Training Supervision Research Articles

Scoping Review of Ethical Discourse in Global Cleft Surgery Literature.

The ethical discourse regarding the delivery of global surgical care has increased in the 21st century. The aims of this manuscript are to explore the differences in ethical domains in the global cleft surgical literature discussed by authors from high-income countries versus lower-middle-income countries and to elucidate changes in ethical discussions over the last decade. A thematic coding analysis was completed using NVivo 12 qualitative data analysis software. Articles were analyzed and coded for discussion of 24 distinct subdomains in the global cleft surgical literature from 1992 to 2022. The domains with the most significant discourse in the global cleft surgery literature found were (1) clinical care and delivery and (2) engagement in collaborations and partnerships. Furthermore, when manuscripts are first authored by low- and middle-income country (LMIC) authors, the subdomains of (1) level of visiting trainee supervision, (2) relevance of educational activities, and (3) patient/procedure/location selection increase in relative discourse. The impact of visiting trainees on local educational programs is the ethical subdomain that has the largest increase in the last decade. There are barriers to publication as evidenced by the exclusion of abstracts which included LMIC authors but did not result in publications in peer-reviewed journals. A critical finding of this study is that the distribution of discussed ethical domains differs when LMIC authors are included as authors, in particular when primary authorship is from an LMIC author. To the authors' knowledge, there is no other study to date which has attempted this form of analysis.

Tunable and real-time automatic interventional x-ray collimation from semi-supervised deep feature extraction.

The use of endovascular procedures is becoming increasingly popular across multiple clinical domains. These procedures are generally performed under image guidance using an interventional c-arm x-ray system. Radiation exposure to both patients and interventional staff due to use of fluoroscopy is a health and occupational concern, but modifications to the interventional workflow to address radiation may come at the cost of procedure time orquality. Interventional x-ray collimation is a crucial task for improving image quality as well as reducing radiation exposure to both patients and operators who work in the x-ray domain. However, collimation is heavily underutilized due to its cumbersome nature and the difficulty of manually manipulating multiple parameters during fast-paced interventional procedures. Additionally, the widely varying collimation preferences of interventionalists across different procedure types, procedure phases, and anatomies makes the standardizing of collimation challenging for radiation technologist supportstaff. Automating collimation has the potential to bridge this gap, freeing up mental bandwidth for interventionalists and technologists and improving outcomes for patients. Here, we propose a tunable algorithm for automatic collimation based on a region-of-interest optimizer driven by a combination of image, system, device, and radiation based features and we illustrate its efficacy across varying personal preferences. Critically, we devise a method with a simple and easily understandable mapping between algorithm parameters and practicaloutcomes. We show a real-time implementation of this algorithm using deep feature extraction by a convolutional neural network and evaluate its performance in a custom dataset of simulated fluoroscopy and recorded fluoroscopy from clinical radial access procedures. We evaluate the effects of a practically implemented mixed supervision training strategy on model performance and show potential for radiation reduction in simulation. An uncertainty analysis indicates that the algorithm is robust to noise and anatomical variation across our clinical dataset. Clinical acceptability and quality is evaluated through a reader study with expert neuro-interventional radiologists, with participants indicating 100% clinical acceptability, high quality ratings, and improved radiation protection over their typicalpractice. The algorithm's modular design ensured that users' collimation requirements were met without disruption to the interventional workflow or procedure time, while exhibiting strong potential to reduce radiation risk to patients and operators. Evaluation in more varied clinical settings could support translation of this technology into theclinic.

NeCA: 3D Coronary Artery Tree Reconstruction from Two 2D Projections via Neural Implicit Representation

Cardiovascular diseases (CVDs) are the most common health threats worldwide. 2D X-ray invasive coronary angiography (ICA) remains the most widely adopted imaging modality for CVD assessment during real-time cardiac interventions. However, it is often difficult for the cardiologists to interpret the 3D geometry of coronary vessels based on 2D planes. Moreover, due to the radiation limit, often only two angiographic projections are acquired, providing limited information of the vessel geometry and necessitating 3D coronary tree reconstruction based only on two ICA projections. In this paper, we propose a self-supervised deep learning method called NeCA, which is based on neural implicit representation using the multiresolution hash encoder and differentiable cone-beam forward projector layer, in order to achieve 3D coronary artery tree reconstruction from two 2D projections. We validate our method using six different metrics on a dataset generated from coronary computed tomography angiography of right coronary artery and left anterior descending artery. The evaluation results demonstrate that our NeCA method, without requiring 3D ground truth for supervision or large datasets for training, achieves promising performance in both vessel topology and branch-connectivity preservation compared to the supervised deep learning model.

Effective components of services for recurrent care experienced parents: A literature review of what works

Recurrent care services aim to reduce the number of repeat removals amongst birth parents who have already ‘lost’ a child through care proceedings. This literature review aimed to identify published evidence about effective components of services to support parents who have experienced repeat removals of their children to care.Searches identified 19 studies that included content relating to the components of service provision within recurrent care services. Across all studies, a range of perspectives were included: birth parents (n = 425); practitioners (n ≥ 151); other professionals (n = 109).The evidence reviewed indicates the importance of relationship-based practice, building a trusted relationship between parents and practitioners, continuity and tenacity in engaging with mothers and a non-judgemental approach. Services should be flexible, holistic and client led, with a long duration of support and a flexible end date. Services should: have a trauma-informed approach; recognise unresolved loss, complex grief and trauma experienced by mothers who have ‘lost’ their children through care proceedings; and provide emotional support, therapeutic support, practical support and advocacy. Services need to have a skilled and multi-disciplinary workforce with robust supervision and ongoing training.

A Deep Learning Algorithm for KOL Segmentation on Social Media Videos

Nowadays, there is high commercial demand for product replacement which places the products virtually in Key Opinion Leader’s (KOL’s) social media videos. However, one of the challenges of placing the products virtually is the KOL segmentation. Since KOLs often hold products in front of them, it requires the segmentation to segment not only humans but also different products. This paper introduces the state-of-the-art deep learning method, namely RSUDISNet, for KOL segmentation. The proposed technique integrates two deep Convolutional Neural Network (CNN) technologies. One is the Matting Objective Decomposition Network (MODNet), which segments KOLs well but not the products blocking the KOLs. The other one is the two-level nested U-structure network (U2Net) based on the salient object detection method to segment the objects well, but not the KOL. The key technique of the proposed research is to employ the feature of the U2Net to embed the MODNet to overcome the problem of KOL segmentation. Since both MODNet and U2Net are lightweights, the combined network can be used for real-time scenarios. After that, the Intermediate Supervision (IS) training strategy is utilized to overcome the overfitting. The experimental results show that our proposed method outperforms the MODNet and U2Net.

Realist assessment of fidelity during the implementation of the PARTNERS collaborative care intervention for people with diagnoses of severe mental illness within a cluster randomised controlled trial

Many with severe mental illnesses are underserved by disjointed service provision. PARTNERS aims to address this via collaborative care with recovery-based coaching. PARTNERS was evaluated in a randomised controlled trial. Understanding how intervention delivery compared to the model, why this was, and under what circumstances, aids interpretation of trial results and optimisation of future implementation. This paper reports the results of a Realist assessment of fidelity, exploring delivery compared to model and refining programme theory. Practitioners, service users, supervisors, primary care representatives, and researchers (n = 39) were interviewed. Additional data included session recordings, follow up interviews, practitioner reflective logs, supervision logs, contact data, service user surveys, and meeting minutes. A framework analysis with evaluative coding was used to assess the extent to which delivery matched the Realist initial programme theory, and how, why and under what circumstances this was the case. Retroductive analysis was used to refine the programme theory. Delivery was good, but varied by practitioner and over time. Delivery improved over time, as practitioner understanding of the intervention increased. Refinements to the programme theory include training leading to practitioners forming collaborative relationships with service users most of the time, but unidentified contextual factors causing variation in consistency. Whether training led to practitioners liaising across different bodies was dependant on the contextual factors of existing relationship skills and previous connections. System-level difficulties in providing consistent supervision made it difficult to assess the impact of this mechanism on delivery. Variation in delivering means caution should be applied when interpreting trial results. Implementation of practitioner-level change without implementing system-level change limits the ability to fully implement the model and to draw conclusions as to effectiveness. Current changes to NHS community mental health care may make this more achievable. Further research is needed to understand the role of supervision and optimal training. Trial registration: This is the realist process evaluation of the cluster randomised controlled trial ISRCTN95702682. REC approval: West Midlands–Edgbaston Research Committee 29/06/2017, ref: 14/WM/0052 (trial registration number ISRCTN95702682).

Muscular Endurance Training: Bridging Gym Practices with Science Recommendations

This study investigated the effectiveness of training methodologies for improving muscular endurance in young adult males and whether these practices align with scientific recommendations. A cross-sectional descriptive comparative study was conducted with 115 male participants aged 18 to 26. Data on various training parameters were collected using a self-administered questionnaire. The results indicated that participants exhibited discrepancies in their training practices compared to established scientific recommendations. An important percentage of study participants did not exercise according to the recommended guidelines regarding exercise sequencing, intensity, repetitions, rest periods, and training supervision. Participants who followed the recommendations regarding intensity, sets, repetitions, weekly training frequency, and supervision achieved higher objective accomplishment scores. Thus, there are notable discrepancies between everyday gym practices and scientific recommendations for improving muscular endurance in young adult men. Adherence to current recommendations and professional supervision are essential for maximizing training effectiveness, preventing injuries, and facilitating future adaptations.

Early Career School Counselors’ Experience of Developing Group Counseling Skills: An Interpretive Phenomenological Analysis

ABSTRACT Group counseling is essential to school counselors’ practice, but training may be insufficient. Little literature exists on school counselors’ post-master’s experience of gaining group skills. The research question for this interpretative phenomenological analysis (IPA) study was as follows: How do early career school counselors (ECSCs) experience developing group counseling skills post-master’s? Interviews with ECSCs, use of IPA data analysis, and application of trustworthiness strategies yielded themes. Findings described participants’ experience of learning group skills in the context of colleague connections, group scarcity, motivation, and tension between barriers and motivations. Implications for group training in counselor education, continuing education, and supervision are provided.

Analysis of rational prescription of medicines by village clinics: a repeated cross-sectional study of a province in eastern China.

To analyse the rational prescription of medicines by village clinics following China's implementation of the New Healthcare System Reform (NHCSR). Retrospective study. Village clinics in a province in eastern China. Our evaluation was based on the core drug use indicators reported in the study 'How to Investigate Drug Use in Health Facilities: Selected Drug Use Indicators'. The level of rational use of medicines (RUMs) in village clinics improved in 2018 compared with 2009; the average number of drugs per prescription decreased from 3.66 to 2.77, the percentage of prescriptions including antibiotics decreased from 65.40% to 46.00%, and the percentage of prescriptions including injections decreased from 55.75% to 37.48% (all p<0.01), whereas the percentage of drugs prescribed from the list of essential medicines increased from 66.50% to 80.34%, and the percentage of drugs prescribed by generic names increased from 61.29% to 70.65% (all p<0.01). The level of RUMs improved after the implementation of the NHCSR, however, it was found that there was still a gap between the level of RUMs in 2018 and the international reference value. Financial investments, electronic prescription systems, improved supervision and regular training are essential actions that must be implemented.

Eight ways to support faculty with Entrustable Professional Activities.

Competency Based Medical Education (CBME) is pushing the medical profession to be more accountable in our standards of assessment. This has led us to focus our efforts at the top of Miller's pyramid, where we aim to see what the trainee 'does' in the clinical environment. In Canadian Royal College specialty training, this has come in the form of workplace-based supervision of trainees performing Entrustable Professional Activities (EPAs). This is unfamiliar territory for many residents and faculty, and implementation of an additional assessment process into already busy clinical practice has been particularly challenging. Because EPA assessments serve as significant contributors in new programs of assessment, failure to collect high quality EPA assessments threaten the validity of this new system. Understanding the barriers to and enablers of EPA acquisition can inform faculty development initiatives to ensure success. Based on our previous work studying early experiences of EPA assessment acquisition in Emergency Medicine, we have identified eight key concepts to guide faculty development initiatives, namely: the rationale for CBME, the 'behind the scenes' of CBME, how to construct rich narrative comments, effective use of supervision scales, the tension of EPA assessments being both formative and summative, the importance of a shared responsibility between residents and faculty for EPA assessment completion, familiarity with the suite of EPAs, and tips and tricks for incorporating EPA assessment completion into busy clinical practice. These key concepts can be integrated into an overall faculty development strategy for building this now essential skill set.

The supervision of experienced secondary school‐based counsellors: A situational analysis constructivist grounded theory exploration of best practice

AbstractIntroduction and AimsSecondary school‐based counselling (SSBC) is used widely throughout the United Kingdom (UK) as an early mental health intervention, and clinical supervision is necessary for its safe and effective practice. Currently, there does not exist a body of research to inform best practice in this area of supervision. The purpose of this study was to explore the supervisory requirements of the experienced secondary school‐based counsellor and what best practice looks like.MethodThis study used situational analysis constructivist grounded theory methodology to explore and develop a grounded theory of best practice in supervising the experienced secondary school counsellor in the UK. The descriptions of best practice were examined from the interviews of 17 experienced secondary school counsellors and/or supervisors.FindingsFrom the data emerged one core category (‘a good fit’) which encapsulated four theoretical categories (‘the supervisory relationship’, ‘understanding the working context’, ‘safeguarding’ and ‘the shared supervisory journey’). The study indicates that the supervisor needs an understanding of the unique context of the secondary school as a therapist's working environment in order to support the supervisee with often complex work. There needs to be an awareness of how elements from within the school and/or counselling agency can impact on the supervision regarding boundaries, trust and containment so they do not impact the supervision in a detrimental way.ConclusionsSupervisor and supervisee need a shared understanding of the nature of supervision within this context for it to be a ‘good fit’ for both. This has implications for supervision training and the externality of supervision within this context.

Evaluasi Kepatuhan Pelaku Usaha Petis Ikan HSN terhadap Sistem Jaminan Produk Halal (SJPH) di Konang Galis Kabupaten Pamekasan

In Pamekasan, many small and medium businesses have received halal certificates, but still have difficulty implementing SJPH in a sustainable manner. Many business actors do not fully understand that halal certification is not just a symbol, but is a system that needs to be implemented continuously and monitored closely. They often focus on the administrative aspects of certification, and ignore the importance of practice in daily activities. This research aims to determine the efforts of HSN fish paste business actors UMK in Pamekasan Regency in ensuring compliance with SJPH and evaluating compliance with SJPH implementation. The research method used is a descriptive qualitative research method, where the process of searching for data is through observation, interviews and documentation techniques. This method was chosen so that the research data is in-depth and comprehensive regarding the evaluation of HSN fish paste business actors' compliance with the Halal Product Guarantee System (SJPH). This research involved 4 fish paste business actors. The findings of this research show that HSN fish paste business actors are trying hard to implement SJPH, even though there are obstacles that hinder its effectiveness. However, there are weaknesses in supervision, internal auditing, and employee training. There needs to be more structured action to achieve optimal SJPH compliance and strengthen consumer trust.

Evolving Trainee Participation in Radiologists’ Workload: A National Medicare-Focused Analysis From 2008 to 2020

PurposeIncreasing volumes and productivity expectations, along with practice type consolidation, may be impacting trainees’ roles in the work effort of radiologists involved in education. We assessed temporal shifts in trainee participation in radiologists’ workload nationally. MethodsAll US radiologists interpreting noninvasive diagnostic imaging for Medicare fee-for-service beneficiaries were identified from annual 5% Research Identifiable Files from 2008 to 2020 (n = 35,595). Teaching radiologists were defined as those billing services using Medicare’s GC modifier, indicating trainee supervision. Billed work relative value units were used to determine the percentage of teaching radiologists’ total workload with trainee participation. Mean trainee participation in workload was calculated for teaching radiologists overall and stratified by radiologist and practice characteristics determined using National Downloadable Files. ResultsThe percentage of radiologists involved in teaching increased from 13.6% (2008) to 20.4% (2020). Among teaching radiologists, mean total workload increased 7% from 2008 to 2019 and decreased in 2020 to 2% below 2008’s level; mean teaching workload decreased 19% from 2008 to 2019 and decreased in 2020 to 31% below 2008’s level. Mean trainee participation in teaching radiologists’ total workload decreased from 35.3% (2008) to 26.3% (2019) and 24.5% (2020). Teaching radiologists showed decreased mean trainee participation when stratified by gender, experience, subspecialty, geography, practice type, and practice size. ConclusionsThe percentage of US radiologists involved in resident teaching has increased, likely reflecting academic practice expansion and academic-community practice consolidation. However, a declining percentage of teaching radiologists’ total workload involves trainees; this dispersion effect could have implications for education quality.

The Thought Broadcast: Discussing a taxonomy of supervision for RANZCP trainees and Fellows.

The Thought Broadcast: Discussing a taxonomy of supervision for RANZCP trainees and Fellows.

Doctoral‐level counselor educators and program experiences across Carnegie Classifications

AbstractBased on online survey data provided by 163 counselor educators associated with counselor education and supervision programs, this study examined the extent to which Carnegie Classifications were associated with counselor educators’ occupational experiences and their perceptions of doctoral‐level training. Implications for doctoral training in counselor education and supervision are discussed.

Debate: How much should nonspecialists be involved in mental health care when resources are limited? A perspective from low- and middle-income countries.

Millions of children and young people (CYP) in low- and middle-income countries (LMICs) have no access to mental health care. This huge treatment gap is primarily due to limited availability of trained mental health professionals. We propose task-sharing as a scalable strategy to expand access to child and adolescent mental health (CAMH) interventions in LMICs. Task-sharing involves using the few mental health specialists in LMICs to train and supervise nonspecialists to provided CAMH interventions. There is strong evidence of clinical and cost effectiveness of task-shared mental health interventions for adults in LMICs and promising evidence for CYP. To succeed, task-shared programmes need to be embedded in a balanced system-wide care setting that includes stakeholder involvement. The existing mental health specialists may require additional training in leadership, supervision, mentoring, service design and evaluation in order to meet the additional expectations of managing task-sharing programmes. The nonspecialists to be trained would need assurances about workload, ongoing supervision, clinical back up for cases that exceed their expertise, certification for their training and career progression. CAMH task-sharing offers good promise for increasing CYP's access to mental health interventions in LMICs. However, planners need to be aware of the important practical, ethical and contextual considerations necessary for success and sustainability.

Reference-then-supervision framework for infrared and visible image fusion

Infrared and visible image fusion has drawn increasing attention of researchers in recent years, wherein the complementary information between two source images is extracted to synthesize a new fusion image with richer information. Deep neural network is the latest technique to tackle various image fusion problems. However, the natural absence of ground truth makes it very challenging to optimize deep learning models. While the current methods mainly consider to uses the two source images themselves or their visual features, to provide supervision for learning, which is easy to result in the imbalance between detail preservation and brightness distribution. To boost the performance of the fusion models, it is meaningful and necessary to establish a flexible framework that can combine the advantages of existing models to produce reliable supervision for model training. In this work, we propose a novel reference-then-supervision framework, which aims to fully leverage and exploit the available favorable reference information based on the performance of existing methods and then construct high-quality reliable supervision to assist in model building. For this purpose, we design an automatic filter to produce favorable reference and devise an adaptive enhancement method to construct reliable supervision, which helps to aggregate the advantages of various existing fusion methods for yielding visually pleasing results adapting to different complex scenarios. Extensive experiments on two commonly used datasets and our built challenging test set demonstrate that our framework can greatly improve the performance of existing fusion methods. Ablation study and empirical analysis also present the efficacy of our framework design. Furthermore, the applications on downstream pedestrian detection and object tracking tasks indicate the great potential of our framework. Our code and data are publicly available at https://github.com/zhenglab/ReferenceSupervisionIVIF.

Association between surgeon training grade and the risk of revision following unicompartmental knee replacement: An analysis of National Joint Registry data.

Unicompartmental knee replacements (UKRs) are performed by surgeons at various stages in training with varying levels of supervision, but we do not know if this is a safe practice with comparable outcomes to consultant-performed UKR. The aim of this study was to use registry data for England and Wales to investigate the association between surgeon grade (consultant, or trainee), the senior supervision of trainees (supervised by a scrubbed consultant, or not), and the risk of revision surgery following UKR. We conducted an observational study using prospectively collected data from the National Joint Registry for England and Wales (NJR). We included adult patients who underwent primary UKR for osteoarthritis (n = 106,206), recorded in the NJR between 2003 and 2019. Exposures were the grade of the operating surgeon (consultant, or trainee) and whether or not trainees were directly supervised by a consultant during the procedure (referred to as "supervised by a scrubbed consultant"). The primary outcome was all-cause revision surgery. The secondary outcome was the number of procedures revised for the following specific indications: aseptic loosening/lysis, infection, progression of osteoarthritis, unexplained pain, and instability. Flexible parametric survival models were adjusted for patient, operation, and healthcare setting factors. We included 106,206 UKRs in 91,626 patients, of which 4,382 (4.1%) procedures were performed by a trainee. The unadjusted cumulative probability of failure at 15 years was 17.13% (95% CI [16.44, 17.85]) for consultants, 16.42% (95% CI [14.09, 19.08]) for trainees overall, 15.98% (95% CI [13.36, 19.07]) for trainees supervised by a scrubbed consultant, and 17.32% (95% CI [13.24, 22.50]) for trainees not supervised by a scrubbed consultant. There was no association between surgeon grade and all-cause revision in either crude or adjusted models (adjusted HR = 1.01, 95% CI [0.90, 1.13]; p = 0.88). Trainees achieved comparable all-cause survival to consultants, regardless of the level of scrubbed consultant supervision (supervised: adjusted HR = 0.99, 95% CI [0.87, 1.14]; p = 0.94; unsupervised: adjusted HR = 1.03, 95% CI [0.87, 1.22]; p = 0.74). Limitations of this study relate to its observational design and include: the potential for nonrandom allocation of cases by consultants to trainees; residual confounding; and the use of the binary variable "surgeon grade," which does not capture variations in the level of experience between trainees. This nationwide study of UKRs with over 16 years' follow up demonstrates that trainees within the current training system in England and Wales achieve comparable all-cause implant survival to consultants. These findings support the current methods by which surgeons in England and Wales are trained to perform UKR.

A brief descriptive analysis of a pilot study of peer support training and supervision for Texas firefighters

Background Peer support has been shown to reduce the incidence and severity of mental health disorders among firefighters. This pilot project had two aims: (1) to assess training satisfaction and knowledge, self-efficacy, and skills development of Texas firefighters participating in the International Association of Fire Fighters (IAFF) Peer Support Training, and (2) to determine if newly trained peer support specialists would use monthly phone supervision. Methods The study included 14 Texas firefighters who enrolled in the IAFF Peer Support Training. Pre- and post-tests were administered to evaluate training satisfaction, skills development, self-efficacy, and behavioral health knowledge of participants. Use of phone supervision over 6 months following the training was also recorded. Results Overall, participants reported high satisfaction with the training provided. While self-efficacy regarding detection of mental health issues and therapeutic empathy skills significantly improved following the training, participants did not show a significant improvement in knowledge regarding mental health. Attendance of participants to supervision calls was less than expected, although 71% attended at least one supervision call. Conclusions This project was successful in increasing firefighters’ self-efficacy and therapeutic empathy skills, and participants were highly satisfied with the training. However, further research on follow-up supervision of peer support trainees is needed.

An evaluation of a quality improvement initiative examining benefits and enablers and challenges and barriers of implementing and embedding core clinical supervision in primary care

Background Core Clinical Supervision has become a valued activity that impacts on the culture and organisational delivery of healthcare. It embeds good practice to ensure that staff have a high skill set, desirable professional attitudes, and provide high quality evidence-based care. It also helps to support good clinical governance and enhances staff retention (CQC 2013). A supervision framework has been adopted and adapted from the ‘General Practice – Developing confidence, capability, and capacity. A Ten Point Action Plan for General Practice Nursing’ ( NHS England 2018 ) and applied at scale across Yorkshire and the Humber, with minimal impact on clinical capacity, quality, and safety. This initiative coincides with general practice (and the wider health service) being under enormous pressure managing the effects of the COVID-19 pandemic, with impact on staff wellbeing and retention. The main aims are to evaluate the impact of embedding the Core Supervision training across primary care practice and strengthen course content for future delivery. Methodology and Methods A quantitative approach using an online survey, was completed by multi-professional primary care staff who had completed the Core Supervision Training. Findings Practitioners indicated that they required protected time due to competing demands and visible senior buy in to undertake core supervision. Additionally, practitioners who had participated or supervised sessions felt the benefits on staff wellbeing and indicated that it improved patient care delivery. Conclusion and Implications Survey findings suggest further research on embedding core supervision within primary care and a focus on national and local strategies are required. Standardised learning outcomes across the regions to ensure transferability of supervision practice and review training in supervision processes, particularly around conducting a supervision session.