Transformation and Articulation of Clinical Data to Understand Students' and Health Professionals' Clinical Reasoning: Protocol for a Scoping Review

BACKGROUND

There are still unanswered questions regarding effective educational strategies to promote the transformation and articulation of clinical data while teaching and learning clinical reasoning. Additionally, understanding how this process can be analyzed and assessed is crucial, particularly considering the rapid growth of natural language processing in artificial intelligence.

OBJECTIVE

The aim of this study is to map educational strategies to promote the transformation and articulation of clinical data among students and health care professionals and to explore the methods used to assess these individuals' transformation and articulation of clinical data.

METHODS

This scoping review follows the Joanna Briggs Institute framework for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist for the analysis. A literature search was performed in November 2022 using 5 databases: CINAHL (EBSCOhost), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), and Web of Science (Clarivate). The protocol was registered on the Open Science Framework in November 2023. The scoping review will follow the 9-step framework proposed by Peters and colleagues of the Joanna Briggs Institute. A data extraction form has been developed using key themes from the research questions.

RESULTS

After removing duplicates, the initial search yielded 6656 results, and study selection is underway. The extracted data will be qualitatively analyzed and presented in a diagrammatic or tabular form alongside a narrative summary. The review will be completed by February 2024.

CONCLUSIONS

By synthesizing the evidence on semantic transformation and articulation of clinical data during clinical reasoning education, this review aims to contribute to the refinement of educational strategies and assessment methods used in academic and continuing education programs. The insights gained from this review will help educators develop more effective semantic approaches for teaching or learning clinical reasoning, as opposed to fragmented, purely symptom-based or probabilistic approaches. Besides, the results may suggest some ways to address challenges related to the assessment of clinical reasoning and ensure that the assessment tasks accurately reflect learners' developing competencies and educational progress.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/50797.

Scoring Methods in Script Concordance Tests: An Exploratory Psychometric Study

BACKGROUND

Despite the increasingly popular role of script concordance test (SCT) scoring methods in the evaluation of clinical reasoning, studies examining these methods in nursing are relatively scarce. This study explored the psychometric properties of five SCT scoring methods.

METHOD

An SCT was administered to 12 experts and 43 learners. Scores were calculated using five methods and descriptive statistics. Differences in scores were assessed with the Mann-Whitney U test, and Spearman correlation coefficients were calculated for the different methods.

RESULTS

The median scores of both experts and learners differed substantially according to the scoring method used. Learners' scores were statistically different from experts' scores (p < .01) for each method. Spearman coefficients (range, 0.44 to 0.95) were positive for the different methods.

CONCLUSION

Further research is needed to refine the influence of SCT scoring methods for use in certifying assessment of clinical reasoning in nursing. [J Nurs Educ. 2023;62(10):549-555.].

Educational strategies used in master's and doctoral nursing education: A scoping review

BACKGROUND

Advanced practice nurses and future nursing researchers must be adequately educated with the best available evidence. However, we know little about educational strategies and their characteristics used explicitly to educate advanced practice nurses and future researchers.

METHOD

A scoping review was used to map the latest educational strategies used in master's and doctoral nursing education between 2011 and 2021. Components of educational strategies were extracted based on the Guideline for Reporting Evidence-Based Practice Educational Interventions and Teaching and the Saskatchewan Education Department Framework of Professional Practice. The New World Kirkpatrick Model was used to categorize the associated learning outcomes. A narrative description approach was used to synthesize the findings.

RESULTS

A total of 56 studies were included. Several information was missing regarding the theoretical foundations of the educational strategies. A total of 158 educational strategies were identified. Individual work (e.g., homework) was the most popular educational strategy. Most studies assessed learning outcomes related to reactions (e.g., satisfaction) or learning (e.g., knowledge).

CONCLUSION

More studies should be done using interactive instruction or multimodal approaches, while the authors should better describe intervention components. A systematic review of effectiveness needs to be conducted to evaluate the best educational strategies in the master's and doctoral nursing education.

Continuing professional development (CPD) system development, implementation, evaluation and sustainability for healthcare professionals in low- and lower-middle-income countries: a rapid scoping review

BACKGROUND

Policymakers and program developers in low-and lower-middle-income countries (LLMICs) are increasingly seeking evidence-based information and guidance on how to successfully develop and implement continuing professional development (CPD) systems. We conducted a rapid scoping review to map and synthesize what is known regarding the development, implementation, evaluation and sustainability of CPD systems for healthcare professionals in LLMICs.

METHODS

We searched MEDLINE, CINAHL and Web of Science. Reference lists were screened and a cited reference search of included articles was conducted. Supplementary information on the CPD systems identified in the articles was also identified via an online targeted grey literature search. English, French and Spanish literature published from 2011 to 2021 were considered. Data were extracted and combined and summarized according to country/region and healthcare profession via tables and narrative text.

RESULTS

We included 15 articles and 23 grey literature sources. Africa was the region most represented followed by South and Southeast Asia and the Middle East. The literature most often referred to CPD systems for nurses and midwives; CPD systems for physicians were frequently referred to as well. Findings show that leadership and buy-in from key stakeholders, including government bodies and healthcare professional organizations, and a framework are essential for the development, implementation and sustainability of a CPD system in a LLMIC. The guiding framework should incorporate a regulatory perspective, as well as a conceptual lens (that informs CPD objectives and methods), and should consider contextual factors (support for CPD, healthcare context and population health needs). In terms of important steps to undertake, these include: a needs assessment; drafting of a policy, which details the regulations (laws/norms), the CPD requirements and an approach for monitoring, including an accreditation mechanism; a financing plan; identification and production of appropriate CPD materials and activities; a communication strategy; and an evaluation process.

CONCLUSION

Leadership, a framework and a clearly delineated plan that is responsive to the needs and context of the setting, are essential for the development, implementation and sustainability of a CPD system for healthcare professionals in a LLMIC.

What can Designing Learning-by-Concordance Clinical Reasoning Cases Teach Us about Instruction in the Health Sciences?

Introduction

Learning-by-concordance (LbC) is an online learning strategy to practice reasoning skills in clinical situations. Writing LbC clinical cases, comprising an initial hypothesis and supplementary data, differs from typical instructional design. We sought to gain a deeper understanding from experienced LbC designers to better support clinician educators' broader uptake of LbC.

Methods

A dialogic action research approach was selected because it yields triangulated data from a heterogeneous group. We conducted three 90-minute dialogue-group sessions with eight clinical educators. Discussions focused on the challenges and pitfalls of each LbC design stage described in the literature. Recordings were transcribed and analyzed thematically.

Results

We identified three themes by thematic analysis about the challenges inherent in designing LbC that are unique for this type of learning strategy: 1) the distinction between pedagogical intent and learning outcome; 2) the contextual cues used to challenge students and advance their learning and 3) the integration of experiential with formalized knowledge for cognitive apprenticeship.

Discussion

A clinical situation can be experienced and conceptualized in many ways, and multiple responses are appropriate. LbC designers use contextual cues from their experience and combine them with formalized knowledge and protocols to write effective LbC clinical reasoning cases. LbC focuses learners' attention on decision-making in grey areas that characterize the nature of professional clinical work. This in-depth study on LbC design, indicating the integration of experiential knowledge, might call for new thinking about instructional design.

Educators and practitioners' perspectives in the development of a learning by concordance tool for medical clerkship in the context of the COVID pandemic

BACKGROUND

The COVID-19 pandemic has forced medical schools to create educational material to palliate the anticipated and observed decrease in clinical experiences during clerkships. An online learning by concordance (LbC) tool was developed to overcome the limitation of students' experiences with clinical cases. However, knowledge about the instructional design of an LbC tool is scarce, especially the perspectives of collaborators involved in its design: 1- educators who wrote the vignettes' questions and 2- practitioners who constitute the reference panel by answering the LbC questions. The aim of this study was to describe the key elements that supported the pedagogical design of an LbC tool from the perspectives of educators and practitioners.

METHODS

A descriptive qualitative research design has been used. Online questionnaires were used, and descriptive analysis was conducted.

RESULTS

Six educators and 19 practitioners participated in the study. Important to the educators in designing the LbC tool were prevalent or high-stake situations, theoretical knowledge, professional situations experienced and perceived difficulties among students, and that the previous workshop promoted peer discussion and helped solidify the writing process. Important for practitioners was standards of practice and consensus among experts. However, they were uncertain of the educational value of their feedback, considering the ambiguity of the situations included in the LbC tool.

CONCLUSIONS

The LbC tool is a relatively new training tool in medical education. Further research is needed to refine our understanding of the design of such a tool and ensure its content validity to meet the pedagogical objectives of the clerkship.

Involvement of End Users in the Development of Serious Games for Health Care Professions Education: Systematic Descriptive Review

BACKGROUND

On the basis of ethical and methodological arguments, numerous calls have been made to increase the involvement of end users in the development of serious games (SGs). Involving end users in the development process is considered a way to give them power and control over educational software that is designed for them. It can also help identify areas for improvement in the design of SGs and improve their efficacy in targeted learning outcomes. However, no recognized guidelines or frameworks exist to guide end users' involvement in SG development.

OBJECTIVE

The aim of this study is to describe how end users are involved in the development of SGs for health care professions education.

METHODS

We examined the literature presenting the development of 45 SGs that had reached the stage of efficacy evaluation in randomized trials. One author performed data extraction using an ad hoc form based on a design and development framework for SGs. Data were then coded and synthesized on the basis of similarities. The coding scheme was refined iteratively with the involvement of a second author. Results are presented using frequencies and percentages.

RESULTS

End users' involvement was mentioned in the development of 21 of 45 SGs. The number of end users involved ranged from 12 to 36. End users were often involved in answering specific concerns that arose during the SG design (n=6) or in testing a prototype (n=12). In many cases, researchers solicited input from end users regarding the goals to reach (n=10) or the functional esthetics of the SGs (n=7). Most researchers used self-reported questionnaires (n=7).

CONCLUSIONS

Researchers mentioned end users' involvement in the development of less than half of the identified SGs, and this involvement was also poorly described. These findings represent significant limitations to evaluating the impact of the involvement of end users on the efficacy of SGs and in making recommendations regarding their involvement.

Learning by concordance (LbC) to develop professional reasoning skills: AMEE Guide No. 141

Developing effective clinical reasoning is central to health professions education. Learning by concordance (LbC) is an on-line educational strategy that makes learners practice reasoning competency in case-based clinical situations. The questions asked are similar to those professionals ask themselves in their practice and participant answers are compared to those of a reference panel. When participants answer the questions, they receive an automated feedback that is two-fold as they see (1) how the panelists respond and (2) justifications each panelist gives for their answer. This provides rich contextual knowledge about the situation, supplemented by a synthesis summarizing crucial points. As many educators in the health sciences are engaging in introducing innovative approaches, many consider building LbC learning modules. Elaborating, designing and implementing a LbC tool remain a challenge. This AMEE Guide describes the steps and elements to be considered when designing a LbC tool, drawing on examples from distinct health professions: medicine, nursing, physiotherapy, and dentistry. Specifically, the following elements will be discussed: (1) LbC theoretical underpinnings; (2) principles of LbC questioning; (3) goals of the concordance-based activity; (4) nature of reasoning tasks; (5) content/levels of complexity; (6) reference panel; (7) feedback/synthesis messages; (8) on-line learning platforms.

Efficacy of Serious Games in Healthcare Professions Education: A Systematic Review and Meta-analysis

SUMMARY STATEMENT

Serious games (SGs) are interactive and entertaining software designed primarily with an educational purpose. This systematic review synthesizes evidence from experimental studies regarding the efficacy of SGs for supporting engagement and improving learning outcomes in healthcare professions education. Randomized controlled trials (RCTs) published between January 2005 and April 2019 were included. Reference selection and data extraction were performed in duplicate, independently. Thirty-seven RCTs were found and 29 were included in random-effect meta-analyses. Compared with other educational interventions, SGs did not lead to more time spent with the intervention {mean difference 23.21 minutes [95% confidence interval (CI) = -1.25 to 47.66]}, higher knowledge acquisition [standardized mean difference (SMD) = 0.16 (95% CI = -0.20 to 0.52)], cognitive [SMD 0.08 (95% CI = -0.73 to 0.89)], and procedural skills development [SMD 0.05 (95% CI = -0.78 to 0.87)], attitude change [SMD = -0.09 (95% CI = -0.38 to 0.20)], nor behavior change [SMD = 0.2 (95% CI = -0.11 to 0.51)]. Only a small SMD of 0.27 (95% CI = 0.01 to 0.53) was found in favor of SGs for improving confidence in skills.

Script concordance testing to understand the hypothesis processes of undergraduate nursing students - Multiple case study

Background: Albeit essential to clinical reasoning (CR), strategies for generating student nursing clinical hypotheses at the time of transition to professional practice are underdeveloped. While script concordance testing (SCT) has been shown to be a valid and reliable assessment tool for CR in nursing education, the thought processes including the hypothesis processes involved in choosing an answer is not examined.Methods: A multiple case study was used to understand the complex phenomenon of students’ hypothesis activation and confrontation with the combined use of SCT questions and the think-aloud method. Structured individual interviews were conducted.Results: A total of 18 students, nine first-year and nine third-year students participated in the study. The results show that the students demonstrate certain CR cognitive processes, including early representation of a clinical situation, semantic transformation of data, and hypothesis comparison.Conclusions: Results suggest promoting knowledge articulation aloud and the frequent use of micro-judgments to compare and differentiate hypotheses involving the uncertainty of clinical practice, which underpin learning in successive layers.

L’apprentissage du raisonnement clinique infirmier dans le cadre d’un dispositif éducatif numérique basé sur la concordance de scripts

Contexte : Un des défis actuels des responsables de la formation des futurs infirmiers est de concevoir des stratégies éducatives pour favoriser le développement optimal du raisonnement clinique infirmier (RCI).But : L’étude visait à développer, mettre à l’essai et évaluer un dispositif éducatif numérique basé sur la concordance de scripts auprès d’étudiants en sciences infirmières. Méthodes : Un devis de recherche-développement a permis de soutenir les étapes de réalisation du dispositif éducatif. Une validation de contenu a été intégrée au devis à l’aide d’une technique Delphi modifiée. Les choix de réponses des étudiants et des experts aux questions du dispositif ont été compilés. Un questionnaire en ligne et des entrevues de groupe focalisées ont été utilisés auprès d’étudiants afin d’évaluer l’acceptabilité et l’utilisabilité du dispositif éducatif. Résultats : Cinq experts-collaborateurs ont validé le contenu du dispositif éducatif. La version finale comptait 81 questions liées à 22 vignettes. Douze experts-panélistes et quarante-cinq étudiants ont répondu aux questions du dispositif éducatif. Les indices alpha (α) de Cronbach ont oscillé entre 0,87 et 0,90. Globalement, les étudiants ont apprécié l’utilisation du dispositif éducatif, dont la rétroaction variée et formative d’experts à des situations apparentées à la vie professionnelle. Conclusion : Le dispositif éducatif repose sur l’utilisation d’un test de concordance de scripts numérisé auquel des rétroactions d’experts sont intégrées à des fins d’apprentissage du RCI. Essentiel, l’engagement des experts-panélistes inscrit la conception d’un tel dispositif éducatif dans une démarche de co-construction et de validation du matériel pédagogique.

Learning strategies used by undergraduate nursing students in the context of a digitial educational strategy based on script concordance: A descriptive study

BACKGROUND

the digital educational strategy based on script concordance is an educational method that has been attracting increasing attention in healthcare education programs to fostering the development of clinical reasoning. It includes a digitized Script Concordance Test with incorporated expert feedback. However, the learning strategies required of students in the context of its use remain unknown.

OBJECTIVE

This study aimed to identify the learning strategies that undergraduate nursing students need to use in the context of the digital educational strategy based on script concordance.

METHOD

A qualitative descriptive design was used to identify student learning strategies. Data was collected using an online questionnaire and semi-directed focus group interviews. Bégin's taxonomy provided the framework for linking the data collected to learning strategies required of students.

RESULTS

Forty-four students participated in the study. Results show that when using a digital educational strategy based on script concordance, students are called to rely on their nascent scripts in order to select the data in short ill-defined clinical vignettes, evaluate new information repeatedly, anticipate microjudgments, and thus, gradually increase their knowledge and refine their scripts. Viewing the experts' feedback and consulting the referencing tools helped students self-monitor their knowledge, a key metacognitive strategy to learning clinical reasoning. Completed individually or with peers, the digital educational strategy could be used to learn a particular concept or as an integrative activity before an evaluation.

CONCLUSION

This original study has allowed us to link nursing clinical reasoning teaching conditions to the learning strategies used to develop this competency. Study results inform instructors about digital educational strategy based on script concordance to make it complementary with other educational strategies to better support complex learning of nursing clinical reasoning.

New graduate nurses' clinical competence: A mixed methods systematic review

AIM

To appraise and synthesize evidence of empirical studies reporting assessment of new graduate nurses' clinical competence in clinical settings.

DESIGN

Mixed methods systematic review.

DATA SOURCES

The search strategy included keywords relevant to: new graduate nurse; clinical competence; and competence assessment. The searched literature databases included CINAHL, MEDLINE, Embase, PsycINFO and Web of Science. The search was limited to full-text papers in English or French, published between 2010 -September 2019.

REVIEW METHODS

Inclusion criteria were: 1) empirical studies; 2) detailed method and complete results sections; 3) competence assessment in clinical settings; and 4) new graduate nurses (≤24 months). Two independent reviewers screened eligible papers, extracted data and used the Mixed Methods Appraisal Tool framework for quality appraisal. Divergences were solved through discussion.

RESULTS

About 42 papers were included in this review: quantitative (N = 31), qualitative (N = 7) and mixed methods (N = 4). Findings suggest that new graduate nurses exhibit a good or adequate level of competence. Longitudinal studies show a significant increase in competence from 0-6 months, but findings are inconsistent from 6-12 months.

CONCLUSION

There are a multitude of quantitative tools available to measure clinical competence. This suggests a need for a review of their rigor.

IMPACT

No recent reviews comprehensively synthesized the findings from new graduate nurses' clinical competence. This review has found that new graduate nurses' competence has been mostly assessed as good, despite the expectation that they should be more competent. Longitudinal studies did not always show a significant increase in competence. These findings can help nurse educators in providing more support to new graduate nurses throughout the transition period or design improved transition programme. This review also identified quantitative tools and qualitative methods that can be used for competence assessment.

Adaptation and validation of a nursing competencies framework for clinical practice on a continuum of care from childhood to adulthood: A Delphi study

BACKGROUND

Too few of nursing competencies framework exceed applicability to a given environment, are validated by a research process or used to guide continuing development of nursing competencies.

OBJECTIVES

The study objectives were: 1) to adapt and validate a nursing competencies framework from the continuum of care from childhood to adulthood and 2) to explore implementation strategies.

DESIGN

A collaborative approach including nurses from different practice perspectives. A modified Delphi method supported the adaptation and the validation of a nursing competencies framework.

SETTING

This study was conducted in a pediatric and an adult care university hospitals in Montreal.

PARTICIPANTS

Forty-two nurses were recruited from both university hospitals.

METHODS

A modified Delphi study was conducted. An online questionnaire, containing dichotomous and open-ended questions, was used to collect data on the nursing competencies framework and the suggested implementation strategies for its use. Consensus percentage was calculated, and thematic analysis was used to analyze nurses' comments and implementation strategies suggested.

RESULTS

The nursing competencies framework (NCF), adapted and validated in this study, includes seven competencies and four development stages, from advanced beginner to clinical expert nurses. After three rounds, the nursing competencies framework describes the professional role from the continuum of care from childhood to adulthood, and proposes a self-assessment tool that promotes professional development and continuing education of nurses. Moreover, four strategies for implementing the framework in the clinical setting obtained a consensus of 70% or more.

CONCLUSIONS

A nursing competencies framework was validated by a rigorous research process and adapted to diverse contexts of care. The results revealed a common vision of the nursing practice for patients and their families on the life course from childhood to adulthood. This innovative framework carries the potential to be a relevant and unique reference tool. The nursing competencies framework can provide guidance for the development of nurses' competencies in clinical setting. Additionally, it is a relevant reference that should be use for knowing the scope and the standards of the professional practice in nursing education.

Measurement properties of scales assessing new graduate nurses' clinical competence: A systematic review of psychometric properties

BACKGROUND

New graduate nurses' competence is a concern for all healthcare organizations. Previous reports show heterogeneous levels of competency amongst them. As a positive association between competency and quality of care in clinical settings has been suggested, it is essential for researchers and clinicians to select valid, reliable, and responsive scales to assess new nurses' competence. However, a systematic evaluation of the measurement properties of scales measuring new nurses' competence had yet to be published.

OBJECTIVE

To analyse, evaluate and synthesize the measurement properties of scales used to assess new nurses' clinical competence.

DESIGN

A systematic psychometric review based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methods.

DATA SOURCES

The search strategy included a combination of keywords and thesaurus terms related to new graduate nurses, clinical competence, and competence assessment. Five databases were searched: Embase, CINAHL, MEDLINE, PsycINFO and Web of Science. The search was limited to full-text papers published in English or French, from 2010 to 2019.

REVIEW METHODS

Two independent reviewers screened eligible papers, extracted data related to validity, reliability, and responsiveness of each scale, and evaluated the quality of their measurement properties as well as risk of bias in their psychometric evaluation. Divergences were solved through discussion.

RESULTS

Ten scales were included: eight original scales, one culturally adapted and one modified. Of these scales, eight were developed or adapted in the 2010s decade and the other two scales were developed earlier. Most scales are divided into 6 to 8 subscales and use an adjectival scale with either 4, 5 or 7 points. The content validity study of all scales in this review was deemed to be doubtful or inadequate quality. Reliability was almost exclusively assessed by calculating the internal consistency with Cronbach's alpha coefficient which gives no information on equivalence or stability of the measure. Responsiveness was never properly assessed in the reviewed studies.

CONCLUSIONS

There is little evidence on the measurement properties for each scale regarding their validity and reliability; responsiveness was not assessed for any scale. Every scale evaluated in this review had different characteristics (length, subscales, response options). Therefore, selection of the most appropriate scale depends on the context and purpose of the assessment. Prospero registration number: CRD42018109711 Tweetable Abstract: Systematic review of scales measuring new nurses' competence: we must do better and conduct more validity/reliability testing of existing scales.

Effect of implementation interventions on nurses' behaviour in clinical practice: a systematic review, meta-analysis and meta-regression protocol

BACKGROUND

Practitioner-level implementation interventions such as audit and feedback, communities of practice, and local opinion leaders have shown potential to change nurses' behaviour in clinical practice and improve patients' health. However, their effectiveness remains unclear. Moreover, we have a paucity of data regarding the use of theory in implementation studies with nurses, the causal processes-i.e. mechanisms of action-targeted by interventions to change nurses' behaviour in clinical practice, and the constituent components-i.e. behaviour change techniques-included in interventions. Thus, our objectives are threefold: (1) to examine the effectiveness of practitioner-level implementation interventions in changing nurses' behaviour in clinical practice; (2) to identify, in included studies, the type and degree of theory use, the mechanisms of action targeted by interventions and the behaviour change techniques constituting interventions and (3) to examine whether intervention effectiveness is associated with the use of theory or with specific mechanisms of action and behaviour change techniques.

METHODS

We will conduct a systematic review based on the Cochrane Effective Practice and Organization of Care (EPOC) Group guidelines. We will search six databases (CINAHL, EMBASE, ERIC, PsycINFO, PubMed and Web of Science) with no time limitation for experimental and quasi-experimental studies that evaluated practitioner-level implementation interventions aiming to change nurses' behaviour in clinical practice. We will also hand-search reference lists of included studies. We will perform screening, full-text review, risk of bias assessment, and data extraction independently with the Covidence systematic review software. We will assess the quality of evidence using the GRADEpro software. We will code included studies independently for theory use (Theory Coding Scheme), mechanisms of action (coding guidelines from Michie) and behaviour change techniques (Behaviour Change Technique Taxonomy v1) with QSR International's NVivo qualitative data analysis software. Meta-analyses will be performed using the Review Manager (RevMan) software. Meta-regression analyses will be performed with IBM SPSS Statistics software.

DISCUSSION

This review will inform knowledge users and researchers interested in designing, developing and evaluating implementation interventions to support nurses' behaviour change in clinical practice. Results will provide key insights regarding which causal processes-i.e. mechanisms of action-should be targeted by these interventions, and which constituent components-i.e. behaviour change techniques-should be included in these interventions to increase their effectiveness.

SYSTEMATIC REVIEW REGISTRATION

The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42019130446).

Concevoir une formation par concordance pour développer le raisonnement professionnel : quelles étapes faut-il parcourir ?

Contexte : Développer le raisonnement est une nécessité dans la formation des professionnels de la santé. La formation par concordance (FpC) est une approche pédagogique qui place les apprenants dans des situations authentiques. Les questions posées sont celles que se posent les professionnels dans leur pratique et les réponses sont comparées à celles qu’ont données les membres d’un panel de référence. But : Décrire les variables dont il est nécessaire de tenir compte pour concevoir une FpC. Méthodes : Ces variables sont au nombre de six : 1) les buts de l’activité pédagogique ; 2) la nature de la tâche ; 3) le contenu et le niveau de complexité ; 4) le panel de référence ; 5) les rétroactions ; 6) l’environnement numérique d’apprentissage. Résultats : Les exemples illustrés dans cet article permettent de constater la versatilité de cette approche pour mettre l’accent sur les divers éléments critiques au raisonnement de diverses professions. Conclusion : Les exemples présentés illustrent comment il est possible de mettre au point des outils de FpC qui se prêtent à l’amélioration à chaque itération. Il est désormais possible d’imaginer qu’un jour cette approche à la formation fera partie importante de toute formation professionnelle.

Efficacy of adaptive e-learning for health professionals and students: a systematic review and meta-analysis

OBJECTIVE

Although adaptive e-learning environments (AEEs) can provide personalised instruction to health professional and students, their efficacy remains unclear. Therefore, this review aimed to identify, appraise and synthesise the evidence regarding the efficacy of AEEs in improving knowledge, skills and clinical behaviour in health professionals and students.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

CINAHL, EMBASE, ERIC, PsycINFO, PubMed and Web of Science from the first year of records to February 2019.

ELIGIBILITY CRITERIA

Controlled studies that evaluated the effect of an AEE on knowledge, skills or clinical behaviour in health professionals or students.

SCREENING, DATA EXTRACTION AND SYNTHESIS

Two authors screened studies, extracted data, assessed risk of bias and coded quality of evidence independently. AEEs were reviewed with regard to their topic, theoretical framework and adaptivity process. Studies were included in the meta-analysis if they had a non-adaptive e-learning environment control group and had no missing data. Effect sizes (ES) were pooled using a random effects model.

RESULTS

From a pool of 10 569 articles, we included 21 eligible studies enrolling 3684 health professionals and students. Clinical topics were mostly related to diagnostic testing, theoretical frameworks were varied and the adaptivity process was characterised by five subdomains: method, goals, timing, factors and types. The pooled ES was 0.70 for knowledge (95% CI -0.08 to 1.49; p.08) and 1.19 for skills (95% CI 0.59 to 1.79; p<0.00001). Risk of bias was generally high. Heterogeneity was large in all analyses.

CONCLUSIONS

AEEs appear particularly effective in improving skills in health professionals and students. The adaptivity process within AEEs may be more beneficial for learning skills rather than factual knowledge, which generates less cognitive load. Future research should report more clearly on the design and adaptivity process of AEEs, and target higher-level outcomes, such as clinical behaviour.

PROSPERO REGISTRATION NUMBER

CRD42017065585.

Addressing the development of both knowledge and clinical reasoning in nursing through the perspective of script concordance: An integrative literature review

Background: In clinical practice settings, where situations of uncertainty exist, clinical reasoning is situated or contextualized. It calls upon honed knowledge, wherein nurses rely on highly-developed and organized knowledge networks known as “mental scripts”.Methods: The aim of this integrative literature review was to address ways to develop knowledge and clinical reasoning in nursing through the use of mental scripts, and to tackle these pedagogical considerations. The literature search was performed using the following data sources: CINHAL, MEDLINE Google Scholar, PubMed, ProQuest, PsycINFO, Scopus and Web of Science.Results: Script concordance, which optimises situated clinical reasoning, ties in with the socio-cognitive perspective of cognitive apprenticeship, using role models to guide the development of knowledge and clinical reasoning in nursing. Moreover, this perspective proposes implementing new teaching strategies, which focus on situational awareness, reflective acuity, and cognitive dialogue.Conclusions: The perspective of script concordance allows a foreseeable innovative formulation of practices favourable to the development of clinical reasoning in nursing.

Effectiveness of Adaptive E-Learning Environments on Knowledge, Competence, and Behavior in Health Professionals and Students: Protocol for a Systematic Review and Meta-Analysis

BACKGROUND

Adaptive e-learning environments (AEEs) can provide tailored instruction by adapting content, navigation, presentation, multimedia, and tools to each user's navigation behavior, individual objectives, knowledge, and preferences. AEEs can have various levels of complexity, ranging from systems using a simple adaptive functionality to systems using artificial intelligence. While AEEs are promising, their effectiveness for the education of health professionals and health professions students remains unclear.

OBJECTIVE

The purpose of this systematic review is to assess the effectiveness of AEEs in improving knowledge, competence, and behavior in health professionals and students.

METHODS

We will follow the Cochrane Collaboration and the Effective Practice and Organisation of Care (EPOC) Group guidelines on systematic review methodology. A systematic search of the literature will be conducted in 6 bibliographic databases (CINAHL, EMBASE, ERIC, PsycINFO, PubMed, and Web of Science) using the concepts "adaptive e-learning environments," "health professionals/students," and "effects on knowledge/skills/behavior." We will include randomized and nonrandomized controlled trials, in addition to controlled before-after, interrupted time series, and repeated measures studies published between 2005 and 2017. The title and the abstract of each study followed by a full-text assessment of potentially eligible studies will be independently screened by 2 review authors. Using the EPOC extraction form, 1 review author will conduct data extraction and a second author will validate the data extraction. The methodological quality of included studies will be independently assessed by 2 review authors using the EPOC risk of bias criteria. Included studies will be synthesized by a descriptive analysis. Where appropriate, data will be pooled using meta-analysis by applying the RevMan software version 5.1, considering the heterogeneity of studies.

RESULTS

The review is in progress. We plan to submit the results in the beginning of 2018.

CONCLUSION

Providing tailored instruction to health professionals and students is a priority in order to optimize learning and clinical outcomes. This systematic review will synthesize the best available evidence regarding the effectiveness of AEEs in improving knowledge, competence, and behavior in health professionals and students. It will provide guidance to policy makers, hospital managers, and researchers in terms of AEE development, implementation, and evaluation in health care.