Enhancing health care non-technical skills: the TINSELS programme

Background and Context: Training in ‘non-technical skills’, social (communication and team work) and cognitive (analytical and personal behaviour) skills, in healthcare have been of great interest over the last decade. Whilst the majority of publications focus on ‘whether’ such education can be successful, they overlook the question of ‘how’ they enhance skills. We designed and piloted an original, theoretically robust and replicable teaching package that addresses non-technical skills in the context of medicines safety through simulation-based inter professional learning: the TINSELS (Training In Non-technical Skills to Enhance Levels of Medicines Safety) Programme. Innovation: A modified Delphi process was completed to identify learning outcomes, and recruitment of multi-professional teams was through local publicity. The faculty developed a three-session simulation based intervention: session one was a simulated ward encounter with multiple medicine related activities; session two was an extended debrief and facilitated discussion; and session three a ‘chamber of horrors’ where inter professional teams identified potential sources of error. Each session was completed in the simulation suite with 6 – 9 participants, lasted approximately 90m minutes, and took place over 2 weeks. Full details of the course will be presented to facilitate dissemination. Implications: Likert scale feedback was collected after the course (1 strongly disagree-5 strongly agree). Mean scores were all greater than 4, with qualitative feedback noting the fidelity of the authentic inter professional learner groups. A previously validated safety attitudes questionnaire found changes in attitudes towards handover of care and perceptions of safety levels in the workplace post intervention. An original, simulation based, multi-professional training programme has been developed with learning and assessment materials available for widespread replication

Emergency Undocking Curriculum in Robotic Surgery

Introduction Traditional instruction for robotic surgery is typically devoid of training that addresses the delineation of interprofessional roles for operating room personnel. An emergency undocking scenario was developed for robotic surgeons with the objectives of improving time to access the patient, provider knowledge of and confidence in emergency undocking, completion of predetermined critical actions, and delineation of operating room personnel roles. Methods Over one month, participants joined in three sessions: Session 1 - formative, Session 2 - review, and Session 3 - summative. Embedded standardized participants (ESPs) represented members of the interprofessional team. Prior to entering the operating room for Sessions 1 and 3, trainees were asked to complete a confidence survey and multiple choice questionnaire (MCQ) for knowledge assessment. Participants were randomized to one of two cases and participated in the reciprocal case for the final session four weeks later. Following Session 1, participants underwent an educational intervention, including the proper technique for emergency undocking, emphasis on operating room personnel roles, and hands-on practice. Obstetrics and Gynecology (OBGYN) residents in post-graduate Years 2-4 and attending physicians with robotics privileges at Summa Health Akron Campus or Cleveland Clinic Akron General Medical Center were invited to participate. A total of 21 participants enrolled and finished the study. Results Among the 21 participants, there was a significant increase in the baseline level of knowledge (p-value=0.001) and in the confidence of surgeons when faced with an emergency undocking after the completion of our curriculum (p-value=0.003). Additionally, an improvement in the undocking times (p-value<0.001) and an increase in the critical actions performed (p-value=0.002) were observed. Conclusion The results of this study demonstrate that incorporating this curriculum into the training programs of robotic surgeons is an effective way to improve the surgical skill of emergency undocking

Less is more: latent learning is maximized by shorter training sessions in auditory perceptual learning

Background: The time course and outcome of perceptual learning can be affected by the length and distribution of practice, but the training regimen parameters that govern these effects have received little systematic study in the auditory domain. We asked whether there was a minimum requirement on the number of trials within a training session for learning to occur, whether there was a maximum limit beyond which additional trials became ineffective, and whether multiple training sessions provided benefit over a single session. Methodology/Principal Findings: We investigated the efficacy of different regimens that varied in the distribution of practice across training sessions and in the overall amount of practice received on a frequency discrimination task. While learning was relatively robust to variations in regimen, the group with the shortest training sessions (~8 min) had significantly faster learning in early stages of training than groups with longer sessions. In later stages, the group with the longest training sessions (>1 hr) showed slower learning than the other groups, suggesting overtraining. Between-session improvements were inversely correlated with performance; they were largest at the start of training and reduced as training progressed. In a second experiment we found no additional longer-term improvement in performance, retention, or transfer of learning for a group that trained over 4 sessions (~4 hr in total) relative to a group that trained for a single session (~1 hr). However, the mechanisms of learning differed; the single-session group continued to improve in the days following cessation of training, whereas the multi-session group showed no further improvement once training had ceased. Conclusions/Significance: Shorter training sessions were advantageous because they allowed for more latent, between-session and post-training learning to emerge. These findings suggest that efficient regimens should use short training sessions, and optimized spacing between sessions

Dynamic reconfiguration of human brain networks during learning

Human learning is a complex phenomenon requiring flexibility to adapt existing brain function and precision in selecting new neurophysiological activities to drive desired behavior. These two attributes -- flexibility and selection -- must operate over multiple temporal scales as performance of a skill changes from being slow and challenging to being fast and automatic. Such selective adaptability is naturally provided by modular structure, which plays a critical role in evolution, development, and optimal network function. Using functional connectivity measurements of brain activity acquired from initial training through mastery of a simple motor skill, we explore the role of modularity in human learning by identifying dynamic changes of modular organization spanning multiple temporal scales. Our results indicate that flexibility, which we measure by the allegiance of nodes to modules, in one experimental session predicts the relative amount of learning in a future session. We also develop a general statistical framework for the identification of modular architectures in evolving systems, which is broadly applicable to disciplines where network adaptability is crucial to the understanding of system performance.Comment: Main Text: 19 pages, 4 figures Supplementary Materials: 34 pages, 4 figures, 3 table

Mindfulness Modulated Attention with Neurofeedback in Multiple Object Tracking

Attention determines what we selectively perceive out of all available stimuli. The multiple-object tracking paradigm is a way of examining divided attention for object tracking in a complex visual scene. Mindfulness is a broad term for a set of diverse and specific methods for distinct attentional engagement and is one technique for increasing visual attentional ability and decreasing distractibility. Neurofeedback can be a way of enhancing mindfulness training for novice participants. This study examined the relationship between attention and mindfulness with neurofeedback through performance on a multiple-object tracking task and the Five Facet Mindfulness Questionnaire. We examined the effectiveness of using a brief mindfulness session to bring about state mindfulness and cognitive enhancement. All participants (N=90) performed a session of the multiple-object tracking task before and after either a mindfulness or relaxation intervention. Additionally half of the participants in the mindfulness training condition received neurofeedback. Results demonstrated that a single, brief mindfulness training session with neurofeedback was successful in increasing divided attention ability and was sufficient for bringing about an increased mindfulness state. An effect of mindfulness without neurofeedback on attention was not found. Results have implications for the use of brief mindfulness practices in a laboratory setting that could be applicable to a real world setting and the feasibility of neurofeedback as a mindfulness training tool

Training loads and practices of competitive organ-recipients at the British and World Transplant Games:Training load of competitive organ-recipients

Background: Little information is available regarding the TL and training practices of competitive athletes who are solid-organ recipients. This study characterized TL and practices of competitive organ-recipients at the British and World Transplant Games, 2017.Methods: Questionnaire data was gathered from 220 participants regarding sporting events and type, frequency, duration and intensity of training sessions undertaken. TL for each training session (session duration x session rating of perceived exertion [RPE]) and total TL were determined.Results: Overall participants trained 5 ±3 times per week at an RPE of 5 ±2 AU for between 60-75 min per session (TL ~1500 to 1875 AU). Most participants (n=176; 79.7%) reported training three or more times each week. Approximately half (49%) the participants reported undertaking resistance training each week (3 ±2 sessions per week, RPE of 6 ±2 AU, 45-60 minutes per session; TL ~810 to 1080 AU, respectively). Of those participants undertaking resistance training 75% undertook two or more sessions each week. Participants generally undertook most events within a predominant sport with one or two events in a secondary sport. Typical weekly TL for the whole group was 2762 ±3583 AU with considerable variation within and across sports (cycling 4383 ±4005 AU; field athletics 3671 ±6181 AU; court-based sports 2645 ±3308 AU; high physical demand sports [e.g. skiing, triathlon] 2595 +2247 AU; track athletics 2547 ±2664 AU; swimming 2091 ±1070 AU; low physical demand sports [e.g. darts, petanque, walking] 1182 +801 AU). Sports-specific TL for predominant and secondary sports was ~1500 AU. Resistance training and gym-based aerobic training were the most frequent non-specific training components undertaken. Most competitors (79%) were active in sport prior to transplant. Conclusion: The wide range of TL and components undertaken by athletes with solid-organ transplants likely reflects the multiple and diverse event participation of competitive organ-recipients as well as well as the diverse physical fitness profiles and incentives to participate. Optimization of TL both for multiple competitive sports and maintenance of health should be considered for these athletes.<br/

Effects of pyramidal behavior skills training on the procedural integrity of school staff when delivering functional communication training to students.

Behavioral skills training (BST) is a commonly used, well-researched method for delivering training that has been shown to generate mastery and fidelity across multiple populations and skills. Despite the evidence supporting its use across multiple settings with a variety of populations, few studies have examined the use of pyramidal BST to train educators in a public school setting in the implementation of functional communication training (FCT). This study utilized a concurrent multiple probe across participants design to examine the effects of pyramidal BST on the procedural integrity of general education teachers providing FCT as part of an intervention plan. BST was provided by the researcher to a special education teacher participant in one training session; the special education teacher then utilized BST to provide FCT implementation training to general education staff in single subsequent training sessions. No additional coaching was provided beyond these training sessions. Data collected throughout the study indicated that pyramidal BST provided in one session resulted in an increase in procedural integrity across all general education teacher participants with strong positive effect sizes (dp estimates range: 11.97 – 16.56). Social validity data indicate that the teacher participants viewed the training as valuable and expressed an interest in receiving further training. The results of this study support the use of pyramidal BST to train general education teachers in the implementation of FCT

Coordinated Multiple Cadaver Use for Minimally Invasive Surgical Training

BackgroundThe human cadaver remains the gold standard for anatomic training and is highly useful when incorporated into minimally invasive surgical training programs. However, this valuable resource is often not used to its full potential due to a lack of multidisciplinary cooperation. Herein, we propose the coordinated multiple use of individual cadavers to better utilize anatomical resources and potentiate the availability of cadaver training.MethodsTwenty-two postgraduate surgeons participated in a robot-assisted surgical training course that utilized shared cadavers. All participants completed a Likert 4-scale satisfaction questionnaire after their training session. Cadaveric tissue quality and the quality of the training session related to this material were assessed.ResultsNine participants rated the quality of the cadaveric tissue as excellent, 7 as good, 5 as unsatisfactory, and 1 as poor. Overall, 72% of participants who operated on a previously used cadaver were satisfied with their training experience and did not perceive the previous use deleterious to their training.ConclusionThe coordinated use of cadavers, which allows for multiple cadaver use for different teaching sessions, is an excellent training method that increases availability of human anatomical material for minimally invasive surgical training