Leveraging Technology to Overcome the "Scalability Problem" in Communication Skills Training Courses

Although multiple consensus statements have called for large-scale efforts to improve clinicians’ communication skills regarding a variety of difficult conversations in medicine, this goal will be difficult to attain because there are no readily scalable, validated communication skills training programs for clinicians. However, novel applications of existing technologies and approaches grounded in learning science can overcome the scalability barriers. Moreover, future advances in virtual reality and artificial intelligence are likely to greatly enhance the possibilities for communication skills training programs. The purpose of this paper is to propose a scalable, theoretically grounded method to train clinicians in advanced communication skills in medicine. First, we summarize four key principles of adult learning relevant to communication skills training in medicine. Second, we discuss recommended practices to design effective technology-enhanced educational interventions, with an emphasis on achieving high amounts of user engagement. Third, we synthesize these principles into a framework for a web- and videoconference-based platform for teaching advanced communication skills in medicine. Once developed, this low-cost, scalable training platform has the potential to allow thousands of clinicians to acquire the advanced communication skills needed for difficult conversations in medicine.

A Mobile App (AMOR Mama) for Women With Breast Cancer Undergoing Radiation Therapy: Functionality and Usability Study

Background

Mobile apps targeting women with breast cancer can facilitate access to information, improve well-being, and record reports of treatment-related symptoms. However, it is important to confirm the benefits of these apps before they are used as a tool in clinical care.

Objective

The aim of this study was to evaluate the functionality and the usability of a mobile app created to guide and monitor patients with breast cancer undergoing radiation therapy.

Methods

The evaluation process of the mobile app was performed in 2 steps with 8 professionals, including nurses, physician, medical physicists, and communication networks engineer. The first step was the focus group, which allowed obtaining suggestions proposed by the participants regarding the improvement of the mobile app. The second step was the individual filling in of an evaluation tool to obtain objective measures about the mobile app. A minimum concordance index of 80% was considered to ensure the adequacy of the material.

Results

After the mobile app was evaluated by 8 professionals, only 1 item of the evaluation tool, that is, concerning the potentiality of the app to be used by users of different educational levels, obtained a concordance index <80%.

Conclusions

The mobile app titled “AMOR Mama” was considered suitable, which suggests its contribution to an educational health technology to guide and monitor patients with breast cancer undergoing radiation therapy. More studies with this target population should be carried out to assess the performance and quality of the mobile app during its use.

Clinician-Created Educational Video Resources for Shared Decision-making in the Outpatient Management of Chronic Disease: Development and Evaluation Study

Background

The provision of reliable patient education is essential for shared decision-making. However, many clinicians are reluctant to use commonly available resources, as they are generic and may contain information of insufficient quality. Clinician-created educational materials, accessed during the waiting time prior to consultation, can potentially benefit clinical practice if developed in a time- and resource-efficient manner.

Objective

The aim of this study is to evaluate the utility of educational videos in improving patient decision-making, as well as consultation satisfaction and anxiety, within the outpatient management of chronic disease (represented by atrial fibrillation). The approach involves clinicians creating audiovisual patient education in a time- and resource-efficient manner for opportunistic delivery, using mobile smart devices with internet access, during waiting time before consultation.

Methods

We implemented this educational approach in outpatient clinics and collected patient responses through an electronic survey. The educational module was a web-based combination of 4 short videos viewed sequentially, followed by a patient experience survey using 5-point Likert scales and 0-100 visual analogue scales. The clinician developed the audiovisual module over a 2-day span while performing usual clinical tasks, using existing hardware and software resources (laptop and tablet). Patients presenting for the outpatient management of atrial fibrillation accessed the module during waiting time before their consultation using either a URL or Quick Response (QR) code on a provided tablet or their own mobile smart devices. The primary outcome of the study was the module’s utility in improving patient decision-making ability, as measured on a 0-100 visual analogue scale. Secondary outcomes were the level of patient satisfaction with the videos, measured with 5-point Likert scales, in addition to the patient’s value for clinician narration and the module’s utility in improving anxiety and long-term treatment adherence, as represented on 0-100 visual analogue scales.

Results

This study enrolled 116 patients presenting for the outpatient management of atrial fibrillation. The proportion of responses that were “very satisfied” with the educational video content across the 4 videos ranged from 93% (86/92) to 96.3% (104/108) and this was between 98% (90/92) and 99.1% (107/108) for “satisfied” or “very satisfied.” There were no reports of dissatisfaction for the first 3 videos, and only 1% (1/92) of responders reported dissatisfaction for the fourth video. The median reported scores (on 0-100 visual analogue scales) were 90 (IQR 82.5-97) for improving patient decision-making, 89 (IQR 81-95) for reducing consultation anxiety, 90 (IQR 81-97) for improving treatment adherence, and 82 (IQR 70-90) for the clinician’s narration adding benefit to the patient experience.

Conclusions

Clinician-created educational videos for chronic disease management resulted in improvements in patient-reported informed decision-making ability and expected long-term treatment adherence, as well as anxiety reduction. This form of patient education was also time efficient as it used the sunk time cost of waiting time to provide education without requiring additional clinician input.

Impact of blended learning on manual defibrillator's use: A simulation-based randomized trial

Background

Blended learning, defined as the combination of traditional face‐to‐face instructor‐led learning and e‐learning course, has never been validated as a teaching method for the effective use of manual defibrillators in cardiopulmonary resuscitation.

Aim

To evaluate whether paediatric emergency and critical care providers exposed to a blended learning session performed better and recalled more defibrillator skills than those exposed to face‐to‐face learning only.

Study design

A two‐period prospective, stratified, single‐centre, simulation‐based, randomized, controlled trial.

Methods

Registered nurses and postgraduate residents from either a paediatric emergency department or an intensive care unit were randomly assigned to a blended learning or face‐to‐face learning sessions on the recommended use of a manual defibrillator. Participants' adherence to recommendations was assessed by testing defibrillator skills in three consecutive paediatric cardiopulmonary scenarios performed on the day of the training and once again 2 months later. The primary endpoint was the number of errors observed during defibrillation, cardioversion, and transcutaneous pacing at the time of the initial intervention.

Results

Fifty participants were randomized to receive the intervention and 51 to the control group. When pooling all three procedures, the median total errors per participant was lower (2 [IQR: 1‐4]) in providers exposed to blended learning than in those exposed to face‐to‐face learning only (3 [IQR: 2‐5]; P = .06). The median of total errors per procedure was also lower. However, both training methods appeared insufficient to maintain appropriate skill retention over time as a repetition of procedures 2 months later without any refresher learning session yielded more errors in both groups.

Conclusions

Learners exposed to blended learning showed a reduced number in the total amount of errors compared with those exposed to face‐to‐face learning alone, with waning of skills over time.

Relevance to clinical practice

Proficiently teaching the use of a manual defibrillator can be performed through blended learning.

Teaching and Learning Modalities in Higher Education During the Pandemic: Responses to Coronavirus Disease 2019 From Spain

The effects of the pandemic have affected and continue to affect education methods every day. The education methods are not immune to the pandemic periods we are facing, so teachers must know how to adapt their methods in such a way that teaching, and its quality, is not negatively affected. This study provides an overview of different types of teaching methodology before, during, and after the coronavirus disease 2019 (COVID-19) pandemic. This study describes the different types of teaching (e.g., presence learning, blended learning, and distance education) used in two Spanish Universities (i.e., one private and one public) during the pandemic. A new teaching methodology is proposed. The purpose of this study report is to share what we learned about the response to COVID-19. Results provide a basis for reflection about the pros and cons of teaching and learning modalities in higher education. The current situation demands that we continue to rethink what is the best methodology for teaching so that the education of students is not affected in any way. This study is useful for learning about different teaching methods that exist and which ones may suit us best depending on the context, situation, and needs of our students.

Evaluating Classification Consistency of Oral Lesion Images for Use in an Image Classification Teaching Tool

A web-based image classification tool (DiLearn) was developed to facilitate active learning in the oral health profession. Students engage with oral lesion images using swipe gestures to classify each image into pre-determined categories (e.g., left for refer and right for no intervention). To assemble the training modules and to provide feedback to students, DiLearn requires each oral lesion image to be classified, with various features displayed in the image. The collection of accurate meta-information is a crucial step for enabling the self-directed active learning approach taken in DiLearn. The purpose of this study is to evaluate the classification consistency of features in oral lesion images by experts and students for use in the learning tool. Twenty oral lesion images from DiLearn's image bank were classified by three oral lesion experts and two senior dental hygiene students using the same rubric containing eight features. Classification agreement among and between raters were evaluated using Fleiss' and Cohen's Kappa. Classification agreement among the three experts ranged from identical (Fleiss' Kappa = 1) for "clinical action", to slight agreement for "border regularity" (Fleiss' Kappa = 0.136), with the majority of categories having fair to moderate agreement (Fleiss' Kappa = 0.332-0.545). Inclusion of the two student raters with the experts yielded fair to moderate overall classification agreement (Fleiss' Kappa = 0.224-0.554), with the exception of "morphology". The feature of clinical action could be accurately classified, while other anatomical features indirectly related to diagnosis had a lower classification consistency. The findings suggest that one oral lesion expert or two student raters can provide fairly consistent meta-information for selected categories of features implicated in the creation of image classification tasks in DiLearn.

Evaluation of Participant Success in Gamified Drone Training Simulator Using Brain Signals and Key Logs

The risk of accidents while operating a drone is quite high. The most important solution is training for drone pilots. Drone pilot training can be done in both physical and virtual environments, but the probability of an accident is higher for pilot trainees, so the first method is to train in a virtual environment. The purpose of this study is to develop a new system to collect data on students’ educational development performance of students during the use of Gamified Drone Training Simulator and objectively analyze students’ development. A multimodal recording system that can collect simulator, keystroke, and brain activity data has been developed to analyze the cognitive and physical activities of participants trained in the gamified drone simulator. It was found that as the number of trials increased, participants became accustomed to the cognitive load of visual/auditory tasks and therefore the power in the alpha and beta bands decreased. It was observed that participants’ meditation and attention scores increased with the number of repetitions of the educational game. It can be concluded that the number of repetitions lowers stress and anxiety levels, increases attention, and thus enhances game performance.

Virtual clinical simulation in nursing education: a concept analysis

OBJECTIVES

To analyze the concept of virtual clinical simulation in nursing education.

METHODS

The Walker and Avant concept analysis model guided the study process and the data collection followed the integrative literature review method. Databases searched were: CINAHL, PubMed, Education Resources Information Center, and Scopus. Search terms and Boolean operators were: e-simulation OR virtual clinical simulation OR computer-simulation OR computer simulation OR virtual gaming OR virtual reality AND nursing education OR nursing. The sample comprised 45 studies.

RESULTS

Virtual clinical simulation in nursing education was defined as the innovative teaching and learning technological strategy that provides immersive self-regulated training of nursing practice, reproducing real-life experiences and feedback in a virtual environment that is safe, interactive, dynamic and enjoyable.

CONCLUSIONS

Clarification of this concept contributes to the development of a standardized terminology to include in the nursing nomenclature system and its dissemination for the construction of nursing science.

Towards an Open Medical School without Checkerboards during the COVID-19 Pandemic: How to Flexibly Self-Manage General Surgery Practices in Hospitals?

Background: Can we create a technological solution to flexibly self-manage undergraduate General Surgery practices within hospitals? Before the pandemic, the management of clerkships was starting to depend less on checkerboards. This study aims to explore undergraduates’ perceptions of doing rotations in teaching hospitals using different teaching styles and elicit their views regarding the options of managing practices to design a mobile app that substitutes for checkerboards. Methods: In this sequential exploratory mixed methods study, 38 semi-structured interviews at a teaching hospital were conducted. The data was used to survey 124 students doing their rotations in four teaching hospitals during the first wave of COVID-19. Results: 21 themes highlighted concerns related to the practices, the teacher involvement in the students’ education, and the students’ adaptation to clinical culture. The students reported positive perceptions concerning self-managing and organizing practices via a mobile application. However, problems emerged regarding transparency, the lack of feedback, and the need for new tools. Regarding the teaching styles, the facilitator and personal models were perceived as optimal, but the personal style had no effect on using or not using a tool. Conclusions: A mobile-learning application designed like an educational opportunities’ manager tool can probably promote self-directed learning, flexible teaching, and bidirectional assessments. However, teachers who employ a personal teaching style may not need either checkerboards or a tool. This solution supports teaching at hospitals in pandemic times without checkerboards.

Using Virtual Patients to Explore the Clinical Reasoning Skills of Medical Students: Mixed Methods Study

BACKGROUND

Improving clinical reasoning skills-the thought processes used by clinicians to formulate appropriate questions and diagnoses-is essential for reducing missed diagnostic opportunities. The electronic Clinical Reasoning Educational Simulation Tool (eCREST) was developed to improve the clinical reasoning of future physicians. A feasibility trial demonstrated acceptability and potential impacts; however, the processes by which students gathered data were unknown.

OBJECTIVE

This study aims to identify the data gathering patterns of final year medical students while using eCREST and how eCREST influences the patterns.

METHODS

A mixed methods design was used. A trial of eCREST across 3 UK medical schools (N=148) measured the potential effects of eCREST on data gathering. A qualitative think-aloud and semistructured interview study with 16 medical students from one medical school identified 3 data gathering strategies: Thorough, Focused, and Succinct. Some had no strategy. Reanalysis of the trial data identified the prevalence of data gathering patterns and compared patterns between the intervention and control groups. Patterns were identified based on 2 variables that were measured in a patient case 1 month after the intervention: the proportion of Essential information students identified and the proportion of irrelevant information gathered (Relevant). Those who scored in the top 3 quartiles for Essential but in the lowest quartile for Relevant displayed a Thorough pattern. Those who scored in the top 3 quartiles for Relevant but in the lowest quartile for Essential displayed a Succinct pattern. Those who scored in the top 3 quartiles on both variables displayed a Focused pattern. Those whose scores were in the lowest quartile on both variables displayed a Nonspecific pattern.

RESULTS

The trial results indicated that students in the intervention group were more thorough than those in the control groups when gathering data. The qualitative data identified data gathering strategies and the mechanisms by which eCREST influenced data gathering. Students reported that eCREST promoted thoroughness by prompting them to continuously reflect and allowing them to practice managing uncertainty. However, some found eCREST to be less useful, and they randomly gathered information. Reanalysis of the trial data revealed that the intervention group was significantly more likely to display a Thorough data gathering pattern than controls (21/78, 27% vs 6/70, 9%) and less likely to display a Succinct pattern (13/78, 17% vs 20/70, 29%; χ²₃=9.9; P=.02). Other patterns were similar across groups.

CONCLUSIONS

Qualitative data suggested that students applied a range of data gathering strategies while using eCREST and that eCREST encouraged thoroughness by continuously prompting the students to reflect and manage their uncertainty. Trial data suggested that eCREST led students to demonstrate more Thorough data gathering patterns. Virtual patients that encourage thoroughness could help future physicians avoid missed diagnostic opportunities and enhance the delivery of clinical reasoning teaching.

Impact and perception about distant online medical education (tele-education) on the educational environment during the COVID-19 pandemic: Experiences of medical undergraduate students from India

INTRODUCTION

The impact of online medical education using videoconferencing platforms on the education environment during the present COVID-19 pandemic is not known. The objectives were to evaluate the impact of online teaching using videoconferencing platforms on the education environment, satisfaction, and perception of the medical undergraduate students to online teaching.

METHODS

This prospective observational survey undertaken at a medical college included voluntarily participating medical undergraduate students from first (2nd semester), second (4th semester), and third year MBBS (6th and 8th semesters). The education environment was evaluated using the validated Dundee Ready Education Environment Measure (DREEM). The perception of the students was evaluated using questionnaire with five point Likert scale response.

RESULTS

The response rate in our survey was 77.5% (465 out of 600 students). The mean DREEM score of medical undergraduate students was 132.3 ± 19.8. Domains of DREEM evaluated were students' perception of learning (30.1 ± 6.3), students' perception of teachers (29.7 ± 4.6), students' academic self-perception (21.3 ± 4.9), students' perception of atmosphere (32.5 ± 6.2), and students' social self-perception (18.7 ± 3.5). Two hundred and fifty five students (54.8%) were extremely satisfied and quite satisfied with the online teaching-learning modalities. Two hundred and fifty eight students (55.5%) rated online learning methods to be very useful and quite useful during the lockdown period.

CONCLUSION

The educational environment at our medical college was positive and students had a positive perception and attitude toward the role of the videoconferencing platforms for learning (telemedicine) during the COVID-19 pandemic lockdown.

Collaborating and teaching a synchronous, multi-university, virtual course: Health policy and access to dental care

PURPOSE

In response to COVID-19, dental educators have been tasked with maintaining the quality of education while reducing cost, increasing efficiency, and leveraging technology.

METHODS

This collaborative, multisite virtual health policy course used the Staged Self-Directed Learning Model (SSDL) to lead a diverse group of students studying health policy. Twelve Core sessions were offered with three additional sessions in August or December for a total of 15 total synchronous Zoom sessions that covered policy issues on supply, demand, and need for dental care.

RESULTS

Twenty-eight students, seven lead instructors, and two course directors from six schools reported positive feedback on the course format, use of technology and the SSDL model, and breadth of topics presented. Participation by universities in four states with differing health policies stimulated virtual classroom discussions.

CONCLUSION

In conclusion, collaborative interinstitutional virtual teaching and learning is cost effective, efficient, and engaging for students. This model has the potential to continue even when institutions are no longer affected by COVID-19.

Using learning management software data to compare students' actual and self-reported viewing of video lectures

PURPOSE

Student engagement is typically measured by class attendance and questionnaires. Learning management systems (LMS) provide additional sources of objective data that can evaluate student performance. This study compared dental students' self-report of course video viewing with LMS data.

METHODS

Dental students in a 2018 flipped pediatric dentistry course were given a questionnaire after course completion that captured self-reported course video viewing. Student data and time spent on videos were extracted from the LMS and matched to the questionnaire. McNemar's test evaluated differences between self-reported and matching LMS data.

RESULTS

Of the 109 enrolled students, 99 (91%) completed the questionnaire. Most students self-reported that they watched more than half of the videos (71%), re-watched at least once (89%), and watched at times other than 8 a.m.-5 p.m. (80%). Of the 104 students with data from the LMS, 40% of students watched more than half of the videos, 49% re-watched at least one video, and 60% watched between 8 a.m.-5 p.m. LMS data showed 14 (13%) students did not watch any videos. Significant differences were found between self-reported video viewing and matched LMS video data in (1) percentage of videos watched, (2) number of times videos were re-watched, and (3) most frequent time for watching the videos (p < 0.001 for all).

CONCLUSION

Technology is a tool that helps instructors more accurately track students' study habits compared to observation or self-report. When evaluating time spent watching videos via an LMS, students tend to overestimate the amount of viewing time.

Adaptive e-learning platforms can improve student performance and engagement in dental education

PURPOSE

Knowledge of normal tissue architecture is essential for one of the vitally important graduate competencies in dentistry, which is the recognition and appropriate referral of patients with oral mucosal and jawbone abnormalities for timely management and improved outcomes. The aim of this study was to examine the effect of online adaptive lessons on improving perceived and measured student performance, motivation, and student perceptions in dental education.

METHODS

This mixed-method study was conducted on year 1 and year 3 undergraduate dental students. Adaptive lessons supplementing a number of histology topics were designed and made available. Adaptive lesson scores and analytics, exam scores on topics that were supplemented by adaptive lessons (Experimental Questions), and those that were not (Control Questions) were compared among the year 1 students (n = 43). A validated questionnaire including Likert-type scales about the student attitudes and perceptions toward adaptive lessons followed by open-ended questions was administered to year 1 and 3 students (n = 57).

RESULTS

Students obtained significantly higher scores in experimental exam questions than control exam questions (p = 0.01). A significantly larger number of students perceived that the adaptive lessons improved their knowledge of the subject (p < 0.001).

CONCLUSIONS

The adaptive lessons employed in this study showed significant potential to improve student engagement, motivation, perceived knowledge, and measured exam performance. These are particularly important findings especially amid the COVID-19 pandemic as institutions transitioned to online education in lieu of face-to-face classes to comply with recommendations from Health Authorities.

Educational Methods and Technological Innovations for Introductory Experiential Learning Given the Contact-Related Limitations Imposed by the SARS-CoV2/COVID-19 Pandemic

BACKGROUND

Acute respiratory syndrome related coronavirus disease (COVID-19) has led to substantial changes in pharmacy curricula, including the ability to provide in-person introductory experiential practice experiences (IPPEs) to University of Colorado's International-Trained PharmD (ITPD) students.

METHODS

The IPPE course for ITPD students was redesigned to offer remote educational activities in the health system setting and simulated practice and communication activities in the community setting. Students were evaluated via surveys regarding the perceived value of these changes, and changes in knowledge, skills and abilities before and after activities.

RESULTS

A total of 6 students were enrolled in the revised IPPE course. Students agreed or strongly agreed that the overall distance-based IPPE experience, the remote health system activities, and the community activities were valuable. Students also strongly agreed that course design successfully met course outcomes and was relevant to pharmacy practice. In terms of knowledge, skills and abilities, numeric improvements were observed in remote health system activities and community-based simulated patient interactions, but results were not statistically significant. A high baseline level of knowledge led to minimal improvements in perceptions of improvement in community pharmacy skills regarding pharmacy simulation software.

CONCLUSION

Implementation of distance-based IPPE activities may be an alternate educational modality.

Contact lens education for the practitioners of the future

The World Health Organization has identified a shortage of trained human resources as one of the greatest challenges to increasing the availability of eye care services and reducing preventable visual impairment around the world. Increased prevalence of myopia and new strategies for myopia management have raised the prospect of various interventions, including contact lenses for therapeutic use as well as for refractive correction. More personnel skilled in contact lens fitting will be needed to address potential worldwide demand for these interventions. This review investigates the current status and future requirements of global contact lens education in light of these developments. The COVD-19 pandemic led educational institutions worldwide to move towards online delivery. An online survey among 546 educators, conducted in May 2020, investigated changes to contact lens education delivery before and after the onset of the pandemic. A total of 214 responses were received from 32 countries. Prior to COVID-19 restrictions, 23% of educators had conducted more than 50% of their total teaching online; however, 69% expected to conduct more than half of their teaching online by the end of 2020 and 12% anticipated 90% or more of their teaching would be online. Some 76% of educators expected to provide more online lectures after the pandemic and 63% anticipated new methods to deliver practical education. Around half were planning to introduce new teaching online platforms (54%) and more online assessment methods (53%). The global need for increasing numbers of skilled personnel points to a crucial role for educators in teaching the contact lens practitioners of the future. Contact lens education delivery was already evolving prior to COVID-19, and changes that are currently occurring may lead to permanent differences in the way contact lenses are taught in future. The International Association of Contact Lens Educators (IACLE) provides educators with a standardised global curriculum, online resources and teaching technology that could also serve as a model for wider ophthalmic education in future.

Barriers and facilitators to clinical information seeking: a systematic review

OBJECTIVE

The study sought to identify barriers to and facilitators of point-of-care information seeking and use of knowledge resources.

MATERIALS AND METHODS

We searched MEDLINE, Embase, PsycINFO, and Cochrane Library from 1991 to February 2017. We included qualitative studies in any language exploring barriers to and facilitators of point-of-care information seeking or use of electronic knowledge resources. Two authors independently extracted data on users, study design, and study quality. We inductively identified specific barriers or facilitators and from these synthesized a model of key determinants of information-seeking behaviors.

RESULTS

Forty-five qualitative studies were included, reporting data derived from interviews (n = 26), focus groups (n = 21), ethnographies (n = 6), logs (n = 4), and usability studies (n = 2). Most studies were performed within the context of general medicine (n = 28) or medical specialties (n = 13). We inductively identified 58 specific barriers and facilitators and then created a model reflecting 5 key determinants of information-seeking behaviors: time includes subthemes of time availability, efficiency of information seeking, and urgency of information need; accessibility includes subthemes of hardware access, hardware speed, hardware portability, information restriction, and cost of resources; personal skills and attitudes includes subthemes of computer literacy, information-seeking skills, and contextual attitudes about information seeking; institutional attitudes, cultures, and policies includes subthemes describing external individual and institutional information-seeking influences; and knowledge resource features includes subthemes describing information-seeking efficiency, information content, information organization, resource familiarity, information credibility, information currency, workflow integration, compatibility of recommendations with local processes, and patient educational support.

CONCLUSIONS

Addressing these determinants of information-seeking behaviors may facilitate clinicians' question answering to improve patient care.

Applying "think-pair-share" for virtual curriculum retreat

With coronavirus disease 2019 (COVID-19) leading to ubiquitous changes across the education system, Tufts University School of Dental Medicine took advantage of their new, fast-changing environment to foster engagement among faculty members regarding curricular modifications and their impact on assessment outcomes. A virtual curricular retreat was planned, where adaptations could be discussed through the lens of Miller's Pyramid. The retreat provided an opportunity for faculty to participate in a guided dialogue via a "think-pair-share" activity that resulted in documenting the outcomes of recent curriculum changes while allowing for reflection for future improvement.

Benefits and Challenges of Interdisciplinarity in CSCL Research: A View From the Literature

Computer-supported collaborative learning (CSCL) has a history of being interdisciplinary from its conception. Its beginnings have included computer scientists, psychologists, cognitive scientists, and educational researchers. These collaborations have been fruitful but have also posed challenges (Suthers et al., 2013). This article builds on the authors’ extensive review of the CSCL literature to examine the nature of interdisciplinary collaboration in CSCL research as well as an interdisciplinary CSCL workshop. Using a corpus of more than 700 CSCL articles, we reported an updated analysis for the theories and methods used in CSCL research. In addition, bibliometric analyses examined journals that publish CSCL research and are cited by CSCL research. CSCL research is published in journals that are aligned with interdisciplinary research with large contributions from educational research followed by technology related fields and social sciences. The contributions from domain knowledge journals are relatively weak. These analyses revealed disciplinary influences and uptakes of CSCL research and how they might differ across CSCL research clusters. Lastly, we provide a case example of a CSCL workshop to further demonstrate the interdisciplinary nature of the field. Through these analyses we aim to characterize the benefits and challenges of interdisciplinary collaboration in CSCL research. Interdisciplinarity has helped CSCL research to adopt multiple theories and methods to understand CSCL. While cultivating diversity, we also need to be mindful that research outcomes are exchanged and appropriated actively across participating disciplines so that our understanding of CSCL rises above individual disciplines.

Pupillary Responses for Cognitive Load Measurement to Classify Difficulty Levels in an Educational Video Game: Empirical Study

Background

A learning task recurrently perceived as easy (or hard) may cause poor learning results. Gamer data such as errors, attempts, or time to finish a challenge are widely used to estimate the perceived difficulty level. In other contexts, pupillometry is widely used to measure cognitive load (mental effort); hence, this may describe the perceived task difficulty.

Objective

This study aims to assess the use of task-evoked pupillary responses to measure the cognitive load measure for describing the difficulty levels in a video game. In addition, it proposes an image filter to better estimate baseline pupil size and to reduce the screen luminescence effect.

Methods

We conducted an experiment that compares the baseline estimated from our filter against that estimated from common approaches. Then, a classifier with different pupil features was used to classify the difficulty of a data set containing information from students playing a video game for practicing math fractions.

Results

We observed that the proposed filter better estimates a baseline. Mauchly’s test of sphericity indicated that the assumption of sphericity had been violated (χ²₁₄=0.05; P=.001); therefore, a Greenhouse-Geisser correction was used (ε=0.47). There was a significant difference in mean pupil diameter change (MPDC) estimated from different baseline images with the scramble filter (F_5,78=30.965; P<.001). Moreover, according to the Wilcoxon signed rank test, pupillary response features that better describe the difficulty level were MPDC (z=−2.15; P=.03) and peak dilation (z=−3.58; P<.001). A random forest classifier for easy and hard levels of difficulty showed an accuracy of 75% when the gamer data were used, but the accuracy increased to 87.5% when pupillary measurements were included.

Conclusions

The screen luminescence effect on pupil size is reduced with a scrambled filter on the background video game image. Finally, pupillary response data can improve classifier accuracy for the perceived difficulty of levels in educational video games.

Impact of Educational Technology on Teacher Stress and Anxiety: A Literature Review

Educational technology has become an increasingly important element for improving the teaching and learning process of students. To achieve these goals, it is essential that teachers have the skills they need to be able to introduce technology into their teaching practice. However, this is often overwhelming and stressful for many of them. The aim of this review was to find out how research on teacher stress and anxiety associated with the use of educational technology was proceeding. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines through the following bibliographic databases: PubMed, Web of Science, and Scopus. Sixteen articles were found from the review. The main findings show that teachers present high levels of anxiety or stress due to their use of educational technology in the classroom. Among the conclusions, the need for research on different strategies to prevent the emergence of these anxiety and stress symptoms in teachers stands out.

Consensus Meeting Report "Technology Enhanced Assessment" in Covid-19 Time, MENA Regional Experiences and Reflections

PURPOSE

Majority of the assessments, appraisals and placements have been disturbed, with some being cancelled, postponed, or modified in design. New approaches for assessment should be well-thought-out. This work attempts at capturing the collective wisdom of educators in the Middle East and North Africa region (MENA), providing an understanding of the online assessment conceptual framework in the era of COVID-19 that tells the story rather than determining cause and effect, and identifying the biggest gaps that derail the digital transformation.

METHODS

A qualitative inductive study using the grounded theory approach was implemented following a synchronous virtual online meeting, a summary of the reflections as well as experiences of medical education experts was prepared. Data for this qualitative study were collected from the meeting. The meeting was video-recorded and transcribed by the researchers. Thematic analysis was performed by three separate researcher coders. The authors then discussed together until they reached a consensus.

RESULTS

Three main thematic areas were identified: 1) feasibility, 2) exam fairness/equity and 3) acceptable graduate attributes, society/community acceptance.

CONCLUSION

The COVID-19 era necessitated revisiting of our assessment strategies to cope with new changes within the available context. Rapid adaptation is required.

Application of telepresence systems in teaching - transfer of an interprofessional teaching module on digital aided communication into the block training "internal medicine" during the Covid-19 pandemic

Objective: The contact restrictions caused by the Covid-19 pandemic fundamentally limit patient-centered teaching. To realize a patient-oriented education in the block training "Internal Medicine" at the University Hospital Halle (Saale) despite the challenges, the already established teaching module "Interprofessional Teleconsultation" was adapted. The short article outlines the interprofessional teaching module including first evaluation results and describes the adapted block training. Method: In the "Internal Medicine" block training, students in a lecture hall navigated a telepresence system, which was accompanied by a physician across the ward and conducted an anamnesis via video and audio transmission without actual patient contact. Results: Students, physicians, and patients were open-minded about this form of communication during the Covid-19 pandemic and quickly got accustomed to the use of the telepresence system. To be able to react to technical challenges (e.g. unstable connection between the communication partners), a careful preparation of the lecturers is necessary. Conclusion: In using a telepresence system, patient-oriented teaching of students in the block training "Internal Medicine" can be ensured with low-threshold technical effort during the Covid-19 pandemic. The telepresence system allows for the involvement of patients into teaching while adhering to the necessary hygiene measures. Despite technical challenges, the teaching format based on telepresence is suitable as an alternative to face-to-face teaching if actual patient contact is not possible.

A Hybrid Human-Neurorobotics Approach to Primary Intersubjectivity via Active Inference

Interdisciplinary efforts from developmental psychology, phenomenology, and philosophy of mind, have studied the rudiments of social cognition and conceptualized distinct forms of intersubjective communication and interaction at human early life. Interaction theorists consider primary intersubjectivity a non-mentalist, pre-theoretical, non-conceptual sort of processes that ground a certain level of communication and understanding, and provide support to higher-level cognitive skills. We argue the study of human/neurorobot interaction consists in a unique opportunity to deepen understanding of underlying mechanisms in social cognition through synthetic modeling, while allowing to examine a second person experiential (2PP) access to intersubjectivity in embodied dyadic interaction. Concretely, we propose the study of primary intersubjectivity as a 2PP experience characterized by predictive engagement, where perception, cognition, and action are accounted for an hermeneutic circle in dyadic interaction. From our interpretation of the concept of active inference in free-energy principle theory, we propose an open-source methodology named neural robotics library (NRL) for experimental human/neurorobot interaction, wherein a demonstration program named virtual Cartesian robot (VCBot) provides an opportunity to experience the aforementioned embodied interaction to general audiences. Lastly, through a study case, we discuss some ways human-robot primary intersubjectivity can contribute to cognitive science research, such as to the fields of developmental psychology, educational technology, and cognitive rehabilitation.

How US dental schools can better prepare their students to perform operative procedures

OBJECTIVE

The aim of this study was to characterize the curricular and supplemental resources used by dental students during their operative dentistry course, survey students' perception of each resource's "helpfulness," and assess students' perceptions of preparedness to perform operative dental procedures in clinical settings.

METHODS

American Student Dental Association delegates at all accredited dental education programs in the United States were asked to forward an email to students enrolled at their respective institutions explaining the purpose of the study and asking them to fill out our survey. The response rate was calculated using the targeted enrollment data found in American Dental Education Association Official Guide to Dental Schools.

RESULTS

A total of 715 qualified respondents completed our questionnaire for a response rate of 13.5%. 90% of students felt at least "moderately prepared" to perform operative procedures in the clinical environment. The 3 most common curricular resources provided to students were lecture slides (n = 707, 99%), live lectures (n = 664, 93%), and live faculty demonstrations (n = 547, 77%). YouTube was the most common supplemental resource utilized by students (n = 575, 80%). When asked to select which resources were the most helpful for their learning, 49% (270/547) selected live faculty demonstrations, 27% (153/575) selected YouTube videos, and 23% (155/664) selected lectures/lecture slides.

CONCLUSION

To best meet the expectations of the current generation of dental students and to prevent early-stage dental learners from being influenced by clinical misinformation online, dental schools should consider adapting and producing more online, video-based learning resources for their curricula.