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López-Jiménez JJ, Fernández-Alemán JL, González LL, Sequeros OG, Valle BM, García-Berná JA, Idri A, Toval A. Taking the pulse of a classroom with a gamified audience response system. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 213:106459. [PMID: 34768233 DOI: 10.1016/j.cmpb.2021.106459] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 10/06/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVE This paper presents an empirical study of a gamified mobile-based assessment approach that can be used to engage students and improve their educational performance. METHOD A gamified audience response system called G-SIDRA was employed. Three gamification elements were used to motivate students in classroom activities: badges for achievements to increase engagement, points to indicate progression and performance in the subject and ranking for promoting competitiveness. A total of 90 medical students in a General and Descriptive Anatomy of the Locomotor System course were taught using G-SIDRA in the academic year 2019/2020. Smart bracelets were configured to collect heart rate measurements from 30 students with the aim of evaluating the impact of the gamification elements. The control group consisted of a sample of 110 students enrolled on the same course in the academic year 2016/2017 using non-gamified SIDRA. RESULTS Statistically significant differences were found between multiple choice questions (MCQ) scores obtained by using SIDRA and G-SIDRA in the four experiments (U = 1.621,50, p < 0,01 for Exp1; U = 1.950,00, p < 0,01 for Exp2; U = 955,00, p < 0,01 for Exp3; U = 2.335,00, p < 0,01 for Exp4). In the students' final exam grades, statistically significant differences between students that used G-SIDRA as opposed to SIDRA (T(157) = 3.992; p = 0.044) were obtained. Concerning gamification elements, statistically significantly differences were found in comparing the pulse increases after and before the badge event in the four experiments (U = 2.484,00, p = 0,038 for Exp1; U = 2.109,50, p = 0,046 for Exp2; U = 1.790,50, p = 0,025 for Exp3; U = 1.557,0, p = 0,048 for Exp4). However, there are not statistically significant differences between the pulse increases after and before the ranking event in the four experiments. In a 5-point Likert-type scale, the students expressed satisfaction with G-SIDRA (M = 4.552) and thought the system helped to better understand both theoretical and practical concepts (M = 4.092). Their global assessment of the G-SIDRA platform was 4.471. CONCLUSIONS Of the three gamification elements used in the study, only badge has an effect on heart rate. Better student responses and academic performance were achieved when using G-SIDRA. Nevertheless, more research is required to evaluate the impact of the gamification elements on the motivation, engagement and performance of students. Physiological measures are promising approaches for gamification elements evaluation.
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Affiliation(s)
- Juan J López-Jiménez
- Faculty of Computer Science, Department of Informatics and System, University of Murcia, Campus of Espinardo, Murcia, Spain.
| | - José L Fernández-Alemán
- Faculty of Computer Science, Department of Informatics and System, University of Murcia, Campus of Espinardo, Murcia, Spain.
| | - Laura López González
- Faculty of Medicine, Department of Human Anatomy, Campus of Espinardo, University of Murcia, Spain.
| | - Ofelia González Sequeros
- Faculty of Medicine, Department of Human Anatomy, Campus of Espinardo, University of Murcia, Spain.
| | - Begoña Moros Valle
- Faculty of Computer Science, Department of Informatics and System, University of Murcia, Campus of Espinardo, Murcia, Spain.
| | - José A García-Berná
- Faculty of Computer Science, Department of Informatics and System, University of Murcia, Campus of Espinardo, Murcia, Spain.
| | - Ali Idri
- Software Project Management Research Team, ENSIAS, Mohammed V University in Rabat, Rabat, Morocco.
| | - Ambrosio Toval
- Faculty of Computer Science, Department of Informatics and System, University of Murcia, Campus of Espinardo, Murcia, Spain.
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Stein C. The effect of clinical simulation assessment on stress and anxiety measures in emergency care students. Afr J Emerg Med 2020; 10:35-39. [PMID: 32161710 PMCID: PMC7058871 DOI: 10.1016/j.afjem.2019.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/18/2019] [Accepted: 12/09/2019] [Indexed: 11/28/2022] Open
Abstract
Background Clinical simulation has become widespread as a training and assessment tool across a range of health professions, including emergency care. As with any form of assessment, simulations may be associated with stress and anxiety (“distress”) which may have a negative effect on student performance if demands required by the simulation outweigh the available resources. This study aimed to assess the effect of participation by students in an emergency care simulation on an objective measure of stress and a subjective measure of anxiety. Methods Heart rate variability (HRV) and scores from a validated state anxiety instrument (the State-Trait Anxiety Inventory) were assessed in 36 emergency medical care students participating in scheduled simulation assessments. Data recorded during a resting control period were used for comparison. Results HRV variables showed changes in the simulation assessment group suggesting decreased variability and parasympathetic withdrawal, however these were not significantly different to control. Heart rate in the simulation assessment group increased significantly (73.5/min vs. 107.3/min, p < 0.001). State anxiety scores increased significantly both before (33.5 vs. 49.1, p < 0.001) and after (33.5 vs. 60, p < 0.001) the simulation assessment, compared to control. No linear relationship was found between any HRV variables and anxiety scores. Conclusion Participating in an emergency care simulation assessment significantly elevated levels of anxiety in a group of 36 students, however an objective measure of stress did not identify changes significantly different to those at rest, with the exception of heart rate. The high levels of anxiety documented before and after simulation assessments may have a negative effect on performance and require further investigation.
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Endocrine and psychological stress response in simulated doctor-patient interactions in medical education. Psychoneuroendocrinology 2019; 105:172-177. [PMID: 30292650 DOI: 10.1016/j.psyneuen.2018.09.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Training of doctor-patient interactions by means of patient actors is considered a useful didactic tool in medical education. However, though students report it as being highly stressful little systematic research has verified this notion. AIMS To assess the endocrine and psychological stress responses of students in the doctor vs. the observer role in simulated doctor-patient interactions. METHODS Salivary cortisol and anxiety was assessed in N = 86 participants of a mandatory course on doctor-patient interactions on three consecutive days. During two of these days they were in the observer role and gave feedback to another student and on one of these days they were in the doctor role and were being given feedback. Saliva was sampled at 4 points in time per day: prior to interaction (T1); after watching the video of the interaction (T2); after feedback (T3); after observation of another interaction (T4). Assessments on observer days took place at the respective time points and at the same time of the day. 3-way mixed ANOVAs were computed with the factors "day of data sampling" (F1); "day with doctor role" (F2); "measurement time"(F3). RESULTS Significant two-way interactions F1 × F2 and three-way interactions F1 × F2 × F3 were observed both for cortisol and for anxiety (all p < .001). Neither cortisol nor anxiety were related to task severity. Anxiety at T1 correlated with cortisol increase from T1 to T2 (r = .266; p = .013). DISCUSSION Results confirm that playing the doctor role in a simulated doctor-patient interaction represents a significant stressor in medical students. Effect sizes considerably exceed those observed in laboratory stress. This brings about new questions regarding moderating factors, effects of repetitions and relationship to medical performance. The ecological validity of this stressor can also make it a useful tool in basic endocrine research.
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Martin J, Schneider F, Kowalewskij A, Jordan D, Hapfelmeier A, Kochs EF, Wagner KJ, Schulz CM. Linear and non-linear heart rate metrics for the assessment of anaesthetists' workload during general anaesthesia. Br J Anaesth 2018; 117:767-774. [PMID: 27956675 DOI: 10.1093/bja/aew342] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Excessive workload may impact the anaesthetists' ability to adequately process information during clinical practice in the operation room and may result in inaccurate situational awareness and performance. This exploratory study investigated heart rate (HR), linear and non-linear heart rate variability (HRV) metrics and subjective ratings scales for the assessment of workload associated with the anaesthesia stages induction, maintenance and emergence. METHODS HR and HRV metrics were calculated based on five min segments from each of the three anaesthesia stages. The area under the receiver operating characteristics curve (AUC) of the investigated metrics was calculated to assess their ability to discriminate between the stages of anaesthesia. Additionally, a multiparametric approach based on logistic regression models was performed to further evaluate whether linear or non-linear heart rate metrics are suitable for the assessment of workload. RESULTS Mean HR and several linear and non-linear HRV metrics including subjective workload ratings differed significantly between stages of anaesthesia. Permutation Entropy (PeEn, AUC=0.828) and mean HR (AUC=0.826) discriminated best between the anaesthesia stages induction and maintenance. In the multiparametric approach using logistic regression models, the model based on non-linear heart rate metrics provided a higher AUC compared with the models based on linear metrics. CONCLUSIONS In this exploratory study based on short ECG segment analysis, PeEn and HR seem to be promising to separate workload levels between different stages of anaesthesia. The multiparametric analysis of the regression models favours non-linear heart rate metrics over linear metrics.
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Affiliation(s)
- J Martin
- Department of Anaesthesiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, München, 81675, Germany
| | - F Schneider
- Department of Anaesthesiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, München, 81675, Germany
| | - A Kowalewskij
- Department of Anaesthesiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, München, 81675, Germany
| | - D Jordan
- Department of Anaesthesiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, München, 81675, Germany
| | - A Hapfelmeier
- Institute of Medical Statistics und Epidemiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, München, 81675, Germany
| | - E F Kochs
- Department of Anaesthesiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, München, 81675, Germany
| | - K J Wagner
- Department of Anaesthesiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, München, 81675, Germany
| | - C M Schulz
- Department of Anaesthesiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, München, 81675, Germany
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Anxiety and Clinical Performance in Simulated Setting in Undergraduate Health Professionals Education: An Integrative Review. Clin Simul Nurs 2017. [DOI: 10.1016/j.ecns.2017.05.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Feda DM, Roemmich JN. Effect of Interpersonal and Cognitive Stressors on Habituation and the Utility of Heart Rate Variability to Measure Habituation. Stress Health 2016; 32:320-327. [PMID: 25393296 DOI: 10.1002/smi.2618] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 09/05/2014] [Accepted: 10/09/2014] [Indexed: 11/07/2022]
Abstract
Habituation is a decrease in responding to a repeated stimulus. Operant responding and salivation measure habituation in eating behaviour research. Stress may increase eating by acting as a distractor, yielding spontaneous recovery and prolonging responding for food. Our research tested differences in the ability of cognitive and interpersonal stressors to recover responding for food. We also tested heart rate variability (HRV) as a measure of habituation. Twenty women worked for portions of macaroni and cheese for 15 trials on three separate laboratory visits. Between the 12th and 13th trial, one of three different stressor types (speech, stroop and subtraction) was presented during each visit. HRV was measured continuously throughout the laboratory visits. Responding for food declined across the 12 trials with no difference in rate of habituation by visit (p > 0.8) There was no difference between stressor type in the magnitude of spontaneous recovery after each stressor (p > 0.8). Rates of habituation of HRV variables correlated (p < 0.02) with the rate of operant responding habituation. Cognitive and interpersonal stressors do not differ in their ability to recover reduced responding for food. HRV variables may measure habituation to food similar to operant responding. Copyright © 2014 John Wiley & Sons, Ltd.
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Affiliation(s)
- Denise M Feda
- Department of Pediatrics, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
| | - James N Roemmich
- USDA-ARS-NPA Grand Forks Human Nutrition Research Center, Grand Forks, ND, USA
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Nikendei C, Diefenbacher K, Köhl-Hackert N, Lauber H, Huber J, Herrmann-Werner A, Herzog W, Schultz JH, Jünger J, Krautter M. Digital rectal examination skills: first training experiences, the motives and attitudes of standardized patients. BMC MEDICAL EDUCATION 2015; 15:7. [PMID: 25638247 PMCID: PMC4322856 DOI: 10.1186/s12909-015-0292-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 01/12/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Physical clinical examination is a core clinical competence of medical doctors. In this regard, digital rectal examination (DRE) plays a central role in the detection of abnormalities of the anus and rectum. However, studies in undergraduate medical students as well as newly graduated doctors show that they are insufficiently prepared for performing DRE. Training units with Standardized Patients (SP) represent one method to deliver DRE skills. As yet, however, it is little known about SPs' attitudes. METHODS This is a qualitative study using a grounded theory approach. Interviews were conducted with 4 standardized patients about their experiences before, during and after structured SP training to deliver DRE competencies to medical students. The resulting data were subjected to thematic content analysis. RESULTS Results show that SPs do not have any predominant motives for DRE program participation. They participate in the SP training sessions with relatively little prejudice and do not anticipate feeling highly vulnerable within teaching sessions with undergraduate medical students. CONCLUSIONS The current study examined SPs' motives, views, expectations and experiences regarding a DRE program during their first SP training experiences. The results enabled us to derive distinct action guidelines for the recruitment, informing and briefing of SPs who are willing to participate in a DRE program.
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Affiliation(s)
- Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Medical Centre, Heidelberg, Germany.
| | - Katja Diefenbacher
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Medical Centre, Heidelberg, Germany.
| | - Nadja Köhl-Hackert
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Medical Centre, Heidelberg, Germany.
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.
| | - Heike Lauber
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Medical Centre, Heidelberg, Germany.
| | - Julia Huber
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Medical Centre, Heidelberg, Germany.
| | - Anne Herrmann-Werner
- Department of Internal Medicine VI, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Medical Centre, Heidelberg, Germany.
| | - Jobst-Hendrik Schultz
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Medical Centre, Heidelberg, Germany.
| | - Jana Jünger
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Medical Centre, Heidelberg, Germany.
| | - Markus Krautter
- Department of Nephrology, University of Heidelberg, INF 162, 69115, Heidelberg, Germany.
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Hulsman RL, Smets EMA, Karemaker JM, de Haes HJCJM. The psychophysiology of medical communication. Linking two worlds of research. PATIENT EDUCATION AND COUNSELING 2011; 84:420-427. [PMID: 21676575 DOI: 10.1016/j.pec.2011.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 05/03/2011] [Accepted: 05/04/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Medical communication is goal oriented behavior. As such, it can be modeled as a chain of decisions, resulting from cognitive and emotional processes each potentially associated with psychophysiological reactions. Psychophysiological may be helpful to detect small changes in affect or arousal in the course of a consultation that would be difficult to detect by other evaluations of the process, like self-reports. The question is how psychophysiological communication research should be modeled for unraveling in more detail the cognitive, emotional and interpersonal processes which underlie physician and patient behavior. METHODS In the world of medical communication research the six-function model of medical communication reveals a number of fundamental perceptual, cognitive and emotional processes which may evoke psychophysiological responses. The world of psychophysiological research encompasses domains of perception, mental imagery, anticipation and action which all have close connections with fundamental tasks in communication. CONCLUSION This paper discusses ten methodological issues in linking continuous psychophysiological data to verbal and nonverbal events in a medical consultation observed with the Verona coding system. PRACTICE IMPLICATIONS When linking the two worlds of research, the methodological challenges discussed need to be solved to obtain a valid and reliable application of psychophysiological measures in medical communication research.
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Affiliation(s)
- Robert L Hulsman
- Department of Medical Psychology, Academic Medical Centre, University of Amsterdam, The Netherlands.
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Werner A, Rieber N, Zipfel S. Curiosity's curious influence on medical doctors. MEDICAL EDUCATION 2011; 45:656-658. [PMID: 21649695 DOI: 10.1111/j.1365-2923.2011.04030.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Anne Werner
- Department of Internal Medicine VI,University Hospital Tu¨bingen,Tübingen, Germany.
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