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Author: Brian S McGowan, PhD

Mobile learning devices in the workplace: ‘as much a part of the junior doctors’ kit as a stethoscope’? | BMC Medical Education | Full Text

Background
Smartphones are ubiquitous and commonly used as a learning and information resource. They have potential to revolutionize medical education and medical practice. The iDoc project provides a medical textbook smartphone app to newly-qualified doctors working in Wales. The project was designed to assist doctors in their transition from medical school to workplace, a period associated with high levels of cognitive demand and stress.

Methods
Newly qualified doctors submitted case reports (n = 293) which detail specific instances of how the textbook app was used. Case reports were submitted via a structured online form (using Bristol Online Surveys – BOS) which gave participants headings to elicit a description of: the setting/context; the problem/issue addressed; what happened; any obstacles involved; and their reflections on the event. Case reports were categorised by the purpose of use, and by elements of the quality improvement framework (IoM 2001). They were then analysed thematically to identify challenges of use.

Results
Analysis of the case reports revealed how smartphones are a viable tool to address clinical questions and support mobile learning. They contribute to novice doctors’ provision of safe, effective, timely, efficient and patient-centred care. The case reports also revealed considerable challenges for doctors using mobile technology within the workplace. Participants reported concern that using a mobile phone in front of patients and staff might appear unprofessional.

Conclusion
Mobile phones blur boundaries between the public and private, and the personal and professional. In contrast to using a mobile as a communication device, using a smartphone as an information resource in the workplace requires different rituals. Uncertain etiquette of mobile use may reduce the capacity of smartphone technology to improve the learning experience of newly qualified doctors.

via Mobile learning devices in the workplace: ‘as much a part of the junior doctors’ kit as a stethoscope’? | BMC Medical Education | Full Text.

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RESOURCE: Harvard Library publishes report on converting subscription journals to open access

The Harvard Library Office for Scholarly Communication (OSC) is pleased to announce the release of a comprehensive literature review on strategies for converting subscription journals to open access.

In the spring of 2015, the OSC commissioned the research from David Solomon, Mikael Laakso, and Bo-Christer Björk, who completed it in the spring of 2016. We posted a preliminary draft online for a four month public-comment period, and asked a distinguished panel of 20 colleagues to add their own comments.

The authors identified 15 journal-flipping scenarios: 10 that depend on article processing charges (APCs) and 5 that dispense with APCs. For each one they give examples, evidence, and their assessment of its strengths and weaknesses. The examples come from all scholarly niches by academic field, regions of the world, and economic strata.

This comprehensive review of diverse approaches is the report’s strength. Not every flip was a success, and not all the flips that were successful using one scenario would have been successful with a different scenario. But there were successes under every scenario and in every scholarly niche. Journals that picked a scenario that fit their circumstances were able preserve or enhance their readership, submissions, quality, and financial sustainability….

via Harvard Library publishes report on converting subscription journals to open access | Journal-Flipping | Harvard OSC.

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MANUSCRIPT: Comparing nurses’ knowledge retention following electronic continuous education and educational booklet: a controlled trial study

BACKGROUND:
Training methods that enhance nurses’ learning and retention will increase the quality of patient care. This study aimed to compare the effectiveness of electronic learning and educational booklet on the nurses’ retention of diabetes updates.
METHODS:
In this controlled trial study, convenience sampling was used to select 123 nurses from the endocrinology and internal medicine wards of three hospitals affiliated to Tehran University of Medical Sciences (Tehran, Iran). The participants were allocated to three groups of manual, electronic learning, and control. The booklet and electronic learning groups were trained using educational booklet and electronic continuous medical education (CME) website, respectively. The control group did not receive any intervention. In all the three groups, the nurses’ knowledge was measured before the intervention, and one and four weeks after the intervention. Data were collected by a questionnaire.
RESULTS:
Significant differences were observed between the mean scores of the three groups one and four weeks after the intervention (F=26.17, p=0.001 and F=4.07, p=0.020, respectively), and post hoc test showed that this difference was due to the higher score in e-learning group. Both e-learning and booklet methods could effectively improve nurses’ knowledge (χ²=23.03, p=0.001 and χ²=51.71, p=0.001, respectively).
CONCLUSION:
According to the results of this study, electronic learning was more effective than booklet in enhancing the learning and retention of knowledge. Electronic learning is suggested as a more suitable method as it provides appropriate interactions and attractive virtual environments to motivate the learners and promote retention.

via Comparing nurses’ knowledge retention following electronic continuous education and educational booklet: a controlled trial study. – PubMed – NCBI.

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MANUSCRIPT: Blended learning: how can we optimise undergraduate student engagement?

BACKGROUND:
Blended learning is a combination of online and face-to-face learning and is increasingly of interest for use in undergraduate medical education. It has been used to teach clinical post-graduate students pharmacology but needs evaluation for its use in teaching pharmacology to undergraduate medical students, which represent a different group of students with different learning needs.
METHODS:
An existing BSc-level module on neuropharmacology was redesigned using the Blended Learning Design Tool (BLEnDT), a tool which uses learning domains (psychomotor, cognitive and affective) to classify learning outcomes into those taught best by self-directed learning (online) or by collaborative learning (face-to-face). Two online courses were developed, one on Neurotransmitters and the other on Neurodegenerative Conditions. These were supported with face-to-face tutorials. Undergraduate students’ engagement with blended learning was explored by the means of three focus groups, the data from which were analysed thematically.
RESULTS:
Five major themes emerged from the data 1) Purpose and Acceptability 2) Structure, Focus and Consolidation 3) Preparation and workload 4) Engagement with e-learning component 5) Future Medical Education.
CONCLUSION:
Blended learning was acceptable and of interest to undergraduate students learning this subject. They expressed a desire for more blended learning in their courses, but only if it was highly structured, of high quality and supported by tutorials. Students identified that the ‘blend’ was beneficial rather than purely online learning.

via Blended learning: how can we optimise undergraduate student engagement? – PubMed – NCBI.

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MANUSCRIPT: What Are We Looking for in Computer-Based Learning Interventions in Medical Education? A Systematic Review

BACKGROUND:
Computer-based learning (CBL) has been widely used in medical education, and reports regarding its usage and effectiveness have ranged broadly. Most work has been done on the effectiveness of CBL approaches versus traditional methods, and little has been done on the comparative effects of CBL versus CBL methodologies. These findings urged other authors to recommend such studies in hopes of improving knowledge about which CBL methods work best in which settings.
OBJECTIVE:
In this systematic review, we aimed to characterize recent studies of the development of software platforms and interventions in medical education, search for common points among studies, and assess whether recommendations for CBL research are being taken into consideration.
METHODS:
We conducted a systematic review of the literature published from 2003 through 2013. We included studies written in English, specifically in medical education, regarding either the development of instructional software or interventions using instructional software, during training or practice, that reported learner attitudes, satisfaction, knowledge, skills, or software usage. We conducted 2 latent class analyses to group articles according to platform features and intervention characteristics. In addition, we analyzed references and citations for abstracted articles.
RESULTS:
We analyzed 251 articles. The number of publications rose over time, and they encompassed most medical disciplines, learning settings, and training levels, totaling 25 different platforms specifically for medical education. We uncovered 4 latent classes for educational software, characteristically making use of multimedia (115/251, 45.8%), text (64/251, 25.5%), Web conferencing (54/251, 21.5%), and instructional design principles (18/251, 7.2%). We found 3 classes for intervention outcomes: knowledge and attitudes (175/212, 82.6%), knowledge, attitudes, and skills (11.8%), and online activity (12/212, 5.7%). About a quarter of the articles (58/227, 25.6%) did not hold references or citations in common with other articles. The number of common references and citations increased in articles reporting instructional design principles (P=.03), articles measuring online activities (P=.01), and articles citing a review by Cook and colleagues on CBL (P=.04). There was an association between number of citations and studies comparing CBL versus CBL, independent of publication date (P=.02).
CONCLUSIONS:
Studies in this field vary highly, and a high number of software systems are being developed. It seems that past recommendations regarding CBL interventions are being taken into consideration. A move into a more student-centered model, a focus on implementing reusable software platforms for specific learning contexts, and the analysis of online activity to track and predict outcomes are relevant areas for future research in this field.

via What Are We Looking for in Computer-Based Learning Interventions in Medical Education? A Systematic Review. – PubMed – NCBI.

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MANUSCRIPT: Web-Based Immersive Virtual Patient Simulators: Positive Effect on Clinical Reasoning in Medical Education

BACKGROUND:
Clinical reasoning is based on the declarative and procedural knowledge of workflows in clinical medicine. Educational approaches such as problem-based learning or mannequin simulators support learning of procedural knowledge. Immersive patient simulators (IPSs) go one step further as they allow an illusionary immersion into a synthetic world. Students can freely navigate an avatar through a three-dimensional environment, interact with the virtual surroundings, and treat virtual patients. By playful learning with IPS, medical workflows can be repetitively trained and internalized. As there are only a few university-driven IPS with a profound amount of medical knowledge available, we developed a university-based IPS framework. Our simulator is free to use and combines a high degree of immersion with in-depth medical content. By adding disease-specific content modules, the simulator framework can be expanded depending on the curricular demands. However, these new educational tools compete with the traditional teaching
OBJECTIVE:
It was our aim to develop an educational content module that teaches clinical and therapeutic workflows in surgical oncology. Furthermore, we wanted to examine how the use of this module affects student performance.
METHODS:
The new module was based on the declarative and procedural learning targets of the official German medical examination regulations. The module was added to our custom-made IPS named ALICE (Artificial Learning Interface for Clinical Education). ALICE was evaluated on 62 third-year students.
RESULTS:
Students showed a high degree of motivation when using the simulator as most of them had fun using it. ALICE showed positive impact on clinical reasoning as there was a significant improvement in determining the correct therapy after using the simulator. ALICE positively impacted the rise in declarative knowledge as there was improvement in answering multiple-choice questions before and after simulator use.
CONCLUSIONS:
ALICE has a positive effect on knowledge gain and raises students’ motivation. It is a suitable tool for supporting clinical education in the blended learning context.

via Web-Based Immersive Virtual Patient Simulators: Positive Effect on Clinical Reasoning in Medical Education. – PubMed – NCBI.

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ABSTRACT: A collaborative strategy to improve geriatric medical education

INTRODUCTION:
Age-related demographic change is not being matched by a growth in relevant undergraduate medical education, in particular communication skills pertinent to elderly patients. To address this, a workshop for medical students focusing on important communication skills techniques for interacting with patients with dementia was designed by clinicians from the Geriatric, General Practice and Psychiatry departments at the University of Oxford.
METHODS:
One hundred and forty-four first-year clinical students (Year 4 of the 6-year course; Year 2 of the 4-year graduate-entry course) attended the teaching. One hundred and twenty-nine students returned feedback forms with 104 forms matched for individual performance before and after the session. Feedback forms assessed student-perceived confidence in communicating with patients with dementia before and after the session using a 4-point Likert scale with corresponding numerical value (low (1), medium (2), high (3), very high (4)).
RESULTS:
Using the Wilcoxon Signed-Rank Test on the 104 matched forms, student-perceived confidence was higher post-teaching intervention (median = 2.75) than pre-intervention (median = 1.50). This difference was statistically significant with large effect size, Z = -8.47, P < 0.001, r = -0.59. Free-text comments focused on non-verbal communication skills teaching, suggesting that these sessions were most beneficial for topics hardest to teach in lecture-based approaches.
CONCLUSION:
The teaching aimed to promote patient-centred care and multidisciplinary collaborative practice, encourage student self-reflection and peer-assisted education and provide insight into the needs of patients with dementia. Student feedback indicated that these objectives had been met. This easily replicable teaching method provides a simple means of improving communication skills.

via A collaborative strategy to improve geriatric medical education. – PubMed – NCBI.

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ABSTRACT: Training Requirements and Curriculum Content for Primary Care Providers Delivering Preventive Oral Health Services to Children Enrolled in Medicaid

Training Requirements and Curriculum Content for Primary Care Providers Delivering Preventive Oral Health Services to Children Enrolled in Medicaid

via Training Requirements and Curriculum Content for Primary Care Providers Delivering Preventive Oral Health Services to Children Enrolled in Medicaid. – PubMed – NCBI.

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MANUSCRIPT: Ultrasound and stethoscope as tools in medical education and practice: considerations for the archives

OBJECTIVES:
In recent years, the use and portability of ultrasound has threatened the utility of the stethoscope, with many debating and even advocating its replacement. The authors set out to assess opinions in this regard among faculty within a medical school and specifically within an anatomy department where ultrasound is incorporated into the curriculum from the first term.
METHODS:
A debate was elicited during a biweekly Anatomy Journal Club session and was centered on three published papers presented. Several questions were raised regarding the possible replacement of stethoscope – the value of early exposure to students as well as how ultrasound and stethoscope should be considered by physicians, students, and teachers.
RESULTS:
The general consensus was that the stethoscope should not be replaced but should be used in conjunction with emerging portable ultrasound. Caution was given that technology could “overcomplicate” diagnosis and lead to increased tests resulting in increased cost of care. In terms of exposing students to ultrasound, just as the stethoscope requires practice to use effectively, so does the ultrasound and should be introduced as early on as possible. As is the case with the stethoscope, students may not initially appreciate all the finer details on ultrasound; however, continual use would improve skill.
CONCLUSION:
The stethoscope should always remain part of the physical examination and ultrasound should be used in addition to, not replacement of. As technology advances the need for apprenticeship, training increases and students of the medical profession should be exposed to these technologies as early as possible. Hence, it is not yet time to archive the stethoscope. Perhaps never.

via Ultrasound and stethoscope as tools in medical education and practice: considerations for the archives. – PubMed – NCBI.

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ABSTRACT: Acquisition and Long-term Retention of Bedside Ultrasound Skills in First-Year Medical Students

OBJECTIVES:
The purpose of this study was to assess bedside ultrasound skill acquisition and retention in medical students after completion of the first year of a new undergraduate bedside ultrasound curriculum at McGill University.
METHODS:
Skill acquisition was assessed in first-year medical students (n = 195) on completion of their bedside ultrasound instruction. Instruction included 6 clinically based 60-minute practical teaching sessions evenly spaced throughout the academic year. Students’ ability to meet course objectives was measured according to a 4-point Likert rating scale. Evaluations were performed by both instructors and the students themselves. Retention of skill acquisition was evaluated 8 months later on a year-end practical examination.
RESULTS:
The mean percentage ± SD of students assigned a rating of “strongly agree” or “agree” by instructors was 98% ± 0.4% for all 6 teaching sessions (strongly agree, 52% ± 3%; agree, 46% ± 3%). According to student self-evaluations, the mean percentage of students assigned a rating of strongly agree was significantly greater than the percentage assigned by instructors for all teaching sessions (86% ± 2% versus 52% ± 3%; P< .0005). Evaluation of skill retention on the year-end examination showed that 91% ± 2% of students were assigned a rating of strongly agree or agree for their ability to demonstrate skills learned 8 months previously. Ninety-five percent of students reported that bedside ultrasound improved their understanding of anatomy for all 6 teaching sessions (mean, 95% ± 0.01%).
CONCLUSIONS:
These results demonstrate that first-year medical students show acquisition and long-term retention of basic ultrasound skills on completion of newly implemented bedside ultrasound instruction.

via Acquisition and Long-term Retention of Bedside Ultrasound Skills in First-Year Medical Students. – PubMed – NCBI.

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