An instructional model for training competence in solving clinical problems

Evaluation of Video-enhanced Case-based Activities Guided by the Pharmacists' Patient Care Process

Objective. To design and develop a series of technology-enhanced, case-based learning activities framed by the Pharmacists' Patient Care Process (PPCP), and to evaluate the impact of these activities on student perceptions and performance. Methods. A mixed methods approach was used to generate both quantitative and qualitative data. Survey and focus group interviews were used to analyze student perceptions. Performance on a pre- and post-assessment was used to measure the impact of PPCP case-based learning activities. Results. Students demonstrated positive attitudes overall towards the case-based learning activities. Themes emerged during focus group interviews regarding awareness of the PPCP, engagement in learning, and a desire for realistic experiences. Significant changes were observed for the pre- and post-assessment within the plan and follow-up parameters, as well as for the total score within each disease state. Conclusion. The use of technology-enhanced, case-based modules framed around a standardized patient care process resulted in positive student perceptions and improved scores on a patient case assessment. The PPCP may be a useful framework for case development to aid students in application of drug therapy knowledge.

Use of case-based or hands-on laboratory exercises with physiology lectures improves knowledge retention, but veterinary medicine students prefer case-based activities

Didactic lectures are prevalent in physiology courses within veterinary medicine programs, but more active learning methods have also been utilized. Our goal was to identify the most appropriate learning method to augment the lecture component of our physiology course. We hypothesized that case-based learning would be well received by students and would be more effective at helping them learn physiological concepts compared with more traditional laboratory exercises. In this study, approximately one-half of the laboratory sessions for the two-semester course were dedicated to traditional hands-on laboratory exercises, whereas the remaining one-half of the sessions were dedicated to case-based exercises. The lecture portion of the course was not altered. Student attitudes were evaluated after each session and at the end of each semester via quantitative and qualitative survey questions. Student performance was evaluated using section exams and end-of-semester posttests. The vast majority of survey responses received were positive for both cased-based activities and traditional hands-on laboratories. In addition, participation in both types of active learning activities, but not lecture, was associated with retention of conceptual knowledge based on student performance between the section exams and posttests ( P < 0.002). These results indicate that both case-based learning and laboratory exercises are beneficial learning activities to incorporate into a lecture-based physiology course. However, positive survey responses were significantly greater following case-based activities vs. traditional hands-on laboratories, and only participation in case-based activities resulted in greater student performance on the posttest ( P < 0.04). Therefore, case-based activities may be the preferred supplemental learning activity for veterinary medical physiology.

Impact of Expert Commentary and Student Reflection on Veterinary Clinical Decision-Making Skills in an Innovative Electronic-Learning Case-Based Platform

One challenge in veterinary education is bridging the divide between the nature of classroom examples (well-defined problem solving) and real world situations (ill-defined problem solving). Solving the latter often relies on experiential knowledge, which is difficult to impart to inexperienced students. A multidisciplinary team including veterinary specialists and learning scientists developed an interactive, e-learning case-based module in which students made critical decisions at five specific points (Decision Points [DPs]). After committing to each decision (Original Answers), students reflected on the thought processes of experts making similar decisions, and were allowed to revise their decisions (Revised Answers); both sets of answers were scored. In Phase I, performance of students trained using the module (E-Learning Group) and by lecture (Traditional Group) was compared on the course final examination. There was no difference in performance between the groups, suggesting that the e-learning module was as effective as traditional lecture for content delivery. In Phase II, differences between Original Answers and Revised Answers were evaluated for a larger group of students, all of whom used the module as the sole method of instruction. There was a significant improvement in scores between Original and Revised Answers for four out of five DPs (DP1, p =.004; DP2, p =.04; DP4, p <.001; DP5, p <.001). The authors conclude that the ability to rehearse clinical decision making through this tool, without direct individual feedback from an instructor, may facilitate students' transition from problem solving in a well-structured classroom setting to an ill-structured clinical setting.

Applicability of Progress Testing in Veterinary Medical Education

A substantial part of graduate education in veterinary medicine is spent in clinical practice. During the clinical experiential phase, it is difficult to monitor students' actual knowledge development: they build individual records of experiences based on the cases they have to deal with, while mainly focusing on knowledge that is of direct, clinical relevance to them. As a result, students' knowledge bases may differ to such a degree that a single test alone may not be able to provide an adequate reflection of progress made. In these circumstances, progress testing, which is a method of longitudinal assessment independent of the curricular structure, may offer a viable solution. The purpose of this study, therefore, was to determine the extent to which progress tests (PT) can be used to monitor progress in knowledge development at a graduate level in veterinary medical education. With a 6-month interval, we administered two tests to students based on the Maastricht Progress Test format that covered a large variety of veterinary topics. Consequently, we analyzed students' progress in knowledge development. Based on a substantive appraisal of the questions and analysis of the test results, we concluded that the tests met the measurement criteria. They appeared sensitive enough to gauge the progress made and were appreciated by the students. Hence, in spite of the differences within the whole graduate group, the PT format can be used to monitor students' knowledge development.

Encouraging Critical Clinical Thinking (CCT) Skills in First-Year Veterinary Students

First-year didactic course instructors at the University of Illinois College of Veterinary Medicine leverage earlier clinical rotation experiences with weekly "Clinical Correlations" exercises to provide early exposure to critical clinical thinking (CCT). This study evaluated the efficacy of individual and paired group exercises on CCT development. Before and after instruction, the Cornell Critical Thinking Test (Level Z) (CCTTZ) was administered. Based on the hypothesis that students with higher scores would coach lower-scoring colleagues during group exercises, heterogeneous groups with similar mean scores were established for the year. Students completed 14 individual and paired group exercises over 6 months. Exercises were designed to increase in complexity and decline in scaffolding. Seven of the exercises were cases using the Applied Learning Platform (ALP) at http://www.whenknowingmatters.com . Student analyses were scored according to a six-category critical-thinking rubric using a 5-point scale. Consistent with our hypothesis, individual and group rubric scores increased significantly, plateauing near the end of the year. Contrary to our hypothesis, mean overall CCTTZ scores did not change, but there was a small statistically significant increase in the ability to assess the validity of an argument. Student attitudes were mixed. Positive comments focused on reinforcement of prior didactic instruction, while negative comments focused on preparation time needed to conduct research on clinical concepts, and on a lack of explicit evaluation by summative examinations. Nonetheless, end-of-year GPAs correlated linearly with cumulative individual rubric scores. In summary, the value of early curriculum CCT training was confirmed when discipline-specific criteria were applied.

Effectiveness of a programme design for the development of competence in solving clinical problems

BACKGROUND

To apply what has been learned theoretically in a clinical context is for many students a major challenge. In order to ease their transition into practice, a training programme was developed, focusing on learning to solve clinical problems.

AIMS

The programme is designed for veterinary medicine students in the preclinical phase with already a sound theoretical base in biomedical and clinical sciences. The design is based on the engagement in learning and work processes derived from clinical practice and exposure to a large variety of real and paper-based cases. This article addresses the effectiveness of this programme design.

METHOD

Programme effectiveness was defined in terms of the progress made by the students. This progress was established using methodological triangulation of the results from student questionnaires, performance observations and (pre and post) assessment.

RESULTS

On all dimensions of effectiveness, the results consistently showed that the programme was perceived as effective and led to improved performances in solving clinical problems and better solutions in the assessment. The students' progress was substantial.

CONCLUSIONS

At preclinical level, a course design based on the work processes in clinical practice and a mixture of real and paper-based patients is effective in enhancing problem-solving competence.