护理专业学生自主学习现状及其影响因素调查

目的探讨护理专业学生的自主学习现状及其影响因素。方法以624名护理专业本专科生为研究对象,运用一般资料调查表、自主学习等级评定量表收集资料。结果护理专业学生的自主学习总分为(223.58±29.86)分,总分及各维度得分率均在70%以上;95.83%的学生表示对"自主学习"了解很少,女生自主学习总分高于男生,一年级高于二年级,高职学生高于本科学生(P<0.05,P<0.01)。学习资源、学习动机、小组学习和学习习惯均为自主学习的重要预测指标(均P<0.01),能够解释总体变异度的59%。结论护理专业学生自主学习总体状况较好,但不同性别、年级、学历层次学生间存在一定差异。学校应指导学生明确学习动机,有效利用学习资源,通过养成良好的学习习惯,参与小组学习等方式进行有效的自主学习。     

Robot‐assisted radical prostatectomy: learning rate analysis as an objective measure of the acquisition of surgical skill

Study Type – Therapy (case series)
Level of Evidence 4

OBJECTIVE

To adapt an industrial definition of learning‐curve analysis to surgical learning, and elucidate the rate at which experienced open surgeons acquire skills specific to robot‐assisted radical prostatectomy (RARP) at a community‐based medical centre.

PATIENTS, SUBJECTS AND METHODS

The total procedure time (TPT) of the first 75 RARPs, performed by three surgeons experienced with retropubic RP, was analysed to determine the point at which their learning rate stabilised. Operative characteristics were compared before and after this point to isolate the plateau of learning rate as a mark of acquiring surgical skill. The operative characteristics examined were TPT, estimated blood loss (EBL), bladder neck contractures (BNC), positive margins (PM) and length of hospital stay (LOS).

RESULTS

The mean rate of TPT decrease, for procedures 1–75, was 13.4% per doubling of RARPs performed. After the first 25 procedures the TPT decreased at a rate of 1.8% per doubling, not significantly different from 0 (P > 0.05). There was no significant difference between procedures 1–25 and 26–75 in rates of EBL, BNC and PM. There was a significant change for all surgeons in TPT, with a mean of 303.1 min (RARPs 1–25) vs 213.6 min (26–75) (P < 0.001), and LOS, of 2.1 days (1–25) vs 1.4 days (26–75) (P < 0.001).

CONCLUSIONS

An industrial definition of learning‐curve analysis can be adapted to provide an objective measure of learning RARP. The average learning rate for RARP was found to plateau by the 25th procedure. Also, the learning rate plateau can serve as an objective measure of the acquisition of surgical skill.     

Proposed model of case based learning for training undergraduate medical student in surgery

Background  

Systematic surveys of undergraduate medical education have cautiously supported the outcomes of Problem Based Learning (PBL) compared with traditional learning. This article provides a critical overview of PBL, its limitations in the developing country scenario and our proposed model of PBL triggered by Real cases, to address these limitations.     

Machine learning in orthopaedic surgery

Artificial intelligence and machine learning in orthopaedic surgery has gained mass interest over the last decade or so. In prior studies, researchers have demonstrated that machine learning in orthopaedics can be used for different applications such as fracture detection, bone tumor diagnosis, detecting hip implant mechanical loosening, and grading osteoarthritis. As time goes on, the utility of artificial intelligence and machine learning algorithms, such as deep learning, continues to grow and expand in orthopaedic surgery. The purpose of this review is to provide an understanding of the concepts of machine learning and a background of current and future orthopaedic applications of machine learning in risk assessment, outcomes assessment, imaging, and basic science fields. In most cases, machine learning has proven to be just as effective, if not more effective, than prior methods such as logistic regression in assessment and prediction. With the help of deep learning algorithms, such as artificial neural networks and convolutional neural networks, artificial intelligence in orthopaedics has been able to improve diagnostic accuracy and speed, flag the most critical and urgent patients for immediate attention, reduce the amount of human error, reduce the strain on medical professionals, and improve care. Because machine learning has shown diagnostic and prognostic uses in orthopaedic surgery, physicians should continue to research these techniques and be trained to use these methods effectively in order to improve orthopaedic treatment.     

Delivering trauma mastery with an international trauma masters

IntroductionTrauma is a global problem. The goal of optimising multidisciplinary trauma care through speciality education is a challenge. No single pathway exists to educate care providers in trauma knowledge, management and skills.Queen Mary University of London (QMUL) devised an online electronic learning (e-learning) Master’s degree (MSc) in Trauma Sciences in 2011. E-learning is increasingly popular however low progression rates question effectiveness. The further post-graduate impact is unknown.Our goal was to establish whether this program is a successful method of delivering multidisciplinary trauma education to an international community. We hypothesized that graduating students make a global impact in trauma care, education and research.MethodsThe Trauma Sciences MSc programs launched in 2011. Electronic surveys were distributed worldwide to students who successfully completed the program between 2013–2016. Graduation rates, degree/qualification awarded, clinical involvement in trauma management, presentation of MSc work, academic progression and roles in trauma education were explored. Supporting demographics were extracted from the QMUL student database.ResultsA total of 176 students, of 29 nationalities, enrolled in the two year course between 2011 and 2014. Clinical backgrounds included multi-speciality physicians (83.5%), nurses (9.6%) and paramedics (6.8%). 119 (67.6%) graduated within the study period, 108 (60.8%) with the full masters award. Completion was independent of clinical background (p = 0.20) and age (p = 0.99). Highest completion rates were seen in students from Australia and New Zealand, Asia and Europe (p = 0.03).All survey responders were currently providing regular clinical care to trauma patients. 73% (n = 36) were delivering trauma education, many at national or international level. 49% (n = 24) had presented work from the MSc and 23% (n = 11) published their dissertation.12% (n = 6) subsequently enrolled in a PhD program.ConclusionCompared with other e-learning courses this Masters program has an enviable completion rate. Graduates go on to make an international multidisciplinary impact with diverse roles in clinical management, research and trauma education.This programme provides a robust trauma education curriculum. The QMUL Trauma Sciences MSc program is an excellent resource for clinicians participating in any form of trauma care or who wish to augment sub-speciality training in trauma.     

直观教学法在口腔正畸教学中的应用

目的:研究直观教学法在口腔正畸教学中的应用及其效果。方法:以佛山科学技术学院口腔医学专业大四学生80人作为研究对象,随机分为实验组和对照组各40人,实验组采取直观教学法,对照组采取传统教学法。以理论考试和调查问卷的方式对两组的教学效果进行评估。结果:实验组理论成绩为(84.5±4.0)分,高于对照组的(73.5±6.5)分,差异具有统计学意义(P<0.05)。调查问卷结果显示95%的学生对直观教学法满意。结论:在口腔正畸学教学中采用直观教学法提高了学生分析问题的能力,培养了临床思维,加强了理论与临床结合的能力,取得了满意的教学效果,值得在口腔正畸教学中推广。     

Two case studies in the application of errorless learning techniques in memory impaired patients with additional executive deficits

Primary objective: The purpose of the present study was to examine in what extent errorless learning can be applied to amnesic patients with additional executive dysfunction.

Research design: Two case studies were used in which two patients with severe closed head-injury were compared according to their different neuropsychological profiles.

Methods and procedures: Patients were taught complex semantic information about their therapists and cognitive procedures needed to programme an electronic organizer.

Main outcomes and results: Both semantic and procedural results suggest that the errorless method can be very helpful for teaching complex new knowledge to amnesic patients with mild executive impairment, whereas the presence of a dysexecutive syndrome may hamper the success of this form of memory rehabilitation.

Conclusions: The present study puts forward that executive deficits should be taken into account when neuropsychologists are planning to use errorless techniques.     

A systematic review of machine learning and automation in burn wound evaluation: A promising but developing frontier

BackgroundVisual evaluation is the most common method of evaluating burn wounds. Its subjective nature can lead to inaccurate diagnoses and inappropriate burn center referrals. Machine learning may provide an objective solution. The objective of this study is to summarize the literature on ML in burn wound evaluation.MethodsA systematic review of articles published between January 2000 and January 2021 was performed using PubMed and MEDLINE (OVID). Articles reporting on ML or automation to evaluate burn wounds were included. Keywords included burns, machine/deep learning, artificial intelligence, burn classification technology, and mobile applications. Data were extracted on study design, method of data acquisition, machine learning techniques, and machine learning accuracy.ResultsThirty articles were included. Nine studies used machine learning and automation to estimate percent total body surface area (%TBSA) burned, 4 calculated fluid estimations, 19 estimated burn depth, 5 estimated need for surgery, and 2 evaluated scarring. Models calculating %TBSA burned demonstrated accuracies comparable to or better than paper methods. Burn depth classification models achieved accuracies of >83%.ConclusionMachine learning provides an objective adjunct that may improve diagnostic accuracy in evaluating burn wound severity. Existing models remain in the early stages with future studies needed to assess their clinical feasibility.     

以问题为基础的教学模式与讲授式教学模式在骨科医学影像学教学中的效果对比

目的 探讨以问题为基础的教学模式（problem based learning, PBL）在骨科影像学教学中的应用效果。方法 选择2016级5年制影像学专业参加我院放射科实习的106名学生作为研究对象,利用随机数字表分为两组（每组53名）,研究组采用PBL教学,对照组采用讲授式教学模式（lecture based learning, LBL）教学。以理论考试、技能测评和问卷调查方式对教学效果进行评价。结果 研究组读片技能测评成绩、总成绩［（40.57±6.58）分、（76.46±13.54）分］高于对照组［（37.01±7.67）分、（71.67±11.75）分］,差异均有统计学意义（P均＜0.05）;而两组理论考试成绩［（35.89±9.51）分 vs. （34.66±10.17）分］的差异无统计学意义（P＞0.05）。研究组在培养团队协作能力和影像诊断思维、提高主动学习能力和临床解决问题的能力以及总体满意情况方面均高于对照组,差异均有统计学意义（P均＜0.05）,而有助于知识点的记忆的差异无统计学意义（P＞0.05）。结论 PBL教学模式在骨科影像学的教学过程中应用效果较好,可以在医学影像学的教学中进一步推广应用。     

Implementation of a flipped classroom approach to promote active learning in the third-year surgery clerkship

Background

Constructivist student-centered instructional models such as the flipped classroom (FC) have been shown to improve learning.

Regional brain activation during concurrent implicit and explicit sequence learning

We used event-related fMRI to identify the brain regions engaged during explicit and implicit sequence learning (ESL and ISL, respectively). Twenty-four subjects performed a concurrent ESL and ISL task. Behavior showed learning in both conditions. Prefrontal (PFC), striatal, anterior cingulate cortex (ACC) and visual regions (V1, V2 and V3) were engaged during both ESL and ISL. With ESL there was increased activity in the visual regions on the predictable (i.e. learned pattern) trials. With ISL, however, there was a relative decrease in activity in visual regions. The opposite patterns in the visual regions highlight the different effects of ESL and ISL. The learning process was distinguished from the result of learning, by fitting subjects' functional magnetic resonance imaging data to their learning curve. This analysis revealed more extensive PFC activity during ESL and caudal ACC activity specific for the result of learning analysis, when the expected response was violated. Our results suggest a relative dissociation of the brain regions engaged during ESL and ISL, whereby ESL and ISL can be viewed as partially distinct but overlapping parallel processes.     

A Data-Driven Random Subfeature Ensemble Learning Algorithm for Weather Forecasting

In this paper, the RSEL (Random Subfeature Ensemble Learning) algorithm is proposed to improve the forecast results of weather forecasting. Based on the classical machine learning algorithms, RSEL algorithm integrates random subfeature selection and ensemble learning combination strategy to enhance the diversity of the features and avoid the influence of a small number of unstable outliers generated randomly. Furthermore, the feature engineering schemes are designed for the weather forecast data to make full use of spatial or temporal context. RSEL algorithm is tested by forecasting the wind speed and direction, and it improves the forecast accuracy of traditional methods and has good robustness.     

护生自导学习技能与学习成绩的相关性研究

目的了解在校大专护生各年级自导学习技能状况及其与学习成绩的相关性 ,从而揭示培养在校护生自导学习技能的重要性。方法采用自导学习技能量表对一、二年级共 398人进行调查 ,并将公共课、专业基础课和专业课的各平均成绩和总平均成绩作为学习成绩考核的指标。结果一、二年级在校护生的自导学习技能各方面及总分处于一般偏强水平 ,二年级的自导学习技能各方面及整体技能与学习成绩呈显著正相关 (P <0 .0 5 ,P <0 .0 1)。结论为了提高在校护生学习成绩 ,必须加强护生自导学习技能的训练。     

以问题为基础的学习联合以案例为基础的学习在脊柱外科实习生临床带教中的应用

目的 探讨以问题为基础的学习（problem-based learning,PBL）联合以案例为基础的学习（case-based learning,CBL）在脊柱外科医学生带教中的教学意义及优势。方法 选取2021年3月至2021年9月在我院脊柱外科实习的53名2017级本科生,随机将其分为传统教学组（简称传统组,28例）和教学方法联合组（简称联合组,25例）进行实习带教,其中传统组男15人,女13人,年龄为（22.04±0.58）岁。联合组男13人,女12人,年龄为（22.36±0.64）岁。实习结束后通过出科考核的方式对学生理论知识及临床实践能力进行考核。同时派发问卷调查,评价老师教学水平及对课程设计满意情况。结果 联合组理论知识及临床实践能力均优于传统组,两组间差异有统计学意义（P＜0.05）。另外,从学生反馈来看,联合组学生对老师教学形式及课程设计的满意度更高。结论 教学方法的组合更有利于调动学生主观能动性及主动学习的积极性,培养学习兴趣,提高学习效率。从而更好地掌握脊柱外科专业知识及临床技能,提高本科生及规培生培养质量。