The effectiveness of Internet-based e-learning on clinician behaviour and patient outcomes: A systematic review

Evaluating the effect of computer-based education on pharmacist behaviour regarding point-of-care testing

Background

Recent regulatory changes in Ontario have enabled pharmacists to perform point-of-care testing (POCT) to manage chronic diseases. With the introduction of any new service(s), educational interventions can aid acceptance and implementation. Computer-based education (CBE) improves pharmacists' knowledge, but there is little evidence of its effect on pharmacist behaviour. This study assessed the impact of CBE on pharmacist knowledge, behaviour intention, and adoption of POCT.

Methods

A three-month, web-based, randomized controlled trial was conducted between April 2024 and Sep 2024 with community pharmacists in Ontario, Canada. The intervention group was asked to complete two POCT modules using a CBE platform, while the control group was asked to review reference materials about POCTs. The primary outcome, the difference in the number of POCTs performed, was collected using monthly reports. Secondary outcomes (knowledge gain and changes in the Theory of Planned Behaviour (TPB) constructs: attitude, subjective norm, perceived behavioural control, and behaviour intention) were assessed using selfreported surveys. Generalized linear models (GLM) with negative binomial distribution were used to analyze the number of POCTs. Knowledge gain was analyzed using repeated measure ANOVA and binomial regression. TPB constructs were analyzed within groups using paired sample t-tests and between groups using two-sample ttests.

Results

Of the 261 pharmacists recruited, 201 completed the pre-study survey, 135 completed the one-week post-test, and 104 completed the three-month post-test. There was a significant difference in knowledge test scores between the two groups at one week (P = .001) and three months (P < .00). There was no significant difference in behavioural constructs between the two groups at three months. However, attitude increased significantly for both groups (intervention group 3.6 ± 0.6 Vs. 3.95 ± 0.5 P < .001; control group 3.5 ± 0.6 Vs. 3.8 ± 0.5 P < .001). There was no significant change in the number of POCTs performed after one, two, and three months for both study groups.

Conclusion

CBE improved pharmacists' knowledge of POCT but showed a limited effect on pharmacist intention or behaviour. The study highlighted that knowledge alone does not influence behaviour change. Factors such as organizational support, adequate reimbursement, and expanded practice scope (e.g., prescribing) are critical to enhance POCT implementation.

Training Hospital Nurses to Write Detailed Narratives and Describe Contributing Factors in Incident Reports: The SAFER Education Program

BACKGROUND

In high-risk industries, the primary purpose of incident reporting is to obtain insights into contributing factors. Incident reporting systems in hospitals receive numerous reports from nurses but often lack detailed, actionable information. Enriching the information captured by incident reports would facilitate local efforts to improve patient safety.

METHODS

The authors developed the Systems Approach For Event Reporting (SAFER) educational program to train nurses to (1) write detailed narratives and (2) describe contributing factors. To achieve these objectives, the research team incorporated the Situation, Background, Assessment, Recommendation (SBAR) model and the Systems Engineering Initiative for Patient Safety (SEIPS) model. The authors conducted pilot tests with nurses, made iterative refinements, then deployed SAFER on eight nursing units at an academic medical center.

RESULTS

An online learning module provides background information, a detailed curriculum leveraging SBAR and SEIPS models, interactive exercises, real-world examples of enhanced reports, and concluding information on how enhanced reporting benefits both nursing practice and patient safety. Nurses received a badge buddy-a laminated, double-sided reminder card to hang behind identification badges that reinforces key elements of SBAR and SEIPS models. In pilot testing, nurses reported that completing the module took 10 to 20 minutes, the material was clear and easy to understand, and they understood its purpose and objectives. The completion rate for implementation of SAFER online training was 88.7% (809/912 eligible nurses).

CONCLUSION

SAFER is an innovative program that introduces human factors principles to nurses and trains them to incorporate SBAR and SEIPS into incident reporting. SAFER is acceptable and feasible. Ongoing work includes testing the impact of SAFER on improving the utility of incident reports.

An Evaluation of Health Behavior Change Training for Health and Care Professionals in St. Helena

Background: Health behavior consultations support self-management if delivered by skilled practitioners. We summarize here the results of a collaborative training intervention program delivered to health and care practitioners working in a remote-island context. The program was designed to build confidence in the implementation of communication and behavior change skills and to sustain their use in work settings. The setting for the behavior change training program was the South Atlantic island of St. Helena, a remote low-middle-income country which has a population with high levels of obesity and a prevalence of long-term conditions. Objectives: We aimed to increase knowledge, confidence, and implementation of behavior change techniques (BCTs) and communication skills of health and social care staff through delivering and evaluating training using the MAP (Motivation, Action, Prompt) behavior change framework. A successful training intervention could ultimately improve self-management and patient health outcomes. Methods: Co-production with onsite representatives adapted the program for local delivery. A two-day training program was delivered face-to-face to 32 multidisciplinary staff. Pre- and post-intervention and 18-month follow-up evaluation assessed reactions, learning and implementation using multiple methods, including participant feedback and primary care patient reports. Results: Positive reactions to training and significant improvement in confidence, perceived importance, intention to use and implementation of BCTs and communication skills immediately post-training and at long-term follow-up were observed. Patient reports suggested some techniques became routinely used. Methodological difficulties arose due to staff retention and disruption through the COVID-19 pandemic. Conclusions: The delivery of health behavior change training can be effective in remote contexts with sustainable impacts on healthcare. There are challenges working in this context including staff continuity and technological reliability.

Nutrition Education and Practice in University Dental and Oral Health Programmes and Curricula: A Scoping Review

INTRODUCTION

Dentists and oral health practitioners have a potential role in supporting the prevention and management of noncommunicable diseases. However, the extent to which university education prepares practitioners to provide nutrition care is unclear. This scoping review identifies and synthesises the evidence related to university-level nutrition education provided to dental and oral health students globally.

METHODS

A scoping review identified relevant literature through search terms "dentistry," "oral health," or "oral hygiene"; "dental students" or "dental education"; "nutrition education" or "nutrition science." Articles were included that examined nutrition education in undergraduate oral health training; or nutrition knowledge, attitudes, confidence, or skills or dietary habits; experts' opinion papers; and position statements. No limitations on the publication years or languages of the articles were applied.

RESULTS

A total of 136 articles were included. Half were surveys of students (n = 49) or academic staff (n = 21). The remainder comprised reports of curriculum initiatives (n = 26), opinion papers or narrative reviews (n = 24), position statements (n = 6), curriculum development (n = 6) and curriculum guidelines (n = 9). While dental and oral health students and curriculum experts overwhelmingly recognised the importance of nutrition, most studies that assessed nutrition knowledge of students revealed limited knowledge. Students were not confident in their skills to provide nutrition care. Lack of nutrition experts on teaching teams and unclear expectations about developing nutrition competencies were identified as barriers to greater nutrition education.

CONCLUSION

Nutrition education in university dental and oral health degrees is highly variable. The potential for oral health professionals of the future to promote oral health through nutrition is unrealised.

Preparedness of Speech Language Pathologists and Occupational Therapists to Treat Pediatric Feeding Disorder: A Cross-Sectional Survey

BACKGROUND

Pediatric feeding disorder (PFD) is increasingly common and is often treated by speech language pathologists (SLPs) and occupational therapists (OTs) in the community setting. However, the preparedness of these disciplines to effectively address PFD is relatively unknown.

METHODS

A national (US), online survey was disseminated to providers who assess and treat PFD. For the present analysis, the responses of SLPs (N = 418) and OTs (N = 195) related to their clinical background, educational background, post-graduate training, and self-rated clinical effectiveness were statistically analyzed and compared across the two disciplines.

RESULTS

Both SLPs and OTs report feeling underprepared to work with PFD clients immediately following their academic training, but time spent in post-graduate training and years of clinical practice both significantly (p < 0.0001) increased feelings of effectiveness in assessing and treating PFD. Most SLPs and OTs pursued self-directed learning activities to increase competence, with the most common activities being article review, podcasts, and peer case review, although SLPs were significantly more likely to use podcasts (p < 0.0001) and peer review (p = 0.0004) than OTs. The most common barriers for providers were financial, time, travel, and institutional support barriers.

CONCLUSIONS

While PFD is a key practice area of both SLPs and OTs, both provider groups feel unprepared and under-supported in providing competent care to these patients upon graduation. Future research and policy should support advancements in training for current SLPs and OTs related to PFD and address current barriers to a specialized educational pathway.

Evaluating the Effects of Mental Health e-Learning on the Knowledge, Attitudes and Practices of Primary Healthcare Professionals in Mali. A Pilot Study

BACKGROUND

Despite their high prevalence and significant burden, mental disorders remain grossly under-diagnosed and under-treated. In low-and-middle-income countries, such as Mali, integrating mental health services into primary care is the most viable way of closing the treatment gap. The aim of this study was to assess the effects of a mental health e-learning program on the knowledge, attitudes and practices of primary healthcare professionals in Mali.

METHODS

An e-learning platform including 12 interactive modules was used to train 46 healthcare professionals. Changes in knowledge, attitudes and practices, as well as in satisfaction with knowledge and in ability to diagnose and manage patients were evaluated by comparing data collected pre and post e-learning.

OUTCOMES

Knowledge and practices scores increased significantly post e-learning for all modules, except the practices score for anxiety disorders. Similarly, scores regarding satisfaction with knowledge and ability to diagnose and manage patients increased significantly, and more so than the knowledge and practices scores. Changes in attitudes however were not significant.

CONCLUSION

Despite the difficult conditions of implementation in isolated areas of rural Mali, preliminary results suggest a positive effect of the e-learning.

E-learning Interventions for Quality Improvement Continuing Medical Education-A Scoping Review

INTRODUCTION

Improving health care quality and patient safety are top priorities for the medical field. Robust continuing medical education (CME) programs represent major interventions to effectively teach quality improvement (QI) principles to practicing physicians. In particular, eLearning, a term describing online and distance learning interventions using digital tools, provides a means for CME interventions to reach broader audiences. Although there has been a focus on CME addressing QI, no knowledge synthesis has focused specifically on eLearning interventions. The purpose of this review was to examine the current landscape of eLearning interventions in QI-focused CME.

METHODS

We conducted a scoping review using the framework developed by Arksey and O'Malley as revised by Levac. We searched five databases and identified 2467 prospective publications, which two authors independently screened for inclusion. From each included article, two authors independently extracted data on the instructional modalities and QI tools used and met regularly to achieve consensus.

RESULTS

Twenty-one studies were included. Most studies used blended instruction ( n = 12) rather than solely eLearning interventions. Salient findings included the importance of coaching from QI experts and institutional support for planning and implementing eLearning interventions. Lack of protected time and resources for participants were identified as barriers to participation in CME activities, with small practices being disproportionately affected.

DISCUSSION

Partnerships between CME developers and sponsoring organizations are vital in creating sustainable eLearning interventions for QI-focused CME. Remote coaching can be an effective strategy to provide ongoing support to geographically separated learners.

Optimizing e-Learning in CPD: Preferences and Perceptions of Health Professionals

INTRODUCTION

Continuing professional development for health professionals increasingly relies on e-learning. However, there is insufficient research into the instructional strategies health professionals prefer to engage with in e-learning. An empirical study was undertaken to answer the research question: What instructional strategies do learners prefer in e-learning modules to improve their learning experience?

METHODS

The Department of Health Professions Education at the Uniformed Services University of Health Sciences developed six, stand-alone, self-paced modules for health professionals focusing on education and leadership. The module evaluation survey consisted of six Likert scale questions and two open-ended questions. Responses from these anonymized module evaluations from 2019 to 2022 were analyzed. Descriptive statistics for the Likert scale questions were calculated. Responses to the two open-ended questions were compiled and analyzed thematically.

RESULTS

All survey respondents found the content of the modules helpful and met their stated learning objectives. A majority (94%) agreed or strongly agreed that readings and videos increased their knowledge in the topic area and that quizzes effectively strengthened their understanding of the topics. Four themes emerged from the qualitative data: pedagogical strategies, technology issues, feedback and interaction, and transfer of learning.

CONCLUSIONS

This study foregrounds the voice of the learner, which emphasizes health professionals' preference for instructional strategies that align with their needs as adult learners. The findings highlight the value of content relevance, expert creation, and authentic examples in enhancing learner satisfaction.

Unleashing leadership potential in unprecedented times: Lessons learned from an evaluation of a virtual cohort-based adaptive leadership program for public health executives

Objectives

This paper presents the evaluation results from the Adaptive Leadership Academy (ALA), a pilot program aimed at developing executive-level leaders in public and community health.

Study design

Mixed methods study.

Methods

The evaluation followed the Kirkpatrick Model to assess program participants' satisfaction with the training, knowledge and skill gain, and behavior change. Data were collected beginning in December 2021 through August 2022 from 20 program participants via online surveys and key informant interviews.

Results

The findings indicated that ALA helped participants improve their leadership knowledge, skills, and capabilities. In particular, the study highlighted the effectiveness of cohort-based leadership development programs using adaptive leadership as the foundation for the curriculum. Participants found the cohort-based model and synchronous components particularly useful in creating a supportive environment in which to be vulnerable and grow.

Conclusions

Overall, the evaluation provided evidence that the ALA pilot enhanced leadership knowledge, skills, and capabilities. The findings support the use of adaptive leadership as a framework for leadership development programs in the public health sector.

Adapting and testing an eLearning resource for professionals to support families when a significant caregiver for children is dying with cancer

PURPOSE

Health and social care professionals (professionals) often lack knowledge, skills and confidence to support adults at end of life with significant caregiving responsibilities for children, < 18. A recent systematic review highlighted a dearth of educational interventions (n = 2) to equip professionals to provide supportive care to families when a parent has cancer. Addressing an evident gap in education, this paper details the adaption and optimisation of a face-to-face educational intervention to an accessible eLearning resource.

METHODS

Guided by the 'Person-based Approach', a theory-driven and evidence-based face-to-face educational intervention was adapted and optimised as an eLearning resource. This incorporated current evidence, alongside insights from an expert group, learning technologists and research team, leading to the design of an eLearning prototype. This was optimised for acceptability and usability using think-aloud interviews with end-users (n = 13) and patient and public involvement (n = 4).

RESULTS

An iterative adaption and optimisation process enabled implementation of navigational improvements, changes to enhance clarity on language and appropriateness of images and interactive components. During optimisation, positive feedback was reported; especially regarding the 'look and feel' and on the educational videos and reflective exercises embedded throughout the eLearning resource.

CONCLUSION

The systematic adaption and optimisation of this novel eLearning resource has aimed to promote relevance, appropriateness, and applicability of an accessible evidence-based and theory-driven training resource for professionals. It has the potential to promote family-centred supportive end of life cancer care, which ultimately can promote better bereavement outcomes. An evaluation of the intervention is required to explore impact on practice.

Capacity-Building Through Digital Approaches: Evaluating the Feasibility and Effectiveness of eLearning to Introduce Subcutaneous DMPA Self-Injection in Senegal and Uganda

Training health workers is one of the biggest challenges and cost drivers when introducing a new contraceptive method or service delivery innovation. PATH developed a digital training curriculum for family planning providers who are learning to offer subcutaneous DMPA (DMPA-SC), including through self-injection, as an option among a range of contraceptive methods. The DMPA-SC eLearning course for health workers includes 10 lessons with an emphasis on informed choice counseling and training clients to self-inject. In partnership with Ministries of Health in Senegal and Uganda, the course was rolled out in select areas in 2019-2020, including during the COVID-19 pandemic when physical distancing requirements restricted in-person training. We conducted evaluations in both countries to assess the practical application of this digital training approach for contraceptive introduction. The evaluation consisted of a post-training survey, an observational assessment conducted during post-training supportive supervision, and an estimation of training costs.In both countries, a majority (88.6% in Uganda and 64.3% in Senegal) scored above 80% on a DMPA-SC knowledge test following the training. In Senegal, where there was a comparison group of providers trained in person, those providers scored similar on the post-test to eLearners. Providers in both groups and in both countries felt more prepared to administer DMPA-SC or offer self-injection to clients after receiving a supervision visit (93%-98% of eLearners felt very prepared after supervision as compared to 45%-72% prior). The evaluation results suggest that digital approaches offer a number of benefits, can be cost-effective, and are most optimal when blended with in-person training and/or supportive supervision.

Scaling up! Staff e-learning for a national take-home naloxone program

Background

A staff e-learning course was developed to prepare for scaling up a national take-home naloxone (THN) program in Norway. The aims of the study were to (a) describe participant characteristics for those that completed a THN e-learning course, (b) compare opioid overdose knowledge scores before and after e-learning course completion, and (c) to explore subsequent THN distribution by those trained.

Methods

This was a quasi-experimental pre-test, post-test longitudinal cohort study of individuals completing a THN e-learning course from April 2021 to May 2022. Frequency analyses were performed for participant characteristics and subsequent naloxone distributions at 1-week and 1-month follow-up. The opioid overdose knowledge scale (OOKS) was used to measure pre-test-post-test knowledge among participants. Wilcoxon signed-rank test was performed for comparison between pre-test and post-test. Effect size was calculated using Cohen criteria.

Results

In total, 371 individuals were included in this study. Most were either nurses or social workers (n = 277, 75%). Participant knowledge increased by medium or large effect for all items measured. At 1-month follow-up, 15% reported naloxone distribution. During the study period, 94 naloxone kits were distributed. Major reasons for not distributing were "clients not interested", "workplace not distributing" and "workplace in process of distributing".

Conclusions

Our findings suggest that an e-learning course is equally effective in terms of knowledge transfer as an in-person classroom setting, and may provide engagement in terms of naloxone distribution. However, our findings also emphasize the importance of clear implementation routines, including support from central coordinators to optimize the implementation process.

New method for autonomous learning of BLS psychomotor skills: Pillow mannequin: Randomized controlled study

BACKGROUND

Evidence supporting the benefits of autonomous learning of basic life support, such as rapid outcomes and cost-effectiveness, is increasing. Reports supporting the autonomous learning of cognitive skills in basic life support exist. However, there is currently no report supporting the autonomous learning of psychomotor skills in basic life support.

AIM

This study aimed to assess how using a research-developed pillow-made mannequin affects autonomous learning of psychomotor skills in basic life support training.

DESIGN

Randomized controlled trial.

SETTING

This study was conducted in a nursing school in Turkey.

PARTICIPANTS

Sixty-one (n = 61) third-year formal science undergraduate students.

METHODS

At XXX University, 61 nursing students were divided into Intervention (n = 31) and Control Groups (n = 30). Students in both groups received basic life support training, including live demonstrations. Intervention Group students practiced with the mannequin for 15 days. Skill assessments were conducted by two independent evaluators using a real mannequin 15 days later and six months later. Researchers used a checklist to assess psychomotor skills.

RESULTS

The sociodemographic characteristics of both student groups were similar. There was no significant difference in cognitive knowledge levels after the blended training (p > 0.05). However, at both post-intervention assessments, after 15 days and after 6 months, significant skill differences emerged in "placing the index finger on the ends of the sternum," "combining the thumbs in the middle," "defining the lower sternum as a massage point," "placing the base of the chest" "placing the weaker hand at the massage point," "placing the body perpendicular to the ribcage," and "performing 30 compressions." Cohen's kappa value was calculated as 0.932.

CONCLUSION

Use of the mannequin facilitates autonomous learning of psychomotor skills and promotes accurate application.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT05346003, 08/02/2022.

Evaluation of the impact of an online video game as an educational intervention on sexual health and the prevention, diagnosis, and treatment of sexually transmitted infection: A randomized controlled trial protocol

BACKGROUND

The incidence of sexually transmitted infections (STIs) is increasing, especially among young people. Tools are needed to increase knowledge about sex education and STI prevention and treatment. Gamification can be a good training tool for both young people and health professionals. The primary objective of this study is to assess the impact of a training intervention on STI prevention, detection, and treatment in primary care professionals.

METHODS/DESIGN

Multicentre cluster randomized controlled trial. Groups of primary care professionals will receive an intervention (online video game on sex education and STIs [SEXIT]) and will be compared with control groups that will not receive the intervention. Group assignments will be randomized by clusters. The study will consist of a pre-post evaluation of the intervention: a knowledge test will be administered before and after the intervention and 3 months after the intervention. This test will also be carried out on the same time sequence in the control groups. The impact of the training intervention will be assessed over a 6-month period, focusing on various variables associated with the clinical management of STIs. This evaluation entails the clinical records of diagnostic tests and antibiotic prescriptions related to the clinical approach to STIs. The required sample size is 262 (131 per group).

DISCUSSION

Compared with those in the control group, improvements in knowledge and clinical behavioural outcomes after the intervention are expected for participants in the intervention groups. We plan to develop an educational video game to increase the knowledge about sexuality, STIs and violence. Protocol registered at ISRCTN with reference number ISRCTN17783607.

Training approaches for the dissemination of clinical guidelines for NSSI: a quasi-experimental trial

BACKGROUND

Non-suicidal self-injury (NSSI) is of high clinical relevance due to its high prevalence and negative long-term implications. In 2016, the German consensus-based clinical guidelines for diagnostic, assessment and treatment of NSSI in childhood and adolescence were published. However, research indicates that clinical guidelines are often poorly implemented in clinical practice. One crucial part of this process is the training of healthcare professionals to transfer knowledge and capacities to bring guideline recommendations into clinical practice.

METHODS

The effect of three different dissemination strategies (printed educational material, e-learning, and blended-learning) on the NSSI guidelines´ recommendations was examined among 671 physicians and psychotherapists via an online-survey. The quasi-experimental study included three measurement points (before the training, after the training, 3-month follow-up) and mixed effects models were used to test for changes in knowledge, competences and attitudes toward NSSI and treatment. Moreover, the transfer of gained competences to practical work and user satisfaction were reviewed.

RESULTS

With all three training formats, the intended changes of the outcome variables could be observed. Hereby, the printed educational material condition showed the lowest improvement in the scores for the 'negative attitudes toward NSSI and those who self-injure'. The training effect remained stable throughout the follow-up measurement. The highest application rate of acquired intervention techniques in clinical practice was reported for the blended-learning condition. For all three training strategies, user satisfaction was high and evaluation of training quality was positive, with printed educational material receiving the lowest and blended-learning the highest evaluations.

CONCLUSIONS

In summary, all three training formats were perceived to be of high quality and seem to be suited to cover the needs of a heterogeneous group of physicians and psychotherapists. The choice of training method could be driven by considering which training goals are desired to be achieved and by the benefit-cost ratio allowing for tailored training approaches.

An Approach to the Design and Development of an Accredited Continuing Professional Development e-Learning Module on Virtual Care

Unlabelled

Virtual care appointments expanded rapidly during COVID-19 out of necessity and to enable access and continuity of care for many patients. While previous work has explored health care providers' experiences with telehealth usage on small-scale projects, the broad-level adoption of virtual care during the pandemic has expounded opportunities for a better understanding of how to enhance the integration of telehealth as a regular mode of health care services delivery. Training and education for health care providers on the effective use of virtual care technologies are factors that can help facilitate improved adoption and use. We describe our approach to designing and developing an accredited continuing professional development (CPD) program using e-learning technologies to foster better knowledge and comfort among health care providers with the use of virtual care technologies. First, we discuss our approach to undertaking a systematic needs assessment study using a survey questionnaire of providers, key informant interviews, and a patient focus group. Next, we describe our steps in consulting with key stakeholder groups in the health system and arranging committees to inform the design of the program and address accreditation requirements. The instructional design features and aspects of the e-learning module are then described in depth, and our plan for evaluating the program is shared as well. As a CPD modality, e-learning offers the opportunity to enhance access to timely continuing professional education for health care providers who may be geographically dispersed across rural and remote communities.

The effects of profession-related films on the professional pride of nursing students: A randomised controlled trial

AIM

This study aimed to determine the effects of profession-related films on the professional pride of nursing students.

DESIGNS

The study was conducted with a randomised controlled experimental design.

METHODS

The sample of the study consisted of 102 students enrolled in the first year of the School of Nursing, Zonguldak Bulent Ecevit University in Türkiye in the 2022-2023 academic year. These students were randomly assigned to the experimental (n = 57) and control (n = 45) groups. The experimental group watched two documentaries and a film on YouTube with a one-week break. Self-administered online questionnaires were distributed via WhatsApp groups for pretests and posttests. Data were collected with a "Sociodemographic Data Form" and the "Nursing Professional Pride Scale (NPPS)" included in the questionnaire forms prepared on the Google Forms platform. Data were analysed using Spearman's rho, the Mann-Whitney U Test, and the Wilcoxon Signed-Rank Test.

RESULTS

The mean age of the participants was 18.80 ± 0.99 years, 80% of the participants were female, the place where 79.4% had lived for the longest duration in their lives was the city, 85.3% had information about the profession of nursing before they started university (36.8% from the internet, 34.6% from people around them). The experimental group had significantly higher NPPS scores than the control group after the intervention (p = 0.017). There was also a significant increase in the dimensions of professional feeling (p = 0.012) and desire to continue the profession in the experimental group (p = 0.002).

PATIENT OR PUBLIC CONTRIBUTION

Patients and public were not involved in this research.

An exploration of organizational climate in community-based opiate prescribing services; a mixed methods study

INTRODUCTION

Assessing the internal dynamics of organizations has been shown to provide information that can help planners and policymakers improve service delivery. A good organizational climate, which in this study incorporates mission clarity, team cohesion, staff autonomy, communication, levels of stress, and openness to change has been shown to be of particular importance. Still, there is a dearth of evidence in this area, and while relationships between organizational factors have been identified, little is known about the mechanisms that might underpin these relationships, and there is little understanding of how to address deficits once they are identified. The objective of this study was to identify relationships between program factors that influence organizational climate and to explore which mechanisms might underpin these relationships.

METHODS

This paper reports on a cross-sectional, concurrent, mixed-methods study design, across twelve discrete community-based prescribing service providers (organizations) in Ireland. Data was obtained using a staff survey [n = 132] which utilized measurements of organizational readiness to change and one-to-one interviews [n = 12]. Quantitative data was analyzed using multivariate linear regression modeling which assessed relationships between variables, while interviews were analyzed using an abductive approach, both types of data were synthesized at the interpretation stage.

RESULTS

A range of interdependent factors were considered to affect the climate of organizations. Surveys identified that specific types of resources, such as physical infrastructure, training, and staffing resources were important for supporting a good organizational climate, while programs with greater needs had a poorer climate. Opportunities for professional growth, the skill sets of staff, and having access to e-communication were also significant. Interviewees reported that rigid organizational hierarchies and bureaucracy, philosophical views of addiction, stress, and staff turnover were influenced by the provision of fewer resources. Interdependent factors such as leadership, supervision, staff relationships, and collective training, also thought to be influenced by resources, were considered to positively influence programs. Resources were not the only challenge identified, and practices within programs and how existing resources are used were also thought to contribute both positively and negatively to the internal dynamics of services.

CONCLUSION

Key findings in this study identified that the organization of effective services is influenced by a range of specific factors, some of which can be addressed without additional resources. Overall, staff views of organizations can provide us with valuable information to support service improvement. Using a mixed methods approach can not only identify where relationships between organizational variables exist but can also help us to understand the mechanisms that underpin these relationships and, importantly, how to address deficits once they are identified. In order to improve how substance misuse services work, the need for a long-term systemic approach to program development, which incorporates some of the findings from this study, is required.

How does training format and clinical education model impact fidelity and confidence in a speech-language pathology rotation?

Clinical education rotations typically involve an initial training phase followed by supervised clinical practice. However, little research has explored the separate contributions of each component to the development of student confidence and treatment fidelity. The dual purpose of this study was to compare the impact of clinical training format (synchronous vs. asynchronous) and education model (traditional vs. collaborative) on student confidence and treatment fidelity. Thirty-six speech-language pathology graduate students completed this two-phase study during a one-term clinical rotation. Phase 1 investigated the impact of training condition (synchronous, asynchronous guided, asynchronous unguided) on student confidence and treatment fidelity. Phase 2 explored the impact of education model (traditional vs. collaborative) on student confidence and treatment fidelity. Treatment fidelity was measured at the conclusion of Phases 1 and 2. Students rated their confidence at six-time points throughout the study. Our results indicate that training condition did not differentially impact student confidence or treatment fidelity; however, education model did: students in the collaborative education model reported increased confidence compared to students in the traditional education model. Students in the collaborative education model also trended towards having higher treatment fidelity than students in the traditional education model. These results demonstrate that pre-clinical trainings can be effective in several different formats provided they cover the discrete skills needed for the clinical rotation. While preliminary, our results further suggest that students may benefit from working with peers during their clinical rotations.

Effectiveness of early diagnosis of cerebral palsy guideline implementation: a systematic review

INTRODUCTION

Tailored implementation interventions are required to overcome the diagnostic research-practice gap for cerebral palsy (CP). Evaluating the impact of interventions on patient outcomes is a priority. This review aimed to summarize the established evidence for the effectiveness of guideline implementations in lowering the age of CP diagnosis.

EVIDENCE ACQUISITION

A systematic review was conducted according to PRISMA. CINAHL, Embase, PubMed and MEDLINE were searched (2017-October 2022). Inclusion criteria were studies that evaluated effect of CP guideline interventions on health professional behaviour or patient outcomes. GRADE was used to determine quality. Studies were coded for use of theory (Theory Coding Scheme). Meta-analysis was performed and a standardized metric used to summarize statistics of intervention effect estimates.

EVIDENCE SYNTHESIS

Of (N.=249) records screened, (N.=7) studies met inclusion, comprising interventions following infants less than 2 years of age with CP risk factors (N.=6280). Guideline feasibility in clinical practice was established through health professional adherence and patient satisfaction. Efficacy of patient outcome of CP diagnosis by 12 months of age was established in all studies. Weighted averages were: (1) high-risk of CP (N.=2) 4.2 months and (2) CP diagnosis (N.=5) at 11.6 months. Meta-analysis of (N.=2) studies found a large, pooled effect size Z = 3.00 (P=0.003) favoring implementation interventions lowering age of diagnosis by 7.50 months, however study heterogeneity was high. A paucity of theoretical frameworks were identified in this review.

CONCLUSIONS

Multifaceted interventions to implement the early diagnosis of CP guideline are effective in improving patient outcomes by lowering the age of CP diagnosis in high-risk infant follow-up clinics. Further targeted health professional interventions including low-risk infant populations are warranted.

The Primary Care and Environmental Health e-Learning Course to Integrate Environmental Health in General Practice: Before-and-After Feasibility Study

BACKGROUND

Environmental and behavioral factors are responsible for 12.6 million deaths annually and contribute to 25% of deaths and chronic diseases worldwide. Through the One Health initiative, the World Health Organization and other international health organizations plan to improve these indicators to create healthier environments by 2030. To meet this challenge, training primary care professionals should be the priority of national policies. General practitioners (GPs) are ready to become involved but need in-depth training to gain and apply environmental health (EH) knowledge to their practice. In response, we designed the Primary Care Environment and Health (PCEH) online course in partnership with the Occitanie Regional Health Agency in France. This course was used to train GP residents from the Montpelier-Nimes Faculty of Medicine in EH knowledge. The course was organized in 2 successive parts: (1) an asynchronous e-learning modular course focusing on EH knowledge and tools and (2) 1 day of face-to-face sessions.

OBJECTIVE

This study assessed the impact of the e-learning component of the PCEH course on participants' satisfaction, knowledge, and behavior changes toward EH.

METHODS

This was a pilot before-and-after study. Four modules were available in the 6-hour e-learning course: introduction to EH, population-based approach (mapping tools and resources), clinical cases, and communication tools. From August to September 2021, we recruited first-year GP residents from the University of Montpellier (N=130). Participants' satisfaction, knowledge improvements for 19 EH risks, procedure to report EH risks to health authorities online, and behavior change (to consider the possible effects of the environment on their own and their patients' health) were assessed using self-reported questionnaires on a Likert scale (1-5). Paired Student t tests and the McNemar χ2 test were used to compare quantitative and qualitative variables, respectively, before and after the course.

RESULTS

A total of 74 GP residents completed the e-learning and answered the pre- and posttest questionnaires. The mean satisfaction score was 4.0 (SD 0.9) out of 5. Knowledge scores of EH risks increased significantly after the e-learning course, with a mean difference of 30% (P<.001) for all items. Behavioral scores improved significantly by 18% for the participant's health and by 26% for patients' health (P<.001). These improvements did not vary significantly according to participant characteristics (eg, sex, children, place of work).

CONCLUSIONS

The e-learning course improved knowledge and behavior related to EH. Further studies are needed to assess the impact of the PCEH course on clinical practice and potential benefits for patients. This course was designed to serve as a knowledge base that could be reused each year with a view toward sustainability. This course will integrate new modules and will be adapted to the evolution of EH status indicators and target population needs.

E-learning-an interventional element of the PRiVENT project to improve weaning expertise

BACKGROUND

PRiVENT (PRevention of invasive VENTilation) is an evaluation of a bundle of interventions aimed at the prevention of long-term invasive mechanical ventilation. One of these elements is an e-learning course for healthcare professionals to improve weaning expertise. The aim of our analysis is to examine the implementation of the course in cooperating intensive care units.

METHODS

The course has been developed through a peer review process by pulmonary and critical care physicians in collaboration with respiratory therapists, supported by health services researchers and a professional e-learning agency. The e-learning platform "weLearn" was made available online to participating healthcare professionals. Feedback on the e-learning programme was obtained and discussed in quality circles (QCs). We measured the acceptance and use of the programme through access statistics.

RESULTS

The e-learning course "Joint Prevention of Long-Term Ventilation" consists of 7 separate modules with practice-oriented training units as well as a cross-module area and corresponding interactive case studies. Users can receive 23 CME (continuing medical education) credits. The platform was released on July 1, 2021. By June 28, 2023, 214 users from 33 clinics had registered. Most users (77-98%) completed the modules, thus performing well in the test, where 90-100% passed. In the QCs, the users commended the structure and practical relevance of the programme, as well as the opportunity to earn CME credits.

CONCLUSION

Especially for medical staff in intensive care units, where continuous training is often a challenge during shift work, e-learning is a useful supplement to existing medical training.

TRIAL REGISTRATION

The PRiVENT study is registered at ClinicalTrials.gov (NCT05260853) on 02/03/2022.

Adapting TeachABI to the local needs of Australian educators - a critical step for successful implementation

Background The present study is the foundational project of TeachABI-Australia , which aims to develop and implement an accessible, nation-wide digital resource for educators to address their unmet acquired brain injury (ABI)-related professional learning needs. The aim of the present study was to identify the adaptations required to improve the suitability and acceptability of the TeachABI professional development module within the Australian education system from the perspectives of Australian educators. Methods The research design employed an integrated knowledge translation approach and followed the ADAPT Guidance for undertaking adaptability research. A purposive sample of eight educators eligible to teach primary school in Australia provided feedback on the module through a quantitative post-module feedback questionnaire and a qualitative semi-structured interview. Results Participants rated the acceptability of the module as 'Completely Acceptable ' (Mdn  = 5, IQR = 1), and reported 'only Minor' changes were required (Mdn  = 2, IQR = 0.25) to improve the suitability to the Australian context. Qualitative analysis of transcripts revealed three broad categories: (1) the usefulness of TeachABI , (2) the local fit of TeachABI , and (3) pathways for implementing TeachABI in the local setting. Recommended adaptations to the module collated from participant feedback included changes to language, expansion of content, and inclusion of Australian resources, legislation, and videos. Conclusions TeachABI is acceptable to Australian educators but requires modifications to tailor the resource to align with the unique schooling systems, needs, and culture of the local setting. The systematic methodological approach to adaptation outlined in this study will serve as a guide for future international iterations of TeachABI .

Implementing adaptive e-learning for newborn care in Tanzania: an observational study of provider engagement and knowledge gains

INTRODUCTION

To improve healthcare provider knowledge of Tanzanian newborn care guidelines, we developed adaptive Essential and Sick Newborn Care (aESNC), an adaptive e-learning environment. The objectives of this study were to (1) assess implementation success with use of in-person support and nudging strategy and (2) describe baseline provider knowledge and metacognition.

METHODS

6-month observational study at one zonal hospital and three health centres in Mwanza, Tanzania. To assess implementation success, we used the Reach, Efficacy, Adoption, Implementation and Maintenance framework and to describe baseline provider knowledge and metacognition we used Howell's conscious-competence model. Additionally, we explored provider characteristics associated with initial learning completion or persistent activity.

RESULTS

aESNC reached 85% (195/231) of providers: 75 medical, 53 nursing and 21 clinical officers; 110 (56%) were at the zonal hospital and 85 (44%) at health centres. Median clinical experience was 4 years (IQR 1-9) and 45 (23%) had previous in-service training for both newborn essential and sick newborn care. Efficacy was 42% (SD ±17%). Providers averaged 78% (SD ±31%) completion of initial learning and 7% (SD ±11%) of refresher assignments. 130 (67%) providers had ≥1 episode of inactivity >30 day, no episodes were due to lack of internet access. Baseline conscious-competence was 53% (IQR: 38%-63%), unconscious-incompetence 32% (IQR: 23%-42%), conscious-incompetence 7% (IQR: 2%-15%), and unconscious-competence 2% (IQR: 0%-3%). Higher baseline conscious-competence (OR 31.6 (95% CI 5.8 to 183.5)) and being a nursing officer (aOR: 5.6 (95% CI 1.8 to 18.1)), compared with medical officer, were associated with initial learning completion or persistent activity.

CONCLUSION

aESNC reach was high in a population of frontline providers across diverse levels of care in Tanzania. Use of in-person support and nudging increased reach, initial learning and refresher assignment completion, but refresher assignment completion remains low. Providers were often unaware of knowledge gaps, and lower baseline knowledge may decrease initial learning completion or activity. Further study to identify barriers to adaptive e-learning normalisation is needed.

Satisfaction with asynchronous e-learning: An exploratory factor analysis of the Learner Satisfaction with Asynchronous e-Learning (LSAeL) instrument

AIM

To describe the development and psychometric testing of the Learner Satisfaction with Asynchronous e-Learning (LSAeL) instrument.

BACKGROUND

Existing satisfaction with e-learning instruments may not accurately evaluate learner satisfaction with constructs associated with asynchronous e-learning.

DESIGN

Methodological study.

METHODS

Content, face and construct validity of the instrument were evaluated using a two-stage process. A five-member expert panel evaluated the instrument's content and face validity. A content validity index and a modified kappa co-efficient was used to calculate the content validity of individual test items and the global instrument and to adjust for chance agreement between raters. These data were then reviewed and individual items were removed, retained or refined accordingly. Using an empirically informed wholly asynchronous e-learning program 237 nursing students from a regional university in New South Wales, Australia completed the 35 item LSAeL instrument. An exploratory factor analysis (EFA) was then conducted to explore the dimensionality of the instrument.

RESULTS

Exploratory factor analysis identified a seven-factor solution with 30 items, explaining an 86.1% of the total variance, was the best fit for the data.

CONCLUSION

The study demonstrates that the construct validity of the LSAeL instrument is acceptable. Instrument development is an iterative process and further testing with other cohorts and in other settings is required.

The Development and Implementation of an Evidence-Based Tumescent Liposuction Protocol, Online Educational Course for Perioperative Staff, and Discharge Instructions: A Quality Improvement Project

PURPOSE

The purpose of this quality improvement project was to improve perioperative management of patients undergoing tumescent liposuction (TL) through the development and implementation of a perioperative evidence-based protocol, educational course for perioperative staff, and patient discharge instructions.

DESIGN

The TL protocol was validated using the modified Delphi process. The educational course and discharge instructions used a pre and postimplementation design.

METHODS

An evidence-based protocol, an educational course for perioperative staff, and readable discharge instructions for patients undergoing TL were developed in accordance with best practice guidelines. The protocol was validated by subject matter experts at the facility and submitted for adoption. The evidence-based educational course was implemented, and the effectiveness of the course was evaluated for improving providers' knowledge and self-confidence. The evidence-based discharge instructions were implemented and evaluated for patient satisfaction and readability.

FINDINGS

Three items were removed from the protocol, 2 items were modified, and 25 items were accepted with no change from modified Delphi analysis. Provider knowledge scores improved from 85.7% ± 16.18 to 97.1% ± 4.88; however, this was not statistically significant (P = .066). There was a trend toward improved confidence scores (P = .180). Overall patient satisfaction scores slightly improved postimplementation; results were not statistically significant (P > .05).

CONCLUSIONS

All three phases of perioperative care in patients receiving TL were evaluated, reflecting best practice guidelines and successful adoption. There was no statistically significant improvement in provider knowledge, provider self-confidence, or patient satisfaction. A small sample size was a significant limiting factor.

Designing and Developing Online Training for Diabetes Prevention Program Coaches Using an Integrated Knowledge Translation Approach: Development and Usability Study

BACKGROUND

e-Learning has rapidly become a popular alternative to in-person learning due to its flexibility, convenience, and wide reach. Using a systematic and partnered process to transfer in-person training to an e-learning platform helps to ensure the training will be effective and acceptable to learners.

OBJECTIVE

This study aimed to develop an e-learning platform for Small Steps for Big Changes (SSBC) type 2 diabetes prevention program coaches to improve the viability of coach training.

METHODS

An integrated knowledge translation approach was used in the first 3 stages of the technology-enhanced learning (TEL) evaluation framework to address the study objective. This included three steps: (1) conducting a needs analysis based on focus groups with previously trained SSBC coaches, meetings with the SSBC research team, and a review of research results on the effectiveness of the previous in-person version of the training; (2) documenting processes and decisions in the design and development of the e-learning training platform; and (3) performing usability testing. Previously trained SSBC coaches and the SSBC research team were included in all stages of this study.

RESULTS

Step 1 identified components from the in-person training that should be maintained in the e-learning training (ie, a focus on motivational interviewing), additional components to be added to the e-learning training (ie, how to deliver culturally safe and inclusive care), and mode of delivery (videos and opportunities to synchronously practice skills). Step 2 documented the processes and decisions made in the design and development of the e-learning training, including the resources (ie, time and finances) used, the content of the training modules, and how coaches would flow through the training process. The design and development process consisted of creating a blueprint of the training. The training included 7 e-learning modules, the learning modalities of which included narrated demonstration videos and user-engaging activities, a mock session with feedback from the research team, and a final knowledge test. Step 3, usability testing, demonstrated high levels of learnability, efficiency, memorability, and satisfaction, with minor bugs documented and resolved.

CONCLUSIONS

Using an integrated knowledge translation approach to the technology-enhanced learning evaluation framework was successful in developing an e-learning training platform for SSBC coaches. Incorporating end users in this process can increase the chances that the e-learning training platform is usable, engaging, and acceptable. Future research will include examining the satisfaction of coaches using the SSBC coach e-learning training platform, assessing coach learning outcomes (ie, knowledge and behavior), and estimating the cost and viability of implementing this training.

Using a mobile application to reduce potentially inappropriate prescribing for older Brazilian adults in primary care: a triple-blind randomised clinical trial

BACKGOUND

Potentially inappropriate prescribing (PIP) has been evaluated in several countries, and several strategies have been devised for deprescribing drugs in older adults. The aim of this study was to evaluate the efficacy of a mobile application in reducing PIP for older adults in primary care facilities in Brazil.

METHODS

This randomised, triple-blind, parallel-group trial was conducted in 22 public primary care facilities in Brazil. During the intervention phase, the general practitioners (GPs) were randomly allocated to the intervention (MPI Brasil app provides information about PIP, therapeutic alternatives and deprescribing) or control (MedSUS app provides general information about medications) group. All GPs were trained on the Clinical Decision-Making Process and how to access an Evidence-Based Health website. The GPs received an Android tablet with an installed mobile application depending on their allocated group, which they used when caring for older patients over at least 3 months. At the end of this period, a sample of older patients aged ≥ 60 years who had been awaiting medical consultation by the participating GPs were interviewed and their prescriptions analysed. The primary outcome was the frequency of PIP in and between the groups.

RESULTS

Among 53 GPs who were administered the baseline survey, 14 were included in the clinical trial. At baseline, 146 prescriptions were analysed: the PIP overall was 37.7% (55/146), in the intervention group was 40.6% (28/69), and in the control group was 35.1% (27/77). After the intervention, 284 prescriptions were analysed: the PIP overall was 31.7% (90/284), in the intervention group was 32.2% (46/143), and in the control group was 31.2% (44/141) (RR: 1.16; 95% CI, 0.76-1.76). In the within-group analysis, the PIP reduced from before to after the intervention in both groups-more significantly in the intervention than in the control group (p < 0.001). In the stratified analysis of PIP frequency by GPs, there was a relative risk reduction in 86% (6/7) of GPs in the intervention group compared to 71% (5/7) in the control group.

CONCLUSION

We found that the MPI Brasil app effectively reduced PIP, suggesting that it may be useful to incorporate this tool into clinical practice.

TRIAL REGISTRATION

The study was registered at ClinicalTrials.gov (NCT02918643). First registration on 22/09/2016.

A prospective observational evaluation of an online health care professional training program to promote healthy pregnancy weight gain

ISSUE ADDRESSED

A lack of programs to develop clinician knowledge and confidence to address weight gain within pregnancy is a barrier to the provision of evidence-based care.

AIM

To examine the reach and effectiveness of the Healthy Pregnancy Healthy Baby online health professional training program.

METHODS

A prospective observational evaluation applied the reach and effectiveness elements of the RE-AIM framework. Health professionals from a range of disciplines and locations were invited to complete questionnaires before and after program completion assessing objective knowledge and perceived confidence around aspects of supporting healthy pregnancy weight gain, and process measures.

RESULTS

There were 7577 views across all pages over a year period, accessed by participants across 22 Queensland locations. Pre- and post- training questionnaires were completed 217 and 135 times, respectively. The proportion of participants with scores over 85% and of 100% for objective knowledge was higher post training (P ≤ .001). Perceived confidence improved across all areas for 88%-96% of those who completed the post- training questionnaire. All respondents would recommend the training to others.

CONCLUSIONS

Clinicians from a range of disciplines, experience and locations accessed and valued the training, and knowledge of, and confidence in delivering care to support healthy pregnancy weight gain improved after completion. SO WHAT?: This effective program to build the capacity of clinicians to support healthy pregnancy weight gain offers a model for online, flexible training highly valued by clinicians. Its adoption and promotion could standardise the support provided to women to encourage healthy weight gain during pregnancy.

Dental Students' Perceptions Towards E-learning in Comparison With Traditional Classroom Learning

INTRODUCTION

Electronic learning (e-learning) has evolved into a popular educational approach since the coronavirus disease 2019 (COVID-19) pandemic. While this represents an additional model for teaching, traditional classroom learning fosters the development of interpersonal skills and enables students to share and discuss specific topics. However, existing research on the comparison of both these modes of learning in the field of dental education is inadequate. This study aimed to evaluate the perceptions of dental students towards both electronic and classroom learning.

METHODS

A cross-sectional questionnaire-based survey was conducted between November 2022 and January 2023 among dental students in Saudi Arabia. Students were questioned on their comparative perceptions of e-learning and classroom learning before, during, and after the COVID-19 pandemic. Questionnaire responses, including demographic data, were collected and tabulated, using electronic data management software. The tabulated data were analyzed to provide descriptive statistics and compare electronic and classroom learning with demographic variables and previous experience with e-learning.

RESULTS

Most respondents reported possessing average information technology (IT) skills and prior experience with e-learning. Blackboard Learning Management System (LMS) (Reston, VA: Blackboard Inc.), Zoom (San Jose, CA: Zoom Video Communications Inc.), and Microsoft Teams (Redmond, WA: Microsoft Corporation) were the most commonly used and advantageous e-learning platforms. While the majority of participants found both methods acceptable for problem-based learning sessions and theoretical lectures, they reported e-learning to be less effective than classroom learning for clinical and practical sessions. Regarding e-learning as a preferred method over classroom learning, most responses were "neutral" or "uncertain." Comparing the mean ranks of the ordinal responses for the different teaching methodologies and the nominal responses for e-learning as the preferred method, no statistically significant interactions were observed for demographic characteristics, IT-skill levels, or prior experience with e-learning.

CONCLUSION

Although enhanced performance and learning capacity are enabled through e-learning, the advantages of personal interactions and the feasibility of practical and clinical dental sessions are achieved only through classroom learning.

Effectiveness of E-learning on clinical application of dental injection anatomy via simulation manikins

PURPOSE

E-learning is frequently integrated into dental education, yet little is known on the effectiveness of e-learning in both instilling foundational knowledge and facilitating translation of newly acquired knowledge and skill into clinical application. The objective of this study was to investigate the impact of learning modality on acquisition of knowledge and translation to clinical skill using objective feedback from oral anesthesia manikins and subjects' self-reported confidence scores.

METHODS

This mixed-method study involved first year dental students (n = 52) who volunteered to participate in a learning intervention, simulation exercise, and survey in 2022. Students were randomly assigned to lecture (n = 26) or e-learning (n = 26) cohorts and then participated in the intervention, postintervention assessment, and a simulation to evaluate correct approaches for each dental block and attempts to success.

RESULTS

All subjects scored significantly higher on post-intervention assessment compared to pre-intervention assessment (8.2 vs. 5.9; p < 0.0001) with no significant differences between intervention groups when comparing preintervention and postintervention scores. Furthermore, there were no significant differences between the two cohorts when comparing abilities to correctly approach each dental block or attempts to success. Finally, all students reported a significant increase in confidence in most categories following intervention and simulation, with no significant differences between lecture and e-learning cohorts.

CONCLUSION

Our findings suggest students learning via e-learning are equally capable as those learning via lecture at demonstrating newly acquired knowledge and skill in both assessments and clinical simulations. Results support incorporating supplemental e-learning and oral anesthesia manikin exercises for students learning the anatomy of dental injections.

Use of a hybrid digital training approach for hormonal IUD providers in Nigeria: results from a mixed method study

BACKGROUND

In Nigeria, in-service trainings for new family planning (FP) methods have typically been conducted using a combination of classroom-based learning, skills labs, and supervised practicums. This mixed-methods study evaluated the feasibility, acceptability, provider competency, and costs associated with a hybrid digital and in-person training model for the hormonal intrauterine device (IUD).

METHODS

The study was conducted in Enugu, Kano, and Oyo states, Nigeria, and enrolled FP providers previously trained on non-hormonal IUDs. Participants completed a digital didactic training, an in-person model-based practicum with an Objective Structured Clinical Examination (OSCE), followed by supervised provision of service to clients. Provider knowledge gains and clinical competency were assessed and described descriptively. Data on the feasibility, acceptability, and scalability of the approach were gathered from participating providers, clinical supervisors, and key stakeholders. Training costs were captured using an activity-based approach and used to calculate a cost per provider trained. All analyses were descriptive.

RESULTS

Sixty-two providers took the hybrid digital training, of whom 60 (91%) were included in the study (n = 36 from public sector, n = 15 from private sector, and n = 9 both public/private). The average knowledge score increased from 62 to 86% pre- and post-training. Clinical competency was overall very high (mean: 94%), and all providers achieved certification. Providers liked that the digital training could be done at the time/place of their choosing (84%), was self-paced (79%), and reduced risk of COVID-19 exposure (75%). Clinical supervisors and Ministry of Health stakeholders also had positive impressions of the training and its scalability. The hybrid training package cost $316 per provider trained.

CONCLUSIONS

We found that a hybrid digital training approach to hormonal IUD service provision in Nigeria was acceptable and feasible. Providers demonstrated increases in knowledge following the training and achieved high levels of clinical competency. Both providers and clinical supervisors felt that the digital training content was of high quality and an acceptable (sometimes preferable) alternative to classroom-based, in-person training. This study provided insights into a hybrid digital training model for a long-acting contraceptive, relevant to scale-up in Nigeria and similar settings.

Walking in their shoes: How primary-care experiences of adults aged 50+ reveal the benefits of e-learning intervention for general practitioners

Patient experiences and activation are increasingly researched. However, related data are limited in three areas: interventions for general practitioners (GPs) working with mature adults (50+), dedicated e-learning interventions for GPs, and assessments of e-learning for medical staff through patient experiences. We examined how e-learning intervention focused on improving GPs' skills in activating communication (understood as promoting engagement and active participation in healthcare) can enhance the experiences of mature patients. The intervention was designed for GPs, yet innovative assessment was based on patient experiences post-visit. Three research conditions for GPs (n = 165) were introduced: (1) e-learning or (2) pdf-article intervention and (3) control. Two independent waves of their patients participated before and after the intervention. Experience measures for patients (n = 1639) included the Patient Expectations Scale (post-visit), perceived GP's Communication Skills scale, and Patient Satisfaction with Visit scale. E-learning intervention compared with the control group had a favorable effect for 5 out of 8 dimensions of patient experience. Change in emotional support and quality of life was particularly visible. Mature patient experiences can be improved with the e-learning intervention for GPs. Measuring patient experience enriches the available knowledge and can help design future research and interventions.

Simulation in a blended learning curriculum for neonatology

Blended learning is a learner-centered educational method that combines online and traditional face-to-face educational strategies. Simulation is a commonly utilized platform for experiential learning and an ideal component of a blended learning curriculum. This section describes blended learning, including its strengths and limitations, educational frameworks, uses within health professions education, best practices, and challenges. Also included is a brief introduction to simulation-based education, along with theoretical and real-world examples of how simulation may be integrated into a blended learning curriculum. Examples of blended learning in Neonatal-Perinatal Medicine, specifically within the Neonatal Resuscitation Program, procedural skills training, and the National Neonatology Curriculum, are reviewed.

Challenges in applying evidence-based practice in stroke rehabilitation: a qualitative description of health professional experience in low, middle, and high-income countries

Purpose: Evidence-based practice (EBP) is considered central to ethical, effective service delivery in rehabilitation, and the implementation of the World Health Organisation's Rehabilitation Strategy 2030. This study aimed to explore and compare the experiences of health professionals regarding the application of EBP for stroke rehabilitation in each participant's region and country, which provided perspectives from low, middle, and high-income countries.Methods and materials: Interviews were conducted with 12 experienced rehabilitation professionals from 12 different countries (5 high-income, 2 upper-middle income, 3 lower-middle income, and 2 low-income countries) and interpreted using qualitative descriptive analysis.Results: Nine factors influencing evidence-based stroke rehabilitation were: 1) the complexity of rehabilitation research; 2) the (ir)relevance of research to local context; 3) lack of time for EBP; 4) minimal training in EBP; 5) changing health professional behaviours; 6) poor access to resources for developing EBP; 7) influence of culture, patients, and families; 8) language barriers; and 9) lack of access to research evidence. Economic constraints contributed to many challenges; but not all challenges related to the country's economic classification.Conclusion: A global approach is needed to share knowledge about EBP, especially scientific evidence and innovative thinking about its application to clinical practice. Implications for rehabilitationRehabilitation professional groups should contribute to a global network to improve informal knowledge sharing and training around evidence-based practice.Support for training in evidence-based practice and its application needs to be developed and accessible in all countries, including low and middle-income countries.It is imperative that policymakers prioritise practical, evidence-based solutions for rehabilitation research in low and middle-income countries that can be effectively implemented within local settings.There must be solutions and increased accessibility of journal articles for those working in low and middle-income countries including those whose first language is not English.

Adaptation of digital navigation training for integrated behavioral health providers: Interview and survey study

Despite effective treatment options, people who experience mental health conditions often do not receive needed care. E-mental health, for instance the use of mobile apps, is emerging as a way to increase access to and extend care. However, little formal training is available to increase the digital literacy level among behavioral healthcare providers (BHPs), seeking to employ such technology. The purpose of this study was to explore the acceptability and usability of an adapted in-person Digital Navigation Training (DNT) curriculum into e-Learning modules focused on the integrated environment for BHPs. BHP confidence to serve as digital navigators was also explored. E-Learning modules were adapted from an existing in-person DNT. A purposeful sampling strategy was used to recruit BHPs (n = 8) to complete the modules. Acceptability, usability, and confidence were assessed via survey and semi-structured interviews. Descriptive statistics were calculated for survey data and qualitative data were analyzed using a directed content analysis approach. BHPs who completed the training (n = 8) felt the modules were usable, enjoyed the structure, and felt the amount of time to complete the modules was acceptable. All participants thought the structure of the training worked well and enjoyed learning new information. While participants' confidence in their digital navigation skills increased, they desired more information and/or experience with screening apps prior to increasing their use of apps within their care. E-Learning modules were an acceptable method of educating BHPs with digital navigation skills. Future research is needed to explore incentives needed for training along with if participating in these modules can increase use of quality mobile apps to augment care within BHP treatment plans.

Feasibility of an Adaptive E-Learning Environment to Improve Provider Proficiency in Essential and Sick Newborn Care in Mwanza, Tanzania

Introduction

To improve healthcare provider knowledge of Tanzanian newborn care guidelines, we developed adaptive Essential and Sick Newborn Care (aESNC), an adaptive e-learning environment (AEE). The objectives of this study were to 1) assess implementation success with use of in-person support and nudging strategy and 2) describe baseline provider knowledge and metacognition.

Methods

6-month observational study at 1 zonal hospital and 3 health centers in Mwanza, Tanzania. To assess implementation success, we used the RE-AIM framework and to describe baseline provider knowledge and metacognition we used Howell's conscious-competence model. Additionally, we explored provider characteristics associated with initial learning completion or persistent activity.

Results

aESNC reached 85% (195/231) of providers: 75 medical, 53 nursing, and 21 clinical officers; 110 (56%) were at the zonal hospital and 85 (44%) at health centers. Median clinical experience was 4 years [IQR 1,9] and 45 (23%) had previous in-service training for both newborn essential and sick newborn care. Efficacy was 42% (SD±17%). Providers averaged 78% (SD±31%) completion of initial learning and 7%(SD±11%) of refresher assignments. 130 (67%) providers had ≥1 episode of inactivity >30 day, no episodes were due to lack of internet access. Baseline conscious-competence was 53% [IQR:38-63%], unconscious-incompetence 32% [IQR:23-42%], conscious-incompetence 7% [IQR:2-15%], and unconscious-competence 2% [IQR:0-3%]. Higher baseline conscious-competence (OR 31.6 [95%CI:5.8, 183.5) and being a nursing officer (aOR: 5.6 [95%CI:1.8, 18.1]), compared to medical officer) were associated with initial learning completion or persistent activity.

Conclusion

aESNC reach was high in a population of frontline providers across diverse levels of care in Tanzania. Use of in-person support and nudging increased reach, initial learning, and refresher assignment completion, but refresher assignment completion remains low. Providers were often unaware of knowledge gaps, and lower baseline knowledge may decrease initial learning completion or activity. Further study to identify barriers to adaptive e-learning normalization is needed.

Asynchronous e-learning with technology-enabled and enhanced training for continuing education of nurses: a scoping review

BACKGROUND

Asynchronous e-learning has become the mainstream choice since the transformation of learning formats by the coronavirus disease-19 pandemic. This scoping review aimed to examine the technologies used in asynchronous e-learning for the continuing education of clinical nurses and their modes of delivery and effectiveness.

METHODS

This scoping review covered the period between 2011 and 2023. Six databases were searched for relevant studies following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) protocol.

RESULTS

Sixty articles met the inclusion criteria. There was a noticeable trend toward using diverse technology-enabled and enhanced training (TEET) options after 2017. The enabling technological approaches, such as interactive online modules (25 articles) and video modules (25 articles), are described in the articles. The most commonly used enhancing technologies were scenario-based learning (nine articles), resource access (eight articles), computer simulation or virtual reality (three articles), and gamification (three articles). Among the outcomes, knowledge acquisition was the most commonly examined outcome (41 articles).

CONCLUSIONS

Notably, many interactive TEET modules were used in asynchronous e-learning. There were few studies on gamification, computer simulation or virtual reality, and scenario-based learning (techniques to enhance intrinsic motivation further). However, the adoption of asynchronous e-learning with advanced TEET options is anticipated to increase in the future. Therefore, objective outcome measures are required to determine the effects of such learning methods on knowledge acquisition and behavioral changes.

The Frailty Matters Project

Preventing and managing frailty is a new area for many community practitioners; yet, frailty specific-education remains limited. This collaborative project aimed to understand and enhance the knowledge, confidence and capability of community nurses to manage frailty in a community setting. A person-centred coaching and educational programme was co-developed with community nurse participants to strengthen their leadership role in managing frailty within interprofessional teams. The "Frailty House" was created as an educational framework for the elements that participants described as important in order to live well with frailty, built on a foundation of leadership and coaching skills. Thematic content analysis of the data revealed the added value of combining technical knowledge and relational skills-building with peer support and coaching. All recognised the challenge of caring for people living with frailty at a difficult time and acknowledged that they would benefit hugely from further knowledge and skill development in this field.

An Exploration of Organizational Characteristics and Training Adoption in Irish Community Drug Treatment Services

BACKGROUND

Changes in patterns of drug use and population needs necessitate the adoption of new technologies. Despite high failure rates in adopting new technologies acquired in training, little is known about the process that can support successful change. This study explores the impact that staff and service characteristics have on the process of training adoption in Irish opiate substitution therapy services, with a specific focus on the concept of organizational readiness to change.

METHODS

A cross-sectional survey was conducted on a convenience sample of 132 staff members across 12 services in Ireland. The relationship between staff demographics, their perceptions of organizational readiness to change, burnout, and a four-stage process of training adoption were considered.

RESULTS

Discipline, job tenure, and educational levels are important predictors of engagement in the adoption process. Staff in services with higher institutional needs, greater pressures for change, and poorer resources were less likely to be exposed to, or adopt, training. Having lower levels of stress and more influence with peers was associated with better adoption of training.

CONCLUSIONS

Planners and service managers need to carefully consider the composition or dynamics of services when initiating change. Organizational readiness to change and staff characteristics as measured by instruments used in this study are important determinants of the process of innovation or training adoption and provide a good basis for developing further understanding of how treatment services work. This article expands on results from previous studies conducted in the United States to a European context.

The development and preliminary evaluation of a clinician e-learning training platform for a neonatal sepsis risk monitor for use in ICU settings

BACKGROUND

Training clinicians on the use of hospital-based patient monitoring systems (PMS) is vital to mitigate the risk of use errors and of frustration using these devices, especially when used in ICU settings. PMS training is typically delivered through face-to-face training sessions in the hospital. However, it is not always feasible to deliver training in this format to all clinical staff given some constraints (e.g., availability of staff and trainers to attend in-person training sessions and the costs associated with face-to-face training).

OBJECTIVE

The literature indicates that E-learning has the potential to mitigate barriers associated with time restrictions for trainers and trainees and evidence shows it to be more flexible, and convenient for learners in healthcare settings. This study aimed to develop and carry out a preliminary evaluation via a case study of an e-learning training platform designed for a novel neonatal sepsis risk monitor system (Digi-NewB).

METHODS

A multi-modal qualitative research case study approach was used, including the analysis of three qualitative data sources: (i) audio/video recordings of simulation sessions in which participants were asked to operate the system as intended (e.g., update the clinical observations and monitor the sepsis risk), (ii) interviews with the simulation participants and an attending key opinion leader (KOL), who observed all simulation sessions, and (iii) post-simulation survey.

RESULTS

After receiving ethical approval for the study, nine neonatal intensive care unit (NICU) nurses completed the online training and participated in the simulation and follow-up interview sessions. The KOL was also interviewed, and seven out of the nine NICU nurses answered the post-simulation survey. The video/audio analysis of the simulations revealed that participants were able to use and interpret the Digi-NewB interface. Interviews with simulation participants and the KOL, and feedback extracted from the survey, revealed that participants were overall satisfied with the training platform and perceived it as an efficient and effective method to deliver medical device training.

CONCLUSIONS

This study developed an online training platform to train clinicians in the use of a critical care medical device and carried out a preliminary evaluation of the platform via a case study. The e-learning platform was designed to supplement and enhance other training approaches. Further research is required to evaluate the effectiveness of this approach.

Evaluation of the Training in Early Detection for Early Intervention (TEDEI) e-learning course using Kirkpatrick's method

BACKGROUND

Early intervention in cerebral palsy could improve motor outcome but is only possible following early identification of those affected. There is a need for training of healthcare professionals (HCPs) in early detection of atypical motor development. We developed a video-based e-learning course - Training in Early Detection for Early Intervention (TEDEI) - to address this need. We evaluated whether participation in the course improved knowledge and changed behaviour of HCPs.

METHODS

Participants were 332 HCPs (38% physiotherapists, 35.8% occupational therapists), predominantly UK-based (83.7%). Analysis of training effects used mixed methods and followed Kirkpatrick's model, first assessing "Reaction" through a feedback questionnaire involving Likert scale and free text responses (n = 141). "Learning" was assessed through multiple choice questions (MCQs): all 332 HCPs completed a pre-course quiz of 6 MCQs followed by the course, then a 16 item post-course quiz including the 6 pre-course questions. "Behaviour" was assessed through in-depth qualitative interviewing of 23 participants.

RESULTS

"Reaction": TEDEI was found to be effective, engaging and well structured. "Learning": Scores improved significantly between the pre-course and post-course quiz, median improvement 1/6 (z = 5.30, p < 0.001). HCPs also reported a perceived improvement in their knowledge, confidence and ability. "Behaviour": HCPs could see how TEDEI would improve their clinical practice through having an assessment framework, ways of working better with parents, and developing observational skills useful for tele-health assessments.

CONCLUSION

Our brief e-learning course on early detection for early intervention was viewed positively, improved knowledge and showed potential for positive changes in practice. Kirkpatrick's model provided a useful framework for undertaking this evaluation.

The impact of training chemotherapy safety standards with a smartphone application on the knowledge, attitude, and performance of nurses

BACKGROUND

Nurses who play the leading role in caring for patients, especially nurses in the chemotherapy department who are constantly exposed to high-risk drugs and their side effects, should pay more attention to occupational safety. This study was performed to determine the effect of training chemotherapy safety standards using a smartphone application on nurses' knowledge, attitude, and performance.

METHODS

The whole enumeration of fifty oncology nurses was recruited who they worked in 3 hospitals affiliated with Lorestan University of Medical Sciences (west of Iran). The study was conducted from June to November 2021. The training was done for four weeks with a smartphone application, including six main courses of familiarity with hazardous drugs, Personal Protective Equipment, preparation, storage and transfer, spilling, and wastes disposal of hazardous drudges . The nurses' knowledge, attitude, and performance questionnaire were completed before, immediately after, and one month after the intervention. Data analysis was performed using SPSS version 26, descriptive and inferential statistical tests of independent t-test, one-way analysis of variance, Spearman's rank correlation coefficient, repeated measures analysis of variance, and the Generalized Estimating Equation (GEE) model.

RESULTS

Mean knowledge score of participants before, immediately after, and one month after the intervention was (47.18 ± 8.19), (60.08 ± 3.82), and (61.88 ± 3.45), respectively. The mean attitude score of participants before, immediately after, and one month after the intervention was (30.34 ± 3.94), (34.32 ± 3.25), and (34.98 ± 2.88), in order, and the mean performance score of participants before, immediately after, and one month after the intervention was (43.60 ± 5.11), (51.78 ± 3.15) and (52.88 ± 3.06), respectively. The mean nurses' knowledge, attitude, and performance score increased significantly over time (P < 0.001).

CONCLUSIONS

Teaching chemotherapy safety standards using the application improved oncology nurses' knowledge, attitude, and performance. Appropriate educational programs, especially by new methods such as E-learning, are recommended for providing safety for nurses.

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.

Effectiveness of blended versus fully digital training in primary care psychiatry: A retrospective comparison from India

Objectives

We compared effectiveness of blended mode (consisting of traditional classroom teaching and e-learning sessions) and fully digital mode (e-learning sessions alone) of primary care psychiatry training for primary care doctors in Chhattisgarh.

Materials and Methods

We retrospectively compared the engagement in training, knowledge (K), attitude (A), and practice (P) in primary care psychiatry, and patient identification by primary care doctors (n = 941) from Chhattisgarh region who underwent training through either blended training mode (n = 546) or fully digital training mode (n = 395) for 16 h each, using Clinical Schedules for Primary Care Psychiatry based modules between June 2019 and November 2020 with a tertiary care center (NIMHANS, Bengaluru) as hub.

Statistical Analysis

The Statistical Package for the Social Sciences version 27 was used to analyze the data. Continuous variables were analyzed using the independent samples t-test, and discrete variables were analyzed using the Chi-square test. A repeated measures analysis of variance (ANOVA) (two-way mixed design) was used to see the interaction of training type and time of pre- and post-KAP measurement while controlling for years of experience. The number of patients identified by both training groups over 8 months was also compared using the repeated measures ANOVA (two-way mixed design).

Results

Engagement inferred by the number of participants completing pre-KAP forms (75%), post-KAP forms (43%), post-session assessments (37- 47%), case presentation (33.9%), and certification (32.1%) was better in the blended group (P < 0.05). The mean gain in KAP scores was significantly higher in the blended group controlling for the years of experience as primary care doctor (PCD) (F = 30.36, P < 0.001). PCDs in the blended training group consistently identified a higher number of patients with mental illness over 8 months of follow-up (F = 6.21, P < 0.001).

Conclusion

The blended mode yielded better results in primary care psychiatry training compared to fully digital mode. In-person interactions while provided for a very brief proportion of the training seem to have an unmistakable imprint on the outcomes and seem critical for better consolidation and assimilation of information, which translates into better practice.

Development of pediatric acute care education (PACE): An adaptive electronic learning (e-learning) environment for healthcare providers in Tanzania

Globally, inadequate healthcare provider (HCP) proficiency with evidence-based guidelines contributes to millions of newborn, infant, and child deaths each year. HCP guideline proficiency would improve patient outcomes. Conventional (in person) HCP in-service education is limited in 4 ways: reach, scalability, adaptability, and the ability to contextualize. Adaptive e-learning environments (AEE), a subdomain of e-learning, incorporate artificial intelligence technology to create a unique cognitive model of each HCP to improve education effectiveness. AEEs that use existing internet access and personal mobile devices may overcome limits of conventional education. This paper provides an overview of the development of our AEE HCP in-service education, Pediatric Acute Care Education (PACE). PACE uses an innovative approach to address HCPs' proficiency in evidence-based guidelines for care of newborns, infants, and children. PACE is novel in 2 ways: 1) its patient-centric approach using clinical audit data or frontline provider input to determine content and 2) its ability to incorporate refresher learning over time to solidify knowledge gains. We describe PACE's integration into the Pediatric Association of Tanzania's (PAT) Clinical Learning Network (CLN), a multifaceted intervention to improve facility-based care along a single referral chain. Using principles of co-design, stakeholder meetings modified PACE's characteristics and optimized integration with CLN. We plan to use three-phase, mixed-methods, implementation process. Phase I will examine the feasibility of PACE and refine its components and protocol. Lessons gained from this initial phase will guide the design of Phase II proof of concept studies which will generate insights into the appropriate empirical framework for (Phase III) implementation at scale to examine effectiveness.

Employing the TAM in predicting the use of online learning during and beyond the COVID-19 pandemic

Online learning systems have become an applied solution for delivering educational content, especially in developing countries, since the start of the COVID-19 pandemic. The present study is designed to identify the factors influencing the behavioral intention of agricultural students at universities in Iran to use online learning systems in the future. This research uses an extended model in which the constructs of Internet self-efficacy, Internet anxiety, and output quality are integrated into the technology acceptance model (TAM). Data analysis was performed using the SmartPLS technique. The analyses showed the proposed model to be strong in terms of predicting the attitude to online learning and the intention to use it. The extended TAM model fit the data well and predicted 74% of the intention variance. Our findings show attitude and perceived usefulness to have directly affected intention. Output quality and Internet self-efficacy indirectly affected attitude and intention. Research findings can help with the design of educational policies and programs to facilitate education and improve student academic performance.

A preliminary study of further attempt at the development, testing and application of an independent primary screening stool card

Stool characteristics are of great value to assess diseases, but patients knew little. E-learning applied in health popularization and patient education is booming. In China, WeChat applets has advantages of abundant users, convenient access and low cost, which may be a great media in patient education on stool. This preliminary study aims to develop and evaluate a stool card WeChat applet. We collected stools images during 2020 to 2022 in the Department of Gastroenterology and Hepatology in the Second Affiliated Hospital of Harbin Medical University, constructed a stool card applet named the Doctor Friend Primary Screening Stool Card (DFPSSC) and evaluated it. Eligible participants were divided into the applet, traditional paper media and control group. We implement a series of tests to evaluate the effectiveness. 20 clinicians and participants using the DFPSSC completed a questionnaire to evaluate the usability. We developed the DFPSSC for an E-learning approach. Of 108 volunteers, 97 completed the DFPSSC learning. No significant pretest differences were found among the three groups (P = 0.303). Applet group had significantly higher posttest scores than pretest scores in intervention (P < 0.001, d = 1.68) and simulation (P = 0.006) test, and it had higher scores than other two group (P < 0.001). 63% participants and 59% clinicians strongly agree or agree to the usability of DFSSC. This preliminary study verified that the DFPSSC can effectively improve participants' knowledge of feces, making it an effective clinical tool for patient education and the avoidance of treatment delay.