Exploring flipped classrooms in undergraduate nursing and health science: A systematic review.

AIM: We conducted a systematic review to investigate the effect of implementing flipped classroom designs on academic performance, student satisfaction and self-efficacy in undergraduate health science disciplines. BACKGROUND: Blended learning approaches, including the flipped classroom, have been increasingly implemented in higher education. To date, studies examining the effectiveness of the flipped classroom in nursing and health sciences programs have reported mixed findings. DESIGN: Systematic review METHODS: We used the PRISMA framework and searched electronic databases (Education Source, ERIC via ProQuest, Scholars Portal, CINAHL, Pubmed) with the terms "flip* class", "health," and "undergraduate" or "higher education". Original research articles were limited to peer-reviewed, quantitative and/or mixed-methods studies published between 2010 and 2021. We extracted data through a full-text screening and of the articles. RESULTS: Three main themes emerged from the 16 articles reviewed, including positive gains in academic performance (n = 8/12 studies reporting; 67 % studies), student satisfaction (n = 7/13 studies reporting; 54 % studies) and increased self-efficacy (n = 1/1 reporting; 100 % studies). Effect sizes demonstrated significant heterogeneity in these outcome measures. Note that none of these studies reported a negative effect for flipped classroom interventions. Structured design of teaching strategies and curriculum appears to be an important determinant of performance, satisfaction and self-efficacy. CONCLUSION: Studies on flipped classrooms in undergraduate health sciences disciplines indicated positive changes in academic performance, student satisfaction and self-efficacy linked to well-designed curriculum. Methodological limitations in the studies reviewed include the absence of demographic analysis, minimal descriptions of the flipped classroom curriculum design, inadequate data reporting and the absence of randomized, comparison groups. Future research should focus on pre-class, in-class and post-class flipped classroom design, careful documentation of research methods and improving the quality of data collected. TWEETABLE ABSTRACT: A systematic review of flipped classroom use in undergraduate nursing and health science programs indicates positive academic performance, satisfaction and self-efficacy changes.

Exploring clinician perceptions of a care pathway for the management of shoulder pain: a qualitative study.

BACKGROUND: Clinical care pathways may be useful tools to improve the quality of healthcare by facilitating the translation of evidence into practice. Our study is situated within a larger project, whereby end-users co-developed a care pathway for the management of shoulder pain. In this study, we explored end-user perceptions of the usefulness and practicality of implementing a care pathway to manage shoulder pain. We also solicited feedback for the pathway's improvement. METHODS: We conducted a qualitative study using a transcendental phenomenological approach seen through a constructivist lens. Clinicians recorded themselves interacting with the care pathway while working through a clinical case. Clinicians described their thoughts and movements aloud as they completed the activity. Second, we conducted individual semi-structured interviews to discuss the usefulness and practicality of pathway implementation. Interview transcripts were coded independently by reviewers. Transcript codes and associated quotes were grouped into themes. Themes were sequenced and linked creating a 'web' of thematic connections. Summary statements were developed to synthesize the overall essence of the phenomena. RESULTS: Nine clinicians participated. Participants included eight chiropractors and one medical physician. We found that clinicians believed the care pathway could be useful at various levels, including education (students, interns), for early career clinicians, for engaging patients, facilitating interprofessional communication, and as a reminder of information for certain, less familiar conditions. When discussing the practicality of implementing the care pathway into practice settings, clinicians expressed that agreement with the care pathway and its recommendations may influence its acceptability among clinicians. Additionally, integrating recommendations into practice may be a skill requirement included into clinical training. Clinicians described the importance of opinion leaders in the acceptability of new evidence. Various difficulties with the replicability of interventions into clinical care was also discussed. In general, clinicians suggested the layout of the care pathway was manageable, and there was sufficient information for clinical decision-making. Clinicians also made several recommendations for improvement. CONCLUSIONS: End-user involvement and collaboration provides tangible instruction to improve care pathways themselves, their implementation strategies and helps to support and strengthen future research for overcoming individual, systemic and contextual barriers.

Exploring clinicians' experiences and perceptions of end-user roles in knowledge development: a qualitative study.

BACKGROUND: End-user involvement in developing evidence-based tools for clinical practice may result in increased uptake and improved patient outcomes. Understanding end-user experiences and perceptions about the co-production of knowledge is useful to further the science of integrated knowledge translation (iKT) - a strategy for accelerating the uptake and impact of research. Our study had two main objectives: (1) explore end-user (clinician) experiences of co-producing an evidence-based practice tool; and (2) describe end-user perceptions in knowledge development. METHODS: We used a qualitative study design. We conducted semi-structured interviews with clinicians and used a transcendental phenomenological approach to analyze themes/phenomena. In addition, we explored the interrelated themes between the thematic maps of each objective. RESULTS: Four themes emerged from clinicians' experiences in co-producing the practice tool: ease/convenience of participating, need for support and encouragement, understanding the value of participating, and individual skillsets yield meaningful contributions. Stakeholder roles in knowledge tool development and improving dissemination of evidence and knowledge tools were themes that related to clinician perceptions in knowledge development. The review of interrelated thematic maps depicts an intertwined relationship between stakeholders and dissemination. CONCLUSIONS: End-users provide invaluable insight and perspective into the development of evidence-based clinical tools. Exploring the experiences and perceptions of end-users may support future research endeavours involving iKT, such as the co-production of clinical resources, potentially improving uptake and patient health outcomes.

Using technology-based educational interventions to improve knowledge about clinical practice guidelines.

OBJECTIVE: To describe the best evidence on the effectiveness of technology-based learning tools designed to improve knowledge of health care providers about clinical practice guidelines (CPGs). METHODS: We conducted a systematic review, searching MEDLINE, Embase, and CINAHL from inception to July 2018. Included studies investigated the effectiveness of any technology-based learning tools developed to improve knowledge of health care providers about CPGs. We used a 2-phase screening process to determine eligibility. Pairs of reviewers critically appraised relevant studies using the Scottish Intercollegiate Guidelines Network checklist for randomized controlled trials or the National Institutes of Health checklist for pre- and postintervention trials. Evidence from internally valid studies was described using a best-evidence summary. We conducted a sensitivity analysis to determine whether results varied according to methodological quality. RESULTS: Twenty-five of 8321 articles met our selection criteria. Six studies had a low risk of bias and were included in this review. Spaced education was associated with improvement in knowledge; however, its effectiveness relative to other interventions is unknown. Module-based online educational interventions were associated with improvement in knowledge of CPGs; however, they may not be more effective than paper-based self-learning or in-person workshops. The sensitivity analysis determined that the evidence was similar between the high and low risk of bias studies. CONCLUSION: Module-based- and spaced-education interventions may be beneficial for improving health care providers' knowledge of CPGs; however, much of the evidence toward their use is preliminary.

The development and evaluation of an online educational tool for the evidence-based management of neck pain by chiropractic teaching faculty.

OBJECTIVE: To develop an online, interactive educational tool to deliver an evidence-based clinical practice guideline to faculty members at a Canadian chiropractic college. Second, to evaluate the learning, design, and engagement constructs of the tool in a sample of chiropractic faculty members. METHODS: Using an integrated knowledge translation methodology and the Knowledge to Action Framework, we developed an evidence-based online learning tool. The context of the tool focused on a clinical practice guideline on the management of neck pain. We evaluated the learning, design, and engagement constructs in a sample of faculty members and residents using the Learning Object Evaluation Scale for Students. Participants were also asked to provide suggestions for improvement of the tool. RESULTS: Sixteen participants completed the evaluation. Most (68.8%) participants were chiropractors, 75% were male and 56% were between the ages of 25 and 44 years. At least 75% of participants agreed that the learning, design, and engagement constructs of the learning tool were adequate. The open-ended suggestions unveiled 3 pedagogical themes, relating to multimedia, thinking skills, and learner control, within the tool that could benefit from further development. These themes informed recommendations to improve the tool. CONCLUSION: Our online, interactive, module-based learning tool has sound pedagogical properties. Further research is needed to determine if its use is associated with a change in knowledge.

Assessing the Impact of a Virtual Lab in an Allied Health Program.

Competency-based education in health care requires rigorous standards to ensure professional proficiency. Demonstrating competency in hands-on laboratories calls for effective preparation, knowledge, and experience, all of which can be difficult to achieve using traditional teaching methods. Virtual laboratories are an alternative, cost-effective approach to providing students with sufficient preparatory information. Research on the use of virtual labs in allied health education is limited. The current study investigated the benefits, challenges, and perceived impact of a virtual lab in an allied health program. The sample consisted of 64 students (55 females, 9 males) enrolled in a university medical laboratory science program. A convergent mixed-methods approach (Likert survey, open-ended questions, think-aloud protocol data) revealed that students had positive attitudes towards visual learning, authenticity, learner control, organization, and scaffolding afforded by the virtual lab. Challenges reported included navigational difficulties, an absence of control over content selection, and lack of understanding for certain concepts. Over 90% of students agreed that the virtual lab helped them prepare for hands-on laboratory sessions and that they would use this format of instruction again. Overall, 84% of the students agreed that the virtual lab helped them to achieve greater success in learning.

Anxiety related to sexual abuse: A case of recurrent priapism.

Recurrent priapism is notoriously difficult to treat and very distressing to the sufferer. There is little literature about emotional contributors to this condition. We report a case of a man with sexual abuse and severe anxiety who responded acutely to emotion-focused treatment with persistent cessation of severe recurrent priapism episodes. A second case treated with the same method had a similar response to treatment. Emotional factors may be relevant in certain cases of recurrent priapism and these factors warrant clinical management and formal study.