[Significance of clinical training. Educational methodology--classroom teaching and practical training in technical education].
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In 1992, HIV/AIDS researchers in Amsterdam, the Netherlands, were invited to work in partnership with researchers in Ethiopia to build an HIV/AIDS research infrastructure in Addis Ababa. This project, which began in 1994, was envisioned to contribute meaningfully to fighting the HIV pandemic in the decades to come. Its immediate objective was to establish an HIV research laboratory to serve international partnerships pursuing HIV vaccine research in Ethiopia and to support national health authorities fighting the HIV epidemic in Ethiopia. The overall goal was to develop research capacity at the Ethiopian Health and Nutrition Research Institute (EHNRI) by improving facilities, training technical and academic personnel (at PhD, MSc, and MPH level), establishing cohort studies to study HIV infection progression, and helping the government to implement a national HIV surveillance program. In the period 1994-2002, the projected HIV/AIDS research laboratory was built and several existing sections of EHNRI were renovated and upgraded. An active HIV-research program was established. Staff grew to more than 60, including three Ethiopian and three expatriate research/managers. Two PhD. students have graduated in immunology and virology (University of Amsterdam, 2000), and five are currently in training. Several technical persons were trained and over 19 MSc/MPH-programs were supported at Addis Ababa University (AAU). The first Ethiopian PhD graduate became the national program manager for ENARP. Two ENARP cohort studies and several HIV-prevalence studies have helped to document the severity of the HIV epidemic in Ethiopia, assisting national authorities in formulation of national and regional policies to prevent HIV transmission. Initial funding for ENARP from the Netherlands government was projected for eight years, to end by 2003. It was expected that management responsibilities would then be transferred from expatriate to Ethiopian staff and all ENARP activities integrated into EHNRI.
BACKGROUND: Education in obtaining informed consent, combined with technical training using a stepwise approach, may improve resident knowledge of, confidence in, and frequency of obtaining consent for bedside procedures. METHODS: Surgical trainees were randomized to receive a lecture on obtaining informed consent. Knowledge of, confidence in, and frequency of obtaining consent were assessed. Subsequent first-year residents received combined technical and consent training using a stepwise approach. Residents listed key steps for procedures before and after training, were observed for consent and technical competency on patients, and were assessed on frequency of obtaining consent by follow-up chart review. RESULTS: Knowledge and confidence improved after lecture instruction, but consent rate (21%) did not. Stepwise training increased resident awareness of obtaining informed consent as a key step (19% to 77%) and increased frequency of obtaining consent (89% for proctored procedures and 79% in follow-up). CONCLUSIONS: Education alone improves knowledge but not practice of obtaining consent. Teaching the consent process concomitantly with technical training may increase awareness and performance of obtaining informed consent for bedside procedures.
BACKGROUND: Residential and commercial painters disturb lead paint on older buildings, exposing workers and potentially building occupants. An intervention strategy was evaluated for improving lead safety in these small businesses. METHODS: Twenty-one painting contractors received 32 hr of training, technical assistance, and a safety manual; their employees attended an 8-hr training session. Impact evaluation involved interviewing participants at baseline, immediately post-intervention, and 1 year later, and conducting contractor focus groups post-intervention. RESULTS: Employers met 15 of 27 target objectives and workers met 3 of 12; however, even in areas where objectives were not met, both groups made improvements. CONCLUSIONS: Motivated contractors and their employees can make moderate improvements in lead-safe practices if provided with extensive training and technical assistance. Changes that are costly, unfamiliar, or perceived as a threat to work quality are more difficult to implement.
OBJECTIVE: To examine the nurse-technology relationship via a case study of ultrasonography in women's health nursing practice. DESIGN: Exploratory case study using ethnographic methods. SETTING: Outpatient obstetric and gynecology clinic of a large teaching hospital. PARTICIPANTS: Three nurses, two technicians, and one physician. RESULTS: Two of the nurses and the physician were very "nurse-like" in their use of the technology of ultrasonography to fulfill the traditional nursing purposes of observation, teaching, and comforting. The third nurse was nurse-like in talk, but at times "technician-like" in performance, allowing the technology to pull her away from nursing purposes. CONCLUSIONS: The expert nurses bent the technology to nursing purposes. Sonographers performed in accordance with professional training and experience, rather than with gender expectations. The subtle differences between expert nurse use and technical use (by novice nurses or technicians) of ultrasonography may provide a strong rationale against current efforts to substitute technically trained or technically oriented personnel for expert nurses.
OBJECTIVE: To assess whether video gaming experience is associated with improved surgical performance in the surgeon population across laparoscopic, robotic, and other surgical modalities, and evaluate its implications on surgical training and education. METHODS: A structured literature search was conducted across five databases on 29th November 2024 in adherence to PRISMA guidelines. Comparative studies evaluating surgical performance outcome data between surgeons with differing video game experience were eligible for inclusion. Outcomes evaluated were time to complete task, error rate, accuracy, economy of motion, and overall score. Included studies were assessed for risk of bias using ROBINS-I and RoB 2. RESULTS: 15 studies involving 641 participants were included, comprising one randomized controlled trial and 14 nonrandomized studies. All nonrandomized studies were judged to be at moderate or serious risk of bias, and the single randomized controlled trial was judged to be at serious risk of bias. Differences in study design and outcome measures meant that quantitative synthesis could not be performed. Across laparoscopic studies, video gaming experience was associated with improved overall score and time to task completion predominantly in the period prior to structured training interventions, with accuracy findings consistently favoring gamers in the two studies reporting this outcome. Error rate and economy of motion findings were inconsistent or predominantly nonsignificant. No meaningful association was identified across nonlaparoscopic modalities. CONCLUSIONS: Video gaming may be associated with improved surgical performance in surgeons, though this appears restricted to laparoscopic tasks and the pretraining intervention period. As a low-cost and accessible activity, video gaming may represent a practical informal adjunct to formal surgical training to help ease the transition into structured technical training. Surgical program directors need not alter existing selection criteria or training modules based on the available literature.
OBJECTIVE: To examine the first decade of experience with minimal access surgery, with particular attention to issues of training surgeons already in practice, and to provide a set of recommendations to improve technical training for surgeons in practice. SUMMARY BACKGROUND DATA: Concerns about the adequacy of training in new techniques for practicing surgeons began almost immediately after the introduction of laparoscopic cholecystectomy. The concern was restated throughout the following decade with seemingly little progress in addressing it. METHODS: A preliminary search of the medical literature revealed no systematic review of continuing medical education for technical skills. The search was broadened to include educational, medical, and psychological databases in four general areas: surgical training curricula, continuing medical education, learning curve, and general motor skills theory. RESULTS: The introduction and the evolution of minimal access surgery have helped to focus attention on technical skills training. The experience in the first decade has provided evidence that surgical skills training shares many characteristics with general motor skills training, thus suggesting several ways of improving continuing medical education in technical skills. CONCLUSIONS: The educational effectiveness of the short-course type of continuing medical education currently offered for training in new surgical techniques should be established, or this type of training should be abandoned. At present, short courses offer a means of introducing technical innovation, and so recommendations for improving the educational effectiveness of the short-course format are offered. These recommendations are followed by suggestions for research.
Endovascular brachytherapy (EVBT) is an established treatment to reduce the probability of restenosis after a percutaneous coronary intervention. The purpose of this study was to assess (1) the manufacturer's stated dosimetric data for (90)Sr/(90)Y source trains to be used in EVBT and (2) the procedure-related radiation burden. The radiation fields in water around six (90)Sr/(90)Y source trains were studied using phantoms made of 'solid water' and MD55-2 radiochromic films. The water equivalence of the phantom material was tested by applying quantitative computed tomography. Thermoluminescence dosemeters were used to assess personal radiation burden and crosscheck the dose distribution along the source trains. Technical failure was observed in one source train and this train was excluded from analysis. The measured dose rate in water at 2 mm radial distance was on average 8% higher than the manufacture's stated value (range of measured to stated values 1.05--1.15). The dose rate decreased exponentially with radial distance between 2 and 6 mm. The dose rate in contact with the source viewing window of the delivery devices ranged between 0.5 and 7.5 mGy h(-1). Low-energy photons were the main contributors to personal dose.
Any thorough examination of the present and future of agricultural education must certainly begin with a look into its past. Since the creation of the United States, many leading American philosophers have viewed a strong agrarian culture as the bedrock of American vigor. These same philosophers repeatedly noted the significance of comprehensive agricultural education to a nation rich in agricultural wealth. The signing of the Agricultural Colleges Act legitimized the concept of formal education in the agricultural sciences and provided funding for such education. The Act, which came to be known as the Morrill Act, after one of its primary authors, stressed the importance of comprehensive education. In fact, the inclusion of liberal studies was specifically mentioned in the Morrill Act and was defended repeatedly by Morrill himself. Comprehensive education prevented graduating technically trained students who were lacking in the basic outcomes of education--critical, comprehensive problem solving, cohesive thought, and effective communication. However, throughout history, the demands of a growing population coupled with rapid advancements in scientific knowledge led to a gradual move away from comprehensive education in agricultural sciences toward increasing specialization, resulting in more narrowly trained students. Today's agricultural students are technically well versed but often lack the skill and knowledge required for cohesive thought and critical problem solving. Addressing the multitude of challenges facing leaders in the future of agriculture requires much more than technical skill. These challenges require quick, yet careful thinkers and communicators who can respond to changing market structure and consumer demand in a dynamic way. Students who are a product of a conscious move toward amalgamation of burgeoning scientific knowledge and technical prowess with an integrative education emphasizing relationships between disciplines would better serve tomorrow's agriculture.
INTRODUCTION: In aviation, it has been realised that technical training ensures competence in specific procedures, but does not counter errors due to communication or decision making in a dynamic environment. As a consequence, Crew Resource Management, consisting of training in co-operation, management, and communication skills, was introduced in order to serve as a countermeasure towards human errors. In the same way, medical school ensures academic and technical insight, but rarely offers systematic training in such non-technical skills. The aim of this study is to identify the standard of competence in skills of co-operation, management, and communication at the end of the Pre-Registration House Officership. METHOD: 30 skills of management, co-operation, and communication divided into five main areas were identified. Using the Delphi method through two rounds of questionnaires, an expert panel of 50 doctors evaluated six different standards of competence for each skill. RESULTS: The Panel reached consensus at a 75% level for five skills, all within the main area "Team communication in the acute situation". Consensus was not reached within any of the other four main areas. None of the 30 skills was evaluated as being irrelevant for the Pre-Registration House Officer by more than one panel member. CONCLUSION: There was broad agreement on the need for high standards of competence within the area of team communication. There was considerable disagreement within the panel with regard to the other main areas, but all of the skills listed in this study were found relevant to the Pre-Registration House Officer in the acute situation.