Best practices for creating social presence and caring behaviors online

AIM

To identify best practices and evidence-based strategies for creating an online learning environment that encompasses caring behaviors and promotes social presence.

BACKGROUND

Faculty who teach online classes are challenged to create a sense of social presence and caring behaviors in a virtual world in which students feel connected and part of the learning environment.

METHOD

To extrapolate evidence to support best practices, a review of literature was conducted focused on social presence and caring online.

RESULTS

Faculty messages that are respectful, positive, encouraging, timely, and frequent foster social presence and caring behaviors while also allowing for caring interactions, mutual respect, and finding meaning in relationships.

CONCLUSION

A variety of measures to emulate caring online intertwine with social presence to promote a sense of caring and belonging. More research is needed to support the evidence for these strategies.

Are we effectively informing patients? A quantitative analysis of on-line patient education resources from the American Society of Neuroradiology

BACKGROUND AND PURPOSE

The ubiquitous use of the Internet by the public in an attempt to better understand their health care requires the on-line resources written at an appropriate level to maximize comprehension for the average user. The National Institutes of Health and the American Medical Association recommend on-line patient education resources written at a third-to-seventh grade level. We evaluated the readability of the patient education resources provided on the Web site of the American Society of Neuroradiology (http://www.asnr.org/patientinfo/).

MATERIALS AND METHODS

All patient education material from the ASNR Web site and the Society of Neurointerventional Surgery Web site were downloaded and evaluated with the computer software, Readability Studio Professional Edition, by using 10 quantitative readability scales: the Flesch Reading Ease, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook, Coleman-Liau Index, Gunning Fog Index, New Dale-Chall, FORCAST Formula, Fry Graph, Raygor Reading Estimate, and New Fog Count. An unpaired t test was used to compare the readability level of resources available on the American Society of Neuroradiology and the Society of Neurointerventional Surgery Web sites.

RESULTS

The 20 individual patient education articles were written at a 13.9 ± 1.4 grade level with only 5% written at <11th grade level. There was no statistical difference between the level of readability of the resources on the American Society of Neuroradiology and Society of Neurointerventional Surgery Web sites.

CONCLUSIONS

The patient education resources on these Web sites fail to meet the guidelines of the National Institutes of Health and American Medical Association. Members of the public may fail to fully understand these resources and would benefit from revisions that result in more comprehensible information cast in simpler language.

Comparison of textbook to fmCases on family medicine clerkship exam performance

BACKGROUND AND OBJECTIVES

The use of online learning with virtual cases has become commonplace in medical education. A series of fmCASES has been developed to assist with learning for clerkship students in family medicine. It has not been shown whether this series of cases improves student learning during their clerkship compared to traditional learning modalities.

METHODS

We designed an intervention study to replace the traditional family medicine clerkship textbook with the fmCASES curriculum at one medical school. We then compared two consecutive cohorts of family medicine clerkship students by examining their performance on overall and small groups of exam questions at the end of the clerkship.

RESULTS

Data were obtained for 95% of students across the 2-year study. Overall performance on the end of clerkship exam was unchanged with the transition to fmCASES. Student performance was variable based on subject area and source of examination question.

CONCLUSIONS

Using a set of online cases to replace a traditional textbook did not change overall performance on the end-of-clerkship assessment. However, our findings suggest that students demonstrated proficiency in answering questions that came from the sources they studied from. This finding should be considered when curricula transition to greater use of online learning resources.

Reliability of CAD CAM technology in assessing crown preparations in a preclinical dental school environment

In order to use CAD CAM (Computer Aided Design, Computer Aided Manufacturing) technology as an assessment tool when evaluating the preclinical performance of dental students, it is imperative that one has confidence in the reliability of the process. In this study, a variety of alignment methods were compared to determine both the consistency and accuracy of each method. Although the "Tooth Dots Diagonal" method exhibited the best precision (coefficient of variation=5.4 percent), it also represented the least accurate method when compared to the other methods tested. Using "Small Dots Diagonal" on the gingiva appears to be the best option, exhibiting an acceptable coefficient of variation (17.6 percent) and a high degree of accuracy in terms of tolerance (mean ± standard deviation=0.163 ± 0.029). Based on the results of this study, further investigation of CAD CAM technology for the purpose of assessment and education of dental students is recommended.

How we make nephrology easier to learn: computer-based modules at the point-of-care

BACKGROUND

Novel educational tools, such as case-based learning in a web-based module format, are an effective approach to teaching clinical concepts to medical trainees, especially if the situations are clinically relevant and the intervention is delivered at the point-of-care. Though studies have evaluated the effectiveness of point-of-care reference materials, limited literature addresses active web-based interventions designed for completion at the point-of-care.

AIMS

By taking advantage of existing technological resources and integrating an effective learning modality into the clinical environment, we can increase trainee understanding of high-yield topics in clinical nephrology.

METHODS

We designed interactive, case-based computer-based modules in Principles of Dialysis, Hyponatremia, and Acid-Base abnormalities, with interwoven multiple-choice and free text questions with immediate feedback, supplemental practice questions, and enrichment material to be completed in the clinical environment. All medicine trainees at an urban, academic institution were invited to participate in a needs assessment, pre and post knowledge tests, and module completion.

RESULTS

Most trainees believed the modules were "very" or "extremely helpful" in understanding the selected topic and that they would likely change their clinical practice. Those who completed the modules performed better on a post-intervention knowledge assessment. Free-text feedback was overwhelmingly supportive of the modules.

CONCLUSION

Our findings confirmed that a novel, simplified approach to renal content by making it readily applicable to a clinical context and available at the point-of-care improves trainee understanding of high-yield topics in nephrology.

How useful is YouTube in learning heart anatomy?

Nowadays more and more modern medical degree programs focus on self-directed and problem-based learning. That requires students to search for high quality and easy to retrieve online resources. YouTube is an emerging platform for learning human anatomy due to easy access and being a free service. The purpose of this study is to make a quantitative and qualitative analysis of the available human heart anatomy videos on YouTube. Using the search engine of the platform we searched for relevant videos using various keywords. Videos with irrelevant content, animal tissue, non-English language, no sound, duplicates, and physiology focused were excluded from further elaboration. The initial search retrieved 55,525 videos, whereas only 294 qualified for further analysis. A unique scoring system was used to assess the anatomical quality and details, general quality, and the general data for each video. Our results indicate that the human heart anatomy videos available on YouTube conveyed our anatomical criteria poorly, whereas the general quality scoring found borderline. Students should be selective when looking up on public video databases as it can prove challenging, time consuming, and the anatomical information may be misleading due to absence of content review. Anatomists and institutions are encouraged to prepare and endorse good quality material and make them available online for the students. The scoring rubric used in the study comprises a valuable tool to faculty members for quality evaluation of heart anatomy videos available on social media platforms.

Evaluating the quality of medical multiple-choice items created with automated processes

OBJECTIVES

Computerised assessment raises formidable challenges because it requires large numbers of test items. Automatic item generation (AIG) can help address this test development problem because it yields large numbers of new items both quickly and efficiently. To date, however, the quality of the items produced using a generative approach has not been evaluated. The purpose of this study was to determine whether automatic processes yield items that meet standards of quality that are appropriate for medical testing. Quality was evaluated firstly by subjecting items created using both AIG and traditional processes to rating by a four-member expert medical panel using indicators of multiple-choice item quality, and secondly by asking the panellists to identify which items were developed using AIG in a blind review.

METHODS

Fifteen items from the domain of therapeutics were created in three different experimental test development conditions. The first 15 items were created by content specialists using traditional test development methods (Group 1 Traditional). The second 15 items were created by the same content specialists using AIG methods (Group 1 AIG). The third 15 items were created by a new group of content specialists using traditional methods (Group 2 Traditional). These 45 items were then evaluated for quality by a four-member panel of medical experts and were subsequently categorised as either Traditional or AIG items.

RESULTS

Three outcomes were reported: (i) the items produced using traditional and AIG processes were comparable on seven of eight indicators of multiple-choice item quality; (ii) AIG items can be differentiated from Traditional items by the quality of their distractors, and (iii) the overall predictive accuracy of the four expert medical panellists was 42%.

CONCLUSIONS

Items generated by AIG methods are, for the most part, equivalent to traditionally developed items from the perspective of expert medical reviewers. While the AIG method produced comparatively fewer plausible distractors than the traditional method, medical experts cannot consistently distinguish AIG items from traditionally developed items in a blind review.

Effective or just practical? An evaluation of an online postgraduate module on evidence-based medicine (EBM)

BACKGROUND

Teaching the steps of evidence-based medicine (EBM) to undergraduate as well as postgraduate health care professionals is crucial for implementation of effective, beneficial health care practices and abandonment of ineffective, harmful ones. Stellenbosch University in Cape Town, South Africa, offers a 12-week, completely online module on EBM within the Family Medicine division, to medical specialists in their first year of training. The aim of this study was to formatively evaluate this module; assessing both the mode of delivery; as well as the perceived effectiveness and usefulness thereof.

METHODS

We used mixed methods to evaluate this module: A document review to assess whether the content of the module reflects important EBM competencies; a survey of the students to determine their experiences of the module; and semi-structured interviews with the tutors to explore their perspectives of the module. Ethics approval was obtained.

RESULTS

The document review indicated that EBM competencies were covered adequately, although critical appraisal only focused on randomised controlled trials and guidelines. Students had a positive attitude towards the module, but felt that they needed more support from the tutors. Tutors felt that students engaged actively in discussions, but experienced difficulties with understanding certain concepts of EBM. Furthermore, they felt that it was challenging explaining these via the online learning platform and saw the need to incorporate more advanced technology to better connect with the students. In their view the key to successful learning of EBM was to keep it relevant and applicable to everyday practice. Tutors also felt that an online module on EBM was advantageous, since doctors from all over the world were able to participate.

CONCLUSION

Our study has shown that the online module on EBM was effective in increasing EBM knowledge and skills of postgraduate students and was well received by both students and tutors. Students and tutors experienced generic challenges that accompany any educational intervention of EBM (e.g. understanding difficult concepts), but in addition had to deal with challenges unique to the online learning environment. Teachers of EBM should acknowledge these so as to enhance and successfully implement EBM teaching and learning for all students.

Developing web-based training for public health practitioners: what can we learn from a review of five disciplines?

During a time when governmental funding, resources and staff are decreasing and travel restrictions are increasing, attention to efficient methods of public health workforce training is essential. A literature review was conducted to inform the development and delivery of web-based trainings for public health practitioners. Literature was gathered and summarized from five disciplines: Information Technology, Health, Education, Business and Communications, following five research themes: benefits, barriers, retention, promotion and evaluation. As a result, a total of 138 articles relevant to web-based training design and implementation were identified. Key recommendations emerged, including the need to conduct formative research and evaluation, provide clear design and layout, concise content, interactivity, technical support, marketing and promotion and incentives. We conclude that there is limited application of web-based training in public health. This review offers an opportunity to learn from other disciplines. Web-based training methods may prove to be a key training strategy for reaching our public health workforce in the environment of limited resources.

Applying the cognitive theory of multimedia learning: an analysis of medical animations

CONTEXT

Instructional animations play a prominent role in medical education, but the degree to which these teaching tools follow empirically established learning principles, such as those outlined in the cognitive theory of multimedia learning (CTML), is unknown. These principles provide guidelines for designing animations in a way that promotes optimal cognitive processing and facilitates learning, but the application of these learning principles in current animations has not yet been investigated. A large-scale review of existing educational tools in the context of this theoretical framework is necessary to examine if and how instructional medical animations adhere to these principles and where improvements can be made.

METHODS

We conducted a comprehensive review of instructional animations in the health sciences domain and examined whether these animations met the three main goals of CTML: managing essential processing; minimising extraneous processing, and facilitating generative processing. We also identified areas for pedagogical improvement. Through Google keyword searches, we identified 4455 medical animations for review. After the application of exclusion criteria, 860 animations from 20 developers were retained. We randomly sampled and reviewed 50% of the identified animations.

RESULTS

Many animations did not follow the recommended multimedia learning principles, particularly those that support the management of essential processing. We also noted an excess of extraneous visual and auditory elements and few opportunities for learner interactivity.

CONCLUSIONS

Many unrealised opportunities exist for improving the efficacy of animations as learning tools in medical education; instructors can look to effective examples to select or design animations that incorporate the established principles of CTML.

[Current state of competence assessment in nursing]

Competency measurement is central to the optimisation of outcome oriented educational processes in nursing, similar to the concept of evidence based practice. The classification of measurement tools provides the basis for describing the current state of research and development in relation to competence measurement in nursing science, and any gaps are identified. The article concludes with questioning the importance of outcome oriented quality orientation in order to achieve an increase in quality during training. Further methodological developments and qualitative studies are needed to examine the context specific processes of interaction and learning, beyond competence diagnostics.

Improving the application of a practice guideline for the assessment and treatment of suicidal behavior by training the full staff of psychiatric departments via an e-learning supported Train-the-Trainer program: study protocol for a randomized controlled trial

BACKGROUND

In 2012, in The Netherlands a multidisciplinary practice guideline for the assessment and treatment of suicidal behavior was issued. The release of guidelines often fails to change professional behavior due to multiple barriers. Structured implementation may improve adherence to guidelines. This article describes the design of a study measuring the effect of an e-learning supported Train-the-Trainer program aiming at the training of the full staff of departments in the application of the guideline. We hypothesize that both professionals and departments will benefit from the program.

METHOD

In a multicenter cluster randomized controlled trial, 43 psychiatric departments spread over 10 regional mental health institutions throughout The Netherlands will be clustered in pairs with respect to the most prevalent diagnostic category of patients and average duration of treatment. Pair members are randomly allocated to either the experimental or the control condition. In the experimental condition, the full staff of departments, that is, all registered nurses, psychologists, physicians and psychiatrists (n = 532, 21 departments) will be trained in the application of the guideline, in a one-day small interactive group Train-the-Trainer program. The program is supported by a 60-minute e-learning module with video vignettes of suicidal patients and additional instruction. In the control condition (22 departments, 404 professionals), the guideline shall be disseminated in the traditional way: through manuals, books, conferences, internet, reviews and so on. The effectiveness of the program will be assessed at the level of both health care professionals and departments.

DISCUSSION

We aim to demonstrate the effect of training of the full staff of departments with an e-learning supported Train-the-Trainer program in the application of a new clinical guideline. Strengths of the study are the natural setting, the training of full staff, the random allocation to the conditions, the large scale of the study and the willingness of both staff and management to participate in the study.

TRIAL REGISTRATION

Dutch trial register: NTR3092.

Enabling the use of enhanced medical SOPs by an mLearning training solution

Standard Operating Procedures (SOPs) has been introduced as a way to provide direction, improve communication, reduce training time and improve work consistency. In healthcare, SOPs may be considered as a means that can fundamentally change the way healthcare is provided, affecting all types of healthcare stakeholders and improving healthcare decisions and patient safety. Nowadays, providing ehealth services is a necessity, even though some healthcare organizations are reluctant to fully use them. An online mobile training facility embedded within ehealth services may increase the likelihood of their adoption by healthcare professionals, who feel that, when needed, they are provided the necessary support for performing each task, as handheld devices and other mobile technologies are showing increased adoption rates. This paper presents a mobile service that provides training content on SOPs, that can be embedded in a relevant ehealth service and can be accessed by authorized healthcare professionals where and when needed.

A domain-based approach for retrieving trustworthy health videos from YouTube

Health information retrieval and YouTube can be used as powerful tools to improve user's health knowledge. However, YouTube videos must be carefully analysed in order to avoid misleading, inaccurate, obsolete and incorrect health content. We present an approach for re-ranking health videos obtained from YouTube, called Domain-based ranking. Our system automatically identifies videos coming from trusted sources (channels), such as hospitals and health organizations, and re-ranks YouTube results so that such videos are presented first in the ranking list. Video and channel metadata are used to automatically determine if a video is provided by a trusted source. The approach is tested and results show that the amount of relevant and reliable videos ranked within top-10 increase when using Domain-based ranking, compared with the original YouTube ranking.

Using automatic item generation to create multiple-choice test items

CONTEXT

Many tests of medical knowledge, from the undergraduate level to the level of certification and licensure, contain multiple-choice items. Although these are efficient in measuring examinees' knowledge and skills across diverse content areas, multiple-choice items are time-consuming and expensive to create. Changes in student assessment brought about by new forms of computer-based testing have created the demand for large numbers of multiple-choice items. Our current approaches to item development cannot meet this demand.

METHODS

We present a methodology for developing multiple-choice items based on automatic item generation (AIG) concepts and procedures. We describe a three-stage approach to AIG and we illustrate this approach by generating multiple-choice items for a medical licensure test in the content area of surgery.

RESULTS

To generate multiple-choice items, our method requires a three-stage process. Firstly, a cognitive model is created by content specialists. Secondly, item models are developed using the content from the cognitive model. Thirdly, items are generated from the item models using computer software. Using this methodology, we generated 1248 multiple-choice items from one item model.

CONCLUSIONS

Automatic item generation is a process that involves using models to generate items using computer technology. With our method, content specialists identify and structure the content for the test items, and computer technology systematically combines the content to generate new test items. By combining these outcomes, items can be generated automatically.

Practice in computer-based testing improves scores on the National Certification Examination for Nurse Anesthetists

This retrospective study examined whether practice in computer-based tests (CBTs) in student registered nurse anesthetists improved scores on the National Certification Examination (NCE). A group of students with extensive practice in CBTs was compared with a group of students whose tests were administered primarily on paper. Groups were matched on age, grade point average (GPA), and gender (n = 73 each). Higher GPA was associated with higher NCE scores overall. Adjusted for GPA (with analysis of covariance), the mean NCE proficiency score (phi) in the CBT group was 2.68 (95% confidence interval, 2.54-2.82), which was higher than the mean score in the paper-based group of 2.36 (95% confidence interval, 2.22-2.50), with an effect size of 0.52. When subgroups were examined, CBT practice improved NCE scores only in those students with graduate GPA less than or equal to 3.50, with an effect size of 1.1. It was concluded that, controlling for GPA, student registered nurse anesthetists at a university with greater exposure to CBTs had higher scores on the NCE than a comparison group with less practice in CBTs. This difference was significant only in students with GPA of 3.50 or less, consistent with a beneficial effect of practice in CBTs.

Learner feedback and educational outcomes with an internet-based ambulatory curriculum: a qualitative and quantitative analysis

BACKGROUND

Online medical education curricula offer new tools to teach and evaluate learners. The effect on educational outcomes of using learner feedback to guide curricular revision for online learning is unknown.

METHODS

In this study, qualitative analysis of learner feedback gathered from an online curriculum was used to identify themes of learner feedback, and changes to the online curriculum in response to this feedback were tracked. Learner satisfaction and knowledge gains were then compared from before and after implementation of learner feedback.

RESULTS

37,755 learners from 122 internal medicine residency training programs were studied, including 9437 postgraduate year (PGY)1 residents (24.4 % of learners), 9864 PGY2 residents (25.5 %), 9653 PGY3 residents (25.0 %), and 6605 attending physicians (17.0 %). Qualitative analysis of learner feedback on how to improve the curriculum showed that learners commented most on the overall quality of the educational content, followed by specific comments on the content. When learner feedback was incorporated into curricular revision, learner satisfaction with the instructive value of the curriculum (1 = not instructive; 5 = highly instructive) increased from 3.8 to 4.1 (p < 0.001), and knowledge gains (i.e., post test scores minus pretest scores) increased from 17.0 % to 20.2 % (p < 0.001).

CONCLUSIONS

Learners give more feedback on the factual content of a curriculum than on other areas such as interactivity or website design. Incorporating learner feedback into curricular revision was associated with improved educational outcomes. Online curricula should be designed to include a mechanism for learner feedback and that feedback should be used for future curricular revision.

Integrating virtual patients into courses: follow-up seminars and perceived benefit

CONTEXT

  The use of virtual patients (VPs) suggests promising effects on student learning. However, currently empirical data on how best to use VPs in practice are scarce. More knowledge is needed regarding aspects of integrating VPs into a course, of which student acceptance is one key issue. Several authors call for looking beyond technology to see VPs in relation to the course context. The follow-up seminar is proposed as an important aspect of integration that warrants investigation.

METHODS

  A cross-sectional explanatory study was performed in a clinical clerkship introduction course at four teaching hospitals affiliated to the same medical faculty. The VP-related activities were planned collaboratively by teachers from all four settings. However, each setting employed a different strategy to follow up the activity in the course. Sixteen questionnaire items were grouped into three scales pertaining to: perceived benefit of VPs; wish for more guidance on using VPs, and wish for assessment and feedback on VPs. Scale scores were compared across the four settings, which were ranked according to the level of intensity of students' processing of cases during VP follow-up activities.

RESULTS

  The perceived benefit of VPs and their usage were higher in the two intense-use settings compared with the moderate- and low-intensity settings. The wish for more guidance was high in the low- and one of the high-intensity settings. Students in all settings displayed little interest in more assessment and feedback regarding VPs.

CONCLUSIONS

  High case processing intensity was related to positive perceptions of the benefit of VPs. However, the low interest in more assessment and feedback on the use of VPs indicates the need to clearly communicate the added value of the follow-up seminar. The findings suggest that a more intense follow-up pays off in terms of the benefit perceived by students. This study illustrates the need to consider VPs from the perspective of a holistic course design and not as isolated add-ons.

The role of collaborative interactivity in the observational practice of clinical skills

CONTEXT

  Video-based observational practice can extend simulation-based learning outside the training space. This study explores the value of collaborative feedback provided during observational practice to the acquisition of clinical skills.

METHODS

  Nursing students viewed a video demonstrating the proper ventrogluteal injection technique before performing a videotaped pre-test trial on a simulator. They were then assigned randomly to one of three observational practice groups: a group that observed the expert demonstration (EO group); a group that viewed the expert demonstration, self-assessed their individual pre-test and contrasted their self-assessments with expert feedback (ESO group), and a group that observed the expert demonstration, self-assessed and contrasted their assessments with those of an expert, and formed a community that engaged in peer-to-peer feedback (ESPO group). The observation of all videos, the provision of assessments and all networking occurred via an Internet-mediated network. After 2 weeks, participants returned for post-tests and transfer tests.

RESULTS

  The pre-test-post-test analyses revealed significant interactions (global rating scale: F((2,22)) =4.00 [p =0.033]; checklist: F((2,22)) =4.31 [p =0.026]), which indicated that post-test performance in the ESPO group was significantly better than pre-test performance. The transfer analyses revealed main effects for both the global rating scale (F((2,23)) =6.73; p =0.005) and validated checklist (F((2,23)) =7.04; p =0.004) measures. Participants in the ESPO group performed better on the transfer test than those in the EO group.

CONCLUSIONS

  The results suggest that video-based observational practice can be effective in extending simulation-based learning, but its effectiveness is mediated by the amount of time the learner spends engaged in the practice and the type of learning activities the learner performs in the observational practice environment. We speculate that increasing collaborative interactivity supports observational learning by increasing the extent to which the educational environment can accommodate learners' specific needs.

Video-based cases disrupt deep critical thinking in problem-based learning

CONTEXT

  Video is a popular tool in problem-based learning (PBL), although its production requires resources and time. Few studies have examined the impact of the use of video in PBL upon cognitive processes and critical thinking. Those that have done focused on cases involving physical signs, where video has natural advantages.

OBJECTIVES

  This study aimed to investigate preferences for video- or text-based cases and the effects of each format upon medical students' deep thinking in PBL. Tutorials were based on material portraying interviews with patients with conditions that include psychosocial elements but no physical signs.

METHODS

  Four tutorial groups of students in a Year 2 endocrine and reproductive pathophysiology course participated in a crossover study using one video-based and one text-based case. Transcripts of tutorials were coded for depth of thinking by a blinded coder. A generalised estimating equation model was used to adjust for potential differences among groups, cases, and tutor participation. The distribution of cognitive activity within the crossover groups and the adjusted odds ratios (ORs) for deep versus superficial thinking were calculated. A prior cohort of 165 students and 18 tutors completed a survey of learning preferences.

RESULTS

  Of 5224 student utterances, the majority referred to problem exploration (2622, 50%) and description (1479, 28%). Overall, the odds of deep thinking versus superficial thinking were significantly lower using video-based cases compared with text-based cases (2045 deep/2454 for video versus 1961 deep/2218 for text; OR 0.663, 95% confidence interval [CI] 0.582-0.754; p < 0.0001). This was also true for the problem exploration domain (1217 deep/1365 for video versus 1178 deep/1257 for text; OR 0.559, 95% CI 0.355-0.882; p = 0.0125). The majority of students (59%) and tutors (78%) indicated a preference for video-based cases over text-based cases.

CONCLUSIONS

  Students and their tutors prefer video-based cases in PBL. However, compared with text-based material, the use of video-based material that refers to cases without dynamic physical signs is associated with a reduction in deep thinking.

[Continuing education in cattle practice - results of a survey]

OBJECTIVE

Continuing education is mandatory for veterinarians in Germany and Austria. The objective of this study was to analyse interests and preferences of veterinarians in cattle practice as well as to elucidate framework requirements for continuing education, including e-learning. Results should help to improve and to optimise continuing education programs.

MATERIAL AND METHODS

A survey was conducted as a questionnaire via internet and shared at two local meetings as well as by email to members of the Farm Animal Health Service Styria (Tiergesundheitsdienst Steiermark). All responses were analysed anonymously.

RESULTS

A total of 259 questionnaires were returned and 195 were included in the final analyses. The majority of participants (59.0%) were in farm animal practice for more than 10 years. Of the participants, 50.8% declared to have attended up to five continuing education events per year, 27.7% more than five. The majority (71.5%) had no experience with e-learning at that time. With regard to framework requirements for attending continuing education events, the majority (62.8%) of participants preferred events of 2 days over weekends. Total expenses, including costs for travelling and lodging, should not exceed 500 € per event (62.8% of participants). The favourite topics were animal reproduction (87.2%), metabolic disorders (85.6%) and mastitis (79.4%). Participants with less than 5 years of professional experience chose significantly more often the topics feed analyses, acupuncture, pregnancy diagnosis and homoeopathy/phytotherapy than participants with longer professional experience.

CONCLUSION

The results of this study provide important information about the interests and framework requirements for continuing education for cattle practitioners that should help to improve the offers in continuing education programs.

New approaches to linking clinical guidelines to virtual patients

An often reported challenge of evidence-based medicine concerns increasing use of clinical guidelines in practice. One of the proposed improvements is to promote guidelines by presenting them in conjunction with virtual patients. Three approaches to linking clinical guidelines to virtual patients are presented in this paper: (1) guidelines as a source for generating virtual patients; (2) guidelines hyper-flowchart as a virtual patient progress indicator; (3) guidelines flowchart reconstruction as a learning activity in virtual patient systems. The scenarios have been preliminarily evaluated using two demonstrator applications: Bit Pathways and CASUS. Challenges and direction for further development are proposed.