Educational strategies in the health professions to mitigate cognitive and implicit bias impact on decision making: a scoping review.

BACKGROUND: Cognitive and implicit biases negatively impact clinicians' decision-making capacity and can have devastating consequences for safe, effective, and equitable healthcare provision. Internationally, health care clinicians play a critical role in identifying and overcoming these biases. To be workforce ready, it is important that educators proactively prepare all pre-registration healthcare students for real world practice. However, it is unknown how and to what extent health professional educators incorporate bias training into curricula. To address this gap, this scoping review aims to explore what approaches to teaching cognitive and implicit bias, for entry to practice students, have been studied, and what are the evidence gaps that remain. METHODS: This scoping review was guided by the Joanna Briggs Institute (JBI) methodology. Databases were searched in May 2022 and included CINAHL, Cochrane, JBI, Medline, ERIC, Embase, and PsycINFO. The Population, Concept and Context framework was used to guide keyword and index terms used for search criteria and data extraction by two independent reviewers. Quantitative and qualitative studies published in English exploring pedagogical approaches and/or educational techniques, strategies, teaching tools to reduce the influence of bias in health clinicians' decision making were sought to be included in this review. Results are presented numerically and thematically in a table accompanied by a narrative summary. RESULTS: Of the 732 articles identified, 13 met the aim of this study. Most publications originated from the United States (n=9). Educational practice in medicine accounted for most studies (n=8), followed by nursing and midwifery (n=2). A guiding philosophy or conceptual framework for content development was not indicated in most papers. Educational content was mainly provided via face-to-face (lecture/tutorial) delivery (n=10). Reflection was the most common strategy used for assessment of learning (n=6). Cognitive biases were mainly taught in a single session (n=5); implicit biases were taught via a mix of single (n=4) and multiple sessions (n=4). CONCLUSIONS: A range of pedagogical strategies were employed; most commonly, these were face-to-face, class-based activities such as lectures and tutorials. Assessments of student learning were primarily based on tests and personal reflection. There was limited use of real-world settings to educate students about or build skills in biases and their mitigation. There may be a valuable opportunity in exploring approaches to building these skills in the real-world settings that will be the workplaces of our future healthcare workers.

The Equivalency of the Binocular Indirect Ophthalmoscope Simulator to Peer Practice: A Pilot Study.

SIGNIFICANCE: Optometric educators are constantly looking for learning and teaching approaches to improve clinical skills training. In addition, the COVID-19 pandemic has made educators scrutinize the time allocated to face-to-face teaching and practice. Simulation learning is an option, but its use must first be evaluated against traditional learning methods. PURPOSE: The purpose of this study was to compare the training of binocular indirect ophthalmoscopy skills achieved by students and optometrists through deliberate practice on the Eyesi Indirect Ophthalmoscope simulator with deliberate practice using a peer. METHODS: Students and optometrists were randomly allocated to practice on either the simulator or a peer. Binocular indirect ophthalmoscopy performance was assessed using a peer and the simulator as the patients at different time points. Knowledge and confidence were examined before and following all practice sessions using a quiz and survey. RESULTS: Significant improvements in binocular indirect ophthalmoscopy performance using either a peer or the simulator as the patient for assessment were seen after 8 hours of student practice (P < .001) and after a half-hour practice time for optometrists (P < .001). There was no significant difference in performance overall between those practicing on a simulator and those practicing on a peer (P > .05). Confidence in ability to perform the technique was lower for students who had practiced on the simulator. CONCLUSIONS: The simulator has similar efficacy to peer practice for teaching binocular indirect ophthalmoscopy to students and maintenance of this clinical skill for optometrists. Simulation does not replace the need for peer practice but may be a useful adjunct reducing the face-to-face hours required. These findings present a need for further research regarding diverse applications of the Eyesi Indirect Ophthalmoscope simulator in the curriculum for training optometry students and as a continuing professional development offering for optometrists, given the short exposure duration required to observe a significant improvement in skill.

Pilot Study: Thinking Outside the Square in Cultivating "Soft Skills"-Going beyond the Standard Optometric Curriculum.

SIGNIFICANCE: No research in optometric education that uses Moore's concept of creativity and object-based learning to cultivate "soft skills" exists. The design and outcomes of this study will contribute to the body of optometric education, and future research will assess the applicability of these findings to other allied health disciplines. PURPOSE: Optometrists, like all health care professionals, need to be proficient in soft skills such as effective communication and interpersonal skills. Rather than assuming these soft skills can be developed "on the job," we implemented a teaching intervention for students to develop their communication, interpersonal, and teamwork skills. METHODS: Students from optometry, arts management, and animation attended an autobiographical museum in interdisciplinary groups and examined an artifact relating to aspects of professionalism mentioned previously. We evaluated whether and how students experienced this activity as enhancing their creativity and other soft skills via survey results and thematic analysis of their reflective essays. RESULTS: Our findings showed that this group work has augmented their professional development, with approximately 90% of the students reporting that it had helped in critical self-reflection and future improvement of communication and interpersonal skills. Eighty percent of the students stated that this group work was beneficial and enjoyable and recommended object-based and interdisciplinary learning to be embedded in future group work. Themes generated from the essays were the following: (a) perceptions of object-based learning in a museum and (b) insights into group work experiences. CONCLUSIONS: This is the first pilot study that investigates group work across optometry and nonclinical disciplines in a post-graduate curriculum using museum objects. Our findings, based on students' perceptions, imply that students emerged from the program with the intent to transfer their learning to their future practice. We propose that this purposefully designed-based and creative group work may support the development of professional attributes essential for optometric students.

Learning professionalism using creativity and diversity concepts.

CLINICAL RELEVANCE: Professionalism is a multidimensional sociocultural construct that is abstract, evolving and context-dependent in nature. This has made the teaching and assessment of professionalism in healthcare complex and challenging. A lack of professionalism can increase patient risk and litigation. BACKGROUND: This article examines group creativity and diversity across healthcare and non-healthcare disciplines and how they can assist students in constructing their own understandings and knowledge of professionalism. It is proposed that linking professionalism to creativity will improve understanding on how to help students studying healthcare learn about professionalism better. METHODS: A total of 30 students from different tertiary levels and across disciplines participated in the study. They explored either a gallery or museum and examined an artefact relating to professionalism. Learning experiences were evaluated via survey results and thematic analyses of their reflective essays and semi-structured interviews. RESULTS: Participants reported increased understanding of professionalism and appreciation of perspectives and skills of others. The creative aspect of the task was fun and engaging, and group diversity enabled different opinions and perspectives to be heard and shared. This is analogous to a professional working environment. Themes generated from the essays were: (a) intrinsic motivation, (b) diversity, (c) learnings of professionalism, and (d) challenge encountered. CONCLUSION: The results of this research make a meaningful contribution to existing literature by empirically demonstrating that students from different disciplines could better construct their own understandings of professionalism when their learning activities were performed in an authentically creative and diverse setting. This educational concept is underpinned by diverse types of creativities that are not mutually exclusive. It is hoped that this first piece of evidence will stimulate more studies on utilising group creativity and diversity in healthcare education.

Clinician Awareness of Stickler Syndromes Among Australian Allied Health Care Professionals.

Purpose: Stickler Syndromes are multisystem collagenopathies affecting 1 in 7500-9000 individuals and are associated with craniofacial, ocular, auditory, and musculoskeletal complications. Prophylactic retinopexy treatment reduces the risk of retinal detachment, emphasising the need for early detection and multidisciplinary referral. This study evaluated knowledge and awareness of Stickler Syndromes among allied health professionals and their perceived needs for targeted education to improve multidisciplinary care. Methods: A cross-sectional survey was undertaken among audiologists, speech pathologists, optometrists, orthoptists, and physiotherapists in Australia. Survey questions included practitioner demographics, awareness and knowledge of Stickler Syndromes, confidence managing Stickler Syndromes, and perception of multidisciplinary care needs for Stickler Syndromes. Results: Of 180 healthcare professions who participated (79% female; 78% aged between 25 and 44 years), 55% indicated that they had heard of Stickler Syndrome, and 14% had directly worked with patients known to have Stickler Syndromes. Practitioners who had were either optometrists, orthoptists, or audiologists. The most recognised clinical sign of Stickler Syndromes was retinal detachment (selected by 66% of optometrists and orthoptists and 16% of other professions), but only 41% of optometrists and orthoptists (27% all respondents) selected cryopexy as a potential management strategy. Vitreous anomaly was recognised as a clinical feature by 20% of all respondents. Overall, 69% of allied health professionals did not feel confident managing Stickler Syndromes, and a similar number of practitioners (69%) indicated that they were willing to attend professional development courses for complex conditions such as Stickler Syndromes. Conclusion: This study provides meaningful insights on awareness and knowledge of Stickler Syndromes among allied healthcare professionals. Targeted clinician education, enhanced communication between healthcare entities, and multidisciplinary care programs can significantly improve the integrated care of Stickler Syndromes leading to better patient outcomes.

Visual search in infantile nystagmus syndrome.

CLINICAL RELEVANCE: Research on infantile nystagmus syndrome (INS) and visual search is limited. Conducting this research could assist practitioners in understanding how INS affects the real-life visual activities of patients and aid in developing new clinical visual function assessments for INS. BACKGROUND: The aim of this work is to investigate how subjects with INS perform visual search tasks, and, particularly, to assess how INS subjects perform when targets are located at their null position or away from it, and when under additional cognitive demands. METHODS: INS subjects (N = 15) and controls (N = 20) performed conjunction and feature search tasks, both with and without mental arithmetic. Search performance was assessed using log-transformed total search time, gaze-dependent search time, and accuracy. Cognitive demand was quantified by pupil size and the NASA task-load index score. RESULTS: INS subjects showed longer search times compared to controls in conjunction search (P < 0.01), but not in feature search. Within INS and control subjects, the total search times were significantly increased by the addition of mental arithmetic (P < 0.0001). There was no difference in gaze-dependent search times between null target position and 15° away from null target position of subjects in conjunction search (P > 0.05). Accuracies were 100% for both control and INS subjects in both conjunction and feature search. CONCLUSION: Conjunction visual search was impaired in adult INS subjects, and further worsened under increased cognitive demand. The null position did not affect the visual search performance in INS.

Perception of Coherent Motion in Infantile Nystagmus Syndrome.

Purpose: Research on infantile nystagmus syndrome (INS) and motion perception is limited. We investigated how individuals with INS perform coherent motion tasks. Particularly, we assessed how the null position affects their performance. Methods: Subjects with INS and controls identified the direction of coherent motion stimuli (22 subjects with INS and 13 controls) in a two-alternative forced-choice design. For subjects with INS, testing was done at the null position and 15 degrees away from it. If there was no null, testing was done at primary gaze position and 15 degrees away from primary. For controls, testing was done at primary gaze position and 20 degrees away from primary. Horizontal and vertical motion coherence thresholds were determined. Results: Subjects with INS showed significantly higher horizontal and vertical motion coherence thresholds compared with controls at both gaze positions (P < 0.001). Within the INS group, for 12 subjects with INS who had an identified null position, no differences in coherence thresholds were found between their null and 15 degrees away from it (P > 0.05). Conclusions: Coherent motion perception was impaired in subjects with INS. The null position did not significantly influence motion coherence thresholds for either horizontal or vertical motion.

Velocity Discrimination in Infantile Nystagmus Syndrome.

Purpose: Research on infantile nystagmus syndrome (INS) and velocity discrimination is limited, and no research has examined velocity discrimination in subjects with INS at their null position and away from it. This study aims to investigate how individuals with INS perform, compared with controls, when carrying out velocity discrimination tasks. Particularly, the study aims to assess how the null position affects their performance. Methods: INS subjects (N = 21, mean age 24 years; age range, 15-34 years) and controls (N = 16, mean age 26 years; age range, 22-39 years) performed horizontal and vertical velocity discrimination tasks at two gaze positions. Eighteen INS subjects were classified as idiopathic INS and three had associated visual disorders (two had oculocutaneous albinism, and one had congenital cataract). For INS subjects, testing was done at the null position and 15° away from it. If there was no null, testing was done at primary gaze position and 15° away from primary. For controls, testing was done at primary gaze position and 20° away from primary. Horizontal and vertical velocity discrimination thresholds were determined and analyzed. Results: INS subjects showed significantly higher horizontal and vertical velocity discrimination thresholds compared with controls at both gaze positions (P < 0.001). Horizontal thresholds for INS subjects were elevated more than vertical thresholds (P < 0.0001) for INS subjects but not for controls. Within the INS group, 12 INS subjects who had an identified null position showed significantly lower horizontal and vertical thresholds at the null than at 15° away from it (P < 0.05). Conclusions: Velocity discrimination was impaired in INS subjects, with better performance at the null. These findings could assist in understanding how INS affects the daily activities of patients in tasks involving moving objects, and aid in developing new clinical visual function assessments for INS.

A digital resource to assess clinical competency.

BACKGROUND: Objective structured clinical examinations (OSCEs) are integral to clinical competency-based assessment in health care disciplines. Traditional paper-based OSCEs require considerable administration time and students typically receive an assessment outcome with minimal feedback. We developed and implemented an iPad-based OSCE assessment system in optometry that delivered timely and specific e-feedback. METHODS: The electronic assessment system contains all of the features of a paper-based OSCE format, including a checklist score, a global score section and pre-written feedback. It was trialed in a year-3 OSCE assessment. We evaluated students and examiners' perceptions of this digital resource via surveys and focus group interviews. RESULTS: Over 90% of the students reported that the e-feedback was timely, facilitated self-reflection and was appropriate for assessment. Students' focus group interviews highlighted the importance of the timeliness of feedback, and students found both verbal and written feedback useful. All examiners were satisfied with the features of the assessment system and felt confident using it for assessment. DISCUSSION: The iPad-based OSCE assessment system has enabled timely feedback to be delivered efficiently. This study has provided a model of what constitutes good e-feedback. The technology was well received by both students and examiners. It has helped to close the assessment loop by delivering usable and developmental feedback to meet students' learning needs.

Use of an automated feedback application to improve communication skills.

This article was migrated. The article was marked as recommended. Effective communication skills are a professional competency, yet are often overlooked during training. Providing immediate and constructive feedback is imperative to assist students in developing better communication skills. We sought to evaluate the educational value of using a university-developed application, Rapid Feedback, to provide feedback following students' oral presentations over two years. An online survey comprising of eight 5-point Likert scale items and one open-ended question was conducted in 114 (response rate = 86.5%) students. Students either strongly agreed or agreed that the feedback delivered was timely (98%), relevant (96%), high quality (90%), and specific to enhance their learning (87%). The feedback obtained has helped to identify strengths and weaknesses (87%). Students commented that feedback received will improve their communication skills (90%). The report was also shown to supplement verbal feedback (95%). Overall, students expressed that the feedback report was valuable, allowing for critical self-reflection and future retention. Staff have also found the application easy to use and administer. In a time- and resource-constrained teaching environment, educators constantly explore technology to support student learning and teaching outcomes. We have implemented an application that is user-friendly to staff, efficient, and has provided effective feedback that is well-received and valued by students.