The Effectiveness of Blended Learning in Health Professions: Systematic Review and Meta-Analysis

Digitale Hochschullehre im ersten COVID-19-Semester. Ergebnisse einer Befragung von Lehrenden in Public Health, Medizin und Pflege

Hintergrund

Die COVID-19(„coronavirus disease 2019“)-Pandemie hat die Ad-hoc-Digitalisierung an Hochschulen vorangetrieben. Zugleich stand die digitale Hochschullehre vor der Herausforderung der Ausgestaltung der Lehre im Zusammenhang mit den vorbestehenden Ressourcen, der digitalen und didaktischen Kompetenzen sowie der zur Verfügung stehenden technischen Infrastruktur.

Ziel der Arbeit/Fragestellung

Das Ziel der Umfrage war die Einschätzung der digitalen Lehre, die die Präsenzlehre infolge der COVID-19-Pandemie zum großen Teil bzw. gänzlich ersetzt hat, aus der Perspektive der Lehrenden in Public Health, Medizin und Pflege.

Material und Methode

Die Querschnitterhebung fand online von Juni bis August 2020 statt und die Daten wurden über www.soscisurvey.de erhoben. Die schriftliche Befragung wurde unter Mitgliedern der Deutschen Gesellschaft für Public Health (DGPH) und des Ausschusses Digitalisierung der Gesellschaft für medizinische Ausbildung (GMA) und der Sektionen Bildung und Beratung der Deutschen Gesellschaft für Pflegewissenschaft (DGP) sowie der Arbeitsgruppe Lehre der Deutschen Gesellschaft für Medizinische Soziologie (DGMS) durchgeführt (n = 100).

Ergebnisse

Bei der Nutzung der digitalen Technologien in den Veranstaltungen rangieren auf der obersten Stelle Präsentationstools, gefolgt von Lernmanagementsystemen, Videoangeboten sowie digitalen Texten. Die Teilnehmenden geben hinsichtlich der Nutzung unterschiedliche (Konferenz‑)Tools an. Das Erstellen von Lehrvideos bejahen 53 % der Befragten, Abstimmungstools) werden bis > 50 % als unbekannt genannt. Als Herausforderungen werden digitale Infrastruktur der Hochschulen, fehlende didaktische Beratung/Unterstützung sowie rechtliche Fragen (Nutzungsrechte, Datenschutz) angegeben.

Schlussfolgerung

Neue Technologie werden vorwiegend für Wissenserwerb, Wissensvermittlung genutzt, selten zur Aktivierung von Studierenden und zur Gestaltung kollaborativer Lehr- und Lernarrangements sowie Neugestaltung von Lernaufgaben und Lernprozessen (individualisiertes Lernen). Welche der aktuell erprobten digitalen Lehr- und Lernformate zukünftig in der Hochschullehre zunehmend eingesetzt werden, hängt von vielen Faktoren ab, u. a. von digitaler Kompetenz sowie der Bereitschaft der Lehrenden und Lernenden die digitale Lernkultur mitzugestalten.

Zusatzmaterial online

Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s11553-022-00937-1) enthalten.

Digital Education for Health Professionals: An Evidence Map, Conceptual Framework, and Research Agenda

BACKGROUND

Health professions education has undergone major changes with the advent and adoption of digital technologies worldwide.

OBJECTIVE

This study aims to map the existing evidence and identify gaps and research priorities to enable robust and relevant research in digital health professions education.

METHODS

We searched for systematic reviews on the digital education of practicing and student health care professionals. We searched MEDLINE, Embase, Cochrane Library, Educational Research Information Center, CINAHL, and gray literature sources from January 2014 to July 2020. A total of 2 authors independently screened the studies, extracted the data, and synthesized the findings. We outlined the key characteristics of the included reviews, the quality of the evidence they synthesized, and recommendations for future research. We mapped the empirical findings and research recommendations against the newly developed conceptual framework.

RESULTS

We identified 77 eligible systematic reviews. All of them included experimental studies and evaluated the effectiveness of digital education interventions in different health care disciplines or different digital education modalities. Most reviews included studies on various digital education modalities (22/77, 29%), virtual reality (19/77, 25%), and online education (10/77, 13%). Most reviews focused on health professions education in general (36/77, 47%), surgery (13/77, 17%), and nursing (11/77, 14%). The reviews mainly assessed participants' skills (51/77, 66%) and knowledge (49/77, 64%) and included data from high-income countries (53/77, 69%). Our novel conceptual framework of digital health professions education comprises 6 key domains (context, infrastructure, education, learners, research, and quality improvement) and 16 subdomains. Finally, we identified 61 unique questions for future research in these reviews; these mapped to framework domains of education (29/61, 47% recommendations), context (17/61, 28% recommendations), infrastructure (9/61, 15% recommendations), learners (3/61, 5% recommendations), and research (3/61, 5% recommendations).

CONCLUSIONS

We identified a large number of research questions regarding digital education, which collectively reflect a diverse and comprehensive research agenda. Our conceptual framework will help educators and researchers plan, develop, and study digital education. More evidence from low- and middle-income countries is needed.

Effectiveness of Diabetes Nursing Course Designed With Hybrid Learning Pedagogy: A Pilot Study

Objective: This study aimed to examine the effectiveness of hybrid learning pedagogy in a redesigned diabetes nursing course for senior nursing students in enhancing knowledge and skills related to diabetes education. Methods: A single-group pre-test and post-test quasi-experimental design were used. The study was conducted between January-June 2018 in a state university's nursing department in Istanbul, Turkey. Sixteen senior nursing students were included in the sample group of the study. Results: It was detected that the Insülin Injection Skill Checklist (II-SC) post-test score, Blood Glucose Measurement Skill Checklist (BGM-SC) post-test score, and Educational Skills Checklist (ESC) post-test score were significantly higher than the pre-test scores. There was a significant difference between the Mini Exams (ME) pre-test and post-test scores of participants for each online lesson. Conclusions: The study results showed that a hybrid learning-based diabetes nursing course effectively increases the knowledge and skills of students regarding diabetes education.

Impact of Face-to-Face Teaching in Addition to Electronic Learning on Personal Protective Equipment Doffing Proficiency in Student Paramedics: Randomized Controlled Trial

Personal protective equipment doffing is a complex procedure that needs to be adequately performed to prevent health care worker contamination. During the COVID-19 pandemic, junior health care workers and students of different health care professions who had not been trained to carry out such procedures were often called upon to take care of infected patients. To limit direct contact, distance teaching interventions were used, but different trials found that their impact was rather limited. We therefore designed and carried out a randomized controlled trial assessing the impact of adding a face-to-face intervention using Peyton's four-step approach to a gamified e-learning module. Sixty-five student paramedics participated in this study. The proportion of doffing sequences correctly performed was higher in the blended learning group (33.3% (95%CI 18.0 to 51.8) versus 9.7% (95%CI 2.0 to 25.8), p = 0.03). Moreover, knowledge and skill retention four to eight weeks after the teaching intervention were also higher in this group. Even though this study supports the use of a blended learning approach to teach doffing sequences, the low number of student paramedics able to adequately perform this procedure supports the need for iterative training sessions. Further studies should determine how often such sessions should be carried out.

Assessment of learning outcomes of first year dental students using an interactive Nearpod educational platform

PURPOSE

The impact of COVID-19 required revisions in curricula, especially among professional programs that have traditionally required hands-on learning of content. This study endeavored to assess the level of effectiveness of the online presentation of material both qualitatively and quantitatively in a 5-week module on cariology for first-year dental students. Quantitative analysis of the assessment data was required to determine if an interactive engagement platform increased student outcomes. Quantitative survey and qualitative student comments were analyzed to determine the students' preferences for supplemental learning opportunities and utilization trends. The purpose of this study was to measure the learning outcomes of online course delivery with the use of an interactive education platform.

METHODS

The dental class of 2023 received the cariology material in a live, in-person lecture format. The class of 2024 received the same material in a combination of synchronous Zoom lectures and asynchronous interactive presentations utilizing the interactive education platform (Nearpod). The identical midterm examination on cariology was administered to both cohorts at the completion of the 5-week module.

RESULTS

Quantitatively, the class of 2024 had a significantly higher mean score than the class of 2023 on the midterm examination, collectively and in both female and male cohorts. Qualitatively, the dental students overwhelmingly expressed support for the ease of use and educational value of the Nearpod platform.

CONCLUSIONS

This study found that student performance on the identical exam was improved through the use of synchronous Zoom lectures and asynchronous Nearpod review sessions. The application of technology to enhance remote learning can be effective in supporting student mastery of core concepts in dental education.

Online Learning Methods during COVID-19 Pandemic: On an Indonesian Nursing Student Experience

BACKGROUND: The policy of limiting community activities during the COVID-19 pandemic affects the learning process. The expectation of the online learning methods is a stressor for the students. For this reason, it is necessary to explore the experiences of the students during online learning. AIM: The purpose of this study was to explore the experiences, especially hopes and needs of the students, while undergoing online learning during the COVID-19 pandemic. METHODS: This study applied a qualitative approach with a phenomenological design. The participants involved were six health students from the Faculty of Health Sciences in Yogyakarta, Indonesia. They were recruited using a purposive sampling technique. Data were collected through online interview. The data were then analyzed using the Colaizzi technique. RESULTS: The results illustrated that there are two themes of the students’ expectations during the learning, including the expectations of the learning process and the expectations of the lecturers. There are two themes for the students’ needs during the online learning, namely, family support and internet network support. The students expect that the learning process is carried out with a combination of learning methods and the lecturers to understand the problems faced by students. CONCLUSION: The students need the support of a good internet network and family support so that they can participate in the online learning well.

Digital Teaching in Medical Education: Scientific Literature Landscape Review

BACKGROUND

Digital teaching in medical education has grown in popularity in the recent years. However, to the best of our knowledge, no bibliometric report to date has been published that analyzes this important literature set to reveal prevailing topics and trends and their impacts reflected in citation counts.

OBJECTIVE

We used a bibliometric approach to unveil and evaluate the scientific literature on digital teaching research in medical education, demonstrating recurring research topics, productive authors, research organizations, countries, and journals. We further aimed to discuss some of the topics and findings reported by specific highly cited works.

METHODS

The Web of Science electronic database was searched to identify relevant papers on digital teaching research in medical education. Basic bibliographic data were obtained by the "Analyze" and "Create Citation Report" functions of the database. Complete bibliographic data were exported to VOSviewer for further analyses. Visualization maps were generated to display the recurring author keywords and terms mentioned in the titles and abstracts of the publications.

RESULTS

The analysis was based on data from 3978 papers that were identified. The literature received worldwide contributions with the most productive countries being the United States and United Kingdom. Reviews were significantly more cited, but the citations between open access vs non-open access papers did not significantly differ. Some themes were cited more often, reflected by terms such as virtual reality, innovation, trial, effectiveness, and anatomy. Different aspects in medical education were experimented for digital teaching, such as gross anatomy education, histology, complementary medicine, medicinal chemistry, and basic life support. Some studies have shown that digital teaching could increase learning satisfaction, knowledge gain, and even cost-effectiveness. More studies were conducted on trainees than on undergraduate students.

CONCLUSIONS

Digital teaching in medical education is expected to flourish in the future, especially during this era of COVID-19 pandemic.

Eight-Year Experience of the Certificate of Competence and Advanced Studies Program Organized by the European School of Oncology

The Certificate of Competence and Advanced Studies Program is an academically recognized postgraduate program that is organized by the European School of Oncology in collaboration with the University of Ulm and the University of Zurich. It is a part-time educational activity that aims to provide physicians and scientists with advanced knowledge in the management of patients with breast cancer, lymphoma, and lung cancer. The program encloses three attendance seminars and four to five e-learning modules that extend over 12 to 14 months. To be certified, participants have to pass an online test after each module followed by a final certification exam at the end of the program. This article reports on the 8-year experience of the 166 graduated fellows who have attended the program.

Impact of sepsis education for healthcare professionals and students on learner and patient outcomes: A systematic review

BACKGROUND

Sepsis is an important global healthcare problem that is a key challenge faced by healthcare professionals face worldwide. One key effort aimed at reducing the global burden of sepsis is educating healthcare professionals about early identification and management of sepsis.

AIM

To provide a comprehensive evaluation of sepsis education among healthcare professionals and students.

METHODS

Six databases (PubMed, CINAHL, Embase, MEDLINE, Cochrane Central Register of Controlled Trials, and Scopus) were searched. We included studies that described and evaluated any form of education or training on sepsis delivered to healthcare professionals and students. Study outcomes were summarised according to the adapted Kirkpatrick model of training evaluation.

RESULTS

Thirty-two studies were included in the review. The learning contents were reported to be in accordance with the Surviving Sepsis Campaign guidelines. Seven studies included the topic of interprofessional teamwork and communication in their sepsis education content. Most educational programs were effective and reported positive effects on immediate knowledge outcomes. Interventions that were delivered through an active learning approach such as simulation and game-based learning generally produced greater gains than didactic teaching. Improvements in patient care processes and patient outcomes were associated with the concomitant existence or implementation of a hospital sepsis care bundle.

CONCLUSION

Incorporating active learning strategies into sepsis education interventions has the potential to improve learners' long-term outcomes. In addition, sepsis education and protocol-based sepsis care bundle act in synergy to augment greater improvements in care processes and patient benefits.

E-Learning and Blended-Learning Program in Wound Care for Undergraduate Nursing Students

BACKGROUND

Due to an increasing number of undergraduate students in a Bachelor of Nursing Science program, the existing teaching modalities in wound care were shifted into blended- and e-learning units. The aim is to present the development and implementation of a blended- and e-learning wound care curriculum in an actual nursing program.

METHOD

The development of the blended- and e-learning units is based on literature reviews and expert discussions. The process was guided by the learning outcomes defined by the European Wound Management Association. The implementation was planned for 3 years.

RESULTS

All 14 learning units were developed and implemented using 12 blended and two e-learning units. Flipped classrooms using asynchronous e-learnings and workshops with clinical wound care specialists were used for blended learning.

CONCLUSION

Blended and e-learning are valuable modalities to provide flexibility and deliver learning units based on the latest evidence. The effectiveness of this curriculum needs to be investigated. [J Nurs Educ. 2022;61(1):53-57.].

Development of a blended emergent research training program for clinical nurses (part 1)

BACKGROUND

Nursing research training is important for improving the nursing research competencies of clinical nurses. Rigorous development of such training programs is crucial for ensuring the effectiveness of these research training programs. Therefore, the objectives of this study are: (1) to rigorously develop a blended emergent research training program for clinical nurses based on a needs assessment and related theoretical framework; and (2) to describe and discuss the uses and advantages of the ADDIE model (Analysis, Design, Development, Implementation, Evaluation) in the instructional design and potential benefits of the blended emergent teaching method.

METHODS

This intervention development study was conducted in 2017, using a mixed-methods design. A theoretical framework of blended emergent teaching was constructed to provide theoretical guidance for the training program development. Nominal group technique was used to identify learners' common needs and priorities. The ADDIE model (Analysis, Design, Development, Implementation, Evaluation) was followed to develop the research training program for clinical nurses based on the limitations of current nursing research training programs, the needs of clinical nurses, and the theoretical foundation of blended emergent teaching.

RESULTS

Following the ADDIE model, a blended emergent research training program for clinical nurses to improve nursing research competence was developed based on the needs of clinical nurses and the theoretical framework of blended emergent teaching.

CONCLUSIONS

This study indicates that nominal group technique is an effective way to identify learners' common needs and priorities, and that the ADDIE model is a valuable process model to guide the development of a blended emergent training program. Blended emergent teaching is a promising methodology for improving trainees' learning initiative and educational outcomes. More empirical studies are needed to further evaluate blended emergent teaching to promote the development of related theories and practice in nursing education.

Ensino híbrido na formação em saúde: uma revisão sistemática

Introdução: A partir da necessidade de reestruturação das instituições de ensino em saúde devido à pandemia da COVID-19, o ensino híbrido vem se destacando como possibilidade de reorganização das atividades educativas. O objetivo deste estudo foi escrever o desenvolvimento do ensino híbrido na formação de profissionais da área da saúde. Materiais e Métodos: Revisão sistemática da literatura, baseada nas recomendações da Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A pesquisa foi desenvolvida em pares, entre julho a setembro de 2020, em quatro bases de dados eletrônicas. Os descritores foram os termos “Educação a Distância”, “Educação Superior”, “Aprendizagem”, “Saúde”, “Enfermagem”, “Medicina”, “Odontologia” e “Fisioterapia” e “Ensino híbrido”. Os artigos foram classificados conforme seu Nível de Evidência. Resultados: 49 artigos foram selecionados, entre estudos quantitativos, qualitativos e de método misto. Foram encontradas experiências do desenvolvimento do ensino híbrido nos diferentes cursos de formação na área da saúde. Observou-se aplicação do ensino híbrido segundo o modelo de Rotação, modelo à la carte e o modelo Flex. Discussão: o ensino híbrido vem ganhando destaque cada vez maior no cenário da educação acadêmica em saúde. Foi visto que, a partir dele, o aluno destaca-se em sua aprendizagem, pois é o principal gerenciador deste processo, aprendendo ativamente por diversos instrumentos educativos a partir da condução do professor. Conclusões: O êxito do ensino híbrido pode estar relacionado ao seu caráter inovador, flexível, com boa relação custo-benefício e capaz de tornar os alunos protagonistas do seu processo de ensino-aprendizagem, influenciando no desempenho acadêmico dos alunos.

Multimodal Three-Dimensional Visualization Enhances Novice Learner Interpretation of Basic Cross-Sectional Anatomy

While integrated delivery of anatomy and radiology can support undergraduate anatomical education, the interpretation of complex three-dimensional spatial relationships in cross-sectional and radiological images is likely to be demanding for novices. Due to the value of technology-enhanced and multimodal strategies, it was hypothesized that simultaneous digital and physical learning could enhance student understanding of cross-sectional anatomy. A novel learning approach introduced at a United Kingdom university medical school combined visualization table-based thoracic cross-sections and digital models with a three-dimensional printed heart. A mixed-method experimental and survey approach investigated student perceptions of challenging anatomical areas and compared the multimodal intervention to a two-dimensional cross-section control. Analysis of seven-point Likert-type responses of new medical students (n = 319) found that clinical imaging (mean 5.64 SD ± 1.20) was significantly more challenging (P < 0.001) than surface anatomy (4.19 ± 1.31) and gross anatomy (4.92 ± 1.22). Pre-post testing of students who used the intervention during their first anatomy class at medical school (n = 229), identified significant increases (P < 0.001) in thoracic cross-sectional anatomy interpretation performance (mean 31.4% ± 15.3) when compared to the subsequent abdominal control activity (24.1% ± 17.6). Student test scores were independent of mental-rotation ability. As depicted on a seven-point Likert-type scale, the intervention may have contributed to students considering cross-sectional interpretation of thoracic images (4.2 ± 1.23) as significantly less challenging (P < 0.001) than comparable abdominal images (5.59 ± 1.14). These findings could have implications for how multimodal cross-sectional anatomy learning approaches are implemented within medical curricula.

E-learning to teach medical students about acute otitis media: A randomized controlled trial

Objectives

Acute otitis media (AOM) is extremely prevalent among children but its diagnosis remains challenging. Our primary objective was to measure the impact of an e-learning module on medical students' accuracy in diagnosing paediatric AOM.

Methods

This randomized controlled trial was performed at a single tertiary care paediatric emergency department (ED). Medical students on their paediatric rotation were randomized to a locally developed e-learning module or a small-group lecture on AOM. They then had to examine at least 10 ears of patients at risk for AOM. The primary outcome was diagnostic accuracy and secondary outcomes included knowledge test scores and learning modality preference.

Results

Between May 2017 and September 2018, 201 medical students were randomized. Eighty-three evaluated at least 10 ears and were included in the primary analysis. Diagnostic accuracies (76.5% for the e-learning group versus 76.4% for the lecture group, difference of 0.1%; 95%CI: -6.2 to 6.4%) and post-test scores (difference of 0.5/20 points; 95%CI: -0.8 to 1.2/20 points) were similar between the groups. Sixty-two per cent of participants preferred the e-learning module to the lecture, while 15% had no preference.

Conclusions

Diagnostic accuracy for AOM was similar between students exposed to an e-learning module or a small-group lecture. E-learning was the preferred learning modality.

Pilot-Testing a Blended Learning Package for Health Care Workers to Improve Index Testing Services in Southern Malawi: An Implementation Science Study

BACKGROUND

HIV index testing, an intervention in which HIV-positive "indexes" (persons diagnosed with HIV) are supported to recruit their "contacts" (sexual partners and children) efficiently identifies HIV-infected persons in need of treatment and HIV-uninfected persons in need of prevention. However, index testing implementation in sub-Saharan African health care settings has been suboptimal. The objective of this study was to develop and pilot test a blended learning capacity-building package to improve index testing implementation in Malawi.

METHODS

In 2019, a blended learning package combining digital and face-to-face training modalities was field tested at 6 health facilities in Mulanje, Malawi using a pre-/post- type II hybrid design with implementation and effectiveness outcomes. Health care worker (HCW) fidelity to the intervention was assessed via observed encounters before and after the training. Preliminary effectiveness was examined by comparing index testing program indicators in the 2 months before and 4 months after the training. Indicators included the mean number of indexes screened, contacts elicited, and contacts who received HIV testing per facility per month.

RESULTS

On a 30-point scale, HCW fidelity to index testing protocols improved from 6.0 pre- to 25.5 post-package implementation (P = 0.002). Index testing effectiveness indicators also increased: indexes screened (pre = 63, post = 101, P < 0.001); contacts elicited (pre = 75, post = 131, P < 0.001); and contacts who received HIV testing (pre = 27, post = 41, P = 0.014).

CONCLUSIONS

The blended learning package improved fidelity to index testing protocols and preliminary effectiveness outcomes. This package has the potential to enhance implementation of HIV index testing approaches, a necessary step for ending the HIV epidemic.

Home-based physiology labs in the time of COVID-19 prove popular with medical students

The COVID-19 pandemic and the resulting "lockdown" have forced many medical schools to shift from traditional "face-to-face" teaching methodologies and embrace full online delivery. Although lectures and tutorials are readily communicated by this approach, the execution of laboratory exercises is much more difficult. To overcome these challenges, face-to-face laboratory sessions were replaced by a blended learning approach in which students were provided instructional material online and then required to conduct the laboratory exercises at home. These laboratory exercises made use of easily accessible household materials and mobile applications. A self-report survey was designed to assess students' perception of their learning experience and attitudes to the home-based laboratory exercises. The survey consisted of 16 questions that students had to respond to using a 5-point Likert scale. Students were also allowed to provide open responses to select questions. Overall, the 80% of students that completed the survey expressed strong satisfaction with their learning experience and were enthusiastic toward home-based laboratory exercises. However, concerns about not being able to complete particular face-to-face exercises that required specialized equipment were expressed. Several students proposed a combined approach going forward. Our results show that home-based laboratory exercises offer a multimodal option that enriches the learning curriculum by engaging students in "hands-on" bespoke practicals using inexpensive household materials.

An approach to teaching psychiatry to medical students in the time of Covid-19

In this time of Covid-19, life in healthcare has changed immeasurably. It has rapidly been injected with an 'all hands-on deck' approach, to facilitate the necessary adaptations required to reduce the spread of the virus and deliver frontline clinical care. Inevitably aspects of these changes have disrupted the delivery of medical education, notably clinical placements have been cancelled and social distancing guidelines prohibit face-to-face teaching. The training of future doctors is an essential part of this effort. Indeed, the emergence of a global health threat has underlined its continued importance. For medical educators and students alike, we have been presented with a challenge. Concurrently, this presents us with an impetus and opportunity for innovation. For some time now, a transformation in medical education has been called for, with an increasing recognition of the need to prepare students for the changing landscape of healthcare systems. This has included a focus on the use of technology-enhanced and self-directed learning. As a team of educators and clinicians in psychiatry, working in the School of Medicine and Medical Sciences (SMMS) in University College Dublin (UCD), we will share how we have responded. We outline the adaptations made to our 'Psychiatry' module and consider the influence this may have on its future delivery. These changes were informed by direct student input.

Efficacy of an Online Blended Learning Curriculum to Improve Medical Student Urologic Education

OBJECTIVE

During the COVID-19 pandemic, limitations on in-person medical school clerkships created a deficit in urologic learning opportunities. We sought to develop and evaluate a blended curriculum of interactive online modules with small-group discussion to enhance the educational experience for medical students in urology.

MATERIALS AND METHODS

We created a curriculum of four online case-based urology modules. Between July and October 2020, 14 fourth-year medical students completed the modules. Students answered questions on a discussion board and engaged in asynchronous dialogue with 16 physicians, in addition to a weekly live review session. Students and physicians completed anonymous surveys to assess satisfaction and perceived learning outcomes, with questions scored on a 5-point Likert scale.

RESULTS

Thirteen students (93% response rate) and 12 physicians (75% response rate) completed the survey. Overall, 12/13 students and 11/12 physicians "strongly agree" or "somewhat agree" that the modules improved the rotation. Students and physicians perceived that the modules were effective for learning/teaching foundational knowledge (average ratings 4.8 and 4.5, respectively) and facilitating performance assessment (4.4 and 4.0). Students reported high learning scores across multiple Accreditation Council for Graduate Medical Education core competencies, and 12/13 students found the modules fun/engaging. The majority of students (12/13) and physicians (10/12) felt that the online modules should be incorporated into future urology electives.

CONCLUSIONS

A blended learning curriculum utilizing online modules is an effective tool for enhancing urologic education, improving perceived learning outcomes and facilitating performance assessment.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-021-01427-3.

[Digital teaching in pathology: experiences from Mainz]

BACKGROUND

Due to the corona pandemic, digital teaching has become especially important in education and has led to a restructuring of teaching, not only in the subject of surgical pathology.

OBJECTIVES

In this article, different forms of e‑learning are presented and illustrated using the example of teaching surgical pathology and neuropathology at the University Medical Center Mainz.

RESULTS

Before the onset of the corona pandemic in spring 2020, digitization had already assumed great importance for teaching in the technology- and method-oriented subject of surgical pathology. In particular, the possibility of virtual microscopy via scanned slides with a digital slide server has been used in many pathology institutes. Virtual microscopy often partially or completely replaced conventional microscopy of histologic slide collections. Complementary virtual learning offers are becoming more and more important. These include asynchronously provided lectures or macroscopy videos, video conferences, scripts and communication via learning platforms. In addition, electronic exams have become an indispensable part of teaching. Nevertheless, the corona pandemic revealed how important personal contact with students is to achieve optimal learning success; learning forms with a combination of face-to-face teaching and e‑learning in the sense of blended learning are of particular importance.

CONCLUSIONS

As part of blended learning, digital teaching is an ideal complement to face-to-face teaching and is changing teaching in the longer term, not only in the field of surgical pathology. Digital learning formats will remain in the future and will at least partially replace classroom formats such as lectures.

Undergraduate medical education amid COVID-19: a qualitative analysis of enablers and barriers to acquiring competencies in distant learning using focus groups

Due to comprehensive social distancing measures related to the COVID-19 pandemic, medical faculties worldwide have made a virtue of necessity in resorting to online teaching. Medical faculties grapple with how to convey clinical competencies to students in this context. There is a need for research not only to map but also to explain the effect of these secondary measures on students' learning and mental wellbeing. During a period of ongoing comprehensive social distancing measures in Germany, we translated a competency-based curriculum including obstetrics, paediatrics, and human genetics to an e-learning course based on online patient and teacher encounters. In our qualitative study on students' and teachers' views, we identify potential enablers and drivers as well as barriers and challenges to undergraduate medical education under lockdown. In summer 2020, we conducted six focus group interviews to investigate medical students' and teachers' perspectives, experiences and attitudes. All focus groups were videotaped, transcribed verbatim and coded. To guide our deductive and inductive analysis, we applied the theoretical framework of Regmi and Jones. Content analysis was performed in a multi-perspective group. We identified five major themes contributing to a successful use of clinical competency-based e-learning under lockdown: Communication (with teachers, students, and patients), Mental wellbeing, Structure and self-organization, Technical issues, and Learning and commitment. We discuss enablers and potential barriers within all themes and their overlap and link them in an explanatory model. In our setting, students and teachers find e-learning holds strong potential and especially in times of COVID-19 it is greatly appreciated. We broaden the understanding of the impact of distant learning on acquiring competencies, on attitudes, and on mental wellbeing. Our model may serve for a thoughtful, necessary transition to future e-learning and hybrid programs for a competency-based medical education with ongoing social distancing measures.

Curiosity in Online Video Concept Learning and Short-Term Outcomes in Blended Medical Education

Background: A student's level of curiosity in a subject after learning about it through online videos has not been addressed well in the medical education field. The purpose of this study, therefore, was to investigate online learning's effect on the stimulation of curiosity and short-term learning outcomes in a blended framework of precision medical education.

Methods: A mixed-methods research design was used. During the 2020 academic year, all fifth-year medical students who, prior to class, viewed 6 video clips that presented 6 core concepts were invited to complete a survey and self-reflection on their learning process to assess their level of curiosity in each concept. For each group of medical students, teaching assistants helped collect anonymous survey data and summative assessment scores representing the students' learning outcomes. Video-viewing patterns, attained through an action log transformation, were also coded for analysis. Mann–Whitney U and Kruskal–Wallis tests were employed to compare differences between groups, and multiple linear regression was used to select the factors affecting learning outcomes. Qualitative data were content-coded through a descriptive approach using thematic analysis.

Results: Of 142 medical students, 136 watched the online videos, 124 responded to the questionnaires, and 92 provided comments. Students' curiosity levels after learning about each concept through online videos significantly correlated with the degree to which a concept was learned. Medical students spent a median of 1.6 h online, and pause frequency correlated with curiosity in certain concepts. Aroused curiosity was associated with short-term learning outcomes in inconsistent effect sizes and directions. Students' feedback revealed various dimensions of curiosity, including novelty acknowledgment, recognition of an information gap, and information-seeking requests.

Conclusions: Curiosity can be induced through online video learning platforms and has a role in short-term learning outcomes in medical education.

Global Workforce Development in Father Engagement Competencies for Family-Based Interventions Using an Online Training Program: A Mixed-Method Feasibility Study

Global access to practitioner training in the clinical engagement of fathers in family-based interventions is limited. The current study evaluated the feasibility of training practitioners in Canada and UK using online training developed in Australia by examining improvements in practitioner confidence and competence in father engagement, training satisfaction, qualitative feedback, and benchmarking results to those from an Australian sample. Practitioners were recruited to participate in a 2-h online training program through health services and charity organisations. The online program required practitioners to watch a video and complete self-reflection exercises in a digital workbook. Pre- and post-training measures were collected immediately before and after the online training program. The results indicated significantly large improvements in self-reported confidence and competence in engaging fathers following training, with levels of improvement similar to those found in Australia. Training satisfaction was high and qualitative feedback suggested providing local resources and increasing representation of social diversity could improve training relevance in local contexts. The findings suggest online training in father engagement can contribute to global workforce development in improving practitioners' skills in engaging fathers in family-based interventions.

Dangers and Benefits of Social Media on E-Professionalism of Health Care Professionals: Scoping Review

BACKGROUND

As we are witnessing the evolution of social media (SM) use worldwide among the general population, the popularity of SM has also been embraced by health care professionals (HCPs). In the context of SM evolution and exponential growth of users, this scoping review summarizes recent findings of the e-professionalism of HCPs.

OBJECTIVE

The purpose of this scoping review is to characterize the recent original peer-reviewed research studies published between November 1, 2014, to December 31, 2020, on e-professionalism of HCPs; to assess the quality of the methodologies and approaches used; to explore the impact of SM on e-professionalism of HCPs; to recognize the benefits and dangers of SM; and to provide insights to guide future research in this area.

METHODS

A search of the literature published from November 1, 2014, to December 31, 2020, was performed in January 2021 using 3 databases (PubMed, CINAHL, and Scopus). The searches were conducted using the following defined search terms: "professionalism" AND "social media" OR "social networks" OR "Internet" OR "Facebook" OR "Twitter" OR "Instagram" OR "TikTok." The search strategy was limited to studies published in English. This scoping review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines.

RESULTS

Of the 1632 retrieved papers, a total of 88 studies were finally included in this review. Overall, the quality of the studies was satisfactory. Participants in the reviewed studies were from diverse health care professions. Medical health professionals were involved in about three-quarters of the studies. Three key benefits of SM on e-professionalism of HCPs were identified: (1) professional networking and collaboration, (2) professional education and training, and (3) patient education and health promotion. For the selected studies, there were five recognized dangers of SM on e-professionalism of HCPs: (1) loosening accountability, (2) compromising confidentiality, (3) blurred professional boundaries, (4) depiction of unprofessional behavior, and (5) legal issues and disciplinary consequences. This scoping review also recognizes recommendations for changes in educational curricula regarding e-professionalism as opportunities for improvement and barriers that influence HCPs use of SM in the context of e-professionalism.

CONCLUSIONS

Findings in the reviewed studies indicate the existence of both benefits and dangers of SM on e-professionalism of HCPs. Even though there are some barriers recognized, this review has highlighted existing recommendations for including e-professionalism in the educational curricula of HCPs. Based on all evidence provided, this review provided new insights and guides for future research on this area. There is a clear need for robust research to investigate new emerging SM platforms, the efficiency of guidelines and educational interventions, and the specifics of each profession regarding their SM potential and use.

Teaching the Neurologic Examination: A Prospective Controlled Study to Compare a Blended Learning Approach With Face-to-Face Instruction

BACKGROUND AND OBJECTIVES

To compare a blended learning approach with traditional face-to-face instruction in terms of their individual effectiveness in imparting neurologic examination (NE) skills in medical students.

METHODS

We conducted a prospective controlled study of 4th-year medical students (n = 163) who were pseudorandomly distributed into 2 groups. Group A (n = 87) was subjected to a traditional teaching method comprising 2 face-to-face sessions. Group B (n = 76) underwent blended learning, which consisted of an individual preparation period using a course handbook and videoclips, plus a single face-to-face session. NE skill acquisition was assessed by an objective structured clinical examination (OSCE). Questionnaires were used for evaluation.

RESULTS

Comparison of mean OSCE scores in groups A vs B revealed that NE skill acquisition was better in group B (blended learning), with a moderate effect size, a smaller OSCE score variance, and fewer students performing poorly than in group A (face-to-face instruction). Student evaluation revealed that both teaching approaches were well accepted, but a higher level of satisfaction was associated with the blended learning approach. This method also provided more time for practice and feedback.

DISCUSSION

The blended learning approach is a highly efficacious and valued method for teaching NE skills. It offers instructors and faculty the advantage of successful skill acquisition in students despite the considerably reduced attendance time.

How do students perceive face-to-face/blended learning as a result of the Covid-19 pandemic?

The impact of Covid-19 has had a far reaching effect on higher education institutions. However, few studies report on the relative perceptions of students about face-to-face (F2F) and blended learning (BL) in periods when Covid-19 is/not a consideration. Using a sample of 103/79 undergraduate students, a mixed-method approach is utilized to report qualitative and quantitative evidence regarding student perceptions. The results demonstrate BL is perceived more positively during the Covid-19 pandemic. However, F2F is preferred to BL when Covid is not an issue. F2F learning is perceived more positively to BL because students feel that there are limitations to BL in terms of; interactions with the lecturer; group work; peer engagement; class involvement; and the ability to ask questions about technical information. Moreover, qualitative evidence shows that students perceive F2F to be superior to BL because social elements expected in a F2F environment may not be embedded into netiquette frameworks. From a policymaking standpoint, we encourage embedding social elements into BL to enhance student experience so that student's negative attitudes regarding the transition from F2F delivery to online/BL can be minimized. From a practical standpoint, we provide insights about strategies to embed socials elements into netiquette frameworks.

Evaluating the Efficacy of an Online Learning Tool for EEG Teaching: A Prospective Cohort Study

ObjectiveTo determine the effectiveness of a 6-month, interactive, multi-modal, web-based EEG teaching program (EEGonline) in improving EEG analysis and interpretation skills for neurologists, neurology residents and technologists, particularly in resource-limited settings.MethodsBetween June 2017 and November 2018, 179 learners originating from 20 African countries, Europe and USA were registered on the EEGonline course. Of these, 128 learners (91% African) participated in the study. Pre- and post-course multiple-choice-question (MCQ) test results and EEGonline user logs were analyzed. Differences in pre- and post-test performance were correlated with quantified exposure to various EEGonline learning modalities. Participants' impressions of EEGonline efficacy and usefulness were assessed through pre- and post-course satisfaction surveys.ResultsNinety-one participants attempted both pre- and post-course tests (71% response rate). Mean scores improved from 46.7% ±17.6% to 64.1% ±18% respectively (p<0.001, Cohen's d 0.974). The largest improvement was in correct identification of normal features (43.2% to 59.1%, p<0.001, Cohen's d 0.664) and artifacts (43.3% to 61.6%, p<0.001, Cohen's d 0.836). Improvement in knowledge was associated with improved subjective confidence in EEG analysis. Overall confidence among post-course survey respondents improved significantly from 35.9% to 81.9% (p<0.001). Lecture notes, self-assessment quizzes and discussion forums were the most utilised learning modalities. The majority of survey respondents (97.2%) concluded that EEGonline was a useful learning tool and 93% recommended that similar courses should be included in EEG training curricula.ConclusionsThis study demonstrated that a multi-modal, online EEG teaching tool was effective in improving EEG analysis and interpretation skills and may be useful in resource-poor settings.

A Systematic Review of Systematic Reviews on Blended Learning: Trends, Gaps and Future Directions

Blended Learning (BL) is one of the most used methods in education to promote active learning and enhance students' learning outcomes. Although BL has existed for over a decade, there are still several challenges associated with it. For instance, the teachers' and students' individual differences, such as their behaviors and attitudes, might impact their adoption of BL. These challenges are further exacerbated by the COVID-19 pandemic, as schools and universities had to combine both online and offline courses to keep up with health regulations. This study conducts a systematic review of systematic reviews on BL, based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, to identify BL trends, gaps and future directions. The obtained findings highlight that BL was mostly investigated in higher education and targeted students in the first place. Additionally, most of the BL research is coming from developed countries, calling for cross-collaborations to facilitate BL adoption in developing countries in particular. Furthermore, a lack of ICT skills and infrastructure are the most encountered challenges by teachers, students and institutions. The findings of this study can create a roadmap to facilitate the adoption of BL. The findings of this study could facilitate the design and adoption of BL which is one of the possible solutions to face major health challenges, such as the COVID-19 pandemic.

Online learning during the Covid-19 pandemic: the experiences and perceptions of undergraduate occupational therapy students at two Australian universities

Purpose

To investigate if first-year occupational therapy students who have had no on-campus, face-to-face learning experiences differed from second-, third- and fourth-year students in their perceptions and experiences of online learning during the Covid-19 pandemic.

Methods

One hundred and fifty-one occupational therapy undergraduate students (80.8% female; 66.2% 20–24 old) completed the Student Engagement in the e-Learning Environment Scale (SELES) and the Distance Education Learning Environment Scale (DELES). Analysis of variance (ANOVA) with bootstrapping was completed to examine the differences between first-year and senior students’ perceptions and experiences of online learning.

Results

Significant differences were observed across several SELES and DELES scales: peer collaboration (SELES) (p = .001), interactions with instructors (SELES) (p = .026), student interaction and collaboration (DELES) (p = .003), authentic learning (DELES) (p = .026) and active learning (DELES) (p = .013).

Conclusion

The findings demonstrate significant differences in first-year and senior students’ perceptions and experiences of online learning during the Covid-19 pandemic. The outcomes highlight the importance of facilitating collaborative and active engagement for all students by implementing academic, technological and social support measures within occupational therapy curricula.

Online anatomy team-based learning using blackboard collaborate platform during COVID-19 pandemic

During the COVID‐19 pandemic, many educational institutions followed the blended learning system. Using the participants' opinions, we evaluated the Blackboard (Bb) collaborate platform for online team‐based learning (TBL) sessions for undergraduate students from different medical programs in the KSA. The participants were students on the MBBS Program (157 year two and 149 year three), together with 53 students in year one of the Nursing Program, 25 in year two of the Doctor of Pharmacy Program, and 11 in year two of the Medical Laboratory Sciences Program in Fakeeh College for Medical Sciences, (FCMS) KSA. To assess students' recall, engagement, and satisfaction with the sessions, an online TBL plan was designed and reviewed by the Medical Education Department. The students completed an online survey at the end of each session. All responses in this study showed a statistically significant positive difference from the neutral mid‐point response (p < 0.05), reflecting high satisfaction. In the MBBS Program, the survey was completed by 40 students in year two and 76 in year three. The mean responses were 4.1 ± 0.3 and 3.9 ± 0.2 respectively (mean ± SD). In the BSN Program, 19 students completed the survey. The mean response was 4.6 ± 0.2. In the Pharm D Program, 10 students completed the survey. The mean response was 4.9 ± 0.12. In the MLS Program, eight students completed the survey. The mean response was 4.8 ± 0.12. It was concluded that online TBL using Bb collaborate is a successful anatomy‐learning tool among FCMS students on different programs.

Social Media Improves Students' Academic Performance: Exploring the Role of Social Media Adoption in the Open Learning Environment among International Medical Students in China

Numerous studies have examined the role of social media as an open-learning (OL) tool in the field of education, but the empirical evidence necessary to validate such OL tools is scant, specifically in terms of student academic performance (AP). In today’s digital age, social media platforms are most popular among the student community, and they provide opportunities for OL where they can easily communicate, interact, and collaborate with each other. The authors of this study aimed to minimize the literature gap among student communities who adopt social media for OL, which has positive impacts on their AP in Chinese higher education. We adopted social constructivism theory (SCT) and the technology acceptance model (TAM) to formulate a conceptual framework. Primary data containing 233 questionnaires of international medical students in China were collected in January 2021 through the survey method. The gathered data were analyzed through structural equation modeling techniques with SmartPLS 3. The results revealed that perceived usefulness, perceived ease of use, and interactions with peers have positive and significant influence on OL. In addition, OL was found to have positive and significant influence on students’ AP and engagement. Lastly, engagement showed a positive impact on students’ AP. Thus, this study shows that social media serves as a dynamic tool to expedite the development of OL settings by encouraging collaboration, group discussion, and the exchange of ideas between students that reinforce their learning behavior and performance.

White Paper: Radiology Curriculum for Undergraduate Medical Education in Germany and Integration into the NKLM 2.0

OBJECTIVE

 The aim was to develop a new curriculum for radiology in medical studies, to reach a national consensus and to integrate it into the new national competence-based learning objectives catalog (NKLM 2.0). In this statement of the German Radiological Society (DRG), the process of curriculum development is described and the new curriculum is presented together with suggestions for practical implementation.

MATERIALS AND METHODS

 The DRG has developed a new curriculum for radiology. This was coordinated nationally among faculty via an online survey and the result was incorporated into the NKLM 2.0. Furthermore, possibilities for the practical implementation of the competency-based content are shown and different teaching concepts are presented.

RESULTS

 The developed curriculum is competency-based and aims to provide students with important skills and abilities for their future medical practice. The general part of the curriculum is divided into the topics "Radiation Protection", "Radiological Methods" and radiologically-relevant "Digital Skills". Furthermore, there is a special part on the individual organ systems and the specific diseases. In order to implement this in a resource-saving way, new innovative teaching concepts are needed that combine the advantages of face-to-face teaching in small groups for practical and case-based learning with digital teaching offers for resource-saving teaching of theoretical content.

CONCLUSION

 We have created a uniform radiology curriculum for medical studies in Germany, coordinated it nationally and integrated it into the NKLM 2.0. The curriculum forms the basis of a uniform mandatory radiology teaching and should be the basis for the individual curriculum development of each faculty and strengthen the position of radiology in the interdisciplinary context.

KEY POINTS

  · A radiology curriculum for undergraduate medical education was developed.. · The curriculum was brought into agreement among the faculties in Germany and integrated into the NKLM 2.0.. · This curriculum is intended to be the basis for curriculum development and to strengthen the position of radiology.. · In order to implement the competence-based teaching, new innovative teaching concepts are necessary..

CITATION FORMAT

· Dettmer S, Barkhausen J, Volmer E et al. White Paper: Radiology Curriculum for Undergraduate Medical Education in Germany and Integration into the NKLM 2.0. Fortschr Röntgenstr 2021; 193: 1294 - 1303.

How COVID-19 kick-started online learning in medical education-The DigiMed study

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic led to far-reaching restrictions of social and professional life, affecting societies all over the world. To contain the virus, medical schools had to restructure their curriculum by switching to online learning. However, only few medical schools had implemented such novel learning concepts. We aimed to evaluate students' attitudes to online learning to provide a broad scientific basis to guide future development of medical education.

METHODS

Overall, 3286 medical students from 12 different countries participated in this cross-sectional, web-based study investigating various aspects of online learning in medical education. On a 7-point Likert scale, participants rated the online learning situation during the pandemic at their medical schools, technical and social aspects, and the current and future role of online learning in medical education.

RESULTS

The majority of medical schools managed the rapid switch to online learning (78%) and most students were satisfied with the quantity (67%) and quality (62%) of the courses. Online learning provided greater flexibility (84%) and led to unchanged or even higher attendance of courses (70%). Possible downsides included motivational problems (42%), insufficient possibilities for interaction with fellow students (67%) and thus the risk of social isolation (64%). The vast majority felt comfortable using the software solutions (80%). Most were convinced that medical education lags behind current capabilities regarding online learning (78%) and estimated the proportion of online learning before the pandemic at only 14%. In order to improve the current curriculum, they wish for a more balanced ratio with at least 40% of online teaching compared to on-site teaching.

CONCLUSION

This study demonstrates the positive attitude of medical students towards online learning. Furthermore, it reveals a considerable discrepancy between what students demand and what the curriculum offers. Thus, the COVID-19 pandemic might be the long-awaited catalyst for a new "online era" in medical education.

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

Background

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

Aim

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

Study design

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

Methods

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

Results

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

Conclusions

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

Relevance to clinical practice

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

The impact of the COVID-19 pandemic on undergraduate and graduate dental courses in Brazil

BACKGROUND

The COVID-19 pandemic has raised challenges in adapting to teaching and learning methods in dental education.

OBJECTIVE

This study aimed to evaluate the impact of the COVID-19 pandemic on the academic activities of undergraduate (UDG) and graduate (GD) dental students in Brazil. Additionally, students' perceptions and attitudes toward teaching activities during this period were analyzed.

METHODS

A nationwide cross-sectional survey was conducted with a sample of Brazilian UDG and GD dentistry students. Data were collected in 2020 through an online, self-administered, and anonymous questionnaire, which comprised 26 questions related to demographic data, activities of the college, family and individual student income, and attitudes and perceptions about e-learning during the pandemic. The data were tabulated and analyzed using descriptive statistics.

RESULTS

The sample included 1,166 students (779 UDG and 387 GD). Among these, 425 (54.6%) UDG and 270 (69.8%) GD students remotely participated in teaching activities, of which 42.6% of the UDG considered their performance in e-learning to be bad or very bad and 49.8% of the GD regarded it as good or excellent. The survey also showed that 354 (45.4%) UDG and 102 (26.4%) GD expressed a desire to discontinue the course following the outbreak of the pandemic. Among the GD, 225 (58.4%) said that their experiments were completely interrupted.

CONCLUSIONS

This study reveals the poor perception and performance of dental students regarding e-learning. Additionally, the findings suggest a negative impact of the pandemic on dental education in Brazil. Effective measures should be taken to mitigate these significant consequences.

Effectiveness of blended learning in pharmacy education: An experimental study using clinical research modules

BACKGROUND &OBJECTIVES

Though there are studies to evaluate the effectiveness of blended learning in pharmacy education, most of them originate from USA and have used previous year students' scores as control. Also there is less research in comparing use of self -regulated learning strategies between blended and other learning strategies. Primary aim was to evaluate the effectiveness of blended learning on knowledge score using clinical research modules. Secondary objective was designed to compare the use of self-regulated learning strategies between blended learning, web-based e-learning and didactic teaching.

MATERIALS AND METHODS

A prospective cluster randomized trial was conducted with didactic teaching as control and web-based e-learning and blended learning as interventions. The target population was final year Pharm D students. Outcome was assessed using a validated knowledge questionnaire, a motivated strategies for learning questionnaire and a feedback form. All statistical analyses were carried out using Statistical Package for Social Science (SPSS) Version 20.

RESULTS

A total of 241 students from 12 colleges completed the study. Mean knowledge score of students in blended learning group was higher than those in the didactic teaching and web- based e- learning program (64.26±18.19 Vs 56.65±8.73 Vs 52.11±22.06,p<0.001).Frequency of use of learning strategies namely rehearsal, elaboration, organization and critical thinking was statistically significantly higher in the blended learning group compared to those of didactic and web-based e-learning group (p<0.05) But there were no statistically significant difference of motivational orientations between didactic and blended learning group except strategies of extrinsic goal orientation and self-efficacy. Students preferred blended learning (86.5%) over didactic and web-based e-learning.

CONCLUSION

Blended learning approach is an effective way to teach clinical research module. Students of blended learning group employed all motivational and learning strategies more often than students of the didactic and web- based e-learning groups except strategies of intrinsic goal orientation, task value, control of learning belief and help seeking.

E- Learning experience of the medical profession's college students during COVID-19 pandemic in Saudi Arabia

BACKGROUND

Worldwide, most of educational institutions have moved to online electronic learning methods because of the COVID-19 pandemic. On March 8, 2020, the Saudi Ministry of Education announced remote learning for public and private schools and universities as a preventive and precautionary measure to curb the spread of the coronavirus. The objective of this study was to explore the e-learning experience of the students of the colleges of health sciences with regard to the technical preparedness, academic achievements, e-learning advantages and limitations. A well-structured and validated questionnaire on a five-point Likert scale and open-ended questions about their e-learning experience was distributed to a heterogeneous purposive sample of the health sciences students in Saudi Arabian universities.

RESULTS

Of the 1288 respondents, of various demographical features a relatively higher proportion of 58.2 % agreed that they had enough information about the online learning. However, the proportion who reported receiving adequate guidance, technical support, and having satisfactory hardware and internet access to online learning were 48.1 %, 42, and 35.4 %, respectively. Of all participants, 40.8 % agreed that they had gained a good understanding of their courses learning outcomes. Only 30.0 % agreed that the quality of the online teaching was similar to traditional classes and 56.1 % agreed that the online learning is unsuitable for the medical sciences studies. E-learning advantages mentioned were the flexible accessibility of the learning materials, time, effort, and money saving, acquiring and improving technical and self-learning skills, health safety, interaction without shyness, and better academic accomplishment. On the other hand, disadvantages and difficulties included inadequate tools to facilitate online learning, poor internet connection, lack of technological skills by the educators and students. In addition, there was inadequate or lack of practical classes, lack of a unified clear policy for the conduct of online classes and exams and grade distribution, limited online exam time.

CONCLUSIONS

The sudden shift to e-learning without prior preparedness has revealed some pitfalls that need to be adjusted. The initial findings were considered satisfactory for such a new experience for both learners and students. However, there is a great chance for improving and expanding the e-learning process.

Impact of the COVID-19 pandemic on teaching and learning in health professional education: a mixed methods study protocol

BACKGROUND

Due to the complex nature of healthcare professionals' roles and responsibilities, the education of this workforce is multifaceted and challenging. It relies on various sources of learning from teachers, peers, patients and may focus on Work Integrated Learning (WIL). The COVID-19 pandemic has impacted many of these learning opportunities especially those in large groups or involving in person interaction with peers and patients. Much of the curriculum has been adapted to an online format, the long-term consequence of which is yet to be recognized. The changed format is likely to impact learning pedagogy effecting both students and teachers. This requires a systematic approach to evaluation of online teaching and learning adaptation, in comparison to the previous format, where, in person education may have been the focus.

METHODS

The proposed study is a broad based evaluation of health professional education in a major Australian University. The protocol describes a mixed methods convergent design to evaluate the impact of online education on students and teachers in health professional courses including Medicine, Nursing, Allied Health and Biomedical Science. A framework, developed at the university, using Contribution Analysis (CA), will guide the evaluation. Quantitative data relating to student performance, student evaluation of units, quantity of teaching activities and resource utilization will be collected and subjected to relevant statistical analysis. Data will be collected through surveys (500 students and 100 teachers), focus groups (10 groups of students) and interviews of students and teachers (50 students beyond graduation and 25 teachers, for long term follow up to 12 months). Application of CA will be used to answer the key research questions on the short term and long-term impact of online education on teaching and learning approaches.

DISCUSSION

The protocol describes the study, which will be widely implemented over the various courses in Health Professional Education and Biomedical Science. It will evaluate how students and teachers engage with the online delivery of the curriculum, student performance, and resources used to implement these changes. It also aims to evaluate longitudinal outcome of student learning attributes and impact on graduate outcomes, which is poorly reported in educational literature.

The Effectiveness of Different E-Learning Modalities in Enhancing Neonatal Cardiopulmonary Resuscitation: Principles, Knowledge, and Communication Skills of Undergraduate Paramedic Students

INTRODUCTION

Paramedic students should have the crucial cognitive and psychomotor skills related to neonatal cardiopulmonary resuscitation (N-CPR).

STUDY OBJECTIVE

The aim of this study was to evaluate the effect of blended learning on the theoretical knowledge and preliminary knowledge of the psychomotor skills, adherence to the algorithm, and teamwork in simulation-based education (SBE) of N-CPR.

METHODS

This randomized, prospective study was conducted on 60 fourth-semester paramedic students. The participants were separated into two groups following a classroom lecture. Each group was assigned either a slide presentation (Group 1; SP-G) or a video clip (Group 2; V-G). All the participants answered multiple-choice questions (MCQs) and each group (Group 1 and Group 2) was divided into 10 sub-groups. These sub-groups were then tested in an observational performance evaluation (OPE) consisting of a neonatal asphyxia megacode scenario, after the classroom lecture and following the blended learning process.

RESULTS

Group performance, teamwork, communication skills, and adherence to the algorithm were evaluated. There was a significant difference in the MCQ and OPE results between the after classroom lecture and after blended learning for both groups. The average score of Group 2 was higher than Group 1 in the MCQ results (Mann-Whitney U test; P <.001). The average score of Group 2 was higher than Group 1 in the OPE results (Mann-Whitney U test; P = .002).

CONCLUSION

Blended learning, especially video clips, in adjunction with the classroom lecture were effective in acquiring and developing both technical and non-technical skills among paramedic students in SBE of N-CPR training.

COVID-19 AND DENTAL DISTANCE-BASED EDUCATION: students' perceptions in an Italian University

BACKGROUND

The aim of the study was to analyze the perception of dental faculties students regarding the complete transition to distance-based education (DE) and the adaptation of this educational strategy, due to Covid-19 pandemic. A questionnaire to be completed anonymously was submitted online to students attending the faculties of Dentistry and Oral Hygiene at Sapienza, University of Rome, after the end of distance lessons. The collected data were processed statistically, providing descriptive data and analysis of correlation of the most significant parameters, using Chi-squared test, Cramér V and Pearson φ2, Goodman and Kruskal's γ and λ and Kendall's τb. The level of statistical significance was p < 0.05.

RESULTS

A total of 314 students participated in the survey. The overall level of satisfaction on a ten- point scale was 5.39 ± 2.59 for Oral Hygiene students and 6.15 ± 2.98 for Dentistry students. The most common complaints were the lack of a structured online curriculum, less interaction with professors and a lower level of attention. On the basis of the responses, scored using Likert-type Scale, oral Hygiene students reported statistically higher level of physical fatigue(p = 0.0189), a lower level of attention (p = 0.0136) and of the quality and quantity of acquired knowledge during distance education (p = 0.0392), compared to Dentistry students. Level of perceived stress and quality and quantity of acquired knowledge (γ = 0.81 and τb =0.56) and quality and quantity of acquired knowledge and fear of a decrease in knowledge (γ = 0.76 and τb =0.54) are associated variables.

CONCLUSION

Students' feedback is essential to solve the key issues emerged from the questionnaire. New educational models should be define in order to ensure that distance education could be effective, meeting the learning needs of the students, and could not be a merely "online shift" of traditional methods, used as an alternative of live education.

Online learning and teaching approaches used in midwifery programs: A scoping review

OBJECTIVE

The objective of this scoping review was to map and identify existing literature that described online learning and teaching approaches used in midwifery education.

DESIGN

An extensive search of multiple databases and gray literature was undertaken following the JBI standards, using predefined selection criteria and following the PRISMA guidelines.

METHODS

This scoping review included studies published in English between 2010 and 2020 that explored the online approaches to learning and teaching for undergraduate midwifery students. The articles were reviewed by three reviewers and content analysis was undertaken.

RESULTS

Twenty-seven articles were included in the review. Results suggest that student engagement is one of the main components of effective teaching in online midwifery education. Online learning resources need to engage the student and promote two-way communication that facilitates and motivates learning.

CONCLUSIONS

Adequate training and support for academic staff and students is essential for the online delivery of midwifery education.

Comparing the effects of teach-back method, multimedia and blended training on self-care and social support in patients with heart failure: A randomized clinical trial

BACKGROUND

The knowledge level of caregivers and their support for patients can affect the self-care of patients with heart failure (HF). The present study was conducted to compare the effects of teach-back, multimedia, and blended training methods on self-care and social support in patients with HF and on knowledge in their caregivers.

MATERIALS AND METHODS

In a randomized clinical trial, a total of 150 HF patient-caregiver dyads were randomly allocated into three equally sized training groups, using a simple number table (n = 50). The study was conducted between May to October 2018 in Sari, northern Iran. In the teach-back, multimedia and blended training groups, patient-caregiver dyads participated in 20-30-min training sessions held face-to-face, using digital video disc (DVD) and combination of teach-back and DVD on 4 consecutive days at the bedside of hospitalized patients in coronary care unit, respectively. Data were collected using the European Heart Failure Self-Care Behaviour Scale and the multidimensional scale of perceived social support for patients. Caregivers' level of knowledge was measured using the HF Knowledge Scale. Data were measured on the first day of hospitalization, 1 day before discharge and 4 and 8 weeks after patients' discharge. Data were analyzed using SPSS version 18 (SPSS Inc., Chicago, IL, USA).

RESULTS

All three educational methods improved self-care behaviors in patients. The comparison of self-care behavior scores in patients with HF among the three groups at different time points showed no statistically significant differences (P > 0.05), except 1 day before discharge (P = 0.04). There were no statistically-significant differences between the teach-back, multimedia and the blended training group in terms of perceived social support at any of the four-time points (P > 0.05). All three training methods improved the level of knowledge of caregivers. However, the score in the blended training groups was higher than the other groups (P < 0.001).

CONCLUSION

According to the results of the present study, it seems that all three educational interventions can improve self-care behaviors in HF patients and increase knowledge in their caregivers. However, using the blended training method was associated with better outcomes.

Longer-term effectiveness of eLearning and blended delivery of Mental Health First Aid training in the workplace: 2-Year follow-up of a randomised controlled trial

INTRODUCTION

Evidence relating to long-term outcomes of online education programs is largely lacking and head-to-head comparisons of different delivery formats are very rare. The aims of the study were to test whether eLearning Mental Health First Aid (MHFA) or blended training (eLearning plus face-to-face course delivery), implemented in an Australian public sector workplace, were more effective than a control intervention at 1-year and 2-year follow-up, and whether blended MHFA training was more effective than eLearning alone.

MATERIAL AND METHODS

Australian public servants (n = 608 at baseline) were randomly assigned to complete an eLearning MHFA course, a blended MHFA course or Red Cross eLearning Provide First Aid (PFA) (the control) and completed online questionnaires pre- and post-training and one and two years later (n = 289, n = 272, n = 243 at post, 1- and 2-year follow-up respectively). The questionnaires were based on vignettes describing a person with depression or post-traumatic stress disorder (PTSD). Primary outcomes were mental health first aid knowledge, desire for social distance and quality of support provided to a person in the workplace. Secondary outcomes were recognition of mental health problems, beliefs about treatment, helping intentions and confidence, personal stigma, quality of support provided to a person outside the workplace, self-reported professional help seeking and psychological distress.

RESULTS

At 1-year follow-up, both eLearning and blended courses produced greater improvements than PFA training in knowledge, confidence and intentions to help a person with depression or PTSD, beliefs about dangerousness and desire for social distance. At 2-year follow-up, some of these improvements were maintained, particularly those relating to knowledge and intentions to help someone with PTSD. When eLearning and blended courses were compared at 1-year follow-up, the blended course led to greater improvements in knowledge and in confidence and intentions to help a person with depression. At 2-year follow-up, improvements in the quality of help provided to a person with a mental health problem outside the workplace were greater in participants in the blended course.

CONCLUSIONS

Both blended and eLearning MHFA courses led to significant longer-term improvements in knowledge, attitudes and intentions to help a person with a mental health problem. Blended MHFA training led to an improvement in the quality of helping behaviours and appears to be more effective than online training alone.Trial registrationACTRN12614000623695 registered on 13/06/2014 (prospectively registered).Trial registry record url: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366410&isReview=true.

Effective Large Group Teaching for General Surgery

Large group settings display no signs of disappearing. Most surgeons charged with this education have received no formal training. Lecturing remains the most common method of educating large groups. Even though factors required for an excellent lecture are known, their inconsistent application results in variation of effectiveness. Long-standing principles of rhetoric and recent advances in neuroscience, cognitive science, learning models, and teaching theory play a role in achieving effectiveness. This article makes recommendations for creating and delivering lectures, including active learning opportunities and modern innovations in information technology supporting teaching methods. Effective lecturing skills are acquired by persistent deliberate practice.

Integration of a new classification scheme for periodontal and peri-implant diseases through blended learning

PURPOSE

In recent years, dental education has experienced a general shift toward an increased technology presence in education delivery and learning. This research examines the student-perceived efficacy of a blended learning approach (mixture of online content and face-to-face instruction) in a predoctoral periodontics curriculum to teach a new periodontal classification scheme to dental students in clinical training.

METHODS

Participants were recruited from third- and fourth-year predoctoral periodontal classes at the University of Washington School of Dentistry. Students were administered a live lecture introducing the new classification system and given access to an online module with built in case quizzes and interactive activities. Upon completing the module, students were given a post-module survey to assess learning preferences, utilization of various learning methods, and student-perceived efficacy of blended learning.

RESULTS

In a study group of 69 predoctoral dental students, the online module was the most preferred (52.2% ranked first) and utilized learning method for students (p < 0.001). Over 80% of students agreed or strongly agreed that they enjoyed using it and found it more effective than traditional lecture alone. Traditional lecture was preferred by 31.9% of students, and no students ranked the assigned reading as their first choice of learning method (p < 0.001).

CONCLUSIONS

Our findings demonstrate higher student preference, utilization, and self-perceived efficacy of blended learning as compared to traditional assigned readings and lectures - supporting blended learning as a promising educational approach for predoctoral dental education.

Training General Practitioners and Medical Assistants Within the Framework of HoPES3, a Holistic Care Program for Elderly Patients to Integrate Spiritual Needs, Social Activity, and Self-Care into Disease Management in Primary Care

Background

This study presents a concept for training general practitioners (GPs) in taking a spiritual history. In the same workshop, medical assistants (MAs) were trained in counselling elderly, chronically ill patients on social activities and home remedies. After the training, GPs and MAs will apply the acquired skills in their practices within the scope of the HoPES3 intervention study, which aims at raising patients’ self-efficacy.

Methods

Sixteen GPs and 18 MAs were trained in a 5-hour workshop and completed an evaluation questionnaire.

Results

All participants reported great satisfaction. In particular, 85% of GPs (n=11) affirmed increased capacity to address patients’ spiritual needs. About 88% (n=15) of MAs were satisfied with the training, yet expressed difficulties in integrating theoretical knowledge into daily professional routine.

Discussion

While the evaluation of the workshop is promising, the results of the randomized-controlled trial evaluating the effectiveness of the complete HoPES3 intervention have to be awaited.

Conclusion

To our knowledge, this is the first interdisciplinary, holistic care training in primary care in Germany. It fosters GPs’ and MAs’ competency in providing a proactive support in spirituality, social activities, and home remedies to their patients. If the concept proves to be effective, it could be integrated into existing care models and curriculums and provide clear guidance on how to consider elderly patients’ spiritual needs and strengthen their self-efficacy in primary care settings.

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Process evaluation of a programme to empower community nurse leadership

Background

The Nurses in the Lead (NitL) programme consists of a systematic approach and training to 1) empower community nurses in implementing evidence, targeted at encouraging functional activities of older adults, and 2) train community nurses in enabling team members to change their practice. This article aims to describe the process evaluation of NitL.

Methods

A mixed-methods formative process evaluation with a predominantly qualitative approach was conducted. Qualitative data were collected by interviews with community nurses (n = 7), focus groups with team members (n = 31), and reviewing seven implementation plans and 28 patient records. Quantitative data were collected among community nurses and team members (N = 90) using a questionnaire to assess barriers in encouraging functional activities and attendance lists. Data analysis was carried out through descriptive statistics and content analysis.

Results

NitL was largely executed according to plan. Points of attention were the use and value of the background theory within the training, completion of implementation plans, and reporting in patient records by community nurses. Inhibiting factors for showing leadership and encouraging functional activities were a lack of time and a high complexity of care; facilitating factors were structure and clear communication within teams. Nurses considered the systematic approach useful and the training educational for their role. Most team members considered NitL practical and were satisfied with the coaching provided by community nurses. To optimise NitL, community nurses recommended providing the training first and extending the training. The team members recommended continuing clinical lessons, which were an implementation strategy from the community nurses.

Conclusions

NitL was largely executed as planned, and appears worthy of further application in community care practice. However, adaptations are recommended to make NitL more promising in practice in empowering community nurse leadership in implementing evidence.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00650-y.

Gaining insight into the implementation of an e-learning smoking cessation course in Latin American countries

Continuous medical education focused on health problems emerging in low- and middle-income countries (LMICs) is scarce. Although tobacco consumption is increasing in LMICs, there is a lack of tobacco cessation training programs in these countries. To promote smoking cessation interventions in Bolivia, Guatemala and Paraguay, we adapted an e-learning program developed in Catalonia (Spain). This process evaluation study reports on reach, dose and satisfaction of participants with the course, as well as the contextual factors of its application. We conducted a multiple method evaluation, which included a survey and several focus groups, each one specific to the same type of healthcare professional (nurses, doctors, other professionals). Two hundred and ninety-two participants registered into the online course. The motivation for undertaking the course was different between doctors and nurses. The main sources of difficulty in enrolling and finishing the course were the technical problems experienced when accessing the platform, and lack of acquaintance with computers and the Internet in general. Our results show that implementing e-learning education in hospitals from LMICs is feasible, especially when there are similarities between participating countries and the country in which the original program was developed. However, several elements such as strong organizational commitment, technical support and resources and adequate communication channels should be provided to facilitate enrollment and training completion. Efforts to improve Internet access should be made to avoid jeopardizing students' motivation to enroll and complete online training.