Transitions of care pose significant risks for patients with complex medical histories. There are few experiential medical education curricula targeting this important aspect of care. We designed and tested an internal medicine transitions of care experience integrated into interns' ambulatory curriculum. The program included 1-hour group didactics, a posthospitalization discharge visit in pairs with a home care nurse (cohort 1: 2011-2012; cohort 2: 2012-2013), and a half-day small-group visit to a skilled nursing facility led by a faculty member in geriatrics (cohort 2 only). Both visits had structured debriefings by faculty in geriatrics. For cohort 1, a quantitative follow-up survey was administered 18 to 20 months after the experience. For cohort 2, reflections were analyzed. Thirty-three of 42 second-year residents (79%) in cohort 1 who participated in didactics and a home visit completed the survey. Seventy-six percent (25 of 33) reported increased knowledge of interprofes...

Growing up in an era of video games and Web-based applications has primed current medical students to expect rapid, interactive feedback. To address this need, the A.T. Still University-School of Osteopathic Medicine in Arizona (Mesa) has developed and integrated a variety of approaches using technology-enhanced active learning for medical education (TEAL-MEd) into its curriculum. Over the course of 3 years (2010-2013), the authors facilitated more than 80 implementations of games and virtual patient simulations into the education of 550 osteopathic medical students. The authors report on 4 key aspects of the TEAL-MEd initiative, including purpose, portfolio of tools, progress to date regarding challenges and solutions, and future directions. Lessons learned may be of benefit to medical educators at academic and clinical training sites who wish to implement TEAL-MEd activities.

Aim Aim This paper in the series on professional assessment provides a practical guide to writing key features problems (KFPs). Key features problems test clinical decision-making skills in written or computer-based formats. They are based on the concept of critical steps or 'key features' in decision making and represent an advance on the older, less reliable patient management problem (PMP) formats. Method Method The practical steps in writing these problems are discussed and illustrated by examples. Steps include assembling problem-writing groups, selecting a suitable clinical scenario or problem and defining its key features, writing the questions, selecting question response formats, preparing scoring keys, reviewing item quality and item banking. Conclusion Conclusion The KFP format provides educators with a flexible approach to testing clinical decisionmaking skills with demonstrated validity and reliability when constructed according to the guidelines provided.

Although the chances of predicting a preventable fracture by bone densitometry may be small, it is also important that two thirds of patients can be reassured that fracture is less likely and therefore long term treatment is not needed. That there is overuse, overdiagnosis, and overtreatment for osteoporosis is due not to bone densitometry or to epidemiological reports but to various factors, including pressure of some competing pharmaceutical companies and the uncritical medical society relying more on technical instrumentation than on clinical skills and reasoning. As Wilkin and Devendra assert above, effectiveness is critical in daily clinical practice.-Jan Dequeker, Frank P Luyten Competing interests: None declared. 1 Dequeker J. Osteoporotic fractures, ageing, and the bone density T-score. . Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 1997;337:670-6. 7 Chapuy MC, Arlot ME, Delmas PD, Meunier PJ. Effect of calcium and cholecalciferol treatment for three years on hip fractures in elderly women. BMJ 1994;308:1081-2. 8 Faulkner KG. Bone matters: are density increases necessary to reduce fracture risk? J Bone Miner Res 2000;15:183-7. 9 Hildebrand T, Laib A, Müller R, Dequeker J, Rüegsegger P. Direct threedimensional morphometry analysis of human cancellous bone: microstructural data from spine, femur, iliac crest, and calcaneus. J Bone Miner Res 1999;14:1167-74. 10 Aerssens J, Van Audekercke R, Talalaj M, Geusens P, Bramm E, Dequeker J. Effect of 1 -vitamin D 3 and estrogen therapy on cortical bone mechanical properties in the ovariectomized rat model. Endocrinol 1996;137:1358-64. 11 Mashiba T, Hirano T, Turner CH, Forwood MR, Johnston CC, Burr DB. Suppressed bone turnover by bisphosphonates increases microdamage accumulation and reduces some biomechanical properties in dog rib. J Bone Miner Res 2000;15:613-20. 12 Aerssens J, Boonen S, Lowet G, Dequeker J. Interspecies differences in bone composition, density and quality. Potential implications for in vivo bone research. Endocrinol 1998;139:663-70. 13 Dequeker J, Nijs J, Verstraeten A, Geusens P, Gevers G. Genetic determinants of bone mineral content at the spine and radius: a twin study. Bone 1987;8:207-9. 14 De Laet CE, van Hout BA, Burger H, Hofman A, Pols HA. Bone density and risk of hip fracture in men and women: cross sectional analysis. BMJ 1997;315:221-5. 15 Cummings SR, Black DM, Thompson DE, Applegate WB, Barrett-Connor E, Musliner TA, et al. Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures. JAMA 1998;280:2077-82.

To explore ways in which student learning during formal ward rounds can be enhanced. Qualitative study of University of Otago medical students (Dunedin, New Zealand) involving observation of surgical teams during formal ward rounds, and indepth interviews with students and consultant surgeons. Teaching and learning opportunities on ward rounds were often missed by both clinical teachers and students as service provision and patient care took precedence. As a result, students often felt excluded and frequently expressed ambivalence about the educational value of formal whole team ward rounds. Students were more likely to consider themselves part of the team when they felt useful and were included in team discussions about patient care. They reported that they learned more effectively on smaller, more educationally focussed ward rounds that incorporated bedside tutorials and opportunities to practice examination skills. Students and clinical teachers know that students need to make th...

The use of simulation as a teaching strategy in undergraduate nursing education is gaining increasing credibility and popularity. This article describes a study undertaken to evaluate first-year undergraduate nursing students' level of satisfaction with a new model of teaching clinical skills using unfolding case studies in a high-fidelity simulated clinical setting. The design incorporated a case study design conducted over 4 Â 6 h simulation sessions. Participants included 47 first year Bachelor of Nursing Science students, three academic staff and two standardised patients. Findings from the study provide qualitative and quantitative evidence to support a high fidelity simulated model of teaching clinical skills development for first year undergraduate nursing students. High positive scores in all sections of the student survey provide quantitative evidence of student's satisfaction with all elements of the teaching model and qualitative data from interviews supporting this claim. Additionally, analysis of interview data provides qualitative evidence to support the value of the learning experience for students and academics, and students desire to participate more frequently in simulation sessions.

Transfer of knowledge from the basic biopsychosocial sciences to patient care is a major task for dental students during their education. Computer-based interactive patient simulations can help students affect this transfer because simulations allow students to develop and practice problem solving and decision-making skills interactively within the context of patient problems. A program for authoring computer-based interactive simulations is described. Patient simulations can effectively integrate basic science relevance, preparation for clinical problem solving, teaching new clinical content and several other necessary elements into curriculum infrastructure. Case simulations also can contribute to evolving educational standards set out by accrediting bodies.

The paper discusses design and development issues of an online program for enhancing management skills of Early Years Childcare practitioners. The program is developed in the frames of the EEEYMS* project by partners from UK, Bulgaria, Finland, and the Netherlands. The purpose is to design an ICT-based flexible learning solution for problem-based learning. The content is organized in nine modules.

One of the biggest challenges that a physician will face is conveying difficult news (CDN) to a patient. The ability to provide this information may either strengthen or destroy the patient-physician relationship. Despite the importance of this skill, formal education for medical students has been limited. To improve upon skill building in the medical student experience, fourth year medical students (on their oncology clerkship) spent 3 hours partaking in a CDN session. During this session, each student had a videotaped encounter with a standardized patient, followed by a small group discussion and review of the tape with other students and a clinician. We evaluated the experience with pre-and post-questionnaires assessing overall knowledge, satisfaction, and specific components of the curriculum. The objective of this study was to review our institution's educational program focused on teaching techniques for CDN.

This study was developed by a group of professionals from different areas (nurses and educators) concerned with health education. It proposes the use of a problem-posing model for the transformation of professional practice. The concept and functions of the model and their relationships with the educative practice of health professionals are discussed. The model of problem-posing education is presented (compared to traditional, ''banking'' education), and four innovative experiences of teaching-learning are reported based on this model. These experiences, carried out in areas of environmental and occupational health and patient education have shown the applicability of the problem-posing model to the practice of the health professional, allowing transformation.

This paper describes the use of problem-based Learning (PBL) in the delivery of a level 3 unit: Design and Implementation of VLSI Systems. A “hybrid ” approach has been taken with lectures being interleaved with floating facilitator, PBL sessions. A series of four problems were presented during the course of the unit, each problem

The teaching and learning of pathology in undergraduate curricula are changing and the methods of assessment of the pathology component need to change with them. The curricular changes from the older, traditional programmes to newer, more integrated courses, often using a problem-based learning (PBL) approach, are a challenge for pathologists at a time of reduction of academic pathology posts. However, pathologists have a broad range of knowledge and skills that are invaluable in undergraduate teaching, learning and assessment. These should be encouraged in training grades and promoted by established pathologists as 'role models'. Newer forms of assessment provide an opportunity for pathologists to maintain the profile of the discipline since 'assessment drives learning'. These methods include the incorporation of well-designed clinical scenarios with pathological relevance into multiple choice questions (MCQs) and extended matching questions (eMQs), examples of which are given. Similarly, objective structured clinical examinations (OSCes) also allow the use of clinically relevant settings such as death certification and multidisciplinary team meetings in undergraduate examinations. Pathologists should get involved in all levels of assessment, especially in question writing and quality assurance. They should also participate in OSCes and function as external examiners to maintain the profile of pathology to undergraduates.

resulting in a pass rate of 51%. Scores ranged from 34.8% to 70.5%. Overall, 80% of students considered the OSCE to be a more objective clinical assessment tool, most appreciated the time-efficiency of the process, and all respondents were in favour of adopting the OSCE as a permanent tool. Future plans in the Department of Internal Medicine include the adoption of the OSCE in Years 4 and 6. In addition, the Departments of Psychiatry and Preventive Dentistry are investigating possible uses of the OSCE model.

Patient education programmes have shown only small to modest effects on diabetes self-care and metabolic control. Despite that, almost all diabetes teams agree that patient education is an extremely important part of the treatment of diabetes. It is, therefore, important to identify components of successful patient education as a basis for creating and testing an evidence-based education programme. In a review of controlled studies evaluating patient education such components were identified and these were then used in building up the new programme. This programme, called 'I'm the Boss', is based on the notion that the patient is an active care participant, setting his own self-care goals, and is the one responsible for his own life. The content of the programme did not, therefore, focus on diabetes as such, but on life with diabetes. Six themes were explored during six three-hour weekly sessions. The educational method used was problem-based learning. This method is founded in cognitive theory and views the learner as active in seeking knowledge and able to solve the self-care problems identified. The aim of this study was to explore the feasibility of the programme which was tested in four small groups (five to eight participants) of diabetic patients together with two facilitators. After completing the programme, the patients participated in focus group interviews to evaluate the programme. They identified both positive and negative factors. After each session the two facilitators reflected upon the group dynamics. In particular, problems with allowing patients to be the experts should be highlighted. This programme has been modified according to the evaluation and it is now being tested in a randomised, controlled, multicentre study.

The purpose of this chapter is to describe the design of template for the design of an immersive virtual learning environment that includes collaborative learning virtual worlds as problem-solving scenarios that engage students in virtual explorations of worlds. The problem-based learning 3d model incorporates a curriculum design model that includes a real-world issue that correlates to the virtual scenarios or games. This virtual PBL design model also includes a learning assessment process that utilizes sociocultural learning theories to develop an ongoing feedback model for assessment of learning in a 3d problem-based learning environment. This problem-based learning model combines the benefits of games, such as high-levels of learner engagement, real-life simulations, with research on cognition and instructional design to create a design model that can be modified to develop advanced knowledge, skills and concepts in multiple educational settings.

Background: It is important to understand how clinical reasoning occurs in podiatry so that podiatrists may be able to make the correct diagnosis and patients may benefit from the correct treatment. It is also important for the education of podiatry students and experts in specialist area of podiatry, so they may be taught procedures for clinical reasoning and problem based learning. Currently, there is little information as to how this process is achieved in the domain of podiatry. Objectives: The aim of this study was to investigate clinical reasoning in podiatry in both expert and novice podiatrists. Method: Think-aloud protocols were used to investigate the clinical reasoning of expert and novice podiatrists in general and specialist clinics. The think-aloud protocols were later analysed for content and themes were produced to help understand the process of clinical reasoning in podiatry. Results: Some of the themes used in clinical reasoning are common to experts in general podiatry practice and specialist podiatry practice. However, there is an increase in the number of clinical reasoning themes used by experts in a specialist setting than in a general setting.

Simulation represents a true paradigm shift in teaching and learning that has revolutionized healthcare education. However, few continuing education opportunities for anesthesia providers exist using simulation of any type. This article explores the usefulness of high-fidelity simulation (HFS) as a valuable tool for continuing education and reports the results of a needs assessment conducted among 22 practicing nurse anesthetists. The questions related to their exposure to HFS and asked them to rank their experience with 11 anesthesia events. Next, respondents were asked to rank a similar list of anesthesia events that would be useful for continuing education using simulation. Of participants, 71% ranked advanced cardiac life support scenarios, anesthesia machine mishaps, and malignant hyperthermia as highly effective choices for using HFS. Eighty-one percent of participants identified that they envision simulation as a valuable tool to assess competency, but respondents had mixed w...

International outreach by schools and colleges of pharmacy is increasing. In this paper, we provide current practice guidelines to establish and maintain successful global/international advanced pharmacy practice experiences (G/I APPEs) with specific recommendations for home/host country and host site/institution. The paper is based on a literature review (2000-2014) in databases and Internet searches with specific keywords or terms. Educational documents such as syllabi and memoranda of understanding (MoUs) from pharmacy programs were also examined. In addition, a preliminary draft was developed and the findings and recommendations were reviewed in a 90-minute roundtable discussion at the 2014 American Association of Colleges of Pharmacy Annual Meeting. Recommendations for the host country include travel considerations (eg, passport, visa, air travel), safety, housing, transportation, travel alerts and warnings, health issues, and financial considerations. For the home country, con...

Rolf Nordahl Medialogy, Aalborg University Copenhagen Lautrupvang 15 2750 Ballerup, DK rn@media.aau.dk ... Stefania Serafin Medialogy, Aalborg University Copenhagen Lautrupvang 15 2750 Ballerup, DK sts@media.aau.dk ... ABSTRACT In this paper we advocate the ...

This paper describes the design and development of an on-line problem-based learning environment designed to provide a means for creating a converged learning environment for on and off-campus students. The paper describes the environment and the intended implementation strategies as well as results from its initial implementation with a large cohort.

The present study investigated relationships between students' conceptions of constructivist learning on the one hand, and their regulation and processing strategies on the other hand. Students in a constructivist, problem-based learning curriculum were questioned about their conceptions of knowledge construction and self-regulated learning, as well as their beliefs regarding their own (in)ability to learn and motivation to learn. Two hypothesized models were tested within 98 psychology students, using a structural equation modelling approach: The first model implemented regulation and processing variables of the Inventory of Learning Styles [ILS, Vermunt (Learning styles and regulation of learning in higher education -towards process-oriented instruction in autonomous thinking, 1992)], the second model of the Motivated Strategies for Learning Questionnaire [MSLQ, Pintrich and de Groot (Journal of Educational Psychology, 82, 33-40, 1990)]. Results showed that structural relations exist between conceptions of constructivist learning and regulation and processing strategies. Furthermore, students who express doubt with regard to their own learning capacities are at risk for adopting an inadequate regulation strategy. A three-tiered structure of conceptual, controlling, and operational level appeared valid for the MSLQ variables, but not entirely for those of the ILS.

DIAGNOSER is an Internet-based tool for classroom instruction. It delivers continuous formative assessment and feedback to high school physics students and their teachers about the correct and incorrect concepts and ideas the students may hold regarding physical situations. That is, it diagnoses misconceptions that underlie wrong answers of students, such as a confusion of velocity with acceleration. We use data about patterns of student responses, particularly consistency of errors from question to question, to improve the system's understanding of student concepts.

Effective faculty development programs are of paramount importance in this era of profound change in nursing education driven by baccalaureate-degree entry to practice and the concurrent implementation of college/university collaborative partnerships in Ontario, Canada. The overall purpose of this study was to design, disseminate, and evaluate a faculty development program involving nursing faculty from the McMaster University, Mohawk College, and Conestoga College. In keeping with selected conceptual models and responses to a needs assessment, faculty participated in a collaborative faculty development program that included a planned workshop, a mentorship program, and regular faculty development activities. This article presents the qualitative program evaluation component that included focus group discussions and subsequent content analysis to gain an understanding of the experiences and meaning of the faculty who participated in the faculty development program. The overarching theme was that the faculty experienced a sense of evolving as nurse educators in problem-based learning (PBL) through a community of faculty development. The following themes emerged: becoming certain in the midst of uncertainty; developing collegial trust and community; embracing PBL; valuing faculty development; and evolving as a nurse educator in PBL through faculty development. The results attest to the benefits of a collaborative faculty development program, guide future faculty development, and promote mastery in PBL. (Index words: Nursing faculty; Faculty development; Program evaluation) J Prof Nurs 23: 75-82, 2007. A

The purpose of this article is to empower those interested in teaching students powerful and engaging social studies. Through the lens of Supreme Court simulations, this article provides educators with a viable, classroom-tested lesson plan to bring Problem-Based Learning into their classrooms. The specific aim of the lesson is to provide students with an opportunity to engage in relevant and powerful civics education.

The present study aimed at providing an overview of the most common themes of research into medical education. Changes in frequency of occurrence of these themes over time and differences between US and European journals were studied. The most productive institutions and researchers in the field were examined. A content analysis was carried out on 10,168 abstracts extracted from the six most influential journals in medical education published since 1988. Twenty-nine major themes were identified, of which student assessment, clinical and communication skills, clinical clerkships, and problem-based learning were the most prominent ones. Some of these themes, such as multiple-choice examinations or computer-assisted instruction seemed to have had their day, whereas other topics, such as the study of clinical clerkships, clinical reasoning, and scholarship in education were on their way up. Medical education research turned out to be a thoroughly international affair to which both US and European research centers contribute. The medical education literature shows an overwhelming emphasis on the preparation of medical students for professional practice. Moreover, the emphasis is very much on the individual student; most research seems to have been conducted with a psychological perspective in mind. It is argued that medical education research would profit from broadening its scope, including sociological, economical, ecological, and system perspectives. These perspectives might bring answers to new questions relevant to the quality of medical education. It is suggested that medical education is in need of moving beyond the conventional effectiveness-driven research approach to a more theory- and discovery-driven approach.

Complex learning aims at the integration of knowledge, skills, and attitudes; the coordination of qualitatively different constituent skills; and the transfer of what is learned to daily life or work settings. Recent instructional theories stress authentic learning tasks as the driving force for learning; but due to the complexity of those tasks, learning may be hampered by the limited processing capacity of the human mind. In this article we present a framework for scaffolding practice and just-in-time information presentation, aiming to control cognitive ...

Although there is increasing focus on provider behavior change as an outcome of continuing medical education (CME), it has long been known that an increase in knowledge alone is rarely sufficient to induce such change. The Personal Learning Plan (PLP), designed to motivate and assess CME learning, was partly derived from SMART goals (specific, measurable, attainable, realistic, and timely), a concept well supported as a strategy to promote behavior change. The goal of this study was to explore the relationship between SMART goals developed after attending a CME conference and subsequent provider behavior change, using the PLP as a tool.

Este texto traz o relato de uma experiência com metodologia de projetos, mais especificamente com um modelo de simulação das Nações Unidas (ONU), desenvolvido no contexto escolar com alunos do Ensino Médio, em uma escola particular na cidade de Manaus/AM. Neste sentido, refletiremos sobre o papel do professor na formação do estudante, tendo como perspectiva a autonomia intelectual, de modo que o aluno possa refletir sobre suas ações, compreendendo os princípios gerais da sociedade em que vivemos e do mundo globalizado, unindo formação intelectual ao processo de apropriação contínua de saberes e práticas.

Statements of commitment to change are advocated both to promote and to assess continuing education interventions. Howevel; most studies of commitment to change have used self-reported outcomes, and self-reports may significantly overestimate actual performance. As part of an educational randomized controlled trial, this study documented changes that family physicians committed to make in their prescribing and then used third-party data to examine actual changes.

In recent years employers in health care organizations have been recognizing the need for nurses to enter the workforce with a set of informatics competencies. Numerous nursing informatics programs have been established worldwide. The challenge becomes to explore innovative tools that will equip nurses with the appropriate skills to utilize information technology to improve health care quality and patient safety and redesign health care services. This paper presents the introduction of problem-based learning (PBL) modules into an existing nursing informatics curriculum, the Clinical Informatics and Patient Centered Technologies Master program at the School of Nursing, University of Washington. Additionally, we discuss recommendations and challenges associated with the integration of PBL in nursing informatics graduate education including the need for facilitators, flexible technology platforms, promotion and documentation of group work, faculty training and supervision by a program committee.

This article describes problem-based learning as a powerful pedagogical approach and an aligned teaching and learning system to explicitly and directly teach critical thinking skills in a broad range of disciplines. Problem-based learning is argued to be a powerful pedagogical approach as it explicitly and actively engages students in a learning and teaching system, characterised by reiterative and reflective cycles of learning domain-specific knowledge and doing the thinking themselves. At the same time, students are guided and coached by the problem-based learning teacher, who models critical thinking skills in the acquisition of the domainspecific knowledge. This article will explore what critical thinking actually means. What are critical thinking skills? How best to teach such skills? What is the potential role of problem-based learning in teaching critical thinking skills? Finally, the article reflects on how critical thinking can be developed through problem-based learning as a pedagogical approach in an aligned learning and teaching context.

This paper brings some results of the tracking of a project held in the training teacher course of Ethics, Values and Citizenship at School sponsored by USP, in which PBL is used as teaching and learning collaborative approach. The project concerned the exploration of the use of school assemblies as an approach for conflict resolution in a public basic school in São Paulo, performed by a group of students, as a research activity in 2011. The aim of this article is to explore common elements among PBL, collaborative work, and school assembly as learning approaches and as strategies of support to the research in education. The group of students was asked to respond a reflective memorial (written record) about four school assemblies they accompanied and analyzed. The results were positive and also indicate possibilities of integration of teaching practice, teaching instruction and academic research in teacher education.

This paper describes a unique social work education model developed by a group of social work practitioners, all but one of whom were new to academia. The University of Newcastle, in New South Wales, pioneered problem-based learning (PBL) in Australia. The social work programme adopted PBL and gave it a strengths focus, making experience and experiential learning central to its approach. Newcastle's model is based on the belief that learning to be good social workers is best achieved through learning by doing, working with students' experiences, integrating theory and practice, using a collaborative or small group approach, and locating these elements in a strong social justice context. The Bachelor of Social Work (BSW) degree is relatively new. Introduced in 1991, its rst graduates entered the workforce in 1995. The Newcastle model provides a unique example of experience-based learning and an integrated approach to social work education.

Problem-based learning (PBL) is gradually becoming popular in medical schools in Asian countries. It is an integrated, student-centered educational approach, which uses problems (triggers) as the key units for stimulating and structuring relevant student learning. Such learning is largely dependent on the quality of the problems and the areas tested in PBL. Aligning PBL activities with subsequent student assessment often proves to be difficult, because it is different from the assessment conducted in the traditional curriculum. A study was conducted to analyze the PBL problems and examination questions used in the School of Medical Sciences, Universiti Sains Malaysia (USM) to examine the demographic characteristics of the people featured and the level of acuity of case scenarios presented.