All analyses were performed using the SAS software (SAS version 9.4, JMP Pro version 14.0, SAS Institute Inc., Cary NC). Results were summarized using counts and percentages or means and standard errors, as appropriate. Pre-post change and differences across years were analyzed using repeated measures mixed models. To compare the North American instructors to the train-the-trainer model scores and evaluations were compared across years. The percent correct score was analyzed using repeated-measures ANOVA and the individual item correct-incorrect score was analyzed using repeated-measures logistic regression.

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