Multiple-choice Knowledge Test Research Articles

Virtual reality simulation to enhance advanced trauma life support trainings – a randomized controlled trial

BackgroundAdvanced Trauma Life Support (ATLS) is the gold standard of initial assessment of trauma patients and therefore a widely used training program for medical professionals. Practical application of the knowledge taught can be challenging for medical students and inexperienced clinicians. Simulation-based training, including virtual reality (VR), has proven to be a valuable adjunct to real-world experiences in trauma education. Previous studies have demonstrated the effectiveness of VR simulations for surgical and technical skills training. However, there is limited evidence on VR simulation training specifically for trauma education, particularly within the ATLS curriculum. The purpose of this pilot study is to evaluate the feasibility, effectiveness, and acceptance of using a fully immersive VR trauma simulation to prepare medical students for the ATLS course.MethodsThis was a prospective randomised controlled pilot study on a convenience sample of advanced medical students (n = 56; intervention group with adjunct training using a commercially available semi-automated trauma VR simulation, n = 28, vs control group, n = 28) taking part in the ATLS course of the Military Physician Officer School.Feasibility was assessed by evaluating factors related to technical factors of the VR training (e.g. rate of interruptions and premature termination). Objective and subjective effectiveness was assessed using confidence ratings at four pre-specified points in the curriculum, validated surveys, clinical scenario scores, multiple choice knowledge tests, and ATLS final clinical scenario and course pass rates. Acceptance was measured using validated instruments to assess variables of media use (Technology acceptance, usability, presence and immersion, workload, and user satisfaction).ResultsThe feasibility assessment demonstrated that only one premature termination occurred and that all remaining participants in the intervention group correctly stabilised the patient. No significant differences between the two groups in terms of objective effectiveness were observed (p = 0.832 and p = 0.237 for the pretest and final knowledge test, respectively; p = 0.485 for the pass rates for the final clinical scenario on the first attempt; all participants passed the ATLS course). In terms of subjective effectiveness, the authors found significantly improved confidence post-VR intervention (p < .001) in providing emergency care using the ATLS principles. Perceived usefulness in the TEI was stated with a mean of 4 (SD 0.8; range 0–5). Overall acceptance and usability of the VR simulation was rated as positive (System Usability Scale total score mean 79.4 (SD 11.3, range 0–100).ConclusionsThe findings of this prospective pilot study indicate the potential of using VR trauma simulations as a feasible and acceptable supplementary tool for the ATLS training course. Where objective effectiveness regarding test and scenario scores remained unchanged, subjective effectiveness demonstrated improvement.Future research should focus on identifying specific scenarios and domains where VR can outperform or enhance traditional learning methods in trauma simulation.

The Effectiveness of a Self-Directed e-Learning Module on Trainee Knowledge and Confidence during Plastic Surgery Clinical Rotations.

Exposure to plastic surgery is limited during medical school. This makes rotations for clinical clerks and off-service residents challenging. Available resources are often too detailed and overwhelming. Having an accessible, concise, and interactive plastic surgery e-learning module reviewing core plastic surgery topics could help prepare incoming trainees for their rotations. An e-learning module was created using text, images, and in-house recorded video recordings. Two cohorts were recruited: control cohort (n = 9), who completed their plastic surgery rotation without use of the module, and an interventional cohort (n = 18), who completed the rotation with use of the module. A demographic survey, a 20-question multiple-choice knowledge test, and self-reported confidence score were completed by both cohorts at the end of their plastic surgery rotations. The intervention cohort also completed the knowledge test at the beginning of their rotation to establish baseline. Knowledge and confidence scores were compared using two-tailed, unpaired, nonparametric analyses (Mann-Whitney test). Learners from the intervention cohort reported a 95% module completion rate and found the resource "extremely helpful" (average Likert of 4.8/5). Learners indicated that they were very likely to recommend the resource to others (average Likert 4.9/5). The intervention cohort scored significantly higher on the knowledge test compared with the control cohort (P = 0.008), and on average reported higher confidence levels; however, this was not statistically significant (P = 0.057). An accessible and concise module on core plastic surgery concepts enhances learner knowledge and confidence during plastic surgery clinical rotations.

Effectiveness of mind mapping as compared to didactic lectures for teaching anatomy among first-year medical students - A randomized control study

Several methods have been suggested to encourage greater student participation during lectures. Mind mapping is a learning tool that uses pictorial representations of concepts and their relationships. The objectives of this study were to compare the knowledge acquisition in anatomy and perceptions between didactic lectures and mind mapping among first year students at a medical college in India. First year undergraduate medical students (n=60 in one batch and n=149 in the next batch) were randomly divided into two groups which received either the mind-mapping intervention or a didactic lecture. Eight topics were covered in such a manner. After each topic, the groups crossed over and received the alternate intervention. Each intervention was followed by a ten-item single-best-response multiple-choice knowledge test. The perceptions of students were obtained using a questionnaire which had both quantitative and qualitative components. The data were summarized using means and standard deviations. Group differences were estimated using the independent sample T test. The mean scores on the multiple-choice-questions (MCQ) test were significantly higher after mind-mapping compared to didactic lectures in seven out of eight sessions. The perceptions of the students about mind mapping were largely positive, especially in relation to integration and interest. One drawback mentioned about the mind-mapping method was that it was relatively time-consuming. Mind mapping resulted in significantly greater knowledge acquisition as compared to didactic lectures, and was well received by the students. It has the potential to be used more widely in anatomy education.

Developing and evaluating a multiple-choice knowledge test about Brønsted-Lowry acid-base reactions for upper secondary school students

Abstract For centuries, chemists have researched acid-base reactions and developing numerous different acid-base concepts. Consequentially, it is difficult to teach about acid-base reactions in a clear and conceptually coherent manner. We aim at contributing to teaching about acid-base chemistry by an intervention introducing upper secondary school chemistry students to an acid-base concept that is scientifically appropriate and learner-centred. This modernized version of the Brønsted-Lowry acid-base concept appears sufficiently complex for the target group. Additionally, it emphasizes the donor-acceptor concept and the reaction mechanism. In order to evaluate the gain in declarative knowledge during our intervention, we developed and piloted a multiple-choice knowledge test with Austrian upper secondary students (N = 136). By estimating a Rasch model (WLE-Rel. = 0.63, Infitmin = 0.90, Infitmax = 1.02, Outfitmin = 0.89, Outfitmax = 1.00, d = −0.44–1.8), we constructed a pre-test (11 MC items, 6 open-ended questions) and a post-test (11 MC items, 6 open-ended questions) based on key concepts of the topic for our intervention study (N = 57). Overall, the test proved a reliable tool to estimate learners’ declarative knowledge about acid-base reactions in the course of the intervention study, showing a significant knowledge increase.

Simulation and team training to improve preterm birth knowledge, evidence-based practices, and communication skills in midwives in Kenya and Uganda: Findings from a pre- and post-intervention analysis.

Simulation training in basic and emergency obstetric and neonatal care has previously shown success in reducing maternal and neonatal mortality in low-resource settings. Though preterm birth is the leading cause of neonatal deaths, application of this training methodology geared specifically towards reducing preterm birth mortality and morbidity has not yet been implemented and evaluated. The East Africa Preterm Birth Initiative (PTBi-EA) was a multi-country cluster randomized controlled (CRCT) trial that successfully improved outcomes of preterm neonates in Migori County, Kenya and the Busoga region of Uganda through an intrapartum package of interventions. PRONTO simulation and team training (STT) was one component of this package and was introduced to maternity unit providers in 13 facilities. This analysis was nested within the larger CRCT and specifically looked at the impact of the STT portion of the intervention package. The PRONTO STT curriculum was modified to emphasize prematurity-related intrapartum and immediate postnatal care practices, such as assessment of gestational age, identification of preterm labour, and administration of antenatal corticosteroids. Knowledge and communication techniques were assessed at the beginning and end of the intervention through a multiple-choice knowledge test. Clinical skills and communication techniques used in context were assessed through the use of evidence-based practiced (EBPs) as documented in video-recorded simulations through StudioCodeTM video analysis. Pre-and-post scores were compared in both categories using Chi-squared tests. Knowledge assessment scores improved from 51% to 73% with maternal-related questions improving from 61% to 74%, neonatal questions from 55% to 73%, and communication technique questions from 31% to 71%. The portion of indicated preterm birth EBPs performed in simulation increased from 55% to 80% with maternal-related EBPs improving from 48% to 73%, neonatal-related EBPs from 63% to 93%, and communication techniques from 52% to 69%. STT substantially increased preterm birth-specific knowledge and EBPs performed in simulation.

Integrating motivated goal achievement in maritime simulator training

The application of cloud-based simulators has increasing momentum in maritime education and training as a virtual platform for supplementing professional training with task-specific simulation-based learning. Congruent with traditional simulator technology and training methods, this new condition allows for asynchronous and unlimited simulator access where participation in training sessions is at the discretion of the trainee. Furthermore, this provides a learning environment that can have adaptive features to the trainee characteristics with selectable complexity levels, automated feedback, and automated performance assessment. With the advent of this emerging training technology, the organization of how training is deployed, the new roles and expectations for trainees and instructors, and the application of new data-driven analytics are not yet well understood. This paper employs a quasi-experimental study to investigate trainee motivation, personality traits, and task performance using a novel training design. The study was administered remotely to a sample (N = 18) of first-year maritime students who first completed a knowledge acquisition phase before conducting a skill acquisition phase with repeated simulator training of a procedural task, and finally a performance assessment of the simulator scenario. Data was collected from (1) a multiple-choice knowledge test, (2) a short-scaled Big Five Inventory, (3) the Motivated Strategies for Learning Questionnaire, and (4) programmed simulator metrics. Results indicate that Extraversion correlates with motivation and self-efficacy predicts training performance. No significant relationship between prior knowledge and the training performance was found. The results can provide knowledge for implementation and delivery of remote simulator training in maritime education and training, as well as other fields.

Building the Nigerian Palliative Care Workforce: An Interdisciplinary Distance Learning Training Program.

Education and capacity building in palliative care are greatly needed in Nigeria. Currently, two institutions integrate palliative care into the undergraduate medical curriculum and no post graduate training exists. A team from the University of Lagos in Nigeria and Northwestern University in the US collaborated to design, implement, and evaluate a 12-hour virtual palliative care training program for Nigerian health professionals. This study investigated the impact of the first session of the training program on healthcare professionals' knowledge, skills, attitudes, and confidence in palliative care. The Education in Palliative and End-of-Life (EPEC) curriculum and the Kenya Hospices and Palliative Care Association (KEHPCA) curriculum were used as foundations for the program and adapted for the Nigerian context. Delivered online, the training focused on goals of palliative care, whole patient assessment, communication skills, pain management, psychosocial issues, palliative care in COVID, oncology, and HIV. A mixed-methods evaluation based on Kirkpatrick's evaluation framework was used and data were gathered from surveys and focus groups. Thirty-five health professionals completed the training. The training had a positive impact on knowledge, skills, and attitudes. Confidence in providing end-of-life care increased from 27.3% to 92.9% while confidence in prescribing medication to relieve symptoms at the end of life increased from 42.9% to 92.0%. Performance on multiple-choice knowledge tests increased by 10% (p < 0.01). All participants stated that they would recommend the program to a peer while 96.4% reported the program was relevant to the Nigerian context. Qualitative analysis suggested that the training would help participants provide more holistic care for patients, communicate better, and change how they interacted with families. Topics to be addressed in future training were identified. This virtual training can be an important element in palliative care capacity building in Nigeria and represents a model for global health collaboration.

Comparing two whole task patient simulations for two different dental education topics

We investigated the effect of two types of whole task patient simulations, role-play and web-based, on learning outcomes for two topics, local anesthesia and non-surgical extractions, in a foundational oral maxillofacial surgery course for second year pre-clinical dental students. Using a 2x2 factorial design, we asked which simulation model allows for deeper cognitive engagement that fosters higher learning outcomes for novices practicing complex skills as a professional, a collaborative role-play simulation (Role-Play Sim), or an individually-paced web-based simulation (Web Sim)? In two studies covering two different topics, we compared the effect of these simulations on 50-item multiple-choice knowledge tests. Participants were randomly assigned to one of four groups: No Sim, Web Sim, Role-Play Sim, or Both Sims. For study 1 covering local anesthesia, there was a statistically significant main effect for the Role-Play Sim, F (1, 105) = 103.804, p < 0.001, ηp2 = 0.497, but not for the Web Sim, F (1, 105) = 1.655, p = 0.201. Similarly, for study 2 covering extractions, there was a statistically significant main effect for the Role-Play Sim, F (1, 108) = 162.362, p < 0.001, ηp2 = 0.601, but not for the Web Sim, F (1, 108) = 0.072, p = 0.798. The interaction term was not statistically significant in either study. Results suggest that role-play simulations achieved a higher level of learning outcomes than the web-based patient simulation.

Rapid deployment of a virtual simulation curriculum to prepare for critical care triage during the COVID-19 pandemic.

BackgroundDuring the COVID-19 pandemic in Ontario, Canada, an Emergency Standard of Care for Major Surge was created to establish a uniform process for the “triage” of finite critical care resources. This proposed departure from usual clinical care highlighted the need for an educational tool to prepare physicians for making and communicating difficult triage decisions. We created a just-in-time, virtual, simulation-based curriculum and evaluated its impact for our group of academic Emergency Physicians.MethodsOur curriculum was developed and evaluated following Stufflebeam’s Context-Input-Process–Product model. Our virtual simulation sessions, delivered online using Microsoft Teams, addressed a range of clinical scenarios involving decisions about critical care prioritization (i.e., Triage). Simulation participants completed a pre-course multiple-choice knowledge test and rating scales pertaining to their attitudes about using the Emergency Standard of Care protocol before and 2–4 weeks after participating. Qualitative feedback about the curriculum was solicited through surveys.ResultsNine virtual simulation sessions were delivered over 3 weeks, reaching a total of 47 attending emergency physicians (74% of our active department members). Overall, our intervention led to a 36% (95% CI 22.9–48.3%) improvement in participants’ self-rated comfort and attitudes in navigating triage decisions and communicating with patients at the end of life. Scores on the knowledge test improved by 13% (95% CI 0.4–25.6%). 95% of participants provided highly favorable ratings of the course content and similarly indicated that the session was likely or very likely to change their practice. The curriculum has since been adopted at multiple sites around the province.ConclusionOur novel virtual simulation curriculum facilitated rapid dissemination of the Emergency Standard of Care for Major Surge to our group of Emergency Physicians despite COVID-19-related constraints on gathering. The active learning afforded by this method improved physician confidence and knowledge with these difficult protocols.Supplementary InformationThe online version contains supplementary material available at 10.1007/s43678-022-00280-6.

Teaching brief motivational interviewing to medical students using a pedagogical framework

ObjectiveMedical schools are charged with assisting medical students to acquire the confidence, knowledge and skills for behavior change conversations in primary healthcare. The present study evaluated teaching brief motivational interviewing (MI) to pre-clinical medical students. MethodsForty-six students participated in an educational intervention premised on the Learn, See, Practice, Prove, Do, Maintain pedagogical framework, comprising 2 × 2-h lectures, a 2-h role-play triad session, and 3 × 2-h small group simulated patient encounters supported by scaffolding strategies. Measures of brief MI knowledge (MI Knowledge and Attitudes Test & Multiple-Choice Knowledge Test) and confidence (MI Confidence Scale) were taken at baseline, post-training, and 3-month follow-up, and skills (Behavior Change Counseling Index) were assessed at three intervals during simulated patient encounters. ResultsStudents who received brief MI training improved in knowledge and confidence from baseline to post-training and gains remained at 3-months. Brief MI skills improved across the simulation sessions. ConclusionPre-clinical medical students can attain knowledge, confidence and skills in brief MI after participation in a short intervention and improvements are sustainable. Practice implicationsOur results support the use of an evidence-based pedagogical framework for teaching brief MI in pre-clinical years of medical curricula and our scaffolding strategy affords promise.

Simulation-Based Training Improves Fellows' Competence in Brain Death Discussion and Declaration.

Despite well-defined American Academy of Neurology guidelines for death by whole brain criteria (brain death), there is marked variability in national practice, which some have attributed to lack of formal education. Further, communication with surrogates and families about brain death is integral to brain death declaration. As such, we developed a targeted brain death curriculum combining didactics and simulation-based education to improve examination and subsequent communication skills with families. Multidisciplinary critical care fellows participated in (1) didactic and case-based curriculum, (2) brain death simulated examination (SimMan3G mannequin), and (3) a standardized family scenario with delivery of a brain death diagnosis to a surrogate "family member". Fellows completed a precurriculum and postcurriculum multiple choice knowledge test and survey (Likert 1 to 10 scale) evaluating measures regarding diagnosis and communication of brain death. t Test and 2-tailed Wilcoxon signed rank test were used for statistical analysis (P<0.05). Thirteen critical care fellows participated in the curriculum. Most fellows [80% (N=12)] had only participated in 0 to 5 brain death declarations before this intervention. There was significant improvement across all measures: self-rated knowledge (P=0.004), perceived knowledge relative to peers (P=0.002), confidence (P=0.001), and comfort (P=0.001) with performing a brain death exam, and comfort with family discussion (P=0.01). Objective test scores improved from 56 to 73% after simulation (P=0.004). All fellows found the curriculum beneficial. Trainees may lack sufficient exposure to brain death education. Didactics with simulation-based education can improve objective knowledge and subjective measures of comfort with brain death declaration and surrogate communication.

A comparison of indoor and outdoor biology education: What is the effect on student knowledge, attitudes, and retention?

ABSTRACT This study investigated the effects of outdoor education on a 10th grade biology curriculum in terms of the knowledge, attitudes, and retention of students compared to indoor teaching. The quasi-experimental design included three groups: experiment (OE; N = 43), control-II (indoor teaching; N = 35), and control-I (no application; N = 35). A multiple-choice knowledge test and biology attitude scale assessed the changes in knowledge and attitudes. The experiment and control-II groups took pre-, post-, and retention-tests, whereas the control-I group took pre- and retention-tests. Overall, the experiment group’s knowledge and attitudes were more positively affected than those of control-II. Outdoor Education had a more positive effect on retention and attitudes than did indoor teaching; it took less time and was more economical and temporarily more efficient. Adding Outdoor Education to secondary education biology curricula would increase students’ knowledge and positive attitudes. Cooperation between policy makers and universities is necessary for its effective application.

Changes in Nutrition Focused Physical Examination Knowledge and Practices of Dietitians Who Completed an In-Person Workshop With 1-Year Online Follow-Up in Malaysia

Abstract Objectives Nutrition-focused physical examination (NFPE) is a component of nutrition assessment performed by dietitians. There is limited research globally on NFPE practices of dietitians. This study explored changes in NFPE knowledge and practices over 1-year among clinical dietitians in Malaysia who completed a hybrid NFPE training program. Methods This was a secondary analysis of data from a pilot study. Participants attended a 2-day in-person workshop in Malaysia with quarterly online follow-up over 1-year. A 50-item multiple-choice knowledge test was completed by participants before and immediately, 6- and 12-months post-training. They completed data collection forms with self-reported performance of 43 NFPE practice tasks conducted during patient assessments before and 6- and 12-months post-training. Descriptive statistics, one-way repeated-measures ANOVA for knowledge assessment scores and Chi-square tests for changes in frequencies of NFPE performance were used for analyses; statistical significance was P ≤ 0.05. Results Of the 16 clinical dietitian participants who enrolled, 81.3% (n = 13) completed the study. Participants had a mean of 9.3 ± 6.4 years ofclinical practice; 81.3% (n = 13) had no prior NFPE training. Mean NFPE knowledge scores increased significantly from before (33.8 ± 3.9) to immediately post-training (44.0 ± 3.2; P &amp;lt; 0.001); this increase was sustained to 12-months post-training (43.3 ± 2.9; P &amp;lt; 0.001). Performance of all 43 NFPE practice tasks increased significantly from before to 12-months post-training (P &amp;lt; 0.001). Conclusions Clinical dietitian participants in this study increased their knowledge and practice of NFPE from before to 12-months post-training. In-person NFPE training with 1-year online follow-up is feasible for training clinical dietitians in Malaysia. Future research should explore using a control group to examine the effectiveness of a hybrid NFPE training program in this population. Funding Sources Rutgers Global Grant.

Changes in Nutrition Focused Physical Exam Knowledge and Curriculum Integration of Dietetic Educators in Malaysia Who Have Completed an NFPE Hybrid Training Program

ObjectivesThere is limited research on the integration of Nutrition Focused Physical Examination (NFPE) into dietetic educators’ curricula practices globally. The primary objectives of this study were to assess changes in dietetic educators’ NFPE knowledge and curricula practices over 12-months after completing a hybrid training program in NFPE. MethodsThis was a secondary analysis of data from the study A Two-phase International Approach to Teaching Nutrition Focused Physical Examination, a prospective cohort pilot study. Dietetic educators in Malaysia completed an NFPE hybrid training program consisting of in-person training and follow-up computer-assisted instruction over 12 months. Participants reported the extent to which they integrated 32 NFPE tasks into their curricula at 3 timepoints (baseline, 6- and 12-months post-training) and completed a 50-item multiple-choice knowledge test at 4 timepoints (baseline and immediately, 6- and 12-months post-training). Descriptive statistics were used for curricula data; one-way repeated measures ANOVA test was used to analyze the change in knowledge scores over time. ResultsData were analyzed from those who completed knowledge tests (n = 14) and NFPE curricula data collection forms (n = 13) at all timepoints. Mean knowledge scores out of 50 possible points) increased significantly from baseline to immediately post-training and 6- and 12-months post-training (P < 0.001 for all) from 34.1 ± 5.4 at baseline to 43.7 ± 3.1 immediately post-training, 43.5 ± 2.9 at 6-months post-training, and 43.1 ± 3.0 at 12-months post-training. Changes in knowledge test scores were maintained from immediately post-training to 6- and 12-months post-training. At baseline, all of the participants reported that they “teach student NFPE tasks,” for three of the 32 NFPE tasks (examination of orbital fat pads, gastrocnemius muscle, and clavicle). At 12-months post-training,100% of the participants reported teaching all 32 NFPE tasks. ConclusionsDietetic educators in Malaysia who participated in the study significantly increased their NFPE knowledge and the integration of NFPE tasks in their nutrition and dietetics curricula from baseline to 12-months post-training. An NFPE hybrid training program is feasible to train dietetic educators in Malaysia. Funding SourcesRutgers Global Grant

How to Teach Medical Students About Pain and Dementia: E-Learning, Experiential Learning, or Both?

Pain management in persons with mild to moderate dementia poses unique challenges because of altered pain modulation and the tendency of some individuals to perseverate. We aimed to test the impact of an e-learning module about pain in communicative people with dementia on third-year medical students who had or had not completed an experiential geriatrics course. Analysis of pre- to postlearning changes and comparison of the same across the student group. University of Pittsburgh School of Medicine and Saint Louis University School of Medicine. One hundred four University of Pittsburgh and 57 Saint Louis University medical students. University of Pittsburgh students were randomized to view either the pain and dementia module or a control module on pain during a five-day geriatrics course. Saint Louis University students were asked to complete either of the two modules without the context of a geriatrics course. A 10-item multiple choice knowledge test and three-item attitudes and confidence questionnaires were administered before viewing the module and up to seven days later. Knowledge increase was significantly greater among students who viewed the dementia module while participating in the geriatrics course than among students who viewed the module without engaging in the course (P < 0.001). The modules did not improve attitudes in any group, while student confidence improved in all groups. Medical students exposed to e-learning or experiential learning demonstrated improved confidence in evaluating and managing pain in patients with dementia. Those exposed to both educational methods also significantly improved their knowledge.

The Importance of Taking Psychology: A Comparison of Three Levels of Exposure

We compared the performance of senior psychology majors, introductory psychology students, and similarly aged individuals with no college psychology on seven different outcome measures including multiple-choice knowledge tests, attitudes, and open-ended scenarios requiring qualitative responses. On all measures, both senior psychology majors and introductory psychology students significantly outperformed individuals with no college psychology. However, the absolute magnitude of introductory psychology student performance would be depicted as a failing grade at most institutions (i.e., below 60% correct). We discuss this pattern of results in the context of judging the effectiveness of the major, the role of the introductory psychology course, and judging the effectiveness of the assessment/outcome measures utilized.

Clinical Virtual Simulation in Nursing Education: Randomized Controlled Trial.

BackgroundIn the field of health care, knowledge and clinical reasoning are key with regard to quality and confidence in decision making. The development of knowledge and clinical reasoning is influenced not only by students’ intrinsic factors but also by extrinsic factors such as satisfaction with taught content, pedagogic resources and pedagogic methods, and the nature of the objectives and challenges proposed.Nowadays, professors play the role of learning facilitators rather than simple “lecturers” and face students as active learners who are capable of attributing individual meanings to their personal goals, challenges, and experiences to build their own knowledge over time.Innovations in health simulation technologies have led to clinical virtual simulation. Clinical virtual simulation is the recreation of reality depicted on a computer screen and involves real people operating simulated systems. It is a type of simulation that places people in a central role through their exercising of motor control skills, decision skills, and communication skills using virtual patients in a variety of clinical settings.Clinical virtual simulation can provide a pedagogical strategy and can act as a facilitator of knowledge retention, clinical reasoning, improved satisfaction with learning, and finally, improved self-efficacy.However, little is known about its effectiveness with regard to satisfaction, self-efficacy, knowledge retention, and clinical reasoning.ObjectiveThis study aimed to evaluate the effect of clinical virtual simulation with regard to knowledge retention, clinical reasoning, self-efficacy, and satisfaction with the learning experience among nursing students.MethodsA randomized controlled trial with a pretest and 2 posttests was carried out with Portuguese nursing students (N=42). The participants, split into 2 groups, had a lesson with the same objectives and timing. The experimental group (n=21) used a case-based learning approach, with clinical virtual simulator as a resource, whereas the control group (n=21) used the same case-based learning approach, with recourse to a low-fidelity simulator and a realistic environment. The classes were conducted by the usual course lecturers.We assessed knowledge and clinical reasoning before the intervention, after the intervention, and 2 months later, with a true or false and multiple-choice knowledge test. The students’ levels of learning satisfaction and self-efficacy were assessed with a Likert scale after the intervention.ResultsThe experimental group made more significant improvements in knowledge after the intervention (P=.001; d=1.13) and 2 months later (P=.02; d=0.75), and it also showed higher levels of learning satisfaction (P<.001; d=1.33). We did not find statistical differences in self-efficacy perceptions (P=.9; d=0.054).ConclusionsThe introduction of clinical virtual simulation in nursing education has the potential to improve knowledge retention and clinical reasoning in an initial stage and over time, and it increases the satisfaction with the learning experience among nursing students.

The design, development, and validation of a multimedia-based performance assessment for credentialing confined space guards

In this article, we present a study on the design, development, and validation of a multimedia-based performance assessment (MBPA) for measuring the skills of confined space guards in Dutch vocational education. An MBPA is a computer-based assessment that incorporates multimedia to simulate tasks. It is designed to measure performance-based skills. A confined space guard (CSG) supervises operations that are carried out in a confined space (e.g., a tank or silo). In the Netherlands, individuals who want to become certified CSGs must participate in a one-day training program, and pass both a multiple-choice knowledge test and a performance-based assessment. In the first part of this article, we focus on the design and development of the MBPA, using a specific framework for design and development. In the second part of the article, we present a validation study. We use the argument-based approach to validation to validate the MBPA (Kane in Educational measurement. American Council on Education and Praeger Publishers, Westport, 2006 and J Educ Meas 50(1):1–73, 2013). More specifically, the extended argument-based approach to validation is used (Wools et al. in CADMO 18(1):63–82, 2010 and Stud Educ Eval 48:10–18, 2016). The approach suggests using multiple sources of validity evidence to build a comprehensive validity case for the proposed interpretation of assessment scores (Kane 2006, 2013) and to evaluate the strength of the validity case (Wools et al. 2010, 2016). We demonstrate that MBPA scores can be used for their intended purpose; students’ performance in the MBPA can be used as the basis for making a CSG certification decision.

The Effect of Narcotics, Psychotropic, and Addictive Substance Counseling toward SMK Students’ Knowledge about Drug Abuse

Understanding about narcotics, psychotropics, and addictive substances is beneficial to prevent drugs abuse among students. One of the ways to provide knowledge about this topic may be done by counseling. This research was aimed to know the effect of narcotics, psychotropics, and addictive substances counseling toward students’ knowledge about drug abuse. The study was conducted in SMK Negeri 34 Jakarta during May 2012 using an experimental method. Simulation method was performed in experimental class whether speech method was applied in control group. This research design was pretest-posttest control group using multiple choice knowledge test instrument. Samples were selected by simple random sampling. Normality testing of the Kolmogorov – Smirnov test and homogeneity testing of t-test showed a normal distribution and homogenous data. Meanwhile, hypothesis testing done by t-test at α = 0.05 result was –ttable &lt; tcount &lt; ttable at -3.23 &lt; -0.67 &lt; 2.03, meaning that there was no effect of narcotics, psychotropics, and addictive substances counseling toward students’ knowledge about drugs abuse.

Empirical Option Weights Improve the Validity of a Multiple-Choice Knowledge Test

Abstract. Standard dichotomous scoring of multiple-choice test items grants no partial credit for partial knowledge. Empirical option weighting is an alternative, polychotomous scoring method that uses the point-biserial correlation between option choices and total score as a weight for each answer alternative. Extant studies demonstrate that the method increases reliability of multiple-choice tests in comparison to conventional scoring. Most previous studies employed a correlational validation approach, however, and provided mixed findings with regard to the validity of empirical option weighting. The present study is the first investigation using an experimental approach to determine the reliability and validity of empirical option weighting. To obtain an external validation criterion, we experimentally induced various degrees of knowledge in a domain of which participants had no knowledge. We found that in comparison to dichotomous scoring, empirical option weighting increased both reliability and validity of a multiple-choice knowledge test employing distractors that were appealing to test takers with different levels of knowledge. A potential application of the present results is the computation and publication of empirical option weights for existing multiple-choice knowledge tests that have previously been scored dichotomously.