Clinical Sessions Research Articles

Integration of a Digital Health Intervention Into Immunization Clinic Workflows in Kenya: Qualitative, Realist Evaluation of Technology Usability.

In an effort to increase vaccination coverage in low-resource settings, digital tools have been introduced to better track immunization records, improve data management practices, and provide improved access to vaccination coverage data for decision-making. Despite the potential of these electronic systems to improve the provision of health services, few digital health interventions have been institutionalized at scale in low- and middle-income countries. In this paper, we aimed to describe how health care workers in Kenya had integrated an electronic immunization registry into their immunization clinic workflows and to use these findings to inform the development of a refined program theory on the registry's usability. Informed by realist methodology, we developed a program theory to explain usability of the electronic immunization registry. We designed a qualitative study based on our theory to describe the barriers and facilitators influencing data entry and use. Qualitative data were collected through semistructured interviews with users and workflow observations of immunization clinic sessions. Our findings were summarized by context-mechanism-outcome relationships formed after analyzing our key themes across interviews and workflow observations. Using these relationships, we were able to identify common rules for future implementers. Across the 12 facilities included in our study, 19 health care workers were interviewed, and 58 workflow sessions were observed. The common rules developed from our qualitative findings are as follows: rule 1-ensure that the users complete training to build familiarity with the system, understand the value of the system and data, and know where to find support; rule 2-confirm that the system captures all data needed for users to provide routine health care services and is easy to navigate; rule 3-identify work-arounds for poor network, system performance, and too few staff or resources; and rule 4-make users aware of expected changes to their workflow, and how these changes might differ over time and by facility size or number of patients. Upon study completion, we revised the program theory to reflect the importance of the goals and workflows of electronic immunization registries aligning with reality. We created a deeper understanding of the underlying mechanisms for usability of the registry. We found that the electronic immunization registry had high acceptability among users; however, there were numerous barriers to using the system, even under ideal conditions, causing a misalignment between the system and the reality of the users' workflows and their environment. Human-centered design and human-factors methods can assist during pilot stages to better align systems with users' needs and again after scale-up to ensure that interventions are suitable for all user settings.

Emotion recognition in doctor-patient interactions from real-world clinical video database: Initial development of artificial empathy

Background and objectiveThe promising use of artificial intelligence (AI) to emulate human empathy may help a physician engage with a more empathic doctor-patient relationship. This study demonstrates the application of artificial empathy based on facial emotion recognition to evaluate doctor-patient relationships in clinical practice. MethodsA prospective study used recorded video data of doctor-patient clinical encounters in dermatology outpatient clinics, Taipei Municipal Wanfang Hospital, and Taipei Medical University Hospital collected from March to December 2019. Two cameras recorded the facial expressions of four doctors and 348 adult patients during regular clinical practice. Facial emotion recognition was used to analyze the basic emotions of doctors and patients with a temporal resolution of 1 second. In addition, a physician-patient satisfaction questionnaire was administered after each clinical session, and two standard patients gave impartial feedback to avoid bias. ResultsData from 326 clinical session videos showed that (1) Doctors expressed more emotions than patients (t [326] > = 2.998, p < = 0.003), including anger, happiness, disgust, and sadness; the only emotion that patients showed more than doctors was surprise (t [326] = -4.428, p < .001) (p < .001). (2) Patients felt happier during the latter half of the session (t [326] = -2.860, p = .005), indicating a good doctor-patient relationship. ConclusionsArtificial empathy can offer objective observations on how doctors' and patients' emotions change. With the ability to detect emotions in 3/4 view and profile images, artificial empathy could be an accessible evaluation tool to study doctor-patient relationships in practical clinical settings.

Improving Oral Presentation Skills for Radiology Residents through Clinical Session Meetings in the Virtual World Second Life.

The objective of this study was to conduct a clinical session meeting in the virtual world of Second Life to improve the oral presentation skills of radiology residents and to assess the perception of the attendees. A clinical session meeting (10 two-hour sessions over four weeks), where participants presented their own clinical sessions, followed by a turn of interventions by the attendees, was designed and carried out. Attendees were asked to complete an evaluation questionnaire. Descriptive statistics were performed. Twenty-eight radiology residents attended the meeting, and 23 (81.2%) completed the evaluation questionnaire; 95.7-100% of them agreed that the virtual environment was attractive and suitable for holding the meeting and that the content was appropriate for their training as residents. They rated with ≥8.9 points (from 1 to 10) different aspects of the experience, highlighting the role of teachers (9.7 ± 0.6) and the usefulness of their training (9.4 ± 0.9). Second Life can be used effectively to train oral communication skills in public, in an environment perceived as attractive and suitable for learning, through an experience described by the attendees as interesting and useful, highlighting the advantages of social contact with their peers.

The gaps in undergraduate medical education due to the ongoing pandemic: An experience from a private medical college in Kerala.

The Covid-19 pandemic affected undergraduate medical education worldwide. By March 2020, colleges in India had to close following a national lockdown. Most of the colleges including ours started using e-platforms. Our earlier studies highlighted concern for lack of patient examination in clinical settings and successes of the online teaching programmes were limited to didactic teaching. The year 2020 also was the year in which the National Medical Commission (NMC) introduced a competency-based system, which was new to all stakeholders. We assessed the impact of Covid-19 on the ongoing teaching pattern in our institute. Actual coverage of theory classes and practical/clinical teaching sessions were gathered from departments across all years of undergraduate medical education and the gap percentage was calculated against the NMC/ Medical Council of India requirements. The gap percentage was calculated as missing classes divided by required classes multiplied by hundred. The heads of departments were consulted, and details of theory, practical and clinical classes taken for each batch before and after lockdown were gathered using a questionnaire. These were compared against the mandated teaching by the NMC guideline for theory, practical and clinics. The results showed a gap ranging from 2% to 83% for theory classes, the least being in anatomy and the highest being in medicine. As there were no practical or clinical sessions during the lockdown, the gap was zero. Various challenges were faced due to online medical education. There was a dilemma over choosing the type of training that would produce adequate numbers with low quality or a delayed training but of assured quality. Various solutions including suspending the ongoing course and converting it to short-term skill training sessions to deal with pandemic care and strategies to improve online teaching were considered.

Computer-Guided Osteotomy with Simultaneous Implant Placement and Immediately Loaded Full-Arch Fixed Restoration: A Case Report

Aim: This case report aims to illustrate a clinical protocol that allows for the rehabilitation of patients requiring extensive osteotomy, simultaneous implant placement, and full-arch, screwed-in prosthetics in one session. This protocol allows for the improvement of the aesthetics and functionality of the fixed implant-supported prosthesis through the preoperative planning of all surgical procedures, including osteotomy, and of the prosthesis through the application of 3D-printing technology for the creation of surgical templates and prostheses. Methods: This case report concerns a 72-year-old patient, ASA1, who, following diagnosis, the establishment of a treatment plan, and the provision of informed consent, opted for an immediate, full-arch rehabilitation of the lower arch. The digital planning stage started with the correct positioning of the fixtures. The proper bone levels were found and used to guide the creation of the provisional screwed-in prothesis. Two templates with the same supports (landmarks/pins) were then 3D-printed: a positioning template, including a slit to assist the surgeon during the osteotomy, and a surgery template to assist the surgeon during the implants’ positioning. A screwed-in prosthesis encased in resin C&amp;B MFH (NEXTDENT®, Soesterberg, The Netherlands) was delivered. Minimal occlusal adjustments were performed. Results: In a single clinical session, through careful planning and the pre-operative 3D printing of a prosthesis, a temporary implant-supported prosthetic rehabilitation was possible in a case that required an extended osteotomy. Clinically, the correspondence between the virtual design phase and the final realization was consistent. At a functional level, the provisional prosthesis required minimal occlusal adjustments and the DVO values obtained in the immediate post-operative period were found to be comparable to those of the virtual design. By planning the final position of the bone and the implants in advance, it was possible to deliver a full-arch prothesis with proper implant emergence, occlusal vertical dimensions, and occlusal relationship. Conclusion: This fully digital protocol allows the clinician to preview and plan the osteotomy and implant surgery as well as the delivery of the temporary, immediately loaded, complete, fixed prosthesis in patients who are candidates for post-extraction surgery with the need for severe osteotomy.

WiFi-Based Detection of Human Subtle Motion for Health Applications

Neurodegenerative diseases such as Parkinson's disease affect motor symptoms with abnormally increased or reduced movements. Symptoms such as tremor and hand movement disorders can be subtle and vary daily such that the actual condition of the disease may not fully present in clinical sessions. Health examination and monitoring, if available in the living space, can capture comprehensive and quantitative information about a patient's motor symptoms, allowing physicians to make a precise diagnosis and devise a more personalized treatment. WiFi-based sensing is a potential solution for passively detecting human motion in a contactless way that collects no personally identifiable information. This study proposed an approach for human micromotion detection using the WiFi channel state information, which can be realized in a regular-sized room for home health monitoring and examination. Three types of motion were tested to evaluate the proposed method in quantifying micromotion using single and multiple WiFi links. The results show that micromotion could be captured at all distributed locations in the experimental environment (4.2 m × 7.9 m). Our computer algorithm computed the frequency and duration of simulated hand tremors with an average accuracy of 90.9% (single WiFi link)-95.7% (multiple WiFi links).

Integration of e-learning approaches in a post-pandemic learning environment – Norwegian nursing students’ recommendations from an action research study

The covid-19 pandemic has profoundly led to changes in use of digital platforms, online teaching, and e-learning strategies. The aim of the present study was to examine how future pedagogical approaches can promote constructive learning environments and facilitate nursing students learning processes in future post-pandemic scenarios based on an action research study, which were conducted through several steps from January 2021 through January 2022 in a Bachelor of Nursing program at UiT the Arctic University of Norway. Students from the 2020 enrollment were invited to focus group interviews in March 2021. The interviews were transcribed, and content analyzed, resulting in concrete advice, which were implemented for the next enrollment. Students from the 2021 enrollment were invited to similar focus groups, resulting in refined advice, which will be presented. The pandemic situation resulted in extensive use of digital platforms for the 2020 enrollment. Students from this cohort described shock and disappointment connected to their study start. They expected a new life, meeting new friends and to develop a student identity, but their expectations were broken. The loss of social connections led to isolation and a weak link to the program and to the nursing profession. They recommended integrated training of theoretical and practical skills in small groups combined with short, well-prepared digital lectures equivalent to “flipped classroom” approaches. Implementing their advice, the 2021 enrollment's experience became different. This group was prepared for extensive use of digital platforms and gave future advise on increased flexibility and balance between the various learning activities centered around the clinical sessions. Based on these experiences during the pandemic, we suggest that digital platforms and e-learning strategies facilitate nursing students learning in combination with active and social learning environments.

Hearing Aid User Perspectives: Reasons and Recommendations for Prescription and Over-The-Counter Device Uptake

Hearing Aid User Perspectives: Reasons and Recommendations for Prescription and Over-The-Counter Device Uptake

Clinical Judgment Development and Assessment in Clinical Nursing Education.

There is a gap in evidence for effective clinical teaching strategies to promote nursing students' development of clinical judgment (CJ). This study examined the effect of active learning strategies (ALSs) during clinical postconference sessions on the CJ of undergraduate nursing students. This quasi-experimental study of ALSs or standard postconferences used the Lasater Clinical Judgment Rubric (LCJR) to rate CJ at 3 time points. All faculty members and students were trained on use of the LCJR. Ratings were done by both faculty and students. All ratings of CJ improved over time ( P < .001). Ratings of CJ varied between the control and intervention groups. The findings of this study contribute to knowledge regarding the effectiveness of clinical teaching strategies for CJ and preparation for entry to nursing practice.

At-risk mental states and personality traits: A cluster analysis approach on a group of help-seeking young adults.

Research on the relationship between personality and psychosis onset is growing, with the goal of preventing or intervening early in patients' vulnerability. The identification of individuals with at-risk mental states has enabled the development of early intervention strategies, such as Programma 2000, a youth mental health service that was implemented in Milan (Italy). Focusing on the 18-25 age range-the time window with the highest incidence of psychotic onset-this study aims to identify the personality traits that may characterize the at-risk mental states and the social functioning of a group of help-seeking young adults. The sample includes 169 people (48.5% males and 51.5% females). Data were collected during an initial assessment that comprised the Social and Occupational Functioning Assessment Scale, the Personality Inventory for DSM-5, the Checklist ERIraos and a clinical session. Results identified a three-cluster solution based on the Checklist scores: Cluster 1 'Not at psychotic risk'; Cluster 2 'At intermediate risk'; Cluster 3 'With psychotic onset'. The multivariate analysis of the variance of personality traits shows significant differences among the clusters in negative affect, detachment and disinhibition. Higher scores in these traits may distinguish individuals, not at psychotic risk from those at intermediate risk or with psychotic onset. Moreover, social functioning was found to be negatively associated with clusters of psychotic risk. Findings from this study highlighted the need to evaluate personalized interventions targeting such personality traits that could prevent psychotic transition and promote psychological well-being.

코로나 감염상황아래 간호학생의 병행수업(비대면/대면) 경험에 대한 인식

Objectives The purpose of this study is to explore the perception of online theoretical classes, online clinical practice and clinical practice conducted in hybrid(online/offline) learning of nursing students during the COVID-19 pandemic. The qualitative study was conducted to gain insight into students’ learning experiences. It is also to provide data for teaching and learning methods suitable for the new environment.&#x0D; Methods 553 statements were collected from 83 nursing students who experienced both online theoretical classes and clinical practice and offline clinical practice. The collected data were analyzed by the proposed domain analysis by Spradley(1980) and Newing et al.(2011). The meaningful experience or attributes of the statement were selected as the subject. While identifying the subject as a similar concept, the domain was constructed by categorizing statements. By confirming the relationship with the concept, the classification system was composed of major domain, middle domain, and minor domain.&#x0D; Results The data analysis results consisted of 6 major domain, 55 middle domain, and 70 minor domain. The major domain of nursing students' perception of online theoretical classes are ‘the harmony between unfamiliarity and recency’ and ‘growing pains of learning alone’. The major domain of nursing students' perception of online clinical practice are ‘diversification of ontact learning’ and ‘insecure learning journey’. The major domain of nursing students' perception of clinical practice are ‘valuing of experience’ and ‘difficulty of field sensitivity’.&#x0D; Conclusions Online classes need to be designed to be realistic and stimulate interactions. Learners are required to develop self-management skills and efforts to manage students’ stress levels in clinical practice sessions need to be continued.

Senior academics’ perceptions of undergraduate prosthodontics curriculum and teaching: a qualitative study

Introduction: Divergence in undergraduate teaching methods in prosthodontics is widely reported, and this could impact on graduate dentists’ competence and affect patient safety. Objectives: To explore the perspectives held by senior dental academics worldwide regarding the undergraduate prosthodontics curriculum, teaching and assessment methods, and teaching staff profile. Materials and methods: Twelve senior dental academics from seven countries participated in semi-structured interviews exploring their perspectives and opinions of the undergraduate prosthodontics curriculum, and current and best teaching and assessment methods. Interviews were undertaken virtually, video-recorded and auto-transcribed. Semantic thematic analysis was used for data analysis. Results: Academic professors, consultants and specialists were considered the most suitable staff members to supervise students during preclinical hands-on sessions due to their experience level. Additionally, participants mentioned the availability of suitable patients for treatment, dental schools’ curricula, and the level of students’ skills as factors influencing the start of clinical sessions in fixed prosthodontics. The course contents and the extent of teaching on dental implants were different between schools. Tailoring the curriculum according to what is expected from the graduating dentists and allowing students to observe dental implant cases before dealing with simple cases were suggestions made by the participants, to include an implant course at undergraduate level. Conclusions: Despite some differences in opinions and current practices in different institutions, barriers to the implementation of an ideal curriculum seemed to be similar in the different institutions. This study provided deeper understanding of the current divergence in prosthodontics teaching, which would allow for future improvement in the dental curriculum.

The exploration of maternal representations during a parenthood-centred psychotherapy from pregnancy to one year postpartum

ABSTRACT Maternal representations play a key role in intrapsychic conflicts relating to accession to parenthood and in the formation of the mother–baby bond. Around the birth of the child, the shadows of past objects are cast on the baby and the parent's self-image. Mother–baby psychoanalytic psychotherapy helps us to understand internal conflicts that tend to interfere with the mother's representations of her child or of herself as a mother, as well as aiming to reduce the risk of difficulties for the child. Through a clinical case, this article explores the development of maternal representations in a course of parenthood-centred psychotherapy that begins during pregnancy and ends 11 months after the baby's birth. The psychic change carried out by the mother frees the mother–baby bond from the projections of the past. Excerpts from clinical sessions illustrate mother–baby interactions during the session, the projection of the mother's internal objects on to the baby, and the elaboration and reintrojection of the mother's internal conflicts. Changes in the mother's representations were measured both qualitatively and quantitatively using the ‘R’ interview, which allows various dimensions of these representations to be measured on a Likert scale.

Stop the Divide: Facilitators and Barriers to Uptake of Digital Health Interventions Among Socially Disadvantaged Populations

Background: The coronavirus disease 2019 pandemic ushered in rapid adoption of telehealth services. This study examines patient and provider experience and provides recommendations for facilitating the use of digital health interventions among socially disadvantaged populations. Methods: This qualitative study was conducted from May to July 2021 via semistructured interviews. Forty patients and 30 primary care providers (PCPs) in Louisiana were recruited within an integrated delivery health system and a rural health center. Technology acceptance models were used to develop a thematic coding scheme. Results: Most patients self-identified as Black (67.5%) and female (72.5%), had a mean age of 51 years, lived in an urban area (76.9%), and had Medicaid (57.9%). Most PCPs were White (79.3%) and male (51.7%), had a mean age of 39 years, and reported Medicaid as the predominant insurer (58.6%). Patient use of smartphones for internet access to health and nonhealth activities was common. PCPs noted the need to address misinformation or misinterpretation of information on the internet. Most patients had used a patient portal (72.5%) and noted the convenience of messaging. PCPs reported large increases in messaging workloads. Most patients had had telemedicine visits (65.6%); however, Wi-Fi/broadband problems limited video visits. PCPs expressed concerns regarding the types of chief complaints that are appropriate for telemedicine visits and reported workflow inefficiencies when clinic sessions had mixed visit types. Patients and PCPs valued remote telemonitoring as adjuncts to care; however, limited service availability and insurance coverage were barriers. Conclusion: Infrastructure barriers (broadband, insurance) and workload imbalance temper enthusiasm for using digital health solutions. Health systems should implement complementary patient and provider user-centric strategies for facilitating uptake of technology.

Time of Clinic Appointment and Serious Illness Communication in Oncology.

Serious illness communication in oncology increases goal concordant care. Factors associated with the frequency of serious illness conversations are not well understood. Given prior evidence of the association between suboptimal decision-making and clinic time, we aimed to investigate the relationship between appointment time and the likelihood of serious illness conversations in oncology. We conducted a retrospective study of electronic health record data from 55 367 patient encounters between June 2019 to April 2020, using generalized estimating equations to model the likelihood of a serious illness conversation across clinic time. Documentation rate decreased from 2.1 to 1.5% in the morning clinic session (8am-12pm) and from 1.2% to .9% in the afternoon clinic session (1pm-4pm). Adjusted odds ratios for Serious illness conversations documentation rates were significantly lower for all hours of each session after the earliest hour (adjusted odds ratios .91 [95% CI, .84-.97], P = .006 for overall linear trend). Serious illness conversations between oncologists and patients decrease considerably through the clinic day, and proactive strategies to avoid missed conversations should be investigated.

Association between sport participation and knee symptoms: a cross-sectional study among undergraduate medical students at King Abdulaziz University

Background: The engagement of university students in sports activities was associated with sports injuries involving the knee. The present study aimed at evaluating the association between sports involvement and knee symptoms and other risk factors in King Abdulaziz University Medical students. Methods: A cross-sectional study was done on 358 undergraduate medical students at King Abdul-Aziz University, Jeddah, Saudi Arabia, from the second to the sixth academic years. A pre-designed questionnaire was used to collect data about participants&amp;apos; demographics, body mass index, smoking, coffee intake, academic activities, smartphone, Internet, computer use, type of school bag, work surface, part-time job, sports activities, and its types were added. Data about musculoskeletal disorders (MSDs) in the knee and other body parts and their patterns and practicing of sports were collected. Results: The prevalence of life experience of musculoskeletal in the knee was 35.5%. While 27.4% experienced it in the last 12 months, and 16.2% experienced it in the previous week. Of the participants, 9.8% were currently experiencing MSDs in the knee. The mean pain intensity of those with musculoskeletal disease was 5.44 ± 1.8, with 8.7% skipping school because of their MSD and 50.8% souk medical advice. Ex-smokers, those with a lower mean of hours per week of engagement in clinical sessions, who were playing fitness sports, and who experienced MSDs in other body parts had a significantly higher percentage of having a history of knee symptoms. Conclusion: Health education programs about the relationship between knee disorders and sports and other risk factors should be directed to university students.

Patient and Clinician Experiences With the Combination of Virtual and In-Person Chronic Kidney Disease Care Since the COVID-19 Pandemic.

Following onset of the COVID-19 pandemic, chronic kidney disease (CKD) clinics in BC shifted from established methods of mostly in-person care delivery to virtual care (VC) and thereafter a hybrid of the two. To determine strengths, weaknesses, quality-of-care delivery, and key considerations associated with VC usage to inform optimal way(s) of integrating virtual and traditional methods of care delivery in multidisciplinary kidney clinics. Qualitative evaluation. British Columbia, Canada. Patients and health care providers associated with multidisciplinary kidney care clinics. Development and delivery of semi-structured interviews of patients and health care providers. 11 patients and/or caregivers and 12 health care providers participated in the interviews. Participants reported mixed experiences with VC usage. All participants foresaw a future where both VC and in-person care was offered. A reported benefit of VC was convenience for patients. Challenges identified with VC included difficulty establishing new therapeutic relationships, and variable of abilities of both patients and health care providers to engage and communicate in a virtual format. Participants noted a preference for in-person care for more complex situations. Four themes were identified as considerations when selecting between in-person and VC: person's nonmedical context, support available, clinical parameters and tasks to be completed, and clinic operations. Participants indicated that visit modality selection is an individualized and ongoing process involving the patient and their preferences which may change over time. Health care provider participants noted that new workflow challenges were created when using both VC and in-person care in the same clinic session. Limited sample size in the setting of one-on-one interviews and use of convenience sampling which may result in missing perspectives, including those already facing challenges accessing care who could potentially be most disadvantaged by implementation of VC. A list of key considerations, aligned with quality care delivery was identified for health care providers and programs to consider as they continue to utilize VC and refine how best to use different visit modalities in different patient and clinical situations. Further work will be needed to validate these findings and evaluate clinical outcomes with the combination of virtual and traditional modes of care delivery. Not registered.

Exploring internship nursing students' experiences regarding the effect of supervision model implementation on medication safety: A descriptive qualitative study.

Medication safety is one of the main aspects of safe care in the nursing profession, which leads to increasing patient safety and preventing medication errors. Clinical supervision is an integral part of nursing education that leads to the professional and social development of nursing students. This study was designed with the aim of revealing the experiences of nursing internship students from the implementation of the clinical supervision model on medication safety. This descriptive qualitative study was done in 2022. The participants were selected from nursing internship students (Last year undergraduate) of Isfahan University of Medical Sciences, Isfahan, Iran. Participants in this study were 15 nursing internship students selected using a purposeful sampling method. Data were collected using in-depth semi-structured interviews. The qualitative content analysis approach was used for data analysis. After analyzing the data, four categories, "promotion medication safety competence and knowledge," "development trust and respect climate," "outcome of feedback," and "role of clinical supervisor," and 10 subcategories were extracted from the participants' experiences. The implementation of the clinical supervision model led to an increase in the competence of nursing internship students in medication safety. The students believed that this educational method made them follow the principles of medication safety administration. The feedback provided in the clinical supervision sessions made students think about their clinical activities, understand the reason for their mistakes, and use the reliable nursing resources introduced by the supervisor to improve their performance.

Digital Technologies Easing the Learning Curve in the Transition to Practicum

Aim/Purpose: This study aims to explore the value of utilizing non-immersive virtual reality (VR) to create virtual learning environments (VLEs) to support and prepare optometry students in their transition into preclinical and clinical teaching spaces. Background: Digital education is widely integrated into university curricula with the use of online simulators, immersive VR, and other digital technologies to support student learning. This study focuses on non-immersive VR as an accessible and low-friction means of accessing VLEs to reduce students’ learning burden. Methodology: Current optometry students were invited to explore 360° 3D panoramic virtual learning environments of preclinical and clinical teaching spaces. Students were recruited to participate in an online Qualtrics survey and individual semi-structured interviews. Quantitative data was analyzed, and thematic analysis was conducted on qualitative data from students’ responses to identify key takeaways on the accessibility and impact of VLEs on students’ learning. Contribution: Non-immersive VR has utility in alleviating student stress and helping transition students into practicum. The VLEs have the means to supplement the curriculum to provide support to students entering the preclinical and clinical teaching spaces. Findings: Students engaged voluntarily with the novel VLEs and utilized the resources to help familiarize themselves with the preclinical and clinical teaching spaces. The open-access resource supported students in their preparation for practical learning and helped to reduce self-reported stress and build confidence prior to entering practical classes. Many of the students enjoyed the experience of navigating through the spaces, which helped to appease their curiosity and reduce the learning curve associated with entering new spaces. The VLEs did not replace attending practical spaces but rather were supportive learning resources that aided students due to limited face-to-face contact hours. For students with existing familiarity with the spaces, through their in-person attendance in pre-clinical and clinical teaching sessions prior to accessing the VLEs, the digital resources were not as beneficial compared to students who were still transitioning into practicum. Recommendations for Practitioners: Introductory digital resources like non-immersive VR are accessible platforms that help to orient and familiarize students with new environments. VLEs can potentially help to relieve student stress and reduce the learning load associated with entering practicum or new learning spaces. Recommendation for Researchers: More work needs to be done on how student preparation can translate to feeling less stressed and more confident in relation to transitioning from traditional learning environments to practical learning spaces. Impact on Society: A broader application of non-immersive VR can be implemented as an introductory learning preparation tool across different disciplines to alleviate student stress and maximize the limited time in practicum to allow focus on learning outcomes and practical skills. Future Research: Future studies should consider different cohorts to study, with a focus on objective measures of engagement with VLEs. The effect of VLEs on students’ cognitive load should be assessed and assessment of self-perceived stress can be evaluated with instruments such as Cohen’s Perceived Stress Scale.

The Suicidal Patient in the Emergency Department Team-Based Learning Activity.

Emergency medicine resident physicians, (PGY1-4), medical students rotating in the emergency department. Emergency physicians have a duty to recognize and provide care for patients who attempt to harm themselves or commit suicide. Mental health-related chief complaints account for 12.5% of emergency department (ED) visits.1 Additionally, patients with depressive symptoms who are discharged from the ED are at the highest risk for suicidal thoughts and behaviors.1 Therefore, evaluating and screening for suicide and determining appropriate dispositions for this patient population is extremely important. This team-based learning (TBL) activity will help prepare residents and medical students to evaluate, recognize, and disposition this at-risk patient population. By the end of the session, participants will be able to: 1) describe risk factors for suicide; 2) summarize the emergency physician's role in assessing patients with psychiatric emergencies; 3) assess a patient using a mental status evaluation; 4) identify the criteria for involuntary psychiatric hold placement; 5) develop a safe discharge plan for patients experiencing depression; and 6) Formulate a plan for evaluating a suicidal patient who is acutely intoxicated. This team-based learning activity is a classic TBL that includes learner responsible content (LRC), an individual readiness assessment test (iRAT), a multiple choice group readiness assessment test (gRAT) with immediate feedback assessment technique (IF/AT), and a group application exercise (GAE). A post-TBL survey was provided to each participant. A Likert scale was used for the survey questions to assess the relevance of the session to emergency medicine practice, learner perception of knowledge gained, learner perception of improvement of clinical practice, session engagement, and session delivery. The post-activity evaluation had a response rate of 33% (11/33). Overall, all the participants "strongly agreed" (Likert 5/5) or "agreed" (Likert 4/5) that the session improved their knowledge of caring for the suicidal patient in the ED with an average score of 4.6/5. All participants "strongly agreed" (Likert 5/5) or "agreed" (Likert 4/5) that the material presented was relevant to their clinical practice in the ED for an average score of 4.6/5. Constructive feedback included requesting learner responsible content (LRC) be sent earlier than one week prior to the activity. Depression and suicidal ideation are common ED complaints. However, it can be difficult to evaluate these patients and select an appropriate disposition because their symptoms can range from benign to life-threatening. The team-based learning (TBL) session allows for discussion of the complexities of the depressed and suicidal patient. Learners found this TBL to be beneficial in providing a diagnostic pathway and treatment algorithm to manage these complex, high-risk patients. Suicide, depression, substance abuse, disposition, team-based learning.