Does collective efficacy drive readiness for interprofessional learning? Evidence from a large-scale interprofessional education program in Hong Kong.

Interprofessional education has been widely integrated into health education curricula to enable students to work comfortably as members of a healthcare team. However, not much is known about the psychosocial mechanism that defines students' readiness for interprofessional learning. Drawing from social cognitive theory, we examined the pathway where collective efficacy was construed to influence subsequent students' satisfaction with team experiences, readiness for interprofessional learning, and attainment of interprofessional learning outcomes. Through path analysis, we examined data from 1,005 health and social care students who participated in a large-scale interprofessional education in Hong Kong. Results indicated that collective efficacy directly and indirectly predicted students' readiness for interprofessional learning and perception of attainment of IPE learning outcomes. Theoretical and practical implications of findings in the management of interprofessional education are discussed.

Gross Anatomy Education in China during the Covid-19 Pandemic: A National Survey.

The Covid-19 pandemic launched the use of online courses in Chinese medical schools during February 2020. To evaluate the state of gross anatomy education in China during the pandemic, a nationwide survey was conducted through convenience sampling by email or respondent invitations on social media. A total of 359 questionnaires were received from the respondents. The first response from a given school was included in the study to represent that school, thus, 77 questionnaires were used for analyses. Schools represented were from all provinces in mainland China as well as Hong Kong and Macao. The survey found that before the pandemic, 74.0% and 33.8% of the 77 schools conducted online theoretical and practical sessions, respectively, on gross anatomy, and 36 (46.8% of 77) had temporarily suspended practical sessions at the time the survey was conducted. Body donation programs were also affected with 26.0% and 27.3% of the 77 schools having suspended donation programs or saw a decreased number of donations. During the pandemic, 40.3% of the 77 schools kept or initiated the implementation of active learning, and online assessment was continued in 49.4% of the 77 medical schools. Another 26 (33.8%) schools initiated online assessment during the pandemic. A total of 359 answers were included for the analysis of the "teachers' perception of the online teaching experience." Over half (51.0%) of the 359 responded teachers were very statisfied or satisfied with the effectiveness of online teaching during the pandemic. A total of 36.2% of these respondents preferred to implement online teaching of theoretical sessions after the pandemic, and 89 (24.8%) teachers were keen to return to traditional face-to-face anatomy education.

Adaptions and perceptions on histology and embryology teaching practice in China during the Covid-19 pandemic.

Backgroud: Under the circumstance of school closures caused by the coronavirus outbreak, medical schools in China began implementing online teaching, including histology and embryology (HE) beginning in the middle of February 2020. The changes in HE education in responding to the pandemic in China needs to be determined, for further adaption of online teaching delivery or blended learning. Methods: A nationwide survey of the major medical colleges was conducted via WeChat. Results: In total, 83 medical schools (one respondent per school) were invited to survey, 78 medical schools responded which represented most medical schools across all the provinces in mainland China, as well as Hong Kong and Macao. The results revealed that 77% (n = 60) and 58% (n = 45) of the responding schools had conducted HE theoretical and practical online teaching, respectively, prior to the pandemic; however, 27% (n = 21) of the medical schools had temporally suspended practical sessions at the time the survey was completed. During the pandemic, 73% (n = 57) and 29% (n = 23) of the medical schools delivered HE theoretical and practical sessions by synchronous live broadcasting, respectively; 65% (n = 51) of the medical schools increased virtual microscopy using during practical sessions. During the pandemic, 54% (n = 42) of the medical schools implemented teaching activities promoting active learning; meanwhile, online assessment was implemented in 84% (n = 66) of the responding medical schools. With regard to the satisfaction with the effectiveness of online teaching during the pandemic, 64% (n = 50) of the medical schools gave positive answers and considered that it was a good opportunity to develop novel and diversified teaching methods. Despite various difficulties such as work overload and unstable online teaching environments, most medical schools are willing to continue or increase theoretical online teaching after the pandemic. Conclusions: Medical institutes in China were the earliest of closing campuses and having complete online teaching experience during the pandemic. This paper presents overall HE teaching situation extracted from the survey, to assist other medical schools optimizing the transitions to quality online teaching within a short time, and to serve as reference for schools that demand essential knowledge in online teaching methods, infrastructure construction, and platform integrations.

Learning environments for interprofessional education: A micro-ethnography of sociomaterial assemblages in team-based learning.

BACKGROUND: Teamwork and collaboration are central to interprofessional education but fostering these attributes in large undergraduate cohorts is challenging. OBJECTIVES: This study aimed to examine the complexities of IPE group learning processes by examining how the material and intersubjective intertwine when newly formed interprofessional groups (Chinese medicine, medicine, nursing, pharmacy, and social work) synchronously engaged with face-to-face and online learning in a blended, team-based learning environment. METHODS: It was a micro-ethnography study using a sociomaterial theoretical lens. We selected two undergraduate interprofessional healthcare student groups within a large scale programme for contrastive video analysis of synchronous spatial and physical configurations, associated talk, and online activity. RESULTS: Video analysis of evolving physical configurations indicated that Group B was spatially more evenly grouped, and physically orientated to an identifiable leader, despite their blinded peer evaluations indicating distributed leadership. Group A faced a critical event at a public forum leading to spatial disruption breaking into subgroups and isolates; however, this group identified one member as a defined leader in the peer evaluations. CONCLUSIONS: Based on online scores, we found that peer identification of leaders may influence learning processes but not learning outcomes in the first IPE team meeting. The design of the physical and virtual learning environments contributed to the developing, sociomaterial processes of group cohesion in interprofessional team-based learning.

Histology and Embryology Education in China: The Current Situation and Changes Over the Past 20 Years.

In mainland China, histology and embryology (HE) are taught in one course as an essential component of medical curricula. The effectiveness of HE courses directly affects the quality of medical students. To determine the present situation and changes in HE teaching in Chinese medical schools, a nationwide survey was conducted among the HE departmental leaders. In total, 66 responses were included in the study, representing prominent Chinese mainland medical schools. The results revealed that most HE teachers have medical educational backgrounds; an increasing number of teaching staff with PhDs have joined the teaching staffs. A range of 71 to 90 HE curriculum contact hours is predominant. The ratio of theory to practice for HE contact hours is 1:1 at half of the surveyed medical schools. The numbers of students in each laboratory are less than 30 and from 31 to 60 at 23 and 36 medical schools, respectively. Virtual microscopy is employed in 40% of the surveyed medical schools. Didactic teaching is the most common strategy, although new teaching approaches are being employed gradually. During the past 20 years, both the total number of HE teachers and the number of HE teachers with medical educational backgrounds have been reduced in at least half of the surveyed schools. A total of 83.33% of the surveyed schools have reduced their HE contact hours. Almost half of the Chinese medical schools remained unchanged in both their ratio of theory to practice and the number of students in each laboratory. The data derived from this study help to understand the development of the HE discipline at Chinese medical schools.

Survey of Gross Anatomy Education in China: The Past and the Present.

Medical education in mainland China has undergone massive expansion and reforms in the past decades. A nation-wide survey of the five-year clinical medicine programs aimed to examine the course hours, pedagogies, learning resources and teaching staff of anatomy both at present and over the past three decades (1990-1999, 2000-2009, and 2010-2018). The directors or senior teachers from 90 out of the 130 five-year clinical medicine programs were invited to fill out a factual questionnaire by email. Ultimately, sixty-five completed questionnaires were received from 65 different schools. It was found that the total number of gross anatomy course hours has decreased by 11% in the past 30 years and that systematic and regional anatomy have been increasingly taught separately among the surveyed medical schools. Problem-based learning has been adopted in thirty-five (54%) of the surveyed schools, and team-based learning is used in ten (15%) of the surveyed schools. The surveyed schools reported receiving more donated cadavers in recent years, with the average number increasing from 20.67 ± 20.29 in 2000-2009 to 36.10 ± 47.26 in 2010-2018. However, this has not resulted in a decrease in the number of students who needed to share one cadaver (11.85 ± 5.03 in 1990-1999 to 14.22 ± 5.0 in 2010-2018). A decreasing trend regarding the teacher-student ratio (1:25.5 in 2000-2009 to 1:33.2 in 2010-2018) was also reported. The survey demonstrated the historical changes in gross anatomy education in China over the past thirty years.

Which of the four models? Examining the measurement properties of the Interdisciplinary Education Perception Scale (IEPS) in healthcare and socialcare prelicensure curriculum in Hong Kong.

Interdisciplinary Education Perception Scale (IEPS) is one of the popular measures of perceptions of collaboration. In its original inception, a four-factor model was proposed but subsequent study offered alternative measurement models: three-factor model, two-factor model, and further revision of the three-factor model. Despite the changes in the model structures, none of these has been examined in the Asian context which could have paved the way for local researchers to start representing Asian perspectives in the discussion of interprofessional practice and cooperation in medical education. This study therefore aimed to examine the measurement properties of the IEPS by testing the four a priori models using the data from 335 Chinese students from eight prelicensure health and social care programs from two universities in Hong Kong. Through item analysis, confirmatory factor analysis, and regression, the results suggest that the 12-item, three-factor model best represented the sample and was invariant across genders and year levels. Theoretical and practical implications to interdisciplinary education literature are discussed.

Psychometric validation of team experiences questionnaire in preregistration Chinese health and social care students in Hong Kong.

The complexity of patients' healthcare needs can be addressed more adequately by professionals working as a healthcare team. In view of this, it is important to prepare students for collaborative work when they become professionals through a students' team training at the preregistration level. As intervention programs are implemented to promote students' collaboration, instruments like Team Experiences Questionnaire (TEQ) are needed. In this connection, this study which involved 335 Chinese students enrolled in eight health and social care programs from two universities in Hong Kong investigated the factor structures of the TEQ using construct validation approach. Using confirmatory factor analysis, we examined the fit of three competing models: unidimensional model, first-order correlated model, and second-order hierarchical model. The results demonstrated that the second-order hierarchical model obtained the best fit, with a higher-order construct called total team experiences subsuming the following first order factors: overall satisfaction with team experiences, team impact on quality of learning, satisfaction with team evaluation, team impact on clinical reasoning ability, and professional development. The "total team experience" construct explained from 21.1% to 35.7% of the variance in predicting students' future perception of team competency and autonomy, perceived need for cooperation, and perception of actual cooperation. Results support the applicability of the TEQ second-order hierarchical model. Implications are discussed.

Construct validation of the English version of Readiness for Interprofessional Learning Scale (RIPLS): Are Chinese undergraduate students ready for 'shared learning'?

Interprofessional education has been receiving attention as a result of research suggesting the benefits of interpersonal collaboration in healthcare. In Hong Kong, the implementation of the Interprofessional Team-based Learning programme provides implicit call to study the psychometric properties of Readiness for Interprofessional Learning Scale (RIPLS) to clarify if this is a valid measure when used in the Chinese undergraduate healthcare context. This study examines the psychometric properties of RIPLS involving predominantly Chinese undergraduate healthcare students in Hong Kong. Using within- and between-network approaches to construct validity, we investigated the applicability of English version of RIPLS among 469 predominantly Hong Kong Chinese students who have competence in the English language. These participants were from complementary health professional programmes: biomedical sciences, chinese medicine, medicine, nursing, and pharmacy, from two universities in Hong Kong. The within-network test results indicated that RIPLS had good internal consistency reliability. Results of the confirmatory factor analysis lend support to the overall factor structure of hypothesized four-factor solution although one item obtained non-significant factor loading. The between-network test also suggests that various subscales of RIPLS correlated systematically with theoretically relevant constructs: collective efficacy, team impact on quality of learning, and team impact on clinical reasoning ability. The RIPLS is a valid measure to estimate the Chinese undergraduate healthcare students' readiness to engage in interprofessional learning.

Implementation of an interprofessional team-based learning program involving seven undergraduate health and social care programs from two universities, and students' evaluation of their readiness for interprofessional learning.

BACKGROUND: Interprofessional learning is gaining momentum in revolutionizing healthcare education. During the academic year 2015/16, seven undergraduate-entry health and social care programs from two universities in Hong Kong took part in an interprofessional education program. Based on considerations such as the large number of students involved and the need to incorporate adult learning principles, team-based learning was adopted as the pedagogy for the program, which was therefore called the interprofessional team-based learning program (IPTBL). The authors describe the development and implementation of the IPTBL program and evaluate the effectiveness of the program implementation. METHODS: Eight hundred and one students, who are predominantly Chinese, participated in the IPTBL. The quantitative design (a pretest-posttest experimental design) was utilized to examine the students' gains on their readiness to engage in interprofessional education (IPE). RESULTS: Three instructional units (IUs) were implemented, each around a clinical area which could engage students from complementary health and social care disciplines. Each IU followed a team-based learning (TBL) process: pre-class study, individual readiness assurance test, team readiness assurance test, appeal, feedback, and application exercise. An electronic platform was developed and was progressively introduced in the three IUs. The students' self-perceived attainment of the IPE learning outcomes was high. Across all four subscales of RIPLS, there was significant improvement in student's readiness to engage in interprofessional learning after the IPTBL. A number of challenges were identified: significant time involvement of the teachers, difficulty in matching students from different programs, difficulty in making IPTBL count towards a summative assessment score, difficulty in developing the LAMS platform, logistics difficulty in managing paper TBL, and inappropriateness of the venue. CONCLUSIONS: Despite some challenges in developing and implementing the IPTBL program, our experience showed that TBL is a viable pedagogy to be used in interprofessional education involving hundreds of students. The significant improvement in all four subscales of RIPLS showed the effects of the IPTBL program in preparing students for collaborative practice. Factors that contributed to the success of the use of TBL for IPE are discussed.

The effect of interprofessional team-based learning among nursing students: A quasi-experimental study.

BACKGROUND: Although interprofessional education has received attention in recent years as a means of providing opportunities for health-care professionals to learn with, from and about other disciplines and enhance the quality of patient care, evidence of its effectiveness is limited. Interprofessional team-based learning was introduced to make it possible for students in different healthcare disciplines to interact with each other, and to prepare them to function effectively within a team in their future career. OBJECTIVES: To examine the effects of interprofessional team-based learning for undergraduate nursing students in terms of knowledge level, readiness for interprofessional learning, attitude towards various aspects of team learning, and perceived collective efficacy. DESIGN: The study employed a one-group pretest-posttest quasi-experimental design. METHODS: An interprofessional education program was given to students from two universities in Hong Kong who were in different healthcare disciplines including medicine, nursing, pharmacy, biomedical science, and Chinese medicine programs. The program was based on four phases of student learning- individual readiness assessment test, ice breaking session, team readiness assessment test, and application exercise. Nursing students involved in the program were invited to complete anonymous questionnaires to evaluate their interprofessional team experience. RESULTS: A total of 40 nursing students (9 male, 31 female) participated in the study. A statistically significant improvement was identified in their knowledge level (p<0.001), attitude towards readiness for interprofessional learning, team learning, and perceived collective efficacy (p<0.001). CONCLUSION: This study suggests that interprofessional team-based learning can enhance cross-disciplinary learning and outcomes resulting from team efforts.

Application of the one-minute preceptor technique by novice teachers in the gross anatomy laboratory.

The one-minute preceptor (OMP) was originally developed in the ambulatory care setting as a time-efficient teaching technique for learner-centered clinical training. There are also possible advantages of using the OMP in the gross anatomy laboratory. However, in a previous study it was found that providing training to experienced gross anatomy teachers in the use of the OMP did not result in improvement in students' perceptions of their learning, probably because of the fact that the experienced teachers had already developed their own pedagogical approaches. In the current study, we examined the effects of training novice teachers with about four years of gross anatomy teaching experience, in the use of the OMP in the gross anatomy laboratory, by surveying students to collect their views on their learning experiences, by observing the teachers' teaching behaviors before and after they were trained in OMP, and then by interviewing them. More students reported a better learning experience in the session after the teachers had been trained in the OMP than reported worse, in eight out of the nine items related to their learning experiences. The novice teachers were receptive to the OMP. After the OMP training, the novice teachers were observed to engage more in getting commitments from the students and in reinforcing what the students have done right, two of the five OMP microskills. They considered the OMP to be very useful for their development as anatomy teachers.

The thoracic shape of hominoids.

In hominoids, the broad thorax has been assumed to contribute to their dorsal scapular position. However, the dorsoventral diameter of their cranial thorax was found in one study to be longer in hominoids. There are insufficient data on thoracic shape to explain the relationship between broad thorax and dorsal scapular position. The current study presents data on multilevel cross-sectional shape and volume distribution in a range of primates. Biplanar radiographs of intact fluid-preserved cadavers were taken to measure the cross-sectional shape of ten equally spaced levels through the sternum (called decisternal levels) and the relative volume of the nine intervening thoracic segments. It was found that the cranial thorax of hominoids is larger and broader (except in the first two decisternal levels) than that of other primates. The cranial thorax of hominoids has a longer dorsoventral diameter because the increase in dorsoventral diameter caused by the increase in the volume of the cranial thorax overcompensates for the decrease caused by the broadening of the cranial thorax. The larger and broader cranial thorax in hominoids can be explained as a locomotor adaptation for scapular gliding and as a respiratory adaptation for reducing the effects of orthograde posture on ventilation-perfusion inequality.

Effects of training experienced teachers in the use of the one-minute preceptor technique in the gross anatomy laboratory.

The one-minute preceptor (OMP) is a time-efficient, learner-centered teaching method used in a busy ambulatory care setting. This project evaluated the effects of training experienced anatomy teachers in the use of the OMP in the gross anatomy laboratory on students' perceived learning. Second-year medical students from a five-year, undergraduate-entry, system- and problem-based medical program were divided randomly into two groups of 76 students each. The groups took part in the same gross anatomy laboratory session on different dates, supervised by the same two teachers (both with over 25 years of teaching experience). The teachers attended a workshop on the use of the OMP between the two sessions. Students were given a questionnaire at the end of the two sessions to indicate their agreements to statements regarding their learning experiences. Semistructured interviews were conducted with the two teachers after the second session. Results showed that training experienced anatomy teachers in the use of the OMP did not result in improvement of student learning perception in the gross anatomy laboratory. The experienced teachers have developed their own approaches with elements similar to those in the OMP: being learner centered and adaptable to individual student's needs, providing feedback, and enhancing teacher immediacy. They do not have an explicit structure such as the OMP, and are thus flexible and adaptive. Confining the teachers' teaching behaviors to the OMP structure could limit their performance. Although there are theoretical advantages for novice teachers in adopting the OMP technique, these advantages still need to be supported by further studies.

Medial subtalar arthroscopy: a cadaveric study of the tarsal canal portal.

PURPOSE: To study the safety of the tarsal canal portal in medial subtalar arthroscopy. METHODS: Twenty-three fresh frozen foot and ankle specimens were divided into two groups with different orientation of the portal tract. Three types of tarsal canal portals were identified. The relationships of the metal rod and the flexor digitorum longus tendon and the posterior neurovascular bundle were studied. RESULT: In group A, a type 1 tarsal canal portal tract was established in seven specimens, a type 2 portal tract in three specimens, and a type 3 portal tract in two specimens. In group B, a type 1 portal tract was established in ten specimens and a type 2 portal tract in one specimen. No type 3 portal tract was established in group B. There was no statistical significance demonstrated for establishment of a type 1 portal tract and "non type 1" (type 2 or 3) portal tract in group A and group B. The average shortest distance between the rod and the posterior tibial neurovascular bundle was 7 mm in group A and 9 mm in group B. CONCLUSIONS: This study provides the anatomic basis for the establishment of the tarsal canal portal. There is a risk of injury to the flexor digitorum longus tendon and the posterior tibial neurovascular bundle with the tarsal canal portal, and it should be used with great caution.

Voices of donors: case reports of body donation in Hong Kong.

Body donation is important for medical education and academic research. However, it is relatively rare in Hong Kong when compared with many Western countries. Comprehensive research has been performed on the motivation for body donation in Western countries; however, there is still insufficient research on body donation in Hong Kong to provide information on how to increase the body-donation rate. To understand the factors involved in the decision to donate one's body, the authors interviewed a registered donor and the daughter of another donor in Hong Kong. The authors interpreted the information collected in light of the available published reports, which mostly focus on body donation in Western countries. Despite the consistency of some demographic factors and motivations between the participants in our study and those investigated in the published reports from Western countries, there are differences in education level and socioeconomic status between the donors in our study and those from Western studies. The authors also suggest that Confucianism and Buddhism in Chinese culture may motivate potential body donors in Hong Kong. Other important factors that influence the body-donation decision may include family members' body donation, registration as organ donors, and good doctor-patient relationships. Although case report studies have their limitations, this study allows us to explore the complexity of events and establish the interconnectivity of factors involved in body donation, which could not be achieved in previous survey-based studies.

Deep peroneal nerve injury following external fixation of the ankle: case report and anatomic study.

BACKGROUND: We present a case of deep peroneal nerve injury after application of external fixator and conducted a cadaveric study of the relationship of the deep peroneal nerve to the lateral tibial cortex. MATERIALS AND METHODS: A case of toe drop after application of the external fixator is reported. Twelve cadaveric lower legs were dissected to identify the course of the deep peroneal nerve. The tibia were divided into four Zones with equal length. The course of the nerve through each Zone of the tibia was studied Result: In Zone 1, the deep peroneal nerve went around the fibular neck and was found on the interosseous membrane at the distal portion of Zone 1. In Zone 2, the nerve still lay on the interosseous membrane in all specimens at the posterior edge of the lateral tibia. In Zone 3, the nerve moved away from the interosseous membrane and had direct contact with the tibia in nine specimens. In Zone 4, the nerve was on the anterior surface of the distal tibia. CONCLUSION: The deep peroneal nerve can be injured during the application of a unilateral frame ankle external fixator. The nerve is particularly at risk in Zone 2 and 3. CLINICAL RELEVANCE: The study provided an anatomic basis for the safe application of a unilateral external fixator of the tibia.