Does case-based blended-learning expedite the transfer of declarative knowledge to procedural knowledge in practice?

Declarative knowledge in oral health: The case of the term 'centric occlusion'

INTRODUCTION

The lack of academic agreement in the practical or clinical use of declarative knowledge can generate unnecessary confusion and miscommunication. The concept Centric Occlusion (CO) is part of the body of declarative knowledge in dentistry, but its definition remains unclear.

OBJECTIVE

To ascertain the CO concept in articles published in dental journals as a study case for the dentistry "corpus" of declarative knowledge.

METHODOLOGY

The alternative definitions of CO used by the GPT (Glossary of Prosthodontic Terms) from 1956-1977, 'CO as a synonym for maximum intercuspal contact (MIC)', or by the GPT from 1987-2017, 'CO may or may not coincide with MIC', were searched in the articles. The association between the CO definition used and variables such as article aims, journal scope and authors specialty was assessed.

RESULTS

Eight hundred and twelve articles were analysed. The widespread use of CO as synonym of MIC was the main finding and was significantly associated to the Orthodontics field. The CO definition according to the GPT 1987-2017 was less frequently observed but appeared in all dentistry fields, showing a significant association with the Oral Rehabilitation field. The difficulty of incorporating the current definition of CO (by GPT) into the main clinical discussions was evidenced all the long of the review process.

CONCLUSION

The lack of consensus in the concept use was confirmed by the present study case, showing the influence of specific fields in Oral Health declarative knowledge. This methodology can provide a tool to the academy to assess controversial terms or concepts in Oral Health education, thus facilitating the critical and reflexive learning by students.

Medical education in times of war: a mixed-methods needs analysis at Ukrainian medical schools

BACKGROUND

As Ukraine struggles with the education of healthcare professionals due to the war, we aimed to identify the specific effects of the war on medical education, the resulting needs, and the expected consequences for schools, faculty, staff, students, and the healthcare system.

METHODS

In October and November 2022, we performed a survey of students, faculty, and staff of medical schools in Ukraine and conducted semi-structured interviews with faculty leaders (i.e., rectors, vice-rectors). We conducted a descriptive analysis of the survey's closed-ended questions. The survey and the interviews included open-ended questions about war-related restrictions to teaching and learning, resulting needs, and expected consequences, for which we applied a thematic analysis.

RESULTS

We received 239 survey responses (N = 49 faculty and staff, N = 190 students) and conducted nine interviews with faculty leaders across Ukraine. Most survey participants indicated that they had experienced restrictions or changes to their work or study due to the war (86% of faculty and staff, 69% of students). From the thematic analysis of the survey and interviews, we identified eight themes: disruption of teaching, increased workload, mental stress, financial restrictions, non-war related needs, international cooperation, quality of education, and prospects of future professionals. The quality of healthcare education in Ukraine was threatened, and schools, faculty, staff, and students were under great strain. While already established international cooperation has been supportive, some needs have still not been addressed.

CONCLUSIONS

We hope that our findings will help researchers and educators from abroad contribute to meeting Ukraine's needs in medical education.

Factors That Enhance and Hinder the Retention and Transfer of Online Pre-Clinical Skills Training to Facilitate Blended Learning

Purpose

During the SARS-CoV-2 pandemic, various online instructional strategies in clinical skills training were piloted. The sudden transition to the remote platform circumvented the rigorous planning associated with curriculum reform. This study aimed to explore students' and tutors' perceptions of factors that promoted or hindered successful learning transfer and to propose a blended conceptual model to guide affective, cognitive, and psychomotor clinical skills training in the pre-clinical phase of medical education.

Methods

A mixed-method quasi-experimental study assessed third-year students' transfer of clinical skills and knowledge following online learning in 2021. Students and their tutors completed online surveys that included open and closed-ended questions regarding factors influencing their experience of the adapted teaching methods. Descriptive statistical analysis was used for the quantitative data. Qualitative responses were thematically analyzed.

Results

One hundred fourteen students (48%) and seven tutors (100%) responded to the surveys. The questionnaires' internal consistency and construct validity were determined using Cronbach's α-Coefficient. There was an overall positive response (86%) to the acceptability of the online platform in clinical skills training. Using online simulations with targeted onsite practice was reported as effective in clinical skills training. Tutors perceived students as well-prepared for the skills laboratory. Five emergent themes, qualified by a linear model of asynchronous and synchronous online and onsite teaching with the evaluation of the instructional design and institutional support, informed the proposed blended learning guide for clinical skills training in the pre-clinical phase.

Conclusion

Blended clinical skills learning that included the flipped classroom concept was well-accepted. Virtual patients proved a convenient cognitive preparation tool for skills training and potentially optimized teaching delivery. The study found that the adapted teaching frameworks incorporating an online clinical skills component into a modified onsite curriculum augmented learners' ability to transfer knowledge to the clinical skills laboratory. An integrated five-step blended model is proposed for future interventions.

Online case-based learning in medical education: a scoping review

BACKGROUND

Case-Based Learning (CBL) in medical education is a teaching approach that engages students as learners through active learning in small, collaborative groups to solve cases from clinical patients. Due to the challenges afforded by the COVID-19 pandemic, small group learning such as CBL, transitioned quickly to include technology-enhanced learning to enable distance delivery, with little information on how to apply pedagogical frameworks and use learning theories to design and deliver online content.

METHODS

To extend understanding of online CBL a scoping review protocol following the PRISMA-ScR framework explored the literature that describes the use of online CBL application in medical education and the outcomes, perceptions, and learning theories. A literature search was conducted in January 2022 followed by a subsequent review in October 2022. After peer review using the PRESS guidelines, the CASP appraisal tool was used to assess the rigor of each study design.

RESULTS

The scoping review identified literature published between 2010 and 2022 (n = 13 articles), on online CBL in the field of medical education with 11 observational studies describing student and facilitator perceptions and two randomized controlled studies. Positive perceptions of online learning included a flexible work-life balance, connection with learners, and improved accessibility. Negative experiences of online CBL included poor internet access, a distracting learning environment, and loss of communication. In the studies that collected student performance data, results showed equivalent or improved outcomes compared to the control. The CASP appraisal tool highlighted the deficiencies in most study designs, lack of framework or learning theory, and poor reproducibility of the methods to answer the research questions.

CONCLUSION

This scoping review identified literature to describe the academic outcomes, and student and facilitator perceptions of online CBL in medical education. However, the CASP tool uncovered deficiencies in study descriptions and design leading to poor quality evidence in this area. The authors provide recommendations for frameworks and learning theories for the future implementation of online CBL.

Developing a Novel Case-Based Gastroenterology/Hepatology Online Resource for Enhanced Education During and After the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic reshaped the delivery of medical education, necessitating novel modes of instruction to facilitate distance learning. Online medical education resources provide opportunities for self-directed and asynchronous learning. GISIM is a free, open access educational website dedicated to gastroenterology (GI)/hepatology, which teaches pathophysiology and disease management, and supports clinical reasoning skill development through interactive, dynamic, case presentation-based journeys.

AIMS

(1) To describe the creation of a mobile-optimized, GI/hepatology educational resource for medical trainees, and (2) to report on trainee feedback on completing and authoring GISIM cases.

METHODS

GISIM was created on WordPress and modeled after NephSIM, an e-learning platform dedicated to Nephrology. Content was developed by internal medicine residents and GI/hepatology fellows and attendings. Cases are interactive, prompting users to select differential diagnoses and management plans, with immediate feedback provided on response. Self-reported user demographics and website feedback were collected with an embedded survey. A separate survey evaluated case authors' experiences.

RESULTS

GISIM launched in February 2021 and received 12,184 website views and 2003 unique visitors between February 1 2021 and February 28 2022. New cases are disseminated bimonthly. Sixty-one user surveys were collected, with a majority completed by fellows (38%) and residents (26%). All users found the website easy to use and most reported enhanced understanding of case topic areas. Nine author surveys were collected. Authors reported significant learning on chosen topics and improved clinical knowledge through their participation.

CONCLUSIONS

We developed a novel GI/hepatology case-based resource that enables distance learning and was perceived as a valuable educational tool by users and authors.

Evaluating the effectiveness of a new student-centred laboratory training strategy in clinical biochemistry teaching

BACKGROUND

The error-proneness in the preanalytical and postanalytical stages is higher than that in the analytical stage of the total testing process. However, preanalytical and postanalytical quality management has not received enough attention in medical laboratory education and tests in clinical biochemistry courses.

METHODS/APPROACH

Clinical biochemistry teaching program aim to improve students' awareness and ability of quality management according to international organization for standardization 15,189 requirements. We designed a student-centred laboratory training program, according to case-based learning that included 4 stages: "establish an overall testing process based on the patient's clinical indicator, clarify principles, improve operational skills, and review process and continuous improvement". The program was implemented in our college during the winter semesters of 2019 and 2020. A total of 185 undergraduate students majoring in medical laboratory science participated in the program as a test group, and the other 172 students were set up as the control group and adopted the conventional method. The participants were asked to finish an online survey to evaluate the class at the end.

RESULTS/OUTCOMES

The test group had significantly better examination scores not only in experimental operational skills (89.27 ± 7.16 vs. 77.51 ± 4.72, p < 0.05 in 2019 grade, 90.31 ± 5.35 vs. 72.87 ± 8.41 in 2020 grade) but also in total examination (83.47 ± 6.16 vs. 68.90 ± 5.86 in 2019 grade, 82.42 ± 5.72 vs. 69.55 ± 7.54 in 2020 grade) than the control group. The results of the questionnaire survey revealed that the students in the test group better achieved classroom goals than those in the control group (all p < 0.05).

CONCLUSIONS

The new student-centred laboratory training program based on case-based learning in clinical biochemistry is an effective and acceptable strategy compared with the conventional training program.

Using standardized patients for undergraduate clinical skills training in an introductory course to psychiatry

BACKGROUND

The goal of this study was to assess the value and acceptance of Standardized or Simulated Patients (SPs) for training clinically inexperienced undergraduate medical students in psychiatric history taking, psychopathological assessment, and communication with psychiatric patients.

METHODS

As part of a newly developed introductory course to psychiatry, pairs of 3rd year medical students conducted psychiatric assessments of SPs, including history and psychopathological state, under the supervision of a clinical lecturer. Prior to the assessment, students attended introductory lectures to communication in psychiatry and psychopathology but were clinically inexperienced. After the interview, the students' summary of their findings was discussed with other students and the lecturer. Students, lecturers, and actors were invited to a survey after the course. Questions for the students included self-reports about perceived learning success and authenticity of the interviews.

RESULTS

41 students, 6 actors and 8 lecturers completed the survey (response rates of 48%, 50%, and 100%, respectively). The survey results indicated that, despite their lack of clinical experience, students learned how to conduct a psychiatric interview, communicate in a non-judgmental and empathetic manner, take a psychiatric history and perform a psychopathological examination. SPs were perceived as authentic. The survey results suggested that this setting allowed for an enjoyable, non-distressful and motivating learning experience within a restricted time frame of just two afternoons.

CONCLUSION

The results indicated that the SP approach presented is useful for teaching clinical skills in psychiatry to students with limited previous clinical experience and knowledge of psychiatry. We argue that SPs can be used to teach practical psychiatric skills already during an early phase of the curriculum. Limitations of our study include a limited sample size, a temporal gap between the course and the survey, reliance on self-reports, and lack of comparison to alternative interventions.

Influencing Appropriate Statin Use in a Charity Care Primary Clinic

According to the American College of Cardiology/American Heart Association (ACC/AHA) new cholesterol management guidelines in 2019, statin regimen was prescribed to only about 46.4% and 30% of diabetes (DM) patients and patients with atherosclerotic cardiovascular disease (ASCVD), respectively. Atherosclerotic cardiovascular disease accounts for most deaths and disabilities in North America. This study argues that a systematic approach to identifying targeted interventions to adhere to the statin regimen for ASCVD is sparse in previous studies. This study seeks to address the research gap. Besides, the study argues that the statin regimen could improve cholesterol management with the enablers of pharmacy, providers, electronic medical records (E.M.R.), and patients. It paves the way for future research on cardiovascular and statin regimens from different perspectives. Current study has adopted the Qualitative observation method. Accordingly, the study approached the charity care primary clinic serving a large population in the northeastern part of the United States, which constitutes the project's setting. The facility has 51 internal medicine residents. The facility has E.H.R., which is used by the clinical staff. Besides, providers use electronic medication prescribing (E-Scribe). Four PDSA cycles were run in six months. Here, the interventions were intensified during each subsequent cycle. The interventions were then incorporated into routine clinical practice. Based on the observation, the study found a 25% relative improvement by six months based on the baseline data of the appropriate intensity statin prescription for patients with ASCVD or DM by medical resident trainees in our single-center primary care clinic. A total of 77% of cardiovascular disease patients were found to be on an appropriate statin dose at baseline. On the other hand, the proportion of patients with DM who were on proper dose statin was 80.4%. According to the study's findings, PDSA could result in a faster uptake and support of the ACC/AHA guidelines. Evidence indicates that overmedication of persons at low risk and time constraints are some of the most significant impediments to the greater use of prescription medications. Proactive panel management can help improve statins' use by ensuring they are used appropriately.

A comparative analysis of the impact of online, blended, and face-to-face learning on medical students' clinical competency in the affective, cognitive, and psychomotor domains

BACKGROUND

The Coronavirus Disease-2019 (COVID-19) pandemic in South Africa compelled medical schools to switch to a purely online curriculum. The innovative changes transformed the standard clinical skills curriculum to increase learning transfer to bridge the theory-practice gap. The efficacy of this intervention remains unknown. This study aims to measure medical students' clinical competency in the affective, cognitive, and psychomotor domains by assessing clinical skills knowledge retention and transfer from the online platform compared to face-to-face and blended learning.

METHODS

A non-random cross-sectional quasi-experimental study assessed third-year medical students' knowledge retention and learning transfer in three domains of clinical skills competence. Data were obtained using a score sheet during a directly observed formative and a trial online summative assessment. One hundred and one third-year medical students volunteered for the formative onsite assessment that tested the psychomotor domain. Two hundred and thirty-nine students were evaluated on the affective and cognitive domains in the summative online trial mini-objective structured clinical examination (tm-OSCE). The OSCE scores were analysed using descriptive statistics. The significance of the findings was evaluated by comparing OSCE scores with the pre-pandemic 2019 third-year medical students.

RESULTS

Statistically significant differences were found between the two cohorts of medical students from both years (p < 0.05). The 2021 blended group's (n = 101) medians were 90%, 95%CI [86, 92], 82%, 95%CI [80, 85], and 87%, 95% CI [84, 90] for the psychomotor, affective, and cognitive skills, respectively. The e-learning group's affective and cognitive skills medians were 78%, 95%CI [73, 79] and 76%, 95%CI [71, 78], respectively. The 2019 face-to-face cohort (n = 249) achieved medians of 70%, 95% CI [69, 72] and 84%, 95%CI [82, 86] for the affective and psychomotor skills, respectively.

CONCLUSION

Medical students demonstrated near and far transfer bridging the theory-practice gap in three clinical skills domains. The blended group performed significantly better than the e-learning and face-to-face groups. Medical schools and educators play a vital role in overcoming learning challenges and achieving higher transfer levels by adopting multiple student-centered teaching delivery approaches and arranging immediate application opportunities. This study offers medical educators suggestions that encourage the transfer of online learning to face-to-face practice, decentralising medical education with a revised blended learning strategy.

Increasing Collaborative Discussion in Case-Based Learning Improves Student Engagement and Knowledge Acquisition

BACKGROUND

In the transition from academic to clinical learning, the development of clinical reasoning skills and teamwork is essential, but not easily achieved by didactic teaching only. Case-based learning (CBL) was designed to stimulate discussions of genuine clinical cases and diagnoses but in our initial format (CBL'10) remained predominantly tutor-driven rather than student-directed. However, interactive teaching methods stimulate deep learning and consolidate taught material, and we therefore introduced a more collaborative CBL (cCBL), featuring a structured format with discussions in small breakout groups. This aimed to increase student participation and improve learning outcomes.

METHOD

A survey with open and closed questions was distributed among 149 students and 36 tutors that had participated in sessions of both CBL formats. A statistical analysis compared exam scores of topics taught via CBL'10 and cCBL.

RESULTS

Students and tutors both evaluated the switch to cCBL positively, reporting that it increased student participation and enhanced consolidation and integration of the wider subject area. They also reported that the cCBL sessions increased constructive discussion and stimulated deep learning. Moreover, tutors found the more structured cCBL sessions easier to facilitate. Analysis of exam results showed that summative assessment scores of subjects switched to cCBL significantly increased compared to previous years, whereas scores of subjects that remained taught as CBL'10 did not change.

CONCLUSIONS

Compared to our initial, tutor-led CBL format, cCBL resulted in improved educational outcomes, leading to increased participation, confidence, discussion and higher exam scores.

Rethinking clinical decision-making to improve clinical reasoning

Improving clinical reasoning techniques is the right way to facilitate decision-making from prognostic, diagnostic, and therapeutic points of view. However, the process to do that is to fill knowledge gaps by studying and growing experience and knowing some cognitive aspects to raise the awareness of thinking mechanisms to avoid cognitive errors through correct educational training. This article examines clinical approaches and educational gaps in training medical students and young doctors. The authors explore the core elements of clinical reasoning, including metacognition, reasoning errors and cognitive biases, reasoning strategies, and ways to improve decision-making. The article addresses the dual-process theory of thought and the new Default Mode Network (DMN) theory. The reader may consider the article a first-level guide to deepen how to think and not what to think, knowing that this synthesis results from years of study and reasoning in clinical practice and educational settings.

The Effects of Learning Transfer on Clinical Performances Among Medical Staff: A Systematic Review of Randomized Controlled Trials

Purpose

This study aimed to evaluate the influence of learning transfer on the clinical performance of medical staff.

Methods

We searched PubMed, Embase, and the Cochrane Library for all associated studies without any language restrictions from the inception until 31 December 2021.

Results

This systematic review screened out 14 eligible studies that met the inclusion criteria. Most of these studies showed that learning transfer contributed to the clinical performance of medical staff. Through education, or when knowledge and skills have common basic principles, learning transfer will be more apparent than for those who learn by themselves and those without simulation training.

Conclusions

The findings of this review support an association between learning transfer and the clinical performance of medical staff. However, it was noted that due to the lack of relevant research and the major differences in the methods and indicators used in previous studies, we are restricted in conducting an effective meta-analysis. Further comprehensive trials will be needed to assess the impact of learning transfer on the clinical performance of medical staff.

Systematic Review Registration

PROSPERO, identifier: 341439.

The current role of telehealth in the management of patients with osteoporosis

INTRODUCTION

Telehealth is the use of electronic technologies for communication, storage, and analysis of health-related information. Telemedicine is a form of telehealth that involves remote patient care. This is a review and update of the use of these modalities as they apply to the education of healthcare professionals who provide care for patients with osteoporosis and the delivery of their care.

AREAS COVERED

This review focuses on technology-enabled collaborative learning and its prototype model, Project ECHO (Extension for Community Healthcare Outcomes). Bone Health TeleECHO and similar programs apply the ECHO model of learning to mentor healthcare professionals on implementation of best practice care for patients with osteoporosis and other skeletal diseases. Telemedicine, which has seen widespread uptake during the COVID-19 pandemic, is an alternative to in-person visits for patients with osteoporosis as well as for those with other conditions.

EXPERT OPINION

Remote education of healthcare professionals and the remote delivery of patient care provides opportunities, as well as challenges, for achieving the goal of reducing the global burden of osteoporotic fractures.

Virtual auscultation course via video chat in times of COVID-19 improves cardiac auscultation skills compared to literature self-study in third-year medical students: a prospective randomized controlled cross-over study

BACKGROUND

Cardiac auscultation is a core clinical skill taught in medical school. Due to contact restrictions during the SARS-CoV-2 pandemic, interaction with patients was very limited. Therefore, a peer-to-peer virtual case-based auscultation course via video conference was established.

METHODS

A randomized controlled cross-over study was conducted to evaluate whether participation in a virtual auscultation course could improve heart auscultation skills in 3^rd-year medical students. A total of sixty medical students were randomly assigned to either the experimental or control group after informed consent was obtained. Due to no-shows, 55 students participated. Depending on allocation, students attended three ninety-minute courses in intervals of one week in a different order: a virtual case-based auscultation course held via video chat, literature self-study, and an on-site course using a high-fidelity auscultation simulator (SAM II). The study's primary endpoint was the performance of the two groups at the simulator after participating in the virtual auscultation course or literature self-study. To evaluate their auscultation skills, students participated in five assessments using the same six pathologies: stenosis and regurgitation of the aortic and mitral valve, ventricular septal defect, and patent ductus arteriosus. Moreover, participants rated their satisfaction with each course and provided a self-assessment of competence.

RESULTS

Compared to literature self-study, participation in the virtual auscultation course led to a significantly improved description of heart murmurs at the auscultation simulator with regard to the presence in systole and diastole, low- and high-pitched sounds, and volume dynamics. There was no significant difference between the groups in diagnostic accuracy and identification of the point of maximal intensity. After the virtual course, students showed higher satisfaction rates and a higher increase in self-assessed competence compared to participants who engaged in literature self-study.

CONCLUSIONS

For the first time, this study demonstrates that a case-based virtual auscultation course can improve aspects of cardiac auscultation skills on a simulator. This may facilitate the further acquisition of an essential clinical skill, even when contact restrictions will be lifted.

[Digital and virtual support in the hermeneutic case-based learning in health professional education: A systematic review]

Digital and virtual support in the hermeneutic case-based learning in health professional education: A systematic review Abstract. Background: Nowadays, the digitization dominates almost all aspects of our lives, especially in the nursing field. The medial-supported teaching design program helps learners to be prepared for the digital challenges of their professional field. In addition, the concept of hermeneutic casework provides nurses with an expertise that can be applied individually and case-related. Virtual simulations can represent a realistic case scenario and extend the conventional concept of casework with modern technology. Aim: The aim of the review is, to identify national and international used types of virtual and digital medias in connection with the method of hermeneutic casework and describe its usefulness in health education. Methods: A literature review according to the design of a systematic review in the databases CINAHL, MEDLINE via PubMed, Cochrane and Springer Link has been conducted and complemented by the snowball principle. Results: Eleven publications were analysed. The results show predominantly positive effects, which can be divide into eleven areas. Conclusion: The use of virtual patients is considered in both empirical and media-didactic research as an effective and an efficient learning arrangement. In a positive and a negative sense, the results depend from the didactic and methodological preparation, the design of the learning modules and the quality of the medium as well as the teaching.

Students' acceptance of case-based blended learning in mandatory interdisciplinary lectures for clinical medicine and veterinary public health

BACKGROUND

In German veterinary education interdisciplinary lectures (ILs) are an important and mandatory part of the curriculum as their merging character builds a useful preparation for the future profession as a veterinarian. These lectures should enable students to work on practically-relevant and interdisciplinary cases, which should ideally be defined jointly by lecturers from different disciplines.

METHODS

In order to give students the opportunity to work on these cases and at the same time have contact with their lecturers and fellow students, the Faculty of Veterinary Medicine, Freie Universität Berlin, has converted its former in-class ILs (face-to-face delivery format) into a blended learning format. The mandatory lectures comprise 196 curricular hours and are delivered over the course of three semesters within the veterinary curriculum. The new concept was developed over a period of three academic years and extensively evaluated (old-new-comparison) with regard to its acceptance and compliance with national requirements for interdisciplinary teaching.

RESULTS

A total of 306 students were asked to evaluate different aspects of the newly implemented format. Overall, more than 79% of the students attending the newly implemented blended learning format responded positively, and the evaluation showed a significant improvement of learning motivation and acceptance when compared to the traditional teaching format.

CONCLUSION

The results indicated that blended learning is a suitable option for teaching mandatory ILs in clinical medicine and veterinary public health.

COVID-19 and psychiatry training: A cross-national trainee perspective

The coronavirus disease 2019 pandemic has significantly altered many aspects of our professional lives, including how psychiatry as a medical discipline is taught and learnt. Training in psychiatry relies on developing competencies through observing and interacting with patients, developing empathic consultation skills and seeking feedback from colleagues derived from cognitive and constructivist theories of learning, in a time-bound manner. The pandemic has drawn attention to the dual role of psychiatry residents as both trainees and physicians, with a pressing identity crisis at an inopportune time. This paper aims to illustrate some of the emerging themes in psychiatry training during the pandemic and some solutions for the same.

Effectiveness of blended learning in pharmacy education: An experimental study using clinical research modules

BACKGROUND &OBJECTIVES

Though there are studies to evaluate the effectiveness of blended learning in pharmacy education, most of them originate from USA and have used previous year students' scores as control. Also there is less research in comparing use of self -regulated learning strategies between blended and other learning strategies. Primary aim was to evaluate the effectiveness of blended learning on knowledge score using clinical research modules. Secondary objective was designed to compare the use of self-regulated learning strategies between blended learning, web-based e-learning and didactic teaching.

MATERIALS AND METHODS

A prospective cluster randomized trial was conducted with didactic teaching as control and web-based e-learning and blended learning as interventions. The target population was final year Pharm D students. Outcome was assessed using a validated knowledge questionnaire, a motivated strategies for learning questionnaire and a feedback form. All statistical analyses were carried out using Statistical Package for Social Science (SPSS) Version 20.

RESULTS

A total of 241 students from 12 colleges completed the study. Mean knowledge score of students in blended learning group was higher than those in the didactic teaching and web- based e- learning program (64.26±18.19 Vs 56.65±8.73 Vs 52.11±22.06,p<0.001).Frequency of use of learning strategies namely rehearsal, elaboration, organization and critical thinking was statistically significantly higher in the blended learning group compared to those of didactic and web-based e-learning group (p<0.05) But there were no statistically significant difference of motivational orientations between didactic and blended learning group except strategies of extrinsic goal orientation and self-efficacy. Students preferred blended learning (86.5%) over didactic and web-based e-learning.

CONCLUSION

Blended learning approach is an effective way to teach clinical research module. Students of blended learning group employed all motivational and learning strategies more often than students of the didactic and web- based e-learning groups except strategies of intrinsic goal orientation, task value, control of learning belief and help seeking.

Cross-disciplinary perspectives on the transition to remote education

The COVID-19 pandemic has prompted the cancellation of clinical attachments and face-to-face teaching at medical schools across the world. Experiential learning—through simulation or direct patient contact—is essential for the development of clinical skills and procedural knowledge. Adapting this type of teaching for remote delivery is a major challenge for undergraduate medical education. It is also an opportunity for innovation in technology enhanced learning and prompts educators to embrace new ways of thinking. In this article, the authors explored how educators from different disciplines (medicine, music and performing arts) are using technology to enhance practical skills-based learning remotely.

The authors, five experienced educators from different fields (surgery, medicine, music and magic), jointly documented the transition to technology enhanced remote teaching through a series of five structured conversations. Drawing from literature on distance learning in medicine and professional experience in education, the authors identified seven practice-enhancing recommendations for optimising teaching of procedural knowledge and skills. These are: (1) make a virtue out of necessity; (2) actively manage your environment; (3) make expectations clear; (4) embrace purposeful communication; (5) use digital resources; (6) be prepared for things to go wrong and (7) personalise the approach. The authors argue that widening the discourse in technology enhanced learning to include cross-disciplinary perspectives adds richness and depth to discussions. This article demonstrates a cross-disciplinary approach to addressing challenges in technology-enhanced medical education.

Encouraging communication and cooperation in e-learning: solving and creating new interdisciplinary case histories

Background: An increasing number of patients to treat combined with a rapidly growing amount of knowledge to integrate, is challenging for future doctors. To take the medical history and diagnose effectively, to send the patient to an expert, to create a relevant expert to expert communication, to discuss with the patient, the time needed for a decision, should be as short as possible. Investigating medical students' cognitive processes while solving a patient's case leads to the conclusion that educators should help and facilitate these reasoning and communication processes. Developments in information technology offer a large variety of tools for educators. Method: Practicing repeated memory retrieval in clinically relevant virtual settings leads to more durable storage of theoretical knowledge, especially when applying the theoretical knowledge to meaningful cases. The cases in the present e-learning tool are only solvable when knowledge is coherent, communicated and well-organized, as they demand combination of different interdisciplinary knowledge-fields. Thus, by practicing in the virtual environment, prospective memory (i.e. the ability to remember to do something in the future) is changed and the intention and attention in learning processes is shaped and adapted to the core requirements of clinical practice. Conclusion: Case-based learning can be a promising approach to teach students how to investigate and ask for important information. This paper focuses on undergraduate education and provides an outlook on possible concepts that can be used in different health care sectors.

Effects on applying micro-film case-based learning model in pediatrics education

BACKGROUND

In view of the harsh reality Chinese paediatricians face, the challenge of paediatric education is about instilling not only knowledge and clinical skills but also resilience and beliefs. The aim of the study is to explore a more effective method than the traditional lecture-based learning (LBL) model for optimizing educational outcomes by establishing an innovative, comprehensive, case-based learning (CBL) model combined with the micro-film technique (MF + CBL). This approach has four important components: interests (attraction), knowledge application, competency, and scenario coping skills.

METHODS

Experimental research was conducted via a controlled parallel group study. The total sample of 104 senior-year students (Chinese) majoring in clinical medicine was randomly divided into two groups. The experimental group was exposed to the MF + CBL model and the control group to the LBL model. Overall, the results were assessed after an 8-week course via a student self-assessment questionnaire, a satisfaction survey and the final examination.

RESULTS

The experimental group generally performed better than the control group on the student self-assessment (P<0.05), satisfaction survey (P<0.05), and final examination (80.02 ± 3.77 vs 73.65 ± 3.69, P = 0.000). The open question at the end of the questionnaire revealed that a small number of students did not favour the MF + CBL model due to its time- and energy-consuming features.

CONCLUSIONS

Compared with LBL, the MF + CBL model was an innovative teaching method that promoted more comprehensive quality development. It represents an alternative model for optimizing the capacity of future paediatric doctors.

The Effects of Case-Based Teaching in Nursing Skill Education: Cases Do Matter

Nursing skill education plays a very important part for the nursing education. It's necessary to analyze the role of the case-based teaching (CBT) in nursing skill education, to provide insights into the nursing education. The sophomore nursing students who received nursing skill teaching from September 2019 to January 2020 were selected. The students either underwent traditional teaching (control group) or CBT (CBT group) intervention. The objective structure clinical examination (OSCE), autonomous learning ability, questionnaire for effects evaluation of CBT, and student's satisfaction level on CBT were analyzed. A total of 146 participants were included. There were no significant differences in the gender, age and the final exam score as freshman between 2 groups (all P > .05). The OSCE scores and autonomous learning ability in CBT group were significantly higher than that of control group (all P < .05). The most students favored the use of CBT, and most students were satisfied with CBT. CBT is beneficial to improve the nursing skill and comprehensive ability of students, and it's conducive to increase the interest of students, which merits application in nursing education.

Learning and competence development via clinical cases – what elements should be investigated to best train good medical doctors?

In European higher education, application of information technology, concentration on the learning-processes, consistent implementation, transfer learning, case-based learning, autonomous learning has been extensively studied in the last decade. Educational sciences based on neuroscientific findings use brain-based learning and teaching, including integrated thematic instructions and emotion-theory. Elements essential to this strategy, such as theory and methods for learning, competencies, attitudes, social reality, and a metadiscourse are described herein. Research on learning tends to focus on declarative knowledge, associative learning with conditional stimuli, and procedural knowledge with polythematic/crosslinking thinking. Research on competencies: In research on competencies (e.g., for clinical reasoning, decision-making), intuitive and analytical components are studied. As repeated presentation and exercising of clinical cases is crucial for an efficient learning process, the implementation of interactive scenarios including affectively involving didactics is considered. For competence-development observational methods, questionnaires/item sets or factors have to be targeted and empirically validated. Attitudes and social reality: Clinical decision-making, identification processes and attitudes (“Hidden curriculum”), as well as secondary socialization processes (integration of social norms, values, preparation of role-acquisition, occupational role) are studied via process research, conceptual research, and observational methods. With respect to social reality research, conscious and unconscious bargaining processes have to be taken into account. Methodology: Neuroscience – memory, neuronal, molecular biology, and computer science (Neurocircuits) are integrated into observational process research (e.g., affective-cognitive interface, identification processes) and conceptual research is added and studied on the meta-level, including discussion of research paradigms. This discussion provides ongoing feedback to projects in a hermeneutic circle.

Designing Cases for Case-Based Immunology Teaching in Large Medical School Classes

Case-based, interactive sessions for small groups (in a large medical school class of 150 students) reinforces basic immunology concepts by including clinical scenarios that stimulate student learning and consolidate critical concepts. Careful design of cases (designing backwards from the key concepts) leads students through successively more complicated and linked group-work questions. This paper details why cases are effective learning tools, how to design an effective case, how to ask appropriate questions and how to help students apply basic immunology concepts to a case. Each group work session is facilitated and followed by a question and answer presentation by faculty, where student groups are directly asked to answer the questions and also challenged with “bonus questions” not presented with the original case. This allows students to “put together” immunology information into a “story” that they can tell and prevents student frustration by summarizing the results at the end of each case. Case design is carefully discussed including clinical relevancy and accuracy, how to write questions that do not give away the answers, how to emphasize mechanistic questions that allow students to “clinically explain as a physician” the immunological basis for the answers. Additionally, students better understand the role of immunity in both normal and disease states. A case-based approach promotes student learning by re-emphasizing basic concepts in the context of the case and promotes better students understanding of critical immunological concepts.

A Clinical Teaching Blended Learning Program to Enhance Registered Nurse Preceptors' Teaching Competencies: Pretest and Posttest Study

Background

Clinical nursing education provides opportunities for students to learn in multiple patient care settings, receive appropriate guidance, and foster the development of clinical competence and professionalism. Nurse preceptors guide students to integrate theory into practice, teach clinical skills, assess clinical competencies, and enhance problem-solving and critical thinking skills. Previous research has indicated that the teaching competencies of nurse preceptors can be transferred to students’ clinical learning to enhance their clinical competencies.

Objective

This study aimed to develop a clinical teaching blended learning (CTBL) program with the aid of web-based clinical pedagogy (WCP) and case-based learning for nurse preceptors and to examine the effectiveness of the CTBL program on nurse preceptors’ clinical teaching competencies, self-efficacies, attitudes toward web-based learning, and blended learning outcomes.

Methods

A quasi-experimental single-group pretest and posttest design was adopted. A total of 150 nurse preceptors participated in the CTBL program, which was conducted from September 2019 to December 2019. A set of questionnaires, including the clinical teaching competence inventory, preceptor self-efficacy questionnaire, attitudes toward web-based continuing learning survey, and e-learning experience questionnaire, was used to assess the outcomes before and after the CTBL program.

Results

Compared with the baseline, the participants had significantly higher total mean scores and subdomain scores for clinical teaching competence (mean 129.95, SD 16.38; P<.001), self-efficacy (mean 70.40, SD 9.35; P<.001), attitudes toward web-based continuing learning (mean 84.68, SD 14.76; P<.001), and blended learning outcomes (mean 122.13, SD 14.86; P<.001) after the CTBL program.

Conclusions

The CTBL program provides a comprehensive coverage of clinical teaching pedagogy and assessment strategies. The combination of the WCP and case-based approach provides a variety of learning modes to fit into the diverse learning needs of the preceptors. The CTBL program allows the preceptors to receive direct feedback from the facilitators during face-to-face sessions. Preceptors also gave feedback that the web-based workload is manageable. This study provides evidence that the CTBL program increases the clinical teaching competencies and self-efficacies of the preceptors and promotes positive attitudes toward web-based learning and better blended learning outcomes. The health care organization can consider the integration of flexible learning and intellect platforms for preceptorship education.