Theoretical foundations and implications of augmented reality, virtual reality, and mixed reality for immersive learning in health professions education.

BACKGROUND: Augmented Reality (AR), Virtual Reality (VR) and Mixed Reality (MR) are emerging technologies that can create immersive learning environments for health professions education. However, there is a lack of systematic reviews on how these technologies are used, what benefits they offer, and what instructional design models or theories guide their use. AIM: This scoping review aims to provide a global overview of the usage and potential benefits of AR/VR/MR tools for education and training of students and professionals in the healthcare domain, and to investigate whether any instructional design models or theories have been applied when using these tools. METHODOLOGY: A systematic search was conducted in several electronic databases to identify peer-reviewed studies published between and including 2015 and 2020 that reported on the use of AR/VR/MR in health professions education. The selected studies were coded and analyzed according to various criteria, such as domains of healthcare, types of participants, types of study design and methodologies, rationales behind the use of AR/VR/MR, types of learning and behavioral outcomes, and findings of the studies. The (Morrison et al. John Wiley & Sons, 2010) model was used as a reference to map the instructional design aspects of the studies. RESULTS: A total of 184 studies were included in the review. The majority of studies focused on the use of VR, followed by AR and MR. The predominant domains of healthcare using these technologies were surgery and anatomy, and the most common types of participants were medical and nursing students. The most frequent types of study design and methodologies were usability studies and randomized controlled trials. The most typical rationales behind the use of AR/VR/MR were to overcome limitations of traditional methods, to provide immersive and realistic training, and to improve students' motivations and engagements. The most standard types of learning and behavioral outcomes were cognitive and psychomotor skills. The majority of studies reported positive or partially positive effects of AR/VR/MR on learning outcomes. Only a few studies explicitly mentioned the use of instructional design models or theories to guide the design and implementation of AR/VR/MR interventions. DISCUSSION AND CONCLUSION: The review revealed that AR/VR/MR are promising tools for enhancing health professions education, especially for training surgical and anatomical skills. However, there is a need for more rigorous and theory-based research to investigate the optimal design and integration of these technologies in the curriculum, and to explore their impact on other domains of healthcare and other types of learning outcomes, such as affective and collaborative skills. The review also suggested that the (Morrison et al. John Wiley & Sons, 2010) model can be a useful framework to inform the instructional design of AR/VR/MR interventions, as it covers various elements and factors that need to be considered in the design process.

The impact of observing lecturer hand motor actions on the learning of cognitive skills in higher education.

Class demonstrations where the lecturer's hand motor actions are observable generally have a positive effect on the learning of motor skills because they trigger an effortless process of embodied simulations. Whether the learning of cognitive skills is likewise affected by such visualisations is yet to be investigated and might depend on the learning content as well as other factors. This study aimed to investigate whether showing the lecturer's hand via a document camera during an introductory financial accounting class affects student learning (transfer performance), cognitive load responses, and note-taking behaviour compared to a writing pad where the lecturer's hand is not visible. The study utilised a quasi-experimental design in an in-person setting, with a pre-test and post-test comparison of two groups of participants: one group that viewed a lecture video without the lecturer's hand being visible (n = 509), and another group that viewed the same lecture with the lecturer's hand being visible (n = 571). The results showed that the with-hand group had a significantly higher increase in test scores compared to the without-hand group. However, the visibility of the hand did not significantly impact cognitive load or note-taking behaviour. The findings have important practical implications for education, as incorporating non-verbal cues such as the lecturer's hand may effectively enhance learning cognitive skills.

Integration of behavioral, social, and humanities sciences into healthcare and education and their alignment with medical education programs.

There has been an increasing acknowledgment of the intricacies inherent in health and healthcare processes, leading to a shift in medical education. This change underscores multidimensional, thorough, reflective, and contextual approaches characterized by mutual interaction and change. The perception of health/well-being and illness is transitioning toward acknowledging them as outcomes arising from the complex interplay of individual, social, and environmental/ecosystemic factors. This includes biological, genetic, behavioral, sociocultural, and environmental influences. In line with this changing perspective, the purpose of this article is to provide a general framework for the integration of behavioral, social, and human sciences into Medical Education Programs in Healthcare and Training Processes. The framework presented is based on the following three conceptual and theoretical basis: (1) Complex systems thinking and reflective, contextual healthcare and education practices, (2) Health systems and socio-economic-political framework, (3) Ecosystem framework in health and disease. Our aim in this article is to provide a guide for the integration of Behavioral, Social, and Humanity Sciences into medical education programs and to present examples from around the world.

Development and delivery of justice, equity, diversity, inclusion, and anti-oppression concepts in entry-level health professional education: A scoping review: BEME Guide No. 88.

PURPOSE: Justice, equity, diversity, inclusion (JEDI), and anti-oppression (AO) concepts are necessary in healthcare settings to promote culturally safe and high-quality care; however, entry-level healthcare program curricula (EHPPC) may lack adequate integration and/or delivery of these concepts. The primary aim of this scoping review is to identify what guidelines, frameworks, and models (GFMs) are used, and how they are used, to develop and deliver JEDI, and AO concepts in mandatory EHPPC. METHODS: A search of Ovid MEDLINE, Ovid EMBASE, and CINAHL was conducted for studies published in English from 2015 onwards that discuss what GFMs are included in mandatory EHPPC and how they guide the development and/or delivery of JEDI and/or AO concepts. Data from the included studies was collated into themes which were presented in tables and figures and described in narrative summaries. RESULTS: Sixty-one studies from various healthcare programs including medicine, nursing, pharmacy, dentistry, and dietetics were included in this review. Data from the studies were organized into eight categories: GFMs, concepts, methods of evaluation, length and frequency of sessions, modes of delivery, learning activities, and training of curricular developers and facilitators. CONCLUSIONS: GFMs are used in a variety of ways to integrate JEDI and/or AO concepts into health professional curriculum. Variability in the training of developers and facilitators of curricular concepts also exists. Future research is needed to determine if consistent or variable GFMs, as well as JEDI and/or AO developer and facilitator training, would be more effective for students' learning of these concepts.

Effects of adaptive scaffolding on performance, cognitive load and engagement in game-based learning: a randomized controlled trial.

BACKGROUND: While game-based learning has demonstrated positive outcomes for some learners, its efficacy remains variable. Adaptive scaffolding may improve performance and self-regulation during training by optimizing cognitive load. Informed by cognitive load theory, this study investigates whether adaptive scaffolding based on interaction trace data influences learning performance, self-regulation, cognitive load, test performance, and engagement in a medical emergency game. METHODS: Sixty-two medical students from three Dutch universities played six game scenarios. They received either adaptive or nonadaptive scaffolding in a randomized double-blinded matched pairs yoked control design. During gameplay, we measured learning performance (accuracy, speed, systematicity), self-regulation (self-monitoring, help-seeking), and cognitive load. Test performance was assessed in a live scenario assessment at 2- and 6-12-week intervals. Engagement was measured after completing all game scenarios. RESULTS: Surprisingly, the results unveiled no discernible differences between the groups experiencing adaptive and nonadaptive scaffolding. This finding is attributed to the unexpected alignment between the nonadaptive scaffolding and the needs of the participants in 64.9% of the scenarios, resulting in coincidentally tailored scaffolding. Exploratory analyses suggest that, compared to nontailored scaffolding, tailored scaffolding improved speed, reduced self-regulation, and lowered cognitive load. No differences in test performance or engagement were found. DISCUSSION: Our results suggest adaptive scaffolding may enhance learning by optimizing cognitive load. These findings underscore the potential of adaptive scaffolding within GBL environments, cultivating a more tailored and effective learning experience. To leverage this potential effectively, researchers, educators, and developers are recommended to collaborate from the outset of designing adaptive GBL or computer-based simulation experiences. This collaborative approach facilitates the establishment of reliable performance indicators and enables the design of suitable, preferably real-time, scaffolding interventions. Future research should confirm the effects of adaptive scaffolding on self-regulation and learning, taking care to avoid unintended tailored scaffolding in the research design. TRIAL REGISTRATION: This study was preregistered with the Center for Open Science prior to data collection. The registry may be found at https://osf.io/7ztws/ .

Peer creation and sharing of mnemonics in collaborative documents for pathology education: a pilot study.

BACKGROUND: Mnemonic techniques are memory aids that could help improve memory encoding, storage, and retrieval. Using the brain's natural propensity for pattern recognition and association, new information is associated with something familiar, such as an image, a structure, or a pattern. This should be particularly useful for learning complex medical information. Collaborative documents have the potential to revolutionize online learning because they could increase the creativity, productivity, and efficiency of learning. The purpose of this study was to investigate the feasibility of combining peer creation and sharing of mnemonics with collaborative online documents to improve pathology education. METHODS: We carried out a prospective, quasi-experimental, pretest-posttest pilot study. The intervention group was trained to create and share mnemonics in collaborative documents for pathological cases, based on histopathological slides. The control group compared analog and digital microscopy. RESULTS: Both groups consisted of 41 students and did not reveal demographic differences. Performance evaluations did not reveal significant differences between the groups' pretest and posttest scores. Our pilot study revealed several pitfalls, especially in instructional design, time on task, and digital literacy, that could have masked possible learning benefits. CONCLUSIONS: There is a gap in evidence-based research, both on mnemonics and on CD in pathology didactics. Even though, the combination of peer creation and sharing of mnemonics is very promising from a cognitive neurobiological standpoint, and collaborative documents have great potential to promote the digital transformation of medical education and increase cooperation, creativity, productivity, and efficiency of learning. However, the incorporation of such innovative techniques requires meticulous instructional design by teachers and additional time for students to become familiar with new learning methods and the application of new digital tools to promote also digital literacy. Future studies should also take into account validated high-stakes testing for more reliable pre-posttest results, a larger cohort of students, and anticipate technical difficulties regarding new digital tools.

Designing an online course using an EXD model: A case of Human-Computer Interaction undergraduate course.

Designing an online course is a complex and resource-intensive activity with a focus on pedagogical and technological aspects. One approach is the e-learning experience design (EXD) model, which combines user-experience design concepts, such as agile methodology and design thinking. This study aimed to design a website and activities for an undergraduate human-computer interaction (HCI) online course based on the EXD model and analyze the students' learning experiences. The students' experiences were captured from two online surveys opened during the first weeks (n = 94 students) and at the end of the semester (n = 93). The surveys utilized the e-Learning Usability Questionnaire (EUS) and asked for suggestions to improve the course delivery. In addition, the students rated their experience in pain points when participating in the course. The findings show that adopting the EXD model for an online course design and implementing some design best practices can promote students' positive attitudes toward the course. The contributions of this study include an example of how an online course can be designed using the EXD model and a description of its effects on student attitudes.

Why educators endorse a neuromyth: relationships among educational priorities, beliefs about learning styles, and instructional decisions.

Despite evidence to the contrary, many people believe in learning styles (LS)-the idea that students learn best in their preferred modality, such as visual, auditory, or kinesthetic. However, the impact of this belief on instructional decisions remains unclear. Therefore, this study investigated how belief in the neuromyth impacts instructional choices and why educators choose an LS lesson plan or an alternative. We found that educators' beliefs about LS indeed predicted their instructional choice, but that other factors influenced their decisions as well. Three themes encapsulate educators' justifications for their lesson plan choices: beliefs about LS, practical considerations, and student learning and motivation. These findings suggest that for many educators, implementing an LS lesson provides an opportunity to integrate diverse teaching strategies that address multiple educational priorities. Although many prior studies have replicated the prevalence of the myth, this is one of the first to explore the reasons that LS is attractive to educators. Attempts to dispel the LS neuromyth could leverage the reasons educators find LS appealing to provide alternative research-backed approaches to meet their goals. Future research should examine the extent to which beliefs in the LS neuromyth are translated into instructional practices within classroom lessons and explore potential differences across grade levels.

An Examination of the Usefulness of a Human Resource Development Tool of New Visiting Nurses.

Japan's aging rate is among the highest in the world these days. Consequently, home-visiting nursing stations ("stations") are increasing rapidly, but visiting nurses do not remain working at them for long. We developed a human resource promotional tool using spreadsheet software (Excel®; Microsoft Corp.) to support the education of newly appointed nurses working at the stations. Through this research we report findings of an examination concerning the usefulness of this tool on a trial basis. The results show that use of the tool led to increased motivation and decreased educational needs, a visualization of the skills acquired by newcomer nurses had an impact on their motivation to learn along with learning effectiveness.

Memes Adoption in Basic Medical Science Education as a Successful Learning Model: A Mixed Method Quasi-Experimental Study.

Purpose: Basic medical sciences are of a solid abstract nature. Pharmacology is a challenging discipline delivered in all healthcare-related curricula with different aims and goals. Memes are one of aiding instructional designs proved to surge students' performance and satisfaction with the educational process. Apart from assessing medical students' and faculty's perception of meme use in pharmacology learning, the current study aimed to explore the criteria of preferences and factors associated with successful memes' adoption in this discipline as one of the most challenging basic medical sciences. Methods: A biphasic study was conducted among second-year undergraduate medical students and faculty members. The study involved assessing the perceptions of staff and students, and thematic content analysis was performed on the narrative responses of the participants to explore factors contributing to the success of learning memes. Additionally, students' performance was also analyzed. Results: The use of memes in pharmacology was well perceived by medical students, with a mean satisfaction rating of 4.5/5 for high-achieving students and 4.33 for low-achieving students. Memes were associated with a performance surge (p = 0.022). Six themes emerged as criteria for a successful learning experience of meme use: previous scientific background on the meme topic, scenario context of the meme, learning concepts tackled by memes, the simplicity of meme's message, the relevance of meme's message to practice, and the modality of meme's use in the topic of education. Regarding the perception of meme use in pharmacology learning, four themes emerged: the mode and engagement of learning experience mode, the feasibility of meme use in pharmacology learning, students' attitudes towards further meme inclusion in their study, and the perceived impact of memes on students' cognitive skills. Conclusion: The use of memes in pharmacology yields positive learning outcomes. A careful selection of memes is required to ensure a successful learning experience.

Changing the delivery of continuing professional education: An action research approach.

AIM: A participatory action research project was used to change the design and delivery of continuing professional education in a large Irish academic teaching hospital. BACKGROUND: Participation in continuing professional education, designed as a short course, is often a method to maintain competence for many nurses. Structured short education courses are often used to orientate and upskill new staff to specialist clinical areas. Traditionally many courses relied on face-to-face delivery over a period of weeks which is challenging for one clinical area to release staff to attend theoretical days in person. DESIGN: A six-stage participatory action research cycle over a 3-year period in a large Irish academic teaching hospital. METHODS: Multiple methods were used in the cyclical process of participatory action research. Constructive alignment theory and instructional design principles were used to redesign the educational framework. Data collection included audits of courses, questionnaires and focus groups with key participants. RESULTS: Analysis of the focus group themes included 1) underestimated time 2) the process of change 3) teaching and learning styles and 4) acceptance and integration. 20 learners completed the evaluation and reported a positive synergy between e-learning and clinical workshops. E-learning was reported as time-consuming. 75 % of learners reported they were motivated to learn. 90 % of the learners reported they gained new knowledge and skills, 84 % reported the clinical area benefited from the education and 80 % identified a direct improvement in their clinical skills in the specialist area. CONCLUSIONS: Participatory action research supports organisational change in continuing professional education. Constructive alignment theory supports the value of outcomes-based learning. In this context it resulted in successfully blending theory and clinical skills for nurses working in specialist areas. The redesigned continuing professional education framework was positively evaluated across nurses in the organisation.

Validation of the motivated strategies for learning questionnaire and instructional materials motivation survey.

PURPOSE: To validate the Motivated Strategies for Learning Questionnaire (MSLQ), which measures learner motivations; and the Instructional Materials Motivation Survey (IMMS), which measures the motivational properties of educational activities. METHODS: Participants (333 pharmacists, physicians, and advanced practice providers) completed the MSLQ, IMMS, Congruence-Personalization Questionnaire (CPQ), and a knowledge test immediately following an online learning module (April 2021). We randomly divided data for split-sample analysis using confirmatory factor analysis (CFA), exploratory factor analysis (EFA), and the multitrait-multimethod matrix. RESULTS: Cronbach alpha was ≥0.70 for most domains. CFA using sample 1 demonstrated suboptimal fit for both instruments, including 3 negatively-worded IMMS items with particularly low loadings. Revised IMMS (RIMMS) scores (which omit negatively-worded items) demonstrated better fit. Guided by EFA, we identified a novel 3-domain, 11-item 'MSLQ-Short Form-Revised' (MSLQ-SFR, with domains: Interest, Self-efficacy, and Attribution) and the 4-domain, 12-item RIMMS as the best models. CFA using sample 2 confirmed good fit. Correlations among MSLQ-SFR, RIMMS, and CPQ scores aligned with predictions; correlations with knowledge scores were small. CONCLUSIONS: Original MSLQ and IMMS scores show poor model fit, with negatively-worded items notably divergent. Revised, shorter models-the MSLQ-SFR and RIMMS-show satisfactory model fit (internal structure) and relations with other variables.

Metaverse-powered basic sciences medical education: bridging the gaps for lower middle-income countries.

BACKGROUND: Traditional medical education often lacks contextual experience, hindering students' ability to effectively apply theoretical knowledge in real-world scenarios. The integration of the metaverse into medical education holds great enormous promise for addressing educational disparities, particularly in lower-middle-income countries (LMICs) accompanied by rapid technological advancements. This commentary paper aimed to address the potential of the metaverse in enhancing basic sciences education within the constraints faced by universities in LMICs. We also addressed learning design challenges by proposing fundamental design elements and a suggested conceptual framework for developing metaverse-based teaching methods.The goal is to assist educators and medical practitioners in comprehensivley understanding key factors in immersive teaching and learning. DISCUSSION: By immersing medical students in virtual scenarios mimicking real medical settings and patient interactions, the metaverse enables practice in clinical decision-making, interpersonal skills, and exposure to complex medical situations in a controlled environment. These simulations can be customized to reflect local healthcare challenges, preparing medical students to tackle specific community needs. Various disciplines, including anatomy, physiology, pharmacy, dentistry, and pathology, have begun leveraging the metaverse to offer immersive learning experiences, foster interdisciplinary collaborations, and facilitate authentic assessments. However, financial constraints pose a significant barrier to widespread adoption, particularly in resource-limited settings like LMICs. Addressing these challenges is crucial to realizing the full potential of metaverse technology in medical education. CONCLUSION: The metaverse offers a promising solution for enhancing medical education by providing immersive, context-rich learning experiences. This paper proposes a conceptual framework and fundamental design elements to aid faculty educators and medical practitioners in effectively incorporating metaverse technology into their teaching methods, thus improving educational outcomes in LMICs.

The metaverse offers a transformative pathway for basic sciences medical education in lower-middle-income countries (LMICs) through leveraging 3D human replicas, virtual dissection, laboratories, and simulations.A metaverse-based learning design may easily combine a variety of learning theories, instructional design models, and/or conceptual frameworks, including constructivism, the ADDIE model, universal design, and minimalism.Unlocking the full potential of VR and AR in basic sciences medical education for LMIC universities requires collaborative synergy among educators, policymakers, and technology developers, with a crucial emphasis on equitable access and resource allocation.Despite the immense promise held by metaverse-powered education, it is crucial to address issues surrounding technology accessibility, learning design challenges, and implementation barriers in LMICs as we provide guidance to educators and practitioners worldwide.

The iBuddy experience: A digital simulation-based approach to enhance secondary school students' privacy awareness.

Privacy is a central issue in the digitalization of society and directly concerns all Internet users. Privacy education is part of the picture of a more just digital society: it aims at making users more aware of the importance of their data and of the technical and financial tools and processes that involve their personal data. Nonetheless, privacy education is confronted with a paradox: while people perceive the importance of privacy, they seldom take action to actually protect their personal data. iBuddy is a narrative simulation-based session inspired by research evidence about the privacy paradox and aims to (a) enhancing awareness and (b) promoting the uptake of privacy-safe behaviors for secondary and higher students (age range 11-20). The paper presents the design and development of the simulation and of the following modular debriefing, as a case study in evidence-based collaborative instructional design and in the instructional used of digital technology. The evaluation of iBuddy, which combined a post-session satisfaction and perceived learning survey (N = 978) and a follow-up survey (N = 124), provides insights in the novel domain of privacy education. Results suggests that iBuddy sessions are engaging, effective and conducive to medium-term behavioral change, thus indirectly confirming the design assumptions about how to tackle the privacy paradox through a simulation-based approach.

The role of implementing instructional design principles on learner experience with training in current good manufacturing practices (cGMP).

INTRODUCTION: The objective of the study was to assess if improvement of the learner experience could be achieved through the use of instructional design strategies in current Good Manufacturing Practices (cGMP) training. This is a novel application in a topic that is known to be boring but is critical to ensuring patient safety. METHODS: An experimental randomized controlled repeated measures cross-over design was utilized in a sample of pharmacy students to determine the effect of an intervention training strategy (which utilized a mix of strategies including weeding, signaling, use of multimedia, and optimized space and type) on the learner experience (Evaluation, Overall Satisfaction, Perceived Knowledge, and Future Recommendation) compared with a control. RESULTS: The sample of 52 pharmacy students that participated evaluated the intervention training strategy with higher scores than the control, with better overall satisfaction, perceived knowledge, and future recommendation scores than the control training strategy. Thus, an apparent effect which resulted from the use of instructional design strategies was seen for all learner experience variables (p < .01). CONCLUSION: Improvement in the learner experience can be achieved by using instructional design strategies in cGMP training. This indicates that similar results could be obtained in other topics where such techniques have not yet been applied.

Twelve tips to virtually operationalize co-creation of educational design.

Co-creation is the active involvement of all stakeholders, including students, in educational design processes to improve the quality of education by embodying inclusivity, transparency and empowerment. Virtual co-creation has the potential to expand the utility of co-creation as an inclusive approach by overcoming challenges regarding the practicality and availability of stakeholders, typically experienced in face-to-face co-creation. Drawing from the literature and our experiences of virtual co-creation activities in different educational contexts, this twelve tips paper provides guidelines on how to effectively operationalize co-creation in a virtual setting. Our proposed three-phased approach (preparation, conduction, follow-up) might help those aiming to virtually co-create courses and programs by involving stakeholders beyond institutes and across borders.

Examining the pedagogical practices that support cultural proficiency development in graduate health science students.

BACKGROUND: Health disparities are often a function of systemic discrimination and healthcare providers' biases. In recognition of this, health science programs have begun to offer training to foster cultural proficiency (CP) in future professionals. However, there is not yet consensus about the best ways to integrate CP into didactic and clinical education, and little is known about the role of clinical rotations in fostering CP. METHODS: Here, a mixed-methods approach was used to survey students (n = 131) from a private all-graduate level osteopathic health sciences university to gain insight into the training approaches students encountered related to CP and how these may vary as a function of academic progression. The research survey included instruments designed to quantify students' implicit associations, beliefs, and experiences related to the CP training they encountered through the use of validated instruments, including Implicit Association Tests and the Ethnocultural Empathy Inventory, and custom-designed questions. RESULTS: The data revealed that most students (73%) had received CP training during graduate school which primarily occurred via discussions, lectures, and readings; however, the duration and students' perception of the training varied substantially (e.g., training range = 1-100 hours). In addition, while students largely indicated that they valued CP and sought to provide empathetic care to their patients, they also expressed personal understandings of CP that often fell short of advocacy and addressing personal and societal biases. The results further suggested that clinical rotations may help students attenuate implicit biases but did not appear to be synergistic with pre-clinical courses in fostering other CP knowledge, skills, and attitudes. CONCLUSIONS: These findings highlight the need to utilize evidence-based pedagogical practices to design intentional, integrated, and holistic CP training throughout health science programs that employ an intersectional lens and empowers learners to serve as advocates for their patients and address systemic challenges.

The implication of instructional design for deciduous tooth identification in a dental morphology course for undergraduate dental students.

Background/purpose: The pediatric dentistry courses are lacking in our six-year undergraduate dental education. The purpose of this study was to evaluate the implication of instructional design for deciduous tooth identification in a dental morphology course for undergraduate dental students through students' perspectives. Materials and methods: A total of 34 s-year dental students who took this dental morphology course were invited to fill out the questionnaire for survey of instructional design for deciduous tooth identification after the class. Results: Of the 34 dental students, 32 of them participated in the survey with a valid response rate of 94.1%. The results showed that most students found the learning activity of instructional design for deciduous tooth identification to be helpful for improving their knowledge about deciduous dentition. Most of them also had positive attitude towards this instructional design. Conclusion: Since the proportion of pediatric dentistry courses in the undergraduate dental education is very low and children's oral problems are indeed faced by all dentists, it is important to add learning units of pediatric dentistry-related knowledge in different undergraduate dental professional courses or to propose strategies to promote students' awareness of self-directed learning about pediatric dentistry. This study may serve as a model for other undergraduate dental courses in Taiwan.

A new practical approach using TeamSTEPPS strategies and tools: - an educational design.

BACKGROUND: Teamwork has played a critical role in ensuring patients' safety and preventing human errors in surgery. With advancements in educational technologies, including virtual reality, it is necessary to develop new teaching methods for interpersonal teamwork based on local needs assessments in countries with indigenous cultures. This study aimed to design and develop a new method of teaching teamwork in cesarean section surgery using virtual reality; we further evaluated the effects of this method on healthcare professionals' knowledge and attitudes about teamwork. METHODS: This study was designed using the ADDIE instructional design model. The TeamSTEPPS Learning Benchmarks questionnaire was used to assess the educational needs of 85 participants who were members of the cesarean section surgery team. A specialized panel analyzed the extracted needs, and the scenario was compiled during the design stage. Finally, four virtual reality contents were created using 360-video H.265 format, which were prepared from specified scenarios in the development of the educational program. The TeamSTEPPS Learning Benchmarks questionnaire was used to measure knowledge, and the T-TAQ was used to measure the participants' attitudes. RESULTS: Six micro- skills were identified as training needs, including briefing, debriefing, cross-monitoring, I'M SAFE checklist, call-out and check-back, and two-challenge rule. Intervention results showed that the virtual reality content improved teamwork competencies in an interprofessional team performing cesarean section surgery. A significant increase was observed in the mean score of knowledge and attitude after the intervention. CONCLUSION: Through addressing the need for teamwork training, utilizing the TeamSTEPPS strategy, and incorporating new educational technologies like virtual reality, the collaboration among surgical team members can be enhanced.

Integrating basic sciences into clerkship rotation utilizing Kern's six-step model of instructional design: lessons learned.

BACKGROUND: It is generally agreed that basic and clinical sciences should be integrated throughout the undergraduate medical education, however, there is still need for continued formal integration of basic sciences into clinical clerkship in many medical schools across the globe. METHODS: Utilizing Kern's Six-Step Model of Instructional Design, we aimed to develop an intervention that would facilitate cognitive integration of basic and clinical sciences. After problem identification and targeted needs assessment through focused group discussion with the students and faculty, objectives were devised with an implementation plan of using flipped class approach to develop a content-focused and learner-centered teaching strategy. This intervention was piloted in the 2-week cardiology clerkship in Year 5. Evaluation of the content, integration, student and faculty experiences were recorded through in-depth interviews, FGDs and a formative MCQ test. RESULTS: Flipped classroom based integrated sessions were successfully developed. The implementation phase was met with challenges that primarily stemmed from the diverse teaching styles among faculty members, hesitance to deviate from conventional practices, variations in clinic timings, and demanding schedules. Noteworthy observations were in terms of ownership of the project, the need for faculty development in modern student-centered teaching pedagogies, opportunities for content improvement, scheduling of sessions, and suggestion of revisiting fundamental concepts in basic sciences through a brief boot camp-style session at the onset of the clerkship. The role of flipped case model and clinical cases in integrating basic sciences into clinical sciences were appreciated by the students. Standardization in teaching practices was identified as the major challenge by the faculty. CONCLUSIONS: A functional, learner-centered framework of cognitive integration of basic sciences in clinical sciences curriculum of cardiology rotation was developed with a potential to be implemented in other clerkship rotations.