Defence Medical Services’ REBOA training course

Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) enables temporary haemorrhage control and physiological stabilisation. This article describes the bespoke Defence Medical Services (DMS) training package for effectively using REBOA. The article covers how the course was designed, how the key learning objectives are taught, participant feedback and the authors’ perceptions of future training challenges and opportunities. Since the inaugural training course in April 2019, the authors have delivered six courses, training over 100 clinicians. For the first time in the UK DMS, we designed and delivered a robust specialist endovascular training programme, with demonstrable, significant increases in confidence and competence. As a result of this course, the first DMS REBOA-equipped forward surgical teams deployed in June 2019. Looking to the future, there is a requirement to develop an assessment of skill retention and the potential need for revalidation.

A preliminary study to evaluate white matter structural correlates of delayed visuospatial memory and one-week motor skill retention in nondemented older adults

Skill retention is important for motor rehabilitation outcomes. Recent work has demonstrated that delayed visuospatial memory performance may predict motor skill retention in older and neuropathological populations. White matter integrity between parietal and frontal cortices may explain variance in upper-extremity motor learning tasks and visuospatial processes. We performed a whole-brain analysis to determine the white matter correlates of delayed visuospatial memory and one-week motor skill retention in nondemented older adults. We hypothesized that better frontoparietal tract integrity would be positively related to better behavioral performance. Nineteen participants (age>58) completed diffusion-weighted imaging, then a clinical test of delayed visuospatial memory and 50 training trials of an upper-extremity motor task; participants were retested on the motor task one week later. Principal component analysis was used to create a composite score for the behavioral data for each participant, i.e., shared variance between delayed visuospatial memory and motor skill retention, which was then entered into a voxel-based regression analysis. Behavioral results demonstrated that participants learned and retained their skill level after a week of no practice, and their delayed visuospatial memory score was positively related to the extent of skill retention. Consistent with previous work, neuroimaging results indicated that regions within bilateral anterior thalamic radiations, corticospinal tracts, and superior longitudinal fasciculi were related to better delayed visuospatial memory and skill retention. Results of this study suggest that the simple act of testing for specific cognitive impairments prior to therapy may identify older adults who will receive little to no benefit from the motor rehabilitation regimen, and that these neural regions may be potential targets for therapeutic intervention.

The Iterative Development and Testing of an Interactive Mobile Application for Skill Retention of Cardiopulmonary Resuscitation Among High School Students: A Pilot Study

Background Locations concentrated with High School (HS) students tend to have lower out-of-hospital cardiac arrest (OHCA) survival rates. Mobile applications (apps) have the capability to augment cardiopulmonary resuscitation (CPR) skill retention as a low-cost, accessible training method. Methods An iterative process to develop an app to reinforce CPR skills emphasizing hand placement, compression rate, real-time feedback, and recurring tips is described. The app was tested on HS students to measure its impact on quality and comfort of CPR using Likert surveys and skills assessments before and after one month of usage. CPR Score and compression rate were measured using the Laerdal™ Little Anne Manikin QCPR software. Results Fourteen HS students participated in a prospective observational study. It was found that the use of the developed app was associated with improved CPR performance (80.43% v. 87.86%, p=0.01-0.02, 95% CI=2.20-12.66) after one month. Additionally, improvements were demonstrated in compression rate accuracy (21.43% v. 64.29%, p=0.041, 95% CI=0.132-0.725), increased comfort performing CPR (3.86 v. 4.79, p<0.001, 95% CI =0.99-1.00) and comfort performing CPR on strangers (2.71 v. 4.42, p<0.001, 95% CI=1.24-2.19). In addition, for every time the app was used, CPR performance increased by 0.5668% (p=0.0182). Conclusion Findings suggest that mobile apps may have promising implications as augmentative tools for CPR curriculums.

BLS ERC Certified Greek Providers’ Willingness to Perform CPR and Skill Retention During the Covid-19 Pandemic. A Survey of the Hellenic Society of Cardiology (WG CPR)

Objective: The aim of this study was to evaluate a. the level of established knowledge regarding cardiopulmonary resuscitation (CPR) during the Covid-19 pandemic era of certified Basic Life Support (BLS) providers and b. their attitude towards CPR, along with possible misconceptions regarding Covid-19. Methods: Certified BLS providers from courses held in Athens, Greece were asked to complete an electronic survey regarding their knowledge and behavioral changes on performing CPR on victims with confirmed or suspected Covid-19 infection. Their perception on BLS courses was also assessed. Answers were collected during June 2020. Results: Out of 5513 certified providers, 25.53% completed the survey. The majority (83.36%) would provide CPR to an arrest victim with possible or confirmed Covid-19 infection. Regarding the use of an automated external defibrillator, the majority thinks that it is equally safe as in the pre-Covid-19 period (58.24%). Older age (<0.001) and a lower level of education (p<0.001) made rescuers more willing to provide CPR. Exposure to the European Resuscitation Council (ERC) (p<0.001) and to a lesser degree to Greek National Public Health Organization (NPHO) guidelines was also correlated to a less negative attitude towards resuscitation, whereas time since the last BLS seminar had no such impact (p=0.18). All responders agree that training in CPR during Covid-19 remains necessary.Conclusion: Certified BLS providers maintain willingness to perform CPR in unresponsive victims even during the Covid-19 pandemic era. This attitude is reinforced by exposure to the updated CPR guidelines. Knowledge regarding Covid-19 CPR is satisfactory, with more training focused on the revised algorithms considered essential.

Increased perceptions of autonomy through choice fail to enhance motor skill retention

There has been growing research interest in the effects that motivation plays in motor learning, and specifically how autonomy, competence, and social relatedness may directly benefit the learning process. Here, we present a preregistered manipulation of autonomy-support by providing learners with choice during the practice of a speed cup-stacking skill. One group was given control over when a video demonstration was provided and the viewing speed. A yoked control group received an identical demonstration schedule, but without choice (as their schedule was matched to a participant with choice). Critically, we addressed a gap in the literature by adding a yoked group who was explicitly told that they were being denied choice and that their schedule was chosen by another participant. We found no statistically significant learning differences between groups, despite finding evidence that providing choice increased perceived autonomy. Equivalence tests further showed that although the groups were not statistically equivalent, the effect size is likely too small to practically study the effects of autonomy-support through choice in most motor learning labs. These findings add to a growing body of research that questions a causal role of autonomy-support on motor learning, and the robustness of the so-called self-controlled learning advantage.

572 Virtual Reality Operative Simulation in Orthopaedic Surgical Training During Periods of Restricted Clinical Hours: Systematic Review

Introduction The public health response to the coronavirus pandemic-imposed limitations upon orthopaedic surgeon’s scheduled care practice, with a consequential diminution of training time for residents. A potentially viable option for maintenance of operative competency is the use of virtual reality (VR) simulation. This review looks at the effectiveness of (VR) as a pedagogical method of learning for orthopaedic trainees. Question Can VR be a viable method of learning and skill retention for orthopaedic trainees during periods of diminished operative time? Method A systematic search using Google Scholar, EMBASE and PubMed was conducted in July 2020. Results Following the PRIMSA guidelines; initial search revealed 779 studies. 35 full text articles were analysed by two reviewers with a final total of 30 articles used in this review. A thematic analysis revealed three broad categories: quality and validity of VR teaching simulations studies (n = 8); learning curves and subject performance (n = 14) and VR simulators utility in orthopaedics reviews (n = 8). Conclusions We demonstrated that VR has the capacity to help trainees maintain their technical skills, enhance their precision, and retain rudimentary competency during this pandemic. Additional improvements are necessary to ensure its safety as a training tool.

Interactive effects of incentive value and valence on the performance of discrete action sequences

Incentives can be used to increase motivation, leading to better learning and performance on skilled motor tasks. Prior work has shown that monetary punishments enhance on-line performance while equivalent monetary rewards enhance off-line skill retention. However, a large body of literature on loss aversion has shown that losses are treated as larger than equivalent gains. The divergence between the effects of punishments and reward on motor learning could be due to perceived differences in incentive value rather than valence per se. We test this hypothesis by manipulating incentive value and valence while participants trained to perform motor sequences. Consistent with our hypothesis, we found that large reward enhanced on-line performance but impaired the ability to retain the level of performance achieved during training. However, we also found that on-line performance was better with reward than punishment and that the effect of increasing incentive value was more linear with reward (small, medium, large) while the effect of value was more binary with punishment (large vs not large). These results suggest that there are differential effects of punishment and reward on motor learning and that these effects of valence are unlikely to be driven by differences in the subjective magnitude of gains and losses.