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\"This text tackles the phenomenon of limited learning on campuses by approaching it from the point of view of the author, an educator who writes about the experience of being, simultaneously, a college student and a college professor. The author lays out her experience as a student struggling in an introductory linguistics class, framing her struggles as sites ripe for autoethnographic interrogation. Throughout the book, the author melds her personal narratives with the extant research on college student learning, college readiness, and the interconnectedness of affect, intellect, and socio-cultural contexts\"-- Provided by publisher.

Introduction Our simulation‐based mastery learning (SBML) curriculum, delivered in person, has been shown to successfully train novices in structured esophagogastroduodenoscopy (EGD). SBML with virtual coaching (VC) has the potential to improve the effectiveness and efficiency of endoscopy training and expand access to trainees from around the world. We share our observations conducting an EGD training course using SBML with VC. Methods We conducted a 1‐week virtual SBML course for novice trainees across seven academic centers in the USA and Asia. The cognitive component was delivered using an online learning platform. For technical skills, a virtual coach supervised hands‐on training and local coaches provided assistance when needed. At the end of training, an independent rater assessed simulation‐based performance using a validated assessment tool. We assessed the clinical performance of 30 EGDs using the ASGE Assessment of Competency in Endoscopy tool. We compared the trainees’ scores to our cohort trained using in‐person SBML training using non‐inferiority t‐tests. Results We enrolled 21 novice trainees (mean age: 30.8 ± 3.6 years; female: 52%). For tip deflection, the trainees reached the minimum passing standard after 31 ± 29 runs and mastery after 52 ± 37 runs. For structured EGD, the average score for the overall exam was 4.6 ± 0.6, similar to the in‐person cohort (4.7 ± 0.5, p = 0.49). The knowledge‐based assessment was also comparable (virtual coaching: 81.9 ± 0.1; direct coaching: 78.3 ± 0.1; p = 0.385). Over time, our novice trainees reached clinical competence at a similar rate to our historical in‐person control. Conclusions VC appears feasible and effective for training novice gastroenterology trainees. VC allowed us to scale our SBML course, expand access to experts, and administer SBML simultaneously across different sites at the highest standards.

Background Nasolacrimal duct probing is traditionally taught through supervised practice on pediatric patients; however, limited case availability and ethical concerns restrict training opportunities. Simulation-based mastery learning (SBML) offers a structured alternative. We developed a multifaceted probing simulation (MPS) incorporating SBML principles for ophthalmology resident training. Methods This prospective pre–post interventional study evaluated feasibility (process outcomes) and preliminary educational outcomes of the MPS program. Twenty ophthalmology residents at a university in Thailand participated. Training included a video tutorial, MCQ assessment with feedback, and supervised simulation-based practice. Feasibility outcomes included implementation, completion rate, and usability (User Experience Questionnaire; UEQ). Educational outcomes included changes in procedural performance (rubric scores), procedure time, and self-reported confidence. Results All participants completed the training program, supporting feasibility of implementation. The simulation demonstrated high usability across all UEQ domains, with attractiveness rated highest, and excellent internal consistency (Cronbach’s alpha = 0.91). Median procedural performance scores improved from 16 (IQR 13.5–19) to 26.5 (IQR 24–29.5), while mean procedure time decreased from 3.45 ± 1.32 to 1.53 ± 0.42 min ( p  < 0.001). Confidence levels increased progressively throughout training. Conclusions The MPS program appears feasible and acceptable for integration into ophthalmology residency training. Improvements in procedural performance, efficiency, and confidence were observed immediately after training, indicating short-term benefits; however, these findings are preliminary. Long-term retention and transfer to clinical practice were not assessed. Further controlled studies are required to determine effectiveness and clinical impact. Trial registration thaiclinicaltrials.org, TCTR20230314004, Registration date: 1 March 2023.

Improving academic engagement of medical postgraduates is crucial for enhancing the quality of learning and the development of medical education. Due to medical postgraduates face high levels of stress and rigorous demands, yet the mechanisms linking challenge-hindrance stressors to academic engagement in this context remain largely unexplored. This study aims to explore the comprehensive relationship between challenge-hindrance stressors and academic engagement among medical postgraduates in China. Data were collected from 437 medical postgraduates in China, to investigate their challenge-hindrance stressors, emotional exhaustion, learning, relaxation and academic engagement. Among these postgraduates, 40.3% were male and 59.7% were female, with the mean age of the participants being 25.71 years. Statistical procedures were conducted using Mplus 8.3, ensuring a robust analysis of the data collected. Our study showed that both challenge and hindrance stressors are significantly positively correlated with emotional exhaustion among Chinese medical postgraduates, and emotional exhaustion is negatively associated with academic engagement. Emotional exhaustion mediates the relationship between challenge-hindrance stressors and academic engagement. Learning plays a protective role, moderating the challenge stressors and emotional exhaustion relationship and its indirect effect on academic engagement. However, relaxation was not identified as a significant moderating factor in this context. Our findings not only revealed emotional exhaustion as a potential mechanism underlying the relationship between challenge-hindrance stressors and academic engagement but also validated the moderating role of learning in mitigating the adverse effects of challenge stressors on emotional exhaustion and academic engagement among Chinese medical postgraduates. This comprehensive insight into the complex dynamics between different stressors and academic engagement provides both theoretical and empirical evidence for medical universities. It underscores the importance of interventions to enhance academic engagement in stressful environments and serves as a valuable reference for the development of reasonable assessment systems. These contributions are crucial for fostering a supportive educational atmosphere and promoting the well-being of medical postgraduates.

The aim of nursing education is to foster in students the competence of applying integrated knowledge with clinical skills to the application domains. In the traditional approach, in-class knowledge learning and clinical skills training are usually conducted separately, such that the students might not be able to integrate the knowledge and the skills in performing standard nursing procedures. Therefore, it is important to develop an integrated curriculum for teaching standard operating procedures in physical assessment courses. In this study, a context-aware mobile learning system is developed for nursing training courses. During the learning activities, each student is equipped with a mobile device; moreover, sensing devices are used to detect whether the student has conducted the operations on the correct location of the dummy patient's body for assessing the physical status of the specified disease. The learning system not only guides individual students to perform each operation of the physical assessment procedure on dummy patients, but also provides instant feedback and supplementary materials to them if the operations or the operating sequence is incorrect. The experimental results show that the students' learning outcomes are notably improved by utilizing the mobile learning system for nursing training.

Background Intercostal chest drain (ICD) insertion is a skill that medical trainees lack confidence in performing. This study explores the impact of a national programme of Simulation-Based Mastery Learning (SBML) on procedural confidence, including the impact of time intervals between booster sessions and interim clinical experience. Methods Internal Medicine Trainees in Scotland were surveyed about confidence and clinical experience with ICD insertion before and immediately after SBML and booster session. Data were matched and analysed using paired sample t-tests. Short interval and long interval groups were compared using Student’s unpaired t-test. The impact of interim clinical experience was assessed using Analysis of Variance. Results Mean confidence in ICD insertion rose following SBML, fell between initial and booster session, and increased again following booster session ( P  =  < 0.001). 33 of 74 trainees had successfully inserted an ICD between sessions. Fall in confidence was unaffected by the time interval between training sessions, but was mitigated by interim clinical experience. Conclusions SBML boosts trainee confidence in ICD insertion. However, there is evidence of confidence decay, possibly due to a lack of clinical experience between sessions. More research is needed to explore barriers to transfer of skills from simulated to real-world environments.

Context: the challenge of unresolved breathlessness in asthmaBreathlessness is the predominant symptom driving the asthma pathway. In primary care, people with asthma who remain breathless despite treatment escalation are typically referred to secondary care. Notably, Type 2 (T2)-high patients may remain breathless even when biologic therapy successfully controls inflammatory biomarkers. In the Type-2 biomarker versus symptom-based treatment trial (Lancet Respir Med 2021; 9:57–61), a substantial number of patients with well-controlled biomarkers were reluctant to reduce treatment, highlighting the disconnect between biomarker control and symptom burden.MethodsWe analysed data from 1628 patients who attended the Severe Asthma Service in autumn 2024. Information from each patient’s earliest contact with the service was extracted to reflect asthma status at the time of referral, while the most recent available data were used to assess the impact of tertiary care treatment (HRA IRAS 342426). Breathlessness was evaluated using the Asthma Control Questionnaire (ACQ), comparing scores at entry with the latest score available to understand the impact of treatment. An ACQ of ≤0.75 typically indicates good asthma control, while ACQ of ≥1.5 is indicative of poor asthma control.ResultsThe latest overall ACQ median (IQR) of 2.2 (1.2–3.2) demonstrated a statistically significant change compared to ACQ at service entry 2.4 (1.4–3.3). Patients started on biologics also demonstrated a statistically significant change in ACQ: 2.7 (1.7–3.5) vs 2.3 (1.2 -3.3). In both cases, the difference did not meet the ACQ minimally clinically important difference (MCID) of 0.5. In 561 patients in which the highest ever eosinophil was <0.3, median ACQ remained unchanged at 2.3 at both entry and follow-up.Abstract M25 Table 1 All(n=1628) On biologics(n=448) Eosinophil <0.3(n=561) Eosinophil >0.3(n=619) Age in years, median (IQR)54.9 (41.3–65.0)56.4 (46.5–64.9)54.5 (39.0–64.4)54.1 (39.0–65.6)Males, n, %510 (31.3)106 (37.3)132 (22.2)212 (32.0)BMI in kg/m2, median (IQR)30.9 (26.4–36.7)31.2 (27.1–37.2)31.4 (26.7–37.6)30.3 (25.9–36.3)Baseline FeNO, median (IQR)20.0 (11.0–43.0)26.5 (15.0–56.0)15.0 (8.0–24.0)23.0 (12.0–48.0)Latest FeNO, median (IQR)21.0 (12.0–42.8)31.0 (17.0–55.0)15.0 (9.0–26.0)24.0 (13.0–44.0)Baseline ACQ, median (IQR)2.4 (1.4–3.3)*2.7 (1.7–3.5)*2.3 (1.4–3.5)2.1 (1.0–3.0)Latest ACQ, median (IQR)2.2 (1.2–3.2)*2.3 (1.2–3.3)*2.3 (1.3–3.3)2.0 (1.2–3.0)*Within–group comparisons of ACQ scores showed statistically significant differences for the overall cohort and for those on biologics (Wilcoxon signed–rank test, adjusted with Bonferroni correction)DiscussionComprehensive data from a single centre demonstrate a post treatment median ACQ of 2.2 which is well above the cut-off for poor control. Though there was a statistically significant fall in ACQ with treatment in patients started on biologics, this did not meet the ACQ MCID, and the ACQ of 2.3 was also above the ACQ cut-off for good control of 0.75. These data support the Lind Alliance Breathlessness consensus that interventions to address non-T2 high breathlessness in severe asthma clinics is a research priority.

Background Diagnostic uncertainty occurs frequently in emergency medical care, with more than one-third of patients leaving the emergency department (ED) without a clear diagnosis. Despite this frequency, ED providers are not adequately trained on how to discuss diagnostic uncertainty with these patients, who often leave the ED confused and concerned. To address this training need, we developed the Uncertainty Communication Education Module (UCEM) to teach physicians how to discuss diagnostic uncertainty. The purpose of the study is to evaluate the effectiveness of the UCEM in improving physician communications. Methods The trial is a multicenter, two-arm randomized controlled trial designed to teach communication skills using simulation-based mastery learning (SBML). Resident emergency physicians from two training programs will be randomly assigned to immediate or delayed receipt of the two-part UCEM intervention after completing a baseline standardized patient encounter. The two UCEM components are: 1) a web-based interactive module, and 2) a smart-phone-based game. Both formats teach and reinforce communication skills for patient cases involving diagnostic uncertainty. Following baseline testing, participants in the immediate intervention arm will complete a remote deliberate practice session via a video platform and subsequently return for a second study visit to assess if they have achieved mastery. Participants in the delayed intervention arm will receive access to UCEM and remote deliberate practice after the second study visit. The primary outcome of interest is the proportion of residents in the immediate intervention arm who achieve mastery at the second study visit. Discussion Patients’ understanding of the care they received has implications for care quality, safety, and patient satisfaction, especially when they are discharged without a definitive diagnosis. Developing a patient-centered diagnostic uncertainty communication strategy will improve safety of acute care discharges. Although use of SBML is a resource intensive educational approach, this trial has been deliberately designed to have a low-resource, scalable intervention that would allow for widespread dissemination and uptake. Trial registration The trial was registered at clinicaltrials.gov ( NCT04021771 ). Registration date: July 16, 2019.

Background Simulation-based mastery learning (SBML) is an effective, evidence-based methodology for procedural skill acquisition, but its application may be limited by its resource intensive nature. To address this issue, an enhanced SBML programme has been developed by the addition of both pre-learning and peer learning components. These components allowed the enhanced programme to be scaled up and delivered to 106 postgraduate doctors participating in a national educational teaching programme. Methods The pre-learning component consisted of an online reading pack and videos. The peer learning component consisted of peer-assisted deliberate practice and peer observation of assessment and feedback within the SBML session. Anonymised pre- and post-course questionnaires were completed by learners who participated in the enhanced programme. A mixture of quantitative and qualitative data was obtained. Results Questionnaires were distributed to and completed by 50 learners. Both sections of the pre-learning component were highly rated on the basis of a seven-point Likert scale. The peer learning component was also favourably received following a Likert scale rating. Peer observation of the performance and assessment process was rated similarly by first and second learners. The thematic analysis of the reasons for which peer-assisted deliberate practice was considered useful showed that familiarisation with equipment, the rehearsal of the procedure itself, the exchange of experiences and sharing of useful tips were important. The thematic analysis of the reasons why peer observation during ‘performance, assessment and feedback’ was useful highlighted that an ability to compare a peer’s performance to their own and learning from observing a peer’s mistakes were particularly helpful. Conclusion The SBML programme described has been enhanced by the addition of pre-learning and peer learning components which are educationally valued and allow its application on a national scale.

Background The use of simulators in medical education is critical for developing procedural competence prior to treating patients. Current training of emergency physicians to perform distal radius fracture reduction is inconsistent and inadequate. Approach We developed a 3D printed distal radius fracture simulation training model that is easy to assemble and relatively inexpensive. We present step-by-step instructions to reproduce the model. Evaluation The model was found to have high fidelity for training by both instructors and participants in a simulation-based mastery learning course. Reflection We successfully designed a low cost, easy to reproduce, high fidelity model for use in a simulation-based mastery learning course to teach distal radius fracture reduction.