A multicenter study to provide evidence of construct validity in a computer-based outcome measure of neurology clinical skills

The effects of neurologic assessment E-learning in nurses

BACKGROUND

A firm understanding of the preliminary assessment of a patient with neurological disorders is needed for ensuring optimal patient outcomes.

OBJECTIVES

The purpose of this study is to evaluate the effects of using e-learning on neurologic assessment knowledge, ability, and self-confidence among nurses.

DESIGN

This study used a non-equivalent control group pretest-posttest design.

SETTINGS

Nurses working in the neurology and neurosurgery wards, Republic of Korea PARTICIPANTS: A convenience sample of 50 nurses was assigned to either the experimental group (n=24) or the control group (n=26).

METHODS

The experimental group participated in the self-directed e-learning program related to neurologic assessment, and control group underwent self-directed learning with handout. Knowledge, ability, and self-confidence were measured at pretest and posttest.

RESULTS

There were no significant differences in knowledge (U=270, p=0.399) and self-confidence (U=241.5, p=0.171) between the two groups. Nurses in the experimental group showed higher neurologic assessment ability compared with those in the control group (U=199, p=0.028).

CONCLUSIONS

Self-directed neurologic assessment e-learning induced improvement in the neurologic assessment ability among nurses. Self-directed e-learning can be applied for improving competencies in neurologic assessment.

Multiple modes of impulsivity in Parkinson's disease

Cognitive problems are a major factor determining quality of life of patients with Parkinson's disease. These include deficits in inhibitory control, ranging from subclinical alterations in decision-making to severe impulse control disorders. Based on preclinical studies, we proposed that Parkinson's disease does not cause a unified disorder of inhibitory control, but rather a set of impulsivity factors with distinct psychological profiles, anatomy and pharmacology. We assessed a broad set of measures of the cognitive, behavioural and temperamental/trait aspects of impulsivity. Sixty adults, including 30 idiopathic Parkinson's disease patients (Hoehn and Yahr stage I–III) and 30 healthy controls, completed a neuropsychological battery, objective behavioural measures and self-report questionnaires. Univariate analyses of variance confirmed group differences in nine out of eleven metrics. We then used factor analysis (principal components method) to identify the structure of impulsivity in Parkinson's disease. Four principal factors were identified, consistent with four different mechanisms of impulsivity, explaining 60% of variance. The factors were related to (1) tests of response conflict, interference and self assessment of impulsive behaviours on the Barrett Impulsivity Scale, (2) tests of motor inhibitory control, and the self-report behavioural approach system, (3) time estimation and delay aversion, and (4) reflection in hypothetical scenarios including temporal discounting. The different test profiles of these four factors were consistent with human and comparative studies of the pharmacology and functional anatomy of impulsivity. Relationships between each factor and clinical and demographic features were examined by regression against factor loadings. Levodopa dose equivalent was associated only with factors (2) and (3). The results confirm that impulsivity is common in Parkinson's disease, even in the absence of impulse control disorders, and that it is not a unitary phenomenon. A better understanding of the structure of impulsivity in Parkinson's disease will support more evidence-based and effective strategies to treat impulsivity.

Comparison of methods for teaching developmental milestones to pediatric residents

BACKGROUND

Interactive media are effective tools in teaching and allow for self-directed study, which develops skills for life-long learning among health professionals. With this type of study, the learner can review material at his/her own pace and target areas that require emphasis. Pediatric residents require an accurate understanding of developmental milestones in children of various ages and their normal variations. The best representation of developmental milestones requires video recordings of children demonstrating appropriate skills. However, such recordings are not always available, so printed materials are most often used. In this realm, a computer-based interactive learning tool using animated cartoons gives flexibility for presentation using drawings. We compared pediatric residents' knowledge of developmental milestones in neonates to 5-year-olds before and after study with either an interactive DVD or paper-based materials.

METHODS

A team of physicians and educational specialists in Texas Tech University Health Sciences Center produced an interactive DVD containing animated cartoons and questions. Residents were divided into an intervention group that used the DVD and a control group that used traditional paper-based materials. Each group's improvement [or increase] in knowledge was measured.

RESULTS

Compared with the 17 residents in the control group, the 37 in the intervention group tended to acquire more knowledge about developmental milestones. The mean scores at T1, T2, and T3 doubled from the initial scores in the intervention group, while no difference was observed in the control group.

CONCLUSION

An interactive educational DVD can be an effective supplement to improve residents' knowledge of developmental milestones.

Effectiveness of a modified Continuum curriculum for medical students: a randomized trial

BACKGROUND

Continuum: Lifelong Learning in Neurology® is a well-regarded and widely used continuing medical education tool published by the American Academy of Neurology. The objective of this study was to test the effectiveness of a modified version of the Dementia module of the Continuum curriculum, adapted for medical students rotating on their neurology clerkship, in increasing medical knowledge of dementia.

METHODS

A multisite longitudinal randomized controlled design was used. Medical students rotating on their Neurology clerkship were recruited from 2 US medical schools. Participants completed 10 multiple-choice questions, 1 fill-in-the-blank, and 1 patient case simulation question to assess medical knowledge of the most prevalent dementias pre- and post-curriculum implementation. All students received their standard dementia curriculum (45-minute live didactic presentation on dementia along with a copy of the slides in handout form). Students were randomized to either the intervention (standard + Continuum curriculum) or control (standard curriculum alone) group. Data collection and outcomes assessment was optimized via an interactive audience response system (pretest) and Web-based survey/database tool (post-test and student satisfaction surveys).

RESULTS

From pre- to post-clinical clerkship, medical students completing the Continuum dementia curriculum in addition to standard clerkship curriculum demonstrated significantly greater increases in medical knowledge of dementia, relative to students completing only the standard curriculum. Subscores were significantly higher among Continuum-trained students on questions regarding Alzheimer disease (AD), frontotemporal lobar dementia, Lewy body dementia, AD treatment fill-in-the-blank, and AD patient case simulation.

CONCLUSIONS

The Continuum: Dementia for Medical Students curriculum provided an inexpensive and readily implementable means for improving medical knowledge of dementia. Improved performance on an AD patient case simulation may be considered a surrogate marker for optimized patient care.

Integrating Innovative Technologies Into a Psychiatric Pharmacy Clerkship Rotation

One quarter of the US population suffers from a diagnosable mental illness, and society is becoming more educated about these diseases and the medications used to treat them. Inasmuch as pharmacy is considered one of the most trusted professions, it is imperative that pharmacists have a good understanding of psychotropics to properly counsel their patients. However, psychopharmacology is often given disproportionate coverage in most pharmacy curricula considering the frequency of these illnesses. For future pharmacists to gain much-needed knowledge, a psychiatric pharmacy clerkship rotation can be instrumental in developing competence through patient consultations and in performing drug regimen reviews. Integrating simple technologies into a clerkship can greatly reduce the burden on the preceptor and provide a consistent and fulfilling experience for the student. Educators in nursing and medicine have used various technologies with much success, albeit in mostly a classroom environment. Applicable media include e-mail, the Internet, personal digital assistants, CD-ROM programs, and video teleconferencing. Various basic and advanced techniques, such as making monthly calendars and using CD-ROM media to free Web-based video teleconferencing, are described in detail to assist preceptors in using these technologies for their rotations. The future potential of the addition of technology into education is only limited by one's imagination and the tools available.