Investigating force-time characteristics of prone thoracic SMT and self-reported patient outcome measures: a feasibility study.

BACKGROUND: Spinal manipulative therapy (SMT) is commonly used to treat musculoskeletal conditions, including thoracic spine pain. Applying patient-specific force-time characteristics are believed to be important to improve SMT's effectiveness. Investigating SMT as part of a multimodal approach is fundamental to account for the complexity of chiropractic clinical practice. Therefore, pragmatic investigations balancing minimal disruptions to the clinical encounter at the same time as ensuring a robust data quality with rigorous protocols are needed. Consequently, preliminary studies are required to assess the study protocol, quality of data recorded and the sustainability of such investigation. Therefore, this study examined the feasibility of investigating SMT force-time characteristics and clinical outcome measures in a clinical setting. METHODS: In this mixed-methods study, providers recorded thoracic SMT force-time characteristics delivered to patients with thoracic spinal pain during regular clinical encounters. Self-reported clinical outcomes of pain, stiffness, comfort during the SMT (using an electronic visual analogue scale), and global rating of change scale were measured before and after each SMT application. Feasibility was quantitatively assessed for participant recruitment, data collection and data quality. Qualitative data assessed participants' perceptions on the impact of data collection on patient management and clinical flow. RESULTS: Twelve providers (58% female, 27.3 ± 5.0 years old) and twelve patients (58% female, 37.2 ± 14.0 years old) participated in the study. Enrolment rate was greater than 40%, data collection rate was 49% and erroneous data was less than 5%. Participant acceptance was good with both providers and patients reporting positive experience with the study. CONCLUSIONS: Recording SMT force-time characteristics and self-reported clinical outcome measures during a clinical encounter may be feasible with specific modification to the current protocol. The study protocol did not negatively impact patient management. Specific strategies to optimize the data collection protocol for the development of a large clinical database are being developed.

Evaluating the baseline auscultation abilities of second-year chiropractic students using simulated patients and high-fidelity manikin simulators: A pilot study.

OBJECTIVE: To assess the ability of 2nd-year students to identify normal and abnormal findings during cardiac and lung auscultation using high-fidelity manikin simulators and standardized patients. A secondary objective was to assess students' perceived competence and confidence in their abilities. METHODS: This was a descriptive pilot study of randomly selected 2nd-year students at 1 chiropractic training program. Participants were asked to perform cardiac and lung auscultation on high-fidelity manikins (2 stations) and standardized human patients (2 stations) with normal and abnormal auscultation sounds. Participants described the auscultated sound as "abnormal" or "normal" and were also asked to score their confidence in describing the sound and competence in performing auscultation on a 100-mm visual analog scale. Descriptive statistics were calculated for all study variables. RESULTS: Thirty-two students (23 women and 9 men) were included. For lung auscultation, 15.6% were incorrect on the human subject and 6.2% were incorrect on the manikin. For cardiac auscultation, 62.5% were incorrect on the human subject and 40.6% were incorrect on the manikin. Confidence mean scores ranged from 34.8 to 60. Competence mean scores ranged from 34.8 to 50. CONCLUSION: Results identified that 2nd-year students from 1 institution were correct in identifying an abnormal sound during lung auscultation but reported low levels of perceived competence or confidence in their responses. They performed poorly on cardiac auscultation and reported low perceived confidence and competence in their abilities to perform cardiac auscultation and identify sounds.

Assessing Repeated-Sprint Ability in Division I Collegiate Women Soccer Players.

Lockie, RG, Liu, TM, Stage, AA, Lazar, A, Giuliano, DV, Hurley, JM, Torne, IA, Beiley, MD, Birmingham-Babauta, SA, Stokes, JJ, Risso, FG, Davis, DL, Moreno, MR, and Orjalo, AJ. Assessing repeated-sprint ability in Division I collegiate women soccer players. J Strength Cond Res 34(7): 2015-2023, 2020-Repeated-sprint ability (RSA) is a key component of soccer, and is the capacity to repeatedly produce near-maximal to maximal sprints with short recovery periods. Repeated-sprint ability has received little analysis in collegiate women soccer players. The purpose of this study was to investigate relationships between RSA and tests of soccer-specific performance. Nineteen players from the same Division I collegiate women's soccer team were recruited. The RSA test consisted of six 20-m sprints completed on 15-second cycles. The measurements taken were total time (TT) and percent decrement (PD; percent change from first to last sprint). Subjects also completed tests of: lower-body strength (1 repetition maximum [1RM] back squat); jump performance (vertical and standing long jumps); linear (0-5, 0-10, and 0-30 m sprint intervals) and change-of-direction (505 from each leg) speed; and soccer-specific fitness (Yo-Yo intermittent recovery test level 1 [YYIRT1]). Pearson's correlations (p ≤ 0.05) were used to calculate relationships between RSA TT and PD with the performance tests. Total time exhibited significant relationships with the 0-10 (r = 0.50) and 0-30 m (r = 0.71) sprint intervals, and the left-leg 505 (r = 0.57). However, lower-body strength measured by the 1RM back squat and jump performance did not relate to TT. Percent decrement correlated only with the left-leg 505 (r = 0.53) and no other performance test. This included the YYIRT1, although both PD and YYIRT1 performance are limited by fatigue. The results from this study indicated that faster linear sprinting speed could positively influence RSA in Division I collegiate women soccer players.

Repeated-Sprint Ability in Division I Collegiate Male Soccer Players: Positional Differences and Relationships With Performance Tests.

Lockie, RG, Moreno, MR, Orjalo, AJ, Stage, AA, Liu, TM, Birmingham-Babauta, SA, Hurley, JM, Torne, IA, Beiley, MD, Risso, FG, Davis, DL, Lazar, A, Stokes, JJ, and Giuliano, DV. Repeated-sprint ability in Division I collegiate male soccer players: positional differences and relationships with performance tests. J Strength Cond Res 33(5): 1362-1370, 2019-Repeated-sprint ability (RSA) in essential for soccer. Important considerations when assessing RSA is whether there are differences between positions (defenders, midfielders, and forwards), and what physiological characteristics may contribute to RSA. This has not been assessed in collegiate male players. Eighteen Division I male field players from one school performed several performance tests. The RSA test involved 7 × 30-m sprints completed on 20-second cycles. Measurements included total time (TT), and performance decrement (percent change in time from the first to last sprint; PD). Subjects also completed tests of lower-body power (vertical [VJ] and standing broad jump [SBJ]); linear (30-m sprint; 0-5 m, 0-10 m, 0-30 m intervals) and change-of-direction (505) speed; and soccer-specific endurance (Yo-Yo Intermittent Recovery Test Level 2; YYIRT2). A one-way analysis of variance (p < 0.05) determined between-position differences, and effect sizes were calculated. Pearson's correlations (p < 0.05) calculated relationships between RSA TT and PD with the other tests. There were no significant between-position differences for any test. There were large effects for the faster right-leg 505 and greater YYIRT2 distance for midfielders compared with defenders and forwards. Nonetheless, no between-position differences in RSA TT and PD were documented. There were relationships between RSA TT and the VJ (r = -0.59), SBJ (r = -0.61), 0-10 m (r = 0.64) and 0-30-m (r = 0.83) sprint intervals. There were no significant correlations for RSA PD. Male field players from one collegiate soccer team can demonstrate similar RSA across different positions. Greater lower-body power and sprinting speed could augment RSA.

Relationships Between Height, Arm Length, and Leg Length on the Mechanics of the Conventional and High-Handle Hexagonal Bar Deadlift.

Lockie, RG, Moreno, MR, Orjalo, AJ, Lazar, A, Liu, TM, Stage, AA, Birmingham-Babauta, SA, Stokes, JJ, Giuliano, DV, Risso, FG, Davis, DL, and Callaghan, SJ. Relationships between height, arm length, and leg length on the mechanics of the conventional and high-handle hexagonal bar deadlift. J Strength Cond Res 32(11): 3011-3019, 2018-The study investigated relationships between arm length (AL) and leg length (LL) and conventional deadlift (CD) and high-handle hexagonal bar deadlift (HHBD) mechanics. Twenty-three resistance-trained subjects (14 men and 9 women) completed a 1 repetition maximum CD and HHBD. A linear position transducer was used to measure lift distance and duration; peak and mean power, velocity, and force; time to peak power and velocity; and work. Right AL and LL were measured, and AL-to-LL ratio (AL:LL) was also calculated. Spearman's correlations (ρ; p ≤ 0.05) computed relationships between anthropometry and deadlift mechanics separately for men and women. For the HHBD, greater height and LL related to greater lift distance and work (ρ = 0.54-0.68); a higher AL:LL related to time to peak power and velocity occurring sooner (ρ = -0.67 to 0.78). For the HHBD, greater height and LL related to greater lift distance and work; a higher AL:LL related to time to peak power and velocity occurring sooner in the lift (ρ = 0.54-0.77). In women, greater height, AL, and LL related to a longer CD lift distance (ρ = 0.67-0.92). For the HHBD, greater height, AL, and LL related to a longer lift distance and greater mean velocity (ρ = 0.69-0.96). There was a negative relationship between AL and lift time (ρ = -0.83), which meant longer arms resulted in a lower HHBD lift time. Arm length may have influenced women more because of the fixed dimensions of the hexagonal bar. Coaches should be cognizant of potential differences in CD and HHBD work when performed by individuals of different body sizes.

The 1 Repetition Maximum Mechanics of a High-Handle Hexagonal Bar Deadlift Compared With a Conventional Deadlift as Measured by a Linear Position Transducer.

Lockie, RG, Moreno, MR, Lazar, A, Risso, FG, Liu, TM, Stage, AA, Birmingham-Babauta, SA, Torne, IA, Stokes, JJ, Giuliano, DV, Davis, DL, Orjalo, AJ, and Callaghan, SJ. The 1 repetition maximum mechanics of a high-handle hexagonal bar deadlift compared with a conventional deadlift as measured by a linear position transducer. J Strength Cond Res 32(1): 150-161, 2018-The high-handle hexagonal bar deadlift (HHBD), a variation of the conventional deadlift (CD), is said to reduce the lift range of motion, which may change the mechanics of the lift. However, no research has investigated this. This study compared the mechanics between a 1 repetition maximum (1RM) CD and HHBD. Thirty-one strength-trained subjects (21 men, 10 women) completed a 1RM CD and HHBD. A linear position transducer measured lift distance, duration, and work; and peak and mean power, velocity, and force. The presence of a sticking region (SR) was determined for each lift. A repeated-measures analysis of variance (ANOVA) calculated differences between 1RM CD and HHBD mechanics. A one-way ANOVA compared the mechanics of each lift between subjects who exhibited an SR or not, and the SR between the CD and HHBD. Significance was set at p < 0.01. Subjects lifted a greater load in the HHBD (154.50 ± 45.29 kg) compared with the CD (134.72 ± 40.63 kg). Lift distance and duration were 22 and 25% shorter during the 1RM HHBD, respectively. The HHBD featured greater peak power and velocity, and peak and mean force; more work was done in the CD. Most subjects did not exhibit a CD (68%) or HHBD (77%) SR. There were no differences in CD or HHBD mechanics between subjects with or without an SR, and no differences in SR region distance or duration between the CD and HHBD. Greater force can be generated in the HHBD, which could have implications for strength-training adaptations over time.

The Physical and Athletic Performance Characteristics of Division I Collegiate Female Soccer Players by Position.

Lockie, RG, Moreno, MR, Lazar, A, Orjalo, AJ, Giuliano, DV, Risso, FG, Davis, DL, Crelling, JB, Lockwood, JR, and Jalilvand, F. The physical and athletic performance characteristics of Division I collegiate female soccer players by position. J Strength Cond Res 32(2): 334-343, 2018-Playing positions in soccer can exhibit different movement demands during a match, contributing to variations in physical and performance characteristics. National Collegiate Athletic Association (NCAA) soccer features different substitution rules when compared to FIFA-sanctioned matches, which could influence each players' characteristics. Therefore, this study determined the athletic performance characteristics of Division I female soccer players. Twenty-six players (3 goalkeepers; 8 defenders; 10 midfielders; 5 forwards) from the same squad completed assessments of: lower-body power (vertical and standing broad jump); linear (0-5, 0-10, 0-30 meter [m] sprint intervals) and change-of-direction (pro-agility shuttle; arrowhead change-of-direction speed test) speed; and soccer-specific fitness (Yo-Yo Intermittent Recovery Test [YYIRT] levels 1 and 2). Players were split into position groups, and a Kruskal-Wallis H test with post hoc pairwise analyses (p ≤ 0.05) calculated significant between-group differences. There were no differences in age, height, or body mass between the positions. Midfielders had a faster 0-5 m time compared with the defenders (p = 0.017) and the goalkeepers (p = 0.030). The defenders (p = 0.011) and midfielders (p = 0.013) covered a greater YYIRT2 distance compared with the goalkeepers. There were no other significant between-position differences. Overall, Division I collegiate female players from the same squad demonstrated similar characteristics as measured by soccer-specific performance tests, which could allow for flexibility in position assignments. However, a relatively homogenous squad could also indicate commonality in training prescription, particularly regarding acceleration and high-intensity running. Strength and conditioning coaches may have to consider the specific movement demands of individual positions when training these capacities.

Physiological Characteristics of Projected Starters and Non-Starters in the Field Positions from a Division I Women's Soccer Team.

NCAA soccer features different substitution rules compared to FIFA-sanctioned matches, with a greater availability of players who can enter the game. This could influence the physiological characteristics of the field position starters (ST) and non-starters (NST) within a collegiate women's team, which has not been previously analyzed. Thus, 22 field players from the same Division I women's soccer squad completed: vertical and standing broad jumps; 30-meter (m) sprint (0-5, 0-10, 0-30 m intervals); pro-agility and 60-yard shuttle; and the Yo-Yo Intermittent Recovery Test Level 1. Players were defined into ST (n=10) and NST (n=12) by the coaching staff. A one-way ANOVA derived any significant (p≤0.05) between-group differences, and effect sizes were used for a magnitude-based inference analysis. Z-scores were also calculated to document worthwhile differences above or below the squad mean for the groups. The results showed no significant between-group differences for any of the performance tests. ST did have a worthwhile difference above the squad mean in the 0-10 and 0-30 m sprint intervals, while NST had a worthwhile difference below the squad mean in the 0-30 m interval. Physiological characteristics between ST and NST from the analyzed Division I squad were similar, although ST were generally faster. The similarities between ST and NST may be a function of the team's training, in that all players may complete the same workouts. Nonetheless, if all players exhibit similar physiological capacities, with appropriate substitutions by the coach a collegiate team should be able to maintain a high work-rate throughout a match.

Relationships between Mechanical Variables in the Traditional and Close-Grip Bench Press.

The study aim was to determine relationships between mechanical variables in the one-repetition maximum (1RM) traditional bench press (TBP) and close-grip bench press (CGBP). Twenty resistance-trained men completed a TBP and CGBP 1RM. The TBP was performed with the preferred grip; the CGBP with a grip width of 95% biacromial distance. A linear position transducer measured: lift distance and duration; work; and peak and mean power, velocity, and force. Paired samples t-tests (p < 0.05) compared the 1RM and mechanical variables for the TBP and CGBP; effect sizes (d) were also calculated. Pearson's correlations (r; p < 0.05) computed relationships between the TBP and CGBP. 1RM, lift duration, and mean force were greater in the TBP (d = 0.30-3.20). Peak power and velocity was greater for the CGBP (d = 0.50-1.29). The 1RM TBP correlated with CGBP 1RM, power, and force (r = 0.685-0.982). TBP work correlated with CGBP 1RM, lift distance, power, force, and work (r = 0.542-0.931). TBP power correlated with CGBP 1RM, power, force, velocity, and work (r = 0.484-0.704). TBP peak and mean force related to CGBP 1RM, power, and force (r = 0.596-0.980). Due to relationships between the load, work, power, and force for the TBP and CGBP, the CGBP could provide similar strength adaptations to the TBP with long-term use. The velocity profile for the CGBP was different to that of the TBP. The CGBP could be used specifically to improve high-velocity, upper-body pushing movements.

A Methodological Report: Adapting the 505 Change-of-Direction Speed Test Specific to American Football.

Lockie, RG, Jalilvand, F, Orjalo, AJ, Giuliano, DV, Moreno, MR, and Wright, GA. A methodological report: Adapting the 505 change-of-direction speed test specific to American football. J Strength Cond Res 31(2): 539-547, 2017-The 505 involves a 10-m sprint past a timing gate, followed by a 180° change-of-direction (COD) performed over 5 m. This methodological report investigated an adapted 505 (A505) designed to be football-specific by changing the distances to 10 and 5 yd. Twenty-five high school football players (6 linemen [LM]; 8 quarterbacks, running backs, and linebackers [QB/RB/LB]; 11 receivers and defensive backs [R/DB]) completed the A505 and 40-yd sprint. The difference between A505 and 0 to 10-yd time determined the COD deficit for each leg. In a follow-up session, 10 subjects completed the A505 again and 10 subjects completed the 505. Reliability was analyzed by t-tests to determine between-session differences, typical error (TE), and coefficient of variation. Test usefulness was examined via TE and smallest worthwhile change (SWC) differences. Pearson's correlations calculated relationships between the A505 and 505, and A505 and COD deficit with the 40-yd sprint. A 1-way analysis of variance (p ≤ 0.05) derived between-position differences in the A505 and COD deficit. There were no between-session differences for the A505 (p = 0.45-0.76; intraclass correlation coefficient = 0.84-0.95; TE = 2.03-4.13%). Additionally, the A505 was capable of detecting moderate performance changes (SWC0.5 > TE). The A505 correlated with the 505 and 40-yard sprint (r = 0.58-0.92), suggesting the modified version assessed similar qualities. Receivers and defensive backs were faster than LM in the A505 for both legs, and right-leg COD deficit. Quarterbacks, running backs, and linebackers were faster than LM in the right-leg A505. The A505 is reliable, can detect moderate performance changes, and can discriminate between football position groups.

An Investigation of the Mechanics and Sticking Region of a One-Repetition Maximum Close-Grip Bench Press versus the Traditional Bench Press.

The close-grip bench press (CGBP) is a variation of the traditional bench press (TBP) that uses a narrower grip (~95% of biacromial distance (BAD)) and has potential application for athletes performing explosive arm actions from positions where the hands are held close to the torso. Limited research has investigated CGBP mechanics compared to the TBP. Twenty-seven resistance-trained individuals completed a one-repetition maximum TBP and CGBP. The TBP was performed with the preferred grip; the CGBP with a grip width of 95% BAD. A linear position transducer measured lift distance and duration; peak and mean power, velocity, and force; distance and time when peak power occurred; and work. Pre-sticking region (PrSR), sticking region, and post-sticking region distance and duration for each lift was measured. A repeated measures ANOVA was used to derive differences between TBP and CGBP mechanics (p < 0.01); effect sizes (d) were also calculated. A greater load was lifted in the TBP, thus mean force was greater (d = 0.16⁻0.17). Peak power and velocity were higher in the CGBP, which had a longer PrSR distance (d = 0.49⁻1.32). The CGBP could emphasize power for athletes that initiate explosive upper-body actions with the hands positioned close to the torso.

Between-Leg Mechanical Differences as Measured by the Bulgarian Split-Squat: Exploring Asymmetries and Relationships with Sprint Acceleration.

Between-leg strength differences can negatively influence sprint acceleration. The challenge is to find a method to measure this within a unilateral exercise. This study analyzed a five repetition-maximum (5RM) Bulgarian split-squat (BSS) to identify between-leg differences for the dominant and non-dominant legs in peak and mean power, force, and velocity as measured by a linear position transducer. Between-leg differences in these variables were correlated with 20-m (0⁻5, 0⁻10, 0⁻20 m intervals) sprint velocity. Eight men were assessed in the 5RM BSS and 20-m sprint. T-tests calculated between-leg differences in power, force, and velocity. Spearman's correlations calculated relationships between the between-leg differences in the mechanical variables with velocity over each interval. When comparing the dominant and non-dominant legs, there were significant (p = 0.002⁻0.056) differences in 11 of 12 variables. However, percentage differences were low (~0.3⁻12%). There was one large, non-significant correlation (best repetition mean force between-leg difference and 0⁻5 m velocity; ρ = -0.810) out of 36 relationships. The BSS can provide a profile of between-leg differences in power, force, and velocity. There were limited relationships between the BSS between-leg differences and 20-m sprint velocities. Smaller between-leg differences in BSS power, force, and velocity could ensure minimal impact on acceleration.

Impact of providing case-specific knowledge in simulation: a theory based study of learning.

Background: Simulation-based education (SBE) has been lauded for its ability to help students recognise and react appropriately to common and rare circumstances. While healthcare professions have started to implement SBE into their curriculum, there is no evidence to suggest which educational theory is best for implementation. This study explores the usage of cognitive load theory (CLT) and the unified theory of emotional learning (UTEL). Study design: A mixed methods ordered-allocation cohort study. Methods: 23 patient management teams were allocated into 2 groups. The first group received prior information about the simulation scenario; the second group did not. Each team had 1 student assigned to the role of doctor. The scenarios were filmed at time 1 (T1), time 2 (T2) and follow-up (F/U). The 'doctor' role was then graded with a validated checklist by a three-judge panel. The scores were evaluated to determine if prior information enabled better performance. Secondary analysis evaluated the role of gender on performance and also evaluated anxiety at the onset of the simulation. Results: 23 doctors were evaluated. There was no difference between groups in performance (t=1.54, p=0.13). Secondary analysis indicated that gender did not play a role. There was no difference in anxiety between groups at baseline (t=0.67, p=0.51). Conclusions: Trends were observed, suggesting that when students enter a simulation environment with prior knowledge of the event they will encounter, their performance may be higher. No differences were observed in performance at T2 or F/U. Withholding information appeared to be an inappropriate proxy for emotional learning as no difference in anxiety was observed between groups at baseline. All trends require confirmation with a larger sample size.

Manikin-based simulation: online orientation and student anxiety.

OBJECTIVE: This study examined changes in anxiety associated with different modes of student orientation to a manikin-based simulation lab. It was purposed that the addition of an online orientation prior to the actual lab would save time for more learning content during the session. METHODS: Anxiety scores were gathered from groups of interns, using a visual analog scale. Some students experienced a 30-minute in-person orientation while others completed an online module. One-way analysis of variance and the Kruskal-Wallis test were used for analysis. RESULTS: Mean anxiety scores were not statistically different (χ2 = 2.51, p = .29) between the group that received a 30-minute in-person orientation and the online group. At the end of the entire introductory phase, there was a significant difference between year cohorts (F = 9.61, p < .001), indicating overall higher anxiety for one of the years receiving in-person orientation. However, when looking at the remaining in-person orientation year vs the online module year, there was no significant difference seen (p = .56). CONCLUSIONS: Successful transition, resulting in substantial gain to learning time, was observed by changing an in-person orientation to an online format. Anxiety levels were noted to fluctuate significantly from year to year regardless of orientation method.

Relationships and Predictive Capabilities of Jump Assessments to Soccer-Specific Field Test Performance in Division I Collegiate Players.

Leg power is an important characteristic for soccer, and jump tests can measure this capacity. Limited research has analyzed relationships between jumping and soccer-specific field test performance in collegiate male players. Nineteen Division I players completed tests of: leg power (vertical jump (VJ), standing broad jump (SBJ), left- and right-leg triple hop (TH)); linear (30 m sprint; 0⁻5 m, 5⁻10 m, 0⁻10, 0⁻30 m intervals) and change-of-direction (505) speed; soccer-specific fitness (Yo-Yo Intermittent Recovery Test Level 2); and 7 × 30-m sprints to measure repeated-sprint ability (RSA; total time (TT), performance decrement (PD)). Pearson's correlations (r) determined jump and field test relationships; stepwise regression ascertained jump predictors of the tests (p < 0.05). All jumps correlated with the 0⁻5, 0⁻10, and 0⁻30 m sprint intervals (r = -0.65⁻-0.90). VJ, SBJ, and left- and right-leg TH correlated with RSA TT (r = -0.51⁻-0.59). Right-leg TH predicted the 0⁻5 and 0⁻10 m intervals (R² = 0.55⁻0.81); the VJ predicted the 0⁻30 m interval and RSA TT (R² = 0.41⁻0.84). Between-leg TH asymmetry correlated with and predicted left-leg 505 and RSA PD (r = -0.68⁻0.62; R² = 0.39⁻0.46). Improvements in jumping ability could contribute to faster speed and RSA performance in collegiate soccer players.

No difference in learning retention in manikin-based simulation based on role.

OBJECTIVE: We evaluated learning retention in interns exposed to simulation. It was hypothesized that learning would degrade after 6 months and there would be a difference in retention between interns who played a critical role versus those who did not. METHODS: A total of 23 groups of 5 to 9 interns underwent a cardiac scenario twice during 1 simulation experience and again 6 months later. We captured 69 recordings (23 before debrief at baseline [PrDV], 23 after debrief at baseline [PoDV], and 23 at 6-month follow-up [FUV]). Students were assigned different roles, including the critical role of "doctor" in a blinded, haphazard fashion. At 6-month follow-up, 12 interns who played the role of doctor initially were assigned that role again, while 11 interns who played noncritical roles initially were newly assigned to doctor. All videos of intern performance were scored independently and in a blinded fashion, by 3 judges using a 15-item check list. RESULTS: Repeated-measures analysis of variance for interns completing all 3 time points indicated a significant difference between time points (F2,22 = 112, p = .00). Contrasts showed a statistically significant difference between PrDV and PoDV (p = .00), and PrDV and FUV (p = .00), but no difference between PoDV and FUV (p = .98). This was consistent with results including all data points. Checklist scores were more than double for PoDV recordings (16) and FUV (15), compared to PrDV recordings (6.6). Follow-up scores comparing old to new doctors showed no statistically significant difference (15.4 vs 15.2 respectively, t21 = 0.26, p = .80, d = .11). CONCLUSIONS: Learning retention was maintained regardless of role.

Consistency and malleability of manipulation performance in experienced clinicians: a pre-post experimental design.

OBJECTIVE: The purpose of this study was to sample the stability of spinal manipulation performance in peak impulse force development over time and the ability of clinicians to adapt to arbitrary target levels with short-duration training. METHODS: A pre-post experimental design was used. Human analog mannequins provided standardized simulation for performance measures. A convenience sample was recruited consisting of 41 local doctors of chiropractic with 5 years of active clinical practice experience. Thoracic impulse force was measured among clinicians at baseline, after 4 months at pretraining, and again posttraining. Intraclass correlation coefficient values and within-subject variability defined consistency. Malleability was measured by reduction of error (paired t tests) in achieving arbitrary targeted levels of force development normalized to the individual's typical performance. RESULTS: No difference was observed in subgroup vs baseline group characteristics. Good consistency was observed in force-time profiles (0.55 ≤ intraclass correlation coefficient ≤ 0.75) for force parameters over the 4-month interval. With short intervals of focused training, error rates in force delivery were reduced by 23% to 45%, depending on target. Within-subject variability was 1/3 to 1/2 that of between-subject variability. Load increases were directly related to rate of loading. CONCLUSION: The findings of this study show that recalibration of spinal manipulation performance of experienced clinicians toward arbitrary target values in the thoracic spine is feasible. This study found that experienced clinicians are internally consistent in performance of procedures under standardized conditions and that focused training may help clinicians learn to modulate procedure characteristics.

Assessment of a generalizable methodology to assess learning from manikin-based simulation technology.

Objective : This study combined a learning outcomes-based checklist and salient characteristics derived from wisdom-of-crowds theory to test whether differing groups of judges (diversity maximized versus expertise maximized) would be able to appropriately assess videotaped, manikin-based simulation scenarios. Methods : Two groups of 3 judges scored 9 videos of interns managing a simulated cardiac event. The first group had a diverse range of knowledge of simulation procedures, while the second group was more homogeneous in their knowledge and had greater simulation expertise. All judges viewed 3 types of videos (predebriefing, postdebriefing, and 6 month follow-up) in a blinded fashion and provided their scores independently. Intraclass correlation coefficients (ICCs) were used to assess the reliability of judges as related to group membership. Scores from each group of judges were averaged to determine the impact of group on scores. Results : Results revealed strong ICCs for both groups of judges (diverse, 0.89; expert, 0.97), with the diverse group of judges having a much wider 95% confidence interval for the ICC. Analysis of variance of the average checklist scores indicated no significant difference between the 2 groups of judges for any of the types of videotapes assessed (F = 0.72, p = .4094). There was, however, a statistically significant difference between the types of videos (F = 14.39, p = .0004), with higher scores at the postdebrief and 6-month follow-up time periods. Conclusions : Results obtained in this study provide optimism for assessment procedures in simulation using learning outcomes-based checklists and a small panel of judges.

Manikin-based clinical simulation in chiropractic education.

OBJECTIVE: The purpose of this pilot investigation was to describe the development and implementation of simulation exercises and investigate the feasibility, satisfaction, and relative effectiveness of a manikin-based simulation program in chiropractic undergraduate education. METHODS: This investigation consisted of (1) a qualitative review of other simulation environments and evaluation of related simulation literature to develop the educational processes to be used, (2) implementation of simulation scenarios for 95 student interns and their 11 supervising clinicians, and (3) implementation of simulation scenarios in a random sample of 35 1st-year and 24 2nd-year chiropractic students. Assessment of success was based on results from satisfaction and usability questionnaires and perceived achievement of learning outcomes. Anxiety scores were measured for all participants via a visual analog scale. The level of successful integration of 2nd-year basic science material was assessed using a t test comparing test results between students who participated in the pilot and those who did not. RESULTS: Implementation methods were developed on the basis of qualitative investigation. Simulation program feedback from all participants indicated high levels of satisfaction, usability, and perceived achievement of learning outcomes. Anxiety levels among interns differed according to role chosen (F = 8.07, p =.00). Mean difference in course examination scores of students who participated in simulations versus those who did not was 3.25% favoring students who participated (t = 1.28, p =.10). CONCLUSIONS: High levels of student satisfaction and perceived achievement of learning outcomes were consistently achieved. A trend to successful integration of basic science knowledge provides reason for cautious optimism. More research is recommended.