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At least 19 recordsLinked to original sources

PubMed2005

Modelling novice clinical reasoning for a computerized decision support system.

AIM: The aim of this paper is to introduce the theoretical framework that directs the project. BACKGROUND: The Novice Computer Decision Support (N-CODES) Project is developing a point-of-care system to assist novice acute care nurses while making clinical judgements. Unlike prior approaches, N-CODES is guided by a theoretical understanding of nurses' decision-making processes, including the manner by which novices develop this skill. FRAMEWORK: Assumptions within information processing theory guided the clinical decision-making framework. The framework is composed of a clinical decision-making model and a second embedded model depicting the clinical reasoning development of novice nurses. MODELS: The model is developed within a pluralistic perspective synthesizing theoretical and empirical knowledge on clinical decision-making and the development of novice reasoning skills. A visual representation of experienced nurse decision-making is presented. A central element is the nurse's use of pre-encounter data and working knowledge. A second model integrates empirical data on the developing clinical reasoning of the novice. This knowledge is loosely scattered through 25 years of literature. The intersection of these models provides a novel perspective on the way novices begin to identify working knowledge patterns and develop a sense of saliency. CONCLUSIONS: Previous attempts to build comprehensive clinical decision support systems have disregarded important theoretical considerations hindering the success of these projects. Grounding a Decision Support System in a theoretical model of novice nurse decision-making will strengthen the utility and acceptance of the Decision Support System. Additionally, a conceptualization of novice nurse development is an asset to nurse educators, managers and scientists interested in improving clinical decision-making.

Clinical Competence↗

PubMed1999

Aircraft control forces and EMG activity: comparison of novice and experienced pilots during simulated take-off and landing.

BACKGROUND: Flying an aircraft requires a considerable degree of coordination, particularly during activities such as takeoff and landing. No studies have examined the magnitude and phasing of muscle activity required to fly an aircraft. The aim of this study was to examine the muscle activation patterns and control forces of novice and experienced pilots during simulated flight. METHODS: Twelve experienced and nine novice pilots were tested on an Aermacchi flight simulator while performing a randomized set of take-off and landing maneuvers. Four different runaway trim settings were used to increase the difficulty of the landings (elevator-up, elevator-down, aileron-left, and aileron-right). Variables recorded included aircraft attitude, pilot applied forces, and electromyographic (EMG) activity. Discriminant function analysis was used to distinguish between novice and experienced pilots. RESULTS: Across all landings, wrist flexors and wrist extensors were the predominant muscles used, with EMG activity consistently around 20-30% maximum voluntary contraction (MVC). In respect to differences in EMG activity between novice and experienced pilots, novices had significantly more activity in wrist extensors during all landings. In contrast, experienced pilots had consistently more vastus lateralis activity for all landings than did novice pilots. Over all landings and take-off, 89.5% of pilots were correctly classified as novice or experienced. When the maneuvers were analyzed individually, normal, elevator-down, and aileron-left landings were the most accurate maneuvers for pilot prediction. EMG and force variables were more important than aircraft attitude in discriminating between novice and experienced pilots (83%, 79%, and 65%, respectively). CONCLUSION: The consistency of the finding that EMG activity and control forces are accurate discriminators of pilot experience is indicative of underlying differences in neuromuscular control strategies between novice and experienced pilots.

Adult↗

PubMed2004

Themes surrounding novice nurse near-miss and adverse-event situations.

OBJECTIVE: The study purpose was to identify human performance factors that characterized novice nurse near-miss/adverse-event situations in acute-care settings. BACKGROUND: Increased focus on recruitment and retention of newly graduated registered nurses (RNs) in light of patient safety improvement goals will challenge healthcare educators and administrators. What we are beginning to learn about human performance issues during real work situations from patient safety research provides information related to human performance in complex environments that may guide education and system supports for novice RNs. METHODS: Data collected during 8 retrospective interviews of novice RNs about details surrounding their individual near-miss or adverse event were analyzed for common themes. RESULTS: Nine themes were identified. Seven themes were present in at least 7 of the 8 cases and included environmental and social issues, as well as novice lack of expertise. CONCLUSIONS: Findings suggest that support for novice nurses in acute care environments requires attention to the following: consistent availability of expertise in light of workload unpredictability, the social climate regarding expectations of novice performers, realistic expectations of novice decision-making ability during complex situations even up to a year after graduation, and strategies to recognize and intervene when novices are at risk for error.

Adult↗

PubMed2006

An evidence-based virtual reality training program for novice laparoscopic surgeons.

OBJECTIVE: To develop an evidence-based virtual reality laparoscopic training curriculum for novice laparoscopic surgeons to achieve a proficient level of skill prior to participating in live cases. SUMMARY BACKGROUND DATA: Technical skills for laparoscopic surgery must be acquired within a competency-based curriculum that begins in the surgical skills laboratory. Implementation of this program necessitates the definition of the validity, learning curves and proficiency criteria on the training tool. METHODS: The study recruited 40 surgeons, classified into experienced (performed >100 laparoscopic cholecystectomies) or novice groups (<10 laparoscopic cholecystectomies). Ten novices and 10 experienced surgeons were tested on basic tasks, and 11 novices and 9 experienced surgeons on a procedural module for dissection of Calot triangle. Performance of the 2 groups was assessed using time, error, and economy of movement parameters. RESULTS: All basic tasks demonstrated construct validity (Mann-Whitney U test, P < 0.05), and learning curves for novices plateaued at a median of 7 repetitions (Friedman's test, P < 0.05). Expert surgeons demonstrated a learning rate at a median of 2 repetitions (P < 0.05). Performance on the dissection module demonstrated significant differences between experts and novices (P < 0.002); learning curves for novice subjects plateaued at the fourth repetition (P < 0.05). Expert benchmark criteria were defined for validated parameters on each task. CONCLUSION: A competency-based training curriculum for novice laparoscopic surgeons has been defined. This can serve to ensure that junior trainees have acquired prerequisite levels of skill prior to entering the operating room, and put them directly into practice.

Benchmarking↗

PubMed2006

Factors affecting rapid turnover of novice nurses in university hospitals.

Rapid turnover of novice nurses eventually results in a shortage of veteran nurses. This study aimed to clarify the factors affecting rapid turnover of novice nurses in a prospective manner. We carried out an investigation in 20 university hospitals whose directors of nursing service departments accepted our request to cooperate with our research program. These hospitals were selected from all of the 102 university hospitals listed in The Hospital Catalog of Japan. The subjects were 1,203 novice hospital nurses who gave their informed consent for participation in our study. The questionnaires, which dealt with burnout, assertiveness, stressful life events, reality shock, ward assignment preference, transfer preference, job satisfaction (workplace, salary, workload, and overtime), social support and coping mechanisms were completed by 923 novice nurses in June 2003. Then, their turnover was investigated in December 2003. Thirty-seven novice nurses (4.0%) quit during this period. Multiple logistic regression analysis showed that the factors affecting rapid turnover were 1) graduation from vocational nursing schools, 2) dissatisfaction with assignment to a ward contrary to their desire, and 3) no peers for support. Assignment of novice nurses to wards they choose as far as possible, avoidance of assigning novice nurses to wards alone, and establishment of a support system for nurses who graduate from vocational nursing schools seem to be important for preventing rapid turnover of novice nurses.

Adult↗

PubMed2000

Aircraft control forces and EMG activity: comparison of novice and experienced pilots during simulated rolls, loops and turns.

BACKGROUND: Flying an aircraft requires a considerable degree of coordination, particularly during aerobatic activities such as rolls, loops and turns. Only one previous study has examined the magnitude of muscle activity required to fly an aircraft, and that was restricted to takeoff and landing maneuvers. The aim of this study was to examine the phasing of muscle activation and control forces of novice and experienced pilots during more complex simulated flight maneuvers. METHODS: There were 12 experienced and 9 novice pilots who were tested on an Aermacchi flight simulator while performing a randomized set of rolling, looping, and turning maneuvers. Four different runaway trim settings were used to increase the difficulty of the turns (elevator-up, elevator-down, aileron-left, and aileron-right). Variables recorded included aircraft attitude, pilot applied forces, and electromyographic (EMG) activity. Discriminant function analysis was used to distinguish between novice and experienced pilots. RESULTS: Over all maneuvers, 70% of pilots were correctly classified as novice or experienced. Better levels of classification were achieved when maneuvers were analyzed individually (67-91%), although the maneuvers that required the greatest force application, elevator-up turns, were unable to discriminate between novice and experienced pilots. There were no differences in the phasing of muscle activity between experienced and novice pilots. The only consistent difference in EMG activity between novice and experienced pilots was the reduced EMG activity in the wrist extensors of experienced pilots (p < 0.05). The increased wrist extensor activity of the novice pilots is indicative of a distal control strategy, whereby distal muscles with smaller motor units are used to perform a task that requires precise control. Muscle activity sensors could be used to detect the onset of high G maneuvers prior to any change in aircraft attitude and control G-suit inflation accordingly.

Adolescent↗

PubMed1994

Wrist kinematics differ in expert and novice tennis players performing the backhand stroke: implications for tennis elbow.

Investigators have suggested that the greater prevalence of lateral humeral epicondylitis (tennis elbow, TE) in novice tennis players compared to expert players may reflect the novice players' use of faulty mechanics for the backhand stroke. We investigated the wrist kinematics (flexion/extension), grip pressures, and wrist muscle electromyographic activity in novice (N = 8) and expert (N = 8) tennis players performing the backhand stroke. Experts performed the backhand stroke with the wrist extended (re: neutral alignment of the forearm and hand dorsum). Collision of the ball and racket occurred with the wrist extended on average of 0.41 rad (about 23 degrees from neutral alignment) in the expert players; moreover, their wrists were moving further into extension at impact. In contrast, novice subjects struck the ball with the wrist flexed 0.22 rad (about 13 degrees) while moving their wrists further into flexion. Wrist extensor EMGs showed similar levels of activity during the 500 ms interval before ball-racket impact, whereas expert subjects displayed greater EMG levels after contact, consistent with the accompanying wrist extension. The wrist kinematic and EMG data together show that the novice subjects eccentrically contracted their wrist extensor muscles throughout the stroke. We argue that conditions exist for novice subjects that assist stretch of wrist extensor muscles upon collision of the ball and racket. The resulting eccentric contraction of wrist extensor muscles may contribute to lateral TE in novice players, given previous research indicating that eccentric muscle contraction facilitates muscle fiber injury.

Adolescent↗

PubMed2005

The LapSim: a learning environment for both experts and novices.

BACKGROUND: Simulated environments present challenges to both clinical experts and novices in laparoscopic surgery. Experts and novices may have different expectations when confronted with a novel simulated environment. The LapSim is a computer-based virtual reality laparoscopic trainer. Our aim was to analyze the performance of experienced basic laparoscopists and novices during their first exposure to the LapSim Basic Skill set and Dissection module. METHODS: Experienced basic laparoscopists (n=16) were defined as attending surgeons and chief residents who performed >30 laparoscopic cholecystectomies. Novices (n=13) were surgical residents with minimal laparoscopic experience. None of the subjects had used a computer-based laparoscopic simulator in the past. Subjects were given one practice session on the LapSim tutorial and dissection module and were supervised throughout the testing. Instrument motion, completion time, and errors were recorded by the LapSim. A Performance Score (PS) was calculated using the sum of total errors and time to task completion. A Relative Efficiency Score (RES) was calculated using the sum of the path lengths and angular path lengths for each hand expressed as a ratio of the subject's score to the worst score achieved among the subjects. All groups were compared using the Kruskal-Wallis and Mann-Whitney U-test. RESULTS: Novices achieved better PS and/or RES in Instrument Navigation, Suturing, and Dissection (p<0.05). There was no difference in the PS and RES between experts and novices in the remaining skills. CONCLUSION: Novices tended to have better performance compared to the experienced basic laparoscopists during their first exposure to the LapSim Basic Skill set and Dissection module.

Clinical Competence↗

PubMed2003

Objective psychomotor skills assessment of experienced and novice flexible endoscopists with a virtual reality simulator.

The objective of this study was to determine whether the GI Mentor II virtual reality simulator can distinguish the psychomotor skills of intermediately experienced endoscopists from those of novices, and do so with a high level of consistency and reliability. A total of five intermediate and nine novice endoscopists were evaluated using the EndoBubble abstract psychomotor task. Each subject performed three repetitions of the task. Performance and error data were recorded for each trial. The intermediate group performed better than the novice group in each trial. The differences were significant in trial 1 for balloons popped (P=.001), completion time (P=.04), and errors (P=.03). Trial 2 showed significance only for balloons popped (P=.002). Trial 3 showed significance for balloons popped (P=.004) and errors (P=.008). The novice group showed significant improvement between trials 1 and 3 (P<0.05). No improvement was noted in the intermediate group. Measures of consistency and reliability were greater than 0.8 in both groups with the exception of novice completion time where test-retest reliability was 0.74. The GI Mentor II simulator can distinguish between novice and intermediate endoscopists. The simulator assesses skills with levels of consistency and reliability required for high-stakes assessment.

Adult↗

PubMed2002

Demystifying wine expertise: olfactory threshold, perceptual skill and semantic memory in expert and novice wine judges.

We investigated recognition and identification of wine-relevant odours as a function of domain-specific expertise. Eleven wine experts and 11 wine novices participated in tasks measuring olfactory threshold, odour recognition, odour identification, and consistency of odour naming. Twenty-four wine-relevant odorants were sampled orthonasally by each participant in the semantic (identification; consistency of naming) and episodic (recognition) memory tasks. Results showed superior olfactory recognition by expert wine judges, despite their olfactory sensitivity and bias measures being similar to those of novices. Contrary to predictions based on reports of an association between odour memory and semantic processing, wine experts did not perform better than novices on the verbal memory tasks. Further, ability to recognize odours and ability to name odours were not positively correlated, although the novices' data showed a trend in this direction. The results imply that the source of superior odour recognition in wine experts was not enhanced semantic memory and linguistic capabilities for wine-relevant odours. One interpretation of the data is that wine experts were less susceptible than wine novices to verbal overshadowing. When forced to identify the odorants, experts' superior perceptual skills protected them from verbal interference, whereas novices' generated verbal representations of the odours were emphasized at the expense of the odorant itself. This has implications for training in wine-evaluation skills.

1-Butanol↗

PubMed2006

Introduction of novice oncology nurses to end-of-life care.

Dying patients and their families often have unique physical, psychosocial, social, and spiritual needs that require special ized end-of-life (EOL) skills. EOL preparation of nurses has been inconsistent. Novice nurses need guidance to develop the knowledge, clinical skills, and coping strategies to provide high-quality and compassionate EOL care. Inadequate preparation for providing EOL care can lead to anxiety, stress, and burnout. Barriers that prevent adequate preparation and support of novice nurses in EOL care include lack of education, financial constraints, poor staffing, and major life changes. However, opportunities are available to support novice oncology nurses as they develop the skills necessary to provide competent EOL care. Nurse extern programs and individually tailored orientation plans that include EOL care should be developed. Careful selection of mentors and preceptors is an important aspect in planning orientation for novice oncology nurses. The presence of peers experienced in EOL care is crucial. Educational materials, standards of practice, and continuing education on EOL care should be available to novice nurses as well. EOL competencies may provide a blueprint to help with performance evaluations. Adequate preparation of novice oncology nurses for EOL care will improve patient outcomes, increase job satisfaction, and promote longevity in the specialty.

Adaptation, Psychological↗

PubMed1995

The psycho-physiological response to parachuting among novice and experienced parachutists.

Elevated heart rate and increased anxiety are two indicators of stress. This study investigated the heart rate and anxiety response to parachuting among seven novice and six experienced parachutists. Heart rate was measured from the moment of boarding the aircraft until landing. Anxiety was measured prior to boarding the aircraft. Heart rate was significantly higher among the novice compared to the experienced parachutists, especially during takeoff (125 +/- 11 vs. 95 +/- 17 beats.min-1, respectively), and upon exit or free fall (184 +/- 12 vs. 164 +/- 17 beats.min-1, respectively). However, due to the difference in ages between the groups, when expressed relative to maximal heart rate, there was no difference in the heart rate response between groups (e.g., exit/free fall: 93.0 +/- 5.5% vs. 88.4 +/- 7.8% for novice and experienced, respectively). No statistical differences were observed in the anxiety scores between groups, although the novice parachutists scored somewhat higher (16.0 +/- 3.7 vs. 12.5 +/- 5.7, respectively). A significant correlation (r = 0.72) was observed between heart rate upon landing and the state anxiety scores. These results demonstrate a high psycho-physiological stress response to parachuting among both novice and experienced parachutists. It is likely that novice parachutists are stressed to a higher degree and may therefore be more prone to performance-related injury (e.g., upon landing). However, since both groups reached a similar percentage of their maximal heart rate, they may be at a similar risk of cardiac injury.

Adult↗

PubMed1997

Differences in Eye and Hand Movements of Novice and Experienced Press Operators.

Presses are very widely used in industrial and commercial companies and are often the source of serious accidents occurring during operation. Most of the accidents are due to inadequate training of novice operators. Continuous recordings of eye and hand movements of five novice operators and five experienced operators in press operation were made. Significant difference between novice and experienced operators was observed in eye fixation time, eye movement patterns, hand dwell time, and eye-hand coordination. Also, differences were observed in spatial distribution of eye fixations during the die-closing portion of a stroke. There were no significant differences between novice and experienced operators in the eye and the hand movement time. The results could be used as basic data to establish a guide determining the method and training period to train novice operators.

experienced↗

PubMed2003

Construct validity: experts and novices performing on the Xitact LS500 laparoscopy simulator.

BACKGROUND: This study was undertaken to establish construct validity of the Xitact LS500, a virtual reality laparoscopic cholecystectomy simulator. The primary research statement is: "The clip-and-cut task on the Xitact LS500 virtual reality laparoscopic cholecystectomy simulator mimics the surgical procedure of the clipping and cutting of the cystic duct and artery during the laparoscopic cholecystectomy adequately." METHODS: According to the level of experience of the surgeon, an "expert group opinion" was formed resulting from 37 surgeons having performed over 100 laparoscopic cholecystectomies, and a "novice group opinion" was formed resulting of 37 surgeons having no experience at all with performing laparoscopic cholecystectomy. Participants received an instructed hands-on "tour" on the Xitact simulator and performed three formal simulation runs. RESULTS: The "novice group" is younger and more surgeons are female. Performance scores in the "expert" group are significantly higher on the second (p value 0.011) and third (p value 0.005) run, compared to the novices' scores. Experts are significantly faster on completion of all three runs. There is an increase in score over runs in both groups, which is statistically significant in the "expert group." Less than one-third of surgeons in either group are able to correctly predict their performance score as generated by Xitact. Both "experts" and "novices" feel it is useful to train with Xitact LS500 in the surgical curriculum. CONCLUSIONS: Three hypotheses, formulated to operationalize the primary research statement, could be answered affirmatively. Although further validation studies are needed, the Xitact LS500 simulator seems to be able to discriminate between expert and novice surgeons in this research setting, and thus the construct for this setting is considered to be valid.

Adult↗

PubMed2001

A computer-based laparoscopic skills assessment device differentiates experienced from novice laparoscopic surgeons.

BACKGROUND: The acquisition of laparoscopic skills is difficult to assess. Previously, through the use of a computer-based skills assessment device (SAD), we have shown that assessments of the time needed to perform a task and graded observations of task performance overestimate the speed at which laparoscopic skills can be acquired. The aim of this study was to test the ability of a laparoscopic SAD to differentiate novices from experienced laparoscopic surgeons and thereby further validate its use in surgical education. METHODS: Using a laparoscopic simulator platform integrated with task simulation and data collection software (MIST VR), we tested both experienced and novice laparoscopists. Each group performed three tasks with a minimum of seven repetitions. The tasks consisted of target acquisition, target traversal, and target manipulation with diathermy. Within each task, time (T), errors (E), and economy of movement for each hand (EML, EMR) were assessed. Results were reported as mean +/- SEM, and comparisons were made using an independent samples t-test. RESULTS: For the target acquisition task, the expert group performed the task faster than the novice group (5.5 +/- 0.24 vs 7.6 +/- 0.40 sec, p < 0.05); the experts also made fewer errors (0.5 +/- 0.10 vs 0.8 +/- 0.11 errors, p < 0.05), and achieved both a better EML (1.8 +/- 0.6 vs 2.3 +/- 0.9, p < 0.05) and a better EMR (2.0 +/- 0.1 vs 2.9 +/- 0.21, p < 0.05). In the target traversal task, the experts made fewer errors than the novices (2.2 +/- 0.25 vs 4.6 +/- 0.38 errors, p < 0.05). For the manipulation and diathermy tasks, the expert group completed the task faster (30.8 +/- 1.5 vs 39 +/- 1.5 sec, p < 0.05), made fewer errors (5.3 +/- 0.59 vs 8.1 +/- 0.63 errors, p < 0.05), and had a better EML (6.0 +/- 0.37 vs 7.2 +/- 0.45, p < 0.05) and EMR (4.3 +/- 0.23 vs 5.8 +/- 0.36, p < 0.05) than the novices. CONCLUSION: A laparoscopic skills assessment device can discern levels of laparoscopic manipulative skill. This type of device can be used in surgical training to make objective assessments of the acquisition of laparoscopic skills.

Clinical Competence↗

PubMed1999

The effect of a second-generation 3D endoscope on the laparoscopic precision of novices and experienced surgeons.

BACKGROUND: Endoscopic surgeons rely on visual feedback to control their movements but lack stereopsis, an important depth cue. Previous three-dimensional (3D) systems alternated images on a two-dimensional (2D) screen, which was uncomfortable for surgeons. A second-generation 3D system provides continuous stereoscopic images on a monitor suspended at arm's length. We studied its effect on the laparoscopic precision of novices and experienced surgeons. METHODS: Experienced laparoscopic surgeons (n = 12) and novices (n = 16) performed a total of 672 tasks in 2D, 3D, and under direct vision. Precision was assessed using the Imperial College Surgical Assessment Device (ICSAD), which generates objective scores of performance by analyzing the movements of surgical instruments. RESULTS: We found that 2D endoscopic vision impaired performance by 35-100% when compared with direct vision, whereas 3D reduced this endoscopic handicap by 41-53% in novices and experienced surgeons (p < 0.03). No side effects were reported with the new 3D system. Even in 2D, novices performed better with an image at arm's length (p < 0. 03). CONCLUSIONS: Second-generation 3D significantly improved the laparoscopic precision of novices and experienced surgeons, without the side effects reported from previous systems. This technology is expected to improve the ease and safety of laparoscopic surgery.

Adolescent↗

PubMed1994

What child is this? What interval was that? Familiar tunes and music perception in novice listeners.

In the laboratory, musical novices often seem insensitive even to basic structural elements of music (octaves, intervals, etc.), undermining long-held theories of music perception, and threatening to leave current theories applicable only to experts. Consequently it is important to demonstrate novices' basic listening competence where possible. Two experiments examined the perception of musical intervals (minor thirds, major thirds and perfect fourths) by musical novices. Subjects received either standard instructions or familiar folk-tune labels to aid performance. The folk-tune labels greatly improved identification performance, producing expert-caliber performance by some musically inexperienced subjects. The effectiveness of the folk-tune manipulation was much more limited in a difficult discrimination task. The results suggest that novices do have some basic competence when assayed appropriately, and that familiar musical tokens may be a critical element in such assays. Larger implications of the role of familiarity in novices' competence are discussed, including those that relate to music cognition and aesthetics.

Adolescent↗

PubMed2001

Bothered by abstraction: the effect of expertise on knowledge transfer and subsequent novice performance.

Although experts should be well positioned to convey their superior knowledge and skill to novices, the organization of that knowledge, and particularly its level of abstraction, may make it difficult for them to do so. Using an electronic circuit-wiring task, the authors found that experts as compared with beginners used more abstract and advanced statements and fewer concrete statements when providing task instructions to novices. In a 2nd study, the authors found that beginner-instructed novices performed better than expert-instructed novices and reported fewer problems with the instructions when performing the same task. In Study 2, the authors found that although novices performed better on the target task when instructed by beginners, they did better on a different task within the same domain when instructed by experts. The evidence suggests that the abstract, advanced concepts conveyed by experts facilitated the transfer of learning between the different tasks.

Adolescent↗