Clinical Learning Research Articles

Robust Interprofessional Clinical Education and Practice to Improve Health Equity

The purpose of this paper is to highlight innovative interprofessional clinical learning opportunities at a Nurse-led Mobile Health Clinic (MHC) that prepares nursing students and allied health students to care for diverse populations with a focus on screening for the social determinants of health (SDOH) and acting on positive screens. Our Nurse-led MHC provides free health screenings in partnership with food pantries and crisis ministries in urban and rural areas. We also provide self-management support classes for those with hypertension and/or diabetes.

MEDICAL STUDENTS PERSPECTIVE ON THE TEACHINGPROCESS OF RADIOLOGY DURING AND AFTER THECOVID-19 PANDEMIC

Background: Over the last few years, radiology teaching and training have transformed from traditional lectures to early team-based clinical learning and case-based teaching. Objectives: To assess the perspective of undergraduate medical students regarding radiology teaching during and after the coronavirus disease 2019 (COVID-19)pandemic. Subjects and methods: A cross-sectional study was conducted among undergraduate medical students from third year to interns enrolled in Taif University for the academic year 2023-2024. An online, self-administered questionnaire was utilized for data collection. It contains 20 questions divided into three sections: I) general information and students demographic data (4 questions) II) questions related to the students teaching-learning experiences after the COVID-19 pandemic period (8 questions) and III) questions related to the students teaching-learning experiences in the COVID-19 pandemic period (8 questions). Results: A total of 204 students were included in the study. They were equally distributed according to their gender and almost equally distributed according to their academic year. The majority (86.3%) of them used tablets as the primary device for e-learning during and after the COVID-19 pandemic. Significant improvements were observed in the perspective of the participants regarding the quality of on-site radiology teaching (p<0.001), their performance in on-site radiologyteaching (p=0.007), and thoughts related to radiology teaching via e-learning (p=0.023) after the COVID-19 pandemic compared to it during the pandemic. Conclusion:Medical students generally view radiology education positively after the pandemic. However, improvements in the structures and assessments of both online and onsite radiology teaching are needed. Interestingly, female students found e-learning and assessments more valuable, while older students appreciated the overall structure more.

Development and psychometric properties of clinical learning environment scale for Chinese nursing students

ObjectiveTo develop a clinical learning environment scale for Chinese nursing students and test its reliability and validity.MethodsBased on Moos social environment theory, qualitative interviews and expert consultations were used to develop a pretest version of the Chinese Nursing Students’ Clinical Learning Environment Scale. With a convenience sampling method, 255 and 1582 Chinese nursing students were selected as the prediction and validation samples, respectively, from December 2022 to March 2023. Exploratory and confirmatory factor analyses were conducted to determine the construct validity.ResultsThe scale consisted of 19 items. Exploratory factor analysis revealed three sub-scales, named goal orientation, interpersonal relation, and learning support, which explained 71.500% of the total variance. The results of the confirmatory factor analysis showed that the GFI was 0.848, the AGFI was 0.806, the RMSEA was 0.090, the RMR was 0.041, the NFI was 0.910, the IFI was 0.916, the CFI was 0.916, the PCFI was 0.798, and the PNFI was 0.793. The reliability values of the three dimensions were 0.870, 0.858, and 0.943, respectively, and the convergent validity values were 0.574, 0.603, and 0.625, respectively.ConclusionThe reliability and validity of the dimensions of the Chinese Nursing Students’ Clinical Learning Environment Scale are acceptable, and the scale can be used as a useful tool for measuring the clinical learning environment of Chinese nursing students.

Enhancing Competency-Based Social Work Skills Through Service Learning and Interprofessional Education in a Student-Run Free Healthcare Clinic

Student-run free clinics (SRFC) offer students the opportunity to learn and work with students from other disciplines; however, there is very little research on the benefits of SRFC to social work students. The purpose of this article is to describe the qualitative student outcomes of a service learning (SL) and interprofessional education (IPE) experience in a SRFC designed to enhance the interprofessional competencies of BSW social work students. Students (n=38) enrolled in a service-learning course and participated in a semester-long SL and IPE experience at a university-affiliated interdisciplinary SRFC. Qualitative findings from student reflections indicated that students perceived that the overall experience facilitated the development of written and verbal communication skills, confidence, and professional identity. The research suggests that SL and IPE were beneficial to student development. We, therefore, recommend that other programs consider exposing BSW students to these experiences early in their program to enhance their educational experience.

Description Competencies of Medical Surgical Nursing Preceptors at Naval Center Hospital Dr. Ramelan Surabaya, Indonesia

This study evaluated the competence of preceptors in surgical medical nursing. The research method uses quantitative descriptive with a cross-sectional research design. The sample number was 100 respondents doing clinical practice in medical-surgical nursing at the Navy Central Hospital. Dr. Ramelan Surabaya. The sampling technique uses Simple Random Sampling. The questionnaire used is the Preceptor Competency Questionnaire, which is a self-assessment. The results showed that all preceptors had good competence in all indicators. These indicators include knowledge competence, clinical skills, teaching ability, communication skills, personal characteristics, leadership, professional behavior, and ethics. However, a small percentage of receptors need to improve the ease of consultation. This research provides new insights into the practice of clinical guidance in surgical medical nursing. It can be applied to enhance the quality of clinical learning in hospitals and nursing education institutions.

Clinical achievement improvement through experiential learning-based training

This study aimed to enhance clinical educators' competence through experiential learning-based preceptorship training. Many clinical educators struggle with implementing effective clinical education, providing guidance, and having limited time for new nurses. The research employed a quasi-experimental design with a pre-posttest control group involving 60 clinical educators. The intervention group received a five-day training module using experiential learning-based preceptorship, while the control group received standard intervention. Data analysis used the Wilcoxon Signed Rank Test to analyse differences before and after intervention, and used Mann-Whitney to analyse differences between the two groups. Analysis revealed significant improvements in critical thinking, patient safety, leadership, communication, research-based practice, and professional development among the intervention group compared to the control group (p-value=0.000). The findings highlight the effectiveness of this training model in enhancing clinical educators' learning outcomes. The study suggests that incorporating experiential learning into clinical education can be a valuable strategy for improving the competence of clinical educators and subsequently achieving better clinical achievements.

Reimagining rural clinical education from lessons learnt during COVID.

Securing access to sufficient and focussed learning experiences is a perennial challenge for medical trainees. This challenge was accentuated during the COVID-19 pandemic lockdowns and with physical isolation processes that decreased in-person patient presentations and a shift to telehealth consultations. This situation has prompted the need to optimise the available experiences and educational responses to overcome the limitations in the number, quantum and range of available clinical learning experiences. Semi-structured interviews were conducted with medical practice teams in four rural general practices to understand how medical trainees' education in rural general practices can be sustained in such circumstances. Key considerations included optimising the available experiences to assist medical trainees to generate the kinds of mental models needed by trainees to conduct medical work, and particularly, when it became even more restricted through remote or physically distanced consultations. It also identified lessons learnt during COVID-19 pandemic lockdowns to inform and improve the provision of trainees' experiences in such practices. Providing experiences for trainees to participate fully in clinical activities is imperative. A sequenced set of experiences was proposed to incrementally prepare trainees to engage in and conduct clinical consultations remotely using digital technologies. Such an approach may not always be easy or possible to enact but offers a pathway of experiences most likely to lead to positive outcomes for the trainees whilst maintaining patient care and safety considerations.

How medical students' trauma histories affect their clinical clerkship experiences.

As the gender demographics of medical students have evolved over the past decades, it is important to understand potential stressors and challenges that may affect clinical learning experiences. This study investigated the prevalence of prior sexual assault (SA) and interpersonal violence (IPV) in medical students and how these affect their clinical clerkship experiences. A survey was distributed to third- and fourth-year medical students at a single institution in August 2022 querying respondents on demographics and prior experiences with SA/IPV at any point in their lives. Respondents who indicated they had previously experienced SA/IPV were directed to questions about how these experiences affected clerkships. Of 419 students, 125 responded to the survey (30.8% response rate). Forty (31.1%) reported a history of SA/IPV-32 (80.0%) women, five (12.5%) men, and three (7.5%) who did not report gender or identified as non-binary. Of the 40 respondents with a history of SA/IPV, 20 (50.0%) reported that their prior history affected their overall clinical experience, and nine (22.5%) felt that it affected their performance. Only seven (17.5%) reported using any resources, such as counselling, during their clerkships. Narrative responses discussed significant effects on performing physical exams, taking a history, interacting with team members, and engaging during clerkships. This work demonstrates the high number of students affected by SA/IPV and how these prior experiences affected core components of their clerkship experiences. Institutions must be proactive to create better supports for learners with histories of trauma, including SA/IPV.

An insight into the clinical learning environment of dental institutes: a study in the twin cities of Pakistan.

To assess the perceptions of dental students regarding their clinical learning environment in an urban setting. This descriptive, cross-sectional survey was conducted from March 2020 to May 2021 after approval from the ethics review committee of Islamic International Dental College, Islamabad, Pakistan. It comprised of clinical year students, house officers and postgraduate trainees from 6 dental teaching hospitals of Rawalpindi and Islamabad. Data was collected using a pre-validated instrument assessing the dental clinical learning environment. Data was analysed using SPSS 24. Of the 1030 students approached, 561(54.4%) responded. Of them, 448(80%) were girls, 234(41.7%) were 3rd year students, 110(19.6%) were 4th year students, 120(21.4%) were house officers and 97(17.3%) were postgraduate trainees. Female students had a better patient attitude and were more confident in their abilities to keep up with their peers (p<0.05). The students were content with the performance of their clinical teachers, with a mean score of 70.99+/-16.0, while the lowest score of 54.67+/-22.9 was for clinical infrastructure and materials. Students of Islamabad pointed out the lack of clinical materials and maintenance of equipment but noted better research opportunities compared to their Rawalpindi counterparts (p<0.05). The clinical learning environment for Islamabad and Rawalpindi cities individually was good. Overall, students were satisfied with their clinical teachers, learning and training experience. Dental materials, infrastructure and maintenance factors scored the lowest.

Use of Mini-CEX as Formative Assessment Tool in the Training of Undergraduate Medical Students in ENT Situation Analysis and the Way Forward.

Mini-CEX assesses clinical competency and is mainly used as a formative assessment tool. Its use in postgraduate training is well documented. However, Mini-CEX would play a significant role in training undergraduate medical students, especially with the commencement of competency-based medical education in India. This work reports the situational analysis of the Mini-CEX implementation in the department of ENT. The Department of ENT is using Mini-CEX for formative assessment of students' clinical competence since 2017. Each student had to complete a minimum of five Mini-CEX encounters before the summative assessment. We reviewed the Mini-CEX assessment records of 149 undergraduate medical students who appeared for the summative exam in 2018. We analysed the records of 874 Mini-CEX encounters. Each Mini-CEX encounter took 11min on average. Each student completed five such assessments, which accounted for 55min of one-to-one teacher-student interaction focused on clinical skills learning. The feedback time varied from 1 to 30min. Feedback was focused on the cognitive (46%) and psychomotor (42%) domains. However, the majority of students reflected that they learned psychomotor skills during the Mini-CEX. Students selected only a few skills for the Mini-CEX, ignoring many must-know skills. Mini-CEX is feasible as a formative assessment tool for medical undergraduates' ENT training. It improves the assessor-student interaction, provides effective feedback, and develops the practice of reflection among students. However, regular review and training of the assessors and students are needed as a quality assurance measure.

Evaluation of the combination of virtual simulation and in-person simulation among undergraduate nursing students: A mixed methods study

AimThis study aimed to evaluate the combination of virtual simulation and in-person simulation among undergraduate nursing students. BackgroundAt present, in-person simulation is the main form of simulation in China. With the development of computer technology, computer-based virtual simulation is gradually applied in simulation and has shown unique advantages. However, simulation format that combines virtual simulation with in-person simulation is rare in China. DesignThis was a mixed methods study, which applied a QUAN→qual sequential explanatory approach. MethodsIn the quantitative phase, a non-randomized controlled trial (NRCT) was employed among 93 junior nursing students from nursing school of a university in China. Students from parallel classes 1, 2 and 3 (45 students) were selected as experimental group, while students from parallel classes 4, 5 and 6 (48 students) were selected as control group. The control group completed the in-person simulation, while the experimental group was required to complete both virtual simulation and in-person simulation. The students’ performance in in-person simulation was evaluated by the teachers according to a demonstrating checklist. After simulation, Students were invited to answer the Students’ Satisfaction and Self-confidence in Learning Scale (SSS), Educational Practices in Simulation Scale (EPSS) and Clinical Learning Environment Comparison Survey (CLECS). A descriptive qualitative study was conducted in qualitative phase. Ten students were recruited by a purposive sampling method from the experimental group and were interviewed by the researcher. A semi-structured interview method was used to conduct in-depth interviews with them. ResultsThe mean score of the students’ performance in the experimental group was higher than that in the control group (63.00 vs 57.67). There were no significant differences in learning satisfaction, self-confidence and simulated practice score (except cooperation dimension) between the two groups (P>0.05). For experimental group, the total CLECS score in in-person simulation was higher than that in virtual simulation, which was 84.98±12.50 and 72.58±13.04 respectively and the difference was statistically significant (t=5.270, p<0.001). Ten students were interviewed in the qualitative phase. Through the interview, we have learned that students believed that virtual simulation combined with in-person simulation is helpful to enhance their knowledge, improve their learning confidence and help them develop non-technical skills (i.e., decision-making and critical thinking). ConclusionIn-person simulation is the preferred form of simulation and virtual simulation is a beneficial supplement to in-person simulation. The combination of the two is suggested to be introduced into the simulation curriculum for undergraduate nursing students.

A clinical consensus-compliant deep learning approach to quantitatively evaluate human in vitro fertilization early embryonic development with optical microscope images

The selection of embryos is a key for the success of in vitro fertilization (IVF). However, automatic quality assessment on human IVF embryos with optical microscope images is still challenging. In this study, we developed a clinical consensus-compliant deep learning approach, named Esava (Embryo Segmentation and Viability Assessment), to quantitatively evaluate the development of IVF embryos using optical microscope images. In total 551 optical microscope images of human IVF embryos of day-2 to day-3 were collected, preprocessed, and annotated. Using the Faster R-CNN model as baseline, our Esava model was constructed, refined, trained, and validated for precise and robust blastomere detection. A novel algorithm Crowd-NMS was proposed and employed in Esava to enhance the object detection and to precisely quantify the embryonic cells and their size uniformity. Additionally, an innovative GrabCut-based unsupervised module was integrated for the segmentation of blastomeres and embryos. Independently tested on 94 embryo images for blastomere detection, Esava obtained the high rates of 0.9940, 0.9121, and 0.9531 for precision, recall, and mAP respectively, and gained significant advances compared with previous computational methods. Intraclass correlation coefficients indicated the consistency between Esava and three experienced embryologists. Another test on 51 extra images demonstrated that Esava surpassed other tools significantly, achieving the highest average precision 0.9025. Moreover, it also accurately identified the borders of blastomeres with mIoU over 0.88 on the independent testing dataset. Esava is compliant with the Istanbul clinical consensus and compatible to senior embryologists. Taken together, Esava improves the accuracy and efficiency of embryonic development assessment with optical microscope images.

Multifaceted nature of young-onset diabetes - can genomic medicine improve the precision of diagnosis and management?

Young-onset type 2 diabetes (YOD), defined as diabetes diagnosis before age 40, has an aggressive clinical course with premature mortality, in part due to long disease duration and lack of evidence to guide diagnosis and management. Autoimmune type 1 diabetes, maturity-onset diabetes of the young (MODY), and latent autoimmune diabetes in adults (LADA) are subtypes of diabetes in young people, which, however, cannot fully explain their complex clinical course. Similarly, family members carrying the same rare genetic variant of monogenic diabetes can have different presentations and outcomes. Ancestral heterogeneity, ecological transition, inter-ethnic differences in genomic architecture, and variations in living environment, lifestyles, access to care, and timeliness of diagnosis and treatment can influence the age of diagnosis and exposure to these cardiometabolic-renal risk factors. Despite the wealth of literature on genetic associations with diabetes, the familial cosegregation of rare variants and their relevance to YOD remains uncertain. This perspective was motivated by decades of clinical observations and learnings from an ongoing randomized controlled trial that uses biogenetic markers to classify patients with YOD for improving outcomes. Apart from highlighting the need to use family-based studies to improve the precision of diagnosis, we discussed atypical causes for diabetic ketoacidosis and the importance of lifecourse and psychosocial-behavioral factors in patients with YOD. Apart from detailed clinical evaluation, we propose using plasma C peptide, homeostasis model of assessment (HOMA) indexes, autoantibodies, and polygenic risk scores to stratify risk, classify diabetes subtypes, and personalize treatment in YOD. To achieve these goals, we advocate changing the practice environment and team structure to enable physicians to use the insights they learn from patients and their family members to implement precision medicine and improve the outlook of these high-risk individuals.

Impact of COVID-19-Related Personal Protective Equipment Changes on Dental Education: A Qualitative Study to Explore Faculty and Student Perspective.

COVID-19 pandemic and its related personal protective equipment have impacted all aspects of dental education. The qualitative study assesses the impact of COVID-19-related changes and their effects on students' clinical learning from student and faculty perspectives. This qualitative study involved third- and fourth-year predoctoral dental students and full-time dental clinical faculty. A semistructured interview guide was used. The interview guide consisted of seven open-ended questions about the impact of the new COVID-19-related infection control procedures on students' learning experience in the dental clinic. Interviews were recorded, transcribed verbatim, and analyzed using a basic interpretative approach by two independent researchers. Emerged themes were identified. Twelve faculty members and 21 students participated in six focus groups. Three major themes emerged from the analysis: learning challenges, learning opportunities, and long-term impact. Students identified four categories of learning challenges: communication, visualization, clinical exposure, and heat. Five learning challenges identified by faculty were: faculty burnout, service delivery challenges, material wastage, teaching difficulties, and lack of comprehensive care. The five learning opportunities students identified were autonomy, preparedness, efficiency, safety, and personalized feedback. Learning opportunities identified by faculty were time management, autonomy, and preparedness. Three categories of long-term impact on students identified were future opportunities, adaptation, and postgraduation plans. Faculty identified apathy, career re-evaluation, and adaption as the long-term impact of COVID-19-related changes. Although the new COVID-19-related infection control procedures and regulations in the dental school clinical setting come with learning challenges, students and faculty also saw learning opportunities through increased autonomy, preparedness, and efficiency. The impact of COVID-19 extends beyond the current learning experiences as it may modify students' long-term plans.

Student Reflections on Learning in a Doctoral-Level Writing Course.

Programs to improve student writing have been deployed widely in nursing graduate education, but few operational indicators exist for measuring their value. The challenge of measuring outcomes reflects the complexity of what transpires when graduate students write. Better understanding is needed of what it means to students to "learn" from writing support. A full-semester writing course was implemented in a nursing science PhD program. In formative course assessment activities, students identified problems in early drafts of their work, which they subsequently learned to detect and resolve. In this article, students report what was learned. Writing skills, like clinical skills, are intertwined with intellectual maturation and sense of professional identity. Writing, like clinical learning, requires an investment of time and labor far beyond what is typical in didactic approaches to classroom-based graduate education. Our experience suggests a need to reconceptualize writing pedagogy in nursing.

Relationship Between the Clinical Learning Environment and Caring Behaviors Among Baccalaureate Nursing Students During the COVID-19 Pandemic.

Caring is a fundamental professional nursing value. This study examined the effect of the clinical learning environment (CLE) on nursing students' caring behaviors during the COVID-19 pandemic. Valuing nursing work in the CLE increased the knowledge and skills aspect of caring behavior. Higher CLE scores in affordances and engagement and student centeredness increased the respectful deference of others and positive connectedness aspects of caring behaviors. These results may inform efforts to promote aspects of nursing students' caring behaviors during global health emergencies by enhancing the value of nursing work, engagement, and student-focused qualities of the CLE.

Perception level among clinical officers’ students on the effectiveness of simulation models in the Department of Clinical Medicine

Introduction Clinical simulation learning as an educational tool is recommended in the clinical officers’ training. Upon entry into the workforce, clinicians are expected to respond to a range of clinical situations they may not have experienced during their program.Methodology. A cross-sectional survey was conducted at Two medical training colleges in Kakamega County, Kenya. This design also enabled testing of causeand-effect relationships of the variables under study. The study employed a systematic way of gathering information. The information gathered described simulation in clinical teaching, specifically a case study of medical training colleges in Kakamega County Kenya.Results. The results show that 215 (71.2%) of the respondents agreed that assessment in the skills laboratory improved the outcome of the early clerkship, 77 (25.5%) disagreed while 10 (3.3%) of the respondents were neutral. The mean score was 3.14 with a standard deviation of 1.14 which shows that most respondents were in agreement that assessment in skills laboratory improves the outcome of the performance and skills of students. The item mean was below the composite mean of 3.36 indicating a negative influence on the composite mean. The standard deviation for the item was above the composite standard deviation of 0.45 indicating a wider spread in response for the item than the variable.Conclusion. OSCE is a competency-based tool widely used in clinical teaching.

Insights into Clinical Learning: Examining the Nursing Process as a Framework for Nursing Student Development - A Qualitative Study

Insights into Clinical Learning: Examining the Nursing Process as a Framework for Nursing Student Development - A Qualitative Study

Education programmes on performance-based assessment for allied health and nursing clinical educators: A scoping review protocol

Background Performance-based assessment (PBA) is a complex process undertaken in the workplace by healthcare practitioners known as clinical educators, who assist universities in determining health professional students’ readiness for independent practice. Preparing healthcare professionals for PBA is considered essential to ensuring the quality of the assessment process in the clinical learning environment. A preliminary search of the literature indicated a paucity of research guiding the development of education programmes that support practice educators to understand and implement PBA. Objective The aim of this scoping review is to investigate and describe education programmes delivered to allied health and nursing clinical educators, to develop PBA knowledge and skills. Methods This review will follow the Joanna Briggs Institute (JBI) methodology for conducting scoping reviews. Electronic databases relevant to this research topic will be searched including, EMBASE, ERIC, MEDLINE (Ovid), Web of Science and CINAHL and other targeted databases for grey literature. Studies that include PBA as the main focus or a component of the education programmes, of any format, delivered to clinical educators in allied health and nursing will be included. Studies may report the design and/or implementation and/or evaluation of PBA education programmes. Relevant English language publications will be sought from January 2000 to October 2022. Two reviewers will screen all titles and abstracts against the inclusion/exclusion criteria, and publications deemed relevant will be eligible for full text screening, confirming appropriateness for inclusion in the scoping review. Data will be charted to create a table of the results, supported a by narrative summary of the findings in line with the review objectives.

Development and usability testing of a patient digital twin for critical care education: a mixed methods study.

Digital twins are computerized patient replicas that allow clinical interventions testing in silico to minimize preventable patient harm. Our group has developed a novel application software utilizing a digital twin patient model based on electronic health record (EHR) variables to simulate clinical trajectories during the initial 6 h of critical illness. This study aimed to assess the usability, workload, and acceptance of the digital twin application as an educational tool in critical care. A mixed methods study was conducted during seven user testing sessions of the digital twin application with thirty-five first-year internal medicine residents. Qualitative data were collected using a think-aloud and semi-structured interview format, while quantitative measurements included the System Usability Scale (SUS), NASA Task Load Index (NASA-TLX), and a short survey. Median SUS scores and NASA-TLX were 70 (IQR 62.5-82.5) and 29.2 (IQR 22.5-34.2), consistent with good software usability and low to moderate workload, respectively. Residents expressed interest in using the digital twin application for ICU rotations and identified five themes for software improvement: clinical fidelity, interface organization, learning experience, serious gaming, and implementation strategies. A digital twin application based on EHR clinical variables showed good usability and high acceptance for critical care education.