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Noushad B, Van Gerven PWM, de Bruin ABH. Twelve tips for applying the think-aloud method to capture cognitive processes. MEDICAL TEACHER 2024; 46:892-897. [PMID: 38071621 DOI: 10.1080/0142159x.2023.2289847] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 11/28/2023] [Indexed: 12/21/2023]
Abstract
The think-aloud method is an established technique for studying human thought (cognitive) processes. Problem-solving and decision-making are essential skills for medical professionals, and the cognitive processes underlying these skills are complex. Studying these thought processes would enable educators, clinicians, and researchers to modify or refine their approaches and interventions. The think-aloud method has been utilized for capturing cognitive processes in a variety of fields, including computer usability, sports and cognitive psychology. Medical education also recognizes thought processes as valuable data for research and education. This article aims to guide researchers and educators through the preparation and implementation of a think-aloud method to record participants' thought processes during an activity.
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Affiliation(s)
- Babu Noushad
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
- College of Health Sciences, University of Buraimi, Al Buraimi, Sultanate of Oman
| | - Pascal W M Van Gerven
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Anique B H de Bruin
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
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Huang D, Whitehead C, Kuper A. Competing discourses, contested roles: Electronic health records in medical education. MEDICAL EDUCATION 2024. [PMID: 38764398 DOI: 10.1111/medu.15428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 04/06/2024] [Accepted: 04/29/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION The integration of electronic health records (EHRs) into medical education remains contested despite their widespread use in clinical practice. For medical trainees, this has resulted in idiosyncratic and often ad hoc methods of instruction on EHR use. The purpose of this study was to understand the currently fragmented nature of EHR instruction by examining discourses of EHR use within the medical education literature. METHODS We conducted a Foucauldian critical discourse analysis to identify discourses of EHRs in the medical education literature. We found our texts through a systematic search of widely cited medical education journals from 2013-2023. Each text was analysed for recurring truth statements-claims framed as self-evidently true and thus not needing supporting evidence-about the role of EHRs in medical education. RESULTS We identified three major discourses: (1) EHRs as a clinical skill and competency, emphasising training of physical interactions between learners, patients and computers; (2) EHRs as a system, emphasising the creation and facilitation of networks of people, technologies, institutions and standards; and (3) EHRs as a cognitive process, framed as a method to shape processes like clinical reasoning and bias. Each discourse privileged certain stakeholders over others and served to rationalise educational interventions that could be seen as beneficial in isolation yet were often disjointed in combination. CONCLUSIONS Competing discourses of EHR use in medical education produce divergent interventions that exacerbate their contested role in contemporary medical education. Identifying different claims for the benefits of EHR use in these settings allows educators to make rational choices between competing educational directions.
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Affiliation(s)
- Daniel Huang
- St. Michael's Hospital, Department of Medicine, University of Toronto, Toronto, Canada
| | - Cynthia Whitehead
- Women's College Hospital, Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- The Wilson Centre, University Health Network and University of Toronto, Toronto, Canada
| | - Ayelet Kuper
- Sunnybrook Health Sciences Centre, Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Canada
- The Wilson Centre, University Health Network and University of Toronto, Toronto, Canada
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Kamboj N, Metcalfe K, Chu CH, Conway A. Designing the User Interface of a Nitroglycerin Dose Titration Decision Support System: User-Centered Design Study. Appl Clin Inform 2024; 15:583-599. [PMID: 39048084 PMCID: PMC11268987 DOI: 10.1055/s-0044-1787755] [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: 12/14/2023] [Accepted: 05/14/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Nurses adjust intravenous nitroglycerin infusions to provide acute relief for angina by manually increasing or decreasing the dosage. However, titration can pose challenges, as excessively high doses can lead to hypotension, and low doses may result in inadequate pain relief. Clinical decision support systems (CDSSs) that predict changes in blood pressure for nitroglycerin dose adjustments may assist nurses with titration. OBJECTIVE This study aimed to design a user interface for a CDSS for nitroglycerin dose titration (Nitroglycerin Dose Titration Decision Support System [nitro DSS]). METHODS A user-centered design (UCD) approach, consisting of an initial qualitative study with semistructured interviews to identify design specifications for prototype development, was used. This was followed by three iterative rounds of usability testing. Nurses with experience titrating nitroglycerin infusions in coronary care units participated. RESULTS A total of 20 nurses participated, including 7 during the qualitative study and 15 during usability testing (2 nurses participated in both phases). Analysis of the qualitative data revealed four themes for the interface design to be (1) clear and consistent, (2) vigilant, (3) interoperable, and (4) reliable. The major elements of the final prototype included a feature for viewing the predicted and actual blood pressure over time to determine the reliability of the predictions, a drop-down option to report patient side effects, a feature to report reasons for not accepting the prediction, and a visual alert indicating any systolic blood pressure predictions below 90 mm Hg. Nurses' ratings on the questionnaires indicated excellent usability and acceptability of the final nitro DSS prototype. CONCLUSION This study successfully applied a UCD approach to collaborate with nurses in developing a user interface for the nitro DSS that supports the clinical decision-making of nurses titrating nitroglycerin.
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Affiliation(s)
- Navpreet Kamboj
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Kelly Metcalfe
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
- Women's College Hospital Research and Innovation Institute, Toronto, Canada
| | - Charlene H. Chu
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Aaron Conway
- School of Nursing, Queensland University of Technology (QUT), Brisbane, Australia
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Fink F, Kalter I, Steindorff JV, Helmbold HK, Paulicke D, Jahn P. Identifying Factors of User Acceptance of a Drone-Based Medication Delivery: User-Centered Design Approach. JMIR Hum Factors 2024; 11:e51587. [PMID: 38687589 PMCID: PMC11094598 DOI: 10.2196/51587] [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: 08/04/2023] [Revised: 12/21/2023] [Accepted: 01/06/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND The use of drones in the health care sector is increasingly being discussed against the background of the aging population and the growing shortage of skilled workers. In particular, the use of drones to provide medication in rural areas could bring advantages for the care of people with and without a need for care. However, there are hardly any data available that focus on the interaction between humans and drones. OBJECTIVE This study aims to disclose and analyze factors associated with user acceptance of drone-based medication delivery to derive practice-relevant guidance points for participatory technology development (for apps and drones). METHODS A controlled mixed methods study was conducted that supports the technical development process of an app design for drone-assisted drug delivery based on a participatory research design. For the quantitative analysis, established and standardized survey instruments to capture technology acceptance, such as the System Usability Scale; Technology Usage Inventory (TUI); and the Motivation, Engagement, and Thriving in User Experience model, were used. To avoid possible biasing effects from a continuous user development (eg, response shifts and learning effects), an ad hoc group was formed at each of the 3 iterative development steps and was subsequently compared with the consisting core group, which went through all 3 iterations. RESULTS The study found a positive correlation between the usability of a pharmacy drone app and participants' willingness to use it (r=0.833). Participants' perception of usefulness positively influenced their willingness to use the app (r=0.487; TUI). Skepticism had a negative impact on perceived usability and willingness to use it (r=-0.542; System Usability Scale and r=-0.446; TUI). The study found that usefulness, skepticism, and curiosity explained most of the intention to use the app (F3,17=21.12; P<.001; R2=0.788; adjusted R2=0.751). The core group showed higher ratings on the intention to use the pharmacy drone app than the ad hoc groups. Results of the 2-tailed t tests showed a higher rating on usability for the third iteration of the core group compared with the first iteration. CONCLUSIONS With the help of the participatory design, important aspects of acceptance could be revealed by the people involved in relation to drone-assisted drug delivery. For example, the length of time spent using the technology is an important factor for the intention to use the app. Technology-specific factors such as user-friendliness or curiosity are directly related to the use acceptance of the drone app. Results of this study showed that the more participants perceived their own competence in handling the app, the more they were willing to use the technology and the more they rated the app as usable.
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Affiliation(s)
- Franziska Fink
- Translation Region for Digitalised Healthcare, Department of Internal Medicine, Faculty of Medicine, University Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Health Service Research Working Group | Acute Care, Department of Internal Medicine, Faculty of Medicine, University Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Ivonne Kalter
- Translation Region for Digitalised Healthcare, Department of Internal Medicine, Faculty of Medicine, University Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Health Service Research Working Group | Acute Care, Department of Internal Medicine, Faculty of Medicine, University Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Jenny-Victoria Steindorff
- Translation Region for Digitalised Healthcare, Department of Internal Medicine, Faculty of Medicine, University Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Health Service Research Working Group | Acute Care, Department of Internal Medicine, Faculty of Medicine, University Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Hans Konrad Helmbold
- Department of Economics, Anhalt University of Applied Sciences, Bernburg, Germany
| | - Denny Paulicke
- Translation Region for Digitalised Healthcare, Department of Internal Medicine, Faculty of Medicine, University Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Health Service Research Working Group | Acute Care, Department of Internal Medicine, Faculty of Medicine, University Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Department of Medical Pedagogy, Akkon University of Human Sciences, Berlin, Germany
| | - Patrick Jahn
- Translation Region for Digitalised Healthcare, Department of Internal Medicine, Faculty of Medicine, University Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Health Service Research Working Group | Acute Care, Department of Internal Medicine, Faculty of Medicine, University Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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Rotthoff T. Practical tips to improve bedside teaching using learning theories and clinical reasoning. MEDEDPUBLISH 2024; 13:215. [PMID: 38707219 PMCID: PMC11069040 DOI: 10.12688/mep.19826.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 05/07/2024] Open
Abstract
Bedside teaching strengthens the link between theory and practice. The tips given here, which were derived from various learning theories and models, aim to provide structure to bedside teaching and to make this format effective, even though empirical evidence is still missing for this specific setting. These 10 tips may not always be fully implemented in each bedside teaching, but they should be applied selectively for targeted students. In essence, they are more to be understood as a repertoire of effective methods and are intended to expand the literature and framework concepts already available.
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Affiliation(s)
- Thomas Rotthoff
- Medical Didactics and Education Research (DEMEDA), Augsburg University, Augsburg, 86259, Germany
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