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PubMed2002

The impact of error training and individual differences on training outcomes: an attribute-treatment interaction perspective.

The authors examined the effectiveness of error training for trainees with different levels of cognitive ability, openness to experience, or conscientiousness. Participants (N = 181) were randomly assigned to control, error-encouragement, or error-avoidance conditions and trained to perform a decision-making simulation. Declarative knowledge, task performance, and self-efficacy were measured posttraining. Findings suggest the effectiveness of error training is dependent on the cognitive ability or dispositional traits of trainees. High cognitive ability or more open individuals benefit more from error-encouragement training than low cognitive ability or less open individuals. Conscientiousness has a negative effect on self-efficacy when trainees are encouraged to make errors.

Adult↗

PubMed2005

Effective group training techniques in job-search training.

The aim was to examine the effects of group training techniques in job-search training on later reemployment and mental health. The participants were 278 unemployed workers in Finland in 71 job-search training groups. Five group-level dimensions of training were identified. The results of hierarchical linear modeling demonstrated that preparation for setbacks at the group level significantly predicted decreased psychological distress and decreased symptoms of depression at the half-year follow-up. Trainer skills at the group level significantly predicted decreased symptoms of depression and reemployment to stable jobs. Interaction analyses showed that preparation for setbacks at the group level predicted fewer symptoms of psychological distress and depression, and shared perceptions of skilled trainers at the group level predicted fewer symptoms of depression among those who had been at risk for depression.

Adolescent↗

PubMed2002

Dermoscopic diagnosis by a trained clinician vs. a clinician with minimal dermoscopy training vs. computer-aided diagnosis of 341 pigmented skin lesions: a comparative study.

BACKGROUND: In the last few years digital dermoscopy has been introduced as an additional tool to improve the clinical diagnosis of pigmented skin lesions. OBJECTIVE: To evaluate the validity of digital dermoscopy by comparing the diagnoses of a dermatologist experienced in dermoscopy (5 years of experience) with those of a clinician with minimal training in this field, and then comparing these results with those obtained using computer-aided diagnoses. METHODS: Three hundred and forty-one pigmented melanocytic and non-melanocytic skin lesions were included. All lesions were surgically excised and histopathologically examined. Digital dermoscopic images of all lesions were framed and analysed using software based on a trained artificial neural network. Cohen's kappa statistic was calculated to assess the validity with regard to the correct diagnoses of melanoma and non-melanoma. RESULTS: Sensitivity was high for the experienced dermatologist and the computer (92%) and lower for the inexperienced clinician (69%). Specificity of the diagnosis by the experienced dermatologist was higher (99%) than that of the inexperienced clinician (94%) and the computer assessment (74%). Notably, computer analysis gave a higher number of false positives (26%) compared with the experienced dermatologist (0.6%) and the inexperienced clinician (5.5%). CONCLUSIONS: Our results indicate that analysis either by a trained dermatologist or an artificial neural network-trained computer can improve the diagnostic accuracy of melanoma compared with that of an inexperienced clinician and that the computer diagnosis might represent a useful tool for the screening of melanoma, particularly at centres not experienced in dermoscopy.

Adolescent↗

PubMed1998

In-training assessment in postgraduate training for general practice.

Assessment within general practice training curricula is necessary to both guide learning and to make certification decisions about competence to practise without supervision in the community, but there is a risk that the two roles could become confused. This paper proposes a conceptual framework that explains the relationship between formative assessment, in-training assessment and end-point assessment, as adopted by the Royal Australian College of General Practitioners Training Programme. The literature is reviewed to suggest assessment formats that could provide a means of making decisions about progress through training without harming the important role of providing feed-back to guide learners.

Australia↗

PubMed2006

How will the introduction of primary certificate training programs change vascular surgery training programs?

New requirements for vascular surgery training allow several routes to Board eligibility in the specialty. Individuals can enter vascular residency directly from medical school, after 3 years of surgical residency, or after completion of the traditional 5 years of surgery training. Vascular surgery program directors will be faced with the challenges of obtaining institutional support, designing an acceptable educational program, and working closely with the general surgery program director to ensure both programs are successful. Faculty in the vascular program may find working with residents right out of medical school or after only 3 years of surgery training to be a challenge, especially in terms of developing the requisite technical skills. Residents must be able to demonstrate mastery of the six competencies in addition to the skills of vascular surgery. Because, in some ways, this new vascular training scheme is an experiment in redesigning all surgical education, the vascular community will need to carefully evaluate the results by monitoring the practices of those who graduate from these programs.

Accreditation↗

PubMed1999

Meeting the training needs of community-based service personnel in Africa through video-based training courses. Leonard Cheshire Foundation International.

PURPOSE: This paper describes the development of a new training model: namely one which is local and open to everyone; in which people learn through seeing and doing; with the focus on information that is practical and relevant to them. A package of video and workbooks enables the courses to be presented by local tutors who have taken part in a training workshop to prepare them for the task. METHOD: This model was applied to an eight unit course on working with children who have cerebral palsy. It was presented in 13 locations by 19 tutors in four southern African countries to over 150 participants within a 6 month period. A developmental approach was adopted which involved working with partners to identify training needs, develop and field test the video course. Tutors and participants evaluated the course separately using quantitative and qualitative methods. RESULTS: Overall tutors and participants rated the course positively. They identified elements which they found particularly useful along with those which were considered less useful. Course results and outcomes are discussed. CONCLUSIONS: The findings indicated that the training model was effective and five further courses have been developed about disability issues. These are described in the Appendix.

Allied Health Personnel↗

PubMed2002

Anaerobic power and physical function in strength-trained and non-strength-trained older adults.

BACKGROUND: Challenging daily tasks, such as transferring heavy items or rising from the floor, may be dependent on the ability to generate short bursts of energy anaerobically. The purposes of this study were to determine if strength-trained (ST) older adults have higher anaerobic power output compared with non-strength-trained (NST) older adults and to determine the relationship between anaerobic power and performance-based physical function. METHODS: Thirty-five men and women (age 71.5 +/- 6.4 years, mean +/- SD; NST: n = 18, ST: n = 17) were grouped by training status. Outcome variables included relative anaerobic power (Wingate test), physical function measured with the Continuous Scale Physical Functional Performance Test (CS-PFP, scaled 0 to 100), and anthropometric lean thigh volume (LTV). Analysis of covariance (with age and sex as covariates) was used to determine group differences in the dependent variables listed above. Pearson's r was used to determine the relationship between anaerobic power, CS-PFP total score (TOT), and CS-PFP lower body strength domain score (LBS). RESULTS: The ST group had significantly higher mean anaerobic power (NST 58.9 +/- 16 W/l, ST 96.3 +/- 23 W/l), CS-PFP total (NST 61.2 +/- 13, ST 73.7 +/- 8), and LBS (NST 54.1 +/- 17, ST 70.9 +/- 8) compared with the NST group (p <.05). However, LTV was similar for both groups (NST 3.323 +/- 0.75; ST 3.179 +/- 0.79), which suggests that the ST group had higher muscle quality compared with the NST group. Anaerobic power was significantly related to TOT (r =.611, p =.001) and LBS (r =.650, p =.001). CONCLUSIONS: High levels of physical function in ST older adults may in part be explained by higher levels of anaerobic power associated with strength training.

Aged↗

PubMed1996

Training in wound ballistics: operation exercise at the Defence Medical Training Centre.

The Defence Medical Training Centre has for a number of years been conducting exercises to give Danish National Service (conscript) surgeons and dentists the opportunity to observe and treat gunshot wounds. The exercises are intended to complement the theoretical training given at the Centre, which has been granted permission by the Ministry of Justice to use experimental animals in the training program. The animals used are shot in the abdomen and both thighs and are kept anesthetized during the exercise but, if possible, breathe spontaneously. Assisted ventilation is available at all times. The weapons used are military weapons: a low velocity 9-mm semiautomatic pistol, SIG P210, a medium velocity rifle, US M1 Carbine, and a high velocity rifle, the AK-74. The ammunition used is conventional, full metal jacketed bullets. Having been shot, the animals are given first aid by the participants who play the roles of ordinary soldiers. The animals are then taken to the regimental aid post, where they are attended by a surgeon for the first time. Intravenous tubes, chest tubes, hemostats, etc. are applied, whereupon the animals are transported by military ambulance to the field hospital. There the abdominal wounds are examined by laparotomy and relevant intraabdominal procedures are performed. The leg wounds are treated by debridement along the lines advocated by the Emergency War Surgery-NATO Handbook. This exercise allows the Defence Medical training Centre to teach wound ballistics in a realistic setting. It is hoped that the pupils will never need the skills acquired at the exercise, but, next to going to war or to some of the more violent parts of the world, Operation Exercise is the best preparation for the demands placed on a medical officer.

Animals↗

PubMed2003

Training in pediatric critical care medicine: A survey of pediatric residency training programs.

BACKGROUND: After completing their critical care rotations, pediatric residents are expected to have acquired skills in the resuscitation of critically ill newborns and children. Recent Accreditation Council on Graduate Medical Education (ACGME) guidelines have limited the time devoted to critical care training during pediatric residency. We sought to determine how individual programs have structured their critical care training experience in light of these changes. MATERIALS AND METHODS: A questionnaire was mailed to each pediatric residency program listed in the 1996-1997 Graduate Medical Education Directory. Information was obtained regarding the structure of critical care training. Data were analyzed using descriptive techniques, one-way analysis of variance with Scheffé post hoc test, and Fisher exact test as appropriate. RESULTS: Data were received from 149 programs (71% response rate). Most programs were in compliance with ACGME standards regarding the number of months devoted to neonatal intensive care, pediatric intensive care, and emergency medicine. There were no significant differences in the total number of rotations in either the neonatal intensive care unit (NICU) or the pediatric intensive care unit (PICU) when the programs were stratified by size. There were no significant differences in the percentage of programs requiring night call in either the NICU or the PICU during off-service months. However, small programs (< 25 residents) required significantly fewer rotations in emergency medicine (P < 0.001). Most programs complemented the critical care experience by offering additional rotations and advanced life support training. CONCLUSIONS: Pediatric residency programs have structured their critical care rotations in a similar fashion in accordance with ACGME guidelines. The success in meeting the stated objectives, as measured by the ability of graduating residents to stabilize critically ill children, is not known and will require further study.

Child↗

PubMedDate not supplied

The Coalition Training Institute: training for the long haul.

Public-private partnerships are integral to our public health paradigm. The Coalition Training Institute (1995-1998) trained 283 participants from 29 U.S. cities, 49 states, and 7 U.S. territories to foster and sustain partnerships that improve immunization rates. Evaluation consisted of on-site and follow-up surveys, effectiveness inventories, and focus groups. The Institute met participants' expectations. Four months later, participants reported training was applicable (93%) and helpful in overcoming organizational barriers. Most built or improved coalitions (81%), helped organizations apply new ideas (86%), and obtained training/support (60%). Participants requested more on-site and distance-learning opportunities to network, train coalition leaders and members, and learn new skills.

Child↗

PubMed1998

The impact of health care reform on gastroenterology fellows: are training programs preparing them for the future? American College of Gastroenterology Educational Affairs Subcommittee on Training.

OBJECTIVE: Health care reform is dramatically changing the practice and delivery of medical care. The goal of this investigation was to examine gastroenterology trainees' outlook on the impact of health care reform on training programs. METHODS: A 24-question survey was mailed in February 1996 to 780 GI fellows obtained from the comprehensive American College of Gastroenterology (ACG) database. RESULTS: A total of 362 fellows responded (46%): 85% were male, 57% Caucasian, 75% married, and 86% were university-based. Ninety-six percent of fellows believed that health care reform is adversely affecting the quality of health care and 94.1% felt that it was adversely affecting fellowship training. Eighty-eight percent expressed concern over the impact of health care reform on practice opportunities. Only 9% of fellows reported that their training program had established a specific educational program addressing health care reform, whereas 83% of fellows felt that their program should do so. CONCLUSION: Gastroenterology fellows are concerned about the impact of health care reform on the quality of care and the quality of their fellowship training. Trainees believe that programs are not providing sufficient education to help them respond to the changes in health care.

Education, Medical, Graduate↗

PubMed2005

Interaction of contractile activity and training history on mRNA abundance in skeletal muscle from trained athletes.

Skeletal muscle displays enormous plasticity to respond to contractile activity with muscle from strength- (ST) and endurance-trained (ET) athletes representing diverse states of the adaptation continuum. Training adaptation can be viewed as the accumulation of specific proteins. Hence, the altered gene expression that allows for changes in protein concentration is of major importance for any training adaptation. Accordingly, the aim of the present study was to quantify acute subcellular responses in muscle to habitual and unfamiliar exercise. After 24-h diet/exercise control, 13 male subjects (7 ST and 6 ET) performed a random order of either resistance (8 x 5 maximal leg extensions) or endurance exercise (1 h of cycling at 70% peak O2 uptake). Muscle biopsies were taken from vastus lateralis at rest and 3 h after exercise. Gene expression was analyzed using real-time PCR with changes normalized relative to preexercise values. After cycling exercise, peroxisome proliferator-activated receptor-gamma coactivator-1alpha (ET approximately 8.5-fold, ST approximately 10-fold, P < 0.001), pyruvate dehydrogenase kinase-4 (PDK-4; ET approximately 26-fold, ST approximately 39-fold), vascular endothelial growth factor (VEGF; ET approximately 4.5-fold, ST approximately 4-fold), and muscle atrophy F-box protein (MAFbx) (ET approximately 2-fold, ST approximately 0.4-fold) mRNA increased in both groups, whereas MyoD (approximately 3-fold), myogenin (approximately 0.9-fold), and myostatin (approximately 2-fold) mRNA increased in ET but not in ST (P < 0.05). After resistance exercise PDK-4 (approximately 7-fold, P < 0.01) and MyoD (approximately 0.7-fold) increased, whereas MAFbx (approximately 0.7-fold) and myostatin (approximately 0.6-fold) decreased in ET but not in ST. We conclude that prior training history can modify the acute gene responses in skeletal muscle to subsequent exercise.

Adult↗

PubMed2006

Local shuffling of spike trains boosts the accuracy of spike train spectral analysis.

Spectral analysis of neuronal spike trains is an important tool in understanding the characteristics of neuronal activity by providing insights into normal and pathological periodic oscillatory phenomena. However, the refractory period creates high-frequency modulations in spike-train firing rate because any rise in the discharge rate causes a descent in subsequent time bins, leading to multifaceted modifications in the structure of the spectrum. Thus the power spectrum of the spiking activity (autospectrum) displays elevated energy in high frequencies relative to the lower frequencies. The spectral distortion is more dominant in neurons with high firing rates and long refractory periods and can lead to reduced identification of low-frequency oscillations (such as the 5- to 10-Hz burst oscillations typical of Parkinsonian basal ganglia and thalamus). We propose a compensation process that uses shuffling of interspike intervals (ISIs) for reliable identification of oscillations in the entire frequency range. This compensation is further improved by local shuffling, which preserves the slow changes in the discharge rate that may be lost in global shuffling. Cross-spectra of pairs of neurons are similarly distorted regardless of their correlation level. Consequently, identification of low-frequency synchronous oscillations, even for two neurons recorded by a single electrode, is improved by ISI shuffling. The ISI local shuffling is computed with confidence limits that are based on the first-order statistics of the spike trains, thus providing a reliable estimation of auto- and cross-spectra of spike trains and making it an optimal tool for physiological studies of oscillatory neuronal phenomena.

1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine↗

PubMed2002

Familial aggregation of blood lipid response to exercise training in the health, risk factors, exercise training, and genetics (HERITAGE) Family Study.

BACKGROUND: Fasting levels of plasma lipids and lipoproteins are reported to improve with regular exercise training. However, little is known on whether the training responses are influenced by heritable factors. METHODS AND RESULTS: The lipid profile was assessed in 115 black (224 individuals) and 99 white families (469 individuals), who participated in the HERITAGE Family Study, while in a sedentary state (baseline visit) and after exercise training for 20 weeks (post visit). Variables included total cholesterol, triglyceride, low-density lipoprotein cholesterol (LDL-C), apolipoprotein B (ApoB), high-density lipoprotein cholesterol (HDL-C), apolipoprotein A-I, and HDL-C subfractions 2 (HDL2-C) and 3 (HDL3-C). Familial correlations for the training responses (Delta=post-baseline) were significant for most variables, and the percent variance accounted for by familial factors (ie, maximal heritabilities) ranged from 25% to 38%. Exceptions were for higher heritabilities near 60% for DeltaApoB in blacks and DeltaHDL2-C in whites and a lower estimate of zero for DeltaLDL-C in blacks. CONCLUSIONS: Heritable factors in part determine lipid profile responses to regular exercise. Maximal heritabilities were similar across ethnic groups and variables, except for DeltaLDL-C, DeltaApoB, and DeltaHDL2-C. Molecular studies to identify the markers and genes associated with these influences are currently underway.

Adolescent↗

PubMed1994

Intensive vascular training in stage IIb of peripheral arterial occlusive disease. The additive effects of intravenous prostaglandin E1 or intravenous pentoxifylline during training.

In a randomized open study, the combination of either prostaglandin E1 (PGE1) or pentoxifylline with controlled vascular training was compared with vascular training alone in patients with peripheral arterial occlusive disease in stage IIb. Forty-four patients were randomly assigned to treatment either of intensive vascular training alone (n = 15) or in combination with either i.v. pentoxifylline (200 mg over 2 hours BID, n = 15) or PGE1 (40 micrograms over 2 hours BID, n = 14). The basic therapy was a well-defined routine for vascular training, which was identical for all groups. The duration of therapy was 4 weeks. In all three test groups, there was a significant increase in the walking distance. There was a 119% increase in symptom-free walking distance in the exercise-only group. In comparison with exercise alone, the additional administration of pentoxifylline produced no greater effect; the increase was 105%. In contrast, administration of PGE1 combined with exercise achieved a remarkable improvement of 604%. Between-group comparison revealed the significant superiority of treatment with PGE1 (P < .05). During the 1-year follow-up, there was a reduction in the walking performance in all groups, albeit of variable extent. In the exercise-only and the pentoxifylline groups, the maintained increase in walking distance was only 30% compared with baseline values before the beginning of therapy. In the PGE1 group, on the other hand, the maintained improvement was 149%. Nine of 14 patients were still in stage IIa of peripheral arterial occlusive disease 1 year after PGE1 therapy.

Alprostadil↗

PubMed2007

Neuromuscular fatigue profile in endurance-trained and power-trained athletes.

PURPOSE: This study examined the effects of training background on the relationship between the neuromuscular fatigue profile and maximal voluntary torque production in isometric, concentric, and eccentric contraction modes. METHODS: Before and after three sets of 31 isokinetic concentric knee extensions at 60 degrees .s(-1), voluntary and electrically induced contractions were recorded in 14 endurance-trained (ENDU) men (seven cyclists: age 25 +/- 2 yr, mass 70 +/- 8 kg, height 175 +/- 5 cm; and seven triathletes: age 27 +/- 4 yr, mass 71 +/- 5 kg, height 179 +/- 6 cm) and seven explosive power-trained men (EXPLO: age 24 +/- 1 yr, mass 73 +/- 5 kg, height 179 +/- 4 cm). Maximal knee-extension torque, activation level (twitch interpolation technique), electromyographic activity of agonist and antagonist muscles, and twitch contractile properties were assessed. RESULTS: At preexercise, the maximal voluntary isometric and concentric torques of EXPLO were greater than those of ENDU (P < 0.05). After the fatiguing exercise, significant isometric (18%; P < 0.01) and concentric (25%; P < 0.05) torque decreases in EXPLO were associated with, respectively, twitch torque (Pt) and maximal rate of twitch development (+dPt/dt) reductions (P < 0.01) and with an increase in the antagonist coactivation level (P < 0.01). No modification was observed for ENDU. Interestingly, the coactivation level was also increased (P < 0.01) in eccentric contraction for EXPLO, although the maximal eccentric torque decrease (P < 0.01) could not be specifically attributed to any group. CONCLUSION: The fatiguing exercise induced central and peripheral adaptations, but the mechanisms differed regarding the contraction mode. At pre- and postfatiguing exercise, it seems that the neuromuscular profile depends on the subject's training background and the contraction modes used to assess fatigue.

Adaptation, Physiological↗

PubMed2000

Effects of physical training on the recovery of the autonomic nervous activity during exercise after coronary artery bypass grafting: effects of physical training after CABG.

Analysis of heart rate variability (HRV) can identify patients at risk of sudden cardiac death after myocardial infarction. The present study examined the effect of 2 weeks of supervised aerobic exercise training on the recovery of the autonomic nervous activity, exercise capacity, and cardiac output (CO) after coronary artery bypass grafting (CABG). Twenty-eight patients were randomly divided into the training group or the control group and performed exercise tests at 1 week, 3 weeks, 3 months, 6 months and 1 year after CABG. The HRV was measured, and the high-frequency component of HRV was used as an index of parasympathetic nerve activity (PNA); the plasma norepinephrine concentration (NE) was used as an index of sympathetic nervous activity. Cardiac output was also measured. In the training group, peak VO2, peak CO and PNA during exercise had improved at 3 weeks, but there was no improvement in these indices in the control group. NE decreased 1 week after CABG in both groups. These results indicate that physical training soon after CABG improves not only the exercise capacity, but also PNA.

Aged↗

PubMed1993

Longterm physical training in rheumatoid arthritis. A randomized trial with different training programs and blinded observers.

The objective was to study the long-term effect (2 years) of different training programs in patients with rheumatoid arthritis. The method was a randomized trial with 75 patients participating. The measured variables included morning stiffness, a pain score, number of swollen joints, a health assessment score, a functional score, ESR, Hb, the cost of medicine, and progression using X-rays of hands and feet. The results showed no effect of training on the disease activity or on the progression of the disease. The conclusion is that although most patients are in favour of training, the present study does not support that training lessons per se affect the disease activity or the progression of the disease.

Adult↗