Self-directed Training Research Articles

How American Adults Obtain Work Skills: Results of a New National Survey

Employer-provided training is an important determinant of economic outcomes, yet our understanding of its extent and distribution is well out of date—with the most recent national survey being from 2008. This article updates our understanding of employer-provided training through a 2020 nationally representative survey of 3,648 working civilian adults between the ages of 24 and 64. Results show that while employer-provided training is reasonably extensive, considerable disparities occur along the lines of race, ethnicity, and educational attainment. Additionally, the author contributes to the literature by making clear distinctions among types of employment—standard, contract (those employed by a contract company but working onsite at another firm), and freelancer (those with no employer per se). Contract workers receive considerably less employer training than do employees who work under standard arrangements. Findings are robust to a range of job skill measures as well as skill specificity. The author also examines the relationship between employer-provided training and whether people seek out training on their own and shows that the inequalities in access to employer-provided training are accentuated with self-directed training.

The Intelligent Platform of Autonomous Learning in Post-Secondary Education

The aim of the study was to develop and test the effectiveness of an autonomous learning intelligent platform in post-secondary education. It was conducted on the basis of the Institute of Dentistry named after E.V. Borovsky in I.M. Sechenov First Moscow State Medical University (Moscow, Russia) and Humanitarian and technical academy (Kokshetau, Kazakhstan). This research involved 59 teachers and 390 students, who comprised the total sample of 449 respondents. The experiment consisted of three stages – introductory, experimental, and final. The introductory stage included the distribution of enrolled students into the experimental and control groups. Besides, at the introductory stage, the development of questionnaires directed at identifying students’ and teachers’ readiness to implement autonomous learning was performed. Apart from this, the involved educators were required to fill the learning platform with predetermined training content. The considered intelligent learning platform was developed by programmers by prior agreement with educational institutions under study. The experimental stage was aimed at introducing the designed model of autonomous learning based on the created intelligent platform. The final stage implied surveying of all study participants according to the developed questionnaires. After the introduction of the created autonomous learning model, it was revealed that 51.5% of enrolled teachers were ready for self-directed education at a high level, 20.4% – at a satisfactory level, 18.4% – at a moderate level, and 9.7% – at a low level. Among the students of Sechenov University, 21% of respondents had a high level of readiness for autonomous learning based on intelligent platforms, 27% of students had a sufficient level, 35% – moderate, and 17% – low. Among the Humanitarian and technical academy students, 29% had a high readiness for autonomous learning, 30% were ready at a sufficient level, 25% at a moderate, and 16% at a low level. This study provided an opportunity to use the developed questionnaires and the model of autonomous learning in post-secondary education for further research on the implementation of self-directed training.

A decision-neuroscientific intervention to improve cognitive recovery after stroke.

Functional recovery after stroke is dose-dependent on the amount of rehabilitative training. However, rehabilitative training is subject to motivational hurdles. Decision neuroscience formalizes drivers and dampers of behaviour and provides strategies for tipping motivational trade-offs and behaviour change. Here, we used one such strategy, upfront voluntary choice restriction ('precommitment'), and tested if it can increase the amount of self-directed rehabilitative training in severely impaired stroke patients. In this randomized controlled study, stroke patients with working memory deficits (n = 83) were prescribed daily self-directed gamified cognitive training as an add-on to standard therapy during post-acute inpatient neurorehabilitation. Patients allocated to the precommitment intervention could choose to restrict competing options to self-directed training, specifically the possibility to meet visitors. This upfront choice restriction was opted for by all patients in the intervention group and highly effective. Patients in the precommitment group performed the prescribed self-directed gamified cognitive training twice as often as control group patients who were not offered precommitment [on 50% versus 21% of days, Pcorr = 0.004, d = 0.87, 95% confidence interval (CI95%) = 0.31 to 1.42], and, as a consequence, reached a 3-fold higher total training dose (90.21 versus 33.60 min, Pcorr = 0.004, d = 0.83, CI95% = 0.27 to 1.38). Moreover, add-on self-directed cognitive training was associated with stronger improvements in visuospatial and verbal working memory performance (Pcorr = 0.002, d = 0.72 and Pcorr = 0.036, d = 0.62). Our neuroscientific decision add-on intervention strongly increased the amount of effective cognitive training performed by severely impaired stroke patients. These results warrant a full clinical trial to link decision-based neuroscientific interventions directly with clinical outcome.

The Challenges of Dyad Practice in Simulation Training of Basic Open Surgical Skills-A Mixed-Method Study.

Simulation training at home improves access to training, but motivation can be difficult to maintain. Dyad training could keep trainees motivated. This study aimed to examine the effect of self-regulated training of basic surgical skills in pairs versus individually. One hundred one medical doctors were included in this prospective, mixed-method, simulation-based study. Participants were randomized to train individually or in pairs during a 6-week course in open surgical skills, consisting of didactic instructions and self-directed training at home. Trainees kept a training log and filled in a questionnaire. Skills were tested before and after the course. Tests were rated by an expert using the Objective Structured Assessment of Technical Skills Global Rating Scale. Ninety-seven doctors completed the study. We found no differences in test score between dyad and individual trainees. Dyad trainees compared with individual trainees improved by 7.23 points (intercept estimate) versus 6.94 points, respectively (P = 0.881). Dyad trainees trained less frequently [7.3 times (intercept estimate) vs. 12.1 times, P < 0.001, but for longer intervals compared with individual trainees (68 minutes vs. 38 minutes)]. Dyad trainees reported benefits such as having a sparring partner, receiving feedback, corrections, increased motivation, having fun, and more structured training sessions. However, the coordination of training sessions was difficult. No differences were found between dyad trainees and individual trainees in improvement of surgical skills. Off-site dyad training led to fewer, but longer training sessions, which may have negatively impacted the effectiveness of training. Dyad trainees perceived dyad training beneficial.

The Role of Virtual Reality Technology in Medical Education in the Context of Emerging Medical Discipline

According to Healthy China, a national strategy of the Government of China, new requirements were put forward for high-quality medical education, high-level surgical research, and precise clinical diagnosis and treatment. In the context of Emerging Medical Discipline, a strategic blueprint of medical education in China, this paper reviews the concept and core value of virtual reality (VR) and its significant role in the medical industry. On that basis, we explore the role of VR technology in medical training against the background of Emerging Medicine Discipline. Furthermore, typical cases are presented to help analyze and illustrate in detail the important role of VR technology in the teaching and training of stomatological and clinical procedures, skills assessment, online self-directed training, and clinical thinking skills training. We herein summarize useful information from past experience so as to help build innovative models of medical education in the context of Emerging Medical Discipline.

A atuação do socorrista leigo em caso de parada cardiorrespiratória em ambiente extra-hospitalar

The aim was to analyze the evidence on the role of laypersons in cases of out-of-hospital cardiopulmonary arrest. This is an integrative literature review, with a critical and retrospective characteristic, with complete primary data sources, published between 2015 and 2020, in the following databases: MEDLINE, LILACS, BDENF, SciELO and Google Scholar. The publications included in the study were 07 articles. The results found showed that the training of lay people can be done through a balance between self-learning and teaching given by instructors with practical classes. If there is no instructor-led course or training, so-called self-directed training is an accepted recommendation for lay rescuers, video classes can further drive learning. With more people trained, there is a greater chance that one of them will witness an out-of-hospital cardiopulmonary arrest case and perform quality cardiopulmonary resuscitation. When analyzing the layperson's performance in cases of out-of-hospital cardiopulmonary arrest, this action, when performed in accordance with international protocols, will provide early assistance to the victim and increase the survival rate, thus serving as a foundation for the assistance of the medical service of emergency when you get to the scene.

Clinical effectiveness of peroneal nerve functional electrical stimulation in chronic stroke patients with hemiplegia (PLEASURE): A multicentre, prospective, randomised controlled trial

Objective: To compare the effectiveness of gait training using a peroneal nerve stimulation device with the effectiveness of gait training without the device in improving gait ability and ankle-specific body functions. Design: Multicentre, prospective, randomised, open-label trial. Setting: Twenty-three hospitals. Subjects: In total, 119 stroke patients with foot drop were randomly assigned to the experimental (with the device) or control (without the device) group. Intervention: Subjects underwent 480-minute self-directed training over four weeks, followed by 260-minute physical therapist-assisted gait training with or without the device. Main measures: The primary endpoint was a change in the six-minute walk test (6MWT) without the device from baseline to after the four-week intervention. The secondary endpoints were changes in the 10-metre walk test (10MWT) without the device, Fugl-Meyer Assessment, range of motion, muscle strength, Modified Ashworth Scale, Stroke Impact Scale Japanese edition (J-SIS) and adverse events. Results: Fifty-six experimental and 59 control group participants, with an average age of 59 years (SD 12) completed the trial. The 6MWT distance changes (m) for the experimental and control groups were 14.7 (SD 37.6) and 22.2 (SD 49.3), respectively. The 10MWT speed changes (m/sec) for the experimental and control groups were 0.06 (SD 0.12) and 0.07 (SD 0.17), respectively. No significant differences were observed in these changes between both groups, and no differences were found in the other secondary endpoints, except for the J-SIS patient’s subjective assessment (P = 0.048). Conclusion: The improvement in gait ability and body functions were equivalent with or without the use of the device.

Confocal Laser Endomicroscopy Interpretation and Differentiation of Pancreatic Cysts: A Randomized Trial of Teaching Modalities

ABSTRACT Background EUS-guided needle-based confocal laser endomicroscopy (nCLE) has not been widely adopted for the differentiation of pancreatic cystic lesions (PCLs), perhaps due to a perceived difficulty in learning novel CLE image patterns. Hence, we sought to investigate the optimal teaching modality for interpretation of nCLE imaging from PCLs. Methods Sixteen nCLE-naive observers blinded to clinical data were randomized into didactic (classroom-based) versus self-directed (computer-based) teaching groups to review nCLE videos and differentiate mucinous and non-mucinous PCLs. The study was conducted concurrently for both groups in 3 phases. Phase-1-Teaching: both groups received an overview of EUS-nCLE of PCLs. Phase-2-Training: assessment of 20 EUS-nCLE subject-videos; the didactic group had a feedback session with an nCLE expert while the self-directed group received this information via pre-recorded presentation. Phase-3-Testing: assessment of 50 EUS-nCLE subject-videos. Results For all observers (n = 16), the diagnostic accuracy for nCLE-based differentiation of mucinous from non-mucinous PCLs was higher (p=0.005) in the Phase-3-Testing (94.6%, 95%CI: 92-96%) than in Phase-2-Training (89.9%, 95%CI: 85-93%). During Phase-3-Testing, both the didactic and self-directed teaching groups achieved a comparable (p=0.48) diagnostic accuracy of 93.9% and 95.4%, respectively. The interobserver agreement (kappa, standard error) for the differentiation of mucinous from non-mucinous PCLs improved from Phase-2-Training to Phase-3-Testing stage, and was “substantial” for both the didactic (k=0.81, 0.03) and self-directed (k=0.79, 0.03) training groups. Conclusion Notwithstanding didactic and self-directed teaching, a ‘training’ and ‘test’ strategy accomplished high diagnostic accuracies and considerable interobserver agreement among naive observers for EUS-nCLE image differentiation of PCLs; Clinical trial NCT02516488 ( https://clinicaltrials.gov/ct2/show/NCT02516488 )

Content validity evidence for a simulation-based test of handheld otoscopy skills.

At graduation from medical school, competency in otoscopy is often insufficient. Simulation-based training can be used to improve technical skills, but the suitability of the training model and assessment must be supported by validity evidence. The purpose of this study was to collect content validity evidence for a simulation-based test of handheld otoscopy skills. First, a three-round Delphi study was conducted with a panel of nine clinical teachers in otorhinolaryngology (ORL) to determine the content requirements in our educational context. Next, the authenticity of relevant cases in a commercially available technology-enhanced simulator (Earsi, VR Magic, Germany) was evaluated by specialists in ORL. Finally, an integrated course was developed for the simulator based on these results. The Delphi study resulted in nine essential diagnoses of normal variations and pathologies that all junior doctors should be able to diagnose with a handheld otoscope. Twelve out of 15 tested simulator cases were correctly recognized by at least one ORL specialist. Fifteen cases from the simulator case library matched the essential diagnoses determined by the Delphi study and were integrated into the course. Content validity evidence for a simulation-based test of handheld otoscopy skills was collected. This informed a simulation-based course that can be used for undergraduate training. The course needs to be further investigated in relation to other aspects of validity and for future self-directed training.

학생선수의 코로나19 경험 인식에 대한 은유분석

Purpose: The purpose of this study investigated that to describe the metaphorical thinking and understand perception of Student-Athlete’s “Experience of COVID-19”. Methods: Participants are 87 middle and high school athletes and 116 college students. Data were collected from open questionnaire using online. The questionnaire conducted on consisting of daily life, study, training, and future career areas and metaphor. The collected data were categorized into inductive content analysis according to the category of metaphor based on metaphor analysis by using the grounded theory of Saban(2007). Results: Analysis through systematic metaphor analysis resulted in a total of three metaphor categories: Obstacle’, ‘The road not taken’, ‘An Oasis in the desert’. The results of inductive categorization in four areas based on metaphor categories were commonly reported in daily life and training areas. Maintain Social distancing was performed due to concerns over infection prevention, reducing exercise motivation and difficulty in systematic training due to absence of feedback. On the other hand, the experience of various experiences and new learning, the time of reflection through recharging, and the experience of positive emotions through efficient learning and self-directed training were recognized as meaningful events.. Conclusion: The student athlete's experience with the COVID-19 incident through metaphor analysis recognized the limitations of training, the anxiety of future career due to the loss of opportunities for participation, and the change of learning environment as major difficulties. However, learning how to cope with a crisis and learning new opportunities other than exercise were also a time for positive coping experiences. Metaphors are formed on the basis of experience and serve as filters for recognition. Metaphors play an important role in changing a person’s perception and attitude, and the progress of counseling using them makes it easier to understand a person's feelings or thoughts. We hope that this research will be used as a basis for research using metaphor in psychological counseling in the sports psychology.

Efficacy of a Computer-Based Learning Program in Children With Developmental Dyscalculia. What Influences Individual Responsiveness?

This study presents the evaluation of a computer-based learning program for children with developmental dyscalculia and focuses on factors affecting individual responsiveness. The adaptive training program Calcularis 2.0 has been developed according to current neuro-cognitive theory of numerical cognition. It aims to automatize number representations, supports the formation and access to the mental number line and trains arithmetic operations as well as arithmetic fact knowledge in expanding number ranges. Sixty-seven children with developmental dyscalculia from second to fifth grade (mean age 8.96 years) were randomly assigned to one of two groups (Calcularis group, waiting control group). Training duration comprised a minimum of 42 training sessions à 20 min within a maximum period of 13 weeks. Compared to the waiting control group, children of the Calcularis group demonstrated a higher benefit in arithmetic operations and number line estimation. These improvements were shown to be stable after a 3-months post training interval. In addition, this study examines which predictors accounted for training improvements. Results indicate that this self-directed training was especially beneficial for children with low math anxiety scores and without an additional reading and/or spelling disorder. In conclusion, Calcularis 2.0 supports children with developmental dyscalculia to improve their arithmetical abilities and their mental number line representation. However, it is relevant to further adapt the setting to the individual circumstances.

Movement Competency Training Delivery: At School or Online? A Pilot Study of High-School Athletes

Movement competency (MC) development of high-school athletes can prepare them for the requirements of physical preparation training and the demands of sport. The aim of this study was to explore the physical effects of and athlete compliance to coach-led versus self-directed training approaches in this population. Thirty-nine high-school athletes (19 male, 14.5 ± 0.3 years old; 20 female, 14.6 ± 0.3 years) were allocated into two groups for a physical preparation program to improve MC. Groups were prescribed either (i) one face-to-face and one online (F2F, n = 18), or (ii) two online (OL, n = 21) sessions per week for 16-weeks. Before and after the intervention, the Athlete Introductory Movement Screen (AIMS) was used to assess MC alongside common physical capacity measures (triple-hop, star-excursion balance, medicine ball throw, 40 m sprint and countermovement jump). Dropout left 22 participants with pre-post physical scores. Compliance with online training was low and F2F session attendance moderate. Semi-structured interviews were conducted to assess participant perceptions following the intervention. Assessing individual responses, the F2F group had a higher proportion of positive responders to AIMS scores, yet capacity measures were inconclusive across groups. Face-to-face coaching when acquiring MCs as part of physical preparation, may provide greater positive perceptions towards training compared to self-directed online prescriptions, and thereby greater compliance.

Improving motivation for self-directed training in Danish EMS personnel

Background: Emergency Medical Services personnel's motivation to carry out self-directed training might be impaired by several factors such as work environment, pressures and training facilities. The aim of this study was to evaluate whether easy access to local training facilities would improve individual motivation for self-directed training. Methods: A before-and-after study of 118 Danish personnel was conducted. Participants were asked to complete two identical questionnaires, exploring their motivation and training efforts, before and after initiatives to promote training were introduced. Results: Response rates were 69 and 77, respectively. Motivation for self-directed training increased, on a scale from 1–10, from 5.6 to 6.7. The rating of opportunities to perform self-directed training increased from 4.1 to 5.9 and the rating of the training facilities from 3.7 to 6.3. The frequency of training sessions completed increased (every shift n=6 to 12, every second-to-third shift n=29 to 37). Conclusion: The increase in ratings regarding motivation and effort for carrying out self-directed training suggests that easily accessible training facilities improves individual motivation for self-directed training in emergency services personnel.

자기 주도적 중국어 낭독훈련을 위한 방법 탐색 －낭독 시각화 방안을 중심으로－

자기 주도적 중국어 낭독훈련을 위한 방법 탐색 －낭독 시각화 방안을 중심으로－

An Adaptive Dyadic Self-directed Coping and Self-management Skills Training Intervention for Caregivers of Individuals With Cancer: A Pilot Sequential Multiple Assignment Randomized Trial (SMART) Design

An Adaptive Dyadic Self-directed Coping and Self-management Skills Training Intervention for Caregivers of Individuals With Cancer: A Pilot Sequential Multiple Assignment Randomized Trial (SMART) Design

Validity and reliability of the Australian Therapy Outcome Measures \u2013 Physiotherapy, for podiatry (AusTOMs-PT for use in podiatry)

BackgroundValid and reliable outcome measure enable measurement of health care service impact. There are limited valid and reliable outcome measures for use in podiatry practice to measure the impact of treatment. This research aimed to test the face validity of the AusTOMs for Physiotherapy (AusTOMs-PT), it’s adaptability to podiatry clinical practice and the reliability of its use with podiatrists.MethodsStage 1 used a nominal group technique with podiatrists who worked in public and/or private settings. All podiatrists underwent self-directed training in the AusTOMs framework and measures prior to interviews or focus group discussion. Discussion was centred about transferability of the core scales of the AusTOMs-PT and an adjunct measure, AusTOMs for Occupational Therapy (AusTOMs-OT) to podiatry practice.Stage 2 used 10 case studies representative of people who had foot or ankle concerns. Podiatrists were recruited and trained in the use of the relevant AusTOMs-PT scales. Podiatrists individually scored the cases at two timepoints (1 month apart) using the six scales from the AusTOMs-PT deemed by stage 1 as relevant to podiatry. Intra and inter-rater reliability of scales were determined using intraclass correlation coefficients (ICCs).ResultsThirteen podiatrists participated in individual or focus group interviews in Stage 1. Consensus was gained on six of the nine core scales adopted from the AusTOMs-PT. These were 1. Balance and Postural Control, 3. Musculoskeletal Movement Related Functions, 4. Neurological Movement Related Functions, 5. Pain, 7. Sensory Functions, 8. Skin Functions. Each core scale rated the functional domains of Impairment, Activity Limitation, Participation Restriction and Wellbeing/Distress relating to that presentation of goals of the person in the case study.There were 22 podiatrists complete training and scored two rounds of case studies using the six scales in Stage 2. There were 91%(n = 20) participants with an intra-rater ICC > 0.5 (moderate or greater). Each domain had an inter-rater reliability of > 0.9 (excellent) during the first round.ConclusionsThe AusTOMs-PT for use in podiatry may be implemented to record change in impairment, function, participation and wellbeing of people receiving podiatry treatment. Podiatry specific training and mentoring, together with repeated use could be expected to improve intra-reliability.

Physical activity promotion in daily exercise therapy: the perspectives of exercise therapists in German rehabilitation settings

BackgroundThis study aims to explore exercise therapists’ perspectives on the topic of physical activity promotion (PAP) with a focus on identifying (i) the intervention content and methodological approaches used for promoting physical activity (PA) in daily practice and (ii) the barriers and facilitators that affect PAP.MethodsThis qualitative study comprised the heads of exercise therapy departments (n = 58; 41% women; mean age = 45 years) from different rehabilitation clinics in Germany. Each participant took part in a semi-structured focus-group discussion on PAP in exercise therapy. The findings of the focus groups were processed and interpreted using a conventional qualitative content analysis.ResultsThe exercise therapists demonstrated detailed didactic–methodological strategies and action orientations for PAP. The identified core topics of the content and methods of PAP were (1) conceptualization, (2) exercise and PA for enjoyment and pleasure, (3) education with practice–theory combinations, (4) media and materials for self-directed training, and (5) strategies to enhance personal responsibility and independence. The core topics for the associated barriers and facilitators were (1) structural conditions, (2) the role of exercise therapists, (3) the interdisciplinary rehabilitation team, (4) rehabilitant experiences and expectations, and (5) aftercare services.ConclusionThe topic of PAP is addressed with a high level of variability; exercise therapists involved in this study identify various methods and content for the promotion of PA within their individual practices. However, they display a limited awareness of existing evidence- and theory-based concepts for the promotion of PA as well as underlying theories of behavioural change. This variability may be due to the lack of a defined common framework for promoting PA, insufficient emphasis being placed on PA promotion in the current curricula and training, or extensive conceptual differences within German exercise therapy departments (e.g. different weighting of PAP).

WORK FORCE COMPETENCIES AND TRAINING FOR SELF-DIRECTED SERVICE PROGRAMS

In 2017 over one million individuals of all ages were enrolled in approximately 260 self-directed long-term services and support programs nationwide. Research conducted by the National Resource Center for Participant-Directed Care (NRCPDS) and the Council for Social Work Education identified training gaps among current aging and disability network professionals and within social work education. Believing that both self-directing individuals and their family caregivers would benefit from a workforce that has the knowledge and skills to implement the principles of self-directed care, NRCPDS and CSWE working with national professional organizations and government agencies have identified workforce competency domains and developed a number of training resources that can be used in both academic and professionals settings. This presentation will review the work of NRCPDS and CSWE in workforce competencies, training resources, and recommendations for self-directed services training.

Nodular Leptomeningeal Disease—A Distinct Pattern of Recurrence After Postresection Stereotactic Radiosurgery for Brain Metastases: A Multi-institutional Study of Interobserver Reliability

For brain metastases, surgical resection with postoperative stereotactic radiosurgery is an emerging standard of care. Postoperative cavity stereotactic radiosurgery is associated with a specific, underrecognized pattern of intracranial recurrence, herein termed nodular leptomeningeal disease (nLMD), which is distinct from classical leptomeningeal disease. We hypothesized that there is poor consensus regarding the definition of LMD, and that a formal, self-guided training module will improve interrater reliability (IRR) and validity in diagnosing LMD. Twenty-two physicians at 16 institutions, including 15 physicians with central nervous system expertise, completed a 2-phase survey that included magnetic resonance imaging and treatment information for 30 patients. In the "pretraining" phase, physicians labeled cases using 3 patterns of recurrence commonly reported in prospective studies: local recurrence (LR), distant parenchymal recurrence (DR), and LMD. After a self-directed training module, participating physicians completed the "posttraining" phase and relabeled the 30 cases using the 4 following labels: LR, DR, classical leptomeningeal disease, and nLMD. IRR increased 34% after training (Fleiss' Kappa K = 0.41 to K = 0.55, P < .001). IRR increased most among non-central nervous system specialists (+58%, P < .001). Before training, IRR was lowest for LMD (K = 0.33). After training, IRR increased across all recurrence subgroups and increased most for LMD (+67%). After training, ≥27% of cases initially labeled LR or DR were later recognized as nLMD. This study highlights the large degree of inconsistency among clinicians in recognizing nLMD. Our findings demonstrate that a brief self-guided training module distinguishing nLMD can significantly improve IRR across all patterns of recurrence, and particularly in nLMD. To optimize outcomes reporting, prospective trials in brain metastases should incorporate central imaging review and investigator training.

Self-Directed, Sequential and Incremental Video-Based Training is Effective in Teaching Novices Basic Surgical Skills

Self-Directed, Sequential and Incremental Video-Based Training is Effective in Teaching Novices Basic Surgical Skills