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Donohue KE, Farber DL, Goel N, Parrino CR, Retener NF, Rizvi S, Dittmar PC. Quality Improvement Amid a Global Pandemic: A Virtual Curriculum for Medical Students in the Time of COVID-19. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11090. [PMID: 33598535 PMCID: PMC7880258 DOI: 10.15766/mep_2374-8265.11090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/27/2020] [Indexed: 05/23/2023]
Abstract
INTRODUCTION The COVID-19 pandemic in March of 2020 necessitated the removal of medical students from direct patient care activities to prevent disease spread and to conserve personal protective equipment. In order for medical student education to continue, virtual and online electives were designed and implemented expeditiously. We created a virtual curriculum that taught quality improvement (QI) skills within the context of the global pandemic. METHODS This 4-week curriculum enrolled 16 students. Students completed the revised QI knowledge application tool (QIKAT-R) before and after the course to assess QI knowledge. Students completed prereading, online modules, and received lectures on QI and incident command systems. Each group designed their own QI project related to our hospital system's response to the pandemic. Finally, groups presented their projects at a peer symposium and completed peer evaluations. RESULTS Students' QIKAT-R scores improved throughout the course from a mean of 5.5 (SD = 1.3) to a mean of 7.5 (SD = 1.1; p < 0.001). Students reported that the virtual learning experience delivered the material effectively, and all students agreed that they would participate in QI work in the future. DISCUSSION Patient safety and QI topics are content areas for multiple medical licensing examinations. Virtual learning is an effective way to deliver QI content to medical students and residents, especially when projects are trainee-led, QI-trained faculty serve as mentors, and the projects harmonize with institutional goals. Our virtual pandemic-focused curriculum has demonstrated efficacy in increasing medical student QI knowledge.
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Affiliation(s)
- Katelyn E. Donohue
- Assistant Professor, Departments of Medicine and Pediatrics, University of Maryland School of Medicine
| | - Dara L. Farber
- Assistant Professor, Departments of Medicine and Pediatrics, University of Maryland School of Medicine
| | - Nidhi Goel
- Assistant Professor, Departments of Medicine and Pediatrics, University of Maryland School of Medicine
| | | | - Norman F. Retener
- Assistant Professor, Department of Medicine, University of Maryland School of Medicine
| | - Syedmehdi Rizvi
- Director of Emergency Management, University of Maryland Medical Center
| | - Philip C. Dittmar
- Assistant Professor, Department of Medicine, University of Maryland School of Medicine
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Seifert T, Becker T, Büttcher AF, Herwig N, Raupach T. Restructuring the clinical curriculum at University Medical Center Göttingen: effects of distance teaching on students' satisfaction and learning outcome. GMS JOURNAL FOR MEDICAL EDUCATION 2021; 38:Doc1. [PMID: 33659606 PMCID: PMC7899111 DOI: 10.3205/zma001397] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/16/2020] [Accepted: 11/24/2020] [Indexed: 05/28/2023]
Abstract
Introduction: In summer term 2020, the clinical phase of the undergraduate medical curriculum at University Medical Center Göttingen was restructured since distance teaching had to be used predominantly due to contact restrictions during the COVID-19 pandemic. This paper investigates the impact of restructuring the clinical curriculum on medical students' satisfaction and learning outcomes. Methods: In each cohort, the 13-week curriculum was divided into two parts: During the first 9 weeks, factual knowledge was imparted using distance teaching by means of a modified inverted classroom approach. This was followed by a 4-week period of adapted classroom teaching involving both real and virtual patients in order to train students' practical skills. The evaluation of the 21 clinical modules comprised students' satisfaction with distance teaching as well as students' learning outcome. The latter was assessed by means of comparative self-assessment (CSA) gain and the results of the module exams, respectively. Data of summer term 2020 (= distance teaching, DT) were compared with respective data of winter term 2019/20 (= classroom teaching, CT) and analysed for differences and correlations. Results: Response rates of evaluations were 51.3% in CT and 19.3% in DT. There was no significant difference between mean scores in module exams in CT and DT, respectively. However, CSA gain was significantly lower in DT (p=0.047) compared with CT. Further analyses revealed that CSA gain depended on the time point of data collection: CSA gain was lower the more time had passed since the end of a specific module. Moreover, we found positive correlations between CSA gain and students' satisfaction with various aspects of distance teaching, particularly with "communication between teachers and students" (rho=0.674; p=0.002). Discussion and conclusions: Although some limitations and confounding factors have to be taken into account (such as evaluation response rates, assessment time points, and proportion of familiar items in module exams), the following recommendations can be derived from our findings: A valid assessment of students' learning outcome by means of exam results requires that as few exam items as possible are familiar to the students. CSA gain seems to be valid if assessment time points are standardised and not contaminated by students' learning activities for other modules. Good communication between teachers and students may contribute to increase students' satisfaction with distance teaching.
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Affiliation(s)
- Theresa Seifert
- Universitätsmedizin Göttingen, Bereich Medizindidaktik und Ausbildungsforschung, Göttingen, Germany
| | - Tim Becker
- Universitätsmedizin Göttingen, Bereich Medizindidaktik und Ausbildungsforschung, Göttingen, Germany
| | | | - Nadine Herwig
- Universitätsmedizin Göttingen, Bereich Medizindidaktik und Ausbildungsforschung, Göttingen, Germany
| | - Tobias Raupach
- Universitätsmedizin Göttingen, Bereich Medizindidaktik und Ausbildungsforschung, Göttingen, Germany
- Universitätsmedizin Göttingen, Klinik für Kardiologie und Pneumologie, Göttingen, Germany
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Joshi M, Chandrasekar M. Disruptive change in medical education during the COVID-19 pandemic: Challenges and opportunities. JOURNAL OF MAHATMA GANDHI INSTITUTE OF MEDICAL SCIENCES 2021. [DOI: 10.4103/jmgims.jmgims_95_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Steiner I, Brandenberger J, Wagner F, Huwendiek S. [Blended Learning With Virtual Pediatric Emergency Patients for Medical Students]. PRAXIS 2021; 110:961-966. [PMID: 34875867 DOI: 10.1024/1661-8157/a003749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Blended Learning With Virtual Pediatric Emergency Patients for Medical Students Abstract. Treating critically ill children is a major challenge for learners. Medical Students often feel inadequately prepared for their later role as physicians. This article describes the implementation and evaluation of blended learning using virtual patients (VP) during the student rotation at the pediatric emergency department Inselspital Bern. Students rated the project as highly beneficial and recommended its integration into the entire clinical curriculum.
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Affiliation(s)
- Isabelle Steiner
- Notfallzentrum für Kinder und Jugendliche, Universitäre Kinderkliniken, Inselspital, Bern
| | - Julia Brandenberger
- Notfallzentrum für Kinder und Jugendliche, Universitäre Kinderkliniken, Inselspital, Bern
| | - Felicitas Wagner
- Institut für Medizinische Lehre, Abteilung für Assessment und Evaluation, Medizinische Fakultät, Bern
| | - Sören Huwendiek
- Institut für Medizinische Lehre, Abteilung für Assessment und Evaluation, Medizinische Fakultät, Bern
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Noverati N, R. Naro G, J. Fischer R, M. Thompson B. Using Video and Virtual Patients in Problem-Based Learning: a Scoping Review. MEDICAL SCIENCE EDUCATOR 2020; 30:1685-1691. [PMID: 34457832 PMCID: PMC8368294 DOI: 10.1007/s40670-020-01108-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 06/07/2023]
Abstract
Problem presentation in problem-based learning can include the use of videos and interactive virtual patients. This review scopes the literature for this variation and what benefits or pitfalls there may be to their use. Themes indicate that videos and virtual patients may better prepare students for future difficult clinical interactions, while also increasing authenticity and memorability of cases. Findings are more inconsistent in determining whether they lead to clear knowledge or critical thinking gains. Despite inconsistent data, in an age where the use of technology is inevitable, the findings of this scoping review can inform future practice and guide innovation.
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Affiliation(s)
| | - Gillian R. Naro
- Pennsylvania State University College of Medicine, Hershey, PA USA
| | - Ryan J. Fischer
- Pennsylvania State University College of Medicine, Hershey, PA USA
| | - Britta M. Thompson
- Department of Medicine and Woodward Center for Excellence in Health Sciences Education, Hershey, PA USA
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Lucero KS, Spyropoulos J, Blevins D, Warters M, Norton A, Cohen J. Virtual Patient Simulation in Continuing Education: Improving the Use of Guideline-Directed Care in Venous Thromboembolism Treatment. J Eur CME 2020; 9:1836865. [PMID: 33178492 PMCID: PMC7594728 DOI: 10.1080/21614083.2020.1836865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Results of a CME-certified activity completed by a total of 986 cardiologists and 783 haematologists-oncologists (haem-oncs) from around the world were examined to determine whether virtual patient simulation could improve decision-making and performance within the simulation related to patient evaluation, tailoring anticoagulant therapy, and patient management to improve adherence using patient-centred care strategies. Results showed a significant overall impact of education from pre- to post-clinical guidance (CG) on correct decisions made in both cases for cardiologists, with a relative improvement of 22% for Case 1 (45% pre- to 55% post-CG, n = 475, t(474) = 14.12, P<.001, Cohen’s d =.46) and 19% for Case 2 (62% pre- to 74% post-CG, n = 245, t(244) = 11.95, P<.001, Cohen’s d =.59). Impact also was seen for haem-oncs, with a relative improvement of 27% for Case 1 (45% pre- to 57% post-CG, n = 280, t(279) = 11.91, P <.001, Cohen’s d =.60) and 19% for Case 2 (63% pre- to 75% post-CG, n = 147, t(146) = 9.52, P <.001, Cohen’s d =.58). Virtual patient simulation improved cardiologists’ and haem-oncs management of patients with pulmonary embolism in a simulated environment.
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Affiliation(s)
| | | | | | - Martin Warters
- Learner Experience and Instructional Design, Medscape, LLC, New York, NY, USA
| | | | - Jacob Cohen
- Outcomes and Insights Manager, Medscape, LLC, New York, NY, USA
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Lange AK, Koch J, Beck A, Neugebauer T, Watzema F, Wrona KJ, Dockweiler C. Learning With Virtual Reality in Nursing Education: Qualitative Interview Study Among Nursing Students Using the Unified Theory of Acceptance and Use of Technology Model. JMIR Nurs 2020; 3:e20249. [PMID: 34345791 PMCID: PMC8279447 DOI: 10.2196/20249] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/16/2020] [Accepted: 08/12/2020] [Indexed: 02/06/2023] Open
Abstract
Background Digital games–based learning is a method of using digital games to impart knowledge. Virtual reality (VR) programs are a practical application of this method. Due to demographic changes, the nursing profession will become increasingly important. These VR applications can be of use in training nurses for future professional challenges they may encounter.
The continuous development of VR applications enables trainees to encounter simulated real life effectively and to experience increasingly concrete situations. This can be of great importance in nursing education, since 3-dimensionality enables a better visualization of many fields of activity and can prevent potential future errors. In addition to this learning effect, VR applications also bring an element of fun to learning. Objective The aim of this qualitative research effort is to observe the degree of acceptance of VR applications by nursing students in Germany. Various factors, including social influences, performance expectations, and effort expectations, are taken into consideration. Methods With a qualitative cohort study, the acceptance of nursing students towards VR applications in anatomy teaching was determined. The 12 participants were first asked to fill out a quantitative questionnaire on their sociodemographic characteristics and the extent to which they valued and liked using technology. The participants were then allowed to test the VR application themselves and were finally asked about their experience in a qualitative interview. For the collection of data and the analysis of results, the unified theory of acceptance and use of technology was used in this study. Results Overall, the study shows that the interviewed persons rated the VR application quite positively. The greatest influence in this was the personal attitude towards technology; the higher this affinity is, the more useful the VR application appears. Social influences can also increase the participant’s own acceptance if peers have a positive attitude towards such applications. The study shows that the trainees' motivation to learn was increased by using VR. We believe this is because each trainee could learn individually and the VR application was perceived as an enjoyable activity.
Nevertheless, the cost factor of implementing VR applications in nursing training is currently still an obstacle, as not every institution has such financial capacities. Conclusions The extent to which the use of VR applications in the training of nursing staff is justified depends on the degree of personal acceptance. The collected results give good practice-oriented insight into the attitude of trainees towards VR. Many of the interviewed persons saw benefits in the use of VR technologies.
As VR applications are constantly developing, it is necessary to conduct further studies on VR applications in nursing education and to include other possible disciplines in which these applications can be helpful.
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Affiliation(s)
| | - Jana Koch
- University of Bielefeld Bielefeld Germany
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Nicolaou PA, El Saifi M. The impact of using virtual patients in preclinical pharmacology teaching. ADVANCES IN PHYSIOLOGY EDUCATION 2020; 44:363-369. [PMID: 32628528 DOI: 10.1152/advan.00009.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
To reduce medication errors, medical educators must nurture the early development of rational and safe prescribing. Teaching pharmacology is challenging because it requires knowledge integration across disciplines, including physiology and pathology. Traditionally, pharmacology has been taught using lecture-based learning, which conveys consistent information but may promote passive learning. Virtual patients (VPs) have been used more recently to promote active learning, mainly in clinical years. Conversely, the use of VPs in preclinical disciplines, including pharmacology, is not well described. The objective was to investigate the potential benefits of combining traditional teaching with VPs in preclinical pharmacology teaching. All year 3 medical students (2 cohorts), enrolled in the Systematic Pharmacology I course (lectures: 3 h weekly; tutorial: 1 h weekly), were invited to participate in this naturalistic, prospective study. During tutorials, students were taught using case-based discussion and single-best-answer questions (control) in four tutorials and VPs (experimental) in the remaining six tutorials. The impact of VPs was assessed by 1) performance in written examinations, and 2) student satisfaction/perceptions, using a validated, modified questionnaire. Examination performance related to teaching in VP-based tutorials was significantly improved, compared with traditional tutorials. The level of difficulty of control and experimental assessment items was comparable, as determined by the Angoff method. Facilitation of learning was higher in VP tutorials, while a no-harm effect was noted on knowledge acquisition/maintenance, authenticity of learning, and disadvantages of learning. VPs may be effectively integrated in preclinical pharmacology teaching, with benefits on pharmacological knowledge and facilitation of learning.
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Affiliation(s)
- Persoulla A Nicolaou
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia, Cyprus
- Division of Population Health Sciences & Education, St. George's University of London, London, United Kingdom
| | - Mamoun El Saifi
- MBBS Programme, St. George's University of London, London, United Kingdom and the University of Nicosia Medical School, Nicosia, Cyprus
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Torres G, Villagrán I, Fuentes J, Araya JP, Jouannet C, Fuentes-López E. Interactive virtual scenarios as a technological resource to improve musculoskeletal clinical reasoning skills of undergraduate physiotherapy students. Physiother Theory Pract 2020; 38:1016-1026. [PMID: 32814476 DOI: 10.1080/09593985.2020.1809043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Clinical reasoning is a fundamental competency in the learning process of health professionals. Since learning with traditional methods presents difficulties, teaching with interactive virtual scenarios is a good alternative. OBJECTIVE To describe the impact of a blended training with interactive virtual scenarios for the development of clinical reasoning skills in undergraduate physiotherapy students. METHODS A sample of 92 students solved eight storylines. Assessment error percentage, clinical pattern recognition, satisfaction, and the perception of difficulty were obtained. A proportions test was used to compare baseline and final assessments. To analyze the relationship between the variables, multilevel univariate logistic regression models were built. RESULTS A significant difference was observed in the error percentage between baseline and final assessment (p < .001). Comparing the last storyline to the first one, there were 2.63 times more possibilities to correctly recognize the pattern. The error percentage was associated with the opportunity to recognize the pattern precisely (p < .001). Thus, for each increasing unit in the error percentage, the possibility to correctly recognize the pattern decreased by 11% (OR = 0.89). CONCLUSIONS The use of this innovative blended training with virtual scenarios allowed students to systematically improve their recognition abilities of clinical patterns and decrease mistakes in the decision-making process.
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Affiliation(s)
- Gustavo Torres
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ignacio Villagrán
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javiera Fuentes
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Pablo Araya
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Chantal Jouannet
- Centro de Desarrollo Docente, Vicerrectoría Académica, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eduardo Fuentes-López
- Carrera de Fonoaudiología, Departamento de Ciencias de La Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Plackett R, Kassianos AP, Kambouri M, Kay N, Mylan S, Hopwood J, Schartau P, Gray S, Timmis J, Bennett S, Valerio C, Rodrigues V, Player E, Hamilton W, Raine R, Duffy S, Sheringham J. Online patient simulation training to improve clinical reasoning: a feasibility randomised controlled trial. BMC MEDICAL EDUCATION 2020; 20:245. [PMID: 32736583 PMCID: PMC7395338 DOI: 10.1186/s12909-020-02168-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/22/2020] [Indexed: 05/25/2023]
Abstract
BACKGROUND Online patient simulations (OPS) are a novel method for teaching clinical reasoning skills to students and could contribute to reducing diagnostic errors. However, little is known about how best to implement and evaluate OPS in medical curricula. The aim of this study was to assess the feasibility, acceptability and potential effects of eCREST - the electronic Clinical Reasoning Educational Simulation Tool. METHODS A feasibility randomised controlled trial was conducted with final year undergraduate students from three UK medical schools in academic year 2016/2017 (cohort one) and 2017/2018 (cohort two). Student volunteers were recruited in cohort one via email and on teaching days, and in cohort two eCREST was also integrated into a relevant module in the curriculum. The intervention group received three patient cases and the control group received teaching as usual; allocation ratio was 1:1. Researchers were blind to allocation. Clinical reasoning skills were measured using a survey after 1 week and a patient case after 1 month. RESULTS Across schools, 264 students participated (18.2% of all eligible). Cohort two had greater uptake (183/833, 22%) than cohort one (81/621, 13%). After 1 week, 99/137 (72%) of the intervention and 86/127 (68%) of the control group remained in the study. eCREST improved students' ability to gather essential information from patients over controls (OR = 1.4; 95% CI 1.1-1.7, n = 148). Of the intervention group, most (80/98, 82%) agreed eCREST helped them to learn clinical reasoning skills. CONCLUSIONS eCREST was highly acceptable and improved data gathering skills that could reduce diagnostic errors. Uptake was low but improved when integrated into course delivery. A summative trial is needed to estimate effectiveness.
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Affiliation(s)
- Ruth Plackett
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
| | - Angelos P Kassianos
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | | | - Natasha Kay
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Sophie Mylan
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Shani Gray
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Jessica Timmis
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | | | | | | | | | - Willie Hamilton
- Institute of Health Service Research, University of Exeter, Exeter, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Stephen Duffy
- Wolfson Institute of Preventive Medicine, QMUL, London, UK
| | - Jessica Sheringham
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
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Cleland J, Chu J, Lim S, Low J, Low-Beer N, Kwek TK. COVID 19: Designing and conducting an online mini-multiple interview (MMI) in a dynamic landscape. MEDICAL TEACHER 2020; 42:776-780. [PMID: 32412815 DOI: 10.1080/0142159x.2020.1762851] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Introduction: The COVID-19 pandemic presented numerous, significant challenges for medical schools, including how to select the best candidates from a pool of applicants when social distancing and other measures prevented "business as usual" admissions processes. However, selection into medical school is the gateway to medicine in many countries, and it is critical to use processes which are evidence-based, valid and reliable even under challenging circumstances. Our challenge was to plan and conduct a multiple-mini interview (MMI) in a dynamic and stringent safe distancing context.Methods: This paper reports a case study of how to plan, re-plan and conduct MMIs in an environment where substantially tighter safe distancing measures were introduced just before the MMI was due to be delivered.Results: We report on how to design and implement a fully remote, online MMI which ensured the safety of candidates and assessors.Discussion: We discuss the challenges of this approach and also reflect on broader issues associated with selection into medical school during a pandemic. The aim of the paper is to provide broadly generalizable guidance to other medical schools faced with the challenge of selecting future students under difficult conditions.
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Affiliation(s)
- Jennifer Cleland
- Lee Kong Chian School of Medicine (LKC Medicine), Nanyang Technological University, Singapore
| | - Jowe Chu
- Lee Kong Chian School of Medicine (LKC Medicine), Nanyang Technological University, Singapore
| | - Samuel Lim
- Lee Kong Chian School of Medicine (LKC Medicine), Nanyang Technological University, Singapore
| | - Jamie Low
- Lee Kong Chian School of Medicine (LKC Medicine), Nanyang Technological University, Singapore
| | - Naomi Low-Beer
- Lee Kong Chian School of Medicine (LKC Medicine), Nanyang Technological University, Singapore
| | - Tong Kiat Kwek
- Lee Kong Chian School of Medicine (LKC Medicine), Nanyang Technological University, Singapore
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Setrakian J, Gauthier G, Bergeron L, Chamberland M, St-Onge C. Comparison of Assessment by a Virtual Patient and by Clinician-Educators of Medical Students' History-Taking Skills: Exploratory Descriptive Study. JMIR MEDICAL EDUCATION 2020; 6:e14428. [PMID: 32163036 PMCID: PMC7099396 DOI: 10.2196/14428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 11/25/2019] [Accepted: 12/16/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND A virtual patient (VP) can be a useful tool to foster the development of medical history-taking skills without the inherent constraints of the bedside setting. Although VPs hold the promise of contributing to the development of students' skills, documenting and assessing skills acquired through a VP is a challenge. OBJECTIVE We propose a framework for the automated assessment of medical history taking within a VP software and then test this framework by comparing VP scores with the judgment of 10 clinician-educators (CEs). METHODS We built upon 4 domains of medical history taking to be assessed (breadth, depth, logical sequence, and interviewing technique), adapting these to be implemented into a specific VP environment. A total of 10 CEs watched the screen recordings of 3 students to assess their performance first globally and then for each of the 4 domains. RESULTS The scores provided by the VPs were slightly higher but comparable with those given by the CEs for global performance and for depth, logical sequence, and interviewing technique. For breadth, the VP scores were higher for 2 of the 3 students compared with the CE scores. CONCLUSIONS Findings suggest that the VP assessment gives results akin to those that would be generated by CEs. Developing a model for what constitutes good history-taking performance in specific contexts may provide insights into how CEs generally think about assessment.
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Affiliation(s)
- Jean Setrakian
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Geneviève Gauthier
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Linda Bergeron
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Martine Chamberland
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Christina St-Onge
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
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Chaudhuri JD. Stimulating Intrinsic Motivation in Millennial Students: A New Generation, a New Approach. ANATOMICAL SCIENCES EDUCATION 2020; 13:250-271. [PMID: 31021529 DOI: 10.1002/ase.1884] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 04/17/2019] [Accepted: 04/21/2019] [Indexed: 06/09/2023]
Abstract
There has been a fundamental change in health care pedagogy to address the demands and challenges posed by the present generation of millennial students. There is also a growing recognition of the role of intrinsic motivation as a catalyst in a positive learning experience. The term intrinsic motivation refers to energizing behavior that comes from within an individual and develops due to an inherent interest in the activity at hand. However, stimulating intrinsic motivation in the present generation of millennial health care students is a daunting task, considering their diverse and disparate nature. In addition, the inherent generational differences between educators and students, and an increasing emphasis on technological tools have resulted in a dichotomy in the educational environment leading to the development of a greater incidence of burnouts among students. Hence, numerous innovative techniques have been introduced in health care education to enhance the levels of intrinsic motivation in these students. Unfortunately, most of these approaches have only been moderately successful due to their limited ability to address the unique educational expectations of millennial students. The cumulative evidence suggests that specific approaches to stimulate intrinsic motivation should aim at nurturing the learning efforts of students, bridging the generational barriers between educators and students, and ameliorating the stress associated with health care education. Hence, the specific aim of this narrative review is to suggest empirically proven curricular strategies and institutional reforms to enhance intrinsic motivation in health care students belonging to the Millennial Generation.
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Affiliation(s)
- Joydeep Dutta Chaudhuri
- School of Occupational Therapy, College of Health Sciences, Husson University, Bangor, Maine
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Berndt M, Thomas F, Bauer D, Härtl A, Hege I, Kääb S, Fischer MR, Heitzmann N. The influence of prompts on final year medical students' learning process and achievement in ECG interpretation. GMS JOURNAL FOR MEDICAL EDUCATION 2020; 37:Doc11. [PMID: 32270025 PMCID: PMC7105760 DOI: 10.3205/zma001304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 09/11/2019] [Accepted: 11/28/2019] [Indexed: 06/11/2023]
Abstract
Objective: ECG interpretation is prone to errors that can lead to relevant misdiagnoses and incorrect treatment. Prompts are one way in lectures to encourage learning from one's own mistakes and to reduce error rates. Prompts are measures such as questions, hints, and suggestions of content-related or metacognitive nature, which can lead to self-explanation in the learner and thus to a deeper understanding of an issue. The aim of the study was therefore to investigate whether the use of prompts can reduce the error rate in ECG interpretation among students. Method: In a 2x2 experimental test and control group design, N=100 final year medical students carried out ECG interpretation tasks in the form of online case vignettes in CASUS®. In these tasks, justification prompts (B) and error analysis prompts (F) were systematically varied in four groups and the learning success was measured using a knowledge test. In addition, prior knowledge in ECG interpretation, motivation, interest in the topic, subjective confidence in ECG interpretation, and cognitive load was collected. Results: Neither error analysis prompts nor justification prompts had a significant effect on the correct ECG interpretation by students, F(1,96)=1.03, p=.31. Justification prompts seemed to have a positive effect on the confidence of answering the questions, F(1,96)=10.15, p=.002, partial η2 =.10; and a negative effect on student motivation, F(1,96)=8.13 , p=.005, partial η2 =.08; but both with comparable diagnostic accuracy. Conclusion: The present study could not confirm the positive effects of prompts on the error rate in ECG interpretation reported in the literature but showed significant effects on subjective confidence and motivation which should be investigated in further studies.
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Affiliation(s)
- Markus Berndt
- University Hospital, LMU Munich, Institute for Medical Education, Munich, Germany
- Walden University, Richard W. Riley College of Education and Leadership, Minneapolis (MN), USA
| | - Franziska Thomas
- SLK Clinics Heilbronn GmbH, Center for Anesthesiology ZAINS, Heilbronn, Germany
| | - Daniel Bauer
- University of Bern, Faculty of Medicine, Institute for Medical Education, Bern, Switzerland
| | - Anja Härtl
- University Hospital, LMU Munich, Institute for Medical Education, Munich, Germany
- University of Augsburg, Medical School, Augsburg, Germany
| | - Inga Hege
- University Hospital, LMU Munich, Institute for Medical Education, Munich, Germany
- University of Augsburg, Medical School, Augsburg, Germany
| | - Stefan Kääb
- University Hospital, LMU Munich, Department of Medicine I, Munich, Germany
| | - Martin R. Fischer
- University Hospital, LMU Munich, Institute for Medical Education, Munich, Germany
| | - Nicole Heitzmann
- University Hospital, LMU Munich, Institute for Medical Education, Munich, Germany
- LMU Munich, Chair of Education and Educational Psychology, Munich, Germany
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Mardani M, Cheraghian S, Naeeni SK, Zarifsanaiey N. Effectiveness of virtual patients in teaching clinical decision-making skills to dental students. J Dent Educ 2020; 84:615-623. [DOI: 10.1002/jdd.12045] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 12/17/2019] [Accepted: 01/11/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Maryam Mardani
- Oral and Dental Disease Research Center; Department of Oral and Maxillofacial Medicine; School of Dentistry; Shiraz University of Medical Sciences; Shiraz Iran
| | - Sajjad Cheraghian
- School of Dentistry; Shiraz University of Medical Sciences; Shiraz Iran
| | | | - Nahid Zarifsanaiey
- Virtual School, and Center of Excellence for e-Learning in Medical Sciences; Shiraz University of Medical Sciences; Shiraz Iran
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Karas SI, Arzhanik MB, Baev AE, Vaizov VK, Vasiltseva OY, Grakova EV, Gulyaev VM, Zavadovsky KV, Kara-Sal EE, Ussov WY. Virtual patients with cardiovascular pathology: technology for postgraduate medical education. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2019. [DOI: 10.15829/1728-8800-2019-6-51-56] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- S. I. Karas
- Scientific Research Institute of Cardiology, Tomsk National Research Medical Center; Siberian State Medical University
| | - M. B. Arzhanik
- Scientific Research Institute of Cardiology, Tomsk National Research Medical Center; Siberian State Medical University
| | - A. E. Baev
- Scientific Research Institute of Cardiology, Tomsk National Research Medical Center
| | - V. Kh. Vaizov
- Scientific Research Institute of Cardiology, Tomsk National Research Medical Center
| | - O. Ya. Vasiltseva
- Scientific Research Institute of Cardiology, Tomsk National Research Medical Center
| | - E. V. Grakova
- Scientific Research Institute of Cardiology, Tomsk National Research Medical Center
| | - V. M. Gulyaev
- Scientific Research Institute of Cardiology, Tomsk National Research Medical Center
| | - K. V. Zavadovsky
- Scientific Research Institute of Cardiology, Tomsk National Research Medical Center
| | | | - W. Yu. Ussov
- Scientific Research Institute of Cardiology, Tomsk National Research Medical Center
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Quail NPA, Boyle JG. Virtual Patients in Health Professions Education. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1171:25-35. [PMID: 31823237 DOI: 10.1007/978-3-030-24281-7_3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Health care professionals must not only have knowledge, but also be able to organise, synthesise and apply this knowledge in such a way that it promotes the development of clinical reasoning. Panels of Virtual patients (VPs) are widely being used in health professions education to facilitate the development of clinical reasoning. VPs can also be used to teach wider educational outcomes such as communication skills, resource utilisation and longitudinal patient care. This chapter will define virtual patients and examine the evidence behind their use in health professions learning and teaching. The chapter will discuss virtual patient design, such as gamification. Finally, the chapter will discuss where this pedagogical innovation is best integrated into assessment and potential barriers to implementation into existing curricula.
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Dahri K, MacNeil K, Chan F, Lamoureux E, Bakker M, Seto K, Yeung J. Curriculum integration of virtual patients. CURRENTS IN PHARMACY TEACHING & LEARNING 2019; 11:1309-1315. [PMID: 31836158 DOI: 10.1016/j.cptl.2019.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 06/05/2019] [Accepted: 09/07/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND PURPOSE Virtual patients (VP) offer an enhanced learning experience for students to assume the role of health professional and make therapeutic decisions in a simulated environment. While VPs are valued by students and offer benefits to the learner, little is known about how best to implement them in pharmacy education curricula. The purpose of our study was to investigate students' perceptions of VPs and build understanding about how to optimally implement them in the future. EDUCATIONAL ACTIVITY AND SETTING Four VP cases were implemented over the first three years of the entry to practice doctor of pharmacy program. Each case was focused on a different condition and implemented in one of three settings (i.e. integration activities, large lecture setting, or independent review). Students were invited to complete a survey and participate in a focus group after completing the patient case. FINDINGS One-hundred eighty students completed the survey and six students participated in a focus group. Ninety-four percent of respondents strongly agreed/agreed that VPs were valuable for their learning. Students preferred the VP cases be implemented in small-group settings and be relevantly timed with course material. Students found helpful that cases were realistic, clear, comprehensive, engaging, and incorporated feedback. Perceived benefits included enhanced learning about medical conditions, development of clinical reasoning skills and processes for working through cases. SUMMARY VPs continue to be identified as a valuable learning experience. When implemented it is important to consider the learner setting in order to get the greatest value from their use.
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Affiliation(s)
- Karen Dahri
- Faculty of Pharmaceutical Sciences, University of British Columbia, Canada; Vancouver General Hospital, Vancouver Coastal Health, 855 West 12th Avenue, Vancouver, BC V5Z 1M9, Canada.
| | - Kimberley MacNeil
- Department of Educational & Counselling Psychology, and Special Education, Faculty of Education, University of British Columbia, Canada
| | - Fong Chan
- Faculty of Pharmaceutical Sciences, University of British Columbia, Canada
| | - Emilie Lamoureux
- Faculty of Pharmaceutical Sciences, University of British Columbia, Canada
| | - Mattie Bakker
- Faculty of Pharmaceutical Sciences, University of British Columbia, Canada
| | - Katherine Seto
- Faculty of Pharmaceutical Sciences, University of British Columbia, Canada
| | - Janice Yeung
- Faculty of Pharmaceutical Sciences, University of British Columbia, Canada
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Fawaz ZS, Posel N, Royal-Preyra BT, Khriguian J, Alfieri J. Creation and Pilot-testing of Virtual Patients for Learning Oncologic Emergency Management. Cureus 2019; 11:e6206. [PMID: 31890407 PMCID: PMC6925369 DOI: 10.7759/cureus.6206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose or objective Management of oncologic emergencies becomes critical at the start of the second year of a radiation oncology residency. Considering the limited exposure to oncology in the medical school curriculum, this knowledge gap needs to be filled prior to managing real patients. The aim of this project was to create virtual patients (VPs) to ease this transition and improve learner readiness for independently managing oncologic emergencies on call. Material and methods A curriculum mapping exercise was done to identify gaps. The main oncologic emergencies that needed to be addressed were selected for development of the modules. Review of the key concepts for management was elucidated and validated. These included history, physical examination, imaging interpretation, staging, as well as anatomy, epidemiology, pertinent literature, differential diagnosis, prognostication, radiation treatment planning, summarizing, and patient- and peer-communication skills. Clinical vignettes were then designed, in collaboration with a virtual patient education expert, to mimic the clinical presentation and evolution of a typical patient for three common oncologic emergencies: spinal cord compression, superior vena cava syndrome, and tumor-induced hemorrhage. Results Three virtual modules were developed: spinal cord compression, superior vena cava syndrome, and tumor-induced hemorrhage. Each case included 25 to 30 vignettes that participants progressed through, with a total estimated completion time of 30 to 45 minutes. Each node branched out to provide a detailed answer and explanation of the key concept. Figures were included to mimic real patients and to provide a more authentic learning experience. The modules also included quantitative pre- and post-testing assessments, including multiple-choice questions, true or false, fill in the blank, short answers, and text response. The cases were then transcribed onto a virtual patient simulation platform. Following completion of the module, a report was generated for each individual learner to track all responses and used as the assessment tool. The pilot test showed an increase of 28% in the pre-to-post-test results in a cohort of nine residents. The mean pre-test result of 58% increased to a mean post-test result of 86% (range: 70-100%) after completing the three modules. Conclusion VPs can be used for learning the management of oncologic emergencies and can be done on a simulation-based learning platform. The modules can be used as both, a learning and an assessment tool for junior residents. The results of the pilot test show a significant improvement in knowledge acquisition between pre- and post-test scores after completion of the three modules.
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Affiliation(s)
- Ziad Simon Fawaz
- Radiation Oncology, McGill University Health Center, Montreal, CAN
| | - Nancy Posel
- Medical Education, McGill University Health Centre, Montreal, CAN
| | | | - Julia Khriguian
- Radiation Oncology, McGill University Health Center, Montreal, CAN
| | - Joanne Alfieri
- Radiation Oncology, McGill University Health Centre, Montreal, CAN
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Dafli E, Fountoukidis I, Hatzisevastou-Loukidou C, D Bamidis P. Curricular integration of virtual patients: a unifying perspective of medical teachers and students. BMC MEDICAL EDUCATION 2019; 19:416. [PMID: 31706296 PMCID: PMC6842463 DOI: 10.1186/s12909-019-1849-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 10/22/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Virtual Patients (VPs) may improve cognitive and behavioral skills better than traditional methods do. The aim of this paper was to investigate challenges faced by teachers and students in order to effectively implement VPs across undergraduate and postgraduate curricula. In addition, differences in student and teacher perceptions that could impact curricular integration of VPs were explored. METHODS A two-phase descriptive study was performed: 1) evaluation of the VP design process and curricular integration, conducted upon academic medical teachers; 2) evaluation of learning and clinical reasoning experiences with VPs, from the students' perspective. RESULTS The results of this study document high acceptance of VPs by both medical teachers and students (n = 252).VPs seem to fulfill most needs as set by course directors, while they satisfy student needs and create perceptions of improved knowledge and clinical skills reasoning. CONCLUSIONS Medical educators have encountered educational challenges upon transforming the curriculum. To develop VPs, academic institutions have to pay equal attention to the needs of potential adopters and VP authors. Strategic development and use of VPs may motivate more widespread integration of VPs and lead to a high quality medical education system.
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Affiliation(s)
- Eleni Dafli
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, PO Box 376, 54124 Thessaloniki, Greece
| | - Ioannis Fountoukidis
- School of Economics, Faculty of Economic and Political Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | | | - Panagiotis D Bamidis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, PO Box 376, 54124 Thessaloniki, Greece
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Bi M, Zhao Z, Yang J, Wang Y. Comparison of case-based learning and traditional method in teaching postgraduate students of medical oncology. MEDICAL TEACHER 2019; 41:1124-1128. [PMID: 31215320 DOI: 10.1080/0142159x.2019.1617414] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Purpose: Case-based learning (CBL) is now used as a teaching strategy to promote clinical problem-solving ability. The purpose of this study was to determine whether CBL is superior to the traditional teaching method in teaching lung cancer curriculum to oncology students. Methods: This study was a randomized controlled trial, enrolled 80 first-year oncology postgraduates from Bengbu medical college in the past 3 years. They were randomized to divide into 2 groups, had courses with the same lung cancer contents and timing. The experimental group (n = 40) utilized the CBL method while the control group (n = 40) used the traditional lecture-based teaching method. A questionnaire was used to attain the students' learning satisfaction and self-efficacy of the course, and a post-study examination was used to assess end-of-course performance. Results: Complete data were obtained from participating students (n = 40 in CBL; n = 40 in traditional teaching). The CBL group performed significantly better in questionnaire and examination compared to traditional teaching groups. Students showed high levels of satisfaction and problem-solving ability in the CBL group. Conclusion: Compared with the traditional teaching method. The case teaching method is a more effective teaching method to improve the ability of problem-solving for graduate students in medical oncology.
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Affiliation(s)
- Minghong Bi
- Department of Medical Oncology, the first affiliated Hospital of Bengbu Medical College , Bengbu , Anhui Province , People's Republic of China
- Department of Oncology Medicine Teaching and Research, the first affiliated Hospital of Bengbu Medical College , Bengbu , Anhui Province , People's Republic of China
| | - Zhibiao Zhao
- Department of Medical Oncology, the first affiliated Hospital of Bengbu Medical College , Bengbu , Anhui Province , People's Republic of China
- Department of Oncology Medicine Teaching and Research, the first affiliated Hospital of Bengbu Medical College , Bengbu , Anhui Province , People's Republic of China
| | - Jingru Yang
- Department of Medical Oncology, the first affiliated Hospital of Bengbu Medical College , Bengbu , Anhui Province , People's Republic of China
- Department of Oncology Medicine Teaching and Research, the first affiliated Hospital of Bengbu Medical College , Bengbu , Anhui Province , People's Republic of China
| | - Yaping Wang
- Department of Medical Oncology, the first affiliated Hospital of Bengbu Medical College , Bengbu , Anhui Province , People's Republic of China
- Department of Oncology Medicine Teaching and Research, the first affiliated Hospital of Bengbu Medical College , Bengbu , Anhui Province , People's Republic of China
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Nicolaou P, McCrorie P, Nicolaou SA. Using virtual patients to integrate physiology, pathophysiology, and pharmacology in preclinical teaching. ADVANCES IN PHYSIOLOGY EDUCATION 2019; 43:277-281. [PMID: 31166125 DOI: 10.1152/advan.00010.2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Persoulla Nicolaou
- Department of Basic and Clinical Sciences, Medical School, University of Nicosia , Nicosia , Cyprus
| | - Peter McCrorie
- Department of Basic and Clinical Sciences, Medical School, University of Nicosia , Nicosia , Cyprus
| | - Stella A Nicolaou
- Department of Life and Health Sciences, University of Nicosia , Nicosia , Cyprus
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Blunk DI, Tonarelli S, Gardner C, Quest D, Petitt D, Leiner M. Evaluating Medical Students' Clinical Reasoning in Psychiatry Using Clinical and Basic Science Concepts Presented in Session-level Integration Sessions. MEDICAL SCIENCE EDUCATOR 2019; 29:819-824. [PMID: 34457546 PMCID: PMC8368579 DOI: 10.1007/s40670-019-00761-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate improvement in clinical reasoning by preclinical medical students following participation in a clinical presentation curriculum that included both course and session-level integration of psychiatric and basic science concepts. A Script Concordance Test (SCT) for psychiatry was developed to assess differences in clinical reasoning in the students. METHODS Pre- and post-integration session tests were used to evaluate clinical reasoning among second-year medical students (MSII) who attended three integration sessions. Scores were compared between experts and medical students, and the validity and reliability of the SCT for psychiatry was assessed. RESULTS MSII scores improved 11% between the pre-and post-test (p < .001). There was no significant difference in scores between experts and MSII after attending the integration sessions. The SCT for psychiatry that was developed and used in this study provides reliable and valid results. CONCLUSION The concepts included in the integration sessions for this study highlighted possibilities for helping novice learners elaborate causal networks with the intention of cultivate illness script formation and clinical reasoning. Additional studies in this area should be considered to further enhance understanding of the possible benefits of this curriculum model.
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Affiliation(s)
- Dan I. Blunk
- Paul Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX USA
| | - Silvina Tonarelli
- Paul Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX USA
| | - Claire Gardner
- Paul Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX USA
| | - Dale Quest
- Paul Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX USA
| | - Diana Petitt
- Paul Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX USA
| | - Marie Leiner
- Paul Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX USA
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Kononowicz AA, Woodham LA, Edelbring S, Stathakarou N, Davies D, Saxena N, Tudor Car L, Carlstedt-Duke J, Car J, Zary N. Virtual Patient Simulations in Health Professions Education: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration. J Med Internet Res 2019; 21:e14676. [PMID: 31267981 PMCID: PMC6632099 DOI: 10.2196/14676] [Citation(s) in RCA: 153] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/06/2019] [Accepted: 06/08/2019] [Indexed: 12/29/2022] Open
Abstract
Background Virtual patients are interactive digital simulations of clinical scenarios for the purpose of health professions education. There is no current collated evidence on the effectiveness of this form of education. Objective The goal of this study was to evaluate the effectiveness of virtual patients compared with traditional education, blended with traditional education, compared with other types of digital education, and design variants of virtual patients in health professions education. The outcomes of interest were knowledge, skills, attitudes, and satisfaction. Methods We performed a systematic review on the effectiveness of virtual patient simulations in pre- and postregistration health professions education following Cochrane methodology. We searched 7 databases from the year 1990 up to September 2018. No language restrictions were applied. We included randomized controlled trials and cluster randomized trials. We independently selected studies, extracted data, and assessed risk of bias and then compared the information in pairs. We contacted study authors for additional information if necessary. All pooled analyses were based on random-effects models. Results A total of 51 trials involving 4696 participants met our inclusion criteria. Furthermore, 25 studies compared virtual patients with traditional education, 11 studies investigated virtual patients as blended learning, 5 studies compared virtual patients with different forms of digital education, and 10 studies compared different design variants. The pooled analysis of studies comparing the effect of virtual patients to traditional education showed similar results for knowledge (standardized mean difference [SMD]=0.11, 95% CI −0.17 to 0.39, I2=74%, n=927) and favored virtual patients for skills (SMD=0.90, 95% CI 0.49 to 1.32, I2=88%, n=897). Studies measuring attitudes and satisfaction predominantly used surveys with item-by-item comparison. Trials comparing virtual patients with different forms of digital education and design variants were not numerous enough to give clear recommendations. Several methodological limitations in the included studies and heterogeneity contributed to a generally low quality of evidence. Conclusions Low to modest and mixed evidence suggests that when compared with traditional education, virtual patients can more effectively improve skills, and at least as effectively improve knowledge. The skills that improved were clinical reasoning, procedural skills, and a mix of procedural and team skills. We found evidence of effectiveness in both high-income and low- and middle-income countries, demonstrating the global applicability of virtual patients. Further research should explore the utility of different design variants of virtual patients.
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Affiliation(s)
- Andrzej A Kononowicz
- Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, Kraków, Poland
| | - Luke A Woodham
- Institute of Medical and Biomedical Education, St George's, University of London, London, United Kingdom.,Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Samuel Edelbring
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.,Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Learning and Professional Development Group, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Natalia Stathakarou
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - David Davies
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Nakul Saxena
- Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore
| | - Lorainne Tudor Car
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Jan Carlstedt-Duke
- President's Office, Nanyang Technological University, Singapore, Singapore
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Nabil Zary
- Games for Health Innovations Centre, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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Psychometric properties of the virtual patient version of the Lasater Clinical Judgment Rubric. Nurse Educ Pract 2019; 38:14-20. [DOI: 10.1016/j.nepr.2019.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 04/11/2019] [Accepted: 05/27/2019] [Indexed: 11/20/2022]
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Virtual Standardized Patient Simulation: Case Development and Pilot Application to High-Value Care. Simul Healthc 2019; 14:241-250. [PMID: 31116172 DOI: 10.1097/sih.0000000000000373] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION High-value care (HVC) suggests that good history taking and physical examination should lead to risk stratification that drives the use or withholding of diagnostic testing. This study describes the development of a series of virtual standardized patient (VSP) cases and provides preliminary evidence that supports their ability to provide experiential learning in HVC. METHODS This pilot study used VSPs, or natural language processing-based patient avatars, within the USC Standard Patient platform. Faculty consensus was used to develop the cases, including the optimal diagnostic testing strategies, treatment options, and scored content areas. First-year resident physician learners experienced two 90-minute didactic sessions before completing the cases in a computer laboratory, using typed text to interview the avatar for history taking, then completing physical examination, differential diagnosis, diagnostic testing, and treatment modules for each case. Learners chose a primary and 2 alternative "possible" diagnoses from a list of 6 to 7 choices, diagnostic testing options from an extensive list, and treatments from a brief list ranging from 6 to 9 choices. For the history-taking module, both faculty and the platform scored the learners, and faculty assessed the appropriateness of avatar responses. Four randomly selected learner-avatar interview transcripts for each case were double rated by faculty for interrater reliability calculations. Intraclass correlations were calculated for interrater reliability, and Spearman ρ was used to determine the correlation between the platform and faculty ranking of learners' history-taking scores. RESULTS Eight VSP cases were experienced by 14 learners. Investigators reviewed 112 transcripts (4646 learner query-avatar responses). Interrater reliability means were 0.87 for learner query scoring and 0.83 for avatar response. Mean learner success for history taking was scored by the faculty at 57% and by the platform at 51% (ρ correlation of learner rankings = 0.80, P = 0.02). The mean avatar appropriate response rate was 85.6% for all cases. Learners chose the correct diagnosis within their 3 choices 82% of the time, ordered a median (interquartile range) of 2 (2) unnecessary tests and completed 56% of optimal treatments. CONCLUSIONS Our avatar appropriate response rate was similar to past work using similar platforms. The simulations give detailed insights into the thoroughness of learner history taking and testing choices and with further refinement should support learning in HVC.
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Padilha JM, Machado PP, Ribeiro A, Ramos J, Costa P. Clinical Virtual Simulation in Nursing Education: Randomized Controlled Trial. J Med Internet Res 2019; 21:e11529. [PMID: 30882355 PMCID: PMC6447149 DOI: 10.2196/11529] [Citation(s) in RCA: 178] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 12/21/2018] [Accepted: 01/03/2019] [Indexed: 12/04/2022] Open
Abstract
Background In the field of health care, knowledge and clinical reasoning are key with regard to quality and confidence in decision making. The development of knowledge and clinical reasoning is influenced not only by students’ intrinsic factors but also by extrinsic factors such as satisfaction with taught content, pedagogic resources and pedagogic methods, and the nature of the objectives and challenges proposed. Nowadays, professors play the role of learning facilitators rather than simple “lecturers” and face students as active learners who are capable of attributing individual meanings to their personal goals, challenges, and experiences to build their own knowledge over time. Innovations in health simulation technologies have led to clinical virtual simulation. Clinical virtual simulation is the recreation of reality depicted on a computer screen and involves real people operating simulated systems. It is a type of simulation that places people in a central role through their exercising of motor control skills, decision skills, and communication skills using virtual patients in a variety of clinical settings. Clinical virtual simulation can provide a pedagogical strategy and can act as a facilitator of knowledge retention, clinical reasoning, improved satisfaction with learning, and finally, improved self-efficacy. However, little is known about its effectiveness with regard to satisfaction, self-efficacy, knowledge retention, and clinical reasoning. Objective This study aimed to evaluate the effect of clinical virtual simulation with regard to knowledge retention, clinical reasoning, self-efficacy, and satisfaction with the learning experience among nursing students. Methods A randomized controlled trial with a pretest and 2 posttests was carried out with Portuguese nursing students (N=42). The participants, split into 2 groups, had a lesson with the same objectives and timing. The experimental group (n=21) used a case-based learning approach, with clinical virtual simulator as a resource, whereas the control group (n=21) used the same case-based learning approach, with recourse to a low-fidelity simulator and a realistic environment. The classes were conducted by the usual course lecturers. We assessed knowledge and clinical reasoning before the intervention, after the intervention, and 2 months later, with a true or false and multiple-choice knowledge test. The students’ levels of learning satisfaction and self-efficacy were assessed with a Likert scale after the intervention. Results The experimental group made more significant improvements in knowledge after the intervention (P=.001; d=1.13) and 2 months later (P=.02; d=0.75), and it also showed higher levels of learning satisfaction (P<.001; d=1.33). We did not find statistical differences in self-efficacy perceptions (P=.9; d=0.054). Conclusions The introduction of clinical virtual simulation in nursing education has the potential to improve knowledge retention and clinical reasoning in an initial stage and over time, and it increases the satisfaction with the learning experience among nursing students.
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Affiliation(s)
| | | | - Ana Ribeiro
- Nursing School of Porto; CINTESIS - NursID, Porto, Portugal
| | - José Ramos
- Nursing School of Porto, Porto, Portugal
| | - Patrício Costa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, ICVS / 3B's-PT Government Associate Laboratory, Braga / Guimarães, Portugal, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
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Hege I, Kononowicz AA, Kiesewetter J, Foster-Johnson L. Uncovering the relation between clinical reasoning and diagnostic accuracy - An analysis of learner's clinical reasoning processes in virtual patients. PLoS One 2018; 13:e0204900. [PMID: 30286136 PMCID: PMC6171878 DOI: 10.1371/journal.pone.0204900] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 09/17/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Clinical reasoning is an important topic in healthcare training, assessment, and research. Virtual patients (VPs) are a safe environment to teach, assess and perform research on clinical reasoning and diagnostic accuracy. Our aim was to explore the details of the clinical reasoning process and diagnostic accuracy of undergraduate medical students when working with VPs using a concept mapping tool. METHODS Over seven months we provided access to 67 German and 30 English VPs combined with a concept mapping tool to visualize and measure the clinical reasoning process of identifying problems, differential diagnoses, recommended tests and treatment options, and composing a summary statement about a VP. A final diagnosis had to be submitted by the learners in order to conclude the VP scenario. Learners were allowed multiple attempts or could request the correct diagnosis from the system. RESULTS We analyzed 1,393 completed concept maps from 317 learners. We found significant differences between maps with a correct final diagnosis on one or multiple attempts and maps in which learners gave up and requested the solution from the system. These maps had lower scores, fewer summary statements, and fewer problems, differential diagnoses, tests, and treatments. CONCLUSIONS The different use patterns and scores between learners who had the correct final diagnosis on one or multiple attempts and those who gave up, indicate that diagnostic accuracy in the form of a correct final diagnosis on the first attempt has to be reconsidered as a sole indicator for clinical reasoning competency. For the training, assessment, and research of clinical reasoning we suggest focusing more on the details of the process to reach a correct diagnosis, rather than whether it was made in the first attempt.
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Affiliation(s)
- Inga Hege
- Institute for Medical Education, University Hospital of LMU Munich, Munich, Germany
- Medical School, University of Augsburg, Augsburg, Germany
- * E-mail:
| | - Andrzej A. Kononowicz
- Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jan Kiesewetter
- Institute for Medical Education, University Hospital of LMU Munich, Munich, Germany
| | - Lynn Foster-Johnson
- Department of Community & Family Medicine at the Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States of America
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Pedersen K, Moeller MH, Paltved C, Mors O, Ringsted C, Morcke AM. Students' Learning Experiences from Didactic Teaching Sessions Including Patient Case Examples as Either Text or Video: A Qualitative Study. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2018; 42:622-629. [PMID: 28986778 DOI: 10.1007/s40596-017-0814-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 09/11/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The aim of this study was to explore medical students' learning experiences from the didactic teaching formats using either text-based patient cases or video-based patient cases with similar content. The authors explored how the two different patient case formats influenced students' perceptions of psychiatric patients and students' reflections on meeting and communicating with psychiatric patients. METHODS The authors conducted group interviews with 30 medical students who volunteered to participate in interviews and applied inductive thematic content analysis to the transcribed interviews. RESULTS Students taught with text-based patient cases emphasized excitement and drama towards the personal clinical narratives presented by the teachers during the course, but never referred to the patient cases. Authority and boundary setting were regarded as important in managing patients. Students taught with video-based patient cases, in contrast, often referred to the patient cases when highlighting new insights, including the importance of patient perspectives when communicating with patients. CONCLUSION The format of patient cases included in teaching may have a substantial impact on students' patient-centeredness. Video-based patient cases are probably more effective than text-based patient cases in fostering patient-centered perspectives in medical students. Teachers sharing stories from their own clinical experiences stimulates both engagement and excitement, but may also provoke unintended stigma and influence an authoritative approach in medical students towards managing patients in clinical psychiatry.
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Affiliation(s)
- Kamilla Pedersen
- Aarhus University, Aarhus, Denmark.
- Corporate HR, MidtSim, Central Denmark Region, Aarhus, Denmark.
| | | | - Charlotte Paltved
- Aarhus University, Aarhus, Denmark
- Corporate HR, MidtSim, Central Denmark Region, Aarhus, Denmark
| | - Ole Mors
- Aarhus University Hospital, Risskov, Denmark
| | | | - Anne Mette Morcke
- Copenhagen Academy for Medical Education and Simulation at Rigshospitalet, Capital Region of Denmark, Copenhagen, Denmark
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80
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Berman NB, Artino AR. Development and initial validation of an online engagement metric using virtual patients. BMC MEDICAL EDUCATION 2018; 18:213. [PMID: 30223825 PMCID: PMC6142316 DOI: 10.1186/s12909-018-1322-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 09/02/2018] [Indexed: 05/30/2023]
Abstract
BACKGROUND Considerable evidence in the learning sciences demonstrates the importance of engagement in online learning environments. The purpose of this work was to demonstrate feasibility and to develop and collect initial validity evidence for a computer-generated dynamic engagement score based on student interactions in an online learning environment, in this case virtual patients used for clinical education. METHODS The study involved third-year medical students using virtual patient cases as a standard component of their educational program at more than 125 accredited US and Canadian medical schools. The engagement metric algorithm included four equally weighted components of student interactions with the virtual patient. We developed a self-report measure of motivational, emotional, and cognitive engagement and conducted confirmatory factor analysis to assess the validity of the survey responses. We gathered additional validity evidence through educator reviews, factor analysis of the metric, and correlations between student use of the engagement metric and self-report measures of learner engagement. RESULTS Confirmatory factor analysis substantiated the hypothesized four-factor structure of the survey scales. Educator reviews demonstrated a high level of agreement with content and scoring cut-points (mean Pearson correlation 0.98; mean intra-class correlation 0.98). Confirmatory factor analysis yielded an acceptable fit to a one-factor model of the engagement score components. Correlations of the engagement score with self-report measures were statistically significant and in the predicted directions. CONCLUSIONS We present initial validity evidence for a dynamic online engagement metric based on student interactions in a virtual patient case. We discuss potential uses of such an engagement metric including better understanding of student interactions with online learning, improving engagement through instructional design and interpretation of learning analytics output.
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Affiliation(s)
- Norman B. Berman
- Dartmouth Geisel School of Medicine, One Rope Ferry Road, Hanover, NH 03756 USA
- One Medical Center Drive, Bethesda, NH 03756 Lebanon
| | - Anthony R. Artino
- Medicine, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814 USA
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Middeke A, Anders S, Schuelper M, Raupach T, Schuelper N. Training of clinical reasoning with a Serious Game versus small-group problem-based learning: A prospective study. PLoS One 2018; 13:e0203851. [PMID: 30204773 PMCID: PMC6133380 DOI: 10.1371/journal.pone.0203851] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/28/2018] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Serious Games are increasingly being used in undergraduate medical education. They are usually intended to enhance learning with a focus on knowledge acquisition and skills development. According to the current literature, few studies have assessed their effectiveness regarding clinical reasoning (CR). The aim of this prospective study was to compare a Serious Game, the virtual Accident & Emergency department 'EMERGE' to small-group problem-based learning (PBL) regarding student learning outcome on clinical reasoning in the short term. METHODS A total of 112 final-year medical students self-selected to participate in ten 90-minute sessions of either small-group PBL or playing EMERGE. CR was assessed in a formative examination consisting of six key feature cases and a final 45-minute EMERGE session. RESULTS Overall, the EMERGE group (n = 78) scored significantly higher than the PBL group (n = 34) in the key feature examination (62.5 (IQR: 17.7)% vs. 54.2 (IQR: 21.9)%; p = 0.015). There was no significant difference in performance levels between groups regarding those cases which had been discussed in both instructional formats during the training phase. In the final EMERGE session, the EMERGE group achieved significantly better results than the PBL group in all four cases regarding the total score as well as in three of four cases regarding the final diagnosis and the correct therapeutic interventions. CONCLUSION EMERGE can be used effectively for CR training in undergraduate medical education. The difference in key feature exam scores was driven by additional exposure to more cases in EMERGE compared to PBL despite identical learning time in both instructional formats. EMERGE is a potential alternative to intensive small-group teaching. Further work is needed to establish how Serious Games enhance CR most effectively.
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Affiliation(s)
- Angélina Middeke
- Division of Medical Education Research and Curriculum Development, Study Deanery of University Medical Centre Göttingen, Göttingen, Germany
| | - Sven Anders
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Madita Schuelper
- Department of Haematology and Medical Oncology, University Medical Centre Göttingen, Göttingen, Germany
| | - Tobias Raupach
- Division of Medical Education Research and Curriculum Development, Study Deanery of University Medical Centre Göttingen, Göttingen, Germany
- Department of Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany
- Health Behaviour Research Centre, University College London, London, United Kingdom
| | - Nikolai Schuelper
- Division of Medical Education Research and Curriculum Development, Study Deanery of University Medical Centre Göttingen, Göttingen, Germany
- Department of Haematology and Medical Oncology, University Medical Centre Göttingen, Göttingen, Germany
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Naismith LM, Lajoie SP. Motivation and emotion predict medical students' attention to computer-based feedback. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2018; 23:465-485. [PMID: 29243052 DOI: 10.1007/s10459-017-9806-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 12/08/2017] [Indexed: 05/21/2023]
Abstract
Students cannot learn from feedback unless they pay attention to it. This study investigated relationships between the personal factors of achievement goal orientations, achievement emotions, and attention to feedback in BioWorld, a computer environment for learning clinical reasoning. Novice medical students (N = 28) completed questionnaires to measure their achievement goal orientations and then thought aloud while solving three endocrinology patient cases and reviewing corresponding expert solutions. Questionnaires administered after each case measured participants' experiences of five feedback emotions: pride, relief, joy, shame, and anger. Attention to individual text segments of the expert solutions was modelled using logistic regression and the method of generalized estimating equations. Participants did not attend to all of the feedback that was available to them. Performance-avoidance goals and shame positively predicted attention to feedback, and performance-approach goals and relief negatively predicted attention to feedback. Aspects of how the feedback was displayed also influenced participants' attention. Findings are discussed in terms of their implications for educational theory as well as the design and use of computer learning environments in medical education.
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Affiliation(s)
- Laura M Naismith
- Centre for Addiction and Mental Health, 33 Russell Street, Room 2051, Toronto, ON, M5S 2S1, Canada.
| | - Susanne P Lajoie
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
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83
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Quesnelle KM, Bright DR, Salvati LA. Interprofessional education through a telehealth team based learning exercise focused on pharmacogenomics. CURRENTS IN PHARMACY TEACHING & LEARNING 2018; 10:1062-1069. [PMID: 30314542 DOI: 10.1016/j.cptl.2018.05.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/05/2018] [Accepted: 05/11/2018] [Indexed: 05/26/2023]
Abstract
BACKGROUND Traditional interprofessional educational (IPE) exercises are those where learning exists "about, from, and with" trainees in two or more professions in order to prepare health sciences professionals to work on interprofessional teams. One emerging difficulty with IPE is the paucity of health profession students at single institutions, and the geographic and financial constraints of multi-institutional collaboration. INTERPROFESSIONAL EDUCATION ACTIVITY To circumvent these barriers, we developed a multi-institution telehealth team-based learning (TBL) event between medical and pharmacy students on the topic of pharmacogenomics (PGx). Using a validated pre-post survey design, student attitudes and perceptions were measured before and after an educational intervention designed to simulate interprofessional telehealth collaboration. The survey results showed significant improvement across all areas of student attitudes toward interprofessional collaboration. Also, medical student PGx confidence increased substantially during the exercise even though the only PGx instruction they received was from pharmacy students. DISCUSSION These data demonstrate that learning exists "about, from, and with" trainees in other professions, even if they do not physically train in the same location. Free tools are available to create virtual interactions between students on different campuses, and telehealth exercises using these tools are a valid way to conduct IPE across different campuses. The instructional experience does not need to be identical for all participants in the IPE event; rather, tailoring the educational experience to each group of students provides opportunities for inter-student teaching.
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Affiliation(s)
- Kelly M Quesnelle
- Department of Biomedical Sciences, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Dr., Kalamazoo 49008-8070, MI, United States.
| | - David R Bright
- Department of Pharmaceutical Sciences, Ferris State University College of Pharmacy, 220 Ferris Dr., Big Rapids 49307, MI, United States.
| | - Lisa A Salvati
- Department of Pharmacy Practice, Ferris State University College of Pharmacy, 25 Michigan NE, Grand Rapids 49503, MI, United States.
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Lau Y, Nyoe RSS, Wong SN, Ab Hamid ZB, Leong BSH, Lau ST. Effectiveness of digital resuscitation training in improving knowledge and skills: A systematic review and meta-analysis of randomised controlled trials. Resuscitation 2018; 131:14-23. [PMID: 30071263 DOI: 10.1016/j.resuscitation.2018.07.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/11/2018] [Accepted: 07/26/2018] [Indexed: 11/29/2022]
Abstract
AIM This review aims to evaluate the effectiveness of digital resuscitation training in improving knowledge and skill compared with standard resuscitation training. METHODS We searched through the CINAHL, Cochrane Library, EMBASE, ERIC, ProQuest Dissertations and Thesis, PsycINFO, PubMed and Scopus from inception of our review until 5 March 2018. The quality of individual and overall evidence was evaluated according to the risk of bias, Medical Education Research Study Quality Instrument (MERSQI) and Grade of Recommendation, Assessment, Development and Evaluation (GRADE) system, respectively. Meta-analyses were performed with the Review Manger software. Z-statistics were used to evaluate the overall effect of training, and I2 test was used to assess heterogeneity. Sensitivity and subgroup analyses were used for additional meta-analyses. RESULTS Amongst the 15,528 studies retrieved, 20 randomised controlled trials (RCTs) were selected from 13 countries across different ethnicities. More than half (52%) of the trials had a low risk of bias, and MERSQI scores ranged from 13.5 to 15.5. The overall quality of evidence was very low according to GRADE criteria. Meta-analyses revealed that trainees in digital resuscitation training had better knowledge scores but poorer chest compression rates than that of trainees in standard resuscitation training. Digital resuscitation trainings were non-inferior to standard resuscitation trainings in skill performance scores. Subgroup analyses suggested that digital resuscitation training might consider using blended learning approach with virtual patient, computer-screen based, learning theories and video-recorded assessment, especially for basic life support trainings amongst health professionals. CONCLUSION Despite the wide variation in digital resuscitation trainings, evidence suggesting the use of digital resuscitation training for improving knowledge and skills is inadequate. Well-designed non-inferiority RCTs in multiple settings with follow-up data and large sample size are needed to ensure the robustness of the evidence.
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Affiliation(s)
- Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | | | - Suei Nee Wong
- Medical Resource Team, National University of Singapore Libraries, National University of Singapore, Singapore.
| | | | | | - Siew Tiang Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Ludwig S, Schuelper N, Brown J, Anders S, Raupach T. How can we teach medical students to choose wisely? A randomised controlled cross-over study of video- versus text-based case scenarios. BMC Med 2018; 16:107. [PMID: 29976211 PMCID: PMC6034339 DOI: 10.1186/s12916-018-1090-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 06/04/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The Choosing Wisely campaign highlights the importance of clinical reasoning abilities for competent and reflective physicians. The principles of this campaign should be addressed in undergraduate medical education. Recent research suggests that answering questions on important steps in patient management promotes knowledge retention. It is less clear whether increasing the authenticity of educational material by the inclusion of videos further enhances learning outcome. METHODS In a prospective randomised controlled cross-over study, we assessed whether repeated video-based testing is more effective than repeated text-based testing in training students to choose appropriate diagnostic tests, arrive at correct diagnoses and identify advisable therapies. Following an entry exam, fourth-year undergraduate medical students attended 10 weekly computer-based seminars during which they studied patient case histories. Each case contained five key feature questions (items) on the diagnosis and treatment of the presented patient. Students were randomly allocated to read text cases (control condition) or watch videos (intervention), and assignment to either text or video was switched between groups every week. Using a within-subjects design, student performance on video-based and text-based items was assessed 13 weeks (exit exam) and 9 months (retention test) after the first day of term. The primary outcome was the within-subject difference in performance on video-based and text-based items in the exit exam. RESULTS Of 125 eligible students, 93 provided data for all three exams (response rate 74.4%). Percent scores were significantly higher for video-based than for text-based items in the exit exam (76.2 ± 19.4% vs. 72.4 ± 19.1%, p = 0.026) but not the retention test (69.2 ± 20.2% vs. 66.4 ± 20.3%, p = 0.108). An additional Bayesian analysis of this retention test suggested that video-based training is marginally more effective than text-based training in the long term (Bayes factor 2.36). Regardless of presentation format, student responses revealed a high prevalence of erroneous beliefs that, if applied to the clinical context, could place patients at risk. CONCLUSION Repeated video-based key feature testing produces superior short-term learning outcome compared to text-based testing. Given the high prevalence of misconceptions, efforts to improve clinical reasoning training in medical education are warranted. The Choosing Wisely campaign lends itself to being part of this process.
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Affiliation(s)
- Sascha Ludwig
- Department of Cardiology and Pneumology, Göttingen University Medical Centre, Robert-Koch-Straße 40, D-37075 Göttingen, Germany
| | - Nikolai Schuelper
- Department of Haematology and Medical Oncology, Göttingen University Medical Centre, Robert-Koch-Straße 40, D-37075 Göttingen, Germany
| | - Jamie Brown
- Health Behaviour Research Centre, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Sven Anders
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Butenfeld 34, D-22529 Hamburg, Germany
| | - Tobias Raupach
- Department of Cardiology and Pneumology, Göttingen University Medical Centre, Robert-Koch-Straße 40, D-37075 Göttingen, Germany
- Health Behaviour Research Centre, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
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Fleiszer D, Hoover ML, Posel N, Razek T, Bergman S. Development and Validation of a Tool to Evaluate the Evolution of Clinical Reasoning in Trauma Using Virtual Patients. JOURNAL OF SURGICAL EDUCATION 2018; 75:779-786. [PMID: 28927667 DOI: 10.1016/j.jsurg.2017.08.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 08/21/2017] [Accepted: 08/22/2017] [Indexed: 06/07/2023]
Abstract
CONTEXT Undergraduate medical students at a large academic trauma center are required to manage a series of online virtual trauma patients as a mandatory exercise during their surgical rotation. PURPOSE Clinical reasoning during undergraduate medical education can be difficult to assess. The purpose of the study was to determine whether we could use components of the students' virtual patient management to measure changes in their clinical reasoning over the course of the clerkship year. In order to accomplish this, we decided to determine if the use of scoring rubrics could change the traditional subjective assessment to a more objective evaluation. BASIC PROCEDURES Two groups of students, one at the beginning of clerkship (Juniors) and one at the end of clerkship (Seniors), were chosen. Each group was given the same virtual patient case, a clinical scenario based on the Advanced Trauma Life Support (ATLS) Primary Trauma Survey, which had to be completed during their trauma rotation. The learner was required to make several key patient management choices based on their clinical reasoning, which would take them along different routes through the case. At the end of the case they had to create a summary report akin to sign-off. These summaries were graded independently by two domain "Experts" using a traditional subjective surgical approach to assessment and by two "Non-Experts" using two internally validated scoring rubrics. One rubric assessed procedural or domain knowledge (Procedural Rubric), while the other rubric highlighted semantic qualifiers (Semantic Rubric). Each of the rubrics was designed to reflect established components of clinical reasoning. Student's t-tests were used to compare the rubric scores for the two groups and Cohen's d was used to determine effect size. Kendall's τ was used to compare the difference between the two groups based on the "Expert's" subjective assessment. Inter-rater reliability (IRR) was determined using Cronbach's alpha. MAIN FINDINGS The Seniors did better than the Juniors with respect to "Procedural" issues but not for "Semantic" issues using the rubrics as assessed by the "Non-Experts". The average Procedural rubric score for the Senior group was 59% ± 13% while for the junior group, it was 51% ± 12% (t(80)= 2.715; p = 0.008; Cohen's d = 1.53). The average Semantic rubric score for the Senior group was 31% ± 15% while for the Junior group, it was 28% ± 14% (t(80) = 1.010; p = .316, ns). There was no statistical difference in the marks given to the Senior versus Junior groups by the "Experts" (Kendall's τ = 0.182, p = 0.07). The IRR between the "Non-Experts" using the rubrics was higher than the IRR of the "Experts" using the traditional surgical approach to assessment. The Cronbach's alpha for the Procedural and Semantic rubrics was 0.94 and 0.97, respectively, indicating very high IRR. The correlation between the Procedural rubric scores and "Experts" assessment was approximately r = 0.78, and that between the Semantic rubric and the "Experts" assessment was roughly r = 0.66, indicating high concurrent validity for the Procedural rubric and moderately high validity for the Semantic rubric. PRINCIPLE CONCLUSION Clinical reasoning, as measured by some of its "procedural" features, improves over the course of the clerkship year. Rubrics can be created to objectively assess the summary statement of an online interactive trauma VP for "procedural" issues but not for "semantic" issues. Using IRR as a measure, the quality of assessment is improved using the rubrics. The "Procedural" rubric appears to measure changes in clinical reasoning over the course of 3rd-year undergraduate clinical studies.
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Affiliation(s)
- David Fleiszer
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Departments of Surgery and Oncology, McGill University Health Center, Montreal, Quebec, Canada
| | - Michael L Hoover
- Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Nancy Posel
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada; McGill University Health Center, Montreal, Quebec, Canada.
| | - Tarek Razek
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Montreal General Hospital, Montreal, Quebec, Canada
| | - Simon Bergman
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Department of Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
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Bergeron D, Champagne JN, Qi W, Dion M, Thériault J, Renaud JS. Impact of a Student-Driven, Virtual Patient Application on Objective Structured Clinical Examination Performance: Observational Study. J Med Internet Res 2018; 20:e60. [PMID: 29472175 PMCID: PMC5843791 DOI: 10.2196/jmir.7548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 08/22/2017] [Accepted: 11/30/2017] [Indexed: 11/13/2022] Open
Abstract
Background Peer-assisted learning (PAL) refers to a learning activity whereby students of similar academic level teach and learn from one another. Groupe de perfectionnement des habiletés cliniques (Clinical Skills Improvement Group), a student organization at Université Laval, Canada, propelled PAL into the digital era by creating a collaborative virtual patient platform. Medical interviews can be completed in pairs (a student-patient and a student-doctor) through an interactive Web-based application, which generates a score (weighted for key questions) and automated feedback. Objectives The aim of the study was to measure the pedagogical impact of the application on the score at medical interview stations at the summative preclerkship Objective Structured Clinical Examination (OSCE). Methods We measured the use of the application (cases completed, mean score) in the 2 months preceding the OSCE. We also accessed the results of medical interview stations at the preclerkship summative OSCE. We analyzed whether using the application was associated with higher scores and/or better passing grades (≥60%) at the OSCE. Finally, we produced an online form where students could comment on their appreciation of the application. Results Of the 206 students completing the preclerkship summative OSCE, 170 (82.5%) were registered users on the application, completing a total of 3133 cases (18 by active user in average, 7 minutes by case in average). The appreciation questionnaire was answered online by 45 students who mentioned appreciating the intuitive, easy-to-use, and interactive design, the diversity of cases, and the automated feedback. Using the application was associated with reduced reported stress, improved scores (P=.04), and improved passing rates (P=.11) at the preclerkship summative OSCE. Conclusions This study suggests that PAL can go far beyond small-group teaching, showing students’ potential to create helpful pedagogical tools for their peers.
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Affiliation(s)
- David Bergeron
- Faculté de médecine, Université Laval, Québec, QC, Canada
| | | | - Wen Qi
- Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Maxime Dion
- Département de mathématiques et statistiques, Université Laval, Québec, QC, Canada
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88
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Marei HF, Donkers J, Al-Eraky MM, van Merrienboer JJG. The effectiveness of sequencing virtual patients with lectures in a deductive or inductive learning approach. MEDICAL TEACHER 2017; 39:1268-1274. [PMID: 28936901 DOI: 10.1080/0142159x.2017.1372563] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Virtual patients (VPs) can be sequenced with other instructional methods in different ways. AIM To investigate the effect of sequencing VPs with lectures in a deductive approach, in comparison with an inductive approach, on students' knowledge acquisition, retention, and transfer. METHODS For two different topics, 84 out of 87 students have participated in the lecture and VP sessions. Students from female and male campuses have been randomly assigned to one of the two learning approaches (deductive and inductive), yielding four experimental groups. Each group received a lecture session and an independent VP learning activity, which either followed the lecture session in the deductive group or preceded it in the inductive group. Students were administrated knowledge acquisition and retention written tests as well as transfer tests using two new VPs. RESULTS There was no significant effect for the learning approach on knowledge acquisition or retention, while for knowledge transfer, males have benefited from the inductive approach in topic 1 while in the more complex topic 2, they have benefited from the deductive approach. On the other hand, females seem to be largely unaffected by learning approach. CONCLUSIONS Sequencing VPs in inductive and deductive learning approaches leads to no significant differences on students' performance when full guidance is offered in the inductive approach.
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Affiliation(s)
- Hesham Fathi Marei
- a Biomedical Dental Sciences Department, College of Dentistry , University of Dammam , Dammam , Saudi Arabia
- b Department of Oral and Maxillofacial Surgery, Faculty of Dentistry , Suez Canal University , Ismailia , Egypt
| | - Jeroen Donkers
- c Department of Educational Development and Research, School of Health Professions Education , Maastricht University , Maastricht , Netherlands
| | - Mohamed Mostafa Al-Eraky
- d Development and Academic Initiatives Directorate , University of Dammam , Dammam , Saudi Arabia
- e Department of Medical Education , University of Zagazig , Zagazig , Egypt
| | - Jeroen J G van Merrienboer
- c Department of Educational Development and Research, School of Health Professions Education , Maastricht University , Maastricht , Netherlands
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89
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Stone EA, Reimann J, Greenhill LM, Dewey CE. Milestone Educational Planning Initiatives in Veterinary Medical Education: Progress and Pitfalls. JOURNAL OF VETERINARY MEDICAL EDUCATION 2017; 45:388-404. [PMID: 29185893 DOI: 10.3138/jvme.1116-181r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Three milestone educational planning initiatives engaged the veterinary medical profession in the United States and Canada between 1987 and 2011, namely the Pew National Veterinary Education Program, the Foresight Project, and the North American Veterinary Medical Education Consortium. In a quantitative study, we investigated the impact of these initiatives on veterinary medical education through a survey of academic leaders (deans, previous deans, and associate deans for academics from veterinary medical schools that are members of the Association of American Veterinary Medical Colleges) to assess their perspectives on the initiatives and eight recommendations that were common to all three initiatives. Two of the recommendations have in effect been implemented: enable students to elect in-depth instruction and experience within a practice theme or discipline area (tracking), and increase the number of graduating veterinarians. For three of the recommendations, awareness of the issues has increased but substantial progress has not been made: promote diversity in the veterinary profession, develop a plan to reduce student debt, and develop a North American strategic plan. Lastly, three recommendations have not been accomplished: emphasize use of information more than fact recall, share educational resources to enable a cost-effective education, and standardize core admissions requirements. The educational planning initiatives did provide collaborative opportunities to discuss and determine what needs to change within veterinary medical education. Future initiatives should explore how to avoid and overcome obstacles to successful implementation.
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Affiliation(s)
- Elizabeth A Stone
- Emeritus Professor in the College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607 USA.
| | - Jessica Reimann
- PhD Candidate in the Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1 Canada.
| | - Lisa M Greenhill
- Senior Director for Institutional Research and Diversity, Association of American Veterinary Colleges, Washington, DC 20001 USA.
| | - Cate E Dewey
- Professor of Epidemiology and Health Management in the Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1 Canada.
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90
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Foster A, Trieu M, Azutillo E, Halan S, Lok B. Teaching Empathy in Healthcare: from Mirror Neurons to Education Technology. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s41347-017-0019-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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91
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Dong T, Kelly W, Hays M, Berman NB, Durning SJ. An investigation of professionalism reflected by student comments on formative virtual patient encounters. BMC MEDICAL EDUCATION 2017; 17:3. [PMID: 28056962 PMCID: PMC5217219 DOI: 10.1186/s12909-016-0840-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 12/07/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND This study explored the use of virtual patient generated data by investigating the association between students' unprofessional patient summary statements, which they entered during an on-line virtual patient case, and detection of their future unprofessional behavior. METHOD At the USUHS, students complete a number of virtual patient encounters, including a patient summary, to meet the clerkship requirements of Internal Medicine, Family Medicine, and Pediatrics. We reviewed the summary statements of 343 students who graduated in 2012 and 2013. Each statement was rated with regard to four features: Unprofessional, Professional, Equivocal (could be construed as unprofessional), and Unanswered (students did not enter a statement). We also combined Unprofessional and Equivocal into a new category to indicate a statement receiving either rating. We then examined the associations of students' scores on these categories (i.e. whether received a particular rating or not) and Expertise score and Professionalism score reflected by a post-graduate year one (PGY-1) program director (PD) evaluation form. The PD forms contained 58 Likert-scale items designed to measure the two constructs (Expertise and Professionalism). RESULTS The inter-rater reliability of statements coding was high (Cohen's Kappa = .97). The measure of receiving an Unprofessional or Equivocal rating was significantly correlated with lower Expertise score (r = -.19, P < .05) as well as lower Professionalism score (r = -.17, P < .05) during PGY-1. CONCLUSION Incident reports and review of routine student evaluations are what most schools rely on to identify the majority of professionalism lapses. Unprofessionalism reflected in student entries may provide additional markers foreshadowing subsequent unprofessional behavior.
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Affiliation(s)
- Ting Dong
- Uniformed Services University of the Health Sciences (USUHS), Bethesda, USA.
- Department of Medicine (A3068), USUHS, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
| | - William Kelly
- Uniformed Services University of the Health Sciences (USUHS), Bethesda, USA
| | - Meredith Hays
- Uniformed Services University of the Health Sciences (USUHS), Bethesda, USA
| | - Norman B Berman
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH, 03755, USA
| | - Steven J Durning
- Uniformed Services University of the Health Sciences (USUHS), Bethesda, USA
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92
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Robison DG, Bridges-Catalano J, Matson CC. The Role for Virtual Patients in the Future of Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:9. [PMID: 28027091 DOI: 10.1097/acm.0000000000001493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Don G Robison
- Assistant professor, Department of Family and Community Medicine, Eastern Virginia Medical School, Norfolk, Virginia; . Instructional designer, Medical Education, Eastern Virginia Medical School, Norfolk, Virginia. Professor and chair, Department of Family and Community Medicine, Eastern Virginia Medical School, Norfolk, Virginia
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93
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White CB, Wendling A, Lampotang S, Lizdas D, Cordar A, Lok B. The Role for Virtual Patients in the Future of Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:9-10. [PMID: 28027092 DOI: 10.1097/acm.0000000000001487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Casey B White
- Associate dean and associate professor for medical education, research, and instruction, University of Virginia School of Medicine, Charlottesville, Virginia; . Associate professor of anesthesiology and division chief, Obstetric Anesthesiology, University of Florida College of Medicine, Gainesville, Florida. Professor of anesthesiology, University of Florida College of Medicine, Gainesville, Florida. Simulation engineer, University of Florida College of Medicine, Gainesville, Florida. Graduate student, University of Florida College of Engineering, Gainesville, Florida. Professor, University of Florida College of Engineering, Gainesville, Florida
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Wong E, Leslie JJ, Soon JA, Norman WV. Measuring interprofessional competencies and attitudes among health professional students creating family planning virtual patient cases. BMC MEDICAL EDUCATION 2016; 16:273. [PMID: 27756294 PMCID: PMC5069921 DOI: 10.1186/s12909-016-0797-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 10/08/2016] [Indexed: 05/14/2023]
Abstract
BACKGROUND The Virtual Interprofessional Patients-Computer-Assisted Reproductive Health Education for Students (VIP-CARES) Project took place during the summers of 2010-2012 for eight weeks each year at the University of British Columbia (UBC). Undergraduate health care students worked collaboratively to develop virtual patient case-based learning modules on the topic of family planning. The purpose of this study was to evaluate the changes in perception towards interprofessional collaboration (IPC) among the participants, before and after the project. METHODS This study utilized a mixed methods evaluation using self-assessment survey instruments, semi-structured interviews, and reflective essays. Pre- and post- project surveys were adapted from the Canadian Medical Education Determinants (CanMEDS) and Canadian Interprofessional Health Collaborative (CIHC) frameworks, as well as the Memorial University Interprofessional Attitudes (IPA) questionnaire. The survey results were analyzed as mean (M) and standard deviation (SD) on Likert scales. The non-parametric Wilcoxon signed-rank test was used to determine if any significant changes were measured between each participant's differences in score (p ≤ 0.05). Post-project interview transcripts and essays were analyzed using recursive abstraction to elicit any themes. RESULTS Altogether, 26 students in medicine, pharmacy, nursing, midwifery, dentistry, counselling psychology, and computer science participated in VIP-CARES, during the three years. Student attitudes toward IPC were positive before and after the project. At the project's conclusion, there was a statistically significant increase in the participants' self-assessment competency scores in the CanMEDS roles of health advocate (p = 0.05), manager (p = 0.02), and medical expert (p = 0.03), as well as the CIHC domains of interprofessional communication (p = 0.04), role clarification (p = 0.01), team functioning (p = 0.05), and collaborative leadership (p = 0.01). Qualitative evaluations yielded three major themes: communication and respect as key to team functioning, importance of role clarification within the team, and existence of inherent challenges to IPC. From the reflections, students generally felt more comfortable with their improvements in the CIHC domains of interprofessional communication, team functioning, and role clarification. CONCLUSION After working within an interdisciplinary team developing virtual patient learning modules on family planning, the student participants of the VIP-CARES Project indicated general improvement in the skills necessary for effective interprofessional collaboration. Triangulation of the overall data suggests this was especially observed within the areas of interprofessional communication, team functioning, and role clarification.
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Affiliation(s)
- Eric Wong
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
- Contraception Access Research Team- Groupe de recherche sur l’accessibilité à la contraception (CART/GRAC), Women’s Health Research Institute, British Columbia Women’s Hospital and Health Centre, Provincial Health Services Authority, Vancouver, BC Canada
| | - Jasmine J. Leslie
- Contraception Access Research Team- Groupe de recherche sur l’accessibilité à la contraception (CART/GRAC), Women’s Health Research Institute, British Columbia Women’s Hospital and Health Centre, Provincial Health Services Authority, Vancouver, BC Canada
- Department of Family Practice, Faculty of Medicine, University of British Columbia, 3rd Floor, David Strangway Building, 5950 University Boulevard, Vancouver, BC V6T 1Z3 Canada
| | - Judith A. Soon
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
- Contraception Access Research Team- Groupe de recherche sur l’accessibilité à la contraception (CART/GRAC), Women’s Health Research Institute, British Columbia Women’s Hospital and Health Centre, Provincial Health Services Authority, Vancouver, BC Canada
| | - Wendy V. Norman
- Contraception Access Research Team- Groupe de recherche sur l’accessibilité à la contraception (CART/GRAC), Women’s Health Research Institute, British Columbia Women’s Hospital and Health Centre, Provincial Health Services Authority, Vancouver, BC Canada
- Department of Family Practice, Faculty of Medicine, University of British Columbia, 3rd Floor, David Strangway Building, 5950 University Boulevard, Vancouver, BC V6T 1Z3 Canada
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Walldorf J, Jähnert T, Berman NB, Fischer MR. Using Foreign Virtual Patients With Medical Students in Germany: Are Cultural Differences Evident and Do They Impede Learning? J Med Internet Res 2016; 18:e260. [PMID: 27678418 PMCID: PMC5059482 DOI: 10.2196/jmir.6040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 07/15/2016] [Accepted: 07/20/2016] [Indexed: 11/13/2022] Open
Abstract
Background Learning with virtual patients (VPs) is considered useful in medical education for fostering clinical reasoning. As the authoring of VPs is highly demanding, an international exchange of cases might be desirable. However, cultural differences in foreign VPs might hamper learning success. Objective We investigated the need for support for using VPs from the United States at a German university, with respect to language and cultural differences. Our goal was to better understand potential implementation barriers of a intercultural VP exchange. Methods Two VPs were presented to 30 German medical students featuring a cultural background different from German standards with respect to diagnostic and therapeutic procedures, ethical aspects, role models, and language (as identified by a cultural adaptation framework). Participants were assigned to two groups: 14 students were advised to complete the cases without further instructions (basic group), and 16 students received written explanatory supplemental information specifically with regard to cultural differences (supplement group). Using a 6-point scale (6=strongly agree), we analyzed the results of an integrated assessment of learning success as well as an evaluation of cases by the students on usefulness for learning and potential issues regarding the language and cultural background. Results The German students found it motivating to work with cases written in English (6-point scale, 4.5 points). The clinical relevance of the VPs was clearly recognized (6 points), and the foreign language was considered a minor problem in this context (3 points). The results of the integrated learning assessment were similar in both groups (basic 53% [SD 4] vs supplement 52% [SD 4] correct answers, P=.32). However, students using the supplemental material more readily realized culturally different diagnostic and therapeutic strategies (basic 4 vs supplement 5 points, P=.39) and were less affirmative when asked about the transferability of cases to a German context (basic 5 vs supplement 3 points, P=.048). Conclusions German students found English VPs to be highly clinically relevant, and they rated language problems much lower than they rated motivation to work on cases in English. This should encourage the intercultural exchange of VPs. The provision of supplemental explanatory material facilitates the recognition of cultural differences and might help prevent unexpected learning effects.
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Affiliation(s)
- Jens Walldorf
- Universitätsklinik und Poliklinik für Innere Medizin I, Universitätsklinikum Halle, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany.
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