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Traditionally, training in gastrointestinal endoscopy has been based upon an apprenticeship model, with novice endoscopists learning basic skills under the supervision of experienced preceptors in the clinical setting. Over the last two decades, however, the growing awareness of the need for patient safety has brought the issue of simulation-based training to the forefront. While the use of simulation-based training may have important educational and societal advantages, the effectiveness of virtual reality gastrointestinal endoscopy simulators has yet to be clearly demonstrated. To determine whether virtual reality simulation training can supplement and/or replace early conventional endoscopy training (apprenticeship model) in diagnostic oesophagogastroduodenoscopy, colonoscopy and/or sigmoidoscopy for health professions trainees with limited or no prior endoscopic experience. Health professions, educational and computer databases were searched until November 2011 including The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Scopus, Web of Science, Biosis Previews, CINAHL, Allied and Complementary Medicine Database, ERIC, Education Full Text, CBCA Education, Career and Technical Education @ Scholars Portal, Education Abstracts @ Scholars Portal, Expanded Academic ASAP @ Scholars Portal, ACM Digital Library, IEEE Xplore, Abstracts in New Technologies and Engineering and Computer & Information Systems Abstracts. The grey literature until November 2011 was also searched. Randomised and quasi-randomised clinical trials comparing virtual reality endoscopy (oesophagogastroduodenoscopy, colonoscopy and sigmoidoscopy) simulation training versus any other method of endoscopy training including conventional patient-based training, in-job training, training using another form of endoscopy simulation (e.g. low-fidelity simulator), or no training (however defined by authors) were included.  Trials comparing one method of virtual reality training versus another method of virtual reality training (e.g. comparison of two different virtual reality simulators) were also included. Only trials measuring outcomes on humans in the clinical setting (as opposed to animals or simulators) were included. Two authors (CMS, MES) independently assessed the eligibility and methodological quality of trials, and extracted data on the trial characteristics and outcomes. Due to significant clinical and methodological heterogeneity it was not possible to pool study data in order to perform a meta-analysis. Where data were available for each continuous outcome we calculated standardized mean difference with 95% confidence intervals based on intention-to-treat analysis. Where data were available for dichotomous outcomes we calculated relative risk with 95% confidence intervals based on intention-to-treat-analysis. Thirteen trials, with 278 participants, met the inclusion criteria. Four trials compared simulation-based training with conventional patient-based endoscopy training (apprenticeship model) whereas nine trials compared simulation-based training with no training. Only three trials were at low risk of bias. Simulation-based training, as compared with no training, generally appears to provide participants with some advantage over their untrained peers as measured by composite score of competency, independent procedure completion, performance time, independent insertion depth, overall rating of performance or competency error rate and mucosal visualization. Alternatively, there was no conclusive evidence that simulation-based training was superior to conventional patient-based training, although data were limited. The results of this systematic review indicate that virtual reality endoscopy training can be used to effectively supplement early conventional endoscopy training (apprenticeship model) in diagnostic oesophagogastroduodenoscopy, colonoscopy and/or sigmoidoscopy for health professions trainees with limited or no prior endoscopic experience. However, there remains insufficient evidence to advise for or against the use of virtual reality simulation-based training as a replacement for early conventional endoscopy training (apprenticeship model) for health professions trainees with limited or no prior endoscopic experience. There is a great need for the development of a reliable and valid measure of endoscopic performance prior to the completion of further randomised clinical trials with high methodological quality.

Background: Particularly in groups of adolescents with lower educational level the smoking prevalence is still high and constitutes a serious public health problem. There is limited evidence of effective smoking cessation interventions in this group. Individualised text messaging (SMS) based interventions are promising to support smoking cessation and could be provided to adolescents irrespective of their motivation to quit. The aim of the current paper is to outline the study protocol of a trial testing the efficacy of an SMS based intervention for smoking cessation in apprentices. Methods/Design. A two-arm cluster-randomised controlled trial will be conducted to test the efficacy of an SMS intervention for smoking cessation in adolescents and young adults compared to an assessment only control group. A total of 910 daily or occasional ( 4 cigarettes in the preceding month and 1 cigarette in the preceding week) smoking apprentices will be proactively recruited in vocational school classes and, using school class as a randomisation unit, randomly assigned to an intervention group (n = 455) receiving the SMS based intervention or an assessment only control group (n = 455). Individualised text messages taking into account demographic data and the individuals' smoking behaviours will be sent to the participants of the intervention group over a period of 3 months. Participants will receive two text messages promoting smoking cessation per week. Program participants who intend to quit smoking have the opportunity to use a more intensive SMS program to prepare for their quit day and to prevent a subsequent relapse. The primary outcome measure will be the proportion of participants with 7-day point prevalence smoking abstinence assessed at 6-months follow-up. The research assistants conducting the baseline and the follow-up assessments will be blinded regarding group assignment. Discussion. It is expected that the program offers an effective and inexpensive way to promote smoking cessation among adolescents and young adults including those with lower educational level and independent of their motivation to quit. Trial registration number. © 2012 Haug et al; licensee BioMed Central Ltd.

Background: Competency-based assessment innovations are being implemented to address concerns about the effectiveness of traditional approaches to medical training and the assessment of competence. Aim: Integrating intended users' perspectives during the piloting and refinement process of an innovation is necessary to ensure the innovation meets users' needs. Failure to do so results in no opportunity for users to influence the innovation, nor for developers to assess why an innovation works or does not work in different contexts. Methods: A qualitative participatory action research approach was used. Sixteen first-year residents participated in three focus groups and two interviews during piloting. Verbatim transcripts were analyzed individually and then across all transcripts using a constant comparison approach. Results: The analysis revealed three key characteristics related to the impact on the residents' acceptance of the innovation as being a worthwhile investment of time and effort: access to frequent, timely, and specific feedback from preceptors. Findings were used to refine the innovation further. Conclusion: This study highlights the necessary conditions for assessing the success of implementation of educational innovations. Reciprocal communication between users and developers is vital. This reflects the approaches recommended in the Ottawa Consensus Statement on research in assessment published in Medical Teacher in March 2011. © 2012 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.

Objective: To evaluate the effectiveness of a work-based module and in-service educational programme in perineal repair for midwives on their perceived level of competency undertaking this skill in clinical practice. Design: a quasi-experimental pre-post intervention case study combining a non-equivalent comparison group and evaluation action research. Setting: six NHS consultant/midwifery led Trusts in South East England between December 2002 and 2006. Participants: 145 midwives from six NHS Trusts. Interventions: a post-registration work-based module in perineal repair for midwives and alternative two hour in-service perineal repair workshops across five intervention Trusts. Main outcome measures: midwives' perceived level of competency and confidence undertaking perineal repair. Main findings: significantly greater numbers of midwives were able to practice perineal repair at higher levels of competency following an educational intervention in five intervention Trusts (P<.006). There was a non-significant difference in the comparison Trust (P<.535). In addition, an educational programme for midwives increased the numbers of senior student midwives who were able to participate in perineal repair confidently under the direct supervision of their mentor when they perceived that their mentor was confident and competent undertaking the procedure. Key conclusions: an educational programme in perineal repair can make a significant difference to the midwives' perceived level of competency and confidence when assessing and managing perineal trauma and repair. Implications for practice: competency and expertise are complex phenomena and the data has provided greater insight into the complex nature of workplace learning alongside the multiple factors influencing clinical decision-making such as staff shortage, time constraints and inadequate numbers of midwives who are able to instruct, supervise and assess competency in perineal repair. Funding for training is fundamental for the sustainability of future practice development. © 2011 Elsevier Ltd.

Objective: This study characterized teachers' work at a vocational training (VT) center and the conditions under which the activity is learned. Methods: We interviewed administrators and 12 teachers (4 males, 8 females) representing three study programs, selected as representative (age, seniority, and employment status). Results: What emerged was a portrait of an evolving profession within an organization that was highly structured in terms of the assignment of tasks and schedules, but unstructured in terms of support for job adaptation and job retention. The major challenges for the teachers were to integrate their trade-specific knowledge with the new skills required to teach the trade, and to find time for class preparation. The lack of resources and support caused dissatisfaction, stress, problematic work-study-family balance, and health problems, particularly among new teachers. Discussion: A passion for teaching seems to compensate partly for these difficulties but it is uncertain for how long. Further research is necessary in order to understand the coping strategies employed by vocational training teachers. Conclusion: The findings of this study offer guidance for the development of resources that can assist with learning and performing the work of a VT teacher, and for a better recognition of the work of VT teachers. © 2012 - IOS Press and the authors. All rights reserved.

Rapid expansion in scientific knowledge, changes in medical practice, and greater demands from patients and society necessitate reform of the medical curriculum. In recognition of this, medical educators across the world have recommended the adoption of competence-based education. This is intended to increase the rigour and relevance of the curriculum, move students beyond a focus on the memorisation and regurgitation of scientific facts, and better enable them to understand scientific principles and apply them to the practice of medicine. Experience from 40 years' use of competence-based curricula across the world suggests that the uncritical application of this approach to the medical curriculum may not achieve its intended aims. There are valuable lessons to be learnt from the history of competence-based education. By taking on board these lessons, confronting the pitfalls of this approach, and devising new and creative solutions to the problems inherent in this methodology, medical educators can better achieve their aim of providing a strong foundation for the practice of medicine in the twenty-first century. It is only through such a strategy-rather than the uncritical adoption of this educational approach-that we will have real movement and progress both in competence-based education in general, and in its applications to medicine in particular. © 2010 Springer Science+Business Media B.V.

Background: Due to the increasing complexity of medical education and practice, the preparation of healthcare professionals for leadership roles and responsibilities has become increasingly important. To date, the literature on faculty development designed to promote leadership in medical education has not been reviewed in a systematic fashion. Aim: The objective of this review is to synthesize the existing evidence that addresses the following question: 'What are the effects of faculty development interventions designed to improve leadership abilities on the knowledge, attitudes, and skills of faculty members in medicine and on the institutions in which they work?' Methods: Search strategy: The search, which covered the period 1980-2009, included six databases (Medline, EMBASE, CINAHL, Web of Science, ERIC, and ABI/Inform) and used the following keywords: faculty development; in-service training; doctor; medic; physician; faculty; leadership; management; administration; executive; and change agent. Hand searches were also conducted, and expert recommendations were solicited. Inclusion and exclusion criteria: Articles with a focus on faculty development to improve leadership, targeting basic science and clinical faculty members, were reviewed. All study designs that included outcome data beyond participant satisfaction were examined. From an initial 687 unique records, 48 articles met the review criteria in three broad categories: (1) reports in which leadership was the primary focus of the intervention; (2) reports in which leadership was a component of a broader focus on educational development; and (3) reports in which leadership was a component of a broader focus on academic career development. Data extraction: Data were extracted by three coders using the standardized Best Evidence Medical Education coding sheet adapted for our use. One reviewer coded all of the articles, and two reviewers each coded half of the dataset. Coding differences were resolved through discussion. Data synthesis: Data were synthesized using Kirkpatrick's four levels of educational outcomes. Findings were grouped by intervention type and level of outcome. Results: Forty-eight articles described 41 studies of 35 different interventions. The majority of the interventions targeted clinical faculty members and included workshops, short courses, fellowships, and other longitudinal programs. The majority of studies were quantitative in nature, though five studies used a qualitative design, and 12 studies used mixed methods. All quantitative studies were quasi-experimental and most employed a single group design; only two studies had a comparison group. Qualitative study designs were typically not specified. The majority of evaluation data, primarily collected post-intervention, consisted of participants' responses to questionnaires and interviews. © 2012 Informa UK Ltd.

The present longitudinal study analyzed the effects of domain-specific goal engagement on the attainment of four developmental goals in 133 adolescents with visual impairment and in 449 sighted peers. Goal engagement predicted stronger progress in goal attainment with regard to getting access to a peer group, career choice and development of romantic relationships at the 1-year-follow-up. However, goal engagement at T1 did not predict progress in the achievement of autonomy from ones' parents. Furthermore, we found an interaction effect between vision status and goal engagement on progress in career choice. Higher initial levels of goal engagement predicted stronger progress in goal attainment of sighted adolescents. No such effect was found in adolescents with visual impairment. It is concluded that effects of goal engagement vary by goal contents and contexts. © 2011 The Foundation for Professionals in Services for Adolescents.

Since the publication of its reports, Health professions education: A bridge to quality (2003) and To err is human: Building a safer health system (2000), the Institute of Medicine has continued to emphasize interprofessional education (IPE), founded on quality improvement and informatics, as a better way to prepare healthcare professionals for practice. As this trend continues, healthcare education will need to implement administrative and educational processes that encourage different professions to collaborate and share resources. With greater numbers of students enrolled in health professional programs, combined with ethical imperatives for learning and reduced access to quality clinical experiences, medical and nursing education increasingly rely on simulation education to implement interdisciplinary patient safety initiatives.In this article, the authors describe one approach, based on the Core Competencies for Interprofessional Collaborative Practice released by the Interprofessional Education Collaborative (2011), toward providing IPE to an audience of diverse healthcare professionals in academia and clinical practice. This approach combines professional standards with the authors' practical experience serving on a key operations committee, comprising members from a school of medicine, a school of nursing, and a large healthcare system, to design and implement a new state-of-the-art simulation center and its IPE-centered curriculum. © 2012 Royal College of Nursing, Australia.

The importance and necessity of interprofessional collaboration (IPC) present challenges for educators as they determine how best to achieve IPC through interprofessional education (IPE). Simulation-based teaching has been shown to enhance students' understanding of professional roles and promote positive attitudes toward team members; yet, empirical evidence providing direction on the conditions necessary to promote these positive outcomes is lacking. This study used a quasi-experimental design with a pre-/post-test to examine changes in undergraduate healthcare students' perceptions and attitudes toward IPC following their participation in an interprofessional simulation program. Allport's (1954) intergroup contact theory was used to help understand the nature of this IPE workshop and its reported outcomes. Participants included students in the final year of their respective programs (n = 84) such as pharmacy technician, paramedic, nursing and occupational therapy assistant/physical therapy assistant programs. These students were engaged in simulation exercises with interactive contact opportunities. Using the interdisciplinary education perceptions scale, statistically significant increases in positive attitudes in three of four sub-scales were found. An analysis of the structure and format of the workshop suggests that this IPE initiative fulfilled the key conditions suggested by intergroup contact theory. Attention to the key conditions provided by Allport's theory in the context of successful intergroup relationships may help provide direction for educators interested in planning IPE initiatives with student groups enrolled in various health programs. © 2012 Informa UK, Ltd.