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Effectiveness of a ‘Do not interrupt’ bundled intervention to reduce interruptions during medication administration: a cluster randomised controlled feasibility study
AimTo evaluate the effectiveness of a ‘Do not interrupt’ bundled intervention to reduce non-medication-related interruptions to nurses during medication administration.MethodsA parallel eight cluster randomised controlled study was conducted in a major teaching hospital in Adelaide, Australia. Four wards were randomised to the intervention which comprised wearing a vest when administering medications; strategies for diverting interruptions; clinician and patient education; and reminders. Control wards were blinded to the intervention. Structured direct observations of medication administration processes were conducted. The primary outcome was non-medication-related interruptions during individual medication dose administrations. The secondary outcomes were total interruption and multitasking rates. A survey of nurses' experiences was administered.ResultsOver 8 weeks and 364.7 hours, 227 nurses were observed administering 4781 medications. At baseline, nurses experienced 57 interruptions/100 administrations, 87.9% were unrelated to the medication task being observed. Intervention wards experienced a significant reduction in non-medication-related interruptions from 50/100 administrations (95% CI 45 to 55) to 34/100 (95% CI 30 to 38). Controlling for clustering, ward type and medication route showed a significant reduction of 15 non-medication-related interruptions/100 administrations compared with control wards. A total of 88 nurses (38.8%) completed the poststudy survey. Intervention ward nurses reported that vests were time consuming, cumbersome and hot. Only 48% indicated that they would support the intervention becoming hospital policy.DiscussionNurses experienced a high rate of interruptions. Few were related to the medication task, demonstrating considerable scope to reduce unnecessary interruptions. While the intervention was associated with a statistically significant decline in non-medication-related interruptions, the magnitude of this reduction and its likely impact on error rates should be considered, relative to the effectiveness of alternate interventions, associated costs, likely acceptability and long-term sustainability of such interventions.
Journal Article
Comparison between flipped classroom and lecture-based classroom in ophthalmology clerkship
Background: In recent years, the flipped classroom method of teaching has received much attention in health sciences education. However, the application of flipped classrooms in ophthalmology education has not been well investigated.
Objective: The goal of this study was to investigate the effectiveness and acceptability of the flipped classroom approach to teaching ophthalmology at the clerkship level.
Design: Ninety-five fourth year medical students in an ophthalmology clerkship were randomly divided into two groups. An ocular trauma module was chosen for the content of this study. One group (FG (flipped group), n = 48) participated in flipped classroom instruction and was asked to watch a recorded lecture video and to read study materials before a face-to-face class meeting. They used the in-class time for discussion. The other group (TG (traditional group), n = 47) was assigned to traditional lecture-based instruction. These students attended a didactic lecture and completed assigned homework after the lecture. Feedback questionnaires were collected to compare students' perspectives on the teaching approach they experienced and to evaluate students' self-perceived competence and interest in ocular trauma. Pre- and post-tests were performed to assess student learning of the course materials.
Results: More students in the FG agreed that the classroom helped to promote their learning motivation, improve their understanding of the course materials, and enhance their communication skill and clinical thinking. However, students in the FG did not show a preference for this method of teaching, and also reported more burden and pressure than those from the TG. Students from the FG performed better on the post test over the ocular trauma-related questions when compared to those from the TG.
Conclusions: The flipped classroom approach shows promise in ophthalmology clerkship teaching. However, it has some drawbacks. Further evaluation and modifications are required before it can be widely accepted and implemented.
Abbreviations FG: Flipped classroom group; TG: Traditional lecture-based classroom group; TBL: Team-based learning; PBL: Problem-based learning; ZOC: Zhongshan Ophthalmic Center
Journal Article
Longitudinally adaptive assessment and instruction increase numerical skills of preschool children
Social inequality in mathematical skill is apparent at kindergarten entry and persists during elementary school. To level the playing field, we trained teachers to assess children’s numerical and spatial skills every 10 wk. Each assessment provided teachers with information about a child’s growth trajectory on each skill, information designed to help them evaluate their students’ progress, reflect on past instruction, and strategize for the next phase of instruction. A key constraint is that teachers have limited time to assess individual students. To maximize the information provided by an assessment, we adapted the difficulty of each assessment based on each child’s age and accumulated evidence about the child’s skills. Children in classrooms of 24 trained teachers scored 0.29 SD higher on numerical skills at posttest than children in 25 randomly assigned control classrooms (P = 0.005). We observed no effect on spatial skills. The intervention also positively influenced children’s verbal comprehension skills (0.28 SD higher at posttest, P < 0.001), but did not affect their print-literacy skills. We consider the potential contribution of this approach, in combination with similar regimes of assessment and instruction in elementary schools, to the reduction of social inequality in numerical skill and discuss possible explanations for the absence of an effect on spatial skills.
Journal Article
Clinical supervision of psychoanalytic psychotherapy
\"In Clinical Supervision of Psychoanalytic Psychotherapy, psychotherapy supervisors from the fields of psychology, psychiatry, social work, and dance movement therapy deal with the ambiguity and complexity of the supervisory role. They attend to the need to establish open, respectful verbal and non-verbal communication, a trusting relationship, a shared language, and a commitment to examining unconscious conflict in the supervisory encounter as well as the patient-therapist dynamics. The contributors show how the supervisor makes room for the supervisee to express her anxieties without becoming her therapist, thereby providing a model for empathic listening but within appropriate boundaries. They also describe the many ways in which the therapist's issues reflect or are triggered by those of the patient, are further reflected in the dynamics of the supervisory pair, and in the institution where supervisee and supervisor work. The contributors approach task, boundary, focus, and interaction in supervision from multiple vertices - research, analytic sensibility, group process, bodily and artistic expression, cross-cultural challenges, and individual teaching and learning in clinical supervision. A clear picture emerges of the qualities that characterize the good supervisor for any psychotherapist. The volume concludes with a list of further reading for those who must educate themselves and those who are inspired to establish a course or training program in analytic psychotherapy supervision.\"--Publisher's website.
Book
Implementation of flipped classroom combined with problem-based learning: an approach to promote learning about hyperthyroidism in the endocrinology internship
Background
With the development of medicine, new teaching methods, such as flipped classroom and problem-based learning (PBL), have received much attention in medical education. However, the implementation of flipped classroom combined with PBL in endocrinology education has not been well investigated. Considering that both two teaching methods may complement each other, therefore, the aim of this study was to evaluate students’ learning effectiveness acceptability of the pedagogy between traditional lecture-based teaching methods and the combination of flipped classrooms with PBL teaching methods in the endocrinology internship.
Methods
74 fourth-year medical students at the Bengbu Medical College were enrolled in the endocrinology internship. Hyperthyroidism was chosen for the content of this study. The participants were randomly allocated into either the combination group of flipped classroom with PBL (CG) or the traditional lecture-based classroom group (TG). Both a pre-quiz and a post-quiz were conducted before and after the classes, respectively. All questions in the quizzes were classified into two aspects, basic theoretical knowledge and clinical case analyses based on the Bloom’s Taxonomy. The scores were compared and students were required to complete the questionnaire to evaluate their perceptions and experience.
Results
The mean post-quiz scores of both the TG and the CG were higher than those of the pre-quiz. Additionally, the post-quiz showed that students in the CG had significantly higher scores in the TG. Further analysis found that after class, only the difference in clinical case analysis between CG and TG was significant. The scores of all items in the questionnaires were higher in the CG than in the TG. More students agreed that the combined teaching method could help to improve their performance, at the same time, it could increase their workload.
Conclusions
The combination of the flipped classroom and PBL teaching approach could be a better option over the traditional lecture-based classroom in the teaching of hyperthyroidism during endocrinology internship, although it can increase students’ workload. To be widely accepted and implemented, further optimizations are required.
Journal Article
Educational leadership preparation : innovation and interdisciplinary approaches to the Ed.D. and graduate education
\"This book explores the efficacy of innovative and interdisciplinary approaches to educational leadership preparation implemented at universities across the United States that serve K-12 populations in urban, rural, and suburban contexts. This collection of chapters draws from seminal and contemporary literature on preparation programs, the Carnegie Project for Education Doctorate. It demonstrates how theory and research play a pivotal role in the creation of new doctoral programs in educational leadership. The book focuses on trends, issues, challenges, and possibilities that weave commonalities and differentiate structures among seven professional doctorate programs in educational leadership (Ed.D.)\"--Provided by publisher.
Book
Peer instruction improves comprehension and transfer of physiological concepts: a randomized comparison with self-explanation
Comprehension of physiology is essential for development of clinical reasoning. However, medical students often struggle to understand physiological concepts. Interactive learning through Peer instruction (PI) is known to stimulate students’ comprehension, but its relative efficacy and working mechanisms remain to be elucidated. In this study, we investigated if and how PI could optimize comprehension of physiological concepts and transfer relative to Self-explanation (SE) which is considered a lower-order type of overt learning. First-year medical students (n = 317) were randomly assigned to either PI or SE in a pre-post test design, followed by a set of near and far transfer questions. In both PI and SE groups post-test scores were significantly improved (
p
< 0.0001) with PI outperforming SE (+ 35% vs. + 23%,
p
= 0.006). Interestingly, a substantial number of students with initial incorrect answers even had enhanced scores after discussion with an incorrect peer. Both methods showed higher transfer scores than control (
p
= 0.006), with a tendency for higher near transfer scores for PI. These findings support PI as a valuable method to enhance comprehension of physiological concepts. Moreover, by comparing the effects of interactive PI with constructive SE we have established new insights that complement educational theories on overt learning activities.
Journal Article