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Farina CL, Moreno J, Schneidereith T. Using Simulation to Improve Communication Skills. Nurs Clin North Am 2024; 59:437-448. [PMID: 39059862 DOI: 10.1016/j.cnur.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
Ineffective communication is implicated in 80% of medical errors, costing the United States approximately $12 billion annually. Teaching communication skills is a component of nursing curricula linked to improved patient outcomes. Simulation-based experience (SBE) is a strategy for healthcare professionals to learn communication skills. Providing nurses with the ability to practice nurse-nurse, nurse-physician, nurse-patient, and team communication skills in a psychologically safe learning environment provides an opportunity for skill development and meaningful self-reflection. The multiple modalities for SBE support needed communication techniques for skill development and acquisition to improve patient outcomes.
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Affiliation(s)
- Crystel L Farina
- Department of Nursing, George Washington University School of Nursing, 45085 University Drive, Ashburn, VA 20147, USA.
| | - Jasline Moreno
- Maryland Clinical Resource Consortium, Montgomery College, 7600 Takoma Avenue, Takoma Park, MD 20912, USA
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Choompunuch B, Kamdee K, Taksino P. Exploring the Components of Multicultural Competence among Pre-Service Teacher Students in Thailand: An Approach Utilizing Confirmatory Factor Analysis. Eur J Investig Health Psychol Educ 2024; 14:2476-2490. [PMID: 39329832 DOI: 10.3390/ejihpe14090164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 07/27/2024] [Accepted: 08/27/2024] [Indexed: 09/28/2024] Open
Abstract
The aim of this study is to examine the components of multicultural competence among pre-service teacher students in Thailand and to develop and assess the reliability of a model of multicultural competence for pre-service teacher students in Thailand. Multistage stratified random sampling was utilized to recruit 600 pre-service teacher students from undergraduate education programs at the Faculty of Education in Thailand. Data were collected through self-report questionnaires. The data analysis employed descriptive statistics and second-order confirmatory factor analysis (CFA). The findings indicate that multicultural competence among pre-service teacher students comprises three components: cultural awareness, cultural knowledge, and personal skills. Furthermore, this study identified that the model of multicultural competence among pre-service teacher students demonstrated good fit indices for the modified model (χ2 = 30.902, df = 21, p-value = 0.0753, χ2/df = 1.472; root mean square error of approximation (RMSEA) = 0.028; standardized root means square residual (SRMR) = 0.013; Tucker-Lewis index (TLI) = 0.996; comparative fit index (CFI) = 0.999). Based on these findings, effective teaching in diverse environments necessitates a thorough understanding of multicultural competence.
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Affiliation(s)
| | - Khanika Kamdee
- Faculty of Humanities and Social Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
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Jeon Y, Choi H, Lee U, Kim H. Technology-based interactive communication simulation addressing challenging communication situations for nursing students. J Prof Nurs 2024; 53:71-79. [PMID: 38997201 DOI: 10.1016/j.profnurs.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 05/03/2024] [Accepted: 05/08/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND Simulation-based interventions for nursing students addressing challenging communication situations involving geriatric patients and end-of-life care are limited. PURPOSE This study evaluated the effects of technology-based interactive communication simulations on nursing students' communication knowledge, self-efficacy, skills, compassion, and program satisfaction. METHOD A randomized controlled repeated-measures design was used with third- and fourth-year nursing students enrolled in five nursing colleges located in five regions in Korea as participants. Participants were randomly assigned to either a technology-based interactive communication simulation or an attention control group. Changes in communication knowledge, self-efficacy, skills, compassion, and program satisfaction were assessed using three self-reported measures and communication skills were measured by the raters. Statistical analyses included descriptive analyses, chi-square tests, t-tests, and a generalized estimating equation model. RESULTS Eighty students participated in one of the two programs, and 77 in the four-week follow-up test. The intervention group indicated significant improvements in communication knowledge, self-efficacy, skills, and compassion, as well as higher program satisfaction compared with the attention control group. Communication skills as assessed by raters also showed significant change at all assessment time points. CONCLUSION The technology-based interactive communication simulation program is effective in improving communication skills among nursing students managing geriatric patients and end-of-life care.
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Affiliation(s)
- Yeseul Jeon
- College of Nursing, Seoul National University, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Heeseung Choi
- College of Nursing, Seoul National University, Jongno-gu, Seoul 03080, Republic of Korea; Research Institute of Nursing Science, Seoul National University, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Ujin Lee
- College of Nursing, Incheon Catholic University, Yeonsu-gu, Incheon 21987, Republic of Korea.
| | - Hannah Kim
- College of Nursing, Seoul National University, Jongno-gu, Seoul 03080, Republic of Korea.
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Westendorp J, van Vliet LM, Meeuwis SH, Olde Hartman TC, Sanders ARJ, Jutten E, Dirven M, Peerdeman KJ, Evers AWM. Optimizing placebo and minimizing nocebo effects through communication: e-learning and virtual reality training development. BMC MEDICAL EDUCATION 2024; 24:707. [PMID: 38951784 PMCID: PMC11218054 DOI: 10.1186/s12909-024-05671-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 06/18/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND The effects of many treatments in healthcare are determined by factors other than the treatment itself. Patients' expectations and the relationship with their healthcare provider can significantly affect treatment outcomes and thereby play a major role in eliciting placebo and nocebo effects. We aim to develop and evaluate an innovative communication training, consisting of an e-learning and virtual reality (VR) training, for healthcare providers across all disciplines, to optimize placebo and minimize nocebo effects through healthcare provider-patient communication. The current paper describes the development, mid-term evaluation, optimization, and final evaluation of the communication training, conducted in The Netherlands. METHODS The development of both the e-learning and the VR training consisted of four phases: 1) content and technical development, 2) mid-term evaluation by healthcare providers and placebo/communication researchers, 3) optimization of the training, and 4) final evaluation by healthcare providers. To ensure the success, applicability, authenticity, and user-friendliness of the communication training, there was ongoing structural collaboration with healthcare providers as future end users, experts in the field of placebo/communication research, and educational experts in all phases. RESULTS Placebo/communication researchers and healthcare providers evaluated the e-learning positively (overall 7.9 on 0-10 scale) and the content was perceived as useful, accessible, and interesting. The VR training was assessed with an overall 6.9 (0-10 scale) and was evaluated as user-friendly and a safe method for practicing communication skills. Although there were some concerns regarding the authenticity of the VR training (i.e. to what extent the virtual patient reacts like a real patient), placebo and communication researchers, as well as healthcare providers, recognized the significant potential of the VR training for the future. CONCLUSIONS We have developed an innovative and user-friendly communication training, consisting of an e-learning and VR training (2D and 3D), that can be used to teach healthcare providers how to optimize placebo effects and minimize nocebo effects through healthcare provider-patient communication. Future studies can work on improved authenticity, translate the training into other languages and cultures, expand with additional VR cases, and measure the expected effects on providers communication skills and subsequently patient outcomes.
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Affiliation(s)
- Janine Westendorp
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands.
- Center for Interdisciplinary Placebo Studies (IPS) Leiden, Leiden, The Netherlands.
| | - Liesbeth M van Vliet
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands
- Center for Interdisciplinary Placebo Studies (IPS) Leiden, Leiden, The Netherlands
| | - Stefanie H Meeuwis
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands
- Center for Interdisciplinary Placebo Studies (IPS) Leiden, Leiden, The Netherlands
| | - Tim C Olde Hartman
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ariëtte R J Sanders
- General Medical Practice Van Lennep Huisartsenpraktijk, Driebergen, The Netherlands
| | - Eric Jutten
- The Simulation Crew (TSC), Nijmegen, The Netherlands
| | - Monique Dirven
- Dutch Institute for Rational Use of Medicine (IVM), Utrecht, The Netherlands
| | - Kaya J Peerdeman
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands
- Center for Interdisciplinary Placebo Studies (IPS) Leiden, Leiden, The Netherlands
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands
- Center for Interdisciplinary Placebo Studies (IPS) Leiden, Leiden, The Netherlands
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Xu J, Yang L, Guo M. Designing and Evaluating an Emotionally Responsive Virtual Patient Simulation. Simul Healthc 2024; 19:196-203. [PMID: 37651599 DOI: 10.1097/sih.0000000000000730] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
INTRODUCTION Virtual patient (VP) simulations have been widely used for healthcare training, education, and assessment. However, few VP systems have integrated emotion sensing and analyzed how a user's emotions may influence the overall training experience. This article presents a VP that can recognize and respond to 5 human emotions (anger, disgust, fear, joy, and sadness), as well as 2 facial expressions (smiling and eye contact). METHODS The VP was developed by combining the capabilities of a facial recognition system, a tone analyzer, a cloud-based artificial intelligence chatbot, and interactive 3-dimensional avatars created in a high-fidelity game engine (Unity). The system was tested with healthcare professionals at Changzhou Traditional Chinese Medicine Hospital. RESULTS A total of 65 participants (38 females and 27 males) aged between 23 and 57 years (mean = 38.35, SD = 11.48) completed the survey, and 19 participants were interviewed. Most participants perceived that the VP was useful in improving their communication skills, particularly their nonverbal communication skills. They also reported that adding users' affective states as an additional interaction increased engagement of the VP and helped them build connections with the VP. CONCLUSIONS The emotionally responsive VP seemed to be functionally complete and usable. However, some technical limitations need to be addressed before the system's official implementation in real-world clinical practice. Future development will include improving the accuracy of the speech recognition system, using more sophisticated emotion sensing software, and developing a natural user interface.
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Affiliation(s)
- Jiayi Xu
- From the Research Institute of China Mobile Communication Co, Ltd, Beijing, China
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Kang W. The use of virtual patients for breaking bad news: A rapid review. CLINICAL TEACHER 2024; 21:e13681. [PMID: 37860892 DOI: 10.1111/tct.13681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 09/21/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Breaking bad news is an imperative skill for clinical practice that health care professionals struggle with. Virtual patients have been adopted as a new teaching aide in medical education and have shown efficacy in teaching clinical skills; however, there is limited research for use in communication skills. Virtual patients are especially well-suited for difficult communication skills, as students can practice without risk to patients. This rapid review aimed to review literature observing the potential of virtual patients as an effective means to teach breaking bad news. METHOD A systematic search strategy was applied for papers published between November 2012 and November 2022 on Medline and Embase databases. Following the application of inclusion criteria, three studies were included. The Medical Education Research Study Quality Instrument and Critical Appraisal Skills Programme checklist were used for quality appraisal of the studies. Tabular and narrative synthesis was used to present the findings. FINDINGS The findings of the studies suggest that when teaching breaking bad news, virtual patients are valuable compared with no intervention and are not inferior compared with simulated patients. An unexpected benefit of virtual patients was videotaping. A barrier to learning was the lack of affect and interaction. More research into the design of virtual simulations and its integration into existing curricula is required. CONCLUSION Virtual patients are a valuable educational tool for breaking bad news; however, they are yet to replace existing educational approaches. There is a need for more large-scale, homogeneous studies to inform instructional design and curriculum integration.
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Schick K, Reiser S, Janssen L, Schacht L, Pittroff SID, Dörfler E, Klein E, Roenneberg C, Dinkel A, Fleischmann A, Berberat PO, Bauer J, Gartmeier M. Training in medical communication competence through video-based e-learning: How effective are video modeling and video reflection? PATIENT EDUCATION AND COUNSELING 2024; 121:108132. [PMID: 38184987 DOI: 10.1016/j.pec.2023.108132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/19/2023] [Accepted: 12/27/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE The present study investigated the efficacy of the didactic approaches of video modeling (VM, best-practice examples), video reflection (VR, problem-based approach), and the combination of both (VMR) in fostering medical communication competence in a video-based digital learning environment. METHODS N = 126 third-year medical students who participated in the pre-post study were assigned to either the intervention groups (VM, VR, and VMR) or the wait-list control group. The efficacy of the three approaches was assessed by means of a situational judgment test (SJT) of medical communication competence. To investigate the differences between the wait-list control and the intervention groups (H1), between the single-mode and combined conditions (H2), and between VM and VR (H3), we applied planned contrast analyses. RESULTS The planned contrasts showed that the VR condition significantly improved learning outcomes in comparison to the VM condition (H3). The decreased mean scores of the VM condition offset the increased mean scores of VR, and thus no significant differences could be found in H1 and H2. CONCLUSIONS Our study provides promising evidence that VR fosters medical communication competence more effectively than VM. PRACTICAL IMPLICATIONS Medical students' learning in video-based digital environments can be facilitated by the use of interactive VR.
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Affiliation(s)
- Kristina Schick
- Technical University of Munich, TUM School of Medicine & Health, Department Clinical Medicine, TUM Medical Education Center, Ismaninger Straße 22, 81675 München, Germany.
| | - Sabine Reiser
- University of Erfurt, Educational Research and Methodology, Nordhäuser Str. 63, 99089 Erfurt, Germany
| | - Laura Janssen
- Technical University of Munich, TUM School of Medicine & Health, Department Clinical Medicine, TUM Medical Education Center, Ismaninger Straße 22, 81675 München, Germany
| | - Laura Schacht
- University of Erfurt, Educational Research and Methodology, Nordhäuser Str. 63, 99089 Erfurt, Germany
| | - Sylvia Irene Donata Pittroff
- Technical University of Munich, TUM School of Medicine & Health, Department Clinical Medicine, TUM Medical Education Center, Ismaninger Straße 22, 81675 München, Germany
| | - Eva Dörfler
- Technical University of Munich, TUM Institute for LifeLong Learning, TUM ProLehre, Arcisstraße 21, 80333 München, Germany
| | - Evelyn Klein
- Technical University of Munich, TUM School of Medicine & Health, Department Clinical Medicine, Klinikum rechts der Isar, Department of Obstetrics and Gynecology, Ismaninger Straße 22, 81675 München, Germany
| | - Casper Roenneberg
- Technical University of Munich, TUM School of Medicine & Health, Department Clinical Medicine, Klinikum rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy, Langerstr. 3, 81675 München, Germany
| | - Andreas Dinkel
- Technical University of Munich, TUM School of Medicine & Health, Department Clinical Medicine, Klinikum rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy, Langerstr. 3, 81675 München, Germany
| | - Andreas Fleischmann
- Technical University of Munich, TUM Institute for LifeLong Learning, TUM ProLehre, Arcisstraße 21, 80333 München, Germany
| | - Pascal O Berberat
- Technical University of Munich, TUM School of Medicine & Health, Department Clinical Medicine, TUM Medical Education Center, Ismaninger Straße 22, 81675 München, Germany
| | - Johannes Bauer
- University of Erfurt, Educational Research and Methodology, Nordhäuser Str. 63, 99089 Erfurt, Germany
| | - Martin Gartmeier
- Technical University of Munich, TUM School of Medicine & Health, Department Clinical Medicine, TUM Medical Education Center, Ismaninger Straße 22, 81675 München, Germany
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Lopina N. A Staged Defragmented Simultaneous Debriefing Model As Integrated Micro-debriefing Components Inside Online Simulation for Competencies Formation. Cureus 2024; 16:e56000. [PMID: 38606236 PMCID: PMC11007450 DOI: 10.7759/cureus.56000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2024] [Indexed: 04/13/2024] Open
Abstract
Background Currently, there are no separate debriefing models for online simulation training, and existing models simply imitate the traditional models used in on-site simulation training (the physical presence of individuals, such as students or trainees, in a simulation center). This involves hands-on, in-person training within a simulated environment to enhance practical skills and knowledge in a controlled setting. This scenario does not fully meet the requirements and capabilities of distance learning. Objective To develop a staged defragmented debriefing model as integrated micro-debriefing components inside an online simulation to support the development of clinical decision-making and competencies formation within medical education and offer recommendations to support the use of this debriefing model as a teaching strategy. Methods This descriptive study was conducted from August 2020 to September 2023. To build a staged defragmented debriefing model as integrated micro-debriefing components inside an online simulation for competencies formation the traditional debriefing model's components for on-site simulation training, simulation type, and structure, modern concepts of e-learning, and classification of the seriousness of medication errors were used. The main focus of this study was on providing a detailed account of the debriefing components for online simulation training, features, and implementation of this new teaching model. A total of 38 participants, healthcare professionals, were recruited for this study. The participants were randomly assigned to two groups: one experiencing the staged defragmented debriefing model (n = 20) and the other control group, which received traditional debriefing following simulation training (n = 18). Results The results allowed us to successfully develop a staged defragmented debriefing model inside the simulation that integrates micro-debriefing components located at different points of the simulation scenarios. This teaching approach was successfully implemented in online clinical case scenarios in the "ClinCaseQuest" Simulation Training Platform for continuous medical education. Additionally, an internal validation experiment comparing the effectiveness of the staged defragmented debriefing model with the traditional debriefing method demonstrated superior learning outcomes and participant satisfaction in the staged debriefing group. Conclusions The staged defragmented debriefing model, when integrated into online simulations, represents a promising strategy for advancing clinical decision-making skills and competencies formation in medical education. Implementation of this debriefing model as a teaching strategy holds promise for enhancing learning outcomes in medical education settings. Further research, validation, and implementation are recommended to maximize the model's potential impact on medical education and training.
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Mitchell S, Blanchard E, Curran V, Hoadley T, Donoghue A, Lockey A. Effects of Simulation Fidelity on Health Care Providers on Team Training-A Systematic Review. Simul Healthc 2024; 19:S50-S56. [PMID: 38240618 DOI: 10.1097/sih.0000000000000762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
ABSTRACT This systematic review, following PRISMA standards, aimed to assess the effectiveness of higher versus lower fidelity simulation on health care providers engaged in team training. A comprehensive search from January 1, 2011 to January 24, 2023 identified 1390 studies of which 14 randomized (n = 1530) and 5 case controlled (n = 257) studies met the inclusion criteria. The certainty of evidence was very low due to a high risk of bias and inconsistency. Heterogeneity prevented any metaanalysis. Limited evidence showed benefit for confidence, technical skills, and nontechnical skills. No significant difference was found in knowledge outcomes and teamwork abilities between lower and higher fidelity simulation. Participants reported higher satisfaction but also higher stress with higher fidelity materials. Both higher and lower fidelity simulation can be beneficial for team training, with higher fidelity simulation preferred by participants if resources allow. Standardizing definitions and outcomes, as well as conducting robust cost-comparative analyses, are important for future research.
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Affiliation(s)
- Sally Mitchell
- From the Department of Anesthesia (S.M.), Indiana University, Bloomington, IN; Department of Health Services Administration (E.B.), School of Health Professions, University of Alabama at Birmingham, Birmingham, AL; Faculty of Medicine (V.C.), Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada; Saint Francis Medical Center College of Nursing (T.H.), Peoria, IL; University of Pennsylvania Perelman School of Medicine (A.D.), Philadelphia, PA; Department of Emergency Medicine (A.L.), Calderdale & Huddersfield NHS Trust, Halifax, Huddersfield, UK; and School of Human and Health Sciences (A.L.), University of Huddersfield, Huddersfield, UK
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Stefanidis D, Cook D, Kalantar-Motamedi SM, Muret-Wagstaff S, Calhoun AW, Lauridsen KG, Paige JT, Lockey A, Donoghue A, Hall AK, Patocka C, Palaganas J, Gross IT, Kessler D, Vermylen J, Lin Y, Aebersold M, Chang TP, Duff J, Kolbe M, Rutherford-Hemming T, Decker S, Collings A, Toseef Ansari M. Society for Simulation in Healthcare Guidelines for Simulation Training. Simul Healthc 2024; 19:S4-S22. [PMID: 38240614 DOI: 10.1097/sih.0000000000000776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
BACKGROUND Simulation has become a staple in the training of healthcare professionals with accumulating evidence on its effectiveness. However, guidelines for optimal methods of simulation training do not currently exist. METHODS Systematic reviews of the literature on 16 identified key questions were conducted and expert panel consensus recommendations determined using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. OBJECTIVE These evidence-based guidelines from the Society for Simulation in Healthcare intend to support healthcare professionals in decisions on the most effective methods for simulation training in healthcare. RESULTS Twenty recommendations on 16 questions were determined using GRADE. Four expert recommendations were also provided. CONCLUSIONS The first evidence-based guidelines for simulation training are provided to guide instructors and learners on the most effective use of simulation in healthcare.
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Affiliation(s)
- Dimitrios Stefanidis
- From the Department of Surgery (D.S., S.-M.K.-M.), Indiana University School of Medicine, Indianapolis, IN; Department of Internal Medicine (D.C.), Mayo Clinic, Rochester, MN; Department of Surgery (S.M.-W.), Emory University, Atlanta, GA; Department of Pediatrics (A.W.C.), University of Louisville School of Medicine and Norton Children's Medical Group, Louisville, KY; Department of Medicine (K.G.L.), Randers Regional Hospital, Randers, Denmark; Research Center for Emergency Medicine (K.G.L.), Aarhus University, Aarhus, Denmark; Department of Surgery (J.T.P.), LSU Health New Orleans School of Medicine, New Orleans, LA; Emergency Department (A.L.), Calderdale and Huddersfield NHS Trust, Halifax; School of Human and Health Sciences (A.L.), University of Huddersfield, Huddersfield, UK; Critical Care Medicine and Pediatrics (A.D.), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Department of Emergency Medicine (A.K.H.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine (C.P.), Cumming School of Medicine University of Calgary, Calgary, AB, Canada; Department of Health Professions Education (J.P.), School of Healthcare Leadership, MGH Institute of Health Professions, Boston, MA; Department of Pediatrics (I.T.G.), Section of Emergency Medicine, Yale University, New Haven, CT; Department of Emergency Medicine (D.K.), Columbia University Vagelos College of Physicians and Surgeons, New York, NY,; Department of Medicine and Medical Education (J.V.), Feinberg School of Medicine, Northwestern University, Chicago, IL; KidSIM Simulation Research Program (Y.L.), Alberta Children's Hospital, Calgary, Canada; University of Michigan School of Nursing (M.A.), Ann Arbor, MI; Las Madrinas Simulation Center, Children's Hospital (T.C.), University South California, Los Angeles, CA; Department of Pediatrics (J.D.), University of Alberta, Edmonton, Alberta, Canada; Simulation Center (M.K.), University Hospital Zurich, ETH Zurich, Switzerland; Department of Nursing (T.R.-H.), University of North Carolina, Chapel Hill, NC; Department of Nursing (S.D.), Texas Tech University Health Sciences Center, Lubbock, TX; Department of Surgery (A.C.), University of Louisville, Louisville, KY; and Independent Methodologist (M.T.A.), Ottawa, Ontario, Canada
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Choi H, Jeon Y, Lee U, Ahn J, Kim H. Technology-based interactive communication simulation for Korean nurses: A randomized controlled repeated-measures design. NURSE EDUCATION TODAY 2023; 128:105879. [PMID: 37352764 DOI: 10.1016/j.nedt.2023.105879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/26/2023] [Accepted: 06/12/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Effective and standardized technology-based communication simulations addressing diverse clinical situations for novice nurses are limited. OBJECTIVES This study evaluated the efficacy of the Technology-based Interactive Communication Simulation for Nurses on communication competency (knowledge, self-efficacy, skills, and clarity), compassion, and assertiveness among novice nurses. DESIGN We used a randomized controlled repeated-measures design. Participants were randomly assigned to either the intervention (Technology-based Interactive Communication Simulation for Nurses) or attention control group and completed the assigned program, the questionnaire thrice (i.e., before, immediately after, and four weeks after the program), and the e-simulation twice (i.e., immediately after and four weeks after the program). SETTINGS AND PARTICIPANTS Korean nurses with six months to two years of experience recruited from five secondary and tertiary hospitals participated in the study at a private, quiet place of their choice. METHODS The intervention comprises two simulation cases across different formats: (1) an interactive communication simulation for various clinical situations followed by a tailored debriefing; and (2) a video showing a conflict between a nurse and caregiver and between nurses, followed by a self-reflection activity. Communication skills and clarity were also evaluated by raters. Data analyses included descriptive analyses, t-tests, chi-square tests, and a generalized estimating equation model. RESULTS In total, 142 nurses (73 in the intervention and 69 in the attention control groups) participated in the programs, and 128 participated through the four-week follow-up. Technology-based Interactive Communication Simulation for Nurses significantly improved communication knowledge and self-efficacy and compassion among novice nurses compared to the attention control program, and its effects were maintained for four weeks. The group difference in communication skills and clarity evaluated by the raters was also significant. CONCLUSION Technology-based Interactive Communication Simulation for Nurses is effective in enhancing the communication competence of novice nurses. Future studies should analyze assertiveness in Korean healthcare settings.
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Affiliation(s)
- Heeseung Choi
- College of Nursing, Seoul National University, Jongno-gu, Seoul 03080, Republic of Korea; Research Institute of Nursing Science, Seoul National University, Jongno-gu, Seoul 03080, Republic of Korea
| | - Yeseul Jeon
- College of Nursing, Seoul National University, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Ujin Lee
- College of Nursing, Incheon Catholic University, Yeonsu-gu, Incheon 21987, Republic of Korea
| | - Junggeun Ahn
- College of Nursing, Seoul National University, Jongno-gu, Seoul 03080, Republic of Korea
| | - Hannah Kim
- College of Nursing, Seoul National University, Jongno-gu, Seoul 03080, Republic of Korea
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Perez A, Fetters MD, Creswell JW, Scerbo M, Kron FW, Gonzalez R, An L, Jimbo M, Klasnja P, Guetterman TC. Enhancing Nonverbal Communication Through Virtual Human Technology: Protocol for a Mixed Methods Study. JMIR Res Protoc 2023; 12:e46601. [PMID: 37279041 PMCID: PMC10282909 DOI: 10.2196/46601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/27/2023] [Accepted: 04/27/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Communication is a critical component of the patient-provider relationship; however, limited research exists on the role of nonverbal communication. Virtual human training is an informatics-based educational strategy that offers various benefits in communication skill training directed at providers. Recent informatics-based interventions aimed at improving communication have mainly focused on verbal communication, yet research is needed to better understand how virtual humans can improve verbal and nonverbal communication and further elucidate the patient-provider dyad. OBJECTIVE The purpose of this study is to enhance a conceptual model that incorporates technology to examine verbal and nonverbal components of communication and develop a nonverbal assessment that will be included in the virtual simulation for further testing. METHODS This study will consist of a multistage mixed methods design, including convergent and exploratory sequential components. A convergent mixed methods study will be conducted to examine the mediating effects of nonverbal communication. Quantitative (eg, MPathic game scores, Kinect nonverbal data, objective structured clinical examination communication score, and Roter Interaction Analysis System and Facial Action Coding System coding of video) and qualitative data (eg, video recordings of MPathic-virtual reality [VR] interventions and student reflections) will be collected simultaneously. Data will be merged to determine the most crucial components of nonverbal behavior in human-computer interaction. An exploratory sequential design will proceed, consisting of a grounded theory qualitative phase. Using theoretical, purposeful sampling, interviews will be conducted with oncology providers probing intentional nonverbal behaviors. The qualitative findings will aid the development of a nonverbal communication model that will be included in a virtual human. The subsequent quantitative strand will incorporate and validate a new automated nonverbal communication behavior assessment into the virtual human simulation, MPathic-VR, by assessing interrater reliability, code interactions, and dyadic data analysis by comparing Kinect responses (system recorded) to manually scored records for specific nonverbal behaviors. Data will be integrated using building integration to develop the automated nonverbal communication behavior assessment and conduct a quality check of these nonverbal features. RESULTS Secondary data from the MPathic-VR randomized controlled trial data set (210 medical students and 840 video recordings of interactions) were analyzed in the first part of this study. Results showed differential experiences by performance in the intervention group. Following the analysis of the convergent design, participants consisting of medical providers (n=30) will be recruited for the qualitative phase of the subsequent exploratory sequential design. We plan to complete data collection by July 2023 to analyze and integrate these findings. CONCLUSIONS The results from this study contribute to the improvement of patient-provider communication, both verbal and nonverbal, including the dissemination of health information and health outcomes for patients. Further, this research aims to transfer to various topical areas, including medication safety, informed consent processes, patient instructions, and treatment adherence between patients and providers. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46601.
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Affiliation(s)
- Analay Perez
- Department of Educational Psychology, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Michael D Fetters
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - John W Creswell
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Mark Scerbo
- Department of Psychology, Old Dominion University, Norfolk, VA, United States
| | - Frederick W Kron
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Richard Gonzalez
- Department of Psychology, University of Michigan, Ann Arbor, MI, United States
| | - Lawrence An
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Masahito Jimbo
- Department of Family and Community Medicine, University of Illinois College of Medicine, Chicago, IL, United States
| | - Predrag Klasnja
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Timothy C Guetterman
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
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13
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Herrmann LE, Elliott LE, Sucharew H, Jerardi K, Zackoff MW, Klein M, Real FJ. Impact of a Remote Virtual Reality Curriculum Pilot on Clinician Conflict Communication Skills. Hosp Pediatr 2023; 13:527-540. [PMID: 37161716 DOI: 10.1542/hpeds.2022-006990] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVES Conflict management skills are essential for interprofessional team functioning, however existing trainings are time and resource intensive. We hypothesized that a curriculum incorporating virtual reality (VR) simulations would enhance providers' interprofessional conflict communication skills and increase self-efficacy. METHODS We conducted a randomized controlled pilot study of the Conflict Instruction through Virtual Immersive Cases (CIVIC) curriculum among inpatient clinicians at a pediatric satellite campus. Participants viewed a 30-minute didactic presentation on conflict management and subsequently completed CIVIC (intervention group) or an alternative VR curriculum on vaccine counseling (control group), both of which allowed for verbal interactions with screen-based avatars. Three months following VR training, all clinicians participated in a unique VR simulation focused on conflict management that was recorded and scored using a rubric of observable conflict management behaviors and a Global Entrustment Scale (GES). Differences between groups were evaluated using generalized linear models. Self-efficacy was also assessed immediately pre, post, and 3 months postcurriculum. Differences within and between groups were assessed with paired independent and 2-sample t-tests, respectively. RESULTS Forty of 51 participants (78%) completed this study. The intervention group (n = 17) demonstrated better performance on the GES (P = .003) and specific evidence-based conflict management behaviors, including summarizing team member's concerns (P = .02) and checking for acceptance of the plan (P = .02), as well as statistical improvements in 5 self-efficacy measures compared with controls. CONCLUSIONS Participants exposed to CIVIC demonstrated enhanced conflict communication skills and reported increased self-efficacy compared with controls. VR may be an effective method of conflict communication training.
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Affiliation(s)
| | | | - Heidi Sucharew
- Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Karen Jerardi
- Departments of Pediatrics
- Divisions of Hospital Medicine
| | | | - Melissa Klein
- Departments of Pediatrics
- General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Francis J Real
- Departments of Pediatrics
- General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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14
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Dalcin AT, Yuan CT, Jerome GJ, Goldsholl S, Minahan E, Gennusa J, Fink T, Gudzune KA, Daumit GL, Dickerson F, Thompson DA, Wang NY, Martino S. Designing Practical Motivational Interviewing Training for Mental Health Practitioners Implementing Behavioral Lifestyle Interventions: Protocol for 3 Pilot Intervention Studies. JMIR Res Protoc 2023; 12:e44830. [PMID: 36927501 PMCID: PMC10132009 DOI: 10.2196/44830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/13/2023] [Accepted: 01/31/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Motivational interviewing (MI) is an evidence-based, patient-centered communication method shown to be effective in helping persons with serious mental illness (SMI) to improve health behaviors. In clinical trials where study staff conducted lifestyle interventions incorporating an MI approach, cardiovascular disease (CVD) risk profiles of participants with SMI showed improvement. Given the disproportionate burden of CVD in this population, practitioners who provide somatic and mental health care to persons with SMI are ideally positioned to deliver patient-centered CVD risk reduction interventions. However, the time for MI training (traditionally 16-24 hours), follow-up feedback, and the coaching required to develop and maintain patient-centered skills are significant barriers to incorporating MI when scaling up these evidence-based practices. OBJECTIVE We describe the design and development of the following 2 scalable MI training approaches for community mental health practitioners: real-time brief workshops and follow-up asynchronous avatar training. These approaches are being used in 3 different pilot implementation research projects that address weight loss, smoking cessation, and CVD risk reduction in people with SMI who are a part of ALACRITY Center, a research-to-practice translation center funded by the National Institute of Mental Health. METHODS Clinicians and staff in community mental health clinics across Maryland were trained to deliver 3 distinct evidence-based physical health lifestyle interventions using an MI approach to persons with SMI. The real-time brief MI workshop training for ACHIEVE-D weight loss coaches was 4 hours; IMPACT smoking cessation counselors received 2-hour workshops and prescribers received 1-hour workshops; and RHYTHM CVD risk reduction program staff received 4 hours of MI. All workshop trainings occurred over videoconference. The asynchronous avatar training includes 1 common didactic instructional module for the 3 projects and 1 conversation simulation unique to each study's target behavior. Avatar training is accessible on a commercial website. We plan to assess practitioners' attitudes and beliefs about MI and evaluate the impact of the 2 MI training approaches on their MI skills 3, 6, and 12 months after training using the MI Treatment Integrity 4.2.1 coding tool and the data generated by the avatar-automated scoring system. RESULTS The ALACRITY Center was funded in August 2018. We have implemented the MI training for 126 practitioners who are currently delivering the 3 implementation projects. We expect the studies to be complete in May 2023. CONCLUSIONS This study will contribute to knowledge about the effect of brief real-time training augmented with avatar skills practice on clinician MI skills. If MI Treatment Integrity scoring shows it to be effective, brief videoconference trainings supplemented with avatar skills practice could be used to train busy community mental health practitioners to use an MI approach when implementing physical health interventions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/44830.
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Affiliation(s)
- Arlene Taylor Dalcin
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institution, Baltimore, MD, United States
| | - Christina T Yuan
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health,, Baltimore, MD, United States
| | - Gerald J Jerome
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,College of Health Professions, Towson University, Towson, MD, United States
| | - Stacy Goldsholl
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Eva Minahan
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Joseph Gennusa
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Tyler Fink
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kimberly A Gudzune
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institution, Baltimore, MD, United States
| | - Gail Lois Daumit
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institution, Baltimore, MD, United States
| | - Faith Dickerson
- Department of Psychology, Sheppard Pratt, Baltimore, MD, United States
| | - David A Thompson
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Nae-Yuh Wang
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institution, Baltimore, MD, United States
| | - Steve Martino
- Department of Psychiatry, Yale University, West Haven, CT, United States.,VA Connecticut Healthcare System, West Haven, CT, United States
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15
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Costa Marion AD, Pereira LC, Lucia Moura Pinho D. The effect of interprofessional simulation practice on collaborative learning: A randomized controlled trial. J Interprof Care 2023:1-8. [PMID: 36606366 DOI: 10.1080/13561820.2022.2147153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 05/05/2022] [Accepted: 10/28/2022] [Indexed: 01/07/2023]
Abstract
This study examined the effect of simulation on readiness for collaborative practice and learning using a randomized-controlled trial design that used the same education protocol with interprofessional and uniprofessional groups. The sample consisted of 43 students from four different majors. The students were assessed with the Readiness for Interprofessional Learning Scale, and a care plan measurement instrument. The interprofessional group showed a small increase (0.1 ± 0.43; p = .02) in readiness for teamwork and collaboration; the uniprofessional group showed a smaller increase for teamwork and collaboration (0.04 ± 0.31; p = .04) and for patient-centred care (0.0 ± 0.35; p = .01). The enriching work of interprofessional learning was evident within the care plan activity, suggesting that interprofessional simulation is an effective learning method for interprofessional education.
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Affiliation(s)
| | - Leonardo Costa Pereira
- Program of post-graduation in Science and Health Technology, University of Brasília (Unb), Brasília, Brazil
| | - Diana Lucia Moura Pinho
- Program of post-graduation in Science and Health Technology, University of Brasília (Unb), Brasília, Brazil
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16
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Exploring the activities and outcomes of digital teaching and learning of practical skills in higher education for the social and health care professions: a scoping review. DISCOVER EDUCATION 2023; 2:2. [PMID: 36619252 PMCID: PMC9809526 DOI: 10.1007/s44217-022-00022-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/05/2022] [Indexed: 01/04/2023]
Abstract
Higher education for health care professionals faces numerous challenges. It is important to develop and apply methods supporting education, especially the practical skills. This scoping review aimed to explore the activities and learning outcomes of digital technology in practical skills teaching and learning in higher education for the social and health professions. Scoping review recommendations and the PRISMA-ScR checklist were applied. Randomized controlled trials published between 2016 and 2021 involving students in higher education who were taking courses in the social sciences and health care and reported interventions with digital technology activities and practices in practical teaching and learning were included. The CINAHL Plus, PubMed, Scopus, ERIC, and Sociological Abstracts/Social Services Abstracts databases were searched. Teaching methods were blended, e-learning or other online-based, and digital simulation-based activities. Teaching and learning environments, methods, resources, and activity characteristics varied, making a summary difficult. Interventions were developed in a face-to-face format prior to digitalization. The outcomes were measured at the knowledge level, not at the performance level. One-third of the studies showed a significant improvement in practical skills in the intervention group in comparison to the control conditions. The use of digital technology in the learning and teaching process have potential to develop of students' skills, knowledge, motivation, and attitudes. The pedagogy of technology use is decisive. The development of new digital methods for teaching and learning practical skills requires the engagement of students and teachers, in addition the researchers.
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17
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Leung T, Cai Y, Cao J, He Q, Wang X, Lu Y, Liang H, Xu D, Liao J. The Agreement Between Virtual Patient and Unannounced Standardized Patient Assessments in Evaluating Primary Health Care Quality: Multicenter, Cross-sectional Pilot Study in 7 Provinces of China. J Med Internet Res 2022; 24:e40082. [PMID: 36459416 PMCID: PMC9758641 DOI: 10.2196/40082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 09/27/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The unannounced standardized patient (USP) is the gold standard for primary health care (PHC) quality assessment but has many restrictions associated with high human and resource costs. Virtual patient (VP) is a valid, low-cost software option for simulating clinical scenarios and is widely used in medical education. It is unclear whether VP can be used to assess the quality of PHC. OBJECTIVE This study aimed to examine the agreement between VP and USP assessments of PHC quality and to identify factors influencing the VP-USP agreement. METHODS Eleven matched VP and USP case designs were developed based on clinical guidelines and were implemented in a convenience sample of urban PHC facilities in the capital cities of the 7 study provinces. A total of 720 USP visits were conducted, during which on-duty PHC providers who met the inclusion criteria were randomly selected by the USPs. The same providers underwent a VP assessment using the same case condition at least a week later. The VP-USP agreement was measured by the concordance correlation coefficient (CCC) for continuity scores and the weighted κ for diagnoses. Multiple linear regression was used to identify factors influencing the VP-USP agreement. RESULTS Only 146 VP scores were matched with the corresponding USP scores. The CCC for medical history was 0.37 (95% CI 0.24-0.49); for physical examination, 0.27 (95% CI 0.12-0.42); for laboratory and imaging tests, -0.03 (95% CI -0.20 to 0.14); and for treatment, 0.22 (95% CI 0.07-0.37). The weighted κ for diagnosis was 0.32 (95% CI 0.13-0.52). The multiple linear regression model indicated that the VP tests were significantly influenced by the different case conditions and the city where the test took place. CONCLUSIONS There was low agreement between VPs and USPs in PHC quality assessment. This may reflect the "know-do" gap. VP test results were also influenced by different case conditions, interactive design, and usability. Modifications to VPs and the reasons for the low VP-USP agreement require further study.
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Affiliation(s)
| | - Yiyuan Cai
- Department of Epidemiology and Medical Statistics, School of Public Health, Guizhou Medical University, Guiyang, China
| | - Jin Cao
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Qianyu He
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xiaohui Wang
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Yun Lu
- Department of Preventive Medicine & Maternal and Child Health, School of Public Health, Guizhou Medical University, Guiyang, China
| | - Huijuan Liang
- Research Institute for Health Policy of Inner Mongolia, Inner Mongolia Medical University, Hohhot, China
| | - Dong Xu
- Center for World Health Organization Studies, Department of Health Management, School of Health Management of Southern Medical University, Guangzhou, China.,ACACIA Lab for Implementation Research, Southern Medical University Institute for Global Health, Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Jing Liao
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
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18
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Lee J, Campbell S, Choi M, Bae J. Authentic learning in healthcare education: A systematic review. NURSE EDUCATION TODAY 2022; 119:105596. [PMID: 36283196 DOI: 10.1016/j.nedt.2022.105596] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 09/06/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The increasing complexity of the clinical environment demands a higher level of clinical performance competency. New pedagogical authentic learning methods have been developed to meet this need by bridging the gap between knowledge and practice. OBJECTIVE This systematic review aimed to examine authentic learning methods and their effects in healthcare education. DESIGN Systematic review. DATA SOURCES Data were obtained from a literature search of Embase, PubMed, MEDLINE, CINAHL, PsycINFO, and Korean databases (e.g., KoreaMed) for studies published until May 2021. This review selected research papers documenting RCTs or quasi-experimental studies targeting undergraduate students training to become healthcare professionals. REVIEW METHODS This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline. The risk of bias assessment utilized the Joanna Briggs Institute (JBI) critical checklist. RESULTS Of 20 selected studies, 12 studies were randomized controlled trials, while 8 had quasi-experimental designs with a control group. Simulation was identified as an effective educational method for authentic learning. Through authentic learning, undergraduate students cultivated their knowledge and learning motivation. However, divergent conclusions were shown for performance skills. CONCLUSIONS Authentic pedagogical methodologies effectively enhanced learners' competencies in the cognitive, psychomotor, and affective domains. Integrating technological applications, e.g., e-learning or web-based approaches, facilitated education across academic boundaries. Further studies on combining technology with authentic learning approaches should be conducted to construct realistic educational environments for learners. TRIAL REGISTRATION CRD42021229350.
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Affiliation(s)
- JuHee Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Yonsei Evidence Based Nursing Centre of Korea, A JBI Affiliated Group, Seoul, Republic of Korea, Yonsei-ro 50, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Suzanne Campbell
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - MoonKi Choi
- College of Nursing, Kangwon National University, 24341, Room 401 Department of Nursing, Gangwondaehak-gil 1, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Juyeon Bae
- Department of Nursing, Konkuk University Glocal Campus, Chungwon-daero 268, Chungju-si, Chungcheongbuk-do 27478, Republic of Korea.
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Lee J, Kron F. Virtual care is growing, but who will train upcoming learners to practice it? MEDICAL EDUCATION 2022; 56:1155-1157. [PMID: 36083399 PMCID: PMC9825889 DOI: 10.1111/medu.14934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 06/15/2023]
Abstract
Lee and Kron describe the current use of virtual care to explain why faculty are reluctant to engage in education in that context in an effort to propose ways to promote better learner integration.
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Affiliation(s)
- Jihyun Lee
- Department of Dental Education, School of DentistrySeoul National UniversitySeoulRepublic of Korea
| | - Frederick Kron
- Department of Internal Medicine, Section of General Internal MedicineYale School of MedicineNew HavenConnecticutUSA
- Department of Family MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
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20
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Hulsbergen MH, de Jong J, van der Smagt MJ. Exploring the use of Online Simulations in Teaching Dialogue Skills. PSYCHOLOGY LEARNING AND TEACHING-PLAT 2022. [DOI: 10.1177/14757257221138936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To aid in teaching dialogue skills a virtual simulator called Communicate! was developed at Utrecht University. Teachers can build scenarios for students to practice dialogues with a virtual character. In two experiments ( n = 128 and 133, a year apart), we investigated if and how Communicate! can be an effective aid to study and practice dialogue skills, by comparing it to traditional “passive” learning tools, such as literature-study and a lecture, in an undergraduate psychology dialogue-skills course. Students were divided into four groups, two of which both read an article about conducting a bad-news dialogue and played a bad-news-dialogue-scenario (but in a different order), while the third group only played the scenario. The final group only read the article (expt. 1) or also attended a lecture on the topic (expt. 2). Playing a scenario improved performance on a different scenario played later. It increased the students’ reported engagement and motivation to learn about this topic, compared to reading the article, whereas their reported self-efficacy decreased, which may indicate a recognized learning need. It also increased the score on an MC-knowledge test on this type of dialogue. This suggests that online dialogue simulations aid studying (basic) dialogue skills, by providing flexible, authentic learning experiences.
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21
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Apodaca C, Casanova-Perez R, Bascom E, Mohanraj D, Lane C, Vidyarthi D, Beneteau E, Sabin J, Pratt W, Weibel N, Hartzler AL. Maybe they had a bad day: how LGBTQ and BIPOC patients react to bias in healthcare and struggle to speak out. J Am Med Inform Assoc 2022; 29:2075-2082. [PMID: 35985279 PMCID: PMC9667158 DOI: 10.1093/jamia/ocac142] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/14/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE People who experience marginalization, including Black, Indigenous, People of Color (BIPOC) and Lesbian, Gay, Bisexual, Transgender, Queer, Plus (ie, all other marginalized genders and sexual orientations) people (LGBTQ+) experience discrimination during healthcare interactions, which negatively impacts patient-provider communication and care. Yet, scarce research examines the lived experience of unfair treatment among patients from marginalized groups to guide patient-centered tools that improve healthcare equity. MATERIALS AND METHODS We interviewed 25 BIPOC and/or LGBTQ+ people about their experiences of unfair treatment and discrimination when visiting healthcare providers. Through thematic analysis, we describe participants' immediate reactions and longer-term consequences of those experiences. RESULTS We identified 4 ways that participants reacted to discrimination in the moment: Fighting, Fleeing, Excusing, and Working Around Bias. Long-term consequences reflect 6 ways they coped: Delaying or Avoiding Care, Changing Healthcare Providers, Self-prescribing, Covering Behaviors, Experiencing Health Complications, and Mistrusting Healthcare Institutions. DISCUSSION By describing how patients react to experiences of unfair treatment and discrimination, our findings enhance the understanding of health disparities as patients cope and struggle to speak out.To combat these problems, we identify 3 future directions for informatics interventions that improve provider behavior, support patient advocacy, and address power dynamics in healthcare. CONCLUSIONS BIPOC and LGBTQ+ patients' perspectives on navigating unfair treatment and discrimination in healthcare offers critical insight into their experiences and long-term consequences of those experiences. Understanding the circumstances and consequences of unfair treatment, discrimination, and the impact of bias through this patient-centered lens is crucial to inform informatics technologies that promote health equity.
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Affiliation(s)
- Calvin Apodaca
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Reggie Casanova-Perez
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Emily Bascom
- Information School, University of Washington, Seattle, Washington, USA
| | - Deepthi Mohanraj
- Department of Biology, University of Washington, Seattle, Washington, USA
| | - Cezanne Lane
- Department of Biology, University of Washington, Seattle, Washington, USA
| | - Drishti Vidyarthi
- Department of Human Centered Design and Engineering, University of Washington, Seattle, Washington, USA
| | - Erin Beneteau
- Information School, University of Washington, Seattle, Washington, USA
| | - Janice Sabin
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Wanda Pratt
- Information School, University of Washington, Seattle, Washington, USA
| | - Nadir Weibel
- Department of Computer Science and Engineering, University of California San Diego, La Jolla, California, USA
| | - Andrea L Hartzler
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, Washington, USA
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McCarthy DM, Formella KT, Ou EZ, Vozenilek JA, Cameron KA, Salzman DH, Doty AM, Piserchia K, Papanagnou D, Rising KL. There's an app for that: Teaching residents to communicate diagnostic uncertainty through a mobile gaming application. PATIENT EDUCATION AND COUNSELING 2022; 105:1463-1469. [PMID: 34674922 PMCID: PMC9109131 DOI: 10.1016/j.pec.2021.09.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 09/17/2021] [Accepted: 09/27/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Clear communication is integral to good clinical care; however, communication training is cost and time intensive. Mobile applications (apps) may provide a useful adjunct to traditional simulation skills training. OBJECTIVE To evaluate (1) use of an app for teaching communication skills about diagnostic uncertainty, (2) feedback on app use, and (3) the association between use and skill mastery. PATIENT INVOLVEMENT The app under study is designed to improve doctor-patient communication. METHODS The study was a planned sub-analysis of a randomized controlled waitlist trial with emergency medicine resident physicians randomized to receive immediate or delayed access to an educational curriculum focused on diagnostic uncertainty. The curriculum included a web-based interactive module and the app. Metrics describing participants' use of the app, feedback on use, and association of use and achieving mastery in communicating diagnostic uncertainty are reported. Differences between groups utilizing the app were analyzed using Chi-squared test; logistic regression assessed the association between app use and achieving mastery of the communication skill. RESULTS Among 109 participants completing the trial, only 34 (31.2%) used the app. Most participants engaged with the app on one occasion for a median of 50 min (IQR 31, 87). Senior residents were more likely to use the app than junior residents (41.3% vs 23.8%, p=0.05). Overall reviews were positive; 76% reported the app helped them learn. There was no significant association between app use and achieving mastery of the communication skill in the trial [OR 2.1, 95% CI (0.91-4.84)]. DISCUSSION Despite positive reviews of app use, overall use was low and there was no association with achieving mastery. PRACTICAL VALUE Offering an app as an auxiliary training opportunity may be beneficial to some residents, but shouldn't be planned for use as a primary didactic modality unless there is evidence for effectiveness and use is mandated. AVAILABILITY OF DATA AND MATERIALS The datasets generated and/or analyzed during the current study are not publicly available since some data may be identifiable but are available from the corresponding author on reasonable request.
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Affiliation(s)
- Danielle M McCarthy
- Department of Emergency Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
| | - Kyle T Formella
- Jump Trading Simulation and Education Center, OSF Healthcare, Peoria, IL, USA.
| | - Eric Z Ou
- Jump Trading Simulation and Education Center, OSF Healthcare, Peoria, IL, USA.
| | - John A Vozenilek
- Jump Trading Simulation and Education Center, OSF Healthcare, Peoria, IL, USA; Department of Emergency Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA; Department of BioEngineering, University of Illinois Grainger College of Engineering Urbana, IL, USA.
| | - Kenzie A Cameron
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University, Chicago, IL, USA; Department of Medical Education, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
| | - David H Salzman
- Department of Emergency Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA; Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University, Chicago, IL, USA.
| | - Amanda Mb Doty
- Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA; Center for Connected Care, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
| | - Katherine Piserchia
- Department of Emergency Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
| | - Dimitrios Papanagnou
- Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
| | - Kristin L Rising
- Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA; Center for Connected Care, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
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Feldman DB, O'Rourke MA, Corn BW, Hudson MF, Patel N, Agarwal R, Fraser VL, Deininger H, Fowler LA, Bakitas MA, Krouse RA, Subbiah IM. Development of a measure of clinicians' self-efficacy for medical communication (SEMC). BMJ Support Palliat Care 2022:bmjspcare-2022-003593. [PMID: 35534186 DOI: 10.1136/bmjspcare-2022-003593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 04/21/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Studies of clinician-patient communication have used varied, ad hoc measures for communication efficacy. We developed and validated the Self-Efficacy for Medical Communication (SEMC) scale as a standard, quantitative measure of clinician-reported skills in communicating difficult news. METHODS Using evidence-based scale development guidelines, we created two 16-item forms of the SEMC, one assessing communication with patients and one assessing communication with families. Clinicians providing oncological care in four organisations were invited to participate and provided consent. Participant demographics, responses to the SEMC items and responses to convergent and discriminant measures (those expected to relate strongly and weakly to the SEMC) were collected online. We performed analyses to determine the convergent and discriminant validity of the SEMC as well as its reliability and factor structure. RESULTS Overall, 221 oncology clinicians (including physicians, residents, fellows, medical students, nurses, nurse practitioners and physician assistants) participated. The patient and family forms both demonstrated high internal consistency reliability (alpha=0.94 and 0.96, respectively) and were strongly correlated with one another (r=0.95, p<0.001). Exploratory factor analysis demonstrated that the SEMC measures a unitary construct (eigenvalue=9.0), and its higher mean correlation with convergent (r=0.46) than discriminant (r=0.22) measures further supported its validity. CONCLUSIONS Our findings support the SEMC's validity and reliability as a measure of clinician-rated communication skills regarding conducting difficult conversations with patients and families. It provides a useful standard tool for future research in oncology provider-patient serious illness communication.
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Affiliation(s)
| | - Mark A O'Rourke
- Prisma Health Upstate Cancer Institute, Greenville, South Carolina, USA
| | | | - Matthew F Hudson
- Prisma Health Upstate Cancer Institute, Greenville, South Carolina, USA
| | - Naimik Patel
- Prisma Health Upstate Cancer Institute, Greenville, South Carolina, USA
| | - Rajiv Agarwal
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Heidi Deininger
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA
| | - Lauren A Fowler
- University of South Carolina School of Medicine Greenville, Greenville, South Carolina, USA
| | - Marie A Bakitas
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Robert A Krouse
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Zak K, Oppl S. Der Einsatz von Virtual-Reality Lernszenarien für Softskills-Trainings. HMD PRAXIS DER WIRTSCHAFTSINFORMATIK 2022. [PMCID: PMC8442524 DOI: 10.1365/s40702-021-00784-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ZusammenfassungDer Artikel zeigt den wirkungsvollen Einsatz von Virtual-Reality-Trainings im Softskills-Bereich besonders für Kommunikations‑, Präsentations- oder Verhandlungskompetenzen. Zunächst werden auf die Vorteile im Vergleich zum klassischen Setting eingegangen, wie etwa die Unabhängigkeit von einer physischen Präsenz von Trainingspartnern, was VR-Trainings in Zeiten der COVID-19 Krise noch attraktiver werden lassen. Nachdem auf das Risiko einer kognitiven Überlastung in einer VR-Umgebung eingegangen wird, wird ein Fallbeispiel eines VR-Szenarios im Softskills-Bereich, das in einem österreichischen Unternehmen eingesetzt wird, dargestellt. Die Ergebnisse einer quantitativen Erhebung zeigen, dass die Gestaltung der VR-Lernsequenzen mit einer niedrigen kognitiven Belastung und förderlich für den Lernprozess wahrgenommen wurde. Konkrete Faktoren, die zu diesem Ergebnis führten, wurden in einer anschließenden qualitativen Befragung erhoben. Der Artikel schließt mit Handlungsempfehlungen für den didaktischen Aufbau von VR-Szenarien, die aus den gewonnenen Erkenntnissen unter Einbeziehung einiger Gestaltungsprinzipien aus der Theorie der kognitiven Beanspruchung abgeleitet werden.
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Virtual Simulation as a Learning Tool for Teaching Graduate Nursing Students to Manage Difficult Conversations. Clin Simul Nurs 2022. [DOI: 10.1016/j.ecns.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Pawassar CM, Tiberius V. Virtual Reality in Health Care: Bibliometric Analysis. JMIR Serious Games 2021; 9:e32721. [PMID: 34855606 PMCID: PMC8686483 DOI: 10.2196/32721] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/20/2021] [Accepted: 09/24/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Research into the application of virtual reality technology in the health care sector has rapidly increased, resulting in a large body of research that is difficult to keep up with. OBJECTIVE We will provide an overview of the annual publication numbers in this field and the most productive and influential countries, journals, and authors, as well as the most used, most co-occurring, and most recent keywords. METHODS Based on a data set of 356 publications and 20,363 citations derived from Web of Science, we conducted a bibliometric analysis using BibExcel, HistCite, and VOSviewer. RESULTS The strongest growth in publications occurred in 2020, accounting for 29.49% of all publications so far. The most productive countries are the United States, the United Kingdom, and Spain; the most influential countries are the United States, Canada, and the United Kingdom. The most productive journals are the Journal of Medical Internet Research (JMIR), JMIR Serious Games, and the Games for Health Journal; the most influential journals are Patient Education and Counselling, Medical Education, and Quality of Life Research. The most productive authors are Riva, del Piccolo, and Schwebel; the most influential authors are Finset, del Piccolo, and Eide. The most frequently occurring keywords other than "virtual" and "reality" are "training," "trial," and "patients." The most relevant research themes are communication, education, and novel treatments; the most recent research trends are fitness and exergames. CONCLUSIONS The analysis shows that the field has left its infant state and its specialization is advancing, with a clear focus on patient usability.
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Affiliation(s)
| | - Victor Tiberius
- Faculty of Economics and Social Sciences, University of Potsdam, Potsdam, Germany
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Dale MacLaine T, Lowe N, Dale J. The use of simulation in medical student education on the topic of breaking bad news: A systematic review. PATIENT EDUCATION AND COUNSELING 2021; 104:2670-2681. [PMID: 33926808 DOI: 10.1016/j.pec.2021.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Simulated patients (SPs) are widely used, but the most effective way of utilising them in undergraduate breaking bad news (BBN) medical education is unknown. OBJECTIVES To conduct a systematic review into SP's use in developing BBN skills in medical students. METHODS 14 databases searched with the terms "Medical education", "Patient simulation", "Bad news". Data was systematically extracted, and thematic analysis undertaken. RESULTS Of 2117 articles screened, 29 publications met the inclusion criteria. These demonstrated a variety of SP models, including actors as patients (65.5%), peers (7.0%), and cancer survivors (3.5%). with delivery at varying times in the curricula. SPs are uniformly reported as having positive impact, but there is a lack of high-quality evidence comparing the use of differing forms of training. There was some evidence that virtual SPs were as useful as in-person SPs. CONCLUSIONS SPs allow students to practise vital BBN communication skills without risking detriment to patient care. Despite the heterogeneity of ways in which SPs have been used, the benefits of different approaches and when and how these should be delivered remains unclear. PRACTICE IMPLICATIONS Further educational development and research is needed about the use of SPs to support undergraduate BBN communication skills development.
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Affiliation(s)
| | - Nicholas Lowe
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK.
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Asselbergs FW, Fraser AG. Artificial intelligence in cardiology: the debate continues. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 2:721-726. [PMID: 36713089 PMCID: PMC9708032 DOI: 10.1093/ehjdh/ztab090] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 10/12/2021] [Indexed: 02/01/2023]
Abstract
In 1955, when John McCarthy and his colleagues proposed their first study of artificial intelligence, they suggested that 'every aspect of learning or any other feature of intelligence can in principle be so precisely described that a machine can be made to simulate it'. Whether that might ever be possible would depend on how we define intelligence, but what is indisputable is that new methods are needed to analyse and interpret the copious information provided by digital medical images, genomic databases, and biobanks. Technological advances have enabled applications of artificial intelligence (AI) including machine learning (ML) to be implemented into clinical practice, and their related scientific literature is exploding. Advocates argue enthusiastically that AI will transform many aspects of clinical cardiovascular medicine, while sceptics stress the importance of caution and the need for more evidence. This report summarizes the main opposing arguments that were presented in a debate at the 2021 Congress of the European Society of Cardiology. Artificial intelligence is an advanced analytical technique that should be considered when conventional statistical methods are insufficient, but testing a hypothesis or solving a clinical problem-not finding another application for AI-remains the most important objective. Artificial intelligence and ML methods should be transparent and interpretable, if they are to be approved by regulators and trusted to provide support for clinical decisions. Physicians need to understand AI methods and collaborate with engineers. Few applications have yet been shown to have a positive impact on clinical outcomes, so investment in research is essential.
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Affiliation(s)
- Folkert W Asselbergs
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands,Institute of Health Informatics and Institute of Cardiovascular Science, University College London, 222 Euston Rd, London NW1 2DA, UK,NIHR BRC Clinical Research Informatics Unit, University College London Hospital, London, UK
| | - Alan G Fraser
- School of Medicine, Cardiff University, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK,Cardiovascular Imaging and Dynamics, Katholieke Universiteit Leuven, UZ Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium,Corresponding author. Tel: +44 (0)29 2184 5366, Fax: +44 (0)29 2184 4473,
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29
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Effectiveness of Virtual Simulation to Enhance Cultural Competence in Pre-licensure and Licensed Health Professionals: A Systematic Review. Clin Simul Nurs 2021. [DOI: 10.1016/j.ecns.2021.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Choi H, Lee U, Gwon T. Development of a Computer Simulation-based, Interactive, Communication Education Program for Nursing Students. Clin Simul Nurs 2021. [DOI: 10.1016/j.ecns.2021.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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31
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Marja SL, Suvi A. Cultural competence learning of the health care students using simulation pedagogy: An integrative review. Nurse Educ Pract 2021; 52:103044. [PMID: 33866235 DOI: 10.1016/j.nepr.2021.103044] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 03/07/2021] [Accepted: 03/10/2021] [Indexed: 11/25/2022]
Abstract
The objective of this literature review was to identify the current evidence available on the learning of cultural competence among health care students using simulation pedagogy. An integrative literature review was conducted systematically. The CINAHL, PubMed and ERIC databases were searched for articles published between 2009 and 2019, resulting in including 17 articles in the review. The data were analyzed using descriptive synthesis. The participants of most of the studies were nursing students. The used simulation methods included low- and high-fidelity simulations, standardized patients, virtual and video-streamed simulations and role-play. The educational contents involved assessing advanced communication skills or focusing on patients' socioeconomic, cultural and environmental needs in care. The learning outcomes included knowledge of cultural competence, culturally competent communication skills, culturally competent nursing skills, self-awareness of cultural diversity and self-efficacy in diverse cultural situations. A variety of simulation methods has been used in the cultural competence education and produced several learning outcomes, including an improved understanding of cross-cultural communication and encouragement to discuss various culturally bound health issues. Further research is needed to find an effective combination of teaching methods using innovative ways to foster learning cultural competence.
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Affiliation(s)
- Silén-Lipponen Marja
- Savonia University of Applied Sciences, Unit of Health Care, Kuopio P.O. Box 6, FI-70201 Kuopio, Finland.
| | - Aura Suvi
- Savonia University of Applied Sciences, Unit of Health Care, Kuopio P.O. Box 6, FI-70201 Kuopio, Finland
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Scholten MR, Kelders SM, Van Gemert-Pijnen JEWC. Can a monologue-style ECA more effectively motivate eHealth users in initial distress than textual guidance? Heliyon 2021; 7:e06509. [PMID: 33842700 PMCID: PMC8020434 DOI: 10.1016/j.heliyon.2021.e06509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/09/2020] [Accepted: 03/10/2021] [Indexed: 11/25/2022] Open
Abstract
Stress is a prevalent issue amongst patients with chronic conditions. As eHealth interventions are gaining importance, it becomes more relevant to invoke the possibilities from the eHealth technology itself to provide motivational acts during experiences of stress as to enhance adherence to the intervention. Embodied Conversational Agents (ECA's) also known as 'robots on screen' can potentially provide a remedy. Within our eHealth experiment we applied a between-subjects design and experimentally studied the difference in appraisal of motivation and guidance. We deployed a functionally modest, monologue-style ECA and compared them with textual guidance. This way, we filtered out the considerable positive impact of interactive features that go along with dialogue-style ECA's. The study was carried out amongst eHealth users of which half were deliberately put in a stressful pre-condition. The rationale was two-sided; first, we hypothesized that it would induce a need for motivational support. Second, it would provide a fair representation of eHealth users in real life. Furthermore, we investigated hypothesized positive effects from a gender match between participant and ECA. The results demonstrated preferential ECA effects compared to text but only in the no stress conditions. Although our set-up controlled for user distraction by putting the facilitating ECA in a pane separate from the eHealth environment, we suspect that the enduring visual presence of the ECA during task completion had still inhibited distressed users. Discussing this phenomenon, our stance is that the hypothesis that ECA support is always superior to textual guidance is open for re-evaluation. Text may sometimes serve users equally well because it lacks human-like aspects that in stressful circumstances can become confrontational. We discuss the potential of ECA's to motivate, but also elaborate on the caveats. Further implications for the ECA, intervention adherence, and eHealth study fields are discussed in relation to stress.
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Affiliation(s)
- Mark R Scholten
- Department of Psychology, Health and Technology, Centre for eHealth and Wellbeing Research, University of Twente, Enschede, Netherlands
| | - Saskia M Kelders
- Department of Psychology, Health and Technology, Centre for eHealth and Wellbeing Research, University of Twente, Enschede, Netherlands.,Optentia Research Focus Area, North-West University, Vanderbijlpark, South Africa
| | - Julia E W C Van Gemert-Pijnen
- Department of Psychology, Health and Technology, Centre for eHealth and Wellbeing Research, University of Twente, Enschede, Netherlands
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Gilligan C, Powell M, Lynagh MC, Ward BM, Lonsdale C, Harvey P, James EL, Rich D, Dewi SP, Nepal S, Croft HA, Silverman J. Interventions for improving medical students' interpersonal communication in medical consultations. Cochrane Database Syst Rev 2021; 2:CD012418. [PMID: 33559127 PMCID: PMC8094582 DOI: 10.1002/14651858.cd012418.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Communication is a common element in all medical consultations, affecting a range of outcomes for doctors and patients. The increasing demand for medical students to be trained to communicate effectively has seen the emergence of interpersonal communication skills as core graduate competencies in medical training around the world. Medical schools have adopted a range of approaches to develop and evaluate these competencies. OBJECTIVES To assess the effects of interventions for medical students that aim to improve interpersonal communication in medical consultations. SEARCH METHODS We searched five electronic databases: Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO, and ERIC (Educational Resource Information Centre) in September 2020, with no language, date, or publication status restrictions. We also screened reference lists of relevant articles and contacted authors of included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs), cluster-RCTs (C-RCTs), and non-randomised controlled trials (quasi-RCTs) evaluating the effectiveness of interventions delivered to students in undergraduate or graduate-entry medical programmes. We included studies of interventions aiming to improve medical students' interpersonal communication during medical consultations. Included interventions targeted communication skills associated with empathy, relationship building, gathering information, and explanation and planning, as well as specific communication tasks such as listening, appropriate structure, and question style. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two review authors independently reviewed all search results, extracted data, assessed the risk of bias of included studies, and rated the quality of evidence using GRADE. MAIN RESULTS We found 91 publications relating to 76 separate studies (involving 10,124 students): 55 RCTs, 9 quasi-RCTs, 7 C-RCTs, and 5 quasi-C-RCTs. We performed meta-analysis according to comparison and outcome. Among both effectiveness and comparative effectiveness analyses, we separated outcomes reporting on overall communication skills, empathy, rapport or relationship building, patient perceptions/satisfaction, information gathering, and explanation and planning. Overall communication skills and empathy were further divided as examiner- or simulated patient-assessed. The overall quality of evidence ranged from moderate to very low, and there was high, unexplained heterogeneity. Overall, interventions had positive effects on most outcomes, but generally small effect sizes and evidence quality limit the conclusions that can be drawn. Communication skills interventions in comparison to usual curricula or control may improve both overall communication skills (standardised mean difference (SMD) 0.92, 95% confidence interval (CI) 0.53 to 1.31; 18 studies, 1356 participants; I² = 90%; low-quality evidence) and empathy (SMD 0.64, 95% CI 0.23 to 1.05; 6 studies, 831 participants; I² = 86%; low-quality evidence) when assessed by experts, but not by simulated patients. Students' skills in information gathering probably also improve with educational intervention (SMD 1.07, 95% CI 0.61 to 1.54; 5 studies, 405 participants; I² = 78%; moderate-quality evidence), but there may be little to no effect on students' rapport (SMD 0.18, 95% CI -0.15 to 0.51; 9 studies, 834 participants; I² = 81%; low-quality evidence), and effects on information giving skills are uncertain (very low-quality evidence). We are uncertain whether experiential interventions improve overall communication skills in comparison to didactic approaches (SMD 0.08, 95% CI -0.02 to 0.19; 4 studies, 1578 participants; I² = 4%; very low-quality evidence). Electronic learning approaches may have little to no effect on students' empathy scores (SMD -0.13, 95% CI -0.68 to 0.43; 3 studies, 421 participants; I² = 82%; low-quality evidence) or on rapport (SMD 0.02, 95% CI -0.33 to 0.38; 3 studies, 176 participants; I² = 19%; moderate-quality evidence) compared to face-to-face approaches. There may be small negative effects of electronic interventions on information giving skills (low-quality evidence), and effects on information gathering skills are uncertain (very low-quality evidence). Personalised/specific feedback probably improves overall communication skills to a small degree in comparison to generic or no feedback (SMD 0.58, 95% CI 0.29 to 0.87; 6 studies, 502 participants; I² = 56%; moderate-quality evidence). There may be small positive effects of personalised feedback on empathy and information gathering skills (low quality), but effects on rapport are uncertain (very low quality), and we found no evidence on information giving skills. We are uncertain whether role-play with simulated patients outperforms peer role-play in improving students' overall communication skills (SMD 0.17, 95% CI -0.33 to 0.67; 4 studies, 637 participants; I² = 87%; very low-quality evidence). There may be little to no difference between effects of simulated patient and peer role-play on students' empathy (low-quality evidence) with no evidence on other outcomes for this comparison. Descriptive syntheses of results that could not be included in meta-analyses across outcomes and comparisons were mixed, as were effects of different interventions and comparisons on specific communication skills assessed by the included trials. Quality of evidence was downgraded due to methodological limitations across several risk of bias domains, high unexplained heterogeneity, and imprecision of results. In general, results remain consistent in sensitivity analysis based on risk of bias and adjustment for clustering. No adverse effects were reported. AUTHORS' CONCLUSIONS: This review represents a substantial body of evidence from which to draw, but further research is needed to strengthen the quality of the evidence base, to consider the long-term effects of interventions on students' behaviour as they progress through training and into practice, and to assess effects of interventions on patient outcomes. Efforts to standardise assessment and evaluation of interpersonal skills will strengthen future research efforts.
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Affiliation(s)
- Conor Gilligan
- School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, Callaghan, Australia
| | - Martine Powell
- Centre for Investigative Interviewing, Griffith Criminology Institute, Griffith University, Brisbane, Australia
| | - Marita C Lynagh
- School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, Callaghan, Australia
| | | | - Chris Lonsdale
- Institute for Positive Psychology and Education, Australian Catholic University, Strathfield, Australia
| | - Pam Harvey
- School of Rural Health, Monash University, Bendigo, Australia
| | - Erica L James
- School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, Callaghan, Australia
| | - Dominique Rich
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Sari P Dewi
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Smriti Nepal
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Darlington, Australia
| | - Hayley A Croft
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Australia
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Mulli J, Nowell L, Lind C. Reflection-in-action during high-fidelity simulation: A concept analysis. NURSE EDUCATION TODAY 2021; 97:104709. [PMID: 33352351 DOI: 10.1016/j.nedt.2020.104709] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/19/2020] [Accepted: 12/01/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Our primary aim was to complete an in-depth analysis of the concept of "reflection-in-action" during high-fidelity simulation. We sought to identify what is currently known about the topic and establish a strong foundation for theory development regarding cultivating reflection-in-action during high-fidelity simulation. DESIGN Walker and Avant's (2011) systematic approach to concept analysis was used as a framework to develop a comprehensive understanding of reflection-in-action during high-fidelity simulation. DATA SOURCES We conducted a review of literature on reflection-in-action (with open date parameters) in PubMed, Eric, PsychInfo, ABI/Business Premium Collection, and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) electronic data bases using key terms "reflection-in-action" AND "simulation". In addition, we hand-searched reference lists from key articles in the journals Simulation in Healthcare, Simulation and Gaming, and Advances in Simulation. RESULTS Our search resulted in 22 articles, from 1998 to 2019, that met the inclusion criteria. Four defining attributes of the concept were identified: (1) reflection-in-action must occur during high-fidelity simulation and cannot be captured within post-simulation debriefing; (2) a critical learning juncture must occur and be identified by the learners; (3) a pause in student action must occur during the high-fidelity simulation; and (4) knowledge sharing must occur through out-loud discussion. Antecedents, consequences, and empirical referents of reflection-in-action were also identified. CONCLUSIONS The insights from this review may enhance the ability of nursing educators to effectively support reflection-in-action within high-fidelity simulation nursing education. This concept analysis also establishes a foundation for reflection-in-action strategy development, as well as suggestions for future research in high-fidelity simulation nursing education.
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Affiliation(s)
- Jessica Mulli
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada.
| | - Lorelli Nowell
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada.
| | - Candace Lind
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada.
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Coyne E, Calleja P, Forster E, Lin F. A review of virtual-simulation for assessing healthcare students' clinical competency. NURSE EDUCATION TODAY 2021; 96:104623. [PMID: 33125979 DOI: 10.1016/j.nedt.2020.104623] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/11/2020] [Accepted: 10/01/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Health professional education is transitioning to online platforms to meet students' need for flexibility and international access. However, there is a necessity for authentic presentation of educational material particularly in regard to clinical skills development. There has been major growth in the delivery of virtual simulated-based learning and assessment to provide clinical skill acquisition in an online platform. The aim of this review was to explore the use of virtual simulation to assess clinical competence in health education. DESIGN Integrative review. DATA SOURCES Peer reviewed studies published between 2008 to March 2020 were searched across PubMed, Embase, Cochrane Library, CINAHL Medline, Scopus, and PsycINFO. REVIEW METHODS The Preferred Reporting Items for Systematic reviews and Meta-Analyses was followed. Twenty-three studies, which met the inclusion criteria, were downloaded, and a quality appraisal and analysis was completed by the research team. RESULTS A thematic analysis identified four themes; pedagogy differences across disciplines, debriefing to enhance learning, preparing healthcare professionals in a safe and cost-effective environment, and managing challenges of virtual simulation. Debriefing with students within the online environment enabled students to share experience and reflect on choices for a deeper learning experience. CONCLUSIONS Virtual simulation can prepare students for the clinical environment by providing safe practice within complex clinical situations. Challenges related to managing and debriefing students must be overcome to ensure best student learning outcomes. Virtual simulation is a feasible strategy to assess students' clinical competency and support their learning in both medical and nursing programs, however simulation should be authentic and incorporate reflection.
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Affiliation(s)
- Elisabeth Coyne
- School of Nursing and Midwifery, Griffith University, Australia; Menzies Health Institute Queensland, Griffith University, Australia.
| | - Pauline Calleja
- School of Nursing and Midwifery, Griffith University, Australia; School of Nursing, Midwifery and Social Sciences, CQUniversity, Australia.
| | - Elizabeth Forster
- School of Nursing and Midwifery, Griffith University, Australia; Menzies Health Institute Queensland, Griffith University, Australia.
| | - Frances Lin
- School of Nursing and Midwifery, Griffith University, Australia; School of Nursing, Midwifery, and Paramedicine, University of the Sunshine Coast, Sunshine Coast Health Institute, Australia.
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Renn BN, Areán PA, Raue PJ, Aisenberg E, Friedman EC, Popović Z. Modernizing Training in Psychotherapy Competencies With Adaptive Learning Systems: Proof of Concept. RESEARCH ON SOCIAL WORK PRACTICE 2021; 31:90-100. [PMID: 34321858 PMCID: PMC8315227 DOI: 10.1177/1049731520964854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE This proof-of-concept study assessed the feasibility, acceptability, and effectiveness of an intelligent tutoring system (ITS) as a classroom adjunct to improve training bachelor of social work (BSW) students in client engagement strategies. METHODS We codeveloped the ITS with 11 undergraduate students and pilot tested it with six BSW students enrolled in a class on telephone-based cognitive behavioral therapy (tCBT). Student competencies in tCBT were assessed by expert review of role-plays. We also examined time spent using ITS and relation with competency. RESULTS The majority of students (81.8%) in Wave 1 and all of the students who submitted role-plays in Wave 2 passed the clinical skills role-play. Students advancing through the ITS more quickly had better tCBT competency ratings than those progressing more slowly. DISCUSSION One of the most challenging aspects of training is how to competently deliver evidence-based practices. ITS has the potential to streamline and scale such training.
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Affiliation(s)
- Brenna N. Renn
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- Department of Psychology, University of Nevada, Las Vegas, NV, USA
| | - Patricia A. Areán
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Patrick J. Raue
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Eugene Aisenberg
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Emily C. Friedman
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Zoran Popović
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA, USA
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Bakhos D, Galvin J, Aoustin JM, Robier M, Kerneis S, Bechet G, Montembault N, Laurent S, Godey B, Aussedat C. Training outcomes for audiology students using virtual reality or traditional training methods. PLoS One 2020; 15:e0243380. [PMID: 33270806 PMCID: PMC7714342 DOI: 10.1371/journal.pone.0243380] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/19/2020] [Indexed: 11/19/2022] Open
Abstract
Due to limited space and resources, it can be difficult to train students on audiological procedures adequately. In the present study, we compared audiology training outcomes between a traditional approach and a recently developed immersive virtual reality (VR) approach in audiology students. Twenty-nine first-year audiology students participated in the study; 14 received traditional training (“TT group”), and 15 received the VR training (“VRT group”). Pre- and post-training evaluation included a 20-item test developed by an audiology educator. Post-training satisfaction and self-confidence were evaluated using Likert scales. Mean post-training test scores improved by 6.9±9.8 percentage points in the TT group and by 21.1±7.8 points in the VRT group; the improvement in scores was significant for both groups. After completing the traditional training, the TT group was subsequently trained with the VR system, after which mean scores further improved by 7.5 points; there was no significant difference in post-VR training scores between the TT and VRT groups. After training, the TT and VRT groups completed satisfaction and self-confidence questionnaires. Satisfaction and self-confidence ratings were significantly higher for the VR training group, compared to the traditional training group. Satisfaction ratings were “good” (4 on Likert scale) for 74% of the TT group and 100% of the VRT group. Self-confidence ratings were “good” for 71% of the TT group and 92% of the VRT group. These results suggest that a VR training approach may be an effective alternative or supplement to traditional training for audiology students.
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Affiliation(s)
- David Bakhos
- CHU de Tours, service ORL et Chirurgie Cervico-Faciale, Tours, France
- Faculté de Médecine de Tours, Université François-Rabelais de Tours, CHRU de Tours, Tours, France
- INSERM UMR 1253 I-brain, Université François-Rabelais de Tours, CHRU de Tours, Tours, France
- * E-mail:
| | - John Galvin
- INSERM UMR 1253 I-brain, Université François-Rabelais de Tours, CHRU de Tours, Tours, France
- House Ear Institute, Los Angeles, California, United States of America
| | - Jean-Marie Aoustin
- CHU de Tours, service ORL et Chirurgie Cervico-Faciale, Tours, France
- Audilab, Saint-Pierre-des-Corps, France
| | - Mathieu Robier
- CHU de Tours, service ORL et Chirurgie Cervico-Faciale, Tours, France
- Audilab, Saint-Pierre-des-Corps, France
| | - Sandrine Kerneis
- CHU de Tours, service ORL et Chirurgie Cervico-Faciale, Tours, France
| | - Garance Bechet
- Ecole d’audioprothèse JE Bertin, Université de Rennes 1, Javene, France
| | | | - Stéphane Laurent
- Ecole d’audioprothèse JE Bertin, Université de Rennes 1, Javene, France
| | - Benoit Godey
- Ecole d’audioprothèse JE Bertin, Université de Rennes 1, Javene, France
- Service d’ORL et Chirurgie Cervico-Faciale, CHU de Rennes, Rennes, France
| | - Charles Aussedat
- CHU de Tours, service ORL et Chirurgie Cervico-Faciale, Tours, France
- Faculté de Médecine de Tours, Université François-Rabelais de Tours, CHRU de Tours, Tours, France
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Lee J, Kim H, Kim KH, Jung D, Jowsey T, Webster CS. Effective virtual patient simulators for medical communication training: A systematic review. MEDICAL EDUCATION 2020; 54:786-795. [PMID: 32162355 DOI: 10.1111/medu.14152] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/04/2020] [Accepted: 03/09/2020] [Indexed: 06/10/2023]
Abstract
CONTEXT Despite the growing use of virtual patients (VPs) in medical education, few studies have explored the features and effectiveness of VP-based medical communication skills training. We undertook a systematic review to summarise the design and evaluation of VP-based medical communication skills training systems in order to identify features of successful cases. METHODS Following PRISMA guidelines, we searched four databases for studies published between 2006 and 2018. Using a refined classification scheme, we extracted data on instructional design (scenario and instructional intervention), technological design (modality and interaction), and evaluation (user experience, learning effectiveness and evaluator). We assessed the quality of studies using the Medical Education Research Study Quality Instrument (MERSQI) and the QualSyst standard assessment criteria. RESULTS A total of 14 studies were included for review. Of these, 85.7% (n = 12) were quantitative and 71.4% (n = 10) involved undergraduate students. The most common VP training scenario was history taking followed by the delivery of bad news. Diverse instructional interventions, including tutorials, learning activities, and feedback, were embedded in the VPs. The first-person perspective animated within-screen size VP was a popular technological feature. Most evaluations concerned the reality of simulation (for user experience) and skill in expressing empathy (as a learning outcome). Of the eight comparative studies, half reported significant attitude or skill improvements in the VP group. The distinct features of VPs shown to be effective were well-designed instructional interventions (eg, a pre-activity with a protocol-informed tutorial), and post-activity (eg, debrief or reflection), scaffolding and human feedback, but not system feedback. CONCLUSIONS Evidence-based VP training can enable students to gain communication skills in a safe and affordable learning environment. Elaborate technology alone cannot guarantee effective learning, but evidence-based instructional interventions can facilitate its optimal use and bring about better learning outcomes.
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Affiliation(s)
- Jihyun Lee
- Department of Dental Education, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Hyungsin Kim
- Smart Experience Design, Graduate School of Techno Design, Kookmin University, Seoul, South Korea
| | - Kwan Hoon Kim
- Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Daeun Jung
- Educational Psychology and Learning Systems, Florida State University, Tallahassee, Florida, USA
| | - Tanisha Jowsey
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
| | - Craig S Webster
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
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Warrier V, Pradhan A. A Narrative Review of Interventions to Teach Medical Students How to Break Bad News. MEDICAL SCIENCE EDUCATOR 2020; 30:1299-1312. [PMID: 34457793 PMCID: PMC8368663 DOI: 10.1007/s40670-020-01015-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Breaking bad news (BBN) is a key advanced communication skill that physicians must learn. Despite the breadth of literature describing patients' preferences and data citing poor physician competency in this arena, there remains significant dissatisfaction with how doctors deliver bad news. One way to solve this dilemma is to ensure that we are using the best evidence-based educational approaches to train the cadre of medical students who graduate from medical school each year. This article provides a 15-year review of articles on BBN in the undergraduate medical education curriculum that have been validated using the Medical Education Research Quality Instrument (MERSQI) (Acad Med 90:1067-76, 2015). This narrative review aims to identify articles which describe undergraduate medical education curriculum that evaluate how to best teach students to communicate bad news to patients. In the process, the authors reviewed 179 abstracts in 118 academic journals. Articles that met the inclusion criteria were evaluated using the MERSQI and those that scored higher than 11.3 were chosen for analysis. This paper summarizes the 15 articles that met the criteria. The review reveals (1) standard components which should be included in an undergraduate BBN curriculum, (2) a pressing need for utilizing a teaching and evaluation tool that incorporates nonverbal communication, and (3) a further need to test long-term curriculum retention.
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Affiliation(s)
| | - Archana Pradhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ USA
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Persky S, Lewis MA. Advancing science and practice using immersive virtual reality: what behavioral medicine has to offer. Transl Behav Med 2020; 9:1040-1046. [PMID: 31116851 DOI: 10.1093/tbm/ibz068] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Interest in immersive virtual reality (VR) technologies is burgeoning as the hardware becomes less costly and more accessible to users, including researchers and practitioners. This commentary outlines the field of immersive VR and highlights applications of its use relevant to translational behavioral medicine. We describe the challenges facing VR applications for health and medicine, and how the core strengths of behavioral medicine can advance theory, research, and practice using VR. By highlighting potential uses of immersive VR alongside the challenges facing the field, we hope to inspire researchers to apply robust theories, methods, and frameworks to generate stronger evidence about the feasibility, acceptability, efficacy, and effectiveness of using this technology in translational behavioral medicine.
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Affiliation(s)
- Susan Persky
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Megan A Lewis
- Patient & Family Engagement Research Program, Center for Communication Science, RTI International, Research Triangle Park, NC, USA
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Carrard V, Bourquin C, Orsini S, Schmid Mast M, Berney A. Virtual patient simulation in breaking bad news training for medical students. PATIENT EDUCATION AND COUNSELING 2020; 103:1435-1438. [PMID: 32019697 DOI: 10.1016/j.pec.2020.01.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The present study explores students' perspective on the added value of a virtual patient (VP) simulation as part of a breaking bad news training in undergraduate medical education. METHODS The VP simulation allows trying out and practicing different ways of disclosing a cancer diagnosis to a VP (avatar) and to react to emotionally-laden patient statements with the opportunity of self-observation through video recording. After testing the simulation, 23 students shared their experience in focus groups analyzed using thematic analysis. RESULTS Self-observation is the most valued feature of the simulation, because it enables users to reflect on their behaviors and adjust them. The competences developed are otherwise technical (e.g., organization of information) and concern less interactional competences. Areas for improvement of the simulation are the interactivity, quality, and diversity of the VPs. CONCLUSION The findings show that VP simulations help develop technical communication competences and are best suited as add-ons to other forms of training, in which relational aspects can be targeted. Self-observation is especially valued because it allows for a critical view regarding one's own communication behaviors in a stress-free environment. PRACTICE IMPLICATIONS The proposed simulation is beneficial as an add-on to lectures, supervision, and simulated patient interviews.
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Affiliation(s)
- Valerie Carrard
- Psychiatric Liaison Service, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Céline Bourquin
- Psychiatric Liaison Service, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Sandy Orsini
- Psychiatric Liaison Service, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Marianne Schmid Mast
- Department of Organizational Behavior, University of Lausanne, Lausanne, Switzerland
| | - Alexandre Berney
- Psychiatric Liaison Service, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
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Choi H, Lee U, Jeon YS, Kim C. Efficacy of the computer simulation-based, interactive communication education program for nursing students. NURSE EDUCATION TODAY 2020; 91:104467. [PMID: 32464566 DOI: 10.1016/j.nedt.2020.104467] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/16/2020] [Accepted: 05/04/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Simulation-based education using standardized patients or high fidelity patient simulators is resource-intensive and can be limited in its consistency and repeatability. Standardized, interactive, and effective computer simulation-based education programs that improve communication skills among nursing students are greatly needed. OBJECTIVES This study aimed to (1) compare the efficacy of a computer simulation-based, interactive communication education (ComEd) program and an attention control (AC) program on communication knowledge, learning self-efficacy, and communication efficacy at baseline and twice after the intervention (immediately after and two weeks after); and (2) assess the acceptability and satisfaction of the ComEd reported by the participants. DESIGN This study employed a mixed-method, randomized controlled design with repeated measures. METHODS Students were recruited from four nursing schools and randomly assigned to either the intervention or AC group. They received either the ComEd or AC program installed on a tablet PC or a desktop computer in the classrooms and completed a 15-item communication knowledge scale, 10-item learning self-efficacy scale, 22-item communication efficacy scale, and 14-item satisfaction scale. In addition, six open-ended questions were used to help participants reflect on their learning experiences and explore their satisfaction with the programs. The Generalized Estimating Equation (GEE) model was the main model employed to examine the effects of the ComEd program over time in comparison with the AC program, and the content analysis method was used for qualitative data. RESULTS In total, 131 nursing students (66 in ComEd and 65 in AC) completed the programs and 127 participated through the two-week follow-up test. Compared to the AC group, the ComEd group significantly improved communication knowledge, learning self-efficacy, and communication efficacy; these effects were maintained at two weeks. The ComEd program was well accepted by the participants. CONCLUSIONS The ComEd is a promising approach because it is highly accessible, consistent, and repeatable, and has positive learning effects.
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Affiliation(s)
- Heeseung Choi
- College of Nursing, Seoul National University, Seoul, Republic of Korea; College of Nursing & The Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea.
| | - Ujin Lee
- College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Ye Seul Jeon
- College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Chanhee Kim
- College of Nursing, Dong-A University, Busan, Republic of Korea
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Stuij SM, Drossaert CHC, Labrie NHM, Hulsman RL, Kersten MJ, van Dulmen S, Smets EMA. Developing a digital training tool to support oncologists in the skill of information-provision: a user centred approach. BMC MEDICAL EDUCATION 2020; 20:135. [PMID: 32357886 PMCID: PMC7195777 DOI: 10.1186/s12909-020-1985-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 02/25/2020] [Indexed: 05/02/2023]
Abstract
BACKGROUND For patients with cancer, being well informed by their oncologist about treatment options and the implications thereof is highly relevant. Communication skills training (CST) programs have shown to be effective in improving clinicians' communication skills, yet CSTs are time-consuming, inconvenient to schedule, and costly. Online education enables new ways of accessible learning in a safe and personalised environment. AIM AND METHODS We describe the design of a digital CST-tool for information provision skills that meets oncologists' learning needs. We used the CeHRes Roadmap for user-centred design as a guiding framework. Phase 1 (Contextual Inquiry) involved consultation of the literature and a focus group interview study to uncover the learning needs and training preferences of clinicians' regarding a digital training for the skill of information-provision. In phase 2 (Value Specification), two multidisciplinary expert panels specified the learning content and format of a digital training. Phase 3 (Design) encompassed an iterative development process, including two user group assessment sessions and 5 individual user sessions in which prototypes were tested. All sessions were recorded and independently analyzed by two researchers. RESULTS Based on literature and consultation of the users in the inquiry phase of the development process, and on expert opinion in the value specification phase, relevant (sub) skills and user requirements were defined to consider for the digital training format. It was decided to develop a conventional e-learning and a chatbot. Personalization and interactivity were integrated in the prototypes by including features that allow for e.g., choosing text, video or animation; to upload video-recorded consultations to receive peer-feedback; and to consult a communication expert. Results revealed that, overall, participants expressed a willingness to use a digital training tool to acquire information-provision skills. Individual user testing (including junior clinicians), indicated a preference for the chatbot over the e-learning. CONCLUSION We offer a description of extensive development work which was conducted in collaboration with multiple health care professionals to iteratively develop two innovative prototypes of digital tools that would appropriately engage oncologists in learning effective information giving skills. The resulting prototypes were well appreciated and thus provide a solid basis for further development and testing.
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Affiliation(s)
- Sebastiaan M Stuij
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Constance H C Drossaert
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Nanon H M Labrie
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Robert L Hulsman
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Marie José Kersten
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Haematology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, The Netherlands
| | - Sandra van Dulmen
- NIVEL (Netherlands institute for health services research), Utrecht, the Netherlands
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, the Netherlands
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Public Health research institute, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Amsterdam, The Netherlands.
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O'Rourke SR, Branford KR, Brooks TL, Ives LT, Nagendran A, Compton SN. The Emotional and Behavioral Impact of Delivering Bad News to Virtual versus Real Standardized Patients: A Pilot Study. TEACHING AND LEARNING IN MEDICINE 2020; 32:139-149. [PMID: 31437006 DOI: 10.1080/10401334.2019.1652180] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Phenomenon: Virtual standardized patients (vSPs) are becoming increasingly common in medical education, though one limitation of vSPs is the artificiality of computer-based simulators. Past research on the use of vSPs has not clearly established whether learners have different emotional responses to real SPs (rSPs) compared with vSPs; however, understanding learners' emotional responses to vSPs is important in providing realistic learning experiences and establishing the validity of this teaching and assessment tool. This study compared the emotional experiences of individuals who interacted with rSPs and vSPs. Approach: Sixty medical students at a medical school in the southeastern United States participated in the study. Participants were randomly assigned to deliver bad news to an rSP or vSP. The vSP for this study used a hybrid intelligence model that allowed a person to "inhabit" the vSP. Salivary cortisol and a self-report measure of mood-the Profile of Mood States, Second Edition (POMS 2)-were gathered before and after delivering the bad news. The SP and 2 independent evaluators rated the behavioral performance of each participant in real and virtual conditions. Participants also rated the performance of the SP. Findings: Participants in both conditions reported increased negative emotionality on the POMS 2 following the SP interaction. There were no significant between-group differences on the POMS 2 or salivary cortisol concentration following the SP interaction. Ratings by the SP and independent evaluators indicated that participants performed similarly on most interpersonal dimensions, except tone of voice. Participants perceived the vSP as less realistic than the rSP. Insights: These results suggest that medical students may have similar emotional and behavioral responses when delivering bad news to a vSP when compared to an rSP. These findings provide support for the continued use of vSPs in training learners to deliver bad news and other communication-based skills and to assess their performance on these tasks.
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Affiliation(s)
- Sarah R O'Rourke
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kelly R Branford
- Clinical Skills and Standardized Patient Program, Duke University School of Medicine, Durham, North Carolina, USA
| | - Taylor L Brooks
- Department of Psychology, Duke University, Durham, North Carolina, USA
| | - Lindsay T Ives
- Department of Psychology, Duke University, Durham, North Carolina, USA
| | | | - Scott N Compton
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Psychology, Duke University, Durham, North Carolina, USA
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Chaudhuri JD. Stimulating Intrinsic Motivation in Millennial Students: A New Generation, a New Approach. ANATOMICAL SCIENCES EDUCATION 2020; 13:250-271. [PMID: 31021529 DOI: 10.1002/ase.1884] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 04/17/2019] [Accepted: 04/21/2019] [Indexed: 06/09/2023]
Abstract
There has been a fundamental change in health care pedagogy to address the demands and challenges posed by the present generation of millennial students. There is also a growing recognition of the role of intrinsic motivation as a catalyst in a positive learning experience. The term intrinsic motivation refers to energizing behavior that comes from within an individual and develops due to an inherent interest in the activity at hand. However, stimulating intrinsic motivation in the present generation of millennial health care students is a daunting task, considering their diverse and disparate nature. In addition, the inherent generational differences between educators and students, and an increasing emphasis on technological tools have resulted in a dichotomy in the educational environment leading to the development of a greater incidence of burnouts among students. Hence, numerous innovative techniques have been introduced in health care education to enhance the levels of intrinsic motivation in these students. Unfortunately, most of these approaches have only been moderately successful due to their limited ability to address the unique educational expectations of millennial students. The cumulative evidence suggests that specific approaches to stimulate intrinsic motivation should aim at nurturing the learning efforts of students, bridging the generational barriers between educators and students, and ameliorating the stress associated with health care education. Hence, the specific aim of this narrative review is to suggest empirically proven curricular strategies and institutional reforms to enhance intrinsic motivation in health care students belonging to the Millennial Generation.
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Affiliation(s)
- Joydeep Dutta Chaudhuri
- School of Occupational Therapy, College of Health Sciences, Husson University, Bangor, Maine
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Davies J, Churchhouse G, Buckley M. Improving the provision of clinical skills teaching for undergraduate medical students during their psychiatry placement: a trainee-led quality improvement project. Australas Psychiatry 2020; 28:101-105. [PMID: 31535561 DOI: 10.1177/1039856219871874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To increase the provision of clinical skills training during their psychiatry placement by providing a new teaching course to enhance both their clinical knowledge and communication skills. METHOD We delivered a pilot teaching course consisting of five workshops (incorporating facilitated, 'near peer' role-play) during the students' psychiatry placement. Qualitative and quantitative feedback was collected pre- and post-course to allow for development of the course. RESULTS Data collected indicated that all students found the course a valuable addition to their usual teaching. They indicated that their confidence in their ability to assess patients with common clinical problems improved. CONCLUSIONS This trainee-led course was easily integrated into the curriculum and received positive feedback from students. It may have enhanced students' confidence and readiness for exams but this will require further examination of objective assessments and ongoing research to establish this.
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Affiliation(s)
- Joanne Davies
- Psychiatry Registrar, Avon and Wiltshire Mental Health Partnership Trust, Bath, UK
| | - Gabrielle Churchhouse
- Psychiatry Core Trainee (CT3), Avon and Wiltshire Mental Health Partnership NHS Trust, Bath, UK
| | - Melissa Buckley
- Psychiatry Specialty Trainee (ST6), 2gether NHS Foundation Trust, Gloucester, UK
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Deliz JR, Fears FF, Jones KE, Tobat J, Char D, Ross WR. Cultural Competency Interventions During Medical School: a Scoping Review and Narrative Synthesis. J Gen Intern Med 2020; 35:568-577. [PMID: 31705475 PMCID: PMC7018865 DOI: 10.1007/s11606-019-05417-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/15/2019] [Accepted: 09/16/2019] [Indexed: 02/04/2023]
Abstract
Many medical accreditation bodies agree that medical students should be trained to care for diverse patient populations. However, the teaching methods that medical schools employ to accomplish this goal vary widely. The purpose of this work is to summarize current cultural competency teaching for medical students and their evaluation methods. A scoping review was completed by searching the databases PubMed, Scopus, MedEdPORTAL, and MEDLINE for the search terms "medical education" and "cultural competency" or "cultural competence." Results were summarized using a narrative synthesis technique. One hundred fifty-four articles on cultural competency interventions for medical students were systematically identified from the literature and categorized by teaching methods, length of intervention, and content. Fifty-six articles had a general focus, and ninety-eight articles were focused on specific populations including race/ethnicity, global health, socioeconomic status, language, immigration status, disability, spirituality at the end of life, rurality, and lesbian, gay, bisexual, transgender, and queer. About 54% of interventions used lectures as a teaching modality, 45% of the interventions described were mandatory, and 9.7% of interventions were not formally evaluated. The authors advocate for expansion and more rigorous analysis of teaching methods, teaching philosophies, and outcome evaluations with randomized controlled trials that compare the relative effectiveness of general and population-specific cultural competency interventions.
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Affiliation(s)
- Juan R Deliz
- Washington University School of Medicine, 660 S Euclid Ave, CB 8126, St. Louis, MO, 63110, USA.
| | - Fayola F Fears
- Washington University School of Medicine, 660 S Euclid Ave, CB 8126, St. Louis, MO, 63110, USA
| | - Kai E Jones
- Washington University School of Medicine, 660 S Euclid Ave, CB 8126, St. Louis, MO, 63110, USA
| | - Jenny Tobat
- Washington University School of Medicine, 660 S Euclid Ave, CB 8126, St. Louis, MO, 63110, USA
| | - Douglas Char
- Department of Emergency Medicine, Washington University School of Medicine, Campus Box 8072, 660 South Euclid Ave, St. Louis, MO, USA
| | - Will R Ross
- Division of Nephrology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
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Schick K, Reiser S, Mosene K, Schacht L, Janssen L, Thomm E, Dinkel A, Fleischmann A, Berberat PO, Bauer J, Gartmeier M. How can communicative competence instruction in medical studies be improved through digitalization? GMS JOURNAL FOR MEDICAL EDUCATION 2020; 37:Doc57. [PMID: 33225049 PMCID: PMC7672381 DOI: 10.3205/zma001350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 03/29/2020] [Accepted: 05/29/2020] [Indexed: 05/10/2023]
Abstract
The teaching of communicative competence plays an increasingly important role in medical education. In addition to traditional teaching formats, such as role-plays with simulated patients, technology-based approaches become more important in medical education. Teaching materials are increasingly augmented by videos of simulated doctor-patient conversations. This combination allows the content of teaching materials to be demonstrated with video or for videos to create a basis for reflection activities. In addition, conversation videos can illustrate different qualities of clinical communication and serve as illustrative material for describing particular issues in more detail. In addition to teaching clinical communicative competence, the assessment of this competence also plays an important role in medical educational research. So far, this has mainly been conducted through direct observation using checklists or rating scales. Relatively little is known about the assessment of communicative competence using standardized online-based tests. Situational Judgement Tests (SJTs) offer a promising approach in this respect. The BMBF-funded (BMBF = Bundesministerium für Bildung und Forschung - Federal Ministry of Education and Research) joint project voLeA (Entwicklung videobasierter Lehr- und Assessmentmodule zur Gesprächskompetenz im Medizinstudium = Development of video-based teaching and assessment modules for communicative competence in medical studies) addresses these two issues. Specifically, the project is engaged in developing e-learning modules to promote communicative competence and an assessment of this competence using an SJT. The present paper focuses on the benefits of technology-based learning and assessment units for clinical communicative competence in medical studies, using the voLeA project as an example.
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Affiliation(s)
- Kristina Schick
- Technical University of Munich, TUM Medical Education Center, Munich, Germany
- *To whom correspondence should be addressed: Kristina Schick, Technical University of Munich, TUM Medical Education Center, Ismaninger Str. 22, D-81675 Munich, Germany, Phone: +49 (0)89/4140-6311, E-mail:
| | - Sabine Reiser
- University Erfurt, Professur für Bildungsforschung und Methodenlehre, Erfurt, Germany
| | - Katharina Mosene
- Technical University of Munich, TUM Medical Education Center, Munich, Germany
| | - Laura Schacht
- University Erfurt, Professur für Bildungsforschung und Methodenlehre, Erfurt, Germany
| | - Laura Janssen
- Technical University of Munich, TUM Medical Education Center, Munich, Germany
| | - Eva Thomm
- University Erfurt, Professur für Bildungsforschung und Methodenlehre, Erfurt, Germany
| | - Andreas Dinkel
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Munich, Germany
| | - Andreas Fleischmann
- Technical University of Munich, Pro Lehre, Medien und Didaktik, Munich, Germany
| | - Pascal O. Berberat
- Technical University of Munich, TUM Medical Education Center, Munich, Germany
| | - Johannes Bauer
- University Erfurt, Professur für Bildungsforschung und Methodenlehre, Erfurt, Germany
| | - Martin Gartmeier
- Technical University of Munich, TUM Medical Education Center, Munich, Germany
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Supporting Empathy Training Through Virtual Patients. LECTURE NOTES IN COMPUTER SCIENCE 2020. [PMCID: PMC7334701 DOI: 10.1007/978-3-030-52240-7_43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
For the training of interpersonal skills, such as those required in the medical field, virtual agents can provide a safe environment for practice. However, many agent systems are not developed with the ability to understand non-verbal input. Being able to automatically parse such input is essential for the practice of interpersonal skills such as empathy. Currently, it is still an open question which prosodic or visual features would aid automatic classification of empathy and how this knowledge can be used to support the practice of these skills. As a first step towards this goal, we report on 42 second-year nursing students practicing their empathy skills with a virtual patient or through collaborative role playing. We found that across both the role playing and simulation, students assessed their empathy as increasing over time but as higher during the role playing. This work contributes to the continued development of virtual agents for the training of interpersonal skills.
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Guetterman TC, Sakakibara R, Baireddy S, Kron FW, Scerbo MW, Cleary JF, Fetters MD. Medical Students' Experiences and Outcomes Using a Virtual Human Simulation to Improve Communication Skills: Mixed Methods Study. J Med Internet Res 2019; 21:e15459. [PMID: 31774400 PMCID: PMC6906619 DOI: 10.2196/15459] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/27/2019] [Accepted: 09/28/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Attending to the wide range of communication behaviors that convey empathy is an important but often underemphasized concept to reduce errors in care, improve patient satisfaction, and improve cancer patient outcomes. A virtual human (VH)-based simulation, MPathic-VR, was developed to train health care providers in empathic communication with patients and in interprofessional settings and evaluated through a randomized controlled trial. OBJECTIVE This mixed methods study aimed to investigate the differential effects of a VH-based simulation developed to train health care providers in empathic patient-provider and interprofessional communication. METHODS We employed a mixed methods intervention design, involving a comparison of 2 quantitative measures-MPathic-VR-calculated scores and the objective structured clinical exam (OSCE) scores-with qualitative reflections by medical students about their experiences. This paper is a secondary, focused analysis of intervention arm data from the larger trial. Students at 3 medical schools in the United States (n=206) received simulation to improve empathic communication skills. We conducted analysis of variance, thematic text analysis, and merging mixed methods analysis. RESULTS OSCE scores were significantly improved for learners in the intervention group (mean 0.806, SD 0.201) compared with the control group (mean 0.752, SD 0.198; F1,414=6.09; P=.01). Qualitative analysis revealed 3 major positive themes for the MPathic-VR group learners: gaining useful communication skills, learning awareness of nonverbal skills in addition to verbal skills, and feeling motivated to learn more about communication. Finally, the results of the mixed methods analysis indicated that most of the variation between high, middle, and lower performers was noted about nonverbal behaviors. Medium and high OSCE scorers most often commented on the importance of nonverbal communication. Themes of motivation to learn about communication were only present in middle and high scorers. CONCLUSIONS VHs are a promising strategy for improving empathic communication in health care. Higher performers seemed most engaged to learn, particularly nonverbal skills.
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