The effectiveness of the problem-based learning in medical cell biology education: A systematic meta-analysis.

BACKGROUND: Problem-based learning (PBL) was widely adopted in medical cell biology education for Chinese student; however, there was no systematic analysis to prove PBL was much more effective than lecture-based learning (LBL). Our aim is to evaluate the effectiveness of PBL on cell biology curriculum compared with LBL. METHOD: We systematically searched the publications related to PBL teaching approach in cell biology curriculum for medical education from databases until to February 2021. Pooled standard mean differences (SMDs) and risk ratios with their 95% confidence intervals were used to assess the effectiveness of PBL and the satisfaction of students to PBL compared to LBL in meta-analysis. The heterogeneity of the included studies was assessed by statistical I2 of heterogeneity. Meta-regression and subgroup analysis were performed to analyze the source of heterogeneity. Funnel plots and Egger tests were performed to assess publication bias. RESULT: After initial searching and selection, 9 studies were included for meta-analysis. All of these 9 studies were in high quality. The SMDs (95% confidence intervals) of total examination scores and comprehensive examination scores between PBL and LBL curriculum in cell biology teaching was calculated to be 0.89 (0.52, 1.26) and 0.53 (0.29, 0.78). Meanwhile, the risk ratios of the satisfaction of PBL vs LBL were calculated to be 1.18 (0.96, 1.46). However, there was a heterogeneity among the pooled SMDs of 10 studies with I2 = 89.7%, P < .001. The factors including the different teachers, the similar or same examination paper and over 100 student numbers among PBL and LBL groups raised the heterogeneity in the pooled SMDs. There is no publication bias in these 10 publications after Egger and Begg test. CONCLUSION: The result indicated PBL was better than LBL in improvement of examination scores and comprehensive examination scores in cell biology curriculum to some extent. However, the satisfaction of students to PBL and LBL had no difference. The factors, including the different teachers, the similar or same examination papers and over 100 student numbers, affected the effectiveness of PBL and raised the heterogeneity of the pooled SMDs.

Bronchoscopy Teaching Without a Gold Standard: Attending Pulmonologists' Assessment of Learners, Supervisory Styles, and Variation in Practice.

BACKGROUND: Despite the growing role of simulation in procedural teaching, bronchoscopy training largely is experiential and occurs during patient care. The Accreditation Council for Graduate Medical Education sets a target of 100 bronchoscopies to be performed during pulmonary fellowship. Attending physicians must balance fellow autonomy with patient safety during these clinical teaching experiences. Few data on best practices for bronchoscopy teaching exist, and a better understanding of how bronchoscopy currently is supervised could allow for improvement in bronchoscopy teaching. RESEARCH QUESTION: How do attending bronchoscopists supervise bronchoscopy, and in particular, how do attendings balance fellow autonomy with patient safety? STUDY DESIGN AND METHODS: This was a focused ethnography conducted at a single center using audio recording of dialog between attendings and fellows during bronchoscopies, supplemented by observation of nonverbal teaching. Interviews with attending bronchoscopists and limited interviews of fellows also were recorded. Interviews were transcribed verbatim before analysis. We used constant comparative analysis to analyze data and qualitative research software to support data organization and thematic analysis. Education researchers from outside of pulmonary critical care joined the team to minimize bias. RESULTS: We observed seven attending bronchoscopists supervising eight bronchoscopies. We noted distinct teaching behaviors, classified into themes, which then were grouped into four supervisory styles of modelling, coaching, scaffolding, and fading. Observation and interviews illuminated that assessing fellow skill was one tool used to choose a style, and attendings moved between styles. Attendings accepted some, but not all, variation in both performing and supervising bronchoscopy. INTERPRETATION: Attending pulmonologists used a range of teaching microskills as they moved between different supervisory styles and selectively accepted variation in practice. These distinct approaches may create well-rounded bronchoscopists by the end of fellowship training and should be studied further.

Using the 4Ms framework to teach geriatric competencies in a community clinical experience.

BACKGROUND: As the population of older adults in the US steadily increases and becomes more diverse, there is an urgent need to integrate geriatric competencies into baccalaureate nursing education. PURPOSE: To integrate the Institute for Healthcare Improvement 4 Ms Framework into an existing baccalaureate nursing community clinical experience to build geriatric and interprofessional competencies and promote positive health outcomes. METHODS: As part of the Geriatric Workforce Enhancement Program, 15 students worked with bilingual social workers and community health workers in an affordable housing urban highrise, assessed building residents and implemented personalized plans of care using the 4Ms framework (what matters to the individual, medications, mentation, and mobility). RESULTS: Students demonstrated competence conducting cognition and depression screening, medication review, and functional and fall risk assessments. Student self-rated achievement of learning objectives ranged from 4.3 to 4.8 (1-5 scale). A retrospective pretest-posttest survey suggested learning about the importance of interprofessional teamwork, and integration of person-centered values when providing care to older adults in the community. Students reflected on barriers to health for older adults in low socioeconomic states and the importance of improving care across the continuum. CONCLUSION: The 4Ms framework provided a valuable construct to guide the community experience and teach geriatric evidence-based practice to nursing students.

Retos para la implementación del aprendizaje basado en problemas en facultades de medicina en América Latina / No disponible

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How Do OSCE Cases Activate Learners About Transgender Health?

PURPOSE: To describe the effect of transgender health-related objective structured clinical examination (THOSCE) case exposure on learner activation regarding gender-affirming care. METHOD: A modified grounded theory approach was applied to identify the educational value of THOSCE cases. Focus groups with current and former primary care internal medicine residents who participated in THOSCE cases were conducted in 2018-2019. Transcripts were analyzed and coded until saturation to identify themes. RESULTS: Eighteen (72%) eligible learners participated in the focus groups. Themes were identified relating to gender-affirming care, and modified grounded theory analysis was used as a framework to organize the themes into 4 stages of learner activation: (1) believing the learner role is important, (2) having the confidence and knowledge necessary to take action, (3) taking action to maintain and improve one's skills, and (4) staying the course even under stress. CONCLUSIONS: Residents were grateful for the opportunity to practice the skills involved in transgender health in a simulation. Many felt unprepared and were concerned about how they were perceived by the standardized patient and faculty. Residents identified feeling more comfortable with gender-affirming language in the inpatient setting, which may provide an opportunity for learning in the future. Residents identified the psychosocial skills of gender-affirming care as more directly relevant while biomedical aspects of gender-affirming care seemed less accessible to residents, given the lack of outpatient experience. The authors propose a staged approach to teaching the skills of gender-affirming care using simulation to address learners of all levels.

Concept-based curriculum: design and implementation strategies.

Objectives Novice nurses are struggling to exercise the critical thinking skill set needed to make competent clinical decisions in today's complex health care environment. This poses immense threats to the health and safety of patients. To address this alarming concern, many prominent organizations have called for a widespread overhaul of nursing curricula. Methods A consistent theme among the recommendations for revising nursing curricula is the utilization of innovative curricula designs that focus on enhancing the critical thinking ability of nursing students, such as a concept-based curriculum. Results Planning and implementing a curriculum revision is an overwhelming undertaking. Conclusions Providing nurse educators with a guide on how to transition to a concept-based curriculum may help to facilitate a course revision.

Inter-rater Reliability of a Clinical Documentation Rubric Within Pharmacotherapy Problem-Based Learning Courses.

Objective. To evaluate a clinical documentation rubric for pharmacotherapy problem-based learning (PBL) courses using inter-rater reliability (IRR) among different evaluators. Methods. A rubric was adapted for use in grading student pharmacists' clinical documentation in pharmacotherapy PBL courses. Multiple faculty evaluators used the rubric to assess student pharmacists' clinical documentation. The mean rubric score given by the evaluators and the standard deviation were calculated. Intra-class correlation coefficients (ICC) were calculated to determine the inter-rater reliability (IRR) of the rubric. Results. Three hundred seventeen clinical documentation submissions were scored twice by multiple evaluators using the rubric. The mean initial evaluation score was 9.1 (SD=0.9) and the mean second evaluation score was 9.1 (SD=0.9), with no significant difference found between the two. The overall ICC was 0.7 across multiple graders, indicating good IRR. Conclusion. The clinical documentation rubric demonstrated overall good IRR between multiple evaluators when used in pharmacotherapy PBL courses. The rubric will undergo additional evaluation and continuous quality improvement to ensure that student pharmacists are provided with the formative feedback they need.

Interactive pedagogical tools could be helpful for medical education continuity during COVID-19 outbreak.

Training and education are essential for medical students. During the COVID-19 outbreak, numerous schools and universities have had to close. Ensuring pedagogical continuity requires alternatives to the traditional classroom, especially in medical education. Usual distance learning tools such as videos and downloadable handouts are not sufficient to promote efficient teaching. Distance learning requires self-motivation and does not give you direct access to your instructor. Some students fear the loss of human contact with an instructor - like asking questions during and after class - which promotes learning, understanding and communication. Moreover, classical distance learning methods do not offer immediate feedback that can help students in their understanding of the lecture. In this context, interactive pedagogic tools (IPT) could be useful for medical education continuity and for maintaining human contact necessary in pedagogy. We briefly evaluated interactive pedagogic tool compared to traditionnal distancial tools on medical students. This study showed the importance to have direct contact with a teacher and feedback during a lecture and to not exclusively perform distance learning without direct interaction and feedback. Hence, in the present context, we encourage teacher to use this type of tools to maintain direct interaction with students - which is essential in pedagogy - and ensure a qualitative pedagogical continuity.

Practice-based learning: an appropriate means to acquire the attitude and skills for evidence-based medicine.

OBJECTIVES:   To evaluate a practice-based, self-directed EBM-course in an undergraduate medical curriculum in terms of EBM attitude and motivation beliefs. METHODS: This study was conducted in a 4-week course of the first-year undergraduate medical curriculum, which takes place twice in an academic year. One group of students (n=210) received a normal EBM-module in November. A practice-based EBM-module was implemented in January for another group of students (n=130). We approached all students following the courses for participation in our research project. In a quasi-experimental design, a validated survey was used to assess students' EBM task value and self-efficacy on a 7-point Likert-scale. In the experimental group, complementary qualitative data were gathered on attitude and motivation by open evaluative questions. RESULTS: Overall response rate was 93,5%, resulting in 191 students in the control group and 127 students in the experimental group. We did not find differences between the groups in terms of EBM task value and self-efficacy. However, the experimental group showed a higher increased perception of the importance of EBM in decision making in clinical practice (60.0% vs 77.2%; χ2(1, N=318) = 8.432, p=0.004). These students obtained a better understanding of the complexities and time-consuming nature of EBM in medical practice. CONCLUSIONS: The practice-based EBM-course helps students to reflect on practice and knowledge critically. Our findings indicate that integrating clinical practice in the undergraduate learning environment fosters attitude and motivation, suggesting that practice-based learning in EBM education may advance student development as a critically reflective practitioner.

Impact of an electronic-based assessment on student pharmacist performance in a required therapeutics course.

INTRODUCTION: The use of technology in the classroom has continued to grow, and with the advancement of classroom management systems and online exam software, there are opportunities to administer exams electronically. This study assessed the impact of electronic-based assessments on examination scores in a required therapeutics course. METHODS: This was a retrospective, single-centered, observational study including second professional year pharmacy students enrolled in a required, one semester therapeutics course. Four assessments were administered each semester. Lecture content and exam format, a mixture of multiple-choice questions and free response written cases, did not differ significantly between years. Assessments administered during the first two years were printed on paper, while assessments administered during the third and fourth year of the study were all electronic, submitted through a classroom management system. Following institutional review board approval, the change in mean overall examination scores between paper and electronic-based assessments were analyzed. RESULTS: Of the 948 students enrolled in this study, there was no difference in overall mean scores between paper and electronic-based assessments (74.8% vs. 73.8%). In addition, there was no difference in mean examination scores between overall individual paper and electronic Exam 1 through 4 or overall multiple-choice or free response scores between paper and electronic-based assessments. CONCLUSIONS: Scores did not differ between paper and electronic-based assessments. From this study, test method does not appear to impact exam results.

Team teaching with pharmacy practice and pharmaceutics faculty in a nonsterile compounding laboratory course to increase student problem-solving skills.

BACKGROUND AND PURPOSE: Combining pharmaceutics and pharmacy practice into nonsterile compounding is ideal to increase problem-solving skills. The objectives of this activity were to: (1) create a nonsterile compounding activity through a team-teaching collaboration, (2) increase students' independent problem-solving skills to compound a nonsterile natural product, and (3) assess student and faculty perceptions of the learning activity. EDUCATIONAL ACTIVITY AND SETTING: The activity was created, implemented, and assessed using a team-teaching technique between pharmacy practice and pharmaceutics faculty. The first week students were tasked with extraction of an active ingredient from a natural product, and the second week students independently compounded a nonsterile product using the concentrated extract. Faculty and students were asked to give their perceptions of the activity. FINDINGS: The activity has been taught to two cohorts of elective students. Students from both cohorts (n = 57) independently created a nonsterile compound, scoring an average (standard deviation) of 8.1 (1) and 8.6 (0.9) out of 10 points on their graded products for the 2018 and 2019 elective, respectively. Faculty collaboration and team-teaching adjustments to the content resulted in increased student performance (p = 0.0392). Student feedback on the activity was overwhelmingly positive. Faculty appreciated the collaborative approach and improved the course activity together. SUMMARY: A team-teaching approach created an activity that focused on elements of both pharmaceutics and pharmacy practice. Students developed problem-solving abilities by creating their own independent nonsterile compounded natural product. The collaboration between faculty was positive and well received by students.

Does the tutors' academic background influence the learning objectives in problem-based learning?

Background: Problem-based learning (PBL) is an essential element of the curriculum of the Medical University of Vienna (MUV) and is performed in an eight steps model with: clarifying, defining, analysing, shifting & sorting, identifying learning objectives, going to learn and coming back to talk and feedback. With an annual intake of up to 740 students the MUV has to recruit PBL tutors from various academic backgrounds including undergraduate near-peer students. Therefore, we were interested to see whether a tutor's academic background had an influence on the resulting PBL sessions as reflected by the percentage of learning objectives (LOs) which were actually achieved in relation to the intended LOs. Methods: For each PBL session "intended learning objectives" (ILOs) were defined. ILOs were communicated to all tutors by means of PBL session guides in order to provide homogenous learning opportunities to all students. However, it was not mandatory to reach all ILOs. The PBL coordination regarded a range of two thirds to three quarters of ILOs as a desirable goal. For analysis we retrieved data concerning ILOs, characteristics of tutors and PBL groups from the institution's PBL quality assurance system. Results: From 2012-2014, 216 PBL groups were facilitated by 106 tutors with different academic backgrounds. On average, 70.8% (95% CI: 69.2-72.5%) of the ILOs were achieved; MUV clinicians reached 74.3% (70.8-77.8%), MUV non-clinicians 74.2% (71.7-76.6%), external faculty (clinicians and non-clinicians) 68.6% (64.4-72.8%), and near-peer students 64.7% (61.8-67.7%). Statistically significant differences were found between near-peer students and MUV clinicians (p<.001) as well as MUV non-clinicians (p<.001). Conclusions: ILOs were reached within a satisfactory range. However, groups taught by near-peer students reached significantly fewer ILOs than groups taught by MUV faculty tutors. This finding raises the question whether tutor training for near-peer students should be intensified. Also, further research is needed to explore the group dynamics of student-led PBL groups.

Experiential knowledge in clinical medicine: use and justification.

Within the evidence-based medicine (EBM) construct, clinical expertise is acknowledged to be both derived from primary experience and necessary for optimal medical practice. Primary experience in medical practice, however, remains undervalued. Clinicians' primary experience tends to be dismissed by EBM as unsystematic or anecdotal, a source of bias rather than knowledge, never serving as the "best" evidence to support a clinical decision. The position that clinical expertise is necessary but that primary experience is untrustworthy in clinical decision-making is epistemically incoherent. Here we argue for the value and utility of knowledge gained from primary experience for the practice of medicine. Primary experience provides knowledge necessary to diagnose, treat, and assess response in individual patients. Hierarchies of evidence, when advanced as guides for clinical decisions, mistake the relationship between propositional and experiential knowledge. We argue that primary experience represents a kind of medical knowledge distinct from the propositional knowledge produced by clinical research, both of which are crucial to determining the best diagnosis and course of action for particular patients.

A peer evaluation training results in high-quality feedback, as measured over time in nutritional sciences graduate students.

Peer evaluation skills are not typically taught to students, yet they are expected to provide high-quality feedback to their peers. Gameful learning, a pedagogy supporting student-driven learning, can further reinforce the development of peer evaluation skills, if students are motivated to improve upon them. To better understand the effects of a peer evaluation training on the quality of student-generated peer evaluations, we scored peer evaluations from two cohorts taking a graduate-level nutritional sciences class using gameful learning pedagogy. The intervention group completed a peer evaluation training before engaging in peer reviews, while the control group did not. The training included two readings, a video, and reflection questions. The peer evaluations submitted by both the intervention and control groups were assessed on a validated rubric. The peer evaluation training had a positive effect on the quality of the submitted peer evaluations. The intervention group had a 10.8% higher score on its first submitted peer evaluation compared with controls (P = 0.003). The intervention group improved the quality of its future submissions by a further 8.9%, whereas the controls did not continue to improve substantially (P < 0.001). Overall, peer review training enhanced the quality of peer evaluations and allowed students to develop professional skills that they can utilize in any biomedical profession. Our results highlight the importance of peer evaluation training in combination with repeated practice and student-driven learning brought forth by gameful learning pedagogy in improving the quality of evaluations and developing professional skills.

Assessment of structured classroom debate to teach an antimicrobial stewardship elective course.

BACKGROUND AND PURPOSE: The main aim of this study was to evaluate the effect of a structured classroom debate format on teaching antimicrobial stewardship. EDUCATIONAL ACTIVITY AND SETTING: An active learning approach using a debate format was implemented to engage students in infectious diseases concepts to further develop critical thinking skills. This was a one-group, pre- and posttest design conducted in third year pharmacy students enrolled at the Philadelphia College of Osteopathic Medicine School of Pharmacy Georgia campus. A ten-item assessment survey was used prior to and after the course to evaluate student knowledge. Student perception of skill development was assessed by a survey using a five-point Likert scale. The skills assessed included critical thinking, communication, public speaking, research/drug information, and teamwork. FINDINGS: Thirty-three students participated in the six debates over the course of the semester. There was a statistically significant increase in post-knowledge assessment mean score (75%) compared to pre-knowledge assessment mean score (45%). The post-course survey showed improved confidence in perception of skills in all of the areas assessed. SUMMARY: The structured classroom debate format has a positive association with increasing students' knowledge level and perception of skills assessed.

Impact of Service Learning on Student Attitudes Toward the Poor and Underserved.

BACKGROUND: Patient-centered care necessitates an appreciation of one's socioeconomic status and its influence on health and well-being. PURPOSE: We explored how student attitudes toward poverty changed as a result of participation in an interprofessional service-learning experience. METHODS: Students from 6 health profession programs participated in an interprofessional military-sponsored free health care event serving nearly 8000 individuals from our community. Students' pre-post attitudes toward poverty were measured using the Attitude Toward Poverty Short Form (ATP-SF) and Beliefs About the Relationship Between Poverty and Health (BRPH) scale. RESULTS: Two subscales and 14 items on the ATP-SF and 3 items on the BRPH had significant differences between their pre and post experience. Students expressed less bias, a decrease in stereotypic views, and a heightened willingness to advocate on behalf of those with limited means of support. CONCLUSION: Findings suggest that experiential, transformative service learning has a positive impact on students' attitudes toward poverty and the underserved.

The Quality of Assessment of Learning (Qual) Score: Validity Evidence for a Scoring System Aimed at Rating Short, Workplace-Based Comments on Trainee Performance.

Construct: This study seeks to determine validity evidence for the Quality of Assessment for Learning score (QuAL score), which was created to evaluate short qualitative comments that are related to specific scores entered into a workplace-based assessment, common within the competency-based medical education (CBME) context. Background: In the age of CBME, qualitative comments play an important role in clarifying the quantitative scores rendered by observers at the bedside. Currently there are few practical tools that evaluate mixed data (e.g. associated score-and-comment data), other than the comprehensive Completed Clinical Evaluation Report Rating tool (CCERR) that was originally derived to rate end-of-rotation reports. Approach: A multi-center, randomized cohort-based rating exercise was conducted to evaluate the rating properties of the QuAL score as compared to the CCERR. One group rated comments using the QuAL score, and the other group rated comments using the CCERR. A generalizability study (G-Study) and a decision study (D-study) were conducted to determine the number of meta-raters for a reliable rating (phi-coefficient target of >0.80). Both scores were correlated against rater's gestalt perceptions of utility for both faculty and residents reading the scores. Results: Twenty-five meta-raters from 20 sites participated in this rating exercise. The G-study revealed that the CCERR group (n = 13) rated the comments with a very high reliability (Phi = 0.97). Meanwhile, the QuAL group (n = 12) rated the comments with a similarly high reliability (Phi = 0.97). The QuAL score required only two raters to reach an acceptable target reliability of >0.80, while the CCERR required three. The QuAL score correlated with perceptions of utility (Meta-rater usefulness, Pearson's r = 0.69, p < 0.001; Perceived usefulness for trainee, r = 0.74, p < 0.001). The CCERR performed similarly, correlating with perceived faculty (r = 0.67, <0.001) and resident utility (0.79, <0.001). Conclusions: The QuAL score is reliable rating score that correlates well with perceptions of utility. The QuAL score may be useful for rating shorter comments generated by workplace-based assessments.

Technical Simulation Using Goldfish Bowl Method: A Medical Teaching Method for Increasing Student's Creativity.

BACKGROUND: Promoting students' creative thinking with new techniques is important in order to foster innovation in a pleasant educational atmosphere. This study aimed to determine the effect of technical simulation using Goldfish Bowl (GFB) method on creative thinking of midwifery students in Tehran University of Medical Sciences. METHODS: During 2015-2016, 70 students in two groups (n = 35 midwifery students in each group) were enrolled in this study and educational intervention was conducted on one of the groups. The intervention was the new GFB method. The students' creative thinking was assessed using Dr. Abedi's standardized creative thinking questionnaire in both groups before and after the intervention and in one-month follow-up. The results were gathered and entered into the SPSS software version 16. For data analysis, descriptive and analytical statistical tests were used to compare the scores of three stages of creative thinking, and variance analysis in the intervention and control groups with the significant level of 0.05. RESULTS: There were no significant differences between the results of the two groups before the intervention. The statistical results showed changes at different levels after intervention, indicating an improvement in the students' creative thinking. The mean score of creative thinking was 70.71 ± 15.75 before the intervention, 80.40 ± 14.68 at the end of the eighth week of the intervention, and 72.09 ± 14.98 in the follow-up. The effect size of this technique on creative thinking was 0.91 in week 8. CONCLUSION: The use of Goldfish Bowl technique in teaching medical students is recommended to promote their creative thinking.