Evaluation of an interactive web-based nursing course with streaming videos for medication administration skills

PurposeNursing students should exhibit competence in nursing skills in order to provide safe and quality patient care. This study describes the design and students’ response to an interactive web-based course using streaming video technology tailored to students’ needs and the course objectives of the fundamentals of nursing skills clinical course.MethodA mixed-methodology design was used to describe the experience of 102 first-year undergraduate nursing students at a school of nursing in Jordan who were enrolled in the course. A virtual course with streaming videos was designed to demonstrate medication administration fundamental skills. The videos recorded the ideal lab demonstration of the skills, and real-world practice performed by registered nurses for patients in a hospital setting. After course completion, students completed a 30-item satisfaction questionnaire, 8 self-efficacy scales, and a 4-item scale solicited their preferences of using the virtual course as a substitute or a replacement of the lab demonstration. Students’ grades in the skill examination of the procedures were measured. Relationships between the main variables and predictors of satisfaction and self-efficacy were examined.ResultsStudents were satisfied with the virtual course (3.9 ± 0.56, out of a 5-point scale) with a high-perceived overall self-efficacy (4.38 ± 0.42, out of a 5-point scale). Data showed a significant correlation between student satisfaction, self-efficacy and achievement in the virtual course (r = 0.45–0.49, p < 0.01). The majority of students accessed the course from home and some faced technical difficulties. Significant predictors of satisfaction were ease of access the course and gender (B = 0.35, 0.25, CI = 0.12–0.57, 0.02–0.48 respectively). The mean achievement score of students in the virtual class (7.5 ± 0.34) was significantly higher than that of a previous comparable cohort who was taught in the traditional method (6.0 ± 0.23) (p < 0.05). Nearly 40% of the students believed that the virtual course is a sufficient replacement of the lab demonstration.ConclusionsThe use of multimedia within an interactive online learning environment is a valuable teaching strategy that yields a high level of nursing student satisfaction, self-efficacy, and achievement. The creation and delivery of a virtual learning environment with streaming videos for clinical courses is a complex process that should be carefully designed to positively influence the learning experience. However, the learning benefits gained from such pedagogical approach are worth faculty, institution and students’ efforts.     

The role of virtual interactive simulators in medical education: Exploring their integration as an assessment methodology in clinical years

IntroductionAssessment takes a fundamental role in medical education. In Portugal, the main assessment method used is multiple-choice questions (MCQ). The virtual interactive patients (VIP) as an assessment method can be indicated for the development of clinical reasoning for medical students of the clinical years. This study compared the use of MCQ and VIP as assessment methodologies in medical students.MethodsA randomized crossover study carried out, which 35 Portuguese medical students from clinical years evaluated by MCQ and VIP in four medical specialties. In each specialty, students randomized into two groups. One group started being evaluated by MCQ and finished with VIP, the other vice-versa. After the evaluation, students asked to complete a satisfaction questionnaire.ResultsThe final score was higher with the VIP than MCQ method (MCQ: 67.40 ± 8.96 vs. VIP: 73.34 ± 10.8; p < 0.01) with significant differences higher in Clinical History and Physical Examination. The satisfaction quiz showed although both methodologies are adequate and satisfactory, but VIP method allows to improve knowledge.ConclusionVIP is more accurate for clinical reasoning, accepted by medical students and should be integrated into the pre-graduate medical curriculum with other methodologies already used. The COVID-19 pandemic allowed a digital transformation of medical education and VIP will have a crucial role as a knowledge and evaluation method.     

Clima de aprendizaje y preparación para el aprendizaje autodirigido en cirugía: ¿influye el enfoque de enseñanza?

IntroductionThe effect of learning climate effect on self-directed student learning remains controversial. This study aims to compare this effect between 2 teaching approaches in surgery.MethodsUsing previously validated questionnaires, student perceptions about climate and self-directed learning were evaluated in an interactive teaching approach (inverted classroom) and a traditional approach (lecture). The inter-variable correlations in each group were calculated and then between both groups.ResultsA total of 75 students (inverted classroom) and 74 students (lecture) self-completed questionnaires at the end of surgery course. Although the learning climate was higher in the inverted classroom, the perceptions of self-directed learning were similar in both groups. All correlations, between the scores of the 2 questionnaires, overall, and by domain, were higher in the inverted classroom, compared with lectures (P< .05)ConclusionsThe inverted classroom fosters a higher learning climate, with respect to the lecture, which is positively related to self-directed learning in surgical undergraduates. However, self-directed learning skills were similar in both approaches, and offer opportunities to evaluate other factors in this context.     

The impact of medical informatics on patient satisfaction: A USA-based literature review

PurposePatient satisfaction is increasingly recognized as an important component of quality. The expansion of health information technologies (HIT) might have an impact on patient satisfaction – either positively or negatively. We conducted a literature review to explore the impact of these technologies on patient satisfaction.MethodsThe database of PubMed was searched from inception through May 2010, using the MeSH terms “Medical Informatics” and “Patient Satisfaction”. We included all original interventional studies regardless of their study design that were published in English and were evaluating HIT impact on patient satisfaction. Studies were categorized by technology type according to the American Medical Informatics Association framework and by study design. The major outcome of interest was the HIT impact on patient satisfaction.ResultsOf 1293 citations reviewed, 56 studies met our inclusion criteria. Design of these studies included mostly randomized controlled trials (RCTs) (n = 20, 36%), cross-sectional surveys (n = 17, 30%), and a pre and post studies (n = 14, 25%). Overall, 54% (n = 30) of the studies demonstrated a positive effect of HIT on patient satisfaction, 34% (n = 19) failed to show any effect, 11% (n = 6) had inconclusive results, and 2% (n = 1) revealed a negative effect. Of the 20 RCTs, 40% (n = 8) showed a positive effect of HIT on patient satisfaction, 50% (n = 10) failed to show any effect, and 10% (2) had inconclusive results.ConclusionsAnalysis suggested that while there is some evidence that HIT improves patient satisfaction, studies in this literature review, and in particularly RCTs, were not consistent in their findings. Although HIT may be a promising tool to improve patient satisfaction, more well-designed research studies are needed in order to get a better understanding of this domain and accordingly find new opportunities to improve quality of care.     

Análisis de la ansiedad en los primeros encuentros clínicos: experiencias utilizando la simulación clínica en estudiantes de pregrado

IntroductionThe first clinical encounters trigger strong feelings and emotions in medical students, when facing complex illnesses, and by feelings of guilt of «using patients’ sufferings» for their learning purposes. Clinical simulation offers them an opportunity for experiencing anxiety in a safe environment prior to being involved in the hospital. The objective of this work was to assess the level of anxiety in the first clinical encounters through clinical simulation experiences in undergraduate students.Material and methodsWe used the Inventory of Anxiety in Clinical Simulation Scenarios in a sample of 49 students. This instrument is made up of 25 items grouped into 7 factors. ANOVA test was considered to evaluate the trends by factor, for the analysis of the data.ResultsWe found an average of 2.67. In considering the gender as a factor, significant difference was obtained by using ANOVA (P = 0.016). The results of trends by factor show significant differences in corporal expressions (P = 0.003), concern about how others perceive me (P = 0.007) and worries about self-image (P = 0.019).DiscussionAssessment is of great value in medical school programs, where it becomes one of the vital elements in designing each activity developed throughout the career. Anxiety is present along the training program, having a positive or negative impact on student learning and performance, according to the way it is handled. Assessing knowledge and skills is imperative, therefore both anxiety and assessment go hand in hand. Different types of assessment can generate different levels and manifestations of anxiety in students.     

Integrative medical education: Educational strategies and preliminary evaluation of the Integrated Curriculum for Anthroposophic Medicine (ICURAM)

Objectivesthe development and preliminary evaluation of a new medical program aimed at educating students in patient-centered integrative care and developing appropriate educational strategies.MethodsThe Integrated Curriculum for Anthroposophic Medicine (ICURAM) was developed with modules on anthroposophic medicine integrated into the full 6 years of the regular medical curriculum. The educational strategy is the ESPRI²T approach, combining Exploratory learning, Supported participation, Patient-based learning, Reflective practice, Integrated learning, an Integrative approach and Team-based learning. The student participation, assessed based on the number of credit points earned per year (ctp/year) through the ICURAM (1 ctp = 30 h workload), served as a preliminary indicator of student interest.ResultsOf the 412 55%medical students participated in the program: 16% full participation (≥4 ctp/year), 18% partial participation (1–3.99 ctp/year) and 22% occasional participation (0.25–0.99 ctp/year). The amount of additional workload taken on by students was between 7.8 h/year for occasional participants, 33 h/year for partial participants and 84 h/year for full participants.ConclusionMore than half of medical students were willing to invest a significant amount of additional time in the optional program.Practice implicationsAn integrative medical curriculum with a student-centered educational strategy seems to be of interest to most medical students.     

Specifying the effects of physician's communication on patients’ outcomes: A randomised controlled trial

ObjectiveTo experimentally test the effects of physician's affect-oriented communication and inducing expectations on outcomes in patients with menstrual pain.MethodsUsing a 2 × 2 RCT design, four videotaped simulated medical consultations were used, depicting a physician and a patient with menstrual pain. In the videos, two elements of physician's communication were manipulated: (1) affect-oriented communication (positive: warm, emphatic; versus negative: cold, formal), and (2) outcome expectation induction (positive versus uncertain). Participants (293 women with menstrual pain), acting as analogue patients, viewed one of the four videos. Pre- and post video participants’ outcomes (anxiety, mood, self-efficacy, outcome expectations, and satisfaction) were assessed.ResultsPositive affect-oriented communication reduced anxiety (p < 0.001), negative mood (p = 0.001), and increased satisfaction (p < 0.001) compared to negative affect-oriented communication. Positive expectations increased feelings of self-efficacy (p < 0.001) and outcome expectancies (p < 0.001), compared to uncertain expectations, but did not reduce anxiety. The combination of positive affect-oriented communication and a positive expectation reduced anxiety (p = 0.02), increased outcome expectancies (p = 0.01) and satisfaction (p = 0.001).ConclusionBeing empathic and inducing positive expectations have distinct and combined effects, demonstrating that both are needed to influence patients’ outcomes for the best.Practice implicationsContinued medical training is needed to harness placebo-effects of medical communication into practice.     

Early postoperative predictors of satisfaction following total knee arthroplasty

BackgroundDespite the excellent total knee arthroplasty (TKA) results reported using traditional outcome measures, dissatisfaction rates of up to 30% are reported following surgery. Although several preoperative factors have been identified as possible predictors of satisfaction, there is conflicting evidence. Identification of dissatisfaction in the early postoperative assessment may therefore be an alternative consideration.MethodsWe examined the relationship between 12-month satisfaction, and early post-operative outcomes in a cohort of 486 TKA patients. Preoperative, and postoperative outcome measures at 3- and 12-months (Oxford knee score, pain score, SF12, and knee motion), were analysed and compared between patients who were satisfied and dissatisfied at 12-months following TKA. Mean scores, and postoperative change in scores were calculated. Postoperative outcomes were examined for correlation with satisfaction, and multivariate logistic regression models used to identify potential predictors of dissatisfaction.ResultsOverall satisfaction was 77.0%. No preoperative differences were observed between groups. Dissatisfaction was associated with worse postoperative status across all outcome measures (p < 0.001), except the 3-month SF12-physical component (p = 0.052). Dissatisfied patients demonstrated minimal further improvement or even worsening of outcome scores between 3- and 12-months postoperatively (p < 0.02). Both the 3-month OKS (OR = 1.15, p < 0.001), and knee flexion (OR = 1.03, p = 0.009) were significant predictors of subsequent 12-month satisfaction.ConclusionsDissatisfaction following TKA is associated with worse outcomes as early as 3 months following surgery, with minimal further improvement subsequently achieved at 12-months. Early postoperative assessment following TKA should therefore be considered, including clinical assessment, to identify those patients at risk of dissatisfaction.     

One-year outcome of an interactive internet-based physical activity intervention among university students

ObjectiveThe purpose of the present study was to evaluate whether improvement in physical activity of students following a 4-month intervention of a university course was maintained 8 months later.MethodsData on 77 students who responded to our scheduled inquiries completely through 1 year were analyzed. Participants of the intervention group (n = 49) using the internet-based physical activity program exhibited significant increases in energy expenditures measured by IPAQ compared with the no-treatment control group (n = 28) through 1 year.ResultsParticipants who did not engage in regular university sports activities (baseline: 450 ± 351 kcal day⁻¹; post: 587 ± 320 kcal day⁻¹; 8-month follow-up: 580 ± 394 kcal day⁻¹) only exhibited significant increases in energy expenditures compared with those of the control group (baseline: 498 ± 341 kcal day⁻¹; post: 414 ± 242 kcal day⁻¹; 8-month follow-up: 347 ± 275 kcal day⁻¹).ConclusionThese results suggested that an internet-based interactive intervention could become a helpful tool in promoting and maintaining physical activity in the long term.     

The effect of multimedia-based education on students’ anger management skill

IntroductionAnger leads to behaviors that cause a lot of damage. Life skills training can be effective in controlling anger because anger is due to a lack of skills and unpredictability of the situation. The present study aimed to determine the effect of multimedia-based education on students’ anger management skill.Material and methodsThe quasi-experimental study was performed on 88 students of Anesthesiology, Nursing, Midwifery and Operating Room of North Khorasan Nursing and Midwifery School. The educational content was screened through the monitor in front of the main hall of the Nursing & Midwifery School during the students’ attendance for one week. Students’ anger control skills were assessed by tests paired T-test, independent T-test and one-way ANOVA. Data were analyzed using spss16 software.ResultsThe mean age of the students was 20 ± 2.3. Regarding the effect of multimedia-based education on students’ anger control skills, the mean of anger control score was 24.61 ± 2.83 (Min = 11 and Max = 33) before the intervention, and 28.64 ± 2.40 after the intervention. There was a significant difference in mean scores before and after the intervention (P = .000).ConclusionMultimedia-based education has been effective in controlling students’ anger. Given the effect of multimedia-based education on anger control skills, this approach can be used to teach other essential topics to students, including life skills, especially in health science students.     

Basic and immediate paediatric cardiopulmonary resuscitation training in medical students

BackgroundTo analyse the effectiveness of Paediatric Basic Life Support (PBLS) and Paediatric Immediate Life Support (PILS) courses to train medical students in paediatric cardiopulmonary resuscitation (CPR).MethodsEighteen courses (13 in PBLS and 5 in PILS) were delivered to 1214 medical students. Two theory tests and one practical test were performed. Students filled in an anonymous questionnaire after each course.ResultsThe mean scores (out of 20) in the theory tests of the PBLS course were 11.4 before the course, and 19.2 upon completion (P < 0.0001). Infant BLS skills were achieved by 98.4% of students, and children BLS skills by 97% of them. The mean scores (out of 30) in the PILS courses were 17.3 before the course, and 29.1 at the end of the course (P < 0.0001). PBLS skills were achieved by 99% of students and PILS skills by 98.3% of them. The scores (out of 5) in the anonymous questionnaire were: theory classes, 4.5; teaching methods, 4.5; practice sessions, 4.7; instructor teaching skills, 4.8; and coordination of theory and practice and between instructors, 4.7. There were no significant differences between basic and intermediate CPR courses.ConclusionsPBLS and PILS courses are useful methods for delivering theory and practice training to medical students, and should be mandatory in the paediatric curriculum of medical studies.     

Clinical Reasoning Training based on the analysis of clinical case using a virtual environment

IntroductionStudents experience difficulties defining a sequential order and analyzing variables when solving a clinical problem on real-time. Learning in a virtual environment using PBL and e-learning promotes hypothesis-generating research and case study through clinical reasoning.MethodsTwenty-two physical therapy students enrolled in a Clinical Reasoning course were asked to solve virtual clinical cases that included three different fields: orthopedic, cardiovascular/pulmonary and neurological. To evaluate the intervention, students’ perception as well as their lecture/lab academic performance, were considered.ResultsAn increase in academic performance in both lecture and lab average grades in comparison to previous years (ANOVA test, *p < 0.05). Fifty-eight percent of students reported prior study, critical thinking and technical language were aspects improved by this resource. Half of the enquired subjects also reported not having enough time to solve cases and suggested be given more adequate feedback.ConclusionsAfter this experience, teacher's role as a facilitator in the teaching learning process, putting the student in a leading role by using metacognitive strategies in tune with technology. Case-solving presents an advantage by improving the process of hypothesis-generation based on the information gathered from a case study problem. Early introduction of teaching strategies promote a systematic practice such as critical thinking through case study, and debate about the feedback needed for its achievement.     

Undergraduate medical students. Simulation-based activity to conduct the informed consent process for health research studies

IntroductionTraining through medical simulation allows for continuous learning under controlled conditions. Simulation-based training activities can be used simultaneously with other educational strategies to strengthen the attitudinal skills needed to develop an informed consent process in the context of health research.ObjectiveTo facilitate learning in undergraduate medicine students, and to evaluate their competences to carry out an informed consent process in a scenario that resembles reality.Materials and methodsIn this semi-longitudinal study, a simulation-based activity was conducted with 136 medical students of the fourth (Group A) and fifth year (Group B) of the Marist University of Mérida, in southern Mexico.ResultsThe mean score for both groups was 72.48 ± 1.05 (95% CI = 70.4–74.5); 86.2 ± 0.96 (95% CI = 84.2–88.0); and 77.7 ± 0.72 (95% CI = 76.3–79.1), in the pre-test, the simulation and the post-test, respectively. The students of group A self-evaluated their performance with 3.93/5.00, and those of Group B, 4.04/5.00.DiscussionThis study showed that Group A students did not score lower on simulation-based activity when compared to students in Group B, suggesting that before the fifth year of undergraduate medical education, students could properly develop an informed consent-process for health research if they receive early education about medical ethics and research bioethics. Issues related to bioethics in human health research can be included as soon as medical students initiate research methodology courses.     

Improving chemotherapy processes with a protocol-based information system: A pre and post-implementation study

BackgroundThe medical application domain has been a great challenge for information technology solutions for decades, especially when the target process has been complex and multidisciplinary such as chemotherapy processes.ObjectiveTo evaluate the impact of a homegrown protocol based information system on the efficiency of chemotherapy workflow processes in an outpatient setting.MethodsA day care unit of the Hematology/Oncology outpatient clinic of Erasmus Medical Center was the setting for this study. The study consisted of comparison of pre- and post-implementation of four workflow efficiency related external indicators: turn-around times of a commonly administered chemotherapy course (Paclitaxel–Carboplatin), chemotherapy course administration postponing rate, the rate of recording course administration time, and patient admission rate of the outpatient clinic. The data was gathered retrospectively from patient charts and information systems’ log files. For the purpose of turn-around-time 109 Paclitaxel–Carboplatin chemotherapy courses of pre-implementation were compared to 118 those of post-implementation. For the other indicators: 247 chemotherapy courses pre-implementation were compared to 324 courses post-implementation. The process maps of pre- and post-implementation were also compared to each other.ResultsThe implementation of the system improved the process by removing repetition and sequencing of the tasks. Following the implementation, chemotherapy postponing decreased by 17.2% (Z = ?4.723, P = .000) and there were 5.7% less records with missing administration time (Z = ?3.047, P = .002). The admission rate increased 1.9 patient per working day (t(94) = ?5.974, P = .000). The overall turn-around-time reduced 18.9 min following the implementation (t(169) = 3.48, P = .001). In a multivariate multiple regression model the reduction in turn-around time was related to the implementation of the system (Pillai's Trace = 0.159, F(4,161) = 7.613, P = .000).ConclusionInformation systems based on treatment protocols can reduce communication and synchronization needs between the stakeholders in a complex workflow process. These systems can help reengineering the process and improve workflow efficiency by removing unnecessary sequencing and repetitions of tasks.     

Clinical presentation and response to treatment of novel influenza A H1N1 in a university-based summer camp population

BackgroundLittle is known about the clinical presentation and course of novel H1N1 influenza in summer camps.ObjectivesTo describe the clinical course and evaluate the effect of influenza treatment in a summer camp population.Study designTwo large influenza outbreaks occurred in university-based residential camps between May 21 and August 2, 2009. Through active daily surveillance, medical evaluation at symptom onset, and data collection during isolation, we describe the clinical course of a large outbreak of novel H1N1 influenza.ResultsInfluenza-like illness (ILI) was documented in 119 individuals. Influenza A was confirmed in 66 (79%) of 84 samples tested. Three early samples were identified as novel H1N1. ILI cases had an average age of 15.7 years and 52% were male. Sixty-three were treated with oseltamivir or zanamivir, which was initiated within 24 h of diagnosis. Cough, myalgia and sore throat occurred in 69, 64 and 63% of cases, respectively. The highest temperature over the course of illness (T_max) occurred within 48 h after symptom onset in 87.5% of individuals. Average T_max was 38.4 °C (range 36.1–40.2 °C). Among confirmed influenza cases, 69% defervesced by 72 h and 95% defervesced by 96 h. Defervescence at 72 h was not different in the treated and untreated groups (p = 0.12).ConclusionsNovel H1N1 generally has a mild, self-limited course in healthy adolescent campers. Defervescence occurred within 72 h and was unaffected by treatment.     

Implementation and outcomes of telephone disclosure of clinical BRCA1/2 test results

ObjectivesWith an increasing demand for genetic services, effective and efficient delivery models for genetic testing are needed.MethodsIn this prospective single-arm communication study, participants received clinical BRCA1/2 results by telephone with a genetic counselor and completed surveys at baseline, after telephone disclosure (TD) and after in-person clinical follow-up.ResultsSixty percent of women agreed to participate; 73% of decliners preferred in-person communication. Anxiety decreased from baseline to post-TD (p = 0.03) and satisfaction increased (p < 0.01). Knowledge did not change significantly from baseline to post-TD, but was higher post-clinical follow-up (p = 0.04). Cancer patients had greater declines in state anxiety and African-American participants reported less increase in satisfaction. 28% of participants did not return for in-person clinical follow-up, particularly those with less formal education, and higher post-disclosure anxiety and depression (p < 0.01).ConclusionsTelephone disclosure of BRCA1/2 test results may not be associated with negative cognitive and affective responses among willing patients, although some subgroups may experience less favorable responses. Some patients do not return for in-person clinical follow-up and longitudinal outcomes are unknown.Practice implicationsFurther evaluation of longitudinal outcomes of telephone disclosure and differences among subgroups can inform how to best incorporate telephone communication into delivery of genetic services.     

Effectiveness of online peer assisted learning as a teaching methodology for dental undergraduate students

IntroductionPeer-assisted learning (PAL) has been extensively used in professional courses. However, its effectiveness as an adjunct to teacher-assisted learning (TAL) has not been evaluated. The objective of this study was to evaluate the effectiveness of Online PAL as an independent teaching methodology and as an adjunct to TAL, for dental students.MethodsForty BDS year 3 students were divided into 2 groups of 20 each. Four year 5 students were chosen as tutors to teach 4 different topics using the Microsoft teams platform. The study was conducted in two parts. At first, two topics were taught to one group by the tutor (peer-led group) and the other group, by a teacher (teacher-led group). Next, the remaining two topics were taught to both groups by the teacher initially. This was followed by repeated teaching of the topics to peer-led group by tutors, while other group did self-study. Students’ perception and performance scores were compared using an independent sample t-test for all the topics.ResultsThe mean performance scores in the teacher-led group for topics 1 and 2 were 86.15 and 90.22, whereas scores in the peer-led group were 75.38 and 79.21 which was statistically significant (p < 0.05). The mean scores in the teacher-led group for topics 3 and 4 were 71.82 and 65.42, whereas in the peer-led group as an adjunct to TAL were 84.55 and 82.50. This was statistically significant (p < 0.01).DiscussionOnline PAL as an adjunct to teacher-assisted learning can be useful for teaching dental undergraduate students.