LBL联合PBL教学法在ICU专科护士培训中的应用

[目的]探讨以问题为基础的学习法（problem based learning,PBL）联合传统教学法（lecture based learning,LBL）在ICU专科护士培训中的教学效果。[方法]对2010年1月-2011年12月在我院重症监护专业护士培训基地进行重症监护病房（ICU）专科培动I的护士85名采用LBI,联合PBL教学法,比较分析培训前后在理论考核、专科技能操作考核及综合能力方面的差异。[结果]采用PBI。与LBL联合教学法使护士在理论考核、专科技能操作考核和综合能力方面都有了提高。[结论]PBL与LBL联合教学法应用于ICU专科护士的临床培训中可有效帮助ICU护士学习,提高ICU专科护士培养的质量。     

PBL联合CBL教学法在新护士岗前培训中的应用

目的探究以问题为基础的学习(problem-based learning,PBL)教学法联合以案例为导向的学习(case-based learning,CBL)教学法在新护士岗前培训中的应用及其效果。方法采用非平行对照方法,选取2013年7月~2014年12月期间接受岗前培训的80名新护士为对照组,采用传统教学方法;选取2014年7月~2015年12月期间接受岗前培训的80名新护士为观察组,采用PBL联合CBL教学法培训。比较两组不同教学方法的教学效果差异。结果观察组护士对相应授课方式的接受程度和学习兴趣都明显优于对照组(P0.05)。观察组护士在接受相应授课方式后的操作成绩、临床能力和临床实践能力测试成绩都明显优于对照组(P0.05)。结论 PBL联合CBL教学法,有利于新护士尽快掌握岗前培训知识,并将其运用于临床护理工作。     

PBL法在临床骨科护理见习教学中的应用

在骨科临床护理见习教学中，选取160名本科见习学生，随机分为两组。PBL组进行以问题为基础的学习（PBL），LBL组采用传统的以授课为基础（LBL）的教学法。结果PBL组理论学习成绩显著优于LBL组（P〈0．05），PBL组的问卷调查满意率也高于LBL组，表明在骨科临床护理见习教学中PBL法优于LBL法。     

综合PBL教学法在临床免疫学课程教学中的改革探索

目的 为提高临床免疫学教学质量,将"基于问题的学习(PBL)"教学模式与传统教学模式(LBL)和综合讨论PBL教学法相结合,研究新方法在临床免疫学教学中的作用.方法 选取90名2009级医学检验系学生,对结合综合讨论的PBL教学法与单纯PBL教学法及LBL教学法进行对比研究,课程结束后采用统一试卷进行考试以评价教学效果,并对学生进行问卷调查以评价学生的学习态度及学习动力.结果 结合综合讨论的PBL法试验组理论考试成绩显著优于PBL组及LBL组,PBL组与LBL组考试成绩差异无统计学意义,而前两者学生学习态度及学习动力明显好于LBL组.结论 结合综合讨论的PBL教学法在医学免疫学理论教学中优于单纯PBL法和LBL教学法,值得进一步研究和推广.     

PBL、CBL、TBL相结合教学模式在眼科护士培训中的应用

目的探讨PBL、CBL、TBL三种教学模式相结合在眼科护士科内培训中的应用效果。方法将某三级甲等综合性医院眼科的14名护理人员随机分为对照组6名和观察组8名,分别采用LBL教学法和TBL、PBL、CBL三种相结合的教学方法进行为期3个月的培训,培训结束后进行笔试和操作考核,并对学员进行教学效果调查。结果观察组学员笔试和操作考核成绩均显著高于对照组,差异均有统计学意义（P〈0.05）;通过课程体验调查,“评价合适”维度差异无统计学意义（P〉0．05）,“学习负担合适”维度对照组得分高于观察组（P〈0．05）,其余各项指标评价观察组均优于对照组,差异均有统计学意义（P〈0．05）。结论TBL、PBL、CBL结合的教学模式更能有效激发学习激情,增强学员沟通交流和临床实践能力。     

两种教学模式结合在检验核医学教学中的应用

为了提高检验核医学的教学水平,改变传统的教学模式积弊,本文采用了以问题为基础的学习（PBL ）与以讲义教材为导向的教学（LBL ）相结合教学模式,其中PBL教学法主要用于课前预习,LBL教学法主要用于课堂教学。通过采用这种新教学模式,使教学质量更上一层楼,取得较好的教学效果。     

导师制联合PBL教学法在新护士规范化培训中的应用

目的 评价采用“一对一护理导师制”联合“PBL教学法”培训新护士的成效。方法 将2009年招聘的75名新毕业护士作为观察组，采用“一对一护理导师制”联合“PBL教学法”进行培训。将2008年招聘的62名新毕业护士作为对照组，仅采用“一对一护理导师制”进行培训。比较2组培训结果。结果 观察组的培训结果要明显优于对照组。结论 采用“一对一护理导师制”联合“PBL教学法”培训新护士成效可靠，值得在基层医院推广。     

PBL教学法在手术室新护士基础教学培训中的应用

目的：探讨新护士入科后的基础培训方式,以提高教学质量。方法：将以问题为基础的教学法（PBL）应用于12名手术室新护士的基础教学。结果：PBL教学法能发挥新护士的主动性和创造性,提高解决实际问题和自主学习的能力,达到临床轮转良性循环。结论：PBL教学法改变了传统教学模式,提高了新护士的参与意识,激发了学习兴趣和求知欲,拓展了知识深度和广度,提高了思维能力。     

PBL结合LBL教学法在骨科护理临床教学中的应用

目的 探讨基于问题的学习(PBL)教学模式结合传统教学模式(LBL)对提高骨科临床实习的护理学生教学质量的作用.方法 选取90名2008～2009年度在骨科临床实习的学生作为研究对象,进行PBL结合LBL教学法与单纯PBL 教学法及LBL教学法进行对比研究,课程结束后采用统一试卷进行考试以评价教学效果,并对实验组学生进行问卷调查以评价学生的学习态度及学习动力.结果 PBL结合LBL教学法实验组考试成绩显著优于PBL组及LBL组,PBL组与LBL组考试成绩差异无显著性,且绝大部分实验组学生认为PBL结合LBL教学法能树立良好学习态度及激发学习动力.结论 PBL结合LBL教学法既可运用传统教学法将基础知识传授给学生,又可用PBL教学法培养学生独立思考、协调合作、运用知识和解决问题的能力,充分发挥了各自教学方法的特长,从而提高教学质量.     

PBL结合LBL教学法在骨科护理临床教学中的应用

目的 探讨基于问题的学习(PBL)教学模式结合传统教学模式(LBL)对提高骨科临床实习的护理学生教学质量的作用.方法 选取90名2008～2009年度在骨科临床实习的学生作为研究对象,进行PBL结合LBL教学法与单纯PBL 教学法及LBL教学法进行对比研究,课程结束后采用统一试卷进行考试以评价教学效果,并对实验组学生进行问卷调查以评价学生的学习态度及学习动力.结果 PBL结合LBL教学法实验组考试成绩显著优于PBL组及LBL组,PBL组与LBL组考试成绩差异无显著性,且绝大部分实验组学生认为PBL结合LBL教学法能树立良好学习态度及激发学习动力.结论 PBL结合LBL教学法既可运用传统教学法将基础知识传授给学生,又可用PBL教学法培养学生独立思考、协调合作、运用知识和解决问题的能力,充分发挥了各自教学方法的特长,从而提高教学质量.     

The approaches to learning of student nurses in the Republic of Ireland and Northern Ireland

The approaches to learning of student nurses in the Republic of Ireland and Northern Ireland In recent years during a period of change in nurse education, there has been an increased interest in educational theory and nurse educators have examined and questioned the fundamental principles upon which the system of education is constructed. In nurse education it is likely that no single theory of learning can account for all aspects of learning and there are reflections of many learning theories in the nursing curriculum. The literature in the area of student learning is complex and wide ranging and is poorly represented in the nurse education literature. In recognition of a lack of understanding and clarity on learning approaches in nurse education during a period of unprecedented change in Irish and United Kingdom (UK) nurse education, this paper aims to highlight the importance of understanding student nurse learning. A study is described which investigated the approaches to learning of student nurses from the Republic of Ireland, who were receiving a traditional apprenticeship training, and student nurses from Northern Ireland in a Project 2000 programme. On comparative statistical analysis significant differences were identified between the two groups in their approaches to learning. It is concluded that students' constructs of learning in nurse education are primarily dependent on their interpretation of the demands of the task, on assessment, teaching and the learning environment. The study provides nurse educationalists with important evaluative information from the students' perspective. It suggests that the way forward is to identify the significant contextual factors influencing student learning and to incorporate them into the nursing curriculum. Such an approach will serve to focus the system on variability in the quality of learning rather than on stability in human attributes.     

Informal interprofessional learning: an untapped opportunity for learning and change within the workplace

Abstract

In this paper, we explore the educational and workplace learning literature to identify the potential and significance for informal interprofessional learning within the workplace. We also examine theoretical perspectives informing informal workplace interprofessional learning. Despite numerous studies focusing on formal interprofessional education programs, we suggest that informal interprofessional learning opportunities are currently unrealized. We highlight reasons for a focus on learning within the workplace and the potential benefits within an interprofessional context.     

Use of Individualized Learning Plans to Facilitate Feedback Among Medical Students

Abstract

Theory

Self-regulated learning theory suggests that individualized learning plans can benefit medical trainees by providing a structured means of goal setting, self-monitoring, and self-evaluation. External feedback also plays an important role in affecting learner motivations, perceptions, and self-evaluations. Accordingly, having learners share individualized learning plans with preceptors might promote self-regulated learning by helping align the feedback they receive with their learning goals. Hypothesis: We hypothesized having medical students share individualized learning plans with attendings and residents would improve the quality of the feedback they received, increase the likelihood that feedback correlated to their learning goals, and improve their perceptions of feedback received. Method: In this multisite study, third-year medical students on their pediatric clerkship created individualized learning plans and shared them with residents and attendings by writing a learning goal on at least one of their required faculty feedback forms. The quality of feedback on forms with versus without a learning goal written on top was scored using a validated scoring tool and compared using a Wilcoxon signed-ranks test, and the frequency with which feedback directly correlated to a student learning goal on forms with versus without a learning goal written on top was compared using a chi-square test. Students completed a post-clerkship survey rating the quality of feedback and teaching they received, perceptions of the individualized learning plans, progress toward achieving learning goals, and whether or not they received teaching and/or feedback related to learning goals. Results: Thirty-six students completed a total of 108 learning goals and 181 feedback forms, of which 42 forms (23.2%) had a learning goal written on top. The mean (SD) feedback score between forms with [3.9 (0.9)] versus without [3.6 (0.6)] a learning goal written on top was not different (p = .113). Feedback on forms with a learning goal written on top was more likely to correlate to a student learning goal than feedback on forms without a learning goal (92.9% vs 23.0% respectively, p < .001). Student perceptions of the usefulness of learning goals did not differ between students who reported receiving teaching or feedback related to a learning goal and those who did not. Conclusions: Sharing individualized learning plans with preceptors helped align feedback with learning goals but did not affect the quality of feedback. Further research should examine the bidirectional relationship between individualized learning plans and feedback in light of other contextual and interpersonal factors.     

Local contrastive loss with pseudo-label based self-training for semi-supervised medical image segmentation

Supervised deep learning-based methods yield accurate results for medical image segmentation. However, they require large labeled datasets for this, and obtaining them is a laborious task that requires clinical expertise. Semi/self-supervised learning-based approaches address this limitation by exploiting unlabeled data along with limited annotated data. Recent self-supervised learning methods use contrastive loss to learn good global level representations from unlabeled images and achieve high performance in classification tasks on popular natural image datasets like ImageNet. In pixel-level prediction tasks such as segmentation, it is crucial to also learn good local level representations along with global representations to achieve better accuracy. However, the impact of the existing local contrastive loss-based methods remains limited for learning good local representations because similar and dissimilar local regions are defined based on random augmentations and spatial proximity; not based on the semantic label of local regions due to lack of large-scale expert annotations in the semi/self-supervised setting. In this paper, we propose a local contrastive loss to learn good pixel level features useful for segmentation by exploiting semantic label information obtained from pseudo-labels of unlabeled images alongside limited annotated images with ground truth (GT) labels. In particular, we define the proposed contrastive loss to encourage similar representations for the pixels that have the same pseudo-label/GT label while being dissimilar to the representation of pixels with different pseudo-label/GT label in the dataset. We perform pseudo-label based self-training and train the network by jointly optimizing the proposed contrastive loss on both labeled and unlabeled sets and segmentation loss on only the limited labeled set. We evaluated the proposed approach on three public medical datasets of cardiac and prostate anatomies, and obtain high segmentation performance with a limited labeled set of one or two 3D volumes. Extensive comparisons with the state-of-the-art semi-supervised and data augmentation methods and concurrent contrastive learning methods demonstrate the substantial improvement achieved by the proposed method. The code is made publicly available at https://github.com/krishnabits001/pseudo_label_contrastive_training.     

Friendship fosters learning: The importance of friendships in clinical practice

This paper reports on one of the key findings from a recent ethnographic study (Roberts, D., 2007. Friendships and the community of students: peer learning amongst a group of pre-registration student nurses. Unpublished PhD Thesis, University of Salford, UK) and aims to highlight the importance of friendships for student nurses in clinical practice. An interpretive ethnographic approach was taken in order to reveal the student experience during their pre registration programme. Data was collected using ethnographic interviewing (Sorrell, J.M., Redmond, G.M., 1995. Interviews in qualitative nursing research: differing approaches for ethnographic and phenomenological studies. Journal of Advanced Nursing 21, 1117–1122.) and participant observation. Within this paper I argue that student nurses exist on the edge of the community of practice (of the qualified staff) and therefore form their own parallel community where students are all seen as being in the same boat. In particular students use the friendships they develop in clinical practice to enable them to learn; developing an ‘ask anything’ culture where all students are perceived as valuable sources of knowledge. Furthermore, it appears that knowledge is contextually bound and not therefore linked to seniority, or length of time served on the course.     

自主学习及其在护理教育中的应用研究

在回顾自主学习思想起源、概念界定、模式、策略和测评的基础上,重点介绍自主学习在护理教育中的应用。     

Interprofessional learning at work: what spatial theory can tell us about workplace learning in an acute care ward

Abstract

It is widely recognized that every workplace potentially provides a rich source of learning. Studies focusing on health care contexts have shown that social interaction within and between professions is crucial in enabling professionals to learn through work, address problems and cope with challenges of clinical practice. While hospital environments are beginning to be understood in spatial terms, the links between space and interprofessional learning at work have not been explored. This paper draws on Lefebvre’s tri-partite theoretical framework of perceived, conceived and lived space to enrich understandings of interprofessional learning on an acute care ward in an Australian teaching hospital. Qualitative analysis was undertaken using data from observations of Registered Nurses at work and semi-structured interviews linked to observed events. The paper focuses on a ward round, the medical workroom and the Registrar’s room, comparing and contrasting the intended (conceived), practiced (perceived) and pedagogically experienced (lived) spatial dimensions. The paper concludes that spatial theory has much to offer understandings of interprofessional learning in work, and the features of work environments and daily practices that produce spaces that enable or constrain learning.     

High-Frequency Learning Goals: Using Self-Regulated Learning to Influence Day-to-Day Practice in Clinical Education

Problem: Although self-regulated learning (SRL) is considered a fundamental skill that must be developed in physician training, many programs of SRL utilize learning goals that are generated only at the beginning of learning experiences or are widely spaced apart in time. These goals are often not formally shared with those actually working with the learner in the clinical setting. Intervention: We developed a program of written, student-generated weekly learning goals in which students focused on processes of becoming better doctors for their patients. These goals were shared at the beginning of each week with students' clinical teams for feedback and incorporation into the work. Context: The weekly learning goals program was developed and implemented as part of a required 3rd-year neurology clerkship. At the end of each 4-week clerkship, students were asked to evaluate the program through an anonymous electronic survey utilizing quantitative and open-ended qualitative questions. Outcome: Seventy-six of 82 students completed the evaluation survey (93% response rate). Eighty-six percent reported that the weekly learning goals increased their awareness of their thoughts and actions. Seventy-eight percent reported that the learning goals helped to improve their clinical performance to some degree, and 57% reported that the learning goals increased their focus on patient care. Students described a greater sense of focus on self-assessment and accountability from their goals. Students often commented that engagement from attendings and residents regarding their goals was a key element for successful learning from their goals. Lessons Learned: Student-generated weekly learning goals on a neurology clerkship appear to be an effective method to operationalize SRL. For most students, the frequency of the goals allowed for close self-monitoring, and the act of sharing goals with the team opened a new avenue for dialogue between students and their supervisors.     

Distributed contrastive learning for medical image segmentation

Supervised deep learning needs a large amount of labeled data to achieve high performance. However, in medical imaging analysis, each site may only have a limited amount of data and labels, which makes learning ineffective. Federated learning (FL) can learn a shared model from decentralized data. But traditional FL requires fully-labeled data for training, which is very expensive to obtain. Self-supervised contrastive learning (CL) can learn from unlabeled data for pre-training, followed by fine-tuning with limited annotations. However, when adopting CL in FL, the limited data diversity on each site makes federated contrastive learning (FCL) ineffective. In this work, we propose two federated self-supervised learning frameworks for volumetric medical image segmentation with limited annotations. The first one features high accuracy and fits high-performance servers with high-speed connections. The second one features lower communication costs, suitable for mobile devices. In the first framework, features are exchanged during FCL to provide diverse contrastive data to each site for effective local CL while keeping raw data private. Global structural matching aligns local and remote features for a unified feature space among different sites. In the second framework, to reduce the communication cost for feature exchanging, we propose an optimized method FCLOpt that does not rely on negative samples. To reduce the communications of model download, we propose the predictive target network update (PTNU) that predicts the parameters of the target network. Based on PTNU, we propose the distance prediction (DP) to remove most of the uploads of the target network. Experiments on a cardiac MRI dataset show the proposed two frameworks substantially improve the segmentation and generalization performance compared with state-of-the-art techniques.     

Understanding the essential elements of work-based learning and its relevance to everyday clinical practice

williams c. (2010) Journal of Nursing Management  18, 624–632
Understanding the essential elements of work-based learning and its relevance to everyday clinical practice Aim To critically review the work-based learning literature and explore the implications of the findings for the development of work-based learning programmes. Background With NHS budgets under increasing pressure, and challenges to the impact of classroom-based learning on patient outcomes, work-based learning is likely to come under increased scrutiny as a potential solution. Evidence from higher education institutions suggests that work-based learning can improve practice, but in many cases it is perceived as little more than on-the-job training to perform tasks. Evaluation The CINAHL database was searched using the keywords work-based learning, work-place learning and practice-based learning. Those articles that had a focus on post-registration nursing were selected and critically reviewed. Key issues Using the review of the literature, three key issues were explored. Work-based learning has the potential to change practice. Learning how to learn and critical reflection are key features. For effective work-based learning nurses need to take control of their own learning, receive support to critically reflect on their practice and be empowered to make changes to that practice. Conclusions A critical review of the literature has identified essential considerations for the implementation of work-based learning. A change in culture from classroom to work-based learning requires careful planning and consideration of learning cultures. Implications for nursing management To enable effective work-based learning, nurse managers need to develop a learning culture in their workplace. They should ensure that skilled facilitation is provided to support staff with critical reflection and effecting changes in practice. Contribution to New Knowledge This paper has identified three key issues that need to be considered in the development of work-based learning programmes.