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Liu K, Xu Y, Ma C, Yu N, Tan F, Li Y, Bai Y, Fu X, Wan J, Fan D, Yin H, Chen M, Chen H, Jiang L, Song J, Ji P, Zhao X, Pang M. Efficacy of a Virtual 3D Simulation-Based Digital Training Module for Building Dental Technology Students' Long-Term Competency in Removable Partial Denture Design: Prospective Cohort Study. JMIR Serious Games 2024; 12:e46789. [PMID: 38596827 PMCID: PMC11009623 DOI: 10.2196/46789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 01/29/2024] [Accepted: 02/21/2024] [Indexed: 04/11/2024] Open
Abstract
Background Removable partial denture (RPD) design is crucial to long-term success in dental treatment, but shortcomings in RPD design training and competency acquisition among dental students have persisted for decades. Digital production is increasing in prevalence in stomatology, and a digital RPD (D-RPD) module, under the framework of the certified Objective Manipulative Skill Examination of Dental Technicians (OMEDT) system reported in our previous work, may improve on existing RPD training models for students. Objective We aimed to determine the efficacy of a virtual 3D simulation-based progressive digital training module for RPD design compared to traditional training. Methods We developed a prospective cohort study including dental technology students at the Stomatology College of Chongqing Medical University. Cohort 1 received traditional RPD design training (7 wk). Cohort 2 received D-RPD module training based on text and 2D sketches (7 wk). Cohort 3 received D-RPD module pilot training based on text and 2D sketches (4 wk) and continued to receive training based on 3D virtual casts of real patients (3 wk). RPD design tests based on virtual casts were conducted at 1 month and 1 year after training. We collected RPD design scores and the time spent to perform each assessment. Results We collected the RPD design scores and the time spent to perform each assessment at 1 month and 1 year after training. The study recruited 109 students, including 58 (53.2%) female and 51 male (56.8%) students. Cohort 1 scored the lowest and cohort 3 scored the highest in both tests (cohorts 1-3 at 1 mo: mean score 65.8, SD 21.5; mean score 81.9, SD 6.88; and mean score 85.3, SD 8.55, respectively; P<.001; cohorts 1-3 at 1 y: mean score 60.3, SD 16.7; mean score 75.5, SD 3.90; and mean score 90.9, SD 4.3, respectively; P<.001). The difference between cohorts in the time spent was not statistically significant at 1 month (cohorts 1-3: mean 2407.8, SD 1370.3 s; mean 1835.0, SD 1329.2 s; and mean 1790.3, SD 1195.5 s, respectively; P=.06) but was statistically significant at 1 year (cohorts 1-3: mean 2049.16, SD 1099.0 s; mean 1857.33, SD 587.39 s; and mean 2524.3, SD 566.37 s, respectively; P<.001). Intracohort comparisons indicated that the differences in scores at 1 month and 1 year were not statistically significant for cohort 1 (95% CI -2.1 to 13.0; P=.16), while cohort 3 obtained significantly higher scores 1 year later (95% CI 2.5-8.7; P=.001), and cohort 2 obtained significantly lower scores 1 year later (95% CI -8.8 to -3.9; P<.001). Conclusions Cohort 3 obtained the highest score at both time points with retention of competency at 1 year, indicating that progressive D-RPD training including virtual 3D simulation facilitated improved competency in RPD design. The adoption of D-RPD training may benefit learning outcomes.
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Affiliation(s)
- KeXin Liu
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - YaQian Xu
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - ChaoYi Ma
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Na Yu
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - FaBing Tan
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Yi Li
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - YaXin Bai
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - XiaoMing Fu
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - JiaWu Wan
- Beijing Unidraw Virtual Reality Technology Research Institute Co, Ltd, Beijing, China
| | - DongQi Fan
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - HuBin Yin
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - MeiXi Chen
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - HongJi Chen
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Lin Jiang
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - JinLin Song
- College of Stomatology, Chongqing Medical University, Chongqing, China
| | - Ping Ji
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - XiaoHan Zhao
- State Key Laboratory of Virtual Reality Technology and Systems, BeiHang University, Beijing, China
| | - MengWei Pang
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
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Cunningham JM, Johnson M, Kincaid T, Christensen W, Baker J, Turbyfill W, Adams JE. The spacing effect: Improving electrocardiogram interpretation. CLINICAL TEACHER 2024; 21:e13626. [PMID: 37646381 DOI: 10.1111/tct.13626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/22/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Accurate electrocardiogram (ECG) interpretation is critical for safe patient care, making this skill a necessary competency for medical school graduation. Improved long-term memory retention with repeated exposure to material is one of the most evidenced-based components of adult learning science. This curricular innovation aimed to determine if implementing spaced repetition and retrieval practice using ECG quizzes during the principal clinical year would improve ECG interpretation skills among medical students enrolled in a Longitudinal Integrated Clerkship (LIC). APPROACH The curricular innovation applied the spacing effect and retrieval practice. Cognitive science demonstrates enhanced long-term retention through repeated interval exposure to learned material. Studies of spaced retrieval indicate that memory retention is enhanced through tests involving effortful recall. LIC students in an intervention group were exposed to the spacing effect with periodic ECG quizzes throughout their clinical clerkship year. EVALUATION The results of the 17-item post-test for 140 students were analysed: LIC intervention, N = 54; block control, N = 62; and LIC control, N = 24. The ANOVA test was significant (p < 0.001). Games-Howell post hoc testing showed that the mean score in the LIC intervention group was significantly higher compared with the LIC control group (p < 0.001) and the block control group (p < 0.001). There was no significant difference between the LIC control and block control groups (p = 0.59). IMPLICATIONS Spaced repetition of material through ECG quizzes improved ECG interpretation skills on an ECG post-test and mitigates the forgetting curve, maintaining student competency in ECG interpretation.
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Affiliation(s)
- John M Cunningham
- Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Melissa Johnson
- Department of Internal Medicine and Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Troy Kincaid
- Department of Internal Medicine and Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Wendy Christensen
- Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jaime Baker
- Division of Internal Medicine, UCHealth Memorial Hospital, Colorado Springs, Colorado, USA
| | - William Turbyfill
- Division of Internal Medicine, VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Jennifer E Adams
- Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Saravi M, Rezaei Majd A, Qassemi Darzi MA, Habibzadeh Y, Hoseini Motlagh Z, Ghaemi-Amiri M. Educating correct ECG interpretation is a way to promote the satisfaction and competency the diagnostic service providers. CASPIAN JOURNAL OF INTERNAL MEDICINE 2024; 15:141-146. [PMID: 38463923 PMCID: PMC10921113 DOI: 10.22088/cjim.15.1.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/08/2022] [Accepted: 10/31/2022] [Indexed: 03/12/2024]
Abstract
Background Given electrocardiogram (ECG) interpretation as one of the diagnostical challenges for medical students and health professionals, this research was carried out to present an experience of web-based teaching method and novel approaches used for training of ECG interpretation. Methods This online program was conducted in three days. The main content of the class was taught during one hour, and after that, the teacher spent enough time for responding the asked questions. The components of a normal ECG and different changes that can occur in these waves were taught through clinical case-based scenarios using the web platform and Adobe Connect software. The participants' satisfaction was assessed with a 12-item questionnaire, and the short-term retention of ECG interpretation skill was examined by comparing the posttest scores with pretest. Results A total of 224 individuals completed the course. Total satisfaction score was 53.05±6.98 (out of the maximum score of 60). Based on the results of the paired t test, the interpretation skill scores of the participants increased significantly from 2.5 ± 1.57 to 6.96 ± 1.89. (p<0.001, CI = -4.8 to- 4.11). Conclusion This web-based nationwide training program provided a supplementary resource for ECG learning among medical students and health-care providers.
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Affiliation(s)
- Mehrdad Saravi
- Department of Cardiology, School of Medicine, Mobility Impairment Research Center, Health Research Institute, Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | | | | | - Yasaman Habibzadeh
- Medical Education Development Student Committee, Babol University of Medical Sciences, Babol, Iran
| | - Zeinab Hoseini Motlagh
- Medical Education Development Student Committee, Babol University of Medical Sciences, Babol, Iran
| | - Maryam Ghaemi-Amiri
- Education Development Center, Babol University of Medical Sciences, Babol, Iran
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Nielsen MS, Lundorff SH, Hansen PM, Nielsen BU, Andersen SAW, Konge L, Nielsen AB, Brøchner AC. Anesthesiologists' skills in emergency cricothyroidotomy mandate a brush-up training after 3 months-A randomized controlled trial. Acta Anaesthesiol Scand 2024; 68:91-100. [PMID: 37729943 DOI: 10.1111/aas.14329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 06/09/2023] [Accepted: 09/04/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND In the Difficult Airway Society's 2015 "cannot intubate, cannot oxygenate" guideline, the emergency cricothyroidotomy is the final option when managing an unanticipated difficult airway. How often training for maintenance of this skill is required for anesthesiologists remains unknown. We aimed to assess if specialist-trained anesthesiologists' skills improved from a brush-up intervention and if skills were retained after 3 months. METHODS In this multicenter, randomized, controlled trial, participants were randomized to either a simulation-based brush-up or no brush-up. Both groups performed a mannequin-based technical skills emergency cricothyroidotomy test twice and were assessed by a blinded rater using a structured assessment tool that included time, positioning, palpation, appropriate employment of instruments, and stepwise progression. After 3 months of non-training, participants completed identical tests of retention. RESULTS A total of 54 anesthesiologists were included from three hospitals in the Region of Southern Denmark. Thirty-seven percent of the participants had received skills training in emergency cricothyroidotomy in the prior 12 months. The intervention group (N = 27) performed better in the initial tests, with a mean time of 51.5 s (SD = 10.82), a total score per minute of 15.9 points (SD = 4.91), and 93% passing both initial tests compared to the control group (N = 27) with a mean time of 76.8 s (SD = 35.82), a total score per minute of 6.6 (SD = 4.68) and only 15% passing both initial tests. The intervention group managed to retain overall performance in retention tests in terms of performance time (48.9 s, p = .26), total score per minute (13.6 points, p = .094), and passing the tests (75%, p = .059). CONCLUSION Exposure to simulation-based brush-up training in emergency cricothyroidotomy improved anesthesiologists' technical performance and was overall retained after 3 months. Some loss of skill concerning specific items was observed, highlighting the need for regular training in emergency cricothyroidotomy. Simulation-based training should be prioritized to improve and maintain technical skills in infrequent high-stakes procedures.
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Affiliation(s)
- Martine S Nielsen
- Department of Anaesthesiology and Intensive Care, Lillebaelt University Hospital, Kolding, Denmark
- SimC - Simulation Center, Odense University Hospital, Odense, Denmark
- OPEN, Open Patient Data Explorative Network, Odense University Hospital, Region of Southern Denmark, Odense, Denmark
| | - Simon H Lundorff
- Department of Anaesthesiology and Intensive Care, Lillebaelt University Hospital, Kolding, Denmark
| | - Peter Martin Hansen
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Svendborg, Denmark
- Danish Air Ambulance, Aarhus, Denmark
| | - Bjørn U Nielsen
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Steven A W Andersen
- Department of Otorhinolaryngology - Head and Neck Surgery, Copenhagen, Denmark
- Copenhagen Academy for Medical Education and Simulation, Center for HR & Education, The Capital Region of Denmark, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Center for HR & Education, The Capital Region of Denmark, Copenhagen, Denmark
| | - Anders B Nielsen
- SimC - Simulation Center, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anne C Brøchner
- Department of Anaesthesiology and Intensive Care, Lillebaelt University Hospital, Kolding, Denmark
- Department of Regional Health Research, Region of Southern Denmark, Odense, Denmark
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Nielsen MS, Raben‐Levetzau FN, Andersen SAW, Wennervaldt K, Konge L, Nielsen AB. Retention of emergency cricothyroidotomy skills: A multicenter randomized controlled trial. AEM EDUCATION AND TRAINING 2023; 7:e10900. [PMID: 37529172 PMCID: PMC10387827 DOI: 10.1002/aet2.10900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/26/2023] [Accepted: 07/11/2023] [Indexed: 08/03/2023]
Abstract
Objectives Emergency cricothyroidotomy is the final approach to establishing a secure airway. The procedure is acute and highly infrequent, making it difficult to achieve and maintain competence in the clinic. Simulation-based training in emergency cricothyroidotomy is effective but it is unknown how often training should be repeated to maintain skills. This study aimed to assess novices' retention of technical skills in emergency cricothyroidotomy after completing SBT. Methods Novices in emergency cricothyroidotomy completed a structured, simulation-based training program and were randomized to retention tests after 1, 3, or 6 months. Participants completed two emergency cricothyroidotomy tests at end-of-training and follow-up retention testing. Test performances were video recorded and evaluated by two experienced blinded raters using a structured assessment tool. Differences in the performances and the pass/fail rates were analyzed. Results Eighty-two medical students from two different Danish universities were included from April 2021 to February 2022. Paired t-tests showed skills decay significantly after 1 month (mean loss 6.7 points, p < 0.001). The mean loss of points, representing the difference in global score points, from the end-of-training to retention test was 6.7 points (95% confidence interval [CI] 4.5-8.8) for the 1-month group, 8.2 points (95% CI 5.8-10.0) for the 3-months group, and 9.9 points (95% CI 8.1-11.7) for the 6-months group. Six participants in both the 1-month group (23.1%) and the 3-month group (24%) passed the first retention test, but no one in the 6-months group had a passing performance. Conclusions Novices' technical skills performance in emergency cricothyroidotomy decay significantly already after 1 month. This initial loss of skill seems to be stable until 3 months, after which there is a further significant loss of skills. Recurring training should be implemented for the benefit of patient safety and outcomes.
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Affiliation(s)
- Martine Siw Nielsen
- SimC—Simulation CenterOdense University HospitalOdenseDenmark
- Open Patient Data Explorative Network (OPEN)Odense University HospitalOdenseDenmark
| | - Felix Nicolai Raben‐Levetzau
- Copenhagen Academy for Medical Education and Simulation, Center for HR & EducationThe Capital Region of DenmarkCopenhagenDenmark
| | - Steven Arild Wuyts Andersen
- Copenhagen Academy for Medical Education and Simulation, Center for HR & EducationThe Capital Region of DenmarkCopenhagenDenmark
- Department of Otorhinolaryngology—Head and Neck SurgeryRigshospitaletCopenhagenDenmark
| | | | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Center for HR & EducationThe Capital Region of DenmarkCopenhagenDenmark
| | - Anders Bo Nielsen
- SimC—Simulation CenterOdense University HospitalOdenseDenmark
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
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Olvet DM, Sadigh K. Comparing the effectiveness of asynchronous e-modules and didactic lectures to teach electrocardiogram interpretation to first year US medical students. BMC MEDICAL EDUCATION 2023; 23:360. [PMID: 37217893 DOI: 10.1186/s12909-023-04338-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 05/09/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Medical students are expected to be competent in interpreting electrocardiograms (ECGs) by the time they graduate, but many are unable to master this skill. Studies suggest that e-modules are an effective way to teach ECG interpretation, however they are typically evaluated for use during clinical clerkships. We sought to determine if an e-module could replace a didactic lecture to teach ECG interpretation during a preclinical cardiology course. METHODS We developed an asynchronous, interactive e-module that consisted of narrated videos, pop-up questions and quizzes with feedback. Participants were first year medical students who were either taught ECG interpretation during a 2-hour didactic lecture (control group) or were given unlimited access to the e-module (e-module group). First-year internal medicine residents (PGY1 group) were included to benchmark where ECG interpretation skills should be at graduation. At three time-points (pre-course, post-course, and 1-year follow-up), participants were evaluated for ECG knowledge and confidence. A mixed-ANOVA was used to compare groups over time. Students were also asked to describe what additional resources they used to learn ECG interpretation throughout the study. RESULTS Data was available for 73 (54%) students in the control group, 112 (81%) in the e-module group and 47 (71%) in the PGY1 group. Pre-course scores did not differ between the control and e-module groups (39% vs. 38%, respectively). However, the e-module group performed significantly better than the control group on the post-course test (78% vs. 66%). In a subsample with 1-year follow-up data, the e-module group's performance decreased, and the control group remained the same. The PGY1 groups' knowledge scores were stable over time. Confidence in both medical student groups increased by the end of the course, however only pre-course knowledge and confidence were significantly correlated. Most students relied on textbooks and course materials for learning ECG, however online resources were also utilized. CONCLUSIONS An asynchronous, interactive e-module was more effective than a didactic lecture for teaching ECG interpretation, however continued practice is needed regardless of how students learn to interpret ECGs. Various ECG resources are available to students to support their self-regulated learning.
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Affiliation(s)
- Doreen M Olvet
- Department of Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11549, USA.
| | - Kaveh Sadigh
- Department of Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, 11794, USA
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Ardekani A, Hider AM, Rastegar Kazerooni AA, Hosseini SA, Roshanshad A, Amini M, Kojuri J. Surfing the clinical trials of ECG teaching to medical students: A systematic review. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:107. [PMID: 37288415 PMCID: PMC10243439 DOI: 10.4103/jehp.jehp_780_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/12/2022] [Indexed: 06/09/2023]
Abstract
Interpreting an electrocardiogram (ECG) is crucial for every physician. The physician's competency in ECG interpretation needs to be improved at any stage of medical education. The aim of the present study was to review the currently published clinical trials of ECG teaching to medical students and provide suggestions for future works. On May 1, 2022, PubMed, Scopus, Web of Science, Google Scholar, and ERIC were searched to retrieve relevant articles on clinical trials of ECG teaching to medical students. The quality of the included studies was assessed utilizing the Buckley et al. criteria. The screening, data extraction, and quality appraisal processes were duplicated independently. In case of disagreements, consultation with a third author was put forth. In total, 861 citations were found in the databases. After screening abstracts and full texts, 23 studies were deemed eligible. The majority of the studies were of good quality. Peer teaching (7 studies), self-directed learning (6 studies), web-based learning (10 studies), and various assessment modalities (3 studies) comprised the key themes of the studies. Various methods of ECG teaching were encountered in the reviewed studies. Future studies in ECG training should focus on novel and creative teaching methods, the extent to which self-directed learning can be effective, the utility of peer teaching, and the implications of computer-assisted ECG interpretation (e.g., artificial intelligence) for medical students. Long-term knowledge retention assessment studies based on different approaches integrated with clinical outcomes could be beneficial in determining the most efficient modalities.
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Affiliation(s)
- Ali Ardekani
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad M. Hider
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | | | | | - Mitra Amini
- Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Javad Kojuri
- Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Dzikowicz DJ, Carey MG. Implementing interactive technology to teach electrocardiographic interpretation online. J Prof Nurs 2022; 42:148-155. [DOI: 10.1016/j.profnurs.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/14/2022] [Accepted: 06/19/2022] [Indexed: 11/15/2022]
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Calixte D, Haynes NA, Robert M, Edmond C, Yan LD, Raiti-Palazzolo K, Toussaint E, Isaac BD, Fenelon DL, Kwan GF. Online team-based electrocardiogram training in Haiti: evidence from the field. BMC MEDICAL EDUCATION 2022; 22:360. [PMID: 35545788 PMCID: PMC9094130 DOI: 10.1186/s12909-022-03421-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The electrocardiogram (ECG) is the most relied upon tool for cardiovascular diagnosis, especially in low-resource settings because of its low cost and straightforward usability. It is imperative that internal medicine (IM) and emergency medicine (EM) specialists are competent in ECG interpretation. Our study was designed to improve proficiency in ECG interpretation through a competition among IM and EM residents at a teaching hospital in rural central Haiti in which over 40% of all admissions are due to CVD. METHODOLOGY The 33 participants included 17 EM residents and 16 IM residents from each residency year at the Hôpital Universitaire de Mirebalais (HUM). Residents were divided into 11 groups of 3 participants with a representative from each residency year and were given team-based online ECG quizzes to complete weekly. The format included 56 ECG cases distributed over 11 weeks, and each case had a pre-specified number of points based on abnormal findings and complexity. All ECG cases represented cardiovascular pathology in Haiti adapted from the Association of Program Directors in Internal Medicine evaluation list. The main intervention was sharing group performance and ECG solutions to all participants each week to promote competition and self-study without specific feedback or discussion by experts. To assess impact, pre- and post-intervention assessments measuring content knowledge and comfort for each participant were performed. RESULTS Overall group participation was heterogeneous with groups participating a median of 54.5% of the weeks (range 0-100%). 22 residents completed the pre- and post-test assessments. The mean pre- and post-intervention assessment knowledge scores improved from 27.3% to 41.7% (p = 0.004). 70% of participants improved their test scores. The proportion of participants who reported comfort with ECG interpretation increased from 57.6% to 66.7% (p = 0.015). CONCLUSION This study demonstrates improvement in ECG interpretation through a team-based, asynchronous ECG competition approach. This method is easily scalable and could help to fill gaps in ECG learning. This approach can be delivered to other hospitals both in and outside Haiti. Further adaptations are needed to improve weekly group participation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Gene F Kwan
- Section of Cardiovascular Medicine, Boston University School of Medicine, 72 East Concord St, Boston, MA, D-808, USA.
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
- Partners In Health, Boston, MA, USA.
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Oh SY, Cook DA, Van Gerven PWM, Nicholson J, Fairbrother H, Smeenk FWJM, Pusic MV. Physician Training for Electrocardiogram Interpretation: A Systematic Review and Meta-Analysis. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:593-602. [PMID: 35086115 DOI: 10.1097/acm.0000000000004607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Using electrocardiogram (ECG) interpretation as an example of a widely taught diagnostic skill, the authors conducted a systematic review and meta-analysis to demonstrate how research evidence on instruction in diagnosis can be synthesized to facilitate improvement of educational activities (instructional modalities, instructional methods, and interpretation approaches), guide the content and specificity of such activities, and provide direction for research. METHOD The authors searched PubMed/MEDLINE, Embase, Cochrane CENTRAL, PsycInfo, CINAHL, ERIC, and Web of Science databases through February 21, 2020, for empirical investigations of ECG interpretation training enrolling medical students, residents, or practicing physicians. They appraised study quality with the Medical Education Research Study Quality Instrument and pooled standardized mean differences (SMDs) using random effects meta-analysis. RESULTS Of 1,002 articles identified, 59 were included (enrolling 17,251 participants). Among 10 studies comparing instructional modalities, 8 compared computer-assisted and face-to-face instruction, with pooled SMD 0.23 (95% CI, 0.09, 0.36) indicating a small, statistically significant difference favoring computer-assisted instruction. Among 19 studies comparing instructional methods, 5 evaluated individual versus group training (pooled SMD -0.35 favoring group study [95% CI, -0.06, -0.63]), 4 evaluated peer-led versus faculty-led instruction (pooled SMD 0.38 favoring peer instruction [95% CI, 0.01, 0.74]), and 4 evaluated contrasting ECG features (e.g., QRS width) from 2 or more diagnostic categories versus routine examination of features within a single ECG or diagnosis (pooled SMD 0.23 not significantly favoring contrasting features [95% CI, -0.30, 0.76]). Eight studies compared ECG interpretation approaches, with pooled SMD 0.92 (95% CI, 0.48, 1.37) indicating a large, statistically significant effect favoring more systematic interpretation approaches. CONCLUSIONS Some instructional interventions appear to improve learning in ECG interpretation; however, many evidence-based instructional strategies are insufficiently investigated. The findings may have implications for future research and design of training to improve skills in ECG interpretation and other types of visual diagnosis.
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Affiliation(s)
- So-Young Oh
- S.-Y. Oh is assistant director, Program for Digital Learning, Institute for Innovations in Medical Education, NYU Grossman School of Medicine, NYU Langone Health, New York, New York; ORCID: https://orcid.org/0000-0002-4640-3695
| | - David A Cook
- D.A. Cook is professor of medicine and medical education, director of education science, Office of Applied Scholarship and Education Science, research chair, Mayo Clinic Rochester Multidisciplinary Simulation Center, and consultant, Division of General Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-2383-4633
| | - Pascal W M Van Gerven
- P.W.M. Van Gerven is associate professor, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; ORCID: https://orcid.org/0000-0002-8363-2534
| | - Joseph Nicholson
- J. Nicholson is director, NYU Health Sciences Library, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Hilary Fairbrother
- H. Fairbrother is associate professor, Department of Emergency Medicine, Memorial Hermann-Texas Medical Center, Houston, Texas
| | - Frank W J M Smeenk
- F.W.J.M. Smeenk is professor, Department of Educational Development and Research, Maastricht University, Maastricht, and respiratory specialist, Catharina Hospital, Eindhoven, The Netherlands
| | - Martin V Pusic
- M.V. Pusic is associate professor of pediatrics and associate professor of emergency medicine, Harvard Medical School, Boston, Massachusetts; ORCID: https://orcid.org/0000-0001-5236-6598
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Cook DA, Oh SY, Pusic MV. Assessments of Physicians' Electrocardiogram Interpretation Skill: A Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:603-615. [PMID: 33913438 DOI: 10.1097/acm.0000000000004140] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE To identify features of instruments, test procedures, study design, and validity evidence in published studies of electrocardiogram (ECG) skill assessments. METHOD The authors conducted a systematic review, searching MEDLINE, Embase, Cochrane CENTRAL, PsycINFO, CINAHL, ERIC, and Web of Science databases in February 2020 for studies that assessed the ECG interpretation skill of physicians or medical students. Two authors independently screened articles for inclusion and extracted information on test features, study design, risk of bias, and validity evidence. RESULTS The authors found 85 eligible studies. Participants included medical students (42 studies), postgraduate physicians (48 studies), and practicing physicians (13 studies). ECG selection criteria were infrequently reported: 25 studies (29%) selected single-diagnosis or straightforward ECGs; 5 (6%) selected complex cases. ECGs were selected by generalists (15 studies [18%]), cardiologists (10 studies [12%]), or unspecified experts (4 studies [5%]). The median number of ECGs per test was 10. The scoring rubric was defined by 2 or more experts in 32 studies (38%), by 1 expert in 5 (6%), and using clinical data in 5 (6%). Scoring was performed by a human rater in 34 studies (40%) and by computer in 7 (8%). Study methods were appraised as low risk of selection bias in 16 studies (19%), participant flow bias in 59 (69%), instrument conduct and scoring bias in 20 (24%), and applicability problems in 56 (66%). Evidence of test score validity was reported infrequently, namely evidence of content (39 studies [46%]), internal structure (11 [13%]), relations with other variables (10 [12%]), response process (2 [2%]), and consequences (3 [4%]). CONCLUSIONS ECG interpretation skill assessments consist of idiosyncratic instruments that are too short, composed of items of obscure provenance, with incompletely specified answers, graded by individuals with underreported credentials, yielding scores with limited interpretability. The authors suggest several best practices.
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Affiliation(s)
- David A Cook
- D.A. Cook is professor of medicine and medical education, director of education science, Office of Applied Scholarship and Education Science, research chair, Mayo Clinic Rochester Multidisciplinary Simulation Center, and consultant, Division of General Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-2383-4633
| | - So-Young Oh
- S.-Y. Oh is assistant director, Program for Digital Learning, Institute for Innovations in Medical Education, NYU Grossman School of Medicine, NYU Langone Health, New York, New York; ORCID: https://orcid.org/0000-0002-4640-3695
| | - Martin V Pusic
- M.V. Pusic is associate professor of emergency medicine and pediatrics, Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York; ORCID: https://orcid.org/0000-0001-5236-6598
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Ko Y, Issenberg SB, Roh YS. Effects of peer learning on nursing students' learning outcomes in electrocardiogram education. NURSE EDUCATION TODAY 2022; 108:105182. [PMID: 34741917 DOI: 10.1016/j.nedt.2021.105182] [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: 06/14/2021] [Revised: 10/04/2021] [Accepted: 10/18/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Nurses should have the ability to interpret electrocardiograms (ECGs) quickly and accurately, but their ECG interpretation skills may be suboptimal. The best evidence for effective teaching methods is lacking. OBJECTIVES This study aimed to compare the effects of peer and self-directed individual learning methods on nursing students' learning flow, interpretation skills, and self-confidence in web-based ECG education. DESIGN This study employed a nonequivalent control group with a pretest-posttest design. SETTINGS This study was conducted at two colleges of nursing in the Republic of Korea. PARTICIPANTS Nursing students were conveniently assigned to either a peer learning group (n = 45) or a self-directed individual learning group (n = 51). METHODS A self-administered questionnaire was used to measure the nursing students' learning flow and self-confidence in ECG rhythm interpretation. ECG interpretation skills were measured using a web-based interpretation skills test. Data were analyzed using a paired t-test and a two-sample t-test. RESULTS Nursing students in both groups showed improved learning flow, interpretation skills, and self-confidence after ECG education compared with before learning. However, there were no significant pretest-posttest differences in learning flow, interpretation skills, or self-confidence between the two groups. CONCLUSIONS Peer learning was as effective as self-directed individual learning in improving nursing students' learning flow, interpretations skills, and self-confidence in web-based education. Nurse educators should educate nursing students to have optimal ECG interpretation abilities, and web-based peer or individual learning are effective education methods.
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Affiliation(s)
- Youngmin Ko
- Graduate School of Nursing and Health Professions, Chung-Ang University, Seoul, Republic of Korea
| | | | - Young Sook Roh
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro Dongjak-gu, Seoul 06974, Republic of Korea.
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Asukile MT, Viljoen CA, Lee Pan E, Eastman R, Tucker LM. Evaluating the Efficacy of an Online Learning Tool for EEG Teaching: A Prospective Cohort Study. Neurology 2021; 98:e164-e173. [PMID: 34675104 DOI: 10.1212/wnl.0000000000012996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 10/14/2021] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo determine the effectiveness of a 6-month, interactive, multi-modal, web-based EEG teaching program (EEGonline) in improving EEG analysis and interpretation skills for neurologists, neurology residents and technologists, particularly in resource-limited settings.MethodsBetween June 2017 and November 2018, 179 learners originating from 20 African countries, Europe and USA were registered on the EEGonline course. Of these, 128 learners (91% African) participated in the study. Pre- and post-course multiple-choice-question (MCQ) test results and EEGonline user logs were analyzed. Differences in pre- and post-test performance were correlated with quantified exposure to various EEGonline learning modalities. Participants' impressions of EEGonline efficacy and usefulness were assessed through pre- and post-course satisfaction surveys.ResultsNinety-one participants attempted both pre- and post-course tests (71% response rate). Mean scores improved from 46.7% ±17.6% to 64.1% ±18% respectively (p<0.001, Cohen's d 0.974). The largest improvement was in correct identification of normal features (43.2% to 59.1%, p<0.001, Cohen's d 0.664) and artifacts (43.3% to 61.6%, p<0.001, Cohen's d 0.836). Improvement in knowledge was associated with improved subjective confidence in EEG analysis. Overall confidence among post-course survey respondents improved significantly from 35.9% to 81.9% (p<0.001). Lecture notes, self-assessment quizzes and discussion forums were the most utilised learning modalities. The majority of survey respondents (97.2%) concluded that EEGonline was a useful learning tool and 93% recommended that similar courses should be included in EEG training curricula.ConclusionsThis study demonstrated that a multi-modal, online EEG teaching tool was effective in improving EEG analysis and interpretation skills and may be useful in resource-poor settings.
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Affiliation(s)
- Melody Tunsubilege Asukile
- Division of Neurology, Department of Medicine, University of Cape Town/ Groote Schuur Hospital, Cape Town, South Africa
| | - Charle A Viljoen
- Division of Cardiology, Department of Medicine, University of Cape Town/ Groote Schuur Hospital, Cape Town, South Africa
| | - Edward Lee Pan
- Division of Neurology, Department of Medicine, University of Cape Town/ Groote Schuur Hospital, Cape Town, South Africa
| | - Roland Eastman
- Division of Neurology, Department of Medicine, University of Cape Town/ Groote Schuur Hospital, Cape Town, South Africa
| | - Lawrence Maskew Tucker
- Division of Neurology, Department of Medicine, University of Cape Town/ Groote Schuur Hospital, Cape Town, South Africa
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Sormunen M, Heikkilä A, Salminen L, Vauhkonen A, Saaranen T. Learning Outcomes of Digital Learning Interventions in Higher Education: A Scoping Review. Comput Inform Nurs 2021; 40:154-164. [PMID: 34347644 DOI: 10.1097/cin.0000000000000797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Implementing digital technologies has become a policy priority worldwide among all types of education. The COVID-19 pandemic has further accelerated educational institutions' efforts to reorganize their teaching and introduce new digital learning technologies. Although using digital technologies in higher education, including nursing, is considered a modern and innovative way of teaching and learning, uncertainty exists concerning these technologies' actual usefulness in achieving positive learning outcomes. The aim of this scoping review was to examine the current evidence related to the effects of using digital technologies on learning outcomes in higher education. The authors searched five electronic databases for relevant studies and used a scoping review method to analyze and synthesize the evidence. Eighty-six articles from six disciplines met the selection criteria. As a key finding, the outcomes of the interventions were mainly positive. Increased professional knowledge, skills, and attitudes reflect the advancement of professional competence. Academic, collaborative, and study skills, in turn, contribute to general competence development. Our findings suggest that digital technology has the potential to improve learning in various disciplines.
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Affiliation(s)
- Marjorita Sormunen
- Author Affiliations: Faculty of Health Sciences, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio (Dr Sormunen); Faculty of Medicine, Department of Nursing Science, University of Turku, and Director of Nursing Excellence, Hospital District of Southwest Finland, Turku (Dr Heikkilä); Faculty of Medicine, Department of Nursing Science, University of Turku, Turku University Hospital, Turku (Dr Salminen); and Faculty of Health Sciences, Department of Nursing Science, University of Eastern Finland, Kuopio (Drs Vauhkonen and Saaranen)
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Sormunen M, Saaranen T, Heikkilä A, Sjögren T, Koskinen C, Mikkonen K, Kääriäinen M, Koivula M, Salminen L. Digital Learning Interventions in Higher Education: A Scoping Review. Comput Inform Nurs 2021; 38:613-624. [PMID: 32520782 DOI: 10.1097/cin.0000000000000645] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This scoping review was undertaken to synthesize and describe research related to digital learning interventions in higher education, focusing on technological outcomes. Five electronic databases were searched, and 86 articles were included in the review. The data related to positive and negative technological outcomes and authors' suggestions were analyzed using inductive content analysis. The articles represented six disciplines across six continents and included quantitative (n = 65), qualitative (n = 3), and mixed-methods (n = 18) intervention studies. For positive technological outcomes, digital formats of learning were considered effective and participatory forms of learning in a majority of the articles. The students appreciated individualized and self-paced learning, and the digital form increased their motivation to learn. Automatized technical solutions that enabled learning and teaching had several advantages, and digital learning was believed to save the resources of students, teachers, and organizations. For negative technological outcomes, the technical difficulties in using the digital devices or platforms were described the most, and a need for resources was identified. Feedback from teachers was considered important from positive and negative viewpoints. Authors' suggestions for future digital teaching and learning as well as related interventions consisted of various activities, resources, environments, and methods.
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Affiliation(s)
- Marjorita Sormunen
- Author Affiliations: Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio (Drs Sormunen and Saaranen); Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio (Dr Sormunen); Department of Nursing Science, Faculty of Medicine, University of Turku (Drs Heikkilä and Salminen); Faculty of Sport and Health Sciences, University of Jyväskylä (Dr Sjögren); University of Stavanger, Faculty of Health Science, Department of Caring and Ethics and Åbo Akademi, Faculty of Pedagogy and Welfare Studies, Department of Caring Science, Turku (Dr Koskinen); Research Unit of Nursing Science and Health Management, University of Oulu (Drs Mikkonen and Kääriäinen); Medical Research Center Oulu, Oulu University Hospital and University of Oulu, and The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence, Helsinki (Dr Kääriäinen); and Faculty of Social Sciences, University of Tampere (Dr Koivula), Finland
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Viljoen CA, Millar RS, Manning K, Burch VC. Effectiveness of blended learning versus lectures alone on ECG analysis and interpretation by medical students. BMC MEDICAL EDUCATION 2020; 20:488. [PMID: 33272253 PMCID: PMC7713171 DOI: 10.1186/s12909-020-02403-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 11/24/2020] [Indexed: 05/29/2023]
Abstract
BACKGROUND Most medical students lack confidence and are unable to accurately interpret ECGs. Thus, better methods of ECG instruction are being sought. Current literature indicates that the use of e-learning for ECG analysis and interpretation skills (ECG competence) is not superior to lecture-based teaching. We aimed to assess whether blended learning (lectures supplemented with the use of a web application) resulted in better acquisition and retention of ECG competence in medical students, compared to conventional teaching (lectures alone). METHODS Two cohorts of fourth-year medical students were studied prospectively. The conventional teaching cohort (n = 67) attended 4 hours of interactive lectures, covering the basic principles of Electrocardiography, waveform abnormalities and arrhythmias. In addition to attending the same lectures, the blended learning cohort (n = 64) used a web application that facilitated deliberate practice of systematic ECG analysis and interpretation, with immediate feedback. All participants completed three tests: pre-intervention (assessing baseline ECG competence at start of clinical clerkship), immediate post-intervention (assessing acquisition of ECG competence at end of six-week clinical clerkship) and delayed post-intervention (assessing retention of ECG competence 6 months after clinical clerkship, without any further ECG training). Diagnostic accuracy and uncertainty were assessed in each test. RESULTS The pre-intervention test scores were similar for blended learning and conventional teaching cohorts (mean 31.02 ± 13.19% versus 31.23 ± 11.52% respectively, p = 0.917). While all students demonstrated meaningful improvement in ECG competence after teaching, blended learning was associated with significantly better scores, compared to conventional teaching, in immediate (75.27 ± 16.22% vs 50.27 ± 17.10%, p < 0.001; Cohen's d = 1.58), and delayed post-intervention tests (57.70 ± 18.54% vs 37.63 ± 16.35%, p < 0.001; Cohen's d = 1.25). Although diagnostic uncertainty decreased after ECG training in both cohorts, blended learning was associated with better confidence in ECG analysis and interpretation. CONCLUSION Blended learning achieved significantly better levels of ECG competence and confidence amongst medical students than conventional ECG teaching did. Although medical students underwent significant attrition of ECG competence without ongoing training, blended learning also resulted in better retention of ECG competence than conventional teaching. Web applications encouraging a stepwise approach to ECG analysis and enabling deliberate practice with feedback may, therefore, be a useful adjunct to lectures for teaching Electrocardiography.
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Affiliation(s)
- Charle André Viljoen
- Division of Cardiology, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, 7925, South Africa.
- Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, 7925, South Africa.
- Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, 7925, South Africa.
| | - Rob Scott Millar
- Division of Cardiology, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, 7925, South Africa
- Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - Kathryn Manning
- Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - Vanessa Celeste Burch
- Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, 7925, South Africa
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Viljoen CA, Millar RS, Manning K, Burch VC. Determining electrocardiography training priorities for medical students using a modified Delphi method. BMC MEDICAL EDUCATION 2020; 20:431. [PMID: 33198726 PMCID: PMC7670661 DOI: 10.1186/s12909-020-02354-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/02/2020] [Indexed: 05/02/2023]
Abstract
BACKGROUND Although electrocardiography is considered a core learning outcome for medical students, there is currently little curricular guidance for undergraduate ECG training. Owing to the absence of expert consensus on undergraduate ECG teaching, curricular content is subject to individual opinion. The aim of this modified Delphi study was to establish expert consensus amongst content and context experts on an ECG curriculum for medical students. METHODS The Delphi technique, an established method of obtaining consensus, was used to develop an undergraduate ECG curriculum. Specialists involved in ECG teaching were invited to complete three rounds of online surveys. An undergraduate ECG curriculum was formulated from the topics of ECG instruction for which consensus (i.e. ≥75% agreement) was achieved. RESULTS The panellists (n = 131) had a wide range of expertise (42.8% Internal Medicine, 22.9% Cardiology, 16% Family Medicine, 13.7% Emergency Medicine and 4.6% Health Professions Education). Topics that reached consensus to be included in the undergraduate ECG curriculum were classified under technical aspects of performing ECGs, basic ECG analysis, recognition of the normal ECG and abnormal rhythms and waveforms and using electrocardiography as part of a clinical diagnosis. This study emphasises that ECG teaching should be framed within the clinical context. Course conveners should not overload students with complex and voluminous content, but rather focus on commonly encountered and life-threatening conditions, where accurate diagnosis impacts on patient outcome. A list of 23 "must know" ECG diagnoses is therefore proposed. CONCLUSION A multidisciplinary expert panel reached consensus on the ECG training priorities for medical students.
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Affiliation(s)
- Charle André Viljoen
- Division of Cardiology, Groote Schuur Hospital, University of Cape Town, Observatory, Cape Town, 7925, South Africa.
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, Observatory, Cape Town, 7925, South Africa.
- Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Observatory, Cape Town, 7925, South Africa.
| | - Rob Scott Millar
- Division of Cardiology, Groote Schuur Hospital, University of Cape Town, Observatory, Cape Town, 7925, South Africa
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - Kathryn Manning
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - Vanessa Celeste Burch
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, Observatory, Cape Town, 7925, South Africa
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Cook DA, Oh SY, Pusic MV. Accuracy of Physicians' Electrocardiogram Interpretations: A Systematic Review and Meta-analysis. JAMA Intern Med 2020; 180:1461-1471. [PMID: 32986084 PMCID: PMC7522782 DOI: 10.1001/jamainternmed.2020.3989] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IMPORTANCE The electrocardiogram (ECG) is the most common cardiovascular diagnostic test. Physicians' skill in ECG interpretation is incompletely understood. OBJECTIVES To identify and summarize published research on the accuracy of physicians' ECG interpretations. DATA SOURCES A search of PubMed/MEDLINE, Embase, Cochrane CENTRAL (Central Register of Controlled Trials), PsycINFO, CINAHL (Cumulative Index to Nursing and Allied Health), ERIC (Education Resources Information Center), and Web of Science was conducted for articles published from database inception to February 21, 2020. STUDY SELECTION Of 1138 articles initially identified, 78 studies that assessed the accuracy of physicians' or medical students' ECG interpretations in a test setting were selected. DATA EXTRACTION AND SYNTHESIS Data on study purpose, participants, assessment features, and outcomes were abstracted, and methodological quality was appraised with the Medical Education Research Study Quality Instrument. Results were pooled using random-effects meta-analysis. MAIN OUTCOMES AND MEASURES Accuracy of ECG interpretation. RESULTS Of 1138 studies initially identified, 78 assessed the accuracy of ECG interpretation. Across all training levels, the median accuracy was 54% (interquartile range [IQR], 40%-66%; n = 62 studies) on pretraining assessments and 67% (IQR, 55%-77%; n = 47 studies) on posttraining assessments. Accuracy varied widely across studies. The pooled accuracy for pretraining assessments was 42.0% (95% CI, 34.3%-49.6%; n = 24 studies; I2 = 99%) for medical students, 55.8% (95% CI, 48.1%-63.6%; n = 37 studies; I2 = 96%) for residents, 68.5% (95% CI, 57.6%-79.5%; n = 10 studies; I2 = 86%) for practicing physicians, and 74.9% (95% CI, 63.2%-86.7%; n = 8 studies; I2 = 22%) for cardiologists. CONCLUSIONS AND RELEVANCE Physicians at all training levels had deficiencies in ECG interpretation, even after educational interventions. Improved education across the practice continuum appears warranted. Wide variation in outcomes could reflect real differences in training or skill or differences in assessment design.
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Affiliation(s)
- David A Cook
- Office of Applied Scholarship and Education Science and Division of General Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - So-Young Oh
- Institute for Innovations in Medical Education, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Martin V Pusic
- Department of Emergency Medicine, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
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The effectiveness of a nationwide interactive ECG teaching workshop for UK medical students. J Electrocardiol 2020; 58:74-79. [DOI: 10.1016/j.jelectrocard.2019.11.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/16/2019] [Accepted: 11/19/2019] [Indexed: 11/20/2022]
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Bube S, Dagnaes-Hansen J, Mahmood O, Rohrsted M, Bjerrum F, Salling L, Hansen RB, Konge L. Simulation-based training for flexible cystoscopy – A randomized trial comparing two approaches. Heliyon 2020; 6:e03086. [PMID: 31922043 PMCID: PMC6948262 DOI: 10.1016/j.heliyon.2019.e03086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/29/2019] [Accepted: 12/17/2019] [Indexed: 01/16/2023] Open
Abstract
Background Simulation-based training allows trainees to experiment during training and end-of-training tests could increase motivation and retention. The aim of this trial was to determine if a simulation-based training program including directed self-regulated learning and post-testing improved clinical outcomes compared to a traditional simulation-based training program. Methods A randomized trial was conducted involving 32 participants without prior experience in endoscopic procedures. The intervention group practiced independently in a simulation centre and got a post-test whereas the control group received traditional instructions and demonstrations before being allowed to practice. Three weeks after the intervention the participants performed cystoscopies on two consecutive patients. Clinical performance was assessed using a global rating scale (GRS) with established evidence of validity. Independent samples t-test, Cronbach's α, Pearson's r, and paired samples t-test were used for statistical analysis. Results Twenty-five participants performed two cystoscopies on patients. There was no significant difference between the two study groups with respect to mean GRS of performance (p = 0.63, 95 % CI; -2.4–3.9). The internal consistency of the global rating scale was high, Cronbach's α = 0.91. Participants from both study groups demonstrated significant improvement between the first and second clinical procedures (p = 0.004, 95 % CI, 0.8–3.5). Eight (32%) and 15 (60%) participants demonstrated adequate clinical skills in their first and second procedure, respectively. Conclusions No significant differences were found on the clinical transfer when comparing the two programs. Neither of our training programs was able to ensure consistent, competent performance on patients and this finding could serve as an important argument for simulation-based mastery learning where all training continues until a pre-defined level of proficiency is met. Trial registrations The trial was submitted before enrolment of participants to the Regional Scientific Ethics Committee of the Capital Region which established that ethical approval was not necessary (H-4-2014-122). The trial was registered at Clinicaltrials.gov (NCT02411747).
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Affiliation(s)
- Sarah Bube
- Department of Urology, Roskilde Hospital, Zealand University Hospital, University of Copenhagen, Zealand Region, Roskilde, Denmark
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, University of Copenhagen, Capital Region, Copenhagen, Denmark
- Corresponding author.
| | - Julia Dagnaes-Hansen
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, University of Copenhagen, Capital Region, Copenhagen, Denmark
- Department of Urology, Rigshospitalet, University of Copenhagen, Capital Region, Copenhagen, Denmark
| | - Oria Mahmood
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, University of Copenhagen, Capital Region, Copenhagen, Denmark
- Department of Anaesthesiology, Holbaek Hospital, Zealand Region, Holbaek, Denmark
| | - Malene Rohrsted
- Department of Urology, Rigshospitalet, University of Copenhagen, Capital Region, Copenhagen, Denmark
| | - Flemming Bjerrum
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, University of Copenhagen, Capital Region, Copenhagen, Denmark
- Department of Surgery, Herlev/Gentofte Hospital, University of Copenhagen, Capital Region, Copenhagen, Denmark
| | - Lisbeth Salling
- Department of Urology, Rigshospitalet, University of Copenhagen, Capital Region, Copenhagen, Denmark
| | - Rikke B. Hansen
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, University of Copenhagen, Capital Region, Copenhagen, Denmark
- Department of Urology, Herlev/Gentofte Hospital, University of Copenhagen, Capital Region, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, University of Copenhagen, Capital Region, Copenhagen, Denmark
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Patterson D, Resko S. Factors Associated With Knowledge Retention 3 Months After a Sexual Assault Forensic Examiner Blended Learning Course. JOURNAL OF FORENSIC NURSING 2020; 16:138-145. [PMID: 32732528 DOI: 10.1097/jfn.0000000000000293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION A blended learning continuing education course may appeal to busy healthcare professionals because the primary content can be learned online while an in-person component can hone clinical skills. The current study assessed knowledge retention in a sample of healthcare professionals who participated in a nationwide sexual assault forensic examiner blended learning course (12-week online course and 2-day in-person patient simulation). METHODS Participants' characteristics, motivation, and external barriers were collected through a precourse web-based survey. Participants' knowledge was assessed through pretests and posttests for 12 modules and a 3-month postcourse examination. Utilizing repeated measures analysis of variance, the study examined whether participants retained their knowledge at the 3-month follow-up point. Multiple linear regression was utilized to explore the factors associated with knowledge retention. RESULTS The results found a knowledge score from 77.92% to 68.83% correct. The findings indicate that participants who were interested in the blended learning course because of the 2-day patient simulation were more likely to retain knowledge. Learners with more years of experience also had slightly higher knowledge retention. Conversely, participants who were interested in becoming a sexual assault forensic examiner because of a sexual assault experience had lower knowledge retention. Participation in a past online course also was associated with a reduction in knowledge retention. DISCUSSION The findings indicate a modest knowledge loss 3 months after the blended learning course. Still, some participants experienced less knowledge retention than others. Postcourse activities such as a brief refresher course may be useful to help these participants maintain their knowledge gains.
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Affiliation(s)
- Debra Patterson
- Author Affiliations: School of Social Work, Wayne State University
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Kashou A, May A, DeSimone C, Noseworthy P. The essential skill of ECG interpretation: How do we define and improve competency? Postgrad Med J 2019; 96:125-127. [PMID: 31874907 DOI: 10.1136/postgradmedj-2019-137191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/14/2019] [Accepted: 12/16/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Anthony Kashou
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Adam May
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Peter Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Viljoen CA, Scott Millar R, Engel ME, Shelton M, Burch V. Is computer-assisted instruction more effective than other educational methods in achieving ECG competence amongst medical students and residents? A systematic review and meta-analysis. BMJ Open 2019; 9:e028800. [PMID: 31740464 PMCID: PMC6886915 DOI: 10.1136/bmjopen-2018-028800] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES It remains unclear whether computer-assisted instruction (CAI) is more effective than other teaching methods in acquiring and retaining ECG competence among medical students and residents. DESIGN This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES Electronic literature searches of PubMed, databases via EBSCOhost, Scopus, Web of Science, Google Scholar and grey literature were conducted on 28 November 2017. We subsequently reviewed the citation indexes for articles identified by the search. ELIGIBILITY CRITERIA Studies were included if a comparative research design was used to evaluate the efficacy of CAI versus other methods of ECG instruction, as determined by the acquisition and/or retention of ECG competence of medical students and/or residents. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data from all eligible studies and assessed the risk of bias. After duplicates were removed, 559 papers were screened. Thirteen studies met the eligibility criteria. Eight studies reported sufficient data to be included in the meta-analysis. RESULTS In all studies, CAI was compared with face-to-face ECG instruction. There was a wide range of computer-assisted and face-to-face teaching methods. Overall, the meta-analysis found no significant difference in acquired ECG competence between those who received computer-assisted or face-to-face instruction. However, subanalyses showed that CAI in a blended learning context was better than face-to-face teaching alone, especially if trainees had unlimited access to teaching materials and/or deliberate practice with feedback. There was no conclusive evidence that CAI was better than face-to-face teaching for longer-term retention of ECG competence. CONCLUSION CAI was not better than face-to-face ECG teaching. However, this meta-analysis was constrained by significant heterogeneity amongst studies. Nevertheless, the finding that blended learning is more effective than face-to-face ECG teaching is important in the era of increased implementation of e-learning. PROSPERO REGISTRATION NUMBER CRD42017067054.
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Affiliation(s)
| | | | - Mark E Engel
- Medicine, Unversity of Cape Town, Cape Town, South Africa
| | - Mary Shelton
- Health Sciences Library, University of Cape Town, Cape Town, South Africa
| | - Vanessa Burch
- Medicine, Unversity of Cape Town, Cape Town, South Africa
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Habibzadeh H, Rahmani A, Rahimi B, Rezai SA, Aghakhani N, Hosseinzadegan F. Comparative study of virtual and traditional teaching methods on the interpretation of cardiac dysrhythmia in nursing students. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2019; 8:202. [PMID: 31807592 PMCID: PMC6852378 DOI: 10.4103/jehp.jehp_34_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 06/16/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Due to the importance of correct interpretation of electrocardiogram (ECG) in the quality of healthcare delivery, new educational methods are increasingly being implemented and evaluated. In this regard, the purpose of this study was to compare the traditional and virtual teaching methods on the interpretation of cardiac dysrhythmia in nursing students. METHODS The present study is a quasi-experimental research with pretest and posttest design. Sixty nursing students in the seventh semester from schools of nursing in Urmia and Khoy cities were randomly assigned to two virtual and traditional education groups. Students' knowledge was measured by a researcher-made 30-item test. RESULTS The mean and standard deviation of the students' scores in the traditional education group was 11.20 ± 4.41 and 14.40 ± 4.62 and in the virtual group was 11.30 ± 2.74 and 18.43 ± 4.68, pre- and post-training, respectively. Paired t-test showed a significant difference between the mean score of pretest and posttest in both types of training (P < 0.001). According to the results of independent sample t-test, there were no significant differences between the two groups before the training (P > 0.05). However, in the posttraining period, there were significant differences between traditional and virtual education groups (P < 0.001). CONCLUSION Considering the results of this study, which shows the positive effects of virtual education method on nursing students' knowledge about cardiac dysrhythmia, this method can be used as an alternative or complementary method to the traditional education.
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Affiliation(s)
- Hosein Habibzadeh
- Department of Nursing, Urmia University of Medical Sciences, Urmia, Iran
| | - Alireza Rahmani
- Department of Nursing, Urmia University of Medical Sciences, Urmia, Iran
| | - Bahlol Rahimi
- Department of Health Information Technology, Urmia University of Medical Sciences, Urmia, Iran
| | | | - Nader Aghakhani
- Department of Nursing, Urmia University of Medical Sciences, Urmia, Iran
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Boutis K, Pecaric M, Carrière B, Stimec J, Willan A, Chan J, Pusic M. The effect of testing and feedback on the forgetting curves for radiograph interpretation skills. MEDICAL TEACHER 2019; 41:756-764. [PMID: 31046500 DOI: 10.1080/0142159x.2019.1570098] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Objectives: Forgetting curves plot skill decay over time. After exposure to a simulation-based radiograph interpretation learning system, we determined the rate of learning decay and how this was impacted by testing (with and without feedback). Further, we examined the association of initial learning parameters on the forgetting curve. Methods: This was a multicenter, four-arm randomized control trial. Medical trainees completed 80 elbow radiographs and a 20-case post-test. Group 1 had no testing until 12 months; Groups 2-4 had testing every 2 months until 12 months. At 6 months, Group 3 testing was feedback-enhanced, while Group 4 had feedback-enhanced testing at 2, 6, and 10 months. Results: There were 106 participants (n = 42 Group 1; n = 22 Groups 2 and 3; n = 20 Group 4). Group 1 showed an -8.1% learning decay at 12-months relative to other groups. In Groups 2, 3, and 4, there was no significant learning decay (+0.8%), and there were no differences in skill decay between these groups. Initial score and learning curve slope were predictive of retained skill. Conclusions: Learning decay was mitigated by exposure to 20 test cases (with and without feedback) every two months. Initial learning parameters predicted learning retention and may inform refresher education scheduling.
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Affiliation(s)
- Kathy Boutis
- a Department of Pediatrics, Division of Emergency Medicine , Hospital for Sick Children and the University of Toronto , Toronto , Canada
| | | | - Benoit Carrière
- c Department of Pediatrics, Division of Emergency Medicine , CHU Sainte-Justine and Université de Montréal , Montreal , Canada
| | - Jennifer Stimec
- d Department of Diagnostic Imaging , Hospital for Sick Children and the University of Toronto , Toronto , Canada
| | - Andrew Willan
- e Hospital for Sick Children , Research Institute, University of Toronto , Toronto , Canada
- f Dalla Lana School of Public Health, University of Toronto , Toronto , Canada
| | - Julie Chan
- g Department of Surgery, Division of Orthopedic Surgery , Queen's University , Kingston , Canada
| | - Martin Pusic
- h Department of Emergency Medicine, Division of Learning Analytics , NYU School of Medicine , New York , NY , USA
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Breen CJ, Kelly GP, Kernohan WG. ECG interpretation skill acquisition: A review of learning, teaching and assessment. J Electrocardiol 2019; 73:125-128. [PMID: 31005264 DOI: 10.1016/j.jelectrocard.2019.03.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/09/2018] [Accepted: 03/14/2019] [Indexed: 01/19/2023]
Abstract
The recording of 12 lead electrocardiograms (ECG) is one of the most useful and commonly performed medical procedures. ECGs are used in diagnosis, risk-stratification management decision-making, and assessment in response to therapy. The correct interpretation of 12 lead ECG recordings is complex and clinically challenging with misinterpretation having the potential to result in poor outcomes or even patient fatality. Despite its widespread use, several studies have highlighted deficiencies in ECG interpretation skills among health professionals. The literature suggests that up to 33% of ECG interpretations have some error when compared to the expert reference and up to 11% resulted in inappropriate management. The pedagogy of ECG interpretation lacks universal establishment; time allocation, faculty training and teaching format vary considerably within the literature. This review of the literature reports how a lack of established ECG reporting methods may contribute to the variation in reported ECG interpretation competence across many healthcare professionals. The ubiquity of the ECG in clinical practice and an over reliance on computer assisted ECG interpretation are additionally explored as factors affecting acquisition and retention of this clinical skill.
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Affiliation(s)
- C J Breen
- School of Health Sciences, Ulster University, Shore Road, Jordanstown Campus, BT37 0QB, United Kingdom of Great Britain and Northern Ireland; Institute of Nursing and Health Research, Ulster University, Shore Road, Jordanstown Campus, BT37 0QB, United Kingdom of Great Britain and Northern Ireland.
| | - G P Kelly
- School of Health Sciences, Ulster University, Shore Road, Jordanstown Campus, BT37 0QB, United Kingdom of Great Britain and Northern Ireland; Institute of Nursing and Health Research, Ulster University, Shore Road, Jordanstown Campus, BT37 0QB, United Kingdom of Great Britain and Northern Ireland
| | - W G Kernohan
- School of Nursing, Ulster University, Shore Road, Jordanstown Campus, BT37 0QB, United Kingdom of Great Britain and Northern Ireland; Institute of Nursing and Health Research, Ulster University, Shore Road, Jordanstown Campus, BT37 0QB, United Kingdom of Great Britain and Northern Ireland
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Berland N, Lugassy D, Fox A, Goldfeld K, Oh SY, Tofighi B, Hanley K. Use of online opioid overdose prevention training for first-year medical students: A comparative analysis of online versus in-person training. Subst Abus 2019; 40:240-246. [PMID: 30767715 DOI: 10.1080/08897077.2019.1572048] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: In response to the opioid epidemic and efforts to expand substance use education in medical school, the authors introduced opioid overdose prevention training (OOPT) with naloxone for all first-year medical students (MS1s) as an adjunct to required basic life support training (BLST). The authors previously demonstrated improved knowledge and preparedness following in-person OOPT with BLST; however, it remains unclear whether online-administered OOPT would produce comparable results. In this study, the authors perform a retrospective comparison of online-administered OOPT with in-person-administered OOPT. Objectives: To compare the educational outcomes: knowledge, preparedness, and attitudes, for online versus in-person OOPT. Methods: In-person OOPT was administered in 2014 and 2015 during BLST, whereas online OOPT was administered in 2016 during BLST pre-work. MS1s completed pre- and post-training tests covering 3 measures: knowledge (11-point scale), attitudes (66-point scale), and preparedness (60-point scale) to respond to an opioid overdose. Online scores from 2016 and in-person scores from 2015 were compared across all 3 measures using analysis of covariance (ANCOVA) methods. Results: After controlling for pre-test scores, there were statistical, but no meaningful, differences across all measures for in-person- and online-administered training. The estimated differences were knowledge: -0.05 (0.5%) points (95% confidence interval [CI]: -0.47, 0.36); attitudes: 0.65 (1.0%) points (95% CI: -0.22, 1.51); and preparedness: 2.16 (3.6%) points (95% CI: 1.04, 3.28). Conclusions: The educational outcomes of online-administered OOPT compared with in-person-administered OOPT were not meaningfully different. These results support the use of online-administered OOPT. As our study was retrospective, based on data collected over multiple years, further investigation is needed in a randomized controlled setting, to better understand the educational differences of in-person and online training. Further expanding OOPT to populations beyond medical students would further improve generalizability.
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Affiliation(s)
- Noah Berland
- Kings County Hospital, SUNY Downstate Medical Center , Brooklyn , New York , USA
| | - Daniel Lugassy
- Department of Emergency Medicine and Toxicology, New York University School of Medicine , New York , New York , USA
| | - Aaron Fox
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine , Bronx , New York , USA
| | - Keith Goldfeld
- Department of Population health, New York University School of Medicine , New York , New York , USA
| | - So-Young Oh
- Institute for Innovations in Medical Education, New York University School of Medicine , New York , New York , USA
| | - Babak Tofighi
- Department of Population health, New York University School of Medicine , New York , New York , USA
| | - Kathleen Hanley
- Department of Medicine, New York University School of Medicine , New York , New York , USA
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Rourke L, Leong J, Chatterly P. Conditions-Based Learning Theory as a Framework for Comparative-Effectiveness Reviews: A Worked Example. TEACHING AND LEARNING IN MEDICINE 2018; 30:386-394. [PMID: 29452002 DOI: 10.1080/10401334.2018.1428611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Phenomenon: An evidence-informed era of medical education encourages the generation and use of comparative-effectiveness reviews, yet the reviews often conclude, curiously, that all instructional approaches are equally effective. Approach: We used a conditions-based learning theory to structure a review of the comparative-effectiveness literature on electrocardiogram instruction. We searched MEDLINE, EMBASE (Ovid), ERIC (Ovid), PsycINFO (Ovid), and CINAHL (EBSCO) from inception to June 2016. We selected prospective studies that examined the effect of instructional interventions on participants' knowledge and skill with electrocardiogram interpretation. Two reviewers extracted information on the quality of the studies, the effect of instruction on the acquisition of knowledge and skill, and instructional quality. Instructional quality is an index of the extent to which instruction incorporates 4 practices of Gagne's conditions-based learning theory: presenting information, eliciting performance, providing feedback, and assessing learning. Findings: Twenty-five studies (3,286 participants) evaluating 47 instructional interventions were synthesized. The methodological quality of most studies was moderate. Instructional quality varied: All interventions presented information and assessed learning, but fewer than half elicited performances or provided feedback. Instructional interventions that incorporated all 4 components improved trainees' abilities considerably more than those that incorporated 3 or fewer; respectively, standardized mean difference (SMD) = 2.80, 95% confidence interval (CI) [2.05, 3.55], versus SMD = 1.44, 95% CI [1.18, 1.69]. Studies that compared "innovative" to "traditional" types of instruction did not yield a significant pooled effect: SMD = 0.18, 95% CI [-0.09, 0.45]. Insights: The use of a conditions-based learning theory to organize the comparative-effectiveness literature reveals differences in the instructional impact of different instructional approaches. It overturns the unlikely, but common, conclusion that all approaches are equally effective.
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Affiliation(s)
- Liam Rourke
- a Department of Medicine , University of Alberta , Edmonton Alberta , Canada
| | - Jessica Leong
- a Department of Medicine , University of Alberta , Edmonton Alberta , Canada
| | - Patricia Chatterly
- a Department of Medicine , University of Alberta , Edmonton Alberta , Canada
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Riding NR, Drezner JA. Performance of the BMJ learning training modules for ECG interpretation in athletes. Heart 2018; 104:2051-2057. [DOI: 10.1136/heartjnl-2018-313066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 06/09/2018] [Accepted: 06/11/2018] [Indexed: 11/04/2022] Open
Abstract
To assess the accuracy of interpreting the athlete’s ECG both pre and post a series of online training modules among a range of healthcare professionals. 10 512 healthcare professionals from 138 different nations commenced the online course. These were primarily doctors (43%), nurses (18.4%) and other healthcare professionals (3.9%). The users came from 102 different specialities, with General Practice/Family Medicine (24.5%), Cardiology (10.6%), Emergency Medicine (8.7%) and Sports Medicine (6.6%) predominating. Among the 2023 users who completed both the pre-course and post-course test, there was an overall improvement of 15.3% (95% CI 13.9% to 16.6%; p<0.001). 930 completed all four other modules, and these users fared significantly better (18.7% increase; 95% CI 17.3 to 20.0) than those completing no additional modules (11.7% increase; 95% CI 3.3 to 17.7, p=0.036). Demographic analysis showed that while the starting pre-test scores varied significantly between profession/specialty groups (57.8%–82.6%), post-test scores were largely consistent (80.8%–84.6%). Although users showed the most improvement when interpreting primary electrical diseases (12.4% increase), it was also an area of notable weakness compared with the modules of normal training-related findings and cardiomyopathies. With the evolving criteria for ECG interpretation eliciting ever improving levels of specificity and sensitivity in the detection of conditions associated with sudden cardiac death among athletes, training is required to ensure the infrastructure and personnel is in place to uphold these standards. The BMJ Learning course presented is a valuable first step and demonstrates that such an online tool can be effective in aiding ECG interpretation among healthcare professionals globally.
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Educational Software Applied in Teaching Electrocardiogram: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8203875. [PMID: 29736398 PMCID: PMC5875041 DOI: 10.1155/2018/8203875] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 12/17/2017] [Accepted: 01/21/2018] [Indexed: 11/17/2022]
Abstract
Background The electrocardiogram (ECG) is the most used diagnostic tool in medicine; in this sense, it is essential that medical undergraduates learn how to interpret it correctly while they are still on training. Naturally, they go through classic learning (e.g., lectures and speeches). However, they are not often efficiently trained in analyzing ECG results. In this regard, methodologies such as other educational support tools in medical practice, such as educational software, should be considered a valuable approach for medical training purposes. Methods We performed a literature review in six electronic databases, considering studies published before April 2017. The resulting set comprises 2,467 studies. From this collection, 12 studies have been selected, initially, whereby we carried out a snowballing process to identify other relevant studies through the reference lists of these studies, resulting in five relevant studies, making up a total of 17 articles that passed all stages and criteria. Results The results show that 52.9% of software types were tutorial and 58.8% were designed to be run locally on a computer. The subjects were discussed together with a greater focus on the teaching of electrophysiology and/or cardiac physiology, identifying patterns of ECG and/or arrhythmias. Conclusions We found positive results with the introduction of educational software for ECG teaching. However, there is a clear need for using higher quality research methodologies and the inclusion of appropriate controls, in order to obtain more precise conclusions about how beneficial the inclusion of such tools can be for the practices of ECG interpretation.
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Viljoen CA, Scott Millar R, Engel ME, Shelton M, Burch V. Is computer-assisted instruction more effective than other educational methods in achieving ECG competence among medical students and residents? Protocol for a systematic review and meta-analysis. BMJ Open 2017; 7:e018811. [PMID: 29282268 PMCID: PMC5988085 DOI: 10.1136/bmjopen-2017-018811] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Although ECG interpretation is an essential skill in clinical medicine, medical students and residents often lack ECG competence. Novel teaching methods are increasingly being implemented and investigated to improve ECG training. Computer-assisted instruction is one such method under investigation; however, its efficacy in achieving better ECG competence among medical students and residents remains uncertain. METHODS AND ANALYSIS This article describes the protocol for a systematic review and meta-analysis that will compare the effectiveness of computer-assisted instruction with other teaching methods used for the ECG training of medical students and residents. Only studies with a comparative research design will be considered. Articles will be searched for in electronic databases (PubMed, Scopus, Web of Science, Academic Search Premier, CINAHL, PsycINFO, Education Resources Information Center, Africa-Wide Information and Teacher Reference Center). In addition, we will review citation indexes and conduct a grey literature search. Data extraction will be done on articles that met the predefined eligibility criteria. A descriptive analysis of the different teaching modalities will be provided and their educational impact will be assessed in terms of effect size and the modified version of Kirkpatrick framework for the evaluation of educational interventions. This systematic review aims to provide evidence as to whether computer-assisted instruction is an effective teaching modality for ECG training. It is hoped that the information garnered from this systematic review will assist in future curricular development and improve ECG training. ETHICS AND DISSEMINATION As this research is a systematic review of published literature, ethical approval is not required. The results will be reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement and will be submitted to a peer-reviewed journal. The protocol and systematic review will be included in a PhD dissertation. PROSPERO REGISTRATION NUMBER CRD42017067054; Pre-results.
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Affiliation(s)
- Charle André Viljoen
- Division of Cardiology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Rob Scott Millar
- Division of Cardiology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Mark E Engel
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Mary Shelton
- Health Sciences Library, University of Cape Town, Cape Town, South Africa
| | - Vanessa Burch
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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Sandau KE, Funk M, Auerbach A, Barsness GW, Blum K, Cvach M, Lampert R, May JL, McDaniel GM, Perez MV, Sendelbach S, Sommargren CE, Wang PJ. Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association. Circulation 2017; 136:e273-e344. [DOI: 10.1161/cir.0000000000000527] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Kok EM, van Geel K, van Merriënboer JJG, Robben SGF. What We Do and Do Not Know about Teaching Medical Image Interpretation. Front Psychol 2017; 8:309. [PMID: 28316582 PMCID: PMC5334326 DOI: 10.3389/fpsyg.2017.00309] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/20/2017] [Indexed: 11/13/2022] Open
Abstract
Educators in medical image interpretation have difficulty finding scientific evidence as to how they should design their instruction. We review and comment on 81 papers that investigated instructional design in medical image interpretation. We distinguish between studies that evaluated complete offline courses and curricula, studies that evaluated e-learning modules, and studies that evaluated specific educational interventions. Twenty-three percent of all studies evaluated the implementation of complete courses or curricula, and 44% of the studies evaluated the implementation of e-learning modules. We argue that these studies have encouraging results but provide little information for educators: too many differences exist between conditions to unambiguously attribute the learning effects to specific instructional techniques. Moreover, concepts are not uniformly defined and methodological weaknesses further limit the usefulness of evidence provided by these studies. Thirty-two percent of the studies evaluated a specific interventional technique. We discuss three theoretical frameworks that informed these studies: diagnostic reasoning, cognitive schemas and study strategies. Research on diagnostic reasoning suggests teaching students to start with non-analytic reasoning and subsequently applying analytic reasoning, but little is known on how to train non-analytic reasoning. Research on cognitive schemas investigated activities that help the development of appropriate cognitive schemas. Finally, research on study strategies supports the effectiveness of practice testing, but more study strategies could be applicable to learning medical image interpretation. Our commentary highlights the value of evaluating specific instructional techniques, but further evidence is required to optimally inform educators in medical image interpretation.
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Affiliation(s)
- Ellen M Kok
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University Maastricht, Netherlands
| | - Koos van Geel
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University Maastricht, Netherlands
| | - Jeroen J G van Merriënboer
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University Maastricht, Netherlands
| | - Simon G F Robben
- Department of Radiology, Maastricht University Medical Centre Maastricht, Netherlands
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Hernández-Padilla JM, Granero-Molina J, Márquez-Hernández VV, Suthers F, López-Entrambasaguas OM, Fernández-Sola C. Design and validation of a three-instrument toolkit for the assessment of competence in electrocardiogram rhythm recognition. Eur J Cardiovasc Nurs 2017; 16:425-434. [DOI: 10.1177/1474515116687444] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - José Granero-Molina
- Nursing, Physiotherapy and Medicine Department, University of Almeria, Spain
- Faculty of Health Sciences, Universidad Autónoma de Chile, Chile
| | | | - Fiona Suthers
- Adult, Child and Midwifery Department, Middlesex University, UK
| | | | - Cayetano Fernández-Sola
- Nursing, Physiotherapy and Medicine Department, University of Almeria, Spain
- Faculty of Health Sciences, Universidad Autónoma de Chile, Chile
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Bayefsky SD, Shah HH, Jhaveri KD. Nephrology education for medical students: a narrative review. Ren Fail 2016; 38:1151-9. [PMID: 27197981 DOI: 10.1080/0886022x.2016.1185352] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Strategies used to teach nephrology to medical students are not well studied. This study assesses the published literature on medical student education in nephrology. METHODS A review of the published literature on nephrology education for medical students was conducted on two major online search engines (PubMed and ERIC). In addition, references of the manuscripts discovered in these searches were reviewed. The empirical studies were categorized by subject within nephrology and research design. RESULTS We found 26 original studies in which a method of teaching nephrology to medical students was described. The studies dated from 1977 to 2015. The focus of these nephrology teaching experiences was as follows: anatomy (6.5%), physiology (22.6%), pathophysiology (29.0%), pathology (6.5%), treatment (25.8%), and general nephrology (9.7%). The studies were also categorized into various types of research design. 6.9% had either no assessment of the educational experience or had a description too vague to categorize it; 3.4% involved a survey about the existing educational approach before a curriculum change was implemented; 55.2% used surveys or tests after an educational course was carried out; 10.3% sought feedback from students before and after the educational experience; 13.8% were case studies; and 10.3% included a randomized controlled trial. The randomized controlled trials involved teaching techniques focused on the pathophysiology of renal disease. CONCLUSIONS Rigor was lacking in most empirical studies on medical student education in nephrology. Well-designed randomized controlled studies are needed to accurately assess the effectiveness of the educational techniques introduced into medical school curricula.
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Affiliation(s)
| | - Hitesh H Shah
- a Hofstra Northwell School of Medicine , Hempstead , NY , USA ;,b Division of Kidney Diseases and Hypertension, Department of Medicine , North Shore University Hospital and Long Island Jewish Medical Center, Northwell Health , Great Neck , NY , USA
| | - Kenar D Jhaveri
- a Hofstra Northwell School of Medicine , Hempstead , NY , USA ;,b Division of Kidney Diseases and Hypertension, Department of Medicine , North Shore University Hospital and Long Island Jewish Medical Center, Northwell Health , Great Neck , NY , USA
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