Clinical Decision-making Skills Research Articles

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.

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.

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.

The relationship between emotional intelligence, self-efficacy, and clinical decision-making among critical care nurses in Jordan

ABSTRACT Nurses with high self-efficacy and emotional intelligence can provide effective clinical decision-making, which could influence the quality of healthcare. Also, there is a lack of studies about these variables in Arab countries including Jordan. Thus, this study purposed to assess the relationship between emotional intelligence, self-efficacy, and clinical decision-making among critical care nurses in Jordan. A descriptive correlational design was conducted on a sample of 407 nurses who work in critical care units in government, private, and educational health hospitals. The data were collected using a structured questionnaire during the period from March to May 2022. The results revealed that the participants’ mean scores of emotional intelligence, self-efficacy, and clinical decision-making were as follows: M = 5.22 (SD ± 0.18), M = 3.71 (SD ± 0.481), and M = 3.88 (SD ± 0.518), respectively, which reflected high levels of these variables. Emotional intelligence, self-efficacy, age, and marital status were positively correlated with clinical decision-making (β = 0.218, p < .001; β = 0.328, p < .001; β = 0.182, p = .01; β = 0.092, p < .05, respectively). Self-efficacy had the greatest association with clinical decision-making (T-Statistics = 6.37). Therefore, it is important to encourage and continuously implement strategies for critical care nurses to enhance their emotional intelligence and self-efficacy, and take into consideration age and marital status to improve their clinical decision-making skills to provide high-quality patient care. The main practical contribution originates from improving emotional intelligence and self-efficacy may increase the critical care nurses’ competencies in clinical decision-making, which will reflect positively on nurses’ health and patients’ outcomes.

Development and Effectiveness of a Rapid Cycle Deliberate Practice Neonatal Resuscitation Simulation Program: A Quasi-Experimental Study.

The Rapid Cycle Deliberate Practice (RCDP) simulation during neonatal resuscitation program (NRP) training provides in-event feedback for each simulation step, repeats the simulation from the beginning, and undergoes a continuous improvement process. It also offers after-event debriefing that involves follow-up discussion and reflection after completing simulations. These two methods differ in the timing and frequency of feedback application, and there may be differences in the effectiveness of neonatal resuscitation training. A quasi-experimental simulation study with a pre- and post-test design was used; the experimental group received RCDP simulation NRP training, based on the self-determination theory, while the control group received an after-event debriefing, following the NRP scenario. The experimental group displayed significantly improved clinical decision-making skills compared with the control group. When responding to emergencies involving high-risk newborns, we found that RCDP simulation during NRP training and better preparation for neonatal resuscitation among nursing students improved outcomes for newborns.

Student Nurses' Perceptions of the Role of High-Fidelity Simulation in Developing Decision-Making Skills for Clinical Practice: A Qualitative Research Study.

The integration of high-fidelity simulation (HFS) in nursing education has increased, but its effect on students' clinical decision-making skills and their ability to transfer these skills to clinical practice remains unclear. This qualitative study aimed to explore nursing students' perceptions of simulation's role in developing decision-making skills for clinical practice. Twenty-three self-selected final-year nursing students participated in an HFS exercise in 2016. They engaged in "think-aloud" activities during the simulation, reviewed videos of their performance, and attended a structured debriefing session. Four to six weeks later, face-to-face semistructured interviews were conducted to gather their views on the application of learning from simulation into practice. Thematic analysis was used to analyze the interview data. Four themes emerged from the analysis: "enhancing clinical decision-making skills," "recognition of the types of clinical decision-making," "recognition of cognitive biases," and "transferability and integrating theory into practice." Simulation improved student self-awareness, decision-making skills, and recognition of cognitive biases applied in practice. Overall, students found that the simulation improved their ability to apply theoretical knowledge gained through simulation to practice. The students' perception of the authenticity of activities in relation to real-world scenarios played a crucial role in enhancing the transferability and application of acquired knowledge from simulation to clinical practice. The findings provide valuable insights into how simulation optimizes learning and decision-making skills, ultimately promoting effective care in clinical settings.

A45Developing low carbon care – using simulation to calculate and reduce carbon emissions

Climate change is considered one of the most pressing global concerns for the future and the single biggest health threat [1]. Healthcare delivery is a major contributor to the climate crisis, producing 4.4% of net carbon global emissions today [2]. One of the largest contributors to NHS carbon emissions is the use of equipment, consumables and clinical care itself [2]. Therefore, clinical staff have a significant part to play in reducing carbon emissions and achieving national carbon reduction targets. However, they must be carbon literate and understand the impact of personal practice on global carbon emissions and be able to identify ways to deliver low carbon models of care [3]. Simulation could play a significant role in educating and developing sustainable practice in healthcare students through a system thinking approach. Allowing students to examine the environmental impact of healthcare delivery and support innovative solutions to reduce carbon emissions without compromising care. The aim was to firstly increase nursing students’ awareness of the carbon emissions from the delivery of patient care. Secondly to improve clinical decision-making in the selection and implementation of interventions to enable the delivery of low carbon care. Undergraduate nursing students took part in a specifically designed simulation scenario. Students completed the scenario of a patient presenting to the Emergency Department with exacerbation of Chronic Obstructive Pulmonary Disease (COPD), implementing care and interventions as clinically indicated. After completion of the simulation students then calculated the carbon emissions from the clinical resources they used, using the Centre for Sustainable Healthcare carbon emissions calculation. Debriefing identified that students did not consider sustainability and carbon emissions in their current clinical decision-making. Students were shocked by the amount of carbon emissions generated from interventions. Students identified areas where they could reduce carbon emissions without compromising care such as inappropriate use of gloves, using dry powdered inhalers, and reducing unnecessary cannulation. Simulation could play a pivotal role in developing sustainable clinical decision-making skills in healthcare students and staff. Actively calculating carbon emissions allows students to directly see the environmental impact of their practice, increasing carbon literacy and stimulating low carbon care practice. This use of simulation should be explored further by educators across professions to support both national and global climate change policies. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Applying AI and Guidelines to Assist Medical Students in Recognizing Patients With Heart Failure: Protocol for a Randomized Trial.

The integration of artificial intelligence (AI) into clinical practice is transforming both clinical practice and medical education. AI-based systems aim to improve the efficacy of clinical tasks, enhancing diagnostic accuracy and tailoring treatment delivery. As it becomes increasingly prevalent in health care for high-quality patient care, it is critical for health care providers to use the systems responsibly to mitigate bias, ensure effective outcomes, and provide safe clinical practices. In this study, the clinical task is the identification of heart failure (HF) prior to surgery with the intention of enhancing clinical decision-making skills. HF is a common and severe disease, but detection remains challenging due to its subtle manifestation, often concurrent with other medical conditions, and the absence of a simple and effective diagnostic test. While advanced HF algorithms have been developed, the use of these AI-based systems to enhance clinical decision-making in medical education remains understudied. This research protocol is to demonstrate our study design, systematic procedures for selecting surgical cases from electronic health records, and interventions. The primary objective of this study is to measure the effectiveness of interventions aimed at improving HF recognition before surgery, the second objective is to evaluate the impact of inaccurate AI recommendations, and the third objective is to explore the relationship between the inclination to accept AI recommendations and their accuracy. Our study used a 3 × 2 factorial design (intervention type × order of prepost sets) for this randomized trial with medical students. The student participants are asked to complete a 30-minute e-learning module that includes key information about the intervention and a 5-question quiz, and a 60-minute review of 20 surgical cases to determine the presence of HF. To mitigate selection bias in the pre- and posttests, we adopted a feature-based systematic sampling procedure. From a pool of 703 expert-reviewed surgical cases, 20 were selected based on features such as case complexity, model performance, and positive and negative labels. This study comprises three interventions: (1) a direct AI-based recommendation with a predicted HF score, (2) an indirect AI-based recommendation gauged through the area under the curve metric, and (3) an HF guideline-based intervention. As of July 2023, 62 of the enrolled medical students have fulfilled this study's participation, including the completion of a short quiz and the review of 20 surgical cases. The subject enrollment commenced in August 2022 and will end in December 2023, with the goal of recruiting 75 medical students in years 3 and 4 with clinical experience. We demonstrated a study protocol for the randomized trial, measuring the effectiveness of interventions using AI and HF guidelines among medical students to enhance HF recognition in preoperative care with electronic health record data. DERR1-10.2196/49842.

Creating and Using Poetry to Teach Theoretical and Conceptual Nursing Content

Abstract In nursing academia, educators are faced with the longstanding challenge of bridging the theory-practice gap. In a second-year nursing theory course, students were introduced to poetry on a biweekly basis, written by their educator in response to student needs in understanding complex theoretical and conceptual nursing topics. Through anecdotal evidence from clinical instructors and students, the sharing of poetry and subsequent discussions helped students to develop and enhance their critical thinking and clinical judgment, reasoning, and decision-making skills. This transformative pedagogical approach offers an alternative teaching strategy that can provide the basis for meaningful discussion and bridge the theory-practice gap.

Professional competence required in advanced practice nursing in critical care: An exploratory qualitative study.

To identify the required competencies of advanced practice nurses (APNs) working with patients in critical care units in Norway. An exploratory qualitative design. Four focus group interviews were performed with 18 nurses who worked in critical care units. The data were examined by inductive content analysis following Graneheim and Lundman's approach. Our study found that APNs in critical care require the following professional competencies to meet the needs of patients characterised by greater age, comorbidities and increased complexity: (1) intrapersonal skills as revealed in the subthemes of self-awareness; motivation and commitment; strong mental health and upholding ethical standards, (2) advanced clinical decision-making skills as identified in the subthemes of integration of theory and practice; complex practical and technical skills; dealing with increased delegated responsibility and taking the lead in managing increased practice complexity and (3) interpersonal skills, including peer guidance, practising collaboratively and the ability to position oneself.

Translating Clinical Decision-Making Skills From a Critical Care Pharmacy Elective to the Required Curriculum

ObjectiveTo examine the impact of a critical care pharmacy elective (CCPE) on student performance in other courses in the Doctor of Pharmacy curriculum that emphasize clinical reasoning and decision making. MethodsThis is a retrospective, cohort study including all students from the 2019–2021 graduating classes enrolled in required courses, Pharmacotherapy and Integrated Patient Cases (IPCs). Students were divided for comparison based on completion of the CCPE. The primary outcome was outstanding performance, defined by a final course grade ≥90%, in Pharmacotherapy and IPC. Baseline characteristics and outcomes were analyzed using descriptive statistics and the χ2 test or two-sided t test for categorical and continuous variables, respectively. Binary logistic regression models were constructed to identify variables associated with the primary outcome. ResultsOf 377 students included, 129 (34%) completed the CCPE. Baseline characteristics were similar between both groups, except more females completed the CCPE. Students that completed the CCPE were not more likely to demonstrate outstanding performance in Pharmacotherapy III (20% vs 30%) or Pharmacotherapy IV (27% vs 24%), but were more likely in IPC (34% vs 23%). In the adjusted analysis, CCPE students were almost twice as likely to exhibit outstanding performance in IPC. ConclusionStudents that completed the CCPE were more likely to demonstrate outstanding performance in IPC, but not in either of the Pharmacotherapy courses. Students may benefit from practicing clinical reasoning earlier in the curriculum to build-up to effective and efficient clinical decision-making. Implications of course structure on student performance should be further explored.

CN74 The effect of nursing senior's self-efficacy on symptom management in cancer patients on clinical decision-making skills

CN74 The effect of nursing senior's self-efficacy on symptom management in cancer patients on clinical decision-making skills

A Team-based Learning Approach During Pediatric Clerkship to Promote Clinical Reasoning.

Clinical reasoning skills are essential to medical practice. The problem lies in assuming junior medical students with limited experience develop clinical reasoning and decision-making skills passively and solely through clinical exposure. To prepare learners for independent practice and care for future patients, explicit teaching and assessment of clinical reasoning in low-stakes, collaborative learning environments are needed. The key-feature question (KFQs) format is an assessment approach that focuses on the reasoning and decision-making aspects of medical problems rather than knowledge recall. This report describes the development, implementation, and evaluation of a team-based learning (TBL) approach using KFQs to foster clinical reasoning in the third-year pediatric clerkship at our institution. Over the first 2 years of implementation (2017-18, 2018-19), 278 students participated in TBL sessions. Mean individual student scores significantly improved in the group setting for both academic years (P<.001). Individual scores were moderately positively correlated with their total summative Objective Structured Clinical Examination score (r[275]=0.51; P<.001). The correlation between individual score and their multiple-choice question examination was weaker at 0.29 (P<.001) but remained positive. A TBL session using KFQs to both teach and assess clinical reasoning in clerkship students may help educators identify students with gaps in knowledge and/or reasoning. The next steps include developing and implementing individualized coaching opportunities, and expanding this approach within the undergraduate medical curriculum. Outcome measures to assess clinical reasoning in authentic patient encounters require further research and development.

ChatGPT in Medical Education and Research: A Boon or a Bane?

Science fiction literature and films no longer focus on artificial intelligence. In contrast to all other aspects of life, medical education and clinical patient care have been progressing slowly. Recently, a lot of text from the internet was used to construct and train chatbots, especially ChatGPT. The language model ChatGPT, created by OpenAI, has emerged as a useful resource for medical research and education. It has proven to be a useful tool for researchers, students, and medical professionals because of its capacity to produce human-like answers to challenging medical queries. However, using ChatGPT also has significant drawbacks. The possibility of erroneous or biased information being spread, which could have negative effects on patient care, is one of the key worries. Moreover, the overreliance on technology in medical education could also lead to a decline in critical thinking and clinical decision-making skills. Overall, ChatGPT has the potential to be a boon to medical education and research, but its use must be accompanied by caution and critical evaluation.

Perceptions of Pharmacy Students on the Application of Problem-based Learning Approach in Renal Pharmacotherapeutics

The millennial pharmacists are often concerned with solving problems related to a patient’s health, and achievement of desired therapeutic goals that improve the patient quality of life in the practice of their profession. In Indian pharmacy education, there is very little research on problem-based learning. The current study was performed to investigate pharmacy practice student experiences towards problem-based learning in pharmacotherapeutics in south India. The current exploratory research aimed to assess the perception of pharmacy practice students towards pharmacotherapeutic course for renal diseases through small group problem-based pedagogy, and its end assessment of understanding through a 20 inventories objective structured clinical examination reflecting each case study. On a microscopic observation, student awareness of therapeutic courses in the renal disease has been considered more satisfied. Student reactions show that they find PBL sessions beneficial in their learning, and helping them understand basic scientific concepts. In addition, students reported that PBL session encouraged collaborative and self-directed learning, improved clinical decision-making and problem-solving skills, and helped them identify their strengths and weaknesses in the process of this program. In conclusion, the problem-based pedagogy of pharmacotherapeutic course for renal diseases gained a great momentum among pharmacy practice students and appraised objective structured clinical examination as an efficient tool for PBL assessment.

The Effect of Expert Patient Simulation on Clinical Judgment: A Quasi-Experimental Study.

Worldwide, quality education is one of the important tools to improve healthcare quality. Healthcare practitioners must be competent in their clinical judgement to meet clients' need. However, poor clinical judgment skill accounts for almost one-third of all patient problems in health care. Expert patient simulation has been used as a training method for clinical judgement skill. However, according to empirical studies, using expert patients to develop clinical judgement skill is unclear. The method is effective in one situation but not in another. To examine the effect of expert patient simulation on the clinical judgment skill of health science students of Mizan-Tepi University. A pre-test/post-test quasi-experimental design was used on 92 randomly selected samples from the graduating cohort of midwifery students. The research subjects who took part in the experiment were picked at random. Tools included the Creighton Competency Evaluation Instrument (C-CEI®), the Learning Satisfaction and Self-Confidence Questionnaire, and the Kolb Learning Style Inventory (LSI). The Wilcoxon-signed rank test was utilized to compare the self-confidence scores among intervention and control group of students, and the paired sample test was used to compare clinical judgment scores. Cohen's d was used to assess the effect size, and Spearman correlation was used to explore the association. Clinical decision-making ability and self-confidence measures revealed statistical and practical differences between before and after simulation. There was a mean difference of 2.28 (95% CI, 1.78, 2.79), t (45)=9.13, p 0.001, and an effect size of 1.3, p 0.001. A pre-and post-simulation self-confidence measure showed statistically significant improvement after simulation (W = 1, Z = -3.57, P 0.001). A moderately significant positive connection (r = 0.419, p 0.004) was also discovered. The study found that human expert patient simulation is a tremendous clinical training technique for improving students' clinical decision-making skill competency and self-confidence.

Reviewing the current state of virtual reality integration in medical education – a scoping review protocol

BackgroundDue to an increasing focus of medical curricula on clinical decision-making skills, new learning tools are constantly developed. Virtual reality (VR) is one of the emerging technologies with the potential to improve health professionals’ education. Highly realistic learning experiences with repeatable training scenarios can be created within a protected environment that is independent from real patients' presence. Our project “medical tr.AI.ning” is following this approach aiming to simulate immersive virtual first-person scenarios with intelligent, interactable virtual patients. So far, VR has been mainly used in surgical training, but there is evidence for effectiveness in training different procedural skills, such as cardiopulmonary resuscitation, knowledge acquisition, and improvement of reasoning and creativity, while still being cost-effective.The objective of this scoping review is to explore the usage and identify key areas of VR applications in the field of medical education. Furthermore, the corresponding requirements, evaluation methods and outcomes, advantages, and disadvantages will be covered.MethodsThis scoping review protocol implements the updated JBI Scoping Review Methodology. In March 2022, a preliminary literature research in PubMed was performed by two independent reviewers to refine search terms and strategy as well as inclusion criteria of the protocol, accounting for actuality and scientific relevance. The final search will be conducted using PubMed, ScienceDirect, Cochrane Library, Web of Science Core Collection, and JBI Evidence Synthesis. Search, study screening, and data extraction will be done in parallel and independently by two reviewers. Discrepancies will be handled by consensus or consulting a third review author.DiscussionWith this scoping review, we anticipate collating the range of application of VR in medical education while using a transparent and reproducible search strategy. This may contribute to the design and development of novel educational VR platforms and their integration into medical curricula while pointing out previous omissions and pitfalls.