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1.  Teaching tools in Evidence Based Practice: evaluation of reusable learning objects (RLOs) for learning about Meta-analysis 
BMC Medical Education  2011;11:18.
Background
All healthcare students are taught the principles of evidence based practice on their courses. The ability to understand the procedures used in systematically reviewing evidence reported in studies, such as meta-analysis, are an important element of evidence based practice. Meta-analysis is a difficult statistical concept for healthcare students to understand yet it is an important technique used in systematic reviews to pool data from studies to look at combined effectiveness of treatments. In other areas of the healthcare curricula, by supplementing lectures, workbooks and workshops with pedagogically designed, multimedia learning objects (known as reusable learning objects or RLOs) we have shown an improvement in students' perceived understanding in subjects they found difficult. In this study we describe the development and evaluation of two RLOs on meta-analysis. The RLOs supplement associated lectures and aim to improve students' understanding of meta-analysis in healthcare students.
Methods
Following a quality controlled design process two RLOs were developed and delivered to two cohorts of students, a Master in Public Health course and Postgraduate diploma in nursing course. Students' understanding of five key concepts of Meta-analysis were measured before and after a lecture and again after RLO use. RLOs were also evaluated for their educational value, learning support, media attributes and usability using closed and open questions.
Results
Students rated their understanding of meta-analysis as improved after a lecture and further improved after completing the RLOs (Wilcoxon paired test, p < 0.01 in all cases) Whilst the media components of the RLOs such as animations helped most students (86%) understand concepts including for example Forest plots, 93% of students rated usability and control as important to their learning. A small number of students stated they needed the support of a lecturer alongside the RLOs (7% 'Agreed' and 21% 'Neutral').
Conclusions
Meta-analysis RLOs that are openly accessible and unrestricted by usernames and passwords provide flexible support for students who find the process of meta-analysis difficult.
doi:10.1186/1472-6920-11-18
PMCID: PMC3123313  PMID: 21542905
2.  Audience response technology: Engaging and empowering non-medical prescribing students in pharmacology learning 
BMC Medical Education  2010;10:73.
Background
Non-medical prescribing (NMP) is a six month course for nurses and certain allied health professionals. It is critical that these students develop a good understanding of pharmacology; however, many students are mature learners with little or no formal biological science knowledge and struggle with the pharmacology component. The implications for patient safety are profound, therefore we encourage students not just to memorise enough pharmacology to pass the exam but to be able to integrate it into clinical practice. Audience response technology (ART), such as the KeePad system (KS) has been shown to promote an active approach to learning and provide instant formative feedback. The aim of this project, therefore, was to incorporate and evaluate the use the KS in promoting pharmacology understanding in NMP students.
Methods
Questions were incorporated into eight pharmacology lectures, comprising a mix of basic and clinical pharmacology, using TurningPoint software. Student (n = 33) responses to questions were recorded using the KS software and the percentage of students getting the question incorrect and correct was made immediately available in the lecture in graphical form. Survey data collected from these students investigated student perceptions on the use of the system generally and specifically as a learning tool. More in depth discussion of the usefulness of the KS was derived from a focus group comprising 5 students.
Results
100% of students enjoyed using the KS and felt it promoted their understanding of key concepts; 92% stated that it helped identify their learning needs and 87% agreed that the technology was useful in promoting integration of concepts. The most prevalent theme within feedback was that of identifying their own learning needs. Analysis of data from the focus group generated similar themes, with the addition of improving teaching. Repeated questioning produced a significant increase (p < 0.05) in student knowledge of specific pharmacological concepts.
Conclusions
The use of ART enhanced non-medical prescribing students' experience of pharmacology teaching. Student perceptions were that this system increased their ability to identify learning needs and promoted understanding and integration of concepts. Students also reported that the technology aided exam revision and reduced associated anxiety.
doi:10.1186/1472-6920-10-73
PMCID: PMC2978227  PMID: 20979620
3.  Pharmacology as a foreign language: A preliminary evaluation of podcasting as a supplementary learning tool for non-medical prescribing students 
Background
Nurses and other health professionals in the U.K. can gain similar prescribing rights to doctors by undertaking a non-medical prescribing course. Non-medical prescribing students must have a thorough understanding of the pharmacology of prescribing to ensure safe practice. Pharmacology education at this level is complicated by the variation in students' prior subject knowledge of, and anxiety about, the subject. The recent advances in technology, particularly the potential for mobile learning, provide increased opportunities for students to familiarise themselves with lecture materials and hence promote understanding. The objective of this study was therefore to evaluate both the subjective (student perception) and objective (student use and exam results) usefulness of podcasts of pharmacology lectures which were provided as an extra learning tool to two cohorts (n = 69) of non-medical prescribing students.
Methods
The podcasts were made available to students through the virtual learning environment WebCT. Use of podcasts by two successive cohorts of nurse prescribing students (n = 69) was tracked through WebCT. Survey data, which was collected from 44 of these students, investigated patterns of/reasons for podcast use and perceived usefulness of podcasts as a learning tool. Of these 69 students, 64 completed the pharmacology exam. In order to examine any impact of podcasts on student knowledge, their exam results were compared with those of two historical cohorts who did not have access to podcasts (n = 70).
Results
WebCT tracking showed that 91% of students accessed at least one podcast. 93% of students used the podcasts to revisit a lecture, 85% used podcasts for revision, and 61% used the podcasts when they had a specific question. Only 22% used the podcasts because they had missed a pharmacology session. Most students (81%) generally listened to the entire podcast rather than specific sections and most (73%) used them while referring to their lecture handouts. The majority of students found the podcasts helpful as a learning tool, as a revision aid and in promoting their understanding of the subject. Evaluation of the range of marks obtained, mode mark and mean mark suggested improved knowledge in students with access to podcasts compared to historical cohorts of students who did not have access to pharmacology podcasts.
Conclusions
The results of this study suggest that non-medical prescribing students utilised podcasts of pharmacology lectures, and have found the availability of these podcasts helpful for their learning. Exam results indicate that the availability of podcasts was also associated with improved exam performance.
doi:10.1186/1472-6920-9-74
PMCID: PMC2804703  PMID: 20021673
4.  Pharmacology podcasts: a qualitative study of non-medical prescribing students' use, perceptions and impact on learning 
Background
There is growing research on student use of podcasts in academic settings. However, there is little in-depth research focusing on student experience of podcasts, in particular in terms of barriers to, and facilitators of, podcast use and students' perceptions of the usefulness of podcasts as learning tools. This study aimed to explore the experiences of non-medical prescribing students who had access to podcasts of key pharmacology lectures as supplementary learning tools to their existing course materials.
Methods
Semi-structured interviews were carried out with seven non-medical prescribing students (average age = 43 years), all of whom were nurses, who had access to seven podcasts of key pharmacology lectures. These podcasts took the form of downloadable audio lecture recordings available through the virtual learning environment WebCT. Low, medium and high users of the podcasts took part in the interviews in order to access a variety of student experiences. Interview data was analysed using thematic template analysis to identify key themes surrounding student experience of podcast availability, particularly in relation to barriers to and facilitators of podcast use, and students' experiences of podcasts as a learning tool.
Results
Students used podcasts for a variety of reasons such as revisiting lectures, preparing for exams, to clarify or revise specific topics and, to a lesser extent, to catch up on a missed lecture. Barriers to podcast use centred mainly around technological issues. Lack of experience of the technology required to access podcasts proved a barrier for some students. A lack of access to suitable technology was also a reported barrier. Family assistance and I.T. assistance from the university helped facilitate students' use of the podcasts. Students found that using podcasts allowed them to have greater control over their learning and to gauge their learning needs, as well as helping them build their understanding of a complex topic.
Conclusions
Students used podcasts for a variety of reasons. Barriers to podcasts use were generally related to technological issues. Students often found that once assistance had been gained regarding these technological issues, they accessed the podcasts more easily. Students felt that access to podcasts added value to their learning materials by allowing them to better manage their learning and build their understanding. Podcasts represent a valuable additional learning tool for this specific group of older students.
doi:10.1186/1472-6920-11-2
PMCID: PMC3024307  PMID: 21223547
5.  An exploration of student experiences of using biology podcasts in nursing training 
BMC Medical Education  2013;13:12.
Background
Students regard biological science as one of the most difficult components of the nursing curriculum. However, a good understanding of this area is essential for effective nursing practice. The aim of this study was to explore nursing students’ perceptions of the usefulness of supplementary biology podcasts for their learning.
Methods
Biological science podcasts (n = 9) were made available to first-year nursing students (n = 189) as supplementary learning tools. On completion of their first year, students were asked to complete a survey which investigated the frequency of their podcast use, reasons for use and their perception of the usefulness of podcasts as a learning tool. 153 of these students participated in the survey study (80.9%). Two focus groups were conducted with students (n = 6) to gain a detailed understanding of student experiences of the usefulness of the podcasts for their learning.
Results
Survey data demonstrated that most students (71%) accessed at least one podcast. The majority of students who reported accessing podcasts agreed that they were useful as learning tools (83%), revision aids (83%) and that they helped promote understanding of course materials (72%). Focus group participants discussed how they found podcasts especially useful in terms of revision. Students valued being able to repeatedly access the lecture materials, and appreciated having access to podcasts from a range of lecturers. Focus group members discussed the benefits of live recordings, in terms of valuing the information gleaned from questions asked during the lecture sessions, although there were concerns about the level of background noise in live recordings. Lack of awareness of the availability of podcasts was an issue raised by participants in both the survey component and the focus groups and this negatively impacted on podcast use.
Conclusions
Nursing students found the availability of biology podcasts helpful for their learning. Successful implementation of these tools to support learning requires teaching staff to understand and promote the importance of these tools.
doi:10.1186/1472-6920-13-12
PMCID: PMC3565862  PMID: 23360078
Podcast; Biology; Pre-registration nursing
6.  Introducing quality improvement to pre-qualification nursing students: evaluation of an experiential programme 
Quality in Health Care : QHC  2001;10(4):204-210.
Objective—To evaluate a programme introducing quality improvement (QI) in nursing education.
Settings—Betanien College of Nursing and clinical practices at hospitals in Bergen.
Subjects—52 nursing students from a second year class working in 16 groups undertaking hospital based practical studies.
Intervention—Second year nursing students were assigned to follow a patient during a day's work and to record the processes of care from the patient's perspective. Data collected included waiting times, patient information, people in contact with the patient, investigations, and procedures performed. Students also identified aspects of practice that could be improved. They then attended a 2 day theoretical introductory course in QI and each group produced flow charts, cause/effect diagrams, and outlines of quality goals using structure, process, and results criteria to describe potential improvements. Each group produced a report of their findings.
Main measures—A two-part questionnaire completed by the students before and after the intervention was used to assess the development of their understanding of QI. Evidence that students could apply a range of QI tools and techniques in the specific setting of a hospital ward was assessed from the final reports of their clinical attachments.
Results—The students had a significantly better knowledge of QI after the introductory course and group work than before it, and most students indicated that they considered the topic highly relevant for their later career. They reported that it was quite useful to observe one patient throughout one shift and, to some extent, they learned something new. Students found the introductory course and working in groups useful, and most thought the programme should be included in the curriculum for other nursing students. They considered it important for nurses in general to have knowledge about QI, indicating a high perceived relevance of the course. All 16 groups delivered reports of their group work which were approved by the tutors. Through the reports, all the groups demonstrated knowledge and ability to apply tools and techniques in their practical studies in a hospital setting.
Conclusions—The introduction of a short experience-based programme into the practical studies of second year nursing students enabled them to learn about the concepts, tools, and techniques of continuous QI in a way that should provide them with the skills to undertake it as part of routine practice.
Key Words: learning; quality improvement; nursing education; intervention
doi:10.1136/qhc.0100204..
PMCID: PMC1743458  PMID: 11743148
7.  Embedding a Learning Management System Into an Undergraduate Medical Informatics Course in Saudi Arabia: Lessons Learned 
Medicine 2.0  2013;2(2):e13.
Background
Public universities in Saudi Arabia today are making substantial investments in e-learning as part of their educational system, especially in the implementation of learning management systems (LMS). To our knowledge, this is the first study conducted in Saudi Arabia exploring medical students’ experience with an LMS, particularly as part of a medical informatics course.
Objective
This study investigates students’ use of various features of the LMS embedded in a recently implemented medical informatics course.
Methods
A mixed methodology approach was employed. Survey questionnaires were distributed to all third year medical informatics students at the end of the course. In addition, two focus group sessions were conducted with twelve students. A thematic analysis of the focus group was performed.
Results
A total of 265 third year medical student surveys (167/265, 63% male and 98/265, 37% female) were completed and analyzed. Overall, 50.6% (134/265) of the students agreed that the course was well planned and up-to-date, had clearly stated objectives and clear evaluation methods, appropriate course assignment, and that the LMS offered easy navigation. Most of the students rated the course as good/fair overall. In general, females were 10.4% more likely to prefer the LMS, as revealed by higher odd ratios (odds ratio [OR] 1.104, 95% CI 0.86-1.42) compared to males. Survey results showed that students’ use of LMS tools increased after taking the course compared to before taking the course. The full model containing all items were statistically significant (χ2 25=69.52, P<.001, n=243), indicating that the model was able to distinguish between students who had positive attitudes towards LMS and those who did not. The focus group, however, revealed that the students used social networking for general use rather than learning purposes, but they were using other Internet resources and mobile devices for learning. Male students showed a higher preference for using technology in general to enhance learning activities. Overall, medical student attitudes towards the LMS were generally positive. Students also wanted a reminder and notification tool to help them stay updated with course events. Interestingly, a subset of students had been running a parallel LMS of their own that has features worth exploring and could be integrated with an official LMS in the future.
Conclusions
To our knowledge, this was the first time that an LMS was used in a medical informatics course. Students showed interest in adapting various LMS tools to enhance their learning and gained more knowledge through familiarity with the tool. Researching an official LMS also revealed the existence of a parallel student-created LMS. This could allow teacher-led and student-led platforms to be integrated in the future for an enhanced student-centered experience.
doi:10.2196/med20.2735
PMCID: PMC4085123  PMID: 25075236
medical education; medical informatics; learning management systems (LMS)
8.  Knowledge of drug prescription in dentistry students 
Background
Students in schools of dentistry attend to patients with illnesses, and often prescribe medication. Because students are still learning, they are influenced by a variety of factors: the different teaching approaches of the professors at the clinics and in the pharmacology course, fellow students, and even the information provided by the pharmaceutical industry.
Objectives
The aim of this pilot study was to assess the prescription knowledge and common mistakes in fourth-year students at the School of Dentistry at the Universidad Nacional Autónoma de México.
Methods
In March 2010, a survey was conducted among 66 fourth-year students at the School of Dentistry, applying a previously validated questionnaire consisting of six open-ended questions The following factors were assessed: the most frequent illness requiring dental prescription; the most prescribed nonsteroidal anti-inflammatory drugs and antibiotics; the most frequent errors; sources of information used for prescribing drugs; and whether the students knew and followed the World Health Organization Guide to Good Prescribing.
Results
The most frequent response for each question was considered the most significant. The most common reason for prescribing medication was infection (n = 37, 56%), followed by pain (n = 24, 38%); the most used painkillers were ibuprofen and acetaminophen at equal levels (n = 25, 37.8%), followed by ketorolac (n = 7, 10.6%), naproxen (n = 6, 9.1%), diclofenac (n = 2, 3%), and aspirin (n = 1, 1.5%); the most widely prescribed antibiotics were amoxicillin (n = 52, 78.9%), ampicillin (n = 7, 10.6%), and penicillin V and clindamycin (n = 3, 4.5%). The most frequent errors reported by students were: lack of knowledge about drug posology (n = 49, 74.2%), improperly filled prescriptions (n = 7, 10.7%), not knowing the brand names and uncertainty about the correct drug indicated for each case (n = 3, 4.54%), not knowing the duration of treatment (n = 2, 3%), not asking the patient about possible allergies, and not giving prescriptions (n = 1, 1.5%). The sources of information used by students for prescribing drugs included the professors at the clinics (n = 49, 74.2%), the pharmacology course (n = 7, 10.7%), medical dictionary consultation (n = 15, 22.72%), classmate support (n = 3, 4.54%), and information provided by medical representatives from pharmaceutical companies (n = 1, 1.5%). Finally, only 20 students (30.3%) followed the WHO Guide to Good Prescribing, 40 students acknowledged not following it (60.6%), and six students (9.1%) had no knowledge of it.
Conclusion
The knowledge of pharmacology among fourth-year students in the School of Dentistry has gaps that could affect patient safety. More studies are needed to determine whether this issue affects the quality of patient care and the effectiveness and safety of treatments. Since prescribing accurately is extremely important, it is necessary to develop therapeutic guidelines, and to provide pharmacological therapy courses. The implementation of educational programs, including the WHO Guide to Good Prescribing and Patient Safety Curriculum Guide, would be beneficial in helping students develop prescribing skills.
doi:10.2147/DHPS.S30984
PMCID: PMC3396048  PMID: 22807647
prescription; dentistry prescription; most used NSAIDs by dentists; most used antibiotics; dentist prescribing errors; sources of information for prescribing; WHO Guide to Good Prescribing
9.  Medical Students' Exposure to and Attitudes about the Pharmaceutical Industry: A Systematic Review 
PLoS Medicine  2011;8(5):e1001037.
A systematic review of published studies reveals that undergraduate medical students may experience substantial exposure to pharmaceutical marketing, and that this contact may be associated with positive attitudes about marketing.
Background
The relationship between health professionals and the pharmaceutical industry has become a source of controversy. Physicians' attitudes towards the industry can form early in their careers, but little is known about this key stage of development.
Methods and Findings
We performed a systematic review reported according to PRISMA guidelines to determine the frequency and nature of medical students' exposure to the drug industry, as well as students' attitudes concerning pharmaceutical policy issues. We searched MEDLINE, EMBASE, Web of Science, and ERIC from the earliest available dates through May 2010, as well as bibliographies of selected studies. We sought original studies that reported quantitative or qualitative data about medical students' exposure to pharmaceutical marketing, their attitudes about marketing practices, relationships with industry, and related pharmaceutical policy issues. Studies were separated, where possible, into those that addressed preclinical versus clinical training, and were quality rated using a standard methodology. Thirty-two studies met inclusion criteria. We found that 40%–100% of medical students reported interacting with the pharmaceutical industry. A substantial proportion of students (13%–69%) were reported as believing that gifts from industry influence prescribing. Eight studies reported a correlation between frequency of contact and favorable attitudes toward industry interactions. Students were more approving of gifts to physicians or medical students than to government officials. Certain attitudes appeared to change during medical school, though a time trend was not performed; for example, clinical students (53%–71%) were more likely than preclinical students (29%–62%) to report that promotional information helps educate about new drugs.
Conclusions
Undergraduate medical education provides substantial contact with pharmaceutical marketing, and the extent of such contact is associated with positive attitudes about marketing and skepticism about negative implications of these interactions. These results support future research into the association between exposure and attitudes, as well as any modifiable factors that contribute to attitudinal changes during medical education.
Please see later in the article for the Editors' Summary
Editors' Summary
Background
The complex relationship between health professionals and the pharmaceutical industry has long been a subject of discussion among physicians and policymakers. There is a growing body of evidence that suggests that physicians' interactions with pharmaceutical sales representatives may influence clinical decision making in a way that is not always in the best interests of individual patients, for example, encouraging the use of expensive treatments that have no therapeutic advantage over less costly alternatives. The pharmaceutical industry often uses physician education as a marketing tool, as in the case of Continuing Medical Education courses that are designed to drive prescribing practices.
One reason that physicians may be particularly susceptible to pharmaceutical industry marketing messages is that doctors' attitudes towards the pharmaceutical industry may form early in their careers. The socialization effect of professional schooling is strong, and plays a lasting role in shaping views and behaviors.
Why Was This Study Done?
Recently, particularly in the US, some medical schools have limited students' and faculties' contact with industry, but some have argued that these restrictions are detrimental to students' education. Given the controversy over the pharmaceutical industry's role in undergraduate medical training, consolidating current knowledge in this area may be useful for setting priorities for changes to educational practices. In this study, the researchers systematically examined studies of pharmaceutical industry interactions with medical students and whether such interactions influenced students' views on related topics.
What Did the Researchers Do and Find?
The researchers did a comprehensive literature search using appropriate search terms for all relevant quantitative and qualitative studies published before June 2010. Using strict inclusion criteria, the researchers then selected 48 articles (from 1,603 abstracts) for full review and identified 32 eligible for analysis—giving a total of approximately 9,850 medical students studying at 76 medical schools or hospitals.
Most students had some form of interaction with the pharmaceutical industry but contact increased in the clinical years, with up to 90% of all clinical students receiving some form of educational material. The highest level of exposure occurred in the US. In most studies, the majority of students in their clinical training years found it ethically permissible for medical students to accept gifts from drug manufacturers, while a smaller percentage of preclinical students reported such attitudes. Students justified their entitlement to gifts by citing financial hardship or by asserting that most other students accepted gifts. In addition, although most students believed that education from industry sources is biased, students variably reported that information obtained from industry sources was useful and a valuable part of their education.
Almost two-thirds of students reported that they were immune to bias induced by promotion, gifts, or interactions with sales representatives but also reported that fellow medical students or doctors are influenced by such encounters. Eight studies reported a relationship between exposure to the pharmaceutical industry and positive attitudes about industry interactions and marketing strategies (although not all included supportive statistical data). Finally, student opinions were split on whether physician–industry interactions should be regulated by medical schools or the government.
What Do These Findings Mean?
This analysis shows that students are frequently exposed to pharmaceutical marketing, even in the preclinical years, and that the extent of students' contact with industry is generally associated with positive attitudes about marketing and skepticism towards any negative implications of interactions with industry. Therefore, strategies to educate students about interactions with the pharmaceutical industry should directly address widely held misconceptions about the effects of marketing and other biases that can emerge from industry interactions. But education alone may be insufficient. Institutional policies, such as rules regulating industry interactions, can play an important role in shaping students' attitudes, and interventions that decrease students' contact with industry and eliminate gifts may have a positive effect on building the skills that evidence-based medical practice requires. These changes can help cultivate strong professional values and instill in students a respect for scientific principles and critical evidence review that will later inform clinical decision-making and prescribing practices.
Additional Information
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001037.
Further information about the influence of the pharmaceutical industry on doctors and medical students can be found at the American Medical Students Association PharmFree campaign and PharmFree Scorecard, Medsin-UKs PharmAware campaign, the nonprofit organization Healthy Skepticism, and the Web site of No Free Lunch.
doi:10.1371/journal.pmed.1001037
PMCID: PMC3101205  PMID: 21629685
10.  MED6/357: Looking over the Horizon: An Internet-based International Course in Comparative Healthcare Management 
Introduction
In 1998, the unique and experimental "Looking over the horizon - An Internet-based International Course in Comparative Healthcare Management" started. The course is a component of the larger project on "Promoting International Co-operation and Understanding in Healthcare Management". It is funded by the Canada-European Community Program for Co-operation in Higher Education and Training - a joint initiative between the Canadian Government and the European Commission.
Methods
The purpose of the course is to enable graduate students from participating countries - Canada, Germany, Finland, and Ireland - to become better healthcare managers by learning more about their own and each others' healthcare systems and management processes. The course is structured around an introductory module (Healthcare Systems) and four theme modules: Financing and Funding, Healthcare Delivery Issues, Impact of Health System Reform, and Evidence-based Management. The technology used for the delivery of the course is WebCT, a web-based distance learning software developed at the University of British Colombia. WebCT provides a large number of functions both for students - e.g.,
e-mail, bulletin boards, chat rooms, and calendar - and for instructors - e.g., student tracking, page tracking, chat room log files, and marking management. Instructors are able to design the whole course, receive students' assignments, and post their assessments, via the World Wide Web.
Results
From January to April 1999, 25 students participated in the second course (19 students in the first course in 1998). The tracking function of the WebCT system was used to get some data about the students' activities. In 15 weeks, the students read an average number of 585 (min. 137, max. 806) contributions -- i.e. the sometimes very profound messages posted by students and instructors --, whereas they posted 26 (min. 6, max. 67) own contributions. The high activity of students is a typical characteristic of this student-centred course. Students have the opportunity and responsibility to be both students and teachers for the others. The role of the instructor, however, changes from that of the source of knowledge to that of a supervisor. Therefore students themselves can significantly increase the quality of the course.
Discussion
So far, 44 students participated in the course. For all of them, it has been a valuable experience of learning, which both increased their knowledge of national and international management issues and improved their technical skills on the field of the new medium Internet. The possibility to provide international courses via the Internet gives a new dimension to world-wide medical education and should be used very intensively. For the part of "Looking over the Horizon", the course is planned to expand on more students and even more countries.
doi:10.2196/jmir.1.suppl1.e49
PMCID: PMC1761779
Education, Distance; International Educational Exchange; Education, Medical, Graduate; Internet
11.  Ontogeny of Fc receptors and complement receptor (CR3) during human myeloid differentiation. 
Journal of Clinical Investigation  1984;73(2):516-525.
Two different Fc receptors for IgG (Fc gamma R) have been identified on human leukocytes: a high avidity receptor (Fc gamma Rhi) present on monocytes but not on neutrophils, and a low avidity receptor (Fc gamma Rlo) present on neutrophils but not on monocytes. Fc gamma Rlo can be inhibited and the receptor precipitated by monoclonal antibody 3G8. We have used this monoclonal antibody to study the course of Fc gamma Rlo appearance on bone marrow cells, leukocytes of patients with chronic myelogenous leukemia (CML), and HL-60 and U937 cells induced to differentiate with agents such as dimethyl sulfoxide (DMSO), retinoic acid, phorbol myristate acetate, and lymphokine. We report that Fc gamma Rlo is a late differentiation antigen, first expressed at the metamyelocyte stage. Since precursors to metamyelocytes bear Fc gamma R, and the promyelocyte line HL-60 bears Fc gamma Rhi, there must be a progressive loss of Fc gamma Rhi during myeloid differentiation and the reciprocal expression of Fc gamma Rlo. Results of immunoprecipitation and polyacrylamide gel analysis of the proteins are consistent with these results. We have also studied the receptor for the C3bi complement component (CR3), which is blocked and immunoprecipitated by monoclonal antibody OKM10. During DMSO-driven differentiation of HL-60 cells, we find that CR3 is induced on all cells, whereas Fc gamma Rlo is induced on only 24% of cells, suggesting that CR3 appears earlier during differentiation than Fc gamma Rlo does.
Images
PMCID: PMC425043  PMID: 6230373
12.  Introducing students to patient safety through an online interprofessional course 
Interprofessional education (IPE) is increasingly called upon to improve health care systems and patient safety. Our institution is engaged in a campus-wide IPE initiative. As a component of this initiative, a required online interprofessional patient-safety-focused course for a large group (300) of first-year medical, dental, and nursing students was developed and implemented. We describe our efforts with developing the course, including the use of constructivist and adult learning theories and IPE competencies to structure students’ learning in a meaningful fashion. The course was conducted online to address obstacles of academic calendars and provide flexibility for faculty participation. Students worked in small groups online with a faculty facilitator. Thematic modules were created with associated objectives, online learning materials, and assignments. Students posted completed assignments online and responded to group members’ assignments for purposes of group discussion. Students worked in interprofessional groups on a project requiring them to complete a root cause analysis and develop recommendations based on a fictional sentinel event case. Through project work, students applied concepts learned in the course related to improving patient safety and demonstrated interprofessional collaboration skills. Projects were presented during a final in-class session. Student course evaluation results suggest that learning objectives and content goals were achieved. Faculty course evaluation results indicate that the course was perceived to be a worthwhile learning experience for students. We offer the following recommendations to others interested in developing an in-depth interprofessional learning experience for a large group of learners: 1) consider a hybrid format (inclusion of some face-to-face sessions), 2) address IPE and broader curricular needs, 3) create interactive opportunities for shared learning and working together, 4) provide support to faculty facilitators, and 5) recognize your learners’ educational level. The course has expanded to include students from additional programs for the current academic year.
doi:10.2147/AMEP.S13350
PMCID: PMC3643135  PMID: 23745069
patient safety; interprofessional; online education
13.  Interactions between Non-Physician Clinicians and Industry: A Systematic Review 
PLoS Medicine  2013;10(11):e1001561.
In a systematic review of studies of interactions between non-physician clinicians and industry, Quinn Grundy and colleagues found that many of the issues identified for physicians' industry interactions exist for non-physician clinicians.
Please see later in the article for the Editors' Summary
Background
With increasing restrictions placed on physician–industry interactions, industry marketing may target other health professionals. Recent health policy developments confer even greater importance on the decision making of non-physician clinicians. The purpose of this systematic review is to examine the types and implications of non-physician clinician–industry interactions in clinical practice.
Methods and Findings
We searched MEDLINE and Web of Science from January 1, 1946, through June 24, 2013, according to PRISMA guidelines. Non-physician clinicians eligible for inclusion were: Registered Nurses, nurse prescribers, Physician Assistants, pharmacists, dieticians, and physical or occupational therapists; trainee samples were excluded. Fifteen studies met inclusion criteria. Data were synthesized qualitatively into eight outcome domains: nature and frequency of industry interactions; attitudes toward industry; perceived ethical acceptability of interactions; perceived marketing influence; perceived reliability of industry information; preparation for industry interactions; reactions to industry relations policy; and management of industry interactions. Non-physician clinicians reported interacting with the pharmaceutical and infant formula industries. Clinicians across disciplines met with pharmaceutical representatives regularly and relied on them for practice information. Clinicians frequently received industry “information,” attended sponsored “education,” and acted as distributors for similar materials targeted at patients. Clinicians generally regarded this as an ethical use of industry resources, and felt they could detect “promotion” while benefiting from industry “information.” Free samples were among the most approved and common ways that clinicians interacted with industry. Included studies were observational and of varying methodological rigor; thus, these findings may not be generalizable. This review is, however, the first to our knowledge to provide a descriptive analysis of this literature.
Conclusions
Non-physician clinicians' generally positive attitudes toward industry interactions, despite their recognition of issues related to bias, suggest that industry interactions are normalized in clinical practice across non-physician disciplines. Industry relations policy should address all disciplines and be implemented consistently in order to mitigate conflicts of interest and address such interactions' potential to affect patient care.
Please see later in the article for the Editors' Summary
Editors' Summary
Background
Making and selling health care goods (including drugs and devices) and services is big business. To maximize the profits they make for their shareholders, companies involved in health care build relationships with physicians by providing information on new drugs, organizing educational meetings, providing samples of their products, giving gifts, and holding sponsored events. These relationships help to keep physicians informed about new developments in health care but also create the potential for causing harm to patients and health care systems. These relationships may, for example, result in increased prescription rates of new, heavily marketed medications, which are often more expensive than their generic counterparts (similar unbranded drugs) and that are more likely to be recalled for safety reasons than long-established drugs. They may also affect the provision of health care services. Industry is providing an increasingly large proportion of routine health care services in many countries, so relationships built up with physicians have the potential to influence the commissioning of the services that are central to the treatment and well-being of patients.
Why Was This Study Done?
As a result of concerns about the tension between industry's need to make profits and the ethics underlying professional practice, restrictions are increasingly being placed on physician–industry interactions. In the US, for example, the Physician Payments Sunshine Act now requires US manufacturers of drugs, devices, and medical supplies that participate in federal health care programs to disclose all payments and gifts made to physicians and teaching hospitals. However, other health professionals, including those with authority to prescribe drugs such as pharmacists, Physician Assistants, and nurse practitioners are not covered by this legislation or by similar legislation in other settings, even though the restructuring of health care to prioritize primary care and multidisciplinary care models means that “non-physician clinicians” are becoming more numerous and more involved in decision-making and medication management. In this systematic review (a study that uses predefined criteria to identify all the research on a given topic), the researchers examine the nature and implications of the interactions between non-physician clinicians and industry.
What Did the Researchers Do and Find?
The researchers identified 15 published studies that examined interactions between non-physician clinicians (Registered Nurses, nurse prescribers, midwives, pharmacists, Physician Assistants, and dieticians) and industry (corporations that produce health care goods and services). They extracted the data from 16 publications (representing 15 different studies) and synthesized them qualitatively (combined the data and reached word-based, rather than numerical, conclusions) into eight outcome domains, including the nature and frequency of interactions, non-physician clinicians' attitudes toward industry, and the perceived ethical acceptability of interactions. In the research the authors identified, non-physician clinicians reported frequent interactions with the pharmaceutical and infant formula industries. Most non-physician clinicians met industry representatives regularly, received gifts and samples, and attended educational events or received educational materials (some of which they distributed to patients). In these studies, non-physician clinicians generally regarded these interactions positively and felt they were an ethical and appropriate use of industry resources. Only a minority of non-physician clinicians felt that marketing influenced their own practice, although a larger percentage felt that their colleagues would be influenced. A sizeable proportion of non-physician clinicians questioned the reliability of industry information, but most were confident that they could detect biased information and therefore rated this information as reliable, valuable, or useful.
What Do These Findings Mean?
These and other findings suggest that non-physician clinicians generally have positive attitudes toward industry interactions but recognize issues related to bias and conflict of interest. Because these findings are based on a small number of studies, most of which were undertaken in the US, they may not be generalizable to other countries. Moreover, they provide no quantitative assessment of the interaction between non-physician clinicians and industry and no information about whether industry interactions affect patient care outcomes. Nevertheless, these findings suggest that industry interactions are normalized (seen as standard) in clinical practice across non-physician disciplines. This normalization creates the potential for serious risks to patients and health care systems. The researchers suggest that it may be unrealistic to expect that non-physician clinicians can be taught individually how to interact with industry ethically or how to detect and avert bias, particularly given the ubiquitous nature of marketing and promotional materials. Instead, they suggest, the environment in which non-physician clinicians practice should be structured to mitigate the potentially harmful effects of interactions with industry.
Additional Information
Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001561.
This study is further discussed in a PLOS Medicine Perspective by James S. Yeh and Aaron S. Kesselheim
The American Medical Association provides guidance for physicians on interactions with pharmaceutical industry representatives, information about the Physician Payments Sunshine Act, and a toolkit for preparing Physician Payments Sunshine Act reports
The International Council of Nurses provides some guidance on industry interactions in its position statement on nurse-industry relations
The UK General Medical Council provides guidance on financial and commercial arrangements and conflicts of interest as part of its good medical practice website, which describes what is required of all registered doctors in the UK
Understanding and Responding to Pharmaceutical Promotion: A Practical Guide is a manual prepared by Health Action International and the World Health Organization that schools of medicine and pharmacy can use to train students how to recognize and respond to pharmaceutical promotion.
The Institute of Medicine's Report on Conflict of Interest in Medical Research, Education, and Practice recommends steps to identify, limit, and manage conflicts of interest
The University of California, San Francisco, Office of Continuing Medical Education offers a course called Marketing of Medicines
doi:10.1371/journal.pmed.1001561
PMCID: PMC3841103  PMID: 24302892
14.  Using Audience Response Technology to provide formative feedback on pharmacology performance for non-medical prescribing students - a preliminary evaluation 
BMC Medical Education  2012;12:113.
Background
The use of anonymous audience response technology (ART) to actively engage students in classroom learning has been evaluated positively across multiple settings. To date, however, there has been no empirical evaluation of the use of individualised ART handsets and formative feedback of ART scores. The present study investigates student perceptions of such a system and the relationship between formative feedback results and exam performance.
Methods
Four successive cohorts of Non-Medical Prescribing students (n=107) had access to the individualised ART system and three of these groups (n=72) completed a questionnaire about their perceptions of using ART. Semi-structured interviews were carried out with a purposive sample of seven students who achieved a range of scores on the formative feedback. Using data from all four cohorts of students, the relationship between mean ART scores and summative pharmacology exam score was examined using a non-parametric correlation.
Results
Questionnaire and interview data suggested that the use of ART enhanced the classroom environment, motivated students and promoted learning. Questionnaire data demonstrated that students found the formative feedback helpful for identifying their learning needs (95.6%), guiding their independent study (86.8%), and as a revision tool (88.3%). Interviewees particularly valued the objectivity of the individualised feedback which helped them to self-manage their learning. Interviewees’ initial anxiety about revealing their level of pharmacology knowledge to the lecturer and to themselves reduced over time as students focused on the learning benefits associated with the feedback.
A significant positive correlation was found between students’ formative feedback scores and their summative pharmacology exam scores (Spearman’s rho = 0.71, N=107, p<.01).
Conclusions
Despite initial anxiety about the use of individualised ART units, students rated the helpfulness of the individualised handsets and personalised formative feedback highly. The significant correlation between ART response scores and student exam scores suggests that formative feedback can provide students with a useful reference point in terms of their level of exam-readiness.
doi:10.1186/1472-6920-12-113
PMCID: PMC3515432  PMID: 23148762
Audience response technology; Teaching; Pharmacology; Non-medical prescribing
15.  Exploring students' perceptions on the use of significant event analysis, as part of a portfolio assessment process in general practice, as a tool for learning how to use reflection in learning 
Background
Portfolio learning enables students to collect evidence of their learning. Component tasks making up a portfolio can be devised that relate directly to intended learning outcomes. Reflective tasks can stimulate students to recognise their own learning needs.
Assessment of portfolios using a rating scale relating to intended learning outcomes offers high content validity.
This study evaluated a reflective portfolio used during a final-year attachment in general practice (family medicine). Students were asked to evaluate the portfolio (which used significant event analysis as a basis for reflection) as a learning tool. The validity and reliability of the portfolio as an assessment tool were also measured.
Methods
81 final-year medical students completed reflective significant event analyses as part of a portfolio created during a three-week attachment (clerkship) in general practice (family medicine). As well as two reflective significant event analyses each portfolio contained an audit and a health needs assessment.
Portfolios were marked three times; by the student's GP teacher, the course organiser and by another teacher in the university department of general practice. Inter-rater reliability between pairs of markers was calculated. A questionnaire enabled the students' experience of portfolio learning to be determined.
Results
Benefits to learning from reflective learning were limited. Students said that they thought more about the patients they wrote up in significant event analyses but information as to the nature and effect of this was not forthcoming.
Moderate inter-rater reliability (Spearman's Rho .65) was found between pairs of departmental raters dealing with larger numbers (20 – 60) of portfolios. Inter-rater reliability of marking involving GP tutors who only marked 1 – 3 portfolios was very low.
Students rated highly their mentoring relationship with their GP teacher but found the portfolio tasks time-consuming.
Conclusion
The inter-rater reliability observed in this study should be viewed alongside the high validity afforded by the authenticity of the learning tasks (compared with a sample of a student's learning taken by an exam question). Validity is enhanced by the rating scale which directly connects the grade given with intended learning outcomes.
The moderate inter-rater reliability may be increased if a portfolio is completed over a longer period of time and contains more component pieces of work.
The questionnaire used in this study only accessed limited information about the effect of reflection on students' learning. Qualitative methods of evaluation would determine the students experience in greater depth. It would be useful to evaluate the effects of reflective learning after students have had more time to get used to this unfamiliar method of learning and to overcome any problems in understanding the task.
doi:10.1186/1472-6920-7-5
PMCID: PMC1852102  PMID: 17397544
16.  Iranian nursing students’ experiences of nursing 
Background:
The negative attitudes and behaviors of Iranian nursing students impede learning and threaten their progression and retention in nursing programs. The need to understand students’ perception and experiences of nursing provide knowledge about effectiveness of nursing education program as well as their professional identity. The purpose of this study was to discover experiences of nursing students.
Materials and Methods:
In a descriptive, exploratory and qualitative study, twelve senior nursing students of Isfahan University of Medical Sciences (School of Nursing and Midwifery) were participated. Data was collected via unstructured in-depth interview, and thematic analysis method was used for analyzing the data.
Findings:
The findings from this study revealed that the nursing students in Iran experienced altered experiences during their education program as positive and negative. Two major themes were constructed from the thematic analysis of the transcripts: professional dimensions and professional conflicts.
Conclusions:
Regarding the findings, positive experiences of students have leaded them to acceptance and satisfaction of nursing and negative experiences to rejection and hating of nursing and lack of adaptation with their professional roles. Therefore, it is recommended that revision and improvement in nursing education program is essential to facilitate positive experiences and remove negative experiences of nursing student’s educational environment.
PMCID: PMC3696962  PMID: 23833591
Perception; nursing; students; qualitative research
17.  Interactive E-learning module in pharmacology: a pilot project at a rural medical college in India 
Many medical educators are experimenting with innovative ways of E-learning. E-learning provides opportunities to students for self-directed learning in addition to other advantages. In this study, we designed and evaluated an interactive E-learning module in pharmacology for effectiveness, acceptability and feasibility, with the aim of promoting active learning in this fact-filled subject. A quasi-experimental single-group pre-test/post-test study was conducted with fourth-semester students of the second professionals course (II MBBS), selected using non-probability convenience sampling method. An E-learning module in endocrine pharmacology was designed to comprise three units of interactive PowerPoint presentations. The pre-validated presentations were uploaded on the website according to a predefined schedule and the 42 registered students were encouraged to self-learning using these interactive presentations. Cognitive gain was assessed using an online pre- and post-test for each unit. Students’ perceptions were recorded using an online feedback questionnaire on a 5-point Likert scale. Finally, focused group discussion was conducted to further explore students’ views on E-learning activity. Significant attrition was observed during the E-learning activity. Of the 42 registered students, only 16 students completed the entire E-learning module. The summed average score of all three units (entire module) was increased significantly from 38.42 % (summed average pre-test score: 11.56/30 ± 2.90) to 66.46 % (summed average post-test score: 19.94/30 ± 6.13). The class-average normalized gain for the entire module was 0.4542 (45.42). The students accepted this E-learning activity well as they perceived it to be innovative, convenient, flexible and useful. The average rating was between 4 (agree) and 5 (strongly agree). The interactive E-learning module in pharmacology was moderately effective and well perceived by the students. The simple, cost-effective and readily available Microsoft PowerPoint tool appealed to medical educators to use this kind of simple E-learning technology blended with traditional teaching to encourage active learning among students especially in a rural setup is attractive.
doi:10.1007/s40037-013-0081-0
PMCID: PMC3890000  PMID: 24072666
E-learning; Pharmacology; Active learning; Self-learning; PowerPoint
18.  Medication Error Identification Rates by Pharmacy, Medical, and Nursing Students 
Objective
To assess and compare prescribing error-identification rates by health professional students.
Methods
Medical, pharmacy, and nursing students were asked to complete a questionnaire on which they evaluated the accuracy of 3 prescriptions and indicated the type of error found, if any. The number of correctly identified prescribing errors and the number of correct types of errors identified were compared and error identification rates for each group were calculated.
Results
One hundred seventy-five questionnaires were returned (87% response rate). Pharmacy students had a significantly higher error-identification rate than medical and nursing students (p < 0.001). No significant differences were found between medical and nursing students (p = 0.88). Compared to medical students, pharmacy students more often were able to identify correctly the error type for each prescription (p < 0.001; p = 0.023; p = 0.001).
Conclusions
Of the 3 student groups, pharmacy students demonstrated a significantly higher error-identification rate, which may be associated with the greater number of pharmacology and pharmacotherapeutics course hours that pharmacy students complete.
PMCID: PMC3073098  PMID: 21519414
prescription; medication error; simulation
19.  Teaching Diabetes to Middle-School Students with the www.2aida.net AIDA Online Diabetes Software Simulator 
Introduction
The lifetime risk of developing diabetes for students born in the new millennium in the United States is estimated to be 27% to 52%. Many students need to learn about diabetes for their personal care, or desire to learn about diabetes to develop a career in healthcare. Most teenagers are adept at learning through Web-based computer tools.
Methods
Twenty-one students entering 8th and 9th grades (aged 12 to 14 years old) enrolled in a Biotechnology Summer Camp focused on diabetes. Lectures on pathophysiology and clinical aspects of diabetes were followed by simulated cases using the AIDA online diabetes software simulator accessed via the internet at www.2aida.net. Two cases demonstrated glycemic effects and pharmacokinetics of insulin administration, diet, and exercise in insulin-dependent (Type 1) diabetes and non-insulin-dependent (Type 2) diabetes. Students filled out standardized evaluations at the end of the session to assess receptiveness to this type of learning; opinions on the utility, information, and ease of use; and perceived risks of using the online simulator to understand diabetes.
Results
All students were receptive to this educational tool. The majority found AIDA online useful (17/21 [81%]), educational (21/21 [100%]), worthy of wider distribution (20/21 [95%]), and would recommend the program to others with diabetes or wanting to learn about diabetes (18/21 [86%]). A minority (2/21 [9.5%]) found the program risky regarding the information given to the students. Positive comments included the ability to visualize concepts being taught in earlier lectures, and recognized the rigors required to manage diabetes. Fewer negative comments reflected frustration with the web-based user interface, the course materials, or difficulty in achieving good simulated glycemic control.
Discussion
Teaching pathophysiology of diabetes and pharmacology of insulin to middle school students is enhanced with the AIDA online diabetes simulator. Future versions of this program, and development of similar programs, could be useful in teaching adolescents who have diabetes, and might help stimulate interested students to learn more about the care of people with diabetes.
PMCID: PMC2769599  PMID: 19888387
AIDA; computer; diabetes; simulation; software
20.  1, 2, 3, 4: Infusing Quantitative Literacy into Introductory Biology 
CBE Life Sciences Education  2010;9(3):323-332.
Biology of the twenty-first century is an increasingly quantitative science. Undergraduate biology education therefore needs to provide opportunities for students to develop fluency in the tools and language of quantitative disciplines. Quantitative literacy (QL) is important for future scientists as well as for citizens, who need to interpret numeric information and data-based claims regarding nearly every aspect of daily life. To address the need for QL in biology education, we incorporated quantitative concepts throughout a semester-long introductory biology course at a large research university. Early in the course, we assessed the quantitative skills that students bring to the introductory biology classroom and found that students had difficulties in performing simple calculations, representing data graphically, and articulating data-driven arguments. In response to students' learning needs, we infused the course with quantitative concepts aligned with the existing course content and learning objectives. The effectiveness of this approach is demonstrated by significant improvement in the quality of students' graphical representations of biological data. Infusing QL in introductory biology presents challenges. Our study, however, supports the conclusion that it is feasible in the context of an existing course, consistent with the goals of college biology education, and promotes students' development of important quantitative skills.
doi:10.1187/cbe.10-03-0033
PMCID: PMC2931680  PMID: 20810965
21.  MED8/367: Developing an Internet-based Informatics Diploma 
Introduction
We have been running an Internet and CD-ROM based course in Health Informatics in New Zealand, since July 1998. This paper describes the structure of the course, the technology used and the development process and lessons we have learned. Our target audience is working health care professionals, including primary care and hospital doctors, nurses, and managers. The educational goals of the course include skills in:
Using electronic information sources, databases, presentation and analysis tools, electronic communication and collaboration tools.
Understanding of the breadth of the field of Health and Medical Informatics (HMI), including basic computing concepts, advantages and disadvantages of the application of IT in HealthCare situations and the concept of professional HealthCare workers as knowledge workers and information users.
Methods
The format of the course is a four semester, part-time course run over the Internet for HealthCare workers throughout New Zealand. Some course material is delivered via CD-ROM; some via the Web and communication takes place over the Internet using synchronous and asynchronous tools. A face-to-face workshop is provided at the start of each semester. At present 45 students are enrolled on the course. Student assessment takes the form of a set of competency tests (one every 3 weeks) covering application of topics covered in the current module. In addition 40% of the student's mark is assigned according to group work (groups are 4-5 students). These projects include a report on a topic of relevance along with web pages and presentations. Marks are also awarded for active participation in the group.
Results
A standard set of questions is provided to each student by the university - the first set of results have been very positive. Feedback forms have been provided and returned at the end of each workshop.
Conclusion
Internet technology has allowed a higher level of communication between staff and students, and student to student than would be possible with conventional means. Off-the-shelf software can support this process and the barriers to this method of teaching can be breached.
doi:10.2196/jmir.1.suppl1.e51
PMCID: PMC1761717
Computer Literacy; Graduate Medical Education; Internet
22.  Learning gain of pharmacy students after introducing guided inquiry learning with computer simulation in a pharmacology class in Fiji 
Purpose:
Active learning methods such as problem-based learning have been widely adopted in health professions education, although guided inquiry learning has been used only in limited settings. The objective of this study was to determine students’ learning gain when guided inquiry learning was combined with computer simulation in a basic pharmacology course.
Methods:
The second-year pharmacy students from Fiji National University participated in the study. Following classroom lectures on pharmacokinetics and pharmacodynamics, the students used tutor-prepared practice problems in groups of 3-4 to explore their concepts with Cyber Patient and Virtual Organ Bath software. Pre- and posttest assessments were administered to determine the learning gain from the exercises based on Hake’s criteria.
Results:
Forty-two students participated in the study. The average normalized learning gain from the pharmacokinetics exercises was 0.68. Thirty-seven participants (88.1%) achieved a significant learning gain, while 5 (11.90%) did not. The average normalized learning gain from the pharmacodynamics exercises was 0.76. Forty-one participants (97.6%) achieved a significant learning gain, while one participant (2.4%) did not.
Conclusion:
These results demonstrated that use of guided inquiry learning with computer simulations could produce significant learning gains with improvement in students’ understanding of basic pharmacology.
doi:10.3352/jeehp.2013.10.9
PMCID: PMC3912697  PMID: 24498470
Active learning; Computer simulation; Learning gain; Fiji; Pharmacology; Pharmacy students
23.  Pedagogic Strategies Perceived to Enhance Student Learning in Athletic Training Education 
Journal of Athletic Training  2002;37(4 suppl):S-199-S-207.
Objective: To investigate students' and instructors' educational experiences in Commission on Accreditation of Allied Health Education Programs (CAAHEP)-accredited athletic training education programs and specifically to determine to what extent pedagogic strategies were reflected in students' perceptions of their learning experiences, instructors' perceptions of their teaching, and athletic training course syllabi.
Design and Setting: Students and instructors currently enrolled in or teaching in 5 university athletic training programs accredited by CAAHEP provided in-depth interviews pertaining to students' educational experiences. Students' educational experiences in CAAHEP-accredited athletic training programs were also examined through current athletic training education course syllabi.
Subjects: Twenty-one students (9 males, 12 females) and 12 instructors (7 males, 5 females) were interviewed to examine their perceptions of teaching and learning experiences within their program.
Measurements: Students' and instructors' perceptions of their educational experiences in CAAHEP-accredited athletic training education programs were analyzed qualitatively using the data-analysis software program NUD*IST. Data from all 3 sources (students' interviews, instructors' interviews, course syllabi) were coded into categories within the NUD*IST program and then triangulated to ensure the authenticity of the findings.
Results: Based on the analysis of students' and instructors' interviews and course syllabi, 3 pedagogic strategies were identified that appeared to facilitate athletic training education in CAAHEP-accredited programs: use of scenarios and case studies, authentic experiences, and a positive educational environment.
Conclusions: Students and instructors in CAAHEP-accredited athletic training education programs recognize and value specific pedagogic theories of teaching and learning and achievement motivation in students' educational experiences. Specific educational themes identified across athletic training instructors, students, and programs are outlined. All athletic training educators should take an interest in understanding what students and instructors in CAAHEP-accredited athletic training programs view as helpful pedagogic practices within their educational experiences.
PMCID: PMC164425  PMID: 12937545
educational experiences; teaching; pedagogy
24.  Pragmatists, Positive Communicators, and Shy Enthusiasts: Three Viewpoints on Web Conferencing in Health Sciences Education 
Background
Web conferencing is a synchronous technology that allows coordinated online audio and visual interactions with learners logged in to a central server. Recently, its use has grown rapidly in academia, while research on its use has not kept up. Conferencing systems typically facilitate communication and support for multiple presenters in different locations. A paucity of research has evaluated synchronous Web conferencing in health sciences education.
Objective
McMaster University Faculty of Health Sciences trialed Wimba’s Live Classroom Web conferencing technology to support education and curriculum activities with students and faculty. The purpose of this study was to explore faculty, staff, and student perceptions of Web conferencing as a support for teaching and learning in health sciences. The Live Classroom technology provided features including real-time VoIP audio, an interactive whiteboard, text chat, PowerPoint slide sharing, application sharing, and archiving of live conferences to support student education and curriculum activities.
Methods
Q-methodology was used to identify unique and common viewpoints of participants who had exposure to Web conferencing to support educational applications during the trial evaluation period. This methodology is particularly useful for research on human perceptions and interpersonal relationships to identify groups of participants with different perceptions. It mixes qualitative and quantitative methods. In a Q-methodology study, the goal is to uncover different patterns of thought rather than their numerical distribution among the larger population.
Results
A total of 36 people participated in the study, including medical residents (14), nursing graduate students (11), health sciences faculty (9), and health sciences staff (2). Three unique viewpoints were identified: pragmatists (factor 1), positive communicators (factor 2A), and shy enthusiasts (factor 2B). These factors explained 28% (factor 1) and 11% (factor 2) of the total variance, respectively. The majority of respondents were pragmatists (n = 26), who endorsed the value of Web conferencing yet identified that technical and ease-of-use problems could jeopardize its use. Positive communicators (N = 4) enjoyed technology and felt that Web conferencing could facilitate communication in a variety of contexts. Shy enthusiasts (N = 4) were also positive and comfortable with the technology but differed in that they preferred communicating from a distance rather than face-to-face. Common viewpoints were held by all groups: they found Web conferencing to be superior to audio conferencing alone, felt more training would be useful, and had no concerns that Web conferencing would hamper their interactivity with remote participants or that students accustomed to face-to-face learning would not enjoy Web conferencing.
Conclusions
Overall, all participants, including pragmatists who were more cautious about the technology, viewed Web conferencing as an enabler, especially when face-to-face meetings were not possible. Adequate technical support and training need to be provided for successful ongoing implementation of Web conferencing.
doi:10.2196/jmir.9.5.e39
PMCID: PMC2270418  PMID: 18166527
Web conferencing; Q-methodology; synchronous communication; e-learning; distance education; Internet
25.  Are care workers appropriate mentors for nursing students in residential aged care? 
BMC Nursing  2014;13(1):44.
Background
The aged care sector is increasingly dominated by a less-qualified workforce at a time of increasing prevalence of complex health concerns, such as dementia. An Australian program to develop teaching aged care facilities is being undertaken to build the sector’s capacity and provide nursing students with positive experiences of engaging with vulnerable clients. This research aimed to examine care staff potential to facilitate nursing student engagement with clinically relevant knowledge in the performance of hygiene care in a residential aged care facility.
Methods
This study was designed as an action research study. A cycle of reflection, planning, action, and evaluation is described to illustrate the carer mentor capacity to engage with and contribute to the learning of nursing students. Participants were second year student nurses (n = 10) on a four-week placement in a Tasmanian aged care facility in 2013 and their nurse/carer mentors (n = 17). Mentors participated in six action research meetings, and nursing students engaged in a parallel series of four feedback meetings during the placement.
Results
At the beginning of the placement, nursing students exhibited a disregard for the clinical value of care provision. Students considered provision of hygiene care, in particular, the preserve of care workers and an inappropriate training exercise in the context of an undergraduate nursing qualification. To assist students to make links between core nursing competencies and hygiene care as well as to engender respect for their role within the aged care facility, carer mentors developed the Carer Assessment and Reporting Guide. Once implemented during the final weeks of the placement, the Guide improved student perceptions of resident hygiene care (reframed as assessment) and the role of facility care workers, as well as reinforcing carer self-esteem.
Conclusion
Hygiene care is replete with nursing competencies that are valuable for undergraduate learners, including assessments of skin integrity, mobility, cognitive function, bowels and urine, and basic hygiene. Nurse education programs should strive to address student misconceptions about care work in facilities to account for population level increases in care needs.
doi:10.1186/s12912-014-0044-8
PMCID: PMC4271505  PMID: 25530713
Aged care; Nursing; Clinical placement; Carer; Hygiene; Action research

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