Healthcare Students Research Articles

Participation and satisfaction with thee-learning course “Mental health promotion in school health care”: a mixed-method study

PurposeThis study aims to evaluate the participation and satisfaction of learners with the brief “Mental health promotion in school health care” e-learning course, and to describe factors related to their participation and satisfaction.Design/methodology/approachA convergent mixed-method study with a descriptive, posttest-only design was conducted in Finland. Quantitative data was collected from the learning portal data and via an electronic feedback questionnaire and qualitative data in four focus group discussions.FindingsThe three modules of the course were opened altogether 12,922 times during the 21 months period. The identified factors influencing participation within the course were: favorite methods attracting attention, the relevance of additional information and postprocessing boosting diligence. The learners’ satisfaction with the course was high. The factors identified for improving satisfaction were: filling gaps in earlier education, clear and concise structure and content, inspiring and interesting design and suitability for clinical use. In addition to the primary target group (school nurses), the course was well-participated and evaluated as satisfying among other health and social care professionals as well as undergraduate students.Originality/valueThis study demonstrates demand for brief, fully online mental health trainings among school nurses, but also among other health and social care professionals and students. The results indicate that learners perceive such training as beneficial. This paper also presents a novel training intervention and its pedagogical base.

Healthcare Students' Perceptions and Attitudes Towards Peers with Autism Spectrum Disorders.

The present study investigates healthcare students' affective, behavioral, and cognitive attitudes toward hypothetical peers with autism spectrum disorder (ASD) and the effect of the ASD label on their attitudes. The MAS scale for ASD persons in the postsecondary education (Matthews et al., 2015) was translated and adapted in Greek according to the guidelines of World Health Organization (2016). Participants (n = 444) were randomly divided into three equal groups and completed their demographic information. Each participant read the three vignettes of the Greek-adapted MAS scale describing a communicative interaction with one hypothetical fellow student with autistic characteristics in three different social situations but in each group, the vignette's character was labeled differently (High-functioning, typical college student, and no-label). Students in the High-functioning group demonstrated more positive affective, behavioral, and cognitive attitudes toward the vignette characters than students in the no-label condition. Furthermore, students in the typical student group reported more rejective behaviors toward the vignette characters than students in the high-functioning group, implying that atypical behavior evokes rejection and stigmatization, while the label did not. Male students presented more positive cognitive attitudes across study groups in comparison to female students, while previous contact with individuals with ASD did not seem to impact significantly attitudes. The findings of the study indicate that knowledge of an ASD diagnosis leads to greater acceptance and have important implications for future research, disability policy makers, and university support services.

Exploring attitudes toward xenotransplantation: A scoping review of healthcare workers, healthcare students, and kidney patients.

Recent advances mean that formal clinical trials of solid organ xenotransplantation are increasingly likely to begin and patients requiring a kidney transplant could be the first participants. Healthcare workers and healthcare students constitute the current and future workforce that will influence public opinion of xenotransplantation. The attitudes of these populations are important to consider before recruitment for formal clinical trials begins. This scoping review was reported according to the PRISMA extensions for scoping reviews checklist and the Joanna Briggs Institute methodology for scoping reviews. The Scopus, PubMed, and ScienceDirect databases were searched to identify articles that studied the attitudes of healthcare workers, healthcare students, or kidney patients toward xenotransplantation. The search generated 816 articles, of which 27 met the eligibility criteria. The studies were conducted in 14 different countries on five different continents. Participants from the 27 studies totaled 29,836-this was constituted of 6,223 (21%) healthcare workers, 21,067 (71%) healthcare students, and 2,546 (8%) kidney patients. All three groups had an overall positive attitude toward xenotransplantation. However, in studies where participants were asked to consider xenotransplantation when the risks and results were not equal to allotransplantation-the overall attitude switched from positive to negative. The results also found that Spanish-speaking populations expressed more favorable views toward xenotransplantation compared to English-speaking populations. The results of this review suggest that while attitudes of the three groups toward xenotransplantation are-on the face of it-positive, this positivity deteriorates when the risks and outcomes are framed in more clinically realistic terms. Only formal clinical trials can determine how the risks and outcomes of xenotransplantation compare to allotransplantation.

The effectiveness of virtual reality training on knowledge, skills and attitudes of health care professionals and students in assessing and treating mental health disorders: a systematic review

Background Virtual reality (VR) training can enhance health professionals’ learning. However, there are ambiguous findings on the effectiveness of VR as an educational tool in mental health. We therefore reviewed the existing literature on the effectiveness of VR training on health professionals’ knowledge, skills, and attitudes in assessing and treating patients with mental health disorders.MethodsWe searched MEDLINE, PsycINFO (via Ovid), the Cochrane Library, ERIC, CINAHL (on EBSCOhost), Web of Science Core Collection, and the Scopus database for studies published from January 1985 to July 2023. We included all studies evaluating the effect of VR training interventions on attitudes, knowledge, and skills pertinent to the assessment and treatment of mental health disorders and published in English or Scandinavian languages. The quality of the evidence in randomized controlled trials was assessed with the Cochrane Risk of Bias Tool 2.0. For non-randomized studies, we assessed the quality of the studies with the ROBINS-I tool.ResultsOf 4170 unique records identified, eight studies were eligible. The four randomized controlled trials were assessed as having some concern or a high risk of overall bias. The four non-randomized studies were assessed as having a moderate to serious overall risk of bias. Of the eight included studies, four used a virtual standardized patient design to simulate training situations, two studies used interactive patient scenario training designs, while two studies used a virtual patient game design. The results suggest that VR training interventions can promote knowledge and skills acquisition.ConclusionsThe findings indicate that VR interventions can effectively train health care personnel to acquire knowledge and skills in the assessment and treatment of mental health disorders. However, study heterogeneity, prevalence of small sample sizes, and many studies with a high or serious risk of bias suggest an uncertain evidence base. Future research on the effectiveness of VR training should include assessment of immersive VR training designs and a focus on more robust studies with larger sample sizes.Trial registrationThis review was pre-registered in the Open Science Framework register with the ID-number Z8EDK.

An innovative clinical interprofessional education experience to advance knowledge and skill in communication with aphasic patients: A randomized controlled pilot study

BackgroundBecause of its impact on communication, aphasia increases patients’ risk for poor healthcare outcomes. Healthcare teams should be equipped to effectively serve this population. PurposeThe primary aim was to pilot the effectiveness of an aphasia communication.partner training program for healthcare students by examining changes in knowledge and behavior. A secondary aim assessed learners' understanding of other healthcare professionals’ roles and responsibilities. MethodStudents in pharmacy, physician assistant, and occupational therapy were randomly assigned to experimental or control groups. The former participated in didactic training with speech-language pathology students and mentored interactions with aphasic patients. Both groups completed pre-/post-training knowledge assessments and participated in semi-structured patient interactions. DiscussionThe clinical IPE experience resulted in statistically significant differences in aphasia knowledge and associated behaviors. Additionally, learners’ understanding of healthcare professions improved. ConclusionsClinical IPE experiences are effective at improving clinical communication skills and increasing knowledge of language-impaired populations.

A Comparison of Virtual Reality and Traditional Audio-Recorded Hearing Voices Simulations: Their Impact on Empathy in Health Care Students.

Empathy is essential to the development of communication skills. Simulating psychosis to develop empathy for mental health patients is complex; we hypothesized that virtual reality (VR) would be effective in increasing empathy in health care students. This experimental study compared the effectiveness of a VR simulation with a traditional hearing voices simulation as measured by the Kiersma-Chen Empathy Scale-Revised. Twenty-five health care students were randomized into two groups. The results indicated that both simulated experiences increased empathy levels, supporting the study's hypothesis. A 10-minute VR simulation is an effective teaching strategy for developing empathy in health care students.

Acceptance and Hesitancy of COVID 19 Vaccination Among Medical and Allied Health Students in India - A Pilot Study

Coronavirus disease 2019 (Covid-19) has had a lasting impact globally, resulting in an exponential rise in mortality and morbidity associated with it. In order to counteract this deadly disease, several Covid-19 vaccines were introduced in human trials. In the midst of lot of controversies regarding the efficacy of these vaccines, as well as the potential adverse effects experienced by the vaccinated individuals the questions of acceptance and hesitancy grew stronger. Since the medical and allied health students have access and understanding of evidence based research, their opinions would help in understanding the situation better. Hence, the aim of the present study was to learn about acceptance, hesitancy of Covid vaccination among health care students. A questionnaire-based online survey was conducted in India between 1st May 2021 and 12th July 2021. A total of 212 responses from health care students were obtained from various states. The questionnaire was circulated via social media platforms, which mainly included questions on acceptance, hesitancy, efficacy and adverse effects of vaccines available in India. Responses have been received from Maharashtra, Karnataka, Goa, Haryana, New Delhi, Chhattisgarh, Andhra Pradesh, Tamil Nadu, Kerala, Uttar Pradesh and Punjab. 61.8% of the responders were from the age group of 18-24. The review of this very important aspect is crucial which has been often neglected amidst the pandemic. This study may help in implementation of better public policies in future.

Assessment of Self-Medication Practices among Undergraduate Students Before and During COVID-19

Objective: To assess self-medication knowledge, prevalence, reasons, and conditions among undergraduate medical students. Material and Methods: A survey was conducted among 329 undergraduate healthcare students in tertiary care hospitals & IOD using a self-administered questionnaire. Descriptive statistics were used to summarize the data, and categorical variables were analyzed with Chi-square and logistic regression tests at a significance level of p < 0.05. Results: Self-medication was prevalent among 202 (61.4%) participants: 54 (26.7%) before COVID-19, 16 (7.9%) during COVID-19, and 132 (65.3%) both periods. Knowledge levels varied: 179 (54.4%) with poor knowledge, 150 (45.6%) with good knowledge regarding self-medication. Painkillers 176 (87.1%) were commonly self-administered class of drug, with fever 166 (82.6%) being the most treated condition. Individuals often used their own prior prescriptions 125 (62.5%) as a source of information for self-medication. The predominant reason for self-medication was fear of contact with the infected person during the pandemic, along with fear of quarantine or isolation. Conclusion: In conclusion, this study reveals concerning self-medication practices among undergraduate healthcare students, particularly with painkillers for common ailments. Field of study, academic year, and personal background influenced self-medication tendencies, while highlighting knowledge gaps. The COVID- 19 pandemic exacerbated these behaviours, necessitating immediate attention. Healthcare education must adapt to equip future professionals with decision-making skills amid rising self-medication practices.

Brazilian Version of the Health Care Provider HIV/AIDS Stigma Scale: Cross-Cultural Adaptation and Psychometric Evaluation Among Healthcare Students.

We aimed to validate the Health Care Provider HIV/AIDS Stigma Scale (HPASS) among healthcare students in Brazil. The validation process occurred in three phases from August 2022 to July 2023: translation and cross-cultural adaptation; content validity assessment involving four experts; and evaluation of psychometric properties among 553 healthcare students from the Federal University of Espírito Santo. We used exploratory factor analysis and convergent validity for structural validation. The average scale content validity index was 0.90, while the evaluation of validity evidence based on the internal structure indicated a robust explanatory model. Parallel analysis indicated that the scale is composed by two dimensions: "Discrimination/Prejudice" and "Stereotype"; the composite reliability values for these dimensions were 0.96 and 0.85, respectively. The Brazilian version of HPASS has shown to be a simple, reliable, and psychometrically valid measure to quantify HIV stigma among healthcare students who speak Brazilian Portuguese.Resumen El objetivo de este estudio fue validar la "Health Care Provider HIV/AIDS Stigma Scale" (HPASS) entre estudiantes de salud en Brasil. El proceso de validación se llevó a cabo en tres etapas: traducción y adaptación transcultural; evaluación de la validez de contenido; y evaluación de las propiedades psicométricas con estudiantes de salud de la Universidad Federal de Espírito Santo. El índice de validez de contenido promedio de la escala fue de 0.90, mientras que la evaluación de la evidencia de validez basada en la estructura interna indicó un modelo explicativo sólido. El análisis paralelo indicó que la escala está compuesta por dos dimensiones: "Discriminación/Prejuicio" y "Estereotipo". La versión brasileña de HPASS ha demostrado ser una medida simple, confiable y psicométricamente válida para cuantificar el estigma del VIH entre estudiantes de salud que hablan portugués brasileño.

Knowledge level of the community and healtcare workers about radiological examinations and harmful effects of radiation: a review

Patients, doctors, and radiology professionals are exposed to ionizing radiation in the diagnostic and therapeutic applications of radiology. Despite the proven harmful effects of medical radiological methods used for diagnosis and treatment, it is not possible to completely abandon these procedures. There is a lack of knowledge in the community about radiological examinations, the effects of radiation, and radiation protection. To increase awareness about radiation, it is essential to educate patients, enhance the education of healthcare students, and provide in-service training for all hospital staff. This way, knowledge levels can be improved, and the harmful effects of radiation can be minimized.

Intercultural sensitivity in Chilean healthcare profession students

Each culture has unique health care related values, habits, perceptions, expectations, norms, etc., that makes cultural competence an important attribute to be developed by healthcare professionals, to ensure they provide effective treatment. Intercultural sensitivity (IS) is the affective dimension of cultural competence. The objective of this study is to explore the self-perceived level of IS in first and last year students of three health sciences professions (i.e., Dentistry, Medicine, and Nursing) at the Universidad de la Frontera, Temuco, Chile. This study adopted a cross-sectional design and a group comparison (e.g., year of study). 312 students completed the Intercultural Sensitivity Scale (ISS). Findings showed that overall ISS scores ranged from 1.83 to 4.94, with a mean score of 4.11 (s.d. 0.43). Group comparison between first and final year students showed statistically significant differences (4.18 vs. 4.00; p < 0.001). Medical and nursing students had a significantly higher overall mean IS score compared to dental students (4.21 and 4.16, respectively vs. 4.02; p < 0.01). There were also significant differences between three factors (interaction engagement; interaction confidence; and interaction enjoyment) by healthcare profession. These findings allow for discussion of the need for explicit incorporation and development of cultural competence in on health care professional curricula. Longitudinal research is needed to explore how IS changes over time, along with generating qualitative data from the student populations IS experiences and exposure.

Substantial Increases in Healthcare Students' State Empathy Scores Owing to Participation in a Single Improvisation Session.

To determine whether the 12-item state empathy scale could be modified reliably to measure empathy in healthcare professions students and to detect changes in their empathy owing to a single improvisation (improv) session. Three cohorts of students from two healthcare professions programs (total = 165 students) participated in an improv session. During the session, one of the researchers (BS) tasked the students with several improv activities. Participants' self-reported state empathy scores were assessed at three time points (pre-improv, post-improv, and end of semester) using revised, in-class paper versions of the State Empathy Scale. The exploratory factor analysis revealed a single factor solution for the revised scale, justifying the creation of an overall state empathy score from the questionnaire. Cronbach's alpha reliability values averaged 0.87. Students' mean empathy scores were higher directly after the improv session than directly prior to the session (p < 0.0001; effect size = r = 0.67, 0.55, and 0.79 for cohorts 1, 2, and 3, respectively). These findings show that a single one- or two-hour improv session can foster substantial increases in healthcare professional students' state empathy for one another. Greater healthcare professional empathy and compassion foster better healthcare team cooperation and patient outcomes, so healthcare professionals and their students should engage in such empathy-enhancing activities at regular intervals throughout their training and careers.

Paper-based geriatric interprofessional education for enhancing students’ interest in treating older people

Interprofessional education is one of the interventions used to increase health care students’ motivation for working with older patients. Previous research about such interventions has been conducted without the use of control groups and has given inconclusive results. The objective of the present curricular resource was: Does geriatric paper-based interprofessional education influence students’ interest in treating older people? During a one-year period, undergraduate fourth-year medical and third-year nursing students wrote four health care plans for four different paper-based older patient cases. In the intervention group students were paired up in interprofessional couples. In the control group students made the assignment alone. Interest for working with older patients was measured on a 5-point Likert scale before and one year after the intervention. In both groups, no significant change was found. Before-interest score of the interprofessional group was relatively high (3.8) so the non-significant results may be due to a ceiling effect. Nursing students’ interest in treating older people at the start of the research was higher than medical students’ interest.

Mental Disorders Among Healthcare Students Attending a Large University Hospital in Milan, Italy.

The high incidence rates, treatment difficulties, and tendency to become chronic, which subsequently affects personal and occupational functioning, make mental health disorders among the most important public health concerns. In this context, healthcare university students (HS) appear to be more vulnerable to psychological distress than others. Investigate the prevalence of diagnosed mental illness among different groups of HS to detect students who may be psychologically vulnerable and determine whether the implementation of support interventions is necessary. All HS who had a clinical examination performed by an occupational physician at our occupational health unit between 2021 and 2022 were included in our case series. Data were collected and analyzed as part of the occupational physicians' health surveillance program. out of 679 HS (507 females, 172 males, aged 22.2±3.9 mean±s.d) undergone clinical examination at our Occupational Health Unit, 36 (5.3%) reported a diagnosed psychiatric illness, and 20 were receiving pharmacological therapy at the time of the visit. A higher prevalence of psychological disorders has been highlighted in females (6.1% vs 2.9% in males) and students of the mental health sector (11.1%) when compared with others. A fit-to-work judgment with prescription was necessary for 16.7% of students with mental diseases. The presence of psychiatric disorders was associated with underweight (27.8%) and higher smoking habit (44.4%). These results underline the necessity of improving the current health surveillance protocols, which should also evaluate students' psychological fragility and implement effective intervention strategies to promote their health and wellbeing.

Increased Perceived Confidence in Professional Role Skills among Undergraduate Dietetic Students Following Simulation-Based Learning Experiences

Simulation-based learning experiences (SBLEs) are effective for teaching healthcare students clinical and communication skills. The current study assessed self-perceived clinical and communication confidence among dietetics students completing a series of four SBLEs (3 group, 1 individual) across nine months. Dietetics students were recruited in February 2023 prior to their first SBLE. Simultaneously through the academic year, students completed clinical and communication courses. Students were invited to complete an online, anonymous self-reported survey regarding confidence with nutrition care and communication prior to their first SBLE (Time 1), prior to their third SBLE (Time 2), and following their final SBLE (Time 3). The survey measured healthcare work experience and self-perceived confidence. Student confidence increased among 30 of the 38 indicators (p &lt; 0.05). At Time 2 (following two group SBLEs), those with healthcare experience had higher confidence among 12 of the 39 items (p &lt; 0.05). At Time 3 (following four simulation experiences) those with healthcare experience had higher confidence among just four of the 39 total items (p &lt; 0.05). Cohort increases in confidence suggest that SBLEs, along with dietetics coursework, were critical in increasing confidence and students’ perceived ability to carry-out entry-level tasks of a dietitian. While student confidence increased across the cohort, SBLEs were particularly beneficial in leveling confidence between those with prior clinical experience and those without.

Good Hand Hygiene Practices: Increasing Public Awareness through Policy and Public Campaigns

This descriptive quantitative research evaluates compliance with and perceptions of hand hygiene practices among healthcare workers in hospitals in the city of Prabumulih and in the district of Muara Enim. Employing a simple random sample, 115 healthcare professionals were surveyed using a questionnaire based on the Health Belief Model (HBM) administered via Google Forms. The study primarily focuses on various perceptions including susceptibility, severity, benefits, barriers, cues to action, and self-efficacy towards hand hygiene. Statistical analyses, both descriptive to outline the general tendencies and inferential to explore the interconnections between different HBM constructs, aim to provide insights into the factors influencing hand hygiene practices. This research underscores the critical gaps between knowledge and actual hand hygiene behavior, particularly evident among healthcare students, highlighting the need for targeted educational strategies to enhance compliance and reduce disease transmission effectively.

Substance use Attitudes, Beliefs, Experience, and Knowledge Among Nursing and Nursing Assistant Students

ABSTRACT Stigma is a public health concern. Stigmatizing attitudes toward persons with substance use disorders (SUDs) can adversely impact clinical care and outcomes. Beliefs about SUD, prior experience and familiarity to persons with SUD, and educational curricula drive attitudes among health-care workers. In 2019, nursing and nursing assistant students were recruited through an online survey platform. Participants completed an SUD knowledge test and a survey assessing education, beliefs, personal experience, and confidence in recognizing the signs and symptoms of SUD. One hundred and ten health-care students (nursing students, n = 67 and nursing assistant students, n = 43) completed the survey. Among nursing assistant students, endorsing a disease model of addiction (F(2, 40) = 5.83, p < .001, R 2 = .23), and personal familiarity with SUD (F(2, 40) = 4.46, p < .001, R 2 = .18), were significantly positively predictive of positive regard toward working with persons with SUD. For nursing students, endorsing a disease model of addiction, educational curricula involving persons with SUD, and personal familiarity were significantly positively predictive of positive regard toward working with persons with SUDs (F(2, 61) = 11.52, p < .001, R2 = .36). Interventions to mitigate drug-related stigma among health-care students should center students with personal familiarity, promote the disease concept of addiction, and incorporate contact-based training.

Enhancing Primary Health Care through Interprofessional education: Insights from a Training Workshop.

Strengthening primary care services with a focus on comprehensive Primary Health Care principles necessitates collaborative work practices within interprofessional teams. In Italy, the Local Health District of Florence embodies a comprehensive Primary Health Care -inspired model of primary care, prominently featuring the House of Community concept. This work presents findings and insights from a multidisciplinary, interprofessional education activity tailored for healthcare professionals, researchers, and students actively participating in the primary care reorganization. The activity was structured using a four-phase learning model (imaginative, analytical, common sense, and dynamic), aligning with four distinct activities (brainstorming, lecture, case study, and group project). Key themes that emerged encompassed the significance of nurturing relationships among team members, the aspiration for an inclusive work environment, the vital role of community engagement and collaboration across various services, disciplines, and sectors beyond healthcare. These themes highlight the essential attributes of successful primary care practices built on the principles of comprehensive comprehensive Primary Health Care. Throughout the innovation process of primary care services, interprofessional education training events emerged as indispensable components for bolstering implementation and ensuring sustainability. This study underscores the crucial role of interprofessional education in bridging the gap between theoretical constructs and practical application, emphasizing that comprehensive Primary Healthcare principles find tangible manifestation in real-world scenarios.

Mitigating Weight Stigma: A Randomized Controlled Trial Addressing Obesity Prejudice through Education among Healthcare Undergraduates

Beyond the challenges presented by obesity itself, a considerable portion of the population encounters prejudice and discriminatory behavior based on their weight and size. This phenomenon, termed weight stigma and weight bias, appears to be perpetuated not only by the broader society but also by healthcare providers, leading to distrust and alienation among individuals with obesity, thereby exacerbating a global issue. Recognizing weight stigma as a violation of human rights and its association with declining health outcomes, there is a pressing need to explore evidence-based strategies for mitigating it within healthcare. This is especially crucial at the early stages of professional development. Methodology: A randomized controlled trial employing a 60 min lecture experimental design was conducted to evaluate changes in conceptions, beliefs, and prejudices toward obesity among healthcare undergraduates (n = 242). Results: Semantic network analysis revealed participants’ conceptualization of obesity as a condition closely linked to diet and sedentary habits. Moreover, three out of four healthcare students considered obesity a disease for which the individual is responsible. While individuals with obesity were described as weak, lazy, and having a high affinity for food, these prejudices decreased following the educational intervention. Conclusion: Following an educational intervention based on the multifactorial nature of obesity and weight stigma, it was possible to modify prejudices and conceptions about obesity among future healthcare professionals.

Fostering engagement in virtual anatomy learning for healthcare students

BackgroundThe use of virtual learning platforms is on the rise internationally, however, successful integration into existing curricula is a complex undertaking fraught with unintended consequences. Looking beyond medical and pedagogic literature can provide insight into factors affecting the user experience. The technology acceptance model, widely used in software evaluation, can be used to identify barriers and enablers of engagement with virtual learning platforms. Here, the technology acceptance model was used to scaffold the exploration of the factors that influenced students' perceptions of the virtual anatomy platform, Anatomage and how these shaped their intention to use it.MethodsFocus groups identified factors influencing students use of the Anatomage tables. Interventions were rolled out to address these findings, then further focus groups and the technology acceptance model identified how factors including self-efficacy, enjoyment, and social norms influenced students’ intention to use the Anatomage table in the future.ResultsStudents raised significant concerns about understanding how to use the Anatomage table. Moreover, students who considered themselves to be poor at using technology perceived the Anatomage table as more complicated to use. The subjective norm of the group significantly altered the perceived ease of use and usefulness of the Anatomage. However, enjoyment had the greatest impact in influencing both perceived usefulness and perceived ease of use. Indicating that enjoyment is the largest contributing factor in altering technology engagement in healthcare cohorts and has the biggest potential to be manipulated to promote engagement.ConclusionsFocus groups used in tandem with the technology acceptance model provide an effective way to understand student perceptions around technology used in the healthcare curricula. This research determined interventions that promote student engagement with virtual learning platforms, which are important in supporting all healthcare programmes that incorporate technology enhanced learning.