Clinical Confidence Research Articles

Increasing Treatment Rates for Hepatitis C in Primary Care.

Despite antiviral agents that can cure the disease, many individuals with Hepatitis C Virus (HCV) remain untreated. Primary care clinicians can play an important role in HCV treatment but often feel they do not have the requisite skills. We implemented a population-based improvement intervention over 10 months to support treatment of HCV in a primary care setting. The intervention included a decision-support tool, education for clinicians, enhanced interprofessional team supports, mentorship, and proactive patient outreach. We used process and outcome measures to understand the impact on the proportion of patients who initiated treatment and achieved Sustained Virologic Response (SVR). We used physician focus groups and pharmacist interviews to understand the context and mechanisms influencing the impact of the intervention. Between December 2018 and June 2020, the percentage of HCV RNA positive patients who started treatment rose from 66.0% (354/536) to 75.5% (401/531) with 92.5% (371/401) of those starting treatment achieving SVR. Qualitative findings highlighted that the intervention helped raise awareness and confidence among physicians for treating HCV in primary care. A collaborative team environment, education, mentorship, and a decision-support tool integrated into the electronic record were all enablers of success although patient psychosocial complexity remained a barrier to engagement in treatment. A multifaceted primary care improvement initiative increased clinician confidence and was associated with an increase in the proportion of HCV RNA positive patients who initiated curative treatment.

Off-label Use of 8-F Angio-Seal for Large-Bore Arterial Closure: Clinical Confidence from Pooled Data?

Off-label Use of 8-F Angio-Seal for Large-Bore Arterial Closure: Clinical Confidence from Pooled Data?

Escape the Monotony: Gamification Enhances Nursing Education

IntroductionCreating meaningful and engaging learning opportunities can be challenged by budgets, time, and learning management systems with limited methods of interaction. An innovative method was necessary to meet competency evaluation and continuing education needs for emergency department staff. DesignGamification and simulation techniques were combined to offer an interactive learning opportunity through an escape room format to improve engagement and knowledge retention. This educational offering was designed to enhance staff learning of trauma care and processes at emergency departments that are not designated trauma centers. OutcomesEmergency department team members completed the trauma escape room challenge, and postsurvey results demonstrated favorable ratings of new knowledge acquisition, skill competency, teamwork, and confidence when providing care for a trauma patient. DiscussionNurse educators can “escape” the monotony of passive learning by using active learning strategies including the fun of gamification to improve clinical skills and confidence.

Gambaran Tingkat Kepercayaan Diri Mahasiswa Profesi Terhadap Perawatan Gigi Tiruan Cekat

Background: Clinical experience and knowledge are important factors for determining clinician's confidence level in performing dental procedures. The success of fixed partial denture treatment is the accuracy of clinicians. Clinicians will undergo education to gain knowledge and practice skills in the treatment of fixed partial dentures. During education, dental students must feel confident in order to support the success of treatment so this must be based on the right method to avoid failure in the treatment of fixed partial dentures. Objectives: To know the confidence level of dental students when performing fixed partial dentures procedures. Methods: This research is a descriptive observational study with a cross-sectional study design. Results: 53.6% of respondents were included in the confidence category while for the level of knowledge included in the category of knowing 56.6% of respondents. The highly confident category was seen to have the highest scores on questions regarding the interpretation of anamnesis results in patients who want to have fixed partial dentures treatment and on the group of questions knowledge about the success of the fixed denture procedure. Conclusion: KBK19’s dental students are predominantly falls in the category of confidence and knowledgeable regarding fixed partial dentures procedures.

Improving the Knowledge, Skills and Confidence of Clinicians Towards Mental Health: An Educational Intervention Based on Reflective Practice

AimsMental illness-related stigma, including that which exists in the healthcare system creates serious barriers to access and quality care. People with lived experience of a mental illness commonly report feeling devalued, dismissed, and dehumanized by many of the health professionals with whom they come into contact. While working in the mental health liaison team in a local general hospital I have experienced first-hand these issues. We decided to organise regular reflective sessions for staff to reflect on what the barriers are to being able to manage patients with mental illness better on the wards, raise mental health awareness, improve staff communication skills, and offer teaching sessions to improve the staff knowledge of psychiatric pathology.MethodsBefore starting, we offered a feedback form to staff to ascertain the value of the project.To ascertain that the learning has taken place, we have delivered a post-session formative quiz to assess the staff's knowledge of managing patients with mental illness.To determine the effectiveness of the project, we decided to use Kirkpatrick's evaluation model and assess the first two levels of the programme outcome: (1) learner satisfaction- through staff feedback; (2) measures of learning- knowledge gained showed in the formative post-session quiz.ResultsThe sessions were carried out on 2 wards in the general hospital •Ward 1: 4 sessions; number of attendees: 12•Ward 2: 4 sessions; number of attendees: 5The student evaluation was done through a quiz offered to the participants at the end of each session.9 quiz questionnaires were completed on ward 1:Correct answers: Q1- 67%; Q2- 89%; Q3- 0%; Q4- 100%.5 quiz questionnaires were completed on ward 2:Correct answers: Q1- 20%; Q2- 60%; Q3- 0%; Q4- 40%.The programme evaluation was done through a feedback form offered to the participants at the end of each session.12 forms were completed on ward 1: 50% strongly agreed that the session was useful to their practice; 70% were quite confident in caring for patients with mental illness following the session.5 forms were completed on ward 2: 20% strongly agreed that the session was beneficial; 75% were quite confident in caring for patients with mental illness following the session.ConclusionDifficult to implement a culture change.Following a meeting with the stakeholders, we agreed on delivering monthly reflective sessions to the staff in their allocated “team time” where attendance is mandatory and we will also take part in a developmental teaching programme for band 5 nursing staffWe are in the process of extending our project to the Emergency department

Improved Confidence, Competence, and Knowledge in Child-Focused APN Clinicians Following Participation in Infant Motor Development Course

Improved Confidence, Competence, and Knowledge in Child-Focused APN Clinicians Following Participation in Infant Motor Development Course

The Role of Clinical Assessment in the Era of Biomarkers.

Hippocratic Medicine revolved around the three main principles of patient, disease, and physician and promoted the systematic observation of patients, rational reasoning, and interpretation of collected information. Although these remain the cardinal features of clinical assessment today, Medicine has evolved from a more physician-centered to a more patient-centered approach. Clinical assessment allows physicians to encounter, observe, evaluate, and connect with patients. This establishes the patient-physician relationship and facilitates a better understanding of the patient-disease relationship, as the ultimate goal is to diagnose, prognosticate, and treat. Biomarkers are at the core of the more disease-centered approach that is currently revolutionizing Medicine as they provide insight into the underlying disease pathomechanisms and biological changes. Genetic, biochemical, radiographic, and clinical biomarkers are currently used. Here, we define a seven-level theoretical construct for the utility of biomarkers in neurodegenerative diseases. Level 1-3 biomarkers are considered supportive of clinical assessment, capable of detecting susceptibility or risk factors, non-specific neurodegeneration or dysfunction, and/or changes at the individual level which help increase clinical diagnostic accuracy and confidence. Level 4-7 biomarkers have the potential to surpass the utility of clinical assessment through detection of early disease stages and prediction of underlying pathology. In neurodegenerative diseases, biomarkers can potentiate, but cannot substitute, clinical assessment. In this current era, aside from adding to the discovery, evaluation/validation, and implementation of more biomarkers, clinical assessment remains crucial to maintaining the personal, humanistic, and sociocultural aspects of patient care. We would argue that clinical assessment is a custom that should never go obsolete.

Pediatric Agitation in the Emergency Department: A Survey of Pediatric Emergency Care Coordinators.

Acute agitation episodes in the emergency department (ED) can be distressing for patients, families, and staff and may lead to injuries. We aim to understand availability of ED resources to care for children with acute agitation, perceived staff confidence with agitation management, barriers to use of de-escalation techniques, and desired resources to enhance care. We conducted a survey of pediatric emergency care coordinators (PECCs) in EDs in Massachusetts, Rhode Island, and Los Angeles County, California. PECCs from 63 of 102 (61.8%) EDs responded. PECCs reported that ED staff feel least confident managing agitation due to developmental delay (DD) or autism spectrum disorder (ASD) (52.4%). Few EDs had a separate space to care for children with mental health conditions (22.5%), a standardized agitation scale (9.6%), an agitation management guideline (12.9%), or agitation management training (24.2%). Modification of the environment was not perceived possible for 42% of EDs. Participants reported that a barrier to the use of the de-escalation techniques distraction and verbal de-escalation was perceived lack of effectiveness (22.6% and 22.6%, respectively). Desired resources to manage agitation included guidelines for medications (82.5%) and sample care pathways (57.1%). ED PECCs report low confidence in managing agitation due to DD or ASD and limited pediatric resources to address acute agitation. Additional pediatric-specific resources and training, especially for children with DD or ASD, are needed to increase clinician confidence in agitation management and to promote high-quality, patient-centered care. Training programs can focus on the early identification of agitation and the effective use of non-invasive de-escalation strategies.

Empowering general practitioners in dementia care: The ANTISTIGMA education intervention in Europe.

There is a well-documented lack or delay of diagnosis of dementia in all countries, including in Europe. Most general practitioners (GPs) have acquired adequate academic and scientific information about dementia but avoid using it in practice because of stigma. To persuade GPs of their role in dementia detection, an Antistigma education intervention was designed, with teaching objectives focusing on "Why" and "How" to diagnosis and manage dementia, based on ethical and practical content, as opposed to classical training centered on teaching "What", with mainly academic content. During the European Joint Action "ACT ON DEMENTIA", the Antistigma education intervention was implemented in four Universities: Lyon and Limoges (France), Sofia (Bulgaria) and Lublin (Poland). General data, including information about training and experience in dementia, was collected. Specific scales measured Dementia Negative Stereotypes DNS and Dementia Clinical Confidence D-CO before and after training. 134 GPs and 58 residents R completed the training. The participants were mainly women (74%), and the mean age was 42.8±13.2. Before training, participants expressed difficulties in defining GPs role and worries about inflicting Stigma, Risks of diagnosis, Lack of benefit and Communication difficulties. Participants' D-CO was significantly higher for Diagnosis process (64%) than for other clinical situations. After training, total NS was reduced from 34.2% to 29.9% (p<0.001), and stereotypes were improved: GPs' role (40.1% reduced to 35.9%; p<0.001), Stigma (38.7% reduced to 35.5%; p<0.001), Risks of diagnosis (39.0% reduced to 33.3%; p<0.001), Lack of Benefit (29.3% reduced to 24.6%; p<0.001) and Communication difficulties (19.9% reduced to 16.9%; p<0.001). After training, D-CO was significantly increased in all the clinical situations (p<0.001), but stayed highest for Diagnosis Process. There was no significant difference between the universities. Participants who benefited best from the Antistigma education intervention were those without training in Geriatrics and those working in nursing homes (who reduced the most D-NS), as well younger participants and those who managed less than five people living with dementia per week (who increased the most D-CO). The Antistigma program is based on the idea that most often GPs and R have acquired adequate academic and scientific information about dementia but avoid using it in practice because of stigma. These results outline the importance of addressing ethical issues and practical management situations in dementia education, to empower GPs in dementia care.

English

Lack of inter-professional collaboration and practice among Health care professionals could impede effective HIV health services delivery leading to poor health outcomes in people living with HIV. Adopting Inter-professional Education by using innovative teaching methods such as the jigsaw technique could foster collaboration among health care professional. The School of Nursing Sciences at the University of Zambia in Lusaka implemented the Strengthening Interprofessional Education for HIV project whose purpose was to integrate innovative approaches that will systematically leverage and strengthen HIV training and professional networks targeted at improving outcomes for people living with HIV. An interactive case based training workshop was conducted with 61 final year undergraduate students from different health professional disciplines at the University of Zambia and Lusaka Apex Medical University in accordance with the jigsaw technique based on cooperate learning. A pre and post-test were administered and data obtained were evaluated using descriptive statistics. From the first training, an improvement was recorded in knowledge scores from 60.5% on pretest to 81.3% on posttest, while an average of 31% improvement was recorded on clinical confidence and inter-professional education. The Jigsaw technique appears to improve knowledge and self-confidence among health care professionals in HIV care. Therefore, inter professional education using the Jigsaw technique could be promoted and in cooperated into the preservice curricular of health care professionals&nbsp; in order to have strong HIV management teams that could achieve better patient outcomes. Key words: Inter-professional Education, Impact, HIV course, Jigsaw technique.

Evidence-Based Medicine and Pharmacotherapy Content Alignment

ObjectiveWhen effectively executed, content alignment can aid student performance in associated courses. Limited research exists for content alignment of evidence-based medicine (EBM) and pharmacotherapy courses. This study assesses the impact of EBM and pharmacotherapy course alignment on student performance. MethodsContent alignment included assignment of 6 landmark trials in EBM coursework. The articles were identified by pharmacotherapy instructors as “landmark” to management of associated diseases in the aligned pharmacotherapy semester. Articles were the basis for quizzes over skills taught in the EBM course and were referenced during pharmacotherapy lectures. ResultsDuring the alignment semester, students were more likely to cite specific guidelines and/or primary literature to rationalize pharmacotherapeutic plans on examinations compared with the prealignment period (54% vs 34%). Overall, pharmacotherapy case performance and plan rationale scores were significantly higher in the alignment semester compared with prealignment. Student performance on the Assessing Competency in Evidence-Based Medicine tool improved from the start of the semester (8.64, SD 1.66) to the end (9.5, SD 1.49; mean score +0.86). Comfort in applying EBM analysis to primary literature increased significantly between the first and final assignments, with 6.7% and 71.7% of students self-reporting a high degree of confidence, respectively. Students (73%) reported an enhanced understanding of pharmacotherapy due to alignment compared with a previous semester of pharmacotherapy without alignment. ConclusionThe use of landmark trial assignments to align EBM and pharmacotherapy coursework demonstrated a positive impact on student rationale for clinical decision-making and student confidence in evaluating primary literature.

The interactive medical simulation toolkit (iMSTK): an open source platform for surgical simulation

Introduction: Human error is one of the leading causes of medical error. It is estimated that human error leads to between 250,000 and 440,000 deaths each year. Medical simulation has been shown to improve the skills and confidence of clinicians and reduce medical errors. Surgical simulation is critical for training surgeons in complicated procedures and can be particularly effective in skill retention.Methods: The interactive Medical Simulation Toolkit (iMSTK) is an open source platform with position-based dynamics, continuous collision detection, smooth particle hydrodynamics, integrated haptics, and compatibility with Unity and Unreal, among others. iMSTK provides a wide range of real-time simulation capabilities with a flexible open-source license (Apache 2.0) that encourages adoption across the research and commercial simulation communities. iMSTK uses extended position-based dynamics and an established collision and constraint implementations to model biological tissues and their interactions with medical tools and other tissues.Results: The platform demonstrates performance, that is, compatible with real-time simulation that incorporates both visualization and haptics. iMSTK has been used in a variety of virtual simulations, including for laparoscopic hiatal hernia surgery, laparoscopic cholecystectomy, osteotomy procedures, and kidney biopsy procedures.Discussion: iMSTK currently supports building simulations for a wide range of surgical scenarios. Future work includes expanding Unity support to make it easier to use and improving the speed of the computation to allow for larger scenes and finer meshes for larger surgical procedures.

Practices, knowledge, and attitudes about lithium treatment: Results of online surveys completed by clinicians and lithium-treated patients

BackgroundLithium remains the gold-standard medication for acute and prophylactic treatment of bipolar disorder. Understanding clinicians' practices and patients’ experiences, knowledge and attitudes about lithium may improve its clinical use. MethodsOnline anonymous surveys collected information about clinician's practices and level of confidence in managing lithium and patients' experiences with lithium treatment and information received about benefits and side effects. Knowledge and attitudes regarding lithium were assessed with the Lithium Knowledge Test (LKT) and the Lithium Attitudes Questionnaire (LAQ). ResultsAmong 201 clinicians, 64.2% endorsed often treating patients with lithium and reported high levels of confidence in assessing and managing lithium. Practices concerning clinical indications, drug titration, and serum levels were guideline-concordant, but compliance with monitoring recommendations was less frequent. Practitioners were interested in receiving more education about lithium. The patients’ survey recruited 219 participants with 70.3% being current lithium users. Most patients (68%) found lithium helpful and 71% reported experiencing any kind of side effect. Most responders did not receive information about side effects or other benefits of lithium. Patients with higher scores on the LKT were more likely to have positive attitudes about lithium. LimitationsCross-sectional design with predominantly English-speaking participants from Brazil and North America. ConclusionsThere is a discrepancy between guidelines, clinician confidence and knowledge of lithium use and practice. A deeper understanding of how to monitor, prevent and manage long-term side effects and which patients are most likely to benefit from lithium may narrow the gap between knowledge and use.

Getting wound care right: evaluation of a week of intensive teaching on wound care for undergraduate nursing students.

Tissue viability skills are essential for nurses, but education on this in undergraduate programmes can be inadequate. After approval of the Future Nurse curriculum in 2019, a small team of staff at the University of Salford developed a Getting Wound Care Right week to improve students' knowledge and clinical skills. To evaluate the week, the 250 students who had participated in all activities were invited 6 months after the week to contribute a 250-word reflection for a case series. The aim of this was to understand the impact of the week on participants' knowledge, skills and confidence in caring for patients with wounds and whether it had sparked interest in further learning. Four students contributed reflections, which were overwhelmingly positive. They described the knowledge attained, which included that on anatomy and physiology of the skin and wound healing, evidence-based assessment, treatment and management of wounds, and the impact of wounds on patients' quality of life. Skills gained included those in categorisation of wounds, wound assessment and pressure redistribution when seated. Responses on the impact on clinical practice focused on the importance of multidisciplinary working within wound care, seating provision for pressure ulcer prevention and management, and dressing selection. Negative comments related to students realising that clinical practice could be improved rather than indications that the format is ineffective or inappropriate. Limitations of the evaluation included the small number of participants and a lack of responses from every field of practice. The Getting Wound Care Right week format is a viable approach to meeting Future Nurse curriculum requirements. The approach could be enhanced by a greater emphasis on the relevance of wound care teaching to children and young people's nursing students. The week improved students' clinical confidence on placements when caring for patients with wounds. Further robust evaluation of the module is needed to confirm the findings of this initial evaluation.

Assessment of Bone Healing: Opportunities to Improve the Standard of Care.

➤ Bone healing is commonly evaluated by clinical examination and serial radiographic evaluation. Physicians should be mindful that personal and cultural differences in pain perception may affect the clinical examination. Radiographic assessment, even with the Radiographic Union Score, is qualitative, with limited interobserver agreement.➤ Physicians may use serial clinical and radiographical examinations to assess bone healing in most patients, but in ambiguous and complicated cases, they may require other methods to provide assistance in decision-making.➤ In complicated instances, clinically available biomarkers, ultrasound, and magnetic resonance imaging may determine initial callus development. Quantitative computed tomography and finite element analysis can estimate bone strength in later callus consolidation phases.➤ As a future direction, quantitative rigidity assessments for bone healing may help patients to return to function earlier by increasing a clinician's confidence in successful progressive healing.

564-P: The Need for Mentorship in Diabetes Is Now

Background: Mentorship for health care professionals is used to offer guidance, knowledge, and transfer experience. Clinical Dietitians (CD) play a key role in diabetes care. Offering mentorship might help build their confidence levels (CL) and grow the profession with the goal of improving outcomes and experiences for people living with diabetes (PWD). The objectives are, in CD (1) to assess the need for mentorship in diabetes and (2) to gather opinions on the structure and content for appropriate mentorship. Methods: A 28-question online survey was developed, piloted with 8 CD through cognitive interviewing, and shared with CD across the province of Quebec (Canada). Descriptive analysis was used to determine the proportions (%) in survey responses, stratified by years of clinical experience (CE). Results: From the 284 participants (97% women, mean age 31+/-10 years), 275 (97%) of CD identified a need for mentorship in diabetes. Desire to participate and in what function (mentee, mentor or both) was dependent on the years of CE. Formal mentorship was preferred by 41%, 30% informal and 29% a combination of both which was independent of the years of CE. Finally, 93.5% believe their confidence level in providing care for PWD would increase if they participated in mentorship. Conclusion: Mentorship in diabetes was perceived as needed to increase Clinical Dietitians confidence level in caring for PWD and for interprofessional collaboration. Disclosure S.Blunden: Employee; Dexcom, Inc. A.Roy-fleming: None. C.South: None. C.Gillis: None. A.Brazeau: Other Relationship; Dexcom, Inc., Diabète québec, Ordre des diététistes nutritionnistes du Québec, Research Support; Canadian Institutes of Health Research, Fonds de recherche du Québec en Santé.

Clinical and imaging modality factors impacting radiological interpretation of breast screening in young women with neurofibromatosis type 1.

Young women with Neurofibromatosis type 1 (NF1) have a high risk of developing breast cancer and poorer survival following breast cancer diagnosis. International guidelines recommend commencing breast screening between 30 and 35 years; however, the optimal screening modality is unestablished, and previous reports suggest that breast imaging may be complicated by the presence of intramammary and cutaneous neurofibromas (cNFs). The aim of this study was to explore potential barriers to implementation of breast screening for young women with NF1.Twenty-seven women (30-47 years) with NF1 completed breast screening with breast MRI, mammogram and breast ultrasound. Nineteen probably benign/suspicious lesions were detected across 14 women. Despite the presence of breast cNFs, initial biopsy rate for participants with NF1 (37%), were comparable to a BRCA pathogenic variant (PV) cohort (25%) (P = 0.311). No cancers or intramammary neurofibromas were identified. Most participants (89%) returned for second round screening.The presence of cNF did not affect clinician confidence in 3D mammogram interpretation, although increasing breast density, frequently seen in young women, impeded confidence for 2D and 3D mammogram. Moderate or marked background parenchymal enhancement on MRI was higher in the NF1 cohort (70.4%) than BRCA PV carriers (47.3%), which is an independent risk factor for breast cancer.Breast MRI was the preferred mode of screening over mammogram, as the majority (85%) with NF1 demonstrated breast density (BI-RADS 3C/4D), which hinders mammogram interpretation. For those with high breast density and high cNF breast coverage, 3D rather than 2D mammogram is preferred, if MRI is unavailable.

The Role of Self-Determined Motivation and the Potential for Pre-registration Student Learning: A Comparative Study within a Mental Health Clinical Placement

Developing therapeutic relationship skills as well as clinical skill confidence is critical for nursing students. While the nursing literature has examined multiple factors that influence student learning, little is known about the role of student motivation in skill development in non-traditional placement settings. Although therapeutic skills and clinical confidence are vital across a variety of contexts, here we focus on its development in mental health settings. The present study aimed to investigate whether the motivational profiles of nursing students varied with the learning associated with developing (1) a therapeutic relationship in mental health and (2) mental health clinical confidence. We examined students’ self-determined motivation and skill development within an immersive, work-integrated learning experience. Undergraduate nursing students (n = 279) engaged in five-day mental health clinical placement, “Recovery Camp,” as part of their studies. Data were collected via the Work Task Motivation Scale, Therapeutic Relationship Scale and the Mental Health Clinical Confidence Scale. Students were ranked into either high (top-third), moderate (mid-third) or low (bottom-third) motivation-level groups. These groups were compared for differences in Therapeutic Relationship and Mental Health Clinical Confidence scores. Students higher in motivation reported significantly higher therapeutic relationship skills (Positive Collaboration, p < .001; Emotional Difficulties, p < .01). Increased student motivation was also associated with greater clinical confidence compared to each lower-ranked motivation group (p ≤ .05). Our findings show that student motivation plays a meaningful role in pre-registration learning. Non-traditional learning environments may be uniquely placed to influence student motivation and enhance learning outcomes.

Experience and number of patients as associated factors toward clinical confidence among nursing students in caring for tuberculosis patients in Indonesia

BackgroundNurses and nursing students are at greater risk of tuberculosis (TB) exposure due to their higher intensity contact with patients. In Indonesia, a country with high TB incidence, it is crucial to assess undergraduate nursing students' clinical confidence during their clinical practicums. PurposeThis study aimed to explore factors associated with nursing students' clinical confidence in caring for TB patients. MethodsThis cross-sectional study utilized an internet survey based on the United States National TB Curriculum Consortium (NTCC) in September and November 2020. The survey questions focused on TB knowledge, beliefs about the value of TB instruction, and clinical confidence in caring for TB patients. Descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient, and hierarchical regression were used for data analysis. The Indonesian version of the original NTCC survey was used. ResultsThe study found that nursing students' knowledge about TB increased with their year of study (r = 0.290, p < .001). However, students perceived TB instruction as less valuable as they neared graduation (r = −0.233, p < .001) and with more frequent practice in the TB unit (r = −0.162, p < .001). Students who spent more time learning about TB outside of class perceived the TB instruction in the nursing curriculum more positively (r = 0.181, p < .004). The study also found a significant difference between nursing students' belief in the value of TB education and their clinical confidence in caring for TB patients (F = 5.711, p < .001). Furthermore, experience caring for TB patients and the number of TB patients cared for predicted clinical confidence. Conclusions/ImplicationsThis study highlights the need for improved curriculum content and teaching methods regarding TB for nursing students. It also suggests that experience caring for TB patients and the number of TB patients cared for can improve clinical confidence in nursing students. Given the high incidence of TB in Indonesia, this study's findings could have important implications for the country's healthcare system.

Excellence via Strategic Experiential Learning (ExSEL): A Continuous Improvement Project for Developing Clinical Reasoning and Management

BackgroundThis improvement project explored using virtual patient simulations to increase an AGANCP students’ confidence applying clinical decision-making skills. MethodsA statistical analysis compared students clinical reasoning, clinical. management, and confidence scores between clinical courses with differing pedagogies focused on case-based learning versus traditional didactics. ResultsStudents showed higher clinical reasoning scores with a virtual-patient case-base pedagogy, and higher clinical management scores using traditional didactics. Higher clinical confidence scores were more frequent within the case-based approach than the traditional pedagogy. ConclusionA well-structured educational strategy using virtual-patient cases showed effectiveness in gaining competence and confidence learning clinical decision-making.