Computer-based Learning Module Research Articles

The feasibility of e-learning as a quality improvement tool.

Many quality problems exist in health care. We aim to investigate the feasibility and acceptability of using e-learning (defined as computer-based learning modules) to address gaps in quality of care. We performed a qualitative evaluation of participants in a pilot e-learning program. Physician members of six medical teaching units (MTUs) at a multi-site tertiary care teaching hospital were asked to complete two e-learning modules addressing hand hygiene practices and management of community-acquired pneumonia (CAP). An e-learning design team created online modules that were made available to members of the six MTUs for 4 weeks using a password secured website. Use of the modules was voluntary. Participants' perceptions of module content, mode of delivery, and suggestions for improvement were determined through focus groups. We then performed content analysis on the transcripts. We used system data to define patterns of module access. Out of 55 eligible users, 30 (55%) logged onto the system at least once. Residents (14/30, 47%) were less likely to use the system than medical students (9/14, 64%) and attending staff (7/11, 64%). Learners at all levels thought the modules were easy to use. Participants liked the knowledge-based material in the CAP module because it directly applied to their work. There were less favourable opinions of the hand hygiene module Generating e-learning modules targeted at gaps in quality of care is feasible and acceptable to learners. Future studies should assess whether these approaches lead to desired changes in behavior.

Tu1157 Gastroenterology Trainees Can Perform Real Time Optical Diagnosis of Diminutive Colorectal Polyps Using Narrow Band Imaging

BACKGROUND Proposed clinical thresholds for optical diagnosis of colorectal polyps recommend ≥90% agreement between opticaland histopathology-based surveillance intervals, and ≥90% negative predictive value in the rectosigmoid colon. Experienced gastroenterologists have exceeded these thresholds in studies, but the performance of trainees is unknown. We aimed to prospectively assess real-time trainee performance of optical diagnosis of diminutive colorectal polyps. METHODS We studied the optical diagnoses of colorectal polyps using narrow band imaging (NBI) in gastroenterology trainees over a 9-month period during a prospective, randomized polyp detection tandem colonoscopy trial. Trainees viewed a computer-based learning module on NBI International Colorectal Endoscopic (NICE) classification and took a test that required minimum 90% accuracy prior to the study. For each polyp found at colonoscopy, trainees stated the diagnosis (neoplastic vs. non-neoplastic) and confidence level in the diagnosis (high vs. low), then removed and submitted it for histopathologic diagnosis. Central, blinded pathology was the reference standard. An optical diagnosis was high confidence if the polyp had at least one of the features of neoplasm or non-neoplasm and none of the features of the opposing diagnosis. Otherwise, low confidence

Development and validation of a computer-based learning module for wrist arthroscopy

The objective of this study was to develop and validate a computer-based module for wrist arthroscopy to which a group of experts could consent. The need for such a module was assessed with members of the European Wrist Arthroscopy Society (EWAS). The computer-based module was developed through several rounds of consulting experts on the content. The module's learning enhancement was tested in a randomized controlled trial with 28 medical students who were assigned to the computer-based module group or lecture group. The design process led to a useful tool, which is supported by a panel of experts. Although the computer based module did not enhance learning, the participants did find the module more pleasant to use. Developing learning tools such as this computer-based module can improve the teaching of wrist arthroscopy skills.

Strengthening Role Clarity in Acute Care Nurse Case Managers

The purpose of this quality improvement study was to evaluate the impact of a novel educational intervention on nurse case managers' (NCMs') perceived role ambiguity, role conflict, and use of nursing competencies. Specific aims were to apply the American Association of Critical-Care Nurses Synergy Model for Patient Care to determine the use of the model's nurse competencies in acute care case management, to pilot test the feasibility of using widely available basic computer technologies to facilitate NCMs' orientation in acute care settings, and to establish the foundation for future work in developing an evidence-based orientation program for new NCMs based on a nursing conceptual framework. Two acute care community hospitals in northeastern Ohio, both part of a large national hospital corporation. The sample consisted of NCMs who were actively employed in 1 of 2 acute care hospitals and voluntarily agreed to participate in this quality improvement study. Data on perceived role conflict and role ambiguity, perceived use of nurse competencies in bedside nursing and in case management, demographics, and evaluative feedback were collected using Google Docs. The intervention consisted of a series of four self-paced computer-based learning modules that provided participants with an introduction to acute care nursing case management based on the American Association of Critical-Care Nurses Synergy Model. Four of the 6 role ambiguity subscale item scores revealed reductions in role ambiguity after the educational intervention. A statistically significant decrease in one role conflict item was observed. Participants rated the use of all nurse competencies as higher in case management than in bedside nursing practice; the variance between the two further increased after the intervention. Statistically significant differences in the use of clinical judgment, advocacy/moral agency, and caring practices were identified. Participants reported that the educational content would be valuable for new NCMs transitioning from bedside clinical practice. The addition of case studies or clinical scenarios illustrating each nurse competency was suggested. Testing of the Synergy Model-based education modules with novice case managers actively transitioning from the bedside to a case management role will be the next step in the development of this program. : The use of widely available computer technologies to deliver introductory case management orientation content is feasible, although conversion to a web-based platform is recommended. Evidence-based strategies to prepare NCMs for expanded competency in clinical judgment, advocacy/moral agency, and caring practices are needed.

Medical Decision-Making among Adolescents with Neonatal Brachial Plexus Palsy and Their Families

Elective surgical management of neonatal brachial plexus palsy is complex, variable, and often individualized. Little is known about the medical decision-making process among adolescents with neonatal brachial plexus palsy and their families when faced with making complex treatment decisions. The experiences of these patients and their parents were analyzed to identify key factors in the decision-making process. Eighteen adolescents with residual neonatal brachial plexus palsy deficits between 10 and 17 years and their parents were included. Qualitative research design was used involving separate, 1-hour, in person, semistructured interviews, which were audio recorded and transcribed. Grounded theory was applied by two members of the research team to identify recurrent themes and create a codebook that was applied to the data. Medical decision-making among adolescents with neonatal brachial plexus palsy and their families is multifaceted and individualized, composed of both patient- and system-dependent factors. Four codes were identified: (1) knowledge acquisition, (2) multidisciplinary care, (3) adolescent autonomy, and (4) patient expectations and treatment desires. Overall, parental decision-making was heavily influenced by system-dependent factors, whereas adolescents largely based their decisions on individual treatment desires to improve function and/or aesthetics. There are many areas for improving the delivery of information and health care organization among adolescents with neonatal brachial plexus palsy and their families. The authors recommend the development of educational interdisciplinary programs and decision aids containing evidence-based management guidelines targeted toward primary care providers and patients. The authors believe that a computer-based learning module may provide the best avenue to achieve maximum penetrance and convenience of information sharing. Therapeutic, IV.

Creative Ways to Teach Arterial Blood Gas Interpretation

There are many creative ways to teach arterial blood gas interpretation. This article illustrates the use of the stepwise approach, tables, figures, case studies, illustrations, computer-based learning modules, and the tic-tac-toe approach. The authors recommend making several approaches available so students and new critical care nurses can choose the ones that work best for them.

The role of electronic records in reporting adverse drug reactions.

309 Background: The Pharmacy and Therapeutics committee at a regional cancer center is responsible to report and trend existing adverse drug reactions. The electronic health record did not have an option to document the history of an event or have an alert function if a medication was re-ordered. The frequency of documented adverse drug reactions did not correlate to what was being observed on the units with the use of a paper document. Methods: InAugust 2010 a Lean Six Sigma project was initiated to improve adverse drug reaction reporting. An adverse drug reaction document along with standard work instructions was completed by March 2011. A report was built in the electronic health record and a computer based learning module was created and rolled out to clinical staff by October 2011. Results: The turn-around time in days to document an adverse drug reaction in the patients chart decreased from 6.8 days to 0.7 days. The documented adverse drug reactions increased by 37%; verified by the use of supportive medications. Conclusions: The root cause for under-reporting was attributed to lack of knowledge, process, and automation. The history of an adverse drug reaction can now be viewed and an automatic alert is produced requiring physician acknowledgement decreasing the chance of repeated discomfort or harm to the patient. Adverse drug reaction documentation can be retrieved within 24 hours, analyzed, trended, and used for educational purposes to improve patient safety. [Table: see text]

Factors influencing medical student attrition and their implications in a large multi-center randomized education trial

Participant attrition may be a significant threat to the generalizability of the results of educational research studies if participants who do not persist in a study differ from those who do in ways that can affect the experimental outcomes. A multi-center trial of the efficacy of different computer-based instructional strategies gave us the opportunity to observe institutional and student factors linked to attrition from a study and the ways in which they altered the participation profile. The data is from a randomized controlled trial conducted at seven US medical schools investigating the educational impact of different instructional designs for computer-based learning modules for surgical clerks. All students undertaking their surgical clerkships at the participating schools were invited participate and those that consented were asked to complete five study measures during their surgery clerkship. Variations in study attrition rates were explored by institution and by participants' self-regulation, self-efficacy, perception of task value, and mastery goal orientation measured on entry to the study. Of the 1,363 invited participants 995 (73%) consented to participate and provided baseline data. There was a significant drop in the rate of participation at each of the five study milestones with 902 (94%) completing at least one of two module post-test, 799 (61%) both module post-tests, 539 (36%) the mid-rotation evaluation and 252 (25%) the final evaluation. Attrition varied between institutions on survival analysis (p<0.001). Small but statistically significant differences in self-regulation (p=0.01), self-efficacy (p=0.02) and task value (p=0.04) were observed but not in mastery or performance goal orientation measures (p=NS). Study attrition was correlated with lower achievement on the National Board of Medical Examiners subject exam. The results of education trials should be interpreted with the understanding that students who persist may be somewhat more self-regulated, self-efficacious and higher achievers than their peers who drop out and as such do not represent the class as a whole.

The Effect of Computer Based Learning (CBL) Regarding Endotracheal Airway Suctioning on Knowledge and Skill Retention of Third Year Pediatric Nursing Students

Endotracheal airway suctioning (ETS) is one of the important pediatric nursing skills that should be used only after careful assessment. High qualified pediatric nursing care requires interesting in clinical skill education and seeking innovative learning methods. Reviewed studies comparing the effectiveness of CBL with traditional methods reported lack of studies that tested knowledge or skill retention. This quasi-experimental study evaluated the effect of CBL regarding ETS on knowledge and skill retention of third year pediatric nursing students. A total 120 students were divided into experimental and control groups. The experimental group was taught used an interactive, multimedia, self-directed computer-based learning module. The control group was taught used face to face lecture and demonstration in a pediatric clinical skills laboratory. Data were collected using knowledge test at four time points and at three time points using ETS performance checklist. The study revealed that CBL method produce significant cognitive gains and higher skill performance scores for the experimental students at immediate follow up but the retained knowledge was almost similar in both groups at 2 weeks follow up. The experimental group achieved significant higher differences emerging in retained knowledge at the 6 week follow up and in retained skill performance at 2 & 6weeksfollow ups. The findings indicated that CBL was an effective strategy for teaching both knowledge and practice. It also produced better knowledge and skill retention than in case of traditional learning method.

Comparison of traditional methods with 3D computer models in the instruction of hepatobiliary anatomy

This study was designed to determine whether an interactive three-dimensional presentation depicting liver and biliary anatomy is more effective for teaching medical students than a traditional textbook format presentation of the same material. Forty-six medical students volunteered for participation in this study. Baseline demographic information, spatial ability, and knowledge of relevant anatomy were measured. Participants were randomized into two groups and presented with a computer-based interactive learning module comprised of animations and still images to highlight various anatomical structures (3D group), or a computer-based text document containing the same images and text without animation or interactive features (2D group). Following each teaching module, students completed a satisfaction survey and nine-item anatomic knowledge post-test. The 3D group scored higher on the post-test than the 2D group, with a mean score of 74% and 64%, respectively; however, when baseline differences in pretest scores were accounted for, this difference was not statistically significant (P = 0.33). Spatial ability did not statistically significantly correlate with post-test scores for the 3D group or the 2D group. In the post-test satisfaction survey the 3D group expressed a statistically significantly higher overall satisfaction rating compared to students in the 2D control group (4.5 versus 3.7 out of 5, P = 0.02). While the interactive 3D multimedia module received higher satisfaction ratings from students, it neither enhanced nor inhibited learning of complex hepatobiliary anatomy compared to an informationally equivalent traditional textbook style approach. .

Computer-Based Learning Module Increases Shared Decision Making in Breast Reconstruction

Computer-Based Learning Module Increases Shared Decision Making in Breast Reconstruction

Effectiveness of the computer enhanced visual learning method in teaching the society for fetal urology hydronephrosis grading system for urology trainees

Objective A novel educational tool, Computer Enhanced Visual Learning (CEVL), has been used to improve resident performance of routine orchiopexy. Our objective was to assess the effect of a CEVL teaching module on the diagnostic accuracy of medical trainees in grading neonatal hydronephrosis on ultrasound using the Society for Fetal Urology (SFU) grading system. Methods The authors designed an online-based computerized tutorial to teach the grading of hydronephrosis using multimedia, practice cases and a grading checklist. In a crossover design trial, 29 residents and medical students were asked to grade 16 standard neonatal renal ultrasounds using the SFU grading system before and after viewing the web-based e-learning module. Primary outcome was percent improvement in grading accuracy. Results The mean percentages of ultrasounds that were graded correctly before and after CEVL intervention were 51% and 72% respectively (mean improvement 21%, 95% CI 3–13%, P < 0.001). Residents graded correctly 56% of ultrasounds before and 74% after CEVL (mean 18%, 7–28%, P = 0.002). Medical students graded correctly 37% before and 69% after CEVL (mean improvement 32%, 95% CI 16–48%, P = 0.002). Conclusion Exposure to a computer-based learning module based on the CEVL platform improved urology residents’ and medical students’ correct assignment of SFU hydronephrosis grading to newborn renal ultrasounds.

Learning About the Unit Cell and Crystal Lattice With Computerized Simulations and Games

The authors have developed a computer-based learning module on the unit cell of various types of crystal. The module has two components: the virtual unit cell (VUC) part and the subsequent unit cell hunter part. The VUC is a virtual reality simulation for students to actively arrive at the unit cell from exploring, from a broad view, the crystal lattice of atoms or ions displayed “three dimensionally.” The unit cell hunter (UCH) part, implemented after the VUC, is a board game with students competing in assembling the atomic pieces for two types of unit cell (cubic and hexagonal) framework. The students were evaluated for achievement after having benefited from working with the learning module and participating in the debriefing. Apart from identical pre- and posttests at the beginning and end of the activities, students also responded to a questionnaire. Active participation by the students and the researcher in the debriefing enhanced learning as set out by the objectives, for example, better visualization of the three-dimensional structures of various types of unit cell and crystal lattice.

Computer-Based Learning Module Increases Shared Decision Making in Breast Reconstruction

Shared decision making (SDM) combines evidence-based medicine with individual patient preferences. Patients who are actively engaged in their own health care management with their physicians have been shown to experience not only increased compliance, but also higher satisfaction and better outcomes. We hypothesize that a computer-based learning module for breast reconstruction increases patient involvement in the decision-making process. Women who underwent either immediate or delayed breast reconstruction at an academic teaching hospital from 2004 to 2007 were identified. Patients meeting inclusion criteria were mailed questionnaires on demographics, informational resources, and decision-making processes. Questionnaire results were divided into 2 groups for analysis: patients who received a standard surgeon consultation and patients who were shown a computer-based decision aid in addition to the standard consultation. There were 358 women eligible for our study. A total of 255 patients (75.9%) responded to the survey; 168 patients were shown the computer-based decision aid and 87 patients were not. Patients who used the computer-based learning module reported a greater role in choosing the type of reconstruction (P < .001). Additionally, these patients reported a greater number of reconstructive options offered to them (P < .001) and were more satisfied with the amount of information provided by their reconstructive surgeon (P = .049). A computer-based learning module allows patients to assimilate information and actively participate in choosing type of breast reconstruction. Use of this educational modality represents a simple and effective way to improve the shared decision-making process.

Computer-Based Learning Module and the Educational Process for Women with Breast Cancer Who Desire Reconstruction

Computer-Based Learning Module and the Educational Process for Women with Breast Cancer Who Desire Reconstruction

Computer-based learning module increases shared decision making in breast reconstruction

Computer-based learning module increases shared decision making in breast reconstruction

Demonstrating the Effectiveness of an Online, Computer-Based Learning Module for Arterial Blood Gas Analysis

To determine the effectiveness of a computer-based learning module specific to arterial blood gas (ABG) interpretation. A pretest and posttest design was used to assess staff nurses' ability to interpret ABGs before and after engaging in a computer-based module. Two community hospitals in northern Illinois. Fifty-eight staff nurses completed the online learning module and the pretest and posttest measures. Subjects consented to participate and completed a pretest measure of their knowledge of ABG interpretation. Subjects participated in a computer-based learning module on ABG interpretation and then completed a posttest. Staff nurses' knowledge increased significantly after viewing the computer-based learning module (t = 6.3; P < .001). This improvement was irrespective of experience or department. Computer-based, online learning has emerged as a means of providing continuing education to nurses. Such a teaching strategy helps to overcome barriers pertinent to traditional classroom settings.

Computer‐assisted teaching of epistaxis management

To determine whether computer-assisted learning (CAL) is an effective tool for the instruction of technical skills. Prospective blinded randomized-control trial conducted on a cohort of 47 first-year medical students. Students were instructed on two techniques of nasal packing (formal nasal pack and nasal tampon) for the management of epistaxis, using either a standard text-based article or a novel computer-based learning module. Students were evaluated on proper nasal packing technique using standardized subjective and objective outcome measures by three board-certified otolaryngologists. Blind assessments took place prior to and following instruction, using the assigned learning modality. There were 47 participants enrolled in the study. Both groups demonstrated improvement in performance of both packing procedures following training. A significant post-training difference favoring CAL learners over text-based learners was observed, using the global assessment of skill for both packing techniques (P < .001). Additionally, a significant post-training difference favoring CAL learners over text-based learners was observed for all checklist items for the tampon pack and five of eight items on the formal pack checklist. The vast majority of students (94.6%) indicated that if given the choice, they would prefer to learn using CAL rather than by using text-based learning materials. CAL learners demonstrated significantly greater improvement across both subjective and objective outcome measures when compared to the text-based group. Additionally, students favored learning via the CAL modality, which further suggests that CAL is a valuable means of imparting procedural knowledge to novice medical trainees.

Effectiveness of a Computer‐Based Educational Program on Nurses' Knowledge, Attitude, and Skill Level Related to Evidence‐Based Practice

To conduct a baseline assessment of nurses' perceptions of knowledge, attitude, and skill level related to evidence-based practice (EBP) and research utilisation; determine the level of organisational readiness for implementing EBP and research; and examine the effectiveness of a computer-based educational program on nurses' perceptions of knowledge, attitude, and skill level related to EBP and research utilisation. A descriptive, quasi-experimental design with a one-group, pre-intervention survey, intervention, and post-intervention survey method was used. A convenience sample of 744 nurses working in an integrated health care system was recruited. The study was conducted from May 2006 through November 2006. Data collection instruments were a demographic data questionnaire and the Evidence-Based Nursing Questionnaire. An education intervention on principles of EBP and research utilisation was conducted via three computer-based learning modules. Statistically significant differences in perceptions of knowledge, attitude, and skill level, as well as beliefs about organisational readiness were found after nurses participated in the computer-based education intervention. Although nurses indicated having positive attitudes about using research to support best nursing practice, gaps in knowledge and skills in retrieving research publications, evaluating the evidence, and incorporating the evidence into practice remain. Nurses rated their managers, senior nursing administrators, and staff nurses on their unit higher than hospital managers in supporting changes to practice based on research. Nurses in clinical settings need to be able to use research findings and incorporate EBP into their nursing practice to promote positive patient outcomes. Appropriate organisational infrastructures are essential for promoting EBP and research utilisation in clinical settings. Diverse and effective methods are essential in educating and engaging nurses in EBP and research utilisation. Computer-based education is an effective approach that can be used by nursing leaders in health care organisations to educate and engage nurses in EBP initiatives and research utilisation.

The Implementation of a Personnel Training and Assessment Program for New Standards in the US Pharmacopeia General Chapter &lt;797&gt; Pharmaceutical Compounding of Sterile Preparations

Purpose The US Pharmacopeia (USP) general Chapter &lt;797&gt; sets standards for personnel training and assessment of aseptic manipulation skills. We describe the implementation of a training and assessment program to meet these standards at an academic medical center. Methods Exempt approval by the University of Kentucky Institutional Review Board was granted. All pharmacy personnel responsible for compounding sterile preparations were included. Participants completed three computer-based learning modules (CBLs) related to mathematics skills, aseptic manipulations, and USP &lt;797&gt;. Participants were given an online test, prior to viewing a CBL (pretest) and after completion of a CBL (posttest). Mean pre- and posttest scores were analyzed using a paired Student's t-test. A proctored practical examination involved manipulations of sterile fluid culture media (media-fill challenge) to assess aseptic manipulation skills. Culture media were incubated at room temperature for 14 days and monitored for growth. Results A significant increase was found in mean percentage of correct answers for pre- and posttest scores for the aseptic manipulation (85% vs 93%; P &lt; 0.05) and USP &lt;797&gt; (78% vs 90%; P &lt; 0.001) CBLs. The mean percentage of correct answers on the mathematics test was 92%. The results of the media-fill challenge revealed that 4 of the 84 (4.2%) proctored assessments were contaminated. Conclusion This personnel training and assessment program meets the requirements of USP &lt;797&gt;. The use of CBLs was effective in teaching and assessing participants on the theoretical and practical principles of aseptic manipulations. The proctored practical assessment meets USP &lt;797&gt; requirements for medium-risk level media-fill challenge tests.