Analysis of screening for neonatal hypoglycemia in large-for-gestational-age newborns without risk factors, and proposed changes in practice at Grenoble University Hospital.

INTRODUCTION: The aim of this study was to evaluate the relevance of screening for neonatal hypoglycemia as it is currently performed, in order to improve the comfort of newborns by reducing the number of painful procedures such as venipunctures or capillary punctures. The primary objective was to determine the prevalence of neonatal hypoglycemia in large-for-gestational-age newborns. The secondary objective was to determine a threshold percentile of birth weight for optimal screening for hypoglycemia. METHODS: We performed a descriptive, cross-sectional, single-center study, based on a structured review of obstetrical records from 11 January 2017 to 21 January 2020, from the maternity department of the University Hospital of Grenoble. Eligible neonates were large-for-gestational-age (birth weight >90th percentile) at term (37-42 weeks) without other risk factors for hypoglycemia. The primary outcome was the prevalence of neonates with capillary or venous glucose levels <2.2 mmol/L in the first 48 hours of life. We performed a sensitivity and specificity analysis of the birth weight percentile as a determinant of the threshold for hypoglycemia detection (ROC curve, area under the curve, Youden index, Brier score, Hosmer-Lemeshow test). RESULTS: In all, 19.2% of the newborns presented at least one hypoglycemic episode during the first 48 hours of life, and 75.7% of the hypoglycemic episodes occurred at 1 hour of life. The cut-off percentile that seemed most appropriate for screening was determined to be the 97th percentile of birth weight (AUC=0.64; 95% CI: 0.52-0.75). CONCLUSIONS: Our statistical model is robust and allows us to state that the currently used birth weight percentile threshold can be revised upwards. Thus, the protocol for neonatal hypoglycemia screening can be updated to improve the comfort of newborns at risk of hypoglycemia.

User-centered evaluation of Discord in midwifery education during the COVID-19 pandemic: Analysis of the adaptation of the tool to student needs.

INTRODUCTION: In the context of the COVID-19 pandemic in 2020, and in order to overcome the lack of face-to-face contact between students and teachers, the midwifery department of Grenoble (France) decided to use the Discord tool in the training of midwifery students. In order to evaluate the relevance of using instant messaging software for the education of future midwives, the tool was evaluated by the students. METHODS: We conducted, in January 2021, a user-centered online study with all midwifery students in training for the classes of 2020-2021, using the French translation of Anstey and Watson's Rubric for the Evaluation of eLearning Tools. This evaluation analyzed the different dimensions of Discord in the context of training: functionality, accessibility, technology, design, privacy and data protection, social presence, pedagogical presence, and cognitive presence. RESULTS: Discord had a good functionality for 75% of the students surveyed. They found Discord to be suitable for maintaining social links and creating serious games. But they did not find it useful for following courses or practical work. More than 80% of the midwifery students interviewed agreed that Discord can be adapted to different learning contexts. CONCLUSIONS: The department can continue to use Discord without reservation for the creation of serious games, as well as for maintaining links between students and teaching staff in the department. Discord has the characteristics of a social network, allowing students to connect with each other.

Biostatistics Disruptive Acculturation Through Serious Gaming: A New Hope.

Biostatistics is one of the transversal subjects that all future doctors must acquire and master. Nonetheless, it is a subject that has the reputation of being difficult, which has not been able to be corrected even with the application of new pedagogical methods such as blended learning. We address this problem with our acculturative and disruptive approach in the form of a serious game scenario in clinical research that integrates biostatistics with our R4Web adapted tools. Our approach was launched in 2008 for the second year of medical school. Here we describe this LOE scenario for serious game including the biostatistics disruptive acculturation task and present its new international version.

Freedom of Master's Degree Students to Study in Health Curricula: Switching to Optimized Blended Learning as a Solution!

OBJECTIVES: The Grenoble (France) Master's degree in health includes 17 sub-specialty programs, 120 separate teaching units (TUs) and caters for up to 400 students per year. We present the pedagogical transition to blended learning based on flipped classroom initiated in 2010 to overcome the pedagogical limitations of classical lectures. METHODS: The pedagogical organization of each TU is based on the weekly and sequential implementation of five sequences. The first three sequences comprise the learning stages of (1) self-learning on knowledge capsules, (2) interactive on-line questions and votes of interest, and (3) interactive on-site training and explanation meetings. The last two sequences include the evaluation stages with (4) positioning tests, and (5) an anonymous evaluation of the TU allowing access to personalized follow-ups. This pedagogical sequence is completed with a final certification on a tablet computer. RESULTS: The systematic evaluation and debriefing sessions of TUs gave us a clear SWOT vision of the revised Master's degree in health. The feedback was very positive from students, teachers, and the institution, which encourages us to move forward in this transition. Nonetheless, some of this positive feedback was unexpected, such as the ease of managing mobile learners (e.g. Erasmus, International internship) or personalized reinforcement. CONCLUSION: Our results indicate that a switch to blended learning is feasible in a large Master program, with improvements on student/teacher equity and for the institution.

Blended Learning for French Health Students: Does Acceptance of a Learning Management System Influence Students' Self-Efficacy?

A learning management system (LMS) used for the initial training of health professionals has been rejected by students. Our study aimed to explain the reason of this rejection. We performed this evaluation on a sample of health students in 2012 and 2017 (n = 144). We used scales from the literature (Technology Acceptance Model, General Self-Efficacy Scale, LMS-Self-Efficacy Scale), and studied the social representation of the LMS. The system seemed accessible and useful, but unfortunately with similarities to the system used in a traumatic student environment. Health students using the system did not have a lower self-efficacy. Although the LMS seemed relevant to students, its initial rejection might have been due to a confounding context that created confusion in the acceptability of the tool. To conclude, there is a need to create new dematerialized course formats but with strong tutorship to improve the usage of the technologies by students.

Disruptive Analysis of Closed Questions Assessments at Medical School, Interest of Massive Multi-Choice Tests.

Descriptive statistics, Classical Test Theory (CTT), and Item Response Theory (IRT) are used to analyze learning. These results are a powerful synthesis for students to evaluate their progression into their personal pathway of learning, for teachers to improve the quality of different multiple-choice questions (MCQ) series, and for administration to assist in making pedagogical decisions. Our study explores tools to evaluate MCQ tests, and MCQs. Answers to tutorials and final examination of students of the first year of health contest were collected and analyzed.

Consequences of Switching to Blended Learning: The Grenoble Medical School Key Elements.

INTRODUCTION: In 2006, the Grenoble-Alpes University Medical School decided to switch the learning paradigm of the first year to a blended learning model based on a flipped classroom with a continuous dual assessment system providing personal follow-up. We report a descriptive analysis of two pedagogical models. METHODS: The innovative blended learning model is divided into 5 week-sequences of learning, starting with a series of knowledge capsules, following with Interactive On Line Questions, Interactive On Site Training and an Explanation Meeting. The fourth and final steps are the dual assessment system that prepares for the final contest and the personal weekly follow-up. The data were extracted from the information systems over 17 years, during which the same learning model was applied. RESULTS: With the same student workload, the hourly knowledge/skills ratio decreased to approximately 50% with the blended learning model. The teachers' workload increased significantly in the first year (+70%), and then decreased each year (reaching -20%). Furthermore, the type of education has also changed for the teacher, from an initial hourly knowledge/skill ratio of 3, to a ratio of 1/3 with the new model after a few years. The institution also needed to resize the classroom from a large amphitheatre to small interactive learning spaces. DISCUSSION: There is a significant initial effort required to establish this model both for the teachers and for the institution, which have different needs and costs However, the satisfaction rates and the demand for extension to the other curriculums from medics and paramedics learners indicate that this model provides the enhanced learning paradigm of the future.

Does the acceptance of hybrid learning affect learning approaches in France?

PURPOSE: Acceptance of a learning technology affects students' intention to use that technology, but the influence of the acceptance of a learning technology on learning approaches has not been investigated in the literature. A deep learning approach is important in the field of health, where links must be created between skills, knowledge, and habits. Our hypothesis was that acceptance of a hybrid learning model would affect students' way of learning. METHODS: We analysed these concepts, and their correlations, in the context of a flipped classroom method using a local learning management system. In a sample of all students within a single year of study in the midwifery program (n= 38), we used 3 validated scales to evaluate these concepts (the Study Process Questionnaire, My Intellectual Work Tools, and the Hybrid E-Learning Acceptance Model: Learner Perceptions). RESULTS: Our sample had a positive acceptance of the learning model, but a neutral intention to use it. Students reported that they were distractible during distance learning. They presented a better mean score for the deep approach than for the superficial approach (P< 0.001), which is consistent with their declared learning strategies (personal reorganization of information; search and use of examples). There was no correlation between poor acceptance of the learning model and inadequate learning approaches. The strategy of using deep learning techniques was moderately correlated with acceptance of the learning model (rs= 0.42, P= 0.03). CONCLUSION: Learning approaches were not affected by acceptance of a hybrid learning model, due to the flexibility of the tool. However, we identified problems in the students' time utilization, which explains their neutral intention to use the system.