CASE-BASED TEACHING AND LEARNING EXPERIENCES

Case-based teaching and learning strategies can be utilized to assist advanced practice psychiatric nursing students in both obtaining requisite knowledge and enhancing clinical reasoning skills. We discuss the benefits of case-based learning in terms of how it (1) contributes to students' appropriate organization of information to be recalled later for use in clinical reasoning situations; (2) generates experiences that students would not otherwise have; (3) increases the visibility of students' clinical reasoning processes; and (4) enhances students' confidence. This article also explores three examples of case-based teaching and learning: use of written cases in a seminar; use of standardized patients in an assessment course; and utilization of web-based cases for learning assessment and intervention skills. Finally, we compare and contrast each of these methods in terms of their relative effectiveness in achieving each of the benefits.     

Virtual patients for assessment of clinical reasoning in nursing -- a pilot study

In different nursing programmes, one important learning outcome is clinical reasoning (CR) skills. However, to date, there is limited number of methods available for assessment of CR skills; especially for distance-based courses. This study investigates students' opinions about the feasibility of using Virtual Patients (VPs) for assessing CR in nursing education. VPs were introduced as an assessment tool in three different nursing courses at two universities, comprising 77 students in total. Students' overall acceptance of this assessment tool, including its applicability to the practise of nursing and the potential of VP-based assessment as a learning experience, were investigated using questionnaires. Course directors used the Web-SP system to assess students' interactions with VPs and their answers regarding diagnoses, caring procedures and their justifications. Students' found the VP cases to be realistic and engaging, and indicate a high level of acceptance for this assessment method. In addition, the students' indicated that VPs were good for practising their clinical skills, although some would prefer that the VP system be less "medical" and asked for more focus on nursing. Although most students supplied correct diagnoses and made adequate clinical decisions, there was a wide range in their ability to explain their clinical reasoning processes.     

案例式考核法在护理学基础实验教学中的应用

目的 探讨护理学基础实验考核方法和教学效果.方法 使用自编案例对学生进行实验考核,通过"职业素质、操作技能、团队协作、分析问题、沟通技能和理论知识"6个方面进行评价.考核后对学生进行问卷调查及分析.结果 绝大多数学生赞成案例式考核法,认为此法优于传统考核法.结论 改革后的护理学基础实验教学考核方法有利于提高护理专业学生的综合能力.     

Revitalization of clinical skills training at the University of the Western Cape

Most educational institutions that offer health related qualifications make use of clinical skills laboratories. These spaces are generally used for the demonstration and assessment of clinical skills. The purpose of this paper is to share our experiences related to the revitalization of skills training by introducing the skills lab method at the School of Nursing (SoN), University of the Western Cape (UWC). To accommodate the contextual changes as a result of the restructuring of the higher education landscape in 2003, the clinical skills training programme at UWC had to be reviewed. With a dramatic increase in the student numbers and a reduction in hospital beds, the skills lab method provided students with an opportunity to develop clinical skills prior to their placement in real service settings. The design phase centred on adopting a skills training methodology that articulates with the case-based approach used by the SoN. Kolb's, experiential learning cycle provided the theoretical underpinning for the methodology. The planning phase was spent on the development of resources. Eight staff members were trained by our international higher education collaborators who also facilitated the training of clinical supervisors and simulated patients. The physical space had to be redesigned to accommodate audio visual and information technology to support the phases of the skills lab method. The implementation of the skills lab method was phased in from the first-year level. An interactive seminar held after the first year of implementation provided feedback from all the role players and was mostly positive. The results of introducing the skills lab method include: a move by students towards self-directed clinical skills development, clinical supervisors adopting the role of facilitators of learning and experiential clinical learning being based on, amongst others, the students' engagement with simulated patients. Finally, the recommendations relate to tailor-making clinical skills training by using various aspects of teaching and learning principles, i.e. case-based teaching, experiential learning and the skills lab method.     

Effects of unfolding case-based learning on academic achievement,critical thinking,and self-confidence in undergraduate nursing students learning health assessment skills

AimTo determine whether using unfolding case-based learning for undergraduate nursing students learning health assessment skills enhanced academic achievement, critical thinking and self-confidence, in comparison to traditional learning methods.BackgroundUnfolding case-based learning is an effective strategy for nursing students to narrow the gap between classroom learning and clinical practice. Little is known about whether unfolding case-based learning can be applied effectively in learning health assessment skills for undergraduate nursing students in China.MethodsA quasi-experimental design was used in this study. One hundred and fifteen undergraduate nursing students were recruited using convenience sampling from a medical university in southern China. They were assigned to an intervention group (n = 54) receiving unfolding case-based learning of health assessment skills, or a control group (n = 61) using traditional learning methods based on students’ choices. Learning outcomes were evaluated by students’ academic achievement, critical thinking and self-confidence. Data for critical thinking and self-confidence were collected before and after using the teaching strategies.ResultsThe academic achievements of undergraduate nursing students in the intervention group were better than those in the control group. The total average scores of critical thinking (272.51 vs. 266.47) and self-confidence (24.92 vs. 21.04) for nursing students in the intervention group were also higher than those in the control group after implementing teaching strategies. There were statistical differences in the theory test (P = 0.041), skill test (P = 0.013), critical thinking (P = 0.008) and self-confidence (P = 0.036) between the two groups. Additionally, the statistical significance of the scores for critical thinking (264.36 vs. 272.51, P < 0.001) and self-confidence (18.76 vs. 24.92, P < 0.001) before and after teaching strategies were also observed among participants in the intervention group, but not in the control group (P = 0.143, P = 0.738).ConclusionsUnfolding case-based learning may be effective and suitable for undergraduate nursing students learning health assessment skills. The findings of this study provide useful information to nursing teachers for the development of unfolding case-based learning when teaching other nursing skills to undergraduate nursing students.     

Faculty Development for Fostering Clinical Reasoning Skills in Early Medical Students Using a Modified Bayesian Approach

Problem: Clinical reasoning is a necessary skill for medical students to acquire in the course of their education, and there is evidence that they can start this process at the undergraduate level. However, physician educators who are experts in their given fields may have difficulty conveying their complex thought processes to students. Providing faculty development that equips educators with tools to teach clinical reasoning may support skill development in early medical students. Intervention: We provided faculty development on a modified Bayesian method of teaching clinical reasoning to clinician educators who facilitated small-group, case-based workshops with 2nd-year medical students. We interviewed them before and after the module regarding their perceptions on teaching clinical reasoning. We solicited feedback from the students about the effectiveness of the method in developing their clinical reasoning skills. Context: We carried out this project during an institutional curriculum rebuild where clinical reasoning was a defined goal. At the time of the intervention, there was also increased involvement of the Teaching and Learning Center in elevating the status of teaching and learning. Outcome: There was high overall satisfaction with the faculty development program. Both the faculty and the students described the modified Bayesian approach as effective in fostering the development of clinical reasoning skills. Lessons Learned: Through this work, we learned how to form a beneficial partnership between a clinician educator and Teaching and Learning Center to promote faculty development on a clinical reasoning teaching method for early medical students. We uncovered challenges faced by both faculty and early learners in this study. We observed that our faculty chose to utilize the method of teaching clinical reasoning in a variety of manners in the classroom. Despite obstacles and differing approaches utilized, we believe that this model can be emulated at other institutions to foster the development of clinical reasoning skills in preclerkship students.     

微课结合案例教学法对中医外科本科临床实践技能教学的影响

目的探讨微课结合案例教学法在中医外科本科临床实践技能教学中的应用价值。方法选取2018年7月至2019年12月在我院临床技能中心接受培训的78名中医外科学专业本科学生作为研究对象,按照随机数字表法将其分为对照组和观察组,各39名。对照组给予传统的中医外科技能教学,观察组在对照组基础上给予微课结合案例教学法。比较两组的考核成绩、能力提升自我评价情况以及对教学的满意度。结果观察组学生的基础理论、病例分析、病历书写及技能操作成绩均高于对照组(P<0.05)。观察组学生的自我训练、思维、沟通、协作能力、兴趣提升占比均高于对照组(P<0.05)。观察组学生对教学的满意度高于对照组(P<0.05)。结论微课结合案例教学法应用于中医外科临床实践技能教学中能够明显提升教学质量及学生对教学的满意度。     

Using debriefing for meaningful learning to foster development of clinical reasoning in simulation

Debriefing is critical to learning from simulation experiences, yet the literature reports little research describing best practices within nursing. Debriefing for Meaningful Learning (DML) is a systematic process for debriefing in which teachers and students explicate different aspects of reflection and generate new meanings from simulation experiences. The purpose of this exploratory, quasi-experimental, pretest-posttest study was to test the relationship of DML on the development of clinical reasoning skills in prelicensure nursing students when compared with customary debriefing strategies and on students' perception of quality of the debriefing experience. Analysis of data demonstrated a greater change in clinical reasoning skills and identification of higher-quality debriefing and a positive correlation between clinical reasoning and perception of quality. Findings demonstrate that DML is an effective debriefing method. It contributes to the body of knowledge supporting the use of debriefing in simulation learning and supports the development of best teaching practices.     

An investigation into students' performance of invasive and non-invasive procedures on each other in classroom settings

A belief that pre-registration nursing programmes in the United Kingdom were not adequately equipping students with fundamental clinical skills has led to increasing interest in alternative methods for developing students' practical skills, as an adjunct to their placement experiences. Whilst recent literature offers insight into the operational aspects of developing and running clinical skills facilities in higher education institutions, there is limited evidence regarding the types of procedures taught, or the risks and benefits to students practising these procedures on each other. This study therefore sought to identify the current status of peer-practised learning within pre-registration nurse education. A survey approach was adopted and questionnaires were sent to all Higher Education Institutes delivering pre registration nursing and midwifery programmes in the United Kingdom (n=72). Ethical approval was acquired and principles of strict confidentiality were adhered to throughout. Both quantitative and qualitative data were obtained. Quantitative data were analysed using SPSS (version 11.5), and qualitative data were systematically scrutinised for emerging themes. The findings support the notion that peer-practised learning in the classroom setting is a desirable method of teaching and learning core clinical skills from a teacher perspective. However, notable inconsistencies in the range of procedures students are allowed to perform on each other were found. The mechanisms of risk assessment and concept of consent were also found to be decidedly variable.     

Evaluation of the Outcome-Present State Test Model as a way to teach clinical reasoning

The Outcome-Present State Test (OPT) Model of Clinical Reasoning is a nursing process model designed to help students develop clinical reasoning skills. Although many nurse educators are using the OPT model as a teaching strategy, few are formally evaluating its use as a method. We used the OPT model as a teaching tool in an undergraduate psychiatric and mental health clinical nursing course and evaluated how quickly students became adept at using it. Most students mastered the use of the model; 29 of 43 students achieved the criterion score (a score greater than 65 on 3 or more models completed over 4 weeks). Not only did the students gain clinical reasoning skills, but they also used and learned more about the North American Nursing Diagnosis Association, Nursing Interventions Classification, and Nursing Outcomes Classification languages. Recommendations for future use of the model include adding client strengths and increasing focus on the quality of students' responses.     

以案例为基础的学习法在临床诊断学教学中的应用

以案例为基础的学习法(CBL)在医学、商学和法学领域应用日益广泛,CBL在医学教育领域一直受到人们的关注。笔者将CBL应用在临床诊断学教学,以真实的临床场景为基础培养医学生临床实践技能和正确诊断思维,培养学生使用所学理论知识和推理能力来解决临床问题。CBL具有参与性和启发性,能有效提高医学生的分析和解决问题能力,有助于医学生的逻辑推理能力和综合诊断技能的培养并在未来的职业发展过程中灵活运用其诊断技能。CBL能有效提高学生临床诊断技能,在临床诊断学教学中取得了较好效果,值得重视和推广。     

基于案例教学法建设的护理专业学位研究生《高级护理实践导论》案例库的应用及探讨

目的本研究基于案例教学法(CBL)建设护理专业学位研究生《高级护理实践导论》案例库,并探究其应用效果。方法组建专家团队建设《高级护理实践导论》案例库,对21名护理硕士研究生实施案例课堂教学,用问卷调查法及质性访谈法评价案例库教学效果。结果护理研究生对案例库教学效果评价总均分(32.99±15.77)分。质性访谈中发现案例教学法可以培养研究生的团队合作能力、临床思维能力等各项综合能力。结论护理专业学位研究生《高级护理实践导论》案例库的建设新颖性高、创新科学性强,应用案例库开展教学可以全面提高护理研究生的综合素质,推进临床实践教学改革。     

Use of classroom "clickers" to promote acquisition of advanced reasoning skills

Use of classroom response systems (a.k.a. "clickers" or "audience polling systems") are growing in popularity among faculty in colleges and universities. When used by faculty in a strategic instructional design, clickers can raise the level of participation and the effectiveness of interaction, promote engagement of students in active learning, foster communication to clarify misunderstanding and incorrect thinking, and provide a method to instructionally embed assessment as a learning activity rather than reliance on the traditional approach of summative assessment for assigning grades. This article describes the use of clicker technology in a baccalaureate nursing program to promote acquisition and application of advanced reasoning skills. Methods are suggested for embedding formative assessment and the tactical use of questioning as feedback and a powerful learning tool. Operational aspects of clickers technology are summarized and students' perceptions and satisfaction with use of this teaching and learning technology are described.     

A process of informed consent for student learning through peer physical examination in pelvic floor physiotherapy practice

Peer physical examination (PPE) is a method of teaching and learning clinical skills in which students use fellow students as surrogate patients or models. PPE is recognised as useful as an experiential learning method to increase skill development for physiotherapy clinical practice. However students may feel pressured to participate despite discomfort and embarrassment when practising physical examination and treatment skills with their peers. Obtaining students' informed consent to participate in PPE is an important process to address these disadvantages of PPE. This paper proposes a three stage process for obtaining informed consent from postgraduate physiotherapy students learning pelvic floor examination and treatment skills. The process is designed to encourage educators to articulate the ethical issues that are relevant in this area of teaching; to provide information to students to enable them to understand what is involved and to choose to participate, and to offer alternatives to participation through a formalised process of informed consent. These steps mirror students' future obligations and actions when communicating with their patients.     

Nursing students' and tutors' perceptions of learning and teaching in a clinical skills centre

BACKGROUND: Clinical Skills Centres (CSCs) can ease pressure on clinical skills development and assessment in clinical areas; and provide added value through experiential learning and self-directed learning. Published accounts of innovation in CSCs tell part of this story but little is known about perceptions of students and tutors engaged in day-to-day learning and teaching in CSCs. METHODS: This paper reports one strand of a mixed methods study in a busy multidisciplinary CSC: a questionnaire survey of nursing students' and tutors' perceptions of learning and teaching. Questionnaires focused on items representing commonly espoused views regarding the use and usefulness of CSCs. RESULTS: Students and tutors enjoyed learning and teaching within the CSC, although senior students were slightly muted in their views. All groups valued the supported practice of clinical and communication skills. The CSC was seen as a learning environment that supports the linking of theory and practice. There was some ambivalence, particularly among tutors, about the relationship between performance in the CSC and in clinical areas. DISCUSSION: The favoured pedagogic approach of expert demonstration by tutors followed by supported practice necessitates attention to tutors' training. The muted responses of senior students may signal a need to review the CSC learning experiences offered to them.     

应用PBL法构建新的护理技能教学模式

[目的]探讨应用以问题为基础的学习(PBL)法构建新的护理技能教学模式的教学实践效果.[方法]选择4年制护理本科生100名为研究对象,随机分为观察组和对照组,各50名,对照组采用传统教学模式,观察组采用PBL教学模式,比较两组学生技能操作评价成绩.[结果]观察组学生技能操作考核成绩优于对照组,两组比较差异有统计学意义(P<0.05).[结论]护理技能教学中应用PBL教学法可明显提高学生的主动学习和解决问题的能力,有效提高教学实践效果.     

The design and implementation of an Interactive Computerised Decision Support Framework (ICDSF) as a strategy to improve nursing students' clinical reasoning skills

This paper describes the conceptual design and testing of an Interactive Computerised Decision Support Framework (ICDSF) which was constructed to enable student nurses to "think like a nurse." The ICDSF was based on a model of clinical reasoning. Teaching student nurses to reason clinically is important as poor clinical reasoning skills can lead to "failure-to rescue" of deteriorating patients. The framework of the ICDSF was based on nursing concepts to encourage deep learning and transferability of knowledge. The principles of active student participation, situated cognition to solve problems, authenticity, and cognitive rehearsal were used to develop the ICDSF. The ICDSF was designed in such a way that students moved through it in a step-wise fashion and were required to achieve competency at each step before proceeding to the next. The quality of the ICDSF was evaluated using a questionairre survey, students' written comments and student assessment measures on a pilot and the ICDSF. Overall students were highly satisfied with the clinical scenarios of the ICDSF and believed they were an interesting and useful way to engage in authentic clinical learning. They also believed the ICDSF was useful in developing cognitive skills such as clinical reasoning, problem-solving and decision-making. Some reported issues were the need for good technical support and the lack of face to face contact when using e-learning. Some students also believed the ICDSF was less useful than actual clinical placements.     

Effectiveness of an interprofessional workshop on pain management for medical and nursing students

Interprofessional (IP) care is critical for effective pain management, but evidence is lacking about the best way to teach pain management skills to medical and nursing students using IP strategies. In 2013 and 2014, 307 medical and 169 nursing students participated in an IP case-based pain management workshop. The aims of this study were to determine (1) if students who participate in IP case-based learning groups will have improved pain management skills compared to students who participate in uniprofessional case-based learning groups, and (2) if students mentored by faculty with IP training will have improved pain management skills compared to students who are not mentored by IP-trained faculty. Student learning was assessed and compared using scored checklists for each group’s pain management plans. Findings show that IP mentorship and IP group participation improved medical students’ pain management skills but did not have the same effect on nursing student performance. Continued work is needed to develop, refine, and integrate innovative and tailored IP strategies into the curricula of medical and nursing schools to advance the pain management competencies of students before they enter clinical practice.     

CBL与TBL联合教学法在急诊规培学员教学中的应用效果

目的探讨病例教学法(CBL)与以团队为基础的学习法(TBL)联合教学法在急诊规培学员教学培训中的应用效果。方法将2018年1月至2018年8月于我院急诊进行规范化培训的60例学员随机分为对照组与观察组,各30例。对照组采用传统教学法(LBL),观察组采用CBL与TBL联合教学法。比较两组的综合能力考核、教学方法评价结果。结果观察组的理论成绩、操作成绩及总成绩均显著高于对照组(P<0.05)。观察组的教学方法评价结果显著优于对照组(P<0.05)。结论采用CBL与TBL联合教学法能明显提高教学效果,提高规培学员的学习积极性和临床技能,值得进一步的改进和推广。     

The think aloud approach as an educational tool to develop and assess clinical reasoning in undergraduate students

Even though clinical reasoning is attributed with the expert practitioner, there is limited evidence to support methods of teaching and learning that are used to foster its development in nurses. In nursing, a considerable range of teaching and learning strategies are available that can be used to develop clinical reasoning skills. This includes the think aloud seminar. This process oriented method has been successfully used to develop reasoning skills in nursing students [Lee, J.E.M. and Ryan-Wenger, N. 1997. The "think aloud" seminar for teaching clinical reasoning: A case study of a child with pharyngitis. J. Pediatric Health Care 11(1), 105-110.] and is one that should be adopted by nurse educators as a core teaching and learning strategy when educating pre-registration student nurses.