors. Using a reinforcement learning environment tailored to mimic teacher-learner interactions, we tested our AI model against four guiding hypotheses, emphasizing improved learner performance, enhanced rate of skill acquisition, and reduced variability in learning outcomes. Our findings, validated on synthetic learners, revealed significant improvements across all tested hypotheses. Notably, our model showcased robustness across different learners and settings and demonstrated adaptability to handwriting. This research underscores the potential of integrating Imitation and Reinforcement Learning models with robotics in revolutionizing the teaching of critical motor skills.

Frontoparietal function and underlying structure reflect capacity for motor skill acquisition during healthy aging

While capacity for motor skill acquisition changes with healthy aging, there has been little consideration of how age-related changes in brain function or baseline brain structure support motor skill acquisition. We examined: (1) age-dependent changes in functional reorganization related to frontoparietal regions during motor skill acquisition, and (2) whether capacity for motor skill acquisition relates to baseline white matter microstructure in frontoparietal tracts. Healthy older and younger adults engaged in 4 weeks of skilled motor practice. Resting-state functional connectivity (rsFC) assessed functional reorganization before and after practice. Diffusion tensor imaging indexed microstructure of a frontoparietal tract at baseline, generated by rsFC seeds. Motor skill acquisition was associated with decreases in rsFC in healthy older adults and increases in rsFC in healthy younger adults. Frontoparietal tract microstructure was lower in healthy older versus younger adults, yet it was negatively associated with rate of skill acquisition regardless of group. Findings indicate that age-dependent alterations in frontoparietal function and baseline structure of a frontoparietal tract reflect capacity for motor skill acquisition.

Baseline performance in a robotic virtual reality platform predicts rate of skill acquisition in a proficiency-based curriculum: a cohort study of surgical trainees.

Residency programs must prepare to train the next generation of surgeons on the robotic platform. The purpose of this study was to determine if baseline skills of residents on a virtual reality (VR) robotic simulator before intern year predicted future performance in a proficiency-based curriculum. Across two academic years, 21 general surgery PGY-1s underwent the robotic surgery boot camp at the University of Texas Southwestern. During boot camp, subjects completed five previously validated VR tasks, and their performance metrics (score, time, and economy of motion [EOM]) were extracted retrospectively from their Intuitive learning accounts. The same metrics were assessed during their residency until they reached previously validated proficiency benchmarks. Outcomes were defined as the score at proficiency, attempts to reach proficiency, and time to proficiency. Spearman's rho and Mann-Whitney U tests were used; median (IQR) was reported. Significance level was set at p < 0.05. Twenty-one residents completed at least three out of the five boot camp tasks and achieved proficiency in the former during residency. The median average score at boot camp was 12.3 (IQR: 5.14-18.5). The median average EOM at boot camp was 599.58cm (IQR: 529.64-676.60). The average score at boot camp significantly correlated with lower time to achieve proficiency (p < 0.05). EOM at boot camp showed a significant correlation with attempts to proficiency and time to proficiency (p < 0.01). Residents with an average baseline EOM below the median showed a significant difference in attempts to proficiency (p < 0.05) and time to proficiency (p < 0.05) compared to those with EOMs above or equal to the median. Residents with an innate ability to perform tasks with better EOM may acquire robotic surgery skills faster. Future investigators could explore how these innate differences impact performance throughout residency.

Interactive computer-assisted learning as an educational method for learning pediatric interproximal dental caries identification

We developed a web-based tool to measure the amount and rate of skill acquisition in pediatric interproximal caries diagnosis among pre- and postdoctoral dental students and identified variables predictive for greater image interpretation difficulty. In this multicenter prospective cohort study, a convenience sample of pre- and postdoctoral dental students participated in computer-assisted learning in the interpretation of bitewing radiographs of 193 children. Participants were asked to identify the presence or absence of interproximal caries and, where applicable, locate the lesions. After every case, participants received specific visual and text feedback on their diagnostic performance. They were requested to complete the 193-case set but could complete enough cases to achieve a competency performance standard of 75% accuracy, sensitivity, and specificity. Of 130 participants, 62 (47.7%) completed all cases. The mean change from initial to maximal diagnostic accuracy was +15.3% (95% CI, 13.0-17.7), sensitivity was +10.8% (95% CI, 9.0-12.7), and specificity was +15.5% (95% CI, 12.9-18.1). The median number of cases completed to achieve competency was 173 (interquartile range, 82-363). Of these 62 participants, 45 (72.6%) showed overall improvement in diagnostic accuracy. Greater numbers of interproximal lesions (P < .001) and the presence of noninterproximal caries (P < .001) predicted greater interpretation difficulty. Computer-assisted learning led to improved diagnosis of interproximal caries on bitewing radiographs among pre- and postdoctoral dental students.

Establishing the Validity and Reliability of an Online Motor Learning Game: Applications for Alzheimer's Disease Research Within MindCrowd.

Objective: Motor practice effects (i.e., improvements in motor task performance with practice) are emerging as a unique variable that can predict Alzheimer's disease (AD) progression and biomarker positivity. However, the tasks used to study motor practice effects have involved face-to-face assessment, making them difficult to integrate into large internet-based cohorts that represent the next generation of AD research. The purpose of this study was to validate an online computer game against its in-lab version, which has been shown previously to characterize motor practice effects. Materials and Methods: This study leveraged young adult participants within the MindCrowd electronic cohort, a large nationwide cohort for AD research collected entirely through the internet. Validation compared performance on the online version among MindCrowd users against an age-matched cohort's performance on an in-lab version using a different controller (Xbox 360 controller joystick for in-lab sample versus keyboard arrow keys for online sample). Results: Data indicated that the rate of skill acquisition among MindCrowd users were not significantly different from those of the in-lab cohort. Furthermore, the contact-to-consent rate observed in this study (although low) was similar to that of other online AD cohorts. Conclusion: Overall, this study demonstrates that implementing online games designed to study and measure motor practice effects into online research cohorts is feasible and valid. Future research will explore how online game performance is associated with age and dementia risk factors that may help further an understanding of AD.

Rey-Osterrieth complex figure recall scores and motor skill learning in older adults: A non-linear mixed effect model-based analysis

Age-related declines in motor learning are well documented. Visuospatial memory has been proposed as a key factor explaining age-related declines in sensorimotor adaptation, but most studies have not used standardized visuospatial memory tests nor controlled for age-related visuospatial memory declines. The present study explores the relationship between visuospatial memory and motor learning in older adults while also controlling for age and utilizing a standardized visuospatial memory test. Forty-nine nondemented older adults repetitively practiced a functional upper-extremity motor task and were re-assessed one week later. Training data were modeled with mixed-effect exponential decay functions, with parameters representing amount of performance change, rate of improvement, and final performance. Age and visuospatial memory were included as possible covariates for the parameter measuring rate of improvement (τ). After controlling for age, higher visuospatial memory scores were associated with faster rates of skill acquisition and better short-term retention one week later. These associations with visuospatial memory were dependent, however, on the level of initial skill. These findings suggest that the extent of re-learning motor skills in geriatric physical rehabilitation may depend on intact visuospatial memory.

270 The Innate Aptitude's Effect on the Surgical Task Performance

Abstract Aim Surgery is a craft profession requiring individuals with specific innate aptitudes for manipulative skills, visuospatial and psychomotor abilities. The selection process of surgical trainees excludes aptitude testing for the psychomotor and manual manipulative skills of candidates for required abilities. We scrutinize the effect of innate aptitudes in surgery and its skill-training by systematically reviewing its significance on the surgical task performance. Method A systematic review was performed by PRISMA guidelines. A search on PubMed/Medline for English language articles was performed from January 2001 to January 2021. Search terms were ‘aptitude for surgery’, ‘innate aptitude and surgical skills’, ‘manipulative abilities and surgery’ and ‘psychomotor skills and surgery’. The quality of quantitatively researched citations was assessed by MERSQI scores. Results The results yielded 1142 studies and 21 met the inclusion criteria and 6 high-quality citations rejected our 3-null hypothesis, and all medical students cannot reach proficiency in skills necessary for a career in surgery. Playing video games and/or musical instruments do not promote surgery skill; yet a valid test with predictive value for novices aspiring for a surgical career is helpful. MERSQI mean score was 11.07 (SD= .98; range 9.25 to 12.75). Conclusions Visuospatial aptitude, rate of skill acquisition and quality of surgical performance predicted baseline surgical ability. Additionally, visuospatial aptitude along with psychomotor skills and perceptual talent, furthered laparoscopic simulator performance. The selection process for candidates suitable for a career in surgery requests a simulated surgical environment, where the candidates’ skills also in forms of non-technical aptitudes are assessable.

An educational method for learning and assessing interproximal dental caries diagnosis in children's radiographs

<h3>Background</h3> Dental caries is common in children, and intraoral bitewing radiographs are the gold standard for diagnosing interproximal caries. Accurate interpretation of radiographs is a key competency for dentists treating children to minimize the consequences of misdiagnosis. There are currently no validated methods for assessment of this important competency for Canadian dental trainees. <h3>Objective</h3> We developed an interactive computer-assisted learning (CAL) tool designed to permit the deliberate practice of pediatric bitewing radiograph interpretation. The main objective of this study was to measure the amount and rate of skill acquisition in the diagnosis of interproximal dental caries amongst dental trainees, and to determine the effect size of our education intervention. <h3>Study Design</h3> This multi-center prospective cohort study used a convenience sample of Canadian dental trainees ranging in experience from undergraduate dental education to graduate pediatric dentistry. Reference standard caries diagnosis was determined by consensus between three dental specialists. Study participants learned to interpret children's bitewing radiographs on a web-based platform by deliberately practicing 193 cases with the goal of achieving a performance benchmark of 75% accuracy, sensitivity, and specificity. Participants identified the presence/absence of interproximal dental caries, and if present, identified the specific location of all lesions. <h3>Results</h3> To date, 60 participants have completed all 193 cases, and 10 participants have achieved the performance benchmark. There was a significant increase of 17.8% (95% CI 14.6, 21.0) from mean initial to maximal accuracy amongst participants. The median number of cases to achieve competency was 180 (min 84, max 550). The effect size of the education intervention was large, with a Cohen's d=1.6 (95% CI 1.2-2.10). <h3>Conclusion</h3> The learning intervention evaluated in this study has led to effective and feasible skill improvement in the interpretation of interproximal dental caries on bitewing radiographs amongst dental trainees and may be a valuable adjunct to existing educational methods in dental radiology. <b>Statement of Ethical Review</b> Human/Animal subjects were used and this study was approved by an institutional ethics panel

EP-19 The innate aptitude's effect on the surgical task performance

Abstract Aims Surgery is a craft profession requiring individuals with specific innate aptitudes for manipulative skills, visuospatial and psychomotor abilities. The selection process of surgical trainees excludes aptitude testing for the psychomotor and manual manipulative skills of candidates for required abilities. We scrutinize the effect of innate aptitudes in surgery and its skill-training by systematically reviewing its significance on the surgical task performance. Methods A systematic review was performed by PRISMA guidelines. A search on PubMed/Medline for English language articles was performed from January 2001 to January 2021. Search terms were ‘aptitude for surgery’, ‘innate aptitude and surgical skills’, ‘manipulative abilities and surgery’ and ‘psychomotor skills and surgery’. The quality of quantitatively researched citations was assessed by MERSQI scores. Results The results yielded 1142 studies and 21 met the inclusion criteria and 6 high-quality citations rejected our 3 null hypothesis and all medical students cannot reach proficiency in skills necessary for a career in surgery. Playing video games and/or musical instruments do not promote surgery skill; yet, a valid test with predictive value for novices aspiring for a surgical career is helpful. MERSQI mean score was 11.07 (SD= .98; range 9.25 to 12.75). Conclusion Visuospatial aptitude, rate of skill acquisition and quality of surgical performance predicted baseline surgical ability. Additionally, visuospatial aptitude along with psychomotor skills and perceptual talent, furthered laparoscopic simulator performance. The selection process for candidates suitable for a career in surgery requests a simulated surgical environment, where the candidates’ skills also in forms of non-technical aptitudes are assessable.

306EMF Defining the Learning Curve for First Trimester Ultrasound Image Interpretation Skills for Emergency Physicians

First trimester pregnancy ultrasound is an oft-used, high-stakes skill for emergency physicians (EPs). Performing bedside ultrasound for symptomatic first trimester pregnant patients requires the skill of image acquisition, image interpretation and integration of interpretation in clinical decision-making. Learning curves for EPs' skills in ultrasound applications have been shown to vary considerably. Some have advocated for a “mastery-based” competency evaluation in which trainees practice until they reach a pre-defined level of performance. However, clinical practice alone may not be sufficient in achieving this standard since opportunities for immediate feedback at the bedside may be limited by the number of patient encounters and the frequency of pathology. Little is known about the development of the skill of image interpretation over time among EPs engaged in deliberate practice of image review. The objective of this study is develop an educational innovation to teach first trimester pregnancy ultrasound image assessment using an online learning platform and assess learners’ skill acquisition for this critical emergency medicine skill. This is a multicenter prospective cohort study. First trimester ultrasound examinations from two academic medical centers’ ultrasound image archival systems were reviewed to identify 400 high-quality studies with complete imaging and a specified case mix. An online experience was developed for each case and integrated into an online learning platform. Images, case-specific information and education for each case were developed and reviewed by emergency ultrasound specialists. EPs will be recruited to complete an education experience using the online learning platform which presents cases and images to physicians whose interpretations are then evaluated. 400 cases of early first trimester ultrasound examinations have been reviewed and cataloged, including 200 transvaginal and 200 transabdominal ultrasound examinations. Of these, 195 include an intrauterine pregnancy (IUP), 205 do not include an IUP, 132 are viable, and 43 are confirmed ectopic pregnancies. Classification of findings of each case has been reviewed by one expert reviewer. Development of an online learning intervention is underway. Data acquisition of 135 EPs’ performance with this intervention, rate of skill acquisition and learning curves is forthcoming. We will determine changes in accuracy, sensitivity and specificity, and the effect size of the learning intervention. We will determine the item reliability and interpretation difficulty for each case. We will determine the time it took to complete the course and evaluate the participant experience. We will examine the rate of learning for first trimester TVUS and TAUS measured by deriving learning curves and determining the median number of cases required to reach the following performance benchmarks: 80%, 85%, 90%, and 95% accuracy. EPs frequently evaluate symptomatic first trimester pregnant patients. Patients experience high morbidity and mortality if an ectopic pregnancy is missed and ultrasound is the imaging modality of choice to evaluate for the presence or absence of an IUP. We have developed an online learning platform with an image bank of 400 cases and plan to evaluate 135 physician’ learning with the platform.

Further examination of the effects of order of stimulus presentation on receptive discrimination

AbstractRecent research has demonstrated that the order of stimulus presentation during auditory‐visual discrimination training may influence the rate of skill acquisition. Results of some studies have suggested that presenting the sample auditory stimulus prior to the comparison visual stimuli may enhance learning for typically developing children. However, replication efforts in individuals with autism spectrum disorder (ASD) in structured discrete‐trial formats have produced mixed results. The purpose of the current study was to further evaluate the role of stimulus order during auditory‐visual discrimination training to learners with ASD or speech delays during discrete trial instruction. Five of the six children who participated in the study acquired the skills faster during the sample‐first stimulus condition.

Child Abuse Recognition Training for Prehospital Providers Using Deliberate Practice

Background In most states, prehospital professionals (PHPs) are mandated reporters of suspected abuse but cite a lack of training as a challenge to recognizing and reporting physical abuse. We developed a learning platform for the visual diagnosis of pediatric abusive versus non-abusive burn and bruise injuries and examined the amount and rate of skill acquisition. Methods This was a prospective cross-sectional study of PHPs participating in an online educational intervention containing 114 case vignettes. PHPs indicated whether they believed a case was concerning for abuse and would report a case to child protection services. Participants received feedback after submitting a response, permitting deliberate practice of the cases. We describe learning curves, overall accuracy, sensitivity (diagnosis of abusive injuries) and specificity (diagnosis of non-abusive injuries) to determine the amount of learning. We performed multivariable regression analysis to identify specific demographic and case variables associated with a correct case interpretation. After completing the educational intervention, PHPs completed a self-efficacy survey on perceived gains in their ability to recognize cutaneous signs of abuse and report to social services. Results We enrolled 253 PHPs who completed all the cases; 158 (63.6%) emergency medical technicians (EMT), 95 (36.4%) advanced EMT and paramedics. Learning curves demonstrated that, with one exception, there was an increase in learning for participants throughout the educational intervention. Mean diagnostic accuracy increased by 4.9% (95% CI 3.2, 6.7), and the mean final diagnostic accuracy, sensitivity, and specificity were 82.1%, 75.4%, and 85.2%, respectively. There was an increased odds of getting a case correct for bruise versus burn cases (OR = 1.4; 95% CI 1.3, 1.5); if the PHP was an Advanced EMT/Paramedic (OR = 1.3; 95% CI 1.1, 1.4) ; and, if the learner indicated prior training in child abuse (OR = 1.2; 95% CI 1.0, 1.3). Learners indicated increased comfort in knowing which cases should be reported and interpreting exams in children with cutaneous injuries with a median Likert score of 5 out of 6 (IQR 5, 6). Conclusion An online module utilizing deliberate practice led to measurable skill improvement among PHPs for differentiating abusive from non-abusive burn and bruise injuries.

The MBA in Medical Education: Current MD/MBA Student Aspirations, Perceptions, and Motivations

BackgroundAs combined Doctor of Medicine and Master of Business Administration (MD/MBA) programs gain popularity, it is critical to understand the motives, perceptions, and interests of MD/MBA students. The purpose of this study was to investigate career aspirations of MD/MBA students, skills they perceive to gain from the dual degree, and reasons why students enroll in MD/MBA programs. Materials and methodsAll 73 MD/MBA programs in the United States were invited to participate in a twelve-question, online survey. Responses were collected between August 2019 and February 2020 from students enrolled during the 2019-2020 academic year. The questions were designed to examine career aspirations, program perceptions, and personal motivations. Data were aggregated into descriptive summary statistics and rank orders. ResultsA total of 18 MD/MBA programs agreed to participate in this study, of which 14 met criteria for final analysis. From these programs, 67 of 175 students responded (38%). Among respondents, 100% planned to pursue residency. The most common career interests included the following: clinical practice at an academic hospital (85%), executive leadership in a hospital network (76%), and clinical practice in a community hospital (65%). Students ranked “making a broader impact on health care” and “pursuing leadership in clinical practice” highest among reasons to pursue an MD/MBA. Students reported high rates of acquiring MBA-oriented skills. ConclusionsMD/MBA students in this study focused on pursuing clinical careers. Students appear satisfied with their education, reporting high rates of skill acquisition. Residency programs interested in MD/MBA students can incorporate leadership and entrepreneurial opportunities to foster students’ broad interests.

Training behavioural therapists in presession pairing skills to evaluate the impact on children’s life skill acquisition rates

Presession pairing is a well-documented behaviour analytic practice that supports the development of a positive instructional environment and is associated with reduced rates of challenging behaviour among children with developmental disabilities. However, there is limited research evaluating the impact of presession pairing on children’s skill acquisition rates. Therefore, in the current study, four behavioural therapists were systematically trained in an established presession pairing protocol and using a multiple baseline across participants design, the impact of this training on life skill acquisition rates among a group of four children with Autism Spectrum Disorder was evaluated. A robust improvement rate difference was calculated for each child and a robust omnibus improvement rate difference showed that the impact of training therapists in the presession pairing protocol had a very small effect on the children’s life skill acquisition rates. These findings were discussed in the context of the importance of reporting null findings and designing replication studies that provide an understanding of why an effect was not demonstrated, in order to develop and refine clinical practice.

Evaluating the Effects of Establishing Eye Contact on the Skill Acquisition of Individuals with Autism

Researchers widely assert that requiring eye contact from students with autism spectrum disorder (ASD) before instruction is highly important to the outcome of teaching (Greer and Ross in Verbal behavior analysis, Pearson Education, New York, 2008; Lovaas in J Consult Clin Psychol 55(1):3–9, 1977. https://doi.org/10.1037/0022-006x.55.1.3). However, to our knowledge, no research to date has evaluated the effects of this component of instruction on skill acquisition. In this current study, we evaluated the effect of requiring student eye contact from participants with ASD prior to giving an instruction on the rate of skill acquisition. Using an adapted alternating treatments design, this study compared the skill acquisition of three participants diagnosed with ASD during discrete-trial instruction (DTI) for expressive identification of novel items. Requiring eye contact was manipulated as a treatment integrity error during DTI in high-integrity, low-integrity, and control conditions. The experimenter established eye contact with the participants prior to giving an instruction during 100% of trials in the high-integrity condition, whereas eye contact was only established prior to the instruction in 67% of trials in the low-integrity condition. Results indicate that all three participants acquired expressive labels for items in fewer sessions in the high-integrity condition as compared to the low-integrity condition. Implications for the impact of eye contact on skill acquisition are discussed.

Focused cardiac ultrasound training in medical students: Using an independent, simulator-based curriculum to objectively measure skill acquisition and learning curve.

Using simulators built and validated at the University of Washington (UW), the study sought to test whether medical students can learn the basic skills of focused cardiac ultrasound (FoCUS) from an individually paced, simulator-based curriculum, how skills improve, and the rate at which these skills are acquired. The curriculum presented didactic material interspersed with hands-on practice. Psychomotor skill was measured by the angle error of the acquired image view plane relative to the correct image view plane. The rate of learning was assessed at baseline, after 7 practice cases, and after 10 cases. To assess the rate of learning, the same case was repeatedly presented at all three tests. To assess students' ability to apply their learning, a previously unseen post-test was included. A total of 41 students completed the course. Average angle error improved from 43°±24 pretraining to 23°±16 post-training, with most students falling within one SD of the view angle acquired by sonographers. Regarding learning curve, or the rate of skill acquisition, an angle error of 43±24° (pre) changed to 22±14° (interim test, P<.0001 vs. pretest) and remained at that level for the post-test evaluation on both the repeated case (23±16°) and the new case (26±18°). This study describes the learning curve and technical skill acquisition in FoCUS. A simulator-based curriculum improved medical student's skills in an objective and quantifiable manner. The individually paced curriculum allowed for independent knowledge and skill attainment, without facilitator oversight.

Deliberate practice as an educational method for learning to interpret the prepubescent female genital examination

BackgroundCorrect interpretation of the prepubescent female genital examination is a critical skill; however, physician skill in this area is limited. ObjectiveTo complement the bedside learning of this examination, we developed a learning platform for the visual diagnosis of the prepubescent female genital examination and examined the amount and rate of skill acquisition. Participants and SettingMedical students, residents, and fellows and attendings participated in an on-line learning platform. MethodsThis was a multicenter prospective cross-sectional study. Study participants deliberately practiced 158 prepubescent female genital examination cases hosted on a computer-based learning and assessment platform. Participants assigned the case normal or abnormal; if abnormal, they identified the location of the abnormality and the specific diagnosis. Participants received feedback after every case. ResultsWe enrolled 107 participants (26 students, 31 residents, 24 fellows and 26 attendings). Accuracy (95 % CI) increased by 10.3 % (7.8, 12.8), Cohen’s d-effect size of 1.17 (1.14, 1.19). The change in specificity was +16.8 (14.1, 19.5) and sensitivity +2.4 (-0.9, 5.6). It took a mean (SD) 46.3 (32.2) minutes to complete cases. There was no difference between learner types with respect to initial (p = 0.2) or final accuracy (p = 0.4) scores. ConclusionsThis study’s learning intervention led to effective and feasible skill improvement. However, while participants improved significantly with normal cases, which has relevance in reducing unnecessary referrals to child protection teams, learning gains were not as evident in abnormal cases. All levels of learners demonstrated a similar performance, emphasizing the need for this education even among experienced clinicians.

Using Simulation to Define the Learning Curve for the Digital Cervical Examination.

To assess how skill in the digital cervical examination is acquired in medical students. In a longitudinal study, medical students completed 200 simulated cervical examinations. We performed regressions of each student's cumulative accuracy using the linear, power, and sigmoidal models to determine best fit. We also constructed multilevel models to determine the influence of dilation and effacement on accuracy and to determine whether the starting level and rate of learning varied between individuals. To assess skill decay, we assessed accuracy at 1, 2, and 5 months after training. We defined the amount of sustained accuracy needed to achieve competence using cumulative summation analyses and determined the amount of practice needed to reach this level of skill. Twenty-five medical students participated. The median (interquartile range) of cumulative accuracy at the end of the study was 69% (65-78) for dilation and 80% (76-91) for effacement. The sigmoidal model had the best fit. All students achieved competence during the study. The multilevel models showed that accuracy decreased with higher dilation and lower effacement and found that starting level and rate of learning varied between individuals. Maximal accuracy in both dilation and effacement was seen after 150 repetitions. Accuracy of the medical students persisted for 1 month for dilation and 2 months for effacement. The average±SD number of repetitions needed to achieve competence was 89±46 (range 35-195) for dilation and 48±38 (range 11-174) for effacement. Based on the variability in skill between individuals and the rate of skill acquisition and decay, we feel that a competence-based rather than time-based approach is most appropriate, that trainee performance should be monitored both during and after training, and that 150 repetitions, or more, should be included in any digital cervical examination simulation regimen.