Patient-Centered and Specialty-Specific Case Work-Up: An Effective Method for Teaching Appropriateness of Imaging to Medical Students

Impact of Nursing Clinical Elective Courses on New Graduate Nurses' Clinical Practice: A Mixed-Methods Descriptive Study

BACKGROUND

Clinical elective courses provide additional specialty knowledge for prelicensure nursing students; however, it is unknown how these courses impact nurses' clinical practice after graduation.

PURPOSE

To describe how clinical nursing electives impact graduates' clinical practice.

METHODS

A mixed-methods descriptive design was used. Students who graduated from a prelicensure nursing program were sent an electronic survey and participated in qualitative interviews.

RESULTS

Thirty-three graduates completed the survey, with 9 participating in interviews. Sixteen graduates worked in the clinical practice areas that were the same, or related to, the clinical elective they took. Many graduates felt that taking the elective course improved their confidence in the clinical setting and provided increased knowledge that put them at an advantage over their peers.

CONCLUSION

Clinical electives may offer a means to meet health care system needs by preparing a more confident, knowledgeable new graduate in specialty areas in which nurses are needed most.

Comparative Evaluation of Choose Your Own Adventure and Traditional Linear Case Formats in Radiology Small Group Teaching

RATIONALE AND OBJECTIVES

We aim to compare Choose Your Own Adventure (CYOA) presentation format with linear case format as educational methods for teaching a radiology small group session to medical students.

MATERIALS AND METHODS

A radiology small group session was held for preclinical second-year medical students in the pulmonary course, whereby eight classrooms of students and eight radiology facilitators were each randomized to do either the linear case format or the nonlinear CYOA presentation format. All students in attendance were administered a survey at the end of the session, which assessed students' perceptions using five-point Likert-type questions. The survey also contained a four-question knowledge quiz on chest radiology. The facilitators were administered a qualitative survey as well. Between-group analyses were performed using Student's t-test.

RESULTS

Of the 144 students who attended the small group sessions, 143 students completed the survey (99.3%). The CYOA format group reported significantly greater engagement in the cases (4.5 ± 0.7 vs. 3.8 ± 0.7, p < 0.001), satisfaction with the format (4.6 ± 0.6 vs. 3.7 ± 0.9, p < 0.001), and enhancement of clinical decision making skills (4.5 ± 0.6 vs. 3.5 ± 0.9, p < 0.001). The linear format group reported a greater role for the facilitator to add value (4.6 ± 0.5 vs. 4.3 ± 1.1, p = 0.033). There was no significant difference between groups in performance on the knowledge quiz.

CONCLUSION

Medical students reported higher satisfaction, engagement, and enhanced clinical decision making skills with the CYOA presentation method compared to linear case format for radiology small group learning.

The Short and the Long of It: Transitioning to a Blended Longitudinal Curriculum in Radiology

PURPOSE

The aim of this study was to demonstrate that the transition from a stand-alone radiology clerkship block to a longitudinally integrated radiology curriculum leverages newer teaching tools favored by today's learners.

METHODS

In 2013 and 2014, medical students attended a dedicated 1-week radiology clerkship course. In 2015, the block clerkship model for radiology transitioned to a vertically integrated curriculum. By 2019, radiology content was integrated into many of the health illness and disease course blocks. Pre- and postcourse multiple-choice questions tests as well as anonymous surveys were administered for both clerkship and integrated curriculum blocks. The student survey questions assessed perceptions regarding interpretation skills, imaging modality knowledge, and radiologists' roles.

RESULTS

Among 197 total students in the clerkship block, surveys were completed by 170 respondents, yielding a response rate of 86.3%. Among 106 students in the longitudinal course, surveys were completed by 71 respondents, yielding a response rate of 67%. For both clerkship and longitudinally integrated courses, the average number of correct responses after completion of the courses was significantly greater than the average number of correct precourse responses. Compared with students in the clerkship block curriculum, students in the longitudinal curriculum demonstrated a significantly greater frequency of agreement in response to survey questions regarding significant exposure to radiology, feeling comfortable interpreting CT images, and being familiar with how to use the ACR Appropriateness Criteria.

CONCLUSIONS

Transitioning from a single clerkship block to a more integrated format allows a more effective patient-centered clinical approach to medical imaging.

Student-led peer review of an online teaching file: perspectives after 2 years

PROBLEM

Opportunities for self-directed learning were missing from our medical school curriculum in general and on our radiology electives specifically. Our objective was to explore the feasibility and benefits of using medical students in the development of our student-created teaching files.

APPROACH

In 2018, a website was developed at our institution to support medical student radiology education and create a repository for the online publication of student-developed teaching cases. Students participating in radiology clerkships at our institution had an opportunity to submit case presentations for publication to our online teaching file following peer review. The medical students participated in the peer review process facilitated by the faculty director of radiology undergraduate medical education. The faculty member oversaw the training of new student editors and the development of a peer review guide.

OUTCOMES

The peer review guide included goals of the teaching file project and direction regarding the peer review process. Student editors were trained using the peer review guide in conjunction with individual meetings with the faculty mentor. At twenty-four months, 82 student-developed cases had been published to the online teaching file following medical student peer review. The teaching file had garnered 3884 page views.

NEXT STEPS

The medical student-led peer review process meets core competencies in self-directed learning. The authors plan to explore the application of peer-assisted learning theories to the editing and peer-review process.

The efficacy of microlearning in improving self-care capability: a systematic review of the literature

OBJECTIVE

To determine the effectiveness of microlearning in improving an individual's capability for self-care.

STUDY DESIGN

Systematic review of the literature.

BACKGROUND

The routine adoption of health seeking self-care behaviours can prevent or delay the appearance of various lifestyle diseases including type 2 diabetes and cardiovascular disease. Microlearning delivers complex knowledge in fragments or bite-size 'nuggets' of information and has been applied as a novel intervention to improve individual's self-care capabilities. The aim of this research was to systematically review the literature to determine the effectiveness of microlearning in improving individual self-care capability.

METHODS

A search was conducted on 15 July 2019 across five electronic bibliographic databases: EMBASE, MEDLINE, PsycINFO, CINAHL and Scopus. Randomised and non-randomised controlled trials, controlled before-after studies and interrupted time series studies, published between 1 January 1990 and 15 July 2019 and looking at individuals of all ages were included in the search. The search strategy included a keyword search and a string of "(modality) AND (learning) AND (micro)", which broadly described microlearning to cover all available articles that have used microformat learning interventions. The search was combined with keywords and Medical Subject Headings (MeSH) terms for self-care to identify studies of interests. Studies were screened by two reviewers independently and reported using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart. Data from included articles were extracted using Cochran Data Collection Form. Risk of bias was assessed using Version 2 of the Cochrane Risk-of-bias or Risk Of Bias In Non-Randomised Studies of Interventions (ROBINS-I).

RESULTS

1310 articles were identified in the initial search. A total of 26 manuscripts were included in the narrative synthesis after title and abstract and full text screening was performed by two reviewers. Outcomes of studies were categorised. A total of 23 studies measured cognitive level self-care capabilities-related changes, and 91% showed statistically significant improvements. Only 11 studies measured actual self-care behaviour changes, from which only 36% showed statistically significant results. From the 26 manuscripts included, 25 articles were evaluated as having moderate-to-high risk of bias.

CONCLUSION

Under certain conditions, or when combined with monitoring such as tracking daily medicine intake, microlearning can be effective in improving actual self-care behaviours. Microlearning can also positively influence individuals' cognitive self-care capabilities but was largely ineffective in triggering actual self-care behaviour change. More studies are needed to investigate the effectiveness of microlearning in improving self-care capabilities amongst the general population at scale.

Comparison of Multiple Quantitative Evaluation Indices of Theoretical Knowledge and Clinical Practice Skills and Training of Medical Interns in Cardiovascular Imaging Using Blended Teaching and the Case Resource Network Platform (CRNP)

Background

This study aimed to compare multiple quantitative evaluation indices of levels of theoretical knowledge and clinical practice skills in training medical interns in cardiovascular imaging based on the use of the blended teaching (BT) online artificial intelligence (AI) case resource network platform (CRNP), including time and frequency indices and effectiveness of the CRNP.

Material/Methods

The study included 110 medical interns who were divided into the routine teaching (RT) group (n=55) and the blended teaching (BT) group (n=55). The two were assessed using the mini-clinical evaluation exercise (mini-CEX) that assessed clinical skills, attitudes, and behaviors and using an objective written questionnaire. The following four indices were compared between the RT and BT groups: the X-ray score (XS), the computed tomography angiography (CTA) score (CS), the cardiac magnetic resonance imaging (CMRI) score (MS), and the average score (AS). Seven assessment indicators included: the imaging description (ID), the qualitative diagnosis (QD), the differential diagnosis (DD), examination preparation (EP), interview skill (IS), position display (PD), and human care (HC). Indicators of CRNP use included: number of times (TN), average duration (AD), single maximum duration (SMD), and total duration (TD).

Results

AS significantly correlated with AD (rad=0.761) and TD (rtd=0.754), and showed moderate correlation with TN (rtn=0.595), but weak correlation with SMD (rsmd=0.404).

Conclusions

Levels of theoretical knowledge and clinical practice skills during medical intern training in cardiovascular imaging based on BT using the CRNP teaching technology improved theoretical knowledge and practical skills.