Scoping exercise on fallers’ clinics : report to the National Co-ordinating Centre for NHS Service Delivery and Organisation R & D (NCCSDO)

The National Service Framework for Older People has stated the need for fall-prevention programmes. An appraisal of fallers’ clinics launched by the National Institute for Health and Clinical Excellence (NICE) was suspended because of a lack of information regarding existing services and typology. This project aimed to determine the feasibility of conducting economic modelling to appraise fallers’ clinics. To achieve this a national survey of services and reviews of the evidence of effectiveness of various models of fallers’ clinics and screening tools were undertaken

Systematic review of the current status of cadaveric simulation for surgical training

Background: There is growing interest in and provision of cadaveric simulation courses for surgical trainees. This is being driven by the need to modernize and improve the efficiency of surgical training within the current challenging training climate. The objective of this systematic review is to describe and evaluate the evidence for cadaveric simulation in postgraduate surgical training. Methods: A PRISMA‐compliant systematic literature review of studies that prospectively evaluated a cadaveric simulation training intervention for surgical trainees was undertaken. All relevant databases and trial registries were searched to January 2019. Methodological rigour was assessed using the widely validated Medical Education Research Quality Index (MERSQI) tool. Results: A total of 51 studies were included, involving 2002 surgical trainees across 69 cadaveric training interventions. Of these, 22 assessed the impact of the cadaveric training intervention using only subjective measures, five measured impact by change in learner knowledge, and 23 used objective tools to assess change in learner behaviour after training. Only one study assessed patient outcome and demonstrated transfer of skill from the simulated environment to the workplace. Of the included studies, 67 per cent had weak methodology (MERSQI score less than 10·7). Conclusion: There is an abundance of relatively low‐quality evidence showing that cadaveric simulation induces short‐term skill acquisition as measured by objective means. There is currently a lack of evidence of skill retention, and of transfer of skills following training into the live operating theatre

At Home Progressive Resistance Training for Adults with Down Syndrome - Study Materials Development

Down syndrome (DS) presents secondary characteristics including hypotonia, obesity and poor physical fitness that increase barriers to participation in physical activity. PURPOSE: This project developed tailored exercise videos for adults with DS with the aim of reducing the barrier of access to physical activity. METHODS: In a 2020 pilot study, adults with DS (n=5) consented to a 4-week at home intervention following three separate pre-recorded exercise videos (a warm-up video, an exercise routine video to be replayed 2-3 times, and a cool-down video) hosted online, (n=2) dropped before baseline testing. Videos contained a progressive resistance training (PRT) routine demonstrated by a person with neurotypical development. RESULTS: Participants (n=3) showed variable upper body (modified push-ups: 7-22 reps) and lower body (30 seconds sit-to-stand: 8-11 reps) muscular strength at baseline. Three participants completed the intervention with 100% indicating the need for continuous flowing videos. Based on these results a 10-week PRT program for adults with DS was developed, with volume increasing every 2 weeks following linear periodization. The program contained 30 instructional videos (15 beginner & 15 intermediate). Each 2-week interval included three videos for each week. Videos were 1-hour-to-1.3 hours long and consisted of a warm-up (~10 min), a main exercise routine (~40-50 min), and a cool-down (~10 min). The warm-up included a brief aerobic component and full body muscle priming. Exercise routines depicted 2-3 sets of 7-8 exercises with 6-14 repetitions targeting all major muscle groups using body weight and a backpack for load. The cool down had static stretching. Demonstrations, scripted verbal and breathing cues were provided for all exercises. Regressions were provided for difficult exercises. Exercises went from large to small muscle groups and spaced by one minute of rest time. Males and females, neurotypical and with DS were demonstrators in each video. CONCLUSION: Pilot study results informed future study PRT workload, the need for beginner and intermediate levels, and continuous flowing videos. Access to tailored exercises for adults with DS can be potentially increased by an on-line PRT program. Future studies should evaluate the feasibility and efficacy of this intervention strategy

If we can't get to theatre, we can't learn to operate : a study of factors influencing core trainee access to the operating theatre in trauma and orthopaedics

This is a qualitative research study using in-depth, semi-structured interviews with CT1–ST3 trainees in trauma & orthopaedics (T&O) to characterise the factors that affect core surgical trainees’ access to the operating theatre for training. There were significant reported difficulties in accessing the operating theatre among core surgical T&O trainees in our study sample. The considerable service provision demands of the administrative and routine daily ward work, much of which offers negligible educational value in this group of trainees, is in direct conflict with the need to gain operative experience to meet the learning objectives of the curriculum. These results merit attention as the consequence of being unable to access the appropriate training environment threatens preparedness for registrar practice at ST3, and may serve to exacerbate the known morale issues, career dissatisfaction and burnout in this group

A national survey of services for the prevention and management of falls in the UK

Background: The National Health Service (NHS) was tasked in 2001 with developing service provision to prevent falls in older people. We carried out a national survey to provide a description of health and social care funded UK fallers services, and to benchmark progress against current practice guidelines. Methods: Cascade approach to sampling, followed by telephone survey with senior member of the fall service. Characteristics of the service were assessed using an internationally agreed taxonomy. Reported service provision was compared against benchmarks set by the National Institute for Health and Clinical Excellence (NICE). Results: We identified 303 clinics across the UK. 231 (76%) were willing to participate. The majority of services were based in acute or community hospitals, with only a few in primary care or emergency departments. Access to services was, in the majority of cases, by health professional referral. Most services undertook a multi-factorial assessment. The content and quality of these assessments varied substantially. Services varied extensively in the way that interventions were delivered, and particular concern is raised about interventions for vision, home hazard modification, medication review and bone health. Conclusion: The most common type of service provision was a multi-factorial assessment and intervention. There were a wide range of service models, but for a substantial number of services, delivery appears to fall below recommended NICE guidance

Illustrating potential efficiency gains from using cost-effectiveness evidence to reallocate Medicare expenditures

This article is available open access through the publisher’s website at the linke below. Copyright @ 2013, International Society for Pharmacoeconomics and Outcomes Research (ISPOR).This article has been made available through the Brunel Open Access Publishing Fund.Objectives - The Centers for Medicare & Medicaid Services does not explicitly use cost-effectiveness information in national coverage determinations. The objective of this study was to illustrate potential efficiency gains from reallocating Medicare expenditures by using cost-effectiveness information, and the consequences for health gains among Medicare beneficiaries. Methods - We included national coverage determinations from 1999 through 2007. Estimates of cost-effectiveness were identified through a literature review. For coverage decisions with an associated cost-effectiveness estimate, we estimated utilization and size of the “unserved” eligible population by using a Medicare claims database (2007) and diagnostic and reimbursement codes. Technology costs originated from the cost-effectiveness literature or were estimated by using reimbursement codes. We illustrated potential aggregate health gains from increasing utilization of dominant interventions (i.e., cost saving and health increasing) and from reallocating expenditures by decreasing investment in cost-ineffective interventions and increasing investment in relatively cost-effective interventions. Results - Complete information was available for 36 interventions. Increasing investment in dominant interventions alone led to an increase of 270,000 quality-adjusted life-years (QALYs) and savings of $12.9 billion. Reallocation of a broader array of interventions yielded an additional 1.8 million QALYs, approximately 0.17 QALYs per affected Medicare beneficiary. Compared with the distribution of resources prior to reallocation, following reallocation a greater proportion was directed to oncology, diagnostic imaging/tests, and the most prevalent diseases. A smaller proportion of resources went to cardiology, treatments (including drugs, surgeries, and medical devices, as opposed to nontreatments such as preventive services), and the least prevalent diseases. Conclusions - Using cost-effectiveness information has the potential to increase the aggregate health of Medicare beneficiaries while maintaining existing spending levels.The Commonwealth Fun

HARBER ET AL. DIRECTIVE AND NONDIRECTIVE SOCIAL SUPPORT DIRECTIVE SUPPORT, NONDIRECTIVE SUPPORT, AND MORALE

The concept of social support as being directive or nondirective may help explain why helping can either boost or impede morale. The Inventory of Nondirective and Directive Instrumental Support (INDIS) was developed to investigate this question. The directive factor concerns others' attempts to dominate coping and the nondirective factor concerns others' attempts to facilitate but not dominate coping. Studies 1 and 2 identified and confirmed these factors. Study 3 showed predicted associations between INDIS subscales and measures of morale. Nondirective support (from a family member) was positively related to hope and optimism, and directive support (from either a family member or a friend) was positively related to depression and loneliness, even after controlling for other social support measures. Maintaining hope and morale is one of the most important and difficult challenges faced by people coping with serious problems. Events such as loss of loved ones, professional or interpersonal failure, and cata- 691 Journal of Social and Clinical Psychology, Vol. 24, No. 5, 2005, pp. 691-722 Kent D. Harber, Department of Psychology, Rutgers University at Newark; Joanne Kraenzle Schneider, Department of Nursing, St. Louis University; Kelly Everard and Edwin Fisher, Division of Health Behavior Research, Departments of Medicine and Pediatrics, Washington University School of Medicine. We thank Gabrielle Highstein, Ian Brissette, Lee Jussim, Bäerbel Knauper, and Annette La Greca for their contributions to this research. We also thank Alan Lambert for his assistance. Correspondence concerning this article should be addressed to Kent D. Harber, Department of Psychology, Rutgers University, Smith Hall, 101 Warren Street, Newark, NJ 07044; E-mail: [email protected]. strophic damage to oneself or to one's prized possessions can shake victims' confidence in their self worth and self-efficacy However, support is not always nurturing. In many cases social ties can fail to buttress morale, and can even exacerbate the psychological challenge of coping. Research into "negative social support" identifies a number of ways in which helping attempts can be unhelpful. Sometimes would-be supporters aggravate recovery by being critical, antagonistic, disruptive or even exploitative One of the most common forms of failed support is not generally attributable to insufficient caring, knowledge, or skills. Instead, this form of counterproductive helping is most often and most potently delivered by those closest to copers, and by those most heavily invested in their recovery. Referred to as "over-involvement" By taking charge of too much, supporters may communicate through their very acts of support that copers lack the skills or strengths needed to remedy their own problems 692 HARBER ET AL. teem However, despite these operational difficulties, advances in social support research buttress the over-involvement framework. Cutrona, To a certain degree this tension is an inescapable dilemma of support provision. However, underlying and perhaps aggravating the copers' conflicting needs for help and for autonomy may be helpers' conflicting motives to step in and step back. These motives can be characterized by the degree to which helping is nondirective or directive. In essence, what distinguishes nondirective from directive help is whether supporters attempt to advance the coper's own recuperative agenda or instead impose an agenda of recovery upon the coper. Supporters provide nondirective support when they cooperate without assuming primary responsibility for the other person's performance. Supporters provide directive support when they assume, or attempt to assume, primary responsibility for coping DIRECTIVE AND NONDIRECTIVE SOCIAL SUPPORT 693 nondirective or directive, depending on the manner in which helpers supply it. For example, a supporter who screens phone calls based on the coper's instructions would be providing nondirective support, but would be supplying directive support by screening calls either without, or against, the coper's instruction. The former advances the copers' intent, while the latter supercedes it. It is important to emphasize that nondirective and directive support do not necessarily differ in the degree to which they meet the immediate objective needs of the coper. Screening phone calls may ultimately prove helpful or unhelpful, regardless of whether this action has been requested or not. Instead, nondirective and directive helping differ in the kinds of meta-messages they communicate to copers regarding their physical, mental, and emotional competencies. These messages, we believe, can profoundly affect copers' morale regarding their coping efforts. NONDIRECTIVE SUPPORT VS. DIRECTIVE SUPPORT AND MORALE Kurt Lewin defined morale as the ability to set valued goals combined with confidence in one's own ability to achieve those goals 1 More recently, Charles Snyder and colleagues used this same prescription to define and measure hope. In much the same way as Lewin characterized morale, Snyder et al. define hope as consisting of both an ability to set goals and confidence in one's own capacity to achieve them. Hope serves "as a means of maintaining a fighting spirit" in the face of adversity (Snyder et al., 1998, p. 195). Snyder and his colleagues have demonstrated the contribution of hope to realizing important personal goals The themes of planning, agency, and control that are integral to morale are centrally implicated in the distinction between nondirective and directive support. People who receive primarily nondirective support are encouraged to identify and articulate the goals of their own recovery and, through the assistance of their supporters, to achieve the goals that they, themselves, have set. Moreover, by controlling the amount, nature, 694 HARBER ET AL. 1. Lewin explicitly associated morale with social support, stating "group 'belongingness' may increase a feeling of security, thereby raising the morale . . . of the individual" (Lewin, 1948, p. 85). and timing of help, recipients of nondirective support may be better able to both ascertain and exercise their own coping abilities. Because nondirective support allows them to assert greater agency in their own recovery, copers who mainly receive this kind of support-at least for generally tractable problems-should experience greater morale, compared to people who receive primarily directive support, where others prescribe the nature, time-course, and degree of helping. Research conducted by our group generally confirms these hypotheses DEVELOPMENT OF A SELF REPORT MEASURE OF NONDIRECTIVE AND DIRECTIVE SUPPORT The distinction between nondirective and directive support may help differentiate the ways that over-involved helping depletes morale. According to over-involvement researchers, help that over-reaches can convey to copers a lack of faith in their capacity to solve their own problems The nondirective/directive distinction has two other important advantages over "over-involvement." First, over-involvement is largely empirically derived and for this reason definitions of it vary across the studies in which it has been observed DIRECTIVE AND NONDIRECTIVE SOCIAL SUPPORT 695 ence, judgment, or need of the recipient. Nondirective support and directive support are defined a priori. They remain conceptually consistent across support situations and can be assessed independent of the recipients' preferences or situation. Second, nondirective support and directive support are not necessarily evaluative terms. Indeed there may be situations in which an emphasis on one or the other might be especially appropriate (a point we elaborate upon in the Discussion). "Over-involvement" (and "over-protectiveness"), on the other hand, carries pejorative connotations that may obscure the necessary relation between, for example, assertive helping and acute crises (see HARBER ET AL. 2. Indeed, there may be cases where directive and nondirective support are supplied invisibly, perhaps making the former less injurious and the latter less beneficial to esteem. 3. The adjective "Instrumental" emphasizes the more tangible and action-oriented kinds of support as reported in the over-involvement literature. SPECIFYING SUPPORT SOURCE Many extant measures of social support inquire about the overall quality of support people receive from their social networks. However, there is an increasing appreciation that support does not come from an undifferentiated social field. Instead, the nature and impact of support are strongly affected by support source, such as family versus friends The research reported here describes three studies regarding the development of the INDIS and the testing of the nondirective/directive model. The purpose of the first study was to identify and confirm the directive and non-directive constructs. The second study was conducted to re-confirm these sub-scales. The third study used the INDIS to test whether directive support and nondirective support are differentially associated with morale. STUDY 1 METHOD PARTICIPANTS The participants in this study were 353 Washington University undergraduates enrolled in an introductory psychology class. Two hundred thirteen (60.3%) were women and 140 (39.7%) were men. Participants' ages ranged from 17 to 21 (M = 18.5, SD = 0.92). The sample, in order of representation, was comprised of 250 non-Hispanic whites (70.8%), 73 Asians (20.7%), 18 African Americans (5.1%), and two Latinos (0.6%). Ten participants (2.8%) did not indicate their ethnicity. The religious composition of the sample included 100 Protestants (28.3%), 93 Jews (26.3%), 73 Catholics (20.7%), and 44 atheist or agnostic (12.5%). Forty-three participants (12.2%) did not indicate their religious affiliation. Participants completed the questionnaire as part of a class exercise. DIRECTIVE AND NONDIRECTIVE SOCIAL SUPPORT 697 MEASURES Inventory of Nondirective and Directive Instrumental Support (INDIS). A pool of 40 directive and nondirective items, emphasizing instrumental support, was generated for purposes of modified Q-sorting. These items were based upon themes that emerged from structured interviews investigating directive and nondirective support, and from general concepts of these kinds of support developed by Fisher and his colleagues (e.g., Fisher, Bickle et al., 1997; Fisher, La Greca et al.,1997). Seven colleagues who have conducted extensive interviews designed to investigate directive support and nondirective support were enlisted to complete the sorting task. Sixteen items were excluded due to low concordance (i.e., less than 75% agreement that they represented either directive or nondirective support). The remaining 24 items (12 directive and 12 nondirective) were subsequently administered in survey form. There were two parallel versions of the INDIS, one focusing on support from a family member and the other focusing on support from a friend. The items comprising these versions were the same; the difference between the versions was in the specific source (family member or friend) to which the items referred. Participants indicated how accurately each item reflected the kind of help that they received from their respective support source, using five-point Likert scales that ranged from 1 = not at all accurate to 5 = extremely accurate. Background Questionnaire. A brief background questionnaire was prepared that sampled participants' age, race, gender, and religion. In addition, it instructed participants to indicate whether or not they had experienced any of nine major kinds of problems including personal health, romantic relationships, non-romantic relationships, bereavement, loved one's injury or illness, personal victimization, loved one's victimization, or problems in academics, jobs, or other valued area, or any other kind of problem. Two final questions asked participants to indicate which problem was the most severe, and which family member or friend (depending on INDIS version) served as their primary source of support. PROCEDURE Participants completed the background survey first. They then completed either the family member or the friend version of the INDIS, according to random assignment. Participants completed the INDIS in the context of the most severe problem they weathered in the past 12 months, and in reference to the individual friend or family member (de- 698 HARBER ET AL. pending on INDIS version) who served as their primary support source in dealing with this particular problem. RESULTS PSYCHOMETRIC ANALYSIS OF STUDY 1 Because we had anticipated the underlying latent variable structure of the sub-scales (one directive and one nondirective latent variable), it would have been appropriate for us to immediately test the model using confirmatory factor analysis The 24 survey items were entered into principal components analyses. Because we expected to find two distinct constructs, one directive and one nondirective, two factors were rotated orthogonally using Varimax rotation. For both the family member and friend version of the INDIS items were eliminated if: (1) they did not load on either factor at or above .30; (2) they cross-loaded with a difference in loadings less than .10; or (3) they failed to load on the same factor for both the family member and friend versions. Four items were eliminated through this process. The remaining 20 items accounted for 44.2% of the family version variance and 40.6% of the friend version variance. Kaiser-Meyer-Olkin Measure of Sampling Adequacies (KMO) of .86 and .82 respectively indicated that factor analysis was appropriate for these data. As expected, two factors emerged from this analysis, for both the family and friend versions, which were respectively comprised of nondirective and directive items. The nondirective factor contained those items that reflected support in which the provider cooperated with the recipient without "taking over" responsibility or control. The directive factor contained items that reflected taking over the tasks of coping. DIRECTIVE AND NONDIRECTIVE SOCIAL SUPPORT 699 CONFIRMATORY FACTOR ANALYSIS In order to determine how well individual items fit the overall model, we proceeded to confirmatory factor analysis, using structural equation modeling to evaluate the fit indices of the remaining 20 items. Confirmatory factor analysis uses a set of measured variables (e.g., questionnaire items) to form a variance/covariance matrix from which unobservable latent variables (e.g., hypothesized factors) can be tested. The loading of each questionnaire item indicates its relationship with the latent variable (i.e., construct or factor). In confirmatory factor analysis, the measurement model specifies the observed variables that define the constructs and "reflects the extent to which the observed variables are assessing the latent variables in terms of reliability and validity" (Schumaker & Lomax, 1996, p. 64). We conducted confirmatory factor analysis to detect and delete weak questionnaire items (i.e., items that detract from overall model fit). The process is iterative; after detecting and deleting a weak item, the entire model is re-analyzed in order to detect and delete additional weak items, the model is analyzed again, and so forth until the model cannot be improved with additional deletions guidelines as aids for interpretation and not as absolute thresholds. We reported the RMSEA 90% confidence intervals as recommended by DIRECTIVE AND NONDIRECTIVE SOCIAL SUPPORT 701 STUDY 2 INTRODUCTION Study 1 provided initial confirmation of the predicted two-factor structure of the INDIS. Exploratory analyses showed that items predicted to comprise the nondirective and directive subscales did so, and confirmatory analyses demonstrated that these items generally fit the overall model. However, in order to ensure that the confirmatory results obtained in Study 1 were reliable, we conducted Study 2 to obtain a separate confirmatory test of the two-factor model. METHOD PARTICIPANTS The sample consisted of 142 undergraduates recruited from Rutgers University at Newark (74%) and from Washington University (26% PROCEDURE Participants were tested en masse in a large introductory psychology course at Rutgers, or individually at Washington University, where the study was included as an added task to other ongoing experiments. Participants first completed the revised nine-item INDIS and then filled out a brief background questionnaire sampling gender, age, and ethnic background. Data were collected anonymously. RESULTS AND DISCUSSION The nine items that comprise the INDIS (as identified in Study 1) were taken into confirmatory factor analysis using LISREL. The measurement models for the family member version and the friend version were reexamined separately. As before, items were constrained to zero on latent 702 HARBER ET AL. DIRECTIVE AND NONDIRECTIVE SOCIAL SUPPORT 703 constructs to which they did not belong and the latent constructs were allowed to correlate. Initial fit indices for the family member version (N = 142) were R 2 (26) = 123.24, p = 0.00; RMSEA = .16, 90% CI = 0.13-0.19; CFI = .88; and IFI = .88. Initial fit indices for the friend version (N = 142) were R 2 (26) = 107.40, p = 0.00; RMSEA = .15, 90%CI = 0.12-0.18; CFI = .82; and IFI = .82. Item trimming indicated that the friend model would be improved slightly by deleting the weakest item, "Knows when to back off from being helpful." However, we decided to provisionally retain this item because it fit the model in the Study 1 confirmatory analysis, it is conceptually central to the non-directive factor, and because the model demonstrated acceptable fit in Study 2 when this item was included in the friend version. We therefore decided that the final disposition of this item would be determined in confirmatory analysis conducted in Study 3. Several directive items were allowed to covary. "Decided what kind of help I needed" covaried with "Decided who could help me" and "Organized my schedule for me." "Solved problems for me" covaried with "Took charge of my problems." These items were allowed to covary based on the modification indices and supported conceptually Cumulatively, these fit indices show that the hypothesized constructs of the INDIS are supported by the data reasonably well, and that they support the findings obtained in the prior study. Coefficient alphas were satisfactory. For the family member version, alpha coefficients were .78 for Nondirective Support and .84 for Directive Support. For the friend version they were .75 for Nondirective Support and .79 for Directive Support. Consistent with the fit indices, subscale alphas also supported the strength of the measures. In sum, confirmatory analyses of the INDIS in Study 2 provided further evidence that both the family member and friend versions of the INDIS are psychometrically sound measures. Notably, this reconfirmation was obtained even after sampling from a population largely distinct from the one sampled in the initial test of the two-factor INDIS

Preconceptual administration of doxycycline in women with recurrent miscarriage and chronic endometritis : protocol for the Chronic Endometritis and Recurrent Miscarriage (CERM) trial, a multicentre, double-blind, placebo-controlled, adaptive randomised trial with an embedded translational substudy

Introduction: Recurrent miscarriage is a common condition with a substantial associated morbidity. A hypothesised cause of recurrent miscarriage is chronic endometritis (CE). The aetiology of CE remains uncertain. An association between CE and recurrent miscarriage has been shown. This study will aim to determine if preconceptual administration of doxycycline, in women with recurrent miscarriages, and CE, reduces first trimester miscarriages, increasing live births. Methods and analysis: Chronic Endometritis and Recurrent Miscarriage is a multicentre, double-blind adaptive trial with an embedded translational substudy. Women with a history of two or more consecutive first trimester losses with evidence of CE on endometrial biopsy (defined as ≥5 CD138 positive cells per 10 mm2) will be randomised to oral doxycycline or placebo for 14 days. A subset will be recruited to a mechanistic substudy in which microbial swabs and preintervention/postintervention endometrial samples will be collected. Up to 3062 women recruited from 29 National Health Service (NHS) hospital sites across the UK are expected to be screened with up to 1500 women randomised in a 1:1 ratio. Women with a negative endometrial biopsy (defined as <5 CD138 positive cells per 10 mm2) will also be followed up to test validity of the tool. The primary outcome is live births plus pregnancies ≥24 + 0 weeks gestation at the end of the trial, in the first or subsequent pregnancy. Secondary clinical outcomes will also be assessed. Exploratory outcomes will assess the effect of doxycycline treatment on the endometrial microbiota, the differentiation capacity of the endometrium and the senescent profile of the endometrium with CE. Ethics and dissemination: Ethical approval has been obtained from the NHS Research Ethics Committee Northwest-Haydock (19/NW/0462). Written informed consent will be gained from all participants. The results will be published in an open-access peer-reviewed journal and reported in the National Institute for Health and Care Research journals library. Trial registration number: ISRCTN23947730

Ankle fracture internal fixation performed by cadaveric simulation-trained versus standard-trained orthopaedic trainees : a preliminary, multicentre randomized controlled trial

Aims: Ankle fracture fixation is commonly performed by junior trainees. Simulation training using cadavers may shorten the learning curve and result in a technically superior surgical performance. Methods: We undertook a preliminary, pragmatic, single-blinded, multicentre, randomized controlled trial of cadaveric simulation versus standard training. Primary outcome was fracture reduction on postoperative radiographs. Results:Overall, 139 ankle fractures were fixed by 28 postgraduate year three to five trainee surgeons (mean age 29.4 years; 71% males) during ten months' follow-up. Under the intention-to-treat principle, a technically superior fixation was performed by the cadaveric-trained group compared to the standard-trained group, as measured on the first postoperative radiograph against predefined acceptability thresholds. The cadaveric-trained group used a lower intraoperative dose of radiation than the standard-trained group (mean difference 0.011 Gym2, 95% confidence interval 0.003 to 0.019; p = 0.009). There was no difference in procedure time. Conclusion: Trainees randomized to cadaveric training performed better ankle fracture fixations and irradiated patients less during surgery compared to standard-trained trainees. This effect, which was previously unknown, is likely to be a consequence of the intervention. Further study is required