Effects of competitive computer-assisted learning versus conventional teaching methods on the acquisition and retention of knowledge in medical surgical nursing students

Findings Favor Haptics Feedback in Virtual Simulation Surgical Education: An Updated Systematic and Scoping Review

BACKGROUND

Virtual simulations (VSs) enhance clinical competencies and skills. However, a previous systematic review of 9 RCT studies highlighted a paucity of literature on the effects of haptic feedback in surgical VSs. An updated systematic and scoping review was conducted to encompass more studies and a broader range of study methodologies.

METHODS

A systematic literature search was conducted on July 31, 2023, in MEDLINE, Embase, and Cochrane. English language studies comparing haptic vs non-haptic conditions and using VSs were included. Studies were evaluated and reported using PRISMA-ScR guidelines.

RESULTS

Out of 2782 initial studies, 51 were included in the review. Most studies used RCT (21) or crossover (23) methodologies with medical residents, students, and attending physicians. Most used post-intervention metrics, while some used pre- and post-intervention metrics. Overall, 34 performance results from studies favored haptics, 3 favored non-haptics, and the rest showed mixed or equal results.

CONCLUSION

This updated review highlights the diverse application of haptic technology in surgical VSs. Haptics generally enhances performance, complements traditional teaching methods, and offers personalized learning with adequate simulator validation. However, a sparsity of orienting to the simulator, pre-/post-study designs, and small sample sizes poses concerns with the validity of the results. We underscore the urgent need for standardized protocols, large-scale studies, and nuanced understanding of haptic feedback integration. We also accentuate the significance of simulator validation, personalized learning potential, and the need for researcher, educator, and manufacturer collaboration. This review is a guidepost for navigating the complexities and advancements in haptic-enhanced surgical VSs.

Factors Influencing the Effectiveness of E-Learning in Healthcare: A Fuzzy ANP Study

E-learning has transformed the healthcare education system by providing healthcare professionals with training and development opportunities, regardless of their location. However, healthcare professionals in remote or rural areas face challenges such as limited access to educational resources, lack of reliable internet connectivity, geographical isolation, and limited availability of specialized training programs and instructors. These challenges hinder their access to e-learning opportunities and impede their professional development. To address this issue, a study was conducted to identify the factors that influence the effectiveness of e-learning in healthcare. A literature review was conducted, and two questionnaires were distributed to e-learning experts to assess primary variables and identify the most significant factor. The Fuzzy Analytic Network Process (Fuzzy ANP) was used to identify the importance of selected factors. The study found that success, satisfaction, availability, effectiveness, readability, and engagement are the main components ranked in order of importance. Success was identified as the most significant factor. The study results highlight the benefits of e-learning in healthcare, including increased accessibility, interactivity, flexibility, knowledge management, and cost efficiency. E-learning offers a solution to the challenges of professional development faced by healthcare professionals in remote or rural areas. The study provides insights into the factors that influence the effectiveness of e-learning in healthcare and can guide the development of future e-learning programs.

Clinical clerkship students' preferences and satisfaction regarding online lectures during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has caused an unprecedented disruption in medical education. Students and lecturers had to adapt to online education. The current study aimed to investigate the level of satisfaction and future preference for online lectures among clinical clerkship students and elucidated the factors that affect these outcomes.

METHODS

We selected a sample of 114 medical students undergoing clinical clerkship during the COVID-19 pandemic. We conducted onsite lectures before the pandemic and online lectures after the outbreak. A survey was conducted, and the sample included students and 17 lecturers. The average scores of total satisfaction and future preference related to online lectures were computed.

RESULTS

Students' scores on total satisfaction with online lectures and their future preference were higher than those for onsite lectures. Scores on the ease of debating dimension were low and those on accessibility of lectures in online lectures were higher than those in onsite lectures. There was no difference between the two groups in the scores on the comprehensibility and ease of asking questions dimensions. Results of the multiple regression analysis revealed that accessibility determined total satisfaction, and future preference was determined by comprehensibility as well as accessibility. Contrary to students' future preferences, lecturers favored onsite lectures to online ones.

CONCLUSION

Online lectures are an acceptable mode of teaching during the COVID-19 pandemic for students undergoing clinical clerkship. Online lectures are expected to become more pervasive to avoid the spread of COVID-19.

The impact of three-dimensional visualisation on midwifery student learning, compared with traditional education for teaching the third stage of labour: A pilot randomised controlled trial

BACKGROUND

Complex physiological processes are often difficult for midwifery students to comprehend when using traditional teaching and learning approaches. Face to face instructional workshops using simulation have had some impact on improving understanding. However, in the 21st century new technologies offer the opportunity to provide alternative learning approaches.

AIM

To investigate the impact of using three-dimensional (3D) visualisation in midwifery education on student's experience of learning, and retention of knowledge at three points in time.

DESIGN

A pilot study involving a two-armed parallel Randomised Controlled Trial (RCT) comparing the retention of knowledge scores between the control and intervention groups.

SETTING

An Australian University in the Northern Territory.

PARTICIPANTS

The sample included second year Bachelor of Midwifery students (n = 38). All received traditional midwifery education before being randomly allocated to either the intervention (n = 20) or control (n = 18) group.

METHODS

A new immersive virtual environment was introduced to complement existing traditional midwifery education on the third stage of labour. This intervention was evaluated using a demographic survey and multiple-choice questionnaire to collect baseline information via Qualtrics. To measure change in knowledge and comprehension, participants completed the same multiple-choice knowledge questionnaire at three time points; pre, immediately post and at 1 month post intervention. In addition, the intervention group completed a 3D student satisfaction survey.

RESULTS

Baseline knowledge scores were similar between the groups. A statistically significant increase in knowledge score was evident immediately post intervention for the intervention group, however there was no significant difference in knowledge score at one month.

CONCLUSIONS

The results support the creation of further three-dimensional visualisation teaching resources for midwifery education. However, a larger randomised controlled study is needed to seek generalisation of these findings to confirm enhanced student learning and retention of knowledge post 3DMVR, beyond the immediate exposure time.

Evaluating Evidences of Effectiveness in Web-Based Nursing Education Program

Background

Web-based education programs are essential in every field of learning, and in nursing coursework, they can contribute towards behavioral development. It is found that emerging approach of web-based nursing programs is overpowering the traditional education methods and provides flexibility in learning and training programs. Therefore, it is considered as a promising medium of learning which can take over the traditional methods because of its effectiveness.

Objective

A systematic review and meta-analysis was performed for analysis of efficiency and effectiveness of web-based nursing education. This study is aimed at evaluating the evidences which evaluate the effectiveness of the web-based nursing education programs. Material and Methods. Studies were selected from 2008 to 2020 available from various global databases like PubMed, Embase, CINAHL, ProQuest, and Cochrane Library.

Results

Five studies were selected for analysis where the results demonstrated no significant difference in the effectiveness of use of web-based nursing educational programs.

Conclusion

More evidences are required for supporting the efficiency and effectiveness of use of web-based programs for nursing education. Hence, more research is required for evaluating the length of nursing education, evaluating practice-based clinical aspects like success ratio for outcomes of study, type of patients handled, and severity of cases handled for better outcomes.

Formative online multiple-choice tests in nurse education: An integrative review

AIM

The aim of this integrative review is to explore how formative online multiple-choice tests used in nurse education promote self-regulated learning and report on pedagogies that support their design.

BACKGROUND

Online multiple-choice tests are widely used as learning and formative assessment tools in a range of educational contexts. However, little is known about how these tools are used to promote patterns of learner self-regulation. It is important that nurses and nursing students develop the capability to self-regulate learning to be effective lifelong learners and navigate complex and unfamiliar practice environments.

DESIGN

A five-stage approach guided this integrative review: problem identification, literature search, data evaluation, data analysis and presentation.

METHOD

A systematic search of ERIC, Web of Science, Ovid Medline, Scopus, PubMed, Embase and CINAHL was conducted in February 2021. Seventeen peer-reviewed papers were identified that discussed formative online multiple-choice tests in nurse education. Purposive sampling and ancestry searching identified an additional paper. Articles were analysed and sorted into themes of outcomes (presented as components of self-regulated learning theory) and pedagogy.

RESULTS

Formative online multiple-choice tests are used with good effect in nurse education as measured by knowledge gain and exam performance, increased confidence and learner satisfaction. There was no literature that explored metacognitive outcomes and minimal literature considered behavioural outcomes. Pedagogy supporting the implementation of multiple-choice tests was lacking in most articles.

CONCLUSIONS

Formative online multiple-choice tests are widely used with good effect in nurse education. However, opportunities for further research on how these tools can encourage metacognition and self-regulatory behaviours is warranted.

Virtual and Augmented Realities in Nursing Education: State of the Science

The use of simulation in nursing education is an integrated part of the curriculum and has demonstrated the benefit for learning in nursing students at all levels. The next stage in simulation-based learning will utilize the wide variety of new technologies that are currently available, including virtual and augmented reality. The use of these new technologies brings with it a need for standard definitions, evaluation of its impact on learning, and new opportunities for research. Efforts are underway to standardized definitions and publish early findings on research using these new technologies. There are many opportunities available for nursing educators to create a new era of simulation-based learning methodologies by incorporating virtual and augmented realities in their curriculum. The state of the science is showing promising outcomes and commercial products are maturing.The utilization of these new technologies should be approached in the same way as other learning methodologies as many new ideas and ways of learning are emerging in this area. It will be critical for nursing educators and faculty to determine the optimal ways to utilize them.

Comparing student achievement in traditional learning with a combination of blended and flipped learning

Aim

The aim of this study was to investigate the effectiveness of blended learning with a flipped classroom design on student academic achievement in a Bachelor of Science in Nursing course.

Design

A quasi-experimental study.

Method

Students were split into an experimental blended learning with a flipped classroom design group and a control group using the traditional, teacher-centred learning method. Data were collected during spring 2018 (13.3 weeks) and student's grades for the registered course and their grade point average (GPA) were recorded.

Results

Findings showed statistically significant increases in student grades in the experimental group. Predictability calculations also showed better achievement of learning outcomes if a blended learning with a flipped classroom design is continued to be used in the future.

The effect of testing and feedback on the forgetting curves for radiograph interpretation skills

Objectives: Forgetting curves plot skill decay over time. After exposure to a simulation-based radiograph interpretation learning system, we determined the rate of learning decay and how this was impacted by testing (with and without feedback). Further, we examined the association of initial learning parameters on the forgetting curve. Methods: This was a multicenter, four-arm randomized control trial. Medical trainees completed 80 elbow radiographs and a 20-case post-test. Group 1 had no testing until 12 months; Groups 2-4 had testing every 2 months until 12 months. At 6 months, Group 3 testing was feedback-enhanced, while Group 4 had feedback-enhanced testing at 2, 6, and 10 months. Results: There were 106 participants (n = 42 Group 1; n = 22 Groups 2 and 3; n = 20 Group 4). Group 1 showed an -8.1% learning decay at 12-months relative to other groups. In Groups 2, 3, and 4, there was no significant learning decay (+0.8%), and there were no differences in skill decay between these groups. Initial score and learning curve slope were predictive of retained skill. Conclusions: Learning decay was mitigated by exposure to 20 test cases (with and without feedback) every two months. Initial learning parameters predicted learning retention and may inform refresher education scheduling.

The effectiveness of web-based learning in supporting the development of nursing students' practical skills during clinical placements: A qualitative study

Web-based learning, on its own or in combination with traditional teaching methods, has become a consolidated practice in many countries, and has been described as a valid and effective method that supports practical learning in undergraduate nursing students. The aim of this study was to explore the perception and effectiveness of web-based learning in facilitating the development of clinical skills in undergraduate nursing students. A qualitative descriptive study was conducted including online videos in three nursing schools of a university in Northern Italy. The participants were 26 undergraduate nursing students. A dedicated website was built including four videos and the respective checklists of four nursing techniques: insertion of a urinary catheter; insertion of a nasogastric tube; taking a blood sample; and the insertion of a peripheral intravenous line. Three Focus Groups were conducted, one for each nursing school. Thanks to its ease of use and unlimited access, web-based learning effectively supported students' clinical learning process by offering additional virtual visual support. Web-based learning could be effectively used to reduce the gap between theory and practice, and even as an upgrade for already qualified nurses.

The Effect of Green Software: A Study of Impact Factors on the Correctness of Software

Unfortunately, sustainability is an issue very poorly used when developing software and hardware systems. Lately, and in order to contribute to the earth sustainability, a new concept emerged named Green software which is computer software that can be developed and used efficiently and effectively with minimal or no impact to the environment. Currently, new teaching methods based on students’ learning process are being developed in the European Higher Education Area. Most of them are oriented to promote students’ interest in the course’s contents and offer personalized feedback. Online judging is a promising method for encouraging students’ participation in the e-learning process, although it still has to be researched and developed to be widely used and in a more efficient way. The great amount of data available in an online judging tool provides the possibility of exploring some of the most indicative attributes (e.g., running time, memory) for learning programming concepts, techniques and languages. So far, the most applied methods for automatically gathering information from the judging systems are based on statistical methods and, although providing reasonable correlations, these methods have not been proven to provide enough information for predicting grades when dealing with a huge amount of data. Therefore, the great novelty of this paper is to develop a data mining approach to predict program correctness as well as the grades of the students’ practices. For this purpose, powerful data mining technologies taken from the artificial intelligence domain have been used. In particular, in this study, we have used logistic regression, decision trees, artificial neural network and support vector machines; which have been properly identified as the most suitable ones for predicting activities in the e-learning domains. The results have achieved an accuracy of around 74%, both in the prediction of the program correctness as well as in the practice grades’ prediction. Another relevant issue provided in this paper is a comparison among these four techniques to obtain the best accuracy in predicting grades based on the availability of data as well as their taxonomy. The Decision Trees classifier has obtained the best confusion matrix, and time and memory efficiency were identified as the most important predictor variables. In view of these results, we can conclude that the development of green software leads programmers to implement correct software.

Teaching and evaluation of basic urodynamic skills in urology residency programs: Randomized controlled study

AIMS

Considering the growing role of urodynamic studies (UDS) in urology, we aimed to determine the most effective teaching method with objective evaluation for urodynamic skills, to improve training and patient care.

METHODS

Urology residents (n = 20) post-graduate years 3-5 were randomized to receive either a UDS video training module or a standard UDS teaching document one week prior to an objective structured clinical examination (OSCE). The OSCE was a validated visual recognition exam with interpretation of 12 UDS tracing scenarios. Participants rated their proficiency to interpret UDS tracings before doing the OSCE. Total interpretation score was determined by the accuracy of their response to each question ranging from 0 to 2.

RESULTS

The mean total interpretation score was 13.3 of 24 (55%). The video group achieved significantly higher interpretation scores (15.1 ± 2.08 vs 11.4 ± 2.41, P = 0.0017), and cumulative certainty scores (P = 0.0341). Overall interpretation scores significantly correlated with self-reported proficiency scores prior to the exam (r = 0.502, P < 0.05), and total certainty scores (r = 0.531, P < 0.05).

CONCLUSIONS

Reviewing a UDS video training module resulted in significantly better scores on objective assessment of urology residents' UDS interpretation skills when compared with a standard teaching document. These findings must be interpreted with caution in light of sample size and short knowledge retention required for the assessment within a week. Therefore, using a UDS video training module could be more effective review tool for urology residents. These findings highlight the need to incorporate multimedia teaching into urology training curriculum.

Influence of undergraduate nursing student teaching methods on learning standard precautions and transmission-based precautions: Experimental research

OBJECTIVES

An experimental study was performed with undergraduate nursing students in order to determine, between two methodologies, which is the best for learning standard precautions and precautions based on disease transmission mechanisms.

METHODS

Students in the sample are stratified by performance, with the experimental group (49 students) being exposed to self-instruction and clinical simulation on the topic of standard precautions and special precautions according to disease transmission mechanisms. Conventional classes on the same topics were provided to the control group (49 students).

RESULTS

The experimental group showed the best performance in the multiple-choice post-test of knowledge (p=0.002) and in the assessment of essay questions (p=0.043), as well as in the evaluation of a simulated scenario, in relation to the control group.

CONCLUSIONS

This study demonstrates that it is possible to transfer some teaching subjects on the prevention of Healthcare Associated Infections (HAIs) to self-learning by means of virtual teaching strategies with good results. This allows greater efficiency in the allocation of teachers to clinical simulation or learning situations in the laboratory, where students can apply what they have learned in the self-instruction module.

Conventional vs. e-learning in nursing education: A systematic review and meta-analysis

BACKGROUND

By and large, in health professions training, the direction of the effect of e-learning, positive or negative, strongly depends on the learning outcome in question as well as on learning methods which e-learning is compared to. In nursing education, meta-analytically generated knowledge regarding the comparisons between conventional and e-learning is scarce.

OBJECTIVES

The aim of this review is to discover the size of the effect of e-learning on learning outcomes in nursing education and to assess the quality of studies in which e-learning has been compared to conventional learning.

METHODS

A systematic search of six electronic databases, PubMed, Ovid MEDLINE®, CINAHL (EBSCOhost), Cochrane Library, PsycINFO, and ERIC, was conducted in order to identify relevant peer-reviewed English language articles published between 2011 and 2015. The quality of the studies included as well as the risk of bias in each study was assessed. A random-effects meta-analysis was performed to generate a pooled mean difference in the learning outcome.

RESULTS

Altogether, 10 studies were eligible for the quality assessment and meta-analysis. Nine studies were evaluated as good quality studies, but not without a risk of bias. Performance bias caused a high risk in nearly all the studies. In the meta-analysis, an e-learning method resulted in test scores that were, on average, five points higher than a conventional method on a 0-100 scale. Heterogeneity between the studies was very large.

CONCLUSIONS

The size and direction of the effect of a learning method on learning outcomes appeared to be strongly situational. We suggest that meta-regressions should be performed instead of basic meta-analyses in order to reveal factors that cause variation in the learning outcomes of nursing education. It might be necessary to perform separate meta-analyses between e-learning interventions aimed at improving nursing knowledge and those aimed at improving nursing skills.

Persuasive technology in teaching acute pain assessment in nursing: Results in learning based on pre and post-testing

BACKGROUND

Thousands of patients seek health services every day with complaints of pain. However, adequate pain assessment is still flawed, a fact that is partly related to gaps in professional learning on this topic. Innovative strategies such as the use of a virtual learning object mediated by persuasive technology in the learning of undergraduate nursing students can help to fill these gaps and to provide different ways of learning to learn.

OBJECTIVE

To evaluate the results in learning among undergraduate nursing students about assessment of acute pain in adults and newborns, before and after an online educational intervention.

DESIGN

This is a quasi-experimental, non-equivalent study using pre-and post-testing.

SETTING

Federal University of Santa Catarina, Brazil.

PARTICIPANTS

75 undergraduate nursing students.

METHODS

Our study was conducted in three steps (pre-test, education intervention, post-test). Data were collected from November 2013 to February 2014. The educational intervention was performed using online access to virtual learning object about acute pain assessment, which students accessed on their mobile devices.

CONCLUSION

A significant difference was seen in student learning (p<0.001) in the post-test compared with the pre-test results. The students understood the importance of the topic, and were satisfied and motivated by the technology and method applied. The use of persuasive technology such as small mobile devices as mediators of online educational interventions broadens learning spaces in an innovative, flexible, motivational, and promising manner.

The utility and impact of information communication technology (ICT) for pre-registration nurse education: A narrative synthesis systematic review

OBJECTIVES

To evaluate and summarise the utility and impact of information communication technology (ICT) in enhancing student performance and the learning environment in pre-registration nursing.

DESIGN

A systematic review of empirical research across a range of themes in ICT health-related education.

DATA SOURCES

Science Direct, Cinahl, AMED, MEDLINE, PubMed, ASSIA, OVID and OVID SP (2008-2014). Further date parameters were imposed by theme.

REVIEW METHODS

Evidence was reviewed by narrative synthesis, adopting Caldwell's appraisal framework and CASP for qualitative methods. Selection and inclusion was grounded in the PICOS structure, with language requirements (English), and further parameters were guided by theme appropriateness.

RESULTS

Fifty studies were selected for review across six domains: reusable learning objects, media, audience response systems, e-portfolios, computer-based assessment and faculty adoption of e-learning. Educational ICT was found to be non-inferior to traditional teaching, while offering benefits to teaching and learning efficiency. Where support is in place, ICT improves the learning environment for staff and students, but human and environmental barriers need to be addressed.

CONCLUSION

This review illuminates more advantages for ICT in nurse training than previously. The key advantage of flexibility is supported, though with little evidence for effect on depth of learning.

E-learning in orthopedic surgery training: A systematic review

E-learning is the use of internet-based resources in education. In the field of surgical education, this definition includes the use of virtual patient cases, digital modeling, online tutorials, as well as video recordings of surgical procedures and lectures. In recent years, e-learning has increasingly been considered a viable alternative to traditional teaching within a number of surgical fields. Here we present (1) a systematic review of literature assessing the efficacy of e-learning modules for orthopedic education and (2) a discussion of their relevance. A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted according to the guidelines defined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). The search yielded a total of 255 non-duplicate citations that were screened using predetermined inclusion/exclusion criteria. A total of 9 full text articles met inclusion criteria, which included the use of an objective outcome measure to evaluate an orthopedic e-learning module. Six studies assessed knowledge using a multiple-choice test and 4 assessed skills using a clinical exam. All studies showed positive score improvement pre- to post-intervention, and a majority showed greater score improvement than standard teaching methods in both knowledge (4/6 studies) and clinical skills (3/4 studies). E-learning represents an effective supplement or even alternative to standard teaching techniques within orthopedic education for both medical students and residents. Future work should focus on validating specific e-learning programs using standardized outcome measures and assessing long-term knowledge retention using e-learning platforms.

Promoting Undergraduate Surgical Education: Current Evidence and Students' Views on ESMSC International Wet Lab Course

BACKGROUND

Undergraduate Surgical Education is becoming an essential element in the training of the future generation of safe and efficient surgeons. Essential Skills in the Management of Surgical Cases (ESMSC), is an international, joint applied surgical science and simulation-based learning wet lab course.

METHODS

We performed a review of the existing literature on the topic of undergraduate surgical education. Following that, we analyzed the feedback questionnaire received 480 from 2 recent series of ESMSC courses (May 2015, n = 49 and November 2015, n = 40), in order to evaluate European Union students' (UK, Germany, Greece) views on the ESMSC course, as well as on the undergraduate surgical education. Results Using a 10 point graded scale, the overall ESMSC concept was positively evaluated, with a mean score of 9.41 ± 0.72 (range: 8-10) and 8.94 ± 1.1 (range: 7-10). The majority of delegates from both series [9.86 ± 0.43 (range: 8-10) and 9.58 ± 0.91 (range: 6-10), respectively] believed that ESMSC should be incorporated in the undergraduate surgical curriculum. Comparison of responses from the UK to the Greek Medical Student, as well as the findings from the third and fourth year versus the fifth and sixth year Medical Students, revealed no statistically significant differences pertaining to any of the questions (p > 0.05).

CONCLUSIONS

Current evidence in the literature supports the enhancement of surgical education through the systematic use of various modalities that provide Simulation-Based Training (SBT) hands-on experience, starting from the early undergraduate level. The findings of the present study are in agreement with these previous reports.

The effectiveness of e-learning in pediatric medical student education

BACKGROUND

Electronic learning allows individualized education and may improve student performance. This study assessed the impact of e-modules about infection control and congenital infections on medical knowledge.

METHODS

A descriptive study was conducted involving third-year medical students on pediatric clerkship. e-Module content in three different formats was developed: a text monograph, a PowerPoint presentation, and a narrated PowerPoint lecture. Students' use of the e-modules was tracked, as was participation in the infectious disease rotation and the order of pediatric rotation. Pre- and posttests specific to the e-module content and National Board of Medical Examiners (NBME) pediatric exam scores were recorded.

RESULTS

Among 67 participants, 63% of them visited at least one e-module. Neither accessing any e-modules, timing of pediatric clerkship, nor assignment to ID rotation resulted in improved posttest nor NBME scores. Seventy percent of students rated the e-modules as satisfactory and reported usage improved their confidence with the congenital infections topic.

DISCUSSION

e-Modules did not improve student performance on NBME or posttest; however, they were perceived as satisfactory and to have improved confidence among those who used them. This study underscores the importance of formally evaluating electronic and other innovative curricula when implemented within existing medical education frameworks.

Validation of educational hypermedia about peripheral venipuncture

The objective was to validate an educational hypermedia about peripheral venipuncture. This is a methodological study, conducted from January to October 2012, among nursing specialists and students. Binomial and paired t-tests were used for the analysis, where values of p<0.05 were considered statistically significant. The hypermedia content was considered effective by the specialists, because the values of the proportion among the specialists were greater than 85%. The hypermedia was classified as "very good" and "good" by 92.3% and 7.7% of students, respectively. It was deemed to be a resource that facilitates and complements the teaching-learning process. The hypermedia will assist the practice of nursing in the area of peripheral venipuncture, providing opportunities for future nurses to be qualified and able to promote health among the patients in their care.

[Distance education in neonatal nursing scenarios: a systematic review]

OBJECTIVE

Identify resources that support learning mediated by technology in the field of neonatal nursing.

METHOD

Systematic review with searches conducted in MEDLINE, LILACS and SciELO. Titles and abstracts were independently evaluated by two experts.

RESULTS

Of the 2,051 references, 203 full-text articles were analyzed, resulting in the inclusion of nine studies on semiotics and semiology, cardiopulmonary resuscitation, general aspects of neonatal care, diagnostic reasoning and assessment of pain. Only two articles addressed the development of educational strategies and seven papers described the assessment of these strategies by experts and/or users.

CONCLUSION

Distance education is an important resource for education, and its improvement and updating, and it particularly adds advantages for neonatal nursing by approximating teaching and real-life situations and by minimizing the exposure of newborns for teaching purposes. The lack of educational initiatives mediated by technology suggests the need for the development, evaluation and dissemination of educational resources focused on nursing care of newborns and their families.

Online eLearning for undergraduates in health professions: A systematic review of the impact on knowledge, skills, attitudes and satisfaction

BACKGROUND

Health systems worldwide are facing shortages in health professional workforce. Several studies have demonstrated the direct correlation between the availability of health workers, coverage of health services, and population health outcomes. To address this shortage, online eLearning is increasingly being adopted in health professionals' education. To inform policy-making, in online eLearning, we need to determine its effectiveness.

METHODS

We performed a systematic review of the effectiveness of online eLearning through a comprehensive search of the major databases for randomised controlled trials that compared online eLearning to traditional learning or alternative learning methods. The search period was from January 2000 to August 2013. We included articles which primarily focused on students' knowledge, skills, satisfaction and attitudes toward eLearning and cost-effectiveness and adverse effects as secondary outcomes. Two reviewers independently extracted data from the included studies. Due to significant heterogeneity among the included studies, we presented our results as a narrative synthesis.

FINDINGS

Fifty-nine studies, including 6750 students enrolled in medicine, dentistry, nursing, physical therapy and pharmacy studies, met the inclusion criteria. Twelve of the 50 studies testing knowledge gains found significantly higher gains in the online eLearning intervention groups compared to traditional learning, whereas 27 did not detect significant differences or found mixed results. Eleven studies did not test for differences. Six studies detected significantly higher skill gains in the online eLearning intervention groups, whilst 3 other studies testing skill gains did not detect differences between groups and 1 study showed mixed results. Twelve studies tested students' attitudes, of which 8 studies showed no differences in attitudes or preferences for online eLearning. Students' satisfaction was measured in 29 studies, 4 studies showed higher satisfaction for online eLearning and 20 studies showed no difference in satisfaction between online eLearning and traditional learning. Risk of bias was high for several of the included studies.

CONCLUSION

The current evidence base suggests that online eLearning is equivalent, possibly superior to traditional learning. These findings present a potential incentive for policy makers to cautiously encourage its adoption, while respecting the heterogeneity among the studies.

"iBIM"--internet-based interactive modules: an easy and interesting learning tool for general surgery residents

BACKGROUND

The increased use of information technology supports a resident- centred educational approach that promotes autonomy, flexibility and time management and helps residents to assess their competence, promoting self-awareness. We established a web-based e-learning tool to introduce general surgery residents to bariatric surgery and evaluate them to determine the most appropriate implementation strategy for Internet-based interactive modules (iBIM) in surgical teaching.

METHODS

Usernames and passwords were assigned to general surgery residents at the University of Alberta. They were directed to the Obesity101 website and prompted to complete a multiple-choice precourse test. Afterwards, they were able to access the interactive modules. Residents could review the course material as often as they wanted before completing a multiple-choice postcourse test and exit survey. We used paired t tests to assess the difference between pre- and postcourse scores.

RESULTS

Out of 34 residents who agreed to participate in the project, 12 completed the project (35.3%). For these 12 residents, the precourse mean score was 50 ± 17.3 and the postcourse mean score was 67 ± 14 (p = 0.020).

CONCLUSION

Most residents who participated in this study recommended using the iBIMs as a study tool for bariatric surgery. Course evaluation scores suggest this novel approach was successful in transferring knowledge to surgical trainees. Further development of this tool and assessment of implementation strategies will determine how iBIM in bariatric surgery may be integrated into the curriculum.

Effectiveness of an e-learning tool for education on pressure ulcer evaluation

AIMS AND OBJECTIVES

To evaluate the effectiveness of information and communication technologies in the undergraduate students' pressure ulcer training as a learning tool, compared with traditional teaching methods.

BACKGROUND

Pressure ulcers constitute one of the great challenges faced by nursing professionals. Currently, pressure ulcer training is based on traditional on-campus teaching, involving lecture-style classes with frequent use of photographs of the wounds. This traditional training has some important weaknesses that can put the efficacy of the training at risk.

DESIGN

A randomised controlled trial was developed including undergraduate nursing students.

METHODS

The intervention group used an adaptive self-learning e-learning tool developed by the research team (ePULab) for pressure ulcer assessment and treatment. The control group received a traditional on-campus class on the same topic. Pretest and post-test questionnaires were designed to assess the students' ability in pressure ulcer diagnosis and treatment.

RESULTS

The educational intervention based on the use of the ePULab tool produced significantly better learning acquisition results than those obtained by traditional lecture-style classes: the total score improved in the control group from 8·23 (SD 1·23)-11·6 (SD 2·52) after the lecture, whereas in the intervention group, the knowledge score changed from 8·27 (SD 1·39)-15·83 (SD 2·52) (p = 0·01) with the use of ePULab.

CONCLUSIONS

The results show a higher effectiveness of the devised e-learning approach for education on management of pressure ulcers.

RELEVANCE TO CLINICAL PRACTICE

Our results reveal the suitability of the ePULab e-learning tool as an effective instrument for training on assessment of and treatment for pressure ulcers and its potential impact on clinical decision-making.

Orthopaedic resident preparedness for closed reduction and pinning of pediatric supracondylar fractures is improved by e-learning: a multisite randomized controlled study

BACKGROUND

There is a need to provide more efficient surgical training methods for orthopaedic residents. E-learning could possibly increase resident surgical preparedness, confidence, and comfort for surgery. Using closed reduction and pinning of pediatric supracondylar humeral fractures as the index case, we hypothesized that e-learning could increase resident knowledge acquisition for case preparation in the operating room.

METHODS

An e-learning surgical training module was created on the Computer Enhanced Visual Learning platform. The module provides a detailed and focused road map of the procedure utilizing a multimedia format. A multisite prospective randomized controlled study design compared residents who used a textbook for case preparation (control group) with residents who used the same textbook plus completed the e-learning module (test group). All subjects completed a sixty-question test on the theory and methods of the case. After completion of the test, the control group then completed the module as well. All subjects were surveyed on their opinion regarding the effectiveness of the module after performing an actual surgical case.

RESULTS

Twenty-eight subjects with no previous experience in this surgery were enrolled at four academic centers. Subjects were randomized into two equal groups. The test group scored significantly better (p &lt; 0.001) and demonstrated competence on the test compared with the control group; the mean correct test score (and standard deviation) was 90.9% ± 6.8% for the test group and 73.5% ± 6.4% for the control group. All residents surveyed (n = 27) agreed that the module is a useful supplement to traditional methods for case preparation and twenty-two of twenty-seven residents agreed that it reduced their anxiety during the case and improved their attention to surgical detail.

CONCLUSIONS

E-learning using the Computer Enhanced Visual Learning platform significantly improved preparedness, confidence, and comfort with percutaneous closed reduction and pinning of a pediatric supracondylar humeral fracture. We believe that adapting such methods into residency training programs will improve efficiency in surgical training.

Web-based distance learning for nurse education: a systematic review

BACKGROUND

Web-based distance learning is considered a promising approach to replace or supplement conventional nursing instruction. However, no systematic review has been seen to explore the effect of web-based distance education in nursing.

AIM

To examine the efficacy of the web-based distance education for nursing students and employed nurses.

METHODS

A systematic review of randomized controlled studies was undertaken. Multiple search strategies were performed in PubMed and Embase until July 2012. Two reviewers independently selected trials, conducted quality critical appraisal, and extracted the data from the included studies.

RESULTS

Nine randomized controlled trials met inclusion criteria, among which five studies were rated as A quality level, and the other four studies as B quality level. The results showed that web-based distance learning has produced equivalent or better effects in knowledge acquisition. For nursing skill performance, four studies revealed a positive role for the new teaching mode, and one study showed a negative viewpoint. This review also demonstrated that participants generally accepted web-based education with high satisfaction rates. Two studies reported a more positive trend for self-efficacy in performing nursing skills in the experiment group compared with control group. Some negative feedbacks were also expressed.

CONCLUSION

Web-based education has encouraging effects in improving both participants' knowledge and skills performance, and in enhancing self-efficacy in performing nursing skills, with a high satisfaction rate expressed by participants. More rigorous experimental studies are advocated.