Flipped classroom improves student learning in health professions education: a meta-analysis

The educational value of thyroidectomy YouTube videos for surgical trainees

OBJECTIVE

To evaluate the usefulness of thyroidectomy videos posted on YouTube for surgical training.

METHODS

The following keywords were searched on YouTube: "thyroidectomy", "conventional thyroidectomy", "hemithyroidectomy", and "thyroid lobectomy". The first 30 videos from each search were selected for a total of 120 videos. Included videos were those displaying a conventional approach to thyroidectomy and real, non-animated patient surgery. Two independent reviewers assessed each video using the LAParoscopic surgery Video Educational Guidelines (LAP-VEGaS) and a thyroidectomy-specific grading score (TSS).

RESULTS

The search yielded 22 videos that met the selection criteria. The inter-rater agreement was excellent for the grading systems (ICC = 0.910). The average LAP-VEGaS score was of medium quality (8.82 ± 3.56 standard deviation (SD)). The highest average score (11.00 ± 1.68 SD) was assigned to videos published from academic institutions. There was no statistically significant difference in LAP-VEGaS scores when comparing the type of publisher between videos (p = 0.132). The majority of the videos (12/22, 55 %) did not include all hallmarks of thyroidectomy according to the novel TSS score. There was a significant positive correlation between TSS markers and the overall LAP-VEGaS score (r = 0.577, p = 0.005).

CONCLUSION

YouTube videos as an educational resource for thyroidectomy instructions vary in quality. Most of the thyroidectomy videos were medium quality according to the LAP-VEGaS score. YouTube sourced thyroidectomy videos should be used to supplement traditional educational methods.

Technology-enhanced learning interventions on skin of colour dermatology for dermatology trainees and fellows: are they effective or sustainable?

Recent shifts towards synchronous online learning and raised awareness of ethnic inequalities in health have resulted in the establishment of frequent 'one-off' technology-enhanced learning (TEL) initiatives on diversity issues. There is little established evidence regarding the efficacy or sustainability of such interventions. We designed a prospective cohort pilot study including 14 dermatology registrars and fellows and delivered a TEL programme focusing on central centrifugal cicatricial alopecia and keloid scarring. Information was collected on the existing competence and confidence of our cohort about managing these conditions, as well as the short-term and long-term impact of our intervention. Following our programme, participant knowledge improved transiently, but was not sustainable 6 weeks later. Over half of participants were not confident in adopting newly acquired knowledge on skin of colour into practice. Results demonstrate a disparity between how effective one-off education initiatives are perceived vs. actual benefit. More systemic solutions may be warranted.

Self-Confidence, Satisfaction, and Knowledge of Nursing Students with Training in Basic Life Support in Pregnant Women: A Cross-Sectional Study

Background: A flipped classroom integrating clinical simulation has been shown to be effective for basic life support (BLS) competencies in nursing students. Cardiopulmonary arrests (CPAs) in pregnant women have a low incidence but high morbidity and mortality. Current trends show an increasing incidence; however, most official university nursing training curricula do not include specific training modules for BLS in pregnant women. This study aims to know the satisfaction and self-confidence of nursing students with respect to a training intervention regarding in BLS in pregnant women. Additionally, it aims to assess the adequacy of this intervention for acquiring the necessary knowledge on the subject. Methods: A cross-sectional study was conducted at the University of Jaen in 2022. Data were collected on sociodemographic factors, previous contact with the topic, and topic knowledge in addition to the use of an SCLS questionnaire to measure satisfaction. Participants took the BLS training (a flipped classroom integrating clinical simulation on this topic) before answering the questionnaire. Results: A total of 136 students participated. The mean score on the BLS questionnaire was 9.10 out of 10 (SD = 1.01). The mean score for the SCLS questionnaire for females was 62.36 (SD = 7.70) and 56.23 (SD = 16.94) for the male group. Age showed a statistically significant association with SCLS score: the score decreased with an increase in age (p < 0.001). Conclusions: The flipped classroom, integrating simulation for BLS in pregnant women, improves self-confidence, satisfaction, and knowledge on the topic.

[Use of Video Online Seminars During Clinical Phase of Medical Study from the Perspective of Teachers and Students]

AIM OF THE STUDY

The aim of this study was to investigate the opportunities and challenges of using video online seminars (VOS) in the clinical phase of medical studies from the perspective of teachers and students.

METHODOLOGY

Teachers and medical students from the 5th to the 10th semester completed questionnaires about their attitudes towards and experiences with VOS. Recommended procedures for VOS were derived from the results.

RESULTS

A total of 19 teachers and 108 students participated in this study; 67% of students found VOS helpful in the clinical phase of the degree course. Cognitive learning objectives (91% agreement) should be taught more often in the VOS format than affective learning objectives (71% agreement). However, 83% stated that VOS did not prepare them for future practical activities. Teachers indicated that cognitive (77% agreement) could be significantly better communicated than affective learning objectives (only 27% agreement). For two-thirds of the teachers, support or trainings were important. Good technical conditions were important for both groups.

DISCUSSION/CONCLUSIONS

The study shows the option of individual learning regardless of location to be an advantage of VOS. A teaching format is considered to be particularly useful if successful interaction between teacher and student takes place. In the context of blended learning concepts with preceding lectures and subsequent practical exercises, the learning success of VOS is greatest. Cognitive and some affective learning objectives can be achieved by this method. VOS can prepare for practical exercises, but they are not suitable in medical education for comprehensive teaching of practical learning objectives.

Students' perception of asynchronous versus synchronous distance learning during COVID-19 pandemic in a medical college, southwestern region of Saudi Arabia

BACKGROUND

COVID-19 preventive measures required a drastic shift to online teaching-learning in most of countries. Institutions used different combinations of live online lectures (synchronous) requiring students to attend the class in real-time, as well as recorded lectures uploaded by the instructors to be accessed by students as per their own convenience (asynchronous). We undertook this study to assess and compare the perceptions of students regarding their learning experiences in the synchronous versus asynchronous mode of instruction using  their teaching-learning during the compulsory online mode of instruction at the peak of the COVID-19 pandemic.

METHODOLOGY

This cross-sectional questionnaire-based study received responses from 122 final-year medical students studying at the College of Medicine, King Khalid University, Abha, Saudi Arabia. An online 5-point Likert scale-based questionnaire was used to collect data regarding experience and perception towards synchronous and asynchronous learning. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. A P-value less than 0.05 was considered significant.

RESULT

All the students found both synchronous and asynchronous learning to be equally satisfying, enjoyable and comfortable. No statistically significant difference was found when both the methods were analyzed for enhancement of knowledge. The students opined that asynchronous learning helped them manage their time better whereas synchronous learning encouraged more interaction during the live lectures.

CONCLUSION

Overall, the students' perceptions regarding both synchronous and asynchronous online learning were positive. As both methods have their advantages/limitations, a mix of both synchronous and asynchronous methods may be adopted depending upon the content of the topic and the desired learning outcomes.

Semi-flipped classroom-based learning interventions in a traditional curriculum of oral medicine: students' perceptions and teaching achievements

BACKGROUND

In recent years, flipped classes have emerged and become popular in college medical education. However, due to the huge medical learning system and the limited pre-class study time of students, it is difficult to implement in all courses. And then we adopted the semi-flipped classes (SFCs) to evaluate its teaching effect. This study analysed three educational methods that can be used in oral medicine courses: online education, offline education, and semi-flipped classes.

METHODS

We used two surveys to evaluate the three educational methods. In the first survey 46 teachers and 238 undergraduates shared their experience of the live-streaming and traditional offline courses offered in the different oral medicine curricula; we used anonymous questionnaires to evaluate their class experience. In the second survey 94 students shared their experience of the semi-flipped and traditional classrooms. Students who attended the SFCs in the experimental group learned about the oral mucosa disease by themselves using an online video course and then participated in offline interaction with teachers. The evaluation of the above educational methods was conducted using the anonymous questionnaires and final exam assessment.

RESULTS

According to the first survey, teachers and students both agreed that the overall teaching experience and learning effectiveness in offline education are superior to those in online education. According to the second survey, students who participated in the SFCs performed better in the final exam than those who participated in the simple offline classes. Additionally, the survey showed that the new teaching method helped students gain more knowledge and positively influenced their clinical practice.

CONCLUSIONS

Compared with the online and offline educational methods, the SFC showed better results in both the questionnaire and final exam assessment. Hence, the effectiveness of medical education can be improved by adopting a teaching mode that combines online and offline teaching methods. Scientific and logical SFCs designs, along with their effective implementation, would eventually make SFCs an important tool for medical education.

Challenges regarding digital distance learning of operationally- oriented professions, due to Covid-19 pandemic

The focus on challenges related to digital distance learning has become particularly relevant since educational institutions had to close due to the Covid-19 pandemic. Teaching related to operationally oriented professions, such as e.g., aviation and nautical represent educations that have faced extensive challenges. Education portfolios for such professions contain subjects that require transfer of competence based on experiential-based learning leading to in-demand knowledge, skills, attitudes, and sustainable understanding. Such operative-oriented competence is difficult to acquire through exclusively digital distance learning. This paper highlights challenges related to the operationally oriented topics of maritime education and training (MET). Traditionally, operationally oriented learning associated to MET has been carried out based on "on-scene" transfer of experience i.e., inexperienced sailors have gained experience by being guided by experienced sailors. Modern MET has evolved towards more passive "off-scene" learning activities. As a replacement for reduced "on-scene" learning activities, modern simulator and laboratory-based learning platforms have been developed within maritime and other operationally oriented educations. Learning platforms like these are probably the most challenging to find digital distance teaching substitutes for, regarding the Covid-19 pandemic closure. The purpose of this paper is to show whether the rapid change of learning context due to the pandemic closure affected the instant knowledge displayed in exam grades. In addition, the paper addresses possible challenges related to the loss of experience-oriented simulator and laboratory-based teaching activities, due to the pandemic closure.

AUR Radiology Resident Core Curriculum Lecture Series - A Model for Multi-Society Collaborative Virtual Education

To fulfill ACGME requirements, radiology residency programs are required to provide an educational experience that includes a core didactic curriculum for each subspecialty. Although developing and delivering such a core curriculum may not present a problem for large academic programs, it can present a significant challenge for smaller programs with limited faculty in each subspecialty area. Success of the core curriculum lectures series developed for cardiothoracic radiology by the Society of Thoracic Radiology and for musculoskeletal radiology by the International Skeletal Society in collaboration with the Society for Skeletal Radiology prompted the idea of creating a comprehensive core curriculum lecture series encompassing all subspecialties. This paper aims to describe the multi-society collaborative effort entailed in building a curated, on line resident focused core curriculum lecture series detailing the barriers encountered, effects of the COVID-19 pandemic and impact of the finished project.

Design and Transition of an Emergency E-Learning Pathology Course for Medical Students-Evaluation of a Novel Course Concept

BACKGROUND

Around the world, the emergency brought about by the COVID-19 pandemic forced medical schools to create numerous e-learning supplements to provide instruction during this crisis. The question now is to determine a way in which to capitalize on this momentum of digitization and harness the medical e-learning content created for the future. We have analyzed the transition of a pathology course to an emergency remote education online course and, in the second step, applied a flipped classroom approach including research skills training.

METHODS

In the summer semester of 2020, the pathology course at the Technical University of Munich was completely converted to an asynchronous online course. Its content was adapted in winter 2021 and incorporated into a flipped classroom concept in which research skills were taught at the same time.

RESULTS

Screencasts and lecture recordings were the most popular asynchronous teaching formats. Students reported developing a higher interest in pathology and research through group work. The amount of content was very challenging for some students.

CONCLUSION

Flipped classroom formats are a viable option when using pre-existing content. We recommend checking such content for technical and didactic quality and optimizing it if necessary. Content on research skills can be combined very well with clinical teaching content.

Digital learning designs in occupational therapy education: a scoping review

BACKGROUND

Digital learning is a rapidly advancing method for teaching and learning in professional health education. Although various digital learning designs have been tried in OT education, studies on digital learning designs are still limited.

METHODS

We conducted a scoping study that aimed to identify the digital learning designs used in occupational therapy (OT) education and review the effectiveness, learner perceptions, clinical skills integrated, and technology-based learning strategies used to facilitate learning. Four databases were searched using subheadings and terms relating to digital learning, occupational therapy, and education. The included studies were mapped according to the types of digital learning design, subjects, key clinical skills, and outcomes.

RESULTS

Twenty-two studies were included in this review, most of which were qualitative, observational, or mixed studies of the two designs. The digital learning designs identified in OT education were flipped, blended, hybrid, and distance learning, including e-learning and massive open online courses (MOOC). Among the components of clinical skills, professional reasoning and procedural knowledge were the most integrated into digital learning, and covered various OT subjects. Digital learning designs were reported to be equivalent to or more effective than the traditional face-to-face (F2F) class in learning outcomes of knowledge and skill acquisition, enhancing learning participation, reflection, and collaboration between learners. Various technologies have been used to promote synchronous or asynchronous active learning, providing learning strategies such as thinking, reflection, discussion, peer learning-group activity, and gamifying online learning.

CONCLUSIONS

In OT digital learning, appropriate learning subjects, the arrangement of clinical skill components that can be well integrated into digital learning, and the selection of appropriate technologies for effective learning are important. The results should be confirmed within an experimental study design.

Commentary on Ultrasound Instruction in Undergraduate Medical Education: Perspective from Two Students

BACKGROUND

Ultrasound integration in undergraduate medical education (UME) has been a focused endeavor in recent years. According to the American Institute of Ultrasound in Medicine, more than a third of all US medical schools have adopted a focused ultrasound training program for medical students. Medical student perspectives on best practices in ultrasound education are lacking in the literature.

CURRICULA EXPERIENCES

Two students' reflections are presented regarding two different didactic approaches, flipped classroom and self-study learning models, to teaching ultrasound in the pre-clinical medical education curriculum. Students present reflections on these didactic approaches to facilitate further improvement in ultrasound education curricula.

DISCUSSION

The self-directed learning model enabled students to learn foundational ultrasound exam techniques efficiently in a low-stress environment and subsequently optimized the efficiency of later faculty-led learning events. However, we noted that in both the flipped classroom and self-study learning models of education, the training on basic physical properties of ultrasound, tissue characteristics, and probe manipulation was limited.

CONCLUSION

A self-study learning model ultrasound curricula improves perceived learning efficiency and student confidence, especially when followed by faculty-guided didactics and scanning opportunities. We suggest a framework for ultrasound education curricula that includes components of both formats of ultrasound education alongside faculty-led sessions as an ideal model of ultrasound education. Further, we propose the added benefit of inanimate object scanning to optimize students' knowledge of waveform physics (image acquisition and physical properties of materials) early in the ultrasound education process.

Be in the Digital Room Where it Happens, Part II: Social Media for Neurology Educators

Social media has changed the way we communicate and interact. Unsurprisingly, it has also changed how we teach and learn. Younger generations of learners have transitioned from traditional educational sources to digital ones. Medical educators need to adapt to trends in medical education and develop fluency in the digital methods used by medical learners today. This is part two of a two-part series on social media and digital education in neurology. This article provides an overview of how social media can be used as a teaching tool in medical education and provides an overview in which it is grounded. We offer practical strategies on how social media can promote lifelong learning, educator development, educator support, and foster educator identity with accompanying neurology-specific examples. We also review considerations for incorporating social media into teaching and learning practices and future directions for integrating these tools in neurology education.

Inverted classes as a successful tool to overcome teaching and learning challenges imposed by COVID-19 lockdown to food microbiology laboratory classes

This study evaluated if the online inverted classes (IC) model maintained high students’ learning engagement and performance on the laboratory component of Food Microbiology during an academic year dominated by COVID-19-lockdown, compared to pre-pandemic years. Porto University students from 2 courses (n = 36-Pharmaceutical Sciences; n = 59-Nutrition Sciences) were engaged. A high rate of students answered they prefer the IC rather than lecture-only style delivery mode and were involved in the IC learning process (prepared classes asynchronously; participated in case-studies resolution during synchronous classes). Very good laboratory final performances were maintained as in pre-pandemic years. Variable perceptions about work volume and adaptation to face-to-face laboratory classes were observed among both groups, potentially related to different course organization and defined learning outcomes/competences.

Visualization in Anatomy Education

In the post-pandemic era, one of the significant challenges for anatomy teachers is to reciprocate the experience of practical exposure while teaching the subject to undergraduates. These challenges span from conducting cadaveric dissections to handling real human bones, museum specimens, and tissue sections in the histology lab. Such exposures help the instructors to develop interactive communication with their fellow students and thus help to enhance communication skills among them. Recently, anatomy teachers all over the world started using cutting-edge educational technologies to make teaching-learning experiences for students more engaging, interesting, and interactive. Utilizing such cutting-edge educational technologies was an "option" prior to the pandemic, but the pandemic has significantly altered the situation. What was previously an "option" is now a "compulsion." Despite the fact that the majority of medical schools have resumed their regular on-campus classes, body donation and the availability of cadavers remain extremely limited, resulting in a deadlock. Anatomy teachers must incorporate cutting-edge educational technologies into their teaching and learning activities to make the subject more visual. In this chapter, we have attempted to discuss various new technologies which can provide a near-realistic perception of anatomical structures as a complementary tool for dissection/cadaver, various visualization techniques currently available and explore their importance as a pedagogic alternative in learning anatomy. We also discussed the recent advancement in visualization techniques and the pros and cons of technology-based visualization. This chapter identifies the limitations of technology-based visualization as a supplement and discusses effective utilization as an adjunct to the conventional pedagogical approaches to undergraduate anatomy education.

Novel and Engaging Teaching Method for Pulmonary Physiology

BACKGROUND

Pulmonary physiology is a challenging, necessary component of pediatric pulmonary fellowship education. Our pediatric pulmonology fellowship program provided this education utilizing a flipped classroom approach but satisfaction with the method was declining. Evidence suggests that adult learners benefit from an engaging lecture method, but no evidence exists to compare the flipped classroom approach to the engaging lecture approach for pulmonary physiology education.

OBJECTIVE

To develop the most effective physiology curriculum for pediatric pulmonary fellows by comparing the flipped classroom approach to an engaging lecture method.

METHODS

Five physiology teaching sessions were assigned to the flipped classroom method and 5 to the engaging lecture style. Anonymous surveys assessing satisfaction, utilizing a five-point Likert scale, were completed by fellows at the end of each session. An unpaired t-test was used to compare responses.

RESULTS

Seven pediatric pulmonary fellows enrolled in the study. The average attendance per session was 5 fellows. There was no significant difference in fellows' perceived understanding of the assigned physiology topic prior to the flipped classroom versus engaging lecture sessions. Fellows' perceived understanding of the topics improved after both session types, with significantly more improvement after the engaging lecture sessions. Fellows also reported that engaging lecture sessions were more useful and improved their test-taking confidence. They were more likely to recommend engaging lecture sessions to future pulmonary fellows.

CONCLUSIONS

Pediatric pulmonary fellows benefited from the use of the engaging lecture style for physiology education.

An international exploration of blended learning use in pre-registration nursing and midwifery education

AIM

To explore international experiences of using blended learning in preparing nursing and midwifery students for initial professional registration to inform future education policy.

BACKGROUND

The global nursing and midwifery skills shortage and need for an expanded nursing workforce that is fit for contemporary care delivery is widely acknowledged. The immense pressure the profession was already under because of austerity, staff shortages and increasingly complex healthcare needs has been worsened by the Covid-19 pandemic. The UK is extending and evaluating the use of blended learning programmes for pre-registration nursing and midwifery students to help address these issues. This study sought to explore relevant nursing and midwifery experiences from outside the UK to help inform future health professional education policy here and elsewhere.

DESIGN

Cross-sectional, sequential, mixed methods study PARTICIPANTS/SETTINGS: Nursing/nurse education leaders from across International Council of Nurses regions METHODS: Exploratory online survey (n = 32) and three follow-up case studies (March-May 2021). Participants' knowledge and experiences of blended learning were examined along with any perceived benefits for workforce development and successful strategies for addressing the challenges blended learning presents in this context. Case studies were developed inductively from survey responses and follow up telephone calls to provide more detailed information about reported successes.

RESULTS

Participants reported flexibility, cost effectiveness, increased student/tutor and student/student communication and interaction as benefits of blended learning. Challenges included the design and use of interactive learning resources, appropriate preparation and support for staff and students, the potential of blended learning to exacerbate otherwise hidden disadvantage and the need for multi-stakeholder cost/benefit evaluation.

CONCLUSIONS

Blended learning is used globally in the pre-registration education of nurses, midwives and other healthcare professionals. These results broadly mirror the literature regarding the benefits blended learning offers healthcare students, staff and organisations and the strategies employed to mitigate risk. As the deployment of blended learning nursing and midwifery programmes expands, further work is needed to address gaps in the current evidence base regarding the practice and impact of this approach. These concern adequate preparation and support of students and staff, ensuring access to appropriate equipment and connectivity, exploration of student perceptions that online learning is of lesser value and comprehensive multi-stakeholder, exploratory evaluation to uncover any hidden factors and impact.

TWEETABLE ABSTRACT

Blended learning plays an effective part in the education of pre-registration nursing and midwifery students to help tackle global workforce shortages, but further work is needed to address gaps in the current evidence base regarding the practice and impact of this approach.

Application and evaluation of Flipped Teaching based on Video Conference in standardized training for internal medicine residents

BACKGROUND

In view of the importance of infectious diseases in public health, Shanghai Municipal Health Commission designated a hospital ("Designated Hospital") to carry out infectious diseases training for internal medicine residents in those hospitals ("Dispatching Hospitals") that didn't have an infectious disease ward or could not meet the training standards of infectious diseases.

OBJECTIVE

I aimed to explore Flipped Teaching with Video Conference as the carrier in infectious diseases training for internal medicine residents, to make up for the lack of actual training time of the Department of Infectious Diseases for those residents caused by subjective or objective reasons, and to ensure the smooth implementation and quality assurance of infectious diseases training for those residents.

METHODS

Vertical management mode was adopted, management and lecture teams were established, and training program and teaching implementation were formulated. Flipped Teaching based on Video Conference was carried out for internal medicine residents of Dispatching Hospitals who planned to participate in infectious diseases training of the Designated Hospital in April. The quantitative analysis was applied to this teaching evaluation, and the evaluation indexes were included into statistical analysis to evaluate the effect of the teaching model.

RESULTS

All 19-member internal medicine residents participated in the Flipped Teaching based on Video Conference from April 1 to 4, of which 12 residents were scheduled to participate in infectious diseases training from March 1 to April 30, and 7 residents were scheduled to participate in infectious diseases training from April 1 to May 31 in the Designated Hospital. A management team of 6 internal medicine residents was built, and a lecture team was composed of 12 internal medicine residents who were scheduled to receive infectious diseases training in the Designated Hospital from March 1 to April 30. According to the training requirements in the Department of Infectious Diseases, 12 contents were selected to be taught, and implementation rate of the teaching plan was over 90%. A total of 197 feedback questionnaires were collected. The feedback that the teaching quality was "good" and "very good" accounted for more than 96%, and the attendance rate of the whole teaching process reached more than 94%. Six internal medicine residents put forward 18 "Improvement suggestions", accounting for 9.1%; and 11 internal medicine residents gave 110 suggestions of "Praise highlights", accounting for 55.8%. The overall evaluation feedback of Flipped Teaching was good, P<0.001.

CONCLUSION

Flipped Teaching based on Video Conference was generally effective in delivering lectures and learning for internal medicine residents participating in the infectious diseases training, and it could be used as a supplementary training method for standardized training of internal medicine residents to make up for the shortage of actual training period in a certain stage.

The impact of the transition from flipped classroom to online lectures on learning outcomes and student satisfaction in a rehabilitation medicine clerkship during the COVID-19 pandemic

BACKGROUND

The flipped classroom (FC) is a well-known active learning module that activates the prior knowledge of students and promotes their cognitive skills during in-class activities. However, most on-site teaching during the COVID-19 pandemic had to be conducted online. The FC in our rehabilitation medicine clerkship curriculum was also shifted to online asynchronous lectures (OLs), without real-time interactions. There is no previous comparison of effectiveness between these two methods. Therefore, this study aimed to compare learning outcomes and student satisfaction in both FC and OL models.

METHODS

The study design was a historically controlled study. A physical modality was chosen for the content. The FC group (n = 233), in the academic years 2018 and 2019, was assigned to perform a pre-class activity consisting of reading study materials. Thereafter, the in-class activity comprised a small-group case-based discussion. The OL group (n = 240) in the academic years 2020 and 2021 followed an online model during the COVID-19 lockdown. They were also asked to read the online materials and then watch a self-paced recorded lecture video on Learning Management Systems. The learning outcomes, including their multiple-choice questions (MCQs) scores, final exam scores, grade points, and letter grades, were evaluated. Their overall course satisfaction ratings were also collected.

RESULTS

The OL group had an overall higher MCQ score for the physical modality portion than the FC group (p = 0.047). The median (lower quartile, upper quartile) of the total 50-MCQ scores were 34 (31, 37) in the OL group and 33 (29, 36) in the FC group (p = 0.007). The median final exam scores of the OL and FC groups were 69.5 and 68.3, respectively (p = 0.026). The median grade points and the letter grades were not significantly different between the groups. The proportions of satisfaction were significantly higher in the FC group than in the OL group.

CONCLUSIONS

The OL group revealed significantly higher learning outcomes than the FC group. However, the FC group showed more satisfaction with interactivity than the OL group. The authors are of the view that a combination of both FC and OL methods will likely result in better outcomes.

Dependence of learning outcomes in flipped and lecture classrooms on review questions: A randomized controlled trial and observational study

PURPOSE

The effects of class structure (i.e., lecture vs. flipped) and repeated review on: 1) exam scores and 2) student perceptions of learning were compared in a prospective randomized controlled trial (Study 1) and a retrospective cohort study (Study 2).

METHODS

In Study 1, 42 second year students in a Doctor of Physical Therapy program were randomized to either a lecture or flipped section of a neurobiology class. Both sections incorporated repeated review. In Study 2, exam scores were retrospectively compared between two cohorts: a lecture cohort without repeated review (n = 42) and a flipped cohort with repeated review (n = 46). In both studies, outcomes of interest were exam scores and student surveys.

RESULTS

In Study 1, students in the lecture and flipped sections had similar exam averages (lecture = 76.7 ± 17%, flipped = 77.5 ± 17%, p = 0.73). Repeated review significantly improved exam scores by 12.0 percentage points (95% CI: 8.0 to 16.0 percentage points) in the lecture section and 10.8 percentage points (95% CI: 6.9 to 14.8 percentage points) in the flipped section. The flipped section reported higher levels of satisfaction and perceived learning. In Study 2, the flipped cohort had significantly higher exam scores than the lecture cohort (lecture = 70.2 ± 6.9%, flipped = 83.4 ± 7.7%, p < 0.0001). Student satisfaction and perceived learning were similar in both cohorts.

CONCLUSION

Exam scores improve with review questions and quizzes provided in a class, both in a lecture or flipped classroom.

Effects of Debriefing on Motivation and Reflective Thinking of Nursing Students during In-School Practicum Using a Flipped Learning Model

Debriefing and flipped learning have been determined to be useful strategies for nursing education. Recently, it has been reported that applying debriefing and flipped learning together was helpful for educational outcomes. The objective of this study was to compare learning motivation and reflective thinking before and after debriefing during nursing practicums that applied flipped learning. We implemented a quasi-experimental procedure in the form of a pretest-posttest non-equivalent control group design (1 September to 22 October 2021). The participants comprised 63 nursing students in South Korea (33 in the experimental group and 30 in the control group). Each group took part in a nursing practice class, wherein the experimental group engaged in debriefing using flipped learning, while the control group engaged only in flipped learning. We then examined academic motivation and reflective thinking in both the groups, and found that reflective thinking was significantly higher in the experimental group (53.67 ± 5.71) versus the control group (50.80 ± 4.69) (t = 2.165, p = 0.034). However, there were no differences in learning motivation between the two groups (t = 1.864, p = 0.067). In sum, this study confirmed the benefits of this new teaching approach, in which debriefing and flipped learning were integrated and incorporated into a nursing practice class. Given our promising results, this approach can be applied in various cases to strengthen the clinical practice skills of nursing students.

Implementation and evaluation of crowdsourcing in global health education

BACKGROUND

Current global health course is most set as elective course taught in traditional teacher-taught model with low credit and short term. Innovate teaching models are required. Crowdsourcing characterized by high flexibility and strong application-orientation holds its potential to enhance global health education. We applied crowdsourcing to global health teaching for undergraduates, aiming to develop and evaluate a new teaching model for global health education.

METHODS

Crowdsourcing was implemented into traditional course-based teaching via introducing five COVID-19 related global health debates. Undergraduate students majoring in preventative medicine and nursing grouped in teams of 5-8, were asked to resolve these debates in reference to main content of the course and with manner they thought most effective to deliver the messages. Students' experience and teaching effect, were evaluated by questionnaires and teachers' ratings, respectively. McNemar's test was used to compare the difference in students' experience before and after the course, and regression models were used to explore the influencing factors of the teaching effect.

RESULTS

A total of 172 undergraduates were included, of which 122 (71%) were females. Students' evaluation of the new teaching model improved after the course, but were polarized. Students' self-reported teaching effect averaged 67.53 ± 16.8 and the teachers' rating score averaged 90.84 ± 4.9. Students majoring in preventive medicine, participated in student union, spent more time on revision, and had positive feedback on the new teaching model tended to perform better.

CONCLUSION

We innovatively implemented crowdsourcing into global health teaching, and found this new teaching model was positively received by undergraduate students with improved teaching effects. More studies are needed to optimize the implementation of crowdsourcing alike new methods into global health education, to enrich global health teaching models.

Edpuzzle versus Moodle: Learning Tools in Pediatric Dentistry Practice: A Study Pilot

The aim of the present study was to compare the results of two educational platforms for the development of Flipped Learning (FL) in the preclinical practices of paediatric dentistry: Edpuzzle and Moodle 3.4. Methods: Fifty students filled out a questionnaire on knowledge of pulp treatments in primary dentition (Pre-Q). They were divided into two groups: one watched a video on the pulpotomy technique before preclinical practice using Moodle 3.4 (group A) and the other used Edpuzzle (group B). On the day of practice, the students resolved any doubts with the teacher. Next, they performed a pulpotomy on an artificial tooth and answered the questionnaire again (Post-Q) together with a satisfaction survey. Results: In both groups, an increase in the number of correct answers was found in the Post-Q compared to the Pre-Q (p < 0.001), but with no significant differences between groups. The pulpotomy practice ratings were higher in group B, which used Edpuzzle (p < 0.001). In the satisfaction survey, we only found significant differences (p = 0.003) in access to the video, since 100% of the students in group A found it easy to view it through Moodle, unlike in group B. Conclusions: Our results suggest that the use of educational platforms specially designed for FL, such as Edpuzzle, can improve the qualifications of students in paediatric dentistry practices.

CRISP method with flipped classroom approach in ECG teaching of arrhythmia for trainee nurses: a randomized controlled study

BACKGROUND

This study aimed to explored the effects of the Cardiac Rhythm Identification for Simple People (CRISP) method with flipped classroom approach for arrhythmia interpretation in electrocardiogram (ECG) by trainee nurses.

METHODS

A total of 120 trainee nurses were enrolled and randomly divided into the experimental group and the control group using lecture-based learning method. We observed the effects of the two methods in ECG interpretation training and investigated the students' attitudes toward the teaching practices.

RESULTS

After training, the ECG test scores in the experimental group were significantly higher than that of the control group. Six months later, the ECG test scores of the experimental group was still higher. Self-learning enthusiasm, understanding of teaching content, satisfaction of teaching mode, satisfaction of teaching effectiveness, and interest in learning ECG were significantly higher in the experimental group.

CONCLUSION

CRISP method with flipped classroom approach is a new and effective mode worth trying in ECG teaching for trainee nurses.

Videos of demonstration versus text and image-based material for pre-skill conceptualisation in flipped newborn resuscitation training for medical students: a pilot study

BACKGROUND

The flipped skills lab is a student-centred approach which incorporates pre-class preparation (pre-skill conceptualization) followed by repeated, hands-on practice for practical skills training. Objective measures of skills acquisition in the flipped literature are few and conflicting. The importance of pre-skill conceptualization in flipped skills training suggests that pedagogically informed pre-skill conceptualization can enhance outcomes.

METHODS

A mixed quasi-experimental study was conducted on 41 final year medical students who followed a flipped newborn resuscitation skills lab. Pre-class preparatory material covered conceptual and procedural knowledge. Students in the traditional group (n = 19) and those in the interventionalmental group (n = 22) received identical reading material covering conceptual knowledge. Procedural knowledge was shared with the interventional group as demonstration videos, while the traditional group received a PowerPoint presentation with text and images covering the same material. Knowledge acquisition was assessed by 20 single best answer questions before and after hands-on practice in the skills lab and skill performance was tested post-intervention with a simulated scenario. Students' perceptions were collected by survey. Quantitative data was analysed using Wilcoxon Signed Ranks test and Mann-Whitney U test as appropriate. Qualitative data was analysed by thematic analysis.

RESULTS

Overall student rating of the intervention was positive with ratings of 4.54 and 4.46 out of 5 by the traditional group and the experimental group respectively. Post-intervention skill performance in the experimental group was significantly better (p < .05) in the interventional group (M = 87.86%, SD = 5.89) than in the traditional group (M = 83.44, SD = 5.30) with a medium effect size (r = .40). While both groups showed significant knowledge gains, only students in the experimental group showed a statistically significant gain in procedural knowledge (p < .05) following the flipped skills lab. Finally, while both groups self-reported feeling more knowledgeable and confident following the intervention, the level of confidence was superior in the experimental group.

CONCLUSIONS

Flipping the skills lab with pre-skill conceptualisation combining text-based conceptual knowledge and video-based procedural knowledge followed by simulation-based hands-on practice improves procedural knowledge and skills acquisition in newborn resuscitation training for medical students. This study shows that in addition to temporal benefits, pedagogically informed pre-skill conceptualization can confer procedure-specific cognitive and emotional benefits supporting skills acquisition.

Maintaining informatics training learning outcomes with a COVID-19 era shift to a fully online flipped course

The emergence of the coronavirus disease 2019 pandemic forced us to adapt our recently developed informatics training serving a variety of students as well as faculty and staff. The successful flipped classroom course series (a hybrid-format with both asynchronous online learning and in-person synchronous components) was shifted to a fully online format with the synchronous portion now held via web-based video conference. We repeated our participant survey at the end of each of the 3 one-credit courses to compare student satisfaction and learning outcomes achievement to the original offering. The responses were overall very positive again and while there were no differences in satisfaction levels for 2 of the courses, overall satisfaction was higher for the new, fully online Python Programming course. Likewise, students reported similar achievement of the learning outcomes across all courses with 1 of the 12 objectives receiving higher competency agreement in the new, fully online version. Overall, the fully online version of the course series was equally successful, if not more so, than the original version with a physical classroom session each week. Given that participants also had strong agreement with a new question that they would prefer online class meetings instead of in a classroom, even if there wasn’t a global pandemic (citing a variety of logistical reasons such as “convenience of screen sharing,” parking issues, and job-related time constraints), the fully online version of the informatics training will be retained.

Medical students' self-regulation of learning in a blended learning environment: a systematic scoping review

BACKGROUND

Medical curricula are constantly evolving in response to the needs of society, accrediting bodies and developments in education and technology. The integration of blended learning modalities has challenged traditional methods of teaching, offering new prospects in the delivery of medical education. The purpose of this review is to explore how medical students adapt their learning behaviours in a Blended Learning environment to become more independent and self-regulated, in addition to highlighting potential avenues to enhance the curriculum and support student learning.

METHODS

Using the approach described by Levac et al. (2010), which builds on Arksey and O'Malley's framework, we conducted a literature search of the following databases: MEDLINE (Ovid), ERIC, EBSCO, SCOPUS and Google Scholar, utilising key terms and variants of "medical student', 'self-regulated learning' and 'blended learning'. The search yielded 305 studies which were further charted and screened according to the Joanna Briggs Institute.

RESULTS

Forty-four studies were identified and selected for inclusion in this review. After full analysis of these studies, underpinned by Self-regulation theory, five major concepts associated with students' learning behaviours in a Blended Learning environment were identified: Scaffolding of instructional guidance may support self-regulated learning; Self-regulated learning enhances academic performance; Self-regulated Learning improves study habits through resource selection; Blended learning drives student motivation and autonomy; and the Cognitive apprenticeship approach supports Self-regulated learning.

CONCLUSION

This review uncovers medical students' learning behaviours within a Blended learning environment which is important to consider for curricular adaptations and student support.

Voluntary participation in flipped classroom application sessions has a negligible effect on assessment outcomes in an accelerated pass-fail course

Increasingly, basic science educators at medical and health science programs are faced with the challenge of delivering fundamental science content using evidence-based pedagogical approaches that build students' fund of knowledge while also supporting their development as self-regulated learners. This has led to an increased use of active learning-based pedagogies such as flipped classroom teaching. However, there are many open questions about the conditions necessary for successful flipped classroom sessions. In particular, the role of student compliance (i.e., participation, engagement, attendance) in mediating performance needs to be evaluated. This is especially important in accelerated curricula where multiple basic science disciplines are integrated together in pass-fail courses, presenting challenges to both students' time and cognitive load. Data on prematriculation performance, in-class participation, weekly quiz performance, and summative assessment performance from three cohorts of medical students (n = 146) at a new medical school were collected and analyzed. We found that historically high-performing students more readily participated in flipped classroom application sessions compared with historically lower-performing students. Correlational analysis of performance on weekly formative quizzes and the summative course exam was not related to in-class participation. However, performance on weekly formative quizzes played the most significant role in students' performance on summative exams. Efforts to understand the benefits of in-class participation beyond short-term assessment performance, such as long-term knowledge retention or development of noncognitive skills, should be undertaken to justify using such time- and human resource-intensive pedagogies.NEW & NOTEWORTHY This study explores the use of flipped classroom teaching in a voluntary and accelerated medical school course. We found that historically high-performing students attend class, whereas historically low-performing students do not attend class as readily. Formative assessment performance appears to be more important than participation in determining the final grade. Correlation of high performance (>90%) with participation may differentiate students who excel in our curriculum from those who simply pass with superficial knowledge.

Evaluation of Urinary Catheterization Competency and Self-Efficacy in Nursing Students Using the Flipped Classroom Approach

Urinary catheterization is a complex procedure. Traditional teaching in classroom, such as using a simulator, is not enough to guarantee the necessary learning outcomes. It is therefore necessary to implement new active learning approaches such as the flipped classroom. The aim of this study was to examine the effect of the use of the flipped classroom on the level of self-efficacy and the assessment of clinical competencies in nursing students performing the urinary catheterization procedure. A quasi-experimental study of a single group with pre-/post-testing measures. A convenience sample of 139 nursing students. A flipped classroom approach was implemented. Measurements were taken pre and post intervention. This study followed the consolidated criteria for quality of nonrandomized evaluations studies (TREND) checklist. Regarding self-efficacy, statistically significant differences were found between the pre-test and post-test (Z = -14.453; p < 0.05). With respect to knowledge level, statistically significant differences were found when comparing pre-/post-test results (Z = -14,480; p < 0.05). Furthermore, statistically significant differences were found on the ability scale depending on pre-/post-test (Z = -10.277; p < 0.005); in all cases, obtaining a higher score in the post-test. The flipped classroom could be an effective educational tool for the development of clinical skills, specifically urinary catheterization. This method has been shown to improve the knowledge, skills, and self-efficacy in urinary catheterization of nursing students.

Quantitative Analysis of the Acceptance and Learning Success Instead of Flipped Classroom Teaching in a Caries Diagnosis Course for Undergraduate Students

This pilot study aimed to investigate the effectiveness of a flipped classroom for undergraduate students in dentistry. The main objective was to compare the knowledge level of students before and after lectures and practice. All second-year dental students (n = 44) at Witten/Herdecke University participated in this pilot study. They took four knowledge assessments, i.e., T0: the baseline, T2a: after the online lecture (two weeks after T0), T2b: immediately after the face-to-face session, and T3: after the practical session (three weeks after T2). The students’ satisfaction and self-assessment of their abilities were determined immediately after the practical session in an anonymous online questionnaire using LimeSurvey. To assess the level of knowledge, we used the Friedman and Wilcoxon-signed-rank tests with the Bonferroni correction to analyze the correct answer by comparing the results from different sessions. The students’ satisfaction and self-assessment of their abilities were determined descriptively, presenting the mean and standard deviation. A significance level of $p$  ≤ 0.05 was applied. Data from thirty-nine students regarding the level of knowledge were analyzed. There were statistically significant differences in the level of knowledge of the students at different times ( $p$  = 0.001). A total of 19.5% of students reported a problem with the flipped classroom method, and 80.5% reported no problem with this educational method. Ninety-four percent of students would like further flipped classrooms in dental education. Within the limitations of this pilot study, the results suggest that dental students benefit from the flipped classroom method and that this mode of education can be effective in introducing caries diagnosis education for undergraduate students.

Envisioning nutrition teaching as a three-course meal: a blended approach to knowledge, application and assessment

Medical students receive inadequate training in nutrition counselling, but the best way to teach this topic is unknown. To address this research gap, we developed a longitudinal blended programme - combining physical classroom experiences with online education - to teach nutrition counselling in a primary care clinical course. The learning experience comprised a pre-class online module to convey knowledge; a formative, ungraded standardised patient exercise on dietary modification to practise skills; and a written exam on nutrition knowledge and an Objective Structured Clinical Exam assessing nutrition counselling skills. We likened this three-part curriculum to a complete meal, with its self-paced online 'appetiser', in-class 'entrée' of clinical practice with patients, and 'dessert' of an assessment. We ascertained feasibility, discovered positive student reactions, and, via exam performance analysis, noted achievement of the learning objectives. This three-course meal model can be applied to any learning experience that teaches and assesses skills.

Gender and Sexual Diverse Health Education: A Needs Assessment Among Internal Medicine Residents

Purpose: The purpose of this study was to assess perception of competency and comfort level of internal medicine (IM) residents in caring for gender and sexual diverse (GSD) patients, and to identify residents' preferred educational modalities and perceived facilitators and barriers to GSD curriculum implementation. Methods: A survey was distributed among IM residents during a mandatory didactic session between November 9 and December 18, 2020. Categorical variables were analyzed using Fisher's exact test. Open-ended questions were analyzed using content and theme analysis. Results: Of 138 residents, 89 (64%) completed the survey. Residents had varying levels of comfort and perceived competence. Small group (n = 61, 69%) and case-based learning (n = 58, 66%) formats were preferred. Content and theme analysis resulted in four major themes on facilitators and three major themes on barriers to GSD curricular implementation. Conclusion: This study provides unique insight to facilitate implementation of a learner-centered and developmentally appropriate curricular approach to GSD health education.

Opportunity Amid Crisis in Medical Education: Teaching During the Pandemic of COVID-19

Purpose

The pandemic of COVID-19 had reinforced adaptations in medical education. It was challenging, especially for developing countries where resources were scarce. This study examined the implementation of teaching and learning adaptation during the pandemic in a low-resource country as perceived by teachers. We also present the opportunities that arise from the adaptation process.

Participants and Methods

The participants of this study (n=24) were teachers in an undergraduate medical program. This study employed a qualitative approach using focus group discussions (FGDs) to collect the teachers' perceptions. Thematic analysis was performed to analyse the data.

Results

Teachers' perceptions were categorized into 19 subthemes and were accentuated into four general themes; learning facilitation, assessment during the pandemic, learning resources, and competence achievement. We discovered both challenges as well as opportunities in each theme due to the shifting of learning from offline to online learning. Flexibility and innovation were regarded as the most important opportunities and were perceived to hold potential for medical education in the future. Knowledge acquisition was most benefited from this adaptation. Facilitating skill acquisition and burnout were the major challenges.

Conclusion

Despite the challenges, including burnout, skills acquisition, and risk in academic integrity, innovations in medical education were strengthened during the pandemic of COVID-19. They also provided a positive influence regarding achievement in the cognitive aspect. Faculty development programs need to be encouraged to improve teachers' capacity in the future.

Comparison of knowledge acquisition and retention following traditional didactic vs. flipped classroom education utilizing a standardized national curriculum: a randomized controlled trial

OBJECTIVE

Measure the effectiveness of and preference for a standardized, national curriculum utilizing flipped classrooms (FC) in neonatal-perinatal medicine (NPM) fellowships.

STUDY DESIGN

Multicentered equivalence, cluster randomized controlled trial of NPM fellowship programs randomized to receive standardized physiology education as in-class lectures (traditional didactic, TD arm) or as pre-class online videos followed by in-class discussions (FC arm). Four multiple-choice question quizzes and three surveys were administered to measure knowledge acquisition, retention, and educational preferences.

RESULTS

530 fellows from 61 NPM fellowships participated. Quiz performance was comparable between groups at all time points (p = NS, TD vs FC at 4 time points). Post intervention, more fellows in both groups preferred group discussions (pre/post FC 42% vs. 58%, P = 0.002; pre/post TD 43% vs. 60%, P = < 0.001). FC fellows were more likely to rate classroom effectiveness positively (FC/TD, 70% vs. 36%, P < 0.001).

CONCLUSIONS

FCs promote knowledge acquisition and retention equivalent to TD and FC modalities are preferred by fellows.

Perception of health-related quality of life, sleep quality and sleepiness index in an educational environment at a dental school in Southeast Brazil

INTRODUCTION

University entrance is often associated with changes in quality of life, individuals' cognitive and physical behavior. The present study aimed to evaluate health-related quality of life (HRQoL), sleep quality and sleepiness index in dentistry students at a university in Southeast Brazil, in different semesters of their course.

MATERIALS AND METHODS

Samples were obtained from 55 students from the dentistry course at the Federal University of Alfenas (UNIFAL-MG). For collecting information, validated SF-36 questionnaires (Medical Outcomes Study 36-item Short-Form Health Survey), namely, Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), were used as instruments in an educational environment. The relationship between the association of demographic factors and academic performance with SF-36, PSQI and ESS was assessed with an alpha of 0.05.

RESULTS

The worst HRQoL parameters reported by the participants were observed in the domains of body pain, vitality, general health perception, and limitations due to emotional and social aspects when associated with the investigated variables. Regarding the relative sleep quality index, differences in the PSQI domains were observed when related to demographic factors and academic performance. There was no significant difference in the sleepiness index of these students according to the mean values of the ESS domains.

CONCLUSION

The SF-36, PSQI and ESS questionnaires indicated that it is a reliable instrument for measuring the impact of quality of life on dentistry students. In addition, dentistry students of UNIFAL-MG had poor indicators of quality of life associated with health and an inadequate index of quality of sleep.

Transforming postgraduate GP teaching through collaborative course design and peer-facilitated small-group, reflective learning

Shropshire Vocational Training Scheme's (VTS) traditional structure of peer-delivered teaching had received poor feedback from trainees. There is good evidence in the literature for stakeholder engagement in training design and participation in small group learning and case discussion as a bedrock of GP learning in the VTS. We introduced three new initiatives to improve half-day release (HDR): 1. collaborative course design; 2. reflective, case-based learning with flipped learning resources; and 3. peer-facilitated, small groups. The aim was to marry trainees' desire for clinical context with the need to comprehensively cover the professional knowledge, skills and attitudes of the 'Being a GP' Royal College of General Practitioner's curriculum.The new collaborative model has improved feedback, facilitated high-level small group reflection and resulted in a smooth transition to virtual HDR during Covid-19. We now have a cohort of highly motivated facilitators, with the opportunity to develop leadership skills, and a bank of complex clinical cases developed to facilitate useful, trainee-led, case-based discussion.Our model is deliverable in other VTS areas and could enhance trainee experience of HDR. Future challenges will be maintaining facilitator training, quality control for cases and discussion and how to ensure our near-peer facilitators successfully become future leaders in primary care.

Design principles for fully online flipped learning in health professions education: a systematic review of research during the COVID-19 pandemic

BACKGROUND

During the COVID-19 pandemic, some instructors transitioned their courses into a fully online environment by adopting flipped learning. In this context, this review examined the challenges to fully online flipped learning and identified useful course-design elements for practicing this instructional approach in health professions education.

METHODS

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement for selecting relevant articles. Thirty-three empirical studies (with 32 unique interventions) published between 2020 and 2021 (i.e., the first 2 years of the pandemic) were selected for analysis.

RESULTS

When the instructors in the reviewed studies designed and implemented their online flipped courses, numerous challenges emerged, which could be broadly categorized into student-related challenges (e.g., unfamiliarity with online flipped learning; N = 5), faculty challenges (e.g., increased workload; N = 8), and operational challenges (e.g., students' technical problems; N = 9). Nevertheless, we identified various useful elements for online flipped learning practice and organized them based on the following components of the Revised Community of Inquiry (RCoI) framework: cognitive presence (e.g., application of knowledge/skills; N = 12), social presence (e.g., peer interaction; N = 11), teaching presence (e.g., instructors' real-time demonstration/facilitation; N = 17), and learner presence (e.g., care and emotional support; N = 4).

CONCLUSIONS

Based on the findings from the review and the RCoI framework, we developed nine principles for the effective practice of online flipped learning. These principles appear crucial for sustaining quality health professions education in a fully online flipped learning environment.

Implementing competency-based medical education in post-graduate ophthalmology training: Understanding key concepts and methodologies and overcoming challenges

The National Medical Council (NMC) has mandated that all post-graduate training shall be competency-based, following the principles of Competency. Based Medical Education (CBME). This aims to serve the dual purpose of standardizing ophthalmology post-graduate training and to overcome the shortcomings of the traditional curriculum by employing innovative and interactive teaching-learning and assessment techniques to produce competent ophthalmologists well equipped with clinical, surgical, and professional skills relevant to current times. CBME marks a paradigm shift from traditional curriculum methodologies and involves the introduction of several new concepts. This article aims to highlight the key principles of CBME and the various teaching-learning and assessment technique methodologies which can be employed for post-graduate training. It also highlights the various challenges that are likely to be faced in its implementation and measures to overcome them.

Using Medicare Annual Wellness Visits and telehealth to enhance ambulatory geriatrics education among medical students

The Medicare Annual Wellness visit (AWV) was mandated as a fully covered benefit for older adults to enhance preventive care and improve healthcare outcomes. Although the benefit of conducting AWV is proven, its adoption in primary care is far from universal. The COVID-19 pandemic affected medical education and clinical care in unprecedented ways. Telehealth became a prominent way of delivering healthcare. Older adults, being significantly affected by the pandemic-related mortality and morbidity, were less likely to engage in preventive care with their healthcare providers. Amidst this considerable shift, we conceptualized a clinical experience for third-year medical students during their Ambulatory Care - Geriatrics clerkship that involved a telehealth interaction with an older adult to review AWV components, followed by an in-person office visit with the geriatrician preceptor. Post-session survey data highlighted the beneficial effect on student learning about older adult health maintenance, immunizations and geriatric syndrome assessment. It also facilitated self-directed learning and increased student-patient rapport. Preceptors appreciated the additional elements of care identified by the telehealth call that would otherwise not have been addressed in a time-limited office visit. This hybrid clinical experience reduced crowding in ambulatory clinical space during the COVID-19 pandemic, yet enhanced learning for students in geriatrics preventive care.

Improving Multi-site Interaction Through Remote Learning Technology: Report from a Training Program to Increase Underrepresented Undergraduate and Medical Students in Health Disparities Research

Since 2018, we have evaluated the effectiveness of various teaching technologies for training young investigators on translational research in cancer health disparities. The Southeast Partnership for Improving Research and Training in Cancer Health Disparities (SPIRIT-CHD) unites Moffitt Cancer Center and the Louisiana State University Health Sciences Center. One of the main components of the SPIRIT-CHD is the Cancer Research Education Program (CREP) for training undergraduate and medical students from underrepresented backgrounds. The CREP utilizes a web-based didactic curriculum to engage students at both institutions in biobanking, precision medicine, and cancer health disparities topics. We report experiences from our cross-institutional cancer education program, specifically evaluating the cohorts' satisfaction and learning gains using various communication technologies and instructional approaches. Trainees completed a survey with questions evaluating the curriculum and technology. Trainees reported satisfaction with the flipped classroom model (FCM) content and overall program (mean score = 3.2, SD = 0.79), and would recommend the program to peers. Yet, despite improved program delivery, trainees felt interaction between the two sites (mean score = 1.5, SD = 0.85) and engagement with faculty (mean score = 2.80, SD = 1.14) could be improved. The technology with the highest reported use was e-mail, with a mean score of 4.6 (SD = 0.52). LinkedIn and Twitter had the lowest frequency of use with mean scores at 1.90 (SD = 0.99) and 1.30 (SD = 1.34). Our study highlights the successes and challenges of remote learning using technology to increase interaction and engagement among trainees and faculty in a multi-site cancer research training program.

Near-Peer Teaching in Conjunction with Flipped Classroom to Teach First-Year Medical Students Basic Surgical Skills

BACKGROUND

There is increasing evidence that students are completing medical school with insufficient surgical education. Near-peer tutoring and flipped classroom formatting may be used to enhance learning while simultaneously relieving faculty burden of teaching. Here, we qualitatively evaluate a 3-month course that integrates the use of near-peer teaching and flipped classroom formatting, with the goal of increasing first-year medical students' self-perceived confidence in performing basic sutures and knot-ties as well as interest in surgery.

METHODS

Twenty-one first-year medical students participated in a suturing and knot-tying course led by senior medical students. The course consisted of 2-h sessions held every 2 weeks for a total of five sessions. Students were sent publicly available videos prior to each session by which to learn the upcoming techniques and received live feedback from instructors during sessions. Questionnaires were completed pre-course and post-course.

RESULTS

Compared to pre-course ratings, post-course ratings of self-perceived confidence to perform various knot-ties and sutures all increased significantly (p < 0.05). All students stated that the course strengthened their desire to pursue a career in surgery. Student feedback of the course was overall positive.

CONCLUSIONS

Near-peer teaching can be used in conjunction with flipped classroom to increase first-year medical students' self-perceived confidence in surgical suturing and knot-tying as well as interest in surgery. This curriculum may serve as an outline for student-led courses at other institutions.

Gelingende Ethik-Lehre in der Medizin. Erkenntnisse aus der Lehrforschung

Die Frage nach den Faktoren, die eine wirksame Ethik-Lehre in der Medizin ausmachen, blieb bislang weitgehend unbeantwortet. Vor allem im deutschsprachigen Raum wird hier zu wenig Forschung betrieben. Aufgrund fehlender wissenschaftlich aussagekräftiger Evaluationsstudien lässt sich somit mitunter nur vermuten, wie wirksam bestimmte Lehrformate und -methoden in der Ethik-Lehre tatsächlich sind. Die Auswahl von Lehrformaten und -methoden, die Ethik-Dozierende für das Erreichen eines festgelegten Lernziels einsetzen, wird häufig nicht nach evidenzbasierten Kriterien, sondern auf der Grundlage von guten oder schlechten Lehrerfahrungen sowie von unmittelbarem Feedback der Studierenden getroffen. Im vorliegenden Beitrag werden nach einem kurzen Überblick über Evaluationsverfahren ethischer Kompetenzen Erkenntnisse aus ausgewählten internationalen Wirksamkeitsstudien vorgestellt und auf ihre Relevanz für den Medizinethik-Unterricht diskutiert. Wenngleich die Erkenntnisse aus diesen Evaluations- und Meta-Studien aus anderen, angrenzenden Bereichen wie der Forschungsethik und anderen Lehrkontexten kommen, so können sie doch als Diskussionsanstoß dienen und dazu beitragen, Eckpunkte für die Gestaltung wirksamer Ethik-Lehre in der Medizin im deutschsprachigen Raum zu definieren.

Development of a Scientific Writing Course to Increase Fellow Scholarship

Physicians in training are often taught how to conduct original research but may lack the skills necessary to write their results in a paper for the peer-reviewed medical literature. To help our critical care fellows increase their publication rates, we implemented an 8-hour scientific writing course that provides a structured approach to writing an academic research paper. We have demonstrated an increase in publication rate during fellowship from an average of 0.7 manuscripts per fellow just before course inception to 3.7 manuscripts per fellow in the current graduating class. We highlight strategies for developing a writing course aligned with adult learning theory within three key areas: planning, pedagogy, and implementation. Planning strategies center around creating a case for change, including multiple stakeholders with diverse backgrounds, including the research mentor, and ensuring accountability among stakeholders. Pedagogical strategies focus on harnessing the power of experiential learning, considering a flipped classroom approach, and peer teaching to leverage social and cognitive congruence. Implementation strategies include breaking down the writing process into manageable tasks, organizing the writing process according to learner needs, using peer review processes to drive learning, and celebrating the accomplishments of learners within the course. These strategies represent broad initiatives that can be tailored to local training needs and instituted across a wide variety of teaching platforms.

The Influence of COVID-19 on Medical Student Resource Preferences

Introduction

Over the past decade, pre-clerkship medical education has shifted from solely relying on didactic lectures to implementing more group learning and clinical experience to promote individualized, self-directed, and patient-centered education. COVID-19 required medical schools to examine their curricula and determine which portions were adaptable to virtual learning. This study compared first-year medical students’ (MS1) perceptions of an online curriculum, focusing on the students’ preferred resources before and after the transition to virtual courses.

Materials and methods

At one community-based allopathic medical school, a decision was made to move the entire pre-clerkship curriculum to a virtual format in the setting of the pandemic. An end-of-course survey evaluation was distributed via email to 64 first-year medical students at a community-based allopathic medical school. The participants were asked numerous questions about their overall perceptions of each course, including questions about the usefulness of lectures, small group activities, course administration, and faculty communication. Quantitative and qualitative data were collected during the standard program evaluation process for the two courses, and a third survey that focused on learning resources asked questions regarding virtual learning.

Results

Of the students, 29.7% reported being disappointed with the virtual curriculum, while the other 70.3% reported an unchanged or improved overall medical education. Regarding resource preferences, 56.5% of the students viewed most (76%-100%) course lectures, while 35.5% of the students viewed less than half of the course lectures. In contrast, 75.8% of the students said the majority (>50%) of their learning comes from outside resources. Furthermore, 31% reported that they are satisfied with the resources provided by the school, while 42% reported that they would like the school to provide additional resources. With that being said, 61% reported using more outside resources with the onset of a virtual curriculum, while 34% reported no change in outside resource use. Only 2% reported using fewer outside resources.

Conclusion

This study found that pre-clerkship medical students preferred some aspects of the in-person setting, such as social interaction and clinical exposure that is lacking in the virtual setting. However, students preferred many aspects of the virtual setting, such as having more independent study time and a more efficient learning process. Overall, before and after the transition, students were less satisfied with traditional curricular resources and more likely to choose external, board-specific resources with hopes of building strong residency applications, and these preferences were heightened in the online format.