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Alternative approaches for clinical clerkship during the COVID-19 pandemic: online simulated clinical practice for inpatients and outpatients—A mixed method
Background
The COVID-19 pandemic has created a need for educational materials and methods that can replace clinical clerkships (CCs) for online simulated clinical practice (online-sCP). This study evaluates the impact of using simulated electronic health records (sEHR) for inpatients, and electronic problem-based learning (e-PBL) and online virtual medical interviews (online-VMI) for outpatients, for an online-sCP using a learning management system (LMS) and online meeting system facilitated by a supervising physician.
Methods
The sEHR was reviewed by medical students and subsequently discussed with a supervising physician using an online meeting system. In the e-PBL, medical students reviewed the simulated patients and discussed on the LMS. For the online-VMI, a faculty member acted as an outpatient and a student acted as the doctor. Small groups of students discussed the clinical reasoning process using the online meeting system. A mixed-method design was implemented. Medical students self-assessed their clinical competence before and after the online-sCP. They answered questionnaires and participated in semi-structured focus group interviews (FGIs) regarding the advantages and disadvantages of the practice.
Results
Forty-three students completed the online-sCP during May and June 2020. All students indicated significant improvement in all aspects of self-evaluation of clinical performance after the online-sCP. Students using sEHR reported significant improvement in writing daily medical records and medical summaries. Students using e-PBL and online-VMI reported significant improvement in medical interviews and counseling. Students also indicated CCs as more useful for learning associated with medical interviews, physical examinations, and humanistic qualities like professionalism than the online-sCP. Eight FGIs were conducted (
n
= 42). The advantages of online-sCP were segregated into five categories (learning environment, efficiency, accessibility, self-paced learning, and interactivity); meanwhile, the disadvantages of online-sCP were classified into seven categories (clinical practice experience, learning environment, interactivity, motivation, memory retention, accessibility, and extraneous cognitive load).
Conclusions
Online-sCP with sEHR, e-PBL, and online-VMI could be useful in learning some of the clinical skills acquired through CC. These methods can be implemented with limited preparation and resources.
Journal Article
The structure and dynamics of cities : urban data analysis and theoretical modeling
\"With over half of the world's population now living in urban areas, the ability to model and understand the structure and dynamics of cities is becoming increasingly valuable. Combining new data with tools and concepts from statistical physics and urban economics, this book presents a modern and interdisciplinary perspective on cities and urban systems. Both empirical observations and theoretical approaches are critically reviewed, with particular emphasis placed on derivations of classical models and results, along with analysis of their limits and validity. Key aspects of cities are thoroughly analyzed, including mobility patterns, the impact of multimodality, the coupling between different transportation modes, the evolution of infrastructure networks, spatial and social organisation, and interactions between cities. Drawing upon knowledge and methods from areas of mathematics, physics, economics and geography, the resulting quantitative description of cities will be of interest to all those studying and researching how to model these complex systems\"-- Provided by publisher.
Book
Quantitative methods for health research
A practical introduction to epidemiology, biostatistics, and research methodology for the whole health care community
This comprehensive text, which has been extensively revised with new material and additional topics, utilizes a practical slant to introduce health professionals and students to epidemiology, biostatistics, and research methodology. It draws examples from a wide range of topics, covering all of the main contemporary health research methods, including survival analysis, Cox regression, and systematic reviews and meta-analysis—the explanation of which go beyond introductory concepts. This second edition of Quantitative Methods for Health Research: A Practical Interactive Guide to Epidemiology and Statistics also helps develop critical skills that will prepare students to move on to more advanced and specialized methods.
A clear distinction is made between knowledge and concepts that all students should ensure they understand, and those that can be pursued further by those who wish to do so. Self-assessment exercises throughout the text help students explore and reflect on their understanding. A program of practical exercises in SPSS (using a prepared data set) helps to consolidate the theory and develop skills and confidence in data handling, analysis, and interpretation. Highlights of the book include:
* Combining epidemiology and bio-statistics to demonstrate the relevance and strength of statistical methods
* Emphasis on the interpretation of statistics using examples from a variety of public health and health care situations to stress relevance and application
* Use of concepts related to examples of published research to show the application of methods and balance between ideals and the realities of research in practice
* Integration of practical data analysis exercises to develop skills and confidence
* Supplementation by a student companion website which provides guidance on data handling in SPSS and study data sets as referred to in the text
Quantitative Methods for Health Research, Second Edition is a practical learning resource for students, practitioners and researchers in public health, health care and related disciplines, providing both a course book and a useful introductory reference.
eBook
Patient Outcomes in Simulation-Based Medical Education: A Systematic Review
ABSTRACT
OBJECTIVES
Evaluating the patient impact of health professions education is a societal priority with many challenges. Researchers would benefit from a summary of topics studied and potential methodological problems. We sought to summarize key information on patient outcomes identified in a comprehensive systematic review of simulation-based instruction.
DATA SOURCES
Systematic search of MEDLINE, EMBASE, CINAHL, PsychINFO, Scopus, key journals, and bibliographies of previous reviews through May 2011.
STUDY ELIGIBILITY
Original research in any language measuring the direct effects on patients of simulation-based instruction for health professionals, in comparison with no intervention or other instruction.
APPRAISAL and SYNTHESIS
Two reviewers independently abstracted information on learners, topics, study quality including unit of analysis, and validity evidence. We pooled outcomes using random effects.
RESULTS
From 10,903 articles screened, we identified 50 studies reporting patient outcomes for at least 3,221 trainees and 16,742 patients. Clinical topics included airway management (14 studies), gastrointestinal endoscopy (12), and central venous catheter insertion (8). There were 31 studies involving postgraduate physicians and seven studies each involving practicing physicians, nurses, and emergency medicine technicians. Fourteen studies (28 %) used an appropriate unit of analysis. Measurement validity was supported in seven studies reporting content evidence, three reporting internal structure, and three reporting relations with other variables. The pooled Hedges’ g effect size for 33 comparisons with no intervention was 0.47 (95 % confidence interval [CI], 0.31–0.63); and for nine comparisons with non-simulation instruction, it was 0.36 (95 % CI, −0.06 to 0.78).
LIMITATIONS
Focused field in education; high inconsistency (I
2
> 50 % in most analyses).
CONCLUSIONS
Simulation-based education was associated with small-moderate patient benefits in comparison with no intervention and non-simulation instruction, although the latter did not reach statistical significance. Unit of analysis errors were common, and validity evidence was infrequently reported.
Journal Article
Preliminary evidence of key factors in successful flipping: predicting positive student experiences in flipped classrooms
Flipped classrooms have become widely adopted in educational settings (e.g., in higher education) worldwide. However, there is a need for more precise understanding of the ingredients for student satisfaction in a flipped setting. The aim of this paper was to investigate university students’ experiences of the factors that create a successful flipped course. Ten measures were used to investigate the hypothesized factors affecting satisfaction, which were chosen based on the results from previous flipped classroom studies and higher educational research. These measures were grouped into three dimensions: (1) pedagogical (five measures), (2) social (three measures), and (3) technological (two measures). Exploratory factor analysis was run to analyze the adequacy of the instruments. Results revealed that the factor structure was as expected and that the instruments measuring all ten factors of teaching and learning in a flipped classroom were adequate. Furthermore, confirmatory factor analysis was used to formally operationalize the hypothesized latent constructs, and to build a structural equation model for predicting the student satisfaction of a flipped classroom. In the end, seven factors were found to predict student satisfaction with flipped courses. The highest predictor was guidance from the dimension of pedagogy, and the second-best predictor was experienced teaching for understanding. The results, limitations, and conclusion are discussed in terms of key issues and the development of a flipped classroom pedagogical design for higher education.
Journal Article
Small Samples in Instructed Second Language Acquisition Research
This commentary discusses the issue of small samples in instructed second language acquisition research. We discuss the current state of affairs, and consider the disadvantages of small samples. We also explore other considerations regarding sample size, such as research ethics and ecological validity. We present a range of recommendations for researchers to address the issue of small samples. Recommendations include (a) engaging in sample size planning, (b) opting for appropriate designs and analytical approaches, (c) reporting the constraints that sample size places on the interpretation of findings, and (d) cultivating a culture of collaboration and open science.
Journal Article
Statistics and Probability Have Always Been Value-Laden: An Historical Ontology of Quantitative Research Methods
Quantitative researchers often discuss research ethics as if specific ethical problems can be reduced to abstract normative logics (e.g., virtue ethics, utilitarianism, deontology). Such approaches overlook how values are embedded in every aspect of quantitative methods, including 'observations,' 'facts,' and notions of 'Objectivity.' We describe how quantitative research practices, concepts, discourses, and their objects/subjects of study have always been value-laden, from the invention of statistics and probability in the 1600s to their subsequent adoption as a logic made to appear as if it exists prior to, and separate from, ethics and values. This logic, which was embraced in the Academy of Management from the 1960s, casts management researchers as ethical agents who ought to know about a reality conceptualized as naturally existing in the image of statistics and probability (replete with 'constructs'), while overlooking that S&P logic and practices, which researchers made for themselves, have an appreciable role in making the world appear this way. We introduce a different way to conceptualize reality and ethics, wherein the process of scientific inquiry itself requires an examination of its own practices and commitments. Instead of resorting to decontextualized notions of 'rigor' and its 'best practices,' quantitative researchers can adopt more purposeful ways to reason about the ethics and relevance of their methods and their science. We end by considering implications for addressing 'post truth' and 'alternative facts' problems as collective concerns, wherein it is actually the pluralistic nature of description that makes defending a collectively valuable version of reality so important and urgent.
Journal Article