No abstract

Farmers markets provide social and economic benefits to farmers and communities. In West Virginia, local food, farm, and community development organizations are collaborating to strengthen local food networks. In this reflective essay we discuss the development and execution of a statewide pilot training program for market managers and volunteer leaders and provide results from first year evaluations. Launched in 2012, the West Virginia Farmers Market Training Network Pilot Program (FMTNPP) was designed to address the needs of 10 markets in various stages of development across the state. Originally envisioned as a direct technical assistance model, the program organizers rapidly recognized the benefits of peerto-peer learning and shifted its focus to a hybrid model that embraced both expert and practitioner knowledge. Today, the program emphasizes shared knowledge creation and problem solving, along with strong networking and data collection components. We believe the lessons and strategies learned during the program's implementation will be valuable for food system organizers and service providers trying to encourage the growth and sustainability of small, rural farmers markets.

Internal Medicine (IM) resident physicians lack confidence and knowledge on how to manage basic and emergent clinical situations involving tracheostomy. High fidelity simulation is an effective training medium to address such deficiencies but is under-researched and under-utilized. This prospective, quantitative pilot educational and quality improvement study sought to answer if high fidelity simulation training on tracheostomy improves IM resident knowledge, confidence, and team skill performance.METHODS: Over 4 months (January -April 2021), 31 post-graduate year (PGY) 2 and PGY3 IM residents at a large academic hospital participated in this study. Participants were scored on baseline skill performance as a team in a high fidelity simulation of desaturation in a tracheostomy patient using a validated checklist. Thereafter, participants underwent a 3 hour educational intervention comprised of lecture, skills stations, and several simulations of emergent tracheostomy clinical situations. Final team performance on the same simulation initially used to assess baseline performance was scored. Pre and post intervention confidence and knowledge were assessed and compared to PGY2 and PGY3 IM residents who did not take the course.RESULTS: 20 PGY2 IM residents underwent the course. Confidence (P<0.0001) and knowledge (P<0.0001) significantly improved from pre-intervention to post-intervention. Confidence for residents post-intervention was greater than for PGY2 and PGY3's who did not take the course (P<0.0001). Knowledge for residents post-intervention was greater than for PGY2 and PGY3's who did not take the course (P<0.0001). In general, team skill performance in simulation improved from pre-intervention to post-intervention, though findings are limited by power and are not statistically significant. CONCLUSIONS:Our study demonstrates PGY2 IM resident confidence and knowledge on basic and emergent tracheostomy clinical situations improves significantly following educational intervention with hands-on instruction and high fidelity simulation. Confidence and knowledge in PGY2 IM residents following the course was significantly greater than for PGY2 and PGY3 IM residents who did not take the course. Our study also suggests team skill performance may be improved by the intervention.CLINICAL IMPLICATIONS: This study demonstrates that high fidelity simulation is an effective method of teaching IM resident physicians the knowledge necessary to manage basic and emergent tracheostomy clinical situations and also improves confidence. Given that many patients with acute respiratory failure from COVID-19 and other causes are frequently treated with tracheostomy and cared for by IM residents, this intervention may improve clinical outcomes for patients with tracheostomies.

No abstract