Medical Student and Tutor Perceptions of Video Versus Text in an Interactive Online Virtual Patient for Problem-Based Learning: A Pilot Study

Video-Assisted Versus Traditional Problem-Based Learning: A Quasi-Experimental Study Among Pediatric Nursing Students

BACKGROUND

The text-assisted problem-based, methods traditionally used to teach nursing students cannot adequately simulate holistic clinical situations and patient symptoms. Although video-assisted, problem-based learning methods combined with text have shown positive results in terms of improving comprehension and cognitive abilities, some studies have shown these methods to be inferior to text-assisted methods in terms of promoting deep critical thinking in medical students.

PURPOSE

This study was designed to assess the benefits in nursing education of video-assisted, problem-based learning using online multimedia technologies compared with text-assisted, problem-based learning using traditional face-to-face classes.

METHODS

A quasi-experimental, nonequivalent control group, preintervention-and-postintervention design was used. The experimental group ( n = 31) received video-assisted, problem-based learning materials with multimedia technologies (video scenarios, Google Docs worksheets, Google slides, Zoom cloud meetings, and e-learning management system) and weekly online lectures (100 minutes) for 4 weeks. The control group ( n = 35) received text-assisted, problem-based learning materials with traditional face-to-face classes and weekly lectures (100 minutes) for 4 weeks. The study data were analyzed using chi-square, Fisher's exact, and independent t tests as well as analysis of variance.

RESULTS

At posttest, learning motivation ( t = 3.25, p = .002), academic self-efficacy ( t = 2.41, p = .019), and self-directed learning ( t = 3.08, p = .003) were significantly higher in the experimental group than in the control group.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Video-assisted, problem-based learning using multimedia technologies was shown to be effective in increasing learning motivation, academic self-efficacy, and self-directed learning in nursing students. These findings have implications for the development and planning of contactless classes in response to the coronavirus pandemic. Notably, no intergroup differences were found in terms of problem-solving skills. Future studies should include in-depth reviews and assessments of the difficulties faced in producing problem scenarios as well as the methods of instruction.

A Literature Review of Barriers and Opportunities Presented by Digitally Enhanced Practical Skill Teaching and Learning in Health Science Education

INTRODUCTION

An evidence gap exists identifying the challenges and opportunities presented by digitally enhanced practical skill teaching and learning in health science education. A literature review was carried out to address this gap and to provide recommendations for overcoming identified challenges.

METHOD

A systematic search strategy was carried out using PRISMA guidelines. The research databases PubMed, ERIC, Medline and CINHL, were searched using MeSH terms. Barriers and opportunities were identified through deductive thematic analysis of the included articles.

RESULTS

Of the 602 articles identified through the database screening, 29 were included in the current review. Potential challenges posed by technologically supported practical skill teaching identified were i) Inaccessibility and Inequity of Online Learning (ii) Digital illiteracy Among Staff (iii) Technological Challenges (iv) Lack of Engagement with Preparatory Material Hinders Practical Learning (v) Lack of Staff-Student Interaction (vi) Negative Attitudes Towards Online Learning and (vii) Skill Suitability. The opportunities presented by digital technologies identified were (i) Facilitates Higher Order Learning (ii) Ability to Practice in a Safe Environment (iii) Efficacious Use of Class Time (iv) Access to Education (v) Learning Brought to Life (vi) Diverse Range of Learning Materials (vii) Promotes Autonomous Learning.

DISCUSSION

This literature review demonstrates the acceptability and usability of digitally enhanced practical teaching in health science education among students and educators.

CONCLUSION

To consolidate the positive disturbances in higher education from the Covid-19 pandemic, potential barriers to online delivery and student engagement must be acknowledged and addressed by relevant stakeholders. Recommendations detailed as part of this paper suggest means of overcoming barriers and leveraging opportunities.

From Clinical Practice to the Classroom. Advantages and Disadvantages of Video and Paper Cases on the Motivation and Clinical Reasoning of Occupational Therapy Students

Case-based learning enables the application of theory to practice using real-life patient cases. The present study aims to compare the effect between video cases and paper cases on motivation for learning and knowledge acquisition to perform a clinical reasoning case exercise by occupational therapy students. A mixed-methods design was used with 120 students randomized into two groups. All students conducted a clinical reasoning case exercise on the same case, although in different presentation formats: paper case and video case. The quantitative measures of this study were the scores of motivation for learning from the Instructional Material Motivation Survey and the grades of a clinical reasoning case exercise. The qualitative part was based on the positive and negative aspects perceived by the participants. The results showed that the motivation for learning was significantly higher for the video case compared to the paper case, although there were no differences in the grades of the clinical reasoning case exercise between the two groups. The video cases were perceived as more relevant to professional practice and more informative in terms of non-verbal communication and context. In light of the results, teachers could use these two formats of presentation of cases with different objectives.

The Effectiveness of Self-Instructional Video vs. Classroom Teaching Method on Focused Assessment With Sonography in Trauma Among House Officers in University Hospital

Background: The aim of this study was to compare the effectiveness of self-instructional-video (SIV) and classroom training method (CTM) in learning Focus-Assessment with Sonography-in-Trauma (FAST) among house officers (HO).

Method: A randomized controlled study involving house officers working in the university hospital in Malaysia was conducted where participants were randomized into SIV group (intervention) and CTM group (control). Each group had to undergo a 4 h hands-on training. The intervention group has undergone self-training using the video material without any facilitation while the control group received lecture and hands-on training with facilitators. Participants' performance was assessed using a validated Objective Structured Clinical Examination checklist for landmark identification and interpretation of images generated. Learning preference and confidence level were also assessed.

Result: A total of 33 HO were enrolled in this study. Marks obtained in image acquisition by the intervention and control were 25.3 (SD = 5.3) and 25.6 (SD = 2.3) p > 0.05, respectively. While in image interpretation, the mean score for the intervention and control group was 10.3 (SD 1.7) and 9.8 (SD = 1.7) p > 0.05, respectively. Overall performance assessment, showed the intervention group obtained 35.6 (SD = 5.9) compared to control 35.3 (SD = 3.4), p > 0.05. Based on pre-specified determinant these scores difference falls within the 10% of non-inferiority margin. The absolute difference between both groups was 0.3 (CI = −3.75 to 3.21, p = 0.871), which proves non-inferiority but not superiority. In terms of learning preference and confidence to perform FAST, most of the participants preferred the control group approach.

Conclusion: The SIV method is as effective as the CTM for learning FAST among the house officers and served as an alternative to classroom teaching. However, this technique needs improvement in promoting their confidence and preference. Perhaps incorporating a feedback session after going through the SIV would improve the confidence.

Design and evaluation of mobile scenario based learning in the self-management of chronic pain

Chronic pain is a lifelong issue, being one of the main causes of disability, affecting a great number of people worldwide, many of which often avoid seeking medical advice from pain experts and/or demonstrate poor adherence to their therapeutic plan. One of the most important steps in achieving a manageable course of disease, is the ability of self-management. We aimed at applying a method of systematic patient education and self-management through the use of Virtual Patients (VPs), a well-established method for educating medical doctors and students but never before targeting patients. Two VPs scenarios were designed, tested and evaluated by patients with rheumatic disorders, achieving a SUS score of 88/100 "Best Imaginable", alongside with positive reviews from the participants. The positive feedback from the patients supports the potential of VP educational paradigm to educate these patients and equip them with disease coping skills and strategies.

Learning Outcomes of Digital Learning Interventions in Higher Education: A Scoping Review

Implementing digital technologies has become a policy priority worldwide among all types of education. The COVID-19 pandemic has further accelerated educational institutions' efforts to reorganize their teaching and introduce new digital learning technologies. Although using digital technologies in higher education, including nursing, is considered a modern and innovative way of teaching and learning, uncertainty exists concerning these technologies' actual usefulness in achieving positive learning outcomes. The aim of this scoping review was to examine the current evidence related to the effects of using digital technologies on learning outcomes in higher education. The authors searched five electronic databases for relevant studies and used a scoping review method to analyze and synthesize the evidence. Eighty-six articles from six disciplines met the selection criteria. As a key finding, the outcomes of the interventions were mainly positive. Increased professional knowledge, skills, and attitudes reflect the advancement of professional competence. Academic, collaborative, and study skills, in turn, contribute to general competence development. Our findings suggest that digital technology has the potential to improve learning in various disciplines.

The relation of online learning analytics, approaches to learning and academic achievement in a clinical skills course

INTRODUCTION

This study examined relationships of students' access of e-learning (learning analytics) for a healthcare psychomotor skills course, approaches to learning (R-SPQ-2F psychometric) and academic achievement (summative examination results). An understanding of the relationships may help in supporting students learning.

METHODS

Two consecutive cohorts of 5th year dental students were asked to complete the R-SPQ-2F questionnaire and permission to access data of online videos and associated quizzes and two summative written examination results were examined. The summative assessments were an OSCA and a written-paper question both in prosthodontics. Multiple linear regression and correlation analysis were performed.

RESULTS

Students (n=98) performed a total of 10470 video access events and 7714 attempts in online quizzes. Deep learning approach was the strongest predictor variable (β=0.270; P=.004) on written-paper question result. While video and quiz access were moderately correlated (r=0.600; P<.001) to each other, video access was not a significant predictor to either of the examination results. Quiz access was negatively associated with academic achievement for the written-paper question results (β=-0.349; P<.001).

CONCLUSIONS

Only deep approach to learning appeared to be relevant for the written-paper question examination grades. Conversely, the number of video and quiz access did not relate to either examination results. This suggests e-learning access and examinations do not appear to relate under the conditions explored. Other attributes of learning management access may need to be explored to determine if access to learning management systems may be useful in offering remedial support to students.

Digital Learning Interventions in Higher Education: A Scoping Review

This scoping review was undertaken to synthesize and describe research related to digital learning interventions in higher education, focusing on technological outcomes. Five electronic databases were searched, and 86 articles were included in the review. The data related to positive and negative technological outcomes and authors' suggestions were analyzed using inductive content analysis. The articles represented six disciplines across six continents and included quantitative (n = 65), qualitative (n = 3), and mixed-methods (n = 18) intervention studies. For positive technological outcomes, digital formats of learning were considered effective and participatory forms of learning in a majority of the articles. The students appreciated individualized and self-paced learning, and the digital form increased their motivation to learn. Automatized technical solutions that enabled learning and teaching had several advantages, and digital learning was believed to save the resources of students, teachers, and organizations. For negative technological outcomes, the technical difficulties in using the digital devices or platforms were described the most, and a need for resources was identified. Feedback from teachers was considered important from positive and negative viewpoints. Authors' suggestions for future digital teaching and learning as well as related interventions consisted of various activities, resources, environments, and methods.

Video-based, student tutor- versus faculty staff-led ultrasound course for medical students - a prospective randomized study

BACKGROUND

Ultrasound education is propagated already during medical school due to its diagnostic importance. Courses are usually supervised by experienced faculty staff (FS) with patient bedside examinations or students among each other but often overbooked due to limited FS availability. To overcome this barrier, use of teaching videos may be advantageous. Likewise, peer teaching concepts solely with trained student tutors have shown to be feasible and effective. The aim was to evaluate 1) objective learning outcomes of a combined video-based, student-tutor (ViST) as compared to a FS-led course without media support, 2) acceptance and subjective learning success of the videos.

METHODS

Two ultrasound teaching videos for basic and advanced abdominal ultrasound (AU) and transthoracic echocardiography (TTE) were produced and six students trained as tutors. Fourth-year medical students (N = 96) were randomized to either the ViST- or FS course (6 students per tutor). Learning objectives were defined equally for both courses. Acquired practical basic and advanced ultrasound skills were tested in an objective structured clinical examination (OSCE) using modified validated scoring sheets with a maximum total score of 40 points. Acceptance and subjective learning success of both videos were evaluated by questionnaires based on Kirkpatrick's evaluation model with scale-rated closed and open questions.

RESULTS

79 of 96 medical students completed the OSCE and 77 could be finally analyzed. There was no significant difference in the mean total point score of 31.3 in the ViST (N = 42) and 32.7 in the FS course (N = 35, P = 0.31) or in any of the examined basic or advanced ultrasound skill subtasks. Of the 42 ViST participants, 29 completed the AU and 27 the TTE video questionnaire. Acceptance and subjective learning success of both videos was rated positively in 14-52% and 48-88% of the rated responses to each category, respectively. Attendance of either the student or faculty tutor was deemed necessary in addition to the videos.

CONCLUSIONS

A ViST versus FS teaching concept was able to effectively teach undergraduate students in AU and TTE, albeit acceptance of the teaching videos alone was limited. However, the ViST concept has the potential to increase course availability and FS resource allocation.

Perception of Technology-Enhanced Learning by Medical Students: an Integrative Review

This review aims to explore the perception of technology-enhanced learning by medical students. From the initial 2947 records found, 38 studies from journals indexed in the Web of Science database were included after screening. Several main topics were isolated, based on a thematic analysis: student's attitude towards e-learning and modern technologies in medical education; social networks, video, and mobile devices as information source and communication tool; and barriers to the use of technologies in medical education. The results have shown that a positive attitude towards technologies in medical education and learning is prevalent among students. The popularity of blended learning was confirmed.

Naro G, J. Fischer R, M. Thompson B. Using Video and Virtual Patients in Problem-Based Learning: a Scoping Review

Problem presentation in problem-based learning can include the use of videos and interactive virtual patients. This review scopes the literature for this variation and what benefits or pitfalls there may be to their use. Themes indicate that videos and virtual patients may better prepare students for future difficult clinical interactions, while also increasing authenticity and memorability of cases. Findings are more inconsistent in determining whether they lead to clear knowledge or critical thinking gains. Despite inconsistent data, in an age where the use of technology is inevitable, the findings of this scoping review can inform future practice and guide innovation.

A virtual patient model for students' interprofessional learning in primary healthcare

Objectives

Interprofessional education is important for increasing the quality of patient care, but organising it in primary healthcare is still challenging. The aim of this study was to develop and assess a virtual patient model for primary healthcare and to investigate students' perceptions of learning with this interprofessional virtual patient model.

Methods

The virtual patient case described a patient with several medical conditions who had returned home after surgery. The virtual patient included text files, short videos, and links to illustrate different health professions' roles in home care. Ten interprofessional groups with 39 students assessed the virtual patient from four different study programmes: nursing, physiotherapy, medicine, and occupational therapy. The students answered a questionnaire about how they perceived the usability of the virtual patient and participated in group interviews. Qualitative content analysis was used to analyse the data from the semi-structured group interviews.

Results

The analysis of the interviews resulted in four main categories: The virtual patient model facilitated the learning process; It was beneficial to have students from different programmes in the group when working with the virtual patient; Working with the virtual patient helped the students to understand the roles and competencies of their own and other professions and All professions are needed in clinical work in order to help the patient. The students perceived that the mixture of text and multimedia made the virtual patient seem authentic and stimulated their group discussions, which they valued most. The students gave generally high points for usability in the questionnaire, but they also gave input for improvement of the program in their comments.

Conclusions

The interprofessional virtual patient model facilitated interactions and discussions between students and may be a useful complement for interprofessional education in clinical contexts and might be a suitable tool in preparing students for future teamwork.

The impact of using virtual patients in preclinical pharmacology teaching

To reduce medication errors, medical educators must nurture the early development of rational and safe prescribing. Teaching pharmacology is challenging because it requires knowledge integration across disciplines, including physiology and pathology. Traditionally, pharmacology has been taught using lecture-based learning, which conveys consistent information but may promote passive learning. Virtual patients (VPs) have been used more recently to promote active learning, mainly in clinical years. Conversely, the use of VPs in preclinical disciplines, including pharmacology, is not well described. The objective was to investigate the potential benefits of combining traditional teaching with VPs in preclinical pharmacology teaching. All year 3 medical students (2 cohorts), enrolled in the Systematic Pharmacology I course (lectures: 3 h weekly; tutorial: 1 h weekly), were invited to participate in this naturalistic, prospective study. During tutorials, students were taught using case-based discussion and single-best-answer questions (control) in four tutorials and VPs (experimental) in the remaining six tutorials. The impact of VPs was assessed by 1) performance in written examinations, and 2) student satisfaction/perceptions, using a validated, modified questionnaire. Examination performance related to teaching in VP-based tutorials was significantly improved, compared with traditional tutorials. The level of difficulty of control and experimental assessment items was comparable, as determined by the Angoff method. Facilitation of learning was higher in VP tutorials, while a no-harm effect was noted on knowledge acquisition/maintenance, authenticity of learning, and disadvantages of learning. VPs may be effectively integrated in preclinical pharmacology teaching, with benefits on pharmacological knowledge and facilitation of learning.

How does video case-based learning influence clinical decision-making by midwifery students? An exploratory study

BACKGROUND

Clinical decision-making skills are essential for providing high-quality patient care. To enhance these skills, many institutions worldwide use case-based learning (CBL) as an educational strategy of pre-clinical training. However, to date, the influence of different learning modalities on students' clinical decision-making processes has not been fully explored. This study aims to explore the influence of video and paper case modalities on the clinical decision-making process of midwifery students during CBL.

METHODS

CBL involving a normal pregnant woman was provided for 45 midwifery students. They were divided into 12 groups; six groups received the video modality, and six groups received the paper modality. Group discussions were video-recorded, and focus groups were conducted after the CBL. Transcripts of the group discussions were analysed in terms of their interaction patterns, and focus groups were thematically analysed based on the three-stage model of clinical decision-making, which includes cue acquisition, interpretation, and evaluation/decision-making.

RESULTS

The students in the video groups paid more attention to psychosocial than biomedical aspects and discussed tailored care for the woman and her family members. They refrained from vaginal examinations and electric fetal heart monitoring. Conversely, the students in the paper groups paid more attention to biomedical than psychosocial aspects and discussed when to perform vaginal examinations and electric fetal heart monitoring.

CONCLUSION

This study clarified that video and paper case modalities have different influences on learners' clinical decision-making processes. Video case learning encourages midwifery students to have a woman- and family-centred holistic perspective of labour and birth care, which leads to careful consideration of the psychosocial aspects. Paper case learning encourages midwifery students to have a healthcare provider-centred biomedical perspective of labour and childbirth care, which leads to thorough biomedical assessment.

Applying integrated video assisted learning approaches for medical clerkship - potential adaptations in the post-COVID-19 era

Lockdowns and social distancing measures due to the ongoing COVID-19 pandemic have forced the delivery and assessment of educational material to be performed via online and virtual educational tools. Such disruption has greatly affected hands-on training programs essential to acquire clinical competencies, particularly modes requiring physical patient encounters. While most educational content has successfully been shifted to predominantly web-conferencing platforms, the essential clinical teaching at affiliated hospitals for undergraduate medicine clerkship years has been severely disrupted due to barring of students from hospital premises to minimise spread of COVID-19, presenting a problem requiring unique solutions to ensure that quality of education and subsequent healthcare is kept sufficiently high. To this degree, technological advances increasingly present several elegant solutions which may provide the required levels of educational delivery. In this article, we briefly discuss the number of options that could be deployed to aid in acquisition of requisite skills during the clerkship years, with a focus on wearable technologies and video recording/broadcasting. Given the ongoing pandemic, application of technological advances could provide, with some global coordination, the medical education community with numerous proactive solutions rather than just educational luxuries or novelties.

Problem-Based Learning Could Tackle the Issue of Insufficient Education and Adherence in People Living With HIV/AIDS

Background: Poor medication adherence is still the main cause of antiretroviral therapy (ART) failure among people living with HIV/AIDS (PLWHA). Effective behavioral interventions are needed to improve HIV awareness and medication adherence. Methods: In this retrospective cohort study, we assessed the effect of problem-based learning (PBL) approaches to HIV-related education and adherence outcomes among PLWHA and a college student sample. In our study, compared with 309 demography-matched control participants using conventional counseling methods (109 PLWHA and 200 college students), 321 subjects (111 PLWHA and 210 college students) chose to learn HIV-related knowledge via PBL-integrated methods. Co-primary outcomes were self-administered questionnaire after HIV-related education by all participants and self-reported medication adherence by newly diagnosed PLWHA, measured in terms of the number of missed doses in the past week at each of the seven visits during a 1-year period. Multivariate regression models adjusting different covariates were used to test the robustness of HIV awareness and adherence association. Mediation model was used to investigate the relationship among PBL training, awareness of HIV, and ART adherence. Results: The knowledge scores of participants in the PBL group were higher than those in the controls (P = 0.001), especially the subgroup of newly diagnosed PLWHA in the PBL group (P = 0.001). The HIV-related health scores of the PBL college students were also higher than those of subjects exposed to conventional education (P < 0.001). There was no significant difference between the two by newly diagnosed PLWHA groups in the number of missed doses during the past week at each visit except at the first follow-up visit (P = 0.018). The indirect effect of PBL-integrated education on ART adherence at the 2-week visit through HIV awareness had a point estimate of 0.0349 and a 95% bias-corrected bootstrap confidence interval of 0.0061∼0.0874 in newly diagnosed PLWHA. Conclusions: PLWHA and college students using PBL showed improved awareness of HIV and higher levels of recent ART adherence; however, there was no change in long-term ART adherence in newly diagnosed PLWHA.

The Impact of Medical Students' Individual Teaching Format Choice on the Learning Outcome Related to Clinical Reasoning

BACKGROUND

Repeated formative assessments using key feature questions have been shown to enhance clinical reasoning. Key feature questions augmented by videos presenting clinical vignettes may be more effective than text-based questions, especially in a setting where medical students are free to choose the format they would like to work with. This study investigated learning outcomes related to clinical reasoning in students using video- or text-based key feature questions according to their individual preferences.

OBJECTIVE

The aim of this study was to test the hypothesis that repeated exposure to video-based key feature questions enhances clinical reasoning to a greater extent than repeated exposure to text-based key feature questions if students are allowed to choose between those different formats on their own.

METHODS

In this monocentric, prospective, nonrandomized trial, fourth-year medical students attended 12 computer-based case seminars during which they worked on case histories containing key feature questions. Cases were available in a text- and a video-based format. Students chose their preferred presentation format at the beginning of each case seminar. Student performance in key feature questions was assessed in formative entry, exit, and retention exams and was analyzed with regard to preceding exposure to video- or text-based case histories.

RESULTS

Of 102 eligible students, 75 provided written consent and complete data at all study exams (response rate=73.5%). A majority of students (n=52) predominantly chose the text-based format. Compared with these, students preferring the video-based format achieved a nonsignificantly higher score in the exit exam (mean 76.2% [SD 12.6] vs 70.0% [SD 19.0]; P=.15) and a significantly higher score in the retention exam (mean 75.3% [SD 16.6] vs 63.4% [SD 20.3]; P=.02). The effect was independent of the video- or text-based presentation format, which was set as default in the respective exams.

CONCLUSIONS

Despite students' overall preference for text-based case histories, the learning outcome with regard to clinical reasoning was higher in students with higher exposure to video-based items. Time-on-task is one conceivable explanation for these effects as working with video-based items was more time-consuming. The baseline performance levels of students do not account for the results as the preceding summative exam results were comparable across the 2 groups. Given that a substantial number of students chose a presentation format that was less effective, students might need to be briefed about the beneficial effects of using video-based case histories to be able to make informed choices about their study methods.

Virtual patients designed for training against medical error: Exploring the impact of decision-making on learner motivation

Objectives

Medical error is a significant cause of patient harms in clinical practice, but education and training are recognised as having a key role in minimising their incidence. The use of virtual patient (VP) activities targeting training in medical error allows learners to practice patient management in a safe environment. The inclusion of branched decision-making elements in the activities has the potential to drive additional generative cognitive processing and improved learning outcomes, but the increased cognitive load on learning risks negatively affecting learner motivation. The aim of this study is to better understand the impact that the inclusion of decision-making and inducing errors within the VP activities has on learner motivation.

Methods

Using a repeated study design, over a period of six weeks we provided undergraduate medical students at six institutions in three countries with a series of six VPs written around errors in paediatric practice. Participants were divided into two groups and received either linearly structured VPs or ones that incorporated branched decision-making elements. Having completed all the VPs, each participant was asked to complete a survey designed to assess their motivation and learning strategies.

Results

Our analysis showed that in general, there was no significant difference in learner motivation between those receiving the linear VPs and those who received branched decision-making VPs. The same results were generally reflected across all six institutions.

Conclusions

The findings demonstrated that the inclusion of decision-making elements did not make a significant difference to undergraduate medical students’ motivation, perceived self-efficacy or adopted learning strategies. The length of the intervention was sufficient for learners to overcome any increased cognitive load associated with branched decision-making elements being included in VPs. Further work is required to establish any immediate impact within periods shorter than the length of our study or upon achieved learning outcomes.

What Can Be Achieved With Motivation-Based Teaching of Medical Students? A Monocentric Retrospective Audit of Retention Among Highly Motivated Graduates Who Underwent the Learning-by-Doing Concept in Anesthesiology and Intensive Care Medicine

Background

Medical education, in general, is undergoing a significant shift from traditional methods. It becomes very difficult to discover effective teaching methods within the limited possibilities in patient hands-on education, especially as seen in anesthesiology and intensive care medicine (AIM) teaching. Motivation-based teaching is very popular in all other aspects of education, but it has received scant attention in medical education literature, even though it can make a real difference for both students and physicians.

Objective

The primary aim of this retrospective audit was to find out if proper motivation-based teaching of students via the development of AKUTNE.CZ’s serious games can help retain graduates of the Faculty of Medicine of Masaryk University (FMMU) for the AIM specialty.

Methods

Motivation-based teaching and the learning-by-doing concept were applied to a subject called Individual Project. Our topic, The Development of the Multimedia Educational Portal, AKUTNE.CZ, has been offered since 2010. The objective has been the development of supportive material in the form of interactive algorithms, serious games, and virtual patients for problem-based learning or team-based learning lectures aimed at acute medicine. We performed a retrospective questionnaire evaluation of all participants from the 2010-2017 period, focusing on their choice of medical specialty in 2017. The data were reported descriptively.

Results

We evaluated 142 students who passed Individual Project with topic The Development of the Multimedia Educational Portal, AKUTNE.CZ during 2010 to 2017. In this period, they developed up to 77 electronic serious games in the form of interactive multimedia algorithms. Out of 139 students in general medicine, 108 students (77.7%) had already graduated and 37 graduates (34.3%) worked in the AIM specialty. Furthermore, 57 graduates (52.8%) chose the same specialty after graduation, matching the topic of their algorithm, and 37 (65%) of these graduates decided to pursue AIM.

Conclusions

Motivation-based teaching and the concept of learning-by-doing by the algorithm/serious game development led to the significant retention of FMMU graduates in the AIM specialty. This concept could be considered successful, and as the concept itself can also be well integrated into the teaching of other medical specialties, the potential of motivation-based teaching should be used more broadly within medical education.

Use of Learning Analytics Data in Health Care-Related Educational Disciplines: Systematic Review

Background

While the application of learning analytics in tertiary education has received increasing attention in recent years, a much smaller number have explored its use in health care-related educational studies.

Objective

This systematic review aims to examine the use of e-learning analytics data in health care studies with regards to how the analytics is reported and if there is a relationship between e-learning analytics and learning outcomes.

Methods

We performed comprehensive searches of papers from 4 electronic databases (MEDLINE, EBSCOhost, Web of Science, and ERIC) to identify relevant papers. Qualitative studies were excluded from this review. Papers were screened by 2 independent reviewers. We selected qualified studies for further investigation.

Results

A total of 537 papers were screened, and 19 papers were identified. With regards to analytics undertaken, 11 studies reported the number of connections and time spent on e-learning. Learning outcome measures were defined by summative final assessment marks or grades. In addition, significant statistical results of the relationships between e-learning usage and learning outcomes were reported in 12 of the identified papers. In general, students who engaged more in e-learning resources would get better academic attainments. However, 2 papers reported otherwise with better performing students consuming less e-learning videos. A total of 14 papers utilized satisfaction questionnaires for students, and all were positive in their attitude toward e-learning. Furthermore, 6 of 19 papers reported descriptive statistics only, with no statistical analysis.

Conclusions

The nature of e-learning activities reported in this review was varied and not detailed well. In addition, there appeared to be inadequate reporting of learning analytics data observed in over half of the selected papers with regards to definitions and lack of detailed information of what the analytic was recording. Although learning analytics data capture is popular, a lack of detail is apparent with regards to the capturing of meaningful and comparable data. In particular, most analytics record access to a management system or particular e-learning materials, which may not necessarily detail meaningful learning time or interaction. Hence, learning analytics data should be designed to record the time spent on learning and focus on key learning activities. Finally, recommendations are made for future studies.

The Impact of Manuscript Learning vs. Video Learning on a Surgeon's Confidence in Performing a Difficult Procedure

Introduction: Operative surgical videos are a popular educational resource, not commonly a part of a peer-reviewed article. We wanted to evaluate the impact of either reading a peer-reviewed manuscript or watching an operative video on a surgeon's confidence in performing a complex case. Methods: Pediatric surgeons and fellows were asked to complete an initial questionnaire to assess their confidence (formulated as a score) in the diagnosis and operative repair of anal stenosis and rectal atresia. Results: Of 101 pediatric surgeons and fellows, 52 (51%) were randomized into a "manuscript" group and 49 (49%) into a "video" group. The mean confidence before the intervention was the same in the two groups (6.4 vs. 6.6). Attending surgeons started with more confidence than trainees (7.1 vs. 5.3, p < 0.001). In the manuscript group, the average confidence increased to 7.7 (p = 0.005), and in the video group the average confidence increased to 7.9 (p = 0.001) globally. Trainees in the video group significantly improved their confidence to a score of 6.6 (p = 0.035), as did attending surgeons to 8.5 (p = 0.01). In the manuscript group, only attendings significantly improved their confidence by 1.5-8.3 (p < 0.001), whereas trainees did not with a difference of 1.3 (p = 0.194). When considering experience level, physicians who reported never having performed this surgery improved only by reading the manuscript (3.9-6.2) (p = 0.004), not by watching the video (5.4-6.6) (p = 0.106). Surgeons with experience doing this operation (>5 times) did not improve their confidence by reading the manuscript (p = 0.10), nor by watching the video (p = 0.112). Conclusion: Reviewing either a detailed manuscript or operative video on the surgical management of rectal atresia and anal stenosis demonstrated a significant increase in self-reported confidence. Trainees benefitted the most from operative videos, whereas experienced surgeons did not improve their confidence by reading the manuscript nor watching the video.

How can we teach medical students to choose wisely? A randomised controlled cross-over study of video- versus text-based case scenarios

BACKGROUND

The Choosing Wisely campaign highlights the importance of clinical reasoning abilities for competent and reflective physicians. The principles of this campaign should be addressed in undergraduate medical education. Recent research suggests that answering questions on important steps in patient management promotes knowledge retention. It is less clear whether increasing the authenticity of educational material by the inclusion of videos further enhances learning outcome.

METHODS

In a prospective randomised controlled cross-over study, we assessed whether repeated video-based testing is more effective than repeated text-based testing in training students to choose appropriate diagnostic tests, arrive at correct diagnoses and identify advisable therapies. Following an entry exam, fourth-year undergraduate medical students attended 10 weekly computer-based seminars during which they studied patient case histories. Each case contained five key feature questions (items) on the diagnosis and treatment of the presented patient. Students were randomly allocated to read text cases (control condition) or watch videos (intervention), and assignment to either text or video was switched between groups every week. Using a within-subjects design, student performance on video-based and text-based items was assessed 13 weeks (exit exam) and 9 months (retention test) after the first day of term. The primary outcome was the within-subject difference in performance on video-based and text-based items in the exit exam.

RESULTS

Of 125 eligible students, 93 provided data for all three exams (response rate 74.4%). Percent scores were significantly higher for video-based than for text-based items in the exit exam (76.2 ± 19.4% vs. 72.4 ± 19.1%, p = 0.026) but not the retention test (69.2 ± 20.2% vs. 66.4 ± 20.3%, p = 0.108). An additional Bayesian analysis of this retention test suggested that video-based training is marginally more effective than text-based training in the long term (Bayes factor 2.36). Regardless of presentation format, student responses revealed a high prevalence of erroneous beliefs that, if applied to the clinical context, could place patients at risk.

CONCLUSION

Repeated video-based key feature testing produces superior short-term learning outcome compared to text-based testing. Given the high prevalence of misconceptions, efforts to improve clinical reasoning training in medical education are warranted. The Choosing Wisely campaign lends itself to being part of this process.

Nursing students' perceptions of a video-based serious game's educational value: A pilot study

BACKGROUND

Despite an increasing number of serious games (SGs) in nursing education, few evaluation studies specifically address their educational value in terms of face, content, and construct validity.

OBJECTIVES

To assess nursing students' perceptions of a video-based SG in terms of face, content, and construct validity. In addition, the study assessed perceptions of usability, individual factors, and preferences regarding future use.

DESIGN

A pilot study was conducted.

SETTING AND PARTICIPANTS

An SG prototype was implemented as part of two simulation courses in nursing education: one for home health care and one for hospital medical-surgical wards. The SG aimed to teach clinical reasoning and decision-making skills to nursing students caring for patients with chronic obstructive pulmonary disease. A total of 249second-year nursing students participated in pilot testing of the SG.

METHOD

A paper-based survey was used to assess students' perceptions of the SG's educational value.

RESULTS

Overall, students from both simulation courses perceived the SG as educationally valuable and easy to use. No significant differences were found in perceptions of educational value between nursing students with previous healthcare experience versus those with none. However, significantly more students in the home healthcare simulation course indicated that the SG tested their clinical reasoning and decision-making skills. Students from both the medical-surgical and home healthcare simulation courses suggested that more video-based SGs should be developed and used in nursing education.

CONCLUSIONS

Overall, the survey results indicate that the participants perceived the SG as educationally valuable, and that the SG has potential as an educational tool in nursing education, especially in caring for patients with chronic diseases and in home healthcare simulation. Showing a SG's educational value and user acceptance among nursing students may justify the development and application of more SGs in nursing education.

Problem-based learning in internal medicine: virtual patients or paper-based problems?

BACKGROUND

Teaching using paper problem-based learning (p-PBL) sessions has left some students fatigued with the learning process. Therefore, attempts have been made to replace p-PBL with digitally enhanced, decision-making PBL in the form of virtual patients (VP). Student enthusiasm for substituting p-PBL with VP has not been quantitatively evaluated on the intended educational effects.

AIM

To determine the educational effects of substituting p-PBL sessions with VP on undergraduate medical students in their internal medicine course.

METHODS

We conducted a randomised controlled study on 34 third-year undergraduate medical students in the academic year 2015-2016. Student performance after an intervention substituting p-PBL sessions with VP was analysed. The educational outcomes were measured with knowledge exams and the Diagnostic Thinking Inventory.

RESULTS

There was no difference in exam performance between groups (P > 0.833) immediately after the intervention, or in long term. Nor was there a significant difference in improvement of diagnostic thinking between groups (P > 0.935 and P > 0.320).

CONCLUSIONS

Our study showed no significant improvement in diagnostic thinking abilities or knowledge exam results with the use of VP. Educators can add VP to sessions to motivate students, but a significant improvement to educational outcome should not be expected.

Problem-based learning using patient-simulated videos showing daily life for a comprehensive clinical approach

OBJECTIVES

We examined whether problem-based learning tutorials using patient-simulated videos showing daily life are more practical for clinical learning, compared with traditional paper-based problem-based learning, for the consideration rate of psychosocial issues and the recall rate for experienced learning.

METHODS

Twenty-two groups with 120 fifth-year students were each assigned paper-based problem-based learning and video-based problem-based learning using patient-simulated videos. We compared target achievement rates in questionnaires using the Wilcoxon signed-rank test and discussion contents diversity using the Mann-Whitney U test. A follow-up survey used a chi-square test to measure students' recall of cases in three categories: video, paper, and non-experienced.

RESULTS

Video-based problem-based learning displayed significantly higher achievement rates for imagining authentic patients (p=0.001), incorporating a comprehensive approach including psychosocial aspects (p<0.001), and satisfaction with sessions (p=0.001). No significant differences existed in the discussion contents diversity regarding the International Classification of Primary Care Second Edition codes and chapter types or in the rate of psychological codes. In a follow-up survey comparing video and paper groups to non-experienced groups, the rates were higher for video (χ²=24.319, p<0.001) and paper (χ²=11.134, p=0.001). Although the video rate tended to be higher than the paper rate, no significant difference was found between the two.

CONCLUSIONS

Patient-simulated videos showing daily life facilitate imagining true patients and support a comprehensive approach that fosters better memory. The clinical patient-simulated video method is more practical and clinical problem-based tutorials can be implemented if we create patient-simulated videos for each symptom as teaching materials.

Comprendre la sémiologie psychiatrique par du matériel interactif

Chacun retient mieux certains évènements historiques après les avoir vus au cinéma. Son fort pouvoir de mémorisation est lié au fait qu’il touche à la fois la vue, l’ouïe, mais aussi l’empathie et le vécu émotionnel. La psychiatrie a toujours utilisé la vidéo pour vulgariser des notions auprès du grand public ou pour enseigner aux étudiants  : cassettes VHS, films grand public et maintenant youtube. La vidéo contextualise et donne accès à la dimension multi-sensorielle de la recherche sémiologique. Elle est utilisée pour introduire un cours, illustrer et expliquer des termes, et permettre une analyse critique. Filmer des entretiens permet aussi d’enseigner les bases de la relation médecin/patient et de développer l’empathie des étudiants. Les études ont prouvé que l’enseignement magistral avec vidéo a un apport positif dans l’apprentissage des étudiants – meilleurs résultats aux examens théoriques et pratiques [2–5]. Quel est donc l’apport actuel ? D’une part, la vidéo en accès libre sur un site internet touche une génération d’étudiants naturellement utilisatrice de ces nouvelles technologies . D’autre part, cet accès facilité au niveau national permet une uniformisation des données et de l’enseignement. L’usage de la vidéo en psychiatrie n’est pas sans problèmes éthiques : déontologiquement, il n’est pas possible de filmer des patients hospitalisés sous contrainte, dont le jugement est considéré comme altéré. Pour des fins d’enseignement, l’accès à de telles vidéos doit être protégé. Le site internet de l’AESP étant en accès libre pour un public d’étudiants en médecine, nous avons recours à des comédiens et cinéastes bénévoles. L’AESP a débuté deux projets :

– créer des courts métrages illustrant la sémiologie en suivant des patients « comédiens » dans leur quotidien ;

– illustrer par des séquences de quelques secondes les termes sémiologiques du dicosémiopsy de l’AESP, http://dicosemiopsy.asso-aesp.fr/.