Skills Group Research Articles

Unveiling a hide side of the athlete's heart: a CMR focus on the left atrium.

Abstract Background cardiac magnetic resonance (CMR) is the gold standard to evaluate cardiac chambers’ dimensions and function, but data on left atrium (LA) dimensions and function among elite athletes are lacking. Objective to describe LA size and function among a cohort of elite athletes and evaluate eventual differences based on sports discipline and gender. Methods We enrolled 120 Olympic athletes with un-remarkable cardiovascular pre-participation screening tests (mean age 25±5 years, 50% males, 25% skill, 25% power, 25% mixed, 25% endurance). All the athletes underwent CMR without contrast administration. LA dimensions, in terms of absolute and indexed area and volume, were computed using 4- and 2-chamber steady state precession cine-sequences. LA ejection fraction (LAEF) and LA coupling index (LACI index, as the ratio between LA and LV end-diastolic volumes) were calculated. Cine-images were also used to analyse atrial deformation with a dedicated offline software to measure LA global longitudinal strain. LA dimensions and function were compared between males and females and athletes of different sports categories based on European classification. Results Among the entire cohort, endurance athletes showed the greatest remodelling in terms of LA and LV dimensions (Table). There were no significant differences in LAEF and LV-EF between athletes of different sport categories (p=0.121 and p=0.679). A trend in increasing LA volumes and decreasing LA strain consistent with a growing cardiovascular demand was observed, but the only statistically significant difference was between skill athletes and all the other groups for LA volumes (p<0.001), while there were no significant differences in LA strain (p=0.170). LACI did not differ between athletes of different sports categories (p=0.170). Female athletes showed higher LAEF and LA strain than males (respectively 55±5 vs 52±6% p=0.012 and 35±7 vs 32±7%, p=0.009) while LACI did not differ based on gender (19±5% for both females and males, p=0.385). Conclusion Among our cohort of Olympics, LA remodelling was observed in all athletes, being less evident in skill group, as for the LV. Thus, the ratio between LA and LV did not differ between sport categories. LAEF and LA strain were not significantly different between athletes of different sports categories although LA strain was slightly lower in endurance. Female athletes showed higher LAEF and LA strain than males, while LACI was not different based on gender.

Association of lifelong exercise characteristics with aortic pathology in patients with Marfan syndrome

Abstract Background Marfan syndrome (MFS) is a genetic connective tissue disease with an increased risk for aortic root dilatation and aortic dissection. Current guidelines, based on expert consensus, recommend exercise restrictions due to concerns that exercise-induced hemodynamic stress may accelerate aortopathy. Studies examining exercise characteristics and their association with aortopathy in MFS patients are lacking. Purpose To assess the association of lifelong exercise characteristics (volume, intensity and type) with the presence of aortic dilatation in MFS patients. Methods An international multi-centre study was conducted in MFS adults. Patients were classified as sedentary (<500 metabolic equivalent of task minutes per week [MET-min/wk]), active (500-1000 MET-min/wk), or highly active (≥1000 MET-min/wk) based on lifelong exercise volumes assessed by a validated questionnaire. Patient’s dominant exercise intensity was classified as moderate (3-6 MET) or vigorous (≥6 MET), and sport type as skill, power, mixed, or endurance. Echocardiography was used to assess diameters at the sinuses of Valsalva (SoV) and ascending aorta (AA), and Campens Z-scores were calculated. Aortic dilatation was evaluated as a diameter ≥40, ≥45 mm, a Z-score ≥2 or ≥3 respectively. Results 315 patients (36[27-49] years, 53% male) were included of which 104 were sedentary, 77 active and 134 highly active (Fig. 1). 42 patients did not perform sport-related exercise, whereas 147 and 121 patients predominantly participated in moderate or vigorous intensity sports. Patients performing sports were allocated to the skill (n=13), power (n=27), mixed (n=158), endurance (n=66) or non-dominant (n=9) exercise type group. Mean SoV and AA diameters were 42.9±7.7 mm and 33.9±7.3 mm. SoV or AA diameters of ≥40 mm were present in 200 (64%) and 41 (13%) patients, whereas 223 (71%) and 81 (26%) patients had a Z-score ≥2 for the SoV or AA. Exercise volume was not associated with SoV dilatation (Fig. 2). Moderate and vigorous intensity sports were associated with a lower prevalence of SoV Z-score ≥3. Power sport was associated with a lower prevalence of all definitions of SoV dilatation, whereas mixed and endurance sports were associated with a lower prevalence of SoV Z-score ≥3. No associations were found with AA dilatation. Of the 17 (5%) patients who suffered from an aortic dissection, 1 case occurred during walking (type A dissection) whereas all other cases were not exercise-related. Conclusions Lifelong exercise volumes were not associated with aortic dilatation in MFS patients. Power sports and vigorous intensity exercise were inversely related to SoV dilatation. Further investigation is warranted to clarify whether this association reflects that patients engaging in these activities have a less severe cardiovascular phenotype, or that they are protected from exercise-related aortic complications, and if patients may miss health benefits due to too exercise restrictions.

Empowering Social Growth Through Virtual Reality–Based Intervention for Children With Attention-Deficit/Hyperactivity Disorder: 3-Arm Randomized Controlled Trial

Background Attention-deficit/hyperactivity disorder (ADHD) usually begins in childhood and is often accompanied by impairments in social functioning. Virtual reality (VR) has emerged as an adjunctive tool to embed in social skills training to enhance the social skills of children with ADHD, but its effectiveness requires further investigation. Objective This study aims to enhance the social skills of children with ADHD by examining the feasibility and effectiveness of VR-based training in comparison to traditional social skills training. Methods A 3-arm randomized controlled trial was conducted with 90 children with ADHD aged 6-12 years. Participants were randomly assigned to 3 weeks of 12-session VR-based social skills training, traditional social skills training, or a waitlist control group of equivalent duration. Outcome measures included assessments by a clinical psychologist who was blinded to group assignments, the Social Skills Improvement System Rating Scale, the Behavior Rating Inventory of Executive Function, and the Simulator Sickness Questionnaire, conducted at baseline and after the intervention. Results The preliminary results support the feasibility and acceptability of VR training for children with ADHD aged 6-12 years. Analysis showed that the VR and traditional social skills training groups experienced a statistically significant improvement in the clinical psychologist assessment of social skills and parent-rated self-control, initiative, and emotional control after the intervention compared with baseline. The VR group performed significantly better than the traditional social skills group on social skills assessed by clinical psychologists (F2,85=76.77; P<.001) and on parent-rated self-control (F2,85=18.77; P<.001), initiative (F2,85=11.93; P<.001), and emotional control (F2,85=17.27; P<.001). No significant between-group differences were found for parent-rated cooperation and inhibition (all P>.05). Conclusions The findings provide preliminary evidence supporting the feasibility and superior effectiveness of VR-based social skills training compared to traditional approaches for enhancing social skills and related executive functions in children with ADHD. These results suggest that VR may be a valuable tool to embed within social skills interventions for this population. Further research is warranted to explore the long-term impacts and generalizability of these benefits. Trial Registration ClinicalTrials.gov NCT05778526; https://clinicaltrials.gov/study/NCT05778526 International Registered Report Identifier (IRRID) RR2-10.2196/48208

Impact of motor education levels and circuit training on enhancing wrestling techniques among adolescent athletes

Background Problems: Wrestling is a compulsory course that can improve physical strength, discipline, and strategic skills and student learning outcomes. However, the learning outcomes are still not optimal due to inconsistent training, limited technique understanding, and a lack of independent training opportunities. Research Objectives: The purpose of this study is to evaluate the effect of motor education level and circuit training on proficiency in learning wrestling martial arts techniques. Methods: This study used an experimental design with a pretest-posttest control group where there are two groups, the high motor ability group and the low motor ability group. The population consists of 40 students, and a sample of 20 students was selected using purposive sampling techniques based on certain criteria. Motor ability in this study is defined as an individual's ability to learn and develop motor skills, which is used to measure how quickly and efficiently a person can learn new motor movements. Data collection was done by measuring the level of motor ability and evaluating the techniques of wrestling after a period of practice. Data analysis was conducted using SPSS 23 statistical software to evaluate the learning outcomes of the basic techniques of wrestling. Findings/Results: The results of the data analysis showed that overall, there were no significant differences between the two groups. However, when looking closely at the level of motor skills, there are differences in the post-test scores between students with high and low motor skills. Conclusion: The conclusions of the study showed that although there were no significant differences between the two groups, the high motor skills group showed more consistent improvements. Future research could focus on the development of physical and mental skills such as endurance, strength, and discipline, which are important in improving wrestlers’ performance.

Dialectical Behavior Therapy for Adolescents: Examining Preliminary Pretreatment Expectations and Preferences.

Dialectical behavior therapy for adolescents (DBT-A) is an evidence-based treatment for adolescents with multiple emotional and behavioral problems. Research has demonstrated the posttreatment acceptability of DBT-A by parents and adolescents. However, no study has systematically explored the expectations and preferences of adolescents before beginning DBT-A treatment. The goals of this study were to investigate adolescents' pretreatment expectations for DBT-A by developing the Adolescent Expectancies for Therapy Scale (AETS), adapted from the Parent Expectancies for Therapy Scale, and to explore their preferences regarding treatment delivery format. Participants were 21 adolescents (ages 13-18) with varying race-ethnicities who were referred for DBT-A in either a group private practice or a community mental health clinic. Participants completed the AETS and the Preferences Rating Form, which examined the extent to which participants preferred each of seven treatment modifications or preferred to keep DBT-A as is. Findings indicated that, before beginning DBT-A, adolescents had moderate expectations for the outcome and process of the therapy, and approximately half reported that they preferred to be separate from their parents during multifamily skills group sessions (for at least part of the time) and to add weekly teen-only support groups to DBT-A. The AETS had adequate internal consistency (Cronbach's α=0.88). Understanding adolescents' pretreatment expectations and preferences for the format in which DBT-A is delivered can help clinicians better engage adolescents during the intake and orientation process.

THE DEVELOPMENT OF PEDAGOGICAL SKILLS OF PEDAGOGICAL UNIVERSITY GRADUATE STUDENTS IN COOPERATION WITH STUDENTS OF SPECIALISED PSYCHOLOGICAL AND PEDAGOGICAL CLASSES

The article describes the results of a study on the development of pedagogical skills among final year students in interaction with students of specialised psychological and pedagogical classes. The main groups of teaching skills are described and categorised. It was established that participation in practical work, which involves active participation and organisation of pedagogical interaction, contributes to the development of the main groups of pedagogical skills - analytical, predictive, perceptual, developmental and projective skills. The results obtained can be used to create conditions for graduates’ professionalisation and to organise interaction between specialised universities and classes of psychological and pedagogical orientation.

Collective-Level Edgework, Healing, and Destruction: The Case of the Bolsheviks in the Russian Revolution

ABSTRACT The Russian Revolution of 1917 and the subsequent Russian Civil War were two key events of the 20th Century. They led to substantial morbidity and mortality on a population level. The article argues that, for the Bolsheviks, the Revolution involved a society attempting to escape from a context of stasis and death; that it involved highly skilled individuals and groups; and that the society experienced feelings of transcendence and health as a result of its attempts to escape from this death context. As such, the article argues that, from their perspective, the Bolsheviks engaged in what could be considered collective-level edgework.

The effects of thumb position on backhand disc golf throws of a mid-range disc

In disc golf, having a comfortable and proper grip on the disc is crucial to achieving optimal throw dynamics, and the placement of the thumb is a key component of the grip. This research investigated the relationship between thumb position on a mid-range disc and the resulting angular speed, translational speed, and torque generated during the throw. Using a Discraft Buzzz disc equipped with a TechDisc sensor, measurements were obtained for throws made using five different thumb positions, starting near the outer edge of the disc (p = 1) and ending near the center of the disc (p = 5). Participants were sorted into two skill level groups that were determined based on their Professional Disc Golf Association rating. Each participant performed five throws at each thumb position with maximum effort, and angular and translational speeds of each throw were measured. The results varied between skill groups, but collective data displayed a general linear correlation between angular and translational speeds achieved across all thumb positions. While angular speed and applied torque were observed to be maximum for the thumb position with the largest radial distance from the center of the disc (p = 1), thumb positions located ∼3–5 cm radially inward from the outer edge (p = 2 and p = 3) resulted in the highest translational speeds. In general, a universally favorable thumb position was determined as that resulting in simultaneously large values of both angular and translational speeds for all participants, which occurred closest to the p = 2 position (∼3 cm from the outer edge).

An optimization framework to provide volunteers with task selection autonomy and group opportunities

Nonprofit Organizations (NPOs) rely on volunteers to support community needs but struggle with making strategic volunteer-to-task assignments to enable volunteer satisfaction, and completion of complex tasks. Creation of volunteer groups and their assignment to NPO tasks can help achieve these goals by providing volunteers with opportunity for networking, collaboration, and peer learning. However, strategically creating ideal assignments is challenging because (i) there are exponentially many ways a set of volunteers can be assigned in groups; and (ii) NPOs tend to have limited and uncertain data concerning volunteers’ personal preferences, availabilities, and motivations to participate. To address these challenges, this research contributes by introducing an integer programming framework to offer volunteers a menu of tasks to choose from and then based on volunteers’ willingness information, creates ideal homogenous volunteer group assignments. These groups are created such that the group collectively meet a task’s skill requirements and groups of volunteers of similar skill and affinity levels are prioritized. We apply the developed methodology to a case study based on a partner NPO that works with remote volunteers from multiple countries to produce online educational content. The menu creation method can improve NPO and volunteer-based performance metrics, where the most improvement is observed when a NPO is faced with very picky volunteers. Presenting volunteers with larger menus of tasks also leads to an improvement in ideal group creations. Implementing the group creation methodology helps obtain a statistically significant increase in ideal group creations but results in a tradeoff of decreased benefits to volunteers and the NPO. Finally, implementing a minimum desired group size does not severely impact most KPIs and would be beneficial for an NPO to implement as it encourages the creation and assignment of volunteer groups to tasks.

University students’ socio-emotional skills: the role of the teaching and learning environment

ABSTRACT Socio-emotional skills are vital for individuals to thrive academically, personally, and socially in the twenty-first century. However, limited attention has been devoted to the factors that might facilitate or hinder the development of socio-emotional skills among university students. To address this gap, we explored the association between the teaching and learning environment and socio-emotional skills using both variable-centered (Study 1) and person-centered (Study 2) approaches. A survey was conducted among 1,136 students in 21 universities. In Study 1, the variable-centered approach showed that active learning, good teaching, and clear goals and standards were positively associated with socio-emotional skills, while feedback and appropriate assessment had no significant or negative influence on socio-emotional skills. In Study 2, the person-centered approach identified three groups of students characterized by low, medium, and high socio-emotional skills. Students who experienced higher levels of active learning and clear goals and standards were more likely to belong to the high socio-emotional skills group. Surprisingly, students who received more frequent feedback from their teachers were more likely to belong to the low socio-emotional skills group, which we speculated might be due to low levels of feedback literacy. These findings underscore the importance of the teaching and learning environment in developing students’ socio-emotional skills in the higher education context.

New Skills and Knowledge for Digital Entrepreneurs in the Age of Artificial Intelligence

Digital technologies are becoming increasingly complex and integrated, leading to significant transformations in society and the economy. The article aims to explore and summarize the new opportunities and potential risks of the widespread use of artificial intelligence (AI) in all aspects of life, to define the new skills and necessary knowledge of digital entrepreneurs and to highlight the need for transformation in modern education. Recognizing that the relationship between technology and business is two-way and becoming stronger, revealing that well-prepared employees are a guarantee of success and prosperity of companies in various fields, we try to focus on the main groups of qualities, skills and basic knowledge of students in the age of artificial intelligence. The development of the Internet, expansion of connectivity through social networks, the advent of AI, 3D printing, and immersive technologies like Augmented Reality, and Virtual Reality, require new knowledge and skills, leading to new challenges in education. Qualified personnel in this modern world must have solid professional training and systemic thinking (knowledge, skills, accumulated information), developed cognitive abilities, and personal skills based on collecting and analyzing large amounts of diverse information from heterogeneous sources. Questions arise: how can multiple information sources be combined effectively, and how can the fusion of multiple sources provide additional information to support decision-making processes? Combining information obtained from the real world makes the results heterogeneous and more informative. It follows the need to develop machine learning methods to extract relevant information from increasingly complex data sets. The goal is to improve the accuracy of the applied classification algorithms by combining predictions from multiple models, as well as obtaining a more stable final classification evaluation, effective handling of noisy data, adaptation to changing conditions, and improving stability when solving problems. On the other hand, how to ensure that the enormous potential of artificial intelligence, virtual reality, connection with the physical world, machine learning, and pervasive networks of people and machines will be fully used to improve the quality of life and contribute to the building of stable societies. Changes must be subordinated to policy and investments for reliable artificial intelligence and based on an ethical and human-centered approach. All of these should be established as a fundamental principle of training in Higher education which imposes the need for transformation in modern education.

Building Parental Capacity: Outcomes of a Therapeutic Parent Group Run Concurrently with a Social Skills Group for Their Young Person

Introduction: Raising a child with social communication and emotion regulation challenges, such as those experienced in the context of an autism spectrum disorder (ASD), is associated with family disruption and parental stress. Research shows that parents of children and young people with ASD can experience challenges in managing their child’s behaviour and experience a sense of disconnectedness, a lack of support from the “system”, and a broader lack of understanding within the community. Methods: A therapeutic parent group was held in parallel to a young person group working on social skills. The young person cohort included both boys and girls in early adolescence with neurodevelopmental diagnoses. The parent group provided a space for participants to focus on themselves, tune into their own emotions, and receive support in relation to their lived experiences of parenting. Parental outcomes were assessed using standard measures, and the experiences of the groups were captured qualitatively through focus groups with both parents and staff. Results: The project found that the therapeutic parent group was effective in supporting parents to feel less stressed and more in control, as well as less alone in their parenting journey. Qualitative data indicated that the groups filled an identified need within the service and were engaging and acceptable to parents.

Epley Maneuver Skills in Primary Care: 3D Semicircular Canal Models for Self-Learning.

Posterior canal-type benign paroxysmal positional vertigo (BPPV) is commonly treated using the Epley maneuver; however, the maneuver's use in primary care is limited by insufficient expertise. Therefore, this study aimed to evaluate the efficacy of a three-dimensional (3D) semicircular canal model as a self-learning tool for primary care physicians to improve their Epley maneuver technique. Thirty-one participants (18 family physicians, seven residents, and six medical students) performed the Dix-Hallpike maneuver on a nursing manikin, followed by the Epley maneuver on the covered 3D models before and after a 5-minute self-study period with the uncovered 3D model. We measured the number of moved beads from posterior canal into the utricle of the 3D model, time spent on the Epley maneuver, and head suspension angle of the Dix-Hallpike maneuver. Preintervention performance was divided into a skilled group (n=7) that could move almost all the beads and an unskilled group (n=24) that could move a few beads. Postintervention, the unskilled group members significantly improved their skill: The average moved beads increased from 0.35 to 8.00, maneuver time from 26.1 to 35.8 seconds, and head suspension angle from 10.3° to 16.4°. Most participants recognized the importance of correct positioning and spent adequate time. The 3D model was effective as a self-learning tool for improving Epley maneuver performance, particularly for less experienced practitioners. This approach could bridge the gap between evidence and practice in primary care for BPPV treatment, enhancing patient outcomes and reducing the need for specialist referrals.

When silence feels safer: Challenges and successes of delivering a school-based cognitive behavioral intervention to Central American unaccompanied immigrant youth.

To explore cultural and immigration-related factors, among Central American unaccompanied immigrant youth (UIY), affecting the safety and acceptability of Cognitive Behavioral Intervention for Trauma in Schools (CBITS), a group intervention designed to treat trauma symptoms. Thematic analysis of data from grounded theory study of group interventions to support resilience in UIY, consisting of interviews with 10 key stakeholders (5 CBITS facilitators) and 16 UIY (6 CBITS participants) from El Salvador, Guatemala, or Honduras, interviews conducted in Spanish, English, or Mam. Five themes emerged from interviews with CBITS facilitators and UIY: (a) Todo está bién: self-protective silence about trauma and symptom denial, (b) Chisme goes around: personal risks of disclosure, (c) marginalizing the language and world view of indigenous youth, (d) "CBITS didn't really quite land for them": adapting the curriculum and delivery, and (e) "I learn to appreciate things": benefits of the CBITS group. CBITS facilitators endorsed skill-building aspects of the groups and expressed concerns about a curriculum relying on written homework and parental support for youth with limited home country schooling, currently living with distant relatives. CBITS participants endorsed hearing about other youths' stories and learning coping skills. Models for group intervention that emphasize coping skill development and group support, while de-emphasizing the trauma narrative, should be explored and tested. Group intervention leaders should consider the impact of differences in gender, country of origin, and native language on group dynamics. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Construct Validity of the Athlete Introductory Movement Screen in Grassroots Footballers Aged 11-13 Years.

This study examined the construct validity of the Athlete Introductory Movement Screen (AIMS) in children. Following ethics approval, parental consent, and child assent, 87 children (50 boys, 37 girls) aged 11-13 years (Mean ± SD = 12.4 ± 0.6 years) performed the AIMS and Test of Gross Motor Development (TGMD-3) in a counterbalanced order. AIMS tertiles were subsequently created, classifying children with 'high', 'medium', or 'low' movement skills. A 2 (Gender) X 3 (AIMS tertile) ways analysis of covariance (ANCOVA), controlling for age and age at peak height velocity, with TGMD-3 scores as the dependant variable, indicated that TGMD-3 scores were significantly higher for girls categorised as having a medium movement skill compared to girls categorised as low, and those categorised having high movement skill compared to medium and low movement skill groups (all, p = 0.001). There was no difference in TGMD-3 scores for boys classed as having low and medium movement skills. Boys categorised as high for movement skills had significantly greater TGMD-3 scores than their peers categorised as having both low and medium movement skills (p = 0.001). As the AIMS differentiates the theoretically related construct of motor competence, this study demonstrates that the AIMS has construct validity as a measure of movement skill in children aged 11-13 years.

Effectiveness of an Occupational Therapy-Led Social Skills Group Using Parent Training: A Pilot Study

Effectiveness of an Occupational Therapy-Led Social Skills Group Using Parent Training: A Pilot Study

Efficacy of social skills group intervention among children with mild autism spectrum disorder.

Efficacy of social skills group intervention among children with mild autism spectrum disorder.

Life Skills - The 21st Century Skills

“Skills have become the global currency of the 21st century, but this currency can depreciate if it isn’t used” said Andreas Schleicher, Deputy Director for Education at the OECD Forum (25 May 2012). Our educational system gives more importance to learning of 3 R’s- reading, writing and arithmetic. It is concentrated more on the cognitive dimension rather than on reflective and psychological dimensions. It is achievement oriented than child oriented. But today changes and challenges of fast-growing society demands more contextual approach in education to meet actual use in real life situations. In 21st century India there is raising problem of unemployment, inequality, violence and environmental destruction, etc., demands a new set of skills, and creative problem-solving potential. Life skills are group of psychological competencies and interpersonal skills that help people make informed decisions, communicate effectively and develop coping and self-management skills to lead a healthy and productive life. Life skill learning should be made integral part of the curriculum to promote the well-being of the youth

Exploring the relationship between cultural and structural workforce issues and retention of nurses in general practice: A qualitative study protocol.

The aim of this study is to understand factors that challenge retention and support nurses to stay in general practice. One in four general practice nurse positions in England expected to be left unfilled within the next 10 years. Cultural and structural issues associated with working in general practice have been linked with nurses leaving general practice, re-evaluating their professional futures, adjusting work-life balance and bringing forward retirement. This has implications for the future of the general practice nursing workforce and patient care more broadly. Exploratory qualitative interview study funded by the General Nursing Council Trust for England and Wales. University of York ethics approval (Ref: HSRGC/2023/586/A) was gained in September 2023. The study will be conducted between September 2023 and August 2024. Qualitative interviews will be conducted with a range of nurses working in, or who have worked in, general practice as well as nurse leaders associated with general practice across England and Wales. Recruitment will be via professional and social media networks and snowballing techniques. We aim to purposively recruit 30-40 participants for maximum variation. Cultural and structural influences which may contribute to retention decisions will be explored. Data will be analysed following framework analysis. This study will explore how underpinning cultural and structural issues may impact on retention of this highly skilled professional group and identify factors to support retention. By exploring factors that support or discourage nurses to remain in general practice, retention strategies can be better planned on order to address the general practice nursing workforce crisis. What problem did the study address? This study will address the retention crisis in nursing in general practice by exploring how cultural and structural issues may impact on retention of this highly skilled professional group and identify factors to support retention. Where and on whom will the research have an impact? From the study findings, recommendations will be developed to inform future policy and practice. Key factors to address attrition will be generated to support employers and policy makers in future primary care workforce planning, as well as supporting nurses, at an individual level, in negotiating their roles in practice. Standards for Reporting Qualitative Research (O'Brien etal., 2014). As this is a workforce study protocol, there is no patient or public contribution.

Developing an Effective Off-the-job Training Model and an Automated Evaluation System for Thoracoscopic Esophageal Atresia Surgery

BackgroundPediatric minimally invasive surgery requires advanced technical skills. Off-the-job training (OJT), especially when using disease-specific models, is an effective method of acquiring surgical skills. To achieve effective OJT, it is necessary to provide objective and appropriate skill assessment feedback to trainees. We aimed to construct a system that automatically evaluates surgical skills based on forceps movement using deep learning (DL). MethodsUsing our original esophageal atresia OJT model, participants were tasked with performing esophageal anastomosis. All tasks were recorded for image analysis. Based on manual objective skill assessments, each participant's surgical skills were categorized into two groups: good and poor. The motion of the forceps in both groups was used as training data. Employing this training data, we constructed an automated system that recognized the movement of forceps and determined the quality of the surgical technique. ResultsThirteen participants were assigned to the good skill group and 32 to the poor skill group. These cases were validated using an automated skill assessment system. This system showed a precision of 75%, a specificity of 94%, and an area under the receiver operating characteristic curve of 0.81. ConclusionsWe constructed a system that automatically evaluated the quality of surgical techniques based on the movement of forceps using DL. Artificial intelligence diagnostics further revealed the procedures important for suture manipulation. Levels of EvidenceLevel IV