Perceived positive social interdependence in online versus face-to-face team-based learning styles of collaborative learning: a randomized, controlled, mixed-methods study.

BACKGROUND: Collaborative learning is a group learning approach in which positive social interdependence within a group is key to better learning performance and future attitudes toward team practice. Recent attempts to replace a face-to-face environment with an online one have been developed using information communication technology. However, this raises the concern that online collaborative learning (OCL) may reduce positive social interdependence. Therefore, this study aimed to compare the degree of social interdependence in OCL with face-to-face environments and clarify aspects that affect social interdependence in OCL. METHODS: We conducted a crossover study comparing online and face-to-face collaborative learning environments in a clinical reasoning class using team-based learning for medical students (n = 124) in 2021. The participants were randomly assigned to two cohorts: Cohort A began in an online environment, while Cohort B began in a face-to-face environment. At the study's midpoint, the two cohorts exchanged the environments as a washout. The participants completed surveys using the social interdependence in collaborative learning scale (SOCS) to measure their perceived positive social interdependence before and after the class. Changes in the mean SOCS scores were compared using paired t-tests. Qualitative data related to the characteristics of the online environment were obtained from the focus groups and coded using thematic analysis. RESULTS: The matched-pair tests of SOCS showed significant progression between pre- and post-program scores in the online and face-to-face groups. There were no significant differences in overall SOCS scores between the two groups. Sub-analysis by subcategory showed significant improvement in boundary (discontinuities among individuals) and means interdependence (resources, roles, and tasks) in both groups, but outcome interdependence (goals and rewards) improved significantly only in the online group. Qualitative analysis revealed four major themes affecting social interdependence in OCL: communication, task-sharing process, perception of other groups, and working facilities. CONCLUSIONS: There is a difference in the communication styles of students in face-to-face and online environments, and these various influences equalize the social interdependence in a face-to-face and online environment.

Health Care Team Training and Simulation-Based Education in Obstetrics During the COVID-19 Pandemic.

Health care team training and simulation-based education are important for preparing obstetrical services to meet the challenges of the COVID-19 pandemic. Priorities for training are identified in two key areas. First, the impact of infection prevention and control protocols on processes of care (e.g., appropriate and correct use of personal protective equipment, patient transport, preparation for emergency cesarean delivery with the potential for emergency intubation, management of simultaneous obstetric emergencies, delivery in alternate locations in the hospital, potential for increased decision-to-delivery intervals, and communication with patients). And second, the effects of COVID-19 pathophysiology on obstetrical patients (e.g., testing and diagnosis, best use of modified obstetric early warning systems, approach to maternal respiratory compromise, collaboration with critical care teams, and potential need for cardiopulmonary resuscitation). However, such training is more challenging during the COVID-19 pandemic because of the requirements for social distancing. This article outlines strategies (spatial, temporal, video-recording, video-conferencing, and virtual) to effectively engage in health care team training and simulation-based education while maintaining social distancing during the COVID-19 pandemic.

Twelve tips for implementing a community of practice for faculty development.

Teaching and learning practices often fail to incorporate new concepts in the ever-evolving field of medical education. Although medical education research provides new insights into curricular development, learners' engagement, assessment methods, professional development, interprofessional education, and so forth, faculty members often struggle to modernize their teaching practices. Communities of practice (CoP) for faculty development offer an effective and sustainable approach for knowledge management and implementation of best practices. A successful CoP creates and shares knowledge in the context of a specific practice toward the development of expertise. CoPs' collaborative nature, based on the co-creation of practical solutions to daily problems, aligns well with the goals of applying best practices in health professions education and training new faculty members. In our article, we share 12 tips for implementing a community of practice for faculty development. The tips were based on a comprehensive literature review and the authors' experiences.

Cardiovascular outcome trials in patients with chronic kidney disease: challenges associated with selection of patients and endpoints.

Although cardiovascular disease is a major health burden for patients with chronic kidney disease, most cardiovascular outcome trials have excluded patients with advanced chronic kidney disease. Moreover, the major cardiovascular outcome trials that have been conducted in patients with end-stage renal disease have not demonstrated a treatment benefit. Thus, clinicians have limited evidence to guide the management of cardiovascular disease in patients with chronic kidney disease, particularly those on dialysis. Several factors contribute to both the paucity of trials and the apparent lack of observed treatment effect in completed studies. Challenges associated with conducting trials in this population include patient heterogeneity, complexity of renal pathophysiology and its interaction with cardiovascular disease, and competing risks for death. The Investigator Network Initiative Cardiovascular and Renal Clinical Trialists (INI-CRCT), an international organization of academic cardiovascular and renal clinical trialists, held a meeting of regulators and experts in nephrology, cardiology, and clinical trial methodology. The group identified several research priorities, summarized in this paper, that should be pursued to advance the field towards achieving improved cardiovascular outcomes for these patients. Cardiovascular and renal clinical trialists must partner to address the uncertainties in the field through collaborative research and design clinical trials that reflect the specific needs of the chronic and end-stage kidney disease populations, with the shared goal of generating robust evidence to guide the management of cardiovascular disease in patients with kidney disease.

Utilizing Interactive Surfaces to Enhance Learning, Collaboration and Engagement: Insights from Learners' Gaze and Speech.

Interactive displays are becoming increasingly popular in informal learning environments as an educational technology for improving students' learning and enhancing their engagement. Interactive displays have the potential to reinforce and maintain collaboration and rich-interaction with the content in a natural and engaging manner. Despite the increased prevalence of interactive displays for learning, there is limited knowledge about how students collaborate in informal settings and how their collaboration around the interactive surfaces influences their learning and engagement. We present a dual eye-tracking study, involving 36 participants, a two-staged within-group experiment was conducted following single-group time series design, involving repeated measurement of participants' gaze, voice, game-logs and learning gain tests. Various correlation, regression and covariance analyses employed to investigate students' collaboration, engagement and learning gains during the activity. The results show that collaboratively, pairs who have high gaze similarity have high learning outcomes. Individually, participants spending high proportions of time in acquiring the complementary information from images and textual parts of the learning material attain high learning outcomes. Moreover, the results show that the speech could be an interesting covariate while analyzing the relation between the gaze variables and the learning gains (and task-based performance). We also show that the gaze is an effective proxy to cognitive mechanisms underlying collaboration not only in formal settings but also in informal learning scenarios.

United to end female genital mutilation: an on line knowledge platform for professionals and public.

Introduction: An estimated of 500,000 women and girls in the European Union (EU) have undergone female genital mutilation (FGM), with a further 180,000 at risk every year. Meeting the needs of these women and girls demands multidisciplinary action. This paper presents the United to End Female Genital Mutilation (UEFGM) knowledge platform, which is part of an EU-funded project. The platform is designed as a practice tool to improve the knowledge and skills of professionals who are likely to come into contact with women and girls affected by FGM.Method: Literature review was applied in regard to FGM along with expert validation process for the development of the modules particularly the e-learning section, expert and stakeholders' meetings for the other pillars of the Platform.Results: Three pillars were developed in the Platform: a) e-learning, b) country specific focus and c) live-knowledge discussion forum. The Platform explores related knowledge, skills, good practices, shared knowledge among professionals. UEFGM serves professionals and public as well in EU and worldwide.Conclusion: UEFGM comprises e-learning with a country-specific focus and a live discussion forum in which knowledge is shared between professionals worldwide. UEFGM discusses FGM and all related matters in a culturally- and gender-sensitive manner. It is a unique multidisciplinary and multilingual educational resource that has been found useful in everyday practice.

Bone Health TeleECHO: a Force Multiplier to Improve the Care of Skeletal Diseases in Underserved Communities.

PURPOSE OF REVIEW: This review describes the global development of a model of technology-enabled collaborative learning for healthcare professionals called Project ECHO (Extension for Community Healthcare Outcomes) and its applications for the management of patients with skeletal diseases. RECENT FINDINGS: The prototype Bone Health TeleECHO was established in 2015, with others now operational in the USA and other countries, and more expected to follow soon. Each teleECHO program, in the right language and convenient time zone, provides a virtual community of practice for healthcare professionals to benefit from real-time interactive case-based learning and brief didactic presentations on topics of interest. Bone Health TeleECHO elevates the level of knowledge of participants and improves self-confidence in managing patients with skeletal diseases. The development of many teleECHO programs worldwide serves as a force multiplier, with the potential to narrow the osteoporosis treatment gap and enhance the effectiveness of fracture liaison services.

Combining novel research and community-engaged learning in an undergraduate physiology laboratory course.

To better prepare physiology students for 21st century careers, we incorporated classroom-based undergraduate research experiences and service learning/community-engaged learning (SLCE) into a college-level physiology laboratory course. The interventions were incorporated over 4 yr and assessed using validated surveys of student-reported learning gains related to attitudes toward science, the scientific process, and career paths. Students reported the greatest learning gains in those years when students did novel research oriented around a common theme of water quality. The gains were greater than those of a matched cohort that participated in an apprentice-style summer undergraduate research experience. With respect to the SLCE related to youth science literacy, students provided evidence of learning related to academics, personal growth, and civic mindedness. For example, many expressed discomfort about being in a new situation, often describing the differences between themselves and the youth with whom they interacted. However, students also grew in confidence about collaborating with people who were different from them and in their role as the "scientist." Limitations of the study include the quasi-experimental design and the incorporation of multiple interventions at the same time. Future studies should examine improvement in content acquisition and competency-based learning skills. Nonetheless, these results suggest that both novel research and SLCE increase student learning in the context of an undergraduate physiology laboratory course. Many of the learning gains observed with the SLCE are particularly important for physiology students, many of whom aspire to careers in health sciences, where they will be regularly working with nonscientists.

Investigating the self-study phase of an inverted biochemistry classroom - collaborative dyadic learning makes the difference.

BACKGROUND: The inverted classroom approach is characterized by a primary self-study phase for students followed by an on-site, face-to-face teaching phase that is used to deepen the prior acquired knowledge. Obviously, this teaching approach relies on the students preparing before the on-site phase, which in turn requires optimized preparatory material as well as defined working instructions. The major aim of this study, therefore, was to investigate the effect of different preparatory materials and working instructions for the self-study phase of an e-learning-based inverted classroom on the knowledge gained by medical students in biochemistry. Furthermore, we analyzed whether collaborative dyadic learning during the self-study phase is more effective than individual learning with respect to knowledge gain. METHODS: The study was performed in a biochemistry seminar for second semester medical students at Ulm University in Germany. This seminar was held using an e-learning-based inverted classroom. A total of 196 students were divided into three homogeneous study groups that differed in terms of the working material and instructions provided for the self-study phase. Knowledge gain was measured by formative tests at the beginning of the on-site phases. Questionnaires were also handed out asking about motivation, interest and learning time in the self-study phases. RESULTS: Students who were told to prepare in collaborating dyads during the self-study phase performed better in formative tests taken at the beginning of on-site phases than learners who were told to prepare individually. The study material that was provided was of minor importance for the differences in formative testing since almost all students prepared for the on-site phases. With the dyadic learning approach, both students benefited from this collaboration, characterized by a higher motivation and interest in the topic, as well as a longer time spent on task. CONCLUSION: Our study provides strong evidence that the study material, but more importantly the instructions provided for the self-study phase, affect students` knowledge gain in an e-learning-based inverted classroom. The instructed collaboratively working group was the most successful.

Use of team-based learning pedagogy for predoctoral teaching and learning.

PURPOSE: The purpose of the study was to describe the development and implementation of a Team-based Learning (TBL) educational model in a predoctoral education course to assess its effectiveness in promoting student learning as measured by knowledge acquisition and student satisfaction. METHODS: An interprofessional education course used the TBL structure for the second-year dental students, in which students had an opportunity to first work on the questions individually and then in groups. Each instruction session began with a readiness assurance test (RAT), which students were asked to complete in two formats: each student answered on their own, then each team worked on the same questions to arrive at a consensus decision followed by a team-based application exercise. RESULTS: A significant difference existed in which team scores were higher than individual scores and on average, the teams scored higher than when students worked alone. Student feedback showed a strong preference of TBL over the traditional lecture format. Students found that the sessions helped them to understand the clinical cases from the perspective of other health care fields in this pedagogical approach. CONCLUSION: The TBL methods facilitated an interactive learning environment to promote student-centred learning in a predoctoral education course and the teams performed better in correct evaluation compared with the individual students.

External Facilitation as an Evidence-Based Practice Implementation Strategy During an Antibiotic Stewardship Collaborative in Neonatal Intensive Care Units.

BACKGROUND: Despite research support, evidence-based practices (EBPs) are inconsistently implemented throughout the United States. Facilitation is one implementation strategy to speed adoption in clinical settings. Facilitation has not been previously described in the literature as an implementation strategy within neonatal care. PURPOSE: The purpose of this study was to categorize and describe essential features of facilitation in the context of implementing an EBP using perspectives elicited from neonatal clinicians and external facilitators (EFs). METHODS: In this qualitative descriptive study, semistructured interviews were conducted with a purposive sample of neonatal clinicians and EFs. Participants shared their experiences related to the strategy of facilitation while implementing an EBP during the California Perinatal Quality Care Antibiotic Stewardship Collaborative. Interviews were transcribed, coded, and analyzed using directed content analysis. RESULTS: Five categories emerged to address facilitation as an implementation strategy: (a) facilitated change management, (b) unit and organization receptivity, (c) evaluation strategies, (d) supportive culture, and (e) facilitator stewardship. LINKING EVIDENCE TO ACTION: Implementing EBP is complex and multifactorial. Results from this study provide insights into influencing barriers and drivers as experienced by internal and external facilitators, and context factors that impacted the success of implementation.

Toward Impactful Collaborations on Computing and Mental Health.

We describe an initiative to bring mental health researchers, computer scientists, human-computer interaction researchers, and other communities together to address the challenges of the global mental ill health epidemic. Two face-to-face events and one special issue of the Journal of Medical Internet Research were organized. The works presented in these events and publication reflect key state-of-the-art research in this interdisciplinary collaboration. We summarize the special issue articles and contextualize them to present a picture of the most recent research. In addition, we describe a series of collaborative activities held during the second symposium and where the community identified 5 challenges and their possible solutions.

A Remote Collaborative Care Program for Patients with Depression Living in Rural Areas: Open-Label Trial.

BACKGROUND: In the treatment of depression, primary care teams have an essential role, but they are most effective when inserted into a collaborative care model for disease management. In rural areas, the shortage of specialized mental health resources may hamper management of depressed patients. OBJECTIVE: The aim was to test the feasibility, acceptability, and effectiveness of a remote collaborative care program for patients with depression living in rural areas. METHODS: In a nonrandomized, open-label (blinded outcome assessor), two-arm clinical trial, physicians from 15 rural community hospitals recruited 250 patients aged 18 to 70 years with a major depressive episode (DSM-IV criteria). Patients were assigned to the remote collaborative care program (n=111) or to usual care (n=139). The remote collaborative care program used Web-based shared clinical records between rural primary care teams and a specialized/centralized mental health team, telephone monitoring of patients, and remote supervision by psychiatrists through the Web-based shared clinical records and/or telephone. Depressive symptoms, health-related quality of life, service use, and patient satisfaction were measured 3 and 6 months after baseline assessment. RESULTS: Six-month follow-up assessments were completed by 84.4% (221/250) of patients. The remote collaborative care program achieved higher user satisfaction (odds ratio [OR] 1.94, 95% CI 1.25-3.00) and better treatment adherence rates (OR 1.81, 95% CI 1.02-3.19) at 6 months compared to usual care. There were no statically significant differences in depressive symptoms between the remote collaborative care program and usual care. Significant differences between groups in favor of remote collaborative care program were observed at 3 months for mental health-related quality of life (beta 3.11, 95% CI 0.19-6.02). CONCLUSIONS: Higher rates of treatment adherence in the remote collaborative care program suggest that technology-assisted interventions may help rural primary care teams in the management of depressive patients. Future cost-effectiveness studies are needed. TRIAL REGISTRATION: Clinicaltrials.gov NCT02200367; https://clinicaltrials.gov/ct2/show/NCT02200367 (Archived by WebCite at http://www.webcitation.org/6xtZ7OijZ).

The effectiveness of integration of virtual patients in a collaborative learning activity.

BACKGROUND: Virtual patients (VPs) have been recently integrated within different learning activities. AIM: To compare between the effect of using VPs in a collaborative learning activity and using VPs in an independent learning activity on students' knowledge acquisition, retention and transfer. METHODS: For two different topics, respectively 82 and 76 dental students participated in teaching, learning and assessment sessions with VPs. Students from a female campus and from a male campus have been randomly assigned to condition (collaborative and independent), yielding four experimental groups. Each group received a lecture followed by a learning session using two VPs per topic. Students were administrated immediate and delayed written tests as well as transfer tests using two VPs to assess their knowledge in diagnosis and treatment. RESULTS: For the treatment items of the immediate and delayed written tests, females outperformed males in the collaborative VP group but not in the independent VP group. CONCLUSION: On the female campus, the use of VPs in a collaborative learning activity is more effective than its use as an independent learning activity in enhancing students' knowledge acquisition and retention. However, the collaborative use of VPs by itself is not enough to produce consistent results across different groups of students and attention should be given to all the factors that would affect students' interaction.

Engagement and higher order skill proficiency of students completing a medical physiology course in three diverse learning environments.

The primary aim of this study was to determine whether levels of student engagement, higher order skill proficiency, and knowledge acquisition demonstrated by medical students would differ when completing the same course in three diverse learning environments. Following Institutional Review Board approval, 56 first-year medical students, registered at the same medical school but attending class at three different campus centers, were enrolled in the study. All participants were completing a medical physiology course that utilized the same learning objectives but relied on different faculty incorporating diverse methodologies (percentage of class devoted to active learning strategies), course format (6-wk block vs. 17-wk semester), and student attendance. Students completed a validated survey of student engagement (SSE), a proctored online problem-based assessment of higher order skill proficiency [Collegiate Learning Assessment (CLA+); http://cae.org ], and the National Board of Medical Examiners (NBME) Physiology subject exam. In this limited sample, results indicate no significant differences between campus sites for any of the variables assessed. Levels of engagement were lower than expected compared with published values for graduate students. Higher order skill proficiency assessed by CLA+ was significantly higher than values reported for college seniors nationally. Surprisingly, SSE offered no prediction of performance on CLA+ or NBME, as there were no significant correlations between variables. These data indicate that, although first-year medical students may not perceive themselves as highly engaged, they are adept in using higher order skills and excel in meeting course learning objectives, regardless of learning environment.

Collaborative active learning: bioimpedance and anthropometry in higher education.

Research in the health sciences devotes much attention to overweight and obesity and, consequently, to body composition. In recent years, traditional body measures have been questioned as efficient variables in health sciences due to the fact that they cannot give information about body fat mass. Our aim is to teach how to analyze body composition through anthropometry and bioelectrical impedance analysis to our "Physiology of Vegetative and Reproductive Functions" students, who are studying for their degree in Biology. We proposed project-oriented-learning to promote collaborative interactions among students. Fifty-two students voluntarily formed five groups; they worked with the concepts of basal metabolic rate and body composition from a theoretical point of view and later transformed these concepts into a practical perspective by preparing a manuscript in groups with objectives proposed by our teaching team. In this research, we show a collaborative educational scenario for university students in which students are tutored from a constructivist perspective to promote social interactions, resulting in new knowledge acquisition.

The K-INBRE symposium: a 10-institution collaboration to improve undergraduate education.

The Kansas-IDeA Network of Biomedical Research Excellence (K-INBRE) is an infrastructure-building program funded by the National Institute of General Medical Sciences. Undergraduate education, through undergraduate research, is a key component of the program. The K-INBRE network includes 10 higher education institutions in Kansas and northern Oklahoma, with over 1,000 student participants in 16 yr. Since 2003, the K-INBRE has held an annual state-wide research symposium that includes national and regional speakers and provides a forum for undergraduates to give platform and poster presentations. The symposium is well attended by K-INBRE participants and has grown to a size of over 300 participants per year from all 10 K-INBRE schools. Two surveys were distributed to students and mentors to assess the impact of the symposium on student learning. Surveys (153) were distributed to students who participated in K-INBRE from 2013 through 2015 with a 51% response rate. Mentors were surveyed with a response of 111 surveys out of 161. Survey results indicate that students and mentors alike find the symposium to be beneficial and enriching of the student experience. Almost 80% of student respondents indicated that their participation in the symposium fostered appreciation of research. In short, the K-INBRE symposium provides a unique opportunity for students to gain experience in collecting, preparing, and communicating research in a professional environment. The collaborative experience of the annual K-INBRE symposium, the impact it has on student learning, and how it has influenced the research culture at our 10 institutions will be described.

Implementing interprofessional learning curriculum: how problems might also be answers.

BACKGROUND: Despite interprofessional learning (IPL) being widely recognised as important for health care professions, embedding IPL within core curriculum remains a significant challenge. The aim of this study was to identify tensions associated with implementing IPL curriculum for educators and clinical supervisors, and to examine these findings from the perspective of activity theory and the expansive learning cycle (ELC). METHODS: We interviewed 12 faculty staff and ten health practitioners regarding IPL. Interviews were semi-structured. Following initial thematic analysis, further analysis was undertaken to characterise existing activity systems and the contradictions associated with implementing IPL. These findings were then mapped to the ELC. RESULTS: Five clusters of contradictions were identified: the lack of a workable definition; when and what is best for students; the leadership hot potato; big expectations of IPL; and, resisting cultural change. When mapped to the ELC, it was apparent that although experienced as challenges, these contradictions had not yet generated sufficient tension to trigger 'break through' novel thinking, or contemplation and modelling of new solutions. CONCLUSIONS: The application of activity theory and the ELC offered an approach in which the most troublesome challenges might be reframed as opportunities for change. Seemingly intractable problems could be worked on to identify and address underlying fears and assumptions. If sufficient tension can be generated, an ELC could then be triggered. In reframing challenges as opportunities, the power of tensions and contradictions as potential levers for effective change might be more successfully accessed.

Teaching legal competencies through an individualized elective in medicine and law.

Medical education, including education intended to prepare future physicians to care to older individuals, should include development and implementation of competencies relating to a physician's ability to understand and interact with the legal environment and legal actors who will affect the practice of medicine. The wisdom of integrating legal knowledge into the medical curriculum has been documented, and literature discusses the content and methods of teaching medical students and residents about law and the legal system. This article describes one unique but replicable, pedagogical approach to preparing future physicians to thrive in their inevitably interprofessional careers as they fulfill the fiduciary responsibilities that lie at the heart of their therapeutic and advocacy relationships with older patients.