A collaborative clinical simulation model for the development of competencies by medical students

Computer-Supported Collaborative Design of Standardized Clinical Cases: Algorithm Development and Validation

Background

The creation of computer-supported collaborative clinical cases is an area of educational research that has been widely studied. However, the reuse of cases and their sharing with other platforms is a problem, as it encapsulates knowledge in isolated platforms without interoperability. This paper proposed a workflow ecosystem for the collaborative design and distribution of clinical cases through web-based computing platforms that (1) allow medical students to create clinical cases collaboratively in a dedicated environment; (2) make it possible to export these clinical cases in terms of the Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) interoperability standard; (3) provide support to transform imported cases into learning object repositories; and (4) use e-learning standards (eg, Instructional Management Systems Content Packaging [IMS-CP] or Sharable Content Object Reference Model [SCORM]) to incorporate this content into widely-used learning management systems (LMSs), letting medical students democratize a valuable knowledge that would otherwise be confined within proprietary platforms.

Objective

This study aimed to demonstrate the feasibility of developing a workflow ecosystem based on IT platforms to enable the collaborative creation, export, and deployment of clinical cases.

Methods

The ecosystem infrastructure for computer-supported collaborative design of standardized clinical cases consists of three platforms: (1) Mosaico, a platform used in the design of clinical cases; (2) Clavy, a tool for the flexible management of learning object repositories, which is used to orchestrate the transformation and processing of these clinical cases; and (3) Moodle, an LMS that is geared toward publishing the processed clinical cases and delivering their course deployment stages in IMS-CP or SCORM format. The generation of cases in Mosaico is exported in the HL7 FHIR interoperability standard to Clavy, which is then responsible for creating and deploying a learning object in Moodle.

Results

The main result was an interoperable ecosystem that demonstrates the feasibility of automating the stages of collaborative clinical case creation, export through HL7 FHIR standards, and deployment in an LMS. This ecosystem enables the generation of IMS-CPs associated with the original Mosaico clinical cases that can be deployed in conventional third-party LMSs, thus allowing the democratization and sharing of clinical cases to different platforms in standard and interoperable formats.

Conclusions

In this paper, we proposed, implemented, and demonstrated the feasibility of developing a standards-based workflow that interoperates multiple platforms with heterogeneous technologies to create, transform, and deploy clinical cases on the web. This achieves the objective of transforming the created cases into a platform for web-based deployment in an LMS.

Nurse educators and student nurses’ perspectives on ways to improve implementation of simulation-based education in Lesotho

Background

In order to ensure an effective health system, there is a need to recruit, train and deploy a competent nursing workforce. A competent workforce can be made possible by integrating simulation into the curriculum. Implementation of simulation-based education in Lesotho is facing a number of challenges as the country has limited resources.

Objectives

This study aimed to describe nurse educators and students’ perspectives on ways to improve implementation of simulation-based education in Lesotho.

Method

A qualitative study was conducted. A total of 24 students, 24 nurse educators and 4 principals who were purposely selected participated in the study. Focus group discussions as one of the data collection methods were used to collect data from the nurse educators and students whilst in-depth, unstructured individual interviews were used with the principals. Data were analysed following the Corbin and Strauss grounded theory approach where similar codes were categorised together as part of open coding, and axial coding was conducted by refining the codes and organising them into categories and subcategories.

Results

Two categories emerged from the areas where improvement is required: resources to support simulation. Resources emerged as playing a major role in ensuring quality simulation. The teaching and learning process emerged as collaborative in nature with all key players ensuring that they meet their responsibilities in order to ensure effective simulation-based learning.

Conclusion

The study revealed that there are limited numbers of simulation facilitators and this hinders effective implementation of simulation. Students are concerned about the comments of educators during simulation, as some of the comments are belittling.

Development of a Smartphone-Based Skin Simulation Model for Medical Education

INTRODUCTION

Teaching dermatology to medical students entails a series of lectures, pictures, and hands-on skin examinations to convey a sense of skin features and textures, often by use of simulated skin models. However, such methods can often lack accurate visual and tactile texture representation of skin lesions. To facilitate learning, we have developed a smartphone-based skin simulation model, which provides a configurable visual and tactile sense of a lesion by using the ubiquitous availability of smartphone-based mobile platforms.

METHODS

A polydimethylsiloxane (PDMS) overlay was used as a configurable translucent elastomer material to model the stiffness and texture of skin. A novel custom smartphone-based app was developed to capture images of various skin lesions, which were subsequently displayed on a tablet or second smartphone, over which the PDMS model skin elastomer was placed. Using the local Bluetooth connection between mobile devices, an iterative feedback algorithm corrected the visual distortion caused by the optical scattering of the translucent elastomer, enabling better virtual visualization of the lesion.

RESULTS

The developed smartphone-based app corrected the distortion of images projected through the simulated skin elastomer. Surface topography of the developed PDMS elastomer provided a more accurate representation of skin texture.

CONCLUSIONS

In this investigation, we developed a smartphone-based skin lesion visualization app with a simulated skin elastomer for training/education in not only dermatology but also all general medical specialties that examine the skin. This technique has the potential to advance the educational experience by giving students the ability to see, touch, and feel pragmatic skin textures and lesions.

Collaborative clinical simulation in cardiologic emergency scenarios for medical students. An exploratory study on model applicability and assessment instruments

Aims: This paper evaluates the feasibility of piloting the collaborative clinical simulation (CCS) model and its assessment instruments applicability for measuring interpersonal, collaborative, and clinical competencies in cardiologic emergency scenarios for medical students. The CCS model is a structured learning model for the acquisition and assessment of clinical competencies through small groups working collaboratively to design and perform in simulated environments supported by technology. Methods: Fifty-five students were allocated in five sessions (one weekly session) conducted with the CCS model within the course Cardiovascular Diseases. The applied practice aimed at the diagnosis and treatment of tachyarrhythmias in a simulated emergency department. In addition to the theoretical classes four weeks before the simulation sessions, students were sent a study guide that summarized the Guide to the European Society of Cardiology. For each simulation session, one clinical simulation instructor, one cardiologist teacher, and the principal investigator participated. Students were divided into three groups (3-5 students) for each-session. They designed, performed, role-played, and debriefed three different diagnoses. Three instruments to assess each group's performance were applied: peer assessment used by groups, performance assessment, created and applied by the cardiologist teacher, and individual satisfaction questionnaire for students. Results: The applicability of the CCS model was satisfactory for both students and teachers. The assessment instruments' internal reliability was good, as was internal consistency with a Cronbach Alpha of 0.7, 0.4, and 0.8 for each section (Interpersonal, Clinical, and Collaborative competencies, respectively). The performance group's evaluation was 0.8 for the two competencies assessed (Tachyarrhythmia and Electrical Cardioversion) and 0.8 for the satisfaction questionnaire's reliability. Conclusions: The CCS model for teaching emergency tachyarrhythmias to medical students was applicable and well accepted. The internal reliability of the assessment instruments was considered satisfactory by measuring satisfaction and performance in the exploratory study.

A Web Platform (MOSAICO) to Design, Perform, and Assess Collaborative Clinical Scenarios for Medical Students: Viewpoint

BACKGROUND

The collaborative clinical simulation (CCS) model is a structured method for the development and assessment of clinical competencies through small groups working collaboratively in simulated environments. From 2016 onward, the CCS model has been applied successfully among undergraduate and graduate medical students from the Universidad de Talca, Chile; the Universität de Barcelona, Spain; and the Universidad de Vic-Manresa, Spain. All the templates for building the clinical cases and the assessment instruments with CCS were printed on paper. Considering the large number of CCS sessions and the number of participating students that are required throughout the medical degree curriculum, it is impossible to keep an organized record when the instruments are printed on paper. Moreover, with the COVID-19 pandemic, web platforms have become important as safe training environments for students and medical faculties; this new educational environment should include the consolidation and adaptation of didactic sessions that create and use available virtual cases and use different web platforms.

OBJECTIVE

The goal of this study is to describe the design and development of a web platform that was created to strengthen the CCS model.

METHODS

The design of the web platform aimed to support each phase of the CCS by incorporating functional requirements (ie, features that the web platform will be able to perform) and nonfunctional requirements (ie, how the web platform should behave) that are needed to run collaborative sessions. The software was developed under the Model-View-Controller architecture to separate the views from the data model and the business logic.

RESULTS

MOSAICO is a web platform used to design, perform, and assess collaborative clinical scenarios for medical students. MOSAICO has four modules: educational design, students' collaborative design, collaborative simulation, and collaborative debriefing. The web platform has three different user profiles: academic simulation unit, teacher, and student. These users interact under different roles in collaborative simulations. MOSAICO enables a collaborative environment, which is connected via the internet, to design clinical scenarios guided by the teacher and enables the use of all data generated to be discussed in the debriefing session with the teacher as a guide. The web platform is running at the Universidad de Talca in Chile and is supporting collaborative simulation activities via the internet for two medical courses: (1) Semiology for third-year students (70 students in total) and (2) Medical Genetics for fifth-year students (30 students in total).

CONCLUSIONS

MOSAICO is applicable within the CCS model and is used frequently in different simulation sessions at the Universidad de Talca, where medical students can work collaboratively via the internet. MOSAICO simplifies the application and reuse of clinical simulation scenarios, allowing its use in multiple simulation centers. Moreover, its applications in different courses (ie, a large part of the medical curriculum) support the automatic tracking of simulation activities and their assessment.