Role-playing simulation as an educational tool for health care personnel: developing an embedded assessment framework.

Simulation- and video game-based role-playing techniques have been proven effective in changing behavior and enhancing positive decision making in a variety of professional settings, including education, the military, and health care. Although the need for developing assessment frameworks for learning outcomes has been clearly defined, there is a significant gap between the variety of existing multimedia-based instruction and technology-mediated learning systems and the number of reliable assessment algorithms. This study, based on a mixed methodology research design, aims to develop an embedded assessment algorithm, a Knowledge Assessment Module (NOTE), to capture both user interaction with the educational tool and knowledge gained from the training. The study is regarded as the first step in developing an assessment framework for a multimedia educational tool for health care professionals, Anatomy of Care (AOC), that utilizes Virtual Experience Immersive Learning Simulation (VEILS) technology. Ninety health care personnel of various backgrounds took part in online AOC training, choosing from five possible scenarios presenting difficult situations of everyday care. The results suggest that although the simulation-based training tool demonstrated partial effectiveness in improving learners' decision-making capacity, a differential learner-oriented approach might be more effective and capable of synchronizing educational efforts with identifiable relevant individual factors such as sociobehavioral profile and professional background.

Beyond the evidence-based practice paradigm to achieve best practice in rehabilitation medicine: a clinical review.

OBJECTIVE: Best practice is a practice that, on rigorous evaluation, demonstrates success, has had an impact, and can be replicated. It is differentiated from its constituent parts, evidence-based practice and knowledge translation, by its general meaning and global purview. The purpose of this clinical review is to provide transparency to the concept and achievement of best practice in the context of rehabilitation medicine. The authors will review and analyze the roles of evidence-based practice and knowledge translation in rehabilitation medicine as they work to support best practice. Challenge areas will be discussed, including an evidential hierarchy in need of update, a lack of "high-level" research evidence, and delays in translating evidence to practice. Last, the authors will argue that rehabilitation medicine is well-positioned to effect change by promoting inclusion of emerging research methodologies and analytic techniques that better capture context-specific rehabilitation evidence, into the evidential hierarchy. Achieving best practice is dependent on this, as well as alignment of all key stakeholders, ranging from the patient, researchers and clinicians, to policymakers, payers, and others.

Feasibility study of home care wound management using telemedicine.

OBJECTIVE: Evaluate the effectiveness of telemedicine (TM) with digital cameras in treating wounds in a home care setting. DESIGN: Randomized controlled study. PARTICIPANTS AND SETTING: One hundred three subjects with 160 pressure ulcers (PrUs) or nonhealing surgical wounds referred to a metropolitan Visiting Nurse Agency. INTERVENTIONS: Subjects were randomly assigned to 1 of 3 groups. Group A (n = 40): weekly visits with TM and wound care specialist (WCS) consults; group B (n = 28): weekly visits with weekly consults with WCSs; and group C (n = 35): usual and customary care. MAIN OUTCOME MEASURES: Outcome measures were time to heal, costs, length of stay (LOS), nursing visits, wound status, and change in size. RESULTS: There was a similar distribution of subject characteristics in all 3 groups, but group A had disproportionally larger and more numerous PrUs and larger nonhealing surgical wounds. Group A had increased time to heal, LOS, costs, and visits compared with groups B and C; wound status was similar in all groups. CONCLUSIONS: Uneven distribution of severity and type of wounds among groups, with greatest percentage of large wounds in TM group. Larger wounds consume more resources. TM is a useful communication tool in wound management but with limited power when randomization does not include wound size or type. Two important benchmarks were established for home care. First, it took 51 days, on average, to heal or improve PrUs and 34 days to heal or improve surgical wounds regardless of group. Second, nearly 90% of wounds improved or healed.