Health professions learners' evaluation of e-learning scenario-based case study design: Reinvigorating flipped classroom modalities

OBJECTIVES

Interactive scenario-based learning (SBL) cases were developed using the SoftChalk platform to deliver content about patients' barriers to accessing healthcare and patient management strategies connecting oral to systemic health. The interactive cases were designed to engage the digital-savvy learners, meet them where they are by leveling up, and seek their feedback to determine flipped (FC) or modified flipped classroom (MFC) content delivery approaches.

METHODS

Health professions students completed interactive SBL cases (Phase-I) using either FC as assigning content outside of class time preparation or MFC as allocating time at the beginning of the class deliveries, and a 12-item post-completion survey. The senior dental student cohort (Phase-II) completed an anonymous Qualtrics survey that assessed their confidence leading to clinical competence two years after the interactive SBL case deliveries. The final survey (Phase-III) of first-year dental students evaluated the improved interactive scenario-based cases post modifications. [Corrections added on 03 October 2023: After first online publication the first sentence of methods section has been updated.] RESULTS: No significant differences existed between the FC and MFC content delivery scores; however, learners preferred the structured time allotted in the MFC approach as a learning style for participants (N=989). The overall means percent score was 93.2% (n = 398) for FC and 96.5% (n = 591) for MFC. Thematic analysis of written responses indicated that learners felt the vignettes were relevant, thought-provoking, incorporated decision-making, and provided feedback. Four themes about strengths emerged as engaging, interactive, relevant, and critical. Design and technological challenges emerged as interactive SBL improvements. A follow-up report (74/103, 2021) revealed that 48% of senior dental students surveyed recollected the SBL cases when they delivered preventive, patient-centered dental services as juniors and seniors. They also recalled that the interactive cases prepared them for clinical success. The Final comments (2022) did not commend any significant improvements.

CONCLUSION

Interactive scenario-based approaches nurture active learning and critical thinking. The educator can engage learners by incorporating teaching modalities as SBL cases to enhance their knowledge and create educational environments by meeting learners where they are. Learners can be valuable partners as educators define their instructional strategies to be equitable and student-centered. [Correction added on 04 October 2023: after first online publication, abstract section has been revised.].

Using Interprofessional Education to Promote Oral Health Literacy in a Faculty-Student Collaborative Practice

The aim of this study was to assess the oral health literacy knowledge gained by patients who are refugees, community members, and medical and nursing students after participating in an interprofessional education collaborative of students and faculty from the University of Texas Health San Antonio Schools of Dentistry, Medicine, and Nursing. In this faculty-student collaborative practice, all patients were triaged (including oral hygiene status and alcohol/tobacco use), and tailored treatment options were offered following assessment of their dental, medical, and social histories. The study was designed as a pre-post assessment of an educational intervention on oral health literacy. In the pretest, all groups were invited to respond to questionnaires assessing their knowledge of oral health. After participants engaged in oral hygiene instruction demonstrations and received information about an oral health literacy campaign, a posttest was conducted to assess knowledge gained. A total of 151 patients who were refugees, 38 medical students, 34 nursing students, and 17 community/parish members voluntarily participated in this initiative. Each group had a significant increase in mean oral health literacy score from pre- to posttest: patients 33.5%, community/parish members 22.3%, nursing students 20.8%, and medical students 13% (all p<0.0001). These results showed that the oral health literacy initiative helped increase all participants' oral health literacy and knowledge of preventive care.

Effect of ice on pain after corticosteroid injection in the hand and wrist: a randomized controlled trial

This prospective, randomized controlled study was designed to determine if applying ice to the site of corticosteroid injections in the hand and wrist reduces post-injection pain. Patients receiving corticosteroid injections in the hand or wrist at a tertiary institution were enrolled. Subjects were randomized to apply ice to the injection site and take scheduled over-the-counter analgesics ( n = 36) or take scheduled over-the-counter analgesics alone ( n = 32). There were no significant differences in the mean pain score between the two groups at any time-point (pre-injection or 1-5 days post-injection). In regression modelling, the application of ice did not predict pain after injection. Visual analogue pain scores increased at least 2 points (0-10 scale) after injection in 17 out of 36 patients in the ice group versus ten out of 32 control patients. We conclude that the application of ice in addition to over-the-counter analgesics does not reduce post-injection pain after corticosteroid injection in the hand or wrist.

LEVEL OF EVIDENCE

I Therapeutic Study.

Follicular mycosis fungoides: a histopathologic, immunohistochemical, and genotypic review

Follicular mycosis fungoides (FMF) is a recognized variant of mycosis fungoides. In this review, the authors characterize the distinct histopathological and immunohistochemical patterns of FMF that have been reported in the literature. This article is an extensive review of the literature cited in Medline and own data of the authors. The major patterns of FMF histopathology, immunohistochemistry, and molecular genetics are summarized in this review. Histologically, the quintessential finding in FMF is small to medium atypical CD3+ CD4+ CD8- T lymphocytes around and within the epithelium of the hair follicles. This finding is requisite to the diagnosis. However, this finding may be obscured by a host of other patterns often identified in FMF. This includes basaloid folliculo-lymphoid hyperplasia, a granulomatous reaction, eosinophilic folliculitis, and follicular cystic changes with subtle atypical lymphocytes in the cyst wall. Follicular mucinosis (MF) and syringo-tropism are also variably present. Immunohistochemistry of all reported cases uniformly show a CD4+ T cell infiltrate. This review emphasizes and discusses the broad spectrum of histologic changes which may be seen in FMF, clues to the diagnosis, and some potential mimickers.

Aggression in African-American boys: a discriminant analysis

The main purposes of this study were to determine whether familial variables found to be related to the development of aggressive behavior in Caucasian boys may also be related to similar aggressive patterns in inner-city African-American boys and to assess the relative importance of these variables for classifying the subject population into aggressive and nonaggressive groups. Discriminant analyses were performed using 83 African-American boys, with a mean age of 13.9 years, who were classified as institutionalized aggressive, noninstitutionalized aggressive, and noninstitutionalized nonaggressive subjects. Although the same father and mother variables were used in the analyses, the father variables were not related to group membership. Furthermore, the results showed that both groups of aggressive boys reported more aggression within as well as outside their family home settings than their nonaggressive counterparts. Socioeconomic-related factors such as employment status of parent(s), size of family, and number of parents in the household were not useful predictors of aggressive and nonaggressive group membership.

Aggression and paternal absence: racial-ethnic differences among inner-city boys

Aggression scores were obtained for 132 preadolescent inner-city males to test the hypothesis that paternal absence may differentially influence aggressive behavior. A statistically significant, two-way race by paternal absence interaction (p less than .01) indicated that, when compared to their racial-ethnic counterparts living with both parents, father-absent Puerto Ricans were equally as aggressive, father-absent blacks were less aggressive, and father-absent whites were more aggressive. Tentative interpretations of these findings were developed with a view to the demographic realities of an American inner-city.

Aggression and family size

The aggression displayed under controlled conditions by 56 inner-city Hispanic boys ages 7-8 was measured to test the hypothesis that S s from large families will display less antisocial aggression than S s from small families. The results indicate that aggression and family size were related in a linear manner: decreasing aggression was linked to increasing family size. These behavioral results may be, in part, the result of increased accelerated development of social skills within children living in large families.

Effects of fathers' absence and birth order on aggressive behavior of young male children

Aggression scores were obtained for 50 inner-city Hispanic males. An analysis of variance indicated a statistically significant interaction between birth order and number of parents in the household. Post hoc analysis indicated that last-born subjects reared in low-income families with fathers absent displayed more aggressive behavior than firstborn, middle-born, or last-born subjects in families with fathers present. Moreover, there was an indication that firstborn and middle-born subjects in families with fathers absent may be more aggressive than their counterparts in families with fathers present. These results suggest that birth order should be considered in studies of the behavior and personality development of males in father-absent families. Research designs should differentiate between last-born and middle-born siblings.

Test of the language-aggression hypothesis

This study tested the hypothesis that language is related to aggression in two ways: that relatively low levels of proficiency in the use of language should be associated with relatively high levels of observable aggression and that high levels of language proficiency should be associated with low levels of aggression. The vocabulary subtest of the Wechsler Intelligence Scale for Children (WISC), the Metropolitan Achievement Test in Reading, the total number of words spoken during a free speech session, and the number of different words used during that session constituted the language measures. Aggression of 132 subjects, ranging in age from 9 to 13 yr., was measured using an adaptation of the physical and verbal aggression categories used by Walters, Pearce, and Dahms (1957). The results supported both predictions for the comparisons between black subjects and Puerto Rican subjects but not for the white subjects.