Survey response rates in health sciences education research: A 10-year meta-analysis.

Growth in the online survey market may be increasing response burden and possibly jeopardizing higher response rates. This meta-analysis evaluated survey trends over one decade (2011-2020) to determine: (1) changes in survey publication rates over time, (2) changes in response rates over time, (3) typical response rates within health sciences education research, (4) the factors influencing survey completion levels, and (5) common gaps in survey methods and outcomes reporting. Study I estimated survey publication trends between 2011 and 2020 using articles published in the top three health sciences education research journals. Study II searched the anatomical sciences education literature across six databases and extracted study/survey features and survey response rates. Time plots and a proportional meta-analysis were performed. Per 2926 research articles, the annual estimated proportion of studies with survey methodologies has remained constant, with no linear trend (p > 0.050) over time (Study I). Study II reported a pooled absolute response rate of 67% (95% CI = 63.9-69.0) across 360 studies (k), totaling 115,526 distributed surveys. Despite response rate oscillations over time, no significant linear trend (p = 0.995) was detected. Neither survey length, incentives, sponsorship, nor population type affected absolute response rates (p ≥ 0.070). Only 35% (120 of 339) of studies utilizing a Likert scale reported evidence of survey validity. Survey response rates and the prevalence of studies with survey methodologies have remained stable with no linear trends over time. We recommend researchers strive for a typical absolute response rate of 67% or higher and clearly document evidence of survey validity for empirical studies.

Past and Current Learning and Teaching Resources and Platforms.

For over two centuries, the educational landscape both nationally and globally has changed tremendously. The more traditional teaching and learning resources and platforms, such as traditional textbooks, chalkboards and whiteboards, overhead transparency and carousel projectors, and traditional classroom settings, have been either replaced or supplemented in the anatomical sciences by integrated and virtual eBooks, online learning management (OLM) platforms, and virtual learning and meeting apps. Virtual teaching and learning, especially proliferated with the advent and aftermath of the COVID-19 pandemic, and institutions worldwide that had already been utilizing virtual class and lab sessions in their anatomy curricula expanded virtual course offerings. Many institutions have retained virtual course offerings even after the pandemic, given the distance learning benefits. The future of anatomy education holds many promising possibilities given the voracious speed with which technology is advancing. One such promising advancement is the full, seamless incorporation of virtual three-dimensional (3D) immersive and semi-immersive learning into anatomy laboratories and classroom settings globally as well as into students' laptops and handheld devices for easy use at home or anywhere.

Using Stereoscopic Virtual Presentation for Clinical Anatomy Instruction and Procedural Training in Medical Education.

This chapter begins by exploring the current landscape of virtual and augmented reality technologies in a post-pandemic world and asserting the importance of virtual technologies that improve students' learning outcomes while also reducing costs. Next, the chapter describes clinical anatomy instruction concepts in medical education, including applied anatomy content knowledge, pedagogical anatomy content knowledge, and virtual stereoscopic visualization studies that exemplify these concept areas, respectively. The chapter then explores the concept of procedural training with a specific emphasis on virtual stereoscopic anatomy visualization studies that exemplify or have implications for procedural training in medical education. Subsequently, the chapter discusses the benefits and challenges as well as the potential future positive and negative implications of virtual stereoscopic visualizations in medical education before finally concluding with some pensive considerations for the present and future of anatomy education and training using virtual technologies.

Faculty retirements will likely exacerbate the anatomy educator shortage.

Medical education has reported a shortage of anatomy educators since the 1960s. While the faculty pipeline has recently been explored, insights into retirement intentions, a key driver of faculty turnover, have yet to be investigated. With the mean age of anatomists rising, knowledge of retirement intentions among current educators is essential to understanding the anatomy educator shortage. This study explored the retirement intentions of current anatomy educators and their likely effects on the workforce. Surveys were distributed to department heads and the American Association for Anatomy (AAA) membership to inquire about job postings from 2018-2020 and retirement intentions, respectively. Department heads sought to fill open positions due to faculty retirements (36%, 15 of 42), faculty relocations/sabbaticals/new responsibilities (31%), and brand new positions (24%). The retirement intentions survey revealed that 61% (23 of 38) of faculty '55 and older' intend to retire within five years. Based on the extrapolation of AAA membership data, estimates suggest that almost twice as many anatomy faculty could retire per year (n = 40) over the next five years compared to the estimated number of annual PhD graduates (n = 22) likely to enter the workforce. Factors driving retirement intentions were overwhelmingly age and finances, followed by job satisfaction and family. The creation of new anatomy educator positions to address increased student enrollments and new health sciences programs is likely to place even greater strain on workforce demands.

Exploring the barriers and facilitators of psychological safety in primary care teams: a qualitative study.

BACKGROUND: Psychological safety is the concept by which individuals feel comfortable expressing themselves in a work environment, without fear of embarrassment or criticism from others. Psychological safety in healthcare is associated with improved patient safety outcomes, enhanced physician engagement and fostering a creative learning environment. Therefore, it is important to establish the key levers which can act as facilitators or barriers to establishing psychological safety. Existing literature on psychological safety in healthcare teams has focused on secondary care, primarily from an individual profession perspective. In light of the increased focus on multidisciplinary work in primary care and the need for team-based studies, given that psychological safety is a team-based construct, this study sought to investigate the facilitators and barriers to psychological safety in primary care multidisciplinary teams. METHODS: A mono-method qualitative research design was chosen for this study. Healthcare professionals from four primary care teams (n = 20) were recruited using snowball sampling. Data collection was through semi-structured interviews. Thematic analysis was used to generate findings. RESULTS: Three meta themes surfaced: shared beliefs, facilitators and barriers to psychological safety. The shared beliefs offered insights into the teams' background functioning, providing important context to the facilitators and barriers of psychological safety specific to each team. Four barriers to psychological safety were identified: hierarchy, perceived lack of knowledge, personality and authoritarian leadership. Eight facilitators surfaced: leader and leader inclusiveness, open culture, vocal personality, support in silos, boundary spanner, chairing meetings, strong interpersonal relationships and small groups. CONCLUSION: This study emphasises that factors influencing psychological safety can be individualistic, team-based or organisational. Although previous literature has largely focused on the role of leaders in promoting psychological safety, safe environments can be created by all team members. Members can facilitate psychological safety in instances where positive leadership behaviours are lacking - for example, strengthening interpersonal relationships, finding support in silos or rotating the chairperson in team meetings. It is anticipated that these findings will encourage practices to reflect on their team dynamics and adopt strategies to ensure every member's voice is heard.

Anatomy Visualizations Using Stereopsis: Assessment and Implication of Stereoscopic Virtual Models in Anatomical Education.

Anatomical knowledge, such as gross anatomy, neuroanatomy, histology, and embryology, involve three-dimensional (3D) learning and interpretation. Virtual 3D models especially have been used in the anatomical sciences both as a supplement to traditional anatomical education with cadaveric specimens and as a substitute for cadavers at institutions that do not utilize human donors for educational purposes. This paper discusses the methods used to assess the models' validation and accuracy, as well as suggestions for the models' improvement. This paper also aims to describe students' learning of anatomy using stereoscopic 3D models and provides a summary of the results from the literature concerning students' performance outcomes using virtual stereoscopic models as well as both students' and experts' perceptions of their utilization. There have been mixed results in the literature concerning the effectiveness of virtual 3D anatomical models in general, but there is limited research on stereoscopic anatomical models specifically. Stereoscopic anatomical models have shown to improve the learning of students, particularly for the students with low spatial ability, and they have the potential to enhance students' understanding of 3D relationships.

Development of a competency model and tailored assessment method for high school science teachers utilizing a flipped learning approach.

Many professional development programs aim to improve student outcomes by enhancing teacher competencies. Effective evaluation of these programs requires a clear delineation of the competencies to be gained. A competency model was developed to evaluate the impact of a teacher professional program that aimed to improve teachers' ability to effectively implement technologically engaged modules in a flipped classroom setting. Competencies were identified via participatory evaluation techniques and assessments were aligned to the competencies. The competency of teachers in the knowledge, skills, and abilities needed for creation and delivery of effective flipped lessons can be tracked using a radar graph to guide tailored professional development.

The general practice perspective on barriers to integration between primary and social care: a London, United Kingdom-based qualitative interview study.

OBJECTIVE: There is an ongoing challenge of effective integration between primary and social care in the United Kingdom; current systems have led to fragmentation of services preventing holistic patient-centred care for vulnerable populations. To improve clinical outcomes and achieve financial efficiencies, the barriers to integration need to be identified and addressed. This study aims to explore the unique perspectives of frontline staff (general practitioners and practice managers) towards these barriers to integration. DESIGN: Qualitative study using semistructured interviews and thematic analysis to obtain results. SETTING: General practices within London. PARTICIPANTS: 18 general practitioners (GPs) and 7 practice managers (PMs) based in London with experience of working with social care. RESULTS: The study identified three overarching themes where frontline staff believed problems exist: accessing social services, interprofessional relationships and infrastructure. Issues with contacting staff from other sectors creates delays in referrals for patient care and perpetuates existing logistical challenges. Likewise, professionals noted a hostile working culture between sectors that has resulted in silo working mentalities. In addition to staff being overworked as well as often inefficient multidisciplinary team meetings, poor relationships across sectors cause a diffusion of responsibility, impacting the speed with which patient requests are responded to. Furthermore, participants identified that a lack of interoperability between information systems, lack of pooled budgets and misaligned incentives between managerial staff compound the infrastructural divide between both sectors. CONCLUSION: In this study, primary care staff identify intangible barriers to integration such as poor interprofessional relationships, in addition to more well-described structural issues such as insufficient funding and difficulty accessing social care. Participants believe that educating the next generation of medical professionals may lead to the development of collaborative, instead of siloed, working cultures and that change is needed at both an interpersonal and institutional level to successfully integrate care.

Anatomy Visualizations Using Stereopsis: Current Methodologies in Developing Stereoscopic Virtual Models in Anatomical Education.

Technology for developing three-dimensional (3D) virtual models in anatomical sciences education has seen a great improvement in recent years. Various data used for creating stereoscopic virtual models have also been constantly improving. This paper focuses specifically on the methodologies of creating stereoscopic virtual models and the techniques and materials used in developing stereoscopic virtual models from both our previous studies and other published literature. The presentation and visualization of stereoscopic models are highlighted, and the benefits and limitations of stereoscopic models are discussed. The practice of making 3D measurements on the lengths, angles, and volumes of models can potentially be used to help predict typical measurement parameters of anatomical structures and for the placement of surgical instruments. Once stereoscopic virtual models have been constructed, their visualization and presentation can be implemented in anatomy education and clinical surgical trainings.

Medical school teaching on interprofessional relationships between primary and social care to enhance communication and integration of care - a pilot study.

Background: A pilot study to identify if the delivery of teaching session to medical students would have the potential to enhance communication and a culture of integration between primary and social care, ultimately improving interprofessional relationships between primary and social care. Health and social care integration is a topic of great debate in the developed world and the focus of the upcoming Green Paper by the Secretary of State for Health and Social Care in the NHS. There is much uncertainty to how this should be done and is hindered by the various current barriers. The literature identifies that collaborative cultures encourage effective interprofessional relationships and that communication is vital to integration of primary and social care and should be established early in medical training. Materials and Method: The General Medical Council's Outcomes for Graduates and Imperial College School of Medicine curriculum were reviewed out to identify outcomes relating to inter-professional relationships between primary and social care. The relevant year group was surveyed to identify if the learning objective was delivered. In order to determine if delivery of a teaching session on nurturing interprofessional relationships between primary and social care would be effective, it was delivered to early clinical years to measure benefits as a pilot study. This was devised of case-based scenarios derived from learning objectives developed with experienced health care professionals. A survey was administered before and after the teaching session to determine if the students felt they had improved with respect to the learning objectives. Results: The initial survey identified the majority of students found the learning objectives were not delivered. The teaching session found a statistically significant improvement in confidence to nurture interprofessional relationships between primary and social care. Conclusion: Effective interprofessional relationships between primary and social care, improving communication and collaborative cultures, can be effectively taught in medical school, to improve integration of primary and social care.

Theoretically speaking: use of a communities of practice framework to describe and evaluate interprofessional education.

This article uses Wenger's (1998) theory of communities of practice, and in particular his learning design framework, to describe and evaluate the pedagogy of one interprofessional continuing professional development (CPD) programme for health, education and social care professionals. The article presents findings from 27 post-intervention interviews conducted 12 months after the CPD. Key pedagogic features of small group working, action planning, facilitation, continued independent learning and 'safe' learning environment were found to provide facilities for 'engagement', 'imagination' and 'alignment' (Wenger, 1998), with the use of task-focused small group work particularly appreciated by participants. Problems of falling attendance and marginalisation are discussed using Wenger's concept of 'identification/negotiability'. It is suggested that careful selection of delegates and provision of sufficient organisational support may mitigate such problems.

Structure of dehydroergosterol monohydrate and interaction with sterol carrier protein-2.

Dehydroergosterol [ergosta-5,7,9(11),22-tetraen-3beta-ol] is a naturally-occurring, fluorescent sterol utilized extensively to probe membrane cholesterol distribution, cholesterol-protein interactions, and intracellular cholesterol transport both in vitro and in vivo. In aqueous solutions, the low solubility of dehydroergosterol results in the formation of monohydrate crystals similar to cholesterol. Low temperature X-ray diffraction analysis reveals that dehydroergosterol monohydrate crystallizes in the space group P2(1) with four molecules in the unit cell and monoclinic crystal parameters a = 9.975(1) A, b = 7.4731(9) A, c = 34.054(4) A, and beta = 92.970(2) degrees somewhat similar to ergosterol monohydrate. The molecular arrangement is in a slightly closer packed bilayer structure resembling cholesterol monohydrate. Since dehydroergosterol fluorescence emission undergoes a quantum yield enhancement and red-shift of its maximum wavelength when crystallized, formation or disruption of microcrystals was monitored with high sensitivity using cuvette-based spectroscopy and multi-photon laser scanning imaging microscopy. This manuscript reports on the dynamical effect of sterol carrier protein-2 (SCP-2) interacting between aqueous dispersions of dehydroergosterol monohydrate microcrystal donors and acceptors consisting not only of model membranes but also vesicles derived from plasma membranes isolated by biochemical fractionation and affinity purification from Madin-Darby canine kidney cells. Furthermore, this study provides real-time measurements of the effect of increased SCP-2 levels on the rate of disappearance of dehydroergosterol microcrystals in living cells.

Opportunities and barriers to successful learning transfer: impact of critical care skills training.

AIM: This paper is a report of a study to assess the impact on nursing practice of critical care skills training for ward-based nurses. BACKGROUND: Following a government review in the UK of adult critical care provision, new ways of working were advocated to ensure that critical care services depended on the needs of the patient, not their location in the hospital. A re-conceptualization beyond service provision in high dependency units and intensive care units was required in order to deliver an integrated service. This has ramifications for training requirements. METHODS: Semi-structured interviews were used to explore perceived learning and learning transfer from a range of courses. The data were collected from course attendees (n = 47) and line-managers (n = 19) across two sites between 2005 and 2006. FINDINGS: Learning was closely associated with the clinical application of new skills and knowledge. Commonly, course attendees and line-managers quoted increased knowledge and confidence, better assessment skills and improved interprofessional working. Time with competency assessors, availability of expanding roles, and supernumerary time were key factors for successful learning transfer. Barriers were financial pressures on hospitals, lack of perceived relevance of the course to staff or nursing practice, and lack of time to practice skills or work with clinical skills facilitators. CONCLUSION: Course design should be a collaborative activity between education providers and commissioners to ensure the impact of training on practice. Relevance of material, time to practise skills and new learning, and organizational, rather than merely individual, support are essential for successful training interventions.

Structure of an endoglucanase from termite, Nasutitermes takasagoensis.

Contrary to conventional wisdom, it has been shown recently that termites do not necessarily depend on symbiotic bacteria to process cellulose. They secrete their own cellulases, mainly endo-beta-1,4-glucanase and beta-1,4-glucosidase. Here, the first structure of an endogenous endoglucanase from the higher termite Nasutitermes takasagoensis (NtEgl) is reported at 1.40 A resolution. NtEgl has the general folding of an (alpha/alpha)(6) barrel, which is a common folding pattern for glycosyl hydrolase family 9. Three-dimensional structural analysis shows that the conserved Glu412 is the catalytic acid/base residue and the conserved Asp54 or Asp57 is the base. The enzyme has a Ca(2+)-binding site near its substrate-binding cleft. Comparison between the structure of the Ca(2+)-free enzyme produced by reducing the pH of the soaked crystal from 5.6 (the pH of optimum enzyme activity) to 2.5 with that of the Ca(2+)-bound enzyme did not show significant differences in the locations of the C(alpha) atoms. The main differences are in the conformation of the residue side chains ligating the Ca(2+) ion. The overall structure of NtEgl at pH 6.5 is similar to that at pH 5.6. The major change observed was in the conformation of the side chain of the catalytic acid/base Glu412, which rotates from a hydrophobic cavity to a relatively hydrophilic environment. This side-chain displacement may decrease the enzyme activity at higher pH.

Determination of the structure of an endoglucanase from Aspergillus niger and its mode of inhibition by palladium chloride.

The fungus Aspergillus niger is a main source of industrial cellulase. beta-1,4-Endoglucanase is the major component of cellulase from A. niger. In spite of widespread applications, little is known about the structure of this enzyme. Here, the structure of beta-1,4-endoglucanase from A. niger (EglA) was determined at 2.1 A resolution. Although there is a low sequence identity between EglA and CelB2, another member of family 12, the three-dimensional structures of their core regions are quite similar. The structural differences are mostly found in the loop regions, where CelB2 has an extra beta-sheet (beta-sheet C) at the non-reducing end of the binding cleft of the native enzyme. Incubation of EglA with PdCl(2) irreversibly inhibits the EglA activity. Structural studies of the enzyme-palladium complex show that three Pd(2+) ions bind to each EglA molecule. One of the Pd(2+) ions forms a coordinate covalent bond with Met118 S(delta) and the nucleophilic Glu116 O(epsilon1) at the active site of the enzyme. The other two Pd(2+) ions bind on the surface of the protein. Binding of Pd(2+) ions to EglA does not change the general conformation of the backbone of the protein significantly. Based on this structural study, one can conclude that the palladium ion directly binds to and blocks the active site of EglA and thus inactivates the enzyme.