How We Do It: Remediation Pathways in a Surgical Simulation Curriculum for Competency Improvement.

OBJECTIVE: Validated assessment of procedural knowledge and skills with formative remediation is a foundational part of achieving surgical competency. High-fidelity simulation programs provide a unique area to assess resident proficiency and independence, as well as to assist in identifying residents in need of further practice. While several studies have validated the use of simulation to attain proficiency of specific technical skills, few have validated remediation pathways for their trainees objectively. In this descriptive analysis, we review 2 remediation pathways within our simulation training curricula and how these are used in assessments of resident proficiency. MATERIALS AND METHODS: Two methods of remediation were formulated for use in high-fidelity simulation labs. One remediation pathway was a summative process, where ultimate judgment of resident competency was assessed through intra-operative assessments of a holistic skill set. The second remediation pathway was a formative "coaching" process, where feedback is given at several intervals along the pathway towards a specific technical skills competence. All general surgery residents are enrolled in the longitudinal, simulation curricula. RESULTS: Approximately one-third of surgical residents entered into a remediation pathway for either of the high-fidelity simulation curricula. Both residents and faculty expressed support for the summative and formative remediation pathways as constructed. Residents who entered remediation pathways believed it was a beneficial exercise, and the most common feedback was that remediation principles should be expanded to all residents. Interestingly, faculty demonstrated stronger support for the formative coaching feedback model than the summative assessment model. CONCLUSIONS: Through the complementary use of both formative and summative remediation pathways, resident competence can be enriched in a constructive, nonpunitive method for self-directed performance improvement. Both trainees and faculty express high satisfaction with programs explicitly organized to ensure that skills are rated through a standardized process.

Improving reading skills in children with dyslexia: efficacy studies on a newly proposed remedial intervention-repeated reading with vocal music masking (RVM).

In this work, two different studies are examined to evaluate the effectiveness of a novel intervention program for the improvement of reading ability in children with dyslexia, known as repeated reading with vocal music masking (RVM). The proposed remedial approach is inspired by Breznitz's original work. The studies assess a 5-week program of intensive RVM training in a pre-post-test clinical paradigm, as well as a longitudinal paradigm where it is compared to 8 months of the standard remediation program (SRP). The results of both studies support the efficacy of the newly proposed RVM method. Notably in the longitudinal study, the reading speed of children, as well as related phonological, visuo-attentional, and cognitive skills, and attitudes toward reading, were measured regularly. Significant improvements in reading efficiency and related skills were observed, as well as greater motivation to read after RVM training. A modeling of the data specifically linked executive and processing speed skills to be involved in RVM training, suggesting that RVM may help rebalance the phonological and orthographic coding procedures necessary for efficient reading. The short, intensive, and focused nature of RVM training makes it a viable and attractive intervention for clinical practice. As preliminary results are promising, RVM training may prove to be a valuable tool that clinicians can call upon to effectively treat reading fluency disorders, especially when standard programs do not provide results.

The effect of computer-assisted therapeutic practice for children with handwriting deficit: a comparison with the effect of the traditional sensorimotor approach.

The objective of this study was to compare the effect of computer-assisted practice with the sensorimotor approach on the remediation of handwriting problems in children with dysgraphia. In a randomized controlled trial, experiments were conducted to verify the intervention effect. Forty two children with handwriting deficit were assigned to computer-assisted instruction, sensorimotor training, or a control group. Handwriting performance was measured using the elementary reading/writing test and computerized handwriting evaluation before and after 6 weeks of intervention. Repeated-measures ANOVA of changed scores were conducted to show whether statistically significant differences across the three groups were present. Significant differences in the elementary reading/writing test were found among the three groups. The computer group showed more significant improvements than the other two groups did. In the kinematic and kinetic analyses, the computer group showed promising results in the remediation of handwriting speed and fluency. This study provided clinical evidence for applying a computer-assisted handwriting program for children with dysgraphia. Clinicians and school teachers are provided with a systematic intervention for the improvement of handwriting difficulties.

Effectiveness of treatment approaches for children and adolescents with reading disabilities: a meta-analysis of randomized controlled trials.

Children and adolescents with reading disabilities experience a significant impairment in the acquisition of reading and spelling skills. Given the emotional and academic consequences for children with persistent reading disorders, evidence-based interventions are critically needed. The present meta-analysis extracts the results of all available randomized controlled trials. The aims were to determine the effectiveness of different treatment approaches and the impact of various factors on the efficacy of interventions. The literature search for published randomized-controlled trials comprised an electronic search in the databases ERIC, PsycINFO, PubMed, and Cochrane, and an examination of bibliographical references. To check for unpublished trials, we searched the websites clinicaltrials.com and ProQuest, and contacted experts in the field. Twenty-two randomized controlled trials with a total of 49 comparisons of experimental and control groups could be included. The comparisons evaluated five reading fluency trainings, three phonemic awareness instructions, three reading comprehension trainings, 29 phonics instructions, three auditory trainings, two medical treatments, and four interventions with coloured overlays or lenses. One trial evaluated the effectiveness of sunflower therapy and another investigated the effectiveness of motor exercises. The results revealed that phonics instruction is not only the most frequently investigated treatment approach, but also the only approach whose efficacy on reading and spelling performance in children and adolescents with reading disabilities is statistically confirmed. The mean effect sizes of the remaining treatment approaches did not reach statistical significance. The present meta-analysis demonstrates that severe reading and spelling difficulties can be ameliorated with appropriate treatment. In order to be better able to provide evidence-based interventions to children and adolescent with reading disabilities, research should intensify the application of blinded randomized controlled trials.

Training the brain: fact and fad in cognitive and behavioral remediation.

Putatively safe and effective for improving cognitive performance in both health and disease, products purported to train the brain appeal to consumers and healthcare practitioners. In an increasingly health-centered society, these applications constitute a burgeoning commercial market. Sparse evidence coupled with lack of scientific rigor, however, leaves claims concerning the impact and duration of such brain training largely unsubstantiated. On the other hand, at least some scientific findings seem to support the effectiveness and sustainability of training for higher brain functions such as attention and working memory. In the present paper we provide a tectonic integration and synthesis of cognitive training approaches. Specifically, we sketch the relative merits and shortcomings of these programs, which often appeal to parents who must choose between side-effect-laden medication and other less conventional options. Here we examine how neuroplasticity allows the healthy as well the impaired to benefit from cognitive training programs. We evaluate the evidence and consider whether brain training can be a stand-alone treatment or an adjunct to pharmacotherapy, outline promising future prospects, and highlight what training outcomes are plausible in line with available data. Future research would determine whether the field of brain training realizes its potential to revolutionize education and rehabilitation or withers away engulfed in controversy.

Teaching nutrition integration: MUST screening in cancer.

RATIONALE: Nutritional risk screening should be routine in order to select patients in need of nutrition care; this conduct change has to rely on education. In this project, radiotherapy department health professionals were trained on how to use the Malnutrition Universal Screening Tool (MUST), to foster its integration into cancer outpatient management; we also aimed to identify those more adherent to screening. METHODS: Research dieticians (the standard) conducted interactive sessions with all physicians, nurses, and radiotherapy (RT) technicians, who were closely supervised to facilitate routine MUST integration. There were two phases: after the first session, phase 1 assessed 200 patients over 4 months; after the second session, phase 2 screened 450 patients, always before RT. Validity was evaluated comparing results from the standard against all other health professionals, adjusted for number. RESULTS: RT technicians were most adherent to the MUST: 80% of patients in phase 1, increasing to 85% in phase 2. Nurses doubled their input, from 19% to 36%. Physicians had poor MUST integration, yet they progressively incorporated percentage weight loss into patient records, increasing from 57% in phase 1 to 84% in phase 2, independently of diagnosis and stage. The highest concordance (κ coefficient) with dieticians was found with RT technicians' use of the MUST (p < .002) and percentage weight loss determination by physicians (p < .001). CONCLUSIONS: We show that systematic screening in cancer is feasible by all professionals involved, once a proximity teaching project is put into practice. RT technicians, who daily treat patients, were highly adherent to integrate the MUST and might be in charge of selecting at-risk patients. Physicians are unlikely to use the MUST, but acknowledged nutrition value and changed their routine by integrating recent percentage weight loss into their approach to patients. Our structured methodology may be used as a model for the development of teaching adapted to different departments with other realities.

Gray matter volume changes following reading intervention in dyslexic children.

Studies in children and adults with the reading disability developmental dyslexia have shown behavioral improvements after reading intervention. In another line of work, it has been shown that intensive training in a variety of cognitive and sensorimotor skills can result in changes in gray matter volume (GMV). This study examined changes in GMV following intensive reading intervention in children with dyslexia using voxel-based morphometry (VBM). Eleven dyslexic children underwent an eight week training focused on mental imagery, articulation and tracing of letters, groups of letters and words, which resulted in significant gains in reading skills. This was followed by an eight week null period (control) where no intervention was administered and no further significant gains in reading were observed. Structural scans were obtained before the intervention, after the intervention and after the null period. GMV increases between the first two time points were found in the left anterior fusiform gyrus/hippocampus, left precuneus, right hippocampus and right anterior cerebellum. However these areas did not change between time points two and three (control period), suggesting that the changes were specific to the intervention period. These results demonstrate for the first time that (1) training-induced changes in GMV can be observed in a pediatric sample and (2) reading improvements induced by intervention are accompanied by GMV changes.

Dynamic assessment and response to intervention: two sides of one coin.

This article compares and contrasts the main features of dynamic testing and assessment (DT/A) and response to intervention (RTI). The comparison is carried out along the following lines: (a) historical and empirical roots of both concepts, (b) premises underlying DT/A and RTI, (c) terms used in these concepts, (d) use of these concepts, (e) evidence in support of DT/A and RTI, and (f) expectations associated with each of the concepts. The main outcome of this comparison is a conclusion that both approaches belong to one family of methodologies in psychology and education whose key feature is in blending assessment and intervention in one holistic activity. Because DT/A has been around much longer than RTI, it makes sense for the proponents of RTI to consider both the accomplishments and frustrations that have accumulated in the field of DT/A.

KATTS: a framework for maximizing NCLEX-RN performance.

A key indicator of the quality of a nursing education program is the performance of its graduates as first-time takers of the NCLEX-RN. As a result, nursing schools are open to strategies that strengthen the performance of their graduates on the examination. The Knowledge base, Anxiety control, Test-Taking Skills (KATTS) framework focuses on the three components of achieving a maximum score on an examination. In KATTS, all three components must be present and in proper balance to maximize a test taker's score. By strengthening not just one but all of these components, graduates can improve their overall test scores significantly. Suggested strategies for strengthening each component of KATTS are provided. This framework has been used successfully in designing remedial tutoring programs and in assisting first-time NCLEX test takers in preparing for the licensing examination.

The status of empirical support for treatments of attention deficits.

Deficits in attention and self-regulation are common complaints associated with a number of disorders across the lifespan. The need to address attentional deficits is based on the premise that attention is a precursor and prerequisite to information processing and related cognitive tasks as well as a key factor in the success of other rehabilitation efforts. Many treatment programs have been developed with the intention of restoring or rehabilitating the impaired components of attention; the number and variety of attention programs is increasing rapidly. The purpose of this article is to evaluate available empirical support regarding the efficacy of treatments for remediation of attention deficits across disorders and age levels. The search of the major databases yielded 83 studies that included treatment of attentional deficits. Empirical studies were reviewed and categorized by the type of trial, whether or not the study included a control group, and the nature of the control group. The methodology and results of each study were then rated. For each treatment identified, the aggregated studies were then considered by the disorder of the samples included in the studies. Results indicated that, regardless of the treatment program or population, the existing research does not provide sufficient evidence to reach any conclusions about the efficacy of programs designed to address attention deficits. Before any conclusions, positive or negative, can be drawn, there is a need for more rigorous study of available treatment programs across age levels and disorders, with sufficient baseline and outcome data as well as control or alternative treatment conditions.

Cognitive remediation in traumatic brain injury: update and issues.

Cognitive Remediation (CR) is a relatively new treatment technique for alleviating residual cognitive deficits following traumatic brain injury. This is a promising yet still changing technique. The future of CR as a rational and systematic endeavor requires the incorporation of important new ideas that have been emerging in allied fields. For example, the emerging field of instructional psychology has contributed relevant concepts such as scaffolding, metacognition, and generalization. It is furthermore argued that the issues of awareness, self-concept, and self-efficacy are vital to the process of CR intervention, and an integrative (holistic) approach to the remedial endeavor is thus indicated.

Video-based training of respite care providers: an interactional analysis of presentation format.

We conducted two studies to evaluate a video-based instructional package for training respite care providers and the role of presentation format (viewing the videotapes alone, with a partner, and with structured group training) as a contextual variable. In Study 1, the results of a within-subjects Latin square design nested within a multiple baseline showed that performance during simulated (role-played) respite care situations improved in five of the six skill areas for the 12 trainees following presentation of the videotape, with no differences between presentation formats. Correct responding generalized to respite care situations involving a developmentally disabled child, and in most cases, acquired skills were maintained for up to 6 months. In Study 2, we conducted a clinical replication of Study 1 under conditions more closely approximating those in which the training program would be implemented by respite care agencies. Results of the between-groups analysis were consistent with the findings of Study 1.

The effects of direct feedback and practice on metaphor performance in children with learning disabilities.

Children with learning disabilities may have a problem in interpreting metaphor and need specific guidance and practice. This study found that direct feedback and practice could significantly increase metaphor performance of these children. Further descriptive analyses indicated that grade and reading levels of the subjects correlated with their metaphor performance.

An individualized memory retraining program after closed-head injury: a single-case study.

A memory-retraining program was designed for a patient approximately 2 1/2 months after he suffered a closed-head injury. Tests showed his memory deficit to be relatively isolated in the verbal sphere. An attempt was made to design a program in which tasks resembled the environmental demands on the patient for retention of verbal material. On a routine basis, the patient was read various paragraphs and was subsequently required to write them from memory. Three different strategies were used in an attempt to improve memory. After 15 days of training, the patient improved from an impaired level of verbal recall to a normal level. Strategies employing (a) visual imagery and other mnemonic devices and (b) questioning during presentation appeared to be most effective in facilitating retention. There was some drop in memory performance at a 9 month follow-up, and the patient was encouraged to resume active use of mnemonic strategies. Implications for further study are discussed.

Computerized video tasks as training techniques for driving-related perceptual deficits of persons with brain damage: a pilot evaluation.

This pilot study investigated the modifiability of perceptual deficits by training which consisted of performing microcomputer-generated video tasks. These commercially available remedial programs tapped a range of skills, such as right/left discrimination, color matching, visual scanning, judgment of line orientation, visual search, shape discrimination, visual memory, eye tracking, visuomotor coordination, and visual imagery. Four subjects with acquired brain damage were given 10 hours of training. Perceptual skills were assessed with a battery of seven paper-and-pencil tests administered both before and after the training. Following the training two subjects showed some improvement on several of the perceptual tests used, while two other subjects showed improvement on only a limited number of tests. Based on these results and on the performance changes on the video tasks themselves, a comprehensive evaluation of the potential benefits of this type of training on driving performance is recommended.

Comparison of remedial treatments for cursive handwriting of fourth-grade students.

Fourth-grade students participated in a study to investigate 4 methods of cursive handwriting instruction. Groups were rated by two independent raters on 5 handwriting characteristics. Poor and average writers received one of 4 taped methods. Two pretests, 8 training trials, and 1 posttest were administered. The K-sample binomial test of equal proportions and post hoc multiple comparisons in sample proportions for tests of homogeneity were used to analyze the data. Significant differences were found among the methods on 4 of the 5 characteristics among poor writers. For poor writers, the highest proportions of improvement were noted using 1 of 3 methods. Significant differences were found on 2 of the 5 characteristics for average writers.

Biofeedback theory and application in allied health: speech pathology.

The implementation of biofeedback procedures represents a new approach to clinical management of speech disorders. Thus far, results of experiments utilizing biofeedback techniques have suggested positive effects in the remediation of speech disorders. The purpose of this paper is to provide the reader with the principles of biofeedback; to survey areas of clinical application including voice, fluency, and other clinical disorders; and to explore potential applications of biofeedback procedures for the speech and language pathologist.

Effects of relaxation training on cursive handwriting of fourth grade students.

A relaxation method of handwriting improvement was examined. The experimental and no-treatment control groups were composed of 10 students receiving a poor rating on handwriting characteristics and the normal control group of 10 was composed of students receiving average ratings. All three groups received nine trials of writing. Only the experimental group received relaxation training during each trial. The handwriting of the experimental group improved significantly while that of the no-treatment control group remained the same. Although the handwriting of the normal control group also improved significantly, at posttest they were no longer significantly different from the experimental group.