Large Student Cohorts Research Articles

Quantifying the medical student learning curve for ECG rhythm strip interpretation using deliberate practice.

Objectives: Obtaining competency in medical skills such as interpretation of electrocardiograms (ECGs) requires repeated practice and feedback. Structured repeated practice and feedback for ECGs is likely not provided to most medical students, so skill development is dependent on opportunistic training during clinical rotations. Our aim was to describe: the amount of deliberate practice completed for learning ECG rhythm strip diagnoses in first year medical students, the learning curve for rhythm strip diagnosis, and student experiences with deliberate practice.Methods: First year medical students from two medical schools were provided with online rhythm strip practice cases. Diagnostic accuracy was measured throughout practice, and students were provided feedback for every case they completed. Total cases practiced and time spent practicing were correlated with their performance during practice and on an exam.Results: 314 of 384 (82%) students consented. The mean number of ECGs each student practiced was 59 (range 0-280), representing 18,466 total instances of deliberate practice. We generated mathematical models that accurately correlated both the number of cases practiced and time spent practicing, with diagnostic accuracy on an exam (p<0.001). For example, students would need to spend on average of 112 minutes and complete 34 practice cases to obtain 75% on an ECG rhythm strip exam. Student satisfaction was high using the online cases.Conclusions: We succeeded in delivering deliberate practice for ECG rhythm strip interpretation to a large cohort of students at 2 medical schools. We quantified a learning curve that estimates the number of cases and practice time required to achieve pre-determined levels of diagnostic accuracy. This data can help inform a competency-based approach to curriculum development.

A professional development program with an assessed ePortfolio: A practical solution for engaging undergraduates with their career development in large student cohorts

Undergraduate biomedical science degree-programs are considered to be non-vocational, with a diverse range of career outcomes. At our university, student and academic feedback indicated that biomedical science students were anxious and uncertain about their career options. In response to this careers anxiety, an in-curriculum, course-wide and assessed professional development program (PDP) was developed and delivered into the biomedical science degree-program by an integrated team of careers educators and biomedical academics. This program aimed to engage a large cohort of biomedical students (&gt;1000) with their career development, improving their careers awareness and reducing their anxiety about careers options. The impacts of the program on students’ career and employability skills development, as well as their self-reported levels of psychological distress, were evaluated with on-line anonymous student surveys. Student engagement with the program was linked with program assessment submission rates and student interactions with the University Careers Service. Completion of the program increased students’ careers knowledge and confidence, enhanced their awareness of career options and employability skills and increased their engagement with the University Careers Service. It did not alter students’ self-reported levels of depression, anxiety and stress, but students who rated themselves poorly on careers awareness and confidence statements were more likely to have severe depression, anxiety and stress. This program provides a practical approach for students’ career and employability skills development in large cohorts, but could be expanded to include an intervention to reduce student anxiety.

Theorems or procedures? Exploring undergraduates’ methods to solve routine problems in linear algebra

While the lion’s share of mathematics education research in linear algebra has been concerned with the conceptual aspects of students’ learning, this study focuses on procedural knowledge that undergraduates can develop in a typical first-year course. The study analyzes the methods that a large cohort of second-semester students applied in a final exam to solve three routine problems: finding a basis for a matrix column space, solving a linear system of equations, and devising a normal to a subspace. The results indicate an inverse relation between the efficiency of the methods that students used and the number of students who used them. This was especially evident in the case of theorems, the application of which was avoided by all but a few students in favor of compound algebraic procedures. Furthermore, the study shows that at the end of an instructional sequence, many students can struggle with choosing an appropriate problem-solving method and carrying it out without mistakes. The analysis of students’ mistakes is leveraged to draw university teachers’ attention to common difficulties in linear algebra.

Nursing students' perceptions of a clinical learning assessment activity: 'Linking the puzzle pieces of theory to practice'.

The nursing profession struggles with providing a bridge to close the theory to practice gap for students. Students are expected to graduate with competencies that promote their safe and comprehensive nursing care provision in accordance with professional standards. This paper reports on students' a simulated clinical educational intervention embedded into a second-year nursing student clinical topic offering experiential learning opportunities for a large cohort. Feedback was analysed using Braun and Clarke's (2006) thematic qualitative process to investigate student-learning experiences and present student perceptions of this experience. Three key themes were identified: support promoted learning, focus on the bigger picture and practice clarifies puzzle pieces. Students perceived the simulated clinical experience as beneficial to their confidence, learning and ability to develop their professional practice. Promotion of learning outcomes facilitated by the structured, supportive and educational approach was important for students. Nurse educators have a responsibility to develop learning experiences that enable student's ability to link theory to practice in context. Ongoing exploration and evaluation of this intervention is required however, such an approach appears to support student's knowledge development for transference across situations and within large student cohorts.

Assessing Student's Achievement Gaps between Ethnic Groups in Brazil.

Achievement gaps refer to the difference in the performance on assessments of students belonging to different social groups. Achievement gaps between ethnic groups have been observed in countries with heterogeneous populations. In this paper, achievement gaps between ethnic populations in Brazil were analyzed by studying the performance of a large cohort of senior high-school students in a standardized national exam. Ethnic groups were stratified by Brazilian states and socio-economic variables to homogeneize the groups, and the analyses focused on the disciplines of mathematics and writing that involve different cognitive functions. A Welch’s t-test analysis was performed and key socio-economic variables that may explain the gaps were studied. The results show that gaps between ethnic groups of students living in low-income households were either statistically insignificant or small (2–) if statistically significant. Larger gaps however were observed for students coming from high-income families in some contexts. Although parental education was associated with higher performance, it may either increase, decrease or maintain the gaps between White and Black, and between White and Pardo students. Our results support that socio-economic variables, linked to historical developments, have an impact on student’s performance irrespective of ethnic background, resulting on little to no influence on group performance when students are exposed to similar cultural and economic contexts.

Perception and knowledge of HPV-related and vaccine-related conditions among a large cohort of university students in Italy

ABSTRACT HPV is involved in cervical, anal, penile, vulvar and oropharyngeal cancers, as well as genital warts. It is important to investigate knowledge and attitudes among university students, considering in this age a shift in healthcare decision-making from parents to students themselves. The aim of this study was to estimate knowledge and perception of HPV in terms of potential shame for HPV-related conditions, trust in vaccine efficacy and worry for potential side effects. The study involved students (18–25 years old) from the Universities of Padua and Verona, Italy. Socio-demographic and behavioural characteristics were collected with a questionnaire (n = 9988). Female gender and older age were positively associated with higher knowledge. The adjusted logistic regression showed an association between the set of perceptions investigated and the vaccination status, while a direct connection with knowledge was not found. However, another adjusted linear regression showed that a good set of perceptions could be partially explained by a high level of knowledge. Perceptions seem to fill an intermediate position between the knowledge and the decision to get vaccinated. The potential shame deriving from asking for HPV-vaccination was not identified as a relevant barrier. Having received information from healthcare workers, family and school showed to be positively associated with the adhesion to the vaccination policy. This study identifies university students as a possible target for HPV vaccination and pinpoints specific areas that might be targeted as first to encourage vaccine uptake. Primary prevention together with screening programmes remains essential in further reducing the burden of HPV-related diseases.

Assessing Diagnostic Reasoning Using a Standardized Case-Based Discussion.

Background:Development of diagnostic reasoning (DR) is fundamental to medical students’ training, but assessing DR is challenging. Several written assessments focus on DR but lack the ability to dynamically assess DR. Oral assessment formats have strengths but have largely lost favour due to concerns about low reliability and lack of standardization. Medical schools and specialist medical colleges value many forms of oral assessment (eg, long case, Objective Structured Clinical Examination [OSCE], viva voce) but are increasingly searching for ways in which to standardize these formats. We sought to develop and trial a Standardized Case-Based Discussion (SCBD), a highly standardized and interactive oral assessment of DR.Methods:Two initial cohorts of medical students (n = 319 and n = 342) participated in the SCBD as part of their assessments. All students watch a video trigger (based on an authentic clinical case) and discuss their DR with an examiner for 15 minutes. Examiners probe students’ DR and assess how students respond to new standardized clinical information. An online examiner training module clearly articulates expected student performance standards. We used student achievement and student and examiner perceptions to gauge the performance of this new assessment form over 2 implementation years.Results:The SCBD was feasible to implement for a large student cohort and was acceptable to students and examiners. Most students and all examiners agreed that the SCBD discussion provided useful information on students’ DR. The assessment had acceptable internal consistency, and the associations with other assessment formats were small and positive, suggesting that the SCBD measures a related, yet novel construct.Conclusions:Rigorous, standardized oral assessments have a place in a programme of assessment in initial medical training because they provide opportunities to explore DR that are limited in other formats. We plan to incorporate an SCBD into our clinical assessments for the first year of clinical training, where teaching and assessing basic DR is emphasized. We will also explore further examiners’ understanding of and approach to assessing DR.

After the war is over: the role of General Sir Arthur Currie in the development of academic medicine in Canada

Canadian universities faced a challenge with the return of a large cohort of battle-hardened students and faculty from the First World War. General Sir Arthur Currie, considered one of the few successful generals of the war, returned to a welcome of silence in Canada. McGill University exploited the opportunity to recruit him as its president. Currie oversaw a campaign of building construction and faculty development at McGill that also had a significant effect on the rest of Canada. Through his fostering of the Montreal Neurological Institute and the recruitment of Dr. Wilder Penfield, Currie facilitated the development of multidisciplinary medicine, which integrates clinical care with research — an aspiration still held by specialty medicine in Canada today.

How does studying rurally affect peer networks and resilience? A social network analysis of rural‐ and urban‐based students

To examine differences in peer networks between urban-based students and rural-stream students in an Australian medical school and to examine how characteristics of networks relate to resilience. Cross-sectional survey asking students to signify social, academic and support relationships with students in the same year and to complete a survey on their resilience. All second-, third- and fourth-year students at the Australian National University Medical School. Social network analysis comparing peer networks, t-test comparing mean resilience of urban and rural students. A visual analysis of the peer networks of year 2, 3 and 4 medical students suggests greater integration of rural-stream students within the year 2 and 4 urban cohorts. Resilience is similar between year 2 and 3 students in both urban and rural streams, but is significantly higher in year 4 rural-stream students, compared to their urban-based peers. Networks of rural-stream students suggest key differences between their period spent rurally and on their return and integration within the larger student cohort. Furthermore, rural students, once reintegrated, had larger and stronger social networks than their urban counterparts. The results of the study suggest that the rural experience can instruct support systems in urban settings. However, whether the rural placement creates a more resilient student or resilient students are selected for rural placement is unclear.

The Keys to STEM: Australian Year 7 Students’ Attitudes and Intentions Towards Science, Mathematics and Technology Courses

Educational researchers have long noted the apparent link between positive student attitudes and a student’s desire to continue their study of particular subjects beyond the compulsory years of schooling, with much of the research motivated by concerns around declining student participation rates in high-school and university. However, unambiguously measuring students’ attitudes is notoriously difficult. In addition, the question of which attitudes have the most significant effect on student intentions is not fully understood. This study was designed to address the gap in understanding between students’ attitudes and their enrolment intentions by surveying a large cohort of Australian students at regular intervals during their first year of high-school (Year 7, aged 12–13 years). An innovative, new digital instrument was used to gather quantitative data about students’ attitudes towards school subjects across seven constructs. Subject Attitude Profiles were then constructed for the disciplines of science, mathematics and design technologies and compared with each other and also with a Composite Attitude Profile for all school courses. We show that although students’ attitudes to the STEM subjects vary widely, their attitudes generally decline over the first year of high-school with regard to a number of attitudinal constructs. We also show that the trends within these STEM disciplines are not identical and we therefore conclude that each discipline requires an individual response if students’ attitudes are to be addressed.

Identifying individual differences using log-file analysis: Distributed learning as mediator between conscientiousness and exam grades

Online learning poses major challenges on students' self-regulated learning. This study investigated the role of learning strategies and individual differences in cognitive abilities, high school GPA and conscientiousness for successful online learning. We used longitudinal log-file data to examine learning strategies of a large cohort (N = 424) of university students taking an online class. Distributed learning, the use of self-tests and a better high school GPA was associated with better exam grades. The positive effect of conscientiousness on exam grades was mediated by distributed learning. Conscientious students distributed their studying over the course of the semester, which in turn, improved grades. The results provide insights into objective study behavior of online students and shed light on the question of how individual differences in cognitive and non-cognitive prerequisites shape the use of learning strategies and exam grades. Practical implications for online course designers and ideas for further research are discussed.

The transformative power of digital humanities in teaching family history online

This paper explores the transformative power of digital humanities in teaching family history online to large cohorts of Australian domestic students. It takes as a case study a unit developed specifically for students to learn about how to research their convict ancestors’ lives and how to situate their ancestors’ lived experiences within relevant wider contexts. Its focus is twofold. The convergence of rapidly expanding digital repositories and databases of family history-related information and increasingly sophisticated online teaching platforms and how this has facilitated a shift from face-to-face to fully online learning and teaching is examined. The ways in which this transformative change was engineered through the unit design, delivery, and evaluative processes are then canvassed. The case study demonstrates how, with thoughtful, well-structured, and innovative approaches to design and by adopting a bespoke delivery model for online delivery, students can readily learn to access and engage critically with extensive online resources and can be equipped with the digital tools to use these optimally and to their satisfaction.

Birmingham Bog outdoor laboratory: potentials and possibilities for embedding field-based teaching within the undergraduate classroom

ABSTRACTProviding cost-effective, hands-on field-based experiences to large cohorts of undergraduate students provides a core challenge for effective teaching and learning. This grand challenge is tackled through the construction of an exemplar outdoor learning environment within the Environmental Change Outdoor Laboratory (ECOLAB): Birmingham Bog (BB). Adjacent to the Geography building, the facility aims to produce a seamless, interconnected learning environment (in both space and time) that brings inaccessible fieldwork activities direct to the classroom at the time and frequency appropriate to the learning objectives. With the integration of this facility within a 3rd year undergraduate module, we explore through group interviews the ways in which BB adapted and influenced students’ engagement with lecture material, and the extent to which the approach can complement or replace current field based teaching activities. The group interviews identified how BB was considered an example of “effective learning” within the context of the wider degree programme. However, if confirmed, the value placed on residential field courses cannot be met by such campus experiences. Despite this, BB represents an increasingly fertile space for deeper stimulation and innovative ways of learning; diversifying pedagogical techniques and enabling students to re-engage with lecture content.

A Scoring System for Assessing Learning Progression of Dental Students' Clinical Skills Using Haptic Virtual Workstations.

The aim of this study was to develop and test a scoring system to assess the learning progression of novice dental students using haptic virtual workstations. For the study, 101 first-year dental students at a UK dental school conducted one practice task (task 1) and four simulated cavity removal tasks (tasks 2-5) of increasing difficulty over two laboratory sessions in 2015. Performance data on the students' attempts were recorded as haptic technology-enhanced learning (hapTEL) log-files showing the percentage of caries, healthy tissue, and pulp removed. On-screen results were photographed and submitted by the students to the tutors. A scoring system named the Accuracy of Caries Excavation (ACE) score was devised to score these results and achieve an even distribution of scores and a calculated combined score. A total of 127 individual logged attempts by 80% of the students over sessions 1 and 2 were recorded and submitted to the tutors. The mean ACE scores for both sessions for tasks 2 through 5 were 9.2, 11.6, 6.4, and 4.9, respectively; for Session 2 (tasks 3-5), scores were 12.4, 6.7, and 5.0, respectively (p<0.001). The average performance on task 3, which was attempted in similar numbers during both sessions, improved from the first to the second session (8.14 vs. 12.38; p=0.009). Using the HapTEL system in a first-year BDS curriculum improved the students' performance of simulated cavity preparation after practicing over two sessions. Use of the ACE scoring system enabled tutors to make consistent assessments across a large student cohort and provided an objective method of formative assessment.

Work integrated learning initiatives: live case studies as a mainstream WIL assessment

ABSTRACTIndustry demands highly skilled, work ready and adaptable graduates who can solve complex problems. Work integrated learning (WIL) offers educators an authentic assessment that approximates future performance requirements. Often this would include workplace placements or internships for a selected number of students. In this paper, we evaluate the ‘live case study’ assessment as an example of an alternative embedded approach to WIL. We address a lack of simple and specific criteria for assessing WIL and assess the live case approach against these criteria. We find that the live case approach is an effective form of WIL, offering large numbers of students an authentic learning experience. We recommend this approach to universities seeking to offer large cohorts of students a workplace learning experience that is less time and resource dependent than internships, and effective for international and distance students.

English academic writing convergence for academically weaker senior secondary school students: Possibility or pipe-dream?

This paper discusses key findings of a study which sought to assess the impact of the Reading to Learn (RtL) literacy intervention on individual student performance as applied to senior secondary school students at two schools in the Western Cape of South Africa. The RtL intervention was implemented against a backdrop of serious concerns about the state of literacy development in schools in South Africa, especially amongst non-native English-speaking students from low socioeconomic communities as well as migrant communities. By taking each student's written pieces of work, submitted at various stages throughout the academic school year, each piece of writing was assessed and codified, which allowed for a detailed examination of various patterns using both descriptive and inferential statistics. The salient finding was that students, who were shown to be academically weaker pre-intervention, generally exhibited a greater overall improvement in their respective English writing skills throughout the intervention. Thus, with an appropriately targeted intervention (like RtL) a convergence or ‘catch-up’ effect might likely occur for classes with large cohorts of non-native English-speaking students, who are immersed in English medium-of-instruction schools.

Snapshots of Simulation: Innovative Strategies Used by International Educators to Enhance Simulation Learning Experiences for Health Care Students

BackgroundInnovations in simulation in nursing and health care continue to be developed as creative and committed educators respond to challenges of providing pedagogically sound, engaging and effective learning experiences for large student cohorts. Time-pressed educators may find it difficult to network with others working in simulation-based learning, and thus, it is useful to provide summaries or snapshots to provide a brief overview of activities in various countries using simulation in a variety of ways. MethodThe purpose of this paper is to profile a diverse range of innovative, cost-effective, and tested simulation approaches that have been implemented in healthcare programs by nursing educators from a range of countries to spark creativity. Each strategy was designed to address contemporary and critical practice issues. ResultsThey facilitate immersion in authentic clinical scenarios, increase students' awareness of cues in the environment that may compromise health and safety. ConclusionThese snapshots of simulation prepare students for cultural or clinical realities that they may not routinely encounter because of the inherent restrictions associated with clinical placements.

Modifiable predictors of insufficient sleep durations: A longitudinal analysis of youth in the COMPASS study

The purpose of the current study was to simultaneously examine commonly proposed risk and protective factors for sleep deprivation over time among a large cohort of Ontario and Alberta secondary school students. Using 4-year linked longitudinal data from youth in years 1 through 4 (Y1[2012/2013], Y2[2013/2014], Y3[2014/2015], Y4[2015/2016]) of the COMPASS study (n=26,205), the likelihood of students meeting contemporary sleep recommendations was tested based on their self-reported substance use, bullying victimization, physical activity, and homework and screen time. Models controlled for the effect of student-reported gender, race/ethnicity, grade, school clustering, and all other predictor variables. Relative to baseline, students became less likely to meet the sleep recommendations if at follow-up they had initiated binge drinking, experienced cyber bullying victimization, or were spending more time doing homework, with other factors held constant. The likelihood of reporting sufficient sleep increased if students had begun engaging in resistance training at least three times a week. No longitudinal effect was observed when students increased their caffeine consumption (energy drinks, coffee/tea), initiated cannabis or tobacco use, experienced other forms of bullying victimization (physical, verbal, or belongings), engaged in more moderate-vigorous physical activity, or increased their screen use of any type. Few of the commonly purported modifiable risk and protective factors for youth sleep deprivation held in multinomial longitudinal analyses. Causal conclusions appear premature, with further research required to confirm the targets likely to be most effective in assisting more youth in meeting the sleep recommendations.

HEALTH RISK TRANSITION AND LOW MORTALITY PATTERNS AMONG A NATIONAL COHORT OF ASPIRATIONAL THAI OPEN UNIVERSITY STUDENTS.

In the last 50 years Thailand has achieved advanced demographic and health transitions. Many infectious diseases are controlled and infant and maternal mortality rates are among the lowest in the region. Within such a low mortality setting, however, substantial variations in health persist, with education being a major driver. This paper assesses the ongoing mortality transition in Thailand, examining relationships between risk factors and mortality outcomes among a large nationwide cohort of distance-learning Open University students, as well as examining the differential mortality benefit enjoyed by this educated group when compared with the general Thai population. The cohort comprised 87,151 participants, who in 2005 completed a questionnaire collecting detailed information on socio-demographics, health behaviours and health outcomes. Participants were aged 15-87 at baseline and lived in all regions of the country. Cohort members' citizen identification numbers were matched with official death registration records to identify mortality among participants. A total of 1401 deaths were identified up to November 2016. Results show cohort study participants experiencing mortality at approximately one-third of the rate of the general population in the same age and sex groups. The gap between the mortality rates in the two groups widened with increased age. Differential risk factor prevalence among the two populations, particularly lower overweight and obesity prevalence and lower cigarette smoking rates in the cohort, can explain some of this variation. The largely unmeasurable effect of aspiration for life improvement through distance education while embedded in their communities is shown by this study to have a powerful effect on mortality risk. With overall education levels, including higher education, rising in Thailand this growing group of educated aspirational Thais may represent future trends in Thai mortality. Identifying the drivers and characteristics of this mortality variation can help inform policies to provide health services and to help reduce mortality in the whole population.

Assessing Online Asynchronous Communication Strategies Designed to Enhance Large Student Cohort Engagement and Foster a Community of Learning

With the increasing diversity of pedagogic models of delivery in higher education, universities are continually exploring practises of learning and teaching designed to enhance student experience and retention. The number of courses provided online continues to grow through, among other reasons, an escalation of higher education (HE) students requiring flexible approaches to learning and learner engagement. However, HE Students participating in online courses can experience a sense of physical isolation which, if allowed to escalate, can lead to reduced performance and potential withdrawal from courses. Creating an online learning environment that fosters a sense of connection and assimilation should enhance an individual’s learning experience and engagement. This enquiry, conducted through a two-cycle participatory action research approach, was designed to explore possible strategies to enhance learner engagement. Elaborations introduced in cycle two, and the construct of recommendations, were based upon the analysis of data collected through online interactions between students and lecturer, appraisal of online student communications, and the utilisation of an online questionnaire. Participants were 2nd year undergraduate Bachelor of Education students following a Design and Technology in Education course, with cohorts of 131 and 124 respectively. The research process included assessing the effectiveness of weekly newsletters and group discussion board summaries utilising student quotes, along with supporting practises, for promoting a sense of inclusion and improving interactions within online learning communities. The research concludes by providing a list of suggested strategies shown through this research to have enhanced large student cohort engagement and foster a community of learning and learners having shared values and aspirations, and willing to learn through engagement with others.