Investigating the role of clinical exposure on motivational self-regulation skills in medical students based on cognitive apprenticeship model.

BACKGROUND: The importance of motivation regulation in medical students is highly significant due to their unique educational circumstances, such as clinical exposure. However, the role of clinical exposure in learning motivational self-regulation skills in students has not been explored thus far. This current study aims to investigate the role of clinical exposure on motivational self-regulation skills in medical students based on cognitive apprenticeship model. METHOD: This study was descriptive-analytical research conducted in 2022 on medical students. Data collection involved two questionnaires including Meta motivational Strategies in Medical Students Questionnaire and Maastricht Clinical Teaching Questionnaire. The research comprised two stages including measuring motivational self-regulation strategies in students before entering the clinical exposure phase, and simultaneous measurement of clinical exposure based on the student's viewpoint and their motivational self-regulation strategies at the end of the first term of clinical exposure. RESULTS: The results revealed a significant relationship between six dimensions of the cognitive apprenticeship model, including modeling, coaching, scaffolding, reflection, exploration, and learning environment, with motivational self-regulation strategies. However, there was no significant relationship between the articulation dimension of the cognitive apprenticeship model and motivational self-regulation strategies. CONCLUSION: Clinical exposure indirectly enhances students' metacognitive skills. Observing the behavior of clinical faculty in the clinical exposure setting leads to the improvement of motivational self-regulation strategies in medical students.

Understanding Residents' and Supervisors' Views on Developing Support-Autonomy Balance Through Supervision Methods in Postgraduate Dental Training: A Qualitative Study.

BACKGROUND: Supervisors continuously need to decide when to provide clinical opportunities for unsupervised patient care to facilitate residents' development in the complex clinical learning context. The aim of this study is to explore residents' and supervisors' views and understanding of the influence of clinical supervision on affording a balanced support-autonomy from the cognitive apprenticeship (CA) theoretical lens. METHODS: Residents and supervisors, representing all disciplines, participated in five focus groups and four semi-structured individual interviews. Purposive and convenience sampling methods were used for recruiting participants. The reflexive thematic analysis approach was used for inductive data analysis. RESULTS: A total of 15 residents and 8 supervisors participated in this study. All agreed that CA teaching methods can be applied across all levels. Participants experienced changes in their supervision methods and supervisor-resident interactions at different levels of training. They related the selection of supervision to task-, resident- and supervisor-related factors. Learning facilitating factors in clinical learning environment were identified and suggestions to enrich residents' learning experiences were also reported. CONCLUSION: The current study found that a one-size-fits-all paradigm may not be effective for clinical supervision. It contributes to our understanding of how the CA model may be used to guide supervisor behaviour and how such practices can be modified to residents' level of development and competencies.

Integrating traditional apprenticeship and modern educational approaches in traditional Chinese medicine education.

BACKGROUND: The traditional apprenticeship system and modern educational models both contribute to traditional Chinese medicine (TCM) education in unique ways. This study aims to evaluate the advantages and disadvantages of these approaches and investigates their potential integration for optimal TCM teaching. METHODS: The study employs a comprehensive literature search strategy with specific keywords through Boolean Operators, focusing on articles discussing TCM education, sourced from the databases PubMed, Scopus, and CNKI. For comparative analysis, the study analyzes the advantages and disadvantages of three distinct approaches-traditional, modern, and hybrid-in TCM education. Finally, we use a spider plot methodology to visually evaluate across 11 critical educational aspects for these approaches. RESULTS: A comprehensive review of 70 articles on TCM education highlights the value of both conventional and modern approaches. Conventional methods often emphasize teacher-centered clinical training that aligns well with the apprenticeship model, serving to bridge formal academic learning with hands-on experience. Modern methods incorporate elements like technology and formal accreditation but caution that the absence of traditional apprenticeship could dilute core TCM principles. One recurring theme across multiple studies is the enduring importance of apprenticeship-a pedagogical cornerstone rooted in TCM's historical and cultural context-as well as its tension with modern methodologies that incorporate online resources and scientific frameworks. An integrated approach attempts to harmonize these strengths but reveals a gap in interactivity, suggesting that incorporating apprenticeship could offer a practical, hands-on method to improve student engagement. CONCLUSIONS: Conventional methods in TCM education emphasize teacher-centered clinical training akin to apprenticeship, modern methods incorporate technological advances and formal accreditation; however, the absence of traditional apprenticeship could compromise core TCM principles, and an integrated model, though striving to harmonize these elements, still falls short in the area of student interactivity.

The Shaman and Schizophrenia, Revisited.

This paper presents evidence that some-but not all-religious experts in a particular faith may have a schizophrenia-like psychotic process which is managed or mitigated by their religious practice, in that they are able to function effectively and are not identified by their community as ill. We conducted careful phenomenological interviews, in conjunction with a novel probe, with okomfo, priests of the traditional religion in Ghana who speak with their gods. They shared common understandings of how priests hear gods speak. Despite this, participants described quite varied personal experiences of the god's voice. Some reported voices which were auditory and more negative; some seemed to describe trance-like states, sometimes associated with trauma and violence; some seemed to be described sleep-related events; and some seemed to be interpreting ordinary inner speech. These differences in description were supported by the way participants responded to an auditory clip made to simulate the voice-hearing experiences of psychosis and which had been translated into the local language. We suggest that for some individuals, the apprenticeship trained practice of talking with the gods, in conjunction with a non-stigmatizing identity, may shape the content and emotional tone of voices associated with a psychotic process.

A tripartite understanding of experiences of young apprentices: A case study of the London Borough of Hounslow.

In 2019, a decline in apprenticeship starts prompted the London Borough of Hounslow to make an apprenticeship pledge in its Corporate Plan 2019-2024, committing to create 4,000 new apprenticeships and training opportunities to help young people into work. This article investigates experiences of young apprentices in Hounslow before and during the COVID-19 pandemic. Exploring the perspectives of two apprentices, two employers and one training provider in a small-scale qualitative study, the authors identify key hindering and supporting factors affecting entry into and sustainability of apprenticeships, and progression towards professional employment. They found that labour market entry was intensely hindered by competition (with peers who had better maths and English qualifications, for a small number of apprenticeships) and organisational barriers (such as managers with prejudices against young people, stigmatising apprentices and apprenticeships). Supportive factors identified include personal characteristics (such as a positive mindset, enabling young people to persevere despite a disadvantaged socioeconomic background and lack of family support, for example) and supportive relationships (e.g. mentoring) between apprentices and their training providers or employers.

Compréhension tripartite des expériences de jeunes apprentis : étude de cas réalisée dans le quartier londonien de Hounslow ­ En 2019, un déclin du nombre de nouveaux contrats d'apprentissage a poussé le quartier londonien de Hounslow à prendre un engagement en faveur de l'apprentissage dans son plan 2019­2024 pour les entreprises, dans lequel il s'engageait à créer 4 000 places d'apprentissage et possibilités de formation pour aider les jeunes à entrer dans la vie active. Cet article se penche sur les expériences de jeunes apprentis à Hounslow avant et pendant la pandémie de COVID-19. Les auteurs ont examiné les points de vue de deux apprentis, de deux employeurs et d'un prestataire de formations dans une étude qualitative à petite échelle et ont identifié des facteurs décisifs freinant ou favorisant l'accession aux apprentissages, la viabilité de ces derniers et le parcours des apprentis vers l'emploi. Ils ont constaté que l'entrée sur le marché du travail était fortement freinée par la concurrence (avec des pairs mieux qualifiés en mathématiques et en anglais qui postulaient pour un nombre restreints de place d'apprentissage) et par des obstacles organisationnels (par exemple des managers qui avaient des préjugés à l'égard des jeunes, qui stigmatisaient les apprentis et les apprentissages). Parmi les facteurs favorables qu'ils ont identifiés, notons les traits de caractère personnels (par exemple un état d'esprit positif permettant aux jeunes de persévérer malgré leur milieu socio-économique défavorisé et l'absence de soutien de leur famille) et les relations de soutien (par exemple le mentorat) entre les apprentis et leurs prestataires de formation ou leurs employeurs.

Exploring cognitive apprenticeship and teaching practices in pharmacy education.

Health professions schools in the United States and internationally have engaged in curricular changes to better prepare students for the future of health care. However, designing or selecting evidence-based teaching activities can be a challenge. Research suggests the Cognitive Apprenticeship theory is an effective framework for the health professions to inform instruction design, yet these studies have mainly focused on the clinical setting and not the didactic learning environment. This study used qualitative methods to explore the Cognitive Apprenticeship framework in the didactic learning environment and the teaching practices that pharmacy faculty used to explicate their expert thinking to students. Faculty were observed using all four Cognitive Apprenticeship dimensions (ie, Content, Sequencing, Methods, Sociology) in their teaching practice. Patterns were observed in the data revealing complex, short and sometimes spontaneous teaching practices that faculty used to promote learning.

Young people's health and well-being during the school-to-work transition: a prospective cohort study comparing post-secondary pathways.

BACKGROUND: At the end of secondary education, young people can either start vocational training, enter university, directly transition to employment or become unemployed. Research assumes that post-secondary pathways have immediate and/or long-term impacts on health and well-being, but empirical investigations on this are scarce and restricted to few countries. Therefore, this study traced the development of health and well-being throughout the highly institutionalised school-to-work transition (STWT) in Germany. METHODS: We used longitudinal data of the National Educational Panel Study (NEPS), a representative sample of 11,098 school-leavers (50.5% girls) repeatedly interviewed between 2011 and 2020. We estimated the effect of post-secondary transitions on self-rated health and subjective well-being by applying fixed-effects (FE) regression, eliminating bias resulting from time-constant confounding and self-selection into different pathways. A multiple-sample strategy was used to account for the increasing diversity of STWTs patterns. Models were controlled for age, as well as household and residential changes to minimise temporal heterogeneity. RESULTS: Findings indicate that leaving school was good for health and well-being. Compared with participants who did not find a training position after school, direct transitions to vocational training or university were linked to higher absolute levels of health and well-being, but also to a lower relative decline over time. Furthermore, upward transitions (e.g. to programs leading to better education or from unemployment to employment) were associated with improvements in health and well-being, while downward transitions were followed by deteriorations. CONCLUSION: Findings suggest that school-leave is a sensitive period and that post-secondary pathways provide young people with different abilities to maintain health and well-being. Youth health interventions might benefit when setting a stronger focus on unsuccessful school-leavers.

Describing Ultrasound Skills Teaching by Near-Peer and Faculty Tutors Using Cognitive Apprenticeship.

Phenomenon: Ultrasound skills are becoming increasingly important in clinical practice but are resource-intensive to teach. Near-peer tutors often alleviate faculty teaching burden, but little is known about what teaching methods near-peer and faculty tutors use. Using the lens of cognitive apprenticeship, this study describes how much time faculty and near-peer tutors spend on different teaching methods during abdominal ultrasound skills training. Approach: Sixteen near-peer and 16 faculty tutors were videotaped during one 55-min practical ultrasound lesson with randomly assigned students. Videos were directly coded using Cognitive Apprenticeship teaching methods and activities. Segment durations were summed up and compared quantitatively. Findings: All 32 tutors spent most of the time on observing and helping students (Coaching, Median 29:14 minutes), followed by asking open and stimulating questions (Articulation, 12:04 minutes and demonstrating and giving explanations (Modeling, 04:50 minutes). Overall, distributions of teaching methods used were similar between faculty and near-peer tutors. However, faculty tutors spent more time on helping students manually, whereas near-peer tutors spent more time on exploring students' learning gaps and establishing a safe learning climate. Cognitive Apprenticeship was well suited as observational framework to describe ultrasound skills. Insights: Ultrasound train-the-tutor programs should particularly focus on coaching and articulation. Near-peers' similar use of teaching methods adds to the evidence that supports the use of near-peer teaching in ultrasound skills education.

Implementation of the cognitive apprenticeship model for enhancement of advanced searching skills in a pharmacy academia rotation.

BACKGROUND: Pharmacy students are primarily taught literature searching skills didactically during their Doctor of Pharmacy curriculum. To effect change in the area of advanced literature searching skills, a pharmacy librarian joined with two Advanced Pharmacy Practice Experience (APPE) preceptors to design and implement a crash course on applied systematic searching skills for a cohort of four students. CASE PRESENTATION: Through the cognitive apprenticeship model, a Systematic Searching Crash Course (SSCC) was implemented among a cohort of four academic APPE students. Students developed search strategies using controlled vocabulary and free text, translated their searches into multiple databases, and used citation management software to build libraries of evidence. Additionally, the cohort blindly peer reviewed each other's search strategies, wrote literature reviews, and finally conducted a search together without input from the pharmacy librarian. CONCLUSIONS: Review of the pre-/post-course self-assessment taken by the cohort indicates the SSCC is a success in terms of improving student confidence in accessing and synthesizing primary literature. As the crash course is further refined and implemented, there may be more opportunity to embed the course into didactic curriculum and residency programs and to potentially reproduce it for other health science disciplines.

Motives for studying dental medicine in Germany.

INTRODUCTION: Aim of this study was to investigate the motives for studying dental medicine of pupils and students accepted for first semester. METHODS: Motives of pupils from secondary schools (grades 10-12) around Tübingen and accepted students at the Dental School Tübingen were evaluated using a five-level Likert scale. Information about age, gender, family, apprenticeship and university enrolment was also included in the assessment. RESULTS: A total of 402 out of 409 participants filled out the questionnaires. Of these, 390 (280 females and 110 males) could be evaluated; the mean age was 17.4 years. Sixty-one planned an apprenticeship and 64 already completed it; 93 were readily accepted at university. All participants highly rated the motives "help patients" and "good career prospects." As next, women chose "diversified activity" and men "scientific interest." Participants who planned an apprenticeship rated "help patients" significantly higher than the other participants, whilst the motive "high responsibility of the dental profession" amongst interviewees with completed apprenticeship was highly significant in comparison with the rest. CONCLUSION: Empathy for patients and high responsibility of the dental profession are more important than prestige or social standing. An apprenticeship seems to greatly influence the career choice by giving more weight to "high responsibility of the dental profession." In future, such results can help universities design selection tests to target specific groups. The high proportion of female dentists and the attitude towards work and family of the generations Y and Z may bring change to the traditional practice model in Germany.

Whether to flip Extreme Apprenticeship: which is more effective in programming instruction?

Programming knowledge is more important than ever in the digital world. However, teaching programming can be challenging, especially with novice learners. Considerable research has been conducted into the most effective methods for teaching programming. Extreme apprenticeship, a variation of cognitive apprenticeship, is a method that has been used in teaching programming at university level in recent years. Because this method focuses particularly on completing lots of exercises with coaching and guidance, it may solve many problems related to learning programming. Flipped learning can be useful for student preparedness and providing sufficient theoretical knowledge at the beginning of the course. This study compares the applications of the extreme apprenticeship method, flipped extreme apprenticeship, and traditional classroom, analyzing them at the university level in terms of their effects on academic achievement and engagement coupled with gender differences. The findings of the study indicate that the extreme apprenticeship and flipped extreme apprenticeship instructional methods improve academic achievement and student engagement in introductory programming more than the traditional method. The results of the research point to important directions for the development of the extreme apprenticeship method in programming instruction and provide a guide for instructors. Supplementary Information: The online version contains supplementary material available at 10.1007/s10639-022-11055-y.

Development of teaching, mentoring and supervision skills for basic training registrars: a frustrated apprenticeship?

BACKGROUND: Teaching, mentoring and supervision (TMS) are fundamental skills with a specific commitment within the Royal Australasian College of Physicians professional practice framework. The new basic training standards include 'use of appropriate educational techniques to facilitate the learning of peers, junior colleagues and other health professionals and to provide supervision for junior colleagues' but it is unclear how basic physician trainees and equivalent grade doctors (hereinafter 'registrars') will provide, learn or develop TMS skills. AIMS: To explore how registrars provide, learn and develop TMS skills. METHODS: Mixed methods approach. New Zealand registrars were invited to participate in anonymous survey regarding TMS experiences and learning. Focus groups explored skill acquisition and development more deeply. RESULTS: A total of 121 registrars from 16 District Health Boards responded. Registrars supervise two juniors daily (range 0-4+). Fewer than 1:4 have formal training in TMS skills. Free text and focus group themes include: informal development by observing role models plus personal experience of giving and receiving TMS, inequitable access to development opportunities and formal training, barriers include workload and unsupportive learning cultures. Some registrars lack confidence in delivering TMS. CONCLUSIONS: Registrars are expected to teach, mentor and supervise junior colleagues but experience a 'frustrated apprenticeship': formal training is minimal and informal training is dependent on variable role models, opportunities and systematic support. Registrars feel unprepared and lack confidence despite wanting to succeed in this domain. Suggestions for improvement include baseline formal training, purposeful role modelling by seniors and equitable promotion of TMS opportunities.

What do we know about physical activity interventions in vocational education and training? A systematic review.

BACKGROUND: Although the health benefits of physical activity (PA) are well known, young people's level of PA is often insufficient and tends to decline in adolescence. Numerous studies have investigated the effectiveness of PA-promoting interventions among young people, but none have reviewed the effectiveness of PA interventions in the vocational education and training (VET) setting. This systematic review aims to (1) synthesize and review the available literature on PA-promoting interventions in VET and (2) examine the effects of these interventions on PA-related outcomes such as PA level, physical fitness, physiological parameters, or psychological factors. METHODS: Five electronic databases were searched for studies involving adolescents aged 15 to 20 years that took place in VET settings and evaluated the effects of interventions with a PA component on PA-related outcomes such as PA level, physical fitness, physiological parameters, or psychological factors. The screening process and the quality assessment were conducted by two independent reviewers; data extraction was conducted by one reviewer and verified by another. RESULTS: The literature search identified 18,959 articles and 11,282 unique records. After the screening process, nine studies, all coming from European or Asian countries, met the pre-defined eligibility criteria and were included in qualitative analyses. All but two studies reported significant improvements for at least one PA-related outcome. The interventions substantially differed in their development approaches (top-down vs. bottom-up approaches), complexity (multi- vs. single-component), and addressed behavior (multi-behavioral vs. single-behavioral). The most conspicuous finding was that bottom-up approaches tend to improve outcomes at the psychological level and top-down approaches at the physical level. Regarding the interventions' complexity and addressed behavior, we did not reveal any conclusive results. CONCLUSION: This systematic review highlights the varying effects of PA-promoting interventions in VET. Nevertheless, heterogeneous effects, overall weak study quality and availability of studies only from two continents limited our ability to draw clear conclusions about the potentially most effective intervention strategies. Therefore, future research should focus on high-quality studies with long-term follow-ups to make recommendations for practical use. TRIAL REGISTRATION: PROSPERO CRD42018109845.

Why do apprentices smoke much more than high school students? Understanding educational disparities in smoking with a Oaxaca-blinder decomposition analysis.

BACKGROUND: Educational disparities in daily smoking begin during adolescence and can lead to educational disparities in health among adults. In particular, vocational students including apprentices have higher daily smoking rates compared to non-vocational students. This study aimed to identify the determinants of the gap in daily smoking between French apprentices and high school students aged 17 in 2008 and in 2017. METHODS: We used data from a cross-sectional repeated survey representative of all French adolescents aged 17 in 2008 and 2017. We conducted a non-linear extension of the Oaxaca-Blinder decomposition technique and included the following variables: sociodemographic and familial characteristics, parental smoking, cannabis and alcohol use, suicidal attempt, grade repetition and money received. RESULTS: Daily smoking was about two times higher among French apprentices compared to high school students in 2008. This gap did not decrease between 2008 and 2017. Differences in measured characteristics between the two groups explained this gap partly, from 28.6 to 51.2%. Cannabis and alcohol use, money received and parental smoking contributed the most to the daily smoking gap. CONCLUSIONS: Prevention programs could target cannabis and alcohol use as well as parental smoking to help decrease educational disparities in smoking status among French adolescents.

Improved cognitive apprenticeship clinical teaching after a faculty development program.

BACKGROUND: While it is well known that the cognitive apprenticeship is an effective workplace-based teaching approach for clinical teachers, the effects of faculty development (FD) have not been analyzed from that perspective. The purpose of this study was to investigate self-assessment by clinical teachers of their educational perceptions and behaviors after a FD program using the cognitive apprenticeship model. METHODS: Board-certified pediatricians who participated in a 3-day FD program on practical clinical teaching were asked to complete questionnaires. Fifty participants completed two questionnaires prior to and 3 and 6 months after the FD program: the first was on the participants' general perceptions and behaviors in relation to their own clinical education and the second was a self-assessment using the Maastricht Clinical Teaching Questionnaire (MCTQ) that was developed based on the cognitive apprenticeship model. RESULTS: The general survey demonstrated that 78% of the participants experienced positive changes in their educational perceptions 6 months after FD. Self-assessment using the MCTQ showed that the scores in the categories of "articulation," "exploration," and "safe learning environment" remained significantly improved 6 months after the FD program. CONCLUSIONS: The participants' self-perceived improvement in behaviors was sustainable for 6 months after participation the FD program. The results of the MCTQ show that through their experiences in the FD program, the participants seemingly transformed their clinical teaching to become interactive facilitators, encouraging self-directed learning. Our results also suggest that the MCTQ can be used for self-assessment of clinical teachers and to enhance the effectiveness of the FD program.

Predicting occupational allergy in culinary and hairdressing apprentices.

BACKGROUND: Apprentices are usually exposed to the same workplace agents as qualified professionals. There is therefore a risk of the development of occupational allergy in apprentices exposed to high (HMW-A) and low molecular inhalant allergens (LMW-A). AIMS: To evaluate and compare the occurrence of work-related allergy-like symptoms in apprentices exposed to HMW-A and LMW-A in a culinary and hairdressing school during the first and second year of vocational training. METHODS: We asked culinary and hairdressing apprentices in their first and second year of vocational training to complete a questionnaire about work-related allergy-like symptoms. In first-year apprentices, we undertook spirometry, skin prick tests for occupational allergens and blood tests for allergen-specific Immunoglobulin E (IgE) antibodies. RESULTS: Hypersensitivity to occupational allergens was more frequent in first-year apprentices exposed to HMW-A compared to LMW-A (P < 0.05). Apprentices exposed to LMW-A reported increasing occurrence of skin disorders and upper respiratory tract symptoms between the first and second years of training. First-year apprentices exposed to HMW-A more frequently reported rhino-conjunctivitis and dyspnoea (approximately P < 0.001 and P < 0.05) and those exposed to LMW-A more often reported skin symptoms (P < 0.05). CONCLUSIONS: Periodic skin and respiratory health surveillance for apprentices exposed to LMW-A or HMW-A might help with early identification and management of occupational allergy.

Learning radiotherapy: the state of the art.

BACKGROUND: The last two decades have seen revolutionary developments in both radiotherapy technology and postgraduate medical training. Trainees are expected to attain competencies using a mix of experiential learning, formal postgraduate teaching, self-directed learning and peer education. Radiation (Clinical) Oncology is a recognised 'craft specialty' where the apprenticeship model of training is applicable. This scoping review examines the evidence in relation to how medical trainees learn radiotherapy. METHODS: A systematic search of MEDINE and EMBASE was undertaken to identify studies of trainee and/or trainer experience of radiotherapy learning published 1999-2018. Results pertaining to Medical Oncology, workforce trends, undergraduate radiotherapy exposure, academic training, global health, non-medical staff, health service infrastructure and recruitment to training programmes were not included. RESULTS: A total of 146 publications were included in the synthesis. Five themes were apparent through careful iterative analysis representing broadly inter-related issues. Most articles studied radiotherapy training from the perspective of the trainee doctor. Most literature reports results of observational, local or national surveys with a tightly defined scope. Considerable variation exists within hospitals, within countries, over time and between different curricular areas. CONCLUSIONS: Medical education has not kept pace with changes in the field of radiotherapy and large differences are demonstrated in experience between trainees in different hospitals, countries and training stages. Interpersonal relationships, departmental organisation, and national curricula impact on training quality. Qualitative and quantitative research examining modern radiotherapy learning has been uncommon and uncoordinated, until recently. To date no single study has been designed to comprehensively assess a department's training scheme.

Neuroanesthesiologists as interoperative neurophysiologists: a collaborative cognitive apprenticeship model of training in a community of clinical practice.

Directing intraoperative neurophysiologic monitoring (IONM) is a patient care activity for which no formal training programs exist, even though the need for well-trained practitioners is readily evident while caring for patients with diseases of the brain, spinal cord, spinal column, or nervous system. Here, we present the theoretical basis and institutional experience for a successful model of learning a new and complex set of skills: the medical direction of IONM. In a major academic institution, a clinical community of practice absorbed new members with professional backgrounds ranging from a recent neuroanesthesia fellowship to several decades of neuroanesthesia practice and trained them in a collaborative cognitive apprenticeship model to medically direct IONM. Our community of practice comprises experienced technicians, a diplomate of the American Board of Neurophysiologic Monitoring (DABNM), and six neuroanesthesiologists. This group forms the base of the scaffolding or structure where the apprenticeship and learning take place. The clinical community of practice has trained eight new members in the medical direction of IONM. The group has also trained four outside anesthesiologists-one of whom went on to become certified as a DABNM-who went on to develop the IONM program at a major children's hospital. This collaborative cognitive apprenticeship in anesthesiology to learn the medical direction of IONM is quite innovative as it integrates new members and expands the range of existing ones. In our model, the entire community is elevated by the reciprocal interactions of master clinicians, novice apprentices, and the community of practice.

Surgical resident training in Pakistan and benefits of simulation based training.

Apprentice-mentor is the traditional method for training surgical residents, but with the advent of time, advanced techniques have been developed to train residents. Simulation training is a time-effective method for training residents and is being used globally, but the majority of training hospitals in Pakistan have been practising apprenticeship model since it came into being. This review was planned to demonstrate the results of studies comparing the efficacy of trainees trained via the traditional apprenticeship model versus simulator-based training. Pubmed and Google Scholar were searched. Keywords used were 'simulation-based training', 'laparoscopic simulators' and 'surgical teaching methods'. Articles published between 1995 and 2017 were selected for review. The search was limited to articles published in English language. The review advocates implementation of simulation for training as well as assessment. This can be a magnificent step towards upgrading our healthcare system.

Challenges and opportunities: the role of the district nurse in influencing practice education.

The responsibility of the district nurse (DN), alongside complex case management and leadership, is to ensure Specialist Practitioner Qualification District Nurse (SPQDN) education continues to create practitioners delivering quality evidence-based care. DN leadership and its importance have come to the fore during the COVID-19 crisis, where hospital discharges have increased rapidly to make way for highly complex admissions (HM Government, 2020). This paper examines the importance of the SPQDN qualification, exploring the role of the DN within practice education. Continuation of the vital DN qualification will ensure that the numbers of qualified DNs increase, ultimately protecting community capacity. With a move towards an apprenticeship model to achieve the SPQDN, DNs must engage with and influence curriculum development to confirm courses deliver requirements of the workplace, commissioners and the 2019 NHS Long Term Plan. Expectations of the DN role within practice education have changed, moving away from the practice teacher standards to the new Nursing and Midwifery Council Standards for Student Support and Assessment. This poses new challenges in DN education in practice. The implications of this transition threaten to de-value the quality of the assessment process by removing the high standards of preparation previously demanded; ultimately, this is a risk to the provision of the quality practice education that previously existed.