Learning strategies used by undergraduate nursing students in the context of a digitial educational strategy based on script concordance: A descriptive study

Beliefs and experiences of educators when involved in the design of a Learning-by-concordance tool: A qualitative interpretative study

BACKGROUND

Based on the involvement of qualified educators in its design, the Learning-by-Concordance tool aims to promote the learning of reasoning in contexts of uncertainty. However, data are still scarce on the experience of educators in terms of sharing and exposing their reasoning processes using this tool.

PURPOSE

This study sought to explore the beliefs and experiences of educators when involved in the design of a Learning-by-Concordance tool.

METHOD

This research used a descriptive qualitative design. Four dialogue groups were conducted with educators with different roles and responsibilities while designing a Learning-by-Concordance tool. A descriptive interpretative analysis of educators' verbatim quotes was done.

FINDINGS

A total of 14 participants took part in the study. The results show the discomfort of educators despite their recognized expertise. Three themes emerged: 1- the need to be reassured by the opinions of colleagues; 2-feeling like impostors; and 3- concerns for the quality of instructional supports.

CONCLUSIONS

The role taken by educators for teaching reasoning in contexts of uncertainty is to draw on practical experience where different types of knowledge intersect and are mobilized, to overcome feelings of insecurity, and to engage in close and authentic conversation with learners.

Using learning-by-concordance to develop reasoning in epistaxis management with online feedback: A pilot study

BACKGROUND

Epistaxis is a recurring cause for referral to emergency departments. Its management can be complex; hence, it is critical to provide appropriate support to Otolaryngology-Head and Neck Surgery (OHNS) residents to develop clinical reasoning skills to manage such cases. Learning-by-Concordance (LbC) is a recently developed educational tool that encourages learners to think through simulated clinical scenarios. A panel of ENTs provides insightful feedback to residents, reflecting a diversity of opinions about practice. Our study aimed to assess LbC's feasibility and perceived value for training OHNS residents in epistaxis management.

METHODS

In this qualitative study, three OHNS surgeons, including two faculty members and one resident, wrote the LbC scenarios. The LbC tool was made available to participants through an online platform. A panel of four OHNS faculty provided feedback on answers to LbC questions. Otolaryngology-Head and Neck Surgery residents participated and provided their opinion on the value of this educational tool through an online questionnaire.

RESULTS

A total of 10 one-hour sessions were required to create and upload the training tool. To provide insightful feedback embedded in the learning tool, the four panelists needed 60 min each. Of the 37 participating residents, 25 (68%) completed the training. Overall satisfaction was high: 88% appreciated the training method, and 92% wanted to use this type of training again. Most residents felt the training enabled them to improve their clinical reasoning when encountering a patient with epistaxis (92%) and their knowledge about epistaxis (96%).

CONCLUSION

Findings suggest that OHNS residents could benefit from clinical reasoning exercises with panelist feedback using the LbC approach for clinical presentations that require complex approaches to manage conditions such as epistaxis.

Evaluating clinical reasoning in first year DPT students using a script concordance test

BACKGROUND

A script concordance test (SCT) provides a series of clinical vignettes to assess clinical reasoning in uncertainty. Appraised throughout health education literature, SCTs are cognitive assessments of clinical reasoning, though their use in Doctor of Physical Therapy (DPT) entry-level education has not been investigated. The purpose of this study was to develop and explore the reliability and validity of a SCT for first year DPT students.

METHODS

The SCT was developed and implemented over four phases. During phases one and two, DPT program faculty consulted on course content from the first-year curriculum. Thirty clinical vignettes with three follow-up questions each were constructed. The SCT was pilot tested with five clinicians in phase three to assess question clarity. During phase four, the SCT was administered to students and a reference panel via Qualtrics. First year DPT students (n = 44) and reference panel physical therapists with at least two years of experience and advanced certification (n = 15) completed the SCT. Internal consistency was analyzed using Cronbach's Alpha. Differences between student and reference panel percent-correct scores were analyzed with a t-test. Relationships between student SCT scores and academic records were explored with Spearman's Rho.

RESULTS

The SCT had an internal consistency of 0.74. A significant difference in scores was found between the students [mean 58.5 (+/-5.31)] and reference panel [65.8 (+/-4.88), p < .01]. No significant correlations between student SCT scores and academic records were found.

CONCLUSIONS

The developed SCT was reliable and demonstrated satisfactory internal consistency among test items. The SCT successfully differentiated between groups, with the reference panel demonstrating statistically significant higher percent-correct scores compared to students. SCTs may provide means to measure clinical reasoning in DPT students and lead to novel pedagogical approaches to enhance clinical reasoning.

Adapting to a Pandemic: Web-Based Residency Training and Script Concordance Testing in Emergency Medicine During COVID-19

OBJECTIVE

The coronavirus disease (COVID-19) pandemic necessitated alternative methods to ensure the continuity of medical education. Our study explores the efficacy and acceptability of a digital continuous medical education initiative for medical residents during this challenging period.

METHODS

From September to December 2020, 47 out of 60 enrolled trainee doctors participated in this innovative digital Continuous Medical Education (CME) approach. We utilized the Script Concordance Test to bolster clinical reasoning skills. Three simulation scenarios, namely Advanced Trauma Life Support (ATLS), Advanced Life Support (ALS), and European Paediatric Life Support (EPLS), were transformed into interactive online sessions via Zoom™. Participant feedback was also collected through a survey.

RESULTS

Consistent Script Concordance Testing (SCT) scores among participants indicated the effectiveness of the online training module. Feedback suggested a broad acceptance of this novel training approach. However, discrepancies observed between formative SCT scores, and summative Multiple-Choice Questions (MCQ) assessments highlighted areas for potential refinement.

CONCLUSIONS

Our findings showcase the resilience and adaptability of medical education amidst challenges like the global pandemic. The success of methodologies such as SCT, endorsed by prestigious bodies like the European Resuscitation Council and the American Heart Association, suggests their potential in preparing health care professionals for emergent situations. This research offers valuable insights for shaping future online CME strategies.

What can Designing Learning-by-Concordance Clinical Reasoning Cases Teach Us about Instruction in the Health Sciences?

Introduction

Learning-by-concordance (LbC) is an online learning strategy to practice reasoning skills in clinical situations. Writing LbC clinical cases, comprising an initial hypothesis and supplementary data, differs from typical instructional design. We sought to gain a deeper understanding from experienced LbC designers to better support clinician educators' broader uptake of LbC.

Methods

A dialogic action research approach was selected because it yields triangulated data from a heterogeneous group. We conducted three 90-minute dialogue-group sessions with eight clinical educators. Discussions focused on the challenges and pitfalls of each LbC design stage described in the literature. Recordings were transcribed and analyzed thematically.

Results

We identified three themes by thematic analysis about the challenges inherent in designing LbC that are unique for this type of learning strategy: 1) the distinction between pedagogical intent and learning outcome; 2) the contextual cues used to challenge students and advance their learning and 3) the integration of experiential with formalized knowledge for cognitive apprenticeship.

Discussion

A clinical situation can be experienced and conceptualized in many ways, and multiple responses are appropriate. LbC designers use contextual cues from their experience and combine them with formalized knowledge and protocols to write effective LbC clinical reasoning cases. LbC focuses learners' attention on decision-making in grey areas that characterize the nature of professional clinical work. This in-depth study on LbC design, indicating the integration of experiential knowledge, might call for new thinking about instructional design.

Learning-by-Concordance of Perception: A Novel way to Learn to Read Thoracic Images

RATIONALE AND OBJECTIVE

Learning to interpret thoracic images requires intensive instructor support. Given current cohort sizes at teaching hospitals in North America, instructor availability is rare. A Learning-by-concordance of perception (LbCP) online tool was introduced in a second-year course on lung and oxygenation. The LbCP tool presents thoracic images, students must point or outline abnormal structures directly on the screen and name the lesion. Thereafter, images with correct outline are superimposed on student's work and three key-messages are provided. We aimed to measure student perception of LbCP tool's usefulness and ease of use.

MATERIALS AND METHODS

The online tool was developed and implemented for second year students for cohorts in 2016, 2017 and 2018 (n = 296; 303; and 280; N = 879). A survey, comprisingsix questions on a Likert scale was designed to measure perceptions about tool utility and ease of use. An ANOVA analysis was carried out to ensure the normality of the data, and a principal axis factor analysis was used to confirm the presence of the two expected clusters corresponding to our two dimensions.

RESULTS

The ANOVA conducted on the combined three year data set revealed an F value of 7.688 (p = 0.001), and principal axis factorial analysis revealed a one factor solution. The percentage of variance explained by the factor was 44.5%, with factor loadings leaning heavily in favor of the tool's perceived utility. A second factor was just shy of the eigenvalue threshold of 1.0 and could provide support for the tool's ease of use.

CONCLUSION

The online LbCP tool shows promising impact over three cohorts of students in three consecutive years. Students recognize the pedagogical value of the tool and express their willingness to use more of it in their training.

Development and validation of a script concordance test to assess biosciences clinical reasoning skills: A cross-sectional study of 1st year undergraduate nursing students

BACKGROUND

Developing evaluative measures that assess clinical reasoning remains a major challenge for nursing education. A thorough understanding of biosciences underpins much of nursing practice and is essential to allow nurses to reason effectively. A gap in clinical reasoning can lead to unintended harm. The Script Concordance test holds promise as a measure of clinical reasoning in the context of uncertainty, situations common in nursing practice. The aim of this study is to develop and validate a test for first year undergraduate nursing students that will evaluate how bioscience knowledge is used to clinically reason.

METHODS

An international team, teaching biosciences to undergraduate nurses constructed a test integrating common clinical cases with a series of related test items: diagnostic, investigative and treatment. An expert panel (n = 10) took the test and commented on authenticity/ambiguities/omissions etc. This step is crucial for validity and for scoring of the student test. The test was administered to 47 first year undergraduate nursing students from the author sites. Students rated educational aspects of the tool both quantitatively and qualitatively. Statistical and content analyses inform the findings.

FINDINGS

Results indicate that the test is reliable and valid, differentiating between experts and students. Students demonstrated an ability to identify relevant data, link this to their bioscience content and predict outcomes (mean score = 50.78 ± 8.89). However, they lacked confidence in their answers when the scenarios appeared incomplete to them.

CONCLUSION

Nursing practice is dependent on a thorough understanding of biosciences and the ability to clinically reason. Script concordance tests can be used to promote both competencies. This method of evaluation goes further than probing factual knowledge. It also explores capacities of data interpretation, critical analysis, and clinical reasoning. Evaluating bioscience knowledge and real-world situations encountered in practice is a unique strength of this test.

Assessing the Impact of Online-Learning Effectiveness and Benefits in Knowledge Management, the Antecedent of Online-Learning Strategies and Motivations: An Empirical Study

Online learning is one of the educational solutions for students during the COVID-19 pandemic. Worldwide, most universities have shifted much of their learning frameworks to an online learning model to limit physical interaction between people and slow the spread of COVID-19. The effectiveness of online learning depends on many factors, including student and instructor self-efficacy, attitudes, and confidence in using the technology involved; the educational strategies employed; the ability to monitor and evaluate educational outcomes; and student motivation, among many others. In this study, we analyzed how these factors were associated and impacted each other. We developed a comprehensive model after an extensive review of the relevant literature. The model was validated by applying partial least square regression to the data obtained by surveying 469 students who were enrolled in online education. The test results indicated that all the variables had a positive effect on the effectiveness of online learning. The effectiveness of online learning had a significant impact on the benefits of online learning. This showed that the more effective online learning was, the more benefits and positive outcomes the student experienced. The result of this research showed that learning objectives could enable universities to increase the effectiveness of students’ online learning by motivating students to join online classes and developing appropriate learning strategies for their individual needs.

Educators and practitioners' perspectives in the development of a learning by concordance tool for medical clerkship in the context of the COVID pandemic

BACKGROUND

The COVID-19 pandemic has forced medical schools to create educational material to palliate the anticipated and observed decrease in clinical experiences during clerkships. An online learning by concordance (LbC) tool was developed to overcome the limitation of students' experiences with clinical cases. However, knowledge about the instructional design of an LbC tool is scarce, especially the perspectives of collaborators involved in its design: 1- educators who wrote the vignettes' questions and 2- practitioners who constitute the reference panel by answering the LbC questions. The aim of this study was to describe the key elements that supported the pedagogical design of an LbC tool from the perspectives of educators and practitioners.

METHODS

A descriptive qualitative research design has been used. Online questionnaires were used, and descriptive analysis was conducted.

RESULTS

Six educators and 19 practitioners participated in the study. Important to the educators in designing the LbC tool were prevalent or high-stake situations, theoretical knowledge, professional situations experienced and perceived difficulties among students, and that the previous workshop promoted peer discussion and helped solidify the writing process. Important for practitioners was standards of practice and consensus among experts. However, they were uncertain of the educational value of their feedback, considering the ambiguity of the situations included in the LbC tool.

CONCLUSIONS

The LbC tool is a relatively new training tool in medical education. Further research is needed to refine our understanding of the design of such a tool and ensure its content validity to meet the pedagogical objectives of the clerkship.

Script Concordance Approach in Nursing Education

BACKGROUND

The script concordance approach aims at triggering judgments in simulated contexts of uncertainty.

PROBLEM

Nursing students need to be prepared to manage the uncertainty of clinical practice.

APPROACH

The purpose of this article is to describe the theoretical foundation and the pedagogical use of the script concordance approach, as well as to present the current state of nursing evidence on the subject. The script concordance approach includes (1) script concordance testing, which is a quantitative examination that evaluates clinical reasoning; (2) a face-to-face script concordance activity; and (3) a digital educational strategy based on script concordance delivered via an online teaching/learning platform that aims to support clinical reasoning development.

CONCLUSIONS

Relying on questioning and experts' modeling, the script concordance offers an innovative pedagogical approach that approximates the uncertainty of clinical practice.

The Empirical Study of College Students' E-Learning Effectiveness and Its Antecedents Toward the COVID-19 Epidemic Environment

Due to the impact of COVID-19, universities are forced to suspend their classes, which begin to depend on the usage of online teaching. To investigate the relationship among e-learning self-efficacy, monitoring, willpower, attitude, motivation, strategy, and the e-learning effectiveness of college students in the context of online education during the outbreak of COVID-19. A 519 first- to fifth-year undergraduate students from a medical university were selected for the research in this study. Structural equation model (SEM) was used for a data analysis, which led to the results showing that: (1) e-learning self-efficacy and monitoring have significant positive influence on e-learning strategy, and indirectly influence e-learning effectiveness through e-learning strategy; (2) e-learning willpower and attitude have a significant positive influence on e-learning motivations, and indirectly influence e-learning effectiveness through e-learning motivation and strategy; (3) e-learning motivation is having significant influence on e-learning effectiveness, while e-learning strategy is playing a mediating role; (4) There is a significant positive correlation between e-learning strategy and e-learning effectiveness; and (5) The presence of e-learning experience has a moderating influence on e-learning effectiveness as well as its influential factors. Results from this study provide the necessary information as to how higher education institutions and students can enhance students’ effectiveness of the e-learning system in order to support the usage of online technologies in the learning and teaching process. These results offer important implications for online learning effectiveness.

Learning by concordance (LbC) to develop professional reasoning skills: AMEE Guide No. 141

Developing effective clinical reasoning is central to health professions education. Learning by concordance (LbC) is an on-line educational strategy that makes learners practice reasoning competency in case-based clinical situations. The questions asked are similar to those professionals ask themselves in their practice and participant answers are compared to those of a reference panel. When participants answer the questions, they receive an automated feedback that is two-fold as they see (1) how the panelists respond and (2) justifications each panelist gives for their answer. This provides rich contextual knowledge about the situation, supplemented by a synthesis summarizing crucial points. As many educators in the health sciences are engaging in introducing innovative approaches, many consider building LbC learning modules. Elaborating, designing and implementing a LbC tool remain a challenge. This AMEE Guide describes the steps and elements to be considered when designing a LbC tool, drawing on examples from distinct health professions: medicine, nursing, physiotherapy, and dentistry. Specifically, the following elements will be discussed: (1) LbC theoretical underpinnings; (2) principles of LbC questioning; (3) goals of the concordance-based activity; (4) nature of reasoning tasks; (5) content/levels of complexity; (6) reference panel; (7) feedback/synthesis messages; (8) on-line learning platforms.

A conceptual framework of student professionalization for health professional education and research

OBJECTIVES

To present a conceptual framework of student professionalization for health professional education and research.

METHODS

Synthesis and discussion of a program of research on competency-based education.

RESULTS

Competency-based education relies on active, situation-based group learning strategies to prepare students to become health professionals who are connected to patient and population needs. Professionalization is understood as a dynamic process of imagining, becoming, and being a member of a health profession. It rests on the evolution of three interrelated dimensions: professional competencies, professional culture, and professional identity. Professionalization occurs throughout students' encounters with meaningful learning experiences that involve three core components: the roles students experience in situations bounded within specific contexts. Educational practices conducive to professionalization include active learning, reflection, and feedback.

CONCLUSIONS

This conceptual framework drives a research agenda aimed at understanding how students become health professional and how learning experiences involving action, reflection, and feedback foster that process and the advancement of professional practices.

Nursing Students' Satisfaction: A Comparison between Medium- and High-Fidelity Simulation Training

Training based on clinical simulation is an effective method of teaching in nursing. Nevertheless, there is no clear evidence about if it is better to use high- or medium-fidelity simulation. The aim is to analyse if students are more satisfied when their clinical simulation practices are based on high-fidelity simulation (HFS) or medium-fidelity simulation (MFS). Students´ satisfaction was assessed using the Satisfaction Scale Questionnaire with High-Fidelity Clinical Simulation. The sample is composed of 393 students from two Spanish Universities. Satisfaction with simulation in nursing students is significantly greater in MFS than HFS. Simulation is beneficial for learning in all its forms, but for the acquisition of basic skills, and at a lower cost, MFS proves to be effective. However, high-fidelity is not always better than medium-fidelity as this depends on the student’s level of knowledge and clinical experience.

L’apprentissage du raisonnement clinique infirmier dans le cadre d’un dispositif éducatif numérique basé sur la concordance de scripts

Contexte : Un des défis actuels des responsables de la formation des futurs infirmiers est de concevoir des stratégies éducatives pour favoriser le développement optimal du raisonnement clinique infirmier (RCI).But : L’étude visait à développer, mettre à l’essai et évaluer un dispositif éducatif numérique basé sur la concordance de scripts auprès d’étudiants en sciences infirmières. Méthodes : Un devis de recherche-développement a permis de soutenir les étapes de réalisation du dispositif éducatif. Une validation de contenu a été intégrée au devis à l’aide d’une technique Delphi modifiée. Les choix de réponses des étudiants et des experts aux questions du dispositif ont été compilés. Un questionnaire en ligne et des entrevues de groupe focalisées ont été utilisés auprès d’étudiants afin d’évaluer l’acceptabilité et l’utilisabilité du dispositif éducatif. Résultats : Cinq experts-collaborateurs ont validé le contenu du dispositif éducatif. La version finale comptait 81 questions liées à 22 vignettes. Douze experts-panélistes et quarante-cinq étudiants ont répondu aux questions du dispositif éducatif. Les indices alpha (α) de Cronbach ont oscillé entre 0,87 et 0,90. Globalement, les étudiants ont apprécié l’utilisation du dispositif éducatif, dont la rétroaction variée et formative d’experts à des situations apparentées à la vie professionnelle. Conclusion : Le dispositif éducatif repose sur l’utilisation d’un test de concordance de scripts numérisé auquel des rétroactions d’experts sont intégrées à des fins d’apprentissage du RCI. Essentiel, l’engagement des experts-panélistes inscrit la conception d’un tel dispositif éducatif dans une démarche de co-construction et de validation du matériel pédagogique.