Evidence-Based Principles for Using Technology-Enhanced Learning in the Continuing Professional Development of Health Professionals

Online palliative care education and mentorship in Nepal: Project ECHO - a novel approach to improving knowledge and self-efficacy among interprofessional health-care providers

BACKGROUND

Palliative care access in Nepal is severely limited, with few health-care providers having training and skills to pain management and other key aspects of palliative care. Online education suggests an innovation to increase access to training and mentoring, which addresses common learning barriers in low- and middle-income countries. Project ECHO (Extensions for Community Health Care Outcomes) is a model of online education which supports communities of practices (COPs) and mentoring through online teaching and case discussions. The use of online education and Project ECHO in Nepal has not been described or evaluated.

SETTING

An online course, consisting of 14 synchronous weekly palliative care training sessions was designed and delivered, using the Project ECHO format. Course participants included health-care professionals from a variety of disciplines and practice settings in Nepal.

OBJECTIVES

The goal of this study was to evaluate the impact of a virtual palliative care training program in Nepal on knowledge and attitudes of participants.

METHODS

Pre- and post-course surveys assessed participants' knowledge, comfort, and attitudes toward palliative care and evaluated program acceptability and barriers to learning.

RESULTS

Forty-two clinicians, including nurses (52%) and physicians (48%), participated in program surveys. Participants reported significant improvements in their knowledge and attitudes toward core palliative care domains. Most participants identified the program as a supportive COP, where they were able to share and learn from faculty and other participants.

CONCLUSION

Project ECHO is a model of online education which can successfully be implemented in Nepal, enhancing local palliative care capacity. Bringing together palliative care local and international clinical experts and teachers supports learning for participants through COP. Encouraging active participation from participants and ensuring that teaching addresses availability and practicality of treatments in the local health-care context addresses key barriers of online education.

SIGNIFICANCE OF RESULTS

This study describes a model of structured virtual learning program, which can be implemented in settings with limited access to palliative care to increase knowledge and attitudes toward palliative care. The program equips health-care providers to better address serious health-related suffering, improving the quality of life for patients and their caregivers. The program demonstrates a model of training which can be replicated to support health-care providers in rural and remote settings.

Impact of Bedside Laparotomy Simulation and Microlearning on Trauma Nurse Role Clarity, Knowledge, and Confidence

BACKGROUND

The care of patients undergoing low-volume, high-risk emergency procedures such as bedside laparotomy (BSL) remains a challenge for surgical trauma critical care nurses.

OBJECTIVES

This study evaluates simulation and microlearning on trauma nurse role ambiguity, knowledge, and confidence in caring for patients during emergency BSL.

METHODS

The study is a single-center, prospective pretest-posttest design conducted from September to November 2022 at a Level I trauma center in the Mid-Atlantic United States using simulation and microlearning to evaluate role clarity, knowledge, and confidence among surgical trauma intensive care unit (STICU) nurses. Participants, nurses from a voluntary convenience sample within a STICU, attended a simulation and received three weekly microlearning modules. Instruments measuring role ambiguity, knowledge, and confidence were administered before the simulation, after, and again at 30 days.

RESULTS

From the pretest to the initial posttest, the median (interquartile range [IQR]) Role Ambiguity scores increased by 1.0 (1.13) (p < .001), and at the 30-day posttest, improved by 1.33 (1.5) (p < .001). The median (IQR) knowledge scores at initial posttest improved by 4.0 (2.0) (p < .001) and at the 30-day posttest improved by 3.0 (1.75) (p< .001). The median (IQR) confidence scores at initial posttest increased by 0.08 (0.33) (p = .009) and at the 30-day posttest improved by 0.33 (0.54) (p = .01).

CONCLUSIONS

We found that simulation and microlearning improved trauma nurse role clarity, knowledge, and confidence in caring for patients undergoing emergency BSL.

Development of Web-Based Education Modules to Improve Carer Engagement in Cancer Care: Design and User Experience Evaluation of the e-Triadic Oncology (eTRIO) Modules for Clinicians, Patients, and Carers

BACKGROUND

Carers often assume key roles in cancer care. However, many carers report feeling disempowered and ill-equipped to support patients. Our group published evidence-based guidelines (the Triadic Oncology [TRIO] Guidelines) to improve oncology clinician engagement with carers and the management of challenging situations involving carers.

OBJECTIVE

To facilitate implementation of the TRIO Guidelines in clinical practice, we aimed to develop, iteratively refine, and conduct user testing of a suite of evidence-based and interactive web-based education modules for oncology clinicians (e-Triadic Oncology [eTRIO]), patients with cancer, and carers (eTRIO for Patients and Carers [eTRIO-pc]). These were designed to improve carer involvement, communication, and shared decision-making in the cancer management setting.

METHODS

The eTRIO education modules were based on extensive research, including systematic reviews, qualitative interviews, and consultation analyses. Guided by the person-based approach, module content and design were reviewed by an expert advisory group comprising academic and clinical experts (n=13) and consumers (n=5); content and design were continuously and iteratively refined. User experience testing (including "think-aloud" interviews and administration of the System Usability Scale [SUS]) of the modules was completed by additional clinicians (n=5), patients (n=3), and carers (n=3).

RESULTS

The final clinician module comprises 14 sections, requires approximately 1.5 to 2 hours to complete, and covers topics such as carer-inclusive communication and practices; supporting carer needs; and managing carer dominance, anger, and conflicting patient-carer wishes. The usability of the module was rated by 5 clinicians, with a mean SUS score of 75 (SD 5.3), which is interpreted as good. Clinicians often desired information in a concise format, divided into small "snackable" sections that could be easily recommenced if they were interrupted. The carer module features 11 sections; requires approximately 1.5 hours to complete; and includes topics such as the importance of carers, carer roles during consultations, and advocating for the patient. The patient module is an adaptation of the relevant carer module sections, comprising 7 sections and requiring 1 hour to complete. The average SUS score as rated by 6 patients and carers was 78 (SD 16.2), which is interpreted as good. Interactive activities, clinical vignette videos, and reflective learning exercises are incorporated into all modules. Patient and carer consumer advisers advocated for empathetic content and tone throughout their modules, with an easy-to-read and navigable module interface.

CONCLUSIONS

The eTRIO suite of modules were rigorously developed using a person-based design methodology to meet the unique information needs and learning requirements of clinicians, patients, and carers, with the goal of improving effective and supportive carer involvement in cancer consultations and cancer care.

Effect of digital based nursing intervention on knowledge of self-care behaviors and self-efficacy of adult clients with diabetes

BACKGROUND

In recent years, there has been growing interest in the use of Digital Based Nursing Intervention to support diabetes management. This study aimed to evaluate the effect of digital based nursing intervention on knowledge of self-care behaviors and self-efficacy of clients with diabetes.

METHODS

Employing a quasi-experimental design, a sample of 120 adult participants diagnosed with type 2 diabetes, aged more than 18 years with focus on older adults was drawn from outpatient clinics at Cairo University Hospital. The intervention was approved and registered by the ethical committee of the faculty of nursing with IRB number: RHDIRB2019041701. The intervention group (n = 60) received a digital-based nursing intervention, while the control group (n = 60) received standard care. Data were collected using adopted standardized tools including the Diabetes Knowledge Test, the Diabetes Self-Efficacy Scale, and the Summary of Diabetes Self-Care Activities. Demographic characteristics were analyzed, and pre- and post-intervention scores were compared using paired t-tests were statistical methods.

RESULTS

The digital-based nursing intervention resulted in significant enhancements in participants with diabetes knowledge and self-efficacy levels. Moreover, the intervention group demonstrated marked improvements in various self-care behaviors encompassing diet, exercise, medication adherence, blood glucose testing, and foot care. While the control group also exhibited some progress, the effects were less pronounced. Regression analyses highlighted age as a consistent factor associated with knowledge, self-efficacy, and specific self-care behaviors.

CONCLUSION

This study underscores the potential of tailored digital nursing interventions to complement traditional care approaches, empowering patients with type 2 diabetes to actively engage in self-management. The findings suggest that digital-based nursing interventions hold promise for enhancing patient knowledge, confidence, and proactive health behaviors. Nevertheless, limitations, including the relatively short intervention duration and a sample from a single clinic, warrant consideration. Future research should address these limitations to bolster the validity and applicability of the study's conclusions.

"Just-in-Time" COVID-19 Education: The Story of a Nursing Professional Development Unit

The pandemic jolted our healthcare professionals like none other in modern history. Though it was a crisis of unparalleled proportion, it brought out the best in the nursing professional development unit of a minority nurses association. In this article, the authors describe the journey of a professional development unit that empowered nurses with "just-in-time" education for knowledge and competence to manage the pandemic.

Simulation in a blended learning curriculum for neonatology

Blended learning is a learner-centered educational method that combines online and traditional face-to-face educational strategies. Simulation is a commonly utilized platform for experiential learning and an ideal component of a blended learning curriculum. This section describes blended learning, including its strengths and limitations, educational frameworks, uses within health professions education, best practices, and challenges. Also included is a brief introduction to simulation-based education, along with theoretical and real-world examples of how simulation may be integrated into a blended learning curriculum. Examples of blended learning in Neonatal-Perinatal Medicine, specifically within the Neonatal Resuscitation Program, procedural skills training, and the National Neonatology Curriculum, are reviewed.

Evaluation of the feasibility of a video-transmitted surgical ward round: a proof of concept study

BACKGROUND

Surgical ward rounds are key element to point-of-care interprofessional postoperative treatment and technical and communicational aspects are relevant for the patient's safety and satisfaction. Due to COVID-19 restrictions, the training opportunity of experiencing a face-to-face surgical ward round was massively hampered and thus, we developed a digital concept. This study aims to investigate the feasibility of video-transmitted ward rounds integrating surgical and communicational aspects with live streaming from wards. Further, medical students were asked for their satisfaction and their subjective learning success.

METHODS

The proof-of-concept study consisted of self-reported subjective evaluation of competences in ward round skills. Qualitative feedback was collected to gain deeper insight and students' empathy was rated by using the student version of the Jefferson Empathy Scale (JES).

RESULTS

One hundred three medical students participated. The students were satisfied with the video-transmitted ward round (M = 3.54; SD = 1.22). In the subjective evaluation students' ward round competencies rose significantly (p < .001, Mpre = 3.00, SD = 0.77; Mpost = 3.76, SD = 0.75). The surgeon was rated as empathic (M = 119.05; SD = 10.09). In the qualitative feedback they named helpful aspects like including an expert for communication. However, they preferred the face-to-face setting in comparison to the digital concept.

CONCLUSIONS

It was feasible to implement a video-transmitted ward round within a pandemic. The format worked technically, was well-accepted and also led to a subjective rise in the students' competencies. Video-transmitted ward rounds may be integrated to support the medical education, though, they cannot replace the face-to-face setting.

Adaptation of digital navigation training for integrated behavioral health providers: Interview and survey study

Despite effective treatment options, people who experience mental health conditions often do not receive needed care. E-mental health, for instance the use of mobile apps, is emerging as a way to increase access to and extend care. However, little formal training is available to increase the digital literacy level among behavioral healthcare providers (BHPs), seeking to employ such technology. The purpose of this study was to explore the acceptability and usability of an adapted in-person Digital Navigation Training (DNT) curriculum into e-Learning modules focused on the integrated environment for BHPs. BHP confidence to serve as digital navigators was also explored. E-Learning modules were adapted from an existing in-person DNT. A purposeful sampling strategy was used to recruit BHPs (n = 8) to complete the modules. Acceptability, usability, and confidence were assessed via survey and semi-structured interviews. Descriptive statistics were calculated for survey data and qualitative data were analyzed using a directed content analysis approach. BHPs who completed the training (n = 8) felt the modules were usable, enjoyed the structure, and felt the amount of time to complete the modules was acceptable. All participants thought the structure of the training worked well and enjoyed learning new information. While participants' confidence in their digital navigation skills increased, they desired more information and/or experience with screening apps prior to increasing their use of apps within their care. E-Learning modules were an acceptable method of educating BHPs with digital navigation skills. Future research is needed to explore incentives needed for training along with if participating in these modules can increase use of quality mobile apps to augment care within BHP treatment plans.

Evolution in Congenital Cardiology Education: The Rise of Digital-Learning Tools

Technology-enhanced learning is now an established part of medical education due to its ready availability and on-demand nature. This offers new opportunities but also challenges to both learners and teachers. This review outlines the current use of social media tools and online resources in medical education with a particular emphasis on congenital cardiology. It provides strategies to the reader on how to optimize learning in the digital environment and offers guidance on how such tools can be incorporated into routine educational practice. Suggestions for developing and assessing educational material online are discussed. Lastly, the concepts of digital professionalism and digital scholarship are explored to aid medical teachers and educators employ these technologies effectively into their teaching and career development.

Application of the electronic book to promote self-directed learning in medical technologist continuing education: a cross-sectional study

BACKGROUND

Continuing education (CE) is essential for health professionals to improve competence in clinical practice, yet many medical technologists still experience barriers to learning in complex clinical settings. To better manage CE and address medical technologists' learning needs, we developed a learner-centred electronic book (e-book) to promote self-directed learning for medical technologists.

METHODS

A cross-sectional study was conducted to explore the acceptability and learning impacts of the e-book as CE material for medical technologists in two medical centres in Taiwan. We designed the learner-centred context in the e-book based on medical technologists' practice requirements and learning needs. Moreover, we adopted The New World Kirkpatrick Model with four levels (reactions, learning, behaviours and results) to evaluate the e-book's learning impacts on medical technologists. A total of 280 medical technologists were invited to complete a questionnaire and a post-test, providing learning patterns as well as their satisfaction with the e-book and their learning outcomes after using it.

RESULTS

Most readers had positive learning experiences and better learning outcomes, including knowledge acquisition and behavioural change, after reading the e-book. The e-book became a new CE activity and reached medical technologists in various types of laboratories.

CONCLUSIONS

The low-cost and learner-centred e-book effectively overcame CE learning barriers for medical technologists. The interactivity and flexibility of e-learning particularly helped learners to engage in clinical scenarios in laboratory medicine. This study could pave the way for medical educators to build a high-quality e-learning model in CE.

Blended Learning in Health Care Education: An Overview and Overarching Meta-analysis of Systematic Reviews

INTRODUCTION

Blended learning is an educational approach that integrates face-to-face with online instruction. This overview of existing systematic reviews aims to evaluate the impact of blended learning on educational outcomes in health care professional education, identify gaps in the current evidence, and direction for future reviews.

METHODS

Five databases were searched (January 1, 2000 to January 14, 2021) for systematic reviews of blended versus nonblended learning approaches for health care education. "Flipped classroom", unpublished studies, abstracts, and study protocols were excluded. The extracted data included details of included reviews, description of populations, and outcomes according to Kirkpatrick levels. A narrative review is presented, along with an overarching meta-analysis, which evaluates a synthesized estimate of the effect of blended learning based on standardized mean differences.

RESULTS

Eleven systematic reviews were included, comprising of 160 primary studies (including 117 randomized controlled trials) from 56 countries with over 18,000 participants. The overall level of evidence was very low quality. An overarching meta-analysis of 93 studies addressing knowledge acquisition favored blended over nonblended learning methods (standardized mean difference 0.768 [95% confidence interval 0.594-0.941]; P < .001). None of the reviews identified an adverse effect on other educational outcomes.

DISCUSSION

Blended learning may be superior to traditional teaching approaches in improving knowledge acquisition. We recommend further research to describe the relative benefits of blended learning in each individual context and identify which elements of instructional design are beneficial for each outcome. Finally, we recommend the use of clear and consistent terminology in reported studies.

Data Analysis of Educational Evaluation Using K-Means Clustering Method

It is thought to be an effective technique to handle the problem of educational data explosion and lack of information by identifying potential relationships between data and directing decision-makers through the extraction, transformation, analysis, and modeling of educational data. Based on this, this research constructs a data analysis model for education evaluation using the K-means clustering technique in DM. The weight of each index of students' comprehensive quality is calculated using AHP, and the value of the weight is used to determine whether the index is the important feature of analysis system mining. Improved sampling technology is used to deal with the representation of large-scale data sets; a sample partition clustering technique is proposed as a general framework. The best accuracy of this method, according to experimental data, is 95.6 percent, which is 12.1 percent greater than Mi cluster algorithm and 6.8 percent higher than DRCluster algorithm. The K-means clustering analysis technology is used to analyze students' comprehensive evaluation data in this paper, with the goal of determining the regularity of data implication, accurately diagnosing learning problems, and providing the foundation for developing effective student management strategies.

Randomized Controlled Trial of Interactive Spaced Education to Support Constipation Management by Pediatric Primary Care Providers

INTRODUCTION

Integrating continuing medical education and quality improvement (QI) initiatives is challenging. We aimed to compare one method, Interactive Spaced Education (ISE/QI), with standard (sTD/Qi) education embedded within a constipation management Qi initiative.

METHODS

We conducted a randomized, controlled study to compare ISE/QI and STD/QI education. Pediatric primary care providers (PCPs) were recruited from a network of local private practices. The QI initiative was implemented with all providers before education interventions. ISE/QI participants received questions by email weekly, provided answers, received feedback, and repeated questions over a 4-month period. The STD/QI group received a Power Point with the same educational content. Pre- and post-surveys evaluated usability, self-assessed confidence, and practice changes while quizzes evaluated knowledge. Process control charts tracked subsequent visits to gastroenterology (GI).

RESULTS

Of the 212 eligible PCPs, 101 (48%) enrolled, with 49 PCPs in the ISE/QI arm and 52 in STD/QI education arm. Quiz scores improved in the ISE/QI arm with a strong effect size (Cohen d 1.76). Mean increase in confidence managing difficult cases was higher in the ISE/QI group (1.84 vs 1.21, P  = 0.030). ISE/QI participants were more likely to rate the activity better than most online education (odds ratio [OR] 18.1, P < 0.0001) and incorporate practice changes (OR 3.35, P = 0.0152). Visits to GI decreased among the entire population, but the effect on GI visits within each education arm was mixed.

CONCLUSIONS

ISE/QI improved knowledge and confidence managing difficult cases. ISE/QI participants reported higher likelihood to change practice, but no differences were seen in GI referrals.

Blended and e-learning in pediatric education: harnessing lessons learned from the COVID-19 pandemic

Face-to-face education as the traditional basis for medical education was disrupted by the COVID-19 pandemic as learners and educators were moved online with little time for preparation. Fortunately, as online learning has grown, together with medical education shifting to problem-based and team-centered learning over the last three decades, existing resources have been adapted and improved upon to meet the challenges. Effective blended learning has resulted in innovative synchronous and asynchronous learning platforms. Clearly, to do this well requires time, effort, and adjustment from clinicians, educators, and learners, but it should result in an engaging change in teaching practice. Its success will rely on an evaluation of learning outcomes, educator and learner satisfaction, and long-term retention of knowledge. It will be important to maintain ongoing assessment of all aspects of the medical education process, including how to best teach and assess theory, physiology, pathology, history-taking, physical examination, and clinical management.Conclusion: The COVID-19 pandemic triggered emergency transitional processes for teaching and assessment in medical education which built upon existing innovations in teaching medicine with the use of technology. These strategies will continue to evolve so as to provide the basis for an enduring hybrid teaching model involving blended and e-learning in medical education.. What is Known: • Most pediatricians provide clinical teaching to medical students and residents, but few have had formal training in online educational approaches and techniques. • Being able to adapt to new and innovative integrated teaching methods is of key importance when becoming a competent teacher. What is New: • This review presents an up-to-date summary of best practice in blended and e-learning and how it may be optimally delivered. • Knowledge of the principles of e-learning, and how people learn more generally, helps pediatricians shape their clinical teaching and facilitates better interaction with medical students and residents.

Improving breast cancer nurses' management of challenging situations involving family carers: Pilot evaluation of a brief targeted online education module (TRIO-Conflict)

OBJECTIVE

Given the stressful and emotional nature of cancer, challenging interactions between nurses, patients, and family frequently occur. Nurses are rarely equipped with strategies to avoid or de-escalate stressful situations with carers, which can include displays of conflict, anger, or dominance. A brief online education module (TRIO-Conflict) was developed to provide nurses with management strategies to use in situations of conflict. This study aimed to assess the feasibility, acceptability, and potential efficacy of TRIO-Conflict.

METHODS

Nurses were recruited through an Australian breast cancer organisation (McGrath Foundation). Participants completed pre/post module measures of attitudes towards carers, confidence in their skills to effectively navigate challenging interactions with carers, and applied knowledge of management strategies. Data were analysed using Wilcoxon signed-rank tests. Qualitative feedback was analysed using content analysis.

RESULTS

52 nurses completed pre-/post- measures, with 4 semi-structured interviews conducted. Significant improvements in attitudes towards carers (p = .010) and confidence in one's own ability to manage challenging interactions with carers (p < .001) were found, but not knowledge of strategies. Most nurses found TRIO-Conflict very/extremely helpful (87%) and were satisfied with content (94%) and usability (93%).

CONCLUSION

TRIO-Conflict utilised evidence-based learning techniques (provision of example phrases, video vignettes, reflective exercises) to improve nurses attitudes and confidence.

PRACTICE IMPLICATIONS

TRIO-Conflict is a brief, targeted, clinically relevant, and easily accessible online training programme which could be widely disseminated to oncology nurses.

Speech and Language Therapists' Perspectives of an E-Learning Course on Providing Feedback in the Clinical Learning Environment

BACKGROUND

A fundamental component of supervising a student speech and language therapist (SLT) on placement is the provision of feedback. There are numerous identified challenges to ensure the delivery of high-quality feedback to optimise student learning and student success. Supervisors can help overcome these challenges and engage in evidence-based feedback processes if they are supported to develop the necessary knowledge and skills. E-learning is one possible means to provide this professional development to a large number of practising SLTs who are geographically dispersed and have conflicting schedules.

AIMS

This study aimed to capture and evaluate the perspectives of SLTs who completed an e-learning course on providing feedback in the clinical learning environment, including the suitability and effectiveness of the e-learning tool used.

METHODS AND PROCEDURES

An innovative e-learning course was designed to provide asynchronous video and interactive content on evidence-based theories and practices for effective feedback processes. Clinical scenarios relevant to the discipline of speech and language therapy were included. Participants were invited to complete optional, anonymous pre- and post-evaluation surveys. Data were analysed quantitively (descriptive and inferential statistics) and qualitatively (thematic analysis).

OUTCOMES AND RESULTS

Participants indicated that the e-learning course supported them to enhance their feedback processes in the clinical learning environment through identified changes to their practices. The increases in confidence providing feedback they reported were statistically significant. In addition, the e-learning course was rated highly on numerous variables related to quality. Recommendations for adaptations and additions were also highlighted.

CONCLUSIONS AND IMPLICATIONS

An e-learning course on effective and evidence-based feedback processes provides an opportunity to provide professional development to a large number of geographically dispersed practitioners in a cost-effective and flexible way. This could ensure more SLTs are confident and competent in their role as supervisor of students, which requires distinct knowledge and skills from that of a practitioner. Ultimately, this will help maximise educator and student success in the feedback process and consequently improve clinical performance and healthcare delivery.

Digital Learning in Speech-Language Pathology, Phoniatrics, and Otolaryngology: Interdisciplinary and Exploratory Analysis of Content, Organizing Structures, and Formats

BACKGROUND

The digital revolution is rapidly transforming health care and clinical teaching and learning. Relative to other medical fields, the interdisciplinary fields of speech-language pathology (SLP), phoniatrics, and otolaryngology have been slower to take up digital tools for therapeutic, teaching, and learning purposes-a process that was recently expedited by the COVID-19 pandemic. Although many current teaching and learning tools have restricted or institution-only access, there are many openly accessible tools that have gone largely unexplored. To find, use, and evaluate such resources, it is important to be familiar with the structures, concepts, and formats of existing digital tools.

OBJECTIVE

This descriptive study aims to investigate digital learning tools and resources in SLP, phoniatrics, and otolaryngology. Differences in content, learning goals, and digital formats between academic-level learners and clinical-professional learners are explored.

METHODS

A systematic search of generic and academic search engines (eg, Google and PubMed); the App Store; Google Play Store; and websites of established SLP, phoniatrics, and otolaryngology organizations was conducted. By using specific search terms and detailed inclusion and exclusion criteria, relevant digital resources were identified. These were organized and analyzed according to learner groups, content matter, learning goals and architectures, and digital formats.

RESULTS

Within- and between-learner group differences among 125 identified tools were investigated. In terms of content, the largest proportion of tools for academic-level learners pertained to anatomy and physiology (60/214, 28%), and that for clinical-professional learners pertained to diagnostic evaluation (47/185, 25.4%). Between groups, the largest differences were observed for anatomy and physiology (academic-level learners: 60/86, 70%; clinical-professional learners: 26/86, 30%) and professional issues (8/28, 29% vs 20/28, 71%). With regard to learning goals, most tools for academic-level learners targeted the performance of procedural skills (50/98, 51%), and those for clinical-professional learners targeted receptive information acquisition (44/62, 71%). Academic-level learners had more tools for supporting higher-level learning goals than clinical-professional learners, specifically tools for performing procedural skills (50/66, 76% vs 16/66, 24%) and strategic skills (8/10, 80% vs 2/10, 20%). Visual formats (eg, pictures or diagrams) were dominant across both learner groups. The greatest between-group differences were observed for interactive formats (45/66, 68% vs 21/66, 32%).

CONCLUSIONS

This investigation provides initial insights into openly accessible tools across SLP, phoniatrics, and otolaryngology and their organizing structures. Digital tools in these fields addressed diverse content, although the tools for academic-level learners were greater in number, targeted higher-level learning goals, and had more interactive formats than those for clinical-professional learners. The crucial next steps include investigating the actual use of such tools in practice and students' and professionals' attitudes to better improve upon such tools and incorporate them into current and future learning milieus.

eTRIO trial: study protocol of a randomised controlled trial of online education modules to facilitate effective family caregiver involvement in oncology

OBJECTIVE

Informal family caregivers play a crucial role in cancer care. Effective caregiver involvement in cancer care can improve both patient and caregiver outcomes. Despite this, interventions improving the caregiver involvement are sparse. This protocol describes a randomised controlled trial evaluating the combined effectiveness of novel online caregiver communication education modules for: (1) oncology clinicians (eTRIO) and (2) patients with cancer and caregivers (eTRIO-pc).

METHODS AND ANALYSIS

Thirty medical/radiation/surgical oncology or haematology doctors and nurses will be randomly allocated to either intervention (eTRIO) or control (an Australian State Government Health website on caregivers) education conditions. Following completion of education, each clinician will recruit nine patient-caregiver pairs, who will be allocated to the same condition as their recruiting clinician. Eligibility includes any new adult patient diagnosed with any type/stage cancer attending consultations with a caregiver. Approximately 270 patient-caregiver pairs will be recruited. The primary outcome is caregiver self-efficacy in triadic (clinician-patient-caregiver) communication. Patient and clinician self-efficacy in triadic communication are secondary outcomes. Additional secondary outcomes for clinicians include preferences for caregiver involvement, perceived module usability/acceptability, analysis of module use, satisfaction with the module, knowledge of strategies and feedback interviews. Secondary outcomes for caregivers and patients include preferences for caregiver involvement, satisfaction with clinician communication, distress, quality of life, healthcare expenditure, perceived module usability/acceptability and analysis of module use. A subset of patients and caregivers will complete feedback interviews. Secondary outcomes for caregivers include preparedness for caregiving, patient-caregiver communication and caring experience. Assessments will be conducted at baseline, and 1 week, 12 weeks and 26 weeks post-intervention.

ETHICS AND DISSEMINATION

Ethical approval has been received by the Sydney Local Health District Human Research Ethics Committee (REGIS project ID number: 2019/PID09787), with site-specific approval from each recruitment site. Protocol V.7 (dated 1 September 2020) is currently approved and reported in this manuscript. Findings will be disseminated via presentations and peer-reviewed publications. Engagement with clinicians, media, government, consumers and peak cancer groups will facilitate widespread dissemination and long-term availability of the educational modules.

TRIAL REGISTRATION NUMBER

ACTRN12619001507178.

Pharmacists' knowledge, experiences and perceptions of treatments for attention-deficit/hyperactivity disorder

Background

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that begins in childhood and often persists into adulthood. ADHD increases the risk of various negative impacts, and pharmacists are well positioned to address these issues in the community.

Objectives

This survey study aims to first identify pharmacists' ADHD knowledge gaps and experience with ADHD management and to second assess their preferences for continuing education and their experience with sleep-related issues in ADHD.

Methods

A survey was sent to Part A Ontario pharmacists with active licenses who opted in to receive research-related emails (n = 6022). Descriptive statistics were used to analyze survey data, while free-form answers were pooled and evaluated for common themes and trends.

Results

A total of 238 complete responses were received. The average self-reported ADHD knowledge was 5.8 ± 1.96 on a 10-point scale. There was no correlation between the number of years of practice as a pharmacist, the number of working hours per week or the location of practice on pharmacists' self-reported knowledge scores. There was a significant difference in self-reported knowledge of ADHD between pharmacists who were not aware of the Canadian ADHD Resource Alliance (CADDRA) guidelines (5.1 ± 2.1) and those who refer to it for standard of care (7.1 ± 1.5). Almost all pharmacists (95%) indicated they could benefit from additional ADHD education, with a strong preference for "online continuing education modules" (81%). The majority of responders considered psychostimulant ADHD medication as the major possible contributor to sleep disturbances (47%) in ADHD, highlighting a need for further education on the inconclusive link between ADHD medication effects on sleep.

Conclusion

The study results raise the concern that pharmacists may require additional ADHD education but also show the lack of awareness of available resources, such as the CADDRA guidelines. Can Pharm J (Ott) 2021;154:xx-xx.

Speech-language therapists' perceptions of an eLearning program to support training in videofluoroscopic swallow studies

BACKGROUND

Speech-language therapists (SLTs) seek a range of educational opportunities for training in adult videofluoroscopic swallow studies (VFSS). However, variable training methods and/or unequal access to training can influence VFSS practice.

AIMS

To document current SLT needs and barriers to VFSS training and to determine if a new beginner-level VFSS eLearning program would assist to meet their training needs. The program incorporated multimedia modules on preparing, conducting, interpreting and reporting VFSS.

METHODS & PROCEDURES

SLTs with limited experience in adult VFSS completed surveys relating to VFSS training experience and barriers, and perceived changes in knowledge, skills and confidence on core VFSS module topics pre- (n = 36) and post- (n = 32) eLearning training.

OUTCOMES & RESULTS

Inconsistent access to VFSS training opportunities and time-related work pressures were reported as the greatest training barriers. SLTs viewed the eLearning program as a suitable option for VFSS training. Post-training, participants perceived they gained confidence, as well as improved knowledge and skills in all VFSS aspects along with generalised benefits for dysphagia management. SLTs indicated that key benefits of the eLearning program were its comprehensive content and self-directed learning with multimedia tools, which afforded theoretical and practical learning opportunities.

CONCLUSIONS & IMPLICATIONS

The eLearning program offered SLTs free access to beginner-level adult VFSS training, meeting many identified training needs and providing a foundation from which to develop further practical knowledge and skills within a VFSS clinic setting. What this paper adds What is already known on the subject SLTs demonstrate variable knowledge and skill in conducting and interpreting VFSS, which can impact dysphagia diagnosis and management. While access to VFSS training can be challenging, the barriers to training for SLTs have not been clearly documented. Research has confirmed that eLearning can be used effectively in healthcare education, and in some aspects of VFSS training; however, it is yet to be applied to address the broad range of VFSS training needs. What this paper adds to existing knowledge This study describes the SLT reported barriers to VFSS training which include limited access to formal and practical training, workload-related time pressures and the complexity of learning the VFSS skill set. The findings highlight that an eLearning program, was an accepted mode of learning for VFSS training. SLTs reported the online program met their learning needs by improving access to training, the multimedia program features supported their understanding of complex anatomical and physiological concepts, and training frameworks assisted their clinical reasoning and VFSS interpretation. What are the potential or actual clinical implications of this work? eLearning can assist in overcoming many VFSS training barriers identified by SLTs and the multimedia aspects of eLearning can effectively support VFSS beginner-level education to complement and expedite in-clinic practical training. Given that VFSS results inform decisions regarding commencement and progression of oral intake and swallow rehabilitation, enhanced VFSS training has the potential to positively influence dysphagia outcomes and quality of life.

A retrospective quantitative implementation evaluation of Safer Opioid Prescribing, a Canadian continuing education program

BACKGROUND

Continuing health professions education (CHPE) is an important policy intervention for the opioid epidemic. Besides effectiveness or impact, health policy implementation should be studied to understand how an intervention was delivered within complex environments. Implementation outcomes can be used to help interpret CHPE effects and impacts, help answer questions of "how" and "why" programs work, and inform transferability. We evaluated Safer Opioid Prescribing (SOP), a national CHPE program, using implementation outcomes of reach, dose, fidelity, and participant responsiveness.

METHODS

We conducted a retrospective quantitative implementation evaluation of the 2014-2017 cohorts of SOP. To measure reach and dose, we examined participation and completion data. We used Ontario physician demographic data, including regulatory status with respect to controlled substances, to examine relevant trends. To measure fidelity and participant responsiveness, we analyzed participant-provided evaluations of bias, active learning, and relevance to practice. We used descriptive statistics and measures of association for both continuous and categorical variables. We used logistic regression to determine predictors of workshop participation and analysis of covariance to examine variation in satisfaction across different-sized sessions.

RESULTS

Reach: In total, there were 472 unique participants, 84.0% of whom were family physicians. Among Ontario physician participants, 90.0% were family physicians with characteristics representative of province-wide demographics. Dose: Webinar completion rate was 86.2% with no differences in completion based on rurality, gender, or controlled substance prescribing status with medical regulatory authorities. Fidelity and participant responsiveness: Nearly all participants rated the three webinars and workshop as balanced, and each element of SOP was also rated as highly relevant to clinical practice.

CONCLUSIONS

This evaluation demonstrates that Safer Opioid Prescribing was implemented as intended. Over a short period and without any external funding, the program reached more than 1% of the Ontario physician workforce. This suggests that the program may be a good model for using virtual CHPE to reach a critical mass of prescribers. This study represents a methodological advance of adapting evaluation methods from health policy and complex interventions for continuing health professions education. Future studies will assess effectiveness and impact on opioid prescribing and utilization within evaluation models of complex interventions.

Speech-language pathology managers' perceptions of a videofluoroscopic swallow study eLearning programme to support training and service delivery

PURPOSE

Conducting and interpreting videofluoroscopic swallow studies (VFSS) is a complex, multi-dimensional task, requiring post-qualification training to develop knowledge, skill and competence. Speech-language pathology (SLP) managers must continually ensure staffs are adequately trained to deliver safe and effective VFSS services. However, VFSS training is resource intensive, variable in content and not consistently accessed universally. This study examined managers' perceptions of a new VFSS eLearning programme and its impact on VFSS training and service delivery. The eLearning programme incorporated theoretical and procedural aspects of VFSS, accessed free of charge by speech-language pathologists working in a large public health service in Queensland, Australia.

METHOD

Twenty-two SLP managers participated in semi-structured interviews, which were evaluated using inductive content analysis.

RESULT

Four themes were identified relating to eLearning benefits: (1) design and content facilitated widespread uptake, (2) enhanced training opportunities, (3) increased clinical skill and workforce capacity and (4) benefits and efficiencies for SLP services. A fifth theme described contextual considerations for using the programme.

CONCLUSION

This study contributes information about the benefits of eLearning for delivering consistent, accessible VFSS training, in a resource-efficient manner. Managers perceived the eLearning programme as a valuable resource to supplement practical VFSS training, to ultimately support VFSS service provision.

Continuing Professional Development Needs Amongst University of Toronto's Department of Radiation Oncology Faculty

Continuing professional development (CPD) and lifelong learning are core tenets of most healthcare disciplines. Where undergraduate coursework lays the foundation for entry into practice, CPD courses and offerings are designed to aid clinicians in maintaining these competencies. CPD offerings need to be frequently revised and updated to ensure their continued utility. The purpose of this qualitative study was to better understand the CPD needs of members of the University of Toronto's Department of Radiation Oncology (UTDRO) and determine how these needs could be generalized to other CPD programs. Given that UTDRO consists of members of various health disciplines (radiation therapist, medical physicists, radiation oncologists, etc.), eleven semi-structured interviews were conducted with various health professionals from UTDRO. Inductive thematic analysis using qualitative data processing with NVivo® was undertaken. The data was coded, sorted into categories, and subsequently reviewed for emergent themes. Participants noted that a general lack of awareness and lack of access made participation in CPD programs difficult. Members also noted that topics were often impractical, irrelevant, or not inclusive of different professions. Some participants did not feel motivated to engage in CPD offerings due to a general lack of time and lack of incentive. To address the deficiencies of CPD programs, a formal needs assessment that engages stakeholders from different centers and health professions is required. Needs assessments of CPD programs should include analyzing elements related to access, how to utilize technology-enhanced learning (TEL), determine barriers to participation, and understand how to better engage members.

RapidInfo4U ­– an online individualised COVID-19 support intervention for nursing and allied health professionals: study protocol

Background: The COVID-19 outbreak was declared a pandemic by the World Health Organization on March 11th, 2020. An ongoing challenge in healthcare is ensuring that up-to-date and high-quality research evidence is implemented in practice. In the context of a global pandemic it is assumed, given the increased pressures on healthcare professionals that this problem has the potential to be exacerbated. Furthermore, the COVID-19 pandemic resulted in many health professionals being reassigned to areas outside their usual scope, returning to practice following absence or commencing their career as new entrants in the midst of a major crisis. These professionals are likely to require additional support to assist their confidence and competence. Aims: This project has two broad aims: to design and deliver an online educational platform to support nursing and allied health professionals in their clinical practice throughout the pandemic and to evaluate that platform and its implementation. Methods: The research protocol for this study consists of two work streams: the development and delivery of the online platform; and the project evaluation. This research will have a mixed methods approach including website data analytics, quantitative surveys and qualitative data analysis of semi-structured interviews. Conclusion: Through knowledge brokering and adherence to principles of effective technology-enhanced-learning this project will provide an accessible, individualised online educational resource to effectively meet the needs of individual nurses and allied health professionals in this unprecedented time. The evaluation of the platform and its implementation will provide key learning for future initiatives and may act as proof-of-concept for other organisations and countries seeking to support healthcare professionals’ knowledge needs during similar future pandemics.

The development of an elearning program on the response and recognition of the deteriorating patient using self-study methodology

eLearning may be part of the solution to manage the ongoing training needs of nurses in Australian hospitals. A focus on addressing a knowledge gap in the recognition of and response to the deteriorating patient provided an opportunity to develop an eLearning program. Human factors education was incorporated as an innovative key feature in the eLearning program. A self-study methodological approach was applied to simultaneously research the development process and to integrate an evaluation of the resulting eLearning program. Critical friends were consulted during the planning and development of the eLearning program to ensure that the final program was engaging while also being successful in supporting learning. The resulting eLearning program was evaluated with a cohort of nurses who participated in pre and post test questionnaires and focus group discussions. Nurses reported that the inclusion of a realistic, interactive case study game as a learning device was valuable and resulted in self reflection about experiences in managing deteriorating patients. These findings suggest that eLearning programs can be successful in increasing nurses' confidence in managing the deteriorating patient, reading the track and trigger charts, applying human factors education, and may result in improved in patient outcomes.

Effectiveness of technology-enhanced learning to improve periodontics educational outcomes: A systematic review

OBJECTIVES

Technology-enhanced learning (TEL) has been suggested as a suitable learner-centered pedagogical approach in dental education. However, the results of TEL effectiveness in periodontics education are controversial. Therefore, this systematic review aimed to evaluate the effectiveness of TEL to improve educational outcomes in the periodontics field compared to traditional learning methods.

METHODS

The search comprised randomized controlled trials (RCTs) and crossover studies that were related to periodontics education from the following databases: MedLine, PsycINFO, Eric, Scopus, EMBASE, and Web of Science. Two authors independently performed study selection, data extraction, and assessed risk of bias. Kirkpatrick's 4-level evaluation model was used to evaluate educational outcomes.

RESULTS

From 1642 studies, after applying inclusion criteria, 7 studies remained for analysis. On level 1 (Reaction), undergraduate dental students reported positive attitudes related to TEL. On level 2 (Learning), 3 studies found that TEL improved knowledge gain compared to traditional learning methods. Three other studies did not show any difference between TEL and conventional learning methods, and one found that traditional learning methods presented superior results. On level 3 (Behavior), 1 study found that TEL application improved students' performance. On level 4 (Results), 5 studies suggested that the implementation of TEL would improve educational outcomes in periodontics education if combined with traditional learning methods.

CONCLUSION

The findings showed that the exclusive use of TEL does not significantly improve periodontics educational outcomes when compared to traditional learning methods. However, the combination of TEL and traditional learning methods can be the key to enhancing periodontics education.

Increasing cultural awareness: qualitative study of nurses' perceptions about cultural competence training

BACKGROUND

Nowadays, healthcare professionals worldwide deliver care for increasing numbers of culturally and linguistically diverse patients. The importance of cultural competence is evident in terms of the quality of healthcare, and more knowledge is needed about different educational models and approaches that aim to increase cultural competence. This study examines the perceptions of nurses about the content and utility of cultural competence training that focuses on increasing awareness of one's own cultural features.

METHODS

The training was conducted at one primary care hospital in southern Finland. Participants were registered nurses (n = 14) and practical nurses (n = 6) from different hospital units. Four 4-h training sessions-including lectures, discussions and short web-based learning tasks-were arranged during a four-week period. Semi-structured, small group interviews were conducted with 10 participants to examine their perceptions about the content and utility of the training. Qualitative content analysis with a conventional approach was used to analyse the data.

RESULTS

Perceptions about the training were divided into three main categories: general utility of the training, personal utility of the training, and utility of the training for patients. General utility pertains to the general approach that the training provided on cross-cultural care, the possibility to initiate an open discussion, and the opportunity to improve current practices. Personal utility pertains to the opportunity to become aware of one's own cultural features, to change one's way of thinking, to obtain a new perspective on one's own communication practices and to receive justification for carrying out particular workable practices. Utility for patients pertains to fostering better awareness and acknowledgement of patients' differing cultural features and an increased respect in healthcare delivery. Additionally, the quality of the training was highlighted, and suggestions for improvement were offered.

CONCLUSION

Training that increases healthcare professionals' awareness of their own cultural features was perceived as useful and thought-provoking. Increased awareness might facilitate the communication between healthcare professionals and patients, which is a crucial component of quality healthcare. It seems that in the future, training opportunities that allow larger groups to participate are needed, regardless of the time and place, and utilising the potential of e-learning should be considered.

The use of blended learning to improve health professionals' communication skills: a literature review

Background and aim of the work:

In recent years, health professionals’ education has moved towards the increasing use of blended learning. One of the most widespread blended formulas is the mix of face-to-face and online learning, which combines the advantages of distance learning, both in training provision and in training fruition, with the maintenance of socialization goals and application to practice activities. This literature review aims to find out whether blended-learning is employed for improving health professionals’ communication skills and which are its outcomes.

Methods:

Literature review of publications released from January 2000 to January 2019 was conducted across the academic databases Cinahl (EBSCO), Cochrane and Pubmed using relevant keywords.

Results:

Research has shown that blended learning is used in the education of different health professionals (students, nurses, physicians, etc.) at various stages of the educational path. The enhancement of communication skills appears to be a secondary learning objective in many studies, but it is shown to be nevertheless central to the proper acquisition and application of more clinical skills addressed by the blended courses. The blended modules here examined achieved their goals. However, the evaluation of the learning outcomes is still based on self-assessment, and thus needs to be implemented.

Conclusions:

Blended learning providers would need to pay more attention in the design and implementation phases of blended modules, assessing participants’ needs and offering more tailored and targeted programs, and should provide a more rigorous evaluation of learning outcomes. (www.actabiomedica.it)

Use of the Online Discussion Board in Health Professions Education: Contributions, Challenges, and Considerations

Online discussion boards offer opportunities for individualized and interactive learning in higher education and are frequently used in health professions education. This article investigates the ways in which discussion board activities foster cognitive and affective domain learning among health professions students and contribute to the professional competencies that are required of emerging clinicians. In addition, pedagogical challenges, including the need to develop sophisticated interpersonal affective domain skills, promote problem-based learning, and prepare students for standardized examinations, are addressed. Considerations for practice, which include the importance of specific teaching strategies such as the shaping of student and instructor roles, scaffolding, and online debates and role-playing, are discussed.

A novel 6D-approach to radically transform undergraduate medical education: preliminary reflections from MBRU

BACKGROUND

Designers of undergraduate medical education (UME) need to address the exponentially expanding volume and variability of scientific knowledge, where by didactic teaching techniques need to be augmented by innovative student-centric pedagogical strategies and implementation of milieus, where information, communication and technology-enabled tools are seamlessly integrated, and lifelong information gathering, assimilation, integration and implementation is the ultimate goal. In UME, the basic sciences provide a solid scaffold allowing students to develop their personal critical decisional framework as well as define the understanding of normal human physiology, pivotal for the identification, categorization and management of pathophysiology. However, most medical schools confine themselves to "stagnant curricula", with the implementation of traditional "teacher centered" pedagogical techniques in the dissemination of the courses pertaining to basic sciences in UME.

METHOD

To tackle the above paucity, we present a novel "6D-Approach" for the dissemination of concepts in basic sciences through mentored journal-clubs. The approach is informed by a teaching principle derived from Constructivism. The technique in which the 6D-approach can be implemented in UME, is shown using an example from a first-year course of Molecular Biology and Principles of Genetics at our medical school. A reflection on the impact of 6D-Approach for students as well as instructors is also presented.

RESULT

The 6D-approach was positively received by the students and the formal feedback for the course: Molecular Biology and Principles of Genetics, where the approach was repeatedly employed, indicated that students expressed satisfaction with the teaching strategies employed in the course, with ~ 89% of the students in the cohort strongly agreeing with the highest grading score "extremely satisfied". Further, the approach through the use of mentored journal clubs encourages retention of knowledge, critical thinking, metacognition, collaboration and leadership skills in addition to self-evaluation and peer feedback.

CONCLUSION

Hence, through the 6D-Approach, our attempt is to initiate, advance and facilitate critical thinking, problem-solving and self-learning in UME, demonstrated by graduating accomplished, competent and safe medical practitioners.