BACKGROUND: Training plays a role in reducing traffic accidents, and evaluating the effectiveness of training programs in managers\' decision-making for training continuation is important. Thus, the present study aimed to evaluate the cost-effectiveness of a single-credit traffic safety course based on the four levels of the Kirkpatrick model in all Iranian universities.
METHODS: This interventional study aimed to evaluate the cost-effectiveness of a single-credit traffic safety course based on the Kirkpatrick model from 2016 to 2020 in Iran. The data were collected in three stages: (1) calculating the costs of offering traffic safety courses, (2) determining the effectiveness of providing such courses based on the levels of the Kirkpatrick model, and (3) evaluating the cost-effectiveness of administering traffic safety courses. Data were collected through researcher-made and standardized questionnaires. The research population included traffic safety course instructors and university students who could take this course. Finally, the data were analyzed with SPSS v. 23 and also calculations related to ICER, which shows the cost effectiveness of providing single credit course.
RESULTS: Scores of the students\' reaction level to the traffic safety course was 41.8% before the course; this score was estimated at 67% after the course. At the level of learning, students\' knowledge was 43.6% before the training course, which reached 73% after the course. At the level of behavior, the state of students\' desirable traffic behaviors was 54% before the course, which reached 66.1% after the course. The educational effectiveness of the course presentation at the level of results was 58.2% before and 74.8% after the course. While assuming that the weights of all model levels were constant, the cost of a 1% increase in the overall educational effectiveness by using the Kirkpatrick model, compared to not providing the course (not administering the intervention) was 486.46 USD.
CONCLUSIONS: The results showcased the effectiveness of the traffic safety course in all four levels of The Kirkpatrick model. Therefore, policy-makers and officials in charge of delivering this program should strengthen it and resolve its deficiencies to realize all its educational goals at the highest level.

BACKGROUND: Restricting parturient women in healthcare facilities from choosing positions that provide the greatest comfort and benefit during labor is a global barrier. Several complex factors, including caregiver preference and medical intervention, shape the limitation. Therefore, a practical need exists to train midwives on the knowledge and skills to change this condition.
METHODS: The study used a parallel, single-blind, randomized controlled trial at a provincial maternity and child health hospital in Fujian, China, from June 1 to December 31, 2019. The midwives in a birth suite were selected and randomly enrolled in a one-month simulation-based hybrid training or face-to-face teaching in September 2019. The four-level Kirkpatrick\'s model, including reaction, learning, behavior, and results, was used to evaluate training effects before and after the program. Data were analyzed with SPSS 25.0 using Student\'s t-test, Spearman\'s correlation test, Mann-Whitney U test, Wilcoxon signed-rank test, and chi-square test analysis of variance. The significance level was set at p < 0.05.
RESULTS: Forty-two midwives were initially randomized to either the virtual simulation group or the face-to-face group. One midwife was excluded from the analysis due to intervention discontinuation, resulting in a final analysis of 41 midwives (n1 = 21, n2 = 20). Post-intervention, the virtual simulation group exhibited higher satisfaction and learning effects compared to the face-to-face group, while the rate of perineal incision in primiparas was lower (p<0.05). No significant changes or differences were observed in self-rated behavior between the two groups (p>0.05). The virtual simulation group demonstrated an increase in non-supine birth rate (p = 0.030) and a decrease in perineal incision rate among primiparas compared to pre-intervention (p = 0.035). Moreover, knowledge performance was associated with the duration of virtual simulation (r = 0.664, p = 0.001).
CONCLUSIONS: Virtual simulation is a fascinating innovation that enables midwives to develop birthing positions without practicing on real pregnant women and is one solution to achieve work competency within a shortened training period.

BACKGROUND: Educational evaluation is one of the most significant programs of any organization. In fact, evaluating training effectiveness allows managers and staff of the organization to get a clear picture of the qualities of training activities. The purpose of this study was to evaluate virtual nursing intensive care training courses at Shariati Hospital based on the Kirkpatrick Model in 2020.
METHODS: The current cross-sectional study is an evaluation of the outcome-oriented program to evaluate the results of the e-learning course on nursing intensive care at Shariati Teaching Hospital from March 20, 2020 to September 20, 2020. The total number of nurses working in intensive wards was 168, of whom 150 participated in this research study with convenience sampling. The data collection tool consisted of four-part questionnaires including demographic information and three levels of the Kirkpatrick Model.
RESULTS: The mean age of participants was 34.41 ± 6.63 years. The mean score of participant satisfaction was 76.77, indicating that they showed good reaction to virtual training courses. Virtual training course for intensive care nurses was statistically significant at the levels of learning (P < 0.0001) and behavior (P < 0.0001).
CONCLUSIONS: Virtual training courses are effective educational method based on three levels of Kirkpatrick\'s Model in intensive care nurses and it can be used along with traditional training approaches.

Burnout, depression, and fatigue are common among surgical residents. Most published wellness studies in surgery only focus on a cross-sectional view of attitudes and perceptions around wellness in training. While much of this literature calls for interventions and presents strategies for improving resident well-being, there is a paucity of published wellness initiatives, and even fewer with programmatic evaluation.
A scoping review was designed to address: (1) What wellness initiatives are used in surgery residency programs? (2) Which wellness domains do these programs address? and (3) How are program outcomes evaluated? A formal literature search was conducted using PubMed, Embase, and Scopus databases to identify English-language studies conducted in the United States that described wellness-focused initiatives for surgery residents. Two authors independently screened all abstracts and full texts for inclusion. Data were extracted including wellness domain(s) and outcomes evaluation methods with associated Kirkpatrick level(s) (1-reaction, 2-learning, 3-behavior, 4-results). Study quality was examined using the medical education research study quality index (MERSQI) score.
A total of 2237 abstracts were screened with 115 full texts reviewed for eligibility. Fifty-one studies were included in the final analysis, representing 39 distinct wellness programs. The most common domains of wellness addressed were emotional (19/39, 48.7%), occupational (17/39, 43.6%), and physical (16/39, 41.0%). Of the 51 studies reviewed, 8 (15.7%) did not conduct any program evaluation, 27 (52.9%) evaluated level 1, 30 (58.8%) evaluated level 2, 3 (5.9%) evaluated level 3, and none evaluated level 4 outcomes. The mean MERSQI score was 9.16 (SD 1.8).
Wellness is an established problem in surgical training. This review reveals a small number of published wellness interventions and even fewer that incorporate programmatic evaluation at the level of behavior and results change. Effective change will require rigorous and deliberate programming that addresses multiple domains and evaluation levels.

Breast cancer is now the most commonly diagnosed cancer worldwide. Approximately 30% of those who present with early breast cancer later develop advanced breast cancer (ABC). Additionally, approximately 6% have advanced breast cancer at diagnosis. New treatment options result in an extended lifespan dominated by cycles of deterioration and stable disease. Specialist nurse knowledge is key to multidisciplinary care of people with ABC; however, access to education on ABC for nurses is not universally available in Europe. This paper describes the development and implementation of an online bespoke program on ABC care for specialist and generalist nurses in Europe. The project team is affiliated with the European Oncology Nurses Society (EONS) and comprises specialist breast cancer nurses, oncology nurse academics and breast cancer advocates associated with EUROPA DONNA Turkey, an independent non-profit European breast cancer organisation. The program development involved (1) a systematic review of ABC educational resources for cancer nurses; (2) a modified four-round Delphi study to seek agreement on curriculum content and (3) curriculum development, conversion to an interactive online platform and translation into four European languages. The program evaluation will be guided by Kirkpatrick\'s framework. The phases described in this short report could guide others involved in developing bespoke cancer education programs.

BACKGROUND: Commercialized since 2019, emicizumab (Hemlibra) was available only in French hospital pharmacies for prophylaxis of hemophilia A with or without inhibitors. Since June 15, 2021, patients can choose between a hospital and community pharmacy. These changes in the care pathway have important organizational consequences for patients, their relatives, and health professionals. Two training programs are available for community pharmacists: the \"HEMOPHAR\" training program proposed by the national reference center for hemophilia and the Roche training program proposed by the laboratory that markets the product.
OBJECTIVE: The PASODOBLEDEMI study aims to evaluate the direct impact of the training programs provided to community pharmacists in the context of the dispensing of emicizumab, and to evaluate patients\' satisfaction with their treatment whether they choose dispensation from a community pharmacy or retained dispensation from the hospital pharmacy.
METHODS: We designed a cross-sectional study based on the 4-level Kirkpatrick evaluation model: the immediate reaction of community pharmacists following training (Reaction), the knowledge acquired during the training (Learning), the professional practice of community pharmacists during dispensing of the product (Behavior), and patients\' satisfaction related to the treatment whether it is dispensed from a hospital or from a community pharmacy (Results).
RESULTS: Considering that single outcome measures cannot adequately reflect the complexity of this new organization, the Kirkpatrick evaluation model provides 4 distinct outcomes: the immediate reaction after the HEMOPHAR training program, the level of knowledge acquired after the HEMOPHAR training program, the impact of training on professional practice, and patient satisfaction with access to emicizumab. We developed specialized questionnaires for each of the 4 levels of the Kirkpatrick evaluation model. All community pharmacists involved in dispensing emicizumab, whether they have followed the HEMOPHAR or the Roche training program or neither, were eligible for inclusion. All patients with severe hemophilia A were eligible, irrespective of inhibitor use, age, treatment with emicizumab, and whether they chose dispensation from a community pharmacy or retained dispensation from a hospital pharmacy.
CONCLUSIONS: The new organization for dispensing emicizumab to patients with hemophilia A in French community pharmacies must be accompanied by optimal safety and quality conditions due to the risk of serious and urgent bleeding situations in the management of rare bleeding diseases. The elaboration of the PASODOBLEDEMI protocol has already a positive impact with the commitment of all health professionals, physicians, hospital and community pharmacists, and the patient community. The results will be disseminated among the French authorities and will enable, if necessary, proposing this access model to other rare diseases.
BACKGROUND: ClinicalTrials.gov NCT05449197, https://clinicaltrials.gov/ct2/show/NCT05449197?term=NCT05449197; ClinicalTrials.gov NCT05450640, https://clinicaltrials.gov/ct2/show/NCT05450640?term=NCT05450640.
UNASSIGNED: DERR1-10.2196/43091.

In 2013 the Royal Australian and New Zealand College of Ophthalmologists partnered with the Cambodian Ophthalmological Society (COS) to develop a continuing professional development program for COS using a college-college twinning model. The program was reviewed seven years after launch. No evidenceof a functioning CPD program was identified. Reasons may include lack of engagement by ophthalmologists and lack of COS resources. A planning checklistfor international CPD collaborations is discussed.

UNASSIGNED: Training effectiveness indicates how good a program has met pre-set training objectives or organizational goals for the best benefit of healthcare professionals and service users in the community. The study aimed to evaluate training effectiveness following implementation of new training curriculum of emergency surgical airway procedures (Cricothyroidotomy) organized by the Queen Elizabeth Hospital.
UNASSIGNED: This training evaluation relied on observational descriptive study design. Timed task on Cricothyroidotomy procedures and standardized post-training questionnaire were applied to assess the first 3 levels of Kirkpatrick\'s model: (Level-1) Reaction by training satisfaction; (Level-2) Learning by acquisition of knowledge and skills assessment passing rate; (Level-3) Behavior by personal strengths.
UNASSIGNED: This program was operated in the Multi-Disciplinary Simulation and Skills Centre, a hospital-based high-fidelity simulation training center accredited by the Society for Simulation in Healthcare.
UNASSIGNED: The study recruited 80 trauma service providers, including 35 general surgeons, 15 emergency physicians, 10 anesthesiologists or intensivists, 6 neurosurgeons, 4 orthopedic surgeons, and 10 emergency nurses from five trauma centers under the Hospital Authority. All underwent the Advanced Trauma Life Support training in advance.
UNASSIGNED: Compared with reference score from previous training sessions, the result of program using new training curriculum and simulator demonstrated significant training satisfaction of participants (Level-1), and high level of assertiveness, mental preparedness, self-efficacy, and internal locus of control and responsibility (p < .01, for all in Level-3). All participants (N = 80) completed entire Cricothyroidotomy procedure in 2 min without technical errors (Assessment passing rate = 100%) (Level-2).
UNASSIGNED: Under Kirkpatrick model, simulation training in Cricothyroidotomy procedure using new curriculum and simulators has been proven to be useful for healthcare professionals involved in trauma service management. The result suggests that application of a state-of-the-art training tools to advanced surgical skills training could improve training satisfaction, knowledge and skills acquisition, and personal strengths transferable to clinical practice.
UNASSIGNED: Practice Based Learning and Improvement.

OBJECTIVE: Quality improvement collaboratives (QICs) are a popular approach to improving healthcare services and patient outcomes. This paper evaluates a QIC implemented by a large, integrated healthcare organisation in Wales in the UK.
METHODS: This evaluation study draws on two well-established evaluation frameworks: Kirkpatrick\'s approach to gather data on participant satisfaction and learning and Stake\'s approach to gather data and form judgements about the impact of the intervention. A mixed methods approach was taken which included documentary analysis, surveys, semi-structured interviews, and observation of the QIC programme.
RESULTS: Together the two frameworks provide a rounded interpretation of the extent to which the QIC intervention was fit-for-purpose. Broadly the evaluation of the QIC was positive with some areas of improvement identified.
CONCLUSIONS: This study is limited to a QIC conducted within one organisation. Further testing of the hybrid framework is needed that extends to different designs of QICs.
CONCLUSIONS: A hybrid framework is provided to assist those charged with designing and evaluating QICs.
CONCLUSIONS: Evaluation studies are limited on QICs and if present tend to adopt one framework. Given the complexities of undertaking quality improvement within healthcare, this study uniquely takes a hybrid approach.

Most significant change (MSC) analysis is an evaluative method used to supplement outcome and impact program evaluations. MSC stories provide mini-narratives contextualizing the effect a program had on an individual. The Clinical Scholars program evaluation team used MSC to explore learner-centric leadership outcomes of the Clinical Scholars leadership training program.
To identify thematic outcomes of trainees during the three years of their leadership training in the Clinical Scholars program.
We identified three central thematic areas of most significant change: (1) leadership in practice, (2) self-awareness, and (3) equity, diversity, and inclusion. Other present themes included stakeholder engagement, effective leadership, collaboration, impact, expanded influence, innovation, networking, community engagement, evidence-based, implementation science, organizational development, hope, and advocating within organizations, teams, and the community. A total of 25 mid- and advanced-career level participants represented a diverse array of disciplines within the healthcare sector.
MSC stories represented leaders\' individual and team growth due to participating in the Clinical Scholars program. Results confirmed fidelity of program implementation to the original program goals, as outlined in the grant proposal. They highlighted three critical areas of development for this cohort of Fellows.