Methodological approaches and competence areas of nursing students in virtual reality simulation research - A scoping review.

OBJECTIVES: To analyze methodological approaches (theoretical frameworks, study designs, methods) and competence areas of nursing students in research on virtual reality simulations (VRS) with a high level of immersion. METHODS: A scoping review was performed. A systematic search of the literature was conducted on MEDLINE, CINAHL and ERIC databases on 30/11/22. In addition, a manual search was utilized. The extracted data relating to the research questions was descriptively analyzed and results were narratively summarized. RESULTS: In total 23 studies were included in the review. Selected studies employed a wide range of theoretical frameworks and research designs. The studies aimed to develop competences both through complex interventions where team-based skills are required in acute situations, and they described basic nursing interventions where individual skills are required in non-acute nursing care. CONCLUSIONS: A significant amount of the selected studies did not utilize a learning theory or an instructional design framework as a basis for their research. More knowledge was found on training specific skills compared to facilitating the attitudes and values of the participants. Therefore, there is a need for further research on whether nursing students' attitudes and values can be supported through VRS with a high level of immersion.

Addressing medial student knowledge deficits in 'hospital-to-home' transitions of care using a constructivism theory-based workshop intervention.

INTRODUCTION: Effective teaching and learning initiatives on transitions of patient care, especially from hospital to home, are frequently lacking within medical school curricula. We trialled an integrated test-enhanced active learning strategy to prepare students for the safe management of these patient transitions. METHODS: This randomised, prospective, single blinded, interventional study assessed medical students' knowledge, regarding patients' hospital-to-home transition. The intervention was a purpose-designed transitions of care workshop, the assessment tool was a multiple-choice assessment based on prior studies. Students were randomly allocated to the application of the assessment both pre- and post-workshop or to assessment solely post-workshop to determine the potential for the assessment to prime student learning. RESULTS: Sixteen students enrolled for the workshops. Significant knowledge gaps were identified. No student identified that medication errors were the most common source of post-discharge adverse events. Only 42% of participants knew that age >65 contributes to medication non-adherence, with 50% knowing that the medical reconciliation process should include discontinued medications. The workshop increased student knowledge, addressing identified knowledge gaps (74% pre-workshop versus 87% post-workshop, p < 0.005). Students self-perceived level of competency after completing the workshop intervention was increased (5.5 pre-workshop versus 15 post-workshop, p < 0.001). All aspects of student self-assessed competency increased significantly from the pre-workshop scores. There was no priming effect of the pre-workshop assessment on student knowledge scores or perceived competency. DISCUSSION: Important gaps in student knowledge skills and attitudes exist regarding the hospital to home transition. Our active learning strategy addressed these gaps, enhancing student understanding and confidence around transitions of patient care.

Early Metformin in Gestational Diabetes: A Randomized Clinical Trial.

Importance: Gestational diabetes is a common complication of pregnancy and the optimal management is uncertain. Objective: To test whether early initiation of metformin reduces insulin initiation or improves fasting hyperglycemia at gestation weeks 32 or 38. Design, Setting, and Participants: Double-blind, placebo-controlled trial conducted in 2 centers in Ireland (one tertiary hospital and one smaller regional hospital). Participants were enrolled from June 2017 through September 2022 and followed up until 12 weeks' postpartum. Participants comprised 510 individuals (535 pregnancies) diagnosed with gestational diabetes based on World Health Organization 2013 criteria. Interventions: Randomized 1:1 to either placebo or metformin (maximum dose, 2500 mg) in addition to usual care. Main Outcomes And Measures: The primary outcome was a composite of insulin initiation or a fasting glucose level of 5.1 mmol/L or greater at gestation weeks 32 or 38. Results: Among 510 participants (mean age, 34.3 years), 535 pregnancies were randomized. The primary composite outcome was not significantly different between groups and occurred in 150 pregnancies (56.8%) in the metformin group and 167 pregnancies (63.7%) in the placebo group (between-group difference, -6.9% [95% CI, -15.1% to 1.4%]; relative risk, 0.89 [95% CI, 0.78-1.02]; P = .13). Of 6 prespecified secondary maternal outcomes, 3 favored the metformin group, including time to insulin initiation, self-reported capillary glycemic control, and gestational weight gain. Secondary neonatal outcomes differed by group, with smaller neonates (lower mean birth weights, a lower proportion weighing >4 kg, a lower proportion in the >90% percentile, and smaller crown-heel length) in the metformin group without differences in neonatal intensive care needs, respiratory distress requiring respiratory support, jaundice requiring phototherapy, major congenital anomalies, neonatal hypoglycemia, or proportion with 5-minute Apgar scores less than 7. Conclusion and relevance: Early treatment with metformin was not superior to placebo for the composite primary outcome. Prespecified secondary outcome data support further investigation of metformin in larger clinical trials. Trial Registration: ClinicalTrials.gov Identifier: NCT02980276; EudraCT: 2016-001644-19.

Health literacy education programmes developed for qualified health professionals: a scoping review.

OBJECTIVES: Both literature and policy have identified the need for health literacy education for qualified health professionals. This study aimed to identify and map health literacy competencies and health literacy related communication skills educational interventions for qualified health professionals. The research questions included: Of the qualified health professional education interventions identified, which are focused on diabetes care? What health literacy competencies and health literacy related communication skills are integrated into each programme? What are the characteristics of each education programme? What were the barriers and facilitators to implementation? What methods are used to evaluate intervention effectiveness, if any? DESIGN: Scoping review, informed by the Joanna Briggs Institute guidelines. DATA SOURCES: The following databases: OVID; CINAHL; Cochrane; EMBASE; ERIC: PsycInfo; RIAN; Pro-Quest; UpToDate were searched. ELIGIBILITY CRITERIA: Articles were included if the education programme focused on qualified health professionals, in all clinical settings, treating adult patient populations, of all study types. DATA EXTRACTION AND SYNTHESIS: Two authors independently screened titles, abstracts and full text articles that met the inclusion criteria. The third author mediated any discrepancies. The data were extracted and charted in table format. RESULTS: In total, 53 articles were identified. One article referred to diabetes care. Twenty-six addressed health literacy education, and 27 addressed health literacy related communication. Thirty-five reported using didactic and experiential methods. The majority of studies did not report barriers (N=45) or facilitators (N=52) to implementation of knowledge and skills into practice. Forty-nine studies evaluated the reported education programmes using outcome measures. CONCLUSIONS: This review mapped existing education programmes regarding health literacy and health literacy related communication skills, where programme characteristics were identified to inform future intervention development. An evident gap was identified regarding qualified health professional education in health literacy, specifically in diabetes care.

Mechanisms Driving Postgraduate Health and Social Science Students' Cultural Competence: An Integrated Systematic Review.

PURPOSE: The COVID-19 pandemic revealed a global urgency to address health care provision disparities, which have largely been influenced by systematic racism in federal and state policies. The World Health Organization recommends educational institutions train clinicians in cultural competence (CC); however, the mechanisms and interacting social structures that influence individuals to achieve CC have received little attention. This review investigates how postgraduate health and social science education approaches CC and how it accomplishes (or not) its goals. METHOD: The authors used critical realism and Whittemore and Knafl's methods to conduct a systematic integrated review. Seven databases (MEDLINE, CINAHL, PsycINFO, Scopus, PubMed, Web of Science, and ERIC) were searched from 2000 to 2020 for original research studies. Inclusion criteria were: the use of the term "cultural competence" and/or any one of Campinha-Bacote's 5 CC factors, being about postgraduate health and/or social science students, and being about a postgraduate curriculum or a component of it. Thematic analysis was used to reveal the mechanisms and interacting social structures underlying CC. RESULTS: Thirty-two studies were included and 2 approaches to CC (themes) were identified. The first theme was professionalized pedagogy, which had 2 subthemes: othering and labeling. The second theme was becoming culturally competent, which had 2 subthemes: a safe CC teaching environment and social interactions that cultivate reflexivity. CONCLUSIONS: CC conceptualizations in postgraduate health and social science education tend to view cultural differences as a problem and CC skills as a way to mitigate differences to enhance patient care. However, this generates a focus on the other, rather than a focus on the self. Future research should explore the extent to which insight, cognitive flexibility, and reflexivity, taught in safe teaching environments, are associated with increasing students' cultural safety, cultural humility, and CC.

Evaluation of a Community-Based Cardiovascular Prevention Program in Patients With Type 2 Diabetes.

PURPOSE: An outcomes' evaluation of a community-based cardiovascular disease (CVD) prevention program in persons with newly diagnosed type 2 diabetes. DESIGN: A prospective, observational study. SETTING: A community-setting in Ireland. PARTICIPANTS: Persons with newly diagnosed type 2 diabetes, aged 40 years or older, and 2 or more cardiovascular risk factors. INTERVENTION: A 16-week community-based, cardiovascular prevention program, with health promotion seminars, group exercise, and individual consultations, delivered by a multidisciplinary team. MEASURES: Medical, lifestyle, and well-being measures. ANALYSIS: Changes in categorical and continuous variables were analyzed using the paired exact test and the t test/Wilcoxin matched-pairs test, respectively. RESULTS: In total, 218 persons (134 men) participated, mean age was 59.8 (10.2) years. Completion rate was 75.2% (n = 164). The proportion achieving target glycosylated hemoglobin (HbA1c) increased from 53% at baseline to 75% (P < .001) at end of program. Systolic and diastolic blood pressures reduced by 8.8 mm Hg (95% CI: -11.2 to -6.4, P < .001) and 5.2 mm Hg (95% CI: -6.9 to -3.5, P < .001), respectively. Mean low-density lipoprotein cholesterol reduced from 2.45 to 2.05 mmol/L (P < .001). Significantly higher proportions met recommended targets in diet (6.9% vs 43.4%, P < .001) and physical activity (9.2% vs 56.6%, P < .001). Psychosocial measures significantly improved at end of program. The majority of improvements were sustained at 1 year. CONCLUSION: Participation in this CVD prevention program was associated with significant improvements in glycemia and CVD risk factors in newly diagnosed patients with type 2 diabetes.

Health literacy education programmes developed for qualified health professionals: a scoping review protocol.

Introduction: Health professional education for health literacy has been identified as having the potential to improve patient outcomes and has been recognized as such in policy developments. Health literacy is an emerging concept encompassing individuals' skills and how health information is processed in relation to the demands and complexities of the surrounding environment. Focus has been predominantly on the dimension of functional health literacy (reading, writing and numeracy), although increasing emphasis has been placed on interactive and critical domains. Such dimensions can guide the development of health professional education programmes and bridge the gap in the interaction between health professionals and their patients. Currently little is known about qualified health professional's education for health literacy, its development, implementation or evaluation. Aim: To identify and map current educational interventions to improve health literacy competencies and communication skills of qualified health professionals. Methods: A scoping review will be conducted drawing on methods and guidance from the Joanna Briggs Institute, and will be reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. This study will retrieve literature on health professional education for health literacy through a comprehensive search strategy in the following databases: CINAHL; Medline (Ovid); the Cochrane Library; EMBASE; ERIC; UpToDate; PsycINFO and Central Register of Controlled Trials (CENTRAL). Grey literature will be searched within the references of identified articles: Lenus; ProQuest E-Thesis Portal; the HSE health research repository and RIAN. A data charting form will be developed with categories agreed by the research team, including: article details, demographics, intervention details, implementation and evaluation methods. Conclusion: Little is known about the extent and nature of the current evidence base therefore in order to identify programmes and consolidate their demographics and characteristics within health literacy competencies and communication skills, a scoping review is warranted.

Training in polytrauma management in medical curricula: A scoping review.

INTRODUCTION: Polytrauma (PT) is a leading cause of morbidity and mortality worldwide. However, it is unknown if PT teaching is taught or adequately included in undergraduate medical curricula. We conducted this scoping review to explore the literature on undergraduate PT training. METHODS: Using Arksey and O'Malley's five stage framework, a scoping review was conducted. Nine medical and educational databases, including PubMed, MEDLINE, Scopus, CINAHL, PsycINFO, and EMBASE were searched using keywords identified by the authors. Eligible studies were limited to the English language, with no set limitations on the year of publication. Studies reporting on PT teaching in undergraduate medical curricula were included. RESULTS: Nine studies were included. The articles were sub-categorised into three themes: current teaching of PT in medical curricula, trauma management courses and simulation-based trauma education. Four out of five studies on PT teaching in the curriculum were rated as inadequate by current or past students; on the other hand, three out of four trauma management/simulation courses were evaluated and all three were rated positively by students. Three trauma management courses compared students pre- and post-course scores on a written or practical test and reported significant improvement in post-course scores. CONCLUSIONS: There is a relative paucity of literature on undergraduate PT training. There is a need for more research to explore how to deliver effective PT teaching to medical students.

Travellers with type 1 diabetes: questionnaire development and descriptive analysis of knowledge and practices.

BACKGROUND: Little is known about the awareness of travellers with diabetes about the health effects of international travel. This study aimed to design and validate a questionnaire to examine the travel health knowledge, attitudes and practices of people living with type 1 diabetes. METHODS: A set of 74 items based on a conceptual framework analysis underwent revision and its content validity was established. Items were grouped into three domains. A development study was conducted to establish evidence regarding their factorial structure. A construct validation study was then conducted in which the retained items were tested in an independent sample using confirmatory factor analysis (CFA). RESULTS: Four factors emerged from our development study and were labelled as pre-travel preparation-insect bites, pre-travel preparation-consultation, insulin and glycaemic control and travel risk behaviour. A CFA confirmed the factorial structure identified in the development study in an independent sample. Each factor loading had a significant (P < 0.001) loading of at least 0.4. The factor correlations ranged between 0.1 and 0.6, indicating good discriminant validity. The highest mean domain score in our sample of 268 participants related to insulin and glycaemic control (6.45), followed by travel risk behaviour (5.21) and pre-travel preparation (4.15). CONCLUSIONS: This valid questionnaire for measuring the degree of preparedness of travellers with type 1 diabetes may prove a useful tool in studies involving travellers with type1 diabetes. Our results suggest that improvements are needed in relation to timely pre-travel consultation and screening for diabetic complications.

Inter-rater reliability in clinical assessments: do examiner pairings influence candidate ratings?

BACKGROUND: The reliability of clinical assessments is known to vary considerably with inter-rater reliability a key contributor. Many of the mechanisms that contribute to inter-rater reliability however remain largely unexplained and unclear. While research in other fields suggests personality of raters can impact ratings, studies looking at personality factors in clinical assessments are few. Many schools use the approach of pairing examiners in clinical assessments and asking them to come to an agreed score. Little is known however, about what occurs when these paired examiners interact to generate a score. Could personality factors have an impact? METHODS: A fully-crossed design was employed with each participant examiner observing and scoring. A quasi-experimental research design used candidate's observed scores in a mock clinical assessment as the dependent variable. The independent variables were examiner numbers, demographics and personality with data collected by questionnaire. A purposeful sample of doctors who examine in the Final Medical examination at our institution was recruited. RESULTS: Variability between scores given by examiner pairs (N = 6) was less than the variability with individual examiners (N = 12). 75% of examiners (N = 9) scored below average for neuroticism and 75% also scored high or very high for extroversion. Two-thirds scored high or very high for conscientiousness. The higher an examiner's personality score for extroversion, the lower the amount of change in his/her score when paired up with a co-examiner; reflecting possibly a more dominant role in the process of reaching a consensus score. CONCLUSIONS: The reliability of clinical assessments using paired examiners is comparable to assessments with single examiners. Personality factors, such as extroversion, may influence the magnitude of change in score an individual examiner agrees to when paired up with another examiner. Further studies on personality factors and examiner behaviour are needed to test associations and determine if personality testing has a role in reducing examiner variability.

Exploration of a possible relationship between examiner stringency and personality factors in clinical assessments: a pilot study.

BACKGROUND: The reliability of clinical examinations is known to vary considerably. Inter-examiner variability is a key source of this variability. Some examiners consistently give lower scores to some candidates compared to other examiners and vice versa - the 'hawk- dove' effect. Stable examiner characteristics, such as personality factors, may influence examiner stringency. We investigated whether examiner stringency is related to personality factors. METHODS: We recruited 12 examiners to view and score a video-recorded five station OSCE of six Year 1 undergraduate medical students at our institution. In addition examiners completed a validated personality questionnaire. Examiners' markings were tested for statistically significant differences using non-parametric one way analysis of variance. The relationship between examiners' markings and examiner personality factors was investigated using Spearman correlation coefficient. RESULTS: At each station there was a statistically significant difference between examiners markings, confirming the presence of inter-examiner variability. Correlation analysis showed no association between stringency and any of the five major personality factors. When we omitted an outlier examiner we found a statistically significant negative correlation between examiner stringency and openness to experience with a correlation coefficients (rho) of - 0.66 (p = 0.03). Conversely there was a moderate positive correlation between examiner stringency and neuroticism with a correlation coefficient (rho) of 0.73 (p = 0.01). CONCLUSIONS: In this study we did not find any relationship between examiner stringency and examiner personality factors. However, following the elimination of an outlier examiner from the analysis, we found a significant relationship between examiner stringency and two of the big five personality factors (neuroticism and openness to experience). The significance of this outlier is not known. As this was a small pilot study we recommend further studies in this field to investigate if there is a relationship between examiner stringency in clinical assessments and personality factors.