Computer-based Training Module Research Articles

Newborn Hearing Screening and Beyond: A Continuing Journey in the Philippines

Newborn Hearing Screening and Beyond: A Continuing Journey in the Philippines

Implementation of a Multimodal Interdisciplinary Massive Transfusion Protocol Educational Bundle Improves Knowledge and Self-Efficacy

PurposeCritical events in the operative setting require rapid management to prevent adverse outcomes. This article describes a multimodal educational bundle that was designed and implemented to improve readiness to respond to crises involving significant blood loss. Intended outcomes of this project were to increase knowledge and self-efficacy of anesthesia providers and perioperative staff members related to the use of the massive transfusion protocol (MTP). DesignThis is a quality improvement (QI) project. MethodsA two-part educational bundle consisted of pre-education and low-fidelity simulation (LFS) via computer-based training (CBT) modules followed by hands-on skills sessions. Anesthesia providers, registered nurses, and technicians in the operative suite completed the educational intervention. Knowledge and self-efficacy were measured pre-and-post intervention. FindingsAfter completing the educational bundle, the aggregated mean score on a knowledge test increased by 5.65%. Self-efficacy related to role-specific responsibilities and confidence regarding the team's ability to carry out the MTP significantly increased for all participants (n = 62). ConclusionsThis project serves as an example of how a multimodal educational bundle can improve knowledge, confidence, and readiness to respond to critical events. This model demonstrates how pre-education and LFS enable crisis management training to be readily accessible for an entire interdisciplinary team.

Computer-Based Patient Bias and Misconduct Training Impact on Reports to Incident Learning System.

ObjectiveTo assess the effect of computer-based training (CBT) and leadership communication on incident learning system reports pertaining to institutional policy that targets biased, prejudiced, and racist behaviors of patients and visitors toward health care employees.Patients and MethodsMayo Clinic developed a CBT module and comprehensive communication strategy to educate staff on the Patient and Visitor Conduct Policy. Additional goals were to demonstrate leadership endorsement and support of the policy, teach how to report an incident, and facilitate how policy enforcement might occur. Using descriptive statistics, we compared the reporting data before and after the intervention.ResultsParticipants were 13,980 employees in 68 clinics and 18 hospitals in the US Midwest. Bias and misconduct incidents entered in the incident reporting system increased 312% (n=140 incidents; preintervention, n=34) in the quarter (ie, 3 months) immediately after intervention. The number of incidents in the next quarter stayed increased (234%; n=114) compared with the preintervention number. Secondary debriefing with employees showed the value of the education and the importance of leadership support at the highest level to facilitate comfort in policy enforcement.ConclusionInstitutional policy that targets biased, prejudiced, and racist behaviors of patients toward employees in a health care setting can be augmented with employee education and leadership support to facilitate change. The CBT, paired with a robust communication plan and active leadership endorsement and engagement, resulted in increased reporting of biased, prejudiced, and racist behaviors of patients.

Computer-based multimodal training module facilitates standardization of complete mesocolic excision technique for right-sided colon cancer: Long-term oncological outcomes.

The aim of this study is to demonstrate our video training tool developed to teach and standardize complete mesocolic excision (CME) for right-sided colon cancer and also to present our long-term oncological outcomes. Educational narrative videos were produced to demonstrate the technical steps of CME. First, a three-dimensional animation video was prepared. Then cadaveric dissections were recorded in a step-by-step fashion, following the sequences of open and minimally invasive surgery. These were followed by videos of real-life demonstrations of surgical procedures, enhanced by superimposed animations of key anatomical structures. In order to demonstrate the impact of this training module on outcomes of patients undergoing CME, we retrospectively queried data from before (2005-2010) and after (2011-2019) implementation of standardized CME in our practice. A total of 180 consecutive patients underwent right hemicolectomy between 2005 and 2019. Fifty-four patients underwent surgery before and 126 patients after CME principles were elaborated and standardized. Of those patients who had surgery after the training module, 58 (46%) underwent open surgery and 68 (54%) underwent laparoscopic colectomy. Demographics, perioperative parameters and morbidity were comparable between the groups. The 5-year overall and disease-free survival rates were significantly improved after implementation of CME training (p=0.059 and p=0.041, respectively). Also, 5-year overall and disease-free survival rates for all patients were considerably better than our reported national outcomes. Our comprehensive step-by-step training video module for the CME technique demonstrates surgical anatomical planes and important vascular structures and variations. The video also helps standardization of the CME technique and should contribute to improved histopathological and oncological outcomes.

Working Towards Competence: A Novel Application of Borderline Regression to a Task-Specific Checklist for Technical Skills in Novices

Demonstrated competence through frequent assessment is an expected goal for progressive development in competency-based medical education curricula. The Objective Structured Assessment of Technical Skill (OSATS) is considered a valid method of formative assessment, but in few instances have standards been set for determining competence. The present study used borderline regression methods to examine standard setting of performance on a complex technical task with novices assessed using an OSATS checklist. This was a single institution prospective single arm experimental design study. Participants were 58 non-medical undergraduate students with no previous surgical experience, who observed a computer-based training module on end-to-side vascular anastomosis. Subsequently, participants were provided two 20-minute training sessions, two weeks apart where they received expert feedback whilst performing the task on a low-fidelity model. After each training session, participants completed the task unaided. Sessions were recorded and assessed using an OSATS checklist retrospectively by experts. Paired t-test analyses indicate that for both the checklist total score (t(52) = 8.05, p < 0.001) and the global rating score (t(53) = 8.15, p < 0.001), individuals performed significantly better in Phase 2. Borderline regression analyses indicated that in Phase 1 (R2 = .60) and Phase 2 (R2 = .75), the OSATS checklist could adequately capture variation in performance in novices. Further, the checklist could reliably classify novices at three of the five global rating performance levels. Pass rates determined by regression equations improved from Phase 1 to Phase 2 on all global rating levels. With the increasing focus on competency-based medical education, it is imperative that training programs have the capacity to accurately assess outcomes and set minimum performance standards. Borderline regression methods can accurately differentiate novice learners of varying performance levels before and after training on a complex technical skill task using an OSATS checklist.

Development and Implementation of a Novel Computer-Based Training Module for the Standardization of Splenic Flexure Mobilization.

Computer-based training modules use various multimedia components such as text, graphics, animation, and videos that can theoretically facilitate the learning process. Splenic flexure mobilization (SFM) is a crucial step for tension-free colorectal/anal anastomosis that can be a technically demanding step. This study is designed to demonstrate our novel training module for SFM with high-vessel ligation during surgery and present the anatomical landmarks and embryological plans for SFM. A step-by-step educational video was prepared to standardize and teach the technical steps of the SFM. 3D animation was prepared and cadaveric dissection was performed in a step-by-step manner similar to minimally invasive surgery. This is followed by the laparoscopic technique. Since we have started this modular training program in our department, a consecutive of 100 patients underwent laparoscopic low anterior resection and coloanal anastomosis with covering stoma. Demographics, characteristics, and postoperative outcomes were evaluated. Surgical anatomical planes and important vascular structures/variations are both shown by 3D animation, cadaveric dissection, and laparoscopic surgery. Out of 100 consecutive cases, there were no mortality, 5 anastomotic leakages 1 of which necessitates reoperation, and 2 splenic injuries which were managed conservatively. This unique educational video module for SFM demonstrates surgical anatomical planes and important vascular structures/variations. The employment and implementation of time-independent multimedia components lead to effective training and can theoretically facilitate the learning process.

Kamishibai Cards: A Conversation About Patient Safety.

Kamishibai (K) cards are a quality improvement process focused on improved bundle compliance and promotion of peer-to-peer feedback that the health system has used for a few years. Changing personnel structure and an emphasis on patient outcomes prompted a need to revamp the K Card process. A team approach was used to redesign the process resulting in a program that moved from utilization of champions to engaging all bedside nurses and having a standard completion requirement for all units. In 2 phases spanning 16 weeks, the nurse managers, point-of-care educators, and all bedside nurses were trained in the process using a computer-based training module and validated in the application of the process. By the end of the 16-week period, the completion compliance target was reached, and the system began to see a decrease in central line and Foley catheter device usage days. The result of the project design was a peer-to-peer feedback mechanism, which promotes evidence-based practices and system standards.

Initial testing of a computer-based simulation training module to support clinicians' acquisition of CBT skills for substance use disorder treatment

Cognitive behavioral therapy (CBT) is one of the most common and effective treatments for substance use disorders (SUD); however, effective delivery of CBT depends on a wide variety of nuanced skills that require practice to master. We created a computer-based simulation training system to support the development of necessary skills for student trainees to be able to apply CBT effectively for clients with SUDs. CBT: Introducing Cognitive Behavioral Therapy is an interactive, role-play simulation that provides opportunities for clinician trainees to hone their skills through repeated practice and real-time feedback before application in a clinical setting. This is the first study that tests whether such a simulation improves trainee skills for the treatment of clients with SUDs. Graduate students (N = 65; social work, clinical psychology) completed standardized patient (SP) interviews, were randomized to the simulation training program or manual comparison condition (Project MATCH manual), and completed SP interviews three months post-baseline. Using general linear models, results indicated a significant time x group effect, with students assigned to the simulation training program showing greater improvement in “extensiveness” and “skillfulness” ratings across three skill categories: general agenda setting (p = .03), explaining CBT concepts (p = .007), and understanding of CBT concepts (p = .001). However, manual comparison participants showed greater improvement than simulation trainees in “assessing primary drug use” (prange = .013–.024). No changes in extensiveness or skillfulness of motivational interviewing (MI) style were observed. This pilot test of CBT: Introducing Cognitive Behavioral Therapy offers support for use of this novel technology as a potential approach to scale up CBT training for students, and perhaps clinicians, counseling people with SUDs.

Nurse Vigilance: A Three-Part Simulation Course to Decrease Cardiopulmonary Arrests Outside Intensive Care Units.

Early recognition of and prompt intervention for the deteriorating pediatric patient remains paramount in preventing cardiac arrests from occurring outside intensive care units. To decrease these events, we developed a three-part simulation-based blended learning course consisting of a computer-based training module, a simulation scenario, and follow-up in situ scenarios for inpatient nurses. After initiation of the course, our facility has seen a decrease in the number of codes outside critical care areas.

Creating a learning organization to help meet the needs of multihospital health systems.

The considerations that leaders of multihospital health systems must take into account in developing and implementing initiatives to build and maintain an exceptional pharmacy workforce are described. Significant changes that require constant individual and organizational learning are occurring throughout healthcare and within the profession of pharmacy. These considerations include understanding why it is important to have a succession plan and determining what types of education and training are important to support that plan. Other considerations include strategies for leveraging learners, dealing with a large geographic footprint, adjusting training opportunities to accommodate the ever-evolving demands on pharmacy staffs in terms of skill mix, and determining ways to either budget for or internally develop content for staff development. All of these methods are critically important to ensuring an optimized workforce. Especially for large health systems operating multiple sites across large distances, the use of technology-enabled solutions to provide effective delivery of programming to multiple sites is critical. Commonly used tools include live webinars, live "telepresence" programs, prerecorded programming that is available through an on-demand repository, and computer-based training modules. A learning management system is helpful to assign and document completion of educational requirements, especially those related to regulatory requirements (e.g., controlled substances management, sterile and nonsterile compounding, competency assessment). Creating and sustaining an environment where all pharmacy caregivers feel invested in and connected to ongoing learning is a powerful motivator for performance, engagement, and retention.

Peculiarities of us Border Guard Officers’ Training at the Federal Law Enforcement Training Center Using Online Campus

Abstract Professional training of future US border guard officers at the Federal Law Enforcement Training Center using e-FLETC Online Campus has been substantiated in the article. Special attention has been paid to revealing such topical areas of Online Campus computer-based training modules (crime scene, driver training, drugs, firearms, health, interviewing, investigative, legal, mapping, maritime, officer safety, technology, terrorism, traffic stops, training) that include over 120 lessons and 20 videos which are available on a wide range of topics. Web-based training lessons which include topics such as counterterrorism, crime scene preservation and documentation, disaster, crisis and emergency strategies and management, domestic violence, drug endangered children, drug related crimes, elder abuse, firearms, fitness and healthy lifestyles, human trafficking, interacting with special needs populations, intelligence led policing, interpersonal skills and conflict management, interviews and interrogations, investigating technology related crimes (protecting and collecting digital evidence), investigative skills and techniques, knowledge of laws and regulations, leadership and management, lessons learned (previous case analysis), maritime law enforcement, etc. have been revealed. Besides, examples of “Firearms” and “Use of Force” curricula in e-FLETC Online Campus have been presented.

Clinical Application of Low Vision Rehabilitation Strategies After Completion of a Computer-Based Training Module

ABSTRACTThis study evaluated changes in occupational therapists’ practice behaviors after completion of an online continuing education (CE) program delivered over a hospital Intranet system. The setting was a large rural medical system covering parts of two southeastern states. A convenience sample of 28 occupational therapists and occupational therapy assistants was recruited from the facility therapy staff. A CE module on low vision assessment and treatment was delivered using the hospital Intranet and a follow-up survey assessing practice change was carried out 8 weeks later. Most participants reported an increase in their comfort level when treating clients with low vision after course completion. Fifty percent of participants reported screening for vision impairments, increased use of environmental modifications, and more referrals to other vision specialists. Outcomes suggest that Internet-delivered CE programs can improve knowledge and affect practice.

Evaluation of a Computer-Based Educational Intervention to Improve Medical Teamwork and Performance During Simulated Patient Resuscitations

To determine the impact of a low-resource-demand, easily disseminated computer-based teamwork process training intervention on teamwork behaviors and patient care performance in code teams. A randomized comparison trial of computer-based teamwork training versus placebo training was conducted from August 2010 through March 2011. This study was conducted at the simulation suite within the Kado Family Clinical Skills Center, Wayne State University School of Medicine. Participants (n = 231) were fourth-year medical students and first-, second-, and third-year emergency medicine residents at Wayne State University. Each participant was assigned to a team of four to six members (nteams = 45). Teams were randomly assigned to receive either a 25-minute computer-based training module targeting appropriate resuscitation teamwork behaviors or a placebo training module. Teamwork behaviors and patient care behaviors were video recorded during high-fidelity simulated patient resuscitations and coded by trained raters blinded to condition assignment and study hypotheses. Teamwork behavior items (e.g., "chest radiograph findings communicated to team" and "team member assists with intubation preparation") were standardized before combining to create overall teamwork scores. Similarly, patient care items ("chest radiograph correctly interpreted"; "time to start of compressions") were standardized before combining to create overall patient care scores. Subject matter expert reviews and pilot testing of scenario content, teamwork items, and patient care items provided evidence of content validity. When controlling for team members' medically relevant experience, teams in the training condition demonstrated better teamwork (F [1, 42] = 4.81, p < 0.05; ηp = 10%) and patient care (F [1, 42] = 4.66, p < 0.05; ηp = 10%) than did teams in the placebo condition. Computer-based team training positively impacts teamwork and patient care during simulated patient resuscitations. This low-resource team training intervention may help to address the dissemination and sustainability issues associated with larger, more costly team training programs.

Can driver education be improved by computer based training of cognitive skills?

Deficits in cognitive skills, such as hazard perception, appear to have a tremendous influence on accident involvement of younger drivers. However, conventional forms of driver training have largely failed to build skills that extend beyond the provision of a descriptive knowledge of how to drive. Computer based training (CBT) has the potential to provide new ways to deal with this problem. In this study, a CBT module was developed to complement existing driver training programs by addressing critical cognitive skills. The CBT made use of video sequences of potentially hazardous driving situations, including multiple-choice questions with adaptive feedback, to increase levels of elaboration and understanding. To test effects, a sample of learner drivers completed either CBT, paper based training with similar content, or no training at all. A simulator experiment confirmed that CBT participants exhibited earlier glances towards critical cues and relevant areas in the visual field than participants of the other two groups. It is concluded that CBT can potentially assist instruction of cognitive skills necessary for save driving.

Using ASR Technology in Language Training for Specific Purposes: A Perspective from Quebec, Canada

For many patients throughout the world, access to healthcare depends on the patients’ and healthcare providers’ ability to communicate efficiently in each other’s language. One way to reduce linguistic barriers to healthcare access is to increase the number of linguistically and culturally competent healthcare professionals. Conspicuously absent in the literature on second language (L2) training of healthcare professionals, however, is the use of technology that combines meaningful interaction, feedback, simulation, and asynchronous access. The goal of this paper is to fill this gap by describing and evaluating the “Virtual Language Patient,” a computer-based L2 training module for healthcare professionals. The module employs automatic speech recognition technology, pronunciation assessment, and video clips of a simulated medical history interview with a minority language patient. Five nurses-in-training at a French-language nursing college in Quebec reported that the module was easy to operate and that it addressed their anticipated language learning needs. More importantly, analysis of the data file automatically generated by the module revealed improvements in acceptability of the nurses’ pronunciation of the medical interview questions. These findings suggest that the module can be effective in language training for healthcare professionals. Implications for the improvement of virtual dialogue systems are discussed.

Standardization of computer-assisted semen analysis using an e-learning application

Computer-assisted semen analysis (CASA) is primarily used to obtain accurate and objective kinetic sperm measurements. Additionally, AI centers use computer-assessed sperm concentration in the sample as a basis for calculating the number of insemination doses available from a given ejaculate. The reliability of data is often limited and results can vary even when the same CASA systems with identical settings are used. The objective of the present study was to develop a computer-based training module for standardized measurements with a CASA system and to evaluate its training effect on the quality of the assessment of sperm motility and concentration. A digital versatile disc (DVD) has been produced showing the standardization of sample preparation and analysis with the CASA system SpermVision™ version 3.0 (Minitube, Verona, WI, USA) in words, pictures, and videos, as well as the most probable sources of error. Eight test persons educated in spermatology, but with different levels of experience with the CASA system, prepared and assessed 10 aliquots from one prediluted bull ejaculate using the same CASA system and laboratory equipment before and after electronic learning (e-learning). After using the e-learning application, the coefficient of variation was reduced on average for the sperm concentration from 26.1% to 11.3% (P ≤ 0.01), and for motility from 5.8% to 3.1% (P ≤ 0.05). For five test persons, the difference in the coefficient of variation before and after use of the e-learning application was significant (P ≤ 0.05). Individual deviations of means from the group mean before e-learning were reduced compared with individual deviations from the group mean after e-learning. According to a survey, the e-learning application was highly accepted by users. In conclusion, e-learning presents an effective, efficient, and accepted tool for improvement of the precision of CASA measurements. This study provides a model for the standardization of other laboratory procedures using e-learning.

Development and validation of a training module on the use of narrow-band imaging in differentiation of small adenomas from hyperplastic colorectal polyps

Experts are accurate in differentiating small adenomas from hyperplastic polyps at colonoscopy by using narrow-band imaging (NBI). To prospectively evaluate the effectiveness of an NBI training module on individuals with varying colonoscopy experience. Prospective educational evaluation study. Academic endoscopy unit. Twenty-one participants of varying colonoscopy experience (novices, trainees, and experienced gastroenterologists) and 5 experts in NBI. Participants completed a computer-based test module consisting of 30 NBI polyp images. No feedback was given. They then completed a computer-based training module on the use of NBI in the differentiation of adenomas and hyperplastic polyps. The test module was then completed a second time. Construct validity (the difference in baseline accuracy on the test module between different groups of participants) and content validity (difference in accuracy achieved on the test module before and after training) of the training module. There was a significant difference in the baseline accuracy (P < .001) between experts (0.95; 95% confidence interval [CI], 0.92-0.97), experienced colonoscopists (0.68; 95% CI, 0.68-0.74), trainees (0.75; 95% CI, 0.67-0.82), and novices (0.62; 95% CI, 0.46-0.77). Accuracy increased significantly (P < .001) for all 3 groups after training (novices 0.84; 95% CI, 0.78-0.88, trainees 0.90; 95% CI, 0.84-0.93, and experienced colonoscopists 0.84; 95% CI, 0.76-0.89). After training, the agreement was moderate at least (κ = 0.56 for novices, κ = 0.70 for trainees, and κ = 0.54 for experienced colonoscopists). This study did not assess the accuracy of optical diagnosis in routine clinical practice. A short, computer-based training module can improve the diagnostic accuracy and interobserver agreement for the use of NBI to differentiate adenomas from hyperplastic polyps and could be used for the initial training in optical diagnosis.

Evaluation of Computer-Based Situation Awareness Training for General Aviation Pilots

This article describes the evaluation of 6 different computer-based training modules created to teach skills that underlie the development and maintenance of situation awareness, a competency shown to be critical in pilot decision-making performance. The modules targeted basic skills training for low-time pilots (checklist completion, air traffic control comprehension, psychomotor skills) as well as training on higher order cognitive skills (attention sharing, contingency planning) and intensive preflight planning. Overall, the training modules improved participants' performance on these targeted skills. Results also provided promising albeit limited support for the effect of the training modules in improving situation awareness.

Effects of a Computer-Based Training Module on Drivers’ Willingness to Engage in Distracting Activities

This study examines the effect of a computer-based training module on drivers' attitudes and behaviors with respect to in-vehicle distraction. Research findings on the negative performance implications of distraction call for the need to mitigate these adverse effects. Forty drivers (ages 18 to 20 yrs) were divided into two groups: a training group that completed the module and a control group that viewed an unrelated video. The training promoted enhanced metacognitive skills (e.g., planning, monitoring) and strategies to deal with distraction. Measures of willingness to perform in-vehicle activities while driving (involving the use of short videos) were assessed before and after the intervention. Drivers also performed in-vehicle tasks while driving an instrumented vehicle on a closed test track. Following the training, drivers in the training group showed a decline in their ratings of willingness to engage in distracting activities along with a corresponding increase in perceived risk. In contrast, ratings from drivers in the control group did not change on any measures. Drivers in the training group were also more likely to perform in-vehicle tasks while the vehicle was parked compared with the control group-an obvious safety benefit. However, there was no observable benefit of training for drivers who performed the distracting tasks while the vehicle was in motion. There may be some promise to such a training approach. The implications for distraction and training are discussed. Training general skills in dealing with potentially distracting in-vehicle tasks may help offset some of the negative outcomes associated with their use.

Computer-aided learning in capsule endoscopy leads to improvement in lesion recognition ability

The rapid expansion in use of capsule endoscopy (CE) has led to discussion about training needs and provision. The lesion recognition skills required for CE are ideally suited to computer-based training. The aim of this study was to prospectively evaluate the educational effectiveness of a computer-based CE training and testing module on trainees with varying experience. This was a prospective educational evaluation study. Academic endoscopy unit. This study involved 28 trainees of varying CE experience (medical students, gastroenterology trainees) and 4 CE experts. Trainees (medical students and gastroenterology trainees) without CE experience completed a 60-question, computer-based test module consisting of 30-second video clips and multiple-choice questions. Without feedback, trainees then completed a comprehensive, menu-driven, computer-based CE training module. The test module was then completed a second time and feedback was given. Expert performance on the test module was benchmarked by 4 CE experts. The first measure was the difference in baseline performance on the test module between trainees and experts (to determine construct validity). The second measure was a change in performance on the test module after training (to determine content validity of the training module). A significant difference was noted in baseline performance (P < .001) among CE experts (mean 73.8% +/- 8.0%), gastroenterology trainees (49.5% +/- 10.9%), and medical students (29.5% +/- 3.3%). Performance improved significantly (P < .001) in both trainee groups after training (gastroenterology trainees' posttraining score 62.1% +/- 7.7%; medical students' 46.7% +/- 6.8%). Computer-based learning has a potentially significant role in the development of a training syllabus for CE and in CE accreditation.