Development and Pilot Testing of a Programmatic System for Competency Assessment in US Anesthesiology Residency Training.

BACKGROUND: In 2018, a set of entrustable professional activities (EPAs) and procedural skills assessments were developed for anesthesiology training, but they did not assess all the Accreditation Council for Graduate Medical Education (ACGME) milestones. The aims of this study were to (1) remap the 2018 EPA and procedural skills assessments to the revised ACGME Anesthesiology Milestones 2.0, (2) develop new assessments that combined with the original assessments to create a system of assessment that addresses all level 1 to 4 milestones, and (3) provide evidence for the validity of the assessments. METHODS: Using a modified Delphi process, a panel of anesthesiology education experts remapped the original assessments developed in 2018 to the Anesthesiology Milestones 2.0 and developed new assessments to create a system that assessed all level 1 through 4 milestones. Following a 24-month pilot at 7 institutions, the number of EPA and procedural skill assessments and mean scores were computed at the end of the academic year. Milestone achievement and subcompetency data for assessments from a single institution were compared to scores assigned by the institution's clinical competency committee (CCC). RESULTS: New assessment development, 2 months of testing and feedback, and revisions resulted in 5 new EPAs, 11 nontechnical skills assessments (NTSAs), and 6 objective structured clinical examinations (OSCEs). Combined with the original 20 EPAs and procedural skills assessments, the new system of assessment addresses 99% of level 1 to 4 Anesthesiology Milestones 2.0. During the 24-month pilot, aggregate mean EPA and procedural skill scores significantly increased with year in training. System subcompetency scores correlated significantly with 15 of 23 (65.2%) corresponding CCC scores at a single institution, but 8 correlations (36.4%) were <30.0, illustrating poor correlation. CONCLUSIONS: A panel of experts developed a set of EPAs, procedural skill assessment, NTSAs, and OSCEs to form a programmatic system of assessment for anesthesiology residency training in the United States. The method used to develop and pilot test the assessments, the progression of assessment scores with time in training, and the correlation of assessment scores with CCC scoring of milestone achievement provide evidence for the validity of the assessments.

Shuttle Time for Seniors: The Impact of 8-Week Structured Badminton Training on Markers of Healthy Aging and Evaluation of Lived Experiences-A Quasi-Experimental Study.

BACKGROUND/OBJECTIVES: Engagement in sport offers the potential for improved physical and psychological well-being and has been shown to be beneficial for promoting healthy aging. Opportunities for older adults to (re)engage with sport are limited by a paucity of age-appropriate introductory sports intervention programs. As such, the study evaluated the efficacy of a newly designed 8-week badminton training program (Shuttle Time for Seniors) on markers of healthy aging and the lived experiences of participation. METHODS: Forty-three older adults assigned to a control (N = 20) or intervention group (N = 23) completed pre-post assessment of physical and cognitive function, self-efficacy for exercise, and well-being. Focus groups were conducted for program evaluation and to understand barriers and enablers to sustained participation. RESULTS: Those in the intervention group increased upper body strength, aerobic fitness, coincidence anticipation time, and self-efficacy for exercise. Objectively improved physical and cognitive functions were corroborated by perceived benefits indicated in thematic analysis. Shuttle Time for Seniors was perceived as appropriate for the population, where the age-appropriate opportunity to participate with likeminded people of similar ability was a primary motivator to engagement. Despite willingness to continue playing, lack of badminton infrastructure was a primary barrier to continued engagement. CONCLUSION: Shuttle Time for Seniors offered an important opportunity for older adults to (re)engage with badminton, where the physical and psychosocial benefits of group-based badminton improved facets important to healthy aging. Significance/Implications: Age-appropriate introductory intervention programs provide opportunity for older adults to (re)engage with sport. However, important barriers to long-term engagement need to be addressed from a whole systems perspective.

Secular trends in the physical fitness of Brazilian youth: Evidence that fitness is declining for the majority but not for a fit minority.

BACKGROUND: There has been a decline in children's physical fitness in recent decades. Such concerns are largely based on evidence from North America, Europe, and Asia. The current study describes the secular trend and variation (spread) in the physical fitness scores of young Brazilians from 2005 to 2022. METHODS: This study is a repeated, cross-sectional surveillance study (1999-2022). Children and adolescents (n = 65 139; boys = 36 539) participated between 2005 and 2022. In each cohort six physical fitness tests were conducted: (1) 20-m sprint speed (m s-1 ), (2) cardio-respiratory 6-min run test (m min-1 ), (3) abdominal strength test (sit-ups per min), (4) horizontal jump test (cm), (5) the agility test (m s-1 ), and (6) the medicine ball throw test (cm). Means and distributional characteristics of the population were assessed using ANOVA, ANCOVA adopting BMI as the body-size covariate, Levene's test of equality-of-error variances, and Box and whisker plots. RESULTS: ANOVAs and ANCOVA's identified significant declines in physical fitness over time/year in 5 of the 6 physical fitness variables (e.g., 20-m sprint speed slope B = -0.018 (m s-1 y-1 ); 95% CI -0.019 to -0.017; p < 0.001), the only exception being the medicine ball throw test (cm). The Levene's test of equality-of-error variances also identified a systematic increase in the variances/standard deviations over time/years. CONCLUSIONS: Results provide powerful evidence that children and adolescents' physical fitness is declining, a trend that is also diverging asymmetrically, becoming more extreme in more recent years. The "fit" appear to be getting fitter, but the fitness of the "less-fit" appears to be declining further. These results have important implications for sports medicine and government policy makers.

Identifying modifiable risk factors and screening strategies associated with anterior cruciate ligament injury risk in children aged 6 to 13 years: A systematic review.

Growing anterior cruciate ligament (ACL) injury incidence is reported in countries across Europe, North America and in Australia for 5-14-year-olds, yet research on injury risk reduction predominantly focuses on populations aged > 13 years. For injury risk reduction, it is crucial to understand (i) which modifiable risk factors are associated with ACL injury in children (6-13 years) and (ii) how these risk factors are assessed. Articles were grouped according to sex/gender and/or maturational/age differences and examined modifiable risk factors during different physical screening tasks. The included articles (n = 40) predominantly examined intrinsic risk factors in girls aged 10-13 years. Factors mechanically linked to increased ACL loading at this age included increased peak knee adductor moments, knee valgus angles, hip and knee extension, and ground reaction forces. Assessment focused on laboratory-based assessments (e.g., motion capture, force plates). This review concluded that modifiable risk factors are present in children aged 6-13 years and that injury risk reduction strategies should be implemented as early as possible regardless of sex/gender. Further, screening strategies need updating to be childhood specific and feasible for the wide community. Additional research on extrinsic risk factors, norm values and children aged 6-9 years could allow for more targeted risk reduction strategies.

Increasing rates of ACL injuries in children aged 5 to 14 years are reported in countries across Europe, North America and in AustraliaResearch on modifiable risk factors focuses on internal risk factors in children aged 10-13 years and neglects external risk factors as well as younger children (6-10 years)Screening strategies to determine risk of ACL injury risk in children are laboratory based as opposed to cost-effective and quicker-to-analyse in-field assessmentResearch is warranted to examine external risk factors and in-field screening strategies in childhood.

"All the fun stuff, the teachers say, 'that's dangerous!'" Hearing from children on safety and risk in active play in schools: a systematic review.

BACKGROUND: Active play is vital for healthy child development, and schools are a valuable setting to promote this behaviour. Understanding the determinants of children's physical activity behaviour during recess, particularly the role of risk-taking and the influence safety concerns have on active play, is required. This systematic review aimed to 1) synthesise qualitative research with children that explored their perceptions of safety and risk in active play during recess in elementary and/or middle school, and 2) develop a model from the findings to guide efforts in schools to optimise children's active play opportunities during recess. METHODS: Six online databases were systematically searched for articles published between January 2000 and March 2021. Following PRISMA guidelines, records were screened against eligibility criteria using Covidence software, and data extraction and synthesis was conducted using customised forms in Excel and NVivo software. Framework synthesis methodology was employed, conceptually guided by Bronfenbrenner's socio-ecological model and Gibson's affordance theory. RESULTS: Of 9664 records, 31 studies met inclusion criteria, representing 1408 children across 140 schools from 11 countries. An emergent conceptual framework was developed encompassing 23 risk and safety themes and 10 risky play types that children desired in schools. Individual characteristics (age, gender, physical literacy) influenced children's engagement with risk and how they kept themselves safe. Across outer SEM levels, factors interacted to constrain or afford children's active play. Socio-cultural factors (supervision practices, rules, equipment restrictions) constrained active play, which children perceived were driven by adults' concern with physical safety. These factors contributed to a cycle of risk-averse decision making and diminished play affordances, which could inadvertently exacerbate safety issues. A model for risk tolerance in children's active play has been proposed. CONCLUSIONS: The findings show a disparity between the active play children want in schools and what they are able to do. Future work should balance the concerns of adults against the active play children want, involve children in decisions about playground policy, and foster a risk-tolerant culture in schools.

"Children are precious cargo; we don't let them take any risks!": Hearing from adults on safety and risk in children's active play in schools: a systematic review.

BACKGROUND: Understanding determinants of children's outdoor play is important for improving low physical activity levels, and schools are a key setting for both. Safety concerns shape children's opportunity to play actively outdoors, therefore, this qualitative evidence synthesis aimed to i) examine adult (e.g., parent, teacher, yard supervisor, principal) perspectives on safety and risk in children's active play during recess in elementary and/or middle schools, and ii) identify how safety and risk influence playground supervision and decision making in this setting. METHODS: Six electronic databases were systematically searched in March 2021, with an updated search in June 2022. Records were screened against eligibility criteria using Covidence software, and data extraction and synthesis were performed using predesigned coding forms in Microsoft Excel and NVivo. Framework synthesis methodology was employed, guided by a conceptual framework structured on the socio-ecological model (SEM) and affordance theory. RESULTS: From 10,370 records, 25 studies were included that represented 608 adults across 89 schools from nine countries. The synthesis identified 10 constraining and four affording factors that influenced whether school staff were risk-averse or risk tolerant during recess, and, in turn, the degree to which children's play was managed. Constraining factors stemmed from fears for children's physical safety, and fear of blame and liability in the event of playground injury, which shaped parent, school staff and institutional responses to risk. Interrelated factors across SEM levels combined to drive risk-averse decision making and constraining supervision. Emerging evidence suggests children's active play in schools can be promoted by fostering a risk tolerant and play friendly culture in schools through play facilitation training (e.g., risk-reframing, conflict resolution) and engaging stakeholders in the development of school policies and rules that balance benefits of play against potential risks. CONCLUSIONS: Findings show several socio-cultural factors limited the ability of school staff to genuinely promote active play. Future work should seek to foster risk tolerance in schools, challenge the cultural norms that shape parent attitudes and institutional responses to risk in children's play, and explore novel methods for overcoming policy barriers and fear of liability in schools. TRIAL REGISTRATION: PROSPERO registration: CRD42021238719.

Movement behaviors in short versus adequate nocturnal sleepers: A compositional analysis of preschoolers.

BACKGROUND: Accruing adequate daily amounts of time spent on movement behaviors (physical activity (PA), sedentary behavior (SB), and sleep) in childhood has been associated with positive short and long-term health outcomes. Nonetheless, how waking time is distributed across PA and SB among preschoolers who are short and adequate sleepers at night is unknown. AIM: This study investigated: (1) if there are differences in a movement behaviors composition among adequate and short nocturnal sleepers; and (2) the association between preschoolers' time spent in PA, SB, and sleep among adequate and short nocturnal sleepers. METHODS: A total of 270 preschoolers (132 boys; 3.97 ± 0.81 years old; 15.48 ± 1.62 kg/m2 ) participated in this study. PA and SB were assessed using accelerometry (model wGT3X). Sleep duration was assessed through a parental-proxy interview, and preschoolers were stratified as short and adequate sleepers, according to attendance to international sleep duration guidelines. Compositional data analysis was used to explore the time-use patterns of behaviors among adequate and short sleepers. RESULTS: Short sleepers spent 64 min less time asleep, accumulated 32 min in more sedentary time (p = .005, Cohen's d = 0.36, Bayes Factor: 6.17), and 24 min more in light PA (p = .0005, Cohen's d = 0.44, Bayes Factor: 46.37) compared to adequate sleepers. CONCLUSIONS: Being a short sleeper was associated with greater time spent in SB and light PA during their waking hours. The health implications of movement behaviors composition among short sleep preschoolers should be further investigated.

Identifying actual and perceived motor competence based profiles among children.

This study aimed to develop motor competence (MC) profiles in children based on their actual and perceived MC, and to investigate differences in physical activity (PA) behaviour and motivation towards PA between profiles. Two hundred and sixteen British children (7-10 years) took part in this study. Perceived motor competence (PMC) was assessed using the pictorial scale of movement competence. MC was assessed using process-oriented and product-oriented measures. A validated questionnaire assessed motivation towards PA and an objective measure of PA was employed. K-means cluster analysis was used to create profiles. Differences in PA and motivation towards PA were examined using ANCOVAs. Four groups of divergent and convergent levels were identified based on the contribution of either product or process MC with PMC. Motivation towards PA differed by profiles that included actual-process and PMC. Children with high actual process and high PMC had significantly higher levels of autonomous motivation than children with high actual process but low PMC. No significant differences were found between PA levels and profiles. Developing the quality and execution of actual motor competence (AMC) and PMC is key to stimulate motivation towards PA. Furthermore, maintaining AMC and PMC simultaneously may be imperative to children's future PA behaviour.

TGMD-3 short version: Evidence of validity and associations with sex in Irish children.

This study examined the internal structure and evidence of validity of the Test of Gross Motor Development 3rd edition (TGMD-3) in primary school aged children. Participants (n = 1608, 47% girls, age range 5-11 years, mean age 9.2 ± 2.04) were recruited from Irish schools across twelve counties (56% rural, 44% urban). The TGMD-3 was used to measure FMS proficiency (Ulrich, 2020). A two-factor model (13 skills) was used and confirmatory indexes were calculated. The Bayesian criteria and the Composite Reliability were employed to evaluate alternative models. Relationships between the final model proposed with age, sex and BMI were calculated using a network analysis. Mplus 8.0 and Rstudio were used. A two-factor model (locomotion and object control) with adequate values (> 0.30) for the seven skills (gallop, hop, jump, two-hand strike, bounce, catch, overhand throw) presented excellent indexes. The skills with the highest indicator of strength centrality in the network were bounce and catch for both boys and girls and hop for boys and horizontal jump for girls. This study evidences the validity and reliability of the internal structure of the TGMD-3 and demonstrates that a short version of the TGMD-3, comprising seven skills is a valid measure of FMS in this population.

The Effects of 6 Weeks Eccentric Training on Speed, Dynamic Balance, Muscle Strength, Power, and Lower Limb Asymmetry in Prepubescent Weightlifters.

ABSTRACT: Hammami, R, Duncan, MJ, Nebigh, A, Werfelli, H, and Rebai, H. The effects of 6 weeks eccentric training on speed, dynamic balance, muscle strength, power and lower limb asymmetry in prepubescent weightlifters. J Strength Cond Res 36(4): 955-962, 2022-This study examined whether 6 weeks of twice-weekly in-season hamstring eccentric training would enhance selected performance-related abilities in prepubescent male weightlifters. Twenty elite weightlifters (11.1 ± 0.8 years) were randomly split into an eccentric training intervention group (INT n = 10) or a control group (CON) that maintained their standard in-season regimen (n = 10). Pre-intervention and postintervention speed, dynamic balance, muscle strength, power, and lower limb (LL) asymmetry were assessed. Analysis of covariance controlling for maturation was used to determine any differences in the performance variables. There were no significant changes in muscle strength, dynamic balance, or LL asymmetry (all p < 0.05) because of the intervention. Both 10-m (p = 0.001) and 30-m (p = 0.007) sprint speed and agility (p = 0.049) improved to a greater extent in INT compared with the CON group. Similar results were evident for the standing long jump (p = 0.015) and 3 hop test (p = 0.004) where performance improved to a greater magnitude in INT compared with CON groups. This study suggests that eccentric training, undertaken twice weekly for 6-weeks results in positive changes in sprint speed, change of direction speed, and power performance, but not muscle strength, dynamic balance, or LL asymmetry in prepubertal weightlifters.

The Effects of Physical Fitness on Postactivation Potentiation in Professional Soccer Athletes.

ABSTRACT: Guerra, MA Jr, Caldas, LA, Souza, HL, Tallis, J, Duncan, MJ, and Guimarães-Ferreira, L. The effects of physical fitness on postactivation potentiation in professional soccer athletes. J Strength Cond Res 36(6): 1643-1647, 2022-To investigate the relationship of the response to postactivation potentiation (PAP) with scores of physical fitness. Twenty-four professional male soccer players undertook tests of agility, muscular power, aerobic capacity, and body composition. Conditioning activities (CAs) were performed consisting of plyometrics exercises and sprints with sled towing. In the first and second sessions, body composition, agility, power, and aerobic capacity were assessed. At the third session, countermovement jumps (CMJ) were performed with 1, 3, and 5 minutes after the execution of the CA. Significant differences were found for CMJ height 1, 3, and 5 minutes after the CA compared with baseline values (3.58, 5.10, 5.48%, respectively). There was a significant positive correlation between the level of general physical fitness and PAP (CMJ height increase) 5 minutes after (r = 0.73). When the athletes were divided into groups with higher and lower physical fitness, the CA caused a significant increase in CMJ height in both groups, but a significant difference (p < 0.05) was observed at all times after PAP induction, with better performance in higher versus lower fitness level. The results suggest that plyometrics exercises associated with sled towing sprints as a CA result in an increase in CMJ performance in athletes and that physical fitness directly influences the PAP occurrence, with higher fit players demonstrating an enhanced PAP response.

Practices of Strength and Conditioning Coaches: A Snapshot From Different Sports, Countries, and Expertise Levels.

ABSTRACT: Weldon, A, Duncan, MJ, Turner, A, LaPlaca, D, Sampaio, J, and Christie, CJ. Practices of strength and conditioning coaches: a snapshot from different sports, countries, and expertise levels. J Strength Cond Res 36(5): 1335-1344, 2022-This study describes the practices of strength and conditioning coaches (SCCs) from different sports, countries, and expertise levels. One hundred fifty-six SCCs (31.9 ± 8.9 years old) completed an online survey, consisting of 40 questions (36 fixed response and 4 open-ended), with 8 sections as follows: (a) background information, (b) muscular strength and power development, (c) speed development, (d) plyometrics, (e) flexibility development, (f) physical testing, (g) technology use, and (h) programming and any additional comments. Responses were received from 48 sports and 17 countries. This study provides exploratory evidence incorporating responses primarily in soccer (45%), track and field (30%), volleyball (23%), golf (17%), and tennis (17%). A bachelor's degree or higher were held by 99% of SCCs, of which 94% were in a sports science-related field, and 71% held a strength and conditioning related certification or accreditation. Periodization strategies and physical testing were used by 96% and 94% of SCCs respectively. The hang clean (82%), power clean (76%), and clean high pull (63%) were the most prescribed Olympic weightlifting exercises. Multiple hops/lunges (84%) were the most prescribed plyometrics exercises. For open-ended questions, 40% of SCCs wanted to integrate more technology into their programs and 30% believed technology will be the main future trend. Strength and conditioning coaches from different sports, countries, and expertise levels can use the information presented in this study to review their current practices and provide a source of new ideas for diversifying or modifying future practices.

Practices of strength and conditioning coaches in professional sports: a systematic review.

The practices of strength and conditioning (S&C) coaches have been reported in various professional sports. This study aims to comprehensively assess this available evidence to help establish whether theoretical, practical, and evidence-based guidelines align with the practices employed by these experienced S&C coaches. Three databases were searched (PubMed, SPORTDiscus, and Cochrane) until November 2020. Studies surveying the practices of S&C coaches in professional sports using a survey design with common questions, written in English, and published in peer-reviewed journals were reviewed. Eight studies (n = 318 S&C coaches) were finally included. All studies adapted a similar survey, providing a strong basis for comparison between sports. Periodization strategies were widely used (89%), with training volume consistently reduced during the in-season period. Olympic weightlifting was commonly used across sports, except in baseball (29%). Plyometric exercises were predominantly prescribed for speed development (74%) and lower body power (68%), which were mostly programed as complex training (45%) and conducted all year round (52%). Flexibility exercises were mostly performed before practice (83%) for 6-10 min (40%). Physical tests were mainly conducted during the preseason period (66%), with body composition (86%) being the most used test. S&C coaches generally adhered to current guidelines and research in S&C concerning training prescription and physical testing. Whereas, intersport differences were also noted and further discussed. Results of this study can be used by S&C coaches to plan, implement, and review their professional practices. Furthermore, may inform the development of general and sport-specific guidelines, and future research in S&C.

Enhancing the implementation and sustainability of fundamental movement skill interventions in the UK and Ireland: lessons from collective intelligence engagement with stakeholders.

BACKGROUND: To have population-level impact, physical activity (PA) interventions must be effectively implemented and sustained under real-world conditions. Adequate Fundamental Movement Skills (FMS) is integral to children being able to actively participate in play, games, and sports. Yet, few FMS interventions have been implemented at scale, nor sustained in routine practice, and thus it is important to understand the influences on sustained implementation. The study's aim was to use Collective Intelligence (CI)-an applied systems science approach-with stakeholder groups to understand barriers to the implementation of FMS interventions, interdependencies between these barriers, and options to overcome the system of barriers identified. METHODS: Three CI sessions were conducted with three separate groups of experienced FMS intervention researchers/practitioners (N = 22) in the United Kingdom and Ireland. Participants generated and ranked barriers they perceive most critical in implementing FMS interventions. Each group developed a structural model describing how highly ranked barriers are interrelated in a system. Participants then conducted action mapping to solve the problem based on the logical relations between barriers reflected in the model. RESULTS: The top ranked barriers (of 76) are those related to policy, physical education curriculum, and stakeholders' knowledge and appreciation. As reflected in the structural model, these barriers have influences over stakeholders' efficacy in delivering and evaluating interventions. According to this logical structure, 38 solutions were created as a roadmap to inform policy, practice, and research. Collectively, solutions suggest that efforts in implementation and sustainability need to be coordinated (i.e., building interrelationship with multiple stakeholders), and a policy or local infrastructure that supports these efforts is needed. CONCLUSIONS: The current study is the first to describe the complexity of barriers to implementing and sustaining FMS interventions and provide a roadmap of actions that help navigate through the complexity. By directing attention to the ecological context of FMS intervention research and participation, the study provides researchers, policy makers, and practitioners with a framework of critical components and players that need to be considered when designing and operationalising future projects in more systemic and relational terms.

A systematic review of tools designed for teacher proxy-report of children's physical literacy or constituting elements.

BACKGROUND: Physical literacy (PL) in childhood is essential for a healthy active lifestyle, with teachers playing a critical role in guiding its development. Teachers can assist children to acquire the skills, confidence, and creativity required to perform diverse movements and physical activities. However, to detect and directly intervene on the aspects of children's PL that are suboptimal, teachers require valid and reliable measures. This systematic review critically evaluates the psychometric properties of teacher proxy-report instruments for assessing one or more of the 30 elements within the four domains (physical, psychological, cognitive, social) of the Australian Physical Literacy Framework (APLF), in children aged 5-12 years. Secondary aims were to: examine alignment of each measure (and relevant items) with the APLF and provide recommendations for teachers in assessing PL. METHODS: Seven electronic databases (Academic Search Complete, CINAHL Complete, Education Source, Global Health, MEDLINE Complete, PsycINFO, and SPORTDiscus) were systematically searched originally in October 2019, with an updated search in April 2021. Eligible studies were peer-reviewed English language publications that sampled a population of children with mean age between 5 and 12 years and focused on developing and evaluating at least one psychometric property of a teacher proxy-report instrument for assessing one or more of the 30 APLF elements. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance was followed for the conduct and reporting of this review. The methodological quality of included studies and quality of psychometric properties of identified tools were evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidance. Alignment of each measure (and relevant items) with the APLF domains and 30 elements was appraised. RESULTS: Database searches generated 61,412 citations; reduced to 41 studies that evaluated the psychometric properties of 24 teacher proxy-report tools. Six tools were classified as single domain measures (i.e. assessing a single domain of the APLF), eleven as dual-domain measures, and seven as tri-domain measures. No single tool captured all four domains and 30 elements of the APLF. Tools contained items that aligned with all physical, psychological, and social elements; however, four cognitive elements were not addressed by any measure. No tool was assessed for all nine psychometric properties outlined by COSMIN. Included studies reported a median of 3 out of nine psychometric properties. Most reported psychometric properties were construct validity (n = 32; 78% of studies), structural validity (n = 26; 63% of studies), and internal consistency (n = 25; 61% of studies). There was underreporting of content validity, cross-cultural validity, measurement error, and responsiveness. Psychometric data across tools were mostly indeterminate for construct validity, structural validity, and internal consistency. CONCLUSIONS: There is limited evidence to fully support the use of a specific teacher proxy-report tool in practice. Further psychometric testing and detailed reporting of methodological aspects in future validity and reliability studies is needed. Tools have been designed to assess some elements of the framework. However, no comprehensive teacher proxy-report tool exists to assess all 30 elements of the APLF, demonstrating the need for a new tool. It is our recommendation that such tools be developed and psychometrically tested. TRIAL REGISTRATION: This systematic review was registered in the PROSPERO international prospective register of systematic reviews, with registration number CRD42019130936 .

Development and Pilot Testing of Entrustable Professional Activities for US Anesthesiology Residency Training.

BACKGROUND: Modern medical education requires frequent competency assessment. The Accreditation Council for Graduate Medical Education (ACGME) provides a descriptive framework of competencies and milestones but does not provide standardized instruments to assess and track trainee competency over time. Entrustable professional activities (EPAs) represent a workplace-based method to assess the achievement of competency milestones at the point-of-care that can be applied to anesthesiology training in the United States. METHODS: Experts in education and competency assessment were recruited to participate in a 6-step process using a modified Delphi method with iterative rounds to reach consensus on an entrustment scale, a list of EPAs and procedural skills, detailed definitions for each EPA, a mapping of the EPAs to the ACGME milestones, and a target level of entrustment for graduating US anesthesiology residents for each EPA and procedural skill. The defined EPAs and procedural skills were implemented using a website and mobile app. The assessment system was piloted at 7 anesthesiology residency programs. After 2 months, faculty were surveyed on their attitudes on usability and utility of the assessment system. The number of evaluations submitted per month was collected for 1 year. RESULTS: Participants in EPA development included 18 education experts from 11 different programs. The Delphi rounds produced a final list of 20 EPAs, each differentiated as simple or complex, a defined entrustment scale, mapping of the EPAs to milestones, and graduation entrustment targets. A list of 159 procedural skills was similarly developed. Results of the faculty survey demonstrated favorable ratings on all questions regarding app usability as well as the utility of the app and EPA assessments. Over the 2-month pilot period, 1636 EPA and 1427 procedure assessments were submitted. All programs continued to use the app for the remainder of the academic year resulting in 12,641 submitted assessments. CONCLUSIONS: A list of 20 anesthesiology EPAs and 159 procedural skills assessments were developed using a rigorous methodology to reach consensus among education experts. The assessments were pilot tested at 7 US anesthesiology residency programs demonstrating the feasibility of implementation using a mobile app and the ability to collect assessment data. Adoption at the pilot sites was variable; however, the use of the system was not mandatory for faculty or trainees at any site.

Pre-schoolers fundamental movement skills predict BMI, physical activity, and sedentary behavior: A longitudinal study.

AIMS: This study aimed to predict the variation in future fundamental movement skills (FMS), physical activity (PA) and body mass index (BMI) from prior FMS, PA, and BMI in British pre-schoolers. METHODS: British pre-schoolers (n = 177) underwent assessment of FMS, via the Test of Gross Motor Development 2 (TGMD-2), BMI, and PA, via accelerometer at two time points one year apart. Regression analysis was used to predict the change in PA and BMI in Year 2 from FMS variables in Year 1 and Year 2. RESULTS: Variation in FMS performance between individuals predicted a significant amount of change in BMI, with 12.3 and 9.8% of the change in Year 2 BMI data explained by change in Year 1 and Year 2 FMS data, respectively. Change in FMS performance between individuals predicted a significant amount of change in PA, but was better at predicting change in sedentary activity rather than light or moderate-vigorous activities. A combination of run, throw, dribble, and kick performance predicted 46.1% of the change in sedentary activity between individuals in the 2nd year of testing. CONCLUSIONS: FMS mastery at four years of age predicts children's BMI and time spent sedentary at five years of age.

Technology-based methods for the assessment of fine and gross motor skill in children: A systematic overview of available solutions and future steps for effective in-field use.

The present review aims at providing researchers and practitioners with a holistic overview of technology-based methods for the assessment of fine and gross motor skill in children. We conducted a search of electronic databases using Web of Science, PubMed and Google Scholar, including studies published up to March 2020, that assessed fine and/or gross motor skills, and utilized technological assessment of varying study design. A total of 739 papers were initially retrieved, and after title/abstract screening, removal of duplicates, and full-text screening, 47 were included. Results suggest that motor skills can be quantitatively estimated using objective methods based on a wearable- and/or laboratory-based technology, for typically developing (TD) and non-TD children. Fine motor skill assessment solutions were; force transducers, instrumented tablets and pens, surface electromyography, and optoelectronic systems. Gross motor skill assessment solutions were; inertial measurements units, optoelectronic systems, baropodometric mats, and force platforms. This review provides a guide in identifying and evaluating the plethora of available technological solutions to motor skill assessment. Although promising, there is still a need for large-scale studies to validate these approaches in terms of accuracy, repeatability, and usability, where interdisciplinary collaborations between researchers and practitioners and transparent reporting practices should be advocated.

The influence of COVID-19 measures in the United Kingdom on physical activity levels, perceived physical function and mood in older adults: A survey-based observational study.

In March 2020, the spreading Coronavirus (COVID-19) prompted the United Kingdom government to introduce a societal shutdown, accompanied by self-isolation and social-distancing measures to reduce virus transmission. In doing so, opportunities for physical activity were likely reduced, potentially causing detrimental effects to older adults. Therefore, the present study investigated the influence of the initial six weeks of lockdown on physical activity levels, perceived physical function and mood in older adults. A cross-sectional, mixed-methods, observational study was conducted using self-administered, fortnightly online surveys throughout the UK between 21st March-4 May 2020. A total of 117 participants (52 males [age: 76 ± 4 years] and 65 females [age: 76 ± 4 years]) completed all surveys. Despite lockdown restrictions, this group of older adults maintained their pre-lockdown physical activity levels, but also increased their self-reported sedentary time. Subsequently, perception of physical function was maintained across lockdown. With regards to mood; the only strong evidence for an increase in depression was for males (ps = 95.35%; >0.3 AU), although self-reported levels of depression were similar between sexes at week six. Given the link between sedentary behaviour and negative health outcomes in older adults, strategies to reduce sedentariness during the COVID-19 pandemic are required.

Using Collective Intelligence to identify barriers to implementing and sustaining effective Fundamental Movement Skill interventions: A rationale and application example.

To have population-level impact, interventions must be effectively implemented and sustained under real-world conditions. Few Fundamental Movement Skill (FMS) interventions are implemented at scale, and even fewer are sustained in a way that allows for ongoing evaluation. There has been increasing recognition of applying systems thinking to investigate the multitude of influences on interventions. To improve research-practice translations, investigations need to incorporate synthesised perspective and collective input from intervention stakeholders. This study trials Collective Intelligence (CI) - an applied systems science approach - to understand barriers to the adoption, implementation and institutionalisation of effective FMS interventions for children and adolescents. A total of 58 barriers were generated and organised into 13 barrier categories. Participants voted to select 10 critical barriers and generated a structural map among the barriers to guide future action mapping. Barriers related to Government and Institutional factors and Curricular Conflicts were structured as fundamental drivers of the system of barriers. By presenting this application example, we aim to underline the considerations and alleviate barriers to conducting much needed implementation and sustainability studies in FMS interventions. CI also adds to the "tool box" to understand the complexity and functioning of public health interventions, such as those targeting physical activity behaviours.