Learning to Speak Up for Patient Safety: Interprofessional Scenarios for Training Future Healthcare Professionals.

BACKGROUND: Preventable medical errors represent a leading cause of death in the United States. Effective undergraduate medical education (UME) strategies are needed to train medical students in error prevention, early identification of potential errors, and proactive communication. To address this need, a team of faculty from A.T. Still University's School of Osteopathic Medicine in Arizona developed four digital patient safety case scenarios for second-year medical students. These scenarios were designed to integrate interprofessional collaboration and patient safety principles, increase student ability to identify potential errors, and promote proactive communication skills. METHODS: Faculty used Qualtrics to create four digital case scenarios on patient safety covering the following domains: communicating about potential drug-to-drug interactions; effective handoffs; human factors errors, such as fatigue, illness, and stress; and conflicts with supervising resident. In fall 2018, 97 second-year medical students completed the entire safety module in dyad or triad teams. As they worked through each case study, student teams completed 11 assessment questions with instant feedback, and participated in short case debrief discussions. Next, each individual student took a 12-question post-test to assess learning. Descriptive statistics were reviewed for the assessment questions, and case critical thinking discussion answers were reviewed to evaluate student comprehension. RESULTS: The mean score for the module was 95.5% (SD= 6.36%, range = 75%-100%). Seventy-eight students completed the post-test, which had a mean score of 96.5% (SD = 6.51%, range = 66.7%-100%). Student written responses to the four case critical thinking discussion prompts indicated a high level of comprehension. CONCLUSION: Our results demonstrated that digital case studies can provide an innovative mechanism to introduce key patient safety concepts and experiential practice of interprofessional communication in early UME. Our design and implementation of these engaging interprofessional patient safety training modules provided an opportunity for students to learn key communication and safety concepts in small teams. This training method was cost-effective and could be replicated in other online learning or blended learning environments for a wide range of health professions.

Teaching Medical Students About Health Systems Science and Osteopathic Principles and Practice Using a Virtual World: The Envision Community Health Center.

Medical education technology initiatives can be used to prepare osteopathic medical students for modern primary care practice and to provide students with training to serve vulnerable populations. Over academic years 2014 through 2017, the authors designed and implemented 26 case studies using patient simulations through a virtual community health center (CHC). First-year students, who were preparing for clinical training in CHCs, and second-year students, who were training in CHCs, completed the simulation case studies, gaining practice in clinical reasoning, Health Systems Science, and applied osteopathic principles and practice. This article explains the project, illustrates an alignment with Health Systems Science and osteopathic competencies, and highlights findings from previous research studies.

Gaming science innovations to integrate health systems science into medical education and practice.

Health systems science (HSS) is an emerging discipline addressing multiple, complex, interdependent variables that affect providers' abilities to deliver patient care and influence population health. New perspectives and innovations are required as physician leaders and medical educators strive to accelerate changes in medical education and practice to meet the needs of evolving populations and systems. The purpose of this paper is to introduce gaming science as a lens to magnify HSS integration opportunities in the scope of medical education and practice. Evidence supports gaming science innovations as effective teaching and learning tools to promote learner engagement in scientific and systems thinking for decision making in complex scenarios. Valuable insights and lessons gained through the history of war games have resulted in strategic thinking to minimize risk and save lives. In health care, where decisions can affect patient and population outcomes, gaming science innovations have the potential to provide safe learning environments to practice crucial decision-making skills. Research of gaming science limitations, gaps, and strategies to maximize innovations to further advance HSS in medical education and practice is required. Gaming science holds promise to equip health care teams with HSS knowledge and skills required for transformative practice. The ultimate goals are to empower providers to work in complex systems to improve patient and population health outcomes and experiences, and to reduce costs and improve care team well-being.

Tracking Active Learning in the Medical School Curriculum: A Learning-Centered Approach.

BACKGROUND: Medical education is moving toward active learning during large group lecture sessions. This study investigated the saturation and breadth of active learning techniques implemented in first year medical school large group sessions. METHODS: Data collection involved retrospective curriculum review and semistructured interviews with 20 faculty. The authors piloted a taxonomy of active learning techniques and mapped learning techniques to attributes of learning-centered instruction. RESULTS: Faculty implemented 25 different active learning techniques over the course of 9 first year courses. Of 646 hours of large group instruction, 476 (74%) involved at least 1 active learning component. CONCLUSIONS: The frequency and variety of active learning components integrated throughout the year 1 curriculum reflect faculty familiarity with active learning methods and their support of an active learning culture. This project has sparked reflection on teaching practices and facilitated an evolution from teacher-centered to learning-centered instruction.

What millennial medical students say about flipped learning.

Flipped instruction is gaining popularity in medical schools, but there are unanswered questions such as the optimum amount of the curriculum to flip and whether flipped sessions should be mandatory. We were in a unique position to evaluate feedback from first-year medical students who had experienced both flipped and lecture-based courses during their first semester of medical school. A key finding was that the students preferred a variety of different learning formats over an "all or nothing" learning format. Learning format preferences did not necessarily align with perceptions of which format led to better course exam performance. Nearly 70% of respondents wanted to make their own decisions regarding attendance. Candid responses to open-ended survey prompts reflected millennial preferences for choice, flexibility, efficiency, and the ability to control the pace of their learning, providing insight to guide curricular improvements.

A descriptive, cross-sectional study of medical student preferences for vodcast design, format and pedagogical approach.

BACKGROUND: Vodcasts (video podcasts) are becoming increasingly popular in medical education. At A.T. Still University School of Osteopathic Medicine in Arizona (ATSU SOMA), vodcasts are an essential component of our blended learning environment, where year 2-4 students train in a contextual setting at community health centers across the U.S. Vodcasts are used far less frequently in our year 1 residential learning environment at the main campus in Arizona, but we are considering moving to significantly more interactive educational experiences with on-demand videos followed by in-class activities. The aim of this study was to determine stakeholder (i.e. medical student) preferences for vodcast design, format, and pedagogical strategies. The overall goal was to increase opportunities for students to learn with this modality. METHODS: An interactive Qualtrics™ survey was administered to three cohorts of medical students. The survey generated quantitative and open-ended response data that addressed principles of vodcast instructional design and learning. Responses to survey items were analyzed for statistical significance using the independent samples t-test for interval data, the chi-square test for categorical data, and the Kruskal-Wallis test for ordinal data, using the post-hoc Bonferroni procedure to determine the appropriate α level. Responses to open-ended prompts were categorized using open- and axial-coding. RESULTS: The most highly valued vodcast attributes, considered essential by all three cohorts, were clear explanations, organization, conciseness, high-yield for medical board exams, and the ability to speed vodcasts up. The least helpful vodcast attributes for all three cohorts were music and objects moving on screen. The average preferred vodcast length for each cohort was 27-28 min. There were significant differences between the less experienced learners in the residential setting and the more mature learners in the blended learning environment regarding certain vodcast attribute preferences, format of included practice questions, explanations for preferred vodcast lengths, and reasons for not viewing vodcasts. CONCLUSIONS: Overall, learner preferences were in line with non-interactive, screen-capture type vodcasts, which have lower demands on institutional cost and faculty production time than Flash™-type interactive vodcasts. Students in the blended learning environment were much more focused on vodcast features that decreased their time commitment, including a preference for noninteractive vodcasts. Given the increase in distance learning in medical education, our results should be of value to other medical programs.

Evaluating medical student engagement during virtual patient simulations: a sequential, mixed methods study.

BACKGROUND: Student engagement is an important domain for medical education, however, it is difficult to quantify. The goal of this study was to investigate the utility of virtual patient simulations (VPS) for increasing medical student engagement. Our aims were specifically to investigate how and to what extent the VPS foster student engagement. This study took place at A.T. Still University School of Osteopathic Medicine in Arizona (ATSU-SOMA), in the USA. METHODS: First year medical students (n = 108) worked in teams to complete a series of four in-class virtual patient case studies. Student engagement was measured, defined as flow, interest, and relevance. These dimensions were measured using four data collection instruments: researcher observations, classroom photographs, tutor feedback, and an electronic exit survey. Qualitative data were analyzed using a grounded theory approach. RESULTS: Triangulation of findings between the four data sources indicate that VPS foster engagement in three facets: 1) Flow. In general, students enjoyed the activities, and were absorbed in the task at hand. 2) Interest. Students demonstrated interest in the activities, as evidenced by enjoyment, active discussion, and humor. Students remarked upon elements that caused cognitive dissonance: excessive text and classroom noise generated by multi-media and peer conversations. 3) Relevance. VPS were relevant, in terms of situational clinical practice, exam preparation, and obtaining concrete feedback on clinical decisions. CONCLUSIONS: Researchers successfully introduced a new learning platform into the medical school curriculum. The data collected during this study were also used to improve new learning modules and techniques associated with implementing them in the classroom. Results of this study assert that virtual patient simulations foster engagement in terms of flow, relevance, and interest.

Gamification and Multimedia for Medical Education: A Landscape Review.

BACKGROUND: Medical education is rapidly evolving. Students enter medical school with a high level of technological literacy and an expectation for instructional variety in the curriculum. In response, many medical schools now incorporate technology-enhanced active learning and multimedia education applications. Education games, medical mobile applications, and virtual patient simulations are together termed gamified training platforms. OBJECTIVE: To review available literature for the benefits of using gamified training platforms for medical education (both preclinical and clinical) and training. Also, to identify platforms suitable for these purposes with links to multimedia content. METHODS: Peer-reviewed literature, commercially published media, and grey literature were searched to compile an archive of recently published scientific evaluations of gamified training platforms for medical education. Specific educational games, mobile applications, and virtual simulations useful for preclinical and clinical training were identified and categorized. Available evidence was summarized as it related to potential educational advantages of the identified platforms for medical education. RESULTS: Overall, improved learning outcomes have been demonstrated with virtual patient simulations. Games have the potential to promote learning, increase engagement, allow for real-word application, and enhance collaboration. They can also provide opportunities for risk-free clinical decision making, distance training, learning analytics, and swift feedback. A total of 5 electronic games and 4 mobile applications were identified for preclinical training, and 5 electronic games, 10 mobile applications, and 12 virtual patient simulation tools were identified for clinical training. Nine additional gamified, virtual environment training tools not commercially available were also identified. CONCLUSION: Many published studies suggest possible benefits from using gamified media in medical curriculum. This is a rapidly growing field. More research is required to rigorously evaluate the specific educational benefits of these interventions. This archive of hyperlinked tools can be used as a resource for all levels of medical trainees, providers, and educators.

Student perceptions of gamified audience response system interactions in large group lectures and via lecture capture technology.

BACKGROUND: Higher education students have positive attitudes about the use of audience response systems (ARS), but even technology-enhanced lessons can become tiresome if the pedagogical approach is exactly the same with each implementation. Gamification is the notion that gaming mechanics can be applied to routine activities. In this study, TurningPoint (TP) ARS interactions were gamified and implemented in 22 large group medical microbiology lectures throughout an integrated year 1 osteopathic medical school curriculum. METHODS: A 32-item questionnaire was used to measure students' perceptions of the gamified TP interactions at the end of their first year. The survey instrument generated both Likert scale and open-ended response data that addressed game design and variety, engagement and learning features, use of TP questions after class, and any value of lecture capture technology for reviewing these interactive presentations. The Chi Square Test was used to analyze grouped responses to Likert scale questions. Responses to open-ended prompts were categorized using open-coding. RESULTS: Ninety-one students out of 106 (86 %) responded to the survey. A significant majority of the respondents agreed or strongly agreed that the games were engaging, and an effective learning tool. The questionnaire investigated the degree to which specific features of these interactions were engaging (nine items) and promoted learning (seven items). The most highly ranked engagement aspects were peer competition and focus on the activity (tied for highest ranking), and the most highly ranked learning aspect was applying theoretical knowledge to clinical scenarios. Another notable item was the variety of interactions, which ranked in the top three in both the engagement and learning categories. Open-ended comments shed light on how students use TP questions for exam preparation, and revealed engaging and non-engaging attributes of these interactive sessions for students who review them via lecture capture. CONCLUSIONS: Students clearly valued the engagement and learning aspects of gamified TP interactions. The overwhelming majority of students surveyed in this study were engaged by the variety of TP games, and gained an interest in microbiology. The methods described in this study may be useful for other educators wishing to expand the utility of ARS in their classrooms.

Developing technology-enhanced active learning for medical education: challenges, solutions, and future directions.

Growing up in an era of video games and Web-based applications has primed current medical students to expect rapid, interactive feedback. To address this need, the A.T. Still University-School of Osteopathic Medicine in Arizona (Mesa) has developed and integrated a variety of approaches using technology-enhanced active learning for medical education (TEAL-MEd) into its curriculum. Over the course of 3 years (2010-2013), the authors facilitated more than 80 implementations of games and virtual patient simulations into the education of 550 osteopathic medical students. The authors report on 4 key aspects of the TEAL-MEd initiative, including purpose, portfolio of tools, progress to date regarding challenges and solutions, and future directions. Lessons learned may be of benefit to medical educators at academic and clinical training sites who wish to implement TEAL-MEd activities.