Clinical Decision-making Skills Research Articles

Implementation of an integrated pharmacy education system for pharmacy students: a controlled educational trial

BackgroundTraditional pharmacy education often relies on fragmented, subject-centered curricula, which may inadequately prepare students for the complexities of advanced healthcare. This study evaluates the effectiveness of an integrated pharmacy education approach in enhancing foundational knowledge and practical skills.MethodsAn integrated course focused on respiratory diseases was developed and implemented for final-year pharmacy students at Tabriz University of Medical Sciences. The course utilized case-based learning and incorporated elements from various disciplines such as pharmacology, medicinal chemistry, and pharmaceutics. An educational controlled trial was conducted, comparing an intervention group (integrated course) with a control group (traditional course).ResultsSurvey results revealed that over 60% of students reported substantial improvements in their ability to manage respiratory cases. The intervention group demonstrated significantly higher clinical decision-making skills, with an average test score of 31.4 compared to 15.75 in the control group (p < 0.05). Student feedback highlighted the value of integrated education, advocating for its broader inclusion in the curriculum and the addition of more diverse topics and case studies.ConclusionsIntegrated pharmacy education, through a case-based approach, significantly enhances student competency and practical skills, better preparing them for real-world pharmacy practice. The study supports the implementation of integrated courses across pharmacy schools to develop curricula and improve educational outcomes. Future recommendations include continuous curriculum integration and expansion of topics to further enrich pharmacy education.

Comparing the impact of different transfusion medicine teaching methods—A mobile application versus task-based learning—On two dimensions of clinical competence among nursing students: A quasi-experimental study

AimTo evaluate and compare the impact of a transfusion medicine training course delivered via two different teaching methods—a mobile application and task-based learning—on nursing students' knowledge and clinical decision-making skill. BackgroundTo advance nursing education and clinical competence, it is crucial to integrate innovative methods, such as mobile applications and task-based learning, that promote active and competency-based learning. Evaluating these methods provides educators with insights to enhance nursing students' knowledge and clinical decision-making skill, ultimately improving patient care and supporting professional development. DesignA quasi-experimental study using a pretest-intervention-posttest design with a control group. MethodsThis study included 82 nursing students from the 6th to 8th semesters, selected through convenience sampling and randomly assigned to three groups—mobile application (n=30), task-based learning (n=30) and control (n=30). The first group received educational content through a mobile application, the second group through task-based learning and the control group received no intervention. Data were collected using a valid and reliable three-part researcher-made tool, including a demographic/educational checklist and questionnaires on knowledge and clinical decision-making skill, administered before and two weeks after the intervention. Analysis was done using paired t-test, analysis of covariance and Bonferroni post hoc test, with a significance level set at p<0.05. ResultsFollowing the intervention, both intervention groups showed a significant increase in knowledge and clinical decision-making skill scores (p<0.05). Although both groups had higher knowledge scores than the control group, the differences were not significant (p>0.05). In contrast, clinical decision-making scores were significantly higher in both intervention groups compared with the control (p<0.05). No significant differences were observed between the intervention groups regarding the mean post-test knowledge and clinical decision-making skill scores (p>0.05). ConclusionBoth teaching methods effectively improved nursing students' knowledge and clinical decision-making skills in transfusion medicine. To leverage these findings effectively, educational authorities should integrate mobile applications and task-based learning into nursing curricula, test these methods in various settings to assess their impact and use the findings to update curricula in line with current educational needs.

The effectiveness of simulation-based learning (SBL) on students’ knowledge and skills in nursing programs: a systematic review

BackgroundSimulation-Based Learning (SBL) serves as a valuable pedagogical approach in nursing education, encompassing varying levels of fidelity. While previous reviews have highlighted the potential effectiveness of SBL in enhancing nursing students’ competencies, a gap persists in the evidence-base addressing the long-term retention of these competencies. This systematic review aimed to evaluate the impact of SBL on nursing students’ knowledge and skill acquisition and retention.MethodA comprehensive search of electronic databases, including CINAHL, PubMed, Embase, Scopus, and Eric, was conducted from 2017 to 2023 to identify relevant studies. The Joanna Briggs critical appraisal tools were used to assess the methodological quality of the included studies. A total of 33 studies (15 RCTs and 18 quasi-experimental) met the inclusion criteria and were included in the review. A descriptive narrative synthesis method was used to extract relevant data.ResultsThe cumulative sample size of participants across the included studies was 3,670. Most of the studies focused on the impact of SBL on life-saving skills like cardiopulmonary resuscitation (CPR) or other life-support skills. The remaining studies examined the impact of SBL on critical care skills or clinical decision-making skills. The analysis highlighted consistent and significant improvements in knowledge and skills. However, the evidence base had several limitations, including the heterogeneity of study designs, risk of bias, and lack of long-term follow-up.ConclusionThis systematic review supports the use of SBL as a potent teaching strategy within nursing education and highlights the importance of the ongoing evaluation and refinement of this approach. While current evidence indicates enhancing knowledge and skill acquisition, limited studies evaluated the retention beyond five months, constraining generalisable claims regarding durability. Further research is essential to build on the current evidence and address gaps in knowledge related to the retention, optimal design, implementation, and evaluation of SBL interventions in nursing education.

Developing Clinical Judgment During Transition to Practice With Rapid-Cycle Deliberate Practice Simulation.

New-to-practice nurses (NPNs) make more errors than their experienced peers, affecting patient safety and contributing to sentinel events. Additionally, new nurses have a high attrition rate in their first year of practice. Simulation-based education may bridge the gap between education and practice by supporting the development of clinical judgment of NPNs. With quality improvement methods, an intradisciplinary team implemented a quality improvement project to improve NPNs' clinical judgment skills. A multipatient simulation that used rapid-cycle deliberate practice gave NPNs an opportunity to refine clinical decision-making and communication skills. In total, 24 NPNs participated in the pilot simulation. Pre- and postsurvey scores using the simulation effectiveness tool-modified showed self-reported improvement in clinical judgment and communication skills, among other competencies. Rapid-cycle deliberate practice simulation may support the development of essential nursing competencies, along with increased confidence and enhanced psychological safety among NPNs. [J Contin Educ Nurs. 202x;5x(x):xx-xx.].

Exploring the impact of collaborative learning on the development of critical thinking and clinical decision-making skills in nursing students: A quantitative descriptive design

This study aims to introduce collaborative learning as a method in the Mental Health and Diseases Nursing course for actively enrolled fourth-year nursing students. The objective is to assess the impact of collaborative learning on critical thinking and clinical decision-making among nursing students. Collaborative learning involves the use of small groups to help students identify effective ways of working together to enhance their learning outcomes. A quantitative research methodology was employed in this study. To evaluate the effectiveness of the collaborative learning program, a within-subject repeated-measures design was implemented. This study was conducted in the nursing department of a university in Turkey. The study included 96 female students (92.3 %) and 8 male students (7.7 %). Data collection involved the sociodemographic data form, the California Critical Thinking Disposition Inventory (CCTDI), and the Clinical Decision-Making in Nursing Scale (CDMNS). The students' pre-program CDMNS median score was 146.00 (117.00–177.00), and the post-program CDMNS median score was 147.50 (115.00–175.00). While there was an increase in the students' clinical decision-making scores after the program, this increase was not statistically significant (p > 0.05). The pre-program median score for CCTDI was 223.26 (176.87–296.02), and the post-program median score was 227.88 (188.87–359.00). The students' critical thinking disposition scores showed a statistically significant increase after the program (p < 0.05). The study results revealed notable enhancements among students who participated in courses utilizing the collaborative learning method. These enhancements included heightened academic performance, elevated levels of critical thinking, increased self-confidence, and improved clinical decision-making abilities.

Tumor board simulation improves interdisciplinary decision-making in medical students

IntroductionTraining of interdisciplinary clinical reasoning and decision-making skills, essential in daily clinical practice in oncological specialties, are still underrepresented in medical education. Therefore, at LMU University Hospital Munich, we implemented a didactically modified tumor board simulation with experts from five different disciplines (medical oncology, pathology, radiation oncology, radiology, and surgery) presenting patient cases into a one-week course on the basic principles of oncology. In this survey, we examined the self-assessed impact of our course on the interdisciplinary decision-making skills of medical students.MethodsBetween November-December 2023 and January-February 2024, we surveyed two cohorts of medical students in the third year of medical school in our one-week course before and after participating in the tumor board simulation. The objective was to evaluate the self-assessed knowledge in interdisciplinary clinical decision-making, in integrating ethical considerations into clinical reasoning, and in comprehension of various professional viewpoints in interdisciplinary decision-making. Knowledge was assessed using a five-step Likert scale from 1 (no knowledge) to 5 (complete knowledge).ResultsThe survey was answered by 76 students before and 55 after the simulation, equaling 60–70% of all 100 course participants. Mean knowledge level regarding principles of interdisciplinary clinical decision-making improved significantly in all of the following exemplary aspects: purpose and procedure of tumor boards in clinical practice (from 2.4 ± 1.1 to 4.0 ± 1.0, Spearman’s ρ = 0.6, p < 0.001), principles of dealing with ethical challenges in oncology (from 2.4 ± 1.1 to 3.4 ± 1.0, ρ = 0.4, p < 0.001), and principles of shared decision-making in oncology (2.7 ± 1.1 to 3.7 ± 1.0, ρ = 0.4, p < 0.001). Students reported that their skills in clinical decision-making and ability to discuss oncological patient cases from different professional viewpoints improved due to the teaching course.ConclusionBy employing our interdisciplinary one-week course and a didactically modified tumor board simulation featuring experts from various oncological disciplines, medical students’ comprehension of interdisciplinary clinical decision-making in oncology improved significantly.

The relationship between clinical decision-making levels and self-efficacy levels of operating room nurses

BackgroundClinical decision-making and self-efficacy levels of operating room nurses are critical for patient care quality and safety. ObjectiveThis study aims to examine the relationship between clinical decision-making levels and self-efficacy among operating room nurses and to identify factors influencing these two key components of nursing practice. MethodsA cross-sectional descriptive design was used to survey 94 nurses working in surgical wards at Ankara University Medical Faculty Hospital. Data were collected using the Clinical Decision Making in Nursing Scale (CDMNS), General Self-Efficacy Scale (GSES), and a demographic information form. Data were analyzed using descriptive statistics, correlation analysis, and group comparisons. ResultsA significant positive correlation was found between clinical decision-making ability and self-efficacy (r = 0.355, p < .0001). Nurses with higher education levels demonstrated significantly greater clinical decision-making skills (p < .005). Nurse managers reported significantly higher self-efficacy levels compared to scrub/circulating nurses (p < .05). Age was positively correlated with self-efficacy (r = 0.373, p < .0001) but not with clinical decision-making ability. ConclusionThe research indicated that self-efficacy levels correspond with clinical decision-making capabilities of the operating room nurses. Higher education levels of the practitioners enhanced their clinical decision-making abilities. Nurse managers had higher self-efficacious beliefs than the scrub or circulating nurses. Age was positively associated with self-efficacy, but not with the scores on clinical decision-making abilities. The results of this study nurse leaders have higher GSES and CDMNS scores because they are experienced nurses with higher education degrees.

Game Products: Innovative Pathways for Nursing Education and Clinical Training

To excel in their work, nurses must have specialized tools to support their tasks and professional development. Games, as a crucial pathway to achieving nursing education and clinical training goals, demonstrate significant potential and application value, making them an innovative product. Nursing education games come in various forms, including virtual reality, augmented reality, tabletop, and digital, and may be designed as needed for individual, two-player, or team play (Avşar et al., 2023; Bermejo et al., 2023; Tsai et al., 2024). These games, beyond their entertainment value, have clear educational objectives embedded in their design. Through levels, challenging tasks, and reward mechanisms, they stimulate learning enjoyment and promote nursing development. In this column, experts and scholars in the field of nursing engaged in game development share their experiences and achievements. Integrating games into nursing delivers a wealth of tools and resources for nursing education and clinical practice, offering immersive learning experiences, instant feedback, and individualized learning paths. For nursing students, gamified products offer safe and risk-free learning environments in which they can practice critical tasks and make decisions in simulated medical scenarios, increasing their clinical experience and confidence and enhancing their clinical judgment and decision-making skills (Wu et al., 2023). For patients, many therapeutic games have already been designed that use gameplay to improve health by facilitating user engagement in rehabilitation exercises, promoting healthy eating, and fostering social interactivity (Tsai et al., 2024). For nurses, various games are being used to promote continuous professional growth in an interactive and enjoyable learning environment, improving overall quality of care and job satisfaction (Hsieh et al., 2023). In summary, the application of game products in nursing education and clinical training has introduced new learning and training models that provide multifaceted benefits for nurses, nursing students, and patients. We hope that readers will gain a deeper understanding of related game products after reading this column and use games effectively to enhance nursing quality.

Revolutionizing Nurse Practitioner Training: Integrating Virtual Reality and Large Language Models for Enhanced Clinical Education.

This project introduces an innovative virtual reality (VR) training program for student Nurse Practitioners, incorporating advanced 3D modeling, animation, and Large Language Models (LLMs). Designed to simulate realistic patient interactions, the program aims to improve communication, history taking, and clinical decision-making skills in a controlled, authentic setting. This abstract outlines the methods, results, and potential impact of this cutting-edge educational tool on nursing education.

Time spent on activities that can be delegated and reasons for not delegating among acute care nurses: A mixed-methods study.

To describe the activities nurses perceived to be delegable to other staff (delegable activities) in order to estimate the time nurses spend on delegable activities and explore nurses' reasons for not delegating these activities. Mixed-methods explanatory sequential. In total, 236 nurses from 27 medical and surgical wards of five hospitals in northern Italy completed a web-based survey during a single shift between June and July 2022. Minutes spent on delegable activities, staff member to whom participants could have delegated and reason(s) for not delegating were reported. Chief nurses provided specific wards' characteristics using a paper-and-pencil questionnaire. Twenty semi-structured interviews were conducted to explore delegable activities and reasons for not delegating. Quantitative and qualitative results were merged using joint displays. Participants spent approximately one-quarter of their time performing delegable activities, mainly delegable to nurse aides or nurse clerks, and performed due to a lack/shortage of staff or their concurrent participation in other activities. Participants recognized that activities requiring clinical assessment and decision-making skills cannot be delegated, whereas technical activities and indirect care should be delegated. Organizational, structural and cultural factors, as well as patient characteristics, available staff and experience affected delegation, leading nurses to perform delegable activities to ensure patient care. Nurses spend a considerable part of their time on delegable activities due to a lack of staff or support services and suboptimal organization, which could be addressed by optimal staff management, but also to the complexity of the contexts, including individual and cultural factors that should be addressed through policy interventions. This study estimates the time nurses spend on delegable activities in acute care settings. Our findings highlighted the reasons that sustain the decision not to delegate that policymakers, healthcare managers, and nurse educators should consider to promote nurses' delegation skills. MMR checklist. None.

Albuterol off-label use in the management of hyperkalemia and students survey

This study aimed to explore the evidence in the off-label use of albuterol in the acute management of hyperkalemia. It also aims to explore the knowledge and opinion of first-year pharmacy students related to this topic. Based on the literature survey, it shows a lack of awareness among first-year pharmacy students regarding albuterol, hyperkalemia, and the use of albuterol for hyperkalemia. Demographic factors, such as income and years of work experience, were shown to influence students' understanding of the topic. Regarding the survey, a total of forty participants completed an online survey, providing information on demographic factors such as age, gender, residency state, employment status, income, education, and work experience. Results revealed a predominantly female and younger student population, with diverse geographic representation and varied employment and income levels. Most participants selected the wrong answer to questions related to albuterol and hyperkalemia, suggesting potential knowledge gaps in this area. These findings highlight the need for targeted educational interventions to enhance student understanding and clinical decision-making skills in pharmacotherapy-related concepts. Further research could evaluate the effectiveness of such interventions in improving student knowledge and patient care outcomes.

Pursuit of a Dual Degree During Residency Training

Background: The increasing complexity of the health care system is requiring physicians to become more expansive and comprehensive in their knowledge. Public health awareness, biostatistics, and fiscal understanding including medical reimbursements are only small facets of the expertise physicians are needing to understand. Residency programs across the country are starting to permit the incorporation of graduate education into residency curricula. Residents in academic training programs are starting to have the opportunity to pursue a dual degree study in addition to their residency training. Despite the recognized need for well-rounded physicians and growing opportunities for master’s degree education concurrent with residency training, there is a lack of research regarding residents’ interest in pursuing concurrent degrees. Additionally, the resources that institutions offer repertoires needed to support residents during such endeavors are lacking. Objective: The purpose of this study was to elucidate current interest, resource availability, as well as barriers that Obstetrics and Gynecology (OBGYN) residents may come across when considering a dual degree opportunity during their residency. Methods: A comprehensive questionnaire of 28 items was developed by the researchers using a focus group. The innovative survey was sent to the program directors of all ACGME-accredited OBGYN programs in the US in an electronic format. The survey offered anonymity and easy online accessibility while being available for a total of four weeks (during the month of August 2022). A reminder was sent one week prior to the conclusion of data collection. Results: A total of 298 ACGME-accredited OBGYN programs were contacted with 52 individual responses received. The majority of the respondents identified as white females, with all respondents being under the age of 35. A total of 72% of respondents came from combined academic programs or strictly academic programs with 25% of respondents having initiated or completed additional graduate-level degrees at the time of the survey. Most programs did not mention the opportunity of pursuing a dual degree at the time of residency interviews, and over 50% of programs did not permit their residents to pursue another graduate study during their training. Of those permitting such an endeavor, criteria for pursuing the graduate degree included successfully completing the first year of residency and having a ‘passing’ CREOG score, whereas 40% of respondents were unsure of stipulations by their health systems. Regarding the source of the degree, 90% of respondents stated their residency institution did not have the setup or offer a combined dual degree program option, and &gt;75% of respondents reported a lack of tuition reimbursement for such growth opportunities. Whereas 38% of respondents would consider a dual degree option during residency training if available, 51% of those surveyed are interested in pursuing another degree only after residency, with time and cost being the biggest deterrent to pursuing a degree while in residency. Additionally, the platform utilized for the courses - online versus in-person – was another significant factor that plays a role. Regarding growth opportunities, the majority of respondents are interested in leadership roles and believe that supplementing their credentials, ideally with a Masters in Public Health. Conclusion: The increasing demand for physician knowledge outside of clinical medicine has slowly increased throughout the years. As a response, residency programs are beginning to integrate graduate classes and degrees into the training curriculum. Although a majority of residents appear to be interested in pursuing a graduate degree at some point in their career, their biggest concerns during residency include the time needed to devote to their studies and the cost of earning a graduate degree. It is also apparent through the survey that many programs have not been clear regarding the resources they offer for those who are interested in continuing graduate education during residency training. Recognizing the need for physicians to navigate studies outside of clinical medicine, residency programs need to establish more robust pathways for residents to pursue additional graduate education in fields including business, public health, and social work amongst others. Large-scale research will be needed to further investigate how programs can better support their residents’ interests as they diversify their knowledge base to support their clinical decision-making skills.

Emerging Challenges in Technology-based Support for Surgical Training

This paper stipulates several technological research and development thrusts that can assist in modern day approaches to simulated training of minimally invasive laparoscopic and robot surgery. Basic tenets of such training are explained, and specific areas of research are enumerated. Specifically, augmented and mixed reality are proposed as a means of improving perceptual and clinical decision-making skills, haptics are proposed as mechanism not only to provide force feedback and guidance, but also as a means of reflecting a tactile feel of surgery in simulated training scenarios. Learning optimization is discussed to fine tune the difficulty levels of various exercises. All the above elements can serve as the foundation for building computer-based virtual coaching environments that can reduce the training costs and provide a broader access to learning highly complex, technology driven surgical techniques.

Cognitive load theory in workplace-based learning from the viewpoint of nursing students: application of a path analysis

PurposeThe present study aimed to test the relationship between the components of the Cognitive Load Theory (CLT) including memory, intrinsic and extraneous cognitive load in workplace-based learning in a clinical setting, and decision-making skills of nursing students.MethodsThis study was conducted at Shahid Sadoughi University of Medical Sciences in 2021–2023. The participants were 151 nursing students who studied their apprenticeship courses in the teaching hospitals. The three basic components of the cognitive load model, including working memory, cognitive load, and decision-making as the outcome of learning, were investigated in this study. Wechsler’s computerized working memory test was used to evaluate working memory. Cognitive Load Inventory for Handoffs including nine questions in three categories of intrinsic cognitive load, extraneous cognitive load, and germane cognitive load was used. The clinical decision-making skills of the participants were evaluated using a 24-question inventory by Lowry et al. based on a 5-point scale. The path analysis of AMOS 22 software was used to examine the relationships between components and test the model.FindingsIn this study, the goodness of fit of the model based on the cognitive load theory was reported (GIF = 0.99, CFI = 0.99, RMSEA = 0.03). The results of regression analysis showed that the scores of decision-making skills in nursing students were significantly related to extraneous cognitive load scores (p-value = 0.0001). Intrinsic cognitive load was significantly different from the point of view of nursing students in different academic years (p = 0.0001).ConclusionThe present results showed that the CLT in workplace-based learning has a goodness of fit with the components of memory, intrinsic cognitive load, extraneous cognitive load, and clinical decision-making skill as the key learning outcomes in nursing education. The results showed that the relationship between nursing students’ decision-making skills and extraneous cognitive load is stronger than its relationship with intrinsic cognitive load and memory Workplace-based learning programs in nursing that aim to improve students’ decision-making skills are suggested to manage extraneous cognitive load by incorporating cognitive load principles into the instructional design of clinical education.

Effect of simulation-based zoom learning on clinical decision-making among undergraduate nursing students and experiences of students and instructors: A mixed methods study

AimTo determine the effect of simulation-based Zoom learning (SBZL) on perceived capabilities and clinical decision-making skills among undergraduate nursing students and to explore experiences of the instructors and students participating in SBZL. BackgroundNursing is a practice profession and students acquire clinical decision-making skills in clinical settings. However, the COVID-19 pandemic has disrupted conventional clinical learning activities. In this study, the outcomes of implementing SBZL in an undergraduate programme to support students’ clinical learning were examined. DesignA mixed methods design was employed. MethodsThis study recruited 195 final-year students to participate in the SBZL programme, which was developed based on the NLN Jeffries Simulation Theory to guide its design, implementation and evaluation. Case scenarios were developed and simulated through Zoom. Students’ perceived capabilities, perceptions of the learning environment and clinical decision-making skills were assessed before and after SBZL. A historical control group of 226 previous final year students who had received a clinical practicum was included for comparison. Semi-structured interviews were conducted with 11 instructors and 19 students to explore their experiences of participating in SBZL. ResultsA total of 102 students completed the post-SBZL questionnaire. An increase in perceived creative thinking (mean difference = 0.24, p < 0.001) was observed post-SBZL. After SBZL, the perceptions of the learning environment were significantly improved. However, the SBZL group demonstrated lower perceived problem-solving capability than the control group (mean difference = 0.14, p = 0.007). Clinical decision-making was significantly improved in the SBZL group than in the control group (p < 0.001). Both the instructors and students reported positive experiences with SBZL, and highlighted challenges and factors for improving its implementation. ConclusionsSBZL showed improvement in perceived creative thinking, perceptions of the learning environment and clinical decision-making. This innovative teaching and learning method can be valuable for nursing education in various regions to prepare students for real-life roles. Tweetable abstractSimulation-based Zoom learning is better than traditional teaching in improving clinical decision-making skills among undergraduate nursing students.

Implementation of a Global Pediatric Trauma Course in an Upper Middle–Income Country: A Pilot Study

IntroductionOver 90% of pediatric trauma deaths occur in low- and middle-income countries (LMICs), yet pediatric trauma-focused training remains unstandardized and inaccessible, especially in LMICs. In Brazil, where trauma is the leading cause of death for children over age 1, we piloted the first global adaptation of the Trauma Resuscitation in Kids (TRIK) course and assessed its feasibility. MethodsA 2-day simulation-based global TRIK course was hosted in Belo Horizonte in October 2022, led by one Brazilian and four Canadian instructors. The enrollment fee was $200 USD, and course registration sold out in 4 d. We administered a knowledge test before and after the course and a postcourse self-evaluation. We recorded each simulation to assess participants’ performance, reflected in a team performance score. Groups received numerical scores for these three areas, which were equally weighted to calculate a final performance score. The scores given by the two evaluators were then averaged. As groups performed the specific simulations in varying orders, the simulations were grouped into four time blocks for analysis of performance over time. Statistical analysis utilized a combination of descriptive analysis, Wilcoxon signed-rank tests, Kruskal–Wallis tests, and Wilcoxon rank-sum tests. ResultsTwenty-one surgeons (19 pediatric, one trauma, one general) representing four of five regions in Brazil consented to study participation. Women comprised 76% (16/21) of participants. Overall, participants scored higher on the knowledge assessment after the course (68% versus 76%; z = 3.046, P < 0.001). Participants reported improved knowledge for all tested components of trauma management (P < 0.001). The average simulation performance score increased from 66% on day 1% to 73% on day 2, although this increase was not statistically significant. All participants reported they were more confident managing pediatric trauma after the course and would recommend the course to others. ConclusionsCompletion of global TRIK improved surgeons’ confidence, knowledge, and clinical decision-making skills in managing pediatric trauma, suggesting a standardized course may improve pediatric trauma care and outcomes in LMICs. We plan to more closely address cost, language, and resource barriers to implementing protocolized trauma training in LMICs with the aim to improve patient outcomes and equity in trauma care globally.

An Insight into Knowledge, Perspective, and Practices of Indian Optometrists towards Childhood Myopia.

The current understanding of clinical approaches and barriers in managing childhood myopia among Indian optometrists is limited. This research underscores the necessity and relevance of evidence-based practice guidelines by exploring their knowledge, attitude, and practice towards childhood myopia. A self-administered internet-based 26-item survey was circulated online among practicing optometrists in India. The questions assessed the demographics, knowledge, self-reported clinical practice behavior, barriers, source of information guiding their management, and extent of adult caregiver engagement for childhood myopia. Of 393 responses, a significant proportion of respondents (32.6-92.4%) were unaware of the ocular complications associated with high myopia, with less than half (46.5%) routinely performing ocular biometry in clinical practice. Despite the growing awareness of emerging myopia management options, the uptake remains generally poor, with single-vision distance full-correction spectacles (70.3%) being the most common mode of vision correction. Barriers to adopting optimal myopia care are medicolegal concerns, absence of clinical practice guidelines, and inadequate consultation time. Own clinical experience and original research articles were the primary sources of information supporting clinical practice. Most (>70%) respondents considered involving the adult caregiver in their child's clinical decision-making process. While practitioners' awareness and activity of newer myopia management strategies are improving, there is plenty of scope for its enhancement. The importance of evidence-based practice guidelines and continuing education on myopia control might help practitioners enhance their clinical decision-making skills.

Embracing ChatGPT for Medical Education: Exploring Its Impact on Doctors and Medical Students.

ChatGPT (OpenAI), a cutting-edge natural language processing model, holds immense promise for revolutionizing medical education. With its remarkable performance in language-related tasks, ChatGPT offers personalized and efficient learning experiences for medical students and doctors. Through training, it enhances clinical reasoning and decision-making skills, leading to improved case analysis and diagnosis. The model facilitates simulated dialogues, intelligent tutoring, and automated question-answering, enabling the practical application of medical knowledge. However, integrating ChatGPT into medical education raises ethical and legal concerns. Safeguarding patient data and adhering to data protection regulations are critical. Transparent communication with students, physicians, and patients is essential to ensure their understanding of the technology's purpose and implications, as well as the potential risks and benefits. Maintaining a balance between personalized learning and face-to-face interactions is crucial to avoid hindering critical thinking and communication skills. Despite challenges, ChatGPT offers transformative opportunities. Integrating it with problem-based learning, team-based learning, and case-based learning methodologies can further enhance medical education. With proper regulation and supervision, ChatGPT can contribute to a well-rounded learning environment, nurturing skilled and knowledgeable medical professionals ready to tackle health care challenges. By emphasizing ethical considerations and human-centric approaches, ChatGPT's potential can be fully harnessed in medical education, benefiting both students and patients alike.

A Staged Defragmented Simultaneous Debriefing Model As Integrated Micro-debriefing Components Inside Online Simulation for Competencies Formation.

Background Currently, there are no separate debriefing models for online simulation training, and existing models simply imitate the traditional models used in on-site simulation training (the physical presence of individuals, such as students or trainees, in a simulation center). This involves hands-on, in-person training within a simulated environment to enhance practical skills and knowledge in a controlled setting. This scenario does not fully meet the requirements and capabilities of distance learning. Objective To develop a staged defragmented debriefing model as integrated micro-debriefing components inside an online simulation to support the development of clinical decision-making andcompetencies formation within medical education and offer recommendations to support the use of this debriefing model as a teaching strategy. Methods This descriptive study was conducted from August 2020 to September 2023. To build a staged defragmented debriefing model as integrated micro-debriefing components inside an online simulation for competencies formation the traditional debriefing model's components for on-site simulation training, simulation type, and structure, modern concepts of e-learning, and classification of the seriousness of medication errors were used. The main focus of this study was on providing a detailed account of the debriefing components for online simulation training, features, and implementation of this new teaching model.A total of 38 participants, healthcare professionals, were recruited for this study. The participants were randomly assigned to two groups: one experiencing the staged defragmented debriefing model (n = 20) and the other control group, which received traditional debriefing following simulation training (n = 18). Results The results allowed us tosuccessfully develop a staged defragmented debriefing model inside the simulation that integrates micro-debriefing components located at different points of the simulation scenarios. This teaching approach was successfully implemented in online clinical case scenarios in the "ClinCaseQuest" Simulation Training Platform for continuous medical education.Additionally, an internal validation experiment comparing the effectiveness of the staged defragmented debriefing model with the traditional debriefing method demonstrated superior learning outcomes and participant satisfaction in the staged debriefing group. Conclusions The staged defragmented debriefing model, when integrated into online simulations, represents a promising strategy for advancing clinical decision-making skills and competencies formation in medical education. Implementation of this debriefing model as a teaching strategy holds promise for enhancing learning outcomes in medical education settings. Further research, validation, and implementation are recommended to maximize the model's potential impact on medical education and training.

A case study: lessons learned from online tutorial to improve practice readiness for family medicine residents in Palestine

BackgroundGeopolitical and socioeconomic challenges limit faculty development and clinical teaching in Palestine and many other developing countries. The first, and still only, Family Medicine (FM) residency program is a four-year program based out of An-Najah University in the West Bank. Training in primary care clinics occurs in the final two years and there are many challenges to adequate supervision in the clinical setting that were exacerbated during the pandemic. To improve the readiness for practice skills of 13 Palestinian FM residents a three-month tutorial program was organized in 2020. A nongovernmental organization (NGO) that has worked to support Family Medicine development in the region engaged experienced British and American General Practitioners trained as tutors to offer online tutorials. We examined the program as a case study to understand the factors that facilitated or impaired a positive virtual learning environment in a middle/low income country.MethodsThe tutors and residents were divided into groups and met virtually between June and September 2020. Evaluations and session reports collected during the program, the text of an online chat, and responses to an online survey two years later were collected. Using thematic analysis techniques, we evaluated the value for the residents at the time and two years later and identified factors that facilitated or impaired a positive virtual learning environment.ResultsThemes of knowledge, skills, attitudes, cultural disconnects, and tutorial logistics emerged. The group with the most stable tutor pairing, including one Arabic-speaker familiar with the context, was the most engaged. The all-female group formed a chat group to share real-time case questions during clinical practice and focused on skills (e.g. conducting a thorough medication review) and attitudes (e.g. open to sharing and discussing uncertainties). Other groups were less cohesive.ConclusionsTransnational tutorials that focused on clinical thinking and decision-making skills were most successful when the tutorial pair was stable, offered familiarity with the language and addressed cultural differences. Intrinsic factors such as lacking the motivation to participate and extrinsic factors such as unstable internet and rolling electric cuts, and clinical structures that made applying new skills challenging were more difficult to address but must be considered.