ChatGPT for assessment writing.

What is the educational challenge?Medical schools invest significant resources into the creation of multiple-choice items for assessments. This process is costly and requires faculty training. Recently ChatGPT has been used in various areas to improve content creation efficiency, and it has otherwise been used to answer USMLE-style assessment items.What are the proposed solutions?We proposed the use of ChatGPT to create initial drafts of multiple-choice items.What are the potential benefits to a wider global audience?The use of ChatGPT to generate assessment items can decrease resources required, allowing for the creation of more items, and freeing-up faculty time to perform higher level assessment activities. ChatGPT is also able to consistently produce items using a standard format while adhering to item writing guidelines, which can be very challenging for faculty teams.What are the next steps?We plan to pilot ChatGPT drafted questions and compare item statistics for those written by ChatGPT with those written by our content experts. We also plan to further identify the types of questions that ChatGPT is most appropriate for, and incorporate media into assessment items (e.g. images, videos).

Development of an artificial intelligence system for real-time intraoperative assessment of the Critical View of Safety in laparoscopic cholecystectomy.

BACKGROUND: The Critical View of Safety (CVS) was proposed in 1995 to prevent bile duct injury during laparoscopic cholecystectomy (LC). The achievement of CVS was evaluated subjectively. This study aimed to develop an artificial intelligence (AI) system to evaluate CVS scores in LC. MATERIALS AND METHODS: AI software was developed to evaluate the achievement of CVS using an algorithm for image classification based on a deep convolutional neural network. Short clips of hepatocystic triangle dissection were converted from 72 LC videos, and 23,793 images were labeled for training data. The learning models were examined using metrics commonly used in machine learning. RESULTS: The mean values of precision, recall, F-measure, specificity, and overall accuracy for all the criteria of the best model were 0.971, 0.737, 0.832, 0.966, and 0.834, respectively. It took approximately 6 fps to obtain scores for a single image. CONCLUSIONS: Using the AI system, we successfully evaluated the achievement of the CVS criteria using still images and videos of hepatocystic triangle dissection in LC. This encourages surgeons to be aware of CVS and is expected to improve surgical safety.

Understanding Facilitators and Barriers to Providing Equity-Oriented Care in the NICU.

The current study examined the use of immersive technology as a way to improve access to high-quality interpersonal breastfeeding interactions in an undergraduate clinical lactation course. In particular, we investigated the impact of immersive consultation videos and related activities on student self-efficacy, motivational beliefs, and perceived skill level. Results indicate that usability was high, with participants rating videos, interactives, and activities positively. Although no significant improvements in their level of interest or perceived skill were found, students did report a significant increase in self-efficacy and their perceived ability to meet the course learning objectives. Our results demonstrate that high-quality immersive videos can be an important learning tool for teaching clinical skills when access to direct patient care is limited or absent.

Global assessment of surgical skills (GASS): validation of a new instrument to measure global technical safety in surgical procedures.

BACKGROUND: Broad implementation of the American Board of Surgery's entrustable professional activities initiative will require assessment instruments that are reliable and easy to use. Existing assessment instruments of general laparoscopic surgical skills have limited reliability, efficiency, and validity across the spectrum of formative (low-stakes) and summative (high-stakes) assessments. A novel six-item global assessment of surgical skills (GASS) instrument was developed and evaluated with a focus upon safe versus unsafe surgical practice scoring rubric. METHODS: The GASS was developed by iterative engagement with expert laparoscopic surgeons and includes six items (economy of motion, tissue handling, appreciating operative anatomy, bimanual dexterity, achievement of hemostasis, overall performance) with a uniform three-point scoring rubric ("poor-unsafe", "adequate-safe", "good-safe"). To test inter-rater reliability, a cross-sectional study of four bariatric surgeons with experience ranging from 4 to 28 years applied the GASS and the global operative assessment of laparoscopic skills (GOALS) to 30 consecutive Roux-en-Y gastric bypass procedure operative videos. Inter-rater reliability was assessed for a simplified dichotomous "safe" versus "unsafe" scoring rubric using Gwet's AC2. RESULTS: The GASS inter-rater reliability was very high across all six domains (0.88-1.00). The GASS performed comparably to the GOALS inter-rater reliability scores (0.96-1.00). The economy of motion and bimanual dexterity items had the highest percentage of unsafe ratings (9.2% and 5.8%, respectively). CONCLUSION: The GASS, a novel six-item instrument of general laparoscopic surgical skills, was designed with a simple scoring rubric (poor-safe, adequate-safe, good-safe) to minimize rater burden and focus feedback to trainees and promotion evaluations on safe surgical performance. Initial evaluation of the GASS is promising, demonstrating high inter-rater reliability. Future research will seek to assess the GASS against a broader spectrum of laparoscopic procedures.

Impact of a Brief Suicide Prevention Training with an Interactive Video Case Assessment on Student Pharmacist Outcomes.

OBJECTIVE: To determine whether a brief suicide prevention training with an interactive video case (Pharm-SAVES) improves student pharmacists' suicide prevention knowledge and self-efficacy. METHODS: Student pharmacists (N = 146) from 2 United States universities completed the 75-minute Pharm-SAVES training in September 2021. Suicide prevention knowledge and self-efficacy were measured via an online pre-test and post-test, and a post-test interactive video case assessed self-efficacy to engage in SAVES steps (recognize Signs, Ask about suicide, Validate feelings, Expedite a National Suicide Prevention Lifeline [NSPL] referral, and Set a follow-up reminder). Paired samples t tests compared pre-test and post-test scores (alpha = 0.05). Three months later, students indicated if they had used Pharm-SAVES in practice. RESULTS: Mean knowledge and self-efficacy significantly improved from pre-test to post-test. The interactive video case assessment revealed that students were least confident asking about suicide, moderately confident referring to or calling the NSPL on behalf of patients, and most confident following up with patients. Three months later, 17 (11.6%) students reported that they had recognized someone with suicide warning signs (S in SAVES). Among them, 9 (52.9%) reported asking the person with warning signs if they were considering suicide (A in SAVES), 13 (76.5%) validated feelings (V in SAVES), 3 (9.4%) called the NSPL for the patient, and 6 (35.3%) referred to the NSPL (E in SAVES). CONCLUSION: Pharm-SAVES increased student pharmacists' suicide prevention knowledge and self-efficacy. Within 3 months, more than 10% had used Pharm-SAVES skills with at-risk individuals. All Pharm-SAVES content is now online and available for asynchronous or synchronous instruction.

Developing artificial intelligence models for medical student suturing and knot-tying video-based assessment and coaching.

BACKGROUND: Early introduction and distributed learning have been shown to improve student comfort with basic requisite suturing skills. The need for more frequent and directed feedback, however, remains an enduring concern for both remote and in-person training. A previous in-person curriculum for our second-year medical students transitioning to clerkships was adapted to an at-home video-based assessment model due to the social distancing implications of COVID-19. We aimed to develop an Artificial Intelligence (AI) model to perform video-based assessment. METHODS: Second-year medical students were asked to submit a video of a simple interrupted knot on a penrose drain with instrument tying technique after self-training to proficiency. Proficiency was defined as performing the task under two minutes with no critical errors. All the videos were first manually rated with a pass-fail rating and then subsequently underwent task segmentation. We developed and trained two AI models based on convolutional neural networks to identify errors (instrument holding and knot-tying) and provide automated ratings. RESULTS: A total of 229 medical student videos were reviewed (150 pass, 79 fail). Of those who failed, the critical error distribution was 15 knot-tying, 47 instrument-holding, and 17 multiple. A total of 216 videos were used to train the models after excluding the low-quality videos. A k-fold cross-validation (k = 10) was used. The accuracy of the instrument holding model was 89% with an F-1 score of 74%. For the knot-tying model, the accuracy was 91% with an F-1 score of 54%. CONCLUSIONS: Medical students require assessment and directed feedback to better acquire surgical skill, but this is often time-consuming and inadequately done. AI techniques can instead be employed to perform automated surgical video analysis. Future work will optimize the current model to identify discrete errors in order to supplement video-based rating with specific feedback.

Discussion of cost continues to be uncommon in companion animal veterinary practice.

OBJECTIVE: To determine the prevalence and nature of cost conversations occurring during veterinarian-client-patient interactions within companion animal practice. SAMPLES: 60 randomly selected, practicing veterinarians working in 55 practices across southern Ontario, Canada, and 909 of their clients, sampled by convenience. PROCEDURES: A cross-sectional descriptive study including 917 video-recorded appointments. Associations between veterinarian, client, or appointment-level factors and occurrence of a cost conversation were evaluated using multi-level logistic regression. RESULTS: 215 of 917 (23.4%) videos included a discussion of cost between the veterinarian and client. Cost conversations involving veterinarians primarily focused on conveying the price in relation to the time or service being offered (74.0% [159/215]), whereas the benefit to the future health and wellness of the patient was conveyed in 14.4% (31/215) of veterinarians' cost conversations. Costs were most frequently discussed by veterinarians in relation to diagnostic testing (44.2% [96/215]). The odds of a cost discussion occurring were greater during problem appointments versus wellness (P = .011) or recheck (P = .029) appointments, for feline versus canine patients (P = .037), as appointment duration increased (P < .001), and as a client's number of visits in the past year decreased (P = .049). CLINICAL RELEVANCE: Discussing cost of care in veterinary practice continues to be relatively uncommon. Opportunities exist for veterinary professionals to frame their communication of the cost of veterinary care in relation to the benefits offered to the future health and wellbeing of the veterinary patient.

[Assessment of an e­learning platform for dermatosurgery]. / Beurteilung einer E­Learning-Plattform für Dermatochirurgie.

BACKGROUND: Dermatosurgical (DS) teaching is based on a combination of reading/understanding textbooks and applying surgical procedures (±â€¯supervision). Most textbooks are primarily text-centered. The text is visually supported by photos/sketches (S) and possibly videos (V). A learning goal of this teaching should be that the learner is confident to perform a procedure independently. METHODS: We have developed an online-based platform, the FlapFinder (FF; www.skin-surgery.org ), which teaches the user DS in the facial region primarily in the form of S + V. These are supported by a short text (T) and bonus material (B). B contains personal recommendations from the FF authors. A SurveyMonkey® (Survey Monkey, San Mateo, CA, USA) analysis should clarify how this is assessed by the user. RESULTS: In all, 62 participants completed the questionnaire in full. This was a heterogeneous group (27 dermatologists vs. 35 non-dermatologists; 32â€¯× clinic vs. 30â€¯× non-clinic) with different prior experience. The majority of users found that the combination of T + S + V helped them to understand (55/62; 88.7%), remember (53/62, 85.5%), and perform the procedures independently (43/62; 69.3%). While S + V were most frequently used (22/62; 35.5% and 27/62; 43.6%), users reported having benefited most from this (20/62; 32.3% and 24/62; 38.7%), T + B were used less (0/62, 0.0% and 2/62; 3.2%). Nevertheless, the majority would not want to do without either S, V, T, or B (49/62; 79%). CONCLUSION: The combination of S + V + T + B is rated positively by DS learners. S + V are rated as particularly helpful. Future studies must clarify whether the learning objective of the concrete practical performance of DS is changed by e­media.

An evaluation of temporal and club angle parameters during golf swings using low cost video analyses packages.

The purpose of this study was to compare swing time and golf club angle parameters during golf swings using three, two dimensional (2D) low cost, Augmented-Video-based-Portable-Systems (AVPS) (Kinovea, SiliconCoach Pro, SiliconCoach Live). Twelve right-handed golfers performed three golf swings whilst being recorded by a high-speed 2D video camera. Footage was then analysed using AVPS-software and the results compared using both descriptive and inferential statistics. There were no significant differences for swing time and the golf phase measurements between the 2D and 3D software comparisons. In general, the results showed a high Intra class Correlation Coefficient (ICC > 0.929) and Cronbach's Coefficient Alpha (CCA > 0.924) reliability for both the kinematic and temporal parameters. The inter-rater reliability test for the swing time and kinematic golf phase measurements on average were strong. Irrespective of the AVPS software investigated, the cost effective AVPS can produce reliable output measures that benefit golf analyses.

Is the rating result reliable? A new approach to respond to a medical trainee's concerns about the reliability of Mini-CEX assessment.

PURPOSE: Whether the rating result of mini-clinical evaluation exercise (Mini-CEX) for rating clinical skills is reliable is of a medical trainee's great concerns. The objectives of this study were to analyze the test-retest reliability, interrater reliability and internal consistency reliability of Mini-CEX. METHODS: Three clinical scenarios, each played by a standardized patient and resident, were developed and videotaped. A group of assessors were recruited to rate the resident's clinical skills using Mini-CEX with a nine-point grading scale in each videotaped clinical scenario. Each assessor was required: (1) to watch the videotaped clinical scenarios a sequential order; (2) to rate each medical trainee's clinical skills in each clinical scenario for two rating sessions, and there must be a minimum three-week interval between the first and the second Mini-CEX rating session. RESULTS: A total of 38 assessors participated in this study. This study showed that: (1) an assessor carried out similar rating reuslts under the same clinical performance based on an acceptable test-retest reliability (Pearson's correlation coefficients = 0.24-0.76, P value=<0.01-0.14); (2) assessors gave similar rating results to a medical trainee's clinical performance based on a good interrater reliability (intra-class correlation coefficient = 0.57-0.83, P value=<0.01-0.03); and (3) the items reflected unidimensionally a construct-a medical trainee's clinical skills based on an excellent internal consistency reliability (Cronbach's alpha = 0.92-0.97). CONCLUSION: This study convincingly showed that Mini-CEX is a reliable assessment tool for rating clinical skills, and can be widely used to assess medical trainees' clinical skills.

Skepticism towards advancing VR technology - student acceptance of VR as a teaching and assessment tool in medicine.

Objective: The high didactic potential of Virtual Reality (VR) contrasts with the point of view of students that the technology only has a relatively low significance for current and future teaching. This discrepancy was studied in a differentiated manner in order to gear the further development and implementation of VR towards the target group. Methods: From January 2020 to July 2020, medical students (N=318) were asked to watch ten videos online and rate them on the basis of acceptance indicators (e.g., fun and fairness). Using obstetrics as an example, the videos demonstrated five levels of VR technology functionality (e.g., haptic and adaptive feedback), some of which were visionary, in two use scenarios (teaching and the OSCE). The individual and aggregate indicators were compared with non-parametric testing procedures across application scenarios, functional levels and genders. In addition, correlations between the acceptance and the factors of semester, age, computer affinity, and previous VR experience were analyzed. Results: Across all functional levels, VR was more likely to be accepted in the classroom than in the OSCE. Comparisons across functional levels also revealed that the VR ready to be marketed was significantly more accepted than the visionary functions. This skepticism toward advancing VR technology was most pronounced with regard to the vision of autonomous VR examinations and among female students with a low computer affinity. Conclusion: The results suggest that the students' reservations are due to a lack of experience with the VR technology. In order for young physicians to become familiar with the technology and to be able to use it competently in the everyday clinical practice in the future, VR should not only be used as a teaching tool but also be part of the curriculum. Practical examinations using VR, on the other hand, are only recommended once the technology has become established in teaching and has been proven to be reliable.

Integrating Home Care: An Innovative Approach for Simulation Learning.

BACKGROUND: The nature of a nurse's job is changing dramatically. Nurses are assuming expanded roles for a broad range of patients in community-based care. Nurse educators have a responsibility to teach nursing students about the needs of patients and families in the home care setting. METHOD: To describe how the creation of a home care video series and a medication reconciliation simulation scenario were used as a teaching strategy in a simulation center. RESULTS: The teaching strategy supported senior-level nursing students' understanding of the complexity of home care nursing and the nurse's role and responsibilities in care coordination, care transitions, and interprofessional practice. CONCLUSION: The home care video scenario was received favorably by nursing students. Additional simulation video scenarios are needed that address the health disparities among underrepresented and vulnerable groups. There is potential to offer the simulation in a virtual-online format during the COVID-19 pandemic and social distancing mandates. [J Nurs Educ. 2021;60(3):172-176.].

The use of low-cost ruggedized Android tablets to augment in-service training of community health workers in Mukono, Uganda: perspectives and lessons learned from the field.

BACKGROUND: Despite potential for community health workers (CHWs) to effectively reduce morbidity and mortality in sub-Saharan Africa, they still face multiple barriers including access to on-going and refresher training. Digital technology offers a potential solution to improve the provision of ongoing training for CHWs. OBJECTIVES: This report shares participant insights and experiences following the implementation of a mobile health (mHealth) assisted Integrated Community Case Management (iCCM) refresher training programme for CHWs in Mukono, Uganda. We seek to document benefits and challenges of such an approach. METHODS: CHWs were trained to recognize, treat and prevent childhood pneumonia via locally made videos preloaded onto low cost, ruggedized Android tablets. Subsequent interviews were compiled with key stakeholders including CHWs, CHW leaders and programme supervisors to better understand the strengths, barriers and lessons learned following the intervention. RESULTS: Success factors included the establishment of CHW leadership structures, the ability to use the tablets to learn on an "any pace, any place" basis and using the tablets to conduct community teaching and outreach. Barriers included appropriate consideration of the implementation timeline and avoiding a "one size fits all" approach to digital literacy training. CONCLUSIONS: The strength of the program stemmed from a grassroots approach that prioritized stakeholder input at all stages. Leadership at a local level, a history of local engagement and trust built up over a period time were also integral. As organizations aim to scale up digitally enhanced training initiatives, it is paramount that attention is paid to these human factors which are key for program success.

Lessons learned from the implementation of a video health coaching technology intervention to improve self-care of family caregivers of adults with heart failure.

Individuals with heart failure (HF) typically live in the community and are cared for at home by family caregivers. These caregivers often lack supportive services and the time to access those services when available. Technology can play a role in conveniently bringing needed support to these caregivers. The purpose of this article is to describe the implementation of a virtual health coaching intervention with caregivers of HF patients ("Virtual Caregiver Coach for You"-ViCCY). A randomized controlled trial is currently in progress to test the efficacy of the intervention to improve self-care. In this trial, 250 caregivers will be randomly assigned to receive health information via a tablet computer (hereafter, tablet) plus 10 live health coaching sessions delivered virtually (intervention group; n = 125) or health information via a tablet only (control group; n = 125). Each tablet has specific health information websites preloaded. To inform others embarking on similar technology projects, here we highlight the technology challenges encountered with the first 15 caregivers who received the ViCCY intervention and the solutions used to overcome those challenges. Several adaptations to the implementation of ViCCY were needed to address hardware, software, and network connectivity challenges. Even with a well-designed research implementation plan, it is important to re-examine strategies at every step to solve implementation barriers and maximize fidelity to the intervention. Researcher and interventionist flexibility in adapting to new strategies is essential when implementing a technology-based virtual health coaching intervention.

Descriptive Kinematic Analysis of the Potentially Tragic Accident at the 2020 Austrian MotoGP Grand Prix Using Low-Cost Instruments: A Brief Report.

BACKGROUND: During the first Austrian MotoGP Grand Prix of 2020, following a serious accident involving the riders J. Zarco and F. Morbidelli, Morbidelli's riderless bike cartwheeled across turn 3, narrowly missing V. Rossi and M. Viñales by just a few centimeters. As is the case with ordinary traffic accidents, analyzing the dynamics of motorcycle racing accidents can help improve safety; however, to date, the literature lacks studies that analyze the causes and severity of such accidents. Hence, the purpose of this study was to analyze the main causes that led to the accident at the 2020 Austrian MotoGp Grand Prix, to quantify the speeds and distances of the bikes and riders involved, and to hypothesize several alternative scenarios using a low-cost method. METHOD: Kinovea and Google Earth Pro software were used to identify markers along the racetrack and to measure the distances and calculate the time it took the motorcycles to cover those distances. The analyses were carried out on three 30-fps (frames per second) videos. RESULTS: Zarco's average speed as he was overtaking Morbidelli on the straightaway before turn 2 was 302 ± 1.8 km/h, higher than that of Rins and Rossi (299.7 ± 1.7 and 296 ± 1.7 km/h, respectively). The speed of Zarco and Rossi's bikes 44.5 m before the crash was the same (267 ± 7.9 km/h). Immediately after overtaking Morbidelli, Zarco moved 2.92 m towards the center of the racetrack from point A to B, crossing Morbidelli's trajectory and triggering the accident. Morbidelli's riderless bike flew across turn 3 at a speed of about 76 km/h, missing V. Rossi by just 20 cm. The consequences could have been catastrophic if Rossi had not braked just 0.42 s before encountering Morbidelli's bike in turn 3. CONCLUSION: Through a low-cost quali-quantitative analysis, the present study helps us to gain a deeper understanding of the dynamics of the accident and its main causes. Furthermore, in light of our findings regarding the dynamics and severity of the accident and the particular layout of the Red Bull Ring circuit, racers should be aware that overtaking at the end of turn 2, following the same trajectory as the riders involved in the crash, could be very risky.

AI Approaches Towards Prechtl's Assessment of General Movements: A Systematic Literature Review.

General movements (GMs) are spontaneous movements of infants up to five months post-term involving the whole body varying in sequence, speed, and amplitude. The assessment of GMs has shown its importance for identifying infants at risk for neuromotor deficits, especially for the detection of cerebral palsy. As the assessment is based on videos of the infant that are rated by trained professionals, the method is time-consuming and expensive. Therefore, approaches based on Artificial Intelligence have gained significantly increased attention in the last years. In this article, we systematically analyze and discuss the main design features of all existing technological approaches seeking to transfer the Prechtl's assessment of general movements from an individual visual perception to computer-based analysis. After identifying their shared shortcomings, we explain the methodological reasons for their limited practical performance and classification rates. As a conclusion of our literature study, we conceptually propose a methodological solution to the defined problem based on the groundbreaking innovation in the area of Deep Learning.

An observational study of self-monitoring in ad hoc health care teams.

BACKGROUND: Working in ad hoc teams in a health care environment is frequent but a challenging and complex undertaking. One way for teams to refine their teamwork could be through post-resuscitation reflection and debriefing. However, this would require that teams have insight into the quality of their teamwork. This study investigates (1) the accuracy of the self-monitoring of ad hoc resuscitation teams and their leaders relative to external observations of their teamwork and (2) the relationship of team self-monitoring and external observations to objective performance measures. METHODS: We conducted a quantitative observational study of real-world ad hoc interprofessional teams responding to a simulated cardiac arrest in an emergency room. Teams consisting of residents, consultants, and nurses were confronted with an unexpected, simulated, standardized cardiac arrest situation. Their teamwork was videotaped to allow for subsequent external evaluation on the team emergency assessment measure (TEAM) checklist. In addition, objective performance measures such as time to defibrillation were collected. All participants completed a demographic questionnaire prior to the simulation and a questionnaire tapping their perceptions of teamwork directly after it. RESULTS: 22 teams consisting of 115 health care professionals showed highly variable performance. All performance measures intercorrelated significantly, with the exception of team leaders' evaluations of teamwork, which were not related to any other measures. Neither team size nor cumulative experience were correlated with any measures, but teams led by younger leaders performed better than those led by older ones. CONCLUSION: Team members seem to have better insight into their team's teamwork than team leaders. As a practical consequence, the decision to debrief and the debriefing itself after a resuscitation should be informed by team members, not just leaders.

Adapting a health video library for use in Afghanistan: provider-level acceptability and lessons for strengthening operational feasibility.

BACKGROUND: Community health workers (CHWs) in Afghanistan are a critical care extender for primary health services, including reproductive, maternal, neonatal, and child health (RMNCH) care. However, volunteer CHWs face challenges including an ever-expanding number of tasks and insufficient time to conduct them. We piloted a health video library (HVL) intervention, a tablet-based tool to improve health promotion and counseling by CHWs. We qualitatively assessed provider-level acceptability and operational feasibility. METHODS: CHWs implemented the HVL pilot in three rural districts of Balkh, Herat, and Kandahar provinces. We employed qualitative methods, conducting 47 in-depth interviews (IDIs) with male and female CHWs and six IDIs with community health supervisors. We used semi-structured interview guides to explore provider perceptions of program implementation processes and solicit feedback on how to improve the HVL intervention to inform scale-up. We conducted a thematic analysis. RESULTS: CHWs reported that the HVL increased time efficiencies, reduced work burden, and enhanced professional credibility within their communities. CHWs felt video content and format were accessible for low literacy clients, but also identified challenges to operational feasibility. Although tablets were considered easy-to-use, certain technical issues required continued support from supervisors and family. Charging tablets was difficult due to inconsistent electricity access. Although some CHWs reported reaching most households in their catchment area for visits with the HVL, others were unable to visit all households due to sizeable populations and gender-related barriers, including women's limited mobility. CONCLUSIONS: The HVL was acceptable and feasible for integration into existing CHW duties, indicating it may improve RMNCH counseling, contributing to increased care-seeking behaviors in Afghanistan. Short-term challenges with technology and hardware can be addressed through continued training and provision of solar chargers. Longer-term challenges, including tablet costs, community coverage, and gender issues, require further consideration with an emphasis on equitable distribution.

Early identification of infants at risk of cerebral palsy: developing the use of general movement assessment in routine clinical practice in a tertiary neonatal unit in New Zealand.

BACKGROUND: Preterm infants have a high risk of neurodevelopmental disability, including cerebral palsy (CP). Often, CP is not diagnosed until after 12 months, leading to delay in targeted interventions. The General Movements assessment (GM) evaluates the spontaneous movements of high-risk infants from birth to 20 weeks corrected postnatal age (CPA), and accurately predicts the risk of CP. This allows for earlier diagnosis and intervention, potentially changing the trajectory of disability, yet routine use of GM is not well established in New Zealand. AIM: To describe the process of setting up GM in a tertiary neonatal unit. METHODS: We reviewed the process and progress made to date setting up GM in our service. RESULTS: Challenges and potential solutions for the implementation of GM were identified. Key areas of development included staff training and support, IT services, resources, medical documentation, inter-departmental communication and establishing clinical pathways. CONCLUSION: GM has become successfully integrated into the assessment of high-risk infants in our neonatal unit, with the aim to provide valuable information to health professionals and families to optimise intervention and improve outcomes. Efforts will continue to ensure there is robust and sustainable system for using GM in our service.