Contextualizing Instructional Technology to the Demands of Nursing Education.

This article reviews current technologies in nursing education and the impact of technology on learning. The integration of technology into nursing curricula is thought to improve efficiency and enhance student experiences through active learning and interactive learning designs. The following focused questions are explored: (1) What are the current technologies used by university students and faculty in nursing programs? (2) How does that technology influence student learning? The primary themes were student-centered technology, with five subthemes, and faculty-centered technology. Consumers of healthcare (patients) demand quality care and expect highly skilled, compassionate, ethical practitioners; to this end, training and education of future nurses by skilled, qualified nurse educators who are comfortable with technological demands of all aspects of healthcare are fundamental. While it is essential that nurses and nurse educators continue to publish as a mechanism for open discussion and transparency in our teaching and learning approaches, we need higher levels of evidence to strengthen the argument that technology improves the learning environment and student outcomes and has a positive impact on clinical settings and patient care.

Teaching early reading skills to children with severe intellectual disabilities using Headsprout Early Reading.

BACKGROUND: Beginning reading skills are often taught using phonics. Research has demonstrated the effectiveness of phonics with typically developing students, but less research has evaluated this method with students with intellectual disabilities. METHOD: This paper evaluated the computerized phonics-based intervention Headsprout Early Reading® with eight students aged 7-19 years with severe intellectual disability. Six children were verbal, two were non-verbal. Four students completed Headsprout as it was designed for typically developing children, and four students accessed two adapted version of the intervention. Additional table-top teaching was used to support the intervention for some participants. RESULTS: Verbal students improved in initial sound fluency, nonsense word reading, and word recognition, but did not show improvements in phonemic segmentation, regardless of whether or not they accessed the original or adapted intervention. CONCLUSIONS: The findings suggest that Headsprout Early Reading can be used to support the development of reading skills for students with intellectual disability.

Effects of Spectral Overlays on Reading Performance of Brazilian Elementary School Children.

OBJECTIVE: To investigate the effects of spectral overlays on reading performance of Brazilian elementary school children. METHODS: Sixty-eight children (aged 9-12 years) enrolled in the 5th and 6th grade were included in the study. The Rate of Reading Test (RRT - Brazilian Portuguese version) was used to evaluate reading speed and the Irlen Reading Perceptual Scale was used to allocate the sample according to reading difficulty/discomfort symptoms and to define the optimal spectral overlays. RESULTS: A total of 13% of the children presented an improvement of at least 15% in reading speed with the use of spectral overlays. Pupils with severe reading difficulties tended to have more improvement in RRT with spectral overlays. Children with severe reading discomfort obtained the highest gains in RRT, with an average of 9.6% improvement with intervention, compared to a decrease of -8.2% in the control group. Participants with severe discomfort had an odds ratio of 3.36 to improve reading speed with intervention compared to the control group. CONCLUSION: The use of spectral overlays can improve reading performance, particularly in those children with severe visual discomfort.

Student performance and appreciation using 3D vs. 2D vision in a virtual learning environment.

AIM: The aim of this study was to investigate the differences in the performance and appreciation of students working in a virtual learning environment with two (2D)- or three (3D)-dimensional vision. MATERIAL AND METHODS: One hundred and twenty-four randomly divided first-year dental students performed a manual dexterity exercise on the Simodont dental trainer with an automatic assessment. Group 1 practised in 2D vision and Group 2 in 3D. All of the students practised five times for 45 min and then took a test using the vision they had practised in. After test 1, all of the students switched the type of vision to control for the learning curve: Group 1 practised in 3D and took a test in 3D, whilst Group 2 practised in 2D and took the test in 2D. To pass, three of five exercises had to be successfully completed within a time limit. The students filled out a questionnaire after completing test 2. RESULTS: The results show that students working with 3D vision achieved significantly better results than students who worked in 2D. Ninety-five per cent of the students filled out the questionnaire, and over 90 per cent preferred 3D vision. CONCLUSION: The use of 3D vision in a virtual learning environment has a significant positive effect on the performance of the students as well as on their appreciation of the environment.

Validation of an effective, easy-to-make hemostasis simulator.

The purpose of this study is to describe the construction method of a cost-effective, easy-to-make hemostasis simulator and to compare its effectiveness as a training tool to cadaver training. The simulator is made of materials commonly found in hospitals and clinics. These include a column manometer, a 500-ml saline bag, two intravenous fluid lines, a three-way stopcock, and a 6-mm-diameter Penrose drain. The device was tested on 10 final-year veterinary students. All participants tied 40 knots on the simulator and 40 knots on equine jejunal arteries sourced from a local abattoir. They were then asked to fill out a questionnaire comparing both methods. Participants assigned an overall assessment median score of 8.5/10 to the simulator and of 6.2/10 to cadaver practice. The simulator provided reliable haptic feedback, giving trainees a lifelike feel very close to that experienced when actually closing a blood vessel. In addition, it was effective in objectively evaluating students' ability to place ligatures on vessels. After adequate training, students' skills had significantly improved, alongside their confidence in placing hemostatic sutures. This proves our model is also useful in teaching basic open-surgery skills. Finally, its low production cost makes it ideally suited for self-practice.

The objective structured clinical examination: can physician-examiners participate from a distance?

OBJECTIVES: Currently, a 'pedagogical gap' exists in distributed medical education in that distance educators teach medical students but typically do not have the opportunity to assess them in large-scale examinations such as the objective structured clinical examination (OSCE). We developed a remote examiner OSCE (reOSCE) that was integrated into a traditional OSCE to establish whether remote examination technology may be used to bridge this gap. The purpose of this study was to explore whether remote physician-examiners can replace on-site physician-examiners in an OSCE, and to determine the feasibility of this new examination method. METHODS: Forty Year 3 medical students were randomised into six reOSCE stations that were incorporated into two tracks of a 10-station traditional OSCE. For the reOSCE stations, student performance was assessed by both a local examiner (LE) in the room and a remote examiner (RE) who viewed the OSCE encounters from a distance. The primary endpoint was the correlation of scores between LEs and REs across all reOSCE stations. The secondary endpoint was a post-OSCE survey of both REs and students. RESULTS: Statistically significant correlations were found between LE and RE checklist scores for history taking (r = 0.64-r = 0.80), physical examination (r = 0.41-r = 0.54), and management stations (r = 0.78). Correlations between LE and RE global ratings were more varied (r = 0.21-r = 0.77). Correlations on three of the six stations reached significance. Qualitative analysis of feedback from REs and students showed high acceptance of the reOSCE despite technological issues. CONCLUSIONS: This preliminary study demonstrated that OSCE ratings by LEs and REs were reasonably comparable when using checklists. Remote examination may be a feasible and acceptable way of assessing students' clinical skills, but further validity evidence will be required before it can be recommended for use in high-stakes examinations.

Using Audience Response System technology and PRITE questions to improve psychiatric residents' medical knowledge.

OBJECTIVE: Interactive educational tools are thought to convey material effectively. Audience Response Systems (ARSs), in particular, have been shown to improve written test scores in several residency fields but have not been previously reported in psychiatry. Such an approach may prove a valuable tool in improving test performance and medical knowledge. METHODS: Psychiatry residents were required to attend 12 90-min review sessions throughout the summer that utilized previous Psychiatry Residency In-Training Exam (PRITE) questions and an ARS to provide immediate feedback and a stimulus for discussion. Preparation for these sessions was either unsupervised (phase I) or involved a personalized reading program for residents who scored below the 50th percentile. Data were evaluated with ANOVA and unpaired 2-tail tests. RESULTS: Overall performance on the PRITE examination improved significantly as compared to pre-intervention controls (change in score 17.0 ± SD 16.6 vs 6.4 ± 12.6, P = 0.0068). The addition of a personalized reading program did not improve raw score performance significantly beyond the improvement seen with ARS alone but did slightly improve percentile rank and STD score. CONCLUSIONS: Utilization of the interactive ARS may improve performance on PRITE examination for residents.

The traveling salesman problem in surgery: economy of motion for the FLS Peg Transfer task.

BACKGROUND: In the Peg Transfer task in the Fundamentals of Laparoscopic Surgery (FLS) curriculum, six peg objects are sequentially transferred in a bimanual fashion using laparoscopic instruments across a pegboard and back. There are over 268 trillion ways of completing this task. In the setting of many possibilities, the traveling salesman problem is one where the objective is to solve for the shortest distance traveled through a fixed number of points. The goal of this study is to apply the traveling salesman problem to find the shortest two-dimensional path length for this task. METHODS: A database platform was used with permutation application output to generate all of the single-direction solutions of the FLS Peg Transfer task. A brute-force search was performed using nested Boolean operators and database equations to calculate the overall two-dimensional distances for the efficient and inefficient solutions. The solutions were found by evaluating peg object transfer distances and distances between transfers for the nondominant and dominant hands. RESULTS: For the 518,400 unique single-direction permutations, the mean total two-dimensional peg object travel distance was 33.3 ± 1.4 cm. The range in distances was from 30.3 to 36.5 cm. There were 1,440 (0.28 %) of 518,400 efficient solutions with the minimized peg object travel distance of 30.3 cm. There were 8 (0.0015 %) of 518,400 solutions in the final solution set that minimized the distance of peg object transfer and minimized the distance traveled between peg transfers. Peg objects moved 12.7 cm (17.4 %) less in the efficient solutions compared to the inefficient solutions. CONCLUSIONS: The traveling salesman problem can be applied to find efficient solutions for surgical tasks. The eight solutions to the FLS Peg Transfer task are important for any examinee taking the FLS curriculum and for certification by the American Board of Surgery.

Salient haptic skills trainer: initial validation of a novel simulator for training force-based laparoscopic surgical skills.

BACKGROUND: There is an increasing need for efficient training simulators to teach advanced laparoscopic skills beyond those imparted by a box trainer. In particular, force-based or haptic skills must be addressed in simulators, especially because a large percentage of surgical errors are caused by the over-application of force. In this work, the efficacy of a novel, salient haptic skills simulator is tested as a training tool for force-based laparoscopic skills. METHODS: Thirty novices with no previous laparoscopic experience trained on the simulator using a pre-test-feedback-post-test experiment model. Ten participants were randomly assigned to each of the three salient haptic skills-grasping, probing, and sweeping-on the simulator. Performance was assessed by comparing force performance metrics before and after training on the simulator. RESULTS: Data analysis indicated that absolute error decreased significantly for all three salient skills after training. Participants also generally decreased applied forces after training, especially at lower force levels. Overall, standard deviations also decreased after training, suggesting that participants improved their variability of applied forces. CONCLUSIONS: The novel, salient haptic skills simulator improved the precision and accuracy of participants when applying forces with the simulator. These results suggest that the simulator may be a viable tool for laparoscopic force skill training. However, further work must be undertaken to establish full validity. Nevertheless, this work presents important results toward addressing simulator-based force-skills training specifically and surgical skills training in general.

Face and construct validation of a virtual peg transfer simulator.

BACKGROUND: The Fundamentals of Laparoscopic Surgery (FLS) trainer box is now established as a standard for evaluating minimally invasive surgical skills. A particularly simple task in this trainer box is the peg transfer task which is aimed at testing the surgeon's bimanual dexterity, hand-eye coordination, speed, and precision. The Virtual Basic Laparoscopic Skill Trainer (VBLaST) is a virtual version of the FLS tasks which allows automatic scoring and real-time, subjective quantification of performance without the need of a human proctor. In this article we report validation studies of the VBLaST peg transfer (VBLaST-PT) simulator. METHODS: Thirty-five subjects with medical background were divided into two groups: experts (PGY 4-5, fellows, and practicing surgeons) and novices (PGY 1-3). The subjects were asked to perform the peg transfer task on both the FLS trainer box and the VBLaST-PT simulator; their performance was evaluated based on established metrics of error and time. A new length of trajectory (LOT) metric has also been introduced for offline analysis. A questionnaire was used to rate the realism of the virtual system on a 5-point Likert scale. RESULTS: Preliminary face validation of the VBLaST-PT with 34 subjects rated on a 5-point Likert scale questionnaire revealed high scores for all aspects of simulation, with 3.53 being the lowest mean score across all questions. A two-tailed Mann-Whitney test performed on the total scores showed significant (p = 0.001) difference between the groups. A similar test performed on the task time (p = 0.002) and the LOT (p = 0.004) separately showed statistically significant differences between the experts and the novices (p < 0.05). The experts appear to be traversing shorter overall trajectories in less time than the novices. CONCLUSION: VBLaST-PT showed both face and construct validity and has promise as a substitute for the FLS for training peg transfer skills.

Testing manual dexterity using a virtual reality simulator: reliability and validity.

Virtual reality dental training simulators, unlike traditional human-based assessment, have the potential to enable consistent and reliable assessment. The purpose of this study was to determine whether a haptic simulator (IDEA Dental(®) ) could provide a reliable and valid assessment of manual dexterity. A total of 106 participants were divided into three groups differing in dental manual dexterity experience: (i) 63 dental students, (ii) 28 dentists, (iii) 14 non-dentists. The groups, which were expected to display various performance levels, were required to perform virtual drilling tasks in different geometric shapes. The following task parameters were registered: (i) Time to completion (ii) accuracy (iii) number of trials to successful completion and (iv) score provided by the simulator. The reliability of the tasks was calculated for each parameter. The simulator and its scoring algorithm showed high reliability in all the parameters measured. The simulator was able to differentiate between non-professionals and dental students or non-professionals and dentists. Our study suggests that for improved construct validity, shorter working times and more difficult tasks should be introduced. The device should also be designed to provide greater sensitivity in measuring the accuracy of the task.

Gerotechnology: a new kind of care for aging? An analysis of the relationship between older people and technology.

Healthcare systems in aging societies need to find new solutions in the provision of care and treatment of older people. Gerotechnologies play a crucial role in the "aging-in-place" process. This article offers a critical overview of gerotechnological studies and will suggest a new approach in the study of the relationship between aging and technologies. Some trajectories of analysis and theoretical models are presented to underline the different perspectives in the discipline. Critical positions highlight the lack of theoretical analysis, mainly in relation to the complex social phenomenon of aging related to technology. Conclusions outline a relational approach to gerotechnologies: an analysis of the interactions between technological artifacts, users, and the context in which technologies are used. This approach expands the view from the technical potential of the technology to the way elderly people use technology, and suggests innovative care and cure strategies for aging.

The use of multimodal strategies for distance education in the GRECCs.

The Department of Veterans Affairs (VA) has found distance education to be particularly valuable as a means to disseminate information to large numbers of busy learners in geographically diverse settings. Specifically, Geriatric Research, Education and Clinical Centers (GRECCs) of the VA have used various forms of distance learning to provide geriatrics-focused education to diverse health care providers. Such formats allow programs to be available to audiences regardless of distance or time. Although the distance-learning format has clear benefits, there are also some barriers that have hindered its wider adoption, including technical difficulties and ease of use. Organizers of distance education programs are challenged to overcome these barriers to provide a quality learning experience for the audience. The GRECCs will likely continue to be leaders in exploring innovative distance-learning strategies to accomplish their mission of quality geriatric education.

Dissemination strategies: the evolution of learning resources on the evaluation of delirium, dementia, and depression.

Clinicians experience great pressures to provide timely, effective, and evidence-based medical care. Educators can aid these clinicians through the development of new tools that can facilitate timely completion of clinical tasks. These tools should summarize evidence-based information in a convenient format that allows easy use. This article describes one process in which a group of Geriatric Research, Education, and Clinical Center educators identified an area where important new information accrued, their development of a new clinical and teaching tool for imparting the new information, the initial dissemination of the tool to a preliminary target audience, and the initial evaluation of the new tool to determine how to improve its distribution and use beyond the original target audience.

Adapting Compassion Education Through Technology-Enhanced Learning: An Exploratory Study.

PURPOSE: Compassion is central to health care. Efforts to promote compassion through educational interventions for health professionals show promise, yet such education has not gained widespread dissemination. Adapting compassion education through technology-enhanced learning may provide an opportunity to enhance the scale and spread of compassion education. However, challenges are inherent in translating such curricula for online delivery. In this study, the authors explored how technology influences the delivery of compassion education for health professionals. METHOD: Using constructivist grounded theory methodology, the authors conducted semistructured interviews with 13 participants from across Ontario, Canada, from March to October 2019. The sample consisted of individuals who had experience with the design and evaluation of compassion education for health professionals. The interviews were coded and inductively analyzed to identify pertinent themes using constant comparative analysis. The study originated at the Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada. RESULTS: Participants provided a range of responses regarding technology and compassion education. While participants revealed concerns about the constraints of technology on human interaction, they also described technology as both inevitable and necessary for the delivery of future compassionate care curricula. Participants also shared ways in which technology may enhance compassion education for health professionals by increasing accessibility and learner comfort with vulnerability. Addressing technological ambivalence, improving facilitation, and maintaining a balance between face-to-face instruction and technology-enhanced learning were identified as elements that could advance compassion education into the future. CONCLUSIONS: Compassion education can be enhanced by technology; however, evidence-informed adaptation may require deliberate efforts to maintain some level of face-to-face interaction to ensure that technology does not erode human connection. Further research is required to address the uncertainties surrounding technology and compassion education as identified by participants. These findings provide educators with guidance for adapting compassionate care curricula into a digital domain.

Time and learning efficiency in Internet-based learning: a systematic review and meta-analysis.

UNLABELLED: Authors have claimed that Internet-based instruction promotes greater learning efficiency than non-computer methods. OBJECTIVES: determine, through a systematic synthesis of evidence in health professions education, how Internet-based instruction compares with non-computer instruction in time spent learning, and what features of Internet-based instruction are associated with improved learning efficiency. DATA SOURCES: we searched databases including MEDLINE, CINAHL, EMBASE, and ERIC from 1990 through November 2008. STUDY SELECTION AND DATA ABSTRACTION we included all studies quantifying learning time for Internet-based instruction for health professionals, compared with other instruction. Reviewers worked independently, in duplicate, to abstract information on interventions, outcomes, and study design. RESULTS: we identified 20 eligible studies. Random effects meta-analysis of 8 studies comparing Internet-based with non-Internet instruction (positive numbers indicating Internet longer) revealed pooled effect size (ES) for time -0.10 (p = 0.63). Among comparisons of two Internet-based interventions, providing feedback adds time (ES 0.67, p =0.003, two studies), and greater interactivity generally takes longer (ES 0.25, p = 0.089, five studies). One study demonstrated that adapting to learner prior knowledge saves time without significantly affecting knowledge scores. Other studies revealed that audio narration, video clips, interactive models, and animations increase learning time but also facilitate higher knowledge and/or satisfaction. Across all studies, time correlated positively with knowledge outcomes (r = 0.53, p = 0.021). CONCLUSIONS: on average, Internet-based instruction and non-computer instruction require similar time. Instructional strategies to enhance feedback and interactivity typically prolong learning time, but in many cases also enhance learning outcomes. Isolated examples suggest potential for improving efficiency in Internet-based instruction.

Live lecture versus video podcast in undergraduate medical education: A randomised controlled trial.

BACKGROUND: Information technology is finding an increasing role in the training of medical students. We compared information recall and student experience and preference after live lectures and video podcasts in undergraduate medical education. METHODS: We performed a crossover randomised controlled trial. 100 students were randomised to live lecture or video podcast for one clinical topic. Live lectures were given by the same instructor as the narrator of the video podcasts. The video podcasts comprised Powerpoint™ slides narrated using the same script as the lecture. They were then switched to the other group for a second clinical topic. Knowledge was assessed using multiple choice questions and qualitative information was collected using a questionnaire. RESULTS: No significant difference was found on multiple choice questioning immediately after the session. The subjects enjoyed the convenience of the video podcast and the ability to stop, review and repeat it, but found it less engaging as a teaching method. They expressed a clear preference for the live lecture format. CONCLUSIONS: We suggest that video podcasts are not ready to replace traditional teaching methods, but may have an important role in reinforcing learning and aiding revision.

Using technology in resource limited countries for competency based education and training.

Competency based education and training (CBET) helps to prepare graduates of medical laboratory science programs for the specific needs of the workforce. This is especially important in resource-limited countries where shortage of laboratory personnel creates a large demand for skilled graduates. Internet and other technology can be useful to teach specific tasks in CBET. Even in resource-limited countries, technology can be used in the implementation of competency based education and training curricula in medical laboratory programs.