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Articles 4381 - 4410 of 14474
Full-Text Articles in Medicine and Health Sciences
Response To "Point-Of-Care Ultrasound And Procedural Instruction In The Family Medicine Clerkship: A Cera Study"., Kennedy Ovenseri
Response To "Point-Of-Care Ultrasound And Procedural Instruction In The Family Medicine Clerkship: A Cera Study"., Kennedy Ovenseri
Medical Education Articles
No abstract provided.
Prescribing Protocol For Postoperative Opioids In An Orthopedic Spine Practice, Kelly M. Manda
Prescribing Protocol For Postoperative Opioids In An Orthopedic Spine Practice, Kelly M. Manda
All Doctor of Nursing Practice (DNP) Scholarly Projects
Problem: The opioid epidemic is magnified by excessive post-surgery prescriptions. Over six months at an orthopedic spine practice, 50% of patients received two or more opioid refills beyond their first. This highlighted the absence of a clear prescribing policy and emphasized the need for a structured protocol and to promote patient safety.
Aim of the Project: The primary aim was to implement a prescribing protocol to lower opioid refills provided to post-surgical patients in this surgical practice. The desired result was to reduce the number of opioid refills provided to patients after surgery.
Review of the Evidence: Evidence highlighted …
October 2023, Swosu Bulldog Wellness Committee
October 2023, Swosu Bulldog Wellness Committee
SWOSU BULLDOG WELLNESS
Breast Cancer Awareness Month
MoveSpring Spooktacular Step Challenge
Gluten Free Halloween Puppy Chow
Professional Virtue Of Civility And The Responsibilities Of Medical Educators And Academic Leaders, Laurence B Mccullough, John Coverdale, Frank A Chervenak
Professional Virtue Of Civility And The Responsibilities Of Medical Educators And Academic Leaders, Laurence B Mccullough, John Coverdale, Frank A Chervenak
Center for Medical Ethics and Health Policy Staff Publications
Incivility among physicians, between physicians and learners, and between physicians and nurses or other healthcare professionals has become commonplace. If allowed to continue unchecked by academic leaders and medical educators, incivility can cause personal psychological injury and seriously damage organisational culture. As such, incivility is a potent threat to professionalism. This paper uniquely draws on the history of professional ethics in medicine to provide a historically based, philosophical account of the professional virtue of civility. We use a two-step method of ethical reasoning, namely ethical analysis informed by pertinent prior work, followed by identifying the implications of clearly articulated ethical …
Evaluation Of An Individualized Learning Plan Template For The Transition To Residency, Amber T Pincavage, Ashish Gandhi, Eli Falk, Lauren Dimarino, Douglas Ruiz Carbajal, Uma Ayyala, Jayaram Chandrasekar, Andrew N Dentino, Allison H Ferris, Richard M Forster, Paul A Hemmer, Nancy Masucci, William D Surkis, Valerie O, John H Choe
Evaluation Of An Individualized Learning Plan Template For The Transition To Residency, Amber T Pincavage, Ashish Gandhi, Eli Falk, Lauren Dimarino, Douglas Ruiz Carbajal, Uma Ayyala, Jayaram Chandrasekar, Andrew N Dentino, Allison H Ferris, Richard M Forster, Paul A Hemmer, Nancy Masucci, William D Surkis, Valerie O, John H Choe
Faculty, Staff and Students Publications
Background Specialty-specific individualized learning plans (ILPs) have been promoted to improve the undergraduate to graduate medical education transition, yet few pilots have been described.
Objective To create and report on the feasibility and acceptability of a pilot internal medicine (IM) ILP template.
Methods The ILP was created by a group of diverse IM expert stakeholders and contained questions to stimulate self-reflection and collect self-reported readiness data from incoming interns. US IM residency programs were invited to pilot the ILP with interns in spring 2022. Data was used at the programs’ discretion. The pilot was evaluated by a post-pilot survey of …
Proactively Preventing Medical Errors: A Student-Led Approach To Patient Safety In Pre-Clinical Curriculum, Sahar Panjwani, Daniel Nwosuocha, Nelson D. Gonzalez, Ayleen Godreau
Proactively Preventing Medical Errors: A Student-Led Approach To Patient Safety In Pre-Clinical Curriculum, Sahar Panjwani, Daniel Nwosuocha, Nelson D. Gonzalez, Ayleen Godreau
Research Symposium
Introduction: Preventable medical errors are currently the third leading cause of death in the United States following heart disease and cancer (1). This study was designed to assess the change in knowledge from earlier education of medical students during pre-clinical years.
Methods: Patient safety trainings have been conducted for two years for interested first and second-year medical students and responses are assessed through a pre-test, immediate post-test, 3-month post-test, and 6-month post-test. The survey assesses student knowledge on aspects of patient safety and has Likert scale questions assessing if the training influenced students’ desire to learn about patient safety. …
How Risk Perceptions And Level Of Trust Of Information Influence Individuals’ Health Services Usage, Wan-Lin Chang
How Risk Perceptions And Level Of Trust Of Information Influence Individuals’ Health Services Usage, Wan-Lin Chang
Research Symposium
Background: When facing health-related issues, decision-making is not an easy thing. Some people look for advice from health care professionals, and some people trust their family members' and friends’ experiences more. Previous studies in health communication have suggested differences across various demographic groups in information seeking access and skills, including variables related to the knowledge gap assumption and individuals' risk perceptions.
Methods: Multiple linear regression and logistic regression are used to examine how individuals’ health risk perceptions influence their health service usage by analyzing the Health Information National Trends Survey (HINTS) 5 Cycle 4. HINTS conducts national surveys to monitor …
Expanding Health Professional Education In The Rio Grande Valley During The Covid-19 Pandemic, Sabrina R. Orta, Samantha G. Alvarado, Shuchita Jhaveri
Expanding Health Professional Education In The Rio Grande Valley During The Covid-19 Pandemic, Sabrina R. Orta, Samantha G. Alvarado, Shuchita Jhaveri
Research Symposium
Purpose: The COVID-19 Pandemic has prompted innovation in health professional education, such that learners are able to recognize and mitigate healthcare disparities in the outcomes of vulnerable populations. The objective of our project was to increase education on preventing, preparing for, and responding to COVID-19 and other locally prevalent infectious diseases that disproportionately affect RGV communities.
Description: This project had 3 goals: (1) provide learners with virtual patient-interaction simulations (2) provide interactive training modules on the identification, prevention, and treatment of infectious diseases affecting South TX and strategies to increase child vaccinations, and (3) provide learners an opportunity to coordinate …
The Fortify Resilience Initiative, Nausheen Jamal, Deepu George, Maria Hernandez, Evan Garcia, Myrna Ruiz, Salvador Arellano Iii
The Fortify Resilience Initiative, Nausheen Jamal, Deepu George, Maria Hernandez, Evan Garcia, Myrna Ruiz, Salvador Arellano Iii
Research Symposium
Purpose: The Fortify Resilience Initiative focuses on building and sustaining a culture of wellbeing for Residents and Fellows (R/Fs) at The University of Texas Rio Grande Valley (UTRGV) School of Medicine’s (SOM) Graduate Medical Education (GME) residency and fellowship programs. In order to address the multitude of threats to physician wellness and to mitigate the silent, but pernicious effects of burnout on these physician learners serving in the RGV, this Initiative from the Office of GME will strengthen existing wellbeing pathways while expanding additional solutions that will work to sustain wellbeing. Utilizing a combination of prevention, promotion, and intervention strategies …
Interdisciplinary Integrated Primary And Behavioral Healthcare (I2pbh) Initiative, John Ronnau, Deepu George, Maria Hernandez, Evan Garcia, Myrna Ruiz
Interdisciplinary Integrated Primary And Behavioral Healthcare (I2pbh) Initiative, John Ronnau, Deepu George, Maria Hernandez, Evan Garcia, Myrna Ruiz
Research Symposium
Purpose: The Interdisciplinary Integrated Primary and Behavioral Healthcare (I2PBH) initiative will train University of Texas Rio Grande Valley (UTRGV) mental health graduates to deliver high quality, evidence-based Integrated Behavioral Health (IBH) services in the Rio Grande Valley (RGV) – a high-need, high-demand, medically underserved Hispanic region along the US-Mexico border. Specifically, the I2PBH initiative will train 24 UTRGV mental health graduates annually to deliver high-quality Integrated Behavioral Health (IBH) clinical services through the evidence based Primary Care Behavioral Health (PCBH) model. With a training emphasis on basic/advanced theory and clinical skills in the PCBH model, students …
Covid-19'S Impact On Medical Students' Wellbeing And Residency Choices, Jessy Feng, Sabrina Orta, Lori Berry
Covid-19'S Impact On Medical Students' Wellbeing And Residency Choices, Jessy Feng, Sabrina Orta, Lori Berry
Research Symposium
Background: COVID-19 has impacted medical education in many ways including altering in-person rotations, limiting research opportunities, and introducing additional financial strain for medical students. With these unprecedented changes, we were interested in examining the impact of COVID-19 on medical students’ well-being and choices surrounding their upcoming resident medical education.
Methods: An online questionnaire was written and distributed via Qualtrics to 4th year medical students across Texas from May to December 2020. The inclusion criteria were MD or DO U.S. medical students planning to apply to residency in the 2020-2021 cycle.
Results: A majority of participants (78.05%) identified as a minority …
Sexual Well-Being Among Medical Residents At A Community-Based Academic Institution, Fiore Casale, Hinduja Nallamala, Todd Foster, Christine Alicea, Laurel Fick
Sexual Well-Being Among Medical Residents At A Community-Based Academic Institution, Fiore Casale, Hinduja Nallamala, Todd Foster, Christine Alicea, Laurel Fick
Journal of Wellness
Introduction: Medical residency training is demanding, with challenging workloads, long hours, and excessive stress that impact residents’ physical, mental, and emotional health. Although the concept of health and wellness in residency has become more widespread across programs, few studies have explored the sexual health of medical residents during training.
Methods: To better understand the current state of sexual health and well-being of resident physicians, physicians in training across Internal Medicine, Pediatrics, Family Medicine, OB/GYN, Transitional Year, and General Surgery completed anonymous surveys that incorporated validated questionnaires, including the International Index of Erectile Function (IIEF) and the Index of Premature Ejaculation …
Primary Care Behavioral Health Partnerships Advancing & Transforming Health Sciences (Pcbh Paths), Kristan Diaz-Rios, Deepu George, Maria Hernandez, Evan Garcia, Myrna Ruiz, Salvador Arellano Iii
Primary Care Behavioral Health Partnerships Advancing & Transforming Health Sciences (Pcbh Paths), Kristan Diaz-Rios, Deepu George, Maria Hernandez, Evan Garcia, Myrna Ruiz, Salvador Arellano Iii
Research Symposium
Purpose: Primary Care Behavioral Health Partnerships Advancing & Transforming Health Sciences (PCBH PATHS) is a workforce development pipeline project aimed at permanently augmenting UTRGV’s institutional capacity to address shortage of an Integrated Behavioral Health (IBH) competent workforce locally, regionally and nationally. Our initiative, aligned with UTRGV strategic priorities and key initiatives, will integrate basic(model specific strategy and operational elements), mid-level (role identity and profession specific behavioral competencies specific to each health profession), and advanced (behavioral medicine clinical skills) applications of the evidence based PCBH model of delivery. A PCBH focused delivery system (clinical and educational), in which primary care providers …
Qi In Resident Leadership Workshop, Heidi Y. Pareja, Chelsea H. Chang, Daniel Aragon, Deepu George
Qi In Resident Leadership Workshop, Heidi Y. Pareja, Chelsea H. Chang, Daniel Aragon, Deepu George
Research Symposium
Background: Many residency programs provide some type of leadership training for chief residents. As these emerging leaders transition into their role, it is imperative to provide them with skills and knowledge to help them develop their leadership style. UTRGV’s department of Graduate Medical Education (GME) organized their first “Resident Leader Workshop” for all rising Chiefs and GME Resident Leadership Council (RLC) members. Using a pre and post survey, participants provided feedback on the effectiveness of knowledge and skills presented during the workshop.
Methods: All residency and fellowship rising Chiefs and GME RLC members were invited. The workshop took place …
Patient Safety Workshop: A Graduate Medical Education Interprofessional Simulation Half-Day, Ans Albustamy, Roque Mifuji, Michelle Lopez, Teresa Villagomez, Chelsea Chang
Patient Safety Workshop: A Graduate Medical Education Interprofessional Simulation Half-Day, Ans Albustamy, Roque Mifuji, Michelle Lopez, Teresa Villagomez, Chelsea Chang
Research Symposium
Introduction: As per the National Academy of Medicine, patient safety is considered indistinguishable from the delivery of quality health care, and is referred to as the foundation upon which all other aspects of quality care are built. Throughout the years, graduate medical education (GME) across the world has evolved to ensure the training of future medical professionals includes exposure to many of the elements that compose patient safety, such as implementing root cause analysis, systems thinking, and disclosing adverse events. University of Texas Rio Grande Valley (UTRGV) is the sponsoring institution for 19 GME programs across different specialties. As part …
Medical Students Preventing Medical Errors: A Student-Led Approach To Patient Safety In Preclinical Curriculum, Daniel Habenicht, Niti Dharwadkar, Aishwarya Gatiganti, Sahar Panjwani, Daniel Nwoschua, Lauren Muenchow, Jose Campo Maldonado
Medical Students Preventing Medical Errors: A Student-Led Approach To Patient Safety In Preclinical Curriculum, Daniel Habenicht, Niti Dharwadkar, Aishwarya Gatiganti, Sahar Panjwani, Daniel Nwoschua, Lauren Muenchow, Jose Campo Maldonado
Research Symposium
Introduction: Preventable medical errors are currently the third leading cause of death in the United States following heart disease and cancer (1). Early exposure to patient safety knowledge may lead to students to deliver safer care in their clerkship and residency years. This study was designed to assess the change in knowledge from earlier exposure and education during pre-clinical years and its impact on interest and knowledge about patient safety.
Methods: For the past four years, a patient safety training has been conducted for interested first and second-year medical students and responses are assessed through a pre-test, immediate …
Does Social Media Matter When It Comes To Rank Lists? A Survey Of Applicants For General Surgery Residency During Covid-19, Justin M. Greco, Alessandra Storino, Priyanka V. Chugh, Tara S. Kent, Donald Hess, Dmitry M. Nepomnayshy, Kimberly M. Ellis, Jonathan S. Abelson
Does Social Media Matter When It Comes To Rank Lists? A Survey Of Applicants For General Surgery Residency During Covid-19, Justin M. Greco, Alessandra Storino, Priyanka V. Chugh, Tara S. Kent, Donald Hess, Dmitry M. Nepomnayshy, Kimberly M. Ellis, Jonathan S. Abelson
The Lahey Journal
Abstract:
Introduction: The COVID-19 pandemic greatly disrupted traditional social interactions between residency applicants and General Surgery programs. There is no previous research on the influence of social media in General Surgery residency recruiting.
Methods: We performed a multi-institutional survey of General Surgery residency applicants from the Northeast United States about the effect social media had on their decision to interview and rank programs, after the results of the 2021 National Resident Matching Program. The survey was sent to 311 e-mail addresses. The 22-question survey consisted of multiple choice, Likert Scale, and free text responses.
Results: 66 applicants completed the survey …
Assessing Perspectives Of A Global Health Area Of Concentration Within The Pharmd Curriculum, Jennifer Ko, Lauren Jonkman, Vidya Balakrishna Sharma, Emily Liu, Sharon E. Connor
Assessing Perspectives Of A Global Health Area Of Concentration Within The Pharmd Curriculum, Jennifer Ko, Lauren Jonkman, Vidya Balakrishna Sharma, Emily Liu, Sharon E. Connor
Pharmacy Faculty Articles and Research
Introduction
While global health education in pharmacy expands, limited research has described the outcome of completing a global health area of concentration on career decisions, perceptions on cultural sensitivity, health disparity awareness, and global health competencies among pharmacists and students.
Methods
This mixed methods study enrolled 21 graduates and 17 student pharmacists who participated in a global health concentration at one school of pharmacy in the United States. Data sources included graduate interviews and surveys, student pharmacist focus groups, and global health competency self-assessments.
Results
Five themes emerged among graduates: (1) skills were applicable to diverse settings, (2) early exposure …
Librarian Advocates For Open Educational Resources (Oer) As A Catalyst For Innovation In Health Sciences Education, Christine Andresen
Librarian Advocates For Open Educational Resources (Oer) As A Catalyst For Innovation In Health Sciences Education, Christine Andresen
MUSC Conference Presentations
Purpose: Data shows that at least 81% of medical students and 75% of health professional doctoral students graduate and enter the profession with student loans. Access to textbooks and ancillary instructional materials is essential, yet data shows that textbook prices have increased over 1000% between 1977-2015, exacerbating the systematic barriers to student access, affordability, and success in higher education. Open Educational Resources (OER) can reduce student textbook costs while also giving faculty the flexibility to adapt course materials to meet specific course needs. Librarians have experience leveraging subscription resources to reduce student costs and are well positioned to promote the …
Intouch Week Of September 25, 2023, New York Medical College
Intouch Week Of September 25, 2023, New York Medical College
InTouch
- Clinical Skills and Simulation Center Looks Forward to Expansion
- Nicholas Webb, M.S.I.S., Preserves New York Medical College’s Medical History One Item at a Time
- NYMC Celebrated at Doctors of Distinction 2023
- Founder's Dinner 2023
- GSBMS Office of Admissions Paves the Path to Successful Biomedical Science Careers for Students
Implementation Of High-Fidelity Simulation: Raising The Stakes For Registered Nursing Students, Brittany T. Allen-Marshall
Implementation Of High-Fidelity Simulation: Raising The Stakes For Registered Nursing Students, Brittany T. Allen-Marshall
Doctor of Nursing Practice Projects
Critical thinking is a necessary skill for a nurse to possess to be safe and competent. The problem identified for this Doctor of Nursing Practice (DNP) project is the lack of utilization of high-fidelity simulation (HFS) at the University of Arkansas Community College at Morrilton (UACCM)—the DNP project aimed to implement HFS and reduce the critical thinking gap between RN students and practice. The DNP student evaluated student critical thinking with pre-and post-tests. The pre-and post-test results containing Next Generation (NGN) test items showed no statistical significance (p=0.25). The Nursing Anxiety and Self-Confidence with Clinical Decision Making© (NASC-CDM©) scale pre- …
Healthcare Experience Impact On First-Year Physician Assistant Students’ Communication Self-Efficacy, Joseph Tocco, Sara Maher, Sara Lolar
Healthcare Experience Impact On First-Year Physician Assistant Students’ Communication Self-Efficacy, Joseph Tocco, Sara Maher, Sara Lolar
Internet Journal of Allied Health Sciences and Practice
Purpose: Healthcare experience (HCE) is required by most physician assistant (PA) programs for application, but it is not known what role HCE might play in the success of PA students. Communication skills are an important trait for a successful clinician, and previous HCE might lead to an improved ability to communicate with patients. This study examined the relationship between PA students’ healthcare experience (HCE) and their communication self-efficacy (SE). Methods: First-year PA students from Michigan PA programs were eligible to participate in an anonymous electronic survey. A previously validated survey to assess communication SE was used. HCE was assigned into …
Best Practices In Patient Education: Medical Students’ Perceptions And Implementations, Bridget Croniger, Mikaela Grudzien, Rubab Imtiaz, Dana Kabbani Md, Jennifer Mendez
Best Practices In Patient Education: Medical Students’ Perceptions And Implementations, Bridget Croniger, Mikaela Grudzien, Rubab Imtiaz, Dana Kabbani Md, Jennifer Mendez
Internal Medicine Faculty Publications
Effective patient education can help achieve better clinical outcomes, especially when a patient is managing a chronic illness. Despite patient education being an important skill in the professional formation of physicians, little is known about medical students’ perceptions and implementations of such strategies. After completing a chronic illness educational module, second-year medical students were asked to rate the importance of specific patient education strategies and to assess their use of said strategies in the module’s project assignment. Results indicated students utilized different patient education strategies from those they initially identified as most effective.
2023 September 19 - Medical Student Education Committee Minutes, Medical Student Education Committee, East Tennessee State University
2023 September 19 - Medical Student Education Committee Minutes, Medical Student Education Committee, East Tennessee State University
Medical Student Education Committee Minutes
No abstract provided.
2023 September 19 - Medical Student Education Committee Minutes, Medical Student Education Committee, East Tennessee State University
2023 September 19 - Medical Student Education Committee Minutes, Medical Student Education Committee, East Tennessee State University
Medical Student Education Committee Minutes
No abstract provided.
Intouch Week Of September 18, 2023, New York Medical College
Intouch Week Of September 18, 2023, New York Medical College
InTouch
- The CDM Hosts Groundbreaking For New Simulation and Educational Facility
- GSBMS Hosts Biennial Ph.D. Lab Coat Ceremony
- NYMC Goes Gold for Childhood Cancer Awareness Month
- Women in Medicine Book Discussion What We Bring to the Practice of Medicine: Perspectives from Women Physicians
- Founder's Dinner 2023
- The Office of Student Mental Health and Wellness Prioritizes Student Well-Being
Results Of Nursing Training Reforms: Estimating The Scope Of Nursing Practice, Marat Serikbayev, Saltanat Mamyrbekova, Ainur B. Kumar, Lyazzat Kosherbayeva, Akmaral Abikulova, Laura Seiduanova, Elmira Serikbayeva
Results Of Nursing Training Reforms: Estimating The Scope Of Nursing Practice, Marat Serikbayev, Saltanat Mamyrbekova, Ainur B. Kumar, Lyazzat Kosherbayeva, Akmaral Abikulova, Laura Seiduanova, Elmira Serikbayeva
Journal of Health Research
Background: With the adoption of the Astana Declaration on primary health care, modern approaches are being introduced in the Republic of Kazakhstan. The created national foundations of the nursing management system in Kazakhstan are a visible manifestation of a new organizational culture. In connection with the large-scale reform of nursing and the creation of a new position of nurses that meets modern social challenges and international requirements, the role of nurses in healthcare has increased significantly. In this study, we measured the actual scope of nursing practice among nurses in the medical organizations in the Republic of Kazakhstan.
Methods: …
Nursing Panel Presentation: Certification Champion Pilot Project To Increase Rn Specialty Certification Rates, Ari Meyers, Trisha Saul, Miriam Bender
Nursing Panel Presentation: Certification Champion Pilot Project To Increase Rn Specialty Certification Rates, Ari Meyers, Trisha Saul, Miriam Bender
2023 South Division Nursing Research Conference
No abstract provided.
Anti-Inflammatory And Antioxidant Effects Of Sea Urchin Spine Extract, Dina Magdy El Gamal
Anti-Inflammatory And Antioxidant Effects Of Sea Urchin Spine Extract, Dina Magdy El Gamal
The Undergraduate Research Journal
Diadema savignyi spine extract in an experimental setup using L929 cell line in vitro. The cell metabolic activity of L929 cells is tested through an MTT assay. The sea urchin spine extract is applied to the cells in two concentrations: 100 μg/ml (136% viability) and 200 μg/ml (95% viability). The bioactive components of the sea urchin spine are identified via GC-MS, and the antioxidant and anti-inflammatory activities are evaluated using catalase assay (CAT), glutathione (GSH), and nitric oxide (NO) tests. Results show that the GC-MS identified bioactive components including the anti-inflammatory and anti-irritant bisabolol oxide and the pro-inflammatory oleic acid. …
A Real-Time Contouring Feedback Tool For Consensus-Based Contour Training, Christopher L Nelson, Callistus Nguyen, Raymond Fang, Laurence E Court, Carlos E Cardenas, Dong Joo Rhee, Tucker J Netherton, Raymond P Mumme, Skylar Gay, Casey Gay, Barbara Marquez, Mohammad D El Basha, Yao Zhao, Mary Gronberg, Soleil Hernandez, Kelly A Nealon, Mary K Martel, Jinzhong Yang
A Real-Time Contouring Feedback Tool For Consensus-Based Contour Training, Christopher L Nelson, Callistus Nguyen, Raymond Fang, Laurence E Court, Carlos E Cardenas, Dong Joo Rhee, Tucker J Netherton, Raymond P Mumme, Skylar Gay, Casey Gay, Barbara Marquez, Mohammad D El Basha, Yao Zhao, Mary Gronberg, Soleil Hernandez, Kelly A Nealon, Mary K Martel, Jinzhong Yang
Faculty, Staff and Student Publications
PURPOSE: Variability in contouring structures of interest for radiotherapy continues to be challenging. Although training can reduce such variability, having radiation oncologists provide feedback can be impractical. We developed a contour training tool to provide real-time feedback to trainees, thereby reducing variability in contouring.
METHODS: We developed a novel metric termed localized signed square distance (LSSD) to provide feedback to the trainee on how their contour compares with a reference contour, which is generated real-time by combining trainee contour and multiple expert radiation oncologist contours. Nine trainees performed contour training by using six randomly assigned training cases that included one …