Community-based learning in medical education: A starting guide and lessons learned

Community-based medical education (CBME) addresses real-world health problems and is characterized by its emphasis on reciprocity and collaboration with community stakeholders. Limited evidence shows that CBME is an effective learning strategy to care for underserved communities. However, medical schools and nursing schools struggle to implement CBME in their curriculum. In this article, we present four practical examples of CBME from medical and nursing schools in Belgium and the Netherlands. By taking the lessons learned derived from these practical examples into account, all students can have an authentic learning experience within the community, which empowers community members and increases their health.

Development of the essential learning outcomes for the midwifery student continuity of care learning model: A Delphi study

BACKGROUND

In Australia, midwifery students are required to undertake at least ten Continuity of Care Experiences (CoCE) during their education. The learning outcomes of this experience have never been explicit or standardised resulting in inconsistent assessment.

AIM

To develop and identify standardised learning outcomes for the CoCE.

METHODS

A modified Delphi survey was conducted with an expert panel. Intended learning outcome statements were developed, reflecting the learning objectives identified in a previous study. Bloom's taxonomy levels of thinking complexities guided the wording of the outcomes. Participants were asked to rank and rate their level of agreement with each statement over two survey rounds.

FINDINGS

Round one was completed by 32 participants, with 92.5% of the 40 statements reaching consensus. The second round was completed by 23 participants, with 70.7% of the 33 statements reaching consensus. Content analysis of participant comments from each round identified duplicates that were removed and informed refining the wording of some statements. A final set of 15 learning outcomes were agreed upon. The outcomes were broadly grouped within the themes of accountability, advocacy, and autonomy.

DISCUSSION

This study has identified agreed learning outcomes for midwifery students undertaking CoCE. The consensus agreement of experts reinforced the learning model enables the development of woman-centred practice that is underpinned by accountability, advocacy, and autonomy.

CONCLUSION

Purposeful learning outcomes for the CoCE have been developed, informing how the model can be embedded in curricula, guide student learning and assessment to standardise the pedagogy of the model to prepare future midwives.

Learning with AI Language Models: Guidelines for the Development and Scoring of Medical Questions for Higher Education

In medical and biomedical education, traditional teaching methods often struggle to engage students and promote critical thinking. The use of AI language models has the potential to transform teaching and learning practices by offering an innovative, active learning approach that promotes intellectual curiosity and deeper understanding. To effectively integrate AI language models into biomedical education, it is essential for educators to understand the benefits and limitations of these tools and how they can be employed to achieve high-level learning outcomes.This article explores the use of AI language models in biomedical education, focusing on their application in both classroom teaching and learning assignments. Using the SOLO taxonomy as a framework, I discuss strategies for designing questions that challenge students to exercise critical thinking and problem-solving skills, even when assisted by AI models. Additionally, I propose a scoring rubric for evaluating student performance when collaborating with AI language models, ensuring a comprehensive assessment of their learning outcomes.AI language models offer a promising opportunity for enhancing student engagement and promoting active learning in the biomedical field. Understanding the potential use of these technologies allows educators to create learning experiences that are fit for their students' needs, encouraging intellectual curiosity and a deeper understanding of complex subjects. The application of these tools will be fundamental to provide more effective and engaging learning experiences for students in the future.

The application of Moore's online learning interactions model in learning outcomes: The SOR (stimulus-organism-response) paradigm perspective

This study presents an in-depth exploration of the impact of online learning interactions on student learning outcomes. Drawing from the Stimulus-Organism-Response (SOR) paradigm, our study focuses on the effects of online learning interactions on learners' perception usefulness and ease of use, subsequently impacting their learning outcomes. The study employs a quantitative research methodology, gathering data from a sample of 397 students enrolled in various higher education institutions across China. Data collection involved administering structured questionnaires that were designed to quantitatively assess the three components of the SOR model: stimulus (online learning interactions), organism (students' perceptions), and response (learning outcomes). The measurement model assessment and structural model assessment were conducted. Our findings reveal that online learning interactions can effectively enhance learners' perception of online learning (usefulness and ease of use), thereby influencing their learning outcomes. Notably, perceived usefulness negatively mediates the relationship between online learning interactions and learning outcomes, while perceived ease of use positively mediates this relationship. These findings offer both theoretical and practical implications.

Self-directed learning readiness and learning achievements of a flipped classroom model approach in research methods class: A quasi-experimental study

AIM

This study sought to assess how the flipped classroom model of instruction affected self-directed learning readiness and learning outcomes among Nigerian nursing students enrolled in a research method class.

BACKGROUND

Although the effectiveness of the flipped classroom model of instruction has been thoroughly and scientifically investigated in several fields, its potential to promote self-directed learning readiness and learning outcomes in a research method class has not yet been investigated.

DESIGN

A quasi-experimental design was employed. To achieve the study's objectives, two experiments were conducted: a pre-test and a post-test.

METHODS

Participants were 64 400-level nursing undergraduates purposively recruited from two government-owned universities in Southeast Nigeria. The experimental group received a flipped classroom model of teaching methods, while the control group received traditional teaching methods (TTM) from April - July 2021. A validated self-directed learning readiness scale and multiple-choice questions derived from a research method course were used to gather data. A structured questionnaire was used to collect demographic data. Descriptive statistics of frequencies, percentages, means and standard deviations were applied to the collected data. A one-factor independent measure analysis of covariance (ANCOVA) and an independent sample t-test was employed to compare the pre-and post-test results of FCM and TTM students.

RESULTS

Pre-test results from self-directed learning readiness showed overall scores of 3.99 ± 0.39 and 3.95 ± 0.35 for the traditional teaching method and flipped classroom model, respectively, while post-test results showed overall scores of 3.84 ± 077 for the traditional teaching method and 4.01 ± 0.81 for flipped classroom model. The difference in mean scores between the pre-and post-tests was statistically significant (p=0.030). Pre- (p=.001) and post- (p =.025) learning outcomes for the flipped classroom model were significantly higher than those for the traditional teaching method.

CONCLUSION

The flipped classroom model of instruction had a positive impact on nursing students' readiness for self-directed learning and learning outcomes in the research course. Since the method demonstrated statistically significant benefits in both the development of self-learning abilities and learning achievements, the need to improve learning experiences through the flipped learning method should be promoted.

Blood lead levels and math learning in first year of school: An association for concern

Lead is a well-known neurotoxicant that continues to affect children's cognition and behavior. With the aim to examine the associations of lead exposure with math performance in children at the beginning of formal schooling, we conducted a cross-sectional study of first-grade students from 11 schools in Montevideo, Uruguay. Math abilities were assessed with tests from the Batería III Woodcock-Muñoz (Calculation, Math Facts Fluency, Applied Problems, Math Calculation Skills and Broad Maths). Separate generalized linear models (GLM) tested the association of blood lead level (BLL) and each math ability, adjusting for key covariates including age and sex, maternal education, household assets and Home Observation for Measurement of the Environment Inventory score. In a complete-case of 252 first-grade students (age 67-105 months, 45% girls), mean ± SD blood lead level was 4.0 ± 2.2 μg/dL. Covariate-adjusted logistic models were used to examine the association between childhood BLLs and the odds of low math performance. BLL was negatively associated with scores on the Calculation test (β (95% CI): -0.18 (-0.33, -0.03)), Math Calculation Skills (-1.26 (-2.26, -0.25)), and Broad Maths cluster scores (-0.88 (-1.55, -0.21)). Similarly, performance on the Calculation test, as well as cluster scores for Broad Maths and Math Calculation Skills differed between children with BLLs <5 and ≥ 5 μg/dL (p < 0.01), being lower in children with higher BLLs. Finally, considering the likelihood of low test performance, each 1 μg/dL higher B-Pb was related to 27% higher likelihood for Maths Facts Fluency, 30% for Broad Math and Math Calculation Skills, and 31% for Calculation (p < 0.05). These results suggest that lead exposure is negatively associated with several basic skills that are key to math learning. These findings further suggest that the cognitive deficits related to lead exposure impact student achievement at very early stages of formal education.

Health literacy in the context of child health promotion: a scoping review of conceptualizations and descriptions

BACKGROUND

Increasing health literacy (HL) in children could be an opportunity for a more health literate future generation. The aim of this scoping review is to provide an overview of how HL is conceptualized and described in the context of health promotion in 9-12-year-old children.

METHODS

A systematic and comprehensive search for 'health literacy' and 'children' and 'measure' was performed in accordance with PRISMA ScR in PubMed, Embase.com and via Ebsco in CINAHL, APA PsycInfo and ERIC. Two reviewers independently screened titles and abstracts and evaluated full-text publications regarding eligibility. Data was extracted systematically, and the extracted descriptions of HL were analyzed qualitatively using deductive analysis based on previously published HL definitions.

RESULTS

The search provided 5,401 original titles, of which 26 eligible publications were included. We found a wide variation of descriptions of learning outcomes as well as competencies for HL. Most HL descriptions could be linked to commonly used definitions of HL in the literature, and some combined several HL dimensions. The descriptions varied between HL dimensions and were not always relevant to health promotion. The educational setting plays a prominent role in HL regarding health promotion.

CONCLUSION

The description of HL is truly diverse and complex encompassing a wide range of topics. We recommend adopting a comprehensive and integrated approach to describe HL dimensions, particularly in the context of health promotion for children. By considering the diverse dimensions of HL and its integration within educational programs, children can learn HL skills and competencies from an early age.

The impact of train-the-trainer programs on the continued professional development of nurses: a systematic review

BACKGROUND

Train-the-trainer (TTT) programs are widely applied to disseminate knowledge within healthcare systems, but evidence of the effectiveness of this educational model remains unclear. We systematically reviewed studies evaluating the impact of train-the-trainer models on the learning outcomes of nurses.

METHODS

The reporting of our systematic review followed PRISMA 2020 checklist. Records identified from MEDLINE, Embase, CINAHL, and ERIC were independently screened by two researchers and deemed eligible if studies evaluated learning outcomes of a train-the-trainer intervention for trainers or trainees targeting nurses. Study quality was assessed with Joanna Briggs Institute's critical appraisal tools and data of study characteristics extracted (objective, design, population, outcomes, results). Heterogeneity of outcomes ruled out meta-analysis; a narrative synthesis and vote counting based on direction of effects (p < 0.05) synthesized the results. All records were uploaded and organized in EPPI-Reviewer.

RESULTS

Of the 3800 identified records 11 studies were included. The included studies were published between 1998 and 2021 and mostly performed in the US or Northern Europe. Nine studies had quasi-experimental designs and two were randomized controlled trials. All evaluated effects on nurses of which two also included nurses' assistants. The direction of effects of the 13 outcomes (knowledge, n = 10; skills, n = 2; practice, n = 1) measured in the 11 included studies were all beneficial. The statistical analysis of the vote counting showed that train-the-trainer programs could significantly (p < 0.05) improve trainees' knowledge, but the number of outcomes measuring impact on skills or practice was insufficient for synthesis.

CONCLUSIONS

Train-the-trainer models can successfully disseminate knowledge to nurses within healthcare systems. Considering the nurse shortages faced by most Western healthcare systems, train-the-trainer models can be a timesaving and sustainable way of delivering education. However, new comparative studies that evaluate practice outcomes are needed to conclude whether TTT programs are more effective, affordable and timesaving alternatives to other training programs.

TRIAL REGISTRATION

The protocol was registered in Research Registry ( https://www.researchregistry.com , unique identifying number 941, 29 June 2020).

Reflecting on gamified learning in medical education: a systematic literature review grounded in the Structure of Observed Learning Outcomes (SOLO) taxonomy 2012-2022

BACKGROUND

The acquisition of in-depth medical knowledge, skills, and competencies is of utmost importance when training future medical professionals. This systematic literature review delves into the empirical connection between gamified learning in medical education and the Structure of Observed Learning Outcomes (SOLO) taxonomy.

METHODS

Following PRISMA guidelines, a systematic literature review was conducted in seven databases to identify empirical studies related to gamification and medical education. The literature search was limited to peer-reviewed articles published between January 2012 and December 2022. Articles focusing on games or learning technologies in a broader sense as well as research focusing on nursing or pharmacy education were excluded.

RESULTS

Upon reviewing 23 qualified empirical studies that applied gamified learning strategies in medical education, 18 (78%) studies are associated with the second lowest level (uni-structural) of the SOLO taxonomy. The mid-level (multi-structural) learning outcomes are associated with three (13%) of the reviewed studies. There are five (22%) studies focusing on the second highest (relational) level of the SOLO. Only one study (4%) is associated with the highest SOLO level (extended-abstract). Finally, three (13%) studies were identified with multiple levels of the SOLO. In addition to the SOLO levels, the review found six (26%) studies emphasizing motivational and engagement support of gamified learning strategies in facilitating intended learning outcome attainment. A total of three (13%) studies, across three SOLO levels, suggested that gamified learning strategies can improve students' soft skills in medical education programs.

CONCLUSION

These findings collectively emphasize the need for future research and development to design gamified learning experiences capable of fostering higher SOLO taxonomy attainment in medical education. Moreover, there is potential to extend the SOLO framework to encompass motivational and affective learning outcomes, providing a comprehensive understanding of the impact of gamified learning on medical students.

Feasibility first: Expanding access before fixing learning

The first SDG4 target is to both expand access to universal secondary school and to ensure that all children achieve minimum learning outcomes in primary school. To the extent that action must be prioritized, this article argues that achieving universal secondary education is both more feasible at scale and has clearer benefits than improving learning outcomes in primary schools in developing countries. Removing barriers to access such as fees and exam requirements has been demonstrated to have consistent impacts at scale, even in contexts of weak state capacity. By contrast, efforts to improve school quality have been much less consistent. Wage gains from secondary schooling have been demonstrated repeatedly, even in contexts of low quality education. Wage gains from improving primary school quality have not. Governments should thus focus on reforms that reliably expand access, rather than complex interventions to improve learning that often fail at scale.

Modelling the associations between academic engagement, study process and grit on academic achievement of physical education and sport university students

OBJECTIVE

The present study examined the impact of academic engagement, study processes, and grit on the academic achievement of physical education and sport university students.

METHODS

An internet-based survey recruited 459 university students aged 19-25 years (M = 21 ± 1.3) in physical education and sports (PES) to fill out questionnaires on Physical Education-Study Process Questionnaire (PE-SPQ), Physical Education-Grit (PE-Grit), academic engagement (A-USEI), and Grade Point Average (GPA). A path analysis was carried out to understand variable relationships.

RESULTS

Data from each variable exhibited symmetrical and normal distribution, as indicated by the skewness and kurtosis values. The model's fit indices showed sufficient Comparative Fit Index (CFI = 0.92), Tucker-Lewis Index (TLI = 0.90), Goodness of Fit Index (GFI = 0.99) and Normed Fit Index (NFI = 0.90) and showed acceptable levels. The results indicated a statistically significant positive impact of engagement (β = 0.299, p < 0.001) and study processes (β = 0.397, p < 0.001) on academic achievement. However, the effect of grit on achievement was non-significant.

CONCLUSIONS

Academic engagement as well as study processes are two important factors predicting academic achievement while grit seems to be not a major predictor. Hence, physical education and sport faculty and university administrators should prioritize student engagement as a determinant of academic outcomes by reforming or redesigning physical education and sport curriculum modules that can facilitate engagement.

Mentorship in health professions education - an AMEE guide for mentors and mentees: AMEE Guide No. 167

This AMEE guide discusses theoretical principles and practical strategies for health professions educators to promote impactful mentoring relationships. Traditional definitions are challenged, distinctions are made between roles such as mentor, advisor, coach and sponsor. As educational environments change and options for professional development expand, we argue that the traditional dyadic format of mentoring alone will not help mentees to maximise their professional growth. Newer formats of mentoring are discussed in detail and their advantages and disadvantages compared. We use a variety of theoretical concepts to anchor the practice of mentorship: self-focussed and other-focussed motives; psychological safety; personal interpretive framework; Daloz model for balancing support and challenge; zone of proximal development; communities of practice; and development along multiple layers of competence. Recommended strategies for effective mentoring are based on extensive review of literature, as well as combined professional mentoring experiences of the authors. We use key principles from the theories described and phases of mentoring relationships as foundations for the suggested best practices of mentorship. Finally, we emphasise the role of mentees in their own professional development and provide tips for them on seeking mentors, expanding their mentoring network and taking the lead in setting the agenda during mentoring meetings and formulating action plans for their own advancement.

Instructional educational games in pharmacy experiential education: a quasi-experimental assessment of learning outcomes, students' engagement and motivation

BACKGROUND

This study aimed to determine the impact of implementing instructional educational games on attaining the intended learning outcomes mapped with the competencies of a pharmacy practice experience course, and to assess students' attitudes towards motivation and engagement in this active learning activity.

METHODS

This was a quasi-experimental study that utilized a pretest-posttest for the research groups. Students were divided into teams and challenged to answer different questions related to the case scenarios. Different gaming platforms as Gamilab, Wisc-Online, and Quizizz were accordingly used to create different questions that help students memorize medications' brand names, and acquire the advanced community knowledge and skills. The attainment of the intended learning outcomes was assessed and compared between the experimental and control groups through the course total average of grades, and the subsequent averages of domains relating to the course competencies. Attitudes towards motivation and engagement in educational games activities were also assessed among the experimental group.

RESULTS

A total of 233 students were enrolled in the study. The experimental group had significantly higher total posttest average compared to the control group (Beta = 7.695, 95% CI = 4.964-10.425, P < 0.001). The experimental group had also significantly higher averages of competency domains related to foundational knowledge (Beta = 1.471, 95% CI = 0.723-2.219, P < 0.001), pharmaceutical care (Beta = 1.650, 95% CI = 0.673-2.627, P < 0.001), essentials to practice and care (Beta = 1.838, 95% CI = 0.626-3.050, P < 0.003), and approach to practice and care (Beta = 2.736, 95% CI = 1.384-4.088, P < 0.001) averages. The experimental group reflected positive attitudes toward gamification engagement and motivation, with greater than 60% of the students recommend engage educational games to be part of the course.

CONCLUSION

Incorporation of educational games into pharmacy practice experiences resulted in better learning outcomes. This kind of active learning appears to be acceptable and motivational for students, and is recommended for further research in didactic courses in the pharmacy curriculum.

Students' perception of e-learning during the Covid-19 pandemic: a survey study of Iranian nutrition science students

BACKGROUND

COVID-19 pandemic caused university closures, which created learning challenges for students worldwide. Switching to online educational systems had significant impact on students' performances. The current study aims to investigate the perception of university students from the Nutrition Science department regarding e-learning in Iran.

METHODS

The design of the study is cross-sectional. Data were collected through online surveys from Iranian students from the Nutrition Sciences Department. Stratified random sampling was used to randomly select 955 participants. A self-administered validated questionnaire was used for data collection. Descriptive statistics, Analysis of Variance (ANOVA) and Chi-Square tests were used for analysis of the data.

RESULTS

Results revealed that 67.2% of students didn't have any former experience of e-learning. About 38.3% had moderate levels of Information Technology (IT) skills. Our results revealed that based on students' responses, being able to stay at home was one of the most common benefits of e-learning (39.1%). However, the most common challenge that students faced was related to technical problems (39.6%). When compared to e-learning, most students preferred face-to face type of learning. Students believed that this method no only increased their knowledge but also their skills and social competence as compared to e-learning. Only 28% of students rated e-learning as enjoyable. Furthermore, acceptance of online based education was statistically associated with students' degree level.

CONCLUSION

In conclusion, students reported both advantages and disadvantages of e-learning but still reported that face-to-face learning is considered the most effective form of learning.

Earlier smartphone acquisition negatively impacts language proficiency, but only for heavy media users. Results from a longitudinal quasi-experimental study

There is a growing debate about the proper age at which teens should be given permission to own a personal smartphone. While experts in different disciplines provide parents and educators with conflicting guidelines, the age of first smartphone acquisition is constantly decreasing and there is still limited evidence on the impact of anticipating the age of access on learning outcomes. Drawing on two-wave longitudinal data collected on a sample of 1672 students in 2013 (at grade 5) and 2016 (at grade 8), this study evaluates whether obtaining the first personal smartphone at 10 or 11 years old, during the transition to lower secondary school (early owning), affected their language proficiency trends compared to receiving it from the age of 12 onwards (late owning). Results indicate an overall null effect of smartphone early owning on adolescents' language proficiency trajectories, while a negative effect is found on those who were already heavy screen media users before receiving the device.

The patient involvement in nursing education: A mixed-methods systematic review

OBJECTIVE

To evaluate the effects patient involvement in nursing education has on students, patients and academic staff using a specific theoretical framework.

DESIGN

Mixed-methods systematic review based on Joanna Briggs Institute methodology (Prospero no. CRD42022327158).

DATA SOURCES

Seven databases (PubMed, Cochrane Library, Cinahl, PsychINFO, Scopus, ERIC, Embase), Google Scholar and reference lists were searched.

REVIEW METHODS

Qualitative, quantitative and mixed-method studies published from 2012 to 2022 were included. Two reviewers independently assessed the studies for eligibility and quality; any disagreement was discussed with a third reviewer. Data were extracted and analysed according to the Joanna Briggs Institute converged integrated approach.

RESULTS

Twenty-one qualitative, one quantitative and five mixed-methods studies met the inclusion criteria. Data were provided from three points of view: students, patients and academic staff. Student integrated findings included: (i) students' reactions towards patient involvement in education; (ii) students' views on the learning process and (iii) on ethical issue. From the patient point of view, the integrated findings addressed (i) patients' goals and effects on students' learning; (ii) how patients teach and get involved with students; (iii) how patients perceived their role; the patients' views on facilitators (iv) and barriers (v) in education; (vi) the perceived effects of being involved in education. Four integrated findings were derived from the academic staff's point of view: (i) academics' perceptions on patient vulnerability; (ii) perceived barriers to the efficacy of patient involvement in education; (iii) effects of patient involvement in nursing education; and (iv) methodological aspects of patient involvement in university curriculum.

CONCLUSIONS

This systematic review provides useful information from all stakeholders' perspectives on the effects of patient involvement in nursing education. It offers a broader view of the implications for implementation and for developing theoretical frameworks and hypotheses for future research.

Interactive notebooks for achieving learning outcomes in a graduate course: a pedagogical approach

Social network analysis involves delicate and sophisticated mathematical concepts which are abstract and challenging to acquire by traditional methods. Many studies show that female students perform poorly in computer science-related courses compared to male students. To address these issues, this research investigates the impact of employing a web-based interactive programming tool, Jupyter notebooks, on supporting deeper conceptual understanding and, therefore, better attainment levels of the course learning outcomes in a female setting. The work also highlights the overall experience and enjoyment this tool brought to the classroom. Document analysis and questionnaire were used as data collection methods. A mixed approach was applied, mid-term exam documents were investigated qualitatively, and the questionnaire was analyzed quantitatively. Our results showed that most students correctly perceived the learning outcomes and knowledge introduced within the Jupyter environment. Moreover, the interactive nature of Jupyter enhanced engagement and brought enjoyment to the learning experience.

A comparison of medical and pharmacy student perspectives of a clinical interprofessional home-visit versus a virtual interprofessional workshop

Background: No Place Like Home is a clinical interprofessional education (IPE) activity whereby pharmacy and medical students conduct home visits under the guidance and supervision of a clinical preceptor to homebound patients. Purpose: We examined pharmacy and medical student perceptions of mastery of interprofessional competencies during an in-person clinical home visit pre-COVID-19 pandemic versus a virtual IPE learning activity consisting of didactic and case discussions in response to the global COVID-19 pandemic. Methods: We administered the same modified Interprofessional Collaborative Competency Attainment Survey (ICCAS) instrument, which uses a five-point Likert scale, to both the in-person and the virtual IPE students following their learning activity.   Results: We received a total of 459 completed survey responses with an overall response rate of 84%. For both groups of students, the in-person format was preferred, however, to our surprise, the results indicated that students in the virtual group reported greater perceived gain in interprofessional skills than students in the in-person group. In addition, pharmacy students perceived greater gain from the interprofessional activity and offered more thoughtful reflections about their experience. Conclusions: Even though both groups of students preferred the in-person visit, the IPE objectives were equally (for medical students) or better (for pharmacy students) absorbed in the virtual environment than the in-person clinical home visit.

Mapping the Core Concepts of Physiology Across Australian University Curricula

Core concepts in physiology, designed by physiology educators to promote improved learning and teaching, have existed for over a decade. This study aimed to investigate the extent to which a set of 15 core concepts of physiology (derived by a USA team) are reflected in the Learning Outcomes (LOs) of units (subjects) comprising physiology majors in Australian universities. From publicly accessible online information, we identified 17 Australian universities that offered a physiology major for undergraduate degree students and downloaded 788 LOs from the 166 units that comprised the majors. Each LO was blindly mapped against the 15 core concepts by eight physiology educators from three Australian universities. Additionally, text matching software was employed to match keywords and phrases, (identified as descriptors of the 15 core concepts) against the LOs. The frequency of individual words and two-word phrases for each core concept was calculated and ranked. There was variability in rating LOs for the same university amongst academic mappers, nevertheless, many of the 15 core concepts did not appear to be adequately covered in the LOs. Two core concepts most matched manually were in the top three most mapped by the software. These were, from most common, Structure/function and Interdependence. Our findings suggest a lack of alignment of LOs with the current set of core concepts across Australian physiology curricula. This highlights the need for Australia-wide agreement on a set of core concepts in physiology as the first step in collaboratively improving assessment and learning and teaching practice in physiology.

A Survey of Clinical Immersion Experiences in Biomedical Engineering

Immersion in clinical environments is generally believed to be a valuable experiential learning opportunity for students in biomedical engineering, both at the undergraduate and the graduate level. Immersion is believed to foster an understanding of medical culture, clinical operations, interprofessional collaboration, and oftentimes allows students to either identify unmet clinical needs. The National Institutes of Health supports efforts through grants to incorporate these clinical immersion programs into biomedical engineering curricula, and this has potentially facilitated an expansion of these programs across the United States. Unknown is how common clinical immersion experiences are in biomedical engineering programs, in general how these are organized and executed, and their goals. We conducted a survey of biomedical engineering programs to learn how many programs offer clinical immersion experiences, over what timeframe and in what formats, and what is known about their goals and learning outcomes. We present here the results of that survey which includes 52 clinical immersion courses and programs, 14 of which either are or were previously funded by the NIH. Each of these courses or programs engages, on average, about 27 students per year, but range in size from 2 to 160. The duration of the immersion experience likewise varies greatly from 3 to 400 h. The objectives of these programs are mostly to identify problems, develop engineering solutions to problems, or to learn clinical procedures. Despite the impressive breadth of experiences revealed by this survey, we still know relatively little about their impact on student learning, motivation, identity, or career path. Desired outcomes and assessment strategies must be better aligned with the structure of the clinical immersion experiences themselves if we are to determine if they are effective in meeting those outcomes, including those of professional preparation.

International Health Electives: defining learning outcomes for a unique experience

BACKGROUND

An International Health Elective (IHE) can be a unique learning experience for students. However, it has proven difficult to clearly define learning outcomes that capture the complexity of an IHE and are aligned with future professional performance. This study aimed to further define learning outcomes for IHEs in low- to middle-income countries (LMIC) from a student perspective.

METHODS

We conducted a deductive analysis of pre-departure and post-elective reflective reports of fifth-year medical students who participated in an IHE as part of their program. This provided possible learning objectives that were further explored in semi-structured individual interviews with medical students who had recently returned from an IHE.

RESULTS

We analyzed 33 reports of students participating in an IHE from 2017-2019 and held 19 interviews. Thematic analysis revealed 9 themes: developing intercultural competence, developing appreciation for differences in health care delivery systems, understanding international health, understanding the global burden of disease, developing a career perspective, developing clinical skills in resource low settings, becoming cost conscious, developing social responsibility and self-actualization.

CONCLUSIONS

We identified 9 learning outcomes that are directly and indirectly related to clinical practice. They add to the on-going discourse on the benefits of IHEs. These outcomes can be further developed by investigating the perspectives of home and host supervisors and educationalists, while taking the local context into account. Follow-up studies can evaluate to what extend these outcomes are achieve during an IHE.

Successful learning with whiteboard animations - A question of their procedural character or narrative embedding?

Although whiteboard animations are increasingly used for educational purposes, there is little empirical evidence as to why such animations can enhance learning. To specify essential elements, their dynamic visual presentation, as well as their narrative embedding, were found to be theortically important. In a first Experiment (N = 133) with a 2 (presentation mode: static pictures vs. progressive drawing) x 2 (narrative context: with vs. without a narrative) between-subject factorial design, motivational, cognitive, affective variables, as well as learning outcomes, of secondary school students were measured. Results revealed that progressive drawing, as well as a narrative context, are mostly associated with an increase in learning-relevant variables. In a second experiment with the same sample and the same experimental design but a different whiteboard animation, results from Experiment 1 generalize to another learning content. Again, a progressive drawing, as well as a narrative context within whiteboard animation, fostered learning relevant variables as well as learning outcomes. Results are discussed considering the cognitive theory of multimedia learning, the contiguity effect as well as the instructional design theory of anchored instruction.

How do medical students learn in an online community diagnostics program?

BACKGROUND

The need to engage medical students in understanding the social and environmental determinants of health in disparate communities is increasing. However, previous reviews have noted the limited community diagnosis programs and program evaluation. Given the feasibility of the programs, it is expected to be widely available online. Therefore, this study used a realist approach to identify learning patterns through an online community diagnosis program, namely context (C), mechanism (M), and outcomes (O) patterns.

METHODS

A 2-week general medicine clinical practice program was conducted for 4^th- and 5^th-year medical students at a medical university in Japan. The program included a one-hour zoom-based lecture, feedback for students on their presentations on community diagnosis, and a structural report on community diagnosis. We developed the program based on variation theory, which views discernment and variation in situations having time, space, and social dimensions as core learning. The students' reflections on their learning through the program were thematically analyzed through CMO perspectives. The realist approach used in the online diagnosis program evaluation allows us to explore, test, and refine what mechanisms work under what conditions (context) and with what interventions (including opportunities and resources), from which we can describe iteratively explainable results.

RESULTS

First, the medical students, who spent most of their time in the limited residential areas they lived in, discovered the characteristics of their own community by discovery learning and comparison among peers. Second, they increased their intrinsic interest in the community by discerning specific issues in their familiar community through community diagnosis. Third, they valued community diagnosis by identifying relationships between local data on health issues under their learning responsibility. Fourth, they become more flexible in their thinking and created new knowledge that would fit the local community, and their reflection on themselves was encouraged.

CONCLUSION

In this online community diagnosis program, medical students learned about the community through four types of learning patterns. Medical students may develop an understanding of community with interest using variation theory as a program development perspective and cognitive flexibility theory surrounding the essential ambiguity and abstraction of community.

Learning on OnlyFans: User Perspectives on Knowledge and Skills Acquired on the Platform

OnlyFans is a digital patronage platform on which over two million content creators produce sexually explicit content for more than 130 million users. Increased Internet access and innovative technologies that enhance sexuality via connections and knowledge are changing the ways people navigate their sexual lives. OnlyFans is unique due to its position between digital sex work and social media and its high degree of cultural assimilation. We explored with a mixed-method approach how OnlyFans users perceive the effects of their OnlyFans use on their sexual learning and sexual lives. A diverse sample of 425 OnlyFans users participated in our online survey. The quantitative results revealed that participants reported mostly positive influences of OnlyFans on their sexual lives, and that they learned new things in terms of sexual practices, sexual preferences, relationships, and sexual health. Participants also reported that they tried new things, including toy use, sexual identity exploration, sexual and relationship practices, and gender identity exploration. Thematic analysis for the qualitative question revealed increases in declarative/conceptual and procedural knowledge in terms of sexual improvements/expansion; improvements in relationships; self-improvement/expansion; skill acquisition; connecting with others through OnlyFans; and value-related learning outcomes. These results provide insight into the ways users engage with OnlyFans for sexual learning, exploration, and expansion at individual and partner-levels. Findings have implications for sex education and research and practice in digital spaces.

Digital learning designs in occupational therapy education: a scoping review

BACKGROUND

Digital learning is a rapidly advancing method for teaching and learning in professional health education. Although various digital learning designs have been tried in OT education, studies on digital learning designs are still limited.

METHODS

We conducted a scoping study that aimed to identify the digital learning designs used in occupational therapy (OT) education and review the effectiveness, learner perceptions, clinical skills integrated, and technology-based learning strategies used to facilitate learning. Four databases were searched using subheadings and terms relating to digital learning, occupational therapy, and education. The included studies were mapped according to the types of digital learning design, subjects, key clinical skills, and outcomes.

RESULTS

Twenty-two studies were included in this review, most of which were qualitative, observational, or mixed studies of the two designs. The digital learning designs identified in OT education were flipped, blended, hybrid, and distance learning, including e-learning and massive open online courses (MOOC). Among the components of clinical skills, professional reasoning and procedural knowledge were the most integrated into digital learning, and covered various OT subjects. Digital learning designs were reported to be equivalent to or more effective than the traditional face-to-face (F2F) class in learning outcomes of knowledge and skill acquisition, enhancing learning participation, reflection, and collaboration between learners. Various technologies have been used to promote synchronous or asynchronous active learning, providing learning strategies such as thinking, reflection, discussion, peer learning-group activity, and gamifying online learning.

CONCLUSIONS

In OT digital learning, appropriate learning subjects, the arrangement of clinical skill components that can be well integrated into digital learning, and the selection of appropriate technologies for effective learning are important. The results should be confirmed within an experimental study design.

Virtual reality in midwifery education: A mixed methods study to assess learning and understanding

BACKGROUND

Virtual reality learning environments (VRLEs) are a potentially valuable learning tool that have recently increased in popularity due to widespread availability and decreased cost. VRLEs can provide an immersive learning environment that increases the understanding of three-dimensional relationships between anatomical structures. However, there is a paucity of evidence in the literature supporting its use within Midwifery education.

OBJECTIVES

To explore the effectiveness of a VRLE as an educational tool in midwifery education.

SETTING

A large University in Ireland, with institutional ethical approval.

PARTICIPANTS

Undergraduate and graduate degree midwifery students.

DESIGN

A descriptive qualitative and quantitative study was carried out. Data collection was carried out between September 2020 and March 2021.

METHODS

Participants underwent a VRLE lesson based on the topic of fetal lie, position, and presentation in pregnancy. A multiple-choice questionnaire was used to quantitatively evaluate knowledge before and immediately after the intervention, and knowledge retention after one week. Qualitative data was collected using open-ended questions in the questionnaire. The primary outcome was a difference in pre- and post-intervention knowledge scores. Data was analysed using repeated measures one-way ANOVA. Qualitative data was analysed using thematic analysis and simple content analysis. All students participated in the quantitative and qualitative components of the study. Secondary outcomes included participant satisfaction and self-confidence in learning which were analysed using thematic analysis. The side effect profile of the virtual reality device was also explored using open-ended questions in the questionnaire.

RESULTS

Forty-one midwifery students participated in the study, with a 100 % participation and response rate. Repeated measures one-way ANOVA revealed no statistically significant differences in knowledge scores pre- and post-intervention. Participants rated high satisfaction and self-confidence scores with regard to the VRLE as a learning modality. Side effects most commonly experienced by participants included dizziness (49 %), disorientation (30 %) and symptoms similar to motion sickness (32 %). The following themes were identified: "Learning in 3D", "The Power of Visual Learning", "The value of Educational Technology", "Learning can be fun and enjoyable".

CONCLUSIONS

This study showed that the VRLE had no impact on knowledge gain, though high levels of satisfaction and self-confidence indicate a positive response to the VRLE. VRLEs are a potentially valuable learning tool to help enhance the student learning experience, promoting increased engagement, satisfaction, and self-confidence with the learning material.

Online Courses Provide Robust Learning Gains and Improve Learner Confidence in the Foundational Biomedical Sciences

The early stages of medical school involve education in a number of foundational biomedical sciences including genetics, immunology, and physiology. However, students entering medical school may have widely varying levels of background in these areas due to differences in the availability and quality of prior education on these topics. Even students who have recently taken formal courses in these subjects may not feel confident in their level of preparation, leading to anxiety for early-stage medical students. These differences can make it difficult for instructors to create meaningful learning experiences that are appropriate for all students. Additionally, actual or perceived differences in preparation may lead fewer students from diverse backgrounds to apply to medical school. Therefore, creating an efficient and scalable way to increase students' knowledge and confidence in these topics addresses an important need for many medical schools. We recorded pre- and post-course quiz scores for 9790 individuals who completed HMX online courses, developed in accordance with evidence-based learning practices and covering the fundamentals of biochemistry, genetics, immunology, pharmacology, and physiology. Each question was accompanied by a Likert scale question to assess the learner's confidence in their answer. Learners' median post-course quiz performance and self-assessed confidence significantly increased relative to pre-course quiz performance for each course. Improvements were consistent across US-based medical schools, non-US medical schools, and course runs open to the public. This indicates that online courses created using evidence-based learning practices can lead to significant increases in knowledge and confidence for many learners, helping prepare them for further medical education.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-022-01660-4.

An orange will do: Suspending learner disbelief in simulations

INTRODUCTION

Increasingly, educators are implementing simulation to supplement teaching. Where simulation is not already integral, difficulties have arisen with the utilization of simulation due to limited resources, training requirements, and educator uncertainty.

PERSPECTIVE

A learner's ability to suspend disbelief in a simulation can impact the effectiveness of learning. In other words, they become so immersed in the simulation that they ignore obvious limitations and choose to believe the activity is realistic. When designing simulations, educators need to consider intended learning outcomes (ILOs), realism, and briefings/debriefings to help learners suspend disbelief. Realism encompasses physical realism (fidelity), conceptual realism, and emotional/experiential realism. The ILOs should drive the simulation design and type of realism required. These should be presented to learners in a briefing, explaining where and why they may need to suspend disbelief; this should be reiterated during a debriefing to centre a learner's focus on whether the ILOs were met. Without this, learners may not "buy into" the simulation and instead can get lost in detail not relevant to their learning.

IMPLICATIONS

The use of cutting-edge equipment does not, on its own, ensure that learners get the most realistic learning experience. The goal of simulations should be to utilize resources in the most advantageous manner for attainment of ILOs. In a time when institutions may be pressured for time, staff, and resources, educators should remember that it is possible to facilitate effective learning in low-resource ways.

Framework for developing an exposure science curriculum as part of the European Exposure Science Strategy 2020-2030

BACKGROUND

Evaluating and managing exposures to chemical, physical and biological stressors, which frequently interplay with psychological stressors as well as social and behavioural aspects, is crucial for protecting human and environmental health and transitioning towards a sustainable future. Advances in our understanding of exposure rely on input from well-trained exposure scientists. However, no education programmes in Europe are currently explicitly dedicated to cover the broader range of exposure science approaches, applications, stressors and receptors.

OBJECTIVE

To address this challenge, a curriculum is needed that yields credible, well-defined career pathways in exposure science.

METHODS

Needs and conditions for advancing exposure science education in Europe were identified. As a starting point for a way forward, harmonised learning outcomes for exposure science were defined at each level of the European Qualifications Framework. The course programme coordinators were recruited for three varying courses, with respect to the course level and the proportion of the curriculum dedicated to exposure science. These courses were assessed via our systematic course review procedure. Finally, strategic objectives and actions are proposed to build exposure science education programmes.

RESULTS

The ISES Europe 'Education, Training and Communication' expert working group developed a framework for creating a viable exposure science curriculum. Harmonised learning outcomes were structured under eight learning levels, categorised by knowledge, skills and competence. Illustrative case studies demonstrated how education providers integrated these learning outcomes for their educational context and aligned the overall exposure science curriculum.

CONCLUSIONS

The international recognition and adoption of exposure science education will enable advances in addressing global exposure science challenges for various stressors, from behavioural aspects from individual to population scale, and effective communication between exposure scientists and relevant stakeholders and policy makers, as part of the European Exposure Science Strategy 2020-2030.

Integration of Arts and Humanities in Medical Education: a Narrative Review

This narrative review aims to identify and review the extant literature describing methods and outcomes of embedding the arts and humanities (AH) into medical school curricula. The Association of American Medical Colleges changed the Medical College Admission Test (MCAT) in 2015 to place new emphasis on the role of liberal arts in the process of developing well-rounded physicians. Consequently, medical schools have been implementing more connections to creative writing, literature, theater, movies, music, and the visual arts into their curricula. To review the current literature, we focused on methods medical educators used to embed content related to AH into their curricula to shape and drive associated learning outcomes. We conducted searches in PubMed, CINAHL, PsycINFO, and ERIC for peer-reviewed articles from 2011 to 2020. The authors selected three dyads in medical humanities and reviewed articles independently followed by discussion to identify thematic links to major findings. Out of 261 articles, a total of 177 full-text articles were reviewed with 34 selected for final inclusion. Our review included articles describing curriculum development and delivery in publications from Australia, Canada, India, New Zealand, and the USA. This review showed medical educators are implementing didactic and experiential instructional approaches to embedding the arts, humanities, and social sciences into the medical school classroom. Medical educators' attempts to embed AH into medical school curricula show promising results. Unfortunately, small sample sizes, short-term interventions, and an over-reliance of subjective assessment measures limit our knowledge of the true impact of these interventions. More rigorous assessments of required and longitudinal coursework are necessary to know the true impact of participation in AH coursework for medical students.

How learner engagement impacts non-formal online learning outcomes through value co-creation: an empirical analysis

From the perspective of service science and its core concept of value co-creation, promoting learner engagement is critical for learning outcomes in a non-formal online learning environment. To promote online learning performance, we study how multidimensional learner engagement affects both instrumental and experiential learning outcomes. By incorporating the service-dominant logic perspective into the research model, we designed an online survey to investigate the impact of platform value co-creation on learners' engagement outcomes. By employing a partial least squares-structural equation modeling (PLS-SEM), the results show that behavioral engagement, cognitive engagement, and emotional engagement have a significant impact on learning outcomes through the mediating effect of platform value, a second-order hierarchical latent variable. This study has multiple theoretical contributions and practical implications. First, we found new evidence that pursuing good learning outcomes in a non-formal online learning setting is not just a technological architecture or pedagogic guidelines, but also a "win-win" value co-creation process. Second, our results confirm the posited direct and indirect effects, thus evidencing functional value, emotional value, social value, and personalized value as components of the platform value construct, and it as a driver and mediator for better online learning outcomes. Third, our results underscore the importance of platform value in studying the impact of learner engagement on learning outcomes and provide a sharper theoretical lens to evaluate online learning platform value from the perspective of online learners.

A systematic literature review of requirements engineering education

Requirements engineering (RE) has established itself as a core software engineering discipline. It is well acknowledged that good RE leads to higher quality software and considerably reduces the risk of failure or budget-overspending of software development projects. It is of vital importance to train future software engineers in RE and educate future requirements engineers to adequately manage requirements in various projects. To this date, there exists no central concept of what RE education shall comprise. To lay a foundation, we report on a systematic literature review of the field and provide a systematic map describing the current state of RE education. Doing so allows us to describe how the educational landscape has changed over the last decade. Results show that only a few established author collaborations exist and that RE education research is predominantly published in venues other than the top RE research venues (i.e., in venues other than the RE conference and journal). Key trends in RE instruction of the past decade include involvement of real or realistic stakeholders, teaching predominantly elicitation as an RE activity, and increasing student factors such as motivation or communication skills. Finally, we discuss open opportunities in RE education, such as training for security requirements and supply chain risk management, as well as developing a pedagogical foundation grounded in evidence of effective instructional approaches.

Team-based learning versus interactive lecture in achieving learning outcomes and improving clinical reasoning skills: a randomized crossover study

BACKGROUND

This study aimed to investigate the impact of interactive lecture (IL) and team-based learning (TBL) on improving clinical reasoning skills (CRSs) and achieving learning outcomes (LO). Students' feedback was obtained about the strategies.

METHODS

This study was carried out at the Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia. Two modules, endocrinology, and emergency were selected. Students of each batch in both modules were divided into two arms. With a randomized crossover design, IL & TBL were used for two separate topics in each module. After each topic, a quiz in the form of well-structured MCQs was taken. A questionnaire was designed to obtain students' feedback. SPSS version 23 was used to analyse results. The difference between the mean values was calculated by Student's t-test. Feedback data is presented as frequency. P-value ≤ 0.05 was considered statistically significant.

RESULTS

Learning outcomes were achieved by all groups in two modules, with both instructional strategies, IL and TBL. Students attempted >70% correct answers. However, in the emergency module, the groups with TBL as the instructional strategy performed better in quiz1 and quiz 2 (p = 0.026 and p = 0.016, respectively). Similarly, in the endocrinology module (3^rd year), although the groups with TBL as the instructional strategy performed better in both quizzes, it was significant in quiz1 (p = 0.02). The difficulty indices of the clinical reasoning questions (CRQ) were used as the parameters for comparison. In the emergency module, group1, in quiz1, with TBL as an instructional strategy performed better in the CRQ (p = 0.017), while in quiz2, group2 with TBL as the instructional strategy performed better (p < 0.001). Group1 of the third-year students (endocrinology module) performed better in the CRQ in quiz 1 with TBL as an instructional strategy than group 2 with IL (p = 0.04). Mostly, students in both modules preferred TBL over IL, and especially they liked team application. Students perceived that TBL was a better strategy to learn CRS.

CONCLUSIONS

Students achieved LOs and CRS better with TBL as an instructional strategy. They preferred TBL over IL. It is suggested to include TBL, or increase its percentage, in the curriculum.

An Online Management System for Streamlining and Enhancing the Quality of Learning Outcomes Assessment

Learning outcomes assessment is an effective academic quality assurance tool that enables educators to review and enhance the alignment between planned, delivered, and experienced curricula. Accurately assessing what students know and are able to do after completing a learning module is the first step to decide on the strategies to implement and the proper actions to take in order to ensure the continuous improvement of the student learning experience. Nonetheless, learning outcomes assessment processes in higher education are still facing major challenges that affect their proper and effective implementation. Hence, faculty do not usually experience noticeable improvement in the students' performance over several assessment cycles, which causes their frustration and reluctance to continue participating in the assessment process. This paper discusses the main issues that affect the implementation of the assessment process and prevent the closure of the assessment loop. It also introduces a unified assessment process and an online management system that have been developed recently to address the discussed issues. The online management system streamlines the assessment process, while providing administrators and quality assurance officers with valuable infographics and reports to effectively oversee the implementation of the assessment process. The system has been deployed at the United Arab Emirates University since fall 2018, and has been successfully used by faculty to assess the learning outcomes for more than 1000 courses each semester. Moreover, collected statistics showed that the online features provided by the system allowed faculty to continue their assessment tasks seamlessly during the COVID-19 pandemic.

Teaching design thinking as a tool to address complex public health challenges in public health students: a case study

BACKGROUND

Developing a public health workforce that can understand problems from a population perspective is essential in the design of impactful user-centred responses to current population health challenges. Design Thinking, a user-driven process for problem-defining and solution-finding, not only has utility in the field of public health but stands as a potential mechanism for developing critical skills -such as empathy, creativity and innovation- amongst future professionals. Though the literature reflects the use of DT across many health sciences disciplines, less research has been published on how students apply learned concepts using real-world challenges of their choice and what difficulties they face during the process.

METHODS

This case study evaluates achieved learning outcomes after the introduction of a design thinking block into post-graduate public health curriculum at the University College Dublin. Two independent assessors evaluated student learning outcomes and observed difficulties during the process by assessing group presentations to identify and understand any learning difficulties using an ad-hoc designed tool. The tool consisted of twelve items scored using a 5-point Likert scale. Student feedback, in the form of an online survey, was also analysed to determine their level of enjoyment, perceived learning outcomes and opinions on the course content.

RESULTS

The assessors evaluated thirteen DT group presentations and reports from 50 students. The groups chose a range of topics from socialization of college students during Covid-19 to mental health challenges in a low-income country. Independent assessment of assignments revealed that the highest scores were reached by groups who explored a challenge relevant to their own lives (more than 80% of total possible points versus 60% class average). The groups that explored challenges more distant to themselves struggled with problem finding with a mean score of 2.05 (SD ± 1.2) out of 5 in that domain. The greatest difficulties were observed in problem finding and ideation. Though most students found the design thinking block enjoyable and relevant to their education, they recommended that the DT block be a stand-alone module. Students recognized that groups who chose a familiar topic experienced fewer difficulties throughout the process.

CONCLUSION

The study showed that DT learning outcomes were best achieved when students focused on challenges, they had either personally experienced or were familiar with. These findings provide insight for future iterations of DT workshops and support the teaching of user-centred approaches to future public health practitioners.

Assessment of the impact of co-curricular activities on achievement of Doctor of Pharmacy program outcomes

INTRODUCTION

Co-curricular activities are recognized as an increasingly important aspect of pharmacy education. However, the impact of these activities on student learning is not well understood compared to that of curricular learning. The purpose of this study was to assess student-perceived progress in achieving program outcomes through voluntary co-curricular activities compared with learning of the same outcomes through mandatory curricular activities.

METHODS

The study was performed over six semesters between fall 2017 and spring 2020 at the University of Southern California School of Pharmacy. Separate surveys were sent to all first- through third-year doctor of pharmacy students each semester to assess the impact of curricular and co-curricular activities on improvement in six program outcomes. Graduating student survey data were also mapped to learning outcomes to assess improvement of these outcomes upon graduation.

RESULTS

Three main results emerged from these data. First, there was greater variation in the impact of co-curricular activities on different learning outcomes compared to the effect of curricular activities on the same outcomes. Second, co-curricular activities had a greater impact on "soft skills," including leadership and professionalism, compared to concrete knowledge in areas such as therapeutic mechanisms. Finally, the impact of co-curricular activities on most learning outcomes diminished with progression through the curriculum while the impact of curricular activities remained relatively constant.

CONCLUSIONS

Student-perceived improvement in learning of program outcomes differs when based on co-curricular compared to curricular activities. These results show how these activities can complement each other in achievement of program outcomes.

A novel algorithm-driven hybrid simulation learning method to improve acquisition of endotracheal intubation skills: a randomized controlled study

Background

Simulation-based training is a clinical skill learning method that can replicate real-life situations in an interactive manner. In our study, we compared a novel hybrid learning method with conventional simulation learning in the teaching of endotracheal intubation.

Methods

One hundred medical students and residents were randomly divided into two groups and were taught endotracheal intubation. The first group of subjects (control group) studied in the conventional way via lectures and classic simulation-based training sessions. The second group (experimental group) used the hybrid learning method where the teaching process consisted of distance learning and small group peer-to-peer simulation training sessions with remote supervision by the instructors. After the teaching process, endotracheal intubation (ETI) procedures were performed on real patients under the supervision of an anesthesiologist in an operating theater. Each step of the procedure was evaluated by a standardized assessment form (checklist) for both groups.

Results

Thirty-four subjects constituted the control group and 43 were in the experimental group. The hybrid group (88%) showed significantly better ETI performance in the operating theater compared with the control group (52%). Further, all hybrid group subjects (100%) followed the correct sequence of actions, while in the control group only 32% followed proper sequencing.

Conclusions

We conclude that our novel algorithm-driven hybrid simulation learning method improves acquisition of endotracheal intubation with a high degree of acceptability and satisfaction by the learners’ as compared with classic simulation-based training.

What do I take home after the simulation? The importance of emergent learning outcomes in clinical simulation

BACKGROUND

Clinical simulation learning includes a debriefing after the simulated experience. Debriefing consists of several stages. In this work we focus on the last stage (summary or transfer phase), in which the participants present the most relevant of what they learned during the session.

OBJECTIVES

To analyze the perception of 4th year Nursing Degree students on the most significant aspects they learned during the simulation sessions.

METHOD

A qualitative, cross-sectional and descriptive study was conducted, with students in their last year of the Nursing Degree at the Catholic University of Murcia. The opinions of 67 students from 5 groups, on the debriefing phase, were analyzed, by comparing them with the objectives that were initially proposed during the design of the scenarios used in the simulations.

RESULTS

A total of 78 clinical scenarios were analyzed, with 292 pre-established learning objectives, on a total sample of 67 students. The participants provided a total of 464 learning outcomes that were significant for them, of which 101 coincided with those that were initially planned (21.8%), while the rest, 363 (78.2%), were considered emergent (not planned a priori). For the most part, the learning outcomes described by the students were technical knowledge and/or skills (70.5%), as compared to non-technical knowledge and/or skills (29.5%).

CONCLUSION

For the most part, the learning outcomes considered by the students to be significant did not correspond with the objectives set a priori in the design of the scenarios. Most were emergent elements, especially those that referred to the technical knowledge and skills. The emergent knowledge must be considered crucial by the educators for the teaching and training of students.

Medical Students' Opinions of Anatomy Teaching Resources and Their Role in Achieving Learning Outcomes

Several teaching resources are used to enhance the learning of anatomy. The purpose of this study was to examine the preference of medical students on the use of various resources to learn anatomy and their link to 12 learning outcomes. A selected response item questionnaire was administered that asked students to rank six laboratory teaching resources from most to least preferred, and rate how useful these six resources were towards achieving 12 learning outcomes. These learning outcomes covered many of the learning domains such as demonstrating an understanding of anatomy, visualizing structures, appreciating clinical correlations, and understanding anatomical variations. Medical students ranked cadaveric prosections paired with an active learning clinical tutorial as the highest rank and most useful resource for learning anatomy, followed by dissection videos, electronic resources, and printed material, followed by plastinated specimens and plastic models. Overall, cadaveric prosections were also rated as the most helpful teaching resource in achieving various learning outcomes. In conclusion, anatomy teachers should provide prosections coupled with clinical tutorials as well as electronic resources as students prefer these and think they help them learn anatomy. Future studies will investigate the impact of using these resources on students' performance.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-021-01436-2.

Effects of simulation technology-based learning on nursing students' learning outcomes: A systematic review and meta-analysis of experimental studies

BACKGROUND

Gaps between theory and clinical practice represent challenges for nursing students during their learning processes. Providing simulation technology-based learning for nursing students is essential for modern nurse education, but evidence of efficacy remains scarce.

OBJECTIVES

To determine the effects of simulation technology-based learning for nursing students.

DESIGN

A systematic review and meta-analysis.

METHODS

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Five databases (CINAHL, Embase, MEDLINE, PubMed, and Web of Science) were electronically searched through May 30, 2021. Eligibility criteria included nursing students, simulated technology-based learning as the primary intervention, and randomised controlled trials or quasi-experimental studies published in English. The methodological quality of included studies was evaluated by the Cochrane risk-of-bias tool. Comprehensive Meta-Analysis Version 3.0 was used to conduct a meta-analysis using the random-effects model. Begg's and Egger's tests were performed to assess publication bias, and sensitivity analysis performed using a remove one study method.

RESULTS

A total of 17 studies were included in this study. Simulated technology-based learning significantly increased nursing student knowledge acquisition (standard mean difference [SMD]: 0.72, 95% confidence interval [CI]: 0.25-1.18, p < 0.001), enhanced student's confidence (SMD: 0.50, 95% CI: 0.02-0.99, p = 0.043), and increased student's satisfaction in learning (SMD: 0.81, 95% CI: 0.61-1.00, p < 0.001). Subgroup analyses showed that receiving simulation by manikins simulator had a greater effect on knowledge acquisition (SMD: 1.01, 95% CI: 0.27-1.74, p = 0.007).

CONCLUSIONS

Simulation technology use may meet the expectations of undergraduate nursing students and prepare them for clinical practice, representing an opportunity to fill gaps between theory and clinical practice while simultaneously developing new teaching scenarios.

Comparison of blended versus traditional classrooms among undergraduate nursing students: A quasi-experimental study

BACKGROUND

Blended learning is a relatively new educational approach that has been introduced into higher education in Palestine. While it has many advantages, there is no empirical evidence, nor any case studies from Palestine to support the use of blended learning over traditional classroom.

OBJECTIVES

To compare students' learning outcomes, learning perceptions of their educational environment, and satisfaction of blended learning versus traditional classroom.

DESIGN

A quasi-experimental study.

SETTING

A public university in Palestine.

PARTICIPANTS

102 Bachelor of Science in nursing students enrolled on the maternal health course.

METHODS

Students freely chose to register for the blended teaching section (49 students) or traditional classroom (53 students), then the teaching method for each section was assigned. Student demographics, course component grades, perceptions of the educational environment, measured by the Arabic version of Dundee Ready Education Environment Measurement (DREEM) inventory, and degree of satisfaction were collected in this study. Descriptive statistics and the Independent Sample t-test were used to analyze the data.

RESULTS

The sample included 49 students in the blended teaching section and 53 students in the traditional section. Overall DREEM scores, Student Perceptions of Learning, and Student Perceptions of Teachers were significantly higher for students taught with the blended method compared to traditional classroom settings. The total DREEM scores were between 101 and 151 for both sections, indicating that all students, regardless of teaching method, had more positive than negative perceptions of their educational environment. Moreover, there was no significant difference in scores and total course GPA (Grade Point Average), both with and without assignment grades, or between blended and traditional learning in first, second and final exams. However, students taught with the blended format scored significantly higher in assignments than students taught the traditional classroom.

CONCLUSIONS

Blended learning can be a useful educational approach in nursing education and Palestinian universities may consider using it for nursing courses.

The effects of mindfulness on health profession students' simulation training outcomes: An integrative review

Health profession students (HPSs) continuously experience psychological issues which can exacerbate cognitive errors and harm emotional well-being. The Healthcare simulation environment is stressful and overwhelming in nature and may impair learning outcomes. Therefore, integrating psychological interventions into simulation-based learning (SBL) instructional design may alleviate students' psychological distress and improve their learning outcomes.

OBJECTIVES

to examine the effects of mindfulness on health professions students' SBL outcomes.

DESIGN

a literature review, based on Whittemore and Knafl's (2005) updated methodology was used in this study.

DATA SOURCES

We investigated PubMed, ERIC, ScienceDirect, and Google Scholar to find papers addressing the effects of mindfulness on health professions students' SBL outcomes. We targeted Results: This integrative review suggests that although mindfulness improves SBL outcomes, HPSs still struggle to transfer mindfulness benefits to real clinical practice.

CONCLUSION

research on mindfulness in healthcare SBL is in its infancy, thus, further research is needed to prove mindfulness effects on HPSs' SBL outcomes.

Comparing evaluation responses of an interprofessional education initiative with students in undergraduate nursing and medical programmes

BACKGROUND

Interprofessional education initiatives can be used as effective means to influence students' perceptions of their own and others' roles and interactions as health professionals. There is a need to better understand how interprofessional education learning outcomes are appreciated by students.

AIM

The aims of this study were to describe and compare evaluation feedback from students in undergraduate nursing and medicine programmes about the learning outcomes of an interprofessional education initiative.

METHODS

A mixed methods pre-post-study design was used to collect data using evaluation questions about the initiative and two interprofessional learning outcomes: communication and teamwork. Ratings were analysed with a two-way repeated measures analysis of variance or a t-test. Written responses were analysed using a general inductive approach.

RESULTS

Data from 30 nursing students and 12 medical students were analysed. A noteworthy finding was a significantly higher average rating for nursing students than medicine students before and after the session for the statement about valuing interprofessional learning. Three themes represented comments from both groups: positive experiences, relevance to practice, and learning design issues.

DISCUSSION

Findings were interpreted to indicate that students from both programmes valued the learning outcomes session and was greater at the end of the session. Notably, the perceived value of interprofessional learning was higher for nursing students than medical students before and after the session. This finding may be related to the familiarity nursing students may have with the teaching methods used in the initiative. Further exploration of this finding is needed so educators can better understand how they can provide optimal learning experiences for all students who participate in interprofessional education.

CONCLUSION

Nursing and medicine students appear to value the interprofessional learning outcomes in an undergraduate health professional initiative. However, differences between these two groups of students are an area for further exploration.

Association between maternal hypertensive disorders, fetal growth and childhood learning outcomes

OBJECTIVE

Both small for gestational age (SGA) birthweight and pregnancies complicated by maternal hypertension (HTN) are independently associated with poorer childhood learning outcomes, however the relative contribution of each remains unknown.

STUDY DESIGN

A retrospective cohort was created in which 2014-2017 third grade Rhode Island Department of Education data were linked to Rhode Island Department of Health birth certificate data. The study population was composed of non-anomalous, singleton births between 22- and 42-weeks' gestation. Reading and math proficiency were compared among four groups: 1) appropriate for gestational age (AGA) and no maternal HTN (referent), 2) AGA with HTN, 3) SGA without HTN and 4) SGA with HTN.

MAIN OUTCOME MEASURES

Bivariable and multivariable log-binomial regression were used to examine the association between subject proficiency and pregnancy complication, adjusting for potential confounders.

RESULTS

Of the 23,097 who met inclusion criteria, 1004 (4%) were AGA with HTN, 1575 (7%) were SGA without HTN and 176 (1%) were SGA with HTN. Overall, when adjusted for maternal age, gestational age, sex and socioeconomic factors, only children born SGA without HTN had reduced reading proficiency (relative risk (RR) 0.86 95% confidence interval (CI) 0.78, 0.92) and math proficiency (RR 0.88 95% CI 0.82, 0.94) compared to children born AGA without HTN.

CONCLUSION

In a diverse, statewide cohort, only SGA without HTN was associated with lower reading and math proficiency compared to uncomplicated pregnancies. This suggests that only decreased fetal growth from causes other than HTN is associated with risk of poorer school-age outcomes, and has implications for early resource allocation.

An eye tracking study: positive emotional interface design facilitates learning outcomes in multimedia learning?

Unlike the other studies on emotional design in multimedia learning, the present study differentiated the two confounding variables of visual interface design and structured content to manipulate the instructional material. Specifically, we investigated how the visual aesthetics of positive emotional interface design influenced learners' cognitive processes, emotional valences, learning outcomes, and subjective experience. Eighty-one college students took part in the experimental study. They were divided into the three experimental groups: a holistic layout of positive emotional design group (HPED), a local layout of positive emotional design group (LPED), and a neutral emotional design group (ND). By using a mixed approach of questionnaires and eye tracking, we further explored the differences among the three groups in cognitive processing, learning outcomes, and subjective experience. Results indicated that the LPED group invested higher cognitive effort, put more attentional focus in the relevant knowledge content module, and achieved better learning performance (i.e., retention and transfer tests) in contrast to the HPED group and the ND group. However, no significant difference in dynamic changes of emotional state among the three groups was detected. The analytical results can provide researchers and practitioners with valuable insights into the positive emotional design of multimedia learning, which allows for the facilitation of mental engagement, learning outcomes and subjective perception.

Questioning medical competence: Should the Covid-19 crisis affect the goals of medical education?

The COVID-19 pandemic has disrupted many societal institutions, including health care and education. Although the pandemic's impact was initially assumed to be temporary, there is growing conviction that medical education might change more permanently. The International Competency-based Medical Education (ICBME) collaborators, scholars devoted to improving physician training, deliberated how the pandemic raises questions about medical competence. We formulated 12 broad-reaching issues for discussion, grouped into micro-, meso-, and macro-level questions. At the individual micro level, we ask questions about adaptability, coping with uncertainty, and the value and limitations of clinical courage. At the institutional meso level, we question whether curricula could include more than core entrustable professional activities (EPAs) and focus on individualized, dynamic, and adaptable portfolios of EPAs that, at any moment, reflect current competence and preparedness for disasters. At the regulatory and societal macro level, should conditions for licensing be reconsidered? Should rules of liability be adapted to match the need for rapid redeployment? We do not propose a blueprint for the future of medical training but rather aim to provoke discussions needed to build a workforce that is competent to cope with future health care crises.

Looking beyond changes in averages in evaluating foundational learning: Some inequality measures

This paper uses measurements of learning inequality to explore whether learning interventions that are aimed at improving means also reduce inequality, and if so, under what conditions. There is abundant evidence that learning levels are generally low in low- and middle-income countries (LMIC), but there is less knowledge about how learning achievement is distributed within these contexts, and especially about how these distributions change as mean levels increase. We use child-level data on foundational literacy outcomes to quantitatively explore whether and how learning inequality using metrics borrowed from the economics and inequality literature can help us understand the impact of learning interventions. The paper deepens recent work in several ways. First, it extends the analysis to six LMIC, displaying which measures are computable and coherent across contexts and baseline levels. This extension can add valuable information to program evaluation, without being redundant with other metrics. Second, we show the large extent to which the disaggregation of inequality of foundational skills between- and within-schools and grades varies by context and language. Third, we present initial empirical evidence that, at least in the contexts of analysis of foundational interventions, improving average performance can reduce inequality as well, across all levels of socioeconomic status (SES). The data show that at baseline, the groups with the highest internal inequality tend to be the groups with lowest SES and lowest reading scores, as inequality among the poor themselves is higher than among their wealthier counterparts. Regardless of which SES groups benefit more in terms of a change in mean levels of reading, there is still a considerable reduction in inequality by baseline achievement as means increase. These results have policy implications in terms of targeting of interventions: much can be achieved in terms of simultaneously improving averages and increasing equality. This seems particularly true when the initial learning levels are as low as they currently are the developing world.

Measuring the impact of productive failure on nursing students' learning in healthcare simulation: A quasi-experimental study

BACKGROUND

Previous research suggests that making errors in a non-threatening simulated environment can facilitate learning. Productive failure, which combines problem-solving tasks followed by instruction, enables students to learn from making mistakes. This teaching approach has demonstrated improved learning outcomes such as explanatory knowledge and transfer of knowledge compared to a direct instruction approach where students receive instruction prior to problem-solving tasks. However, no previous studies have examined the impact of productive failure on nursing students' learning in manikin-based simulation.

OBJECTIVE

To measure the impact of productive failure on nursing students' declarative knowledge, explanatory knowledge, and transfer of knowledge compared to a direct instruction approach in a paediatric closed head injury simulation.

METHODS

Second year undergraduate nursing students (n = 349) from one Australian university were invited to participate in the study. Consenting participants (n = 344) were randomised into two groups: productive failure and direct instruction. The intervention consisted of two paediatric closed head injury simulations separated by a simulation debrief. Knowledge tests were administered before and immediately after the simulation.

RESULTS

Data from 331 participants were analysed. The productive failure group outperformed the direct instruction group in the post-test (p < 0.001). Learning gains for participants in the productive failure group were significantly higher than the direct instruction group for both explanatory knowledge (p < 0.001) and the ability to apply learning to solve novel clinical problems (p < 0.001). The difference in the median scores for declarative knowledge was not significant (p = 0.096).

CONCLUSION

This study demonstrated that a productive failure simulation that leads learners to make mistakes before receiving instruction can facilitate deeper levels of explanatory knowledge and enable the transfer of learning to new clinical situations. These results suggest the need for further exploration of pedagogies that foster learning from errors in simulation-based learning.

The influence of the multimedia and modality principles on the learning outcomes, satisfaction, and mental effort of college students with and without dyslexia

The purpose of this study was to examine the application of the multimedia and modality principles on cued-recall, recognition, and mental effort of college students with and without dyslexia. The study used a Multimedia (Image Present vs. Image Absent) × Modality (Narration vs. Onscreen Text) × Dyslexia (Dyslexia vs. Non-Dyslexia) 3-way factorial design with each independent variable serving as a between-subject condition. A total of N = 148 participants (73 with dyslexia and 75 without dyslexia) were recruited from five different institutions of higher education in the Southeastern United States and systematically assigned to one of four multimedia learning conditions. After assessing our data for statistical assumptions, we employed factorial Analysis of Variance (ANOVA) models on each dependent measure. Our findings show a reverse modality effect for students with dyslexia who performed better than their peers without dyslexia in Onscreen Text conditions. Although performance was better across groups and conditions when images were present, there were no significant interactions related to the multimedia condition. Similarly, there were no significant interactions related to mental effort even though learners with dyslexia exhibited high instructional efficiency in the Onscreen Text-Image Present condition while learners without dyslexia exhibited low task involvement in the Onscreen Text-Image Absent condition. Our results provide theoretical implications and important avenues for future research and practice as related to how multimedia learning influences students with dyslexia. We also suggest studies that could inform the eventual design of adaptive and personalized multimedia learning solutions for learners with dyslexia.

Build back better: Avoid the learning loss trap

A dangerous trap exists for educators and education policy makers: the learning loss. This trap comes with a large amount of data and with sophisticated projection methods. It presents a stunningly grim picture for education and it invites educators and policy makers to make wrong decisions and invest in wrong things. The article identifies a number of undesirable outcomes that their concerns could lead to. It also suggests several productive actions when the pandemic is controlled and schools reopen.