Four studies included external assessment of knowledge and skills(Doyle and Klein, 2001; Beech and Leather, 2003; Grenyer et al., 2004;Nau et al., 2010). Doyle and Klein (2001) tested staff knowledge to es-tablish whether a poster presentation or conventional training sessionwas more effective and observed a statistically significant improvementin mean posttest scores on knowledge in both groups. Beech andLeather (2003) and Grenyer et al. (2004) used written scenarios posttraining to test participants' knowledge on risk factor detection. Bothstudies found increases in risk factor detection following training com-pared with baseline, with Beech and Leather (2003) detecting even fur-ther improvement on the 3-month follow-up. Nau et al. (2010) assessedstudents' practical de-escalation skills through videotaped scenario