Training Programs For Practitioners Research Articles

Assessing a Training Program for Integrative Medicine Practitioners in the Treatment of Acute Stress Disorder.

The study examined a training program for integrative medicine (IM) providers, teaching clinical skills for treating acute stress disorder (ASD). A 10-h online training program, designed by IM and mental health professionals, was attended by a group of 32 IM providers working in supportive and palliative oncology care. Pre- and post-course questionnaires assessed self-perceived levels of IM and mental health ASD-related skills (from 1, very low; to 7, very high). Most participants (25; 78%) completed pre- and post-study questionnaires, which showed an increase in post-course scores for the expectation that IM could reduce ASD-related pain (p=0.004). Scores for self-assessed skill levels increased for treating gastro-intestinal symptoms and appetite (p=0.039) and for dyspnea (p=0.048). A borderline increase for arousal was observed (p=0.063), with no increase with other arousal symptom cluster symptoms. The ASD-focused training program for IM practitioners was associated with an increase in self-perceived levels for related clinical skills quality of life-related concerns, primarily pain, appetite and dyspnea. Further research is needed to better understand the implications of the findings, and to explore the implementation of the learned skills in clinical practice.

Strengthening the traditional medicine regulation, education and practice in Nigeria

Background: Despite tremendous advances in medical sciences still a large section of the population in rural areas is heavily dependent on indigenous and Traditional Medicine (TM) for treatment. Moreover, there has been a resurgence of interest in the use of Complementary and Alternative Medicine (CAM), globally. Objective: To review the overall regulator structure for the control of TM and the course curriculum for TM education in Nigeria. Method: Information on CAM and TM was collected via online search. Results: Responding to this unprecedented situation government of many countries have taken proactive steps to streamline and regulate the practitioners of CAM and TM in their countries as mandated by WHO. In many African countries because of the availability of research and training programs many traditional herbal medicines are now being sold over the counter. However, the situation is different in Nigeria, even though TM is very popular across the country, structured institutionalized teaching and research activity on TM are inadequate. Conclusion: Health is a key component in determining the Human Development Index (HDI) of a country. CAM and TM practitioner may play an important role in improving the HDI score of the country. Government-sponsored education & training program for TM practitioners is crucial.

Predictors of Health Care Practitioners' Intention to Use AI-Enabled Clinical Decision Support Systems: Meta-Analysis Based on the Unified Theory of Acceptance and Use of Technology.

Artificial intelligence-enabled clinical decision support systems (AI-CDSSs) offer potential for improving health care outcomes, but their adoption among health care practitioners remains limited. This meta-analysis identified predictors influencing health care practitioners' intention to use AI-CDSSs based on the Unified Theory of Acceptance and Use of Technology (UTAUT). Additional predictors were examined based on existing empirical evidence. The literature search using electronic databases, forward searches, conference programs, and personal correspondence yielded 7731 results, of which 17 (0.22%) studies met the inclusion criteria. Random-effects meta-analysis, relative weight analyses, and meta-analytic moderation and mediation analyses were used to examine the relationships between relevant predictor variables and the intention to use AI-CDSSs. The meta-analysis results supported the application of the UTAUT to the context of the intention to use AI-CDSSs. The results showed that performance expectancy (r=0.66), effort expectancy (r=0.55), social influence (r=0.66), and facilitating conditions (r=0.66) were positively associated with the intention to use AI-CDSSs, in line with the predictions of the UTAUT. The meta-analysis further identified positive attitude (r=0.63), trust (r=0.73), anxiety (r=-0.41), perceived risk (r=-0.21), and innovativeness (r=0.54) as additional relevant predictors. Trust emerged as the most influential predictor overall. The results of the moderation analyses show that the relationship between social influence and use intention becomes weaker with increasing age. In addition, the relationship between effort expectancy and use intention was stronger for diagnostic AI-CDSSs than for devices that combined diagnostic and treatment recommendations. Finally, the relationship between facilitating conditions and use intention was mediated through performance and effort expectancy. This meta-analysis contributes to the understanding of the predictors of intention to use AI-CDSSs based on an extended UTAUT model. More research is needed to substantiate the identified relationships and explain the observed variations in effect sizes by identifying relevant moderating factors. The research findings bear important implications for the design and implementation of training programs for health care practitioners to ease the adoption of AI-CDSSs into their practice.

Revolutionizing Nurse Practitioner Training: Integrating Virtual Reality and Large Language Models for Enhanced Clinical Education.

This project introduces an innovative virtual reality (VR) training program for student Nurse Practitioners, incorporating advanced 3D modeling, animation, and Large Language Models (LLMs). Designed to simulate realistic patient interactions, the program aims to improve communication, history taking, and clinical decision-making skills in a controlled, authentic setting. This abstract outlines the methods, results, and potential impact of this cutting-edge educational tool on nursing education.

A systematic review of shared decision making training programs for general practitioners

BackgroundShared decision making (SDM) has been presented as the preferred approach for decisions where there is more than one acceptable option and has been identified a priority feature of high-quality patient-centered care. Considering the foundation of trust between general practitioners (GPs) and patients and the variety of diseases in primary care, the primary care context can be viewed as roots of SDM. GPs are requesting training programs to improve their SDM skills leading to a more patient-centered care approach. Because of the high number of training programs available, it is important to overview these training interventions specifically for primary care and to explore how these training programs are evaluated.MethodsThis review was reported in accordance with the PRISMA guideline. Eight different databases were used in December 2022 and updated in September 2023. Risk of bias was assessed using ICROMS. Training effectiveness was analyzed using the Kirkpatrick evaluation model and categorized according to training format (online, live or blended learning).ResultsWe identified 29 different SDM training programs for GPs. SDM training has a moderate impact on patient (SMD 0.53 95% CI 0.15–0.90) and observer reported SDM skills (SMD 0.59 95%CI 0.21–0.97). For blended training programs, we found a high impact for quality of life (SMD 1.20 95% CI -0.38-2.78) and patient reported SDM skills (SMD 2.89 95%CI -0.55-6.32).ConclusionSDM training improves patient and observer reported SDM skills in GPs. Blended learning as learning format for SDM appears to show better effects on learning outcomes than online or live learning formats. This suggests that teaching facilities designing SDM training may want to prioritize blended learning formats. More homogeneity in SDM measurement scales and evaluation approaches and direct comparisons of different types of educational formats are needed to develop the most appropriate and effective SDM training format.Trial registrationPROSPERO: A systematic review of shared-decision making training programs in a primary care setting. PROSPERO 2023 CRD42023393385 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023393385.

Supporting best practice in the management of chronic diseases in primary health care settings: a scoping review of training programs for Indigenous Health Workers and Practitioners.

Background To improve diabetes management in primary health care for the Aboriginal and Torres Strait Islander peoples population, training programs that are culturally and contextually relevant to the local context are required. Using a scoping review methodology, the aim of this review was to describe the characteristics of chronic disease management training programs for Aboriginal Health Workers and Practitioners, their effectiveness on knowledge and skills, and client-related outcomes, and the enablers, barriers to delivery and participation. Methods Following protocol parameters, a systematic search was conducted in relevant databases and grey literature. Two independent reviewers screened the title and abstract of each paper to determine if the study met the inclusion criteria. Results Of the 23 included studies, most were developed with stakeholders, profession facilitated and delivered by cultural facilitators. All training programs included content knowledge, two included a professional support network, four provided on-the-job support and six had follow-up support post-training. Modes of delivery ranged from didactic, storytelling and hands-on learning. Two studies reported significant improvement in participants' knowledge and confidence; one reported improvement in knowledge (12.7% increase pre-post training), and an increase in confidence in both clinical and non-clinical skills. Enablers (relevance, modes of learning, power of networking, improved knowledge, confidence and clinical practice) and barriers (adult learning capabilities, competing work-family commitments) were reported. Few studies reported on knowledge transfer into clinical practice and client-related outcomes. Conclusions Multifaceted training programs for Aboriginal health workers are well received and may improve workforce capability.

Digital transformation under the governance of Palestinian banks

This study aims to understand and evaluate the impact of applying governance principles on digital transformation in Palestinian banks listed on the Palestine Stock Exchange. A questionnaire was distributed to 750 employees from the study population. It included four axes representing governance principles (board of directors’ tasks, board practices and conflicts of interest, disclosure and transparency, and risk management) and a fifth axe representing digital transformation. The study found a strong, statistically significant positive effect of applying governance principles on digital transformation in Palestinian banks. The results also showed the keenness of the boards of directors to discuss the commitment of bank management to implement the provisions and regulations of governance issued by the Palestine Monetary Authority. This helped in developing and approving the necessary policies for risk management and enhanced the effectiveness of oversight of the digital transformation system. This was reflected in increasing customer confidence in the banks’ performance and maintaining the interests of related parties. The study recommended the need to enhance the level of transparency and disclosure regarding governance performance and the progress of digital transformation in banks. It also recommended developing an integrated framework for analyzing and managing risks related to digital transformation. This assists in providing comprehensive training and development programs for practitioners to enhance their capabilities in the field of digital transformation and applying governance principles.

A national mental health cascade training programme for practitioners supporting unaccompanied minors in Greece.

Practitioners who support unaccompanied minors (UAMs) come from different professional backgrounds and often are not appropriately trained to address children's complex mental health needs. This gap informed a training programme across all accommodation centres in Greece. The aim of the Train-of-Trainer (ToT) national programme was to upskill trainers from 17 organisations to cascade knowledge. Training was interprofessional, trauma-informed and culturally sensitive. A pilot implementation involved 199 practitioners from all disciplines. A sub-sample of 33 practitioners, nine managers and six trainers shared their experiences in focus group discussions, which were analysed through a thematic framework. Participants found that the programme was useful in generating knowledge relevant to children's needs and their roles, addressing the emotional impact of trauma on staff, sharing learning across professional disciplines and being interactive, but systemic support should be put in place for benefits to be sustained. Train-of-Trainer is a resource-effective approach to upskill mixed staff groups across many organisations. This should involve caregivers and staff with limited educational opportunities, while accommodating for different professional needs. Training should be integrated to service budgets, specifications and structures.

Evaluation of Gender-Related Digital Violence Training in Catalonia

This study examines the results of evaluating a Catalan training program for practitioners working with survivors of gender-related violence. Considering the lack of scientific evidence previously shown by studies on this topic, this article aimed to triangulate the participants’ self-perception with their assessment of knowledge and competencies in tackling digital gender-related violence before and after the training. To do so, a pre-test and post-test case-based design was employed to identify and measure the participants’ improvement in self-perceived knowledge and their effective gain in knowledge and skills to address this kind of violence. Considering the contributions of a feminist evaluation approach, we also included in our evaluation the analysis of classroom interactions and the participants’ responses. The results overall demonstrate that the incorporation of assessment criteria from the feminist evaluation methodology increased the reliability of evaluation criteria. In addition, it also enabled us to identify the need to continue developing training programs that empower participants and prevent women and LGBTQI+ people from disengaging from digital spaces.

IoT and AI for Silambam Martial Arts: A Review

Silambam is a traditional martial art from Tamil Nadu, India. It is a stick-fighting art that has been practiced for centuries. In recent years, there has been growing interest in using technology to enhance the practice and promotion of Silambam. One way to do this is to use the Internet of Things (IoT). IoT devices can be used to collect data on Silambam practitioners' movements and performance. This data can then be analysed using artificial intelligence (AI) to provide insights and recommendations to practitioners. For example, IoT sensors could be attached to Silambam sticks to track the number of rotations, speed, and force of each strike. This data could then be used to provide feedback to practitioners on their technique and progress. AI could also be used to develop personalized training programs for Silambam practitioners. For example, AI could analyse a practitioner's data to identify areas where they need improvement and then recommend specific exercises or drills. In addition to enhancing the practice of Silambam, IoT and AI could also be used to promote the art to a wider audience. For example, IoT-enabled Silambam sticks could be used to create interactive training games or simulations. Overall, IoT and AI have the potential to revolutionize the way that Silambam is practiced and promoted. By using these technologies, we can make Silambam more accessible, engaging, and effective for practitioners of all levels.

Assessment of the Need for Training in Clinical Pharmacology Research on Traditional Medicine among Modern Medicine Practitioners: A Questionnaire-based Study

Introduction: Training young doctors is essential for carrying out need-based research. The field of Traditional Medicine (TM) has made significant contributions to modern medicine, and there is unlimited scope for exploring it further in search of improved treatment options. However, there is a lack of systematic research studies on traditional medicines. It was, therefore, considered necessary to assess the interest and awareness among modern medicine practitioners regarding Traditional Medicine Research (TMR). Aim: To assess the need for training in TMR among modern medicine practitioners. Materials and Methods: A cross-sectional questionnaire-based study was conducted in the Department of Pharmacology and Therapeutics at Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India, from March 2020 to September 2020 among modern medicine practitioners from the Western region of India. A validated questionnaire was used to collect data regarding the level of training in research methodology, research experience including TMR, areas for training, attitude towards training in TMR, challenges in TMR, and therapeutic areas to focus TMR efforts. The data were analysed using descriptive statistics. Results: Out of 109 participants, 96 (88.1%) were trained in research methodology. At least one research project was undertaken by 91 (83.5%) participants. Ninety-seven percent of participants felt that TMR was necessary. TMR was conducted by 19 (17.4%) participants. Approximately 65 (59.6%) participants felt that conducting TMR poses challenges such as lack of funds, infrastructure, lack of belief in TM, unavailability of literature pertaining to TM, lack of expertise, and lack of corporate attention and marketing. Therapeutic areas identified to focus research efforts included lifestyle-related disorders, diabetes mellitus, cancer, ageing, allergic disorders, osteoarthritis, and obesity. Conclusion: All the participants expressed the need to undergo training in TMR. However, the experience of conducting TMR was limited. Lack of funds, infrastructure, and expertise were mentioned as the main hurdles in undertaking TMR. It is essential to conduct systematic and need-based training programs for modern medicine practitioners in basic research methodology and TMR.

Perceptions of Adult Obesity Education: A Pilot Study.

This pilot research study, conducted at a large academic healthcare facility, used mixed methodology to (1) administer a survey to a group of primary care trainees and faculty and (2) conduct key informant interviews with the program directors, or their delegates of these primary care training programs, so as to gain insight into respondents' perceptions about their training on adult obesity. To maintain confidentiality of the key informants, they were defined as "Administrators." Faculty and trainees were from family medicine and internal medicine residency programs, as well as family nurse practitioner and physician assistant training programs. This study used a quantitative survey and four qualitative key informant (Administrator) interviews. Descriptive statistics, χ2, or Fisher exact tests were used to analyze select survey responses. Administrator interviews were analyzed with thematic analysis. Survey respondents (n = 75) included primary care trainees (n=34), faculty (n=30), other (n=2), did not answer (n=9). Surveys indicated that additional training is needed for bariatric surgery, weight loss medications, and clinical nutrition. The three highest ranked topics in the surveys on adult obesity were basic nutrition, behavioral weight management, and a rotation on adult obesity. Most agreed on the need for interprofessional collaboration, a centralized obesity treatment center, and an introductory obesity course. Key themes from the four Administrator interviews revealed the need: for more training; to build upon current curriculum; use innovative technology; fiscal challenges; and time management. Both faculty and trainees perceive that academic and clinical training on adult obesity is inadequate, and that trainees need more education on such topics as nutrition, physical activity, behavioral health, antiobesity medications, and bariatric surgery. Competency to treat varied by topic. It also showed that more interprofessional collaboration and a centralized obesity treatment center are needed. Recommendations included integrating modular units about obesity into already established primary care training programs and providing additional resources.

Core competencies in critical care for general medical practitioners in South Africa: A Delphi study.

Despite a high burden of disease that requires critical care services, there are a limited number of intensivists in South Africa (SA). Medical practitioners at district and regional public sector hospitals frequently manage critically ill patients in the absence of intensivists, despite these medical practitioners having had minimal exposure to critical care during their undergraduate training. To identify core competencies in critical care for medical practitioners who provide critical care services at public sector hospitals in SA where intensivists are not available to direct patient management. A preliminary list of core competencies in critical care was compiled. Thereafter, 13 national and international experts were requested to achieve consensus on a final list of core competencies that are required for critical care by medical practitioners, using a modified Delphi process. A final list of 153 core competencies in critical care was identified. The core competencies identified by this study could assist in developing training programmes for medical practitioners to improve the quality of critical care services provided at district and regional hospitals in SA. The study provides consensus on a list of core competencies in critical care that non-intensivist medical practitioners managing critically ill patients in healthcare settings in South Africa, especially where intensivists are not readily available, should have. The list can form the core content of training programmes aimed at improving critical care competence of general medical practitioners, and in this way hopefully improve the overall outcomes of critically ill patients in South Africa.

Supporting Clinical Competencies in Men's Mental Health Using the Men in Mind Practitioner Training Program: User Experience Study.

Engaging men in psychotherapy is essential in male suicide prevention efforts, yet to date, efforts to upskill mental health practitioners in delivering gender-sensitized therapy for men have been lacking. To address this, we developed Men in Mind, an e-learning training program designed to upskill mental health practitioners in engaging men in therapy. This study involves an in-depth analysis of the user experience of the Men in Mind intervention, assessed as part of a randomized controlled trial of the efficacy of the intervention. Following completion of the intervention, participants provided qualitative (n=392) and quantitative (n=395) user experience feedback, focused on successes and suggested improvements to the intervention and improvements to their confidence in delivering therapy with specific subpopulations of male clients. We also assessed practitioner learning goals (n=242) and explored the extent to which participants had achieved these goals at follow-up. Participants valued the inclusion of video demonstrations of skills in action alongside the range of evidence-based content dedicated to improving their insight into the engagement of men in therapy. Suggested improvements most commonly reflected the desire for more or more diverse content, alongside the necessary adaptations to improve the learning and user experience. Participants also commonly reported improved confidence in assisting men with difficulty articulating their emotions in therapy and suicidal men. The evidence obtained from this study aids in plans to scale Men in Mind and informs the future development of practitioner training interventions in men's mental health. RR2-10.1186/s40359-022-00875-9.

Integral education and Ubuntu: A participatory action research project in South Africa

Background: South Africa is beset with violent, antisocial practices and ways of life hindering peaceful co-existence and participatory democracy. This makes a targeted early education programme to develop a socially responsible generation imperative.Aim: Based on a larger research project, this study aimed to highlight the value of participatory action research in determining the outcomes of an early childhood development (ECD) Integral Education (IE) and Ubuntu approach for incorporation in the education and training of practitioners.Setting: Three ECD practitioners were selected to participate in this study, which was located in a township in the south of Durban in three preschools (urban, semi-urban and rural).Methods: Lewin’s PAR method was used to explore, develop and evaluate an intervention for change. Data were collected through focus group and participant interviews, observations and journal entries and then analysed thematically.Results: The findings revealed that, personally and professionally, the practitioners experienced positive changes through adopting an integral approach that included becoming more introspective and reflective in their practice.Conclusion: Educating and training early childhood practitioners to develop the appropriate knowledge, skills, attitudes and values to adopt and implement an ECD IE and Ubuntu approach are essential for developing a new generation of socially responsible citizens for participatory democracy in South Africa.Contribution: The findings highlighted key components of an ECD IE practitioner training programme based on the integrality of the mind, body, heart, spirit and community. Thus, the development of a caring, compassionate and humane society in democratic South Africa can be enabled.

ECOSHOT study: Prospective evaluation of a shoulder ultrasound training programme for general practitioners

Background and objectiveThe effectiveness of shoulder ultrasound training programmes in primary care is unknown. This study aims to measure the diagnostic agreement between radiologists and general practitioners in shoulder ultrasound examination after a specific training programme. Materials and methodsWe designed a prospective study with patients who required a shoulder ultrasound examination. Ultrasound examination was performed by general practitioners after receiving specific training, consisting of 50 h of theoretical musculoskeletal ultrasound training online and 8 h of hands-on shoulder ultrasound practice. The findings were compared to those of radiologists using Cohen’s Kappa coefficient. Sociodemographic and quantitative variables were also measured. ResultsWe included 153 patients. Finally, 121 radiologists’ reports were used for analyses. The average age was 61.8 years and 62.1% were women. Main occupations were domestic work/cleaning and administrative jobs. Average Visual Analogue Scale score was 5.25. Patients with previous treatment comprised 88.9% (mostly oral painkillers, rest, and physical measures). Complementary testing was performed in 28.8%, radiography was the most frequent. The most frequent motive for referral for ultrasound examination was unspecific shoulder pain. Our study reveals that the global agreement was moderate (Kappa = .4346) overall, but when measured over time improved from weak (Kappa = .3756) to good (Kappa = .6423). There was a tendency to overdiagnose most lesions and underdiagnose partial tears. ConclusionsWe conclude that shoulder ultrasound examination training is feasible in primary care. The interobserver agreement improved with the number of ultrasound examinations performed over time, suggesting that specific programmes may be effective in training general practitioners in musculoskeletal shoulder ultrasound examination.

Reasons for Encounters and Comorbidities in Adolescents with Intellectual Disability in General Practice: A Retrospective Analysis of Data from the Ask Study.

Adolescents with intellectual disability have substantial health needs. This retrospective analysis of data from the Ask Study describes reasons for primary care encounters and the prevalence and incidence of chronic physical and mental conditions among a cohort of community-dwelling adolescents with intellectual disability. Participants attended secondary schools in southern Queensland, Australia. Primary care data were extracted from primary care records. Demographic and health information was collected using carer-completed questionnaires. Reasons for primary care encounters, disease prevalence at age 16 years, and disease incidence through adolescence were reported. Data were obtained for 432 adolescents with intellectual disability (median follow-up: 4.1 years). Skin problems (29.4 per 100 encounters) were the most common reason patients presented for primary care, followed by psychological and behavioural problems (14.4 per 100 encounters) and musculoskeletal problems (13.8 per 100 encounters). Conditions with the highest prevalence were autism spectrum disorder (18.6%) and asthma (18.1%). The prevalence of epilepsy, visual impairment, and cerebral palsy were 14.7, 11.1, and 8.0%, respectively. Gastroesophageal reflux had the highest incidence (9.4 cases per 1000 person-years). Adolescents with intellectual disability have significant healthcare needs, which general practitioners need to be aware of and address. Study findings should inform the development of training programs for general practitioners.

An international analysis of career assistance programmes for high-performance athletes

ABSTRACT This study aims to offer a comprehensive analysis of Career Assistance Programmes (CAPs) available for high-performance athletes across the globe, addressing the current state of resources for their career development and transitional periods. The authors examined 23 sport organisations spanning five continents, focusing on aspects such as CAPs’ accessibility, objectives, content, delivery personnel, practitioner training, and self-evaluation methods. Utilising web-based data collection and research tours, the study acquired pertinent information to address the research questions. Deductive content analysis was employed, with the research questions and the Holistic Athlete Career (HAC) model serving as the framework for categorisation. This study offers an in-depth exploration of global CAPs and provide empirical insights into their current practices. The results show resources available to high-performance athletes, while identifying service gaps, necessitating policies to support a wider range of athletes. Notably, advancements have been made in developing training programmes for practitioners; however, the study highlights the need to further investigate the specific competencies that practitioners develop or seek to acquire through such initiatives. It is suggested that sport organisations actively exchange best practices to augment the effectiveness of their CAPs. The study highlights a service gap for athletes not meeting the high-performance threshold for CAP eligibility, limiting access to resources. Consequently, this population faces limited opportunities for career development and may struggle to cope with the challenges stemming from their athletic pursuits. The authors advocate for the expansion of services to address this disparity, ensuring equitable access to resources for athletes at varying performance levels.

Patient views of the good doctor in primary care: a qualitative study in six provinces in China

BackgroundChina has been striving to train primary care doctors capable of delivering high-quality service through general practitioner training programs and family doctor team reforms, but these initiatives have not adequately met patient needs and expectations. In order to guide further reform efforts to better meet patient expectations, this study generates a profile of the good doctor in primary care from the patient perspective.MethodsSemi-structured interviews were conducted in six provinces (Shandong, Zhejiang, Henan, Shaanxi, Shanxi, Heilongjiang) in China. A total of 58 interviewees completed the recorded interviews. Tape-based analysis was used to produce narrative summaries. Trained research assistants listened to the recordings of the interviews and summarized them by 30-s segments. Thematic analysis was performed on narrative summaries to identify thematic families.ResultsFive domains and 18 attributes were generated from the analysis of the interview data. The domains of the good doctor in primary care from the patient perspective were: strong Clinical Competency (mentioned by 97% of participants) and Professionalism & Humanism (mentioned by 93% of participants) during service delivery, followed by Service Provision and Information Communication (mentioned by 74% and 62% of participants, respectively). Moreover, Chinese patients expect that primary care doctors have high educational attainment and a good personality (mentioned by 41% of participants).ConclusionsThis five-domain profile of the good doctor in primary care constitutes a foundation for further primary care workforce capacity building. Further primary care reform efforts should reflect the patient views and expectations, especially in the family physician competency framework and primary care performance assessment system development. Meanwhile, frontline primary care organizations also need to create supportive environments to assist competent doctors practice in primary care, especially through facilitating the learning of primary care doctors and improving their well-being.

Neuromuscular control strategies of the lower limb during a typical Tai Chi brush knee and twist step in practitioners with and without knee pain: a pilot study

ABSTRACT As a complex movement, Tai Chi (TC) could be challenging for knee control, and the compensatory changes in TC biomechanics of knee pain patients are unknown. The Brush Knee and Twist Step (BKTS) is a typical TC movement that involves basic leg motion repeated in the whole TC. This pilot study examined electromyography and retro-reflective marker trajectory data to investigate neuromuscular control strategies of the lower extremity during BKTS in TC practitioners with and without knee pain. Twelve experienced TC practitioners with (n = 6) and without knee pain (n = 6) participated. Our results revealed that knee pain practitioners presented muscle imbalance in the vastus medialis-vastus lateralis and vastus lateralis-biceps femoris, and poor alignment of the knee with the toes in TC lunge. Additionally, they adaptively developed rigid coordination strategies, showing higher levels of lower limb muscle co-contraction and activity compared to controls. Training programs for TC practitioners with knee pain should be designed to modify both abnormal muscle synergy patterns and incorrect lunge during TC, which may improve exercise safety.