Creation and beta testing of a "choose your own adventure" digital simulation to reinforce motivational interviewing skills in genetic counseling

Standardized patients and/or role-playing are commonly used for practicing genetic counseling (GC) skills. Use of digital simulation, incorporating gamification elements, would require fewer resources to sustain than standardized patients. This manuscript reports steps taken and the lessons learned from creating a digital "Choose your own adventure" simulation in which students select preferred dialog for a genetic counselor who is seeing an adult patient to discuss genetic testing for the known pathogenic variant that caused familial adenomatous polyposis (FAP) in their father. The case has three endings, one of which is attained by selecting options that are mostly consistent with motivational interviewing counseling techniques. We conducted a preliminary evaluation of our beta version among nine GC students and one educator using a survey to assess acceptability and appropriateness as well as to elicit open-ended feedback. All participants agreed or strongly agreed with statements indicating the case was acceptable, appropriate, and fun. Users particularly appreciated the immediate feedback given throughout the case simulation. Many users wanted more options to select from and listed various other recommendations, including several which would require substantial resources to implement.

Ready Patient One: How to Turn an In-Person Critical Care Simulation Scenario Into an Online Serious Game

Introduction

Serious gaming has become popular in healthcare education as an engaging way to train learners. When coronavirus disease 2019 (COVID-19) forced the cancellation of in-person simulation sessions, we designed a serious game to deliver content in an interactive format with no out-of-pocket expense. We describe the design process and game reception so that others may replicate it.

Methods

We designed an online game using Choose-Your-Own-Adventure (CYOA) and Escape Room concepts. Using online survey software, we presented an interactive story based on an existing simulation scenario and included interactive puzzles as roadblocks to scenario progression. Each puzzle represented a critical care concept, and many contained hyperlinks to prior basic science lecture material to reinforce learning. A post-game survey assessed students’ experience.

Results

All (N=88) students enrolled in a scheduled simulation session participated in the game, and 75% (66/88) responded to a post-participation survey. All respondents (100%) were able to complete the game. The majority (57.6%) completed the game in 30 minutes to 1 hour. Most students strongly agreed or agreed that the game enhanced their understanding of critical care concepts (93.9-97.0%), and that they were interested in doing more CYOA games (90.9%).

Conclusion

The game was well-received, delivered critical care content, and challenged students to apply basic science principles to medical decision-making from the safety of their own homes. The game was self-guided, requiring minimal active facilitator involvement. We plan to expand the use of the game to other settings and explore its use in formative/summative assessment and remediation.

Online Module Builds Skills for Internal Medicine Interns in Responding to Emotions During Complex Serious Illness Conversations

CONTEXT

Responding to emotion cues is an essential skill for communicating with patients and families, but many health care trainees have difficulty applying this skill within the context of a complex conversation.

OBJECTIVES

We created an original online module to facilitate deliberate practice of a three-skill framework for responding to emotion cues during complex or nonlinear serious illness conversations.

METHODS

Our original online module uses a gamebook format, which prompts trainees to engage in focused and repetitive practice of three well-defined skills for responding to emotion cues in a simulated family conference. We implemented the module as a part of a communication skills curriculum for interns rotating in the intensive care unit. After completing the module, all interns answered an open-ended survey question about their perceived skill acquisition. Results were analyzed by a qualitative method and coded into themes.

RESULTS

About 71% of interns (n = 65 of 92) completed the online module and open-ended survey question. About 89% of participants responded that they would use a naming, understanding, respecting, supporting, or exploring statement in response to an emotion cue. Nearly two-thirds of participants articulated their rationale for using naming, understanding, respecting, supporting, or exploring statements (e.g., preparing patients to process complex medical information, eliciting information about patient perspective.) CONCLUSION: Our online emotion cue module is a novel tool for deliberate practice of advanced skills for responding to emotion cues in serious illness conversations. In future studies, we will investigate whether our module's efficacy is enhanced by using it as a part of a flipped classroom curriculum with an in-person simulation session.

Beyond silos: An interprofessional, campus-wide ethics education program

BACKGROUND

Ethics education is essential to the education of all healthcare professionals. The purpose of this study was to evaluate an interprofessional approach to ethics education to all students across an academic health science center.

RESEARCH OBJECTIVES

The objectives were to (1) compare student perception of ethics education before and after the implementation of the campus-wide ethics program and (2) determine changes in student ethical decision-making skills following implementation of a campus-wide ethics program.

RESEARCH DESIGN

This study was a quasi-experimental design with seniors graduating prior to the intervention serving as the control group.

PARTICIPANTS AND RESEARCH CONTEXT

The setting was a comprehensive health science center in the southwestern United States. All students enrolled in the university participated in the intervention; however, 976 graduating students were used for evaluation of the intervention.

ETHICAL CONSIDERATIONS

Study materials for each survey were submitted to the university's IRB, and the project was approved as exempt by the Committee for the Protection of Human Subjects. Student participation in the surveys was voluntary. No names or other identifying information were collected, and responses to the survey questions were kept confidential.

FINDINGS

Students' perception of the adequacy of time spent on the ethics content in course instruction and practical training decreased from the baseline to the fifth-year survey. Students' overall comfort level with their abilities to deal with ethical issues increased from the baseline to the fifth year. Student ethical decision-making skills were higher at the third-year evaluation for all indicators. For the fifth-year survey, responses were also higher scoring on all four indicators.

DISCUSSION

After participation in an interprofessional campus-wide effort on health professions ethics, students demonstrated higher ethical decision-making scores according to the Health Professional Ethics Rubric. However, their scores still did not reach the proficiency level identified in the rubric.

CONCLUSION

Examination of the effectiveness of each part of the intervention is needed.

Objectively measured interprofessional education outcome and factors that enhance program effectiveness: A systematic review

Several studies have been conducted to evaluate the implementation of interprofessional education (IPE) across the globe. By looking at the timeline of each previous study, it can be inferred that the implementation of IPE has been improving continuously. However, the effectiveness of IPE still cannot be easily generalized due to misconceptions regarding how interprofessional collaboration capabilities should be evaluated. This study aims to generalize the learning outcomes that were produced by IPE in a global context and analyse the contributing factors. A systematic review was conducted within seven online databases as well as paperback periodical publications to search for the intended articles. A set of four criterions were assigned prior to the study using the standard Population-Intervention-Context-Outcome (PICO) model to ensure the included articles matched the study objectives. The quality of studies were appraised using the Medical Education Research Study Quality Improvement (MERSQI). Each included article was analysed using the narrative method to obtain the relevant information. Sixteen articles included in this study showed that IPE improved interprofessional collaborative knowledge, skills, and behaviour based on objective measurements. Complexity of the learning material, appropriateness of the program design, and referral to a specific standard of competence were assumed to play significant role towards the effectiveness of interprofessional education. This study results in several recommendation for future development of IPE, including a specific suggestion for its development in Asia region.

A blended-learning programme regarding professional ethics in physiotherapy students

BACKGROUND

In the university context, assessing students' attitude, knowledge and opinions when applying an innovative methodological approach to teach professional ethics becomes fundamental to know if the used approach is enough motivating for students.

RESEARCH OBJECTIVE

To assess the effect of a blended-learning model, based on professional ethics and related to clinical practices, on physiotherapy students' attitude, knowledge and opinions towards learning professional ethics.

RESEARCH DESIGN AND PARTICIPANTS

A simple-blind clinical trial was performed (NLM identifier NCT03241693) (control group, n = 64; experimental group, n = 65). Both groups followed clinical practices for 8 months. Control group performed a public exposition of a clinical case about professional ethics. By contrast, an 8-month blended-learning programme regarding professional ethics was worked out for experimental group. An online syllabus and online activities were elaborated, while face-to-face active participation techniques were performed to discuss ethical issues. Students' attitudes, knowledge and opinions towards learning professional ethics were assessed.

ETHICAL CONSIDERATIONS

The study was approved by the University Ethic Committee of Human Research and followed the ethical principles according to the Declaration of Helsinki.

FINDINGS

After the programme, attitudes and knowledge towards learning professional ethics of experimental group students significantly improved, while no differences were observed in control group. Moreover, opinions reported an adequate extension of themes and temporization, importance of clinical practices and interest of topics. Case study method and role playing were considered as the most helpful techniques.

CONCLUSION

The blended-learning programme proposed, based on professional ethics and related to clinical practices, improves physiotherapy students' attitudes, knowledge and opinions towards learning professional ethics.

A Meta-analytic Comparison of Face-to-Face and Online Delivery in Ethics Instruction: The Case for a Hybrid Approach

Despite the growing body of literature on training in the responsible conduct of research, few studies have examined the effectiveness of delivery formats used in ethics courses (i.e., face-to-face, online, hybrid). The present effort sought to address this gap in the literature through a meta-analytic review of 66 empirical studies, representing 106 ethics courses and 10,069 participants. The frequency and effectiveness of 67 instructional and process-based content areas were also assessed for each delivery format. Process-based contents were best delivered face-to-face, whereas contents delivered online were most effective when restricted to compliance-based instructional contents. Overall, hybrid courses were found to be most effective, suggesting that ethics courses are best delivered using a blend of formats and content areas. Implications and recommendations for future development of ethics education courses in the sciences are discussed.

Curricular Approaches in Research Ethics Education: Reflecting on More and Less Effective Practices in Instructional Content

Over the past decade, the effectiveness of ethics education programs has increased with regard to trainee outcomes, such as knowledge, awareness, and ethical decision making. However, despite the overall improvement in training effectiveness, considerable variability still exists across programs. One potential source of variability arises from the substantial range in instructional training content utilized across ethics training courses. The goal of the present effort was to clarify which approaches in ethics education result in positive training outcomes through the identification of instructional content themes. Through a qualitative review of ethics training courses, we identified key themes in instructional content curriculum associated with effective courses: domain-general, domain-specific, standard compliance, professionalism, and process-based. In addition, we identified key themes associated with less effective courses: mixed-specificity, narrow coverage, and idealized ethics. Descriptions and key characteristics of each theme along with example courses are provided. Implications of the content themes for ethics education are discussed.

Validation and Use of a Predictive Modeling Tool: Employing Scientific Findings to Improve Responsible Conduct of Research Education

Although recent evidence suggests ethics education can be effective, the nature of specific training programs, and their effectiveness, varies considerably. Building on a recent path modeling effort, the present study developed and validated a predictive modeling tool for responsible conduct of research education. The predictive modeling tool allows users to enter ratings in relation to a given ethics training program and receive instantaneous evaluative information for course refinement. Validation work suggests the tool's predicted outcomes correlate strongly (r = 0.46) with objective course outcomes. Implications for training program development and refinement are discussed.

Are Ethics Training Programs Improving? A Meta-Analytic Review of Past and Present Ethics Instruction in the Sciences

Given the growing public concern and attention placed on cases of research misconduct, government agencies and research institutions have increased their efforts to develop and improve ethics education programs for scientists. The present study sought to assess the impact of these increased efforts by sampling empirical studies published since the year 2000. Studies published prior to 2000 examined in other meta-analytic work were also included to provide a baseline for assessing gains in ethics training effectiveness over time. In total,this quantitative review consisted of 66 empirical studies, 106 ethics courses, 150 effect sizes, and 10,069 training participants. Overall, the findings indicated that ethics instruction resulted in sizable benefits to participants and has improved considerably within the last decade. A number of specific findings also emerged regarding moderators of instructional effectiveness. Recommendations are discussed for improving the development, delivery, and evaluation of ethics instruction in the sciences.