Learning In Health Professions Education Research Articles

Exploring the use of metacognitive monitoring cues following a diagram completion intervention.

Studying texts constitutes a significant part of student learning in health professions education. Key to learning from text is the ability to effectively monitor one's own cognitive performance and take appropriate regulatory steps for improvement. Inferential cues generated during a learning experience typically guide this monitoring process. It has been shown that interventions to assist learners in using comprehension cues improve their monitoring accuracy. One such intervention is having learners to complete a diagram. Little is known, however, about how learners use cues to shape their monitoring judgments. In addition, previous research has not examined the difference in cue use between categories of learners, such as good and poor monitors. This study explored the types and patterns of cues used by participants after being subjected to a diagram completion task prior to their prediction of performance (PoP). Participants' thought processes were studied by means of a think-aloud method during diagram completion and the subsequent PoP. Results suggest that relying on comprehension-specific cues may lead to a better PoP. Poor monitors relied on multiple cue types and failed to use available cues appropriately. They gave more incorrect responses and made commission errors in the diagram, which likely led to their overconfidence. Good monitors, on the other hand, utilized cues that are predictive of learning from the diagram completion task and seemed to have relied on comprehension cues for their PoP. However, they tended to be cautious in their judgement, which probably made them underestimate themselves. These observations contribute to the current understanding of the use and effectiveness of diagram completion as a cue-prompt intervention and provide direction for future research in enhancing monitoring accuracy.

Role of self-directed learning in health professions education: Essential role of medical graduates of India

To cope with the challenges in the present day’s healthcare, developing self-directed learning (SDL) skills for medical graduates is of immense importance and facilitators of learning have an important role in this aspect and sensitization of faculty is necessary. One-month Mentor-learner web sessions on SDL were arranged and thirty-one learners and five faculty members participated in the month-long sessions. The sessions were divided into five parts with different objectives. Three learners and five faculty members conducted the sessions and were allotted specific roles to smoothly conduct the process. Thread 1 made learners visit their experiences and use the views of peers in understanding SDL. Thread 2 was based on principles and types of SDL and methods of guiding students for SDL sessions. Thread 3 was a group activity to design SDL sessions and review other groups’ SDL models. Thread 4 focused on the motivation of students and the factors affecting them. Thread 5 was on reflection and incorporated a self-assessment link as well. Participants were satisfied with the way SDL dealt with details. The design of the module made the learning diverse and interesting. Through the learning, participants felt more confident about designing and implementing an SDL session when needed. Through the group activity, they gained respect for the thinking and abilities of co-learners.

The Effect of Assessments on Student Motivation for Learning and Its Outcomes in Health Professions Education: A Review and Realist Synthesis.

In health professions education (HPE) the effect of assessments on student motivation for learning and its consequences have been largely neglected. This is problematic because assessments can hamper motivation and psychological well-being. The research questions guiding this review were: How do assessments affect student motivation for learning in HPE? What outcomes does this lead to in which contexts? In October 2020, the authors searched PubMed, Embase, APA PsycInfo, ERIC, CINAHL, and Web of Science Core Collection for "assessments" AND "motivation" AND "health professions education/students." Empirical papers or literature reviews investigating the effect of assessments on student motivation for learning in HPE using quantitative, qualitative, or mixed methods from January 1, 2010-October 29, 2020, were included. The authors chose the realist synthesis method for data analysis to study the intended and unintended consequences of this complex topic. Assessments were identified as stimulating autonomous or controlled motivation using sensitizing concepts from self-determination theory and data on context-mechanism-outcome were extracted. Twenty-four of 15,291 articles were ultimately included. Assessments stimulating controlled motivation seemed to have negative outcomes. An example of an assessment that stimulates controlled motivation is one that focuses on factual knowledge (context), which encourages studying only for the assessment (mechanism) and results in surface learning (outcome). Assessments stimulating autonomous motivation seemed to have positive outcomes. An example of an assessment that stimulates autonomous motivation is one that is fun (context), which through active learning (mechanism) leads to higher effort and better connection with the material (outcome). These findings indicate that students strategically learned what was expected to appear in assessments at the expense of what was needed in practice. Therefore, health professions educators should rethink their assessment philosophy and practices and introduce assessments that are relevant to professional practice and stimulate genuine interest in the content.

Not Just Fun and Games: Game-Based Learning in Health Professions Education.

Not Just Fun and Games: Game-Based Learning in Health Professions Education.

Progress is impossible without change: implementing automatic item generation in medical knowledge progress testing

Progress tests (PT) are a popular type of longitudinal assessment used for evaluating clinical knowledge retention and long-life learning in health professions education. Most PTs consist of multiple-choice questions (MCQs) whose development is costly and time-consuming. Automatic Item Generation (AIG) generates test items through algorithms, promising to ease this burden. However, it remains unclear how AIG-items behave in formative assessment (FA) modalities such as PTs compared to manually written items. The purpose of this study was to compare the quality and validity of AIG-items versus manually written items. Responses to 126 (23 automatically generated) dichotomously scored single best-answer five-option MCQs retrieved from the 2021 University of Minho PT of medicine were analyzed. Procedures based on item response theory (IRT), dimensionality testing, item fit, reliability, differential item functioning (DIF) and distractor analysis were used. Qualitative assessment was conducted through expert review. Validity evidence of AIG-items was assessed by using hierarchical linear modeling (HLM). The PT proved to be a viable tool for assessing medical students cognitive competencies. AIG-items were parallel to manually written-items, presenting similar indices of difficulty and information. The proportion of functional distractors for both AIG and manually written items was similar. Evidence of validity for AIG-items was found while showing higher levels of item quality. AIG-items functioned as intended and were appropriate for evaluating medical students at various levels of the knowledge spectrum.

Progression of Self-Directed Learning in Health Professions Education: Clarifying Terms and Processes.

As the complexity ofmedical knowledge and clinical practice continues to grow, physicians and physicians-intrainingmust learn to identify gaps in their knowledge and understand and engage in self-directed learning (SDL) in pursuit of academic goals and improved clinical performance. There is a lack of consensus, however, on the precise definition of SDL and how it relates to self-regulated learning (SRL) and co-regulated learning (CRL). We propose a conceptual framework for understanding the progression of a self-directed learner in the health professions and describe the interplay of SRL and CRL.

Twelve tips for co-production of online learning

In the digital age, experts in digital learning tools, or learning technologists (LTs), play an increasingly important role in the creation and delivery of online learning in health professions education. However, their expertise in the selection, curation and implementation of digital tools is often underutilized due to imbalanced relationships and lack of effective collaboration between faculty and LTs. Here, we describe how the co-production model can be applied to build equal and synergistic partnerships between faculty and LTs, so as to optimize the use of digital affordances and enhance online learning.

Clinical Faculty Perceptions of Online Learning in Health Professions Education.

The purpose of this study was to investigate clinical faculty perceptions of online learning in health professions education. Clinical faculty members from various health professions programs in New York were surveyed to determine whether there was a relationship between clinical faculty members' attitudes toward online learning competencies and their ability to teach online. Additionally, this study explored what type of impact years of teaching experience and online training had on clinical faculty perceptions of online learning. The study received 60 responses from clinical faculty, most of whom were teaching on Long Island, New York. Although the findings were not significant for most variables, a t -test demonstrated a significant statistical difference between online training and faculty perceptions of online learning. When clinical faculty completed online training, they had a more positive attitude toward online learning. The study also found that clinical faculty members' attitudes toward technology in online learning positively influenced their ability to troubleshoot technical issues in online environments. Years of online teaching experience did not affect how clinical faculty perceived online learning; however, clinical faculty with 1-5 years and 6-10 years of teaching experience rated their attitudes and abilities the lowest out of all the groups. While there appears to be a correlation between faculty perceptions of online learning and online training, more research is needed to objectively determine which specific trainings would be most advantageous.

Outcomes of inquiry-based learning in health professions education: a scoping review.

Open inquiry-based learning (IBL) that aims to foster higher-level thinking, is defined by students formulating their own questions and learning through exploration. The present study aimed to summarize the breadth of metrics used to evaluate health professions trainees in open IBL curricula. We conducted a scoping review to identify publications detailing trainee outcomes in open IBL initiatives in health professions education. We queried five databases and included studies which described interventions with five phases of IBL (orientation, conceptualization, investigation, conclusion, and discussion). We completed abstract and full text reviews in duplicate. Data were collated and summarized. From 3030 record, 21 studies were included in the final extraction (k = 0.94), with nine involving physician trainees and twelve involving nursing trainees. Three studies used validated data collection tools to measure student inquiry behavior, and a single study used a validated data collection tool to measure critical thinking abilities. Most studies (n = 11) reported trainee self-reported satisfaction or perceived gain of skills as the primary outcome. All four studies using validated tools reported high scores in inquiry behaviors at the end of the curriculum and results on critical thinking skills were mixed. One study collected serial data, while remaining studies collected pre-post or post-only data. IBL has the potential to cultivate a climate of curiosity among health professions learners. However, studies have relied heavily on subjective outcomes. Limited studies reported standardized measures of inquiry behaviors suggest favorable results. Curriculum innovations using IBL could make use of existing tools to better understand their impact on students' inquiry-oriented skills.

Design principles for fully online flipped learning in health professions education: a systematic review of research during the COVID-19 pandemic

BackgroundDuring the COVID-19 pandemic, some instructors transitioned their courses into a fully online environment by adopting flipped learning. In this context, this review examined the challenges to fully online flipped learning and identified useful course-design elements for practicing this instructional approach in health professions education.MethodsWe followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement for selecting relevant articles. Thirty-three empirical studies (with 32 unique interventions) published between 2020 and 2021 (i.e., the first 2 years of the pandemic) were selected for analysis.ResultsWhen the instructors in the reviewed studies designed and implemented their online flipped courses, numerous challenges emerged, which could be broadly categorized into student-related challenges (e.g., unfamiliarity with online flipped learning; N = 5), faculty challenges (e.g., increased workload; N = 8), and operational challenges (e.g., students’ technical problems; N = 9). Nevertheless, we identified various useful elements for online flipped learning practice and organized them based on the following components of the Revised Community of Inquiry (RCoI) framework: cognitive presence (e.g., application of knowledge/skills; N = 12), social presence (e.g., peer interaction; N = 11), teaching presence (e.g., instructors’ real-time demonstration/facilitation; N = 17), and learner presence (e.g., care and emotional support; N = 4).ConclusionsBased on the findings from the review and the RCoI framework, we developed nine principles for the effective practice of online flipped learning. These principles appear crucial for sustaining quality health professions education in a fully online flipped learning environment.

An evaluation of undergraduate student nurses' gameful experience whilst playing a digital escape room as part of a FIRST year module: A cross-sectional study

BackgroundThe circumstances arising from the COVID-19 pandemic have accelerated the use of digital teaching and learning in health professions education. Digital gamification-based teaching and learning activities are innovative and versatile tools for the acquisition of professional competencies in higher education, which can be used on a range of topics and can be supplemental to other teaching methods. ObjectivesThis study aimed to investigate nursing students' gameful experience whilst playing a digital escape room. In addition, we aimed to analyze the students' motivation, learning experience and outcome of the activity, and the students' perception of the degree of achievement of the intended learning outcomes. DesignCross-sectional descriptive study. ParticipantsA total of 136 undergraduate first year student nurses enrolled in a “Fundamentals of Nursing” course. MethodThe digital escape room game took place online during the academic year 2020–2021. The measures included the GAMEX scale in its Spanish version and a self-reported questionnaire to evaluate the outcome of the scape room game and the degree of achievement of the intended learning outcomes. ResultsMore than 80 % of the participants were moderately to very motivated to play the game. Three GAMEX dimensions achieved a mean score of 3 or above 3, namely Enjoyment, Creative Thinking and Absence of Negative effects. The mean score for each of the outcome variables was over 3. However, the degree of achievement of the learning outcomes after exiting the digital escape room was uneven. ConclusionGamification-based teaching and learning activities, such as digital escape rooms, can be effective in fostering specific skills, including teamwork, communication and critical thinking. However, they should be designed carefully, and used as a complement, rather than a substitute, of other educational activities.

On embedding assessments of self-regulated learning into licensure activities in the health professions: a call to action.

How well have healthcare professionals and trainees been prepared for the inevitable demands for new learning that will arise in their future? Given the rapidity with which ‘core healthcare knowledge’ changes, medical educators have a responsibility to audit whether trainees have developed the capacity to effectively self-regulate their learning. Trainees who engage in effective self-regulated learning (SRL) skillfully monitor and control their cognition, motivation, behaviour, and environment to adaptively meet demands for new learning. However, medical curricula rarely assess trainees’ capacity to engage in these strategic processes. In this position paper, we argue for a paradigm shift toward assessing SRL more deliberately in undergraduate and postgraduate programs, as well as in associated licensing activities. Specifically, we explore evidence supporting an innovative blend of principles from the science on SRL, and on preparation for future learning (PFL) assessments. We propose recommendations for how program designers, curriculum developers, and assessment leads in undergraduate and postgraduate training programs, and in licensing bodies can work together to develop integrated assessments that measure how and how well trainees engage in SRL. Claims about lifelong learning in health professions education have gone unmatched by responsive curricular changes for far too long. Further neglecting these important competencies represents a disservice to medical trainees and a potential risk to the future patients they will care for.

Implementing blended learning for clinician teachers: a qualitative study identifying their needs and the impact on faculty development initiatives.

Learning Technologies has been a fast-growing field in Health Professions Education (HPE). Approaches to teaching, learning and assessment have been increasingly influenced by learning technologies which requires HPE teachers to adapt their teaching practices and, with that, identify areas for professional development. The implementation of blended learning in HPE, has shown improvements in student performance. However, it seems as if there are challenges with the implementation of a blended learning approach and that there might be some needs that clinical teachers have that are not being addressed in order to implement blended learning successfully. Methods: We used a qualitative exploratory design to identify clinician teachers' needs. Semi-structured, individual interviews were conducted with a total of eight (n=8) module co-ordinators in the third year of the MBChB programme, Stellenbosch University, Faculty of Medicine and Health Sciences. Results: Results indicated the need for continuous technical and pedagogical support which refers to a longitudinal faculty development approach. Additionally, faculty development should include the support in structuring and rethinking the blended curriculum, as well as assisting in the clinicians' development in their role and identity as a clinical teacher. Conclusions: These results reveal the importance of faculty development as a targeted longitudinal approach.

Concept map-based learning in an oral radiographic interpretation course: Dental students' perceptions of its role as a learning tool.

Concept mapping is used to promote critical thinking and meaningful learning in health professions education. This study aimed to evaluate dental undergraduates' perceptions of concept mapping as a learning tool for oral radiographic interpretation competency. A total of 39 third-year undergraduates at a dental college participated in the oral radiological interpretation session. The students received 1 hour of instruction before creating their concept map (CM). Participants were provided an assignment of four relevant clinical cases to draw an individualised CM. The students' draft and final CM were submitted. The instructor evaluated the CMs to identify whether students could analyse, connect and organise the information in a meaningful way. Among them, 37 completed the questionnaire about their experiences and responses to concept mapping. Students perceived concept mapping positively. The instructor's feedback helped them recognise their misconceptions and fostered greater motivation to learn. Students attempted to integrate basic biomedical knowledge and clinical features through cross-linking. However, they also expressed negative attitudes toward concept mapping regarding time consumption and heavy burden. Concept mapping motivated students' directed learning and gave them the opportunity to recognise their misconceptions. This study suggests the potential use of CMs as an adjunctive learning strategy in the oral radiographic interpretation class.

A Systematic Review of Assessment Practices for Self‐Directed Learning in Health Professions Education

IntroductionThis systematic review aimed to describe the assessment practices related to self‐directed learning (SDL) in undergraduate health professions education. There were three main objectives of the review: 1) evaluating the different types of assessment used to determine the effectiveness of SDL; 2) assessing the effectiveness of SDL methods on student learning; and 3) exploring how readiness for SDL is assessed.MethodsThe PRISMA standards were followed for this systematic review. A total of seven electronic databases were searched: CINAHL, Embase, ERIC, PsycINFO, PubMed, Scopus, and Web of Science. Articles published in English between 2015 and March 2020 were retrieved for further evaluation. Two independent investigators screened abstracts and full‐text articles using the inclusion and exclusion criteria. The same investigators independently extracted data from included articles: the type of participant, sample size, study design, SDL activities, and assessment methods used to evaluate effectiveness of SDL. In addition, two independent investigators evaluated study quality using the validated Medical Education Research Study Quality Instrument (MERSQI). A third investigator resolved discrepancies and disagreements.ResultsA total of 65 studies from nineteen different countries were included in the analysis. Most study participants were medical (N=33) or nursing (N=20) students. Overall, there were wide variations in the definition of SDL, SDL activities used, and in the assessments developed to evaluate the effectiveness of SDL activities. The most common type of assessment used was a student perception survey, unrelated to a SDL readiness assessment. Internally‐developed knowledge exams were also commonly used. A total of 38 studies concluded that the SDL had a positive outcome, measured by the assessment instrument, whereas 21 studies reported a mixed or neutral outcome and six studies reported a negative outcome.ConclusionsThis systematic review demonstrates the wide variations in both the SDL activities used as well as the assessment methods developed to determine SDL effectiveness. Since SDL is a necessary skill for lifelong learning and success as a healthcare professional, it must be used and assessed appropriately. It may be valuable to standardize SDL activities and assessment methods across healthcare professions education. In addition, future research should be conducted to help establish the most accurate and effective assessment methods for SDL.

Escape room—the next generation of problem-based learning?

Throughout the physicians' training process and especially in clinical microbiology and infectious diseases, emphasis is put on careful history taking. Currently available data in the medical education field underscores the importance of learners' participation, bringing about the usage of methods such as flipped classroom or problem-based learning [ [1] Hew K.F. Lo C.K. Flipped classroom improves student learning in health professions education: a meta-analysis. BMC Med Educ. 2018; 18: 38 Crossref PubMed Scopus (364) Google Scholar , [2] Prince K.J.A.H. Van Eijs P.W.L.J. Boshuizen H.P.A. Van Der Vleuten C.P.M. Scherpbier A.J.J.A. General competencies of problem-based learning (PBL) and non-PBL graduates. Med Educ. 2005; 39: 394-401 Crossref PubMed Scopus (97) Google Scholar ]. The teaching of medical history taking remains a challenge and is commonly based on linear rolling cases or patient simulations.

Factors that affect student engagement in online learning in health professions education

BackgroundStudent engagement is vital in achieving learning outcomes and improving students' motivation, involvement, and attitudes toward learning. The aim of this study was to identify the factors that affect student engagement in online learning in medical and health science colleges. MethodsA cross-sectional study was conducted among medical and health science students and faculty in May 2020. The Online Engagement Strategies Questionnaire was e-mailed to 370 students and 102 faculty members. The SPSS statistical software was used for the statistical analysis. Exploratory factor analysis was performed to identify the factors that affected the students' engagement in online learning. Composite scores were calculated for factors, separately for the student and faculty responses. Descriptive statistical analysis was performed for the student and faculty responses. ResultsThe response rates of the students and faculty were 85.1% and 74.1%, respectively. The mean ages of the students and faculty were 20.6 and 44.6 years, respectively. Eighty-five percent of the faculty (n = 51) and 88.3% (n = 278) of the students found that the use of technology in proper communication was an important strategy to engage students in online learning. The factor analysis revealed agreement between the students and faculty regarding the factors that support student engagement in online learning. Techno-pedagogical skills were considered very important for faculty and important for students. For both faculty and students, self-directed learning skills were important, and peer-assisted learning (PAL) was fair symmetry.Nevertheless, collaborative learning (CL) was fairly symmetry to students and important to faculty. ConclusionTo enhance student engagement in online learning, faculty members should consider improving their techno-pedagogical skills. Moreover, by incorporating self-directed learning, CL and PAL will support student engagement. Finally, faculty development, updating of course design, and institutional policies are all required to support online learning.

Open Educational Resource-Enabled Pedagogy to Improve Student Outcomes in Nutrition Course

Online learning is a critical component of higher education. In 2017, the US Department of Education National Center for Education Statistics reported that one-third of all college and university students were enrolled in at least 1 online course. 1 Ginder SA Kelly-Reid JE Mann FB Enrollment and Employees in Postsecondary Institutions, Fall 2017; and Financial Statistics and Academic Libraries, Fiscal Year 2017: First Look (Provisional Data). NCES 2019-021rev. National Center for Education Statistics, US Department of Education, 2019https://nces.ed.gov/pubs2019/2019021REV.pdfDate accessed: February 19, 2021 Google Scholar In response to the coronavirus disease 2019 outbreak, online course delivery has flourished, 2 Adedoyin OB, Soykan E. Covid-19 pandemic and online learning: the challenges and opportunities [published online ahead of print September 2, 2020]. Interact Learn Environ.https://doi.org/10.1080/10494820.2020.1813180. Google Scholar but there are still unique challenges in online instruction: feelings of isolation, 3 Gillet-Swan J The challenges of online learning: supporting and engaging the isolated learner. J Learn Des. 2017; 10: 20-30 Google Scholar perceived lack of rigor/effectiveness, 1 Ginder SA Kelly-Reid JE Mann FB Enrollment and Employees in Postsecondary Institutions, Fall 2017; and Financial Statistics and Academic Libraries, Fiscal Year 2017: First Look (Provisional Data). NCES 2019-021rev. National Center for Education Statistics, US Department of Education, 2019https://nces.ed.gov/pubs2019/2019021REV.pdfDate accessed: February 19, 2021 Google Scholar lack of student engagement, 4 Stott P The perils of a lack of student engagement: reflections of a “lonely, brave, and rather exposed” online instructor. Br J Educ Technol. 2014; 47: 51-64 Crossref Scopus (14) Google Scholar greater student attrition, 5 Lee Y Choi J A review of online course dropout research: implications for practice and future research. Educ Technol Res Dev. 2011; 59: 593-618 Crossref Scopus (260) Google Scholar and participation barriers for under-represented students. 6 Baum S McPherson M The human factor: the promise & limits of online education. Daedalus. 2019; 149: 235-254 Crossref Google Scholar Although blended and flipped classroom formats offer promising approaches to overcome these obstacles, 7 Evans L Vanden Bosch ML Harrington S Schoofs N Coviak C Flipping the classroom in health care higher education: a systematic review. Nurse Educ. 2019; 44: 74-78 Crossref PubMed Scopus (20) Google Scholar , 8 Hew KF Lo CK Flipped classroom improves student learning in health professions education: a meta-analysis. BMC Med Educ. 2018; 18: 38 Crossref PubMed Scopus (202) Google Scholar , 9 Liu Q Peng W Zhang F Hu R Li Y Yan W The effectiveness of blended learning in health professions: systematic review and meta-analysis. J Med Internet Res. 2016; 18: e2 Crossref PubMed Scopus (207) Google Scholar courses that are taught entirely asynchronously online face many challenges.

The role of data science and machine learning in Health Professions Education: practical applications, theoretical contributions, and epistemic beliefs.

Data science is an inter-disciplinary field that uses computer-based algorithms and methods to gain insights from large and often complex datasets. Data science, which includes Artificial Intelligence techniques such as Machine Learning (ML), has been credited with the promise to transform Health Professions Education (HPE) by offering approaches to handle big (and often messy) data. To examine this promise, we conducted a critical review to explore: (1) published applications of data science and ML in HPE literature and (2) the potential role of data science and ML in shifting theoretical and epistemological perspectives in HPE research and practice. Existing data science studies in HPE are often not informed by theory, but rather oriented towards developing applications for specific problems, uses, and contexts. The most common areas currently being studied are procedural (e.g., computer-based tutoring or adaptive systems and assessment of technical skills). We found that epistemic beliefs informing the use of data science and ML in HPE poses a challenge for existing views on what constitutes objective knowledge and the role of human subjectivity for instruction and assessment. As a result, criticisms have emerged that the integration of data science in the field of HPE is in danger of becoming technically driven and narrowly focused in its approach to teaching, learning and assessment. Our findings suggest that researchers tend to formalize around the epistemological stance driven largely by traditions of a research paradigm. Future data science studies in HPE need to involve both education scientists and data scientists to ensure mutual advancements in the development of educational theory and practical applications. This may be one of the most important tasks in the integration of data science and ML in HPE research in the years to come.

Simulation-Based Mastery Learning With Virtual Coaching: Experience in Training Standardized Upper Endoscopy to Novice Endoscopists

Simulation-Based Mastery Learning With Virtual Coaching: Experience in Training Standardized Upper Endoscopy to Novice Endoscopists