Training interprofessional teams in geriatric emergency medicine: A modified team-based learning approach.

Background: Older adults deserve special healthcare provision in every branch of medicine. Turkey currently does not have geriatric emergency medicine (GEM) subspecialty training. Thus, interprofessional training for healthcare professionals involved in GEM services is required. Team-based learning (TBL) seems suitable to implement such training. We aimed to develop and implement a training program for healthcare professionals engaged with GEM services, and evaluate the program considering teacher and learner satisfaction and knowledge retention. Methods: This was a design-based study in which a one-day GEM training program was developed based on the literature and expert opinions. The program was applied to 54 physicians, 98 nurses, 70 health officers, and 102 paramedics using a modified version of TBL. Teams included at least one representative from each profession. TBL was modified by adding a 1-h lecture and eliminating peer evaluation. Feedback forms, individual and group tests of TBL, and a retention test conducted six months later were used for program evaluation. Results: The mean group test score was higher than that of individual tests in all professions. Physicians' individual test scores were higher than those of other professions, but this difference disappeared in the group test. The retention test mean score was higher than the individual test mean score but lower than that of the group test. Teacher and learner satisfaction was high. Conclusion: We implemented a training program using a modified TBL approach to teach GEM to relevant healthcare professionals; it yielded promising results regarding knowledge gain and retention, as well as teacher and learner satisfaction. The instruction design and method used in this study can be applied to multidisciplinary team training.

Scenario-based learning: preliminary evaluation of the method in terms of students' academic achievement, in-class engagement, and learner/teacher satisfaction.

We sought to evaluate the effectiveness of a newly developed scenario-based learning (SBL) module considering students' academic achievement, in-class engagement, and learner/teacher satisfaction. Third-year students in a 6-year medical education program, who had preexperience in problem-based learning, studied in small groups with facilitators throughout a week allocated for the SBL module. SBL processes, student/facilitator roles, and expectations were explained to students and facilitators in online training before implementation. Three online discussion sessions were scheduled, but the groups were allowed to organize extra online meetings. The students provided with learning objectives were asked to create a problem-based learning (PBL) scenario with a facilitator's guide including answers to scenario questions, evidence-based information, and tips for facilitators. Evaluated outcomes were learner/teacher satisfaction, students' academic achievement, and engagement. Satisfaction was determined using semistructured feedback forms. Generated scenarios were assessed using a checklist. A written exam was performed to assess students' knowledge and reasoning skills. Student engagement during the sessions was evaluated using forms completed by facilitators and students. SBL module outcomes were compared to students' grade point averages (GPAs) and former PBL outcomes. Mean scenario evaluation, student engagement, and satisfaction scores were around 90%. Mean scores for facilitator satisfaction and whole module success were around 80% and 77%, respectively. Academic achievement and student satisfaction were higher in SBL compared to GPA and previous PBL modules. Facilitator satisfaction and student engagement did not differ between SBL and PBL. Student satisfaction and academic achievement were higher in online SBL compared with PBL without any differences in in-class engagement and facilitator satisfaction.NEW & NOTEWORTHY A newly developed scenario-based learning (SBL) module was implemented assigning third-year medical students to create (highest cognitive level) a problem-based learning facilitator scenario studying in small groups with a facilitator. The 1-wk online SBL module was composed of three scheduled and an unlimited number of nonscheduled sessions. The students and facilitators positively received SBL with some recommendations for improvement. Preliminary evaluation suggests SBL can be implemented without compromising (maybe improving) students' academic achievement, satisfaction, and engagement levels.

Holographic detection of nanoparticles using acoustically actuated nanolenses.

The optical detection of nanoparticles, including viruses and bacteria, underpins many of the biological, physical and engineering sciences. However, due to their low inherent scattering, detection of these particles remains challenging, requiring complex instrumentation involving extensive sample preparation methods, especially when sensing is performed in liquid media. Here we present an easy-to-use, high-throughput, label-free and cost-effective method for detecting nanoparticles in low volumes of liquids (25 nL) on a disposable chip, using an acoustically actuated lens-free holographic system. By creating an ultrasonic standing wave in the liquid sample, placed on a low-cost glass chip, we cause deformations in a thin liquid layer (850 nm) containing the target nanoparticles (≥140 nm), resulting in the creation of localized lens-like liquid menisci. We also show that the same acoustic waves, used to create the nanolenses, can mitigate against non-specific, adventitious nanoparticle binding, without the need for complex surface chemistries acting as blocking agents.

What do otolaryngologists want to learn? An educational targeted needs assessment study.

INTRODUCTION: Targeted needs assessment which includes identifying the needs of learners is a key step of program development. However, this step is commonly underestimated in postgraduate medical education programs, including otolaryngology residency training. Determining the needs of otolaryngologists may help educators to design more purposeful continuing medical education training programs. Furthermore, needs of specialists may provide a clearer insight about effectiveness of the residency programs in that specialty. OBJECTIVE: To determine training needs of otolaryngology specialists and to identify deficiencies in otolaryngology residency training programs. METHODS: Seventy-eight otolaryngology specialists, who completed all data gathering forms properly, were included in this descriptive, cross-sectional study. Demographic data of the participants were collected. Training needs of the participants were determined in seven basic areas of otolaryngology via two-round Delphi method. The basic areas were otology-neurotology, rhinology, laryngology, head and neck surgery, pediatric otolaryngology, sleep disorders and facial plastic surgery. Additionally, we asked an open-ended question to investigate the reasons why the participants perceived themselves incompetent and undereducated, or why they needed further training in some of the basic otolaryngology areas. RESULTS: Facial plastic surgery, otology-neurotology and head and neck surgery were the most cited training areas in the needs assessment. Training needs differed according to experience and place of work. Financial expectations, deficiencies in residency training, regression in knowledge and skills, and special interest were effective determinants on decisions of the participants while determining their training needs. CONCLUSION: Otolaryngologists need further training in some areas of their field due to different reasons. Determining these areas and reasons will help in designing more effective continuous medical education activities and residency training programs in otolaryngology.

Does clinical training period support patient-centeredness perceptions of medical students?

BACKGROUND: Learning environment influences students' professional formation and patient-centered attitudes and behaviors. OBJECTIVE: The purpose of this study is to investigate how hidden curriculum of learning environment and the previous experience with chronically ill patients affect patient-centeredness perceptions of medical students. DESIGN: We followed 144 students and determined their opinions on 'ideal patient-centered practice and learning environment' via patient-centeredness questionnaire (PCQ) just before (third year) and at the end (sixth year) of clinical training years of medical school. At the end of each clinical training year (fourth, fifth, and sixth years), we determined experiences of the students about 'patient-centeredness of the learning environment' using a relevant survey called communication, curriculum, and culture (C3) instrument. We also compared PCQ and C3 instrument scores of the participants who had chronically ill patient in their families/friends and who do not. RESULTS: C3 scores worsened over the years, namely, students faced increasing number of examples against patient centeredness. Final PCQ scores were worse than initial ones. C3 and PCQ scores of the students who had previous experience with chronically ill patients were not different from the scores of the remaining students. CONCLUSION: Medical students, even those who have a chronically ill patient in their families or friends, lose their idealism about patient centeredness to some degree possibly due to hidden curriculum of the medical school.

3D imaging of sex-sorted bovine spermatozoon locomotion, head spin and flagellum beating.

With the advent of sperm sex sorting methods and computer-aided sperm analysis platforms, comparative 2D motility studies showed that there is no significant difference in the swimming speeds of X-sorted and Y-sorted sperm cells, clarifying earlier misconceptions. However, other differences in their swimming dynamics might have been undetectable as conventional optical microscopes are limited in revealing the complete 3D motion of free-swimming sperm cells, due to poor depth resolution and the trade-off between field-of-view and spatial resolution. Using a dual-view on-chip holographic microscope, we acquired the full 3D locomotion of 235X-sorted and 289 Y-sorted bovine sperms, precisely revealing their 3D translational head motion and the angular velocity of their head spin as well as the 3D flagellar motion. Our results confirmed that various motility parameters remain similar between X- and Y-sorted sperm populations; however, we found out that there is a statistically significant difference in Y-sorted bovine sperms' preference for helix-shaped 3D swimming trajectories, also exhibiting an increased linearity compared to X-sorted sperms. Further research on e.g., the differences in the kinematic response of X-sorted and Y-sorted sperm cells to the surrounding chemicals and ions might shed more light on the origins of these results.

Label-free 3D computational imaging of spermatozoon locomotion, head spin and flagellum beating over a large volume.

We report a high-throughput and label-free computational imaging technique that simultaneously measures in three-dimensional (3D) space the locomotion and angular spin of the freely moving heads of microswimmers and the beating patterns of their flagella over a sample volume more than two orders-of-magnitude larger compared to existing optical modalities. Using this platform, we quantified the 3D locomotion of 2133 bovine sperms and determined the spin axis and the angular velocity of the sperm head, providing the perspective of an observer seated at the moving and spinning sperm head. In this constantly transforming perspective, flagellum-beating patterns are decoupled from both the 3D translation and spin of the head, which provides the opportunity to truly investigate the 3D spatio-temporal kinematics of the flagellum. In addition to providing unprecedented information on the 3D locomotion of microswimmers, this computational imaging technique could also be instrumental for micro-robotics and sensing research, enabling the high-throughput quantification of the impact of various stimuli and chemicals on the 3D swimming patterns of sperms, motile bacteria and other micro-organisms, generating new insights into taxis behaviors and the underlying biophysics.

Computational imaging of sperm locomotion.

Not only essential for scientific research, but also in the analysis of male fertility and for animal husbandry, sperm tracking and characterization techniques have been greatly benefiting from computational imaging. Digital image sensors, in combination with optical microscopy tools and powerful computers, have enabled the use of advanced detection and tracking algorithms that automatically map sperm trajectories and calculate various motility parameters across large data sets. Computational techniques are driving the field even further, facilitating the development of unconventional sperm imaging and tracking methods that do not rely on standard optical microscopes and objective lenses, which limit the field of view and volume of the semen sample that can be imaged. As an example, a holographic on-chip sperm imaging platform, only composed of a light-emitting diode and an opto-electronic image sensor, has emerged as a high-throughput, low-cost and portable alternative to lens-based traditional sperm imaging and tracking methods. In this approach, the sample is placed very close to the image sensor chip, which captures lensfree holograms generated by the interference of the background illumination with the light scattered from sperm cells. These holographic patterns are then digitally processed to extract both the amplitude and phase information of the spermatozoa, effectively replacing the microscope objective lens with computation. This platform has further enabled high-throughput 3D imaging of spermatozoa with submicron 3D positioning accuracy in large sample volumes, revealing various rare locomotion patterns. We believe that computational chip-scale sperm imaging and 3D tracking techniques will find numerous opportunities in both sperm related research and commercial applications.

Computational sensing of herpes simplex virus using a cost-effective on-chip microscope.

Caused by the herpes simplex virus (HSV), herpes is a viral infection that is one of the most widespread diseases worldwide. Here we present a computational sensing technique for specific detection of HSV using both viral immuno-specificity and the physical size range of the viruses. This label-free approach involves a compact and cost-effective holographic on-chip microscope and a surface-functionalized glass substrate prepared to specifically capture the target viruses. To enhance the optical signatures of individual viruses and increase their signal-to-noise ratio, self-assembled polyethylene glycol based nanolenses are rapidly formed around each virus particle captured on the substrate using a portable interface. Holographic shadows of specifically captured viruses that are surrounded by these self-assembled nanolenses are then reconstructed, and the phase image is used for automated quantification of the size of each particle within our large field-of-view, ~30 mm2. The combination of viral immuno-specificity due to surface functionalization and the physical size measurements enabled by holographic imaging is used to sensitively detect and enumerate HSV particles using our compact and cost-effective platform. This computational sensing technique can find numerous uses in global health related applications in resource-limited environments.

Computational On-Chip Imaging of Nanoparticles and Biomolecules using Ultraviolet Light.

Significant progress in characterization of nanoparticles and biomolecules was enabled by the development of advanced imaging equipment with extreme spatial-resolution and sensitivity. To perform some of these analyses outside of well-resourced laboratories, it is necessary to create robust and cost-effective alternatives to existing high-end laboratory-bound imaging and sensing equipment. Towards this aim, we have designed a holographic on-chip microscope operating at an ultraviolet illumination wavelength (UV) of 266 nm. The increased forward scattering from nanoscale objects at this short wavelength has enabled us to detect individual sub-30 nm nanoparticles over a large field-of-view of >16 mm2 using an on-chip imaging platform, where the sample is placed at ≤0.5 mm away from the active area of an opto-electronic sensor-array, without any lenses in between. The strong absorption of this UV wavelength by biomolecules including nucleic acids and proteins has further enabled high-contrast imaging of nanoscopic aggregates of biomolecules, e.g., of enzyme Cu/Zn-superoxide dismutase, abnormal aggregation of which is linked to amyotrophic lateral sclerosis (ALS) - a fatal neurodegenerative disease. This UV-based wide-field computational imaging platform could be valuable for numerous applications in biomedical sciences and environmental monitoring, including disease diagnostics, viral load measurements as well as air- and water-quality assessment.