Health science staff and student experiences of teaching and assessing clinical skills using digital tools: a qualitative study.

INTRODUCTION: Once considered a supplement to traditional teaching approaches, digital tools now play a pivotal role in building core clinical competencies. This study aims to explore staff and student experiences of navigating the challenges of teaching and assessing clinical skills using digital technology. It also aims to provide insight into what skills, or aspects of skills, may be best suited to digitally enhanced teaching, thereby advancing the future of health science education. METHODS: This qualitative study comprises the second phase of data generation for a mixed-methods research project entitled DEPTH (Digitally Enhanced Practical Teaching in Health Science). Health science staff and students expressed interest in taking part in the current study during the first stage of data collection. Qualitative data was collected in January 2022 through semi-structured group interviews and individual semi-structured interviews. An interpretivist qualitative research design underpinned by a critical realist epistemological position was used. Themes were generated following Braun and Clarke's 6-step process for reflexive thematic analysis. RESULTS: Overall, 10 staff and 8 students across 11 health science disciplines participated in this research. Fourteen hours of transcripts were analysed and 4 themes generated. Our findings highlight the suitability of digitally enhanced teaching for low-stake skills requiring visual and auditory training, while skills requiring tactile training require in-person practice to build student competency. Importantly, our findings indicate a desire for increased remote teaching. While our work was not specifically aimed at documenting experiences related to the Covid-19 pandemic, all participants had lived experience teaching or learning during the pandemic and many spoke specifically about this. CONCLUSIONS: The timing of this paper captures a novel moment in the history of clinical pedagogy. Staff and students advocate for the continued integration of technology into health science education generally, and clinical skills teaching specifically. For this to be successful, judicious selection of methods, skills, skill components and technology, that can be appropriately mapped onto specific learning outcomes, is required.

Staff and students expressed a desire for more hybrid teaching of clinical skills but are sceptical about the suitability of skills, or aspects of skills, for remote teaching.Clinical skills requiring auditory and visual training can effectively be taught using digital tools while skills requiring haptic awareness and manual dexterity necessitate in-person practice to consolidate learning.The findings from this paper informed the development of an online, open-access, educational resource to support staff and students in maximising technology to support practical skill acquisition.

Did physical activity and associated barriers change during COVID-19 restrictions in Ireland? Repeated cross-sectional study.

This repeated cross-sectional study investigated physical activity and associated barriers and facilitators during the first two waves of COVID-19 restrictions in Ireland. An online, anonymous questionnaire collated data from adults during May (n = 1274) and November (n = 810) 2020. Statistical analysis used a combination of traditional significance testing and Bayesian lasso logistic regression. The pattern of physical activity changed significantly between waves (χ2 86.8 on 3df; p < 0.001). During wave 1 restrictions, the majority [46.1% (n = 587)] of participants reported being more active than usual, decreasing to 26.3% (n = 213) during wave 2. More participants reported that their activity levels were less than usual [W1 29% (n = 369); W2 35% (n = 283)] during wave 2. Adherence to physical activity guidelines decreased from 56.5% (n = 705) to 43.7% (n = 35). Being unable to access their usual means of exercise [OR, 95% OR intervals; W1 1.611 (1.370-1.904), W2 1.638 (1.3731.968)] and advice not to leave home [OR, 95% OR intervals; W1 1.401 (1.164-1.697), W2 1.367 (1.106-1.696)] predicted less activity than usual during both waves. Increased time [OR, 95% OR intervals; W1 2.326 (1.948-2.794), W2 1.809 (1.478-2.233)], and valuing physical activity as important [OR, 95% OR intervals; W1 1.192 (1.001-1.444), W2 1.253 (1.003-1.637)] predicted increased activity during both waves, whilst finding new ways to be active [OR, 95% OR intervals; 2.515 (1.641-3.887)] predicted more activity in wave 2 only. Increases in physical activity of Irish adults during the first phase of COVID-19 restrictions were not maintained during the second wave and barriers to physical activity persisted.

Our study looked at the physical activity levels of Irish adults during the first two waves of COVID-19 restrictions. We also examined the factors that helped or hindered people to be active at this time. We used an anonymous, online questionnaire to collect responses during May and November 2020. In total, 1274 people responded in May and 810 in November. We found that in May, almost half of the respondents reported they were more active than usual. By November this had reduced to just over a quarter and about one in three people reported they were doing less activity than usual. People who were less active than usual reported that the closure of their usual means of getting activity, and the advice not to outdoors were the main factors preventing them from being active. People who were more active than usual reported that having more time and feeling that physical activity was important helped them to be more active. The things that helped or hindered people from being active generally did not change between May and November.

A Literature Review of Barriers and Opportunities Presented by Digitally Enhanced Practical Skill Teaching and Learning in Health Science Education.

INTRODUCTION: An evidence gap exists identifying the challenges and opportunities presented by digitally enhanced practical skill teaching and learning in health science education. A literature review was carried out to address this gap and to provide recommendations for overcoming identified challenges. METHOD: A systematic search strategy was carried out using PRISMA guidelines. The research databases PubMed, ERIC, Medline and CINHL, were searched using MeSH terms. Barriers and opportunities were identified through deductive thematic analysis of the included articles. RESULTS: Of the 602 articles identified through the database screening, 29 were included in the current review. Potential challenges posed by technologically supported practical skill teaching identified were i) Inaccessibility and Inequity of Online Learning (ii) Digital illiteracy Among Staff (iii) Technological Challenges (iv) Lack of Engagement with Preparatory Material Hinders Practical Learning (v) Lack of Staff-Student Interaction (vi) Negative Attitudes Towards Online Learning and (vii) Skill Suitability. The opportunities presented by digital technologies identified were (i) Facilitates Higher Order Learning (ii) Ability to Practice in a Safe Environment (iii) Efficacious Use of Class Time (iv) Access to Education (v) Learning Brought to Life (vi) Diverse Range of Learning Materials (vii) Promotes Autonomous Learning. DISCUSSION: This literature review demonstrates the acceptability and usability of digitally enhanced practical teaching in health science education among students and educators. CONCLUSION: To consolidate the positive disturbances in higher education from the Covid-19 pandemic, potential barriers to online delivery and student engagement must be acknowledged and addressed by relevant stakeholders. Recommendations detailed as part of this paper suggest means of overcoming barriers and leveraging opportunities.

Time and belief in exercise importance predict increased activity during initial COVID-19 restrictions in Ireland.

The aim of this work was to investigate physical activity levels and the associated barriers and facilitators to physical activity in Irish adults during initial COVID-19 restrictions. Members of the general population completed an online questionnaire. Responses from 1274 participants (1274/1568, 81% completion rate) indicated that the majority (46.1%, n = 587) of people were more active than usual during the restrictions, however, 28.6% (n = 365) reported being less active. Fifty-five percent (55.3%, n = 702) of participants were meeting public health physical activity guidelines and more than half (53.3%, n = 679) reported finding new ways to be active. Walking (86%, n = 1101), physical activity in the home (47%, n = 593) and online resources (38%, n = 483) were the most frequently reported types of physical activity people engaged in. Having more time to be physically active [OR 2.326 (SD 1.948-2.794)] and a greater belief in the importance of physical activity [OR 1.192 (SD 1.001-1.444)] were predictive of exercising more than usual. Being unable to access their usual means of exercise [OR 1.612 (SD 1.369-1.902)], advised not to go outside the home [OR 1.402 (SD 1.165-1.698)] and working more than usual [OR 1.201 (SD 1.013-1.443)] were predictive of exercising less than usual. There was a positive trend in physical activity engagement by Irish adults during initial COVID-19 restrictions, likely influenced by increased time, belief that exercise was important and increased use of home-based and online exercise resources. However, almost one in three people reported being less active than usual, highlighting the need for targeted support during restriction periods.

Our study aimed to find out what helped and what hindered people being physically active during the initial COVID-19 restrictions (May 2020). At this time, people in Ireland were advised to stay at home and only permitted to exercise within a limited distance from their homes. The vast majority of exercise facilities, such as gyms and swimming pools were closed. We collected our information using an online survey, which 1274 people completed. Results showed that close to half of people reported being more active than usual during this time, however almost one in three people reported being less active than usual. Those who were more active reported having more time than before and had a strong belief that exercise was important. A lot of people found new ways to exercise, such as online exercise classes. Walking was the most popular physical activity. Those who were exercising less than usual reported their usual means of exercise being unavailable to them, being advised not to leave their homes and having to work more than usual. Understanding what helps and prevents people from being physically active during COVID-19 restrictions helps governments, health professionals and exercise specialists plan how best to promote physical activity if periods of similar restrictions occur.

Cross-cultural applicability of the episodic disability framework with adults living with HIV in Ireland: a qualitative study.

Purpose: To explore the cross-cultural applicability of the Episodic Disability Framework with people living with HIV in Ireland.Methods: We conducted a qualitative descriptive study using semi-structured interviews. We recruited adults with HIV from a hospital clinic and community-based organization in Dublin, Ireland. We asked participants to describe their health-related challenges, the extent to which these challenges were episodic in nature, and the impact on their overall health. We analyzed data using content analytical techniques.Results: Of the 12 participants (9 men; 3 women), with a median time since HIV diagnosis of 12 years, 83% had an undetectable viral load. Participants described multi-dimensional and episodic health challenges that spanned disability dimensions in the Episodic Disability Framework including: physical, cognitive, and mental-emotional symptoms and impairments, challenges to social inclusion, and uncertainty or worrying about future health with HIV. Contextual factors that exacerbated disability included stigma and fear of HIV disclosure whereas living strategies (lifestyle, positive outlook, resiliency) and social support (family, friends, health services and providers) mitigated disability.Conclusions: The Episodic Disability Framework is pertinent to adults living with HIV in Ireland. Contextual factors are critical for understanding cross-cultural distinctions of the disability experience across varying political, economic, socio-cultural, and environmental contexts and should be considered by rehabilitation professionals to address disability for people with HIV.Implications for rehabilitationThe Episodic Disability Framework, originally derived and validated from perspectives of adults living with HIV in Canada, is pertinent to people living with HIV in Ireland.The Episodic Disability Framework can be used to describe disability experienced by people living with HIV, and to better understand the contextual factors that may exacerbate or alleviate dimensions of disability over time.Contextual factors are critical for understanding cross-cultural distinctions of the disability experience across varying political, economic, sociocultural, and environmental contexts, and should be considered by rehabilitation professionals to better address disability for people with HIV.

Improvement in cognitive impairment following a 12-week aerobic exercise intervention in individuals with non-cirrhotic chronic hepatitis C.

Cognitive impairment occurs in 30%-50% of patients with non-cirrhotic chronic hepatitis C virus (HCV) infection. Exercise is beneficial in preventing and treating cognitive impairment and cardiometabolic abnormalities in many chronic inflammatory diseases, but there are few studies investigating the impact of exercise in HCV infection. The study aimed to assess the effect of a 12-week aerobic exercise intervention on cognition and extrahepatic manifestations in individuals with HCV. In this nonrandomized controlled pilot study, individuals with HCV participated in a 12-week aerobic exercise intervention. Outcome measures included cognition (Montreal Cognitive Assessment [MOCA], Trail Making Test A & B [TMT-A; TMT-B], Digit Symbol Test [DST]), cardiorespiratory fitness (estimated V˙O2max ), physical activity (accelerometry), anthropometry, quality of life (depression; fatigue; sleep quality) and biochemical markers. Outcomes were assessed at baseline (T0), intervention completion (T1) and 12 weeks after intervention completion (T2). Thirty-one patients completed the study (exercise group n = 13, control group n = 18). In the exercise group, cognition improved at T1 in the TMT-A (31% mean improvement, p = 0.019), TMT-B (15% mean improvement, p = 0.012) time and MOCA (14% mean improvement, p ≤ 0.001). These improvements were not maintained at T2. Depression (p = 0.038), sleep quality (p = 0.002), fatigue (p = 0.037) and estimated V˙O2max (7.8 mL kg-1  min-1 [22%] mean increase, p = 0.004) also improved at T1. In conclusion, this study demonstrates the benefits of a 12-week aerobic exercise intervention in improving cognition, quality of life and cardiorespiratory fitness in individuals with HCV. Larger studies are needed to confirm these findings and strategies for continued exercise engagement in individuals with HCV are warranted for sustained benefits.

Comparison of energy expenditure of tasks in standing and sitting in adolescent girls.

BACKGROUND: Adolescent girls are prone to increased sedentary behavior and are more sedentary than their male peers or younger girls. This study compared the energy required for identical tasks in standing and sitting. METHOD: Energy expenditure (EE) was measured using indirect calorimetry (n = 24) in four tasks (sitting/standing quietly; reading; typing; sorting paper) under two postural conditions (sitting; standing). The currently accepted definition for sedentary behavior of energy expenditure of ≤1.5 metabolic equivalents (METs) and being in a seated or reclining position was used. RESULTS: All seated tasks resulted in mean EE <1.5 METs with the exception of sorting paper. All standing tasks resulted in mean EE of >1.5 METs with the exception of standing quietly. Standing sorting paper was the only task with a mean EE significantly >1.5 METs. A significant interaction between task and posture was found. CONCLUSIONS: Active tasks in standing had significantly greater EE than in sitting, and sorting paper while standing was the only task with an EE significantly >1.5 METs. The difference between the two postures is likely too low to produce positive metabolic health benefits in the short term. Studies of the effects of long-term use of standing desks in the classroom are required.

Low Dose Resistance Exercise: A Pilot Study Examining Effects on Blood Pressure and Augmentation Index Between Intensities.

INTRODUCTION: The effects of resistance exercise on vascular function are unclear. AIM: To investigate the acute haemodynamic (blood pressure and augmentation index) and rate of perceived exertion (RPE) response to two types of resistance exercises of equal workload-a set of unilateral 35% of one repetition maximum (1RM) quadriceps extension and a set of unilateral 70% 1RM quadriceps extension. METHODS: Twenty two young healthy males completed both exercises on separate days. Heart rate, central and peripheral systolic and diastolic blood pressure (BP), augmentation pressure, augmentation index (AIx), augmentation index at a heart rate of 75 beats per minute (AIx75), and RPE were measured using applanation tonometry before exercise, immediately after exercise, 5 min after exercise and 15 min after exercise. RESULTS: AIx75 was significantly lower 5 min after exercising at 35% of 1RM than 70% of 1RM. Systolic blood pressure was significantly lower at 5 min post exercise for both intensities. There was no significant difference in RPE between conditions or time points. CONCLUSIONS: Results suggest that changes in blood pressure and augmentation index vary depending on the intensity of resistance exercise regardless of the volume of exercise carried out. Changes in AIx75 in response to resistance exercise may be independent of changes in BP.

Physical Activity is Associated with Metabolic Health in Men Living with HIV.

Metabolic health is a cause for concern among those living with HIV, especially those on antiretroviral therapy. Physical activity (PA) is known to benefit metabolic health, however, few studies have objectively measured PA or investigated the relationship between PA and metabolic health among those living with HIV. In this study, PA and indices of metabolic health among twenty men living with HIV and twenty age matched HIV-negative men were measured. PA was measured using Actigraph accelerometers. Components of the metabolic syndrome and insulin resistance were measured using routine laboratory methods. Men living with HIV were significantly more physically active than HIV-negative men, and were reaching public PA guidelines. Significant inverse correlations between moderate PA and both insulin resistance (ρ -0.847; p < 0.001) and triglycerides (ρ -0.575; p = 0.013) were seen in those living with HIV. Results of this study emphasize the importance of an active lifestyle for those living with HIV.

Energy Expenditure of Standing Compared to Sitting While Conducting Office Tasks.

Objectives This study aimed to investigate the energy expenditure of common office-based tasks. The objectives were to: (a) test the classification of tasks as sedentary or light-intensity physical activity and (b) compare the energy expenditure of tasks under two postural conditions (sitting and standing). Background The sedentary nature of office work has been highlighted as a health risk, and strategies to reduce sedentary behavior at work have been developed. However, there is limited evidence to guide the utilization of sit-stand workstations in the workplace for metabolic health benefits. Method A repeated measures laboratory-based study compared the energy expenditure of common office tasks in sitting and standing using indirect calorimetry ( n = 22). Four standardized tasks (sitting/standing quietly, reading, typing, sorting paper) under two postural conditions (sitting, standing) were performed in a randomized order. Results The mean energy expenditure for all tasks in sitting and standing was <1.5 METs. There were no significant differences in the energy expenditure of doing the same task in sitting compared to standing. In a repeated measures ANOVA, task ( p < .001) had a greater influence on METs expended than posture ( p = .030). Conclusion The study confirmed that the difference in energy expenditure of tasks carried out in sitting compared to standing is negligible. Application The ubiquitous use and utility of sit-stand workstations in the workplace needs to be reviewed. Notwithstanding the potential benefits of movement that may occur naturally, this study confirmed that standing as opposed to sitting does not produce a clinically important increase in energy expenditure.

The effects of a 16-week aerobic exercise programme on cognitive function in people living with HIV.

High levels of cardiovascular fitness and physical activity are associated with higher levels of cognitive function in people with HIV, thus, they may reduce the risk of developing HIV-associated neurocognitive disorder (HAND). This study aimed to investigate the effects of a 16-week aerobic exercise intervention on cognitive function in people with HIV. Eleven participants living with HIV were recruited into the study. Participants were randomised into either an exercise group (n = 5), that completed a 16-week aerobic exercise programme training, 3 times per week (2 supervised sessions and one unsupervised session) or a control group (n = 6) that received no intervention. Outcomes measured included cognitive function (Montreal cognitive assessment (MOCA) and the Trail making tests A and B), aerobic fitness (modified Bruce protocol), sleep quality (Pittsburgh sleep quality index; PSQI) and physical activity levels (seven-day accelerometry). At baseline, higher levels of moderate physical activity were positively correlated with higher MOCA scores and levels of aerobic fitness were negatively associated with Trail A scores (P = 0.04 and P = 0.001 respectively). However, exercise training did not induce any significant improvements in cognitive function or aerobic fitness. The overall mean adherence rate to the exercise programme was 60%. In conclusion, in the present study a 16-week aerobic exercise intervention did not affect the cognitive function of participants with HIV. It is likely that longer intervention periods and/or higher adherence rates to exercise might be needed for an aerobic exercise programme to be effective in improving cognitive function in a cohort with no baseline cognitive impairments.

How Children Use Active Videogames and the Association Between Screen Time and Physical Activity.

OBJECTIVE: The energy required to play active videogames (AVGs) has been reported on in the literature; however, little is known about how children use such games in their home environment. The aim of this study was to investigate children's use of AVGs and the association among AVG use, other screen-based activities, and physical activity levels. MATERIALS AND METHODS: Eight hundred and twenty children 12.1 (0.6) years of age participated. Physical activity levels, sedentary screen-based activities, and AVG use were investigated. Differences across genders and deprivation indices were also analyzed. RESULTS: Fifty-eight percent of children met minimal physical activity guidelines. Forty-seven percent of children exceeded screen time recommendations. Of those who had access to AVGs, more children played sedentary games (or active games in a sedentary manner [68 percent]) than active games (55 percent) on AVG consoles. Furthermore, sedentary games were played for longer than active games. AVG play was positively correlated with reported time spent watching television (P=0.02). CONCLUSIONS: In free-living conditions AVG consoles are being used by more children and for longer durations as sedentary screen-based devices rather than active screen-based devices.

Comparison of Patterns of Physical Activity and Sedentary Behavior Between Children With Cerebral Palsy and Children With Typical Development.

BACKGROUND: Reduced participation in physical activity and increased time spent in sedentary behavior are associated with overweight, chronic disease, and disability. In order to optimize recommendations and interventions to increase physical activity and reduce sedentary behavior in children with cerebral palsy (CP), knowledge of their physical activity and sedentary behavior is needed. OBJECTIVES: The aim of this study was to describe light, moderate, and vigorous physical activity and sedentary behavior in preadolescent children with and without CP and compare physical activity and sedentary behavior between the 2 groups. DESIGN: This was a cross-sectional study of 33 children, aged 6 to 10 years, with CP (Gross Motor Function Classification System [GMFCS] levels I-III) and 33 age- and sex-matched children with typical development. METHODS: Physical activity was measured using the RT3 accelerometer over 7 days. RESULTS: Children with CP spent more time in sedentary behavior and accumulated less total activity, moderate activity, vigorous activity, and sustained bouts of moderate-to-vigorous activity (MVPA). They also accumulated a fewer number of bouts of MVPA and vigorous activity, despite spending a similar amount of time in each bout. LIMITATIONS: The small number of children in GMFCS levels II and III did not allow for adjustment for GMFCS level when comparing physical activity between children with and without CP. CONCLUSIONS: Preadolescent children with CP spent less time in moderate and vigorous activity and more time in sedentary behavior than children with typical development. Children with CP also accumulated less continuous MVPA and vigorous activity as a result of achieving fewer sustained bouts of MVPA and vigorous activity throughout the day.