eLearning techniques supporting problem based learning in clinical simulation

TEL Methods Used for the Learning of Clinical Neuroanatomy

Ubiquity of information technology is undoubtedly the most substantial change to society in the twentieth and twenty-first centuries and has resulted in a paradigm shift in how business and social interactions are conducted universally. Information dissemination and acquisition is now effortless, and the way we visualise information is constantly evolving. The face of anatomy education has been altered by the advent of such innovation with Technology-Enhanced Learning (TEL) now commonplace in modern curricula.With the constant development of new computing systems, the temptation is to push the boundaries of what can be achieved rather than addressing what should be achieved. As with clinical practice, education in healthcare should be evidence driven. Learning theory has supplied educators with a wealth of information on how to design teaching tools, and this should form the bedrock of technology-enhanced educational platforms. When analysing resources and assessing if they are fit for purpose, the application of pedagogical theory should be explored and the degree to which it has been applied should be considered.

Simulation Strategies to Teach Patient Transfers: Self-Efficacy by Strategy

OBJECTIVE. We evaluated the effects of transfer training—after training in the classroom and in the high-technology simulation laboratory (WISER Center)—on students’ perceptions of their self-efficacy for knowledge, skill, and safety in executing dependent transfers.

METHOD. After classroom training, occupational therapy students were randomized to three teaching groups on the basis of the amount of participation and observation opportunities provided at the WISER Center—observation dominant, participation dominant, and participation only.

RESULTS. The participation-dominant group reported an increase in knowledge self-efficacy over time compared with the observation-dominant and participation-only groups. Over time, self-efficacy ratings increased for all students, regardless of group.

CONCLUSION. Simulation scenarios implemented at the WISER Center provided a useful adjunct to classroom training in transfer skills. Both participatory and observational experiences contributed to the development of students’ perceptions of their ability to manage acutely ill and medically complex patients.

eLearning course may shorten the duration of mechanical restraint among psychiatric inpatients: a cluster-randomized trial

BACKGROUND

The management of psychiatric inpatients exhibiting severely disturbed and aggressive behaviour is an important educational topic. Well structured, IT-based educational programmes (eLearning) often ensure quality and may make training more affordable and accessible.

AIMS

The aim of this study was to explore the impact of an eLearning course for personnel on the rates and duration of seclusion and mechanical restraint among psychiatric inpatients.

METHODS

In a cluster-randomized intervention trial, the nursing personnel on 10 wards were randomly assigned to eLearning (intervention) or training-as-usual (control) groups. The eLearning course comprised six modules with specific topics (legal and ethical issues, behaviour-related factors, therapeutic relationship and self-awareness, teamwork and integrating knowledge with practice) and specific learning methods. The rates (incidents per 1000 occupied bed days) and durations of the coercion incidents were examined before and after the course.

RESULTS

A total of 1283 coercion incidents (1143 seclusions [89%] and 140 incidents involving the use of mechanical restraints [11%]) were recorded on the study wards during the data collection period. On the intervention wards, there were no statistically significant changes in the rates of seclusion and mechanical restraint. However, the duration of incidents involving mechanical restraints shortened from 36.0 to 4.0 h (median) (P < 0.001). No statistically significant changes occurred on the control wards.

CONCLUSIONS

After our eLearning course, the duration of incidents involving the use of mechanical restraints decreased. However, more studies are needed to ensure that the content of the course focuses on the most important factors associated with the seclusion-related elements. The eLearning course deserves further development and further studies. The duration of coercion incidents merits attention in future research.

Teaching differential diagnosis to nurse practitioner students in a distance program

An interactive case study (ICS) is a novel way to enhance the teaching of differential diagnosis to distance learning nurse practitioner students. Distance education renders the use of many teaching strategies commonly used with face-to-face students difficult, if not impossible. To meet this new pedagogical dilemma and to provide excellence in education, the ICS was developed. Kolb's theory of experiential learning supported efforts to follow the utilization of the ICS. This study sought to determine whether learning outcomes for the distance learning students were equivalent to those of on-campus students who engaged in a live-patient encounter. Accuracy of differential diagnosis lists generated by onsite and online students was compared. Equivalency testing assessed clinical, rather than only statistical, significance in data from 291 students. The ICS responses from the distance learning and onsite students differed by 4.9%, which was within the a priori equivalence estimate of 10%. Narrative data supported the findings.

Designing, implementing and evaluating an online problem-based learning (PBL) environment--a pilot study

Problem-based learning (PBL) has been shown to be effective for promoting student competencies in self-directed and collaborative learning, critical thinking, self-reflection and tackling novel situations. However, the need for face-to-face interactions at the same place and time severely limits the potential of traditional PBL. The requirements of space and for meeting at a specific location at the same time create timetabling difficulties. Such limitations need to be tackled before all potentials of PBL learning can be realized. The present study aimed at designing and implementing an online PBL environment for undergraduate speech/language pathology students, and assessing the associated pedagogical effectiveness. A group of eight PBL students were randomly selected to participate in the study. They underwent 4 weeks of online PBL using Adobe Connect. Upon completion of the experiment, they were assessed via a self-reported questionnaire and quantitative comparison with traditional PBL students based on the same written assignment. The questionnaire revealed that all participating students enjoyed online PBL, without any perceived negative effects on learning. Online PBL unanimously saved the students travel time to and from school. Statistical analysis indicated no significant difference in assignment grades between the online and traditional PBL groups, indicating that online PBL learning appears to be similarly effective as traditional face-to-face PBL learning.

The effect of problem-based learning in nursing education: a meta-analysis

Problem-based learning (PBL) has been identified as an approach that improves the training of nurses by teaching them how to apply theory to clinical practice and by developing their problem-solving skills, which could be used to overcome environmental constraints within clinical practice. A consensus is emerging that there is a need for systematic reviews and meta-analyses regarding a range of selected topics in nursing education. The purpose of this study was to conduct a meta-analysis of the available literature in order to synthesize the effects of PBL in nursing education. Using a number of databases, we identified studies related to the effectiveness of PBL in nursing. An analysis was conducted on a range of outcome variables, including overall effect sizes and effects of evidence and evaluation levels, learning environment, and study characteristics. We found that the effect of PBL in nursing education is 0.70 standard deviations (medium-to-large effect size). We also found that PBL has positive effects on the outcome domains of satisfaction with training, clinical education, and skill course. These results may act as a guide for nurse educators with regard to the conditions under which PBL is more effective than traditional learning strategies.

Impact of eLearning course on nurses' professional competence in seclusion and restraint practices: 9-month follow-up results of a randomized controlled study (ISRCTN32869544)

eLearning may facilitate continuing vocational education, but data on the long-term effects of an eLearning course are lacking. The aim of this study was to explore the long-term impact of an eLearning course entitled ePsychNurse.Net on psychiatric nurses' professional competence in practicing seclusion and restraint and on their job satisfaction and general self-efficacy at 9-month follow-up. In a randomized controlled study, 12 wards were randomly assigned to the ePsychNurse.Net (intervention) or training as usual (control). Baseline and 9-month follow-up data on nurses' knowledge of coercion-related legislation, physical restraint and seclusion, their attitudes towards physical restraint and seclusion, job satisfaction and general self-efficacy were analysed for 137 completers (those who participated in the 9-month follow-up assessment). No between-group differences were found on any variable, with the exception of a change in attitude to seclusion in favour of the control group. The findings of the long-term effects did not differ from the immediate outcomes (3-month follow-up) and the improved level of knowledge acquired and further consolidation of that knowledge did not take place in the 6-month period after the 3-month ePsychNurse.Net course. The ePsychNurse.Net should be further developed and its future modifications will require additional studies, probably with some new outcome measures.

Impact of eLearning course on nurses' professional competence in seclusion and restraint practices: a randomized controlled study (ISRCTN32869544)

Education on the care of aggressive and disturbed patients is fragmentary. eLearning could ensure the quality of such education, but data on its impact on professional competence in psychiatry are lacking. The aim of this study was to explore the impact of ePsychNurse.Net, an eLearning course, on psychiatric nurses' professional competence in seclusion and restraint and on their job satisfaction and general self-efficacy. In a randomized controlled study, 12 wards were randomly assigned to ePsychNurse.Net (intervention) or education as usual (control). Baseline and 3-month follow-up data on nurses' knowledge of coercion-related legislation, physical restraint and seclusion, their attitudes towards physical restraint and seclusion, job satisfaction and general self-efficacy were analysed for 158 completers. Knowledge (primary outcome) of coercion-related legislation improved in the intervention group, while knowledge of physical restraint improved and knowledge of seclusion remained unchanged in both groups. General self-efficacy improved in the intervention group also attitude to seclusion in the control group. In between-group comparison, attitudes to seclusion (one of secondary outcomes) favoured the control group. Although the ePsychNurse.Net demonstrated only slight advantages over conventional learning, it may be worth further development with, e.g. flexible time schedule and individualized content.

Towards case-based medical learning in radiological decision making using content-based image retrieval

BACKGROUND

Radiologists' training is based on intensive practice and can be improved with the use of diagnostic training systems. However, existing systems typically require laboriously prepared training cases and lack integration into the clinical environment with a proper learning scenario. Consequently, diagnostic training systems advancing decision-making skills are not well established in radiological education.

METHODS

We investigated didactic concepts and appraised methods appropriate to the radiology domain, as follows: (i) Adult learning theories stress the importance of work-related practice gained in a team of problem-solvers; (ii) Case-based reasoning (CBR) parallels the human problem-solving process; (iii) Content-based image retrieval (CBIR) can be useful for computer-aided diagnosis (CAD). To overcome the known drawbacks of existing learning systems, we developed the concept of image-based case retrieval for radiological education (IBCR-RE). The IBCR-RE diagnostic training is embedded into a didactic framework based on the Seven Jump approach, which is well established in problem-based learning (PBL). In order to provide a learning environment that is as similar as possible to radiological practice, we have analysed the radiological workflow and environment.

RESULTS

We mapped the IBCR-RE diagnostic training approach into the Image Retrieval in Medical Applications (IRMA) framework, resulting in the proposed concept of the IRMAdiag training application. IRMAdiag makes use of the modular structure of IRMA and comprises (i) the IRMA core, i.e., the IRMA CBIR engine; and (ii) the IRMAcon viewer. We propose embedding IRMAdiag into hospital information technology (IT) infrastructure using the standard protocols Digital Imaging and Communications in Medicine (DICOM) and Health Level Seven (HL7). Furthermore, we present a case description and a scheme of planned evaluations to comprehensively assess the system.

CONCLUSIONS

The IBCR-RE paradigm incorporates a novel combination of essential aspects of diagnostic learning in radiology: (i) Provision of work-relevant experiences in a training environment integrated into the radiologist's working context; (ii) Up-to-date training cases that do not require cumbersome preparation because they are provided by routinely generated electronic medical records; (iii) Support of the way adults learn while remaining suitable for the patient- and problem-oriented nature of medicine. Future work will address unanswered questions to complete the implementation of the IRMAdiag trainer.

Concept analysis: confidence/self-confidence

BACKGROUND

Confidence and self-confidence are crucial practice elements in nursing education and practice. Nurse educators should have an understanding of the concept of confidence in order to assist in the accomplishment of nursing students and their learning of technical and nontechnical skills. With the aim of facilitating trusted care of patients in the healthcare setting, nursing professionals must exhibit confidence, and, as such, clarification and analysis of its meaning is necessary.

PURPOSE

The purpose of this analysis is to provide clarity to the meaning of the concept confidence/self-confidence, while gaining a more comprehensive understanding of its attributes, antecedents, and consequences.

METHOD

Walker and Avant's eight-step method of concept analysis was utilized for the framework of the analysis process with model, contrary, borderline, and related cases presented along with attributes, antecedents, consequences, and empirical referents identified.

CONCLUSION

Understanding both the individualized development of confidence among prelicensure nursing students and the role of the nurse educator in the development of confident nursing practice, nurse educators can assist students in the development of confidence and competency. Future research surrounding the nature and development of confidence/self-confidence in the prelicensure nursing student experiencing human patient simulation sessions would assist to help educators further promote the development of confidence.

FIRST2ACT: educating nurses to identify patient deterioration - a theory-based model for best practice simulation education

Delayed assessment and mismanagement of patient deterioration is a substantial problem for which educational preparation can have an impact. This paper describes the development of the FIRST(2)ACT simulation model based on well-established theory and contemporary empirical evidence. The model combines evidence-based elements of assessment, simulation, self-review and expert feedback, and has been tested in undergraduate nurses, student midwives and post-registration nurses. Participant evaluations indicated a high degree of satisfaction and substantial self-rated increases in knowledge, confidence and competence. This evidence-based model should be considered for both undergraduate and post-registration education programs.

Application of a low-cost web-based simulation to improve students' practical skills in medical education

BACKGROUND

Practical sessions in undergraduate medical education are often costly and have to face constraints in terms of available laboratory time and practice materials (e.g. blood samples from animals). This makes it difficult to increase the time each student spends at the laboratory. We consider that it would be possible to improve the effectiveness of the laboratory time by providing the students with computer-based simulations for prior rehearsal. However, this approach still presents issues in terms of development costs and distribution to the students.

OBJECTIVE

This study investigates the employment of low-cost simulation to allow medical students to rehearse practical exercises through a web-based e-learning environment. The aim is to maximize the efficiency of laboratory time and resources allocated by letting students become familiarized with the equipment and the procedures before they attend a laboratory session, but without requiring large-scale investment. Moreover, students can access the simulation via the Internet and rehearse at their own pace. We have studied the effects of such a simulation in terms of impact on the laboratory session, learning outcomes and student satisfaction.

METHODS

We created a simulation that covers the steps of a practical exercise in a Physiology course (measuring hematocrit in a blood sample). An experimental group (EG, n=66) played the simulation 1 week before the laboratory session. A control group (CG, n=77) attended the laboratory session without playing the simulation. After the session, all students completed a survey about their perception of the difficulty of the exercise on a scale of 1-10 and the HCT final value that they obtained. The students in the EG also completed a survey about their satisfaction with the experience.

RESULTS

After the laboratory session, the perceived difficulty of the procedure was lower on average in the EG compared to the CG (3.52 vs. 4.39, 95% CI: 0.16-1.57, P=.016). There was no significant difference in terms of perceived difficulty using the equipment. The HCT measures reported by the EG group also presented a much lower dispersion, meaning a higher reliability, in determining the HCT value (3.10 vs. 26.94, SD; variances significantly different, P<.001, F: 75.25, Dfd: 68.19 for EG and CG). In the satisfaction test, the majority of the students in the EG reported that the experience was positive or very positive (80.7%) and reported that it had helped them to identify and use the equipment (78%) and to perform the exercise (66%).

CONCLUSIONS

The simulation was well received by students in the EG, who felt more comfortable during the laboratory session, and it helped them to perform the exercise better, obtaining more accurate results, which indicates more effective training. EG students perceived the procedure as easier to perform, but did not report an improvement in the perceived difficulty in using the equipment. The increased reliability demonstrates that low-cost simulations are a good complement to the laboratory sessions.

Video-based self-assessment: implementation and evaluation in an undergraduate nursing course

This research was performed to investigate the effects of video-based self-assessment on the ability of nursing students to accurately measure vital signs, their communication skills, and their satisfaction. This research was conducted between March 2007 and June 2007 as a quasi-experimental control-group, pretest-posttest design. The study population was composed of 40 second-year student nurses who enrolled in a fundamentals of nursing course of a college of nursing, Ajou University in Korea. Results of the research indicate that there was a statistically significant difference in exam scores for assessing long-term memory video-review group demonstrating higher scores. Student satisfaction was also significantly higher in the video-review group than in the control group. These results may suggest video-based self-assessment is a beneficial and effective instructional method of training undergraduate nursing students to develop awareness of their strengths and weaknesses, and to improve their clinical and communication skills.

A critical examination of high-fidelity human patient simulation within the context of nursing pedagogy

The use of high-fidelity human patient simulators (HPS) have been embraced by nursing education programs in the development of immersive clinical simulations despite the lack of research into a pedagogy or educational philosophy appropriate to guide this technology-based learning tool. In this article, we explore this approach to clinical teaching through a critical examination of the application of behaviorist and constructivist pedagogy to high-fidelity scenario-based simulation sessions. Practical guidelines for developing simulation-based learning sessions that reflect both philosophical paradigms are provided. Consideration is also given to societal trends such as the digital revolution and the incoming millennial generation who represent the aptitude of the modern nursing student to utilize high-fidelity realistic and immersive simulation. Depending on the desired goal of simulator utilization, the nurse educator may want to draw on constructivism or behaviorism or a blend of both educational philosophies to best meet the needs of the adult learner.

Development and evaluation of a critical care e-learning scenario

This paper describes the development and evaluation of a critical care e-learning scenario for student nurses. At present, there are insufficient opportunities in the United Kingdom (UK) for student nurses to experience clinical placements where their skills in care of the critically-ill can be developed. There is therefore a need for new learning materials that help learners recognise the signs of clinical deterioration and rehearse the management of critically-ill patients. One way of meeting this need is by using electronic care scenarios. Several electronic care scenarios have been developed at Swansea University as part of the eWARD project. This article describes the design and evaluation of a critical care scenario that follows the care of a road casualty (John Macadam) after admission to an intensive care unit. The scenario was designed by an advisory team comprising a clinical lecturer and e-learning specialists. After using the scenario, 144 nursing students completed a Web-based questionnaire that collected demographic and attitudinal data for analysis using SPSS. Nursing students had a strongly positive attitude to the scenario with median scores in excess of 20 compared to maxima of 25 for scales measuring ease-of-use, interactivity, realism and confidence. None of the demographic data collected had a significant effect on these attitudes. The positive attitude of student nurses to this scenario strongly supports its use to help learners to (1) acquire knowledge and awareness when real life placements in these settings are not available and (2) extend their knowledge after coming across similar situations in practice.

Revolutionizing assessment in a clinical skills environment--a global approach: the recorded assessment

Assessment is an essential component of education and a key element of the student experience. This is never more apparent than in the assessment of student nurses competency in practice skills. The use of clinical skills centres to facilitate the acquisition of nursing skills continues to gain popularity, nonetheless the methods used to develop and assess competency within these environments remains diverse with contemporary literature suggesting that the objective structured clinical examination (OSCE) is predominantly used. This paper presents an innovative approach used within a skills environment to summatively assess nursing students at the end of their first year; one that seeks to cultivate clinical competency through a process of self-appraisal and appreciation of evidence-based literature. The recorded assessment is a unique strategy that endeavours to make the learning experience more meaningful for the students, through the use of an audio-visual tool and written critique. The critique is crucial to the learning process by encouraging the student to adopt a critical and holistic view of their practice; essential skills for future practitioners.

Modeling in biomedical informatics—An exploratory analysis

OBJECTIVE

Modeling is a significant part of research, education and practice in biomedical and health informatics. Our objective was to explore which types of models of processes are used in current biomedical/health informatics research, as reflected in publications of scientific journals in this field. Also, the implications for medical informatics curricula were investigated.

METHODS

Retrospective, prolective observational study on recent publications of the two official journals of the International Medical Informatics Association (IMIA), the International Journal of Medical Informatics (IJMI) and Methods of Information in Medicine (MIM). All publications of the years 2004 and 2005 from these journals were indexed according to a given list of model types. Random samples out of these publications were analysed in more depth.

RESULTS

Three hundred and eighty-four publications have been analysed, 190 of IJMI and 194 of MIM. For publications in special issues (121 in IJMI) and special topics (132 in MIM) we found differences between theme-centered and conference-centered special issues/special topics (SIT) publications. In particular, we could observe a high variation between modeling in publications of theme-centered SITs. It became obvious that often sound formal knowledge as well as a strong engineering background is needed for carrying out this type of research. Usually, this knowledge and the related skills can be best provided in consecutive B.Sc. and M.Sc. programs in medical informatics (respectively, health informatics, biomedical informatics). If the focus should be primarily on health information systems and evaluation this can be offered in a M.Sc. program in medical informatics.

CONCLUSIONS

In analysing the 384 publications it became obvious that modeling continues to be a major task in research, education and practice in biomedical and health informatics. Knowledge and skills on a broad range of model types are needed in biomedical/health informatics.

Situated cognition and cognitive apprenticeship: a model for teaching and learning clinical skills in a technologically rich and authentic learning environment

The acquisition of a range of diverse clinical skills is a central feature of the pre-registration nursing curriculum. Prior to exposure to clinical practice, it is essential that learners have the opportunity to practise and develop such skills in a safe and controlled environment under the direction and supervision of clinical experts. However, the competing demands of the HE nursing curriculum coupled with an increased number of learners have resulted in a reduced emphasis on traditional apprenticeship learning. This paper presents an alternative model for clinical skills teaching that draws upon the principles of cognitive apprenticeship [Collins, A., Brown, J.S., Newman, S., 1989. Cognitive Apprenticeship: teaching the crafts of reading, writing and mathematics. In: Resnick, L.B. (Ed.) Knowing. Learning and Instruction: Essays in Honor of Robert Glaser. Lawrence Erlbaum Associates, New Jersey, pp. 453-494] and situated cognition within a technologically rich and authentic learning environment. It will show how high quality DVD materials illustrating clinical skills performed by expert practitioners have been produced and used in conjunction with CCTV and digital recording technologies to support learning within a pedagogic framework appropriate to skills acquisition. It is argued that this model not only better prepares the student for the time they will spend in the practice setting, but also lays the foundation for the development of a clinically competent practitioner with the requisite physical and cognitive skills who is fit for purpose [UKCC, 1999. Fitness for Practice: The UKCC Commission for Nursing and Midwifery Education. United Kingdom Central Council for Nursing Midwifery and Health Visiting, London].