Skilled Delivery Research Articles

Prevalence and Determinants of Rural-Urban Utilization of Skilled Delivery Services in Northern Ghana.

Background There are wide differences in the uptake of skilled delivery services between urban and rural women in the northern region of Ghana. This study assessed the rural-urban differences in the prevalence of and factors associated with uptake of skilled delivery in the northern region of Ghana. Methods The study population comprised postpartum women who had delivered within the last three months prior to the study. The dataset was analyzed using the chi-square test and multivariable logistic regression. Results The odds of skilled birth attendance (SBA) adjusted for confounding variables in urban areas were higher compared with their rural counterparts (AOR = 1.59; CI: 1. 07–2.37; p=0.02). The determinants of skilled delivery were similar but of different levels and strength in rural and urban areas. The main drivers that explained the relatively high skilled delivery coverage in the urban areas were higher frequency of antenatal care (ANC) attendance, proximity (physical access) to health facility, and greater proportion of women attaining higher educational level of at least secondary school. Distance from health facility less than 4 km was the greatest independent contributor to the variance in skilled delivery in the urban areas, whereas frequency of ANC attendance was the greatest independent contributor in the rural areas. Conclusions This study identified underlying determinants accounting for rural-urban differences in skilled delivery, and covariate effect was more dominant than coefficient effect. Therefore, urban-rural differences in SBA outcomes were primarily due to differences in the levels of critical determinants rather than the nature of the determinants themselves. Therefore, improving skilled delivery outcomes in this study population and other similar settings will not require different policy frameworks and interventions in dealing with rural-urban disparities in SBA outcomes. However, context-specific tailored approaches and strategies including targeting mechanisms have to be designed differently to reduce the rural-urban differences.

Determinants of safe delivery utilization among Indonesian women in eastern part of Indonesia.

Background: Improving maternal health and reducing maternal mortality are part of the United Nations global Sustainable Development Goals for 2030. Ensuring every woman's right to safe delivery is critical for reducing the maternal mortality rate, especially in Indonesia. Our study aimed to identify determinants of safe delivery utilization among women in the eastern Indonesia. Methods: This study was cross-sectional and used data from the 2017 Indonesian Demographic and Health Survey (IDHS). A total of 2,162 women who had their last child in the five years preceding the survey and lived in the eastern part of Indonesia were selected as the respondents. Chi-squared test and binary logistic regression were used to understand the determinants of safe delivery. Results: Higher child rank and interval ≤2 years (OR: 0.30, 95% CI: 0.19-0.47), unwanted pregnancy at time of becoming pregnant (OR: 1.48, 95% CI: 1.05-2.08), richest wealth quintile (OR: 5.59, 95% CI: 3.37-9.30), more than four antenatal care visits (OR: 3.62, 95% CI: 2.73-4.79), rural residence (OR: 0.49, 95% CI: 0.36-0.66), good composite labor force participation (OR: 1.47, 95% CI: 1.15-1.89), and a good attitude towards domestic violence (OR: 1.33, 95% CI: 1.04-1.69) were found to be significantly associated with facility-based delivery. Higher child rank and interval ≤2 years (OR: 0.49, 95% CI: 0.29-0.83), husband/partner having completed secondary or higher education (OR: 2.18, 95% CI: 1.48-3.22), husband/partner having a non-agricultural occupation (OR: 1.35, 95% CI: 1.00-1.81), being in the richest wealth quintile (OR: 15.69, 95% CI: 5.53-44.50), and three other factors were found to be significantly associated with skilled assistance delivery. Conclusions: Safe delivery and facility-based delivery among women in the eastern part of Indonesia were determined by several individual and household factors. An open innovation and partnership process that engages the full range of stakeholders should be developed based on local needs.

Maternal health services utilisation among primigravidas in Uganda: what did the MDGs deliver?

BackgroundAchieving maternal health outcomes in the SDGs requires the implementation of more targeted policies and strategies. While the MDGs may have deepened our understanding in this regard, we know little about the trends in maternal health services utilisation among primigravidas, and how age and geographical regions could have influenced these trends. In this study, we examined utilisation of antenatal and skilled delivery services among primigravidas in Uganda, a country with one of the highest maternal mortality ratios, and where early childbearing and its attendant challenges are common.MethodsGuided by Andersen’s Behavioural Model, we fitted multivariate regression models to a pooled dataset of the 2006, 2011 and 2016 Ugandan Demographic and Health Survey (n = 3477) to understand the dynamics in Antenatal Care (ANC) and Skilled Birth Attendance (SBAs) utilisation among primigravidas. Post-estimation margins were employed to further highlight the effect of age and geographical regions.ResultsThe analyses show an improvement in access to maternal health services among primigravidas from 2006 to 2016. Compared to 2006, primigravidas in 2016 were 48%, 24% and 2.98 times more likely to have early ANC, four or more ANC visits, and SBAs, respectively. Altogether, a primigravida in 2016 relative to 2006 was 42% more likely to meet all three maternal health service indicators. Post-estimation margins analyses on age and geographical disparities revealed that younger primigravidas have lower probability, while primigravidas in Eastern Region, one of the most deprived in the country, have the lowest probability of accessing maternal health services. Also, the study found education, wealth, women’s household decision-making power, place of residence as important determinants of ANC visits and SBAs.ConclusionsBased on our findings, it is important to address the vulnerabilities of primigravidas, particularly younger individuals, in accessing early ANC. Uganda should scale-up decentralisation and integration of maternal health delivery in local communities as a strategy of addressing lingering geographical disparities, and ultimately improve maternal health outcomes in the SDGs period.

Simulation to Teach Cesarean Section and Hemorrhage Management: Evaluation of a Novel High-Fidelity Simulator [38G

INTRODUCTION: The cesarean delivery the most common surgical procedure performed within the military health system (MHS). The gold standard for training physicians to perform a cesarean section is didactics and then practicing on actual patients. The objective of this study is to evaluate the efficacy of a novel high-fidelity simulator to train physicians with limited surgical obstetric experience to perform cesarean sections and manage operative hemorrhage. METHODS: Gynecology, family medicine, and surgery residents were recruited for the IRB approved study. All participants received the same didactic training on performing a cesarean section and managing postpartum hemorrhage. The intervention group received additional training on a simulator to perform the procedure and management of hemorrhage. All participants were then evaluated on their ability to perform a cesarean section with operative complications using the simulator. RESULTS: From July 2017 to January 2019 a total of 33 participants were recruited and randomized. The intervention group had higher scores on the cesarean delivery (p-values 0.013 and 0.017), hemorrhage management (p-value .0002), and overall skill (p-value .008). There was no difference in preoperative management, postoperative management, counseling, technical skills, and teamwork. CONCLUSION: Participants who received training using a high-fidelity simulator performed significantly better on all procedural aspects of a cesarean section and hemorrhage management. Simulation allows trainees to gain procedural experience while eliminating patient risk. Cesarean section simulators may be useful to train and reinforce surgical skills for residents, military physicians about to deploy, ancillary providers in low-resource settings, and physicians at low-volume medical centers.

Women's education and coverage of skilled birth attendance: An assessment of Sustainable Development Goal 3.1 in the South and Southeast Asian Region.

The objective of Sustainable Development Goal 3.1 is to reduce the global maternal mortality ratio (MMR) below 70 per 100,000 live births by 2030. One of the indicators for this objective is the proportion of births attended by skilled health attendants (SBA). This study assessed the progress of low- and middle-income countries from South and Southeast Asian (SSEA) region in SBA coverage and evaluated the contribution of women's education in this progression. The Demographic and Health Surveys were assessed, which included 38 nationally representative surveys on women aged between 15-49 years from 10 selected SSEA region countries in past 30 years. Binary Logistic regression models were fitted adjusting the survey clusters, strata and sampling weights. Meta-analyses were conducted by collapsing effect sizes and confidence intervals of education modeled on SBA coverage. Results indicated that Cambodia, Indonesia and Philippines had over 80% SBA coverage after 2010, whereas Bangladesh and Afghanistan had around 50% coverage. Women with primary, secondary and higher level of education were 1.65, 2.21 and 3.14 times significantly more likely to access SBA care during childbirth respectively as compared to women with no education, suggesting that education is a key factor to address skilled delivery cares in the SSEA region. Evaluation of the existing skilled birth attendance policies at the national level could provide useful insight for the decision makers to improve access to skilled care at birth by investing on women's education in remote and rural areas.

Meeting Students Where They Are: Just in Time Embedded Delivery of Information and Digital Literacy Skills

At the University of Wollongong (UOW) Library we have been exploring ways to deliver information and digital literacy resources at point of need for students. Aligned with the University’s strategic direction, the Future Ready Library Strategy points to a digital first mindset and its application to services and resources offered to the UOW community. Combined with the need to embrace the real life challenges faced by higher education students in Australia today, this has led us to develop a suite of digital learning objects in collaboration with teaching academics that can be delivered at scale, enabling a sustainable way to target student needs. In this article, we discuss the drivers that have brought UOW Library to this point and outline the model for learning and teaching support for our academic community into the future.

Use of Self-Assessment of Video Recording to Raise Students' Awareness of Development of Their Oral Presentation Skills

This paper aims to examine if using video recordings help students raise their awareness of the development of their oral presentation skills by reviewing video recordings of their presentations. For this study, all students who took a Financial Accounting class in the academic year 2018–2019 at Lincoln University (LU) were video-recorded when presenting. Participants were asked to review their video recordings, assess their performance, and record their reflections by using a Self-Assessment Questionnaire (SAQ). The results indicated that the students’ attitude toward recording the presentations was highly positive. The predominant response was that this new learning activity increased students’ awareness of the importance of presentation skills without provoking their anxiety. Participants were able to observe that certain delivery skills such as good preparation, self-confidence, eye contact, and voice quality needed improvement. For managerial implications, LU, through its Writing and Speaking Center (WSC), offered thirty-minute sessions with a presentation coach to improve students’ communication skills and prepare them to give a more polished presentation in class. In comparing the practice presentation at the WSC with the final in-class presentation, students were observed to be more confident, better prepared, and less nervous during the final presentation. However, we observed that the practice presentation did not carry the same weight as the final presentation as the practice presentation was neither graded nor delivered in front of an instructor or a wider audience.

DATA ANALYSIS AND CRITICAL THINKING SKILLS TRAINING FOR TEACHERS – THE WELSH BACCALAUREATE

The Welsh Baccalaureate qualification has been adopted by most secondary schoolswithin Wales. In years 12 and 13 (ages 16-18), 50% of the qualification requires students tocollect primary data and also conduct secondary data analysis to write a 5000 word investigative report. To help teachers develop effective teaching strategies and resources, Welsh Government funding enabled key networking events to establish a teacher conference. This paper describes the supportive nature and potential portability of theconference to help teachers’ delivery of critical thinking and data analysis skills. The impact of the conference over the last three years is also discussed, utilising delegate feedback. First published February 2020 at Statistics Education Research Journal Archives

Women's Perspectives on Influencers to the Utilisation of Skilled Delivery Care: An Explorative Qualitative Study in North West Ethiopia.

Skilled attendance at birth is widely regarded as an effective intervention to reduce maternal and early neonatal morbidity and mortality. However, many women in Ethiopia still deliver without skilled assistance. This study was carried out to identify factors that influenced or motivated women to give birth in a health facility in their previous, current, and future pregnancies. This descriptive explorative qualitative study was conducted in two districts of West Gojjam zone in North West Ethiopia. Fourteen focus group discussions were conducted with pregnant women and women who gave birth within one year. An inductive thematic analysis approach was employed to analyze the qualitative data. In this study, two major themes and a number of subthemes emerged from the focus group discussions with the study participants. The factors that influenced or motivated women to give birth in health facility in their previous, current, and future pregnancies include access to ambulance transport service, prevention of mother to child HIV transmission service, referral service, women friendly service, and emergency obstetric services, good interpersonal care from health workers, and fear and experience of obstetric danger signs and complications. In addition, reception of information and advice on importance of skilled delivery care and obstetric danger signs and complications from health workers, use of antenatal care, previous use of skilled delivery care, ensuring wellbeing of parturient women and newborns, and use of emergency obstetric care were also identified as influencers and motivators for health facility childbirth in previous, current, and future deliveries. Increased understanding of the factors that influenced or motivated women to deliver in facilities could contribute to developing strategies to improve the uptake of facility-based maternity services and corresponding declines in maternal morbidity and mortality.

‘Professionalism’ in English as a Foreign Language Teachers’ Perspectives: A Qualitative Study in a Thai Context

This study presents the meanings, attributes, and roles of ‘professionalism’ synthesized from 20 Thai EFL teachers’ perspectives.  Qualitative research methods were utilized to collect four sources of data including classroom observation transcripts, semi-structured interview transcripts, on-line discussion entries, and field-note recordings.  The findings indicated that professionalism refers to the big picture of exemplar, effective teachers.  Proficient English skills with an emphasis on oral communication, lesson planning abilities, lesson delivery skills, and commitment to successful student learning were believed to form professionalism which, also, plays multi-roles in teaching.

Effectiveness of participatory community solutions strategy on improving household and provider health care behaviors and practices: A mixed-method evaluation.

We implemented a participatory quality improvement strategy in eight primary health care units of Ethiopia to improve use and quality of maternal and newborn health services. We evaluated the effects of this strategy using mixed-methods research. We used before-and-after (March 2016 and November 2017) cross-sectional surveys of women who had children 0-11 months to compare changes in maternal and newborn health care indicators in the 39 communities that received the intervention and the 148 communities that did not. We used propensity scores to match the intervention with the comparison communities at baseline and difference-in-difference analyses to estimate intervention effects. The qualitative method included 51 in-depth interviews of community volunteers, health extension workers, health center directors and staff, and project specialists. The difference-in-difference analyses indicated that 7.9 percentage points (95% confidence interval [CI]: 1.8-13.9%) increase in receiving skilled delivery care between baseline and follow-up surveys in the intervention area that is attributable to the strategy. The intervention effect on postnatal care in 48 hours of the mother was 15.3% (95% CI: 7.4-23.2). However, there was no evidence that the strategy affected the seven other maternal and newborn health care indicators considered. Interview participants said that the participatory design and implementation strategy helped them to realize gaps, identify real problems, and design appropriate solutions, and created a sense of ownership and shared responsibility for implementing interventions. Community participation in planning and monitoring maternal and newborn health service delivery improves use of some high-impact maternal and newborn health services. The study supports the notion that participatory community strategies should be considered to foster community-responsive health systems.

Process Evaluation of Skilled Delivery Service in Hadiya Zone in Southern Nations, Nationalities, and Peoples Region, Ethiopia.

Pregnancy-related death is a cause for maternal and newborn mortality and morbidity as well as an obstacle for economic growth. Three-quarters of mothers' lives can be saved if women have access to a skilled health worker at delivery and emergency obstetric care. This evaluation was conducted to assess skilled delivery service implementation level by using three dimensions (availability, compliance, and acceptability) and identify major contributing issues for underutilization of the service. The evaluation design is cross-sectional. The study included 846 mothers who gave birth in Hadiya zone within one year prior to study period, using one year delivery records. Epi Info 3.5.3 and SPSS version 16 were employed for data analysis. Based on selected indicators, resource availability was inadequate for health facilities, human resource medical equipment, and rooms. On the compliance dimension, skilled delivery service coverage (34.8%), active management of third stage labor (32.7%), and health information at discharge and in postnatal care (PNC) visit (7.1%) critically complied with or poorly agreed to the guidelines and targets. Regarding skilled delivery service acceptability, welcoming, privacy keeping, reassurance during labor pain, follow-up, baby care, comfortability (rooms, beds, and clothing), cost of service, and episiotomy (without local anesthesia) were not acceptable.

Improving the quantitative research skills of Welsh Baccalaureate teachers through university engagement

In 2015, the redesigned Welsh Baccalaureate Qualification (WBQ) was launched and, for the first time, students undertaking the qualification were required to complete the Skills Challenge Certificate (SCC). Consisting of four components – the Individual Project, the Enterprise and Employability Challenge, the Global Citizenship Challenge and the Community Challenge – the SCC aims to enable learners to develop skills needed for education, employment and life. The Individual Project requires students to undertake a research project that includes analysing data utilizing quantitative data analysis skills. This paper identifies the teaching of such quantitative skills as a difficulty for some teachers involved in the delivery of the qualification, drawing on recent engagement work between Cardiff University and schools and colleges in South Wales. It argues that universities have an opportunity to engage with schools, teachers and school students in the delivery of quantitative research skills that can be beneficial for both schools and universities.

Computing the Geographic Extent of Maternity Health Services to Predict the Utilization of Skilled Delivery in Siaya County, Western Kenya

In Kenya, no study has attempted to incorporate the target population, nor the availability coverage and accessibility coverage to expose hidden gaps in the provision of maternity health services that target rural and marginalized populations for a high burden, yet low resource setting such as rural Siaya County. A cross-sectional study design used publicly available geospatial data in combination with administrative ward level data from the web-based district health information software, version 2 (DHIS 2). AccessMod version 5 was used for geographic coverage analysis. ArcGIS (version 10.5) and R (version 3.5.3)sufficed for the preparation of input geospatial data and the manipulation of AccessMod results respectively. The association between the geographic coverage and skilled delivery was computed using a Zero-inflated Poisson regression model at a 95% confidence level. The findings in Siaya County revealed a higher likelihood of a skilled delivery 34% (0.34; CI: 0.339–0.347) and 16% (0.16; CI: 0.162–0.167) respectively. This likelihood is for every unit increase in the proportion of pregnant women within a one-hour geographic extent of a hospital and health center—on foot, as compared to being within a similar geographic catchment area of a dispensary 7% (0.07; CI: 0.0678– 0.0723) based on motorcycle traveling time. The immediate implication is that the population coverage capacity and, by extension, quality of existing facilities offering free maternity health services increases a pregnant woman’s likelihood of utilizing skilled delivery, regardless of proximity. Future research should also consider looking at the cost-implications of scaling up existing maternity health services, albeit based on local routine health facility data.

The relationship between tertiary-level students’ self-perceived presentation delivery and public speaking anxiety: A mixed-methods study

Oral presentations are common in higher education worldwide. There is no shortage of evidence substantiating the association between oral presentations and anxiety. In the light of the close connection between self-perception and anxiety, and the under-researched nature of the delivery aspect of presentations (e.g. use of voice and body language), this study explored the relationship between tertiary-level learners’ (n = 211) perceived delivery competence (23 areas) and their levels of public speaking anxiety. The data were collected via questionnaires and interviews. The questionnaire results revealed highly significant correlations between anxiety and 22 of these areas. The 23 areas overall also had a highly significant predictive power for anxiety levels, indicated by their explaining 45% of the variance. Follow-up in-depth semi-structured interviews were conducted with six participants to shed light on these quantitative findings. This article ends with an argument for greater emphasis on presentation delivery skills in higher education, which can potentially mitigate learners’ public speaking anxiety.

An Active Data Representation of Videos for Automatic Scoring of Oral Presentation Delivery Skills and Feedback Generation

Public speaking is an important skill, the acquisition of which requires dedicated and time consuming training. In recent years, researchers have started to investigate automatic methods to support public speaking skills training. These methods include assessment of the trainee's oral presentation delivery skills which may be accomplished through automatic understanding and processing of social and behavioural cues displayed by the presenter. In this study, we propose an automatic scoring system for presentation delivery skills using a novel active data representation method to automatically rate segments of a full video presentation. While most approaches have employed a two step strategy consisting of detecting multiple events followed by classification, which involve the annotation of data for building the different event detectors and generating a data representation based on their output for classification, our method does not require event detectors. The proposed data representation is generated unsupervised using low-level audiovisual descriptors and self-organizing mapping, and used for video classification. This representation is also used to analyse video segments within a full video presentation in terms of several characteristics of the presenter's performance. The audio representation provides the best prediction results for self-confidence and enthusiasm, posture and body language, structure and connection of ideas, and overall presentation delivery. The video data representation provides the best results for presentation of relevant information with good pronunciation, usage of language according to audience , and maintenance of adequate voice volume for the audience. The fusion of audio and video data provides the best results for eye contact. Applications of the method to provision of feedback to teachers and trainees are discussed.

Relationship Education and HIV Prevention for Young Male Couples Administered Online via Videoconference: Protocol for a National Randomized Controlled Trial of 2GETHER.

BackgroundYoung men who have sex with men have a high HIV incidence, and a substantial proportion of incident infections occur in the context of main partnerships. However, romantic relationships also provide numerous benefits to individual health and wellbeing. 2GETHER is a relationship education and HIV prevention program for young male couples, and the 2GETHER USA randomized controlled trial (RCT) was launched to establish the efficacy of an online version of 2GETHER.ObjectiveThe objective of 2GETHER is to optimize relationship functioning in young male couples as a method to improve communication about sexual risk behaviors and reduce HIV transmission. In the 2GETHER USA study, 2GETHER was adapted for online administration to couples across the United States via videoconferencing. The intervention in question aims to address the unique needs of couples from varied racial/ethnic backgrounds and geographic regions.MethodsThis is a comparative effectiveness RCT of 2GETHER USA relative to existing public health practice (control). 2GETHER USA is a hybrid group- and individual-level intervention that delivers three weekly online group discussion sessions for skills delivery, followed by two individualized couple sessions that focus on skills implementation in each couple. The control condition differs by participant HIV status: (1) the Testing Together protocol for concordant HIV-negative couples; (2) medication adherence and risk reduction counseling for concordant HIV-positive couples; or (3) both protocols for serodiscordant couples. Follow-up assessments are delivered at 3-, 6-, 9-, and 12-months post-intervention in both conditions. Testing for rectal and urethral Chlamydia and Gonorrhea occurs at baseline and 12-month follow-up. The primary behavioral outcome is condomless anal sex with serodiscordant serious partners or any casual partners. The primary biomedical outcome is sexually transmitted infection incidence at a 12-month follow-up.ResultsAs of October 11, 2019, the trial has enrolled and randomized 140 dyads (Individual N=280). Enrollment will continue until we randomize 200 dyads (N=400). Assessment of intervention outcomes at 3-, 6-, 9-, and 12-months is ongoing.Conclusions2GETHER is innovative in that it integrates relationship education and HIV prevention for optimizing the health and wellbeing of young male couples. The 2GETHER USA online adaptation has the potential to reach couples across the United States and reduce barriers to accessing health care services that are affirming of sexual minority identities for those who live in rural or under-resourced areas.Trial RegistrationClinicalTrials.gov NCT03284541; https://clinicaltrials.gov/ct2/show/NCT03284541International Registered Report Identifier (IRRID)DERR1-10.2196/15883

Pengembangan Entrepreneurship pada Program MA Keterampilan melalui Inovasi Model Pembelajaran Teaching Factory di MAN 2 Kulon Progo

MA Skills is one of the programs that is common (not SMK) with the same curriculum content as Madrasah Aliyah in general (regular) plus an intracuricular program in various areas of structured skills. MA Skill has 5 majors namely agribusiness processing agricultural products (APHP), fashion design, visual communication design, audio video engineering, and food management. Skills Program Given according to the spectrum adapted from SMK. Model teaching factory began to be implemented in MAN 2 Kulon Progo aims to improve the competency of the students to be able to become a reliable businessman and work according to their competency skills. Model teaching factory has 3 components, namely: 1) product as a media to introduce competence, 2) sheets of work that contains series and work assessments in accordance with industry standard working procedures, and 3) arrange a learning schedule that Enables optimal delivery of soft skills and skill to the students. The success of the teaching factory model involved all stakeholders in the madrasah can develop entrepreneurship activities in MAN 2 Kulon Progo.

Demographic characteristics of women that use traditional birth attendants in Bongo District, Ghana.

INTRODUCTIONOver the last decade, the government of Ghana has implemented several interventions aimed at increasing access to skilled birth-care services from trained professionals. Despite these efforts, there is a wide gap between antenatal care attendance and skilled delivery attendance, particularly in rural areas. Evidence shows that many women in rural and deprived communities in Ghana rely on traditional birth attendant (TBA) delivery services. This has created a gap where antenatal attendance is high while skilled delivery is relatively low. The purpose of this study is to identify and analyse the sociodemographic characteristics of women who use the services of TBAs in Bongo District, Ghana.METHODSUsing a descriptive study design, a survey was conducted involving 330 mothers randomly selected from 1685 mothers who delivered at home by 2014 in Bongo District. The questionnaire for mothers who delivered at home by a TBA comprised 28 questions.RESULTSThe results show that women who used TBA were older, without formal education, married, predominantly farmers, married to spouses who were farmers without formal education. Most of the sampled women were co-currently covered by the national health insurance.CONCLUSIONSThis study describes the demographic characteristics of women who use a TBA. Therefore, ongoing efforts aimed at increasing access to and use of professional antenatal services should incorporate sociodemographic factors in the rural context.

Optimizing learner engagement during mental skills training: A pilot study of small group vs. individualized training

BackgroundMental skills limit surgical residents’ skill decay resulting from stress. However, optimal mental skills delivery is unknown. We sought to compare the impact of implementing our curriculum in small groups and individually. MethodsAt baseline, residents completed assessments of mental skills and laparoscopic suturing. Residents then participated in a comprehensive mental skills curriculum at two institutions. At the first institution, residents completed small group training, whereas residents at the second institution trained individually. Following mental skills training, residents completed FLS training, at which time they completed the Short State Stress Questionnaire detailing their engagement. At post-test, residents completed baseline assessments again. ResultsTwenty-one residents completed training. Small groups were less engaged after training than individuals (Group average engagement: 26.4 vs. Individual average engagement: 29.6, p = 0.06). ConclusionsDelivering mental skills individually facilitates greater engagement than training in small groups, but regardless of delivery method, our MSC can achieve the same outcomes on surgical performance.