Exploring moral competence regression: a narrative approach in medical ethics education for medical students.

BACKGROUND: Studies from different countries report a stagnation or regression of moral competence in medical students between the first and the last year of their studies, and the value of various educational interventions remains uncertain. METHODS: We used Moral Competence Test (MCT) to measure C-scores of moral competence to determine the change in the MCT C-scores between the first- and the fifth-year medical students from two medical schools in the Czech Republic in the academic year 2022/2023 and to analyze factors associated with the C-scores (observational study). In addition, for the first-year students, we compared the results of the MCT before and after an intervention in medical ethics curriculum (interventional study). We used a cross-sectional and descriptive design for the observational study. Students completed the MCT, consisting of two moral dilemmas (Worker´s Dilemma and Doctor´s Dilemma), the results measured by the C-score, which represents moral competence. RESULTS: In total, 685 students participated in the observational study. Objective 1: based on the analysis of the C-score, we observed a decrease in moral competence between the first and the fifth-year medical students (p < .001). Objective 2: we did not observe a statistically significant effect of gender (p = .278), or self-rated religiosity (p = .163). Objective 3: in the interventional study, 440 students participated in the pretest and 422 students participated in the posttest. The test of statistical significance found no improvement in students' moral competence after the intervention (p = .253). CONCLUSION: Medical students show a regression in moral competence during medical education; it was lower in medical students in their fifth year, compared to the first-year medical students without the effect of gender, or self-rated religiosity. Although educational intervention consisting of multiple tools of medical ethics teaching (PBL, CBL, KMDD and StorED) did not lead to increase in moral competence, the longitudinal effect of such intervention remains to be seen.

Developing a model to promote caretaker confidence and communication in treatment decisions for dairy cattle through case studies.

The significant role of dairy caretakers in maintaining animal welfare on dairy farms emphasizes the necessity of appropriate training and education to ensure the implementation of practices that promote good animal welfare. This study explored the potential of case-based learning as a novel approach to training for dairy caretakers by investigating dairy caretakers' perspectives on case study discussions. Additionally, this study sought to understand thoughts and feelings of caretakers during case study discussions to help identify information that caretakers use to evaluate cases and make decisions. Two case studies were developed and presented to participants, and thematic analysis of case study discussion transcripts was performed. Pre- and post-training questionnaires for 21 caretakers (n = 21) were summarized. The study found that caretaker reactions to case studies were generally positive. Thematic analysis revealed that caretakers use previous knowledge to make treatment decisions for cattle, and valued discussion with coworkers. The results of this study suggest the need for further investigation into the use of case studies and other activities that provide opportunities for critical thinking as training opportunities on dairy farms.

The effect of different patient-based learning models on student perceptions of empathy, engagement, knowledge, and learning experience.

BACKGROUND: Problem-based learning is used widely in pharmacy and medical programmes, incorporating realistic patient scenarios into regular teaching as a way of linking theory to practice. Routine case-based learning lessons ranges from real patient involvement, scripted patient scenarios, digital simulations (avatars) as well as through media such as Zoom. The existing literature has explored the extensive benefits of using patients in clinical education, but fewer studies have directly compared the efficacy of each model as learning tools. AIM: To compare student perceptions of patient-based learning models to elicit student empathy, increase engagement, improve knowledge, and enrich learning experience. METHODS: A questionnaire was distributed to second-year pharmacy students in Swansea University to gather their perceptions on the nine different patient-based learning models in their routine teaching (SUMS RESC 2023-0011). Students were asked to rank their experience of the models explicitly against each other, based on the four pillars of (1) eliciting student empathy, (2) increasing engagement, (3) improving knowledge and (4) enriching the learning experience. Students were also asked to rate the significance of realism (i.e. knowing the patient demographics/having a visual representation of the patient) to their experience. RESULTS: Altogether, 31 student rankings of the nine learning models were weighted (9 = highest rank; 1 = lowest ranked). The data showed clear preferences for real-patient involvement over fictional cases, especially for eliciting empathy. Interestingly, scripted scenarios were rated highly for both engagement and learning experience only when avatars were involved, which suggests a role of animated visual representation of the patient in facilitating these outcomes. CONCLUSION: Whilst it is useful to have multiple patient-based learning models, this study serves as a guide for educators in preparing case-based learning sessions for achieving the desired outcomes of any of the four pillars above.

Using case-based learning supported by role-playing situational teaching method in endocrine physiology education.

Embedding clinically relevant learning experience in basic science subjects is desired for the preclinical phase of undergraduate medical education. The present study aimed to modify case-based learning (CBL) with a role-playing situational teaching method and assess the student feedback and learning effect. One hundred seventy-six sophomore students majoring in clinical medicine from Harbin Medical University were randomly divided into two groups: the control group (n = 90), who received traditional hybrid teaching, and the experimental group (n = 86), who received the role-playing situational teaching. Students in the experimental group were given a 1-wk preclass preparation to dramatize a hyperthyroidism scenario through online autonomous learning of thyroid physiology and performed the patient's consultation process in class, followed by a student presentation about key points of lecture content and a question-driven discussion. A posttest and questionnaire survey were conducted after class. The test scores of the two groups had no statistical differences, whereas the rate of excellence (high scores) of the experimental group was significantly higher than that of the control group. Furthermore, the record of online self-directed learning engagements was significantly improved in the experimental group. In the questionnaire, >70% of the students showed positive attitudes toward the role-playing situational teaching method and were willing to participate in other chapters of the physiology course. Such results show that CBL supported by a role-playing situational teaching method encourages active learning and improves the application of basic knowledge of physiology, which can be incorporated in the preclinical curricula to bridge the gap between theory and practice.NEW & NOTEWORTHY Formal application through structured role-play is often overlooked in physiology education. In traditional case-based learning (CBL), clinical cases are the subject and unfocused discussion often occurs. The present study aimed to modify CBL with a role-playing situational teaching method and assess the student feedback and learning effect. The results show that the new teaching model encourages active learning and improves the application of basic knowledge of physiology.

A novel approach to clinical thinking training for medical students: the combined World Café discussion and case-based learning experience introduction.

It is essential for modern medical students to continuously enhance their clinical thinking abilities. This study aims to evaluate the efficacy of the combined World Café discussion and case-based learning (CBL) approach within the clinical thinking training course. The clinical thinking training course incorporated the combined World Café discussion and CBL approach. The assessment of the accuracy and rationality of clinical symptoms, medical examination, pathological processes, diagnostic results, diagnostic basis, and drug use was conducted through case-related queries. Feedback from students and instructors regarding the teaching content, teaching process, and teaching effect was gathered through questionnaires. The findings indicate that the students achieved high marks in all assessed areas, including clinical symptoms, medical examination, pathological processes, diagnostic results, diagnostic basis, and drug use. The feedback from students and instructors on the teaching content, teaching process, and teaching effect was positive. Medical educators can use our findings to implement the combined World Café discussion and CBL mode to enhance student engagement.NEW & NOTEWORTHY The combined World Café discussion and case-based learning approach was implemented in the clinical thinking training course. Students' scores for clinical symptoms, medical examination, pathological process, diagnostic results, diagnostic basis, and drug use were all excellent. Feedback from both students and teachers on the teaching content, teaching process, and teaching effect was positive.

Using a flipped classroom in a veterinary systems physiology course increases student performance on basic knowledge and clinical applicability questions.

Flipped classrooms are being utilized more frequently in biomedical education to provide more active learning opportunities to students although there are mixed results on the benefits of the flipped classroom in biomedical education. In this study, the effects of using a flipped classroom with case-based learning in the endocrine section of a first-year veterinary-integrated histology and physiology course were investigated. Results demonstrated that the flipped classroom improved performance on the endocrine section exam by 15.9% (Cohen's d = 1.08; P < 0.001) with improvements on both clinically applicable and basic knowledge questions. Student satisfaction with the flipped classroom was also investigated. Students reported high satisfaction with the in-class case-based learning opportunities but lower satisfaction with the asynchronous content delivery and the time required outside of class. Student perceptions of the flipped classroom were measured again after being exposed to the results of the flipped classroom on student learning. After seeing the results, students were significantly more likely to value the time spent in the flipped classroom and to desire more opportunities for flipped classrooms in the future.NEW & NOTEWORTHY A flipped classroom using case-based learning can significantly improve student performance in a veterinary physiology course with the largest gains going to lower performing students. Student perception of the flipped classroom can be improved by showing students data on the improvement in performance on examinations.

Comparison of case-based and lecture-based learning in dental fluorosis diagnostic ability with visual analog scale assessment.

OBJECTIVE: This study aimed to compare the impact of case-based learning (CBL) versus lecture-based learning (LBL) on dental students' clinical decision-making regarding DF severity using Visual Analog Scale (VAS) scoring. METHODS: Eighty first-year graduate dental students were randomly assigned to either the CBL (n = 38) or LBL (n = 42) groups. Both groups received instruction on DF diagnosis, with CBL involving small group sessions analyzing real cases and LBL involving traditional lectures. Effectiveness was assessed by presenting 32 dental fluorosis cases with Thylstrup-Fejerskov Index (TSIF) scores ranging from 0 to 7 through slide presentations to both groups for VAS assessment. Five evaluators of each group randomly selected were asked to repeat the rating 2 weeks later. Statistical analysis included two-way ANOVA for group and gender differences, intra-class correlation coefficient (ICC) for reliability, and Spearman correlation coefficients for validity. RESULTS: Variations in VAS scores were observed between CBL and LBL groups, with no significant gender impact. Excellent inter- and intra-evaluator agreement was found for VAS scoring in both groups, indicating its reliability. Validation against established indices (such as DI and TSIF) demonstrated strong correlations, with CBL students exhibiting higher correlations. CONCLUSIONS: CBL enhances students' clinical decision-making and proficiency in DF diagnosis, as evidenced by more consistent and accurate VAS scoring compared to LBL. These findings highlight the importance of innovative educational strategies in dental curricula, with implications for improving training quality and clinical outcomes. TRIAL REGISTRATION: The study was registered at the Clinical Research Center, Hospital of Stomatology, Wuhan University (Registration code: HGGC-036).

Too much time or not enough? An observational study of teacher wait time after questions in case-based seminars.

BACKGROUND: We define teacher wait time (TWT) as a pause between a teacher question and the following response given by a student. TWT is valuable because it gives students time to activate prior knowledge and reflect on possible answers to teacher questions. We seek to gain initial insights into the phenomenon of TWT in medical education and give commensurate recommendations to clinical teachers. METHODS: We observed n = 719 teacher questions followed by wait time. These were video-recorded in 29 case-based seminars in undergraduate medical education in the areas of surgery and internal medicine. The seminars were taught by 19 different clinical teachers. The videos were coded with satisfactory reliability. Time-to-event data analysis was used to explore TWT overall and independently of question types. RESULTS: In our sample of case-based seminars, about 10% of all teacher questions were followed by TWT. While the median duration of TWT was 4.41 s, we observed large variation between different teachers (median between 2.88 and 10.96 s). Based on our results, we recommend that clinical teachers wait for at least five, but not longer than 10-12 s after initial questions. For follow-up and reproduction questions, we recommend shorter wait times of 5-8 s. CONCLUSIONS: The present study provides insights into the frequency and duration of TWT and its dependence on prior questions in case-based seminars. Our results provide clinical teachers with guidance on how to use TWT as an easily accessible tool that gives students time to reflect on and respond to teacher questions.

Based case based learning and flipped classroom as a means to improve international students' active learning and critical thinking ability.

BACKGROUND: International student education has become an important part of higher education and an important symbol to measure the level of higher education. To change the traditional teaching model, here we introduced a combination of Case-Based Learning (CBL)and Flipped Classroom (FC) into the pathophysiology course for international students. This study aimed to explore whether the active learning ability and critical thinking ability of international students can be improved, based on this new teaching model, improving the innovation ability of teachers' team and students' attitude to the reform. METHODS: The two chapters of Cardiac Insufficiency and Apoptosis in Pathophysiology are designed as a CBL + FC teaching method. Distribute the Self-assessment Scale on Active Learning and Critical Thinking (SSACT) and satisfaction questionnaire to international students to evaluate teaching reform based on CBL + FC. RESULTS: Compared with the traditional classroom, the online flipped classroom based on CBL has significantly improved the learning enthusiasm, as these students are required to independently complete literature review, actively participate in classroom teaching, learn to use multiple learning strategies, and collaborate with other students to complete PowerPoint (PPT)production. At the same time, the students' ability to raise problems and solve problems has been greatly improved by analyzing clinical cases; By consulting the literature, the theoretical knowledge learned can be better applied to clinical analysis. The results of the satisfaction survey also show that international students are more likely to accept the flipped classroom teaching mode. CONCLUSIONS: This teaching mode will stimulate the learning motivation of international students, enhance teaching attraction and increase teaching interaction; At the same time, the CBL + FC teaching method can strengthen the evaluation of international students' in and out of class and online learning, enhance students' active learning ability and critical thinking ability, promote the development of personalized learning, and integrate with international medical education.

Integration of case-based learning and three-dimensional printing for tetralogy of fallot instruction in clinical medical undergraduates: a randomized controlled trial.

BACKGROUND: Case-based learning (CBL) methods have gained prominence in medical education, proving especially effective for preclinical training in undergraduate medical education. Tetralogy of Fallot (TOF) is a congenital heart disease characterized by four malformations, presenting a challenge in medical education due to the complexity of its anatomical pathology. Three-dimensional printing (3DP), generating physical replicas from data, offers a valuable tool for illustrating intricate anatomical structures and spatial relationships in the classroom. This study explores the integration of 3DP with CBL teaching for clinical medical undergraduates. METHODS: Sixty senior clinical medical undergraduates were randomly assigned to the CBL group and the CBL-3DP group. Computed tomography imaging data from a typical TOF case were exported, processed, and utilized to create four TOF models with a color 3D printer. The CBL group employed CBL teaching methods, while the CBL-3DP group combined CBL with 3D-printed models. Post-class exams and questionnaires assessed the teaching effectiveness of both groups. RESULTS: The CBL-3DP group exhibited improved performance in post-class examinations, particularly in pathological anatomy and TOF imaging data analysis (P < 0.05). Questionnaire responses from the CBL-3DP group indicated enhanced satisfaction with teaching mode, promotion of diagnostic skills, bolstering of self-assurance in managing TOF cases, and cultivation of critical thinking and clinical reasoning abilities (P < 0.05). These findings underscore the potential of 3D printed models to augment the effectiveness of CBL, aiding students in mastering instructional content and bolstering their interest and self-confidence in learning. CONCLUSION: The fusion of CBL with 3D printing models is feasible and effective in TOF instruction to clinical medical undergraduates, and worthy of popularization and application in medical education, especially for courses involving intricate anatomical components.

The effectiveness of problem-based learning and case-based learning teaching methods in clinical practical teaching in TACE treatment for hepatocellular carcinoma in China: a bayesian network meta-analysis.

PURPOSE: To investigate the effectiveness of problem-based learning (PBL) and case-based learning (CBL) teaching methods in clinical practical teaching in transarterial chemoembolization (TACE) treatment in China. MATERIALS AND METHODS: A comprehensive search of PubMed, the Chinese National Knowledge Infrastructure (CNKI) database, the Weipu database and the Wanfang database up to June 2023 was performed to collect studies that evaluate the effectiveness of problem-based learning and case-based learning teaching methods in clinical practical teaching in TACE treatment in China. Statistical analysis was performed by R software (4.2.1) calling JAGS software (4.3.1) in a Bayesian framework using the Markov chain-Monte Carlo method for direct and indirect comparisons. The R packages "gemtc", "rjags", "openxlsx", and "ggplot2" were used for statistical analysis and data output. RESULTS: Finally, 7 studies (five RCTs and two observational studies) were included in the meta-analysis. The combination of PBL and CBL showed more effectiveness in clinical thinking capacity, clinical practice capacity, knowledge understanding degree, literature reading ability, method satisfaction degree, learning efficiency, learning interest, practical skills examination scores and theoretical knowledge examination scores. CONCLUSIONS: Network meta-analysis revealed that the application of PBL combined with the CBL teaching mode in the teaching of liver cancer intervention therapy significantly improves the teaching effect and significantly improves the theoretical and surgical operations, meeting the requirements of clinical education.

Integration of 3D printing and case-based learning in clinical practice for the treatment of developmental dysplasia of the hip.

BACKGROUND: Case-based learning (CBL) utilizing three-dimensional (3D) printed hip joint models is a problem-solving teaching method that combines the tactile and visual advantages of 3D-printed models with CBL. This study aims to investigate the impact of integrating 3D printing with CBL on learning developmental dysplasia of the hip (DDH). METHODS: We conducted a prospective study from 2022 to 2023, including 120 fourth-year clinical medical students at Xuzhou Medical University. Students were randomly allocated into two groups of 60 participants each. The CBL group received conventional CBL teaching methods, while the 3D + CBL group utilized 3D-printed models in conjunction with CBL. Post-teaching, we analyzed and compared the theoretical and practical achievements of both groups. A questionnaire was designed to assess the impact of the educational approach on orthopedic surgery learning. RESULTS: The theory scores of the CBL group (62.88 ± 7.98) and 3D + CBL group (66.35 ± 8.85) were significantly different (t = 2.254, P = 0.026); the practical skills scores of the CBL group (57.40 ± 8.80) and 3D + CBL group (63.42 ± 11.14) were significantly different (t = 3.283, P = 0.001). The questionnaire results showed that the 3D + CBL group was greater than the CBL group in terms of hip fundamentals, ability to diagnose cases and plan treatments, interesting teaching content, willingness to communicate with the instructor and satisfaction. CONCLUSIONS: The integration of 3D printing with case-based learning has yielded positive outcomes in teaching DDH, providing valuable insights into the use of 3D-printed orthopedic models in clinical education.

Physiology education in China: the current situation and changes over the past 3 decades.

OBJECTIVE: As an experimental biological science, physiology has been taught as an integral component of medical curricula for a long time in China. The teaching effectiveness of physiology courses will directly affect students' learning of other medical disciplines. The purpose of this study is to investigate the current situation and changes in physiology teaching over 30 years in Chinese medical schools. METHODS: National survey was conducted online on the platform SoJump via WeChat and the web. The head of the physiology department in medical school was asked to indicate the information of physiology education from three periods: 1991-2000, 2001-2010, and 2011-2020. The responses of 80 leaders of the Department of Physiology from mainland Chinese medical schools were included in the study for analysis. RESULTS: The survey showed that the class hours, both of theory and practice, had been decreased. During the past 20 years, the total number of physiology teachers, the number of physiology teachers who had been educated in medical schools, and the number of technicians had been reduced, whereas teachers with doctor's degrees had been increased. In addition to traditional didactic teaching, new teaching approaches, including problem-based learning/case-based learning/team-based learning, integrated curriculum and formative evaluation systems, had been employed, mostly for more than 5 years, in some medical schools. CONCLUSION: The present study has provided historical data regarding the current status of physiology education in China and that in the past thirty years by showing that physiology education in China has developed quickly,even it faces many challenges.

Think-aloud approach combined with case-based learning in nursing teaching round for new nurses in cancer hospital.

BACKGROUND: The transition from nursing students to working as new nurses can be a challenging process. This study aimed to assess the efficacy of a pedagogical approach amalgamating the think-aloud approach and case-based learning in the instructional rounds for new nurses. METHODS: Utilizing convenience sampling, new nurses were selected between 2020 and 2021 in China cancer hospital. A total of 98 participants agreed to participate, with 50 enrolled in 2020 as the control group and 48 in 2021 as the observation group. Across a span of weeks 1, 3, 5, 7, 9, and 11, each clinical department conducted six teaching rounds. The observation group engaged in teaching rounds combining the think-aloud approach with case-based learning, whereas the control group solely utilized case-based learning. Disparities in case analysis scores and critical thinking ability between the two groups were scrutinized, alongside an analysis of learning strategies and the observation group feedback. RESULTS: The observation group exhibited superior case analysis scores (91.92 ± 6.33) and overall critical thinking ability scores (308.39 ± 35.88) in comparison to the control group, which scored (85.27 ± 5.39) and (275.11 ± 31.32) respectively, reflecting statistically significant variances (t = 1.868 ~ 6.361, P < 0.05). Predominant learning strategies employed in the observation group ranged from cognitive to meta-cognitive, followed by psychosocial strategies. During interviews focused on nurses' feedback on the learning process, themes emerged surrounding the enhancement of learning proficiency, invigoration of learning enthusiasm, and bolstering psychological well-being. CONCLUSION: The combination of think-aloud approach and case-based learning in nursing teaching rounds greatly improves the efficiency of training and the critical thinking acuity of new nurses. Concurrently, it facilitated an evaluation of learning strategies, thereby offering valuable insights for the nursing teaching rounds of new nurse.

Assessment of the effectiveness of the BOPPPS model combined with case-based learning on nursing residency education for newly recruited nurses in China: a mixed methods study.

BACKGROUND: Expanding new nurse training and education is a priority for nursing educators as well as a critical initiative to stabilize the nursing workforce. Given that there is currently no standardized program for the training of new nurses in China, we investigated the effectiveness of the bridge-in, objective, pre-assessment, participatory learning, post-assessment, and summary model combined with case-based learning ((BOPPPS-CBL) for the standardized training of new nurses. METHODS: The mixed method approach with explanatory sequential (quantitative-qualitative) method was used. A questionnaire was used to compare the impact of the BOPPPS-CBL model and the Traditional Learning Model (TLM) on the core competencies of 185 new nurses for two years of standardized training. Quantitative data were analyzed using SPSS 22.0. Focus group interviews were used with four groups of new nurses and perceptions of BOPPPS-CBL training were recorded. Qualitative data were analyzed thematically. RESULTS: According to the quantitative data, more new nurses agreed that the BOPPPS-CBL model stimulated their learning and improved their core nursing competencies than the TLM. The BOPPPS-CBL group outperformed the TLM group on theoretical knowledge tests. Qualitative data revealed that 87.5% of new nurses agreed on the value of BOPPPS-CBL training, and three themes were extracted: (1) role promotion; (2) formation of new thinking to solve clinical problems; and (3) suggestions for improvement. CONCLUSION: BOPPPS-CBL training had a significant impact on improving new nurses' core competencies and promoting the transition of new nurses to clinical practice nurses in China. The study recommends BOPPPS-CBL training as an effective teaching model for the standardized training and education of new nurses.

A combination of case-based learning with flipped classroom improved performance of medical students in nephrology bedside teaching.

BACKGROUND: Bedside teaching remains a challenging endeavor for clinical doctors and medical students, as the students often encounter difficulties in applying their knowledge to clinical situations. This study aims to evaluate the efficacy of combining case-based learning (CBL) with a flipped classroom (FC) approach in nephrology bedside teaching. METHODS: A total of 92 medical students were enrolled in this study, including clerks and interns. The students were assigned into two groups. The CBL/FC group students received the combined teaching approach of CBL and FC (CBL/FC). Students who received the traditional lecture-based teaching (LBT) approach were treated as the control group. General knowledge tests, clinical case scenarios, and questionnaires were used to evaluate the teaching efficacy. RESULTS: Ninety-two students were included in this study. Overall, 46 students were assigned to the CBL/FC group, while the other 46 students were assigned to the LBT group. The students in both groups showed comparable performance in the knowledge test. However, in clinical case scenarios, students in the CBL/FC group demonstrated superior performance compared to those in the LBT group. Additionally, the analysis of questionnaires revealed that the CBL/FC group students expressed more positive attitudes toward their proficiency in medical history taking, physical examination, medical record documentation, clinical reasoning, and consideration for patients' welfare. Moreover, the students from the CBL/FC group regarded the CBL/FC teaching approach as an effective and satisfying method without increasing the learning burden. CONCLUSION: This study reveals that the CBL/FC combined teaching approach shows promise in nephrology education and provides an effective and alternative format for medical teaching.

The Effectiveness of Technology-Enhanced Learning in Prosthodontic Education: A Systematic Review.

OBJECTIVE: To compare the effectiveness of technology-enhanced learning (TEL) with traditional learning in prosthodontic education. METHODS: The protocol was registered before commencement [CRD42023390277]. The search was conducted to identify randomized controlled trials (RCTs) focused on comparative assessment of TEL and traditional learning in prosthodontic education up to 6 June 2024. A comprehensive search strategy was formulated, encompassing multiple electronic databases. Screening, data extraction and risk of bias assessment using the Cochrane tool (RoB 2) were performed. Educational outcomes were evaluated by Kirkpatrick's four-level evaluation model. RESULTS: Of 2830 records identified, 14 RCTs were included. All the trials were judged at high risk of bias or had some concerns. The included studies assessed the short-term benefits of various TEL approaches, including e-learning, blended learning, video demonstration specialized self-evaluation software and virtual reality simulation in prosthodontic education for undergraduates. Promising results were found in individual studies, particularly in terms of perceived learning conditions with problem-based learning (PBL) and self-reported understanding and confidence when using video demonstrations. Most studies reported comparable outcomes to traditional learning in practical skills assessments, while the results regarding the acquisition of theoretical knowledge through the incorporation of TEL approaches were contradictory. One study reported promising results in perceived learning conditions with the PBL approach, as well as improved self-reported understanding and confidence with the use of video demonstrations. Furthermore, there was a limited number of studies assessing the effect of TEL approaches on students' behaviour. CONCLUSION: There is a lack of high-quality evidence to support the adoption of TEL approaches in prosthodontics. However, the incorporation of virtual reality simulation has demonstrated promising results, particularly in improving practical clinical skills.

Empowering Nursing Students to Prevent Medication Error-Related Harms: A Step Toward Improving Patient Safety.

Aim: Existing gaps in nursing curriculum particularly related to medication management such as administration and monitoring increase the propensity of nurses to commit medication errors during clinical practice. The present training program was conducted with an aim to sensitize and educate undergraduate nursing students on medication errors' related aspects. Methods: The participants were students pursuing bachelors nursing degree course (second and third year). The training "Medication errors: Role of Nurse practitioners" comprised of blended teaching methods such as theme lectures, hands on training exercises, small group case­based learning, role plays, and nursing officer's practical experiences. The participants' knowledge and perception about medication errors were assessed at baseline (pre-intervention phase) and 1 week after program (post-intervention phase) with the help of a structured self-administered questionnaire in English language. Results: A total of 110 nursing students participated in the program. Post program there was a consistent increase in the number of correct responses to all knowledge-based questions with a significant improvement in knowledge scores from baseline [Baseline: (mean ± SD) 12.62 ± 2.33; Post-training: 18.52 ± 2.22; P < .001]. There was a positive change in the perception about medication errors among students. The participants rated the overall quality of program as excellent [66 (60%)] or very good [40 (36.4%)]. More than 90% agreed on its applicability in their future practice. Conclusions: The training was quite successful in educating nursing students on medication errors. There is a constant need to educate nurses and other healthcare providers including doctors and pharmacists on medication safety related aspects with an ultimate goal to improve patient safety.

A Clinical Reasoning-Encoded Case Library Developed through Natural Language Processing.

IMPORTANCE: Case reports that externalize expert diagnostic reasoning are utilized for clinical reasoning instruction but are difficult to search based on symptoms, final diagnosis, or differential diagnosis construction. Computational approaches that uncover how experienced diagnosticians analyze the medical information in a case as they formulate a differential diagnosis can guide educational uses of case reports. OBJECTIVE: To develop a "reasoning-encoded" case database for advanced clinical reasoning instruction by applying natural language processing (NLP), a sub-field of artificial intelligence, to a large case report library. DESIGN: We collected 2525 cases from the New England Journal of Medicine (NEJM) Clinical Pathological Conference (CPC) from 1965 to 2020 and used NLP to analyze the medical terminology in each case to derive unbiased (not prespecified) categories of analysis used by the clinical discussant. We then analyzed and mapped the degree of category overlap between cases. RESULTS: Our NLP algorithms identified clinically relevant categories that reflected the relationships between medical terms (which included symptoms, signs, test results, pathophysiology, and diagnoses). NLP extracted 43,291 symptoms across 2525 cases and physician-annotated 6532 diagnoses (both primary and related diagnoses). Our unsupervised learning computational approach identified 12 categories of medical terms that characterized the differential diagnosis discussions within individual cases. We used these categories to derive a measure of differential diagnosis similarity between cases and developed a website ( universeofcpc.com ) to allow visualization and exploration of 55 years of NEJM CPC case series. CONCLUSIONS: Applying NLP to curated instances of diagnostic reasoning can provide insight into how expert clinicians correlate and coordinate disease categories and processes when creating a differential diagnosis. Our reasoning-encoded CPC case database can be used by clinician-educators to design a case-based curriculum and by physicians to direct their lifelong learning efforts.

Developing a Flipped Classroom for Clinical Anatomy: Approaches to Pre-class Recordings and a Novel Approach to In-Class Active Learning.

For centuries the established pedagogy for teaching in academia has been the lecture, in which an expert in a given subject speaks from a pulpit while a collection of students listens and takes notes. In recent decades, however, advances in technology have allowed educators to rethink the way in which they deliver course content. One approach that has been given attention is that of the flipped classroom, in which lectures are delivered outside of the class through video recording, and the class session is dedicated to more interactive activities. This chapter provides a rationale for this approach to learning, provides guidance in the development of pre-recorded lectures, and introduces a novel approach to the classroom sessions using audience response software.