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Huon JF, Nizet P, Tollec S, Vene E, Fronteau C, Leichnam A, Tching-Sin M, Michelet-Barbotin V, Foucault-Fruchard L, Nativel F. A systematic review of the impact of simulation on students' confidence in performing clinical pharmacy activities. Int J Clin Pharm 2024; 46:795-810. [PMID: 38632204 DOI: 10.1007/s11096-024-01715-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/13/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Although confidence does not automatically imply competence, it does provide pharmacy students with a sense of empowerment to manage a pharmacotherapeutic problem independently. Among the methods used in higher education, there is growing interest in simulation. AIM To evaluate the impact of simulation on pharmacy students' confidence in performing clinical pharmacy activities. METHOD Articles that reported the use of simulation among pharmacy students with fully described outcomes about confidence were included. Studies for which it was impossible to extract data specific to pharmacy students or simulation were excluded. The search was carried out in Medline, Embase, Lissa and PsycInfo from inception to August the 31th, 2022. The results were synthesized into 4 parts: confidence in collecting information, being an expert in a procedure/pathology, counselling and communicating, and other results. The quality assessment of included studies was conducted using the Mixed Methods Appraisal Tool "MMAT" tool. RESULTS Among the 39 included articles, the majority were published in the last 5 years and conducted in the United States. The majority included pharmacy students in years 1 through 3 (69.2%). The most common study design was the pre-post uncontrolled design (66.7%). Studies measuring the effects of human and/or virtual simulation were mainly focused on confidence to counsel and/or communicate with patients and colleagues (n = 20). Evaluations of the effects of these types of simulation on confidence in information gathering by health professionals were also well represented (n = 16). CONCLUSION Simulation-based training generally yielded positive impact on improving pharmacy students' confidence in performing clinical pharmacy activities. Rigorous assessment methods and validated confidence questionnaires should be developed for future studies.
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Affiliation(s)
- Jean-François Huon
- Nantes Université, CHU Nantes, Pharmacie, 5 allée de l'île Gloriette, 44000, Nantes, France.
- Réseau HUGOPharm : réseau des pharmacies hospitalieres des Hopitaux Universitaires du grand ouest, Nantes, France.
| | - Pierre Nizet
- Nantes Université, CHU Nantes, Pharmacie, 5 allée de l'île Gloriette, 44000, Nantes, France
- Réseau HUGOPharm : réseau des pharmacies hospitalieres des Hopitaux Universitaires du grand ouest, Nantes, France
| | - Sophie Tollec
- Réseau HUGOPharm : réseau des pharmacies hospitalieres des Hopitaux Universitaires du grand ouest, Nantes, France
- CHU Orléans, Orléans, France
| | - Elise Vene
- Réseau HUGOPharm : réseau des pharmacies hospitalieres des Hopitaux Universitaires du grand ouest, Nantes, France
- CHU Rennes, Rennes, France
| | - Clémentine Fronteau
- Nantes Université, CHU Nantes, Pharmacie, 5 allée de l'île Gloriette, 44000, Nantes, France
- Réseau HUGOPharm : réseau des pharmacies hospitalieres des Hopitaux Universitaires du grand ouest, Nantes, France
| | - Alison Leichnam
- Nantes Université, CHU Nantes, Pharmacie, 5 allée de l'île Gloriette, 44000, Nantes, France
- Réseau HUGOPharm : réseau des pharmacies hospitalieres des Hopitaux Universitaires du grand ouest, Nantes, France
| | - Martine Tching-Sin
- Nantes Université, CHU Nantes, Pharmacie, 5 allée de l'île Gloriette, 44000, Nantes, France
- Réseau HUGOPharm : réseau des pharmacies hospitalieres des Hopitaux Universitaires du grand ouest, Nantes, France
| | - Vanessa Michelet-Barbotin
- Réseau HUGOPharm : réseau des pharmacies hospitalieres des Hopitaux Universitaires du grand ouest, Nantes, France
- CHU Rennes, Rennes, France
| | - Laura Foucault-Fruchard
- Réseau HUGOPharm : réseau des pharmacies hospitalieres des Hopitaux Universitaires du grand ouest, Nantes, France
- CHU Tours, Service Pharmacie, Tours, France
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - Fabien Nativel
- Nantes Université, Oniris, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, UMR 1229, 44000, Nantes, France
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Eriksen T, Gögenur I. Interprofessional clinical reasoning education. Diagnosis (Berl) 2024; 0:dx-2024-0059. [PMID: 38963081 DOI: 10.1515/dx-2024-0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 06/13/2024] [Indexed: 07/05/2024]
Abstract
Clinical reasoning is considered one of the most important competencies but is not included in most healthcare curricula. The number and diversity of patient encounters are the decisive factors in the development of clinical reasoning competence. Physical real patient encounters are considered optimal, but virtual patient cases also promote clinical reasoning. A high-volume, low-fidelity virtual patient library thus can support clinical reasoning training in a safe environment and can be tailored to the needs of learners from different health care professions. It may also stimulate interprofessional understanding and team shared decisions. Implementation will be challenged by tradition, the lack of educator competence and prior experience as well as the high-density curricula at medical and veterinary schools and will need explicit address from curriculum managers and education leads.
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Affiliation(s)
- Thomas Eriksen
- Department of Veterinary Clinical Sciences, University of Copenhagen, University Hospital for Companion Animals, Frederiksberg C, Denmark
| | - Ismaïl Gögenur
- Department of Surgery, Center for Surgical Science, Zealand University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Araújo B, Gomes SF, Ribeiro L. Critical thinking pedagogical practices in medical education: a systematic review. Front Med (Lausanne) 2024; 11:1358444. [PMID: 38947238 PMCID: PMC11211358 DOI: 10.3389/fmed.2024.1358444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/20/2024] [Indexed: 07/02/2024] Open
Abstract
Introduction The development of critical thinking (CT) has been a universal goal in higher education. A systematic review of the literature was conducted to evaluate the effectiveness of currently used pedagogical practices to foster CT/ clinical reasoning (CR)/ clinical judgment (CJ) skills and/or dispositions in undergraduate medical students. Methods PubMed, Web of Science and Scopus databases were searched from January 2010 to April 2021 with a predefined Boolean expression. Results Of the 3221 articles originally identified, 33 articles were included by using PICOS methodology. From these, 21 (64%) reported CR pedagogical practices and 12 (36%) CT pedagogical practices. Discussion Overall, pedagogical practices such as cognitive/visual representation, simulation, literature exposure, test-enhancing and team-based learning, clinical case discussion, error-based learning, game-based learning seem to enhance CT/CR skills and/or dispositions. Further research is required to identify the optimal timing, duration and modality of pedagogical interventions for effectively foster CT/CR in medical education.
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Affiliation(s)
- Beatriz Araújo
- Department of Public Health and Forensic Sciences, and Medical Education, Medical Education Unit, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Sandra F. Gomes
- Department of Public Health and Forensic Sciences, and Medical Education, Medical Education Unit, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Laura Ribeiro
- Department of Public Health and Forensic Sciences, and Medical Education, Medical Education Unit, Faculty of Medicine of the University of Porto, Porto, Portugal
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
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Albahari D. Learning Clinical Reasoning: The Experience of Postgraduate Psychiatry Trainee Doctors in Qatar. TEACHING AND LEARNING IN MEDICINE 2024; 36:323-336. [PMID: 37154482 DOI: 10.1080/10401334.2023.2209076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 04/10/2023] [Indexed: 05/10/2023]
Abstract
Phenomenon: As a core competency in medical education, clinical reasoning is a pillar for reducing medical errors and promoting patient safety. Clinical reasoning is a complex phenomenon studied through the lens of multiple theories. Although cognitive psychology theories transformed our understanding of clinical reasoning, the theories fell short of explaining the variations in clinical reasoning influenced by contextual factors. Social cognitive theories propose a dynamic relationship between learners' cognitive process and their social and physical environments. This dynamic relationship highlights the essential role of formal and informal learning environments for learning clinical reasoning. Approach: My research aimed to explore the personal experience of learning clinical reasoning in a sample of postgraduate psychiatry trainee doctors using cognitive psychology and social cognitive theories. A stratified convenience sample of seven psychiatry trainee doctors working in the Mental Health Services in Qatar completed semi-structured interviews in 2020. I analyzed the data manually using theoretical thematic analysis. Findings: I identified three overarching themes with multiple subthemes. The first theme was the hierarchical cultural impact on perceived learning opportunities and learning behavior. The first theme had two subthemes that explored the relationship with team members and the expected hierarchy roles. The second theme was the impact of emotions on the learning and execution of clinical reasoning.The second theme had three subthemes that explored the personal approach to managing emotions related to perceived self-efficacy and professional image. The third theme was characteristics of learning environments and their role in learning clinical reasoning. The last theme included three subthemes that explored stressful, autonomous, and interactive environments. Insights: The results accentuate the complexity of clinical reasoning. Trainees' experience of learning clinical reasoning was influenced by factors not controlled for in the curricula. These factors constitute a hidden curriculum with a significant influence on learning. Our local postgraduate training programmes will benefit from addressing the points raised in this study for effective and culturally sensitive clinical reasoning learning.
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Affiliation(s)
- Dalia Albahari
- Mental Health Services, Hamad Medical Corporation, Doha, Qatar
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Raafat N, Harbourne AD, Radia K, Woodman MJ, Swales C, Saunders KEA. Virtual patients improve history-taking competence and confidence in medical students. MEDICAL TEACHER 2024; 46:682-688. [PMID: 38084413 DOI: 10.1080/0142159x.2023.2273782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
PURPOSE Klark is a novel online medical education tool (www.klark-cases.com) where students take histories from virtual patients with common presentations from multiple specialities. We investigated whether Klark could enhance student confidence and competence in history-taking, and whether students find Klark helpful. METHODS A single cohort of first-year clinical medical students had access to Klark for three weeks. At both ends of the trial, participants were asked to complete feedback forms and participate in two mock Objective Structured Clinical Examination (OSCE) history stations. Outcome measures included self-reported confidence and competence in history-taking, performance in OSCE stations, and qualitative user experience data. RESULTS Seventy participants successfully completed a case on Klark (mean 18.7), of which 63 (90% user retention) completed ≥ 2 cases. Self-reported competence (p < 0.001) and confidence (p < 0.001) improved. Participants found Klark to be helpful, impactful, and would recommend it to other students. OSCE scores improved for medical (57% vs. 69%, p < 0.001) and surgical (58% vs. 70%, p < 0.001) histories. CONCLUSIONS Klark improved competence and confidence in history-taking. Students found it helpful and chose to continue using the platform. By developing confidence and competence at their own pace in the Klark simulated environment, students can then maximise benefit from in-person clinical opportunities.
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Affiliation(s)
- Nader Raafat
- University of Oxford Medical School, John Radcliffe Hospital, Oxford, United Kingdom
| | - Alexander D Harbourne
- University of Oxford Medical School, John Radcliffe Hospital, Oxford, United Kingdom
| | - Kajal Radia
- University of Oxford Medical School, John Radcliffe Hospital, Oxford, United Kingdom
| | - Myles J Woodman
- University of Oxford Medical School, John Radcliffe Hospital, Oxford, United Kingdom
| | - Catherine Swales
- University of Oxford Medical School, John Radcliffe Hospital, Oxford, United Kingdom
| | - Kate E A Saunders
- University of Oxford Medical School, John Radcliffe Hospital, Oxford, United Kingdom
- Department of Psychiatry, Warneford Hospital, Oxford, United Kingdom
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Gonullu I, Bayazit A, Erden S. Exploring medical students' perceptions of individual and group-based clinical reasoning with virtual patients: a qualitative study. BMC MEDICAL EDUCATION 2024; 24:189. [PMID: 38403641 PMCID: PMC10895817 DOI: 10.1186/s12909-024-05121-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/31/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Virtual Patients are computer-based simulations used to teach and evaluate patient interviews, medical diagnoses, and treatment of medical conditions. It helps develop clinical reasoning skills, especially in undergraduate medical education. This study aimed to and investigate the medical students' perceptions of individual and group-based clinical reasoning and decision-making processes by using Virtual Patients. METHODS The study group comprised 24 third-year medical students. Body Interact® software was utilized as a VP tool. The students' readiness and the courses' learning goals were considered when choosing the scenarios. Semi-structured interview forms were employed for data collection. MAXQDA 2020 qualitative analysis software was used to analyze the data. The students' written answers were analyzed using content analysis. RESULTS The participants perceived individual applications as beneficial when making clinical decisions with Virtual Patients, but they suggested that group-based applications used with the same cases immediately following individual applications were a more appropriate decision-making method. The results indicated that students learn to make decisions through trial and error, based on software scoring priorities, or using clinical reasoning protocols. CONCLUSION In group-based reasoning, the discussion-conciliation technique is utilized. The students stated that the individual decision-making was advantageous because it provided students with the freedom to make choices and the opportunity for self-evaluation. On the other hand, they stated that the group based decision-making process activated their prior knowledge, assisted in understanding misconceptions, and promoted information retention. Medical educators need to determine the most appropriate method when using Virtual Patients, which can be structured as individual and/or group applications depending on the competency sought.
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Affiliation(s)
- Ipek Gonullu
- Faculty of Medicine, Department of Medical Education and Informatics, Ankara University, Cebeci, Ankara, Turkey.
| | - Alper Bayazit
- Faculty of Medicine, Department of Medical Education and Informatics, Ankara University, Cebeci, Ankara, Turkey
| | - Sengul Erden
- Faculty of Medicine, Department of Medical Education and Informatics, Ankara University, Cebeci, Ankara, Turkey
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Lippitsch A, Steglich J, Ludwig C, Kellner J, Hempel L, Stoevesandt D, Thews O. Development and evaluation of a software system for medical students to teach and practice anamnestic interviews with virtual patient avatars. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 244:107964. [PMID: 38043500 DOI: 10.1016/j.cmpb.2023.107964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Taking a medical history is a core competence of the diagnostic process. At the beginning of their study medical students need to learn and practice the necessary techniques, initially focusing on good structuring and completeness. For this purpose, an interactive software system (ViPATalk) was developed in which the student can train to pose questions to virtual patient avatars in free conversation. At the end, the student receives feedback on the completeness of the questioning and an explanation of the essential items. The use of this software was compared to the traditional format of student role play in a randomized trial. METHODS The central component of ViPATalk is a chatbot based on the AI language AIML, which generates an appropriate answer based on keywords in the student's question. To enable a realistic use, the student can enter the question via microphone (speech-to-text) and the answer generated by the chatbot is presented as a short video sequence, where the avatar is generated from a real image. Here, the transition between the sequences is seamless, resulting in a continuous movement of the avatar during the conversation. RESULTS The learning success by practicing with ViPATalk was tested in an anamnestic interview with actors as simulated patients. The completeness of the conversation was evaluated with regard to numerous aspects and also certain behaviors during the conversation. These results were compared with those after practicing using peer role play. CONCLUSIONS It was found that practicing with ViPATalk was mostly equivalent to the students' role play. In the subsequent survey of the students, the wish was expressed that the ViPATalk software should also be used as an online tool for self-study and that there should be more cases for practicing.
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Affiliation(s)
- Antonia Lippitsch
- Dorothea Erxleben Learning Centre Halle (DELH), University of Halle-Wittenberg, Germany
| | - Jonas Steglich
- Dorothea Erxleben Learning Centre Halle (DELH), University of Halle-Wittenberg, Germany
| | - Christiane Ludwig
- Dorothea Erxleben Learning Centre Halle (DELH), University of Halle-Wittenberg, Germany
| | - Juliane Kellner
- Dorothea Erxleben Learning Centre Halle (DELH), University of Halle-Wittenberg, Germany
| | - Linn Hempel
- Dorothea Erxleben Learning Centre Halle (DELH), University of Halle-Wittenberg, Germany
| | - Dietrich Stoevesandt
- Dorothea Erxleben Learning Centre Halle (DELH), University of Halle-Wittenberg, Germany
| | - Oliver Thews
- Julius Bernstein Institute of Physiology, University of Halle-Wittenberg, Magdeburger Str. 6, Halle (Saale) 06112, Germany.
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Andrew A. Potential applications and implications of large language models in primary care. Fam Med Community Health 2024; 12:e002602. [PMID: 38290759 PMCID: PMC10828839 DOI: 10.1136/fmch-2023-002602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/16/2024] [Indexed: 02/01/2024] Open
Abstract
The recent release of highly advanced generative artificial intelligence (AI) chatbots, including ChatGPT and Bard, which are powered by large language models (LLMs), has attracted growing mainstream interest over its diverse applications in clinical practice, including in health and healthcare. The potential applications of LLM-based programmes in the medical field range from assisting medical practitioners in improving their clinical decision-making and streamlining administrative paperwork to empowering patients to take charge of their own health. However, despite the broad range of benefits, the use of such AI tools also comes with several limitations and ethical concerns that warrant further consideration, encompassing issues related to privacy, data bias, and the accuracy and reliability of information generated by AI. The focus of prior research has primarily centred on the broad applications of LLMs in medicine. To the author's knowledge, this is, the first article that consolidates current and pertinent literature on LLMs to examine its potential in primary care. The objectives of this paper are not only to summarise the potential benefits, risks and challenges of using LLMs in primary care, but also to offer insights into considerations that primary care clinicians should take into account when deciding to adopt and integrate such technologies into their clinical practice.
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Affiliation(s)
- Albert Andrew
- Medical Student, The University of Auckland School of Medicine, Auckland, New Zealand
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Lee SI, Kahn CE, Luker GD, Rosen BR. Mentoring Radiologists and Imaging Scientists in the Postpandemic Digital Era. Radiology 2023; 309:e231702. [PMID: 38112550 DOI: 10.1148/radiol.231702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Affiliation(s)
- Susanna I Lee
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White Bldg, Rm 270, Boston, MA 02114 (S.I.L., B.R.R.); Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa (C.E.K.); and University of Michigan, Ann Arbor, Mich (G.D.L.)
| | - Charles E Kahn
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White Bldg, Rm 270, Boston, MA 02114 (S.I.L., B.R.R.); Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa (C.E.K.); and University of Michigan, Ann Arbor, Mich (G.D.L.)
| | - Gary D Luker
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White Bldg, Rm 270, Boston, MA 02114 (S.I.L., B.R.R.); Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa (C.E.K.); and University of Michigan, Ann Arbor, Mich (G.D.L.)
| | - Bruce R Rosen
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White Bldg, Rm 270, Boston, MA 02114 (S.I.L., B.R.R.); Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa (C.E.K.); and University of Michigan, Ann Arbor, Mich (G.D.L.)
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Cai W, You M, Li J, Li Q, Wang D, Wang H. Application of "immersive contextualization based-learning teaching" mode in the orthopaedic musculoskeletal disorder module of clinical medicine education. BMC MEDICAL EDUCATION 2023; 23:906. [PMID: 38031076 PMCID: PMC10687819 DOI: 10.1186/s12909-023-04831-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE To evaluate the effect and influence of the "immersive contextualization-based learning" teaching mode (ICBLT) in the orthopaedic musculoskeletal disorder module of clinical medicine education. METHODS Undergraduate students in five consecutive semesters of clinical medicine in West China Hospital, Sichuan University were enrolled in this study. During the teaching process in each semester, a cross-over design was applied, and students were randomly divided into two classes (Class A and Class B) to receive the designated experimental courses with different routes. After they took the final exams, the scores of the selected chapters (sports injury chapter and osteoarthritis chapter) were extracted to conduct Tests of Between-Subjects Effects. Q-Q plot was drawn to test whether the distribution of the scores follows normal distribution. The part of the feedback questionnaires to assess these two teaching modes were also extracted for comparison. RESULTS A total of 441 students were enrolled in this study, among which, Class A teaching route was implemented to 222 students and Class B to the rest 219. The results of Tests of Between-Subjects Effects showed that ICBLT mode could lead to better scores compared to the Lecturing-based learning teaching (LBLT) mode (p < 0.0001). In terms of mastery of practical skills, help to deepen the memory of knowledge and satisfaction with the teaching mode, the ICBLT mode showed better results (p < 0.0001). CONCLUSION ICBLT mode had better potential in helping mastery of practical skills and deepening the memory of knowledge.
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Affiliation(s)
- Wufeng Cai
- Department of Orthopedics, West China Hospital, Orthopedic Research Institute, Sichuan University, Chengdu, China
- Department of Engineering, University of Exeter, Exeter, England
| | - Mingke You
- Department of Orthopedics, West China Hospital, Orthopedic Research Institute, Sichuan University, Chengdu, China
| | - Jian Li
- Department of Orthopedics, West China Hospital, Orthopedic Research Institute, Sichuan University, Chengdu, China.
| | - Qi Li
- Department of Orthopedics, West China Hospital, Orthopedic Research Institute, Sichuan University, Chengdu, China
| | - Duan Wang
- Department of Orthopedics, West China Hospital, Orthopedic Research Institute, Sichuan University, Chengdu, China.
| | - Haoyang Wang
- Department of Orthopedics, West China Hospital, Orthopedic Research Institute, Sichuan University, Chengdu, China.
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Woon LSC, Mohd Daud TI, Tong SF. "It kinda helped us to be there": students' perspectives on the use of virtual patient software in psychiatry posting. BMC MEDICAL EDUCATION 2023; 23:851. [PMID: 37946151 PMCID: PMC10636819 DOI: 10.1186/s12909-023-04834-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND At the Faculty of Medicine of the National University of Malaysia, a virtual patient software program, DxR Clinician, was utilised for the teaching of neurocognitive disorder topics during the psychiatry posting of undergraduate medical students in a modified team-based learning (TBL) module. This study aimed to explore medical students' learning experiences with virtual patient. METHODS Ten students who previously underwent the learning module were recruited through purposive sampling. The inclusion criteria were: (a) Fourth-year medical students; and (b) Completed psychiatry posting with the new module. Students who dropped out or were unable to participate in data collection were excluded. Two online focus group discussions (FGDs) with five participants each were conducted by an independent facilitator, guided by a questioning route. The data were transcribed verbatim and coded using the thematic analysis approach to identify themes. RESULTS Three main themes of their learning experience were identified: (1) fulfilment of the desired pedagogy (2), realism of the clinical case, and (3) ease of use related to technical settings. The pedagogy theme was further divided into the following subthemes: level of entry for students, flexibility of presentation of content, provision of learning guidance, collaboration with peers, provision of feedback, and assessment of performance. The realism theme had two subthemes: how much the virtual patient experience mimicked an actual patient and how much the case scenario reflected real conditions in the Malaysian context. The technical setting theme entailed two subthemes: access to the software and appearance of the user interface. The study findings are considered in the light of learning formats, pedagogical and learning theories, and technological frameworks. CONCLUSIONS The findings shed light on both positive and negative aspects of using virtual patients for medical students' psychiatry posting, which opens room for further improvement of their usage in undergraduate psychiatry education.
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Affiliation(s)
- Luke Sy-Cherng Woon
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia.
| | - Tuti Iryani Mohd Daud
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Seng Fah Tong
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
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Kharidia KM, Lin ME, West JD, Sarode DN, Ma HJ, Vanstrum EB, Wu FM, Johns MM. Virtual Versus In-Person Head and Neck Physical Examination Training in Medical Students: A Pilot Assessment. Ann Otol Rhinol Laryngol 2023; 132:1140-1148. [PMID: 36514234 DOI: 10.1177/00034894221139107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To compare the effect of virtual and in-person head and neck physical examination training events on medical student confidence in performing examination maneuvers and seeking mentorship from otolaryngology faculty and residents. METHODS Training events were held with first-year medical student volunteers in 2020 (in-person) and 2021 (virtual). Participants in both cohorts were given didactics on head and neck cancer, trained to perform a head and neck physical examination, and demonstrated their clinical skills to otolaryngology faculty and residents. Pre- and post-training surveys were utilized to assess the following outcomes: participant head and neck cancer knowledge, confidence in performing examination maneuvers, and confidence in seeking mentorship in otolaryngology. Differences in outcomes between training settings were assessed by comparing participant survey responses pre- and post- training. RESULTS Both in-person and virtual training modalities improved participant confidence in performing the physical examination. There was no significant difference in the degree of improvement between training types. In-person training significantly increased participant confidence in seeking mentorship from otolaryngology faculty and residents (P = .003), while virtual training did not (P = .194). CONCLUSION Virtual training modalities are feasible methods of teaching the head and neck physical examination. Instruction through a video conferencing platform has the potential to be incorporated into traditional in-person medical education in a permanent fashion. This pilot study can inform future studies directly comparing in-person and virtual physical examination training modalities.
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Affiliation(s)
- Khush M Kharidia
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Matthew E Lin
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jonathan D West
- Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Deepika N Sarode
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Harrison J Ma
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Erik B Vanstrum
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Franklin M Wu
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael M Johns
- Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Demiray A, Ilaslan N, Kızıltepe SK, Acıl A. Web-based standardized patient simulation for taking anamnesis: an approach in nursing education during the pandemic. BMC Nurs 2023; 22:325. [PMID: 37730596 PMCID: PMC10512483 DOI: 10.1186/s12912-023-01486-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 09/06/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND To address the challenges in nursing education brought about by the pandemic, this study aimed to evaluate the use of a web-based standardized patient practice in the development of nursing students' anamnesis taking skills and their views about its application. METHOD We conducted a descriptive intervention study with 39 s-year nursing students. The students completed anamnesis using the standardized patient practice in line with a scenario with real standardized patients in a web-based environment with audio and video. RESULTS The total scores of students' anamnesis skills were low. The agreement between the total scores, scores obtained from the health patterns, and each item in the control list was statistically significant (p < 0.05). CONCLUSION Web-based standardized patient practice is an alternative for clinical practice facilitating the gaining of competencies in making holistic nursing diagnoses under conditions that limit face-to-face interactions, such as pandemics.
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Affiliation(s)
- Ayse Demiray
- Fundamentals of Nursing, Nursing Department, Faculty of Health Sciences, Duzce University, Duzce, Turkey.
| | - Nagihan Ilaslan
- Fundamentals of Nursing, Nursing Department, Faculty of Health Sciences, Duzce University, Duzce, Turkey
| | - Selin Keskin Kızıltepe
- Fundamentals of Nursing, Nursing Department, Faculty of Health Sciences, Duzce University, Duzce, Turkey
| | - Aysegül Acıl
- Fundamentals of Nursing, Nursing Department, Faculty of Health Sciences, Duzce University, Duzce, Turkey
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Friedman N, Zuniga-Hernandez M, Titzler J, Suen MY, Wang E, Rosales O, Graham J, D'Souza P, Menendez M, Caruso TJ. Prehospital Pediatric Emergency Training Using Augmented Reality Simulation: A Prospective, Mixed Methods Study. PREHOSP EMERG CARE 2023; 28:271-281. [PMID: 37318845 DOI: 10.1080/10903127.2023.2224876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Pediatric emergencies are high-stakes yet low-volume clinical encounters for emergency medical services (EMS) clinicians, necessitating innovative approaches to training. We sought to explore the acceptability, usability, and ergonomics of a novel augmented reality (AR) software for EMS crisis management training. METHODS This was a prospective, mixed-methods study employing qualitative and quantitative analyses. We enrolled emergency medical technicians (EMTs) and paramedics at a municipal fire service in Northern California. We ran the Chariot Augmented Reality Medical simulation software (Stanford Chariot Program, Stanford University, Stanford, CA) on the ML1 headset (Magic Leap, Inc., Plantation, FL), which enabled participants to view an AR image of a patient overlaid with real-world training objects. Participants completed a simulation of a pediatric hypoglycemia-induced seizure and cardiac arrest. Participants subsequently engaged in structured focus group interviews assessing acceptability, which we coded and thematically analyzed. We evaluated the usability of the AR system and ergonomics of the ML1 headset using previously validated scales, and we analyzed findings with descriptive statistics. RESULTS Twenty-two EMS clinicians participated. We categorized focus group interview statements into seven domains after an iterative thematic analysis: general appraisal, realism, learning efficacy, mixed reality feasibility, technology acceptance, software optimization, and alternate use cases. Participants valued the realism and the mixed reality functionality of the training simulation. They reported that AR could be effective for practicing pediatric clinical algorithms and task prioritization, building verbal communication skills, and promoting stress indoctrination. However, participants also noted challenges with integrating AR images with real-world objects, the learning curve required to adapt to the technology, and areas for software improvement. Participants favorably evaluated the ease of use of the technology and comfortability of wearing the hardware; however, most participants reported that they would need technical support. CONCLUSION Participants positively evaluated the acceptability, usability, and ergonomics of an AR simulator for pediatric emergency management training, and participants identified current technological limitations and areas for improvement. AR simulation may serve as an effective training adjunct for prehospital clinicians.
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Affiliation(s)
- Nicholas Friedman
- Stanford Chariot Program, Lucile Packard Children's Hospital, Palo Alto, California
| | | | - Janet Titzler
- Stanford Chariot Program, Lucile Packard Children's Hospital, Palo Alto, California
| | - Man Yee Suen
- Stanford Chariot Program, Lucile Packard Children's Hospital, Palo Alto, California
| | - Ellen Wang
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Oswaldo Rosales
- Stanford Chariot Program, Lucile Packard Children's Hospital, Palo Alto, California
| | - Jenna Graham
- Mountain View Fire Department, City of Mountain View, Mountain View, California
| | - Peter D'Souza
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Maria Menendez
- Stanford Chariot Program, Lucile Packard Children's Hospital, Palo Alto, California
| | - Thomas J Caruso
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California
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15
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Chen Y, Lin Q, Chen X, Liu T, Ke Q, Yang Q, Guan B, Ming WK. Need assessment for history-taking instruction program using chatbot for nursing students: A qualitative study using focus group interviews. Digit Health 2023; 9:20552076231185435. [PMID: 37426591 PMCID: PMC10328012 DOI: 10.1177/20552076231185435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 06/14/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose A comprehensive health history contributes to identifying the most appropriate interventions and care priorities. However, history-taking is challenging to learn and develop for most nursing students. Chatbot was suggested by students to be used in history-taking training. Still, there is a lack of clarity regarding the needs of nursing students in these programs. This study aimed to explore nursing students' needs and essential components of chatbot-based history-taking instruction program. Methods This was a qualitative study. Four focus groups, with a total of 22 nursing students, were recruited. Colaizzi's phenomenological methodology was used to analyze the qualitative data generated from the focus group discussions. Results Three main themes and 12 subthemes emerged. The main themes included limitations of clinical practice for history-taking, perceptions of chatbot used in history-taking instruction programs, and the need for history-taking instruction programs using chatbot. Students had limitations in clinical practice for history-taking. When developing chatbot-based history-taking instruction programs, the development should reflect students' needs, including feedback from the chatbot system, diverse clinical situations, chances to practice nontechnical skills, a form of chatbot (i.e., humanoid robots or cyborgs), the role of teachers (i.e., sharing experience and providing advice) and training before the clinical practice. Conclusion Nursing students had limitations in clinical practice for history-taking and high expectations for chatbot-based history-taking instruction programs.
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Affiliation(s)
- Yanya Chen
- School of Nursing, Jinan University, Guangzhou, China
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, Hong Kong
| | - Qingran Lin
- School of Nursing, Jinan University, Guangzhou, China
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xiaohan Chen
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, Hong Kong
| | - Taoran Liu
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, Hong Kong
| | - Qiqi Ke
- School of Nursing, Jinan University, Guangzhou, China
| | - Qiaohong Yang
- School of Nursing, Jinan University, Guangzhou, China
| | - Bingsheng Guan
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wai-kit Ming
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, Hong Kong
- School of Public Policy and Management, Tsinghua University, China
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Leung T, Cai Y, Cao J, He Q, Wang X, Lu Y, Liang H, Xu D, Liao J. The Agreement Between Virtual Patient and Unannounced Standardized Patient Assessments in Evaluating Primary Health Care Quality: Multicenter, Cross-sectional Pilot Study in 7 Provinces of China. J Med Internet Res 2022; 24:e40082. [PMID: 36459416 PMCID: PMC9758641 DOI: 10.2196/40082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 09/27/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The unannounced standardized patient (USP) is the gold standard for primary health care (PHC) quality assessment but has many restrictions associated with high human and resource costs. Virtual patient (VP) is a valid, low-cost software option for simulating clinical scenarios and is widely used in medical education. It is unclear whether VP can be used to assess the quality of PHC. OBJECTIVE This study aimed to examine the agreement between VP and USP assessments of PHC quality and to identify factors influencing the VP-USP agreement. METHODS Eleven matched VP and USP case designs were developed based on clinical guidelines and were implemented in a convenience sample of urban PHC facilities in the capital cities of the 7 study provinces. A total of 720 USP visits were conducted, during which on-duty PHC providers who met the inclusion criteria were randomly selected by the USPs. The same providers underwent a VP assessment using the same case condition at least a week later. The VP-USP agreement was measured by the concordance correlation coefficient (CCC) for continuity scores and the weighted κ for diagnoses. Multiple linear regression was used to identify factors influencing the VP-USP agreement. RESULTS Only 146 VP scores were matched with the corresponding USP scores. The CCC for medical history was 0.37 (95% CI 0.24-0.49); for physical examination, 0.27 (95% CI 0.12-0.42); for laboratory and imaging tests, -0.03 (95% CI -0.20 to 0.14); and for treatment, 0.22 (95% CI 0.07-0.37). The weighted κ for diagnosis was 0.32 (95% CI 0.13-0.52). The multiple linear regression model indicated that the VP tests were significantly influenced by the different case conditions and the city where the test took place. CONCLUSIONS There was low agreement between VPs and USPs in PHC quality assessment. This may reflect the "know-do" gap. VP test results were also influenced by different case conditions, interactive design, and usability. Modifications to VPs and the reasons for the low VP-USP agreement require further study.
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Affiliation(s)
| | - Yiyuan Cai
- Department of Epidemiology and Medical Statistics, School of Public Health, Guizhou Medical University, Guiyang, China
| | - Jin Cao
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Qianyu He
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xiaohui Wang
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Yun Lu
- Department of Preventive Medicine & Maternal and Child Health, School of Public Health, Guizhou Medical University, Guiyang, China
| | - Huijuan Liang
- Research Institute for Health Policy of Inner Mongolia, Inner Mongolia Medical University, Hohhot, China
| | - Dong Xu
- Center for World Health Organization Studies, Department of Health Management, School of Health Management of Southern Medical University, Guangzhou, China.,ACACIA Lab for Implementation Research, Southern Medical University Institute for Global Health, Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Jing Liao
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
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Teaching dermatology in the era of digital technology. Ann Dermatol Venereol 2022; 149:276-278. [PMID: 35750511 DOI: 10.1016/j.annder.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/20/2022] [Accepted: 04/01/2022] [Indexed: 12/30/2022]
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18
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Ziane-Casenave S, Mauroux M, Devillard R, Kérourédan O. Influence of practical and clinical experience on dexterity performance measured using haptic virtual reality simulator. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2022; 26:838-848. [PMID: 34990073 DOI: 10.1111/eje.12767] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/15/2021] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Development of dexterity, hand-eye coordination and self-assessment are essential during the preclinical training of dental students. To meet this requirement, dental simulators have been developed combining virtual reality with a force feedback haptic interface. The aim of this study was to assess the capability of the VirTeaSy© haptic simulator to discriminate between users with different levels of practical and clinical experience. MATERIALS AND METHODS Fifty-six volunteers divided into five groups (non-dentists, 1st/3rd/final-year dental students, recent graduates) had three attempts to prepare an occlusal amalgam cavity using the simulator. Percentages of volumes prepared inside (%IV) and outside (%OV) the required cavity, skill index and progression rate, referring to the evolution of skill index between trials 1 and 3, were assessed. The dental students and recent graduates completed a questionnaire to gather their opinions about their first hands-on experience with a haptic simulator. RESULTS The results showed no significant difference between the groups at the first attempt. Following the third attempt, the skill index was improved significantly. Analysis of progression rates, characterised by large standard deviations, did not reveal significant differences between groups. The third attempt showed significant differences in skill index and %IV between 1st-year undergraduate dental students and both non-dentists and recent dental graduates. The questionnaire indicated a tendency for dental operators to consider the simulator as a complement to their learning and not a substitute for traditional methods. CONCLUSION This study did not show the ability of a basic aptitude test on VirTeaSy© haptic simulator to discriminate between users of different levels of expertise. Optimisations must be considered in order to make simulation-based assessment clinically relevant.
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Affiliation(s)
- Sophia Ziane-Casenave
- UFR des Sciences Odontologiques, Université de Bordeaux, Bordeaux, France
- UMR 1026 BioTis INSERM, Université de Bordeaux, Bordeaux, France
| | - Marthe Mauroux
- UFR des Sciences Odontologiques, Université de Bordeaux, Bordeaux, France
| | - Raphaël Devillard
- UFR des Sciences Odontologiques, Université de Bordeaux, Bordeaux, France
- UMR 1026 BioTis INSERM, Université de Bordeaux, Bordeaux, France
| | - Olivia Kérourédan
- UFR des Sciences Odontologiques, Université de Bordeaux, Bordeaux, France
- UMR 1026 BioTis INSERM, Université de Bordeaux, Bordeaux, France
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Hess O, Qian J, Bruce J, Wang E, Rodriguez S, Haber N, Caruso TJ. Communication Skills Training Using Remote Augmented Reality Medical Simulation: a Feasibility and Acceptability Qualitative Study. MEDICAL SCIENCE EDUCATOR 2022; 32:1005-1014. [PMID: 35966166 PMCID: PMC9362415 DOI: 10.1007/s40670-022-01598-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Augmented reality (AR) has promise as a clinical teaching tool, particularly for remote learning. The Chariot Augmented Reality Medical (CHARM) simulator integrates real-time communication into a portable medical simulator with a holographic patient and monitor. The primary aim was to analyze feedback from medical and physician assistant students regarding acceptability and feasibility of the simulator. METHODS Using the CHARM simulator, we created an advanced cardiovascular life support (ACLS) simulation scenario. After IRB approval, preclinical medical and physician assistant students volunteered to participate from August to September 2020. We delivered augmented reality headsets (Magic Leap One) to students before the study. Prior to the simulation, via video conference, we introduced students to effective communication skills during a cardiac arrest. Participants then, individually and remotely from their homes, synchronously completed an instructor-led ACLS AR simulation in groups of three. After the simulation, students participated in a structured focus group using a qualitative interview guide. Our study team coded their responses and interpreted them using team-based thematic analysis. RESULTS Eighteen medical and physician assistant students participated. We identified four domains that reflected trainee experiences: experiential satisfaction, learning engagement, technology learning curve, and opportunities for improvement. Students reported that the simulator was acceptable and enjoyable for teaching trainees communication skills; however, there were some technical difficulties associated with initial use. CONCLUSION This study suggests that multiplayer AR is a promising and feasible approach for remote medical education of communication skills during medical crises. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-022-01598-7.
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Affiliation(s)
- Olivia Hess
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Way, H3580, MC 5640, Stanford, 94304 CA USA
| | - Jimmy Qian
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Way, H3580, MC 5640, Stanford, 94304 CA USA
| | - Janine Bruce
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Way, H3580, MC 5640, Stanford, 94304 CA USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA USA
| | - Ellen Wang
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Way, H3580, MC 5640, Stanford, 94304 CA USA
| | - Samuel Rodriguez
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Way, H3580, MC 5640, Stanford, 94304 CA USA
| | - Nick Haber
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Way, H3580, MC 5640, Stanford, 94304 CA USA
- Stanford University Graduate School of Education, Stanford, CA USA
| | - Thomas J. Caruso
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Way, H3580, MC 5640, Stanford, 94304 CA USA
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Strategies Used to Teach Soft Skills in Undergraduate Nursing Education: A Scoping Review. J Prof Nurs 2022; 42:209-218. [DOI: 10.1016/j.profnurs.2022.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/09/2022] [Accepted: 07/15/2022] [Indexed: 12/20/2022]
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Suárez A, Adanero A, Díaz-Flores García V, Freire Y, Algar J. Using a Virtual Patient via an Artificial Intelligence Chatbot to Develop Dental Students’ Diagnostic Skills. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148735. [PMID: 35886584 PMCID: PMC9319956 DOI: 10.3390/ijerph19148735] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 11/30/2022]
Abstract
Knowing how to diagnose effectively and efficiently is a fundamental skill that a good dental professional should acquire. If students perform a greater number of clinical cases, they will improve their performance with patients. In this sense, virtual patients with artificial intelligence offer a controlled, stimulating, and safe environment for students. To assess student satisfaction after interaction with an artificially intelligent chatbot that recreates a virtual patient, a descriptive cross-sectional study was carried out in which a virtual patient was created with artificial intelligence in the form of a chatbot and presented to fourth and fifth year dental students. After several weeks interacting with the AI, they were given a survey to find out their assessment. A total of 193 students participated. A large majority of the students were satisfied with the interaction (mean 4.36), the fifth year students rated the interaction better and showed higher satisfaction values. The students who reached a correct diagnosis rated this technology more positively. Our research suggests that the incorporation of this technology in dental curricula would be positively valued by students and would also ensure their training and adaptation to new technological developments.
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Affiliation(s)
- Ana Suárez
- Department of Preclinical Dentistry, School of Biomedical Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain; (A.S.); (V.D.-F.G.); (Y.F.)
| | - Alberto Adanero
- Department of Clinical Dentistry, School of Biomedical Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain;
- Correspondence:
| | - Víctor Díaz-Flores García
- Department of Preclinical Dentistry, School of Biomedical Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain; (A.S.); (V.D.-F.G.); (Y.F.)
| | - Yolanda Freire
- Department of Preclinical Dentistry, School of Biomedical Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain; (A.S.); (V.D.-F.G.); (Y.F.)
| | - Juan Algar
- Department of Clinical Dentistry, School of Biomedical Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain;
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Urbanová E, Bašková M, Maskálová E, Mazúchová L, Škodová Z. Virtual patients: an option for future distance midwifery education? Int J Nurs Educ Scholarsh 2022; 19:ijnes-2021-0096. [PMID: 35822716 DOI: 10.1515/ijnes-2021-0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 06/23/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND The objective is to introduce the creating a set of virtual patients (VPs) to support distance midwifery education as well as the impact of distance education by means of VPs on knowledge, skills, motivation, clinical practice, and student satisfaction. METHODS VPs were created using OpenLabyrinth (OL). The impact of the distance education was assessed using a feedback questionnaire. RESULTS When creating our own VPs, the design and development phase can be considered the most difficult. On a scale of 1 (agree) to 4 (disagree), the student feedback rates were mostly positive (1.04-2.13). A high degree of agreement was associated with the acquisition of theoretical knowledge (1.15-1.28) and skills (1.43). CONCLUSIONS The creation of our own VPs is challenging for teachers due to its unconventional character. The students expressed great satisfaction with distance learning, but lacked face-to-face contact with the patient.
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Affiliation(s)
- Eva Urbanová
- Department of Midwifery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Martina Bašková
- Department of Midwifery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Erika Maskálová
- Department of Midwifery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Lucia Mazúchová
- Department of Midwifery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Zuzana Škodová
- Department of Midwifery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
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Luz FM, Yacoub VRD, Silveira KAA, Reis F, Dertkigi SSJ. A model for training ultrasound-guided fine-needle punctures. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2022; 68:948-952. [PMID: 35946773 PMCID: PMC9574963 DOI: 10.1590/1806-9282.20220150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/15/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the efficacy of a training program in ultrasound-guided fine needle puncture using a cost-effective model. METHODS We evaluated the training of 20 resident radiology physicians, based on a theoretical course and a practical simulation part with models that focused on the puncture technique of thyroid nodules. The total time to perform the procedure, the number of punctures on the model surface, and the application of a questionnaire were used to assess the performance and confidence of the resident physicians in performing the procedure. RESULTS The training model used was easy to reproduce, inexpensive, versatile, and capable of simulating the echotexture of thyroid tissue. There was a significant reduction in the total time needed to perform the procedure with a mean of 173.7 s±91.28 s from R1 and 112.8 s±17.66 s from R2 before the course vs. 19.2 s±112.8 s and 14.3 s±9.36 s, respectively, after the course (p<0.0001); as well as the number of superficial punctures, with a mean of 2.2 punctures±0.92 from R1 and 1.5 punctures±0.32 from R2 before the course vs 1.1 punctures±0.71 and 1.0 puncture±0.0, respectively, after the course (p<0.0001). There was also a subjective improvement in the performance and confidence in performing this procedure. CONCLUSIONS An inexpensive and easy-to-reproduce gelatin-based model enabled adequate training of resident physicians and proved capable of improving their skills and confidence in simulating the procedure, even with a short period of training.
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Affiliation(s)
| | | | | | - Fabiano Reis
- Universidade Estadual de Campinas, Department of Radiology – Campinas (SP), Brazil
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Kelly S, Smyth E, Murphy P, Pawlikowska T. A scoping review: virtual patients for communication skills in medical undergraduates. BMC MEDICAL EDUCATION 2022; 22:429. [PMID: 35659213 PMCID: PMC9166208 DOI: 10.1186/s12909-022-03474-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/09/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND Communication is an essential competence for medical students. Virtual patients (VP), computerized educational tools where users take the role of doctor, are increasingly used. Despite the wide range of VP utilization, evidence-based practical guidance on supporting development of communication skills for medical students remains unclear. We focused this scoping review on VP affordance for student learning especially important in the current environment of constrained patient access. METHODS This scoping review followed Arksey & O'Malley's methodology. We tested and used a search strategy involving six databases, resulting in 5,262 citations. Two reviewers independently screened titles, full texts (n= 158) and finally performed data extraction on fifty-five included articles. To support consideration of educational affordance the authors employed a pragmatic framework (derived from activity theory) to map included studies on VP structure, curricular alignment, mediation of VP activity, and socio-cultural context. RESULTS Findings suggest that not only the VP itself, but also its contextualization and associated curricular activities influence outcomes. The VP was trialled in the highest proportion of papers as a one-off intervention (19 studies), for an average duration of 44.9 minutes (range 10-120min), mainly in senior medical students (n=23), notably the largest group of studies did not have VP activities with explicit curricular integration (47%). There was relatively little repeated practice, low levels of feedback, self-reflection, and assessment. Students viewed VPs overall, citing authenticity and ease of use as important features. Resource implications are often omitted, and costings would facilitate a more complete understanding of implications of VP use. CONCLUSION Students should be provided with maximal opportunity to draw out the VPs' full potential through repeated practice, without time-constraint and with curricular alignment. Feedback delivery enabling reflection and mastery is also key. The authors recommend educators to explicitly balance computerized authenticity with instructional design integrated within the curriculum.
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Affiliation(s)
- Síle Kelly
- Department of Medicine, RCSI University of Medicine and Health Science, Smurfit Building, ERC, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
| | - Erica Smyth
- Health Professions Education Centre, RCSI University of Medicine and Health Science, Dublin, Ireland
| | - Paul Murphy
- Library, RCSI University of Medicine and Health Science, Dublin, Ireland
| | - Teresa Pawlikowska
- Health Professions Education Centre, RCSI University of Medicine and Health Science, Dublin, Ireland
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Mestre A, Muster M, El Adib AR, Ösp Egilsdottir H, Byermoen KR, Padilha M, Aguilar T, Tabagari N, Betts L, Sales L, Garcia P, Ling L, Café H, Binnie A, Marreiros A. The impact of small-group virtual patient simulator training on perceptions of individual learning process and curricular integration: a multicentre cohort study of nursing and medical students. BMC MEDICAL EDUCATION 2022; 22:375. [PMID: 35578233 PMCID: PMC9109952 DOI: 10.1186/s12909-022-03426-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 04/26/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The COVID-19 pandemic has precipitated rapid changes in medical education to protect students and patients from the risk of infection. Virtual Patient Simulators (VPS) provide a simulated clinical environment in which students can interview and examine a patient, order tests and exams, prioritize interventions, and observe response to therapy, all with minimal risk to themselves and their patients. Like high-fidelity simulators (HFS), VPS are a tool to improve curricular integration. Unlike HFS, VPS require limited infrastructure investment and can be used in low-resource settings. Few studies have examined the impact of VPS training on clinical education. This international, multicenter cohort study was designed to assess the impact of small-group VPS training on individual learning process and curricular integration from the perspective of nursing and medical students. METHODS We conducted a multi-centre, international cohort study of nursing and medical students. Baseline perceptions of individual learning process and curricular integration were assessed using a 27-item pre-session questionnaire. Students subsequently participated in small-group VPS training sessions lead by a clinical tutor and then completed a 32-item post-session questionnaire, including 25 paired items. Pre- and post-session responses were compared to determine the impact of the small-group VPS experience. RESULTS Participants included 617 nursing and medical students from 11 institutions in 8 countries. At baseline, nursing students reported greater curricular integration and more clinical and simulation experience than did medical students. After exposure to small-group VPS training, participants reported significant improvements in 5/6 items relating to individual learning process and 7/7 items relating to curricular integration. The impact of the VPS experience was similar amongst nursing and medical students. CONCLUSIONS In this multi-centre study, perceptions of individual learning process and curricular integration improved after exposure to small-group VPS training. Nursing and medical students showed similar impact. Small-group VPS training is an accessible, low-risk educational strategy that can improve student perceptions of individual learning process and curricular integration.
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Affiliation(s)
- André Mestre
- Faculty of Medicine and Biomedical Sciences, University of Algarve, Campus de Gambelas, Ed. 2 - Norte, 8005-139, Faro, Portugal
| | - Marek Muster
- Institute of Health Sciences, Medical College of University of Rzeszow, University of Rzeszow, Rzeszow, Poland
| | | | - Hugrun Ösp Egilsdottir
- Science Centre Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Kirsten Røland Byermoen
- Science Centre Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Miguel Padilha
- Porto Nursing School, CINTESIS-Tech4edusim, Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Thania Aguilar
- Central American Technological University (UNITEC), Tegucigalpa, Honduras
| | - Nino Tabagari
- AIETI Medical School, David Tvildiani Medical University, Tbilisi, Georgia
| | - Lorraine Betts
- Sally Horsfall Eaton School of Nursing, Waterfront Campus, George Brown College, Toronto, ON, Canada
| | - Leila Sales
- Red Cross Higher School of Health, Lisbon, Portugal
| | - Pedro Garcia
- Faculty of Medical Sciences, Nova Medical School, Lisbon, Portugal
| | - Luo Ling
- Guangxi Medical College, Nanning, Guangxi, China
| | - Hugo Café
- Faculty of Medicine and Biomedical Sciences, University of Algarve, Campus de Gambelas, Ed. 2 - Norte, 8005-139, Faro, Portugal
| | - Alexandra Binnie
- Faculty of Medicine and Biomedical Sciences, University of Algarve, Campus de Gambelas, Ed. 2 - Norte, 8005-139, Faro, Portugal.
- ABC-RI, Algarve Biomedical Center Research Institute, Faro, Portugal.
- William Osler Health System, Brampton, ON, Canada.
| | - Ana Marreiros
- Faculty of Medicine and Biomedical Sciences, University of Algarve, Campus de Gambelas, Ed. 2 - Norte, 8005-139, Faro, Portugal
- ABC-RI, Algarve Biomedical Center Research Institute, Faro, Portugal
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Plackett R, Kassianos AP, Mylan S, Kambouri M, Raine R, Sheringham J. The effectiveness of using virtual patient educational tools to improve medical students' clinical reasoning skills: a systematic review. BMC MEDICAL EDUCATION 2022; 22:365. [PMID: 35550085 PMCID: PMC9098350 DOI: 10.1186/s12909-022-03410-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 04/19/2022] [Indexed: 06/10/2023]
Abstract
BACKGROUND Use of virtual patient educational tools could fill the current gap in the teaching of clinical reasoning skills. However, there is a limited understanding of their effectiveness. The aim of this study was to synthesise the evidence to understand the effectiveness of virtual patient tools aimed at improving undergraduate medical students' clinical reasoning skills. METHODS We searched MEDLINE, EMBASE, CINAHL, ERIC, Scopus, Web of Science and PsycINFO from 1990 to January 2022, to identify all experimental articles testing the effectiveness of virtual patient educational tools on medical students' clinical reasoning skills. Quality of the articles was assessed using an adapted form of the MERSQI and the Newcastle-Ottawa Scale. A narrative synthesis summarised intervention features, how virtual patient tools were evaluated and reported effectiveness. RESULTS The search revealed 8,186 articles, with 19 articles meeting the inclusion criteria. Average study quality was moderate (M = 6.5, SD = 2.7), with nearly half not reporting any measurement of validity or reliability for their clinical reasoning outcome measure (8/19, 42%). Eleven articles found a positive effect of virtual patient tools on reasoning (11/19, 58%). Four reported no significant effect and four reported mixed effects (4/19, 21%). Several domains of clinical reasoning were evaluated. Data gathering, ideas about diagnosis and patient management were more often found to improve after virtual patient use (34/47 analyses, 72%) than application of knowledge, flexibility in thinking and problem-solving (3/7 analyses, 43%). CONCLUSIONS Using virtual patient tools could effectively complement current teaching especially if opportunities for face-to-face teaching or other methods are limited, as there was some evidence that virtual patient educational tools can improve undergraduate medical students' clinical reasoning skills. Evaluations that measured more case specific clinical reasoning domains, such as data gathering, showed more consistent improvement than general measures like problem-solving. Case specific measures might be more sensitive to change given the context dependent nature of clinical reasoning. Consistent use of validated clinical reasoning measures is needed to enable a meta-analysis to estimate effectiveness.
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Affiliation(s)
- Ruth Plackett
- Department of Applied Health Research, UCL, 1-19 Torrington Place, London, WC1E 6BT, UK.
| | - Angelos P Kassianos
- Department of Applied Health Research, UCL, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Sophie Mylan
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, England
| | | | - Rosalind Raine
- Department of Applied Health Research, UCL, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Jessica Sheringham
- Department of Applied Health Research, UCL, 1-19 Torrington Place, London, WC1E 6BT, UK
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Lavoie P, Lapierre A, Maheu-Cadotte MA, Fontaine G, Khetir I, Bélisle M. Transfer of Clinical Decision-Making-Related Learning Outcomes Following Simulation-Based Education in Nursing and Medicine: A Scoping Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:738-746. [PMID: 34789663 DOI: 10.1097/acm.0000000000004522] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Simulation is often depicted as an effective tool for clinical decision-making education. Yet, there is a paucity of data regarding transfer of learning related to clinical decision-making following simulation-based education. The authors conducted a scoping review to map the literature regarding transfer of clinical decision-making learning outcomes following simulation-based education in nursing or medicine. METHOD Based on the Joanna Briggs Institute methodology, the authors searched 5 databases (CINAHL, ERIC, MEDLINE, PsycINFO, and Web of Science) in May 2020 for quantitative studies in which the clinical decision-making performance of nursing and medical students or professionals was assessed following simulation-based education. Data items were extracted and coded. Codes were organized and hierarchized into patterns to describe conceptualizations and conditions of transfer, as well as learning outcomes related to clinical decision-making and assessment methods. RESULTS From 5,969 unique records, 61 articles were included. Only 7 studies (11%) assessed transfer to clinical practice. In the remaining 54 studies (89%), transfer was exclusively assessed in simulations that often included one or more variations in simulation features (e.g., scenarios, modalities, duration, and learner roles; 50, 82%). Learners' clinical decision-making, including data gathering, cue recognition, diagnoses, and/or management of clinical issues, was assessed using checklists, rubrics, and/or nontechnical skills ratings. CONCLUSIONS Research on simulation-based education has focused disproportionately on the transfer of learning from one simulation to another, and little evidence exists regarding transfer to clinical practice. The heterogeneity in conditions of transfer observed represents a substantial challenge in evaluating the effect of simulation-based education. The findings suggest that 3 dimensions of clinical decision-making performance are amenable to assessment-execution, accuracy, and speed-and that simulation-based learning related to clinical decision-making is predominantly understood as a gain in generalizable skills that can be easily applied from one context to another.
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Affiliation(s)
- Patrick Lavoie
- P. Lavoie is assistant professor, Faculty of Nursing, Université de Montréal, and researcher, Montreal Heart Institute, Montreal, Quebec, Canada; ORCID: https://orcid.org/0000-0001-8244-6484
| | - Alexandra Lapierre
- A. Lapierre is a doctoral candidate, Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada; ORCID: https://orcid.org/0000-0002-8704-4940
| | - Marc-André Maheu-Cadotte
- M.-A. Maheu-Cadotte is a doctoral candidate, Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada; ORCID: https://orcid.org/0000-0003-3190-0901
| | - Guillaume Fontaine
- G. Fontaine is a postdoctoral research fellow, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; ORCID: https://orcid.org/0000-0002-7806-814X
| | - Imène Khetir
- I. Khetir is a master's student, Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
| | - Marilou Bélisle
- M. Bélisle is associate professor, Faculty of Education, Université de Sherbrooke, Longueuil, Quebec, Canada
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Egilsdottir HÖ, Heyn LG, Brembo EA, Byermoen KR, Moen A, Eide H. The value of a redesigned clinical course during COVID-19 pandemic: an explorative convergent mixed-methods study. BMC Nurs 2022; 21:94. [PMID: 35461292 PMCID: PMC9034970 DOI: 10.1186/s12912-022-00872-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 04/12/2022] [Indexed: 11/16/2022] Open
Abstract
Background The COVID-19 lockdown in March 2020 had a significant consequence for nursing students worldwide including limited access to learning situations in clinical rotation. Therefore, this study aims to explore how an innovative redesign of a clinical course in a time of pandemic supported nursing students in learning the fundamentals of care in their first year. The redesign involved the transformation of a traditional hands-on clinical course into a technology-enhanced learning environment. Design This was an explorative convergent mixed-methods study using both quantitative and qualitative methods. Methods Twenty-four first-year nursing students responded to an online questionnaire with open-ended questions. Two nursing students and one faculty member participated in individual online interviews, and three faculty members participated in an online focus group interview. All the data were collected in June 2020. The quantitative data were analyzed using descriptive statistics and the qualitative data using content analysis. The GRAMMS guideline was applied. Results The students achieved the learning outcomes regarding fundamental care, basic physical assessment skills, and clinical reasoning with the help of academic assignments, multimedia learning resources, and virtual patients. Further, six central aspects of the facilitator role in the virtual simulation were identified. The aspect that was considered most valuable involved uncovering the “red thread” between different areas of knowledge in the first year of nursing education; this supported the students to better understand how to think and talk like a nurse. Conclusion This study offers insight into how a technology-enhanced clinical course can foster the learning of fundamental nursing care, basic physical assessment skills, and clinical reasoning skills; enhancing students’ preparedness for clinical hours. Virtual patients’ scenarios contributed to integrating different types of knowledge and skills that are important when providing nursing care for patients in clinical practice. This study also highlighted a gap in pedagogical competence among faculty members with regards to facilitating learning in a technology-enhanced learning environment. Study findings suggest promising pedagogical strategies that should be further developed post-pandemic, in response to the call for a renewal of nursing education using more technologically supported learning designs. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-022-00872-8.
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Ganji J, Shirvani MA, Motahari-Tabari N, Tayebi T. Design, implementation and evaluation of a virtual clinical training protocol for midwifery internship in a gynecology course during COVID-19 pandemic: A semi-experimental study. NURSE EDUCATION TODAY 2022; 111:105293. [PMID: 35134637 PMCID: PMC8809642 DOI: 10.1016/j.nedt.2022.105293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 01/11/2022] [Accepted: 01/31/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Over the past year, the occurrence of COVID-19 pandemic has challenged clinical education for health care students, due to the possibility of exposure to the virus and increased spread of the disease. Clinical training of midwifery students in gynecologic problems, based on the Iran midwifery education curriculum, was also disrupted during this pandemic. OBJECTIVES This study was aimed at designing, implementing and evaluating a virtual clinical training protocol for midwifery internship in a Gynecology course. DESIGN A semi-experimental study. SETTINGS Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran. PARTICIPANTS Forty-seven midwifery interns in Gynecology course were recruited during two semesters in 2020. METHODS Five steps based on the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) model were taken, which included 1) educational and skills needs assessment, 2) design, 3) development via focused group interviews and brainstorming with the presence of the midwifery department members in three sessions, 4) implementation including pretest and posttest, webinar, uploading the information of virtual patients, questions and correct answers, and 5) evaluation including knowledge assessment by a designed questionnaire and skills evaluation by the modified-Mini-CEX checklist. Data were analyzed using mean, standard deviation and paired t-test. RESULTS After training, a significant increase (p < 0.001) was observed in scores of knowledge and interview skills, clinical judgment, consultation, efficiency, professionalism, clinical competence and total score of clinical skills. CONCLUSIONS Training for gynecological diseases through virtual clinic promoted knowledge and clinical skills of midwifery interns. To enhance education, a virtual clinic may be used in crisis situations and in combination with teaching under normal circumstances by strengthening the infrastructure and removing barriers.
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Affiliation(s)
- Jila Ganji
- Department of Midwifery, Sexual and Reproductive Health Research Center, Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Marjan Ahmad Shirvani
- Department of Midwifery, Sexual and Reproductive Health Research Center, Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Narges Motahari-Tabari
- Department of Midwifery, Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Tahereh Tayebi
- Department of Midwifery, Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
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Furlan R, Gatti M, Mene R, Shiffer D, Marchiori C, Giaj Levra A, Saturnino V, Brunetta E, Dipaola F. Learning Analytics Applied to Clinical Diagnostic Reasoning Using a Natural Language Processing-Based Virtual Patient Simulator: Case Study. JMIR MEDICAL EDUCATION 2022; 8:e24372. [PMID: 35238786 PMCID: PMC8931645 DOI: 10.2196/24372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/28/2021] [Accepted: 11/23/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Virtual patient simulators (VPSs) log all users' actions, thereby enabling the creation of a multidimensional representation of students' medical knowledge. This representation can be used to create metrics providing teachers with valuable learning information. OBJECTIVE The aim of this study is to describe the metrics we developed to analyze the clinical diagnostic reasoning of medical students, provide examples of their application, and preliminarily validate these metrics on a class of undergraduate medical students. The metrics are computed from the data obtained through a novel VPS embedding natural language processing techniques. METHODS A total of 2 clinical case simulations (tests) were created to test our metrics. During each simulation, the students' step-by-step actions were logged into the program database for offline analysis. The students' performance was divided into seven dimensions: the identification of relevant information in the given clinical scenario, history taking, physical examination, medical test ordering, diagnostic hypothesis setting, binary analysis fulfillment, and final diagnosis setting. Sensitivity (percentage of relevant information found) and precision (percentage of correct actions performed) metrics were computed for each issue and combined into a harmonic mean (F1), thereby obtaining a single score evaluating the students' performance. The 7 metrics were further grouped to reflect the students' capability to collect and to analyze information to obtain an overall performance score. A methodological score was computed based on the discordance between the diagnostic pathway followed by students and the reference one previously defined by the teacher. In total, 25 students attending the fifth year of the School of Medicine at Humanitas University underwent test 1, which simulated a patient with dyspnea. Test 2 dealt with abdominal pain and was attended by 36 students on a different day. For validation, we assessed the Spearman rank correlation between the performance on these scores and the score obtained by each student in the hematology curricular examination. RESULTS The mean overall scores were consistent between test 1 (mean 0.59, SD 0.05) and test 2 (mean 0.54, SD 0.12). For each student, the overall performance was achieved through a different contribution in collecting and analyzing information. Methodological scores highlighted discordances between the reference diagnostic pattern previously set by the teacher and the one pursued by the student. No significant correlation was found between the VPS scores and hematology examination scores. CONCLUSIONS Different components of the students' diagnostic process may be disentangled and quantified by appropriate metrics applied to students' actions recorded while addressing a virtual case. Such an approach may help teachers provide students with individualized feedback aimed at filling competence drawbacks and methodological inconsistencies. There was no correlation between the hematology curricular examination score and any of the proposed scores as these scores address different aspects of students' medical knowledge.
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Affiliation(s)
- Raffaello Furlan
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Mauro Gatti
- IBM, Active Intelligence Center, Bologna, Italy
| | - Roberto Mene
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Dana Shiffer
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | | | | | - Enrico Brunetta
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Franca Dipaola
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS, Humanitas Research Hospital, Rozzano, Milan, Italy
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The effects of using virtual patients on the history-taking ability of nursing interns: A non-randomized controlled study. Nurse Educ Pract 2022; 59:103289. [DOI: 10.1016/j.nepr.2022.103289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 11/11/2021] [Accepted: 01/08/2022] [Indexed: 11/23/2022]
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Hwang GJ, Chang CY, Ogata H. The effectiveness of the virtual patient-based social learning approach in undergraduate nursing education: A quasi-experimental study. NURSE EDUCATION TODAY 2022; 108:105164. [PMID: 34627030 DOI: 10.1016/j.nedt.2021.105164] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/29/2021] [Accepted: 09/29/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND In nursing education, knowledge and competence in conducting physical assessments are crucial. Therefore, physical assessment knowledge has become a fundamental and essential education program for nursing students. However, most of the current nursing courses are taught via a didactic teaching approach, making it difficult for students to think deeply about relevant issues due to the lack of interaction and context. This may, in turn, have an impact on learning effectiveness and clinical judgment. OBJECTIVE A virtual patient (VP)-based social learning approach is proposed to enhance nursing students' performance and clinical judgment in education programs. DESIGN A quasi-experiment method was adopted to evaluate the effectiveness of the proposed approach. PARTICIPANTS A total of 40 senior nursing students participated in the study (VP-based social learning approach group = 20, control group = 20). METHODS The study involved a pre- and post-test to examine students' learning achievements, self-efficacy, and communication skills. The experimental group adopted the VP-based learning approach, while the control group adopted the conventional didactic learning approach. ANCOVA was employed to compare the performances of the two groups. RESULTS The experimental results indicate that using a VP for learning can enhance students' learning achievements, self-efficacy, and communication skills. In addition, based on the analysis of the results, students generally believed that learning with a VP makes learning more enjoyable. CONCLUSION The VP-based social learning approach would be an effective strategy to train nursing students who have limited opportunities to experience real clinical situations, in particular during the COVID-19 pandemic.
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Affiliation(s)
- Gwo-Jen Hwang
- Graduate Institute of Digital Learning and Education, National Taiwan University of Science and Technology, Taiwan.
| | - Ching-Yi Chang
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wuxing Street, Taipei 11031, Taiwan.
| | - Hiroaki Ogata
- Academic Center for Computing and Media Studies and the Graduate School of Informatics, Kyoto University, Japan.
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Wijnen-Meijer M, Brandhuber T, Schneider A, Berberat P. Implementing Kolb´s Experiential Learning Cycle by Linking Real Experience, Case-Based Discussion and Simulation. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2022; 9:23821205221091511. [PMID: 35592131 PMCID: PMC9112303 DOI: 10.1177/23821205221091511] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Background: To prepare medical students for their future, they must become acquainted with clinical practice, for example by means of simulations, clerkships and discussing patient cases. By connecting these different approaches, according to Kolb´s experiential learning cycle, the learning effect can be strengthened. METHODOLOGY In the development of a didactical program for students who are being prepared for their role as general practitioners, we have adopted a new didactic approach, in which educational formats are interlinked, according to Kolb´s experiential learning cycle. The content of these courses is determined by the Entrustable Professional Activities (EPAs) for the clerkship in family medicine, combined with the most common chief complaints of patients in the GP's practice. In 2019, the first course was implemented at the Technical University of Munich, Germany, with 6 medical students. A first seminar discusses patients who the students have seen for themselves during their clerkship in family medicine. In addition, matching theory is discussed and skills are practiced. In the next seminar, students apply the acquired knowledge and skills in scenarios with standardized patients. Students evaluated the courses as positive. The evaluations show they find discussing personally experienced patient cases and the opportunity to practice very valuable. CONCLUSIONS A course design according to Kolb's Experiential learning cycle, which integrates experience, theory and simulation, is a valuable addition to existing forms of teaching in medical education. Students appreciated both discussing personally experienced patient cases and the opportunity to re-practice similar cases in a simulated environment. To gain more insight into the learning effects, it is recommended to further explore this approach in a different context.
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Affiliation(s)
- M. Wijnen-Meijer
- Technical University of Munich, School of Medicine, TUM Medical
Education Center, Munich, Germany
| | - T. Brandhuber
- Technical University of Munich, School of Medicine, Institute of
General Practice and Health Services Research, Munich, Germany
| | - A. Schneider
- Technical University of Munich, School of Medicine, Institute of
General Practice and Health Services Research, Munich, Germany
| | - P.O. Berberat
- Technical University of Munich, School of Medicine, TUM Medical
Education Center, Munich, Germany
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Christopher A, Gortemiller T, Zemmer J, Wronowski M. Interprofessional Healthcare Student Perceptions of Clinical vs. Simulation Learning Through Participation in Underserved Health Clinics. MEDICAL SCIENCE EDUCATOR 2021; 31:1291-1304. [PMID: 33996247 PMCID: PMC8112832 DOI: 10.1007/s40670-021-01297-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/23/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE The purpose of this research project is to determine how well three health profession student discipline's learning needs are met through a real clinical interprofessional environment compared to previous simulation experience by assessing student perceptions following participation in a student-run underserved healthcare setting. METHODS Various student-run health clinics were initiated throughout Southwest Ohio in underserved settings precepted by healthcare profession faculty. Physician assistant, pharmacy, and medical student learning needs and interprofessional perceptions were assessed following clinic participation utilizing the Clinical Learning Environment Comparison Survey (CLECS) and qualitative comment to allow objectification of students' perceptions to different clinical learning environments and the interprofessional setting. RESULTS The survey had responses from medical, pharmacy, and physician assistant students (n = 60). Overall, students preferred traditional learning environments compared to previous simulated clinical experiences (p < .01). Significance for communication, holism, and the teaching-learning dyad was demonstrated comparing the traditional clinical experience to the simulated experience (p < .05). Pharmacy students felt their critical thinking skills were more significantly improved after the simulated environment (p < .05). Males more significantly favored teaching-learning dyad simulation vs. the traditional environment (F = 5.86, p < .05). Qualitative comments regarding the interprofessional experience included themes of teamwork, patient communication, and clinical skills. CONCLUSION When comparing a traditional clinical experience in an interprofessional student-run clinic vs. previous simulated learning clinical environment, physician assistant, pharmacy, and medical students qualitatively and quantitatively perceive their learning needs are greater met in the volunteer student-run clinic for communication, holism, and the teaching-learning dyad. There were variations in preferences based on sex and discipline of the student.
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Affiliation(s)
- Amy Christopher
- University of Dayton, Fitz Hall, 300 College Park, Dayton, OH USA
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Reger GM, Norr AM, Gramlich MA, Buchman JM. Virtual Standardized Patients for Mental Health Education. Curr Psychiatry Rep 2021; 23:57. [PMID: 34268633 DOI: 10.1007/s11920-021-01273-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW The training of psychiatrists and other mental health professionals requires education on a range of interpersonal, communication, and psychotherapy techniques. Classroom and workshop training must be augmented by experiential learning with feedback for skill implementation with fidelity. Virtual standardized patients (VSPs) are computerized conversational agents that can support experiential learning through standardized, consequence-free training environments at reduced costs. RECENT FINDINGS Research on mental health VSPs is rife with feasibility and acceptability pilot studies across various training populations and settings. Users have generally reported positive reactions to training with VSPs, though frustrations with some VSP speech recognition or VSP response relevance has been reported. Several studies have demonstrated a promising transfer of clinical skills from VSP training to human standardized patients and randomized trials supporting improved skill relative to reading or academic study are encouraging. As technology improves and natural language processing and accurate computer response generation for broad ranging conversational topics emerges, the field would benefit from research on the characteristics of effective VSPs for a range of purposes and trainee populations. Well-designed randomized evaluations of VSPs relative to best practices in education are needed, particularly regarding the impact of VSPs on clinical practice among actual patients.
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Affiliation(s)
- Greg M Reger
- VA Puget Sound Health Care System, 9600 Veterans Drive, A-116, Tacoma, WA, 98493, USA. .,University of Washington School of Medicine, Seattle, WA, USA.
| | - Aaron M Norr
- University of Washington School of Medicine, Seattle, WA, USA.,VISN 20 Mental Illness Research, Education and Clinical Center, Seattle, WA, USA
| | - Michael A Gramlich
- VA Puget Sound Health Care System, 9600 Veterans Drive, A-116, Tacoma, WA, 98493, USA
| | - Jennifer M Buchman
- VA Puget Sound Health Care System, 9600 Veterans Drive, A-116, Tacoma, WA, 98493, USA
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Inurreta-Díaz M, Morales-Gual YM, Aguilar-Vargas E, Álvarez-Baeza A, Magriñá-Lizama JS, Cetina-Sauri G, Méndez-Domínguez N. Family-Planning counselling simulation for medical students: An exploratory educational intervention. EDUCACIÓN MÉDICA 2021; 22:271-276. [DOI: 10.1016/j.edumed.2020.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/02/2024]
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Luo Y, Geng C, Chen X, Zhang Y, Zou Z, Bai J. Three learning modalities' impact on clinical judgment and perceptions in newly graduated registered nurses: A quasi-experimental study. Nurs Health Sci 2021; 23:538-546. [PMID: 33864331 DOI: 10.1111/nhs.12842] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/31/2021] [Accepted: 04/13/2021] [Indexed: 11/30/2022]
Abstract
Newly graduated registered nurses face numerous challenges stemming from high patient workload, complicated interpersonal relationships, and a lack of nursing competence, which can lead to transitional shocks. Clinical judgment and confidence are well-known keys to successful role transitions for these nurses. Simulation training is proposed as a new modality for enhancing comprehensive clinical competence of nurses, but current evidence on the impact of different simulations on nurses' clinical judgment and confidence are still limited or inconsistent. This study compared the impact of three types of learning modalities on newly graduated registered nurses' clinical judgment, perceptions of self-confidence, and evaluations of the design features of the learning modalities. A quasi-experimental design was used. Fifty-nine participants were randomly assigned to three groups: (1) high-fidelity simulation, (2) virtual simulation, and (3) case study. Scales were used after the simulation. The virtual simulation group showed a higher level of clinical judgment. The high-fidelity simulation group felt more confident than the virtual simulation and case study groups. Both the high-fidelity simulation group and virtual simulation group reported higher scores in the domain of fidelity.
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Affiliation(s)
- Yiqing Luo
- Wuhan University School of Health Sciences, Wuhan, China
| | - Cong Geng
- Wuhan University School of Health Sciences, Wuhan, China
| | - Xiaoli Chen
- Wuhan University School of Health Sciences, Wuhan, China
| | | | - Zhijie Zou
- Wuhan University School of Health Sciences, Wuhan, China
| | - Jinbing Bai
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia, USA
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Bahrami M, Hadadgar A, Fuladvandi M. Designing Virtual Patients for Education of Nursing Students in Cancer Course. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:133-136. [PMID: 34036060 PMCID: PMC8132870 DOI: 10.4103/ijnmr.ijnmr_327_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 09/27/2020] [Accepted: 12/27/2020] [Indexed: 11/05/2022]
Abstract
Background: One of the best approaches to promote clinical reasoning in nursing education is Virtual Patient (VP). The purpose of this study was to design and implement VPs for nursing student's education in caring for cancer patients. Materials and Methods: In the first stage, through a descriptive-exploratory qualitative study using a focus group method, topics with higher priority in cancer nursing were identified. Then, based on the VP Nursing Design Model (VPNDM) for each of these topics, a scenario and then an interactive VP was designed and implemented in the Open Labyrinth application. The content validity of VPs was evaluated by eight experts and then the face validity was examined in the pilot group including 15 nursing students. Results: Topics with higher priority in cancer nursing courses were mastectomy, chemotherapy, radiotherapy, hypercalcemia, spinal cord compression, cardiac tamponade, and superior vena cava syndrome. For five scenarios based on the nursing process in three sequences (signs and symptoms, diagnosis and interventions) the VPs were designed. In this process, learning objectives, determining the critical path, adding branches at the decision point, adding feedback, completing the clinical course and related data, and adding multimedia were considered. VPs were revised based on the proposed modifications following face and content validity. Conclusions: This article presents VP design steps for use in a nursing student training course. The researchers were able to provide and validate five VPs to care for cancer patients based on the VPNDM.
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Affiliation(s)
- Masoud Bahrami
- Cancer Prevention Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arash Hadadgar
- Department of Medical Education, Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoumeh Fuladvandi
- School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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Lebdai S, Mauget M, Cousseau P, Granry JC, Martin L. Improving Academic Performance in Medical Students Using Immersive Virtual Patient Simulation: A Randomized Controlled Trial. JOURNAL OF SURGICAL EDUCATION 2021; 78:478-484. [PMID: 32893155 DOI: 10.1016/j.jsurg.2020.08.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 08/06/2020] [Accepted: 08/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To determine whether immersive virtual patient simulation (IVPS) on the MedicActiv platform is influential in improving student academic performance in module validation tests. DESIGN In this prospective randomized controlled study a comparison was made between IVPS training combined with regular faculty courses versus courses alone. The primary endpoint was module validation grades. Secondary endpoints were satisfaction scores (overall interest, ergonomics, realism, immersion, and training efficiency). SETTING Angers School of Medicine, France. PARTICIPANTS 2018 to 2019 class of fourth-year students, included on a voluntary basis. In the first semester 51 students were included, of whom 13 were excluded for lack of compliance (6 and 7 from the IVPS and control groups, respectively). In the second semester we included 57 students, of whom 10 were excluded for lack of compliance (2 and 8 from the IVPS and control groups, respectively). RESULTS Mean age was 21 years (±0.8). There were 85 female and 23 male students. In the first semester mean grades were 13.4 ± 1.6 versus 11/.9 ± 2.4 in the IVPS and control groups, respectively (p = 0.038). In the second semester mean grades were 15.3 ± 2.5 versus 11.9 ± 3.6 in the IVPS and control groups, respectively p < 0.001. The entire study population was pooled (n = 85): mean grades were 14.5 ± 2.4 versus 11.9 ± 3 in the IVPS group and the control group, respectively, p < 0.001. The satisfaction questionnaire response rate was 54% (46/85). Score percentages ≥4 regarding overall interest, ergonomics, realism, immersion and training efficiency were 89%, 85%, 100%, 93%, and 93% respectively. CONCLUSIONS Complementing conventional university education with simulation of virtual consultation cases on the MedicActiv platform improved student academic performance as compared with students studying regular courses. Students reported high levels of satisfaction with overall interest, ergonomics, realism, immersion and training efficiency on the MedicActiv platform.
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Affiliation(s)
- Souhil Lebdai
- Urology Department, University Hospital of Angers, Angers, France; AllSims Center for Simulation in Healthcare, University Hospital of Angers, Angers, France.
| | - Matteo Mauget
- AllSims Center for Simulation in Healthcare, University Hospital of Angers, Angers, France
| | - Pierre Cousseau
- AllSims Center for Simulation in Healthcare, University Hospital of Angers, Angers, France
| | - Jean Claude Granry
- AllSims Center for Simulation in Healthcare, University Hospital of Angers, Angers, France
| | - Ludovic Martin
- AllSims Center for Simulation in Healthcare, University Hospital of Angers, Angers, France
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Steiner I, Brandenberger J, Wagner F, Huwendiek S. [Blended Learning With Virtual Pediatric Emergency Patients for Medical Students]. PRAXIS 2021; 110:961-966. [PMID: 34875867 DOI: 10.1024/1661-8157/a003749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Blended Learning With Virtual Pediatric Emergency Patients for Medical Students Abstract. Treating critically ill children is a major challenge for learners. Medical Students often feel inadequately prepared for their later role as physicians. This article describes the implementation and evaluation of blended learning using virtual patients (VP) during the student rotation at the pediatric emergency department Inselspital Bern. Students rated the project as highly beneficial and recommended its integration into the entire clinical curriculum.
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Affiliation(s)
- Isabelle Steiner
- Notfallzentrum für Kinder und Jugendliche, Universitäre Kinderkliniken, Inselspital, Bern
| | - Julia Brandenberger
- Notfallzentrum für Kinder und Jugendliche, Universitäre Kinderkliniken, Inselspital, Bern
| | - Felicitas Wagner
- Institut für Medizinische Lehre, Abteilung für Assessment und Evaluation, Medizinische Fakultät, Bern
| | - Sören Huwendiek
- Institut für Medizinische Lehre, Abteilung für Assessment und Evaluation, Medizinische Fakultät, Bern
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Milne-Ives M, de Cock C, Lim E, Shehadeh MH, de Pennington N, Mole G, Normando E, Meinert E. The Effectiveness of Artificial Intelligence Conversational Agents in Health Care: Systematic Review. J Med Internet Res 2020; 22:e20346. [PMID: 33090118 PMCID: PMC7644372 DOI: 10.2196/20346] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/12/2020] [Accepted: 09/02/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The high demand for health care services and the growing capability of artificial intelligence have led to the development of conversational agents designed to support a variety of health-related activities, including behavior change, treatment support, health monitoring, training, triage, and screening support. Automation of these tasks could free clinicians to focus on more complex work and increase the accessibility to health care services for the public. An overarching assessment of the acceptability, usability, and effectiveness of these agents in health care is needed to collate the evidence so that future development can target areas for improvement and potential for sustainable adoption. OBJECTIVE This systematic review aims to assess the effectiveness and usability of conversational agents in health care and identify the elements that users like and dislike to inform future research and development of these agents. METHODS PubMed, Medline (Ovid), EMBASE (Excerpta Medica dataBASE), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Science, and the Association for Computing Machinery Digital Library were systematically searched for articles published since 2008 that evaluated unconstrained natural language processing conversational agents used in health care. EndNote (version X9, Clarivate Analytics) reference management software was used for initial screening, and full-text screening was conducted by 1 reviewer. Data were extracted, and the risk of bias was assessed by one reviewer and validated by another. RESULTS A total of 31 studies were selected and included a variety of conversational agents, including 14 chatbots (2 of which were voice chatbots), 6 embodied conversational agents (3 of which were interactive voice response calls, virtual patients, and speech recognition screening systems), 1 contextual question-answering agent, and 1 voice recognition triage system. Overall, the evidence reported was mostly positive or mixed. Usability and satisfaction performed well (27/30 and 26/31), and positive or mixed effectiveness was found in three-quarters of the studies (23/30). However, there were several limitations of the agents highlighted in specific qualitative feedback. CONCLUSIONS The studies generally reported positive or mixed evidence for the effectiveness, usability, and satisfactoriness of the conversational agents investigated, but qualitative user perceptions were more mixed. The quality of many of the studies was limited, and improved study design and reporting are necessary to more accurately evaluate the usefulness of the agents in health care and identify key areas for improvement. Further research should also analyze the cost-effectiveness, privacy, and security of the agents. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/16934.
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Affiliation(s)
- Madison Milne-Ives
- Digitally Enabled PrevenTative Health Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Caroline de Cock
- Digitally Enabled PrevenTative Health Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Ernest Lim
- Imperial College Healthcare NHS Trust, London, United Kingdom
- Ufonia Limited, Oxford, United Kingdom
| | | | - Nick de Pennington
- Ufonia Limited, Oxford, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Guy Mole
- Ufonia Limited, Oxford, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Edward Meinert
- Digitally Enabled PrevenTative Health Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
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Dua AB, Kilian A, Grainger R, Fantus SA, Wallace ZS, Buttgereit F, Jonas BL. Challenges, collaboration, and innovation in rheumatology education during the COVID-19 pandemic: leveraging new ways to teach. Clin Rheumatol 2020; 39:3535-3541. [PMID: 33067772 PMCID: PMC7567647 DOI: 10.1007/s10067-020-05449-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 12/05/2022]
Abstract
The novel coronavirus disease (COVID-19) pandemic has significantly impacted the field of rheumatology, in both the delivery of clinical care and didactic education for our trainees. These changes have generated significant strain for program directors and clinical educators who have had to leverage technology and develop new systems to ensure continued trainee education and assessment. We aim to outline the impacts on formal education programs presented by these unprecedented disruptions, describe the development and deployment of online teaching, reflect on the challenges and opportunities for technology-enabled learning and use of social media for education, and give some international perspectives on impacts on postgraduate rheumatology training outside the USA. With the rapid dissolution of barriers in place during the pre-COVID-19 era, we have the opportunity to assess the efficacy of new methods of care and further integrate technology into teaching and assessment. We propose that a hybrid in-person and technology-enabled learning approach, so-called blended learning, is likely to remain the most desirable future model for supporting trainee learning.
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Affiliation(s)
- Anisha B Dua
- Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine, Galter Pavilion, 675 N St Clair St Ste 14-100, Chicago, IL, 60611, USA.
| | - Adam Kilian
- Department of Medicine, Division of Rheumatology, George Washington University Medical Center, Washington, DC, USA
| | - Rebecca Grainger
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Sarah A Fantus
- Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine, Galter Pavilion, 675 N St Clair St Ste 14-100, Chicago, IL, 60611, USA
| | - Zachary S Wallace
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Frank Buttgereit
- Charité University Medicine, Department of Rheumatology and Clinical Immunology, Berlin, Germany
| | - Beth L Jonas
- Department of Medicine, Division of Rheumatology, Allergy, and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Barry AR, Turgeon RD, Ellis UM. Physical assessment educational programs for pharmacists and pharmacy students: A systematic review. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Arden R. Barry
- Faculty of Pharmaceutical Sciences, University of British Columbia Vancouver British Columbia Canada
- Chilliwack General Hospital, Lower Mainland Pharmacy Services Chilliwack British Columbia Canada
| | - Ricky D. Turgeon
- Faculty of Pharmaceutical Sciences, University of British Columbia Vancouver British Columbia Canada
- St. Paul's Hospital, Lower Mainland Pharmacy Services Vancouver British Columbia Canada
| | - Ursula M. Ellis
- Woodward Library, University of British Columbia Vancouver British Columbia Canada
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Plackett R, Kassianos AP, Kambouri M, Kay N, Mylan S, Hopwood J, Schartau P, Gray S, Timmis J, Bennett S, Valerio C, Rodrigues V, Player E, Hamilton W, Raine R, Duffy S, Sheringham J. Online patient simulation training to improve clinical reasoning: a feasibility randomised controlled trial. BMC MEDICAL EDUCATION 2020; 20:245. [PMID: 32736583 PMCID: PMC7395338 DOI: 10.1186/s12909-020-02168-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/22/2020] [Indexed: 05/25/2023]
Abstract
BACKGROUND Online patient simulations (OPS) are a novel method for teaching clinical reasoning skills to students and could contribute to reducing diagnostic errors. However, little is known about how best to implement and evaluate OPS in medical curricula. The aim of this study was to assess the feasibility, acceptability and potential effects of eCREST - the electronic Clinical Reasoning Educational Simulation Tool. METHODS A feasibility randomised controlled trial was conducted with final year undergraduate students from three UK medical schools in academic year 2016/2017 (cohort one) and 2017/2018 (cohort two). Student volunteers were recruited in cohort one via email and on teaching days, and in cohort two eCREST was also integrated into a relevant module in the curriculum. The intervention group received three patient cases and the control group received teaching as usual; allocation ratio was 1:1. Researchers were blind to allocation. Clinical reasoning skills were measured using a survey after 1 week and a patient case after 1 month. RESULTS Across schools, 264 students participated (18.2% of all eligible). Cohort two had greater uptake (183/833, 22%) than cohort one (81/621, 13%). After 1 week, 99/137 (72%) of the intervention and 86/127 (68%) of the control group remained in the study. eCREST improved students' ability to gather essential information from patients over controls (OR = 1.4; 95% CI 1.1-1.7, n = 148). Of the intervention group, most (80/98, 82%) agreed eCREST helped them to learn clinical reasoning skills. CONCLUSIONS eCREST was highly acceptable and improved data gathering skills that could reduce diagnostic errors. Uptake was low but improved when integrated into course delivery. A summative trial is needed to estimate effectiveness.
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Affiliation(s)
- Ruth Plackett
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
| | - Angelos P Kassianos
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | | | - Natasha Kay
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Sophie Mylan
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Shani Gray
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Jessica Timmis
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | | | | | | | | | - Willie Hamilton
- Institute of Health Service Research, University of Exeter, Exeter, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Stephen Duffy
- Wolfson Institute of Preventive Medicine, QMUL, London, UK
| | - Jessica Sheringham
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
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Koumpouras F, Helfgott S. Stand Together and Deliver: Challenges and Opportunities for Rheumatology Education During the COVID-19 Pandemic. Arthritis Rheumatol 2020; 72:1064-1066. [PMID: 32270923 PMCID: PMC7262333 DOI: 10.1002/art.41278] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 03/31/2020] [Indexed: 01/09/2023]
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Forero DA, Majeed MH, Ruiz-Díaz P. Current trends and future perspectives for medical education in Colombia. MEDICAL TEACHER 2020; 42:17-23. [PMID: 31491350 DOI: 10.1080/0142159x.2019.1659944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Colombia is the second largest country in South America. In this article, we provide an overview of medical education in Colombia, including a description of existing public and private medical schools and available undergraduate and postgraduate programs. Medical education in Colombia has evolved through time, following international trends. In addition to 61 undergraduate medical programs, there are 529 postgraduate clinical, 30 PhD, and 131 Master programs in health sciences in Colombia. We identify current challenges and highlight future perspectives for medical education in Colombia.
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Affiliation(s)
- Diego A Forero
- PhD Program in Health Sciences, School of Medicine, Universidad Antonio Nariño, Bogotá, Colombia
- Laboratory of NeuroPsychiatric Genetics, Biomedical Sciences Research Group, School of Medicine, Universidad Antonio Nariño, Bogotá, Colombia
| | - Muhammad Hassan Majeed
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Paola Ruiz-Díaz
- Academic Unit for Education Sciences, Universidad Piloto de Colombia, Bogotá, Colombia
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Luo J, Zheng J, He H, Liu T, Zhao J, Li K. Quality of Virtual Patients on WeChat for Nursing History-Taking Training. Clin Simul Nurs 2019. [DOI: 10.1016/j.ecns.2019.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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