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Tremblay ML, Rethans JJ, Dolmans D. Task complexity and cognitive load in simulation-based education: A randomised trial. MEDICAL EDUCATION 2023; 57:161-169. [PMID: 36151727 DOI: 10.1111/medu.14941] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 09/12/2022] [Accepted: 09/21/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION When designing simulation for novices, educators aim to design tasks and environments that are complex enough to promote learning but not too complex to compromise task performance and cause cognitive overload. This study aimed to determine the impact of modulating task and environment complexity on novices' performance and cognitive load during simulation. METHODS Second-year pharmacy students (N = 162) were randomly assigned to one of four conditions (2 × 2 factorial design) in simulation: simple task in simple environment, complex task in simple environment, simple task in complex environment and complex task in complex environment. Using video recordings, two raters assessed students' performance during the simulation. We measured intrinsic cognitive load (ICL) and extraneous cognitive load (ECL) with questionnaires after the task and tested knowledge after task and debriefing. RESULTS Mean performance scores in simple environment were 28.2/32 (SD = 3.8) for simple task and 25.8/32 (SD = 4.2) for complex task. In complex environment, mean performance scores were 24.6/32 (SD = 5.2) for simple task and 25.6/32 (SD = 5.3) for complex task. We found significant interaction effects between task and environment complexity for performance. In simple environment, mean ICL scores were 4.2/10 (SD = 2.2) for simple task and 5.7/10 (SD = 1.5) for complex task. In complex environment, mean ICL scores were 4.9/10 (SD = 1.8) for simple task and 5.1/10 (SD = 1.9) for complex task. There was a main effect of task complexity on ICL. For ECL, we found neither an interaction effect nor main effects of task and environment complexity. There was a main effect of task complexity on knowledge test after task and main effects of both task and environment complexity on knowledge after debriefing. CONCLUSIONS Performance was good, and cognitive load remained reasonable in all conditions, which suggests that, despite increased complexity, students seemed to strategically manage their own cognitive load and learn from the simulations. Our findings also indicate that environmental complexity contributes to ICL.
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Affiliation(s)
| | - Jan-Joost Rethans
- School of Health Professions Education, Skillslab, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Diana Dolmans
- School of Health Professions Education, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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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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Harris KM, Sheppard G. The Big Bang: A Virtual Subarachnoid Hemorrhage Simulation for Preclinical Medical Students. Cureus 2021; 13:e14919. [PMID: 34123618 PMCID: PMC8186505 DOI: 10.7759/cureus.14919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Simulation-based learning is important for rare, high mortality cases, which are unlikely to be witnessed during clinical rotations but are likely to be encountered during future practice such as a subarachnoid hemorrhage. Neurology case simulations, especially those targeted at preclinical learners, are underrepresented in simulation pedagogy, and preclinical learners are underrepresented in a meta-analysis of the efficacy of simulation-based medical education. We designed a virtual simulation of subarachnoid hemorrhage for preclinical medical students, which can be implemented during restricted access to clinical learning. The simulation is 15 minutes long and requires only one standardized patient and one evaluator, which makes this simulation accessible to institutions with limited simulation resources. We adapted the validated questions from the "Simulation Evaluation Tool - Modified" for our post-simulation survey, which will detect the students' level of confidence and their perceived learning post-simulation. The analysis of student experiences using this validated tool will contribute to the literature base surrounding the efficacy of virtual simulation as a training tool for preclinical learners.
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Affiliation(s)
- Katie M Harris
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, CAN
| | - Gillian Sheppard
- Emergency Medicine, Memorial University of Newfoundland, St. John's, CAN
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Cardiopulmonary Bypass Video Is an Effective Learning Tool. Ochsner J 2020; 20:279-284. [PMID: 33071660 PMCID: PMC7529140 DOI: 10.31486/toj.19.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Surgical procedures require the collaboration of medical personnel with multiple skill sets who have different levels of training. Someone new to surgical procedures, such as a medical student, faces a steep learning curve. Studies have shown that video-assisted learning is associated with improved learning of surgical procedures. Methods: During their surgical rotation orientation, third-year medical students were invited via email to participate in a learning study featuring a cardiopulmonary bypass video. Study participants took a pretest, reviewed the locally developed video, and took a posttest and an attitudinal questionnaire after viewing the video. Results: A convenience sample of 31 third-year medical students participated in the study. Overall knowledge scores improved from pretest to posttest (36.9% vs 79.6%, P<0.001). In the posttest attitudinal questionnaire, students reported that they preferred video-assisted learning to reading written protocols (90.3% strongly agree/agree) and that they were more knowledgeable about the function of the cardiopulmonary bypass machine (80.7% strongly agree/agree) after viewing the video. Students also reported that the video would be useful during their surgical clerkships (90.4% strongly agree/agree). Conclusion: Video-assisted learning was associated with comprehension of the material immediately after viewing the video, and medical students considered it to be appropriate and useful. This educational video may benefit other learners who are entering the cardiopulmonary bypass operating room for the first time.
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Cleary TJ, Battista A, Konopasky A, Ramani D, Durning SJ, Artino AR. Effects of live and video simulation on clinical reasoning performance and reflection. Adv Simul (Lond) 2020; 5:17. [PMID: 32760598 PMCID: PMC7393892 DOI: 10.1186/s41077-020-00133-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/17/2020] [Indexed: 02/04/2023] Open
Abstract
Introduction In recent years, researchers have recognized the need to examine the relative effectiveness of different simulation approaches and the experiences of physicians operating within such environments. The current study experimentally examined the reflective judgments, cognitive processing, and clinical reasoning performance of physicians across live and video simulation environments. Methods Thirty-eight physicians were randomly assigned to a live scenario or video case condition. Both conditions encompassed two components: (a) patient encounter and (b) video reflection activity. Following the condition-specific patient encounter (i.e., live scenario or video), the participants completed a Post Encounter Form (PEF), microanalytic questions, and a mental effort question. Participants were then instructed to re-watch the video (i.e., video condition) or a video recording of their live patient encounter (i.e., live scenario) while thinking aloud about how they came to the diagnosis and management plan. Results Although significant differences did not emerge across all measures, physicians in the live scenario condition exhibited superior performance in clinical reasoning (i.e., PEF) and a distinct profile of reflective judgments and cognitive processing. Generally, the live condition participants focused more attention on aspects of the clinical reasoning process and demonstrated higher level cognitive processing than the video group. Conclusions The current study sheds light on the differential effects of live scenario and video simulation approaches. Physicians who engaged in live scenario simulations outperformed and showed a distinct pattern of cognitive reactions and judgments compared to physicians who practiced their clinical reasoning via video simulation. Additionally, the current study points to the potential advantages of video self-reflection following live scenarios while also shedding some light on the debate regarding whether video-guided reflection, specifically, is advantageous. The utility of context-specific, micro-level assessments that incorporate multiple methods as physicians complete different parts of clinical tasks is also discussed.
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Affiliation(s)
| | - Alexis Battista
- Center for Health Professions Education, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-4712 USA
| | - Abigail Konopasky
- Center for Health Professions Education, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-4712 USA
| | - Divya Ramani
- Center for Health Professions Education, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-4712 USA
| | - Steven J Durning
- Center for Health Professions Education, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-4712 USA
| | - Anthony R Artino
- Department of Health, Human Function, and Rehabilitation Sciences, The George Washington University School of Medicine and Health Sciences, Washington, USA
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Lacasse M, Audétat MC, Boileau É, Caire Fon N, Dufour MH, Laferrière MC, Lafleur A, La Rue È, Lee S, Nendaz M, Paquette Raynard E, Simard C, Steinert Y, Théorêt J. Interventions for undergraduate and postgraduate medical learners with academic difficulties: A BEME systematic review: BEME Guide No. 56. MEDICAL TEACHER 2019; 41:981-1001. [PMID: 31081426 DOI: 10.1080/0142159x.2019.1596239] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Background: Clinical teachers often struggle to report unsatisfactory trainee performance, partly because of a lack of evidence-based remediation options. Objectives: To identify interventions for undergraduate (UG) and postgraduate (PG) medical learners experiencing academic difficulties, link them to a theory-based framework and provide literature-based recommendations around their use. Methods: This systematic review searched MEDLINE, CINAHL, EMBASE, ERIC, Education Source and PsycINFO (1990-2016) combining these concepts: medical education, professional competence/difficulty and educational support. Original research/innovation reports describing intervention(s) for UG/PG medical learners with academic difficulties were included. Data extraction employed Michie's Behavior Change Techniques (BCT) Taxonomy and program evaluation models from Stufflebeam and Kirkpatrick. Quality appraisal used the Mixed Methods Appraisal Tool (MMAT). The authors synthesized extracted evidence by adapting the GRADE approach to formulate recommendations. Results: Sixty-eight articles met the inclusion criteria, most commonly addressing knowledge (66.2%), skills (53.9%) and attitudinal problems (26.2%), or learner personal issues (41.5%). The most common BCTs were Shaping knowledge, Feedback/monitoring, and Repetition/substitution. Quality appraisal was variable (MMAT 0-100%). A thematic content analysis identified 109 interventions (UG: n = 84, PG: n = 58), providing 24 strong, 48 moderate, 26 weak and 11 very weak recommendations. Conclusion: This review provides a repertoire of literature-based interventions for teaching/learning, faculty development, and research purposes.
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Affiliation(s)
- Miriam Lacasse
- Department of Family Medicine and Emergency Medicine, Université Laval , Quebec City , Canada
| | - Marie-Claude Audétat
- Department of Family Medicine and Emergency Medicine, Université de Montréal , Montreal , Canada
- Family Medicine Unit (UIGP), University of Geneva , Geneva , Switzerland
- Department of Family and Emergency Medicine, Université de Sherbrooke , Sherbrooke , Canada
| | | | - Nathalie Caire Fon
- Department of Family Medicine and Emergency Medicine, Université de Montréal , Montreal , Canada
| | - Marie-Hélène Dufour
- Department of Family Medicine and Emergency Medicine, Université Laval , Quebec City , Canada
| | | | | | - Ève La Rue
- Department of Family and Community Medicine, University of Toronto , Toronto , Canada
| | - Shirley Lee
- Unit of Development and Research (UDREM), University of Geneva , Geneva , Switzerland
- Canadian Medical Protective Association , Ottawa , Canada
| | - Mathieu Nendaz
- Family Medicine Unit (UIGP), University of Geneva , Geneva , Switzerland
- Department of Medicine, University Hospitals , Geneva , Switzerland
| | | | - Caroline Simard
- Department of Family Medicine and Emergency Medicine, Université Laval , Quebec City , Canada
| | - Yvonne Steinert
- Institute of Health Sciences Education, Faculty of Medicine, McGill University , Montreal , Canada
| | - Johanne Théorêt
- Department of Family Medicine and Emergency Medicine, Université Laval , Quebec City , Canada
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Schuelper N, Ludwig S, Anders S, Raupach T. The Impact of Medical Students' Individual Teaching Format Choice on the Learning Outcome Related to Clinical Reasoning. JMIR MEDICAL EDUCATION 2019; 5:e13386. [PMID: 31333193 PMCID: PMC6681636 DOI: 10.2196/13386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 04/02/2019] [Accepted: 05/16/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Repeated formative assessments using key feature questions have been shown to enhance clinical reasoning. Key feature questions augmented by videos presenting clinical vignettes may be more effective than text-based questions, especially in a setting where medical students are free to choose the format they would like to work with. This study investigated learning outcomes related to clinical reasoning in students using video- or text-based key feature questions according to their individual preferences. OBJECTIVE The aim of this study was to test the hypothesis that repeated exposure to video-based key feature questions enhances clinical reasoning to a greater extent than repeated exposure to text-based key feature questions if students are allowed to choose between those different formats on their own. METHODS In this monocentric, prospective, nonrandomized trial, fourth-year medical students attended 12 computer-based case seminars during which they worked on case histories containing key feature questions. Cases were available in a text- and a video-based format. Students chose their preferred presentation format at the beginning of each case seminar. Student performance in key feature questions was assessed in formative entry, exit, and retention exams and was analyzed with regard to preceding exposure to video- or text-based case histories. RESULTS Of 102 eligible students, 75 provided written consent and complete data at all study exams (response rate=73.5%). A majority of students (n=52) predominantly chose the text-based format. Compared with these, students preferring the video-based format achieved a nonsignificantly higher score in the exit exam (mean 76.2% [SD 12.6] vs 70.0% [SD 19.0]; P=.15) and a significantly higher score in the retention exam (mean 75.3% [SD 16.6] vs 63.4% [SD 20.3]; P=.02). The effect was independent of the video- or text-based presentation format, which was set as default in the respective exams. CONCLUSIONS Despite students' overall preference for text-based case histories, the learning outcome with regard to clinical reasoning was higher in students with higher exposure to video-based items. Time-on-task is one conceivable explanation for these effects as working with video-based items was more time-consuming. The baseline performance levels of students do not account for the results as the preceding summative exam results were comparable across the 2 groups. Given that a substantial number of students chose a presentation format that was less effective, students might need to be briefed about the beneficial effects of using video-based case histories to be able to make informed choices about their study methods.
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Affiliation(s)
- Nikolai Schuelper
- Department of Haematology and Medical Oncology, University Medical Centre Göttingen, Göttingen, Germany
| | - Sascha Ludwig
- Department of Anaesthesiology, University Medical Centre Göttingen, Göttingen, Germany
| | - Sven Anders
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Raupach
- Division of Medical Education Research and Curriculum Development, Study Deanery of University Medical Centre Göttingen, Göttingen, Germany
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Tremblay ML, Leppink J, Leclerc G, Rethans JJ, Dolmans DHJM. Simulation-based education for novices: complex learning tasks promote reflective practice. MEDICAL EDUCATION 2019; 53:380-389. [PMID: 30443970 DOI: 10.1111/medu.13748] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/31/2018] [Accepted: 09/07/2018] [Indexed: 05/08/2023]
Abstract
CONTEXT Simulated clinical immersion (SCI), in which clinical situations are simulated in a realistic environment, safely and gradually exposes novices to complex problems. Given their limited experience, undergraduate students can potentially be quite overwhelmed by SCI learning tasks, which may result in misleading learning outcomes. Although task complexity should be adapted to the learner's level of expertise, many factors, both intrinsic and extraneous to the learning task, can influence perceived task complexity and its impact on cognitive processes. OBJECTIVES The purpose of this mixed-methods study was to understand the effects of task complexity on undergraduate pharmacy students' cognitive load, task performance and perception of learning in SCI. METHODS A total of 167 second-year pharmacy students were randomly assigned to undertake one simple and one complex learning task in SCI consecutively. Participants' cognitive load was measured after each task and debriefing. Task performance and time on task were also assessed. As part of a sequential explanatory design, semi-structured interviews were conducted with students showing maximal variations in intrinsic cognitive load to elucidate their perceptions of learning when dealing with complexity. RESULTS Although the complex task generated significantly higher cognitive load and time on task than the simple task, performance was high for both tasks. Qualitative results revealed that a lack of clinical experience, an unfamiliar resource in the environment and the constraints inherent to SCI, such as time limitations, hindered the clinical reasoning process and led to poorer self-evaluation of performance. Simple tasks helped students gain more self-confidence, whereas complex tasks further encouraged reflective practice during debriefings. CONCLUSIONS Although complex tasks in SCI were more cognitively demanding and took longer to execute, students indicated that they learned more from them than they did from simple tasks. Complex tasks constitute an additional challenge in terms of clinical reasoning and thus provide a more valuable learning experience from the student's perspective.
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Affiliation(s)
| | - Jimmie Leppink
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Gilles Leclerc
- Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
| | - Jan-Joost Rethans
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Diana H J M Dolmans
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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Sharma M, Chris A, Chan A, Knox DC, Wilton J, McEwen O, Mishra S, Grace D, Rogers T, Bayoumi AM, Maxwell J, Shahin R, Bogoch I, Gilbert M, Tan DHS. Decentralizing the delivery of HIV pre-exposure prophylaxis (PrEP) through family physicians and sexual health clinic nurses: a dissemination and implementation study protocol. BMC Health Serv Res 2018; 18:513. [PMID: 29970087 PMCID: PMC6029110 DOI: 10.1186/s12913-018-3324-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 06/25/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Gay, bisexual and other men who have sex with men (gbMSM) in Canada continue to experience high rates of incident HIV. Pre-exposure prophylaxis (PrEP, the regular use of anti-HIV medication) reduces HIV acquisition and could reduce incidence. However, there are too few physicians with expertise in HIV care to meet the projected demand for PrEP. To meet demand and achieve greater public health impact, PrEP delivery could be 'decentralized' by incorporating it into front-line prevention services provided by family physicians (FPs) and sexual health clinic nurses. METHODS This PrEP decentralization project will use two strategies. The first is an innovative knowledge dissemination approach called 'Patient-Initiated CME' (PICME), which aims to empower individuals to connect their family doctors with online, evidence-based, continuing medical education (CME) on PrEP. After learning about the project through community agencies or social/sexual networking applications, gbMSM interested in PrEP will use a uniquely coded card to access an online information module that includes coaching on how to discuss their HIV risk with their FP. They can provide their physician a link to the accredited CME module using the same card. The second strategy involves a pilot implementation program, in which gbMSM who do not have a FP may bring the card to designated sexual health clinics where trained nurses can deliver PrEP under a medical directive. These approaches will be evaluated through quantitative and qualitative methods, including: questionnaires administered to patients and physicians at baseline and at six months; focus groups with patients, FPs, and sexual health clinic staff; and review of sexual health clinic charts. The primary objective is to quantify the uptake of PrEP achieved using each decentralization strategy. Secondary objectives include a) characterizing barriers and facilitators to PrEP uptake for each strategy, b) assessing fidelity to core components of PrEP delivery within each strategy, c) measuring patient-reported outcomes including satisfaction with clinician-patient relationships, and d) conducting a preliminary costing analysis. DISCUSSION This study will assess the feasibility of a novel strategy for disseminating knowledge about evidence-based clinical interventions, and inform future strategies for scale-up of an underutilized HIV prevention tool.
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Affiliation(s)
- Malika Sharma
- Division of Infectious Diseases, St. Michael’s Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Maple Leaf Medical Clinic, Toronto, Canada
| | | | - Arlene Chan
- Scarborough Sexual Health Clinic, Toronto, Canada
| | - David C. Knox
- Department of Medicine, University of Toronto, Toronto, Canada
| | | | - Owen McEwen
- Gay Men’s Sexual Health Alliance, Toronto, Canada
| | - Sharmistha Mishra
- Division of Infectious Diseases, St. Michael’s Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Center for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Tim Rogers
- Canadian Treatment Information Exchange (CATIE), Toronto, Canada
| | - Ahmed M. Bayoumi
- Department of Medicine, University of Toronto, Toronto, Canada
- Center for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Division of General Internal Medicine, St. Michael’s Hospital, Toronto, Canada
| | | | | | - Isaac Bogoch
- Department of Medicine, University of Toronto, Toronto, Canada
- Division of Infectious Diseases, University Health Network, Toronto, Canada
| | - Mark Gilbert
- British Columbia Center for Disease Control, Vancouver, Canada
| | - Darrell H. S. Tan
- Division of Infectious Diseases, St. Michael’s Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Center for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Division of Infectious Diseases, University Health Network, Toronto, Canada
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10
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Haji FA, Cheung JJH, Woods N, Regehr G, de Ribaupierre S, Dubrowski A. Thrive or overload? The effect of task complexity on novices' simulation-based learning. MEDICAL EDUCATION 2016; 50:955-68. [PMID: 27562895 DOI: 10.1111/medu.13086] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 07/30/2015] [Accepted: 03/21/2016] [Indexed: 05/08/2023]
Abstract
CONTEXT Fidelity is widely viewed as an important element of simulation instructional design based on its purported relationship with transfer of learning. However, higher levels of fidelity may increase task complexity to a point at which novices' cognitive resources become overloaded. OBJECTIVES In this experiment, we investigate the effects of variations in task complexity on novices' cognitive load and learning during simulation-based procedural skills training. METHODS Thirty-eight medical students were randomly assigned to simulation training on a simple or complex lumbar puncture (LP) task. Participants completed four practice trials on this task (skill acquisition). After 10 days of rest, all participants completed one additional trial on their assigned task (retention) and one trial on a 'very complex' simulation designed to be similar to the complex task (transfer). We assessed LP performance and cognitive load on each trial using multiple measures. RESULTS In both groups, LP performance improved significantly during skill acquisition (p ≤ 0.047, f = 0.29-0.96) and was maintained at retention. The simple task group demonstrated superior performance compared with the complex task group throughout these phases (p ≤ 0.002, d = 1.13-2.31). Cognitive load declined significantly in the simple task group (p < 0.009, f = 0.48-0.76), but not in the complex task group during skill acquisition, and remained lower at retention (p ≤ 0.024, d = 0.78-1.39). Between retention and transfer, LP performance declined and cognitive load increased in the simple task group, whereas both remained stable in the complex task group. At transfer, no group differences were observed in LP performance and cognitive load, except that the simple task group made significantly fewer breaches of sterility (p = 0.023, d = 0.80). CONCLUSIONS Reduced task complexity was associated with superior LP performance and lower cognitive load during skill acquisition and retention, but mixed results on transfer to a more complex task. These results indicate that task complexity is an important factor that may mediate (via cognitive overload) the relationship between instructional design elements (e.g. fidelity) and simulation-based learning outcomes.
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Affiliation(s)
- Faizal A Haji
- Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- SickKids Learning Institute, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Clinical Neurological Sciences, Faculty of Medicine, Western University, London, Ontario, Canada
| | - Jeffrey J H Cheung
- Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- SickKids Learning Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nicole Woods
- Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Glenn Regehr
- Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sandrine de Ribaupierre
- Division of Clinical Neurological Sciences, Faculty of Medicine, Western University, London, Ontario, Canada
| | - Adam Dubrowski
- Division of Emergency Medicine, Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland, Canada
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Haji FA, Khan R, Regehr G, Ng G, de Ribaupierre S, Dubrowski A. Operationalising elaboration theory for simulation instruction design: a Delphi study. MEDICAL EDUCATION 2015; 49:576-588. [PMID: 25989406 DOI: 10.1111/medu.12726] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 12/02/2014] [Accepted: 01/27/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The aim of this study was to assess the feasibility of incorporating the Delphi process within the simplifying conditions method (SCM) described in elaboration theory (ET) to identify conditions impacting the complexity of procedural skills for novice learners. METHODS We generated an initial list of conditions impacting the complexity of lumbar puncture (LP) from key informant interviews (n = 5) and a literature review. Eighteen clinician-educators from six different medical specialties were subsequently recruited as expert panellists. Over three Delphi rounds, these panellists rated: (i) their agreement with the inclusion of the simple version of the conditions in a representative ('epitome') training scenario, and (ii) how much the inverse (complex) version increases LP complexity for a novice. Cronbach's α-values were used to assess inter-rater agreement. RESULTS All panellists completed Rounds 1 and 2 of the survey and 17 completed Round 3. In Round 1, Cronbach's α-values were 0.89 and 0.94 for conditions that simplify and increase LP complexity, respectively; both values increased to 0.98 in Rounds 2 and 3. With the exception of 'high CSF (cerebral spinal fluid) pressure', panellists agreed with the inclusion of all conditions in the simplest (epitome) training scenario. Panellists rated patient movement, spinal anatomy, patient cooperativeness, body habitus, and the presence or absence of an experienced assistant as having the greatest impact on the complexity of LP. CONCLUSIONS This study demonstrated the feasibility of using expert consensus to establish conditions impacting the complexity of procedural skills, and the benefits of incorporating the Delphi method into the SCM. These data can be used to develop and sequence simulation scenarios in a progressively challenging manner. If the theorised learning gains associated with ET are realised, the methods described in this study may be applied to the design of simulation training for other procedural and non-procedural skills, thereby advancing the agenda of theoretically based instruction design in health care simulation.
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Affiliation(s)
- Faizal A Haji
- Wilson Centre, University of Toronto, Toronto, Ontario, Canada
- SickKids Learning Institute, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | - Rabia Khan
- Wilson Centre, University of Toronto, Toronto, Ontario, Canada
| | - Glenn Regehr
- Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gary Ng
- Faculty of Business and Information Technology, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
| | | | - Adam Dubrowski
- Division of Emergency Medicine, Memorial University, St John's, Newfoundland, Canada
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Hemmer PA, Dong T, Durning SJ, Pangaro LN. Novel Examination for Evaluating Medical Student Clinical Reasoning: Reliability and Association With Patients Seen. Mil Med 2015; 180:79-87. [DOI: 10.7205/milmed-d-14-00576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
ABSTRACT
Background: Medical students learn clinical reasoning, in part, through patient care. Although the numbers of patients seen is associated with knowledge examination scores, studies have not demonstrated an association between patient problems and an assessment of clinical reasoning. Aim: To examine the reliability of a clinical reasoning examination and investigate whether there was association between internal medicine core clerkship students' performance on this examination and the number of patients they saw with matching problems during their internal medicine clerkship. Methods: Students on the core internal medicine clerkship at the Uniformed Services University students log 11 core patient problems based on the Clerkship Directors in Internal Medicine curriculum. On a final clerkship examination (Multistep), students watch a scripted video encounter between physician and patient actors that assesses three sequential steps in clinical reasoning: Step One focuses on history and physical examination; Step Two, students write a problem list after viewing additional clinical findings; Step Three, students complete a prioritized differential diagnosis and treatment plan. Each Multistep examination has three different cases. For graduating classes 2010–2012 (n = 497), we matched the number of patients seen with the problem most represented by the Multistep cases (epigastric pain, generalized edema, monoarticular arthritis, angina, syncope, pleuritic chest pain). We report two-way Pearson correlations between the number of patients students reported with similar problems and the student's percent score on: Step One, Step Two, Step Three, and Overall Test. Results: Multistep reliability: Step 1, 0.6 to 0.8; Step 2, 0.41 to 0.65; Step 3, 0.53 to 0.78; Overall examination (3 cases): 0.74 to 0.83. For three problems, the number of patients seen had small to modest correlations with the Multistep Examination of Analytic Ability total score (r = 0.27 for pleuritic pain, p < 0.05, n = 81 patients; r = 0.14 for epigastric pain, p < 0.05, n = 324 patients; r = 0.19 for generalized edema, p < 0.05, n = 118 patients). Discussion or Conclusion: Although a reliable assessment, student performance on a clinical reasoning examination was weakly associated with the numbers of patients seen with similar problems. This may be as a result of transfer of knowledge between clinical and examination settings, the complexity of clinical reasoning, or the limits of reliability with patient logs and the Multistep.
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Affiliation(s)
- Paul A. Hemmer
- Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Ting Dong
- Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Steven J. Durning
- Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Louis N. Pangaro
- Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
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13
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Durning SJ, Dong T, LaRochelle JL, Artino AR, Gilliland WR, DeZee KJ, Saguil A, Cruess DF, Picho K, McManigle JE. The Long-Term Career Outcome Study: Lessons Learned and Implications for Educational Practice. Mil Med 2015; 180:164-70. [PMID: 25850148 DOI: 10.7205/milmed-d-14-00574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
ABSTRACT
The work of the Long-Term Career Outcome Study has been a program of scholarship spanning 10 years. Borrowing from established quality assurance literature, the Long-Term Career Outcome Study team has organized its scholarship into three phases; before medical school, during medical school, and after medical school. The purpose of this commentary is to address two fundamental questions: (1) what has been learned? and (2) how does this knowledge translate to educational practice and policy now and into the future? We believe that answers to these questions are relevant not only to our institution but also to other educational institutions seeking to provide high-quality health professions education.
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Affiliation(s)
- Steven J. Durning
- Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Ting Dong
- Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Jeffrey L. LaRochelle
- Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Anthony R. Artino
- Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - William R. Gilliland
- Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Kent J. DeZee
- Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Aaron Saguil
- Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - David F. Cruess
- Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Katherine Picho
- Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - John E. McManigle
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
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14
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Chen R, Grierson LE, Norman GR. Evaluating the impact of high- and low-fidelity instruction in the development of auscultation skills. MEDICAL EDUCATION 2015; 49:276-85. [PMID: 25693987 DOI: 10.1111/medu.12653] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 08/07/2014] [Accepted: 10/28/2014] [Indexed: 05/25/2023]
Abstract
CONTEXT A principal justification for the use of high-fidelity (HF) simulation is that, because it is closer to reality, students will be more motivated to learn and, consequently, will be better able to transfer their learning to real patients. However, the increased authenticity is accompanied by greater complexity, which may reduce learning, and variability in the presentation of a condition on an HF simulator is typically restricted. OBJECTIVES This study was conducted to explore the effectiveness of HF and low-fidelity (LF) simulation for learning within the clinical education and practice domains of cardiac and respiratory auscultation and physical assessment skills. METHODS Senior-level nursing students were randomised to HF and LF instruction groups or to a control group. Primary outcome measures included LF (digital sounds on a computer) and HF (human patient simulator) auscultation tests of cardiac and respiratory sounds, as well as observer-rated performances in simulated clinical scenarios. RESULTS On the LF auscultation test, the LF group consistently demonstrated performance comparable or superior to that of the HF group, and both were superior to the performance of the control group. For both HF outcome measures, there was no significant difference in performance between the HF and LF instruction groups. CONCLUSIONS The results from this study suggest that highly contextualised learning environments may not be uniformly advantageous for instruction and may lead to ineffective learning by increasing extraneous cognitive load in novice learners.
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Affiliation(s)
- Ruth Chen
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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15
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Chen R, Dore K, Grierson LEM, Hatala R, Norman G. Cognitive Load Theory: Implications for Nursing Education and Research. Can J Nurs Res 2014; 46:28-41. [PMID: 29509499 DOI: 10.1177/084456211404600204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This article provides an overview of cognitive load theory (CLT) and explores applications of CLT to health profession and nursing education research, particularly for multimedia and simulation-based applications. The article first reviews the 3 components of cognitive load: intrinsic, extraneous, and germane. It then discusses strategies for manipulating cognitive load variables to enhance instruction. Examples of how CLT variables can be modulated during instruction are provided. Lastly, the article discusses current applications of CLT to health profession and nursing education research and presents future research directions, focusing on the areas of multimedia and simulation-based learning.
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Affiliation(s)
- Ruth Chen
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Kelly Dore
- Department of Medicine and Program for Educational Research and Development, McMaster University
| | - Lawrence E M Grierson
- Department of Family Medicine and Program for Educational Research and Development, McMaster University
| | - Rose Hatala
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Geoffrey Norman
- Department of Clinical Epidemiology and Biostatistics and Program for Educational Research and Development, McMaster University
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