Edgar Dale's Pyramid of Learning in medical education: a literature review

The Daily Fact Pile: Exploring Mutual Microlearning in Neurology Resident Education

Problem: A significant proportion of learning during residency takes place through informal channels. Spontaneous collaboration among medical learners significantly contributes to this informal learning and is increasingly recognized as a component of the hidden curriculum in medical education. Yet historically, a disproportionate emphasis in medical education has been placed on didactic, structured, and faculty-initiated methods, leaving an important force in medical education understudied and underutilized. We hypothesize that there is significant educational potential in studying and deploying targeted tools to facilitate collaboration among medical learners. Intervention: At our institution, neurology residents implemented the "Daily Fact Pile" (DFP), a resident-led, email-based collaboration that served as a platform to share clinical pearls in an informal, digital way. Participation was voluntary and participants were encouraged to share facts that were new to them and thought to be clinically relevant. Motivated by the positive collective experience, we conducted a retrospective examination of this phenomenon. In this context, we developed the concept of "mutual microlearning" to characterize this efficient, multidirectional exchange of information. Context: Thirty-six residents in a single neurology residency program utilized the DFP at a large university hospital in the USA between 2018 and 2019. After 21 months of spontaneous and voluntary participation, we assessed the feasibility of the DFP, its impact on the education and morale of neurology residents, and compared its mutual microlearning approach to traditional lectures. This was done through a survey of the DFP participants with a response rate of 80.7%, and analysis of the statistics of participation and interaction with the DFP. Impact: Most participants felt that the DFP was beneficial to their education and thought they often or always learned something new from reading the DFP. The impact of the DFP extended beyond education by improving interest in neurology, morale, and sense of teamwork. The DFP was feasible during neurology residency and participation was high, though participants were more likely to read facts than share them. Lessons learned: Mutual microlearning represents an opportunity to augment residents' education, and well-designed mutual microlearning tools hold promise for complementing traditional teaching methods. We learned that efficiency, ease of use, and a supportive, non-judgmental environment are all essential to the success of such tools. Future research should delve deeper into the underlying mechanisms of mutual microlearning to establish its position within the theoretical frameworks of medical education.

The Undermined ACGME Subcompetency: A Roadmap for Radiology Residency Programs to Foster Residents-as-Educators

Radiology Residency programs in the United States use a set of six core competencies as laid out by the Accreditation Council for Graduate Medical Education (ACGME) to evaluate the foundational skills of every resident. Despite the fact that educational skills are included under the heading of Practice-Based Learning and Improvement in the ACGME guidelines for radiology residents, it is often underappreciated and undervalued, when compared with medical knowledge or patient care. In this paper, the authors lay out the important role of residents-as-educators and how it can be inculcated as part of formal training during residency. They enunciate five pillars for academic programs to build and maintain the pedagogical skills of their radiology residents: Training, Practicing, Providing Feedback, Mentoring, and Changing the Culture. The authors believe that implementing this will holistically benefit radiology residents as well as radiology in building future educators. The authors also delineate the challenges that programs currently face in implementation and ways to overcome them.

Influence of teach-back strategy on hemodialysis related knowledge level, self-efficacy and self-management in patients receiving maintenance hemodialysis

To investigate the effect of teach-back strategy on hemodialysis related knowledge level, self-efficacy and self-management among hemodialysis patients. The research is a quasi-randomized control trial. A total of 92 patients receiving maintenance hemodialysis were randomly divided into observation group (n = 46) and control group (n = 46) by random number table method. The control group received conventional health education, and the observation group received teach-back. The intervention lasted six months. The hemodialysis related knowledge level, self-efficacy and self-management of the two groups were evaluated before and after the intervention. There were no significant difference on hemodialysis related knowledge level, self-efficacy and self-management scores between the two groups before intervention (P > 0.05). After intervention, the scores of hemodialysis knowledge in the observation group was higher than that in the control group and before intervention. The total scores of self-efficacy and items "3,4,5" were higher than those of the control group. The total scores of self-efficacy and item "1~6" in the observation group were higher than before intervention. The total scores of self-management and the three subscales of "problem solving", "partnership" and "emotional processing" were higher than those of the control group and before intervention. All of the above differences were statistically significant (P < 0.05). Teach-back is helpful to improve the hemodialysis related knowledge level, self-efficacy and self-management level of patients receiving maintenance hemodialysis, and it is worth to be popularized clinically.

Assessing the Merits and Effectiveness of Peer Teaching in Small Groups through the Employment of Different Learning Media

Background  Peer teaching is a well-acknowledged method to facilitate teaching and learning among medical students. The objective of the study was to assess the merits and effectiveness of peer teaching in small groups using a student-centered approach through the employment of different learning media. Methods  This was a cross-sectional descriptive study conducted among a group of 34 students from third professional year. Purposive sampling was used, wherein students were subdivided into five small groups. At the beginning, a pretest consisting of 10 multiple-choice questions was conducted on the topic "Epidemiology of Hypertension." This topic was further subdivided into five subtopics, and five separate learning media (viz., video, PowerPoint, white board, chalk-and-talk, and chart) were allocated using the lottery method. Each group discussed the allotted topic and then presented their findings in the large group using the assigned learning media, while other groups gave feedback, and the best group was decided through multivoting. Posttest was administered and the results were compared with the pretest. Data entry was done in Microsoft Excel and analysis was done using SPSS 16. Descriptive statistics and paired t -test was used to compare the results in pretest and posttest at p level < 0.05. Results  This innovative session of peer teaching featured 34 students, with a mean age of 22 ± 1.3 years. While carrying out the Kirkpatrick Level 1 evaluation, almost 90% students liked the role of the facilitator in stimulating interest in the topic. There was a mean average increase of 1.7 marks on comparing the scores of posttest with pretest (Kirkpatrick Level 2), and the reported difference was statistically significant. Joyful learning 24 (66.7%) and group discussion 23 (63.9%) emerged as the most liked aspects of the session. Conclusion  In conclusion, peer teaching through learning media is an effective method as it promotes active learning, improves communication skills, and improves the academic performance of students. Peer teaching using different learning media proved to be quite effective in improvement of knowledge about epidemiology of hypertension, the pros and cons of different learning media, and encouraged creativity among students.

What Happens to the Principles of Evidence-Based Practice When Clinicians Become Educators? A Case Study of the Learning Styles Neuromyth

Introduction

The approach of matching teaching practice to individual student "Learning Styles" has been repeatedly shown to be ineffective, even harmful. Yet, it appears a majority of educators believe it to be an effective approach. The status of Learning Styles theory in health professions education is unclear.

Method

We surveyed health professions educators to determine whether they believed that Learning Styles theory is effective and whether this belief translates to action. We also test knowledge of Learning Styles theory.

Results

87.4% of participants are familiar with Learning Styles, but knowledge about specific models varies. 69.9% of participants believed that Learning Styles theory is effective, but only one-third of them were actually using it.

Discussion

More effort is required to emphasise the importance of evidence-based educational awareness and practice in the healthcare community. As is the case with clinical practice, a culture of promoting pedagogy validated by the scientific method should be the norm.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-023-01849-1.

3D-Printing-Based Fluoroscopic Coronary Angiography Simulator Improves Learning Capability Among Cardiology Trainees

Aim

One of the essential competencies of cardiology trainees is the ability to perform coronary angiography with good projection.

Purpose

This study is a research and development study aimed at testing the effectiveness of 3D-printing-based fluoroscopic coronary angiography simulator as a learning medium for diagnostic coronary angiogram.

Methods

Thirty-four cardiology trainees randomly were divided into two groups. Both groups took a pretest before the intervention. The first group (group A) studied using conventional learning media and underwent the first post-test. Afterward, they switched to a 3D-printing-based fluoroscopic coronary angiography simulator and underwent a second post-test. The second group (group B) studied using a 3D-printing-based fluoroscopic coronary angiography simulator, underwent the first post-test, switched to the conventional learning media, and underwent a second post-test.

Results

The delta between the post-test I and the pretest of group B was 8.53, higher than the delta between the post-test I and the pretest of group A (5.21) with a significant difference (p = 0.003). In group A, the delta between post-test II and pretest was 9.65, higher than the delta between post-test I and pretest (5.21) with a significant difference (p < 0.001).

Conclusion

3D-printing-based fluoroscopic coronary angiography simulator is effective as a learning medium for coronary angiogram diagnostics.

Effectiveness of breastfeeding educational interventions to improve breastfeeding knowledge, attitudes, and skills among nursing, midwifery, and medical students: A systematic review and meta-analysis

BACKGROUND

Breastfeeding education programs are necessary to prepare healthcare students to address the breastfeeding needs of families. Various breastfeeding educational modules have been used in academic settings; however, the effectiveness of breastfeeding educational interventions remains unclear.

OBJECTIVES

To examine the effectiveness of educational interventions to improve the breastfeeding knowledge, attitudes, and skills of nursing, midwifery, and medical students.

METHODS

A systematic review was conducted searching academic databases from inception to December 22, 2022. Searches were carried out by two authors independently in PubMed, MEDLINE, Web of Science, Scopus, CINAHL Plus, Embase, Cochrane Library, and ERIC. Joanna Briggs Institute critical appraisal checklist was used. The data were extracted for a random-effects meta-analysis to estimate the standardized mean differences (SMDs) with 95 % confidence interval (CI). Subgroup analyses were performed to identify potential moderators.

RESULTS

Thirty-three quasi-experimental studies (12 two-group studies and 21 one-group studies), which included 1313 nursing students, 204 midwifery students, and 1066 medical students, were identified. The students who received educational interventions had significantly higher scores in breastfeeding knowledge (SMD: 0.67, 95 % CI: 0.46, 0.87 for two-group studies; SMD: 1.42, 95 % CI: 0.91, 1.94 for one-group studies), more positive attitudes toward breastfeeding (SMD: 0.43, 95 % CI: 0.22, 0.63 for two-group studies; SMD: 0.98, 95 % CI: 0.32, 1.63 for one-group studies), and higher scores for breastfeeding skills (SMD: 1.52, 95 % CI: 0.46, 2.58 for two-group studies; SMD: 1.33, 95 % CI: 0.43, 2.23 for one-group studies) than the control groups. As a teaching method, clinical practicums were a significant moderator of both breastfeeding knowledge (p = .035) and skills (p < .001). Few studies (n = 5) described the educational framework underpinning the program development.

CONCLUSIONS

Breastfeeding educational interventions effectively improve the breastfeeding knowledge, attitudes, and skills of undergraduate nursing, midwifery, and medical students. Incorporating clinical practicums in interventions is important. Future studies to examine useful teaching strategies for enhancing learning outcomes are warranted.

Pyramids in medical education: Their conceptualization and utility summarized

Objectives

To examine the conceptual underpinnings of learning pyramids, their limitations and some proposed modifications, and to describe their utility.

Materials and methods

Starting with a selection of pyramids based on whether graphic design was part of their original design and on their conceptual description, we examined the criticisms they have received and the modifications derived from those observations, and the use given to the pyramids most commonly used in medical education.

Results

Five pyramids were included, namely, George Miller, Edgar Dale, Donald Kirkpatrick, Benjamín Bloom and Abraham Maslow. Pyramids describe different aspects of medical education evaluation, either of individuals or of training programs, including competencies, identity, reliability, learning, behavior, results, cognitive complexity and self-realization.

Conclusions

As theoretical models, the pyramids examined have contributed to support learning processes in health professions. Their practical utility extends to different specialties and education levels given that they can help faculty optimize curricular design, teaching and evaluation processes. It is important to conduct a local assessment of the effects on health science programs built on these theoretical models.

An initial reliability analysis of a patient counseling rubric to objectively measure student pharmacist performance

Current literature outlines the documented need for improved communication during patient medication counseling. Although many tools exist, there needs to be a national standardized tool that complies with federal and state law, to objectively measure student pharmacist performance during patient counseling in the community pharmacy setting. The primary objective of this study is to perform an initial analysis of the internal consistency reliability of a patient medication counseling rubric designed with an Indian Health Services theoretical framework. Secondary objectives include measuring changes in student performance over the time of the study. The 18-item rubric was developed to objectively measure student pharmacist performance during patient medication counseling sessions in a 21-h Introductory Pharmacy Practice Experience (IPPE) course. The community-pharmacy-based IPPE patient counseling course evaluates students' communication skills and patient-centered counseling techniques in live and simulated patient counseling sessions. Three pharmacist evaluators assessed a total of 247 student counseling sessions. The rubric's internal consistency reliability was analyzed, and student performance improvement was observed within the course. Students' performance was evaluated as "meets expectations" in most live and simulated sessions. However, an independent groups t-test showed that the mean performance score for the live counseling sessions (2.59, SD = 0.29) was higher (p < 0.001) than that for the simulated counseling sessions (2.35, SD = 0.35). Students' performance in the course improved over three weeks [Week 1: mean (SD) = 2.29 (0.32), Week 2: mean (SD) = 2.44 (0.33), Week 3: mean (SD) = 2.62 (0.29); p < 0.001]. A Tukey-Kramer comparison post hoc test found a significant increase in the mean performance scores between weeks (p < 0.05). The overall internal consistency reliability of the counseling rubric was determined acceptable, with a Cronbach's alpha of 0.75. Further study is required, including the assessment of inter-rater reliability, factor analysis, variable analysis, and use in other states with patient confirmation testing necessary to validate the rubric for use with student pharmacists in the community pharmacy setting.

Tutorials in anatomy education of medical students during the COVID-19 pandemic - An evaluation of its effectiveness

Anatomy has traditionally been taught through prosected specimens and the use of models and other techniques. During the COVID-19 period, this was replaced by tutorials, where students came to college to continue taking practical sessions. The study comprised four components. The first component consisted of demographic data. The second component consisted of questions concerning students' satisfaction with the tutorials. The third component included questions for Year 2 medical students only because they had tried both the new and old systems. The fourth component included the results for the Year 2 medical students. The study included 102 medical students. The number of tutorials each week and the duration of each tutorial were considered successful, since 47 (46.1%) and 44 (43.1%) students approved, respectively. The students were comfortable with understanding the information from PowerPoint presentations; 41 (40.2%) agreed with this statement. Moreover, 44 students (43.1%) agreed about the ability to recall material after the tutorial and the interaction it allowed them with the doctors. Overall, all the questions proved that the tutorials were of great value to the students during the COVID-19 period. Although COVID-19 limited anatomy teaching, tutorials were seen as a light at the end of the tunnel pending the end of the COVID-19 period.

Challenges regarding digital distance learning of operationally- oriented professions, due to Covid-19 pandemic

The focus on challenges related to digital distance learning has become particularly relevant since educational institutions had to close due to the Covid-19 pandemic. Teaching related to operationally oriented professions, such as e.g., aviation and nautical represent educations that have faced extensive challenges. Education portfolios for such professions contain subjects that require transfer of competence based on experiential-based learning leading to in-demand knowledge, skills, attitudes, and sustainable understanding. Such operative-oriented competence is difficult to acquire through exclusively digital distance learning. This paper highlights challenges related to the operationally oriented topics of maritime education and training (MET). Traditionally, operationally oriented learning associated to MET has been carried out based on "on-scene" transfer of experience i.e., inexperienced sailors have gained experience by being guided by experienced sailors. Modern MET has evolved towards more passive "off-scene" learning activities. As a replacement for reduced "on-scene" learning activities, modern simulator and laboratory-based learning platforms have been developed within maritime and other operationally oriented educations. Learning platforms like these are probably the most challenging to find digital distance teaching substitutes for, regarding the Covid-19 pandemic closure. The purpose of this paper is to show whether the rapid change of learning context due to the pandemic closure affected the instant knowledge displayed in exam grades. In addition, the paper addresses possible challenges related to the loss of experience-oriented simulator and laboratory-based teaching activities, due to the pandemic closure.

Analysis of a multifaceted interactive pedagogy program in an upper limb anatomy course: A time series study

Many new methods have contributed to the learning of anatomy, including several interactive methods, increasing the effectiveness of educational programs. The effectiveness of an educational program involving several interactive learning methods such as problem-based learning and reciprocal peer teaching was researched in this study. A quasi-experimental before-after study on three consecutive groups of second-year students at the Grenoble School of Medicine was conducted. The lectures were replaced by an educational program based on the problem-based learning method and reciprocal peer teaching. The first session was dedicated to reading clinical cases illustrating the medical concept, so that the learning objectives for the second session could be set. Then, after viewing digital courses, the second session was dedicated to a synthetic presentation by the students themselves, followed by an interactive summary with the teacher. The analysis of 630 students showed a significant increase in the theory test results for those who took part in the intervention: 9.71 versus 9.19 (β = 0.57, P = 0.036). Moreover, satisfaction was high after the intervention (mean = 4.5/5), and when comparing the two pedagogical approaches the students showed a clear preference for the program implemented with the concepts highlighted such as interactivity, in-depth work, group work, and autonomy. A multifaceted interactive pedagogy program could have a significant impact on the results of the theoretical concepts presented and on satisfaction as well as increased investment by students in learning anatomy.

The experiences of district public health officers during the COVID-19 crisis and its management in the upper southern region of Thailand: A mixed methods approach

District public health officers (DPHO) are the major health care providers and vital resources for tackling the coronavirus disease 2019 (COVID-19) outbreak in Thailand. No studies have been published on their experiences of combating COVID-19 in Thailand. To guide and improve COVID-19 control efforts, we aimed to describe their experiences and analyze associated factors for tackling the outbreak. This mixed-methods design involved providing structured questionnaires to selected DPHOs across 52 districts of seven provinces in the upper southern region Thailand. We performed data analysis using descriptive and multivariate statistics. The quantitative approach used questionnaires that demonstrated the content validity and reliability. Data collection involved Google forms, analyzed by multivariate statistics. The qualitative approach comprised an online in-depth interview of 11 DPHOs and a thematic analysis. Results found of the 52 DPHOs, 41 were men (78.8%), and the mean age was 50.02 years (SD = 8.52 years). Their proactive experiences were significantly associated with sex (OR_adj = 2.38, 95% CI = 1.11-3.30), age (OR_adj = 1.73, 95% CI = 1.09-2.76), the length of experience in the current position (OR_adj = 2.27, 95% CI = 1.43-3.63), and working time in the current position (OR_adj = 2.27, 95% CI = 1.43-3.63). There was no significant association between marital status, knowledge, understanding, opinion, proactive practice, and participation experiences. These results were related to six themes of the qualitative approach as follows: High morbidity and mortality of COVID-19, COVID-19 concomitant with several problems, Reaching out to the community for better COVID-19 solutions, The importance of regular reports and feedback, Solution planning based on the situation, and Providing relief to all stakeholders from COVID-19 issue. Proactive experiences of district public health officers are important for sustainable COVID-19 solutions. Disseminating relevant equipment, guidelines, policy, and government regulations is necessary to promote preparedness and efficacy in the crisis management of COVID-19.

Incorporating Mixed Reality for Knowledge Retention in Physiology, Anatomy, Pathology, and Pharmacology Interdisciplinary Education: A Randomized Controlled Trial

Disease education is a fundamental component in health science and medicine curricula, as it prepares students for their progression into health profession careers. However, this requires an ability to integrate concepts across multiple disciplines. Technology-enhanced interventions may bridge this gap, and this study assessed the effectiveness of a textbook-style or a three-dimensional mixed reality (MR, a hybrid of augmented and virtual reality) HoloLens resource for student learning and knowledge retention using asthma as a model of disease. Sixty-seven first-year undergraduate health science and medical students were randomized into two groups to complete a lesson on the physiology, anatomy, pathology, and pharmacology of asthma, delivered through either a textbook-style (n = 34) or MR (n = 33) resource. Participants took part in the study in small groups and completed the intervention and surveys in separate areas of a large laboratory space. A pre-test prior to the lesson included multiple-choice questions, with the post-test having additional multiple-choice questions to assess learning. A follow-up test to assess retention was performed two weeks later. Pre- and post-test scores revealed increased learning across both the textbook (p = 0.001) and MR (p = 0.05) interventions, although higher test results were obtained by those using the textbook-style resource (p < 0.05). There was no difference between groups in knowledge retention scores. Although the textbook-style resource was more effective for increasing test results, participants perceived MR as more favorable, highlighting the experience as enjoyable and useful. This study presents MR as an option for integration in cases where educators wish to enhance student enjoyment of the learning experience. However, the results suggest that traditional text-based resources persist as a fundamental delivery mode within a modern curriculum.

Strategies to improve the vaccine distribution and community awareness of taking COVID-19 vaccine in rural areas in Indonesia

COVID-19 has spread worldwide, and several governments, including Indonesia, are actively vaccinating. However, numerous factors may contribute to decreased vaccination administration, including hesitation, a lack of information, and demographic considerations. Therefore, this review provides insights on maximizing vaccine distribution and raising community awareness about COVID-19 vaccination in rural regions with difficulty in transportation access, a lack of health care workers, and limited vaccine storage facilities. It was discovered that numerous potential methods, such as the Internet of Things (IoT), bio-tracking and bio-detect, P-median, and Vehicle Routing Problem (VRP), can monitor vaccination delivery in rural parts of Indonesia. The correct vaccine distribution system can monitor situations during distribution by combining IoT technology with bio-tracking and bio-detect in airborne transportation. Besides enhancing vaccine distribution technologies, healthcare professionals play a critical role in maintaining vaccine quality and improving community awareness of diseases. In particular, as a healthcare professional, a pharmacist has an essential role in ensuring the quality of the vaccine until it is administered to the patient and improving patients’ awareness of COVID-19 and the vaccinations. Pharmacists can collaborate with other healthcare professionals to educate the community to identify important information related to wrong perceptions about COVID-19 and vaccinations.

Observed structured clinical examination as a means of assessing clinical skills competencies of ANPs

Observed structured clinical examinations (OSCEs) are a common method of assessment within higher education to prepare for the advanced nurse practitioner (ANP) role. This article reviews a wide range of literature relating to OSCE assessment in the healthcare arena, from an ANP, interprofessional and advanced clinical practice perspective. Theories underpinning OSCE and advanced nursing roles are explored, with relevant supporting literature indicating how established OSCEs can become integrated with other methods to improve outcomes for this level of practice. Alternative assessments are explored with specific reference to the context of the education delivered, and the suitability for higher education today.

A survey study on distance anatomy education: challenges unique to anatomy

PURPOSE

Traditional anatomy education (TAE) is based on teaching by seeing and touching cadavers/plastic materials that enable three-dimensional thinking, but there was no opportunity like this in distance anatomy education (DAE). Due to the COVID-19 pandemic in 2020, many trainings planned face-to-face were carried out remotely. In this study, our aim is to evaluate students' views on the efficiency of DAE, and to increase the efficiency of DAE in the future.

METHODS

The questionnaire used in the study was applied to the first grade students in the Faculty of Medicine, at the Eskisehir Osmangazi University, in 2019-2020. 239 students completed the survey. The questionnaire consisted of the demographic information, that was obtained with voluntary consent, and sections containing suggestions on DAE, and its comparison with distance education of other basic medical science courses. The survey was prepared as a Likert scale (with 1 = totally disagree to 5 = totally agree), on Google forms and sent to the students online.

RESULTS

82.4% of the students marked "totally disagree" or "disagree" for the statement of "DAE is more efficient than TAE". The total percentage of students who marked "totally disagree" or "disagree" for the statement of "I was satisfied with the theoretical education in DAE" was 58.6%, but when it came to practical education the percentage raised to 79.9%.

CONCLUSIONS

According to the results the efficiency of DAE, especially in terms of practice lessons, was found to be lower than TAE. To make DAE a powerful alternative to TAE, future studies should aim to develop a new syllabus for DAE.

The promotion of healthy breakfast and snacks based on the social marketing model: a mixed-methods study

BACKGROUND

Skipping breakfast and replacing it with non-nutritious snacks are progressively increasing among adolescents. This study aimed to develop an educational intervention based on the Social Marketing Model and evaluate its effects on healthy breakfast and snack consumption among female adolescent students.

METHODS

This mixed-methods study was conducted in 2016-2019 in two phases. In the first phase, a qualitative study was conducted through directed content analysis in guidance schools in Khorramabad, Isfahan, and Tehran, Iran, to explore factors affecting breakfast consumption. The results of this phase were set in the benchmarks of the Social Marketing Model. In the second phase, a randomized controlled trial was conducted based on the benchmarks of the Social Marketing Model on 94 students randomly recruited from guidance schools in Khorramabad, Iran.

RESULTS

The findings of the qualitative phase were categorized into the benchmarks of the Social Marketing Model, namely the social marketing mix, the intended behavior, internal and external competing factors for behavior modification, theoretical concepts related to the behavior, and the role of supporters. In the quantitative phase, the univariate analysis showed significant between-group differences concerning the product, price, promotion, and behavior (p < 0.05).

CONCLUSION

Healthy breakfast and snack consumption can be promoted through making acceptable the tastes, costs, preparations, and consumption places of breakfast and snack.

TRIAL REGISTRATION

The trial was registered in the Iranian Registry of Clinical Trials (code: IRCT20170201032347N1 ). The trial was registered in 11/07/2018 and is accessible on the Iranian Clinical Trial Registration website.

Transforming Agricultural Extension Service Delivery through Innovative Bottom–Up Climate-Resilient Agribusiness Farmer Field Schools

Conventional approaches to agricultural extension based on top–down technology transfer and information dissemination models are inadequate to help smallholder farmers tackle increasingly complex agroclimatic adversities. Innovative service delivery alternatives, such as field schools, exist but are mostly implemented in isolationistic silos with little effort to integrate them for cost reduction and greater technical effectiveness. This article presents a proof-of-concept effort to develop an innovative, climate-resilient field school methodology, integrating the attributes of Farmers’ Field School, Climate Field School, Climate-Smart Agriculture and indigenous technical knowledge of weather indicators in one package to address the gaps, while sensitizing actors on implications for policy advocacy. Some 661 local facilitators, 32% of them women and 54% youth, were trained on the innovation across East Africa. The initiative has reached 36 agribusiness champions working with 237,250 smallholder farmers in Kenya, Tanzania and Uganda. Initial results show that the innovation is strengthening adaptation behaviour of agribusiness champions, farmers and supply chain actors, and reducing training costs. Preliminary findings indicate that the process is rapidly shaping group adaptive thinking. The integrated approach offers lessons to transform extension and to improve food security and resilience. The approach bundles the costs of previously separate processes into the cost of one joint, simultaneous process, while also strengthening technical service delivery through bundled messaging. Experience from this initiative can be leveraged to develop scalable participatory extension and training models, especially scaling out through farmer-to-farmer replication and scaling up through farmer group networks.

A Scoping Review of Radiation Oncology Educational and Career-Planning Interventions in Undergraduate Medical Education

Radiation oncology (RO) teaching in undergraduate medical education (UME) is lacking worldwide with potentially detrimental effects on medical student career choices and patient care. The objective of this scoping review is to examine the extent of published literature describing RO educational and career-planning interventions in UME. Online databases were searched from respective dates of inception to June 2020 for articles that reported outcomes from RO educational and career-planning interventions in UME. Two independent reviewers screened entries for inclusion. Following full-text reviews, 25 articles were analyzed. Most interventions were a single session, involved clinical medical students, and were based in North America. Didactic teaching was most commonly used, though a majority included interactive learning in addition to or in place of didactic teaching. As expected, there was a heterogeneity of outcomes reported, and most studies collected data using surveys alone. Recurring topics included the multidisciplinary nature of oncology and psychosocial oncology. There was a paucity of studies reporting on formal mentorship programs and research programs. The data collated in this study can help develop new initiatives based on what has succeeded in the past. Areas that may benefit from future studies include mentorship programs, research programs, and interventions from outside North America.

The use of internet platforms for oral health information and associated factors among adolescents from Jakarta: a cross sectional study

Background

The growth of the internet has increased its use to obtain health information including oral health information (OHI). This study assessed Indonesian adolescents’ use of different internet platforms to obtain OHI and factors associated with this use.

Methods

A cross-sectional study surveyed middle school students in five regions in Jakarta in 2019. Participants completed a questionnaire that assessed demographics, oral health practices (toothbrushing and dental visits), the presence of dental pain, using internet platform to obtain OHI and type of information searched for. Multinomial logistic regression was used to assess the association between using the internet for OHI (Google, Social Media (SM), both or none) and the independent factors: demographics, oral health practice, dental pain and whether participants search for causes, symptoms, prevention or treatment of oral diseases (ODs).

Results

Most of the 521 participants were female (55.7%) with mean age = 13.4 years. Almost all of them (93.7%) searched the internet for OHI through Google (40.7%) or Google with SM (36.1%). Searching for OHI over SM was significantly associated with toothbrushing (OR = 4.12, 95% CI = 1.43, 11.89) and less dental visits (OR = 0.16, 95% CI = 0.05, 0.60). Searching Google for OHI was significantly associated with looking for information about causes (OR = 3.69, 95% CI = 1.33, 10.26) and treatment (OR = 6.17, 95% CI = 2.23, 17.03) of ODs.

Conclusions

Most adolescents used Google to seek OHI. Oral health practices and types of OHI searched for differed by internet platform. Dental health professionals should consider using internet-based interventions to promote oral health to this age group.

Simulation-Based Learning Versus Didactic Lecture in Teaching Bronchial Asthma for Undergraduate Medical Students: a Step Toward Improvement of Clinical Competencies

BACKGROUND

Simulation-based learning (SBL), an effective teaching strategy, is still questionable on whether it can be an alternative to didactic lectures in medical education. Our study aimed to evaluate the effectiveness of SBL versus traditional lectures in retention of knowledge.

METHODS

A randomized controlled trial was conducted among medical students who were divided in two groups (36 students each). Each group received the same information about diagnosis and management of bronchial asthma, but with a different teaching method: didactic lecture or simulation. Knowledge level was tested before, immediately after the teaching sessions and 3 months later using multiple-choice questions. Student's satisfaction was evaluated using feedback questionnaire.

RESULTS

The simulation group scored higher than the lecture group in the post-test and the late test. However, these differences were not significant. Additionally, students' satisfaction scores were significantly higher in the simulation group than in the lecture group (p < 0.01). Students ranked simulation significantly better regarding motivation (71.9%), comfort (59.4%), understanding (59.4%), and effective communication (59.4%) (p < 0.01).

CONCLUSION

Simulation is as effective as lecture in retention of medical knowledge. Nonetheless, students agree that it is more satisfactory and interesting. SBL integration in medical programs is recommended to overcome obstacles in clinical training.

Teaching Glasgow Coma Scale Assessment by Videos: A Prospective Interventional Study among Surgical Residents

Objective  Glasgow Coma Scale (GCS) assessment is vital for the management of various neurological, neurosurgical, and critical care disorders. Learning GCS scoring needs good training and practice. Due to limitation of teachers, the new entrants of the clinical team find it difficult to learn and use it correctly. Training through videos is being increasingly utilized in the medical field. This study aimed to evaluate the efficiency of video teaching of GCS scoring among general surgery residents. Materials and Methods  A prospective study was done utilizing the freely available video at glasgowcomascale.org. The participants (general surgery residents, 1st-3rd year) were asked to assess and record their responses related to GCS both before and after watching the video. A blinded neurosurgeon recorded the correct responses separately. Statistical Analysis  The difference between correct responses of the residents before and after watching the video was calculated using the "chi-square test." p -Value ≤ 0.05 was taken as significant. Results  There was a significant improvement in GCS scoring by residents after watching the videos ( p < 0.05). On estimating the responses separately, all the three responses (eye, verbal, and motor) improved significantly for 1st-year residents while only the motor response improved significantly for 2nd- and 3rd-year residents. The mode subjective improvement for the 1st-, 2nd-, and 3rd-year residents was 5, 4, and 3, respectively. Conclusion  Training GCS scoring through videos is an effective way of teaching the surgery residents with maximum benefit to the junior-most ones.

Ethics in medical education digital scholarship: AMEE Guide No. 134

Ethics has long been a concern in medicine, education and scholarship. In the digital age, new complexities have arisen, and many medical education researchers are unprepared for the pitfalls ahead, often negotiating these in the absence of guidelines, and unaware of the many tools that can be used to assist them. This Guide takes the medical education scholar through a journey in which issues of ethics are discussed in all stages of digital scholarship: research preparation, research subject monitoring and data gathering, securing one's data (and balancing security against accessibility), anonymising textual and non-textual data, third party identifiability in digital data, writing one's own work (including plagiarism and paper mills), copyright (including issues of Creative Commons and royalty-free), accessing inaccessible reference material, ethically citing electronic material, and manuscript submission (including issues of selecting journals, open access and data sharing). The Guide ends with a brief look to the future. This Guide aims to be a useful tool to alert the readers to some of the most important ethical issues that need to be considered, and some practical solutions to ethical problems faced, when engaging in medical education digital scholarship.

Augmenting training–learning experience by design: a conceptual framework

Purpose

The purpose of this paper is to explore the possibility of designing training sessions on the basis of a dramatic structure and inclusion of contextual narrative for facilitating transfer of learning. The role of stimulating curiosity in this process has also been scanned under the lens of neurobiological insights.

Design/methodology/approach

The paper theoretically develops a framework through an integrative literature review to examine the prospect of enhanced learner engagement through structure, narrative and some interdisciplinary theories, namely, the gap theory of curiosity and the peak end theory.

Findings

A contextual story-based training method designed on the basis of a dramatic plot structure can leverage on the learners’ emotions for engaging learning sessions and retention of content. Such design offers potential to improvise and strengthen the overall training module design and delivery mechanism. The outcome is seen through enhanced peak moments of curiosity and satisfaction, thus enriching the overall training–learning process.

Research limitations/implications

The study is theory based and non-empirical which does not give it a ground to make generalised statements and conclusions. This factor, however, paves the way for future research in the allied areas such as empirical testing of the framework by identifying and testing the variables and other contextual and causal factors.

Practical implications

The suggested framework has practical implications for Learning and Development managers as well as academies. The conceptual framework provided in this work can lend some unique insights towards strengthening the training–learning process.

Originality/value

Although the concept of using stories for training is not new, this study contributes by proposing a new theoretical framework that examines together the elements of sound dramatic structure and a story-based training method. Such a design, conceived by taking into account an understanding of the working mind, can influence the overall experience of achieving positive training–learning results.

Practical ultrasound workshops to teach medical students basic concepts of ultrasound semiology

OBJECTIVES

To evaluate the effectiveness of practical ultrasound workshops for the acquisition and consolidation of conceptual learning about the basic physics and semiology of ultrasonography aimed at third-year medical school students doing the physical examination module of their studies.

MATERIAL AND METHODS

We carried out practical ultrasound workshops with two groups of 177 and 175 students in two consecutive academic years. All students had taken a class in basic radiology in the previous year. Students examined each other with ultrasonography under instructors' supervision in a two-hour session. Before and after the workshop, students did a seven-question multiple-choice test about basic semiology and answered two questions evaluating their degree of confidence in interpreting ultrasonographic images and handling the ultrasound scanner on a scale from 1 to 10.

RESULTS

No significant differences were found between the scores obtained in the two groups. Overall, the mean score on the multiple-choice test improved from 59.71% on the initial assessment to 88.29% on the post-workshop assessment (p <0.01). Confidence in interpreting images improved from 3.39/10 to 6.28/10 (p <0.01), and confidence in handling the equipment improved from 3.73/10 to 6.51/10 (p <0.01).

CONCLUSION

Practical workshops were useful for learning basic concepts about ultrasound imaging, allowing students to significantly improve their scores on the multiple-choice test. Students had a low level of confidence in their ability to interpret ultrasound images and handle the equipment before starting the workshop, but their confidence improved significantly after completing the workshop.

Edgar Dale's Pyramid of Learning in medical education: Further expansion of the myth

INTRODUCTION

A mythical Pyramid of Learning, usually attributed to Edgar Dale (or the National Training Laboratories [NTL]) and giving student learning retention rates, has been cited in a wide range of educational literature. A 2013 literature review indicated that medical education literature similarly cites this Pyramid. It was hoped that highlighting this myth in that review would reduce references to the Pyramid in future medical education literature. This study aimed at determining what change in Pyramid citation has occurred in the past 5 years.

METHODS

A documented literature review, following the same process as the original review, was conducted. The search dates were September 2012 to April 2018, and the databases were Academic Search Complete, CINAHL, Medline and Google Scholar. Sources were from peer-reviewed journals or conferences, in English.

RESULTS

From an initial search result of 992 documents, 41 were found to match the criteria. Trends discovered are: the number of Pyramid citations in medical education literature is increasing dramatically, new sources of the Pyramid are now being used, refutations of the Pyramid are being used to support it, and even researchers who acknowledge the weakness of the Pyramid still cite it.

DISCUSSION AND CONCLUSION

In spite of the 2013 review, the situation has become worse. One possible reason is that refutations use too polite academic wording, and other researchers then consider the Pyramid to be merely "disputed" or "debated." To kill the myth of the Pyramid, it is necessary for this article's Abstract to state unequivocally: The Pyramid is rubbish, the statistics are rubbish, and they do not come from Edgar Dale. Until the NTL can provide details about the original research, their version must also be treated as rubbish.

The outcome-based iCAN! / theyCAN! feedback paradigm differentiates strong and weak learning outcomes, learner diversity, and the learning outcomes of each learner: A shift to metacognitive assessment

Background

Can learning outcomes be transformed in useful tools revealing strong and weak learning outcomes, learners, teachers; reporting student self-assessment overestimation; informing formative feedback and summative examinations?

Methods

Based on the ESMO / ASCO global curriculum, 66 level-two learning outcomes were identified and transformed in the iCAN!-Oncology and theyCAN!-Oncology questionnaires, anonymously completed online, before and after teaching, by trainees and trainers respectively, in a five-day fulltime undergraduate oncology course.

Results

In total, students assessed themselves (iCAN!) with 55% before and 70% after the course (27% improvement); teachers assessed students (theyCAN!) with 43% before and 69% after (60% improvement). Twenty level-two learning outcomes (30%) were scored below the pass / fail cut-point by students while 46 (70%) by teachers, before the course; none after the course. Students assessed themselves the highest in “TNM system” before (81%) and after (82%), while the teachers assessed students so in “Normal cell biology” before (72%) and “Moral / ethical issues in clinical research” after (83%). The lowest assessed outcome was the “Research protocol” by students (28%) and teachers (18%) before, and the “Anticancer agents” after (54% by both). Individual students self-assessed themselves from 31% to 88% before, and from 54% to 88% after; individual teachers assessed students from 29% to 66% before, and from 55% to 94% after. The iCAN! / theyCAN! provided detailed individual student or teacher profile, tightfisted or generous.

Conclusions

The iCAN! / theyCAN! differentiate strong and weak learning outcomes, learners, teachers; reveal no student self-assessment overestimation; inform formative feedback and summative exams at a metacognitive level; generalize to any course and assessor; support evidence-based teaching and learning SWOT policy.

Feasibility of Telesimulation and Google Glass for Mass Casualty Triage Education and Training

Introduction

Our goal was to evaluate the feasibility and effectiveness of using telesimulation to deliver an emergency medical services (EMS) course on mass casualty incident (MCI) training to healthcare providers overseas.

Methods

We conducted a feasibility study to establish the process for successful delivery of educational content to learners overseas via telesimulation over a five-month period. Participants were registrants in an EMS course on MCI triage broadcast from University of California, Irvine Medical Simulation Center. The intervention was a Simple Triage and Rapid Treatment (START) course. The primary outcome was successful implementation of the course via telesimulation. The secondary outcome was an assessment of participant thoughts, feelings, and attitudes via a qualitative survey. We also sought to obtain quantitative data that would allow for the assessment of triage accuracy. Descriptive statistics were used to express the percentage of participants with favorable responses to survey questions.

Results

All 32 participants enrolled in the course provided a favorable response to all questions on the survey regarding their thoughts, feelings, and attitudes toward learning via telesimulation with wearable/mobile technology. Key barriers and challenges identified included dependability of Internet connection, choosing appropriate software platforms to deliver content, and intercontinental time difference considerations. The protocol detailed in this study demonstrated the successful implementation and feasibility of providing education and training to learners at an off-site location.

Conclusion

In this feasibility study, we were able to demonstrate the successful implementation of an intercontinental MCI triage course using telesimulation and wearable/mobile technology. Healthcare providers expressed a positive favorability toward learning MCI triage via telesimulation. We were also able to establish a process to obtain quantitative data that would allow for the calculation of triage accuracy for further experimental study designs.

Posttraining Knowledge Retention among Licensed Cupping Providers in Saudi Arabia

BACKGROUND

One of the licensing requirements for cupping providers in Saudi Arabia is to attend a compulsory training course that lasts 5 days for non-physicians and 4 days for physicians, irrespective of any previous experience in cupping therapy. The course is conducted by the National Center of Complementary and Alternative Medicine (NCCAM/MOH). As a part of course auditing, the current study aimed to evaluate knowledge retention among licensed cupping providers 1-3 years after passing the official cupping course.

METHODS

Licensed cupping providers were invited to attend a continuing medical education activity. Sixty-two attended the continuing medical education activity. Before the event, participants were asked to answer 35 multiple-choice questions taken from the same data bank as the pretest and posttest of the course. The test scores were linked and compared with the pre- and posttest of the training course.

RESULTS

A paired t test showed significant differences between the pre- and posttest knowledge scores (mean difference: 224.6 ± 86, p = 0.0001) and between the posttest and follow-up knowledge scores (mean difference: -115.26 ± 103.9, p = 0.0001). The follow-up score was still significantly higher than the pretest score, with a mean difference of 112 (95% CI: 83.66-140.34, p = 0.0001). There was no significant effect of category (physician vs. non-physician) on knowledge retention after controlling for the postcourse score. Gender, the total duration of experience, and total years of experience in cupping did not affect knowledge score retention between the physicians and the non-physicians.

CONCLUSION

The official cupping training course of the NCCAM/MOH achieved reasonable knowledge retention. To achieve long-term knowledge retention, refresher training/courses and continuous professional development will be required.

Using a Novel Student-centered Teaching Method to Improve Pharmacy Student Learning

Objective. To improve students' learning and develop their learning skills in pharmacy education. Methods. A novel teaching method composed of Self-study, Test, Question and Discussion (STQD) sessions uses self-, peer-, co-learning, active learning, inductive teaching, and formative assessment to promote student-centered teaching in pharmacy education. STQD has been implemented within courses focusing on instrumental analysis and analytical chemistry. In a four-year study, qualitative and quantitative approaches were used to evaluate the effectiveness of STQD in facilitating students' learning. Results. Students positively evaluated their experience in STQD class with an overall mean and standard deviation of 4.35 (0.64) in a 5-point Likert scale, where a score of 1 is "strongly disagree" and a score of 5 is "strongly agree." The final examination results showed students' average score in an STQD class was higher than students' average score in a traditional class. Most students indicated that the STQD improved their learning ability, communication ability and facilitated their learning. Conclusion. The use of STQD in an integrated basic science curriculum has the potential to develop students' learning skills and improve their learning in pharmacy education.

A Randomized Trial of SMART Goal Enhanced Debriefing after Simulation to Promote Educational Actions

Introduction

Goal setting is used in education to promote learning and performance. Debriefing after clinical scenario-based simulation is a well-established practice that provides learners a defined structure to review and improve performance. Our objective was to integrate formal learning goal generation, using the SMART framework (Specific, Measurable, Attainable, Realistic, and Time-bound), into standard debriefing processes (i.e., “SMART Goal Enhanced Debriefing”) and subsequently measure the impact on the development of learning goals and execution of educational actions.

Methods

This was a prospective multicenter randomized controlled study of 80 emergency medicine residents at three academic hospitals comparing the effectiveness of SMART Goal Enhanced Debriefing to a standard debriefing. Residents were block randomized on a rolling basis following a simulation case. SMART Goal Enhanced Debriefing included five minutes of formal instruction on the development of SMART learning goals during the summary/application phase of the debrief. Outcome measures included the number of recalled learning goals, self-reported executed educational actions, and quality of each learning goal and educational action after a two-week follow-up period.

Results

The mean number of reported learning goals was similar in the standard debriefing group (mean 2.05 goals, SD 1.13, n=37 residents), and in the SMART Goal Enhanced Debriefing group (mean 1.93, SD 0.96, n=43), with no difference in learning goal quality. Residents receiving SMART Goal Enhanced Debriefing completed more educational actions on average (Control group actions completed 0.97 (SD 0.87), SMART debrief group 1.44 (SD 1.03) p=0.03).

Conclusion

The number and quality of learning goals reported by residents was not improved as a result of SMART Goal Enhanced Debriefing. Residents did, however, execute more educational actions, which is consistent with the overarching intent of any educational intervention.

Using Twitter to increase content dissemination and control educational content with Presenter Initiated and Generated Live Educational Tweets (PIGLETs)

Live-tweeting during educational presentations is typically learner-generated and can lead to misquoted information. Presenter curated tweets have not been well described. We created Presenter Initiated and Generated Live Educational Tweets (PIGLETs) with the goal to broaden the reach of educational conferences. We hypothesized that using PIGLETs would increase the reach and exposure of our material. We developed a prospective single-arm intervention study performed during the "Not Another Boring Lecture" workshops presented at two national conferences in 2015. Presenters tweeted PIGLETs linked to unique hashtags #NotAnotherBoringLecture and #InnovateMedEd. Analytic software was used to measure the following outcomes: (1) number of tweets published by presenters versus learners, (2) reach (users exposed to content containing the hashtag), and (3) exposure (total number of times content was delivered). One hundred and twenty-six participants attended the workshops. A total of 636 tweets (including retweets) were sent by presenters containing the study hashtags, compared with 162 sent by learners. #NotAnotherBoringLecture reached 47,200 users and generated 136,400 impressions; #InnovateMedEd reached 36,400 users and generated 79,100 impressions. PIGLETs allowed presenters to reach a significant number of learners, as well as control the content delivered through Twitter. PIGLETs can be used to augment educational sessions beyond the physical confines of the classroom.

Face validation of the Virtual Electrosurgery Skill Trainer (VEST©)

BACKGROUND

Electrosurgery is a modality that is widely used in surgery, whose use has resulted in injuries, OR fires and even death. The SAGES has established the FUSE program to address the knowledge gap in the proper and safe usage of electrosurgical devices. Complementing it, we have developed the Virtual Electrosurgery Skill Trainer (VEST(©)), which is designed to train subjects in both cognitive and motor skills necessary to safely operate electrosurgical devices. The objective of this study is to asses the face validity of the VEST(©) simulator.

METHODS

Sixty-three subjects were recruited at the 2014 SAGES Learning Center. They all completed the monopolar electrosurgery module on the VEST(©) simulator. At the end of the study, subjects assessed the face validity with questions that were scored on a 5-point Likert scale.

RESULTS

The subjects were divided into two groups; FUSE experience (n = 15) and no FUSE experience (n = 48). The median score for both the groups was 4 or higher on all questions and 5 on questions on effectiveness of VEST(©) in aiding learning electrosurgery fundamentals. Questions on using the simulator in their own skills lab and recommending it to their peers also scored at 5. Mann-Whitney U test showed no significant difference (p > 0.05) indicating a general agreement. 46% of the respondents preferred VEST compared with 52% who preferred animal model and 2% preferred both for training in electrosurgery.

CONCLUSION

This study demonstrated the face validity of the VEST(©) simulator. High scores showed that the simulator was visually realistic and reproduced lifelike tissue effects and the features were adequate enough to provide high realism. The self-learning instructional material was also found to be very useful in learning the fundamentals of electrosurgery. Adding more modules would increase the applicability of the VEST(©) simulator.

Do Veterinary Students See a Need for More In-Course Discussion? A Survey

Rather than merely transferring information, veterinary education should stimulate and motivate students and encourage them to think. Currently in veterinary education, most curricula use the method of frontal teaching (e.g., in lectures). A student-centered critical approach to information is rarely used. Our research sought to determine if students consider in-course discussion useful and if sufficient possibilities for discussion are provided and supported by their lecturers. In December 2013, we conducted a survey of fourth-year students. Specifically, we wanted to know if students consider in-course discussion about course content useful for successful learning and if students wish to have more opportunities for discussion during class time. Finally, we wanted to identify barriers that limit the students' motivation and ability to engage in discussion of course content. In total, 105 students completed the survey. The majority of students agreed or strongly agreed that clinical topics should be discussed during class time. Frequently stated reasons were improved learning (85.7%) and the opportunity to look at topics from different perspectives (92.4%). In conclusion, we found a considerable dearth of and request for discussion within veterinary education. In light of these findings, we emphasize the need for new teaching strategies that promote independent thinking and critical questioning. We suggest the implementation of more discussion opportunities in well considered and moderated settings in veterinary teaching.

Cross analysis of knowledge and learning methods followed by French residents in cardiology

BACKGROUND

No scientific assessment of the theoretical teaching of cardiology in France is available.

AIM

To analyse the impact of the available teaching modalities on the theoretical knowledge of French residents in cardiology.

METHODS

Electronic questionnaires were returned by 283 residents. In the first part, an inventory of the teaching/learning methods was taken, using 21 questions (Yes/No format). The second part was a knowledge test, comprising 15 multiple-choice questions, exploring the core curriculum.

RESULTS

Of the 21 variables tested, four emerged as independent predictors of the score obtained in the knowledge test: access to self-assessment (P=0.0093); access to teaching methods other than lectures (P=0.036); systematic discussion about clinical decisions (P=0.013); and the opportunity to prepare and give lectures (P=0.039). The fifth variable was seniority in residency (P=0.0003). Each item of the knowledge test was analysed independently: the score was higher when teaching the item was driven by reading guidelines and was lower if the item had not been covered by the programme (P<0.001). Finally, 91% of students would find it useful to have a national source for each topic of the curriculum; 76% of them would often connect to an e-learning platform if available.

CONCLUSIONS

It is necessary to rethink teaching in cardiology by involving students in the training, by using teaching methods other than lectures and by facilitating access to self-assessment. The use of digital tools may be a particularly effective approach.

Nipping an education myth in the bud: Poh's brain activity during lectures

The debate around the value of lectures is raging strongly, and new empirical data arguing against the value of lectures comes from a chart showing student brain activity during lectures. The evidence from the chart, however, suffers from crucial problems. These include a small and unspecific sample, mislabeling of the student activities, and a misinterpretation of the type of measurement. This chart has appeared on the Internet, in education conferences and journals, and recently at a medical education conference. For medical education to be taken seriously, it is crucial that researchers apply the same standards that they would to clinical research. As a result, this chart should be avoided in the debate on the value of lectures before it has a chance to follow a pattern in medical education set by other myths.

Impact of a hands-on component on learning in the Fundamental Use of Surgical Energy™ (FUSE) curriculum: a randomized-controlled trial in surgical trainees

BACKGROUND

While energy devices are ubiquitous in the operating room, they remain poorly understood and can result in significant complications. The purpose of this study was to estimate the extent to which adding a novel bench-top component improves learning of SAGES' Fundamental Use of Surgical Energy™ (FUSE) electrosurgery curriculum among surgical trainees.

METHODS

Surgical residents participated in a 1-h didactic electrosurgery (ES) course, based on the FUSE curriculum. They were then randomized to one of two groups: an unstructured hands-on session where trainees used ES devices (control group) or a goal-directed hands-on training session (Sim group). Pre- and post-curriculum (immediate and at 3 months) assessments included knowledge of ES (multiple-choice examination), self-perceived competence for each of the 35 course objectives (questionnaire), and self-perceived comfort with performance of seven tasks related to safe use of ES. Data expressed as median[interquartile range], *p < 0.05.

RESULTS

56 (29 control; 27 Sim) surgical trainees completed the curriculum and assessments. Baseline characteristics, including pre-curriculum exam and questionnaire scores, were similar. Total score on the exam improved from 46%[40;54] to 84%[77;91]* for the entire cohort, with higher immediate post-curriculum scores in the Sim group compared to controls (89%[83;94] vs. 83%[71;86]*). At 3 months, performance on the exam declined in both groups, but remained higher in the Sim group (77%[69;90] vs 60%[51;80]*). Participants in both groups reported feeling greater comfort and competence post-curriculum (immediate and at 3 months) compared to baseline. This improvement was greater in the Sim group with a higher proportion feeling "Very Comfortable" or "Fully Competent" (Sim: 3/7 tasks and 28/35 objectives; control: 0/7 tasks and 10/35 objectives).

CONCLUSIONS

A FUSE-based curriculum improved surgical trainees' knowledge and comfort in the safe use of electrosurgical devices. The addition of a structured interactive bench-top simulation component further improved learning and retention at 3 months.