Self-reported and digital-trace measures of computer science students' self-regulated learning in blended course designs.

This study investigated the extent to which self-report and digital-trace measures of students' self-regulated learning in blended course designs align with each other amongst 145 first-year computer science students in a blended "computer systems" course. A self-reported Motivated Strategies for Learning Questionnaire was used to measure students' self-efficacy, intrinsic motivation, test anxiety, and use of self-regulated learning strategies. Frequencies of interactions with six different online learning activities were digital-trace measures of students' online learning interactions. Students' course marks were used to represent their academic performance. SPSS 28 was used to analyse the data. A hierarchical cluster analysis using self-reported measures categorized students as better or poorer self-regulated learners; whereas a hierarchical cluster analysis using digital-trace measures clustered students as more active or less active online learners. One-way ANOVAs showed that: 1) better self-regulated learners had higher frequencies of interactions with three out of six online learning activities than poorer self-regulated learners. 2) More active online learners reported higher self-efficacy, higher intrinsic motivation, and more frequent use of positive self-regulated learning strategies, than less active online learners. Furthermore, a cross-tabulation showed significant (p < .01) but weak association between student clusters identified by self-reported and digital-trace measures, demonstrating self-reported and digital-trace descriptions of students' self-regulated learning experiences were consistent to a limited extent. To help poorer self-regulated learners improve their learning experiences in blended course designs, teachers may invite better self-regulated learners to share how they approach learning in class.

The relations between self-reported perceptions of learning environment, observational learning strategies, and academic outcome.

This study investigated the relations between students' self-reported perceptions of the blended learning environment, their observed online learning strategies, and their academic learning outcomes. The participants were 310 undergraduates enrolled in an introductory course on computer systems in an Australian metropolitan university. A Likert-scale questionnaire was used to examine students' perceptions. The digital traces recorded in a bespoke learning management system were used to detect students' observed online learning strategies. Using the data mining algorithms, including the Hidden Markov Model and an agglomerative hierarchical sequence clustering, four types of online learning strategies were found. The four strategies not only differed in the number of online learning sessions but also showed differences in the proportional distribution with regard to different online learning behaviors. A one-way ANOVA revealed that students adopting different online learning strategies differed significantly on their final course marks. Students who employed intensive theory application strategy achieved the highest whereas those used weak reading and weak theory application scored the lowest. The results of a cross-tabulation showed that the four types of observed online learning strategies were significantly associated with the better and poorer perceptions of the blended learning environment. Specially, amongst students who adopted the intensive theory application strategy, the proportion of students who self-reported better perceptions was significantly higher than those reporting poorer perceptions. In contrast, amongst students using the weak reading and weak theory application strategy, the proportion of students having poorer perceptions was significantly higher than those holding better perceptions.

Optimal Surveillance Strategies for Early-Stage Cutaneous Melanoma Post Primary Tumor Excision: An Economic Evaluation.

Background. Consensus on standardized active surveillance or follow-up care by clinicians is lacking leading to considerable variation in practice across countries. An important structural modelling consideration is that self-examination by patients and their partners can detect melanoma recurrence outside of active surveillance regimes. Objectives. To identify candidate melanoma surveillance strategies for American Joint Committee on Cancer (AJCC) stage I disease and compare them with the current recommended practice in a cost-utility analysis framework. Methods. In consultation with UK clinical experts, a microsimulation model was built in TreeAge Pro 2019 R1.0 (Williamstown, MA, USA) to evaluate surveillance strategies for AJCC stage IA and IB melanoma patients separately. The model incorporated patient behaviors such as self-detection and emergency visits to examine suspicious lesions. A National Health Service (NHS) perspective was taken. Model input parameters were taken from the literature and where data were not available, local expert opinion was sought. Probabilistic sensitivity analysis, one-way sensitivity analysis on pertinent parameters and value of information was performed. Results. In the base-case probabilistic sensitivity analysis, less intensive surveillance strategies for AJCC stage IA and IB had lower total lifetime costs than the current National Institute for Health and Care Excellence (NICE) recommended strategy with similar effectiveness in terms of quality-adjusted life years and thereby likely to be cost-effective. Many strategies had similar effectiveness due to the relatively low chance of recurrence and the high rate of self-detection. Sensitivity and scenario analyses did not change these findings. Conclusions. Our model findings suggest that less resource intensive surveillance may be cost-effective compared with the current NICE surveillance guidelines. However, to advocate convincingly for changes, better evidence is required.

Explaining medical students' learning outcomes in blended course designs: combining self-reported and observational learning experiences.

Blended course designs have been increasingly adopted in medical education. However, research on the relations between the key aspects of students' learning experience and their learning outcomes often only measures students' self-reported experience, neglecting what they actually do in learning. This study combined both self-reported and observational measures of students' learning experiences and examined the relations between the two sets of measures and their contributions to learning outcomes. Australian medical students were asked to report their approaches to, and perceptions of, learning. The frequency and duration of their interactions with both online formative and summative tasks were observed and recorded. Correlation analyses showed that the learning outcome was positively related to deep approaches to using online technologies and duration of interactions with online summative tasks. The hierarchical multiple regression analysis found that the self-reported approaches and duration of interactions jointly explained the learning outcomes, accounting for 6% of the variance. The study demonstrated the complementary nature of using both self-reported and observational measures of students' learning experiences to explain the learning outcomes in blended course designs.

Configurations of collaborations based on learning orientations amongst medical students.

While collaboration is an important and key attribute for medical students in order to prepare them to perform well in health care teams, how to effectively develop and assess such skills is challenging. The current widespread practice of using Likert-scale questionnaire only to measure the quantity of collaboration at course and/or program level appears to be insufficient to provide an evidence-base for what counts desirable collaborative learning experience. Drawing on research into student approaches to learning and social network analysis, this study investigates differences in collaborative learning configurations amongst 217 Australian medical students. Based on students' learning orientations (i.e., 'understanding' and 'reproducing') and their choice of collaborations (i.e., whether to collaborate or not, with whom to collaborate, and mode of collaboration), the analyses found five configurations of collaborations differing in a number of features. The most desirable collaborative experience was a configuration of collaborations formed by students with an 'understanding' orientation. This configuration revealed a strong tendency towards intensive pair work with measurable differences in how easy and effectively they collaborated. The results of the study not only have practical implications for teaching and curriculum design for collaborative learning, but also have significant implications for assessing students' collaborative learning experiences.

Using Phenomenography to Tackle Key Challenges in Science Education.

This article describes how phenomenography, as a qualitative research method, can be used to tackle key challenges in science education. It begins with an overview of the development of phenomenography. It then describes the philosophical underpinnings of phenomenographic inquiry, including ontological and epistemological roots, and its unique second-order perspective. From theoretical background to practicality, the paper uses rich examples to describe in detail the procedures of conducting a phenomenographic study, including sampling and data collection, analyzing phenomenographic data, and communicating key findings. The paper concludes by showing how the phenomenographic method can be used to develop students' conceptual understanding of scientific concepts, to inform effective instructional design in science teaching, and to identify and improve evidence-based factors in student learning to enhance learning outcomes in science.

Evaluating the Quality of Veterinary Students' Experiences of Learning in Clinics.

Educators seeking to evaluate the quality of students' experiences of clinic-based learning (CBL) face a challenging task. CBL programs provide multiple opportunities for learning and aim to develop a wide range of skills, knowledge, and capacities. While direct observation of learners provides important information about students' proficiency in performing various clinical tasks, more comprehensive measures are required to unpack and identify factors relating to practice readiness as a whole. This study identified variables that have a logical and statistically significant association with learning outcomes across the broad range of attributes expected of new graduate veterinarians. The research revealed that the extent of final-year veterinary students' practice readiness, as assessed by placement supervisors against criteria relevant to new graduate practice, is related to the quality of their conceptions of and approaches to CBL. Students' conceptions of and approaches to CBL were evaluated using quantitative survey instruments, with a 93% response rate (N=100) obtained for the two questionnaires. Descriptive and exploratory statistics were used to link qualitative differences in students' conceptions of and approaches to CBL with performance against criteria relevant to new graduate practice. Students who reported poorer-quality conceptions of and approaches to CBL (n=38) attained lower levels of achievement than students who reported better-quality conceptions of and approaches to CBL (n=55). Evaluation of students' conceptions of and approaches to CBL can be used by educators seeking to evaluate and improve the extent to which CBL programs are achieving their desired goals.

Prognostic Impact of Autophagy Biomarkers for Cutaneous Melanoma.

Prognosis and survival for malignant melanoma is highly dependent on early diagnosis and treatment. While the American Joint Committee on Cancer (AJCC) criterion provides a means of staging melanomas and guiding treatment approaches, it is unable to identify the risk of disease progression of early stage tumors or provide reliable stratification for novel adjuvant therapies. The demand for credible prognostic/companion biomarkers able to identify high-risk melanoma subgroups as well as guide more effective personalized/precision-based therapy is therefore of paramount importance. Autophagy, the principle lysosomal-mediated process for the degradation/recycling of cellular debris, is a hot topic in cancer medicine, and observations of its deregulation in melanoma have brought its potential as a prognostic biomarker to the forefront of current research. Key regulatory proteins, including Atg8/microtubule-associated light chain 3 (LC3) and BECN1 (Beclin 1), have been proposed as potential prognostic biomarkers. However, given the dynamic nature of autophagy, their expression in vitro does not translate to their use as a prognostic biomarker for melanoma in vivo. We have recently identified the expression levels of Sequestosome1/SQSTM1 (p62) and activating molecule in Beclin 1-regulated autophagy protein 1 (AMBRA1) as novel independent prognostic biomarkers for early stage melanomas. While increasing followed by subsequent decreasing levels of p62 expression reflects the paradoxical role of autophagy in melanoma, expression levels additionally define a novel prognostic biomarker for AJCC stage II tumors. Conversely, loss of AMBRA1 in the epidermis overlying primary melanomas defines a novel prognostic biomarker for AJCC stage I tumors. Collectively, the definition of AMBRA1 and p62 as prognostic biomarkers for early stage melanomas provides novel and accurate means through which to identify tumors at risk of disease progression, facilitating earlier patient therapeutic intervention and stratification tools for novel personalized therapeutic approaches to improve clinical outcome.

Established and Emerging Biomarkers in Cutaneous Malignant Melanoma.

In an era of personalized medicine, disease specific biomarkers play an increasing role in the stratification of high-risk patient groups. Cutaneous malignant melanoma is the most deadly form of skin cancer with an ever-increasing global incidence, especially in patients under 35-years of age. Despite the excellent prognosis for patients diagnosed with early stage disease, metastatic disease still carries significant overall mortality. Biomarkers aim not only to identify high-risk patients, but also to provide potential therapeutic targets for differing patient subgroups. Furthermore, accessibility to tissue samples from a range of disease stages in malignant melanoma, unlike most other solid tissue tumours, provides the unique opportunity to explore the biology of tumour progression that may be relevant in the biology of cancer as a whole. Over the past decade, there have been major advances in targeted therapies, providing new avenues and hope to patients with this devastating disease. This review will focus on most up to date histological, serological and molecular biomarkers in malignant melanoma.

New graduates' conceptions of and approaches to veterinary professional practice, and relationships to achievement during an undergraduate internship programme.

New graduate veterinarians report differing experiences of the transition to practice. Some make a rapid transition to professional autonomy while others require prolonged and extensive support from their colleagues. Factors contributing to this variation are unclear. This study used phenomenography to analyse the conceptions of and approaches to veterinary professional practice (VPP) reported by new graduates in semi-structured interviews (n = 22). Quantitative statistical analysis was used to investigate links between the quality of graduates' experiences and their achievement during a comprehensive final year internship programme. Strong associations were identified between the quality of graduates' conceptions of and approaches to VPP. Links were also established between the quality of graduates' conceptions of VPP and their performance in practice prior to graduation. The outcomes of this research can be used to improve teaching and assessment during final year internships and enhance graduate attribute statements for professional degree programmes. The results also indicate that student learning research methodologies can be used to evaluate the quality of graduates' experiences in the workplace. This has implications for career outcomes research in a range of healthcare professions.

The agreement and repeatability of computer-based wear measurement of total hip arthroplasties.

We assessed the agreement and repeatability of a software package for wear measurement in 19 total hip arthroplasties followed up for 4 to 8 years. Three observers with different levels of expertise (a hip surgeon [O1], a fellow [O2], and a medical student who is a research assistant of the laboratory in which the software was developed [O3]) determined the 2-dimensional wear and wear direction with the Hip Suite software (University of Chicago, Chicago, Ill). For intraobserver and interobserver comparisons, we used intraclass correlation coefficient (ICC) and repeatability. The intraobserver ICC for wear and wear direction was 0.83 and 0.78 for O1, 0.54 and 0.48 for O2, and 0.81 and 0.89 for 03. The interobserver ICCs were 0.43 (range, 0.07-0.87) for wear and 0.8 (range, 0.71-0.86) for wear direction. Computerized wear measurements have substantial intraobserver and interobserver variability, especially when performed by surgeons without extensive experience in the use of the software, a finding which questions its precision and validity.

Student experiences of problem-based learning in pharmacy: conceptions of learning, approaches to learning and the integration of face-to-face and on-line activities.

This study investigates fourth-year pharmacy students' experiences of problem-based learning (PBL). It adopts a phenomenographic approach to the evaluation of problem-based learning, to shed light on the ways in which different groups of students conceive of, and approach, PBL. The study focuses on the way students approach solving problem scenarios in class, and using professional pharmacy databases on-line. Qualitative variations in student approaches to solving problem scenarios in both learning situations are identified. These turn out to be associated with qualitatively different conceptions of PBL and also with levels of achievement. Conceptions and approaches that emphasis learning for understanding correlate with attaining higher course marks. The outcomes of the study reinforce arguments that we need to know more about how students interpret the requirements of study in a PBL context if we are to unravel the complex web of influences upon study activities, academic achievement and longer-term professional competence. Such knowledge is crucial to any theoretical model of PBL and has direct practical implications for the design of learning tasks and the induction of students into a PBL environment.

A good death certificate: improved performance by simple educational measures.

BACKGROUND AND AIMS: The initial aim of this audit was to determine whether information on death certificates is correct and all legal requirements are met. As shortcomings were found, educational measures were undertaken and the effect of those was measured by a re-audit. METHOD: All death certificates issued during a 4-month period within the elderly care department of a district general hospital were retrospectively audited. A re-audit was performed later the same year over a 3-month period. RESULTS: 19 (13.6%) of 140 certificates issued during the initial 4-month period could not be shown to meet the statutory criteria, as no evidence was found that these patients were attended by the issuing medical officer. Minor errors and omissions were found in 58.6% of certificates. Following education about these problems, there was a significant improvement in death certification. Only 2 (2.4%) of 85 certificates issued in the re-audit period did not meet the statutory criteria (p = 0.01) and minor errors and omissions occurred in 20%. CONCLUSION: The incidence of unsatisfactory death certificates within a hospital setting is high. Increased education and better documentation leads to improvements in accuracy and legitimacy.