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Health and social care students are expected to apply evidence-based practice (EBP). An innovative mobile application, EBPsteps, was developed to support learning EBP. The aim of this study was to explore health and social care students' experiences of learning about EBP using the mobile application EBPsteps during their clinical placements. An interpretive description approach guided the exploration of student experiences. Four focus groups were conducted with a convenience sample of students from three undergraduate degree programs: occupational therapy, physical therapy, and social education. The constant comparison method was used to categorize and compare the qualitative data. Three integrated themes were generated: \"triggers for EBP\", \"barriers to EBP\", and \"design matters\". Information needs, academic requirements, and encouragement from clinical instructors triggered the students to use EBPsteps. Lack of EBP knowledge, lack of academic demand, and lack of emphasis on EBP in clinical placement were barriers to using EBPsteps. Design issues mattered, as use of the app was motivated by design features such as the opportunity to practice EBP in one place and taking notes in a digital notebook. The use of the app was hindered by anticipation that the use of phones during clinical placements would be viewed negatively by others and by specific design features, such as unfamiliar icons. The students perceived the EBPsteps app as a relevant tool for learning EBP, although they also suggested specific changes to the design of the app. Requirements must be embedded in the curriculum to ensure that the app is used. Our findings bring important information to developing and implementing mobile applications as a teaching method in health and social care educations.

Longitudinal research is one effective way to gauge changes in a student cohort over time, however attrition in these studies is typically high, which can result in study bias. This study explored learning environment factors, approaches to studying, and academic performance as predictors of occupational therapy students' consistent participation in data collection conducted over three years of their professional program. A longitudinal study of Norwegian occupational therapy students (analyzed n = 240) was conducted. Logistic regression analysis was used to explore occupational therapy students' perceptions of the learning environment, their approaches to studying, and exam grades as they related to the likelihood of consistent participation at three annual surveys. Annual response rates varied between 55.1%, and 65.6%, and consistent participation was observed among 49.2%. The fully adjusted regression models showed that higher strategic approach scores increased the odds of consistent participation (adjusted OR: 1.04, p < 0.01), whereas higher surface approach scores decreased the odds of consistent participation (adjusted OR: 0.95, p < 0.05). Neither sociodemographic factors, learning environment factors nor academic performance predicted participation over time.

Mobile devices can provide extendable learning environments in higher education and motivate students to engage in adaptive and collaborative learning. Developers must design mobile apps that are practical, effective, and easy to use, and usability testing is essential for understanding how mobile apps meet users' needs. No previous reviews have investigated the usability of mobile apps developed for health care education. The aim of this scoping review is to identify usability methods and attributes in usability studies of mobile apps for health care education. A comprehensive search was carried out in 10 databases, reference lists, and gray literature. Studies were included if they dealt with health care students and usability of mobile apps for learning. Frequencies and percentages were used to present the nominal data, together with tables and graphical illustrations. Examples include a figure of the study selection process, an illustration of the frequency of inquiry usability evaluation and data collection methods, and an overview of the distribution of the identified usability attributes. We followed the Arksey and O'Malley framework for scoping reviews. Our scoping review collated 88 articles involving 98 studies, mainly related to medical and nursing students. The studies were conducted from 22 countries and were published between 2008 and 2021. Field testing was the main usability experiment used, and the usability evaluation methods were either inquiry-based or based on user testing. Inquiry methods were predominantly used: 1-group design (46/98, 47%), control group design (12/98, 12%), randomized controlled trials (12/98, 12%), mixed methods (12/98, 12%), and qualitative methods (11/98, 11%). User testing methods applied were all think aloud (5/98, 5%). A total of 17 usability attributes were identified; of these, satisfaction, usefulness, ease of use, learning performance, and learnability were reported most frequently. The most frequently used data collection method was questionnaires (83/98, 85%), but only 19% (19/98) of studies used a psychometrically tested usability questionnaire. Other data collection methods included focus group interviews, knowledge and task performance testing, and user data collected from apps, interviews, written qualitative reflections, and observations. Most of the included studies used more than one data collection method. Experimental designs were the most commonly used methods for evaluating usability, and most studies used field testing. Questionnaires were frequently used for data collection, although few studies used psychometrically tested questionnaires. The usability attributes identified most often were satisfaction, usefulness, and ease of use. The results indicate that combining different usability evaluation methods, incorporating both subjective and objective usability measures, and specifying which usability attributes to test seem advantageous. The results can support the planning and conduct of future usability studies for the advancement of mobile learning apps in health care education. RR2-10.2196/19072.

Multiple risk-prediction models are used in clinical practice to triage patients as being at low risk or high risk of ovarian cancer. In the ROCkeTS study, we aimed to identify the best diagnostic test for ovarian cancer in symptomatic patients, through head-to-head comparisons of risk-prediction models, in a real-world setting. Here, we report the results for the postmenopausal cohort. In this multicentre, prospective diagnostic accuracy study, we recruited newly presenting female patients aged 16–90 years with non-specific symptoms and raised CA125 or abnormal ultrasound results (or both) who had been referred via rapid access, elective clinics, or emergency presentations from 23 hospitals in the UK. Patients with normal CA125 and simple ovarian cysts of smaller than 5 cm in diameter, active non-ovarian malignancy, or previous ovarian malignancy, or those who were pregnant or declined a transvaginal scan, were ineligible. In this analysis, only postmenopausal participants were included. Participants completed a symptom questionnaire, gave a blood sample, and had transabdominal and transvaginal ultrasounds performed by International Ovarian Tumour Analysis consortium (IOTA)-certified sonographers. Index tests were Risk of Malignancy 1 (RMI1) at a threshold of 200, Risk of Malignancy Algorithm (ROMA) at multiple thresholds, IOTA Assessment of Different Neoplasias in the Adnexa (ADNEX) at thresholds of 3% and 10%, IOTA SRRisk model at thresholds of 3% and 10%, IOTA Simple Rules (malignant vs benign, or inconclusive), and CA125 at 35 IU/mL. In a post-hoc analysis, the Ovarian Adnexal and Reporting Data System (ORADS) at 10% was derived from IOTA ultrasound variables using established methods since ORADS was described after completion of recruitment. Index tests were conducted by study staff masked to the results of the reference standard. The comparator was RMI1 at the 250 threshold (the current UK National Health Service standard of care). The reference standard was surgical or biopsy tissue histology or cytology within 3 months, or a self-reported diagnosis of ovarian cancer at 12 month follow-up. The primary outcome was diagnostic accuracy at predicting primary invasive ovarian cancer versus benign or normal histology, assessed by analysing the sensitivity, specificity, C-index, area under receiver operating characteristic curve, positive and negative predictive values, and calibration plots in participants with conclusive reference standard results and available index test data. This study is registered with the International Standard Randomised Controlled Trial Number registry (ISRCTN17160843). Between July 13, 2015, and Nov 30, 2018, 1242 postmenopausal patients were recruited, of whom 215 (17%) had primary ovarian cancer. 166 participants had missing, inconclusive, or other reference standard results; therefore, data from a maximum of 1076 participants were used to assess the index tests for the primary outcome. Compared with RMI1 at 250 (sensitivity 82·9% [95% CI 76·7 to 88·0], specificity 87·4% [84·9 to 89·6]), IOTA ADNEX at 10% was more sensitive (difference of –13·9% [–20·2 to –7·6], p<0·0001) but less specific (difference of 28·5% [24·7 to 32·3], p<0·0001). ROMA at 29·9 had similar sensitivity (difference of –3·6% [–9·1 to 1·9], p=0·24) but lower specificity (difference of 5·2% [2·5 to 8·0], p=0·0001). RMI1 at 200 had similar sensitivity (difference of –2·1% [–4·7 to 0·5], p=0·13) but lower specificity (difference of 3·0% [1·7 to 4·3], p<0·0001). IOTA SRRisk model at 10% had similar sensitivity (difference of –4·3% [–11·0 to –2·3], p=0·23) but lower specificity (difference of 16·2% [12·6 to 19·8], p<0·0001). IOTA Simple Rules had similar sensitivity (difference of –1·6% [–9·3 to 6·2], p=0·82) and specificity (difference of –2·2% [–5·1 to 0·6], p=0·14). CA125 at 35 IU/mL had similar sensitivity (difference of –2·1% [–6·6 to 2·3], p=0·42) but higher specificity (difference of 6·7% [4·3 to 9·1], p<0·0001). In a post-hoc analysis, when compared with RMI1 at 250, ORADS achieved similar sensitivity (difference of –2·1%, 95% CI –8·6 to 4·3, p=0·60) and lower specificity (difference of 10·2%, 95% CI 6·8 to 13·6, p<0·0001). In view of its higher sensitivity than RMI1 at 250, despite some loss in specificity, we recommend that IOTA ADNEX at 10% should be considered as the new standard-of-care diagnostic in ovarian cancer for postmenopausal patients. UK National Institute for Health and Care Research.

Background Bachelor students of occupational therapy are expected to work in accordance with evidence-based practice (EBP). The EBP work file, a learning tool in a Word document format, covering all steps in the EBP process, is an approach to teaching and learning EBP. The aim of this study was to examine the attitudes and behaviours of occupational therapy students’ in relation to applying evidence-based practice during their second-year clinical placement. We compared cohorts who received training in EBP work files with those who did not receive such training. Methods A descriptive, cross-sectional comparative study was conducted. Five cohorts of second-year occupational therapy students took part in the study. The students answered two questionnaires, the EBP Beliefs Scale and the EBP Implementation Scale, after completing their second-year clinical placement. The analysis was based on descriptive statistics and calculation of the frequencies, percentages, mean and standard deviations of all participating students’ scores across both questionnaires. ANOVA with Bonferroni correction was conducted to analyse the differences between the mean totals of the questionnaires. Results In this study, 126 occupational therapy students participated (response rate = 57.3%). The students reacted positively to EBP, although few were practicing EBP. The students believed that EBP resulted in the best clinical care for patients, but they lacked confidence in their own ability to apply EBP. The students in Cohort 5, who received extra instruction and assignments via the EBP work file, rated their EBP behaviour statistically lower than the students in Cohort 1, who did not receive extra training on the EBP work file. Conclusions Additional EBP work file assignments were insufficient in terms of supporting students in the implementation of EBP during clinical placements. It is, therefore, important to facilitate the learning strategies of EBP skills and demonstrate how students can practise this competency during clinical placements. Including clinical instructors in EBP teaching and learning seems essential.

Background Aspects of the learning environment may be related to students` approaches to studying, but few studies have investigated these relationships in the context of occupational therapy education. Objective To examine associations between occupational therapy students’ perceptions of the learning environment and their approaches to studying. Method One hundred eighty-seven first-year occupational therapy students in Norway (response rate 61.3%) participated in this study. Aside from sociodemographic information, the students completed the Course Experience Questionnaire and the Approaches and Study Skills Inventory for Students . Associations between learning environment variables and study approaches were investigated with hierarchical linear regression analyses. Results Higher scores on Generic skills were associated with higher scores on the deep and strategic approach scales ( β ranging 0.18–0.51), while lower scores were associated with higher surface approach scale scores ( β  = − 0.24). Lower scores on Clear goals and standards and Appropriate workload were associated with higher surface approach scores ( β ranging − 0.16 - -0.42). Conclusion By improving aspects of the learning environment, there may be a potential for influencing occupational therapy students’ approaches to studying. Based on this study, emphasizing how generic skills developed in the study program may become useful in practising a profession, ensuring clarity of goals and standards, and maintaining an appropriate workload on students appear to be important.

While studies have examined predictors of study performance in various student groups, cluster analytic studies identify groups of students with similar characteristics. The purpose of this study was to explore relevant clusters of occupational therapy students and examine profile differences between participants in different clusters. A total of 177 first-year students from six occupational therapy programs in Norway participated in this study. Data on age, gender, study approaches, study effort, and study performance were collected. A two-step cluster analysis was conducted. Three clusters were identified. Cluster 1, the high-strategic high-performing students, comprised the successful students, mostly females, who invested much effort and used productive approaches to studying. Cluster 2, the high-surface average-performing students, consisted of less successful female students, who used poor study strategies and made little effort. Cluster 3, the low-strategic low-performing students, comprised the least successful students, who were all male, with study efforts and study strategies in the middle range. Overall, this study suggests that occupational therapy students can be classified into clusters based on a combination of measures. To enhance student learning and performance, educators should pay particular attention to male students and to students investing little effort and using poor study strategies.

Evidence-based practice (EBP) is an important aspect of the health care education curriculum. EBP involves following the 5 EBP steps: ask, assess, appraise, apply, and audit. These 5 steps reflect the suggested core competencies covered in teaching and learning programs to support future health care professionals applying EBP. When implementing EBP teaching, assessing outcomes by documenting the student's performance and skills is relevant. This can be done using mobile devices. The aim of this study was to assess occupational therapy students' EBP skills as reported in a mobile app. We applied a cross-sectional design. Descriptive statistics were used to present frequencies, percentages, means, and ranges of data regarding EBP skills found in the EBPsteps app. Associations between students' ability to formulate the Population, Intervention, Comparison, and Outcome/Population, Interest, and Context (PICO/PICo) elements and identifying relevant research evidence were analyzed with the chi-square test. Of 4 cohorts with 150 students, 119 (79.3%) students used the app and produced 240 critically appraised topics (CATs) in the app. The EBP steps \"ask,\" \"assess,\" and \"appraise\" were often correctly performed. The clinical question was formulated correctly in 53.3% (128/240) of the CATs, and students identified research evidence in 81.2% (195/240) of the CATs. Critical appraisal checklists were used in 81.2% (195/240) of the CATs, and most of these checklists were assessed as relevant for the type of research evidence identified (165/195, 84.6%). The least frequently correctly reported steps were \"apply\" and \"audit.\" In 39.6% (95/240) of the CATs, it was reported that research evidence was applied. Only 61% (58/95) of these CATs described how the research was applied to clinical practice. Evaluation of practice changes was reported in 38.8% (93/240) of the CATs. However, details about practice changes were lacking in all these CATs. A positive association was found between correctly reporting the \"population\" and \"interventions/interest\" elements of the PICO/PICo and identifying research evidence (P<.001). We assessed the students' EBP skills based on how they documented following the EBP steps in the EBPsteps app, and our results showed variations in how well the students mastered the steps. \"Apply\" and \"audit\" were the most difficult EBP steps for the students to perform, and this finding has implications and gives directions for further development of the app and educational instruction in EBP. The EBPsteps app is a new and relevant app for students to learn and practice EBP, and it can be used to assess students' EBP skills objectively.

Introduction Although the learning environment influences students’ motivation, learning outcomes, and satisfaction with the study program, less is known about how these factors change as the students’ progress through the study program. Aim The aim of this study was to examine changes in occupational therapy students’ perceptions of the academic learning environment during their three-year study program and to examine factors associated with the students’ perceptions of the learning environment. Materials and methods A longitudinal cohort study was conducted throughout the three-year study program. Data were collected annually using the Course Experience Questionnaire (CEQ). In total, 263 students from six occupational therapy programs participated in at least one data gathering point. The number of participants was 186 in the first year, 168 in the second year and 200 in the third year. Of the 263 students who participated in the study, 87 participated in only one point of data collection, 58 at two points and 118 at all three points of the data collection. Data were analyzed with linear mixed models. Results The results showed statistically significant temporal changes on the “Emphasis on independence”, “Good teaching” and “Generic skills” scales. There was a significant decrease in scores from the first to the second year of study and the scores remained at this level in the third study year on both the “Emphasis on independence” and “Good teaching” scales. In addition, associations were found between study effort and educational institution related to the “Appropriate workload” scale, as well as between age and the “Generic skills” scale. Conclusion The temporal changes of the students’ perceptions of the “Emphasis on independence” as well as “Good teaching” scales are noteworthy. Both scales indicated a significant decrease in scores, indicating that the students perceived that they were less independent from first to second and third year, as well as a perceived decline in the quality of teaching from first to second and third year. The results of this study are central when planning to facilitate learning, especially related to independence and perceptions of good teaching for students in occupational therapy programs.

Objectives To validate recent guidance changes by establishing the performance of cut-off values for embryo crown-rump length and mean gestational sac diameter to diagnose miscarriage with high levels of certainty. Secondary aims were to examine the influence of gestational age on interpretation of mean gestational sac diameter and crown-rump length values, determine the optimal intervals between scans and findings on repeat scans that definitively diagnose pregnancy failure.) Design Prospective multicentre observational trial. Setting Seven hospital based early pregnancy assessment units in the United Kingdom. Participants 2845 women with intrauterine pregnancies of unknown viability included if transvaginal ultrasonography showed an intrauterine pregnancy of uncertain viability. In three hospitals this was initially defined as an empty gestational sac <20 mm mean diameter with or without a visible yolk sac but no embryo, or an embryo with crown-rump length <6 mm with no heartbeat. Following amended guidance in December 2011 this definition changed to a gestational sac size <25 mm or embryo crown-rump length <7 mm. At one unit the definition was extended throughout to include a mean gestational sac diameter <30 mm or embryo crown-rump length <8 mm. Main outcome measures Mean gestational sac diameter, crown-rump length, and presence or absence of embryo heart activity at initial and repeat transvaginal ultrasonography around 7-14 days later. The final outcome was pregnancy viability at 11-14 weeks’ gestation. Results The following indicated a miscarriage at initial scan: mean gestational sac diameter ≥25 mm with an empty sac (364/364 specificity: 100%, 95% confidence interval 99.0% to 100%), embryo with crown-rump length ≥7 mm without visible embryo heart activity (110/110 specificity: 100%, 96.7% to 100%), mean gestational sac diameter ≥18 mm for gestational sacs without an embryo presenting after 70 days’ gestation (907/907 specificity: 100%, 99.6% to 100%), embryo with crown-rump length ≥3 mm without visible heart activity presenting after 70 days’ gestation (87/87 specificity: 100%, 95.8% to 100%). The following were indicative of miscarriage at a repeat scan: initial scan and repeat scan after seven days or more showing an embryo without visible heart activity (103/103 specificity: 100%, 96.5% to 100%), pregnancies without an embryo and mean gestational sac diameter <12 mm where the mean diameter has not doubled after 14 days or more (478/478 specificity: 100%, 99.2% to 100%), pregnancies without an embryo and mean gestational sac diameter ≥12 mm showing no embryo heartbeat after seven days or more (150/150 specificity: 100%, 97.6% to 100%). Conclusions Recently changed cut-off values of gestational sac and embryo size defining miscarriage are appropriate and not too conservative but do not take into account gestational age. Guidance on timing between scans and expected findings on repeat scans are still too liberal. Protocols for miscarriage diagnosis should be reviewed to account for this evidence to avoid misdiagnosis and the risk of terminating viable pregnancies.